E J Angtuaco

University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States

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Publications (55)138.62 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Bone marrow necrosis (BMN) is a rare malignancy-associated hematologic disorder characterized by necrosis of myeloid and stromal marrow elements with preservation of cortical bone. Overlap between the imaging appearances of BMN and avascular necrosis (AVN) raises the potential for diagnostic confusion. We report a case of BMN presenting with a traumatic multi-level vertebral body collapse, and finding that may potentially confound distinction between the two entities. We discuss important pathophysiologic, clinical, and radiologic differences between BMN and AVN with emphasis on features important in the differential diagnosis.
    Skeletal Radiology 05/2014; · 1.74 Impact Factor
  • Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 05/2014; · 1.44 Impact Factor
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    ABSTRACT: The pathophysiology of posterior reversible encephalopathy syndrome (PRES) is incompletely understood; however, an underlying state of immune dysregulation and endothelial dysfunction has been proposed. We examined alterations of serum lactate dehydrogenase (LDH), a marker of endothelial dysfunction, relative to the development of PRES in patients receiving chemotherapy. A retrospective Institutional Review Board approved database of 88 PRES patients was examined. PRES diagnosis was confirmed by congruent clinical diagnosis and MRI. Clinical features at presentation were recorded. Serum LDH values were collected at three time points: prior to, at the time of, and following PRES diagnosis. Student's t-test was employed. LDH values were available during the course of treatment in 12 patients (nine women; mean age 57.8years [range 33-75years]). Chemotherapy-associated PRES patients were more likely to be normotensive (25%) versus the non-chemotherapy group (9%). LDH levels at the time of PRES diagnosis were higher than those before and after (p=0.0263), with a mean difference of 114.8 international units/L. Mean time intervals between LDH measurement prior to and following PRES diagnosis were 44.8days and 51.4days, respectively. Mean elapsed time between last chemotherapy administration and PRES onset was 11.1days. In conclusion, serum LDH, a marker of endothelial dysfunction, shows statistically significant elevation at the onset of PRES toxicity in cancer patients receiving chemotherapy. Our findings support a systemic process characterized by endothelial injury/dysfunction as a factor, if not the prime event, in the pathophysiology of PRES.
    Journal of Clinical Neuroscience 04/2014; · 1.25 Impact Factor
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    ABSTRACT: We report two cases of posterior reversible encephalopathy syndrome (PRES) occurring in association with supra-therapeutic serum lithium levels. Although the neurologic manifestations of lithium toxicity are well known, this is, to our knowledge, the first report describing a link between lithium toxicity and PRES. We discuss the current understanding of the pathogenesis of PRES and suggest mechanisms by which lithium may play a role in its development.
    Journal of neuroimaging: official journal of the American Society of Neuroimaging 02/2014; · 3.36 Impact Factor
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    ABSTRACT: The pathophysiology of posterior reversible encephalopathy syndrome (PRES) is incompletely understood; however, an underlying state of immune dysregulation and endothelial dysfunction has been proposed. We examined alterations of serum lactate dehydrogenase (LDH), a marker of endothelial dysfunction, relative to the development of PRES in patients receiving chemotherapy. A retrospective Institutional Review Board approved database of 88 PRES patients was examined. PRES diagnosis was confirmed by congruent clinical diagnosis and MRI. Clinical features at presentation were recorded. Serum LDH values were collected at three time points: prior to, at the time of, and following PRES diagnosis. Student’s t-test was employed. LDH values were available during the course of treatment in 12 patients (nine women; mean age 57.8 years [range 33–75 years]). Chemotherapy-associated PRES patients were more likely to be normotensive (25%) versus the non-chemotherapy group (9%). LDH levels at the time of PRES diagnosis were higher than those before and after (p = 0.0263), with a mean difference of 114.8 international units/L. Mean time intervals between LDH measurement prior to and following PRES diagnosis were 44.8 days and 51.4 days, respectively. Mean elapsed time between last chemotherapy administration and PRES onset was 11.1 days. In conclusion, serum LDH, a marker of endothelial dysfunction, shows statistically significant elevation at the onset of PRES toxicity in cancer patients receiving chemotherapy. Our findings support a systemic process characterized by endothelial injury/dysfunction as a factor, if not the prime event, in the pathophysiology of PRES.
