Bio

Clinical Focus


  • Diagnostic Radiology
  • Radiology

Academic Appointments


  • Professor, Radiology
  • Member, Bio-X

Administrative Appointments


  • Acting Division Chief, Body Imaging, Department of Radiology, Stanford University Medical Center (2018 - Present)
  • Section Chief, Abdominal Imaging, Department of Radiology, Stanford University Medical Center (1990 - 2012)
  • Fellowship Director, Abdominal Imaging, Department of Radiology, Stanford University Medical Center (1990 - Present)
  • Associate Chair for Academic Affairs, Department of Radiology, Stanford University Medical Center (2004 - Present)
  • Vice Chair, Department of Radiology (2010 - 2017)

Honors & Awards


  • SAR Lifetime Achievement Award, Society of Abdominal Radiology (2016)
  • SRU Lifetime Achievement Award, Society of Radiologists in Ultrasound (2016)
  • Fellow, Society of Radiologists in Ultrasound (2013)
  • Corecipient Cum Laude Award, SCBT/MR (1999)
  • Corecipient Cum Laude Award for poster presentation, RSNA (1999)
  • Corecipient Hounsfield Award, SCBT/MR (1999)
  • Hounsfield Award, SCBT/MR (1999)
  • Corecipient of Magna & Cum Laude Awards, SCBT/MR (1998)
  • Corecipient Cum Laude Award for Outstanding Scientific Paper, SCBT/MR (1996)
  • Research Award: Virtual Colonoscopy, Society of Gastrointestinal Radiologists (1996)
  • Teacher of the Year, Department of Radiology, Stanford University (1993)
  • Corecipient Magna Cum Laude Award for scientific exhibit, RSNA (1992)
  • Corecipient Mocada Research Award, SCBT/MR (1992)
  • Named to Editorial Board, Radiology (1992)
  • Outstanding Alumnus Award, UC San Francisco (1992)
  • Corecipient Winthrop Research Award, SCBT/MR (1991)
  • Corecipient Lauterbur Research Award, SCBT/MR (1990)
  • Teacher of the Year Award, Department of Radiology, Stanford University (1990)
  • Teacher of the Decade, UC San Francisco (1989)
  • Residents' Tribute for Outstanding Faculty Member, Department of Radiology, UC San Francisco (1985)
  • Teacher of the Year Award, UC San Francisco (1982)
  • Heller Fellowship in Diagnostic Radiology, UC San Francisco (1979)
  • Chief Resident, Department of Radiology, UC San Francisco (1978)
  • Elmer Ng Award for Outstanding Resident in Radiology, UC San Francisco (1978)

Professional Education


  • Fellowship:UCSF Medical Center (1980) CA
  • Board Certification: Diagnostic Radiology, American Board of Radiology (1979)
  • Residency:UCSF Medical Center (1979) CA
  • Internship:Columbia Presbyterian Medical Center (1975) NY
  • Medical Education:Jefferson Medical College (1974) PA
  • A.B., Princeton University (1970)
  • M.D., Jefferson Medical College (1974)
  • Internship, Columbia Presbyterian Med Center, Surgical Internship (1975)
  • Residency, UC San Francisco, Radiology (1979)
  • Fellowship, UC San Francisco, Abdominal Imaging (1980)

Research & Scholarship

Current Research and Scholarly Interests


Pancreatic MDCT
Thyroid ultrasound/biopsy
Virtual Colonoscopy
Imaging of appendicitis
Hepatic MDCT
Capsule ultrasound (wireless) of GI tract

Clinical Trials


  • Perfusion CT as a Predictor of Treatment Response in Patients With Rectal Cancer Not Recruiting

    A research study of rectal cancer perfusion (how blood flows to the rectum over time). We hope to learn whether perfusion characteristics of rectal masses may be predictive of response to treatment and whether rectal perfusion characteristics can be used to follow response to treatment.

    Stanford is currently not accepting patients for this trial. For more information, please contact Laura Gable, 650-736-0798.

    View full details

  • Prognostic Value of Baseline Computed Tomography (CT) Perfusion Parameters of Pancreatic Cancer for Patients Undergoing Stereotactic Body Radiotherapy or Surgical Resection Not Recruiting

    The purpose of this study is first, to determine whether baseline perfusion characteristics of pancreatic cancer, as characterized by CT perfusion studies, can predict tumor response to treatment by stereotactic body radiotherapy (SBRT). The second goal of this study is to determine whether baseline perfusion characteristics in those patients with resectable pancreatic cancer correlate with immunohistologic markers of angiogenesis such as microvessel density and vascular endothelial growth factor (VEGF) expression.

    Stanford is currently not accepting patients for this trial. For more information, please contact Lindee Burton, (650) 725 - 4712.

    View full details

Teaching

2018-19 Courses


Publications

All Publications


  • Performance of Hepatic Artery Velocity in Evaluation of Causes of Markedly Elevated Liver Tests. Ultrasound in medicine & biology Tse, J. R., Jeffrey, R. B., Kamaya, A. 2018

    Abstract

    The purpose of this study was to assess the utility of peak systolic proper hepatic artery velocity (HAV) in differentiating causes of severely elevated liver function tests. HAV, hepatic artery resistive index and portal vein velocity of 41 patients with severely elevated liver function tests were evaluated. In 19 patients (46%), the causes were structural (e.g., cholecystitis, cholangitis), whereas in 22 patients (54%) the causes were non-structural (e.g., rhabdomyolysis, drug-induced liver injury). The average HAV for structural causes was 138 ± 68 cm/s, and for non-structural causes, 65 ± 29 cm/s (p < 0.0001). An HAV >100 cm/s was correlated with structural causes (p = 0.0001). With respect to diagnostic performance, this threshold was 79% sensitive and 86% specific, with a high positive likelihood ratio (5.8) and low negative likelihood ratio (0.24). The resistive index and portal vein velocity were not statistically different. In patients with severely elevated liver function tests, an HAV >100 cm/s can help distinguish structural from non-structural causes, which may guide management while awaiting definitive laboratory tests.

    View details for DOI 10.1016/j.ultrasmedbio.2018.07.006

    View details for PubMedID 30143340

  • Radiologic Evaluation of Intrahepatic Cholangiocarcinoma Perineural Invasion AMERICAN JOURNAL OF ROENTGENOLOGY Raghavan, K., Jeffrey, R., Olcott, E. W. 2018; 210 (3): W129

    View details for DOI 10.2214/AJR.17.18950

    View details for Web of Science ID 000426017600005

    View details for PubMedID 29469628

  • Extrapancreatic perineural invasion in pancreatic adenocarcinoma ABDOMINAL RADIOLOGY Patel, B. N., Olcott, E., Jeffrey, R. 2018; 43 (2): 323–31

    Abstract

    Pancreatic ductal adenocarcinoma continues to be a highly lethal disease, despite advances in modern medicine. Curative surgical options continue to carry significant morbidity and offer little improvement in overall 5-year survival. Currently, imaging plays an essential role in the pre-operative evaluation of patients who are undergoing evaluation for resection. However, some pancreatic cancers have particularly aggressive biology, despite appearing resectable by conventional imaging criteria. Imaging biomarkers that serve as surrogates for tumors with such aggressive phenotype have been recently described, namely duodenal invasion and extrapancreatic perineural invasion. In this pictorial review, we will summarize key concepts of extrapancreatic perineural invasion, describe its association with a poor prognosis, and highlight the role of imaging in its detection.

    View details for DOI 10.1007/s00261-017-1343-9

    View details for Web of Science ID 000426466400009

    View details for PubMedID 28980054

  • Diagnostic Performance of Margin Features in Thyroid Nodules in Prediction of Malignancy. AJR. American journal of roentgenology Siebert, S. M., Gomez, A. J., Liang, T., Tahvildari, A. M., Desser, T. S., Jeffrey, R. B., Kamaya, A. 2018: 1–6

    Abstract

    The purpose of this study was to evaluate thyroid nodule margins for specific morphologic features and determine the diagnostic performance of these features in differentiating papillary carcinoma from benign thyroid nodules.Nodules measuring 1-3 cm in largest diameter that had been evaluated with high-resolution ultrasound (12-18 MHz) and ultrasound-guided biopsy with definitive pathologic diagnosis were analyzed. Three blinded board-certified readers evaluated high-resolution images of each nodule for jagged edges, lobulated borders, and curved borders along their margins. Reader interpretations were correlated with the pathologic diagnosis to determine the diagnostic performance of each feature. A board-certified pathologist analyzed 10 randomly selected nodules with jagged edges by slide review to evaluate for structural correlation with the imaging finding.The diagnostic performance of jagged edges in papillary carcinoma of the thyroid was 67.4% sensitive and 78.3% specific (odds ratio, 7.44; p < 0.001) for malignancy. Jagged edges correlated with infiltrative variant expansion at slide review. Lobulated borders had sensitivity of 76.1% and specificity of 60.9% for papillary carcinoma (odds ratio, 4.95; p = 0.001) for malignancy. Curved borders were not a significant predictor of papillary carcinoma.Jagged edges and lobulated borders of thyroid nodule margins are statistically significant predictors of papillary carcinoma of the thyroid. Jagged edges correlate with infiltrative-type expansion and may be useful predictors of more aggressive papillary carcinomas.

    View details for DOI 10.2214/AJR.17.18787

    View details for PubMedID 29446670

  • Central echogenic areas in thyroid nodules: Diagnostic performance in prediction of papillary cancer. European journal of radiology Siebert, S. M., Jeffrey, R. B., Gomez, A. J., Kamaya, A. 2018; 101: 45–49

    Abstract

    To determine the diagnostic performance of the "central echogenic area" sonographic finding in differentiating papillary carcinomas from benign nodules and to how this finding may be used to improve fine needle aspiration(FNA) technique/utilization.We retrospectively analyzed ultrasound guided FNAs of thyroid nodules between 1 and 3 cm for central echogenic areas. 92 patients (evenly distributed benign vs papillary carcinoma) were evaluated by a blinded reader for areas of non-shadowing homogenously echogenic centers within the nodules and correlated with FNA proven pathologic diagnosis. A selection of nodules with the central echogenic area finding were selected for further slide review to establish a pathologic basis for the finding.Diagnostic performance of the "central echogenic area" feature in papillary thyroid cancers was 52.2% sensitive and 91.3% specific for papillary thyroid carcinoma with a PPV of 85.7% and NPV of 65.6%. There was a significant correlation with a p < 0.01 between the central echogenic area finding and papillary carcinoma. On pathologic slide review, nodules with central echogenic areas consistently demonstrated a central scar with conglomerate fibrosis and very few viable cells.Despite its relatively low sensitivity, the central echogenic area finding is highly specific for papillary carcinoma of the thyroid and can be a useful sonographic finding in decisions regarding FNA. Additionally, due to the paucity of cells and high density of conglomerate fibrosis, central echogenic areas should be avoided during FNA to decrease the chance of an inadequate sample collection.

    View details for DOI 10.1016/j.ejrad.2018.01.029

    View details for PubMedID 29571800

  • INTRA-INDIVIDUAL COMPARISON BETWEEN 2-D SHEAR WAVE ELASTOGRAPHY (GE SYSTEM) AND VIRTUAL TOUCH TISSUE QUANTIFICATION (SIEMENS SYSTEM) IN GRADING LIVER FIBROSIS ULTRASOUND IN MEDICINE AND BIOLOGY Sigrist, R. S., El Kaffas, A., Jeffrey, R., Rosenberg, J., Willmann, J. K. 2017; 43 (12): 2774–82

    Abstract

    Ultrasound-based shear wave elastography (SWE) has recently gained substantial attention for non-invasive assessment of liver fibrosis. The purpose of this study was to perform an intra-individual comparison between 2-D shear wave elastography (2-D-SWE with a GE system) and Virtual Touch Tissue Quantification (VTTQ with a Siemens system) to assess whether these can be used interchangeably to grade fibrosis. Ninety-three patients (51 men, 42 women; mean age, 54 y) with liver disease of various etiologies (hepatitis B virus = 47, hepatitis C virus = 22; alcohol = 6, non-alcoholic steatohepatitis = 5, other = 13) were included. Using published system-specific shear wave speed cutoff values, liver fibrosis was classified into clinically non-significant (F0/F1) and significant (≥F2) fibrosis. Results indicated that intra-modality repeatability was excellent for both techniques (GE 2-D-SWE: intra-class correlation coefficient = 0.89 [0.84-0.93]; VTTQ: intra-class correlation coefficient = 0.90 [0.86-0.93]). Intra-modality classification agreement for fibrosis grading was good to excellent (GE 2-D-SWE: κ = 0.65, VTTQ: κ = 0.82). However, inter-modality agreement for fibrosis grading was only fair (κ = 0.31) using published system-specific shear wave speed cutoff values of fibrosis. In conclusion, although both GE 2-D-SWE and Siemens VTTQ exhibit good to excellent intra-modality repeatability, inter-modality agreement is only fair, suggesting that these should not be used interchangeably.

    View details for DOI 10.1016/j.ultrasmedbio.2017.08.934

    View details for Web of Science ID 000415604700004

    View details for PubMedID 28967501

  • Spectral Doppler Waveforms for Diagnosis of Appendicitis: Potential Utility of Point Peak Systolic Velocity and Resistive Index Values. Radiology Shin, L. K., Jeffrey, R. B., Berry, G. J., Olcott, E. W. 2017: 162251-?

    Abstract

    Purpose To test the hypothesis that appendiceal spectral Doppler waveforms can distinguish patients with and patients without appendicitis. Materials and Methods In this retrospective study, Doppler waveforms were obtained from intramural appendiceal arteries identified with color Doppler imaging in 60% (93 of 155) of consecutive patients whose appendices were visualized at graded compression ultrasonography (US) performed for suspected appendicitis (53 male and 40 female; age, 1-56 years; mean, 14.5 years) over the 5-month period from November 2015 through March 2016. Point, non-angle-corrected peak systolic velocity (PSV) and resistive index (RI) values were compared between patients with and patients without appendicitis by utilizing histopathologically proven appendicitis and 6-week clinical follow-up as diagnostic reference standards. Data were assessed by using the Student t test, exact binomial distribution, two-sample test of proportions, and receiver operating characteristic analysis. Results Among the 93 patients, 36 (38.7%) had proven appendicitis (mean PSV, 19.7 cm/sec; mean RI, 0.69) and 57 patients (61.2%) did not (mean PSV, 7.1 cm/sec, P < .0001; mean RI, 0.50, P < .0001). The area under the receiver operating characteristic curve for the diagnosis of appendicitis was 0.97 (95% confidence interval [CI]: 0.95, 1.00) for PSV and 0.86 (95% CI: 0.78, 0.95; P = .011) for RI. Chosen discriminatory criteria of PSV greater than 10 cm/sec and RI greater than 0.65 yielded specificity for appendicitis of 94.7% and 96.5% with sensitivity of 88.9% and 63.9% (P = .013) and negative predictive value of 93.1% and 80.9% (P = .045), respectively. Original clinical graded compression US interpretations based on established US findings demonstrated specificity of 96.2% and sensitivity of 100.0%. Considering the subset of 20 patients whose maximum outer diameter measured 6-8 mm, the discriminatory criteria of PSV greater than 10 cm/sec and RI greater than 0.65 yielded specificity for appendicitis of 88.9% each, with sensitivity of 100.0% and 63.6% and negative predictive value of 100.0% and 66.6%, respectively. Conclusion In patients with visualized appendices at US, those with appendicitis exhibit significantly higher point PSV and point RI values than do patients without appendicitis and are distinguishable with high specificity by using a PSV greater than 10 cm/sec and an RI greater than 0.65 as diagnostic criteria. (©) RSNA, 2017.

    View details for DOI 10.1148/radiol.2017162251

    View details for PubMedID 28582634

  • Cholestyramine as a promising, strong anion exchange resin for direct capture of genetic biomarkers from raw pancreatic fluids BIOTECHNOLOGY AND BIOENGINEERING Hilmer, A. J., Jeffrey, R. B., Park, W. G., Khosla, C. 2017; 114 (4): 934-938

    Abstract

    The ability to capture cell-free DNA from the gastrointestinal tract, in a minimally invasive manner, could enhance our ability to diagnose gastrointestinal disease, or gain a better understanding of the spatial mapping of the intestinal microbiota. We, therefore, sought to identify a class of capture agents that could directly and efficiently sequester genetic material from intestinal fluids. As a particular case study, we examined the ability to capture DNA from pancreatic secretions, for potential application in enabling the sequestration of early, genetic biomarkers of pancreatic disease. We hypothesized that the cholestyramine series of strong cation exchange resins, which are FDA approved for the treatment of high cholesterol, may be capable of capturing DNA from pancreatic secretions. We identified a particular cholestyramine resin, DOWEX 1 × 2 100-200 mesh, which is able to efficiently capture and purify DNA from pancreatic fluid. Using only 200 μL of pancreatic secretions, we are able to recover 247 ± 182 ng of amplifiable human DNA, giving an estimated pancreatic fluid DNA content of 1.23 ± 0.91 ng/μL. To our knowledge, this is the first demonstration of a material that can effectively capture and purify DNA directly from untreated pancreatic fluids. Thus, our approach could hold high utility for the in vivo capture of DNA and disease biomarkers if incorporated into an appropriate sampling device. Biotechnol. Bioeng. 2016;9999: 1-5. © 2016 Wiley Periodicals, Inc.

    View details for DOI 10.1002/bit.26207

    View details for Web of Science ID 000395650600022

  • Doppler Ultrasound in Liver Cirrhosis: Correlation of Hepatic Artery and Portal Vein Measurements With Model for End-Stage Liver Disease Score JOURNAL OF ULTRASOUND IN MEDICINE Park, H. S., Desser, T. S., Jeffrey, R. B., Kamaya, A. 2017; 36 (4): 725-730
  • Imaging Pancreatic Cysts with CT and MRI. Digestive diseases and sciences Jeffrey, R. B. 2017

    Abstract

    CT and MRI are the imaging modalities of choice to guide the clinical management of incidentally discovered pancreatic cysts. Most of these lesions are mucinous cysts with varying degrees of malignant potential. This article reviews the CT and MRI findings that help differentiate a potentially aggressive lesion that requires EUS or surgery from a lesion of low malignant potential that is appropriate for imaging surveillance. The imaging-based societal guidelines for these cysts are reviewed.

    View details for DOI 10.1007/s10620-017-4501-6

    View details for PubMedID 28220262

  • Sonographic Differentiation of Complicated From Uncomplicated Appendicitis Implications for Antibiotics-First Therapy JOURNAL OF ULTRASOUND IN MEDICINE Xu, Y., Jeffrey, R. B., Chang, S. T., DiMaio, M. A., Olcott, E. W. 2017; 36 (2): 269-277

    Abstract

    To evaluate sonographic findings as indicators of complicated versus uncomplicated appendicitis in the setting of known appendicitis, a necessary distinction in deciding whether to proceed with antibiotic therapy or with appendectomy.With Institutional Review Board approval and Health Insurance Portability and Accountability Act compliance, appendiceal sonograms of 119 patients with histopathologically proven appendicitis were retrospectively blindly reviewed to determine the presence or absence of the normally echogenic submucosal layer, the presence of mural hyperemia, periappendiceal fluid, appendicoliths, and hyperechoic periappendiceal fat and to determine the maximum outside diameter. Results were compared with the presence of complicated versus uncomplicated appendicitis on histopathologic examination and assessed by both univariate and mulitvariate logistic regression; confidence intervals (CIs) of proportions were assessed by the exact binomial test.Thirty-two (26.9%) of the 119 patients had complicated appendicitis, including 11 with gangrenous appendicitis without perforation and 21 with gangrenous appendicitis and perforation. Loss of the submucosal layer was the only independent significant indicator of complicated appendicitis in multivariate regression (P < .001) and provided sensitivity and specificity values of 100.0% (95% CI, 89.1%-100.0%) and 92.0% (95% CI, 84.1%-96.7%), respectively.Loss of the normally echogenic submucosal layer was the most useful sonographic finding for discriminating complicated from uncomplicated appendicitis, being the only finding independently and significantly associated with complicated appendicitis and, additionally, providing both high sensitivity and high specificity. This information may help a physician decide whether to proceed with antibiotic therapy or with appendectomy when treating a patient with appendicitis.

    View details for DOI 10.7863/ultra.16.03109

    View details for Web of Science ID 000392290300004

    View details for PubMedID 28039865

  • Capsule Ultrasound Device: Characterization and Testing Results Wang, J., Memon, F., Touma, G., Baltsavias, S., Jang, J., Chang, C., Rasmussen, M., Olcott, E., Jeffrey, R., Arbabian, A., Khuri-Yakub, B. T., IEEE IEEE. 2017
  • Duodenal invasion by pancreatic adenocarcinoma: MDCT diagnosis of an aggressive imaging phenotype and its clinical implications. Abdominal radiology (New York) Patel, B. N., Olcott, E. W., Jeffrey, R. B. 2017

    Abstract

    Despite advances in oncologic and imaging technology, pancreatic ductal adenocarcinoma remains a highly deadly disease. The only curative option, pancreaticoduodenectomy or pancreatectomy, carries a significant morbidity. Current imaging plays a role in pre-operative staging to determine the probability of achieve disease-free margins. However, a small but not insignificant number of pancreatic cancers have a relatively higher aggressive biology, despite being resectable based on traditional criteria. Recently, imaging biomarkers that serve as a surrogate for tumors with such aggressive phenotype have been described. These include duodenal invasion and extrapancreatic perineural invasion. This review will focus on the former highlighting the summary of literature supporting duodenal invasion as a surrogate for aggressive disease as well as review its MDCT imaging features.

    View details for DOI 10.1007/s00261-017-1271-8

    View details for PubMedID 28770287

  • The utility of hepatic artery velocity in diagnosing patients with acute cholecystitis. Abdominal radiology (New York) Loehfelm, T. W., Tse, J. R., Jeffrey, R. B., Kamaya, A. 2017

    Abstract

    To test the diagnostic performance of elevated peak systolic hepatic arterial velocity (HAv) in the diagnosis of acute cholecystitis.229 patients with an ultrasound (US) performed for right upper quadrant (RUQ) pain were retrospectively reviewed. 35 had cholecystectomy within 10 days of ultrasound and were included as test subjects. 47 had normal US and serology and were included as controls. Each test patient US was reviewed for the presence of gallstones, gallbladder distention, sludge, echogenic pericholecystic fat, pericholecystic fluid, gallbladder wall thickening, gallbladder wall hyperemia, and reported sonographic Murphy sign. Demographic, clinical, and hepatic artery parameters at time of original imaging were recorded. Acute cholecystitis at pathology was the primary outcome variable.21 patients had acute cholecystitis and 14 had chronic cholecystitis by pathology. For patients who went to cholecystectomy, HAv ≥100 cm/s to diagnose acute cholecystitis was more accurate (69%) than the original radiology report (63%), the presence of gallstones (51%), and sonographic Murphy sign (50%). Statistically significant predictors of acute cholecystitis included HAv ≥100 cm/s (p = 0.008), older age (p = 0.012), and elevated WBC (p = 0.002), while gallstones (p = 0.077), hepatic artery resistive index (HARI) (p = 0.199), gallbladder distension (p = 0.252), sludge (p = 0.147), echogenic fat (p = 0.184), pericholecystic fluid (p = 0.357), wall thickening (p = 0.434), hyperemia (p = 0.999), and sonographic Murphy sign (p = 0.765) were not significantly correlated with acute cholecystitis compared to chronic cholecystitis.HAv ≥100 cm/s is a useful objective parameter that may improve the performance of US in the diagnosis of acute cholecystitis.

    View details for DOI 10.1007/s00261-017-1288-z

    View details for PubMedID 28840272

  • Doppler Ultrasound in Liver Cirrhosis: Correlation of Hepatic Artery and Portal Vein Measurements With Model for End-Stage Liver Disease Score. Journal of ultrasound in medicine Park, H. S., Desser, T. S., Jeffrey, R. B., Kamaya, A. 2016

    Abstract

    To determine whether hepatic arterial and portal venous Doppler ultrasound measurements of the liver in cirrhotic patients correlate with patients' Model for End-Stage Liver Disease (MELD) scores, splenomegaly, or ascites.Sonographic images and reports were reviewed of 264 patients with hepatic cirrhosis who underwent abdominal ultrasound with Doppler in this internal review board-approved retrospective study. MELD scores were recorded at the time of ultrasound. On gray-scale ultrasound, spleen length was measured and the presence of ascites was noted. Hepatic arterial velocity (HAv) with angle correction, hepatic arterial resistive index, and portal vein velocity with angle correction were measured on Doppler ultrasound. Correlation of hepatic arterial and portal venous Doppler values with MELD score, presence of splenomegaly, and presence of ascites was tested using linear or binary logistic regression analysis. Diagnostic performance of Doppler parameters for high-risk MELD was assessed.The HAv statistically significantly correlated with the MELD score (P = .0001), spleen size (P =.027), and presence of ascites (P =.0001), whereas the hepatic arterial resistive index and portal vein velocity did not correlate with these factors. For MELD scores greater than 19, an HAv greater than 120 cm/s showed accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 74, 42, 90, 67, and 76%, respectively. With an HAv greater than 160 cm/s, the odds ratio for MELD scores greater than 19 was 42.1.We found a statistically significant correlation with elevated HAv and increasing MELD scores, splenomegaly, and presence of ascites in patients with cirrhotic liver disease; this may be a useful imaging biomarker in the evaluation of patients with cirrhosis.

    View details for DOI 10.7863/ultra.16.03107

    View details for PubMedID 28026900

  • Clinical and imaging predictors of management in retained products of conception ABDOMINAL RADIOLOGY Kamaya, A., Krishnarao, P. M., Nayak, N., Jeffrey, R. B., Maturen, K. E. 2016; 41 (12): 2429-2434

    Abstract

    To determine if clinical and ultrasound (US) imaging features help predict management in clinically suspected retained products of conception (RPOC).334 patients sonographically evaluated for RPOC were included in this IRB-approved retrospective study. Of the 334 patients, 176 had sonographic diagnosis of RPOC and comprised the final study group. Patients were managed expectantly, medically, or surgically in accordance with clinical judgment of treating physicians. Pelvic sonograms were retrospectively reviewed for endometrial stripe thickness and vascularity was graded on a 0-3 scale based on appearance relative to myometrium (Grade 0: no vascularity, Grade 1: minimal vascularity, Grade 2: moderate vascularity, Grade 3: marked vascularity). Clinical and imaging predictors of management were evaluated in univariate and multivariate analysis.Mean patient age was 29.6 years and mean gestational age was 17.4 weeks. Most (74.4%) women presented with vaginal bleeding. 83 patients (47.2%) were treated conservatively with expectant management, 42 (23.8%) were treated medically, and 51 (29.0%) required surgical intervention. Mean endometrial stripe thickness was 21.3 mm. 47 women (26.7%) had vascularity score of 0; 50 (28.4%) had score 1; 52 (29.6%) had score 2; and 27 (15.3%) had score 3. In univariate analysis, serum hemoglobin (Hb) (p < 0.0001), endometrial stripe thickness on US (p < 0.005), presenting symptoms (p = 0.03), and US vascularity score (p < 0.005) were statistically significant predictors of final management. In multivariate logistic regression, serum Hb (OR 0.69, 95% CI 0.55-0.86, p < 0.0009), endometrial stripe thickness (OR 1.08, 95% CI 1.04-1.12, p < 0.0001), and US vascularity score (OR 1.77, 95% CI 1.16-2.70, p < 0.01) were statistically significant predictors of need for surgery.Serum Hb, endometrial stripe thickness, and US vascularity score were significant predictors of clinical management, particularly the need for surgical intervention, in women with clinically suspected RPOC.

    View details for DOI 10.1007/s00261-016-0954-x

    View details for Web of Science ID 000390050600015

    View details for PubMedID 27853850

  • Preoperative Multidetector CT Diagnosis of Extrapancreatic Perineural or Duodenal Invasion Is Associated with Reduced Postoperative Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma: Preliminary Experience and Implications for Patient Care RADIOLOGY Chang, S. T., Jeffrey, R. B., Patel, B. N., DiMaio, M. A., Rosenberg, J., Willmann, J. K., Olcott, E. W. 2016; 281 (3): 816-825

    Abstract

    Purpose To test the hypothesis that patients with pancreatic adenocarcinoma who otherwise are viewed to have resectable disease but have preoperative findings of extrapancreatic perineural invasion (EPNI) and/or duodenal invasion at multidetector computed tomography (CT) have reduced postoperative survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (PDAC). Materials and Methods This study was approved by the institutional review board and complied with HIPAA. The authors retrospectively evaluated 76 consecutive patients with PDAC who underwent preoperative multidetector CT and subsequent pancreaticoduodenectomy. Two radiologists blinded to surgical pathology results and clinical outcome evaluated multidetector CT images for evidence of EPNI and duodenal invasion; discrepancies were resolved by consensus. Also determined for each patient were resected lymph node status, tumor size, surgical margin status, time to progression, and time to death. Data were assessed with the Goodman-Kruskal gamma for correlations among indicators and the log-rank test, Kaplan-Meier estimates, and multivariate Cox proportional hazards regression for survival analysis. Results In univariate analysis, duodenal invasion and/or EPNI on preoperativemultidetector CT images was associated with significantly decreased progression-free survival (P < .0001) and overall survival (P = .0013), and the clinical indicators (lymph node status, tumor size, and surgical margin status) as well as duodenal invasion and/or EPNI showed correlation with each other. In multivariate regression that included multidetector CT findings as well as the three traditional clinical indicators, only duodenal invasion and/or EPNI showed significant independent association with reduction in both modes of survival (P < .0001 and P = .014, respectively). Interobserver agreement was substantial with respect to EPNI and duodenal invasion (κ = 0.691 and 0.682, respectively). Conclusion Patients with evidence of EPNI and/or duodenal invasion on preoperative multidetector CT images have significantly reduced survival after pancreaticoduodenectomy for PDAC. (©) RSNA, 2016.

    View details for DOI 10.1148/radiol.2016152790

    View details for Web of Science ID 000393201500015

    View details for PubMedID 27438167

  • Cholestyramine as a promising, strong anion exchange resin for direct capture of genetic biomarkers from raw pancreatic fluids. Biotechnology and bioengineering Hilmer, A. J., Jeffrey, R. B., Park, W. G., Khosla, C. 2016

    Abstract

    The ability to capture cell-free DNA from the gastrointestinal tract, in a minimally invasive manner, could enhance our ability to diagnose gastrointestinal disease, or gain a better understanding of the spatial mapping of the intestinal microbiota. We, therefore, sought to identify a class of capture agents that could directly and efficiently sequester genetic material from intestinal fluids. As a particular case study, we examined the ability to capture DNA from pancreatic secretions, for potential application in enabling the sequestration of early, genetic biomarkers of pancreatic disease. We hypothesized that the cholestyramine series of strong cation exchange resins, which are FDA approved for the treatment of high cholesterol, may be capable of capturing DNA from pancreatic secretions. We identified a particular cholestyramine resin, DOWEX 1 × 2 100-200 mesh, which is able to efficiently capture and purify DNA from pancreatic fluid. Using only 200 μL of pancreatic secretions, we are able to recover 247 ± 182 ng of amplifiable human DNA, giving an estimated pancreatic fluid DNA content of 1.23 ± 0.91 ng/μL. To our knowledge, this is the first demonstration of a material that can effectively capture and purify DNA directly from untreated pancreatic fluids. Thus, our approach could hold high utility for the in vivo capture of DNA and disease biomarkers if incorporated into an appropriate sampling device. Biotechnol. Bioeng. 2016;9999: 1-5. © 2016 Wiley Periodicals, Inc.

    View details for DOI 10.1002/bit.26207

    View details for PubMedID 27800600

  • Multidetector CT imaging of the pancreatic groove: differentiating carcinomas from paraduodenal pancreatitis CLINICAL IMAGING Shin, L. K., Jeffrey, R. B., Pai, R. K., Raman, S. P., Fishman, E. K., Olcott, E. W. 2016; 40 (6): 1246-1252

    Abstract

    This study aims to identify multidetector row CT (MDCT) findings that differentiate paraduodenal pancreatitis (PDP) from groove carcinomas (GC).Two radiologists retrospectively reviewed various imaging features on pancreas protocol CT scans of 8 PDP and 8 GC patients. Two-tailed Fisher's Exact Test was used for statistical analysis.MDCT findings correlating with PDP included benign common bile duct morphology (P<.01), duodenal wall thickening (P<.05), and cystic groove lesions (P<.01). A statistical difference in gastroduodenal artery (GDA) encasement was not observed (P=.119).There are several MDCT findings that favor PDP over GC. However, presence of GDA encasement is not a reliable distinguishing feature.

    View details for DOI 10.1016/j.clinimag.2016.08.004

    View details for Web of Science ID 000387529900029

    View details for PubMedID 27636383

  • Color Doppler Imaging of the Appendix: Criteria to Improve Specificity for Appendicitis in the Borderline-Size Appendix. Journal of ultrasound in medicine Xu, Y., Jeffrey, R. B., Shin, L. K., DiMaio, M. A., Olcott, E. W. 2016; 35 (10): 2129-2138

    Abstract

    To test the hypothesis that continuous intramural vascular signal measuring at least 3 mm on color Doppler imaging is highly specific for appendicitis in patients with diagnostically borderline-size appendices.Two blinded observers independently reviewed color Doppler images of the appendix in 94 consecutive patients who had undergone sonography for suspected appendicitis and whose appendices were of diagnostically borderline size (6-8 mm maximum outer diameter). Intramural vascular flow on color Doppler images was classified as absent, type 1 (only punctate and dispersed signal), or type 2 (continuous linear or curvilinear signal measuring at least 3.0 mm in long- or short-axis views). Histopathologic examination and clinical follow-up served as reference standards. Proportions were assessed by the exact binomial test.Of the 94 patients, 33 (35.1%) had type 1 flow (of whom 5 [15.2%] had appendicitis); 23 (24.5%) had type 2 flow (of whom 20 [87.0%] had appendicitis); and 38 (40.4%) had absent flow (of whom 10 [26.3%] had appendicitis). The sensitivity, specificity, and odds ratio of type 2 flow as an indicator of appendicitis were 57.1%, 94.9%, and 24.9 (P< .001), respectively; the corresponding values for type 1 flow as an indicator of normal appendices were and 47.5%, 85.7%, and 5.4 (P = .002).Continuous intramural linear or curvilinear signal measuring at least 3 mm on color Doppler imaging is a highly specific, although relatively insensitive, sign of acute appendicitis in noncompressible appendices of diagnostically borderline size (6-8 mm).

    View details for DOI 10.7863/ultra.15.11064

    View details for PubMedID 27562977

  • Secondary sclerosing cholangitis in a critically ill patient. Quantitative imaging in medicine and surgery Weiss, K. E., Willmann, J. K., Jeffrey, R. B., Desser, T. S. 2016; 6 (2): 224-228

    Abstract

    Critically ill patients are commonly imaged for liver dysfunction. An often fatal condition, secondary sclerosing cholangitis, is an important and likely under-recognized hepatic condition in these patients. In presenting this case report, we hope to raise awareness of this condition amongst radiologists as well as other physicians caring for the critically ill.

    View details for DOI 10.21037/qims.2016.04.04

    View details for PubMedID 27190777

    View details for PubMedCentralID PMC4858453

  • Lymphoid Hyperplasia of the Appendix: A Potential Pitfall in the Sonographic Diagnosis of Appendicitis AMERICAN JOURNAL OF ROENTGENOLOGY Xu, Y., Jeffrey, R. B., DiMaio, M. A., Olcott, E. W. 2016; 206 (1): 189-194

    Abstract

    The objective of this study was to test the hypothesis that thickening of the lamina propria, a finding produced by lymphoid hyperplasia, is significantly associated with false-positive sonographic diagnoses of appendicitis in 6- to 8-mm noncompressible appendixes.Sonograms of 119 consecutive patients with suspected appendicitis and 6- to 8-mm noncompressible appendixes were retrospectively blindly evaluated for thickening of the lamina propria (short axis thickness ≥ 1 mm). The reference standard for appendicitis was pathologic analysis of resected specimens. Results were compared with the two-tailed Fisher exact test.Thirty-one patients (26.1%) had a thickened lamina propria and 88 (73.9%) did not. Of the 27 pediatric patients with a thickened lamina propria, five (18.5%) had true-positive and 22 (81.5%) had false-positive sonograms for appendicitis; among the 55 pediatric patients without a thickened lamina propria, 27 (49.1%) had true-positive and 28 (50.9%) had false-positive sonograms for appendicitis (p = 0.009). Similar differences in adult patients were not statistically significant. All five pediatric patients with appendicitis and thickened lamina propria also showed two or more findings of periappendiceal fluid, hyperechoic periappendiceal fat, or mural hyperemia on color Doppler examination, compared with two of 22 similar pediatric patients without appendicitis (p < 0.001).Lymphoid hyperplasia may result in a noncompressible appendix 6-8 mm in diameter and may be misdiagnosed as appendicitis in pediatric patients. True-positive diagnoses of appendicitis can be accurately identified by the presence of at least two additional findings from the group of periappendiceal fluid, hyperechoic periappendiceal fat, and mural hyperemia. Identifying the characteristic sonographic appearance of lymphoid hyperplasia may help prevent false-positive misdiagnoses of appendicitis.

    View details for DOI 10.2214/AJR.15.14846

    View details for Web of Science ID 000367181400038

    View details for PubMedID 26700351

  • Sonographic Detection of Extracapsular Extension in Papillary Thyroid Cancer. Journal of ultrasound in medicine Kamaya, A., Tahvildari, A. M., Patel, B. N., Willmann, J. K., Jeffrey, R. B., Desser, T. S. 2015; 34 (12): 2225-2230

    Abstract

    To identify and evaluate sonographic features suggestive of extracapsular extension in papillary thyroid cancer.Three board-certified radiologists blinded to the final pathologic tumor stage reviewed sonograms of pathologically proven cases of papillary thyroid cancer for the presence of extracapsular extension. The radiologists evaluated the following features: capsular abutment, bulging of the normal thyroid contour, loss of the echogenic capsule, and vascularity extending beyond the capsule.A total of 129 cases of pathologically proven thyroid cancer were identified. Of these, 51 were excluded because of lack of preoperative sonography, and 16 were excluded because of pathologic findings showing anaplastic carcinoma, follicular carcinoma, or microcarcinoma (<10 mm). The final analysis group consisted of 62 patients with papillary thyroid carcinoma, 16 of whom had pathologically proven extracapsular extension. The presence of capsular abutment had 100% sensitivity for detection of extracapsular extension. Conversely, lack of capsular abutment had a 100% negative predictive value (NPV) for excluding extracapsular extension. Contour bulging had 88% sensitivity for detection of extracapsular extension and when absent had an 87% NPV. Loss of the echogenic capsule was the best predictor of the presence of extracapsular extension, with an odds ratio of 10.23 (P= .034). This sonographic finding had 75% sensitivity, 65% specificity, and an 88% NPV. Vascularity beyond the capsule had 89% specificity but sensitivity of only 25%.Sonographic features of capsular abutment, contour bulging, and loss of the echogenic thyroid capsule have excellent predictive value for excluding or detecting extracapsular extension and may help in biopsy selection, surgical planning, and treatment of patients with papillary thyroid cancer.

    View details for DOI 10.7863/ultra.15.02006

    View details for PubMedID 26518279

  • Combining in Vitro Diagnostics with in Vivo Imaging for Earlier Detection of Pancreatic Ductal Adenocarcinoma: Challenges and Solutions RADIOLOGY Laeseke, P. F., Chen, R., Jeffrey, R. B., Brentnall, T. A., Willmann, J. K. 2015; 277 (3): 644-661

    Abstract

    Pancreatic ductal adenocarcinoma (PDAC) is the fourth-leading cause of cancer-related death in the United States and is associated with a dismal prognosis, particularly when diagnosed at an advanced stage. Overall survival is significantly improved if PDAC is detected at an early stage prior to the onset of symptoms. At present, there is no suitable screening strategy for the general population. Available diagnostic serum markers are not sensitive or specific enough, and clinically available imaging modalities are inadequate for visualizing early-stage lesions. In this article, the role of currently available blood biomarkers and imaging tests for the early detection of PDAC will be reviewed. Also, the emerging biomarkers and molecularly targeted imaging agents being developed to improve the specificity of current imaging modalities for PDAC will be discussed. A strategy incorporating blood biomarkers and molecularly targeted imaging agents could lead to improved screening and earlier detection of PDAC in the future. (©) RSNA, 2015.

    View details for DOI 10.1148/radiol.2015141020

    View details for Web of Science ID 000369525100006

    View details for PubMedID 26599925

    View details for PubMedCentralID PMC4666099

  • MDCT Diagnosis of Perineural Invasion Involving the Celiac Plexus in Intrahepatic Cholangiocarcinoma: Preliminary Observations and Clinical Implications. AJR. American journal of roentgenology Raghavan, K., Jeffrey, R. B., Patel, B. N., DiMaio, M. A., Willmann, J. K., Olcott, E. W. 2015; 205 (6): W578-84

    Abstract

    The purpose of this study was to test the hypothesis that soft-tissue infiltration along the celiac plexus and delayed enhancement exceeding two-thirds of the tumor area on preoperative MDCT correlate with histologic evidence of perineural invasion in resected intrahepatic cholangiocarcinomas.Two experienced abdominal radiologists retrospectively reviewed preoperative multiphasic MDCT scans of 20 patients who underwent resection of intrahepatic cholangiocarcinoma, identifying soft-tissue infiltration along the celiac plexus, delayed enhancement exceeding two-thirds of the tumor area, and maximum tumor diameter. Consensus findings were compared with intratumoral perineural invasion in resected intrahepatic cholangiocarcinomas using the Fisher exact test.Six patients had histologic intratumoral perineural invasion, five of whom had soft-tissue infiltration along the celiac plexus on preoperative MDCT, with corresponding 83.3% sensitivity and 92.9% specificity for perineural invasion and significant association between these MDCT and histologic findings (p = 0.002). No patients with histologic perineural invasion had enhancement exceeding two-thirds of the tumor area on MDCT; sensitivity was 0.0% for this finding. Tumor diameter on MDCT was not significantly associated with perineural invasion at histopathology (p = 0.530).Soft-tissue infiltration along the celiac plexus on MDCT is an indicator of perineural invasion in patients with intrahepatic cholangiocarcinoma. The data did not confirm an association between delayed enhancement exceeding two-thirds of the tumor area and perineural invasion. Because perineural invasion from intrahepatic cholangiocarcinoma is associated with a very poor prognosis and is generally a contraindication to surgery, the MDCT diagnosis of celiac plexus perineural invasion in patients with intrahepatic cholangiocarcinoma may have important implications for prognosis and treatment planning.

    View details for DOI 10.2214/AJR.15.14607

    View details for PubMedID 26587947

  • MDCT Diagnosis of Perineural Invasion Involving the Celiac Plexus in Intrahepatic Cholangiocarcinoma: Preliminary Observations and Clinical Implications. AJR. American journal of roentgenology Raghavan, K., Jeffrey, R. B., Patel, B. N., DiMaio, M. A., Willmann, J. K., Olcott, E. W. 2015; 205 (6): W578-84

    View details for DOI 10.2214/AJR.15.14607

    View details for PubMedID 26587947

  • How the radiologist can add value in the evaluation of the pre- and post-surgical pancreas ABDOMINAL IMAGING Patel, B. N., Gupta, R. T., Zani, S., Jeffrey, R. B., Paulson, E. K., Nelson, R. C. 2015; 40 (8): 2932-2944
  • Variable color Doppler sonographic appearances of retained products of conception: radiologic-pathologic correlation. Abdominal imaging Kamaya, A., Krishnarao, P. M., Folkins, A. K., Jeffrey, R. B., Desser, T. S., Maturen, K. E. 2015; 40 (7): 2683-2689

    Abstract

    Retained products of conception (RPOC) displays variable vascularity, ranging from avascular to markedly vascular on color Doppler sonography. We hypothesize that variability in sonographic vascularity may be due to histopathologic variation in the placental tissue.After institutional review board approval, sonographic images and pathologic specimens were retrospectively reviewed in 26 patients with pathologically proven RPOC. Ultrasound (US) images were scored 0-3 for the degree of vascularity by two radiologists blinded to the diagnosis. Corresponding pathologic specimens were evaluated for vascularization of chorionic villi, degree of inflammation, morphology of maternal arteries, chorionic villous preservation, and percentage of clot, membranes, chorionic villi, and decidua/myometrium. Statistical analysis, including multiple linear regression, was performed.RPOC with histologically avascular chorionic villi or those with markedly reduced vascularization had significantly lower US vascularity scores (p = 0.030) than those with chorionic villi showing normal or decreased vascularization. Sonographically avascular RPOC had a significantly lower percentage villi (p = 0.028) and higher percentage of decidua (p = 0.004) than specimens where US showed any Doppler vascularity. Histologic vascularity of villi (p = 0.049) and non-observation of maternal arteries (p = 0.001) were significant predictors of US vascularity scores in multivariate linear regression analysis, while inflammation of villi (p = 0.053) was a marginally significant predictor.Histologic vascularity of villi appears to contribute to the observed variation in sonographic vascularity. This finding may underlie known differences in clinical outcomes between sonographic vascularity groups.

