Leaders in Medical Imaging – ProScan’s Continuous Investment in the Community

For over three decades, ProScan Imaging, its accomplished professionals and the Cris Collinsworth ProScan Fund have continued to invest and reinvest in the Greater Cincinnati community, advancing the standard of healthcare, and providing affordable access to the highest level of diagnostic imaging.

Along with high quality and affordable access to healthcare, there is great attention placed on patient comfort.  With that in mind, the Eastgate location upgraded to a completely Open High-Field MRI in March of this year.  The Open MRI allows claustrophobic patients to have a relaxing and stress free experience, while providing state-of-the-art high field diagnostic imaging at the same time.  

“We listened to our referring physicians and the need for a high field imaging option for their claustrophobic patients,” says Dr. Stephen J. Pomeranz, CEO and Medical Director of ProScan Imaging.

Most recently, in June, the ProScan Family of Companies relocated and opened the doors of its newest Tri-State imaging center at 568 Centre View Blvd., in Northern Kentucky. The upgraded Northern Kentucky center provides exceptional care and service, featuring a new 3 Tesla MRI, as well as state of the art CT and digital X-Ray technology.

“We are excited to add this cutting edge technology and expand our services to patients of Northern Kentucky.” says Dr. Pomeranz. 

Arriving at any of the freestanding centers is easy with convenient parking in front. From the moment you enter the door, there is a clean and welcoming check-in area, with an experienced radiology technologist ready to take care of you.  Dr. Pomeranz and his expert team of subspecialty-trained radiologists review each patient’s scan providing timely and accurate results, eliminating the need for repeat imaging. 

With eight locations around the Tri-State, there is a ProScan Imaging center located within 15 minutes of nearly every home and workplace address.  The flexible appointment times, including evening and weekend appointments, help accommodate all patient’s schedules, whether they are busy students, working parents or seniors.

“ProScan will continue to build on its trusted name by focusing on investing in our community and pairing our patients with the highest level of service and professional experience,” says Mike O’Brien, President and Chief Operating Officer of the ProScan Family of Companies.

For more information, please visit www.proscan.com. To schedule your next scan at one of our imaging centers, please call 877-776-7226.    

PROSCAN IMAGING EXPANDS SERVICES IN NORTHERN KENTUCKY

Crestview Hills, Kentucky – On June 29th, 2020, ProScan Radiology Northern Kentucky, LLC relocated its imaging center from 350 Thomas More Parkway to 568 Centre View Blvd. featuring a new High-Field 3T Philips MRI, a new Siemens 64 Slice CT and Digital X-Ray.  “We are excited to lead with cutting edge technology and expand our services to patients of Northern Kentucky to produce a higher quality and lower cost, independent imaging option in their neighborhood. The support that the Northern Kentucky community has shown us over the past two years has been overwhelming and this has inspired us to expand our services,” said Dr. Stephen J. Pomeranz, CEO and Medical Director of ProScan Imaging.  

The ProScan Family of Companies is headquartered in Cincinnati, Ohio and operates 28 independent imaging centers throughout the United States, 12 of which are in the Greater Cincinnati/Northern Kentucky area. ProScan’s team of sub-specialty trained radiologists are recognized as among the best and most experienced radiologists in the U.S. ProScan radiologists professionally serve physicians and hospitals in all 42 states and US protectorates in Guam, US Virgin Islands, and Puerto Rico. 

While providing superior image quality and medical interpretation, ProScan Imaging is proud to be the more affordable price-option for all patients in the Northern Kentucky/Greater Cincinnati area. The addition of a technologically advanced Northern Kentucky ProScan location is significant for the local community as patients now have another independent, low cost and easily accessible imaging option when choosing their MRI or CT provider in the Greater Cincinnati region.  

“Being part of the fabric of the Northern Kentucky community has been a great experience for our organization. We are excited to continue to raise the bar of imaging care by offering additional modalities and another option for referring physicians and their patients,” said Dr. Stephen Pomeranz.

