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Biomedical subjects

Deborah Levine

Publications and source records attributed to Deborah Levine.

At least 19 recordsLinked to original sources
PubMed2007

Sonographic evaluation of the endometrium in patients with a history or an appearance of polycystic ovarian syndrome.

OBJECTIVE: The purpose of this study was to assess the incidence and significance of a thick, cystic-appearing endometrium in association with a history or an ovarian appearance of polycystic ovarian syndrome. METHODS: An Institutional Review Board-approved, retrospective medical record review of sonographic studies from January 1, 1998, to December 31, 2005, found 245 patients with clinical features, a characteristic sonographic appearance of the ovaries, hormonal abnormalities, or a history of polycystic ovarian syndrome. The sonographic thickness and appearance of the endometrium (homogeneous or heterogeneous) and histologic findings on biopsy were obtained. RESULTS: Two hundred twenty-seven patients had a homogeneous endometrium in the range of 1 to 17 mm (mean +/- SD, 6.4 +/- 3.1 mm); 18 patients had a heterogeneous endometrium in the range of 4 to 23 mm (mean, 13.2 +/- 5.6 mm). Of the 18 patients with a heterogeneous endometrium, 9 also had a sonographic finding of tiny cystic foci within the endometrium. Of these, 5 had endometrial biopsy, resulting in 2 cases of a proliferative endometrium and 1 case each of simple hyperplasia, hyperplasia with atypia, and scant tissue. No cases of hyperplasia were present in the patients with a homogeneous endometrium. CONCLUSIONS: A heterogeneous cystic endometrium is associated with the prolonged proliferative phase from chronic anovulation as well as endometrial hyperplasia.

Adolescent↗
PubMed2006

Two cases of pott disease associated with bilateral psoas abscesses: case report.

STUDY DESIGN: Two case reports and a literature review of spinal osteomyelitis with bilateral psoas abscesses secondary to Mycobacterium tuberculosis. OBJECTIVE: Describe the presentation, diagnosis, treatment, and outcome of spinal tuberculosis (i.e., Pott disease). SUMMARY OF BACKGROUND DATA: Pott disease is a well-known condition in unindustrialized countries causing multiple spinal deformities in children. However, its association with bilateral psoas abscesses in adults with minimal risk factors is not commonly recognized in industrialized countries. METHODS: There are 2 adult cases of Pott disease with psoas abscesses presented, and the relevant literature is reviewed. Plain spine radiographs, spine magnetic resonance imaging (MRI), routine bacterial and acid-fast bacilli cultures of infected material, and other diagnostic testing for M. tuberculosis were performed. RESULTS: Plain radiographs and MRI of the spine showed vertebral osteomyelitis with compression fractures, and MRI also revealed bilateral psoas abscesses. Acid-fast bacilli culture and other M. tuberculosis diagnostic testing of psoas abscess specimens confirmed the diagnosis of M. tuberculosis. CONCLUSION: Although spinal osteomyelitis with psoas abscess is classically associated with Staphylococcus aureus infection, Pott disease should be considered in this clinical setting, and risk factor assessment and testing for tuberculosis should be performed.

Aged, 80 and over↗
PubMed2006

Obstetric MRI.

Ultrasound is the imaging modality of choice for pregnant patients. However, MRI is increasingly utilized in patients in whom the sonographic diagnosis is unclear. These include maternal conditions unique to pregnancy such as ectopic pregnancy, placenta accreta, and uterine dehiscence. MRI is also being increasingly utilized in the assessment of abdominopelvic pain in pregnancy, in particular in assessment for appendicitis. Fetal MRI is performed to assess central nervous system (CNS) abnormalities and patients who are considering fetal surgery for conditions such as neural tube defects, congenital diaphragmatic hernia, and masses that obstruct the airway. In the future, functional MRI and fetal volumetry may provide additional information that can aid in our care of complicated pregnancies.

Central Nervous System↗
PubMed2006

Apert syndrome: what prenatal radiographic findings should prompt its consideration?

Apert syndrome was diagnosed in a newborn with typical facial and digital features whose only detected prenatal abnormality had been agenesis of the corpus callosum. This prompted a review of the central nervous system findings in all cases of Apert syndrome treated at the Craniofacial Center Boston Children's Hospital between 1978 and 2004. Two of 30 patients with Apert syndrome had prenatal identification of mild dilatation of the lateral cerebral ventricles and complete agenesis of the corpus callosum (ACC) documented with both ultrasound and MRI. Both had the common S252W mutation of FGFR2. Though cranial and orbital malformations typical of Apert were eventually seen in these fetuses in the third-trimester, even in retrospect, these were not detectable at mid second-trimester, ultrasound screening for congenital malformations. Hand malformations also went undetected in the second-trimester despite extensive imaging by experienced radiologists. We conclude that prenatal ultrasonographic identification of mild ventriculomegaly or ACC should stimulate a careful search for features of Apert syndrome and prompt follow-up imaging to look for bony abnormalities that have later onset. Prenatal molecular testing for Apert mutations should be considered in cases of mild ventriculomegaly and ACC.

