- Diagnostic Radiology
Clinical Instructor, Radiology
Board Certification: American Board of Radiology, Neuroradiology (2022)
Fellowship: Stanford University Neuroradiology Fellowship (2022) CA
Board Certification: American Board of Radiology, Diagnostic Radiology (2021)
Residency: Yale New Haven Medical Center Radiology Residency (2020) CT
Internship: Virginia Commonwealth University Internal Medicine Residency (2016) VA
Medical Education: Florida Atlantic University Registrar (2015) FL
Thoracic and Lumbosacral Spine Anatomy.
Neuroimaging clinics of North America
2022; 32 (4): 889-902
We review anatomy of the thoracic, lumbar, and sacral spine. Knowledge of normal anatomy is vital when reviewing imaging of the spine because it allows for the detection of abnormal findings. We emphasize the normal appearance of the thoracic and lumbosacral spine on imaging, focusing on the most common imaging techniques of computed tomography and magnetic resonance imaging, as well as highlighting a few less common and emerging imaging techniques that can evaluate the spine.
View details for DOI 10.1016/j.nic.2022.07.024
View details for PubMedID 36244729
Collateral Blood Flow and Ischemic Core Growth.
Translational stroke research
Treatment of a large vessel occlusion in the acute ischemic stroke setting focuses on vessel recanalization, and endovascular thrombectomy results in favorable outcomes in appropriate candidates. Expeditious treatment is imperative, but patients often present to institutions that do not have neurointerventional surgeons and need to be transferred to a comprehensive stroke center. These treatment delays are common, and it is important to identify factors that mitigate the progression of the ischemic core in order to maximize the preservation of salvageable brain tissue. Collateral blood flow is the strongest factor known to influence ischemic core growth, which includes the input arterial vessels, tissue-level vessels, and venous outflow. Collateral blood flow at these different levels may be imaged by specific imaging techniques that may also predict ischemic core growth during treatment delays and help identify patients who would benefit from transfer and endovascular therapy, as well as identify those patients in whom transfer may be futile. Here we review collateral blood flow and its relationship to ischemic core growth in stroke patients.
View details for DOI 10.1007/s12975-022-01051-2
View details for PubMedID 35699917
A Case of Spinal Infectious Osteomyelitis Versus Gout: Advanced Imaging with Dual Energy CT
YALE JOURNAL OF BIOLOGY AND MEDICINE
2021; 94 (4): 599-602
View details for Web of Science ID 000740789900009
Utility of routine follow-up imaging in patients with small paraflacine and/or paratentorial hemorrhages.
Clinical neurology and neurosurgery
2020; 196: 105956
Imaging follow-up for acute intracranial hemorrhage has followed the same protocols despite differences in clinical progression and outcome associated with bleed in different compartments. We evaluated isolated, small parafalcine and paratentorial subdural hemorrhages to determine the necessity of routine imaging follow up.We conducted a retrospective review of all patients presenting to the Emergency Department who were found to have an isolated parafalcine and/or paratentorial subdural hemorrhage, and obtained follow up imaging over the course of 3 years. Subsequent imaging was reviewed to assess for changes in hemorrhage size and the average number of studies performed; clinical data was reviewed for changes in patient status and any intervention if performed.95 patients were identified with isolated parafalcine and/or paratentorial hemorrhage that were evaluated with multiple follow-up imaging studies. The average initial subdural hemorrhage thickness was 3.5 mm, with all smaller than 1 cm. The average number of subsequent imaging studies performed was 2.7. All patients received follow up imaging despite remaining neurologically stable. 96 % of the patients had stable to decreased size off hemorrhage on follow up exams. The remaining 4% had a slight increase on the second imaging study but, stabilized without any intervention. Anticoagulation use had no correlation with increase on subsequent imaging.Small isolated parafalcine and/or paratentorial hemorrhage in a neurologically stable patient and absence of anticoagulation does not require scheduled routine follow-up imaging.
View details for DOI 10.1016/j.clineuro.2020.105956
View details for PubMedID 32526488
A Rare Case of a Pediatric Medullary Intracranial Germinoma.
