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Hoang, Jenny K.

Overview:

Dr. Jenny K. Hoang MBBS is a neuroradiologist and Associate Professor in Radiology and Radiation Oncology at Duke University, NC USA where she is the Director of Head and Neck Radiology and Chair of the Grand Rounds Committee. Her career is accentuated by her strong involvement in research and education. She led the American College of Radiology (ACR) efforts in producing a White Paper on Incidental Thyroid Findings and was a core member of the ACR TI-RADS committee for thyroid ultrasound. She also serves on the National Cancer Institute PDQ Screening and Prevention Editorial Board.


She has published more than 110 peer-reviewed articles with a focus on thyroid and parathyroid imaging. Dr. Hoang was the recipient of GE-Radiology Research Academic Fellowship (GERRAF) Program (2010-2012) and ACR Innovations Grant (2017). She is a popular a faculty lecturer at national and international meetings. She is also actively educating and advocating on Twitter. Connect with her at @JennyKHoang.

Positions:

Associate Professor of Radiology

Radiology, Neuroradiology
School of Medicine

Associate Professor in Radiation Oncology

Radiation Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.B.B.S. 1999

M.B.B.S. — University of Melbourne (Australia)

Grants:

Incidental Thyroid Nodules Detected in the National Lung Screening Trial:

Administered By
Radiology
AwardedBy
American Society of Head and Neck Radiology
Role
Advisor
Start Date
July 01, 2014
End Date
June 30, 2015

Publications:

Biopsy of enlarging lesions after stereotactic radiosurgery for brain metastases frequently reveals radiation necrosis.

Stereotactic radiosurgery (SRS) offers excellent local control for brain metastases (BM) with low rates of toxicity. Radiation necrosis (RN) may occur after treatment and is challenging to distinguish from local recurrence (LR). We evaluated enlarging brain lesions following SRS that were subsequently biopsied to differentiate RN versus LR.This study reviewed patients receiving SRS for BM between 2008 and 2012 who underwent a biopsy for suspicion of RN versus LR on MRI. Data collection included demographics, radiation parameters, imaging findings, and post-biopsy pathology. Kaplan-Meier methods determined overall survival. Fisher's exact test assessed for association between lesion biopsy result and variables of interest.Thirty-four patients with 35 biopsied BM were included. Lesions were biopsied a median of 8.8 months after SRS. Most patients had primary lung cancer (11; 31.4%). Eleven (31.4%) biopsies were positive for LR and 24 (68.6%) showed RN only. Median overall survival was longer for patients with RN (31.0 mo) than for patients with LR (14.5 mo; P = 0.135). Time from SRS to biopsy was significantly different between RN and LR groups; 10 lesions (52.5%) biopsied ≤9 months after SRS showed LR, whereas 1 lesion (6.3%) biopsied >9 months after SRS showed LR (P = 0.004). For 16 (65.7%) lesions, management was changed or directed by the biopsy results.Stereotactic biopsy for accessible enlarging lesions after SRS appears diagnostically valuable in patients with few lesions and changes clinical management. RN should be suspected in patients with an enlarging lesion more than 9 months post-SRS.

Authors
Narloch, JL; Farber, SH; Sammons, S; McSherry, F; Herndon, JE; Hoang, JK; Yin, F-F; Sampson, JH; Fecci, PE; Blackwell, KL; Kirkpatrick, JP; Kim, GJ
MLA Citation
Narloch, JL, Farber, SH, Sammons, S, McSherry, F, Herndon, JE, Hoang, JK, Yin, F-F, Sampson, JH, Fecci, PE, Blackwell, KL, Kirkpatrick, JP, and Kim, GJ. "Biopsy of enlarging lesions after stereotactic radiosurgery for brain metastases frequently reveals radiation necrosis." Neuro-oncology 19.10 (October 2017): 1391-1397.
PMID
28472527
Source
epmc
Published In
Neuro-Oncology
Volume
19
Issue
10
Publish Date
2017
Start Page
1391
End Page
1397
DOI
10.1093/neuonc/nox090

Understanding the Risks and Harms of Management of Incidental Thyroid Nodules: A Review.

Incidental thyroid nodules are defined as nodules originally detected in a patient with no thyroid-related clinical symptoms, examination findings, or suspected thyroid disease. Medical imaging for diseases in the neck, chest, and spine is a common source of incidental thyroid nodules. They are easily detected but poorly characterized. The next step is to decide whether the incidental thyroid nodule should be further evaluated with ultrasonography.Indiscriminate workup of incidental thyroid nodules with ultrasonography is not cost-effective and is potentially harmful. Although the concern for malignant neoplasms drives workup, the risk for poor outcomes without evaluation is minimal. The rate of malignant tumors in patients with 1 or more thyroid nodules larger than 5 mm is only 1.6%, and most small thyroid cancers are indolent. Substantial evidence suggests that a reservoir of thyroid cancers does not progress, and workup after detection with imaging leads to epidemiologic overdiagnosis. Finally, a significant proportion of patients with benign nodules have cytologic results that are not definitive and require lobectomy. Evidence-based recommendations for incidental thyroid nodules detected at computed tomography, magnetic resonance imaging, nuclear medicine studies, and extrathyroidal ultrasonography include selection criteria for nodule workup based on suspicious imaging findings, patient age, and nodule size. In the absence of clinical risk factors or suspicious imaging findings, workup with dedicated thyroid ultrasonography is only recommended for nodules at least 1.5 cm in patients 35 years or older and for nodules at least 1.0 cm in patients younger than 35 years.Only a few select incidental thyroid nodules require further evaluation with ultrasonography based on recommendations that aim to diagnose clinically significant thyroid cancers while reducing unnecessary workup and provide guidance for clinical practice.

Authors
Hoang, JK; Nguyen, XV
MLA Citation
Hoang, JK, and Nguyen, XV. "Understanding the Risks and Harms of Management of Incidental Thyroid Nodules: A Review." JAMA otolaryngology-- head & neck surgery 143.7 (July 2017): 718-724. (Review)
PMID
28426843
Source
epmc
Published In
JAMA Otolaryngology - Head and Neck Surgery
Volume
143
Issue
7
Publish Date
2017
Start Page
718
End Page
724
DOI
10.1001/jamaoto.2017.0003

Professional Social Networking in Radiology: Who Is There and What Are They Doing?

Although it is perceived that the use of social media professionally is increasing among radiologists, little is known about the habits and demographics of this subspecialty. This study aims to compare radiologists who use social networking for professional purposes to those who do not with regard to their characteristics, habits, and attitudes.Radiologists were invited by e-mail and through posts on social networks to participate in a survey on the use of social media platforms. Questions included type of user, pattern of use, and benefits and barriers. Professional users and professional nonusers were compared.One hundred eighty-six radiologists responded. One hundred ten (59.1%) used social networking for professional purposes, 34 (18.2%) for personal-use only, and 42 (22.6%) denied using social media. LinkedIn was the most common platform among all professional users, and Twitter was the most commonly used platform among highly active professional users. Trainees comprised 52 out of 110 (47.3%) professional social networking users compared to 18 out of 76 (23.7%) nonusers (P < 0.01). A subgroup analysis on Twitter use for professional purposes revealed a significant gender difference: 15 out of 66 (22.7%) professional Twitter users were female compared to 48 out of 120 (40.0%) non-Twitter users (P < 0.05). The greatest barrier to professional social media use for nonusers was confidentiality.Nearly 60% of radiologist respondents use social networking for professional purposes. Radiology is likely to see growth in the role of social networking in the coming years as nearly half of professional users are radiology trainees. Twitter use for professional purposes among radiologists was disproportionately male. It is important to be cognizant of gender imbalance and to improve visibility of female leaders on social networking.

Authors
Patel, SS; Hawkins, CM; Rawson, JV; Hoang, JK
MLA Citation
Patel, SS, Hawkins, CM, Rawson, JV, and Hoang, JK. "Professional Social Networking in Radiology: Who Is There and What Are They Doing?." Academic radiology 24.5 (May 2017): 574-579.
PMID
28153576
Source
epmc
Published In
Academic Radiology
Volume
24
Issue
5
Publish Date
2017
Start Page
574
End Page
579
DOI
10.1016/j.acra.2016.09.026

Add Value in Radiology Reports by Providing a Frame of Reference.

Authors
Hoang, JK
MLA Citation
Hoang, JK. "Add Value in Radiology Reports by Providing a Frame of Reference." Journal of the American College of Radiology : JACR 14.5 (May 2017): 585-586.
PMID
28139413
Source
epmc
Published In
Journal of the American College of Radiology
Volume
14
Issue
5
Publish Date
2017
Start Page
585
End Page
586
DOI
10.1016/j.jacr.2016.11.005

ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee.

Thyroid nodules are a frequent finding on neck sonography. Most nodules are benign; therefore, many nodules are biopsied to identify the small number that are malignant or require surgery for a definitive diagnosis. Since 2009, many professional societies and investigators have proposed ultrasound-based risk stratification systems to identify nodules that warrant biopsy or sonographic follow-up. Because some of these systems were founded on the BI-RADS® classification that is widely used in breast imaging, their authors chose to apply the acronym TI-RADS, for Thyroid Imaging, Reporting and Data System. In 2012, the ACR convened committees to (1) provide recommendations for reporting incidental thyroid nodules, (2) develop a set of standard terms (lexicon) for ultrasound reporting, and (3) propose a TI-RADS on the basis of the lexicon. The committees published the results of the first two efforts in 2015. In this article, the authors present the ACR TI-RADS Committee's recommendations, which provide guidance regarding management of thyroid nodules on the basis of their ultrasound appearance. The authors also describe the committee's future directions.

Authors
Tessler, FN; Middleton, WD; Grant, EG; Hoang, JK; Berland, LL; Teefey, SA; Cronan, JJ; Beland, MD; Desser, TS; Frates, MC; Hammers, LW; Hamper, UM; Langer, JE; Reading, CC; Scoutt, LM; Stavros, AT
MLA Citation
Tessler, FN, Middleton, WD, Grant, EG, Hoang, JK, Berland, LL, Teefey, SA, Cronan, JJ, Beland, MD, Desser, TS, Frates, MC, Hammers, LW, Hamper, UM, Langer, JE, Reading, CC, Scoutt, LM, and Stavros, AT. "ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee." Journal of the American College of Radiology : JACR 14.5 (May 2017): 587-595.
PMID
28372962
Source
epmc
Published In
Journal of the American College of Radiology
Volume
14
Issue
5
Publish Date
2017
Start Page
587
End Page
595
DOI
10.1016/j.jacr.2017.01.046

ACR Appropriateness Criteria® Cerebrovascular Disease.

Diseases of the cerebral vasculature represent a heterogeneous group of ischemic and hemorrhagic etiologies, which often manifest clinically as an acute neurologic deficit also known as stroke or less commonly with symptoms such as headache or seizures. Stroke is the fourth leading cause of death and is a leading cause of serious long-term disability in the United States. Eighty-seven percent of strokes are ischemic, 10% are due to intracerebral hemorrhage, and 3% are secondary to subarachnoid hemorrhage. The past two decades have seen significant developments in the screening, diagnosis, and treatment of ischemic and hemorrhagic causes of stroke with advancements in CT and MRI technology and novel treatment devices and techniques. Multiple different imaging modalities can be used in the evaluation of cerebrovascular disease. The different imaging modalities all have their own niches and their own advantages and disadvantages in the evaluation of cerebrovascular disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Authors
Expert Panel on Neurologic Imaging:, ; Salmela, MB; Mortazavi, S; Jagadeesan, BD; Broderick, DF; Burns, J; Deshmukh, TK; Harvey, HB; Hoang, J; Hunt, CH; Kennedy, TA; Khalessi, AA; Mack, W; Patel, ND; Perlmutter, JS; Policeni, B; Schroeder, JW; Setzen, G; Whitehead, MT; Cornelius, RS; Corey, AS
MLA Citation
Expert Panel on Neurologic Imaging:, , Salmela, MB, Mortazavi, S, Jagadeesan, BD, Broderick, DF, Burns, J, Deshmukh, TK, Harvey, HB, Hoang, J, Hunt, CH, Kennedy, TA, Khalessi, AA, Mack, W, Patel, ND, Perlmutter, JS, Policeni, B, Schroeder, JW, Setzen, G, Whitehead, MT, Cornelius, RS, and Corey, AS. "ACR Appropriateness Criteria® Cerebrovascular Disease." Journal of the American College of Radiology : JACR 14.5S (May 2017): S34-S61.
PMID
28473091
Source
epmc
Published In
Journal of the American College of Radiology
Volume
14
Issue
5S
Publish Date
2017
Start Page
S34
End Page
S61
DOI
10.1016/j.jacr.2017.01.051

Applying Criteria of Active Surveillance to Low-Risk Papillary Thyroid Cancer Over a Decade: How Many Surgeries and Complications Can Be Avoided?

The 2015 American Thyroid Association guidelines acknowledged that "an active surveillance management approach can be considered as an alternative to immediate surgery" in patients with low-risk papillary thyroid carcinoma (PTC). The aim of this study was to determine the proportion of PTC that would meet the criteria for active surveillance and the surgeries and complications that could have been avoided.A total of 681 patients with thyroid cancer who underwent thyroid surgery from 2003 to 2012 were retrospectively reviewed. A decision-making framework for active surveillance was applied to patients with PTC in nodules measuring ≤1.5 cm on ultrasound. Patients were identified as suitable for active surveillance based on imaging and patient characteristics. These patients were reviewed for management and outcomes.PTC was diagnosed based on fine-needle aspiration histology of Bethesda V or VI in thyroid nodules in 243 patients. Of these, 77 patients had nodules measuring ≤1.5 cm on ultrasound, and 56/77 (23%) patients met the criteria for surveillance: 15/243 (6%) patients met the criteria with a ≤1 cm size threshold, and 41/243 (17%) met the criteria with a 1.1-1.5 cm threshold. Of the 56 patients who met the criteria for active surveillance, 52 underwent total thyroidectomy, and four had a lobectomy. Forty-five (80%) patients had elective central nodal dissection, and 14 had nodal metastases on pathology (all <4 mm). Three patients had permanent complications from surgery, including vocal cord paralysis, hypoparathyroidism, and a chipped tooth from intubation. No patients died or had recurrent disease.Future programs in the United States should consider increasing the size threshold for active surveillance of PTC to 1.5 cm, since this will allow up to one quarter of patients to be eligible instead of only 6% with a 1 cm size threshold. Without an active surveillance program, the majority of patients with low-risk cancers have thyroidectomy and carry a small risk of permanent complications.

Authors
Griffin, A; Brito, JP; Bahl, M; Hoang, JK
MLA Citation
Griffin, A, Brito, JP, Bahl, M, and Hoang, JK. "Applying Criteria of Active Surveillance to Low-Risk Papillary Thyroid Cancer Over a Decade: How Many Surgeries and Complications Can Be Avoided?." Thyroid : official journal of the American Thyroid Association 27.4 (April 2017): 518-523.
PMID
28125944
Source
epmc
Published In
Thyroid
Volume
27
Issue
4
Publish Date
2017
Start Page
518
End Page
523
DOI
10.1089/thy.2016.0568

Extrapulmonary Findings and Malignancies in Participants Screened With Chest CT in the National Lung Screening Trial.

The aim of this study was to measure the prevalence of clinically significant extrapulmonary findings on chest CT for lung cancer screening in the National Lung Screening Trial (NLST).Prospectively acquired data on 17,309 participants who underwent low-dose screening chest CT from August 2002 through September 2007 during the NLST were retrospectively analyzed for extrapulmonary findings. NLST radiologist readers coded such findings as "minor" or "potentially significant." On the basis of review of recorded text descriptions, extrapulmonary findings were assigned to five organ groupings (cardiovascular, thyroid, adrenal, renal, and hepatobiliary). Extrapulmonary malignancies diagnosed during screening were also identified from medical and vital status records in the same population. The prevalence rates of organ-specific findings and newly diagnosed extrapulmonary malignancies were calculated. Exemption from human subjects research review was obtained.Extrapulmonary findings were noted in 58.7% of CT-screened participants, and 19.6% had findings coded as potentially significant. The prevalence of potentially significant abnormalities was highest for cardiovascular findings (8.5%), followed by renal (2.4%), hepatobiliary (2.1%), adrenal (1.2%), and thyroid (0.6%) findings. Sixty-seven of 17,309 participants (0.39%) had primary extrathoracic cancers diagnosed during screening. The prevalence of cancers among screened participants was 0.26% (n = 45) for kidney, 0.08% (n = 14) for thyroid, and 0.05% (n = 8) for liver cancers.One in five patients screened with CT for lung cancer will have extrapulmonary findings potentially requiring further evaluation. Indiscriminate workups of incidental extrapulmonary findings could place a significant burden on the health care system with little benefit because extrapulmonary malignancies diagnosed during screening are uncommon. Radiologists reporting screening CT should be familiar with existing recommendations for incidental findings from the ACR white papers.

Authors
Nguyen, XV; Davies, L; Eastwood, JD; Hoang, JK
MLA Citation
Nguyen, XV, Davies, L, Eastwood, JD, and Hoang, JK. "Extrapulmonary Findings and Malignancies in Participants Screened With Chest CT in the National Lung Screening Trial." Journal of the American College of Radiology : JACR 14.3 (March 2017): 324-330.
PMID
28259326
Source
epmc
Published In
Journal of the American College of Radiology
Volume
14
Issue
3
Publish Date
2017
Start Page
324
End Page
330
DOI
10.1016/j.jacr.2016.09.044

Do Not Hedge When There Is Certainty.

Authors
Hoang, JK
MLA Citation
Hoang, JK. "Do Not Hedge When There Is Certainty." Journal of the American College of Radiology : JACR 14.1 (January 2017): 5-.
PMID
27889193
Source
epmc
Published In
Journal of the American College of Radiology
Volume
14
Issue
1
Publish Date
2017
Start Page
5
DOI
10.1016/j.jacr.2016.08.027

Parathyroid 4D-CT: Multi-institutional International Survey of Use and Trends.

Four-dimensional computed tomography (4D-CT) is a new modality for preoperative localization of parathyroid adenomas. We performed a survey study to describe the role and trends in the utilization of 4D-CT. Of 361 radiologists, 200 (55%) reported that 4D-CT was used in their practices. Nineteen (10%) used 4D-CT as the first-line imaging study; 155 (76%) reported that 4D-CT played a secondary role; and 26 (13%) reported that it is performed routinely in combination with ultrasound and scintigraphy. Early adopters of 4D-CT (use for >3 years) were 3 times more likely to use 4D-CT in a first-line role (18%) when compared with radiologists who used 4D-CT for ≤3 years (6%; P < .05). In conclusion, more than half of radiologists perform 4D-CT, and a majority reported that 4D-CT plays a secondary role. However, this role may change, as utilization is increasing and radiologists may follow early adopters, who are more likely to use it as a first-line study.

Authors
Hoang, JK; Williams, K; Gaillard, F; Dixon, A; Sosa, JA
MLA Citation
Hoang, JK, Williams, K, Gaillard, F, Dixon, A, and Sosa, JA. "Parathyroid 4D-CT: Multi-institutional International Survey of Use and Trends." Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 155.6 (December 2016): 956-960.
PMID
27329424
Source
epmc
Published In
Otolaryngology - Head and Neck Surgery
Volume
155
Issue
6
Publish Date
2016
Start Page
956
End Page
960
DOI
10.1177/0194599816655311

Prospective Validation of Two 4D-CT-Based Scoring Systems for Prediction of Multigland Disease in Primary Hyperparathyroidism.

Patients with multigland primary hyperparathyroidism are at higher risk for missed lesions on imaging and failed parathyroidectomy. The purpose of this study was to prospectively validate the ability of previously derived predictive score systems, the composite multigland disease score, and the multiphase multidetector contrast-enhanced CT (4D-CT) composite multigland disease score, to identify patients with a high likelihood of multigland disease.This was a prospective study of 71 patients with primary hyperparathyroidism who underwent 4D-CT and successful parathyroidectomy. The size and number of lesions identified on 4D-CT, serum calcium levels, and parathyroid hormone levels were collected. A composite multigland disease score was calculated from 4D-CT imaging findings and the Wisconsin Index (the product of the serum calcium and parathyroid hormone levels). A 4D-CT multigland disease score was obtained by using the CT data alone.Twenty-eight patients with multigland disease were compared with 43 patients with single-gland disease. Patients with multigland disease had a significantly smaller lesion size (P < .01) and a higher likelihood of having either ≥2 or 0 lesions identified on 4D-CT (P < .01). Composite multigland disease scores of ≥4, ≥5, and 6 had specificities of 72%, 86%, and 100% for multigland disease, respectively. 4D-CT multigland disease scores of ≥3 and 4 had specificities of 74% and 88%.Predictive scoring systems based on 4D-CT data, with or without laboratory data, were able to identify a subgroup of patients with a high likelihood of multigland disease in a prospectively accrued population of patients with primary hyperparathyroidism. These scoring systems can aid in surgical planning.

Authors
Sho, S; Yilma, M; Yeh, MW; Livhits, M; Wu, JX; Hoang, JK; Sepahdari, AR
MLA Citation
Sho, S, Yilma, M, Yeh, MW, Livhits, M, Wu, JX, Hoang, JK, and Sepahdari, AR. "Prospective Validation of Two 4D-CT-Based Scoring Systems for Prediction of Multigland Disease in Primary Hyperparathyroidism." AJNR. American journal of neuroradiology 37.12 (December 2016): 2323-2327.
PMID
27659191
Source
epmc
Published In
American Journal of Neuroradiology
Volume
37
Issue
12
Publish Date
2016
Start Page
2323
End Page
2327
DOI
10.3174/ajnr.a4948

Incidental Findings on Imaging: Omit or Provide Recommendations.

Authors
Hoang, JK
MLA Citation
Hoang, JK. "Incidental Findings on Imaging: Omit or Provide Recommendations." Journal of the American College of Radiology : JACR 13.10 (October 2016): 1170-.
PMID
27570132
Source
epmc
Published In
Journal of the American College of Radiology
Volume
13
Issue
10
Publish Date
2016
Start Page
1170
DOI
10.1016/j.jacr.2016.06.048

Reply to "Thyroid Nodule Characterization Using Combined Fine-Needle Aspiration and (99m)Tc-Sestamibi Scintigraphy Strategy".

Authors
Yerubandi, V; Hoang, JK
MLA Citation
Yerubandi, V, and Hoang, JK. "Reply to "Thyroid Nodule Characterization Using Combined Fine-Needle Aspiration and (99m)Tc-Sestamibi Scintigraphy Strategy"." AJR. American journal of roentgenology 207.2 (August 2016): W22-.
PMID
27447344
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
207
Issue
2
Publish Date
2016
Start Page
W22
DOI
10.2214/ajr.16.16228

Avoid "Short-Term": Use Units of Time for Follow-Up Recommendations.

Authors
Hoang, JK
MLA Citation
Hoang, JK. "Avoid "Short-Term": Use Units of Time for Follow-Up Recommendations." Journal of the American College of Radiology : JACR 13.8 (August 2016): 893-.
PMID
27493087
Source
epmc
Published In
Journal of the American College of Radiology
Volume
13
Issue
8
Publish Date
2016
Start Page
893
DOI
10.1016/j.jacr.2016.05.003

Deep Neck Fibromatosis After Diskectomy and Cervical Fusion: Case Series and Review of the Literature.

The objective of our study was to report head and neck deep fibromatosis as part of the differential diagnosis of a firm painful neck mass after cervical fusion and diskectomy.Although they are rare tumors, fibromatosis tumors or desmoid tumors should be considered in a patient with a painful neck mass; a history of cervical spine surgery; and MRI findings showing a large, avidly enhancing, heterogeneous mass adjacent to surgical hardware that is hyperintense on T2-weighted imaging.

Authors
Lacayo, EA; Glastonbury, CM; Hoang, JK; Magliocca, KR; Hill, KL; Hudgins, PA
MLA Citation
Lacayo, EA, Glastonbury, CM, Hoang, JK, Magliocca, KR, Hill, KL, and Hudgins, PA. "Deep Neck Fibromatosis After Diskectomy and Cervical Fusion: Case Series and Review of the Literature." AJR. American journal of roentgenology 206.5 (May 2016): 1068-1072. (Review)
PMID
26914791
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
206
Issue
5
Publish Date
2016
Start Page
1068
End Page
1072
DOI
10.2214/ajr.15.14864

Parathyroid 4D CT and Scintigraphy: What Factors Contribute to Missed Parathyroid Lesions?

To determine the prevalence of missed lesions for parathyroid 4-dimensional computed tomography (4D CT) and scintigraphy and to describe the factors leading to missed lesions for both modalities.Case series with chart review.Single center, hospital based.Forty patients undergoing 4D CT and scintigraphy before parathyroidectomy between July 2009 and October 2013 were included. Radiology reports and imaging were reviewed and correlated with operative notes to identify cases with missed lesions and the reasons for those misses. All lesions were then classified according to the following factors: multigland disease, lesion size, patient body weight, and multinodular goiter.Of the 40 patients, 6 had multigland disease, resulting in 51 lesions; 12 and 29 lesions were missed on 4D CT and scintigraphy, respectively. The sensitivity for detection of all lesions was 76% for 4D CT and 43% for scintigraphy. Sensitivities for single-gland disease were 88% for 4D CT and 50% for scintigraphy. Sensitivities for multigland disease were 53% for 4D CT and 24% for scintigraphy. Rates of multigland disease in patients with missed lesions were 75% on 4D CT and 48% on scintigraphy, as compared with patients with detected lesions, 23% and 18%, respectively (P ≤ .04). Mean weight of lesions missed on 4D CT was 0.3 and 0.6 g in detected lesions (P = .15). Mean weight of lesions missed on scintigraphy was 0.4 and 0.8 g in detected lesions (P = .03).4D CT has higher sensitivity than scintigraphy. Missed lesions are more likely to occur with multigland disease for both modalities and in smaller lesions for scintigraphy.

Authors
Galvin, L; Oldan, JD; Bahl, M; Eastwood, JD; Sosa, JA; Hoang, JK
MLA Citation
Galvin, L, Oldan, JD, Bahl, M, Eastwood, JD, Sosa, JA, and Hoang, JK. "Parathyroid 4D CT and Scintigraphy: What Factors Contribute to Missed Parathyroid Lesions?." Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 154.5 (May 2016): 847-853.
PMID
26932954
Source
epmc
Published In
Otolaryngology - Head and Neck Surgery
Volume
154
Issue
5
Publish Date
2016
Start Page
847
End Page
853
DOI
10.1177/0194599816630711

Keep "As Above" Out of the Impression.

