Publications by authors named "Tarun Pandey"

59 Publications

Coronary-Cameral Fistula, Thebesian Veins, and Anomalous Coronary Vein on Cardiac Computed Tomography.

Cureus 2021 Jun 11;13(6):e15589. Epub 2021 Jun 11.

Cardiology, University of Arkansas for Medical Sciences, Little Rock, USA.

A 63-year-old female with a history of hypertension presented with progressively worsening shortness of breath. She underwent a cardiac catheterization and was found to have prominent Thebesian veins as well as anomalous connections between the proximal right coronary artery and the right ventricle. Cardiac computed tomography was ordered for further evaluation and showed a coronary fistula to the right ventricular outflow tract confirming the diagnosis of a coronary-cameral fistula (CCF). CCF are rare congenital anomalous communications that occur between coronary arteries and a cardiac chamber. They are usually an incidental finding and patients are rarely symptomatic. As the use of coronary computed tomography angiography is rapidly expanding, the detection of CCF will likely increase in the general population.
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http://dx.doi.org/10.7759/cureus.15589DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270069PMC
June 2021

Tumor Occupancy Ratio-An Imaging Characteristic Prognosticating the Surgical Outcome of Benign Intradural Extramedullary Spinal Cord Tumors.

Int J Spine Surg 2021 Jun 7;15(3):570-576. Epub 2021 May 7.

Department of Neurosurgery, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, India.

Background: Intradural extramedullary (IDEM) spinal cord tumors are two thirds of all spinal tumors. We have prospectively analyzed the importance of the tumor occupancy ratio as a factor for predicting the course of the disease and in prognosticating the surgical outcome in patients with IDEM tumors.

Methods: We prospectively analyzed 44 consecutive cases of IDEM tumors, diagnosed as cervical, thoracic, and lumbar IDEM tumors (excluding conus/cauda equina lesion) by magnetic resonance imaging (MRI), that were operated on at our institution between 2014 and 2016. We measured the tumor occupancy ratio and noted the sagittal and axial location of the tumor in the preoperative MRI and performed the laminectomy and unilateral medial facetectomy. A primary outcome has been noted according to the gait disability score in the preoperative period and in the follow-up period of 1 year. In the statistical analysis, categorical variables were compared using a chi-square test, and an analysis of variance and student tests were used for the continuous variables. < .05 was considered statistically significant.

Results: The tumor occupancy ratio showed a significant association to the preoperative gait disability score ( < .001) and also predicted that the surgical outcome is much better in patients with tumors with a low tumor occupancy ratio than in patients with tumors with a high occupancy ratio ( < .001). No difference in the tumor occupancy ratio was noted in 2 different pathological tumors, and there was also no difference in the tumor occupancy ratio at different sagittal and axial locations of the tumor.

Conclusion: Tumor occupancy ratio has shown a significant impact on the preoperative course and also predicts the surgical outcome in patients with IDEM tumors. Hence, it is an important imaging characteristic to prognosticate the outcome in IDEM tumors and should be noted in each case.
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http://dx.doi.org/10.14444/8077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8176837PMC
June 2021

Congenital Mobile Atlantoaxial Dislocation with Cervicomedullary Astrocytoma in Pediatric Patient.

Neurol India 2021 Jan-Feb;69(1):194-197

Department of Neurosurgery, Vivekananda Polyclinic and Institute of Medical Sciences and Hospital, Lucknow, Uttar Pradesh, India.

Congenital mobile atlantoaxial dislocation with cervicomedullary astrocytoma has never been described. We present a case of a 7-year-old male child who presented to us with gradually progressive spastic quadriparesis following a fall from table. His lateral radiograph and magnetic resonance images showed mobile atlantoaxial dislocation with intramedullary heterogeneously enhancing cervicomedullary mass. The patient underwent suboccipital craniectomy with C1-4 laminectomy. Tumor was pinkish grey, tenacious with ill-defined plane and cyst at poles. C1-C2 fusion was done using C1 lateral mass and C2 pars screw and rod system with onlay bone graft. Histopathology revealed pilocytic astrocytoma. At the time of discharge, the patient showed improvement in spasticity. Postoperative lateral radiograph showed reduced atlantoaxial dislocation with stable construct.
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http://dx.doi.org/10.4103/0028-3886.310076DOI Listing
June 2021

Comprehensive Review of Abdominopelvic Mesenchymal Tumors With Radiologic Pathologic Correlation and Update on Current Treatment Guidelines-Part 2.

Semin Ultrasound CT MR 2020 Apr 14;41(2):239-259. Epub 2020 Mar 14.

Department of Radiology and Orthopedics, University of Arkansas for Medical Sciences, Little Rock, AR; University of Arkansas for Medical Sciences, Little Rock, AR.

