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J E Reed

Publications and source records attributed to J E Reed.

At least 37 records · Page 2Linked to original sources
PubMed1997

Automatic segmentation, tissue characterization, and rapid diagnosis enhancements to the computed tomographic colonography analysis workstation.

An image processing system developed to support examination of computed tomographic colonoscopy (CTC) was developed in 1995. The clinical viability of CTC is enhanced by the solution of several technical problems. These problems include the limited detectability of sessile polyps and difficulties in discrimination between polypoid masses and retained stool. CTC is also made more feasible by simplifying the required colon preparation and reducing the time required to analyze scan results. Each of these challenges have been addressed by enhancements to the CTC analysis workstation software. Endoluminal volume rendering has been enhanced by the addition of automatic segmentation to facilitate analysis of colon segments, which contain tagged liquid stool. By automating this function, the system is able to process scans that are acquired following a wide variety of colon preparation protocols. Similar approaches have been used to identify retained stool. Automatic tissue characterization has also been incorporated into the volume rendering routines to help identify and diagnose polypoid masses. These enhancements have improved the quality of CTC interpretation, while reducing the time required to perform the analysis. This time reduction was necessary to reduce the cost of CTC enough to make it viable for asymptotic population screening. To date, over 150 patient examinations have been performed using this new technique. A recent blinded, prospective study reporting the results from two independent observers has been presented. The technique is feasible, reliable, and has been implemented clinically with results reported within 1 hour of the examination.

Colon↗
PubMed1997

Computed tomographic colonography (Virtual colonoscopy): a new method for detecting colorectal neoplasms.

Computed tomographic (CT) colonography is an exciting new technique that uses volumetric CT data combined with advanced imaging software to create two-dimensional and three-dimensional images of the colon. The technique uses both three-dimensional images that simulate the endoluminal perspective of the colonoscope, as well as axial and reformatted two-dimensional images. The two-dimensional and three-dimensional images are complementary, and in combination offer the most robust performance for the detection of colorectal polyps. Currently, CT colonographic examinations are performed in the fully cleansed and air-inflated colon using a slice thickness of 5 mm, a reconstruction interval of 3 mm, a pitch of 1.3, and 70 mA. In a blinded, prospective study of 70 patients (half with a known lesion, and half from a surveillance population with a low disease prevalence) the sensitivity for the detection of polyps of 1 cm or more is 75%, and the specificity is 90%. The most commonly encountered problems include retained colonic fluid and stool, suboptimally distended colonic segments, and long interpretation times. Many of these problems can be solved using both supine and prone imaging. It is expected that the performance of this examination will improve, and that a new era of colorectal screening will begin.

Colonoscopy↗
PubMed1997

Detection of colorectal polyps with CT colography: initial assessment of sensitivity and specificity.

PURPOSE: To estimate the sensitivity and specificity of computed tomographic (CT) colography in detection of colorectal polyps and to compare these findings with those at axial CT. MATERIALS AND METHODS: In 70 consecutive patients, CT colography and colonoscopy were performed. Helical axial CT images and CT colographic images (multiplanar two- and three-dimensional endoluminal images) were evaluated separately by two radiologists blinded to results from colonoscopy and other imaging studies. Findings were compared with those at colonoscopy, which was the standard. RESULTS: The sensitivity and specificity for the two observers with CT colography averaged 75% and 90% in patients with adenomas 10 mm in diameter or larger, 66% and 63% in patients with adenomas 5 mm in diameter or greater, and 45% and 80% for patients with adenomas less than 5 mm in diameter, respectively. Sensitivity and specificity with axial CT were lower than those with CT colography (58% and 74%, respectively) in patients with adenomas 10 mm in diameter or larger. CONCLUSION: Compared with axial CT, CT colography appears to have superior sensitivity and specificity in detection of clinically important colorectal adenomas. Early performance of CT colography seems promising for detection of colorectal polyps 5 mm and larger.

Adenoma↗
PubMed1996

Fixed vs. flexible neuropsychological test batteries under the Daubert standard for the admissibility of scientific evidence.

