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Biomedical subjects

E K Fishman

Publications and source records attributed to E K Fishman.

At least 163 records · Page 9Linked to original sources
PubMed1995

Pulmonary nodules: effect of increased data sampling on detection with spiral CT and confidence in diagnosis.

PURPOSE: To compare spiral computed tomography (CT) with interscan spacing of 4-5 mm versus 8-10 mm for detection rate and level of confidence in diagnosis of pulmonary nodules. MATERIALS AND METHODS: Four radiologists (two junior and two senior faculty members) retrospectively reviewed 67 spiral CT studies with one to six nodules per study. Every second image was masked, which resulted in 8-mm sections every 8 or 10 mm; then all images reconstructed every 4 or 5 mm were reviewed. Lesions were classified as definite, probable, or possible. RESULTS: Narrow interscan spacing yielded more lesions overall (583 vs 566, P < .025) and more definite lesions and fewer equivocal lesions (482 vs 431 and 101 vs 135, respectively; P < .055). The greatest effects were in the reduction of possible lesions (50 vs 88, P < .001) and in the reduction of false-positive diagnoses made by less experienced radiologists. CONCLUSION: Increased reconstruction frequency of spiral CT volume data sets improves detection of pulmonary nodules and enhances confidence in the diagnosis.

False Positive Reactions↗
PubMed1995

Potentially resectable pancreatic adenocarcinoma: spiral CT assessment with surgical and pathologic correlation.

PURPOSE: To evaluate the accuracy of spiral computed tomography (CT) in assessing the resectability of small pancreatic ductal adenocarcinoma and to correlate the CT findings with histopathologic and surgical findings. MATERIALS AND METHODS: Spiral CT scans obtained in 64 patients who underwent surgery for potentially resectable pancreatic adenocarcinoma were prospectively assessed for tumor resectability. CT findings were correlated with surgically assessed extent of tumor and pathologic findings. RESULTS: Fifty-seven (89%) of 64 carcinomas were detected with spiral CT. Twenty-four carcinomas were resectable at surgery and 40 were not. The average size of resectable tumors was 3.1 cm (range, 1.0-7.5 cm). The overall accuracy of spiral CT for assessing resectability was 70%. Of resected tumors, 14 were hypoattenuating compared with the remaining pancreas and 10 were isoattenuating. Eleven tumors showed neointimal proliferation in arterioles at histologic examination. CONCLUSION: Further progress in preoperative staging of pancreatic ductal adenocarcinoma with spiral CT should be directed toward improving detection of small pancreatic tumors and assessment of early metastatic disease.

Adenocarcinoma↗
PubMed1995

Variations in the intrahepatic portions of the hepatic and portal veins: findings on helical CT scans during arterial portography.

OBJECTIVE: The goals of this study were to describe variations in the intrahepatic portions of the hepatic and portal veins as visualized by helical CT during arterial portography (CTAP) and to examine the surgical implications of these findings. MATERIALS AND METHODS: A retrospective review of 69 helical CTAP scans of 69 patients with small hepatic tumors and no evidence of vascular invasion or distortion was done. Axial helical CTAP scans were reviewed to determine the presence, number, and location of intrahepatic portions of the hepatic and portal veins. RESULTS: Among the 60 patients (87%) in whom the right, middle, and left hepatic veins were visualized, 19 (32%) had supernumerary hepatic veins. Right inferior hepatic veins were found in six (9%) of the 69 patients. Variations in intrahepatic portal anatomy were found in four patients (6%) and involved an immediate trifurcation of the portal vein in three patients (4%) and a left main portal vein originating from the right anterior portal branch in one patient (2%). CONCLUSION: Variations in the intrahepatic portions of the hepatic and portal veins are frequently seen on helical CTAP scans. Recognition of such variations is important in the preoperative evaluation of patients with hepatic tumors because these variations may have implications for tumor resection and for planning the operative approach.

Adult↗
PubMed1995

Splenic involvement in pancreatitis: spectrum of CT findings.

