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1.
Autops Case Rep ; 10(2): e2020164, 2020 May 06.
Article in English | MEDLINE | ID: mdl-33344282

ABSTRACT

Emphysematous gastritis (EG) is a rare and potentially lethal process caused by invasive, gas-producing bacteria leading to inflammation and gas dissection of the stomach. The most common etiologic agents are Clostridium infections, but other organisms, including enterobacteria, staphylococcus, and fungi have also been identified. We report the first case of EG due to Sarcina ventriculi in a solid organ transplant recipient, who presented with epigastric pain and vomiting. The patient had a history of type 1 diabetes mellitus (DM) with recurrent episodes of ketoacidosis and systemic diabetic complications, including severe gastroparesis. CT scan studies demonstrated EG with venous air, and endoscopy showed severe gastritis and ulcerations. In the gastric biopsies, abundant Sarcina ventriculi were noted in areas of mucosal/submucosal necrosis. Antibiotic treatment was instituted at admission, and subsequent endoscopy demonstrated the disappearance of Sarcina, with some improvement of the gastric inflammation; however, the patient developed septic shock with multiorgan failure and expired. This case highlights the need to consider other infectious etiologies in transplant patients, in addition to the well-known opportunistic infections.

2.
Autops. Case Rep ; 10(2): e2020164, Apr.-June 2020. graf
Article in English | LILACS | ID: biblio-1131820

ABSTRACT

Emphysematous gastritis (EG) is a rare and potentially lethal process caused by invasive, gas-producing bacteria leading to inflammation and gas dissection of the stomach. The most common etiologic agents are Clostridium infections, but other organisms, including enterobacteria, staphylococcus, and fungi have also been identified. We report the first case of EG due to Sarcina ventriculi in a solid organ transplant recipient, who presented with epigastric pain and vomiting. The patient had a history of type 1 diabetes mellitus (DM) with recurrent episodes of ketoacidosis and systemic diabetic complications, including severe gastroparesis. CT scan studies demonstrated EG with venous air, and endoscopy showed severe gastritis and ulcerations. In the gastric biopsies, abundant Sarcina ventriculi were noted in areas of mucosal/submucosal necrosis. Antibiotic treatment was instituted at admission, and subsequent endoscopy demonstrated the disappearance of Sarcina, with some improvement of the gastric inflammation; however, the patient developed septic shock with multiorgan failure and expired. This case highlights the need to consider other infectious etiologies in transplant patients, in addition to the well-known opportunistic infections.


Subject(s)
Humans , Adult , Diabetes Complications , Transplant Recipients , Infections/etiology , Autopsy , Opportunistic Infections/etiology , Cholestasis , Clostridium Infections , Liver Failure , Fatal Outcome , Gastroparesis/complications , Renal Insufficiency/complications , Graft Rejection
3.
BMC Nephrol ; 20(1): 386, 2019 10 25.
Article in English | MEDLINE | ID: mdl-31653199

ABSTRACT

BACKGROUND: Patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD) often develop hypertension in childhood or early adulthood. Although this could result in left ventricular hypertrophy (LVH), a major risk factor for cardiovascular morbidity and mortality, prior studies of LVH in ADPKD have yielded conflicting results. We estimated the prevalence of LVH using consensus echocardiography criteria and examined the independent association of ADPKD severity with LV mass in a contemporary cohort of ADPKD patients. METHODS: Adults with ADPKD and eGFR> 15 ml/min/1.73m2 were enrolled in a single-center study. Left Ventricular Mass (LVM) was quantified using 2D echocardiography, and LVH was defined using gender-specific cut-points of LVM and LVM indexed to body surface area (LVMI) from consensus guidelines. Total Kidney Volume (TKV) was quantified using Magnetic Resonance Imaging, and GFR was estimated from serum creatinine using the CKD-Epi equation. Multiple linear regression was used to estimate the association of TKV and eGFR with LVM and LVMI, adjusting for potential confounders. RESULTS: Among 126 participants (78% with hypertension), median age was 46 years, median eGFR 63 ml/min/1.73 m2, and median [IQR] systolic blood pressure was 125 [116-133] mmHg. Prevalence of LVH was 21.4% as defined by LVMI and was not significantly different (p = 0.8) between those with and without HTN, and was similar (21.4%) after excluding those (N = 21) with known cardiac disease. Greater TKV and lower eGFR were directly correlated with greater LVMI (p = .016 and p < .001, respectively). In multiple linear regression models accounting for potential confounders including blood pressure, greater TKV was positively associated with LVM ([Formula: see text] =0.19, p = 0.04). CONCLUSIONS: In a contemporary cohort of ADPKD patients with well-controlled blood pressure, the prevalence of LVH is high, and ADPKD severity as reflected by TKV is independently associated with greater LV mass. These results may suggest a relationship between ADPKD pathophysiology and increased LV mass.


