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Biomedical subjects

Lane F Donnelly

Publications and source records attributed to Lane F Donnelly.

At least 19 recordsLinked to original sources
PubMed2007

Visceral abdominal fat is correlated with whole-body fat and physical activity among 8-y-old children at risk of obesity.

BACKGROUND: Abdominal fat is more related to health risk than is whole-body fat. Determining the factors related to children's visceral fat could result in interventions to improve child health. OBJECTIVE: Given the effects of physical activity on adults' visceral fat, it was hypothesized that, after accounting for whole-body fat, physical activity would be inversely related to children's visceral (VAT), but not to subcutaneous (SAT), abdominal adipose tissue. DESIGN: In this cross-sectional observational study conducted in forty-two 8-y-old children (21 boys, 21 girls) at risk of obesity [>75th body mass index (BMI) percentile, with at least one overweight parent], familial factors (eg, maternal BMI), historic weight-related factors (eg, birth weight), and the children's current physical activity (self-reported and measured with accelerometry) and diet were examined as potential correlates of the children's whole-body composition (measured with BMI and dual-energy X-ray absorptiometry) and abdominal fat distribution (measured by magnetic resonance imaging). RESULTS: Accelerometer-measured physical activity was related to whole-body fat (r = -0.32, P < 0.10), SAT (r = -0.29, P < 0.10), and VAT (r = -0.43, P < 0.05). In regression models, whole-body fat was positively associated with and the only significant correlate of SAT. Whole-body fat was positively related and accelerometer-measured physical activity was negatively and independently related to the children's VAT. CONCLUSIONS: Both SAT and VAT in 8-y-old children at risk of obesity are most closely associated with whole-body fat. However, after control for whole-body fat, greater physical activity is only associated with lower VAT, not SAT, in these children.

Absorptiometry, Photon↗
PubMed2006

Allantoic cyst: a prenatal clue to patent urachus.

A patent urachus, which is typically diagnosed as leakage from the umbilicus postnatally, can present as an allantoic cyst in the umbilical cord antenatally. We report a case of a patent urachus with an allantoic cyst diagnosed via fetal MR imaging at 24 weeks' gestation. Early detection allowed for appropriate counseling and prompt corrective surgery after birth.

Adolescent↗
PubMed2006

Determination of respiratory phase during acquisition of airway cine MR images.

Subjects were imaged on a 1.5-T Signa MRI system using the head-neck vascular coil. An axial fast gradient echo cine, at the base of the second cervical vertebra, was obtained. A total of 128 images were acquired with a rapid image acquisition (one per second) over several respiratory cycles. The analog signal from the MR scanner (RF unblank) was utilized to determine the duration of the cine MR sequence. The phase of respiration was determined by analyzing the nasal air flow connected via pressure tubing to a pressure transducer outside the MR scanner room. We were thus able to determine the phase of respiration during acquisition of individual airway cine MR images. There was a wide range of airway volume measurements over the respiratory cycle with the lowest volume at end expiration and the highest at peak inspiration.

Adolescent↗
PubMed2006

Comparison of lingual tonsil size as depicted on MR imaging between children with obstructive sleep apnea despite previous tonsillectomy and adenoidectomy and normal controls.

BACKGROUND: Cine MRI has become a useful tool in the evaluation of patients with persistent obstructive sleep apnea (OSA) despite previous surgical intervention and in patients with underlying conditions that render them susceptible to multilevel airway obstruction. Findings on cine MRI studies have also increased our understanding of the mechanisms and anatomic causes of OSA in children. OBJECTIVE: To compare lingual tonsil size between children with OSA and a group of normal controls. In addition, a subanalysis was made of the group of children with OSA comparing lingual tonsils between children with and without underlying Down syndrome. MATERIALS AND METHODS: Children with persistent OSA despite previous palatine tonsillectomy and adenoidectomy and controls without OSA underwent MR imaging with sagittal fast spin echo inversion-recovery images, and lingual tonsils were categorized as nonperceptible at imaging or present and measurable. When present, lingual tonsils were measured in the maximum anterior-posterior diameter. If lingual tonsils were greater than 10 mm in diameter and abutting both the posterior border of the tongue and the posterior pharyngeal wall, they were considered markedly enlarged. RESULTS: There were statistically significant differences between the OSA and control groups for the presence vs. nonvisualization of lingual tonsils (OSA 33% vs. control 0%, P=0.0001) and mean diameter of the lingual tonsils (OSA 9.50 mm vs. control 0.0 mm, P=0.00001). Within the OSA group, there were statistically significant differences between children with and without Down syndrome for the three lingual tonsil width categories (P=0.0070) and occurrence of markedly enlarged lingual tonsils (with Down syndrome 35% vs. without Down syndrome 3%, P=0.0035). CONCLUSIONS: Enlargement of the lingual tonsils is relatively common in children with persistent obstructive sleep apnea after palatine tonsillectomy and adenoidectomy. This is particularly true in patients with Down syndrome.

