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Biomedical subjects

Elliot K Fishman

Publications and source records attributed to Elliot K Fishman.

At least 145 records · Page 8Linked to original sources
PubMedDate not supplied

Computed tomography appearance of an intra-aortic balloon pump: a potential pitfall in diagnosis.

The case of a patient with an indwelling intra-aortic balloon pump (IABP) who underwent computed tomography (CT) to rule out mesenteric ischemia is reported. Three-dimensional reconstruction revealed regularly spaced air-fluid levels within the aorta. Intra-aortic balloon pump function is reviewed, and it is shown that its artifactual appearance on CT results from the phase difference between the cardiac cycle and gantry speed. Recognizing and understanding the appearance of an IABP is important so as not confuse it with intra-aortic air, which suggests ischemia.

Angioplasty, Balloon, Coronary↗
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Focal FDG uptake in a pancreatic lipoma mimicking malignancy.

Positron emission tomography (PET) using the glucose analog 18-F-fluoro-2-deoxy-D-glucose (FDG) is commonly obtained to stage patients with cancer. Benign lesions can be a source of false-positive PET examinations, leading to incorrect staging and treatment of tumors. Computed tomography can aid in distinguishing between certain benign and malignant lesions. The authors report a case of a pancreatic lipoma producing a false-positive PET examination.

Aged↗
PubMedDate not supplied

Three-dimensional computed tomographic imaging of complex congenital cardiovascular abnormalities.

Primary evaluation of congenital cardiac abnormalities traditionally relies upon echocardiography and conventional angiography, both of which have potential limitations. Echocardiography is an operator dependant study, limited by a small window and patient movement. Conventional angiography is an invasive procedure with an inherent risk of catheter complication such as vessel damage, bleeding, stroke and infection. During angiography, overlapping of the pulmonary and systemic circulation often provides a confusing picture given complex anatomy. Another limiting factor of particular significance in young children is radiation dose and contrast administration during catherization procedures. Three-dimensional MDCT provides an alternative to alleviate these pitfalls of traditional cardiac diagnostic studies. Development of multi-detector computed tomography (MDCT) and 3D software provides new methods for non-invasive visualization and evaluation of congenital cardiac abnormalities. The multiplanar, volumetric functions allow faster and more complete computed tomography diagnosis and better understanding of clinical relevance of complex cardiac anatomy. In addition, 3D imaging is particularly useful for preoperative planning and postoperative outcomes. This essay provides case studies to illustrate the usefulness of MDCT/3D CT for evaluation of complex congenital heart disease.

Adolescent↗
PubMedDate not supplied

Hemodialysis fistula occlusion: demonstration with 64-slice CT angiography.

The speed and resolution of 64-slice CT have resulted in new applications for CT angiography (CTA) owing to rapid data acquisition during the arterial phase, improved visualization of small vessels, and lengthened anatomic coverage. Extremity CT angiography is one such region. This case report shows the utility of multislice CTA for the evaluation of hemodialysis graft dysfunction.

Adult↗
PubMedDate not supplied

Multidetector computed tomography for suspected appendicitis: multi-institutional survey of 16-MDCT data acquisition protocols and review of pertinent literature.

PURPOSE: To determine acquisition protocol parameters currently used by different institutions for appendiceal multidetector computed tomography (MDCT). MATERIALS AND METHODS: A survey inquiring about multiple MDCT protocols was mailed to 99 fellows of the Society of Computed Body Tomography in August of 2004, with a second mailing sent in May 2005. A total of 46 institutions or hospitals are represented by these Society of Computed Body Tomography fellows. Details pertaining to protocols for the most advanced MDCT scanner in the department were requested. RESULTS: The overall survey response rate was 17 of 46 or 37%. Fifteen protocols using 16-MDCT for suspected appendicitis were collected and tabulated. Parameters that are similar across institutions include a nonfocused acquisition using oral and intravenous contrast. Detector configuration is even divided between submillimeter and greater than 1 mm, and the most common reconstruction section thickness is 5 mm. CONCLUSIONS: Contrast administration and anatomical coverage are quite consistent across this set of protocols. However, future appendiceal MDCT research will need to address the most efficacious detector row collimation, reconstruction section thickness and interval, and the diagnostic capacity of protocols implementing dose reduction measures.

Adolescent↗
PubMedDate not supplied

Modern CT applications in veterinary medicine.

