W H Moore

Baylor College of Medicine, Houston, TX, United States

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Publications (59)168.77 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To prospectively evaluate use of bone scintigraphy with single photon emission computed tomography (SPECT) for identification of patients with low back pain who would benefit from facet joint injections. The protocol was reviewed and approved by the institutional review board. All patients provided informed consent. Forty-seven patients (23 men and 24 women) with low back pain, who were scheduled for facet joint injections, were prospectively enrolled and randomized into groups A and B (mean ages, 43.3 and 44.2 years, respectively) with a group A-group B ratio of 2:1. Group A patients underwent bone scintigraphy with SPECT prior to injection. Group A patients with bone scans positive for facet joint abnormalities received injections at the levels where abnormalities were identified on the scan (group A1). Group A patients with negative scans (group A2) received injections at the levels that were decided as in group B. Group B patients received injections at the levels indicated by the referring physician and did not undergo bone scintigraphy. All patients completed a pain and function questionnaire before injection and at 1, 3, and 6 months afterward. The change in the American Academy of Orthopaedic Surgeons pain scores after 1, 3, and 6 months compared with baseline scores was analyzed with analysis of variance and post hoc Bonferroni multiple-comparison tests between groups. Cost analysis was performed. The change in the pain score at 1 month was significantly higher (P < .004) in group A1 than it was in the other two groups. In group A1, 13 of 15 patients had improvement in pain score of greater than 1 standard deviation at 1 month, whereas improvement occurred in only two of 16 patients in group A2 and five of 16 patients in group B. In patients with positive scans, the number of facets treated with injection was decreased from 60, which was the number originally indicated by the referring physician, to 27. The Medicare cost was reduced from $2191 per patient to $1865 with the use of SPECT. Bone scintigraphy with SPECT can help identify patients with low back pain who would benefit from facet joint injections.
    Radiology 02/2006; 238(2):693-8. · 6.34 Impact Factor
  • Tanuja Kanderi, Warren H Moore, Julie A Wendt
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    ABSTRACT: The potential applications of molecular imaging in the clinical arena are diverse and expanding rapidly. One such area of application is transplantation. Currently, biopsy is the gold standard for monitoring allograft well-being after transplantation of organs or tissues. However, biopsies are invasive, associated with morbidity if performed on a routine basis and can potentially miss focal rejection. It is notable that none of the existing studies in the literature have examined the possible role of molecular imaging in transplantation-related indications. In this direction, this paper aims to discuss imaging strategies that could be of pertinence in monitoring immune events and improving long-term outcomes after solid organ or tissue transplantation. This paper discusses the currently available direct/surrogate imaging techniques/agents that can be used to detect chemokine receptors/ligands, leucocyte endothelial events and ischaemia-reperfusion injury in transplantation. Molecular imaging methods can non-invasively detect, quantify and monitor immune phenomena, such as rejection or graft-versus-host disease, after transplantation. Molecular imaging could help in targeted biopsy and could improve graft survival by allowing for early intervention with tailored immunosuppressive regimens. Given the unprecedented progress in the field, the potential benefits of molecular imaging to the speciality of organ and tissue transplantation cannot be underestimated.
    Nuclear Medicine Communications 12/2005; 26(11):947-55. · 1.38 Impact Factor
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    ABSTRACT: Injections of botulinum toxin A are an effective treatment for sialorrhea in Parkinson's disease (PD). Based on the relatively high rates of dry mouth seen with botulinum toxin B, there is reason to suspect that it may also improve sialorrhea. To determine whether botulinum toxin B (Myobloc; Elan Pharmaceuticals, New York, NY) is a safe and effective treatment for sialorrhea in patients with PD. Demographics, PD treatments, head posture, the Unified Parkinson's Disease Rating Scale (UPDRS), two questionnaires regarding drooling, Visual Analogue Scale, global impressions, salivary gland imaging, and a dysphagia questionnaire were assessed in 16 PD subjects with problematic sialorrhea. Patients were then randomized to receive either botulinum toxin B (1,000 units into each parotid gland and 250 units into each submandibular gland) or a pH-matched placebo, using only anatomic landmarks. Patients returned 1 month later to undergo an identical assessment. Compared with placebo, those randomized to drug reported improvement on the Visual Analogue Scale (p < 0.001), global impressions of change (p < 0.005), Drooling Rating Scale (p < 0.05), and Drooling Severity and Frequency Scale (p < 0.001). There was no change in UPDRS, head posture, or Dysphagia Scale. Adverse events were mild and included dry mouth (three patients), worsened gait (two), diarrhea (one), and neck pain (one) in the botulinum toxin B group. Anatomically guided injections of botulinum toxin B into the parotid and submandibular glands appear to effectively improve sialorrhea without compromising dysphagia in patients with PD.
