Jonathan Luchs, MD FACR

Jonathan S. Luchs, MD, Carolyn M. Sofka, MD, Ronald S. Adler, PhD, MD
Objective. The purpose of this study was to investigate the extent and duration of the sonographic contrast effect during guided steroid-anesthetic injections and to propose a potential mechanism based on mixture immiscibility and density differences. Methods. A steroid-anesthetic mixture was injected into cyst phantoms under sonographic visualization, and time-dependent data were acquired. Regions of interest were drawn… Show more

Jonathan S. Luchs, MD, Carolyn M. Sofka, MD, Ronald S. Adler, PhD, MD
Objective. The purpose of this study was to investigate the extent and duration of the sonographic contrast effect during guided steroid-anesthetic injections and to propose a potential mechanism based on mixture immiscibility and density differences. Methods. A steroid-anesthetic mixture was injected into cyst phantoms under sonographic visualization, and time-dependent data were acquired. Regions of interest were drawn within each cyst, and measured mean pixel intensities were compared with a gel phantom background that served as a control. Two test tubes were also prepared similarly with the steroid-anesthetic mixture and saline in one test tube and synovial fluid in the other; these were observed to estimate separation time to form a fluid-fluid level. Results. There was a substantial contrast effect after injection of the steroid-anesthetic suspension into a cyst phantom containing saline. The background levels remained constant during the period of observation. The contrast effect decreased as a function of time to 4 (94% decrease from the time of injection) in the upper half and to 34 (64% decrease from the time of injection) in the lower half throughout the course of the exper- iment. The test tube containing the injected material in saline achieved separation in approximately 15 minutes, whereas in the synovial fluid, separation was achieved in 48 hours. Conclusions. We have verified, in vitro, an apparent clinically observed contrast effect noted during sonographically guided therapeutic injections of cortisone-anesthetic mixtures. We have shown that this effect relates to dif- ferences in acoustic impedance and immiscibility, differences in density of the mixture, or both. Key words: contrast; guided injection; steroid. Show less

Written by radiologists but for clinicians, and meant for consultation in the "heat of battle" (the busy—sometimes hectic—clinical setting), this one-of-a-kind little book guides you through the most cost-effective and direct imaging route to a diagnosis. Unlike all other books by radiologists, it does not try to teach image interpretation. Rather, covering 65 common clinical problems, from GI bleed, to Pulmonary Embolus, to Myocardial Ischemia, to Stroke, The Clinicians's Guide incorporates… Show more

Written by radiologists but for clinicians, and meant for consultation in the "heat of battle" (the busy—sometimes hectic—clinical setting), this one-of-a-kind little book guides you through the most cost-effective and direct imaging route to a diagnosis. Unlike all other books by radiologists, it does not try to teach image interpretation. Rather, covering 65 common clinical problems, from GI bleed, to Pulmonary Embolus, to Myocardial Ischemia, to Stroke, The Clinicians's Guide incorporates all available technologies—Multi-detector CT, MR, CT angiography, MR angiography, PET, and combined PET/CT— to help clinicians get the answers they need. Show less

pt. 13. Peripheral. Musculoskeletal system measurments? Ronald S. Adler, Jonathan S Luchs.