Although computed tomography (CT) is used primarily for diagnosis in humans, it can also be used to diagnose disease in veterinary patients. CT and associated three-dimensional reconstruction have a role in diagnosis of a range of illnesses in a variety of animals. In a sea turtle with failure to thrive, CT showed a nodal mass in the chest, granulomas in the lungs, and a ball in the stomach. CT of a sea dragon with balance and movement problems showed absence of the swim bladder. In a sloth with failure to thrive, CT allowed diagnosis of a coin in the intestine. CT of a puffin with failure to thrive showed a mass in the chest, which was found to be a hematoma. In a smooth-sided toad whose head was tilted to one side and who was circling in that direction, CT showed partial destruction of the temporal bone. CT of a domestic cat with listlessness showed a mass with focal calcification, which proved to be a leiomyosarcoma. CT of a sea otter showed pectus excavatum, which is caused by the animal smashing oysters against its chest. In a Japanese koi with abdominal swelling, CT allowed diagnosis of a hepatoma.

Animals↗
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Volume-rendered 3D CT of the mesenteric vasculature: normal anatomy, anatomic variants, and pathologic conditions.

Multi-detector row computed tomography (CT) offers important advantages over more conventional imaging methods in the evaluation of the mesenteric vasculature. It allows faster scanning, which practically eliminates motion and breathing artifacts, as well as thinner collimation. These advances, coupled with rapid intravenous administration of contrast material, allow excellent opacification of the mesenteric arteries and veins. This improves the quality of the three-dimensional (3D) data sets, which in turn leads to improved 3D vascular maps and more accurate assessment of various conditions such as arterial or venous encasement in patients with pancreatic cancer, mesenteric ischemia, or inflammatory bowel disease. Three-dimensional multi-detector row CT also allows better visualization of arterial and venous branching, thereby improving detection of more distal vascular involvement. In addition, 3D multi-detector row CT may help detect hemodynamic changes in patients with active inflammation and hyperemia of a bowel segment because it can be used to measure bowel wall enhancement over time. Carcinoid tumors that have infiltrated the mesentery have a characteristic CT appearance, and other conditions such as lymphoma or sclerosing mesenteritis can also manifest as an infiltrating mass that envelops mesenteric vessels. Three-dimensional multi-detector row CT represents a significant advance in CT technology and can help ensure prompt, accurate evaluation of the mesenteric vasculature.

Humans↗
PubMedDate not supplied

A five-step approach to digital image manipulation for the radiologist.

Digital manipulation of images plays a key role in development of multimedia presentations. Five basic steps to digitizing images and preparing them for publication and computer presentation are scanning, correction, editing and labeling, saving files, and producing final output. These steps can be completed with commercially available hardware and image manipulation software (eg, Photoshop). The higher the quality of the original scanned image, the more image data there will be to edit: A good image cannot be created from an inferior scan. The most important functions for properly scanning images are size, resolution, and color. Resolutions of 300 ppi and 72 ppi should be used for print publication and computer presentations, respectively. The higher resolution image has the larger file size. The scanned image should be saved as a TIFF (tagged image file format), which is an uncompressed file type used for printed images. The Joint Photographic Experts Group (JPEG) format compresses the size of the image file but also reduces image quality. The JPEG format is a good choice if a small file size is needed, such as in Web and PowerPoint presentations. If the user needs to save an image as a JPEG file, the image should be edited first and then saved once in JPEG format. With Photoshop, the user can rotate and crop an image; adjust its brightness, contrast, and color; remove unwanted patient information, dust, and scratches; and add text and symbol labels to enhance images for teaching purposes. Digital manipulation can be fast and effective if the user has some basic knowledge and tools.

Humans↗
PubMedDate not supplied

CT findings in sclerosing mesenteritis (panniculitis): spectrum of disease.

Sclerosing mesenteritis is a complex inflammatory disorder of the mesentery. Although sclerosing mesenteritis is often associated with other idiopathic inflammatory disorders such as retroperitoneal fibrosis, sclerosing cholangitis, Riedel thyroiditis, and orbital pseudotumor, its exact cause is unknown. The computed tomographic (CT) appearance of sclerosing mesenteritis will vary depending on the predominant tissue component (fat, inflammation, or fibrosis). CT plays an important role in suggesting the diagnosis in the proper clinical setting and can be useful in distinguishing sclerosing mesenteritis from other mesenteric diseases with similar CT features such as carcinomatosis, carcinoid tumor, lymphoma, desmoid tumor, and mesenteric edema. Nevertheless, surgical biopsy and pathologic analysis are usually necessary to make the diagnosis. Treatment may consist of therapy with steroids, colchicine, immunosuppressive agents, or orally administered progesterone. Surgical resection is sometimes attempted for definitive therapy, although the surgical approach is often limited by vascular involvement. CT with three-dimensional volume rendering is optimal for accurate, noninvasive follow-up of sclerosing mesenteritis and of any potential complications.