Authors
Hoang, JK
MLA Citation
Hoang, JK. "Keep "As Above" Out of the Impression." Journal of the American College of Radiology : JACR 13.5 (May 2016): 490-.
PMID
26908393
Source
epmc
Published In
Journal of the American College of Radiology
Volume
13
Issue
5
Publish Date
2016
Start Page
490
DOI
10.1016/j.jacr.2016.01.003

If There Is No Change, Just Say So.

Authors
Hoang, JK
MLA Citation
Hoang, JK. "If There Is No Change, Just Say So." Journal of the American College of Radiology : JACR 13.3 (March 2016): 236-.
PMID
26681165
Source
epmc
Published In
Journal of the American College of Radiology
Volume
13
Issue
3
Publish Date
2016
Start Page
236
DOI
10.1016/j.jacr.2015.10.017

Incidental Thyroid Nodules at Non-FDG PET Nuclear Medicine Imaging: Evaluation of Prevalence and Malignancy Rate.

The purpose of this study was to estimate the prevalence of thyroid nodules detected incidentally on non-FDG PET nuclear medicine imaging studies, the malignancy rate, and predictors of malignancy.A retrospective review of more than 10 years of patient records at an academic medical center identified the cases of 31 patients with incidental focal radiotracer-avid thyroid findings on non-FDG PET nuclear medicine studies who underwent biopsy or surgical excision. Statistical analysis of patient and imaging features was performed to identify features predictive of malignancy. Society of Radiologists in Ultrasound and American Thyroid Association biopsy criteria were applied to patients who had ultrasound images for review.Thirty-one patients had incidental thyroid findings on (99m)Tc-sestamibi parathyroid scans (80.6%), (111)In-pentetreotide scans (16.1%), and (99m)Tc-tetrofosmin cardiac scans (3.2%). These three types of scans accounted for 21,402 total examinations in the study period. Thus, the prevalence of incidental thyroid findings on non-PET nuclear medicine studies that were evaluated by pathologic examination was 0.14%. The malignancy rate was 16.1% (5/31). No clinical or imaging features were identified as predictive of malignancy. Society of Radiologists in Ultrasound and American Thyroid Association criteria were applied to 23 thyroid nodules with available ultrasound images. According to both sets of criteria, biopsy was recommended for 19 of 23 (82.6%) nodules, and one of three (33.3%) cases of thyroid cancer was missed.Most thyroid nodules incidentally detected on non-FDG PET nuclear medicine studies are detected on (99m)Tc-sestamibi parathyroid scans and (111)In-pentetreotide scans. Because these nodules are extremely rare and the malignancy rate is high, further evaluation of incidental focal radiotracer-avid thyroid findings with ultrasound is an appropriate recommendation.

Authors
Yerubandi, V; Chin, BB; Sosa, JA; Hoang, JK
MLA Citation
Yerubandi, V, Chin, BB, Sosa, JA, and Hoang, JK. "Incidental Thyroid Nodules at Non-FDG PET Nuclear Medicine Imaging: Evaluation of Prevalence and Malignancy Rate." AJR. American journal of roentgenology 206.2 (February 2016): 420-425.
PMID
26797373
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
206
Issue
2
Publish Date
2016
Start Page
420
End Page
425
DOI
10.2214/ajr.15.15192

Reducing Patient Radiation Exposure From CT Fluoroscopy-Guided Lumbar Spine Pain Injections by Targeting the Planning CT.

CT fluoroscopy-guided lumbar spine pain injections typically include a preprocedural planning CT that contributes considerably to patient dose. The purpose of this study was to quantify the degree of radiation exposure reduction achieved by modifying only the planning CT component of the examination.A retrospective review was performed of 80 CT fluoroscopy-guided lumbar spine injections. Forty patients were scanned with a standard protocol using automatic tube current modulation (method A). Another 40 patients were scanned using a new technique that fixed the tube current of the planning CT to either 50 or 100 mA on the basis of the patient's anteroposterior diameter and that reduced the z-axis coverage (method B). Dose-length products (DLPs) were compared for the two methods.The mean maximal tube current for the planning CT was 435.0 mA for method A and 67.5 mA for method B. The mean z-axis was shorter for method B at 6.5 cm than for method A at 9.6 cm (p < 0.0001). The mean DLP for the planning CT was 11 times lower for method B than for method A: 27.9 versus 313.1 mGy × cm, respectively (p < 0.0001). When method B was used, the mean DLP for the total procedure (i.e., planning CT plus CT fluoroscopy components) was reduced by 78%. There was no significant difference between methods A and B in CT fluoroscopy time (p = 0.37). All procedures were technically successful.A nearly fivefold reduction in radiation exposure can be achieved in CT fluoroscopy-guided lumbar spine pain injections through modifications to the planning CT alone.

Authors
Amrhein, TJ; Schauberger, JS; Kranz, PG; Hoang, JK
MLA Citation
Amrhein, TJ, Schauberger, JS, Kranz, PG, and Hoang, JK. "Reducing Patient Radiation Exposure From CT Fluoroscopy-Guided Lumbar Spine Pain Injections by Targeting the Planning CT." AJR. American journal of roentgenology 206.2 (February 2016): 390-394.
PMID
26797369
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
206
Issue
2
Publish Date
2016
Start Page
390
End Page
394
DOI
10.2214/ajr.15.14436

Extramucosal spaces of the head and neck

© Springer International Publishing Switzerland 2016. The extramucosal head and neck consists of several distinct spaces bounded by fascia [1, 2]. Knowing the anatomy of these spaces and their contents helps the radiologist to describe and correctly diagnose pathology. Some neck diseases are incidental findings while others are large enough to pres ent as a palpable mass. Other diseases are not large, but in a location that leads to symptoms of ear pain, ear pressure/fullness, tinnitus, dysphagia, or cranial nerve palsies.

Authors
Loevner, LA; Hoang, JK
MLA Citation
Loevner, LA, and Hoang, JK. "Extramucosal spaces of the head and neck." Diseases of the Brain, Head and Neck, Spine 2016-2019: Diagnostic Imaging. January 1, 2016. 169-176.
Source
scopus
Publish Date
2016
Start Page
169
End Page
176
DOI
10.1007/978-3-319-30081-8_19

Caution Against Overinvestigation of Small Thyroid Nodules.

Authors
Hoang, JK; Seidenwurm, D
MLA Citation
Hoang, JK, and Seidenwurm, D. "Caution Against Overinvestigation of Small Thyroid Nodules." JAMA otolaryngology-- head & neck surgery 142.1 (January 2016): 102-103. (Letter)
PMID
26660336
Source
epmc
Published In
JAMA Otolaryngology - Head and Neck Surgery
Volume
142
Issue
1
Publish Date
2016
Start Page
102
End Page
103
DOI
10.1001/jamaoto.2015.2905

Thyroid Ultrasound Reporting Lexicon: White Paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee.

Ultrasound is the most commonly used imaging technique for the evaluation of thyroid nodules. Sonographic findings are often not specific, and definitive diagnosis is usually made through fine-needle aspiration biopsy or even surgery. In reviewing the literature, terms used to describe nodules are often poorly defined and inconsistently applied. Several authors have recently described a standardized risk stratification system called the Thyroid Imaging, Reporting and Data System (TIRADS), modeled on the BI-RADS system for breast imaging. However, most of these TIRADS classifications have come from individual institutions, and none has been widely adopted in the United States. Under the auspices of the ACR, a committee was organized to develop TIRADS. The eventual goal is to provide practitioners with evidence-based recommendations for the management of thyroid nodules on the basis of a set of well-defined sonographic features or terms that can be applied to every lesion. Terms were chosen on the basis of demonstration of consistency with regard to performance in the diagnosis of thyroid cancer or, conversely, classifying a nodule as benign and avoiding follow-up. The initial portion of this project was aimed at standardizing the diagnostic approach to thyroid nodules with regard to terminology through the development of a lexicon. This white paper describes the consensus process and the resultant lexicon.

Authors
Grant, EG; Tessler, FN; Hoang, JK; Langer, JE; Beland, MD; Berland, LL; Cronan, JJ; Desser, TS; Frates, MC; Hamper, UM; Middleton, WD; Reading, CC; Scoutt, LM; Stavros, AT; Teefey, SA
MLA Citation
Grant, EG, Tessler, FN, Hoang, JK, Langer, JE, Beland, MD, Berland, LL, Cronan, JJ, Desser, TS, Frates, MC, Hamper, UM, Middleton, WD, Reading, CC, Scoutt, LM, Stavros, AT, and Teefey, SA. "Thyroid Ultrasound Reporting Lexicon: White Paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee." Journal of the American College of Radiology : JACR 12.12 Pt A (December 2015): 1272-1279. (Review)
PMID
26419308
Source
epmc
Published In
Journal of the American College of Radiology
Volume
12
Issue
12 Pt A
Publish Date
2015
Start Page
1272
End Page
1279
DOI
10.1016/j.jacr.2015.07.011

Insignificant Findings: Don't Leave Them Questioning the Significance.

Authors
Hoang, JK
MLA Citation
Hoang, JK. "Insignificant Findings: Don't Leave Them Questioning the Significance." Journal of the American College of Radiology : JACR 12.12 Pt A (December 2015): 1244-.
PMID
26421853
Source
epmc
Published In
Journal of the American College of Radiology
Volume
12
Issue
12 Pt A
Publish Date
2015
Start Page
1244
DOI
10.1016/j.jacr.2015.08.022

Incidental Thyroid Nodules on CT or MRI: Discordance Between What We Report and What Receives Workup.

The objective of this study was to determine the proportion of incidental thyroid nodules (ITNs) reported on CT or MRI that receive additional workup and the factors that influence workup. A secondary aim was to evaluate the effect of the American College of Radiology (ACR) white paper recommendations for reporting of ITNs.We retrospectively reviewed patients with ITNs reported on CT or MRI studies over 12 months. We identified patients with ITNs that underwent workup and the factors associated with workup. The ACR white paper recommendations were retrospectively applied to estimate how their use would have changed the number of nodules reported in the impression section of radiology reports and the number of cancers diagnosed. The recommendations are based on suspicious imaging features, patient age, and nodule size.A total of 375 patients had ITNs reported. For 138 of these patients (37%), ITNs were reported by radiologists in the impression section of their reports; 26 patients (19%) received workup. Patients with ITNs reported in the impression section were 14 times more likely to undergo workup than were patients with ITNs reported only in the findings section of the radiology report. On multivariate analysis, the only factors associated with workup were younger patient age and larger nodule size (p ≤ 0.002). The ACR recommendations resulted in a 54% reduction in the number of ITNs reported in the impression section and one missed papillary cancer (TNM classification T1bN0M0).Only one in five patients with ITNs reported in the impression section of CT or MRI reports underwent additional workup, and this decision was influenced by younger patient age and larger nodule size. These factors are components of the ACR recommendations, which have the potential to reduce the number of reported ITNs and improve the standardization of radiology reporting.

Authors
Tanpitukpongse, TP; Grady, AT; Sosa, JA; Eastwood, JD; Choudhury, KR; Hoang, JK
MLA Citation
Tanpitukpongse, TP, Grady, AT, Sosa, JA, Eastwood, JD, Choudhury, KR, and Hoang, JK. "Incidental Thyroid Nodules on CT or MRI: Discordance Between What We Report and What Receives Workup." AJR. American journal of roentgenology 205.6 (December 2015): 1281-1287.
PMID
26587935
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
205
Issue
6
Publish Date
2015
Start Page
1281
End Page
1287
DOI
10.2214/ajr.15.14929

Parathyroid Adenomas and Hyperplasia on Four-dimensional CT Scans: Three Patterns of Enhancement Relative to the Thyroid Gland Justify a Three-Phase Protocol.

To describe the prevalence of three relative enhancement patterns of parathyroid lesions on four-dimensional (4D) computed tomographic (CT) scans.The institutional review board approved this HIPAA-compliant study and waived the need for informed consent. The authors retrospectively reviewed preoperative 4D CT scans obtained from November 2012 to June 2014 in 94 patients with pathologically proven parathyroid adenomas or hyperplasia. Lesions were classified into one of three relative enhancement patterns. All patterns required lesions to be lower in attenuation than the thyroid on non-contrast material-enhanced images, but patterns differed in the two contrast-enhanced phases. Type A lesions were higher in attenuation than the thyroid in the arterial phase, type B lesions were not higher in attenuation than the thyroid in the arterial phase but were lower in attenuation than the thyroid in the delayed phase, and type C lesions were neither higher in attenuation than the thyroid in the arterial phase nor lower in attenuation than the thyroid in the delayed phase. The prevalence of the relative enhancement patterns was compared. The t test was used to compare mean attenuation differences in Hounsfield units between the relative enhancement patterns.Ninety-four patients had 110 parathyroid lesions, including 11 patients with multigland disease. The sensitivity for single-gland disease was 94% (78 of 83) and that for multigland disease was 59% (16 of 27). Type B enhancement was most common, with a prevalence of 57% (54 of 94), followed by type C (22% [21 of 94]) and type A (20% [19 of 94]). Five lesions were interpreted incorrectly as parathyroid adenoma (false-positive), and all lesions had the type C pattern. Relative to the thyroid, lesions categorized as type A by readers had mean attenuation difference (± standard deviation) of 39 HU ± 13 in the arterial phase, and type B lesions had a difference of -58 HU ± 26 in the delayed phase. These values differed from the mean attenuation difference of lesions not in these categories (P < .001).Parathyroid adenomas and hyperplasia can be grouped into three relative enhancement patterns based on a protocol with a non-contrast-enhanced and two contrast-enhanced phases. The type B pattern is most common and could be diagnosed with two contrast-enhanced phases. However, almost one quarter of lesions have the type C pattern and thus could be missed without the non-contrast-enhanced phase.

Authors
Bahl, M; Sepahdari, AR; Sosa, JA; Hoang, JK
MLA Citation
Bahl, M, Sepahdari, AR, Sosa, JA, and Hoang, JK. "Parathyroid Adenomas and Hyperplasia on Four-dimensional CT Scans: Three Patterns of Enhancement Relative to the Thyroid Gland Justify a Three-Phase Protocol." Radiology 277.2 (November 2015): 454-462.
PMID
26024308
Source
epmc
Published In
Radiology
Volume
277
Issue
2
Publish Date
2015
Start Page
454
End Page
462
DOI
10.1148/radiol.2015142393

Nasopharyngeal Masses Arising from Embryologic Remnants of the Clivus: A Case Series.

Objectives This study aims to (1) discuss rare nasopharyngeal masses originating from embryologic remnants of the clivus, and (2) discuss the embryology of the clivus and understand its importance in the diagnosis and treatment of these masses. Design and Participants This is a case series of three patients. We discuss the clinical and imaging characteristics of infrasellar craniopharyngioma, intranasal extraosseous chordoma, and canalis basilaris medianus. Results Case 1: A 16-year-old male patient with a history of craniopharyngioma resection, who presented with nasal obstruction. A nasopharyngeal cystic mass was noted to be communicating with a patent craniopharyngeal canal. Histology revealed adamantinomatous craniopharyngioma. Case 2: A 43-year-old male patient who presented with nasal obstruction and headache. Computed tomography (CT) and magnetic resonance imaging revealed an enhancing polypoid mass in the posterior nasal cavity abutting the clivus. Histopathology revealed chondroid chordoma. Case 3: A 4-year-old female patient with a recurrent nasopharyngeal polyp. CT cisternogram showed that this mass may have risen from a bony defect of the middle clivus suggestive of canalis basilaris medianus. Conclusions Understanding the embryology of the clivus is crucial when considering the differential diagnosis of a nasopharyngeal mass. Identification of characteristic findings on imaging is critical in the diagnosis and treatment of these lesions.

Authors
Sajisevi, M; Hoang, JK; Eapen, R; Jang, DW
MLA Citation
Sajisevi, M, Hoang, JK, Eapen, R, and Jang, DW. "Nasopharyngeal Masses Arising from Embryologic Remnants of the Clivus: A Case Series." Journal of neurological surgery reports 76.2 (November 2015): e253-e257.
Website
http://hdl.handle.net/10161/11526
PMID
26623237
Source
epmc
Published In
Journal of Neurological Surgery Reports
Volume
76
Issue
2
Publish Date
2015
Start Page
e253
End Page
e257
DOI
10.1055/s-0035-1564603

Avoid "Cannot Exclude": Make a Diagnosis.

Authors
Hoang, JK
MLA Citation
Hoang, JK. "Avoid "Cannot Exclude": Make a Diagnosis." Journal of the American College of Radiology : JACR 12.10 (October 2015): 1009-.
PMID
26277334
Source
epmc
Published In
Journal of the American College of Radiology
Volume
12
Issue
10
Publish Date
2015
Start Page
1009
DOI
10.1016/j.jacr.2015.06.018

Overdiagnosis of thyroid cancer: answers to five key questions.

Thyroid cancer fulfills the criteria for overdiagnosis by having a reservoir of indolent cancers and practice patterns leading to the diagnosis of incidental cancers from the reservoir. The occurrence of overdiagnosis is also supported by population-based data showing an alarming rise in thyroid cancer incidence without change in mortality. Because one of the activities leading to overdiagnosis is the workup of incidental thyroid nodules detected on imaging, it is critical that radiologists understand the issue of overdiagnosis and their role in the problem and solution. This article addresses 1) essential thyroid cancer facts, 2) the evidence supporting overdiagnosis, 3) the role of radiology in overdiagnosis, 4) harms of overdiagnosis, and 5) steps radiologists can take to minimize the problem.

Authors
Hoang, JK; Nguyen, XV; Davies, L
MLA Citation
Hoang, JK, Nguyen, XV, and Davies, L. "Overdiagnosis of thyroid cancer: answers to five key questions." Academic radiology 22.8 (August 2015): 1024-1029. (Review)
PMID
26100186
Source
epmc
Published In
Academic Radiology
Volume
22
Issue
8
Publish Date
2015
Start Page
1024
End Page
1029
DOI
10.1016/j.acra.2015.01.019

Feasibility of using the computed tomography dose indices to estimate radiation dose to partially and fully irradiated brains in pediatric neuroradiology examinations.

The purpose of this study was two-fold: (a) to measure the dose to the brain using clinical protocols at our institution, and (b) to develop a scanner-independent dosimetry method to estimate brain dose. Radiation dose was measured with a pediatric anthropomorphic phantom and MOSFET detectors. Six current neuroradiology protocols were used: brain, sinuses, facial bones, orbits, temporal bones, and craniofacial areas. Two different CT vendor scanners (scanner A and B) were used. Partial volume correction factors (PVCFs) were determined for the brain to account for differences between point doses measured by the MOSFETs and average organ dose. The CTDIvol and DLP for each protocol were recorded. The dose to the brain (mGy) for scanners A and B was 10.7 and 10.0 for the brain protocol, 7.8 and 3.2 for the sinus, 10.2 and 8.6 for the facial bones, 7.4 and 4.7 for the orbits and 1.6 and 1.9 for the temporal bones, respectively. On scanner A, the craniofacial protocol included a standard and high dose option; the dose measured for these exams was 3.9 and 16.9 mGy, respectively. There was only one craniofacial protocol on scanner B; the brain dose measured on this exam was 4.8 mGy. A linear correlation was found between DLP and brain dose with the conversion factors: 0.049 (R(2) = 0.87), 0.046 (R(2) = 0.89) for scanner A and B, and 0.048 (R(2) = 0.89) for both scanners. The range of dose observed was between 1.8 and 16.9 mGy per scan. This suggests that brain dose estimates may be made from DLP.

Authors
Januzis, N; Nguyen, G; Frush, DP; Hoang, JK; Lowry, C; Yoshizumi, TT
MLA Citation
Januzis, N, Nguyen, G, Frush, DP, Hoang, JK, Lowry, C, and Yoshizumi, TT. "Feasibility of using the computed tomography dose indices to estimate radiation dose to partially and fully irradiated brains in pediatric neuroradiology examinations." Physics in medicine and biology 60.14 (July 6, 2015): 5699-5710.
PMID
26147244
Source
epmc
Published In
Physics in Medicine and Biology
Volume
60
Issue
14
Publish Date
2015
Start Page
5699
End Page
5710
DOI
10.1088/0031-9155/60/14/5699

Using Social Media to Share Your Radiology Research: How Effective Is a Blog Post?

The aim of this study was to compare the volume of individuals who viewed online versions of research articles in 2 peer-reviewed radiology journals and a radiology blog promoted by social media.The authors performed a retrospective study comparing online analytic logs of research articles in the American Journal of Neuroradiology (AJNR) and the American Journal of Roentgenology (AJR) and a blog posting on Radiopaedia.org from April 2013 to September 2014. All 3 articles addressed the topic of reporting incidental thyroid nodules detected on CT and MRI. The total page views for the research articles and the blog article were compared, and trends in page views were observed. Factors potentially affecting trends were an AJNR podcast and promotion of the blog article on the social media platforms Facebook, Tumblr, and Twitter to followers of Radiopaedia.org in February 2014 and August 2014.The total numbers of page views during the study period were 2,421 for the AJNR article and 3,064 for the AJR article. The Radiopaedia.org blog received 32,675 page views, which was 13.6 and 10.7 times greater than AJNR and AJR page views, respectively, and 6.0 times greater than both journal articles combined. Months with activity above average for the blog and the AJNR article coincided with promotion by Radiopaedia.org on social media.Dissemination of scientific material on a radiology blog promoted on social media can substantially augment the reach of more traditional publication venues. Although peer-reviewed publication remains the most widely accepted measure of academic productivity, researchers in radiology should not ignore opportunities for increasing the impact of research findings via social media.

Authors
Hoang, JK; McCall, J; Dixon, AF; Fitzgerald, RT; Gaillard, F
MLA Citation
Hoang, JK, McCall, J, Dixon, AF, Fitzgerald, RT, and Gaillard, F. "Using Social Media to Share Your Radiology Research: How Effective Is a Blog Post?." Journal of the American College of Radiology : JACR 12.7 (July 2015): 760-765.
PMID
25959491
Source
epmc
Published In
Journal of the American College of Radiology
Volume
12
Issue
7
Publish Date
2015
Start Page
760
End Page
765
DOI
10.1016/j.jacr.2015.03.048

Avoid Jargon Terms for Normal.

Authors
Hoang, JK
MLA Citation
Hoang, JK. "Avoid Jargon Terms for Normal." Journal of the American College of Radiology : JACR 12.6 (June 2015): 546-.
PMID
26047396
Source
epmc
Published In
Journal of the American College of Radiology
Volume
12
Issue
6
Publish Date
2015
Start Page
546
DOI
10.1016/j.jacr.2015.03.018

Predictors of Multigland Disease in Primary Hyperparathyroidism: A Scoring System with 4D-CT Imaging and Biochemical Markers.

Multigland disease represents a challenging group of patients with primary hyperparathyroidism. Additional lesions may be missed on imaging because they are not considered or are too small to be seen. The aim of this is study was to identify 4D-CT imaging and biochemical predictors of multigland disease.This was a retrospective study of 155 patients who underwent 4D-CT and successful surgery with a biochemical cure that compared patients with multigland and single-gland disease. Variables studied included the size of the largest lesion on 4D-CT, the number of lesions prospectively identified on 4D-CT, serum calcium levels, serum parathyroid hormone levels, and the Wisconsin Index (the product of serum calcium and parathyroid hormone levels). Imaging findings and the Wisconsin Index were used to calculate a composite multigland disease scoring system. We evaluated the predictive value of individual variables and the scoring system for multigland disease.Thirty-six patients with multigland disease were compared with 119 patients with single-gland disease. Patients with multigland disease had significantly lower Wisconsin Index scores, smaller lesion size, and a higher likelihood of having either multiple or zero lesions identified on 4D-CT (P ≤ .01). Size cutoff of <7 mm had 85% specificity for multigland disease, but including other variables in the composite multigland disease score improved the specificity. Scores of ≥4, ≥5, and 6 had specificities of 81%, 93%, and 98%, respectively.The composite multigland disease scoring system based on 4D-CT imaging findings and biochemical data can identify patients with a high likelihood of multigland disease. Communicating the suspicion for multigland disease in the radiology report could influence surgical decision-making, particularly when considering re-exploration in a previously operated neck or initial limited neck exploration.

Authors
Sepahdari, AR; Bahl, M; Harari, A; Kim, HJ; Yeh, MW; Hoang, JK
MLA Citation
Sepahdari, AR, Bahl, M, Harari, A, Kim, HJ, Yeh, MW, and Hoang, JK. "Predictors of Multigland Disease in Primary Hyperparathyroidism: A Scoring System with 4D-CT Imaging and Biochemical Markers." AJNR. American journal of neuroradiology 36.5 (May 2015): 987-992.
PMID
25556203
Source
epmc
Published In
American Journal of Neuroradiology
Volume
36
Issue
5
Publish Date
2015
Start Page
987
End Page
992
DOI
10.3174/ajnr.a4213

Advanced magnetic resonance techniques: 3 T.

Magnetic resonance (MR) imaging at 3 T is clinically feasible and, in the right context, can provide improvements compared with 1.5-T MR imaging. Improvements in both signal/noise ratio and contrast/noise ratio can be used to improve image homogeneity and/or spatial and temporal resolution. Some techniques, such as brain functional MR imaging, are considered far superior at 3 T than at 1.5 T. Although several challenges still exist, 3 T has been become well established in clinical MR imaging.

Authors
Bhatti, L; Hoang, JK; Dale, BM; Bashir, MR
MLA Citation
Bhatti, L, Hoang, JK, Dale, BM, and Bashir, MR. "Advanced magnetic resonance techniques: 3 T." Radiologic clinics of North America 53.3 (May 2015): 441-455. (Review)
PMID
25953283
Source
epmc
Published In
Radiologic Clinics of North America
Volume
53
Issue
3
Publish Date
2015
Start Page
441
End Page
455
DOI
10.1016/j.rcl.2014.12.001

Misinterpretation of the American College of Radiology white paper on managing incidental thyroid nodules.

