Publications by authors named "Christie M Lincoln"

16 Publications

  • Page 1 of 1

To Sustain or not to sustain: Varying educational sessions on advanced imaging of low back pain and R-SCAN.

Curr Probl Diagn Radiol 2020 Nov 16. Epub 2020 Nov 16.

Department of Radiology, Baylor College of Medicine, Houston, TX.

Purpose: The aim is to present our long-term institutional experience on the use of the American College of Radiology's (ACR's) Radiology Support, Communication, and Alignment Network (R-SCAN) via educational presentations and guideline dissemination in sustaining lumbar spine magnetic resonance imaging (MRI) appropriateness for low back pain.

Methods: Initial educational presentations on appropriate use criteria for lumbar spine MRI were given to referring providers at three county clinics in April and May of 2016. A second educational refresher was given to the same 3 clinics in November 2017: Clinic A received guideline dissemination, Clinic B served as a control group, and Clinic C received a refresher presentation. Wilcoxon rank-sum test was used to compare the monthly MRI referral rate and ACR Appropriateness Criteria rating.

Results: There was no significant difference in monthly referral rates and ACR Appropriateness Criteria after the second education. Monthly referral rates were significantly lower than the baseline rates before the first education for Clinic A (P <0.001), C (P = 0.004), and the combined total (P = 0.002). ACR Appropriateness Criteria ratings were significantly higher than the baseline ratings before the first education for Clinic C (P = 0.002) and the combined total (P = 0.024).

Discussion: After the second education, inappropriateness, and referral rates remained significantly lower when compared to rates before but not after the first education. Radiology Support, Communication, and Alignment Network is an invaluable online tool for both radiology practices and referring clinicians to become familiar in preparing to comply with the Protecting Access to Medicare Act and satisfying the Improvement Activities category of the Merit Based Incentive Payment Systems.
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http://dx.doi.org/10.1067/j.cpradiol.2020.10.017DOI Listing
November 2020

Corrigendum to "Papillary thyroid carcinoma metastasis to a branchial cleft cyst: A case report and review of imaging" [Clin. Imaging 64 (2020) 1-6].

Clin Imaging 2021 Feb 18;70:142. Epub 2020 Sep 18.

Department of Radiology, Baylor College of Medicine, Houston, TX, USA; School of Medicine, Baylor College of Medicine, Houston, TX, USA.

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http://dx.doi.org/10.1016/j.clinimag.2020.09.001DOI Listing
February 2021

Volumetric Analysis of the Vocal Folds Using Computed Tomography: Effects of Age, Height, and Gender.

Laryngoscope 2021 01 17;131(1):E240-E247. Epub 2020 Jun 17.

Department of Radiology, Baylor College of Medicine, Houston, Texas, U.S.A.

Objective: The goal of this study was to use computed tomography (CT) volumetric analysis to assess the effect of age, gender, height, body mass index (BMI), and ethnicity on vocal fold volume in patients with normal larynges.

Study Design: Retrospective cross-sectional study.

Methods: Vocal fold length, width, and height were measured in a total of 105 patients without a history of laryngeal or thyroid pathology on thin-section soft-tissue neck CTs. The product of the three dimensions was used to calculate vocal fold volume. Simple and multiple linear regression analyses were used to assess for an association between vocal fold volume and age, gender, height, BMI, and ethnicity. Intraclass correlation coefficients (ICCs) were estimated to evaluate the degree interobserver and intraobserver agreement.

Results: Vocal fold volume was not associated with age, BMI, or ethnicity. Gender-adjusted height (P = .002) and height-adjusted gender (P = .016) were significantly associated with volume. Height remained significantly associated with volume after stratifying by gender (P < 0.001). There was moderate-to-good correlation in both interobserver (ICC = 0.690 to 0.761) and intraobserver (ICC = 0.733 to 0.873) agreement.

Conclusion: Age was not associated with vocal fold volume, which is in accordance with several prior negative studies. Age-related vocal fold atrophy may not substantially contribute to presbyphonia symptoms, but other processes such as changes in the extracellular matrix may play a larger role. However, both gender and height were independently associated with vocal fold volume.

Level Of Evidence: 4 Laryngoscope, 131:E240-E247, 2021.
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http://dx.doi.org/10.1002/lary.28750DOI Listing
January 2021

Assessment of the Radiology Support, Communication and Alignment Network to Reduce Medical Imaging Overutilization: A Multipractice Cohort Study.

