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Elliot K Fishman

Publications and source records attributed to Elliot K Fishman.

At least 73 records · Page 4Linked to original sources
PubMed2004

MDCT of the duodenum: technique and clinical applications.

Computed Tomography (CT) is useful for evaluation of both benign and malignant pathology involving the duodenum. CT can detect and stage duodenal malignancies as well as detect inflammatory conditions such as duodenitis. Careful CT technique is necessary to optimize detection of abnormalities. This includes the use of oral contrast, preferably water, as well as i.v. contrast. 3D imaging can improve disease detection and help with surgical planning. This article reviews the current role of CT in duodenal imaging, describes appropriate CT protocols and illustrates a wide variety of duodenal pathology.

Abdominal Injuries↗
PubMed2004

CT angiography: principles, techniques and study optimization using 16-slice multidetector CT with isotropic datasets and 3D volume visualization.

Significant advances in computed tomography (CT) scanner technology as well as 3D imaging software and hardware have resulted in amazing improvements in CT imaging of blood vessels. CT angiography has now been incorporated into daily practice and in may cases has replaced conventional angiography. CT angiography has also resulted in new applications for CT such as coronary angiography. This article discusses the current state of the art of 3D CT angiography and reviews the literature. Extensive case examples are included.

Angiography↗
PubMed2003

Computer-assisted detection of pulmonary nodules: preliminary observations using a prototype system with multidetector-row CT data sets.

The continued revolution in multidetector-row CT (MDCT) scanning increases the quality of lung imaging but at the cost of a greater burden of data for review and interpretation. This article discusses our preliminary experience with prototype software for lung nodule detection and characterization using MDCT data sets. We discuss the potential role of computer-assisted detection (CAD) as applied to the automatic detection of lung nodules. We also review the process of CAD, outline its potential results, and explore how it may fit into existing radiology practice. Finally, we discuss MDCT data-acquisition parameters and how they may affect the performance of CAD.

Algorithms↗
PubMed2003

Two cases of pseudoaneurysm of the renal artery following laparoscopic partial nephrectomy for renal cell carcinoma: CT angiographic evaluation.

Partial nephrectomy via a laparoscopic approach can be technically challenging, and associated vascular complications such as pseudoaneurysm may occur. CT with CT angiography is ideal for the noninvasive imaging of this process. This article reports two cases of pseudoaneurysm of the renal artery detected on CT as a complication of laparoscopic partial nephrectomy and demonstrates the usefulness of 3-D CT angiography in the evaluation of vascular pathology.

Aneurysm, False↗
PubMed2003

Imaging in cervical cancer.

Cervical cancer traditionally has been staged clinically. Advances in imaging could improve the staging of cervical cancer by facilitating the detection of lymph node metastases and micrometastases in distant organs. Such progress could lead to improvements in treatment selection and therefore increase overall survival rates. At the Second International Conference on Clinical Cancer (Houston, TX, April 11-14, 2002), a panel composed of gynecologic oncologists, radiation oncologists, and diagnostic radiologists reviewed relevant technologies. Advances in lymphangiography, ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and lymphatic mapping were reviewed, along with the impact of these advances on the diagnosis, treatment, and survival of patients with cervical cancer. Few cancer centers still use lymphangiography, but the sensitivity of this method ranges from 28% to 83%, with specificity ranging from 47% to 100%. The roles of transabdominal and transvaginal ultrasonography in evaluating cervical cancer are expected to expand when new contrast agents increase the sensitivity of these techniques to parametrial invasion and lymph node metastases; meanwhile, ultrasonography's most significant contributions may involve the identification of uterine and cervical leiomyomas and the evaluation of urinary tract obstruction. Advances in CT have made it a rival technique to MRI, but limitations prevent CT from providing definitive information on certain parameters. MRI, which is valuable because of its superior soft tissue contrast resolution, multiplanar capabilities, and cost-effectiveness, is used to determine the size of the cervix and to detect certain types of invasion, characteristics of lymph nodes, and the presence of disease in the ureter, lung, and liver. PET with 2-[fluorine-18]fluoro-2-deoxy-D-glucose has been found to detect abnormal lymph node regions better than CT does but PET can also be used in conjunction with CT to measure tumor dimensions. PET also has become a method for identifying tumors that are unresponsive to chemoradiation. When used together with immunohistochemical and molecular techniques as well as conventional stains, sentinel lymph node mapping, an important development in the surgical management of solid tumors, is expected to improve gynecologic cancer management. Advances in imaging methods and in contrast agents, along with advances in the combined use of the two, are expected to make imaging technologies more valuable in cervical cancer assessment.

