Senta Maria Berggruen

Northwestern University, Evanston, Illinois, United States

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Publications (13)21.29 Total impact

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    ABSTRACT: PURPOSE/AIM The purpose of this exhibit is: 1. To discuss the imaging features and various etiologies of adrenal and renal hemorrhage 2. To discuss mimickers of hemorrhage 3. To explain management strategies and imaging features that help in the diagnosis CONTENT ORGANIZATION Adrenal gland hemorrhage 1. Imaging features and causes 2. Importance of underlying mass lesions and lesions associated with hemorrhage including adrenal cortical carcinoma, metastases and pheochromocytoma 3. Mimickers of adrenal hemorrhage including lymphoma and melanoma Renal and perirenal hemorrhage 1. Imaging features and causes including AMLs, RCC, vascular causes, trauma, etc 2. Diagnosis of AMLs, tuberous sclerosis and pseudoaneurysms 3. Antopol-Goldman lesion 4. Utility of MR and followup imaging for diagnosis 5. Mimickers of hemorrhage including perirenal lymphoma SUMMARY The major teaching points are: 1. Adrenal hemorrhage is important to diagnose and can be a harbinger of underlying masses including adrenal cortical carcinoma, metastases and pheochromocytoma. 2. A variety of causes can lead to renal and perirenal hemorrhage, and it is incumbent upon the radiologist to determine the exact etiology.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 06/2015
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    ABSTRACT: Placenta accreta is abnormal placental adherence or invasion of the myometrium or extrauterine structures. It is increasing in incidence because of increasing number of cesarean sections and is one of the main causes of excessive postpartum hemorrhage. Recognition of this entity is crucial because improved outcomes have been shown when the antenatal diagnosis of placenta accreta is made. Ultrasound is the first-line tool; magnetic resonance imaging (MRI) is complementary. Ultrasound and MRI features and MRI protocols will be reviewed.
    Ultrasound Quarterly 01/2015; 31(1). DOI:10.1097/RUQ.0000000000000127 · 1.40 Impact Factor
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    ABSTRACT: Natural orifice transluminal endoscopic surgery (NOTES) is a surgical technique that has been evolving rapidly. Endoscopic submucosal dissection was initiated in 1999, in Japan, for en-bloc resection of large lesions of the stomach (Zhou et al., World J Gastroenterol 19:6962-6968, 2013, ; Kobara et al., Clin Exp Gastroenterol 7:67-74, 2014). Since then, many additional therapies utilizing natural transluminal endoscopic approach have evolved. Peroral endoscopic myotomy (POEM) is a minimally invasive type of transluminal endoscopic surgery that was recently developed for the treatment of achalasia and esophageal motility disorders. The peroral endoscopic myotomy is a less invasive surgical treatment that is suitable for all types of achalasia and used as an alternate to the Heller myotomy. The radiographic findings of achalasia and surgical changes after Heller myotomy have been described, however, very little is available on the post-POEM esophagram appearance. The purpose of this article is to illustrate the anatomy, surgical procedure, and normal and abnormal findings seen on esophagrams in patients who have undergone a POEM.
    Abdominal Imaging 08/2014; 40(3). DOI:10.1007/s00261-014-0209-7 · 1.73 Impact Factor
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    ABSTRACT: The ampulla of Vater is an important anatomic landmark where the common bile duct and main pancreatic duct converge in the major duodenal papilla. Imaging evaluation of the ampulla and periampullary region poses a unique diagnostic challenge to radiologists because of the region's complex and variable anatomy and the variety of lesions that can occur. Lesions intrinsic to the ampulla and involved segment of the biliary tree can be neoplastic, inflammatory, or congenital. Neoplastic lesions include ampullary adenocarcinomas and adenomas, which often are difficult to differentiate, as well as pancreatic or duodenal adenocarcinomas, pancreatic neuroendocrine tumors, and cholangiocarcinomas. Ultrasonography (US), computed tomography, magnetic resonance (MR) imaging, and MR cholangiopancreatography are commonly used to evaluate this region. Endoscopic retrograde cholangiopancreatography or endoscopic US examination may be necessary for more definitive evaluation. Periampullary conditions in the duodenum that may secondarily involve the ampulla include neoplasms, duodenitis, duodenal diverticula, and Brunner's gland hyperplasia or hamartomas. Because these lesions can exhibit a wide overlap of imaging features and subtle or nonspecific imaging findings, diagnosis is made on the basis of patient age, clinical history, and imaging and laboratory findings. Given the complexity of imaging evaluation of the ampulla and periampullary region, it is essential for radiologists to understand the variety of lesions that can occur and recognize their imaging characteristics. ©RSNA, 2014.