Soft-tissue sarcomas are a diverse group of rare mesenchymal malignancies accounting for only 1% of all solid adult malignancies. These have been categorized in 12 broad groups by the World Health Organization (WHO) with their recent update in 2013. Majority of them lack specific imaging features serving as imaging conundrums for a radiologist. These are often large masses at presentation as they are asymptomatic or cause vague clinical symptoms. These tumors are challenging for surgeons as well as they find it difficult to achieve complete resection because of complex intra-abdominal anatomy and their close relationship with critical structures. Often, a multidisciplinary approach is required to decide on the most appropriate management for these complex cases so as to provide optimal patient care. Knowledge of the WHO classification, pathologic features, and treatment options available helps the radiologist make a meaningful contribution in multidisciplinary discussions of such cases and overall patient care. Liposarcoma (well-differentiated and dedifferentiated liposarcomas), leiomyosarcoma, and gastrointestinal stromal tumor are the 3 most common primary intra-abdominal sarcomas. In part 1 of this article, general features of soft-tissue sarcomas and some of the common tumors from WHO category 1-4 found in abdomen and pelvis are discussed. Part 2 will focus on common tumors from remainder of the WHO categories.
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http://dx.doi.org/10.1053/j.sult.2020.03.003DOI Listing
April 2020

Comprehensive Review of Abdominopelvic Mesenchymal Tumors with Radiologic Pathologic Correlation and Update on Current Treatment Guidelines - Part 1.

Semin Ultrasound CT MR 2020 Apr 15;41(2):222-238. Epub 2020 Feb 15.

Department of Radiology and Orthopedics, University of Arkansas for Medical Sciences, Little Rock, AR.

Soft-tissue sarcomas are a diverse group of rare mesenchymal malignancies accounting for only 1% of all solid adult malignancies. These have been categorized in 12 broad groups by the World Health Organization (WHO) with their recent update in 2013. Majority of them lack specific imaging features serving as imaging conundrums for a radiologist. These are often large masses at presentation as they are asymptomatic or cause vague clinical symptoms. These tumors are challenging for surgeons as well as they find it difficult to achieve complete resection because of complex intra-abdominal anatomy and their close relationship with critical structures. Often, a multidisciplinary approach is required to decide on the most appropriate management for these complex cases so as to provide optimal patient care. Knowledge of the WHO classification, pathologic features and available treatment options will help the radiologist make a meaningful contribution in multidisciplinary discussions of such cases and overall patient care. Liposarcoma (well-differentiated and dedifferentiated liposarcomas), leiomyosarcoma, and gastrointestinal stromal tumor are the 3 most common primary intra-abdominal sarcomas. In part 1 of this article, general features of soft tissue sarcomas and some of the common tumors from WHO category 1-4 found in abdomen and pelvis are discussed. Part 2 will focus on common tumors from remainder of the WHO categories.
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http://dx.doi.org/10.1053/j.sult.2020.01.002DOI Listing
April 2020

Imaging and Management of Rectal Cancer.

Semin Ultrasound CT MR 2020 Apr 24;41(2):183-206. Epub 2020 Jan 24.

Department of Radiology and Orthopedics, University of Arkansas for Medical Sciences, Little Rock, AR.

High-resolution phased array external magnetic resonance imaging (MRI) is the first investigation of choice in rectal cancer for local staging, both in the primary and restaging situations. Use of MRI helps differentiate between those with good prognosis, which can be offered upfront surgery and the poor prognostic cases where treatment intensification is needed. MRI identified poor prognostic factors are threatened or involved mesorectal fascia, T3 tumors with >5 mm extramural spread, those with extramural vascular invasion, pelvic sidewall nodes and mucinous tumors. At restaging, use of MRI helps evaluate response and an MR tumor regression grading system is being evaluated. Complete response seen on clinical examination and endoscopy, needs confirmation on MRI using both T2-weighted and diffusion-weighted sequences to justify a "watch and wait" approach. In this subset of patients, MRI also plays a role in monitoring and detecting early regrowth. In those with partial response, MRI helps define surgical margins and can be used as a roadmap to decide between sphincter preserving surgeries and radical sphincter sacrificing surgeries; pelvic exenteration and pelvic sidewall lymph node dissection. Poor responders on MRI may benefit from adjuvant chemotherapy. Use of MRI thus helps in individualizing treatment in rectal cancer.
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http://dx.doi.org/10.1053/j.sult.2020.01.001DOI Listing
April 2020

Letter from the Guest Editors.

Semin Ultrasound CT MR 2020 04 9;41(2):121. Epub 2020 Mar 9.

Department of Radiology, University of Arkansas for Medical Sciences, 4301, W. Markham Street, Little Rock, 72205 AR.

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http://dx.doi.org/10.1053/j.sult.2020.03.002DOI Listing
April 2020

Pelvic floor imaging with MR defecography: correlation with gynecologic pelvic organ prolapse quantification.

