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2019-20 Oncologic Neuroradiology Fellowship – UT MD Anderson Cancer Center

2019-20 Oncologic Neuroradiology Fellowship – UT MD Anderson Cancer Center

We are currently looking to fill our position for the Oncologic Neuroradiology Fellowship for 2019-2020 at MD Anderson Cancer Center in Houston, Texas.

For additional program information please visit: https://bit.ly/2DTiDOR

Why MD Anderson

Fellowship at a top ranked cancer center in the country for several years running.

A comprehensive program of imaging for brain, spine, head and enck tumors, with focus on advanced imaging techniques.

The Section of Neuroradiology is an integral part of the Brain and Spine Center.

The Head and Neck Surgery Department is also a premiere oncologic service that also receives national and international referral with over 60-70 new tumor patients presenting in the average week.

Diverse case material providing fellow with exposure to the full gamut of head and neck imaging from primary diagnosis to surveillance in complex post-treatment cases.

Curriculum that includes journal club, case conferences, tumor board, advanced neurologic imaging conferences, weekly lectures, and multidisciplinary conferences.

Opportunities for research/publications.

The University of Texas MD Anderson Cancer Center is an equal employment opportunity employer.

If you have a question or have questions, please contact:
 
Komal Shah, MD
Associate Professor & Oncologic Neuroradiology Fellowship Program Director
Department of Diagnostic Radiology
The University of Texas MD Anderson Cancer Center, 1400 Pressler St. – Unit 1482
Houston, Texas 77030
E-Mail: komal.shah@mdanderson.org

Interested applicants should complete application at: https://www2.mdanderson.org/sapp/discover/Default.aspx
** Application and interview required by November 1, 2018, for consideration for fellowship beginning July 1, 2019

Applicants may also email the following; CV, USMLE transcript, Personal Statement, 3 LORS to:
Melanie Gracia – Program Administrative Assistant
Phone: 713-745-0567
Email: melanie.garcia@mdanderson.org


REQUISITE QUALIFICATIONS
1) Be board eligible or certified for diagnostic radiology or its foreign equivalent, 2) Have completed an ACGME approved neuroradiology 1 year fellowship or its foreign equivalent. Alternatively, significant work experience (at least 1 year full time …

Clinical and Radiologic Characteristics of Deep Lumbosacral Dural Arteriovenous Fistulas

Fellows’ Journal Club

Twenty patients with deep lumbosacral spinal dural arteriovenous fistulas were included in this series. Cord T2 hyperintensity and contrast enhancement were present in most cases. The filum vein and/or lumbar veins were dilated in 95% of patients. Time-resolved contrast-enhanced dynamic MRA indicated a spinal DAVF at or below the L5 vertebral level in 7/8 (88%) patients who received time-resolved contrast-enhanced dynamic MRA before DSA. A bilateral arterial supply of the fistula was detected via DSA in 5 (25%) patients. The authors conclude that time-resolved contrast-enhanced dynamic MRA facilitates the detection of the drainage vein and helps to localize deep lumbosacral-located fistulas with a high sensitivity before DSA. Definite detection remains challenging and requires conventional spinal angiography.

Localizing the L5 Vertebra Using Nerve Morphology on MRI: An Accurate and Reliable Technique

Fellows’ Journal Club

The authors sought to determine whether the L5 vertebra could be accurately localized by using nerve morphology on MR imaging. A sample of 108 cases with full spine MR imaging were numbered from the C2 vertebral body to the sacrum. The reference standard of numbering by full spine imaging was compared with the nerve morphology numbering method with 5 blinded raters. The percentage of perfect agreement with the reference standard was 98.1%, which was preserved in transitional and numeric variation states. The iliolumbar ligament localization method showed 83.3% perfect agreement with the reference standard.

