Carcinoma of the gallbladder: imaging features with surgical correlation.
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Aged↗
Biomedical subjects
E K Fishman
Publications and source records attributed to E K Fishman.
Three-dimensional CT stereoscopic visualization of renal masses: impact on diagnosis and patient treatment.
OBJECTIVE: The objective of this study was to determine whether three-dimensional reconstruction with stereoscopic display of helical CT data sets and CT angiography are useful in the examination of patients with known or suspected renal masses. CONCLUSION: Volume-rendering techniques applied to helical CT data sets coupled with three-dimensional stereoscopic imaging provide a complete examination of patients with known or suspected renal masses. Such information can help guide patient treatment and provide a single preoperative study when nephron-sparing surgery or total nephrectomy is considered.
Adult↗
Localized persistent pulmonary interstitial emphysema: CT findings with radiographic-pathologic correlation.
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Humans↗
Intrahepatic cholangiocarcinoma: the role of imaging in detection and staging.
Intrahepatic cholangiocarcinoma can be divided into two basic categories: hilar and peripheral forms. This distinction has important implications in imaging evaluation, treatment, and prognosis. Cholangiocarcinoma often requires multiple imaging modalities for proper evaluation of potential resectability. In this review, we outline the role of CT, MR, ultrasound, cholangiography, and angiography in the evaluation of cholangiocarcinoma. We also describe newer techniques such as CT angiography, CT cholangiography, MR angiography, and MR cholangiography, and look at the possible future roles of these techniques.
Angiography↗
Small bowel cancer. Imaging features and staging.
Small bowel neoplasms are relatively rare. This article presents the imaging features of the most frequently encountered small bowel masses, with emphasis on adenocarcinomas and carcinoid tumors. The CT scan findings and correlative barium and angiographic studies of various small bowel tumors are illustrated. The staging of adenocarcinoma of the small intestine is addressed, with attention to the role of CT scans for radiologic staging.
Humans↗
The natural history and treatment of adrenal myelolipoma.
PURPOSE: We determined the natural history and clarified the treatment of adrenal myelolipoma. MATERIALS AND METHODS: A retrospective review of medical records and radiographic imaging studies of 20 patients diagnosed with adrenal myelolipoma was performed. RESULTS: Of 20 patients 4 presented with abdominal pain and 1 had Cushing's syndrome. The remaining tumors were discovered incidentally. Four patients underwent surgery because of abdominal pain in 2, adrenal hyperfunction (Cushing's syndrome) in 1 and a tumor 10.5 cm. in largest dimension in 1. Of 15 patients (16 adrenal myelolipomas) followed without surgical intervention for an average of 3.2 years (range 0.3 to 10.8) 13 remained asymptomatic and 2 experienced persistent, vague abdominal discomfort. One patient was lost to followup. A total of 13 tumors from 12 patients was serially imaged, with tumor size increasing in 6, decreasing in 2 and remaining unchanged in 5. CONCLUSIONS: These data suggest that the majority of adrenal myelolipomas can be treated conservatively. While tumors can become enlarged, they also exhibit variable growth, and size and growth rate do not necessarily correlate with symptoms. Computerized tomography can be used for diagnosis.
Adrenal Gland Neoplasms↗
Renal inflammatory disease: the current role of CT.
Computed tomography (CT) plays a significant role in establishing the diagnosis in clinically equivocal cases of renal infection, determining the extent of the disease process, and assessing its complications. Gas, calculi, renal parenchymal calcifications, hemorrhage, and masses can be revealed with unenhanced CT. A subsequent study with contrast enhancement is crucial for the complete evaluation of patients with renal infection in order to demonstrate the areas of altered nephrogram that occur as a result of the inflammatory process and to identify complications. In this article we review a spectrum of renal inflammatory disease, with illustrations of the CT findings in representative cases. We also review the role and potential pitfalls of fast scanning techniques that can image a particular phase of the nephrogram in a renal infection. In acute pyelonephritis, enhanced CT scans obtained during the cortical nephrographic phase typically demonstrate solitary or multifocal hypodense areas with obliteration of the corticomedullary differentiation. Delayed images obtained during the excretory phase are frequently more helpful in defining the extent of the disease process, identifying the complications such as renal abscess, and confirming the presence of urinary obstruction than are early images.