2020; 138: 137-140
Germinomas are rare intracranial lesions, with medulla germinomas being reported in only approximately 20 cases to date. These tumors are extremely sensitive to radiotherapy, and knowledge of them can allow for accurate diagnosis as well as significantly impact treatment and prognosis.We present a case of medullary germinoma and review the cases previously reported in the literature.A few imaging characteristics are noted in multiple cases, such as cystic components, enhancement, and absence of hydrocephalus. These features can provide clues to diagnosis of this rare entity.
View details for DOI 10.1016/j.wneu.2020.02.147
View details for PubMedID 32147555
- Rare Case of Bilateral Orbital Masses. JAMA ophthalmology 2019; 137 (9): 1074-1075
Screening for Intracranial Aneurysms in Patients with Thoracic Aortic Aneurysms.
Cerebrovascular diseases (Basel, Switzerland)
2019; 47 (5-6): 253-259
A higher prevalence of intracranial aneurysms (IAs) has been previously reported by retrospective studies in patients with thoracic aortic aneurysms (TAAs). The goal of this study was to evaluate the prevalence of IAs in a large cohort of prospectively screened patients with TAAs and identify potential risk factors.Patients above 18 years with TAAs who were prospectively screened for IAs using computed tomographic angiogram/magnetic resonance angiogram over a 9-year period were included in the study. Patient demographics, comorbidities, aortic, and IA locations and sizes were analyzed. Univariate analysis was performed with the χ2 test for categorical variables and the Student t test or ANOVA for continuous variables.Five hundred and fifty-four patients with TAAs were prospectively screened for IAs and included in the study. Thirty-one IAs were identified in 27 patients (prevalence = 4.9%). The prevalence of IAs in patients with ascending TAAs was 4.51% and in descending TAAs was 9.09%. Twenty out of 31 IAs were 2 mm in size, 6/31 were 3 mm, and 5/31 were 4 mm in size. Hypertension was associated with an increased prevalence of IAs, especially in patients with descending TAAs.The prevalence of IAs in patients with TAAs may not be as high as described in previous retrospective studies. Our results suggest that the prevalence of IAs in patients with TAAs is similar to the general population. Study results reveal that IAs have a higher correlation to patients with descending TAAs, although not statistically significant. Hypertension was found to be a statistically significant risk factor for IAs in patients with TAAs.
View details for DOI 10.1159/000501194
View details for PubMedID 31412341
Patterns of Superficial Midfacial Fat Volume Distribution Differ by Age and Body Mass Index.
Aesthetic plastic surgery
2019; 43 (1): 83-90
The changes that occur to midfacial fat with increasing age and BMI are poorly understood. The aim of this study was to determine how superficial cheek fat volume and distribution are differentially predicted by changes in BMI versus age.We conducted a retrospective observational study of patients with facial computed tomography scans. Superficial cheek fat volumes were measured, and multiple linear regression analysis was performed to model the relationships between cheek fat and corresponding sex, age, and BMI data.A total of 109 patients were included in our analysis (51 male, 58 female). The subjects' ages ranged from 21.7 to 91.1 years with a mean (SD) age of 59.7 (15.0) years. The mean (SD) superficial cheek volume of the subjects was 10.46 (2.57) cc. Female subjects had a significantly greater mean total superficial cheek fat volume compared to male subjects (11.18 cc vs. 9.64 cc; P < 0.001). The results of multiple linear regression analysis indicated that together, age, sex, and BMI explained 50.8% of the variance in cheek fat volumes (R2 = 0.51, P < 0.001). BMI significantly predicted total cheek fat volume (β = 0.239, P < 0.001), in addition to age (β = 0.029, P < 0.017) and sex (β = - 1.183, P = 0.001; female = 0, male = 1). Age predicted the greatest gain of fat in the caudal subdivision of cheek (β = 0.015, P < 0.001), whereas BMI predicted the greatest gain in the cephalad subdivision (β = 0.106, P < 0.001).Age, sex, and BMI are important predictors of midfacial fat volume. This study shows that increases in age and BMI differentially predict the distribution of superficial cheek fat.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
View details for DOI 10.1007/s00266-018-1249-0
View details for PubMedID 30283987
- Unusual case of recurrent otitis JOURNAL OF CLINICAL NEUROSCIENCE 2018; 54: 119-121
Longitudinal Analysis of Superficial Midfacial Fat Volumes Over a 10-Year Period.
