Publications (30) View all
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Article: Magnetic resonance enterography.
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ABSTRACT: Magnetic resonance (MR) enterography is a targeted examination of the gastrointestinal tract, particularly the small intestine, without nasojejunal intubation (in which case it is referred to as MR enteroclysis). Until recently, MR imaging of the small bowel could not reliably compete with the high-quality small bowel images generated by computed tomography (CT). Now, however, MR enterography is not only a feasible alternative to CT, but may provide superior diagnostic information, specifically with regard to differentiating active, inflammatory disease from chronic, fibrostenotic disease. MR enterography is no longer merely adequate and radiation-free; it is an essential part of the imaging armamentarium.Radiologic Clinics of North America 01/2013; 51(1):99-112. · 2.59 Impact Factor -
Article: MR enterography correlates highly with colonoscopy and histology for both distal ileal and colonic Crohn's disease in 310 patients.
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ABSTRACT: To evaluate the efficacy of MR enterography (MRE) in patients with known or suspected Crohn's disease without the use of anti-peristaltic pharmacologic agents compared to colonoscopy and histology. A retrospective review of 850 consecutive patients who underwent routine MRE to evaluate known or suspected Crohn's disease was performed. Of these, 310 patients also underwent colonoscopy with biopsy(s) within 90 days. The results of the MRE were compared to the colonoscopy and pathology reports to determine the presence or absence of disease in evaluable bowel segments. Individual imaging parameters (including wall thickening, enhancement, T2 signal, mesenteric vascular prominence and adenopathy) were also separately analyzed to determine their independent predictive value. In 310 patients, the overall sensitivity and specificity of MRE (using endoscopy as a gold standard) were 85% and 80% respectively (kappa=0.65). The sensitivity of MRE for detection of pathologically severe disease was 87% in the terminal ileum (TI) and 88% in the colon. In the subset of 162 patients who underwent colonoscopy within 30 days of MRE, the overall sensitivity remained 85% but the specificity increased to 85% (kappa=0.69). Wall thickening and abnormal enhancement were sensitive indicators of Crohn's disease (75% and 78%), while abnormal T2 signal, mesenteric vascular prominence and adenopathy were specific (86%, 91% and 93%). MRE compares favorably to colonoscopy for evaluation of known or suspected Crohn's disease noninvasively and without the exposure to ionizing radiation associated with CT enterography (CTE).European journal of radiology 03/2012; 81(5):e763-9. · 2.65 Impact Factor -
Article: Optimum imaging of colorectal metastases.
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ABSTRACT: Dramatic improvements in diagnostic imaging have developed with and enabled increasingly sophisticated treatments for metastatic colorectal cancer. Advances in therapeutic techniques, such as surgical resection and percutaneous therapies, demand that diagnostic imaging provide an accurate assessment of disease burden as well as precise localization. In this article, we present the current state-of-the-art of diagnostic imaging for evaluation of metastatic colorectal cancer.Journal of Surgical Oncology 12/2010; 102(8):909-13. · 2.10 Impact Factor -
Article: Placement of marker coils at biopsy: usefulness in the localization of poorly visualized renal neoplasms for subsequent CT-guided radiofrequency ablation.
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ABSTRACT: To determine whether placement of marking coils at biopsy of small renal neoplasms to facilitate localization at subsequent radiofrequency (RF) ablation is safe and can reduce fluoroscopy time during the ablative procedure. This retrospective study was approved by the hospital institutional review board and was compliant with HIPAA. The requirement to obtain informed consent was waived. A search of the renal RF ablation database (235 patients) identified 23 consecutive patients who had a marking coil placed at biopsy of a renal neoplasm (coil group) and 23 patients who did not have a marking coil placed at biopsy (control group). The patients were matched for tumor characteristics, including size, parenchymal position, location in the kidney, and laterality. All patients underwent subsequent RF ablation. The authors compared computed tomographic (CT) fluoroscopy times and technical success rates between the two groups. Statistical analyses were performed by using a single-tailed paired t test for comparison of CT fluoroscopy times, a two-tailed paired t test for comparison of age and tumor size, and a single-tailed McNemar test for comparison of the technical success rate of ablation. The mean CT fluoroscopy time for the RF ablation procedure was 28 seconds ± 11.7 (standard deviation) for the coil group and 66 seconds ± 85.8 for the control group (P = .025). There was no significant difference in the technical success rates of renal RF ablation. For small renal neoplasms that are poorly visualized at unenhanced CT, placement of a metallic marking coil at biopsy facilitates tumor localization, thus reducing CT fluoroscopy time and radiation dose for subsequent RF ablation procedures.Radiology 03/2012; 263(2):555-61. · 5.73 Impact Factor -
Article: Incidence of multiple sporadic renal cell carcinomas in patients referred for renal radiofrequency ablation: implications for imaging follow-up.
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ABSTRACT: The objective of our study was to report the incidence of multiple sporadic primary renal cell carcinomas (RCCs) in patients referred for radiofrequency ablation (RFA). A retrospective search identified 162 patients (104 men and 58 women; mean age, 74 years) without a history of von Hippel-Lindau disease with a total of 175 tumors treated with RFA for biopsy-proven primary renal malignancies at our institution from 1998 to 2009. Three groups of patients with multiple RCCs were identified: patients with a history of nephrectomy for RCC who had been referred for RFA of a new renal tumor, patients who presented with multiple renal tumors at the time of referral for RFA, and patients who were shown to have developed a new renal tumor on follow-up imaging after RFA. Twenty-eight patients (17%) had multiple biopsy-proven RCCs. Eighteen patients (11%) had undergone prior nephrectomy for surgically proven RCC. The mean interval between prior nephrectomy and RFA referral was 122 months (range, 12-456 months). Seven patients (4%) without a history of nephrectomy presented with two biopsy-proven RCCs at RFA referral. Three patients (2%) who had not undergone nephrectomy and had a solitary RCC at the time of RFA had developed a new biopsy-proven RCC separate from the original treatment site on follow-up imaging after RFA. The mean time to diagnosis from the initial RFA treatment was 52 months (range, 25-89 months). Imaging surveillance of patients referred for renal RFA may be important not only to assess treatment success but also to detect new RCCs.American Journal of Roentgenology 09/2011; 197(3):671-5. · 2.78 Impact Factor
