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Biomedical subjects

E K Fishman

Publications and source records attributed to E K Fishman.

At least 541 records · Page 30Linked to original sources
PubMedDate not supplied

Multiplanar computed tomography of acetabular fractures.

Following plain radiographic examination CT with multiplanar reformatting (CT/MPR) was used to assess 34 patients with pelvic trauma and definite (24 patients) or clinically suspected (10 patients) fractures. Computed tomography/MPR detected four fractures missed on conventional radiography. The findings on CT/MPR led to major alterations of patient management in seven cases. In four patients in whom the initial decision had been to use closed management with traction, information derived from CT/MPR led to open surgical reduction. In three patients in whom the initial impression had been that open management was dictated, CT/MPR contributed anatomical information that reserved that decision, leading to more conservative management. In all patients going to surgery the surgeons believed that surgical planning and execution had been significantly affected by the information provided by CT/MPR. Computed tomography/MPR was used postoperatively in 10 patients to confirm the status of reduction and fixation and to evaluate patients with unusual problems in the recovery period.

Accidents, Traffic↗
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Typical and atypical CT manifestations of pulmonary sarcoidosis.

Chest CT of 36 patients with proven sarcoidosis were reviewed retrospectively. In all cases CT was obtained in an attempt to answer a diagnostic dilemma, either a patient with abnormal chest radiography and no clinical diagnosis or a patient with a history of known sarcoidosis and an atypical presentation on chest radiography. Computed tomography was superior to chest radiography in detecting and defining the presence of adenopathy. In addition, CT was more accurate in detecting the presence and extent of infiltrates. Secondary findings in sarcoidosis including pleural effusions, bullous disease, bronchiectasis, cavitation with and without mycetoma, and fibrosing mediastinitis were detected using CT. Using the information obtained from CT, we were able to arrive at the correct diagnosis in the majority of cases and to decide which modality would be most useful to secure tissue confirmation (bronchoscopy, transtracheal biopsy, or percutaneous needle biopsy of a solitary mass).

Adult↗
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CT demonstration of calcified liver metastases in medullary thyroid carcinoma.

The presence of calcification can be found in greater than 50% of thyroid cancers. With medullary thyroid carcinoma, calcifications may be found in the primary lesion as well as in metastatic lymph nodes and in the liver. We report two cases of medullary thyroid carcinoma with associated calcified liver metastases.

Adult↗
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CT demonstration of prominent right hilar soft tissue collections.

Three cases of normal soft tissue collections of the right hilum which could be confused with thrombus of the right pulmonary artery or adenopathy are demonstrated. These abnormalities are due to normal accumulations of hilar fat and lymph nodes. Their typical appearance allows easy recognition.

Aged↗
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CT findings in splenic hemangiomas in the Klippel-Trenaunay-Weber syndrome.

The Klippel-Trenaunay-Weber syndrome consists of cutaneous port wine hemangiomas, superficial venous varicosities, and soft tissue and bony hypertrophy of an extremity. We describe three patients with this syndrome with hypodense lesions in the spleen which in one case became isodense after bolus contrast CT. In one case ultrasound found numerous echopenic and echogenic masses. These lesions are presumed to represent multiple hemangiomata.

Adolescent↗
PubMedDate not supplied

Computed tomography of hepatic cavernous hemangioma.

Fifty hepatic hemangiomas in 38 patients were evaluated by CT using sequential scanning following bolus injection. Lesions were assessed for the following CT features: (a) low density lesion on unenhanced scan; (b) early peripheral contrast enhancement; (c) progressive opacification from the periphery to the center; (d) a delay of at least 3 min before total opacification; and (e) eventual isodense appearance with or without unopacified cleft. The criteria for diagnosis of hepatic hemangioma were (d) and (e) plus at least two of the remaining three features. Forty-eight lesions were identified by CT; 38 displayed all five features, five lesions were missing one feature, and five lesions did not meet the criteria for diagnosis. Larger lesions required a significantly longer period to opacify (p less than 0.05). The positive predictive value of CT in the diagnosis of hemangioma was 100%.

Adult↗
PubMedDate not supplied

Design of custom hip stem prostheses using three-dimensional CT modeling.

Long life expectancy, demand for high activity levels, and bone loss at the time of revision motivate the search for reliable and successful noncemented hip stem designs. It is hypothesized that improved implant fit may increase the longevity of noncemented total joints. Quantitative X-ray CT has enabled the use of a computerized stem design program, which designs an optimal-fit hip stem for individual femurs. Computed tomography and interactive image processing methods are used to generate the individual three-dimensional femoral models, which are used by the stem design program. Optimal-fit design provides maximum stem-bone contact while satisfying the requirement of being surgically insertable. Previous methods of custom implant design, including those that use three-dimensional CT modeling, have not provided optimal stem-bone fit. Quantitative results of this new process are presented.

Aged↗
PubMedDate not supplied

Computed tomography vs barium studies in the acutely symptomatic patient with Crohn disease.