    Journal of Clinical Neuroscience. 01/2014;
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    ABSTRACT: Sinonasal imaging is performed in 2 major clinical scenarios: inflammatory rhinosinusitis or suspected mass lesion. Rhinosinusitis affects more than 16% of the US population annually. It poses an immense economic burden, accounting for more than 26 million outpatient visits annually and costing more than $4.3 billion annually in direct medical expenses. Most cases of uncomplicated acute and subacute rhinosinusitis are diagnosed clinically and should not require any imaging procedure. CT of the sinuses without contrast is the imaging method of choice in patients with recurrent acute sinusitis or chronic sinusitis. Sinusitis cannot be diagnosed on the basis of imaging findings alone. CT scan findings should be interpreted in conjunction with clinical and endoscopic findings. MRI is currently used for evaluation of sinus disease as a complementary study in cases of aggressive sinus infection with ocular/intracranial complications, potential invasive fungal sinusitis in immunocompromised patients or in the evaluation of a sinonasal mass. 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 02/2013;
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    ABSTRACT: Background. Multiple myeloma causes major morbidity resulting from osteolytic lesions that can be detected by metastatic bone surveys. Magnetic resonance imaging and positron emission tomography can detect bone marrow focal lesions long before development of osteolytic lesions.Design and Methods: Using data from patients enrolled in Total Therapy 3 for newly diagnosed myeloma (N=303), we analyzed associations of these imaging techniques with baseline standard laboratory variables assessed before initiating treatment. Of 270 patients with complete imaging data, 245 also had gene expression profiling data. Results. Osteolytic lesions detected on metastatic bone surveys correlated with focal lesions detected by magnetic resonance imaging and positron emission tomography, although, in two-way comparisons, focal lesion counts based on both magnetic resonance imaging and positron emission tomography tended to be greater than those based on metastatic bone survey. Higher numbers of focal lesions detected by magnetic resonance imaging and positron emission tomography were positively linked to high serum concentrations of C-reactive protein, gene-expression-profiling-defined high risk, and the Proliferation molecular subgroup. Positron emission tomography focal lesion maximum standardized unit values were significantly correlated with gene-expression-profiling-defined high risk and higher numbers of focal lesions detected by positron emission tomography. Interestingly, four genes associated with high-risk disease (related to cell cycle and metabolism) were linked to counts of focal lesions detected by magnetic resonance imaging and positron emission tomography. Conclusions. Collectively, our results demonstrate significant associations of all three imaging techniques with tumor burden and, especially, disease aggressiveness captured by gene-expression-profiling-risk designation. (clinicaltrials.gov identifier: NCT00081939).
    Haematologica 06/2012; · 5.94 Impact Factor
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    ABSTRACT: Myelopathy is a problem that requires imaging to distinguish among numerous specifically treatable causes. The first priority is to determine mechanical stability after trauma. Next, it is crucial to distinguish intrinsic disease from extrinsic compression-for example, by epidural abscess. Osteophytes or disc extrusions and metastatic compression are the most common causes of extrinsic lesions. Imaging approaches rely on clinical features such as pain, fever, trauma, and pattern of progression. CT is preferred initially in acute trauma and MRI in all other circumstances. Contrast-enhanced MRI is added when tumor or infection is suspected or with slow or stepwise progression, especially when pain is not prominent. Vascular imaging is used when arteriovenous malformation, fistula, or occlusive disease is suspected. Because the treatment of myelopathy is often complex, treatment planning may require more than one imaging study or sequential examination to assess interval change. 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 in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
    Journal of the American College of Radiology: JACR 05/2012; 9(5):315-24.
  • Article: Curtains.
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    ABSTRACT: A 55-year-old immunocompetent man presented with headache, nausea, progressive bilateral upper lid ptosis, and diplopia. Examination showed bilateral asymmetric upper lid ptosis with limited adduction and elevation of both eyes. Cranial magnetic resonance imaging revealed enhancing intra-axial and extra-axial midbrain lesions. Blood and cerebrospinal fluid were positive for cryptococcal antigen and cerebrospinal fluid fungal cultures grew Cryptococcus neoformans. Treatment with liposomal amphotericin B and flucytosine resulted in complete resolution of his neurological deficits and lesions on neuroimaging. Patients with cryptococcal meningitis may rarely present with bilateral cranial nerve III dysfunction.
    Survey of Ophthalmology 08/2011; 57(3):284-91. · 2.86 Impact Factor
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    ABSTRACT: Stroke is the sudden onset of focal neurologic symptoms due to ischemia or hemorrhage in the brain. Current FDA-approved clinical treatment of acute ischemic stroke involves the use of the intravenous thrombolytic agent recombinant tissue plasminogen activator given <3 hours after symptom onset, following the exclusion of intracerebral hemorrhage by a noncontrast CT scan. Advanced MRI, CT, and other techniques may confirm the stroke diagnosis and subtype, demonstrate lesion location, identify vascular occlusion, and guide other management decisions but, within the first 3 hours after ictus, should not delay or be used to withhold recombinant tissue plasminogen activator therapy after the exclusion of acute hemorrhage on noncontrast CT scans. MR diffusion-weighted imaging is highly sensitive and specific for acute cerebral ischemia and, when combined with perfusion-weighted imaging, may be used to identify potentially salvageable ischemic tissue, especially in the period >3 hours after symptom onset. Advanced CT perfusion methods improve sensitivity to acute ischemia and are increasingly used with CT angiography to evaluate acute stroke as a supplement to noncontrast CT. 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 in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
    Journal of the American College of Radiology: JACR 08/2011; 8(8):532-8.
