Robert B. Lufkin's research while affiliated with Los Angeles City College and other places
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Publications (225)
This report presents a 55-year-old woman who underwent 2 Teflon injections in 1971 for a patulous eustachian tube. The patient returned in 2006 with a bloody left otorrhea. A positron-emission tomography-CT scan demonstrated a 2-cm hypermetabolic parapharyngeal mass, initially interpreted as a skull base tumor. Repeat neck CT confirmed a 2-cm hyper...
(18)F-FDG PET has a high accuracy for re-staging of head and neck cancer. The purpose of this study was to determine whether the diagnostic accuracy can be further improved with integrated PET/CT.
Forty-nine patients with a mean age of 59+/-18 years were studied retrospectively. Histo-pathological verification was available either from complete tum...
Involvement of the CNS due to viral infection has tremendous importance because of the potential for death and neurologic damage. These viruses display tissue tropism and cause illness with a characteristic temporal course. Viral infections of the CNS may present as meningitis, encephalitis, meningoencephalitis, or meningoencephalomyelitis or myeli...
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Laser-induced thermal therapy (LITT) for cancer is a technique whereby a source of energy (laser, radiofrequency, ultrasonic, cryoenergy, and so on) is directly applied into a tumor at various depths. Recent studies have demonstrated the efficiency of ultrasound (UTZ) and magnetic resonance imaging (MRI) for real- or "near" real-time tumor and vess...
A 27-year-old woman was referred for evaluation of a right-sided intranasal mass. Her medical history was significant for recurring unilateral nasal obstruction, sinus infections, epistaxis, and headaches. She also had a history of hyponatremia and seizures due to SIADH (syndrome of inappropriate antidiuretic hormone). A biopsy was performed after...
The authors describe four types of brain structural change in "normal aging:" cortical atrophy, central atrophy, deep white-matter hyperintensities (DWMH), and periventricular hyperintensities (PVH). Cross-sectional investigations have reported that greater volumes of these forms of "subclinical structural brain disease" (SSBD) were found with incr...
Our goal was to determine the incidental Lund score for pediatric patients without chronic rhinosinusitis (CRS).
Pediatric patients with computed tomography scans of the orbit or brain were identified. Patients with a clinical history of sinonasal disorders or skeletal facial trauma were excluded. The remaining scans were scored according to the Lu...
Recurrent pleomorphic adenoma of the parotid gland is a significant problem. Rates have been as high as 40% in some series of patients who have undergone surgery for the primary lesion. In the imaging literature, anecdotal case reports show multiple lesions in recurrent pleomorphic adenoma. Our aim was to analyze the imaging of a series of patients...
To describe MR-guided access to the retropharynx for precise fine-needle aspiration cytology (FNAC), and other indications for needle placement.
A retrospective review was made of 15 procedures that had been performed on 14 patients. These patients had a retropharyngeal mass on MRI and had undergone MR-guided minimally invasive access to the retrop...
Primary inverting papilloma of the sphenoid sinus is rare. We present a case of inverting papilloma with isolated involvement of the sphenoid sinus and discuss the incidence, clinical presentation, radiographic features, histological findings, and management of patients with this disease.
Case report.
The medical records, films, and pathology slide...
A 66-YEAR-OLD MAN with a 25–pack-year smoking history was seen in 1994 for a complaint of progressive hoarseness over the preceding 10 years. Indirect laryngoscopy revealed the presence of a vocal cord polyp, which was removed with no complications. The patient reported that his hoarseness diminished greatly after this procedure, but then he noted...
Healthy elderly persons commonly show 4 types of change in brain structure-cortical atrophy, central atrophy, deep white-matter hyperintensities, and periventricular hyperintensities-as forms of subclinical structural brain disease (SSBD).
To characterize the volumes of SSBD present with aging and to determine the associations of SSBD, physiology,...
Two cases of cranial cholesteatomas centered at the occipitoparietotemporal junction are presented, and 12 similar cases reported as diploic cholesteatomas involving the temporal bone are reviewed. Among the reported diploic cholesteatomas, 3 involved the occipitoparietotemporal junction and had the same clinical characteristics as the ones present...
Cortical atrophy, central atrophy, deep white-matter hyperintensities, and periventricular hyperintensities are reported in normal aging.
