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Elaine M Caoili

Publications and source records attributed to Elaine M Caoili.

16 recordsLinked to original sources
PubMed2007

Extensor retinaculum of the wrist: sonographic characterization and pseudotenosynovitis appearance.

OBJECTIVE: We have found in our practice that the normal extensor retinaculum of the wrist may appear hypoechoic on sonography and, because it is closely applied to the extensor tendons, may simulate tenosynovitis. This study prospectively evaluates the extensor retinaculum in 50 healthy adult volunteers, characterizing its sonographic appearance. CONCLUSION: The extensor retinaculum has a characteristic appearance on sonography. A hypoechoic appearance from anisotropy should not be confused with tenosynovitis.

Adult↗
PubMed2006

Evaluation of imaging-guided core biopsy of pancreatic masses.

OBJECTIVE: The purpose of this study was to determine the sensitivity and accuracy of imaging-guided core biopsy in the diagnosis of pancreatic masses. CONCLUSION: Imaging-guided core biopsy is sensitive, safe, and accurate in the diagnosis of malignant lesions of the pancreas. Benign biopsy findings cannot be used to exclude the presence of a neoplasm, and repetition of a biopsy should be considered if there is high clinical suspicion of malignancy.

Adenocarcinoma↗
PubMed2006

MRI of sonographically indeterminate adnexal masses.

OBJECTIVE: The purpose of this study was to assess the ability of MRI to characterize sonographically indeterminate adnexal masses and to define the sonographic features contributing to indeterminate diagnoses. MATERIALS AND METHODS: Two blinded radiologists retrospectively reviewed the MRI examinations of 87 patients with 95 sonographically indeterminate adnexal masses. Reviewers determined the origin of a mass, its tissue content (cystic, solid, complex cystic, or cystic and solid), tissue characteristics (fat, blood, fibrous, or leiomyomatous), and benignity versus malignancy. Sonograms were reviewed by three reviewers to determine the origin of a mass, its tissue content, and reasons for an indeterminate diagnosis. Sensitivity and specificity of MRI were calculated, and agreement of sonography and MRI with the final diagnosis was determined using kappa statistics. The final diagnosis was determined by histopathology, surgical findings, or imaging or clinical follow-up. RESULTS: The sensitivity of MRI for identifying malignancy (n = 5) was 100% and its specificity for benignity (n = 90) was 94%. Excellent agreement was seen between MRI and the final diagnosis for determining the origin (kappa = 0.93), tissue content (kappa = 0.98), and tissue characteristics (kappa = 0.91) of a mass. Sonography had poor agreement with the final diagnosis for the origin (kappa = 0.19) and tissue content (kappa = 0.33) of a mass. The main reasons for indeterminate sonographic diagnoses were the inability to determine origin because of location and large mass size and the appearances of purely solid or complex cystic masses. CONCLUSION: Sonographically indeterminate adnexal masses of uncertain origin and solid or complex cystic content benefit from further evaluation with MRI, which is highly accurate for identifying the origin of a mass and characterizing its tissue content, obviating surgery.

Adnexa Uteri↗
PubMed2005

Optimization of multi-detector row CT urography: effect of compression, saline administration, and prolongation of acquisition delay.

PURPOSE: To retrospectively compare the effects of abdominal compression, intravenous saline hydration, and two imaging delays on both distention and opacification of the intrarenal collecting system and ureter during multi-detector row computed tomographic (CT) urography. MATERIALS AND METHODS: Institutional review board approval for reviewing images and medical records of the patients was obtained; informed patient consent was not required. Excretory phase images obtained from multi-detector row CT urography in 85 patients (57 men, 28 women) were reviewed. Examinations were performed by using one of four techniques: abdominal compression and intravenous hydration with 250 mL of normal saline, compression only, intravenous hydration with saline only, and neither compression nor saline hydration. Excretory phase imaging was performed at 300 and 450 seconds for each patient. Two reviewers measured urinary tract distention on transverse images and graded opacification and image quality on volume-rendered images. Effects were compared by using statistical mixed models with repeated-measures analysis of variance. RESULTS: Saline hydration significantly improved opacification (P = .02) and overall image quality (P < .001) of the intrarenal collecting system and proximal ureter. Delayed excretory phase image acquisition of 450 seconds significantly increased distention of the intrarenal collecting system and proximal ureter (P < .001). No significant effects involving the lower segment of the ureter were seen with any technique; however, there were fewer nonvisualized distal ureteral segments with the longer imaging delay. CONCLUSION: Compression does not significantly improve distention or opacification of the urinary tract. Saline hydration is effective in improving opacification of the proximal urinary tract. Longer imaging delays improve distention of the proximal urinary tract and may aid in visualization of the lower segment of the ureter.

