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Article ; Online: Cardiothoracic Magnetic Resonance Angiography.

Kocaoglu, Murat / Pednekar, Amol / Fleck, Robert J / Dillman, Jonathan R

Current problems in diagnostic radiology

2023 Volume 53, Issue 1, Page(s) 154–165

Abstract: Catheter-based angiography is regarded as the clinical reference imaging technique for vessel imaging; however, it is invasive and is currently used for intervention or physiologic measurements. Contrast enhanced magnetic resonance angiography (MRA) with ...

Abstract	Catheter-based angiography is regarded as the clinical reference imaging technique for vessel imaging; however, it is invasive and is currently used for intervention or physiologic measurements. Contrast enhanced magnetic resonance angiography (MRA) with gadolinium-based contrast agents can be performed as a three-dimensional (3D) MRA or as a time resolved 3D (4D) MRA without physiologic synchronization, in which case cardiac and respiratory motion may blur the edges of the vessels and cardiac chambers. Ferumoxytol has recently been a popular contrast agent for MRA in patients with chronic renal failure. Noncontrast 3D MRA with ECG gating and respiratory navigation are safe and accurate noninvasive cross-sectional imaging techniques for the visualization of great vessels of the heart and coronary arteries in a variety of cardiovascular disorders including complex congenital heart diseases. Noncontrast flow dependent MRA techniques such as time of flight, phase contrast, and black-blood MRA techniques can be used as complementary or primary techniques. Here we review both conventional and relatively new contrast enhanced and non-contrast enhanced MRA techniques including ferumoxytol enhanced MRA, and bright-blood and water-fat separation based noncontrast 3D MRA techniques.
MeSH term(s)	Humans ; Magnetic Resonance Angiography/methods ; Ferrosoferric Oxide ; Contrast Media ; Heart ; Magnetic Resonance Imaging ; Imaging, Three-Dimensional/methods
Chemical Substances	Ferrosoferric Oxide (XM0M87F357) ; Contrast Media
Language	English
Publishing date	2023-10-21
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	198954-6
ISSN	1535-6302 ; 0363-0188
ISSN (online)	1535-6302
ISSN	0363-0188
DOI	10.1067/j.cpradiol.2023.10.001
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Article ; Online: Extracardiac Findings on Cardiac Magnetic Resonance: A Children's Hospital Experience.

Trussell, Taylor M / Kocaoglu, Murat / Fleck, Robert J / Taylor, Michael D / Zang, Huaiyu / Ollberding, Nicholas J / Lang, Sean M

Pediatric cardiology

2023 Volume 44, Issue 6, Page(s) 1201–1208

Abstract: Cardiac magnetic resonance (CMR) incorporates a field of view that has the potential to capture clinically relevant extracardiac findings (ECF); however, there has been minimal investigation of ECF prevalence in children's hospitals, where the patient ... ...

Abstract	Cardiac magnetic resonance (CMR) incorporates a field of view that has the potential to capture clinically relevant extracardiac findings (ECF); however, there has been minimal investigation of ECF prevalence in children's hospitals, where the patient population varies in age and diagnosis. We retrospectively reviewed consecutive, clinically indicated, CMR studies performed at a tertiary care children's hospital during a 1-year period from January 1 to December 31, 2019. ECFs were classified as significant or non-significant based on whether they were described in the final impression of the CMR report. A total of 851 distinct patients had a CMR study during the 1-year period. Mean age was 19.5 (range 0.2; 74.2) years. A total of 254 ECFs were present in 158 of the 851 studies (18.6%) with 9.8% of all studies having significant ECFs. A total of 40.2% of ECFs were previously unknown and 9.1% (23/254) of ECFs included further recommendations (2.1% of all studies). ECFs were most often found in the chest (48%) or abdomen/pelvis (46%). Three patients were incidentally found to have malignancy (renal cell, thyroid, and hepatocellular carcinoma). Comparing studies with significant ECFs to the group without, CMR indications for biventricular CHD (43% vs 31%, p = 0.036), single ventricle CHD (12% vs 3.9%, p = 0.002), and aortopathy/vasculopathy (16% vs 7.6%, p = 0.020) were more common. The odds of significant ECF increased with increasing age (OR 1.82, 95% CI 1.10-3.01) and increased most notably between ages 14 to 33 years old. Recognition of the high percentage of ECFs remains important for timely diagnosis of these incidental findings.
MeSH term(s)	Humans ; Child ; Young Adult ; Adult ; Infant ; Retrospective Studies ; Heart ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Hospitals
Language	English
Publishing date	2023-05-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	800857-7
ISSN	1432-1971 ; 0172-0643
ISSN (online)	1432-1971
ISSN	0172-0643
DOI	10.1007/s00246-023-03190-1
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Article ; Online: Virtual Bronchoscopy of Neonatal Airway Malacia via High-Resolution, Respiratory-gated Magnetic Resonance Imaging.