We examined the effects of estrogen replacement therapy (ERT) on these forms of 'subclinical structural brain disease' (SSBD) in normal, postmenopausal women in a pilot, naturalistic, longitudinal study of 15 sub...
The purpose of this study was to demonstrate that fungal mucoceles of the sphenoid sinus do not necessarily require an external approach for eradication of disease. We report 6 cases of fungal mucoceles of the sphenoid sinus seen at UCLA Medical Center from 1980-1999, 4 of which were successfully treated with endoscopic intranasal sphenoidotomy and...
High-resolution magnetic resonance imaging (MRI) at 1.5 T preferentially enhances the perilymph over endolymph after administration of contrast with gadodiamide, which allows for differentiation of the membranous labyrinth. Furthermore, this imaging allows for the detection of endolymphatic hydrops.
Endolymphatic hydrops is believed to be associate...
A two-dimensional (2D) chemical shift correlated MR spectroscopic (COSY) sequence integrated into a new volume localization technique (90 degrees -180 degrees -90 degrees ) is proposed for whole-body MR spectroscopy (MRS). Using the product operator formalism, a theoretical calculation of the volume localization as well as the coherence transfer ef...
Numerous attempts to deal surgically with otosclerosis were made before the current method of stapedectomy with stapes prosthesis was established. We report a case with unique CT findings of a patient who underwent fenestration surgery for otosclerosis in the early 1940s. Recognition of this old surgical procedure on the imaging scans may avoid mis...
MRI-guided procedures have previously been limited by technical difficulties, including the need for MRI-compatible instruments, slow image acquisition time, and the closed nature of conventional MRI scanners. The development of open configuration MRI systems with in-room, contemporaneous imaging has greatly increased the potential for MRI-guided i...
Destructive lesions of the sinonasal tract, lacking a discernible etiology and referred to as midline destructive disease, have been pathologically classified in accordance with a variety of confusing terms. Development of new pathologic concepts and immunohistochemical techniques has provided a fresh understanding of these lesions, and, as a resul...
In addition to the impact that magnetic resonance imaging (MRI) has made in the diagnosis of head and neck pathology, one of the more exciting novel areas of investigation is its use to guide interventional procedures directly.
Magnetic resonance (MR) has revolutionized head and neck imaging and has replaced computed tomography (CT) as the imaging study of choice for many lesions of the extracranial head and neck. MR easily surpasses CT in its ability to differentiate subtle differences in soft tissue boundaries in the head and neck. The beam-hardening artifacts on CT ima...
Through the technological and clinical advances of the past decade, magnetic resonance imaging (MRI) has become one of the most powerful noninvasive diagnostic tools in the evaluation of the brain. The superior soft-tissue contrast, the oblique and multiplanar imaging capability, and the absence of ionizing radiation have made MRI the imaging modal...
Until the advent of the Access open magnet, introduced by Diasonics in 1988, claustrophobia and the loud hammering noise were considered part of the price patients had to pay for the ben efits of this superb imaging approach. The fact that it was possi ble to obtain images of acceptable diagnostic quality while the patient was resting comfortably...
Focal regions of T1-shortening have been observed in magnetic resonance imaging (MRI)-monitored thermal ablations of perfused tissues. The aims of this study were two-fold: to find evidence for heat-induced conversion of hemoglobin (Hb) to methemoglobin (mHb), and to investigate the effects of heat treatment of in-vitro blood components upon their...
Chondromas and chondrosarcomas of the larynx are rare cartilaginous tumors making up less than 1% of all laryngeal tumors. Patients typically present with symptoms of hoarseness, dysphagia, or dyspnea. The most common location in the larynx for these tumors is the cricoid cartilage. Radiographically, these lesions are typically hypodense, well-circ...
Magnetic resonance (MR) imaging-guided biopsy is one of the most exciting and rapidly developing areas in radiology. MRI offers the best demonstration of many pathological lesions because of its multiplanar and three-dimensional (3D) capabilities, excellent soft tissue contrast, and high spatial resolution. This article reviews the state of the art...
Magnetic resonance imaging (MRI), computed tomography (CT), and electron beam tomography (EBT) units are constructed for radiological diagnosis. They are being used with increasing frequency for interventional procedures and in open surgeries. All scanners can be combined with various imaging modalities such as endoscopy and electronic equipment wh...