Subject(s)
Hypertrophy, Left Ventricular/epidemiology , Polycystic Kidney, Autosomal Dominant/epidemiology , Polycystic Kidney, Autosomal Dominant/pathology , Adult , Blood Pressure , Cohort Studies , Comorbidity , Echocardiography , Female , Glomerular Filtration Rate , Humans , Hypertension/epidemiology , Hypertrophy, Left Ventricular/diagnostic imaging , Male , Middle Aged , Organ Size , Patient Acuity , Polycystic Kidney, Autosomal Dominant/diagnostic imaging , Polycystic Kidney, Autosomal Dominant/physiopathology , Prevalence
5.
Pediatr Radiol ; 49(5): 694-701, 2019 05.
Article in English | MEDLINE | ID: mdl-30815716

ABSTRACT

Postmortem CT for investigating childhood deaths is increasingly utilised as a noninvasive adjunct or alternative to standard autopsy; however there are no standardised published imaging protocols. This article describes a standardised imaging protocol that has been developed based on current practices of international postmortem imaging practitioners and experts. This recommendation is expected to be useful for postmortem imaging centres wishing to update their existing practices and for those starting paediatric postmortem CT as a new service.


Subject(s)
Autopsy/standards , Forensic Medicine/standards , Pediatrics/standards , Tomography, X-Ray Computed/standards , Cause of Death , Child , Humans , Postmortem Changes
6.
J Comput Assist Tomogr ; 41(1): 141-147, 2017 Jan.
Article in English | MEDLINE | ID: mdl-27560016

ABSTRACT

OBJECTIVE: To evaluate image quality (IQ) of a reduced contrast volume, low kilovolt (peak) [kV(p)] abdominopelvic computed tomographic angiography (AP-CTA) protocol compared to a standard 120-kV(p) AP-CTA protocol. METHODS: A retrospective image analysis was performed on 103 patients with end-stage renal disease who underwent AP-CTA. Forty-nine patients were scanned at 80 kV(p) with a mean of 48 mL of contrast, and 54 patients were scanned at 120 kV(p) with a mean of 98 mL of contrast. Objective comparison of arterial attenuation, noise, and contrast-to-noise ratio was obtained, in addition to radiation dose. Subjective assessment of IQ, enhancement intensity, and image noise (IN) was scored on a 3-point scale. RESULTS: The 6-level aggregate contrast-to-noise ratio for the 80-kV(p) group was 11.8 ± 7.0, compared to 12.4 ± 4.6 in the 120-kV(p) group (P = 0.210). Radiation exposure was significantly lower in the 80-kV(p) group versus the 120-kV(p) group, as measured by average CT dose index (mGy) of 9.0 ± 3.1 and 15.8 ± 5.8 (P < 0.0001), respectively; and average dose length product (mGy × cm) of 490.0 ± 214.1 and 863.1 ± 344.4 (P < 0.0001), respectively. The 120-kV(p) technique scored better for subjective IQ (P = 0.042) and IN (P = 0.004) but not for enhancement intensity (P = 0.205). CONCLUSIONS: A 50% reduced iodinated contrast dose coupled with 80-kV(p) technique with iterative reconstruction allows for satisfactory AP-CTA studies at a 43% mean radiation dose reduction compared to a standard protocol. Negative but potentially reversible sequelae of this drop in radiation dose include increased IN and reduced subjective IQ.