    Neurology 02/2004; 62(1):37-40. · 8.30 Impact Factor
  • Spine Journal - SPINE J. 01/2004; 4(5).
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    ABSTRACT: Disaccharide Intolerance Type I (Mendelian Interance in Man database: *222900) is a rare inborn error of metabolism resulting from mutation in sucrase-isomaltase (Enzyme Catalyzed 3.2.1.48). Usually, infants with SI deficiency come to attention because of chronic diarrhea and nutritional evidence of malabsorption. We describe an atypical presentation of this disorder in a 10-month-old infant. In addition to chronic diarrhea, the child displayed severe and chronic hypercalcemia, the evaluation of which was negative. An apparently coincidental right orbital hemangioma was detected. Following identification of the SI deficiency, an appropriately sucrose-restricted, but normal calcium diet regimen was instituted which led to cessation of diarrhea, substantial weight gain, and resolution of hypercalcemia. This case illustrates that, similar to congenital lactase deficiency (Mendelian Interance in Man database: *223000, Alactasia, Hereditary Disaccharide Intolerance Type II), hypercalcemia may complicate neonatal Sucrase-Isomaltase deficiency. Hypercalcemia in the presence of chronic diarrhea should suggest disaccharide intolerance in young infants.
    BMC Pediatrics 05/2002; 2:4. · 1.98 Impact Factor
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    ABSTRACT: Myocardial perfusion imaging (MPI) provides incremental diagnostic and prognostic information, even in patients with high exercise tolerance. Myocardial perfusion imaging provides significant diagnostic value, specifically in women with high exercise tolerance. Our study population consisted of all women who underwent exercise MPI in our Department from January 1992 to June 1996 and reached at least Stage IV in the Bruce protocol. Patients were divided into those with known and those with possible coronary artery disease (CAD). All patients were followed for 3 years from the performance of MPI. Of 4,803 women who underwent myocardial perfusion imaging, 3,183 had exercise stressing, and of those, 311 reached at least Stage IV in the Bruce protocol. Of these 311 MPI scans, only 23 (7.4%) were abnormal (reversible, fixed, or mixed) and the remaining 288 (92.6%) were normal. Of the 82 patients with known CAD, 13 (15.8%) had an abnormal MPI, while only 10 (4.4%) of the 229 patients with possible CAD. No myocardial infarction or cardiac death occurred within 3 years; one patient with normal MPI needed revascularization. In women with high exercise tolerance, especially in those without already known CAD, the yield of MPI is very low. Women with high exercise tolerance have an excellent prognosis.
    Clinical Cardiology 07/2001; 24(6):475-80. · 1.83 Impact Factor
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    ABSTRACT: During routine myocardial perfusion imaging, a common observation is that patients with normal cardiac function and small hearts, in particular small women, have higher left ventricular ejection fractions (LVEFs), as measured by quantitative gated SPECT (QGS) software, than anticipated, often markedly so. The goal of this project was to determine if the QGS LVEF varies with the change in end-diastolic left ventricular volume (EDV) and in particular to verify that the clinically observed phenomenon of falsely elevated QGS LVEF in patients with small hearts is actually occurring. A series of mathematically defined left ventricles (LVs) was produced by varying the EDV and targeted LVEF (tLVEF). These were created using concentric hemiellipsoids with nine different EDVs. The tLVEF was varied from 15% to 75% by 5% increments for a total of 13 different ejection fractions. These datasets were then smoothed, creating a total of 234 sets. The smoothed and unsmoothed images were then processed using QGS software. The LVEFs and EDVs were recorded. For lower LVEFs the agreement between the QGS LVEF and the tLVEF is good. A marked overestimation occurs when the EDVs are low and the ejection fractions are in the higher range. This effect is greater in the smoothed images. An artifactual increase in the LVEF can occur when measurements are made with the QGS software. These data argue against using QGS LVEF for monitoring the LVEF in patients with small hearts. Our data imply that a mildly decreased LVEF may still appear to be in the normal range when measured by QGS software.