Analysis of 30 Spinal Angiograms Falsely Reported as Normal in 18 Patients with Subsequently Documented Spinal Vascular Malformations

Fellows’ Journal Club

Eighteen patients with 19 lesions underwent a total of 30 negative spinal angiograms. The lesions included 9 epidural arteriovenous fistulas, 8 dural arteriovenous fistulas, and 2 perimedullary arteriovenous fistulas. Seventeen patients underwent endovascular (11) or surgical (6) treatment, with a delay ranging between 1 week and 32 months; the Aminoff-Logue score improved in 76.5%. Causes of the inadequate results included: 1) lesion angiographically documented but not identified (55.6%); 2) region of interest not documented (29.6%); or 3) level investigated but injection technically inadequate (14.8%). All the angiograms falsely reported as normal were caused by correctible, operator-dependent factors.

Clinically Feasible Microstructural MRI to Quantify Cervical Spinal Cord Tissue Injury Using DTI, MT, and T2*-Weighted Imaging: Assessment of Normative Data and Reliability

Fellows’ Journal Club

Forty healthy subjects underwent T2WI, DTI, magnetization transfer, and T2*WI at 3T in <35 minutes using standard hardware and pulse sequences. Cross-sectional area, fractional anisotropy, magnetization transfer ratio, and T2*WI WM/GM signal intensity ratio were calculated. Reliable multiparametric assessment of spinal cord microstructure is possible by using clinically suitable methods. These results establish normalization procedures and pave the way for clinical studies.

Intraforaminal Location of Thoracolumbar Radicular Arteries Providing an Anterior Radiculomedullary Artery Using Flat Panel Catheter Angiotomography

Fellows’ Journal Club

Ninety-four flat panel catheter angiotomography acquisitions obtained during the selective injection of intersegmental arteries providing an anterior radiculomedullary artery were reviewed. The location of radicular arteries could be ascertained in 78/94 flat panel catheter angiotomography acquisitions. Fifty-three acquisitions (67.9%) were on the left side, and 25 (32.1%), on the right, between T2 and L3. The arteries were found in the anterosuperior quadrant in 75 cases (96.2%), in the posterosuperior quadrant in 2 (2.6%), and in the anteroinferior quadrant in 1(1.3%). Needle placement in the anterosuperior quadrant (subpedicular approach) should be avoided during transforaminal epidural steroid injection. The authors advocate the posterolateral approach that allows placing the needle tip away from the documented position of ARMA contributors within the neural foramen, reducing the risk of intra-arterial injection or injury to the spinal vascularization.

MRI Atlas-Based Measurement of Spinal Cord Injury Predicts Outcome in Acute Flaccid Myelitis

Editor’s Choice

Using the open source platform, the “Spinal Cord Toolbox,” the authors sought to correlate measures of GM, WM, and cross-sectional area pathology on T2 MR imaging with motor disability in 9 patients with acute flaccid myelitis. Proportion of GM metrics at the center axial section significantly correlated with measures of motor impairment upon admission and at 3-month follow-up. The proportion of GM extracted across the full lesion segment significantly correlated with initial motor impairment. This is the first atlas-based study to correlate clinical outcomes with segmented measures of T2 signal abnormality in the spinal cord.

Limited Dorsal Myeloschisis and Congenital Dermal Sinus: Comparison of Clinical and MR Imaging Features

Editor’s Choice

These investigators retrospectively reviewed the clinical and MR imaging findings of 12 patients with limited dorsal myeloschisis and 10 patients with congenital dermal sinus. A crater covered with pale epithelium was the most common skin lesion in limited dorsal myeloschisis (83%). Infectious complications were common in congenital dermal sinus (60%), but not found in limited dorsal myeloschisis. They show that limited dorsal myeloschisis has distinct MR imaging features including a visible intrathecal tract with dorsal tenting of the cord at the tract-cord union.

