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Biomedical subjects

P C Goodman

Publications and source records attributed to P C Goodman.

At least 55 records · Page 3Linked to original sources
PubMed1995

Thoracic nodal staging with PET imaging with 18FDG in patients with bronchogenic carcinoma.

PURPOSE: To assess the role of positron emission tomographic (PET) imaging with 18-fluoro-2-deoxyglucose (18FDG) in detecting thoracic lymph node metastases in patients with bronchogenic carcinoma. MATERIALS AND METHODS: Over a 2-year period, any patient presenting to our institution with newly diagnosed bronchogenic carcinoma who was to have thoracic nodes sampled was considered eligible. All PET studies were performed prior to nodal sampling and areas of increased uptake were mapped according to the American Thoracic Society classification. Studies were correlated with CT and pathology. Sensitivity and specificity for predicting nodal metastases was calculated. RESULTS: Forty-two patients had 62 nodal stations (40 hilar/lobar, 22 mediastinal) sampled. The sensitivity and specificity for hilar/lobar lymph node station metastases using PET imaging was 73% and 76%, respectively. With CT, the sensitivity and specificity were 27% and 86%. The sensitivity and specificity using PET imaging for mediastinal node station metastases was 92% and 100%, respectively, while with CT the figures were 58% and 80%. The sensitivity and specificity for combined thoracic nodal station metastases using PET imaging was 83% and 82%, respectively, while with CT it was 43% and 85%. There was a strong statistical relationship between positive PET imaging and lymph node abnormalities. CONCLUSIONS: 18FDG-PET imaging is accurate in detecting thoracic lymph node metastases in patients with bronchogenic carcinoma. Normal results of PET studies virtually preclude the need for mediastinal nodal sampling prior to surgery, whereas abnormal results of studies most likely represent mediastinal metastases. Treatment can be based on the extent of disease suggested by PET imaging.

Adult↗
PubMed1995

Palliative treatment of malignant pleural effusions: value of small-bore catheter thoracostomy and doxycycline sclerotherapy.

OBJECTIVE: This study evaluates small-bore catheter thoracostomy combined with doxycycline sclerotherapy for palliative treatment of presumed malignant pleural effusions. SUBJECTS AND METHODS: Forty-seven consecutive patients referred from the medical oncology department to the thoracic radiology section with known primary malignant tumors and symptomatic pleural effusions over a 2-year period were treated with small-bore pleural catheter drainage followed by doxycycline sclerotherapy. Of the 47 patients, 20 (43%) died less than 30 days after sclerotherapy, one (2%) died without radiographic follow-up, and five (11%) were lost to follow-up. Twenty-one patients formed the study group. Response to treatment was defined based on findings on follow-up chest radiographs obtained 30 days after sclerotherapy as complete (no reaccumulation of pleural effusion), partial (accumulation above postpleurodesis level but below that at presentation), or as a failure (reaccumulation to the amount seen at presentation). RESULTS: Seventeen (81%) evaluable patients showed complete response to sclerotherapy, three (14%) showed a partial response, and one (5%) showed no response. All complete and partial responders were clinically improved with resolution of their shortness of breath. Therefore, 95% of evaluable patients had clinically and radiographically successful treatment. Six patients underwent sclerotherapy when their tube output was greater than 100 ml/24 hr. Five of the six had completely successful pleurodesis, and one failed to respond. Two (10%) of the 21 patients had greater than 150 ml drainage in the 24 hr after initial doxycycline administration and were therefore given a second dose of intrapleural doxycycline. Both of these patients subsequently had less than 150 ml drainage in an additional 24-hr observation period and went on to complete response. Complications included three patients (14%) with mild discomfort at the chest tube site during drainage, one patient (5%) with pain during instillation of doxycycline, and one patient (5%) with transient fever (38.3 degrees C body temperature) one day after sclerotherapy. CONCLUSION: Small-bore catheter thoracostomy followed by doxycycline sclerotherapy successfully resolves symptomatic pleural effusion in patients with known primary malignant tumors.

Adult↗
PubMed1995

Tuberculosis and AIDS.

In the mid-1980s, the incidence of tuberculosis (TB) in the United States increased. Recently, TB became an index diagnosis for AIDS. Chest radiographs in patients with AIDS and TB may be atypical; various features are addressed in this article. Radiologists should be aware of the possibility of TB because this disease is not only communicable to health care workers and other patients but more recently has become difficult to treat because of multidrug-resistant Mycobacterium tuberculosis.

