Tara Henrichsen - Academia.edu (original) (raw)

Papers by Tara Henrichsen

Journal of Vascular and Interventional Radiology, Jun 1, 2011

Purpose-To assess 12-month outcomes and safety of clinical magnetic resonance (MR)-guided focused... more Purpose-To assess 12-month outcomes and safety of clinical magnetic resonance (MR)-guided focused ultrasound (US) treatments of uterine leiomyomas. Materials and Methods-Between March 2005 and December 2009, 150 women with symptomatic uterine leiomyomas were clinically treated with MR-guided focused US at a single institution; 130 patients completed treatment and agreed to have their data used for research purposes. Patients were followed through retrospective review of medical records and phone interviews conducted at 3-, 6-, and 12-month intervals after treatment to assess additional procedures and symptom relief. Outcome measures and treatment complications were analyzed for possible correlations with the appearance of the tumors on T2-weighted imaging. Results-The cumulative incidence of additional tumor-related treatments 12 months after MRguided focused US was 7.4% by the Kaplan-Meier method. At 3-, 6-, and 12-month follow-up, 86% (90 of 105), 93% (92 of 99), and 88% (78 of 89) of patients reported relief of symptoms, respectively. No statistically significant correlation between tumor appearance on T2-weighted imaging and 12-month outcome was found. Treatment-related complications were observed in 17 patients (13.1%): 16 patients had minor complications and one had a major complication (deep vein thrombosis). All complications were resolved within the 12-month follow-up period. Conclusions-MR-guided focused US is a noninvasive treatment option that can be used to effectively and safely treat uterine leiomyomas and delivers significant and lasting symptom relief for at least 12 months. The incidence of additional treatment during this time period is comparable with those in previous reports of uterine artery embolization.

Ultrasound in Obstetrics & Gynecology, Sep 21, 2007

Oral communication abstracts Conclusions: On ultrasound GCT is characterized by a large multilocu... more Oral communication abstracts Conclusions: On ultrasound GCT is characterized by a large multilocular or solid mass with a large number of locules and increased vascularization; it rarely has papillarities.

Ultrasound Quarterly, Jun 1, 2008

Uterine fibroids are common smooth muscle tumors, which can result in substantial symptoms affect... more Uterine fibroids are common smooth muscle tumors, which can result in substantial symptoms affecting the quality of life of women. Whereas patients have several options available for treatment, focused ultrasound ablation is one of the least invasive treatment options outside medical therapy. Magnetic resonance-guided focused ultrasound (MRgFUS) ablation combines therapy delivered by an ultrasound transducer with imaging, guidance for therapy, and thermal feedback provided by magnetic resonance imaging. In 2004, the MRgFUS system ExAblate 2000 (InSightec, Haifa, Israel) was approved by the United States Food and Drug Administration for clinical treatments of uterine fibroids. Since its approval, our institution has performed more than 140 treatments. This paper provides an overview of our site's clinical experience with MRgFUS, including a brief description of the treatment system, pertinent features to review on screening magnetic resonance imaging, how the procedure is performed, and risks and benefits of the treatment. Some potential clinical applications of the technology are also briefly reviewed.

Journal of The American College of Radiology, May 1, 2018

Vaginal bleeding is not uncommon in the first trimester of pregnancy. The majority of such patien... more Vaginal bleeding is not uncommon in the first trimester of pregnancy. The majority of such patients will have a normal intrauterine pregnancy (IUP), a nonviable IUP, or an ectopic pregnancy. Ultrasound (US) is the primary imaging modality in evaluation of these patients. US, along with clinical observations and serum human chorionic gonadotropin levels, can usually distinguish these causes. Although it is important to diagnose ectopic pregnancies and nonviable IUPs, one should also guard against injury to normal pregnancies due to inappropriate treatment with methotrexate or surgical intervention. Less common causes of first trimester vaginal bleeding include gestational trophoblastic disease and arteriovenous malformations. Pulsed methods of Doppler US should generally be avoided in the first trimester when there is a normal, or a potentially normal, IUP. Once a normal IUP has been excluded, Doppler US may be useful when other diagnoses such as retained products of conception or arteriovenous malformations are suspected. MRI may occasionally be helpful as a problem-solving tool. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Academic Radiology, Sep 1, 2003

