Bio

Clinical Focus


  • Diagnostic Radiology

Academic Appointments


Professional Education


  • Residency:Tufts Medical Center Radiology Residency (2013) MA
  • Internship:Newton-Wellesley Hospital Transitional Year (2009) MA
  • Fellowship:Massachusetts General Hospital Dept of RadiologyMAUnited States of America
  • Board Certification: Cardiovascular Computed Tomography, Council for Certification in Cardiovascular Imaging (2016)
  • Medical Education:Harvard Medical School (2008) MA
  • Board Certification: Pediatric Radiology, American Board of Radiology (2015)
  • Fellowship:Lucile Packard Children's Hospital, Stanford University School of Medicine (2014) CAUnited States of America
  • Board Certification: Diagnostic Radiology, American Board of Radiology (2013)

Publications

All Publications


  • Perivascular Epicardial Fat Stranding at Coronary CT Angiography: A Marker of Acute Plaque Rupture and Spontaneous Coronary Artery Dissection. Radiology Hedgire, S., Baliyan, V., Zucker, E. J., Bittner, D. O., Staziaki, P. V., Takx, R. A., Scholtz, J., Meyersohn, N., Hoffmann, U., Ghoshhajra, B. 2018; 287 (3): 808?15

    Abstract

    Purpose To evaluate the frequency and implications of perivascular fat stranding on coronary computed tomography (CT) angiograms obtained for suspected acute coronary syndrome (ACS). Materials and Methods This retrospective registry study was approved by the institutional review board. The authors reviewed the medical records and images of 1403 consecutive patients (796 men, 607 women; mean age, 52.8 years) who underwent coronary CT angiography at the emergency department from February 2012 to March 2016. Fat attenuation, length and number of circumferential quadrants of the affected segment, and attenuation values in the unaffected epicardial and subcutaneous fat were measured. "Cases" were defined as patients with perivascular fat stranding. Patients with significant stenosis but without fat stranding were considered control subjects. Baseline imaging characteristics, ACS frequency, and results of subsequent downstream testing were compared between cases and control subjects by using two-sample t, Mann-Whitney U, and Fisher tests. Results Perivascular fat stranding was seen in 11 subjects, nine with atherosclerotic lesions and two with spontaneous coronary artery dissections, with a mean fat stranding length of 19.2 mm and circumferential extent averaging 2.9 quadrants. The mean attenuation of perivascular fat stranding, normal epicardial fat, and normal subcutaneous fat was 17, -93.2, and -109.3 HU, respectively (P < .001). Significant differences (P < .05) between cases and control subjects included lower Agatston score, presence of wall motion abnormality, and initial elevation of serum troponin level. ACS frequency was 45.4% in cases and 3.8% in control subjects (P = .001). Conclusion Recognition of perivascular fat stranding may be a helpful additional predictor of culprit lesion and marker of risk for ACS in patients with significant stenosis or spontaneous coronary artery dissection. RSNA, 2018 Online supplemental material is available for this article.

    View details for DOI 10.1148/radiol.2017171568

    View details for PubMedID 29401041

  • Abdominal aortic aneurysm screening: concepts and controversies CARDIOVASCULAR DIAGNOSIS AND THERAPY Zucker, E. J., Prabhakar, A. M. 2018; 8: S108?S117

    Abstract

    Abdominal aortic aneurysms (AAAs) are a leading cause mortality and morbidity but often go undiagnosed until late stages unless imaging is performed. In 2005, the United States Preventive Services Task Force (USPSTF) for the first time recommended one-time ultrasound screening for elderly male smokers and selective screening in other populations. These guidelines were reaffirmed and updated in 2014; a proposal for potential further revisions is now in early planning stages. In this article, we review the past and current USPSTF AAA screening recommendations and techniques for performing optimal screening. Evidence supporting screening and alternative guidelines are also discussed. In addition, emerging concepts and controversies in AAA screening are highlighted, including conflicting data on screening benefits, screening underutilization, inconsistent follow-up recommendations, and the potential for duplicative testing, alternative screening modalities, and clinically significant incidental findings.