    View details for DOI 10.1007/s00261-015-0424-x

    View details for PubMedID 25862548

  • Predictors of appendicitis on computed tomography among cases with borderline appendix size. Emergency radiology Thompson, A. C., Olcott, E. W., Poullos, P. D., Jeffrey, R. B., Thompson, M. O., Rosenberg, J., Shin, L. K. 2015; 22 (4): 385-394

    Abstract

    Confident diagnosis of appendicitis when the appendix is borderline (6 to 7 mm) in size can be challenging. This retrospective study assessed computed tomography (CT) findings that are most predictive of appendicitis when the appendix is borderline in diameter. Three radiologists conducted separate, blind retrospective reviews of 105 contrast-enhanced CTs with borderline appendices. Presence or absence of appendicitis was confirmed by chart review of clinical or surgical outcomes. Logistic regression was used to determine the odds ratio (OR) and the receiver operating characteristic for CT features predictive of appendicitis. Absence of intraluminal air (OR = 5.11, p < 0.001), wall hyperemia (OR = 3.92, p = 0.002), wall thickening (OR = 29.7, p < 0.001), and fat stranding (OR = 3.85, p = 0.003) were significant findings in univariate logistic regression. Using a multivariate model, we found that the absence of intraluminal air (OR = 6.04, p = 0.002) and wall thickening (OR = 24.6, p < 0.001) remained statistically significant and were unaffected by adjustment for gender and pediatric age. The area under the curve was significantly greater for the multivariate model than the initial, clinical CT impressions (p = 0.024). The combination of wall thickening and absence of intraluminal air was 92.6 % (95 % CI 75.7-99.1) sensitive and 82.4 % (95 % CI 65.5-93.2) specific for appendicitis. Wall thickening and the absence of intraluminal air are prominent predictors of appendicitis and, if present together, these features may aid in identifying appendicitis on CT when the appendix is borderline in size.

    View details for DOI 10.1007/s10140-015-1297-6

    View details for PubMedID 25687166

  • Value of Intraoperative Sonography in Pancreatic Surgery JOURNAL OF ULTRASOUND IN MEDICINE Weinstein, S., Morgan, T., Poder, L., Shin, L., Jeffrey, R. B., Aslam, R., Yee, J. 2015; 34 (7): 1307-1318

    Abstract

    The utility of intraoperative sonography for pancreatic disease has been well described for detection and evaluation of neoplastic and inflammatory pancreatic disease.(1-8) Intraoperative sonography can help substantially reduce surgical time as well as decrease potential injury to tissues and major structures. Imaging with sonography literally at the point of care-the surgeon's scalpel-can precisely define the location of pancreatic lesions and their direct relationship with surrounding structures in real time during surgery. This article highlights our experience with intraoperative sonography at multiple institutional sites for both open and laparoscopic surgical procedures. We use intraoperative sonography for a wide range of pancreatic disease to provide accurate localization and staging of disease, provide guidance for enucleation of nonpalpable, nonvisible tumors, and in planning the most direct and least invasive surgical approach, avoiding injury to the pancreatic duct or other vital structures.

    View details for DOI 10.7863/ultra.34.7.1307

    View details for Web of Science ID 000357355100019

    View details for PubMedID 26112636

  • Atypical thyroid cancers on sonography. Ultrasound quarterly Klang, K., Kamaya, A., Tahvildari, A. M., Jeffrey, R. B., Desser, T. S. 2015; 31 (1): 69-74

    Abstract

    The management of thyroid nodules is a common clinical problem. Thyroid nodules are present in up to 50% of the adult population. However, thyroid malignancy is rare, occurring in only 5% to 15% of nodules. Although certain specific patterns on imaging are almost always indicative of benignity, there is considerable overlap between the sonographic appearances of benign and malignant nodules. Radiologists should be wary of applying pattern recognition approaches too liberally as some malignant nodules may exhibit sonographic features more commonly associated with benign nodules such as cystic change, comet-tail artifact, smooth margins, echogenic echotexture, hypoechoic halos, or peripheral calcifications. This article illustrates atypical imaging appearances of thyroid malignancies and reviews recent literature in an attempt to clarify nuances in the diagnosis of malignancy in benign-appearing nodules.

    View details for DOI 10.1097/RUQ.0000000000000079

    View details for PubMedID 25706368

  • The Alvarado Score as a Method for Reducing the Number of CT Studies When Appendiceal Ultrasound Fails to Visualize the Appendix in Adults AMERICAN JOURNAL OF ROENTGENOLOGY Jones, R. P., Jeffrey, R. B., Shah, B. R., Desser, T. S., Rosenberg, J., Olcott, E. W. 2015; 204 (3): 519-526

    Abstract

    OBJECTIVE. The purpose of this article is to evaluate the hypothesis that Alvarado scores of 3 or lower identify adult patients who are unlikely to benefit from CT after appendiceal ultrasound fails to show the appendix and is otherwise normal. MATERIALS AND METHODS. We identified 119 consecutive adults for whom the appendix was not seen on otherwise normal appendiceal sonography performed as the first imaging study for suspected appendicitis, who subsequently underwent CT within 48 hours, and whose data permitted retrospective calculation of admission Alvarado scores. Specific benefits of CT were defined as diagnoses of appendicitis or significant alternative findings, and specific benefits were compared between patients with Alvarado scores of 3 or less and 4 or higher. Significant alternative findings on CT were findings other than appendicitis that were treated with medical or surgical therapy during the admission or that were to be addressed during follow-up care. Diagnostic reference standards were discharge diagnoses, pathologic examinations, and clinical follow-up. RESULTS. No patients (0.0%, 0/49) with Alvarado scores 3 or lower had appendicitis, compared with 17.1% (12/70) of patients with Alvarado scores 4 or higher (p = 0.001), and CT showed neither appendicitis nor significant alternative findings in 85.7% (42/49) versus 58.6% (41/70) of these patients, respectively (p = 0.002). The rates of perforated appendicitis, as well as significant alternative CT findings, did not differ significantly. CONCLUSION. Adults with Alvarado scores 3 or lower who have nonvisualized appendixes and otherwise normal appendiceal sonography are at very low risk for appendicitis or significant alternative findings and therefore are not likely to benefit from CT.

    View details for DOI 10.2214/AJR.14.12864

    View details for Web of Science ID 000351598800030

  • JOURNAL CLUB: The Alvarado Score as a Method for Reducing the Number of CT Studies When Appendiceal Ultrasound Fails to Visualize the Appendix in Adults. AJR. American journal of roentgenology Jones, R. P., Jeffrey, R. B., Shah, B. R., Desser, T. S., Rosenberg, J., Olcott, E. W. 2015; 204 (3): 519-526

    Abstract

    OBJECTIVE. The purpose of this article is to evaluate the hypothesis that Alvarado scores of 3 or lower identify adult patients who are unlikely to benefit from CT after appendiceal ultrasound fails to show the appendix and is otherwise normal. MATERIALS AND METHODS. We identified 119 consecutive adults for whom the appendix was not seen on otherwise normal appendiceal sonography performed as the first imaging study for suspected appendicitis, who subsequently underwent CT within 48 hours, and whose data permitted retrospective calculation of admission Alvarado scores. Specific benefits of CT were defined as diagnoses of appendicitis or significant alternative findings, and specific benefits were compared between patients with Alvarado scores of 3 or less and 4 or higher. Significant alternative findings on CT were findings other than appendicitis that were treated with medical or surgical therapy during the admission or that were to be addressed during follow-up care. Diagnostic reference standards were discharge diagnoses, pathologic examinations, and clinical follow-up. RESULTS. No patients (0.0%, 0/49) with Alvarado scores 3 or lower had appendicitis, compared with 17.1% (12/70) of patients with Alvarado scores 4 or higher (p = 0.001), and CT showed neither appendicitis nor significant alternative findings in 85.7% (42/49) versus 58.6% (41/70) of these patients, respectively (p = 0.002). The rates of perforated appendicitis, as well as significant alternative CT findings, did not differ significantly. CONCLUSION. Adults with Alvarado scores 3 or lower who have nonvisualized appendixes and otherwise normal appendiceal sonography are at very low risk for appendicitis or significant alternative findings and therefore are not likely to benefit from CT.

    View details for DOI 10.2214/AJR.14.12864

    View details for PubMedID 25714280

  • Ischemic colitis due to a mesenteric arteriovenous malformation in a patient with a connective tissue disorder. Journal of radiology case reports Poullos, P. D., Thompson, A. C., Holz, G., Edelman, L. A., Jeffrey, R. B. 2014; 8 (12): 9-21

    Abstract

    Ischemic colitis is a rare, life-threatening, consequence of mesenteric arteriovenous malformations. Ischemia ensues from a steal phenomenon through shunting, and may be compounded by the resulting portal hypertension. Computed tomographic angiography is the most common first-line test because it is quick, non-invasive, and allows for accurate anatomic characterization. Also, high-resolution three-dimensional images can be created for treatment planning. Magnetic resonance angiography is similarly sensitive for vascular mapping. Conventional angiography remains the gold standard for diagnosis and also allows for therapeutic endovascular embolization. Our patient underwent testing using all three of these modalities. We present the first reported case of this entity in a patient with a vascular connective tissue disorder.

    View details for DOI 10.3941/jrcr.v8i12.1843

    View details for PubMedID 25926912

    View details for PubMedCentralID PMC4394977

  • Three-step sequential positioning algorithm during sonographic evaluation for appendicitis increases appendiceal visualization rate and reduces CT use. AJR. American journal of roentgenology Chang, S. T., Jeffrey, R. B., Olcott, E. W. 2014; 203 (5): 1006-1012

    Abstract

    The purpose of this article is to examine the rates of appendiceal visualization by sonography, imaging-based diagnoses of appendicitis, and CT use after appendiceal sonography, before and after the introduction of a sonographic algorithm involving sequential changes in patient positioning.We used a search engine to retrospectively identify patients who underwent graded-compression sonography for suspected appendicitis during 6-month periods before (period 1; 419 patients) and after (period 2; 486 patients) implementation of a new three-step positional sonographic algorithm. The new algorithm included initial conventional supine scanning and, as long as the appendix remained nonvisualized, left posterior oblique scanning and then "second-look" supine scanning. Abdominal CT within 7 days after sonography was recorded.Between periods 1 and 2, appendiceal visualization on sonography increased from 31.0% to 52.5% (p < 0.001), postsonography CT use decreased from 31.3% to 17.7% (p < 0.001), and the proportion of imaging-based diagnoses of appendicitis made by sonography increased from 63.8% to 85.7% (p = 0.002). The incidence of appendicitis diagnosed by imaging (either sonography or CT) remained similar at 16.5% and 17.3%, respectively (p = 0.790). Sensitivity and overall accuracy were 57.8% (95% CI, 44.8-70.1%) and 93.0% (95% CI, 90.1-95.3%), respectively, in period 1 and 76.5% (95% CI, 65.8-85.2%) and 95.4% (95% CI, 93.1-97.1%), respectively, in period 2. Similar findings were observed for adults and children.Implementation of an ultrasound algorithm with sequential positioning significantly improved the appendiceal visualization rate and the proportion of imaging-based diagnoses of appendicitis made by ultrasound, enabling a concomitant decrease in abdominal CT use in both children and adults.

    View details for DOI 10.2214/AJR.13.12334

    View details for PubMedID 25341138

  • The sonographic "bright band sign" of splenic infarction. Journal of ultrasound in medicine Llewellyn, M. E., Jeffrey, R. B., DiMaio, M. A., Olcott, E. W. 2014; 33 (6): 929-938

    Abstract

    To evaluate the frequency of the "bright band sign" in patients with splenic infarcts as well as control patients and to thereby assess whether the bright band sign has potential utility as a sonographic sign of splenic infarction.Using an electronic search engine and image review, 37 patients were retrospectively identified with noncystic parenchymal splenic infarcts on sonography. Nineteen abnormal control patients with noninfarcted splenic lesions on sonography and 100 normal control patients with sonographically normal spleens were also identified. The sonographic appearance of each splenic lesion was evaluated by 2 reviewers and assessed for the bright band sign, defined as thin specular reflectors perpendicular to the sound beam within hypoechoic parenchymal lesions, and for the presence or absence of the classic sonographic appearance of splenic infarction. Possible histologic counterparts of the bright band sign were assessed in archival infarct specimens.The bright band sign was present in 34 (91.9%; 95% confidence interval [CI], 78.1%-98.3%) of 37 patients with splenic infarcts on sonography, including 12 (85.7%; 95% CI, 57.2%-98.2%) of 14 with classic and 22 (95.7%; 95% CI, 78.1%-99.9%) of 23 with nonclassic infarct appearances. No normal or abnormal control patients had the bright band sign. Histologic sections suggested that preserved splenic trabeculae within infarcts may generate the bright band sign.The bright band sign is a potentially useful sonographic sign of splenic infarction, which may confer additional sensitivity and specificity and may be particularly helpful with infarcts having nonclassic appearances.

    View details for DOI 10.7863/ultra.33.6.929

    View details for PubMedID 24866600

  • Sonography of the normal appendix: its varied appearance and techniques to improve its visualization. Ultrasound quarterly Ung, C., Chang, S. T., Jeffrey, R. B., Patel, B. N., Olcott, E. W. 2013; 29 (4): 333-341

    Abstract

    The sonographic identification of the normal appendix is crucial to the success of ultrasound as an effective screening method for diagnosing acute appendicitis. The normal appendix can be challenging to identify on sonography, however, because it is a narrow tubular structure and has variable sonographic appearances. Moreover, the tip of the appendix can be quite variable in location. In this article, we review the various sonographic appearances of the normal appendix and highlight strategies to improve its visualization.

    View details for DOI 10.1097/RUQ.0b013e3182a2aa8e

    View details for PubMedID 24263759

  • The elusive parathyroid adenoma: techniques for detection. Ultrasound quarterly Devcic, Z., Jeffrey, R. B., Kamaya, A., Desser, T. S. 2013; 29 (3): 179-187

    Abstract

    The success of minimally invasive surgery for hyperparathyroidism depends on accurate preoperative localization of the hyperfunctioning adenoma with imaging. Ultrasound is an excellent initial modality because it has a high positive predictive value, sensitivity, and specificity, while being inexpensive and noninvasive without use of ionizing radiation. Determining the exact location and number of adenomas is essential, because these factors guide the surgical approach. The goal of this review article was to discuss specific sonographic techniques that can be applied to find even the elusive adenoma, which include (1) compression scanning, (2) color Doppler, (3) scanning regions where ectopic glands may be located, and (4) evaluating intrathyroidal adenomas.

    View details for DOI 10.1097/RUQ.0b013e3182a1ba6f

    View details for PubMedID 23975046

  • Ultrasonographic evaluation of malignant and normal cervical lymph nodes. Seminars in ultrasound, CT, and MR Giacomini, C. P., Jeffrey, R. B., Shin, L. K. 2013; 34 (3): 236-247

    Abstract

    Head and neck malignancies, including squamous cell carcinoma, lymphoma, and thyroid cancer, are a major cause of morbidity and mortality worldwide and frequently present with cervical lymphadenopathy. Distinguishing normal from malignant lymph nodes is critical for accurate staging, prognosis, and determination of optimal therapeutic options. Gray-scale, power, and color Doppler ultrasonography offers an inexpensive yet effective method in identifying abnormal cervical lymph nodes. Sonographic nodal features that should be assessed include size, shape, echotexture (including microcalcifications and cystic changes), presence of an echogenic hilus, and vascularity. Although no single sonographic feature can accurately distinguish malignant from normal nodes, a combination of these characteristics can help to make this determination.

    View details for DOI 10.1053/j.sult.2013.04.003

    View details for PubMedID 23768890

  • Physiologic, histologic, and imaging features of retained products of conception. Radiographics Sellmyer, M. A., Desser, T. S., Maturen, K. E., Jeffrey, R. B., Kamaya, A. 2013; 33 (3): 781-796

    Abstract

    Retained products of conception (RPOC) are a common and treatable complication after delivery or termination of pregnancy. The pathologic diagnosis of RPOC is made based on the presence of chorionic villi, which indicates persistent placental or trophoblastic tissue. In the setting of postpartum hemorrhage, however, distinguishing RPOC from bleeding related to normal postpartum lochia or uterine atony can be clinically challenging. Ultrasonographic (US) evaluation can be particularly helpful in these patients, and a thickened endometrial echo complex (EEC) or a discrete mass in the uterine cavity is a helpful gray-scale US finding that suggests RPOC. However, gray-scale US findings alone are inadequate for accurate diagnosis. Detection of vascularity in a thickened EEC or an endometrial mass at color or power Doppler US increases the positive predictive value for the diagnosis of RPOC. Computed tomography or magnetic resonance imaging may be helpful when US findings are equivocal and typically demonstrates an enhancing intracavitary mass in patients with RPOC. Diagnostic pitfalls are rare but may include highly vascular RPOC, which can be mistaken for a uterine arteriovenous malformation; true arteriovenous malformations of the uterus; invasive moles; blood clot; and subinvolution of the placental implantation site. © RSNA, 2013.

    View details for DOI 10.1148/rg.333125177

    View details for PubMedID 23674774

  • Extraglandular extension of parotid actinomycosis after sonographically guided fine-needle aspiration. Journal of ultrasound in medicine Nayak, L., DiMaio, M., Jeffrey, R. B. 2013; 32 (4): 715-716

    View details for PubMedID 23525398

  • Sonographic Evaluation of Cervical Lymph Nodes in Papillary Thyroid Cancer ULTRASOUND QUARTERLY Shin, L. K., Olcott, E. W., Jeffrey, R. B., Desser, T. S. 2013; 29 (1): 25-32

    Abstract

    Sonography is the modality of choice for imaging cervical lymph nodes in patients with papillary thyroid cancer, both before surgery and for postoperative surveillance. Sonography is also an invaluable tool to guide fine-needle aspiration of abnormal nodes. Microcalcifications, cystic changes, abnormal morphology, and disordered vascularity are features of metastatic nodal involvement with papillary thyroid carcinoma and should be sought during surveillance scans as well as in targeting for fine-needle aspiration.

    View details for DOI 10.1097/RUQ.0b013e31827c7a9e

    View details for Web of Science ID 000315449400004

    View details for PubMedID 23358214

  • Quantitatively Defining Washout in Hepatocellular Carcinoma AMERICAN JOURNAL OF ROENTGENOLOGY Liu, Y. I., Shin, L. K., Jeffrey, R. B., Kamaya, A. 2013; 200 (1): 84-89

    Abstract

    Washout on delayed phase (or equilibrium phase) imaging of an arterially hyperenhancing lesion is an excellent predictor of hepatocellular carcinoma (HCC). The purpose of our study was to quantitatively define washout in pathologically proven HCC. A quantitative definition of HCC may minimize interobserver variability and facilitate more accurate diagnosis.We identified 47 liver lesions that were hyperenhancing in the arterial phase from 24 patients who underwent triphasic MDCT as part of preoperative evaluation for liver transplantation. All HCCs were pathologically proven. Regions of interest were obtained of lesions and areas of adjacent liver on arterial, portal venous, and delayed phase images. Enhancement profiles were assessed by three radiologists.Of the 47 hypervascular lesions, 14 HCCs were identified. There was a statistically significant difference in percentage attenuation ratio (defined as 100 × ratio of attenuation of adjacent liver to that of the lesion) between lesions that were HCC (median percentage attenuation ratio, 121) and those that were not (median percentage attenuation ratio, 101) on delayed phase. Percentage attenuation ratio ≥ 107 on delayed phase imaging achieved maximal sensitivity (100%) with good specificity (75.8%), positive predictive value (PPV) (63.6%), and negative predictive value (NPV) (100%) in HCC detection. Percentage attenuation ratio also correlated well with radiologists' assessments of enhancement profiles of lesions (multinomial logistic regression McFadden R(2), 0.72; chi-square p, < 0.01).Our analysis of simple CT attenuation measurements indicates that percentage attenuation ratio offers excellent sensitivity, specificity, PPV, and NPV for HCC detection and very good correlation with radiologists' assessments of washout.

    View details for DOI 10.2214/AJR.11.7171

    View details for Web of Science ID 000312772200027

    View details for PubMedID 23255745

  • Three-dimensional volume-rendered multidetector CT imaging of the posterior inferior pancreaticoduodenal artery: its anatomy and role in diagnosing extrapancreatic perineural invasion CANCER IMAGING Patel, B. N., Giacomini, C., Jeffrey, R. B., Willmann, J. K., Olcott, E. 2013; 13 (4): 580-590
  • Three-dimensional volume-rendered multidetector CT imaging of the posterior inferior pancreaticoduodenal artery: its anatomy and role in diagnosing extrapancreatic perineural invasion. Cancer imaging Patel, B. N., Giacomini, C., Jeffrey, R. B., Willmann, J. K., Olcott, E. 2013; 13 (4): 580-590

    Abstract

    Extrapancreatic perineural spread in pancreatic adenocarcinoma contributes to poor outcomes, as it is known to be a major contributor to positive surgical margins and disease recurrence. However, current staging classifications have not yet taken extrapancreatic perineural spread into account. Four pathways of extrapancreatic perineural spread have been described that conveniently follow small defined arterial pathways. Small field of view three-dimensional (3D) volume-rendered multidetector computed tomography (MDCT) images allow visualization of small peripancreatic vessels and thus perineural invasion that may be associated with them. One such vessel, the posterior inferior pancreaticoduodenal artery (PIPDA), serves as a surrogate for extrapancreatic perineural spread by pancreatic adenocarcinoma arising in the uncinate process. This pictorial review presents the normal and variant anatomy of the PIPDA with 3D volume-rendered MDCT imaging, and emphasizes its role as a vascular landmark for the diagnosis of extrapancreatic perineural invasion from uncinate adenocarcinomas. Familiarity with the anatomy of PIPDA will allow accurate detection of extrapancreatic perineural spread by pancreatic adenocarcinoma involving the uncinate process, and may potentially have important staging implications as neoadjuvant therapy improves.

    View details for DOI 10.1102/1470-7330.2013.0051

    View details for PubMedID 24434918

  • Sonography for appendicitis: Nonvisualization of the appendix is an indication for active clinical observation rather than direct referral for computed tomography JOURNAL OF CLINICAL ULTRASOUND Stewart, J. K., Olcott, E. W., Jeffrey, R. B. 2012; 40 (8): 455-461

    Abstract

    To determine the prevalence of perforated and nonperforated appendicitis in patients with nonvisualization of the appendix on ultrasound (US) performed for suspected appendicitis, and to evaluate the value of CT in these patients.We analyzed 400 consecutive patients undergoing US for suspected appendicitis. Of these patients, 260 had nonvisualization of the appendix, but otherwise normal scans. We analyzed the clinical outcome in these patients to determine the prevalence of appendicitis, referrals for CT, and the contribution of CT in these patients.Of the 400 patients, 140 (35%) had either a normal (80 patients, 25%) or an abnormal appendix (60 patients, 15%); 260 (65%) had nonvisualization of the appendix. Overall 75 patients had appendicitis (18.8%) and 17 (4.3%) had appendicitis with perforation. Of the 260 patients with nonvisualization of the appendix, 14 patients (5.4%) had appendicitis and 2 were perforated (0.8%). The prevalence of perforated and nonperforated appendicitis in this group was significantly lower than the overall group (p < 0.001 and p < 0.01, respectively). Of these 260 patients, 101 patients (38.8%) had CT within 48 hours and 79 (78.2%) had normal scans.Patients with nonvisualization of the appendix on US, but otherwise normal scans, are at significantly lower risk for appendicitis, either perforated or nonperforated. Active clinical observation should be considered in these patients, rather than direct referral for CT.

    View details for DOI 10.1002/jcu.21928

    View details for Web of Science ID 000308645400001

    View details for PubMedID 22638942

  • F-18-FDG PET/CT Demonstration of a Liver Metastasis in a Patient With Papillary Thyroid Cancer CLINICAL NUCLEAR MEDICINE Mosci, C., McDougall, I. R., Jeffrey, R. B., Iagaru, A. 2012; 37 (9): E234-E236

    Abstract

    A 51-year-old woman with papillary thyroid cancer had recurrent disease. An unexpected FDG-avid hepatic metastasis was identified. Follow-up contrast-enhanced CT scan showed a hepatic lesion, compatible with malignancy. Histopathologic examination demonstrated metastatic carcinoma, consistent with thyroid primary. Few studies reported liver metastases originating from thyroid cancer on FDG PET. These were medullary thyroid carcinomas (MTC) or poorly differentiated cancers. There are no reports describing liver metastasis from PTC diagnosed by FDG PET/CT.

    View details for DOI 10.1097/RLU.0b013e318262ae07

    View details for Web of Science ID 000307808000007

    View details for PubMedID 22889801

  • Pancreatic Neuroendocrine Tumors: Radiographic Calcifications Correlate with Grade and Metastasis ANNALS OF SURGICAL ONCOLOGY Poultsides, G. A., Huang, L. C., Chen, Y., Visser, B. C., Pai, R. K., Jeffrey, R. B., Park, W. G., Chen, A. M., Kunz, P. L., Fisher, G. A., Norton, J. A. 2012; 19 (7): 2295-2303

    Abstract

    Studies to identify preoperative prognostic variables for pancreatic neuroendocrine tumor (PNET) have been inconclusive. Specifically, the prevalence and prognostic significance of radiographic calcifications in these tumors remains unclear.From 1998 to 2009, a total of 110 patients with well-differentiated PNET underwent surgical resection at our institution. Synchronous liver metastases present in 31 patients (28%) were addressed surgically with curative intent. Patients with high-grade PNET were excluded. The presence of calcifications in the primary tumor on preoperative computed tomography was recorded and correlated with clinicopathologic variables and overall survival.Calcifications were present in 16% of patients and were more common in gastrinomas and glucagonomas (50%), but never encountered in insulinomas. Calcified tumors were larger (median size 4.5 vs. 2.3 cm, P=0.04) and more commonly associated with lymph node metastasis (75 vs. 35%, P=0.01), synchronous liver metastasis (62 vs. 21%, P<0.01), and intermediate tumor grade (80 vs. 31%, P<0.01). On multivariate analysis of factors available preoperatively, calcifications (P=0.01) and size (P<0.01) remained independent predictors of lymph node metastasis. Overall survival after resection was significantly worse in the presence of synchronous liver metastasis (5-year, 64 vs. 86%, P=0.04), but not in the presence of radiographic calcifications.Calcifications on preoperative computed tomography correlate with intermediate grade and lymph node metastasis in well-differentiated PNET. This information is available preoperatively and supports the routine dissection of regional lymph nodes through formal pancreatectomy rather than enucleation in calcified PNET.

    View details for DOI 10.1245/s10434-012-2305-7

    View details for Web of Science ID 000305558000030

    View details for PubMedID 22396008

  • Adenocarcinoma of the uncinate process of the pancreas: MDCT patterns of local invasion and clinical features at presentation EUROPEAN RADIOLOGY Padilla-Thornton, A. E., Willmann, J. K., Jeffrey, R. B. 2012; 22 (5): 1067-1074

    Abstract

    To compare the multidetector CT (MDCT) patterns of local invasion and clinical findings at presentation in patients with adenocarcinoma of the uncinate process of the pancreas to patients with adenocarcinomas in the non-uncinate head of the pancreas.We evaluated the two cohorts for common duct and pancreatic duct dilatation, mesenteric vascular encasement, root of mesentery invasion, perineural invasion and duodenal invasion. In addition, we compared the clinical findings at presentation in both groups.Common duct (P < 0.001) and pancreatic duct dilatation (P = 0.001) were significantly less common in uncinate process adenocarcinomas than in the non-uncinate head of the pancreas. Clinical findings of jaundice (P = 0.01) and pruritis (P = 0.004) were significantly more common in patients with lesions in the non-uncinate head of the pancreas. Superior mesenteric artery encasement (P = 0.02) and perineural invasion (P = 0.001) were significantly more common with uncinate process adenocarcinomas.Owing to its unique anatomic location, adenocarcinomas within the uncinate process of the pancreas have significantly different patterns of both local invasion and clinical presentation compared to patients with carcinomas in the non-uncinate head of the pancreas. Key Points • SMA encasement and perineural invasion were more common with uncinate process adenocarcinomas. • Common bile duct and pancreatic duct dilatation were less common in uncinate process adenocarcinomas • Jaundice and pruritis were more common with lesions elsewhere in the pancreatic head.

    View details for DOI 10.1007/s00330-011-2339-4

    View details for Web of Science ID 000303875900015

    View details for PubMedID 22124777

  • MR Enterography in Crohn Disease With Endoscopic Correlation: Protocol, Pearls, and Pitfalls Annual Meeting of the American-Roentgen-Ray-Society Jones, R., Olcott, E., Shah, S., Jeffrey, R., Do, B., Shin, L. AMER ROENTGEN RAY SOC. 2012
  • Pancreatic Cancer: Radiologic Imaging GASTROENTEROLOGY CLINICS OF NORTH AMERICA Jeffrey, R. B. 2012; 41 (1): 159-?

    View details for DOI 10.1016/j.gtc.2011.12.012

    View details for Web of Science ID 000301989100012

    View details for PubMedID 22341256

  • Multidetector Computed Tomography Triphasic Evaluation of the Liver Before Transplantation: Importance of Equilibrium Phase Washout and Morphology for Characterizing Hypervascular Lesions JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY Liu, Y. I., Kamaya, A., Jeffrey, R. B., Shin, L. K. 2012; 36 (2): 213-219

    Abstract

    We aim to identify the sensitivity and positive predictive value (PPV) of arterial phase imaging in detecting hepatocellular carcinoma (HCC) and determine the added value of portal venous and equilibrium phase imaging and lesion morphology characterization.We reviewed all patients who underwent liver transplantation at our institution that had a triphasic multidetector computed tomography examination within 6 months of transplantation. Forty-seven hypervascular lesions were identified in 24 patients. Imaging findings were correlated with explant pathologic correlation.Hypervascularity in the arterial phase resulted in sensitivity of 87.5% and PPV of 29.8%. The presence of washout in the equilibrium phase increased the PPV to 92.9% with a slight decrease in sensitivity (81.3%). The negative predictive value of hypervascular lesions without washout in the equilibrium phase was 97.1%. There was significant correlation between larger lesions and HCC and between round lesions and HCC.The presence of washout in the equilibrium phase is a better indicator of malignancy.

    View details for DOI 10.1097/RCT.0b013e318247c8f0

    View details for Web of Science ID 000302141800011

    View details for PubMedID 22446362

  • Incidentally discovered solid pancreatic masses: imaging and clinical observations ABDOMINAL IMAGING Goodman, M., Willmann, J. K., Jeffrey, R. B. 2012; 37 (1): 91-97

    Abstract

    The purpose of this study was to review the CT findings and clinical outcome in patients with incidentally discovered solid pancreatic masses.Over an 8-year period, from 2001 to 2009, we identified 24 patients with solid pancreatic masses incidentally detected by CT. There were 13 females and 11 males, with a mean age of 67 years. We determined the indication for initial CT, analyzed the CT features, and ascertained the clinical follow-up in all the patients.All of the solid masses were malignant. There were 14 adenocarcinomas and 10 neuroendocrine tumors. The most common indications for the initial CT were surveillance of an extrapancreatic malignancy (n = 10) and evaluation for hematuria (n = 6). On the initial CT, 16 of the patients (67%) had a clearly visible pancreatic mass. In eight patients isoattenuating masses were identified, only recognized by subtle signs including unexplained dilatation of the pancreatic duct (n = 5) or minimal contour deformity or density of the pancreas (n = 3). The mean survival time for the patients with adenocarcinoma was 21.6 months, and 42 months for the patients with neuroendocrine tumors.Although uncommon, incidentally discovered solid pancreatic masses are malignant neoplasms, either ductal adenocarcinomas or neuroendocrine tumors. Unlike incidentally discovered small cystic lesions, solid pancreatic lesions are often biologically aggressive.

    View details for DOI 10.1007/s00261-011-9720-2

    View details for Web of Science ID 000299890300011

    View details for PubMedID 21394600

  • Antiangiogenic and Radiation Therapy Early Effects on In Vivo Computed Tomography Perfusion Parameters in Human Colon Cancer Xenografts in Mice INVESTIGATIVE RADIOLOGY Ren, Y., Fleischmann, D., Foygel, K., Molvin, L., Lutz, A. M., Koong, A. C., Jeffrey, R. B., Tian, L., Willmann, J. K. 2012; 47 (1): 25-32

    Abstract

    To assess early treatment effects on computed tomography (CT) perfusion parameters after antiangiogenic and radiation therapy in subcutaneously implanted, human colon cancer xenografts in mice and to correlate in vivo CT perfusion parameters with ex vivo assays of tumor vascularity and hypoxia.Dynamic contrast-enhanced CT (perfusion CT, 129 mAs, 80 kV, 12 slices × 2.4 mm; 150 μL iodinated contrast agent injected at a rate of 1 mL/min intravenously) was performed in 100 subcutaneous human colon cancer xenografts on baseline day 0. Mice in group 1 (n=32) received a single dose of the antiangiogenic agent bevacizumab (10 mg/kg body weight), mice in group 2 (n=32) underwent a single radiation treatment (12 Gy), and mice in group 3 (n=32) remained untreated. On days 1, 3, 5, and 7 after treatment, 8 mice from each group underwent a second CT perfusion scan, respectively, after which tumors were excised for ex vivo analysis. Four mice were killed after baseline scanning on day 0 for ex vivo analysis. Blood flow (BF), blood volume (BV), and flow extraction product were calculated using the left ventricle as an arterial input function. Correlation of in vivo CT perfusion parameters with ex vivo microvessel density and extent of tumor hypoxia were assessed by immunofluorescence. Reproducibility of CT perfusion parameter measurements was calculated in an additional 8 tumor-bearing mice scanned twice within 5 hours with the same CT perfusion imaging protocol.The intraclass correlation coefficients for BF, BV, and flow extraction product from repeated CT perfusion scans were 0.93 (95% confidence interval: 0.78, 0.97), 0.88 (0.66, 0.95), and 0.88 (0.56, 0.95), respectively. Changes in perfusion parameters and tumor volumes over time were different between treatments. After bevacizumab treatment, all 3 perfusion parameters significantly decreased from day 1 (P ≤ 0.006) and remained significantly decreased until day 7 (P ≤ 0.008); tumor volume increased significantly only on day 7 (P=0.04). After radiation treatment, all 3 perfusion parameters decreased significantly on day 1 (P < 0.001); BF and flow extraction product increased again on day 3 and 5, although without reaching statistically significant difference; and tumor volumes did not change significantly at all time points (P ≥ 0.3). In the control group, all 3 perfusion parameters did not change significantly, whereas tumor volume increased significantly at all the time points, compared with baseline (P ≤ 0.04). Ex vivo immunofluorescent staining showed good correlation between all 3 perfusion parameters and microvessel density (ρ=0.71, 0.66, and 0.69 for BF, BV, and flow extraction product, respectively; P < 0.001). There was a trend toward negative correlation between extent of hypoxia and all 3 perfusion parameters (ρ=-0.53, -0.47, and -0.40 for BF, BV, and flow extraction product, respectively; P ≥ 0.05).CT perfusion allows a reproducible, noninvasive assessment of tumor vascularity in human colon cancer xenografts in mice. After antiangiogenic and radiation therapy, BF, BV, and flow extraction product significantly decrease and change faster than the tumor volume.

    View details for DOI 10.1097/RLI.0b013e31823a82f6

    View details for Web of Science ID 000298400100006

    View details for PubMedID 22178893

  • Common Incidental Findings on MDCT: Survey of Radiologist Recommendations for Patient Management JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY Johnson, P. T., Horton, K. M., Megibow, A. J., Jeffrey, R. B., Fishman, E. K. 2011; 8 (11): 762-767

    Abstract

    The aim of this study was to evaluate for agreement with respect to how radiologists report incidental findings encountered on CT.A multiple-choice survey was designed to query radiologists about how they handle 12 incidental findings on body CT, assuming the patient is a 45-year-old woman with no history of malignancy. Included were a 1-cm thyroid nodule, a 5-mm noncalcified lung nodule, coronary artery calcification, a 2-cm adrenal nodule, a 2-cm pancreatic cyst, a 1-cm enhancing liver lesion, a 2-cm high-density renal cyst, short-segment small bowel intussusception, a 1-cm splenic cyst, focal gallbladder wall calcification, and a 3-cm ovarian cyst in both a premenopausal woman and a postmenopausal woman. Choices ranged from "do not report" to advising interventional procedures tailored to the organ. Surveys were administered to body CT attending radiologists at 3 academic institutions.Twenty-seven radiologists completed the survey. The mean experience level was 15.7 years after training. Seventy percent or greater agreement on interpretation was identified for only 6 findings: recommend ultrasound for a 1-cm thyroid nodule, recommend ultrasound for a 3-cm cyst in postmenopausal woman, follow Fleischner Society recommendations for a 5-mm lung nodule, describe only coronary calcification, and describe as likely benign both short-segment small bowel intussusception and a 1-cm splenic cyst.Agreement is lacking, both across institutions and within departments, for the management of 6 commonly encountered incidental findings on body CT. Individual departments should develop internal guidelines to ensure consistent recommendations based on existing evidence.

    View details for DOI 10.1016/j.jacr.2011.05.012

    View details for Web of Science ID 000306202100008

    View details for PubMedID 22051458

  • Multidetector computed tomography of acute vascular injury in blunt abdominal/pelvic trauma: imaging predictors of treatment EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY Sims, M. E., Shin, L. K., Rosenberg, J., Jeffrey, R. B. 2011; 37 (5): 525-532

    Abstract

    The purpose of this study was to analyze the multidetector computed tomography (MDCT) morphologic characteristics of non-aortic acute vascular injuries (AVI) in patients with blunt abdominopelvic trauma that predict treatment.CT scans of 65 trauma patients with non-aortic AVI were reviewed. AVI morphology was categorized as linear or round. The organ of involvement, location of hemorrhage, initial size of hematoma, and hemodynamic status were recorded. Expansion rates of the hematoma were calculated in 40 patients who had delayed imaging. Multivariate regression was used to analyze the morphologic features of AVI and treatment.Patients with linear AVI were four times more likely to require aggressive treatment (surgery or embolization) than those with a round morphology, independent of the hemodynamic status. There was no main effect of the organ involved, location of hemorrhage, initial bleed size, or expansion rate on the probability of aggressive treatment.The location, initial size, and expansion rate of AVI are not significant predictors of aggressive treatment with surgery or embolization. Linear morphology of AVI, however, is more likely to require aggressive treatment than round AVI, independent of the hemodynamic status. Linear AVI likely reflects a spurting jet of active extravasation, whereas round AVI likely represents a pseudoaneurysm or slow bleed.

    View details for DOI 10.1007/s00068-011-0075-8

    View details for Web of Science ID 000296292000013

  • Complicated Cholecystitis The Complementary Roles of Sonography and Computed Tomography ULTRASOUND QUARTERLY Charalel, R. A., Jeffrey, R. B., Shin, L. K. 2011; 27 (3): 161-170

    Abstract

    Acute cholecystitis is a common cause of abdominal pain in the Western world. Unless treated promptly, patients with acute cholecystitis may develop complications such as gangrenous, perforated, or emphysematous cholecystitis. Because of the increased morbidity and mortality of complicated cholecystitis, early diagnosis and treatment are essential for optimal patient care. Nevertheless, complicated cholecystitis may pose significant challenges with cross-sectional imaging, including sonography and computed tomography (CT). Interpreting radiologists should be familiar with the spectrum of sonographic findings seen with complicated cholecystitis and as well as understand the complementary role of CT. Worrisome imaging findings for complicated cholecystitis include intraluminal findings (sloughed mucosa, hemorrhage, abnormal gas), gallbladder wall abnormalities (striations, asymmetric wall thickening, abnormal gas, loss of sonoreflectivity and contrast enhancement), and pericholecystic changes (echogenic fat, pericholecystic fluid, abscess formation). Finally, diagnosis of complicated cholecystitis by sonography and CT can guide alternative treatments including minimally invasive percutaneous and endoscopic options.

    View details for Web of Science ID 000297527400004

    View details for PubMedID 21873853

  • A Prospective Study of Total Gastrectomy for CDH1-Positive Hereditary Diffuse Gastric Cancer ANNALS OF SURGICAL ONCOLOGY Chen, Y., Kingham, K., Ford, J. M., Rosing, J., Van Dam, J., Jeffrey, R. B., Longacre, T. A., Chun, N., Kurian, A., Norton, J. A. 2011; 18 (9): 2594-2598

    Abstract

    Hereditary diffuse gastric cancer (HDGC) is an autosomal dominant cancer syndrome. Up to 30% of families with HDGC have mutations in the E-cadherin gene, CDH1. The role of prophylactic versus therapeutic gastrectomy for HDGC was studied prospectively.Eighteen consecutive patients with CDH1 mutations and positive family history were studied prospectively, including 13 without and 5 with symptoms. Proportions were compared by Fisher's exact test, and survival by the Breslow modification of the Wilcoxon rank-sum test.Each patient underwent total gastrectomy (TG), and 17 (94%) were found to have signet ring cell adenocarcinoma. Twelve of 13 asymptomatic patients had T1, N0 cancer, and only 2/12 (16%) had it diagnosed preoperatively despite state-of-the-art screening methods. Each asymptomatic patient did well postoperatively, and no patient has recurred. For five symptomatic patients, each (100%) was found to have signet ring cell adenocarcinoma (P = 0.002 versus asymptomatic) by preoperative endoscopy; three (60%) had lymph node involvement and two (40%) had distant metastases at time of operation. Two-year survival was 100% for asymptomatic and 40% for symptomatic patients (P < 0.01).The data show that asymptomatic patients with family history of HDGC and CDH1 mutation have high probability of having signet ring cell adenocarcinoma of the stomach that is not able to be diagnosed on endoscopy; when symptoms arise, the diagnosis can be made by endoscopy, but they have metastases and decreased survival. Surveillance endoscopy is of limited value, and prophylactic gastrectomy (PG) is recommended for patients with family history of HDGC and CDH1 mutations.

    View details for DOI 10.1245/s10434-011-1648-9

    View details for Web of Science ID 000294346700027

    View details for PubMedID 21424370

  • Pathologic Continuum of Acute Appendicitis Sonographic Findings and Clinical Management Implications ULTRASOUND QUARTERLY Chan, L., Shin, L. K., Pai, R. K., Jeffrey, R. B. 2011; 27 (2): 71-79

    Abstract

    Appendicitis is one of the most common causes of the acute abdomen often requiring emergent surgery. Delayed diagnosis leads to the progression of uncomplicated appendicitis to complicated (gangrenous, perforated) appendicitis, often changing clinical management. Computed tomography and ultrasound are imaging modalities of choice to preoperatively diagnose appendicitis. Recent concerns of radiation exposure and cost have renewed interest in using ultrasound as an initial, diagnostic study. A sonographic pictorial and histopathologic review of the continuum of appendicitis is presented. A comprehensive sonographic examination of the appendix should investigate the size (maximal diameter), the echogenic submucosal layer integrity, the mural color Doppler signature, the presence of a fecalith, and the periappendiceal changes. Features of an uncomplicated appendicitis include size greater than 6 to 7 mm, hyperemia on color Doppler, mural thickening, and an intact echogenic submucosal layer. Gangrenous appendicitis is characterized by loss of the echogenic submucosal layer with absent color Doppler flow. Loculated pericecal fluid, prominent pericecal fat, and circumferential loss of the submucosal layer are suggestive of perforation. Sonographic staging can triage management of appendicitis by directing urgent laparoscopic appendectomy for uncomplicated appendicitis, open appendectomy for complicated appendicitis, and conservative management (antibiotics with percutaneous drainage) for perforated appendicitis with abscess formation.

    View details for Web of Science ID 000297527300002

    View details for PubMedID 21606789

  • Non-emergency small bowel obstruction: assessment of CT findings that predict need for surgery EUROPEAN RADIOLOGY Deshmukh, S. D., Shin, D. S., Willmann, J. K., Rosenberg, J., Shin, L., Jeffrey, R. B. 2011; 21 (5): 982-986

    Abstract

    To identify CT findings predictive of surgical management in non-emergency small bowel obstruction (SBO).Contrast-enhanced abdominal CT of 129 patients with non-emergency SBO were evaluated for small bowel luminal diameter, wall thickness, presence of the small bowel faeces sign (intraluminal particulate matter in a dilated small bowel) and length, transition point, submucosal oedema, mesenteric stranding, ascites and degree of obstruction (low grade partial, high grade partial and complete obstruction). Medical records were reviewed for age, gender, management and history of abdominal surgery, abdominal malignancy, or SBO. Statistical analyses were performed with Stata Release 9.2.Degree of obstruction was the only predictor of need for surgery. Whereas 18.0% of patients with low-grade partial obstruction (n = 50) underwent surgery, 32.5% of patients with high-grade partial obstruction (n = 77) and 100% of patients with complete obstruction (n = 2) required surgery (P = 0.004). The small bowel faeces sign was inversely predictive of surgery (P = 0.018).In non-emergency SBO patients with contrast-enhanced CT imaging, grade of obstruction predicts surgery, while the small bowel faeces sign inversely predicts need for surgery.

    View details for DOI 10.1007/s00330-010-1983-4

    View details for Web of Science ID 000289291100011

    View details for PubMedID 20963444

  • Foreign Objects Encountered in the Abdominal Cavity at CT RADIOGRAPHICS Gayer, G., Petrovitch, I., Jeffrey, R. B. 2011; 31 (2): 409-U156

    Abstract

    Foreign objects are not infrequently seen at computed tomography (CT) of the abdomen and pelvis and may pose a diagnostic challenge to the radiologist, who must recognize the object, characterize its nature and location, and determine its clinical significance. Most foreign objects are incidentally detected at CT, but they may mimic a wide range of pathologic conditions. Some foreign objects (eg, an object that has been swallowed either intentionally or unintentionally) are the cause of the patient's signs and symptoms and require prompt medical attention. Other objects, such as a sponge or surgical instrument that has been retained postoperatively, may have medicolegal consequences. Furthermore, certain objects, such as intentionally concealed drug packets, may go undetected unless a high degree of suspicion exists and appropriate window settings are used to review the study. The radiologist should be familiar with the wide range of foreign objects that may be encountered at abdominopelvic CT, be able to recognize them promptly, and understand their implications for patient treatment.