In Chapple v. Ganger, (1994), the Daubert standard was applied for the very first time to the use of fixed (standardized) versus flexible (nonstandardized) neuropsychological test batteries in the federal court. In this personal injury case the Chapple court gave far greater weight to the results obtained from a fixed battery than to the results obtained from two flexible neuropsychological test batteries. Significantly, under the Daubert standard the District Judge noted the lack of medical and scientific evidence to support the conclusions made by the Plaintiffs' two expert witnesses, a psychologist and a neuropsychologist, even though each had administered a comprehensive and flexible neuropsychological test battery and had based their conclusions on the test results. However, the Judge accepted as scientific evidence the objective test results obtained from the fixed Halstead-Reitan Neuropsychological Test Battery for Older Children administered by the Defendants' expert witness Dr. Ralph Reitan and also accepted his scientific expert medical testimony which was closely derived from these data. Applying the Daubert standard to the neuropsychological test results and opinions of the expert witnesses, the District Judge held that the entire reasoning process and not simply part of the reasoning process upon which the expert witness derives a conclusion must reflect scientific methodology.

Criminal Law↗
PubMed1996

Regional left ventricular wall thickness and systolic function during the first year after index anterior wall myocardial infarction: serial effects of ventricular remodeling.

There is controversy regarding changes in regional left ventricular systolic function and thickness during remodeling after infarction. To address this, electron beam computed tomography was done in 22 patients with an index anterior wall infarction at discharge, 6 weeks, 6 months and 1 year, and global ventricular chamber volumes and mass quantified. A mid-ventricular short-axis scan from each study was divided into 4, 90 degrees sectors (anterior, septal, lateral and posterior walls). Regional wall thickness, ejection fraction, and absolute and percent wall thickening were determined and compared with 10 normal adults. Global infarct size was estimated at 24.2%+/- 3.4% of the ventricle. In these subjects, the ventricular chamber enlarged steadily during the year, while global ventricular mass initially decreased during the first 6 weeks, but then increased by 1 year. Regional ejection fraction changed little during the year, apart from the lateral wall, which was less than normal. Absolute wall thickening was reduced in the anterior (infarct) and septal walls throughout the year, but was normal and unchanged in the posterior and lateral walls. Regional percent wall thickening was not different from normal individuals. The anterior wall was thinned at discharge and tended to thin further during the year. The lateral wall was thinner than normal 6 weeks after infarction, but remained unchanged thereafter. The posterior wall tended to thin for the first 6 months, but the values at any time were not above normal. There was little change in septal wall thickness throughout the year. It is concluded that, after a moderate size, uncomplicated index anterior infarction, regional systolic function remains generally unaffected by remodeling. However, regional walls tend to thin and/or remain at normal thickness. These data confirm differential regional patterns after anterior infarction for systolic function, muscle atrophy and/or minimal hypertrophy which accompany serial changes in global ventricular chamber volumes and mass.

Aged↗
PubMed1996

Detection of colorectal polyps by computed tomographic colography: feasibility of a novel technique.

BACKGROUND & AIMS: Computed tomographic colography (CTC) represents a novel technique for colorectal polyp detection. A prospective study was undertaken to determine the optimal CTC scanning parameters based on an artificial colon model and to assess the feasibility of CTC to detect clinically significant colorectal polyps. METHODS: A colon model was scanned by helical computed tomography at multiple parameters. Reformatted two-dimensional and three-dimensional images were then graded for polyp detection and image quality. Subsequently, 10 patients with known colon polyps underwent CTC immediately before colonoscopy. The number of polyps detected by two radiologists using CTC were compared with colonoscopy results that served as the gold standard. RESULTS: The optimal scanning parameters in the colon model were 5-mm collimation, 5 mm/s table speed, and 1-mm reconstruction interval. Ten patients had 30 polyps (range, 0.2-2.0 cm) by colonscopy, and all polyps > or = 0.5 cm were adenomas. Polyp detection by CTC for both observers was 100% (5 of 5) > or = 1 cm, 71% (5 of 7) between 0.5 and 0.9 cm, and 11%-28% (2-5 of 18) < 0.5 cm. CONCLUSIONS: Based on this small, unblinded pilot study, CTC is feasible for colorectal polyp detection > or = 0.5 cm in diameter.

