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Neuroradiology

The Neuroradiology Division is an integral part of the Clinical Neurosciences Program at DHMC. We are responsible for imaging studies of the brain, spine, and head and neck. We offer the full spectrum of spine and endovascular neurointerventional procedures. Advancing knowledge to improve diagnosis and treatment of brain and spine disease is a crucial part of our mission, and we are actively involved in research and in the training of residents, fellows, and medical students.

Subspecialty diagnostic expertise

The Neuroradiology Division maintains a level of subspecialty expertise that is unique in New Hampshire. Each member has board certification in Radiology and a Certificate of Added Qualification in Neuroradiology from the American Board of Radiology. Our faculty offers particular expertise in the following areas:

  • Functional Neuroimaging
    Dr. Stephen Guerin
  • Head & Neck Imaging
    Dr. David Pastel, Dr. Clifford Eskey
  • Interventional Neuroradiology
    Dr. Clifford Eskey, Dr. Stephen Guerin
  • Pediatric Neuroradiology
    Dr. Leah Palifka
  • Spine Imaging
    Dr. John McIntyre, Dr. David Pastel, Dr. Sword Cambron

The clinical faculty supervise and interpret imaging studies of the brain, spine, and head & neck performed at DHMC and at our numerous affiliated hospitals in New Hampshire and Vermont. We offer consultative services for imaging studies performed elsewhere. We support the regular multidisciplinary conferences in epilepsy, stroke and cerebrovascular diseases, pituitary tumors, head and neck oncology, and neuro-oncology.

Subspecialty Image-guided Therapy

We are dedicated to the safe and effective treatment of cerebrovascular, spine, and head & neck diseases with image-guided therapy. Endovascular therapies include coil embolization of aneurysms, embolization of arteriovenous malformations, treatment of intracranial arterial stenosis, and emergency therapy to dissolve or remove clot in the setting of acute stroke. Spine procedures include vertebroplasty, kyphoplasty, sacroplasty, nerve root blocks, facet injections, synovial cyst rupture, and epidural injections.

Advanced technology

fMRI images, such as these from our GE 3T
magnet, reconstructed on PRISM software,
permit precise location of brain structures
linked to specific neural function.

DHMC offers state-of-the-art neuroimaging with standard and 3T MR, 64-channel helical CT, and flat-panel biplane angiography systems.

  • MRI
    Wide-bore 1.5T and 3.0T MR systems offer excellent image quality. The MR systems include wide-bore magnets to improve patient comfort. We offer a comprehensive sedation and anesthesia program for children and adults who are otherwise unable to complete these imaging studies. Advanced imaging studies routinely performed include time-resolved angiography, perfusion imaging, CSF flow imaging, magnetic resonance spectroscopy, diffusion tensor imaging, and BOLD functional MRI.
  • CT
    CT systems include dedicated units for the emergency department and for image-guided procedures.  Our dedicated advanced post-processing lab creates 3-dimensional depictions of key anatomical structures to aid diagnosis and plan treatments.  To provide high quality images while minimizing risk we continually monitor our imaging equipment and protocols and participate in the ACR CT Accreditation Program and the ACR Dose Index Registry. Advanced imaging studies routinely performed include CT angiography and CT perfusion.

Education

Education is a key part of our mission, and we are proud of our role and the recognition we have received.  We offer a 1-year ACGME-accredited neuroradiology fellowship for radiologists seeking dedicated training in clinical neuroradiology.  Dr. Pastel serves as the director of the Neuroradiology Fellowship. Dr. Cambron is the education director for the neuroradiology rotation and medical student elective. Drs. McIntyre and Eskey have won the Residents Teaching Award.   Weekly didactic and case conferences for residents provide both structured learning and practice with boards-style cases.

Research

Neuroimaging research is performed by the core clinical faculty and by several dedicated basic scientists. We collaborate with the Dartmouth Brain Imaging Laboratory, the Electron Paramagnetic Resonance Center, the Advanced Imaging Center, and the Center for Surgical Innovation. Projects underway cover innovation in advanced imaging at 3T in glioblastoma recurrence, MRI in pediatric head trauma, CTA in intracerebral hemorrhage and aneurysm evaluation, imaging of pharyngeal carcinoma, vertebroplasty, and synovial cyst rupture.

Services

  • Carotid stenting
  • Discography
  • Embolization for epistaxis and preoperative treatment of vascular tumors
  • Nerve root and facet injections for pain
  • Thrombolysis
  • Vertebroplasty

Diagnostic Capabilities

  • Balloon occlusion test
  • Cerebral and spinal angiography
  • CT angiography
  • Diagnostic angiography
  • ENT Radiology
  • Functional activation studies with BOLD imaging evaluation
  • Functional MR
  • MR angiography
  • MR diffusion weighted imaging
  • MR proton spectroscopy – single and multivoxel
  • MR spectroscopy
  • MR and CT angiography of the head and neck
  • MR and CT perfusion imaging
  • Routine MRI and CT of the brain, spine, and head and neck
  • Myelography
  • WADA testing

Interventional Procedures

  • Biopsy of head, neck, and spine lesions
  • Endovascular therapy for cerebral aneurysms
  • Endovascular therapy for vascular malformations of the brain and spine
  • Endovascular treatment of acute stroke
  • Endovascular treatment of epistaxis
  • Image-guided nerve root, facet, and epidural injections
  • Intracranial angioplasty and stenting
  • Preoperative embolization of head, neck, and spine tumors
  • Vertebroplasty and Kyphoplasty

Program

  • Vertebroplasty and Kyphoplasty for Image-Guided Treatment of Painful Spine Fractures
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