Radiographics, Mar 1, 2020

Diagnostic and interventional radiology residency programs must educate trainees on quality and p... more Diagnostic and interventional radiology residency programs must educate trainees on quality and patient safety topics to meet board requirements and prepare residents to become effective physician leaders. A quality curriculum should encompass process improvement methodology as well as instruction about crucial patient safety subjects. The authors have developed a standardized and structured approach to fulfill this need using didactic and experiential learning. The educational format includes short lectures, peer-to-peer instruction, and self-study, with the value of presented information reinforced by physician leaders and process improvement specialists. Equally important is a structured experience in departmental quality improvement wherein trainees learn the collaborative nature of effective durable process change in areas of interest to them. This curriculum is implemented during the 3rd year of radiology residency to leverage residents' knowledge and experience with radiology workflows and proximity to the American Board of Radiology Core Exam. Feedback from educators and trainees as well as objective examination data support this approach. This article shares guidance and lessons learned from the authors' radiology residency educational efforts and offers a framework for successful implementation of a comprehensive quality curriculum at any residency training program. This curriculum serves the dual purpose of developing skilled future physician leaders and promoting value for patients. ©

Endocrine Practice, Apr 1, 2022

American Journal of Roentgenology, Nov 1, 2013

W765 [5-7]. The sensitivity of mammography is reported to be lower for ILC than for invasive duct... more W765 [5-7]. The sensitivity of mammography is reported to be lower for ILC than for invasive ductal carcinoma-ranging from 72% to 92%-and ILC is frequently seen in only one view [8]. The sensitivity of physical examination is also reduced in ILC because of vague or absent clinical findings [1, 5, 9]. Ultrasound has an important role in ILC diagnosis, especially in patients with concerning clinical findings but negative or equivocal mammographic findings. Sonography is more sensitive than mammography in the detection of ILC, ranging from 68% to 98% in studies from 2004 to 2011 [9-12]. The most common sonographic appearance of ILC reported in the literature is a hypoechoic or heterogeneously echogenic mass with spiculated and indistinct margins in 54-61% of cases [13].

Journal of Ultrasound in Medicine, May 1, 2009

Ovarian causes of hyperandrogenism include PCOS, androgen-secreting neoplasms, and SH. The sonogr... more Ovarian causes of hyperandrogenism include PCOS, androgen-secreting neoplasms, and SH. The sonographic features of PCOS and androgen-secreting neoplasms have been described, 6 – 12 but there is little published information regarding the imaging ...

American Journal of Roentgenology, 2010

The histopathologic classification of these tumors includes papillary thyroid cancer (60-80%), fo... more The histopathologic classification of these tumors includes papillary thyroid cancer (60-80%), follicular carcinoma (15-18%), anaplastic carcinoma (3-10%), medullary carcinoma (4-5%), lymphoma (5%), and metastases [3].

American Surgeon, Apr 1, 2018

For patients with ductal carcinoma in situ (DCIS), sentinel lymph node (SLN) surgery is generally... more For patients with ductal carcinoma in situ (DCIS), sentinel lymph node (SLN) surgery is generally reserved for patients at high risk of being upstaged to invasive disease. The use of frozen section (FS) pathologic analysis of the primary tumor may allow for selective surgical nodal staging within one procedure. We sought to define the reliability of FS for detection of upstaging. Eight hundred and twenty-seven patients were identified with DCIS on core needle biopsy that underwent 834 operations at our institution between January 2004 and October 2014. We calculated the rate of upstage from DCIS to invasive cancer on both intraoperative FS and final pathology to determine the performance of FS. Upstage rate on final pathology was 118/834 (14.1%) 95 per cent confidence interval 11.8 to 16.7 per cent. FS identified 88/118 (74.6%) of the upstages. Specificity was 99.3 per cent (711/716). Overall accuracy was 95.8 per cent (799/834) and the positive predictive value was 96.0 per cent (711/741 patients). Mean size of invasive cancers identifiedon FS was 5.6 mm, versus 3.5 mm for those identified only on permanent section, P = 0.11. Intraoperative FS analysis of DCIS is useful for identification of upstage to invasive disease. This may facilitate a selective approach to SLN surgery that both decreases unnecessary SLN surgery and the need for a second operation.

