Biomedical subjects

T E Hartman

Publications and source records attributed to T E Hartman.

At least 37 records · Page 2Linked to original sources

PubMed1996

Disease progression in usual interstitial pneumonia compared with desquamative interstitial pneumonia. Assessment with serial CT.

OBJECTIVE: To determine the outcome of areas of ground-glass attenuation and assess disease progression on serial high-resolution CT (HRCT) scans of patients with biopsy specimen-proved usual interstitial pneumonia (UIP) and desquamative interstitial pneumonia (DIP). MATERIALS AND METHODS: Twelve patients with biopsy specimen-proved UIP and 11 patients with biopsy specimen-proved DIP who had initial and follow-up HRCT scans (median interval, 10 months) were reviewed. Eleven patients with UIP and 11 with DIP received treatment between the initial and follow-up CT scans. The scans were evaluated for the presence and extent of ground-glass attenuation, irregular linear opacities and honeycombing, and overall extent of parenchymal involvement. RESULTS: On initial CT scans, all 12 patients with UIP had areas of ground-glass attenuation (mean +/- SD extent, 30 +/- 16%) and irregular lines (mean +/- SD extent, 17 +/- 7%) and 10 patients had honeycombing (mean +/- SD extent, 10 +/- 6%). All 11 patients with DIP had areas of ground-glass attenuation on initial HRCT scans (mean +/- SD extent, 51 +/- 26%), 5 patients had irregular linear opacities (mean +/- SD extent, 5 +/- 5%), and 1 patient had honeycombing. Nine of the 12 patients with UIP showed increase in the extent of ground-glass attenuation (n = 6) or progression to irregular lines (n = 2) or honeycombing (n = 4) on follow-up as compared with only 2 patients with DIP who showed progression to irregular lines (n = 1) or honeycombing (n = 1) (p < 0.01 chi 2 test). CONCLUSION: In patients with UIP, areas of ground-glass attenuation usually increase in extent or progress to fibrosis despite treatment. Areas of ground-glass attenuation in most patients with DIP remain stable or improve with treatment.

Adult↗

PubMed1995

Pulmonary tuberculosis and Mycobacterium avium-intracellulare: a comparison of CT findings.

PURPOSE: To compare the computed tomographic (CT) findings of tuberculosis and Mycobacterium avium-intracellulare (MAI) infection in immunocompetent patients. MATERIALS AND METHODS: Seventy-seven consecutive immunocompetent patients with culture-proved pulmonary mycobacterial infection (45 with pulmonary tuberculosis, 32 with MAI) underwent thin-section CT. CT scans were randomized and reviewed by two observers; decisions were reached by consensus. RESULTS: Micronodules, consolidation, and cavity formation in the lung were seen with similar frequency in pulmonary tuberculosis and MAI cases. Twenty-three patients (51%) with tuberculosis and four patients (12%) with MAI had interlobular septal thickening (P < .001). Twelve patients (27%) with tuberculosis and 30 patients (94%) with MAI had bronchiectasis (P < .001). Bronchiectasis was seen in a mean of 4.6 +/- 1.8 and 1.8 +/- 1.6 lobes (+/- standard deviation) in each patient with MAI and with tuberculosis, respectively (P < .01). CONCLUSION: Although CT findings of pulmonary tuberculosis and MAI are similar, interlobular septal thickening is more common in patients with tuberculosis and bronchiectasis is more common and more extensive in patients with MAI.

Adolescent↗

PubMed1995

Diaphragmatic rupture: CT findings in 11 patients.

PURPOSE: To determine the signs of diaphragmatic rupture at computed tomography (CT) and the frequency of preoperative diagnosis with CT. MATERIALS AND METHODS: CT scans in 11 consecutive patients with surgically proved tears of the diaphragm due to blunt trauma were reviewed by two chest radiologists. The observers assessed the presence of discontinuity of the diaphragm, herniation of abdominal viscera or omentum, and waistlike constriction of the herniated stomach or bowel (collar sign). Hospital records were reviewed to confirm surgical findings and ascertain whether the diagnosis has been suggested at CT. RESULTS: In eight of 11 patients, rupture of the diaphragm was on the left, and in three it was on the right. In nine patients, diagnostic findings were identified retrospectively on CT scans; these included discontinuity of the diaphragm (n = 9), herniation of the abdominal organs or bowel (n = 7), and constriction of the stomach (n = 3). CONCLUSION: CT enables detection of most diaphragmatic tears due to blunt trauma.

