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Papers by Amy Deipolyi

Research paper thumbnail of Drs. Deipolyi et al respond

Drs. Deipolyi et al respond

Journal of vascular and interventional radiology : JVIR, 2015

Research paper thumbnail of Adrenal Vein Sampling for Conn’s Syndrome: Diagnosis and Clinical Outcomes

Adrenal Vein Sampling for Conn’s Syndrome: Diagnosis and Clinical Outcomes

Diagnostics, 2015

Research paper thumbnail of Occlusion of the Internal Iliac Artery Is Associated with Smaller Prostate and Decreased Urinary Tract Symptoms

Occlusion of the Internal Iliac Artery Is Associated with Smaller Prostate and Decreased Urinary Tract Symptoms

Journal of vascular and interventional radiology : JVIR, Jan 8, 2015

To characterize the relationship of proximal internal iliac artery (IIA) occlusion or embolizatio... more To characterize the relationship of proximal internal iliac artery (IIA) occlusion or embolization on prostate volume (PV) and the presence of lower urinary tract symptoms (LUTS) or benign prostatic hyperplasia (BPH). The study included 2 parts: Part 1 comprised 99 men ≥ 50 years old who underwent abdominopelvic computed tomography angiography for lower extremity claudication assessed in a retrospective cohort design; Part 2 comprised 18 patients who underwent iatrogenic IIA embolization during endovascular aneurysm repair assessed by a within-subjects approach. Prostate volume and IIA origin diameter were measured; IIA occlusion was noted. Chart review documented body mass index, LUTS, impotence, and buttock claudication. Of 99 men in Part 1, 60 had no IIA occlusion, and 39 had IIA occlusion (17 unilateral, 22 bilateral). Prostate volume differed significantly between groups (no IIA occlusion, 27.3 mL; unilateral IIA occlusion, 20.7 mL; bilateral IIA occlusion, 17.1 mL; P = .001). ...

Research paper thumbnail of Alternative endovascular technique to treat hemodialysis graft-associated steal syndrome

Alternative endovascular technique to treat hemodialysis graft-associated steal syndrome

Journal of vascular and interventional radiology : JVIR, 2014

Research paper thumbnail of Bilateral inferior petrosal sinus sampling using desmopressin or corticotropic-releasing hormone: a single-center experience

Journal of NeuroInterventional Surgery, 2014

Background Bilateral inferior petrosal sinus sampling (BIPSS) following corticotropic-releasing h... more Background Bilateral inferior petrosal sinus sampling (BIPSS) following corticotropic-releasing hormone (CRH) stimulation is the current gold standard technique in the diagnosis of Cushing disease. However, as a result of CRH shortage, desmopressin (DDAVP) has been used instead for BIPSS. We present the experience of a single tertiary care center using the modified BIPSS protocol and compare the results obtained with DDAVP with those obtained with CRH. Methods Using the radiology department's electronic database, BIPSS procedures performed at our institution using DDAVP and CRH were identified. Electronic medical records and imaging studies were reviewed and the clinical history, demographic data, endocrine test results, complications of BIPSS, and patient outcomes were recorded. BIPSS data were analyzed for centralization and lateralization of pituitary adrenocorticotropic hormone (ACTH) source. We identified 20 BIPSS cases (16 women, mean age 38 years) performed using DDAVP between 2012 and 2013. Results The 20 cases demonstrated conventional inferior petrosal sinus anatomy and were successfully cannulated bilaterally. Of these, 18 met the criteria for both centralization and lateralization. A total of 18 patients underwent trans-sphenoidal tumor resection; one patient was lost to follow-up and one is still being followed. There were no complications resulting from the use of DDAVP, specifically no thromboembolic events. Calculated sensitivity for BIPSS with DDAVP was 94.5%. There was also no significant difference in the biochemical results produced by BIPSS using either DDAVP or CRH. All 18 patients demonstrated an ACTH-secreting adenoma on pathology review.

Research paper thumbnail of Bilateral inferior petrosal sinus sampling with desmopressin

Bilateral inferior petrosal sinus sampling with desmopressin

Journal of NeuroInterventional Surgery, 2012

In this technical note, the use of desmopressin to stimulate pituitary adrenocorticotropic hormon... more In this technical note, the use of desmopressin to stimulate pituitary adrenocorticotropic hormone secretion in place of the commercially available corticotropin releasing hormone (CRH) in bilateral inferior petrosal sinus sampling is described. Although the use of CRH is the standard of practice, it is currently unavailable in the USA and desmopressin provides reliable results with no additional observed side effects.