Higano, Nara S / Gandhi, Deep B / Xiao, Qiwei / Gunatilaka, Chamindu C / Hysinger, Erik B / Fleck, Robert J / Woods, Jason C / Bates, Alister J

American journal of respiratory and critical care medicine

2022 Volume 206, Issue 5, Page(s) e42–e43

MeSH term(s)	Bronchial Diseases ; Bronchoscopy/methods ; Humans ; Infant, Newborn ; Magnetic Resonance Imaging/methods ; Respiratory System ; Tracheal Diseases
Language	English
Publishing date	2022-06-02
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	1180953-x
ISSN	1535-4970 ; 0003-0805 ; 1073-449X
ISSN (online)	1535-4970
ISSN	0003-0805 ; 1073-449X
DOI	10.1164/rccm.202202-0362IM
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Article ; Online: Bronchopulmonary dysplasia from chest radiographs to magnetic resonance imaging and computed tomography: adding value.

Higano, Nara S / Bates, Alister J / Gunatilaka, Chamindu C / Hysinger, Erik B / Critser, Paul J / Hirsch, Russel / Woods, Jason C / Fleck, Robert J

Pediatric radiology

2022 Volume 52, Issue 4, Page(s) 643–660

Abstract: Bronchopulmonary dysplasia (BPD) is a common long-term complication of preterm birth. The chest radiograph appearance and survivability have evolved since the first description of BPD in 1967 because of improved ventilation and clinical strategies and ... ...

Abstract	Bronchopulmonary dysplasia (BPD) is a common long-term complication of preterm birth. The chest radiograph appearance and survivability have evolved since the first description of BPD in 1967 because of improved ventilation and clinical strategies and the introduction of surfactant in the early 1990s. Contemporary imaging care is evolving with the recognition that comorbidities of tracheobronchomalacia and pulmonary hypertension have a great influence on outcomes and can be noninvasively evaluated with CT and MRI techniques, which provide a detailed evaluation of the lungs, trachea and to a lesser degree the heart. However, echocardiography remains the primary modality to evaluate and screen for pulmonary hypertension. This review is intended to highlight the important findings that chest radiograph, CT and MRI can contribute to precision diagnosis, phenotyping and prognosis resulting in optimal management and therapeutics.
MeSH term(s)	Bronchopulmonary Dysplasia/diagnostic imaging ; Female ; Humans ; Hypertension, Pulmonary ; Infant, Newborn ; Magnetic Resonance Imaging/adverse effects ; Pregnancy ; Premature Birth ; Tomography, X-Ray Computed/adverse effects
Language	English
Publishing date	2022-02-05
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	124459-0
ISSN	1432-1998 ; 0301-0449
ISSN (online)	1432-1998
ISSN	0301-0449
DOI	10.1007/s00247-021-05250-1
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Article ; Online: Correction to: Bronchopulmonary dysplasia from chest radiographs to magnetic resonance imaging and computed tomography: adding value.