ProScan Northern Kentucky center is now located at 568 Centre View Blvd., Crestview Hills, KY 41017. 

For a price quote or to schedule an MRI, CT or X-Ray appointment at the new Northern Kentucky location, patients should call 859-331-5300

For questions regarding this press release, please contact Kate Kafel at 513-284-6777.

LAWSUIT AGAINST PROSCAN DISMISSED

On Oct. 25, 2019, a little more than a month after the Department of Justice determined it would not intervene and closed its investigation into the whistleblower complaint against ProScan Imaging, the Relators who initiated the claim formally withdrew their lawsuit. The DOJ concurred, and a federal judge formally dismissed the case.

100% OF PROSCAN CASES ARE READ BY PHYSICIANS; DOJ DECLINES TO PURSUE LAWSUIT

Update: On 10/25/19, the lawsuit against ProScan Imaging was dismissed.

On Wednesday, September 11th, the Department of Justice declined to intervene in a whistleblower complaint filed by a competitor against ProScan Imaging. The complaint alleged that ProScan utilizes non-physicians in place of radiologists. This is completely untrue.

Here are the facts: The U.S. Department of Justice thoroughly investigated the allegations. We cooperated fully, including answering every question and providing every document requested. The result: The DOJ declined to pursue the lawsuit and closed its investigation. The DOJ made that determination last week, which resulted in the unsealing of the complaint against ProScan (the unsealing of these allegations is standard practice).

To set the record straight:

  • 100 percent of ProScan cases are read by licensed, board-certified physicians. Period. No exceptions.
  • ProScan has never had a malpractice judgment in our 30 years in business.
  • ProScan has complied with Medicare regulations throughout our 30 years in business. ProScan has, and always will, treat its Medicare responsibilities with the utmost seriousness.
  • ProScan currently has more than 400 employees, including 38 full-time, board-certified physicians. We have one part-time and one full-time physician assistant on staff.
  • All physicians and clinical support personnel, including PAs, perform activities that fall within the parameters of their professional credentials.

Our business is built on trust, high-quality medical care, and exceptional service. We always act with the highest integrity. We want our patients, our referring physicians, and our radiology clients to know that nothing has changed. We are the same group of professionals providing expert, high- quality radiology services.

Three visits, two modalities, and one ankle… Go!

This 64-year-old female fell approximately three weeks ago, and presents with right ankle pain.

Prior to this incident, this patient’s foot was assessed in 2015 and 2017. Images 1 and 2 are radiographs of the patient’s foot from 2015. Images 3 and 4 are radiographs of the patient’s foot from 2017. Images 5 and 6 are MRIs of the patients foot from the current visit (2018).

Q1 – From images 1 through 6, what do you think the most likely diagnosis would be?

X-ray (2015)

X-ray (2015)

X-ray (2017)

X-ray (2017)

MRI (2018) Sagittal STIR

MRI (2018) Sagittal STIR

 

A1 – The most likely diagnosis is a full-thickness tear of the peroneus longus tendon. The diagnosis can be made using plain film radiographs. The os peroneum, noted on the 2015 and 2017 exams (images 7 through 10, green arrows), is fractured and distracted on the 2017 study (images 9 and 10, blue arrows).

Followup MRI in 2018 confirms a complete full-thickness tear (image 11, blue arrow). The fracture of the os peroneum is most clearly identified on sagittal images (image 12, green arrow).

*Given how uncommon fractures of the os peroneum are, they may be mistaken for bipartite or multipartite sesamoids. Typically, association of such fractures are with either acute or chronic peroneal longus tendon dysfunctions where:

  • Acute – Result from peroneal longus tendon rupture upon injury
  • Chronic – Degeneration / Tearing resulting from friction of fragments along the tendon

With distal peroneus longus ruptures, displacement and proximal migration of an intact os peroneum can be seen.

