NYU Imaging / Interventions

The NYU Langone Department of Radiology is consistently innovating in order to provide new and unique imaging services and interventions that will improve patient care. The following are just some of our most recent advances:

Neuroradiology

Brain Mapping Service
Timothy Shepherd, M.D./Ph.D.,

NYU Neuroradiology has recently implemented advanced clinical imaging protocols that use diffusion tensor imaging (“DTI”) and functional magnetic resonance imaging (“fMRI”) to create brain maps of eloquent cortex and important white matter pathways.

This service collaborates closely with neurosurgeons, neurologists, psychiatrists and psychologists at NYU to provide MRI protocols that improve pre-surgical planning in patients with brain tumors, epilepsy or movement disorders.

Brain mapping can help NYU neurosurgeons to:

- avoid eloquent cortex and important white matter pathways
- improve the chances of a gross total resection of a patient’s brain tumor
- reduce the need or amount of time required for intra-operative mapping
- reduce the need for invasive tests to lateralize brain function in epilepsy patients
- improve accuracy of anatomic targeting in patients undergoing functional neurosurgery for movement disorders

The NYU Brain Mapping Service also has several important ongoing translational research projects to further improve the diagnosis and treatment of patients with neurologic disease. These include efforts to develop and implement cutting-edge tractography methods, resting state fMRI brain mapping and multiband MRI acquisition strategies in clinical patients.

Example of diffusion tractography of the left corticospinal tract. NYU radiology researchers are testing innovative methods to improve detection of the lateral corticospinal and corticobulbar fibers that are typically obscured by the arcuate fasciculus with conventional tractography methods.

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FMRI of semantic decision task demonstrates “receptive” language areas immediately lateral to a cavernoma in the left posterior insula

MR Concussion Imaging
Yvonne Lui, MD
Section Chief of Neuroradiology

NYU Neuroradiology supports research across the spectrum of neuroimaging including CNS tumor genomics, Multiple Sclerosis, Pituitary dynamic perfusion, CSF flow dynamics, Dementia, MR microscopy, PET/MRI applications and Concussion. We participate in collaborative research projects across the medical center. Our research on concussion is led by Yvonne W. Lui MD, Section Chief of Neuroradiology, and uses MR imaging techniques to improve our understanding of injury after head trauma with the ultimate goal of improving patient diagnosis and treatment. Concussion is a highly prevalent injury that is under-reported and can lead to substantial disability. Much remains unknown about this disease and uncovering the neurobiology of this disorder will pave the way for accurate diagnosis, early patient stratification and the development of targeted therapy. Here at NYU, we have a multidisciplinary translational research team composed of neuroimagers, physicists, neuropsychologist and clinical collaborators from the Departments of Emergency Medicine, Neurology and Rehabilitation. Our research is supported by the National Institute of Health, Neurological Institute for Neurological Disorders and Stroke. Our work has been published widely in the scientific literature as well as cited in the media.

A, Default Mode Network of connectivity in 18 healthy controls. B, 23 patients with mild traumatic brain injury. C, Differences comparing MTBI to control groups. Red = increased functional connectivity, Blue = decreased functional connectivity in patients compared with control subjects.

Co-registered data (from 28 patients with MTBI) projected onto medial and lateral projects of the right cerebral hemisphere template show areas of significant regional brain volume loss (Bonferroni-corrected P < .05) at 1-year follow-up.

Musculoskeletal Radiology

MR Metal imaging
Leon Rybak, MD

In the Section of Musculoskeletal Imaging at NYULMC, we are actively engaged in research dedicated to the evaluation of pathology in patients with metallic implants. For many years, imaging in patients with such implants has been limited to plain radiography and nuclear imaging with incomplete evaluation of the soft tissue structures surrounding the metallic implant. Recent advances in the design of certain implants have led, in some instances, to a unique set of complications, many of which affect predominantly the joint capsule and surrounding musculotendinous structures. MRI, though capable of exquisite delineation of osseous and soft tissue anatomy, is subject to extensive artifact and distortion in proximity to metallic implants. This can make evaluation of complications related to these implants difficult, if not impossible, in some cases.

To a degree, this artifact can be reduced by applying certain principles of physics to the standard imaging sequences already employed at most centers. At NYU, we are working to perfect these modifications, as well as collaborating with Siemens in regards to the use of a novel imaging sequence developed by their physicists called SEMAC. Utilizing a combination of these various techniques, we have arrived at what we believe to be the most comprehensive examination possible in the presence of large metallic implants. This has made it possible for our surgeons to get valuable information which can help determine the need for surgical intervention and provide pre-operative planning which can aid in the reduction of operating room time and complication rates.

We are continually working on optimization of these techniques and are actively engaged in review of early results as they correlate with findings at surgery. We hope, by this process, to improve both the quality of the imaging as well as reduce scan times and increase patient comfort.

Examples of STIR images obtained in the coronal plane without (A) and with (B) SEMAC technique applied. A dramatic reduction in the degree of metal induced artifact around the implant can be noted with the SEMAC technique.

MR-PET MSK imaging
Luis S. Beltran, MD

PET-MRI is a new scanning test being used at NYU Medical Center primarily in the evaluation of patients with certain types of cancer including prostate cancer and metastases to bone, hepatocellular carcinoma, thyroid cancer, breast cancer, pediatric lymphoma, and brain gliomas. The images are generated from combined magnetic resonance imaging (MRI) and positron emission tomography (PET) data in order to assess certain aspects of a cancer such as size of the cancer and biochemical and molecular activity in the cancer.  The test is also useful to determine the presence and extent of metastatic disease to the rest of the body.  This information may be helpful in planning a biopsy or surgery of the cancer and potentially may help in evaluating whether a treatment is working.

3DMR Shoulder instability imaging
Soterios Gyftopoulos, MD

3DMR reconstructions of the shoulder are a new tool used in the evaluation of patients with a history of shoulder dislocation. The reconstructions are generated from MR data obtained during a conventional MRI of the shoulder. The 3D models are used to assess and quantify the osseous injuries that can occur along the surfaces of the humeral head and glenoid in the setting of shoulder instability.

Our MR shoulder dislocation imaging studies provide the important soft tissue and bone information that can be useful for management of the patient with shoulder instability without the need for additional CT imaging and its radiation dose.

Examples of our 3DMR reconstructions of the shoulder in a patient with recurrent shoulder instability. (a) There is a well-defined Hill-Sachs defect along the humeral head, and (b) flattening of the anterior margin of the glenoid.