Mylene T Truong

NYU Langone Medical Center, New York City, New York, United States

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Publications (100)292.51 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Small cell lung carcinoma (SCLC) is the most common primary pulmonary neuroendocrine malignancy and is characterized by a rapid doubling time and high growth fraction. Approximately 60%-70% of patients present with metastatic disease at the time of diagnosis, and their prognosis is poor. However, improved survival has been demonstrated when SCLC is diagnosed early and specific treatment strategies are used. A modified version of the Veterans Administration Lung Cancer Study Group (VALSG) staging system has traditionally been used to categorize SCLC as limited-stage or extensive-stage disease to guide therapy. However, the International Association for the Study of Lung Cancer has recommended that the current seventh edition of the American Joint Committee on Cancer tumor-node-metastasis staging system for lung cancer replace the VALSG system for staging of SCLC. Appropriate staging and patient management require knowledge of imaging manifestations of SCLC across multiple imaging modalities, the strengths and weaknesses of specific examinations, the correlation of these findings with the staging criteria used in clinical practice, and the impact of appropriate staging on patient treatment and survival. Computed tomography (CT) is primarily used to evaluate the primary tumor and the extent of intrathoracic disease. In recent years, however, 2-[fluorine-18]fluoro-2-deoxy-d-glucose positron emission tomography/CT has proved to be more accurate than conventional imaging in the staging of SCLC and can be used to guide therapy and assess treatment response. ©RSNA, 2014.
    Radiographics 10/2014; 34(6):1707-1721. · 2.73 Impact Factor
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    ABSTRACT: A solitary pulmonary nodule (SPN) is defined as a round opacity that is smaller than 3 cm. It may be solid or subsolid in attenuation. Semisolid nodules may have purely ground-glass attenuation or be partly solid (mixed solid and ground-glass attenuation). The widespread use of multidetector computed tomography (CT) has increased the detection of SPNs. Although clinical assessment of patients' risk factors for malignancy-such as age, smoking history, and history of malignancy-is important to determine appropriate treatment, in the recently published Fleischner guidelines for subsolid nodules, smoking history does not factor into their recommendations for management because there is an increasing incidence of lung adenocarcinoma in younger and nonsmoking patients. At imaging evaluation, obtaining prior chest radiographs or CT images is useful to assess nodule growth. Further imaging evaluation, including CT enhancement studies and positron emission tomography (PET), helps determine the malignant potential of solid SPNs. For subsolid nodules, initial follow-up CT is performed at 3 months to determine persistence, because lesions with an infectious or inflammatory cause can resolve in the interval. CT enhancement studies are not applicable for subsolid nodules, and PET is of limited utility because of the low metabolic activity of these lesions. Because of the likelihood that persistent subsolid nodules represent adenocarcinoma with indolent growth, serial imaging reassessment for a minimum of 3 years and/or obtaining tissue samples for histologic analysis are recommended. In the follow-up of subsolid SPNs, imaging features that indicate an increased risk for malignancy include an increase in size, an increase in attenuation, and development of a solid component. ©RSNA, 2014.
    Radiographics 10/2014; 34(6):1658-1679. · 2.73 Impact Factor
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    ABSTRACT: Oncologic therapy is constantly evolving to improve patient outcomes, especially with regard to chemotherapy. The use of combination therapies and development and implementation of molecular targeted therapy lead to iatrogenic conditions that the radiologist must be aware of in interpreting studies of and caring for the oncologic patient. Knowledge of the chemotherapeutic agents and the imaging appearances of associated toxicities can impact patient management and decrease patient morbidity and mortality.
    Radiologic Clinics of North America 09/2014; 52(5):1029-1040. · 1.83 Impact Factor
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    ABSTRACT: Oncologic patients are treated with a combination of chemotherapy, radiation therapy, and surgery. Advances in therapeutic options have greatly improved the survival of patients with cancer. Examples of these advances are newer chemotherapeutic agents that target the cell receptors and advanced radiation therapy delivery systems. It is imperative that radiologists be aware of the variety of imaging findings seen after therapy in patients with cancer. Complications may occur with classic cytotoxic therapies (eg, 5-fluorouracil), usually at higher or prolonged doses or when administered to radiosensitive areas. Newer targeted systemic agents, such as bevacizumab and imatinib, have associated characteristic toxicities because their effects on cells do not depend on dose. Radiation may induce early and late effects in local normal tissues that may be seen at imaging. Imaging findings after chemotherapy include fatty liver, pseudocirrhosis, hepatic veno-occlusive disease, and splenic rupture. Complications of radiation therapy include large and small bowel strictures and radiation-induced hepatitis and tumors. Awareness of the various therapeutic options and knowledge of the spectrum of posttherapeutic complications allows radiologists to provide a comprehensive report that may impact patient management. ©RSNA, 2014.