Journal of Clinical Ultrasound, Jun 8, 2010

Purpose.The aim of this study was to determine the prevalence and amount of cystic change in thyr... more Purpose.The aim of this study was to determine the prevalence and amount of cystic change in thyroid cancer. This study also examined associated sonographic characteristics of cystic malignant thyroid nodules to help recognize these clinically important nodules.Methods.This study was a retrospective review of 360 malignant thyroid nodules surgically removed at our institution between January 1, 2002 and December 31, 2004. All patients had signed research authorization. All patients had preoperative sonograms and surgical pathologic proof of their thyroid malignancy. The 360 malignant nodules were found in 307 patients. All scans were performed using 7‐ to 15‐MHz transducers, and most studies included a digital video clip of the cancer. The preoperative ultrasound examinations were retrospectively reviewed by three radiologists and a sonographer. An estimate of cystic component percentage was derived by consensus. The presence of a mural nodule, thick irregular wall, microcalcifications, and prominent vascularity was also recorded.Results.Of the 360 carcinomas, 318 (88.3%) were solid to minimally (less than 5%) cystic, 33 (9.2%) were 6–50% cystic, 9 (2.5%) were 51–100% cystic. Of the nine (2.5%) malignancies that were greater than 50% cystic, all had other suspicious findings including mural nodules, microcalcifications, increased vascularity, and/or a thick irregular wall about the cystic portion.Conclusion.The vast majority (88%) of thyroid cancer is uniformly solid or has minimal (1–5%) cystic change by sonography. Marked cystic change (>50% of the nodule) occurred in only 2.5% of cancers, which had other sonographic findings worrisome for malignancy. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 38:361‐366, 2010

Journal of The American College of Radiology, Feb 1, 2017

Purpose: Many studies have suggested that disparities exist in the use of medical screening tests... more Purpose: Many studies have suggested that disparities exist in the use of medical screening tests. The purpose of this study was to assess racial disparities in screening mammography in the United States via a systematic review and meta-analysis. Methods: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus for comparative studies published between 1946 and 2015 comparing utilization of mammography among various racial groups. Two independent reviewers extracted data and appraised study. Meta-analysis was conducted when appropriate using the random-effects model. Results: A total of 5,818,380 patients were included across 39 relevant studies; 43.1% of patients were white, 33.3% were black, 17.4% were Hispanic, and 6.2% were Asian/Pacific Islander. Black and Hispanic populations had lower odds of utilizing screening mammography when compared with the white population (odds ratio [OR] ¼ 0.81; 95% confidence interval [CI], 0.72-0.91; I 2 ¼ 89.4% and OR ¼ 0.83; 95% CI, 0.74-0.93, respectively). For African Americans, these disparities were present in both the 40 to 65 age group and the >65 age group; for Hispanics, these differences were present only in the 40 to 65 age group. There was no difference in mammography utilization between Asians/Pacific Islanders and whites (OR ¼ 1.82; 95% CI, 0.09-38.41). Conclusions: Racial disparities in utilization of screening mammography are evident in black and Hispanic populations in the United States. Further studies are needed to understand reasons for disparities, trends over time, and the effectiveness of interventions targeting these disparities.

Radiologic Clinics of North America, May 1, 2011

Fine-needle aspiration (FNA) is a critical component of thyroid nodule evaluation. This minimally... more Fine-needle aspiration (FNA) is a critical component of thyroid nodule evaluation. This minimally invasive test was initially performed with palpation guidance; however, today the vast majority of these procedures are performed with ultrasound guidance. This chapter will review ultrasound-guided thyroid nodule FNA including the recommended preprocedural planning and procedure setup. Different techniques for obtaining samples will also be described. Although uncommon, the potential complications will be discussed.

Journal of Vascular and Interventional Radiology, Feb 1, 2010

Results: A total of 375 patients completed baseline enrollment; 101 normals, 107 embolization, 61... more Results: A total of 375 patients completed baseline enrollment; 101 normals, 107 embolization, 61 myomectomy and 106 hysterectomy. The mean symptom score at baseline for normals was 15.3 (SD 14.5) and 64.8 (SD 20) for the fibroid patients. At 6 months, the mean normal score was unchanged but the fibroid group reduced to a mean of 21.0 (20.6). At one year, mean normal score remained stable at 15.2 (SD 16.0) and was a mean of 17.8 (SD 17.5) for the fibroid group, not statistically different (P ϭ 0.23). One year after treatment, the mean symptom score for hysterectomy patients was 7.6 (SD 8.4), UAE 24.9 (SD 18.6), and myomectomy 23.4 (SD 18.9), with hysterectomy significantly better than the other two therapies (P Ͻ 0.001), with a mean score at 12 months of 7.6 (8.4). There were no differences between the symptom scores of myomectomy and UAE patients at 12 months. Similar improvements in HRQL were noted. Conclusion: These fibroid therapies result in substantial symptom relief and HRQL to near normal levels, with the greatest improvement with hysterectomy.

