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Biomedical subjects

Douglas S Katz

Publications and source records attributed to Douglas S Katz.

At least 19 recordsLinked to original sources
PubMed2006

Computed tomography evaluation of spondylolysis and spondylolisthesis in asymptomatic patients.

STUDY DESIGN: A retrospective radiographic study involving analysis of abdominal and pelvic computed tomography (CT) scans obtained on patients presenting with clinical conditions other than back pain. OBJECTIVE: To determine the incidence of spondylolysis and spondylolisthesis in patients requiring inpatient or emergency department CT evaluation for unrelated abdominal and pelvic conditions. SUMMARY OF BACKGROUND DATA: Spondylolysis and spondylolisthesis are part of a disease process that is thought to be resultant from biomechanical stresses related to bipedal locomotion. The incidence is estimated to be 3% to 10% in the general population. Many of these cases occur without associated symptoms. To our knowledge, there is a relative paucity of data on the use of CT to evaluate the prevalence of these 2 entities in patients seeking medical attention for unrelated conditions. METHODS: Five hundred ten consecutive abdominal and pelvic multi-detector CT scans obtained on a single scanner (Philips MX8000; Eindhoven, The Netherlands) were reviewed. These patients presented with such complaints as abdominal pain and fever, or were imaged as part of their inpatient evaluation for conditions unrelated to lumbar spine pathology. A board certified radiologist and a radiology resident retrospectively evaluated CT scans for lumbar spondylolysis, spondylolisthesis, and associated degenerative changes. A neuroradiologist confirmed all positive cases. RESULTS: Of the 510 cases examined, there were 29 cases of spondylolysis at L5, corresponding to a prevalence of 5.7%. Twenty-three of the cases demonstrated bilateral spondylolysis and 6 unilateral. Sixteen of the 23 cases of bilateral spondylolysis also had spondylolisthesis, 13 of which were grade I, and 3 of which were grade II. In patients 45 years old and younger who did not have spondylolysis or spondylolisthesis, we observed a 32.2% incidence of sclerosis involving the L5 lumbar pedicles. CONCLUSIONS: This study demonstrates a 5.7% prevalence of spondylolysis and a 3.1% prevalence of spondylolisthesis in patients undergoing CT scans of the abdomen and pelvis for unrelated reasons, corresponding to the rate of spondylolysis and spondylolisthesis detected in prospective plain radiographic studies. We observed a 1.2% incidence of unilateral spondylolysis, and approximately 67% of these demonstrated contralateral sclerosis. It is suggested in the literature that sclerosis of the contralateral pedicle seen in cases of unilateral spondylolysis may be a compensatory response to mechanical stresses on an unstable lumbar vertebral body.

Adolescent↗
PubMed2005

Nontraumatic acute abdominal pain: unenhanced helical CT compared with three-view acute abdominal series.

PURPOSE: To prospectively evaluate and compare the diagnostic accuracy of unenhanced helical computed tomography (CT) for patients with nontraumatic acute abdominal pain with that of traditional abdominal radiography. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained; this study was completed before implementation of the HIPAA. Ninety-one patients (44 men; 47 women; age range, 18-84 years; mean age, 48.5 years) with acute nontraumatic abdominal pain over a 7-month period were referred by the emergency department of one institution. These patients underwent a three-view acute abdominal series (AAS) and unenhanced helical CT. AAS included an upright chest radiograph and upright and supine abdominal radiographs. Unenhanced helical CT images with 5-mm collimation were obtained from the lung bases to the pubic symphysis, without intravenous, oral, or rectal contrast material. AAS and unenhanced helical CT images were each separately and prospectively interpreted by a different experienced radiologist who was blinded to patient history and the images and interpretation of the other examination for each patient. Final diagnosis was established with surgical, pathologic, and clinical follow-up. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and positive and negative likelihood ratios were calculated for AAS and unenhanced helical CT. Confidence intervals of 95% were calculated for each value with the standard equation for population proportions. Results of AAS and unenhanced helical CT examinations were compared with chi2 analysis. RESULTS: Among the 91 patients examined, unenhanced helical CT yielded an overall sensitivity, specificity, and accuracy of 96.0%, 95.1%, and 95.6%, respectively. The AAS interpretations yielded an overall sensitivity, specificity, and accuracy of 30.0%, 87.8%, and 56.0%, respectively. The accuracy of unenhanced helical CT was significantly greater than the accuracy of AAS (P < .05). CONCLUSION: AAS is an insensitive technique in the evaluation of nontraumatic acute abdominal pain in adults. Unenhanced helical CT is an accurate technique in the evaluation of adult patients with nontraumatic acute abdominal pain and should be considered as an alternative to radiography as the initial imaging modality.

