E S Siegelman

University of Pennsylvania, Philadelphia, Pennsylvania, United States

Are you E S Siegelman?

Claim your profile

Publications (166)556.01 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to determine the accuracy of pelvic magnetic resonance imaging (MRI) diagnoses compared with the final pathology diagnoses for a series of women with indeterminate adnexal masses.
    International Journal of Gynecological Cancer 09/2014; 24(7):1215-1221. · 1.95 Impact Factor
  • Evan S. Siegelman, Anil Chauhan
    [Show abstract] [Hide abstract]
    ABSTRACT: Magnetic resonance (MR) can characterize specific tissue subtypes, thus facilitating focal liver lesion diagnosis. Focal liver lesions that are isointense to hyperintense to liver on T1-weighted images are usually hepatocellular in origin. Chemical shift imaging can narrow the differential diagnosis by detecting the presence of lipid or iron. T2 and heavily T2-weigthed fast spin echo imaging can differentiate solid from nonsolid focal liver lesions. The authors illustrate these MR imaging pearls and the uncommon exceptions (pitfalls). The authors hope that you will find this less traditional contribution to the Magnetic Resonance Clinics of North America helpful in clinical practice.
    Magnetic Resonance Imaging Clinics of North America. 08/2014; 22(3):295–313.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Chemical shift (CS) MRI of the adrenal glands exploits the different precessional frequencies of fat and water protons to differentiate the intracytoplasmic lipid-containing adrenal adenoma from other adrenal lesions. The purpose of this review is to illustrate both technical and interpretive pitfalls of adrenal imaging with CS MRI and emphasize the importance of adherence to strict technical specifications and errors that may occur when other imaging features and clinical factors are not incorporated into the diagnosis. When performed properly, the specificity of CS MRI for the diagnosis of adrenal adenoma is over 90%. Sampling the in-phase and opposed-phase echoes in the correct order and during the same breath-hold are essential requirements, and using the first echo pair is preferred, if possible. CS MRI characterizes more adrenal adenomas then unenhanced CT but may be non-diagnostic in a proportion of lipid-poor adenomas; CT washout studies may be able to diagnose these lipid-poor adenomas. Other primary and secondary adrenal tumours and supra-renal disease entities may contain lipid or gross fat and mimic adenoma or myelolipoma. Heterogeneity within an adrenal lesion that contains intracytoplasmic lipid could be due to myelolipoma, lipomatous metaplasia of adenoma, or collision tumour. Correlation with previous imaging, other imaging features, clinical history, and laboratory investigations can minimize interpretive errors.
    Clinical Radiology 07/2014; · 1.66 Impact Factor
  • Benjamin L Yam, Evan S Siegelman
    [Show abstract] [Hide abstract]
    ABSTRACT: Although ultrasound, computed tomography, and cholescintigraphy play essential roles in the evaluation of suspected biliary abnormalities, magnetic resonance (MR) imaging and MR cholangiopancreatography can be used to evaluate inconclusive findings and provide a comprehensive noninvasive assessment of the biliary tract and gallbladder. This article reviews standard MR and MR cholangiopancreatography techniques, clinical applications, and pitfalls. Normal biliary anatomy and variants are discussed, particularly as they pertain to preoperative planning. A spectrum of benign and malignant biliary processes is reviewed, emphasizing MR findings that aid in characterization.
    Radiologic Clinics of North America 07/2014; 52(4):725-755. · 1.83 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Living donor liver transplantation (LDLT) demands a careful assessment of abnormal findings discovered during the evaluation process to determine if there will be any potential risks to the donor or recipient. Varying degrees of elevated hepatic iron levels are not uncommonly seen in otherwise healthy individuals. We questioned whether mild expression of hemosiderin deposition presents a safety concern when considering outcomes of living donation for both the donor and the recipient. We report on three LDLT patients who were found to have low- to moderate-grade hemosiderin deposition on liver biopsy. All other aspects of their evaluation proved satisfactory, and the decision was made to proceed with donation. There were no significant complications in the donors, and all demonstrated complete normalization of liver function postoperatively, with appropriate parenchymal regeneration. The recipients also had unremarkable postoperative recovery. We conclude that these individuals can be considered as potential donors after careful evaluation.
    American Journal of Transplantation 01/2014; 14(1):216-20. · 6.19 Impact Factor
  • Benjamin L. Yam, Evan S. Siegelman