Conservative or surgical treatment methods may include:

  • Conservative – Casting, soft dressing, and steroid injections
  • Surgical – Excision of fragments complemented by repair of associated peroneal longus tendon abnormalities

Pearl: Very small tears of the peroneus longus tendon may be seen as the tendon passes around the os peroneum and prove highly symptomatic.

X-ray (2015)

X-ray (2015)

X-ray (2017)

X-ray (2017)

MRI (2018) Sagittal STIR

MRI (2018) Sagittal STIR

 

*Reference:

Peterson, J.J. and Bancroft, L.W. Os Peroneal Fracture with Associated Peroneus Longus Tendinopathy. American Journal of Roentgenology. 2001;177: 257-258.

 

Check out MRI Online for more case review.

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Aftermath of a motor vehicle accident

This 45-year-old male presents with lower back pain due to a motor vehicle accident. Have a look at images 1 through 7, and see how many findings catch your eye.

Sagittal T2

Sagittal STIR

Sagittal T1

Sagittal T1

Sagittal STIR

Sagittal T2

Axial T1

 

Bone marrow edema within the L3 and L4 vertebral bodies nearly encompasses the entire L3 vertebral body and the majority of the L4 vertebral body, and is associated with hyperintense signal within the intervertebral disc. Patient is post left laminotomy at this level. Edema and swelling track along the left laminotomy site.

After administration of intravenous contrast, the surgical site was enhanced via enhancement of the paravertebral soft tissues along the intervertebral disc space (image 7, pink arrows), anteriorly. Furthermore, extensive abnormal heterogeneous signal within the thecal sac, starting at the level of L2-L3 and extending to the sacrum, has peripheral enhancement with central low signal (image 3, purple arrow).

Patient history also indicated discitis osteomyelitis at the L3-L4 level. Combination of these findings are compatible with discitis / osteomyelitis at L3-L4 with a prevertebral soft tissue collection, involvement of the epidural space along the left laminotomy site dorsal aspect of L3-L4, and an enhancing intradural abscess extending from L2-L3 to the sacrum.

Vertebral body heights are preserved. There is a loss of intervertebral disc space height at L3-L4 with active inflammation and edema. Remaining intervertebral disc space heights are preserved with varying degrees of mild disc desiccation.

The thoracolumbar junction is intact. Spinal canal is mildly congenitally narrowed with subtle retrolistheses of L3 on L4, and L4 on L5.

Conus medullaris is visualized at L1-L2. Cauda equina nerve roots are displaced and irregular extending from the conus to the distal thecal sac due to the intradural soft tissue and fluid collection.

 

Clinical considerations as you might report them:

T12-L1: There is no focal disc herniation or spinal canal stenosis. The neural foramina are patent. Mild facet arthropathy is indicated.

L1-L2: There is no focal disc herniation or spinal canal stenosis. The neural foramina are patent. Mild facet arthropathy is indicated.

L2-L3: There is no focal disc herniation or spinal canal stenosis. The neural foramina are patent. Bilateral facet arthropathy is indicated. Cystic soft tissue within the thecal sac at this level extends to the distal thecal sac.

L3-L4: Patient is post remote left laminotomy at this level. Bilateral facet arthropathy is indicated. Irregular cystic soft tissue within the thecal sac is present without high grade spinal canal stenosis. Left neural foramen is moderately narrowed. Right neural foramen is mildly narrowed.

L4-L5: Subtle retrolisthesis of L4 on L5 with a shallow concentric spondylotic disc displacement. Irregular soft tissue within the thecal sac extends towards the sacrum. Bilateral facet arthropathy encroaches upon the neural foramina resulting in mild-moderate foraminal narrowing.

L5-S1: Shallow concentric disc displacement without spinal canal stenosis. The neural foramina are patent. Bilateral facet arthropathy. Abnormal soft tissue and enhancement within the thecal sac extends towards the sacrum.