Adolescent↗
PubMed2005

Estimating the effects of informal radiology resident teaching on radiologist productivity: what is the cost of teaching?

RATIONALE AND OBJECTIVES: One mission of an academic radiology department is to teach. The greatest teaching effort is directed at radiology residents. As clinical work demands increase, informal, non-revenue-generating, teaching may suffer. We sought to determine the economic consequences of teaching. MATERIALS AND METHODS: With the use of a picture archiving and communications system, 6 radiology faculty members independently interpreted and dictated digitally acquired bone and chest radiographs for 1 hour alone and again 10-12 weeks later with a first-year resident. During the second session, the quality of teaching was graded by independent observers. The number of cases, relative value units (RVUs), and reimbursement for each session were calculated. RESULTS: The difference in number of cases dictated working alone (mean, 44.7) and with a first-year resident (mean, 23.5) was significant (P = 0.007). The difference between RVUs generated by faculty alone (mean, 9.0) and with a resident (mean, 4.5) also was significant (P = 0.006), and the difference in dollars billed when working alone (mean, $1558.45) and with a resident (mean, $777.65) was significant (P = 0.007). As teaching quality increased, the number of cases interpreted, dollars billed, and RVUs trended lower. CONCLUSION: Informal resident teaching significantly reduces clinical throughput, reducing examination volume, RVUs, and dollars billed by approximately half.

Bone and Bones↗
PubMed2005

Incidence of acute appendicitis in patients with equivocal CT findings.

OBJECTIVE: The purpose of our study was to determine the incidence of acute appendicitis in patients for whom the CT interpretation is deemed equivocal. MATERIALS AND METHODS: Of 1,344 patients referred for CT with suspected appendicitis between January 1998 and December 2002, 172 patients were identified in whom the radiographic findings were equivocal. Two radiologists reviewed the equivocal CT cases, reassessing appendiceal size and the presence of right lower quadrant stranding, fluid, or an appendicolith. The reviewers' findings were correlated with surgical pathology reports and clinical follow-up. RESULTS: Fifty-three (31%) of 172 patients with indeterminate findings on CT scans were subsequently diagnosed with appendicitis. For reviewers 1 and 2, respectively, appendicitis was present in five (14%) of 36 and six (13%) of 47 patients who had isolated appendiceal diameter less than 9 mm, and in 11 (52%) of 21 and in 10 (50%) of 20 patients who had isolated appendiceal dilatation equal to or greater than 9 mm. If a normal diameter appendix (< 6 mm) was visualized in a patient who had right lower quadrant stranding or fluid, appendicitis was present in only one (17%) of six and in four (27%) of 15 patients for reviewers 1 and 2, respectively. If the appendix could not be identified but there was right lower quadrant stranding or fluid, appendicitis was present in seven (37%) of 19 and in eight (53%) of 15 patients. CONCLUSION: Appendicitis is encountered in about 30% of patients with equivocal findings on CT, and the diagnosis should be considered in most of these patients if they are appropriately symptomatic. However, when the appendix measures less than 9 mm alone, the likelihood of appendicitis is much smaller.

Acute Disease↗
PubMed2005

MDCT urography of upper tract urothelial neoplasms.