AIDS-Related Opportunistic Infections↗
PubMed1995

Detection of pulmonary embolism: comparison of contrast-enhanced spiral CT and time-of-flight MR techniques.

We compared the conspicuity of acute pulmonary emboli with contrast-enhanced spiral computed tomography (CT) and two- and three-dimensional time-of-flight magnetic resonance (MR) techniques. Seven dogs who received experimental pulmonary emboli and one control were imaged with spiral CT and with 2-D (FMPVAS and FASTCARD) and 3-D time-of-flight MR. Blinded, independent, prospective evaluations of the CT and MR images by two MR radiologists and two chest radiologists were then compared to the location of the emboli as determined by subsequent pathologic evaluation of the excised lungs. Embolus/blood contrast-to-noise ratios (CNRs) were calculated on both MR and CT images for pulmonary emboli that could be identified. Fifty emboli ranging from 1.0 to 5.5 mm (mean, 2.7, +/- 0.14 SEM) in diameter and from 3.0 to 60 mm (mean, 28.1 +/- 1.9 SEM) in length were found in the seven embolized dogs on pathologic examination. Three of the four radiologists identified more thrombi on CT images than they did on their best MR pulse sequence (FASTCARD) and with greater confidence. The fourth radiologist identified an equal percentage of clot on CT and FASTCARD images with confidence slightly greater on FASTCARD MR than on spiral CT. Mean CNR for the best MR technique was 43.4 (+/- 3.9 SEM) and for CT was 20.7 (+/- 1.3 SEM). In general, pulmonary emboli were detected more accurately on contrast-enhanced spiral CT than on MR. This occurred although the embolus/blood CNR was higher on MR than on CT. Better pulmonary embolus conspicuity on CT images was attributed to better spatial resolution and fewer artifacts on CT than on MR. One MR radiologist performed equally well with both spiral CT and FASTCARD techniques, suggesting that experience may be a factor in performance.

Animals↗
PubMed1994

Evolution of chest radiographs in treated patients with pulmonary tuberculosis and HIV infection.

A large number of patients with coexisting tuberculosis and HIV infection has been reported. The chest radiographic findings are well described and primarily consist of bilateral, medium-to-coarse reticulonodular opacities often associated with hilar and mediastinal adenopathy. The evolution of chest radiographic abnormalities following treatment for tuberculosis in patients with HIV infection has not been previously studied. Initial and follow-up chest films of 33 patients with tuberculosis and HIV infection were evaluated. All 25 patients whose only pulmonary infection was tuberculosis exhibited radiographic improvement after appropriate treatment. In 8 patients, the chest radiograph worsened while on tuberculosis therapy. In each of these individuals, a newly acquired nontuberculous pulmonary disease was diagnosed as the cause of radiographic deterioration. We conclude that chest radiographs in patients with tuberculosis and HIV-infection will improve with appropriate tuberculosis therapy. Worsening of the chest radiograph does not suggest a poor therapeutic response, but instead indicates the presence of another pulmonary disease.

AIDS-Related Opportunistic Infections↗
PubMed1994

Pulmonary drug toxicity following high-dose chemotherapy with autologous bone marrow transplantation: CT findings in 20 cases.

We retrospectively evaluated the computed tomography (CT) findings in 20 patients with pulmonary drug toxicity that followed high-dose chemotherapy and autologous bone marrow transplantation (ABMT). Eighty-five patients with Stage II or III breast cancer that involved > or = 10 axillary lymph nodes were enrolled in a treatment protocol that included four cycles of standard-dose therapy (CAF) followed by one cycle of high-dose treatment (CPA/cDDP/BCNU). After chemotherapy, ABMT was performed. Twenty-six patients (31%) developed pulmonary drug toxicity. Serial thoracic CT studies were available in 20 of these 26 patients. All 20 patients exhibited clinical symptoms (i.e., dyspnea, nonproductive cough, and fever) and abnormal pulmonary function following transplantation. Thirteen patients had pathologically proven drug toxicity, and seven patients had clinical features and treatment responses highly suggestive of this diagnosis. Multiple sputum and blood cultures were negative in all patients. CT scans of 13 patients (65%) demonstrated scattered, predominantly peripheral ground-glass or consolidated opacities that occasionally looked nodular or masslike. Two patients (10%) had CT scans suggestive of pulmonary edema and in five patients (25%), the CT examinations revealed no significant abnormalities. Pleural effusions and adenopathy were uncommon. Pulmonary drug toxicity after high-dose chemotherapy and ABMT should be suspected in the appropriate clinical and radiographic setting, and therapy may be initiated on the basis of these observations.