Diagnostic Imaging↗
PubMed2003

Evaluation of cervical cancer by computed tomography: current status.

In the evaluation of cervical cancer, computed tomography (CT) is used primarily to stage advanced tumors and evaluate for recurrence. Because of reports that CT imaging lacks sensitivity and specificity in the detection of primary tumors and metastatic lesions, its use in these applications has been limited, but recent improvements in CT technology may have increased its accuracy and may broaden its use. At the Second International Conference on Cervical Cancer, held April 11-14, 2002, the limitations of single-detector row CT scanners were compared with the capabilities of new CT technology. Improvements include the introduction of multidetector-row CT scanners, which can produce thinner tissue slices. This technology is needed for detection of parametrial extension, pelvic side-wall disease, extension into the pelvic viscera, lymphadenopathy, local tumor recurrence, and distant metastatic disease. New technology reduces the thickness of each slice to 1-3 mm, improving spatial resolution and making multiplanar imaging possible, which previously was feasible only with magnetic resonance imaging. Studies are needed to assess the use of the improved CT technology in evaluating cervical cancer.

Female↗
PubMed2003

Cervical spine trauma: evaluation by multidetector CT and three-dimensional volume rendering.

Multidetector-row computed tomography (CT) offers important advantages over conventional imaging modalities in the evaluation of the post-trauma cervical spine. It allows for faster scanning times, critical for triaging post-trauma patients as well as for eliminating motion artifacts, and allows for thinner collimation and the ability to achieve an isotropic data set which can be reformatted in any plane without loss of spatial resolution. In addition, three-dimensional volume-rendered reconstructions of images obtained using multidetector scanners can provide additional information in defining extent of injury, allowing neurosurgeons to see the fractures in any plane, simulating intraoperative views. 3D multidetector-row CT represents an advance in CT technology and can help ensure rapid, accurate evaluation of cervical spine injuries.

Journal Article↗
PubMed2003

Electron beam CT versus helical CT scans for assessing coronary calcification: current utility and future directions.

BACKGROUND: Traditional risk factors for coronary artery disease predict the development of atherosclerosis; however, their ability to identify individual patients at risk of events is limited. METHODS: Coronary artery calcium (CAC) is a specific marker of atherosclerosis. It can be visualized and measured noninvasively by various imaging techniques, which may add incremental prognostic value to conventional coronary factors. RESULTS: The field of atherosclerosis imaging has expanded rapidly in the last decade, and technologies such as electron-beam computed tomography (EBCT) have contributed to our understanding of the prevalence of occult coronary artery disease and its consequences. Other modalities have been previously limited by the decreased temporal and spatial resolution and slower acquisition. Recent advances in helical CT (HCT) imaging with the development of multiple row detectors CT (MDCT) and improvements in the temporal resolution have renewed clinicians' interests in using this modality to evaluate CAC, although the scores obtained with MDCT may differ somewhat from those obtained with the EBCT technology. This study critically analyzes the literature comparing the utility of EBCT and HCT in detecting coronary calcium to identify individuals at increased risk for future coronary events. CONCLUSIONS: MDCT is a promising tool for coronary calcium scoring; however, more studies are needed comparing EBCT and MDCT, especially at lower CAC levels.

Calcinosis↗
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

Clinically occult recurrent ovarian cancer: patient selection for secondary cytoreductive surgery using combined PET/CT.