OBJECTIVE: The purpose of our study was to review the MDCT urography appearance of pathologically proven transitional cell carcinomas of the renal collecting system and ureter and to correlate the MDCT urography findings with pathology findings. MATERIALS AND METHODS: Of 370 MDCT urography examinations performed over an 18-month period, 18 patients were diagnosed with 27 renal collecting system or ureteral urothelial neoplasms at endoscopic biopsy (n = 8) or surgery (n = 19). Initial MDCT reports were reviewed to determine the sensitivity of original reviewers in detecting these neoplasms. Two radiologists also retrospectively reviewed these scans and characterized the CT appearance of the neoplasms on both axial CT and 3D reformatted images. Findings at retrospective review were correlated with pathology results to determine whether any CT features could be used to predict tumor grade. RESULTS: Eighteen of 27 neoplasms were prospectively identified on MDCT urography, and an additional six neoplasms were detected on retrospective review. Three ureteral neoplasms could not be visualized. The 24 retrospectively detected neoplasms had three distinct MDCT appearances: circumferential urothelial wall thickening (n = 14), small masses (> 5 mm in maximal diameter) (n = 5), and large masses (> 5 mm in maximal diameter) (n = 5). All detected lesions could be seen on axial excretory phase images provided wide window settings were reviewed; however, only six were detected on 3D reconstructions. MDCT urography appearance did not correlate with tumor grade. CONCLUSION: MDCT urography is a promising technique for detecting upper urinary tract neoplasms. The static 3D reconstructions used in this study are insufficient for visualization. Axial image review remains essential for tumor identification.

Aged↗
PubMed2004

MRI for preoperative staging of renal cell carcinoma using the 1997 TNM classification: comparison with surgical and pathologic staging.

OBJECTIVE: The purpose of our study was to determine the accuracy of MRI for preoperative staging of renal cell carcinoma using the 1997 TNM classification. MATERIALS AND METHODS: We conducted a retrospective review of MRI performed in 40 consecutive patients with 42 renal cell carcinomas before radical (n = 35) or partial (n = 4) nephrectomy or exploratory laparotomy (n = 3). The interval between imaging and surgery ranged from 1 to 59 days (mean, 17.9 days). Imaging was performed with T1- and T2-weighted, dynamic gadolinium-enhanced, and time-of-flight sequences. MRI and surgical-pathologic staging was performed using the 1997 TNM staging system. MRI staging was compared with surgical-pathologic staging as the gold standard. Agreement between the two staging methods was assessed using the kappa statistic. RESULTS: Agreement between MRI and surgical-pathologic staging was good for T staging (kappa = 0.72 and 0.78 for reviewers 1 and 2 respectively), poor for N staging (kappa = 0.13, both reviewers), good for M staging (kappa = 0.66, both reviewers), and excellent for the assessment of venous involvement (kappa = 0.93, both reviewers). MRI overestimated the T stage in five patients and the N stage in five and underestimated the T stage in three, the N stage in four, the M stage in one, and the extent of venous thrombosis in two patients. CONCLUSION: MRI is a reliable method for preoperative staging of renal cell carcinoma using the 1997 TNM classification, in particular for assessing venous involvement.

Adolescent↗
PubMed2004

Changing role of imaging-guided percutaneous biopsy of adrenal masses: evaluation of 50 adrenal biopsies.

OBJECTIVE: Prior series of percutaneous imaging-guided biopsies of adrenal masses before the advent of dedicated CT and MRI of the adrenal glands have shown that 40-57% of adrenal masses biopsied were adenomas-benign lesions requiring no further evaluation or treatment. This study was performed to assess the effect of dedicated adrenal imaging with CT and MRI on the rate of percutaneous imaging-guided biopsies of adrenal masses. MATERIALS AND METHODS: We reviewed 50 consecutive adrenal mass biopsies performed during a 48-month period. The patient demographics, technique of biopsy, pathology results, and results of any prior dedicated adrenal imaging with MRI or CT protocols were noted. RESULTS: Only six (12%) of 50 biopsies were adenomas. Five of these six cases were preceded by dedicated adrenal CT or MRI. Thirty-five cases were metastatic disease, four were adrenal cortical carcinoma, three were pheochromocytoma, and two biopsies were nondiagnostic. Overall, 20 of 50 cases were preceded by a dedicated adrenal CT or MRI examination to exclude an adenoma; in 21 of the remaining 30 cases, the imaging characteristics before biopsy were inconsistent with the potential diagnosis of an adenoma and dedicated adrenal CT or MRI was not recommended. CONCLUSION: The number of adrenal adenomas biopsied has declined markedly with the introduction of dedicated adrenal CT and MRI for adrenal adenomas. Percutaneous imaging-guided biopsy is useful in confirming the presence and nature of suspected metastatic deposits to the adrenal gland and in diagnosing or excluding adrenal adenomas in patients with equivocal imaging characteristics.

