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A Man’s Guide to Testicular Ultrasound

August 10, 2021 in 2020 Learn Posts, Roth Blog Post

A Man’s Guide to Testicular Ultrasound

Testicular ultrasound is a non-invasive, painless way for specialists to evaluate out-of-the-ordinary symptoms that a man may be experiencing in his testicles. The most common symptoms that lead to a testicular ultrasound include pain, swelling or the detection of a lump. Occasionally, ultrasound is also needed to examine an injury to the testicular area. Typically, a man is referred to a radiologist for a testicular ultrasound by his primary care physician or urologist.

“Some men will experience new pain and/or swelling in their testicle(s) for several days, waiting until things progress before they visit their doctor,” explained Dr. Todd Roth, nuclear medicine and abdominal imaging radiologist at Raleigh Radiology. “However, I would encourage any man not to wait. In most cases the symptoms he is experiencing will be due to an easily treatable infection or other minor condition; however, the symptoms could be due to a more serious condition such as twisting of the blood vessels (testicular torsion) which, if not treated quickly, could lead to loss of the testicle. If a man notices a new lump without pain it is likely not urgent, but he should still schedule an appointment with his doctor and get it evaluated. “

Details of the Testicular Ultrasound Exam

When a man arrives to the radiologist’s office for a testicular ultrasound, he will be asked to change into a hospital-type gown and lie flat on the exam table. He will then meet the ultrasonographer who is specially trained to perform this type of exam.

With an ultrasound probe (or transducer), the ultrasonographer will scan the area of concern – the testicles and surrounding structures. Ultrasound does not use radiation, but instead uses sound waves and a computer to create still pictures and movies of the interiors of these areas.

Occasionally, the ultrasonographer may ask the radiologist to look at the images while the patient is in the room, but in most cases they will send the images to the radiologist for later interpretation. In total, the testicular ultrasound scan should only take around 15 to 30 minutes. Results will be sent to the referring provider within a few days.

What Do the Ultrasound Images Show?

When reviewing testicular ultrasound scans, the radiologist analyzes many different types of anatomy, including the testicles, the epididymis (tube along the back of each testicle that carries and stores sperm cells), soft tissues in the testicular and surrounding area, as well as the blood vessels that supply blood to the testicles. In particular, he or she will pay close attention to the:

  • Symmetry and size of the testicles
  • Swelling or enlargement of the testicles
  • Density of the testicle (echogenicity)
  • loss or decrease of blood flow

Conditions Diagnosed by Testicular Ultrasound

The most urgent problem the radiologist is looking for is the loss or decrease of blood flow to the testicle, which occurs when the blood vessels become twisted. Although relatively rare, this dangerous condition is called testicular torsion and is of urgent concern. It requires immediate evaluation by a urologist and surgery to untwist the blood vessels. Other, less-concerning conditions that are diagnosed by testicular ultrasound include:

  • Orchitis – Swelling/inflammation of the testicle due to a bacterial or viral infection
  • Epididymitis – Swelling/inflammation of the epididymitis due to bacterial or viral infection
  • Varicocele – Enlargement of the veins within the scrotum (loose sac of skin that holds each testicle)
  • Hydrocele – A collection of fluid around the testicle
  • Spermatocele – A round fluid-filled cyst that develops in the epididymis

Inflammation of the epididymis or testicle is most commonly caused by spread of infection from the bladder or prostate. It is usually treated with antibiotics and medication for pain control. A varicocele is most commonly due to a congenital abnormality in the veins or may rarely be due to vein compression or obstruction. It typically does not cause symptoms or require treatment but in some cases may cause swelling/pain or lead to infertility, in which case surgical treatment may be needed. A hydrocele is the most common cause of swelling and may be congenital but is usually due to another underlying condition such as inflammation or injury. They will typically resolve on their own and only rarely require minor surgery. The detection of a spermatocele – even though it is not harmful – will typically result in referral to a urologist to decide if the “watch and wait” method will be used or if minor surgery is needed.

The Rare Case of Testicular Cancer

On a rare occasion, a malignant lump is detected inside the testicle, and the diagnosis is testicular cancer. The ultrasound images will show a nodule or mass in the testicle that shows the typical features of cancer. If the radiologist suspects a primary testicular cancer, the patient will be referred to a urologist for treatment.

Raleigh Radiology Cares

“At Raleigh Radiology, we are committed to using the latest technology and ultrasound equipment as well as the highest standard of care when performing and reviewing testicular ultrasounds,” added Dr. Roth. “While the more serious conditions such as torsion and testicular cancer are generally rare, it is important for men who are experiencing any symptoms to get checked out as soon as possible. This will help eliminate concern and avoid delaying any necessary treatment.”

For more information about testicular ultrasound at Raleigh Radiology, please visit www.raleighrad.com.

Sources:

https://www.healthline.com/health/testicle-ultrasound

https://www.healthline.com/health/hydrocele

https://www.mayoclinic.org/diseases-conditions/varicocele/symptoms-causes/syc-20378771#:~:text=A%20varicocele%20(VAR%2Dih%2D,quality%2C%20which%20can%20cause%20infertility

https://my.clevelandclinic.org/health/diseases/17697-epididymitis#:~:text=Epididymitis%20is%20inflammation%20(swelling%20and,ages%20of%2014%20and%2035.

Todd Roth, MD, Body Radiologist Raleigh, NC

Todd Roth, MD

Nuclear Medicine and Abdominal Imaging Radiologist

  • BS, University of Texas, Austin
  • MD, University of Texas Health Sciences Center, San Antonio
  • Residency, Baptist Medical Center, Wake Forest University, Winston-Salem
  • Fellowship in abdominal imaging, Baptist Medical Center, Wake Forest University
  • MQSA-Certified Breast Radiologist
  • Native of Kansas

Expertise in abdominal and pelvic MRI, CT, and ultrasound
Joined Raleigh Radiology in 2004

Using Pediatric Imaging to Detect Developmental Dysplasia of the Hip

May 18, 2021 in 2020 Learn Posts, Llanos Blog Post

Using Pediatric Imaging to Detect Developmental Dysplasia of the Hip

For new parents, the health of their newborn baby is a top priority. From pregnancy, to the hospital stay after delivery, and then subsequent check-ups with the pediatrician, prenatal and pediatric care providers perform numerous evaluations and assessments to ensure a baby’s development is normal and on track. One area of concentration is to ensure that the infant is not at risk for developmental dysplasia of the hip (DDH).

 

What is Developmental Dysplasia of the Hip (DDH)?

DDH is a congenital, abnormal development of the hip that occurs while a baby is in utero. The hip is a ball-and-socket joint connecting the femur or thigh bone to the pelvis – it is where the rounded end of the femur bone fits into a cup-like area formed by several bones in the pelvis, called the acetabulum. In a baby with DDH, a spectrum of different issues could be at play. Something could be wrong with the socket of the joint or the ligaments, tendons or muscles that hold it together. For instance, the ligaments around the joint could be loose, creating too much mobility or motion.

 

“Detecting DDH during the early stages of a baby’s life is critical for normal development,” explained Dr. Robert Llanos, a board-certified pediatric radiologist with Raleigh Radiology. “If DDH is left undetected and untreated, there is a chance that the hip will not form properly, which could result in a hip or leg that turns outward, or one leg could end up being shorter than the other. This will affect how the child walks and could result in a limp. Additionally, if one hip is not functioning normally or developing properly, this could lead to pain and early arthritis damage later in life.”

