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Biomedical subjects

Elliot K Fishman

Publications and source records attributed to Elliot K Fishman.

At least 19 recordsLinked to original sources
PubMed2007

Multidetector row CT of superior mesenteric artery syndrome.

GOALS: The purpose of this case series is to illustrate the diagnostic criteria of superior mesenteric artery syndrome (SMAS) using 16-slice multidetector row computed tomography (MDCT) angiography with multiplanar and 3-dimensional reconstructions. BACKGROUND: SMAS is a rare condition causing functional obstruction of the third portion of the duodenum. When suspected, diagnostic imaging can be performed with upper gastrointestinal, arteriography, or CT. STUDY: Four patients with clinical symptoms and correlative CT evidence of SMAS are described. Axial, multiplanar, and 3-dimensional rendered MDCT images were retrospectively reviewed by 1 investigator, who measured the aortomesenteric angle and aortomesenteric distance on a sagittal maximum intensity projection rendering, and compared these values with normal ranges described in the literature. RESULTS: In each patient, MDCT demonstrated gastric and proximal duodenal dilatation with abrupt narrowing of the third portion of the duodenum between the aorta and SMA. Sagittal maximum intensity projection images reliably demonstrated the decreased aortomesenteric angle (mean in subjects 13.5 degrees, normal range 28 to 65 degrees) and distance (mean in subjects 4.4 mm, normal range 10 to 34 mm) in all 4 patients. CONCLUSIONS: As opposed to traditional imaging modalities like upper gastrointestinal and mesenteric arteriography, which depict either the bowel or vasculature respectively, CT enables direct visualization of obstructed bowel owing to duodenal compression by the SMA. Multiplanar MDCT with 3-dimensional rendering provides sagittal reconstructions that can be used to confirm the CT criteria of decreased aortomesenteric angle and distance in SMAS.

Adolescent↗
PubMed2006

MDCT for suspected pulmonary embolism: multi-institutional survey of 16-MDCT data acquisition protocols.

The purpose of this study was to determine the extent to which a consensus exists on multidetector row computed tomography (MDCT) protocol parameters for suspected pulmonary embolism (PE). In August of 2004, a questionnaire addressing a number of body MDCT protocols was mailed to 99 fellows of the Society of Computed Body Tomography, representing a total of 46 institutions. In May 2005, this was followed up with a second mailing. The survey requested details pertaining to protocols for the most advanced MDCT scanner in the department. The overall survey response rate of 37% (17/46) yielded 15 protocols for 16-MDCT imaging of suspected PE. This data was tabulated and revealed a consensus for the use of bolus tracking, rapid contrast infusion, caudo-cranial scanning, the narrowest detector row collimation, and thin (<2 mm) reconstruction sections. However, contrast infusion timing, contrast concentration, and implementation of radiation dose modulation were variable. This compilation of protocols reflects recently published studies advocating the use of narrow acquisition collimation and reconstruction sections for MDCT of suspected PE. Future studies are necessary to elucidate the optimal intravenous contrast infusion parameters and further assess the efficacy of reduced radiation dose protocols.

Consensus↗
PubMed2006

Multidetector-row CT of the appendix in healthy adults.

The purpose of this study is to characterize the caliber of the normal appendix and the effect of luminal content on appendiceal diameter in adults using thin section intravenous (IV) contrast enhanced multidetector-row computed tomography (MDCT). A retrospective review was conducted using the MDCT datasets from 82 adults being screened as potential renal donors. The four-channel CT technique included IV contrast and 1-mm collimation. Arterial phase scans were reviewed by two radiologists blinded to surgical history, to evaluate the following parameters related to the appendix: quality of visualization, origin and course relative to the cecum, maximum cross-sectional diameter of the lumen and luminal contents at the point of measurement, appearance of the periappendiceal fat, and presence of any luminal calcification. Medical records were reviewed to determine which subjects had reported a previous appendectomy or to confirm the absence of symptoms in any subjects with findings suspicious for appendicitis. The appendix was visualized in 72 of the 77 subjects who did not report an appendectomy (94%). The mean diameter of the collapsed appendix was 5 mm (range: 3-7 mm) and the air-distended appendix, 7 mm (range: 4-10 mm). Sixteen to 17% of the collapsed appendices measured 7 mm in diameter. Minimal periappendiceal stranding was identified in 2/72 subjects (3%). Chart notes from within 24 h of the MDCT confirmed no signs or symptoms of appendicitis in cases that demonstrated any CT finding suspicious for appendicitis. In this healthy, adult population, the collapsed appendix measured up to 7 mm at MDCT. Air distention of the lumen results in a wider diameter, up to 10 mm.