J Am Coll Radiol 2020 May;17(5):597-605

Department of Radiology, Neuroradiology Division, Stanford University, Stanford, California. Electronic address:

Purpose: The aim of this study was to determine whether participation in Radiology Support, Communication and Alignment Network (R-SCAN) results in a reduction of inappropriate imaging in a wide range of real-world clinical environments.

Methods: This quality improvement study used imaging data from 27 US academic and private practices that completed R-SCAN projects between January 25, 2015, and August 8, 2018. Each project consisted of baseline, educational (intervention), and posteducational phases. Baseline and posteducational imaging cases were rated as high, medium, or low value on the basis of validated ACR Appropriateness Criteria®. Four cohorts were generated: a comprehensive cohort that included all eligible practices and three topic-specific cohorts that included practices that completed projects of specific Choosing Wisely topics (pulmonary embolism, adnexal cyst, and low back pain). Changes in the proportion of high-value cases after R-SCAN intervention were assessed for each cohort using generalized estimating equation logistic regression, and changes in the number of low-value cases were analyzed using Poisson regression.

Results: Use of R-SCAN in the comprehensive cohort resulted in a greater proportion of high-value imaging cases (from 57% to 79%; odds ratio, 2.69; 95% confidence interval, 1.50-4.86; P = .001) and 345 fewer low-value cases after intervention (incidence rate ratio, 0.45; 95% confidence interval, 0.29-0.70; P < .001). Similar changes in proportion of high-value cases and number of low-value cases were found for the pulmonary embolism, adnexal cyst, and low back pain cohorts.

Conclusions: R-SCAN participation was associated with a reduced likelihood of inappropriate imaging and is thus a promising tool to enhance the quality of patient care and promote wise use of health care resources.
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http://dx.doi.org/10.1016/j.jacr.2020.02.011DOI Listing
May 2020

Invited Commentary on "Preoperative Imaging for Facial Transplant".

Radiographics 2019 Jul-Aug;39(4):1107-1109. Epub 2019 May 24.

Department of Radiology, Baylor College of Medicine Houston, Texas.

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http://dx.doi.org/10.1148/rg.2019190093DOI Listing
August 2019

High-grade Features of Papillary Cystadenocarcinoma of the Parotid Gland.

Oman Med J 2019 Mar;34(2):164-168

Department of Radiology, Baylor College of Medicine, Houston, Texas.

Papillary cystadenocarcinomas (PCAs) are rare low-grade salivary gland tumors first introduced in the World Health Organization classification in 1991. While classically regarded as a low-grade malignancy, PCAs with more clinically and histologically high-grade features have been reported, reflecting the often-underrecognized morphological diversity of this entity. Although no universally advocated grading system exists, high-grade PCAs tend to demonstrate locally aggressive features, cytologic atypia, high mitotic rate, necrosis, and an absence of papillary features. We present a case of a 51-year-old male with slow-onset, progressive right facial fullness over four years. Contrast-enhanced computed tomography of the neck demonstrated a 3.3 cm peripherally enhancing cystic and solid mass in the right superficial lobe of the parotid gland. Following a superficial parotidectomy and a selective right neck dissection, histopathology demonstrated a large cyst with papillary projections lined with cuboidal cells of mild to moderate atypia and surrounding solid tumor nests. The tumor displayed stromal, lymphovascular, and subcutaneous fibroadipose tissue invasion. One of 12 lymph nodes was positive for metastatic carcinoma without extranodal extension. A diagnosis of intermediate-grade PCA was rendered. This case report summarizes the features typical of high-grade PCAs, the few reported cases of intermediate- and high-grade PCAs within the existing literature and provides a brief overview of the radiological and pathological differential diagnosis when considering a parotid gland PCA.
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http://dx.doi.org/10.5001/omj.2019.30DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6425058PMC
March 2019

Cryptococcal meningitis in a multiple sclerosis patient treated with Fingolimod: a case report and review of imaging findings.

Clin Imaging 2019 Mar - Apr;54:53-56. Epub 2018 Nov 14.

Department of Radiology, Baylor College of Medicine, One Baylor Plaza, BCM 360, Houston, TX 77030, United States.

