Diagnostic Imaging

Body Imaging
Ultrasound
Musculoskeletal
Cardiac CT/MR
Neuroradiology

Body Imaging

Body imaging physicians are radiologists specializing in the use and interpretation of cross-sectional imaging techniques to diagnose and follow disease processes of the chest, abdomen and pelvis. Using computed tomography (CT scan), ultrasound and magnetic resonance imaging (MRI), plain radiographs, and fluoroscopy, they identify neoplastic, inflammatory and traumatic lesions throughout the body. They also provide image-guided biopsies of suspicious lesions and catheter drainage of abnormal fluid collections.

Physicians

Christopher A. Boals, M.D.
Paul C. Carruth, MD
Randall Davis, MD
Andrew Dyer, MD
Hollis H. Halford, III, MD, FACR
Dale E. Hansen, Jr, MD
Ben Holman, MD
Michael A. Lemmi, M.D.
Davis D. Moser, MD, FACR
Eddie Taylor, MD

Ultrasound

MRPC Ultrasound radiologists are specialists in the use of ultrasound and noninvasive vascular assessment (NIVA) for the study of a wide range of body regions. This sophisticated cross-sectional imaging technique is used to detect disease in the abdominal and pelvic organs, thyroid, breast and other soft tissues. The exquisite sensitivity of ultrasound to flowing blood allows for the noninvasive assessment of arteries and veins throughout the body. Obstetrical ultrasound allows for the safe evaluation of the developing fetus. Ultrasound radiologists also use this imaging technique to guide biopsy and fluid aspiration procedures.

Ultrasound examination, also called diagnostic medical sonography or sonography, is an imaging method that uses high-frequency sound waves to produce precise images of structures within your body. These images often provide information that’s valuable in diagnosing and treating disease. Ultrasound may be used, among other things, to:

  • Evaluate a fetus
  • Diagnose gallbladder disease
  • Evaluate flow in blood vessels
  • Guide a needle biopsy
  • Guide the biopsy and treatment of a tumor
  • Check your thyroid gland
  • Study the heart
  • Diagnose some forms of infection
  • Diagnose some forms of cancer
  • Reveal abnormalities in the scrotum and prostate

Physicians

Paul C. Carruth, M.D.
Donald S. Emerson, M.D.

Musculoskeletal Radiology

MRPC Musculoskeletal radiologists focus on the diagnosis of traumatic, degenerative, and metabolic bone and joint disorders, as well as tumors of bone and muscle. Primarily using magnetic resonance imaging (MRI) and standard x-rays, our musculoskeletal radiologists identify subtle derangements of bones, ligaments, muscles and cartilage, aiding orthopedic surgeons in the approach and management of these patients’ conditions. Computed tomography (CT) displays fractures in superb detail, and is of great value in surgical planning. MRPC Musculoskeletal radiologists also perform arthrograms and joint injections, as well as image-guided therapeutic spine injections. Additionally, they provide a complete service for evaluating sports-related injuries and Emergency Room and Trauma cases.

Radiography has been used in the assessment of bone disease for over 100 years, and today approximately 40 % of all examinations performed in a general department of radiology relate to the musculoskeletal system. The two most prominent indications for radiographic examination are trauma and degenerative joint disease. Until approximately 20 years ago, radiologic examination of the musculoskeletal system was limited to plain film radiography. However, during the last two decades, musculoskeletal radiology has undergone a revolution as a result of the introduction and refinement of new diagnostic imaging methods, such as ultrasonography, scintigraphy, CT, and MRI.

Our Musculoskeletal services include:

Computed Tomography (CT)

  • Computed Tomography (CT) – Body
  • Computed Tomography (CT) – Spine

Magnetic Resonance Imaging (MRI)

  • Magnetic Resonance Imaging (MRI) – Body
  • Magnetic Resonance Imaging (MRI) – Musculoskeletal
  • Magnetic Resonance Imaging (MRI) – Spine

Radiography (X-ray)

  • Arthrography
  • Bone Densitometry
  • X-ray (Radiography), Bone

Ultrasound

  • Ultrasound – Musculoskeletal

Physicians
Timothy B. Donovan, M.D.
Houston Graves, MD
Kristopher C. Horne, M.D.
Salil P. Parikh, M.D.
David Sallee, M.D.
Ben Wilkerson, MD

Cardiac Imaging

A Coronary CTA is a heart-imaging test currently undergoing rapid development and evaluation for non-invasively determining whether either fatty deposits or calcium deposits have built up in the coronary arteries, which supply blood to the heart muscle. If left untreated, these areas of build-up, called plaques, can cause heart muscle disease. Heart muscle disease, in turn, can lead to fatigue, shortness of breath, chest pain and/or heart attack.