Aged↗
PubMed1996

Colorectal polyp detection with CT colography: two- versus three-dimensional techniques. Work in progress.

PURPOSE: To compare detection of colorectal polyps with two-dimensional (2D) computed tomographic (CT) colography only, three-dimensional (3D) CT colography only, and a combination of 2D and 3D CT colography. MATERIALS AND METHODS: A total of 11 computer-simulated polyps (1-10 mm) were placed randomly in five identical CT data sets for images of a 72-year-old man's polyp-free, rectosigmoid colon. Fifteen CT colographic data sets were produced: five with 2D CT images only, five with 3D CT images only, and five with 2D and 3D CT images. Two radiologists randomly, blindly, and independently evaluated all 15 data sets to detect the simulated polyps. RESULTS: No polyps 2 mm or smaller were detected. No statistically significant differences in the detection of colorectal polyps were found between the three techniques. However, the combination of 2D and 3D CT colography resulted in polyp detection rates that were greater than or equal to those of 2D or 3D CT colography alone. Flat polyps were more difficult to detect than sessile polyps. Five false-positive findings occurred with 2D CT colography. CONCLUSION: A combined display of 2D and 3D CT images likely provides the greatest rate of detection of colorectal polyps.

Aged↗
PubMed1995

Serial changes in left and right ventricular systolic and diastolic dynamics during the first year after an index left ventricular Q wave myocardial infarction.

OBJECTIVES: This study quantified serially biventricular emptying and filling after infarction and related these to changes in volume, muscle mass, wall stress and contractility. BACKGROUND: There are limited data on serial changes in ventricular dynamics after infarction. METHODS: Forty patients had serial electron beam computed tomographic examinations during the first year after index Q wave infarction (21 anterior, 19 inferior), and global biventricular volumes, peak rates of emptying and filling and left ventricular muscle masses were quantified. Mean mid-left ventricular end-systolic wall stresses, rate-corrected velocities of circumferential shortening and two indexes of left ventricular contractility--the end-systolic wall stress/volume ratio and the end-systolic wall stress/rate-corrected velocity of circumferential shortening relation--were estimated in each instance. RESULTS: Patients with anterior infarction had an increase in biventricular chamber volume of 15% to 35% by 1 year. Global biventricular peak rates of emptying and filling were decreased by 20% to 30% from hospital discharge to 6 weeks but thereafter remained unchanged. Despite a significant increase in mean wall stresses, the end-systolic wall stress/volume ratio remained unchanged during the year. The rate-corrected velocities of circumferential shortening declined serially after anterior infarction but did so in proportion to the increase in mean wall stresses, consistent with no net change in left ventricular contractility. Patients with inferior infarction showed a trend toward similar changes, but the magnitudes did not reach significance. CONCLUSIONS: Left (and right) ventricular global peak rates of emptying and filling during the first year after infarction can be altered in the absence of additional ischemic injury but are more consistent with responses to changes in left ventricular afterload than changes in intrinsic ventricular performance or contractility. Serial changes in left ventricular afterload after infarction are largely due to progressive chamber enlargement and limited development of compensatory hypertrophy during the first year. Intrinsic global left ventricular contractile performance was not altered by postinfarction cardiac remodeling in the patients examined.

Coronary Circulation↗
PubMed1995

Serial changes in regional right ventricular free wall and left ventricular septal wall lengths during the first 4 to 5 years after index anterior wall myocardial infarction.