  • Ryan T. Fitzgerald, Rudy L. Van Hemert, Edgardo J. Angtuaco
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    ABSTRACT: The topic of central skull base tumors is presented in 2 issues: Part I, Volume 34, Number 15; and Part II, Volume 34, Number 16. Imaging is integral to the workup of central skull base tumors to define the extent of involvement and to develop an accurate differential diagnosis, factors that greatly impact planning of the appropriate treatment. This CME activity will discuss images of several tumors known to affect the central skull base (invasive pituitary macroadenoma, nerve sheath tumors, plasma cell neoplasms, and metastasis), and is a companion to Part I (Volume 34, Number 15) of this review, which covered chordoma, chondrosarcoma, meningioma, and nasopharyngeal carcinoma. This article will focus on imaging characteristics that allow differentiation of these entities from one another. Particular attention will be given to specific characteristics of each tumor on MR, CT, angiography, and noninvasive CT and MR angiography techniques that will enable radiologists to determine the extent of involvement and form a concise differential diagnosis.
    Contemporary Diagnostic Radiology. 07/2011; 34(16):1–6.
  • Ryan T. Fitzgerald, Rudy L. Van Hemert, Edgardo J. Angtuaco
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    ABSTRACT: The topic of central skull base tumors is presented in 2 issues: Part I, Volume 34, Number 15; and Part II, Volume 34, Number 16. Imaging is integral to the workup of skull base tumors in order to define the extent of involvement and to develop an accurate differential diagnosis, factors that greatly impact planning of the most appropriate course of treatment. This CME activity will discuss and display images of several lesions known to affect the central skull base including chordoma, chondrosarcoma, meningioma, and nasopharyngeal carcinoma. Invasive pituitary adenomas, nerve sheath tumors, plasma cell neoplasms, and metastasis will be discussed in Part II of this topic. The review will focus on imaging characteristics that allow differentiation of these entities from one another. Particular attention will be given to specific characteristics of each lesion on MR, CT, angiography, and noninvasive CT/MR angiography techniques that allow determination of the extent of involvement and formation of a concise differential diagnosis.
    Contemporary Diagnostic Radiology. 07/2011; 34(15):1–6.
  • Chhavi Kaushik, Raghu Ramakrishnaiah, Edgardo J Angtuaco
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    ABSTRACT: An ectopic location of pituitary adenoma is rare. Nasopharyngeal location of ectopic pituitary adenoma has been attributed to remnants of the Rathke pouch. We describe an interesting case of ectopic pituitary adenoma in the setting of partially persistent craniopharyngeal canal. Embryological basis of ectopic pituitary adenoma and craniopharyngeal canal have been discussed.
    Journal of computer assisted tomography 07/2010; 34(4):612-4. · 1.38 Impact Factor
  • Joseph G Chacko, Jessica L Miller, Edgardo J Angtuaco
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    ABSTRACT: A 27-year-old pregnant woman reported progressive loss of vision. Brain MRI disclosed an intracranial mass compressing the optic nerves and chiasm with imaging features suggestive of meningioma. Because delivery was imminent, surgical removal was deferred. Within a few days after delivery, the patient noted improvement in vision. Subsequent neuro-ophthalmological evaluations documented almost complete visual recovery within 2 months postpartum. The mass was removed surgically at 10 months postpartum. It was a grade I meningioma with progesterone cell surface receptors. The patient's visual function has remained stable during a follow-up of 14 months. This is the first reported case with full visual function and MRI documentation of spontaneous postpartum visual recovery in a progesterone receptor-positive meningioma compressing the anterior visual pathway.
    Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society 06/2010; 30(2):132-4. · 1.09 Impact Factor
  • Edgardo J.C. Angtuaco, Eren Erdem, Twyla Brianne Bartel
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    ABSTRACT: LEARNING OBJECTIVES 1) Provide clinical background and classification of patients with multiple myeloma and describe the current therapeutic approach to this disease. 2) Define the current diagnostic approach to multiple myeloma utilizing the various imaging modalities of skeletal survey, MR, CT and PET/CT in the initial workup and follow-up of these patients. 3) Delineate the relevant imaging features of this disease utilizing the various imaging modalities and provide staging features of this disease. 4) Present our experience and current data on prognostic value of imaging characteristics. 5) Introduce radiologic interventional techniques helpful in the staging of multiple myeloma (cytogenetic features and chromosomal abnormalities) and describe the various therapeutic maneuvers to treat patients with bone pain (kyphoplasty, vertebroplasty, epidural injections, sacroplasty, ilioplasty).