Authors
Hoang, JK; Langer, JE; Middleton, WD; Wu, CC; Hammers, LW; Cronan, JJ; Tessler, FN; Grant, EG; Berland, LL
MLA Citation
Hoang, JK, Langer, JE, Middleton, WD, Wu, CC, Hammers, LW, Cronan, JJ, Tessler, FN, Grant, EG, and Berland, LL. "Misinterpretation of the American College of Radiology white paper on managing incidental thyroid nodules." Thyroid : official journal of the American Thyroid Association 25.5 (May 2015): 469-470.
PMID
25777589
Source
epmc
Published In
Thyroid
Volume
25
Issue
5
Publish Date
2015
Start Page
469
End Page
470
DOI
10.1089/thy.2015.0069

Lifetime Attributable Risk of Cancer From Radiation Exposure During Parathyroid Imaging: Comparison of 4D CT and Parathyroid Scintigraphy.

OBJECTIVE: The purpose of this study is to measure the organ doses and effective dose (ED) for parathyroid 4D CT and scintigraphy and to estimate the lifetime attributable risk of cancer incidence associated with imaging. MATERIALS AND METHODS: Organ radiation doses for 4D CT and scintigraphy were measured on the basis of imaging with our institution's protocols. An anthropomorphic phantom with metal oxide semiconductor field effect transistor detectors was scanned to measure CT organ dose. Organ doses from the radionuclide were based on International Commission for Radiological Protection report 80. ED was calculated for 4D CT and scintigraphy and was used to estimate the lifetime attributable risk of cancer incidence for patients differing in age and sex with the approach established by the Biologic Effects of Ionizing Radiation VII report. A 55-year-old woman was selected as the standard patient according to the demographics of patients with primary hyperparathyroidism. RESULTS: Organs receiving the highest radiation dose from 4D CT were the thyroid (150.6 mGy) and salivary glands (137.8 mGy). For scintigraphy, the highest organ doses were to the colon (41.5 mGy), gallbladder (39.8 mGy), and kidneys (32.3 mGy). The ED was 28 mSv for 4D CT, compared with 12 mSv for scintigraphy. In the exposed standard patient, the lifetime attributable risk for cancer incidence was 193 cancers/100,000 patients for 4D CT and 68 cancers/100,000 patients for scintigraphy. Given a baseline lifetime incidence of cancer of 46,300 cancers/100,000 patients, imaging results in an increase in lifetime incidence of cancer over baseline of 0.52% for 4D CT and 0.19% for scintigraphy. CONCLUSION: The ED of 4D CT is more than double that of scintigraphy, but both studies cause negligible increases in lifetime risk of cancer. Clinicians should not allow concern for radiation-induced cancer to influence decisions regarding workup in older patients.

Authors
Hoang, JK; Reiman, RE; Nguyen, GB; Januzis, N; Chin, BB; Lowry, C; Yoshizumi, TT
MLA Citation
Hoang, JK, Reiman, RE, Nguyen, GB, Januzis, N, Chin, BB, Lowry, C, and Yoshizumi, TT. "Lifetime Attributable Risk of Cancer From Radiation Exposure During Parathyroid Imaging: Comparison of 4D CT and Parathyroid Scintigraphy." AJR. American journal of roentgenology 204.5 (May 2015): W579-W585.
PMID
25905965
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
204
Issue
5
Publish Date
2015
Start Page
W579
End Page
W585
DOI
10.2214/ajr.14.13278

A novel method of estimating effective dose from the point dose method: a case study--parathyroid CT scans.

The purpose of this study was to validate a novel approach of applying a partial volume correction factor (PVCF) using a limited number of MOSFET detectors in the effective dose (E) calculation. The results of the proposed PVCF method were compared to the results from both the point dose (PD) method and a commercial CT dose estimation software (CT-Expo). To measure organ doses, an adult female anthropomorphic phantom was loaded with 20 MOSFET detectors and was scanned using the non-contrast and 2 phase contrast-enhanced parathyroid imaging protocols on a 64-slice multi-detector computed tomography scanner. E was computed by three methods: the PD method, the PVCF method, and the CT-Expo method. The E (in mSv) for the PD method, the PVCF method, and CT-Expo method was 2.6  ±  0.2, 1.3  ±  0.1, and 1.1 for the non-contrast scan, 21.9  ±  0.4, 13.9  ±  0.2, and 14.6 for the 1st phase of the contrast-enhanced scan, and 15.5  ±  0.3, 9.8  ±  0.1, and 10.4 for the 2nd phase of the contrast-enhanced scan, respectively. The E with the PD method differed from the PVCF method by 66.7% for the non-contrast scan, by 44.9% and by 45.5% respectively for the 1st and 2nd phases of the contrast-enhanced scan. The E with PVCF was comparable to the results from the CT-Expo method with percent differences of 15.8%, 5.0%, and 6.3% for the non-contrast scan and the 1st and 2nd phases of the contrast-enhanced scan, respectively. To conclude, the PVCF method estimated E within 16% difference as compared to 50-70% in the PD method. In addition, the results demonstrate that E can be estimated accurately from a limited number of detectors.

Authors
Januzis, N; Nguyen, G; Hoang, JK; Lowry, C; Yoshizumi, TT
MLA Citation
Januzis, N, Nguyen, G, Hoang, JK, Lowry, C, and Yoshizumi, TT. "A novel method of estimating effective dose from the point dose method: a case study--parathyroid CT scans." Physics in medicine and biology 60.5 (March 2015): 1763-1773.
PMID
25658032
Source
epmc
Published In
Physics in Medicine and Biology
Volume
60
Issue
5
Publish Date
2015
Start Page
1763
End Page
1773
DOI
10.1088/0031-9155/60/5/1763

Radiology reports for incidental thyroid nodules on CT and MRI: high variability across subspecialties.

Variability in radiologists' reporting styles and recommendations for incidental thyroid nodules can lead to confusion among clinicians and may contribute to inconsistent patient care. Our aim was to describe reporting practices of radiologists for incidental thyroid nodules seen on CT and MR imaging and to determine factors that influence reporting styles.This is a retrospective study of patients with incidental thyroid nodules reported on CT and MR imaging between January and December 2011, identified by text search for "thyroid nodule" in all CT and MR imaging reports. The studies included CT and MR imaging scans of the neck, spine, and chest. Radiology reports were divided into those that mentioned the incidental thyroid nodules only in the "Findings" section versus those that reported the incidental thyroid nodules in the "Impression" section as well, because this latter reporting style gives more emphasis to the finding. Univariate and multivariate analyses were performed to identify radiologist, patient, and nodule characteristics that influenced reporting styles.Three hundred seventy-five patients met the criterion of having incidental thyroid nodules. One hundred thirty-eight (37%) patients had incidental thyroid nodules reported in the "Impression" section. On multivariate analysis, only radiologists' divisions and nodule size were associated with reporting in "Impression." Chest radiologists and neuroradiologists were more likely to report incidental thyroid nodules in the "Impression" section than their abdominal imaging colleagues, and larger incidental thyroid nodules were more likely to be reported in "Impression" (P ≤ .03). Seventy-three percent of patients with incidental thyroid nodules of ≥20 mm were reported in the "Impression" section, but higher variability in reporting was seen for incidental thyroid nodules measuring 10-14 mm and 15-19 mm, which were reported in "Impression" for 61% and 50% of patients, respectively.Reporting practices for incidental thyroid nodules detected on CT and MR imaging are predominantly influenced by nodule size and the radiologist's subspecialty. Reporting was highly variable for nodules measuring 10-19 mm; this finding can be partially attributed to different reporting styles among radiology subspecialty divisions. The variability demonstrated in this study further underscores the need to develop CT and MR imaging practice guidelines with the goal of standardizing reporting of incidental thyroid nodules and thereby potentially improving the consistency and quality of patient care.

Authors
Grady, AT; Sosa, JA; Tanpitukpongse, TP; Choudhury, KR; Gupta, RT; Hoang, JK
MLA Citation
Grady, AT, Sosa, JA, Tanpitukpongse, TP, Choudhury, KR, Gupta, RT, and Hoang, JK. "Radiology reports for incidental thyroid nodules on CT and MRI: high variability across subspecialties." AJNR. American journal of neuroradiology 36.2 (February 2015): 397-402.
PMID
25147197
Source
epmc
Published In
American Journal of Neuroradiology
Volume
36
Issue
2
Publish Date
2015
Start Page
397
End Page
402
DOI
10.3174/ajnr.a4089

Managing incidental thyroid nodules detected on imaging: white paper of the ACR Incidental Thyroid Findings Committee.

The incidental thyroid nodule (ITN) is one of the most common incidental findings on imaging studies that include the neck. An ITN is defined as a nodule not previously detected or suspected clinically, but identified by an imaging study. The workup of ITNs has led to increased costs from additional procedures, and in some cases, to increased risk to the patient because physicians are naturally concerned about the risk of malignancy and a delayed cancer diagnosis. However, the majority of ITNs are benign, and small, incidental thyroid malignancies typically have indolent behavior. The ACR formed the Incidental Thyroid Findings Committee to derive a practical approach to managing ITNs on CT, MRI, nuclear medicine, and ultrasound studies. This white paper describes consensus recommendations representing this committee's review of the literature and their practice experience.

Authors
Hoang, JK; Langer, JE; Middleton, WD; Wu, CC; Hammers, LW; Cronan, JJ; Tessler, FN; Grant, EG; Berland, LL
MLA Citation
Hoang, JK, Langer, JE, Middleton, WD, Wu, CC, Hammers, LW, Cronan, JJ, Tessler, FN, Grant, EG, and Berland, LL. "Managing incidental thyroid nodules detected on imaging: white paper of the ACR Incidental Thyroid Findings Committee." Journal of the American College of Radiology : JACR 12.2 (February 2015): 143-150.
PMID
25456025
Source
epmc
Published In
Journal of the American College of Radiology
Volume
12
Issue
2
Publish Date
2015
Start Page
143
End Page
150
DOI
10.1016/j.jacr.2014.09.038

Imaging Thyroid Disease. Updates, Imaging Approach, and Management Pearls.

© 2015 Elsevier Inc.. There are many disorders that can occur in the thyroid gland, ranging from benign to malignant entities. This article focuses on 5 common problems of the thyroid that require special consideration with regard to optimizing imaging strategies in a multidisciplinary and collaborative platform. These problems are the incidental thyroid nodule, preoperative evaluation of goiter, hyperthyroidism, invasive thyroid cancer, and recurrent thyroid cancer. For each problem essential facts, interesting updates, imaging approach, and management pearls are reviewed.

Authors
Hoang, JK; Sosa, JA; Nguyen, XV; Galvin, PL; Oldan, JD
MLA Citation
Hoang, JK, Sosa, JA, Nguyen, XV, Galvin, PL, and Oldan, JD. "Imaging Thyroid Disease. Updates, Imaging Approach, and Management Pearls." Radiologic Clinics of North America 53.1 (January 1, 2015): 145-161. (Review)
Source
scopus
Published In
Radiologic Clinics of North America
Volume
53
Issue
1
Publish Date
2015
Start Page
145
End Page
161
DOI
10.1016/j.rcl.2014.09.002

What to do with incidental thyroid nodules identified on imaging studies? Review of current evidence and recommendations.

PURPOSE OF REVIEW: To discuss the problem of incidental thyroid nodules (ITN) detected on imaging; summarize the literature for workup methods; and provide recommendations based on current evidence. RECENT FINDINGS: ITN are a common problem, seen in 40-50% of ultrasound and 16% of computed tomography (CT) and MRI studies that include the thyroid. The personal and financial costs of workup frequently outweigh the benefits when considering that the majority of ITN are benign; 25-41% of patients undergo surgery after biopsy, of which more than half ultimately result in a benign diagnosis, and small thyroid cancers have an indolent course. Workup should consider reduction in unnecessary workup in addition to cancer diagnosis. The Society of Radiologists in Ultrasound recommendations have been proposed for ITN detected on ultrasound and found to reduce workup by 30%. For ITN detected on CT, MRI, or PET/CT, a three-tiered system categorization method reduces workup of ITN by 35-46%. SUMMARY: The ideal approach to selecting ITN detected on imaging for workup would not be to diagnose all cancers, but to diagnose cancers that have reached clinical significance, while avoiding unnecessary tests and surgery in patients with benign nodules, especially those who have limited life expectancy. The three-tiered system and the Society of Radiologists in Ultrasound recommendations are supported by existing studies and focus on reducing unnecessary biopsy.

Authors
Hoang, JK; Grady, AT; Nguyen, XV
MLA Citation
Hoang, JK, Grady, AT, and Nguyen, XV. "What to do with incidental thyroid nodules identified on imaging studies? Review of current evidence and recommendations." Current opinion in oncology 27.1 (January 2015): 8-14. (Review)
PMID
25310642
Source
epmc
Published In
Current Opinion in Oncology
Volume
27
Issue
1
Publish Date
2015
Start Page
8
End Page
14
DOI
10.1097/cco.0000000000000147

Imaging thyroid disease: updates, imaging approach, and management pearls.

There are many disorders that can occur in the thyroid gland, ranging from benign to malignant entities. This article focuses on 5 common problems of the thyroid that require special consideration with regard to optimizing imaging strategies in a multidisciplinary and collaborative platform. These problems are the incidental thyroid nodule, preoperative evaluation of goiter, hyperthyroidism, invasive thyroid cancer, and recurrent thyroid cancer. For each problem essential facts, interesting updates, imaging approach, and management pearls are reviewed.

Authors
Hoang, JK; Sosa, JA; Nguyen, XV; Galvin, PL; Oldan, JD
MLA Citation
Hoang, JK, Sosa, JA, Nguyen, XV, Galvin, PL, and Oldan, JD. "Imaging thyroid disease: updates, imaging approach, and management pearls." Radiologic clinics of North America 53.1 (January 2015): 145-161. (Review)
PMID
25476178
Source
epmc
Published In
Radiologic Clinics of North America
Volume
53
Issue
1
Publish Date
2015
Start Page
145
End Page
161
DOI
10.1016/j.rcl.2014.09.002

Defining the optimal planning target volume in image-guided stereotactic radiosurgery of brain metastases: results of a randomized trial.

PURPOSE: To identify an optimal margin about the gross target volume (GTV) for stereotactic radiosurgery (SRS) of brain metastases, minimizing toxicity and local recurrence. METHODS AND MATERIALS: Adult patients with 1 to 3 brain metastases less than 4 cm in greatest dimension, no previous brain radiation therapy, and Karnofsky performance status (KPS) above 70 were eligible for this institutional review board-approved trial. Individual lesions were randomized to 1- or 3- mm uniform expansion of the GTV defined on contrast-enhanced magnetic resonance imaging (MRI). The resulting planning target volume (PTV) was treated to 24, 18, or 15 Gy marginal dose for maximum PTV diameters less than 2, 2 to 2.9, and 3 to 3.9 cm, respectively, using a linear accelerator-based image-guided system. The primary endpoint was local recurrence (LR). Secondary endpoints included neurocognition Mini-Mental State Examination, Trail Making Test Parts A and B, quality of life (Functional Assessment of Cancer Therapy-Brain), radionecrosis (RN), need for salvage radiation therapy, distant failure (DF) in the brain, and overall survival (OS). RESULTS: Between February 2010 and November 2012, 49 patients with 80 brain metastases were treated. The median age was 61 years, the median KPS was 90, and the predominant histologies were non-small cell lung cancer (25 patients) and melanoma (8). Fifty-five, 19, and 6 lesions were treated to 24, 18, and 15 Gy, respectively. The PTV/GTV ratio, volume receiving 12 Gy or more, and minimum dose to PTV were significantly higher in the 3-mm group (all P<.01), and GTV was similar (P=.76). At a median follow-up time of 32.2 months, 11 patients were alive, with median OS 10.6 months. LR was observed in only 3 lesions (2 in the 1 mm group, P=.51), with 6.7% LR 12 months after SRS. Biopsy-proven RN alone was observed in 6 lesions (5 in the 3-mm group, P=.10). The 12-month DF rate was 45.7%. Three months after SRS, no significant change in neurocognition or quality of life was observed. CONCLUSIONS: SRS was well tolerated, with low rates of LR and RN in both cohorts. However, given the higher potential risk of RN with a 3-mm margin, a 1-mm GTV expansion is more appropriate.

Authors
Kirkpatrick, JP; Wang, Z; Sampson, JH; McSherry, F; Herndon, JE; Allen, KJ; Duffy, E; Hoang, JK; Chang, Z; Yoo, DS; Kelsey, CR; Yin, F-F
MLA Citation
Kirkpatrick, JP, Wang, Z, Sampson, JH, McSherry, F, Herndon, JE, Allen, KJ, Duffy, E, Hoang, JK, Chang, Z, Yoo, DS, Kelsey, CR, and Yin, F-F. "Defining the optimal planning target volume in image-guided stereotactic radiosurgery of brain metastases: results of a randomized trial." International journal of radiation oncology, biology, physics 91.1 (January 2015): 100-108.
PMID
25442342
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
91
Issue
1
Publish Date
2015
Start Page
100
End Page
108
DOI
10.1016/j.ijrobp.2014.09.004

Using the 3-tiered system for categorizing workup of incidental thyroid nodules detected on CT, MRI, or PET/CT: how many cancers would be missed?

BACKGROUND: A 3-tiered system has been proposed by radiologists for the reporting and workup of incidental thyroid nodules (ITN) detected on computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography/computed tomography (PET/CT). It has been shown to reduce the workup rate, but there remains concern about missed malignancies. This study aims at estimating the proportion of incidental cancers that would be missed relative to all thyroid cancers if the 3-tiered system were applied to ITN seen on CT, MRI, or PET/CT. We also aim to characterize these missed incidental cancers by histology and tumor stage. METHODS: A retrospective review was performed of 680 consecutive patients with thyroid cancer who underwent surgery between January 2003 and December 2012. Medical records were reviewed to identify incidental thyroid cancers detected on imaging. Patients with incidental cancers detected on CT, MRI, or PET/CT were categorized according to the system as 3-tiered system-positive and 3-tiered system-negative. The system recommends that only 3-tiered system-positive ITN undergo further workup with ultrasound. Three-tiered system-negative cancers were the cancers that would have been missed if the system were used in practice. These tumors are described by tumor type, size, and stage to determine the potential impact if the 3-tiered system were adopted. RESULTS: One hundred and one patients had imaging-detected incidental cancers, of whom 64 met the inclusion criteria and were originally detected on CT, MRI, or PET/CT. Eight were 3-tiered system-negative, which represents 13% of the 64 incidental cancers that could be categorized and 1.2% of all thyroid cancers treated at our institution in the 10-year period. Three-tiered system-negative tumors were all papillary in histology and had a median size of 12 mm (interquartile range 10-12 mm). Six tumors (75%) were American Joint Committee on Cancer (AJCC) stage I, one was AJCC stage II, and one was AJCC stage III at diagnosis. CONCLUSIONS: Based on thyroid cancers diagnosed during a decade, incidental malignancies missed by the 3-tiered system represent 1.2% of all thyroid malignancies. Three-tiered system-negative incidental cancers were all small papillary cancers. Given that few cancers would be missed and most are less aggressive, we propose that the 3-tiered system could be adopted in clinical practice to guide the workup of ITN identified on CT, MRI, and PET/CT.

Authors
Bahl, M; Sosa, JA; Eastwood, JD; Hobbs, HA; Nelson, RC; Hoang, JK
MLA Citation
Bahl, M, Sosa, JA, Eastwood, JD, Hobbs, HA, Nelson, RC, and Hoang, JK. "Using the 3-tiered system for categorizing workup of incidental thyroid nodules detected on CT, MRI, or PET/CT: how many cancers would be missed?." Thyroid : official journal of the American Thyroid Association 24.12 (December 2014): 1772-1778.
PMID
25203387
Source
epmc
Published In
Thyroid
Volume
24
Issue
12
Publish Date
2014
Start Page
1772
End Page
1778
DOI
10.1089/thy.2014.0066

Imaging-detected incidental thyroid nodules that undergo surgery: a single-center experience over 1 year.

Incidental thyroid nodules are commonly seen on imaging, and their work-up can ultimately lead to surgery. We describe characteristics and pathology results of imaging-detected incidental thyroid nodules that underwent surgery.A retrospective review was performed of 303 patients who underwent thyroid surgery over a 1-year period to identify patients who presented with incidental thyroid nodules on imaging. Medical records were reviewed for the types of imaging studies that led to detection, nodule characteristics, and surgical pathology.Of 303 patients, 208 patients (69%) had surgery for thyroid nodules. Forty-seven of 208 patients (23%) had incidental thyroid nodules detected on imaging. The most common technique leading to detection was CT (47%). All patients underwent biopsy before surgery. The cytology results were nondiagnostic (6%), benign (4%), atypia of undetermined significance or follicular neoplasm of undetermined significance (23%), follicular neoplasm or suspicious for follicular neoplasm (19%), suspicious for malignancy (17%), and diagnostic of malignancy (30%). Surgical pathology was benign in 24 of 47 (51%) cases of incidental thyroid nodules. In the 23 incidental cancers, the most common histologic type was papillary (87%), the mean size was 1.4 cm, and nodal metastases were present in 7 of 23 cases (30%). No incidental cancers on imaging had distant metastases.Imaging-detected incidental thyroid nodules led to nearly one-fourth of surgeries for thyroid nodules, and almost half were initially detected on CT. Despite indeterminate or suspicious cytology results that lead to surgery, more than half were benign on final pathology. Guidelines for work-up of incidental thyroid nodules detected on CT could help reduce unnecessary investigations and surgery.

Authors
Bahl, M; Sosa, JA; Nelson, RC; Hoang, JK
MLA Citation
Bahl, M, Sosa, JA, Nelson, RC, and Hoang, JK. "Imaging-detected incidental thyroid nodules that undergo surgery: a single-center experience over 1 year." AJNR. American journal of neuroradiology 35.11 (November 2014): 2176-2180.
PMID
24970551
Source
epmc
Published In
American Journal of Neuroradiology
Volume
35
Issue
11
Publish Date
2014
Start Page
2176
End Page
2180
DOI
10.3174/ajnr.a4004

Diffusion-weighted imaging for head and neck squamous cell carcinoma: quantifying repeatability to understand early treatment-induced change.

OBJECTIVE: The purpose of this study was to define baseline variability of apparent diffusion coefficient (ADC) on diffusion-weighted MR imaging (DWI) in patients with head and neck squamous cell carcinoma (HNSCC) and to compare it with early treatment-induced ADC change. SUBJECTS AND METHODS: Patients with American Joint Committee on Cancer stages III and IV HNSCC were imaged with two baseline DWI examinations 1 week apart and a third DWI examination during the 2nd week of curative-intent chemoradiation therapy. Mean ADC was measured in the primary tumor and largest lymph node for each patient on the three DWI scans. Mean baseline percentage differences (%∆ADC) were compared with intratreatment change. The repeatability coefficient for baseline %∆ADC was calculated and compared with intratreatment %∆ADC. Repeatability was also assessed with Bland-Altman plots and the intraclass correlation coefficient (ICC). RESULTS: Sixteen patients underwent double baseline imaging, with 14 also undergoing intratreatment imaging. Baseline nodal disease ADC could be measured in 16 patients, but ADC in primary tumors could only be measured in five patients. The nodal mean (SD) baseline %∆ADC was 8% (± 7%), which was significantly different compared with intratreatment changes of 32% (± 31%) (p = 0.01). Baseline ICC was 0.86 for nodal disease and 0.99 for primary tumor (excellent correlation). The calculated repeatability coefficient for baseline nodal ADC was 15%. No patients had decreases in intratreatment ADC of more than 15%. CONCLUSION: Baseline ADC variability for HNSCC is less than intratreatment ADC change for nodal disease. Assessment of response should consider intrinsic baseline variability.

Authors
Hoang, JK; Choudhury, KR; Chang, J; Craciunescu, OI; Yoo, DS; Brizel, DM
MLA Citation
Hoang, JK, Choudhury, KR, Chang, J, Craciunescu, OI, Yoo, DS, and Brizel, DM. "Diffusion-weighted imaging for head and neck squamous cell carcinoma: quantifying repeatability to understand early treatment-induced change." AJR. American journal of roentgenology 203.5 (November 2014): 1104-1108.
PMID
25341151
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
203
Issue
5
Publish Date
2014
Start Page
1104
End Page
1108
DOI
10.2214/ajr.14.12838

Effect of Body Habitus on Radiation Dose During CT Fluoroscopy-Guided Spine Injections.

This study investigated the degree to which body habitus influences radiation dose during CT fluoroscopy (CTF)-guided lumbar epidural steroid injections (ESI). An anthropomorphic phantom containing metal oxide semiconductor field effect transistor (MOSFET) detectors was scanned at two transverse levels to simulate upper and lower lumbar CTF-guided ESI. Circumferential layers of adipose-equivalent material were sequentially added to model patients of three sizes: small (cross-sectional dimensions 25×30 cm), average (34×39 cm), and oversize (43×48 cm). Point dose rates to skin and internal organs within the CTF beam were measured. Scattered point dose rates 5 cm from the radiation beam were also measured. Direct point dose rates to the internal organs ranged from 0.05-0.11 mGy/10mAs in the oversized phantom, and from 0.18-0.43 mGy/10mAs in the small phantom. Skin direct point dose rates ranged from 0.69-0.71 mGy/10mAs in the oversized phantom and 0.88-0.94 mGy/10mAs in the small phantom. This represents a 180-310% increase in organ point dose rates and 24-36% increase in skin point dose rates in the small habitus compared with the oversize habitus. Scatter point dose rates increased by 83-117% for the small compared to the oversize phantom. Decreasing body habitus results in substantial increases in direct organ and skin point doses as well as scattered dose during simulated CTF-guided procedures. Failure to account for individual variations in body habitus will result in inaccurate dose estimation and inappropriate choice of tube current in CTF-guided procedures.

Authors
Viola, RJ; Nguyen, GB; Yoshizumi, TT; Stinnett, SS; Hoang, JK; Kranz, PG
MLA Citation
Viola, RJ, Nguyen, GB, Yoshizumi, TT, Stinnett, SS, Hoang, JK, and Kranz, PG. "Effect of Body Habitus on Radiation Dose During CT Fluoroscopy-Guided Spine Injections." Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences 20.5 (October 17, 2014): 525-532.
PMID
25363254
Source
epmc
Published In
Interventional Neuroradiology
Volume
20
Issue
5
Publish Date
2014
Start Page
525
End Page
532
DOI
10.15274/inr-2014-10043

Effect of the CT table strap on radiation exposure and image quality during cervical spine CT.