OBJECTIVES: This study investigated serial changes in regional right ventricular free wall and interventricular septal wall lengths during the first 4 to 5 years after an index anterior wall myocardial infarction. BACKGROUND: We previously demonstrated that remodeling after anterior wall myocardial infarction was a biventricular process; however, regional changes in biventricular topology were not investigated. METHODS: Serial electron beam computed tomographic scanning was performed in 19 patients at five times (hospital discharge and at 6 weeks, 6 months, 1 year and 4 to 5 years) after an index anterior wall myocardial infarction, and global and regional right ventricular free wall and interventricular septal wall lengths were quantified. RESULTS: At a mean (+/- SD) of 1,642 +/- 171 days (4 to 5 years) after infarction, global end-diastolic and end-systolic right ventricular free wall and interventricular septal wall lengths increased in parallel by 13% to 23% as global left and right ventricular volumes increased 22% to 29% from hospital discharge to 4 to 5 years after infarction. When global right ventricular free wall was compared with interventricular septal wall lengths, percent increases at end-diastole and end-systole were not statistically different at any time during the study period. Distinct regional changes in both right ventricular free wall and interventricular septal wall lengths after infarction were most dramatic during the first 6 weeks and primarily confined to the most apical levels. However, further and significant increases in both were observed by 4 to 5 years after infarction. CONCLUSIONS: Changes in both right ventricular free wall and interventricular septal wall lengths were apparent during the 4 to 5 years after the index anterior wall infarction, and the combination of both contributed to global increases in right and left ventricular chamber volumes. Regional changes in both right ventricular free wall and interventricular septal wall lengths were almost exclusively confined to their respective apices and progressed generally in parallel; however, the cause-and-effect relation remains speculative at the present time.

Adult↗
PubMed1995

Measurement of abdominal and visceral fat with computed tomography and dual-energy x-ray absorptiometry.

These studies were undertaken to compare dual-energy x-ray absorptiometry (DXA) and computed tomography (CT) measurements of abdominal fat and to determine whether anthropometry could be combined with DXA to predict intraabdominal (visceral) fat mass in humans. Twenty-one volunteers underwent abdominal CT scans, DXA, and anthropometry. DXA- and CT-measured total abdominal fat were similar (8448 +/- 5005 and 8066 +/- 5354 mL, respectively; NS) and were highly correlated (r = 0.985, P < 0.001). The combination of anthropometry and DXA was a suboptimal predictor of CT-measured intraabdominal fat (r = 0.61, P < 0.05); however, the combination of a single CT slice (to assess the ratio of intraabdominal to total abdominal adipose tissue) and DXA-measured abdominal fat was an excellent predictor of CT-measured intraabdominal fat (r = 0.98, P < 0.001). We conclude that a single-slice CT scan (or other imaging technique) with or without DXA is required for accurate predictions of intraabdominal fat.

Absorptiometry, Photon↗
PubMed1994

A method for automatic edge detection and volume computation of the left ventricle from ultrafast computed tomographic images.

RATIONALE AND OBJECTIVES: Detection of endocardial and epicardial borders of the left ventricle (LV) using various imaging modalities is time-consuming and prone to interpretive error. An automatic border detection algorithm is presented that is used with ultrafast computed tomographic images of the heart to compute cavity volumes. METHODS: The basal-level slice is identified, and the algorithm automatically detects the endocardial and epicardial borders of images from the basal to the apical levels. From these, the ventricular areas and chamber volumes are computed. The algorithm uses the Fuzzy Hough Transform, region-growing schemes, and optimal border-detection techniques. The cross-sectional areas and the chamber volumes computed with this technique were compared with those from manually traced images using canine hearts in vitro (n = 8) and studies in clinical patients (n = 27). RESULTS: Though the correlation was good (r = .88), the algorithm overestimated the LV epicardial area by 4.8 +/- 6.4 cm2, though this error was not statistically different from zero (P > .05). There was no difference in endocardial areas (r = .95, P > .05). The algorithm tended to underestimate the end-diastolic volume (r = .94) and the end-systolic volume (r = .94), although these errors were not statistically different from zero (P > .05). The algorithm tended to underestimate the ejection fraction (r = .80), although this error was not statistically different from zero (P > .05). CONCLUSIONS: Automatic detection of myocardial borders provides the clinician with a useful tool for calculating chamber volumes and ejection fractions. The algorithm, with the corrections suggested, provides an accurate estimation of areas and volumes. This algorithm may be useful for contour border identification with ultrasound, positron-emission tomography, magnetic resonance imaging, and other imaging modalities in the heart, as well as other structures.

