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Biomedical subjects

M Atri

Publications and source records attributed to M Atri.

At least 19 recordsLinked to original sources
PubMed2007

CT assessment of anastomotic bowel leak.

AIM: To evaluate the predictors of clinically important gastrointestinal anastomotic leaks using multidetector computed tomography (CT). SUBJECTS AND METHODS: Ninety-nine patients, 73 with clinical suspicion of anastomotic bowel leak and 26 non-bowel surgery controls underwent CT to investigate postoperative sepsis. Fifty patients had undergone large bowel and 23 small bowel anastomoses. The time interval from surgery was 3-30 days (mean 10+/-5.9 SD) for the anastomotic group and 3-40 days (mean 14+/-11 SD) for the control group (p=0.3). Two radiologists blinded to the final results reviewed the CT examinations in consensus and recorded the presence of peri-anastomotic air, fluid or combination of the two; distant loculated fluid or combination of fluid and air; free air or fluid; and intestinal contrast leak. Final diagnosis of clinically important anastomotic leak (CIAL) was confirmed at surgery or by chart review of predetermined clinical and laboratory criteria. RESULTS: The prevalence of CIAL in the group undergoing CT was 31.5% (23/73). The CT examinations with documented leak were performed 5-28 (mean; 11.4+/-6 SD) days after surgery. Nine patients required repeat operation, 10 percutaneous abscess drainage, two percutaneous drainage followed by surgery, and two prolonged antibiotic treatment and total parenteral nutrition (TPN). Of the CT features examined, only peri-anastomotic loculated fluid containing air was more frequently seen in the CIAL group as opposed to the no leak group (p=0.04). There was no intestinal contrast leakage in this cohort. Free air was present up to 9 days and loculated air up to 26 days without CIAL. CONCLUSION: Most postoperative CT features overlap between patients with and without CIAL. The only feature seen statistically more frequently with CIAL is peri-anastomotic loculated fluid containing air.

Abscess↗
PubMed2002

Linking Histopathology and Family History in Breast Cancer.

In order to assess the prognostic value of family history (FH) of malignancies in patients afflicted with breast cancer (BC), we examined FH and histopathologic characteristics of 542 Iranian primary BC patients. Cases with distant metastasis at the time of diagnosis were excluded. Mean age of the studied population was 49 and the most common presenting stage was stage IIA followed by stage IIB. Data on a total of 6089 relatives (1st to 4th generations with the assumption of probands as the 3rd generation) were gathered. FH of BC and other malignancies (OM) was positive in 29 and 54% of cases, respectively. The most common OM's were gastric (67), lung (52) and uterus (47) cancers. We found that a FH of BC does not have any significant correlation with proven prognostic factors but a history of BC among relatives at or before the age of 36 is associated with more aggressive tumours. On the other hand, although FH of OM was associated with an older age of the probands (which is generally associated with a favourable prognosis), tumours of the cases with FH of OM had higher grades, lymphatic invasion being detected more frequently. Also we noted that the younger the age of the relatives diagnosed with cancer, the higher the stage of the probands themselves. All together our study indicates the possibility of a relation between FH of BC and OM, and histopathologic characteristics of the probands' tumours which would put forward FH as a prognostic factor rather than a simple risk factor in BC.

Journal Article↗
PubMed2001

Expectant treatment of ectopic pregnancies: clinical and sonographic predictors.

OBJECTIVE: We identified the potential clinical and sonographic predictors of the spontaneous resolution of ectopic pregnancies. SUBJECTS AND METHODS: We performed a prospective study of 78 consecutive patients with a transvaginal sonographic diagnosis of ectopic pregnancy who had either two consecutive quantitative measurements of their beta subunit of human chorionic gonadotropin (beta-hCG) more than 24 hrs apart or an embryo with a heart beat. We evaluated the patient's age, time from the last menstrual period, beta-hCG level, size of ectopic pregnancy, presence of a gestational sac or embryonic elements, vascularity on color Doppler sonography, peak systolic velocity, and resistive index of ectopic pregnancy at the time of presentation as potential independent predictors of the final outcome. Logistic regression was performed to identify the independent predictors. RESULTS: Forty-six patients had declining beta-hCG levels, and 32 ectopic pregnancies showed an embryo with a heart beat or had steady or rising beta-hCG levels. Univariate analysis indicated that a longer time from the last menstrual period (older ectopic pregnancies), lower beta-hCG levels, and the absence of gestational sac are statistically more significantly seen in ectopic pregnancies with declining beta-hCG levels (p < 0.05). Resistive index of ectopic pregnancy reached borderline significance (p = 0.05). In a multiple logistic model, the same variables were independent predictors of outcome (p < 0.05). Resistive index was also a predictor (p = 0.09). CONCLUSION: Longer times from the last menstrual period, lower beta-hCG levels, absence of gestational sacs, and higher resistive indexes of ectopic pregnancy at the time of presentation appear to be independent predictors of the spontaneous resolution of ectopic pregnancy.

