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Biomedical subjects

C Beigelman

Publications and source records attributed to C Beigelman.

At least 19 recordsLinked to original sources
PubMed2000

CT of parenchymal and bronchial tuberculosis.

Tuberculosis (TB) remains a common disease in the World. Its incidence has risen steadily since 1985, despite a preexisting continuous decreasing of its frequency due to an effective chemotherapy. Nonwhite people, socioeconomically disadvantaged, chronically debilitated groups and AIDS patients are the most concerned. Chest radiography remains the first imaging modality to evaluate TB. Widely radiographic appearances can be encountered, including normal chest X-ray. CT can be useful in all stages of the disease, particularly when clinical and radiological findings are in disagreement and/or when imaging findings are equivocal. CT should be proposed at the end of an effective antituberculous treatment to better subsequently detect fine lesions suggestive of reactivation TB.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Iron oxide-enhanced MR lymphography: initial experience.

The detection of nodal metastases is of utmost importance in oncologic imaging. Ultrasmall superparamagnetic iron oxide particles (USPIO) are novel contrast agents specifically developed for MR lymphography. After intravenous administration, they are taken up by the macrophages of the lymph nodes, where they accumulate. They reduce the signal intensity (SI) of normally functioning nodes on postcontrast T2-and T2*-weighted images through the magnetic susceptibility effects on iron oxide. Metastatic nodes, in which macrophages are replaced by tumor cells, show no significant change in SI on postcontrast T2-and T2*-weighted images. Early clinical experience suggests that USPIO-enhanced MR lymphography improves the sensitivity and specificity for the detection of nodal metastases. It also suggests that micrometastases could be detected in normal-sized nodes. This article reviews the physiochemical properties of USPIO contrast agents, their enhancement patterns, and early clinical experience.

Contrast Media↗
PubMed2000

Pancreatic involvement in von Hippel-Lindau disease. The Groupe Francophone d'Etude de la Maladie de von Hippel-Lindau.

BACKGROUND & AIMS: Pancreatic involvement in von Hippel-Lindau (VHL) disease, a genetic disorder with a dominant mode of inheritance affecting various organs, has rarely been studied. We assessed the prevalence, type of lesions, natural history, and impact of pancreatic involvement in patients with VHL. METHODS: A total of 158 consecutive patients from 94 families with VHL disease were studied in a prospective French collaborative study. All patients underwent systematic screening for VHL lesions, including computerized tomography (CT) scanning of the pancreas reviewed by an experienced radiologist. Clinical data, investigations, and treatments performed were also reviewed. RESULTS: Pancreatic involvement was observed in 122 patients (77.2%) and included true cysts (91.1%), serous cystadenomas (12.3%), neuroendocrine tumors (12.3%), or combined lesions (11.5%). The pancreas was the only organ affected in 7.6% of patients. Patients with pancreatic lesions had fewer pheochromocytomas than those without (14/122 vs. 16/36; P<0.0001), and patients with neuroendocrine pancreatic tumors had renal involvement less often than those without (8/99 vs. 6/20; P = 0.013). None of the patients with neuroendocrine tumors had symptoms of hormonal hypersecretion. Pancreatic lesions evolved in half of patients but required specific treatment in only 10 (8.2%) when they were symptomatic or for the resection of large neuroendocrine tumors. CONCLUSIONS: Pancreatic involvement is seen in most patients with VHL disease. Although symptoms are rare, specific treatment of pancreatic lesions is required in selected patients, mainly those with neuroendocrine tumors.

Adult↗
PubMed2000

[Computed tomography in 2000: technique, expected progress, limitations, indications].

Computed tomography (CT) is today a fundamental technique for thoracic imaging, a logical direct extension of the standard chest x-ray. Since the early 90s, volume-acquisition CT has greatly improved the performance of the conventional technique. After replacing lung and bronchial tomography, the technique has greatly contributed to the reduction in the number of diagnostic conventional angiographies. Certain decisional algorithms have been totally changed, particularly for the diagnosis of pulmonary embolism. In addition, technological advances offer new perspectives, particularly in the field of morphofunctional imaging. There are still many indications for CT and new applications can be expected. Possible drawbacks related to radiation dose and injection of contrast agents must be kept in mind.

Humans↗
PubMed1999

Contrast-enhanced helical CT for pulmonary embolism detection: inter- and intraobserver agreement among radiologists with variable experience.

