Dr. Leo Wolansky

MRIs Now Offered on UConn Storrs Campus

MRI service manager Elisa Medeiros prepares a patient for functional MRI testing at the Brain Imaging Research Center in Storrs.

MRI service manager Elisa Medeiros prepares a patient for functional MRI testing at the Brain Imaging Research Center in Storrs.


UConn Health patients in eastern Connecticut will now be able to get MRI scans done in Storrs just as if they were at UConn Health in Farmington, thanks to a collaboration between doctors and researchers at the two campuses.

UConn’s Brain Imaging Research Center (BIRC) houses a powerful 3 Tesla Magnetic Resonance Imaging (MRI) scanner that was installed in 2015 and originally dedicated purely to research. The BIRC’s machine can take detailed pictures of fine structures in the brain, do functional MRI, and spot tiny flecks of blood that might signal a concussion or spine injuries. But the state had not previously licensed the BIRC’s machine to perform medical work.

“Soon after I started as chair, it became clear we had a long history of our UConn Husky athletes having scans done on the outside. But then their docs would bring the scans to us for a second read because they trusted us,” says Dr. Leo Wolansky, head of radiology at UConn Health. “It’s our moral obligation to take care of our own people,” but it was a lot of unpaid work too, he observes.

When we read the scans, it’s no different than if patients were down the hall.

Wolansky worked with the team at BIRC, along with regulatory and business development staff at UConn Health, to get permission from the state to use the center’s machine for medical imaging. The machine was set up to run clinical scans, and hardware was installed to transmit medical data securely from the BIRC, which is located in the Phillips Communication Sciences Building in Storrs, to UConn Health in Farmington.

UConn Health doctors can now schedule MRIs for their patients at the BIRC in Storrs for Monday and Wednesday afternoons as easily as if they were going to the imaging center in Farmington. Urgent scans can be squeezed in at other times on a case-by-case basis. The BIRC capacity will free up some space at UConn Health, bringing new patients into the system, and is not expected to impact research done at the center at all.

“The biggest benefit is the integration between campuses. It’s a huge success for us to do this,” says Fumiko Hoeft, the director of BIRC, noting that revenue from the scans will enhance the financial stability of the center.

Wolansky, who is based in Farmington, agrees.

“Even though [patients] may be 40 minutes away by car, when we read the scans [at the imaging center in Farmington], it’s no different than if the patients were down the hall.”

Sharing Knowledge for Better Patient Care

Q&A with Dr. Leo J. Wolansky, professor and chair of UConn Radiology

Q

You’ve spearheaded a teaching tool on the UConn Health Radiology website that features cases with images, diagnoses, and even a quiz mode. Where did this idea come from, and how do you envision physicians using it?

Technology has changed the way we get information, and we find that most people answer questions by looking online. Radiology, which relies so heavily on technology, is a specialty that is much more visual than most other fields of medicine. Every day we encounter an abundance of complex digital images created by sophisticated equipment. The digital images can be captured, uploaded, and sent throughout the world with relatively little effort. I thought it would be a waste not to share this valuable material with everyone.

Medical students and radiology residents will likely use it the most. Furthermore, resident doctors in many different fields are tested on the imaging that relates to their specialty. Even after their training, patients expect doctors and other providers to be knowledgeable about everything related to their care, including imaging. Radiology Online can further educate providers and even educate patients about their health. It also provides the contributing physicians and students from UConn as well as other institutions with an academic outlet that is beneficial for career development. It’s UConn’s own open-access radiology review book.


Q

What other projects are you focused on?

We have a number of other initiatives, such as the Linda Clemens Foundation Free Mammogram Program, which provides funds for screening and diagnostic mammograms, breast ultrasounds, and breast biopsies for uninsured and underinsured UConn Health patients. We have added a new CT scanner in the Musculoskeletal Institute building that will increase our capacity significantly and will create a more patient-friendly outpatient setting. We will also offer weekend MRI appointments at the Musculoskeletal Institute. Additionally, we have a new attending, Dr. Abner Gershon, who strengthens our stroke service and is opening a minimally invasive neck and back pain clinic. In the area of nuclear medicine, we are now offering DaTscan brain scans for differentiation of Parkinsonian syndromes from essential tremor.


