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Biomedical subjects

Elliot K Fishman

Publications and source records attributed to Elliot K Fishman.

At least 19 recordsLinked to original sources
PubMed2003

The current status of multidetector row CT and three-dimensional imaging of the small bowel.

Radiologists have played an important role in evaluation of patients with small bowel pathology. The small bowel series and, later, enteroclysis were the mainstays in radiologic diagnosis of many small bowel diseases, because the resolution and speed of CT was limited. Continued improvements in CT technology over the last 2 decades have resulted in a expanding role of CT for evaluation of the gastrointestinal tract, including the small intestine. Many conditions, such as small bowel obstruction and ischemia, that would traditionally be imaged with other modalities (small bowel series or angiography) are now routinely imaged with CT. The development of MDCT and improvements in 3D imaging systems have greatly improved the ability to examine the small bowel and mesenteric vasculature. With the introduction of new CT oral contrast agents and faster 32-detector row CT scanners, the diagnosis and evaluation of patients with small bowel disease will continue to improve.

Contrast Media↗
PubMed2003

Thoracic venous anatomy multidetector row CT evaluation.

Two-dimensional CT angiography provides much information of the systemic and pulmonary thoracic veins. The combination of MDCT and volume-rendering techniques postprocessing provides higher-quality data sets and a method fully to harness the potential for image display and interpretation. Although this may not radically alter sensitivity for detection of systemic or pulmonary venous pathology it does provide a more comprehensive and sophisticated evaluation through volume acquisition and interpretation.

Angiography↗
PubMed2003

Role of computed tomography and magnetic resonance imaging in assessment of acute aortic syndromes.

Acute aortic syndromes refer to the spectrum of aortic emergencies that include nontraumatic diseases of the aorta, such as aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, aortic aneurysm leak, as well as traumatic aortic transection. Patients presenting with nontraumatic acute aortic syndromes usually have a similar clinical profile; hence, clinical diagnosis is difficult. Computed tomography (CT) and magnetic resonance imaging (MRI) allow for specific diagnosis of the underlying condition. Traumatic rupture of the aorta is one of the most dreaded complications of blunt chest trauma; therefore, in patients with high-risk deceleration injuries, radiographic assessment of the aorta is crucial. Imaging methods should detect even subtle aortic wall disruption and should provide a mechanism for communicating the findings to the surgical team. Noninvasive, cross-sectional imaging techniques have proven efficacy in the diagnosis of aortic pathology and have largely replaced aortography. Both CT and MR imaging provide aortogram-like reconstruction of the original data sets, and in addition to assessing the aortic lumen, permit detailed evaluation of the aortic wall, as well as comprehensive assessment of thoracic and abdominal viscera. This article addresses the role of different imaging modalities in assessment of acute aortic syndromes, with focus on CT and MRI, and with discussion of the key imaging findings that allow distinction among the various aortic pathologies.

Acute Disease↗
PubMed2003

Utility of high-resolution CT for management of diffuse lung disease: results of a survey of U.S. pulmonary physicians.

RATIONALE AND OBJECTIVES: This study was performed to determine how U.S. pulmonologists rate the clinical contributions of high-resolution computed tomography (CT) in patients with diffuse lung disease, to ascertain how the technique affects management decisions, and to determine the effect of three physician characteristics on these attitudes. MATERIALS AND METHODS: The authors surveyed 450 practicing pulmonologists. The questionnaire explored perceptions of the efficacy of high-resolution CT for achieving five clinical objectives, the importance of high-resolution CT in 17 diseases, and the effects of the CT results on management decisions. Responses were examined by type of clinical practice, monthly referral volume, and year of completion of pulmonary fellowship. RESULTS: The response rate was 52.6%. High-resolution CT was rated most helpful for determining the extent of diffuse lung disease and least helpful for assessing disease activity and prognosis. Pulmonologists believed that high-resolution CT was most important in the idiopathic interstitial pneumonias and least important in Pneumocystis carinii pneumonia and emphysema. High-resolution CT results frequently increased the physician's confidence in a presumptive diagnosis. Recently trained pulmonologists were more likely to report that high-resolution CT results altered their management plan. There were no significant differences related to type of practice. CONCLUSION: U.S. pulmonologists in a variety of practice settings value the contributions of high-resolution CT in patients with diffuse lung disease and find it particularly important in the chronic interstitial pneumonias. High-resolution CT results have their greatest effect in confirming a presumptive clinical diagnosis and less frequently alter the management plan.

Humans↗
PubMed2003

Surgically staged focal liver lesions: accuracy and reproducibility of dual-phase helical CT for detection and characterization.