Adult↗

PubMed1995

CT of the chest: minimal tube current required for good image quality with the least radiation dose.

OBJECTIVE: We wanted to determine minimal tube current (mAs) required for consistently good image quality on conventional 10-mm collimation chest CT and effect of tube current reduction on detection of mediastinal and lung abnormalities. Tube current reduction is desirable to reduce patient radiation dose. SUBJECTS AND METHODS: Prospectively, 30 consecutive patients (mean weight, 68 kg; range, 34-93 kg) older than 45 undergoing conventional chest CT with standard technique (120 kVp, 400 mAs) had four additional sections imaged at reduced tube current (200, 140, 80, 20 mAs) at two levels (tracheal carina and left atrium). CT scans were evaluated in random order by two independent observers who were blinded to technical factors used. Subjective image quality was graded on a five-point scale from non-diagnostic to excellent. Visualization of mediastinal adenopathy (n = 18), pleural plaques (n = 17), effusions (n = 28), lung parenchymal nodules (n = 37), and emphysema (n = 15) were assessed. The 400 mAs scan was considered the reference standard. RESULTS: When compared with the reference technique (400 mAs), the first and second (200 mAs and 140 mAs) reduction levels showed no significant difference (p > .05) in subjective image quality. A significant difference (p < .001) was seen at the third and fourth (80 mAs and 20 mAs) reduction levels. However, no significant difference (p > .05) was seen in detection of mediastinal or lung parenchymal abnormalities with different tube currents. CONCLUSION: A twofold reduction in tube current (400-140 mAs) and resultant radiation dose did not cause a significant change in subjective image quality or in detection of mediastinal or lung abnormalities with conventional chest CT. One hundred forty milliampere-seconds is the minimal tube current required to provide good image quality in patients of average weight.

Aged↗

PubMed1995

CT mosaic pattern of lung attenuation: distinguishing different causes.

Areas of variable lung attenuation in a lobular or multilobular distribution are occasionally seen on CT or high-resolution CT scans of the lungs [1], although never as a normal finding. This mosaic pattern of lung attenuation presents a challenge to the radiologist when deciding which are the abnormal regions of lung--those of low attenuation, those of high attenuation, or both. We have observed three categories of disease known to cause a CT mosaic pattern of lung attenuation: small-airway disease, vascular lung disease, and infiltrative disease. Diseases from each of these categories can cause similar patterns of mosaic lung attenuation on CT scans. However, it is sometimes possible to distinguish among these categories by using additional CT findings. We illustrate the known causes of a CT mosaic pattern of lung attenuation and highlight distinguishing features.

Aged↗

PubMed1995

CT mosaic pattern of lung attenuation: etiologies and terminology.

Areas of variable lung attenuation forming a "mosaic pattern" are occasionally seen on computed tomography (CT) or high-resolution CT (HRCT) images of the lungs. This CT mosaic pattern of lung attenuation is a nonspecific finding that can reflect the presence of vascular disease, airway abnormalities, or ground-glass interstitial or air-space infiltrates. However, it is often possible to distinguish among these categories. In small airways disease and pulmonary vascular disease, the pulmonary vessels within the lucent regions of lung are small relative to the vessels in the more opaque lung. In infiltrative diseases, the vessels are more uniform in size throughout the different regions of lung attenuation. The distinction of small airways disease from primary vascular disease requires the use of paired inspiratory/expiratory CT scans. The terms "mosaic perfusion" or "mosaic oligemia" have also been used to describe this heterogeneous pattern of lung attenuation. We believe that the term "mosaic pattern of lung attenuation" is preferable when describing areas of variable lung attenuation because the term "mosaic perfusion" implies pulmonary vascular pathology.

Adolescent↗

PubMed1994

CT of bronchial and bronchiolar diseases.

