Jade J Wong-You-Cheong

University of Maryland, Baltimore, Baltimore, Maryland, United States

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Publications (18)15.39 Total impact

  • Barton F. Lane, Jade J. Wong-You-Cheong
    Ultrasound Clinics. 01/2014;
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    ABSTRACT: Vaginal bleeding occurring in the second or third trimesters of pregnancy can variably affect perinatal outcome, depending on whether it is minor (i.e. a single, mild episode) or major (heavy bleeding or multiple episodes.) Ultrasound is used to evaluate these patients. Sonographic findings may range from marginal subchorionic hematoma to placental abruption. Abnormal placentations such as placenta previa, placenta accreta and vasa previa require accurate diagnosis for clinical management. In cases of placenta accreta, magnetic resonance imaging is useful as an adjunct to ultrasound and is often appropriate for evaluation of the extent of placental invasiveness and potential involvement of adjacent structures. MRI is useful for preplanning for cases of complex delivery, which may necessitate a multi-disciplinary approach for optimal care.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
    Ultrasound quarterly 12/2013; 29(4):293-301.
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    ABSTRACT: Imaging is used to detect and characterize adnexal masses and to stage ovarian cancer both before and after initial treatment, although the role for imaging in screening for ovarian cancer has not been established. CT and MRI have been used to determine the resectability of tumors, the candidacy of patients for effective cytoreductive surgery, the need for postoperative chemotherapy if debulking is suboptimal, and the need for referral to a gynecologic oncologist. Radiographic studies such as contrast enema and urography have been replaced by CT and other cross-sectional imaging for staging ovarian cancer. Contrast-enhanced CT is the procedure of choice for preoperative staging of ovarian cancer. MRI without and with contrast may be useful after equivocal CT, but is usually not the best initial procedure for ovarian cancer staging. Fluorine-18-2-fluoro-2-deoxy-D-glucose-PET/CT may not be needed preoperatively, but its use is appropriate for detecting and defining post-treatment recurrence. Ultrasound is useful for evaluating adnexal disease, but has limited utility for staging ovarian cancer. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
    Journal of the American College of Radiology: JACR 11/2013; 10(11):822-7.
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    ABSTRACT: Fetal growth disturbances include fetuses at risk for intrauterine growth restriction. These fetuses may have an estimated fetal weight at less than the 10% or demonstrate a plateau of fetal growth with an estimated fetal growth greater than the 10%. Uteroplacental insufficiency may play a major role in the etiology of intrauterine growth restriction. Fetuses at risk for intrauterine fetal growth restriction are susceptible to the potential hostility of the intrauterine environment leading to fetal hypoxia and fetal acidosis. Fetal well-being can be assessed using biophysical profile, Doppler velocimetry, fetal heart rate monitoring, and fetal movement counting.The ACR Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
    Ultrasound quarterly 07/2013;
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    ABSTRACT: Vaginal bleeding is not uncommon in the first trimester of pregnancy. Ultrasound is the foremost modality for evaluating normal development of the gestational sac and embryo and for discriminating the causes of bleeding. While correlation with quantitative βHCG and clinical presentation is essential, sonographic criteria permit diagnosis of failed pregnancies, ectopic pregnancy, gestational trophoblastic disease and spontaneous abortion. The American College of Radiology Appropriateness Criteria guidelines have been updated to incorporate recent data. A failed pregnancy may be diagnosed when there is absence of cardiac activity in an embryo exceeding 7 mm in crown rump length or absence of an embryo when the mean sac diameter exceeds 25 mm. In a stable patient with no intrauterine pregnancy and normal adnexae, close monitoring is advised. The diagnosis of ectopic pregnancy should be based on positive findings rather than on the absence of an intrauterine sac above a threshold level of βHCG. Following abortion, ultrasound can discriminate retained products of conception from clot and arteriovenous fistulae. The American College of Radiology Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
    Ultrasound quarterly 05/2013;
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    ABSTRACT: Adnexal masses are a common problem clinically and imaging-wise, and transvaginal US (TVUS) is the first-line imaging modality for assessing them in the vast majority of patients. The findings of US, however, should be correlated with the history and laboratory tests, as well as any patient symptoms. Simple cysts are uniformly benign, and most warrant no further interrogation or treatment. Complex cysts carry more significant implications, and usually engender serial ultrasound(s), with a minority of cases warranting a pelvic MRI.Morphological analysis of adnexal masses with gray-scale US can help narrow the differential diagnosis. Spectral Doppler analysis has not proven useful in most well-performed studies. However, the use of color Doppler sonography adds significant contributions to differentiating between benign and malignant masses and is recommended in all cases of complex masses. Malignant masses generally demonstrate neovascularity, with abnormal branching vessel morphology. Optimal sonographic evaluation is achieved by using a combination of gray-scale morphologic assessment and color or power Doppler imaging to detect flow within any solid areas.The ACR Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