Springer eBooks, Aug 23, 2017

Emergency Radiology, Feb 24, 1999

Lisfranc fracture dislocations are uncommon foot injuries and can be difficult to diagnose clinic... more Lisfranc fracture dislocations are uncommon foot injuries and can be difficult to diagnose clinically and radiographically. Associated dislocation of the medial cuneiform is rare and also is difficult to diagnose. We present a case of combined Lisfranc and medial cuneiform fracture dislocation; the dislocation of the medial cuneiform was overlooked on initial radiographs. Subsequent CT examination showed the degree of midfoot disruption better than plain radiographs.

Journal of The American College of Radiology, Nov 1, 2017

Women with twin or higher-order pregnancies will typically have more ultrasound examinations than... more Women with twin or higher-order pregnancies will typically have more ultrasound examinations than women with a singleton pregnancy. Most women will have at minimum a first trimester scan, a nuchal translucency evaluation scan, fetal anatomy scan at 18 to 22 weeks, and one or more scans in the third trimester to evaluate growth. Multiple gestations are at higher risk for preterm delivery, congenital anomalies, fetal growth restriction, placenta previa, vasa previa, and velamentous cord insertion. Chorionicity and amnionicity should be determined as early as possible when a twin pregnancy is identified to permit triage of the monochorionic group into a closer surveillance model. Screening for congenital heart disease is warranted in monochorionic twins because they have an increased rate of congenital cardiac anomalies. In addition, monochorionic twins have a higher risk of developing cardiac abnormalities in later gestation related to right ventricular outflow obstruction, in particular the subgroups with twin-twin transfusion syndrome or selective intrauterine growth restriction. Monochorionic twins have unique complications including twin-to-twin transfusion syndrome, twin embolization syndrome, and acardius, or twin-reversed arterial perfusion sequence.

Current Problems in Diagnostic Radiology, Nov 1, 2022

Journal of Vascular and Interventional Radiology, Jun 1, 2011

Purpose-To assess 12-month outcomes and safety of clinical magnetic resonance (MR)-guided focused... more Purpose-To assess 12-month outcomes and safety of clinical magnetic resonance (MR)-guided focused ultrasound (US) treatments of uterine leiomyomas. Materials and Methods-Between March 2005 and December 2009, 150 women with symptomatic uterine leiomyomas were clinically treated with MR-guided focused US at a single institution; 130 patients completed treatment and agreed to have their data used for research purposes. Patients were followed through retrospective review of medical records and phone interviews conducted at 3-, 6-, and 12-month intervals after treatment to assess additional procedures and symptom relief. Outcome measures and treatment complications were analyzed for possible correlations with the appearance of the tumors on T2-weighted imaging. Results-The cumulative incidence of additional tumor-related treatments 12 months after MRguided focused US was 7.4% by the Kaplan-Meier method. At 3-, 6-, and 12-month follow-up, 86% (90 of 105), 93% (92 of 99), and 88% (78 of 89) of patients reported relief of symptoms, respectively. No statistically significant correlation between tumor appearance on T2-weighted imaging and 12-month outcome was found. Treatment-related complications were observed in 17 patients (13.1%): 16 patients had minor complications and one had a major complication (deep vein thrombosis). All complications were resolved within the 12-month follow-up period. Conclusions-MR-guided focused US is a noninvasive treatment option that can be used to effectively and safely treat uterine leiomyomas and delivers significant and lasting symptom relief for at least 12 months. The incidence of additional treatment during this time period is comparable with those in previous reports of uterine artery embolization.

Ultrasound in Obstetrics & Gynecology, Sep 21, 2007

Oral communication abstracts Conclusions: On ultrasound GCT is characterized by a large multilocu... more Oral communication abstracts Conclusions: On ultrasound GCT is characterized by a large multilocular or solid mass with a large number of locules and increased vascularization; it rarely has papillarities.