 

Detecting DDH in the Early Weeks of Life

There are several different ways DDH can be detected in a young infant. To begin, all babies are examined by a provider (typically their pediatrician) for DDH after birth, while they are still in the hospital. The provider looks to ensure the infant’s legs are the same length, that there are equal folds in the hips, that the hips move appropriately when rotated, and to see what happens when pressure is placed on the hips. If the hips feel unstable with pressure or there is too much movement, or if a dislocation can be felt, DDH could be the problem. Newborn babies are also consistently examined for DDH throughout early infancy during their regular pediatrician well-visits.

 

The best way to clearly determine if a baby has DDH is via a hip ultrasound, performed with a pediatric radiologist in the radiology office. Babies who are sent for a hip ultrasound typically have one of these risk factors:

 

  • An abnormality was detected during the infant’s hospital exam or during one of their subsequent exams at the pediatrician’s office.
  • The infant is considered high-risk for DDH since there is a family history, i.e., a parent or sibling was diagnosed with DDH in the past.
  • The baby was found to be in the breech position during the third trimester of pregnancy.

 

What Happens During a Pediatric Hip Ultrasound?

With Raleigh Radiology, all newborn hip ultrasounds are performed in the Cary office location where a pediatric radiologist works on site and participates in each exam. Upon arrival, the parent or caregiver will check in and then be escorted by an ultrasound technician to an exam room. Once in the exam room, the parent/caregiver will experience a supportive and child-friendly environment. Lowered lighting and colorful wall stickers help create a relaxed mood. The parent/caregiver is also encouraged to assist with holding and positioning the baby during the exam, offering a sense of comfort and familiarity for the child.

 

For the exam, the ultrasound technician will ask the parent/caregiver to partially undress the baby down to his or her diaper. He or she will then use a special wand called a transducer, along with warm gel, to take images of the hips from different angles by rolling the baby from side to side.

 

“This ultrasound exam is a painless experience,” explained Dr. Llanos. “The only feeling for the infant will be a feeling of slight pressure when we are examining and taking images of the hips.”

 

After both hips are imaged, the ultrasound technician will leave the room and the radiologist will review the images. He or she will meet with the family in person to review the results and discuss any initial findings.

 

“As a pediatric radiologist, I enjoy interacting with my patient’s family members – having a discussion with them, answering any questions, and providing reassurance about this common childhood condition,” explains Dr. Llanos.

 

DDH Treatment Options

If an abnormality is found after the DDH ultrasound, most pediatricians will send the infant to a pediatric orthopedist for further evaluation and a treatment plan. If the findings are mild and the baby is of an early age, the issue might correct on its own. In this case, the infant will be reimaged about a month later, but no other treatments will be given at that time. However, if the results are more severe, treatment options could include:

 

  • A harness or soft brace that keeps the hips in an open position and directs the ball of the joint to the socket so that it will grow and develop properly. This is a more common treatment option.
  • In more severe cases, which are less common, the infant might need a rigid cast placed around the pelvis and thighs, allowing for less motion and flexibility, again, so the ball of the joint is directed to the socket for proper growth and development.
  • In very severe cases (i.e. dislocation), which are most uncommon, the infant will require surgery or the manipulation of the joint while under anesthesia, and then the placement of a rigid cast.

 

“Through our partnership with WakeMed, we have a great relationship with Wake Orthopaedics and can reach out to their team directly with questions or concerns,” added Dr. Llanos. “This collaborative connection makes it a seamless experience for parents and caregivers.”

 

To learn more about Raleigh Radiology and our pediatric imaging services, please visit www.raleighrad.com.

Robert Llanos, MD Pediatric Radiologist Raleigh, NC

Robert Llanos, MD

Pediatric Radiologist

    • BS, Sophie Davis School of Biomedical Education at CUNY
    • MD, SUNY Downstate
    • Resident in Diagnostic Radiology, Maimonides Medical Center
    • Fellowship in Pediatric Radiology, Children’s National Medical Center
    • MQSA-Certified Breast Radiologist
    • Member, The Society for Pediatric Radiology, Radiological Society of North America, American College of Radiology

Joined Raleigh Radiology in 2017

COVID-19 and the Brain – Imaging Plays a Role in Detection & Treatment Planning

May 18, 2021 in 2020 Learn Posts, Tanpitukpongse Blog Post

COVID-19 and the Brain Imaging Plays a Role in Detection & Treatment Planning

One in 7 COVID-19 patients may experience neurological injury

During the initial phases of the COVID-19 pandemic, it was widely believed that the novel virus was primarily a respiratory illness affecting the lungs. The medical community was warning mostly of respiratory symptoms such as shortness of breath and cough, in addition to other flu-like symptoms, such as fever, fatigue, body aches, chills and sore throat.

 

COVID-19: Not Just a Respiratory Illness

Over time, however, the medical community has learned that COVID-19 is much more than a respiratory virus. There’s evidence that it can cause a variety of bizarre symptoms that scientists and doctors are still learning much about, some of which include those that affect the heart, kidneys, and central nervous system (brain and spinal cord). The neurological impact of COVID-19 is highly concerning and neuroradiologists are seeing firsthand some of its devastating effects. In fact, a study published in late 2020 at the NYU Grossman School of Medicine suggests that one in seven people infected with the virus experiences some type of neurological injury.

 

Studies have shown that a notable percentage of patients who are hospitalized with COVID-19 are experiencing headaches, fatigue and an altered mental status – confusion, agitation, delirium and memory issues. Some even experience ischemic stroke, caused when an artery to the brain is blocked; seizures; encephalopathy, or altered brain function; and movement disorders associated with the corticospinal tract, a pathway from the brain to the spine that controls movement of the body’s trunk and lungs.

 

A rare few have also experienced cerebral sinus thrombosis, a blood clot in the brain that leads to stroke, or meningoencephalitis, brain inflammation that causes symptoms such as blurred vision and bodily rash. There has also been an increase in the number of young and middle-aged COVID-19 patients who experience stroke.

 

Lastly, some patients known as ‘long-haulers’ who have recovered from COVID-19 are experiencing unexplained neurological symptoms months later such as long-term loss of smell (hyposmia), tremors, fatigue, memory loss and sleep disorders.

 

Experts aren’t sure exactly what’s causing neurological complications of COVID-19 – it could be either a direct viral invasion from the virus, a post-inflammatory condition based on how the immune system is responding to COVID-19, or simply how the body of a critically-ill patient is responding to the illness.

 

The Critical Role Radiology Plays in Fighting COVID-19

As COVID-19 continues to spread, imaging studies have become even more critical to the diagnosis and treatment of patients who are suffering from this virus. There now exists a heightened sensitivity and awareness among medical providers that certain symptoms of COVID-19 could be due to neurological complications. This is where neuroradiologists provide an essential piece to the puzzle. They possess the critical tests, tools and training to assess patients for serious problems and can often provide the pathway toward life-saving treatments.

 

“We’ve definitely seen an increase in neuroradiology studies as a result of COVID-19,” explains Dr. Peter Tanpitukpongse, a neuroradiologist with Raleigh Radiology. He explains that some patients are experiencing acute problems such as stroke or seizure, while others are looking for answers for unexplained cognitive symptoms like dizziness, confusion or brain fog.

 

“The most important thing is to identify if a COVID-19 patient has had a stroke, since many stroke treatments can only be administered within a certain number of hours from the onset of symptoms,” explained Dr. Tanpitukpongse.

 

When Treating Stroke, Diagnosis and Timing Are the Key

Dr. Tanpitukpongse further explained that determining the right treatment for stroke depends on whether the stroke is ischemic or hemorrhagic – and imaging studies are the key to determining the type of stroke that may have occurred.

 

Four Types of Imaging Studies Used for Stroke Detection

Neuroradiologists use four different types of imaging studies to learn more about what is happening inside of a COVID-19 patient’s brain and to make the quick decisions necessary when it comes to the potential of stroke.