    Radiographics 05/2014; 34(3):624-41. DOI:10.1148/rg.343125191 · 2.73 Impact Factor
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    ABSTRACT: To determine whether asymmetric spermatic cord vessel enhancement (ASE) on contrast-enhanced computed tomography (CECT) indicates scrotal pathology. Sixty-one male patients with scrotal symptoms who underwent both scrotal ultrasound (US) and CECT within 24 h were identified through a radiology information system. Twenty-eight emergency department patients who underwent CECT only for unrelated symptoms were included for comparison. Two blinded radiologists independently reviewed each CECT scan for qualitative ASE. These data were compared with US diagnoses, when present. A third blinded radiologist reviewed each CECT scan for quantitative ASE by measuring Hounsfield unit (HU) density ratios. McNemar, Kappa, Student's t test, and ANOVA were used for analysis. Eighty-nine total patients included 28 with CECT only and 61 with CECT and US, of which 41 had abnormal US: 15 acute epididymitis and/or orchitis, 7 testicular neoplasms, 11 varicoceles, and 8 with other pathologies. Twenty patients with normal US and 28 patients with CECT only served as control groups. Identification of ASE agreed with US diagnosis of epididymitis (and/or orchitis) or testicular neoplasm (reader 1: κ = 0.79, reader 2: κ = 0.75) with average 95.5% sensitivity and 88.8% specificity, and no significant difference between readers (p = 0.58). For epididymitis (and/or orchitis) or testicular neoplasm patients, the average ratio of spermatic cord HU density (ipsilateral:contralateral) was significantly different from other patients (4.01 vs. 1.26, p = 0.0025). ASE on CECT shows stronger correlation with epididymitis (and/or orchitis) and testicular neoplasm compared with other scrotal pathologies. If discovered on CECT, this should prompt further clinical and/or imaging workup.
    Abdominal Imaging 04/2014; 39(5). DOI:10.1007/s00261-014-0133-x · 1.73 Impact Factor
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    ABSTRACT: PURPOSE To assess feasibility of a novel MRI grading scale using major and minor imaging criteria to assign confidence in diagnosing abnormal placental implantation (API), and improve the accuracy, consistency, and clinical utility of placental MRI. METHOD AND MATERIALS Two board certified radiologists blinded to all reports independently, retrospectively reviewed 20 randomized placental MRI exams (10 with API by surgery and/or pathology and 10 negative cases). Assessment was made for major and minor diagnostic criteria of API, based on MRI signs reported in literature. Major criteria included placental invasion outside the uterus, intraplacental bands, uterine bulging, very heterogeneous placenta, and bladder tenting. Minor criteria included mild/moderately heterogeneous placenta, tortuous flow voids, focal interruption of the myometrial wall and myometrial thinning. Confidence levels (CL) were assigned for the diagnosis of any level of API, including placental accreta, increta, and percreta. CL were: 90% confidence for cases with 2 or more major criteria, 75% confidence with either 1 major criterion or all 4 minor criteria, 50% confidence with 3 minor criteria, 25% confidence with 1-2 minor criteria and 10% confidence if no criteria met. RESULTS Between the two radiologists, there was complete agreement on 12 of 20 cases based on CL. 6 cases demonstrated a difference of only one CL. 2 cases demonstrated complete disagreement. When grouping the 90% and 75% CL into high suspicion and the 25% and 10% CL into low suspicion of API, the radiologists agreed on 18 of 20 cases. Of these 18 cases, 7 were high suspicion and 11 were low suspicion. The 7 high suspicion cases and 9 of the 11 low suspicion cases matched the surgical/pathology results. 2 of the 11 low suspicion cases were positive for placenta accreta. This resulted in a sensitivity of 0.7-0.89 and specificity of 0.91-1.0 for detection of API between the radiologists. Accuracy ranged from 0.85-0.91. CONCLUSION Utilizing major and minor imaging criteria on MRI to diagnose API can make placental MRI reporting more consistent and accurate and thus aid in surgical planning. CLINICAL RELEVANCE/APPLICATION Introducing a placental MRI grading scale with major and minor imaging criteria to assign confidence in diagnosing abnormal placental implantation, improving reports’ accuracy and consistency.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: To evaluate the correlation between change in attenuation and tumor metabolic activity assessed by using fluorodeoxyglucose (FDG) positron emission tomography (PET) in colon cancer liver metastases treated with yttrium 90 ((90)Y) radioembolization. This Health Insurance Portability and Accountability Act-compliant retrospective study was approved by the institutional review board; patient informed consent was waived. Unresectable chemorefractory colon cancer liver metastases treated with (90)Y radioembolization in 28 patients were evaluated at pre- and posttreatment multidetector computed tomographic (CT) and FDG PET scans. Maximum cross-sectional diameter, volume, and overall attenuation of target lesions were calculated. The percentage change (%Delta) in these parameters after treatment was calculated and correlated with the standardized uptake value (SUV) analysis at FDG PET. The accuracy of the radiologic parameters in helping predict response to treatment at FDG PET was assessed. Data were analyzed by using the Student t, Wilcoxon matched pair, Mann-Whitney, Spearman rank correlation, and chi(2) tests. The significance level was set at .05. Seventy-four metastatic lesions in 10 women and 18 men (mean age, 61.5 years +/- 14.3 [standard deviation]) were evaluated. Mean follow-up interval for multidetector CT after treatment was 30 days. A significant reduction in maximum cross-sectional diameter, volume, and attenuation was observed from pre- to posttreatment multidetector CT (P < .05). The %Delta in attenuation had higher correlation with %Delta in SUV (r = 0.61) than diameter (r = 0.39) or volume (r = 0.49) and also predicted the metabolic activity at FDG PET with higher sensitivity (P < .001). By using a threshold level of a reduction in attenuation of 15% or greater, attenuation showed 84.2% sensitivity and 83.3% specificity in predicting response at FDG PET evaluation. Changes in attenuation of colon cancer liver metastases treated with (90)Y radioembolization correlate highly with metabolic activity at FDG PET and may be useful as an early surrogate marker for assessing treatment response.
