Stephen E Jones

Publications of Stephen E Jones

• Importance of systematic review of rotating projection images from Tc99m-sestamibi cardiac perfusion imaging for noncardiac findings.

  Authors: Stephen E Jones, Kusai Aziz, Tsunehiro Yasuda, Henry Gewirtz, James A Scott

  Nuclear medicine communications. 08/2008; 29(7):607-13.

  PURPOSE: To test the hypothesis that the observed incidence of important noncardiac findings (NCFs) on myocardial perfusion imaging increases significantly when readers systematically review allPURPOSE: To test the hypothesis that the observed incidence of important noncardiac findings (NCFs) on myocardial perfusion imaging increases significantly when readers systematically review all rotating projectional images. METHODS: We prospectively studied NCF reported from a population of 7658 stress cardiac perfusion studies using a single-agent same-day protocol by a review of rotating projectional images. The incidence of NCF was evaluated for both an ensemble of general clinical readers and for a subset of readers who systematically review all rotating projectional images. The clinical validation of NCF was determined first from an evaluation of the electronic medical record and then after direct communication with the primary physicians. RESULTS: NCF incidence for general clinical readers was 0.08%, increasing significantly to 0.82% for readers who systematically review all rotating projectional images (P=0.0013). The spectrum of pathology was diverse, particularly including significant findings such as previously unknown cancers. A total of 53 NCFs were detected, of which clinical follow-up found a corresponding diagnosis in 35 cases (66%). Of these, 43% were previously known, 20% new, and 37% false positives. Thirty-four percent of all NCF had no follow-up, mainly because of lack of additional diagnostic tests. CONCLUSION: NCFs are infrequent but often clinically important findings, whose detection is significantly enhanced by systematic reviews of all rotating projectional images.

• 99mTc sestamibi uptake by acute pulmonary embolism.

  Authors: Conrad Wittram, Stephen E Jones, James A Scott

  AJR. American journal of roentgenology. 01/2007; 187(6):1611-3.

• Computed tomographic angiography in stroke imaging: fundamental principles, pathologic findings, and common pitfalls.

  Authors: Rajiv Gupta, Stephen E Jones, Eline A Q Mooyaart, Stuart R Pomerantz

  Seminars in ultrasound, CT, and MR. 07/2006; 27(3):221-42.

  The development of multidetector row computed tomography (MDCT) now permits visualization of the entire vascular tree that is relevant for the management of stroke within 15 seconds. Advances in MDCTThe development of multidetector row computed tomography (MDCT) now permits visualization of the entire vascular tree that is relevant for the management of stroke within 15 seconds. Advances in MDCT have brought computed tomography angiography (CTA) to the frontline in evaluation of stroke. CTA is a rapid and noninvasive modality for evaluating the neurovasculature. This article describes the role of CTA in the management of stroke. Fundamentals of contrast delivery, common pathologic findings, artifacts, and pitfalls in CTA interpretation are discussed.

• The indeterminate CT pulmonary angiogram: imaging characteristics and patient clinical outcome.

  Authors: Stephen E Jones, Conrad Wittram

  Radiology. 10/2005; 237(1):329-37.

  PURPOSE: To retrospectively review imaging characteristics of indeterminate computed tomographic (CT) pulmonary angiograms for pulmonary embolism (PE) and patient outcome. MATERIALS AND METHODS:PURPOSE: To retrospectively review imaging characteristics of indeterminate computed tomographic (CT) pulmonary angiograms for pulmonary embolism (PE) and patient outcome. MATERIALS AND METHODS: Investigational review board approval was obtained, informed consent was waived, and the study was HIPAA compliant. Retrospective review of 3612 CT pulmonary angiography reports created between July 1, 2001, and July 1, 2003, was performed with a keyword search for "indeterminate," "nondiagnostic," or "inadequate" (thereafter, all defined as "indeterminate") and yielded studies from 237 patients (mean age, 57 years; 117 men, 120 women). Randomly selected diagnostic studies were used to form a control group of 25 subjects (mean age, 64 years; eight men, 17 women). Electronic medical records were reviewed for follow-up imaging (repeat CT pulmonary angiography, conventional pulmonary angiography, ventilation-perfusion scintigraphy, or lower-extremity ultrasonography [US]), use of anticoagulation, placement of inferior vena cava (IVC) filters, clinical outcomes, and comments regarding indeterminate reading of CT angiograms. Studies (in patients and control subjects) were reviewed for PE, contrast attenuation in the main pulmonary artery (MPA), motion artifacts, image noise, and flow artifacts. Findings were compared with two-sample t tests assuming unequal variance. RESULTS: The cause cited for indeterminism was most often motion (74%), followed by poor contrast enhancement (40%). Contrast attenuation in the MPA was 245 HU +/- 80 (standard deviation) in patients and 339 HU +/- 88 in control subjects (P < .001). Only 46% of indeterminate studies met institutional criteria for adequate contrast attenuation in the MPA. Rereview of studies demonstrated five missed PEs. A total of 81 patients (33%) underwent follow-up imaging within 5 days, with one positive pulmonary angiogram and four positive lower-limb US scans. Reread or follow-up images depicted thromboembolic disease in 4.2% of patients. Nineteen patients (8%) with indeterminate final result were treated for thromboembolic disease with either anticoagulation or IVC filters. Reports on 22% of indeterminate studies contained recommendations for follow-up imaging, and those recommendations nonsignificantly increased the rate for those examinations from 13% to 19%. Review of discharge summaries showed 22% of studies are clinically interpreted as negative. CONCLUSION: The two major causes of indeterminism are motion artifacts and poor contrast enhancement.

• Inherently 3-dimensional method for measurement of computed tomographic resolution anisotropy.

  Authors: Stephen E Jones, Michael Grasruck, Bernhard Schmidt, Ijad Madisch, Ryan Egeland, Tom Brady, Rajiv Gupta

  Journal of computer assisted tomography. 30(6):962-71.

  OBJECTIVE: Current techniques to measure computed tomography (CT) spatial resolution use separate methods for in-plane and out-of-plane directions. The growing use of near-isotropic voxel sizeOBJECTIVE: Current techniques to measure computed tomography (CT) spatial resolution use separate methods for in-plane and out-of-plane directions. The growing use of near-isotropic voxel size necessitates a new single method that inherently measures resolution in any direction. METHOD: We introduce a method using a set of numerous glass microspheres suspended in a small volume from which a mean sphere image is constructed. Projecting asymptotes after imaging different microsphere sets with decreasing diameters provides an inherently 3-dimensional measure of spatial resolution and anisotropy. We apply the method to both a flat-panel and multidetector CT scanner. RESULTS: The full-width at half-maximum from line profiles through mean sphere in transverse directions corresponds to known microsphere diameters. Increased longitudinal full-width at half-maximum corresponds to known anisotropy, which is larger for a multidetector CT scanner than for a flat-panel CT scanner. CONCLUSIONS: A new single method to measure CT resolution is inherently isotropic.

  Download