    Ultrasound quarterly 01/2013;
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    ABSTRACT: Multiple gestations are high-risk compared with singleton pregnancies. Prematurity and intrauterine growth restrictions are the major sources of morbidity and mortality common to all twin gestations. Monochorionic twins are at a higher risk for twin-twin transfusion, fetal growth restriction, congenital anomalies, vasa previa, velamentous insertion of the umbilical cord and fetal death. Therefore, determination of multiple gestation, amnionicity and chorionicity in the first trimester is important. Follow up examinations to evaluate fetal well-being include assessment of fetal growth and amniotic fluid volume, umbilical artery Doppler, nonstress test and biophysical profile. To date, there is a paucity of literature regarding imaging schedules for follow-up. At the very least, antepartum testing in multiple gestations is recommended in all situations in which surveillance would ordinarily be performed in a singleton pregnancy.The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed biennially by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging.
    Ultrasound quarterly 06/2012; 28(2):149-55.
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    ABSTRACT: Whole pancreas transplantation is an established treatment for selected patients with diabetic nephropathy or poorly controlled diabetes. Surgical techniques vary and have evolved over the past 4 decades. Imaging evaluation of the whole-pancreas transplant should begin with an understanding of the most commonly used surgical techniques and the spectrum of postoperative complications. Ultrasonography (US) should be the first-line modality in evaluating the pancreas allograft and vasculature. Computed tomography (CT) is useful in the assessment of extra-allograft processes, particularly in ruling out abscess formation or evaluating suspected bowel complications. Magnetic resonance (MR) imaging is reserved for cases in which complete evaluation with US or CT is not possible. MR angiography can help provide an accurate assessment of vascular abnormalities. The radiologist must be familiar with the spectrum of surgical techniques and the normal postoperative imaging appearances of the whole-pancreas transplant so as to be able to recognize abnormal postoperative findings. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.322115144/-/DC1.
    Radiographics 03/2012; 32(2):411-35. · 2.79 Impact Factor
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    ABSTRACT: It is well recognized that preterm birth is the leading cause of perinatal mortality and morbidity. There is a significant association between cervix length and preterm birth risk. Most authorities consider a cervical length <3 cm as the lower limit of normal. A cervical length >3 cm has a high negative predictive value for delivery less than 34 weeks. A cervical length of <15 mm is moderately predictive (∼ 70%) of preterm birth within 48 hours. Cervical length is normally distributed and should remain relatively constant until the third trimester. Transabdominal US is the least reliable method of cervical length assessment. The most reliable method of documenting cervical length is transvaginal ultrasound (TVUS). Transperineal US is an alternative for imaging if TVUS is contraindicated, such as with premature rupture of membranes. However, the resolution is decreased compared to TVUS. Short cervix length is the single most important predictive finding for premature delivery. This observation should prompt consultation for high risk obstetrical care and consideration of other management options such as cerclage or activity restriction.The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed biennially by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging.
    Ultrasound quarterly 12/2011; 27(4):275-80.
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    ABSTRACT: Premenopausal women who present with acute pelvic pain frequently pose a diagnostic dilemma, exhibiting nonspecific signs and symptoms, the most common being nausea, vomiting, and leukocytosis. Diagnostic considerations encompass multiple organ systems, including obstetric, gynecologic, urologic, gastrointestinal, and vascular etiologies. The selection of imaging modality is determined by the clinically suspected differential diagnosis. Thus, a careful evaluation of such a patient should be performed and diagnostic considerations narrowed before a modality is chosen. Transvaginal and transabdominal pelvic sonography is the modality of choice when an obstetric or gynecologic abnormality is suspected, and computed tomography is more useful when gastrointestinal or genitourinary pathology is more likely. Magnetic resonance imaging, when available in the acute setting, is favored over computed tomography for assessing pregnant patients for nongynecologic etiologies because of the lack of ionizing radiation. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
    Ultrasound quarterly 09/2011; 27(3):205-10.