    Radiology 04/2010; 255(1):164-72. DOI:10.1148/radiol.09091028 · 6.21 Impact Factor
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    ABSTRACT: The purpose of our study was to evaluate the utility of apparent diffusion coefficient (ADC) values for characterizing adrenal lesions and determine if diffusion-weighted imaging (DWI) can distinguish lipid-rich from lipid-poor adenomas. We retrospectively evaluated 160 adrenal lesions in 156 patients (96 women and 60 men; mean age, 63 years). ADCs and signal intensity (SI) decrease on chemical shift imaging were measured in adrenal lesions with a wide variety of pathologies. Lipid-rich and lipid-poor adenomas were identified by unenhanced CT. The overall predictive power of ADC, SI decrease, and lesion size were determined by receiver operating characteristic (ROC) analysis. Areas under the ROC curve (AUC) were compared for equivalence using nonparametric methods. Sensitivity, specificity, and positive and negative predictive values were calculated. Correlation coefficients were used to assess ADCs versus percentage SI decrease and ADCs versus CT attenuation. ADCs of adrenal malignancies (median, 1.67 x 10(-3) mm(2)/s; interquartile range, 1.41-1.84 x 10(-3) mm(2)/s) were not different compared with those of benign lesions (1.61 x 10(-3) mm(2)/s; 1.27-1.96 x 10(-3) mm(2)/s; p > 0.05). Cysts (2.93 x 10(-3) mm(2)/s; 2.70-3.09 x 10(-3) mm(2)/s) showed higher ADCs than the remaining adrenal lesions (p < 0.05). The median ADCs of lipid-rich adenomas did not differ from those of lipid-poor ones (p > 0.05). The CT attenuation had no negative or positive correlation with the ADCs of adrenal adenomas (r = -0.05, p = 0.97). Unlike lesion size and percentage decrease in SI, the ADCs were not useful in distinguishing benign from malignant adrenal lesions. Lipid-poor adenomas could not be distinguished from lipid-rich adenomas and all other nonfatty lesions of the adrenal gland with DWI.
    American Journal of Roentgenology 02/2010; 194(2):W179-85. DOI:10.2214/AJR.09.2891 · 2.74 Impact Factor
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    ABSTRACT: Response Evaluation Criteria in Solid Tumors (RECIST) guidelines assume spherical shape of tumors. Morphology of pancreatic adenocarcinoma (PAC) on multidetector row computed tomography was investigated to evaluate the applicability of RECIST guidelines. Study population comprised 16 patients with histologically confirmed localized PAC enrolled in a phase II clinical trial of chemoradiation. Pancreatic adenocarcinomas were segmented on baseline and follow-up multidetector row computed tomography with commercially available software. Tumor volumes (mL), RECIST diameter (mm), volume equivalent sphere diameter (VESD, mm), maximum 3-dimensional diameter (M3DD, mm), and elongation value were obtained. RECIST diameter, VESD and M3DD of the tumors at baseline and follow-up were compared to determine differences. Elongation values were analyzed. The significance level was set at P less than 0.05. Mean volume, RECIST diameter, VESD, M3DD, and elongation for baseline versus follow-up studies were 23.12 mL versus 19.43 mL (P > 0.05), 41.86 mm versus 39.35 mm (P > 0.05), 33.14 mm versus 32.1 mm (P > 0.05), 51.76 mm versus 51.73 mm (P > 0.05), and 0.67 versus 0.76 (P > 0.05), respectively. There was a significant difference at baseline and follow-up between RECIST diameter, VESD, and M3DD (P < 0.05, in all instances). Our results suggest that PACs are not spherical in shape. Evaluation of PAC treatment response based on RECIST guidelines may not be accurate.