The CT table strap may impair shoulder lowering during cervical spine CT. The purpose of this investigation was to evaluate the effect of the CT table strap on radiation exposure and image quality during CT of the cervical spine.Patients undergoing cervical spine CT were prospectively randomized to having the CT table strap placed around the torso and arms (control group) or around the torso only (intervention group). Radiation exposure, shoulder position, and image quality were evaluated. Potential confounders, including neck diameter and scan length, were also assessed.Fifty-eight patients were enrolled and randomized, and 51 subjects were included in the final study population. There was a 21% decrease in radiation exposure in the intervention group compared with the control group (mean dose-length product, 540 ± 152 versus 686 ± 200 mGy × cm, P = .005). Subjects in the intervention group achieved shoulder lowering of an average of >1 vertebral body lower than the control group (mean shoulder level, 7.7 ± 1.3 versus 6.5 ± 1.3, P = .001). Subjective image quality, determined by the lowest level of spinal cord visibility, was also better in the intervention group (mean cord visibility level, 6.9 ± 1.3 versus 5.9 ± 1.3, P = .006). No differences in neck diameter (P = .28) or scan length (P = .55) were observed between groups.The CT table strap inhibits shoulder lowering during CT of the cervical spine. Placement of the patient's arms outside the CT table strap results in decreased radiation exposure and increased image quality compared with patients whose arms are placed inside the strap.

Authors
Kranz, PG; Wylie, JD; Hoang, JK; Kosinski, AS
MLA Citation
Kranz, PG, Wylie, JD, Hoang, JK, and Kosinski, AS. "Effect of the CT table strap on radiation exposure and image quality during cervical spine CT." AJNR. American journal of neuroradiology 35.10 (October 2014): 1870-1876.
PMID
25059701
Source
epmc
Published In
American Journal of Neuroradiology
Volume
35
Issue
10
Publish Date
2014
Start Page
1870
End Page
1876
DOI
10.3174/ajnr.a4074

Reply to "Three-tiered system for incidental thyroid nodules: do not forget the calcifications".

Authors
Hoang, JK
MLA Citation
Hoang, JK. "Reply to "Three-tiered system for incidental thyroid nodules: do not forget the calcifications"." AJR. American journal of roentgenology 203.4 (October 2014): W453-. (Letter)
PMID
25247979
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
203
Issue
4
Publish Date
2014
Start Page
W453
DOI
10.2214/ajr.14.12650

A novel, reproducible, and objective method for volumetric magnetic resonance imaging assessment of enhancing glioblastoma.

Robust methodology that allows objective, automated, and observer-independent measurements of brain tumor volume, especially after resection, is lacking. Thus, determination of tumor response and progression in neurooncology is unreliable. The objective of this study was to determine if a semi-automated volumetric method for quantifying enhancing tissue would perform with high reproducibility and low interobserver variability.Fifty-seven MR images from 13 patients with glioblastoma were assessed using our method, by 2 neuroradiologists, 1 neurosurgeon, 1 neurosurgical resident, 1 nurse practitioner, and 1 medical student. The 2 neuroradiologists also performed traditional 1-dimensional (1D) and 2-dimensional (2D) measurements. Intraclass correlation coefficients (ICCs) assessed interobserver variability between measurements. Radiological response was determined using Response Evaluation Criteria In Solid Tumors (RECIST) guidelines and Macdonald criteria. Kappa statistics described interobserver variability of volumetric radiological response determinations.There was strong agreement for 1D (RECIST) and 2D (Macdonald) measurements between neuroradiologists (ICC = 0.42 and 0.61, respectively), but the agreement using the authors' novel automated approach was significantly stronger (ICC = 0.97). The volumetric method had the strongest agreement with regard to radiological response (κ = 0.96) when compared with 2D (κ = 0.54) or 1D (κ = 0.46) methods. Despite diverse levels of experience of the users of the volumetric method, measurements using the volumetric program remained remarkably consistent in all users (0.94).Interobserver variability using this new semi-automated method is less than the variability with traditional methods of tumor measurement. This new method is objective, quick, and highly reproducible among operators with varying levels of expertise. This approach should be further evaluated as a potential standard for response assessment based on contrast enhancement in brain tumors.

Authors
Kanaly, CW; Mehta, AI; Ding, D; Hoang, JK; Kranz, PG; Herndon, JE; Coan, A; Crocker, I; Waller, AF; Friedman, AH; Reardon, DA; Sampson, JH
MLA Citation
Kanaly, CW, Mehta, AI, Ding, D, Hoang, JK, Kranz, PG, Herndon, JE, Coan, A, Crocker, I, Waller, AF, Friedman, AH, Reardon, DA, and Sampson, JH. "A novel, reproducible, and objective method for volumetric magnetic resonance imaging assessment of enhancing glioblastoma." Journal of neurosurgery 121.3 (September 2014): 536-542.
PMID
25036205
Source
epmc
Published In
Journal of neurosurgery
Volume
121
Issue
3
Publish Date
2014
Start Page
536
End Page
542
DOI
10.3171/2014.4.jns121952

Response.

Authors
Hoang, JK
MLA Citation
Hoang, JK. "Response." Radiology 272.1 (July 2014): 303-. (Letter)
PMID
25093219
Source
epmc
Published In
Radiology
Volume
272
Issue
1
Publish Date
2014
Start Page
303
DOI
10.1148/radiol.14140830

Trends in incidentally identified thyroid cancers over a decade: a retrospective analysis of 2,090 surgical patients.

BACKGROUND: The aim of this study was to describe trends in the incidence of incidental thyroid cancers and compare their characteristics with clinically presenting cancers. METHODS: We performed a retrospective review of patients with thyroid cancer who underwent thyroid surgery from 2003 to 2012. Patients' initial presentation was categorized as incidental (on imaging or final surgical pathology) or clinical (palpable or symptomatic) cancer. Characteristics of incidental and clinical cancers were compared. RESULTS: Of the 2,090 patients who underwent thyroid surgery, 680 (33 %) were diagnosed with cancer. One hundred ninety (28 %) were incidental cancer, of which 101 were detected on imaging studies and 89 were detected on analysis of the surgical pathology specimens. The incidence of thyroid cancer increased by 7.6-fold from 2003 to 2012. The proportion of incidental cancers on imaging did not increase, but incidental cancers found on pathology steadily increased from 6 % in 2003 to 20 % in 2012. 84 % of the cancers were papillary cancer, and the proportion of papillary cancer was similar for both clinical and incidental cancers. Clinical cancers were larger than incidental cancers on imaging (2.2 vs. 1.8 cm, p = 0.02). Incidental cancers on imaging were less likely to have lateral compartment nodal metastases (7 vs. 13 %, p < 0.001). CONCLUSIONS: Thyroid cancer diagnoses have increased at our institution, but the proportion of incidental cancers identified on imaging relative to clinical cancers has been stable over a decade and is not the sole explanation for the observed increase in thyroid cancer diagnoses. Incidental cancers on imaging are smaller in size and less likely to have lateral compartment nodal metastases than clinical cancers.

Authors
Bahl, M; Sosa, JA; Nelson, RC; Esclamado, RM; Choudhury, KR; Hoang, JK
MLA Citation
Bahl, M, Sosa, JA, Nelson, RC, Esclamado, RM, Choudhury, KR, and Hoang, JK. "Trends in incidentally identified thyroid cancers over a decade: a retrospective analysis of 2,090 surgical patients." World J Surg 38.6 (June 2014): 1312-1317.
PMID
24357246
Source
pubmed
Published In
World Journal of Surgery
Volume
38
Issue
6
Publish Date
2014
Start Page
1312
End Page
1317
DOI
10.1007/s00268-013-2407-9

High variability in radiologists' reporting practices for incidental thyroid nodules detected on CT and MRI.

BACKGROUND AND PURPOSE: There are no guidelines for reporting incidental thyroid nodules seen on CT and MR imaging. We evaluated radiologists' current reporting practices for incidental thyroid nodules detected on these imaging modalities. MATERIALS AND METHODS: Radiologists were surveyed regarding their reporting practices by using 14 scenarios of incidental thyroid nodules differing in size, patient demographics, and clinical history. Scenarios were evaluated for the following: 1) radiologists' most commonly selected response, and 2) the proportion of radiologists selecting that response (degree of agreement). These measures were used to determine how the patient scenario and characteristics of the radiologists affected variability in practice. RESULTS: One hundred fifty-three radiologists participated. In 8/14 scenarios, the most common response was to "recommend sonography." For the other scenarios, the most common response was to "report in only body of report." The overall mean agreement for the 14 scenarios was 53%, and agreement ranged from 36% to 75%. Smaller nodules had lower agreement: 43%-51% for 8-mm nodules compared with 64%-75% for 15-mm nodules. Agreement was poorest for the 10-mm nodule in a 60-year-old woman (36%) and for scenarios with additional history of lung cancer (39%) and multiple nodules (36%). There was no significant difference in reporting practices and agreement when radiologists were categorized by years of practice, practice type, and subspecialty (P > .55). CONCLUSIONS: The reporting practice for incidental thyroid nodules on CT or MR imaging is highly variable among radiologists, especially for patients with smaller nodules (≤10 mm) and patients with multiple nodules and a history of cancer. This variability highlights the need for practice guidelines.

Authors
Hoang, JK; Riofrio, A; Bashir, MR; Kranz, PG; Eastwood, JD
MLA Citation
Hoang, JK, Riofrio, A, Bashir, MR, Kranz, PG, and Eastwood, JD. "High variability in radiologists' reporting practices for incidental thyroid nodules detected on CT and MRI." AJNR. American journal of neuroradiology 35.6 (June 2014): 1190-1194.
PMID
24407274
Source
epmc
Published In
American Journal of Neuroradiology
Volume
35
Issue
6
Publish Date
2014
Start Page
1190
End Page
1194
DOI
10.3174/ajnr.a3834

Thyroid cancers incidentally detected at imaging in a 10-year period: how many cancers would be missed with use of the recommendations from the Society of Radiologists in Ultrasound?

PURPOSE: To estimate the prevalence of incidental thyroid cancer (ITC) among patients undergoing thyroid surgery and to apply the Society of Radiologists in Ultrasound (SRU) guidelines to ITC. MATERIALS AND METHODS: This HIPAA-compliant study was approved by the institutional review board, with waiver of the need to obtain informed consent. A retrospective review of data in patients who underwent thyroid surgery between January 1, 2003, and December 31, 2012, was performed. Imaging studies and reports were reviewed for ITCs that were first detected at either ultrasonography (US) or a different imaging modality and that included US as part of the work-up. ITCs were categorized by using the SRU guidelines to determine the characteristics of SRU criteria-positive and SRU criteria-negative malignancies. Patient demographic data, tumor histologic findings, tumor size, and tumor stage were compared for the SRU criteria-positive and SRU criteria-negative cancers by using the unpaired t test and the χ(2) test. RESULTS: Among 2090 patients who underwent thyroid surgery, 680 had thyroid cancer; of these patients, 101 (15%) had imaging-detected ITC. The SRU recommendations were applied to the findings in 90 of the 101 patients who had undergone US with images or had reports available for review. Sixteen (18%) of the 90 patients had SRU criteria-negative tumors, which represented 2% (16 of 680) of all thyroid cancers. SRU criteria-negative tumors were smaller than SRU criteria-positive tumors (mean, 1.1 cm [range, 0.9-1.4 cm] vs mean, 2.5 cm [range, 1.0-7.6 cm]; P < .001) and were more likely to be stage I (15 [94%] of 16 vs 47 [64%] of 74; P = .02). CONCLUSION: Imaging-detected ITCs are uncommon. Two percent (16 of 680) of malignancies would not undergo fine-needle aspiration biopsy or surgery if the SRU guidelines were used for work-up of incidental thyroid nodules. SRU criteria-negative tumors are lower in stage than SRU criteria-positive tumors.

Authors
Bahl, M; Sosa, JA; Nelson, RC; Hobbs, HA; Wnuk, NM; Hoang, JK
MLA Citation
Bahl, M, Sosa, JA, Nelson, RC, Hobbs, HA, Wnuk, NM, and Hoang, JK. "Thyroid cancers incidentally detected at imaging in a 10-year period: how many cancers would be missed with use of the recommendations from the Society of Radiologists in Ultrasound?." Radiology 271.3 (June 2014): 888-894.
PMID
24475865
Source
epmc
Published In
Radiology
Volume
271
Issue
3
Publish Date
2014
Start Page
888
End Page
894
DOI
10.1148/radiol.13132002

Population-based study provides a step towards evidence-based management of thyroid nodules detected on ultrasound.

Authors
Hoang, JK
MLA Citation
Hoang, JK. "Population-based study provides a step towards evidence-based management of thyroid nodules detected on ultrasound." Evidence-based medicine 19.3 (June 2014): 109-.
PMID
24476844
Source
epmc
Published In
Evidence-based medicine
Volume
19
Issue
3
Publish Date
2014
Start Page
109
DOI
10.1136/eb-2013-101686

An exponential growth in incidence of thyroid cancer: trends and impact of CT imaging.

BACKGROUND AND PURPOSE: Workup of incidental thyroid nodules detected on CT imaging could be contributing to the increased diagnosis of small thyroid cancers. The purpose of this study was to evaluate recent trends in the incidence of thyroid cancer, and to determine the relationship between annual CT imaging volume and rate of thyroid cancer diagnosis. MATERIALS AND METHODS: This retrospective cohort study used data bases for thyroid cancer and CT imaging volume. Thyroid cancer data from 1983-2009 were obtained from the Surveillance, Epidemiology, and End Results data base. National Council of Radiation Protection and Measurements Report No. 160 provided data on hospital and nonhospital CT imaging volume for 1993-2006. Trends in thyroid cancer were modeled for overall incidence on the basis of patient age, tumor histologic features, and tumor size and stage. Linear regression analysis was performed to evaluate the strength of the relationship between annual CT scan volume and the incidence of thyroid cancer by tumor size and histologic type. RESULTS: In 2009, the incidence of thyroid cancer was 14 per 100,000, which represented a 1.9-fold increase compared with 2000. The growth in incidence was exponential compared with a minimal linear increase in thyroid cancer mortality rate. The subgroup with the greatest change was subcentimeter papillary carcinoma, with doubling in incidence approximately every 6.2 years. The linear relationship between annual CT scan volume and the incidence of subcentimeter papillary carcinoma was very strong (R(2) = 0.98; P < .0001). CONCLUSIONS: The incidence of subcentimeter papillary carcinoma is growing at an exponential rate without significant change in mortality rate. The strong linear relationship between new cases of subcentimeter papillary carcinomas and the number of CT scans per year suggests that an increase in CT scans may increase the detection of incidental thyroid cancers.

Authors
Hoang, JK; Choudhury, KR; Eastwood, JD; Esclamado, RM; Lyman, GH; Shattuck, TM; Nguyen, XV
MLA Citation
Hoang, JK, Choudhury, KR, Eastwood, JD, Esclamado, RM, Lyman, GH, Shattuck, TM, and Nguyen, XV. "An exponential growth in incidence of thyroid cancer: trends and impact of CT imaging." AJNR Am J Neuroradiol 35.4 (April 2014): 778-783.
PMID
24113469
Source
pubmed
Published In
American Journal of Neuroradiology
Volume
35
Issue
4
Publish Date
2014
Start Page
778
End Page
783
DOI
10.3174/ajnr.A3743

Applying the society of radiologists in ultrasound recommendations for fine-needle aspiration of thyroid nodules: Effect on workup and malignancy detection

OBJECTIVE. The Society of Radiologists in Ultrasound (SRU) recommendations on thyroid nodules are intended to "diagnose thyroid cancers that have reached clinical significance, while avoiding unnecessary tests and surgery in patients with benign nodules." The aim of our study was to determine the proportion of thyroid nodules undergoing ultrasound-guided fine-needle aspiration (FNA) that do not meet SRU recommendations. MATERIALS AND METHODS. This study is a retrospective study of 400 consecutive ultrasound-guided thyroid FNA encounters from July 2010 through June 2011. An encounter was defined as presentation to the department of radiology on a given date for FNA of one or more thyroid nodules. The criteria for performing biopsy of a nodule were determined by the referring clinicians. Nodules were categorized on the basis of sonographic findings as meeting SRU recommendations for biopsy, which we refer to as "SRU-positive," or not, which we refer to as "SRU-negative." Patients without a definitive pathology diagnosis of Bethesda class benign or malignant nodules were excluded. The characteristics of malignancies were compared for SRU-positive and SRU-negative encounters. RESULTS. The final study group consisted of 360 biopsy encounters for 350 patients and 29 malignancies (8%). Of the 360 biopsy encounters, 86 (24%) were SRU-negative encounters. Malignancy rates in SRU-positive and SRU-negative encounters were 9% (24/274) and 6% (5/86), respectively, and were not significantly different ( p = 0.5). Eighteen malignancies (75%) in the SRU-positive group were localized, whereas the others had nodal metastases (4/24) or distant metastases (2/24). SRU-positive encounters included medullary carcinoma, anaplastic carcinoma, and melanoma metastasis in addition to papillary carcinoma. All SRU-negative malignancies were localized papillary carcinomas. CONCLUSION. One in four thyroid biopsy encounters at our institution did not meet SRU recommendations for biopsy. The application of SRU recommendations reduces the number of benign nodules that undergo workup. Potentially missed malignancies in SRU-negative nodules are less aggressive by histologic type and stage compared with SRU-positive malignancies. © American Roentgen Ray Society.

Authors
Hobbs, HA; Bahl, M; Nelson, RC; Eastwood, JD; Esclamado, RM; Hoang, JK
MLA Citation
Hobbs, HA, Bahl, M, Nelson, RC, Eastwood, JD, Esclamado, RM, and Hoang, JK. "Applying the society of radiologists in ultrasound recommendations for fine-needle aspiration of thyroid nodules: Effect on workup and malignancy detection." American Journal of Roentgenology 202.3 (March 1, 2014): 602-607.
Source
scopus
Published In
AJR. American journal of roentgenology
Volume
202
Issue
3
Publish Date
2014
Start Page
602
End Page
607
DOI
10.2214/AJR.13.11219

Applying the Society of Radiologists in Ultrasound recommendations for fine-needle aspiration of thyroid nodules: effect on workup and malignancy detection.

OBJECTIVE: The Society of Radiologists in Ultrasound (SRU) recommendations on thyroid nodules are intended to "diagnose thyroid cancers that have reached clinical significance, while avoiding unnecessary tests and surgery in patients with benign nodules." The aim of our study was to determine the proportion of thyroid nodules undergoing ultrasound-guided fine-needle aspiration (FNA) that do not meet SRU recommendations. MATERIALS AND METHODS: This study is a retrospective study of 400 consecutive ultrasound-guided thyroid FNA encounters from July 2010 through June 2011. An encounter was defined as presentation to the department of radiology on a given date for FNA of one or more thyroid nodules. The criteria for performing biopsy of a nodule were determined by the referring clinicians. Nodules were categorized on the basis of sonographic findings as meeting SRU recommendations for biopsy, which we refer to as "SRU-positive," or not, which we refer to as "SRU-negative." Patients without a definitive pathology diagnosis of Bethesda class benign or malignant nodules were excluded. The characteristics of malignancies were compared for SRU-positive and SRU-negative encounters. RESULTS: The final study group consisted of 360 biopsy encounters for 350 patients and 29 malignancies (8%). Of the 360 biopsy encounters, 86 (24%) were SRU-negative encounters. Malignancy rates in SRU-positive and SRU-negative encounters were 9% (24/274) and 6% (5/86), respectively, and were not significantly different (p=0.5). Eighteen malignancies (75%) in the SRU-positive group were localized, whereas the others had nodal metastases (4/24) or distant metastases (2/24). SRU-positive encounters included medullary carcinoma, anaplastic carcinoma, and melanoma metastasis in addition to papillary carcinoma. All SRU-negative malignancies were localized papillary carcinomas. CONCLUSION: One in four thyroid biopsy encounters at our institution did not meet SRU recommendations for biopsy. The application of SRU recommendations reduces the number of benign nodules that undergo workup. Potentially missed malignancies in SRU-negative nodules are less aggressive by histologic type and stage compared with SRU-positive malignancies.

Authors
Hobbs, HA; Bahl, M; Nelson, RC; Eastwood, JD; Esclamado, RM; Hoang, JK
MLA Citation
Hobbs, HA, Bahl, M, Nelson, RC, Eastwood, JD, Esclamado, RM, and Hoang, JK. "Applying the Society of Radiologists in Ultrasound recommendations for fine-needle aspiration of thyroid nodules: effect on workup and malignancy detection." AJR. American journal of roentgenology 202.3 (March 2014): 602-607.
PMID
24555597
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
202
Issue
3
Publish Date
2014
Start Page
602
End Page
607
DOI
10.2214/ajr.13.11219

Prevalence of the polar vessel sign in parathyroid adenomas on the arterial phase of 4D CT.

BACKGROUND AND PURPOSE: The "polar vessel" sign has been previously described on sonography of parathyroid adenomas. We estimated the 4D CT prevalence of the polar vessel sign and determined features of parathyroid adenomas that are associated with this sign. MATERIALS AND METHODS: Twenty-eight consecutive patients with parathyroid adenomas underwent 4D CT between 2008 and 2012 at 2 institutions. 4D CT images were reviewed for the presence of the polar vessel sign and a second vascular finding of an enlarged ipsilateral inferior thyroid artery. The polar vessel sign was correlated with adenoma weight and size and arterial phase CT attenuation. RESULTS: Thirty-two parathyroid adenomas in 28 patients were studied, with a mean adenoma weight of 0.66 ± 0.65 g, a mean maximal CT diameter of 11.1 ± 4.9 mm, and a mean arterial attenuation of 148 ± 47 HU. The polar vessel sign was seen in 20/32 (63%) adenomas. Adenomas with a polar vessel had higher arterial phase attenuation than adenomas without a polar vessel (163 and 122 HU, respectively, P < .01). Size and weight were not significantly different for adenomas with and without polar vessels. An enlarged inferior thyroid artery was seen in only 2/28 (7%) patients with unilateral disease. CONCLUSIONS: The polar vessel sign was present in nearly two-thirds of parathyroid adenomas on 4D CT and was more likely to be present in adenomas that had greater arterial phase enhancement. This sign can be used along with enhancement characteristics to increase the radiologist's confidence that a visualized lesion is a parathyroid adenoma rather than a thyroid nodule or lymph node.

Authors
Bahl, M; Muzaffar, M; Vij, G; Sosa, JA; Choudhury, KR; Hoang, JK
MLA Citation
Bahl, M, Muzaffar, M, Vij, G, Sosa, JA, Choudhury, KR, and Hoang, JK. "Prevalence of the polar vessel sign in parathyroid adenomas on the arterial phase of 4D CT." AJNR Am J Neuroradiol 35.3 (March 2014): 578-581.
PMID
23945223
Source
pubmed
Published In
American Journal of Neuroradiology
Volume
35
Issue
3
Publish Date
2014
Start Page
578
End Page
581
DOI
10.3174/ajnr.A3715

Trends in incidentally identified thyroid cancers over a decade: A retrospective analysis of 2,090 surgical patients

Background: The aim of this study was to describe trends in the incidence of incidental thyroid cancers and compare their characteristics with clinically presenting cancers. Methods: We performed a retrospective review of patients with thyroid cancer who underwent thyroid surgery from 2003 to 2012. Patients' initial presentation was categorized as incidental (on imaging or final surgical pathology) or clinical (palpable or symptomatic) cancer. Characteristics of incidental and clinical cancers were compared. Results: Of the 2,090 patients who underwent thyroid surgery, 680 (33 %) were diagnosed with cancer. One hundred ninety (28 %) were incidental cancer, of which 101 were detected on imaging studies and 89 were detected on analysis of the surgical pathology specimens. The incidence of thyroid cancer increased by 7.6-fold from 2003 to 2012. The proportion of incidental cancers on imaging did not increase, but incidental cancers found on pathology steadily increased from 6 % in 2003 to 20 % in 2012. 84 % of the cancers were papillary cancer, and the proportion of papillary cancer was similar for both clinical and incidental cancers. Clinical cancers were larger than incidental cancers on imaging (2.2 vs. 1.8 cm, p = 0.02). Incidental cancers on imaging were less likely to have lateral compartment nodal metastases (7 vs. 13 %, p < 0.001). Conclusions: Thyroid cancer diagnoses have increased at our institution, but the proportion of incidental cancers identified on imaging relative to clinical cancers has been stable over a decade and is not the sole explanation for the observed increase in thyroid cancer diagnoses. Incidental cancers on imaging are smaller in size and less likely to have lateral compartment nodal metastases than clinical cancers. © 2013 Société Internationale de Chirurgie.

Authors
Bahl, M; Sosa, JA; Nelson, RC; Esclamado, RM; Choudhury, KR; Hoang, JK
MLA Citation
Bahl, M, Sosa, JA, Nelson, RC, Esclamado, RM, Choudhury, KR, and Hoang, JK. "Trends in incidentally identified thyroid cancers over a decade: A retrospective analysis of 2,090 surgical patients." World Journal of Surgery 38.6 (January 1, 2014): 1312-1317.
Source
scopus
Published In
World Journal of Surgery
Volume
38
Issue
6
Publish Date
2014
Start Page
1312
End Page
1317
DOI
10.1007/s00268-013-2407-9

Case-control study: Population-based study provides a step towards evidence-based management of thyroid nodules detected on ultrasound

Authors
Hoang, JK
MLA Citation
Hoang, JK. "Case-control study: Population-based study provides a step towards evidence-based management of thyroid nodules detected on ultrasound." Evidence-Based Medicine 19.3 (January 1, 2014): 109-.
Source
scopus
Published In
Evidence-based medicine
Volume
19
Issue
3
Publish Date
2014
Start Page
109
DOI
10.1136/eb-2013-101686

Journal Club: incidental thyroid nodules detected at imaging: can diagnostic workup be reduced by use of the Society of Radiologists in Ultrasound recommendations and the three-tiered system?

