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Biomedical subjects

Peter L Munk

Publications and source records attributed to Peter L Munk.

At least 19 recordsLinked to original sources
PubMed2006

Current concepts and techniques in percutaneous vertebroplasty.

Percutaneous vertebroplasty is a safe and effective alternative for the treatment of many different types of painful vertebral lesions, including osteoporotic compression fractures,hemangiomas, or malignancy-induced pathologic vertebral fractures. Medical therapy often is limited to pain control and immobilization. Because surgery is contraindicated frequently in patients who have osteoporotic compression fractures, and because patients who have widespread metastatic disease often are not surgical candidates, vertebroplasty may be the only practical option. In experienced hands and with appropriately selected patients, percutaneous vertebroplasty is a safe, inexpensive, and highly efficacious procedure; however, because of the potential for devastating complications, all efforts must be made to optimize patient safety.

Antibiotic Prophylaxis↗
PubMed2006

Image-guided corticosteroid injection of calcific tendonitis of gluteus maximus.

Gluteus maximus tendonitis with its clinical and imaging patterns has been described in radiologic, orthopedic, and rheumatology texts and journals. Image-guided treatment, however, is not a familiar approach and has only been described in one case report in the English literature to the best of our knowledge. We present 4 patients with calcific tendonitis of the gluteus maximus who presented with excruciating pain in the posterior upper thigh with limitation of daily activities. The diagnosis was based on the characteristic radiologic appearances of calcifications in the tendon with cortical bone erosion and muscle edema. Treatment was with image-guided (fluoroscopy or computed tomography) injection of a local anesthetic and corticosteroid. All patients were pain-free on follow up.

Aged↗
PubMed2006

Calcific myonecrosis: keys to recognition and management.

OBJECTIVE: Calcific myonecrosis masses can become quite large and worrisome for malignancy. The key to recognition is a combination of radiologic imaging features and remote clinical history of injury associated with compartment syndrome or vascular or neurologic compromise. CONCLUSION: This article will highlight importance of correct diagnosis by identifying the severe and devastating complications following inappropriate management.

Adult↗
PubMed2005

Management of central venous stent migration in a patient with a permanent inferior vena cava filter.

Stent embolization is a rare complication in the treatment of central venous stenoses in patients receiving long-term hemodialysis. The authors report a case of nitinol stent embolization into the right atrium in which the stent could not be repositioned across an indwelling permanent inferior vena cava (IVC) filter. The migrated stent was managed by advancing the stent to the superior margin of the IVC filter and then deploying a second suprarenal IVC filter to prevent repeat embolization.

Alloys↗
PubMed2004

Quantitative evaluation of metal artifact reduction techniques.

PURPOSE: To develop a technique to quantify artifact, and to use it to compare the effectiveness of several approaches to metal artifact reduction, including view angle tilting and increasing the slice select and image bandwidths (BWs), in terms of metal artifact reduction, noise, and blur. MATERIALS AND METHODS: Nonmetallic replicas of two metal implants (stainless steel and titanium/chromium-cobalt femoral prostheses) were fabricated from wax, and MR images were obtained of each component immersed in water. The differences between the images of each metal prosthesis and its wax counterpart were measured. The contributions from noise and blur were isolated, resulting in a measure of the metal artifact. Several off-resonance artifact reduction techniques were assessed in terms of metal artifact reduction capability, as well as signal to noise ratio and blur. RESULTS: Increasing the image BW from +/-16 kHz to +/-64 kHz was found to reduce the artifact by an average of 60%, while employing view angle tilting (VAT) alone was found to reduce the artifact by an average of 63%. The metal artifact reduction sequence (MARS), which combines several susceptibility artifact reduction techniques, resulted in the least amount of image distortion, reducing the artifact by an average of 79%. CONCLUSION: The results indicate that while VAT alone (with an image BW of +/-16 kHz) resulted in the smallest amount of total energy and no reduction in the signal-to-noise ratio compared to a conventional spin-echo pulse sequence, MARS resulted in significantly less artifact and dramatically less blur.

Artifacts↗
PubMed2003

Pelvic bone asymmetry in 323 study participants receiving abdominal CT scans.

STUDY DESIGN: Retrospective review of all CT scans of pelvis and abdomen performed at our institution in October and November 2000. OBJECTIVE: To determine the prevalence and extent of radiographic pelvic asymmetry in a population of patients not preselected for having low back pain. SUMMARY OF BACKGROUND DATA: Pelvic asymmetry refers to asymmetric positioning of landmarks on the two sides of the pelvis and may have a structural or functional etiology. Pelvic asymmetry can be associated with the presence of true leg length discrepancy, lead to false diagnosis or inaccurate measurement of leg length discrepancy, or itself be independently associated with back pain. Although the prevalence of pelvic asymmetry has been reported in patients with back pain to be 24-91%, its prevalence in the general population is not known. METHODS: A total of 323 consecutive CT scans of the pelvis/abdomen were assessed for pelvic asymmetry by one of three examiners. Pelvic asymmetry was defined as an unequal distance from the iliac crests to the acetabuli bilaterally, measured on the anteroposterior scout view of the CT scan. Measurements made on 30 randomly selected scans by the three examiners were used to assess interrater reliability of the measurement method. RESULTS: Pelvic asymmetry ranged in magnitude from -11 mm to 7 mm [right pelvis (mm) - left pelvis (mm)]. Pelvic asymmetry was >5 mm in 17 of 323 (5.3%) and >10 mm in 2 of 323 (0.6%) of the subjects; 172 of 323 (53.3%) had a smaller right hemipelvis (mean asymmetry = -3.0 mm). A total of 95 of 323 (29.4%) had a smaller left hemipelvis (mean asymmetry = 2.1 mm). The intraclass correlation coefficient [ICC(2,1)] between the three observers was high (0.91). CONCLUSION: Pelvic asymmetry of >5 mm was uncommon, with a prevalence of approximately 5% in the population studied. CT scanography was found to be a practical and reliable method for the assessment of suspected pelvic asymmetry.

Adolescent↗
PubMed2003

Fibroid in the buttock: an unexpected diagnosis.

Uterine leiomyomas (fibroids) are very common lesions with well-described imaging features. We present an unusual case of a fibroid which presented in the buttock with atypical clinical and imaging features in a woman who had had a previous hysterectomy. Despite extensive imaging and biopsies, the diagnosis was not suspected until pathological evaluation of the resected mass. The differential diagnosis for such a lesion, and the imaging and pathological features of fibroids, including atypical and parasitic leiomyomas, are discussed.

Buttocks↗
PubMed2003

Imaging features of fat necrosis.

OBJECTIVE: We describe five cases of biopsy-proven fat necrosis and review the imaging with an emphasis on MRI. CONCLUSION: MRI showed the classically reported finding of central globular high signal intensity with a low-signal-intensity rim in only two of the five cases. We noted peripheral contrast enhancement, which to our knowledge has not been reported previously, in three of our five cases. Other patterns such as amorphous, cloudlike stranding and a serpentine appearance were also encountered. In reviewing the literature, we found that the MRI appearance of fat necrosis is more varied than previously thought.

Aged↗