 

Computed Tomography (CT) Scan – Because it can be performed relatively quickly and is widely available in the office, hospital and emergency room settings, the CT scan is typically the test chosen as the first line of defense. It uses X-ray and computers to take multiple images of the inside of the head, at multiple angles. Neuroradiologists can use the CT scan to look for signs of ischemic stroke and hemorrhagic stroke.

 

Magnetic Resonance Imaging (MRI) – MRI is a scan used by neuroradiologists because of its greater sensitivity in detecting stroke. Much more can be seen on an MRI than on a CT scan. MRI is used in the inpatient and outpatient settings and allows the neuroradiologist to use diffusion-weighted imaging (DWI), which is a sensitive and specific MRI sequence that is highly effective and almost immediate in detecting any signs of stroke in the brain.

 

“The most common test we use from the neuroradiology perspective is the MRI brain exam,” said Dr. Tanpitukpongse. “In addition to identifying stroke, MRI also evaluates for possible alternative explanations for chronic neurological symptoms, for instance, a mass, hemorrhage, stroke, demyelinating disease, etc. The real benefit is to exclude a worrisome underlying condition so that the neurologist or other provider can focus on treating the symptoms.”

 

CT Angiography (CTA) – This imaging study is mostly performed in an acute setting, where a patient is showing acute signs of stroke from large vessel occlusion, or large blood clots in the head and neck. Importantly, it can determine if a patient is a candidate for treatment, and more specifically, embolectomy. To perform a CTA, the patient is injected with contrast into the body and follows it through the vessels in the neck and head to determine if there is any evidence of occlusion or dissection (a tear).

 

CTA Perfusion – The CTA perfusion is a relatively new study for patients who have presented to the hospital with stroke-like symptoms up to six hours after symptom onset. The neuroradiologist uses CTA perfusion to look for evidence of ischemic penumbra, an area of the brain that is severely damaged by stroke via decreased oxygen and decreased cerebral blood flow (the amount of blood that flows through the brain per unit of brain tissue).

 

This test helps determine how much of the brain is salvageable with treatment and how much is irreversibly damaged, also called cerebral infarction. To perform CTA perfusion, the neuroradiologist injects a contrast into the body and analyzes blood flow to the brain to calculate how adequate it is. In addition to other imaging scans, CTA perfusion can aid a neuroradiologist and stroke team in determining if the patient should receive neurointervention (such as embolectomy) versus tPA or other treatment.

 

To perform imaging scans, Raleigh Radiology and WakeMed Health & Hospitals use RapidAI™ software, advanced specialized imaging for patients who present to the hospital with acute stroke. This automated system allows neuroradiologists to quickly obtain stroke test values and report them to emergency room doctors and the stroke team as soon as possible.

 

Providing the Best Care Possible in the Age of COVID-19
Dr. Tanpitukpongse concludes by acknowledging that there is still much to learn about the effects of COVID-19 on the brain. “At Raleigh Radiology, our team is committed to continuously reviewing and evaluating all new research and literature that suggest a connection between COVID-19 and neurological disorders so we can provide the best care and treatment possible to our patients.”

 

Sources:

https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/what-coronavirus-does-to-the-lungs

https://weillcornell.org/news/what-to-know-about-stroke-and-covid-19

https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Stroke

https://www.mayoclinic.org/diseases-conditions/brain-avm/diagnosis-treatment/drc-20350265

https://www.nejm.org/doi/10.1056/NEJMc2008597

https://www.stroke.org/en/about-stroke/treatment/why-getting-quick-stroke-treatment-is-important

http://www.strokecenter.org/patients/about-stroke/ischemic-stroke/

Peter Tanpitukpongse, MD, Neuroradiology Radiologist Raleigh, NC

Peter Tanpitukpongse, MD

Neuroradiologist

  • BA, Johns Hopkins University
  • MD, New York University
  • Internship, Winthrop University Hospital
  • Residency, Winthrop University Hospital
  • Fellowship, Duke University Medical Center
  • MQSA-Certified Breast Radiologist
  • Member, American College of Radiology
  • Member, Radiological Society of North America
  • Member, American Roentgen Ray Society
  • Member, American Society of Neuroradiology

Expertise in Neuroradiology

Joined Raleigh Radiology in 2016

Examining the Liver Using Body Imaging

May 17, 2021 in 2020 Learn Posts, Alley Blog Post

Examining the Liver Using Body Imaging
A Look Inside

In the world of radiology, body imaging is one of many subspecialties.   In most cases, radiologists use body imaging to diagnose diseases and conditions of the organs found in the chest, abdomen and pelvis, including the liver, pancreas, kidneys, bladder, stomach, intestines, heart and lungs, among others. Specific scanning techniques are used to tailor-fit each organ, allowing for highly detailed results.

The Magic is in the Modality

When performing body imaging on the liver and other organs, radiologists may use a variety of modalities, including ultrasound, computed tomography (CT or CAT) scan and magnetic resonance imaging (MRI).

  • Ultrasound – This modality is a non-invasive, diagnostic exam for which the imaging technician uses a transducer (wand-like instrument) that is placed on and moved over the skin. Ultrasound waves then move through the body and bounce off organs to produce computer images of internal structures. No radiation is used for ultrasound.
  • CT Scan – CT scan is known as the “workhorse of body imaging” because it is widely available in hospitals and radiology practices, and it can be completed quickly. While the CT scan uses radiation via rotating X-ray machines to create images of organs and tissues, it only requires the patient to lie still for a short amount of time. CT scan is excellent at providing spatial resolution and “the view from 30,000 feet,” so to speak, but sometimes issues arise that will need more investigation, and MRI is often the next step in that process.
  • MRI – Often known as the problem-solving tool for body imaging, MRI uses magnetic forces and radio waves to produce gradient-weighted images of a patient’s organs and internal structures. Without the use of radiation, MRI produces high-quality, clear pictures so that radiologists can determine in much greater detail what might be happening within a certain organ or tissue. However, patients must lie still in a tube-like machine for an extended period of time so that the radiologist can obtain effective results.

“My Doctor Says I Have a Liver Mass – Now What?”

The liver is one organ that is frequently scanned by body imaging radiologists. In fact, 10 to 15 percent of the population experience benign or non-cancerous liver cysts, and body imaging is an essential method used for examining this condition.

The power of using MRI on the abdomen was first shown through, and continues to be essential in, the examination of liver masses. Liver masses are incredibly common and are typically detected when a patient is being examined for another health issue, rather than for the liver itself.

“Often, we find that liver masses are incidental findings, like when a patient goes in for a CT scan after experiencing abdominal pain,” explained Dr. Jay Alley, neuroradiologist and abdominal imaging radiologist with Raleigh Radiology. “In other words, we might be looking for appendicitis, diverticulitis, or kidney stones, and then notice a mass on the liver.”

Other times, liver mass detection is simply related to the body’s anatomy. For example, in performing a chest CT scan, portions of liver are imaged which may reveal an abnormality that needs further workup with CT or MRI.

“The beauty of MRI is that it can provide such good soft tissue resolution that we are able to analyze lesions or masses that are even very small,” said Dr. Alley. “However, some can be too small, and we might take another look in three to six months to see if anything changes.”

During an MRI, multiple images will be taken of the liver, with intravenous contrast being injected about three-fourths of the way through the exam. Intravenous contrast is a special liquid medication that is injected into the patient’s vein. It travels through the blood vessels and highlights those areas being examined. If certain areas enhance and become conspicuous (or light up brighter), the radiologist will gain more information about the mass.

Different Types of Liver Masses

During an MRI for a liver mass, the radiologist wants to determine if the mass is solid, cystic (filled with fluid) or both. The challenge is knowing what these different types of liver lesions look like when imaged on various MRI sequences, as well as the way they react to intravenous contrast. This is where the radiologist’s body imaging experience and years of training come into play.