What is a Coronary CTA?
A Coronary CTA is a test which images the heart and non-invasively determines whether plaque is present in the coronary arteries. These plaques, if not treated, can grow and cause various symptoms including shortness of breath, chest pain, or a heart attack. Because Coronary CTA…

How does a Coronary CTA work?

Prior to the exam:

  • Patient should not consume caffeine 12 hours prior to the exam.
  • Patients should not take Viagra or other erectile dysfunction medications within 48 hours of the exam.

During the exam:

  • An IV will be placed in the person’s arm preferably near the elbow.
  • Blood pressure and heart rate will be checked.
  • 100 mg pill of a beta-blocker called metoprolol will be given.
  • One hour after the beta-blocker is taken, the person will be placed in the CT scanner.
  • EKG leads will be placed.
  • The person will usually need to hold their breath approximately 15-20 seconds a total of 3 times.
  • Person will also receive a squirt of nitroglycerine under the tongue during the exam.

After the exam:

  • Patient should drink plenty of fluids after the study.

Who should consider a Coronary CTA?

  • Patients with risk factors for coronary artery disease, i.e. Family Hx, Diabetes, Hypertension, Smoking, Elevated LDL, Low HDL.
  • Unusual symptoms for coronary artery disease (such as chest pain unrelated to physical exertion), but low to intermediate risk profiles for coronary artery disease.
  • Unclear or inconclusive stress-test (treadmill test results) results.

Who should not have a Coronary CTA?

  • Acute, undiagnosed classic chest pain.
  • Atrial fibrillation, bigeminy, trigeminy, high grade heart block.
  • Severe asthma.
  • Creatinine > 1.8.
  • Pacemakers, AICD/defibrillator device.
  • Allergy to Beta blockers.
  • Contrast allergy that has failed a prior premedication protocol.

What is it for?
A Coronary CTA is a heart-imaging test currently undergoing rapid development and evaluation for non-invasively determining whether either fatty deposits or calcium deposits have built up in the coronary arteries, which supply blood to the heart muscle. If left untreated, these areas of build-up, called plaques, can cause heart muscle disease. Heart muscle disease, in turn, can lead to fatigue, shortness of breath, chest pain and/or heart attack.

How does it work?
A Coronary CTA comes from a special type of X-ray examination. Patients undergoing a Coronary CTA scan receive an iodine-containing contrast dye as an IV solution to ensure the best images possible. The same IV in the arm may be used to give a medication to slow or stabilize the patient’s heart rate for better imaging results. During the examination, which usually takes about 10 minutes, X-rays pass through the body and are picked up by special detectors in the scanner. Typically, higher numbers (especially 16 or more) of these detectors result in clearer final images. For that reason, Coronary CTA often is referred to as “multi-detector” or “multi-slice” CT scanning. The information collected during the Coronary CTA examination is used to identify the coronary arteries and, if present, plaques in their walls with the creation of 3D images on a computer screen.

Click here for photos of CT angiography.

How is Coronary CTA different from other heart tests?
One of the most common heart tests is the coronary angiogram, or cardiac catheterization. This test is more invasive and requires more patient recovery time than Coronary CTA. Patients who receive coronary angiograms must have a catheter, or small transport tube, threaded into their coronary arteries, which run along the outside of the heart. The catheter typically is inserted into a blood vessel in the upper thigh and then maneuvered up to the coronary arteries. The catheter then is used to inject the iodine dye needed for the test, which uses X-rays to record “movies” of interior of the coronary arteries.

