Research

Faculty Research Initiatives — Other Clinical Research

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Intussusception on mdct following roux-en-y gastric bypass (rygbp) surgery: incidence and implications
Principal Investigator: Laura R. Carucci, M.D.
Sub-investigators: Mary Ann Turner, M.D.
Intussusception is a complication of gastric bypass (GBP) surgery for mobid obesity that is a reported rare cause of small bowel obstruction following RYGBP and occurs most often at the distal small bowell anastomosis. With technological advances, we now more frequently identify small bowel intussusception in the general population on CT, however, often the etiology and significance are unknown. Intussusception may be an incidental, transient finding detected on abdominal CT or may be associated with additional complications including obstruction, incarceration and rarely perforation. Many RYGBP patients present with nonspecific abcominal pain and undergo radiologic evaluation with CT of the abdomen and pelvis. However, the incidence and signigicance of Intussusception diagnosed with CT following RYGBP has not been described in the radiologic literature.
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Characterization of urethral diverticula using CT
Principal Investigator: Laura R. Carucci, M.D.
Sub-investigators: Adam P. Klausner, M.D., Ann S. Fulcher, M.D.
Urethral diverticula occur in up to 6% of women and frequently present with postvoid dribbling, urethral pain and dyspareunia. In patients with classic symptomatology, a diagnosis of UD may be made with voiding cystourethrography (VCUG) and/or MRI. However, many patients may present with nonspecific and persistent abdomen and pelvis to assess the entire urinary tract. Also, UD may be an incidental finding in a patient undergoing CT for a different reason. However, the diagnosis of UD with CT has not been described in the radiologic literature, therefore, UD may be an under recognized finding on CT. We believe that CT may diagnose a urethral diverticulum, and may also assess for potential complications of a UD including calculi and neoplasm.
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Pancreas Divisum without Pancreatitis on MRCP: Prevalence and Significance
Principal Investigator: Ann S. Fulcher, M.D.
Sub-investigators: Dengbin Wang, M.D., Ph.D., (visiting professor), Jinxing Yu, M.D.
Pancreas divisum is currently believed to be a cause of chronic and/or relapsing acute pancreatitis. However, to our knowledge, there has been no published study investigating the prevalence of pancreas divisum in patients without symptoms of pancreatitis. Therefore, the purpose of this study was to determine the prevalence of pancreas divisum in the general population — patients without symptoms of pancreatitis — in order to determine whether the presence of pancreas divisum is truly associated with a higher incidence of pancreatitis.

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Utility of Cine MRI, Delayed Enhancement and First-pass Perfusion in the Evaluation of Cardiac Masses by Magnetic Resonance Imaging
Principal Investigator: John D. Grizzard, M.D.
Sub-investigators: Sarah Joyner, M.D. (Cardiology)
In collaboration with cardiologists and radiologists at Duke University, Drs. Grizzard and Joyner are investigating the usefulness of new MRI techniques for diagnosing cardiac masses. The challenge in evaluating a patient with a suspected cardiac mass is the accurate differentiation of the mass, because different types of masses require very different kinds of treatment, or even no treatment. Therefore, the goal of cardiac mass imaging, and of this study, is to minimize unnecessary invasive procedures to the patient and to direct appropriate medical management.
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Standard for quantification of delayed-enhancement magnetic resonance imaging of myocardial infarction - a muticenter study
Principal Investigator: John D. Grizzard, M.D.
Sub-investigators: Igor Klem, M.D. (Duke Cardiovascular Magnetic Resonance Center)

To study the extent and source of variability in scar size measurments.

To compare the visually determined scar size measurements to those generated with the use of computer-defined scar size using SEGMENT software.

To study the agreement of visual assessment of scar size using a 5-point scoring system for 17 segments and quantitative measurements.
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Biphasic Hepatic and Splenic Imaging with MDCT in Blunt Trauma Patients
Principal Investigator: Robert A. Halvorsen, Jr., M.D.
Sub-investigators: Laura Carucci, M.D., Ajai Malhotra, M.D. (Trauma Surgery), Michael Rolen, Kathryn Starkweather, Malcolm Sydnor, M.D., Jinxing Yu, M.D.
This is a retrospective review of CT studies of patients who have undergone both chest CT and abdominal CT in the blunt trauma setting. The aim of the study is to demonstrate that biphasic imaging of the liver and spleen, compared to monophasic imaging, improves the diagnostic accuracy in hepatic and splenic injuries from blunt trauma using multi-detector CT.
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Utility of MDCT in Predicting Arterial Bleeding in Patients with Abdominal Trauma
Principal Investigator: Robert A. Halvorsen, Jr., M.D.
Sub-investigators: Jaime Tisnado, M.D.
This study is a retrospective review of patients who underwent both a contrast enhanced CT and angiography in the trauma setting for presumed active arterial bleeding. The aim is to identify the number of false negative CT examinations and the cause of false negative studies, in the hope that this information will improve the ability to detect active arterial bleeding on CT imaging.
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Estimated Glomerular Filtration Rate: Is this a superior screening test in the identification of patients at risk for contrast induced nephropathy? Retrospective comparison of serum creatinine and estimated glomerular filtration rate in the elderly.
Principal Investigator: Robert A. Halvorsen, Jr., M.D.
Sub-investigators: C. Fitzhugh Yeatman, M.D., Byrd Davenport, M.D.
Contrast induced nephropathy is the third most common cause of acute renal failure. Serum creatinine has traditionally been used to identify patients who are at increased risk of CIN. However, the estimated glomerular filtration rate has been suggested as a more accurate way of identifying patients at risk for CIN. The research team conducted a retrospective analysis of patients age 70 and older who were administered iodinated contrast as part of an inpatient CT study. The aim of the study was to show that by screening using the e-GFR, additional patients who had a higher than normal risk of CIN could have been identified.
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Multidetector ct of splenic Injury: development of an improved ct staging system for splenic injuries
Principal Investigator: Robert A. Halvorsen Jr, M.D.
Sub-investigators: Ajai K. Malhotra, M.D., Malcolm K. Sydnor, M.D., Laura R. Carucci, M.D. and Jinxing Yu, M.D.
There are three hypotheses for this project. The first is that the use of multidetector CT with multiplanar reconstruction will improve the classification of splenic injuries compared to current axial helical CT studies used. The second is that biphasic scanning of the spleen will improve diagnostic accuracy in the detection of splenic injury. The third is that the development of a database combining operative and angiographic findings will improve the quality of the reference or "gold standard" currently utilized for evaluating CT.
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A humanitarian device exemption treatment protocol of therasphere® for treatment of unresectable hepatocellular carcinoma
Principal Investigator: Daniel Komorowski, M.D.
Sub-investigators: Melvin J. Fratkin, M.D., Shiyu Song, M.D.,