Fingolimod is an oral medication approved by the Food and Drug Administration in 2009 for the treatment of relapsing remitting multiple sclerosis (RRMS). Initial clinical trials did not show a significantly increased rate of serious infections with fingolimod therapy. However, a mildly increased risk of less serious infections, such as varicella zoster virus and herpes simplex virus, was reported. Recently, however, several instances of serious opportunistic infections have been reported. In the years following approval of fingolimod for use in multiple sclerosis (MS), seven cases of cryptococcal meningitis in patients undergoing treatment have been described in the literature. We present a 40-year old woman with RRMS on fingolimod therapy presenting with a rare case of cryptococcal meningitis exhibiting alterations of consciousness, which was initially diagnosed as an MS relapse.
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http://dx.doi.org/10.1016/j.clinimag.2018.11.005DOI Listing
May 2019

Solitary fibrous tumor of thyroid: a case report with review of literature.

Clin Imaging 2019 Jan - Feb;53:105-107. Epub 2018 Sep 18.

Department of Radiology, Baylor College of Medicine, Houston, TX, USA. Electronic address:

Solitary fibrous tumors are rare spindle cell tumors of mesenchymal origin most commonly found in the pleura and peritoneum. In contrast, extra-serosal locations are rare. We present a 41-year-old female with a progressively enlarging left-sided neck mass of one-year duration with subsequent rapid-onset growth over two months, and was pathologically confirmed to be a benign solitary fibrous tumor of the thyroid gland.
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http://dx.doi.org/10.1016/j.clinimag.2018.09.011DOI Listing
March 2019

Comparing lesion detection of infratentorial multiple sclerosis lesions between T2-weighted spin-echo, 2D-FLAIR, and 3D-FLAIR sequences.

Clin Imaging 2018 Sep - Oct;51:229-234. Epub 2018 May 29.

Department of Radiology, Baylor College of Medicine, Houston, TX, United States.

Purpose: Infratentorial lesions in patients with multiple sclerosis are associated with long-term disability. Two-dimensional fluid-attenuated inversion recovery demonstrates poor infratentorial lesion detection when compared to T2-weighted spin echo. Evidence of improved detection with 3D fluid-attenuated inversion recovery has been conflicting. This study compares the infratentorial lesion detection performance, observer performance, and signal and contrast properties between T2-weighted spin echo, 2D, and 3D fluid-attenuated inversion recovery.

Methods: Two board-certified radiologists independently reviewed and counted infratentorial lesions from 85 brain MRIs in patients with clinically definite multiple sclerosis and concurrent 3D, 2D fluid-attenuated inversion recovery, and T2-weighted spin echo sequences. Contrast-to-noise and signal-to-noise ratios were measured for 25 MRIs. Wilcoxon signed-rank test was used for pairwise comparisons of the combined average infratentorial lesion count, contrast-to-noise, and signal-to-noise ratios, and was adjusted for three pairwise comparisons using Bonferroni correction. A corrected p value < 0.05 was considered statistically significant.

Results: The number of lesions on 3D fluid-attenuated inversion recovery was significantly higher than those on 2D (p < 0.001) and T2-weighted spin echo (p < 0.001). Results of contrast-to-noise and signal-to-noise ratios were overall mixed and predominantly not concordant with lesion count findings, with T2-weighted spin echo demonstrating the highest signal-to-noise ratios and contrast-to-noise ratio of lesion compared with white matter but the lowest contrast-to-noise ratio of lesion compared with gray matter.

Conclusion: The 3D fluid-attenuated inversion recovery sequence addresses the disadvantage of poor infratentorial lesion detection on 2D, while still maintaining the advantage over T2-weighted spin echo in the detection of lesions adjacent to the cerebrospinal fluid.
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http://dx.doi.org/10.1016/j.clinimag.2018.05.017DOI Listing
December 2018

Neuroimaging findings of extensive sphenoethmoidal dysplasia in NF1.

Clin Imaging 2018 Sep - Oct;51:160-163. Epub 2018 May 16.

Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Medicine, Baylor College of Medicine, Houston, One Baylor Plaza, Houston, TX 77030, USA; Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA. Electronic address:

Whereas isolated sphenoid wing dysplasia (SWD) is a well-known clinical feature in neurofibromatosis 1 (NF1), extensive cranial defects involving multiple bones have been rarely reported in this disorder. In this report, we describe the clinical course of a 20-year-old male with NF1 and an extensive cranial bone dysplasia. The large sphenoethmoidal defect was associated with transethmoidal and orbital cephalocele as well as inferolateral herniation of the frontal lobe. In spite of the large defect, the individual did not have any symptoms or complications resulting from the osteopathy. We review the current knowledge of the pathogenesis and management of cranial bone dysplasia in NF1.
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http://dx.doi.org/10.1016/j.clinimag.2018.04.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6138553PMC
December 2018

Spectrum of MRI brain lesion patterns in neuromyelitis optica spectrum disorder: a pictorial review.

Br J Radiol 2018 Jun 5;91(1086):20170690. Epub 2018 Feb 5.

1 Department of Radiology, Baylor College of Medicine , Houston, TX , USA.

Neuromyelitis optica is a neurotropic autoimmune inflammatory disease of the central nervous system traditionally thought to exclusively involve the optic nerves and spinal cord. With the discovery of the disease-specific aquaporin-4 antibody and the increasing recognition of clinical and characteristic imaging patterns of brain involvement in what is now termed neuromyelitis optica spectrum disorder (NMOSD), MRI now plays a greater role in diagnosis of NMOSD based on the 2015 consensus criteria and in distinguishing it from other inflammatory disorders, particularly multiple sclerosis (MS). Several brain lesion patterns are highly suggestive of NMOSD, whereas others may serve as red flags. Specifically, long corticospinal lesions, hemispheric cerebral white matter lesions and periependymal lesions in the diencephalon, dorsal brainstem and white matter adjacent to lateral ventricles are typical of NMOSD. In contrast, juxtacortical, cortical, or lesions perpendicularly oriented to the surface of the lateral ventricle suggests MS as the diagnosis. Ultimately, a strong recognition of the spectrum of MRI brain findings in NMOSD is essential for accurate diagnosis, and particularly in differentiating from MS. This pictorial review highlights the spectrum of characteristic brain lesion patterns that may be seen in NMOSD and further delineates findings that may help distinguish it from MS.
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http://dx.doi.org/10.1259/bjr.20170690DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6223278PMC
June 2018

Haemorrhagic conversion of infectious myelitis in an immunocompromised patient.

BMJ Case Rep 2017 Dec 2;2017. Epub 2017 Dec 2.

Department of Radiology, Baylor College of Medicine, Houston, Texas, USA.

A 28-year-old man recently diagnosed with HIV (CD4 19 cells/mm, viral load 3.6 million copies/mL, not on highly active antiretroviral therapy on initial diagnosis at outside hospital), disseminated histoplasmosis, shingles and syphilis presented with paraplegia developing over 3 days. Spine MRI demonstrated a longitudinally extensive cord lesion extending from C3 to the tip of the conus. Brain MRI was consistent with meningoencephalitis. Cerebrospinal fluid findings were notable for positive varicella zoster virus (VZV) and cytomegalovirus (CMV) PCRs as well as a Venereal Disease Research Laboratory titre of 1:2. Patient was started on treatment for VZV and CMV meningoencephalitis, neurosyphilis and high-dose steroids for infectious myelitis. Repeat spine MRI demonstrated subacute intramedullary haemorrhage of the cervical cord. He was ultimately discharged to a skilled nursing facility for long-term intravenous antiviral therapy and rehabilitation. After 59 days in the hospital, his neurological exam remained grossly unchanged, with flaccid paraplegia and lack of sensation to fine touch in his lower extremities.
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http://dx.doi.org/10.1136/bcr-2017-221866DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5720289PMC
December 2017

Imaging spectrum of immunomodulating, chemotherapeutic and radiation therapy-related intracranial effects.

Br J Radiol 2018 Feb 3;91(1082):20170553. Epub 2017 Nov 3.

4 Albert Einstein College of Medicine, Montefiore Medical Center , Bronx, NY , USA.

Objective: A wide range of treatment-related side effects result in specific neurologic symptoms and signs and neuroimaging features. Even to the most seasoned neuroradiologist, elucidating therapy-related side effects from other common mimics can be challenging. We provide a pictorial survey of some common and uncommon medication-induced and therapy-related neuroimaging manifestations, discuss pathophysiology and common pitfalls in imaging and diagnosis.