Algorithms↗
PubMed1993

Right ventricular dilatation and remodeling the first year after an initial transmural wall left ventricular myocardial infarction.

Left ventricular (LV) remodeling after LV myocardial infarction was described previously. Little is known regarding concomitant adaptation, if any, in right ventricular (RV) volumes after LV infarction. To examine this issue, cine-computed tomography was used to determine serial changes in absolute global LV and RV volumes in 27 patients without clinical heart failure during the first year after an initial Q-wave myocardial infarction (14 anterior and 13 inferior). The patient group with anterior wall LV infarction showed progressive increases in LV and RV volumes from hospital discharge to 1 year (end-diastolic volumes +25 and +13%, respectively; and end-systolic volumes +35 and +15%, respectively). In patients with inferior wall LV infarction, both LV end-diastolic and end-systolic volumes increased significantly during the study period (+13 and +15%, respectively). Despite a trend for RV end-diastolic volume to be increased at 1 year, neither end-diastolic nor end-systolic volume increased significantly after hospital discharge following inferior wall LV infarction. Absolute RV end-diastolic volume was not significantly different between the infarct groups at any time after infarction. In conclusion, global changes occur in both LV and RV volumes during the first year after an initial infarction regardless of infarct location. The magnitude of these changes was greater after anterior than inferior wall LV infarction.

Adult↗
PubMed1993

Nonparallel changes in global left ventricular chamber volume and muscle mass during the first year after transmural myocardial infarction in humans.

OBJECTIVES: This study was designed to serially assess time-dependent changes in both chamber volume and myocardial muscle mass after infarction in humans. BACKGROUND: Dilation of the left ventricular chamber has been previously described after transmural myocardial infarction. METHODS: Global left ventricular chamber volumes and muscle mass were quantified by using cine computed tomographic scanning in 18 patients at hospital discharge and 6 weeks, 6 months and 1 year after an initial transmural myocardial infarction (12 anterior and 6 inferior). No patient had heart failure during the initial hospital stay or on any subsequent follow-up visit. RESULTS: The patients with anterior myocardial infarction (estimated infarct extent 27 +/- 2% of left ventricle) demonstrated a progressive increase in left ventricular end-diastolic volume from 148 +/- 9 ml (mean +/- SEM) at hospital discharge to 180 +/- 9 ml at 1 year after infarction (p < 0.001). However, global left ventricular muscle mass decreased significantly during the 1st 6 weeks after infarction but returned by 1 year to nearly the value determined at hospital discharge (177 +/- 13 vs. 165 +/- 10 g, p = NS). The changes in global muscle mass did not parallel the steady and progressive increases in chamber end-diastolic volume. The end-diastolic chamber volume to muscle mass ratio, an index of global left ventricular wall tension, increased steadily after hospital discharge but remained level by 1 year after infarction. The time course of changes in global end-systolic chamber volume was roughly proportional to the concomitant changes in end-diastolic volume. During this same time period, left ventricular stroke volume remained constant or improved from that determined at baseline. Global left ventricular end-diastolic and end-systolic volumes remained relatively static during the 1st year in the patient subgroup with inferior wall myocardial infarction (estimated infarct extent 10 +/- 1% of left ventricle), but global muscle (myocardial) mass initially decreased and then increased in a pattern similar, although of smaller magnitude, to that observed in patients with anterior wall myocardial infarction. CONCLUSIONS: Overall, left ventricular end-diastolic and end-systolic chamber volumes increase progressively from hospital discharge to 1 year after an initial transmural myocardial infarction in patients with a moderately large anterior wall infarction but remain stable in patients with a small inferior wall infarction. Concurrently, total left ventricular muscle mass decreases significantly during the initial 6 weeks after infarction (presumed largely secondary to changes in the necrotic segments) but then returns to the hospital discharge baseline values by 1 year. These data are consistent with the late development of, at most, limited ventricular hypertrophy in the noninfarcted myocardium that occurs well after the early and progressive left ventricular chamber dilation observed in patients with a moderate to large myocardial infarction. These data, in particular as applied to patients with anterior infarction, suggest that ventricular wall tension is significantly elevated at least during the 1st year after an initial transmural myocardial infarction. These observations may explain the potential utility of agents aimed at reducing afterload or ventricular wall tension during the early convalescent phase after myocardial infarction.

