Elinor Goshen

Sheba Medical Center, Gan, Tel Aviv, Israel

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Publications (44)101.56 Total impact

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    ABSTRACT: The choice of a rituximab-based regimen and the prognostic significance of interim 2-[fluorine-18]fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) in primary mediastinal large B cell lymphoma (PMBCL) are debatable. We evaluated the clinical features and outcomes of 95 consecutive patients with PMBCL who were treated between 1985 and 2009. Forty-three patients received rituximab-based chemotherapy, R-VACOP-B (N = 30) or R-CHOP21 (N = 13), whereas 52 patients were treated with VACOP-B (N = 47) or CHOP21 (N = 5). Radiotherapy was not given. Patients who received rituximab had a 5-year progression-free survival (PFS) of 79 % and overall survival (OS) of 97 % compared with 58 % (p = 0.06) and 88 % (p = 0.2), respectively, without rituximab. Five-year PFS in patients treated with R-VACOP-B, R-CHOP21, VACOP-B, and CHOP21 were 83, 69, 62, and 20 %, respectively (p = 0.039). However, direct comparison showed that the difference between PFS rates in patients receiving R-VACOP-B compared to R-CHOP21 was not statistically significant (p = 0.3). None of the standard clinical risk factors predicted for PFS and OS in patients receiving rituximab (R)-chemotherapy. Mid-interim FDG-PET/CT scans were performed in 30/43 patients who received R-chemotherapy. The negative predictive values of mid-PET activity were high (100 % for R-VACOP-B and 86 % for R-CHOP21) while the positive predictive values (PPV) were relatively low (30 and 75 %, respectively). Despite the low PPV, the 5-year PFS for mid-PET-negative patients (N = 16) was significantly higher (94 %) than that for mid-PET-positive (N = 14) patients (57 %, p = 0.015). This retrospective analysis demonstrates that the superiority of VACOP-B over CHOP21 for treatment of PMBCL disappeared once rituximab was added. The potential benefit of using interim PET activity as a guide for continuing therapy in patients with PMBCL remains unclear due to the relatively low PPV.
    Annals of Hematology 03/2014; 93(8). DOI:10.1007/s00277-014-2043-y · 2.63 Impact Factor
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    ABSTRACT: Abstract FDG-PET/CT scanning is often used for staging and response assessment in Mantle cell lymphoma (MCL); however, the ability of interim and post therapy scans to predict outcome is debatable. We retrospectively evaluated the prognostic impact of interim and post therapy FDG-PET/CT scan on outcome of patients with MCL. Fifty eight consecutive patients diagnosed between 1998 and 2011 were included in the analysis. Scans, performed at diagnosis, mid-therapy, post chemotherapy (prior to ASCT) and post transplantation, were reviewed and outcome was analyzed. Median age was 59. Most patients presented with advanced disease. MIPI was low in 45%, intermediate in 41% and high in 14%. Thirty four patients (58%) received RCHOP or RCHOP-like chemotherapy and 24 (42%) underwent an upfront ASCT. Three years overall (OS) and progression free survival (PFS) were 81% and 45% respectively. No significant differences in OS or PFS between the PET positive and PET negative groups both for interim and post therapy scans were observed. Analysis of chemotherapy only and chemotherapy+ASCT groups separately did not reveal any correlation between interim, post therapy or pre transplant PET result to OS and PFS. We conclude that in patients treated with R-CHOP-21 or R-CHOP- like chemotherapy using the International Harmonization Project criteria to determine whether a scan is positive or negative, there is no role for interim or post therapy PET.