OBJECTIVE: The purpose of this study was to determine the number of thyroid nodule workups that could be eliminated and the number of malignant tumors that would be missed if the Society of Radiologists in Ultrasound (SRU) recommendations and the three-tiered system were applied to incidental thyroid nodules (ITN) detected at imaging. MATERIALS AND METHODS: This retrospective study included ITN in 390 consecutively registered patients who underwent ultrasound-guided fine-needle aspiration of one or more thyroid nodules from July 2010 to June 2011. Images were reviewed, and nodules were categorized according to two workup criteria: ITN seen on ultrasound images were categorized according to SRU recommendations, and those seen on CT, MR, or PET/CT images were classified according to the three-tiered risk-categorization system. RESULTS: In this study 114 of 390 (29%) patients had nodules first detected incidentally during imaging studies, and 107 patients met the inclusion criteria. These patients had 47 ITN seen at ultrasound and 60 ITN seen at either CT, MRI, or PET/CT. If the SRU recommendations had been applied, 14 of 47 (30%) patients with ITN on ultrasound images would not have received fine-needle aspiration and one of four cases of cancer would have been missed. The missed malignant tumor was a 14-mm localized papillary carcinoma. If the three-tiered system had been applied, 21 of 60 (35%) patients with ITN on CT, MR, or PET/CT images would not have received fine-needle aspiration, but none of the three malignancies would have been missed. Overall, 35 of 107 (33%) of patients with ITN did not meet the SRU recommendations or the three-tiered criteria. CONCLUSION: Use of the SRU recommendations and three-tiered system can reduce the workup of ITN by one third compared with current practice without specific guidelines. One case of localized papillary carcinoma was missed when the SRU recommendations were used.

Authors
Hobbs, HA; Bahl, M; Nelson, RC; Kranz, PG; Esclamado, RM; Wnuk, NM; Hoang, JK
MLA Citation
Hobbs, HA, Bahl, M, Nelson, RC, Kranz, PG, Esclamado, RM, Wnuk, NM, and Hoang, JK. "Journal Club: incidental thyroid nodules detected at imaging: can diagnostic workup be reduced by use of the Society of Radiologists in Ultrasound recommendations and the three-tiered system?." AJR Am J Roentgenol 202.1 (January 2014): 18-24.
PMID
24370125
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
202
Issue
1
Publish Date
2014
Start Page
18
End Page
24
DOI
10.2214/AJR.13.10972

How to perform parathyroid 4D CT: tips and traps for technique and interpretation.

Parathyroid four-dimensional (4D) computed tomography (CT) is an imaging technique for preoperative localization of parathyroid adenomas that involves multidetector CT image acquisition during two or more contrast enhancement phases. Four-dimensional CT offers an alternative or additional tool in the evaluation of primary hyperparathyroidism. The purpose of this article is to describe the 4D CT technique and provide a practical guide to the radiologist for imaging interpretation. The article will discuss the rationale for imaging, approach to interpretation, imaging findings, and pitfalls.

Authors
Hoang, JK; Sung, W-K; Bahl, M; Phillips, CD
MLA Citation
Hoang, JK, Sung, W-K, Bahl, M, and Phillips, CD. "How to perform parathyroid 4D CT: tips and traps for technique and interpretation." Radiology 270.1 (January 2014): 15-24. (Review)
PMID
24354373
Source
pubmed
Published In
Radiology
Volume
270
Issue
1
Publish Date
2014
Start Page
15
End Page
24
DOI
10.1148/radiol.13122661

Optimal contrast concentration for CT-guided epidural steroid injections.

BACKGROUND AND PURPOSE: Contrast is used in CT-guided epidural steroid injections to ensure proper needle placement. Once injected, undiluted contrast often obscures the needle, hindering subsequent repositioning. The purpose of this investigation was to establish the optimal contrast dilution for CT-guided epidural steroid injections. MATERIALS AND METHODS: This investigation consisted of an initial phantom study, followed by a prospective, randomized, single-center trial assessing a range of contrast dilutions. In the phantom study, a phantom housing a chamber containing a 22-gauge needle and various dilutions of contrast was scanned, and images were evaluated for needle visibility. On the basis of these results, concentrations of 66, 100, 133, and 150 mg/mL iodine were selected for evaluation in a clinical study. Patients presenting for CT-guided epidural steroid injections were randomly assigned to a contrast dilution, and images from the procedure were evaluated by 2 readers blinded to the contrast assignment. Needle visibility was scored by use of a 5-point scale. RESULTS: In the phantom study, the needle was not visible at contrast concentrations of ≥133 mg/mL. In the clinical study, needle visibility was strongly associated with contrast concentration (P < .0001). Significant improvements in visibility were found in 66 mg/mL and 100 mg/mL compared with higher iodine concentrations; no difference was found comparing 66 mg/mL with 100 mg/mL iodine. Neither injection location (cervical versus lumbar) nor technique (interlaminar versus transforaminal) influenced visibility scores. CONCLUSIONS: For CT-guided epidural steroid injections, the optimal contrast concentration is 66-100 mg/mL iodine. Because these concentrations are not commercially available, proceduralists must dilute their contrast for such procedures.

Authors
Kranz, PG; Abbott, M; Abbott, D; Hoang, JK
MLA Citation
Kranz, PG, Abbott, M, Abbott, D, and Hoang, JK. "Optimal contrast concentration for CT-guided epidural steroid injections." AJNR Am J Neuroradiol 35.1 (January 2014): 191-195.
PMID
23886739
Source
pubmed
Published In
American Journal of Neuroradiology
Volume
35
Issue
1
Publish Date
2014
Start Page
191
End Page
195
DOI
10.3174/ajnr.A3626

Estimation of radiation exposure for brain perfusion CT: standard protocol compared with deviations in protocol.

OBJECTIVE: The purpose of this study was to measure the organ doses and estimate the effective dose for the standard brain perfusion CT protocol and erroneous protocols. MATERIALS AND METHODS: An anthropomorphic phantom with metal oxide semiconductor field effect transistor (MOSFET) detectors was scanned on a 64-MDCT scanner. Protocol 1 used a standard brain perfusion protocol with 80 kVp and fixed tube current of 200 mA. Protocol 2 used 120 kVp and fixed tube current of 200 mA. Protocol 3 used 120 kVp with automatic tube current modulation (noise index, 2.4; minimum, 100 mA; maximum, 520 mA). RESULTS: Compared with protocol 1, the effective dose was 2.8 times higher with protocol 2 and 7.8 times higher with protocol 3. For all protocols, the peak dose was highest in the skin, followed by the brain and calvarial marrow. Compared with protocol 1, the peak skin dose was 2.6 times higher with protocol 2 and 6.7 times higher with protocol 3. The peak skin dose for protocol 3 exceeded 3 Gy. The ocular lens received significant scatter radiation: 177 mGy for protocol 2 and 435 mGy for protocol 3, which were 4.6 and 11.3 times the dose for protocol 1, respectively. CONCLUSION: Compared with the standard protocol, erroneous protocols of increasing the tube potential from 80 kVp to 120 kVp will lead to a three- to fivefold increase in organ doses, and concurrent use of high peak kilovoltage with incorrectly programmed tube current modulation can increase dose to organs by 7- to 11-fold. Tube current modulation with a low noise index can lead to doses to the skin and ocular lens that are close to thresholds for tissue reactions.

Authors
Hoang, JK; Wang, C; Frush, DP; Enterline, DS; Samei, E; Toncheva, G; Lowry, C; Yoshizumi, TT
MLA Citation
Hoang, JK, Wang, C, Frush, DP, Enterline, DS, Samei, E, Toncheva, G, Lowry, C, and Yoshizumi, TT. "Estimation of radiation exposure for brain perfusion CT: standard protocol compared with deviations in protocol." AJR Am J Roentgenol 201.5 (November 2013): W730-W734.
PMID
24063388
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
201
Issue
5
Publish Date
2013
Start Page
W730
End Page
W734
DOI
10.2214/AJR.12.10031

Multidetector CT of nasolacrimal canal morphology: normal variation by age, gender, and race.

PURPOSE: To accurately characterize anatomical age, gender, and racial differences in normal nasolacrimal canal morphology and to describe a new, accurate technique for measuring nasolacrimal canal parameters based on high-resolution CT. METHODS: The CT images of 72 patients were reviewed retrospectively and grouped according to age, gender, and race. Patients with history of long-term sinusitis, facial trauma, or nasolacrimal duct pathology were excluded from study. Variations in nasolacrimal duct length, minimal and maximal diameter, and other metrics were recorded and compared across each category. All patient records were deidentified to protect privacy. RESULTS: Nasolacrimal canal length and volume were significantly greater in men than those in women. A trend was noted for greater canal cross-sectional diameter in patients older than 50 years when compared with that in younger patients. Significant differences in canal diameters were noted at the canal apex and base of older patients compared with those of younger patients. The cross-sectional area of the canal base was greater in black patients than that in Caucasian patients. CONCLUSIONS: Although some significant age, gender, and racial variations of nasolacrimal canal morphology exist, these do not fully explain the epidemiology of primary acquired nasolacrimal duct obstruction. The new method described here for measuring nasolacrimal canal metrics is straightforward and theoretically more accurate than those previously defined in the literature.

Authors
Ramey, NA; Hoang, JK; Richard, MJ
MLA Citation
Ramey, NA, Hoang, JK, and Richard, MJ. "Multidetector CT of nasolacrimal canal morphology: normal variation by age, gender, and race." Ophthal Plast Reconstr Surg 29.6 (November 2013): 475-480.
PMID
24145910
Source
pubmed
Published In
Ophthalmic Plastic and Reconstructive Surgery
Volume
29
Issue
6
Publish Date
2013
Start Page
475
End Page
480
DOI
10.1097/IOP.0b013e3182a230b0

Incidental thyroid nodules on CT: evaluation of 2 risk-categorization methods for work-up of nodules.

BACKGROUND AND PURPOSE: Thyroid nodules are common incidental findings on CT, but there are no clear guidelines regarding their further diagnostic work-up. This study compares the performance of 2 risk-categorization methods of selecting CT-detected incidental thyroid nodules for work-up. MATERIALS AND METHODS: The 2 categorization methods were method A, based on nodule size ≥10 mm, and method B, a 3-tiered system based on aggressive imaging features, patient age younger than 35 years or nodule size of ≥15 mm. In part 1, the 2 categorization methods were applied to thyroid cancers in the SEER data base of the National Cancer Institute to compare the cancer capture rates and survival. In part two, 755 CT neck scans at our institution were retrospectively reviewed for the presence of ITNs of ≥5 mm, and the same 2 categorization methods were applied to the CT cases to compare the number of patients who would theoretically meet the criteria for work-up. Comparisons of proportions of subjects captured under methods A and B were made by using the McNemar test. RESULTS: For 84,720 subjects in the SEER data base, methods A and B each captured 74% (62,708/84,720 and 62,586/84,720, respectively) of malignancies. SEER subjects who would not have met the criteria for further work-up by both methods had equally excellent 10-year cause-specific and relative survival of >99%. For part 2, the prevalence of ITNs of ≥5 mm at our institution was 133/755 (18%). The number of ITNs that would be recommended for work-up by method A was 57/133 (43%) compared with 31/133 (23%) for method B (P < .0005). CONCLUSIONS: Compared with using a 10-mm cutoff, the 3-tiered risk-stratification method identified fewer ITNs for work-up but captured the same proportion of cancers in a national data base and showed no difference in missing high-mortality cancers.

Authors
Nguyen, XV; Choudhury, KR; Eastwood, JD; Lyman, GH; Esclamado, RM; Werner, JD; Hoang, JK
MLA Citation
Nguyen, XV, Choudhury, KR, Eastwood, JD, Lyman, GH, Esclamado, RM, Werner, JD, and Hoang, JK. "Incidental thyroid nodules on CT: evaluation of 2 risk-categorization methods for work-up of nodules." AJNR Am J Neuroradiol 34.9 (September 2013): 1812-1817.
PMID
23557957
Source
pubmed
Published In
American Journal of Neuroradiology
Volume
34
Issue
9
Publish Date
2013
Start Page
1812
End Page
1817
DOI
10.3174/ajnr.A3487

Concurrent stereotactic radiosurgery and bevacizumab in recurrent malignant gliomas: a prospective trial.

PURPOSE: Virtually all patients with malignant glioma (MG) eventually recur. This study evaluates the safety of concurrent stereotactic radiosurgery (SRS) and bevacizumab (BVZ), an antiangiogenic agent, in treatment of recurrent MG. METHODS AND MATERIALS: Fifteen patients with recurrent MG, treated at initial diagnosis with surgery and adjuvant radiation therapy/temozolomide and then at least 1 salvage chemotherapy regimen, were enrolled in this prospective trial. Lesions <3 cm in diameter were treated in a single fraction, whereas those 3 to 5 cm in diameter received 5 5-Gy fractions. BVZ was administered immediately before SRS and 2 weeks later. Neurocognitive testing (Mini-Mental Status Exam, Trail Making Test A/B), Functional Assessment of Cancer Therapy-Brain (FACT-Br) quality-of-life assessment, physical exam, and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) were performed immediately before SRS and 1 week and 2 months following completion of SRS. The primary endpoint was central nervous system (CNS) toxicity. Secondary endpoints included survival, quality of life, microvascular properties as measured by DCE-MRI, steroid usage, and performance status. RESULTS: One grade 3 (severe headache) and 2 grade 2 CNS toxicities were observed. No patients experienced grade 4 to 5 toxicity or intracranial hemorrhage. Neurocognition, quality of life, and Karnofsky performance status did not change significantly with treatment. DCE-MRI results suggest a significant decline in tumor perfusion and permeability 1 week after SRS and further decline by 2 months. CONCLUSIONS: Treatment of recurrent MG with concurrent SRS and BVZ was not associated with excessive toxicity in this prospective trial. A randomized trial of concurrent SRS/BVZ versus conventional salvage therapy is needed to establish the efficacy of this approach.

Authors
Cabrera, AR; Cuneo, KC; Desjardins, A; Sampson, JH; McSherry, F; Herndon, JE; Peters, KB; Allen, K; Hoang, JK; Chang, Z; Craciunescu, O; Vredenburgh, JJ; Friedman, HS; Kirkpatrick, JP
MLA Citation
Cabrera, AR, Cuneo, KC, Desjardins, A, Sampson, JH, McSherry, F, Herndon, JE, Peters, KB, Allen, K, Hoang, JK, Chang, Z, Craciunescu, O, Vredenburgh, JJ, Friedman, HS, and Kirkpatrick, JP. "Concurrent stereotactic radiosurgery and bevacizumab in recurrent malignant gliomas: a prospective trial." Int J Radiat Oncol Biol Phys 86.5 (August 1, 2013): 873-879.
PMID
23725997
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
86
Issue
5
Publish Date
2013
Start Page
873
End Page
879
DOI
10.1016/j.ijrobp.2013.04.029

Using FDG-PET to measure early treatment response in head and neck squamous cell carcinoma: quantifying intrinsic variability in order to understand treatment-induced change.

BACKGROUND AND PURPOSE: Quantification of both baseline variability and intratreatment change is necessary to optimally incorporate functional imaging into adaptive therapy strategies for HNSCC. Our aim was to define the baseline variability of SUV on FDG-PET scans in patients with head and neck squamous cell carcinoma and to compare it with early treatment-induced SUV change. MATERIALS AND METHODS: Patients with American Joint Committee on Cancer stages III-IV HNSCC were imaged with 2 baseline PET/CT scans and a third scan after 1-2 weeks of curative-intent chemoradiation. SUVmax and SUVmean were measured in the primary tumor and most metabolically active nodal metastasis. Repeatability was assessed with Bland-Altman plots. Mean percentage differences (%ΔSUV) in baseline SUVs were compared with intratreatment %ΔSUV. The repeatability coefficient for baseline %ΔSUV was compared with intratreatment %ΔSUV. RESULTS: Seventeen patients had double-baseline imaging, and 15 of these patients also had intratreatment scans. Bland-Altman plots showed excellent baseline agreement for nodal metastases SUVmax and SUVmean, but not primary tumor SUVs. The mean baseline %ΔSUV was lowest for SUVmax in nodes (7.6% ± 5.2%) and highest for SUVmax in primary tumor (12.6% ± 9.2%). Corresponding mean intratreatment %ΔSUVmax was 14.5% ± 21.6% for nodes and 15.2% ± 22.4% for primary tumor. The calculated RC for baseline nodal SUVmax and SUVmean were 10% and 16%, respectively. The only patient with intratreatment %ΔSUV above these RCs was 1 of 2 patients with residual disease after CRT. CONCLUSIONS: Baseline SUV variability for HNSCC is less than intratreatment change for SUV in nodal disease. Evaluation of early treatment response should be measured quantitatively in nodal disease rather than the primary tumor, and assessment of response should consider intrinsic baseline variability.

Authors
Hoang, JK; Das, SK; Choudhury, KR; Yoo, DS; Brizel, DM
MLA Citation
Hoang, JK, Das, SK, Choudhury, KR, Yoo, DS, and Brizel, DM. "Using FDG-PET to measure early treatment response in head and neck squamous cell carcinoma: quantifying intrinsic variability in order to understand treatment-induced change." AJNR Am J Neuroradiol 34.7 (July 2013): 1428-1433.
PMID
23391836
Source
pubmed
Published In
American Journal of Neuroradiology
Volume
34
Issue
7
Publish Date
2013
Start Page
1428
End Page
1433
DOI
10.3174/ajnr.A3412

Recurrent laryngopyocele: CT-guided hookwire localization for re-excision surgery.

Laryngopyocele recurrence after initial surgical resection is a very rare occurrence. We present a case of recurrent laryngopyocele in which CT fluoroscopy-guided hookwire placement was used to facilitate resection. In this article, we illustrate the imaging findings of laryngopyocele, review the approach to management, and describe the CT fluoroscopy-guided hookwire placement procedure.

Authors
Gafton, AR; Cohen, SM; Eastwood, JD; Dang, MK; Hoang, JK
MLA Citation
Gafton, AR, Cohen, SM, Eastwood, JD, Dang, MK, and Hoang, JK. "Recurrent laryngopyocele: CT-guided hookwire localization for re-excision surgery." AJNR Am J Neuroradiol 34.4 (April 2013): E39-E42. (Review)
PMID
22173772
Source
pubmed
Published In
American Journal of Neuroradiology
Volume
34
Issue
4
Publish Date
2013
Start Page
E39
End Page
E42
DOI
10.3174/ajnr.A2810

Imaging of thyroid carcinoma with CT and MRI: approaches to common scenarios.

Computed tomography (CT) and magnetic resonance imaging (MRI) can play an important role in preoperative and post-treatment assessment of thyroid malignancy. The radiologist should be aware of the pathological behavior of thyroid carcinoma, and the characteristic imaging appearance of the primary tumor and metastases. This review describes the approach to imaging thyroid cancer on CT and MRI for four common scenarios: detection of the incidental thyroid nodule, evaluation of thyroid metastases, presurgical imaging for invasive disease, and evaluation for recurrence in the post-treatment neck.

Authors
Hoang, JK; Branstetter, BF; Gafton, AR; Lee, WK; Glastonbury, CM
MLA Citation
Hoang, JK, Branstetter, BF, Gafton, AR, Lee, WK, and Glastonbury, CM. "Imaging of thyroid carcinoma with CT and MRI: approaches to common scenarios. (Published online)" Cancer Imaging 13 (March 26, 2013): 128-139. (Review)
PMID
23545125
Source
pubmed
Published In
Cancer imaging : the official publication of the International Cancer Imaging Society
Volume
13
Publish Date
2013
Start Page
128
End Page
139
DOI
10.1102/1470-7330.2013.0013

CT-guided cervical transforaminal steroid injections: where should the needle tip be located?

BACKGROUND AND PURPOSE: The aim of CT-guided CTSI is to inject medication into the foraminal region where the nerve root is inflamed. The optimal location for needle placement and therapeutic delivery, however, remain uncertain. The purpose of this study was to investigate how needle positioning and angle of approach impact the transforaminal distribution of injectate. MATERIALS AND METHODS: We retrospectively reviewed fluoroscopic images from 90 CT-guided CTSI procedures for needle-tip location, needle angle, and contrast distribution. Needle-tip position was categorized as either foraminal zone, junctional, or extraforaminal. Distribution of contrast injected immediately before steroid administration was categorized as central epidural, intraforaminal, or extraforaminal in location. Needle-tip location and angle were correlated with contrast distribution. RESULTS: The needle tip was most commonly placed in the junctional position (36 cases, 40%), followed by foraminal (30 cases, 33%) and extraforaminal (24 cases, 27%) locations. Intraforaminal contrast distribution was highest when the needle location was foraminal (30/30, 100%) or junctional (35/36, 97%), compared with extraforaminal (7/24, 29%) (P value <.0001). There was no relationship between needle angle and contrast distribution. CONCLUSIONS: Needle-tip location at the outer edge of the neural foramen (junctional location) correlated well with intraforaminal distribution of contrast for CT-guided CTSI and compared favorably with injectate distribution following foraminal zone needle positioning. Junctional needle positioning may be preferred over the foraminal zone by some proceduralists. Extraforaminal needle positioning resulted in less favorable contrast distribution, which may significantly diminish the therapeutic efficacy of CTSI.

Authors
Hoang, JK; Massoglia, DP; Apostol, MA; Lascola, CD; Eastwood, JD; Kranz, PG
MLA Citation
Hoang, JK, Massoglia, DP, Apostol, MA, Lascola, CD, Eastwood, JD, and Kranz, PG. "CT-guided cervical transforaminal steroid injections: where should the needle tip be located?." AJNR Am J Neuroradiol 34.3 (March 2013): 688-692.
PMID
22954742
Source
pubmed
Published In
American Journal of Neuroradiology
Volume
34
Issue
3
Publish Date
2013
Start Page
688
End Page
692
DOI
10.3174/ajnr.A3266

Evaluation of cervical lymph nodes in head and neck cancer with CT and MRI: tips, traps, and a systematic approach.

OBJECTIVE: In this article, we present a 4-step approach to evaluating lymph nodes in the setting of head and neck squamous cell and thyroid carcinoma and highlight important tips and traps. CONCLUSION: The presence and extent of nodal metastases in head and neck cancer has a great impact on treatment and prognosis. Pretreatment CT and MRI of the neck are commonly performed to evaluate for nodal metastases.

Authors
Hoang, JK; Vanka, J; Ludwig, BJ; Glastonbury, CM
MLA Citation
Hoang, JK, Vanka, J, Ludwig, BJ, and Glastonbury, CM. "Evaluation of cervical lymph nodes in head and neck cancer with CT and MRI: tips, traps, and a systematic approach." AJR Am J Roentgenol 200.1 (January 2013): W17-W25. (Review)
PMID
23255768
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
200
Issue
1
Publish Date
2013
Start Page
W17
End Page
W25
DOI
10.2214/AJR.12.8960

Multidetector CT of nasolacrimal canal morphology: Normal variation by age, gender, and race

PURPOSE:: To accurately characterize anatomical age, gender, and racial differences in normal nasolacrimal canal morphology and to describe a new, accurate technique for measuring nasolacrimal canal parameters based on high-resolution CT. METHODS:: The CT images of 72 patients were reviewed retrospectively and grouped according to age, gender, and race. Patients with history of long-term sinusitis, facial trauma, or nasolacrimal duct pathology were excluded from study. Variations in nasolacrimal duct length, minimal and maximal diameter, and other metrics were recorded and compared across each category. All patient records were deidentified to protect privacy. RESULTS:: Nasolacrimal canal length and volume were significantly greater in men than those in women. A trend was noted for greater canal cross-sectional diameter in patients older than 50 years when compared with that in younger patients. Significant differences in canal diameters were noted at the canal apex and base of older patients compared with those of younger patients. The cross-sectional area of the canal base was greater in black patients than that in Caucasian patients. CONCLUSIONS:: Although some significant age, gender, and racial variations of nasolacrimal canal morphology exist, these do not fully explain the epidemiology of primary acquired nasolacrimal duct obstruction. The new method described here for measuring nasolacrimal canal metrics is straightforward and theoretically more accurate than those previously defined in the literature. (Ophthal Plast Reconstr Surg 2013;29:475-480) © 2013 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc..

Authors
Ramey, NA; Hoang, JK; Richard, MJ
MLA Citation
Ramey, NA, Hoang, JK, and Richard, MJ. "Multidetector CT of nasolacrimal canal morphology: Normal variation by age, gender, and race." Ophthalmic Plastic and Reconstructive Surgery 29.6 (2013): 475-480.
Source
scival
Published In
Ophthalmic Plastic and Reconstructive Surgery
Volume
29
Issue
6
Publish Date
2013
Start Page
475
End Page
480
DOI
10.1097/IOP.0b013e3182a230b0

Ascending Thoracic Aorta: Postoperative Imaging Evaluation

Authors
Prescott-Focht, JA; Martinez-Jimenez, S; Hurwitz, LM; Hoang, JK; Christensen, JD; Ghoshhajra, BB; Abbara, S
MLA Citation
Prescott-Focht, JA, Martinez-Jimenez, S, Hurwitz, LM, Hoang, JK, Christensen, JD, Ghoshhajra, BB, and Abbara, S. "Ascending Thoracic Aorta: Postoperative Imaging Evaluation." RADIOGRAPHICS 33.1 (2013): 73-85.
PMID
23322828
Source
wos-lite
Published In
Radiographics : a review publication of the Radiological Society of North America, Inc
Volume
33
Issue
1
Publish Date
2013
Start Page
73
End Page
85
DOI
10.1148/rg.331125090

Complications of vision loss and ophthalmoplegia during endoscopic sinus surgery

Objective: To describe two rare cases of concurrent vision loss and external ophthalmoplegia following powered endoscopic sinus surgery (ESS). Design: Observational case report. Results: The records of two patients who underwent powered ESS and developed multiple concurrent ophthalmic complications were retrospectively reviewed for clinical history, neuro-ophthalmologic examination, and imaging findings. Patient 1 developed a retinal vascular occlusion and complete loss of adduction. Patient 2 developed an orbital hemorrhage, optic neuropathy, and a restrictive global ophthalmoplegia. Similar published case reports were also reviewed. Conclusion: Despite advances in powered ESS technique and instrumentation, serious ophthalmic complications can still occur. Inadvertent entry into the medial orbital wall can result in a combination of blindness and ocular motility dysfunction. The variety of mechanisms responsible for these complications underscores the importance of thorough pre- and postoperative clinical examination and review of imaging studies. © 2013 Maharshak et al, publisher and licensee Dove Medical Press Ltd.