    Radiographics 07/2014; 34(4):941-961. · 2.73 Impact Factor
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    ABSTRACT: Richter's syndrome (RS) is associated with poor outcome. The prognosis of patients with histologically aggressive chronic lymphocytic leukemia (CLL), HAC, has not been studied. We aimed to correlate 2-Deoxy-2-[(18)F]fluoroglucose/positron emission tomography (FDG/PET) data, histological diagnosis, clinical characteristics and survival in patients with CLL. 332 patients with CLL were histologically classified as: 95 RS, 117 HAC, and 120 histologically indolent CLL (HIC). HAC and RS patients had higher maximum standardized uptake value (SUVmax), more frequent constitutional symptoms, poorer PS, lower hemoglobin and platelets, higher LDH and beta-2-microglobulin. A SUVmax≥10 strongly correlated with mortality (overall survival, OS, 56.7 vs 6.9 months in patients with SUVmax<10 vs ≥10). Survival of patients with RS and HAC was similar among patients with SUVmax<10 or ≥10. SUVmax≥10, PS≥2, bulky disease, and age≥65 were independently associated with shorter OS. In patients undergoing both fine-needle aspiration (FNA) and biopsy, FNA proved diagnostically inadequate in 23%, 29% and 53% of HIC, HAC and RS, respectively. FDG/PET is a useful diagnostic tool in patients with CLL and suspected transformation. Patients with HAC show different characteristics and worse prognosis compared to those with HIC. Patients with different CLL phases, but similar SUVmax have similar outcome. Tissue biopsy should be preferred for diagnosing RS.
    Blood 03/2014; · 9.78 Impact Factor
  • Radiologic Clinics of North America 01/2014; 52(1):85–103. · 1.83 Impact Factor
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    ABSTRACT: PET/CT is widely used in the staging and assessment of therapeutic response in patients with malignancies. Accurate interpretation of PET/CT requires knowledge of the normal physiologic distribution of [18F]-fluoro-2-deoxy-d-glucose, artifacts due to the use of CT for attenuation correction of the PET scan and potential pitfalls due to malignancies that are PET negative and benign conditions that are PET positive. Awareness of these artifacts and potential pitfalls is important in preventing misinterpretation that can alter patient management.
    Radiologic Clinics of North America 01/2014; 52(1):17-25. · 1.83 Impact Factor
  • Radiologic Clinics of North America 01/2014; 52(1):17–25. · 1.83 Impact Factor
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    ABSTRACT: Thoracotomy with lung resection produces postoperative changes that can be challenging for the radiologist. Complications related to anatomic and physiologic changes, infection, and breakdown of surgical anastomoses can significantly increase morbidity and mortality. Prompt and accurate diagnosis of serious postoperative complications is essential.
    Radiologic Clinics of North America 01/2014; 52(1):85-103. · 1.83 Impact Factor
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    ABSTRACT: In oncological imaging, staging with computed tomography (CT) is widely used to determine treatment. Misinterpretation of fluid in pericardial recesses as mediastinal adenopathy can lead to inaccurate clinical staging and inappropriate management. In this review, we describe normal pericardial anatomy and illustrate imaging features to differentiate fluid in pericardial sinuses and recesses from mediastinal adenopathy.
    Clinical Radiology 11/2013; · 1.66 Impact Factor
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    ABSTRACT: Cancer patients are a high-risk population for venous thromboembolism (VTE); the natural history of gonadal vein thrombosis (GVT) occurring in cancer patients is not well described in the medical literature. Utilizing a software program the computerized tomographic scan reports of patients at a single cancer center from January 1, 2004 to June 30, 2011 were searched for the term GVT. Patients included in this analysis had a diagnosis of cancer, an isolated GVT (i.e. no evidence of thrombosis at another site), no symptoms referable to the GVT, and at least six months of follow-up information. All subsequent recurrent VTE events were confirmed by imaging studies. 196 cancer patients with GVT were identified. The majority of patients in this analysis had metastatic disease (118, 61.2%) as well as active cancer (167, 85.2%). Twenty patients (10.8%) developed recurrent VTE (median follow-up 14.5months); median time to recurrent VTEs was 5.5months (range 0-19months). When considering only patients with without a recent history of gynecologic surgery, VTE recurrence rates were 14.3%. Active cancer was the only risk factor significantly associated with recurrent VTE (P=0.047). Based upon the patient's risk factors for VTE, treatment of an incidentally detected GVT in cancer patients with anticoagulation, as per guidelines for other VTE sites, may be indicated in certain high risk subgroups, especially those patients with active cancer who have not had prior pelvic surgery.
