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Biomedical subjects

Deborah J Rubens

Publications and source records attributed to Deborah J Rubens.

At least 19 recordsLinked to original sources
PubMed2006

Incidence of arterial injuries detected by arteriography following percutaneous right-lobe ultrasound-guided core liver biopsies in human subjects.

PURPOSE: To determine the incidence and significance of arterial injuries detected by angiography subsequent to ultrasound-guided random core liver biopsies in normal healthy adults. MATERIALS AND METHODS: Retrospective analysis of 55 potential living related liver donors who underwent an ultrasound-guided random liver biopsy and a visceral angiogram was performed (January, 1999 to May, 2002). All liver biopsy samples (obtained by 2-3 18-gauge needle passes) were re-evaluated prospectively by a transplant pathologist for adequacy (defined: >or=5 complete portal triads). Subjects who underwent angiograms before the biopsy or >7 days after the biopsy were excluded from the arterial injury evaluation. Angiograms were reviewed by two angiographers. Arterial injuries were identified and classified by consensus into contusions, active bleeding, arterial-venous fistulae, and pseudoaneurysms. RESULTS: Mean needle pass was 2.1. No major complications were encountered. All samples were deemed pathologically adequate. Forty-eight potential donors were included for the arterial injury evaluation. Three arterial injuries (two arterioportal fistulae, 4.2%) were found in 48 angiograms (6.3%). None of the three injuries required intervention. CONCLUSION: The incidence of arterioportal fistulae following core liver biopsies has not changed over the past three decades despite improvement in biopsy needle technology, reduction of needle caliber, and the use of image guidance.

Adult↗
PubMed2006

Image-guided brachytherapy for prostate cancer.

Prostate brachytherapy offers and effective treatment for organ-confined prostate carcinoma. It is rapidly delivered compared with external beam radiation therapy or surgery and well tolerated by patients. Volumetric imaging and image guidance play critical roles in patient selection, treatment planning, treatment delivery, and postimplant assessment. Costs, availability and ease of use often dictate the local and regional differences in imaging approach, whether ultrasound, CT, or MR. Future volumetric image developments may permit multimodality image fusion to integrate tumor-specific imaging such as MR spectroscopy or positron emission tomography/CT into real-time ultrasound, CT, or MR.

Brachytherapy↗
PubMed2006

Doppler artifacts and pitfalls.

With increasing technologic advances in ultrasound, its applications have continued to grow for the detection of pathology and physiology. To avoid misinterpretation of results, however, the Doppler US practitioner must understand the factors that produce a Doppler signal, whether vascular, motion, or artifact. Color or power Doppler artifacts can be verified by their atypical spectral waveform. Some artifacts, such as aliasing (for rapid detection of stenoses or arteriovenous fistulae) and the twinkle artifact (for identification of renal calculi and verification of other stones or crystals), are extremely useful diagnostically. Careful attention to the technical parameters of frequency, gain, filter and scale is required to correctly identify vascular patency or thrombosis, especially in slow-flowing vessels.

Artifacts↗
PubMed2006

Sonography of benign intrascrotal lesions.

Ultrasound plays an important role and adds essential information in diagnosing benign intrascrotal lesions. Characterization of benign intrascrotal lesions with sonography, in combination with clinical assessment, can lead to nonsurgical management or testicular sparing surgery. We present important sonographic features of benign intrascrotal lesions, including extratesticular lesions: adenomatoid tumors, papillary cystadenomas, spermatoceles, hydroceles, varicoceles, hernias; and intratesticular lesions: tunica albuginea cysts, testicular simple cysts, epidermoid cysts, tubular ectasia of the rete testis, intratesticular varicoceles, adrenal rest tumors, and splenogonadal fusion. The goal of this review is to provide the radiologist with a better understanding of benign lesions that occur in the scrotum.

Diagnosis, Differential↗
PubMed2006

Safety and efficacy of fluoroscopic versus ultrasound guidance for core liver biopsies in potential living related liver transplant donors: preliminary results.