    Radiologic Clinics of North America 01/2014; · 1.83 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Radiotherapy (RT) is an integral component in the management of many abdominal and pelvic malignancies. Imaging follow-up in patients who have received RT is performed to assess for treatment response, evaluate for tumour recurrence and to diagnose complications related to treatment. The purpose of this pictorial review is to depict the expected imaging findings and potential complications following RT in the genitourinary (GU) tract using an organ-based approach and to review the diagnosis of locally recurrent tumour in the GU tract following RT. Some GU malignancies, namely cervical and prostatic carcinoma, can be treated with radical RT with intent to cure. More frequently, the GU tract is indirectly treated as a result of RT to adjacent cancers. Expected imaging findings, RT-related complications and the diagnosis of recurrent tumour following RT in the GU tract often necessitate a multi-modality imaging approach, the incorporation of functional imaging techniques and an organ-based approach for diagnosis.
    Insights into imaging. 11/2013;
  • Source
    Nicola Schieda, Parvati Ramchandani, Evan S Siegelman
    [Show abstract] [Hide abstract]
    ABSTRACT: Radiation nephropathy was first recognized in 1906. The kidney is a radiosensitive organ with a tolerance dose (5% complications in 5 years) of 20 Gray. The imaging findings of acute and chronic radiation induced renal injury are previously described. Radiation-induced adrenal injury, to our knowledge, has not been described in the literature. Unlike the kidneys and other upper abdominal organs, the adrenal glands are traditionally thought to be radio-resistant, protected from radiation-induced injury by proximity to adjacent organs and by the adrenal medulla which reportedly has increased radio-resistance. We present the computed tomographic imaging findings of a patient with acute radiation induced adrenal injury which resulted in adrenal insufficiency following radiotherapy of an adjacent thecal metastasis.
    Acta radiologica short reports. 11/2013; 2(7):2047981613501305.
  • [Show abstract] [Hide abstract]
    ABSTRACT: This white paper describes adnexal (ovarian and paraovarian) incidental findings found on CT and MRI in nonpregnant postmenarchal patients in whom no adnexal disorder is clinically known or suspected. This represents the first of 4 such papers from the ACR Incidental Findings Committee II, which used a consensus method based on repeated reviews and revisions and a collective review and interpretation of relevant literature. Recommendations for the management of incidental adnexal findings are organized into 4 main categories: benign-appearing cysts, probably benign cysts, adnexal masses with characteristic features, and all other adnexal masses, with pathways on the basis of patient menstrual status or age (when last menstrual period is unknown). A table and flowchart are provided for reference.
    Journal of the American College of Radiology: JACR 09/2013; 10(9):675-81.
  • Evan S Siegelman
    Academic radiology 04/2013; 20(4):391-2. · 2.09 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to examine early MRI changes in renal cell carcinoma (RCC) treated with the antiangiogenic agent sorafenib and to identify MRI biomarkers of RCC response to sorafenib. Sixteen patients with RCC were evaluated by MRI before and 3-12 weeks after commencing treatment with sorafenib. Two experienced MR radiologists, blinded to treatment status, independently graded tumor appearance on T1-weighted, T2-weighted, and gadolinium-enhanced images. The proportional odds mixed model was used to compare qualitative appearance of tumors before and after therapy. Time-to-progression was correlated with Response Evaluation Criteria in Solid Tumors (RECIST) 1.0 and MR-modified Choi criteria, incorporating changes in both tumor enhancement and size. After sorafenib therapy, there was a significant increase in T1 signal intensity of tumors (p < 0.0001) and a significant decrease in degree of tumor enhancement (p < 0.0001). The sum of unidimensional tumor diameters decreased significantly after therapy (p = 0.005). However, the average decrease in size at early follow-up was 13%, and all patients except one had stable disease by RECIST 1.0. Early responders defined by MR-modified Choi criteria had increased time-to-progression compared with nonresponders, whereas early RECIST evaluation did not predict clinical outcome. Decreased enhancement and T1 shortening of tumors on MRI may be useful biomarkers of RCC response to angiogenesis inhibitors. Response criteria combining early changes in size and enhancement lead to better correlation with clinical outcome compared with size decrease alone.
    American Journal of Roentgenology 01/2013; 200(1):120-6. · 2.74 Impact Factor
  • Evan Spencer Siegelman
    [Show abstract] [Hide abstract]
    ABSTRACT: LEARNING OBJECTIVES 1) Understand how MR can characterize tissue and facilitate the detection and staging of neoplasms in the abdomen and pelvis. 2) Appreciate how the audience response system provides immediate feeback, and enhances the learning process.