Abdom Radiol (NY) 2021 04;46(4):1381-1389

Department of Diagnostic Radiology, University of Arkansas for Medical Sciences, 4301 W Markham Street, Slot #556, Little Rock, AR, 72205-7199, USA.

Purpose: Pelvic organ prolapse (POP) is assessed differently by gynecologists and radiologists. It is clinically staged by physical examination using the POP-Q (Pelvic Organ Prolapse Quantification) system and radiologically staged by modalities such as by Magnetic Resonance Defecography (MRD). The purpose of this study was to correlate the two methods of staging pelvic organ prolapse for each pelvic compartment by comparing correlative anatomic points and differences in technique. This understanding will help synthesize information from two different perspectives and bridge the gap between multiple specialists who participate in the care of patients with complex pelvic floor disorders.

Methods: A retrospective single institution study comparison of patients who underwent both dynamic magnetic resonance pelvic floor imaging and pelvic organ prolapse quantification (POP-Q) at our medical center was done. Two urogynecologists performed the POP-Q and one fellowship-trained radiologist interpreted the MRD and both staged pelvic organ prolapse independently.

Results: A total of 280 patients underwent magnetic resonance imaging (MRI) of the pelvic floor from 1/2013 to 12/2017, of whom 68 met our inclusion criteria. When compared to POP-Q, MRI has strong, moderate, and weak correlation for quantification of anterior, middle, and posterior compartment prolapse, respectively. POP-Q measurements Aa, Ba, C, and D are analogous to true pelvic anatomical landmarks which are directly and consistently measurable by MRI, hence accounting for the better correlation in anterior and middle compartments when compared to measurements Ap and Bp which do not correlate with true anatomical landmarks, and hence can explain the weak correlation for posterior compartment prolapse.

Conclusion: When comparing POP-Q to MRI, anterior and middle compartment prolapse have better correlation than posterior compartment prolapse. Inherent differences that exist in technique and anatomic landmarks used for staging pelvic organ prolapse by clinical exam and imaging criteria account for this. MRD, however, still provides anatomic details on static images, real time simultaneous overview of multi-compartmental prolapse, characterizes contents of cul-de-sac hernias and rectal evacuation on dynamic imaging. Corroborative information derived from both methods of staging organ will result in optimum patient care.
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http://dx.doi.org/10.1007/s00261-020-02476-9DOI Listing
April 2021

MR neurography in Parsonage-Turner syndrome.

Indian J Radiol Imaging 2019 Jul-Sep;29(3):264-270. Epub 2019 Oct 30.

Department of Neurology, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandapuri, Nirala Nagar, Uttar Pradesh, India.

Background And Aims: Parsonage Turner Syndrome is a well known clinical entity. Several excellent articles have succinctly described Magnetic Resonance Imaging (MRI) findings in PTS. However, these articles have inferred neural involvement in PTS based on the patterns of denervation of muscles in the shoulder region. The aim of this study is to directly visualize the distribution and extent of abnormality in MR Neurography (MRN) of the brachial plexus in known cases of brachial plexus neuritis or Parsonage-Turner Syndrome (PTS).

Methods: 15 patients who were diagnosed with PTS based on clinical and electrophysiological findings participated in the study. MRN of the brachial plexus was done in a 1.5T system using a combination of T1W (T1-weighted), T2W (T2-weighted) fat-saturated, STIR (Short Tau Inversion Recovery), 3D STIR SPACE (Sampling Perfection with Application Optimized Contrasts) and 3D T2W SPACE sequences. Findings were recorded and assessed.

Results: The age range of our patients was 7-65 years (mean 37.87 years). Most of the patients had unilateral symptoms. All patients had weakness in shoulder abduction. Other common associated complaints included pain in the shoulder/neck/arm and preceding fever. MRN revealed the percentage of involvement of roots, trunks, cords and terminal branches was 53.3%, 46.7%, 40% and 13.3% respectively. Evidence of muscle denervation in the form of edema, fatty infiltration and atrophy was noted in 8 (53.3%) patients.

Conclusion: Most of the patients in this study had unilateral involvement on MRN. The roots were the commonest site of involvement followed by the trunks, cords and terminal branches. C5 was the most commonly involved root.
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http://dx.doi.org/10.4103/ijri.IJRI_269_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6857269PMC
October 2019

A Cadaveric Study of Cutaneous Vascular Anatomy about the Elbow Using Computed Tomography Angiography.

Clin Anat 2019 May 19;32(4):509-514. Epub 2019 Feb 19.

University of Arkansas for Medical Sciences, Little Rock, Arkansas.