Ultrasound Quarterly, Jun 1, 2008

Uterine fibroids are common smooth muscle tumors, which can result in substantial symptoms affect... more Uterine fibroids are common smooth muscle tumors, which can result in substantial symptoms affecting the quality of life of women. Whereas patients have several options available for treatment, focused ultrasound ablation is one of the least invasive treatment options outside medical therapy. Magnetic resonance-guided focused ultrasound (MRgFUS) ablation combines therapy delivered by an ultrasound transducer with imaging, guidance for therapy, and thermal feedback provided by magnetic resonance imaging. In 2004, the MRgFUS system ExAblate 2000 (InSightec, Haifa, Israel) was approved by the United States Food and Drug Administration for clinical treatments of uterine fibroids. Since its approval, our institution has performed more than 140 treatments. This paper provides an overview of our site's clinical experience with MRgFUS, including a brief description of the treatment system, pertinent features to review on screening magnetic resonance imaging, how the procedure is performed, and risks and benefits of the treatment. Some potential clinical applications of the technology are also briefly reviewed.

Journal of The American College of Radiology, May 1, 2018

Vaginal bleeding is not uncommon in the first trimester of pregnancy. The majority of such patien... more Vaginal bleeding is not uncommon in the first trimester of pregnancy. The majority of such patients will have a normal intrauterine pregnancy (IUP), a nonviable IUP, or an ectopic pregnancy. Ultrasound (US) is the primary imaging modality in evaluation of these patients. US, along with clinical observations and serum human chorionic gonadotropin levels, can usually distinguish these causes. Although it is important to diagnose ectopic pregnancies and nonviable IUPs, one should also guard against injury to normal pregnancies due to inappropriate treatment with methotrexate or surgical intervention. Less common causes of first trimester vaginal bleeding include gestational trophoblastic disease and arteriovenous malformations. Pulsed methods of Doppler US should generally be avoided in the first trimester when there is a normal, or a potentially normal, IUP. Once a normal IUP has been excluded, Doppler US may be useful when other diagnoses such as retained products of conception or arteriovenous malformations are suspected. MRI may occasionally be helpful as a problem-solving tool. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Academic Radiology, Sep 1, 2003

Radiographics, Mar 1, 2020

Diagnostic and interventional radiology residency programs must educate trainees on quality and p... more Diagnostic and interventional radiology residency programs must educate trainees on quality and patient safety topics to meet board requirements and prepare residents to become effective physician leaders. A quality curriculum should encompass process improvement methodology as well as instruction about crucial patient safety subjects. The authors have developed a standardized and structured approach to fulfill this need using didactic and experiential learning. The educational format includes short lectures, peer-to-peer instruction, and self-study, with the value of presented information reinforced by physician leaders and process improvement specialists. Equally important is a structured experience in departmental quality improvement wherein trainees learn the collaborative nature of effective durable process change in areas of interest to them. This curriculum is implemented during the 3rd year of radiology residency to leverage residents' knowledge and experience with radiology workflows and proximity to the American Board of Radiology Core Exam. Feedback from educators and trainees as well as objective examination data support this approach. This article shares guidance and lessons learned from the authors' radiology residency educational efforts and offers a framework for successful implementation of a comprehensive quality curriculum at any residency training program. This curriculum serves the dual purpose of developing skilled future physician leaders and promoting value for patients. ©

Endocrine Practice, Apr 1, 2022

American Journal of Roentgenology, Nov 1, 2013

W765 [5-7]. The sensitivity of mammography is reported to be lower for ILC than for invasive duct... more W765 [5-7]. The sensitivity of mammography is reported to be lower for ILC than for invasive ductal carcinoma-ranging from 72% to 92%-and ILC is frequently seen in only one view [8]. The sensitivity of physical examination is also reduced in ILC because of vague or absent clinical findings [1, 5, 9]. Ultrasound has an important role in ILC diagnosis, especially in patients with concerning clinical findings but negative or equivocal mammographic findings. Sonography is more sensitive than mammography in the detection of ILC, ranging from 68% to 98% in studies from 2004 to 2011 [9-12]. The most common sonographic appearance of ILC reported in the literature is a hypoechoic or heterogeneously echogenic mass with spiculated and indistinct margins in 54-61% of cases [13].

Journal of Ultrasound in Medicine, May 1, 2009

Ovarian causes of hyperandrogenism include PCOS, androgen-secreting neoplasms, and SH. The sonogr... more Ovarian causes of hyperandrogenism include PCOS, androgen-secreting neoplasms, and SH. The sonographic features of PCOS and androgen-secreting neoplasms have been described, 6 – 12 but there is little published information regarding the imaging ...