Research paper thumbnail of Bilateral inferior petrosal sinus sampling

Bilateral inferior petrosal sinus sampling

Journal of NeuroInterventional Surgery, 2011

Bilateral inferior petrosal sinus sampling, the gold standard assay in diagnosing pituitary secre... more Bilateral inferior petrosal sinus sampling, the gold standard assay in diagnosing pituitary secretion of adrenocorticotropic hormone in Cushing disease, is highly accurate and safe when performed by experienced interventionalists. We review the anatomic and technical considerations essential for safe and reliable practice.

Research paper thumbnail of Safety and Efficacy of 70–150 μm and 100–300 μm Drug-Eluting Bead Transarterial Chemoembolization for Hepatocellular Carcinoma

Safety and Efficacy of 70–150 μm and 100–300 μm Drug-Eluting Bead Transarterial Chemoembolization for Hepatocellular Carcinoma

Journal of Vascular and Interventional Radiology, 2015

To compare the safety and efficacy of using 70-150 μm drug-eluting beads (DEBs) (LC BeadM1; Bioco... more To compare the safety and efficacy of using 70-150 μm drug-eluting beads (DEBs) (LC BeadM1; Biocompatibles UK Ltd, Farnham, Surrey, United Kingdom) in addition to 100-300 μm DEBs with 100-300 μm DEBs alone in transarterial chemoembolization for treatment of hepatocellular carcinoma (HCC). A cohort of patients with HCC who underwent transarterial chemoembolization with two vials of 100-300 μm DEBs (group 1, 55 procedures among 42 patients, 33 men, average Model for End-Stage Liver Disease score 10 ± 0.6, 67% Child-Pugh A, 33% Child-Pugh B) was retrospectively compared with a cohort of patients who underwent transarterial chemoembolization with one vial of 70-150 μm DEBs followed by one vial of 100-300 μm DEBs (group 2, 51 procedures among 42 patients, 29 men, average Model for End-Stage Liver Disease score 9 ± 0.6, 73% Child-Pugh A, 27% Child-Pugh B) in regard to adverse events and response on 1-month follow-up imaging using modified Response Evaluation Criteria In Solid Tumors criteria. There was no difference in 1-month imaging response (P = .3). Patients in group 2 were readmitted more often within 1 month for hepatobiliary adverse events (group 2, 25%; group 1, 9%; P < .0001), including ascites, gastrointestinal hemorrhage, biliary dilatation, and cholecystitis. Despite similar efficacy based on short-term follow-up imaging, transarterial chemoembolization with smaller DEBs (70-150 μm) followed by larger DEBs (100-300 μm) may cause more hepatobiliary adverse events.

Research paper thumbnail of Reduction in Portal Venous Pressure by Transjugular Intrahepatic Portosystemic Shunt for Treatment of Hemorrhagic Stomal Varices

American Journal of Roentgenology, 2014

Va s c u l a r a n d I nt e r ve nt io n a l R a d io l og y • O r ig i n a l R e s e a rc h

Research paper thumbnail of High Lung Shunt Fraction in Colorectal Liver Tumors Is Associated with Distant Metastasis and Decreased Survival

Journal of Vascular and Interventional Radiology, 2014

Purpose: To assess how intratumoral shunting relates to liver metastasis and to clinical outcome.

Research paper thumbnail of The role of preoperative angiogram in colon interposition surgery

Diagnostic and Interventional Radiology, 2011

Research paper thumbnail of The role of bilateral inferior petrosal sinus sampling in the diagnostic evaluation of cushing’s disease

Diagnostic and Interventional Radiology, 2010

Research paper thumbnail of Intratumoral Vascular Shunting

Intratumoral Vascular Shunting

American Journal of Clinical Oncology, 2014

Predicting which patients will benefit from radioembolization remains a challenge, as reliable pr... more Predicting which patients will benefit from radioembolization remains a challenge, as reliable prognostic indicators are not defined. Abnormal tumor vascular anatomy could not only impact the ability of cancer therapies to penetrate tumors, but may also contribute to a lesion's metastatic potential. Specifically, intratumoral vascular shunts could allow circulating tumor cells to initiate metastases by allowing them to gain access to distant sites in the body, bypassing capillary beds. Here, we describe how tumoral angiogenesis occurs and how intratumoral vascular shunts may form.