Frameless MR-guided procedures have had limited application using conventional closed magnets, due largely to the technical difficulties involved. As a result of in-room MR image-monitoring capabilities, new open-design magnets now allow frameless stereotaxis using contemporaneous imaging to guide more invasive procedures. We evaluate our clinical...
Early experience has shown that positron-emission tomography (PET) is a useful technique for the detection of occult squamous cell carcinoma of the head and neck. Although highly sensitive, PET lacks definition of anatomic detail and therefore does not localize pathology precisely. To circumvent this limitation, a computerized coregistration techni...
Therapeutic outcome of head and neck cancer is influenced strongly by the presence of nodal metastases. Sensitivity and specificity of the physical examination for the diagnosis of nodal metastasis is unsatisfactory, resulting in both false negatives and false positives of 25 to 40%. Preoperative detection of nodal metastases therefore becomes one...
Proton phase shift imaging methods with keyholing were developed to rapidly monitor temperature during MR-guided radiofrequency (RF) interventional procedures on a .2-T open configuration scanner. Temperature calibration was performed on thermally controlled gel phantom and ex vivo bovine liver samples. Keyholing methods were implemented for rapid...
Our objectives were to further characterize an artifact related to the localized failure of the frequency-selective (FATSAT) fat suppression magnetic resonance (MR) imaging technique. We constructed two phantoms simulating human orbital anatomy and imaged them on a 1.5-T MR scanner using (FATSAT) and short T1 inversion recovery (STIR) techniques of...
The purpose of this study was to test the feasibility of MR-guided percutaneous ethanol ablation of liver tissue on a .2-T open MR scanner. Needles were placed by MR guidance first into an ex vivo sheep liver and then into livers of three anesthetized pigs, and injection of 10 ml of 96% alcohol was performed. T1 fast low-angle shot (FLASH), T2 turb...
A prototype multimedia medical database is described for supporting thermal ablation therapy of brain tumors. Its design is motivated by the major need to manage and access multimedia information on the progress and reaction of tumors to various therapy protocols. The database links images to patient data in a way that permits the use to view and q...
Depressed patients have a variety of brain structural alterations, the most common being atrophy and deep white-matter lesions. Alterations in brain function also are common, particularly regional decreases in cerebral metabolism and perfusion.
We review here the evidence that alterations in brain structure and function may explain some of the hete...
Interventional MRI is in its early stages of development. Nevertheless, the design of new interventional MRI scanners that allow maximum direct access to the patient combined with the development of new interventional MRI pulse sequences and localization systems, means that the archetypal operating rooms of the 21st century may well contain dedicat...
To assess the effect of a capitation reimbursement plan with attendant changes in service arrangements on the utilization of radiologic services, financially on the payer, and on the satisfaction of patients and referring physicians.
Outpatient radiologic services for a defined population of 20,000 company employees and their dependents were conver...
A multimedia medical database model and prototype is described for supporting a timeline-based presentation of information. The database links image and text data in a way that permits users to look at medical information in a single unified view. Various visualization programs permit the user to view data in various ways, including full image view...
The use of magnetic resonance imaging to directly guide therapy is a new area of investigation. Clinical magnetic resonance imaging has the potential to evolve from a purely diagnostic tool into a guide for invasive procedures. The idea of using magnetic resonance to guide percutaneous biopsy developed one decade ago. Magnetic resonance-guided fine...
The optic nerve is a fiber tract of the brain, and is not a true cranial nerve. Primary pathologic processes seen in the central nervous system and its linings can therefore affect the optic nerve. Along their course the fibers of the visual pathways are also susceptible to secondary extrinsic processes. The MR appearance of many of the primary and...
We have designed a teleradiology and telemedicine architecture over the
World-Wide Web using current HIS, RIS and PACS. Our implementation
allows remote access to hypermedia medical record and automatic
management of interactive communications between referring physician and
consultants. Security and privacy issues are also discussed. Its
successfu...
Obstructive lung disease is the most common form of respiratory disturbance. However, the location of brain structures underlying the ventilatory response to resistive expiratory loads is unknown in humans. To study this issue, midsagittal magnetic resonance images were acquired in eight healthy volunteers before and after application of a moderate...