Computed tomography (CT) is useful in evaluating bronchial and bronchiolar abnormalities. Common bronchial and bronchiolar abnormalities include bronchiectasis, asthma, bronchial obstruction, and various forms of bronchiolitis. Causes of bronchiectasis include cystic fibrosis, childhood viral infection, allergic bronchopulmonary aspergillosis, and pulmonary fibrosis. On CT scans, cystic fibrosis may manifest with bronchial wall thickening, bronchiectasis (usually cylindrical, with varicose and cystic forms seen in advanced cases), and mucus plugs in the bronchi. Allergic bronchopulmonary aspergillosis is characterized by central, varicose or cystic bronchiectasis, predominantly in the upper lobes, with mucoid impaction in the bronchi. Traction bronchiectasis may be seen on CT scans of pulmonary fibrosis. Asthma is characterized by bronchial wall thickening due to inflammation. Bronchial dilatation and air trapping may also be seen. Bronchiolitis obliterans is manifested by direct and indirect signs on CT scans; the former consist of centrilobular branching structures and nodules, and the latter consist of bronchiectasis and bronchiolectasis, mosaic perfusion, and air trapping. CT findings of bronchiolitis obliterans organizing pneumonia (also known as cryptogenic organizing pneumonia) include air-space consolidation and nodules, with occasional bronchial dilatation and pleural effusions.

Adult↗

PubMed1994

Pulmonary nodules and the CT halo sign.

PURPOSE: To determine whether the "halo sign" at computed tomography (CT) could be used to differentiate hemorrhagic from nonhemorrhagic pulmonary nodules. MATERIALS AND METHODS: CT scans of 12 patients with hemorrhagic pulmonary nodules and of a control group of 10 patients with nonhemorrhagic pulmonary nodules were randomized and reviewed by two chest radiologists. Nodules were considered hemorrhagic if a surrounding halo of ground-glass attenuation was present. RESULTS: Nodules were correctly identified as either hemorrhagic or nonhemorrhagic by both observers in 19 of the 22 cases (86%). Eight of the 12 patients with hemorrhagic nodules had an infectious process including invasive aspergillosis, candidiasis, cytomegalovirus, herpes simplex virus, or coccidioidomycosis. Four of 12 patients with hemorrhagic nodules had a noninfectious cause including Wegener granulomatosis, metastatic angiosarcoma, and Kaposi sarcoma. CONCLUSION: Most hemorrhagic pulmonary nodules have a characteristic CT appearance consisting of a central area of soft-tissue attenuation with a surrounding halo of ground-glass attenuation that allows distinction from nonhemorrhagic nodules.

Adult↗

PubMed1994

Computed tomographic diagnosis of Mycobacterium avium-intracellulare complex in patients with bronchiectasis.

We tested the hypothesis that bronchiectasis and multiple small lung nodules seen on chest computed tomography (CT) are indicative of Mycobacterium avium-intracellulare complex (MAC) infection or colonization by reviewing CT scans and histories of 100 outpatients with CT diagnosis of bronchiectasis. Of the 24 patients with multiple pulmonary nodules, 19 had lung nodules and bronchiectasis in the same lobe. Mycobacterial cultures were performed on 63 of the 100 patients, including 15 of the 24 patients with lung nodules and 48 of the 76 patients with no lung nodules. Of the 15 patients with lung nodules, 8 (53 percent) had cultures positive for MAC, as did 2 of the 48 (4 percent) patients with no CT evidence of lung nodules. The number of cultures positive for fungi was approximately the same in both groups. In our outpatient population, CT prediction of cultures positive for MAC in bronchiectatic patients with multiple small lung nodules has a sensitivity of 80 percent, a specificity of 87 percent, and an accuracy of 86 percent.

Adolescent↗

PubMed1994

Cryptogenic organizing pneumonia: CT findings in 43 patients.

