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Biomedical subjects

E K Fishman

Publications and source records attributed to E K Fishman.

At least 577 records · Page 32Linked to original sources
PubMedDate not supplied

CT evaluation following Whipple procedure: potential pitfalls in interpretation.

A series of 41 CT examinations in 14 patients who had undergone a Whipple procedure for pancreatic cancer followed by adjuvant chemotherapy and radiation therapy were reviewed to determine the spectrum of CT findings, as well as to identify potential sources of error in interpretation. Thickening of the wall of the gastric antrum and proximal duodenum from 5 to 10 mm (9 of 14 patients) occurred as early as 1 month after completion of radiotherapy and simulated recurrent tumor. Unopacified anastomotic bowel loops in the porta hepatis in 23 of 41 examinations (56%) also mimicked recurrent tumor or adenopathy. Five of 14 patients showed liver metastases and 4 of 14 had recurrent disease in the pancreatic bed. Pneumobilia (33 of 41 examinations) was a frequent normal finding.

Adult↗
PubMedDate not supplied

Thoracic Kaposi sarcoma in AIDS: CT findings.

Cases of acquired immunodeficiency syndrome (AIDS) related Kaposi sarcoma (KS) were reviewed to characterize the spectrum of thoracic findings seen with chest CT. Of 15 patients with AIDs-related KS involving the chest, 13 (87%) demonstrated pulmonary parenchymal disease characterized by multiple, bilateral flame-shaped or nodular lesions with ill-defined margins distributed along bronchovascular bundles. Pleural disease was noted in 10 (67%) patients, characterized by 9 cases of pleural effusions and 1 case of pleural implants. Chest wall disease involving the sternum, ribs, thoracic spine, and/or subcutaneous tissue was noted in eight (53%) patients. Although pleural and parenchymal lung disease are recognized manifestations of thoracic KS, there is also a high incidence of extrapulmonary chest disease evident on CT in patients with AIDS.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

CT arterial portography vs pancreatic arteriography in the assessment of vascular involvement in pancreatic and periampullary tumors.

OBJECTIVE: Preoperative staging of pancreatic tumors is frequently accomplished through a combined effort of CT and arteriography. For tumor detection and delineation of disease extent CT is utilized routinely, with CT arterial portography (CTAP) being the single most accurate study for the detection liver metastases. Arteriography has remained the "gold" standard for assessing vascular involvement. The purpose of this study was to determine whether CTAP could become the single study of choice for assessing resectability in patients with pancreatic and periampullary tumors with particular emphasis on its accuracy in determining vascular involvement. MATERIALS AND METHODS: Radiologic studies and medical records were reviewed in 20 patients who had received both CTAP and arteriographic examinations for preoperative assessment of pancreatic and periampullary tumors. These findings were correlated with results from either surgery (12 cases) or percutaneous biopsy and follow-up (8 cases) in 12 nonresectable and 8 resectable tumors. RESULTS: Arteriography and CTAP correctly concurred in 75% of cases (15 of 20); CTAP correctly demonstrated vascular involvement not appreciated on arteriography in 15% (3 of 20) with an overall sensitivity and specificity of 90 and 100%, respectively. Arteriography was superior to CTAP in one patient (5%) with an overall sensitivity and specificity of 70 and 90%, respectively, for predicting vascular involvement by tumor. CONCLUSION: Our experience suggests that CTAP is more accurate than arteriography for demonstrating tumor involvement of major peripancreatic vessels. Because CTAP, additionally, has a high sensitivity for detecting liver metastases, no further studies may be necessary to determine operability of these patients.

Adenocarcinoma↗
PubMedDate not supplied

Depiction of pelvic fractures using 3D volumetric holography: comparison of plain X-ray and CT.