Acute Disease↗
CT and MRI evaluation of musculoskeletal infection.
While the plain film and nuclear medicine bone scan are still the traditional imaging modalities used in the evaluation of musculoskeletal infection, the cross-sectional imaging modalities, computed tomography (CT) and magnetic resonance imaging (MRI), have become critical in the delineation of many types of musculoskeletal infection. In particular, the evaluation of soft tissue infections, including cellulitus, myositis, fasciitis, abscess, and septic arthritis are often best evaluated by MRI or CT due to their excellent anatomic resolution and soft tissue contrast. Even in osseous infection, CT and MRI can give better anatomic delineation of the extent of infection. In cases where the plain film and nuclear medicine bone scan findings are complicated due to previous surgery, trauma, or underlying illness, the anatomic resolution and soft tissue contrast provided by MRI and CT are often necessary to determine if underlying infection exists. MRI's visualization of the bone marrow allows for the sensitive detection of osteomyelitis, although specificity for the diagnosis of osteomyelitis is aided by other findings, including cortical destruction. The CT and MRI findings in the spectrum of musculoskeletal infections are discussed and contrasted, and pitfalls in their evaluation of musculoskeletal infection are described.
Abscess↗
Skeletal 3-D CT: advantages of volume rendering over surface rendering.
Both surface rendering and volume rendering have been extensively applied to CT data for 3-D visualization of skeletal pathology. The review illustrates potential limitations of each technique by directly comparing 3-D images of bone pathology created using volume rendering and surface rendering. Surface rendering show gross 3-D relationships most effectively, but suffer from more stairstep artifacts and fail to effectively display lesions hidden behind overlying bone or located beneath the bone cortex. Volume-rendering algorithms effectively show subcortical lesions, minimally displaced fractures, and hidden areas of interest with few artifacts. Volume algorithms show 3-D relationships with varying degrees of success depending on the degree of surface shading and opacity. While surface rendering creates more three-dimensionally realistic images of the bone surface, it may be of limited clinical utility due to numerous artifacts and the inability to show subcortical pathology. Volume rendering is a flexible 3-D technique that effectively displays a variety of skeletal pathology with few artifacts.
Algorithms↗
Tropical pyomyositis: imaging findings and a review of the literature.
Tropical pyomyositis is a rare cause of multiple abscesses of skeletal muscle. The entity is rare in temperate climates and, as its name suggests, is more common in areas such as the tropics and South Pacific. Staphylococcus aureus is the most common cause of infection. Therapy is aggressive, with surgical debridement and drainage followed by antibiotics. We report an unusual case of tropical myositis which simulated tumor recurrence in a patient without the typical risk factors associated with tropical pyomyositis.
Abscess↗
Computed tomography in the management of chest infections: current status.
The application of computed tomography has advanced our ability to diagnose and treat chest infections. Although conventional computed tomography has been shown to be useful in diagnosing pulmonary disease, new technological developments including high-resolution computed tomography (HRCT) and spiral (continuous imaging) computed tomography have resulted in earlier detection and more precise characterization of parenchymal lung infections and their complications. For the immunocompetent host, computed tomographic findings are helpful in the staging of disease, in differentiating infections from tumors, and in detecting complications. For the immunocompromised host, HRCT is useful in identifying subtle infiltrates earlier than other imaging methods can. Computed tomography is also useful in guiding transthoracic biopsy, aspiration, or drainage of chest infections or abscesses. In addition, computed tomographic findings can provide guidance for surgical biopsy, bronchoscopic biopsy, and bronchoalveolar lavage.
Animals↗
Spiral CT: applications in the emergency patient.
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Abdomen, Acute↗
CT of the stomach: spectrum of disease.
