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Biomedical subjects

E K Fishman

Publications and source records attributed to E K Fishman.

At least 145 records · Page 8Linked to original sources
PubMed1996

Imaging of pelvic trauma: the role of CT with multiplanar and three-dimensional reconstruction.

Pelvic injury is a major cause of morbidity and mortality after trauma. Accurate and timely diagnosis is essential to the orthopaedic surgeon in choosing the proper management course. Traditional radiography is an important initial mode of evaluation. Computed tomography (CT) using multiplanar and three-dimensional reconstruction is a valuable complementary modality. This article reviews the role of multiplanar and three-dimensional CT imaging in the assessment of pelvic injury.

Fractures, Bone↗
PubMed1996

CT evaluation of the acute abdomen: bowel pathology spectrum of disease.

CT has become the primary imaging modality for the evaluation of the patient with clinical symptoms of an acute abdomen and a confusing clinical picture. Because these patients may have a range of various pathologies, CT has been used successfully to define the presence of disease and localize it to a specific organ or organ system. In this article, we review the various processes that resulted in acute abdomen focusing on the small bowel and colon. Specific entities discussed include appendicitis, diverticulitis, Crohn disease, and ulcerative colitis. Other less common processes, including pseudomembranous colitis, intussusception, and bowel ischemia are also discussed. The specific role of CT scanning and specific CT signs are discussed and addressed. The value of CT in relationship to other modalities and clinical evaluation is discussed and key statistics provided.

Abdomen, Acute↗
PubMed1995

The current state of the art in three dimensional oncologic imaging: an overview.

PURPOSE: To provide an overview of the methods and clinical applications of three dimensional (3D) medical imaging in the oncologic patient. METHODS AND MATERIALS: We briefly outline the techniques currently used to create 3D medical images with an emphasis on their strengths and shortcomings as they relate to oncologic imaging and radiation therapy planning. We then discuss some of the most important and promising oncologic applications of 3D imaging and suggest likely future directions in this rapidly developing field. RESULTS: Since the first application of 3D techniques to medical data over a decade ago, 3D medical images have evolved from relatively crude representations of musculoskeletal abnormalities to detailed and accurate representations of a variety of soft tissue, vascular, and oncologic pathology. The rapid development of both computer hardware and software coupled with the application of 3D techniques to a variety of imaging modalities have expanded the clinical applications of this technology dramatically. CONCLUSIONS: 3D medical images are clinically practical tools for oncologic evaluation and effective radiation therapy planning.

Humans↗
PubMed1995

Primary vs secondary iliopsoas abscess. Presentation, microbiology, and treatment.

OBJECTIVE: To review the characteristics of patient presentation, microbiology, and treatment of primary iliopsoas abscess. DESIGN: A case series of patients with iliopsoas abscess diagnosed on computed tomographic scans from 1987 to 1994. SETTING: Tertiary care inner-city university hospital. PATIENTS: Eleven patients with secondary iliopsoas abscess, defined as being secondary to gastrointestinal or genitourinary causes or trauma, and seven patients with primary abscess, defined as the absence of the above causes. MAIN OUTCOME MEASURES: Patient characteristics, presenting symptoms and signs, microbiologic characteristics, treatment, and clinical course of patients with primary iliopsoas abscesses compared with those in patients with secondary abscesses. RESULTS: In the primary group, six patients (86%) were intravenous drug users and four (57%) were positive for human immunodeficiency virus. Staphylococcus aureus grew from cultures from five of seven patients with primary abscesses, whereas secondary abscesses had enteric flora. The typical patient presentation included fever, with complaints of pain in the flank, hip, or abdomen. Comparison of abscess drainage options showed shorter hospitalizations for surgical drainage than for percutaneous drainage (15.9 vs 28.5 days; P < or = .01). CONCLUSIONS: A patient who presents with pain in the flank, hip, or abdomen may have a primary iliopsoas abscess. Computed tomography is the standard method of diagnosis. Antibiotic regimens for patients with primary iliopsoas abscess should include coverage for S aureus, and patients with secondary abscesses should have antibiotic regimens tailored for enteric bacteria. Drainage of abscess is essential for appropriate treatment, and surgical drainage is superior to percutaneous drainage in achieving prompt recovery.

AIDS-Related Opportunistic Infections↗
PubMed1995

Spiral CT with multiplanar reconstruction in the diagnosis of sternoclavicular osteomyelitis.

