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Biomedical subjects

G A DeAngelis

Publications and source records attributed to G A DeAngelis.

At least 19 recordsLinked to original sources
PubMed2000

MRI-guided needle localization: technique.

Magnetic resonance imaging (MRI) is being used increasingly in breast cancer diagnosis. Such indications include the search for a breast primary in women with metastatic carcinoma in the axillary lymph nodes, improving surgical planning in women with a biopsy-proven breast cancer, and in screening very high-risk women. If a suspicious lesion is found by MRI, localization with either directed additional mammographic or sonographic views or with MRI-guided needle localization or biopsy is necessary. We describe the use of a biopsy device with embedded internal fiducial markers. The coordinates for needle placement are calculated by distances between the fiducial markers and the lesion. The technique is simple to master and is aided by the use of a practice phantom.

Aged↗
PubMed2000

Technique and pitfalls of ultrasound-guided core-needle biopsy of the breast.

When using ultrasound guidance to perform core-needle biopsy, the curvature of the breast can be used to advantage. By entering the breast from the periphery, chest wall injury is avoided and needle visualization is improved. Visualization of the needle is expedited by bringing the needle to the lesion by using a gentle sweeping motion while keeping the transducer relatively fixed in position. Standard techniques can be modified for difficult lesions, such as those that are mobile, deep, small, or in a large breast. Careful correlation with the mammogram will insure biopsy of the corresponding sonographic lesion. Although complications are uncommon, hematoma or infection may occur after the procedure. With practice, application of standard and modified techniques can result in efficient and accurate ultrasound-guided percutaneous core-needle biopsy of the breast.

Aged↗
PubMed1998

The fetal-pelvic index has minimal utility in predicting fetal-pelvic disproportion.

OBJECTIVE: Our purpose was to evaluate the fetal-pelvic index in our patient population and to determine whether it would be predictive of route of delivery. STUDY DESIGN: One hundred seventy-six patients with a previous history or clinical findings in the current pregnancy suggestive of fetal-pelvic disproportion participated in this Human Investigation Committee-approved study. All underwent fetal ultrasonographic examinations and modified digital radiography before labor. Fetal head and abdominal circumferences and maternal inlet and midpelvic circumferences were determined, and the fetal-pelvic index was calculated. RESULTS: Ninety-one patients fulfilled all aspects of the study, including rigorous criteria pertaining to labor management. Thirty of these patients underwent cesarean delivery and 61 were delivered vaginally. The fetal-pelvic index value for the vaginal delivery group was -5.4 +/- 5.3, as opposed to -2.4 +/- 5.8 in the cesarean delivery group (P <.02). Notwithstanding this difference, the fetal-pelvic index had a low overall ability to predict fetal-pelvic disproportion (0.65) and had associated sensitivity and specificity of 0.27 and 0.84, respectively. Predictive thresholds other than zero were tested, but optimal predictive ability, at a fetal-pelvic index cutoff of 2, was only 70% (sensitivity 0.20, specificity 0.95). CONCLUSION: In our patient population the fetal-pelvic index was only moderately predictive of fetal-pelvic disproportion. Factors other than those assessed by the fetal-pelvic index are probably important in determining the route of delivery. Further studies are indicated.

Adult↗
PubMed1998

Placement of endovascular embolization microcoils to localize the site of breast lesions removed at stereotactic core biopsy.

In 13 cases, a breast abnormality was inadvertently removed during stereotactic core biopsy, and a 0.5- or 1.0-cm-long endovascular embolization microcoil was placed to mark the biopsy site. In seven patients, the microcoils allowed successful preoperative localization of the lesion site. In six patients, 6-month follow-up mammograms showed no change in microcoil position. Placement of embolization microcoils helped localize the site of breast lesions removed during stereotactic core biopsy.

Biopsy, Needle↗
PubMed1997

Diagnostic efficacy of compressed digitized real-time sonography of uterine fibroids.