    View details for DOI 10.21037/cdt.2017.09.13

    View details for Web of Science ID 000431655700010

    View details for PubMedID 29850423

    View details for PubMedCentralID PMC5949596

  • Syndromes with aortic involvement: pictorial review CARDIOVASCULAR DIAGNOSIS AND THERAPY Zucker, E. J. 2018; 8: S71?S81

    Abstract

    A variety of syndromes are associated with thoracoabdominal aortic pathologies. While these diseases are collectively rare, the presence of advanced or unusual aortic disease at a young age should raise suspicion of an underlying syndrome. Similarly, patients with a known syndrome require close monitoring in anticipation of future aortic disease. In this article, the syndromes most commonly encountered in clinical practice are reviewed, including Marfan syndrome (MFS) and other connective tissue disorders, Turner syndrome (TS), autosomal dominant polycystic kidney disease (ADPKD), neurofibromatosis (NF), Williams syndrome (WS), Alagille syndrome (AGS), and DiGeorge syndrome (DGS). The distinct clinical, imaging, and management features of each disorder are discussed. Attention is focused on the unique patterns of aortic disease in each syndrome, emphasizing the role of recent imaging modalities and treatment strategies. Ancillary and distinguishing aspects of the syndromes that aid in diagnosis are also highlighted.

    View details for DOI 10.21037/cdt.2017.09.14

    View details for Web of Science ID 000431655700007

    View details for PubMedID 29850420

    View details for PubMedCentralID PMC5949600

  • Advanced aortic imaging and intervention Preface CARDIOVASCULAR DIAGNOSIS AND THERAPY Zucker, E. J., Prabhakar, A. M., Ganguli, S. 2018; 8: S1?S2

    View details for Web of Science ID 000431655700001

    View details for PubMedID 29850414

    View details for PubMedCentralID PMC5949584

  • Free-breathing pediatric chest MRI: Performance of self-navigated golden-angle ordered conical ultrashort echo time acquisition. Journal of magnetic resonance imaging : JMRI Zucker, E. J., Cheng, J. Y., Haldipur, A., Carl, M., Vasanawala, S. S. 2017

    Abstract

    To assess the feasibility and performance of conical k-space trajectory free-breathing ultrashort echo time (UTE) chest magnetic resonance imaging (MRI) versus four-dimensional (4D) flow and effects of 50% data subsampling and soft-gated motion correction.Thirty-two consecutive children who underwent both 4D flow and UTE ferumoxytol-enhanced chest MR (mean age: 5.4 years, range: 6 days to 15.7 years) in one 3T exam were recruited. From UTE k-space data, three image sets were reconstructed: 1) one with all data, 2) one using the first 50% of data, and 3) a final set with soft-gating motion correction, leveraging the signal magnitude immediately after each excitation. Two radiologists in blinded fashion independently scored image quality of anatomical landmarks on a 5-point scale. Ratings were compared using Wilcoxon rank-sum, Wilcoxon signed-ranks, and Kruskal-Wallis tests. Interobserver agreement was assessed with the intraclass correlation coefficient (ICC).For fully sampled UTE, mean scores for all structures were ?4 (good-excellent). Full UTE surpassed 4D flow for lungs and airways (P < 0.001), with similar pulmonary artery (PA) quality (P = 0.62). 50% subsampling only slightly degraded all landmarks (P < 0.001), as did motion correction. Subsegmental PA visualization was possible in >93% scans for all techniques (P = 0.27). Interobserver agreement was excellent for combined scores (ICC = 0.83).High-quality free-breathing conical UTE chest MR is feasible, surpassing 4D flow for lungs and airways, with equivalent PA visualization. Data subsampling only mildly degraded images, favoring lesser scan times. Soft-gating motion correction overall did not improve image quality.2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017.