Adenoma↗
PubMed2003

Is it necessary to study accessory arteries when screening the renal arteries for renovascular hypertension?

PURPOSE: To determine the prevalence of isolated hemodynamically significant stenoses of accessory renal arteries when the main renal arteries are patent. MATERIALS AND METHODS: In 68 adults (24 men, mean age, 67 years +/- 10; 44 women, mean age, 67 years +/- 12), angiograms that fulfilled the following criteria were studied: (a) technically adequate renal angiograms obtained to evaluate suspected renovascular hypertension and (b) angiographically documented hemodynamically significant stenosis of any renal artery. The percentage of kidneys and the percentage of patients with hemodynamically significant isolated stenoses of accessory renal arteries were calculated. RESULTS: Eighty-seven kidneys in 68 patients had hemodynamically significant renal artery stenoses. Fifteen kidneys had 16 accessory renal arteries. Four accessory arteries in three patients had hemodynamically significant stenoses. Only one of 68 patients (1.5%) had an accessory artery stenosis unaccompanied by a main renal artery stenosis in either kidney; this patient had bilateral hemodynamically significant accessory artery stenoses. Two patients had coexistent hemodynamically significant stenoses of accessory and main renal arteries. CONCLUSION: The prevalence of a hemodynamically significant stenosis isolated to an accessory renal artery was 1.5% in our study. Thus, failure to detect accessory renal arteries should not unduly affect the utility of a noninvasive test for detecting renovascular hypertension.

Adult↗
PubMed2002

Imaging of the urinary tract using multidetector computed tomography urography.

In the past few years, radiologists have begun to design a single imaging test to thoroughly evaluate the urinary tract. Multidetector computed tomography urography (MDCTU) is a novel imaging technique that provides high-resolution images of the entire renal collecting system in a single helical run. This technique lends itself to creating detailed 3-dimensional urograms. Combining the known strengths of CT axial data and the 3-dimensional urograms can provide a comprehensive evaluation of the genitourinary tract.

Adult↗
PubMed2002

Urinary tract abnormalities: initial experience with multi-detector row CT urography.

PURPOSE: To evaluate multi-detector row computed tomographic (CT) urography for detection of urinary tract abnormalities. MATERIALS AND METHODS: Sixty-five patients referred from the urology service, in whom urinary tract abnormalities were strongly suspected, underwent multi-detector row CT urography. The technique included unenhanced, nephrographic, compression, and excretory-phase images through the abdomen and pelvis. Transverse images and three-dimensional reformations were reviewed by one of two radiologists. Findings were retrospectively compared with results of urinalysis, cystoscopy and/or ureteroscopy, and/or surgery. RESULTS: Multi-detector row CT urography depicted many clinically diagnosed urinary tract abnormalities, including 15 of 16 uroepithelial malignancies, five congenital anomalies, five urinary tract calculi, and 18 calyceal and/or papillary, 30 renal pelvic and/or ureteral, and 25 bladder abnormalities. All abnormalities were detected on transverse images. These abnormalities included diffuse urothelial wall thickening in four patients (three of whom had transitional cell carcinoma), a renal abscess, a colovesical fistula, and incidentally detected extrarenal disease (a liver mass, hepatic metastases, lymph node metastases, an aortic dissection, and a pheochromocytoma; each of these findings was seen in one patient). CONCLUSION: Multi-detector row CT urography is a useful method for detecting urinary tract abnormalities.

