Brian Richard Decosta, M.D.

With FDG-PET, hypometabolic activity (decreased glucose utilization) in certain parts of the brain namely temporal and occipital lobe is characteristic of Alzheimer’s disease and can distinguish this from Lewey Body dementia and vascular dementia as well as Parkinson’s dementia. Florbetaben is an FDA approved imaging agent that directly bonds to beta amyloid in the brain showing diffuse increased cortical uptake of the radiotracer in Alzheimer’s disease. Hope this helps understand this kind of PET imaging a little better.

The word PET means positron emission tomography and uses F-18 labeled agents typically glucose. The presence of the F-18 replacing one of the hydroxyl groups in the glucose allows it to be treated by the body as glucose which becomes trapped in the cells as the phosphorylated form. The presence of the fluorine atom blocks further metabolism of the molecule which remains in the cell and allows it to be imaged as positrons are emitted from decay of the F18 into Oxygen. The half life of the F-18 is 110 minutes.

Brian

It would show you whether you have other processes going on besides pneumonia or bronchitis such as interstitial lung disease. It would also see if there are abnormalites of the mediastinum or bronchi such as adenopathy or endobronchial lesions. It would help to exclude lung mass as a cause. The list goes on and a chest scan or chest CT can be very helpful in the correct clinical setting.

The first thing to do would be to get a urinalysis to see if your husband has hematuria. If the urinalysis is positive for hematuria, then a CT Renal stone study would be the next course of action to determine if there is a stone either within the kidney or with in the ureter. It would also help to exclude other etiologies for your husband’s pain. I hope this helps.

Brian

An angioplasty procedure means vessel plasty. The interventional radiologist uses image guidance which includes ultrasound and X rays to guide an angioplasty balloon into a narrowed blood vessel usually an artery. The balloon is inflated within the narrowed diseased segment of the vessel to increase the luminal diameter in the area of narrowing. In some cases angioplasty also includes placement of a wall stent to keep the narrowed segment patent and to reduce the chance of re-stenosis. However, the placement of the stent may require lifetime anticoagulation with medicines such as placid.

The first thing to try is an arterial lower extremity duplex ultrasound to determine if you are have peripheral vascular disease, especially if you experiencing leg claudication (i.e., the aching is worsened with walking or exercise).

Thanks,

Brian

Could be so called “growing” pain especially if it is worse at night. If patient continues or worsens with exercise, an MRI of the knee would be the next step.

It's not painful at all. It is, however, very loud. Most places offer noise canceling headsets +/- relaxing music. Some people can find the narrow bore of the MRI magnet claustrophobic. In these instances, it is recommended to take a relaxing agent such as Valium prior to the scan, the duration of which can last anywhere from a few minutes to an hour depending on what is being imaged. If a sedative is given, then you would need to make sure you use taxi/public transportation or have someone to drive you home.

MRI is very insensitive for evaluating for kidney stones because it is not very sensitive for picking up calcifications. A much better and more sensitive study for detecting even small kidney stones or stones within the ureters or bladder is a CT scan of the absomen and pelvis without contrast using the so-called renal stone protocol. This would be a great test to evaluate for the presence of kidney stones. If you are concerned about radiation exposure from CT scan for kidney stones, then ultrasound can be useful to evaluate for stones with in the kidneys but it is not useful for evaluating stones with in the ureters. I hope this helps.

The treatment is via a radiation oncologist. The radiation therapy is localized to the affected breast and not the whole body. Some side effects may be similar to a sunburn and with thickening of the skin of the treated breast post radiation therapy. The radiologist is involved in interpretation of the imaging findings and is part of the team approach to patient care.

The first and most straightforward test would be a sinus series or a CT scan of the sinuses to determine whether or not sinus disease is responsible for the headaches. If this proves to be negative, then another test would be an MRI of the brain.This will prove helpful to determine if there are other causes such is a mass within the brain, or if the headaches are migraines not regular headaches. Whether or not the headache is due to migraine would initially be evaluated from the clinical history. Hope this helps.

Given your history of pain, a CT abdomen and pelvis with IV contrast is a better option as CT has better spatial resolution and is better at finding tumor, pathologic lymph nodes and inflammation.