Research paper thumbnail of May-Thurner syndrome: diagnosis and management

May-Thurner syndrome: diagnosis and management

Vasa, 2013

For over fifty years, the pathogenesis of May-Thurner syndrome (MTS) has been associated with chr... more For over fifty years, the pathogenesis of May-Thurner syndrome (MTS) has been associated with chronic left common iliac vein compression resulting in the formation of intraluminal, permanent obstructive lesions. However, despite this association, the mechanism by which compression produces these lesions is unknown. Diagnostic accuracy of MTS is critical since it often afflicts young patients requiring endovascular management. This review will focus on the historical, embryological and evolutionary description of MTS and examine its development, diagnosis, clinical management and potential diagnostic errors.

Research paper thumbnail of Spatial cognition and the human navigation network in AD and MCI

Spatial cognition and the human navigation network in AD and MCI

Neurology, 2007

The mechanisms underlying navigation impairments in Alzheimer disease (AD) are unknown. We charac... more The mechanisms underlying navigation impairments in Alzheimer disease (AD) are unknown. We characterized navigation in AD and mild cognitive impairment (MCI) to test the hypothesis that navigation disability reflects selective impairments in spatial cognition and relates to atrophy of specific brain regions. We compared 13 mild AD and 21 MCI patients with 24 controls on a route-learning task that engaged various spatial processes. Using structural MRI and optimized voxel-based morphometry, we also investigated the neural correlates of spatial abilities in a subset of subjects (10 AD, 12 MCI, 21 controls). AD and MCI patients recognized landmarks as effectively as controls, but could not find their locations on maps or recall the order in which they were encountered. Half of AD and one-quarter of MCI patients got lost on the route, compared with less than 10% of controls. Regardless of diagnosis, patients who got lost had lower right posterior hippocampal and parietal volumes than patients and controls who did not get lost. The ability to identify locations on a map correlated with right posterior hippocampal and parietal volumes, whereas order memory scores correlated with bilateral inferior frontal volumes. The navigation disability in Alzheimer disease and mild cognitive impairment (MCI) involves a selective impairment of spatial cognition and is associated with atrophy of the right-lateralized navigation network. Extensive spatial impairments in MCI suggest that navigation tests may provide early markers of cognitive and neural damage.

Research paper thumbnail of Comparing microstructural and macrostructural development of the cerebral cortex in premature newborns: Diffusion tensor imaging versus cortical gyration

NeuroImage, 2005

This study assessed microstructural development in four regions of the human cerebral cortex duri... more This study assessed microstructural development in four regions of the human cerebral cortex during preterm maturation using diffusion tensor imaging (DTI), compared to the macrostructural development of cortical gyration evaluated using three-dimensional volumetric T1-weighted MR imaging. Thirty-seven premature infants of estimated gestational age (EGA) ranging from 25 to 38 weeks were prospectively enrolled and imaged in an MR-compatible neonatal incubator with a high-sensitivity neonatal head coil. Cortical gyration was measured quantitatively as the ratio of gyral height to width on the volumetric MR images in four regions bilaterally (superior frontal, superior occipital, precentral, and postcentral gyri). Mean diffusivity (D av ), fractional anisotropy (FA-the fraction of D av that is anisotropic), and the three DTI eigenvalues (components of diffusivity radial and tangential to the pial surface of cortex) were measured in the same cortical regions. Cortical gyration scores, FA, and radial diffusivity were all significantly correlated with EGA ( P < 0.0001). However, in multivariate analysis, no significant relationship ( P > 0.05) was found between DTI parameters and cortical gyration beyond their common association with estimated gestational age. Pre-and postcentral gyri had significantly lower anisotropy than the superior occipital and superior frontal gyri ( P < 0.05), indicating that DTI is sensitive to regional heterogeneity in cortical development. Maturational changes in the DTI eigenvalues of cortical gray matter were found to differ from those that have previously been described in developing white matter, with a significant age-related decline in the radial diffusivity ( P < 0.0001) but not in the tangential diffusivities ( P > 0.05).