OBJECTIVE: Description of the CT findings of cryptogenic organizing pneumonia has been limited to a small number of cases. This study was performed to characterize the CT findings of this disease in a larger number of cases and to compare the findings in immunocompetent and immunocompromised patients. MATERIALS AND METHODS: The CT scans of 43 (32 immunocompetent and 11 immunocompromised) patients who had biopsy-proved cryptogenic organizing pneumonia were reviewed. The scans were obtained by using contiguous 8- or 10-mm collimation and selected thin (1.5 or 2.0 mm) section (n = 23), thin-section collimation at 10-mm intervals (n = 12), or 8- or 10-mm collimation only (n = 8). The scans were analyzed by three observers, and final decisions were reached by consensus. RESULTS: The most common pattern seen was consolidation, which was present alone or as part of a mixed pattern in 34 cases (79%). The consolidation had a predominantly subpleural and/or peribronchovascular distribution in 27 cases (63%). Ground-glass attenuation and nodules were seen in 26 patients (60%) and 13 patients (30%), respectively, and were usually random in distribution. Consolidation was present in 91% (29/32) of immunocompetent and 45% (5/11) of immunocompromised patients (p < .01). Ground-glass attenuation was present in 56% (18/32) of immunocompetent and 73% (8/11) of immunocompromised patients (p > .25). Nodules were present in seven (22%) of 32 immunocompetent patients and six (55%) of 11 immunocompromised patients (p < .025). CONCLUSION: We conclude that in immunocompetent patients the CT findings in cryptogenic organizing pneumonia most commonly consist of bilateral areas of consolidation involving mainly the subpleural and/or peribronchovascular regions. In the immunocompromised patient, the CT findings are variable.

Adult↗

PubMed1994

Diagnosis of thoracic complications in AIDS: accuracy of CT.

OBJECTIVE: The purpose of this study was to assess the accuracy of CT interpretation in the diagnosis of thoracic complications of AIDS. If CT is accurate, more invasive diagnostic procedures can be avoided. MATERIALS AND METHODS: We reviewed the CT scans of 102 patients who had AIDS with proved thoracic complications and 20 HIV-positive patients without active intrathoracic disease. The scans were independently assessed by two observers from a different institution who did not know the clinical or pathologic data. The observers listed the three most likely diagnoses in order of probability and recorded the degree of confidence in their first-choice diagnosis. Imaging diagnoses were compared with final diagnoses based on results of sputum cultures, bronchoscopy, fine-needle aspiration, mediastinoscopy, open lung biopsy, autopsy, gallium scans, other clinical data, and extensive follow-up. RESULTS: Nineteen of the 20 cases in which no active disease was present were correctly identified by one observer, and 18 were correctly identified by the other. All 102 cases of active disease were correctly identified as abnormal by one observer, and 101 cases were identified as abnormal by the second observer. The correct first-choice diagnosis, regardless of the degree of confidence, was made in 66% of the cases. A confident diagnosis was made in 48% of all cases, and the observers were correct in 92% of those cases. There was good agreement between the two observers in the confident diagnosis based on CT (kappa statistic = 0.71). The interpretations of CT scans were most often accurate in the confident diagnosis of pneumocystis pneumonia (94%) and Kaposi's sarcoma (90%) and in the exclusion of active thoracic disease (93%). CONCLUSION: Certain findings on chest CT scans allow confident diagnoses of specific complications in patients with AIDS. CT-based diagnosis may preclude more invasive diagnostic procedures in selected cases.

AIDS-Related Opportunistic Infections↗

PubMed1994

Metastatic pulmonary calcification in patients with hypercalcemia: findings on chest radiographs and CT scans.