Female↗
PubMed1992

Quantitative dynamics of left ventricular emptying and filling as a function of heart size and stroke volume in pure aortic regurgitation and in normal subjects.

Quantitative understanding of the dynamics of left ventricular (LV) emptying and filling as the left ventricle dilates but maintains ejection fraction is limited. Cine computed tomography was used to quantify peak LV emptying and filling characteristics in 30 patients with normal ejection fraction but variable end-diastolic and stroke volumes. Group I consisted of 15 normal male patients and group II of 15 male patients with chronic, well-compensated, isolated aortic regurgitation. For each patient global LV volumes, absolute peak emptying and peak early diastolic filling rates and the timing of these maximal slopes were quantified. Mean arterial pressure and heart rate were within the normal range and ejection fraction and ages similar between groups I and II. Between-group analyses showed significantly increased end-diastolic and stroke volumes in group II compared with group I but nearly identical end-systolic volumes. Likewise, absolute peak emptying and filling rates were significantly greater in group II than in group I patients. The ratio of peak emptying rate to peak filling rate remained constant between groups. Timing of peak emptying and filling were similar in both groups. Absolute LV peak emptying and filling rates were found to vary linearly with end-diastolic and stroke volumes in all subjects examined. However, referencing peak emptying or peak filling rates to end-diastolic or total stroke volumes eliminated intergroup differences. Thus, in the presence of preserved ejection fraction and normal arterial pressure, the dynamic rates of LV emptying and early diastolic filling increase in direct proportion to absolute end-diastolic and stroke volumes, but the ratio of peak emptying to peak filling rate remains constant.

Adult↗
PubMed1990

Early events in the import/assembly pathway of an integral thylakoid protein.

The light-harvesting chlorophyll a/b protein (LHCP) is nuclear-encoded and must traverse the chloroplast envelope before becoming integrally assembled into thylakoid membranes. Previous studies implicated a soluble stromal form of LHCP in the assembly pathway, but relied upon assays in which the thylakoid insertion step was intentionally impaired [Cline, K., Fulsom, D. R. and Viitanen, P. V. (1989) J. Biol. Chem. 264, 14225-14232]. Here we have developed a rapid-stopping procedure, based upon the use of HgCl2, to analyze early events of the uninhibited assembly process. With this approach, we have found that proper assembly of LHCP into thylakoids lags considerably behind trans-envelope translocation. During the first few minutes of import, two distinct populations of mature-size LHCP accumulate within the chloroplast. One is the aforementioned soluble stromal intermediate, while the other is a partially (or improperly) assembled thylakoid species. Consistent with precursor/product relationships, both species reach peak levels at a time when virtually none of the imported molecules are correctly assembled. These results confirm and extend our previous interpretation, that upon import, preLHCP is rapidly processed to its mature form, giving rise to a soluble stromal intermediate. They further suggest that the stromal intermediate initially inserts into the thylakoid bilayer in a partially assembled form, which eventually becomes properly assembled into the light-harvesting complex.

Biological Transport↗
PubMed1990

Malignant glaucoma induced by an intraocular lens.

A case of malignant (ciliary block) glaucoma apparently induced by a large posterior chamber intraocular lens (PC-IOL) is presented. The involved eye was small, with an axial length of 21.7 mm and a preoperative refractive error of +8.25 D. An uncomplicated extracapsular cataract extraction with implantation of a PC-IOL with a 7 mm optic was performed. Within 1 week postoperatively, malignant glaucoma developed, for which surgical intervention was required. We recommend avoiding implantation of PC-IOLs with large optics in certain small eyes, since these implants may be more likely than lenses with smaller optics to induce malignant glaucoma in such eyes.

Aged↗