    Thrombosis Research 10/2013; · 2.43 Impact Factor
  • Seminars in roentgenology 10/2013; 48(4):295-307. · 0.70 Impact Factor
  • Seminars in roentgenology 10/2013; 48(4):323-34. · 0.70 Impact Factor
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    ABSTRACT: OBJECTIVE. Vulvar carcinoma is a rare malignancy, most commonly seen in elderly women. Survival depends on the lymph node status. Lymph node-negative patients have a 5-year survival of 90%, whereas survival drops to about 50% in patients with positive lymph nodes. The purpose of this article is to familiarize the reader with the revised International Federation of Gynecology and Obstetrics (FIGO) staging of vulvar cancer and incorporate it into daily practice when interpreting cross-sectional imaging studies. CONCLUSION. Although vulvar cancer is diagnosed clinically, cross-sectional imaging plays an important complimentary role in staging of the tumor, assessing extent of disease, and selecting operable versus inoperable candidates to ultimately help in decreasing morbidity and increasing survival in these patients.
    American Journal of Roentgenology 06/2013; 200(6):1387-1400. · 2.74 Impact Factor
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    ABSTRACT: Esophageal cancer is among the leading causes of cancer-related deaths worldwide. The management of patients with esophageal cancer is determined to a large extent by patient performance status, location of the primary cancer, and stage of disease at presentation. Multimodality regimens combining neoadjuvant chemotherapy and/or radiotherapy followed by surgery have been increasingly used in suitable candidates with locally advanced cancer. There is substantial morbidity and mortality associated with this treatment strategy, which makes appropriate patient selection important. Endoscopic esophageal ultrasound is the optimal modality to evaluate the local extent of the primary tumor and diagnose locoregional nodal metastasis. Computed tomography is more useful in detecting distant nodal and systemic metastasis. Positron emission tomography/CT is increasingly being used in patient management and improves the accuracy of staging, particularly in the detection of distant nodal and systemic metastatic disease. In this article, we review the role of imaging in the staging, assessment of therapeutic response, and detection of recurrent disease, as well as the evaluation of therapeutic complications in patients with esophageal cancer.
    Abdominal Imaging 05/2013; · 1.91 Impact Factor
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    ABSTRACT: LEARNING OBJECTIVES 1) The physics of SUV quantification. 2) Artifacts from the use of CT for attenuation correction: high CT attenuation material, respiratory artifact, truncation artifact. 3) Clinical pitfalls in interpretation: physiologic uptake and iatrogenic procedures. 4) To show current and future development of novel tracers for PET/CT. ABSTRACT The routine use of integrated PET/CT in the staging and follow up of oncology patients has improved diagnostic accuracy but many interpretation pitfalls are encountered. These may be related to the physics of SUV quantification. Other potential pitfalls are introduced by the use of CT for attenuation correction, including those related to contrast media, the presence of metallic prostheses, or due to respiratory motion and truncation. However, other pitfalls in interpretation may be encountered due to biological factors, such as normal variants of FDG uptake, as well as uptake due to iatrogenic causes. Knowledge of these artifacts is important in preventing misinterpretation. Current and future developments in novel tracers will be discussed. ACTIVE HANDOUT http://media.rsna.org/media/abstract/2012/9000264/lzqm844_9000264_RC551_Truong.pdf
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
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    ABSTRACT: PURPOSE/AIM 1. Review CT findings that help in the differential diagnosis of common and uncommon pleural diseases. 2. Illustrate radiologic-pathologic correlation of benign and malignant pleural lesions. CONTENT ORGANIZATION 1. Introduction 2. Differential diagnosis of focal and diffuse pleural disease 3. Radiological-Pathological Correlation: A. Benign pleural diseases—Fibrous tumor of the pleura, neurofibroma, lipoma, pleural endometriosis, infection, benign fibrothorax. B. Malignant pleural diseases— Mesothelioma, metastases of pulmonary and extrathoracic primaries, small cell carcinoma, lymphoma, synovial sarcoma, liposarcoma, epithelioid hemangioendothelioma. 4. Conclusion SUMMARY Pleural lesions are frequently seen on chest imaging studies and may represent benign or malignant diseases. They manifest as a spectrum of imaging appearances ranging from focal to diffuse and vary in density, location and extent of metabolic activity. This review of radiologic-pathologic correlation aids the radiologist in formulating a tailored differential diagnosis of common and uncommon pleural diseases.