PURPOSE: To assess the accuracy and reproducibility of dual-phase helical computed tomography (CT) in enabling preoperative detection and characterization of surgically staged focal liver lesions. MATERIALS AND METHODS: Surgically and histopathologically proven liver lesions were evaluated by three experienced CT readers. These lesions were present in 77 patients who underwent dual-phase helical CT. Images were interpreted separately by the three blinded reviewers. Each lesion was graded on a nine-point scale of confidence, with 1 being definitely benign, 9 being definitely malignant, and 5 being indeterminate. The chi2 test was used to determine if the distribution of lesion classifications was different between readers. RESULTS: There was a total of 237 lesions: 73 were benign and 164 were malignant. Sensitivity for lesion detection was 69%, 70%, and 71% for the three reviewers, respectively. Specificity was 91%, 86%, and 90%, and the area under the curve for the alternative-free response receiver operating characteristic curve was 0.84, 0.83, and 0.85, respectively. The difference in the distributions of lesion classification between the three reviewers was not statistically significant (P =.67) as determined by chi2 analysis. CONCLUSION: Dual-phase CT has sensitivity of 69%-71% and high specificity (86%-91%) in enabling the detection and characterization of focal liver lesions. Interpretation is highly reproducible, as there is minimal variation between experienced reviewers.

Female↗
PubMed2003

Physician satisfaction with high-resolution CT services provided by radiologists: results of a nationwide survey of pulmonary subspecialists.

OBJECTIVE: Our objectives were to measure the level of satisfaction of pulmonary medicine specialists who refer patients to radiology facilities for high-resolution CT and to identify determinants of their reported satisfaction. MATERIALS AND METHODS: We surveyed 450 pulmonologist members of the American College of Chest Physicians. The self-administered questionnaire sought information about the radiologists and imaging facilities to which these clinicians referred patients for high-resolution CT of the lungs. The participants rated their satisfaction with the radiology services, estimated the number of patients referred for high-resolution CT per month, answered questions about certain attitudes and utilization practices, and provided general demographic information. RESULTS: Completed surveys were received from 230 pulmonologists practicing in 43 states. Satisfaction with high-resolution CT services was rated as follows: very satisfied (35% of respondents), satisfied (49%), and indifferent or dissatisfied (16%). A higher rating was found in pulmonologists in academic practice, in those who believed that the radiologists desired as much clinical information as possible, and in those who believed that two or more members of the radiology group were interested in high-resolution CT. Among satisfied pulmonologists, confidence in the radiologist's high-resolution CT interpretation was very important. Physician satisfaction was not significantly associated with the size of the radiology group or the number of monthly referrals for high-resolution CT. CONCLUSION: Pulmonologists in the United States appear to be satisfied with the high-resolution CT services provided by the radiologists in their communities. Satisfaction with radiology services might be further increased if radiologists expressed greater interest in high-resolution CT and pertinent clinical information and improved their interpretive skills.

Adult↗
PubMed2003

Multidetector CT angiography for preoperative evaluation of living laparoscopic kidney donors.

OBJECTIVE: The purpose of this study was to determine the accuracy of multidetector CT (MDCT) angiography as the primary imaging technique in the evaluation of living kidney donors. SUBJECTS AND METHODS: Seventy-four consecutive living kidney donors (30 men, 44 women; mean age, 41.7 years) who underwent MDCT were evaluated. CT examination was performed with 120 mL of IV contrast material at an injection rate of 3 mL/sec and a pitch of 6. In every case, arterial and venous phase volumetric data sets were acquired at 25 and 55 sec, respectively. Scans were reconstructed at 1-mm intervals for three-dimensional (3D) imaging using a volume-rendering technique. Axial CT images and 3D CT angiography were evaluated prospectively by one reviewer and retrospectively by two reviewers who had no knowledge of surgical results. Surgical correlation for the location of primary and accessory renal arteries, early branching of the renal arteries, and renal vein anomalies was made. RESULTS: Seventy-two subjects underwent left nephrectomy, and two subjects underwent right nephrectomy because supernumerary left renal arteries were detected on preoperative CT angiography. Eighteen supernumerary renal arteries (two arteries to 16 kidneys and three arteries to one kidney) to 74 kidneys underwent nephrectomy. CT and surgical findings agreed in 93% of subjects (the average of three reviewers; range, 89-97%). Two small accessory renal arteries were missed by all three reviewers. Those arteries were diminutive and were thought to be insignificant by the surgeons. Early branching of the renal arteries was shown in 14 arteries, and CT and surgical findings agreed in 96% (the average of three reviewers; range, 93-97%). Renal vein anomalies were present in eight subjects, and CT and surgical findings agreed in 99% of the cases (range, 96-100%). CONCLUSION: MDCT angiography is highly accurate for detecting vascular anomalies and providing anatomic information for laparoscopic living donor nephrectomy.