Adenoidectomy↗
PubMed2006

Embolization of renal angiomyolipomata in patients with tuberous sclerosis complex.

BACKGROUND: Renal angiomyolipomata can reduce renal reserve and lead to renal insufficiency and failure. Angiomyolipomata often have abnormal vasculature, with aneurysms that can hemorrhage. Treatment of angiomyolipomata greater than 4 cm in diameter is suggested to decrease the risk for hemorrhage. Nephron-sparing procedures are critical in patients because of their limited renal reserve. Embolization has been used to treat these tumors, but there are limited studies examining efficacy. Our study examines the efficacy of selective embolization in decreasing tumor burden, preventing hemorrhage, and preserving renal function. METHODS: We conducted a retrospective study of 16 patients with 20 angiomyolipomata on 18 kidneys who underwent 18 transcatheter transarterial embolization procedures. Aneurysm number and size were documented and tumor volumes were measured before and after embolization. Preprocedure and follow-up renal function also were measured. Changes in angiomyolipoma volume and kidney function were assessed for significance by using paired t-test. RESULTS: Before embolization, 7 angiomyolipomata had more than 5 aneurysms, 9 had 1 to 5 aneurysms, and 4 had no aneurysms, but showed tortuous dysmorphic arteries. Mean aneurysm size was 5 mm. In patients available for follow-up, 15 of 16 tumors had decreased in volume (mean decrease, 56.1%; P = 0.001). At an average of 40 months' follow-up, there have been no subsequent hemorrhages. Patients' decline in renal function was not significantly different from that expected because of the natural course of the disease. CONCLUSION: Selective embolization decreases tumor size, prevents hemorrhage, and preserves kidney function in patients with tuberous sclerosis with renal angiomyolipomata.

Adolescent↗
PubMed2006

Establishing a program to promote professionalism and effective communication in radiology.

Effective health care delivery systems rely heavily on high degrees of skill in professionalism and communication. These skills are essential to all of the missions of a successful radiology department. Until recently, there was a lack of emphasis on the importance of these issues and a lack of efforts in setting expectations and measuring performance. Herein the authors describe the components of a program implemented to promote professionalism and effective communication in their radiology department.

Communication↗
PubMed2006

The frequency of radiology reporting of childhood obesity.

OBJECTIVE: The purpose of our study was to review the current practice of radiologists with respect to dictating the presence of obesity in imaging reports. MATERIALS AND METHODS: Over 1 million radiology reports dictated at a large pediatric hospital from 1994 to 2002 were analyzed for several keywords relating to obesity. The number of cases in which the keywords appeared was recorded for each year, and a percentage was calculated. Reports done in 1999 and 2000 were further analyzed to determine where the keywords were positioned within the report. RESULTS: The number of reports containing a keyword ranged from 131 to 456 per year. During each year, documentation of obesity occurred in less than 0.4% of all reports. During that same time period, the national prevalence of pediatric obesity ranged from 6-16%. Detailed examination of the 1999 and 2000 reports showed that even in the reports that mentioned obesity, it was usually not listed in the diagnostic impression. CONCLUSION: Despite the increase in public awareness of obesity and increasing recognition of obesity-related disease, this study did not find a similar awareness among radiologists at a large pediatric radiology department. The reason for this discrepancy is speculative and likely multifactorial. Regardless, radiologists may be missing an opportunity to play a role in disease prevention and early recognition by documenting findings of obesity and thereby bringing them to the attention of referring physicians.