Adult↗
PubMed2006

The reverse shoulder prosthesis: A review of imaging features and complications.

BACKGROUND: The reverse shoulder prosthesis is a prosthesis that has been in clinical use in Europe since 1985 and was approved for use in the United States in 2004. This unique prosthesis has a baseplate attached to the glenoid, which holds a spherical component, while the humeral component includes a polyethylene insert that is flat. This design is the "reverse" configuration of that seen with a conventional arthroplasty, in which the spherical component is part of the humeral component. The indications for the reverse prosthesis are: (1) painful arthritis associated with irreparable rotator cuff tears (cuff tear arthropathy), (2) failed hemiarthroplasty with irreparable rotator cuff tears, (3) pseudoparalysis due to massive, irreparable rotator cuff tears, (4) some reconstructions after tumor resection, and (5) some fractures of the shoulder not repairable or reconstructable with other techniques. This prosthesis can produce a significant reduction in pain and some improvement in function for most of the indications mentioned. However, the unique configuration and the challenge of its insertion can result in a high incidence of a wide variety of unusual complications. Some of these complications, such as dislocation of the components, are similar to conventional shoulder replacement. Other complications, such as notching of the scapula and acromial stress fractures, are unique to this prosthesis. CONCLUSION: The configuration of the reverse prosthesis, its normal radiographic appearance and potential complications associated with its use are reviewed.

Arthroplasty, Replacement↗
PubMed2006

Sixteen-slice CT with volumetric analysis of foot fractures.

Computed tomography (CT) imaging of the foot demands excellent resolution for the delineation of complex fractures and joint alignment after trauma. The quality of current multislice volumetric acquisition results in exceptional multiplanar and 3-D reconstructions, precluding the requirement for an additional acquisition in a second plane. This pictoral essay depicts fractures of various bones of the foot, with reference to recent investigative studies demonstrating the value of CT in the evaluation of foot fractures.

Adolescent↗
PubMed2006

Ascariasis infection of the colon: MDCT evaluation.

Ascariasis is the most common helminth infection in the world and is a common cause of abdominal symptoms worldwide. Although rare in the United States, isolated cases do occur in the Southwestern States. We present a case of a 34-year-old woman who presented to the emergency room with abdominal pain and diarrhea. The diagnosis of ascariasis was made on CT scan.

Adult↗
PubMed2006

Characterization of pediatric skeletal tumors and tumor-like conditions: specific cross-sectional imaging signs.

The radiograph is indispensable for characterizing pediatric skeletal lesions. However, cross-sectional imaging with CT and MRI can provide additional information and augment or confirm an impression obtained from the initial radiographic findings. This review will highlight the role of CT and MRI in characterizing pediatric skeletal tumors and tumor-like conditions. Focus will be given to the contributions of each modality to the process of characterizing skeletal lesions, recalling that cross-sectional imaging is more commonly obtained for the purpose of determining extent of disease rather than for characterization.

Anatomy, Cross-Sectional↗
PubMed2006

Comparison of coronary calcium and stress myocardial perfusion imaging in apparently healthy siblings of individuals with premature coronary artery disease.

Detection of subclinical coronary atherosclerosis is possible using exercise myocardial perfusion imaging for inducible ischemia or multidetector computed tomography for coronary artery calcium (CAC), which is used to detect subclinical coronary atherosclerosis. The extent to which these screening tests converge in an asymptomatic population that is at increased risk for coronary artery disease remains unknown. We compared the concordance of findings in 260 asymptomatic middle-age siblings of hospitalized index patients <60 years of age with documented coronary artery disease. All subjects underwent maximal exercise testing with postexercise and delayed attenuation-corrected thallium single-photon emission computed tomography and multidetector computed tomography for CAC. An abnormal exercise single-photon emission computed tomographic (SPECT) result occurred in >50% of subjects with a CAC score >100, but also in 12% with no CAC, 9% with CAC scores of 1 to 10, and 20% with CAC scores of 11 to 100. In subjects with an abnormal exercise SPECT result, 59% had CAC scores < or =100. Overall, there was only a modest agreement between an abnormal exercise SPECT result and high CAC scores. In conclusion, although moderate or severe CAC is often associated with inducible ischemia, the absence of CAC or the presence of only mild CAC by no means precludes inducible myocardial ischemia. These screening tests may reflect different aspects or stages of coronary disease in an asymptomatic middle-age population.

