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Latest Developments

> 3D Craniofacial Imaging
> 3D CT
> 3D Virtual Bronchoscopy

> Advanced Head and Neck Imaging
> Angioplasty
> CT & MR Angiography
> Diffusion MRI
> Endovascular Stent Graft
> Functional MRI
> MRI Spectroscopy
> Perfusion MRI
> Spine Pain Management
> Uterine Fibroid Embolization

 

New medical discoveries merge with the latest computer technologies to allow radiologists to look inside the human body with greater detail than ever before. RCND, as diagnostic imagers, make use of these latest developments in the diagnosis and treatment of diseases. We hope to update our referring physicians and patients about some of the newest radiology techniques and procedures.

If you are a patient, ask your doctor if you may be a candidate for one of these studies. As always, the risks and benefits of potential treatments are best discussed with your own doctor first.

 

3D Craniofacial Imaging

People from around the world come to Medical City and TheNorth Texas Hospital for Children, for life altering surgery to repair deformities or birth defects of the skull and face. The Radiologists of RCND perform 3D Craniofacial Imaging of these patients to map the underlying bones to help the internationally known team of plastic surgeons, neurosurgeons, and craniofacial surgeons and staff of the Dallas Craniofacial Center to plan their surgical approaches. Computed tomography (CT) is performed of the head, and 3D processing produces images such as these which can be examined in depth to help characterize the skull and facial deformities.


3D CT

The next generation of CT machines have multiple detectors and even greater computer speed. A CT scanner can image a patient with continuous table movement and multiple similtaneous spiral cuts covering the body in a matter of seconds.

The image to the left is a 3D reconstruction of a routine abdomen CT. Utilizing the latest multi-detector CT’s, rapid, sub-second scanning is a reality, and 300-400 images can be obtained of the body with a single breath-hold. As the data set is large, alternative ways of interacting and interpreting images include 3D real-time data manipulation by the radiologists. These new paradigms of image interpretation are a necessity, but the results are also revolutionary in the way radiologists like those in RCND can diagnose disease, and more importantly, represent the data to physicians and patients in a single, yet inclusive photo.

 

3D Virtual Bronchoscopy

Bronchoscopy is the visual inspection of the trachea and airways using a rigid or flexible scope through the nose or mouth, while the patient is under anesthesia. 3D Virtual bronchoscopy examines the airways using data obtained from a multislice CT of the neck and upper chest, targeted to the airway, with a single breath hold. No anesthesia, No pain. The images to the right are from such an exam with the viewer proceeding from the trachea into the left mainstem bronchus, and finally into the left lower lobe bronchus.

 

Advanced Head and Neck Imaging

RCND Section of Neuroradiology utilizes the latest cross-sectional imaging techniques in the imaging of the Head and Neck. Computed tomography (CT) and MRI provide anatomic detail, and PET scan, perfusion, diffusion and functional MRI and spectroscopy can help determine vascular supply, changes in water content and a patient’s brain function, in the areas of tumor involvement, stroke or proposed surgery.

In addition, different information can be added together to yield a 3D image of tumor, vessels, and brain function. (see Functional MRI and Perfusion/Diffusion Imaging).

These images are a reconstruction of an actual case showing a neck mass and its relationship to major vessels and bones. This information can be used by surgeons to plan tumor extent and surgical options. The tumor (purple) is close to the major vessels of the right neck (red), and extends behind the right jaw (mandible).

 

Angioplasty

Angioplasty is a way of opening a narrowed or closed blood vessel without having to do major surgery. Instead, a catheter with a tiny balloon at its tip is inserted into the vessel—usually one of the coronary arteries supplying the heart wall or a major artery bringing blood to an arm or leg. After advancing the catheter until its tip is at the site of blockage, the balloon is inflated and then deflated and removed.

The narrowing or blockage most often is caused by arteriosclerosis, or hardening of the arteries, when fatty plaques form on the inner wall of the artery and become larger, gradually cutting down on free blood flow. Expanding the balloon stretches the arterial wall and disrupts the fatty plaques, helping to restore blood flow.

Between 70 percent and 90 percent of angioplasty procedures use a stent, a hollow thin-walled wire mesh tube, to keep the vessel open after widening it. Otherwise, because arteriosclerosis is an ongoing disease, more plaques might form and again limit blood flow. The stent is placed onto the balloon and pressed firmly against the artery wall when inflating it. The balloon then is deflated, leaving the stent in place to act as a scaffold.

CT and MR Angiography

CT and MRI data sets can be reconstructed in three dimensions, and specifically can yield diagnostic angiographic images without the pain or risks of traditional angiography. Possible areas of imaging include MR and CT angiography of the vessels of the brain, neck, chest, pulmonary arteties, abdominal aorta, renal vessels, and peripheral arteries and veins.

The radiologists of RCND are experienced in these various imaging techniques, and work closely with the referral vascular surgeons, internists, cardiologists and neurosurgeons in diagnosing vascular diseases and planning possible traditional or non-invasive treatment. (A) MR angiogram of the carotid vessels. (B) MR angiogram of the renal arteries. (C) CT angiogram of the abdomen demonstrating multiple aneurysms and active bleeding from the colic artery. (D) MR angiogram of the brain-circle of Willis.

 

Diffusion MRI

Diffusion MRI is a hyper-fast technique for evaluation of molecular movement of water, which is reduced in some conditions, namely acute stroke.This technique is nearly 100% accurate in the diagnosis of areas of acute cerebral infarction. 

This patient presented with acute findings suggesting a stroke, which worsened over a two day period. Imaging demonstrates an acute stroke in evolution with subsequent extension. (a) Day 1 diffusion MRI demonstrates a small cortical a sub-cortical infarct.