OBJECTIVE: The objective of this study was to characterize the findings on chest radiographs and CT scans in patients with metastatic pulmonary calcification due to hypercalcemia. MATERIALS AND METHODS: The chest radiographs and CT scans of seven patients with biopsy-proved metastatic pulmonary calcification were reviewed by two observers. Metastatic calcification was due to chronic renal failure (n = 4), T-cell leukemia (n = 1), multiple endocrine neoplasia type I syndrome (n = 1), and idiopathic hypercalcemia (n = 1). RESULTS: Numerous nodular opacities measuring 3-10 mm in diameter were seen on the chest radiographs in five cases, and patchy areas of parenchymal opacification were seen in two cases. Calcification of the nodules was evident in two cases. On CT scans, pulmonary nodules were present in all seven cases. These nodules were predominant in the upper lung zone in three cases, were diffuse in three cases, and were predominant in the lower lung zone in one case. Calcification of the nodules was evident on the CT scans in four of the seven cases, and calcification of vessels in the chest wall was evident in six of seven cases. Other findings on CT scans included diffuse areas of ground-glass attenuation (n = 3) and patchy consolidation (n = 2). CONCLUSION: Numerous small nodules are the most common finding on the chest radiographs of patients with metastatic pulmonary calcification. The calcific nature of the nodules is seldom obvious, however. Pulmonary nodules are also the most common finding on CT scans, where the calcific nature of the nodules is more readily apparent. Additionally, calcification is often seen in the vessels of the chest wall on CT scans. The combination of calcified nodules and calcified vessels in the chest wall on CT scans may be characteristic.

Adult↗

PubMed1993

Mycobacterium avium-intracellulare complex: evaluation with CT.

Pulmonary Mycobacterium avium-intracellulare (MAI) complex has been reported with increasing frequency, but computed tomographic (CT) evaluation of pulmonary MAI complex has been seldom reported. The authors retrospectively reviewed chest CT examinations performed in 62 patients with positive MAI cultures within 1 month of CT. Of the 62 patients, 40 had bronchiectasis and 60 had infiltrates, usually of the nodular variety (39 patients). All 35 patients with small nodular infiltrates had bronchiectasis. These 35 patients did not have concurrent malignancy or clinical evidence of immunocompromise, and 29 (83%) of them were women (mean age, 66 years). Of the 27 patients without small nodular infiltrates and bronchiectasis, 25 had underlying malignancy or immunocompromise. The predominance of older women without underlying malignancy or immunocompromise but with findings of small nodular infiltrates and bronchiectasis at chest CT may indicate such patients to be a subtype of patients with pulmonary MAI complex.

Adult↗

PubMed1993

Desquamative interstitial pneumonia: thin-section CT findings in 22 patients.

To evaluate the findings on thin-section computed tomographic (CT) scans in desquamative interstitial pneumonia (DIP), the CT scans from 22 patients aged 22-71 years (mean age, 43 years) were reviewed. In all patients, DIP was proved with open-lung biopsy performed 1 day to 17 months before or after examination with CT (median interval, 1.5 months). The lungs were divided into three zones (upper, middle, and lower); each zone was evaluated separately. The predominant finding was the presence of areas of ground-glass attenuation that involved the middle and lower lung zones in all patients and the upper lung zones in 18 patients (82%). Such areas had a lower lung zone predominance in 16 patients (73%) and a predominantly peripheral distribution in 13 patients (59%). Irregular lines of attenuation suggestive of fibrosis were seen in 11 patients (50%) and cystic changes, in seven patients (32%). The distribution of abnormalities in DIP is similar to that seen in usual interstitial pneumonia (UIP), but the greater extent of ground-glass attenuation and the paucity of cystic changes in DIP should enable distinction from UIP in most patients.

Adult↗

PubMed1993

Acute interstitial pneumonia: radiographic and CT findings in nine patients.

The radiologic findings were reviewed in nine patients with biopsy- or autopsy-proved acute interstitial pneumonia (AIP). All patients had bilateral air-space opacification on radiographs and bilateral, symmetric areas of ground-glass attenuation on computed tomographic (CT) scans. The areas of ground-glass attenuation had a patchy distribution in six patients (67%) and were diffuse in three patients. Air-space consolidation was seen at CT in six patients (67%) and involved mainly the lower lung zones in three patients and upper lung zones in one patient and was diffuse in two patients. A predominantly subpleural distribution of the consolidation was present in two patients. Eight of the nine patients died within 3 months of presentation. The authors conclude that the radiographic and CT features of AIP are similar to those of adult respiratory distress syndrome and represent acute alveolar damage. AIP differs from the more chronic forms of interstitial pneumonia in clinical presentation and in pathologic and radiologic findings.

Acute Disease↗

PubMed1993

End-stage lung disease: CT findings in 61 patients.