Gastrointestinal contrast studies and CT performed on 43 patients with known Crohn disease with acute symptoms were retrospectively reviewed to assess the ability of each study to define the location and extent of disease. In 39 of 43 (91%) patients the contrast studies and CT agreed on the location of active disease. However, in 15 of 43 (35%) patients, contrast studies demonstrated additional areas of mucosal disease remote from the major area of activity that were not suggested by CT. In addition to demonstrating more extensive mucosal disease, contrast studies proved superior in demonstrating enteroenteric fistulae, sinus tracts, strictures, postsurgical anatomy, and relation of recurrence to anastomosis. Computed tomography proved superior in demonstrating mesenteric inflammation, abscesses, enterovesical and enterocutaneous fistulae, fistula to iliopsoas muscle and to sacrum. We conclude that in the patient with suspected abscess, enterovesical or enterocutaneous fistula, CT is the study of choice. In other clinical circumstances both CT and contrast studies should be performed since they are complementary.

Acute Disease↗
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Pseudomembranous colitis: CT evaluation.

The CT findings in five patients with pseudomembranous colitis are presented. The findings consisted of varying degrees of bowel wall and haustral fold thickening. Ascites was noted in three patients. Clinically and radiologically, pseudomembranous colitis can be confused with other inflammatory disorders of the gastrointestinal tract. Although the CT findings were not pathognomonic, they were highly suggestive of pseudomembranous colitis when combined with the clinical information.

Adult↗
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CT detection of sacral osteomyelitis associated with pelvic abscesses.

In three patients the diagnosis of sacral osteomyelitis was made when CT demonstrated intraosseous (two) and intraforaminal (one) gas. Two of the three patients also had radionuclide bone scans, one of which was unremarkable. In the other case, radionuclide scintigraphy greatly underestimated the extent of the disease process when compared with CT. All three patients had contiguous pelvic abscesses as a cause of the osteomyelitis. Although there was a high clinical suspicion for an intraabdominal process, the diagnosis of superimposed osteomyelitis of the sacrum was unsuspected. The detection of intraosseous gas is a pathognomonic, albeit uncommon, manifestation of osteomyelitis. Although the radionuclide bone scan is the method of choice for detecting osteomyelitis, CT should be used as a complementary study in certain patients.

Abscess↗
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Musculoskeletal desmoid tumors: CT assessment during therapy.

Musculoskeletal desmoid tumors can be difficult to characterize and to follow. The rate of regression after radiotherapy is variable, with poor response to chemotherapy and postoperative recurrence being common. Eighteen patients undergoing therapy for proven musculoskeletal desmoid tumors had 52 CT studies, which were assessed to determine the utility of CT in following such patients. Computed tomography was found to offer excellent initial baselines prior to additional treatment and in the early postoperative period and followed the tumor response to treatment. Ultimate tumor response could not be predicted by characteristics of or change in tumor margins, by initial or subsequent tumor CT attenuation, by appearance following intravenous contrast medium, or by tumor location. Decreasing size and stabilization of size in a previously growing lesion were the only reliable signs of response; markedly increasing attenuation heterogeneity suggested but was unreliable as an isolated sign of response.

Adolescent↗
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Evaluation of CT techniques for reducing artifacts in the presence of metallic orthopedic implants.

Metallic intramedullary orthopedic implants generate artifacts that can markedly degrade transaxial CT images. The artifacts, typically seen as starburst streaking, result primarily from reconstructions involving missing projection data. Two approaches are clinically available to reduce the artifacts around orthopedic implants. These are (a) the imaging of implants with lower attenuation coefficients or smaller path lengths (less attenuating objects) and (b) the planar reformatting of image data. The sizing accuracy of these two approaches was quantified using phantoms and the efficacy using cadaveric femoral specimens. Results demonstrated that metal artifacts may be reduced and accurate bony dimensional data obtained.

Evaluation Studies as Topic↗
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Spontaneous hepatic hemorrhage: clinical and CT findings.

The clinical records and radiologic findings in six patients with spontaneous (nontraumatic) intrahepatic and subcapsular hemorrhage were reviewed. Four patients had underlying liver lesions (hepatocellular carcinoma and metastasis from B-cell lymphoma in one patient each and hepatic adenoma in two other patients). One patient had intrahepatic hemorrhage associated with hepatic necrosis secondary to organophosphate toxicity. The specific etiology of hemorrhage in the remaining patient proved elusive despite an exhaustive search. Hepatic hemorrhage was diagnosed and followed by CT (six cases), sonography (two cases), and celiac arteriography (three cases). Computed tomography was useful in defining the extent of the hematoma and showing density changes related to the age of the hematoma.

Adolescent↗
PubMedDate not supplied

Three-dimensional imaging and display of musculoskeletal anatomy.

Conventional three-dimensional imaging uses thresholding, or surface rendering technique, which limits accuracy and detail, and hinders soft tissue definition. Volumetric image rendering preserves all CT data, not just surface boundaries, and therefore overcomes these limitations. Three-dimensional images thus generated can be used for muscular and vascular anatomy as well as skeletal structures, with preservation of subtle detail. Representative cases are used to illustrate this technique and its implications for therapy and plastic and reconstructive surgery.

Humans↗
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Vascular abnormalities following radio- and chemotherapy of hepatic neoplasms: CT angiographic findings.

Four patients (three with hepatocellular carcinoma and one with colorectal carcinoma metastatic to the liver) previously treated with chemotherapy or radiotherapy or both in an attempt to reduce tumor bulk prior to surgical resection were examined by CT angiography (CTA). Areas of abnormal enhancement and irregular vessels simulating tumor involvement proved to be free of neoplasm at surgery. Perfusion abnormalities and vascular irregularity on CTA following radiotherapy or chemotherapy should not be automatically considered as neoplastic. Tissue confirmation in such cases should be obtained to rule out treatment related hepatic parenchymal changes.

Adolescent↗