Clinical Focus

  • Diagnostic Radiology

Institute Affiliations

  • Member, Bio-X

Honors & Awards

  • 2009 RSNA Seed Grant. Real-Time MRI Evaluation in Patients with Sleep Apnea with EEG Correlation, Radiological Society of North America (7/1/2009)

Education & Certifications

  • Board Certification: Diagnostic Radiology, American Board of Radiology (2005)
  • NCI Fellowship, Stanford University, Body Imaging (2007)
  • Residency, Winthrop University Hospital, Diagnostic Radiology (2005)
  • Internship, Winthrop University Hospital, Internal Medicine (2001)
  • M.D., Warren Alpert Medical School of Brown University, Medical degree (2000)
  • BS, Brown University, Neuroscience (1996)

Research & Scholarship

Current Research and Scholarly Interests

After completing an NCI-fellowship in advanced cancer imaging, I have concentrated my clinical and research interests in abdominal pelvic imaging.

I interpret the gamut of cross-sectional gastrointestinal / genitourinary imaging studies (CT/MRI/US) with a focus on Liver / HCC Imaging, MRI Prostate, and CT/MRI Enterography.


All Publications

  • The impact of computed high b-value images on the diagnostic accuracy of DWI for prostate cancer: A receiver operating characteristics analysis. Scientific reports Ning, P., Shi, D., Sonn, G. A., Vasanawala, S. S., Loening, A. M., Ghanouni, P., Obara, P., Shin, L. K., Fan, R. E., Hargreaves, B. A., Daniel, B. L. 2018; 8 (1): 3409


    To evaluate the performance of computed high b value diffusion-weighted images (DWI) in prostate cancer detection. 97 consecutive patients who had undergone multiparametric MRI of the prostate followed by biopsy were reviewed. Five radiologists independently scored 138 lesions on native high b-value images (b = 1200 s/mm2), apparent diffusion coefficient (ADC) maps, and computed high b-value images (contrast equivalent to b = 2000 s/mm2) to compare their diagnostic accuracy. Receiver operating characteristic (ROC) analysis and McNemar's test were performed to assess the relative performance of computed high b value DWI, native high b-value DWI and ADC maps. No significant difference existed in the area under the curve (AUC) for ROCs comparing B1200 (b = 1200 s/mm2) to computed B2000 (c-B2000) in 5 readers. In 4 of 5 readers c-B2000 had significantly increased sensitivity and/or decreased specificity compared to B1200 (McNemar's p < 0.05), at selected thresholds of interpretation. ADC maps were less accurate than B1200 or c-B2000 for 2 of 5 readers (P < 0.05). This study detected no consistent improvement in overall diagnostic accuracy using c-B2000, compared with B1200 images. Readers detected more cancer with c-B2000 images (increased sensitivity) but also more false positive findings (decreased specificity).

    View details for DOI 10.1038/s41598-018-21523-6

    View details for PubMedID 29467370

    View details for PubMedCentralID PMC5821845

  • 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-?


    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

  • The incidental bone lesion on computed tomography: management tips for abdominal radiologists. Abdominal radiology Nguyen, M., Beaulieu, C., Weinstein, S., Shin, L. K. 2017


    Incidental bone lesions are commonly seen on abdominal and pelvic computed tomography (CT) examinations. These incidental bone lesions can be diagnostically challenging to the abdominal radiologist who may not be familiar with their appearance or their appropriate management. The characterization of such bone lesions as non-aggressive or aggressive based on their CT appearance involves similar principles to their morphologic evaluation on radiographs. Knowledge of the age of the patient and the presence of symptoms, mainly bone pain, can improve analysis. Examples of bone lesions that may be encountered include solitary or multifocal bone lesions, osteochondromatous and chondroid tumors, Paget's disease, avascular necrosis/bone infarctions, iatrogenic lesions, and periarticular lesions. This pictorial essay aims to provide a framework for the analysis of incidental bone lesions on CT and when further imaging and clinical work-up should be recommended.