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE Quantitative assessment of cancer response is a time-consuming activity. We recently developed the open-source electronic Physician Annotation Device (ePAD) to streamline this process by facilitating reader annotations on images, tracking target lesions, and automatically generating RECIST tables. Our objective is to determine the impact of ePAD on reader efficiency in performing RECIST analyses. METHOD AND MATERIALS We chose CT exams of the chest, abdomen, and pelvis from an archive of imaging studies of subjects with metastatic carcinoid tumor from a Phase III therapeutic trial. Exams were selected from 20 subjects who had one baseline and three consecutive follow-up imaging exams. Five body radiologists with between 3 and 21 years of experience were recruited to perform replicate quantitative assessments of these exams using RECIST 1.1 criteria. Exams were read initially with the aid of the ePAD tool (“assisted read”) running on the Osirix imaging viewing workstation. After a thirty-day washout period, the exams were re-read using Osirix but without ePAD (“unassisted read”); in this session, RECIST tables were created by hand (per routine practice) during and after the reader review. The total time for image review and generation of the RECIST summary of measurements was tracked and analyzed with linear mixed model to compare the review time of the two methods, where the reader is treated as the random effect. RESULTS For unassisted reads, the mean review time per patient for each of the five readers was 10.7, 16.2, 8.3, 13.9 and 14.3 minutes (average 12.7 minutes), while for the assisted reads, the mean time required for each of the same five readers was 9.3, 12.0, 4.9, 10.2 and 12.6 minutes (average 9.8 minutes), respectively. On average across the five readers, the use of ePAD produced a savings of 2.9 minutes (95% CI: 1.8 to 4.0 minutes, p=0.007) per patient, representing a net increase in reader efficiency of 23%. CONCLUSION The use of the ePAD software improved reader efficiency for quantitative assessment of CT examinations using RECIST. Further evaluation of this and similar software to assist support of image interpretation and improve radiologist productivity is warranted. CLINICAL RELEVANCE/APPLICATION Tool support for quantitative imaging evaluation of quantitative imaging studies can improve radiologist efficiency, potentially making this suitable for incorporation into routine clinical practice..
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
  • Evan S Siegelman, Edward R Oliver
    [Show abstract] [Hide abstract]
    ABSTRACT: Endometriosis, which is defined as the presence of ectopic endometrial glands and stroma outside the uterus, is a common cause of pelvic pain and infertility, affecting as many as 10% of premenopausal women. Because its effects may be devastating, radiologists should be familiar with the various imaging manifestations of the disease, especially those that allow its differentiation from other pelvic lesions. The "pearls" offered here are observations culled from the authors' experience with the use of magnetic resonance (MR) imaging for the detection and characterization of pelvic endometriosis. First, the inclusion of T1-weighted fat-suppressed sequences is recommended for all MR examinations of the female pelvis because such sequences facilitate the detection of small endometriomas and aid in their differentiation from mature cystic teratomas. Second, it must be remembered that benign endometriomas, like many pelvic malignancies, may exhibit restricted diffusion. Although women with endometriosis are at risk for developing clear cell and endometrioid epithelial ovarian cancers (ie, endometriosis-associated ovarian cancers), imaging findings such as enhancing mural nodules should be confirmed before a diagnosis of ovarian malignancy is offered. The presence of a dilated fallopian tube, especially one containing hemorrhagic content, is often associated with pelvic endometriosis. Deep (solid infiltrating) endometriosis can involve the pelvic ligaments, anterior rectosigmoid colon, bladder, uterus, and cul-de-sac, as well as surgical scars; the lesions often have poorly defined margins and T2 signal hypointensity as a result of fibrosis. The presence of subcentimeter foci with T2 hyperintensity representing ectopic endometrial glands within these infiltrating fibrotic masses may help establish the diagnosis. © RSNA, 2012.
    Radiographics 10/2012; 32(6):1675-91. · 2.73 Impact Factor
  • Evan S Siegelman
    [Show abstract] [Hide abstract]
    ABSTRACT: The article reviews current magnetic resonance imaging (MRI) techniques and illustrates the MRI features of the commonly encountered lesions of the adrenal gland. MR may not always be able to characterize an adrenal mass. In these instances, reviewing the patient's clinical history and prior imaging can usually differentiate benign from malignant lesions, even if you cannot establishing an exact tissue diagnosis. The reader is referred to other reviews of adrenal imaging that emphasizes the use of CT and imaging-management algorithms that are beyond the purview of this focused review (1-6).
    Journal of Magnetic Resonance Imaging 08/2012; 36(2):272-85. · 2.57 Impact Factor
  • Evan Spencer Siegelman
    [Show abstract] [Hide abstract]
    ABSTRACT: LEARNING OBJECTIVES 1) Understand how MR can characterize tissue and facilitate the detection and staging of neoplasms in the abdomen and pelvis. 2) Appreciate how the audience response system provides immediate feeback, and enhances the learning process.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 12/2011
