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E K Fishman

Publications and source records attributed to E K Fishman.

At least 595 records · Page 33Linked to original sources
PubMedDate not supplied

Dual-phase spiral CT angiography with volumetric 3D rendering for preoperative liver transplant evaluation: preliminary observations.

PURPOSE: The goal of our study was to determine whether dual-phase spiral CT angiography with 3D volume rendering could be used for preoperative evaluation and patient selection for orthotopic liver transplantation candidates. METHOD: Fifty consecutive potential candidates for liver transplantation were evaluated with dual-phase spiral CT with 3D volume rendering. Intravenous contrast medium was administered as bolus peripheral injection at 3 ml/s. The protocol consisted of a contrast-enhanced dual-phase spiral CT (arterial phase acquisition at 30 s after initiation of contrast medium injection followed by portal venous phase beginning at 60 s) with scan parameters of 0.75 s gantry rotation speed, 3 mm collimation, 5 to 6 mm/s table speed, and reconstruction at 1 mm intervals for arterial-phase images and 3 mm collimation for portal venous-phase studies (Siemens Plus 4 scanner; Siemens Medical Systems, Iselin, NJ, U.S.A.). All scan information was sent to a free-standing workstation (Silicon Graphics Onyx or Infinite Reality, Mountain View, CA, U.S.A.) for interactive real-time 3D volume rendering using a customized version of the Volren volume renderer (Silicon Graphics; Advanced Imaging Laboratory, Johns Hopkins Medical Institutions, Baltimore, MD, U.S.A.). The arterial phase was used to create vascular maps of the celiac axis including the origin(s) of the hepatic artery and origin of the superior mesenteric artery. The portal phase was used to define portal venous patency as well as the hepatic venous anatomy. All images were analyzed for vascular patency, shunting, or collateralization as well as the status of the underlying liver (i.e., liver size, cirrhosis, tumor, etc.). RESULTS: All 50 studies were successfully completed without complication. The 3D CT angiograms defined key arterial and venous structures including origin(s) of the hepatic artery, portal vein and/or superior mesenteric vein thrombosis, cavernous transformation of the portal vein, and/or other collateral vasculature. Ten patients (20%) demonstrated anomalous anatomy at the origin(s) of the hepatic artery. Portal vein thrombosis with cavernous transformation of the portal vein was shown in six patients, and there were three cases of partial venous thrombosis. Underlying liver tumors as well as parenchymal liver disease were well defined. Hepatic masses were found in five patients. Masses were pathologically proven as hepatocellular carcinoma (n = 1), giant cavernous hemangioma (n = 1), hepatic adenoma (n = 1), and focal nodular hyperplasia (n = 2). CONCLUSION: Preliminary results suggest that dual-phase spiral CT with CT angiography can provide a comprehensive preoperative liver transplant evaluation, supplying the necessary information for patient selection and surgical planning. As a single, minimally invasive examination, this should significantly impact patient care by minimizing procedures and avoiding potential complications.

Adolescent↗
PubMedDate not supplied

Aortic dissection involving an aberrant right subclavian artery: CT and MR findings.

Three cases of aortic dissection involving an aberrant right subclavian artery are presented. Preoperative diagnosis was made based on CT and MRI. The association of dissection and aberrant right subclavian artery is rarely encountered; however, the diagnostic and therapeutic implications of these associations are important. We describe the chest radiographic, CT, and MR findings of this rare complication of a relatively common congenital vascular anomaly.

Aged↗
PubMedDate not supplied

Pseudomembranous colitis: can CT predict which patients will need surgical intervention?

