Publications (57) View all
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Article: Low-Dose Fetal CT in the Prenatal Evaluation of Skeletal Dysplasias and Other Severe Skeletal Abnormalities.
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ABSTRACT: OBJECTIVE. Prenatal diagnosis of skeletal dysplasia is often difficult and based on findings with ultrasound, a technique with 40-60% sensitivity. The purpose of this study was to evaluate a preliminary experience in assessing severe prenatal osseous abnormalities with low-dose fetal CT. The hypothesis was that use of CT may improve the prenatal diagnosis of skeletal dysplasia beyond the available capabilities of ultrasound. MATERIALS AND METHODS. Retrospective search of a radiology database (July 2008-February 2011) yielded the records of unenhanced CT examinations of patients referred because of abnormal fetal bones. The original ultrasound and CT reports as interpreted at image acquisition were independently analyzed by two radiologists blinded to the final diagnosis and to the findings of the opposing imaging modality. Blinded review of the images was also performed. Correlation was made with the postmortem and postnatal findings. RESULTS. According to the reports of the studies, 5 of 21 cases were interpreted correctly with CT and incorrectly with ultrasound. In 17 cases, CT revealed additional osseous findings not in the ultrasound report. There were no cases in which ultrasound findings were correct and CT findings were incorrect. Blinded review of the images revealed that CT outperformed ultrasound (p < 0.001). There were a total of four CT errors among 218 total measures recorded and a total of 19 ultrasound errors among 218 total measures. CONCLUSION. Although low-dose fetal CT should never be used as the initial diagnostic modality in cases of suspected skeletal dysplasia, it is a powerful imaging adjunct that depicts the fetal bones in exquisite detail. Use of CT of fetuses at risk of skeletal dysplasia may provide clinicians with more accurate information for counseling of families regarding neonatal morbidity and mortality.American Journal of Roentgenology 05/2013; 200(5):989-1000. · 2.78 Impact Factor -
Article: Osteoid osteomas: a pain in the night diagnosis.
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ABSTRACT: Osteoid osteoma is a common benign bone-forming lesion that is composed of a nidus of vascular osteoid tissue and woven bone lined by osteoblasts. It is frequently associated with considerable surrounding inflammation. The diagnosis is usually straightforward when imaging reveals a radiolucent nidus surrounded by variable degrees of reactive sclerosis. However, the diagnosis can be elusive when osteoid osteomas occur in atypical locations, as they may have a nonspecific and misleading appearance on different imaging modalities, particularly on MRI. The purpose of this pictorial essay is to review the typical and atypical features of osteoid osteomas on different imaging modalities, and the appearance of osteoid osteomas in different locations. We also review growth disturbances caused by osteoid osteomas and potential mimickers, with imaging characteristics that can aid in diagnosis.Pediatric Radiology 10/2012; · 1.67 Impact Factor -
Article: Complex genitourinary abnormalities on fetal MRI: imaging findings and approach to diagnosis.
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ABSTRACT: OBJECTIVE: The objective of this article is to present the fetal MRI patterns of complex genitourinary abnormalities including epispadias-exstrophy complex, cloacal malformation, urogenital sinus anomaly, posterior urethral valves, and other causes that result in lower urinary tract dilatation without oligohydramnios. Relevant embryology will be reviewed, and practical points will be provided that can aid in interpretation. CONCLUSION: Complex genitourinary abnormalities have recognizable imaging findings on fetal MRI. Imaging findings may be subtle; a high index of suspicion and a systematic checklist are useful for accurate diagnosis. Familiarity with fetal MRI patterns of complex genitourinary abnormalities is crucial for making more precise diagnoses that will likely impact pregnancy management, counseling, and postnatal treatment.American Journal of Roentgenology 08/2012; 199(2):W222-31. · 2.78 Impact Factor -
Article: Pre- and postoperative imaging of the Rex shunt in children: what radiologists should know.
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ABSTRACT: OBJECTIVE: The objective of this article is to illustrate the imaging features of patients with extrahepatic portal venous obstruction who are evaluated before or after a Rex shunt surgery. CONCLUSION: The Rex shunt is a potentially curative surgical procedure that reestablishes physiologic hepatopetal portal flow. It is typically accomplished by interposing a vascular conduit between the superior mesenteric vein to the still patent intrahepatic portal venous system. This procedure results in resolution of portal hypertension.American Journal of Roentgenology 05/2012; 198(5):1032-7. · 2.78 Impact Factor -
Article: Ultrasound of the pediatric chest.
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ABSTRACT: Historically, the evaluation of the pediatric chest has been accomplished via CT and conventional radiography. Our objective is to discuss and illustrate the role of US as a non-ionizing radiation alternative in the evaluation of the pediatric chest. US is a valuable tool in the evaluation of the pediatric chest. It can be used as a first-line modality in the evaluation of superficial lumps and bumps of the chest wall, diaphragmatic motion, the thymus and pleural effusions, and it can play a valuable secondary role in evaluation of mediastinal masses and pulmonary parenchymal disease.Pediatric Radiology 04/2012; 42(11):1287-97. · 1.67 Impact Factor