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Hepatocellular adenoma is a benign tumour associated with bleeding and malignant transformation. Obesity has been linked to hepatic tumourigenesis. To evaluate the presentation of hepatocellular adenoma in obesity, and the impact of obesity on the clinical course. Records of 60 consecutive patients (between 2005 and 2010) with a diagnosis of hepatocellular adenoma from a single tertiary centre were analysed. Fifty six of 60 patients were women, median age was 36years, 75% had history of contraceptive use, 18% were overweight and 55% were obese (BMI ≥30kg/m(2) ). Majority (63%) were asymptomatic; seven patients presented with bleeding. Single (28%) and multiple adenomas (72%) were encountered; size ranged from 1 to 19.7cm. Obesity was more often associated with multiple adenomas (85% vs. 48%, P=0.005), bilobar distribution (67% vs. 33%, P=0.01), lower serum albumin (P=0.007) and co-morbidities of fatty liver (P=0.006), diabetes (P=0.003), hypertension (P=0.006) and dyslipidemia (P=0.03). During median follow-up of 2.6years, there were no instances of bleeding, malignant transformation or death. Thirty four patients underwent therapeutic intervention (17 surgical resection, nine transarterial embolization and eight both interventions sequentially). The rate of complete resection of adenoma(s) was significantly lower in obese patients (8% vs. 69%, P=0.004). In the 26 patients without intervention, tumour size progression was more frequently observed in obese patients (33% vs. 0%, P=0.05). Three of 15 obese patients (20%) lost ≥5% body weight and there was no progression in the liver lesions. Obesity and features of metabolic syndrome were frequently observed in hepatocellular adenoma. Multiple and bilobar adenomas were more frequent in obese patients. Among patients who were conservatively managed, tumour progression was more often associated with obesity.
    Alimentary Pharmacology & Therapeutics 09/2011; 34(6):664-74. · 4.55 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To report a case of bilateral ovarian fibromas and ovarian leiomyomas in a young patient with Gorlin syndrome and to highlight issues of fertility preservation, ovarian conservation, and preimplantation genetic diagnosis in this population. Case report. University hospital. A 15-year-old female patient with Gorlin syndrome and bilateral ovarian masses. Ultrasound, magnetic resonance imaging, hormone analysis, and laparotomy with resection of ovarian fibromas. Preservation of ovarian function, pathologic diagnosis. Our patient represented an adolescent case of bilateral ovarian fibromas and leiomyomas in Gorlin syndrome presenting with menstrual irregularities. She was managed surgically with resection of the lesions and conservation of normal ovarian tissue. In Gorlin syndrome, ovarian fibromas are a common clinical manifestation. Patients with ovarian involvement may present with complex gynecologic needs and may have decreased fertility potential. Careful surgical management, follow-up, and counseling on options for future fertility should be offered to all patients.
    Fertility and sterility 05/2011; 96(1):e47-50. · 4.30 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The widespread use of imaging analyses, either routinely or to evaluate symptomatic patients, has increased the detection of liver lesions (tumors and cysts) in otherwise healthy individuals. Although some of these incidentally discovered masses are malignant, most are benign and must be included in the differential diagnosis. The management of benign hepatic tumors ranges from conservative to aggressive, depending on the nature of the lesions. New imaging modalities, increased experience of radiologists, improved definition of radiologic characteristics, and a better understanding of the clinical features of these lesions have increased the accuracy of diagnoses and reduced the need for invasive diagnostic tests. These advances have led to constant adjustments in management approaches to benign hepatic lesions. We review the biologic and clinical features of some common hepatic lesions, to guide diagnosis and management strategies.
    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 03/2011; 9(7):547-62.e1-4. · 5.64 Impact Factor
  • Gastroenterology 03/2011; 140(5). · 12.82 Impact Factor

Publication Stats

3k Citations
556.01 Total Impact Points

Institutions

  • 1997–2014
    • University of Pennsylvania
      • • Department of Radiology
      • • Department of Medicine
      Philadelphia, Pennsylvania, United States
    • Thomas Jefferson University Hospitals
      • Department of Radiology
      Philadelphia, Pennsylvania, United States
  • 1996–2014
    • Hospital of the University of Pennsylvania
      • Department of Radiology
      Philadelphia, Pennsylvania, United States
  • 2013
    • University of Ottawa
      • Department of Radiology
      Ottawa, Ontario, Canada
  • 2008
    • Rhode Island Hospital
      Providence, Rhode Island, United States
  • 2002
    • Yamaguchi University
      • Division of Radiology
      Yamaguti, Yamaguchi, Japan
  • 1996–2000
    • University of North Carolina at Chapel Hill
      • Department of Radiology
      Chapel Hill, NC, United States
  • 1991–2000
    • Thomas Jefferson University
      • Department of Radiology
      Philadelphia, PA, United States
  • 1998
    • Cooper University Hospital
      • Department of Diagnostic Radiology and Nuclear Medicine
      Camden, New Jersey, United States