    View details for DOI 10.1148/rg.312105123

    View details for Web of Science ID 000288533500011

    View details for PubMedID 21415187

  • Recurrence in the Thyroidectomy Bed: Sonographic Findings AMERICAN JOURNAL OF ROENTGENOLOGY Kamaya, A., Gross, M., Akatsu, H., Jeffrey, R. B. 2011; 196 (1): 66-70

    Abstract

    The purpose of this article is to characterize sonographic features of differentiated thyroid cancer recurrence in the thyroidectomy bed.Patients referred for biopsy of thyroidectomy bed lesions between February 2006 and December 2009 were identified. Patient data and gray-scale and color Doppler features were recorded.Results of ultrasound-guided biopsies of 30 nodules in 27 patients were reviewed. Twenty-five lesions yielded diagnostic findings, including 22 recurrences in 19 patients and three benign lesions in three patients. Five biopsies were nondiagnostic. Among the 22 recurrences, 21 (95%) were hypoechoic and one (5%) was mixed hypoechoic and hyperechoic on gray-scale imaging. On Doppler imaging, 100% of recurrences had detectable vascularity. Eight lesions (36%) had microcalcifications, and five (23%) had coarse calcifications; the average long-axis dimension was 1.5 cm. Of the five nondiagnostic lesions, four (80%) were hypoechoic, one (20%) was isoechoic, one (20%) had microcalcifications, none had coarse calcifications, and two (40%) had vascularity; the average long-axis dimension was 0.6 cm. Of the negative lesions, three (100%) were hypoechoic, two (66%) had vascularity, and two (66%) had coarse calcifications. No microcalcifications were seen, and the average long-axis dimension was 2 cm. Serum thyroglobulin (Tg) or anti-Tg antibodies were elevated in 12 (63%) of 19 patients with recurrence (eight [42%] with elevated Tg levels and four [21%] with elevated anti-Tg antibody levels).An ultrasound finding of a hypoechoic thyroidectomy bed lesion with internal vascularity and size greater than 6 mm is highly sensitive in predicting recurrence. Serum Tg levels were less sensitive than ultrasound in detection of recurrence in the thyroidectomy bed.

    View details for DOI 10.2214/AJR.10.4474

    View details for Web of Science ID 000286018800009

    View details for PubMedID 21178048

  • Sonography and Computed Tomography of the Mimics of Appendicitis ULTRASOUND QUARTERLY Shin, L. K., Jeffrey, R. B. 2010; 26 (4): 201-210

    Abstract

    There are numerous entities that can mimic acute appendicitis. Ultrasound and computed tomography are the most common first-line, cross-sectional imaging modalities in the acute care setting. Ideally, imaging will either confirm appendicitis or exclude it by identifying a normal appendix. In the latter scenario, an alternate diagnosis can frequently be established that range from genitourinary, gastrointestinal, to even abdominal wall processes. Imaging is especially helpful in cases of patients presenting with atypical signs/symptoms for acute appendicitis and those presenting with a classic presentation where an alternative diagnosis is determined. The correct diagnosis will allow the most appropriate clinical management and therapy; specifically, avoiding nonindicated surgery is essential. Common and uncommon mimics of acute appendicitis are discussed with specific attention to their sonographic and computed tomographic appearances.

    View details for Web of Science ID 000297527100003

    View details for PubMedID 21084934

  • Incidental Thyroid Nodules on Chest CT: Review of the Literature and Management Suggestions AMERICAN JOURNAL OF ROENTGENOLOGY Ahmed, S., Horton, K. M., Jeffrey, R. B., Sheth, S., Fishman, E. K. 2010; 195 (5): 1066-1071

    Abstract

    This article will review the current literature regarding the detection of thyroid nodules with an emphasis on CT diagnosis. We will also discuss management strategies.With advances in cross-sectional imaging, the detection of incidental thyroid nodules has increased significantly. Detection of thyroid nodules is common on chest CT that is being performed for unrelated reasons. The workup of these nodules can be timeconsuming and expensive.

    View details for DOI 10.2214/AJR.10.4506

    View details for Web of Science ID 000283295300016

    View details for PubMedID 20966308

  • 3-D Deep Penetration Photoacoustic Imaging with a 2-D CMUT Array. Proceedings. IEEE Ultrasonics Symposium Ma, T., Kothapalli, S. R., Vaithilingam, S., Oralkan, O., Kamaya, A., Wygant, I. O., Zhuang, X., Gambhir, S. S., Jeffrey, R. B., Khuri-Yakub, B. T. 2010; 2010: 375-377

    Abstract

    In this work, we demonstrate 3-D photoacoustic imaging of optically absorbing targets embedded as deep as 5 cm inside a highly scattering background medium using a 2-D capacitive micromachined ultrasonic transducer (CMUT) array with a center frequency of 5.5 MHz. 3-D volumetric images and 2-D maximum intensity projection images are presented to show the objects imaged at different depths. Due to the close proximity of the CMUT to the integrated frontend circuits, the CMUT array imaging system has a low noise floor. This makes the CMUT a promising technology for deep tissue photoacoustic imaging.

    View details for PubMedID 22977296

    View details for PubMedCentralID PMC3438520

  • Interpatient Variability of Enhancement of Five Abdominal Organs in Triphasic MDCT 110th Annual Meeting of the American-Roentgen-Ray-Society Liu, Y., Shin, L., Jeffrey, R., Kamaya, A. AMER ROENTGEN RAY SOC. 2010
  • What Defines Hepatic "Washout" in Triphasic MDCT? 110th Annual Meeting of the American-Roentgen-Ray-Society Liu, Y., Shin, I., Jeffrey, R., Kamaya, A. AMER ROENTGEN RAY SOC. 2010
  • The Fat Triangle Sign: improving diagnostic accuracy of extraperitoneal bladder rupture ABDOMINAL IMAGING Gross, M., Mindelzun, R., Jeffrey, R. B. 2010; 35 (2): 253-255

    View details for DOI 10.1007/s00261-009-9502-2

    View details for Web of Science ID 000276510000020

    View details for PubMedID 19259726

  • MR colonography and MR enterography. Gastrointestinal endoscopy clinics of North America Shin, L. K., Poullos, P., Jeffrey, R. B. 2010; 20 (2): 323-346

    Abstract

    The bowel is a common site for pathologic processes, including malignancies and inflammatory disease. Colorectal cancer accounts for 10% of all new cancers and 9% of cancer deaths. A significant decrease in the incidence of colorectal cancer and cancer death rates has been attributed to screening measures, earlier detection, and improved therapies. Virtual colonoscopy (VC), also known as computed tomography colonography, is an effective method for detecting polyps. However, in light of increasing concerns about ionizing radiation exposure from medical imaging and potential increased risk of future radiation-induced malignancies, magnetic resonance imaging (MRI) is seen as an increasingly attractive alternative. Improvements in MRI technology now permit three-dimensional volumetric imaging of the entire colon in a single breath hold at high spatial resolution, making VC with MRI possible.

    View details for DOI 10.1016/j.giec.2010.02.010

    View details for PubMedID 20451820

  • Pathways of Extrapancreatic Perineural Invasion by Pancreatic Adenocarcinoma: Evaluation With 3D Volume-Rendered MDCT Imaging AMERICAN JOURNAL OF ROENTGENOLOGY Deshmukh, S. D., Willmann, J. K., Jeffrey, R. B. 2010; 194 (3): 668-674

    Abstract

    The purpose of this article is to familiarize radiologists with the common pathways of extrapancreatic perineural invasion of pancreatic adenocarcinoma and to highlight the potential value of 3D volume-rendered MDCT in its diagnosis.The perineural plexuses closely follow peripancreatic vessels, which are well depicted by contrast-enhanced 3D volume-rendered imaging, thus facilitating the diagnosis of extrapancreatic perineural invasion of pancreatic adenocarcinoma.

    View details for DOI 10.2214/AJR.09.3285

    View details for Web of Science ID 000274741100020

    View details for PubMedID 20173143

  • Pearls and Pitfalls in Hepatic Ultrasonography ULTRASOUND QUARTERLY Shin, D. S., Jeffrey, R. B., Desser, T. S. 2010; 26 (1): 17-25

    Abstract

    Ultrasonography is often the initial imaging study in patients who present with right upper quadrant abdominal complaints. However, due to its intrinsic technical limitations, ultrasonography generally has a lower sensitivity than contrast-enhanced computed tomography or magnetic resonance imaging in detecting hepatic lesions. In this review, we describe several subtle sonographic signs that suggest the presence of an otherwise inconspicuous focal liver lesion, including disease in the pleural space or the lung parenchyma, refractive edge shadows, distorted or absent venous landmarks, abnormal Doppler patterns, and venous thrombosis. When encountered, these features should trigger careful evaluation of the adjacent areas for abnormalities and may warrant further studies with computed tomography, magnetic resonance imaging, or positron emission tomography. We also summarize common sonographic findings of diffuse liver diseases, including fatty infiltration and cirrhosis.

    View details for Web of Science ID 000297526800003

    View details for PubMedID 20216191

  • Solid Pseudopapillary Tumor of the Pancreas: An Unexpected Finding After Minor Abdominal Trauma DIGESTIVE DISEASES AND SCIENCES Cisco, R., Jeffrey, R. B., Norton, J. A. 2010; 55 (2): 240-241

    View details for DOI 10.1007/s10620-009-1030-y

    View details for Web of Science ID 000273520900004

    View details for PubMedID 19890713

  • The dangling diaphragm sign: sensitivity and comparison with existing CT signs of blunt traumatic diaphragmatic rupture. Emergency radiology Desser, T. S., Edwards, B., Hunt, S., Rosenberg, J., Purtill, M. A., Jeffrey, R. B. 2010; 17 (1): 37-44

    Abstract

    The objectives of our study were to describe a new CT sign of diaphragmatic injury, the "dangling diaphragm" sign, and assess its comparative utility relative to other signs in the diagnosis of diaphragmatic injury resulting from blunt trauma. CT scans of 16 blunt trauma patients (12 men and four women, mean age 36.6 years old) with surgically proven diaphragmatic injury and 32 blunt trauma patients (24 men and eight women; mean age 37.4 years old) without evidence of diaphragmatic injury at surgery were blindly reviewed by three board certified radiologists specializing in body imaging. Studies were evaluated for the presence of established signs of diaphragmatic injury, as well as the dangling diaphragm sign, in which the free edge of the torn hemidiaphragm curls inward from its normal course parallel to the body wall. The sensitivity and specificity of each sign were determined, as were the correlation between the signs and the interobserver agreement in evaluation of these findings. The radiologists' overall impression as to whether rupture was present was also recorded. In select cases, coronal and/or sagittal reformatted images were available, and they were reviewed following evaluation of the original axial images. Any change in interpretation due to these images was noted. The sensitivity of the radiologists' overall impression for detection of diaphragmatic injury was 77%, with 98% specificity. Individual signs of diaphragmatic injury had sensitivities ranging from 44% to 69%, with specificities of 98% to 100%. The dangling diaphragm sign had a sensitivity of 54% and a specificity of 98%, similar to the other signs. Multiple signs were present in most cases of diaphragmatic injury, and coronal and sagittal reformatted images had little impact. Diaphragmatic injury remains a challenging radiographic diagnosis. The dangling diaphragm is a conspicuous sign of diaphragmatic injury, and awareness of it may increase detection of diaphragmatic injury on CT studies.

    View details for DOI 10.1007/s10140-009-0819-5

    View details for PubMedID 19449046

  • Metastatic Squamous Cell Carcinoma Presenting as Diffuse and Punctate Cervical Lymph Node Calcifications Sonographic Features and Utility of Sonographically Guided Fine-Needle Aspiration Biopsy JOURNAL OF ULTRASOUND IN MEDICINE Shin, L. K., Fischbein, N. J., Kaplan, M. J., Jeffrey, R. B. 2009; 28 (12): 1703-1707

    Abstract

    The purpose of this series was to show the sonographic appearance of calcified cervical lymph nodes and the utility of sonographically guided fine-needle aspiration biopsy (FNAB) in the setting of metastatic squamous cell carcinoma (SCC).Two cases of confirmed metastatic SCC to cervical lymph nodes were identified. Sonography and sonographically guided FNAB were performed in both cases with positron emission tomography (PET)/computed tomography (CT) correlation.In case 1, sonography identified a diffusely calcified, avascular cervical lymph node. Positron emission tomography/CT suggested granulomatous disease as a cause for hypermetabolism; however, sonographically guided FNAB identified metastatic SCC. In the second case, FNAB initially performed without sonographic guidance did not show malignancy. Subsequent FNAB with sonographic guidance identified an abnormal cervical lymph node with focal calcifications and internal color Doppler flow. Metastatic SCC was diagnosed on histopathologic examination. Subsequent PET/CT confirmed multiple punctate calcifications in a hypermetabolic lymph node.Calcifications in cervical lymph nodes from metastatic SCC are very rare. These 2 cases show the variable sonographic appearances and the utility of sonographically guided FNAB in establishing the correct diagnosis.

    View details for Web of Science ID 000272375100015

    View details for PubMedID 19933485

  • Three-Dimensional Photoacoustic Imaging Using a Two-Dimensional CMUT Array IEEE TRANSACTIONS ON ULTRASONICS FERROELECTRICS AND FREQUENCY CONTROL Vaithilingam, S., Ma, T., Furukawa, Y., Wygant, I. O., Zhuang, X., de la Zerda, A., Oralkan, O., Kamaya, A., Gambhir, S. S., Jeffrey, R. B., Khuri-Yakub, B. T. 2009; 56 (11): 2411-2419

    Abstract

    In this paper, we describe using a 2-D array of capacitive micromachined ultrasonic transducers (CMUTs) to perform 3-D photoacoustic and acoustic imaging. A tunable optical parametric oscillator laser system that generates nanosecond laser pulses was used to induce the photoacoustic signals. To demonstrate the feasibility of the system, 2 different phantoms were imaged. The first phantom consisted of alternating black and transparent fishing lines of 180 mum and 150 mum diameter, respectively. The second phantom comprised polyethylene tubes, embedded in chicken breast tissue, filled with liquids such as the dye indocyanine green, pig blood, and a mixture of the 2. The tubes were embedded at a depth of 0.8 cm inside the tissue and were at an overall distance of 1.8 cm from the CMUT array. Two-dimensional cross-sectional slices and 3-D volume rendered images of pulse-echo data as well as photoacoustic data are presented. The profile and beamwidths of the fishing line are analyzed and compared with a numerical simulation carried out using the Field II ultrasound simulation software. We investigated using a large aperture (64 x 64 element array) to perform photoacoustic and acoustic imaging by mechanically scanning a smaller CMUT array (16 x 16 elements). Two-dimensional transducer arrays overcome many of the limitations of a mechanically scanned system and enable volumetric imaging. Advantages of CMUT technology for photoacoustic imaging include the ease of integration with electronics, ability to fabricate large, fully populated 2-D arrays with arbitrary geometries, wide-bandwidth arrays and high-frequency arrays. A CMUT based photoacoustic system is proposed as a viable alternative to a piezoelectric transducer based photoacoustic systems.

    View details for DOI 10.1109/TUFFC.2009.1329

    View details for Web of Science ID 000271478600010

    View details for PubMedID 19942528

  • Appendiceal hyperemia and/or distention is not always appendicitis: appendicitis mimicry in the pediatric population CLINICAL IMAGING Price, R. O., Jeffrey, R. B., Vasanawala, S. S. 2009; 33 (5): 402-405

    Abstract

    Appendicitis is the most common surgical cause of acute abdominal pain in the pediatric population. Several conditions can mimic the clinical presentation of appendicitis, leaving imaging as an essential modality to uncover the etiology, yet under certain circumstances, it can be misleading. Here, we present three cases where findings on multidetector computerized tomography scans supported the diagnosis of appendicitis, yet an alternate cause was found. These cases highlight a particular pitfall of satisfaction of search.

    View details for DOI 10.1016/j.clinimag.2009.01.010

    View details for Web of Science ID 000269764400014

    View details for PubMedID 19712824

  • Early Sonographic Diagnosis of Intrauterine Device Migration to the Adnexa JOURNAL OF CLINICAL ULTRASOUND Deshmukh, S., Ghanouni, P., Jeffrey, R. B. 2009; 37 (7): 414-419

    Abstract

    Uterine perforation is an uncommon complication of intrauterine devices (IUDs). Perforating IUDs can migrate to various locations but paradoxically are rarely found in ovaries or broad ligament. We describe an unusual case of a 23-year-old woman 1-month postpartum with an IUD translocation to the right adnexa. The IUD was inserted only 1 week prior to presentation, and she experienced pain on insertion. After visualization by ultrasound, the IUD was laparoscopically removed. We suggest early use of ultrasound in cases of potential IUD migration, particularly in high-risk patients and when IUD insertion causes pain.

    View details for DOI 10.1002/jcu.20591

    View details for Web of Science ID 000269365100011

    View details for PubMedID 19484740

  • Evaluation of periampullary pathology with CT volumetric oblique coronal reformations. AJR. American journal of roentgenology Pham, D. T., Hura, S. A., Willmann, J. K., Nino-Murcia, M., Jeffrey, R. B. 2009; 193 (3): W202-8

    Abstract

    The purpose of this article is to show the value of volumetric oblique coronal reformation of CT data sets for assessing the normal anatomy and abnormalities of the ampulla of Vater.Volumetric oblique coronal reformations are a useful noninvasive method to provide diagnostic information about periampullary abnormalities as well as show secondary features important for local staging and management. The technique is also valuable in providing a time-efficient method to review pertinent findings with clinicians.

    View details for DOI 10.2214/AJR.08.2069

    View details for PubMedID 19696260

  • Acute gastrointestinal bleeding: the potential role of 64 MDCT and 3D imaging in the diagnosis. Emergency radiology Horton, K. M., Jeffrey, R. B., Federle, M. P., Fishman, E. K. 2009; 16 (5): 349-356

    Abstract

    Advancements in both CT scanner technology and three-dimensional (3D) imaging software have now made it feasible to image patients with acute GI bleeding in an effort to identify the bleeding source. This pictorial essay will explore the potential role of utilizing 64 MDCT and 3D imaging in patients presenting with acute gastrointestinal bleeding. A discussion of current technology, appropriate CT protocols, and interpretation strategies will be included.

    View details for DOI 10.1007/s10140-009-0798-6

    View details for PubMedID 19221816

  • Retained Products of Conception Spectrum of Color Doppler Findings JOURNAL OF ULTRASOUND IN MEDICINE Kamaya, A., Petrovitch, I., Chen, B., Frederick, C. E., Jeffrey, R. B. 2009; 28 (8): 1031-1041

    Abstract

    The purpose of this study was to characterize color Doppler imaging features of retained products of conception (RPOC) with gray scale correlation.Clinically suspected cases of RPOC between January 2005 and February 2008 were reviewed. Patient data and relevant color Doppler and gray scale features were recorded.A total of 269 patients referred for sonographic evaluation for RPOC were identified. Thirty-five patients had confirmed pathologic diagnoses, 28 of whom had RPOC. In those with RPOC, 5 (18%) were avascular (type 0); 6 (21%) had minimal vascularity (type 1); 12 (43%) had moderate vascularity (type 2); and 5 (18%) had marked vascularity (type 3). Peak systolic velocities ranged from 10 to 108 cm/s (average, 36.1 cm/s). Resistive indices in arterial waveforms ranged from 0.33 to 0.7 (average, 0.5). Five (45%) of the patients with type 0 vascularity had RPOC; 6 (86%) of those with type 1 had RPOC; and 17 (100%) of those with types 2 and 3 had RPOC. An echogenic mass had a moderate positive predictive value (80%) but low sensitivity (29%) for RPOC.Color Doppler evaluation of the endometrium is helpful in determining the presence of RPOC. Endometrial vascularity is highly correlated with RPOC, whereas the lack of vascularity can be seen in both intrauterine clots and avascular RPOC.

    View details for Web of Science ID 000268556800008

    View details for PubMedID 19643786

  • Massive Extra-adrenal Retroperitoneal Paraganglioma: Pre-operative Embolization and Resection DIGESTIVE DISEASES AND SCIENCES Rosing, J. H., Jeffrey, R. B., Longacre, T. A., Greco, R. S. 2009; 54 (8): 1621-1624

    View details for DOI 10.1007/s10620-009-0804-6

    View details for Web of Science ID 000267485400002

    View details for PubMedID 19408117

  • Subinvolution of the Placental Site JOURNAL OF ULTRASOUND IN MEDICINE Petrovitch, I., Jeffrey, R. B., Heerema-McKenney, A. 2009; 28 (8): 1115-1119

    View details for Web of Science ID 000268556800021

    View details for PubMedID 19643799

  • Differentiating a Benign From Malignant Liver Lesion in the Pretransplant Cirrhotic Liver on Triphasic MDCT: When to Worry, When to Relax? 109th Annual Meeting of the American-Roentgen-Ray-Society Liu, Y., Shin, L., Kamaya, A., Jeffrey, R. AMER ROENTGEN RAY SOC. 2009
  • Intraoperative Ultrasound of the Pancreas ULTRASOUND QUARTERLY Shin, L. K., Brant-Zawadzki, G., Kamaya, A., Jeffrey, R. B. 2009; 25 (1): 39-48

    Abstract

    Intraoperative ultrasound provides spatial resolution of the pancreas superior to computed tomography, magnetic resonance imaging, and transabdominal sonography. This pictorial essay will review common benign and malignant pancreatic processes including the following: pancreatic ductal adenocarcinoma, pancreatitis, endocrine tumors, mucinous cystic neoplasm, intraductal papillary mucinous neoplasm, serous cystadenoma, and solid pseudopapillary tumor. The use of intraoperative ultrasound in specific surgical situations will be discussed, which include the following: (1) identification of insulinoma(s) which are not detectable preoperatively, (2) identification of the pancreatic duct to determine dissection planes for chronic pancreatitis surgery (eg, Puestow procedure) and for tumor resection, and (3) staging purposes for malignant disease.

    View details for Web of Science ID 000208118300005

    View details for PubMedID 19276960

  • Management of Biliary Strictures Following Liver Transplantation DIGESTIVE DISEASES AND SCIENCES Alexopoulos, S. P., Henningsen, J. A., Jeffrey, R. B., Bonham, C. A., Ahmed, A., Gonzalez, S. A. 2009; 54 (1): 25-27

    View details for DOI 10.1007/s10620-008-0626-y

    View details for Web of Science ID 000261653400007

    View details for PubMedID 19034649

  • Imaging of hepatic infections. Ultrasound quarterly Benedetti, N. J., Desser, T. S., Jeffrey, R. B. 2008; 24 (4): 267-278

    Abstract

    Hepatic infections include pyogenic and amebic abscesses and fungal and parasitic diseases. Entry of the infectious organisms into the liver can occur by hematogenous spread via the portal vein or hepatic artery, ascension of the infection from the biliary tract, or from trauma. Worldwide, liver abscess is most often caused by Entamoeba histolytica, but in the developed world, pyogenic liver abscess is more common. Fungal infection is most often seen in immunosuppressed chemotherapy patients, whereas parasitic infections are seen in patients with recent travel to endemic areas of Asia, Africa, and South America. Imaging, and in particular ultrasound, plays a crucial role in following patients from treatment to resolution of disease.We review the ultrasound and computed tomographic findings and the clinical features that are characteristic of hepatic pyogenic abscess, amebic abscess, fungal infection, and parasitic infection.

    View details for DOI 10.1097/RUQ.0b013e31818e5981

    View details for PubMedID 19060716

  • An unusual imaging and clinical presentation of papillary thyroid carcinoma JOURNAL OF ULTRASOUND IN MEDICINE Liu, Y. I., Shin, L. K., Kamaya, A., Jeffrey, R. B. 2008; 27 (8): 1241-1244

    View details for Web of Science ID 000258088100015

    View details for PubMedID 18645084

  • Risk-reducing total gastrectomy for germline mutations in E-cadherin (CDH1): pathologic findings with clinical implications. American journal of surgical pathology Rogers, W. M., Dobo, E., Norton, J. A., Van Dam, J., Jeffrey, R. B., Huntsman, D. G., Kingham, K., Chun, N., Ford, J. M., Longacre, T. A. 2008; 32 (6): 799-809

    Abstract

    Hereditary diffuse gastric cancer is a rare autosomal dominant cancer susceptibility syndrome caused by germline E-cadherin (CDH1) mutations in 40% of cases with a high degree of penetrance. Screening endoscopy has not been useful in identifying early cancer, in part owing to conflicting data concerning site(s) of involvement in the stomach and the lack of endoscopically detectable pathology. Risk-reducing total gastrectomy specimens from 8 asymptomatic adults with germline mutations in the CDH1 gene (3 different pedigrees) were studied using a sequential serial sectioning protocol with submission of the entire stomach for histologic analysis. The presence, size, and distribution of signet ring cell clusters were determined for each section and geographic maps of the invasive foci were constructed and compared with gastrectomy specimens from patients with germline E-cadherin mutation and symptomatic gastric cancer. All but 1 of the asymptomatic patients with germline mutations in the CDH1 gene had negative endoscopic screening. All risk-reducing gastrectomy specimens were macroscopically normal. All contained multiple foci (mean, 10.9) of microscopic intramucosal signet ring cell carcinoma confined to the superficial gastric mucosa; no invasion of submucosa was identified. In situ carcinoma was present in 6/8 cases. The majority of signet ring foci were located in the proximal one third of the stomach, most within oxyntic-type mucosa. The number and size of foci were not related to age, but there was a trend toward more severe disease burden in women. Stomachs from the symptomatic group of patients with germline CDH1 mutations exhibited infiltrative foci with higher Ki-67 labeling that extended well beyond the superficial mucosa. In addition, while superficial signet ring cancer exhibited decreased or absent E-cadherin and beta-catenin protein expression in all cases studied, deeply invasive signet ring cancer showed reversion to E-cadherin and beta-catenin protein expression in a subset of mutation carriers. Our study indicates that superficial intramucosal signet ring carcinoma, although widespread, is predominantly located in the proximal one third of the stomach in patients with E-cadherin gene mutations. The observed site predilection suggests a possible role for geographically targeted endoscopic surveillance biopsy in patients who elect to delay surgical intervention.

    View details for DOI 10.1097/PAS.0b013e31815e7f1a

    View details for PubMedID 18391748

  • Techniques for thyroid FNA: A Synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference National-Cancer-Institute Conference on Thyroid Fine-Needle Aspiration State of the Science Pitman, M. B., Abele, J., Ali, S. Z., Duick, D., Elsheikh, T. M., Jeffrey, R. B., Powers, C. N., Randolph, G., Renshaw, A., Scoutt, L. WILEY-BLACKWELL. 2008: 407–24

    Abstract

    The National Cancer Institute (NCI) sponsored the NCI Thyroid fine-needle aspiration (FNA) State of the Science Conference on October 22-23, 2007 in Bethesda, MD. The 2-day meeting was accompanied by a permanent informational website and several on-line discussion periods between May 1 and December 15, 2007 (http://thyroidfna.cancer.gov). This document summarizes matters addressing manual and ultrasound guided FNA technique and related issues. Specific topics covered include details regarding aspiration needles, devices, and methods, including the use of core needle biopsy; the pros and cons of anesthesia; the influence of thyroid lesion location, size, and characteristics on technique; the role of ultrasound in the FNA of a palpable thyroid nodule; the advantages and disadvantages of various specialists performing a biopsy; the optimal number of passes and tissue preparation methods; sample adequacy criteria for solid and cystic nodules, and management of adverse reactions from the procedure. (http://thyroidfna.cancer.gov/pages/info/agenda/)

    View details for DOI 10.1002/dc.20829

    View details for Web of Science ID 000256652000010

    View details for PubMedID 18478608

  • CT of pancreas: minimum intensity projections ABDOMINAL IMAGING Salles, A., Nino-Murcia, M., Jeffrey, R. B. 2008; 33 (2): 207-213

    Abstract

    The purpose of this pictorial essay is to showcase the use of minimum intensity projection in the imaging of low attenuation structures such as the pancreatic duct.Minimum intensity projection is a valuable adjunct to other processing techniques for the diagnosis and staging of pancreatic adenocarcinoma and cystic tumors of the pancreas.

    View details for DOI 10.1007/s00261-007-9212-6

    View details for Web of Science ID 000254847000014

    View details for PubMedID 17387537

  • High predictive value of pancreatic protocol CT as the only preoperative staging in pancreatic cancer 15th Workshop on Information Technology and Systems (WITS 2005) Cisco, R. M., Jeffrey, R. B., Greco, R. S., NORTON, J. A. SPRINGER. 2008: 88–88
  • Investigating Large 2D Arrays for Photoacoustic and Acoustic Imaging using CMUT Technology IEEE Ultrasonics Symposium Vaithilingam, S., Ma, T., Furukawa, Y., Oralkan, O., Kamaya, A., Torashima, K., Kupnik, M., Wygant, I. O., Zhuang, X., Jeffrey, R. B., Khuri-Yakub, B. T. IEEE. 2008: 1238–1241
  • Molecular imaging techniques in body imaging RADIOLOGY Margolis, D. J., Hoffman, J. M., Herfkens, R. J., Jeffrey, R. B., Quon, A., Gambhir, S. S. 2007; 245 (2): 333-356

    Abstract

    Molecular imaging of the body involves new techniques to image cellular biochemical processes, which results in studies with high sensitivity, specificity, and signal-to-background. The most prevalently used molecular imaging technique in body imaging is currently fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET). FDG PET has become the method of choice for the staging and restaging of many of the most common cancers, including lymphoma, lung cancer, breast cancer, and colorectal cancer. FDG PET has also become extremely valuable in monitoring the response to therapeutic drugs in many cancers. New PET agents, such as fluorothymidine and acetate, have also shown promise in the evaluation of response to therapy and in the staging of prostate cancer. Magnetic resonance (MR) spectroscopy has shown promise in the evaluation of prostate cancer. Breast cancer evaluation benefits from advances in spectroscopic imaging and contrast-enhanced kinetic evaluation of vascular permeability, which is altered in neoplastic processes because of release of angiogenic factors. Superparamagnetic iron oxide (SPIO) particles represent the first of an expanding line of MR contrast agents that target specific cellular processes. SPIO particles have also been used in the evaluation of the cirrhotic liver and at MR lymphangiography.

    View details for DOI 10.1148/radiol.2452061117

    View details for Web of Science ID 000250343800007

    View details for PubMedID 17940297

  • CDH1 truncating mutations in the E-cadherin gene - An indication for total gastrectomy to treat hereditary diffuse gastric cancer ANNALS OF SURGERY Norton, J. A., Ham, C. M., Van Dam, J., Jeffrey, R. B., Longacre, T. A., Huntsman, D. G., Chun, N., Kurian, A. W., Ford, J. M. 2007; 245 (6): 873-879

    Abstract

    Approximately 1% to 3% of all gastric cancers are associated with families exhibiting an autosomal dominant pattern of susceptibility. E-cadherin (CDH1) truncating mutations have been shown to be present in approximately 30% of families with hereditary diffuse gastric cancer (HDGC) and are associated with a significantly increased risk of gastric cancer and lobular breast cancer.Individuals from a large kindred with HDGC who were identified to have a CDH1 mutation prospectively underwent comprehensive screening with stool occult blood testing, standard upper gastrointestinal endoscopy with random gastric biopsies, high-magnification endoscopy with random gastric biopsies, endoscopic ultrasonography, CT, and PET scans to evaluate the stomach for occult cancer. Subsequently, they each underwent total gastrectomy with D-2 node dissection and Roux-en-Y esophagojejunostomy. The stomach and resected lymph nodes were evaluated pathologically.Six patients were identified as CDH1 carriers from a single family. There were 2 men and 4 women. The mean age was 54 years (range, 51-57 years). No patient had any signs or symptoms of gastric cancer. Exhaustive preoperative stomach evaluation was normal in each case, and the stomach and adjacent lymph nodes appeared normal at surgery. However, each patient (6 of 6, 100%) was found to have multiple foci of T1 invasive diffuse gastric adenocarcinoma (pure signet-ring cell type). No patient had lymph node or distant metastases. Each was staged as T1N0M0. Each patient recovered uneventfully without morbidity or mortality.CDH1 mutations in individuals from families with HDGC are associated with gastric cancer in a highly penetrant fashion. CDH1 mutations are an indication for total gastrectomy in these patients. This mutation will identify patients with cancer before other detectable symptoms or signs of the disease.

    View details for DOI 10.1097/01.sla.0000254370.29893.e4

    View details for Web of Science ID 000246873000007

    View details for PubMedID 17522512

  • MDCT Characterization of Active Extravasation: Prognostic Value of Extravasation Morphology, Location, and Delayed Imaging Enriquez, M., Shin, L. K., Rosenberg, J., Jeffrey, R. AMER ROENTGEN RAY SOC. 2007
  • Ultrasonography of abnormal neck lymph nodes. Ultrasound quarterly Chan, J. M., Shin, L. K., Jeffrey, R. B. 2007; 23 (1): 47-54

    Abstract

    Ultrasonography is a useful imaging modality for assessing cervical lymphadenopathy in patients with head and neck carcinomas. Features of cervical lymph nodes using gray-scale and color and power Doppler ultrasonography can help to distinguish normal and reactive lymph nodes from potentially metastatic lymph nodes. The distinguishing features that separate abnormal from normal cervical lymph nodes include peripheral vascularity, shape, overall lymph node echogenicity, absence of hilus, presence of nodal microcalcifications, and cystic changes. Often, a combination of these features is needed to assign a cervical lymph node as being abnormal.

    View details for PubMedID 17558229

  • Small cystic lesions of the pancreas: clinical significance and findings at follow-up ABDOMINAL IMAGING Kirkpatrick, I. D., Desser, T. S., Nino-Murcia, M., Jeffrey, R. B. 2007; 32 (1): 119-125

    Abstract

    Our purpose was to correlate the imaging findings of small cystic pancreatic lesions to the incidence of growth on follow-up imaging and their pathologic diagnoses.CT images for 159 patients with cystic pancreatic lesions were retrospectively evaluated and lesions were assessed for size, number, connection to the main pancreatic duct (MPD), MPD dilatation, and any presence of loculation, wall irregularity, thick septations, or solid components. A total of 86 patients had follow-up imaging with time periods of less than 6 months (n = 21), 6-12 months (n = 22), 1-2 years (n = 14), and greater than 2 years (n = 29). Lesion histology was available in 20 patients.Lesions with pathologic correlation proved to be: side branch intraductal papillary mucinous neoplasm or tumor (IPMT) (n = 5), combined type IPMT (n = 4), nonmucinous cyst (n = 4), chronic pancreatitis (n = 2), and reactive atypia with nonmucinous fluid (n = 1), combined type IMPT with foci of adenocarcinoma (n = 1), mucinous adenocarcinoma (n = 2), and nonmucinous adenocarcinoma (n = 1). Lesions with solid components were significantly more likely to grow and be malignant (P < 0.05). The presence of MPD dilatation was more common in patients with combined type IPMTs or malignancies. No other factors were predictive of malignancy.Solid components are predictive of malignancy, and MPD dilatation should prompt consideration of surgery. Other cystic lesions can be followed.

    View details for DOI 10.1007/s00261-006-9080-5

    View details for Web of Science ID 000246405800020

    View details for PubMedID 16944031

  • A co-axial scanning acoustic and. photoacoustic microscope IEEE Ultrasonics Symposium Vaithilingam, S., Ma, T., Furukawa, Y., de la Zerda, A., Oralkan, O., Kamaya, A., Keren, S., Gambhir, S. S., Jeffrey, R. B., Khuri-Yakub, B. T. IEEE. 2007: 2413–2416
  • Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Ultrasound quarterly Frates, M. C., Benson, C. B., Charboneau, J. W., Cibas, E. S., Clark, O. H., Coleman, B. G., Cronan, J. J., Doubilet, P. M., Evans, D. B., Goellner, J. R., Hay, I. D., Hertzberg, B. S., Intenzo, C. M., Jeffrey, R. B., Langer, J. E., Larsen, P. R., Mandel, S. J., Middleton, W. D., Reading, C. C., Sherman, S. I., Tessler, F. N. 2006; 22 (4): 231-238

    Abstract

    The Society of Radiologists in Ultrasound convened a panel of specialists from a variety of medical disciplines to come to a consensus on the management of thyroid nodules identified with thyroid ultrasonography (US), with particular focus on which nodules should be subjected to US-guided fine needle aspiration and which thyroid nodules need not be subjected to fine-needle aspiration. The panel met in Washington, DC, October 26-27, 2004, and created this consensus statement. The recommendations in this consensus statement, which are based on analysis of the current literature and common practice strategies, are thought to represent a reasonable approach to thyroid nodular disease.

    View details for PubMedID 17146329

  • Sonography of the abnormal parathyroid gland. Ultrasound quarterly Kamaya, A., Quon, A., Jeffrey, R. B. 2006; 22 (4): 253-262

    Abstract

    In 80% to 90% of patients with primary hyperparathyroidism, a single parathyroid adenoma will be identified as the culprit, whereas the remaining 10% to 20% are caused by multiple adenomas, parathyroid hyperplasia, and rarely, parathyroid carcinoma. At the 2002 National Institute of Health consensus meeting, minimally invasive parathyroidectomy was endorsed as a promising and attractive alternative to total parathyroidectomy. Therefore, preoperative localization of the adenoma is critical in the clinical evaluation of the patient before surgical resection. Although adenomas less than 1 cm may be difficult to visualize sonographically, knowledge of typical imaging characteristics of parathyroid adenomas and use of special sonographic techniques will facilitate identification in most patients. Typical imaging characteristics of parathyroid adenomas include homogeneously hypoechoic echotexture on gray scale with an enlarged feeding artery and peripheral arc of vascularity seen on color and power Doppler. Proper neck extension, unilateral graded compression techniques, and patient swallowing will improve visualization of adenomas.

    View details for PubMedID 17146333

  • Value of delayed imaging in MDCT of the abdomen and pelvis AMERICAN JOURNAL OF ROENTGENOLOGY Vasanawala, S. S., Desser, T. 2006; 187 (1): 154-163

    Abstract

    Our objective was to illustrate the benefits of obtaining delayed CT images.There are several clinical scenarios in which delayed CT images may improve diagnostic specificity.

    View details for DOI 10.2214/AJR.05.0148

    View details for Web of Science ID 000238659600027

    View details for PubMedID 16794170

  • CT colonography: Influence of 3D viewing and polyp candidate features on interpretation with computer-aided detection RADIOLOGY Shi, R., Schraedley-Desmond, P., Napel, S., Olcott, E. W., Jeffrey, R. B., Yee, J., Zalis, M. E., Margolis, D., Paik, D. S., Sherbondy, A. J., Sundaram, P., Beaulieu, C. F. 2006; 239 (3): 768-776

    Abstract

    To retrospectively determine if three-dimensional (3D) viewing improves radiologists' accuracy in classifying true-positive (TP) and false-positive (FP) polyp candidates identified with computer-aided detection (CAD) and to determine candidate polyp features that are associated with classification accuracy, with known polyps serving as the reference standard.Institutional review board approval and informed consent were obtained; this study was HIPAA compliant. Forty-seven computed tomographic (CT) colonography data sets were obtained in 26 men and 10 women (age range, 42-76 years). Four radiologists classified 705 polyp candidates (53 TP candidates, 652 FP candidates) identified with CAD; initially, only two-dimensional images were used, but these were later supplemented with 3D rendering. Another radiologist unblinded to colonoscopy findings characterized the features of each candidate, assessed colon distention and preparation, and defined the true nature of FP candidates. Receiver operating characteristic curves were used to compare readers' performance, and repeated-measures analysis of variance was used to test features that affect interpretation.Use of 3D viewing improved classification accuracy for three readers and increased the area under the receiver operating characteristic curve to 0.96-0.97 (P<.001). For TP candidates, maximum polyp width (P=.038), polyp height (P=.019), and preparation (P=.004) significantly affected accuracy. For FP candidates, colonic segment (P=.007), attenuation (P<.001), surface smoothness (P<.001), distention (P=.034), preparation (P<.001), and true nature of candidate lesions (P<.001) significantly affected accuracy.Use of 3D viewing increases reader accuracy in the classification of polyp candidates identified with CAD. Polyp size and examination quality are significantly associated with accuracy.

    View details for Web of Science ID 000237738600018

    View details for PubMedID 16714460

  • Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement RADIOLOGY Frates, M. C., Benson, C. B., Charboneau, J. W., Cibas, E. S., Clark, O. H., Coleman, B. G., Cronan, J. J., Doubilet, P. M., Evans, D. B., Goellner, J. R., Hay, I. D., Hertzberg, B. S., Intenzo, C. M., Jeffrey, R. B., Langer, J. E., Larsen, P. R., Mandel, S. J., Middleton, W. D., Reading, C. C., Sherman, S. I., Tessier, F. N. 2005; 237 (3): 794-800

    Abstract

    The Society of Radiologists in Ultrasound convened a panel of specialists from a variety of medical disciplines to come to a consensus on the management of thyroid nodules identified with thyroid ultrasonography (US), with particular focus on which nodules should be subjected to US-guided fine needle aspiration and which thyroid nodules need not be subjected to fine-needle aspiration. The panel met in Washington, DC, October 26-27, 2004, and created this consensus statement. The recommendations in this consensus statement, which are based on analysis of the current literature and common practice strategies, are thought to represent a reasonable approach to thyroid nodular disease.

    View details for DOI 10.1148/radiol.2373050220

    View details for Web of Science ID 000233380100006

    View details for PubMedID 16304103

  • The sonographic features of papillary thyroid carcinomas: pictorial essay. Ultrasound quarterly Jun, P., Chow, L. C., Jeffrey, R. B. 2005; 21 (1): 39-45

    Abstract

    Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy in children and adults, with an incidence of 22,000 cases per year in the United States. Differentiating PTC from more frequently occurring benign thyroid nodules has proved challenging as there may be significant overlap in their clinical presentation and sonographic appearance. That said, high-resolution ultrasound provides a safe and affordable way of identifying and characterizing thyroid nodules and guiding percutaneous biopsies. Although no single sonographic feature is pathognomonic for PTC, certain features should raise suspicion and the combination of several features may be even more suggestive. In this pictorial essay, we describe the high-resolution sonographic features of pathologically proven PTCs. The nodule number, echo texture, internal architecture, calcifications, margins, contours, vascularity, and lymph nodes are considered. While the classic sonographic description of PTC is a solitary, hypoechoic solid nodule with microcalcifications and intrinsic vascularity, in practice, PTC may manifest with a myriad of sonographic appearances making biopsy necessary for a definitive diagnosis.

    View details for PubMedID 15716757

  • Registration of central paths and colonic polyps between supine and prone scans in computed tomography colonography: Pilot study MEDICAL PHYSICS Ping, L., Napel, S., Acar, B., Paik, D. S., Jeffrey, R. B., Beaulieu, C. F. 2004; 31 (10): 2912-2923

    Abstract

    Computed tomography colonography (CTC) is a minimally invasive method that allows the evaluation of the colon wall from CT sections of the abdomen/pelvis. The primary goal of CTC is to detect colonic polyps, precursors to colorectal cancer. Because imperfect cleansing and distension can cause portions of the colon wall to be collapsed, covered with water, and/or covered with retained stool, patients are scanned in both prone and supine positions. We believe that both reading efficiency and computer aided detection (CAD) of CTC images can be improved by accurate registration of data from the supine and prone positions. We developed a two-stage approach that first registers the colonic central paths using a heuristic and automated algorithm and then matches polyps or polyp candidates (CAD hits) by a statistical approach. We evaluated the registration algorithm on 24 patient cases. After path registration, the mean misalignment distance between prone and supine identical anatomic landmarks was reduced from 47.08 to 12.66 mm, a 73% improvement. The polyp registration algorithm was specifically evaluated using eight patient cases for which radiologists identified polyps separately for both supine and prone data sets, and then manually registered corresponding pairs. The algorithm correctly matched 78% of these pairs without user input. The algorithm was also applied to the 30 highest-scoring CAD hits in the prone and supine scans and showed a success rate of 50% in automatically registering corresponding polyp pairs. Finally, we computed the average number of CAD hits that need to be manually compared in order to find the correct matches among the top 30 CAD hits. With polyp registration, the average number of comparisons was 1.78 per polyp, as opposed to 4.28 comparisons without polyp registration.

    View details for DOI 10.1118/1.1796171

    View details for Web of Science ID 000224743200025

    View details for PubMedID 15543800

  • Automatic detection and classification of hypodense hepatic lesions on contrast-enhanced venous-phase CT MEDICAL PHYSICS Bilello, M., Gokturk, S. B., Desser, T., Napel, S., Jeffrey, R. B., Beaulieu, C. F. 2004; 31 (9): 2584-2593

    Abstract

    The objective of this work was to develop and validate algorithms for detection and classification of hypodense hepatic lesions, specifically cysts, hemangiomas, and metastases from CT scans in the portal venous phase of enhancement. Fifty-six CT sections from 51 patients were used as representative of common hypodense liver lesions, including 22 simple cysts, 11 hemangiomas, 22 metastases, and 1 image containing both a cyst and a hemangioma. The detection algorithm uses intensity-based histogram methods to find central lesions, followed by liver contour refinement to identify peripheral lesions. The classification algorithm operates on the focal lesions identified during detection, and includes shape-based segmentation, edge pixel weighting, and lesion texture filtering. Support vector machines are then used to perform a pair-wise lesion classification. For the detection algorithm, 80% lesion sensitivity was achieved at approximately 0.3 false positives (FP) per slice for central lesions, and 0.5 FP per slice for peripheral lesions, giving a total of 0.8 FP per section. For 90% sensitivity, the total number of FP rises to about 2.2 per section. The pair-wise classification yielded good discrimination between cysts and metastases (at 95% sensitivity for detection of metastases, only about 5% of cysts are incorrectly classified as metastases), perfect discrimination between hemangiomas and cysts, and was least accurate in discriminating between hemangiomas and metastases (at 90% sensitivity for detection of hemangiomas, about 28% of metastases were incorrectly classified as hemangiomas). Initial implementations of our algorithms are promising for automating liver lesion detection and classification.

