Infants born with heart defects sometimes must undergo invasive cardiac catheterization to give surgeons an accurate picture of the arteries and veins of the heart. CUMC pediatric cardiologists have now successfully used MRI to obtain the same information noninvasively, with no radiation exposure.
      MRI has been used for several years to visualize the major arteries and veins inside the chest in older children and adults, but infants under 3 months of age present several technical challenges, including movement by the infant. Dr. Prakash developed a procedure to overcome those challenges and obtained images from 28 infants.
      The study found that the image quality of the blood vessels – which was evaluated by an outside radiologist – was adequate for diagnosis in all cases. Among the 28 high-quality images, subsequent surgical or catheterization procedures confirmed the accuracy of the MRI diagnosis.
      “Now we only use catheterization when it’s really needed to perform an interventional procedure or measure pressure inside the vessels,” says Ashwin Prakash, M.D., assistant professor in pediatric cardiology and radiology.
American Journal of Cardiology (2007) 100: 715-72

Less Radical Cervical Cancer Surgery Possible
Radical hysterectomy may become a thing of the past for many women diagnosed with early stage cervical cancer, according to two studies by Jason Wright, M.D., assistant professor of obstetrics and gynecology.
      For 50 years, the standard treatment for cervical cancer has been a radical hysterectomy. In addition to removing the cervix, the procedure removes the uterus and the surrounding parametrium to eliminate potential metastases in those tissues.
      Since many cases of cervical cancer in the United States are caught before the tumor has spread, many women could be spared the extensive surgery, which causes long-term urinary and sexual problems.
      To identify those women, Dr. Wright analyzed nearly 600 patients diagnosed with early stage cervical cancer who underwent
a radical hysterectomy between 1989 and 2005. In a surprisingly high 29 percent of patients, no residual cervical cancer was noted in the uterus at the time of radical hysterectomy and all remained cancer-free during follow-up. Such patients may be spared uterus removal in the future, but Dr. Wright says more work is needed to reliably identify the women before surgery.
      For now, however, radical hysterectomy remains the standard of care for all patients with early stage cervical cancer until prospective trials are conducted.
Cancer 110(6):1281-6
Gynecologic Oncology 2007 in press