    View details for DOI 10.1007/s00261-016-1040-0

    View details for PubMedID 28132074

  • 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


    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


    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

  • 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


    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


    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

  • Model-based Iterative Reconstruction Compared to Adaptive Statistical Iterative Reconstruction and Filtered Back-projection in CT of the Kidneys and the Adjacent Retroperitoneum. Academic radiology Olcott, E. W., Shin, L. K., Sommer, G., Chan, I., Rosenberg, J., Molvin, F. L., Boas, F. E., Fleischmann, D. 2014; 21 (6): 774-784


    To prospectively evaluate the perceived image quality of model-based iterative reconstruction (MBIR) compared to adaptive statistical iterative reconstruction (ASIR) and filtered back-projection (FBP) in computed tomography (CT) of the kidneys and retroperitoneum.With investigational review board and Health Insurance Portability and Accountability Act compliance, 17 adults underwent 31 contrast-enhanced CT acquisitions at constant tube potential and current (range 30-300 mA). Each was reconstructed with MBIR, ASIR (50%), and FBP. Four reviewers scored each reconstruction's perceived image quality overall and the perceived image quality of seven imaging features that were selected by the authors as being relevant to imaging in the region and pertinent to the evaluation of high-quality diagnostic CT.MBIR perceived image quality scored superior to ASIR and FBP both overall (P < .001) and for observations of the retroperitoneal fascia (99.2%), corticomedullary differentiation (94.4%), renal hilar structures (96.8%), focal renal lesions (92.5%), and mitigation of streak artifact (100.0%; all, P < .001). MBIR achieved diagnostic overall perceived image quality with approximately half the radiation dose required by ASIR and FBP. The noise curve of MBIR was significantly lower and flatter (P < .001).Compared to ASIR and FBP, MBIR provides superior perceived image quality, both overall and for several specific imaging features, across a broad range of tube current levels, and requires approximately half the radiation dose to achieve diagnostic overall perceived image quality. Accordingly, MBIR should enable CT scanning with improved perceived image quality and/or reduced radiation exposure.

    View details for DOI 10.1016/j.acra.2014.02.012

    View details for PubMedID 24809318

  • Improved sleep MRI at 3 tesla in patients with obstructive sleep apnea. Journal of magnetic resonance imaging Shin, L. K., Holbrook, A. B., Capasso, R., Kushida, C. A., Powell, N. B., Fischbein, N. J., Pauly, K. B. 2013; 38 (5): 1261-1266


    PURPOSE: To describe a real-time MR imaging platform for synchronous, multi-planar visualization of upper airway collapse in obstructive sleep apnea at 3 Tesla (T) to promote natural sleep with an emphasis on lateral wall visualization. MATERIALS AND METHODS: A real-time imaging platform was configured for sleep MR imaging which used a cartesian, partial k-space gradient-echo sequence with an inherent temporal resolution of 3 independent slices every 2 s. Combinations of axial, mid-sagittal, and coronal scan planes were acquired. The system was tested in five subjects with polysomnography-proven obstructive sleep apnea during sleep, with synchronous acquisition of respiratory effort and combined oral-nasal airflow data. RESULTS: Sleep was initiated and maintained to allow demonstration of sleep-induced, upper airway collapse as illustrated in two subjects when using a real-time, sleep MR imaging platform at 3T. Lateral wall collapse could not be visualized on mid-sagittal imaging alone and was best characterized on multiplanar coronal and axial imaging planes. CONCLUSION: Our dedicated sleep MR imaging platform permitted an acoustic environment of constant "white noise" which was conducive to sleep onset and sleep maintenance in obstructive sleep apnea patients at 3T. Apneic episodes, specifically the lateral walls, were more accurately characterized with synchronous, multiplanar acquisitions. J. Magn. Reson. Imaging 2013;. © 2013 Wiley Periodicals, Inc.

    View details for DOI 10.1002/jmri.24029

    View details for PubMedID 23390078

  • Digital fabrication of vocal tract models from magnetic resonance imaging during expert pitch bending on the harmonica. journal of the Acoustical Society of America Granzow, J., Egbert, P., Barrett, D., Rossing, T., Shin, L. 2013; 134 (5): 3993-?