Adult↗
PubMed2006

Internet-based medical education: use of an "expert-corner" for disseminating radiologic information and determining users' educational interests.

RATIONALE AND OBJECTIVES: A website dedicated to body computed tomography (CT) offers users the opportunity to submit any question to a national expert. The purpose of this study was to characterize inquiries submitted over a 1-year period. MATERIALS AND METHODS: A total of 408 questions posed by users between February 2003 and February 2004 were reviewed and categorized. Web tracking was conducted to evaluate the program utilization over a 3-year period. RESULTS: Of the questions submitted, those addressing data acquisition protocols and intravenous contrast administration comprised 55% (224/408). Web tracking demonstrated that the number of visits to this educational program has progressively increased since 2003. CONCLUSIONS: Users requesting information were most interested in the proper performance of CT data acquisition. An Internet-based expert corner is a promising channel to deliver experience based radiologic information.

Internet↗
PubMed2006

CT pulmonary angiography is the first-line imaging test for acute pulmonary embolism: a survey of US clinicians.

RATIONALE AND OBJECTIVES: Our aim is to document current imaging practices for diagnosing acute pulmonary embolism (PE) among physicians practicing in the United States and explore factors associated with these practices. MATERIALS AND METHODS: Between September 2004 and February 2005, we surveyed by mail 855 physicians selected at random from membership lists of three professional organizations. Physicians reported their imaging practices and experiences in managing patients with suspected acute PE during the preceding 12 months. RESULTS: Completed questionnaires were received from 240 of 806 eligible participants (29.8%) practicing in 44 states: 86.7% of respondents believed that computed tomographic pulmonary angiography (CTPA) was the most useful imaging procedure for patients with acute PE compared with 8.3% for ventilation-perfusion (V-P) scintigraphy and 2.5% for conventional pulminary angiography (PA). After chest radiography, CTPA was the first imaging test requested 71.4% of the time compared with V-P scintigraphy (19.7%) and lower-limb venous ultrasound (5.8%). Participants received indeterminate or inconclusive results 46.4% of the time for V-P scintigraphy, 10.6% of the time for CTPA, and 2.2% of the time for PA. CTPA was available around the clock to 88.3% of participants compared with 53.8% for V-P scintigraphy and 42.5% for PA. A total of 68.6% of respondents received CTPA results in 2 hours or less (vs 37.5% for V-P scintigraphy and 22.9% for PA). CTPA also provided an alternative diagnosis to PE or showed other significant abnormalities 28.5% of the time, and these findings frequently altered management. CONCLUSION: US clinicians unequivocally prefer CTPA in patients with suspected acute PE. Reasons for this preference include availability and timely reporting, a lower rate of inconclusive results, and the additional diagnostic capabilities that CTPA can provide.

Angiography↗
PubMed2006

Scanning systems and protocols used during imaging for acute pulmonary embolism: how much do our clinical colleagues know?

RATIONALE AND OBJECTIVES: The imaging systems and protocols used during ventilation-perfusion lung (V-P) scintigraphy and computed tomographic (CT) pulmonary angiography (CTPA) can affect diagnostic performance. We investigated the level of awareness of these factors among US clinicians who refer patients for imaging for suspected acute pulmonary embolism. MATERIALS AND METHODS: Between September 2004 and February 2005, we conducted a mail survey of 855 physicians selected at random from three professional organizations. We asked participants how important the availability of state-of-the-art equipment was in their imaging decisions, whether V-P scintigraphy was performed with planar or single-photon emission CT (SPECT) equipment in their communities, to identify the most advanced type of CT scanner used for CTPA, and whether CT venography (CTV) was performed routinely after CTPA. RESULTS: We received completed surveys from 240 (29.8%) physicians practicing in 44 states. One hundred sixty-six respondents (70.9%) indicated that state-of-the-art equipment was an extremely or very important factor when they made imaging decisions. However, 191 clinicians (80.3%) did not know whether SPECT equipment was used for V-P scintigraphy, and 119 (50.6%) did not know the type of CT scanner used for CTPA in their communities. Of respondents, 39.2% reported access to multidetector row CT technology for CTPA, whereas 10.2% referred patients to facilities using single-detector CT. Only 9.3% of respondents indicated that CTV was performed routinely after CTPA. CONCLUSION: Although state-of-the-art equipment is important to them, clinicians practicing in the United States have limited knowledge of the equipment being used during CTPA and V-P scintigraphy scanning in their communities. Radiologists should intensify efforts to familiarize their clinical colleagues with the equipment they use.

