K Garg

University of Colorado, Denver, Colorado, United States

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Publications (12)53.64 Total impact

  • Kavita Garg · Loren Macey
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    ABSTRACT: CT pulmonary angiography has become the screening exam of choice to evaluate for pulmonary embolism (PE), especially in subjects with an abnormal chest radiograph. A good-quality CT pulmonary angiogram has a high accuracy rate for the evaluation of PE. Investigators have reported that subsegmental emboli can be missed; however, visualization of smaller arterial branches and, therefore, detection of small emboli have improved with the availability of multidetector scanners. Some of the advantages of using CT for PE compared to lung scintigraphy include: (1) direct visualization of emboli on CT; (2), evaluation of lung parenchyma and mediastinum (this may provide an alternate diagnosis); (3) capability to acquire a CT venogram without additional contrast with 'one-stop examination' for the evaluation of thromboembolic disease.
    Respiration 05/2003; 70(3):231-7. DOI:10.1159/000072001 · 2.59 Impact Factor
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    ABSTRACT: To assess the feasibility of conducting a randomized controlled trial for lung cancer screening. Subjects are being recruited into a randomized controlled trial to undergo either low-dose spiral computed tomography (CT) or observation. Subjects are from a high-risk group with known chronic obstructive pulmonary disease and sputum atypia and a moderate-risk group randomly selected from the general population of a Veterans Affairs Medical Center. All subjects must be 50-80 years of age with 30 or more pack-years of cigarette smoking and must not have undergone chest CT during the previous 3 years. Baseline screening CT is performed with 50 mA, 120 kVp, 5-mm collimation, and a pitch of 2. CT scan interpretation and management of nodules is based on Society of Thoracic Radiology guidelines. The chi(2) test for categoric data was used for statistical analysis. To date, 304 eligible subjects have been contacted, and 239 (79%) have agreed to participate in the trial. One hundred nineteen (88%) of the 136 subjects in the high-risk group and 120 (71%) of the 168 subjects in the moderate-risk group agreed to randomization (P <.001). To date, 190 subjects have been randomized. Of the first 92 subjects examined with CT, 22 (40%) of 55 in the high-risk group and eight (22%) of 37 in the moderate-risk group had one to six noncalcified nodules that required follow-up (P =.07). In all but three subjects, nodules were smaller than 5 mm. Two of the three larger nodules were malignancies. Findings of this study indicate that a randomized controlled trial of CT to screen for lung cancer is feasible.
    Radiology 11/2002; 225(2):506-10. DOI:10.1148/radiol.2252011851 · 6.87 Impact Factor
  • Kavita Garg · David A Lynch
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    ABSTRACT: The imaging features of occupational lung cancer are similar to those of nonoccupational cancer. Occupational lung cancer in patients with asbestos exposure must be differentiated from mimics such as round atelectasis and fissural pleural plaques. Mesothelioma remains a largely incurable tumor, though treatment options are expanding. CT, MRI, and PET scanning may all have complementary roles in staging mesothelioma.
    Journal of Thoracic Imaging 08/2002; 17(3):198-210. DOI:10.1097/00005382-200207000-00004 · 1.74 Impact Factor
  • Kavita Garg
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    ABSTRACT: A good quality CT pulmonary angiogram has a high accuracy rate for the evaluation of pulmonary embolism. Investigators have reported that the subsegmental emboli can be missed; however, visualization of smaller arterial branches, and therefore, detection of small emboli may improve with the availability of multidetector scanners. Some of the advantages of using CT for pulmonary embolism compared with lung scintigraphy include: (1) direct visualization of emboli on CT, (2) evaluation of lung parenchyma and mediastinum, which may provide an alternate diagnosis, and (3) capability to acquire CT venogram without additional contrast with "one-stop examination" for evaluation of thromboembolic disease.
    Radiologic Clinics of North America 02/2002; 40(1):111-22, ix. DOI:10.1016/S0033-8389(03)00112-X · 1.98 Impact Factor
  • K Garg · J L Kemp · P D Russ · AE Barón
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    ABSTRACT: The objective of this study was to determine interobserver agreement in the diagnosis of acute deep venous thrombosis on CT venography performed in addition to CT pulmonary angiography. One hundred forty-six CT venograms of 144 patients (mean age, 61.74 years) clinically suspected of having pulmonary embolism were analyzed prospectively and independently by two experienced thoracic and body imaging radiologists and later by consensus of the two radiologists. The CT venography protocol consisted of 5-mm-thick axial images at 20-mm intervals from the popliteal fossa to the renal veins. Images were acquired 3-4 min after the start of 100-150 mL of undiluted contrast medium administration at 4 mL/sec. Thirteen venous segments were analyzed in each patient. There were 1586 analyzable venous segments. Interobserver agreement, with the patient as the unit of analysis, was moderately good (kappa, 0.59; 95% confidence interval [CI], 0.39-0.78). Kappa values were similar for CT venography studies performed with 150 mL of contrast medium and 4-min delay (kappa, 0.62; 95% CI, 0.30-0.88) and with 3-min delay and 100 mL of contrast medium (kappa, 0.56; 95% CI, 0.32-0.80). Interobserver disagreement occurred in 17 (12%) of 146 CT venography studies. Findings of 11 CT venography studies were interpreted as negative, and six were interpreted as positive after consensus interpretation. Interobserver agreement for deep venous thrombosis with CT venography is moderately good.