    View details for DOI 10.1002/jmri.25776

    View details for PubMedID 28570032

  • Impact of California Computed Tomography Dose Legislation: Survey of Radiologists JOURNAL OF MEDICAL IMAGING AND RADIATION SCIENCES Zucker, E. J., Barth, R. A. 2017; 48 (2): 144?50
  • Abdominal Aortic Aneurysm Screening Practices: Impact of the 2014 U.S. Preventive Services Task Force Recommendations. Journal of the American College of Radiology Zucker, E. J., Misono, A. S., Prabhakar, A. M. 2017

    Abstract

    To assess changes in abdominal aortic aneurysm (AAA) ultrasound screening associated with the release of revised U.S. Preventive Services Task Force (USPSTF) recommendations on June 24,2014.All AAA screening ultrasound examinations performed in the Massachusetts General Hospital radiology department in the 15 months before and after the new guidelines were retrospectively reviewed to assess changes in examination volume and appropriateness, demographics, aneurysm detection rate and size at diagnosis, frequency and type of incidental findings, and radiologist recommendations. Examinations were considered "definitely appropriate" if meeting USPSTF grade "B" evidence and "possibly appropriate" if meeting grade "C" or "I" evidence, based on available guidelines. Means were compared with the t test.A total of 831 examinations were reviewed, 417 (50.2%) performed before and 414 (49.8%) after the new guidelines, with overall mean (SD) subject age 67.9 (6.8) years, 89.2% male. Appropriate examinations increased from 289 of 417 (69.3%) to 313 of 414 (75.6%) after the new guidelines (P= .04), mostly due to definitely appropriate examinations (253/417 [60.7%] versus 286/414 [69.1%], P= .01). Aneurysm detection rates increased from 23 of 417 (5.5%) to 39 of 414 (9.4%), P= .03. Mean (SD) aneurysm size (cm) at diagnosis decreased from 3.8 (0.7) to 3.3 (0.6), P= .01. Examination volume, demographics, and rates of incidentals and recommendations remained similar. Incidentals arose in 15.4% of all examinations, often iliac artery aneurysms or renal masses. Recommendations were made in 5.1%, mostly for cross-sectional imaging.The revised USPSTF guidelines have been associated with increased AAA screening appropriateness and aneurysm detection in our practice, with smaller aneurysm size at diagnosis.

    View details for DOI 10.1016/j.jacr.2017.02.020

    View details for PubMedID 28427905

  • Imaging of venous compression syndromes. Cardiovascular diagnosis and therapy Zucker, E. J., Ganguli, S., Ghoshhajra, B. B., Gupta, R., Prabhakar, A. M. 2016; 6 (6): 519-532

    Abstract

    Venous compression syndromes are a unique group of disorders characterized by anatomical extrinsic venous compression, typically in young and otherwise healthy individuals. While uncommon, they may cause serious complications including pain, swelling, deep venous thrombosis (DVT), pulmonary embolism, and post-thrombotic syndrome. The major disease entities are May-Thurner syndrome (MTS), variant iliac vein compression syndrome (IVCS), venous thoracic outlet syndrome (VTOS)/Paget-Schroetter syndrome, nutcracker syndrome (NCS), and popliteal venous compression (PVC). In this article, we review the key clinical features, multimodality imaging findings, and treatment options of these disorders. Emphasis is placed on the growing role of noninvasive imaging options such as magnetic resonance venography (MRV) in facilitating early and accurate diagnosis and tailored intervention.