TheraSphere® is a therapeutic device which consists of yttrium-90 as an integral constituent of insoluble glass microspheres. TheraSphere® is a non-dissolvable, non-biodegradable glass microsphere. The study has the following objectives:

  1. Provide supervised access to treatment with TheraSphere® to eligible patients with primary cancer to the liver who are not surgical resection candidates.
  2. Evaluate patient experience and toxicities associated with TheraSphere® treatment.

 

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Splenic Artery Embolization in the Blunt Trauma Patient: Splenic Salvage Rate and Radiation Dose of Proximal Embolization when compared to Distal Embolization
Principal Investigator: Malcolm K. Sydnor, M.D.
Sub-investigators: Robert Halvorsen, M.D., Kumapley Lartevi (VCU School of Medicine, 2008), Daniel Leung M.D., Daniel Komorowski, M.D., Ajai Malhotra, M.D. (Trauma Surgery), Leroy Thacker, Ph.D. (Biostatistics), Jaime Tisnado, M.D.
In this medical student project supported by the Society of Interventional Radiology Foundation, researchers compared several factors — fluoroscopy time, radiation dose and outcome — in patients who underwent splenic arterial embolization for blunt abdominal trauma. Embolization of the splenic artery is a well-known and accepted treatment for blunt splenic trauma. Its primary advantages are control of hemorrhage and preservation of splenic function. Although several studies have shown that embolization of the main splenic artery is as effective as distal embolization, other studies advocate distal selective embolization with microcatheter technology. The aim of this study was to compare patient outcomes and radiation doses for proximal vs. distal splenic arterial embolization in order to provide appropriate recommendations.
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Bowel and Mesenteric Injury Following Blunt Abdominal Trauma: Evaluation with MDCT
Principal Investigator: Jinxing Yu, M.D.
Sub-investigators: Ann Fulcher, M.D., Robert Kennedy, IV, M.D., Ajai Malhotra, M.D. (Trauma Surgery), Mary Ann Turner, M.D.
Bowel and mesenteric injury is a surgical emergency, but unfortunately, it is not always obvious clinically or radiographically. In the era of multidetector computed tomography and picture archiving and communications systems, radiologists are able to detect subtle features of BMI and to determine the quantity and volume, and attenuation values of free fluid in blunt abdominal trauma patients, which are an important CT feature of bowel injury. Therefore, determining the accuracy of MDCT for the detection of bowel and mesenteric injuries in BAT patients may be important to prevent unnecessary surgery and to identify BMI that may previously have been missed. The aim of this study is to set thresholds, thereby maximizing the sensitivity and specificity of MDCT for diagnosing BMI and thus for identifying surgical patients.
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Multidetector CT Detection of a Small Amount of Isolated Pelvic Free Fluid in Male Blunt Trauma Patients: Prevalence and Significance
Principal Investigator: Jinxing Yu, M.D.
Sub-investigators: Ann Fulcher, M.D., Jonathan Ha, M.D., Robert Halvorsen, M.D., Ajai Malhotra, M.D. (Trauma Surgery), Mary Ann Turner, M.D.
The presence of large amounts of abdominal or pelvic free fluid on CT scan, even without evidence of organ injury, may require surgical intervention. However, management is less obvious when only small amounts of isolated pelvic free fluid are present, particularly in male blunt abdominal trauma patients, who, unlike their female counterparts, are not expected to have any intraperitoneal fluid. It is possible that in males, a small amount of pelvic free fluid in the absence of visualized organ injury may have little clinical significance and not require further intervention. The development of MDCT technology and the emergence of digital image archive systems have facilitated the means to precisely assess the volume and attenuation of free fluid. Therefore, the goal of the study is to determine thresholds for quantity and attenuation values of isolated pelvic free fluid in male BAT patients to guide management decisions.
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Pancreatitis Associated with Pancreas Divisum: Imaging Features on MRI and MRCP
Principal Investigator: Jinxing Yu, M.D.
Sub-investigators: Ann Fulcher, M.D., Mary Ann Turner, M.D., Dengbin Wang, M.D., Ph.D. (visiting professor)
The clinical significance of pancreas divisum remains controversial. Although the majority of patients with pancreas divisum have no clinical symptoms, there is a subset of patients who have either unexplained abdominal pain or relapsing acute pancreatitis. These patients may benefit from interventional management. Imaging examinations play an important role in the diagnosis of pancreatitis and pancreas divisum. However, there is no published data on the imaging findings of pancreatitis associated with pancreas divisum except those on ERCP and MRCP. The purpose of this study is to establish the imaging features of pancreatitis associated with pancreas divisum and to identify the imaging characteristics of patients who may benefit from intervention.
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VCU Department of Radiology Virginia Commonwealth University VCU Medical Center