Full Body Imaging

Our mantra of early disease detection and lifelong passion to perfect the ultimate full body imaging screen has lead us to an integrated triple modality approach: MRI/CT/US. We achieved this by employing a 1.5T Siemens MRI and observed hundreds of sequences on thousands of diagnostic studies accumulating a two- year period of clinical data. The highest yielding, shortest sequences have been selected to produce the most sensitive and best patient compliant, unique protocol.  The inherent shortcoming of chest MRI is addressed with multidetector CT and areas of concern are further targeted with Duplex ultrasound. Our finalized protocol promises to deliver a very comprehensive analysis of the patient’s health status. All studies are preformed on American College of Radiology Accredited units with specialty- certified technologists at our Ambulatory Care licensed center.

Fluid sensitive MRI sequences are employed for the head/ neck and entire axial skeleton in evaluation of the central nervous system.  Similar sequences are utilized for the abdomen/ pelvis in the axial and coronal planes. Sequences are modified to address specific risk factors elicited in the questionnaire. The survey is completed with helical CT of the chest.

Ultrasound is added to screen the biliary tree and the urinary tract. Additional areas of concern are further targeted with ultrasound for cyst versus solid determination. Sonographically accessible areas with suspected vascular lesions or anomalies are subjected to Duplex US. Normally, this process is accomplished in 1 hour and 45 minutes.

Acquisition is supervised by the on-site radiologist, and tailored based on the findings. The images are interpreted upon completion by a board- certified radiologist with 30 years’ experience in all three modalities. Results are discussed with the patient immediately after completion. A CD and a technical transcript of the interpretation are provided for outside consult and can be accessed online. The images are archived permanently as a baseline for future comparison.

 

A.G Dikengil, M.D Board Certified Radiologist

Pediatric Headache

While imaging patterns of gross structural intracranial abnormalities accounting for headache presentation in the pediatric patients are often conspicuous, recent literature and our daily clinical experience have directed our attention to a relatively more frequent group of overlooked and over lapping entities presenting with headaches in children.

Understanding their etiologies and recognizing their distinct MRI findings can be immensely helpful in managing these patients. We have condensed the subject to seven such etiologies with nonspecific clinical presentation yet distinct associated MRI findings to assist our team and referring physician in accurate radiological diagnosis and optimal patient management. 

DISEASE ENTITY CLINICAL PRESENTATION ETIOLOGY MRI PATTERN
Chairi I malformation short duration occipital/nuchal headaches congenital >5 mm cerebellar tonsillar descent. Complex Chiari 1.5: also brain stem descent with craniocervical junction & osseous dyplasias
Intracranial hypotension orthostatic headache improved in supine position CSF leak, over shunting cerebellar tonsillar ectopia, pachymeningeal enhancement, venous sinus distention, pituitary enlargement, brain/optic chiasm & iter descent
Idiopathic intracranial hypertension variable headaches in obese female altered CSF resorption cerebellar tonsillar ectopia. Papilledema, dilated optic nerve sheaths, empty sella
 
DISEASE ENTITY CLINICAL PRESENTATION ETIOLOGY MRI PATTERN
Vasculopathy without ischemia (moyamoya) migrainous headaches idiopathic stenosis or occlusion of terminal ICA Narrowed or occluded ICA or anterior-mid branches with collaterals at suprasellar, basal ganglia or pial collaterals
Cerebral sinovenous thrombosis headaches, seizure, motor deficits, nausea, vomiting dehydration, infection, malignancy, oral contraceptives, iron deficiency anemia, pseudotumor cerebri, prothrombotic state, chronic systemic disease intra-axial edema/hemorrhage in parasagittal cerebrum, posterotemporal lobe or thalamic distribution with segmental increase in dural sinus CT attenuation
Hemiplegic migrane Hemiparesis with migraine aura, post-ictal confusion mutation of Fe Na/K pump channels (ATP1A2) ; vasospasm/dilatation uniateral reversible edema with altered perfusion
Opthalmoplegic migraine two episodes of headache with paresis of CN III/IV/VI recurrent cranial nerve demyelination/ischemia MRI: CN III thickening and enhancement at the interpenduncular cistem responsive to steroids

I hope this helps better understand the service we offer.

 

A.G Dikengil, M.D Board Certified Radiologist

CPA masses on MRI

Two patients suffering from hearing loss, each of different etiology with similar but distinguishing MRI findings:

  1. Vestibular Schwannoma: predominant CPA cistern mass with small IAC component forming the so called “ice-cream cone” pattern.
  2. Meningioma: Also CPA cistern mass, however eccentrically straddling IAC with predominant broad base petrous dural origin.

These were captured on a 1.5T Siemens MRI unit also utilized at The Radiology Center of Lyndhurst.

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A.G Dikengil, M.D Board Certified Radiologist

Breast MRI

As we deliver positive histology from the US-guided breast biopsies we realize that early part of their subsequent management is placed in your auspices. We can continue to assist you as difficult decisions arise. . In this respect we would like to familiarize you with the current indications on preoperative breast MRI for these following positive cases:

  1. Dense breast mammographic pattern limiting tumor visibility.
  2. Invasive lobular carcinoma with propensity for multiplicity and bilaterally.
  3. Posterior position for tumor increasing risk of pectoralis and chest wall spread.
  4. Partial breast irradiation candidates.
  5. Genetic high risk (BRCA I/ BRCA II).
  6. History of mantle chest radiation.
  7. Multifocal, bilateral presentation.
  8. Metastases to axillary lymph nodes with negative mammogram and US.
  9. Positive surgical margins after first lumpectomy.
  10. Paget disease of nipple on exam without mammographic findings.
  11. Neoadjuvant chemotherapy monitoring.
  12.  Significant (>10mm) discordance of tumor size between mammogram and US.

Please retain this summary as a reference and feel free to discuss further with our radiologists.

A.G Dikengil, M.D. Board certified Radiologist