PURPOSE: To describe and evaluate the safety and efficacy of fluoroscopically guided percutaneous liver biopsies in comparison with ultrasound (US)-guided percutaneous liver biopsies in potential living related liver donors. MATERIALS AND METHODS: Retrospective analysis of 133 consecutive preoperative workups of potential living related liver donors was performed. The subjects were treated from January 1999 through May 2002. Subjects were divided into those who underwent US-guided subcostal 18-gauge core liver biopsies (group I) and those who underwent fluoroscopically guided intercostal 18-gauge core liver biopsies (group II). Group II biopsies were performed in a manner similar to percutaneous transhepatic cholangiography. All samples obtained during the study period were reevaluated prospectively by a transplant pathologist blinded to guidance modality for sample adequacy (defined as >or=5 complete portal triads). Subjects were followed for 4 hours before discharge and afterward in the transplant clinic until donation. Subjects who did not donate organs were followed for at least 1 month. RESULTS: One hundred thirty-three potential donors were evaluated (55 for group I, 78 for group II). Mean follow-up was 1.7 months, and 77% of subjects donated. The mean numbers of needle passes were 2.1 and 2.3 for groups I and II, respectively. No major complications were encountered, and all subjects were discharged in 4 hours. Incidences of minor complications were 3.6% (vasovagal reactions) and zero for groups I and II, respectively. Sample adequacy rates were 100% and 99% for groups I and II, respectively. One case (1.8%) in group I, although pathologically adequate, had additional renal tissue. CONCLUSION: Fluoroscopically guided liver biopsy shows encouraging initial safety results and is as effective as US-guided liver biopsy in normal subjects.

Adult↗
PubMed2006

Sonoelastographic imaging of interference patterns for estimation of shear velocity distribution in biomaterials.

The authors have recently demonstrated the shear wave interference patterns created by two coherent vibration sources imaged with the vibration sonoelastography technique. If the two sources vibrate at slightly different frequencies omega and omega+deltaomega, respectively, the interference patterns move at an apparent velocity of (deltaomega/2omega)upsilon(shear), where upsilon(shear) is the shear wave speed. We name the moving interference patterns "crawling waves." In this paper, we extend the techniques to inspect biomaterials with nonuniform stiffness distributions. A relationship between the local crawling wave speed and the local shear wave velocity is derived. In addition, a modified technique is proposed whereby only one shear wave source propagates shear waves into the medium at the frequency omega. The ultrasound probe is externally vibrated at the frequency omega-deltaomega. The resulting field estimated by the ultrasound (US) scanner is proven to be an exact representation of the propagating shear wave field. The authors name the apparent wave motion "holography waves." Real-time video sequences of both types of waves are acquired on various inhomogeneous elastic media. The distribution of the crawling/holographic wave speeds are estimated. The estimated wave speeds correlate with the stiffness distributions.

Animals↗
PubMed2005

Prostate cancer: three-dimensional sonoelastography for in vitro detection.

PURPOSE: To prospectively evaluate the accuracy of three-dimensional (3D) sonoelastographic imaging, relative to that of gray-scale ultrasonography (US), in the in vitro detection of prostate cancer. MATERIALS AND METHODS: The study was approved by the institutional review board and was HIPAA compliant. Informed consent was obtained from all patients. Nineteen prostatectomy specimens from patients aged 46-70 years with biopsy-proved prostate cancer were scanned in three dimensions by using conventional B-mode US and sonoelastography with vibrations of more than 100 Hz. Step-sectioned whole-mount histologic specimens were used to create a 3D volume of the prostate and the tumors within it. B-mode US scans and regions of low vibration on the sonoelastographic images (hard regions) were formatted in three dimensions. The lesions in the 19 cases were classified into two groups, as follows: G1 lesions were pathologically confirmed tumors with a volume of at least 1.0 cm3, and G2 lesions were pathologically confirmed tumors smaller than 1.0 cm3. G1 lesions were evaluated with B-mode US and sonoelastography and classified as true-positive, false-positive, true-negative, or false-negative; G2 lesions were evaluated only with sonoelastography. Findings at histologic examination were used as the reference standard. True-positive findings necessitated 3D lesion correlation between pathologic and imaging data. Conventional definitions of accuracy and sensitivity were used for statistical analysis. RESULTS: For G1 lesions (seven lesions with a volume of at least 1.0 cm3), sonoelastography had an accuracy of 55% and a sensitivity of 71% and B-mode US had an accuracy of 17% and a sensitivity of 29%. The mean tumor volume was 3.1 cm3 +/- 2.1 (standard deviation). For G2 lesions (22 lesions with a volume of less than 1.0 cm3), the mean tumor volume was 0.32 cm3 +/- 0.21. Sonoelastography had an accuracy of 34% and a sensitivity of 41%; there were six false-positive findings. CONCLUSION: Sonoelastography performed considerably better than did gray-scale US in the depiction of prostate cancer for tumors with volumes of more than 1 cm3.