RATIONALE AND OBJECTIVES: The authors investigated the diagnostic efficacy of compression of real-time ultrasound (US) examinations. METHODS: Low- and high-compression recordings (9:1 and 15:1, respectively) of examinations were generated by using Joint Photographic Experts Group algorithms. Seven radiologists used a five-level response scale to answer questions about the presence, number, and location of focal fibroid tumors in 67 randomly sorted uterine examinations. The images were viewed after no, low, and high compression. Results were evaluated by using multipatient, multireader receiver operating characteristic jack-knife analysis. RESULTS: Given the reduction in the US digital video rates from 74 Mbit/sec for uncompressed images to 8 Mbit/sec for low compression and 4.7 Mbit/sec for high compression, there were no statistically significant differences in accuracy between the compression schemes. Confidence intervals suggested that the sample size was adequate. CONCLUSION: Compressed images with compression ratios of 9:1 and 15:1 were diagnostically equivalent to uncompressed images of uterine fibroid tumors.

Female↗
PubMed1997

Attitudes of radiology residents toward personal computing: results of survey.

RATIONALE AND OBJECTIVES: The authors' purpose was to evaluate radiology residents' assessment of their own computer skills for potential development of computer training in a residency curriculum. METHODS: The authors conducted a survey to evaluate the attitudes of radiology residents concerning personal computing. Surveys were completed by 136 radiology residents from six academic institutions. RESULTS: Sixty percent of residents surveyed considered themselves to be computer literate and 93% would like further computer training. Fifty-six percent had a computer at home and 9% had a laptop. Almost all residents had access to a computer at work. Word processing and medical literature searches were the most common computer tasks performed by residents. Image processing was the least common task performed. Although all hospitals surveyed were connected to the Internet, only 26% of residents used the Internet and 14% used Internet teaching files. Most residents expressed a preference for self-paced, on-line evening training sessions. CONCLUSION: Most radiology residents believed they possessed adequate computer skills. This proportion has markedly increased over that found in previous surveys. Radiology residents desire and could likely benefit from computer training included as part of the residency curriculum.

Attitude of Health Personnel↗
PubMed1997

Evaluation of a turkey-breast phantom for teaching freehand, US-guided core-needle breast biopsy.

RATIONALE AND OBJECTIVES: Use of a turkey-breast phantom for developing freehand ultrasound (US)-guided core-needle biopsy skills was evaluated. MATERIALS AND METHODS: Thirteen diagnostic radiology trainees with varied experience in freehand US-guided breast core-needle biopsy were given instruction and allowed to practice the technique in a turkey-breast phantom. Three attempts were made before and after instruction and practice, and a questionnaire regarding experience, confidence, and anxiety was administered after these attempts. Technique, accuracy, and completion time were evaluated. RESULTS: Confidence related to procedure performance increased (P < .01), but the change in anxiety was not statistically significant. Accuracy improved, with the target being obtained in 87% of passes performed after instruction and practice versus 56% initially. Difficulty with visualizing the core needle sonographically during phantom biopsy decreased from 49% to 5% of attempts. Needle positioning perpendicular to the chest wall was observed initially in 38% of passes but was not observed after instruction and practice. There was no statistically significant change in time to complete biopsy. CONCLUSION: For teaching US-guided breast core-needle biopsy, use of a turkey-breast phantom helps improve technique, accuracy, and confidence of diagnostic radiology trainees.

Animals↗
PubMed1997

Sonographic features of mammary oil cysts.

Mammographic lesions that are pathognomonic for oil cysts require no further evaluation. Oil cysts, however, may first be discovered by ultrasonography. Between 1988 and 1995, we performed sonography of 26 oil cysts in 15 patients. Sonography was used to evaluate a palpable finding when an oil cyst was not initially perceived on the mammogram (47%) or as an initial evaluation of a palpable lump (33%); in addition, oil cysts were identified incidentally in 20% of cases. Retrospective review showed that the sonographic appearance of oil cysts is highly variable; only 8% mimic simple apocrine cysts. Twelve percent mimic an intracystic mass. Most have smooth walls (88%), are hypoechoic (65%), and have neither enhancement or shadowing (50%). The sonographic appearance of oil cysts can be suggestive of a pathologic lesion such as an intracystic carcinoma. Unnecessary biopsy can be avoided using directed mammography.

Breast Diseases↗
PubMed1997

The role of stereotactic biopsy in abnormal mammograms.