Adult↗
PubMed2002

Adrenal masses: characterization with combined unenhanced and delayed enhanced CT.

PURPOSE: To assess the accuracy of a dedicated adrenal computed tomographic (CT) protocol. MATERIALS AND METHODS: One hundred sixty-six adrenal masses were evaluated with a protocol consisting of unenhanced CT, and, for those with attenuation values greater than 10 HU, contrast material-enhanced and delayed enhanced CT. Attenuation values and enhancement washout calculations were obtained. An adenoma was diagnosed if a mass had an attenuation value of 10 HU or less at unenhanced CT or a percentage enhancement washout value of 60% or higher. RESULTS: The final diagnosis was adenoma in 127 masses and non-adenoma in 39. Masses measuring more than 10 HU on unenhanced CT scans were confirmed at biopsy (n = 28) or were examined for stability or change in size at follow-up CT performed at a minimum interval of 6 months (n = 33). Thirty-six (92%) of 39 non-adenomas and 124 (98%) of 127 adenomas were correctly characterized. The sensitivity and specificity of this protocol were 98% and 92%, respectively. This protocol correctly characterized 160 (96%) of 166 masses. CONCLUSION: With a combination of unenhanced and delayed enhanced CT, nearly all adrenal masses can be correctly categorized as adenomas or non-adenomas.

Adenoma↗
PubMed2002

Evaluation of sonographically guided percutaneous core biopsy of renal masses.

OBJECTIVE: Our objective was to determine the utility of sonographically guided percutaneous core biopsy to evaluate renal masses. MATERIALS AND METHODS: We conducted a retrospective analysis of our imaging-guided procedures from January 1999 to June 2001. We performed 26 sonographically guided percutaneous core biopsies of renal masses in 26 patients. From two to five specimens were obtained from a single mass in each patient using an 18-gauge automated biopsy system. We examined the patients' medical records, pathology results, and imaging studies. Core biopsy results were compared with surgical pathology (n = 6) or clinical follow-up (n = 20). RESULTS: All biopsies provided sufficient material for analysis. Biopsy findings were positive for malignancy in 19 (73%) of 26 masses. Histologic diagnoses included renal cell carcinoma were (n = 11), metastasis (n = 3), lymphoma (n = 2), and transitional cell carcinoma (n = 2). Specific cell type characterization could not be made on one biopsy, but the specimens were highly suspicious for malignancy. Biopsy revealed seven (27%) of 26 benign diagnoses: oncocytoma (n = 3), angiomyolipoma (n = 2), and fibrosis (n = 2). The average follow-up period for patients with benign diagnoses was 10 months. One case of surgically proven necrotic pyelonephritis was mischaracterized as fibrosis at core biopsy. Sonographically guided percutaneous core biopsy of renal masses showed a sensitivity of 100% and a specificity of 100% for the diagnosis of malignancy. The core specimens yielded a specific diagnosis in 92% (24/26) of masses. No immediate complications occurred after the procedure. One patient developed a pseudoaneurysm that presented 3 months after the biopsy. CONCLUSION. Sonographically guided percutaneous core biopsy is a reliable and accurate method for evaluating renal masses.

Adult↗
PubMedDate not supplied

The radiologic spectrum of pulmonary Aspergillus infections.

Aspergillus infections may be categorized by specific radiographic patterns, the patient's immunologic status, and the presence or absence of preexisting structural lung disease. General patterns include invasive aspergillosis (both vascular and airway invasive varieties and acute tracheobronchitis), semiinvasive aspergillosis (including allergic bronchopulmonary aspergillosis and hypersensitivity pneumonitis), mycetoma, allergic aspergillosis, and obstructing bronchial aspergillosis. Knowledge of these various radiographic patterns as well as the immune derangements that accompany these infections may allow proper diagnosis.

Aspergillosis, Allergic Bronchopulmonary↗