    Leukemia & lymphoma 01/2014; DOI:10.3109/10428194.2014.882506 · 2.89 Impact Factor
  • Tima Davidson · Elinor Goshen · Abraham Avigdor · Tzila Zwas
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    ABSTRACT: PURPOSE NL is defined as infiltration of nerves by malignant cells of lymphocyte origin presenting as a rare extra-nodal manifestation of lymphoma. About 50% of NL was diagnosed prior to PET-CT development, at autopsy. Yet, even since then only sporadic cases of NL were reported. We present a retrospective study of 9 lymphoma patients group with NL diagnosed by PET/CT either at presentation or upon disease recurrence,at our institution. METHOD AND MATERIALS During 2004-2010 period, 9 patients (age range 23-69); mean 50 yrs, including 5 females and 4 males were evaluated. 7/9 patients had diffuse large B-cell lymphoma (DLBC) and 2/9- Hodgkin’s lymphoma, transformed to DLBC, who underwent PET CT .A whole body PET-CTwas performed 50` post i.v. injection of 10 mCi F-18-FDG, using 16 slices Helical CT (GXL Philips,LTD). Disease staging, treatment monitoring and follow-up was performed .Their PET-CT findings were correlated with clinical findings, other pertinent diagnostic modalities (MRI,US) and clinical follow-up of up to 6 years. RESULTS Most typical NL visualization on 18F-FDG PET-CT scan was a linear shaped uptake pattern along the corresponding thickened nerve tract or neural plexus; or a linear uptake finding simulating the course of a neural tract location. These NL findings were located in extra nodal sites, mostly involving multiple cranial or peripheral nerves, nerve roots at different vertebral levels, or branchial and lumbar plexsuses. These findings frequently accompanyed nodal disease recurrence, necessitating specific attention with early changes in this aggressive disorder management. There were no falsely diagnosed NL results in our group. The appearance of the findings often resembled vascular , lymphatic or muscular tract but anatomic CT localizations aided in identifying their correct nature and locations and as a viable neural disease. CONCLUSION F-l8 FDG PET-CT in our lymphoma group appears to be a highly sensitive and specific in the disgnosis of NL. It has been more frequently diagnosed in recent years, due to increased awareness and extensive use of hybrid PET-CT, enabling anatomic as well as hypermetabolic processes localization in neural structures. Early recognition and treatment of this rare lymphoma manifestation indeed improved disease outcome in our group. CLINICAL RELEVANCE/APPLICATION Early recognition and treatment of NL, a rare lymphoma manifestation, indeed improves disease outcome in lymphoma patients.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 11/2011
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    ABSTRACT: Venous thromboembolism is a well-recognized and relatively frequent complication of malignancy, whereas tumor thrombosis is a rare complication of solid cancers. The correct diagnosis of tumor thrombosis and its differentiation from VTE can alter patient management and prevent unnecessary long-term anticoagulation treatment. To evaluate the contribution of 18F-fluorodeoxyglucose positron emission tomography/computed tomography to the diagnosis of tumor thrombosis and its differentiation from VTE. PET/CT scans from 11 patients with suspected tumor thrombosis were retrospectively evaluated. Suspicion arose from positive PET/CT in eight cases, or from findings on contrast-enhanced CT in three patients. Criteria for positivity of PET/CT included increased focal or linear uptake of 18F-FDG in the involved vessel. Findings were categorized as PET/CT positive, or PET/CT negative and compared to contrast-enhanced or ultrasound Doppler, pathology where available, and clinical follow-up. Eight occult tumor thromboses were identified by PET/CT-positive scans. Underlying pathologies included pancreatic, colorectal, renal cell, and head-neck squamous cell carcinoma, as well as lymphoma (4 patients). Three thrombotic lesions on contrast-enhanced CT were PET/ CT negative, due to VTE (2 patients) and leiomyomatosis. Accuracy of PET/CT to differentiate between tumor thrombosis and benign VTE was 100% in this small study. Contrast-enhanced CT defines the extent of thrombotic lesions, while the functional information from PET/CT characterizes the lesions. It appears that PET/CT may be helpful in the diagnosis of occult tumor thrombosis and its differentiation from VTE.