Authors
Maharshak, I; Hoang, JK; Bhatti, MT
MLA Citation
Maharshak, I, Hoang, JK, and Bhatti, MT. "Complications of vision loss and ophthalmoplegia during endoscopic sinus surgery." Clinical Ophthalmology 7 (2013): 573-580.
PMID
23658475
Source
scival
Published In
Clinical Ophthalmology
Volume
7
Publish Date
2013
Start Page
573
End Page
580
DOI
10.2147/OPTH.S40061

Concurrent stereotactic radiosurgery and bevacizumab in recurrent malignant gliomas: A prospective trial

Purpose: Virtually all patients with malignant glioma (MG) eventually recur. This study evaluates the safety of concurrent stereotactic radiosurgery (SRS) and bevacizumab (BVZ), an antiangiogenic agent, in treatment of recurrent MG. Methods and Materials: Fifteen patients with recurrent MG, treated at initial diagnosis with surgery and adjuvant radiation therapy/temozolomide and then at least 1 salvage chemotherapy regimen, were enrolled in this prospective trial. Lesions <3 cm in diameter were treated in a single fraction, whereas those 3 to 5 cm in diameter received 5 5-Gy fractions. BVZ was administered immediately before SRS and 2 weeks later. Neurocognitive testing (Mini-Mental Status Exam, Trail Making Test A/B), Functional Assessment of Cancer Therapy-Brain (FACT-Br) quality-of-life assessment, physical exam, and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) were performed immediately before SRS and 1 week and 2 months following completion of SRS. The primary endpoint was central nervous system (CNS) toxicity. Secondary endpoints included survival, quality of life, microvascular properties as measured by DCE-MRI, steroid usage, and performance status. Results: One grade 3 (severe headache) and 2 grade 2 CNS toxicities were observed. No patients experienced grade 4 to 5 toxicity or intracranial hemorrhage. Neurocognition, quality of life, and Karnofsky performance status did not change significantly with treatment. DCE-MRI results suggest a significant decline in tumor perfusion and permeability 1 week after SRS and further decline by 2 months. Conclusions: Treatment of recurrent MG with concurrent SRS and BVZ was not associated with excessive toxicity in this prospective trial. A randomized trial of concurrent SRS/BVZ versus conventional salvage therapy is needed to establish the efficacy of this approach. © 2013 Elsevier Inc.

Authors
Cabrera, AR; Cuneo, KC; Desjardins, A; Sampson, JH; McSherry, F; II, JEH; Peters, KB; Allen, K; Hoang, JK; Chang, Z; Craciunescu, O; Vredenburgh, JJ; Friedman, HS; Kirkpatrick, JP
MLA Citation
Cabrera, AR, Cuneo, KC, Desjardins, A, Sampson, JH, McSherry, F, II, JEH, Peters, KB, Allen, K, Hoang, JK, Chang, Z, Craciunescu, O, Vredenburgh, JJ, Friedman, HS, and Kirkpatrick, JP. "Concurrent stereotactic radiosurgery and bevacizumab in recurrent malignant gliomas: A prospective trial." International Journal of Radiation Oncology Biology Physics 86.5 (2013): 873-879.
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
86
Issue
5
Publish Date
2013
Start Page
873
End Page
879
DOI
10.1016/j.ijrobp.2013.04.029

The Role of Intrinsic Fluctuation in Glucose Metabolism in the Use of FDG-PET in Assessing Metabolic Response to Chemoradiation in Head-and-Neck Cancer

Authors
Das, SK; Hoang, JK; Choudhury, KR; Peterson, B; Yoo, DS; Brizel, DM
MLA Citation
Das, SK, Hoang, JK, Choudhury, KR, Peterson, B, Yoo, DS, and Brizel, DM. "The Role of Intrinsic Fluctuation in Glucose Metabolism in the Use of FDG-PET in Assessing Metabolic Response to Chemoradiation in Head-and-Neck Cancer." November 1, 2012.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
84
Issue
3
Publish Date
2012
Start Page
S525
End Page
S525

CT-guided lumbar nerve root injections: are we using the correct radiation dose settings?

BACKGROUND AND PURPOSE: Selecting a lower tube current for CT fluoroscopic spine injections is a method of radiation dose reduction. Ideally tube current should be tailored to the patient's body habitus, but a greater influence on tube current may be the proceduralist's personal preference. The purpose of this study was to compare tube current and fluoroscopy time of different proceduralists for lumbar spine CT-guided selective nerve root blocks, and to correlate image quality to patient diameter and tube current. MATERIALS AND METHODS: Eighty CT-guided SNRBs performed by 4 proceduralists were retrospectively reviewed for tube current and fluoroscopy time. Patient body habitus was evaluated by measuring anteroposterior diameters on scout images. Image quality was evaluated objectively and subjectively: noise was measured in the psoas muscle and images were graded on a 3-point scale. RESULTS: The mean tube current was 59 ± 20 mA and mean fluoroscopy time was 10.4 ± 7.5 seconds. The mean tube current between proceduralists differed by almost 2-fold, and there was greater than 2-fold difference in mean fluoroscopy time (P < .0001 and .01, respectively). Mean AP body size was 27 ± 5 cm. When categoric data of tube current and AP diameter were analyzed, only AP diameter was a statistically significant variable influencing image noise (P = .009). Twenty of 23 patients with AP diameter ≤30 cm had adequate to excellent image quality, even with lower tube current of ≤40 mA. CONCLUSIONS: Wide variability in tube current selection between proceduralists calls for a more objective method of selecting tube current to minimize radiation dose. Body size, measured by AP diameter, had the greatest influence on image quality. This could be used to identify patients for lower tube current selection.

Authors
Schauberger, JS; Kranz, PG; Choudhury, KR; Eastwood, JD; Gray, L; Hoang, JK
MLA Citation
Schauberger, JS, Kranz, PG, Choudhury, KR, Eastwood, JD, Gray, L, and Hoang, JK. "CT-guided lumbar nerve root injections: are we using the correct radiation dose settings?." AJNR Am J Neuroradiol 33.10 (November 2012): 1855-1859.
PMID
22576884
Source
pubmed
Published In
American Journal of Neuroradiology
Volume
33
Issue
10
Publish Date
2012
Start Page
1855
End Page
1859
DOI
10.3174/ajnr.A3096

CT-guided hookwire placement: a technical innovation for preoperative localization of nonpalpable cervical lymph nodes.

The aim is to describe the technique of preoperative CT-guided hookwire localization of small, but suspicious, cervical lymph nodes. We present 3 patients who underwent the procedure for nonpalpable cervical nodes detected on PET/CT prior to complete surgical resection of the nodes. The details of the radiological procedure, surgical outcomes, and pathologic results are described. The mean intervention time for preoperative hookwire localization was 9 minutes (range 7-14 minutes). There were no complications. All surgeons felt that the lengths of the surgical skin incision and operative times were reduced because of localization. The pathologic diagnoses were 2 benign nodes and 1 case of metastatic ovarian carcinoma. In conclusion, preoperative CT-guided hookwire localization is a useful technique for guiding surgical excision, especially when cervical nodes are small and deep in location.

Authors
Hoang, JK; De Jesus, R; Eastwood, JD; Gafton, AR; Witsell, DL
MLA Citation
Hoang, JK, De Jesus, R, Eastwood, JD, Gafton, AR, and Witsell, DL. "CT-guided hookwire placement: a technical innovation for preoperative localization of nonpalpable cervical lymph nodes." AJNR Am J Neuroradiol 33.7 (August 2012): E104-E106.
PMID
21757524
Source
pubmed
Published In
American Journal of Neuroradiology
Volume
33
Issue
7
Publish Date
2012
Start Page
E104
End Page
E106
DOI
10.3174/ajnr.A2538

CT fluoroscopy-guided cervical interlaminar steroid injections: safety, technique, and radiation dose parameters.

BACKGROUND AND PURPOSE: Cervical epidural steroid injections are approached with trepidation because of concerns over safety, including direct spinal cord injury. CT fluoroscopy is an alternative to conventional fluoroscopy that could potentially help reduce the risk of injury by providing improved localization of the needle tip. We sought to determine rates of technical success and risk of complications in our initial cohort of patients treated with cervical interlaminar ESI performed under CTF guidance. MATERIALS AND METHODS: In this retrospective case series, we reviewed procedural details and CTF images of 53 consecutive cervical interlaminar ESIs performed on 50 patients over a period of 8 months. Rates of technical success, incidence of complications, procedure times, and factors that influence radiation exposure were examined. RESULTS: No symptomatic procedural complications were observed. A single case of intrathecal contrast injection was observed, from which the patient was asymptomatic. The remaining injections were all technically successful. Injections were performed at every cervical level, as high as C1-C2. Total procedure times averaged less than 20 minutes. Average CT fluoroscopic time was 24 seconds and median tube current was 70 mA. CONCLUSIONS: CTF-guided cervical interlaminar ESI can be performed at all levels in the cervical spine with a low rate of procedural complications. Short total procedure times, CT-fluoroscopy times, and reduced tube current make this procedure a practical alternative to cervical ESI performed under conventional fluoroscopy.

Authors
Kranz, PG; Raduazo, P; Gray, L; Kilani, RK; Hoang, JK
MLA Citation
Kranz, PG, Raduazo, P, Gray, L, Kilani, RK, and Hoang, JK. "CT fluoroscopy-guided cervical interlaminar steroid injections: safety, technique, and radiation dose parameters." AJNR Am J Neuroradiol 33.7 (August 2012): 1221-1224.
PMID
22322610
Source
pubmed
Published In
American Journal of Neuroradiology
Volume
33
Issue
7
Publish Date
2012
Start Page
1221
End Page
1224
DOI
10.3174/ajnr.A2954

Resection and survival.

Authors
Sampson, JH; Hoang, JK
MLA Citation
Sampson, JH, and Hoang, JK. "Resection and survival." J Neurosurg 116.6 (June 2012): 1169-1170.
PMID
22424561
Source
pubmed
Published In
Journal of neurosurgery
Volume
116
Issue
6
Publish Date
2012
Start Page
1169
End Page
1170
DOI
10.3171/2011.10.JNS111437

Stereotactic radiotherapy for malignancies involving the trigeminal and facial nerves.

Involvement of a cranial nerve caries a poor prognosis for many malignancies. Recurrent or residual disease in the trigeminal or facial nerve after primary therapy poses a challenge due to the location of the nerve in the skull base, the proximity to the brain, brainstem, cavernous sinus, and optic apparatus and the resulting complex geometry. Surgical resection caries a high risk of morbidity and is often not an option for these patients. Stereotactic radiosurgery and radiotherapy are potential treatment options for patients with cancer involving the trigeminal or facial nerve. These techniques can deliver high doses of radiation to complex volumes while sparing adjacent critical structures. In the current study, seven cases of cancer involving the trigeminal or facial nerve are presented. These patients had unresectable recurrent or residual disease after definitive local therapy. Each patient was treated with stereotactic radiation therapy using a linear accelerator based system. A multidisciplinary approach including neuroradiology and surgical oncology was used to delineate target volumes. Treatment was well tolerated with no acute grade 3 or higher toxicity. One patient who was reirradiated experienced cerebral radionecrosis with mild symptoms. Four of the seven patients treated had no evidence of disease after a median follow up of 12 months (range 2-24 months). A dosimetric analysis was performed to compare intensity modulated fractionated stereotactic radiation therapy (IM-FSRT) to a 3D conformal technique. The dose to 90% (D90) of the brainstem was lower with the IM-FSRT plan by a mean of 13.5 Gy. The D95 to the ipsilateral optic nerve was also reduced with IM-FSRT by 12.2 Gy and the D95 for the optic chiasm was lower with FSRT by 16.3 Gy. Treatment of malignancies involving a cranial nerve requires a multidisciplinary approach. Use of an IM-FSRT technique with a micro-multileaf collimator resulted in a lower dose to the brainstem, optic nerves and chiasm for each case examined.

Authors
Cuneo, KC; Zagar, TM; Brizel, DM; Yoo, DS; Hoang, JK; Chang, Z; Wang, Z; Yin, FF; Das, SK; Green, S; Ready, N; Bhatti, MT; Kaylie, DM; Becker, A; Sampson, JH; Kirkpatrick, JP
MLA Citation
Cuneo, KC, Zagar, TM, Brizel, DM, Yoo, DS, Hoang, JK, Chang, Z, Wang, Z, Yin, FF, Das, SK, Green, S, Ready, N, Bhatti, MT, Kaylie, DM, Becker, A, Sampson, JH, and Kirkpatrick, JP. "Stereotactic radiotherapy for malignancies involving the trigeminal and facial nerves." Technol Cancer Res Treat 11.3 (June 2012): 221-228.
PMID
22468993
Source
pubmed
Published In
Technology in cancer research & treatment
Volume
11
Issue
3
Publish Date
2012
Start Page
221
End Page
228
DOI
10.7785/tcrt.2012.500290

Parathyroid lesions: characterization with dual-phase arterial and venous enhanced CT of the neck.

This clinical report describes the enhancement characteristics of hypersecreting parathyroid lesions on dual-phase neck CT. We retrospectively analyzed the enhancement characteristics of 5 pathologically confirmed PTH-secreting lesions on dual-phase CT examinations. Attenuation values were measured for PTH-secreting lesions, vascular structures (CCA and IJV), and soft tissue structures (thyroid gland, jugulodigastric lymph node, and submandibular gland). From the attenuation values, "relative enhancement washout percentage" and "tissue-vascular ratio" were calculated and compared. All lesions decreased in attenuation from arterial to venous phase, while the mean attenuation values of other soft tissue structures increased. A high relative enhancement washout percentage was correlated with parathyroid lesions (P < .006). The tissue-CCA ratio and tissue-IJV ratio for PTH-secreting lesions in the arterial phase were statistically significantly higher compared with soft tissue structures (P < .05). If these results are validated in future larger studies, noncontrast and delayed venous phases of 4D-CT could be eliminated to markedly reduce radiation exposure.

Authors
Gafton, AR; Glastonbury, CM; Eastwood, JD; Hoang, JK
MLA Citation
Gafton, AR, Glastonbury, CM, Eastwood, JD, and Hoang, JK. "Parathyroid lesions: characterization with dual-phase arterial and venous enhanced CT of the neck." AJNR Am J Neuroradiol 33.5 (May 2012): 949-952.
PMID
22241395
Source
pubmed
Published In
American Journal of Neuroradiology
Volume
33
Issue
5
Publish Date
2012
Start Page
949
End Page
952
DOI
10.3174/ajnr.A2885

Organ-based dose current modulation and thyroid shields: techniques of radiation dose reduction for neck CT.

OBJECTIVE: The purpose of this study was to assess the difference in absorbed organ dose and image quality for MDCT neck protocols using automatic tube current modulation alone compared with organ-based dose modulation and in-plane thyroid bismuth shielding. MATERIALS AND METHODS: An anthropomorphic female phantom with metal oxide semiconductor field effect transistor (MOSFET) detectors was scanned on a 64-MDCT scanner. The protocols included a reference neck CT protocol using automatic tube current modulation and three modified protocols: organ-based dose modulation, automatic tube current modulation with thyroid shield, and organ-based dose modulation with thyroid shield. Image noise was evaluated quantitatively with the SD of the attenuation value, and subjectively by two neuroradiologists. RESULTS: Organ-based dose modulation, automatic tube current modulation with thyroid shield, and organ-based dose modulation with thyroid shield protocols reduced the thyroid dose by 28%, 33%, and 45%, respectively, compared with the use of automatic tube current modulation alone (p ≤ 0.005). Organ-based dose modulation also reduced the radiation dose to the ocular lens (33-47%) compared with the use of automatic tube current modulation (p ≤ 0.04). There was no significant difference in measured noise and subjective image quality between the protocols. CONCLUSION: Both organ-based dose modulation and thyroid shields significantly reduce the thyroid organ dose without degradation of subjective image quality compared with automatic tube current modulation. Organ-based dose modulation has the additional benefit of dose reduction to the ocular lens.

Authors
Hoang, JK; Yoshizumi, TT; Choudhury, KR; Nguyen, GB; Toncheva, G; Gafton, AR; Eastwood, JD; Lowry, C; Hurwitz, LM
MLA Citation
Hoang, JK, Yoshizumi, TT, Choudhury, KR, Nguyen, GB, Toncheva, G, Gafton, AR, Eastwood, JD, Lowry, C, and Hurwitz, LM. "Organ-based dose current modulation and thyroid shields: techniques of radiation dose reduction for neck CT." AJR Am J Roentgenol 198.5 (May 2012): 1132-1138.
PMID
22528904
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
198
Issue
5
Publish Date
2012
Start Page
1132
End Page
1138
DOI
10.2214/AJR.11.7445

What to do with incidental thyroid nodules on imaging? An approach for the radiologist.

The incidental thyroid nodule is a common finding on cross-sectional imaging of the neck and chest. Although the majority of nonpalpable incidental nodules are benign, the radiologist must assess the risk of malignancy, intelligently report the finding, and potentially direct the subsequent workup. To do so, the radiologist requires an understanding of issues around thyroid cancer, costs of thyroid nodule workup, and suspicious findings for malignancy. This article describes the problem of the incidental thyroid nodule, reviews the imaging findings of malignancy, and discusses an approach to reporting the incidental thyroid nodule.

Authors
Hoang, JK; Raduazo, P; Yousem, DM; Eastwood, JD
MLA Citation
Hoang, JK, Raduazo, P, Yousem, DM, and Eastwood, JD. "What to do with incidental thyroid nodules on imaging? An approach for the radiologist." Semin Ultrasound CT MR 33.2 (April 2012): 150-157.
PMID
22410363
Source
pubmed
Published In
Seminars in Ultrasound, CT and MRI
Volume
33
Issue
2
Publish Date
2012
Start Page
150
End Page
157
DOI
10.1053/j.sult.2011.12.004

Prospective trial of synchronous bevacizumab, erlotinib, and concurrent chemoradiation in locally advanced head and neck cancer.

PURPOSE: We assessed the safety and efficacy of synchronous VEGF and epidermal growth factor receptor (EGFR) blockade with concurrent chemoradiation (CRT) in locally advanced head and neck cancer (HNC). EXPERIMENTAL DESIGN: Newly diagnosed patients with stage III/IV HNC received a 2-week lead-in of bevacizumab and/or erlotinib, followed by both agents with concurrent cisplatin and twice daily radiotherapy. Safety was assessed using Common Toxicity Criteria version 3.0. The primary efficacy endpoint was clinical complete response (CR) rate after CRT. RESULTS: Twenty-nine patients enrolled on study, with 27 completing therapy. Common grade III toxicities were mucositis (n = 14), dysphagia (n = 8), dehydration (n = 7), osteoradionecrosis (n = 3), and soft tissue necrosis (n = 2). Feeding tube placement was required in 79% but no patient remained dependent at 12-month posttreatment. Clinical CR after CRT was 96% [95% confidence interval (CI), 82%-100%]. Median follow-up was 46 months in survivors, with 3-year locoregional control and distant metastasis-free survival rates of 85% and 93%. Three-year estimated progression-free survival, disease-specific survival, and overall survival rates were 82%, 89%, and 86%, respectively. Dynamic contrast enhanced MRI (DCE-MRI) analysis showed that patients who had failed had lower baseline pretreatment median K(trans) values, with subsequent increases after lead-in therapy and 1 week of CRT. Patients who did not fail had higher median K(trans) values that decreased during therapy. CONCLUSIONS: Dual VEGF/EGFR inhibition can be integrated with CRT in locally advanced HNC, with efficacy that compares favorably with historical controls albeit with an increased risk of osteoradionecrosis. Pretreatment and early DCE-MRI may prospectively identify patients at high risk of failure.

Authors
Yoo, DS; Kirkpatrick, JP; Craciunescu, O; Broadwater, G; Peterson, BL; Carroll, MD; Clough, R; MacFall, JR; Hoang, J; Scher, RL; Esclamado, RM; Dunphy, FR; Ready, NE; Brizel, DM
MLA Citation
Yoo, DS, Kirkpatrick, JP, Craciunescu, O, Broadwater, G, Peterson, BL, Carroll, MD, Clough, R, MacFall, JR, Hoang, J, Scher, RL, Esclamado, RM, Dunphy, FR, Ready, NE, and Brizel, DM. "Prospective trial of synchronous bevacizumab, erlotinib, and concurrent chemoradiation in locally advanced head and neck cancer." Clin Cancer Res 18.5 (March 1, 2012): 1404-1414.
PMID
22253412
Source
pubmed
Published In
Clinical cancer research : an official journal of the American Association for Cancer Research
Volume
18
Issue
5
Publish Date
2012
Start Page
1404
End Page
1414
DOI
10.1158/1078-0432.CCR-11-1982

Variation in tube voltage for adult neck MDCT: effect on radiation dose and image quality.

OBJECTIVE: The purpose of this study was to assess the effect of peak kilovoltage on radiation dose and image quality in adult neck MDCT. MATERIALS AND METHODS: An anthropomorphic phantom with metal oxide semiconductor field effect transistor detectors was imaged with a 64-MDCT scanner. The reference CT protocol called for 120 kVp, and images obtained with that protocol were compared with CT images obtained with protocols entailing 80, 100, and 140 kVp. All imaging was performed with automatic tube current modulation. Organ dose and effective dose were determined for each protocol and compared with those obtained with the 120-kVp protocol. Image noise was evaluated objectively and subjectively for each protocol. RESULTS: The highest organ doses for all protocols were to the thyroid, ocular lens, skin, and mandible. The greatest reductions in organ dose were for the bone marrow of the cervical spine and mandible: 43% and 35% with the 100-kVp protocol and 63% and 53% with the 80-kVp protocol. Effective dose decreased as much as 9% with the 100-kVp protocol and 12% with the 80-kVp protocol. Use of the 140-kVp protocol was associated with an increase in organ dose as high as 64% for bone marrow in the cervical spine and a 19% increase in effective dose. Image noise increased with lower peak kilovoltage. The measured noise difference was greatest at 80 kVp, absolute increases were less than 2.5 HU. There was no difference in subjective image quality among protocols. CONCLUSION: Reducing the voltage from 120 to 80 kVp for neck CT can result in greater than 50% reduction in the absorbed organ dose to the bone marrow of the cervical spine and mandible without impairment in subjective image quality.

Authors
Hoang, JK; Yoshizumi, TT; Nguyen, G; Toncheva, G; Choudhury, KR; Gafton, AR; Eastwood, JD; Lowry, C; Hurwitz, LM
MLA Citation
Hoang, JK, Yoshizumi, TT, Nguyen, G, Toncheva, G, Choudhury, KR, Gafton, AR, Eastwood, JD, Lowry, C, and Hurwitz, LM. "Variation in tube voltage for adult neck MDCT: effect on radiation dose and image quality." AJR Am J Roentgenol 198.3 (March 2012): 621-627.
PMID
22358002
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
198
Issue
3
Publish Date
2012
Start Page
621
End Page
627
DOI
10.2214/AJR.11.6831

Analysis of pretreatment FDG-PET SUV parameters in head-and-neck cancer: tumor SUVmean has superior prognostic value.

PURPOSE: To evaluate the prognostic significance of different descriptive parameters in head-and-neck cancer patients undergoing pretreatment [F-18] fluoro-D-glucose-positron emission tomography (FDG-PET) imaging. PATIENTS AND METHODS: Head-and-neck cancer patients who underwent FDG-PET before a course of curative intent radiotherapy were retrospectively analyzed. FDG-PET imaging parameters included maximum (SUV(max)), and mean (SUV(mean)) standard uptake values, and total lesion glycolysis (TLG). Tumors and lymph nodes were defined on co-registered axial computed tomography (CT) slices. SUV(max) and SUV(mean) were measured within these anatomic regions. The relationships between pretreatment SUV(max), SUV(mean), and TLG for the primary site and lymph nodes were assessed using a univariate analysis for disease-free survival (DFS), locoregional control (LRC), and distant metastasis-free survival (DMFS). Kaplan-Meier survival curves were generated and compared via the log-rank method. SUV data were analyzed as continuous variables. RESULTS: A total of 88 patients was assessed. Two-year OS, LRC, DMFS, and DFS for the entire cohort were 85%, 78%, 81%, and 70%, respectively. Median SUV(max) for the primary tumor and lymph nodes was 15.4 and 12.2, respectively. Median SUV(mean) for the primary tumor and lymph nodes was 7 and 5.2, respectively. Median TLG was 770. Increasing pretreatment SUV(mean) of the primary tumor was associated with decreased disease-free survival (p = 0.01). Neither SUV(max) in the primary tumor or lymph nodes nor TLG was prognostic for any of the clinical endpoints. Patients with pretreatment tumor SUV(mean) that exceeded the median value (7) of the cohort demonstrated inferior 2-year DFS relative to patients with SUV(mean) ≤ the median value of the cohort, 58% vs. 82%, respectively, p = 0.03. CONCLUSION: Increasing SUV(mean) in the primary tumor was associated with inferior DFS. Although not routinely reported, pretreatment SUV(mean) may be a useful prognostic FDG-PET parameter and should be further evaluated prospectively.