The pancreas is located deep within the retroperitoneum in the anterior pararenal space. The distal portion of the pancreatic tail extends along the course of the splenic artery and vein (Fig. 1) and enters the splenic hilum contained within the splenorenal ligament. Because of these anatomic relationships, the spleen and splenic vessels may be involved by pancreatitis. Although rare (frequency, 1-5%), splenic involvement by pancreatitis includes intrasplenic pseudocyst, abscess, hemorrhage, infarction, splenic rupture, and vascular injury. Because these complications can be life-threatening, the extent and course of the disease are closely monitored with CT to determine whether and when aggressive intervention is necessary to avoid catastrophic clinical outcomes. The purpose of this essay is to illustrate the spectrum of CT findings in cases of pancreatitis with splenic involvement.

Humans↗
PubMed1995

Nontumorous low-attenuation defects in the liver on helical CT during arterial portography: frequency, location, and appearance.

OBJECTIVE: Low-attenuation defects in the liver that are caused by variations in the portal perfusion of the liver rather than by intrahepatic tumor can be detected using helical CT during arterial portography (CTAP). The purpose of this study was to characterize these nontumorous low-attenuation defects detected with helical CTAP in terms of their frequency, location, and appearance. MATERIALS AND METHODS: Helical CTAP examinations of 89 patients referred for preoperative evaluation of metastatic or primary liver tumors performed over a 20-month period were retrospectively reviewed by three radiologists. The frequency, appearance, and location of focal (within a subsegment) and diffuse (affecting more than one subsegment) nontumorous perfusion defects were determined. Findings on helical CTAP images were correlated with surgical findings (53 patients), results of MR examinations (25 patients), and follow-up CT examinations (11 patients). RESULTS: Ninety-seven nontumorous perfusion defects were identified in 68 patients. The most frequent defects were located adjacent to the gallbladder fossa (35), anterior to the porta hepatis (34), in the subcapsular portion of the liver (13), and adjacent to the falciform ligament (12). Nontumorous perfusion defects characteristically appeared wedge-shaped or flat and ranged in size from 8-20 mm. CONCLUSION: Nontumorous perfusion abnormalities have characteristic appearances and locations on helical CTAP examinations and are more common than previously reported with conventional CTAP. Familiarity with the locations and characteristic appearances of these defects is essential to prevent false-positive diagnoses, so that operative candidates are not mistakenly denied surgical therapy.

Adult↗
PubMed1995

Imaging of intrahepatic cholangiocarcinoma: 1. Peripheral cholangiocarcinoma.

Cholangiocarcinoma is the second most common primary hepatic malignant tumor after hepatocellular carcinoma, accounting for 5-30% of all primary hepatic malignant tumors [1]. Intrahepatic cholangiocarcinomas can be classified as peripheral cholangiocarcinoma, which originates from an interlobular biliary duct, or as hilar cholangiocarcinoma, which originates from a main hepatic duct or from the bifurcation of the common hepatic duct. Intrahepatic cholangiocarcinomas account for only about half of cholangiocarcinomas, and this pictorial essay focuses only on the peripheral form of the disease. Clinically, therapeutically, and radiologically, these two types of cholangiocarcinomas differ. Features suggestive of the diagnosis of peripheral cholangiocarcinoma can be shown by sonography, CT, and MR imaging. Cholangiography and angiography have a limited role in evaluating this neoplasm that manifests as a focal mass. This essay reviews the appearances of peripheral cholangiocarcinoma and discusses the various imaging techniques that can be used to evaluate this unusual tumor that is often resectable and potentially curable.

Adult↗
PubMed1995

Imaging of intrahepatic cholangiocarcinoma: 2. Hilar cholangiocarcinoma.

Hilar cholangiocarcinoma (also called Klatskin's tumor) is more common than peripheral cholangiocarcinoma. Sonography, CT, MR imaging, angiography, and cholangiography can suggest the diagnosis, but the major issue of imaging with this tumor is to determine whether the tumor is resectable. The anatomic location of hilar cholangiocarcinoma makes resection difficult, so that surgical exploration of patients with this condition should be undertaken only when preoperative evaluation has shown a potential for curative resection. Preoperative assessment of resectability of hilar cholangiocarcinoma is often extensive, requiring several types of imaging. This pictorial essay reviews the imaging features of hilar cholangiocarcinoma. The role of imaging in the preoperative planning, with specific emphasis on staging extent of disease, including hepatic and vascular involvement, is discussed and illustrated.