Aesthetic plastic surgery
2018; 42 (4): 995-1001
Volumetric changes to facial fat that occur with aging remain poorly understood. The aim of this study was to evaluate for longitudinal changes to midfacial fat volumes in a group of individuals.We conducted a retrospective longitudinal study of adult subjects who underwent multiple facial computed tomographic (CT) scans timed at least 8 years apart. Subjects who underwent facial surgery or suffered facial trauma were excluded. Facial CT scans were analyzed, and superficial cheek fat volumes were measured and compared to track changes that occurred with aging.Fourteen subjects were included in our analysis of facial aging (5 male, 9 female; mean initial age 50.9 years; mean final age 60.4 years). In the right superficial cheek there was an increase in mean (SD) superficial fat volume from 10.33 (2.01) to 10.50 (1.80) cc, which was not statistically significant (P = 0.75). Similar results were observed in the left cheek. There were no statistically significant longitudinal changes to caudal, middle, or cephalad subdivisions of bilateral superficial cheek fat. A simple linear regression was performed to predict superficial cheek fat pad volume based on age which did not reach statistical significance (P = 0.31), with an R2 of 0.039.This study is the first to quantitatively assess for longitudinal changes to midfacial fat in a group of individuals. Superficial cheek fat remained stable as subjects aged from approximately 50 to 60 years old, with no change in total volume or redistribution within a radiographically defined compartment.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
View details for DOI 10.1007/s00266-018-1134-x
View details for PubMedID 29644417
The impact of DaTscan on the diagnosis and management of movement disorders: A retrospective study.
American journal of neurodegenerative disease
2013; 2 (1): 29-34
The diagnosis of Parkinson's disease remains a challenge in patients who have abnormal symptoms or show a lack of response to medication. The imaging technique, DaTscan, can be used to visualize dopamine degeneration in the nigro-striatum, which is associated with Parkinsonian Syndrome. We examined the use of the DaTscan in diagnosis, confidence in diagnosis, and clinical management.Physicians of 125 patients were contacted to fill out a brief survey about changes in diagnosis, confidence of diagnosis, and clinical management after assessment with the DaTscan.There was an overall increase in confidence of diagnosis with the results of the DaTscan. Physicians also stated that the DaTscan impacted their diagnosis in 68% of the patients, as well as an impact in the clinical management of 58% of the patients.The DaTsan can be used as a tool to help diagnose Parkinsonian Syndrome in patients with unclear symptoms.
View details for PubMedID 23515233
View details for PubMedCentralID PMC3601468
Sex and estrous cycle differences in the behavioral effects of high-strength static magnetic fields: role of ovarian steroids.
American journal of physiology. Regulatory, integrative and comparative physiology
2006; 290 (3): R659-67
Advances in magnetic resonance imaging are driving the development of higher-resolution machines equipped with high-strength static magnetic fields (MFs). The behavioral effects of high-strength MFs are largely uncharacterized, although in male rats, exposure to 7 T or above induces locomotor circling and leads to a conditioned taste avoidance (CTA) if paired with a novel taste. Here, the effects of MFs on male and female rats were compared to determine whether there are sex differences in behavioral responses and whether these can be explained by ovarian steroid status. Rats were given 10-min access to a novel saccharin solution and then restrained within a 14-T magnet for 30 min. Locomotor activity after exposure was scored for circling and rearing. CTA extinction was measured with two-bottle preference tests. In experiment 1, males were compared with females across the estrous cycle after a single MF exposure. Females circled more and acquired a more persistent CTA than males; circling was highest on the day of estrus. In experiment 2, the effects of three MF exposures were compared among intact rats, ovariectomized females, and ovariectomized females with steroid replacement. Compared with intact rats, ovariectomy increased circling; estrogen replacement blocked the increase. Males acquired a stronger initial CTA but extinguished faster than intact or ovariectomized females. Thus the locomotor circling induced by MF exposure was increased in females and modulated by ovarian steroids across the estrous cycle and by hormone replacement. Furthermore, female rats acquired a more persistent CTA than male rats, which was not dependent on estrous phase or endogenous ovarian steroids.
View details for DOI 10.1152/ajpregu.00305.2005
View details for PubMedID 16223851