    Pancreas 07/2009; 38(7):799-803. DOI:10.1097/MPA.0b013e3181ac7511 · 3.01 Impact Factor
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    ABSTRACT: PURPOSE The purpose of our study was to compare volumetry, RECIST and density measurements for response evaluation of hepatic tumors in patients undergoing transcatheter arterial radioembolization. METHOD AND MATERIALS Twenty-three solid hepatic tumors in ten patients were evaluated on baseline and post-treatment contrast-enhanced multislice CT. The average time interval between CT exams was 5 weeks (range 3-10 weeks). Two radiologists evaluated the hepatic masses using automated software (CT Oncology, Siemens Medical Solutions, Forchheim, GER) to obtain RECIST, volume and density of each lesion before and after treatment. Average and percentage change of volume, RECIST and density measurements were calculated. The Wilcoxon matched pairs signed ranks test was used to analyze data (InStat 3, GraphPad, San Diego, CA). P<0.05 was considered significant. RESULTS The average RECIST measurement decreased from 40.1 to 37.57 mm ( -2.53 mm or -6%, P< 0.02). The median RECSIT decreased from 36.8 to 34.5 mm. The average volume for the same lesions decreased 33.06 to 31.37 ml ( -1.69 ml or -5%, P<0.15). The median volume decreased 12.72 to 12.24 ml. The average density decreased from 76.95 to 59.69 HU ( - 17.26 HU or -22%, P<0.0013). The median density decreased from 67 to 54 HU. CONCLUSION Our results suggest that for treated hepatic tumors, volumetry does not produce better approximation of tumor response than RECIST measurements. However, the decrease in tumor density may be a better indicator of response to radioembolization. CLINICAL RELEVANCE/APPLICATION For CT monitoring of radioembolized hepatic tumors, the decrease in Hounsfield units of tumor is an important indicator of tumor response.
    Radiological Society of North America 2008 Scientific Assembly and Annual Meeting; 11/2008
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    ABSTRACT: PURPOSE/AIM The purpose of the exhibit is to illustrate the anatomy, surgical procedure, normal and abnormal findings seen on esophagram in patients who underwent POEM. CONTENT ORGANIZATION Introduction of the normal anatomy and pathology Clinical indications for POEM Description of the surgical procedure Common radiology findings associated with POEM procedure Abnormal findings and complications of POEM procedure SUMMARY POEM is a relatively new procedure for the treatment of achalasia. At the end of the exhibit the viewer should: Understand normal anatomy and indications for POEM Learn how the surgical procedure is performed Become familiar with common expected radiological findings after this procedure Be able to identify complications
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting;
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    ABSTRACT: PURPOSE/AIM To review the pathophysiology and predisposing factors of placenta accreta. To illustrate the sonographic and MR imaging features of placenta accreta. To discuss the precautionary measures taken when placenta accreta is suspected, including interventional radiology balloon placement. CONTENT ORGANIZATION Illustrate the pathophysiology of placenta accreta and its subtypes. Review of normal and pathologic imaging findings and pitfalls -Ultrasound -MRI Sample cases of diagnosis and treatment with interventional radiology SUMMARY The diagnosis of placenta accreta can be made with ultrasound. MRI is often used to increase diagnostic certainty. Placental heterogeneity, dark placental bands, lobularity, bulging, and loss of the myometrial line are MRI findings that indicate placenta accreta.
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting;
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    ABSTRACT: PURPOSE/AIM Medical management of patients with Crohn disease is highly dependent on the level of disease activity. A gastroenterologist managing Crohn patients is therefore interested in not only the presence or absence of disease but also the extent and level of its activity. CTE is a robust method of imaging the intestinal and extraintestinal manifestations of Crohn disease and offers distinct advantages over other imaging modalities such as small bowel follow-through or wireless capsule endoscopy. These advantages and their implications in patient management will be presented. CONTENT ORGANIZATION A)Discussion of the distinguishing imaging features that affect medical treatment including specific findings indicating acute and chronic disease along with complications of advanced disease such as fistulas and abscesses.B) Discuss the importance of standardization of terminology in reporting. SUMMARY This exhibit will familiarize radiologists with relevant CTE findings of Crohn disease that affect medical management of these patients.
    Radiological Society of North America 2007 Scientific Assembly and Annual Meeting;