Adult↗
PubMed2001

Perineural cysts presenting as complex adnexal cystic masses on transvaginal sonography.

OBJECTIVE: This study describes the sonographic features of sacral perineural cysts that initially presented as adnexal complex cystic masses on transvaginal sonography. CONCLUSION: Perineural cysts may have a complex cystic appearance, including septation and internal debris, on transvaginal sonography. The extraovarian, extraperitoneal, and posterior location on real-time sonography are suggestive features.

Adnexal Diseases↗
PubMed2000

Acute female pelvic pain: ultrasound evaluation.

Ultrasound has become a valuable primary imaging tool in the assessment of acute pelvic pain in women, both for diagnosis and for assessment of complications. Although ultrasound is an established imaging tool for gynecologic diseases, it is also a useful modality for assessing nongynecologic disorders that cause acute pelvic pain, such as diverticulitis and urinary tract calculi. These are important differential diagnoses in women with acute pelvic pain, and sonologists are not always expert in their diagnosis. This article reviews the gamut of conditions that can cause acute pelvic pain in women. The usual gynecologic causes are included, such as ectopic pregnancy, but also considered are conditions such as diverticulitis, appendicitis, and incarcerated hernia, which are important differential considerations.

Diagnosis, Differential↗
PubMed2000

Adenomyosis: US features with histologic correlation in an in-vitro study.

PURPOSE: To evaluate the accuracy of ultrasonographic (US) features of adenomyosis by correlating them with histologic findings and to assess inter- and intraobserver agreement. MATERIALS AND METHODS: US was performed and videotaped in 102 consecutive hysterectomy specimens in a water bath. Videotapes were reviewed initially by two independent radiologists blinded to the clinical and histologic findings and after 1 month by one of the two; US and histologic findings were correlated. Features evaluated included diffuse abnormal echotexture of myometrium, subendometrial myometrial cysts, subendometrial echogenic nodules, subendometrial echogenic linear striations, nodular endometrial-myometrial junction, poor definition of the endometrial-myometrial junction, asymmetric thickness of the anteroposterior wall of the myometrium, and globular configuration. RESULTS: The prevalence of adenomyosis in this cohort was 29.4% (30 of 102 specimens). The mean sensitivity, specificity, negative predictive value, positive predictive value (PPV), and accuracy for the diagnosis of adenomyosis for the three reviews were 81%, 71%, 90%, 54%, and 74%, respectively. All findings evaluated, except for nodular endometrial-myometrial junction, were significantly more common in uteri with adenomyosis (P <.05). Heterogeneous myometrium reached borderline significance (P =.05). The specificities and PPVs of subendometrial striations, subendometrial echogenic nodules, and asymmetric myometrial thickness were significantly higher than those of other features (P <.05). The interobserver agreement was moderate (kappa = 0.48), and the intraobserver agreement was good (kappa = 0. 67) for the three reviews. CONCLUSION: The presence of subendometrial linear striations, subendometrial echogenic nodules, or asymmetric myometrial thickness improves the specificity and PPV of US in diagnosing adenomyosis.

Adult↗
PubMed1999

Uterine adenomyosis: endovaginal US and MR imaging features with histopathologic correlation.

Uterine adenomyosis is a common gynecologic condition that is characterized by the presence of heterotopic endometrial glands and stroma in the myometrium with adjacent smooth muscle hyperplasia. The histopathologic features of adenomyosis are varied and contribute to its imaging appearance. The accompanying smooth muscle hyperplasia produces the typical gross appearance of adenomyosis and corresponds to areas of decreased echogenicity at endovaginal ultrasonography (US) and areas of decreased signal intensity at magnetic resonance (MR) imaging. Endovaginal US also shows heterogeneity of the myometrial echotexture, which corresponds to small echogenic islands of heterotopic endometrial tissue surrounded by the hypoechoic smooth muscle. On T2-weighted MR images, bright foci are seen in areas of abnormal low signal intensity within the myometrium in approximately 50% of patients. These foci correspond to islands of heterotopic endometrial tissue, cystic dilatation of heterotopic glands, or hemorrhagic foci. With the advent of high-resolution imaging techniques, signs associated with the presence of heterotopic endometrial tissue are being detected with increasing frequency. These signs include myometrial cysts, myometrial nodules, linear striations, pseudowidening of the endometrium, and poor definition of the endomyometrial junction. Pitfalls in diagnosis of uterine adenomyosis include leiomyoma, endometrial carcinoma, myometrial contractions, and muscular hypertrophy.