Present is left paraspinal muscle edema, and enhancement along the surgical tract at the level of L3-L4 left laminotomy site.

Visualized soft tissues of the abdomen and pelvis are grossly unremarkable.

 

Conclusion as it might appear:

  • Discitis / osteomyelitis at L3-L4 with anterior prevertebral phlegmonous changes
  • Edema and enhancement tracking along the left laminotomy site at this level
  • Associated abnormal heterogeneous peripheral enhancing soft tissue / fluid within the thecal sac from the level of L2-L3 extending to the sacrum compatible with intradural abscess
  • Mild spondylosis

 

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For more case review, check out MRI Online.

Dr. Stephen Pomeranz

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Then Wrisberg said, “That tears it!”

This 19-year-old male presents with left knee pain. The patient had an anterior cruciate ligament (ACL) repair three years prior.

When looking through the images, think about the following questions:

Q1 – What is a common pitfall when diagnosing meniscal tears of the posterior horn of the lateral meniscus?

Q2 – How can a Wrisberg rip be diagnosed with confidence?

Q3 – What major injury is associated with a Wrisberg rip?

Q4 – Vertical posterior sliver tears adjacent to the capsule of the medial meniscus are associated with which major injury?

Sagittal PD (Images 1 – 5)

 

Coronal T2 SPIR

Sagittal PD

Coronal T2 SPIR

Sagittal PD

Coronal T2 SPIR

Sagittal PD

 

As hinted, this case is that of a Wrisberg rip. A Wrisberg rip can be difficult to accurately diagnose. There is normally a cleft between the Wrisberg ligament (images 7 and 8, yellow arrows) as it attaches to the posterior horn of the lateral meniscus (images 7 and 8, pink arrows), and this cleft of high signal can be misdiagnosed as a tear. However, when abnormally high signal extends beyond the posterior root, and into the posterior horn towards the body, a pathological tear can be diagnosed with confidence.

In this case, the coronal images clearly demonstrate lateral extension of high signal towards the lateral posterior horn / body junction over a length of 2 to 3cm (image 6, blue and red arrows). It can also be traced with its oblique orientation from anterosuperior to posteroinferior on the sagittal images (images 1 – 5, green arrows) along its mediolateral length, confirming the pathological nature of this finding.

A Wrisberg rip is associated with anterior cruciate ligament rupture. In this case, the patient has a ruptured anterior cruciate ligament graft (image 9, orange arrow).

Also associated with anterior cruciate ligament rupture, is a vertical sliver (“linear”) tear, or peripheral rim tear, adjacent to the posterior and medial capsule (image 10, purple arrow; image 11, green arrow) of the body and posterior horn of the medial meniscus. Whether these meniscal injuries occurred with the initial anterior cruciate ligament rupture, or subsequent rupture of the graft, is indeterminate. However, a chronic time frame is favored. You can often tell if these tears are new by their higher signal, and more intense swelling around them.

 

A1 – Attachment of the Wrisberg ligament onto the posterior horn of the lateral meniscus can produce a high signal cleft that can be misdiagnosed as a tear, but is actually a normal variant. It’s typical course is anterosuperior to posteroinferior.

A2 – When abnormal signal is seen to track from the posterior root through the posterior horn and towards the body. In other words, the normal Wrisberg reflection is only seen on one or two sagittal slices.

A3 – Anterior cruciate ligament rupture.

A4 – Anterior cruciate ligament rupture.

 

Check out MRI Online for more case review.

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A wrist’s tale: When pain met swelling

This 15-year-old female presents with anterior right wrist pain and swelling. There is no known injury or prior surgery. Have a look at images 1 through 6, and see if you can answer the following questions.

Q1 – What is the most likely diagnosis in this 15-year-old female with a mass of the volar aspect of the forearm?

Q2 – What are the low-signal filling defects within the lesion?