Adult↗
PubMedDate not supplied

Current role of CT in imaging of the stomach.

Recent advances in computed tomographic (CT) technology and three-dimensional (3D) imaging software have sparked renewed interest in using CT to evaluate gastric disease. Multidetector row CT scanners allow thinner collimation, which improves the visualization of subtle tumors as well as the quality of the 3D data sets. When water is used as an oral contrast agent, subtle disease is easier to visualize, especially when a rapid contrast material bolus is intravenously administered. Adenocarcinoma is the most common gastric malignancy and typically appears as focal or segmental wall thickening or a discrete mass. Gastric lymphoma can have a CT appearance similar to that of adenocarcinoma. Both gastric adenocarcinoma and lymphoma may be associated with adenopathy. Gastrointestinal stromal tumors (GISTs) tend to appear as well-defined masses that arise from the gastric wall and may be exophytic when large. GISTs are usually not associated with significant adenopathy. In addition to gastric malignancies, CT can also help detect inflammatory conditions of the stomach, including gastritis and peptic ulcer disease. CT angiography is especially helpful for depicting the gastric vasculature, which may be affected by a variety of disease conditions.

Angiography↗
PubMedDate not supplied

Mesenteric neoplasms: CT appearances of primary and secondary tumors and differential diagnosis.

Computed tomography (CT) remains the optimal imaging modality for diagnosing tumors in the mesentery. Although primary neoplasms arising from the mesenchymal tissues of the mesentery are rare, the small bowel mesentery is a major avenue for the dissemination of tumor within the peritoneal cavity. Tumors spread to the mesentery by four major routes: (a) direct extension, commonly seen with carcinoid tumor of the small intestine as well as intraabdominal cancers such as pancreatic and colon cancer; (b) lymphatic dissemination of lymphoma and some epithelial malignancies; (c) hematogenic spread resulting in embolic metastases to the small intestinal wall, usually seen in melanoma and breast cancer; and (d) seeding through the peritoneum from ovarian and gastrointestinal malignancies as well as some lymphomas. Although percutaneous imaging-guided or surgical biopsy is often necessary to guide management, analysis of CT features along with the clinical history may be useful in differentiating mesenteric tumors from infectious, inflammatory, or vascular processes affecting the mesentery. The article presents the characteristic appearances of primary and secondary mesenteric neoplasms at CT and offers a rational approach to the differential diagnosis of mesenteric masses depicted at CT.

Diagnosis, Differential↗
PubMedDate not supplied

Multidetector CT of peritoneal carcinomatosis from ovarian cancer.

Ovarian cancer is usually in an advanced stage at diagnosis due to the presence of peritoneal carcinomatosis, which develops as a result of peritoneal fluid circulation. Tumor implants of varying size can occur anywhere from the diaphragm through the pelvis. Computed tomography (CT) can be used to detect these metastatic lesions, which can be miliary or large and appear as soft-tissue or low-attenuation masses. Recent advances in CT technology have increased the flexibility of image acquisition, thereby allowing the use of thin sections and multiplanar reformatting. With multidetector CT, thin-section images of the abdomen and pelvis can be obtained to assess for subcentimeter implants and to create three-dimensional images with reduced artifact. Multiplanar reformatting can be used to confirm the presence of implants. Structures such as the diaphragm, paracolic gutters, bowel, and cul-de-sac can be evaluated in multiple planes for surface nodularity and small implants. Interactive multiplanar review of the abdomen and pelvis has the potential to improve detection of peritoneal metastases at CT.

Carcinoma↗
PubMedDate not supplied

Peripancreatic masses that simulate pancreatic disease: spectrum of disease and role of CT.

A number of entities can simulate pancreatic disease at computed tomography (CT), which may lead to misdiagnosis. Common pitfalls include peripancreatic lesions of the foregut, adrenal gland, and kidney as well as disease of the mesentery and neurovascular structures. Optimal design and application of multi-detector row CT protocols with multiplanar reformation and maximum-intensity-projection and volume-rendering postprocessing improves the specificity of image interpretation. In most cases, helical CT is highly accurate for distinguishing primary disease of the pancreas from adjacent disease, although there are cases in which the differential diagnosis is more challenging and the potential for misdiagnosis still exists. Familiarity with some of the entities that can simulate pancreatic disease, careful attention to scanning protocol and contrast material administration, use of the full potential of multi-detector row CT data sets, and judicious application of postprocessing tools may help avoid some of the pitfalls caused by peripancreatic lesions.