Aged↗
PubMed2005

Multidetector CT of the female pelvis.

In the emergency room setting, multidetector detector CT (MDCT) offers rapid, noninvasive, multiplanar evaluation of female patients who have acute pelvic pain. MDCT has been integrated into several of the major trauma centers, and its use may surpass the use of ultrasound in the trauma evaluation of the pregnant patient. In the nonemergent setting, MDCT can be used to stage gynecologic malignancy and to evaluate tumor recurrence. Multiplanar MDCT has received some acceptance for evaluation of small primary tumor volume and small metastatic implants. MDCT also has a role in the evaluation of pelvic varices and suspected pelvic congestion syndrome.

Contrast Media↗
PubMed2005

A unified view of imaging the elastic properties of tissue.

A number of different approaches have been developed to estimate and image the elastic properties of tissue. The biomechanical properties of tissues are vitally linked to function and pathology, but cannot be directly assessed by conventional ultrasound, MRI, CT, or nuclear imaging. Research developments have introduced new approaches, using either MRI or ultrasound to image the tissue response to some stimulus. A wide range of stimuli has been evaluated, including heat, water jets, vibration shear waves, compression, and quasistatic compression, using single or multiple steps or low-frequency (<10 Hz) cyclic excitation. These may seem to be greatly dissimilar, and appear to produce distinctly different types of information and images. However, our purpose in this tutorial is to review the major classes of excitation stimuli, and then to demonstrate that they produce responses that fall within a common spectrum of elastic behavior. Within this spectrum, the major classes of excitation include step compression, cyclic quasistatic compression, harmonic shear wave excitation, and transient shear wave excitation. The information they reveal about the unknown elastic distribution within an imaging region of interest are shown to be fundamentally related because the tissue responses are governed by the same equation. Examples use simple geometry to emphasize the common nature of the approaches.

Biomechanical Phenomena↗
PubMed2005

Pseudoaneurysms and the role of minimally invasive techniques in their management.

Pseudoaneurysms are common vascular abnormalities that represent a disruption in arterial wall continuity. Some complications associated with pseudoaneurysms develop unpredictably and carry high morbidity and mortality rates. The advent of new radiologic techniques with a greater sensitivity for asymptomatic disease has allowed more frequent diagnosis of pseudoaneurysms. Conventional angiography remains the standard of reference for diagnosis but is an invasive procedure, and noninvasive diagnostic modalities (eg, ultrasonography [US], computed tomographic angiography, magnetic resonance angiography) should be included in the initial work-up if possible. A complete work-up will help in determining the cause, location, morphologic features, rupture risk, and clinical setting of the pseudoaneurysm; identifying any patient comorbidities; and evaluating surrounding structures and relevant vascular anatomy, information that is essential for treatment planning. Therapeutic options have evolved in recent years from the traditional surgical option toward a less invasive approach and include radiologic procedures such as US-guided compression, US-guided percutaneous thrombin injection, and endovascular management (embolization, stent-graft placement). The use of noninvasive treatment has led to a marked decrease in the morbidity and mortality rates for pseudoaneurysms.

Adult↗
PubMed2005

Sonographic evaluation of penile trauma.

OBJECTIVE: The purpose of this presentation is to illustrate the normal sonographic anatomy of the penis and various imaging manifestations of penile trauma. METHODS: Penile trauma cases were collected and reviewed retrospectively from our archive. RESULTS: The normal sonographic anatomy of the penis and various pathologic conditions of patients with penile trauma are discussed. CONCLUSIONS: Sonography (especially with color Doppler sonography) is a useful imaging method for evaluating penile anatomy and various pathologic features in patients with penile trauma.

Hematoma↗
PubMed2004

Sonoelastographic imaging of interference patterns for estimation of the shear velocity of homogeneous biomaterials.