OBJECTIVE: The aim of this study was to evaluate the utility of combined positron emission tomography/computed tomography (PET/CT) for identifying ovarian cancer tumor masses > or =1 cm in patients with clinically occult recurrent disease by conventional CT imaging. METHODS: Twenty-two patients with epithelial ovarian cancer, rising serum CA125 levels, and negative or equivocal conventional CT imaging > or =6 months after primary therapy underwent combined PET/CT imaging followed by surgical reassessment. Fisher's exact test was used to measure the ability of PET/CT to predict macroscopic disease > or =1 cm. RESULTS: The median patient age was 55 years, and 91% of patients had FIGO Stage IIIC/IV disease. The median increase in serum CA125 was 24 U/ml (range 10 to 330 U/ml). Conventional CT was reported as negative (n = 15) or equivocal (n = 7) in all cases. Eighteen patients were ultimately found to harbor recurrent ovarian cancer measuring > or =1 cm at the time of surgery, with a median maximal tumor diameter of 2.3 cm (range 1.5 to 3.2 cm). The overall patient-based accuracy of PET/CT in detecting recurrent disease > or =1 cm was 81.8%, with a sensitivity of 83.3% and positive predictive value of 93.8% (P = 0.046). Of patients with recurrent ovarian cancer > or =1 cm, complete cytoreduction to no gross residual tumor was accomplished in 72.2%. CONCLUSION: PET/CT imaging demonstrates high sensitivity and positive predictive value in identifying potentially resectable, macroscopic recurrent ovarian cancer among patients with biochemical evidence of recurrence and negative or equivocal conventional CT findings. In appropriately selected patients, early identification of macroscopic recurrent disease may facilitate complete surgical cytoreduction.

CA-125 Antigen↗
PubMed2003

Multidetector row computed tomography of the aorta and peripheral arteries.

MDCT represents a significant advance on SDCT and the advantages it brings are particularly clear in CTA applications. It allows cost effective assessment of longer segments of vascular territories to be imaged with higher spatial, contrast, and temporal resolution. It has replaced SDCT as the new CT standard and its technical abilities are rapidly approaching the temporal resolution of EBCT. With 3-D post processing tools its main benefit is in imaging studies customized to the patient's pathology, with greater measurement accuracy and reliable longitudinal assessment. MDCTA is increasingly applied not to individual vascular territories but to a complete assessment dictated by the pathology, such as the entire aorta and branch vessels in aneurysm evaluation and the aorta and the coronary arteries in dissection cases or the vascular and non-vascular chest in acute chest pain. Greater accuracy of vessel assessment will lead to a refinement of interventional and surgical techniques for an individual patient and facilitates conservative management of conditions that can be reliably monitored non-invasively and the development of intervention criteria. MDCTA will continue to increase its major role in peripheral vascular evaluation in the future though its reliability in assessing small vessels below the knee and in the foot remains to be conclusively proven to obviate the need for diagnostic catheter angiography.

Aortic Dissection↗
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

Current concepts in multi-detector row CT evaluation of the coronary arteries: principles, techniques, and anatomy.

Cardiac imaging is becoming a practical application of mechanical computed tomography (CT) with the availability of four, eight, and 16 detector row scanners. The role of imaging is progressing from simple determination of the presence of arterial calcifications on nonenhanced scans to demonstration of vascular stenoses on coronary CT angiograms. Optimization of the imaging technique and knowledge of coronary artery anatomy are both important for the development of CT of the heart. Technical factors such as a slow heart rate, a short scanning time, subcentimeter spatial resolution, high temporal resolution, and reconstruction of multiple image data sets at various intervals in the cardiac cycle result in optimal visualization of the coronary arteries. Axial, thin-slab maximum intensity projection, and volume-rendered images are used to display the normal anatomy and anomalies of the coronary arteries. The challenges of CT angiography of the coronary arteries have been partially met and will likely be overcome with continued evolution of the technology.

Artifacts↗
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↗