Adult↗
PubMed2003

Initial experience with oral contrast in PET/CT: phantom and clinical studies.

UNLABELLED: The aims of the study were to evaluate the effects of oral contrast on apparent tracer activity measured with PET/CT when using CT attenuation correction and to report our initial experience in the use of oral contrast with PET/CT. METHODS: Phantom studies with (18)F activity and saline bags or syringes filled with barium or gastrografin of varying densities were performed using a PET/CT scanner (CT attenuation correction). In the study, 91 clinical patients received dilute oral contrast and were evaluated by whole-body (18)F-FDG PET. RESULTS: A phantom experiment with CT contrast (1.3% weight/volume [w/v] barium) showed a "cold" area in the cold stomach whereas a phantom with high-density barium (98% w/v) showed an artifactual focus of intense "activity" in the cold stomach. In clinical studies, stomach and right colon were opacified by CT contrast. Maximal measured contrast density was 239 Hounsfield units. CONCLUSION: High-density barium causes overestimation of tissue (18)F-FDG concentration. Low-density barium does not cause significant artifacts and appears suitable for clinical use.

Administration, Oral↗
PubMed2003

Anterior mediastinal extension of primary chest wall infections: role of spiral CT in detection and management.

UNLABELLED: The purpose of this review was to define the role of spiral CT in the diagnosis and clinical management of patients with mediastinal infections resulting from extension of anterior chest wall infections. The review focuses on determining the frequency of mediastinal extension of chest wall infections as well as to define the patterns spread. SUBJECTS AND METHODS: CT scans of 22 consecutive patients collected over a 2-year period with anterior chest wall infections were evaluated both prospectively and retrospectively. Clinical, pathologic, and CT characteristics of the infections were evaluated. The extension of the infection into the mediastinum as well as the role of CT in diagnosis and management of these patients was examined. RESULTS: Of the 22 patients, 10/22 (45.4%) showed CT evidence of mediastinal infection. Extension of chest wall infection occurred in patients with both soft tissue and sternoclavicular joint processes. The assessment of mediastinal involvement was best seen at the level of the great vessels origin from the aortic arch. CT findings in the mediastinum included fat hyperdensity and stranding, fluid collections (abscess), and mass effect on the great vessels. Sensitivity and specificity of CT for determination of mediastinal infection were both 100%. In 5 of 10 cases with evidence of mediastinal extension, the clinical situation required surgical drainage. In the other five cases the patients were managed with antibiotic therapy alone. CONCLUSIONS: Mediastinal involvement of chest wall infections is a common occurrence. Conservative and/or surgical management must be tailored to the patient. Factors to consider in management decisions include the clinical status, CT findings, and patient compliance. Rapid CT evaluation may permit timely surgical intervention, limiting complications in some patients.

Adult↗
PubMed2002

Prevalence of significant noncardiac findings on electron-beam computed tomography coronary artery calcium screening examinations.

BACKGROUND: Screening electron-beam computed tomography (EBCT) examinations for the detection and quantification of coronary artery calcification are being performed throughout the country. In addition to information about the heart, great vessels, and coronary arteries, these examinations include portions of the lungs, bony thorax, and upper abdomen. The purpose of this study was to determine the prevalence of significant noncardiac findings in a series of patients undergoing coronary artery calcification screening studies with EBCT scanning. METHODS AND RESULTS: Between January 1, 2001, and October 1, 2001, 1326 consecutive patients underwent coronary artery calcification screening with EBCT (3-mm-thick slices were obtained at 3-mm intervals). Two board-certified radiologists reviewed the examinations on a workstation using standard mediastinal windows, lung windows, and bone windows. Significant extracardiac abnormalities were noted. Of 1326 patients, 103 (7.8%) had significant extracardiac pathology requiring clinical or imaging follow-up. These included 53 patients with noncalcified lung nodules <1 cm, 12 patients with lung nodules > or =1 cm, 24 patients with infiltrates, 7 patients with indeterminate liver lesions, 2 patients with sclerotic bone lesions, 2 patients with breast abnormalities, 1 patient with polycystic liver disease, 1 patient with esophageal thickening, and 1 patient with ascites. CONCLUSIONS: In this study, 7.8% of patients undergoing screening EBCT examinations for coronary artery calcification were found to have important extracardiac pathology requiring additional work-up. Therefore, it is essential that a radiologist review the entire examination.

Adult↗
PubMed2002

Positron emission tomography for detecting clinically occult surgically resectable metastatic ovarian cancer.