    View details for DOI 10.1118/1.1782674

    View details for Web of Science ID 000224117400027

    View details for PubMedID 15487741

  • Value of curved planar reformations in MDCT of abdominal pathology AMERICAN JOURNAL OF ROENTGENOLOGY Desser, T. S., Sommer, F. G., Jeffrey, R. B. 2004; 182 (6): 1477-1484

    View details for Web of Science ID 000221555900028

    View details for PubMedID 15149993

  • Increased through-transmission in abdominal tuberculous lymphadenitis JOURNAL OF ULTRASOUND IN MEDICINE Ghazinoor, S., Desser, T., Jeffrey, R. B. 2004; 23 (6): 837-841

    Abstract

    To describe 2 cases of abdominal tuberculosis in which sonographic evaluation of mesenteric lymphadenopathy showed increased through-transmission suggestive of caseating necrosis.Two patients with abdominal pain and other symptoms (including fever, diarrhea, and weight loss) underwent abdominal sonography with a 6-MHz curved array transducer. One patient also underwent sonographically guided fine-needle aspiration of multiple lymph nodes, and the other underwent computed tomography, colonoscopy, and colon biopsy.In both patients, sonography showed multiple rounded hypoechoic lesions with increased ultrasound through-transmission suggestive of necrotic lymphadenopathy. No color flow was shown. In 1 case, the posterior acoustic enhancement was accentuated in the harmonic imaging mode. In the other case, the lesions shown on sonography corresponded to computed tomographic findings of low-density lymph nodes. Results of fine-needle aspiration and colon biopsy were positive for tuberculosis.Posterior acoustic enhancement in abdominal lymphadenopathy can suggest the diagnosis of tuberculous lymphadenitis. Detection of this finding is facilitated by scanning in the harmonic mode. Necrotic nodes will lack color flow and can be distinguished from lymphadenopathy of other causes. Sonography can also be used for fine-needle aspiration of necrotic nodes to yield a definitive diagnosis.

    View details for Web of Science ID 000221973600013

    View details for PubMedID 15244308

  • Surface normal overlap: A computer-aided detection algorithm, with application to colonic polyps and lung nodules in helical CT IEEE TRANSACTIONS ON MEDICAL IMAGING Paik, D. S., Beaulieu, C. F., Rubin, G. D., Acar, B., Jeffrey, R. B., Yee, J., Dey, J., Napel, S. 2004; 23 (6): 661-675

    Abstract

    We developed a novel computer-aided detection (CAD) algorithm called the surface normal overlap method that we applied to colonic polyp detection and lung nodule detection in helical computed tomography (CT) images. We demonstrate some of the theoretical aspects of this algorithm using a statistical shape model. The algorithm was then optimized on simulated CT data and evaluated using a per-lesion cross-validation on 8 CT colonography datasets and on 8 chest CT datasets. It is able to achieve 100% sensitivity for colonic polyps 10 mm and larger at 7.0 false positives (FPs)/dataset and 90% sensitivity for solid lung nodules 6 mm and larger at 5.6 FP/dataset.

    View details for DOI 10.1109/TMI.2004.826362

    View details for Web of Science ID 000221723600001

    View details for PubMedID 15191141

  • Disproportionate fat stranding: A helpful CT sign in patients with acute abdominal pain RADIOGRAPHICS Pereira, J. M., Sirlin, C. B., Pinto, P. S., Jeffrey, R. B., Stella, D. L., Casola, G. 2004; 24 (3): 703-715

    Abstract

    Fat stranding adjacent to thickened bowel wall seen at computed tomography (CT) in patients with acute abdominal pain suggests an acute process of the gastrointestinal tract, but the differential diagnosis is wide. The authors observed "disproportionate" fat stranding (ie, stranding more severe than expected for the degree of bowel wall thickening present) and explored how this finding suggests a narrower differential diagnosis, one that is centered in the mesentery: diverticulitis, epiploic appendagitis, omental infarction, and appendicitis. The characteristic CT findings (in addition to fat stranding) of each of these entities often lead to a final diagnosis. Diverticulitis manifests with mild, smooth bowel wall thickening and no lymphadenopathy. Epiploic appendagitis manifests with central areas of high attenuation and a hyperattenuated rim, in addition to its characteristic location adjacent to the colon. In contrast, omental infarction is always centered in the omentum. The most specific finding of appendicitis is a dilated, fluid-filled appendix. Correct noninvasive diagnosis is important because treatment approaches for these conditions range from monitoring to surgery.

    View details for DOI 10.1148/rg.24035084

    View details for Web of Science ID 000221289700005

    View details for PubMedID 15143223

  • Postpartum uterine arteriovenous fistula OBSTETRICS AND GYNECOLOGY Aziz, N., Lenzi, T. A., Jeffrey, R. B., Lyell, D. J. 2004; 103 (5): 1076-1078

    Abstract

    Uterine arteriovenous communications are uncommon lesions that may be associated with life-threatening postpartum and postinstrumentation hemorrhage.A primigravida presented with infected retained products of conception. Excessive hemorrhage of unclear etiology occurred at dilation and curettage. After a second episode of bleeding, the patient received a diagnosis of uterine arteriovenous fistula.Uterine arteriovenous communications should be included in the differential diagnosis in patients with excessive postpartum or postinstrumentation bleeding. Color and spectral flow Doppler can aid diagnosis and clinical management.

    View details for DOI 10.1097/01.AOG.0000123241.44401.01

    View details for Web of Science ID 000225470300017

    View details for PubMedID 15121613

  • Periaortic hematoma at diaphragmatic crura at helical CT: Sign of blunt aortic injury in patients with mediastinal hematoma RADIOLOGY Wong, H., Gotway, M. B., Sasson, A. D., Jeffrey, R. B. 2004; 231 (1): 185-189

    Abstract

    To evaluate periaortic hematoma (PH) near the level of the diaphragm at abdominal computed tomography (CT) as an indirect sign of acute traumatic aortic injury after blunt trauma in patients with mediastinal hematoma.From 1998 to 2001, 97 patients with CT evidence of mediastinal hematoma after blunt thoracic trauma were retrospectively identified at two level 1 trauma centers. The presence or absence of PH near the level of the diaphragmatic crura was retrospectively established by a blinded reviewer at each institution. Aortic injury status was determined by reviewing angiographic, surgical, and clinical records. Sensitivity, specificity, positive and negative productive values, and positive and negative likelihood ratios were calculated.Among the 97 patients with mediastinal hematoma, 14 had both PH near the level of the diaphragm and aortic injury; six had aortic injuries without PH, five had PH near the level of the diaphragm without aortic injury, and 72 had no evidence of PH near the diaphragm and no aortic injury. Sensitivity for PH near the level of the diaphragm as a sign of aortic injury was 70%; specificity, 94%; positive predictive value, 74%; and negative predictive value, 92%. The positive likelihood ratio for the presence of aortic injury was 10.8, and the negative likelihood ratio was 0.3.PH near the level of the diaphragmatic crura is an insensitive but relatively specific sign for aortic injury after blunt trauma. The presence of this sign at abdominal CT should prompt imaging of the thoracic aorta to evaluate potential thoracic aortic injury.

    View details for DOI 10.1148/radiol.2311021776

    View details for Web of Science ID 000220394300027

    View details for PubMedID 14990823

  • MDCT in pancreatic adenocarcinoma: Prediction of vascular invasion and resectability using a multiphasic technique with curved planar reformations AMERICAN JOURNAL OF ROENTGENOLOGY Vargas, R., Nino-Murcia, M., Trueblood, W., Jeffrey, R. B. 2004; 182 (2): 419-425

    Abstract

    The objective of our study was to determine the negative predictive value of MDCT with curved planar reformations for detecting vascular invasion and predicting overall resectability in patients with pancreatic adenocarcinoma.Imaging findings related to vascular invasion and overall tumor resectability in 25 patients who underwent contrast-enhanced biphasic MDCT evaluation were correlated with actual vessel invasion and overall resectability determined at surgery and pathologic examination. The presence of vascular invasion was assessed in 110 major peripancreatic vessels in 22 patients who underwent resection.On MDCT, 23 (92%) of 25 patients were deemed to have resectable pancreatic adenocarcinoma. The tumors in the remaining two (8%) were considered not resectable because of the presence of vascular invasion (which was confirmed in only one patient at surgery). Of those 23 patients deemed to be candidates for curative resection on the basis of MDCT results, 20 were found to have resectable adenocarcinoma at time of surgery, yielding a negative predictive value for MDCT of 87% (20/23 patients) for overall resectability. In the other three patients, adenocarcinoma was deemed to be unresectable because of small metastases to the liver (two patients) or to the peritoneum (one patient) discovered at surgery. For detection of vascular invasion, MDCT yielded a negative predictive value of 100% (108/108 vessels) with no false-negative findings and an accuracy of 99% (109/110 vessels) with 108 true-negative findings, one true-positive finding, and one false-positive finding.Our preliminary data on MDCT show that the technique has excellent negative predictive value for vascular invasion and good negative predictive value for overall tumor resectability in patients with pancreatic adenocarcinoma, suggesting an improvement over previous results reported using single-detector CT. The problem of undetected micrometastases to the liver and peritoneum remains.

    View details for Web of Science ID 000188590800035

    View details for PubMedID 14736675

  • Common and uncommon sonographic features of papillary thyroid carcinoma JOURNAL OF ULTRASOUND IN MEDICINE Chan, B. K., Desser, T. S., McDougall, I. R., Weigel, R. J., Jeffrey, R. B. 2003; 22 (10): 1083-1090

    Abstract

    To determine the relative frequency of various sonographic findings in papillary carcinoma of the thyroid.We retrospectively analyzed the sonographic features in 55 patients with proven papillary carcinoma of the thyroid. Sonographic features analyzed were echo texture, cystic change, margin, contour, presence of a peripheral halo, vascularity, and calcification pattern. Features were classified as common (> or = 35% of cases) or uncommon (< 10% of cases). Combinations of features were also analyzed.Common sonographic features of papillary carcinoma included hypoechoic texture (86%), microcalcifications (42%) or no calcifications (47%), well-defined margins (47%), and intrinsic hypervascularity (69%). Uncommon features included hyperechoic or mixed echo texture, cystic elements, irregular margins, hypovascularity, and coarse or peripheral calcifications. Of the 29 lesions that had calcifications, 20 (69%) had microcalcifications; 5 (17%) had coarse calcifications; and 1 had peripheral calcifications. In total, 54% of cases had at least 1 uncommon feature, and 11% had 2 or more uncommon features. Cystic carcinomas were rare and accounted for only 6% of lesions; all had hypervascular solid components. No carcinomas in our series were completely avascular.There is a broad spectrum of sonographic findings in papillary carcinoma of the thyroid. Half of the lesions in this series had at least 1 uncommon sonographic feature.

    View details for Web of Science ID 000185658300011

    View details for PubMedID 14606565

  • Multidetector CT of pancreatic adenocarcinoma: diagnostic advances and therapeutic relevance EUROPEAN RADIOLOGY Prokesch, R. W., Schima, W., Chow, L. C., Jeffrey, R. B. 2003; 13 (9): 2147-2154

    Abstract

    Detection and staging of pancreatic malignancies remains a challenge for radiologists. Considering the poor prognosis of pancreatic adenocarcinoma, accurate preoperative staging is the key to a possibly curative surgical treatment. Contrast-enhanced helical CT has been the most commonly used for evaluation of pancreatic cancer in many institutions, although it suffers from many limitations. With the fast pace of advances in multidetector CT (MDCT), and the beginning clinical implementation of 16-row scanners, improvements in spatial resolution in the z-axis with near-isotropic imaging provide exquisite multiplanar reconstructions of pancreatic anatomy. This article provides an overview of current MDCT technique and protocols for assessment of pancreatic adenocarcinoma, and describes new 3D-display methods for effective visualization of large data sets provided by MDCT.

    View details for DOI 10.1007/s00330-003-1926-4

    View details for Web of Science ID 000185537700013

    View details for PubMedID 12819917

  • Surgical management of adrenal cysts AMERICAN SURGEON Lal, T. G., Kaulback, K. R., Bombonati, A., Palazzo, J. P., Jeffrey, R. B., Weigel, R. J. 2003; 69 (9): 812-814

    Abstract

    Adrenal cysts are rare and are often found incidentally during abdominal imaging for another reason. We describe two cases of adrenal cysts, one of which was found to be a cystic pheochromocytoma. Most cystic pheochromocytomas are not diagnosed by urinary screening studies, and the first indication of a pheochromocytoma may be hemodynamic instability during resection. We review the literature on adrenal cysts and make recommendations for the management of cystic adrenal masses.

    View details for Web of Science ID 000185237200022

    View details for PubMedID 14509334

  • Laparoscopic radical nephrectomy incorporating intraoperative ultrasonography for renal cell carcinoma with renal vein tumor thrombus UROLOGY Hsu, T. H., Jeffrey, R. B., Chon, C., Presti, J. C. 2003; 61 (6): 1246-1248

    Abstract

    The purpose of this study was to describe the technique of laparoscopic right radical nephrectomy incorporating intraoperative, real-time ultrasonography in the management of renal cell carcinoma with level 1 renal vein tumor thrombus. With the patient in a modified flank position, a transperitoneal four-port approach was used to laparoscopically resect an 8.5-cm right renal mass with tumor thrombus extending to, but not into, the inferior vena cava. Early arterial control with gentle traction on the right renal vein provided a short proximal renal venous segment devoid of tumor on laparoscopic inspection. Intraoperative laparoscopic ultrasonography allowed confident identification of the proximal extent of the tumor thrombus. After hilar control, complete resection and intact removal of the renal specimen was performed using standard non-hand-assisted laparoscopic techniques. The actual surgical time was 180 minutes. Surgical resection was successfully performed laparoscopically. No postoperative complications or hospital readmission occurred. Pathologic examination confirmed T3b renal cell carcinoma with negative surgical margins. Laparoscopic right radical nephrectomy incorporating intraoperative, real-time ultrasonography is feasible in the management of renal cell carcinoma with a large-sized level 1 renal vein thrombus. Additional studies are necessary to evaluate its role in urologic oncologic surgery.

    View details for DOI 10.1016/S0090-4295(03)00126-2

    View details for Web of Science ID 000183547000048

    View details for PubMedID 12809912

  • Imaging and intervention in the hepatic veins AMERICAN JOURNAL OF ROENTGENOLOGY Desser, T. S., Sze, D. Y., Jeffrey, R. B. 2003; 180 (6): 1583-1591

    View details for Web of Science ID 000183149200015

    View details for PubMedID 12760925

  • Multidetector-row helical CT and advanced postprocessing techniques for the evaluation of pancreatic neoplasms ABDOMINAL IMAGING Nino-Murcia, M., Tamm, E. P., Charnsangavej, C., Jeffrey, R. B. 2003; 28 (3): 366-377

    Abstract

    An important feature of multidetector-row helical computed tomography (CT) is the increased speed of scanning that permits routine use of very thin collimation and acquisition of near isometric imaging data of the abdomen within the time span of a single breath-hold. The parallel escalation in the capabilities of workstations makes feasible the practical use of advanced postprocessing techniques to create high quality volumetric imaging. This article highlights the unique contributions of multidetector-row CT and advanced postprocessing techniques to the evaluation of the pancreas and peripancreatic vascular structures and their value in the diagnosis and staging of pancreatic neoplasms.

    View details for DOI 10.1007/s00261-002-0056-9

    View details for Web of Science ID 000182610300011

    View details for PubMedID 12719907

  • Intraoperative ultrasonography improves identification of recurrent thyroid cancer 23rd Annual Meeting of the American-Association-of-Endocrine-Surgeons Karwowski, J. K., Jeffrey, R. B., McDougall, I. R., Weigel, R. J. MOSBY-ELSEVIER. 2002: 924–28

    Abstract

    Surgical resection is the only curative treatment option for locoregional recurrence of well-differentiated thyroid cancer that does not trap radioiodine. We hypothesized that intraoperative ultrasonography would aid in the localization of recurrent thyroid cancer and would enhance the ability to perform a complete resection.Between June 2000 and October 2001, 13 patients with recurrent, scan-negative, papillary thyroid cancer were explored by using intraoperative ultrasonography.All patients had identification and resection of recurrent papillary thyroid cancer. Eleven patients had a complete resection, and 2 patients had incomplete resection as a result of local invasion. Ultrasound was required for identification of tumor in 7 patients and included all patients with a history of external beam radiotherapy. In 6 of these 7 patients, the tumor was paratracheal or invasive into the trachea or thyroid cartilage. In 11 patients with detectable serum thyroglobulin preoperatively, the level demonstrated a decline in 10 patients and became undetectable in 7 patients.Intraoperative ultrasonography is a useful method to identify nonpalpable, locoregional recurrences of thyroid cancer. Ultrasound was particularly helpful in patients who had previous external beam radiotherapy and in the identification of tumor nodules of 20 mm or less that were invasive or adherent to the airway.

    View details for DOI 10.1067/msy.2002.128478

    View details for Web of Science ID 000180123000004

    View details for PubMedID 12490837

  • Edge displacement field-based classification for improved detection of polyps in CT colonography IEEE TRANSACTIONS ON MEDICAL IMAGING Acar, B., Beaulieu, C. F., Gokturk, S. B., Tomasi, C., Paik, D. S., Jeffrey, R. B., Yee, J., Napel, S. 2002; 21 (12): 1461-1467

    Abstract

    Colorectal cancer can easily be prevented provided that the precursors to tumors, small colonic polyps, are detected and removed. Currently, the only definitive examination of the colon is fiber-optic colonoscopy, which is invasive and expensive. Computed tomographic colonography (CTC) is potentially a less costly and less invasive alternative to FOC. It would be desirable to have computer-aided detection (CAD) algorithms to examine the large amount of data CTC provides. Most current CAD algorithms have high false positive rates at the required sensitivity levels. We developed and evaluated a postprocessing algorithm to decrease the false positive rate of such a CAD method without sacrificing sensitivity. Our method attempts to model the way a radiologist recognizes a polyp while scrolling a cross-sectional plane through three-dimensional computed tomography data by classification of the changes in the location of the edges in the two-dimensional plane. We performed a tenfold cross-validation study to assess its performance using sensitivity/specificity analysis on data from 48 patients. The mean specificity over all experiments increased from 0.19 (0.35) to 0.47 (0.56) for a sensitivity of 1.00 (0.95).

    View details for DOI 10.1109/TMI.2002.806405

    View details for Web of Science ID 000180871100003

    View details for PubMedID 12588030

  • Local staging of pancreatic carcinoma with multi-detector row CT: Use of curved planar reformations initial experience RADIOLOGY Prokesch, R. W., Chow, L. C., Beaulieu, C. F., Nino-Murcia, M., Mindelzun, R. E., Barnmer, R., Huang, J., Jeffrey, R. B. 2002; 225 (3): 759-765

    Abstract

    To evaluate the utility of curved planar reformations compared with standard transverse images in the assessment of pancreatic tumors.Forty-three patients suspected of having pancreatic tumors underwent contrast material-enhanced biphasic multi-detector row computed tomography (CT). Curved planar reformations were generated along the pancreatic duct, common bile duct, and major mesenteric vessels. Three blinded independent readers assessed the curved planar reformations and transverse images separately for the presence of tumor, resectability, and vascular involvement. The results were compared with those of a consensus panel who evaluated the curved planar reformations and transverse images together along with clinical data and surgical findings.Of 43 patients, 20 had pancreatic malignancies as judged by the consensus panel and proven at biopsy and/or clinical follow-up. For tumor detection, transverse images and curved planar reformations had an average sensitivity of 95.0% and 98.4% (P >.05), respectively, and an average specificity of 90.9% and 91.3% (P >.05), respectively. For tumor resectability, transverse images and curved planar reformations had an average sensitivity of 85.7% and 71.4% (P >.05), respectively, and an average specificity of 85.2% and 84.3% (P >.05), respectively. Average interpretation time was 6.4 minutes with transverse images and 4.1 minutes with curved planar reformations.Curved planar reformations are equivalent to transverse images in the detection of pancreatic tumors and determination of surgical resectability.

    View details for DOI 10.1148/radiol.2253010886

    View details for Web of Science ID 000179420800020

    View details for PubMedID 12461258

  • Sonographic diagnosis of traumatic gallbladder rupture JOURNAL OF ULTRASOUND IN MEDICINE Kao, E. Y., Desser, T. S., Jeffrey, R. B. 2002; 21 (11): 1295-1297

    Abstract

    Gallbladder injuries after blunt abdominal trauma are rare and often follow a vague and insidious clinical course. Consequently, gallbladder injuries commonly go undiagnosed until exploratory laparotomy. Early diagnosis is essential, because trauma to the gallbladder is typically treated surgically, and delay in treatment can result in considerable mortality and morbidity. With sonography emerging as a first-line modality for evaluation of intra-abdominal trauma, sonographers may wish to become more familiar with the appearance of gallbladder injury on sonography to facilitate earlier diagnosis and to improve treatment and prognosis. We report a case of gallbladder perforation after blunt abdominal trauma diagnosed on the basis of computed tomography (CT) and sonography.

    View details for Web of Science ID 000178888200011

    View details for PubMedID 12418769

  • 3D differential descriptors for improved computer-aided detection (CAD) of colonic polyps in computed tomography colonography (CTC) 88th Scientific Assembly and Annual Meeting of the Radiological-Society-of-North-America Acar, B., Beaulieu, C. F., Paik, D. S., Yee, J., Jeffrey, R. B., Napel, S. S. RADIOLOGICAL SOC NORTH AMERICA. 2002: 405–406
  • Imaging for suspected appendicitis: Negative appendectomy and perforation rates RADIOLOGY Bendeck, S. E., Nino-Murcia, M., Berry, G. J., Jeffrey, R. B. 2002; 225 (1): 131-136

    Abstract

    To determine which patients suspected of having acute appendicitis benefit from preoperative imaging.The medical records of 462 consecutive patients who underwent appendectomy for clinically suspected acute appendicitis and underwent preoperative evaluation at our institution were retrospectively reviewed. Patients were divided into four groups: women (n = 166), girls (n = 46), men (n = 178), and boys (n = 72). Preoperative computed tomography (CT) or ultrasonography (US), requested by the referring clinician, was performed in 313 of the 462 patients. Unnecessary, or negative, appendectomy and perforation rates were calculated for each group for preoperative evaluation with CT, with US, and with neither CT nor US. In addition, the sensitivity and positive predictive value of CT and US were calculated for diagnosing appendicitis.In women, the negative appendectomy rate was significantly lower for those who underwent preoperative CT (7% [six of 85 patients], P =.005) or US (8% [four of 49 patients], P =.019), as compared with 28% [nine of 32 patients] for those who underwent no preoperative imaging (P >.35 for all groups). The negative appendectomy rates for girls, men, and boys were not significantly affected by preoperative imaging. The sensitivity of CT and US for diagnosing acute appendicitis exceeded 93% and 77%, respectively, in all groups. The positive predictive values for both CT and US were greater than 92% in all groups.Women suspected of having appendicitis benefit the most from preoperative CT or US, with a statistically significantly lower negative appendectomy rate than women who undergo no preoperative imaging. Therefore, we propose that preoperative imaging be considered part of the routine evaluation of women suspected of having acute appendicitis.

    View details for DOI 10.1148/radiol.2251011780

    View details for Web of Science ID 000178264300021

    View details for PubMedID 12354996

  • Multidetector-row CT and volumetric imaging of pancreatic neoplasms GASTROENTEROLOGY CLINICS OF NORTH AMERICA Nino-Murcia, M., Jeffrey, R. B. 2002; 31 (3): 881-?

    Abstract

    Multidetector-row CT provides excellent visualization of the pancreas and peripancreatic structures, yielding information that is crucial for detecting pancreatic neoplasms and accurately determining their staging. This new technology enables the acquisition of large volumetric data sets to create high-quality curved planar reformations that clearly depict the common bile duct, the pancreatic duct, and the peripancreatic vasculature. Additionally, curved planar reformations highlight critical anatomic and pathologic relationships which are useful for surgical planning in patients with resectable disease.

    View details for Web of Science ID 000179691500012

    View details for PubMedID 12481736

  • Ultrasonography GASTROENTEROLOGY CLINICS OF NORTH AMERICA Ralls, P. W., Jeffrey, R. B., Kane, R. A., Robbin, M. 2002; 31 (3): 801-?

    Abstract

    Diagnostic sonography is experiencing a breath-taking period of technological advancement. Ultrasound contrast agents, new imaging techniques, and handheld instruments will play a role in facilitating more diagnostic power in high-end imaging and insuring more widespread use of diagnostic sonography in medicine in general.

    View details for Web of Science ID 000179691500008

    View details for PubMedID 12481732

  • Isoattenuating pancreatic adenocarcinoma at multi-detector row CT: Secondary signs RADIOLOGY Prokesch, R. W., Chow, L. C., Beaulieu, C. F., Bammer, R., Jeffrey, R. B. 2002; 224 (3): 764-768

    Abstract

    To assess the frequency of isoattenuating pancreatic adenocarcinoma with multi-detector row computed tomography (CT) and determine whether there are specific secondary signs that aid in detection.Fifty-three patients with pancreatic adenocarcinoma underwent contrast material-enhanced biphasic multi-detector row CT with curved planar reformation. Tumors were initially deemed isoattenuating or hypoattenuating to normal pancreatic parenchyma on the basis of visual inspection, and the degree of attenuation was confirmed by calculating the mean attenuation differences between normal pancreatic parenchyma and tumor (tumor-pancreas contrast) during the pancreatic phase. Indirect signs of pancreatic tumor were tabulated in patients with an isoattenuating tumor.Of the 53 patients, six (11%) had isoattenuating tumors with a mean tumor-pancreas contrast of 9.25 HU +/- 11.3 during the pancreatic phase and 4.15 HU +/- 8.5 during the portal venous phase. The secondary signs of pancreatic tumor in these six patients included an interrupted pancreatic duct (n = 5), dilated biliary and pancreatic ducts (n = 1), atrophic distal pancreatic parenchyma (n = 3), and mass effect and/or convex contour abnormality (n = 3). The mean tumor-pancreas contrast for the remaining 47 patients was 74.76 HU +/- 35.61 during the pancreatic phase.With no visible tumor-pancreas contrast for isoattenuating tumors, indirect signs such as mass effect, atrophic distal parenchyma, and an interrupted duct sign are important indicators for the presence of tumor.

    View details for DOI 10.1148/radiol.2243011284

    View details for Web of Science ID 000177621700021

    View details for PubMedID 12202711

  • Acute thrombosis of a giant portal venous aneurysm - Value of color Doppler sonography JOURNAL OF ULTRASOUND IN MEDICINE Santana, P., Jeffrey, R. B., Bastidas, A. 2002; 21 (6): 701-704

    View details for Web of Science ID 000175839500015

    View details for PubMedID 12054311

  • Sonography in primary hyperparathyroidism - Review with emphasis on scanning technique JOURNAL OF ULTRASOUND IN MEDICINE Reeder, S. B., Desser, T. S., Weigel, R. J., Jeffrey, R. B. 2002; 21 (5): 539-552

    Abstract

    To review the sonographic features and focused sonographic scanning techniques that may assist in the preoperative localization of parathyroid adenomas in patients with primary hyperparathyroidism.The sonographic findings were reviewed in 54 of 58 consecutive patients with pathologically proven parathyroid adenomas. A systematic scanning approach including real-time gray scale, color and power Doppler, and graded compression gray scale imaging was used in all patients.Fifty-four (93%) of 58 proven adenomas were correctly identified by sonography. Gray scale imaging alone was sufficient for identifying 26 (100%) of 26 large (> or =1-cm) and 3 (11%) of 25 small (<1-cm) parathyroid adenomas. However, for 25 (89%) of 28 small adenomas, a combination of color and power Doppler and graded compression real-time gray scale imaging was required for sonographic localization and identification.Knowledge of typical locations and characteristic imaging features, as well as a systematic scanning approach, can result in accurate preoperative sonographic localization of parathyroid adenomas.

    View details for Web of Science ID 000175342900009

    View details for PubMedID 12008817

  • Automated generation of curved planar reformations from volume data: Method and evaluation RADIOLOGY Raman, R., Napel, S., Beaulieu, C. F., Bain, E. S., Jeffrey, R. B., Rubin, G. D. 2002; 223 (1): 275-280

    Abstract

    The authors developed and evaluated a method to automatically create interactive vascular curved planar reformations with computed tomographic (CT) angiographic data. The method decreased user interaction time by 86%, from 15 to 2 minutes. Expert reviewers were asked to indicate their confidence in differentiating automatically created images from clinical-quality manually produced images. The area under the receiver operating characteristic curve was 0.45 (95% CI: 0.39, 0.51), and a test of equivalency indicated that reviewers could not distinguish between images. They also graded image quality as equivalent to that with manual methods and found fewer artifacts on automatically created images. Automatic methods rapidly produce curved planar reformations of equivalent quality with reduced time and effort.

    View details for Web of Science ID 000174611900037

    View details for PubMedID 11930078

  • Quantification of distention in CT colonography: Development and validation of three computer algorithms RADIOLOGY Hung, P. W., Paik, D. S., Napel, S., Yee, J., Jeffrey, R. B., Steinauer-Gebauer, A., Min, J., Jathavedam, A., Beaulieu, C. F. 2002; 222 (2): 543-554

    Abstract

    Three bowel distention-measuring algorithms for use at computed tomographic (CT) colonography were developed, validated in phantoms, and applied to a human CT colonographic data set. The three algorithms are the cross-sectional area method, the moving spheres method, and the segmental volume method. Each algorithm effectively quantified distention, but accuracy varied between methods. Clinical feasibility was demonstrated. Depending on the desired spatial resolution and accuracy, each algorithm can quantitatively depict colonic diameter in CT colonography.

    View details for Web of Science ID 000173502500035

    View details for PubMedID 11818626

  • Carotid disease: Automated analysis with cardiac-gated three-dimensional US - Technique and preliminary results RADIOLOGY Napel, S., Xu, H. B., Paik, D. S., Ross, B. A., Sumanaweera, T. S., Hossack, J. A., Jeffrey, R. B. 2002; 222 (2): 560-563

    Abstract

    Automatic analysis was performed of four-dimensional ultrasonographic (US) data in the carotid artery. The data, which were acquired in 31 subjects (eight healthy volunteers and 23 patients) by using a US scanner fitted with a special probe, were successfully processed. Acquisition time averaged 12 minutes. Data for all healthy volunteers (n = 8) and patients with complete occlusions (n = 3) were correctly classified. Data for two of the 12 patients with mild to severe (but not occlusive) disease were misclassified by one category.

    View details for Web of Science ID 000173502500037

    View details for PubMedID 11818628

  • Using contrast-enhanced helical CT to visualize arterial extravasation after blunt abdominal trauma: Incidence and organ distribution AMERICAN JOURNAL OF ROENTGENOLOGY Yao, D. C., Jeffrey, R. B., MIRVIS, S. E., Weekes, A., Pederle, M. P., Kim, C., Lane, M. J., Prabhakar, P., Ralls, P. W. 2002; 178 (1): 17-20

    Abstract

    We evaluated the incidence and organ distribution of arterial extravasation identified using contrast-enhanced helical CT in patients who had sustained abdominal visceral injuries and pelvic fractures after blunt trauma.Five hundred sixty-five consecutive patients from four level I trauma centers who had CT scans showing abdominal visceral injuries or pelvic fractures were included in this series. The presence or absence of arterial extravasation, as well as the anatomic sites of arterial extravasation, was noted. We obtained clinical follow-up data, including surgical or angiographic findings.In our series, 104 (18.4%) of 565 patients had arterial extravasation. Of the 104 patients, 81 (77.9%) underwent surgery, embolization, or both. The combined rate of surgery or embolization in patients with arterial extravasation was statistically higher than expected at all four institutions (p <0.001). The spleen was the most common organ injured, occurring in 277 (49.0%) of 565 patients, and arterial extravasation occurred in 49 (17.7%) of 277 patients with splenic injury. Several other visceral injuries were associated with arterial extravasation, including hepatic, renal, adrenal, and mesenteric injuries.Based on the limited reports of arterial extravasation in the nonhelical CT literature, the percentage (18%) of clinically stable patients in our study with CT scans showing arterial extravasation was higher than anticipated. This finding likely reflects the improved diagnostic capability of helical CT. Although the spleen and liver were the organs most commonly associated with arterial extravasation, radiologists should be aware that arterial extravasation may be associated with several other visceral injuries.

    View details for Web of Science ID 000172927900003

    View details for PubMedID 11756079

  • Impact of multidetector CT hepatic arteriography on the planning of chemoembolization treatment of hepatocellular carcinoma AMERICAN JOURNAL OF ROENTGENOLOGY Sze, D. Y., Razavi, M. K., So, S. K., Jeffrey, R. B. 2001; 177 (6): 1339-1345

    Abstract

    We examined the impact of the increased sensitivity for hypervascular masses of multidetector CT hepatic arteriography on treatment decisions involving selective chemoembolization of hepatocellular carcinomas.Thirty patients were referred for chemoembolization of unresectable hepatocellular carcinoma. Initial selective chemoembolization plans were formulated on the basis of diagnostic biphasic CT or MR imaging. Ultrafast CT hepatic arteriography was performed using a multidetector CT scanner and selective contrast material injection into the hepatic artery. The entire liver was scanned in a single breath-hold of approximately 20 sec with a slice thickness of 1 mm. Lesions and their arterial supplies were identified, and these data were immediately used to formulate a final plan for chemoembolization.Hypervascular masses were detected in 29 patients. In 16 (53%) of the patients, preprocedural CT or MR imaging underestimated the number of lesions. In nine (30%) of these 16 patients, the additional lesions were detected only on CT hepatic arteriography, not on conventional angiography. CT hepatic arteriography findings had a major impact on planning the way in which chemoembolization treatment was performed. In three of the nine patients, the previously undetected lesions were treated with additional superselective chemoembolization. In the other six patients, chemoembolization was performed less selectively than originally planned.Primarily because of the high sensitivity of multidetector CT hepatic arteriography in revealing small and multifocal hepatomas, findings of this modality frequently alter treatment plans involving selective administration of chemoembolic material.

    View details for Web of Science ID 000172326800019

    View details for PubMedID 11717079

  • A statistical 3-D pattern processing method for computer-aided detection of polyps in CT colonography IEEE TRANSACTIONS ON MEDICAL IMAGING Gokturk, S. B., Tomasi, C., Acar, B., Beaulieu, C. F., Paik, D. S., Jeffrey, R. B., Yee, J., Napel, S. 2001; 20 (12): 1251-1260

    Abstract

    Adenomatous polyps in the colon are believed to be the precursor to colorectal carcinoma, the second leading cause of cancer deaths in United States. In this paper, we propose a new method for computer-aided detection of polyps in computed tomography (CT) colonography (virtual colonoscopy), a technique in which polyps are imaged along the wall of the air-inflated, cleansed colon with X-ray CT. Initial work with computer aided detection has shown high sensitivity, but at a cost of too many false positives. We present a statistical approach that uses support vector machines to distinguish the differentiating characteristics of polyps and healthy tissue, and uses this information for the classification of the new cases. One of the main contributions of the paper is the new three-dimensional pattern processing approach, called random orthogonal shape sections method, which combines the information from many random images to generate reliable signatures of shape. The input to the proposed system is a collection of volume data from candidate polyps obtained by a high-sensitivity, low-specificity system that we developed previously. The results of our ten-fold cross-validation experiments show that, on the average, the system increases the specificity from 0.19 (0.35) to 0.69 (0.74) at a sensitivity level of 1.0 (0.95).

    View details for Web of Science ID 000173296700006

    View details for PubMedID 11811825

  • Parathyroid crisis in a 20 year old - an unusual cause of hypercalcaemic crisis POSTGRADUATE MEDICAL JOURNAL Wong, P., Carmeci, C., Jeffrey, R. B., Weigel, R. J. 2001; 77 (909): 468-470

    Abstract

    Since the advent of automated serum analysis, patients with primary hyperparathyroidism (PHPT) are often asymptomatic at presentation or have mild symptoms attributable to the disease. Parathyroid crisis is a rare and potentially fatal complication of PHPT in which patients develop severe hypercalcaemia with signs and symptoms of multiple organ dysfunction. A case of parathyroid crisis in a 20 year old man who presented with brown tumours and renal stones is described.

    View details for Web of Science ID 000169815000013

    View details for PubMedID 11423601

  • Preoperative duplex ultrasonography evaluation for deep venous thrombosis in revision hip arthroplasty patients ORTHOPEDICS Wallace, B., Jeffrey, R. B., Goodman, S. B. 2001; 24 (6): 577-579

    Abstract

    In a prospective consecutive series, 53 revision hip arthroplasties were performed in 51 patients. Pre- and postoperative Duplex ultrasonography examinations were reviewed by an independent, experienced radiologist. Three of 51 patients (53 procedures) had evidence of chronic deep venous thrombosis (DVT) or other venous abnormality preoperatively, yielding an incidence of 5.6%. One (1.9%) patient developed an acute DVT postoperatively despite pharmacological and mechanical preventative measures. These results indicate the use of preoperative ultrasonography as a screening tool prior to revision hip arthroplasty is not warranted based on the low incidence of acute or chronic DVT detected preoperatively. Long-term anticoagulation, when necessary, can be based on the findings of a postoperative scan.

    View details for Web of Science ID 000169308100015

    View details for PubMedID 11430738

  • Intraoperative ultrasonography for localization of recurrent thyroid cancer SURGERY Desai, D., Jeffrey, R. B., McDougall, I. R., Weigel, R. J. 2001; 129 (4): 498-500

    Abstract

    Advances in measurement of thyroglobulin (Tg) and in imaging techniques including high resolution ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET) scan have increased our ability to detect thyroid cancer recurrences at an earlier stage. (1,2) After thyroidectomy, patients are often treated with radioiodine, but the recurrent cancers may not image with radioiodine. In these instances, the only definitive treatment is surgical resection. Reoperative neck surgery can be challenging, especially when trying to find a small cancer nodule within the central neck that contains dense fibrotic scar tissue. Herein we describe the use of intraoperative ultrasonography to identify the location of recurrent thyroid cancer. This technique can aid in tumor localization and may help to avoid complications such as recurrent nerve injury.

    View details for Web of Science ID 000167986600016

    View details for PubMedID 11283542

  • Imaging the patient with right upper quadrant pain SEMINARS IN ROENTGENOLOGY Nino-Murcia, M., Jeffrey, R. B. 2001; 36 (2): 81-91

    Abstract

    A variety of high-resolution imaging techniques are currently available for the evaluation of patients with RUQ pain. In these patients, an imaging approach that is based on identifying the presence of certain clinical signs and symptoms can aid in choosing the appropriate imaging modality and establishing the diagnosis. For patients presenting with a positive Murphy sign, sonography and biliary scintigraphy are the most useful initial imaging techniques. In patients with fever and a negative Murphy sign, a combination of sonography and contrast-enhanced CT can establish the diagnosis in most cases. And finally, in patients without fever or a positive Murphy sign, CT and MR are appropriate first-line imaging techniques.

    View details for Web of Science ID 000168046900003

    View details for PubMedID 11329660

  • Multidetector CT of the pancreas and bile duct system: value of curved planar reformations. AJR. American journal of roentgenology Nino-Murcia, M., Jeffrey, R. B., Beaulieu, C. F., Li, K. C., Rubin, G. D. 2001; 176 (3): 689-693

    View details for PubMedID 11222206

  • Pictorial essay - Multidetector CT of the pancreas and bile duct system: Value of curved planar reformations AMERICAN JOURNAL OF ROENTGENOLOGY Nino-Murcia, M., Jeffrey, R. B., Beaulieu, C. F., Li, K. C., Rubin, G. D. 2001; 176 (3): 689-693
  • Tissue harmonic imaging techniques: Physical principles and clinical applications SEMINARS IN ULTRASOUND CT AND MRI Desser, T. S., Jeffrey, R. B. 2001; 22 (1): 1-10

    Abstract

    Tissue harmonic imaging (THI) is a new gray-scale sonographic technique that improves image clarity. Harmonics form within the insonated tissue as a consequence of nonlinear sound propagation. Imaging with endogenously formed harmonics means that the distorting layer of the body wall is traversed only once by the harmonic beam--during echo reception. Both image contrast and lateral resolution are improved in harmonic mode compared with conventional (fundamental mode) sonography. This article summarizes the physics and various implementations of harmonic imaging mode, and reviews the clinical applications that have emerged to date.

    View details for DOI 10.1053/sult.2001.20872

    View details for Web of Science ID 000167475600002

    View details for PubMedID 11300583

  • Ultrasonographically guided thyroid biopsy - A review with emphasis on technique JOURNAL OF ULTRASOUND IN MEDICINE Rausch, P., Nowels, K., Jeffrey, R. B. 2001; 20 (1): 79-85

    Abstract

    We describe our technique for ultrasonographically guided fine-needle aspiration biopsy of the thyroid that achieves a high rate of diagnostic specimens. Indications for ultrasonographically guided fine-needle aspiration biopsy included a difficult-to-palpate thyroid nodule and previously unsuccessful palpation-guided fine-needle aspiration. Ultrasonographically guided fine-needle aspiration biopsy was performed on 316 thyroid nodules in 306 patients. Adequate cytologic specimens were obtained in 97.2% of the nodules in which biopsy was performed, with a 2.8% rate of inadequate cellularity. Two helpful aspects of this technique that were thought to improve the overall diagnostic yield were the use of color and power Doppler "vascular mapping" of the nodule just before biopsy and on-site cytologic control.

    View details for Web of Science ID 000167755100015

    View details for PubMedID 11149534

  • Medial axis registration of supine and prone CT colonography data 23rd Annual International Conference of the IEEE-Engineering-in-Medicine-and-Biology-Society Acar, B., Napel, S., Paik, D. S., Li, P., Yee, J., Jeffrey, R. B., Beaulieu, C. F. IEEE. 2001: 2433–2436
  • Thickened submucosal layer: a sonographic sign of acute gastrointestinal abnormality representing submucosal edema or hemorrhage. 2000 ARRS Executive Council Award II. American Roentgen Ray Society. AJR. American journal of roentgenology Frisoli, J. K., Desser, T. S., Jeffrey, R. B. 2000; 175 (6): 1595-1599

    Abstract

    We correlated the sonographic appearance of bowel wall thickening with the acuity of the underlying disease process.Sonograms of thickened bowel walls were reviewed in 37 patients with proven gastrointestinal abnormalities. Sonographic findings were correlated with clinical presentation, endoscopy, histology, laboratory data, barium studies, and CT.Twenty-eight patients presented acutely, and nine patients had chronic or subacute disease processes. Two of the 28 patients had concurrent acute and chronic processes. In 27 of 28 patients with acute processes, the abnormal bowel segments were characterized by an echogenic submucosal layer thicker than 2.5 mm. In contrast, nine patients with chronic or subacute processes had relatively uniform hypoechoic thickening of the bowel wall with loss of visualization of a discrete echogenic submucosal layer. CT was available for comparison in 30 of 37 patients. Of the 28 patients with acute abnormalities, the thickened echogenic submucosal layer on sonography corresponded to either low-attenuation submucosal edema (n = 25) or acute submucosal hemorrhage (n = 3).The finding of a thickened submucosal layer suggests an acute disease process of the bowel and corresponds to either submucosal edema or hemorrhage.

    View details for PubMedID 11090383

  • Thickened submucosal layer: A sonographic sign of acute gastrointestinal abnormality representing submucosal edema or hemorrhage AMERICAN JOURNAL OF ROENTGENOLOGY Frisoli, J. K., Desser, T. S., Jeffrey, R. B. 2000; 175 (6): 1595-1599
  • Automated polyp detector for CT colonography: Feasibility study RADIOLOGY Summers, R. M., Beaulieu, C. F., Pusanik, L. M., Malley, J. D., Jeffrey, R. B., Glazer, D. I., Napel, S. 2000; 216 (1): 284-290

    Abstract

    An abdominal computed tomographic scan was modified by inserting 10 simulated colonic polyps with use of methods that closely mimic the attenuation, noise, and polyp-colon wall interface of naturally occurring polyps. A shape-based polyp detector successfully located six of the 10 polyps. When settings that enhanced the edge profile of polyps were chosen, eight of 10 polyps were detected. There were no false-positive detections. Shape analysis is technically feasible and is a promising approach to automated polyp detection.

    View details for Web of Science ID 000087829500042

    View details for PubMedID 10887263

  • Focal liver lesions: Pattern-based classification scheme for enhancement at arterial phase CT RADIOLOGY Nino-Murcia, M., Olcott, E. W., Jeffrey, R. B., Lamm, R. L., Beaulieu, C. F., Jain, K. A. 2000; 215 (3): 746-751

    Abstract

    To present our early experience with a classification scheme for categorizing focal liver lesions on the basis of the enhancement patterns that they exhibit in the arterial phase of computed tomography (CT) and to determine whether particular enhancement patterns suggest particular diagnoses.The authors reviewed arterial phase CT images in 100 consecutive patients with focal liver lesions, excluding simple cysts. The enhancement pattern of the dominant or representative lesion in each patient was classified into one of five categories-homogeneous, abnormal internal vessels or variegated, peripheral puddles, complete ring, or incomplete ring-by three radiologists blinded to the proved diagnosis. Lesions without enhancement were recorded separately. Agreement was reached by consensus in all cases. Standards of reference included findings at histologic examination, correlative imaging, or clinical and imaging follow-up.Ninety-two percent of the 100 lesions demonstrated arterial phase enhancement. Patterns associated with positive predictive values of 82% or greater and specificity of 80% or greater included abnormal internal vessels or variegated (hepatocellular carcinoma), peripheral puddles (hemangioma), and complete ring (metastasis).The appearance of hepatic lesions in the arterial phase of enhancement has potential use in the determination of specific diagnoses. The classification scheme used in this study may be a useful tool for the interpretation of arterial phase CT studies.