The types of liver masses include:

Benign Hepatic Cyst – A fluid-filled sac that forms in the liver. It is not cancerous, rarely requires treatment and typically does not affect liver function.

Hemangioma – The most common type of benign liver tumor. Hemangiomas are actually non-cancerous tangles of blood vessels. These are common, do not cause symptoms, rarely need treatment, and do not spread to other areas of the body.

Malignant Liver Mass – A mass that is cancerous. Radiologists typically can determine if a mass or lesion in the liver is malignant when it shows early peripheral (around the edge) enhancement with contrast that fades or washes out quickly.

“Like a parasite, a malignant mass or tumor has a way of taking over the adjacent blood vessels to use them for its own purposes and to make itself grow,” explained Dr. Alley. “As such, the enhancement from MRI contrast will show a variation in the vascular pattern within that region. If the blood supply is trying to go there, we know that something is trying to grow and that the mass is likely cancerous.”

Other less common findings on an MRI of the liver include focal nodular hyperplasia (FNH) and hepatic adenoma, both of which are non-cancerous, solid lesions that can develop on the liver. These are typically left untreated, unless they need to be removed due to size and/or propensity to bleed.

“I tell patients that a growth on the liver is generally nothing to worry about, and I am grateful that we have a body imaging tool like MRI to effectively rule out serious complications or alert the need for further treatment,” said Dr. Alley. “In my experience, approximately 80 percent of the time, liver masses are benign cysts or hemangiomas, which are common, non-cancerous lesions.”

However, for patients who do receive the news about a possible malignant lesion, a biopsy would likely be the next step, after being referred to a surgical oncologist or hepatologist. If caught early, the tumor can often be surgically removed before the cancer spreads to other areas of the body.

For more information about the body imaging services provided by Raleigh Radiology, visit www.raleighrad.com.

 

Sources:

Body Imaging – OHSU
https://www.ohsu.edu/school-of-medicine/diagnostic-radiology/body-imaging

Body Imaging – Johns Hopkins Medicine
https://www.hopkinsmedicine.org/radiology/specialties/body-imaging/

Liver Hemangioma – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/liver-hemangioma/symptoms-causes/syc-20354234

Benign Liver Tumors – American Liver Foundation
https://liverfoundation.org/for-patients/about-the-liver/diseases-of-the-liver/benign-liver-tumors/

Focal nodular hyperplasia – Radiopaedia
https://radiopaedia.org/articles/focal-nodular-hyperplasia?lang=us#:~:text=Focal%20nodular%20hyperplasia%20(FNH)%20is,may%20be%20atypical%20in%20appearance.

John G. Alley, Jr., MD Neuroradiology, Nuclear Medicine & Abdominal Imaging Radiologist Raleigh, NC

John G. Alley, Jr. MD

Neuroradiologist, Nuclear Medicine, and Abdominal Imaging Radiologist

  • BA, University of North Carolina at Chapel Hill
  • Post-Baccalaureate Premedical Program, Columbia University, New York
  • MD, University of North Carolina School of Medicine
  • Co-chief resident in diagnostic radiology, University of North Carolina Hospital
  • Fellowship in neuroradiology, University of North Carolina Hospital
  • MQSA-Certified Breast Radiologist
  • Native of North Carolina

Expertise in neuroradiology, PET/CT, oncologic imaging and abdominal imaging

Joined Raleigh Radiology in 2004

Prostate Artery Embolization: A Minimally Invasive Option to Treat Benign Prostatic Hyperplasia

January 18, 2021 in 2020 Learn Posts, Dalal Blog Post

Prostate Artery Embolization:
A Minimally Invasive Option to Treat Benign Prostatic Hyperplasia

A common condition among most aging men is benign prostatic hyperplasia (BPH), a noncancerous condition where the prostate becomes enlarged and urinary issues start to take hold.

In fact, approximately 50 percent of men who are 50 and older and 80 percent of men who are 80 and older struggle with BPH, symptoms of which include urinary urgency, frequent urination, straining to urinate, urinating multiple times in the night, incomplete emptying of the bladder, and sexual side effects. BPH can have a deeply negative impact on a man’s quality of life and leaves most searching for relief.

 

Why Does Urination Become a Problem for Some Men?

The prostate gland sits below the bladder, between the bladder and the penis. Running through the center of the prostate is a vessel or tube called the urethra, which allows urine to flow out of the body. When the prostate becomes enlarged, pressure is placed on the urethra and a man cannot urinate properly or efficiently. The goal of treatment is to remove this pressure.

 

Traditional Complex & Invasive Treatment Options for BPH

Treatment of BPH involves medication as well as several procedural options, some of which require invasive surgery, an inpatient hospital stay, and the potential for unpleasant side effects. Additionally, a patient must meet certain requirements to qualify. Treatment options include:

  • Transurethral resection of the prostate (TURP) – The urologist essentially removes the parts of the prostate gland that are causing problems. While TURP is the “gold standard” and essentially eliminates BPH, it is also major surgery that involves an overnight hospital stay, blood loss, and many potential side effects. Additionally, if the prostate is too large, TURP is not an option.
  • Prostatectomy – This procedure is a partial or complete removal of the prostate, and is widely used for men who have a very enlarged prostate. This treatment option presents the best overall improvement of symptoms, but also involves surgery, a hospital stay, and potential side effects.
  • Laser treatment – Lasers are used to kill the prostate tissue and reduce the size of the gland.
  • UroLift® system – A permanent device is implanted to lift and hold the enlarged prostate tissue, preventing it from blocking the urethra.
  • Rezum™ Therapy – This minimally invasive treatment option uses hot steam to attempt “burning out” the parts of the prostate that are squeezing the urethra.

 

Benefits of Minimally Invasive Prostate Artery Embolization (PAE)

Dr. Ravi Dalal, an interventional and vascular radiologist with Raleigh Radiology, reports that there is a different way to approach treatment of BPH that does not involve burning or removing the prostate, is minimally invasive, and presents relatively few side effects. Prostate artery embolization (PAE) is a newer, intravascular treatment, introduced more widely within the past ten years. It has grown in popularity due to the benefits mentioned above and its success rate. Additionally, the patient receives moderate sedation, so general anesthesia is not necessary. The procedure takes anywhere from one and a half to three hours.

 

“The idea is that if we shrink the prostate by getting rid of the blood supply on both sides, it will have the same effect as other treatments, but it is safer,” said Dr. Dalal. “Without a blood supply, nutrients can’t reach the prostate, and the cells will die. This is called necrosis. The body’s immune system will then remove the cells and create scar tissue, the prostate will shrink, and the tissue around the urethra will open up allowing urine to flow freely and reducing many symptoms.”

Performed in the hospital by an interventional radiologist like Dr. Dalal, PAE is a technical procedure that requires precision and expertise. Dr. Dalal has had extensive training for PAE during his interventional radiology fellowship.

 

Depending on the patient’s height (shorter than six feet, due to the catheter length), the radiologist may decide to perform the procedure trans-radially, through the patient’s wrist. This method is easier on recovery, but is only available for patients shorter than 6 feet tall due to the catheter length. Otherwise, the radiologist goes in through the groin. Either option creates no more than a 2 mm incision and requires no stitches.

 

The radiologist will then inject microscopic beads into the artery that runs to the prostate. These beads will ultimately block the blood supply. Multiple techniques are employed during the procedure to ensure the beads are inserted into the correct artery.

 

Positive Results & Improved Symptoms

Before PAE, most men report a variety of negative symptoms that impact their quality of life using a symptom tracking score methodology known as the International Prostate Symptom Score (I-PSS) rubric. The I-PSS is an eight-question screening tool that tracks and assesses symptoms of patients with BPH. The questions determine a man’s difficulty with urination and also help select the best treatment options. Whether it’s sexual dysfunction or urinary symptoms – men want relief and to live their lives to the fullest. Interventional radiologists like Dr. Dalal determine their success rate based on patients’ improved I-PASS scores after the procedure.