OBJECTIVE: The purpose of this study was to determine whether contrast-enhanced spiral ct scanning supplemented by multiplanar reconstruction is of value in the evaluation of suspected infection of the sternoclavicular joints. MATERIALS AND METHODS: Seven patients with suspected infection of the sternoclavicular joints were evaluated with spiral CT using narrow collimation (4 mm) and close interscan reconstruction (2-4 mm). All patients were scanned immediately following the injection of 120 ml Omnipaque-300 at a rate of 3 ml/s. Spiral CT scans were of 24 or 32 s duration and done as single-breath-hold studies. All images were then filmed at soft tissue and bone settings (window width 2300, window center 270). In selected cases, coronal, sagittal, and/or oblique reconstruction of data was done for review. RESULTS: All studies were successfully completed without any interscan or intrascan motion. In six cases, infections of the sternoclavicular joint was found, including five cases of osteomyelitis of the clavicular head. The scans obtained during the phase of high contrast enhancement allowed definition of the extension into the soft tissue and muscle. Bone windows demonstrated subtle cortical and periosteal abnormalities. CONCLUSION: Imaging of the sternoclavicular joints with standard CT can be difficult due to interscan motion and the inability to get good data sets for reconstruction. Spiral CT with 24- to 32-s acquisition allows high quality images enabling detection of disease and definition of extent of disease, thus helping to guide patient management.

Adult↗
PubMed1995

CT/MRI of musculoskeletal complications of AIDS.

While uncommon, many musculoskeletal disorders may be seen in association with the acquired immune deficiency syndrome (AIDS). Infections such as osteomyelitis, bacterial myositis and septic arthritis, neoplasms such as non-Hodgkin lymphoma and Kaposi sarcoma, and myopathies and polymyositis have been reported in this patient population. Computed tomography and magnetic resonance imaging frequently detect unanticipated musculoskeletal disease in a patient with AIDS, and may further help to distinguish infections from neoplastic disorders.

AIDS-Related Opportunistic Infections↗
PubMed1995

Hepatic leiomyosarcomas: CT features with pathologic correlation.

The purpose of this study was to determine the computed tomographic (CT) features of hepatic leiomyosarcoma and to correlate them with pathologic findings. CT examinations of 15 patients with pathologically proven leiomyosarcoma of the liver were retrospectively reviewed. Three patients had primary leiomyosarcoma of the liver and 12 patients had 43 distinct hepatic metastases originating from a primary gastrointestinal (n = 8), uterine (n = 2) or retroperitoneal (n = 2) leiomyosarcoma. In the 11 patients who had partial hepatic resection or surgical biopsy of their tumors, a correlation was made between CT imaging and pathologic findings. Primary leiomyosarcomas showed heterogeneous enhancement; two displayed internal and peripheral enhancement, and one showed peripheral enhancement with a pseudocystic pattern (i.e. enhancing thick wall with internal nonenhancing low attenuation area). Leiomyosarcomas metastatic to the liver were homogeneous, showing no or moderate enhancement (10 of 43 metastases, 23%) or heterogeneous and predominantly peripheral enhancement (33 of 43 metastases, 77%). A pseudocystic pattern was seen in 13 of the 43 metastases (30%). Homogeneous tumors were made of smooth fibrous-like tissue without area of necrosis. Heterogeneous tumors contained varying degrees of necrosis and hemorrhage or gelatinous tissue. We found that primary and secondary hepatic leiomyosarcomas of the liver can exhibit different features. A pseudocystic pattern is uncommon. Furthermore, purely cystic tumors were not seen in our series.

Adult↗
PubMed1995

Effect of contrast concentration on abdominal enhancement in the rabbit: spiral computed tomography evaluation.

RATIONALE AND OBJECTIVES: We examined the effect of varying the concentration of a nonionic iodinated contrast agent on hepatic and abdominal vascular enhancement using spiral computed tomography (CT) scanning. METHODS: Spiral CT scans of 10 New Zealand male rabbits were obtained after intravenous injection of 240 mg I/ml iohexol and 350 mg I/ml iohexol injected at a rate of 2 ml/sec. Each animal was studied at both concentrations using four different contrast volumes: 2.3, 1.7, 1.1, and 0.57 ml/kg. Enhancement values of the aorta, hepatic veins, inferior vena cava, and hepatic parenchyma were measured using a region-of-interest cursor. RESULTS: At all contrast doses, equal volumes of contrast iohexol-350 resulted in statistically higher hepatic (p < or = .003, paired Student's t test) as well as vascular (p < .04) enhancement compared with iohexol-240. The slopes and intercepts of the enhancement curves for iohexol-350 and iohexol-240 were not statistically different (p >> .05) when enhancement was plotted as a function of total grams of iodine administered. CONCLUSION: With spiral CT scanning, appropriate contrast doses and relative costs per dose of iohexol should be considered on the basis of total iodine load administered rather than total volume administered.

Animals↗
PubMed1995

Differentiation of benign and malignant musculoskeletal tumors: potential pitfalls with MR imaging.