In evaluation of gastric disease, computed tomography (CT) has proved to be a valuable adjunct to barium studies and endoscopy. CT clearly demonstrates the primary pathologic condition and shows extension of disease to adjacent or distant structures. Useful in staging gastric cancer, CT has also proved valuable in detecting and defining the extent of other gastric neoplasms such as lymphoma, leiomyosarcoma, and metastasis to the stomach. Recent advances in CT technology such as spiral CT-coupled with air contrast gastric studies and a better understanding of the need to optimize CT protocols-suggest that the value of CT in these applications will increase. CT has also been shown to be valuable in detection and differentiation of other gastric conditions such as benign tumors, Helicobacter pylori and other infections, various forms of gastritis (radiation, eosinophilic, and emphysematous), ulcer disease, Ménétrier disease, and varices. Adequate gastric distention is essential for successful gastric CT.
Adult↗
CT angiography with volume rendering: advantages and applications in splanchnic vascular imaging.
The authors compared volume rendering with maximum intensity projection (MIP) and shaded surface display as a technique for generating three-dimensional (3D) images of the vasculature from spiral computed tomography (CT) data sets. In four patients with pathologic splanchnic vasculature, the advantages of volume-rendered display are illustrated for depiction of 3D vascular anatomy, vascular and visceral interrelationships, variant vasculature, tumor encasement, and hepatic tumor localization for presurgical planning.
Abdomen↗
Transitional cell carcinoma of the renal pelvis: a retrospective look at CT staging with pathologic correlation.
PURPOSE: To identify the reasons for the discrepancies between computed tomographic (CT) and pathologic staging of transitional cell carcinoma of the renal pelvis and to develop new criteria to increase the accuracy of CT in staging. MATERIALS AND METHODS: CT scans of 31 consecutive patients with renal pelvic transitional cell carcinoma were evaluated. CT and pathologic staging were compared. RESULTS: Pathologic staging revealed four stage 0 tumors, three stage I, five stage II, 10 stage III, and nine stage IV. The initial overall CT staging accuracy was 52% (16 of 31 patients). The sensitivity for minimal invasion was 17% (two of 12 patients). Two-thirds (10 of 15 patients) of the misinterpreted cases were overstaged as stage III. Proximal hydronephrosis was present in 80% of overstaged cases (eight of 10 patients). Reevaluation of the CT studies by using proximal hydronephrosis as a criterion for minimal invasion improved overall CT staging accuracy (77%). The revised staging yielded a sensitivity of 83% and specificity of 95% for minimal invasion and improved the specificity for deep invasion (17% to 92%). CONCLUSION: In a patient with transitional cell carcinoma of the renal pelvis, hydronephrosis proximal to the tumor may cause overstaging of stage 0-II disease and may not indicate more advanced disease.
Carcinoma in Situ↗
Automatic liver segmentation technique for three-dimensional visualization of CT data.
PURPOSE: To develop a system for automatic segmentation of the liver from computed tomographic (CT) scans of the abdomen for three-dimensional volume-rendering displays. MATERIALS AND METHODS: An automated liver segmentation system was developed, which combined domain knowledge with analysis of a global histogram, morphologic operators, and the parametrically deformable contour model. Boundaries of the thresholded liver volume were modified section-by-section by exploiting information from adjacent sections. These boundaries were refined by optimization of the parametrically deformable contour model. Volume-rendered images were created by using the boundaries to exclude tissues outside the liver. The system was tested on CT data sets from 10 cases of potentially resectable hepatic neoplasm. RESULTS: Of the 401 sections in the 10 cases, 53 sections (13.2%) required user modifications during segmentation. The utility of the three-dimensional-rendered images with use of these liver boundaries was judged by a radiologist as being comparable to that of three-dimensional images created with manual editing. Twenty-eight of the sections were deemed imperfect by the radiologist and might need further modifications. CONCLUSION: An effective technique for automatic segmentation of the liver from CT images has been developed. This technique promises to save time and simplify the creation of three-dimensional liver images by minimizing operator intervention.
Humans↗
Portal-phase contrast-enhanced helical CT for the detection of malignant hepatic tumors: sensitivity based on comparison with intraoperative and pathologic findings.