Acrocephalosyndactylia↗
PubMed2006

Diagnosis of inferior vermian hypoplasia by fetal magnetic resonance imaging: potential pitfalls and neurodevelopmental outcome.

OBJECTIVE: Advances in fetal magnetic resonance imaging allow the detection of subtle anatomic anomalies of unclear long-term clinical significance. The purpose of this study was to examine the accuracy of fetal magnetic resonance imaging in the diagnosis of isolated inferior vermian hypoplasia and to describe the neurodevelopmental outcome. STUDY DESIGN: We reviewed all cases with fetal and postnatal magnetic resonance imaging studies between 1999 and 2003 and identified 19 cases with a diagnosis of isolated inferior vermian hypoplasia. We compared prenatal and postnatal magnetic resonance imaging studies and evaluated subjects using developmental scales. RESULTS: Isolated inferior vermian hypoplasia was confirmed by postnatal magnetic resonance imaging in 68% of the patients (13/19); the remaining 6 patients had normal postnatal magnetic resonance imaging results. On developmental testing at mean age 19.8 +/- 4.9 months, 3 infants (23%) with confirmed postnatal diagnosis demonstrated motor and language delays and functional difficulties, and 2 infants (15%) had behavioral problems; none of the infants with normal postnatal magnetic resonance imaging studies were delayed. CONCLUSION: Isolated inferior vermian hypoplasia in the second trimester may be over-diagnosed by fetal magnetic resonance imaging and therefore warrants postnatal magnetic resonance imaging confirmation.

Cerebellum↗
PubMed2006

Imaging of pelvic pain in the first trimester of pregnancy.

Pelvic pain during the first trimester of pregnancy can pose a challenge to the clinician. The noninvasive nature, safety, and reliability of ultrasonography make it the diagnostic method of choice for pregnant patients who have pelvic pain. Sonography provides information that allows for diagnosis of both pregnancy-related pain, such as a ruptured ectopic pregnancy, miscarriage, or threatened abortion; and may be useful in the diagnosis of pain unrelated to pregnancy, such as that seen in appendicitis and nephrolithiasis.

Diagnosis, Differential↗
PubMed2006

All-terrain vehicle, trampoline and scooter injuries and their prevention in children.

PURPOSE: Childhood injuries are the leading cause of death in children and result in significant healthcare utilization. Injuries specifically related to all terrain vehicles, trampolines and scooter usage can be devastating and are often preventable. Our understanding of how and why these injuries occur can aid in preventing morbidity and mortality. RECENT FINDINGS: The popularity of all-terrain vehicles, nonmotorized scooters and trampolines has soared over recent years. This increased usage has led to a tremendous rise in injuries in children utilizing these recreational activities. Many of the injuries occur in younger children who may not possess the motor and cognitive skills necessary to safely engage in these activities. These activities lead to a number of head and extremity injuries, most of which can be attenuated by the use of protective gear such as helmets and protective padding. SUMMARY: Understanding the nature of these injuries can lead to advocacy and hopefully legislation to prevent further injuries from occurring.

Adolescent↗
PubMed2006

Solving the problem pelvic ultrasound with magnetic resonance imaging.

Ultrasound is the screening method of choice for evaluation of pelvic anatomy and abnormalities of the female pelvis. It allows for detailed assessment of the uterus, endometrium, and ovaries. However, there are times when the sonographic diagnosis is nonspecific. This review article details the use of magnetic resonance imaging for assessment of uterine duplication anomalies, adnexal and uterine masses, and for aiding in the assessment of pregnant patients with nonspecific sonographic findings in the pelvis.

Embolization, Therapeutic↗
PubMed2006

MR imaging evaluation of acute appendicitis in pregnancy.