    The Israel Medical Association journal: IMAJ 03/2009; 11(2):69-73. · 0.90 Impact Factor
  • Tima Davidson · Elinor Goshen
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    ABSTRACT: PURPOSE Venous thromboembolism (VTE) is a well recognised and relatively frequent complication of malignancy, whereas tumor thrombosis (TT) is a rare complication of some cancers.This study was aimed to evaluate the contribution of F18-FDG PET/CT to the diagnosis of TT and its differentiation from VTE. METHOD AND MATERIALS PET/CT scans from 10 patients with suspected thrombotic lesions were retrospectively evaluated. Suspicion arose from positive PET in 7 cases, and or from findings on contrast enhanced CT in 3 patients. Criteria for positivity of PET are: increased focal or linear uptake of 18F-FDG in the involved vessel and standard uptake value (SUV) above 2.5. Findings were categorized as PETpositive (+) or PET negative (-) and compared to contrast enhanced CT or US Doppler, pathology when available and clinical follow-up. RESULTS Seven cases of occult tumor thrombosis were identified by PET (+) scans and all 7 patients had CT findings consistent with thrombosis. Underlying pathologies included pancreatic , renal cell and head and neck squamous cell carcinoma, and 4 patients with lymphoma. Three patients had thrombotic lesions on contrast enhanced CT and PET (-) scans. These were due to VTE (2cases) and leiomyomatosis. Accuracy of PET/CT to differentiate between TT and benign VTE was 100% in this small study. CONCLUSION Anatomic localization of positive PET lesions was enabled by the fusion of functional PET and anatomic CT data. Contrast enhanced CT reveals presence and defines extent of thrombotic lesions, yet the functional information from PET charcterizes the lesions. PET/CT may be contributory in the diagnosis of occult TT and its differentiation from VTE. CLINICAL RELEVANCE/APPLICATION Correct diagnosis of TT and its differentiation from VTE can alter patient management and prevent unnecessary long- term anticoagulation treatment.
    Radiological Society of North America 2008 Scientific Assembly and Annual Meeting; 12/2008
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    ABSTRACT: Positron emission tomography (PET) with F-18 fluorodeoxyglucose detects active lymphoid tissue during HIV-1 infection, with distinct patterns of lymphoid activation correlating to various stages of disease activity. Patients with HIV-1 are at risk for lymphoma, making the differential diagnosis between benign and malignant lymphadenopathy imperative. This study retrospectively evaluated the role of PET/computed tomography (CT) in differentiating active lymphoma from persistent generalized lymphadenopathy in patients with HIV-1. Seven patients with HIV-1 underwent PET/CT. Six, with known non-Hodgkin lymphoma underwent a total of 16 PET/CT scans; 5/16 scans were performed for initial staging, and 10/16 for evaluating treatment response and follow-up. One patient was referred for evaluation of lymphadenopathy suspected of being lymphoma. PET/CT findings were compared with concurrent clinical, immunologic, and virological data. PET/CT accurately depicted the extent of lymphoma in 12/16 patients' scans (75%), yet in 4/16 (25%) scans increased fluorodeoxyglucose uptake was noted in lymph nodes of normal CT appearance (PET+/CT-). Viral loads ranged from 0 to 84,000 copies/mL, CD4 T-cell count ranged from 130 to 474 cells/muL in the group. The highest values of both laboratory parameters were concurrent with the discrepant PET+/CT- scans, seen in 4 scans, in 2 patients. The PET+/CT- findings in both these patients were observed in neck, axillae, mediastinum, spleen, and inguinal regions, and sample biopsies of the PET (+) nodes consequently proved benign findings in both patients. All PET+/CT+ findings correctly indicated lymphoma status, as proven by clinical follow-up. PET/CT accurately detected lymphoma in patients with HIV-1 and had been used confidently as a management tool in this patient group. In the context of discrepant PET/CT findings, increased viral loads and CD4 levels may imply benign HIV-related lymphadenopathy.
    Clinical nuclear medicine 10/2008; 33(9):610-4. DOI:10.1097/RLU.0b013e3181813047 · 3.93 Impact Factor
  • Elinor Goshen · Tima Davidson · Moshe Yeshurun · S Tzila Zwas
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    ABSTRACT: Increased uptake of F-18 FDG is the general mainstay of diagnosis, because it indicates hypermetabolic foci of pathology. This case, describing a patient with relapsing lymphoma, represents the diagnostic dilemmas of both locally decreased and diffusely increased uptake in the skeleton.