The posterior approach is a commonly employed exposure of the elbow that provides excellent visualization and efficacy for various orthopedic procedures, including total elbow arthroplasty (TEA) and fracture care. The posterior approach to the elbow has been associated with an increased rate of wound complications, including infection, skin necrosis, and wound dehiscence. Despite an association between these complications and decreased elbow perfusion, data regarding the intrinsic anatomic etiology for preferential complications in this area has been scarcely reported in the literature. This study characterizes the subdermal and cutaneous vascular perfusion about the elbow by describing the predominant direction of circulation, subdermal anastomoses, and volume of perfusion through cadaveric modeling using computed tomography angiography (CTA). Fifteen upper extremity cadaver specimens were prepared with injection of radiographic contrast directly into the axillary artery immediately preceding CTA imaging of each specimen. Sectra IDS7 software for Windows was used for analysis of all images to produce superimposed axial and 3-D reconstructions of each CTA series. From these images it was discerned that the predominant direction of flow in the posterior elbow integument is anterior medial to posterior lateral. Both the posterior medial and posterior lateral subdermal vascular networks emanate from proximally derived medial arterial sources with few anastomoses and minimal collateral perfusion from the anterolateral location. Consequently, it is important to preserve medial subdermal vascular structures to prevent ischemic wound complications. This is especially true in previously incised elbow integuments. Clin. Anat. 32:509-514, 2019. © 2019 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ca.23341DOI Listing
May 2019

The Incremental Value of Magnetic Resonance Neurography for the Neurosurgeon: Review of the Literature.

World Neurosurg 2019 Feb 9;122:331-341. Epub 2018 Nov 9.

Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. Electronic address:

Introduction: Magnetic resonance neurography (MRN) is a newer imaging technique that is increasingly used for detailed visualization of peripheral nerves not reliably achieved with conventional imaging modalities. Although MRN has been previously characterized in the literature, few studies have assessed its utility to neurosurgery, where there is potentially substantial impact particularly with preoperative assessment. In this article, we performed a retrospective review of cases in which MRN was used for clinical evaluation and surgical decision making.

Methods: MRN, clinical assessment, and operative decision making were retrospectively assessed in 206 consecutive patients at our institution between 2015 and 2018.

Results: MRN was determined to lead to a change in diagnosis or surgical decision making in 44 patients (21.4%: 27 female, 17 male). These were classified into 6 major diagnostic categories: trauma, postsurgical evaluation, compressive/degenerative conditions, tumors, neuritis/inflammation, and other neurogenic lesions. Nine representative cases were selected from these categories to highlight the range of neurosurgical pathologies in which MRN was useful in diagnostic assessment and surgical decision making.

Conclusions: MRN is an underused resource with great potential value in the diagnoses, surgical planning, and postoperative assessment of various neurosurgical conditions. These present incremental utility to the neurosurgeon as well as socioeconomic benefit in the detection of potentially surgically treatable lesions.
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http://dx.doi.org/10.1016/j.wneu.2018.10.212DOI Listing
February 2019

Medial meniscal extrusion: Detection, evaluation and clinical implications.

Eur J Radiol 2018 May 6;102:115-124. Epub 2018 Mar 6.

Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States. Electronic address:

The menisci play an important role in knee kinematics. Their unique anatomy allows them to channel forces generated during knee movements through the larger tibio-femoral condylar surfaces while simultaneously resisting deleterious hoop stresses. Although physiologic meniscal extrusion occurs with every knee joint movement, pathologic meniscal extrusion subjects the knee to persistent and excessive load transmission. This renders the knee structures susceptible to injury or exacerbates worsening of existing knee joint internal derangement. Detection and quantification of meniscus extrusion is important given its association with underlying pathological processes and internal derangements such as cartilage loss, osteoarthritis and meniscal tears. The medial and lateral menisci vary in size, attachments and load transmission, and the medial meniscus is more susceptible to injury. In this article, the authors illustrate the role of meniscus kinematics, and the identification and quantification of medial meniscal extrusion. Multimodality imaging appearances and implications of presence of medial meniscal extrusion in different knee joint pathologies are discussed with review of the relevant literature.
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http://dx.doi.org/10.1016/j.ejrad.2018.03.007DOI Listing
May 2018

Rational design and evaluation of HBsAg polymeric nanoparticles as antigen delivery carriers.

Int J Biol Macromol 2018 May 16;111:804-812. Epub 2018 Jan 16.