Magnetic resonance (MR) imaging is the most sensitive and accurate imaging technique for evaluation of musculoskeletal tumors. With increasing clinical experience, however, an overlap between the classic characteristics of benign and malignant tumors is frequently observed. In a prospective analysis of 87 consecutive cases of musculoskeletal tumors, the malignancy of skeletal lesions was correctly assessed with MR imaging in 55% of the cases. In 39% of the cases, the malignancy of skeletal lesions was overestimated with MR imaging. Correlation with plain radiography is extremely important in such cases and would have resulted in correct assessment of 73% of the skeletal lesions. For soft-tissue lesions, a large variability is found in the benign versus malignant appearances of lesions on MR images, with poor correlation between classic benign characteristics and the benignity of the lesion (17% of cases). The exceptions are hemangiomas and lipomas, which have characteristic appearances on MR images. Knowledge of potentially misleading appearances of musculoskeletal tumors on MR images allows more accurate diagnosis of such tumors.

Adolescent↗
PubMed1995

Spiral CT during arterial portography: technique and applications.

Spiral computed tomography during arterial portography (CTAP) combines rapid scanning with selective imaging during the portal phase of enhancement of the liver, resulting in an effective method for evaluation of liver neoplasms prior to partial hepatic resection. Compared with dynamic incremental CTAP, spiral CTAP results in improved quality of three-dimensional and multiplanar reconstructions, facilitating presurgical planning. Accurate volumetric analysis of the tumor can be performed, and subsegmental tumor localization is facilitated by the high levels of hepatic and portal venous enhancement. Additional advantages of spiral CTAP include small reconstruction intervals for improved lesion detection. However, the specificity of spiral CTAP is low because both benign and malignant tumors appear as hypoattenuating perfusion defects. In addition, both focal and geographic nontumorous perfusion defects may be seen more frequently with spiral CTAP than with dynamic CTAP. Knowledge of common diagnostic pitfalls is necessary for accurate interpretation of spiral CTAP images.

Adult↗
PubMed1995

Three-dimensional spiral CT during arterial portography: comparison of three rendering techniques.

The three most common techniques for three-dimensional reconstruction are surface rendering, maximum-intensity projection (MIP), and volume rendering. Surface-rendering algorithms model objects as collections of geometric primitives that are displayed with surface shading. The MIP algorithm renders an image by selecting the voxel with the maximum intensity signal along a line extended from the viewer's eye through the data volume. Volume-rendering algorithms sum the weighted contributions of all voxels along the line. Each technique has advantages and shortcomings that must be considered during selection of one for a specific clinical problem and during interpretation of the resulting images. With surface rendering, sharp-edged, clear three-dimensional reconstruction can be completed on modest computer systems; however, overlapping structures cannot be visualized and artifacts are a problem. MIP is computationally a fast technique, but it does not allow depiction of overlapping structures, and its images are three-dimensionally ambiguous unless depth cues are provided. Both surface rendering and MIP use less than 10% of the image data. In contrast, volume rendering uses nearly all of the data, allows demonstration of overlapping structures, and engenders few artifacts, but it requires substantially more computer power than the other techniques.

Algorithms↗
PubMed1995

CT of the esophagus: spectrum of disease with emphasis on esophageal carcinoma.

The esophagus is involved by a wide range of pathologic processes that can be detected, defined, and staged with computed tomography (CT). These processes include esophageal carcinoma; benign esophageal tumors; inflammatory and infectious diseases; miscellaneous conditions such as Barrett esophagus, achalasia, and varices; and trauma and perforation. CT is usually performed to clarify findings seen with other imaging modalities or to stage a pathologic condition; however, it may be the primary imaging modality in some cases. Because of the critical location of the esophagus, it can be involved secondarily by other disease processes or as part of a systemic process. By being aware of the appearances of the various entities that affect the esophagus, the radiologist can play an important role in detecting and staging esophageal disease. Although the role of CT in the evaluation of esophageal disease has been controversial, recent developments such as spiral CT have the potential to renew interest in this application.

Adult↗
PubMed1995

Radiation therapy of external iliac lymph nodes with lateral pelvic portals: identification of patients at risk for inadequate regional coverage.

PURPOSE: To determine whether "standard" lateral pelvic radiation therapy portals provide adequate margins for treating the external iliac lymph nodes (EILNs). MATERIALS AND METHODS: With computed tomographic (CT) data and a computerized algorithm, the course of the EILN chain was reconstructed in 48 patients. The marginal distance between a consistently localized portion of the EILNs and the anterior field border that was placed at the front of the pubic symphysis was recorded for each patient. RESULTS: The EILNs were covered adequately in only 50% of both men and women. More adequate EILN margins were observed in (a) women older than 68 years, (b) women with small anteroposterior separations, (c) men older than 70 years, and (d) men and women with a low central obesity index. Less adequate margins were observed in men who were obese or men with large anteroposterior separations. In the study population, no correlation was observed for sex, race, or tumor site. CONCLUSION: The authors recommend portals that are designed specifically for patients rather than standard portals that may inadequately cover the intended targets.

Adult↗