OBJECTIVE: The objective of this study was to evaluate inter- and intraobserver agreement in the diagnosis of central pulmonary embolism using contrast-enhanced helical CT among observers with variable experience in the interpretation of pulmonary CT angiograms. MATERIALS AND METHODS: Helical CT angiograms of 60 patients clinically suspected of having pulmonary embolism were analyzed retrospectively and independently by two chest radiologists, one cardiovascular radiologist, and three general radiologists. The films were rated a second time by the chest radiologists to assess intraobserver variability. Findings for pulmonary embolism were categorized as positive, negative, or indeterminate at the main, lobar, and segmental pulmonary artery levels. RESULTS: The observers interpreted 19-21 CT angiograms as positive for pulmonary embolism (mean, 19.7) and one to six as indeterminate (mean, 3.2). Agreement occurred among all observers in 50 patients (83.3%), among five observers in six patients (10.0%), among four observers in three patients (5.0%), and among three observers in one patient (1.7%). Interobserver agreement was very good (kappa, .85) for the diagnosis of pulmonary embolism on a per-patient basis. Agreement on a per-artery basis for all arteries was moderate (66%; kappa, .56); for lobar arteries was good (83%; kappa, .75); and for segmental arteries was moderate (57%; kappa, .47). Mean intraobserver agreement on a per-patient basis was very good (93%; kappa, .87). CONCLUSION: Inter- and intraobserver agreement in the diagnosis of pulmonary embolism with helical CT is very good despite a wide variety of experience among radiologists.

Adult↗
PubMed1999

[CT angiography of the pulmonary arteries].

CT angiography of the pulmonary arteries recently appeared as an alternative method potentially useful in the diagnosis of pulmonary embolism. Technical aspects, normal aspects and variants, diagnostic criteria of pulmonary embolism as well as potential pitfalls are successively described. The accuracy of CT angiography compared with pulmonary angiography and V-Q scintigraphy has been evaluated in several studies. The method appears accurate for the diagnosis of pulmonary embolism at the level of segmental arteries. The signification of more distal embolism remains however controversed. CT angiography seems to play a major role in the diagnosis of pulmonary embolism, as well as echo-doppler of the legs.

Angiography↗
PubMed1998

Congenital anomalies of tracheobronchial branching patterns: spiral CT aspects in adults.

Congenital abnormalities of the bronchi have been classically described with chest X-rays, conventional tomography, bronchography, CT and MR imaging. Recently, the capacity of spiral CT to explore a complete volume with no gap and excellent multiplanar reformations has been emphasized. The contribution of this technique to the analysis of congenital anomalies of tracheobronchial branching patterns encountered in adult patients is illustrated. Agenesis, aplasia, and hypoplasia are discussed, followed by bronchial atresia and abnormalities of bronchial divisions. In most cases spiral CT permits a full and correct evaluation of the malformation as well as its associated anomalies. It appears therefore to be the preferable technique for studying such anomalies of the tracheobronchial tree. Moreover, knowledge of CT aspects of the main congenital bronchial abnormalities along with complete visualization of the tracheobronchial tree will probably lead to detection of more incidental anomalies.

Adult↗
PubMed1998

Pyogenic bacterial pneumonia in human immunodeficiency virus-infected inpatients: a clinical, radiological, microbiological, and epidemiological study.

We prospectively studied features of pyogenic bacterial pneumonia in 263 consecutive human immunodeficiency virus-infected inpatients over a 6-month study period. Risk factors for bacterial pneumonia were examined by a case-control study that included 33 cases who presented with at least one episode of bacterial pneumonia and 80 controls without bacterial pneumonia. The estimated cumulative incidence of bacterial pneumonia per year was 12.5 cases per 100 inpatients (95% confidence interval [CI], 8.8-17.2). The 38 episodes of bacterial pneumonia that occurred in the 33 inpatients were mainly unilateral, but 32 episodes were patchy lobar or diffuse infiltrates. Microbiological etiologies were obtained in 33 of the 38 episodes of bacterial pneumonia. Thirty-seven pathogens were identified, including Streptococcus pneumoniae (16, of which 12 had a decreased susceptibility to penicillin), Haemophilus influenzae (6), and Pseudomonas aeruginosa (6). The risk factors for bacterial pneumonia that were identified after logistic regression included prior sinusitis within 1 month before admission (odds ratio [OR], 3.2; 95% CI, 1.1-9.1) and prior bacterial infection of the lower respiratory tract within 6 months before admission (OR, 3.1; 95% CI, 1.1-8.3).