Department of Pharmaceutics, Indian Institute of Technology, Banaras Hindu University, Varanasi 221005, India. Electronic address:

The present work is focused on the development and evaluation of single dose sustained-release Hepatitis B surface antigen (HBsAg) loaded nanovaccine for Hepatitis B. The conventional treatment suffers from repeated administration and hence requires a booster dose. Therefore, polymeric nanovaccine of HBsAg was developed by double emulsion solvent evaporation technique, utilizing central composite design for formulation optimization. The effects of independent variables (like polymer amount, stabilizer concentration, aqueous/organic phase ratio and homogenizer speed) were also studied on critical quality attributes like particle size and entrapment efficiency. Nanovaccine was characterized in terms of physicochemical parameters, release, internalization and in vivo immunological evaluation in BALB/c mice after administration by different routes such as oral, sub-cutaneous, nasal and intramuscular. The designed nanovaccine demonstrated nanometric size with smooth surface, negative zeta potential, maximum entrapment, sustained release and better internalization in macrophage and MRC-5 cell line. The immune-stimulating activity of nanovaccine administered by different routes was evaluated by measuring anti-HBsAg titre like specific immunoglobulin IgG and IgA response and cytokine level (interleukin-2, interferon-Y) measurement. The results indicated that the nanovaccine administered by intramuscular route produced better humoral as well as cellular responses and potential carriers for antigen delivery at single dose administration via intramuscular route.
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http://dx.doi.org/10.1016/j.ijbiomac.2018.01.073DOI Listing
May 2018

Nanovaccine for immunotherapy and reduced hepatitis-B virus in humanized model.

Artif Cells Nanomed Biotechnol 2018 Dec 27;46(8):2033-2042. Epub 2017 Nov 27.

a Department of Pharmaceutics , Indian Institute of Technology (Banaras Hindu University) , Varanasi , India.

Chronic Hepatitis B Virus (HBV) infections are severe with weak antiviral immune responses. The lack of an appropriate small animal model for chronic hepatitis, a major hurdle for studying the immunotolerance and immunopathogenesis induced by hepatitis B viral (HBV) infection. In this study, for enhancing the antibody production efficiency the prepared polymeric HBsAg-loaded nanoparticles (nanovaccine) will be tested in immune-deficit mice, which suffer from chronic Hepatitis B virus. Vaccination of Balb/c mice by this prepared nanoparticles that were engrafted with peripheral blood mononuclear cells (PBMCs), which was already lethally irradiated and transplanted by the bone marrow of NOD (knockout mice) mice. In the present study, after the vaccination detected the high frequencies of immunoglobulin G (IgG)-secreting B cells and mitogen-responsive interferon-Y (IFN-Y) secreting T cells in serum, determined by specific ELISA technique. During the entire observation period, unvaccinated animals showed lower concentration of specific IgG secreting B cells and IFN-Y secreting T cells found in comparison to vaccinated mice group. Chronic HBV carrier PBMCs transplanted into the chimera failed to produce antigen and increased the antibodies production due to vaccination. Furthermore, another advantage was that the viral gene expression and viral DNA replication was no longer observed in vaccinated group. This prepared nanovaccine formulations is better for the cure of Hepatitis B viral infection carrier. Therefore, specific memory responses were elicited by vaccination with Hepatitis B virus surface (HBsAg) antigen of chimeric mice transplanted with PBMCs derived from HBV donors.
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http://dx.doi.org/10.1080/21691401.2017.1408118DOI Listing
December 2018

Magnetic Resonance Imaging of Nonneoplastic Musculoskeletal Pathologies in the Pelvis.

Semin Ultrasound CT MR 2017 Jun 28;38(3):291-308. Epub 2016 Nov 28.

Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR.

Musculoskeletal pathologies in the pelvis encompass a wide variety of lesions including femoroacetabular impingement, athletic pubalgia, ischiofemoral impingement, and apophyseal avulsion injuries. Magnetic resonance imaging is the noninvasive imaging modality of choice for the diagnosis and management of these lesions. In this article, the authors discuss the nonneoplastic musculoskeletal lesions in the pelvis, with illustrations and relevant case examples.
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http://dx.doi.org/10.1053/j.sult.2016.11.008DOI Listing
June 2017

Imaging of Pelvic Floor Reconstruction.

Semin Ultrasound CT MR 2017 Jun 25;38(3):200-212. Epub 2016 Nov 25.

Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR.

Stress urinary incontinence and pelvic organ prolapse are 2 common pelvic floor disorders that are important causes of pelvic pain and disability. Mesh and sling placement are some of the surgical treatment options available for treatment of these conditions. In addition to clinical assessment, imaging plays an important role in managing postoperative patients with complications such as recurrent organ prolapse and chronic pain. Role of high-resolution pelvic magnetic resonance imaging with additional advanced imaging techniques, such as magnetic resonance neurography that are invaluable in managing such patients, are discussed in this article.
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http://dx.doi.org/10.1053/j.sult.2016.11.003DOI Listing
June 2017

Letter From the Guest Editor: Pelvic Magnetic Resonance Imaging.

Authors:
Tarun Pandey

Semin Ultrasound CT MR 2017 Jun 31;38(3):187. Epub 2017 Jan 31.

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http://dx.doi.org/10.1053/j.sult.2017.01.002DOI Listing
June 2017

Malignant Triton Tumor (Malignant Peripheral Nerve Sheath Tumor With Rhabdomyoblastic Differentiation) Occurring in a Vascularized Free Flap Reconstruction Graft.