    View details for Web of Science ID 000087247000020

    View details for PubMedID 10831693

  • Aortic aneurysmal disease: Assessment of stent-graft treatment - CT versus conventional angiography RADIOLOGY Armerding, M. D., Rubin, G. D., Beaulieu, C. F., Slonim, S. M., Olcott, E. W., Samuels, S. L., Jorgensen, M. J., Semba, C. P., Jeffrey, R. B., Dake, M. D. 2000; 215 (1): 138-146

    Abstract

    To compare computed tomographic (CT) angiography and conventional angiography for determining the success of endoluminal stent-graft treatment of aortic aneurysms.Forty patients underwent conventional angiography and CT angiography following treatment of aortoiliac aneurysms with endoluminal stent-grafts. Six additional sets of conventional angiographic-CT angiographic examinations were performed in five patients after placement of additional stent-grafts or coil embolization to treat perigraft leakage. Three faculty CT radiologists who were blinded to patient clinical data and outcome independently interpreted the CT angiograms, and three faculty angiographers, who were not involved in the stent-graft deployment, interpreted the conventional angiograms. Images were assessed for the presence of postdeployment complications. A reference standard was developed by experienced radiologists using all available images and clinical data. Sensitivities, specificities, and kappa values were calculated.Perigraft leakage was the most commonly identified complication. Twenty perigraft leaks were detected in the results of 46 examinations. Sensitivities and specificities for detecting perigraft leakage were 63% and 77% for conventional angiography and 92% and 90% for CT angiography, respectively. The kappa value was 0. 41 for conventional angiography and 0.81 for CT angiography.CT angiography is the preferred method for establishing the presence of perigraft leakage following treatment of aortoiliac aneurysms with stent-grafts.

    View details for Web of Science ID 000086156700021

    View details for PubMedID 10751479

  • Visualization modes for CT colonography using cylindrical and planar map projections JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY Paik, D. S., Beaulieu, C. F., Jeffrey, R. B., Karadi, C. A., Napel, S. 2000; 24 (2): 179-188

    Abstract

    The purpose of this study was to demonstrate the limitations to the effectiveness of CT colonography, colloquially called virtual colonoscopy (VC), for detecting polyps in the colon and to describe a new technique, map projection CT colonography using Mercator projection and stereographic projection, that overcomes these limitations.In one experiment, data sets from nine patients undergoing CT colonography were analyzed to determine the percentage of the mucosal surface visible in various visualization modes as a function of field of view (FOV). In another experiment, 40 digitally synthesized polyps of various sizes (10, 7, 5, and 3.5 mm) were randomly inserted into four copies of one patient data set. Both Mercator and stereographic projections were used to visualize the surface of the colon of each data set. The sensitivity and positive predictive value (PPV) were calculated and compared with the results of an earlier study of visualization modes using the same CT colonography data.The percentage of mucosal surface visualized by VC increases with greater FOV but only approaches that of map projection VC (98.8%) at a distorting, very high FOV. For both readers and polyp sizes of > or =7 mm, sensitivity for Mercator projection (87.5%) and stereographic projection (82.5%) was significantly greater (p < 0.05) than for viewing axial slices (62.5%), and Mercator projection was significantly more sensitive than VC (67.5%). Mercator and stereographic projection had PPVs of 75.4 and 78.9%, respectively.The sensitivity of conventional CT colonography is limited by the percentage of the mucosal surface seen. Map projection CT colonography overcomes this problem and provides a more sensitive method with a high PPV for detecting polyps than other methods currently being investigated.

    View details for Web of Science ID 000086026800001

    View details for PubMedID 10752876

  • Spontaneous intrahepatic vascular shunts AMERICAN JOURNAL OF ROENTGENOLOGY Lane, M. J., Jeffrey, R. B., Katz, D. S. 2000; 174 (1): 125-131

    View details for Web of Science ID 000084487300025

    View details for PubMedID 10628467

  • Automated quantification of 4D ultrasound for carotid artery disease 14th International Congress and Exhibition on Computer Assisted Radiology and Surgery (CARS 2000) Xu, H., Paik, D. S., Ross, B., Sumanaweera, T. S., Hossack, J., Jeffrey, R. B., Napel, S. ELSEVIER SCIENCE BV. 2000: 666–670
  • Computed tomographic angiography: Historical perspective and new state-of-the-art using multi detector-row helical computed tomography Workshop on Multiple Perspectives in Magnetic Resonance Imaging Contrast Rubin, G. D., Shiau, M. C., Schmidt, A. J., Fleischmann, D., Logan, L., Leung, A. N., Jeffrey, R. B., Napel, S. LIPPINCOTT WILLIAMS & WILKINS. 1999: S83–S90

    Abstract

    Since its clinical introduction in 1991, volumetric computed tomography scanning using spiral or helical scanners has resulted in a revolution for diagnostic imaging. In addition to new applications for computed tomography, such as computed tomographic angiography and the assessment of patients with renal colic, many routine applications such as the detection of lung and liver lesions have substantially improved. Helical computed tomographic technology has improved over the past eight years with faster gantry rotation, more powerful X-ray tubes, and improved interpolation algorithms, but the greatest advance has been the recent introduction of multi detector-row computed tomography scanners. These scanners provide similar scan quality at a speed gain of 3-6 times greater than single detector-row computed tomography scanners. This has a profound impact on the performance of computed tomography angiography, resulting in greater anatomic coverage, lower iodinated contrast doses, and higher spatial resolution scans than single detector-row systems.

    View details for Web of Science ID 000084391500012

    View details for PubMedID 10608402

  • Intramural varices of the bile duct: An unusual pattern of cavernous transformation of the portal vein AMERICAN JOURNAL OF ROENTGENOLOGY Chow, L., Jeffrey, R. B. 1999; 173 (5): 1255-1256

    View details for Web of Science ID 000083312300021

    View details for PubMedID 10541099

  • Treatment and stabilization of complex wounds involving the pelvic bone, groin, and femur with the inferiorly based rectus abdominis musculocutaneous flap and the use of power color Doppler imaging in preoperative evaluation ANNALS OF PLASTIC SURGERY Chen, J. J., Giese, S., Jeffrey, R. B., Lineaweaver, W. 1999; 43 (5): 494-498

    Abstract

    The authors present case reports demonstrating the trilevel utility of the inferiorly based rectus abdominis musculocutaneous flap in the closure of complex wounds involving the pelvis, groin, and femur that had failed previously or were not amenable to traditional closure techniques. The use of the rectus abdominis flap was especially advantageous for achieving infection eradication and large dead space closure. Additionally they present the emerging technique of power color Doppler imaging as a valuable tool in preoperative flap planning. This technique is particularly useful in evaluating the candidacy for rectus abdominis musculocutaneous flap placement of patients with a prior history of abdominal surgeries, trauma, infection, irradiation, or other conditions that might compromise the patency of the deep inferior epigastric vessels.

    View details for Web of Science ID 000083557300007

    View details for PubMedID 10560864

  • Suspected acute appendicitis: Nonenhanced helical CT in 300 consecutive patients RADIOLOGY Lane, M. J., Liu, D. M., Huynh, M. D., Jeffrey, R. B., Mindelzun, R. E., Katz, D. S. 1999; 213 (2): 341-346

    Abstract

    To determine the accuracy of helical computed tomography (CT) without the oral, intravenous, or rectal administration of contrast material in confirming suspected acute appendicitis.Three hundred consecutive patients referred from the departments of surgery and emergency medicine were examined for suspected acute appendicitis by using thin-section nonenhanced helical CT. All transverse CT scans were obtained in a single breath hold from the upper abdomen (T12 vertebra) to the pubic symphysis with 5-mm collimation and a pitch of 1.6. All scans were obtained without oral, intravenous, or rectal contrast material. Criteria for diagnosis of acute appendicitis included an enlarged appendix (> 6 mm) and periappendiceal inflammation. CT diagnoses were recorded prospectively. Final diagnoses were established with the results of surgical or clinical follow-up or both.There were 110 true-positive diagnoses, 181 true-negative diagnoses (63 of which were an alternative diagnosis correctly established prospectively), five false-negative diagnoses, and four false-positive diagnoses, which yielded a sensitivity of 96%, a specificity of 99%, and an accuracy of 97%.Nonenhanced helical CT is a highly accurate technique for diagnosing or excluding acute appendicitis. Developing experience with the technique and understanding the subtleties of interpretation can further improve diagnostic accuracy.

    View details for Web of Science ID 000083308900005

    View details for PubMedID 10551210

  • Disseminated peritoneal plasmacytoma following cardiac transplantation ABDOMINAL IMAGING Chan, B. K., Ranheim, E., Jeffrey, R. B. 1999; 24 (5): 508-510

    Abstract

    Posttransplant lymphoproliferative disorders (PTLD) are an important comorbidity in immunosuppressed transplant patients. We describe a unique case of PTLD, a disseminated peritoneal plasmacytoma in a 56-year-old cardiac transplant patient presenting with ascites. The associated computed tomographic findings include omental thickening, mesenteric stranding, and ascites.

    View details for Web of Science ID 000082193900017

    View details for PubMedID 10475938

  • Parathyroid localization with high-resolution ultrasound and technetium Tc 99m sestamibi 70th Annual Session of the Pacific-Coast-Surgical-Association Purcell, G. P., Dirbas, F. M., Jeffrey, R. B., Lane, M. J., Desser, T., McDougall, R., Weigel, R. J. AMER MEDICAL ASSOC. 1999: 824–28

    Abstract

    High-resolution ultrasound and technetium Tc 99m sestamibi scanning can be used for preoperative localization of abnormal parathyroid glands in patients with hyperparathyroidism.Ultrasound and sestamibi scanning were performed in patients undergoing neck exploration for hyperparathyroidism. If the 2 scans agreed in identifying a single adenoma, and surgery confirmed the location of a single adenoma and an ipsilateral normal gland, a unilateral exploration was performed.University tertiary care center.Sixty-one consecutive patients undergoing surgery for hyperparathyroidism from September 1, 1994, through September 30, 1997.High-resolution ultrasound was performed in 59 patients and sestamibi scanning in 58 patients; all patients underwent neck exploration by a single surgeon.The results of preoperative ultrasound and sestamibi scanning were compared with operative and histological findings.All patients were cured of hypercalcemia. Specificity of ultrasound and sestamibi scanning was 98% and 99%, respectively; however, their sensitivity was only 57% and 54%, respectively. Both imaging modalities had lower sensitivities in the setting of multigland disease. If both imaging studies were considered as a single test, sensitivity for imaging in patients with primary hyperparathyroidism reached 78%. Our localization protocol allowed a unilateral approach in 43% of patients (23 of 53).These results confirm the value of preoperative localization in patients with hyperparathyroidism. A unilateral approach can be used with a high degree of success in cases when ultrasound and sestamibi scanning agree in the identification of a single adenoma confirmed by surgical exploration with the identification of a normal ipsilateral gland.

    View details for Web of Science ID 000081876300006

    View details for PubMedID 10443804

  • Display modes for CT colonography - Part II. Blinded comparison of axial CT and virtual endoscopic and panoramic endoscopic volume-rendered studies RADIOLOGY Beaulieu, C. F., Jeffrey, R. B., Karadi, C., Paik, D. S., Napel, S. 1999; 212 (1): 203-212

    Abstract

    To determine the sensitivity of radiologist observers for detecting colonic polyps by using three different data review (display) modes for computed tomographic (CT) colonography, or "virtual colonoscopy."CT colonographic data in a patient with a normal colon were used as base data for insertion of digitally synthesized polyps. Forty such polyps (3.5, 5, 7, and 10 mm in diameter) were randomly inserted in four copies of the base data. Axial CT studies, volume-rendered virtual endoscopic movies, and studies from a three-dimensional mode termed "panoramic endoscopy" were reviewed blindly and independently by two radiologists.Detection improved with increasing polyp size. Trends in sensitivity were dependent on whether all inserted lesions or only visible lesions were considered, because modes differed in how completely the colonic surface was depicted. For both reviewers and all polyps 7 mm or larger, panoramic endoscopy resulted in significantly greater sensitivity (90%) than did virtual endoscopy (68%, P = .014). For visible lesions only, the sensitivities were 85%, 81%, and 60% for one reader and 65%, 62%, and 28% for the other for virtual endoscopy, panoramic endoscopy, and axial CT, respectively. Three-dimensional displays were more sensitive than two-dimensional displays (P < .05).The sensitivity of panoramic endoscopy is higher than that of virtual endoscopy, because the former displays more of the colonic surface. Higher sensitivities for three-dimensional displays may justify the additional computation and review time.

    View details for Web of Science ID 000081086900032

    View details for PubMedID 10405743

  • Display modes for CT colonography - Part I. Synthesis and insertion of polyps into patient CT data RADIOLOGY Karadi, C., Beaulieu, C. F., Jeffrey, R. B., Paik, D. S., Napel, S. 1999; 212 (1): 195-201

    Abstract

    To develop and validate a method for the insertion of digitally synthesized polyps into computed tomographic (CT) images of the human colon for use as ground truth for evaluation of virtual colonoscopy.Spiral CT simulator software was used to generate 10 synthetic polyps in various configurations. Additional software was developed to insert these polyps into volume CT scans. Ten polyps in eight patients were selected for comparison. Three radiologists evaluated whether two-dimensional (2D) CT images and three-dimensional (3D) volume-rendered CT images showed synthetic or real polyps.Edge-response profiles and noise of simulated polyps matched those of native polyps. Frequency distributions of reviewers' responses were not significantly different for synthetic versus real polyps in either 3D or 2D images. Responses were clustered around the response of "unsure" if lesions were real or synthetic. Receiver operating characteristic curves had areas of 0.54 (95% CI = 0.39, 0.68) for 3D and 0.39 (95% CI = 0.25, 0.53) for 2D images, which were not significantly different from random guessing (P = .70 and .28 for 3D and 2D images, respectively).Synthetic polyps were indistinguishable from real polyps. This method can be used to generate ground truth experimental data for comparison of CT colonographic display and detection methods.

    View details for Web of Science ID 000081086900031

    View details for PubMedID 10405742

  • Malignant fibrous histiocytoma presenting as cystic pancreatic mass ABDOMINAL IMAGING Liu, D. M., Jeffrey, R. B., Mindelzun, R. E. 1999; 24 (3): 299-300

    Abstract

    Although malignant fibrous histiocytoma (MFH) is a common sarcoma of late adulthood, it has rarely been reported to involve the pancreas. We describe the clinical and imaging features of a 27-year-old patient presenting with a predominantly cystic MFH. The cystic appearance of the lesion corresponded histologically to necrosis and hemorrhage within the mass.

    View details for Web of Science ID 000080166900019

    View details for PubMedID 10227898

  • Power Doppler imaging of acute renal transplant rejection JOURNAL OF CLINICAL ULTRASOUND Sidhu, M. K., Gambhir, S., Jeffrey, R. B., Sommer, F. G., Li, K. C., Krieger, N. R., Alfrey, E. J., Scandling, J. D. 1999; 27 (4): 171-175

    Abstract

    We evaluated the usefulness of power Doppler imaging (PDI) in diagnosing acute renal-transplant rejection.Twenty-eight patients underwent 33 renal-transplant biopsies for suspected acute rejection. Patterns of renal parenchymal vascularity revealed by PDI in patients with abnormal biopsy results were compared with patterns in a group who had normal biopsy results. PDI examinations were reviewed retrospectively by 2 independent radiologists who had no knowledge of the biopsy results. A PDI diagnosis of acute rejection required marked vascular pruning in both the cortex and medulla. PDI results then were compared with transplant-biopsy results.The sensitivity and specificity of PDI for diagnosing acute renal-transplant rejection were 40% and 100%, respectively. None of the patients with negative biopsy results had PDI abnormalities. The negative predictive value of PDI was 33%, and the positive predictive value was 100%.In our study, an abnormal sonogram was highly predictive of acute transplant rejection. However, a normal sonogram did not exclude the possibility of rejection.

    View details for Web of Science ID 000079955100001

    View details for PubMedID 10323186

  • Virtual endoscopy using perspective volume-rendered three-dimensional sonographic Data: Technique and clinical applications AMERICAN JOURNAL OF ROENTGENOLOGY Yuh, E. L., Jeffrey, R. B., Birdwell, R. L., Chen, B. H., Napel, S. 1999; 172 (5): 1193-1197

    Abstract

    We present a technique for obtaining three-dimensional external and virtual endoscopy views of organs using perspective volume-rendered gray-scale and Doppler sonographic data, and we explore potential clinical applications in the carotid artery, the female pelvis, and the bladder.Using the proposed methods, radiologists will find it possible to create virtual endoscopy and external perspective views using sonographic data. The technique works well for revealing the interior of fluid-filled structures and cavities. However, expected improvements in computer performance and integration with existing sonographic equipment will be necessary for the technique to become practical in the clinical environment.

    View details for Web of Science ID 000079919700005

    View details for PubMedID 10227488

  • The acute abdomen: Current CT imaging techniques SEMINARS IN ULTRASOUND CT AND MRI Mindelzun, R. E., Jeffrey, R. B. 1999; 20 (2): 63-67

    Abstract

    Currently, CT plays a pivotal role in the evaluation of the patient with an acute abdomen. Several competing techniques have been described and investigated. Each appears to possess advantages and disadvantages which will be examined. Each imaging center needs to modify these protocols to satisfy local scanner availability, patient demographics, radiologic expertise, and economic considerations.

    View details for Web of Science ID 000079764600002

    View details for PubMedID 10222514

  • Tissue harmonic imaging: Utility in abdominal and pelvic sonography JOURNAL OF CLINICAL ULTRASOUND Desser, T. S., Jeffrey, R. B., Lane, M. J., Ralls, P. W. 1999; 27 (3): 135-142

    View details for Web of Science ID 000078596000006

    View details for PubMedID 10064411

  • Hepatic abscess following transhepatic drainage of subphrenic abscess ABDOMINAL IMAGING Yu, A., Mindelzun, R. E., Jeffrey, R. B. 1999; 24 (2): 163-164

    Abstract

    A case of an hepatic abscess that developed after percutaneous transhepatic drainage of a subphrenic abscess is presented. The location of the abscess immediately along the tract of the drainage catheter and the similar organisms recovered from bacteriologic culture suggest that the abscess was related to direct contamination along the tract of the drainage catheter. The potential for abscess formation within the liver should be considered in the choice of access route for percutaneous drainage of retroabdominal abscesses. It may be preferable to avoid transhepatic drainage in patients in whom it is anticipated that the catheter drainage will require considerable length of time.

    View details for Web of Science ID 000078810300013

    View details for PubMedID 10024403

  • New visualization techniques for virtual colonoscopy: Methods and evaluation 1st International Workshop on Computer-Aided Diagnosis Napel, S., Beaulieu, C. F., Paik, D. S., Karadi, C., Jeffrey, R. B. ELSEVIER SCIENCE BV. 1999: 463–468
  • CT angiography of the visceral vasculature SEMINARS IN ULTRASOUND CT AND MRI Nghiem, H. V., Jeffrey, R. B. 1998; 19 (5): 439-446

    Abstract

    CT angiography (CTA) is a minimally invasive technique that has proven to be clinically useful in evaluating the vasculature of the abdominal viscera. In many instances, the diagnostic information obtained from abdominal CTA is sufficient to avoid the expense and morbidity of conventional angiography. This article reviews the indications, technique, and pitfalls of abdominal CTA with specific emphasis on disorders of the hepatic, splenic, and superior mesenteric arteries and the portal venous system.

    View details for Web of Science ID 000076458100007

    View details for PubMedID 9800253

  • CT angiography of the abdominal and thoracic aorta SEMINARS IN ULTRASOUND CT AND MRI Jeffrey, R. B. 1998; 19 (5): 405-412

    Abstract

    Evaluation of the abdominal and thoracic aorta is one of the most common indications for CT angiography (CTA). CTA largely has replaced conventional angiography in the assessment of aortic aneurysms and dissections because it provides all the relevant anatomic information at reduced cost, morbidity, and radiation exposure. This article will focus on the technique, interpretation, and pitfalls in the CTA evaluation of the abdominal and thoracic aorta.

    View details for Web of Science ID 000076458100004

    View details for PubMedID 9800250

  • Active arterial contrast extravasation on helical CT of the abdomen, pelvis, and chest AMERICAN JOURNAL OF ROENTGENOLOGY Lane, M. J., Katz, D. S., Shah, R. A., Rubin, G. D., Jeffrey, R. B. 1998; 171 (3): 679-685

    View details for Web of Science ID 000075496700029

    View details for PubMedID 9725295

  • Use of color and power Doppler sonography to identify feeding arteries associated with parathyroid adenomas AMERICAN JOURNAL OF ROENTGENOLOGY Lane, M. J., Desser, T. S., Weigel, R. J., Jeffrey, R. B. 1998; 171 (3): 819-823

    Abstract

    The objective of our study was to determine the value of using color and power Doppler sonography to reveal extrathyroidal feeding arteries in the detection of abnormal parathyroid glands.Forty-four patients with primary hyperparathyroidism were imaged prospectively with high-resolution gray-scale, color flow, and power Doppler sonography. The presence of extrathyroidal arteries supplying the adenomas was noted. All patients underwent subsequent neck exploration. The locations of the abnormal glands were recorded.At surgery, 51 abnormal parathyroid glands were removed in the 44 patients. Sonography correctly revealed an adenoma in 40 of the 44 patients. Likewise, sonography revealed 42 of the 51 adenomas. Nine false-negative and two false-positive interpretations of the sonograms were made. Thus, overall sensitivity was 83%, specificity was 98%, and accuracy was 94%. Three of the false-negative interpretations were ectopic glands within the superior mediastinum. Excluding these three glands from analysis, the sensitivity for detection of adenomas within the neck was 88%, specificity was 98%, and accuracy was 95%. An extrathyroidal artery leading to a parathyroid adenoma was seen in 35 of the 42 adenomas revealed by sonography. The presence of an extrathyroidal artery leading to an adenoma was found to aid in the detection of an otherwise inconspicuous parathyroid gland in five patients, which improved sensitivity from 73% to 83%.Prominent vessels supplying parathyroid adenomas are frequently revealed by color flow and power Doppler sonography. These vessels can serve as "road maps" to abnormal parathyroid glands.

    View details for Web of Science ID 000075496700057

    View details for PubMedID 9725323

  • Detection of colonic polyps in a phantom model: Implications for virtual colonoscopy data acquisition JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY Beaulieu, C. F., Napel, S., Daniel, B. L., Ch'en, I. Y., Rubin, G. D., Johnstone, I. M., Jeffrey, R. B. 1998; 22 (4): 656-663

    Abstract

    Virtual colonoscopy is a new method of colon examination in which computer-aided 3D visualization of spiral CT simulates fiberoptic colonoscopy. We used a colon phantom containing various-sized spheres to determine the influence of CT acquisition parameters on lesion detectability and sizing.Spherical plastic beads with diameters of 2.5, 4, 6, 8 and 10 mm were randomly attached to the inner wall of segments of plastic tubing. Groups of three sealed tubes were scanned at 3/1, 3/2, 5/1 collimation (mm)/pitch settings in orientations perpendicular and parallel to the scanner gantry. For each acquisition, image sets were reconstructed at intervals from 0.5 to 5.0 mm. Two blinded reviewers assessed transverse cross-sections of the phantoms for bead detection, using source CT images for images for acquisitions obtained with the tubes oriented perpendicular to the gantry and using orthogonal reformatted images for scans oriented parallel to the gantry.Detection of beads of > or = 4 mm was 100% for both tube orientations and for all collimator/pitch settings and reconstruction intervals. For the 2.5 mm beads, detection decreased to 78-94% for 5 mm collimation/pitch 2 scans when the phantom sections were oriented parallel to the gantry (p = 0.01). Apparent elongation of beads in the slice direction occurred as the collimation and pitch increased. The majority of the elongation (approximately 75%) was attributable to changing the collimator from 3 to 5 mm, with the remainder of the elongation due to doubling the pitch from 1 to 2.CT scanning at 5 mm collimation and up to pitch 2 is adequate for detection of high contrast lesions as small as 4 mm in this model. However, lesion size and geometry are less accurately depicted than at narrower collimation and lower pitch settings.

    View details for Web of Science ID 000074812400028

    View details for PubMedID 9676463

  • Diverticulitis of the right colon revisited AMERICAN JOURNAL OF ROENTGENOLOGY Katz, D. S., Lane, M. J., Ross, B. A., Gold, B. M., Jeffrey, R. B., Mindelzun, R. E. 1998; 171 (1): 151-156

    View details for Web of Science ID 000074291000028

    View details for PubMedID 9648779

  • Helical body CT: Evolution of scanning protocols AMERICAN JOURNAL OF ROENTGENOLOGY ZEMAN, R. K., BARON, R. L., Jeffrey, R. B., Klein, J., SIEGEL, M. J., Silverman, P. M. 1998; 170 (6): 1427-1438

    View details for Web of Science ID 000073769500005

    View details for PubMedID 9609149

  • Automated flight path planning for virtual endoscopy MEDICAL PHYSICS Paik, D. S., Beaulieu, C. F., Jeffrey, R. B., Rubin, G. D., Napel, S. 1998; 25 (5): 629-637

    Abstract

    In this paper, a novel technique for rapid and automatic computation of flight paths for guiding virtual endoscopic exploration of three-dimensional medical images is described. While manually planning flight paths is a tedious and time consuming task, our algorithm is automated and fast. Our method for positioning the virtual camera is based on the medial axis transform but is much more computationally efficient. By iteratively correcting a path toward the medial axis, the necessity of evaluating simple point criteria during morphological thinning is eliminated. The virtual camera is also oriented in a stable viewing direction, avoiding sudden twists and turns. We tested our algorithm on volumetric data sets of eight colons, one aorta and one bronchial tree. The algorithm computed the flight paths in several minutes per volume on an inexpensive workstation with minimal computation time added for multiple paths through branching structures (10%-13% per extra path). The results of our algorithm are smooth, centralized paths that aid in the task of navigation in virtual endoscopic exploration of three-dimensional medical images.

    View details for Web of Science ID 000073650800004

    View details for PubMedID 9608471

  • Ultrasound-guided fine-needle aspiration biopsy of thyroid masses THYROID Carmeci, C., Jeffrey, R. B., McDougall, I. R., Nowels, K. W., Weigel, R. J. 1998; 8 (4): 283-289

    Abstract

    The purpose of this study was to determine the impact of ultrasound-guided fine-needle aspiration biopsy (USFNA) in the cytological diagnosis of nodular thyroid disease. It remains unclear exactly what role USFNA should play in the cytological diagnosis of nodular thyroid disease. All patients who underwent fine-needle aspiration (FNA) for nodular thyroid disease at Stanford University Medical Center from 1991 to 1996 were included in the study. Histopathologic diagnoses were compared to cytological diagnoses for those patients who underwent surgery. FNA was performed on a total of 497 thyroid nodules. Palpation-guided FNA (pFNA) was performed on 370 nodules, and USFNA was done on 127. The USFNAs were performed for the following reasons: 95 (75%) for nonpalpable or difficult-to-palpate nodules; 14 (11%) for previously failed FNA; and 18 (14%) for incidentally detected nodules. FNA had an unsuccessful biopsy rate of 16% and a sensitivity and specificity of 89% and 69%, respectively. USFNA had an unsuccessful biopsy rate of 7% and a sensitivity and specificity of 100% and 100%, respectively. The cancer yield at surgery for pFNA was 40%, and the cancer yield at surgery for USFNA was 59%. The complementary use of USFNA with pFNA improves the diagnostic approach to nodular thyroid disease. The use of USFNA has increased the cancer yield at surgery and the sensitivity of thyroid biopsy at our institution.

    View details for Web of Science ID 000073292800002

    View details for PubMedID 9588492

  • Dual-phase helical CT of locally invasive pancreatic adenocarcinoma. Journal of computer assisted tomography Nino-Murcia, M., Olcott, E. W., Jeffrey, R. B. 1998; 22 (2): 282-287

    Abstract

    Dual-phase helical CT permits imaging of the pancreas and the peripancreatic structures in the arterial dominant and portal venous phases of enhancement, providing information crucial in the assessment of the local extent of pancreatic adenocarcinoma. This essay reviews the dual-phase helical CT findings of local extension that preclude potentially curative surgery, including vascular involvement, ligamentous or mesenteric invasion, extension of the tumor to involve the stomach or duodenum, and invasion of adjacent solid organs.

    View details for PubMedID 9530395

  • Pictorial essay - Dual-phase helical CT of locally invasive pancreatic adenocarcinoma JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY Nino-Murcia, M., Olcott, E. W., Jeffrey, R. B. 1998; 22 (2): 282-287
  • CT and sonographic evaluation of acute right lower quadrant abdominal pain AMERICAN JOURNAL OF ROENTGENOLOGY Birnbaum, B. A., Jeffrey, R. B. 1998; 170 (2): 361-371

    View details for Web of Science ID 000071619500024

    View details for PubMedID 9456947

  • Chemo-radiotherapy for localized pancreatic cancer: Increased dose intensity and reduced acute toxicity with concomitant radiotherapy and protracted venous infusion 5-fluorouracil Conference on Overcoming Bad Blood in Cancer Clinical Trials - Tuskegee Trial Revisited Poen, J. C., Collins, H. L., Niederhuber, J. E., Oberhelman, H. A., Vierra, M. A., Bastidas, A. J., Young, H. S., Slosberg, E. A., Jeffrey, B. R., Longacre, T. A., Fisher, G. A., Goffinet, D. R. ELSEVIER SCIENCE INC. 1998: 93–99

    Abstract

    Although concomitant radiation therapy (RT) and bolus 5-Fluorouracil (5-FU) have been shown to improve survival in locally confined pancreatic cancer, most patients will eventually succumb to their disease. Since 1994, we have attempted to improve efficacy by administering 5-FU as a protracted venous infusion (PVI). This study compares treatment intensity and acute toxicity of consecutive protocols of concurrent RT and 5-FU by bolus injection or PVI.Since 1986, 74 patients with resected or locally advanced pancreatic cancer were treated with continuous course RT and concurrent 5-FU by bolus injection (n = 44) or PVI throughout the course of RT (n = 30). Dose intensity was assessed for both 5-FU and radiotherapy. Toxicity endpoints which could be reliably and objectively quantified (e.g., neutropenia, weight loss, treatment interruption) were evaluated.Cumulative 5-FU dose (mean = 7.2 vs. 2.5 gm/m2, p < 0.001) and weekly 5-FU dose (mean = 1.3 vs. 0.5 gm/m2/wk, p < 0.001) were significantly higher for patients receiving PVI 5-FU. Following pancreaticoduodenectomy, 95% of PVI patients maintained a RT dose intensity of > or = 900 cGy/wk, compared with 63% of those receiving bolus 5-FU (p = 0.02). No difference was seen for patients with locally advanced disease (72% vs. 76%, p = n.s.). Grade II-III neutropenia was less common for patients treated with PVI (13% vs. 34%, p = 0.05). Grade II-III thrombocytopenia was uncommon (< or = 3%) in both treatment groups. Mean percent weight loss (3.8% vs. 4.1%, p = n.s.) and weight loss > or = 5% of pre-treatment weight (21% vs. 31%, p = n.s.) were similar for PVI and bolus treatment groups, respectively. Treatment interruptions for hematologic, gastrointestinal or other acute toxicities were less common for patients receiving PVI 5-FU (10% vs. 25%, p = 0.11).Concurrent RT and 5-FU by PVI was well tolerated and permitted greater chemotherapy and radiotherapy dose intensity with reduced hematologic toxicity and fewer treatment interruptions compared with RT and bolus 5-FU. Longer follow-up will be needed to assess late effects and the impact on overall survival.

    View details for Web of Science ID 000071164200015

    View details for PubMedID 9422563

  • Sonography of intraabdominal gas collections AMERICAN JOURNAL OF ROENTGENOLOGY Pattison, P., Jeffrey, R. B., Mindelzun, R. E., Sommer, F. G. 1997; 169 (6): 1559-1564

    View details for Web of Science ID A1997YH01000018

    View details for PubMedID 9393165

  • Power Doppler imaging in preoperative planning and postoperative monitoring of muscle flaps JOURNAL OF CLINICAL ULTRASOUND Loh, N. N., Chen, I. Y., Olcott, E., Jeffrey, R. B., Hui, K. C., PERSONS, B., Lineaweaver, W. C. 1997; 25 (9): 465-471

    Abstract

    We assessed the utility of power Doppler imaging (PDI) in preoperative planning and postoperative evaluation of microvascular tissue transfers.Twenty-five PDI studies were performed on 23 patients using a 5-10-MHz linear-array transducer. Thirteen patients were assessed preoperatively for patency of the desired donor vessel; 8 of them had surgical scars overlying the desired vascular territory. Twelve patients (including 2 from the first group) were evaluated postoperatively for patency of the vascular anastomoses and adequacy of the blood supply to the transferred tissue.Twelve of the 13 patients assessed preoperatively had successful flap transfers. Four of the 8 patients with scars over the desired vascular territories had absent or aberrant arteries, necessitating a change in the operative plan. None of these patients had operative complications. Eight of the 12 patients scanned postoperatively had patent anastomoses. In 2 of these patients, impending surgery was averted when the adequacy of the tissue blood supply was established with PDI. In 4 patients, PDI showed arterial or venous compromise, which was confirmed at surgery.PDI is a useful technique in microsurgical tissue transfer for assessing the patency of desired donor vessels preoperatively and for postoperative evaluation of blood supply.

    View details for Web of Science ID A1997YC38100001

    View details for PubMedID 9350564

  • Unenhanced helical CT for evaluating acute abdominal pain: A little more cost, a lot more information RADIOLOGY Mindelzun, R. E., Jeffrey, B. 1997; 205 (1): 43-45

    View details for Web of Science ID A1997XX26600008

    View details for PubMedID 9314959

  • Preliminary experience with power Doppler imaging of solid breast masses 1995 Annual Meeting of the Radiological-Society-of-North-America Birdwell, R. L., Ikeda, D. M., Jeffrey, S. S., Jeffrey, R. B. AMER ROENTGEN RAY SOC. 1997: 703–7

    Abstract

    The purpose of our study was to assess the potential of power Doppler imaging (PDI) to differentiate benign from malignant solid breast masses.Sixty-nine biopsy-proven solid breast masses were evaluated with PDI using 7- to 10-MHz transducers optimized for low-volume flow sensitivity. The extent of flow on PDI was estimated as a percentage of the lesion area on multiple longitudinal and transverse static sonographic images. Flow was categorized as avascular; less than 10%; 10-25%; 25.1-50%; and greater than 50%.Of the 69 lesions evaluated, 33 were malignant and 36 were benign. Of the avascular lesions, nine were malignant and eight were benign. Significant overlap was seen in the vascularity of the other 52 lesions: both malignant and benign lesions revealed a similar range of vascular patterns.Preliminary experience with PDI suggests that both malignant and benign lesions can be avascular and that the presence of color within a solid breast mass is a nonspecific finding. Assessing the extent of vascularity with PDI appears to be of limited value in the diagnostic evaluation of solid breast masses.

    View details for Web of Science ID A1997XR81100021

    View details for PubMedID 9275882

  • Acalculous cholecystitis in patients undergoing bone marrow transplantation EUROPEAN JOURNAL OF SURGERY WIBOLTT, K. S., Jeffrey, R. B. 1997; 163 (7): 519-524

    Abstract

    To evaluate factors associated with acalculous cholecystitis in patients undergoing bone marrow transplantation and the role of repeat ultrasound examinations.Retrospective study.University hospital, United States.381 Patients who underwent bone marrow transplantation between 1987 and 1992.Abdominal ultrasound examination (n = 134), repeat ultrasound in those considered to have acalculous cholecystitis (n = 8), and acute cholecystectomy (n = 5).14 Patients (4%) with acalculous cholecystitis were identified. The 8 who had had liver tissue examined also had veno-occlusive disease of the liver. It was possible to follow progressing or resolving acalculous cholecystitis by repeat ultrasound examinations. 4 Of the 5 patients treated surgically survived, compared with 3 of the 9 not operated on.Acalculous cholecystitis was associated with veno-occlusive disease of the liver. Repeat ultrasound examinations were valuable in showing progressing or resolving acalculous cholecystitis and may guide treatment. Cholecystectomy seems to be a safe procedure for acalculous cholecystitis in patients undergoing bone marrow transplantation.

    View details for Web of Science ID A1997XL26200007

    View details for PubMedID 9248986

  • Do arterial phase helical CT images improve detection or characterization of colorectal liver metastases? JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY Chen, I. Y., Katz, D. S., Jeffrey, R. B., Daniel, B. L., Li, K. C., Beaulieu, C. F., Mindelzun, R. E., Yao, D., Olcott, E. W. 1997; 21 (3): 391-397

    Abstract

    Our goal was to determine if arterial phase images from dual phase helical CT improve either the detection or the characterization of hepatic metastases in patients with colorectal carcinoma. Sixty-two patients with known colorectal cancer underwent 65 dual phase helical CT examinations to evaluate for possible liver metastases. Three blinded reviewers independently evaluated the portal venous phase images alone to determine if hepatic metastases were present or absent. Arterial phase images were then analyzed to determine if they identified additional lesions or aided in characterizing small hepatic lesions. Scores of the two methods for diagnosing metastases were compared with the "gold standard" established by a consensus panel of three other radiologists who reviewed all images together with clinical, pathologic, and other imaging data. The addition of arterial phase imaging did not detect any new metastases. However, in 6 of the 64 technically adequate examinations, hepatic arterial phase images increased lesion conspicuity and significantly increased diagnostic confidence when compared with portal vein phase scans alone. In patients with colorectal cancer, the addition of arterial phase imaging does not increase sensitivity, but improves the specificity in diagnosing liver metastases in a small number of cases. Dual phase helical CT does not appear to be indicated in the evaluation of liver metastases from colorectal cancer.

    View details for Web of Science ID A1997WV86400010

    View details for PubMedID 9135646

  • Spontaneous intramural small bowel haemorrhage: Importance of non-contrast CT CLINICAL RADIOLOGY Lane, M. J., Katz, D. S., Mindelzun, R. E., Jeffrey, R. B. 1997; 52 (5): 378-380

    Abstract

    The purpose of this study was to evaluate the abdominal CT findings in patients with spontaneous intramural small bowel haemorrhage. We retrospectively reviewed the abdominal CT scans of six patients with known intramural small bowel haemorrhage. All of the patients had an underlying coagulopathy. All six patients underwent CT examinations without oral or intravenous contrast media. All six non-contrast CT scans showed hyperattenuation of the involved bowel segments, with thickened and dilated proximal small bowel. Therefore, patients who are clinically at risk for intramural small bowel haemorrhage should undergo a non-contrast CT scan of the abdomen prior to the routine oral and intravenous contrast-enhanced scan. In most cases the non-contrast scan will provide definitive diagnostic information which may not be evident from the contrast-enhanced scan alone.

    View details for Web of Science ID A1997WY92600009

    View details for PubMedID 9171792

  • Renal hypoperfusion: Value of power Doppler imaging AMERICAN JOURNAL OF ROENTGENOLOGY CLAUTICEENGLE, T., Jeffrey, R. B. 1997; 168 (5): 1227-1231

    Abstract

    The improved depiction of renal parenchymal vascularity with power Doppler imaging facilitates the sonographic detection of hypovascular lesions such as pyelonephritis, renal abscesses, and infarction. However, the finding of diminished or absent lobar perfusion may be present in all of these entities; thus, the abnormalities shown on power Doppler imaging are often nonspecific. Clinical and laboratory data are often essential to establish the correct diagnoses. Contrast-enhanced CT remains useful for distinguishing these various disorders.

    View details for Web of Science ID A1997WV56800018

    View details for PubMedID 9129416

  • Power versus color Doppler sonography of the normal cystic artery: Implications for patients with acute cholecystitis AMERICAN JOURNAL OF ROENTGENOLOGY Olcott, E. W., Jeffrey, R. B., Jain, K. A. 1997; 168 (3): 703-705

    Abstract

    The purposes of this investigation were to compare prospectively the pattern and extent of cystic artery flow revealed by power Doppler sonography and color Doppler sonography in patients with normal gallbladders and to analyze the potential implications of these findings for power Doppler sonography in diagnosing acute cholecystitis.The cystic arteries of 142 patients (79 women and 63 men) with normal gallbladders were imaged with both power Doppler sonography and color Doppler sonography using 5-MHz transducers and settings optimized to reveal low-volume flow. The presence or absence of cystic artery flow and the anatomic extent of its visualization were recorded for each patient.Power Doppler sonography revealed flow in 73% of patients with normal gallbladders compared with 53% revealed by color Doppler sonography. Cystic artery flow within the distal fundal quartile was revealed by power Doppler sonography in 20% of patients and flow spanning greater than 50% of the anterior gallbladder wall was revealed by power Doppler sonography in 17% of patients. These findings differed from those of color Doppler sonography at a highly significant level (p < .0001, chi-square test).Power Doppler sonography is significantly more sensitive than color Doppler sonography for revealing cystic artery flow in patients with normal gallbladders. The flow patterns in patients with normal gallbladders obtained with power Doppler sonography overlap flow patterns previously reported as fairly specific criteria for diagnosing acute cholecystitis using color Doppler sonography, namely, flow within the distal fundal quartile and flow spanning greater than 50% of the anterior gallbladder wall. Accordingly, these color Doppler sonography criteria are not applicable to the diagnosis of acute cholecystitis with power Doppler sonography. Different power Doppler sonography criteria are necessary for the diagnosis of acute cholecystitis.

    View details for Web of Science ID A1997WJ62800027

    View details for PubMedID 9057519

  • The infraconal compartment: A multidirectional pathway for spread of disease between the extraperitoneal abdomen and pelvis JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY Beaulieu, C. F., Mindelzun, R. E., Dolph, J., Jeffrey, R. B. 1997; 21 (2): 223-228

    Abstract

    The space below the kidneys where the anterior and posterior pararenal spaces converge has been defined only vaguley in the past. We describe observations on clinical CT cases and studies on cadavers that lead to a refinement in the terminology for this extraperitoneal compartment.Abdominal/pelvic CT scans from 18 patients and the scans of 2 cadavers injected in the femoral region with iodinated contrast material were reviewed concerning the location and distribution of fluid or gas collections relative to the renal fascial enclosure.Pathologic processes involving the anterior or posterior pararenal spaces in addition to the pelvic extraperitoneal spaces were always accompanied by collections in the space below the cone of renal fascia.The term infraconal compartment is a suggested term for the caudal continuation of the anterior and posterior pararenal spaces. This compartment serves as an important multidirectional pathway for the spread of disease between the extraperitoneal abdomen and the pelvis. Fluid collections within this compartment have a characteristic CT appearance.

    View details for Web of Science ID A1997WM65500010

    View details for PubMedID 9071290

  • Unenhanced helical CT for suspected acute appendicitis AMERICAN JOURNAL OF ROENTGENOLOGY Lane, M. J., Katz, D. S., Ross, B. A., CLAUTICEENGLE, T. L., Mindelzun, R. E., Jeffrey, R. B. 1997; 168 (2): 405-409

    Abstract

    The purpose of this study was to determine the diagnostic accuracy of unenhanced helical CT scans in patients with a suspected acute appendicitis.Over a 20-month period, 109 adult patients with suspected acute appendicitis were referred by the emergency department for an unenhanced helical CT scan. Each scan was obtained in a single breath-hold from the T12 vertebral body to the public symphysis using a 5-mm collimation and a pitch of 1.6. No patients were given oral or IV contrast media. The primary CT criteria for diagnosing acute appendicitis was the identification of an appendix with a transverse diameter larger than 6 mm with associated periappendiceal inflammatory changes. The presence of an appendicolith was considered a secondary finding as was isolated periappendiceal inflammation; however, appendicitis was not diagnosed in such patients unless an enlarged appendix was definitely identified. Final diagnoses were established by surgical or clinical follow-up and were compared with the original CT reports.We found 66 true-negatives, 37 true-positives, four false-negatives, and two false-positives that yielded a sensitivity of 90%, a specificity of 97%, a positive predictive value of 95%, a negative predictive value of 95%, and an accuracy of 94%. An alternative diagnosis was established by an unenhanced helical CT scan in 24 patients (22%), which included cecal diverticulitis (seven patients), urinary tract disease (five patients), adnexal pathology (four patients), sigmoid diverticulitis (two patients), small bowel disease (three patients), right lower quadrant tumor (two patients), and an infected dialysis catheter (one patient).Unenhanced thin-section helical CT is an accurate, effective technique for diagnosing acute appendicitis.

    View details for Web of Science ID A1997WD85600020

    View details for PubMedID 9016216

  • Multiple mesenteric lymphatic cysts: An unusual feature of mesenteric panniculitis (Sclerosing mesenteritis) JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY Johnson, L. A., Longacre, T. A., Wharton, K. A., Jeffrey, R. B. 1997; 21 (1): 103-105

    View details for Web of Science ID A1997WF02100019

    View details for PubMedID 9022778

  • The misty mesentery on CT: Differential diagnosis AMERICAN JOURNAL OF ROENTGENOLOGY Mindelzun, R. E., Jeffrey, R. B., Lane, M. J., Silverman, P. M. 1996; 167 (1): 61-65

    View details for Web of Science ID A1996UT68400012

    View details for PubMedID 8659422

  • Perspective volume rendering of CT and MR images: Applications for endoscopic imaging RADIOLOGY Rubin, G. D., Beaulieu, C. F., Argiro, V., Ringl, H., Norbash, A. M., Feller, J. F., Dake, M. D., Jeffrey, R. B., Napel, S. 1996; 199 (2): 321-330

    Abstract

    To use perspective volume rendering (PVR) of computed tomographic (CT) and magnetic resonance (MR) imaging data sets to simulate endoscopic views of human organ systems.Perspective views of helical CT and MR images were reconstructed from the data, and tissues were classified by assigning color and opacity based on their CT attenuation or MR signal intensity. "Flight paths" were constructed through anatomic regions by defining key views along a spline path. Twelve movies of the thoracic aorta (n=3), tracheobronchial tree (n=4), colon (n=3), paranasal sinuses (n=1), and shoulder joint (n=1) were generated to display images along the flight path. All abnormal results were confirmed at surgery.PVR fly-through enabled evaluation of the full range of tissue densities, signal intensities, and their three-dimensional spatial relationships.PVR is a novel way to present volumetric data and may enable noninvasive diagnostic endoscopy and provide an alternate method to analyze volumetric imaging data for primary diagnosis.