OBJECTIVE: The purpose of this study was to determine the sensitivity of portal-phase IV contrast-enhanced helical CT in detecting malignant hepatic tumors using a lesion-by-lesion comparison with surgical and pathologic findings. MATERIALS AND METHODS: Preoperative portal-phase contrast-enhanced helical CT studies in 21 patients (13 men, eight women) with malignant neoplasms of the liver (12 patients with primary hepatic tumors, nine patients with metastases) were reviewed retrospectively by three radiologists with the knowledge that hepatic malignancies were present in each case. Helical CT findings were compared with intraoperative findings by palpation (21 patients), sonography (15 patients), and the results of pathologic examination of resected specimens (10 patients) in a lesion-by-lesion manner. Sixty-four malignant nodules were identified in resected specimens or at surgery by palpation or intraoperative sonography. For each nodule identified by surgical or pathologic means, CT findings were reviewed for the presence of a lesion of similar size and location. RESULTS: The readers identified 52 of 64 nodules on helical CT scans for an overall sensitivity of 81%. Sixteen of 21 primary tumors (76%) and 36 of 43 metastatic tumors (84%) were identified on CT scans. The sensitivity was 91% for nodules greater than 1 cm (42 of 46) and 56% for nodules 1 cm or less (10 of 18). False-positive findings occurred in 4% of lesions seen on helical CT scans. CONCLUSION: Our results show that portal-phase contrast-enhanced helical CT is extremely sensitive (91%) for detecting malignant hepatic tumors greater than 1 cm, is relatively insensitive (56%) for tumors less than 1 cm, and has a low false-positive rate. These results compare favorably with published results for CT during arterial portography, the current gold standard for liver tumor detection, suggesting that portal-phase IV contrast-enhanced helical CT is an excellent noninvasive preoperative study prior to hepatic resection or cryosurgery.
Adult↗
Hepatic tumors treated by cryosurgery: normal CT appearance.
OBJECTIVE: An understanding of the normal appearance of hepatic tumors treated with cryosurgery is essential for accurately distinguishing normal postoperative changes from potential complications such as hepatic abscess or infarct, which may necessitate further interventions. The purpose of this study was to characterize the normal spectrum of CT findings after cryoablation of hepatic tumors. SUBJECTS AND METHODS: The CT scans of 14 patients who had undergone hepatic cryoablation 4-16 days (mean, 7 days) before scanning were reviewed by three radiologists. None of these patients had postprocedural complications that necessitated intervention (e.g. abscess, infarct, or hemorrhage). Indications for cryoablation included primary hepatic tumors in four patients and hepatic metastases in 10 patients. CT findings were correlated with surgical findings in a lesion-by-lesion manner to ensure that only cryolesions were included in the analysis. RESULTS: Twenty-eight cryolesions from 3 to 11 cm maximum diameter (mean, 7 cm) were detected on CT scans. All cryolesions were primarily hypodense and extended to the liver capsule. Ten (36%) of 28 lesions contained air, and 26 (93%) of 28 lesions contained hemorrhage. Thirteen (54%) of 24 lesions evaluated with i.v. contrast material showed peripheral enhancement. Cryolesions were primarily wedge shaped (54%), round (29%), or teardrop shaped (21%). One iatrogenic portosystemic shunt was detected. Other associated findings included subcapsular hemorrhage (29%), perihepatic fluid collections (43%), right-sided pleural effusion (93%), left-sided pleural effusion (64%), atelectasis of one or both lungs (93%), and ascites (7%). CONCLUSION: The postoperative CT appearance of the liver in patients who underwent hepatic cryoablation without complications mimics that seen in the liver of patients with hepatic abscesses or infarcts. The CT appearance of the liver in patients undergoing cryosurgery needs to be carefully analyzed to avoid confusing normal findings related to the procedure with those related to procedural complications, it may be impossible to differentiate hepatic complications from normal postoperative changes on the basis of CT findings in many of these patients.
Cryosurgery↗