Int J Surg Pathol 2017 Aug 7;25(5):462-467. Epub 2017 Apr 7.

3 Department of Orthopedics Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.

Malignant peripheral nerve sheath tumor (MPNST) is a rare form of sarcoma arising from Schwann cells or pluripotent cells of the neural crest. Malignant triton tumor (MTT) is a subtype of MPNST with a component of malignant rhabdomyoblasts in addition to malignant Schwann cells. MPNST and MTT are both aggressive malignancies that most commonly arise from large deep neurofibromas in patients with neurofibromatosis type 1 (NF-1). However, sporadic non-NF-1 cases of MTT have also been reported in the literature. We present a case of a 50-year-old African American male with no stigmata of NF-1 who developed a large mass in a free flap on the right calf. The free flap had been placed by plastic surgery 15 years previously following open right tibial and fibular fractures associated with a large soft tissue defect. Biopsy of the enlarging mass, followed by wide surgical excision, confirmed the pathology to be MTT. Although the development of a high-grade soft tissue sarcoma has been previously reported as a late complication of radiation therapy following free flap reconstructions, we believe this is the first reported case of sarcomatous transformation arising in a vascularized, free muscle transfer.
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http://dx.doi.org/10.1177/1066896917700725DOI Listing
August 2017

Evaluation of Myocardial Strain in Patients With Amyloidosis Using Cardiac Magnetic Resonance Feature Tracking.

Curr Probl Diagn Radiol 2017 Jul - Aug;46(4):288-294. Epub 2016 Nov 10.

Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR.

Purpose: To study the use of cardiac magnetic resonance (CMR) feature tracking technique in evaluation of myocardial amyloidosis.

Materials And Methods: CMR scans of 28 patients with biopsy proven myocardial amyloidosis and 35 controls were reviewed. Conventional short axis, vertical long axis, and 4-chamber cine steady-state free precession images from CMR scans were used to generate radial, circumferential, and longitudinal myocardial strain maps using feature tracking software. Global and regional peak radial, circumferential, and longitudinal strain values were computed.

Results: There were significant decreases in radial, circumferential, and longitudinal strains in patients with myocardial amyloidosis globally and across layers (all P < 0.001). Strain was relatively preserved for the apex and most affected for the basal level. The area under the receiver operating characteristic curve for base peak radial, circumferential, and longitudinal strain 0.899, 0.884, and 0.866 and cut offs of 22.9, -13.3, and -10.9, respectively, were determined by receiver operating characteristic analysis. CMR feature tracking strain analysis of base-level strain parameters was able to differentiate patients with myocardial amyloidosis from those without myocardial amyloid with high sensitivity (82.5%) and specificity (82.9%) particularly for radial strain. The maximum sensitivity (89.3%) was achieved if any of the 3 parameters were abnormal, and the maximum specificity (88.6%) when all 3 parameters were abnormal.

Conclusion: Myocardial amyloidosis produces significant changes in regional and global strain parameters, and the peak radial and circumferential strain are the most affected at the basal layer.
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http://dx.doi.org/10.1067/j.cpradiol.2016.11.008DOI Listing
August 2017

Magnetic Resonance Enterography (MRE): The role of imaging in the management of adult patients with Crohn's disease.

J Ark Med Soc 2016 Dec;113(6):136-139

Crohn's disease, an inflammatory bowel disease with devastating complications, often requires frequent imaging to detect active disease and its complications. Endoscopy, which is the gold standard for diagnosis, is contraindicated in come patients and has limited role in detecting deep submucosal/mesenteric disease, mid small bowel disease and intra-abdominal complications. Magnetic Resonance Enterography (MRE) has evolved as a complimentary non-invasive, radiation free, high resolution imaging modality in evaluating these patients, with clinical studies haveing shown MRE to help in the diagnosis and follow up of these patients. Its major advantage over CT Enterography is the absence of radiation.
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December 2016

Prognostic Value of Late Gadolinium Enhancement CMR in Systemic Amyloidosis.

JACC Cardiovasc Imaging 2016 11 24;9(11):1267-1277. Epub 2016 Aug 24.

Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

Objectives: The aim of this study was to access the prognostic implication of late gadolinium enhancement (LGE) in patients with systemic amyloidosis undergoing cardiac magnetic resonance (CMR).

Background: Cardiac amyloidosis confers significantly worse prognosis in patients with systemic amyloidosis. CMR imaging has emerged as an attractive noninvasive modality to diagnose cardiac involvement in patients with systemic amyloidosis. We performed a systemic review and meta-analysis to evaluate the prognostic role of LGE-CMR imaging in patients with systemic amyloidosis.