Q

What can you tell us about the new imaging center in Storrs? How will it benefit patients in the area?

When I started here, I immediately saw how important to the state the UConn athletics program is. It seemed strange that it was so difficult for us to image our own athletes, or any UConn students, in Storrs. From my previous research, I was aware of the Brain Imaging Research Center (BIRC) in Storrs, which has a fabulous scanner. It occurred to me that their MRI scanner could provide patient care without interfering with the research mission of the BIRC.

Once we converted it, we’d be able to read the images here at UConn Health. This would allow us to care for our own student-athletes, other students, faculty, staff, as well as the general public in the Storrs area, sparing them the 45-minute trip to Farmington. I explored a partnership with the BIRC leadership, working closely with Inge-Marie Eigsti, Jay Rueckl, and now the new director, Fumiko Hoeft, who has been extremely helpful. While the scanner will continue to be primarily an instrument of research, soon we will be rolling out this clinical service at the BIRC.

Neuroimaging Technique Raises Stroke Treatment Standard

Dr. Leo Wolansky

Dr. Leo Wolansky, chair of the UConn Health Department of Radiology, shows the types of images CT perfusion scanning yields to help determine the best course of action in stroke treatment.


UConn John Dempsey Hospital is among only a few hospitals in the state to offer a new neuroimaging technique to patients who’ve suffered the most common type of stroke, potentially quadrupling the narrow window for intervention to 24 hours from the onset of symptoms.

The cutting-edge technique, which involves new software called RAPID, facilitates computed tomography (CT) perfusion imaging in emergency settings by making radiologic interpretation of perfusion data simpler, a particularly crucial feature when treating emergency stroke patients.

This helps physicians determine which patients are good candidates for a highly specialized neurosurgical and interventional radiological procedure called mechanical thrombectomy. The lifesaving procedure is only available at a few hospitals in the state; UConn Health Chief of Neurosurgery Dr. Ketan Bulsara performed UConn John Dempsey Hospital’s first-ever mechanical thrombectomy in November.

“It enables us to easily check how large an area of the brain is deprived of blood flow,” says Dr. Leo Wolansky, chair of the UConn Health Department of Radiology. “We can distinguish between the part of the brain that’s already dead [cerebral infarction] and the part of the brain that is in danger of dying [ischemic] but can be saved.”

In October, UConn Health rolled out the perfusion imaging program a week after processing its first functional MRI case for surgical guidance. The innovations are part of a system-wide initiative by UConn Health leadership to provide cutting-edge technology and recruit top physicians familiar with its use, such as Wolansky, in order to provide the finest care for neurological conditions.

Historically, when a patient has cerebral infarction, the most common type of stroke, the race is on to administer a clot-dissolving medication known as a tissue plasminogen activator (TPA). Mechanical thrombectomy traditionally has also been an option with a very limited timespan. With the introduction of advanced imaging such as RAPID, patients now can be treated safely for up to 24 hours of their stroke if the CT perfusion scan is favorable.

“We can tell if there is brain that can be saved, even beyond the previously accepted window of time for thrombectomy,” Wolansky says. “This creates the possibility of treating many ‘wake-up’ strokes, people who went to sleep well, but woke up eight hours later with a stroke.”

The results of a major study known as the DAWN trial, released in May 2017, showed good outcomes for stroke patients who were treated with thrombectomy up to 24 hours after the event.

The Power of MRI

A UConn Health physician is seen reviewing an MRI brain scan.