    Journal of Nuclear Medicine 04/2001; 42(3):454-9. · 5.77 Impact Factor
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    ABSTRACT: Radionuclides represent a means of functional imaging, which is able to reflect the metabolic state of tissues. Recently developed radiotracers and older radiotracers with newer applications, imaged through single photon emission computed tomography (SPECT) and positron emission tomography (PET), can provide significant information in the diagnosis, grading, therapy response or recurrence of primary musculoskeletal tumors. The unique ability of these radiotracers to demonstrate non-invasively the efflux pump rate, which is a common reason of therapy failure, as well as the metabolic and proliferative rates of the tumors should be a powerful tool in the orthopaedic oncology in the evaluation of musculoskeletal tumors.
    Critical Reviews in Oncology/Hematology 04/2001; 37(3):217-26. · 4.64 Impact Factor
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    ABSTRACT: It has been reported that the effect of radioactive iodine (RAI) treatment is complete in 4 to 6 months. This retrospective study evaluated the appropriate time for repeated treatment of hyperthyroid disease with RAI after initial treatment failure. Outcomes of 128 patients treated with RAI for hyperthyroid disease were reviewed retrospectively at 3 and 6 months. Eighty patients (group A) were treated successfully with a single dose of RAI. Twenty patients (group B) required a second treatment dose. Twenty-eight patients were lost to follow-up. All patients in group A were clinically improved to various degrees at 3 months and continued to improve at 6 months. All eight patients in group B who showed no improvement at 3 months remained the same at 6 months. The difference between the two groups was statistically significant. Patients with hyperthyroid disease who are unimproved at 3 months can be retreated with RAI without further delay.
    Clinical Nuclear Medicine 02/2001; 26(1):1-5. · 2.96 Impact Factor
  • Journal of Nuclear Cardiology 01/2001; 8(1). · 2.85 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate the utility of indium-111 leukocyte (In-111 WBC) scintigraphy in a large number of patients with suspected bowel ischemia. All patients who underwent In-111 WBC scintigraphy for possible bowel ischemia over a 4-yr period and had subsequent endoscopic or surgical biopsy were retrospectively evaluated. Early (1-4 h postinjection) and late (18-24 h postinjection) images were obtained. Any study with tracer activity in the bowel on early or late images was considered positive for bowel ischemia. Fifty-nine patients were included in the analysis. In-111 WBC scintigraphy detected 23 of 24 cases of bowel ischemia (sensitivity = 96%). Of 35 cases without ischemia, 16 had a negative In-111 WBC scintiscan (specificity = 46%). Negative and positive predictive values for the diagnosis of bowel ischemia were 94% and 55%, respectively. Of the 19 cases without bowel ischemia and a positive scintiscan, 15 had another intraabdominal process responsible for the patients' symptomatology. In-111 WBC scintigraphy is a highly sensitive diagnostic tool for bowel ischemia. A normal In-111 WBC scintiscan strongly suggests that this disease is not present.
    The American Journal of Gastroenterology 09/2000; 95(8):1983-9. · 9.21 Impact Factor
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    ABSTRACT: Hepatobiliary scintigraphy is a very accurate test in the diagnosis of acute cholecystitis. However, ultrasonography is extensively used for the diagnosis of this disease. In this study, we directly compare the diagnostic accuracy of these techniques for acute cholecystitis. Materials and Methods: The diagnostic accuracy of scintigraphy and ultrasonography was evaluated in 107 consecutive patients with suspected acute cholecystitis who underwent both imaging modalities within one day. The incremental diagnostic value of each modality was determined. The sensitivity, specificity, positive and negative predictive values, and accuracy for the diagnosis of acute cholecystitis in the entire cohort were superior for scintigraphy compared with ultrasonography. The accuracy was 92% for scintigraphy and 77% for ultrasonography. Similarly, if only surgically treated patients were considered, the accuracy of scintigraphy was 91% versus 61% for ultrasonography. The diagnostic value of scintigraphy for the entire cohort was significantly superior to ultrasonography (global, chi(2) = 58.1 vs 9.7, respectively); the addition of the information derived from the latter did not further improve the diagnostic value of scintigraphy (global, chi(2) = 58.2). Hepatobiliary scintigraphy has superior diagnostic accuracy for acute cholecystitis compared with ultrasonography. The addition of ultrasonography does not further improve the diagnostic accuracy of scintigraphy alone.