 

“After a PAE, we want to see those scores trending in the right direction. Fortunately, we typically see a significant impact,” added Dr. Dalal. “In fact, 75 to 80 percent of men say they experience an improvement in symptoms after this procedure.”

 

Patients also appreciate that PAE comes with few side effects. While there may be pain with urination or blood in the urine afterward, symptoms are usually mild and improve within a few weeks. A patient spends about two hours in recovery and is then sent home. The patient is prescribed antibiotics and NSAIDs to help with any inflammation or pain.

 

Rarely, post embolization syndrome can occur after PAE (low-grade fever, nausea, chills, discomfort when urinating), but this is temporary and resolves within a week. After the procedure, a patient should meet again with his radiologist to assess progress.

 

Helping High-Risk Patients Face BPH

Interventional radiologists and urologists are very selective when choosing patients for PAE.

They will assess each patient via CT scan prior to the procedure so they can map out the prostate’s anatomy and ensure the blood vessels are healthy enough for a successful PAE. PAE is most helpful in patients who have a large prostate of 150-200 grams. It is also a good option for patients for whom medical therapies have failed and/or who have pre-existing medical conditions such that surgery is not an option (i.e., heart disease and chronic obstructive pulmonary disease).

 

PAE can also help patients who have chronic indwelling foley catheters by shrinking the prostate and removing the catheter, as well as men who have hematuria, or bleeding from the prostate. By blocking the blood supply, the radiologist can use PAE to help heal the hematuria and shrink the prostate.

“Urologists prefer to avoid surgery with their high-risk patients, making PAE a good option. The risk is less for PAE since it only requires moderate sedation and it is not a surgical procedure,” explained Dr. Dalal. The interventional radiologists at Raleigh Radiology will consult with your urologist to develop a multidisciplinary approach and develop the best treatment option for each patient.

 

“PAE takes a lot of skill and experience; we use all the tools and training we have. Every patient is different, but I enjoy the challenge,” reflected Dr. Dalal. “Patients report a significant improvement in their symptoms – I’ve actually had men tell me they feel like they are 20 years old again.

The fact that we can treat these patients with a minimally invasive approach and have such a significant impact on their symptoms, meanwhile enhancing quality of life, is very exciting and satisfying.”

 

To learn more about Dr. Dalal and Raleigh Radiology, visit www.raleighrad.com.

Ravi Dalal, MD, Vascular & Interventional Radiologist Raleigh, NC

Ravi Dalal, MD

Interventional and Vascular Radiologist

  • BS: Cornell University
  • MD: University of Miami Miller School of Medicine
  • Radiology Residency: Jackson Memorial Hospital/University of Miami
  • Vascular and Interventional Radiology Fellowship: Jackson Memorial Hospital/University of Miami
  • Member, Society of Interventional Radiology
  • Member, American College of Radiology
  • Member, Radiological Society of North America
  • Interests: Prostate Artery Embolization
  • Native of New York State

Joined Raleigh Radiology in 2017

Ending the Monthly Cycle of Fear: Treating Uterine Fibroids with Uterine Fibroid Embolization

January 18, 2021 in 2020 Learn Posts, Doster Blog Post

Ending the Monthly Cycle of Fear:
Treating Uterine Fibroids with Uterine Fibroid Embolization

For many women, uterine fibroids can have a significant impact on quality of life. They find it difficult to go to work or leave their homes on certain days of their menstrual periods for fear of excessive and uncontrollable bleeding. While there are numerous treatment options, most require major surgery that isn’t ideal for most women.

What are Uterine Fibroids?

According to the National Institute of Environmental Health Sciences, 70 percent (or more) of women have uterine fibroids by age 50. Uterine fibroids are noncancerous tumors or growths that appear in a woman’s uterus during her reproductive years. They can cause heavy menstrual bleeding, severe cramping pain, periods that last longer than normal, breakthrough bleeding between periods, and even abdominal pain and pressure, bloating, constipation, frequent urination and pain during intercourse.

Surgical Methods to Treat Uterine Fibroids

The only way to resolve uterine fibroids with 100 percent efficacy is via a hysterectomy, or the surgical removal of the uterus. A hysterectomy will end a woman’s menstrual periods – meaning pregnancy is no longer an option. This procedure requires a complex, invasive surgery with a long recovery time.

Another surgical option is the myomectomy, where the surgeon makes an incision in the lower abdomen and goes through the uterus to cut out portions of or remove entire fibroids. However, because women can have many fibroids at once and they can grow on multiple areas of the uterine muscle, this procedure cannot guarantee the complete removal of all fibroids. Recovery for this procedure typically takes 2-4 weeks.

Uterine Fibroid Embolization as an Alternative Treatment Option

Uterine fibroid embolization (UFE) is a minimally invasive, non-surgical option available for treating uterine fibroids. According to Dr. Jamie Doster, chair of Interventional and Vascular Radiology at Raleigh Radiology, this common, alternative treatment option is successful for about 90 percent of patients, helps patients avoid major surgery, and allows for a much shorter recovery time. Dr. Doster was specifically trained to perform UFE during her interventional radiology fellowship.

“UFE works because we take away the blood supply to the fibroids, which then causes them to shrink and die off (necrosis),” explained Dr. Doster. “When they shrink, they are no longer hormonally active, which helps eliminate the heavy and breakthrough bleeding. Meanwhile, the shrinkage helps resolve the bulk of the patient’s other symptoms. After this procedure, patients can go back to work much sooner and the procedure is often more affordable than surgery as well.”

How Does UFE Work?

Interventional radiologists perform UFEs in the hospital, including at both WakeMed Raleigh Campus and Cary Hospital. As part of the treatment process, the patient will first receive an MRI to ensure she is a candidate for UFE – to check the anatomy of the fibroids, determine where they are located and ensure no other complications (i.e., malignancy) are at play. After this MRI and a pre-planning consult, where the MRI results and details of the procedure are discussed, the patient is scheduled for her UFE.

During this very technical and precise procedure, the radiologist uses a catheter inserted through the uterine artery to inject tiny beads into the blood vessels that feed the fibroids. Hence, the blood flow to the fibroids is blocked, and they will all begin to shrink. For 90 percent of patients, UFE can be performed trans-radially, or through a tiny incision in the wrist. For the other 10 percent, the procedure is performed through the groin, also just a tiny incision. This is based on the patient’s height (the size of catheter will not allow trans-radial on taller patients) and blood flow. With the wrist incision, a patient can get up and walk very soon after her procedure. In total, UFE takes about one to two hours. When the procedure is finished, patients either stay overnight or in some cases, may be able to leave the hospital on the same day.

What is Recovery Like?

According to Dr. Doster, the first 24 to 48 hours after UFE are the most difficult. A patient will typically remain in bed for that time and may experience pain, abdominal cramping, fatigue or vomiting. These symptoms usually resolve within a week, and patients are then able to return to work or their normal daily activities. Patients do not experience the total loss of their menstrual periods (amenorrhea) after UFE; however, a smaller and less impactful period remains. Some patients may continue to have slight discomfort and spotting for two to three menstrual cycles before they report a complete improvement.

“The complete resolution of symptoms is our ultimate goal, and most patients come back to tell us their symptoms are gone or significantly improved,” said Dr. Doster. “It’s remarkable and very rewarding when we can help these women take back their quality of life.”