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    ABSTRACT: The objective of this study was to evaluate the effectiveness of BLADE (proprietary name for periodically rotated overlapping parallel lines with enhanced reconstruction [PROPELLER] in MR systems from Siemens Healthcare) MRI compared with conventional T2-weighted fast spin-echo (FSE) MRI for reducing artifacts and improving image quality when imaging the female pelvis. Sagittal T2-weighted BLADE and FSE examinations of the pelvis of 26 women were performed on a 1.5-T scanner. Three radiologists assessed the images for the presence of artifacts, level of anatomic detail, and overall image quality using a modified Likert scale. Scores for each radiologist and each imaging sequence were analyzed with a linear mixed model, adjusting for correlation within radiologist and within patient. A quantitative comparison was conducted to investigate signal uniformity. The BLADE sequence was superior for evaluation of the junctional zone (p = 0.0019), delineation of ovarian borders and depiction of follicles (p < 0.0001), and detection of fibroids (p = 0.022). Overall image quality was improved with BLADE, with fewer respiratory motion artifacts. The BLADE sequence introduced "radial" artifact that was absent from the FSE images, but this artifact did not affect image quality. Quantitative analysis revealed mean coefficients of variation for BLADE and FSE in the uterus of 21.6% and 22.5%, respectively (p = 0.36). The mean coefficients of variation were 4.6% and 6.1% in fat (p = 0.0007), indicating less variation with BLADE. The mean acquisition times for the BLADE and FSE sequences were 4 minutes 31 seconds and 3 minutes 46 seconds, respectively. Imaging of uterine junctional zone anatomy, ovaries, and fibroids was improved and artifacts were reduced with BLADE compared with FSE. Radial artifact introduced by the BLADE sequence and slightly longer imaging times needed for the BLADE sequence were offset by improved image quality.
    American Journal of Roentgenology 08/2011; 197(2):W307-13. · 2.90 Impact Factor
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    ABSTRACT: In evaluating a woman with abnormal vaginal bleeding, imaging cannot replace definitive histologic diagnosis but often plays an important role in screening, characterization of structural abnormalities, and directing appropriate patient care. Transvaginal ultrasound (TVUS) is generally the initial imaging modality of choice, with endometrial thickness a well-established predictor of endometrial disease in postmenopausal women. Endometrial thickness measurements of ≤5 mm and ≤4 mm have been advocated as appropriate upper threshold values to reasonably exclude endometrial carcinoma in postmenopausal women with vaginal bleeding; however, the best upper threshold endometrial thickness in the asymptomatic postmenopausal patient remains a subject of debate. Endometrial thickness in a premenopausal patient is a less reliable indicator of endometrial pathology since this may vary widely depending on the phase of menstrual cycle, and an upper threshold value for normal has not been well-established. Transabdominal ultrasound is generally an adjunct to TVUS and is most helpful when TVUS is not feasible or there is poor visualization of the endometrium. Hysterosonography may also allow for better delineation of both the endometrium and focal abnormalities in the endometrial cavity, leading to hysteroscopically directed biopsy or resection. Color and pulsed Doppler may provide additional characterization of a focal endometrial abnormality by demonstrating vascularity. MRI may also serve as an important problem-solving tool if the endometrium cannot be visualized on TVUS and hysterosonography is not possible, as well as for pretreatment planning of patients with suspected endometrial carcinoma. CT is generally not warranted for the evaluation of patients with abnormal bleeding, and an abnormal endometrium incidentally detected on CT should be further evaluated with TVUS.
    Journal of the American College of Radiology: JACR 07/2011; 8(7):460-8.
  • Barton F Lane, Jade J Wong-You-Cheong
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    ABSTRACT: The normal endometrium changes regularly with the menstrual cycle and atrophies after menopause. It is important to be aware of the normal spectrum of endometrial appearances at imaging to accurately detect and diagnose pathologic conditions. This article reviews imaging features of the normal and abnormal endometrium, and conditions which may mimic endometrial pathology. Emphasis will be on ultrasound with sonohysterography and magnetic resonance imaging as these are the imaging modalities of choice for evaluation of the endometrium. The complementary role of hysterosalpingography, computed tomography, and 18-fluorodeoxyglucose-positron emission tomography will also be discussed.
    Topics in magnetic resonance imaging: TMRI 07/2010; 21(4):237-45.
  • Fauzia Q Vandermeermd, Jade J Wong-You-Cheong
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    ABSTRACT: Determining the cause of acute pelvic pain in the female patient is often a clinical challenge. Diagnostic imaging can be invaluable in this situation. Ectopic pregnancy, pelvic inflammatory disease, and hemorrhagic ovarian cysts are the most commonly diagnosed gynecologic conditions presenting with acute pelvic pain. Ovarian torsion and degenerating fibroids occur less frequently. Other causes to consider include endometriosis, and postpartum causes such as endometritis, or ovarian vein thrombosis. Finally, nongynecologic conditions may overlap in their presentation of acute pelvic pain and should also be considered. The most important of these is acute appendicitis.
    Topics in magnetic resonance imaging: TMRI 07/2010; 21(4):201-11.
  • Barton F Lane, Jade J Wong-You-Cheong