    Clinical Nuclear Medicine 10/2006; 31(9):520-2. DOI:10.1097/01.rlu.0000233080.16944.a4 · 3.93 Impact Factor
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    E Goshen · T Davidson · D Aderka · S T Zwas
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    ABSTRACT: Abdominal wall metastases from colorectal cancer (CRC) may be resected with curative results. Such lesions, often indicators of additional intra-abdominal lesions, may appear in surgical scars, stomas and port site metastases after laparoscope-assisted surgery (LAS). Post-operative changes, primarily surgical scars, alter local physical findings making early detection of small lesions challenging. The purpose of this study was to retrospectively evaluate the contribution of PET/CT to the diagnosis of recurrent colorectal cancer in the post-operative abdominal wall. 120 patients were referred for PET/CT with suspected recurrent CRC based on clinical, radiological or laboratory findings. All underwent whole body PET/CT imaging. 12 of these 120 (10%), were found to have abdominal wall lesions. A total of 16 abdominal wall lesions were detected, located to surgical scars, stomas, drain and laparoscope ports. Additional findings on PET/CT in this group included liver metastases, intra-abdominal lesions and retroperitoneal lymph node involvement. In general, the patients in this small group were young with high grade tumours presenting in advanced stages. In conclusion, PET/CT appears to be a sensitive tool for the diagnosis of abdominal wall recurrence of CRC. The accuracy of localization afforded by the fused functional and anatomic images makes PET/CT a likely tool for diagnosing abdominal wall lesions, including port site metastases of other aetiologies.
    The British journal of radiology 08/2006; 79(943):572-7. DOI:10.1259/bjr/25287790 · 2.03 Impact Factor
  • E Goshen · T Davidson · R Yahalom · Y.P. Talmi · S.T. Zwas
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    ABSTRACT: The purpose of this study was to compare the findings of positron emission tomography (PET) with fused PET and computed tomography (CT) in patients with suspected locoregional and distant head and neck cancer and to evaluate the impact of those findings on clinical management. Studies of 25 patients were retrospectively evaluated. PET findings were classified as malignant, benign or equivocal. PET/CT findings were then similarly classified and the PET-only results were amended accordingly. Comparison of findings was done on lesion and patient levels. A total of 45 foci of increased 18F-fluorodeoxyglucose (FDG) uptake were noted in 18 patients. PET/CT imaging defined anatomic localization of 41/45 lesions and clarified 6/10 equivocal PET findings. Additional information was provided by PET/CT regarding 9/45 (20%) of the lesions. PET/CT significantly affected patient management in 3/25 patients (12%) by limiting the extent of disease in one and excluding viable disease in two others. The accuracy of PET/CT was 88%, the sensitivity 100% and the specificity was 77%. The negative predictive value was 100% in this combined group of patients with locoregional and distant head and neck cancer. PET/CT is highly contributory for initial staging and in the evaluation of patients with suspected recurrent SCC of the head and neck, in whom anatomic imaging is inconclusive due to the locoregional distortions rendered by surgery and radiotherapy.
    International Journal of Oral and Maxillofacial Surgery 05/2006; 35(4):332-6. DOI:10.1016/j.ijom.2005.08.003 · 1.57 Impact Factor
  • Elinor Goshen · Tima Davidson · S. Tzila Zwas · Dan Aderka
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    ABSTRACT: The present approach at our institution for the treatment of patients with colorectal (CRC) cancer and with liver metastases planned for metastasectomy is the neoadjuvant administration of Bevacizumab with Irinotecan based therapy. Metabolic imaging of tumor viability with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET), and simultaneous anatomic localization provided by low-dose non-enhanced computed tomography (CT), can be obtained in a combined modality FDG-PET/CT scan. The purpose of this study was to evaluate the possible contribution of FDG-PET/CT as a surrogate marker to evaluate treatment response of liver metastases in vivo. This is a retrospective evaluation of 18F-FDG PET and CT findings in the first seven consecutive patients. FDG-PET/CT scans were performed before the start of the neoadjuvant and after four cycles of therapy, just prior to surgery. Results were compared to concurrent contrast-enhanced CT, when required, and pathology. Response to treatment was determined according to RECIST size criteria obtained from data from thin (3–5mm) slice CT, and changes in uptake of 18F-FDG uptake on PET.