    View details for Web of Science ID A1996UG01100006

    View details for PubMedID 8668772

  • Normal variations in the lateral contour of the head and neck of the pancreas mimicking neoplasm: Evaluation with dual-phase helical CT AMERICAN JOURNAL OF ROENTGENOLOGY Ross, B. A., Jeffrey, R. B., Mindelzun, R. E. 1996; 166 (4): 799-801

    Abstract

    The purpose of this study was to analyze variations in the lateral contour of the head and neck of the pancreas that can mimic pancreatic masses on CT imaging.We retrospectively reviewed dual-phase helical CT examinations of 119 patients who had no clinical or CT evidence of pancreatic disease. Contour variations of the head and neck of the pancreas were analyzed and were classified according to their anatomic orientation.Forty-one (34.5%) of the 119 patients had discrete lobulations of pancreatic tissue greater than 1 cm lateral to the gastroduodenal or anterior superior pancreaticoduodenal artery. These lobulations showed normal pancreatic density on both predominantly arterial and portal venous phase images. Contour variants of the pancreatic head and neck were categorized as three main types: anterior (type I), posterior (type II), and horizontal (type III). In the 119 patients, we found 12 type I variants (10%), 23 type II variants (19%), and six type III variants (5%).Variations in the lateral contour of the normal head and neck of the pancreas are common. Recognition of the different types of contours may help avoid misinterpretation of normal variants as pancreatic masses.

    View details for Web of Science ID A1996UB52100010

    View details for PubMedID 8610553

  • Diagnosis of pancreatic injury after blunt abdominal trauma SEMINARS IN ULTRASOUND CT AND MRI Lane, M. J., Mindelzun, R. E., Jeffrey, R. B. 1996; 17 (2): 177-182

    Abstract

    Expeditious diagnosis and treatment of pancreatic injury continues to elude the trauma surgeon and radiologist. Missed or underestimated pancreatic injury is responsible for a high level of morbidity and mortality after blunt or penetrating trauma. Unfortunately, inappropriate therapy can lead to devastating consequences such as severe endocrine or exocrine insufficiency. Abdominal CT is currently the imaging method of choice for evaluating patients with blunt trauma. This article reviews the constellation of CT findings that the radiologist must rely on to establish the diagnosis of pancreatic injury.

    View details for Web of Science ID A1996UE62400009

    View details for PubMedID 8845200

  • Screening for deep venous thrombosis in asymptomatic postoperative orthopedic patients using color Doppler sonography: Analysis of prevalence and risk factors AMERICAN JOURNAL OF ROENTGENOLOGY Davidson, H. C., MAZZU, D., Gage, B. F., Jeffrey, R. B. 1996; 166 (3): 659-662

    Abstract

    The purpose of our study was to assess the prevalence and risk factors for sonographically detectable lower extremity deep venous thrombosis (DVT) in asymptomatic patients following major orthopedic surgery.We performed color Doppler sonography of the lower extremities in 474 asymptomatic patients following major hip or knee surgery. We determined the prevalence of lower extremity DVT and used stepwise logistic regression to identify factors predictive of DVT. All patients received routine prophylactic measures.The prevalence of DVT was 7%. Laterality of surgery, age, and gender were all independent predictors of DVT (p < or = .01): the odds of having DVT were 20 times higher in the leg that was operated upon than in the leg that was not; the odds of DVT rose by a factor of 1.5 per decade of life; and the odds of DVT were 3.4 times greater in men than in women. DVT was more common in patients who had received general rather than epidural anesthesia, with borderline significance (p = .06). The length of anesthesia and the joint involved (hip or knee) were not predictive of DVT (p > .10).Despite prophylaxis, DVT is a relatively common postoperative complication in patients who undergo major orthopedic procedures. Routine screening for DVT is warranted in asymptomatic patients who have undergone hip or knee surgery, and color Doppler sonography, despite its limitations, offers a reasonably accurate noninvasive method for screening these patients. Subsets of patients who are at particular risk include the elderly, male patients, and patients who have undergone general anesthesia. The low prevalence of DVT in limbs not operated upon suggests that routine screening may be limited to evaluating the affected limbs only, thus helping to minimize the cost of screening.

    View details for Web of Science ID A1996TW77400033

    View details for PubMedID 8623645

  • Power Doppler imaging of focal lesions of the gastrointestinal tract: Comparison with conventional color Doppler imaging JOURNAL OF ULTRASOUND IN MEDICINE CLAUTICEENGLE, T., Jeffrey, R. B., Li, K. C., Barth, R. A. 1996; 15 (1): 63-66

    Abstract

    To compare the usefulness of power Doppler imaging and color Doppler imaging in the vascular evaluation of gastrointestinal lesions, 21 patients with focal gastrointestinal tract lesions were examined with both power and color Doppler imaging. Two reviewers blinded to the diagnosis compared intramural vascularity detected by each of these methods. Power Doppler imaging detected flow in 16 patients with nonischemic lesions, whereas color Doppler imaging detected flow in only 11 patients. Neither modality detected flow in three patients with transmural infarction, but only power Doppler imaging detected minimal flow in the two patients with reversible ischemia. Power Doppler imaging improves visualization of intramural gastrointestinal vascularity, increasing the level of confidence in differentiating ischemic from nonischemic lesions.

    View details for Web of Science ID A1996TN42100010

    View details for PubMedID 8667486

  • Assessment of several virtual endoscopy techniques using computed tomography and perspective volume rendering 4th International Conference on Visualization in Biomedical Computing (VBC 96) Shahidi, R., Argiro, V., Napel, S., Gray, L., McAdams, H. P., Rubin, G. D., Beaulieu, C. F., Jeffrey, R. B., Johnson, A. SPRINGER-VERLAG BERLIN. 1996: 521–528
  • Perspective volume rendering of cross-sectional images for simulated endoscopy and intra-parenchymal viewing Conference on Image Display Napel, S., Rubin, G. D., Beaulieu, C. F., Jeffrey, R. B., Argiro, V. SPIE - INT SOC OPTICAL ENGINEERING. 1996: 75–86
  • Sonographic differential diagnosis of right lower quadrant pain other then appendicitis CLINICAL IMAGING Jain, K. A., Ablin, D. S., Jeffrey, R. B., Brant, W. E. 1996; 20 (1): 12-16

    Abstract

    Most patients presenting with right lower quadrant pain are clinically suspected to have acute appendicitis. However, sonographic findings other than appendicitis are detected in patients who are referred for ultrasound to rule out appendicitis. This pictorial essay delineates a number of unsuspected pathological conditions revealed by ultrasound examination of the right lower quadrant that do not involve the appendix but closely mimic acute appendicitis. Imaging studies play a significant role in preoperative diagnosis and determination of proper treatment. The patient can undergo triage for proper further workup and surgical versus nonsurgical management. Acute appendicitis initially was considered on clinical presentation in all of our patients. The correct diagnosis of other pathological conditions was made on the basis of sonographic findings.

    View details for Web of Science ID A1996TX72200003

    View details for PubMedID 8846302

  • DEGENERATED UTERINE LEIOMYOMA MIMICKING ACUTE APPENDICITIS - SONOGRAPHIC DIAGNOSIS JOURNAL OF CLINICAL ULTRASOUND YACOE, M. E., Jeffrey, R. B. 1995; 23 (8): 473-475

    Abstract

    The present study reviews four cases in which degenerated uterine leiomyomas mimicked appendicitis clinically. The correct diagnosis was made prospectively by sonography in each case. Appendicitis was excluded by graded compression sonography and an exophytic uterine leiomyoma was identified at the point of maximal symptoms. The leiomyomas demonstrated central hypoechoic foci, but no detectable Doppler flow indicating necrosis. Although the phenomenon of a degenerated uterine leiomyoma mimicking appendicitis clinically is known, sonographic diagnosis has not been reported previously. The importance of making this diagnosis sonographically is that management of a degenerated leiomyoma is conservative and unnecessary surgery could be avoided.

    View details for Web of Science ID A1995RU78700002

    View details for PubMedID 7499517

  • DETECTION OF URETERAL CALCULI IN PATIENTS WITH SUSPECTED RENAL COLIC - VALUE OF REFORMATTED NONCONTRAST HELICAL CT AMERICAN JOURNAL OF ROENTGENOLOGY Sommer, F. G., Jeffrey, R. B., Rubin, G. D., Napel, S., RIMMER, S. A., Benford, J., Harter, P. M. 1995; 165 (3): 509-513

    Abstract

    The purpose of this study was to determine the value of reformatted noncontrast helical CT in patients with suspected renal colic. We hoped to determine whether this technique might create images acceptable to both radiologists and clinicians and replace our current protocol of sonography and abdominal plain film.Thirty-four consecutive patients with signs and symptoms of renal colic were imaged with both noncontrast helical CT and a combination of plain film of the abdomen and renal sonography. Reformatting of the helical CT data was performed on a workstation to create a variety of reformatted displays. The correlative studies were interpreted by separate blinded observers. Clinical data, including the presence of hematuria and the documentation of stone passage or removal, were recorded.Findings on 18 CT examinations were interpreted as positive for the presence of ureteral calculi; 16 of these cases were determined to be true positives on the basis of later-documented passage of a calculus. Thirteen of the 16 cases proved to be positive were interpreted as positive for renal calculi using the combination of abdominal plain film and renal sonography. The most useful CT reformatting technique was curved planar reformatting of the ureters to determine whether a ureteral calculus was present.In this study, noncontrast helical CT was a rapid and accurate method for determining the presence of ureteral calculi causing renal colic. The reformatted views produced images similar in appearance to excretory urograms, aiding greatly in communicating with clinicians. Limitations on the technique include the time and equipment necessary for reformatting and the suboptimal quality of reformatted images when little retroperitoneal fat is present.

    View details for Web of Science ID A1995RQ00600003

    View details for PubMedID 7645461

  • IN PATIENTS WITH RIGHT LOWER QUADRANT PAIN, IS SONOGRAPHY OR CT THE PREFERRED IMAGING TECHNIQUE FOR INITIAL EVALUATION AMERICAN JOURNAL OF ROENTGENOLOGY Jeffrey, R. B. 1995; 164 (6): 1547-1548

    View details for Web of Science ID A1995QZ54200050

    View details for PubMedID 7754913

  • ASSESSMENT OF LIVING RENAL DONORS WITH SPIRAL CT RADIOLOGY Rubin, G. D., Alfrey, E. J., Dake, M. D., Semba, C. P., Sommer, F. G., Kuo, P. C., Dafoe, D. C., WASKERWITZ, J. A., Bloch, D. A., Jeffrey, R. B. 1995; 195 (2): 457-462

    Abstract

    To determine whether spiral computed tomography (CT) can be used to evaluate potential living renal donors.Twelve potential living renal donors underwent spiral CT and conventional arteriography. CT angiography was performed with 30-second spiral acquisition during injection of 150 mL of nonionic iodinated contrast material into an antecubital vein at 5 mL/sec. Five minutes after injection, a frontal abdominal scout projection was obtained to assess the renal collecting system. Results of blinded interpretations of axial CT angiograms, three-dimensional CT angiograms, and conventional arteriograms were correlated with intraoperative findings in 11 cases.Axial and three-dimensional CT angiography were 100% sensitive for identifying seven accessory renal arteries and 14% and 93% sensitive for identifying five prehilar renal artery branches. Renal venous anomalies were confirmed in three patients at surgery. Operative management changed in four of 11 patients who underwent donor nephrectomy.Spiral CT holds promise as a single examination for anatomic assessment of living renal donors.

    View details for Web of Science ID A1995QU71700028

    View details for PubMedID 7724766

  • QUANTITATIVE-EVALUATION OF PANCREATIC ENHANCEMENT DURING DUAL-PHASE HELICAL CT RADIOLOGY HOLLETT, M. D., Jorgensen, M. J., Jeffrey, R. B. 1995; 195 (2): 359-361

    Abstract

    To determine the improvement in pancreatic enhancement at helical computed tomography (CT) performed with an early delay after administration of contrast material compared with that performed with a standard delay.Dual-phase helical CT of the abdomen was performed in 120 patients with a 150-mL bolus of contrast material infused at 5 mL/sec. Early and standard delayed scanning was performed beginning at 20 seconds and 49-71 seconds, respectively. Regions of interest were measured in the head, body, and tail of the pancreas in 92 patients. The difference in enhancement between early and standard delayed scanning was calculated.Mean pancreatic enhancement was 82 HU +/- 3 (standard error) with an early delay, whereas enhancement on standard delay scans was 62 HU +/- 2 (P < .001). An improvement in enhancement greater than 10 HU was attained in 66 of 92 cases (72%).Pancreatic enhancement at helical CT with an early delay after contrast material administration is often significantly greater than the enhancement seen with a standard delay when a monophasic, rapidly infused bolus of contrast material is used.

    View details for Web of Science ID A1995QU71700013

    View details for PubMedID 7724753

  • MAGNETIC-RESONANCE-IMAGING AND HEPATIC HEMODYNAMICS - CORRELATION WITH METABOLIC FUNCTION IN LIVER-TRANSPLANTATION CANDIDATES SURGERY Kuo, P. C., Li, K., Alfrey, E. J., Jeffrey, R. B., Garcia, G., Dafoe, D. C. 1995; 117 (4): 373-379

    Abstract

    Preoperative assessment of orthotopic liver transplantation candidates requires definition of both the anatomy and metabolic function of the native liver. Current evaluation techniques combine computed tomographic scanning, duplex ultrasonography with blood chemistry analysis, and physical stigmata of end-stage liver disease. Recently, magnetic resonance imaging (MRI) has emerged as an alternative method for delineation of hepatic and portal venous anatomy. In addition, MRI accurately measures hepatic volume and portal venous blood flow.To examine the role of MRI-derived indexes of hepatic hemodynamics in the preoperative assessment of liver function, 39 consecutive liver transplantation candidates were studied in a prospective manner. Liver function (aspartate aminotransferase), alanine aminotransferase, alkaline phosphatase, total bilirubin, and albumin levels), hematologic indexes (complete blood cell count, prothrombin time), and Child's classification were determined at the time of evaluation. Axial breath-held multiplanar spoiled-gradient echo MRI measured hepatic volume, whereas a cine phase-contrast sequence perpendicular to the portal vein measured flow.Hepatic index, defined as hepatic mass corrected for body surface area, was found to correlate with prothrombin time (p < 0.04) and platelet count (p < 0.03) by multivariate regression analysis. Portal flow index (PFI), defined as portal flow corrected for hepatic mass), was associated with aspartate aminotransferase (p < 0.02), alanine aminotransferase (p < 0.04), and albumin (p < 0.03) by multivariate regression analysis. In addition, PFI was closely correlated with the patients' functional status as determined by Child's classification system. Increasing values of PFI were associated with declining hepatic functional reserve. Child's class A patients had a mean PFI that was two times less than that of Child's class B patients (0.26 +/- 0.04 versus 0.04 +/- 0.06 ml/min/gm; p < 0.02) and five times less than that of Child's class C patients (0.26 +/- 0.04 versus 1.05 +/- 0.14 ml/min/gm; p < 0.001). Similarly, the mean PFI associated with Child's class B was two times less than that of Child's class C (0.46 +/- 0.06 versus 1.05 +/- 0.14 ml/min/gm; p < 0.01). These data show that MRI-derived indexes of portal hemodynamics and hepatic mass (1) correlate well with biochemical indexes of hepatic dysfunction and (2) serve as anatomic and hemodynamic correlates to Child's functional classification.We conclude that MRI may serve to noninvasively delineate preoperative hepatic vascular anatomy and metabolic dysfunction in candidates undergoing examination for liver transplantation.

    View details for Web of Science ID A1995QQ96800003

    View details for PubMedID 7716717

  • DUAL-PHASE HELICAL CT OF THE LIVER - VALUE OF ARTERIAL PHASE SCANS IN THE DETECTION OF SMALL (LESS-THAN-OR-EQUAL-TO-1.5-CM) MALIGNANT HEPATIC NEOPLASMS AMERICAN JOURNAL OF ROENTGENOLOGY HOLLETT, M. D., Jeffrey, R. B., NINOMURCIA, M., Jorgensen, M. J., Harris, D. P. 1995; 164 (4): 879-884

    Abstract

    Helical CT scanners now allow sequential arterial phase and portal venous phase scans of the entire liver to be obtained during a single bolus injection of contrast material. The purpose of this study was to determine if arterial phase scans improve detection of small (< or = 1.5 cm) malignant hepatic neoplasms when compared with portal venous scans alone.Dual-phase helical CT of the liver was done in 96 patients referred for known or suspected malignant hepatic lesions. Malignant hepatic neoplasms were detected in 38 patients (27 with at least one small neoplasm), one patient had undetected metastases, one patient had a benign hepatic neoplasm, and 56 patients had no hepatic neoplasm. Proof of individual neoplasms was based on biopsy results, surgical findings, or findings on other imaging studies (primarily follow-up CT). The absence of disease was established by surgical or autopsy findings, findings on subsequent imaging studies, or a combination of clinical and laboratory data. A total of 150 ml of 60% nonionic contrast material was infused at 5 ml/sec followed by sequential arterial phase and portal venous phase helical scans of the liver. Three radiologists retrospectively reviewed the scans. Individual lesions were measured and the conspicuity of each lesion on arterial phase and portal venous phase scans was compared. The percentage of patients in whom some malignant neoplasms were detected better on the arterial phase scan was calculated using categories based on lesion size and typical tumor vascularity.In 10 (37%) of 27 patients who had at least one small malignant neoplasm, lesions 1.5 cm or less in diameter were only visible or were more conspicuous on the arterial phase scan. No malignant neoplasms more than 1.5 cm in diameter were visible only on the arterial phase scan. In four (11%) of 38 cases, malignant neoplasms more than 1.5 cm in diameter were more conspicuous on the arterial phase scan. The arterial phase scans improved lesion conspicuity in nine (39%) of 23 patients who had typically hypervascular neoplasms, whereas lesion conspicuity was improved in three (20%) of 15 patients who had typically hypovascular neoplasms (p = .02). The arterial phase scan resulted in the false-positive detection of lesions in two (2%) of 96 cases.Arterial phase helical CT of the liver improves detection of some small, malignant hepatic neoplasms when performed in addition to portal venous scanning. The value is greatest in those patients who have hypervascular neoplasms.

    View details for Web of Science ID A1995QN20700015

  • Dual-phase helical CT of the liver: value of arterial phase scans in the detection of small (< or = 1.5 cm) malignant hepatic neoplasms. AJR. American journal of roentgenology HOLLETT, M. D., Jeffrey, R. B., Nino-Murcia, M., Jorgensen, M. J., Harris, D. P. 1995; 164 (4): 879-884

    Abstract

    Helical CT scanners now allow sequential arterial phase and portal venous phase scans of the entire liver to be obtained during a single bolus injection of contrast material. The purpose of this study was to determine if arterial phase scans improve detection of small (< or = 1.5 cm) malignant hepatic neoplasms when compared with portal venous scans alone.Dual-phase helical CT of the liver was done in 96 patients referred for known or suspected malignant hepatic lesions. Malignant hepatic neoplasms were detected in 38 patients (27 with at least one small neoplasm), one patient had undetected metastases, one patient had a benign hepatic neoplasm, and 56 patients had no hepatic neoplasm. Proof of individual neoplasms was based on biopsy results, surgical findings, or findings on other imaging studies (primarily follow-up CT). The absence of disease was established by surgical or autopsy findings, findings on subsequent imaging studies, or a combination of clinical and laboratory data. A total of 150 ml of 60% nonionic contrast material was infused at 5 ml/sec followed by sequential arterial phase and portal venous phase helical scans of the liver. Three radiologists retrospectively reviewed the scans. Individual lesions were measured and the conspicuity of each lesion on arterial phase and portal venous phase scans was compared. The percentage of patients in whom some malignant neoplasms were detected better on the arterial phase scan was calculated using categories based on lesion size and typical tumor vascularity.In 10 (37%) of 27 patients who had at least one small malignant neoplasm, lesions 1.5 cm or less in diameter were only visible or were more conspicuous on the arterial phase scan. No malignant neoplasms more than 1.5 cm in diameter were visible only on the arterial phase scan. In four (11%) of 38 cases, malignant neoplasms more than 1.5 cm in diameter were more conspicuous on the arterial phase scan. The arterial phase scans improved lesion conspicuity in nine (39%) of 23 patients who had typically hypervascular neoplasms, whereas lesion conspicuity was improved in three (20%) of 15 patients who had typically hypovascular neoplasms (p = .02). The arterial phase scan resulted in the false-positive detection of lesions in two (2%) of 96 cases.Arterial phase helical CT of the liver improves detection of some small, malignant hepatic neoplasms when performed in addition to portal venous scanning. The value is greatest in those patients who have hypervascular neoplasms.

    View details for PubMedID 7726040

  • CT OF BLUNT TRAUMA TO THE BOWEL AND MESENTERY SEMINARS IN ULTRASOUND CT AND MRI Nghiem, H. V., Jeffrey, R. B., Mindelzun, R. E. 1995; 16 (2): 82-90

    Abstract

    Injuries to the bowel and mesentery are found in approximately 5% of all patients undergoing laparotomy after blunt abdominal trauma. Bowel and mesenteric injuries are often subtle and difficult to diagnose, and a delay in the diagnosis is associated with increased mortality and morbidity. CT is the best imaging method for diagnosing injuries to the bowel and mesentery. With meticulous scanning techniques, most significant bowel and mesenteric injuries can be reliably identified with CT preoperatively, and associated injuries to other abdominal viscera can be confirmed.

    View details for Web of Science ID A1995QU72000002

    View details for PubMedID 7794607

  • EMPHYSEMATOUS PYELONEPHRITIS WITH RESULTANT EMPHYSEMATOUS CHOLECYSTITIS SECONDARY TO HEMATOGENOUS DISSEMINATION ABDOMINAL IMAGING Lee, H. M., Jeffrey, R. B. 1995; 20 (2): 169-172

    Abstract

    Both emphysematous pyelonephritis and emphysematous cholecystitis are uncommon, but potentially fatal, clinical entities. The simultaneous diagnosis of these two entities in the same patient has not previously been reported. In this paper, we describe a 68-year-old diabetic male who presented acutely with emphysematous pyelonephritis and emphysematous cholecystitis. This case demonstrates several important diagnostic and treatment considerations. Additionally, the unique circumstances of this case offer support for the proposal that emphysematous cholecystitis may often be secondary to hematogenous seeding/embolic phenomena rather than obstruction of the cystic duct. Prompt diagnosis is essential, as prompt intervention can minimize mortality and morbidity.

    View details for Web of Science ID A1995QM55500021

    View details for PubMedID 7787725

  • LYMPHOMA AND LEUKEMIA INVOLVING THE TESTICLES - FINDINGS ON GRAY-SCALE AND COLOR DOPPLER SONOGRAPHY AMERICAN JOURNAL OF ROENTGENOLOGY MAZZU, D., Jeffrey, R. B., Ralls, P. W. 1995; 164 (3): 645-647

    Abstract

    The purpose of this study was to determine the gray-scale and color Doppler sonographic appearance of testicular lymphoma and leukemia to aid in its differentiation from primary testicular neoplasms and inflammatory processes.We retrospectively reviewed the testicular sonograms of eight male patients 5-74 years old (mean age, 43 years) with pathologically proved testicular leukemia or lymphoma. All patients presented with testicular enlargement. Gray-scale sonograms were obtained to determine the presence or absence of a mass, focal nodule, or diffuse infiltration, as well as the degree of parenchymal echogenicity. Color Doppler sonography was applied in each case to determine the degree of vascularity compared with normal ipsilateral or contralateral testicular parenchyma. In patients with focal, measurable lesions, the size was correlated with its color Doppler sonographic appearance.Gray-scale sonograms showed either homogeneously hypoechoic testes in patients with diffuse round-cell infiltration or multifocal hypoechoic lesions of various sizes. Five patients had a total of 11 focal lesions that ranged in size from 8 mm to 26 mm in maximum diameter (mean diameter, 16 mm). Color Doppler sonography revealed increased intralesional flow in all areas of lymphomatous or leukemic involvement irrespective of lesion size.Our results show that testicular lymphoma and leukemia are hypervascular on color Doppler sonograms regardless of the size of the tumor. Although color Doppler sonography may provide useful information, differentiating round-cell infiltration from inflammatory processes of the testes remains difficult.

    View details for Web of Science ID A1995QH86000020

    View details for PubMedID 7863887

  • THE USE OF SPIRAL COMPUTED-TOMOGRAPHY IN THE EVALUATION OF LIVING DONORS FOR KIDNEY-TRANSPLANTATION 13th Annual Meeting of the American-Society-of-Transplant-Physicians Alfrey, E. J., Rubin, G. D., Kuo, P. C., WASKERWITZ, J. A., Scandling, J. D., MELL, M. W., Jeffrey, R. B., Dafoe, D. C. WILLIAMS & WILKINS. 1995: 643–45

    View details for Web of Science ID A1995QK22500037

    View details for PubMedID 7878773

  • COLOR DOPPLER SONOGRAPHY OF THE CYSTIC ARTERY - COMPARISON OF NORMAL CONTROLS AND PATIENTS WITH ACUTE CHOLECYSTITIS JOURNAL OF ULTRASOUND IN MEDICINE Jeffrey, R. B., NINOMURCIA, M., Ralls, P. W., Jain, K. A., Davidson, H. C. 1995; 14 (1): 33-36

    Abstract

    Color Doppler sonography was used to evaluate the length and distribution of the cystic artery in the gallbladder wall in 115 normal adults and in 54 patients with surgically proved cholecystitis. All patients were scanned with a 5 MHz curved array transducer optimized for low volume color sensitivity. A specific attempt was made to visualize the cystic artery throughout its course. Spectral Doppler waveforms were obtained to document arterial flow. The length of the cystic artery visualized was analyzed as a quartile percentage length of the anterior gallbladder wall. The distribution of the cystic artery flow also was analyzed in specific quartiles. Of 54 patients with acute cholecystitis, 26% had cystic artery length greater than half of the anterior gallbladder wall, compared with 2% of 115 normal controls (P < 0.001); 19% of patients with cholecystitis had flow in the distal (fundal) quartile, compared to 0% of normal controls (P < 0.0001). Although the presence or absence of flow in the gallbladder is not a reliable finding to establish the diagnosis of acute cholecystitis, length of cystic artery visualized is a potentially useful criterion to suggest the diagnosis of acute cholecystitis, especially in cases in which flow in the distal fundal quartile of the gallbladder. The usefulness of color Doppler sonography in acute cholecystitis is limited owing to the fact that it is insensitive, and many patients with cholecystitis have no detectable flow or have normal flow patterns.

    View details for Web of Science ID A1995QB24000006

    View details for PubMedID 7707474

  • INFLAMED PERICHOLECYSTIC FAT - COLOR DOPPLER FLOW IMAGING AND CLINICAL-FEATURES RADIOLOGY McDonnell, C. H., Jeffrey, R. B., Vierra, M. A. 1994; 193 (2): 547-550

    Abstract

    To analyze the color Doppler flow imaging features and clinical importance of inflamed pericholecystic fat.Forty patients with surgically proved right upper quadrant inflammatory lesions in the gallbladder or the pericholecystic space underwent color Doppler sonography (CDS). Findings in the pericholecystic space were correlated with those at computed tomography (CT) in four patients and with surgical findings in 40 patients.CDS performed in 12 (30%) of the 40 patients demonstrated echogenic pericholecystic masses greater than 1 cm in diameter that contained internal vascularity. CT in four patients and surgical findings in all 12 patients demonstrated inflamed fat adherent to the gallbladder.Identification with CDS of inflamed pericholecystic fat may provide preoperative information that could be pertinent in the decision to perform open or laparoscopic cholecystectomy in patients with acute cholecystitis.

    View details for Web of Science ID A1994PN94700053

    View details for PubMedID 7972777

  • EVALUATION OF PELVIC MASSES WITH MAGNETIC-RESONANCE-IMAGING AND ULTRASONOGRAPHY JOURNAL OF ULTRASOUND IN MEDICINE Jain, K. A., Jeffrey, R. B. 1994; 13 (11): 845-853

    Abstract

    Magnetic resonance imaging is becoming increasingly useful in characterizing adnexal masses, whereas endovaginal ultrasound is an invaluable technique for examining the uterus and adnexa. This pictorial essay depicts the internal architectural details necessary for characterization of various adnexal masses imaged with both EVU and MR imaging. Forty consecutive examinations that revealed 51 adnexal masses were reviewed. All patients had MR imaging and EVU examinations within 1 week of each other. T1- and T2-weighted images in coronal, axial, and sagittal planes were included. Fat suppression technique also was used in selected cases. EVU, because of its high spatial resolution, was able to depict better internal architectural details, allowing specific diagnosis of most adnexal masses, whereas MR imaging was superior in differentiating hemorrhagic masses from dermoids when specific fat suppression techniques were used.

    View details for Web of Science ID A1994PQ66000004

    View details for PubMedID 7837330

  • CT DIAGNOSIS OF BLUNT PANCREATIC TRAUMA - IMPORTANCE OF DETECTING FLUID BETWEEN THE PANCREAS AND THE SPLENIC VEIN AMERICAN JOURNAL OF ROENTGENOLOGY Lane, M. J., Mindelzun, R. E., Sandhu, J. S., MCCORMICK, V. D., Jeffrey, R. B. 1994; 163 (4): 833-835

    Abstract

    The purpose of this study was to determine the value of detecting fluid between the splenic vein and the pancreas on CT scans in the diagnosis of pancreatic injury after blunt abdominal trauma.We retrospectively reviewed the abdominal CT scans of 10 patients with surgical- or autopsy-proved pancreatic injury after blunt abdominal trauma. The finding of fluid interdigitating between the pancreas and the splenic vein was then studied along with the reported CT features of pancreatic injury. These included intraperitoneal fluid, fluid in the lesser sac, extraperitoneal fluid, pancreatic edema or hematoma, and thickening of the anterior renal fascia.The CT scans of all 10 patients reviewed showed abnormalities suggesting pancreatic injury. Only 40% of patients showed all of the findings reported in the literature. Fluid interdigitating between the splenic vein and the pancreatic parenchyma was seen on CT scans in 90%.Our experience suggests that fluid between the splenic vein and the pancreas is a helpful CT finding for the diagnosis of pancreatic injury after blunt abdominal trauma. This finding was easy to recognize and in the proper clinical setting directs attention to additional subtle findings of pancreatic injury.

    View details for Web of Science ID A1994PH68300013

    View details for PubMedID 7503824

  • SONOGRAPHY OF APPENDICITIS AND DIVERTICULITIS RADIOLOGIC CLINICS OF NORTH AMERICA YACOE, M. E., Jeffrey, R. B. 1994; 32 (5): 899-912

    Abstract

    Graded compression sonography has gained widespread acceptance as a useful technique to evaluate patients with atypical signs and symptoms of appendicitis. When positive, early surgery can be performed prior to perforation. When there is no sonographic evidence of appendicitis, other alternative diagnoses may be established. CT scans and the contrast enema remain the primary imaging modalities to evaluate suspected diverticulitis; however, sonography may be useful in selected patients with an atypical clinical presentation.

    View details for Web of Science ID A1994PG42300007

    View details for PubMedID 8085003

  • DIFFERENTIATING SIGMOID DIVERTICULITIS FROM CARCINOMA ON CT SCANS - MESENTERIC INFLAMMATION SUGGESTS DIVERTICULITIS AMERICAN JOURNAL OF ROENTGENOLOGY PADIDAR, A. M., Jeffrey, R. B., Mindelzun, R. E., DOLPH, J. F. 1994; 163 (1): 81-83

    Abstract

    The purpose of this study was to analyze the usefulness of two specific CT signs of sigmoid mesenteric inflammation (fluid at the root of the mesentery and vascular engorgement) for identifying and differentiating sigmoid diverticulitis from carcinoma.CT scans of 69 patients with surgically proved sigmoid diverticulitis were retrospectively reviewed and compared with CT findings in 29 patients with surgically proved sigmoid carcinoma. Two specific patterns of inflammation of the sigmoid mesentery were analyzed: fluid at the root of the sigmoid mesentery and engorgement of the sigmoid mesenteric vessels.The CT findings were present more often in patients with sigmoid diverticulitis than in those with carcinoma (p < .001). Fluid at the base of the mesentery had a sensitivity, specificity, and positive predictive value for diverticulitis of 36%, 90%, and 89% respectively. Vascular engorgement alone had a sensitivity, specificity, and positive predictive value of 29%, 100%, and 100%, respectively.Our results suggest that CT findings of fluid at the root of the mesentery and vascular engorgement are useful in distinguishing sigmoid diverticulitis from carcinoma of the sigmoid.

    View details for Web of Science ID A1994QE28600016

    View details for PubMedID 8010253

  • COLOR DOPPLER SONOGRAPHY OF FOCAL GASTROINTESTINAL LESIONS - INITIAL CLINICAL-EXPERIENCE JOURNAL OF ULTRASOUND IN MEDICINE Jeffrey, R. B., Sommer, F. G., Debatin, J. F. 1994; 13 (6): 473-478

    Abstract

    Graded compression color Doppler sonography was used to evaluate gastrointestinal blood flow in 20 normal fasting subjects and 32 patients with focal gastrointestinal lesions. Imaging was optimized for color sensitivity using a 5 MHz linear array transducer. Criteria were established for normal mural blood flow based on findings in normal controls. Two reviewers blinded to the final diagnosis compared patterns of mural vascularity in normal and abnormal patients. Increased mural blood flow was demonstrated in all 32 patients with gastrointestinal inflammatory disorders and in seven of nine patients with neoplasms. No mural flow was demonstrated in four patients with small bowel infarction. The greatest overall degree of flow was noted in patients with Crohn's disease and cytomegalovirus colitis. Flow in tumors was variable, ranging from strikingly increased flow in a giant villoglandular polyp to absent flow in a metastasis from lung carcinoma. Our preliminary experience suggests that the presence of considerable overlap in the color Doppler patterns of mural blood flow in inflammatory and neoplastic lesions. Color Doppler sonography alone without spectral waveform analysis may not distinguish focal inflammatory from neoplastic disorders of the gastrointestinal tract reliably. However, this technique potentially may be useful in diagnosing small bowel ischemia when thickened segments of small bowel are identified with absent flow.

    View details for Web of Science ID A1994NP96200009

    View details for PubMedID 8083948

  • SPIRAL COMPUTED-TOMOGRAPHY IN THE DIAGNOSIS OF TRANSPLANT RENAL-ARTERY STENOSIS TRANSPLANTATION MELL, M. W., Alfrey, E. J., Rubin, G. D., Scandling, J. D., Jeffrey, R. B., Dafoe, D. C. 1994; 57 (5): 746-748

    View details for Web of Science ID A1994NC19000019

    View details for PubMedID 8140637

  • SONOGRAPHIC DIAGNOSIS OF ACUTE APPENDICITIS - INTERPRETIVE PITFALLS AMERICAN JOURNAL OF ROENTGENOLOGY Jeffrey, R. B., Jain, K. A., Nghiem, H. V. 1994; 162 (1): 55-59

    Abstract

    Graded compression sonography has proven to be of significant clinical value in the assessment of patients with right lower quadrant pain and possible appendicitis [1-3]. Despite its proven utility, a number of imaging pitfalls must be kept in mind when sonograms of the right lower quadrant are interpreted. The purpose of this pictorial essay is to illustrate a number of important limitations and areas of interpretive difficulty in sonography for appendicitis.

    View details for Web of Science ID A1994MQ20700013

    View details for PubMedID 8273690

  • CHRONIC MESENTERIC ISCHEMIA - EVALUATION WITH PHASE-CONTRAST CINE MR-IMAGING RADIOLOGY Li, K. C., Whitney, W. S., McDonnell, C. H., Fredrickson, J. O., Pelc, N. J., Dalman, R. L., Jeffrey, R. B. 1994; 190 (1): 175-179

    Abstract

    To compare superior mesenteric artery (SMA) blood flow in healthy volunteers and patients with stenoses in the fasting state and after food intake by using phase-contrast (PC) cine magnetic resonance (MR) imaging.Ten healthy subjects, four asymptomatic patients (three with 50% stenosis, one with 70% stenosis), and one symptomatic patient (with 80% stenosis) were studied. All subjects were studied after fasting at least 8 hours and 15, 30, and 45 minutes after ingesting a standard meal.In healthy volunteers, SMA blood flow at all postprandial intervals increased significantly compared with that obtained after fasting (P < or = .0005). The percentage change in SMA blood flow 30 minutes after food intake provided the best distinction between the healthy subjects, the asymptomatic patients, and the symptomatic patient.Cine PC MR imaging is an effective, noninvasive technique for measuring SMA blood flow.

    View details for Web of Science ID A1994MW25300035

    View details for PubMedID 8259400

  • SPIRAL CT OF RENAL-ARTERY STENOSIS - COMPARISON OF 3-DIMENSIONAL RENDERING TECHNIQUES RADIOLOGY Rubin, G. D., Dake, M. D., Napel, S., Jeffrey, R. B., McDonnell, C. H., Sommer, F. G., Wexler, L., Williams, D. M. 1994; 190 (1): 181-189

    Abstract

    To evaluate the accuracy of computed tomographic (CT) angiography in the detection of renal artery stenosis (RAS).CT angiography was performed in 31 patients undergoing conventional renal arteriography. CT angiographic data were reconstructed with shaded surface display (SSD) and maximum-intensity projection (MIP). Stenosis was graded with a four-point scale (grades 0-3). The presence of mural calcification, poststenotic dilatation, and nephrographic abnormalities was also noted.CT angiography depicted all main (n = 62) and accessory (n = 11) renal arteries that were seen at conventional arteriography. MIP CT angiography was 92% sensitive and 83% specific for the detection of grade 2-3 stenoses (> or = 70% stenosis). SSD CT angiography was 59% sensitive and 82% specific for the detection of grade 2-3 stenoses. The accuracy of stenosis grading was 80% with MIP and 55% with SSD CT angiography. Poststenotic dilatation and the presence of an abnormal nephrogram were 85% and 98% specific, respectively.CT angiography shows promise in the diagnosis of RAS. The accuracy of CT angiography varies with the three-dimensional rendering technique employed.

    View details for Web of Science ID A1994MW25300036

    View details for PubMedID 8259402

  • DYNAMIC BREATH-HOLD MULTIPLANAR SPOILED GRADIENT-RECALLED MR-IMAGING WITH GADOLINIUM ENHANCEMENT FOR DIFFERENTIATING HEPATIC HEMANGIOMAS FROM MALIGNANCIES AT 1.5-T 1992 ANNUAL SCIENTIFIC ASSEMBLY OF THE RADIOLOGICAL-SOC-OF-NORTH-AMERICA Whitney, W. S., Herfkens, R. J., Jeffrey, R. B., McDonnell, C. H., Li, K. C., VANDALSEM, W. J., Low, R. N., Francis, I. R., DABATIN, J. F., Glazer, G. M. RADIOLOGICAL SOC NORTH AMERICA. 1993: 863–70

    Abstract

    To compare the enhancement patterns of focal liver lesions at dynamic breath-hold gadolinium-enhanced multiplanar spoiled gradient-recalled (SPGR) magnetic resonance (MR) imaging with T2 relaxation times in the differentiation of liver hemangiomas from malignancies.Forty-seven patients with focal liver lesions underwent MR imaging with spin-echo and gadolinium-enhanced multiplanar SPGR techniques. T2 relaxation times and enhancement patterns were compared for accuracy in liver lesion characterization.Enhancement patterns allowed better characterization of liver lesions than did T2 relaxation times. Only specific patterns of contrast enhancement indicated a hemangioma. Although 18 of the 33 malignancies and 10 of the 12 hemangiomas showed progressive centripetal hyperintense enhancement, only hemangiomas filled in with hyperintense peripheral nodules. Malignancies often filled in with hyperintense thick rinds.Gadolinium-enhanced multiplanar SPGR imaging allows more accurate characterization of liver lesions than does T2 relaxation time.

    View details for Web of Science ID A1993MH58600042

    View details for PubMedID 8234717

  • EXPERIMENTAL HEPATIC TUMOR NECROSIS - COMPARISON OF SPIN-ECHO AND PULSED MAGNETIZATION-TRANSFER CONTRAST MAGNETIC-RESONANCE-IMAGING INVESTIGATIVE RADIOLOGY Li, K. C., Jeffrey, R. B., Ning, S. C., Kandil, A., Hahn, G. M., Pike, B., Glover, G., Kosek, J. 1993; 28 (10): 896-902

    Abstract

    We compared the effectiveness of pulsed magnetization transfer contrast (MTC) magnetic resonance imaging (MRI) and spin-echo MRI in detecting tumor necrosis.Adenocarcinoma cells were transplanted in the livers of 12 syngenic BDIX rats. To induce various degrees of tumor necrosis, the rats were randomly assigned to the following groups: 1) control; 2) localized hyperthermia; 3) intralesional cisplatin; and 4) hyperthermia plus intralesional cisplatin. At day 7 after treatment, the rats were imaged using a 1.5-T imager with 1) multiplanar gradient-recalled echo sequence (MPGR) 500/8/20 degrees with and without magnetization transfer contrast (MTC); 2) spin-echo 2500/20,80, and 3) spin-echo 300/20 pulse sequences. The rats were then sacrificed and pathologic specimens were prepared using MR images as guidance. T2 and ratios of signal intensity after saturation to signal intensity before saturation (Ms/Mo ratios) of the necrotic and granulation tissues and viable tumors were determined in 10 rats.Compared with standard MPGR images, MPGR images with MTC provided better contrast between the pathologic tissues and normal liver. However, T2 values were more useful than Ms/Mo ratios in distinguishing necrotic areas from viable tumor. The T2 values of coagulative necrosis and granulation tissue were significantly different from that of viable tumor. No significant difference between the Ms/Mo ratios of the different pathologic tissues and normal liver was found.Pulsed magnetization transfer contrast MRI was inferior to spin-echo MRI in distinguishing necrotic from viable tumors in rat livers using the pulse sequences described, and none of the sequences studied was thought to be reliable enough for this purpose.

    View details for Web of Science ID A1993MD17700004

    View details for PubMedID 8262743

  • 3-DIMENSIONAL SPIRAL COMPUTED TOMOGRAPHIC ANGIOGRAPHY - AN ALTERNATIVE IMAGING MODALITY FOR THE ABDOMINAL-AORTA AND ITS BRANCHES 8TH ANNUAL MEETING OF THE WESTERN-VASCULAR-SOC Rubin, G. D., Walker, P. J., Dake, M. D., Napel, S., Jeffrey, R. B., McDonnell, C. H., Mitchell, R. S., Miller, D. C. MOSBY-ELSEVIER. 1993: 656–65

    Abstract

    We sought to apply a new technique of computed tomographic angiography (CTA) to the preoperative and postoperative assessment of the abdominal aorta and its branches.After a peripheral intravenous contrast injection, the patient is continuously advanced through a spiral CT scanner, while maintaining a 30-second breath-hold. Thirty-five patients with abdominal aortic, renal, and visceral arterial disease have undergone CTA.Diagnostic three-dimensional images were obtained in patients with aortic aneurysms (n = 9), aortic dissections (n = 4), and mesenteric artery stenoses (n = 4). The technique has also been used to assess vessels after operative reconstruction or endovascular intervention in 18 patients. These preliminary studies have correlated well with conventional arteriographic findings. In aneurysmal disease both the lumen and mural thrombus and associated renal artery stenoses are visualized. The true and false channels of aortic dissections and the perfusion source of the visceral vessels are clearly shown; patency of visceral and renal reconstruction or stent placement are confirmed. CTA is relatively noninvasive and can be completed in less time than conventional angiography with less radiation exposure.This initial experience suggests that CTA may be a valuable alternative to conventional arteriography in the evaluation of the aorta and its branches.

    View details for Web of Science ID A1993MB16500013

    View details for PubMedID 8411473

  • STS-MIP - A NEW RECONSTRUCTION TECHNIQUE FOR CT OF THE CHEST JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY Napel, S., Rubin, G. D., Jeffrey, R. B. 1993; 17 (5): 832-838

    Abstract

    The authors present sliding thin-slab maximum intensity projection (STS-MIP) as a technique for improved visualization of blood vessels and airways from rapidly acquired thin-section CT data. The STS-MIP reconstructions can be computed rapidly and without operator intervention directly from the transaxial sections. The resulting images retain the high contrast resolution of thin-section (1-3 mm) CT while providing vascular or airway visibility within a sequence of overlapping thin-slabs (3-10 mm). Examples are presented of pulmonary vessels and airways derived from spiral CT and of pulmonary vessels and coronary arteries derived from electron-beam CT.