Variations in venous deoxyhemoglobin levels in response to neuronal activation represent a complex interplay between focal changes in cerebral blood flow (CBF), cerebral blood volume (CBV), and regional metabolism. The authors present a mathematic model that characterizes the response of venous oxygenation to changes in these variables.
Using a mas...
Interventional magnetic resonance (MR) using laser fiberoptics is being tested clinically for tumor ablation. The response of MR contrast agents to photothermal exposure in tumors is unknown. This study explores the effect of heating at reduced pH and intense light on release of toxic cations by five different paramagnetic contrast agents. Metal co...
We wished to determine whether the number of central nervous system (CNS) white matter lesions on magnetic resonance imaging (MRI) is increased in patients with nonarteritic ischemic optic neuropathy (NAION). T2-Weighted axial images of the brain in 13 patients with acute NAION and 16 age-matched controls were used to tabulate the number of subcort...
To determine the natural time course of development of hyperacute thermal lesions in the brain.
Ten interstitial lesions were created in five rabbit brains with a radio-frequency probe; an electrode-tip temperature of 80 degrees C was maintained for 60 seconds. Continuous fast spin-echo magnetic resonance (MR) imaging was used to follow lesion deve...
Although computed tomography and magnetic resonance imaging have contributed to the ability to identify metastatic disease in head and neck cancer, inadequacies in evaluating lymphadenopathy still exist. This study was undertaken to estimate the accuracy of radiological criteria used to detect cervical lymph node metastases. The morphological chara...
Many modern surgical techniques have been developed to provide exposure or visualization of the surgical field to perform definitive treatment. The actual therapeutic part of surgery is often a small fraction of the procedure. In obtaining exposure, however, morbidity can ensue. This has led to newer techniques that use minimally invasive treatment...
Compensatory ventilatory responses to increased inspiratory loading are essential for adequate breathing regulation in a number of pulmonary diseases; however, the human brain sites mediating such responses are unknown. Midsagittal and axial images were acquired in 11 healthy volunteers during unloaded and loaded (30 cmH2O; 1 cmH2O = 98 Pa) inspira...
The effectiveness of combining surgery with chemo- and radiation therapy in treatment of human cancer provides a useful model for further development of new multimodality approaches including laser photochemotherapy. Laser endoscopy often is a useful treatment for obstructive tumors in airways, but interstitial laser fiberoptics is becoming a more...
Eleven patients who underwent stereotactic radiofrequency lesions in the central nervous system had magnetic resonance imaging follow-up within 72 hours of surgery to determine the early appearance of their lesions. Eight patients with severe tremor, one with chronic pain, and two with dystonia were analyzed. There were six female patients and five...
Intracranial aneurysms are the primary cause of non-traumatic subarachnoid hemorrhage. Morbidity and mortality remain high even with current endovascular intervention techniques. It is presently impossible to identify which aneurysms will grow and rupture, however hemodynamics are thought to play an important role in aneurysm development. With this...
A 71-year-old woman developed chronic progressive visual loss in the right eye and computed tomographic scan showed enlargement of the intraorbital optic nerve consistent with optic nerve sheath meningioma. Over 12 years, the contralateral optic nerve was not clinically affected, and serial neuroradiologic imaging showed no evidence of intracranial...
Positron emission tomography (PET) has recently proved to be highly sensitive in detecting known extracranial head and neck squamous cell carcinomas when compared to computed tomography and magnetic resonance imaging (MRI). The ability of PET to detect early subclinical recurrent squamous cell malignancies in patients who received primary radiother...
To evaluate the feasibility of a technique of MR-guided stereotactic radio frequency ablation, which was developed as a minimally invasive treatment for brain tumors, and to determine MR characteristics and sequential evolution of radio frequency lesions created to ablate brain tumors.
Fourteen lesions in 12 patients with primary and metastatic bra...
The authors describe the magnetic resonance (MR) imaging appearance of the head of the right caudate nucleus in patients who have undergone adrenal medullary transplant surgery for Parkinson disease. All four patients examined showed some clinical improvement after surgery. The MR images acquired 4-6 months postoperatively showed no evidence of cau...
Periventricular white matter hyperintensities (PVHs) seen on T2 weighted MRI studies are common in elderly people and often represent demyelination of fibres. Damage to these fibres could lead to functional disconnection between brain regions. Electroencephalographic coherence, a measure of shared electrical activity between regions, was examined t...