Subject(s)
Azotemia/diagnostic imaging , Computed Tomography Angiography/methods , Iodine/administration & dosage , Kidney Diseases/diagnostic imaging , Pelvis/diagnostic imaging , Radiation Exposure/prevention & control , Contrast Media/administration & dosage , Female , Humans , Male , Middle Aged , Pelvis/blood supply , Radiation Dosage , Radiation Exposure/analysis , Radiography, Abdominal/methods , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity
7.
Emerg Radiol ; 23(2): 117-25, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26610766

ABSTRACT

This study aims to review the imaging findings of distal (thoracic and abdominal) complications related to ventriculo-peritoneal (VP), ventriculo-pleural (VPL), and ventriculo-atrial (VA) cerebrospinal fluid (CSF) shunt catheter placement. Institution review board-approved single-center study of patients with thoracic and abdominal CSF catheter-related complications on cross-sectional imaging examinations over a 14-year period was performed. Clinical presentation, patient demographics, prior medical history, and subsequent surgical treatment were recorded. The presence or absence of CSF catheter-related infection and/or acute hydrocephalus on cross-sectional imaging was also recorded. There were 81 distal CSF catheter-related complications identified on 47 thoracic or abdominal imaging examinations in 30 patients (age 5-80 years, mean 39.3 years), most often on CT (CT = 42, MRI = 1, US = 4). Complications included 38 intraperitoneal and 11 extraperitoneal fluid collections. Extraperitoneal collections included nine abdominal wall subcutaneous (SC) pseudocysts associated with shunt migration and obesity, an intrapleural pseudocyst, and a breast pseudocyst. There were also two large VPL-related pleural effusions, a fractured catheter in the SC tissues, and a large VA shunt thrombus within the right atrium. Ten patients (33.3 %) had culture-positive infection from CSF or shunt catheter samples. Ten patients (33.3 %) had features of temporally related acute or worsening hydrocephalus on neuroimaging. In four of these patients, the detection of thoracic and abdominal complications on CT preceded and predicted the findings of acute hydrocephalus on cranial imaging. Thoracic and abdominal complications of CSF shunts, as can be identified on CT, include shunt infection and/or obstruction, may be both multiple and recurrent, and may be predictive of concurrent acute intracranial problems.


Subject(s)
Abdomen/diagnostic imaging , Catheters/adverse effects , Cerebrospinal Fluid Shunts/instrumentation , Thoracic Diseases/diagnostic imaging , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Humans , Hydrocephalus/surgery , Middle Aged , Obesity/complications , Radiography, Abdominal , Thoracic Diseases/etiology , Tomography, X-Ray Computed , Young Adult
8.
Radiol Clin North Am ; 52(5): 1087-99, 2014 Sep.
Article in English | MEDLINE | ID: mdl-25173660

ABSTRACT

The development of colorectal cancer screening programs in many countries has led to increasingly large numbers of patients undergoing optical colonoscopy. Although acute complications from screening optical colonoscopy are uncommon, they may occur in up to 5% or more of patients where biopsies or therapeutic procedures are performed. Abdominal radiographs are of value only for the detection of intraperitoneal perforation. There is a wide spectrum of other important associated complications. Such complications are most reliably identified using abdominal and pelvic CT, which also can guide appropriate conservative, interventional, or surgical management.