Child↗
PubMed2006

Three-dimensional rotational angiography of neurovascular lesions in pediatric patients.

OBJECTIVE: In this pictorial essay, we review the 3D rotational angiography (RA) studies of six pediatric patients; in these cases, the information obtained with 3D RA was uniquely beneficial in diagnosis and treatment planning. CONCLUSION: Three-dimensional RA is an excellent tool for the evaluation of a number of intracranial lesions in pediatric patients: There is less total radiation exposure from a single rotational run than from CT or a conventional angiography examination that involves more than one view and the study is quick, with data acquisition requiring less than 8 sec and fully rendered 3D reconstructions generated within 180 sec.

Cerebral Angiography↗
PubMed2005

Obstructive sleep apnea in pediatric patients: evaluation with cine MR sleep studies.

Cine magnetic resonance (MR) imaging sleep studies have become a useful tool in the evaluation of obstructive sleep apnea in children with certain categories of pathologic conditions. In this article, the author describes a program for the use of cine MR sleep studies in the evaluation of children with obstructive sleep apnea. The following areas are discussed: clinical indications, patient preparation, anatomic considerations, MR technique, technical issues, image interpretation, commonly encountered diagnoses, volume segmentation processing of data, and controversial areas.

Child↗
PubMed2005

Imaging findings in pleuropulmonary blastoma.

BACKGROUND: Pleuropulmonary blastoma (PPB) is a rare tumor of the chest seen in young children and recently recognized as distinct from the pulmonary blastoma typically encountered in adults. OBJECTIVE: The purpose of this study is to review and describe the findings of PPB on radiography and CT in four patients. METHODS: Radiographs and CT findings were reviewed in four patients with pathologically proven PPB. RESULTS: All four cases demonstrated large masses in the right hemithorax with heterogeneous low attenuation, pleural effusion, contralateral mediastinal shift, and lack of chest wall invasion. CONCLUSION: When a large pleural-based mass is identified in a young child, PPB should be considered. Suggestive findings include absence of chest wall invasion, presence of pleural fluid, right-sided location, and heterogeneous low attenuation.

Child↗
PubMed2005

Managing bariatric patients in a children's hospital: radiologic considerations and limitations.

As the increasing prevalence of pediatric obesity and its associated risks gain national attention, adolescent bariatric surgery is gradually gaining acceptance as a viable weight loss tool for some severely obese adolescents. Obese patients often exceed the capacity limits of most radiological devices used for imaging. Because the radiological evaluation often plays a crucial role in the management of these patients, it is important for pediatric surgeons and radiologists to be aware of the special challenges and alternative algorithms for radiological evaluation. This review outlines and illustrates these considerations and limitations. Herein the authors discuss these topics within the context of characteristic bariatric patient profiles and the Roux-en-Y gastric bypass procedure, currently the authors' standard operative approach.

Adolescent↗
PubMed2005

Imaging in immunocompetent children who have pneumonia.

This article discusses the common clinical scenarios regarding otherwise healthy children who develop suspected pneumonia in which imaging becomes an issue. The following topics are covered concerning the roles of imaging in the management of pneumonia: evaluation for possible pneumonia, determination of a specific etiologic agent, exclusion of other pathology, evaluation of the child with failure of pneumonia to clear, and evaluation of complications related to pneumonia.

Child↗
PubMed2005

Placement of peripherally inserted central catheters without fluoroscopy in children: initial catheter tip position.