PURPOSE: To determine whether the cause of end-stage lung disease could be determined on the basis of pattern and distribution of abnormalities at computed tomography (CT). MATERIALS AND METHODS: The CT scans from 61 consecutive patients with end-stage lung disease were independently assessed by two observers without knowledge of clinical or pathologic data. End-stage lung disease was defined by the presence of honeycombing, extensive cystic changes, or conglomerate fibrosis. The observers listed the three most likely diagnoses and recorded the degree of confidence in the first-choice diagnosis on a three-point scale. RESULTS: The observers made a correct first-choice diagnosis in an average of 87% of cases. A correct first-choice diagnosis was made most often in silicosis (100%), Langerhans cell histiocytosis (100%), asbestosis (90%), usual interstitial pneumonia (88%), extrinsic allergic alveolitis (87%), and sarcoidosis (83%). There was good agreement between the two observers on the first-choice diagnosis (kappa statistic, 0.89). CONCLUSION: The pattern and distribution of abnormalities in end-stage lung disease are determined by the underlying cause. In most cases, a specific diagnosis can be made on the basis of the CT findings.

Alveolitis, Extrinsic Allergic↗

PubMed1992

MR imaging of extraabdominal desmoids: differentiation from other neoplasms.

A retrospective review of MR images of 36 patients with histologically proved extraabdominal desmoids was done to define the MR characteristics of these tumors and to determine if MR could be used to differentiate desmoids from other benign and malignant soft-tissue neoplasms. The desmoids evaluated included eight primary and 30 recurrent lesions. Our study was conducted in parallel with another study in which the MR appearance of 95 benign and malignant soft-tissue masses was evaluated, and the MR images of these masses were compared with our findings. The four desmoids from that study are included in our data. The signal intensity of the tumor on T1- and T2-weighted images was graded relative to the intensities of muscle and fat. Homogeneity, margin, neurovascular and bone involvement, and fibrosis (low-signal regions within the tumor on both T1- and T2-weighted images) were evaluated. On MR imaging, the desmoids showed inhomogeneous signal (97%), poor margination (89%), neurovascular involvement (58%), and bone involvement (37%). Fibrosis was present in 88% of primary desmoids and 90% of recurrent ones, and intermediate signal (greater than that of muscle and less than that of fat) was present in 75% and 50% of these, respectively. Our results show that the MR features of desmoids have characteristics that are commonly found in malignant tumors (inhomogeneous signal, poor margination, and neurovascular involvement). MR features of desmoids that distinguish them from malignant neoplasms are the presence of fibrosis and intermediate signal in the regions of the tumor.

Adolescent↗

PubMedDate not supplied

MRI of infiltrative lung disease: comparison with pathologic findings.

OBJECTIVE: Our goal was to compare MRI with pathologic findings in patients with chronic infiltrative lung disease. MATERIALS AND METHODS: The study included 22 consecutive patients who had MRI and lung biopsy performed within 21 days (median 4 days). Fifteen patients had open lung biopsy: five with idiopathic pulmonary fibrosis, three with extrinsic allergic alveolitis, and seven with miscellaneous conditions. Seven patients had transbronchial biopsy: four with sarcoidosis and three with miscellaneous conditions. All patients had 1.5 T MRI with cardiac-gated T1-, proton density-, and T2-weighted SE sequences. RESULTS: The predominant patterns of abnormality seen on MR included parenchymal opacification (n = 12), parenchymal opacification and reticulation (n = 2), reticulation (n = 3), nodularity (n = 3), and interlobular septal thickening (n = 1); normal findings were found in 1. The 14 patients with parenchymal opacification included 9 with ground-glass intensity and 5 with consolidation. In 12 of these 14 patients the parenchymal opacification represented an active inflammatory process including alveolitis, pneumonia, and granulomatous inflammation, while in 2 patients it represented fibrosis. Reticulation was shown to represent fibrosis in five of five cases. The three patients with nodules had sarcoidosis. CONCLUSION: The MR findings correlate closely with those seen on lung biopsy. Parenchymal opacification on MR usually indicates the presence of potentially reversible disease, while reticulation usually indicates irreversible fibrosis.

Adult↗