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
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    ABSTRACT: The reversed halo sign is characterised by a central ground-glass opacity surrounded by denser air-space consolidation in the shape of a crescent or a ring. It was first described on high-resolution CT as being specific for cryptogenic organising pneumonia. Since then, the reversed halo sign has been reported in association with a wide range of pulmonary diseases, including invasive pulmonary fungal infections, paracoccidioidomycosis, pneumocystis pneumonia, tuberculosis, community-acquired pneumonia, lymphomatoid granulomatosis, Wegener granulomatosis, lipoid pneumonia and sarcoidosis. It is also seen in pulmonary neoplasms and infarction, and following radiation therapy and radiofrequency ablation of pulmonary malignancies. In this article, we present the spectrum of neoplastic and non-neoplastic diseases that may show the reversed halo sign and offer helpful clues for assisting in the differential diagnosis. By integrating the patient's clinical history with the presence of the reversed halo sign and other accompanying radiological findings, the radiologist should be able to narrow the differential diagnosis substantially, and may be able to provide a presumptive final diagnosis, which may obviate the need for biopsy in selected cases, especially in the immunosuppressed population.
    The British journal of radiology 05/2012; 85(1017):1226-35. · 2.11 Impact Factor
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    ABSTRACT: LEARNING OBJECTIVES 1) The physics of SUV quantification. 2) Artifacts from the use of CT for attenuation correction: high CT attenuation material, respiratory artifact, truncation artifact. 3) Clinical pitfalls in interpretation: physiologic uptake and iatrogenic procedures. 4) To show current and future development of novel tracers for PET/CT. ABSTRACT The routine use of integrated PET/CT in the staging and follow up of oncology patients has improved diagnostic accuracy but many interpretation pitfalls are encountered. These may be related to the physics of SUV quantification. Other potential pitfalls are introduced by the use of CT for attenuation correction, including those related to contrast media, the presence of metallic prostheses, or due to respiratory motion and truncation. However, other pitfalls in interpretation may be encountered due to biological factors, such as normal variants of FDG uptake, as well as uptake due to iatrogenic causes. Knowledge of these artifacts is important in preventing misinterpretation. Current and future developments in novel tracers will be discussed. ACTIVE HANDOUT http://media.rsna.org/media/abstract/2011/9000264/jrnh216_9000264_Truong_RC451.pdf
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 11/2011
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    ABSTRACT: PURPOSE PACS systems, including open source and proprietary versions, allow for various levels of user interface customizability. The utility of macro software for saving mouse clicks with keyboard shortcuts is well known. We present a set of user interface customizations, designed to work any windows based PACS implementation. We hypothesize that user efficiency and satisfaction with these tools will be greater compared to native user interfaces. METHOD AND MATERIALS We have developed a set of hotkeys that utilize the Windows API for controlling the following functions: scrolling, windowing, measuring, annotating, saving presentation states, and controlling audio editing. We have successfully used the software with a variety of major commercial and free PACS implementations on windows. The software can also be used with any internet browser based PACS. No installation or administrative privileges are needed to use the software. RESULTS At our institution, 72 faculty members and trainees across multiple subspecialties have requested access to our software, the majority of whom use it on a regular basis. The user satisfaction rate is high. The use of more efficient scrolling enables review of a greater number of prior examinations . The use of more efficient markup tools enable objective quantification of a greater number of lesions. CONCLUSION A radiologist could make good use of a software toolbox that could be carried onto various PACS workstations in a variety of practice settings. CLINICAL RELEVANCE/APPLICATION A vendor-neutral abstraction over a radiologist user interface has the potential to improve the radiologists workflow.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 11/2011

Publication Stats

2k Citations
292.51 Total Impact Points

Institutions

  • 2014
    • NYU Langone Medical Center
      • Department of Radiology
      New York City, New York, United States
  • 2000–2014
    • University of Texas MD Anderson Cancer Center
      • Division of Diagnostic Imaging
      Houston, Texas, United States
  • 2013
    • University of Texas Medical School
      • Department of Diagnostic and Interventional Imaging
      Houston, Texas, United States