Authors
Higgins, KA; Hoang, JK; Roach, MC; Chino, J; Yoo, DS; Turkington, TG; Brizel, DM
MLA Citation
Higgins, KA, Hoang, JK, Roach, MC, Chino, J, Yoo, DS, Turkington, TG, and Brizel, DM. "Analysis of pretreatment FDG-PET SUV parameters in head-and-neck cancer: tumor SUVmean has superior prognostic value." Int J Radiat Oncol Biol Phys 82.2 (February 1, 2012): 548-553.
PMID
21277108
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
82
Issue
2
Publish Date
2012
Start Page
548
End Page
553
DOI
10.1016/j.ijrobp.2010.11.050

Chest radiology

Authors
Heyneman, LE; Washington, L; Christensen, JD; Hoang, JK; Knutson, TM; Hoang, PB
MLA Citation
Heyneman, LE, Washington, L, Christensen, JD, Hoang, JK, Knutson, TM, and Hoang, PB. "Chest radiology." Duke Radiology Case Review: Imaging, Differential Diagnosis, and Discussion: 2nd Edition. January 19, 2012. 1-.
Source
scopus
Publish Date
2012
Start Page
1

Chest radiology: Case 25

Authors
Hoang, JK
MLA Citation
Hoang, JK. "Chest radiology: Case 25." Duke Radiology Case Review: Imaging, Differential Diagnosis, and Discussion: 2nd Edition. January 19, 2012. 50-51.
Source
scopus
Publish Date
2012
Start Page
50
End Page
51

Chest radiology: Case 28

Authors
Hoang, JK
MLA Citation
Hoang, JK. "Chest radiology: Case 28." Duke Radiology Case Review: Imaging, Differential Diagnosis, and Discussion: 2nd Edition. January 19, 2012. 56-57.
Source
scopus
Publish Date
2012
Start Page
56
End Page
57

Chest radiology: Case 29

Authors
Hoang, JK
MLA Citation
Hoang, JK. "Chest radiology: Case 29." Duke Radiology Case Review: Imaging, Differential Diagnosis, and Discussion: 2nd Edition. January 19, 2012. 58-59.
Source
scopus
Publish Date
2012
Start Page
58
End Page
59

FDG-PET assessment of the effect of head and neck radiotherapy on parotid gland glucose metabolism.

PURPOSE: Functional imaging with [F-18]-fluorodeoxyglucose positron emission tomography (FDG-PET) provides the opportunity to define the physiology of the major salivary glands before and after radiation therapy. The goal of this retrospective study was to identify the radiation dose-response relationship of parotid gland glucose metabolism in patients with head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS: Forty-nine adults with HNSCC were identified who had curative intent intensity-modulated radiation therapy (IMRT) and FDG-PET imaging before and after treatment. Using a graphical user interface, contours were delineated for the parotid glands on axial CT slices while all authors were blinded to paired PET slices. Average and maximal standard uptake values (SUV) were measured within these anatomic regions. Changes in SUV and volume after radiation therapy were correlated with parotid gland dose-volume histograms from IMRT plans. RESULTS: The average parotid gland volume was 30.7 mL and contracted 3.9 ± 1.9% with every increase of 10 Gy in mean dose (p = 0.04). However, within the first 3 months after treatment, there was a uniform reduction of 16.5% ± 7.3% regardless of dose. The average SUV(mean) of the glands was 1.63 ± 0.48 pretreatment and declined by 5.2% ± 2.5% for every increase of 10 Gy in mean dose (p = 0.04). The average SUV(max) was 4.07 ± 2.85 pretreatment and decreased in a sigmoid manner with mean dose. A threshold of 32 Gy for mean dose existed, after which SUV(max) declined rapidly. CONCLUSION: Radiation dose responses of the parotid glands can be measured by integrated CT/FDG-PET scans. Retrospective analysis showed sigmoidal declines in the maximum metabolism but linear declines in the average metabolism of the glands with dose. Future studies should correlate this decline in FDG uptake with saliva production to improve treatment planning.

Authors
Roach, MC; Turkington, TG; Higgins, KA; Hawk, TC; Hoang, JK; Brizel, DM
MLA Citation
Roach, MC, Turkington, TG, Higgins, KA, Hawk, TC, Hoang, JK, and Brizel, DM. "FDG-PET assessment of the effect of head and neck radiotherapy on parotid gland glucose metabolism." Int J Radiat Oncol Biol Phys 82.1 (January 1, 2012): 321-326.
PMID
21030160
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
82
Issue
1
Publish Date
2012
Start Page
321
End Page
326
DOI
10.1016/j.ijrobp.2010.08.055

Reply

Authors
Hoang, JK; Gafton, AR
MLA Citation
Hoang, JK, and Gafton, AR. "Reply." American Journal of Neuroradiology 33.4 (2012): E67-.
Source
scival
Published In
American Journal of Neuroradiology
Volume
33
Issue
4
Publish Date
2012
Start Page
E67
DOI
10.3174/ajnr.A3109

Reply

Authors
Kranz, PG; Raduazo, P; Gray, L; Kilani, RK; Hoang, JK
MLA Citation
Kranz, PG, Raduazo, P, Gray, L, Kilani, RK, and Hoang, JK. "Reply." American Journal of Neuroradiology 33.11 (2012): E139-.
Source
scival
Published In
American Journal of Neuroradiology
Volume
33
Issue
11
Publish Date
2012
Start Page
E139
DOI
10.3174/ajnr.A3430

Correlation of cross-sectional diameter with image quality and radiation exposure in MDCT examinations of the neck.

OBJECTIVE: The purpose of this study was to identify an optimal cross-sectional neck diameter that correlates with image quality and radiation exposure in MDCT examinations of the neck performed with automatic tube current modulation. MATERIALS AND METHODS: Ninety-six adults underwent 64-MDCT of the neck with automatic tube current modulation at the same noise setting. On frontal and lateral scout images, maximal body diameters were measured in the transverse and anteroposterior planes at two levels: just below the mandible (upper neck) and at the lung apex (lower neck). Neck diameters were correlated with image quality on a subjective 4-point scale and with radiation exposure (volume CT dose index). RESULTS: As continuous variables, both anteroposterior and transverse diameters in the lower neck were associated with image quality (p ≤ 0.0012). Diameters in the upper neck were not associated with image quality. When diameters in the lower neck were categorized into small, medium, and large, image quality grades were higher for smaller patients (p < 0.001). Images of 81% of small patients (lower neck transverse diameter < 40 cm) had a high image quality grade, compared with images of 7-20% of large patients (diameter > 48 cm). Transverse diameter in the lower neck correlated best with radiation dose measured as volume CT dose index (r = 0.78). When transverse diameter in the lower neck was used to categorize patients' size, the mean volume CT dose index for small patients was 34.1 mSv and that for large patients was 63.5 mSv. CONCLUSION: Lower neck transverse diameter on the CT scout image best correlates with image quality and radiation exposure for neck MDCT examinations performed with automatic tube current modulation. Images of patients with a lower neck transverse diameter less than 40 cm are of higher quality than those of larger patients. Individualized dose reduction techniques therefore may be appropriate for smaller patients.

Authors
Hoang, JK; Gafton, AR; Eastwood, JD; Chen, LF; Hurwitz, LM
MLA Citation
Hoang, JK, Gafton, AR, Eastwood, JD, Chen, LF, and Hurwitz, LM. "Correlation of cross-sectional diameter with image quality and radiation exposure in MDCT examinations of the neck." AJR Am J Roentgenol 197.5 (November 2011): W904-W909.
PMID
22021540
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
197
Issue
5
Publish Date
2011
Start Page
W904
End Page
W909
DOI
10.2214/AJR.10.5476

Imaging the oral cavity: key concepts for the radiologist.

The oral cavity is a challenging area for radiological diagnosis. Soft-tissue, glandular structures and osseous relations are in close proximity and a sound understanding of radiological anatomy and common pathways of disease spread is required. In this pictorial review we present the anatomical and pathological concepts of the oral cavity with emphasis on the complementary nature of diagnostic imaging modalities.

Authors
Law, CP; Chandra, RV; Hoang, JK; Phal, PM
MLA Citation
Law, CP, Chandra, RV, Hoang, JK, and Phal, PM. "Imaging the oral cavity: key concepts for the radiologist." Br J Radiol 84.1006 (October 2011): 944-957. (Review)
PMID
21933981
Source
pubmed
Published In
British Journal of Radiology
Volume
84
Issue
1006
Publish Date
2011
Start Page
944
End Page
957
DOI
10.1259/bjr/70520972

Radiation dose exposure for lumbar spine epidural steroid injections: a comparison of conventional fluoroscopy data and CT fluoroscopy techniques.

OBJECTIVE: The purpose of this article is to compare the radiation dose of conventional fluoroscopy-guided lumbar epidural steroid injections (ESIs) and CT fluoroscopy (CTF)-guided lumbar ESI using both clinical data and anthropomorphic phantoms. MATERIALS AND METHODS: We performed a retrospective review of dose parameters for 14 conventional fluoroscopy ESI procedures performed by one proceduralist and 42 CTF-guided ESIs performed by three proceduralists (14 each). By use of imaging techniques similar to those for our clinical cohorts, a commercially available anthropomorphic male phantom with metal oxide semiconductor field effect transistor detectors was scanned to obtain absorbed organ doses for conventional fluoroscopy-guided and CTF-guided ESIs. Effective dose (ED) was calculated from measured organ doses. RESULTS: The mean conventional fluoroscopy time for ESI was 37 seconds, and the mean procedural CTF time was 4.7 seconds. Calculated ED for conventional fluoroscopy was 0.85 mSv compared with 0.45 mSv for CTF. The greatest contribution to the radiation dose from CTF-guided ESI came from the planning lumbar spine CT scan, which had an ED of 2.90 mSv when z-axis ranged from L2 to S1. This resulted in a total ED for CTF-guided ESI (lumbar spine CT scan plus CTF) of 3.35 mSv. CONCLUSION: The ED for the CTF-guided ESI was almost half that of conventional fluoroscopy because of the shorter fluoroscopy time. However, the overall radiation dose for CTF-guided ESIs can be up to four times higher when a full diagnostic lumbar CT scan is performed as part of the procedure. Radiation dose reduction for CTF-guided ESI is best achieved by minimizing the dose from the preliminary planning lumbar spine CT scan.

Authors
Hoang, JK; Yoshizumi, TT; Toncheva, G; Gray, L; Gafton, AR; Huh, BK; Eastwood, JD; Lascola, CD; Hurwitz, LM
MLA Citation
Hoang, JK, Yoshizumi, TT, Toncheva, G, Gray, L, Gafton, AR, Huh, BK, Eastwood, JD, Lascola, CD, and Hurwitz, LM. "Radiation dose exposure for lumbar spine epidural steroid injections: a comparison of conventional fluoroscopy data and CT fluoroscopy techniques." AJR Am J Roentgenol 197.4 (October 2011): 778-782.
PMID
21940563
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
197
Issue
4
Publish Date
2011
Start Page
778
End Page
782
DOI
10.2214/AJR.10.6102

Bilateral retropharyngeal parathyroid hyperplasia detected with 4D multidetector row CT.

We present a case of bilateral retropharyngeal parathyroid hyperplasia detected with 4D-CT in a patient with persistent primary hyperparathyroidism and failed neck exploration. We discuss the embryologic basis of ectopic retropharyngeal parathyroid adenomas and hyperplasia and the utility of 4D-CT in their localization for surgical planning.

Authors
Welling, RD; Olson, JA; Kranz, PG; Eastwood, JD; Hoang, JK
MLA Citation
Welling, RD, Olson, JA, Kranz, PG, Eastwood, JD, and Hoang, JK. "Bilateral retropharyngeal parathyroid hyperplasia detected with 4D multidetector row CT." AJNR Am J Neuroradiol 32.5 (May 2011): E80-E82.
PMID
20413605
Source
pubmed
Published In
American Journal of Neuroradiology
Volume
32
Issue
5
Publish Date
2011
Start Page
E80
End Page
E82
DOI
10.3174/ajnr.A2104

Incorporating gross anatomy education into radiation oncology residency: a 2-year curriculum with evaluation of resident satisfaction.

PURPOSE: Radiation oncologists require a thorough understanding of anatomy, but gross anatomy is not part of the standard residency curriculum. "Oncoanatomy" is an educational program for radiation oncology residents at Duke University that integrates cadaver dissection into the instruction of oncologic anatomy, imaging, and treatment planning. In this report, the authors document their experience with a 2-year curriculum. METHODS: Nineteen radiation oncology residents from Duke University and the University of North Carolina participated during academic years 2008-2009 and 2009-2010. Monthly modules, based on anatomic site, consisted of one or two clinically oriented hour-long lectures, followed by a 1-hour gross anatomy session. Clinical lectures were case based and focused on radiographic anatomy, image segmentation, and field design. Gross anatomy sessions centered on cadaver prosections, with small groups rotating through stations at which anatomists led cadaver exploration. Adjacent monitors featured radiologic imaging to facilitate synthesis of gross anatomy with imaging anatomy. Satisfaction was assessed on a 10-point scale via anonymous survey. RESULTS: Twenty modules were held over the 2-year period. Participants gave the course a median rating of 8 (interquartile range, 7-9), with 1 signifying "as effective as the worst educational activities" and 10 "as effective as the best educational activities." High resident satisfaction was seen with all module components. CONCLUSIONS: Incorporating a structured, 2-year gross anatomy-based curriculum into radiation oncology residency is feasible and associated with high resident satisfaction.

Authors
Cabrera, AR; Lee, WR; Madden, R; Sims, E; Hoang, JK; White, LE; Marks, LB; Chino, JP
MLA Citation
Cabrera, AR, Lee, WR, Madden, R, Sims, E, Hoang, JK, White, LE, Marks, LB, and Chino, JP. "Incorporating gross anatomy education into radiation oncology residency: a 2-year curriculum with evaluation of resident satisfaction." J Am Coll Radiol 8.5 (May 2011): 335-340.
PMID
21531310
Source
pubmed
Published In
Journal of the American College of Radiology
Volume
8
Issue
5
Publish Date
2011
Start Page
335
End Page
340
DOI
10.1016/j.jacr.2010.10.005

Multiplanar CT and MRI of collections in the retropharyngeal space: is it an abscess?

OBJECTIVE: The purpose of this article is to describe a practical imaging approach to evaluating collections in the retropharyngeal space. CONCLUSION: The differential diagnoses for fluid in the retropharyngeal space include both noninfectious and infectious processes. The multiplanar capabilities of CT and MRI are ideal for characterizing and delineating collections. In this pictorial essay, we describe the anatomy of the retropharyngeal space and offer a four-step approach to evaluating retropharyngeal collections on multiplanar imaging.

Authors
Hoang, JK; Branstetter, BF; Eastwood, JD; Glastonbury, CM
MLA Citation
Hoang, JK, Branstetter, BF, Eastwood, JD, and Glastonbury, CM. "Multiplanar CT and MRI of collections in the retropharyngeal space: is it an abscess?." AJR Am J Roentgenol 196.4 (April 2011): W426-W432. (Review)
PMID
21427307
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
196
Issue
4
Publish Date
2011
Start Page
W426
End Page
W432
DOI
10.2214/AJR.10.5116

Ischemic stroke because of intracranial fibromuscular dysplasia.

Ischemic stroke in a 12-year-old African-American boy was caused by intracranial fibromuscular dysplasia. Imaging investigations included computed tomography and magnetic resonance angiography, before reaching a definitive diagnosis with a conventional cerebral angiogram. This pediatric case of intracranial fibromuscular dysplasia highlights the need to consider this rare disorder in the differential diagnosis of pediatric stroke and the role of imaging in establishing a diagnosis. The literature of fibromuscular dysplasia is reviewed, and other causes of pediatric stroke are discussed.

Authors
Shea, KJ; Hoang, JK; Smith, EC
MLA Citation
Shea, KJ, Hoang, JK, and Smith, EC. "Ischemic stroke because of intracranial fibromuscular dysplasia." Pediatr Neurol 44.3 (March 2011): 214-217.
PMID
21310338
Source
pubmed
Published In
Pediatric Neurology
Volume
44
Issue
3
Publish Date
2011
Start Page
214
End Page
217
DOI
10.1016/j.pediatrneurol.2010.11.004

Incorporating gross anatomy education into radiation oncology residency: A 2-year curriculum with evaluation of resident satisfaction

Purpose: Radiation oncologists require a thorough understanding of anatomy, but gross anatomy is not part of the standard residency curriculum. "Oncoanatomy" is an educational program for radiation oncology residents at Duke University that integrates cadaver dissection into the instruction of oncologic anatomy, imaging, and treatment planning. In this report, the authors document their experience with a 2-year curriculum. Methods: Nineteen radiation oncology residents from Duke University and the University of North Carolina participated during academic years 2008-2009 and 2009-2010. Monthly modules, based on anatomic site, consisted of one or two clinically oriented hour-long lectures, followed by a 1-hour gross anatomy session. Clinical lectures were case based and focused on radiographic anatomy, image segmentation, and field design. Gross anatomy sessions centered on cadaver prosections, with small groups rotating through stations at which anatomists led cadaver exploration. Adjacent monitors featured radiologic imaging to facilitate synthesis of gross anatomy with imaging anatomy. Satisfaction was assessed on a 10-point scale via anonymous survey. Results: Twenty modules were held over the 2-year period. Participants gave the course a median rating of 8 (interquartile range, 7-9), with 1 signifying "as effective as the worst educational activities" and 10 "as effective as the best educational activities." High resident satisfaction was seen with all module components. Conclusions: Incorporating a structured, 2-year gross anatomy-based curriculum into radiation oncology residency is feasible and associated with high resident satisfaction. © 2011 American College of Radiology.

Authors
Cabrera, AR; Lee, WR; Madden, R; Sims, E; Hoang, JK; White, LE; Marks, LB; Chino, JP
MLA Citation
Cabrera, AR, Lee, WR, Madden, R, Sims, E, Hoang, JK, White, LE, Marks, LB, and Chino, JP. "Incorporating gross anatomy education into radiation oncology residency: A 2-year curriculum with evaluation of resident satisfaction." Journal of the American College of Radiology 8.5 (2011): 335-340.
Source
scopus
Published In
Journal of the American College of Radiology
Volume
8
Issue
5
Publish Date
2011
Start Page
335
End Page
340
DOI
10.1016/j.jacr.2010.10.005

CT fluoroscopy-assisted cervical transforaminal steroid injection: tips, traps, and use of contrast material.

OBJECTIVE: CT fluoroscopy-assisted cervical transforaminal steroid injection is an effective therapeutic option for cervical radiculopathy, yet it is approached with trepidation by some interventionalists. CT fluoroscopy is superior to conventional fluoroscopy for delineating complex anatomic relations in the neck but must be combined with careful technique to avoid rare but serious complications. We describe the anatomy of the neural foramen, our technique of CT fluoroscopy-assisted cervical transforaminal steroid injection, and the CT appearance of appropriate and inappropriate needle positions. CONCLUSION: Understanding anatomy will help to avoid complications and optimize the therapeutic potential of cervical transforaminal steroid injection. Use of contrast material for CT fluoroscopic guidance facilitates appropriate needle positioning and reduces the risk of complications.

Authors
Hoang, JK; Apostol, MA; Kranz, PG; Kilani, RK; Taylor, JN; Gray, L; Lascola, CD
MLA Citation
Hoang, JK, Apostol, MA, Kranz, PG, Kilani, RK, Taylor, JN, Gray, L, and Lascola, CD. "CT fluoroscopy-assisted cervical transforaminal steroid injection: tips, traps, and use of contrast material." AJR Am J Roentgenol 195.4 (October 2010): 888-894.
PMID
20858814
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
195
Issue
4
Publish Date
2010
Start Page
888
End Page
894
DOI
10.2214/AJR.10.4369

CT mucosal window settings: a novel approach to evaluating early T-stage head and neck carcinoma.

OBJECTIVE: The purpose of this study is to evaluate the CT densities of small head and neck mucosal cancers as a means of deriving a CT mucosal window display of narrower window width and higher window level to better detect and delineate head and neck carcinomas. MATERIALS AND METHODS: We retrospectively studied 19 subjects with T1-2 head and neck carcinomas. The density of tumor and adjacent normal mucosa on CT were measured. CT scans for the 19 patients with tumors and 35 subjects without mucosal tumors were anonymized and interpreted by two readers using standard soft-tissue windows and were reviewed again 1 week later with the addition of mucosal windows. RESULTS: The mean (± SD) attenuation of 17 visible tumors was 85.5 ± 18.3 Hounsfield units (HU) and that of the surrounding normal mucosa was 55.3 ± 15.2 HU (p < 0.0001). From our data, we derived guideline mucosal window settings-a window width of 120 HU and a window level of 60 HU. On blinded review, reader A detected 12 tumors with the addition of mucosal windows (sensitivity, 63%; specificity, 82%) and nine tumors on soft-tissue windows alone (sensitivity, 47%; specificity, 94%). Reader B detected nine tumors with use of mucosal windows (sensitivity, 47%; specificity, 71%) and eight tumors on soft-tissue windows alone (sensitivity, 42%; specificity, 74%). CONCLUSION: Early T-stage tumors have higher CT density than normal mucosa. Their conspicuity can be amplified using display windows with narrower window width and higher window level. The potential clinical applications are for the improved detection of unknown primary tumors and delineation of a known mucosal tumor.

Authors
Hoang, JK; Glastonbury, CM; Chen, LF; Salvatore, JK; Eastwood, JD
MLA Citation
Hoang, JK, Glastonbury, CM, Chen, LF, Salvatore, JK, and Eastwood, JD. "CT mucosal window settings: a novel approach to evaluating early T-stage head and neck carcinoma." AJR Am J Roentgenol 195.4 (October 2010): 1002-1006.
PMID
20858831
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
195
Issue
4
Publish Date
2010
Start Page
1002
End Page
1006
DOI
10.2214/AJR.09.4149

The postradiation neck: evaluating response to treatment and recognizing complications.

OBJECTIVE: We summarize the rationale for and physiology of radiation therapy for the treatment of head and neck cancer and review the imaging findings of expected changes and complications after radiation to the neck. It is important to be able to recognize these features at all stages during management of patients with squamous cell carcinoma and other head and neck malignancies and to be able to distinguish these changes from residual or recurrent disease. CONCLUSION: Radiation therapy results in imaging findings of tissue edema followed by fibrosis, scarring, and atrophy. Complications from radiation therapy can occur months to years after treatment. Findings of a new mass, lymphadenopathy, or bone or cartilage destruction must be viewed as concerning for recurrent disease.

Authors
Glastonbury, CM; Parker, EE; Hoang, JK
MLA Citation
Glastonbury, CM, Parker, EE, and Hoang, JK. "The postradiation neck: evaluating response to treatment and recognizing complications." AJR Am J Roentgenol 195.2 (August 2010): W164-W171.
PMID
20651177
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
195
Issue
2
Publish Date
2010
Start Page
W164
End Page
W171
DOI
10.2214/AJR.09.4122

Radiation dose for routine clinical adult brain CT: Variability on different scanners at one institution.

OBJECTIVE: The purpose of this study was to determine, using an anthropomorphic phantom, whether patients are subject to variable radiation doses based on scanner assignment for routine CT of the brain. MATERIALS AND METHODS: Twenty metal oxide semiconductor field effect transistor dosimeters were placed in the brain of a male anthropomorphic phantom scanned three times with a routine clinical brain CT protocol on four scanners from one manufacturer in four configurations and on one 64-MDCT scanner from another manufacturer. Absorbed organ doses were measured for skin, cranium, brain, lens of the eye, mandible, and thyroid. Effective dose was calculated on the basis of the dose-length product recorded on each scanner. RESULTS: Organ dose ranges were as follows: cranium, 2.57-3.47 cGy; brain, 2.34-3.78 cGy; lens, 2.51-5.03 cGy; mandible 0.17-0.48 cGy; and thyroid, 0.03-0.28 cGy. Statistically significant differences between scanners with respect to dose were recorded for brain and lens (p < 0.05). Absorbed doses were lowest on the single-detector scanner. In the comparison of MDCT scanners, the highest doses were found on the 4-MDCT scanner and the dual-source 64-MDCT scanner not capable of gantry tilt. Effective dose ranged from 1.22 to 1.86 mSv. CONCLUSION: According to the phantom data, patients are subject to different organ doses in the lens and brain depending on scanner assignment. At our institution with existing protocols, absorbed doses at brain CT are lowest with the single-detector CT scanner, followed by MDCT scanners capable of gantry tilt. On scanners without gantry tilt, CT of the brain should be performed with careful head positioning and shielding of the orbits. These precautions are especially true for patients who need repeated scanning and for pediatric patients.

Authors
Jaffe, TA; Hoang, JK; Yoshizumi, TT; Toncheva, G; Lowry, C; Ravin, C
MLA Citation
Jaffe, TA, Hoang, JK, Yoshizumi, TT, Toncheva, G, Lowry, C, and Ravin, C. "Radiation dose for routine clinical adult brain CT: Variability on different scanners at one institution." AJR Am J Roentgenol 195.2 (August 2010): 433-438.
PMID
20651201
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
195
Issue
2
Publish Date
2010
Start Page
433
End Page
438
DOI
10.2214/AJR.09.3957

Multiplanar sinus CT: a systematic approach to imaging before functional endoscopic sinus surgery.

OBJECTIVE: The purpose of this essay is to present a systematic approach to the use of coronal, axial, and sagittal images for CT evaluation of the sinuses before functional endoscopic sinus surgery (FESS). CONCLUSION: We present a systematic approach to the use of coronal, axial, and sagittal images in CT evaluation before FESS. Each imaging plane is valuable for displaying anatomic variants, which can predispose a patient to recurrent disease and affect the surgical approach, and critical variants, which can make surgery hazardous.

Authors
Hoang, JK; Eastwood, JD; Tebbit, CL; Glastonbury, CM
MLA Citation
Hoang, JK, Eastwood, JD, Tebbit, CL, and Glastonbury, CM. "Multiplanar sinus CT: a systematic approach to imaging before functional endoscopic sinus surgery." AJR Am J Roentgenol 194.6 (June 2010): W527-W536. (Review)
PMID
20489073
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
194
Issue
6
Publish Date
2010
Start Page
W527
End Page
W536
DOI
10.2214/AJR.09.3584

What's in a name? Eponyms in head and neck imaging.

Head and neck (H&N) eponyms serve to honour physicians who have made important contributions. Compared with more descriptive diagnostic names, eponyms can sometimes be confusing, especially to the novice. Adding to the confusion, eponyms are sometimes applied incorrectly. Nevertheless, their use remains common in the medical literature and clinical practice. Familiarity with H&N eponyms is important for accurate communication with radiology colleagues and clinicians. Some eponyms describe potentially fatal infections and their urgency should be appreciated. Other eponyms, such as those for inner ear congenital anomalies, are probably best avoided as they can be used imprecisely and cause confusion. This review summarizes the clinical and imaging findings of some common and important H&N eponyms under the following categories of disease: (1) neck infections, (2) diseases in the temporal bone, (3) orbital diseases, and (4) sinus disease.