    American Journal of Roentgenology 05/2001; 176(4):1043-7. DOI:10.2214/ajr.176.4.1761043 · 2.73 Impact Factor
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    ABSTRACT: The purpose of this study was to compare combined CT pulmonary angiography and venography with leg sonography for accuracy and relative efficacy in diagnosis of deep venous thrombosis from the popliteal vein to the common femoral vein. Seventy consecutive patients with clinically suspected pulmonary embolism underwent both combined CT pulmonary angiography and venography and bilateral leg sonography within 24 hr. CT venograms were analyzed independently in a blinded fashion for quality of venous opacification and patency by two observers. CT venography was compared with sonography for femoropopliteal vein thrombosis, and the final assessment based on multiple subjective and objective clinical and imaging criteria was recorded in three categories: 1, CT venography better than sonography; 2, CT venography equivalent to sonography; and 3, sonography better than CT venography. Sixty-eight patients (97%) had a satisfactory or good quality CT venography examination. Two CT venography studies had false-positive findings due to flow artifacts. Both CT venography and sonography had positive findings for deep venous thrombosis in five patients, and both had negative findings in 63 patients (100% sensitivity, 97% specificity, 100% negative predictive value, and 71% positive predictive value). CT venography was better and more efficacious than sonography (category 1) in 25 patients (36%). CT venography was equivalent to sonography (category 2) in 26 patients (37%), and sonography was better than CT venography (category 3) in 19 patients (27%). Compared with sonography, CT venography in addition to CT pulmonary angiography is a relatively accurate method for evaluation of femoropopliteal venous thrombosis. Combined CT pulmonary angiography and CT venography may be more efficacious than sonography or two separate examinations in selected patients.
    American Journal of Roentgenology 11/2000; 175(4):997-1001. · 2.73 Impact Factor
  • American Journal of Roentgenology 10/2000; 175(4):997-1001. DOI:10.2214/ajr.175.4.1750997 · 2.73 Impact Factor
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    ABSTRACT: The purpose of our study was to assess the clinical usefulness of helical CT findings that are interpreted as negative for pulmonary embolism. One hundred twenty-six patients underwent 132 helical CT examinations and 352 patients underwent ventilation-perfusion scanning for suspected acute pulmonary embolism over a 17-month period at a single institution. Findings from clinical follow-up at a minimum of 6 months were assessed, with a special focus on the presence of recurrent thromboembolism and mortality in 78 consecutive patients in whom helical CT findings were interpreted as negative for pulmonary embolism and anticoagulant therapy was not administered (group I). During the same 17-month period, 46 patients underwent ventilation-perfusion scanning that was interpreted as normal (group II), and 132 patients underwent ventilation-perfusion scanning that was interpreted as showing a very low to low probability for pulmonary embolism (group III). Patients in groups II and III did not undergo helical CT or pulmonary angiography and did not receive anticoagulant therapy. However, clinical follow-up was solicited. Patients from groups II and III were used as control subjects. Nine patients in group I died, one of whom was found to have a microscopic pulmonary embolism at autopsy. In group II, four patients died, none of whom were shown to have a missed or recurrent pulmonary embolism. Of the 18 patients in group III who died, three had a recurrent or missed pulmonary embolism (mean interval, 9 days), and two were found to have deep vein thrombosis on sonography of the leg (mean interval, 12 weeks). Negative predictive values for helical CT, normal lung scanning, and low-probability ventilation-perfusion scanning were 99%, 100%, and 96%, respectively (p = .299). CT provided either additional findings or an alternate diagnosis in 42 (53.8%) of the 78 patients in whom helical CT findings had been interpreted as negative for pulmonary embolism. A helical CT scan can be effectively used to rule out clinically significant pulmonary emboli and may prevent further investigation or unnecessary treatment of most patients.