BACKGROUND: The specific indications for PET imaging in patients with ovarian cancer have yet to be precisely defined. While PET has limited sensitivity for detecting small-volume (<1 cm) metastatic disease, accurate identification of larger tumor nodules may have a significant impact on clinical management and the selection of patients for cytoreductive surgery. CASES: The cases of two patients with suspected recurrent Stage IIIC serous ovarian cancer based solely on elevated CA125 levels and one patient with an apparent Stage IC poorly differentiated ovarian sex cord-stromal tumor who had macroscopic surgically resectable disease (>1 cm) identified by PET after negative or equivocal computed tomography are presented. CONCLUSION: PET imaging may be a useful technique for identifying potentially surgically resectable, macroscopic metastatic ovarian cancer when computed tomography findings are negative or equivocal.

Adolescent↗
PubMed2002

Imaging of uncommon tumors of the pancreas.

In this article, the radiological manifestations of a variety of uncommon tumors of the pancreas are illustrated, with emphasis placed on their appearance at helical CT. Islet cell tumors, because of their vascularity, typically present as masses that are hyperattenuating to the normal pancreas at dual-phase helical CT. Lymphomas appear as hypoattenuating focal lesions or can diffusely infiltrate the gland. Absence of biliary tree dilatation, despite the presence of a bulky tumor, or associated extensive retroperitoneal adenopathy should offer clues to the diagnosis. Pancreatic metastases are usually seen in patients with advanced cancers, although isolated metastases from renal cell carcinoma can occurs years after the original tumor; such patients may benefit from surgical resection. Finally, the appearance of some rare neoplasms of mesenchymal origin is discussed.

Adenoma, Islet Cell↗
PubMed2002

Adenocarcinoma of the pancreas: CT imaging.

CT currently plays a vital role in pancreatic cancer staging. Continued advancements in computers, scanner technology, and 3D software have improved CT detection of smaller masses and staging. In particular, the introduction of MDCT and real-time 3D volume-rendering software have greatly improved the visualization of the pancreas and adjacent vasculature. This progress will continue as manufacturers introduce the next generation of scanners, which can acquire up to 32 slices per second with ever faster scan times. The impact of these new scanners on diagnostic accuracy will need to be carefully evaluated.

Adenocarcinoma↗
PubMed2002

Classic bladder exstrophy in a nonhuman primate: a comparative analysis.

OBJECTIVES: To describe the pelvic floor musculature and bony pelvic anatomy in a case of naturally occurring classic bladder exstrophy in a rhesus monkey, the first reported case in the animal population since 1832, and compare the results to exstrophy seen in human newborns. METHODS: A 7-day-old male rhesus monkey with classic bladder exstrophy was examined by a pediatric urologist and primate veterinarian before being killed. A multidetector row computed tomography study with three-dimensional reconstruction was obtained, and a comparison computed tomography study of a 17-day-old male human with exstrophy was also reconstructed three dimensionally. The bony pelvis and pelvic floor muscular anatomy of both subjects were then examined and compared. RESULTS: On gross examination, a similar appearance of classic bladder exstrophy in the rhesus monkey and human newborn were noted, including an open exposed bladder, associated penile epispadias, and widely separated pubic bones. The evaluation of the three-dimensional models showed a similar orientation of the bony pelvis in both the rhesus and the human newborn. The iliac wings were significantly rotated outward, and the sacroiliac joint was 10 degrees wider than that seen in normal children. The exstrophy pelvic floor in both the rhesus and the newborn was markedly flattened, with approximately 33% of the muscle located anterior to the rectum to support the pelvic structures (normal children have 50% of their levator ani anterior to the rectum). CONCLUSIONS: By using advancements in imaging modalities, this study illustrated that naturally occurring classic bladder exstrophy in the human newborn and rhesus monkey were identical in both external appearance and internal anatomy.

Animals↗
PubMed2002

Influence of a new prophylactic antibiotic therapy on the incidence of liver abscesses after chemoembolization treatment of liver tumors.

Intrahepatic abscess is a complication of transcatheter arterial chemoembolization (TACE) treatment in patients who have a history of biliary reconstructive surgery. This study followed eight patients who underwent chemoembolization after biliary surgery. These patients were divided into two groups. Patients in group one (n = 4) were administered intravenous cephalexin for prophylaxis. Patients in group two (n = 4) were administered bowel preparation and tazobactam/piperacillin. All patients in group one developed hepatic abscesses, which were treated with percutaneous catheter drainage and antibiotics. None of the patients in group two developed abscesses. Aggressive antibiotic prophylaxis with bowel preparation may provide protection against intrahepatic abscesses after chemoembolization in patients who have a history of biliary reconstructive surgery.

Adenocarcinoma↗