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Dive into the research topics where Hillary W. Garner is active.

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Featured researches published by Hillary W. Garner.


Radiographics | 2011

Clinical Utility of Dual-Energy CT for Evaluation of Tophaceous Gout

Madhura A. Desai; Jeffrey J. Peterson; Hillary W. Garner; Mark J. Kransdorf

Although diagnosing gout generally is straightforward, atypical disease may present a challenge if it is associated with unusual symptoms or sites, discordant serum urate level, or mimics of gout. Dual-energy computed tomography (CT) may be used to differentiate urate crystals from calcium by using specific attenuation characteristics, which may help diagnose gout. In patients with known tophaceous gout, dual-energy CT may be used for serial volumetric quantification of subclinical tophi to evaluate response to treatment. Given the utility of dual-energy CT in challenging cases and its ability to provide an objective outcomes measure in patients with tophaceous gout, dual-energy CT promises to be a unique and clinically relevant modality in the diagnosis and management of gout.


Radiographics | 2009

Benign and Malignant Soft-Tissue Tumors: Posttreatment MR Imaging

Hillary W. Garner; Mark J. Kransdorf; Laura W. Bancroft; Jeffrey J. Peterson; Thomas H. Berquist; Mark D. Murphey

Soft-tissue sarcoma requires aggressive treatment, often with a combination of radiation therapy, chemotherapy, and surgical resection. Even after multimodality treatment, local recurrence is common, and regular follow-up imaging at short intervals is required. Interpretation of posttreatment magnetic resonance (MR) images may be complicated by changes in the surgical bed or treatment field. The challenge of distinguishing posttreatment change from recurrent tumor may be minimized by using an organized, systematic approach to imaging, with emphasis on the patients clinical and surgical history and a review of pretreatment images. Common changes that result from radiation therapy include soft-tissue trabeculation, increased fatty marrow, and focal marrow abnormalities. Rarely, radiation-induced malignancies may develop within the treatment field. Chemotherapy also influences posttreatment imaging appearance. Occasionally, it causes a substantial increase in tumor size that is a result of chemotherapy-induced hemorrhage. Although myocutaneous flaps used in reconstructive surgery may mimic a mass, they demonstrate time-dependent changes in size, signal intensity, and enhancement on MR images. Recurrent tumor is characterized by the presence of a discrete nodule or mass with signal characteristics that typically mirror those of the original tumor. MR imaging sequences such as unenhanced T1-weighted fat-suppressed and gradient-echo sequences may help differentiate posttreatment hemorrhage from local tumor recurrence. A consistent imaging approach combined with a detailed knowledge of the patients history, familiarity with pretreatment images, and an understanding of the various posttreatment changes enables optimal monitoring of the treatment bed and maximizes accuracy in the detection of recurrence.


Seminars in Musculoskeletal Radiology | 2013

Benign synovial tumors and proliferative processes.

Hillary W. Garner; Joseph M. Bestic

This article discusses several benign tumors and proliferative processes of the synovium including giant cell tumor of the tendon sheath, pigmented villonodular synovitis, synovial chondromatosis, lipoma arborescens, and synovial hemangioma, lipoma, and fibroma. We review the clinical features and imaging characteristics of each entity, with a special focus on the unique imaging findings that can enable a confident diagnosis or a limited differential diagnosis.


Radiologic Clinics of North America | 2011

Posttherapy imaging of musculoskeletal neoplasms.

Hillary W. Garner; Mark J. Kransdorf; Jeffrey J. Peterson

Posttreatment imaging is important to ensure early detection of oncological complications, and appropriate timing and frequency is an important consideration, especially in high-risk patients. Focused magnetic resonance (MR) imaging is the preferred modality for detection of local recurrence of soft tissue tumors and is also used in high-risk osteosarcoma. Although posttreatment changes can mimic or obscure local recurrence on MR imaging, a systematic approach and knowledge of the features of recurrence versus therapeutic change allows differentiation in almost all cases. Positron emission tomography/computed tomography is also emerging as an important problem-solving tool in local recurrence and in metastatic surveillance.