When clinical condition worsens, (b) day 2 DWI demonstrates enlargement of the stroke. (c) Perfusion MRI demonstrates areas of reduced blood flow corresponding to final infarct size. These scanning techniques provide valuable information regarding the region of ischemia which maybe salvageable with thrombolytic therapy.


 

Endovascular Stent Graft

An abdominal aortic aneurysm (AAA) is a bulge in the aortawhich can continue to grow like a balloon until it bursts, becoming a life-threatening emergency. The normal aorta is 2.0-2.3cm in diameter, is aneurysmal when it grows 50% more than its normal size, and the risk of rupture increases rapidly when it is greater than 4-5cm.


AAAs are more common in men, and caused by cigarette smoking, atherosclerosis, high blood pressure or infection. Many aneurysms are without symptoms at the time of diagnosis, but can undergo rapid or unpredictable growth and rupture. An aneurysm can be diagnosed by physical exam, and imaged or monitored with ultrasound, CT, MRI or arteriogram. Repair by traditional open surgery requires a large incision in the abdominal wall and clamping of the aorta, cutting it open, and sewing in an aortic graft bypass.

There is now an alternative to traditional surgery in many patients. An endovascular endograft can repair the AAA from the inside of the vessel by using a catheter pre-fitted with a stent, customize-sized to the individual patient’s aneurysm. The hospital stay is shorter, usually 2-3days, rather than a week or more, and the complications of surgery are fewer. A specially trained Vascular Surgeon and Interventional-Radiology team uses X-ray guidance in the operating suite, to position the graft in the aneurysm through small incisions in the groin vessels.

To date, the RCND Radiology and Surgical team at Medical City Dallas Hospital have placed more endovascular endografts to repair AAA than any other team in Dallas.

Physicians can call RCND at 972-566-7866, to arrange an evaluation for your patient to see if the endograft procedure is appropriate. Images can be evaluated, and frequently customized packaged stents can be manufactured from measurements made from a CT scan. (Images courtesy of Ancure™ Endograft Systems)

 

Functional MRI

Functional MRI demonstrates regions of temporary increase of cerebral blood flow associated with thought processes or movement. Functional data superimposed on regular MRI images permits mapping of areas of the brain which can be useful in pre-surgical planning. In this case, the patient presents with a cavernous malformation of the brain.

The patient was asked to perform a simple motor task while in the scanner, left hand finger tapping, in order to identify the area of the brain responsible for hand motion (red areas). This region was shown to be intimately associated with the cavernous malformation (white) which was being considered for surgical resection.

Techniques such as these can help determine which patients may or may not be eligible for surgery and possible risks for post-operative paralysis. (Note some plasticity of the brain with areas of the left motor cortex activated.)

 

MRI Spectroscopy (MRS)
 

MRI Spectroscopy (MRS) is a special technique used for characterization of the biochemistry of tumors, infarcts, and other pathology.

MRS is useful for demonstrating aspects of physiology such as tumor aggressiveness and anaerobic metabolism.

2D MRS of the brain demonstrates the characteristic internal biochemical makeup of glioblastoma multiforme, a highly aggressive brain tumor.


 

Perfusion MRI

Perfusion MRI is a special technique for evaluation of microscopic blood flow in cerebral capillaries and venules. (A) Calculated MRI perfusion map of a high grade brain tumordemonstrates areas of increased capillary blood volume in tumor (red) corresponding to tumor neovascularity. (B) Perfusion map superimposed on FLAIR image demonstrates area of tumor with highest malignancy potential to aid biopsy planning.

 

Spine Pain Management: Vertebroplasty, Facet Joint Injections, Epidural Steroid Injections

The osteoporotic spine loses strength and with age a vertebra (B) can collapse causing loss of height, compression fractures, and severe pain. In addition, degenerative disc disease (A) often has proliferative bone spurs, and sclerosis and arthritis of the facet joints (D), which together can cause painful compression of the exiting nerve roots (C).

Percutaneous transpedicular polymethylmethacrylate vertebroplasty (PTPV) is a therapeutic neuroradiological procedure in which an acrylic cement is injected into the partially collapsed vertebral body to stabilize the bone. Once hardened, the cement prevents further compression fracture. Most patients have a marked improvement in the pain associated with this instability.

With fluoroscopic guidance, the facet joints themselves can be injected with medicines to relieve pain in the arthritic joints. Also, epidural steroid injections can reduce the inflammation around the exiting nerve roots, also improving pain.

The Neuroradiologists of RCND are trained to aid in the treatment of back pain due to these conditions. Ask your physician if you are a candidate for these procedures. Contact us for more information.

Uterine Fibroid Embolization

Large fibroids of the uterus can cause pain and dysfunctional bleeding, which can lead to a hysterectomy. An alternate palliative or pre-surgical procedure called Uterine Fibroid Embolization, now exists which gives a woman another option for treatment or lessening the risk of bleeding with directed fibroid removal. Small catheters are placed in the vessels in the groin and advanced into the arteries supplying the fibroid tumors of the uterus, and microparticles injected directly into the fibroid vessels, interrupting blood flow to the fibroid causing it to shrink and or be relatively less vascular, making risk of blood loss during surgical removal less likely. The RCND section of interventional radiology evaluates women for potential therapy, and are experienced in this cutting-edge therapy.

 

Want to know more?

Patients can find out more about specific procedures and the specialty of radiology at radiologyinfo.org, a site co-sponsored by the American College of Radiology and The Radiology Society of North America.

 

          


14679 Midway Road
Bldg 4, Suite 206
Addison, TX 75001
469/317-9900

 

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