AIDS-Related Opportunistic Infections↗
PubMed1998

Spiral computed tomographic scanning and magnetic resonance angiography for the diagnosis of pulmonary embolism.

PURPOSE: To compare prospectively the accuracy of spiral computed tomography (CT) with that of ventilation-perfusion scintigraphy for diagnosing pulmonary embolism. MATERIALS AND METHODS: Within 48 hours of presentation, 142 patients suspected of having pulmonary embolism underwent spiral CT, scintigraphy, and (when indicated) pulmonary angiography. Pulmonary angiography was attempted if interpretations of spiral CT scans and of scintigrams were discordant or indeterminate and intermediate-probability, respectively. RESULTS: In the 139 patients who completed the study, interpretations of spiral CT scans and of scintigrams were concordant in 103 patients (29 with embolism, 74 without). In 20 patients, intermediate-probability scintigrams were interpreted (six with embolism at angiography, 14 without); diagnosis with spiral CT was correct in 16. Interpretations of spiral CT scans and those of scintigrams were discordant in 12 cases; diagnosis with spiral CT was correct in 11 cases and that with scintigraphy was correct in one. Spiral CT and scintigraphic scans of four patients with embolism did not show embolism. Sensitivities, specificities, and kappa values with spiral CT and scintigraphy were 87%, 95%, and 0.85 and 65%, 94%, and 0.61, respectively. CONCLUSION: In cases of pulmonary embolism, sensitivity of spiral CT is greater than that of scintigraphy. Interobserver agreement is better with spiral CT.

Humans↗
PubMed1998

Association of small cell lung cancer and the anti-Hu paraneoplastic syndrome: radiographic and CT findings.

OBJECTIVE: The anti-Hu syndrome (bearing the name of the patient in whom the antibody was first discovered) is characterized by a paraneoplastic encephalomyelitis or sensory neuronopathy and the presence of a specific antibody in the serum or CSF and is associated with lung cancer in most patients who have the syndrome. The objective of this study was to determine the relative merits of chest radiography and CT in the imaging of patients with the anti-Hu syndrome. MATERIALS AND METHODS: Chest radiographic and CT findings of 11 patients with anti-Hu syndrome were reviewed and correlated with results of bronchoscopy, surgery, or autopsy. RESULTS: Ten of the 11 patients had small cell lung cancer; in the remaining patient, no cancer was found. Small cell lung cancer was first revealed on radiographs in one patient and solely on CT in the remaining nine patients with small cell lung cancer. In six of these nine patients, the initial CT findings were positive for lung cancer. Tumor was found on follow-up CT in 4-8 months when initial CT findings were negative. Mediastinal adenopathy was present in all 10 cancer patients. Hilar adenopathy was present in four. Parenchymal involvement was seen in three of the 10 patients with cancer. In two patients, the only CT finding of small cell lung cancer was one mediastinal lymph node of 10 mm in each patient. CONCLUSION: Chest CT should be recommended for patients with anti-Hu syndrome, even when chest radiographic findings are interpreted as normal.

Aged↗
PubMed1998

[Thoracic infections in immunocompetent patients. The contribution of computed tomography].

Chest X-Ray is the most accurate method of imaging for infectious diseases in an immunocompetent patient. Computed tomography (CT) may be useful in certain circumstances, particularly in case of atypical findings at the time of diagnosis or in case of complications. CT helps to detect and perform a complete study of the lesions, some aspects being very suggestive of a diagnosis, as in post-primary active tuberculosis. CT may also detect an unknown underlying etiology. Multiplanar reformations with helical CT can be useful for example in case of empyema. In case of non tuberculous bacterial infections, CT is mainly recommended when abscess and empyema are difficult to differentiate or in case of pleural complications with possible percutaneous treatment. In case of tuberculosis, CT may be indicated when clinical and chest X-Ray findings are discordant, in case of mediastinal adenopathies, when reactivation is suspected or in case of complications as hemoptysis. A baseline CT examination could be proposed at the end of a specific treatment to facilitate the diagnosis of reactivation tuberculosis. A nontuberculous mycobacterial infection should finally be suspected in front of peculiar CT findings.

Abscess↗
PubMed1996

Bronchiectasis: comparative assessment with thin-section CT and helical CT.