American Journal of Roentgenology, 2010

The histopathologic classification of these tumors includes papillary thyroid cancer (60-80%), fo... more The histopathologic classification of these tumors includes papillary thyroid cancer (60-80%), follicular carcinoma (15-18%), anaplastic carcinoma (3-10%), medullary carcinoma (4-5%), lymphoma (5%), and metastases [3].

American Surgeon, Apr 1, 2018

For patients with ductal carcinoma in situ (DCIS), sentinel lymph node (SLN) surgery is generally... more For patients with ductal carcinoma in situ (DCIS), sentinel lymph node (SLN) surgery is generally reserved for patients at high risk of being upstaged to invasive disease. The use of frozen section (FS) pathologic analysis of the primary tumor may allow for selective surgical nodal staging within one procedure. We sought to define the reliability of FS for detection of upstaging. Eight hundred and twenty-seven patients were identified with DCIS on core needle biopsy that underwent 834 operations at our institution between January 2004 and October 2014. We calculated the rate of upstage from DCIS to invasive cancer on both intraoperative FS and final pathology to determine the performance of FS. Upstage rate on final pathology was 118/834 (14.1%) 95 per cent confidence interval 11.8 to 16.7 per cent. FS identified 88/118 (74.6%) of the upstages. Specificity was 99.3 per cent (711/716). Overall accuracy was 95.8 per cent (799/834) and the positive predictive value was 96.0 per cent (711/741 patients). Mean size of invasive cancers identifiedon FS was 5.6 mm, versus 3.5 mm for those identified only on permanent section, P = 0.11. Intraoperative FS analysis of DCIS is useful for identification of upstage to invasive disease. This may facilitate a selective approach to SLN surgery that both decreases unnecessary SLN surgery and the need for a second operation.

Journal of Clinical Ultrasound, Jun 8, 2010

Purpose.The aim of this study was to determine the prevalence and amount of cystic change in thyr... more Purpose.The aim of this study was to determine the prevalence and amount of cystic change in thyroid cancer. This study also examined associated sonographic characteristics of cystic malignant thyroid nodules to help recognize these clinically important nodules.Methods.This study was a retrospective review of 360 malignant thyroid nodules surgically removed at our institution between January 1, 2002 and December 31, 2004. All patients had signed research authorization. All patients had preoperative sonograms and surgical pathologic proof of their thyroid malignancy. The 360 malignant nodules were found in 307 patients. All scans were performed using 7‐ to 15‐MHz transducers, and most studies included a digital video clip of the cancer. The preoperative ultrasound examinations were retrospectively reviewed by three radiologists and a sonographer. An estimate of cystic component percentage was derived by consensus. The presence of a mural nodule, thick irregular wall, microcalcifications, and prominent vascularity was also recorded.Results.Of the 360 carcinomas, 318 (88.3%) were solid to minimally (less than 5%) cystic, 33 (9.2%) were 6–50% cystic, 9 (2.5%) were 51–100% cystic. Of the nine (2.5%) malignancies that were greater than 50% cystic, all had other suspicious findings including mural nodules, microcalcifications, increased vascularity, and/or a thick irregular wall about the cystic portion.Conclusion.The vast majority (88%) of thyroid cancer is uniformly solid or has minimal (1–5%) cystic change by sonography. Marked cystic change (>50% of the nodule) occurred in only 2.5% of cancers, which had other sonographic findings worrisome for malignancy. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 38:361‐366, 2010

Journal of The American College of Radiology, Feb 1, 2017

Purpose: Many studies have suggested that disparities exist in the use of medical screening tests... more Purpose: Many studies have suggested that disparities exist in the use of medical screening tests. The purpose of this study was to assess racial disparities in screening mammography in the United States via a systematic review and meta-analysis. Methods: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus for comparative studies published between 1946 and 2015 comparing utilization of mammography among various racial groups. Two independent reviewers extracted data and appraised study. Meta-analysis was conducted when appropriate using the random-effects model. Results: A total of 5,818,380 patients were included across 39 relevant studies; 43.1% of patients were white, 33.3% were black, 17.4% were Hispanic, and 6.2% were Asian/Pacific Islander. Black and Hispanic populations had lower odds of utilizing screening mammography when compared with the white population (odds ratio [OR] ¼ 0.81; 95% confidence interval [CI], 0.72-0.91; I 2 ¼ 89.4% and OR ¼ 0.83; 95% CI, 0.74-0.93, respectively). For African Americans, these disparities were present in both the 40 to 65 age group and the >65 age group; for Hispanics, these differences were present only in the 40 to 65 age group. There was no difference in mammography utilization between Asians/Pacific Islanders and whites (OR ¼ 1.82; 95% CI, 0.09-38.41). Conclusions: Racial disparities in utilization of screening mammography are evident in black and Hispanic populations in the United States. Further studies are needed to understand reasons for disparities, trends over time, and the effectiveness of interventions targeting these disparities.