    Expressive pitch bending on the harmonica requires the acoustic coupling of contiguous free reeds, an effect known to arise from highly constrained vocal postures. These techniques have been difficult to demonstrate and instructors often rely on associated vowels to help novices achieve the required constriction of the vocal tract. Magnetic Resonance Imaging (MRI) was recently used to expose the precise vocal contours involved in such expert pitch bends (Egbert, etal., J. Acoust. Soc. Am. 133, 3590 (2013). To further this investigation, we process the MRI data using 3D slicing software, generating digital models of the vocal tract during sustained bends. In addition to providing volumetric data, the models are also fabricated with fusion deposition modeling and tested on real harmonicas. These tests reveal error tolerances in the conversion from MRI slices to 3d printed models when working with geometries that are highly constrained by a desired acoustic output. Furthermore, comparisons between human performance and simulated output provide clues to the contribution of factors not reproduced in the plastic models such as pharynx dilation.

    View details for DOI 10.1121/1.4830563

    View details for PubMedID 24180969

  • Taller Haustral Folds in the Proximal Colon: A Potential Factor Contributing to Interval Colorectal Cancer? 78th Annual Scientific Meeting of the American-College-of-Gastroenterology Thompson, A., Jones, R., Banerjee, S., Poullos, P., Shin, L. NATURE PUBLISHING GROUP. 2013: S628–S628
  • 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


    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

  • Real-time magnetic resonance imaging fo the upper airways during harmonica pitch bends. journal of the Acoustical Society of America Egbert, P. R., Shin, L. K., Barrett, D., Rossing, T. D., Holbrook, A. 2013; 133 (5): 3590-?


    Skilled harmonica players learn to bend the pitch of certain notes by a semitone or more, especially in blues playing, by adjusting the shape of their vocal tract [Bahnson et al., J. Acoust. Soc. 103, 2134 (2008)]. The changes of the vocal tract have been partially viewed with endoscopy and ultrasound but are still incompletely understood. While in a magnetic resonance imaging (MRI) scanner, a professional harmonica player using nonmagnetic, MRI-compatible diatonic harmonicas played draw and blow notes in both unbent and bent positions. Three-dimensional static and two-dimensional real-time magnetic resonance images of the upper airway were recorded in the sagittal and coronal planes. We identified and characterized the static and dynamic changes that facilitated pitch bends for low and high notes with specific attention to tongue positioning, tongue morphology, and airway shape. Deliberate changes in the tongue shape are often accompanied by changes in other parts of the vocal tract such as the pharynx.

    View details for DOI 10.1121/1.4806625

    View details for PubMedID 23655957

  • 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


    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


    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

  • Heparin-induced thrombocytopenia (HIT) causing portosplenic, superior mesenteric, and splenic vein thrombosis resulting in splenic rupture and pulmonary emboli formation CLINICAL IMAGING Lammering, J. C., Wang, D. S., Shin, L. K. 2012; 36 (6): 865-868


    Heparin-induced thrombocytopenia (HIT) is a life-threatening complication of heparin administration. Of the few reported cases of HIT-associated intra-abdominal thrombosis, none to our knowledge provide multidetector-row computed tomography (MDCT) imaging findings or emphasize its utility in diagnosis. We describe a case of HIT with MDCT images demonstrating extensive intra-abdominal thrombosis and end-organ complications including splenic rupture and pulmonary emboli. This case emphasizes the potential role of MDCT in the rapid detection of HIT-related thromboembolic complications in patients with nonspecific abdominal pain.

    View details for DOI 10.1016/j.clinimag.2012.01.011

    View details for Web of Science ID 000311533800037

    View details for PubMedID 23154026

  • 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


    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

  • 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


    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


    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

  • 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


    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


    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

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


    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

  • In Situ Vaccination With a TLR9 Agonist Induces Systemic Lymphoma Regression: A Phase I/II Study JOURNAL OF CLINICAL ONCOLOGY Brody, J. D., Ai, W. Z., Czerwinski, D. K., Torchia, J. A., Levy, M., Advani, R. H., Kim, Y. H., Hoppe, R. T., Knox, S. J., Shin, L. K., Wapnir, I., Tibshirani, R. J., Levy, R. 2010; 28 (28): 4324-4332