    American Journal of Roentgenology 07/1999; 172(6):1627-31. DOI:10.2214/ajr.172.6.10350303 · 2.73 Impact Factor
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    ABSTRACT: To compare the accuracy of spiral computed tomography (CT) with that of ventilation-perfusion (V-P) scintigraphy in the diagnosis of pulmonary embolism (PE). Fifty-four patients in whom indeterminate V-P scans or discordant clinical and scintigraphic results were obtained underwent both V-P scanning and contrast material-enhanced spiral CT. The reference standard was pulmonary angiographic results in 26 patients (group I) or clinical outcome in 28 (group II). Six (25%) of 24 group I patients had proved PE. The prospective sensitivity and specificity for segmental or subsegmental PE were 67% and 100%, respectively, and the positive and negative predictive values were 100% and 90%, respectively. In two group II patients, V-P scans had high probability for acute embolism, but spiral CT scans showed only chronic PE; in one patients, the V-P scan had low probability and the CT scan was positive for acute PE. An alternative CT diagnosis was established in four (31%) of 13 patients in whom a normal or low-probability V-P scan was obtained. Clinical outcome was consistent with spiral CT results in all cases. Spiral CT has greater accuracy and specificity than V-P scanning in patients with an unresolved diagnosis and may be useful as the primary screening technique for PE.
    Radiology 08/1998; 208(1):201-8. DOI:10.1148/radiology.208.1.9646814 · 6.87 Impact Factor
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    ABSTRACT: Lung transplantation has become a well-established treatment for end-stage pulmonary parenchymal and vascular disease. Careful selection of recipients and donors is important to decrease early graft failure, which is primarily due to rejection and bronchial dehiscence. Common complications include the reimplantation response, acute rejection, pleural effusion, lymphoproliferative disorders, bronchiolitis obliterans, infection, and airway stenosis or dehiscence. The reimplantation response is a form of noncardiogenic pulmonary edema that begins soon after surgery and resolves in days to weeks. Acute rejection occurs in most recipients; a dramatic response to steroid therapy is the most diagnostic clinical feature. Lymphoproliferative disorders are posttransplantation neoplasms that may disappear when immunosuppressive therapy is stopped and often manifest as a discrete lung mass. In bronchiolitis obliterans-a major long-term complication probably due to chronic rejection-computed tomography (CT) often shows bronchial dilatation and air trapping. Airway stenosis and dehiscence are easily diagnosed with bronchoscopy and CT. Infections remain the major cause of morbidity and mortality.
    Radiographics 04/1996; 16(2):355-67. DOI:10.1148/radiographics.16.2.8966293 · 2.60 Impact Factor
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    ABSTRACT: Placement of central venous lines for the administration of a variety of therapies has become common practice. The most severe complication of this procedure is perforation of a large vessel, with bleeding, infusion of fluids into an extravascular site, and death. It is not clear from currently available data how often this occurs, what risk factors are associated, and how this complication can be avoided. We reviewed the records of all patients who were identified as having perforation of a major vessel during central venous line placement occurring between 1986 and 1993 at the University Hospital, the major teaching facility of the University of Colorado Health Sciences Center, Denver. Data collected included the age and sex of the patient, diagnosis, type of catheter and site of placement, operator means and time to the diagnosis of perforation, and outcome. Eleven such complications were identified and 10 of them are reviewed in detail. The overall incidence was less than 1%. Most complications occurred when the right subclavian vein approach was attempted, and they were thought to result from guidewire kinking during advancement of a vessel dilator. All medical specialties and levels of training were involved. Four of 10 patients died of immediate or subsequent complications of the perforation. Perforation of a great vessel is an uncommon, but often fatal, complication of central venous line placement. It occurs most often, when using the right subclavian vein approach, from guidewire kinking. Physicians performing this procedure should have formal training in central venous catheterization and be aware of this complication, its presumed cause, diagnosis, and treatment.
    Archives of Internal Medicine 07/1995; 155(11):1225-8. DOI:10.1001/archinte.1995.00430110149016 · 17.33 Impact Factor
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    K Garg · DA Lynch · J D Newell · T E King
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    ABSTRACT: The small airways of the lung consist of the terminal bronchioles, respiratory bronchioles, and alveolar ducts. A recently introduced pathologic classification system divides bronchiolitis into proliferative and constrictive types. The histologic classification of small-airways disease into proliferative and constrictive bronchiolitis frequently correlates with the radiographic appearances. Proliferative bronchiolitis is characterized by air-space opacification, whereas constrictive bronchiolitis tends to be associated with lobular areas of decreased attenuation and airway dilatation. The purpose of this essay is to illustrate the radiographic and CT features of these two varieties of bronchiolitis.
    American Journal of Roentgenology 05/1994; 162(4):803-8. DOI:10.2214/ajr.162.4.8140994 · 2.73 Impact Factor