    Technology in cancer research & treatment 03/2006; 5(1):37-43. DOI:10.1177/153303460600500105 · 1.73 Impact Factor
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    ABSTRACT: We aimed to assess low-dose recombinant human thyroid-stimulating hormone (rhTSH)-aided, fixed-activity radioiodine therapy of large, multinodular goiters (MNGs) in elderly patients with comorbidities. This was a short-term, observational study. We measured 24-h thyroid radioiodine uptake (RAIU) of 2 microCi 131-iodine at baseline and 24 h after intramuscular injection of 0.03 mg rhTSH in 17 patients (aged 60-86 years, 12 women), who subsequently received 30 mCi 131-iodine 24 h after an identical rhTSH injection. TSH and free thyroxine (FT4) were measured at baseline and days 10, 30 and 90 after therapy. Thyroid volume was assessed by computed tomography at baseline and day 180. rhTSH, 0.03 mg, significantly increased mean 24-h thyroid RAIU from 25.8% +/- 10.3% to 43.3% +/- 8.4% (68% relative increase; t(16) = -8.43, P < 0.001). The proportion of patients overtly or subclinically hyperthyroid (TSH < 0.5 mU/l) decreased from 71% (12/17) at baseline to 19% (3/16) at 3 months. Mean serum FT4 peaked at slightly above normal range, 25.9 +/- 7.7 pmol/l (46% over baseline) and was 21% under baseline levels at 3 months. Mean estimated thyroid volume fell 34% from baseline to 6 months (170.0 +/- 112.8 to 113.1 +/- 97.5 ml; P < 0.01). Symptomatic relief, improved well-being, and/or reduction or elimination of antihyperthyroid medication were seen in 76% of patients. Three (18%) patients had transient neck pain or tenderness, or palpitations; one had transient asymptomatic thyroid enlargement; and three (18%) became hypothyroid by 3 months. Intramuscular rhTSH, 0.03 mg, followed 24 h later by 30 mCi 131-iodine, is a safe, effective and convenient treatment for MNG in elderly patients with comorbidities.
    European Journal of Endocrinology 02/2006; 154(2):243-52. DOI:10.1530/eje.1.02094 · 4.07 Impact Factor
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    ABSTRACT: AD, a 45-year-old man, presented with a severe and global anterograde amnesia following surgery for removal of a colloid cyst. Structural neuroimaging confirmed bilateral lesions to the fornix and a small lesion in the basal forebrain. Testing for remote episodic memory of autobiographical events, and for remote semantic memory of personal and public events, and of famous people, revealed that AD had a severe retrograde amnesia for autobiographical episodes that covered his entire lifetime, and a time-limited retrograde amnesia for semantic memory. Because the fornix and basal forebrain lesions disrupted major afferent and efferent pathways of the hippocampus, it was concluded that the integrity of the hippocampus and its projections are needed to retain and/or recover autobiographical memories no matter how old they are. By contrast, hippocampal contribution to semantic memory is time-limited. These findings were interpreted as consistent with Multiple Trace Theory, which holds that the hippocampal system is essential for recovering contextually rich memories no matter how old they are, but is not needed for recovering semantic memories.
    Neuropsychologia 02/2006; 44(12):2241-8. DOI:10.1016/j.neuropsychologia.2006.05.020 · 3.30 Impact Factor
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    ABSTRACT: Somatostatin receptor scintigraphy has been used widely for the evaluation of neuroendocrine tumors in the gastrointestinal tract. Its use for detecting and staging thoracic carcinoids is only sporadically reported. To evaluate the possible roles of SRS in the management of proven or suspected pulmonary carcinoids. We conducted a retrospective study of all patients undergoing SRS for known or suspected pulmonary carcinoids in a tertiary referral center during a 10 year period. During this period 89 patients underwent resection of pulmonary carcinoids and SRS was used for detection, staging or localization purposes in 8 of them (9%). Scans were labeled true positive, true negative, false positive, or false negative in comparison with histologic or follow-up results. SRS was true positive in 6/6 lung locations; true positive in 2/8, true negative in 4/8 and false positive in 2/8 lymph node locations; and true positive in 1/8, true negative in 6/8 and false negative in 1/8 distant locations. The sensitivity, specificity, positive and negative predictive values and accuracy were 90%, 83%, 83%, 91% and 87% respectively. The scans were strongly positive in the tumors and involved lymph nodes. SRS correctly localized an occult secreting pulmonary carcinoid. Granulomatous and reactive lymph nodes showed increased uptake. SRS was accurate in ruling out distant metastases. SRS is effective for visualizing and localizing pulmonary carcinoids. It assists in the staging of these tumors by detecting lymph node involvement and confirming or ruling out distant metastases. Inflammatory areas in the lung or lymph nodes may be falsely positive.