American Journal of Roentgenology | 2017

Variation in Attenuation in L1 Trabecular Bone at Different Tube Voltages: Caution Is Warranted When Screening for Osteoporosis With the Use of Opportunistic CT

Hillary W. Garner; Michelle M. Paturzo; Gabriela Gaudier; Perry J. Pickhardt; Daniel E. Wessell

OBJECTIVE The purpose of this study is to investigate the variation in attenuation values (expressed as Hounsfield units) for L1 vertebral body trabecular bone at different tube voltages used in dual-energy CT (DECT) and to remind physicians to consider changes in attenuation values when they approach opportunistic screening for osteoporosis. MATERIALS AND METHODS Consecutive patients who underwent DECT examination of the abdomen and pelvis for suspected urolithiasis were included in the study. Attenuation noted on CT of the L1 trabecular bone performed with the use of tube voltages of 80, 100, and 140 kV was recorded. The correlation between the attenuation noted when the tube voltage was 140 kV and the attenuation noted when the tube voltage was either 80 or 100 kV was calculated, and differences in the mean CT attenuation values were compared. RESULTS The mean attenuation values from L1 trabecular bone measurement performed for 191 patients were analyzed. As expected, the mean attenuation values decreased as the tube voltage increased. There was a strong correlation between the attenuation values noted when tube voltages of 80 and 140 kV were used (r2 = 0.97) and those noted when 100 and 140 kV were used (r2 = 0.96). The mean attenuation value noted at 80 kV was 76.4 HU (65%) higher than that noted at 140 kV (p < 0.001). The mean attenuation value at 100 kV was 45.5 HU (39.9%) higher than that noted at 140 kV (p < 0.001). CONCLUSION We confirmed that attenuation values of L1 trabecular bone, unlike attenuation values of fat, fluid, or soft tissue, vary at different CT x-ray tube voltages. Therefore, standard reference attenuation values for trabecular bone seen at 120 kV cannot be applied to other single-energy settings, DECT, or CT examinations where dose modulation software automatically raises or lowers the tube voltage from 120 kV. Knowledge of the specific energy spectra used is essential before performing opportunistic CT evaluation for osteoporosis.


American Journal of Roentgenology | 2013

Sclerosing Variant of Well-Differentiated Liposarcoma: Relative Prevalence and Spectrum of CT and MRI Features

Joseph M. Bestic; Mark J. Kransdorf; Lawrence M. White; Mellena D. Bridges; Mark D. Murphey; Jeffrey J. Peterson; Hillary W. Garner

OBJECTIVE The purpose of this study was to determine the relative prevalence of the sclerosing variant of well-differentiated liposarcoma at one institution and to elucidate the CT and MRI characteristics of this subtype of well-differentiated liposarcoma. MATERIALS AND METHODS A retrospective computerized search was conducted to calculate the relative prevalence of the sclerosing variant of well-differentiated liposarcoma among all well-differentiated liposarcoma subtypes at one institution. The MRI and CT features of a total of 19 cases of pathologically proven sclerosing variant of well-differentiated liposarcoma were evaluated (seven identified from the study institution database and 12 cases contributed by other institutions). RESULTS The cases of a total of 36 patients with well-differentiated liposarcoma were identified in the pathology database; six (17%) cases had evidence of dedifferentiation. Seven (19%) cases of sclerosing variant of well-differentiated liposarcoma were identified. Of these, three (43%) had evidence of dedifferentiation. On images, the sclerosing variant of well-differentiated liposarcoma typically presented as a large (average, 16.6 cm) well-circumscribed heterogeneous mass most commonly situated in the retroperitoneum (58%). Sixteen of the 19 tumors evaluated (84%) had predominantly well-circumscribed margins. Tumor composition ranged from predominantly fatty to entirely devoid of macroscopic fat; only three (16%) were composed of more than 75% fat. Variable amounts of nonlipomatous elements were identified in all cases. Enhancement of these elements was evident at CT or MRI in all 14 cases in which enhancement could be reliably assessed. CONCLUSION The sclerosing variant of well-differentiated liposarcoma should be included in the differential diagnosis of any well-circumscribed lipomatous mass containing variable amounts of nonlipomatous elements, particularly when located in the retroperitoneum. Unlike other subtypes of well-differentiated liposarcoma, the sclerosing variant is less likely to be composed predominantly of fat and may be associated with an increased propensity for dedifferentiation.