Adult↗
PubMed1995

Helical (spiral) CT of the liver.

Helical (spiral) CT of the liver consistently results in high quality scans as a result of the ability to image the liver in a single breath hold. Lesion detection is aided by scanning during the peak of hepatic enhancement, by the lack of respiratory misregistration, and by obtaining overlapping axial reconstructions. Because of these advantages, helical (spiral) CT is the preferred scanning mode for evaluation of hepatic disease.

Contrast Media↗
PubMed1995

Helical (spiral) CT of the female pelvis.

Helical CT is well suited for evaluation of the female pelvis. The advantages of peak contrast enhancement and data continuity provide a major advance over conventional CT. Helical CT provides improved detection and characterization of gynecologic pathology and is recommended for the primary staging of gynecologic malignancy.

Female↗
PubMed1995

Helical (spiral) CT of the musculoskeletal system.

Helical (spiral) CT scanning of the musculoskeletal system is a valuable adjunct in patients with complex disease processes where standard radiography may prove to be of limited use. When CT scans are ordered, the use of helical (spiral) acquisition provides specific advantages in terms of ease of performance of the study, potential successful completion of the study, and in quality of the CT data set. Future advances in technology will enhance these advantages.

Adult↗
PubMed1995

[Hepatic angiomyolipoma. Magnetic resonance imaging and imaging by CT-xray].

A case, is reported of a 40 year-old woman with a "form fruste" of tuberous sclerosis, multiple angiomyolipomas of the kidney, and an angiomyolipoma of the liver. On magnetic resonance imaging the hepatic mass was markedly hyperintense to liver on short TR/short TE spin-echo sequence. Spiral computed tomography during arterial portography showed hepatic mass in the right hemiliver with areas of negative attenuation values suggesting fat content. Pathologic examination of the resected specimen confirmed the diagnosis of an angiomyolipoma of the liver. Computed tomography during arterial portography is a commonly performed preoperative imaging modality. Therefore, recognition of angiomyolipoma of the liver by this technique is important, because this benign mesenchymal neoplasm may not require resection.

Adult↗
PubMed1995

Differential diagnosis and evaluation of the incidentally discovered renal mass.

Recent advances in technology, coupled with decreasing costs, have led to a substantial rise in the diagnosis of the incidentally discovered renal mass. In virtually all of these cases, the underlying signs and symptoms of an occult renal tumor were either absent or sufficiently minor as to escape the notice of the referring physician. Although the majority of the renal masses are benign renal cysts, many are indeterminate or frankly malignant. The evaluation of these tumors is typically completed with contrast-enhanced static or spiral computed tomography; however, ultrasound may be sufficient in many cases to definitively diagnose renal cysts. The size and location of these tumors often dictates treatment, and recently, less conservative management has found to be reasonably safe and effective. For instance, small localized tumors are now being considered for tumor enucleation, heminephrectomy or partial nephrectomy, even in the presence of an otherwise normal contralateral kidney. Recent innovations, including intraoperative sonography, have given the urologic surgeon an additional tool for complete evaluation of the indeterminate renal mass. These issues are discussed in detail, in order to achieve a rational approach to the differential diagnosis and evaluation of the incidental renal mass.

Biopsy, Needle↗
PubMed1994

Mucinous adenocarcinoma at the ileocecal valve mimicking Crohn's disease.

Two patients presented to their clinicians with bowel complaints thought to be suggestive of Crohn's disease. The patients were sent for radiological studies to confirm that diagnosis. The radiologic findings in both patients were thought to be consistent with Crohn's disease, although not classical. No further diagnostic studies were initially undertaken. Each patient suffered small bowel obstruction and at surgery each was found to have a mucinous adenocarcinoma of the ileocecal valve. No evidence of Crohn's disease was found. At pathologic examination some interesting characteristics of the tumors were observed, which perhaps accounted for the misdiagnosis of Crohn's disease. It also was evident that the clinical information supplied to the radiologist may have influenced the radiologic interpretations. These cases stress the importance of obtaining tissue diagnoses in situations where radiographic findings are consistent but atypical with the clinical diagnosis of Crohn's disease.

Adenocarcinoma, Mucinous↗