A UConn Health physician is seen reviewing an MRI brain scan. At UConn Health, doctors are pioneering ways to use MRI technology to diagnose and monitor a range of conditions affecting many parts of the body Photo: Peter Morenus


Magnetic resonance imaging (MRI) has come a long way since the technique was first used in the U.S. in the late 1970s. UConn Health is now taking this powerful, non-invasive imaging tool to the next level.

UConn Health physicians in a variety of specialties are using the technology — which captures images of the inside of the body using a large magnet rather than radiation — in new ways to detect and monitor illnesses.

Prostate Cancer

Dr. Peter Albertsen, chief of UConn Health’s Division of Urology, currently follows 100 patients with localized prostate cancer, which is slow-growing, using advanced multiple-parametric MRI imaging. The technology has now replaced ultrasound as the imaging method of choice for prostate cancer. The technique yields multiple imaging sequences of the prostate, providing information about the anatomy, cellular density measurement, and vascular supply.

There is growing evidence to support the idea that the best treatment plan for low-grade prostate cancer is “watchful waiting” to monitor its progression, instead of immediate surgery or radiation. Albertsen’s practice of active surveillance, and not intervention, for localized prostate cancer was reinforced by a recent long-term study published in September in the New England Journal of Medicine, on which Albertsen served as a consultant.

The technology is extraordinarily helpful, allowing us to avoid invasive biopsy testing and associated risks of bleeding and infection.

Liver Disease

UConn Health is the first in Greater Hartford to use MRI to measure the stiffness of patients’ livers to reveal disease without the need for biopsy. Its MR elastography technique involves placing a paddle on a patient’s skin over the liver during MRI to create vibrations and measure the velocity of the radio waves penetrating the organ. This can indicate a stiffer liver and help diagnose fibrosis, cirrhosis, a fatty liver, or inflammation associated with hepatitis. The initiative is led by Dr. Marco Molina, radiologist in the Department of Diagnostic Imaging and Therapeutics.

“The technology is extraordinarily helpful, allowing us to avoid invasive biopsy testing and associated risks of bleeding and infection,” Molina says. “Plus, with the obesity epidemic, patients developing nonalcoholic steatohepatitis (NASH), or fatty liver, can receive earlier diagnosis and take action to reverse their disease’s progression with diet and exercise.”

Breast Cancer

The new Women’s Center at UConn Health has opened its state-of-the-art Beekley Imaging Center, featuring advanced breast cancer screening. Dr. Alex Merkulov, associate professor of radiology and section head of women’s imaging, and his team are conducting research to test the effectiveness of using an abbreviated, five-minute MRI scan to confirm or rule out a breast cancer diagnosis. Typically, an MRI test takes 20 minutes, but researchers are seeing that a briefer MRI scan of just a few minutes can help provide a definitive answer to whether an abnormal breast growth is cancer or not — and potentially help women avoid the biopsy process.

Arthritis

The UConn Musculoskeletal Institute is now researching the use of MRI to assess and map the strength, weakness, and underlying makeup of a patient’s cartilage, especially for those with arthritis. The tool can allow orthopedic experts to identify any thinning or loss of cartilage in the body, which signifies moderate to late-stage disease. In early stages of arthritis, MRI can help pinpoint early morphological and subtle biochemical changes in cartilage.

Neurological Disorders

In neuroradiology, UConn Health is using the power of MRI to differentiate brain tumors, to detect strokes, to assess dementia, to diagnose multiple sclerosis, to evaluate traumatic brain injury, to find the source of epilepsy, and to guide brain surgery. In March 2017, leading neuroradiologist Dr. Leo Wolansky joins UConn Health to advance its research and chair the Department of Diagnostic Imaging and Therapeutics. Wolansky’s neuroimaging research has focused on enhancing understanding of MRI and its contrast agents, especially for multiple sclerosis and brain tumors. He also specializes in the hybrid imaging modality PET-MRI.

“Thanks to the power and advancement of MRI, doctors can see early evidence of disease and seize the opportunity to intervene and improve their patients’ health,” Molina says.