Research paper thumbnail of Altered navigational strategy use and visuospatial deficits in hAPP transgenic mice

Neurobiology of Aging, 2008

Navigation deficits are prominent in Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s ... more Navigation deficits are prominent in Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (AD) patients and transgenic mice expressing familial AD-mutant hAPP and A beta peptides. To determine the impact of strategy use on these deficits, we assessed hAPP and nontransgenic mice in a cross maze that can be solved by allocentric (world-based) or egocentric (self-based) strategies. Most nontransgenic mice used allocentric strategies, whereas half of hAPP mice were egocentric. At 3 months, all mice learned the cross maze rapidly; at 6 months, only allocentric hAPP mice were impaired. At 3 and 6 months, hAPP mice had reduced hippocampal Fos expression, which correlated with cross maze learning in older mice. Striatal pCREB expression was unaltered in hAPP mice, suggesting striatal sparing. We conclude that egocentric strategy use may be an earlier indicator of hAPP/A beta-induced hippocampal impairment than spatial learning deficits. Persistent use of allocentric strategies when egocentric strategies are available is maladaptive when there is hippocampal damage. Interventions promoting flexibility in selecting learning strategies might help circumvent otherwise debilitating navigational deficits caused by AD-related hippocampal dysfunction.

Research paper thumbnail of Pelvic Congestion Syndrome: Etiology of Pain, Diagnosis, and Clinical Management

Pelvic Congestion Syndrome: Etiology of Pain, Diagnosis, and Clinical Management

Journal of Vascular and Interventional Radiology, 2014

Pelvic congestion syndrome is associated with pelvic varicosities that result in chronic pelvic p... more Pelvic congestion syndrome is associated with pelvic varicosities that result in chronic pelvic pain, especially in the setting of prolonged standing, coitus, menstruation, and pregnancy. Although the underlying pathophysiology of pelvic congestion syndrome is unclear, it probably results from a combination of dysfunctional venous valves, retrograde blood flow, venous hypertension, and dilatation. Asymptomatic women may also have pelvic varicosities, making pelvic congestion syndrome difficult to diagnose. This article explores the etiologies of pain, use of imaging techniques, and clinical management of pelvic congestion syndrome. Possible explanations for the spectrum of pain among women with pelvic varicosities are also discussed.

Research paper thumbnail of Reliability of cerebral blood volume maps as a substitute for diffusion-weighted imaging in acute ischemic stroke

Reliability of cerebral blood volume maps as a substitute for diffusion-weighted imaging in acute ischemic stroke

Journal of Magnetic Resonance Imaging, 2012

To assess the reliability of cerebral blood volume (CBV) maps as a substitute for diffusion-weigh... more To assess the reliability of cerebral blood volume (CBV) maps as a substitute for diffusion-weighted MRI (DWI) in acute ischemic stroke. In acute stroke, DWI is often used to identify irreversibly injured &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;core&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; tissue. Some propose using perfusion imaging, specifically CBV maps, in place of DWI. We examined whether CBV maps can reliably subsitute for DWI, and assessed the effect of scan duration on calculated CBV. We retrospectively identified 58 patients who underwent DWI and MR perfusion imaging within 12 h of stroke onset. CBV in each DWI lesion&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s center was divided by CBV in the normal-appearing contralateral hemisphere to yield relative regional CBV (rrCBV). The proportion of lesions with decreased rrCBV was calculated. After using the full scan duration (110 s after contrast injection), rrCBV was recalculated using simulated shorter scans. The effect of scan duration on rrCBV was tested with linear regression. Using the full scan duration (110 s), rrCBV was increased in most DWI lesions (62%; 95% confidence interval, 48-74%). rrCBV increased with increasing scan duration (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Even with the shortest duration (39.5 s) rrCBV was increased in 33% of lesions. Because DWI lesions may have elevated or decreased CBV, CBV maps cannot reliably substitute for DWI in identifying the infarct core.

Research paper thumbnail of Occipital ganglioglioma in an older adult

Occipital ganglioglioma in an older adult

Journal of Clinical Neuroscience, 2010

Gangliogliomas are rare benign tumors of the central nervous system that typically involve the te... more Gangliogliomas are rare benign tumors of the central nervous system that typically involve the temporal lobe in younger patients. We present a 63-year-old man with an unusual occipital ganglioma with new seizures resolving after resection. A search of the literature revealed only three reports of occipital ganglioma in adults over 30 years old. Therefore, ganglioglioma of the occipital lobe in older patients is rare, but is a diagnostic consideration.