Cervical Spinal Cord DTI Is Improved by Reduced FOV with Specific Balance between the Number of Diffusion Gradient Directions and Averages

Fellows’ Journal Club

The authors evaluated multiple parameters of reduced-FOV DTI to optimize image quality. Fifteen healthy individuals underwent cervical spinal cord 3T MRI, including an anatomic 3D Multi-Echo Recombined Gradient Echo, high-resolution full-FOV DTI with a NEX of 3 and 20 diffusion gradient directions, and 5 sets of reduced-FOV DTIs differently balanced in terms of NEX/number of diffusion gradient directions. Qualitatively, reduced-FOV DTI sequences with a NEX of >5 were significantly better rated than the full-FOV DTI and the reduced-FOV DTI with low NEX (N=3) and a high number of diffusion gradient directions (D=20). Quantitatively, the best trade-off was reached by the reduced-FOV DTI with a NEX of 9 and 9 diffusion gradient directions. They conclude that the best compromise was obtained with a NEX of 9 and 9 diffusion gradient directions, which emphasizes the need for increasing the NEX at the expense of the number of diffusion gradient directions for spinal cord DTI, unlike brain imaging.

Abstract

BACKGROUND AND PURPOSE

Reduced-FOV DTI is promising for exploring the cervical spinal cord, but the optimal set of parameters needs to be clarified. We hypothesized that the number of excitations should be favored over the number of diffusion gradient directions regarding the strong orientation of the cord in a single rostrocaudal axis.

MATERIALS AND METHODS

Fifteen healthy individuals underwent cervical spinal cord MR imaging at 3T, including an anatomic 3D-Multi-Echo Recombined Gradient Echo, high-resolution full-FOV DTI with a NEX of 3 and 20 diffusion gradient directions and 5 sets of reduced-FOV DTIs differently balanced in terms of NEX/number of diffusion gradient directions: (NEX/number of diffusion gradient directions = 3/20, 5/16, 7/12, 9/9, and 12/6). Each DTI sequence lasted 4 minutes 30 seconds, an acceptable duration, to cover C1–C4 in the axial plane. Fractional anisotropy maps and tractograms were reconstructed. Qualitatively, 2

Evaluation of Focal Cervical Spinal Cord Lesions in Multiple Sclerosis: Comparison of White Matter–Suppressed T1 Inversion Recovery Sequence versus Conventional STIR and Proton Density–Weighted Turbo Spin-Echo Sequences

Fellows’ Journal Club

The authors performed a retrospective blinded analysis of cervical cord MR imaging examinations of 50 patients with MS. In each patient, 2 neuroradiologists measured the number of focal lesions and overall lesion conspicuity in the STIR/proton density–weighted TSE and WM-suppressed T1 inversion recovery sequence groups. Substantial interreader agreement was noted on the WM-suppressed T1 inversion recovery sequence compared with STIR/proton density–weighted TSE. Average lesion conspicuity was better on the WM-suppressed T1 inversion recovery sequence. Additionally, spurious lesions were more common on STIR/proton density–weighted TSE than on the WM-suppressed T1 inversion recovery sequence. They conclude that the WM-suppressed T1 inversion recovery sequence could potentially be substituted for either STIR or proton density–weighted TSE sequences in routine clinical protocols.

Abstract

BACKGROUND AND PURPOSE

Conventional MR imaging of the cervical spinal cord in MS is challenged by numerous artifacts and interreader variability in lesion counts. This study compares the relatively novel WM-suppressed T1 inversion recovery sequence with STIR and proton density–weighted TSE sequences in the evaluation of cervical cord lesions in patients with MS.

MATERIALS AND METHODS

Retrospective blinded analysis of cervical cord MR imaging examinations of 50 patients with MS was performed by 2 neuroradiologists. In each patient, the number of focal lesions and overall lesion conspicuity were measured in the STIR/proton density–weighted TSE and WM-suppressed T1 inversion recovery sequence groups. Independent side-by-side comparison was performed to categorize the discrepant lesions as either “definite” or “spurious.” Lesion contrast ratio and edge sharpness were independently calculated in each sequence.

RESULTS

Substantial interreader agreement was noted on the WM-suppressed T1 inversion recovery sequence (κ = 0.82) compared with STIR/proton density–weighted TSE (κ = 0.52). Average lesion conspicuity was better on the WM-suppressed T1 inversion recovery sequence (conspicuity of 3.1/5.0 versus 3.7/5.0, P < .01, in the WM-suppressed T1 inversion recovery sequence