Subject(s)
Colonography, Computed Tomographic/methods , Colonoscopy/adverse effects , Intestinal Diseases/diagnostic imaging , Intestinal Diseases/etiology , Hemorrhage/diagnostic imaging , Hemorrhage/etiology , Humans , Peritoneum/diagnostic imaging , Peritoneum/injuries , Spleen/diagnostic imaging , Spleen/injuries
9.
J Surg Res ; 185(2): 581-6, 2013 Dec.
Article in English | MEDLINE | ID: mdl-23845870

ABSTRACT

BACKGROUND: Small, single-institution studies have suggested risk factors for bowel ischemia/necrosis (I/N) in patients with computed tomography (CT) findings of pneumatosis (PN) and portal venous gas (PVG). Here, analysis has been expanded in a large, multicenter study. MATERIALS & METHODS: Logistic regression models and receiver operating characteristic curves were used to construct a scoring system for I/N in cases of PN/PVG. RESULTS: Of 265 patients with PN/PVG identified, 209 had adequate data. In unadjusted analyses the following variables were significantly associated with I/N: age, peritoneal signs, ascites, the presence of both PVG and PN, blood urea nitrogen (BUN), CO2, albumin, and a history of hypertension, myocardial infarction, or stroke. In contrast, the CT findings of mesenteric stranding, bowel-wall thickening, and type of PN were not associated with I/N. In adjusted analyses, three variables were significantly associated with I/N: age ≥60 y (odds ratio = 2.51, 95% confidence interval: 1.26-4.97), peritoneal signs (10.58, 4.23-26.4), and BUN >25 mg/dL (3.08, 1.54-6.17), whereas presence of both PN and PVG (versus only one) was associated with an increase (but not statistically significant increase) in odds (2.01, 0.94-4.36). Although several ad hoc models were used to maximize diagnostic ability, with maximal odds ratio = 174, the areas of receiver operating characteristic curves were all below 0.80, revealing suboptimal accuracy to diagnose I/N. CONCLUSIONS: Older age, peritoneal signs, and high BUN are associated with I/N, suggesting an ability to predict which patients need operation. CT findings traditionally suggestive of ischemic PN/PVG, however, do not diagnose I/N accurately enough to reliably identify patients needing operation.


Subject(s)
Patient Selection , Pneumatosis Cystoides Intestinalis/diagnostic imaging , Pneumatosis Cystoides Intestinalis/surgery , Portal Vein/diagnostic imaging , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , Female , Humans , Ischemia/diagnostic imaging , Ischemia/epidemiology , Ischemia/surgery , Logistic Models , Male , Middle Aged , Necrosis/diagnostic imaging , Necrosis/epidemiology , Necrosis/surgery , Pneumatosis Cystoides Intestinalis/epidemiology , Predictive Value of Tests , Preoperative Care/methods , ROC Curve , Risk Factors , Severity of Illness Index , Young Adult
10.
Forensic Sci Int ; 225(1-3): 20-6, 2013 Feb 10.
Article in English | MEDLINE | ID: mdl-22947431

ABSTRACT

Although 3D CT imaging data are available on survivors of accidental blunt trauma, little similar data has been collected and classified on major injuries in victims of fatal injuries. This study compared the sensitivity of post mortem computed tomography (PMCT) with that of conventional autopsy for major trauma findings classified according to the trauma Abbreviated Injury Scale (AIS). Whole-body 3D PMCT imaging data and full autopsy findings were analyzed on 21 victims of accidental blunt force trauma death. All major injuries were classified on the AIS scale with ratings from 3 (serious) to 6 (unsurvivable). Agreement between sensitivity of autopsy and PMCT for major injuries was determined. A total of 195 major injuries were detected (mean per fatality, 9.3; range, 1-14). Skeletal injuries by AIS grade included 37 grade 3, 45 grade 4, 12 grade 5, and 2 grade 6 major findings. Soft tissue injuries included 10 grade 3, 68 grade 4, 16 grade 5, and 5 grade 6 major findings. Of these, PMCT detected 165 (88 skeletal, 77 soft tissue), and autopsy detected 127 (59 skeletal, 68 soft tissue). PMCT agreed with autopsy in 86% and 76% of skeletal and soft tissue injuries, respectively. PMCT detected an additional 37 skeletal and 31 soft tissue injuries that were not identified at autopsy. Autopsy detected 8 skeletal and 22 soft tissue injuries that were not detected by PMCT. PMCT was more sensitive for skeletal (P=0.05) and head and neck region injury (P=0.043) detection. PMCT showed a trend for greater sensitivity than autopsy, but this did not reach statistical significance (P=0.083). 3D PMCT detected significantly more skeletal injuries than autopsy and a similar number of soft tissue injuries to autopsy and promises to be a sensitive tool for detection and classification of skeletal injuries in fatal blunt force accidental trauma. Use of the AIS scale allows standardized categorization and quantification of injuries that contribute to death in such cases and allows more objective comparison between autopsy and PMCT.