Radiologic Clinics of North America, May 1, 2011

Fine-needle aspiration (FNA) is a critical component of thyroid nodule evaluation. This minimally... more Fine-needle aspiration (FNA) is a critical component of thyroid nodule evaluation. This minimally invasive test was initially performed with palpation guidance; however, today the vast majority of these procedures are performed with ultrasound guidance. This chapter will review ultrasound-guided thyroid nodule FNA including the recommended preprocedural planning and procedure setup. Different techniques for obtaining samples will also be described. Although uncommon, the potential complications will be discussed.

Journal of Vascular and Interventional Radiology, Feb 1, 2010

Results: A total of 375 patients completed baseline enrollment; 101 normals, 107 embolization, 61... more Results: A total of 375 patients completed baseline enrollment; 101 normals, 107 embolization, 61 myomectomy and 106 hysterectomy. The mean symptom score at baseline for normals was 15.3 (SD 14.5) and 64.8 (SD 20) for the fibroid patients. At 6 months, the mean normal score was unchanged but the fibroid group reduced to a mean of 21.0 (20.6). At one year, mean normal score remained stable at 15.2 (SD 16.0) and was a mean of 17.8 (SD 17.5) for the fibroid group, not statistically different (P ϭ 0.23). One year after treatment, the mean symptom score for hysterectomy patients was 7.6 (SD 8.4), UAE 24.9 (SD 18.6), and myomectomy 23.4 (SD 18.9), with hysterectomy significantly better than the other two therapies (P Ͻ 0.001), with a mean score at 12 months of 7.6 (8.4). There were no differences between the symptom scores of myomectomy and UAE patients at 12 months. Similar improvements in HRQL were noted. Conclusion: These fibroid therapies result in substantial symptom relief and HRQL to near normal levels, with the greatest improvement with hysterectomy.

Springer eBooks, Aug 23, 2017

Emergency Radiology, Feb 24, 1999

Lisfranc fracture dislocations are uncommon foot injuries and can be difficult to diagnose clinic... more Lisfranc fracture dislocations are uncommon foot injuries and can be difficult to diagnose clinically and radiographically. Associated dislocation of the medial cuneiform is rare and also is difficult to diagnose. We present a case of combined Lisfranc and medial cuneiform fracture dislocation; the dislocation of the medial cuneiform was overlooked on initial radiographs. Subsequent CT examination showed the degree of midfoot disruption better than plain radiographs.

Journal of The American College of Radiology, Nov 1, 2017

Women with twin or higher-order pregnancies will typically have more ultrasound examinations than... more Women with twin or higher-order pregnancies will typically have more ultrasound examinations than women with a singleton pregnancy. Most women will have at minimum a first trimester scan, a nuchal translucency evaluation scan, fetal anatomy scan at 18 to 22 weeks, and one or more scans in the third trimester to evaluate growth. Multiple gestations are at higher risk for preterm delivery, congenital anomalies, fetal growth restriction, placenta previa, vasa previa, and velamentous cord insertion. Chorionicity and amnionicity should be determined as early as possible when a twin pregnancy is identified to permit triage of the monochorionic group into a closer surveillance model. Screening for congenital heart disease is warranted in monochorionic twins because they have an increased rate of congenital cardiac anomalies. In addition, monochorionic twins have a higher risk of developing cardiac abnormalities in later gestation related to right ventricular outflow obstruction, in particular the subgroups with twin-twin transfusion syndrome or selective intrauterine growth restriction. Monochorionic twins have unique complications including twin-to-twin transfusion syndrome, twin embolization syndrome, and acardius, or twin-reversed arterial perfusion sequence.

Current Problems in Diagnostic Radiology, Nov 1, 2022