OBJECTIVE: The goal of this study was to demonstrate the feasibility and test the diagnostic performance of a new technology, 3D volumetric holography, for imaging pelvic fractures. The management of pelvic fractures may be complex, and advanced imaging studies such as CT are frequently indicated. Multiplanar CT reformations and 3D renderings provide clinically useful and complementary display of the directly acquired CT data. With the recent availability of volumetric multiple exposure holograms, produced from serial image data, it is now possible to produce true 3D images of the pelvis. In the hologram, one may view the CT data in 3D or as individual planar slices constituting the whole 3D pelvis. The diagnostic performance of the volumetric multiple exposure holograms was tested against routine radiography, CT, and 3D volumetric CT reconstructions. MATERIALS AND METHODS: Routine radiography and CT were performed in 15 patients with suspected pelvic fractures. Volumetric multiple exposure holograms and 3D volumetric CT reconstructions were created from the CT data. Axial and multiplanar reformation CT images were used as the standard for fracture, diastasis, and intraarticular fragment detection. RESULTS: Radiograms detected 39 of 50 of the fractures and diastases and no intraarticular fragments. The 3D CT reconstructions and the holograms viewed as 3D objects alone missed two small fractures of the anterior column and one hip with intraarticular bone fragments. When the volumetric multiple exposure holograms were viewed as a 3D object and as individual planar slices constituting the whole, their results were the same as the standard. CONCLUSION: Volumetric multiple exposure holograms were as sensitive and specific as axial CT and multiplanar reformations in detecting fracture pathology. By containing and making available, from one image, both planar and 3D information, volumetric multiple exposure holograms detected subtle anatomical features that were hidden by overlapping structures in the radiographs and the 3D CT images.

Fractures, Bone↗
PubMedDate not supplied

Three-dimensional helical CT of intrahepatic venous structures: comparison of three rendering techniques.

OBJECTIVE: To define the advantages and disadvantages of various rendering techniques to obtain three-dimensional (3D) displays of intrahepatic venous structures with helical CT data. MATERIALS AND METHODS: After rapid preprocessing segmentation of the liver, helical CT data (8 mm slice thickness overlapped every 4 mm) from 10 patients were reconstructed using maximum intensity projection (MIP), volume rendering, and surface rendering algorithms. Three-dimensional imaging was evaluated blindly and independently by three observers for presence of artifacts and overall quality. RESULTS: Three-dimensional displays showed the hepatic veins and fifth order portal branches with the volume and MIP rendering techniques. Best overall quality in the 3D representation of the liver was achieved with the MIP technique (p < 0.05). Small details in venous anatomy and portal involvement by tumor were better imaged with the MIP technique. "Stair-step" artifacts markedly degraded the 3D displays obtained with the surface rendering technique, making it inappropriate for imaging the intrahepatic venous structures. CONCLUSION: Maximum intensity projection appears to be an adequate technique to perform 3D imaging of intrahepatic venous structures with helical CT data when 8 mm slice thicknesses overlapping every 4 mm are used. However, optimization of imaging protocols needs to be done and compared in a larger series.

Aged↗
PubMedDate not supplied

CT of hemorrhagic complications of anticoagulant therapy.

Anticoagulant therapy is commonly used in patients at risk for, or known to have, thromboembolic disease. Although complications of therapy are uncommon in most patients, in others it may result in complications with substantial morbidity and occasionally may be life threatening. This essay reviews the role of anticoagulant therapy and defines the potential complications that may occur in the chest, abdomen, musculoskeletal system, and CNS. Specific pitfalls in diagnosis as well as complications of the bleeding process are discussed and illustrated. The role of CT scanning in the diagnosis and triage of these patients is clearly defined through select cases and clinical dilemmas.

Anticoagulants↗
PubMedDate not supplied

CT of appendicitis in children.

PURPOSE: Our goal was to review the CT findings and to help define the role of CT in the evaluation of appendicitis in children. METHOD: Of 730 children with surgically proven appendicitis, 22 underwent preoperative CT evaluation. Their CT scans and operative and pathology records were retrospectively reviewed. The CT scans were evaluated for appendiceal wall thickness, diameter, and location, appendicoliths, pericecal inflammation, phlegmon, abscess, free fluid, small bowel dilatation, and bowel wall thickening. Criteria for diagnosing appendicitis were (a) appendiceal wall thickening (> 1 mm) or (b) presence of abscess, phlegmon, or pericecal inflammation associated with appendicolith(s). Prospective reports of ultrasound examinations performed within 2 days of the CT scans were available in 14 children and were correlated with the CT findings. RESULTS: An abnormally thickened appendix, with a diameter ranging from 9 to 18 mm, was seen in four children. Three appendices were retrocecal and one was near the cecal tip, anterior to the iliac vessels. Appendicoliths were present in 10 children, multiple in 1. Abscesses were seen in 13 of 22 children, multiple in 5. Phlegmon was seen in five children and pericecal inflammation in two. Bowel wall thickening was present in seven children and small bowel dilatation was noted in six. Other findings included free fluid, hydronephrosis, thickening of urinary bladder wall, air in the uterus and vagina, adenopathy, and thickening of the abdominal wall musculature. CT was diagnostic of appendicitis in 11 of 22 children (50%). In 14 children with both ultrasound and CT studies, CT was slightly better in diagnosing appendicitis and visualizing the abnormal appendix and was superior in defining the presence and extent of abscess and inflammation in 9 of 14 children. CONCLUSION: CT is a useful adjunct in diagnosing appendicitis in children, with a major role in cases of complicated appendicitis.