Adult↗
PubMedDate not supplied

PET-CT in recurrent ovarian cancer: initial observations.

Noninvasive diagnosis of early recurrence of ovarian cancer is challenging due to the small size of peritoneal metastases. Small-volume disease may not be evident at anatomic imaging in patients with elevated serum tumor markers. Functional imaging in the form of positron emission tomography (PET) can help identify patients with recurrent tumor. However, lesion localization for possible surgical treatment is difficult with PET alone. Combined functional-anatomic imaging with fused PET and computed tomographic (CT) scans is feasible and may improve disease detection by increasing radiologic sensitivity and specificity. PET and PET-CT have a potential role in evaluating patients for recurrent ovarian cancer, particularly those with negative CT or magnetic resonance imaging findings and rising tumor marker levels. Fused PET-CT scans obtained with combined scanners can help localize pathologic activity and differentiate this activity from physiologic radiotracer uptake. Combined functional-anatomic imaging can also increase diagnostic confidence at CT. Further study is needed to determine the possible benefits of lesion conspicuity at PET and anatomic localization at CT on fused PET-CT scans.

Aged↗
PubMedDate not supplied

Multi-detector row CT evaluation of living renal donors prior to laparoscopic nephrectomy.

Since its introduction in 1995, laparoscopic nephrectomy has become the preferred technique at many medical centers for the harvesting of kidneys from living donors for transplantation. Because the field of view at laparoscopic surgery is limited, preoperative radiologic evaluation of the donor's anatomy---the renal veins and arteries, collecting system, and parenchyma--is critical. Spiral computed tomographic (CT) angiography is a fast, safe, minimally invasive, and generally accepted method for preoperative evaluation of the renal vessels. Multi-detector row CT scanners offer shorter image acquisition time, narrower collimation, better spatial resolution, and less tube heating than do single-detector row CT scanners. Multi-row scanners also provide more complete anatomic coverage, increased contrast enhancement of the arteries, and greater longitudinal spatial resolution--all of which are important both for accurate imaging of the renal vasculature and for three-dimensional postprocessing of image data. Dual-phase multi-detector row CT angiography combined with three-dimensional postprocessing enables minimally invasive and highly accurate depiction of the preoperative donor anatomy. To make the most effective use of this method, radiologists must be familiar with its technical aspects, advantages, and potential pitfalls. They also must be able to identify variations in vasculature and in renal and extrarenal anatomy that are important for laparoscopic donor nephrectomy.

Equipment Design↗
PubMedDate not supplied

Amyloidosis: review and CT manifestations.

Amyloidosis is a collection of disease entities that produce considerable morbidity and mortality and are increasing in prevalence. The imaging findings are problematically nonspecific and diverse. This lack of specificity is compounded by the fact that amyloidosis is strongly associated with and frequently coexists with many other chronic disease states that have their own imaging findings. Amyloidosis can involve any organ singly or in conjunction with other organs and can do so in the form of a focal, tumorlike lesion or an infiltrative process. In the proper clinical setting, that is, in a patient with chronic inflammatory disease and especially in a patient with multiple myeloma, amyloidosis should be considered as a possible cause of worsening or new symptoms or imaging findings. Occasionally, the radiologic findings may precede the clinical findings, thus providing the radiologist with the opportunity to contribute to the patient's care. However, to make a difference in patient care, the radiologist must be familiar with the diverse imaging findings of amyloidosis as well as the patient's clinical history, which could raise the suspicion of amyloidosis.

Aged↗
PubMedDate not supplied

Adult ureteropelvic junction obstruction: insights with three-dimensional multi-detector row CT.

Ureteropelvic junction obstruction (UPJO) is a benign, congenital condition that remains an enigma in terms of both diagnosis and therapy. On the basis of a series of cases that were referred to the authors in their clinical practice, they found that the unprecedented quality and novel perspectives of multi-detector row computed tomography (CT) with two- and three-dimensional postprocessing allow a comprehensive, single-study assessment of the ureterovascular relationships in UPJO. This topic is important because the causative role of crossing vessels may be questioned on the basis of such studies, and the therapeutic approach may be altered by using precise anatomic images customized to the pathologic features of the individual patient. Although CT images can provide only circumstantial or supportive evidence of the pathophysiology of UPJO, they greatly facilitate therapeutic intervention when it is clinically indicated and may eliminate the need for it in select cases. Careful attention to the postprocessing of CT images may show that the crossing vasculature has no direct relationship to the transition point of the UPJO in many cases.

Adult↗