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    ABSTRACT: The normal endometrium changes regularly with the menstrual cycle and atrophies after menopause. It is important to be aware of the normal spectrum of endometrial appearances at imaging to accurately detect and diagnose pathologic conditions. This article reviews imaging features of the normal and abnormal endometrium, and conditions which may mimic endometrial pathology. Emphasis will be on ultrasound with sonohysterography and magnetic resonance imaging as these are the imaging modalities of choice for evaluation of the endometrium. The complementary role of hysterosalpingography, computed tomography, and 18-fluorodeoxyglucose-positron emission tomography will also be discussed.
    Clinical obstetrics and gynecology 04/2009; 52(1):57-72. · 2.06 Impact Factor
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    Fauzia Q Vandermeer, Jade J Wong-You-Cheong
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    ABSTRACT: Determining the cause of acute pelvic pain in the female patient is often a clinical challenge. Diagnostic imaging can be invaluable in this situation. Ectopic pregnancy, pelvic inflammatory disease, and hemorrhagic ovarian cysts are the most commonly diagnosed gynecologic conditions presenting with acute pelvic pain. Ovarian torsion and degenerating fibroids occur less frequently. Other causes to consider include endometriosis, and postpartum causes such as endometritis, or ovarian vein thrombosis. Finally, nongynecologic conditions may overlap in their presentation of acute pelvic pain and should also be considered. The most important of these is acute appendicitis.
    Clinical obstetrics and gynecology 04/2009; 52(1):2-20. · 2.06 Impact Factor
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    ABSTRACT: Although the vast majority of bladder tumors are epithelial neoplasms, a variety of nonneoplastic disorders can cause either focal bladder masses or diffuse mural thickening and mimic malignancy. Some of these entities are rare and poorly understood such as inflammatory pseudotumor, which produces ulcerated, bleeding polypoid bladder masses. These masses may be large and have an extravesical component. Bladder endometriosis manifests as submucosal masses with characteristic magnetic resonance imaging features consisting of hemorrhagic foci and reactive fibrosis. Nephrogenic adenoma has no typical features, and pathologic evaluation is required for diagnosis. Although imaging features of malacoplakia are also nonspecific, characteristic Michaelis-Gutmann bodies are found at pathologic evaluation. The various types of cystitis (cystitis cystica, cystitis glandularis, and eosinophilic cystitis) require pathologic diagnosis. Bladder infection with tuberculosis and schistosomiasis produces nonspecific bladder wall thickening and ulceration in the acute phase and should be suspected in patients who are immunocompromised or from countries where these infections are common. The diagnosis of chemotherapy cystitis and radiation cystitis should be clinically evident, but imaging may be used to determine severity and to assess complications. Extrinsic inflammatory diseases such as Crohn disease and diverticulitis may be associated with fistulas to the bladder and focal bladder wall abnormality. The extravesical findings allow the diagnosis to be made easily. Finally, extrinsic masses arising from the prostate or distal ureter may cause filling defects, which can be confused with intrinsic bladder masses.
    Radiographics 01/2006; 26(6):1847-68. · 2.79 Impact Factor
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    ABSTRACT: In the United States, primary bladder neoplasms account for 2%-6% of all tumors, with bladder cancer ranked as the fourth most common malignancy. Ninety-five percent of bladder neoplasms arise from the epithelium; the most common subtype is urothelial carcinoma, which accounts for 90% of cases. Squamous cell carcinoma accounts for 2%-15%, with rates varying widely according to geographic location. Adenocarcinoma (primary bladder, urachal, or metastatic) represents less than 2%. Bladder cancer typically occurs in men aged 50-70 years and is related to smoking or occupational exposure to carcinogens. Most urothelial neoplasms are low-grade papillary tumors, which tend to be multifocal and recur but have a relatively good prognosis. High-grade invasive tumors are less common and have a much poorer prognosis. Squamous cell carcinoma and adenocarcinoma occur in the setting of chronic bladder infection and irritation. Mesenchymal tumors represent the remaining 5% of bladder tumors, with the most common types being rhabdomyosarcoma, typically seen in children, and leiomyosarcoma, a disease of adults. Rarer mesenchymal tumors include paraganglioma, lymphoma, leiomyoma, and solitary fibrous tumor. Although imaging findings are not specific for these tumors, patterns of growth and tumor characteristics may allow differentiation. For accurate staging, computed tomography and magnetic resonance imaging are the modalities of choice.
    Radiographics 01/2006; 26(2):553-80. · 2.79 Impact Factor

Publication Stats

95 Citations
15.39 Total Impact Points

Institutions

  • 2006–2014
    • University of Maryland, Baltimore
      • Department of Diagnostic Radiology and Nuclear Medicine
      Baltimore, Maryland, United States
  • 2013
    • Thomas Jefferson University Hospitals
      Philadelphia, Pennsylvania, United States
  • 2012
    • Georgetown University
      Washington, Washington, D.C., United States
  • 2011
    • Vanderbilt University
      Nashville, Michigan, United States
    • Sunnybrook Health Sciences Centre
      Toronto, Ontario, Canada