Adenomyoma↗
PubMed1999

Acute pancreatitis: interobserver agreement and correlation of CT and MR cholangiopancreatography with outcome.

PURPOSE: To assess the correlation between and the interobserver agreement of contrast medium-enhanced computed tomography (CT) and nonenhanced and contrast-enhanced magnetic resonance (MR) imaging findings in patients with acute pancreatitis and to correlate these findings with outcome. MATERIALS AND METHODS: Two blinded reviewers separately assessed contrast-enhanced CT and nonenhanced and contrast-enhanced MR images in 30 patients with acute pancreatitis and established a severity index based on the presence of peripancreatic fluid collections and pancreatic necrosis. The Spearman rank correlation coefficient and weighted kappa statistic were used to assess the correlation between each imaging technique and the interobserver agreement, respectively. Correlation between hospitalization days, morbidity, and severity indexes were assessed by using linear correlation. RESULTS: A strong correlation existed for both reviewers when comparing contrast-enhanced CT with nonenhanced (r = 0.82, 0.79) or contrast-enhanced (r = 0.82, 0.79) MR cholangiopancreatography or when comparing nonenhanced and contrast-enhanced MR cholangiopancreatography (r = 0.99, 1.00). The interobserver agreement in staging was stronger with nonenhanced (kappa = 0.76) and contrast-enhanced (kappa = 0.78) MR cholangiopancreatography than with contrast-enhanced CT (kappa = 0.70). There was no linear correlation between the severity index for contrast-enhanced CT and outcome, while there was a linear correlation between nonenhanced or contrast-enhanced MR cholangiopancreatographic staging and the patient morbidity rate. CONCLUSION: MR cholangiopancreatography could be an alternative to contrast-enhanced CT for the initial staging of acute pancreatitis.

Acute Disease↗
PubMed1998

Helical CT of the pancreas: a comparison of cine display and film-based viewing.

OBJECTIVE: Radiologists must manage a tremendous number of helical CT images daily. Hence, the use of cine display review is increasing. Our aim was to compare cine display of helical CT examinations of the pancreas with conventional film-based viewing. SUBJECTS AND METHODS: Forty-eight consecutive patients undergoing helical CT of the pancreas were prospectively included in the study. Five-millimeter-thick contrast-enhanced helical CT sections of the pancreas were reconstructed in 1-mm increments for cine display review and in 5-mm-thick increments for film-based review. Two radiologists reviewed the two sets of data independently. Review of the cine display images was followed by review of the film-based images 2 months later. For both the cine display and the film-based images, reviewers used a four-point scale to grade vascular anatomy (splenic vein and artery, superior mesenteric vein and artery, portal confluence, dorsal pancreatic artery, and gastroduodenal artery); ductal anatomy (common bile duct in its hilar, suprapancreatic, and intrapancreatic portions and pancreatic duct in its caudal, corporeal, and cephalic portions); sharpness of the pancreatic and lesion contours; and overall image quality. RESULTS: The conspicuity of pancreatic contours was graded better on cine display (p = .0035). All venous and arterial landmarks were graded significantly better on cine display. Likewise, visibility of the common bile ducts and pancreatic ducts was scored significantly better with cine display. In three patients, cine display images revealed the pancreatic duct, and the film-based images did not. Although 21 lesions were shown on both sets of images, the lesions were better seen on cine display (p < .005). CONCLUSION: Vascular and ductal anatomy is better delineated on cine images generated from overlapped sections than on conventional film-based images. Lesions are also more sharply delineated on cine display images.

Contrast Media↗
PubMed1998

Sonographic appearance of benign and malignant conditions of the colon.