Subject(s)
Autopsy , Imaging, Three-Dimensional , Multidetector Computed Tomography , Whole Body Imaging , Wounds and Injuries/diagnostic imaging , Wounds and Injuries/pathology , Abbreviated Injury Scale , Accidents , Forensic Pathology , Humans
11.
Arch Surg ; 147(12): 1114-22, 2012 Dec.
Article in English | MEDLINE | ID: mdl-23248013

ABSTRACT

OBJECTIVES: To determine the safety, clinical yield, and cost of computed tomography angiography (CTA) use in the workup of potential renal transplant recipients. DESIGN: Single-site, retrospective review of medical, surgical, and radiologic records. SETTING: Large university tertiary care center. PATIENTS: Potential recipients of transplants from living donors. INTERVENTIONS: Computed tomography with and without 100 mL of iodixanol intravenous contrast enhancement as part of the preoperative workup. MAIN OUTCOME MEASURES: Mean pre- and post-CTA estimated glomerular filtration rate and number of patients requiring emergent dialysis after CTA, number of patients who had their treatment changed by CTA findings, patient predictors of significant CTAs, and cost per significant CTA. RESULTS: From July 20, 2006, through December 10, 2010, a total of 179 transplant candidates underwent CTA. Forty-two patients were predialysis at the time of CTA. Mean (SD) serum creatinine levels in this group were unchanged after CTA (5.06 [2.13] mg/dL vs 5.00 [2.28] mg/dL [to convert to micromoles per liter, multiply by 88.4], P = .49), and no patients required subsequent emergent dialysis. Forty-one patients (22.9%) had their treatment changed by CTA findings. Multivariate logistic regression analysis revealed 3 patient history and physical criteria that predicted significant CTA findings: chronic infection (odds ratio, 10.91; 95% CI, 2.72-43.69; P < .001), patient weight less than 69 kg (3.11; 1.49-6.51; P < .001), and ventral torso surgical scarring (4.13; 1.57-10.84; P < .001). Diagnostic cost per significant CTA study was $2660, with an estimated reduced cost of $1480 per significant study with screening using 1 of the 3 predictors. CONCLUSION: Diagnostic CTA is a safe and cost-effective procedure for both operative planning and screening for potentially prohibitive abdominal disease.


Subject(s)
Angiography/economics , Kidney Transplantation , Perioperative Care/economics , Renal Insufficiency/diagnostic imaging , Renal Insufficiency/therapy , Tomography, X-Ray Computed/economics , Adult , Aged , Angiography/adverse effects , Contrast Media , Cost-Benefit Analysis , Female , Humans , Male , Middle Aged , Patient Selection , Perioperative Care/adverse effects , Predictive Value of Tests , Renal Insufficiency/complications , Retrospective Studies , Risk Factors , Tomography, X-Ray Computed/adverse effects , Triiodobenzoic Acids
12.
Nature ; 489(7416): 391-399, 2012 Sep 20.
Article in English | MEDLINE | ID: mdl-22996553

ABSTRACT

Neuroanatomically precise, genome-wide maps of transcript distributions are critical resources to complement genomic sequence data and to correlate functional and genetic brain architecture. Here we describe the generation and analysis of a transcriptional atlas of the adult human brain, comprising extensive histological analysis and comprehensive microarray profiling of ∼900 neuroanatomically precise subdivisions in two individuals. Transcriptional regulation varies enormously by anatomical location, with different regions and their constituent cell types displaying robust molecular signatures that are highly conserved between individuals. Analysis of differential gene expression and gene co-expression relationships demonstrates that brain-wide variation strongly reflects the distributions of major cell classes such as neurons, oligodendrocytes, astrocytes and microglia. Local neighbourhood relationships between fine anatomical subdivisions are associated with discrete neuronal subtypes and genes involved with synaptic transmission. The neocortex displays a relatively homogeneous transcriptional pattern, but with distinct features associated selectively with primary sensorimotor cortices and with enriched frontal lobe expression. Notably, the spatial topography of the neocortex is strongly reflected in its molecular topography-the closer two cortical regions, the more similar their transcriptomes. This freely accessible online data resource forms a high-resolution transcriptional baseline for neurogenetic studies of normal and abnormal human brain function.