PURPOSE: To determine how often placement of peripherally inserted central catheters (PICCs) without imaging guidance results in an initially correct central venous catheter tip location. MATERIALS AND METHODS: This study was approved by the hospital's institutional review board, which waived the requirement for informed consent. In a children's hospital, 843 PICCs were placed in 698 patients (age range, 0 days to 26 years; mean, 6.9 years) during a 14-month study period. All PICCs were placed by a specialized team of PICC nurses and interventional radiology technologists in an angiography suite with the supervision of pediatric interventional radiologists. All catheters were threaded blindly to a previously estimated length by either a PICC nurse or a pediatric interventional radiologist, according to National Association of Vascular Access Networks guidelines, and the initial PICC tip location was then determined by means of spot fluoroscopy. PICC tips were regarded as central if they resided anywhere within the superior vena cava (SVC). All catheters were then manipulated with intermittent fluoroscopic guidance to achieve a final central position in the distal third of the SVC. A chi2 test was used to compare initial and final PICC tip locations according to patient age, catheter size, accessed vein, and need for radiologist assistance. A t test was used to compare procedure time with and without radiologist assistance. RESULTS: Analysis included 843 consecutively placed pediatric PICCs, of which 723 (85.8%) had a noncentral initial PICC tip position and required additional manipulation. After catheter repositioning performed with intermittent fluoroscopic guidance, a final central PICC tip location was achieved in 760 PICCs (90.2%). CONCLUSION: Pediatric PICC placement without fluoroscopic guidance required catheter manipulation of initial PICC tip position in 723 cases (85.8%). PICC placement with fluoroscopic guidance is highly successful, and the authors believe it is best performed in an angiography suite.

Adolescent↗
PubMed2005

Identifying children with pneumonia in the emergency department.

Emergency physicians need to clinically differentiate children with and without radiographic evidence of pneumonia. In this prospective cohort study of 510 patients 2 to 59 months of age presenting with symptoms of lower respiratory tract infection, 100% were evaluated with chest radiography and 44 (8.6%) had pneumonia on chest radiography. With use of multivariate analysis, the adjusted odds ratio (AOR) and 95% confidence intervals (CI) of the clinical findings significantly associated with focal infiltrates were age older than 12 months (AOR 1.4, CI 1.1-1.9), RR 50 or greater (AOR 3.5, CI 1.6-7.5), oxygen saturation 96% or less (AOR 4.6, CI 2.3-9.2), and nasal flaring (AOR 2.2 CI 1.2-4.0) in patients 12 months of age or younger. The combination of age older than 12 months, RR 50 or greater, oxygen saturation 96% or less, and in children under age 12 months, nasal flaring, can be used in determining which young children with lower respiratory tract infection symptoms have radiographic pneumonia.

Age Distribution↗
PubMed2005

MRI of fat distribution in a mouse model of lysosomal acid lipase deficiency.

OBJECTIVE: We assessed the use of MRI in the evaluation of abdominal fat distribution in a lysosomal acid lipase (LAL)-deficient mouse model. MATERIALS AND METHODS: LAL-deficient mice are born with a normal fat distribution but over time deplete the fat stores in the subcutaneous and retroperitoneal tissues and accumulate fat in the liver, spleen, and bowel. Four MRI studies of LAL-deficient mice and control mice were obtained with 3-T T1-weighted spin-echo images and volume segmentation processing to create parameters for the study of fat distribution: intraabdominal adipose tissue-subcutaneous adipose tissue (IAT/SAT) ratio, liver volume, reproductive fat, and retroperitoneal fat. MRI adiposity parameters in LAL-deficient mice were compared with those in control mice. Adiposity volumes calculated on MRI were compared with those calculated at autopsy. RESULTS: Statistically significant differences were found between LAL-deficient and control mice for IAT/SAT ratio (p=0.0336), liver volume (p=0.0336), and reproductive fat (p=0.0336), and a statistically significant trend was found for retroperitoneal fat (p=0.0514). No statistically significant difference was found between adiposity volumes calculated on MRI and adiposity volumes found at autopsy (all p >0.2). CONCLUSION: Use of an in vivo model showed MRI techniques to be accurate in predicting visceral adiposity. LAL-deficient mice provided a unique model showing a pattern of adipose distribution that is markedly different from that in control mice, and MRI may provide a means of evaluating therapeutic interventions sequentially.

Abdomen↗
PubMed2005

Performance-based assessment of radiology faculty: a practical plan to promote improvement and meet JCAHO standards.

OBJECTIVE: The objective of this article is to describe the process of implementing a program for performance-based assessment of clinical faculty. CONCLUSION: A performance-based assessment of clinical faculty program facilitated quality improvements in our department, improved communication concerning our reappointment process, and was well received by faculty. The presence of measures on a scorecard stresses what is important for clinical care and facilitates process improvement in these areas. Having practitioner-specific data compiled in an organized fashion helps meet the standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

Clinical Competence↗