Research paper thumbnail of Drs. Deipolyi et al respond

Drs. Deipolyi et al respond

Journal of vascular and interventional radiology : JVIR, 2015

Research paper thumbnail of Adrenal Vein Sampling for Conn’s Syndrome: Diagnosis and Clinical Outcomes

Adrenal Vein Sampling for Conn’s Syndrome: Diagnosis and Clinical Outcomes

Diagnostics, 2015

Research paper thumbnail of Occlusion of the Internal Iliac Artery Is Associated with Smaller Prostate and Decreased Urinary Tract Symptoms

Occlusion of the Internal Iliac Artery Is Associated with Smaller Prostate and Decreased Urinary Tract Symptoms

Journal of vascular and interventional radiology : JVIR, Jan 8, 2015

To characterize the relationship of proximal internal iliac artery (IIA) occlusion or embolizatio... more To characterize the relationship of proximal internal iliac artery (IIA) occlusion or embolization on prostate volume (PV) and the presence of lower urinary tract symptoms (LUTS) or benign prostatic hyperplasia (BPH). The study included 2 parts: Part 1 comprised 99 men ≥ 50 years old who underwent abdominopelvic computed tomography angiography for lower extremity claudication assessed in a retrospective cohort design; Part 2 comprised 18 patients who underwent iatrogenic IIA embolization during endovascular aneurysm repair assessed by a within-subjects approach. Prostate volume and IIA origin diameter were measured; IIA occlusion was noted. Chart review documented body mass index, LUTS, impotence, and buttock claudication. Of 99 men in Part 1, 60 had no IIA occlusion, and 39 had IIA occlusion (17 unilateral, 22 bilateral). Prostate volume differed significantly between groups (no IIA occlusion, 27.3 mL; unilateral IIA occlusion, 20.7 mL; bilateral IIA occlusion, 17.1 mL; P = .001). ...

Research paper thumbnail of Alternative endovascular technique to treat hemodialysis graft-associated steal syndrome

Alternative endovascular technique to treat hemodialysis graft-associated steal syndrome

Journal of vascular and interventional radiology : JVIR, 2014

Research paper thumbnail of Bilateral inferior petrosal sinus sampling using desmopressin or corticotropic-releasing hormone: a single-center experience

Journal of NeuroInterventional Surgery, 2014

Background Bilateral inferior petrosal sinus sampling (BIPSS) following corticotropic-releasing h... more Background Bilateral inferior petrosal sinus sampling (BIPSS) following corticotropic-releasing hormone (CRH) stimulation is the current gold standard technique in the diagnosis of Cushing disease. However, as a result of CRH shortage, desmopressin (DDAVP) has been used instead for BIPSS. We present the experience of a single tertiary care center using the modified BIPSS protocol and compare the results obtained with DDAVP with those obtained with CRH. Methods Using the radiology department's electronic database, BIPSS procedures performed at our institution using DDAVP and CRH were identified. Electronic medical records and imaging studies were reviewed and the clinical history, demographic data, endocrine test results, complications of BIPSS, and patient outcomes were recorded. BIPSS data were analyzed for centralization and lateralization of pituitary adrenocorticotropic hormone (ACTH) source. We identified 20 BIPSS cases (16 women, mean age 38 years) performed using DDAVP between 2012 and 2013. Results The 20 cases demonstrated conventional inferior petrosal sinus anatomy and were successfully cannulated bilaterally. Of these, 18 met the criteria for both centralization and lateralization. A total of 18 patients underwent trans-sphenoidal tumor resection; one patient was lost to follow-up and one is still being followed. There were no complications resulting from the use of DDAVP, specifically no thromboembolic events. Calculated sensitivity for BIPSS with DDAVP was 94.5%. There was also no significant difference in the biochemical results produced by BIPSS using either DDAVP or CRH. All 18 patients demonstrated an ACTH-secreting adenoma on pathology review.

Research paper thumbnail of Bilateral inferior petrosal sinus sampling with desmopressin

Bilateral inferior petrosal sinus sampling with desmopressin

Journal of NeuroInterventional Surgery, 2012

In this technical note, the use of desmopressin to stimulate pituitary adrenocorticotropic hormon... more In this technical note, the use of desmopressin to stimulate pituitary adrenocorticotropic hormone secretion in place of the commercially available corticotropin releasing hormone (CRH) in bilateral inferior petrosal sinus sampling is described. Although the use of CRH is the standard of practice, it is currently unavailable in the USA and desmopressin provides reliable results with no additional observed side effects.

