Advances in Medical Imaging

More often, the diagnosis of causes of upper abdominal pain and specialty triage of patients as necessary has become the province of the radiologist. How do radiologists best approach diagnosis and management for these patients, and what factors underlie positive interactions between referring physician and radiologist for this common clinical problem? Host Dr. Jason Birnholz is joined by Dr. Dushyant Sahani, clinical instructor of radiology at Harvard Medical School and director of CT imaging services at Massachusetts General Hospital, to examine the radiology of upper abdominal pain and the expanding role of the radiologist.

Autoimmunity has been identified in over 100 separate diseases. Depending on the target tissues, these disorders may be systemic, localized, or perhaps somewhere in between. The characteristics of autoimmune pancreatitis represent one such example of diffuse-to-localized disorders, and is the subject of this discussion. New forms of imaging enable us to map the inflammatory components of this and other diseases, often identifying conditions that were not part of the original differential diagnosis. How does this both aid and complicate management strategies for patients? Host Dr. Jason Birnholz welcomes Dr. Dushyant Sahani, clinical instructor of radiology at Harvard Medical School and director of CT imaging services at Massachusetts General Hospital, to share insights and expertise on imaging autoimmune pancreatitis.

In 1888, William Osler wrote in the Lancet the following: "In patients with suspected acute appendicitis, one should urge towards laparotomy. The indications for surgical interference are not always clear, but in my experience I have been taught that the abdomen is much more frequently left untouched than it should be, and that an operation is too often deferred until practically useless." Clearly, diagnosis of acute appendicitis has come a long way since then. But challenges remain in selecting the safest, most timely, and cost-effective diagnostic modalities for this condition. Dr. Andrea Doria, associate professor in the department of medical imaging at the University of Toronto School of Medicine, clarifies the use of ultrasound versus CT for evaluation of acute appendicitis in children. Dr. Jason Birnholz hosts.

Successful cochlear implantation has remarkable impact on quality of life for children with congenital and early onset hearing loss. How do clinicians best evaluate these children for likelihood of success with implants, and what are the imaging challenges when following up with these patients later on? Drs. Scott Holland and Daniel Choo from the University of Cincinnati examine new technologies on the horizon, from fMRI to near-infrared spectrophotometry, for screening and following candidates of cochlear implantation. In the process, they outline salient features of sensorineural hearing deficits and share the state-of-the-art in operative methods for implantation. Dr. Jason Birnholz hosts.

Many clinicians are well familiarized with standard contrast agents such as barium and iodinated compounds to enhance angiographic imaging. Ultrasound, capable of visualizing bloodflow with the use of doppler alone, is yet insufficiently sensitive to capture perfusion of organs and/or tumors at the capillary level. What special kinds of contrast enhancements are needed for ultrasound in this case? Dr. Stephanie Wilson, professor of medical imaging and obstetrics and gynecology at the University of Calgary in Alberta, Canada, discusses the science and art of using micro-bubble contrast agents, and the emergence of contrast-enhanced ultrasound (CEUS) as a safer alternative to traditional angiography. Dr. Jason Birnholz hosts.

It's not uncommon for women to report experiencing menstrual changes after having given birth two or more times. These changes include shorter cycles, increased cramping, and heavier bleeding, at times with clots. Such changes are hallmark signs of adenomyosis. Definitive diagnosis of adenomyosis can be made easily with MRI or ultrasound, but are there therapeutic options from interventional radiology as well? If so, can these methods replace hysterectomy? Dr. James Spies, professor of radiology at Georgetown University and chairman of the department of radiology at Georgetown University Medical Center, joins host Dr. Jason Birnholz to resolve these questions.

Host Dr. Jason Birnholz and Dr. James Spies, professor of radiology at Georgetown University and chairman of the department of radiology at Georgetown University Medical Center, look at fibroid tumors- their incidence and treatment. They discuss the populations in which there is a high prevalence, as well as genetic factors and the basics of interventional radiology protocol.

Pre-treatment MRI can eliminate unnecessary diagnostic or surgical procedures for children with suspected musculoskeletal infections. Host Dr. Jason Birnholz and Dr. J. Herman Kan, assistant professor of radiology at Vanderbilt University Medical Center, specializing in pediatric and adolescent radiology, discuss the application of MRIs and the results of his recent study which showed that a significant number of surgeries could be avoided with early MRI evaluation. Tune in to hear the valuable role MRI plays in the evaluation of musculoskeletal infection. 

Dr. Sherry Teefey, professor of radiology at Washington University School of Medicine in St. Louis, discusses with host Dr. Beverly Hashimoto her experience in Bhutan and Uganda, teaching medical professionals how to use ultrasound and computed tomography and enhancing current techniques. Tune in to hear the challenges to providing imaging services in these countries and the future goals to introduce new modalities and improve radiological services in third world countries.

Ultrasound images of the musculoskeletal system provides pictures of muscles, tendons, ligaments, joints and soft tissue throughout the body. Dr. Sherry Teefey, associate professor of radiology at Washington University School of Medicine in St. Louis, discusses with host Dr. Beverly Hashimoto some of the common uses for this procedure. Dr. Teefey also discusses the application of musculoskeletal ultrasound in conjunction with aspiration or injection. Tune in to hear the benefits and limitations of diagnostic musculoskeletal ultrasound.