Methods: Electronic databases MEDLINE, PubMed, Embase, and Cochrane were systematically searched to identify studies evaluating the association between LGE-CMR and prognosis in systemic amyloidosis with cardiac involvement. The present study was designed to systematically review and assess the association between LGE and the primary endpoint of all-cause mortality. A random effects model was used to calculate a pooled odds ratio using inverse-variance weighting.

Results: Data were included from 7 studies with a total of 425 patients and a mean follow-up of 25 months. Patients had a weighted average age of 64 years and left ventricular ejection fraction of 59.2%; 67% were male. Endomyocardial biopsy was positive for amyloidosis in 20%, whereas LGE was present in 73% of patients. LGE-positive patients had increased overall mortality compared with those without LGE (pooled odds ratio: 4.96; 95% confidence interval [CI]: 1.90 to 12.93; p = 0.001). For the LGE group, the pooled death rate was 0.07 (95% CI: 0.03 to 0.19) events per year and for the LGE+ group, the rate was 0.25 (95% CI: 0.16 to 0.39 per year; p = 0.001). The proportion of patients with cardiac biopsy within each study ranged from 3% to 68%, and the relationship between LGE status and death did not vary according to cardiac biopsy proportion across studies.

Conclusions: LGE on CMR in patients with systemic amyloidosis with known or suspected cardiac amyloidosis is associated with increased risk of all-cause mortality.
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http://dx.doi.org/10.1016/j.jcmg.2016.01.036DOI Listing
November 2016

Successful management of ischemic cholangiopathy after failed endoscopic/percutaneous interventions, facilitated by digital cholangioscopy.

Gastrointest Endosc 2016 Dec 20;84(6):1053-1054. Epub 2016 Jul 20.

Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.

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http://dx.doi.org/10.1016/j.gie.2016.07.011DOI Listing
December 2016

Magnetic resonance enterography: A stepwise interpretation approach and role of imaging in management of adult Crohn's disease.

Indian J Radiol Imaging 2016 Apr-Jun;26(2):173-84

Department of Radiology, University of Arkansas for Medical Sciences, Arkansas, USA.

Crohn's disease (CD) is a chronic inflammatory bowel disease that often requires frequent imaging of patients in order to detect active disease and other complications related to disease activity. While endoscopy is the gold standard for diagnosis, it may be contraindicated in some patients and has a limited role in detecting deep submucosal/mesenteric diseases and intra abdominal complications. In recent years, magnetic resonance enterography (MRE) has evolved as a noninvasive, radiation free imaging modality in the evaluation of patients with CD. This review article will focus on role of MRE in imaging patients with CD with emphasis on technical considerations, systematic image interpretation, differential diagnoses, and the role of imaging in deciding treatment options for patients.
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http://dx.doi.org/10.4103/0971-3026.184405DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931774PMC
July 2016

Clinical and prognostic utility of cardiovascular magnetic resonance imaging in myeloma patients with suspected cardiac amyloidosis.

Eur Heart J Cardiovasc Imaging 2016 Sep 25;17(9):970-7. Epub 2016 May 25.

Division of Cardiovascular Medicine, Department of Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA.

Objectives: AL amyloidosis affects up to 30% of patients with multiple myeloma (MM), and cardiac involvement is associated with worse outcomes. Traditional screening modalities including EKG, echocardiography and biomarkers have limited value. The aim of this study was to evaluate the clinical and prognostic value of late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR) imaging in patients with plasma cell dyscrasias and suspected cardiac amyloidosis (CA).

Methods: A total of 251 consecutive patients with plasma cell dyscrasias who underwent CMR were enrolled in this study. Primary endpoint was all cause mortality. Clinical, ECG, echocardiographic, biomarker and CMR predictors of mortality were analyzed.

Results: Mean age of population was 63 ± 10 years, 36% females and 19% African Americans. During a median follow-up duration of 28 months (IQR 5-56), there were 97 deaths (39%). Patients who died were more likely to have diabetes (28% vs. 14%; P = 0.03), CAD (28% vs. 16%; P = 0.04) and CKD (33% vs. 21%; P = 0.04). With endomyocardial biopsy as the gold standard (42 (17%) patients), amyloid pattern on CMR (LGE+) had sensitivity and negative predictive values of 100%; specificity and positive predictive values of 80 and 81% with an AUC 0.9 for CA. History of CAD (HR 1.64, 95% CI 1.01-2.6; P = 0.04), brain natriuretic peptide (HR 1.0003 95% CI 1.0001-1.0006; P = 0.004) and LGE + (HR 1.72, 95% CI 1.05-2.8; P = 0.02) were independent predictors of mortality. LGE+ possessed incremental prognostic value over clinical, laboratory and echocardiographic variables for mortality prediction.

Conclusions: CMR is a clinically useful tool for diagnosis and prognostication in myeloma patients with suspected CA.
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http://dx.doi.org/10.1093/ehjci/jew101DOI Listing
September 2016

Imaging of Sarcoidosis: A Contemporary Review.