    View details for Web of Science ID A1993LX47700036

    View details for PubMedID 8370848

  • HEPATIC FOCAL NODULAR HYPERPLASIA - FINDINGS WITH COLOR DOPPLER SONOGRAPHY JOURNAL OF ULTRASOUND IN MEDICINE Learch, T. J., Ralls, P. W., Johnson, M. B., Jeffrey, R. B., NINOMURCIA, M., Lee, K. P., RADIN, D. R. 1993; 12 (9): 541-544

    Abstract

    Color Doppler sonographic images of five patients with a total of six lesions of FNH were reviewed. All cases were confirmed pathologically. All six lesions showed increased intralesional flow in comparison to surrounding liver parenchyma on color Doppler sonography. Four of the six lesions showed significant peripheral flow; two of the six lesions showed central flow radiating peripherally from a central vessel. We conclude that increased color Doppler flow may be a characteristic feature of FNH. Increased internal flow has also been reported in HCC and hepatic metastatic disease. Considerable overlap is seen in color Doppler flow patterns. However, in patients clinically at low risk for malignancy, detection of a liver mass with increased color Doppler flow should suggest the diagnosis of FNH.

    View details for Web of Science ID A1993LU71000012

    View details for PubMedID 8107187

  • FOLLOW-UP SONOGRAPHY IN SUSPECTED ACALCULOUS CHOLECYSTITIS - PRELIMINARY CLINICAL-EXPERIENCE JOURNAL OF ULTRASOUND IN MEDICINE Jeffrey, R. B., Sommer, F. G. 1993; 12 (4): 183-187

    Abstract

    Fourteen adult patients with clinically suspected AAC and inconclusive initial sonograms underwent follow-up sonography within 24 hours. Eight patients had initial studies demonstrating a normal thickness of the gallbladder wall. Four of these patients demonstrated progressive thickening of the gallbladder wall on follow-up scans and were diagnosed as having AAC. In three of these patients AAC was proved at surgery, and the remaining patient improved clinically after percutaneous cholecystostomy. Four other patients with normal gallbladder wall thickness on both the initial and follow-up sonograms had benign clinical follow-up results without evidence of AAC. The remaining six patients had a thickened gallbladder on the initial sonogram. In one of these patients, the gallbladder wall thickening resolved on follow-up sonography. In the remaining five patients the gallbladder wall thickening did not change. Four of these patients had benign follow-up results but one patient was found to have AAC at surgery. Follow-up sonography may be helpful to confirm AAC if there is progressive edema of the gallbladder wall. A normal gallbladder wall on an initial study does not exclude early AAC. Thickening of the gallbladder wall on initial studies still remains a problem and other ancillary criteria must be used to establish the diagnosis of AAC.

    View details for Web of Science ID A1993KY03400001

    View details for PubMedID 8497021

  • FAST MULTIPLANAR SPOILED GRADIENT-RECALLED IMAGING OF THE LIVER - PULSE SEQUENCE OPTIMIZATION AND COMPARISON WITH SPIN-ECHO MR IMAGING AMERICAN JOURNAL OF ROENTGENOLOGY Low, R. N., Francis, I. R., Herfkens, R. J., Jeffrey, R. B., Glazer, G. M., Foo, T. K., Shimakawa, A., Pelc, N. J. 1993; 160 (3): 501-509

    Abstract

    The purpose of this study was to optimize a new rapid-acquisition MR pulse sequence, called fast multiplanar spoiled gradient-recalled (FMPSPGR) imaging, for breath-hold imaging of the liver and to compare unenhanced and contrast-enhanced FMPSPGR with standard spin-echo imaging in detecting liver tumors.The pulse sequence was optimized at 1.5 T with a healthy volunteer. Various scanning parameters were evaluated, and liver-spleen signal difference/noise measurements were used to estimate lesion contrast-to-noise ratios. We examined 24 patients with hepatic masses using the optimized sequence with spin-echo T1-weighted and T2-weighted imaging as well as unenhanced and gadopentetate dimeglumine-enhanced FMPSPGR imaging. The contrast-to-noise ratio for the hepatic tumors was determined for each sequence. Three radiologists who did not know the biopsy or test results reviewed all images for lesion conspicuity, lesion tissue specificity, and overall image quality.A comparison of unenhanced FMPSPGR images with spin-echo T1-weighted images showed a 40% improvement in mean contrast-to-noise ratio and a 70% improvement in liver signal-to-noise ratio for the FMPSPGR images. A comparison of gadopentetate dimeglumine-enhanced FMPSPGR images with spin-echo T1- and T2-weighted images showed a superior contrast-to-noise ratio for the enhanced FMPSPGR images in 17 (68%) of 25 hepatic lesions, which included all hepatic cysts (n = 3) and all hepatomas (n = 6), and in six of 12 patients with other liver tumors. The results of contrast-to-noise ratio for four patients with hemangiomas were mixed. For the remaining eight lesions, the contrast-to-noise ratio for spin-echo T1- and T2-weighted images predominated in three and five cases, respectively. Contrast-enhanced FMPSPGR images revealed a 40% and 300% increase in contrast-to-noise ratio compared with T2- and T1-weighted images, respectively. All three radiologists preferred the contrast-enhanced FMPSPGR images for overall image quality. For lesion conspicuity and specificity, however, the three radiologists differed, with a preference for the FMPSPGR images in 52%, 80%, and 40% of cases for lesion conspicuity and in 68%, 40%, and 60% of cases for lesion specificity.FMPSPGR is a new, ultrafast MR sequence that provides T1-weighted images of the liver during suspended respiration. Contrast-to-noise ratio and liver signal-to-noise ratio are significantly improved over those on conventional spin-echo T1-weighted images. The combination of breath-hold FMPSPGR with gadopentetate dimeglumine is an excellent technique that can be used to rapidly evaluate the liver with superior overall image quality. Contrast-to-noise ratios are generally superior to T2-weighted spin-echo images, making this technique a useful adjunct to conventional spin-echo MR imaging.

    View details for Web of Science ID A1993KM93500009

    View details for PubMedID 8381572

  • ADNEXAL MASSES - COMPARISON OF SPECIFICITY OF ENDOVAGINAL ULTRASOUND AND PELVIC MR IMAGING RADIOLOGY Jain, K. A., Friedman, D. L., PETTINGER, T. W., Alagappan, R., Jeffrey, R. B., Sommer, F. G. 1993; 186 (3): 697-704

    Abstract

    In a prospective study, 32 women with suspected pelvic masses at physical examination underwent both endovaginal ultrasound (US) and magnetic resonance (MR) imaging to compare their ability in diagnosis of adnexal masses. Criteria for the diagnosis of various types of adnexal masses with MR imaging and endovaginal US were prospectively defined, and the ability of either modality to allow a specific diagnosis was assessed. For each modality, measures of sensitivity, specificity, and accuracy were obtained. Results indicated higher diagnostic capability of endovaginal US for simple cysts (five of five), hemorrhagic cysts (eight of nine), endometriomas (nine of 14), and ovarian carcinomas (three of three). MR imaging demonstrated higher diagnostic capability for dermoids (three of three). MR imaging and endovaginal US showed equal diagnostic capability for pedunculated fibroids (two of two). For all masses, observers, and observations, the overall sensitivity of endovaginal US was 76% versus 49% for MR imaging, and the overall accuracy of endovaginal US was 83% versus 70% for MR imaging. The authors suggest that endovaginal US is a better modality than MR imaging for the assessment of suspected pelvic masses.

    View details for Web of Science ID A1993KN05300017

    View details for PubMedID 8430177

  • 3-DIMENSIONAL SPIRAL CT ANGIOGRAPHY OF THE ABDOMEN - INITIAL CLINICAL-EXPERIENCE RADIOLOGY Rubin, G. D., Dake, M. D., NAPEL, S. A., McDonnell, C. H., Jeffrey, R. B. 1993; 186 (1): 147-152

    Abstract

    Spiral computed tomography (CT) is a new technology that couples continuous tube rotation with continuous table feed. This allows compilation of a data set that has continuous anatomic information without the establishment of arbitrary boundaries at section interfaces as in conventional CT. The unique method of data collection of the spiral scanner has been combined with a dynamic intravenous contrast material bolus to image abdominal vasculature, specifically, the aorta, renal arteries, and splanchnic circulation. Through various techniques of image processing, including surface renderings and maximum-intensity projections, it is possible to obtain excellent anatomic detail of the aorta and its major branches. The authors applied this technique in 15 patients and reliably saw third-order aortic branches as well as third-order splenic-portal venous anatomic detail with remarkable clarity. Pathologic conditions detected include stenotic renal arteries, abdominal aortic dissection, abdominal aortic aneurysm, and celiac bypass graft occlusion.

    View details for Web of Science ID A1993KD15300033

    View details for PubMedID 8416556

  • CT OF BLUNT TRAUMA TO THE BOWEL AND MESENTERY AMERICAN JOURNAL OF ROENTGENOLOGY Nghiem, H. V., Jeffrey, R. B., Mindelzun, R. E. 1993; 160 (1): 53-58

    Abstract

    The high mortality and morbidity rates associated with traumatic rupture of the hollow viscera have been attributed to the clinical difficulty in establishing an early diagnosis. CT has been shown to be accurate for detecting bowel and mesenteric injuries caused by blunt trauma and may be useful in predicting the need for either surgical repair or conservative management. However, many major gastrointestinal injuries have subtle CT findings. In this pictorial essay, we illustrate the broad spectrum of gastrointestinal abnormalities that can be shown by CT in patients with blunt abdominal trauma.

    View details for Web of Science ID A1993KF47700012

    View details for PubMedID 8416646

  • ARTERIAL AND VENOUS-BLOOD FLOW - NONINVASIVE QUANTITATION WITH MR IMAGING RADIOLOGY Pelc, L. R., Pelc, N. J., Rayhill, S. C., Castro, L. J., Glover, G. H., Herfkens, R. J., Miller, D. C., Jeffrey, R. B. 1992; 185 (3): 809-812

    Abstract

    Quantitative measurements of arterial and venous blood flow were obtained with phase-contrast cine magnetic resonance (MR) imaging and compared with such measurements obtained by means of implanted ultrasound (US) blood flow probes in anesthetized dogs. The US flowmeter was enabled during a portion of each MR imaging sequence to allow virtually simultaneous data acquisition with the two techniques. MR imaging data were gated by means of electrocardiography and divided into 16 phases per cardiac cycle. The rates of portal venous blood flow measured with MR imaging and averaged across the cardiac cycle (710 mL/min +/- 230 [standard deviation]) correlated well with those measured with the flowmeter and averaged in like fashion (751 mL/min +/- 238) (r = .995, slope = 1.053). The correspondence in arterial blood flow was almost as good. No statistically significant difference existed between the paired measurements of blood flow obtained with MR imaging and the implanted probe. It is concluded that, as a noninvasive means of accurate quantification of blood flow, phase-contrast MR imaging may be especially useful in deep blood vessels in humans.

    View details for Web of Science ID A1992JZ34700042

    View details for PubMedID 1438767

  • COLOR FLOW DOPPLER CHARACTERIZATION OF FOCAL HEPATIC-LESIONS 1992 ANNUAL MEETING OF THE AMERICAN ROENTGEN RAY SOC NINOMURCIA, M., Ralls, P. W., Jeffrey, R. B., Johnson, M. AMER ROENTGEN RAY SOC. 1992: 1195–97

    Abstract

    The purpose of this study was to determine the sensitivity and specificity of color flow Doppler sonography for the specific diagnosis of focal hepatic lesions.Color flow Doppler images of 118 focal hepatic lesions in 108 patients were analyzed prospectively. In most patients, liver disease was suspected or known to be present before the Doppler images were obtained. Experienced sonologists obtained and interpreted all sonograms. The lesions were classified, according to their color flow pattern, into two main categories: lesions with internal vascularity and lesions with no internal vascularity. The color flow Doppler pattern of each lesion was correlated with the diagnosis of the lesion on a lesion-by-lesion basis. One hundred two lesions were proved by biopsy and 16 lesions were confirmed by evaluation with other imaging techniques. Lesions included 29 hepatocellular carcinomas, 64 metastases, one cholangiocarcinoma, and 24 benign lesions. The sensitivity and specificity of vascularity as shown by color Doppler imaging in the diagnosis of hepatocellular carcinoma were determined.The majority of hepatocellular carcinoma lesions (76%) had internal vascularity. Most of the metastases (67%) and benign lesions (75%) had no internal vascularity. When the presence of internal vascularity was used as the discriminating criterion, the sensitivity of color flow Doppler findings for the diagnosis of hepatocellular carcinoma was 0.76. The specificity of internal vascularity for the diagnosis of hepatocellular carcinoma vs other focal lesions was 0.69; for hepatocellular carcinoma vs metastases it was 0.67.Although most hepatocellular carcinomas have internal vascularity on color flow Doppler images, a significant number of metastases also have internal vascularity. This overlap limits the usefulness of color flow Doppler imaging for distinguishing hepatocellular carcinoma from metastatic tumors.

    View details for Web of Science ID A1992JZ24000008

    View details for PubMedID 1332456

  • CT ANGIOGRAPHY WITH SPIRAL CT AND MAXIMUM INTENSITY PROJECTION RADIOLOGY Napel, S., Marks, M. P., Rubin, G. D., Dake, M. D., McDonnell, C. H., Song, S. M., Enzmann, D. R., Jeffrey, R. B. 1992; 185 (2): 607-610

    Abstract

    The authors describe a technique for obtaining angiographic images by means of spiral computed tomography (CT), preprocessing of reconstructed three-dimensional sections to suppress bone, and maximum intensity projection. The technique has some limitations, but preliminary results in 48 patients have shown excellent anatomic correlation with conventional angiography in studies of the abdomen, the circle of Willis in the brain, and the extracranial carotid arteries. With continued development and evaluation, CT angiography may prove useful as a screening tool or replacement for conventional angiography in some patients.

    View details for Web of Science ID A1992JV36000058

    View details for PubMedID 1410382

  • INTRAPANCREATIC ACCESSORY SPLEEN MIMICKING PANCREATIC MASS ON CT JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY HAYWARD, I., Mindelzun, R. E., Jeffrey, R. B. 1992; 16 (6): 984-985

    Abstract

    Accessory spleens occur in approximately 10% of the population and are usually located in the region of the splenic hilum. In 16% of patients the accessory spleen will be located within the pancreatic tail. The diagnosis of an intrapancreatic accessory spleen can be suggested when CT, with and without intravenous contrast agent, demonstrates that the mass enhances in a manner identical to the spleen.

    View details for Web of Science ID A1992JY18700030

    View details for PubMedID 1430454

  • GRADED COMPRESSION SONOGRAPHY OF ABDOMINAL NEOPLASMS MIMICKING ACUTE APPENDICITIS GASTROINTESTINAL RADIOLOGY Rubin, G. D., Jeffrey, R. B. 1992; 17 (4): 292-294

    Abstract

    Over a 3-year period nine patients (mean age of 43 years) with acute abdominal pain and unsuspected abdominal neoplasms were referred for graded compression sonography to rule out appendicitis. Six of the nine patients had right lower quadrant neoplasms involving the cecum, terminal ileum, iliacus muscle, or iliac lymph nodes. However, in three patients neoplasm was noted outside the right iliac fossa involving the liver, right kidney, and upper abdominal mesentery. This study underscores the fact that in patients without sonographic evidence of acute appendicitis, a survey of the upper abdomen and right flank should routinely be performed in addition to scanning the right iliac fossa and pelvis. In patients more than 50 years of age neoplasm must also be kept in mind in the differential diagnosis of appendicitis.

    View details for Web of Science ID A1992JL06900002

    View details for PubMedID 1426842

  • LIMITATIONS OF LIVER SURFACE US IN THE DIAGNOSIS OF CIRRHOSIS RADIOLOGY LADENHEIM, J. A., LUBA, D. G., Yao, F., Gregory, P. B., Jeffrey, R. B., Garcia, G. 1992; 185 (1): 21-23

    Abstract

    Ultrasound (US) of the liver surface with a high-frequency, small-parts, short-focused probe has been proposed as a method of diagnosing cirrhosis. US of the liver was performed in 50 consecutive patients undergoing diagnostic liver biopsy to assess the clinical usefulness of this noninvasive procedure in diagnosing hepatic cirrhosis. Eight patients had histologically proved cirrhosis, and 42 had no histologic evidence of cirrhosis. Seven of the eight patients with cirrhosis had a normal liver surface at US, and five of the 42 patients without cirrhosis had an abnormal liver surface. US of the liver surface with this probe was not reliable in this heterogeneous patient population.

    View details for Web of Science ID A1992JN60800005

    View details for PubMedID 1523310

  • Spiral CT creates 3-D neuro, body angiograms. Diagnostic imaging Rubin, G. D., Napel, S., Dake, M. D., Walker, P. J., McDonnell, C. H., Marks, M. P., Jeffrey, R. B. 1992; 14 (8): 66-74

    View details for PubMedID 10147535

  • MUCOCELE OF THE APPENDIX - IMAGING FINDINGS AMERICAN JOURNAL OF ROENTGENOLOGY MADWED, D., Mindelzun, R., Jeffrey, R. B. 1992; 159 (1): 69-72

    Abstract

    Mucocele of the appendix, a cystic mass resulting from a dilated appendiceal lumen caused by abnormal accumulation of mucus, is a rare entity that often is not considered when problems of the right lower quadrant are assessed. Preoperative recognition of mucocele of the appendix is important because of the possibility of rupture at surgery with development of pseudomyxoma peritonei and to predict malignant transformation. The appearances of mucoceles of the appendix on sonography, CT, and barium studies are illustrated.

    View details for Web of Science ID A1992JA20000018

    View details for PubMedID 1609724

  • ABDOMINAL IMAGING IN THE IMMUNOCOMPROMISED PATIENT RADIOLOGIC CLINICS OF NORTH AMERICA Jeffrey, R. B. 1992; 30 (3): 579-596

    Abstract

    Abdominal and gastrointestinal disease may result in clinically important complications in immunocompromised patients. The major types of disease are opportunistic infections and immunodeficiency-associated neoplasms. A multimodality approach is often essential in the diagnosis and staging of these lesions. A combination of bacteriologic culture, endoscopy, barium studies, and cross-sectional imaging of the abdomen with computed tomography and sonography is required to assess the extent of the disease accurately.

    View details for Web of Science ID A1992HR68200005

    View details for PubMedID 1570396

  • ACUTE APPENDICITIS CONFINED TO THE APPENDICEAL TIP - EVALUATION WITH GRADED COMPRESSION SONOGRAPHY JOURNAL OF ULTRASOUND IN MEDICINE Nghiem, H. V., Jeffrey, R. B. 1992; 11 (5): 205-207

    Abstract

    Focal appendicitis at the tip of the appendix has not been emphasized in the sonographic literature. We present the sonographic findings in four patients with pathologically confirmed acute appendicitis confined to the appendiceal tip. In all four patients, the base of the appendix had a normal appearance with maximal outer diameters measuring 4 to 6 mm. However, the inflamed tip was focally enlarged, measuring greater than 7 mm. The importance of a careful survey of the entire length of the appendix is emphasized to avoid a false-negative examination.

    View details for Web of Science ID A1992KY02000005

    View details for PubMedID 1588690

  • COAXIAL TRANSTHORACIC FINE-NEEDLE BIOPSY IN PATIENTS WITH A HISTORY OF MALIGNANT-LYMPHOMA RADIOLOGY Wittich, G. R., Nowels, K. W., Korn, R. L., Walter, R. M., Lucas, D. E., Dake, M. D., Jeffrey, R. B. 1992; 183 (1): 175-178

    Abstract

    Efficacy and safety of coaxial transthoracic fine-needle biopsy were evaluated in 54 patients with a history of malignant lymphoma and new chest lesions. Twenty-one patients had recurrent lymphoma. Correct diagnosis was made in 17 of the 21 patients (81%) after one biopsy. The sensitivity increased to 95% with repeat needle biopsy in three patients. Immunophenotyping (determining phenotype by means of immunologic examination) was essential for a definitive diagnosis of lymphoma in three patients. Non-lymphomatous malignancies were correctly diagnosed in 14 patients. An infectious organism was identified in 11 of 19 patients (58%) with benign lesions. Pneumothorax occurred in eight patients (15%), necessitating placement of a chest tube in two (4%). Mild hemoptysis was observed in four patients (7%). The authors conclude that coaxial transthoracic fine-needle biopsy in patients with a history of lymphoma is safe and accurate. The use of large cutting needles or surgical biopsy can be restricted to patients with false-negative findings at percutaneous biopsy and to patients in whom histologic transformation of lymphoma is suspected.

    View details for Web of Science ID A1992HJ87400033

    View details for PubMedID 1549668

  • COMPARISON OF IOHEXOL-300 AND DIATRIZOATE MEGLUMINE-60 FOR BODY CT - IMAGE QUALITY, ADVERSE REACTIONS, AND ABORTED REPEATED EXAMINATIONS AMERICAN JOURNAL OF ROENTGENOLOGY Bernardino, M. E., Fishman, E. K., Jeffrey, R. B., Brown, P. C. 1992; 158 (3): 665-667

    Abstract

    Six hundred patients were prospectively randomized and given either diatrizoate meglumine 60 or iohexol 300 during dynamic contrast-enhanced body CT in order to compare image quality, contrast reactions, and the number of aborted studies or studies in which images had to be repeated. Three hundred two patients received iohexol 300, and 298 patients received diatrizoate meglumine 60. Thirty-nine percent (119/302) of the patients given iohexol 300 and 63% (188/298) of the patients given diatrizoate meglumine 60 had at least one adverse reaction thought to be related to contrast material during, or within 24 hr of, the body CT scan. When reactions of discomfort (heat or warmth, flushing, bad taste) were excluded, 16% (48/302) of the patients who received iohexol and 33% (99/298) of the patients who were given diatrizoate meglumine 60 had at least one adverse reaction. The differences in both types of reactions between the two agents were significant (p less than .001). Among scans evaluated for study quality, 71% (214/302) of the iohexol 300 group and 62% (184/298) of the diatrizoate meglumine 60 group had optimal enhancement (p = .02). However, when the optimal and adequate categories were combined, 301 of 302 patients given iohexol 300 and 292 of 298 patients given diatrizoate meglumine 60 had diagnostic-quality studies (no statistical difference). Studies were not terminated nor were images repeated in 97% (292/302) of the patients given iohexol 300 and in 94% (280/298) of those given diatrizoate meglumine 60. The CT study was repeated because of movement during the contrast injection or aborted because of contrast-related reactions in 0.7% of the patients given iohexol 300 and in 3.0% of the patients given diatrizoate meglumine 60. This difference was statistically significant (p = .04). Our results suggest that the difference in image quality, number of adverse reactions, and number of aborted/repeated CT scans performed with iohexol 300 or diatrizoate meglumine 60 are not sufficiently different to warrant conversion to nonionic agents for body CT scans.

    View details for Web of Science ID A1992HE96400039

    View details for PubMedID 1739017

  • IMAGING OF BLUNT HEPATIC-TRAUMA RADIOLOGIC CLINICS OF NORTH AMERICA Jeffrey, R. B., Olcott, E. W. 1991; 29 (6): 1299-1310

    Abstract

    This article focuses on the clinical role of high resolution computed tomography (CT) in the initial diagnosis and management of hemodynamically stable patients with blunt hepatic trauma. The increased utilization and diagnostic confidence afforded by CT has dramatically changed the surgical approach and need for laparatomy. The most important development has been the growing realization by many trauma surgeons that nonoperative management is often successful in stable patients who have CT evidence of isolated blunt hepatic trauma.

    View details for Web of Science ID A1991GN74000011

    View details for PubMedID 1947047

  • RANDOMIZED, DOUBLE-BLIND COMPARISON OF OMNIPAQUE-300 AND HYPAQUE-60 IN PATIENTS UNDERGOING BOLUS-ENHANCED DYNAMIC COMPUTED BODY TOMOGRAPHY SYMP ON CONTRAST MEDIA RESEARCH ( CMR 91 ) Brown, P. C., Bernardino, M. E., Fishman, E. K., Jeffrey, R. B. LIPPINCOTT WILLIAMS & WILKINS. 1991: S205–S207

    View details for Web of Science ID A1991GQ30600071

    View details for PubMedID 1808131

  • THE GAS-CONTAINING APPENDIX - POTENTIAL SONOGRAPHIC PITFALL IN THE DIAGNOSIS OF ACUTE APPENDICITIS JOURNAL OF ULTRASOUND IN MEDICINE Poljak, A., Jeffrey, R. B., KERNBERG, M. E. 1991; 10 (11): 625-628

    Abstract

    The presence of gas within the appendix on plain abdominal radiographs is nonspecific and may or may not be associated with acute appendicitis. This finding, however, has not previously been reported with graded compression sonography of the right lower quadrant. Gas within the appendix was identified in four of 154 patients with a visualized appendix. All four patients had surgically confirmed acute appendicitis. Diagnostic difficulties were encountered in three of these four patients. In two patients, the findings were misinterpreted as an extraluminal gas-forming periappendiceal abscess. In an additional patient, the gas-filled appendix was initially mistaken for a segment of normal terminal ileum. The gas-filled appendix is a potential pitfall in the sonographic diagnosis of acute appendicitis. However, if other diagnostic criteria are met, gas within the appendix should not preclude establishing a sonographic diagnosis of appendicitis.

    View details for Web of Science ID A1991GM82000005

    View details for PubMedID 1811080

  • PICTORIAL ESSAY - TRANSABDOMINAL AND ENDOVAGINAL SONOGRAPHY OF ADNEXAL MASSES CLINICAL IMAGING Jain, K. A., Jeffrey, R. B. 1991; 15 (4): 245-252

    Abstract

    Endovaginal sonography is rapidly becoming the diagnostic procedure of choice when evaluating patients with early pregnancy and assessing uterine abnormalities. However, there has been relatively little discussion of endovaginal sonography in the evaluation of adnexal masses. Using endovaginal sonography we studied 50 patients with clinically suspected adnexal masses, in whom transabdominal sonography was either suboptimal or failed to adequately characterize the mass. The purpose of this pictorial essay is to depict the normal anatomy of the ovaries and adnexa and highlight the unique contribution of endovaginal sonography in diagnosing a variety of adnexal masses, including tubal and ovarian lesions.

    View details for Web of Science ID A1991GN51800001

    View details for PubMedID 1742672

  • GONADAL VEIN-THROMBOSIS IN PATIENTS WITH ACUTE GASTROINTESTINAL INFLAMMATION - DIAGNOSIS WITH CT RADIOLOGY Jain, K. A., Jeffrey, R. B. 1991; 180 (1): 111-113

    Abstract

    During a 31-month period, evidence of gonadal vein thrombosis (GVT) was demonstrated by computed tomography (CT) in seven patients who had a broad spectrum of acute gastrointestinal inflammatory lesions, including diverticulitis, ulcerative colitis, Crohn disease, appendicitis with abscess, and perforated appendix with pseudomembranous colitis. All patients had lower abdominal pain, tenderness, fever, and leukocytosis. CT demonstrated thrombus through the length of the gonadal vein in each patient; the entire lumen of the vein was filled. No symptoms relating to GVT were present. GVT may resolve with treatment of the underlying enteric disease alone, and anticoagulant therapy may not be necessary.

    View details for Web of Science ID A1991FR67900025

    View details for PubMedID 2052675

  • IMAGING OF THE PERITONEAL-CAVITY CURRENT OPINION IN RADIOLOGY Jeffrey, R. B. 1991; 3 (3): 471-473

    Abstract

    Newer techniques and applications of cross-sectional imaging of the abdomen with CT, ultrasound, and MR imaging have facilitated the diagnosis of diseases primarily involving the peritoneal cavity. CT peritoneography may aid in diagnosing complications of peritoneal dialysis, and detecting internal hernias and small peritoneal implants. Uncommon abnormalities such as sclerosing encapsulating peritonitis, cystic mesothelioma, and peritonitis from rupture of a retroperitoneal teratoma may also be diagnosed with CT or ultrasonography.

    View details for Web of Science ID A1991FQ56200018

    View details for PubMedID 1859782

  • DETECTION OF ACTIVE INTRAABDOMINAL ARTERIAL HEMORRHAGE - VALUE OF DYNAMIC CONTRAST-ENHANCED CT AMERICAN JOURNAL OF ROENTGENOLOGY Jeffrey, R. B., Cardoza, J. D., Olcott, E. W. 1991; 156 (4): 725-729

    Abstract

    Contrast-enhanced dynamic CT was used prospectively to diagnose and locate the site of active arterial intraabdominal hemorrhage in 18 patients. Active arterial extravasation was confirmed by angiography in five patients and by immediate surgery in nine. Two patients not undergoing surgery or angiography required multiple blood transfusions to correct rapidly falling hematocrit due to a coagulopathy. One patient died of hypovolemic shock, and autopsy confirmed a large acute retroperitoneal hematoma. Another patient with a splenic laceration and massive hemoperitoneum on CT had no active bleeding at the time of surgery, which was delayed 1 hr from the time of the CT. All patients were clinically thought to be hemodynamically stable and had systolic blood pressures greater than 110 mm Hg at the time of CT. In seven patients, hypotension developed either during (two patients) or immediately after (five patients) CT scanning, necessitating either immediate surgery or angiographic embolization. Contrast-enhanced dynamic CT is valuable in the diagnosis and localization of active arterial intraabdominal hemorrhage. Identification of the anatomic site of this potentially life-threatening hemorrhage is critical in determining whether immediate laparotomy or angiographic embolization is the preferred method of treatment.

    View details for Web of Science ID A1991FC83000010

    View details for PubMedID 2003435

  • PANCREATIC MICROCYSTIC ADENOMA PRESENTING WITH ACUTE HEMOPERITONEUM - CT DIAGNOSIS AMERICAN JOURNAL OF ROENTGENOLOGY Rubin, G. D., Jeffrey, R. B., Walter, J. F. 1991; 156 (4): 749-750

    View details for Web of Science ID A1991FC83000015

    View details for PubMedID 2003439

  • COMPUTED-TOMOGRAPHY AS AN ADJUNCT TO ULTRASOUND IN THE DIAGNOSIS OF ACUTE ACALCULOUS CHOLECYSTITIS GASTROINTESTINAL RADIOLOGY Blankenberg, F., Wirth, R., Jeffrey, R. B., Mindelzun, R., Francis, I. 1991; 16 (2): 149-153

    Abstract

    The sonographic and computed tomographic (CT) findings were reviewed in 17 patients with acute acalculous cholecystitis (AAC) over a 6-year period from 1984 to 1989. Of the six patients in whom both ultrasound and CT were performed, CT revealed marked gallbladder (GB) wall abnormalities, including perforation, and pericholecystic fluid collections in five patients not demonstrated by sonography. Of the total group, five patients had GB wall thicknesses of less than or equal to 3 mm (normal) at pathologic examination, which demonstrated a spectrum of disease ranging from acute hemorrhagic/necrotizing, to gangrenous acalculous cholecystitis with perforation. Sonography was falsely negative or significantly underestimated the severity of AAC in seven of the 13 patients examined by sonography. CT because of its superior ability to assess pericholecystic inflammation may provide additional diagnostic information even after a thorough sonographic study in cases of AAC.

    View details for Web of Science ID A1991EX38300014

    View details for PubMedID 2016029

  • GYNECOLOGIC VASCULAR ABNORMALITIES - DIAGNOSIS WITH DOPPLER US RADIOLOGY Jain, K. A., Jeffrey, R. B., Sommer, F. G. 1991; 178 (2): 549-551

    Abstract

    The authors describe the use of duplex and/or color Doppler ultrasonography of the pelvis in three women to demonstrate the presence of venous malformations. One patient with a pulsatile vaginal mass was shown to have an arteriovenous malformation of the vaginal wall. The second patient was shown to have an unsuspected venous angioma in the endometrial cavity. The third patient was shown to have adnexal varices that closely mimicked hydrosalpinx. In the latter two cases, the duplex and color flow capabilities of an endovaginal probe were especially important.

    View details for Web of Science ID A1991EU03500049

    View details for PubMedID 1987622

  • DIFFUSE INFILTRATING RENAL METASTASES PRESENTING AS PYONEPHROSIS JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY Issa, M. M., Cox, J. L., Jeffrey, R. B., DIETRICK, D. D., Freiha, F. S. 1991; 15 (1): 175-177

    View details for Web of Science ID A1991ET71800035

    View details for PubMedID 1987196

  • IMAGING OF THE GASTROINTESTINAL-TRACT IN THE ACQUIRED-IMMUNODEFICIENCY-SYNDROME CURRENT OPINION IN RADIOLOGY Jeffrey, R. B. 1990; 2 (3): 467-471

    View details for Web of Science ID A1990DV62500020

    View details for PubMedID 2201386

  • AORTOENTERIC FISTULA AND PERIGRAFT INFECTION - EVALUATION WITH CT RADIOLOGY Low, R. N., Wall, S. D., Jeffrey, R. B., SOLLITTO, R. A., REILLY, L. M., Tierney, L. M. 1990; 175 (1): 157-162

    Abstract

    A blinded retrospective study was performed to determine the sensitivity and specificity of computed tomography (CT) in detecting perigraft infection (PGI) and aortoenteric fistula (AEF), rare but devastating complications of aortic reconstructive surgery. Two observers independently reviewed CT scans in 55 cases including AEF (n = 23); PGI (n = 12); and normal, noninfected grafts (n = 20). Each scan was assessed for ectopic gas, focal bowel wall thickening, perigraft fluid, perigraft soft tissue, pseudoaneurysm formation, disruption of the aneurysmal wrap, and increased soft tissue between the graft and surrounding wrap. Comparison of CT findings with operative results revealed that each observer correctly identified as abnormal 33 of 35 cases of PGI either with or without AEF (sensitivity, 94%) and that results were falsely positive in three cases (specificity, 85%). CT findings ranged from large amounts of perigraft soft tissue and ectopic gas to subtle findings of minimal or no abnormalities; thus, strict criteria must be applied to the interpretation of CT scans after aortic surgery. Although CT is not 100% sensitive or specific, the authors conclude that it will continue to be valuable for diagnosing PGI and AEF.

    View details for Web of Science ID A1990CV27100029

    View details for PubMedID 2315475

  • VISCERAL AND NODAL CALCIFICATION IN PATIENTS WITH AIDS-RELATED PNEUMOCYSTIS-CARINII INFECTION AMERICAN JOURNAL OF ROENTGENOLOGY RADIN, D. R., Baker, E. L., Klatt, E. C., Balthazar, E. J., Jeffrey, R. B., Megibow, A. J., Ralls, P. W. 1990; 154 (1): 27-31

    Abstract

    Clinical and radiologic findings in nine patients with AIDS and disseminated Pneumocystis carinii infection were analyzed retrospectively. The diagnosis was confirmed by autopsy (five patients) and by biopsy (two patients). All nine had a history of P. carinii pneumonia. CT showed parenchymal calcifications in the spleen (seven patients), liver (six patients), kidneys (six patients), abdominal lymph nodes (three patients), adrenal glands (two patients), and mediastinal lymph nodes (one patient). Multiple punctate calcifications in the liver, spleen, kidneys, and/or adrenal glands were visible on plain films in three patients. Sonography showed diffuse tiny echogenic foci without shadowing in the liver, spleen, and kidneys. In one patient, CT showed multiple hypodense lesions in the spleen. P. carinii infection should be included in the differential diagnosis when calcifications or focal lesions are detected at one or more extrapulmonary sites in an immunodeficient patient, even if there is no history or evidence of P. carinii pneumonia.

    View details for Web of Science ID A1990CF33500005

    View details for PubMedID 2104720

  • CT FINDINGS IN ACUTE RENAL CORTICAL NECROSIS JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY Jordan, J., Low, R., Jeffrey, R. B. 1990; 14 (1): 155-156

    Abstract

    Acute renal cortical necrosis has three characteristic findings on contrast enhanced CT: (a) lack of enhancement of the renal cortex, (b) enhancement of the renal medulla, and (c) absent renal excretion.

    View details for Web of Science ID A1990CK60400034

    View details for PubMedID 2298986

  • SEPTIC THROMBOSIS OF THE PORTAL-VEIN - CT AND CLINICAL OBSERVATIONS JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY Lim, G. M., Jeffrey, R. B., Ralls, P. W., Marn, C. S. 1989; 13 (4): 656-658

    Abstract

    The CT and clinical findings were reviewed in seven patients with septic thrombosis of the portal vein (STPV). Of the seven patients, five had associated pyogenic liver abscesses. Five of seven patients presented de novo with STPV without a clinically obvious extrahepatic source of intraabdominal infection. All seven patients were successfully managed nonsurgically with intravenous antibiotics and in two patients percutaneous drainage of hepatic abscesses. Serial follow-up examinations in five patients demonstrated complete resolution of portal venous thrombus in three patients and progression to cavernous transformation in two. When diagnosed early by CT or sonography, STVP may have a more benign clinical course following appropriate antibiotic therapy.

    View details for Web of Science ID A1989AG41700018

    View details for PubMedID 2745784

  • CT OF PERITONEAL LYMPHOMATOSIS AMERICAN JOURNAL OF ROENTGENOLOGY Lynch, M. A., Cho, K. C., Jeffrey, R. B., Alterman, D. D., Federle, M. P. 1988; 151 (4): 713-715

    Abstract

    The CT and clinical findings are presented in seven patients with diffuse peritoneal malignancy caused by non-Hodgkin lymphoma. All seven patients had CT evidence of ascites, omental infiltration, and peritoneal implants mimicking carcinomatosis. Bulky retroperitoneal or mesenteric adenopathy was present in only one patient. Four of the seven patients had documented AIDS. Paracentesis provided a diagnosis of lymphoma in only one of the seven patients. In the other six patients, the final diagnosis was established by surgery (three patients), by autopsy (one patient), by laparoscopy (one patient), and by guided needle aspiration (one patient). Although uncommon, lymphoma should be considered in patients who have diffuse peritoneal malignancy, particularly those who are at risk for AIDS.

    View details for Web of Science ID A1988Q258400014

    View details for PubMedID 3262271

  • CT OF SMALL PYOGENIC HEPATIC-ABSCESSES - THE CLUSTER SIGN AMERICAN JOURNAL OF ROENTGENOLOGY Jeffrey, R. B., TOLENTINO, C. S., Chang, F. C., Federle, M. P. 1988; 151 (3): 487-489

    Abstract

    Of 36 consecutive patients with pyogenic liver abscesses evaluated by CT, five (14%) had multiple small abscesses less than 2 cm in size. The CT appearance of the small pyogenic abscesses was compared with that of 10 patients who had either fungal or mycobacterial abscesses and with that of 50 patients who had hepatic metastases. In all five patients who had small pyogenic abscesses, the abscesses appeared to cluster, or aggregate, in a pattern that suggested the beginning of coalescence into a single, larger abscess cavity (cluster sign). This cluster appearance was not seen in in any of the patients who had fungal or mycobacterial microabscesses. It was present in only one of the patients who had confirmed hepatic metastasis. Despite the small size of the abscesses, guided needle aspiration was successful in recovering pyogenic organisms in four of the five patients. In our experience, the presence of the cluster sign suggests that the lesions are pyogenic abscesses.

    View details for Web of Science ID A1988P691800013

    View details for PubMedID 3261506

  • INTRAPERITONEAL HEMORRHAGE AFTER RENAL BIOPSY - A GRAVE PROGNOSTIC SIGN AMERICAN JOURNAL OF ROENTGENOLOGY Low, R. N., Jeffrey, R. B. 1988; 151 (1): 113-114

    View details for Web of Science ID A1988N858700023

    View details for PubMedID 3259792

  • PERIAPPENDICEAL INFLAMMATORY MASSES - CT-DIRECTED MANAGEMENT AND CLINICAL OUTCOME IN 70 PATIENTS RADIOLOGY Jeffrey, R. B., Federle, M. P., TOLENTINO, C. S. 1988; 167 (1): 13-16

    Abstract

    The outcome was reviewed in 70 patients with computed tomographic (CT) and clinical evidence of periappendiceal inflammatory masses. On the basis of the initial CT scan, patients were divided into three broad categories: (a) patients with periappendiceal phlegmons or abscesses less than 3 cm (n = 32); (b) patients with well-defined and well-localized periappendiceal abscesses greater than 3 cm (n = 28); and (c) patients with extensive, poorly defined periappendiceal abscesses with either pelvic, retroperitoneal, or interloop involvement (n = 10). Thirty-two patients with either phlegmons or small abscesses were treated initially with antibiotic therapy alone; clinical resolution of the inflammatory process occurred in 28 patients (88%). Twenty-eight patients with well-defined and well-localized periappendiceal abscesses underwent percutaneous catheter drainage, which was successful in 26 patients (93%). Nine of ten patients underwent early surgical drainage for extensive, poorly defined abscesses. One patient underwent percutaneous drainage as a temporizing measure before surgery. There were three false-positive CT diagnoses of periappendiceal abscesses in this series.

    View details for Web of Science ID A1988M653600003

    View details for PubMedID 3347712

  • NASOJEJUNAL FEEDING TUBE PLACEMENT IN IMMOBILE PATIENTS RADIOLOGY Cardoza, J. D., Jeffrey, R. B. 1988; 166 (3): 893-893

    Abstract

    A technique for placement of nasojejunal feeding tubes has been developed that makes use of a long peel-away sheath for nasoesophageal access and a torque catheter for tube placement. The technique requires little dependent patient positioning. It was successful in 33 of 34 patients, 24 of whom were relatively immobile. Procedure time and fluoroscopy time were reduced, and irritation to the oropharynx, hypopharynx, and esophagus was minimized.

    View details for Web of Science ID A1988M043800057

    View details for PubMedID 3124206

  • THE COLLAPSED INFERIOR VENA-CAVA - CT EVIDENCE OF HYPOVOLEMIA AMERICAN JOURNAL OF ROENTGENOLOGY Jeffrey, R. B., Federle, M. P. 1988; 150 (2): 431-432

    Abstract

    In a review of 100 patients undergoing abdominal CT for blunt abdominal trauma, seven had flattening of the infrahepatic inferior vena cava at multiple levels. In six of these patients, emergency surgery was required to control major hemorrhage. Three patients had hypotension documented during or shortly after abdominal CT. Five patients had major intraabdominal injuries, and one patient had massive hemorrhage from facial lacerations. The severity of the blood loss was not fully appreciated clinically in five of the six patients before CT. The seventh patient had no clinical evidence of significant blood loss; in this case the flattened inferior vena cava probably was related to a normal variant. In a group of 100 patients scanned for nonacute conditions, none had flattening of the infrahepatic inferior vena cava at multiple levels. Presence of a collapsed inferior vena cava may be CT evidence of significant hypovolemia from major blood loss and should prompt careful hemodynamic and central venous pressure monitoring.

    View details for Web of Science ID A1988L774600044

    View details for PubMedID 3257336

  • PERCUTANEOUS DRAINAGE OF PERIAPPENDICEAL ABSCESSES - REVIEW OF 20 PATIENTS AMERICAN JOURNAL OF ROENTGENOLOGY Jeffrey, R. B., TOLENTINO, C. S., Federle, M. P., Laing, F. C. 1987; 149 (1): 59-62

    Abstract

    Twenty patients with periappendiceal abscesses diagnosed by CT underwent percutaneous catheter drainage. Eighteen (90%) of the 20 patients were successfully treated by percutaneous drainage and antibiotic therapy alone. In two of these patients, however, small recurrent abscesses were diagnosed by CT 4 and 6 weeks after drainage, but these abscesses resolved with additional antibiotic therapy. Surgery was performed in two patients in whom percutaneous drainage failed. One was a diabetic patient who had a gas-forming abscess that extended into the posterior pararenal space. Surgery was necessary in a second patient because of a technical failure of catheter insertion, which resulted in perforation of the abscess cavity and peritonitis. Abscess sinograms in eight (44%) of 18 patients showed fistulas between the abscess cavity and the base of the cecum or appendix. However, the fistulas did not pose a problem in clinical management, and all closed within 14 days. Percutaneous drainage is an effective alternative to surgery in selected patients with periappendiceal abscesses.

    View details for Web of Science ID A1987H899800012

    View details for PubMedID 3495993

  • AIDS-RELATED CHOLANGITIS - RADIOGRAPHIC FINDINGS IN 9 PATIENTS RADIOLOGY Dolmatch, B. L., Laing, F. C., Federle, M. P., Jeffrey, R. B., Cello, J. 1987; 163 (2): 313-316

    Abstract

    Acalculous inflammation of the biliary tract is a recently reported complication of the acquired immunodeficiency syndrome (AIDS). In a 33-month period, nine men with AIDS were evaluated because of right upper quadrant and/or epigastric pain, jaundice, or abnormal liver function test results. Each patient underwent ultrasonography and endoscopic retrograde cholangiopancreatography; seven also underwent computed tomography. In eight of nine patients the imaging studies disclosed intrahepatic and extrahepatic bile duct changes identical to those seen in sclerosing cholangitis (strictures, focal dilatation, thickened duct walls). Isolated papillary stenosis and ductal dilatation were present in one patient, while eight patients had some stricturing of the distal common duct. The combination of papillary stenosis and intrahepatic ductal strictures appears unique to AIDS-related cholangitis. Endoscopic papillotomy provided variable relief to symptoms and biochemical abnormalities. Cholangitis caused by cytomegalovirus and/or Cryptosporidium infection is the proposed pathophysiologic mechanism.

    View details for Web of Science ID A1987G924000004

    View details for PubMedID 3550877

  • CT EVALUATION OF MEDIASTINAL INFECTIONS JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY Carrol, C. L., Jeffrey, R. B., Federle, M. P., VERNACCHIA, F. S. 1987; 11 (3): 449-454

    Abstract

    Of 104 patients evaluated for thoracic sepsis by CT, 22 patients had both CT and clinical evidence of mediastinal infections. The CT findings in these patients were reviewed and compared with a control group of seven postoperative patients following uncomplicated median sternotomy. Based on CT appearance, patients were classified into one of three groups: (a) diffuse soft tissue infiltration with or without gas (i.e., mediastinitis) (10 patients); (b) focal mediastinal abscess (four patients); (c) mediastinal infection associated with empyema or subphrenic abscess (eight patients). Computed tomography proved reliable in distinguishing diffuse mediastinitis from a localized drainable abscess. However, in the absence of mediastinal gas, CT could not differentiate mediastinitis from benign postoperative changes. Computed tomography was helpful in identifying associated empyemas and a variety of other secondary complications. In five of six patients with mediastinal abscess, CT demonstrated communication or contiguity with four empyemas and one subphrenic abscess. Closed chest tube drainage of the empyemas and percutaneous drainage of the subphrenic abscess combined with antibiotic therapy were successful in treating the mediastinal abscess in these five patients. Although overall mortality for mediastinal infection in this series was 27%, there was a 50% mortality for patients with diffuse mediastinitis.