    Radiological Society of North America 2009 Scientific Assembly and Annual Meeting; 12/2009
  • Source
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    ABSTRACT: F18-fluorodeoxyglucose positron emission tomography (FDG-PET) is a powerful tool to investigate the role of tumor metabolic activity and its suppression by therapy for cancer survival. As part of Total Therapy 3 for newly diagnosed multiple myeloma, metastatic bone survey, magnetic resonance imaging, and FDG-PET scanning were evaluated in 239 untreated patients. All 3 imaging techniques showed correlations with prognostically relevant baseline parameters: the number of focal lesions (FLs), especially when FDG-avid by PET-computed tomography, was positively linked to high levels of beta-2-microglobulin, C-reactive protein, and lactate dehydrogenase; among gene expression profiling parameters, high-risk and proliferation-related parameters were positively and low-bone-disease molecular subtype inversely correlated with FL. The presence of more than 3 FDG-avid FLs, related to fundamental features of myeloma biology and genomics, was the leading independent parameter associated with inferior overall and event-free survival. Complete FDG suppression in FL before first transplantation conferred significantly better outcomes and was only opposed by gene expression profiling-defined high-risk status, which together accounted for approximately 50% of survival variability (R(2) test). Our results provide a rationale for testing the hypothesis that myeloma survival can be improved by altering treatment in patients in whom FDG suppression cannot be achieved after induction therapy.
    Blood 06/2009; 114(10):2068-76. · 9.78 Impact Factor
  • Radiology Case Reports. 01/2009; 4(3).
  • Edgardo J.C. Angtuaco, Eren Erdem, Twyla Brianne Bartel
    [Show abstract] [Hide abstract]
    ABSTRACT: LEARNING OBJECTIVES 1) Provide clinical background and classification of patients with multiple myeloma and describe the current therapeutic approach to this disease. 2) Define the current diagnostic approach to multiple myeloma utilizing the various imaging modalities of skeletal survey, MR, CT and PET/CT in the initial workup and follow-up of these patients. 3) Delineate the relevant imaging features of this disease utilizing the various imaging modalities and provide staging features of this disease. 4) Present our experience and current data on prognostic value of imaging characteristics. 5) Introduce radiologic interventional techniques helpful in the staging of multiple myeloma (cytogenetic features and chromosomal abnormalities) and describe the various therapeutic maneuvers to treat patients with bone pain (kyphoplasty, vertebroplasty, epidural injections, sacroplasty, ilioplasty).
    Radiological Society of North America 2008 Scientific Assembly and Annual Meeting; 12/2008
  • Conference Paper: Adult Head and Neck
    Edgardo J.C. Angtuaco
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    ABSTRACT: LEARNING OBJECTIVES 1) To classify abnormalities on scans into appropriate categories of disease. 2) To provide limited differential diagnoses of mass lesions in the brain, spine and head and neck in children. 3) To understand related abnormalities and how to distinguish among the entities in neuroradiology abnormalities using a case-based approach to teaching.
    Radiological Society of North America 2008 Scientific Assembly and Annual Meeting; 12/2008
  • Conference Paper: Adult Head and Neck
    Edgardo J.C. Angtuaco
    [Show abstract] [Hide abstract]
    ABSTRACT: LEARNING OBJECTIVES 1. To classify abnormalities on scans into appropriate categories of disease. 2. To provide limited differential diagnoses of mass lesions in the brain, spine and head and neck in children. 3. To understand related abnormalities and how to distinguish among the entities in neuroradiology abnormalities using a case-based approach to teaching.
    Radiological Society of North America 2007 Scientific Assembly and Annual Meeting; 11/2007

Publication Stats

611 Citations
138.62 Total Impact Points

Institutions

  • 1989–2014
    • University of Arkansas for Medical Sciences
      Little Rock, Arkansas, United States
    • University of New Mexico Hospitals
      Albuquerque, New Mexico, United States
  • 1984–2014
    • University of Arkansas at Little Rock
      Little Rock, Arkansas, United States
  • 1994
    • Arkansas Children's Hospital
      • Department of Radiology
      Little Rock, Arkansas, United States
  • 1988–1994
    • Washington University in St. Louis
      San Luis, Missouri, United States