Adult↗
PubMed1994

Persistent or recurrent bronchogenic carcinoma: detection with PET and 2-[F-18]-2-deoxy-D-glucose.

PURPOSE: To assess positron emission tomography (PET) with 2-[fluorine-18]-2-deoxy-D-glucose (FDG) in the differentiation of recurrent bronchogenic carcinoma from fibrosis after therapy. MATERIALS AND METHODS: Any patient treated for bronchogenic carcinoma who had a residual chest radiographic abnormality was eligible. Forty-three patients (mean age, 63.5 years) participated. Chest radiographs and thoracic computed tomographic scans helped localize the abnormality prior to PET. Semiquantitative analysis was performed on FDG PET images with calculated standardized uptake ratios (SURs). Sensitivity, specificity, and confidence intervals for recurrent disease were determined. RESULTS: Thirty-five patients had recurrent or persistent tumor (median SUR, 7.6; range, 1.9-18.7). Eight patients had fibrosis but no evidence of disease (SUR, 1.6; range, 0.6-2.4). The sensitivity for detecting recurrent tumor (SUR > 2.5) was 97.1%, and specificity was 100%. The SUR for recurrent tumor was statistically significantly higher than for fibrosis (P = .0001). CONCLUSION: FDG PET accurately helps differentiate recurrent bronchogenic carcinoma from fibrosis.

Carcinoma, Bronchogenic↗
PubMed1994

Positron emission tomography imaging of the thorax.

Positron emission tomography (PET) is just beginning to emerge as a clinically useful tool in the thorax. Imaging with FDG is used primarily to differentiate benign from malignant abnormalities, including solitary pulmonary nodules, staging bronchogenic carcinoma, and differentiating recurrent tumor from fibrosis following treatment. This article discusses the fundamental properties of PET images, techniques, and current clinical indications in the thorax.

Animals↗
PubMed1993

Variable compensation chest radiography performed with a computed radiography system: design considerations and initial clinical experience.

The authors describe a variable compensation (VC) technique in which an x-ray equalizer and a computed radiography system are used. The VC technique allows retrospective alteration of equalized chest appearance with maintenance of improved signal-to-noise ratio in dense regions. Two imaging plates are used: one upstream of the patient to record the incident beam profile and one down-stream to record the equalized image. Subtraction of a weighted version of the upstream image from the down-stream image permits alteration of the appearance of the VC image, from the extremes of stimulated-unequalized to highly equalized. VC image appearance was optimized with a real-time workstation. The quality of VC images obtained in 33 patients was evaluated by three chest radiologists. Mediastinal appearance was better on VC equalized images than on conventional screen-film images. The stimulation of the appearance of a conventional radiograph with VC proved useful in interpretation of lung appearances on equalized radiographs.

Aged↗
PubMed1993

Focal pulmonary abnormalities: evaluation with F-18 fluorodeoxyglucose PET scanning.

The authors assessed the role of positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose (FDG) in differentiation of benign from malignant focal pulmonary abnormalities seen on chest radiographs. Fifty-one patients underwent FDG PET scanning. Focal abnormalities at radiography included solitary pulmonary nodules (n = 38), pulmonary masses (n = 5), and poorly marginated infiltrates or opacities (n = 8). Proof of diagnosis was obtained by means of transbronchial biopsy (n = 21), open lung biopsy (n = 14), percutaneous needle biopsy (n = 14), or cytologic evaluation of sputum (n = 1). A nodule in one patient had been radiographically stable for at least 8 years. Quantitative analysis was performed by calculation of a standardized uptake ratio (SUR). Thirty-three malignant lesions had a mean SUR (+/- 1 standard deviation) of 6.5 +/- 2.9. Eighteen benign lesions had a mean SUR of 1.7 +/- 1.2. For a benign lesion with SUR of 2.5 or less, specificity of FDG PET was 100%, while sensitivity was 89%. These results suggest that FDG PET is accurate in differentiation of benign from malignant focal pulmonary abnormalities.

Adult↗
PubMed1992

Pulmonary cryptococcosis.

Cryptococcus neoformans is a ubiquitous soil fungus that rarely causes pneumonia in normal hosts but is a common cause of opportunistic infection. Pulmonary disease is initiated by inhalation of the organism, and a spectrum of radiographic manifestations can be seen. The most common finding is a poorly marginated nodule or mass. Lobar or segmental parenchymal opacities and, less commonly, a diffuse scattered nodular or reticulonodular pattern have also been observed. Associated adenopathy, pleural effusions, and cavitation are uncommon; when present, these are more common in immunocompromised patients. Establishing the diagnosis can be difficult, but pulmonary cryptococcosis should be considered in the differential diagnosis of patients in the proper clinical setting and with compatible radiographic findings.