PURPOSE: To retrospectively assess the diagnostic performance of magnetic resonance (MR) imaging in pregnant patients suspected of having acute appendicitis. MATERIALS AND METHODS: The study was approved by the committee on clinical investigations and was HIPAA compliant. The informed consent requirement was waived. MR images were obtained in 51 consecutive pregnant patients (mean age, 28.3 years) who were clinically suspected of having acute appendicitis. In this protocol for pregnant patients, MR imaging is performed when findings at ultrasonography (US) are inconclusive or additional information is needed. Four patients had appendicitis, which was confirmed at surgery in three patients and at follow-up computed tomography in one patient. Initial interpretations were used for patient care and to calculate diagnostic accuracy. The appendix was considered normal at MR imaging if its diameter was less than or equal to 6 mm or if it was filled with air, oral contrast material, or both. An enlarged fluid-filled appendix (>7 mm in diameter) was considered an abnormal finding. An appendix with a diameter of 6-7 mm was considered an inconclusive finding; in those cases, the presence of periappendiceal inflammation was used for the final diagnosis. Three radiologists retrospectively assessed the visualization of the appendix by using a 5-point scale. Statistical analysis was performed by using the median and Fisher exact tests and the Spearman correlation coefficient. RESULTS: MR images were positive for appendicitis in four patients and inconclusive in three. In the three patients with inconclusive results, the appendix was not seen in two patients and was borderline enlarged (7 mm in diameter) in the third. The overall sensitivity, specificity, prevalence-adjusted positive and negative predictive values, and accuracy for MR imaging was 100%, 93.6%, 1.4%, 100%, and 94.0%, respectively. CONCLUSION: MR imaging is an excellent modality for use in excluding acute appendicitis in pregnant women who present with acute abdominal pain and in whom a normal appendix is not visualized at US.

Acute Disease↗
PubMed2006

Fetal lung volume measurements: determination with MR imaging--effect of various factors.

PURPOSE: To retrospectively determine the effect of gestational age (GA), imaging plane, section thickness, and inter- and intraobserver variability on fetal lung volume (FLV) measurements obtained with magnetic resonance (MR) imaging in a cohort of fetuses without thoracic abnormalities. MATERIALS AND METHODS: Institutional review board approval was obtained. Informed consent for this retrospective cohort study was waived, and the conduct of this study was HIPAA compliant. FLV was measured in 30 fetuses (GA, 17-36 weeks) referred for MR imaging for indications other than pulmonary abnormalities. Measurements were made on single-shot fast spin-echo images by tracing free-form regions of interest on individual consecutive sections in the transverse, sagittal, and coronal planes. Measurements were performed twice by two observers independently. Correlations between FLV and GA, imaging plane, and section thickness were assessed, as were intra- and interobserver variability. Time to perform FLV was assessed in a subset of fetuses. RESULTS: Total FLV ranged from 2 to 110 mL. Mixed-effects regression model showed significant quadratic trend in FLV with increasing GA, with comparable strength of correlation (r = 0.89-0.91) in the three imaging planes of measurement. Intraobserver agreement was good in all three planes (r = 0.65-0.83) and was highest in the transverse plane. Interobserver agreement was good in all three planes (r = 0.68-0.76). FLV showed no significant dependence on section thickness (P = .23) or imaging plane (P = .82). Mean time to obtain FLV measurements ranged from 48 seconds at GA of 21 weeks to 77 seconds at GA of 29-30 weeks. CONCLUSION: GA-based FLV measurements obtained with MR images are independent of section thickness and imaging plane and can be performed with good inter- and intraobserver agreement in less than 2 minutes.

Female↗
PubMed2006

Evaluation of real-time single-shot fast spin-echo MRI for visualization of the fetal midline corpus callosum and secondary palate.

OBJECTIVE: The objective of our study was to assess the visibility of the fetal corpus callosum and soft palate on standard single-shot fast spin-echo (SSFSE) imaging versus real-time (RT) SSFSE imaging. SUBJECTS AND METHODS: Part 1 of the study was a prospective analysis using a questionnaire rating the ease of use and utility of RT imaging. Part 2 of the study was a retrospective analysis of 69 fetal MRI studies with RT sagittal midline imaging of the head, face, or both. Standard and RT SSFSE image sets were de-identified, randomized, and shown to three pediatric neuroradiologists who rated on a 5-point scale whether the images were midline and how well they could see and characterize as normal the corpus callosum and secondary palate. The imaging results were correlated with postnatal diagnosis. Statistical methods included the Wilcoxon's signed rank test, McNemar chi-square test, and analysis of variance. RESULTS: Prospectively, the RT SSFSE technique was ranked as excellent in all the categories assessed. Retrospective analysis showed that the midline view obtained with RT SSFSE imaging was helpful in diagnosing the normal and abnormal secondary palate, allowing improved diagnosis of 19 (30.6%) of 62 cases of normal palate and four (57.1%) of seven cases of abnormal palate, when compared with the standard SSFSE technique. RT SSFSE imaging improved the ability to diagnose a normal corpus callosum on the midline view in 13 (27.6%) of 47 fetuses of 20 or more weeks gestational age. CONCLUSION: The RT SSFSE technique can aid in obtaining images in planes that are critical to the evaluation of a moving fetus, particularly when a midline sagittal view of the corpus callosum or palate is required. The use of this technique may lead to improved diagnosis of CNS or orofacial abnormalities in fetuses.