Abscess↗
PubMedDate not supplied

Ossification of a rectal tumor: CT evaluation.

Adenocarcinoma of the colon is a common malignancy. Not infrequently, this tumor can calcify. An extremely rare occurrence in these tumors is ossification. This is the first reported case of rectal carcinoma in which ossification was demonstrated with CT.

Adenocarcinoma↗
PubMedDate not supplied

The accuracy of CT staging of small bowel adenocarcinoma: CT/pathologic correlation.

PURPOSE: Several studies have documented the use of CT in the evaluation of small bowel neoplasms, but few have addressed the CT staging of adenocarcinoma. We retrospectively correlated CT and pathologic staging to evaluate the accuracy of CT for staging small bowel adenocarcinoma using American Joint Committee on Cancer criteria. METHOD: The preoperative CT scans of 15 patients with pathologically proven small bowel adenocarcinoma were analyzed. Two blinded readers separately interpreted extent of invasion, presence of lymphadenopathy, and distant metastases. Pathologic and CT staging were compared. RESULTS: The overall accuracy of CT staging was 47% (14/30). The sensitivity of detection of mesenteric infiltration was 88%. The sensitivity and specificity for detection of distant metastases were 58 and 63% and for lymphadenopathy 75 and 20%, respectively. Errors occurred in patients with Crohn disease, adenomas, Peutz-Jegher syndrome, small bowel obstruction, and perforation and on suboptimal studies. CONCLUSION: The accuracy of CT staging of small bowel adenocarcinoma is 47%. CT is highly sensitive but not specific for the detection of mesenteric infiltration and regional lymphadenopathy. Since spiral CT may offer improved detection of distant metastases and increased accuracy in the evaluation of patients with concomitant bowel disease, further research is needed to determine the maximal utility of CT in the staging of adenocarcinoma of the small bowel.

Adenocarcinoma↗
PubMedDate not supplied

The CT halo sign: a new finding in intestinal lymphangiectasia.

A "halo sign" has been described in patients with Crohn disease, ulcerative colitis, radiation enteritis, ischemic colitis, and pseudomembranous colitis. This sign is characterized by an inner ring of low CT attenuation surrounded by a higher attenuation outer ring. We present a patient with primary intestinal lymphangiectasia in whom CT demonstrated a halo sign correlated with mucosal biopsy.

Adult↗
PubMedDate not supplied

Virtual angioscopy using spiral CT and real-time interactive volume-rendering techniques.

Our purpose was to describe a technique for visualizing the inner contours of the vasculature using contrast enhanced spiral CT and volume rendering techniques. Because the technique is similar to using a camera to look inside vessels, we call this technique "virtual angioscopy." Preliminary results suggest virtual angioscopy using volumetric 3D rendering techniques as a potentially useful technique for the noninvasive evaluation of vascular pathology.

Adult↗
PubMedDate not supplied

Helical CT with multiplanar display: role in evaluation and clarification of complex renal pathology.

Helical CT provides an accurate tool in the diagnosis and detection of renal disease. A major advantage of renal helical CT is the ability to obtain a volumetric dataset during optimal vascular and parenchymal enhancement. In addition, multiplanar display improves demonstration of key anatomic relationships and clarifies complex pathology. In this essay, we demonstrate the advantages of multiplanar display in evaluation of the kidney.

Adult↗