    Combining tumor antigens with an immunostimulant can induce the immune system to specifically eliminate cancer cells. Generally, this combination is accomplished in an ex vivo, customized manner. In a preclinical lymphoma model, intratumoral injection of a Toll-like receptor 9 (TLR9) agonist induced systemic antitumor immunity and cured large, disseminated tumors.We treated 15 patients with low-grade B-cell lymphoma using low-dose radiotherapy to a single tumor site and-at that same site-injected the C-G enriched, synthetic oligodeoxynucleotide (also referred to as CpG) TLR9 agonist PF-3512676. Clinical responses were assessed at distant, untreated tumor sites. Immune responses were evaluated by measuring T-cell activation after in vitro restimulation with autologous tumor cells.This in situ vaccination maneuver was well-tolerated with only grade 1 to 2 local or systemic reactions and no treatment-limiting adverse events. One patient had a complete clinical response, three others had partial responses, and two patients had stable but continually regressing disease for periods significantly longer than that achieved with prior therapies. Vaccination induced tumor-reactive memory CD8 T cells. Some patients' tumors were able to induce a suppressive, regulatory phenotype in autologous T cells in vitro; these patients tended to have a shorter time to disease progression. One clinically responding patient received a second course of vaccination after relapse resulting in a second, more rapid clinical response.In situ tumor vaccination with a TLR9 agonist induces systemic antilymphoma clinical responses. This maneuver is clinically feasible and does not require the production of a customized vaccine product.

    View details for DOI 10.1200/JCO.2010.28.9793

    View details for Web of Science ID 000282272700032

    View details for PubMedID 20697067

    View details for PubMedCentralID PMC2954133

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


    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

  • 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


    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

  • In Vivo Deformation of the Human Abdominal Aorta and Common Iliac Arteries With Hip and Knee Flexion: Implications for the Design of Stent-Grafts JOURNAL OF ENDOVASCULAR THERAPY Choi, G., Shin, L. K., Taylor, C. A., Cheng, C. P. 2009; 16 (5): 531-538


    To quantify in vivo deformations of the abdominal aorta and common iliac arteries (CIAs) caused by musculoskeletal motion.Seven healthy subjects (age 34+/-11 years, range 24-50) were imaged in the supine and fetal positions (hip flexion angle 134.0 degrees +/-9.7 degrees ) using contrast-enhanced magnetic resonance angiography. Longitudinal strain, twisting, and curvature change of the infrarenal aorta and CIAs were computed. The angle between the left and right CIAs and translation of the arteries were also computed.Maximal hip flexion induced shortening (5.2%+/-4.6%), twisting (0.45+/-0.27 degrees /mm), and curvature changes (0.015+/-0.007 mm(-1)) of the CIAs. The angle between the CIAs increased by 17.6 degrees +/-8.6 degrees . The iliac arteries moved predominantly in the superior direction relative to the aortic bifurcation, which would induce compression and bending, thus increasing curvature and angle between the CIAs. The abdominal aorta also exhibited shortening (2.9%+/-2.1%) and twisting (0.07+/-0.05 degrees /mm) deformation associated with the hip flexion.Although this study was limited to a few healthy young adults, musculoskeletal motion, specifically hip flexion, caused significant in vivo morphological changes (shortening, twisting, and bending) of the arteries. Predominant superior translation of the CIAs was observed, which suggests that preclinical testing of cyclic superior-inferior translational motion may aid in predicting stent-graft fractures. In turn, stent-graft design could be improved, decreasing overall stent-graft-related complications.

    View details for Web of Science ID 000271308800001

    View details for PubMedID 19842734

    View details for PubMedCentralID PMC2793421

  • Intraoperative Ultrasound of the Pancreas ULTRASOUND QUARTERLY Shin, L. K., Brant-Zawadzki, G., Kamaya, A., Jeffrey, R. B. 2009; 25 (1): 39-48


    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

  • Emergency Gynecologic Imaging SEMINARS IN ULTRASOUND CT AND MRI Kamaya, A., Shin, L., Chen, B., Desser, T. S. 2008; 29 (5): 353-368