Coronal T1

Coronal T1 (Post-contrast)

Coronal T2

Gradient

Axial T1

Axial T2

 

A1 – Venous malformation (formerly hemangioma).

Vascular anomalies are divided into two major groups. The first are vascular tumors that arise due to vascular proliferation, and are called hemangiomas. The second group of lesions are called vascular malformation, and arise because of inborn errors in morphogenesis.

Vascular malformations are classified according to the dominant distorted vessel type, and include capillary, lymphatic, and venous malformations. Vascular malformations are also categorized into low-flow and high-flow groups which is important for treatment of the lesions. Hemangiomas, on the other hand, occur in infancy, have rapid neonatal growth, and slowly involute. Venous malformations can occur anywhere in the body, and can present with pain at rest or during exertion.

A2 – Phleboliths.

Phleboliths are seen in some, but not all, venous malformations. MRI is the study of choice for evaluation of vascular malformations. Imaging of vascular malformations present as high-signal, tubular-like structures (image 9, arrows). The presence of fat could be an indicator of muscular atrophy secondary to vascular insufficiency. Gradient-echo sequences may reveal low signal related to phleboliths or hemosiderin (image 10, arrows). Variable enhancement is noted after gadolinium administration (image 8, arrows). In the orbit, venous malformations frequently overlap with lymphatic malformations (“lymphangiomas”) and vice-versa.

Coronal T1

Coronal T1 (Post-contrast)

Coronal T2

Gradient

Axial T1

Axial T2

 

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She really put her shoulder into moving that desk

This 59-year-old female presents with left shoulder pain. The pain began three years earlier after moving a heavy desk, and has progressively worsened even after physical therapy. There is also limited range of motion. Have a look at the highlighted regions of images 1 through 7, and see if you can identify the potential cause of this patient’s symptoms.

Q1 – When abnormal signal is detected in the rotator cuff, what other features should help guide interpretation as to the primary cause for this appearance?

Coronal STIR

Sagittal T1

Coronal STIR

Coronal T1

Coronal T1

Sagittal T1

Coronal STIR

 

This is a case of subacromial impingement coexisting with likely subclinical fibroinflammatory capsulitis. There is clear:

  • Subacromial stenosis
  • Impingement with a thick coracoacromial ligament (CAL) (image 1, pink arrow)
  • A moderate to large amount of bursal fluid (image 3, blue arrow)
  • Peritendinobursitis (image 1, green arrow) of the superior cuff with tendinopathy (image 7, green arrows) consisting of small, but deep, interstitial tears of the supraspinatus (image 2, red arrows)

Therefore, subacromial impingement, and associated tendinopathy and peritendinobursitis, are the most likely cause for the patient’s symptoms.

Although uncommonly seen at the same time, fibroinflammatory capsulitis can coexistent with impingement. They coexist more commonly with partial, rather than communicating full-thickness, tears. This is because a communicating tear allows for inflammatory decompression into the bursal space, and prevents concentric contraction. As indicated above, adhesive capsulitis infiltrates the rotator cuff, and may produce T1 “grey” cuff ghosting. Sometimes infiltrative adhesive capsulitis and small partial tears may overlap or be difficult to differentiate. This is demonstrated by the thickening of the inferior glenohumeral ligament (image 4, yellow arrow) and anterior rotator interval (image 4, purple arrow), as well as a mild “corona sign” (image 6, yellow arrows). Additionally, note that there is no fluid in the axillary recess (image 5, orange arrow). In this case, the abnormal signal in the supraspinatus tendon is not interpreted as being primarily due to infiltrative fibroinflammatory capsulitis; the dominant features of impingement.

 

A1 – Other associated or contributing factors would be:

  • Subacromial impingement
  • Abnormal shape of the acromion
  • Thickening of the coracoacromial ligament
  • Associated rotator cuff tears
  • Presence of peritendinobursitis

 

Check out MRI Online for more case review.

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