Although Coronary CTA examinations are growing in use, coronary angiograms remain the “gold standard” for detecting coronary artery stenosis, which is a significant narrowing of an artery that could require catheter-based intervention (such as stenting) or surgery (such as bypassing). On the other hand, this new technology has consistently shown the ability to rule out significant narrowing of the major coronary arteries and can non-invasively detect “soft plaque,” or fatty matter, in their walls that has not yet hardened but that may lead to future problems without lifestyle changes or medical treatment.

Who should consider Coronary CTA?
The single most important step for patients trying to determine whether they should consider a Coronary CTA is consultation with their primary physician. This is because some Coronary CTA uses are more appropriate than others, and the scan carries some risk from X-ray exposure (potential for stimulating cancer) and contrast dye exposure (allergic reactions and kidney damage). Applying careful patient selection and risk-reduction efforts, The Cleveland Clinic has successfully performed more than 13,000 clinical cardiac CT examinations over the past two-year period, many for Coronary CTA.

Overall, Coronary CTA examinations have tended to help determine a lack of significant narrowing and calcium deposits in the coronary arteries, as well as a presence of fatty deposits. This has been found to be particularly valuable in asymptomatic patients with higher risk for coronary disease, in patients with atypical symptoms but lower risk of coronary disease, or in patients with unclear stress-test results. As a result, the Center for Integrated Non-Invasive Cardiovascular Imaging at The Cleveland Clinic currently supports the careful use of Coronary CTA for patients who have:

  • Intermediate to high-risk profiles for coronary artery disease, but who do not have typical symptoms (especially chest pain, shortness of breath, or fatigue during heavy physical activity).
  • Unusual symptoms for coronary artery disease (such as chest pain unrelated to physical exertion), but low to intermediate risk profiles for coronary artery disease.
  • Unclear or inconclusive stress-test (treadmill test) results.

For these types of patients, Coronary CTA can provide important insights to their primary physician into the extent and nature of plaque formation with or without any narrowing of the coronary arteries. Coronary CTA also can non-invasively exclude narrowing of the arteries as the cause of chest discomfort and detect other possible causes of symptoms. But again, initial consultation with their primary physician is key for patients seeking to determine the appropriateness of Coronary CTA.

Who should not have Coronary CTA?
To date, Coronary CTA has not been proven as effective as the coronary angiogram in detecting disease in the smaller heart arteries that branch off the major coronary arteries. For that reason, Cleveland Clinic physicians do not consider Coronary CTA as an adequate substitute for needed coronary angiography in patients with strong evidence of narrowing of the coronary arteries. Such patients include those with a history of chest pain during heavy physical activity, a history of positive stress-test results, or a known history of coronary artery disease or heart attack. Coronary CTA also is of limited use in patients with extensive areas of old calcified, or hardened, plaque, which is often the case in older patients. Patients who are extremely overweight or who have abnormal heart rhythms also tend not to be suitable candidates for this test because imaging quality is compromised.

Physicians
F. Daniel Donovan, M.D.
Hollis H. Halford, III, M.D.

Neuroradiology

Neuroradiology is the branch of radiology dealing with the nervous system. MRPC Neuroradiologists specialize in evaluating the various disorders of the central nervous system, including the brain, head and neck regions, and spine. Primarily using the powerful cross-sectional techniques of magnetic resonance imaging (MRI) and computed tomography (CT scan), they also perform contrast myelography and image directed therapeutic injections in the spine. Angiography is used to diagnose vascular lesions of the central nervous system, which in some instances may be treated by catheter directed techniques.

Like some other areas in radiology, neuroradiology has both diagnostic and invasive branches. Interventional neuroradiology or endovascular surgical neuroradiology is a subspecialty of neuroradiology that utilizes catheter directed, minimally invasive techniques to occlude aneurysms, arteriovenous malformations and tumors in the brain, neck and spine. Endovascular catheter directed techniques can also be used to treat acute stroke with clot removing catheters and intra-arterial administration of clot dissolving medication, often reversing stroke symptoms. Arterial stenosis in the arteries of the neck and brain can be treated using stents and drug eluting stents.

The major professional association in the United States representing neuroradiologists is the American Society of Neuroradiology (ASNR).

Physicians
David Buechner, MD
William E. Routt, Jr., M.D.
Sidney D. D. Selvidge, M.D.
Christopher Somogyi, MD