Core needle biopsy using either stereotactic or ultrasonographic guidance is a reasonable and accurate alternative to surgical biopsy for diagnosis of most nonpalpable breast lesions. An important component of a stereotactic core breast biopsy procedure is the mammographic and pathologic correlation of findings to plan optimal patient management. The level of suspicion of a mammographic lesion, the accuracy of stereotactic targeting, and the confirmation of microcalcifications in specimen radiographs for calcified lesions must be considered carefully and correlated with the histopathologic findings. Meticulous operator technique is essential to provide representative samples of the mammographic abnormality. Properly performed, imaging-guided percutaneous core breast biopsy has reduced the morbidity of surgical breast biopsy and the overall cost of breast cancer diagnosis. Recent work has demonstrated that stereotactic core breast biopsy can reduce the cost of diagnosing mammographically detected breast lesions by more than 50%. At a time when health-care policy and reimbursement decisions are influenced by cost considerations, increased use of stereotactic core breast biopsy is anticipated. Meticulous attention to technique allows maximal realization of the benefits of this procedure.

Biopsy↗
PubMed1996

Comparison of contrast detail curves of full field digital with screen film breast phantom images.

In this investigation, we imaged a standard breast phantom and compared the contrast detail curves from a prototype full breast digital mammography system with the corresponding curves for a conventional, analog screen-film system. The full breast digital system exhibited superior contrast detail detectability. The results from this study will be used to plan future clinical evaluations comparing full breast digital and screen film mammography.

Breast Neoplasms↗
PubMed1996

Prevalence of deep venous thrombosis in the lower extremities of children in the intensive care unit.

PURPOSE: To determine the prevalence of lower extremity deep venous thrombosis (LE-DVT) in children who spent at least 72 h in the pediatric intensive care unit (ICU). MATERIALS AND METHODS: Children up to the age of 17 years who spent at least 72 h in the ICU underwent lower extremity venous ultrasound at the end of their stay. Prevalence range for the sample size was calculated with a confidence interval of 95%. RESULTS: Among 76 children who spent 3-141 days in the ICU, the prevalence of acute (and silent) DVT was 4% (confidence interval 0-9%). All three affected children had femoral venous catheters in that leg during their ICU stay (17 unaffected children also had catheters). CONCLUSION: Children in an ICU setting are at significantly lower risk for thrombosis than adults in the same setting.

Acute Disease↗
PubMed1996

Fetal radiation exposure is minimal after pelvimetry by modified digital radiography.

OBJECTIVE: Our purpose was to determine the maximal fetal exposure to radiation by use of thermoluminescent dosimeters when pelvic measurements were performed by standard or modified digital radiography. STUDY DESIGN: Digital radiography of the pelvis was performed according to a standard technique. Lithium fluoride thermoluminescent dosimeters were positioned on the patient's skin to quantitate the maximal amount of radiation exposure to the fetus. The standard technique often included a portion of fetal vertex. The axial view technique was modified to use an angle of inclination of 17 to 29 degrees relative to the vertical axis. RESULTS: Digital radiography was well tolerated and interpretable images were consistently obtained. The maximal dose to the fetal vertex by use of the standard digital axial slice was 465 mrad. By modifying the standard digital technique and using an angle of inclination of 17 to 29 degrees it was possible to obtain an axial section without including any portion of the fetal vertex. This reduced the maximal total dose to the fetal vertex to 55 mrad, which is less than the background radiation exposure to the fetus over a 9-month period from natural sources. CONCLUSION: Data reported indicate that total fetal radiation exposure is minimal after pelvimetry by digital radiography. Incorporating the modification of the angle for the axial slice, as reported here, resulted in a further significant decrease in fetal radiation exposure.

Female↗
PubMed1996

Focal liver disease: comparison of breath-hold T1-weighted MP-GRE MR imaging and contrast-enhanced CT--lesion detection, localization, and characterization.

PURPOSE: To compare breath-hold T1-weighted magnetization-prepared gradient-echo (MP-GRE) magnetic resonance (MR) imaging with contrast material-enhanced computed tomography (CT) in the assessment of focal liver disease. MATERIALS AND METHODS: The MR and CT images obtained in 64 patients with focal liver disease were reviewed by six independent reviewers in a randomized, blinded fashion. Sets of axial T1-weighted MP-GRE images, three-plane (a compilation of axial, sagittal, and coronal) T1-weighted MP-GRE images, and contrast-enhanced CT scans were analyzed. T2-weighted spin-echo (SE) MR images were also compared with CT scans. RESULTS: Lesions were detected, localized, and characterized more accurately and generally with greater confidence with three-plane T1-weighted MP-GRE imaging than with CT (P < .01). Axial T1-weighted MP-GRE imaging was also superior (P < .05) to CT (although slightly less superior than three-plane imaging) except in the characterization of specific lesions, where both techniques were equal. T2-weighted SE MR imaging and CT were about equal. CONCLUSION: Lesion detection, localization, and characterization are performed more accurately and confidently with breath-hold T1-weighted MP-GRE imaging than with contrast-enhanced CT, particularly when breath-hold images are obtained in three planes.