Each patient should have a follow-up appointment with her radiologist one to three months after the procedure. Meanwhile, Dr. Doster’s office will call the patient one week later to check on her during recovery. Based on age, a small subset of women may have a recurrence of symptoms within five years, possibly due to the growth of new fibroids. However, these patients are typically younger women (around age 30) who are years away from menopause, and having a second UFE will help. For all women, the symptoms of uterine fibroids will typically resolve with menopause.

“At Raleigh Radiology, we are proud to offer UFE for women who suffer from uterine fibroids. We can help them stop living in fear of their menstrual periods and give them more freedom to enjoy their lives again,” added Dr. Doster. “We are also proud to offer same-day discharge as well as the trans-radial (wrist) option for a minimally invasive and safer treatment experience.”

To learn more about Dr. Doster and Raleigh Radiology, visit www.raleighrad.com.

 

Sources:

National Institute of Environmental Health Sciences: www.niehs.nih.gov

Office on Women’s Health: www.womenshealth.gov

Mayo Clinic: www.mayoclinic.org

Jamie Doster, MD Vascular & Interventional Radiologist Raleigh, NC

Jamie Doster, MD

Chair, Interventional and Vascular Radiology, Interventional and Vascular Radiologist

  • BS, Florida State University
  • MD, Florida State University College of Medicine
  • Internship, Greenville Memorial Hospital, Greenville, S.C.
  • Residency, University of Virginia, Charlottesville, VA
  • Fellowship in Vascular and Interventional
  • Radiology, University of Virginia
  • Member, Society of Interventional Radiology
  • Member, American College of Radiology
  • Member, Radiological Society of North America

Expertise in Interventional Radiology

Joined Raleigh Radiology in 2016

Clearing the Congestion: Ovarian Vein Embolization as a Treatment for Pelvic Venous Insufficiency & Chronic Pelvic Pain

January 18, 2021 in 2020 Learn Posts, Doster Blog Post

Clearing the Congestion:
Ovarian Vein Embolization as a Treatment for Pelvic Venous Insufficiency & Chronic Pelvic Pain

Pelvic pain and pressure are common symptoms for women that too often just become part of her daily life. Since there are many possible causes of pelvic pain, pelvic venous insufficiency, also known as pelvic congestion syndrome, can often go undiagnosed or ignored – leaving women stuck with constant feelings of general discomfort, painful pressure in the pelvic area, difficulty standing for long intervals, and a constant feeling of heaviness or fullness in the abdomen or pelvis. She may even suffer from hemorrhoids (swollen veins in the lower rectum) as a result.

“Because there are so many different sources for chronic pelvic pain, many providers shy away from treating it,” explained Dr. Jamie Doster, chair of Interventional and Vascular Radiology at Raleigh Radiology. “It’s a hard condition to diagnose and therefore, patients are often left without answers or options.”

However, Dr. Doster and her interventional radiology colleagues at Raleigh Radiology are committed to helping women who suffer from chronic pelvic pain find long-term relief.

Pelvic Venous Insufficiency as a Cause for Chronic Pelvic Pain

Pelvic congestion syndrome (PCS), medically known as pelvic venous insufficiency, can often be the cause for chronic pelvic pain. PCS is an abnormality in some women where the veins that drain blood from the pelvis are dilated and create blood flow in the wrong direction (away from the heart). This results in increased pressure and swelling in those pelvic veins, much like the varicose veins some women suffer from in the legs.

The only way to know for sure if a patient is suffering from PCS is through an imaging study such as a CT scan. The challenging part is that approximately four out of 10 women who have PCS don’t have any symptoms.

“To accurately diagnose PCS, you have to confirm that both the patient has symptoms and the imaging study must determine the condition is present,” explained Dr. Doster. “Our success in improving a patient’s symptoms is based on our ability to prove both. In other words, treatment will not work if PCS is not the source of the patient’s pain.”

Diagnostic studies offered by interventional radiologists like Dr. Doster greatly increase the chances that treatment will be effective. Often, a patient with pelvic pain will see a radiologist when her gynecologist has been unable to find the reason for her discomfort using other tests or assessments, such as hysteroscopy, a procedure where a gynecologist looks inside the uterus to investigate abnormal bleeding or check for endometriosis.

“Many patients are not even referred to us by their gynecologist,” added Dr. Doster. “They have often done their own research online and feel PCS could be affecting them.”

Ovarian Vein Embolization: A Minimally-Invasive Option to Treat PCS

Treatment options include ovarian vein embolization, a minimally invasive, non-surgical procedure performed in the hospital, where a radiologist uses a catheter to close off the faulty or abnormal veins. Locally, it’s performed at both the WakeMed Raleigh Campus and WakeMed Cary Hospital. This procedure essentially removes the abnormal veins from the circuit of pelvic blood flow, and the blood is then rerouted through the healthy veins. The abnormal veins are coil embolized using image guidance, contrast fluid and a catheter. Through the catheter, an embolic agent is inserted to treat the veins. All of this is performed through a tiny incision in the patient’s neck or groin.

However, before a patient can receive ovarian vein embolization, she must first complete a series of other steps for PCS diagnosis. She will start by meeting with a radiologist for a pre-procedure consultation where her symptoms and quality of life are assessed. From there, an imaging study, such as a CT scan, will help the radiologist examine the anatomy of the patient’s pelvis and pelvic veins.

Finally – prior to the ovarian vein embolization, a pelvic venogram is required. This is where a catheter is inserted into the pelvic veins with a wire, and contrast fluid is used to confirm the diagnosis and help the radiologist get a better look at the veins prior to the embolization procedure. It is a same-day, minimally invasive procedure using a tiny incision in the neck or groin that allows the radiologist to take pressure measurements of the pelvic veins. The venogram and the ovarian vein embolization can be done together or separately, depending on the patient’s preference and/or insurance coverage. This will also be discussed during the pre-procedure consultation.

Recovering from Ovarian Vein Embolization & Enjoying the Results

After an ovarian vein embolization, a patient is typically discharged on the same day. Patients may experience mild discomfort, nausea, low-grade fever and/or cramping in the days after the procedure, which can typically be treated with ibuprofen. According to Dr. Doster, about 80 percent of patients can experience significant improvement in pelvic pain after undergoing an ovarian vein embolization.

“It’s remarkable that we can treat our PCS patients with an option that doesn’t require surgery. They can potentially be home recovering on the same day and then experience long-term benefits and symptom relief from this innovative non-surgical procedure,” added Dr. Doster. “It’s so rewarding to know we can help women suffering from pelvic congestion truly improve their quality of life.”

To learn more about Dr. Doster and Raleigh Radiology, visit www.raleighrad.com.

Source:

RadiologyInfo.org: www.radiologyinfo.org

Jamie Doster, MD Vascular & Interventional Radiologist Raleigh, NC

Jamie Doster, MD

Chair, Interventional and Vascular Radiology, Interventional and Vascular Radiologist

  • BS, Florida State University
  • MD, Florida State University College of Medicine
  • Internship, Greenville Memorial Hospital, Greenville, S.C.
  • Residency, University of Virginia, Charlottesville, VA
  • Fellowship in Vascular and Interventional
  • Radiology, University of Virginia
  • Member, Society of Interventional Radiology
  • Member, American College of Radiology
  • Member, Radiological Society of North America

Expertise in Interventional Radiology

Joined Raleigh Radiology in 2016

The Bright Future of PET Imaging

December 16, 2020 in 2020 Learn Posts

The Bright Future of PET Imaging
– Using Hybrid PET/CT Scanning to Target & Treat Specific Types of Cancer

A critical weapon in the fight against cancer is having a detailed and accurate diagnosis.  Therefore, it’s not surprising that hybrid PET/CT (positron emission tomography/computerized tomography) scan technology is now essential to detecting and diagnosing different types of cancer.  Radiologists can see things on a PET/CT scan that typically cannot be found using traditional CT scan or MRI imaging alone. While CT shows the location, size and shape of a potentially cancerous growth, PET scan can actually show if a tumor or growth is malignant.  This is credited to the use of radioactive imaging agents, such as fluorodeoxyglucose F 18, or FDG, which can detect metabolic activity indicative of cancer.