Higano, Nara S / Bates, Alister J / Gunatilaka, Chamindu C / Hysinger, Erik B / Critser, Paul J / Hirsch, Russel / Woods, Jason C / Fleck, Robert J

Pediatric radiology

2022 Volume 52, Issue 12, Page(s) 2442

Language	English
Publishing date	2022-09-07
Publishing country	Germany
Document type	Published Erratum
ZDB-ID	124459-0
ISSN	1432-1998 ; 0301-0449
ISSN (online)	1432-1998
ISSN	0301-0449
DOI	10.1007/s00247-022-05490-9
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Article ; Online: Seeing sleep: dynamic imaging of upper airway collapse and collapsibility in children.

Nayak, Khrishna S / Fleck, Robert J

IEEE pulse

2014 Volume 5, Issue 5, Page(s) 40–44

Abstract: Sleep disordered breathing in children ranges from snoring, which has a prevalence of 12%, to obstructive sleep apnea (OSA) syndrome, which has a prevalence of 2?3% in the general population [1]. The underlying causes of pediatric OSA are extremely ... ...

Abstract	Sleep disordered breathing in children ranges from snoring, which has a prevalence of 12%, to obstructive sleep apnea (OSA) syndrome, which has a prevalence of 2?3% in the general population [1]. The underlying causes of pediatric OSA are extremely complex. There are bony structural influences, as seen in craniofacial abnormalities, and soft tissue abnormalities, such as a large tongue, redundant soft tissue, or compliance/collapsibility issues. In some groups, such as those with Down syndrome, a combination of these factors comes into play.
MeSH term(s)	Adolescent ; Child ; Female ; Humans ; Imaging, Three-Dimensional/methods ; Magnetic Resonance Imaging/methods ; Male ; Mouth/pathology ; Mouth/physiopathology ; Pharynx/pathology ; Pharynx/physiopathology ; Respiration ; Sleep Apnea Syndromes/diagnosis ; Sleep Apnea Syndromes/pathology ; Sleep Apnea Syndromes/physiopathology
Language	English
Publishing date	2014-09-29
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2567191-1
ISSN	2154-2317 ; 2154-2287
ISSN (online)	2154-2317
ISSN	2154-2287
DOI	10.1109/MPUL.2014.2339398
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Zs.A 6869: Show issues

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Article: Characterization of Auricular Growth within the Pediatric Population Using Computed Tomography Scan Measurements.

Leto Barone, Angelo A / Farley, Gabrielle / Vieira Alves, Vinicius P / Bredemeier, Nina O / Hogan, Elise / Madzia, Jules / Woodyard, Kiersten / Schwentker, Ann R / Fleck, Robert J

Plastic and reconstructive surgery. Global open

2023 Volume 11, Issue 8, Page(s) e5210

Abstract: Background: In patients with microtia, auricular reconstruction is ideally performed promptly to prevent impaired socialization during formative childhood years. The earliest viable age for reconstruction is widely accepted from 7-10 years of age, as ... ...

Abstract	Background: In patients with microtia, auricular reconstruction is ideally performed promptly to prevent impaired socialization during formative childhood years. The earliest viable age for reconstruction is widely accepted from 7-10 years of age, as full auricular size is achieved around age 8, with some variability dependent on sex. This retrospective study aims to provide an auricular growth curve that accounts for age and sex, enhancing the individualized approach to ear reconstruction. Methods: A total of 319 images of unaffected patients who underwent computed tomography angiography of the head and neck were reviewed, with bilateral cartilage height and width measured according to a consensus-standardized image measurement protocol. Means and SDs of cartilage height and width were calculated for both sexes, and analysis of ear growth was performed through plotting the mean cartilage height, width, and width:height ratio over time. Results: Cartilage height and width differed significantly between male and female groups. Maximum cartilage height was reached at age 11 for female and at age 12 for male patients, whereas maximum cartilage width was reached at ages 10 and 8, respectively. On average, the width:height ratio for female group was 0.58. For male group, the average width:height ratio was 0.59. Conclusions: An auricular growth map was designed using computed tomography measurements demonstrating maximum auricular size at age 11 and 12 respectively for female and male patients, with both sexes having a width:height ratio maintained at approximately 0.6 throughout growth.
Language	English
Publishing date	2023-08-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	2851682-5
ISSN	2169-7574 ; 2169-7574
ISSN (online)	2169-7574
ISSN	2169-7574
DOI	10.1097/GOX.0000000000005210
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Zs.A 7091: Show issues

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Article ; Online: Using T1 mapping in cardiovascular magnetic resonance to assess congestive hepatopathy.