Research paper thumbnail of Bilateral inferior petrosal sinus sampling

Bilateral inferior petrosal sinus sampling

Journal of NeuroInterventional Surgery, 2011

Bilateral inferior petrosal sinus sampling, the gold standard assay in diagnosing pituitary secre... more Bilateral inferior petrosal sinus sampling, the gold standard assay in diagnosing pituitary secretion of adrenocorticotropic hormone in Cushing disease, is highly accurate and safe when performed by experienced interventionalists. We review the anatomic and technical considerations essential for safe and reliable practice.

Research paper thumbnail of Safety and Efficacy of 70–150 μm and 100–300 μm Drug-Eluting Bead Transarterial Chemoembolization for Hepatocellular Carcinoma

Safety and Efficacy of 70–150 μm and 100–300 μm Drug-Eluting Bead Transarterial Chemoembolization for Hepatocellular Carcinoma

Journal of Vascular and Interventional Radiology, 2015

To compare the safety and efficacy of using 70-150 μm drug-eluting beads (DEBs) (LC BeadM1; Bioco... more To compare the safety and efficacy of using 70-150 μm drug-eluting beads (DEBs) (LC BeadM1; Biocompatibles UK Ltd, Farnham, Surrey, United Kingdom) in addition to 100-300 μm DEBs with 100-300 μm DEBs alone in transarterial chemoembolization for treatment of hepatocellular carcinoma (HCC). A cohort of patients with HCC who underwent transarterial chemoembolization with two vials of 100-300 μm DEBs (group 1, 55 procedures among 42 patients, 33 men, average Model for End-Stage Liver Disease score 10 ± 0.6, 67% Child-Pugh A, 33% Child-Pugh B) was retrospectively compared with a cohort of patients who underwent transarterial chemoembolization with one vial of 70-150 μm DEBs followed by one vial of 100-300 μm DEBs (group 2, 51 procedures among 42 patients, 29 men, average Model for End-Stage Liver Disease score 9 ± 0.6, 73% Child-Pugh A, 27% Child-Pugh B) in regard to adverse events and response on 1-month follow-up imaging using modified Response Evaluation Criteria In Solid Tumors criteria. There was no difference in 1-month imaging response (P = .3). Patients in group 2 were readmitted more often within 1 month for hepatobiliary adverse events (group 2, 25%; group 1, 9%; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001), including ascites, gastrointestinal hemorrhage, biliary dilatation, and cholecystitis. Despite similar efficacy based on short-term follow-up imaging, transarterial chemoembolization with smaller DEBs (70-150 μm) followed by larger DEBs (100-300 μm) may cause more hepatobiliary adverse events.

Research paper thumbnail of Reduction in Portal Venous Pressure by Transjugular Intrahepatic Portosystemic Shunt for Treatment of Hemorrhagic Stomal Varices

American Journal of Roentgenology, 2014

Va s c u l a r a n d I nt e r ve nt io n a l R a d io l og y • O r ig i n a l R e s e a rc h

Research paper thumbnail of High Lung Shunt Fraction in Colorectal Liver Tumors Is Associated with Distant Metastasis and Decreased Survival

Journal of Vascular and Interventional Radiology, 2014

Purpose: To assess how intratumoral shunting relates to liver metastasis and to clinical outcome.

Research paper thumbnail of The role of preoperative angiogram in colon interposition surgery

Diagnostic and Interventional Radiology, 2011

Research paper thumbnail of The role of bilateral inferior petrosal sinus sampling in the diagnostic evaluation of cushing’s disease

Diagnostic and Interventional Radiology, 2010

Research paper thumbnail of Intratumoral Vascular Shunting

Intratumoral Vascular Shunting

American Journal of Clinical Oncology, 2014

Predicting which patients will benefit from radioembolization remains a challenge, as reliable pr... more Predicting which patients will benefit from radioembolization remains a challenge, as reliable prognostic indicators are not defined. Abnormal tumor vascular anatomy could not only impact the ability of cancer therapies to penetrate tumors, but may also contribute to a lesion&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s metastatic potential. Specifically, intratumoral vascular shunts could allow circulating tumor cells to initiate metastases by allowing them to gain access to distant sites in the body, bypassing capillary beds. Here, we describe how tumoral angiogenesis occurs and how intratumoral vascular shunts may form.