    View details for Web of Science ID A1987H192100015

    View details for PubMedID 3571587

  • EXTENSIVE CERVICAL LYMPHADENITIS DUE TO MYCOBACTERIUM-AVIUM-INTRACELLULARE PEDIATRIC INFECTIOUS DISEASE JOURNAL Kinsella, J. P., Culver, K., Jeffrey, R. B., Kaplan, M. J., Grossman, M. 1987; 6 (3): 289-291

    View details for Web of Science ID A1987G520600015

    View details for PubMedID 3575011

  • PANCREATIC-ABSCESS - PREDICTIVE VALUE OF EARLY ABDOMINAL CT RADIOLOGY VERNACCHIA, F. S., Jeffrey, R. B., Federle, M. P., Grendell, J. H., Laing, F. C., WING, V. W., Wall, S. D. 1987; 162 (2): 435-438

    Abstract

    The value of a recently reported grading system of early abdominal computed tomography (CT) for predicting development of pancreatic abscess in patients with acute pancreatitis was reassessed. When the previously described CT grading system was used in another patient population, it did not demonstrate the same degree of prognostic value of baseline CT. In this series pancreatic abscess occurred in only eight of 29 patients (28%) with grade E CT scans (with grade E representing the most severe involvement), compared with 60% in the previous series. Of 44 patients with either grade D or E baseline CT scans, abscesses developed in only 30%, with a minimum clinical follow-up of 3 months. A second grading system, which used a semiquantitative analysis of the degree of peripancreatic inflammation (a "CT severity score"), also did not strongly correlate with the future risk of abscess, The authors conclude that early abdominal CT should be performed selectively in patients with acute pancreatitis and reserved for patients who are either diagnostic dilemmas or who fail to respond to supportive treatment and have clinically suspected surgical complications such as pancreatic abscess.

    View details for Web of Science ID A1987F696400025

    View details for PubMedID 3797656

  • SPLENIC TRAUMA - EVALUATION WITH CT RADIOLOGY Federle, M. P., Griffiths, B., Minagi, H., Jeffrey, R. B. 1987; 162 (1): 69-71

    Abstract

    Fifty-five consecutive cases of surgically proved splenic injuries were evaluated with computed tomography (CT). CT permitted correct identification of 54 splenic injuries, with one false-negative and three false-positive cases. In the single false-negative case and in two of the three false-positive cases, CT scans correctly indicated the presence of a large hemoperitoneum and other abdominal visceral lacerations and so correctly indicated the need for surgery. Of the 55 proved cases, CT demonstrated hemoperitoneum in 54 (98%), perisplenic clot in 47 (85%), splenic laceration in 39 (71%), and subcapsular hematoma in 13 (24%). Perisplenic clot can be distinguished from lysed blood in the peritoneal cavity and is a sensitive and specific sign of splenic trauma, even in the absence of visible splenic laceration. The authors conclude that CT is a highly reliable means of evaluating splenic trauma.

    View details for Web of Science ID A1987F351700013

    View details for PubMedID 3786787

  • IMPROVED SURVIVAL WITH EARLY CT-DIAGNOSIS OF PANCREATIC-ABSCESS GASTROINTESTINAL RADIOLOGY Jeffrey, R. B., Grendell, J. H., Federle, M. P., Meyer, A. A., WING, V. W., Wall, S. D., SHEA, W. J. 1987; 12 (1): 26-30

    Abstract

    Until recently pancreatic abscess was often a lethal complication of acute pancreatitis. A major factor contributing to this high mortality has been delay in diagnosis. When combined with diagnostic needle aspiration, computed tomography (CT) has greatly enhanced the early detection of pancreatic abscesses. In the past 5 years at our institutions 23 patients with proven pancreatic abscesses were evaluated early in their clinical course by CT. In follow-up ranging from 4 months to 4 1/2 years there were only 4 deaths: a mortality rate of 17%. Many of the surviving patients had a long and protracted clinical course (mean length of hospitalization, 58 days) and reoperation for recurrent abscess or gastrointestinal complications was required in 9 patients (39%). Computed tomography proved helpful both in localizing the site of de novo or recurrent pancreatic abscess and in detecting postoperative complications. An aggressive approach to early CT scanning with diagnostic needle aspiration appears to be a factor in the improved survival of these patients.

    View details for Web of Science ID A1987F227000007

    View details for PubMedID 3792753

  • COMPUTERIZED TOMOGRAPHIC STAGING OF RENAL TRAUMA - 85 CONSECUTIVE CASES JOURNAL OF UROLOGY Bretan, P. N., McAninch, J. W., Federle, M. P., Jeffrey, R. B. 1986; 136 (3): 561-565

    Abstract

    In 85 patients with renal trauma we compared the findings on computerized tomography with those of excretory urography, renal surgery, intra-abdominal surgery and angiography. Patients underwent computerized tomography because of a suspected associated thoracic or abdominal injury, or indeterminate findings on excretory urography, nephrotomography or angiography. Blunt trauma accounted for 87.1 per cent of the renal injuries and penetrating trauma for 12.9 per cent. The most common findings on computerized tomography were perirenal hematoma in 29.4 per cent, intrarenal hematoma in 24.7 per cent and parenchymal disruption in 17.6 per cent. In 33 patients who underwent laparotomy computerized tomographic staging was confirmed. In contrast, the most common finding on excretory urography, diminished opacification (17 of 53 patients), was found to have no correlation with the severity of renal injury as assessed by computerized tomography or laparotomy. Angiography appreciably understaged 1 of 5 cases by failing to show extracapsular extravasation with parenchymal disruption. All findings on angiography were depicted by computerized tomography. We conclude that computerized tomographic staging for renal trauma is more sensitive and specific than excretory urography, nephrotomography and angiography, and that it should be used primarily when multiple traumatic injuries are suspected, when excretory urography suggests major trauma or is nonspecific and when clinical evidence of major trauma exists, regardless of what excretory urography shows.

    View details for Web of Science ID A1986D791800002

    View details for PubMedID 3735529

  • COMPUTED-TOMOGRAPHY OF BLUNT TRAUMA TO THE GALLBLADDER JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY Jeffrey, R. B., Federle, M. P., Laing, F. C., WING, V. W. 1986; 10 (5): 756-758

    Abstract

    The CT findings are reviewed in two patients with injuries to the gallbladder following blunt abdominal trauma. In one patient with a laceration of the cystic artery a large intraluminal clot was identified within the gallbladder associated with extensive hemoperitoneum. Another patient presented with extensive bile leakage into the peritoneal cavity 72 h after blunt trauma due to laceration of the fundus of the gallbladder. The clinical features of blunt trauma to the gallbladder and the utility of CT in this entity are reviewed.

    View details for Web of Science ID A1986E002700008

    View details for PubMedID 3745544

  • CT IN THE MANAGEMENT OF PERIAPPENDICEAL ABSCESS AMERICAN JOURNAL OF ROENTGENOLOGY Barakos, J. A., Jeffrey, R. B., Federle, M. P., WING, V. W., Laing, F. C., HIGHTOWER, D. R. 1986; 146 (6): 1161-1164

    Abstract

    Abdominal CT was the primary diagnostic method used to evaluate 40 patients with suspected periappendiceal abscess. Its subsequent impact on patient management was then analyzed for several categories of clinical presentation, including patients with and without a palpable right-lower-quadrant mass and postoperative patients. CT was reliable in distinguishing periappendiceal abscesses from phlegmons; 17 of 18 patients with phlegmons responded promptly to antibiotic therapy alone without need for surgery. Patients with larger, poorly localized abscesses underwent early surgical drainage. CT was successful in guiding percutaneous catheter drainage (nine patients) or aspiration (one patient) of well-localized periappendiceal abscesses in 10 of 11 patients. One attempted catheter drainage guided by sonography was technically unsuccessful. In patients without a palpable right-lower-quadrant mass, CT was helpful in establishing the diagnosis of periappendiceal inflammation. However, there were three false-positive diagnoses in patients with pericecal fluid collections including a ruptured cecal lymphoma, a ruptured cecal diverticulum, and a ruptured corpus luteum cyst. A diagnostic approach with CT is presented in patients with suspected periappendiceal abscess.

    View details for Web of Science ID A1986C417100010

    View details for PubMedID 3486560

  • AIDS-RELATED LYMPHOMAS - EVALUATION BY ABDOMINAL CT RADIOLOGY Nyberg, D. A., Jeffrey, R. B., Federle, M. P., Bottles, K., Abrams, D. I. 1986; 159 (1): 59-63

    Abstract

    Recent evidence indicates that individuals with acquired immunodeficiency syndrome (AIDS) or those at high risk for AIDS have an increased occurrence of lymphoma. AIDS-related lymphomas (ARLs) often present with an advanced stage of disease and highly malignant histologic subtypes. This study reviewed the abdominal computed tomographic (CT) findings in 29 patients with ARL, including ten with Hodgkin disease (HD) and 19 with non-Hodgkin lymphoma (NHL). Focal splenic and hepatic involvement was more common in both AIDS-related HD (10%) and NHL (26%) than reported in the non-AIDS population. In addition, mesenteric lymphadenopathy was demonstrated in 20% of patients with AIDS-related HD, compared with less than 5% in non-AIDS patients. In this series, patients with NHL had pelvic nodal masses in 37%, bowel involvement in 26%, and renal lesions in 11%. The authors conclude that ARLs are highly aggressive neoplasms that often present with atypical features compared with lymphomas in other patients. Potential problems in the CT interpretation of ARL for homosexual men are discussed.

    View details for Web of Science ID A1986A427700013

    View details for PubMedID 3952331

  • ABDOMINAL CT IN ACQUIRED-IMMUNODEFICIENCY-SYNDROME AMERICAN JOURNAL OF ROENTGENOLOGY Jeffrey, R. B., Nyberg, D. A., Bottles, K., Abrams, D. I., Federle, M. P., Wall, S. D., WING, V. W., Laing, F. C. 1986; 146 (1): 7-13

    Abstract

    Acquired immunodeficiency syndrome (AIDS) is a lethal infectious disease that has reached epidemic proportions in urban centers of the United States. Intraabdominal opportunistic infections and malignancies are common features of this syndrome. A prodromal phase or possibly milder form of infection is known as the AIDS-related complex. Abdominal computed tomography (CT) in patients with AIDS-related complex often demonstrates a triad of mild retroperitoneal and mesenteric adenopathy, splenomegaly, and perirectal inflammation. Lymph node enlargement greater than 1.5 cm is unusual in the AIDS-related complex and should prompt CT-guided biopsy. Abdominal adenopathy (greater than 1.5 cm) in AIDS, in our experience, is most commonly related to non-Hodgkin lymphoma, Kaposi sarcoma, or infection with Mycobacterium avium-intracellulare. In most instances, CT-guided biopsy with appropriate staining technique can readily distinguish these entities. However, the subtyping of non-Hodgkin lymphoma by fine-needle aspiration biopsy alone remains controversial. Unusual features of abdominal malignancies are common in AIDS. These include a purely lymphadenopathic form of AIDS-related Kaposi sarcoma and a predilection for extranodal sites of lymphoma in AIDS. In general, patients with AIDS-related lymphoma present with advanced stages of disease with highly malignant histologic subtypes. Abdominal CT may be useful clinically for diagnosing intraabdominal complications of AIDS.

    View details for Web of Science ID A1986AXA9500002

    View details for PubMedID 3510046

  • COMPUTED-TOMOGRAPHY OF OMENTAL PATHOLOGY JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY Cooper, C., Jeffrey, R. B., Silverman, P. M., Federle, M. P., CHUN, G. H. 1986; 10 (1): 62-66

    Abstract

    Computed tomographic scans were reviewed in 46 patients with documented omental pathology to analyze the radiographic characteristics of benign and malignant disease. The normal omentum is identified on CT of the abdomen as a homogeneous fat density anterior to the transverse colon. Four distinct patterns of omental pathology were identified: (a) omental caking, (b) finely infiltrated fat with a "smudged" appearance, (c) cystic masses, and (d) discrete nodules. The smudged pattern of omental pathology was identified most frequently; it was present in 20 to 39 patients with malignant disease and in five of seven patients with inflammatory disease. Omental caking was present in 17 of 46 patients but was only identified in malignant disease. Computed tomography provides the most reliable radiographic technique to routinely evaluate omental pathology. A thorough understanding of the variable appearance of omental disease is important in identifying omental pathology.

    View details for Web of Science ID A1986AXR4500013

    View details for PubMedID 3944319

  • COMPUTED-TOMOGRAPHY OF CERVICAL INFECTIONS JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY Nyberg, D. A., Jeffrey, R. B., BRANTZAWADZKI, M., Federle, M., Dillon, W. 1985; 9 (2): 288-296

    Abstract

    Computed tomography of 31 patients with infections of the face and neck was reviewed and correlated with the clinical and surgical results. Computed tomography was found to be valuable for (a) distinguishing cellulitis from abscess, (b) defining the precise location and extent of complex infections, (c) demonstrating secondary complications, and (d) occasionally suggesting the etiology of infection. Based on this review, we concluded that CT provides important diagnostic information that aids clinical assessment and guides medical and surgical management of cervical infections. The anatomic relationships of selected cervical spaces are reviewed with respect to pathways of spread and potential complications of cervical infections.

    View details for Web of Science ID A1985ADG8100011

    View details for PubMedID 3973152

  • PANCREATIC-ABSCESS - IMPACT OF COMPUTERIZED-TOMOGRAPHY ON EARLY DIAGNOSIS AND SURGERY AMERICAN JOURNAL OF SURGERY Crass, R. A., Meyer, A. A., Jeffrey, R. B., Federle, M. P., Grendell, J. H., WING, V. W., Trunkey, D. D. 1985; 150 (1): 127-131

    Abstract

    Pancreatic abscess continues to be a lethal complication of acute pancreatitis, with mortality rates of 40 percent in recent surgical series. A major factor contributing to this high mortality has been delay in diagnosis. When combined with diagnostic needle aspiration, computerized tomographic scanning has greatly enhanced the early detection of pancreatic abscesses. In a 4 year period at our institutions, 21 patients with proved pancreatic abscesses were evaluated early in their clinical course by computerized tomography. On follow-up ranging from 7 months to 3 1/2 years, there were only four deaths for a mortality rate of 19 percent. Many of the surviving patients had a long and protracted clinical course (mean length of hospitalization was 56 days) and reoperation for recurrent abscess or gastrointestinal complications was required in eight patients (38 percent). Computerized tomography proved to be of considerable value in localizing the site of de novo or recurrent pancreatic abscess and in detecting postoperative complications. An aggressive approach encompassing early computerized tomographic scanning with diagnostic needle aspiration appears to be a factor in the improved survival rate of these patients.

    View details for Web of Science ID A1985ALZ0700020

    View details for PubMedID 4014563

  • CHRONIC OSTEOMYELITIS EXAMINED BY CT RADIOLOGY WING, V. W., Jeffrey, R. B., Federle, M. P., Helms, C. A., Trafton, P. 1985; 154 (1): 171-174

    Abstract

    CT examination of 25 patients who had acute exacerbations of chronic osteomyelitis allowed for the correct identification of single or multiple sequestra in 14 surgical patients. Plain radiographs were equivocal for sequestra in seven of these patients, because the sequestra were too small or because diffuse bony sclerosis was present. CT also demonstrated a foreign body and five soft tissue abscesses not suspected on the basis of plain radiographs. CT studies, which helped guide the operative approach, were also useful in treating those patients whose plain radiographs were positive for sequestra. We review the potential role of CT in evaluating patients with chronic osteomyelitis.

    View details for Web of Science ID A1985TX19500035

    View details for PubMedID 3964936

  • SELECTIVE NONOPERATIVE MANAGEMENT OF BLUNT LIVER-INJURY USING COMPUTED-TOMOGRAPHY ARCHIVES OF SURGERY Meyer, A. A., Crass, R. A., Lim, R. C., Jeffrey, R. B., Federle, M. P., Trunkey, D. D. 1985; 120 (5): 550-554

    Abstract

    Computed tomographic (CT) scans are used to evaluate victims of blunt trauma for abdominal injury when reasons for immediate laparotomy are not present. Twenty-four patients whose CT scans showed liver injuries that were small parenchymal lacerations or intrahepatic hematomas were managed without laparotomy. Intra-abdominal blood was absent or estimated to be less than 250 mL in volume. None of the patients were in shock; six patients required transfusions, none for acute abdominal bleeding. None of these patients subsequently required laparotomy or showed hepatobiliary problems at a follow-up examination less than one year later. Five follow-up scans showed varying degrees of resolution. Two patients died of severe head injury, but the liver injury did not contribute to the cause of death. Other patients with more severe blunt liver injury who were treated nonoperatively developed significant complications that required delayed surgery. It seems that patients with limited liver injury diagnosed by CT scan and selected by strictly applied criteria can be managed safely without laparotomy in a setting where rapid evaluation and treatment of any potential complication is available.

    View details for Web of Science ID A1985AGF2200005

    View details for PubMedID 3985796

  • THE CLINICAL IMPACT OF CT FOR BLUNT ABDOMINAL-TRAUMA AMERICAN JOURNAL OF ROENTGENOLOGY WING, V. W., Federle, M. P., Morris, J. A., Jeffrey, R. B., Bluth, R. 1985; 145 (6): 1191-1194

    Abstract

    The use of computed tomography (CT) has had a tremendous impact on the evaluation and management of blunt abdominal trauma. It is noninvasive, easy to perform, and has been shown to be highly sensitive (100%), specific (96.8%), and accurate (97.6%). The use of CT has helped decrease the total number of laparotomies performed for abdominal trauma at this institution (231 in 1975-1976, 74 in 1983) as well as the number of negative and nontherapeutic laparotomies. The use of other diagnostic tests such as radionuclide scans and angiography in blunt abdominal trauma has been virtually replaced by CT. Of the 41 peritoneal lavages performed in 1983, 39 were in patients who were in the operating room for treatment of other extraabdominal injuries (i.e., closed head injury, severe extremity trauma).

    View details for Web of Science ID A1985AUJ5200019

    View details for PubMedID 3877421

  • ABDOMINAL CT FINDINGS OF DISSEMINATED MYCOBACTERIUM-AVIUM-INTRACELLULARE IN AIDS AMERICAN JOURNAL OF ROENTGENOLOGY Nyberg, D. A., Federle, M. P., Jeffrey, R. B., Bottles, K., Wofsy, C. B. 1985; 145 (2): 297-299

    Abstract

    Disseminated infection from Mycobacterium avium-intracellulare (MAI) has recently been recognized as a common and serious complication of the acquired immunodeficiency syndrome (AIDS). The authors report the computed tomographic (CT) findings of 17 patients with AIDS and disseminated MAI referred for abdominal CT examination. Multiple large retroperitoneal and mesenteric lymph nodes were demonstrated in 14 patients (82%). MAI involvement was confirmed within abdominal lymph nodes in six patients by fine-needle percutaneous aspiration (five patients) or postmortem examination (one patient) and within enlarged peripheral lymph nodes in two other patients. The authors concluded that large, bulky, intraabdominal adenopathy in AIDS patients should suggest the diagnosis of MAI infection as well as other known causes of adenopathy, including lymphoma and metastatic Kaposi sarcoma. The authors recommend percutaneous aspiration of enlarged intraabdominal lymph nodes to establish the correct diagnosis.

    View details for Web of Science ID A1985AMB6000020

    View details for PubMedID 3875228

  • THE COMPUTERIZED-TOMOGRAPHY APPEARANCE OF RENAL PEDICLE INJURY JOURNAL OF UROLOGY Steinberg, D. L., Jeffrey, R. B., Federle, M. P., McAninch, J. W. 1984; 132 (6): 1163-1164

    Abstract

    The computerized tomography findings in 2 cases of traumatic renal artery occlusion are reviewed. Both patients had a nonfunctioning, normal-sized kidney with minimal or no contrast enhancement. Based on a review of 60 cases of renal trauma at our institution these findings appear to be specific for occlusion of the renal pedicle.

    View details for Web of Science ID A1984TU33500025

    View details for PubMedID 6502811

  • HEPATOCELLULAR-CARCINOMA - ASSESSMENT OF RESECTABILITY BY COMPUTED-TOMOGRAPHY AND ULTRASOUND RADIOLOGY LaBerge, J. M., Laing, F. C., Federle, M. P., Jeffrey, R. B., Lim, R. C. 1984; 152 (2): 485-490

    Abstract

    A retrospective review of the CT and ultrasound scans from examinations of 30 patients who had hepatocellular carcinoma (hepatoma) was undertaken with special emphasis placed on evaluation of hepatic distribution of tumor, vascular invasion, and extrahepatic spread. Although both CT and ultrasound detected hepatoma in 29 of 30 patients (96%), CT showed more extensive hepatic parenchymal involvement in eight of the patients. Vascular invasion was seen more frequently with ultrasound than with CT. Invasion into the main portal vein was seen by ultrasound in 11 of 30 patients (37%). Extrahepatic spread of tumor was much more frequently detected by CT and was present in 21 of 30 patients (70%). A reasoned approach to the diagnostic workup of hepatomas that will minimize invasive procedures and unnecessary surgery is presented.

    View details for Web of Science ID A1984TB29100043

    View details for PubMedID 6330790

  • HEMORRHAGIC PANCREATIC FLUID COLLECTIONS EXAMINED BY ULTRASOUND RADIOLOGY Hashimoto, B. E., Laing, F. C., Jeffrey, R. B., Federle, M. P. 1984; 150 (3): 803-808

    Abstract

    Ultrasound examination of nine patients revealed that the appearance of their hemorrhagic pancreatic fluid collections varied depending on the age of the hemorrhage. Acute hemorrhage was visualized as a well-defined homogeneous mass, while subacute hemorrhage (studied about a week after the bleeding episode) appeared as a mass that contained cystic and solid elements or was septated. Remote hemorrhage, studied several weeks after the acute event, was visualized as a simple cyst. Findings of CT, which were available for correlation in eight patients, revealed that acute hemorrhagic collections had CT numbers between 45 and 65 HU: older collections had CT numbers between 14 and 25 HU. The ultrasonographic evolution of hemorrhagic pancreatic fluid collections followed a pattern similar to that described by in vitro studies, which determined that hemorrhage and clotted blood may appear either echogenic or sonolucent, depending on the age of the hemorrhage and the transducer used. Factors that affect the echogenicity of hemorrhagic collections and the difficulties encountered in recognizing them by ultrasound are discussed.

    View details for Web of Science ID A1984SD43800034

    View details for PubMedID 6695082

  • CT OF TRAUMA TO THE ABNORMAL KIDNEY AMERICAN JOURNAL OF ROENTGENOLOGY RHYNER, P., Federle, M. P., Jeffrey, R. B. 1984; 142 (4): 747-750

    Abstract

    Traumatic injuries to already abnormal kidneys are difficult to assess by excretory urography and clinical evaluation. Bleeding and urinary extravasation may accompany minor trauma; conversely, underlying tumors, perirenal hemorrhage, and extravasation may be missed on urography. Computed tomography (CT) was performed in eight cases including three neoplasms, one adult polycystic disease, one simple renal cyst, two hydronephrotic kidneys, and one horseshoe kidney. CT provided specific and clinically useful information in each case that was not apparent on excretory urography.

    View details for Web of Science ID A1984SH78400019

    View details for PubMedID 6608235

  • COMPUTED TOMOGRAPHIC FINDINGS IN BOWEL INFARCTION AMERICAN JOURNAL OF ROENTGENOLOGY Federle, M. P., Chun, G., Jeffrey, R. B., RAYOR, R. 1984; 142 (1): 91-95

    Abstract

    Findings on computed tomography (CT) were considered diagnostic or highly suggestive in seven cases of bowel infarction. Important findings were portal or mesenteric venous gas, intramural gas, focal thickening of bowel wall, focal or diffusely dilated fluid-filled bowel, and clot in the superior mesenteric artery. Only one patient had unequivocal extraluminal gas on initial abdominal radiographs, although others had equivocal findings or later developed obvious extraluminal gas. Because CT may detect extraluminal gas and mesenteric arterial occlusion not apparent on plain films, and because CT is increasingly used early in the evaluation of abdominal pain, it can play an important role in the diagnosis and management of bowel infarction.

    View details for Web of Science ID A1984RW79400022

    View details for PubMedID 6606971

  • COMPUTED-TOMOGRAPHY OF SILENT ABDOMINAL ABSCESSES JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY Jeffrey, R. B., Federle, M. P., Laing, F. C. 1984; 8 (1): 67-70

    Abstract

    Computed tomographic (CT) findings are reviewed in nine patients with clinically unsuspected abdominal abscesses. None of the patients in this series had significant fever or leukocytosis. Localized pain or a palpable mass was the primary clinical feature in seven patients. Computed tomography demonstrated encapsulated fluid collections without gas in five patients representing chronic abscess. Computed tomography was diagnostic of an abscess in three patients and guided aspiration was helpful in demonstrating an abscess in two other patients. The inability to make a correct preoperative diagnosis of an abscess in four of the nine cases was due to a low level of clinical suspicion, a nonspecific CT appearance, and failure to perform diagnostic aspiration.

    View details for Web of Science ID A1984RW60300014

    View details for PubMedID 6690527

  • VALUE OF COMPUTED-TOMOGRAPHY IN DETECTING OCCULT GASTROINTESTINAL PERFORATION JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY Jeffrey, R. B., Federle, M. P., Wall, S. 1983; 7 (5): 825-827

    Abstract

    Five patients with clinically unsuspected gastrointestinal perforation were evaluated preoperatively with computed tomography (CT). In each case the CT demonstration of pneumoperitoneum established the diagnosis of a ruptured viscus and prompted early surgical intervention. The site of perforation was apparent on CT in four of the five patients. Plain radiographs including upright chest films (two patients) and supine radiographs of the abdomen (one patient) were interpreted as negative for free air prior to CT. The CT features of pneumoperitoneum and its clinical implications are reviewed.

    View details for Web of Science ID A1983RG57300013

    View details for PubMedID 6886134

  • CT AND SONOGRAPHY OF SEVERE RENAL AND PERIRENAL INFECTIONS AMERICAN JOURNAL OF ROENTGENOLOGY HODDICK, W., Jeffrey, R. B., Goldberg, H. I., Federle, M. P., Laing, F. C. 1983; 140 (3): 517-520

    Abstract

    Twelve patients with urosepsis and severe renal or perirenal infections were evaluated with both computed tomography (CT) and sonography. Six patients had nine proven renal or perirenal abscesses larger than 2 cm in diameter. One patient had multiple microabscesses smaller than 1 cm. Five patients had CT or sonographic evidence of focal or multifocal bacterial nephritis. Computed tomography correctly diagnosed all renal (six) and perirenal (three) abscesses. Sonography was falsely negative in a patient with multiple microabscesses and in another patient with a gas-forming perinephric abscess. In one patient with four bilateral renal abscesses, sonography correctly diagnosed only one of the abscesses. In the five patients with focal or multifocal bacterial nephritis, CT demonstrated poorly defined, poorly enhancing lesions in all cases. Sonography was normal in three of these patients. Although this report is based on a limited experience, computed tomography seems to be the more sensitive method of evaluating severe renal and perirenal infections.

    View details for Web of Science ID A1983QC36400020

    View details for PubMedID 6600545

  • COMPUTED-TOMOGRAPHY OF CHOLEDOCHOLITHIASIS AMERICAN JOURNAL OF ROENTGENOLOGY Jeffrey, R. B., Federle, M. P., Laing, F. C., Wall, S., Rego, J., Moss, A. A. 1983; 140 (6): 1179-1183

    Abstract

    Computed tomography (CT) correctly diagnosed common bile duct stones in 19 (90%) of 21 surgically proven cases. CT demonstrated calculi in all 13 patients with calcium bilirubinate common duct stones and six of eight patients with predominantly cholesterol stones. There were two false-negative diagnoses in patients with cholesterol calculi scanned at 1 cm intervals. Cholesterol stones are nearly isodense with bile and may be difficult to visualize in the common duct by routine scanning techniques. There are three suggestive CT features of cholesterol common duct calculi: (1) abrupt termination of the distal common bile duct without an obstructing mass, (2) a faint rim of increased density along the peripheral margin of a low-density calculus, and (3) mottled areas of increased density centrally within a calculus elevating its CT number above values for normal bile. Modification of scanning technique to obtain high-resolution images of the extrahepatic biliary tree is stressed to optimize visualization of the above findings.

    View details for Web of Science ID A1983QT94900024

    View details for PubMedID 6602489

  • CT AND ULTRASONOGRAPHY OF ACUTE RENAL ABNORMALITIES RADIOLOGIC CLINICS OF NORTH AMERICA Jeffrey, R. B., Federle, M. P. 1983; 21 (3): 515-525

    Abstract

    Computed tomography and ultrasonography are important in the evaluation of patients with acute renal abnormalities, either as adjuncts or, less commonly, as alternatives to excretory urography. Ultrasonography has become the imaging procedure of choice in evaluation of acute renal failure. Detection of obstructive uropathy by ultrasonography is very accurate, although the potential pitfalls of minimal dilatation obstructive uropathy, false absence of caliectasis in dehydrated patients, and peripelvic cysts simulating hydronephrosis should be considered. Both CT and ultrasonography have improved our ability to define specific causes of intrinsic or extrinsic renal or ureteral obstructing lesions, including tumor, inflammatory masses, and calculi. Renal infections and infarctions also have characteristic appearances on CT and ultrasonography, though ultrasonography is somewhat limited by its inability to reliably demonstrate gas-containing or small abscesses, and its inability to provide functional information about the concentrating capacity of regional areas of the kidney.

    View details for Web of Science ID A1983RQ98800007

    View details for PubMedID 6356219

  • HEMOPERITONEUM STUDIED BY COMPUTED-TOMOGRAPHY RADIOLOGY Federle, M. P., Jeffrey, R. B. 1983; 148 (1): 187-192

    Abstract

    Three hundred patients who had sustained blunt abdominal injury were evaluated with computed tomography (CT). The images showed areas of hemorrhage by varying attenuation coefficients (average, 45 Hounsfield units; exceeding 30 Hounsfield units in all cases except in those patients with bleeding more than 48 hours old). Small hematomas tended to accumulate near the site of origin while free intraperitoneal bleeding most frequently accumulated in the Morison pouch, paracolic gutters, and pelvis. CT estimates of the extent of hemoperitoneum (small, moderate, or large) correlated well with clinical assessments and surgical findings. Only one false-negative and two false-positive CT interpretations occurred, and each was potentially avoidable in retrospect. CT is sensitive and specific for the diagnosis of hemoperitoneum and can estimate the extent and probable source of bleeding. This information may obviate the need for a peritoneal lavage and laparotomy in many instances.

    View details for Web of Science ID A1983QV03900037

    View details for PubMedID 6856833

  • CT DIAGNOSIS OF UNSUSPECTED PNEUMOTHORAX AFTER BLUNT ABDOMINAL-TRAUMA AMERICAN JOURNAL OF ROENTGENOLOGY Wall, S. D., Federle, M. P., Jeffrey, R. B., Brett, C. M. 1983; 141 (5): 919-921

    Abstract

    Review of abdominal CT scans for evaluation of blunt abdominal trauma yielded 35 cases of pneumothorax, 10 of which had not been diagnosed before CT by clinical examination or plain radiographs. Of the 10 cases initially diagnosed on CT, seven required tube thoracostomy for treatment of the pneumothorax. CT detection of pneumothorax is especially important if mechanical assisted ventilation or general anesthesia is used. Demonstration of pneumothorax requires viewing CT scans of the upper abdomen (lower thorax) at lung windows in addition to the usual soft-tissue windows.

    View details for Web of Science ID A1983RM63600009

    View details for PubMedID 6605061

  • COMPUTED-TOMOGRAPHY OF MESENTERIC INVOLVEMENT IN FULMINANT PANCREATITIS RADIOLOGY Jeffrey, R. B., Federle, M. P., Laing, F. C. 1983; 147 (1): 185-188

    View details for Web of Science ID A1983QG07600039

    View details for PubMedID 6828726

  • COMPUTED-TOMOGRAPHY OF PANCREATIC TRAUMA RADIOLOGY Jeffrey, R. B., Federle, M. P., Crass, R. A. 1983; 147 (2): 491-494

    Abstract

    In a review of over 300 CT scans of abdominal trauma, we encountered 13 patients with surgically proved pancreatic injuries. CT correctly diagnosed pancreatic fractures, contusions, or posttraumatic pseudocysts in 11 of these patients. There were two false positive and two false negative diagnoses. The CT diagnosis of pancreatic trauma may be difficult in selected patients who are scanned soon after injury. Acutely, the actual plane of a pancreatic fracture may be difficult to identify with CT, and the peripancreatic soft-tissue changes of traumatic pancreatitis are often subtle. Eight of 11 correctly diagnosed pancreatic injuries showed thickening of the left anterior renal fascia on CT scans. This sign should prompt a critical evaluation of the pancreas of the traumatized patient.

    View details for Web of Science ID A1983QL99900032

    View details for PubMedID 6836127

  • INTRAMURAL HEMATOMA OF THE CECUM FOLLOWING BLUNT TRAUMA JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY Jeffrey, R. B., Federle, M. P., Stein, S. M., Crass, R. A. 1982; 6 (2): 404-405
  • COMPUTED-TOMOGRAPHY IN BLUNT ABDOMINAL-TRAUMA ARCHIVES OF SURGERY Federle, M. P., Crass, R. A., Jeffrey, R. B., Trunkey, D. D. 1982; 117 (5): 645-650

    Abstract

    Emergency abdominal computed tomography (CT) has been performed in more than 200 cases of acute blunt abdominal trauma. Computed tomography was highly sensitive and specific for a wide variety of intraperitoneal and retroperitoneal traumatic lesions. There were no false-positive or false-negative CT interpretations, except for a single case in which residual peritoneal lavage fluid was mistaken for intraperitoneal blood. Computed tomobraphy has major advantages over otherradiologic techniques, including angiography, and may obviate peritoneal lavage and explo4atory laparatomy in some circumstances.

    View details for Web of Science ID A1982NN40700016

    View details for PubMedID 7073484

  • SPONTANEOUS RUPTURE OF HEPATIC AND SPLENIC ANGIOSARCOMA DEMONSTRATED BY CT AMERICAN JOURNAL OF ROENTGENOLOGY Mahony, B., Jeffrey, R. B., Federle, M. P. 1982; 138 (5): 965-966

    View details for Web of Science ID A1982NM44700035

    View details for PubMedID 6979189

  • RECURRENT PYOGENIC CHOLANGITIS IN ASIAN IMMIGRANTS - USE OF ULTRASONOGRAPHY, COMPUTED-TOMOGRAPHY, AND CHOLANGIOGRAPHY RADIOLOGY Federle, M. P., Cello, J. P., Laing, F. C., Jeffrey, R. B. 1982; 143 (1): 151-156

    Abstract

    Five cases of recurrent pyogenic cholangitis (RPC) were studied by ultrasonography, computed tomography (CT), and cholangiography. All patients were recent immigrants from the Orient or Indonesia and had had recurrent attacks of cholangitis for many years. The bile was infected by E. coli and the biliary ducts were dilated; in addition, extrahepatic bile-pigment calculi were present in all 5 and intrahepatic calculi in 4. Abdominal ultrasound usually failed to demonstrate duct calculi and extrahepatic dilatation due to the soft, mud-like consistency of the stones. CT was successful in showing the calculi and the full extent of dilatation. The authors conclude that preoperative diagnosis of RPC is best achieved by awareness of the characteristic clinical presentation and the findings on abdominal CT. Preoperative cholangiography provides excellent detail, but poses the danger of biliary sepsis requiring antibiotics.

    View details for Web of Science ID A1982NG95400027

    View details for PubMedID 7063721

  • EARLY COMPUTED TOMOGRAPHIC SCANNING IN ACUTE SEVERE PANCREATITIS SURGERY GYNECOLOGY & OBSTETRICS Jeffrey, R. B., Federle, M. P., Cello, J. P., Crass, R. A. 1982; 154 (2): 170-174

    View details for Web of Science ID A1982NB09400003

    View details for PubMedID 7058474

  • NON-INVASIVE IMAGING OF UNUSUAL REGENERATING NODULES IN THE CIRRHOTIC LIVER GASTROINTESTINAL RADIOLOGY Laing, F. C., Jeffrey, R. B., Federle, M. P., Cello, J. P. 1982; 7 (3): 245-249

    Abstract

    Despite the common occurrence of regenerating liver nodules, little has been written regarding their ultrasound or computed tomographic appearance. In the great majority of cases, they have an echo texture and CT number identical to surrounding hepatic parenchyma. Exceptionally, as in the 2 cases described, they can mimic a malignant neoplasm. Because radionuclide imaging almost always demonstrates uptake over a regenerating nodule, this modality should be used in suspicious cases in conjunction with either ultrasound or computed tomography in order to exclude a malignancy.

    View details for Web of Science ID A1982NX53500009

    View details for PubMedID 7106489

  • CT DIFFERENTIATION OF PORTAL VENOUS AIR FROM BILIARY-TRACT AIR JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY HODDICK, W., Jeffrey, R. B., Federle, M. P. 1982; 6 (3): 633-634

    View details for Web of Science ID A1982NP68800035

    View details for PubMedID 7096713

  • GASTRIC WALL THICKENING AND EXTRA-GASTRIC INFLAMMATORY PROCESSES - A RETROSPECTIVE CT STUDY JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY Brown, B., Federle, M. P., Jeffrey, R. B. 1982; 6 (4): 762-765

    Abstract

    A retrospective CT study was undertaken to evaluate nonneoplastic extragastric lesions associated with gastric wall thickening (GWT). A total of 70 cases was reviewed including 44 with acute pancreatitis, 6 with infected left upper quadrant fluid collections, and 20 with noninfected left upper quadrant fluid collections. Patients with acute pancreatitis and measurable gastric walls disclosed GWT in 67% of cases. All patients with infected left upper quadrant fluid collections (including abscesses and infected splenic hematomas) adjacent to the stomach exhibited GWT on computed tomography (CT). No patients with noninfected perigastric left upper quadrant fluid collections had GWT. Gastric wall thickening has been emphasized as an important feature in CT staging of gastric malignancies and has been noted in intrinsic gastric inflammatory disease. We conclude that extragastric inflammatory processes are commonly identified on CT and can be demonstrated to account for GWT, which appears to be a relatively sensitive and specific sign for distinguishing inflammatory from noninflammatory perigastric lesions.

    View details for Web of Science ID A1982NX94800017

    View details for PubMedID 7119195

  • ANGIOGRAPHIC EVALUATION OF THE DUCTUS DIVERTICULUM CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY Goodman, P. C., Jeffrey, R. B., Minagi, H., Federle, M. P., Thomas, A. N. 1982; 5 (1): 1-4

    Abstract

    The aortic isthmus in adults has a variable appearance on thoracic aortograms. Its configuration may show a concavity, a straightening or slight convexity, or a discrete focal bulge. The latter finding represents a ductus diverticulum and, in review of 103 aortograms, was found present in 9% of patients. At times a prominent ductus diverticulum may resemble, and be mistaken for, a traumatic pseudoaneurysm of the aortic isthmus. A traumatic pseudoaneurysm may be distinguished from a ductus diverticulum on aortography by demonstration of an intimal flap and/or delayed clearance of contrast material on subtracted films. However, a ductus diverticulum will exhibit neither of these features.

    View details for Web of Science ID A1982NJ17900001

    View details for PubMedID 6805955

  • A COMPARISON STUDY OF COMPUTED-TOMOGRAPHY AND LAPAROSCOPY IN THE STAGING OF ABDOMINAL NEOPLASMS DIGESTIVE DISEASES AND SCIENCES Barth, R. A., Jeffrey, R. B., Moss, A. A., LIBERMAN, M. S. 1981; 26 (3): 253-256

    View details for Web of Science ID A1981LH35900012

    View details for PubMedID 6453706

  • COMPUTED-TOMOGRAPHY OF PANCREATIC ABSCESSES AMERICAN JOURNAL OF ROENTGENOLOGY Federle, M. P., Jeffrey, R. B., Crass, R. A., VANDALSEM, V. 1981; 136 (5): 879-882

    Abstract

    Computed tomography (CT) was used as the primary diagnostic tool in 10 cases of pancreatic abscess and seven cases of infected pseudocyst. Pancreatic gas collections were the only definitive feature of infection and were seen in five cases (29%). An equally common finding was poorly defined nonencapsulated peripancreatic fluid collections or mottled mass density. It was not possible to distinguish infected from noninfected pseudocysts or peripancreatic fluid collections by other CT criteria. Diagnostic percutaneous needle aspiration is indicated in patients with pancreatic pseudocyst or fluid collections with persistent fever or leukocytosis. CT is also useful in the preoperative evaluation of multiple abscesses and of recurrent abscesses after surgery.

    View details for Web of Science ID A1981LN18900005

    View details for PubMedID 6784520

  • COMPUTED-TOMOGRAPHY OF SPLENIC TRAUMA RADIOLOGY Jeffrey, R. B., Laing, F. C., Federle, M. P., Goodman, P. C. 1981; 141 (3): 729-732

    Abstract

    Fifty patients with abdominal trauma and possible splenic injury were evaluated by computed tomography (CT). CT correctly diagnosed 21 of 22 surgically proved traumatic lesions of the spleen (96%). Twenty-seven patients had no evidence of splenic injury. This was confirmed at operation in 1 patient and clinical follow-up in 26. There were one false negative and one false positive. In 5 patients (10%), CT demonstrated other clinically significant lesions, including hepatic or renal lacerations in 3 and large retroperitoneal hematomas in 2. In adolescents and adults, CT is an accurate, noninvasive method of rapidly diagnosing splenic trauma and associated injuries. Further experience is needed to assess its usefulness in evaluating splenic injuries in infants and small children.

    View details for Web of Science ID A1981MT04900025

    View details for PubMedID 7302229

  • ULTRASONIC EVALUATION OF PATIENTS WITH ACUTE RIGHT UPPER QUADRANT PAIN RADIOLOGY Laing, F. C., Federle, M. P., Jeffrey, R. B., Brown, T. W. 1981; 140 (2): 449-455

    Abstract

    To define the role of ultrasound in evaluating acute right upper quadrant pain, a prospective study was performed on 52 patients having clinically suspected acute cholecystitis. Ultrasonographic determination of acute or chronic cholecystitis, or diagnosis of a normal gallbladder, was based on analysis of location of tenderness, calculi, sludge, and wall thickness. The diagnosis of acute cholecystitis (34.6% of patients) was based on the highly significant observations of focal gallbladder tenderness and calculi. Sludge and wall thickening were also statistically significant, but to a lesser degree. Cholelithiasis allowed differentiation of patients with chronic cholecystitis (32.7%) from patients with normal gallbladders (32.7%). Neither of these two groups had significant focal gallbladder tenderness, sludge, or thickened walls. Because acute cholecystitis is found in the minority of patients with acute right upper quadrant pain, and because ultrasound is rapid, accurate, and noninvasive, it should be the initial modality used to evaluate these patients.

    View details for Web of Science ID A1981LZ76900029

    View details for PubMedID 7255722

  • EVALUATION OF ABDOMINAL-TRAUMA BY COMPUTED-TOMOGRAPHY RADIOLOGY Federle, M. P., Goldberg, H. I., Kaiser, J. A., Moss, A. A., Jeffrey, R. B., MALL, J. C. 1981; 138 (3): 637-644

    Abstract

    Computed tomography (CT) was used in the evaluation of 100 patients suffering abdominal trauma. The type of trauma was blunt in 78 patients, penetrating in eight, and iatrogenic in 14. Forty per cent of cases had normal CT scans, while 60% showed substantial abdominal or retroperitoneal injuries. Surgery, clinical follow-up, and repeated radiologic examinations confirmed the accuracy of CT, and there were no cases in which medical or surgical management was inappropriately guided by CT. A wide variety of injuries was detected, including 19 splenic, eight hepatic, six pancreatic, 13 renal, 13 retroperitoneal or abdominal wall, and one intraperitoneal. CT has major advantages over plain radiography, radionuclide imaging, and angiography in assessment of trauma-induced injuries.

    View details for Web of Science ID A1981LE80900017

    View details for PubMedID 6450962

  • THE ROLE OF COMPUTED-TOMOGRAPHY IN RENAL TRAUMA RADIOLOGY Federle, M. P., Kaiser, J. A., McAninch, J. W., Jeffrey, R. B., MALL, J. C. 1981; 141 (2): 455-460

    Abstract

    Computed tomography (CT) and excretory urography were performed in 15 patients thought to have major renal trauma. In 4 cases, CT demonstrated extravasation of urine not detected by urography, and in all cases parenchymal injuries and extrarenal hematomas were depicted more accurately by CT. CT also proved to be superior to excretory urography in distinguishing relatively minor renal injuries (confusion, incomplete laceration, intrarenal hematoma, small extrarenal hematoma) from major or catastrophic injuries (complete laceration, fracture, shattered kidney), which significantly influenced the choice of surgical or medical therapy. CT also detected concurrent injuries of the spleen, liver, and/or pancreas in 4 cases. The authors feel that CT is valuable in the assessment of major renal trauma.

    View details for Web of Science ID A1981MM65400032

    View details for PubMedID 7291573