Corpus Callosum↗
PubMed2005

Fetal surgery in otolaryngology: a new era in the diagnosis and management of fetal airway obstruction because of advances in prenatal imaging.

OBJECTIVE: To evaluate the efficacy, safety, and outcome of prenatal imaging and fetal surgery in the diagnosis and management of fetal airway obstruction caused by cervical teratoma or lymphatic malformation. SETTING: Tertiary care medical center. Patients A retrospective study of all consecutive fetal patients with cervical teratoma or lymphatic malformation between January 2001 and December 2003. RESULTS: The indication was potential airway obstruction due to a fetal neck mass in 8 patients. Prenatal images were obtained by ultrasonography and magnetic resonance imaging, and were consistent with teratoma in 4 patients. The mean cervical mass was 8.3 x 7.3 x 6.7 cm, with airway obstruction suspected in all 4 patients. All 4 patients were successfully delivered by ex utero intrapartum treatment, during which 3 newborns required tracheotomy and 1 was successfully intubated. Prenatal images were consistent with lymphatic malformation in the remaining 4 patients. The mean cervical mass was 4.6 x 4.4 x 3.4 cm. There was no indication of airway obstruction based on prenatal images. All 4 patients had an uncomplicated vaginal delivery. CONCLUSIONS: Technological advances in prenatal ultrasonography and magnetic resonance imaging have improved the ability to diagnose congenital abnormalities in utero. This allows for proper assessment of the airway to prevent any unexpected problems at delivery. We believe that many airway emergencies can be avoided by prenatal imaging and initiation of airway management in the prenatal period.

Adult↗
PubMed2005

Imaging of fetal cerebral ventriculomegaly: a guide to management and outcome.

Ultrasound imaging is the screening modality of choice for initial evaluation of the fetal central nervous system. However, there are times when fast magnetic resonance imaging (MRI) provides information additional to that available from ultrasound. This review will: (1) discuss the ultrasound evaluation of ventriculomegaly and its associated anomalies; (2) illustrate and expand upon the type of additional information MRI can provide beyond that which is available from ultrasound; and (3) discuss how this additional information can alter diagnosis as well as change maternal counselling and case management.

Central Nervous System↗
PubMed2005

A simple method for displaying cine images on web-based teaching files.

OBJECTIVE: Our objective was to develop a simple method for displaying dynamic cine images on Web-based teaching files. CONCLUSION: We developed a simple method for displaying cine images on Web-based teaching files using an open-source utility, the Java applet. This interactive utility offers improved 3D visualizations compared with the traditional approach using thumbnail and static images. Because Java is a built-in component of common Web browsers and computer systems, no other software was required. We have used this applet successfully for more than 2 years in our Web-based teaching system, including in our teaching files and on our case-of-the-week page.

Computer-Assisted Instruction↗
PubMed2005

Real-time magnetic resonance imaging aids prenatal diagnosis of isolated cleft palate.

OBJECTIVE: Cleft of the secondary palate without cleft lip is difficult to visualize sonographically. This study was performed to assess the utility of sonography, standard magnetic resonance (MR) imaging, and real-time MR imaging in the diagnosis of isolated cleft palate. METHODS: We prospectively assessed 5 fetuses at risk for isolated cleft palate on the basis of family history, micrognathia, or both, using sonography and standard and real-time single-shot fast spin echo MR sequences. Written informed consent was obtained under our Institutional Review Board-approved Health Insurance Portability and Accountability Act-compliant protocol. Images were assessed for confidence in a diagnosis of cleft or normal palate. Prenatal and postnatal diagnoses were compared. RESULTS: In 3 fetuses, micrognathia was visualized by sonography and MR imaging with standard and real-time sequences. One fetus at 19 weeks had a wide cleft of the entire secondary palate, and another fetus at 33 weeks had a cleft of the soft palate; these defects were seen only with real-time MR imaging. One 35-week gestational age fetus had a cleft soft palate that was visualized on standard and real-time MR imaging. Two fetuses with no abnormalities had the normal midline secondary palate seen only on real-time MR imaging. In all fetuses, real-time images were helpful in assessing the secondary palate because the entire midline naso-oropharynx could be visualized. CONCLUSIONS: Real-time MR imaging allows for rapid assessment of the midline structures, providing accurate diagnosis of isolated cleft palate.

Cleft Palate↗