Subject(s)
Anatomy, Artistic , Atlases as Topic , Brain/anatomy & histology , Brain/metabolism , Gene Expression Profiling , Transcriptome/genetics , Adult , Animals , Brain/cytology , Calbindins , Databases, Genetic , Dopamine/metabolism , Health , Hippocampus/cytology , Hippocampus/metabolism , Humans , In Situ Hybridization , Internet , Macaca mulatta/anatomy & histology , Macaca mulatta/genetics , Male , Mice , Neocortex/anatomy & histology , Neocortex/cytology , Neocortex/metabolism , Oligonucleotide Array Sequence Analysis , Post-Synaptic Density/genetics , RNA, Messenger/analysis , RNA, Messenger/genetics , S100 Calcium Binding Protein G/genetics , Species Specificity
13.
Radiographics ; 31(5): 1403-13, 2011.
Article in English | MEDLINE | ID: mdl-21918051

ABSTRACT

The spectrum of causes of hepatic gas detected at computed tomography (CT) and ultrasonography (US) is widening. There are many iatrogenic and noniatrogenic causes of hepatic parenchymal, biliary, hepatic venous, and portal venous gas. Hepatic gas may be an indicator of serious acute disease (infarct, infection, abscess, bowel inflammation, or trauma). In other clinical scenarios, it may be an expected finding related to therapeutic interventions (such as surgery; hepatic artery embolization for a tumor or for active bleeding in acute trauma cases; percutaneous tumor ablation performed with radiofrequency, cryotherapy, laser photocoagulation, or ethanol). In some cases, hepatic gas is an incidental finding of no clinical significance. Familiarity with the expanding list of newer intervention-related causes of hepatic gas detected at CT and US, knowledge of the patient's clinical history, and a careful search for associated clues on images are all factors that may allow the radiologist to better determine the clinical relevance of this finding.


Subject(s)
Gases , Liver/diagnostic imaging , Abdominal Injuries/diagnostic imaging , Biliary Tract/diagnostic imaging , Biliary Tract Diseases/diagnostic imaging , Cellulose, Oxidized/adverse effects , Colonoscopy , Digestive System Surgical Procedures , Humans , Iatrogenic Disease , Incidental Findings , Intestines/pathology , Intraoperative Complications/diagnostic imaging , Liver Diseases/diagnostic imaging , Necrosis , Postoperative Complications/diagnostic imaging , Radiography , Ultrasonography
14.
Dig Dis Sci ; 54(10): 2290-5, 2009 Oct.
Article in English | MEDLINE | ID: mdl-19082722

ABSTRACT

Oral involvement is common in patients with Crohn's disease (CD) and can precede intestinal symptoms, making diagnosis difficult. We report a case of severe orofacial CD. A 41-year-old woman presented with palate and tongue ulcers. Biopsies showed acute inflammation with ulcer. Colonoscopy demonstrated ascending colon ulceration. Biopsies revealed acute colitis and mild architectural distortion. Prednisone was started but the symptoms recurred with taper; steroids were resumed and infliximab (IFX) 5 mg/kg was infused. After improvement, oral pain and weight loss returned. A G tube was placed. Mercaptopurine was started at 1.5 mg/kg per day. IFX was increased to 10 mg/kg. Debridement of the oral ulcers and a skin graft to the lips was performed. Pathology from oral and facial lesions was consistent with granulation tissue and fibrosis with chronic inflammation. She was readmitted several months later for weight loss and dehydration. Abdominal pain, distension, and feculent drainage developed around the G tube. Repeat computed tomography (CT) scan demonstrated pneumatosis. Laparotomy revealed purulent drainage from a perforated segment of sigmoid colon. Histology was consistent with perforated CD. Despite ventilatory and hemodynamic support and broad-spectrum antibiotics, the patient died 1 week later. Our case highlights the difficulty in diagnosing and managing orofacial CD. In this case, medical treatment was initiated based on a high index of suspicion. CD was only confirmed after intestinal resection very late in the disease course. Treatment of orofacial CD includes topical or systemic steroids, immunomodulators, and anti-tumor necrosis factor (TNF) therapies. As our case demonstrated, patients can be refractory to therapy.