    The Israel Medical Association journal: IMAJ 12/2005; 7(11):712-6. · 0.90 Impact Factor
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    ABSTRACT: Moyamoya disease is a cerebral vasculopathy characterized mainly by progressive narrowing of the major intracranial vessels. While more common and having a familial predilection in the Far East, it can also develop in association with some common hereditary diseases and can be acquired after environmental exposure. In the young its manifestations are the result of cerebral ischemia. Adults usually suffer from repeated incidents of intracerebral hemorrhage. Surgical revascularization of ischemic cerebral territories plays a major role in their treatment. We review the literature and present our series of three adult and five pediatric patients; these patients were diagnosed at our institution and treated with indirect revascularization techniques.
    The Israel Medical Association journal: IMAJ 11/2005; 7(10):661-6. · 0.90 Impact Factor
  • E Goshen · R Yahalom · Y P Talmi · G Rotenberg · Y Oksman · S T Zwas
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    ABSTRACT: Squamous cell carcinoma (SCC) is the most common cancer of the head and neck (HNC). Advanced HNC warrants extensive ablative and reconstructive procedures, significantly altering locoregional anatomy, while radiation treatment further adds to the distortion. Anatomic imaging is therefore often inconclusive in suspected recurrent HNC. Functional imaging with fluorodeoxyglucose-positron emission tomography (FDG-PET) has been reported contributory in the evaluation of patients with SCC. While most reports are from dedicated PET systems, full ring PET is of limited availability and gamma-PET may offer a suitable compromise. The therapeutic impact of gamma-PET in patients with suspected recurrent HNC was retrospectively evaluated. Seventeen patients were evaluated. All had undergone surgery for HNC, 16 also received radiotherapy. gamma-PET scans were compared to anatomic imaging, histopathology and clinical follow-up. The impact of the FDG-PET scan on patient management was then evaluated. Eleven positive findings were confirmed. Two false positives were due to radiation changes, a recognized pitfall. There were no false negatives. Overall accuracy of the 18F-FDG gamma-PET scans was 88% with considerable effect on patient management. Gamma-PET with FDG appears valuable in the evaluation of suspected recurrent HNC, and may provide a suitable alternative when dedicated PET is unavailable.
    International Journal of Oral and Maxillofacial Surgery 07/2005; 34(4):386-90. DOI:10.1016/j.ijom.2004.08.007 · 1.57 Impact Factor
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    ABSTRACT: To review our experience using dynamic 99mTc-diethylenetriamine penta-acetic acid renal scintigraphy combined with indirect radionuclide cystography (IRC) in the acute phase of pyelonephritis, as a possible alternative to the conventional imaging, as investigating acute pyelonephritis usually includes imaging the upper urinary tract during the acute phase, to exclude obstruction, and delayed voiding cysto-urethrography (VCUG) when underlying vesico-ureteric reflux (VUR) is suspected. Between 1997 and 1999, 47 young women (median age 22 years, range 18-37) were hospitalized for acute pyelonephritis. The combined study was used during the acute phase of the disease, usually within 24 h of hospitalization. The principle of IRC is based on the reappearance of radioactivity in the ureters or kidneys after previously detecting renal clearance of an intravenously injected radioisotope. The increase in radioactivity over the ureters or kidneys indicates VUR. The subsequent follow-up included VCUG, after recovery and at least 6 weeks after discharge. Overall, 47 patients had early IRC studies; obstruction of the urinary tract during the acute phase of the disease was excluded in all. In 13 (28%) of the patients early IRC studies showed VUR involving 21 upper tract units. The renal parenchymal scan was impaired in 17 (36%) patients, and six of these 17 also had detectable concomitant reflux on IRC. Overall, 24 IRC studies (51%) were considered positive, showing VUR, renal parenchymal pathology or both; 23 (49%) were normal. Follow-up VCUG was used in 32 patients (68%); only three (9%) detected VUR. All of the patients with VUR on follow-up VCUG had also had an abnormal early IRC study, showing either reflux (two) or findings suggestive of pathological renal parenchyma (one). In addition to the well-established role of renal scintigraphy in excluding obstruction of the collecting system, early IRC is characterized by high sensitivity and accurate negative predictive value for detecting VUR. It can therefore be used to screen adults presenting with acute pyelonephritis for the presence of VUR. Patients with an abnormal IRC require follow-up VCUG after complete recovery, while those with a negative study may be managed expectantly, with no further radiological evaluation. This proposed strategy may avoid up to half of the delayed VCUG studies, preclude the related inconvenience, and substantially reduce the costs.