Abdomen, Acute↗
PubMed2005

Indications for CT in patients receiving anticoagulation after head trauma.

BACKGROUND AND PURPOSE: Head CT is frequently ordered for trauma patients who are receiving anticoagulation. However, whether patients with a Glasgow Coma Scale (GCS) score of 15 and normal findings on neurologic examination require CT is still debated. The purpose of our study was to assess the use of cranial CT in patients receiving anticoagulants after head trauma and to establish clinical criteria to identify those in this group who do not need emergency CT. METHODS: We retrospectively reviewed patients receiving heparin or coumadin who had head trauma and who subsequently underwent cranial CT at a level I trauma center within a 4-year period. Patients were evaluated for mechanism of injury, clinical signs and symptoms of head injury, and type and reason for anticoagulation. Prothrombin time, international normalized ratio, partial thromboplastin time, GCS score, age, and head CT results were recorded for each patient. RESULTS: A total of 89 patients fulfilled the enrollment criteria. Among them, 82 had no evidence of intracranial injury on CT. Seven patients had evidence of intracranial hemorrhage. Patients without hemorrhage had no significant focal neurologic deficits and presented with an average GCS score of 14.8. Patients with intracranial hemorrhage tended to have focal neurologic deficits and presented with an average GCS score of 12.0. CONCLUSION: Patients with head injury, normal GCS scores, and no focal neurologic deficits and who are receiving the anticoagulants heparin or coumadin may not necessarily require emergency CT.

Aged↗
PubMed2004

Ovarian torsion: CT findings in a child.

The computed tomography (CT) findings of ovarian torsion in a 10-year-old girl are presented. The CT scan was the first cross-sectional imaging examination performed in this patient, who presented with suspected acute appendicitis. Analogous to the sonographic diagnosis of ovarian torsion, the imaging findings may be pathognomonic on CT and should be prospectively recognized for prompt diagnosis.

Abdominal Pain↗
PubMed2004

CT venography in suspected pulmonary thromboembolism.

Pulmonary embolism (PE) and deep venous thrombosis (DVT) are a continuum and are difficult to diagnose clinically. Combined CT venography and pulmonary angiography (CTVPA) is a single examination that combines multidetector CT pulmonary angiography (CTPA) and CT venography (CTV) of the abdomen, pelvis, and lower extremities, providing "one-stop shopping" for venous thromboembolism without additional venipuncture or i.v. contrast, and it adds only a few additional minutes to scanning time. CTVPA rapidly and accurately examines the deep veins, reveals the presence, absence, and extent of deep venous thrombosis, serves as a baseline, and helps guide patient management. Multiple investigators have reported a high degree of accuracy when CTV is compared with venous ultrasound. There are some pitfalls in image interpretation, especially with regard to mixing artifacts, and there are continuing controversies as to exactly which parts of the abdomen, pelvis, and legs should be scanned routinely, the ideal timing of CTV acquisition relative to contrast injection, and the slice thickness and gap, if any, that should be used.

Abdomen↗
PubMed2004

Current DVT imaging.

Accurate diagnosis of deep venous thrombosis (DVT) is very difficult, and imaging plays a crucial role in the diagnosis or exclusion of DVT. The initial test of choice for diagnosis of acute thigh as well as upper extremity DVT is ultrasound, because of its high accuracy, relatively low cost, portability, and lack of ionizing radiation. In patients who are undergoing CT pulmonary angiography for suspected pulmonary embolism, CT venography can be performed as part of the examination, for comprehensive evaluation of the venous system in the legs, abdomen, and pelvis. MR has a problem-solving role, and conventional venography is now limited to specific scenarios including evaluation of central DVT in the upper extremities, as a prelude to intervention for thrombolysis/thrombectomy, and prior to placement of an inferior vena cava filter. This article discusses the imaging findings of DVT, and the role of these imaging examinations in the evaluation of patients with suspected DVT.

Contrast Media↗