Imaging-guided, minimally invasive surgery is a new concept that uses ultrasound (US) and/or high-speed magnetic resonance imaging (MRI) to guide various energy sources such as lasers, radio frequency, ultrasonic, or cryotherapy devices for treatment of deep-seated tumors and to monitor tissue changes during energy deposition. This approach for tre...
Brain electrical activity is related to cerebral perfusion. The nature of this relationship is unclear, however and surface-recorded activity has not been a reliable indicator of brain perfusion. We studied 27 subjects, all of whom were examined with single photon emission tomography (SPECT) and quantitative electroencephalography (QEEG), to assess...
To investigate the efficacy of magnetic resonance (MR) imaging with dextran-coated superparamagnetic iron oxide in the differentiation of metastatic and benign nodes in patients with head and neck cancer.
MR imaging was performed before and after intravenous administration of iron oxide in 12 patients. Ninety-one pathologically proved nodes were vi...
Radiographic studies were reviewed from a group of 24 patients with biopsy-proven inverted papilloma of the nasal cavity or paranasal sinuses. Thirty-two cases of computed tomography (CT), 17 cases of plain sinus radiography, four cases of polytomography, and three cases of magnetic resonance imaging (MRI) were retrieved for analysis. Although no p...
Previous studies have shown that Rhodamine 123 (Rh123) is an efficient tumor targeting agent for argon laser photodynamic therapy in vitro. Effectiveness of this approach for cancer treatment in vivo will depend on Rh123 tumor uptake kinetics and laser energy delivery via fiberoptics to the tumor site. In the present study, tumor and normal cells w...
Increased slow-wave and decreased fast-wave activity on the electroencephalogram is common in brain dysfunction and may be caused by partial cortical deafferentation. No measure that is specific or sensitive for this deafferentation, however, has yet been reported. We studied a series of subjects with white-matter lesions undercutting the cortex an...
Although the histologic anatomy of the lower eyelid retractors is well defined, the physiology of the lower retractors has been determined only by interference based on anatomic and clinical findings. In this study, in five normal subjects we investigated the physiology of the lower eyelid retractors utilizing dynamic high resolution magnetic reson...
In humans, the location of brain regions responsible for mediating the ventilatory response to CO2 remains unknown. Most of the available knowledge has been derived from animal studies or from pathophysiological correlations in patients presenting altered control of breathing. Magnetic resonance imaging at a specific pulse sequence designed to asse...
Surgical planning for the treatment of congenital aural atresia has depended greatly on the use of high resolution computerized tomography (CT) and, recently, three-dimensional CT for visual representation of the complex anatomy associated with this condition. Computerized plastic model construction, stereolithography, allows the digital data obtai...
Neuroradiologists require rapid access to large multislice, multisequence image datasets, as well as tools for planning interventional procedures and predicting the probable outcome of an intervention. To address these challenges, we are integrating virtual reality (VR) technology with a large-scale picture archiving and communication system (PACS)...
We localized right median nerve somatosensory evoked responses in a normal human subject using an equivalent dipole method applied to magnetic field recordings. High resolution, 3-dimensional MRI data were used to confine source locations to the cortical surface. Results localized in Brodmann area 3b corresponding to location of hand somatosensory...
To investigate dextran-coated superparamagnetic iron oxide particles (BMS 180549) as an MR contrast agent for assessing lymph nodes.
Five different doses ranging from 0.3 to 1.7 mg Fe/kg were evaluated in five healthy human male subjects as part of a phase 1 clinical study. T1-, T2-, and proton density-weighted spin-echo images as well as multiplan...
Fat suppression MR imaging is a valuable technique mainly used for the orbit, head and neck, and spine, where the high signal from fat can often obscure adjacent pathology. Fat suppression failure artifact manifested as a high signal area without geographic distortion. The purpose of this study was to investigate the frequency and common location o...
Fast spin-echo (FSE) is a new magnetic resonance (MR) imaging pulse sequence that employs echo trains of 180 degrees radio-frequency pulses to generate multiple refocused echoes during a single repetition-time interval. Phase encoding is reordered with the lowest spatial frequency views obtained in the echoes nearest the desired effective echo time...