FDG – The Workhorse of PET Scan Technology
Known as the workhorse of PET imaging, FDG was the first imaging tracer to receive approval from the U.S. Food & Drug Administration (FDA) and is widely used for oncology imaging.  FDG is a radioactive molecule that is similar to glucose.  It is injected into the body and travels to areas of highest metabolism, helping radiologists discern metabolic abnormalities when the body is scanned.  This is important because cancerous growths and tumors have a very high metabolic rate.  FDG accumulates in the body’s neoplasm (new or abnormal tissue growth) and then provides a map to where a primary tumor is located as well as areas of metastatic disease.

“It’s a tremendously exciting time to be part of a new PET/CT practice,” shared Dr. Andrew Moran, chair of Nuclear Medicine and a nuclear medicine/PET imaging radiologist at Raleigh Radiology.  He and his team have worked tirelessly to bring hybrid PET/CT to the practice.  “Combined PET/CT scanning is an incredible tool to support oncologists in making sound treatment decisions for their patients. Playing a role in helping cancer patients get the best care possible is very rewarding.”

New Radiopharmaceuticals Emerge to Image Specific Cancers
PET/CT can be used to help diagnose many different types of cancers, including neuroendocrine cancers, prostate cancer, lung cancer, breast cancer, gastric cancer, and cancers of the head and neck.  According to the American Cancer Society, a PET/CT scan with FDG, most often used for diagnosing lung cancer and detecting if the cancer has spread.  However, over the past six-plus years, radiopharmaceutical scientists have also been working to develop new PET imaging agents that are specifically targeted for detecting certain types and sub-types of cancer.

“PET imaging is really just in its infancy stage now,” explained Dr. Moran.  “In 20 to 30 years, the field is on target for a revolution that will introduce many new, more specific radiotracers – we will be able to track tumors and metastatic disease better than we ever have in the past.”

For example, gallium-68 DOTATATE is being used to diagnose neuroendocrine cancers with great sensitivity and specificity.  Meanwhile, Axumin® (fluciclovine F 18) has already received FDA approval in the United States for metastatic prostate cancer by tracking rising prostate-specific antigen (PSA) levels.  Additionally, gallium-68 PMSA (prostate-specific membrane antigen) just recently received FDA approval, although it isn’t yet commercially available.  It’s an even more specific tracing agent for metastatic prostate cancer.

“Urologists are really excited about these new tracers and the opportunity to order these scans when they become available,” explained Dr. Moran. “Historically, no good imaging method for metastatic prostate cancer has ever been available, we’ve been relying on bone and CT scans.” 

For breast cancer imaging, the radiopharmaceutical Cerianna™ (fluoroestradiol F 18) just recently received FDA approval and can be used specifically for patients with estrogen receptor positive cancer; looking for the metastatic or recurring disease in these patients.  

“It’s amazing that a radiotracer can be targeted for this specific sub-type of breast cancer.  It will have an immense impact on detection and treatment decisions for breast cancer patients,” added Dr. Moran.  “Additionally, new tracers will be developed in the next several years for specific sub-types of lung cancer and GI tract cancers, making the process to track these diseases even more sophisticated as well.”

Theranostics – Using Radiotracers to Treat Cancer
Meanwhile, to peek further into the future, a new field has developed within PET imaging called theranostics.  In addition to being able to image tumors with PET imaging agents, radiologists will soon be able to use those tracers to treat cancer as well.  This will be done by attaching a radioactive particle to the imaging agent.  For example, a radiologist will use gallium-68 DOTATATE to image a patient and detect metastatic disease, then will follow up with an IV injection of lutetium (radioactive element) DOTATATE and actually ablate the tumor.  Currently, scientists are developing approximately 25 different theranostics agents to pair with PET imaging agents for cancer treatment.

“Actually being able to treat cancer based on the imaging agent is a real gamechanger,” said Dr. Moran.  “It’s a fascinating time in the field of PET because of the future and where all of this is headed for patient care.” 

Raleigh Radiology and WakeMed Health & Hospitals introduced a new hybrid PET/CT scanner in February 2021. 

References

Stanford Health Care: Advantages of a PET/CT Scan

National Cancer Institute: Radiopharmaceuticals – Radiation Therapy Enters the Molecular Age

Physics World: New PET tracers show immense promise in cancer imaging

American Cancer Society: Tests for Lung Cancer

Andrew Moran, MD Nuclear Medicine, Chair & Radiation Safety Officer Raleigh, NC

Andrew Moran, MD

Chair, Nuclear Medicine, Radiation Safety Officer, Nuclear Medicine/PET and Abdominal Imaging Radiologist

  • BS, Idaho State University
  • MD, Utah School of Medicine
  • Residency, Duke University Medical Center
  • Fellowships in body imaging and nuclear radiology, Duke University Medical Center
  • Member, Society of Nuclear Medicine
  • Native of California

Expertise in abdominal imaging, oncologic imaging, nuclear medicine and PET/CT

Joined Raleigh Radiology in 2006

Too Much Elbow Grease? The Causes, Treatment & Rold of MRI for Elbow Pain

December 8, 2020 in 2020 Learn Posts, Pendergrast Blog Post

Too Much Elbow Grease?
The Causes, Treatment & Role of MRI for Elbow Pain

“Just give it a little more elbow grease!”  We’ve all heard this expression before as a playful way to refer to hard work.  But as we get older, many of us realize how much sense it actually makes.  We use our elbows for all sorts of activities, work-related and recreational.  Therefore, it’s no surprise that elbow pain is a common condition found in adults who are 30 to 40-plus years of age, due to repetitive overuse.  Sports like golf, tennis and other racquet sports, and occupations such as painting, carpentry and plumbing are usually the culprits. 

Elbow Pain and Epicondylitis
The common cause of elbow pain is medically referred to as epicondylitis, and there are two types that occur.

  • Medial epicondylitis – or golfer’s elbow – occurs on the inside of the elbow and affects the common flexor tendon and muscles in the forearm that contribute to moving the wrist and fingers.
  • Lateral epicondylitis – or tennis elbow – occurs in the outer elbow, where the common extensor tendon attaches the forearm muscle to the elbow bone.

Both types of epicondylitis develop gradually and create a dull and achy type of pain or soreness in the elbow.  Dr. Thomas Pendergrast, a musculoskeletal radiologist with Raleigh Radiology, is well-acquainted with elbow pain, both as doctor and patient. 

“I have golfer’s elbow myself … from playing tennis,” he shared.  “Back in the 1800s [when they coined the phrase], different equipment was used for tennis which affected the lateral tendons and muscles.  In today’s game, tennis is more stressful on the medial elbow.”

Conservative Measures Come First in Treating Elbow Pain
Regardless if you are a tennis player suffering from golfer’s elbow, or a golfer suffering from tennis elbow, medical intervention is probably needed to relieve the pain, especially if your elbow is feeling tender to the touch. 

A good first step is to visit your primary care physician or orthopaedist where your condition can be evaluated based upon a physical exam and an understanding of your activities and history.  Dr. Pendergrast explained that if the symptoms and exam fit epicondylitis, your doctor will likely first recommend three to six months of conservative measures for the cessation of pain. 