Research paper thumbnail of May-Thurner syndrome: diagnosis and management

May-Thurner syndrome: diagnosis and management

Vasa, 2013

For over fifty years, the pathogenesis of May-Thurner syndrome (MTS) has been associated with chr... more For over fifty years, the pathogenesis of May-Thurner syndrome (MTS) has been associated with chronic left common iliac vein compression resulting in the formation of intraluminal, permanent obstructive lesions. However, despite this association, the mechanism by which compression produces these lesions is unknown. Diagnostic accuracy of MTS is critical since it often afflicts young patients requiring endovascular management. This review will focus on the historical, embryological and evolutionary description of MTS and examine its development, diagnosis, clinical management and potential diagnostic errors.

Research paper thumbnail of Spatial cognition and the human navigation network in AD and MCI

Spatial cognition and the human navigation network in AD and MCI

Neurology, 2007

The mechanisms underlying navigation impairments in Alzheimer disease (AD) are unknown. We charac... more The mechanisms underlying navigation impairments in Alzheimer disease (AD) are unknown. We characterized navigation in AD and mild cognitive impairment (MCI) to test the hypothesis that navigation disability reflects selective impairments in spatial cognition and relates to atrophy of specific brain regions. We compared 13 mild AD and 21 MCI patients with 24 controls on a route-learning task that engaged various spatial processes. Using structural MRI and optimized voxel-based morphometry, we also investigated the neural correlates of spatial abilities in a subset of subjects (10 AD, 12 MCI, 21 controls). AD and MCI patients recognized landmarks as effectively as controls, but could not find their locations on maps or recall the order in which they were encountered. Half of AD and one-quarter of MCI patients got lost on the route, compared with less than 10% of controls. Regardless of diagnosis, patients who got lost had lower right posterior hippocampal and parietal volumes than patients and controls who did not get lost. The ability to identify locations on a map correlated with right posterior hippocampal and parietal volumes, whereas order memory scores correlated with bilateral inferior frontal volumes. The navigation disability in Alzheimer disease and mild cognitive impairment (MCI) involves a selective impairment of spatial cognition and is associated with atrophy of the right-lateralized navigation network. Extensive spatial impairments in MCI suggest that navigation tests may provide early markers of cognitive and neural damage.

Research paper thumbnail of Comparing microstructural and macrostructural development of the cerebral cortex in premature newborns: Diffusion tensor imaging versus cortical gyration

NeuroImage, 2005

This study assessed microstructural development in four regions of the human cerebral cortex duri... more This study assessed microstructural development in four regions of the human cerebral cortex during preterm maturation using diffusion tensor imaging (DTI), compared to the macrostructural development of cortical gyration evaluated using three-dimensional volumetric T1-weighted MR imaging. Thirty-seven premature infants of estimated gestational age (EGA) ranging from 25 to 38 weeks were prospectively enrolled and imaged in an MR-compatible neonatal incubator with a high-sensitivity neonatal head coil. Cortical gyration was measured quantitatively as the ratio of gyral height to width on the volumetric MR images in four regions bilaterally (superior frontal, superior occipital, precentral, and postcentral gyri). Mean diffusivity (D av ), fractional anisotropy (FA-the fraction of D av that is anisotropic), and the three DTI eigenvalues (components of diffusivity radial and tangential to the pial surface of cortex) were measured in the same cortical regions. Cortical gyration scores, FA, and radial diffusivity were all significantly correlated with EGA ( P < 0.0001). However, in multivariate analysis, no significant relationship ( P > 0.05) was found between DTI parameters and cortical gyration beyond their common association with estimated gestational age. Pre-and postcentral gyri had significantly lower anisotropy than the superior occipital and superior frontal gyri ( P < 0.05), indicating that DTI is sensitive to regional heterogeneity in cortical development. Maturational changes in the DTI eigenvalues of cortical gray matter were found to differ from those that have previously been described in developing white matter, with a significant age-related decline in the radial diffusivity ( P < 0.0001) but not in the tangential diffusivities ( P > 0.05).