OBJECTIVE: The objective of this study was to compare the sonographic appearance of different abnormalities of the colon to evaluate the role of sonography in their differential diagnosis. MATERIALS AND METHODS: We retrospectively reviewed videotaped sonographic examinations of 99 patients with proven diagnoses that included diverticulitis (n = 35), malignancy (n = 20), Crohn's disease (n = 16), pseudomembranous colitis (n = 14), ischemic colitis (n = 9), and ulcerative colitis (n = 5). Data were collected with regard to gut features, including the site of colonic involvement, associated small-bowel involvement, length of diseased segment, stratification, luminal contents, pneumatosis, and diverticula. Perigut features evaluated included abnormal fat, abscess, fistula, and ascites. RESULTS: On sonography, the following features were statistically significant (p < .05). Involvement of the small bowel was more common in patients with Crohn's disease than in the remainder of the study population (44% versus 1%). Left-sided colonic disease (91% versus 38%), diverticula (91% versus 3%), and perigut findings (91% versus 57%), including abnormal fat (83% versus 39%) and abscess (34% versus 8%), were features that indicated diverticulitis. Malignant conditions were more common in patients with a greater wall thickness (mean, 26.2 mm versus 10.2 mm), asymmetric involvement (85% versus 39%), loss of stratification (85% versus 20%), absence of perigut findings (65% versus 22%), and involvement of a short diseased segment (70% versus 16%). Involvement of the entire colon (50% versus 2%), luminal contents (64% versus 28%), and ascites (64% versus 26%) were features suggesting pseudomembranous colitis. CONCLUSION: Although the sonographic appearances of abnormalities of the colon overlap, some sonographic features are helpful in the differential diagnosis of colonic abnormalities.

Adult↗
PubMed1997

Spontaneously resolving acute appendicitis: clinical and sonographic documentation.

PURPOSE: To document findings in a subgroup of patients with acute appendicitis that spontaneously resolved. MATERIALS AND METHODS: From February 1989 through December 1995, nine patients were seen with a diagnosis of acute appendicitis that did not necessitate immediate surgery. Clinical, ultrasound (US), and pathologic findings were retrospectively reviewed. RESULTS: Four of the nine patients underwent elective appendectomy 15-84 days (mean, 52 days) after initial presentation, and five did not undergo surgery. Seven patients experienced spontaneous pain relief before admission to the hospital, and two improved within a few hours of being admitted. No patient had an indication of peritoneal irritation at physical examination. Four patients had a normal white blood cell count, and five had leukocytosis. Maximum appendiceal diameter was 9-12 mm. Five patients had inflamed periappendiceal fat. No patient had abscess or appendicolithiasis shown at US. A normal appendix was identified at follow-up (mean, 40 months; range, 1-60 months) in four of five patients who did not undergo elective appendectomy. Two patients experienced recurrent bouts of pain, and one of these patients underwent appendectomy before the planned elective procedure. CONCLUSION: On the basis of clinical, US, and pathologic findings, mild acute appendicitis spontaneously resolved in a subgroup of patients.

Acute Disease↗
PubMed1996

MR cholangiopancreatography: potential clinical applications.

Magnetic resonance cholangiopancreatography (MRCP), when performed with heavily T2-weighted fast spin-echo sequences and a phased-array torso coil, provides high-resolution images of the biliary tree and pancreatic duct in multiple planes of section. Use of maximum-intensity projection (MIP) reformations is helpful when overall three-dimensional views are needed (eg, in cases of cholangiocarcinoma), but the source image must be carefully compared with the MIP reformation to avoid missing potential filling defects and other important details obscured by the reformation. Preliminary work indicates that the accuracy of MRCP is comparable to that of endoscopic retrograde cholangiopancreatography in diagnosing the cause of bile duct obstruction. At MRCP, bile duct stones appear as hypointense foci within high-signal-intensity ducts, and stones as small as 2 mm in diameter can be seen. In cases of cholangiocarcinoma, the main advantage of MRCP is that it can noninvasively provide a three-dimensional overview of the biliary tree, which can help in planning treatment. However, the limited spatial resolution of MRCP curtails its role in the characterization of bile duct stenosis, visualization of small intraampullary tumors, and diagnosis of chronic pancreatitis. MRCP is an important adjunct to traditional pulse sequences in the work-up of pancreatic and biliary diseases.

Biliary Tract↗
PubMed1996

Role of endovaginal sonography in the diagnosis and management of ectopic pregnancy.