PURPOSE: Our purpose was to determine if patients with pseudomembranous colitis (PMC) requiring surgical intervention demonstrate radiographic features distinct from those of patients treated successfully with standard medical therapy. METHOD: The indications for a CT study and the imaging findings from 17 patients who required laparotomy with colon resection for PMC were retrospectively reviewed. The CT findings were compared with the findings from 17 control patients (matched by clinical presentation) with PMC who were treated medically and did not require surgical intervention. RESULTS: None of the CT findings evaluated in this study were significantly different between the surgical and nonsurgical groups. The CT findings evaluated for the surgical and nonsurgical groups, respectively, were as follows: wall thickness of the colon: 17.8+/-6.6 and 16.9+/-3.9 mm; largest caliber of the colon: 6.8+/-1.6 and 6.1+/-1.2 cm; presence of the accordion sign: 52.9 and 70.6%; heterogeneous contrast enhancement pattern (target sign): 57.1 and 57.1%; pericolonic stranding: 82.4 and 88.2%; ascites: 70.6 and 58.8%; pleural effusion(s): 64.7 and 64.7%; and subcutaneous edema: 64.7 and 64.7%. CONCLUSION: Although none of the CT findings evaluated in this study was significantly different between the surgical and nonsurgical groups, CT was often the initial diagnostic modality in both groups. It is important for radiologists to recognize the CT appearance of PMC and suggest the diagnosis. However, patient triage may not be based solely on the CT findings.

Adult↗
PubMedDate not supplied

CT of nonneoplastic diseases of the small bowel: spectrum of disease.

This article reviews the CT imaging features of a variety of nonneoplastic conditions that affect the small bowel and stresses important distinctive patterns that may help distinguish specific entities. Various inflammatory conditions (Crohn disease, radiation enteritis, graft versus host disease, celiac disease, Whipple disease, eosinophilic gastroenteritis, Behçet disease) as well as infiltrative disorders (amyloidosis, lymphangiectasia) and infectious diseases (Mycobacterium avium intracellulare, cytomegalovirus, cryptosporidiosis) are reviewed, with key differential points emphasized. In addition, miscellaneous conditions such as ischemia, small bowel diverticulitis, and small bowel hemorrhage are discussed.

Colon↗
PubMedDate not supplied

Normal enhancement of the small bowel: evaluation with spiral CT.

PURPOSE: The purpose of this work was to determine normal contrast enhancement of the small bowel with biphasic spiral CT, using water as oral contrast agent. METHOD: Biphasic spiral CT was performed in 50 healthy patients undergoing evaluation as potential renal donors. All patients received 500 ml of water as oral contrast agent and 150 ml of Omnipaque 350 administered by mechanical injector at a rate of 3 ml/s. Dual phase CT of the abdomen was performed in each patient. Acquisition of early phase images began 30 s after the start of the intravenous injection, and portal phase images were obtained 60 s after initiation of the contrast agent injection. Attenuation measurements (in Hounsfield units) were obtained from the wall of the small bowel (duodenum, jejunum, ileum) in both the arterial and the portal phases. RESULTS: During the arterial phase, the mean (95% confidence interval) attenuation of the duodenum, jejunum, and ileum was 120 (+/- 5), 119 (+/- 5), and 118 (+/- 5) HU, respectively. During the portal phase, the average attenuation of the duodenum, jejunum, and ileum was 111 (+/- 4), 111 (+/- 3), and 107 (+/- 3) HU, respectively. There was no statistically significant difference between the attenuation of the duodenum, jejunum, or ileum within either the arterial or the portal venous phases. There was a statistically significant difference in small bowel enhancement between the arterial and portal venous phases. CONCLUSION: There is no important variation in small bowel attenuation during the 30 and 60 s scanning phases. This study serves as a normal reference that may be helpful when spiral CT is used to evaluate ischemic bowel or inflammatory small bowel diseases.

Administration, Oral↗
PubMedDate not supplied

Multidetector CT angiography in the evaluation of pancreatic carcinoma: preliminary observations.

Multidetector CT (MDCT) provides unparalleled capabilities for combining narrow scan collimation with rapid data acquisition protocols. When combined with CT angiographic techniques and 3D-volume rendering we are able to create unique displays for evaluating a range of clinical pathologies. In this pictorial review we present the potential advantages of using MDCT angiography for the evaluation of pancreatic cancer and its role in the accurate staging of these patients. The use of dual-phase CT scanning in both the arterial phase and portal phase is addressed with the role of 3D CT angiography clearly defined. Numerous case studies are presented to show the advantages of these techniques over simple axial CT imaging.