Kazour, Isabel / Serai, Suraj D / Xanthakos, Stavra A / Fleck, Robert J

Abdominal radiology (New York)

2018 Volume 43, Issue 10, Page(s) 2679–2685

Abstract: The goal of this study was to assess the ability of quantitative T1 cardiovascular magnetic resonance (CMR) imaging to calculate liver extracellular volume (ECV) in patients with varying degrees of congestive hepatopathy (CH). T1 measurements and ECV ... ...

Abstract	The goal of this study was to assess the ability of quantitative T1 cardiovascular magnetic resonance (CMR) imaging to calculate liver extracellular volume (ECV) in patients with varying degrees of congestive hepatopathy (CH). T1 measurements and ECV calculations were performed retrospectively in three cohorts of patients: normal cardiac function, tetralogy of fallot (TOF) repair and Fontan palliation. All CMR studies included modified look-locker inversion recovery (MOLLI) T1 mapping scans performed pre- and post-injection of a gadolinium-based contrast agent (GBCA). Pixel intensity data were manually collected from images of the liver and cardiac blood pool to determine contrast-induced changes in T1 for liver and blood. These data were then used to compute liver ECV. 172 subjects were included in the study. Of these, 140 subjects were normal cardiac function patients, 16 were TOF repair patients and 16 patients were with Fontan palliation. A statistically significant difference in both the liver native T1 and ECV measurements was found between patients with normal cardiac function vs. Fontan palliation patients (p < 0.01). Our data indicate that measuring T1 maps both pre- and post-GBCA injection within CMR scan session can be used to follow progression of liver fibrosis. This technique has the potential to improve diagnosis and treatment of patients with chronic liver disease and liver fibrosis.
MeSH term(s)	Adolescent ; Adult ; Child ; Child, Preschool ; Contrast Media ; Disease Progression ; Female ; Heart Diseases/complications ; Heart Diseases/surgery ; Humans ; Image Interpretation, Computer-Assisted ; Infant ; Infant, Newborn ; Liver Diseases/diagnostic imaging ; Liver Diseases/etiology ; Magnetic Resonance Imaging/methods ; Male ; Retrospective Studies
Chemical Substances	Contrast Media
Language	English
Publishing date	2018-02-27
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2839786-1
ISSN	2366-0058 ; 2366-004X
ISSN (online)	2366-0058
ISSN	2366-004X
DOI	10.1007/s00261-018-1528-x
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Zs.A 1262: Show issues

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Article ; Online: Outcomes of dexmedetomidine sedation for drug-induced sleep ciné magnetic resonance imaging studies in pediatric obstructive sleep apnea patients.

Narayanasamy, Suryakumar / Winograd-Gomez, Vera / Joshi, Hem / Yang, Fang / Ding, Lili / Ishman, Stacey L / Fleck, Robert J / Patino, Mario / Mahmoud, Mohamed

Paediatric anaesthesia

2021 Volume 31, Issue 11, Page(s) 1241–1249

Abstract: Background: Dexmedetomidine is utilized as a sedative agent for drug-induced sleep cine magnetic resonance imaging studies due to its ability to mimic natural sleep and lack of respiratory depressant effects. The outcomes of dexmedetomidine sedation ... ...