Canadian Association of Radiologists Journal-journal De L Association Canadienne Des Radiologistes | 2016

Musculoskeletal Sarcoma: Update on Imaging of the Post-treatment Patient

Hillary W. Garner; Mark J. Kransdorf

Post-treatment imaging of musculoskeletal sarcoma remains challenging, but newer imaging techniques are improving our ability to recognize both local and distant recurrence and accurately distinguish local recurrence from post-treatment change. We review recent advances in dynamic contrast-enhanced magnetic resonance imaging, diffusion-weighted magnetic resonance imaging with apparent diffusion coefficient mapping and positron emission tomography/computed tomography in the post-treatment follow-up of musculoskeletal sarcoma. We also describe our multidisciplinary sarcoma team approach to patient care and the essential role of the radiologist in the clinical follow-up scheme.


Skeletal Radiology | 2016

Sarcoidosis: radiographic manifestations in the nails and distal phalanges

Brittany K. Albers; Jason C. Sluzevich; Hillary W. Garner

Sarcoidosis is a granulomatous disease which can affect multiple organ systems. Clinical and radiologic manifestations depend on the organ system involved and the chronicity of disease. Nail involvement in sarcoidosis is rare, but is clinically relevant as it indicates chronic systemic disease. Nail abnormalities can be identified radiographically, and when seen in patients with known or suspected sarcoidosis, should prompt careful evaluation of the underlying bone for osseous involvement. We describe a case of sarcoidosis with radiographic findings in the nails and distal phalangeal tufts, which were indicative of nail and osseous sarcoid involvement and strongly supported the presence of chronic systemic disease. Although the nail findings resolved clinically and on radiographs after treatment, the osseous findings showed only minimal improvement. To our knowledge, the radiographic findings of nail sarcoidosis have not been previously addressed in the literature.


Bone reports | 2016

Tumor induced osteomalacia secondary to anaplastic thyroid carcinoma: A case report and review of the literature

Ejigayehu G. Abate; Victor Bernet; Cherise Cortese; Hillary W. Garner

Context Tumor induced osteomalacia related to anaplastic thyroid cancer has never been reported. Objective We describe a case of tumor induced osteomalacia (TIO) in a patient with a fibroblast growth factor 23 (FGF-23) secreting anaplastic thyroid carcinoma. The current imaging modalities are reviewed. Design and intervention Clinical, biochemical, and radiological assessments were done, including computer tomography (CT) of the neck and skull to thigh positron emission tomography (PET)/CT. The patient underwent surgical tumor debulking three days after presentation due to airway compromise. Molecular studies of the resected tissue were performed using reverse transcriptase–polymerase chain reaction (RT-PCR) and gel electrophoresis for the phosphaturic mesenchymal tumor FGF-23. Results Resected tissue demonstrated features of anaplastic thyroid cancer with positive markers for FGF-23 protein, consistent with a FGF-23 secreting paraneoplastic tumor. The patients metastatic burden rapidly progressed as demonstrated by a dramatic rise in serum FGF-23 levels and worsening hypophosphatemia in concert with progression of the metastatic lesions on PET/CT. Conclusion We believe that our patients rapidly progressive anaplastic thyroid cancer was responsible for persistent hypophosphatemia and osteomalacia, substantiated by the finding of FGF-23 protein within the thyroid tumor cells. Our case indicates that anaplastic thyroid cancer can cause TIO.


Clinical Lymphoma, Myeloma & Leukemia | 2015

A Rare Case of Primary High-Grade Large B-Cell Lymphoma of the Sciatic Nerve

Pooja Advani; Aneel Paulus; Peter M. Murray; Liuyan Jiang; Ryan Goff; Robert A. Pooley; Manoj Jain; Hillary W. Garner; James M. Foran

Primary high-grade large B-cell lymphoma of the sciatic nerve without any systemic or central nervous system manifestations is rare, and the natural history of the disease is reported to be aggressive. There is a paucity of data on the optimal treatment strategies for primary sciatic nerve lymphoma. Combined modality dose-adjusted R-EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) followed by involved field radiation treatment to the sciatic nerve might result in functional and sustained complete remission and is an alternative treatment option. Neurolymphomatosis should be considered in the differential diagnosis of sciatic nerve tumors, and its accurate diagnosis is based on clinical features, expert hematopathology review, and functional imaging modalities including positron emission tomography-computed tomography scan.

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Mark D. Murphey

Uniformed Services University of the Health Sciences

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