Subject(s)
Crohn Disease/pathology , Granulomatosis, Orofacial/pathology , Adult , Crohn Disease/diagnosis , Fatal Outcome , Female , Granulomatosis, Orofacial/diagnosis , Humans
15.
Semin Ultrasound CT MR ; 29(4): 251-62, 2008 Aug.
Article in English | MEDLINE | ID: mdl-18795492

ABSTRACT

New developments in positron emission tomography-computed tomography (PET-CT) have included the introduction of scanners with multidetector 16- to 64-row CT that allow thin-section essentially isotropic imaging datasets to be acquired rapidly in multiple time phases. "Diagnostic quality" CT with both oral and intravenous enhancement is now routinely possible in PET-CT and allows greater potential for the accurate diagnosis and staging of the full range of cancers involving the abdomen and pelvis. This article explores the considerations for more tailored, specific tumor-related protocols for PET-CT in the abdomen and pelvis, with emphasis on the use and value of fully optimized CT as part of an integrated PET-CT examination.


Subject(s)
Abdominal Neoplasms/diagnosis , Pelvic Neoplasms/diagnosis , Positron-Emission Tomography/methods , Tomography, X-Ray Computed/methods , Colorectal Neoplasms/diagnosis , Contrast Media , Female , Fluorodeoxyglucose F18 , Gastrointestinal Stromal Tumors/diagnosis , Genital Neoplasms, Female/diagnosis , Humans , Lymphoma/diagnosis , Lymphoproliferative Disorders/diagnosis , Pancreatic Neoplasms/diagnosis , Sarcoma/diagnosis , Stomach Neoplasms/diagnosis
16.
J Gastrointest Surg ; 11(1): 36-42, 2007 Jan.
Article in English | MEDLINE | ID: mdl-17390184

ABSTRACT

BACKGROUND: A standardized method for predicting unresectability in pancreatic cancer has not been defined. We propose a system using CT and endoscopic ultrasound (EUS) to assess patients for unresectable pancreatic cancers. METHODS: Radiologic and surgical data from 101 patients who underwent exploration/resection for pancreatic cancer were reviewed. Chi-squares were used to identify five factors significantly correlated with unresectability, which were incorporated into a scoring system (one point for each factor). RESULTS: The resectability rates were 84, 56, and 10% for patients with scores of 0, 1, and 2, respectively. All four patients with three risk factors for unresectability had unresectable tumors. The most accurate results were achieved in patients evaluated with both CT and EUS. DISCUSSION: This scoring system stratifies pancreatic cancer patients into three groups: (1) patients with a score of zero (likely to undergo successful resection), (2) patients with a score of one (likely to benefit from laparoscopic staging prior to attempting resection), and (3) patients with a score of two or higher (low probability of successful resection, who may be better served by neoadjuvant therapy).