Although diagnostic laparoscopy is still considered the standard reference in the diagnosis of ectopic pregnancy (EP), use of high-resolution endovaginal sonography, in conjunction with qualitative serum assays of the beta subunit of human chorionic gonadotropin (beta-hCG), allows detection of earlier and smaller EPs. The most common endovaginal sonographic finding of EP (89%-100% of cases) is an extraovarian, round or elongated, solid tubal mass. A tubal ring (an extrauterine saclike structure) is the second most common finding (40%-68% of cases). Pelvic fluid may be present, but it is a nonspecific finding. An EP may have a pseudosac, which can be distinguished sonographically from the true gestational sac of an intrauterine pregnancy. Color Doppler techniques can complement endovaginal sonographic findings, but they should be performed only after a thorough real-time evaluation of the adnexal region. Current therapeutic options for EP include expectant management (ie, close follow-up), medical treatment (usually injections of methotrexate), and surgery. Accurate diagnosis with endovaginal sonography is the prerequisite to nonsurgical management, since surgery is the logical treatment if laparoscopy is used for diagnosis.

Chorionic Gonadotropin, beta Subunit, Human↗
PubMed1996

Diffuse adenomyosis: comparison of endovaginal US and MR imaging with histopathologic correlation.

PURPOSE: To compare the accuracy of endovaginal ultrasound (US) and magnetic resonance (MR) imaging in the diagnosis of adenomyosis. MATERIALS AND METHODS: The authors prospectively studied 119 consecutive patients undergoing hysterectomy. The endovaginal US scans and MR images were interpreted independently in a double-blind fashion. Imaging findings were compared with those at histopathologic examination. RESULTS: At histopathologic examination, adenomyosis was found in 28 of the 119 patients (24%). Sensitivity and specificity was 89% for endovaginal US and 89% for MR imaging. The positive predictive value was 71% for US and 65% for MR imaging. The negative predictive value was 96% for US and 95% for MR imaging. There was no statistically significant difference between the sensitivities (P = .65) and specificities (P = .75) of endovaginal US and MR imaging. The mean junctional zone (JZ) thickness on MR images in patients with and without proved adenomyosis was 15.0 mm +/- 4.9 and 7.7 mm +/- 3.3, respectively (P < .0001). When receiver operating characteristic curves were applied retrospectively, the optimal JZ value for the diagnosis of adenomyosis with MR imaging was > or = 12 mm. CONCLUSION: Endovaginal US was as accurate as MR imaging in the diagnosis of uterine adenomyosis. Use of a JZ thickness of > or= 12 mm should further optimize the diagnostic accuracy of MR imaging.

Double-Blind Method↗
PubMed1996

Effect of rate of contrast medium injection on hepatic enhancement at CT.

PURPOSE: To determine the effect of the rate of contrast medium injection on liver enhancement at computed tomography (CT). MATERIALS AND METHODS: Forty-five patients who underwent a follow-up CT examination of the liver were included in five different groups according to the compared rates of contrast material delivery: group A, 2 versus 3 mL/sec; group B, 2 versus 4.5 mL/sec; group C, 3 versus 4.5 mL/sec; group D, 3 versus 6 mL/sec; and group E, 4.5 versus 6 mL/sec. RESULTS: Time to peak enhancement was shorter for the faster rates of injection. In each group, maximum enhancement was nearly identical for the paired examinations (group A, 57 vs 58 HU; group B, 48 vs 47 HU; group C, 55 vs 58 HU; group D, 55 vs 54 HU; group E, 62 vs 61 HU, respectively). Mean enhancement in each group was similar when calculated at 3-second intervals. CONCLUSION: Higher rates of injection shorten the time to peak liver enhancement but have no effect on maximum liver enhancement.

Contrast Media↗
PubMed1996

Pancreas divisum: evaluation with MR cholangiopancreatography.

PURPOSE: To determine the usefulness of magnetic resonance (MR) cholangiopancreatography in the diagnosis of pancreas divisum. MATERIALS AND METHODS: In 310 patients, MR imaging was performed with heavily T2-weighted, two-dimensional, fast-spin-echo sequences. A body coil was used for 139 patients, and a torso multicoil and high-resolution imaging parameters were used for 171 patients. In 108 patients, correlation with endoscopic retrograde cholangiopancreatography (ERCP) was available. RESULTS: Two hundred sixty-eight examinations (86%) were diagnostic. Pancreas divisum was observed with MR imaging in 25 of 268 cases (9%)(interobserver agreement, 98% [kappa = .88]). Among the 171 examinations performed with a torso multicoil, 10% were nondiagnostic and the rate of detection of pancreas divisum was 12%. Pancreas divisum was depicted in six of the 108 patients who underwent ERCP, and there were no false-negative or false-positive MR imaging results in these patients. CONCLUSION: MR cholangiopancreatography is an accurate tool in the diagnosis of pancreas divisum and could replace ERCP.

Case-Control Studies↗