PURPOSE: To compare thin-section computed tomography (CT) and helical CT in the detection and assessment of the extent of bronchiectasis. MATERIALS AND METHODS: Both thin-section and helical CT scans were obtained in 50 consecutive patients with clinical symptoms suggestive of bronchiectasis. Thin-section CT was performed with 1.5-mm collimation and 10-mm intervals, and helical CT was performed with 3-mm collimation and a pitch of 1.6 during a 24-second breath hold. Three observers evaluated 593 segments on CT scans both independently and in consensus. Radiation dose was measured for both techniques. RESULTS: Bronchiectasis was noted in 77 segments (22 patients) on thin-section CT scans compared with 90 segments (26 patients) on helical CT scans. No findings were positive for bronchiectasis on only thin-section CT scans. Interobserver agreement was statistically significantly better (P < .05) in identification of segments that were positive for bronchiectasis on helical CT scans (kappa = 0.87) than on thin-section CT scans (kappa = 0.71). Total skin dose of radiation delivered with helical CT was 3.4 times greater than that delivered with thin-section CT. CONCLUSION: Helical scanning can improve CT depiction of bronchiectasis but with an increase in radiation exposure to the patient. It should be used in patients considered for surgery or for thin-section CT scans that are difficult to interpret.

Adult↗
PubMed1996

[Comparative evaluation of iopamidol 300 versus 370 during spiral x-ray computed tomographic studies of the thorax].

PURPOSE: A retrospective study was performed to assess the role of iodine concentration on the opacification of different vascular compartments of the chest with a nonionic contrast agent (Iopamidol) during routine spiral CT examination. MATERIAL AND METHOD: 105 injected spiral CTs of the chest were studied. 50 examinations were done with Iopamidol 300 (iodine concentration 300 g/L) (I300). 55 examinations were done with Iopamidol 370 (iodine concentration 370 g/L) (I370). A constant 24- g total iodine dose was delivered with no difference in the injected iodine flow rates (respectively 0.6 and 0.55 g/s). Images were scored for opacification success, opacification quality and for artefacts in each vascular, of the chest. RESULTS: There was no statistically significant difference in opacification success or in opacification quality, in each chest vascular compartment between the group receiving I300 and the group receiving I370. Artefact frequencies on the lower part of superior vena cava were however different, 24% and 41.8% respectively. CONCLUSION: For a constant injected iodine flow rate, a moderate increase in iodine concentration, with decreased injection volume and flow rate, had little or no effect on opacification of the aorta and the pulmonary artery. The presence of artefacts on the lower part of the superior vena cava would suggest that the use of lower concentration contrast media would be advisable for specific vena cava examinations.

Adult↗
PubMed1995

[Imaging of COPD].

Standard chest radiographs have been shown to be insensitive for the diagnosis of morphologic abnormalities of airways. Computed tomography is the most sensitive and specific investigation to diagnose emphysema. However, as emphysema may be missed on computed tomography, this investigation cannot be used to definitely rule out the diagnosis. Computed tomography may contribute to the investigation of bronchiolitis, and it is now considered as the gold standard for establishing the diagnosis of bronchiectasis. Imaging may contribute to identify complications such as bronchopulmonary infection, pulmonary hypertension, pneumothorax, cancer of the lung, compressive bullae, and pulmonary embolism.

Bronchiolitis↗
PubMed1995

[Variety of pancreatic lesions observed in von Hippel-Lindau disease. Apropos of 8 cases].

Von Hippel-Lindau's disease is a rare genetic disease, with an autosomal dominant mode of inheritance, characterised by the development of several tumours, such as haemangioblastoma of the central nervous system and retina, renal cysts or carcinoma and pheochromocytoma. Several pancreatic lesions, mainly represented by multiple cysts, are also encountered. We report here 8 cases of pancreatic involvement in patients affected with von Hippel-Lindau's disease. It consisted of multiple cysts (3 cases), serous cystadenoma (2 cases), endocrine tumour (1 case), haemangioblastoma (1 case) and ductal adenocarcinoma (1 case). Diagnosis of a rare lesion of the pancreas (multiple cysts, serous cystadenoma or vascularized tumour) in a young patient may lead to search the other lesions of von Hippel-Lindau's disease and to undergo a familial inquiry in order to propose a multidisciplinary approach for patients affected by the disease.

Adenocarcinoma↗