Conservative measures include:

  • Anti-inflammatory medications
  • Icing after activity
  • Corticosteroid injections in the elbow, given by an orthopaedist
  • Activity modification
  • Physical therapy exercises, which can be done at home

Using MRI to Evaluate Persistent Elbow Pain
If conservative treatment measures are not successful and the symptoms of elbow pain continue, an MRI (short for Magnetic Resonance Imaging) is likely the next step. The elbow MRI is relatively simple and is a highly effective method for diagnosing elbow pain.  The scan takes approximately 20 minutes and can be done without contrast fluid. After interpreting the images, a radiologist will report back to the patient’s referring physician.

“The sensitivity of MRI for detection of epicondylitis is nearly 100 percent,” explained Dr. Pendergrast.  “With elbow pain, MRI findings and clinical findings tend to correlate nicely, making this condition readily identifiable – which is very helpful when it comes to determining the best treatment plan.  I find it very satisfying to be able to use MRI to give patients a clear answer about their pain.”

MRI can determine the severity of epicondylitis, for example, whether the tendon is thickening or inflamed, or if there is a tear in the tendon.  Tears can even be quantified using MRI to determine if surgical repair is needed.  MRI can also identify other abnormalities associated with elbow pain, such as nerve entrapment syndrome (when the nerves around the elbow are being compressed or squeezed) and osteoarthritis.  To an orthopaedic surgeon, a patient’s MRI results are often critical for surgical planning.

Does an MRI Always Mean Surgery?
Receiving an MRI for elbow pain does not always mean surgery is necessary.  As Dr. Pendergrast also explained, “The severity of a tendon tear can be present on a spectrum, from low-grade to more severe.  For example, I have tendinosis, a lower grade condition, and can keep it under control myself with the correct exercises.”   

Tendinosis is a chronic, degenerative condition that can occur in the elbow tendons, typically due to overuse.  This can increase the risk of a higher-grade tear but can also be managed with conservative measures such as activity modification, wearing a brace, consistent and correct exercises, strength training, nutrition and even massage. 

However, high-grade tendon tears may require surgery, especially if there is associated ligamentous injury, which can also be seen on MRI.  For this reason, it is important to see your doctor if you are experiencing elbow pain that is affecting daily activities.  Proper treatment is needed to help resolve the pain and prevent further deterioration. 

To learn more about Raleigh Radiology, visit https://www.raleighrad.com/.

Resources

Healthline

https://www.healthline.com/health/nerve-compression-syndrome

https://www.healthline.com/health/tendonosis#outlook

OrthoInfo – American Academy of Orthopaedic Surgeons

https://orthoinfo.aaos.org/

Thomas Pendergrast, MD

Musculoskeletal Radiologist, MQSA-Certified Breast Radiologist

  • BA – Chemistry: Wake Forest University
  • MD: Wake Forest School of Medicine
  • Internship – Internal Medicine: University of Tennessee Health Science Center
  • Residency – Radiology: Wake Forest Baptist Medical Center
  • Fellowship – Musculoskeletal Radiology – Wake Forest Baptist Medical Center
  • Member: American College of Radiology, American Medical Association, Radiological Society of North America, Society of Nuclear Medicine
  • Native of Wilmington, North Carolina

Interests: Diagnostic musculoskeletal imaging, image-guided musculoskeletal procedures

Joined Raleigh Radiology in 2020

A Joint Effort for Effective Pain Relief

December 7, 2020 in 2020 Learn Posts

A Joint Effort for Effective Pain Relief

Image-Guided Steroid/Anesthetic Injections to Treat Chronic Joint Pain
Osteoarthritis and chronic joint pain impact more than 25 million Americans. If you’re a sufferer, you know how this pain can hinder your daily life – holding you back from your normal, daily activities.  Maybe you’ve had to give up walking or golfing with friends because your ankles or knees won’t allow you to keep up.  Maybe it has become too difficult to play with your children or grandchildren because your joints continue to ache.  Or maybe your yard and garden have suffered because mowing grass, weeding and trimming hedges are impossible with pain in your shoulders, elbows or wrists.

Acute and chronic joint pain are common conditions that can certainly put a damper on life.  Often this type of pain is caused by an acute inflammatory process or trauma – such as a sports or overuse injury – or a chronic, degenerative disorder such as rheumatoid arthritis or osteoarthritis.  It may be that you have already tried conservative therapy for your pain, such as over-the-counter medication, physical therapy, massage, heat packs, stretching and/or even acupuncture, but nothing seems to work.  Fortunately, there is another option that doesn’t involve having surgery.

The Benefits of Image-Guided Steroid/Anesthetic Joint Injections
For chronic joint pain sufferers, steroid injections can provide fast and long-lasting relief. These injections typically comprise of a short-acting anesthetic and long-acting corticosteroid – which allows patients to feel relief almost instantly.  It’s a safe and effective pain relief method that comes with minimal side effects. While these injections are often given by orthopedic doctors, rheumatologists or even in some cases, primary care physicians – there are benefits to having the treatment administered by a radiologist who has image-guided technology at their fingertips.

Using ultrasound or low dose real time x-ray imaging called fluoroscopy, a radiologist can see directly into the joint to ensure the treatment is placed correctly every time. Image-guided joint injection therapy can also be used to diagnose the site of pain, control pain in non-surgical candidates, diminish pain to allow patients to begin physical therapy or exercise, and eliminate or delay surgical intervention. 

“Radiologists will always use image guidance to confirm that the injection is going directly into the affected joint – where it will have the greatest impact,” explained Dr. Jeffrey Browne, a musculoskeletal radiologist with Raleigh Radiology.  “X-ray guidance allows us to see inside the body in real-time, leading directly to the appropriate treatment location. This more exact science has been shown to have better outcomes compared to blind injections.  It’s quick, more accurate, more effective and reduces risk of complications.”

The Joint Injection Appointment – Quick and Easy
From start to finish, a patient having joint injection therapy will likely spend less than 30 minutes in the radiology office.  He or she will lie down on a table and be prepped for the procedure by a radiologic technician.  A musculoskeletal radiologist, like Dr. Browne, will then enter the room and discuss the procedure with the patient.  He or she will confirm the correct joint for treatment and also explain the risks and benefits of the injection, before sterilizing and draping the injection site and applying a local anesthetic. 

Once confirming the needle is in the correct location by ultrasound or fluoroscopy, the radiologist will inject a short-acting anesthetic and an intermediate to long-acting corticosteroid into the joint.   Complications are infrequent.

Immediate Pain Relief and Long-Term Results
In general, a patient will feel immediate relief of his or her symptoms but may be sore for one or two days after the injection until the long-term steroid becomes effective.  Patients with an acute inflammatory condition or trauma may only need one injection, however, patients with arthritis or chronic conditions may need multiple injections.  Three to four injections can be given per year and they typically provide three to six months of pain relief.

“As musculoskeletal radiologists, we are well-trained in performing these injections for multiple joints, including shoulders, elbows, wrists, hips, knees, ankles and feet,” added Dr. Browne.  “During each appointment, I enjoy the opportunity for facetime with my patients as well as the ability to relieve their pain using such a simple procedure.”

If you have been experiencing persistent joint pain and feel image-guided injections may be the right option for you, speak with your primary care physician, orthopedist or rheumatologist, or contact our office directly today: (919) 781-1437.

Jeffrey Browne, MD, Raleigh Radiology MSK Chair Raleigh, NC

Jeffrey Browne, MD

Chair, Musculoskeletal Imaging, Medical Director Raleigh Radiology

  • Medical Director, Raleigh Radiology
  • BS, Boston College
  • MD, University of Connecticut School of Medicine
  • Internship, St. Raphael’s Hospital
  • Residency, Duke University Medical Center
  • Fellowship in musculoskeletal radiology, Duke University Medical Center
  • Member, American College of Radiology, Radiological Society of North America and American Roentgen Ray Society.
  • Native of Connecticut

Interests: Musculoskeletal imaging

Joined Raleigh Radiology in 2008