Authors
Hoang, JK; Eastwood, JD; Glastonbury, CM
MLA Citation
Hoang, JK, Eastwood, JD, and Glastonbury, CM. "What's in a name? Eponyms in head and neck imaging." Clin Radiol 65.3 (March 2010): 237-245. (Review)
PMID
20152281
Source
pubmed
Published In
Clinical Radiology
Volume
65
Issue
3
Publish Date
2010
Start Page
237
End Page
245
DOI
10.1016/j.crad.2009.10.008

Response.

Authors
Mathews, R; Peterson, ED
MLA Citation
Mathews, R, and Peterson, ED. "Response." 2010.
PMID
24774349
Source
epmc
Published In
Revista espa�ola de cardiolog�a (English ed.)
Volume
63
Issue
10
Publish Date
2010
Start Page
1215
End Page
1216
DOI
10.1016/s1885-5857(10)70242-5

Optimization of tube current in coronary multidetector computed tomography angiography: assessment of a standardized method to individualize current selection based on body habitus.

UNLABELLED: This study sought to extract information on individual patient habitus from scout imaging and to correlate radiograph tube current settings with enhancement of the coronaries as a function of patient profiles for coronary multidetector computed tomography. MATERIALS AND METHODS: Fifty patients underwent coronary 64-slice multidetector computed tomography consisting of 2-plane scouts and electrocardiography-gated coronary studies at 64 x 0.625 mm, radiograph voltage of 120 kVp, and radiograph currents of 295 to 788 mA, which were reconstructed during 65%, 75%, and 85% R-R intervals. Patients' weight was recorded. On scout imaging, chest diameters were determined, and circumferences were calculated. To determine whether body weight showed sex-specific characteristics, t test was used. Pearson correlation determined whether cross-sectional measurements reflected female/male body habitus. On coronary imaging, contrast-to-noise ratios (CNRs) of the aorta and the coronaries were calculated. To assess whether CNRs differed throughout the diastolic phase, t test was used. Data triplets of CNRs and the corresponding current and circumference were plotted; CNRs less than 250 Hounsfield unit (HU) were discarded, dissecting lines as 95th percentiles correlating radiograph currents and patients' circumferences were calculated. RESULTS: Female/male weights differed significantly (P = 0.0006); circumferences based on scouts adequately reflected body weight (coefficients, 0.86 male/0.87 female). Homogenous vascular enhancement of the aorta (mean +/- SD, 344.4 +/- 81.8 HU) and the right (292.3 +/- 82.8 HU) and left (285.8 +/- 81.3 HU) coronaries was achieved (P > 0.005). Ninety-fifth percentile cutoffs identified linear relationships between patient's circumference and the minimal adequate radiograph current achieving CNR less than or equal to 250 HU. CONCLUSION: Scout imaging can be used to determine individual patient habitus; habitus-adjusted minimal radiograph tube current cutoff levels identified in this study ensuring clinically required levels of coronary enhancement can be used for future coronary CT angiography optimization of tube current based on scout imaging.

Authors
Hoang, JK; Hurwitz, LM; Boll, DT
MLA Citation
Hoang, JK, Hurwitz, LM, and Boll, DT. "Optimization of tube current in coronary multidetector computed tomography angiography: assessment of a standardized method to individualize current selection based on body habitus." J Comput Assist Tomogr 33.4 (July 2009): 498-504.
PMID
19638839
Source
pubmed
Published In
Journal of Computer Assisted Tomography
Volume
33
Issue
4
Publish Date
2009
Start Page
498
End Page
504
DOI
10.1097/RCT.0b013e31818af37c

Ruptured maxillary retention cyst: cause of unilateral rhinorrhea after trauma.

This study describes a case of a patient with traumatic rupture of a maxillary sinus retention cyst, which had an interesting clinical presentation of unilateral rhinorrhea, mimicking a CSF leak. The diagnosis was made fortuitously by comparison of a posttraumatic CT brain examination with a CT sinus study performed 1 day earlier.

Authors
Hoang, JK; Smith, EC; Barboriak, DP
MLA Citation
Hoang, JK, Smith, EC, and Barboriak, DP. "Ruptured maxillary retention cyst: cause of unilateral rhinorrhea after trauma." AJNR Am J Neuroradiol 30.6 (June 2009): 1121-1122.
PMID
19439483
Source
pubmed
Published In
American Journal of Neuroradiology
Volume
30
Issue
6
Publish Date
2009
Start Page
1121
End Page
1122
DOI
10.3174/ajnr.A1457

Early changes in tumor size in patients treated for advanced stage nonsmall cell lung cancer do not correlate with survival.

BACKGROUND: In clinical trials, change in tumor size is used to stratify patients into response categories. The objective of the current study was to: 1) determine whether early change in the tumor size were correlated with survival in patients with advanced nonsmall cell lung cancer (NSCLC) using modified response categories from the Response Evaluation Criteria in Solid Tumors (RECIST), and 2) to determine whether there was an optimal percentage change in tumor size that could be used to define a partial response that also correlated with survival. METHODS: A total of 99 consecutive patients presenting for the treatment of advanced NSCLC during the year 2003 who had computed tomography (CT) scans before and after treatment available for review were included in the study. The largest target thoracic lesion was measured on CT before treatment, and again 2 months to 3 months after the initiation of treatment. Percent change in tumor size was calculated. The relation between tumor response and patient survival was investigated. RESULTS: There was no definite relation noted between early tumor response and patient survival (P = .754). Patients who had any initial reduction in tumor size were not found to have a significantly different survival compared with patients with initial disease progression (P = .580). In addition, there was no particular percent reduction in tumor size that was found to optimally correlate with survival. CONCLUSIONS: There is no evidence of a relation between early changes in tumor size and survival among patients with advanced stage NSCLC. To predict survival in patients with advanced NSCLC, response criteria other than change in lesion size are needed.

Authors
Birchard, KR; Hoang, JK; Herndon, JE; Patz, EF
MLA Citation
Birchard, KR, Hoang, JK, Herndon, JE, and Patz, EF. "Early changes in tumor size in patients treated for advanced stage nonsmall cell lung cancer do not correlate with survival." Cancer 115.3 (February 1, 2009): 581-586.
PMID
19117348
Source
pubmed
Published In
Cancer
Volume
115
Issue
3
Publish Date
2009
Start Page
581
End Page
586
DOI
10.1002/cncr.24060

MDCT angiography of thoracic aorta endovascular stent-grafts: pearls and pitfalls.

OBJECTIVE: The objective of our study was to review expected findings and complications after thoracic endovascular aortic repair on CT angiography (CTA). CONCLUSION: Luminal and extraluminal changes to the thoracic aorta occur after endovascular stent-grafting. The radiologist can facilitate appropriate management by detecting and differentiating expected CTA findings from complications.

Authors
Hoang, JK; Martinez, S; Hurwitz, LM
MLA Citation
Hoang, JK, Martinez, S, and Hurwitz, LM. "MDCT angiography of thoracic aorta endovascular stent-grafts: pearls and pitfalls." AJR Am J Roentgenol 192.2 (February 2009): 515-524. (Review)
PMID
19155419
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
192
Issue
2
Publish Date
2009
Start Page
515
End Page
524
DOI
10.2214/AJR.08.1365

Imaging of the postoperative thoracic aorta: the spectrum of normal and abnormal findings.

Authors
Hoang, JK; Martinez, S; Hurwitz, LM
MLA Citation
Hoang, JK, Martinez, S, and Hurwitz, LM. "Imaging of the postoperative thoracic aorta: the spectrum of normal and abnormal findings." Semin Roentgenol 44.1 (January 2009): 52-62. (Review)
PMID
19064071
Source
pubmed
Published In
Seminars in Roentgenology
Volume
44
Issue
1
Publish Date
2009
Start Page
52
End Page
62
DOI
10.1053/j.ro.2008.10.003

MDCT angiography after open thoracic aortic surgery: pearls and pitfalls.

OBJECTIVE: The purpose of this article is to review open thoracic aortic surgical techniques and to describe the range of postoperative findings on CT angiography (CTA). CONCLUSION: An understanding of surgical thoracic aortic procedures will allow appropriate differentiation of normal from abnormal CTA findings on postoperative imaging.

Authors
Hoang, JK; Martinez, S; Hurwitz, LM
MLA Citation
Hoang, JK, Martinez, S, and Hurwitz, LM. "MDCT angiography after open thoracic aortic surgery: pearls and pitfalls." AJR Am J Roentgenol 192.1 (January 2009): W20-W27. (Review)
PMID
19098168
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
192
Issue
1
Publish Date
2009
Start Page
W20
End Page
W27
DOI
10.2214/AJR.08.1364

Erratum: Optimization of tube current in coronary multidetector computed tomography angiography: assessment of a standardized method to individualize current selection based on body habitus (J Comput Assist Tomogr (2009) 33 (498-504))

Authors
Hoang, JK; Hurwitz, LM; Boll, DT
MLA Citation
Hoang, JK, Hurwitz, LM, and Boll, DT. "Erratum: Optimization of tube current in coronary multidetector computed tomography angiography: assessment of a standardized method to individualize current selection based on body habitus (J Comput Assist Tomogr (2009) 33 (498-504))." Journal of Computer Assisted Tomography 33.6 (2009): 986--.
Source
scival
Published In
Journal of Computer Assisted Tomography
Volume
33
Issue
6
Publish Date
2009
Start Page
986-
DOI
10.1097/RCT.0b013e3181c955a7

Prognostic Value of Pre- and Post-treatment FDG PET in Head-and-Neck Cancer

Authors
Higgins, KA; Hoang, JK; Chino, JP; Brizel, DM
MLA Citation
Higgins, KA, Hoang, JK, Chino, JP, and Brizel, DM. "Prognostic Value of Pre- and Post-treatment FDG PET in Head-and-Neck Cancer." 2009.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
75
Issue
3
Publish Date
2009
Start Page
S18
End Page
S18

Infected (mycotic) aneurysms: spectrum of imaging appearances and management.

Infected aneurysms are uncommon. The aorta, peripheral arteries, cerebral arteries, and visceral arteries are involved in descending order of frequency. Staphylococcus and Streptococcus species are the most common causative pathogens. Early clinical diagnosis of infected aneurysms is challenging owing to their protean manifestations. Clinically apparent infected aneurysms are often at an advanced stage of development or are associated with complications, such as rupture. Nontreatment or delayed treatment of infected aneurysms often has a poor outcome, with high morbidity and mortality from fulminant sepsis or hemorrhage. Current state-of-the-art imaging modalities, such as multidetector computed tomography and magnetic resonance imaging, have replaced conventional angiography as minimally invasive techniques for detection of infected aneurysms in clinically suspected cases, as well as characterization of infected aneurysms and vascular mapping for treatment planning in confirmed cases. Doppler ultrasonography allows noninvasive assessment for infected aneurysms in the peripheral arteries. Imaging features of infected aneurysms include a lobulated vascular mass, an indistinct irregular arterial wall, perianeurysmal edema, and a perianeurysmal soft-tissue mass. Perianeurysmal gas, aneurysmal thrombosis, aneurysmal wall calcification, and disrupted arterial calcification at the site of the infected aneurysm are uncommon findings. Imaging-guided endovascular stent-graft repair and embolotherapy can be performed in select cases instead of open surgery. Familiarity with the imaging appearances of infected aneurysms should alert the radiologist to the diagnosis and permit timely treatment, which may include endovascular techniques.

Authors
Lee, W-K; Mossop, PJ; Little, AF; Fitt, GJ; Vrazas, JI; Hoang, JK; Hennessy, OF
MLA Citation
Lee, W-K, Mossop, PJ, Little, AF, Fitt, GJ, Vrazas, JI, Hoang, JK, and Hennessy, OF. "Infected (mycotic) aneurysms: spectrum of imaging appearances and management." Radiographics 28.7 (November 2008): 1853-1868. (Review)
PMID
19001644
Source
pubmed
Published In
Radiographics : a review publication of the Radiological Society of North America, Inc
Volume
28
Issue
7
Publish Date
2008
Start Page
1853
End Page
1868
DOI
10.1148/rg.287085054

Multidetector CT pulmonary angiography features of pulmonary embolus.

Pulmonary embolism (PE) is a life-threatening condition. Multidetector CT pulmonary angiography is currently the imaging method of choice for the detection of PE. The aim of this pictorial essay is to review the appearances of PE on multidetector CT pulmonary angiography, including signs that differentiate acute and chronic PE and markers of severity. The features of a non-diagnostic study and pitfalls leading to a false-positive or false-negative study are presented.

Authors
Hoang, JK; Lee, WK; Hennessy, OF
MLA Citation
Hoang, JK, Lee, WK, and Hennessy, OF. "Multidetector CT pulmonary angiography features of pulmonary embolus." J Med Imaging Radiat Oncol 52.4 (August 2008): 307-317. (Review)
PMID
18811753
Source
pubmed
Published In
Journal of Medical Imaging and Radiation Oncology
Volume
52
Issue
4
Publish Date
2008
Start Page
307
End Page
317
DOI
10.1111/j.1440-1673.2008.01961.x

Can mammographic findings help discriminate between atypical ductal hyperplasia and ductal carcinoma in situ after needle core biopsy?

In a screening population of women, the mammographic characteristics for 68 cases of atypical ductal hyperplasia (ADH) diagnosed by needle core biopsy (NCB) were reviewed to seek mammographic findings which differentiate between ductal carcinoma in situ (DCIS) and ADH. A blinded analysis by two radiologists was performed for 48 cases with microcalcification. The mammographic findings were correlated with the surgical histological results of benign non-atypical, ADH and carcinoma (DCIS or invasive) to identify features which were associated with a higher or lower odds ratio (OR) for malignancy. Underestimates for malignancy occurred in 14 of 29 cases with granular calcification form (OR 7.9, 95% confidence interval (CI) 1.5-41) and 6 of 8 cases with segmental/linear branching distribution (OR 9.0, 95%CI 1.6-52). No malignancy was found at surgical excision in 16 cases with fine, rounded calcification. In conclusion, detailed assessment of calcification distribution and form gave helpful predictors for malignancy. Lesions with fine rounded calcification were always benign.

Authors
Hoang, JK; Hill, P; Cawson, JN
MLA Citation
Hoang, JK, Hill, P, and Cawson, JN. "Can mammographic findings help discriminate between atypical ductal hyperplasia and ductal carcinoma in situ after needle core biopsy?." Breast 17.3 (June 2008): 282-288.
PMID
18063369
Source
pubmed
Published In
The Breast
Volume
17
Issue
3
Publish Date
2008
Start Page
282
End Page
288
DOI
10.1016/j.breast.2007.10.016

Prognostic value of fluorine-18 fluorodeoxyglucose positron emission tomography imaging in patients with advanced-stage non-small-cell lung carcinoma.

PURPOSE: To determine whether the amount of fluorine-18 fluorodeoxyglucose (FDG) uptake in the primary lung cancer on positron emission tomography (PET) imaging at the time of presentation has prognostic significance in patients with advanced-stage non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: A retrospective review identified 214 patients with advanced-stage NSCLC (stage IIIA, IIIB, and IV) who underwent FDG PET study at the time of diagnosis. Extensive clinical data, including tumor histologic cell type, pathologic stage at presentation, and treatment, were recorded. The maximum standardized uptake value (SUV(max)) in the primary tumor on FDG PET on survival was examined using Cox proportional hazards regression. RESULTS: One hundred fifty-eight (74%) of the 214 patients died and 56 patients were reported alive at 27 months (range, 3 to 140 months) after the diagnosis of NSCLC. Using the median SUV(max) of 11.1, the patient population was subdivided. The median survival of the 106 patients with the primary tumor having an SUV(max) less than 11.1 was 16 months (95% CI, 12 to 21 months), whereas the median survival of the 108 patients with the primary tumor having an SUV(max) > or = 11.1 was 12 months (95% CI, 10 to 15 months). Univariate and multivariate analysis did not provide evidence that survival for patient subgroups defined by the median SUV(max) were significantly different (univariate P = .11; multivariate P = .45). CONCLUSION: FDG uptake of the primary lesions in patients with a new diagnosis of advanced-stage NSCLC does not have a significant relationship with survival.

Authors
Hoang, JK; Hoagland, LF; Coleman, RE; Coan, AD; Herndon, JE; Patz, EF
MLA Citation
Hoang, JK, Hoagland, LF, Coleman, RE, Coan, AD, Herndon, JE, and Patz, EF. "Prognostic value of fluorine-18 fluorodeoxyglucose positron emission tomography imaging in patients with advanced-stage non-small-cell lung carcinoma." J Clin Oncol 26.9 (March 20, 2008): 1459-1464.
PMID
18349396
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
26
Issue
9
Publish Date
2008
Start Page
1459
End Page
1464
DOI
10.1200/JCO.2007.14.3628

Percutaneous intracorporeal lithotripsy of biliary calculi.

The standard management for patients presenting with bile duct calculi is endoscopic retrograde cholangiopancreatography and sphincterotomy with stone retrieval. In failed cases and for intrahepatic duct stones, there are a number of non-operative alternative extraction methods. We describe two cases of percutaneous intracorporeal lithotripsy for biliary calculi and review the literature regarding the indications, complications and success rate.

Authors
Hoang, JK; Little, AF; Clarke, A
MLA Citation
Hoang, JK, Little, AF, and Clarke, A. "Percutaneous intracorporeal lithotripsy of biliary calculi." Australas Radiol 51 Suppl (December 2007): B324-B327.
PMID
17991097
Source
pubmed
Published In
Australasian Radiology
Volume
51 Suppl
Publish Date
2007
Start Page
B324
End Page
B327
DOI
10.1111/j.1440-1673.2007.01787.x

Frequency and prognostic significance of preoperatively detected enlarged regional lymph nodes in patients with pathological stage I non-small cell lung cancer following resection.

PURPOSE: To explore the clinical significance of enlarged regional lymph nodes in patients with pathological stage I non-small cell lung cancer (NSCLC). MATERIAL AND METHODS: We retrospectively reviewed the tumor registry of the International Association for the Study of Lung Cancer (IASLC) Staging Database to identify 6995 patients between January 1, 1990 and December 31, 2000 with clinical stage I, II, and IIIA tumors (cT1-2N0-2M0, excluding T3N0-2M0 cases) who proved to have pathological stage I NSCLC (T1-2N0M0, pStage I). The frequency of enlarged nodes in patients with pStage I disease is reported, and the overall survival of these patients who had enlarged regional lymph nodes was compared with that of patients with pStage I disease with normal size regional lymph nodes. RESULTS: Enlarged regional lymph nodes (cN1-2) were seen in approximately 12% of patients with pStage I disease. Median survival for patients with enlarged versus normal nodes was 102 versus 107 months (hazard ratio 1.16, p = 0. 01). Survival curves converged at 8 years postsurgery. CONCLUSIONS: Enlarged regional lymph nodes are uncommon in patients with pStage I NSCLC, and the size of regional lymph nodes in these early stage patients does not seem to provide clinically useful prognostic information.

Authors
Hoang, JK; Patz, E; Giroux, D; Goldstraw, P
MLA Citation
Hoang, JK, Patz, E, Giroux, D, and Goldstraw, P. "Frequency and prognostic significance of preoperatively detected enlarged regional lymph nodes in patients with pathological stage I non-small cell lung cancer following resection." J Thorac Oncol 2.12 (December 2007): 1103-1106.
PMID
18090582
Source
pubmed
Published In
Journal of Thoracic Oncology
Volume
2
Issue
12
Publish Date
2007
Start Page
1103
End Page
1106
DOI
10.1097/JTO.0b013e31815c04b4

US Features of thyroid malignancy: pearls and pitfalls.

Thyroid nodules are common and occur in up to 50% of the adult population; however, less than 7% of thyroid nodules are malignant. High-resolution ultrasonography (US) is commonly used to evaluate the thyroid gland, but US is frequently misperceived as unhelpful for identifying features that distinguish benign from malignant nodules. Microcalcifications are one of the most specific US findings of a thyroid malignancy. Other useful US features include a marked hypoechogenicity, irregular margins, and the absence of a hypoechoic halo around the nodule. Lymphadenopathy and local invasion of adjacent structures are highly specific features of thyroid malignancy but are less commonly seen. The number, size, and interval growth of nodules are nonspecific characteristics. Suspicious US features may be useful for selecting patients for fine-needle aspiration biopsy when incidental nodules are discovered and when multiple nodules are present. Common interpretative pitfalls that may lead to failure to recognize a malignancy include mistaking cystic or calcified nodal metastases for nodules in a multinodular thyroid, mistaking diffusely infiltrative thyroid carcinomas and multifocal carcinomas for benign disease, and failing to recognize microcalcifications in papillary thyroid cancer.

Authors
Hoang, JK; Lee, WK; Lee, M; Johnson, D; Farrell, S
MLA Citation
Hoang, JK, Lee, WK, Lee, M, Johnson, D, and Farrell, S. "US Features of thyroid malignancy: pearls and pitfalls." Radiographics 27.3 (May 2007): 847-860. (Review)
PMID
17495296
Source
pubmed
Published In
Radiographics : a review publication of the Radiological Society of North America, Inc
Volume
27
Issue
3
Publish Date
2007
Start Page
847
End Page
860
DOI
10.1148/rg.273065038

Renal cell carcinoma metastasis to the breast: mammographic, sonographic, CT, and pathologic correlation.

Authors
Lee, W-K; Cawson, JN; Hill, PA; Hoang, J; Rouse, H
MLA Citation
Lee, W-K, Cawson, JN, Hill, PA, Hoang, J, and Rouse, H. "Renal cell carcinoma metastasis to the breast: mammographic, sonographic, CT, and pathologic correlation." Breast J 13.3 (May 2007): 316-317.
PMID
17461914
Source
pubmed
Published In
The Breast Journal
Volume
13
Issue
3
Publish Date
2007
Start Page
316
End Page
317
DOI
10.1111/j.1524-4741.2007.00433.x

US features of thyroid malignancy: Pearls and pitfalls

Thyroid nodules are common and occur in up to 50% of the adult population; however, less than 7% of thyroid nodules are malignant. High-resolution ultrasonography (US) is commonly used to evaluate the thyroid gland, but US is frequently misperceived as unhelpful for identifying features that distinguish benign from malignant nodules. Microcalcifications are one of the most specific US findings of a thyroid malignancy. Other useful US features include a marked hypoechogenicity, irregular margins, and the absence of a hypoechoic halo around the nodule. Lymphadenopathy and local invasion of adjacent structures are highly specific features of thyroid malignancy but are less commonly seen. The number, size, and interval growth of nodules are nonspecific characteristics. Suspicious US features may be useful for selecting patients for fine-needle aspiration biopsy when incidental nodules are discovered and when multiple nodules are present. Common interpretative pitfalls that may lead to failure to recognize a malignancy include mistaking cystic or calcified nodal metastases for nodules in a multinodular thyroid, mistaking diffusely infiltrative thyroid carcinomas and multifocal carcinomas for benign disease, and failing to recognize microcalcifications in papillary thyroid cancer. ©RSNA, 2007.

Authors
Hoang, JK; Wai, KL; Lee, M; Johnson, D; Farrell, S
MLA Citation
Hoang, JK, Wai, KL, Lee, M, Johnson, D, and Farrell, S. "US features of thyroid malignancy: Pearls and pitfalls." Radiographics 27.3 (2007): 847-860.
Source
scival
Published In
Radiographics : a review publication of the Radiological Society of North America, Inc
Volume
27
Issue
3
Publish Date
2007
Start Page
847
End Page
860
DOI
10.1148/rg.273065038
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Research Areas:

  • Abscess
  • Academic Medical Centers
  • Age Distribution
  • Anesthetics, Local
  • Angiogenesis Inhibitors
  • Angiography
  • Anti-Inflammatory Agents
  • Aorta, Thoracic
  • Aortography
  • Arteries
  • Biopsy, Fine-Needle
  • Body Burden
  • Brain Ischemia
  • Brain Neoplasms
  • Calcinosis
  • Carcinoma, Intraductal, Noninfiltrating
  • Carcinoma, Papillary
  • Carcinoma, Renal Cell
  • Carcinoma, Squamous Cell
  • Carotid Artery, Internal
  • Case-Control Studies
  • Cervical Vertebrae
  • Chemoradiotherapy
  • Circle of Willis
  • Coronary Angiography
  • Coronary Disease
  • Documentation
  • Dose-Response Relationship, Drug
  • Electrocardiography
  • Eponyms
  • Fibromuscular Dysplasia
  • Fluorodeoxyglucose F18
  • Four-Dimensional Computed Tomography
  • Frontal Bone
  • Gallstones
  • Glioma
  • Glucose
  • Guideline Adherence
  • Head and Neck Neoplasms
  • Health Care Surveys
  • Hyperparathyroidism, Primary
  • Hyperthyroidism
  • Image Enhancement
  • Imaging, Three-Dimensional
  • Immunohistochemistry
  • Incidental Findings
  • Injections
  • Injections, Epidural
  • Injections, Intra-Arterial
  • Injections, Intralesional
  • Injections, Intravenous
  • Jugular Veins
  • Kidney Neoplasms
  • Lymph Nodes
  • Lymphatic Metastasis
  • Magnetic Resonance Angiography
  • Mammography
  • Mastoiditis
  • Myelography
  • Nasopharyngeal Neoplasms
  • Neck
  • Nerve Block
  • Observer Variation
  • Oligodendroglioma
  • Organ Size
  • Outcome Assessment (Health Care)
  • Parathyroid Neoplasms
  • Parotid Gland
  • Patient Safety
  • Petrous Bone
  • Phantoms, Imaging
  • Physician's Practice Patterns
  • Pneumonectomy
  • Positron-Emission Tomography
  • Practice Guidelines as Topic
  • Pulmonary Artery
  • Radiation Dosage
  • Radiation Protection
  • Radiculopathy
  • Radiographic Image Enhancement
  • Radiographic Image Interpretation, Computer-Assisted
  • Radiology
  • Radiotherapy, Conformal
  • Respiratory-Gated Imaging Techniques
  • Retropharyngeal Abscess
  • Sex Distribution
  • Sex Factors
  • Spinal Nerve Roots
  • Staphylococcal Infections
  • Statistics, Nonparametric
  • Streptococcal Infections
  • Stroke
  • Syndrome
  • Thrombophlebitis
  • Thyroid Diseases
  • Thyroid Gland
  • Thyroid Neoplasms
  • Thyroid Nodule
  • Thyroidectomy
  • Tomography, Spiral Computed
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Triiodobenzoic Acids
  • Tumor Burden
  • Ultrasonography
  • Young Adult