The shear wave velocity is one of a few important parameters that characterize the mechanical properties of bio-materials. In this paper, two noninvasive methods are proposed to measure the shear velocity by inspecting the shear wave interference patterns. In one method, two shear wave sources are placed on the opposite two sides of a sample, driven by the identical sinusoidal signals. The shear waves from the two sources interact to create interference patterns, which are visualized by the vibration sonoelastography technique. The spacing between the pattern bands equals half of the shear wavelength. The shear velocity can be obtained by taking the product of the wavelength and the frequency. An alternative method is to drive the two vibration sources at slightly different frequencies. In this case, the interference patterns no longer remain stationary. It is proved that the apparent velocity of the moving patterns is proportional to the shear velocity in the medium. Since the apparent velocity of the patterns can be measured by analysing the video sequence, the shear velocity can be obtained thereafter. These approaches are validated by a conventional shear wave time-of-flight approach, and they are accurate within 4% on various homogeneous tissue-mimicking phantoms.

Connective Tissue↗
PubMed2004

Hepatobiliary imaging and its pitfalls.

In summary, US is the initial imaging modality for the evaluation of acute right upper quadrant pain. It permits accurate diagnosis of acute cholecystitis and successfully identifies multiple other causes of patient symptomatology. Some of these processes lie outside the hepatobiliary system and include renal infection and obstruction, pancreatitis and its sequelae, duodenal or colonic perforation or mass lesions, peritoneal tumor spread, adrenal hemorrhage, and even remote problems, such as pneumonia. The limitations on US include incomplete imaging of the liver, most often at the dome or beneath ribs on the surface, and incomplete visualization of lesion boundaries, particularly with some infections and tumors. For these clinical scenarios, contrast-enhanced CT is complementary to US and should be encouraged. In the biliary tree, US has limitations in situations in which the ducts are not dilated and sometimes with imaging the extra hepaticducts, especially distally. For these patients, CT or MR imaging (MRCP) is especially useful. If one keeps the clinical scenario in mind and always images a patient where he or she hurts, US is a powerful and effective diagnostic method for evaluating acute right upper quadrant pain.

Biliary Tract Diseases↗
PubMed2004

Three-dimensional registration of prostate images from histology and ultrasound.

A whole mount histology protocol for 3-D tissue reconstruction to compare the size and spatial location of tumors (and other components) identified in histology data with that from 3-D ultrasound (US) images is presented. Prostate specimens are imaged in 3-D using B-mode (US) and sonoelastography. The prostate surface is outlined in each B-mode image and a 3-D surface reconstruction is made. The specimen is then prepared for whole mount histology and the histology slides are digitally reconstructed to make a 3-D surface. These two surfaces are then aligned using a 3-D correlation algorithm, and the tumor boundary determined by the pathologist is compared with that using sonoelastography. 3-D images showing the overlapping histology and sonoelastography of prostate surface reconstructions for one prostate are presented to illustrate the technique; results for four prostates yielded an accuracy of 92% +/- 3%.

Humans↗
PubMed2004

Torsion and beyond: new twists in spectral Doppler evaluation of the scrotum.

OBJECTIVE: To illustrate how spectral Doppler waveform analysis plays an adjunctive but very definite role in scrotal sonography. METHODS: The cases illustrate a variety of testicular disorders that were collected at a referral tertiary care center. RESULTS: Normal and a variety of pathologic conditions of the testes are discussed, along with their signature spectral waveforms. CONCLUSIONS: Analysis of the spectral waveform provides important additional information in various scrotal disorders with acute pain. Spectral waveform analysis is critical to diagnosing incomplete torsion when color and power Doppler examinations are indeterminate.

Genital Diseases, Male↗
PubMed2003

Sonography of the scrotum.

Ultrasonography (US) with a high-frequency (7.5-10-MHz) transducer has become the imaging modality of choice for examination of the scrotum. US examination can provide information valuable for the differential diagnosis of a variety of disease processes involving the scrotum that have similar clinical manifestations (eg, pain, swelling, or presence of mass). The pathologic condition that may be at the origin of such symptoms can vary from testicular torsion to infection to malignancy. The ability of color and power Doppler US to demonstrate testicular perfusion aids in reaching a specific diagnosis in patients with acute scrotal pain. This review covers the anatomy of the scrotum and the scanning protocol for scrotal US, as well as detailed descriptions of disease processes and their US appearances. Newly described conditions such as intratesticular varicoceles and other benign intratesticular cystic lesions are also discussed.

Epididymis↗
PubMed2003

Doppler ultrasound imaging of magnetically vibrated brachytherapy seeds.

Vibration induced by an alternating magnetic field is proposed as a method for the identification of modified brachytherapy seeds with Doppler ultrasound. In vitro experiments with agar and liver-tissue phantoms using a clinical scanner and simple apparatus demonstrate that the technique is feasible.

Animals↗