Cryptococcosis↗
PubMed1992

Pulmonary toxoplasmosis in AIDS.

The chest radiographs obtained in nine patients with acquired immunodeficiency syndrome (AIDS) and pulmonary toxoplasmosis were reviewed. In three patients, a bilateral, diffuse, fine to medium reticulonodular pattern indistinguishable from that seen in Pneumocystis carinii pneumonia (PCP) was observed. In six patients, however, a bilateral, predominantly coarse, nodular pattern was observed. This type of abnormality is unusual with PCP, and its presence may help in distinguishing between pulmonary infections caused by Toxoplasma gondii and P carinii. Other opportunistic pneumonias occurring in patients with AIDS, including tuberculosis, histoplasmosis, and coccidioidomycosis, might show similar coarse, nodular opacities on chest radiographs and thus may not be differentiated from pulmonary toxoplasmosis. No hilar or mediastinal adenopathy was observed. Two patients had pleural fluid. Radiologists familiar with the chest radiographic appearance of T gondii pneumonia could be first to suggest this unusual complication of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection.

BACKGROUND AND METHODS: Infection with the human immunodeficiency virus (HIV) increases the risk of tuberculosis and may interfere with the effectiveness of antituberculosis chemotherapy. To examine the outcomes in patients with both diagnoses, we conducted a retrospective study of all 132 patients listed in both the acquired immunodeficiency syndrome (AIDS) and tuberculosis case registries in San Francisco from 1981 through 1988. RESULTS: At the time of the diagnosis of tuberculosis, 78 patients (59 percent) did not yet have a diagnosis of AIDS, 18 patients (14 percent) were given a concomitant diagnosis of AIDS (as determined by the presence of an AIDS-defining disease other than tuberculosis), and the remaining 36 patients (27 percent) already had AIDS. The manifestations of tuberculosis were entirely pulmonary in 50 patients (38 percent), entirely extrapulmonary in 40 patients (30 percent), and both pulmonary and extrapulmonary in 42 patients (32 percent). The treatment regimens were as follows: isoniazid and rifampin supplemented by ethambutol for the first two months, 52 patients; isoniazid and rifampin supplemented by pyrazinamide and ethambutol for the first two months, 39 patients; isoniazid and rifampin, 13 patients; isoniazid and rifampin supplemented by pyrazinamide for the first two months, 4 patients; and other drug regimens, 17 patients. The intended duration of treatment for patients whose regimen included pyrazinamide was six months, and for patients who did not receive pyrazinamide, nine months. Seven patients received no treatment because tuberculosis was first diagnosed after death. Sputum samples became clear of acid-fast organisms after a median of 10 weeks of therapy. Abnormalities on all chest radiographs taken after three months of treatment were stable or improved except for those of patients who had new nontuberculous infections. The only treatment failure occurred in a man infected with multiple drug-resistant organisms who did not comply with therapy. Adverse drug reactions occurred in 23 patients (18 percent). For all 125 treated patients, median survival was 16 months from the diagnosis of tuberculosis. Tuberculosis was a major contributor to death in 5 of the 7 untreated patients and 8 of the 125 treated patients. Three of 58 patients who completed therapy had a relapse (5 percent); compliance was poor in all 3. CONCLUSIONS: Tuberculosis causes substantial mortality in patients with advanced HIV infection. In patients who comply with the regimen, conventional therapy results in rapid sterilization of sputum, radiographic improvement, and low rates of relapse.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Pneumocystis carinii pneumonia.

Pneumocystis carinii pneumonia (PCP) is the most common index diagnosis in patients with acquired immunodeficiency syndrome (AIDS). Eighty percent of AIDS patients will eventually develop PCP. Common presenting symptoms are shortness of breath, cough, weight loss, and fever. The chest radiograph typically reveals a diffuse, bilateral, symmetric, fine-to-medium reticulonodular pattern of opacities. Upper lobe disease has been reported recently in patients who have undergone prophylactic therapy with aerosolized pentamidine. Pneumatoceles, or thin-walled air-containing cysts, have been noted in 10% of patients with PCP. Lymphadenopathy and pleural effusion are extremely rare. Therapy with various agents is generally successful, resulting in clinical and radiographic improvement within 7 to 10 days. Recurrence of PCP is common.

Acquired Immunodeficiency Syndrome↗