Contrast Media↗
PubMed1994

Laparoscopic ultrasound-guided drainage of lymphoceles following renal transplantation.

The development of a lymphocele is an uncommon but well-documented complication of renal transplantation. In most patients, lymphoceles remain asymptomatic, and no intervention is required. In some cases, however, lymphoceles become symptomatic and cause systemic and local manifestations. Ultrasonic scanning can easily diagnose and locate the size and position of perirenal fluid collections. Many of these patients can be managed conservatively by aspiration and drainage of the lymphocele under radiologic guidance. However, if the lymphocele remains symptomatic or reaccumulates after aspiration and drainage, surgical intervention may be required. We describe two different ultrasound-guided laparoscopic techniques for drainage of a perirenal lymphocele into the peritoneal cavity. Successful drainage was accomplished in 5 patients, with 1 patient suffering an injury to the ureter of the transplant kidney. Recommendations regarding patient selection and operative technique are presented.

Catheterization↗
PubMed1994

MR imaging of breast implants.

Magnetic resonance (MR) images of 57 implants in 32 women were reviewed for possible complications. Spin-echo T2-weighted MR imaging of one or both breasts was performed with dedicated breast coils in axial, coronal, and sagittal planes. At surgery in 19 patients, MR evaluation for rupture correlated in 17 cases (two false-negative ruptures). Implant ruptures were seen at surgery in 15 of the 19 patients. Nine ruptures involved single-lumen implants: Six were ruptured within the fibrous capsule that normally forms around the foreign implant (intracapsular rupture [two were seen only at surgery]), and three were ruptured beyond this fibrous capsule into the soft tissues (extracapsular rupture). Five ruptures involved double-lumen implants, in which only the outer lumen had ruptured, and one involved a single-lumen saline implant that had completely collapsed. Additional complications of capsule formation and infection were suggested in two implants, and infection was suggested in one. The MR imaging appearances of the various types of implants as well as their complications are presented.

Adolescent↗
PubMed1994

MR imaging of the liver: breath-hold T1-weighted MP-GRE compared with conventional T2-weighted SE imaging--lesion detection, localization, and characterization.

PURPOSE: To compare breath-hold T1-weighted magnetization-prepared gradient-echo (MP-GRE) imaging with conventional T2-weighted spin-echo (SE) imaging in evaluation of focal liver disease. MATERIALS AND METHODS: Images of 68 patients evaluated for focal liver disease were reviewed. Five sets of images were analyzed: axial, sagittal, and coronal breath-hold T1-weighted MP-GRE images, axial T2-weighted SE images, and a compilation of axial, sagittal, and coronal (three-plane) T1-weighted MP-GRE images. Lesion signal intensity (SI) and signal difference-to-noise (SD/N) ratios were calculated. RESULTS: Lesions were detected, localized, and characterize more accurately (P < .05-.001) and with greater confidence on three-plane T1-weighted MP-GRE images than on almost all single-plane images. Mean SI ratios of nonsolid and solid lesions on MP-GRE and SE images were significantly different at all lesion sizes; mean SD/N ratio was significantly different only for large lesions. CONCLUSION: Lesion detection, localization, and characterization can be accurately and confidently performed with three-plane T1-weighted MP-GRE breath-hold imaging, potentially obviating conventional T2-weighted SE imaging.

Artifacts↗
PubMed1992

Ultrasonic detection of osteomyelitis. Pathologic correlation in an animal model.

The authors correlated sonographic findings with histologic findings in a rabbit model of osteomyelitis. Staphylococcus aureus osteomyelitis was induced in the femora of 11 New Zealand white rabbits. The opposite leg was used as a control. Sonographic findings showed fluid adjacent to the bone in 11 cases. The fluid was believed to be an inflammatory exudate, and its presence suggested osteomyelitis. Pathologic analysis showed extraperiosteal purulent fluid adjacent to the cortex as well as histopathologic changes of osteomyelitis in the 11 rabbits. There was one false-positive sonographic diagnosis of osteomyelitis in a rabbit that had a soft tissue abscess adjacent to the cortex.

Animals↗