    Acute pelvic pain in the female patient can have myriad presentations and, depending on the diagnosis, profound consequences. In the pregnant patient with pelvic pain or bleeding, an ectopic pregnancy must be first excluded. Ultrasound is important in determining the size and location of the ectopic pregnancy, and presence of bleeding, which in turn helps guide treatment decisions. Subchorionic or subplacental bleeds in an intrauterine pregnancy may also present with vaginal bleeding with consequences dependent on gestational age and size of bleed. In the postpartum female suspected to have retained products of conception, sonographic findings may vary from a thickened endometrial stripe to an echogenic mass with associated marked vascularity, often mimicking an arterial-venous malformation. In the nonpregnant patient, early diagnosis and treatment of ovarian torsion can preserve ovarian function. Other causes of peritoneal irritation may also cause acute pelvic pain including a ruptured hemorrhagic cyst or ruptured endometrioma. When pelvic inflammatory disease is suspected, imaging is used to evaluate for serious associated complications including the presence of a tuboovarian abscess or peritonitis. While leiomyomas of the uterus are largely asymptomatic, a leiomyoma that undergoes necrosis, torsion or prolapse through the cervix may be associated with acute severe pain or bleeding. The imaging features of these and other important clinical entities in the female pelvis will be presented.

    View details for DOI 10.1053/j.sult.2008.06.006

    View details for Web of Science ID 000260064700006

    View details for PubMedID 18853841

  • 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

  • Transparent rendering of intraluminal contrast for 3D polyp visualization at CT colonography JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY Shi, R., Napel, S., Rosenberg, J. K., Shin, L. K., Walsh, C. F., Mogensen, M. A., Joshi, A. J., Pankhudi, P., Beaulieu, C. F. 2007; 31 (5): 773-779


    We developed a classifier that permits transparent rendering of both tagging material and air to facilitate interpretation of tagged computed tomographic (CT) colonography. With this technique, a reader can simultaneously appreciate polyps on endoluminal views both covered with tagging material and against air, along with unmodified 2-dimensional CT images. Evaluated with 49 polyps from 26 patients (data from public National Library of Medicine, Health Insurance Portability and Accountability Act compliant), 3 readers were able to determine the presence/absence of polyps in tagged locations with equivalent accuracy compared with polyps in air. This method offers an alternative way to visualize tagged CT colonography.

    View details for Web of Science ID 000249964800020

    View details for PubMedID 17895791

  • 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
  • Pitfalls in PET/CT: Physiologic or Not Physiologic? Shin, L. K., Iagaru, A., Quon, A., Kamaya, A. 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


    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

  • Splenic diffuse large B-cell lymphoma in a patient with type 1 Gaucher disease: diagnostic and therapeutic challenges ANNALS OF HEMATOLOGY Brody, J. D., Advani, R., Shin, L. K., Bingham, D. B., Rosenberg, S. A. 2006; 85 (11): 817-820

    View details for DOI 10.1007/s00277-006-0176-3

    View details for Web of Science ID 000240520100011

    View details for PubMedID 16937096

  • Prospective CT diagnosis of stump appendicitis AMERICAN JOURNAL OF ROENTGENOLOGY Shin, L. K., HALPERN, D., Weston, S. R., Meiner, E. M., Katz, D. S. 2005; 184 (3): S62-S64

    View details for Web of Science ID 000227522800022

    View details for PubMedID 15728024

  • Hypermetabolism on F-18 FDG PET of multiple pulmonary nodules resulting from bronchiolitis obliterans organizing pneumonia CLINICAL NUCLEAR MEDICINE Shin, L., Katz, D. S., Yung, E. 2004; 29 (10): 654-656

    View details for Web of Science ID 000223992700017

    View details for PubMedID 15365446

  • Radiology-Pathology Conference - Bilateral renal oncocytomas CLINICAL IMAGING Shin, L. K., Badler, R. L., Bruno, F. M., Gupta, M., Katz, D. S. 2004; 28 (5): 344-348


    Oncocytoma is an uncommon benign, typically solitary renal tumor first reported in 1942. Renal oncocytomas are rarely multiple and/or bilateral. Accurate preoperative diagnosis and differentiation from renal carcinoma is difficult. We report the radiology and pathology of a patient with bilateral renal oncocytomas and review the literature of this rare presentation.

    View details for DOI 10.1016/j.clinimag.2004.04.002

    View details for Web of Science ID 000224672200006

    View details for PubMedID 15471666

  • Fluoroscopic diagnosis of a second branchial cleft fistula AMERICAN JOURNAL OF ROENTGENOLOGY Shin, L. K., Gold, B. M., Zelman, W. H., Katz, D. S. 2003; 181 (1): 285-285

    View details for Web of Science ID 000183644800071

    View details for PubMedID 12818885