Methods: A case-based review is utilized to depict scenarios on a routine basis in a general radiology or neuroradiology practice such as medication-induced posterior reversible encephalopathy syndrome to the more challenging cases of pseudoprogression and pseudoregression in temozolmide and bevacizumab therapy in gliobastoma treatment protocols.

Conclusion: Knowledge of the treatment-induced imaging abnormalities is essential in the accurate interpretation and diagnosis from the most routine to most challenging of clinical situations. We provide a pictorial review for the radiologist to employ in order to be an invaluable provider to our clinical colleagues and patients.
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http://dx.doi.org/10.1259/bjr.20170553DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5965791PMC
February 2018

Thorn in My Spine: A case of a retained intradural extramedullary foreign body.

Clin Imaging 2017 Sep - Oct;45:118-121. Epub 2017 May 18.

Baylor College of Medicine, Department of Radiology, One Baylor Plaza, BCM 360, Houston, TX 77030, United States.

Foreign bodies in the spine are most commonly traumatic and managed in an acute setting. A few case reports describe foreign bodies resulting in delayed neurologic dysfunction, most commonly iatrogenic or from penetrating injury. We present a 30-year old man with lower extremity weakness from an intradural extramedullary foreign body granuloma secondary to a thorn, which was initially thought to represent an aggressive malignant process with intra and extramedullary involvement on MR. Postoperatively, the patient endorsed a causative trauma several years prior. We also present a review of the few similar published cases as well as the described prototypical imaging features and pathologic process.
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http://dx.doi.org/10.1016/j.clinimag.2017.05.011DOI Listing
May 2018

MRI in the Evaluation of Acute Visual Syndromes.

Top Magn Reson Imaging 2015 Dec;24(6):309-24

Michael E. DeBakey VA Medical Center Houston and Baylor College of Medicine, Houston, TX.

Acute visual symptom emergencies occur commonly and present a challenge to both clinical and radiologic facets. Although most patients with visual complaints routinely require clinical evaluation with direct ophthalmologic evaluation, imaging is rarely necessary. However, there are highly morbid conditions where the prompt recognition and management of an acute visual syndrome (AVS) requires an astute physician to probe further. Suspicious symptomatology including abrupt visual loss, diplopia, ophthalmoplegia, and proptosis/exophthalmos require further investigation with advanced imaging modalities such as magnetic resonance imaging and magnetic resonance angiography. This review will discuss a variety of AVSs including orbital apex syndrome, cavernous sinus thrombosis, cavernous carotid fistula, acute hypertensive encephalopathy (posterior reversible encephalopathy syndrome), optic neuritis, pituitary apoplexy including hemorrhage into an existing adenoma, and idiopathic intracranial hypertension. A discussion of each entity will focus on the clinical presentation, management and prognosis when necessary and finally, neuroimaging with emphasis on magnetic resonance imaging. The primary purpose of this review is to provide an organized approach to the differential diagnosis and typical imaging patterns for AVSs. We have provided a template for radiologists and specialists to assist in early intervention in order to decrease morbidity and provide value-based patient care through imaging.
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http://dx.doi.org/10.1097/RMR.0000000000000070DOI Listing
December 2015

Cervical carotid artery dissection: current review of diagnosis and treatment.

Cardiol Rev 2012 May-Jun;20(3):145-52

Department of Radiology, Bronx-Lebanon Hospital Center, 1650 Grand Concourse, Bronx, NY 10457, USA.

Carotid artery dissection is a cause of stroke, especially in young and middle-aged patients. A dissection occurs when there is an intimal tear or rupture of the vasa vasorum, leading to an intramural hematoma, which is thought to result from trauma or can occur spontaneously, and is likely multifactorial, involving environmental and intrinsic factors. The clinical diagnosis of carotid artery dissection can be challenging, with common presentations including pain, partial Horner syndrome, cranial nerve palsies, or cerebral ischemia. With the use of noninvasive imaging, including magnetic resonance and computed tomography angiography, the diagnosis of carotid dissection has increased in frequency. Treatment options include thrombolysis, antiplatelet or anticoagulation therapy, endovascular or surgical interventions. The choice of appropriate therapy remains controversial as most carotid dissections heal on their own and there are no randomized trials to compare treatment options.
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http://dx.doi.org/10.1097/CRD.0b013e318247cd15DOI Listing
May 2012