    Surgery 07/2000; 127(6):609-13. · 3.37 Impact Factor
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    ABSTRACT: Gating of myocardial perfusion imaging helps to differentiate artifacts from perfusion defects. We used this technique to evaluate the impact of routine gating on the interpretation of results by physicians experienced in this field. We studied, prospectively, 270 consecutive patients (161 men and 109 women) who underwent gated myocardial perfusion imaging. Single-photon emission-computed tomography was performed to evaluate myocardial perfusion in patients at rest and after stress, using technetium-99m sestamibi and post-stress gating. Participating physicians interpreted each study and indicated a confidence level for the interpretation. Initially, these opinions were formed on the basis of static slices alone and subsequently, with the addition of gating information. The impact of gating was evaluated by the number of studies in which gating led to a change in interpretation from normal to abnormal or vice versa, or from borderline to definite. The interpretation was changed from abnormal to normal or vice versa in 10 studies (3.7%) and from borderline to definite in 3 (1.1%). In 37 studies (13. 7%), the confidence level was increased from confident to very confident with no change in interpretation. We conclude that routine gating of every myocardial perfusion imaging study for the identification of artifacts is of low value for physicians experienced in interpreting such studies. Although gating frequently increases the confidence level, it seldom leads to a change in interpretation. Specific subgroups of patients who would benefit from gating should be identified.
    Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 02/2000; 27(1):14-8. · 0.67 Impact Factor
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    ABSTRACT: Although high exercise tolerance is associated with an excellent prognosis, the significance of abnormal myocardial perfusion imaging (MPI) in patients with high exercise tolerance has not been established. This study retrospectively compares the utility of MPI and exercise ECG (EECG) in these patients. Of 388 consecutive patients who underwent exercise MPI and reached at least Bruce stage IV, 157 (40.5%) had abnormal results and 231 (59.5%) had normal results. Follow-up was performed at 18+/-2.7 months. Adverse events, including revascularization, myocardial infarction, and cardiac death, occurred in 40 patients. Nineteen patients had revascularization related to the MPI results or the patient's condition at the time of MPI and were not included in further analysis. Seventeen patients (12.2%) with abnormal MPI and 4 (1.7%) with normal MPI had adverse cardiac events (P<0.001). Cox proportional-hazards regression analysis showed that MPI was an excellent predictor of cardiac events (global chi2=13.2; P<0.001; relative risk=8; 95% CI=3 to 23) but EECG had no predictive power (global chi2=0.05; P=0.8; relative risk=1; 95% CI=0.4 to 3.0). The addition of Duke's treadmill score risk categories did not improve the predictive power of EECG (global chi2=0.17). The predictive power of the combination of EECG (including Duke score categories) and MPI was no better than that of MPI alone (global chi2=13.5). Unlike EECG, MPI is an excellent prognostic indicator for adverse cardiac events in patients with known or suspected CAD and high exercise tolerance.
    Circulation 03/1999; 99(7):867-72. · 15.20 Impact Factor
  • Journal of Nuclear Cardiology 02/1999; 6(1). · 2.85 Impact Factor
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    ABSTRACT: Technetium 99m sestamibi is widely used in the evaluation of myocardial perfusion imaging. Although the aim of such imaging is cardiac evaluation, numerous other organs are included in the imaging field. Failure to identify incidental abnormal findings in these organs delays diagnosis and treatment. In common with other radiopharmaceutical agents, technetium 99m sestamibi is distributed throughout the body and accumulates in multiple tissues. When interpreting studies that involve this radiotracer, the physician must be aware of its physiologic distribution, in order to recognize abnormal uptake. We present an illustrative case in which areas of decreased tracer activity were noted incidentally during the evaluation of unprocessed single photon emission computed tomography data. These findings were due to metastasis of colon cancer to the liver.
    Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 02/1999; 26(3):229-31. · 0.67 Impact Factor
  • Clinical Nuclear Medicine - CLIN NUCL MED. 01/1999; 24(3).
  • Clinical Nuclear Medicine - CLIN NUCL MED. 01/1998; 23(2).
  • Clinical Nuclear Medicine - CLIN NUCL MED. 01/1998; 23(2).
  • Clinical Nuclear Medicine - CLIN NUCL MED. 01/1998; 23(2).

Publication Stats

589 Citations
168.77 Total Impact Points

Institutions

  • 1986–2004
    • Baylor College of Medicine
      • • Department of Neurology
      • • Department of Radiology
      Houston, TX, United States
  • 1997–1999
    • St. Luke's Episcopal Health System
      Houston, Texas, United States
  • 1994–1996
    • University of Houston
      • Department of Electrical & Computer Engineering
      Houston, TX, United States
  • 1995
    • Texas Heart Institute
      Houston, Texas, United States
  • 1988
    • Texas Children's Hospital
      Houston, Texas, United States