Aged↗
PubMedDate not supplied

Helical CT of the abdomen and pelvis: potential diagnostic pitfalls of arterial-phase imaging in the genitourinary tract.

Spiral computed tomography (CT) is the state of the art today in imaging many features of the genitourinary tract. The use of dual-phase CT imaging improves our ability to detect and stage a wide range of pathologies. However, imaging in the arterial phase has several potential pitfalls that can result in either overcalling or undercalling genitourinary pathology. This paper reviews some of the common pitfalls and presents strategies on how to avoid them.

Diagnosis, Differential↗
PubMedDate not supplied

Three-dimensional volume-rendering CT angiography in vasculitis: spectrum of disease and clinical utility.

Spiral computed tomographic angiography (CTA) coupled with three-dimensional volume-rendering image processing is a less invasive alternative to conventional catheter angiography. The technique has been used successfully in a variety of vascular diseases. In this pictorial essay, we review the CTA findings in selected cases of vasculitis. Technical considerations and the potential clinical value of this method are discussed.

Adult↗
PubMedDate not supplied

Visual survey of cancer dissemination: classic patterns on helical CT. Abdomen and pelvis.

Helical CT evaluation of the abdomen and pelvis can be challenging in the cancer patient. This pictorial essay illustrates the important sites of neoplastic dissemination in the abdomen and pelvis. We will emphasize the classic CT appearance of several selected sites and indicate, where appropriate, the primary lesions usually associated with each.

Abdominal Neoplasms↗
PubMedDate not supplied

Conjoined twins: multiorgan system evaluation by multidetector CT and 3D volume rendering.

Conjoined twins, though uncommon, continue to present some of the most challenging questions for current diagnosis and therapy. The myriad of presentations demands a thorough multisystemic imaging evaluation before fully informed therapeutic and ethical decisions can be made. We present an unusual case of asymmetric omphaloischiopagus conjoined twins who were evaluated by multidetector CT and 3D volume rendering. This single technique can provide a large amount of information from a single study that can negate the need for some other imaging tests and can complement those other tests that remain necessary. We would suggest that when a CT examination is considered to evaluate this condition, an imaging interpretation that is independent of acquisition plane and that has multisystem versatility should be considered.

Abnormalities, Multiple↗
PubMedDate not supplied

Dural ectasia in the Marfan syndrome: MR and CT findings and criteria.

PURPOSE: To create criteria for detecting dural ectasia on MR or CT images in adult Marfan patients. METHODS: Images were analyzed using a workstation. Parameters that predicted dural ectasia were included in our criteria. RESULTS: Major criteria include: (1) width of dural sac below L5 > width above L4; (2) anterior sacral meningocele. Minor criteria include: (1) L5 nerve root sleeve diameter > 6.5 mm and (2) S1 scalloping > 3.5. Dural ectasia exists if 1 major or 2 minor criteria are present. CONCLUSION: MR and CT diagnose dural ectasia with high specificity and sensitivity. Our criteria accurately diagnose dural ectasia in adult Marfan patients.

Adult↗
PubMedDate not supplied

The GI Project: a prototype electronic textbook for high school biology.

A prototype electronic science textbook for secondary education was developed to help bridge the gap between state-of-the-art medical technology and the basic science classroom. The prototype combines the latest in radiologic imaging techniques with a user-friendly multimedia computer program to teach the anatomy, physiology, and diseases of the gastrointestinal (GI) tract. The program includes original text, illustrations, photographs, animations, images from upper GI studies, plain radiographs, computed tomographic images, and three-dimensional reconstructions. These features are intended to create a stimulus-rich environment in which the high school science student can enjoy a variety of interactive experiences that will facilitate the learning process. The computer-based book is a new educational tool that promises to play a prominent role in the coming years. Current research suggests that computer-based books are valuable as an alternative educational medium. Although it is not yet clear what form textbooks will take in the future, computer-based books are already proving valuable as an alternative educational medium. For beginning students, they reinforce the material found in traditional textbooks and class presentations; for advanced students, they provide motivation to learn outside the traditional classroom.

Biology↗