Attitude of Health Personnel↗
PubMed2006

Catecholamine-secreting metastatic carcinoid as differential diagnosis in pheochromocytoma: clinical, laboratory, and imaging clues in the search for the lurking neuroendocrine tumor (NET).

Catecholamine-secreting metastatic carcinoid should be considered in differential diagnosis of malignant pheochromocytoma. Paroxysmal functioning or hormonally silent gastroenteropancreatic neuroendocrine tumors (GEP NETs) require repeat biochemical measurements and sensitive anatomic and functional imaging studies overlapping those for malignant pheochromocytoma. This report presents clinical, laboratory, and radiologic findings in a patient presenting with heart rate variability; vasoactive headaches reactive to ethanol, tyramine and tryptophan; labile blood pressure; diaphoresis; diarrhea; abdominal pain; unexplained pancreatitis; joint pain; and paroxysmal flushing with pallor. GI studies (including endoscopic ultrasound) and multiple imaging modalities (including 2D CT, MRI with gadolinium, [18]FDG PET/CT, [123I]MIBG, and SRS [111In]Octreotide [OctreoScan]) were not diagnostic. 24-h BP, Holter and 30-day cardiac event monitors plus urinary biochemical studies consistently suggested catecholamine-synthesizing NET. NIH plasma metanephrines studies and [6]-[18F]Fluorodopamine PET ruled out malignant pheochromocytoma (pheo). Repeated studies showed persistently abnormal GEP NET biomarkers and urinary catecholamines. Capsule endoscopy revealed suspicious submucosal lesions throughout the small intestine. Dual-phase 64-slice multidetector computed tomography (MDCT) with 3D volumetric reconstruction of the abdomen and pelvis revealed multiple diffuse liver metastases and three extrahepatic lesions consistent with metastatic carcinoid. In combination, intensive biochemical testing repeated over time, dual-phase 64-slice MDCT with 3D image reconstruction and volume-rendering (VR) technique, and advanced radionuclide imaging are required to detect NETs' sporadic or paroxysmal functioning, rule out extra-adrenal pheochromocytoma, and localize and characterize metastatic carcinoid. If pheochromocytoma is ruled out, yet symptoms and biochemical markers for catecholamine excess are present, then carcinoid and other amine-precursor-uptake decarboxylation (APUD) tumors must remain in the differential diagnosis.

Adrenal Gland Neoplasms↗
PubMed2006

MDCT of intraductal papillary mucinous neoplasm of the pancreas: evaluation of features predictive of invasive carcinoma.

OBJECTIVE: The purpose of our study was to evaluate factors predictive of the presence of invasive carcinoma associated with intraductal papillary mucinous neoplasm (IPMN) of the pancreas on MDCT. MATERIALS AND METHODS: Preoperative MDCT of 36 consecutive patients (23 men, 13 women; mean age, 66.6 years) who had undergone surgical resection and had a pathologic diagnosis of IPMN were retrospectively assessed. CT was performed with a 4-MDCT scanner with 120 mL of IV contrast material at an injection rate of 3 mL/sec. Arterial and venous phase images were acquired at 25 and 50-60 sec from the start of IV contrast administration. Type of ductal involvement, location, tumor size in branch duct type and combined type lesions, caliber of the main pancreatic duct, caliber of the common bile duct or common hepatic duct, and solid appearance of the lesion were assessed on CT and correlated with pathologic findings for invasive carcinoma. RESULTS: Pathologic analysis revealed carcinoma in situ in seven patients (19%) and invasive carcinoma in 15 patients (42%) arising from the IPMN. With invasive carcinoma, the size of the tumor in branch duct type and combined type, and the caliber of the main pancreatic duct were significantly larger compared with the lesions without invasive carcinoma (4.7 +/- 1.7 cm vs 2.6 +/- 1.4 cm [p = 0.0007] and 9.3 +/- 5.5 mm vs 4.6 +/- 4.1 mm [p = 0.006], respectively). A solid mass (p < 0.001), dilatation of the common bile duct or common hepatic duct (> or = 15 mm), and the presence of a stent (p = 0.0004) were correlated with the presence of associated invasive carcinoma. CONCLUSION: MDCT helped to predict invasive carcinoma associated with IPMN.

Adenocarcinoma, Mucinous↗