A CT scan uses ionizing radiation to look for differences in attenuation of the tissues to generate tomographic images. For example, bone attenuated more X-rays then fat or muscle and muscle attenuated more X-rays compared with fat. Fat attenuated more X-rays the air.

MRI does not use ionizing radiation and is safer than CT as there is no radiation exposure in the X-ray wavelength. It uses radio waves instead to excite water molecules in tissues. These molecules are undergoing rotational/tumbling motion and absorb radio waves at that frequency and the. Reemit them. Because of this property, MRI is good at seeing the protons in tissues like fat, water, and lack of such protons in bone and air. MRI is therefore more specific for tissue type then CT. Diseased tissue is therefore easier to detect with MRI then CT. However, both have their advantages and disadvantages. For example, CT has better resolution and is better at looking at bone.

Hope this helps,

Brian

Radiologist reports are accurate if they describe accurately any acute findings and then go on to describe non acute or chronic incidental findings. Any chronic findings that need additional work up or surgery also need to be described. These would include findings such as tumors, aneurysms, lymphadenopathy etc. Such subacute or chronic findings would require further treatment including but not limited to surgery, chemotherapy, radiation etc.. The report should be concise and should contain 4 sections- patient demographics, indication for study or clinical history, date and time of study, study type and modality, radiographic findings, impression, timed and dated electronic signature. The report should become part of the patients permanent clinical record. If additional findings or changes need to be r made to the report, then these would fall under a timed, dated and signed Addendum section. Any acute findings such as GI bleed, bowel perforation, aortic aneurysm rupture, ectopic or ruptured ectopic pregnancy, ovarian or testicular torsion etc need to be communicated on the phone or in person directly with the provider and this needs to be documented on the original radiology report. The report is incomplete without comparison to prior similar studies. The date of the comparison exam and any changes or additional new findings need to documented in the original report.

Hope this helps.

Brian

A renal ultrasound would be the best way to assess whether your kidneys are obstructed or hydronephrotic. Such a study would also help to assess whether you have “medical renal disease”. It can also see renal cysts and stones as a possible source of abnormal renal function.

Sorry for the late reply. MRI scans have no after effects. The only thing is noise during the scan. Some MRI scans to work up migraines may require the use of an intravenous contrast agent. However, these contrast agents are much less nephrotoxic then CT contrast agents. It is unusual to have any side effects after either non contrast or contrast enhanced MRI scans.

Ultrasound is limited by poor penetration and may not see a mass or growth if it is obscured by overlying bowel gas or is located in a deep tetroperitoneal location. CT scan is a much better test if there is concern for an abdominal or pelvic mass or adenopathy.

There is no known minimum risk for X-ray dose exposure because it is more of a probability effect. The concept used is to keep X-ray exposure to as low as reasonably achievable or ALARA. It the risks versus the benefits of X Ray exposure are high, then it is better not to receive the test. Also X rays or any ionizing radiation are more harmful when received acutely compared with the same dose received chronically over a much longer time period where there is more time for dna damage to be repaired by the body.

The most common cause is claustrophobia. The best treatment is get the study done in a wide bore or even an “open” MRI machine if that is an option. Alternatively, light sedation with 10 mg of Valium taken shortly before the MRI test is helpful if you have a driver to get you home safely at the conclusion of the study.

Radiotherapy for RA has been recently evaluated and appears to be useful in resistant cases that do not respond to DMARDS. Here is a useful summary:

https://www.news-medical.net/amp/health/Radiotherapy-and-Rheumatoid-Arthritis.aspx

Sincerely,

Bria

It may be a central cause ie a lesion in the brain, or it may be a peripheral cause such as nerve compression or neuropathy. I would start with getting an MRI of the brain. If this does not show a potential cause, the next step is an MRI of the lumbar spine to look for herniated disc or other source of nerve compression. If the L spine MRI and brain MRI are
negative, then you may have neuropathy related so something systemic such as diabetes or renal disease. It may be also related to peripheral nerve compression such as can occur when wearing tight clothes. In these latter cases, an EMG or conduction study would prove helpful to evaluated for peripheral neuropathy.

BRIAN DECOSTA