    View details for DOI 10.21037/cdt.2016.11.19

    View details for PubMedID 28123973

    View details for PubMedCentralID PMC5220205

  • Hemodynamic safety and efficacy of ferumoxytol as an intravenous contrast agents in pediatric patients and young adults MAGNETIC RESONANCE IMAGING Ning, P., Zucker, E. J., Wong, P., Vasanawala, S. S. 2016; 34 (2): 152-158
  • Perinatal Thoracic Mass Lesions: Pre- and Postnatal Imaging. Seminars in ultrasound, CT, and MR Zucker, E. J., Epelman, M., Newman, B. 2015; 36 (6): 501-521

    View details for DOI 10.1053/j.sult.2015.05.016

    View details for PubMedID 26614133

  • Added Value of Radiologist Consultation for Pediatric Ultrasound: Implementation and Survey Assessment. AJR. American journal of roentgenology Zucker, E. J., Newman, B., Larson, D. B., Rubesova, E., Barth, R. A. 2015; 205 (4): 822-826

    Abstract

    The purpose of this study was to determine whether radiologist-parent (guardian) consultation sessions for pediatric ultrasound with immediate disclosure of examination results if desired increases visit satisfaction, decreases anxiety, and increases understanding of the radiologist's role.Parents chaperoning any outpatient pediatric ultrasound were eligible and completed surveys before and after ultrasound examinations. Before the second survey, parents met with a pediatric radiologist on a randomized basis but could opt out and request or decline the consultation. Differences in anxiety and understanding of the radiologist's role before and after the examination were compared, and overall visit satisfaction measures were tabulated.Seventy-seven subjects participated, 71 (92%) of whom spoke to a radiologist, mostly on request. In the consultation group, the mean score (1, lowest; 4, highest) for overall experience was 3.8 0.4 (SD), consultation benefit was 3.7 0.6, and radiologist interaction was 3.7 0.6. Demographics were not predictive of satisfaction with statistical significance in a multivariate model. Forty-six of 68 (68%) respondents correctly described the radiologist's role before consultation. The number increased to 60 (88%) after consultation, and the difference was statistically significant (p < 0.001). There was also a statistically significant decrease in mean anxiety score from 2.0 1.0 to 1.5 0.8 after consultation (p < 0.001). Sixty-four of 70 (91%) respondents indicated that they would prefer to speak with a radiologist during every visit.Radiologist consultation is well received among parents and associated with decreased anxiety and increased understanding of the radiologist's role. The results of this study support the value of routine radiologist-parent interaction for pediatric ultrasound.

    View details for DOI 10.2214/AJR.15.14542

    View details for PubMedID 26397331

  • Radiologist Compliance With California CT Dose Reporting Requirements: A Single-Center Review of Pediatric Chest CT AMERICAN JOURNAL OF ROENTGENOLOGY Zucker, E. J., Larson, D. B., Newman, B., Barth, R. A. 2015; 204 (4): 810-816

    Abstract

    Effective July 1, 2012, CT dose reporting became mandatory in California. We sought to assess radiologist compliance with this legislation and to determine areas for improvement.We retrospectively reviewed reports from all chest CT examinations performed at our institution from July 1, 2012, through June 30, 2013, for errors in documentation of volume CT dose index (CTDIvol), dose-length product (DLP), and phantom size. Reports were considered as legally compliant if both CTDIvol and DLP were documented accurately and as institutionally compliant if phantom size was also documented accurately. Additionally, we tracked reports that did not document dose in our standard format (phantom size, CTDIvol for each series, and total DLP).Radiologists omitted CTDIvol, DLP, or both in nine of 664 examinations (1.4%) and inaccurately reported one or both of them in 56 of the remaining 655 examinations (8.5%). Radiologists omitted phantom size in 11 of 664 examinations (1.7%) and inaccurately documented it in 20 of the remaining 653 examinations (3.1%). Of 664 examinations, 599 (90.2%) met legal reporting requirements, and 583 (87.8%) met institutional requirements. In reporting dose, radiologists variably used less decimal precision than available, summed CTDIvol, included only series-level DLP, and specified dose information from the scout topogram or a nonchest series for combination examinations.Our institutional processes, which primarily rely on correct human performance, do not ensure accurate dose reporting and are prone to variation in dose reporting format. In view of this finding, we are exploring higher-reliability processes, including better-defined standards and automated dose reporting systems, to improve compliance.

    View details for DOI 10.2214/AJR.14.13693

    View details for Web of Science ID 000351614700037

    View details for PubMedID 25794071

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