Subject(s)
Endosonography , Pancreatic Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Adult , Aged , Aged, 80 and over , Chi-Square Distribution , Female , Humans , Male , Middle Aged , Neoplasm Staging , Pancreatic Neoplasms/pathology , Pancreatic Neoplasms/surgery , Predictive Value of Tests , Survival Rate
17.
J Digit Imaging ; 19 Suppl 1: 84-8, 2006.
Article in English | MEDLINE | ID: mdl-16972010

ABSTRACT

Rapid advances are changing the technology and applications of multidetector computed tomography (CT) scanners. The major increase in data associated with this new technology, however, breaks most commercial picture archiving and communication system (PACS) architectures by preventing them from delivering data in real time to radiologists and outside clinicians. We proposed a phased model for 3D workflow, installed a thin-slice archive and measured thin-slice data storage over a period of 5 months. A mean of 1,869 CT studies were stored per month, with an average of 643 images per study and a mean total volume of 588 GB/month. We also surveyed 48 radiologists to determine diagnostic use, impressions of thin-slice value, and requirements for retention times. The majority of radiologists thought thin slice was helpful for diagnosis and regularly used the application. Permanent storage of thin slice CT is likely to become best practice and a mission-critical pursuit for the health care enterprise.


Subject(s)
Imaging, Three-Dimensional , Radiology Information Systems/organization & administration , Software , Tomography, X-Ray Computed , Humans , Information Storage and Retrieval , Surveys and Questionnaires
18.
AJR Am J Roentgenol ; 187(3): 689-94, 2006 Sep.
Article in English | MEDLINE | ID: mdl-16928931

ABSTRACT

OBJECTIVE: On the basis of our experience in recent years, we hypothesized that acute diverticulitis occurs more frequently in young adult patients (age, < or = 50 years) now than previously recognized. We reviewed the CT findings, clinical features, and demographic data of a cohort of patients who presented with acute diverticulitis at an urban U.S. academic medical center. MATERIALS AND METHODS: We used our hospital and radiology databases to identify 104 adult patients with both CT and clinical diagnoses of acute diverticulitis. Clinical parameters recorded included age, sex, ethnicity, in- or outpatient management, and therapy (medical treatment, percutaneous drainage, or surgery). CT studies were evaluated for the site of diverticulitis; associated complications; and the presence of abdominal obesity, as determined by measurement of sagittal abdominal diameter. RESULTS: The study group was composed of 55 men and 49 women (age range, 22-88 years; mean age, 52.2 years; median age, 49.0 years). Fifty-six (53.8%) were 50 years old or younger, and 22 were 40 years old or younger. Forty-one complications were noted in 38 patients (36%). There was no significant age difference between the < or = 50 and > 50 years old age groups for hospital admission (90 patients, 86.5%), medical therapy (76, 73.1%), or surgery or percutaneous abscess drainage (28, 26.9%). Abdominal obesity measured by sagittal abdominal diameter was present in 48 (85.7%) and 37 (77%) of the < or = 50 and > 50 years old age groups, respectively. The mean sagittal abdominal diameter for patients < or = 50 years old (27.0 cm) was greater than that for patients > 50 years old (25.6 cm) (p = 0.05). CONCLUSION: In this urban population, acute diverticulitis occurred more frequently in patients 20-50 years old than previously recognized. This group had significantly greater abdominal obesity than the older group. Severe disease requiring hospital admission, surgery, or percutaneous drainage (or both surgery and percutaneous drainage) was common in all age groups.


Subject(s)
Diverticulitis/diagnostic imaging , Diverticulitis/epidemiology , Obesity/complications , Academic Medical Centers/statistics & numerical data , Acute Disease , Adult , Aged , Aged, 80 and over , Cohort Studies , Diverticulitis/etiology , Female , Humans , Incidence , Male , Middle Aged , Retrospective Studies , Tomography, X-Ray Computed , United States/epidemiology , Urban Population
19.
Semin Intervent Radiol ; 21(4): 335-43, 2004 Dec.
Article in English | MEDLINE | ID: mdl-21331144

ABSTRACT

Pancreas organ transplantation has been a therapeutic option for the treatment of diabetes mellitus for over a decade. More recently, percutaneous injection of isolated pancreas islet cells via the portal vein has been developed as an exciting minimally invasive alternative procedure to whole organ transplantation, and one where the interventional radiologist may play a major role. This chapter reviews the role of image guided intervention in the whole organ pancreas transplant and describes the evolving technique of percutaneous islet cell transplantation.

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