Research paper thumbnail of Altered navigational strategy use and visuospatial deficits in hAPP transgenic mice

Neurobiology of Aging, 2008

Navigation deficits are prominent in Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s ... more Navigation deficits are prominent in Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (AD) patients and transgenic mice expressing familial AD-mutant hAPP and A beta peptides. To determine the impact of strategy use on these deficits, we assessed hAPP and nontransgenic mice in a cross maze that can be solved by allocentric (world-based) or egocentric (self-based) strategies. Most nontransgenic mice used allocentric strategies, whereas half of hAPP mice were egocentric. At 3 months, all mice learned the cross maze rapidly; at 6 months, only allocentric hAPP mice were impaired. At 3 and 6 months, hAPP mice had reduced hippocampal Fos expression, which correlated with cross maze learning in older mice. Striatal pCREB expression was unaltered in hAPP mice, suggesting striatal sparing. We conclude that egocentric strategy use may be an earlier indicator of hAPP/A beta-induced hippocampal impairment than spatial learning deficits. Persistent use of allocentric strategies when egocentric strategies are available is maladaptive when there is hippocampal damage. Interventions promoting flexibility in selecting learning strategies might help circumvent otherwise debilitating navigational deficits caused by AD-related hippocampal dysfunction.

Research paper thumbnail of Pelvic Congestion Syndrome: Etiology of Pain, Diagnosis, and Clinical Management

Pelvic Congestion Syndrome: Etiology of Pain, Diagnosis, and Clinical Management

Journal of Vascular and Interventional Radiology, 2014

Pelvic congestion syndrome is associated with pelvic varicosities that result in chronic pelvic p... more Pelvic congestion syndrome is associated with pelvic varicosities that result in chronic pelvic pain, especially in the setting of prolonged standing, coitus, menstruation, and pregnancy. Although the underlying pathophysiology of pelvic congestion syndrome is unclear, it probably results from a combination of dysfunctional venous valves, retrograde blood flow, venous hypertension, and dilatation. Asymptomatic women may also have pelvic varicosities, making pelvic congestion syndrome difficult to diagnose. This article explores the etiologies of pain, use of imaging techniques, and clinical management of pelvic congestion syndrome. Possible explanations for the spectrum of pain among women with pelvic varicosities are also discussed.

Research paper thumbnail of Reliability of cerebral blood volume maps as a substitute for diffusion-weighted imaging in acute ischemic stroke

Reliability of cerebral blood volume maps as a substitute for diffusion-weighted imaging in acute ischemic stroke

Journal of Magnetic Resonance Imaging, 2012

To assess the reliability of cerebral blood volume (CBV) maps as a substitute for diffusion-weigh... more To assess the reliability of cerebral blood volume (CBV) maps as a substitute for diffusion-weighted MRI (DWI) in acute ischemic stroke. In acute stroke, DWI is often used to identify irreversibly injured &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;core&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; tissue. Some propose using perfusion imaging, specifically CBV maps, in place of DWI. We examined whether CBV maps can reliably subsitute for DWI, and assessed the effect of scan duration on calculated CBV. We retrospectively identified 58 patients who underwent DWI and MR perfusion imaging within 12 h of stroke onset. CBV in each DWI lesion&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s center was divided by CBV in the normal-appearing contralateral hemisphere to yield relative regional CBV (rrCBV). The proportion of lesions with decreased rrCBV was calculated. After using the full scan duration (110 s after contrast injection), rrCBV was recalculated using simulated shorter scans. The effect of scan duration on rrCBV was tested with linear regression. Using the full scan duration (110 s), rrCBV was increased in most DWI lesions (62%; 95% confidence interval, 48-74%). rrCBV increased with increasing scan duration (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Even with the shortest duration (39.5 s) rrCBV was increased in 33% of lesions. Because DWI lesions may have elevated or decreased CBV, CBV maps cannot reliably substitute for DWI in identifying the infarct core.

Research paper thumbnail of Occipital ganglioglioma in an older adult

Occipital ganglioglioma in an older adult

Journal of Clinical Neuroscience, 2010

Gangliogliomas are rare benign tumors of the central nervous system that typically involve the te... more Gangliogliomas are rare benign tumors of the central nervous system that typically involve the temporal lobe in younger patients. We present a 63-year-old man with an unusual occipital ganglioma with new seizures resolving after resection. A search of the literature revealed only three reports of occipital ganglioma in adults over 30 years old. Therefore, ganglioglioma of the occipital lobe in older patients is rare, but is a diagnostic consideration.