Abstract	Background: Dexmedetomidine is utilized as a sedative agent for drug-induced sleep cine magnetic resonance imaging studies due to its ability to mimic natural sleep and lack of respiratory depressant effects. The outcomes of dexmedetomidine sedation such as respiratory complications and unplanned admissions in obstructive sleep apnea patients undergoing these studies are currently unknown. Aim: To describe the outcomes of dexmedetomidine sedation for outpatient drug-induced sleep magnetic resonance imaging in pediatric patients with obstructive sleep apnea. Methods: This is a retrospective chart review conducted in pediatric patients with obstructive sleep apnea undergoing outpatient drug-induced sleep ciné magnetic resonance imaging studies with dexmedetomidine sedation. Demographics, comorbidities, polysomnography study results, vital signs, respiratory complications, airway interventions, successful completion of the scan, and unplanned hospital admissions were measured. Main results: We analyzed 337 patients aged 2-18 years (median age of 11 years). The imaging was completed with dexmedetomidine as the sole sedative agent in 61% (N = 207) patients. Ketamine was administered as additional sedative agent in 36% (N = 122) of the patients. There was no difference in sedation-related adverse events and respiratory complications with regard to the severity of sleep apnea with the exception of mild desaturation episodes (SpO2 85%-90%). Patients who received additional sedative agents had significantly longer recovery room stay (71.5 [44] vs 55 [39] minutes; 95% CI of difference [9 to 23 min], p < 0.001) and total periprocedural stay (164.5 [52] vs 138 [64] minutes; 95% CI of difference [17 to 35 min], p < .001). Conclusions: Dexmedetomidine alone or along with ketamine provided acceptable sedation in majority of the patients with obstructive sleep apnea undergoing outpatient diagnostic sleep magnetic resonance imaging studies without significant respiratory adverse events regardless of the severity of sleep apnea. Sedation failure and unplanned admissions are rare, and routine planned admission may not be required for this patient population.
MeSH term(s)	Child ; Dexmedetomidine/adverse effects ; Humans ; Hypnotics and Sedatives/adverse effects ; Magnetic Resonance Imaging ; Magnetic Resonance Imaging, Cine ; Pharmaceutical Preparations ; Polysomnography ; Retrospective Studies ; Sleep ; Sleep Apnea, Obstructive
Chemical Substances	Hypnotics and Sedatives ; Pharmaceutical Preparations ; Dexmedetomidine (67VB76HONO)
Language	English
Publishing date	2021-09-12
Publishing country	France
Document type	Journal Article
ZDB-ID	1086049-6
ISSN	1460-9592 ; 1155-5645
ISSN (online)	1460-9592
ISSN	1155-5645
DOI	10.1111/pan.14290
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Article ; Online: Ventilatory limitations are not associated with dyspnea on exertion or reduced aerobic fitness in pectus excavatum.

Hardie, William / Powell, Adam W / Jenkins, Todd M / Foster, Karla / Tretter, Justin T / Fleck, Robert J / Garcia, Victor F / Brown, Rebeccah L

Pediatric pulmonology

2021 Volume 56, Issue 9, Page(s) 2911–2917

Abstract: Exercise intolerance and chest pain are common symptoms in patients with pectus excavatum. To assess if the anatomic extent of pectus deformities determined by the correction index (CI) is associated with a pulmonary impairment at rest and during ... ...

Abstract	Exercise intolerance and chest pain are common symptoms in patients with pectus excavatum. To assess if the anatomic extent of pectus deformities determined by the correction index (CI) is associated with a pulmonary impairment at rest and during exercise we performed a retrospective review on pectus patients in our center who completed a symptom questionnaire, cardiopulmonary exercise test (CPET), pulmonary function tests (PFT), and chest magnetic resonance imaging. Of 259 patients studied, dyspnea on exertion and chest pain was reported in 64% and 41%, respectively. Peak oxygen uptake (VO
MeSH term(s)	Dyspnea/etiology ; Exercise Test ; Exercise Tolerance ; Funnel Chest/diagnostic imaging ; Humans ; Physical Exertion ; Retrospective Studies
Language	English
Publishing date	2021-06-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	632784-9
ISSN	1099-0496 ; 8755-6863
ISSN (online)	1099-0496
ISSN	8755-6863
DOI	10.1002/ppul.25540
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