    BJU International 04/2005; 95(4):619-23. DOI:10.1111/j.1464-410X.2005.05350.x · 3.53 Impact Factor
  • European Neuropsychopharmacology 03/2005; 15. DOI:10.1016/S0924-977X(05)80171-3 · 4.37 Impact Factor
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    ABSTRACT: A patient suffering from aggressive personality changes and cognitive impairment following head trauma, without neurological or anatomical imaging findings, underwent neuroSPECT scans with and without acetazolamide injection, both before treatment and during treatment with valproate. Acetazolamide injection induced increased prefrontal perfusion not evident at baseline. Valproate treatment was associated with increased prefrontal perfusion concomitant with clinical improvement and abolished response to acetazolamide challenge.
    Psychiatry Research 01/2005; 132(3):279-83. DOI:10.1016/j.pscychresns.2004.09.004 · 2.47 Impact Factor
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    Elinor Goshen · Yakov Oksman · Galina Rotenberg · S Tzila Zwas
    Seminars in Nuclear Medicine 05/2004; 34(2):157-8. DOI:10.1053/j.semnuclmed.2003.12.007 · 3.34 Impact Factor
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    ABSTRACT: A pertinent question in biological psychiatry is what differentiates responders and non-responders to pharmacological treatment. One possibility is that individual differences in the symptomatic spectrum as well as in the underlying biology of the disorder lead to the known 40% failure in pharmacological treatment. Our study aimed to maximize individual brain markers of obsessive-compulsive disorder (OCD) by applying single photon emission computed tomography (SPECT) during a provoked symptomatic state prior to and following treatment. Four brain SPECT scans were obtained from 26 OCD patients prior to and at 6 months of sertraline treatment. At each time point, two SPECT scans were performed in a counterbalanced order of two specific states; one a symptom-provoking condition and the other a relaxed condition. At 6 months of treatment, patients were divided into responders and non-responders according to a predetermined clinical criterion. Prospective responders showed significantly lower brain perfusion in the dorsal-caudal anterior cingulum and higher brain perfusion in the right caudate, when compared to non-responders, only during symptom provocation. When pre- and post-treatment scans during symptom provocation were compared, only responders showed significant change in brain response: increased perfusion in the left anterior temporal cortex and prefrontal cortex at 6 months' treatment. These findings suggest that obtaining functional brain imaging during specific symptom provocation emphasizes individual differences in brain reactivity. Thus can indicate prospective responders to symptom-related treatment in OCD and mark the relevant brain regions for effective response to treatment.
    Psychiatry Research 11/2003; 124(2):87-103. DOI:10.1016/S0925-4927(03)00091-X · 2.47 Impact Factor

Publication Stats

464 Citations
101.56 Total Impact Points


  • 1997–2014
    • Sheba Medical Center
      • • Department of Pathology
      • • Institute of Endocrinology
      Gan, Tel Aviv, Israel
  • 1995–2008
    • Tel Aviv University
      • Faculty of Medicine
      Tell Afif, Tel Aviv, Israel
  • 2005
    • Ministry of Health (Israel)
      Yerushalayim, Jerusalem District, Israel