The Council on Scientific Affairs of the California Medical Association presents the following inventory of items of progress in otolaryngology-head and neck surgery. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. T...
Citations
... OVER RECENT YEARS, magnetic resonance imaging (MRI) has developed from a purely diagnostic tool to an imaging modality that can also be used to monitor interventional procedures (1,2). Initially, open configuration magnets with field strengths well below 1 Tesla were preferred for interventional MRI, because these systems offer a better access to the patient than closedbore high field magnets (3). However, in open MRI systems, both gradient strength and achievable signal-tonoise ratios are limited, and imaging times of several seconds per image are common. ...
... Studies comparing outcomes in carpal tunnel27282930 and ulnar nerve release surgeries [31] show that MR neurography is as effective as needle elecromyography for identifying patients who are helped by surgical treatment. In conditions such as thoracic outlet syndromes (TOS) [32,33] and in lumbar radiculopathy after unsuccessful spine surgery, where electrophysiologic studies have so far been of only varying effectiveness [34,35], the application of MR neurography can have considerable clinical significance. ...
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... Secondly, there currently is no established paradigm for realtime imaging of ultrasonic perturbations of a magnetic field in the MRI space, making target engagement less conclusive. Unlike High Intensity Focused Ultrasound [50] which is used for ablation by creating thermal lesions in tissue, we did not perform MR thermometry [51] as tFUS operates at power levels that do not induce thermal changes in tissue. This results in "invisible" tFUS trajectories that are based on offline computer modelling and needs refinement and technological advancement. ...
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... Many extraskeletal manifestations of NF occur because of the neuroectodermal and mesodermal derivation of the tissue [3]. Gliomas of the optic nerves, pheochromocytomas, aneurysms of cerebral and renal arteries and acoustic neurilemmomas are well recognized. ...
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... 11 However, no single method is entirely reliable and the relationship of a large mass (which distorts the anatomy of the gland) to the nerve may not be defined by MRI. 12 It is also important to identify whether a mass arises from the deep lobe of the parotid gland or is primary to the parapharyngeal space (PPS) as the surgical approach for these operations usually differs. Identification of the origin of the tumor requires computed tomography (CT) or MRI. ...
... However, the patients with experience of telemedicine were satisfied with the telemedicine's advantages, for example, the medical fees [11]. And also launching telemedicine could reduce the number of repeated medical tests and lower the costs, such as transportation fees and the cost to the accompanying persons, etc [12]. The above contents showed that some patients had lower knowledge level for telemedicine, they didn't know the benefits of telemedicine, and so it was critical to let more patients enjoy telemedicine service. ...
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... MRI has also been used for intraoperative guidance. 2 Multiplanar reconstruction allows MRI to create virtual endoscopy, similar to CT, virtual angiography and lymphography. MRI is also used in image-guided brain surgery to locate tumours and key structural components of the brain. ...
Reference: Imaging in cancer
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... Interstitial laser therapy can improve the quality of life for post-treatment patients with head and neck cancer. 1,2 Until recently, there have been some reports that combined treatment with cisplatin and hyperthermia can enhance the therapeutic effect of cancer in the head and neck region. [3][4][5][6][7] On the other hand, high fever increases vascular blood flow, the permeability of the cell membranes, facilitates the intratumoral absorption of cisplatin, and increases the sensitivity of cisplatin to living cells. ...
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... For thermal treatment monitoring, MRI currently offers many of the most practical and widely available methods to accurately and non-invasively measure temperature inside the human body. Using MRI does require that the therapy equipment should not interact with the radio frequency (RF), gradient, and main magnetic fields of the MRI scanner, and that any magnetic or inducible parts be far from the MRI scanner [2][3][4][5][6][7]. Further, the presence of various biomedical implants and devices in the body may pose hazards for patients undergoing MR procedures, and thorough screening before any scan is important [8][9][10]. ...
... The method later evolved into minimally invasive MRI-guided treatments as described by Pushek et al. (1995). Sinha et al. (1997) established temperatura monitoring system for thermal-ablative procedures using a software system that correlated tissue changes with MRI imaging. MRI is a non-invasive and extremely sensitive diagnostic imaging system, used to locate and guide biopsies of deep and difficult tumors and to access target tissues using needles with extremely low magnetic susceptibilities (Kahn et al., 2008; Pushek et al., 1995). ...
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