Radiol Clin North Am 2016 May 10;54(3):519-34. Epub 2016 Mar 10.

Department of Diagnostic Radiology, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 556, Little Rock, AR 72205, USA. Electronic address:

Sarcoidosis is a systemic granulomatous disorder with a variety of clinical presentations and radiological appearances. Although it primarily affects the lungs and lymphatics, sarcoidosis potentially involves essentially every organ system. On imaging, sarcoidosis can mimic different disease entities, including primary and metastatic neoplasms, vasculitis, and other granulomatous infections. Definitive diagnosis often requires a combination of clinical, radiological, and histologic information. Imaging plays a crucial role in diagnosis and evaluating response to therapy. This review covers imaging findings in sarcoidosis within each organ system, with an emphasis on the use of imaging in the diagnosis and management of this condition.
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http://dx.doi.org/10.1016/j.rcl.2015.12.009DOI Listing
May 2016

Current Indications, Techniques, and Imaging Findings of Stem Cell Treatment and Bone Marrow Transplant.

Radiol Clin North Am 2016 Mar 7;54(2):375-96. Epub 2016 Jan 7.

Radiology Residency Program, Division of Abdominal Imaging, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite 201 East, Wing PUH, Pittsburgh, PA 15213, USA.

The role of stem cell therapy in the treatment of hematologic and nonhematologic conditions is ever increasing. A thorough knowledge of the applications of stem cells and transplant physiology is essential for understanding the imaging manifestations. Stem cell imaging includes molecular imaging, and diagnostic and interventional radiology. It is possible to make a diagnosis of various complications and diseases associated with stem cell transplant. This article presents a simplified overview of stem cell applications and techniques with focus on hematopoietic stem cell transplant imaging.
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http://dx.doi.org/10.1016/j.rcl.2015.09.015DOI Listing
March 2016

A rare case of extra nodal Rosai-Dorfman disease with isolated multifocal osseous manifestation.

Indian J Radiol Imaging 2015 Jul-Sep;25(3):284-7

Department of Radiology, Musculoskeletal and Body MRI Division, University of Arkansas for Medical Sciences, Arkansas, USA.

Sinus histiocytosis with massive lymphadenopathy (SHML) or Rosai-Dorfman disease is a non-neoplastic condition which typically presents as massive, bilateral cervical lymphadenopathy and can involve multiple extranodal organ systems such as skin, eyes, and upper respiratory tract in about 28% cases. Bone lesions in association with nodal disease are seen in less than 10% cases. Isolated bone involvement as the only manifestation of SHML is extremely rare, with less than 50 cases reported in the literature. We report a very uncommon case of Rosai-Dorfman disease with isolated multifocal osseous involvement as the only presenting feature, involving about 10 different sites with no lymphadenopathy or other organ system involvement.
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http://dx.doi.org/10.4103/0971-3026.161459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531454PMC
August 2015

MR imaging findings in diabetic muscle infarction.

J Ark Med Soc 2014 Oct;111(5):91-3

Diabetic muscle infarction is a rare, often unrecognized complication seen in patients with poorly controlled Diabetes Mellitus. The diagnosis is often missed and leads to unnecessary invasive investigations and inappropriate treatment. The patients usually present with unilateral thigh pain and swelling. MRI typically demonstrates diffuse swelling and increased T2 signal intensity within the affected muscles. The condition is self-limiting and is treated conservatively with bed rest and analgesics. Recurrences have been reported in the same or contralateral limb. We report a case of diabetic muscle infarction with spontaneous resolution of symptoms and imaging abnormality with recurrence on the contralateral side.
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October 2014

Imaging of complications from hematopoietic stem cell transplant.

Indian J Radiol Imaging 2014 Oct;24(4):327-38

Department of Radiology, University of Washington and VA Puget Sound Health Care System, Seattle, Washington, USA.

Stem cell transplant has been the focus of clinical research for a long time given its potential to treat several incurable diseases like hematological malignancies, diabetes mellitus, and neuro-degenerative disorders like Parkinson disease. Hematopoietic stem cell transplantation (HSCT) is the oldest and most widely used technique of stem cell transplant. HSCT has not only been used to treat hematological disorders including hematological malignancies, but has also been found useful in treamtent of genetic, immunological, and solid tumors like neuroblastoma, lymphoma, and germ cell tumors. In spite of the rapid advances in stem cell technology, success rate with this technique has not been universal and many complications have also been seen with this form of therapy. The key to a successful HSCT therapy lies in early diagnosis and effective management of complications associated with this treatment. Our article aims to review the role of imaging in diagnosis and management of stem cell transplant complications associated with HSCT.
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http://dx.doi.org/10.4103/0971-3026.143895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247502PMC
October 2014
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