Sheila Sheth

Johns Hopkins University, Baltimore, Maryland, United States

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Publications (80)218.27 Total impact

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    ABSTRACT: The purpose of this study was to determine the prevalence and types of renal and extrarenal abnormalities that preclude renal donation or lead to alteration of the surgical approach on the basis of abdominal CT angiography (CTA) in a large group of potential renal donors. In this retrospective study, 654 potential renal donors undergoing dual-phase CTA were identified from January 2005 to January 2009. The CT reports were systemically reviewed by two radiologists to determine the presence of renal and extrarenal abnormalities. The operative notes of the renal donors were reviewed by one radiologist to determine whether the presence of renal pathology had affected the surgical approach. In the candidates who did not proceed to kidney donation, the reasons that precluded kidney donation were abstracted from the transplant database. Four hundred seventeen potential donors (269 men and 385 women; mean age, 44.0 years; age range, 17-79 years) proceeded to renal donation and 237 did not. The most common renal abnormalities were cysts (34%) and renal stones (4.4%). Renal artery disease was identified in 3.4% of potential donors, including renal artery stenosis, possible fibromuscular dysplasia, and renal artery aneurysm. Suspicious renal masses were incidentally found in 0.5% of potential donors. The most common extrarenal pathology was an incidental adrenal nodule (2.6%). Other significant extrarenal pathology identified included gallbladder mass (0.2%), Crohn disease (0.2%), ovarian mass (0.2%), and possible sarcoidosis (0.2%). Although renal and extrarenal abnormalities were present in 41% of potential renal donors, abnormalities seen on CT only contributed to exclusion of 27 potential donors (4.1%). The most common reason for exclusion was the presence of renal stones or scarring (1.8%). Significant CT findings also contributed to the selection of the right kidney in 29 donors, most commonly due to presence of ipsilateral vascular disease or complex left vascular anatomy. Renal parenchymal and vascular abnormalities are common in asymptomatic potential kidney donors. Although most of these represent incidental CT findings, abnormalities can exclude potential renal donors and alter the surgical approach in a small minority of cases.
    American Journal of Roentgenology 11/2012; 199(5):1035-41. DOI:10.2214/AJR.11.8058 · 2.74 Impact Factor
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    ABSTRACT: On computed tomography (CT), gallbladder pathology may be detected incidentally or as the etiology of symptoms that prompted imaging. Accurate pathologic diagnosis can be challenging, however, due to overlapping appearances of malignant and benign gallbladder disease. This pictorial essay takes a pattern-based approach to CT of the gallbladder, to help the radiologist formulate the proper differential diagnosis.
    Abdominal Imaging 05/2012; 38(3). DOI:10.1007/s00261-012-9907-1 · 1.73 Impact Factor
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    ABSTRACT: Cervical lymph node metastases from differentiated thyroid cancer (DTC) are common. Thirty to eighty percent of patients with papillary thyroid cancer harbor lymph node metastases, with the central neck being the most common compartment involved. The goals of this study were to: (1) identify appropriate methods for determining metastatic DTC in the lateral neck and (2) address the extent of lymph node dissection for the lateral neck necessary to control nodal disease balanced against known risks of surgery. A literature review followed by formulation of a consensus statement was performed. Four proposals regarding management of the lateral neck are made for consideration by organizations developing management guidelines for patients with thyroid nodules and DTC including the next iteration of management guidelines developed by the American Thyroid Association (ATA). Metastases to lateral neck nodes must be considered in the evaluation of the newly diagnosed thyroid cancer patient and for surveillance of the previously treated DTC patient. Lateral neck lymph nodes are a significant consideration in the surgical management of patients with DTC. When current guidelines formulated by the ATA and by other international medical societies are followed, initial evaluation of the DTC patient with ultrasound (or other modalities when indicated) will help to identify lateral neck lymph nodes of concern. These findings should be addressed using fine-needle aspiration biopsy. A comprehensive neck dissection of at least nodal levels IIa, III, IV, and Vb should be performed when indicated to optimize disease control.
    Thyroid: official journal of the American Thyroid Association 03/2012; 22(5):501-8. DOI:10.1089/thy.2011.0312 · 3.84 Impact Factor
  • Sheila Sheth
    Ultrasound Clinics 04/2011; 6(2):163-176. DOI:10.1016/j.cult.2011.03.006
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    ABSTRACT: Sestamibi scintigraphy and neck ultrasonography have both been proposed as screening modalities for the detection of abnormal parathyroid glands in patients with primary hyperparathyroidism. As a result, many surgeons use both techniques prior to surgery. The goal of this study was to independently evaluate both ultrasound and sestamibi as single-modality preoperative screening tools for primary hyperparathyroidism. A retrospective review of consecutive patients who underwent surgery for primary hyperparathyroidism from January 1999 to December 2009. Imaging results were compared to surgical findings. 440 patients were found to meet inclusion criteria. Sensitivities for correct localization of a single parathyroid adenoma for sestamibi versus ultrasound were: 83% (95% CI 78-86) versus 72% (95% CI 67-76). Ultrasound operator had no influence on sensitivity, and ultrasound identified nodular thyroid disease in 31% of patients. Ultrasonography alone can be used as the primary screening modality in patients with primary hyperparathyroidism. Ultrasound sensitivity is conserved despite operator variability, and identifies concomitant thyroid pathology.
    ORL 03/2011; 73(2):116-20. DOI:10.1159/000323912 · 0.67 Impact Factor
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    ABSTRACT: OBJECTIVE: This article will review the current literature regarding the detection of thyroid nodules with an emphasis on CT diagnosis. We will also discuss management strategies. CONCLUSION: With advances in cross-sectional imaging, the detection of incidental thyroid nodules has increased significantly. Detection of thyroid nodules is common on chest CT that is being performed for unrelated reasons. The workup of these nodules can be timeconsuming and expensive.
    American Journal of Roentgenology 11/2010; 195(5):1066-71. DOI:10.2214/AJR.10.4506 · 2.74 Impact Factor
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    ABSTRACT: Small cell osteosarcoma may present a challenging primary diagnosis on cytologic assessment owing to its rarity and its morphologic similarity to other small round blue cell tumors. Five cases of small cell osteosarcoma from our cytopathology archives were identified and reviewed and cytologic features elaborated. Three cases were fine-needle aspirations from bony lesions in the classic location for osteosarcoma (2 distal femur and 1 proximal tibia), and 2 aspirations were from metastases. Common cytomorphologic features included relatively small to intermediate cell size, high nuclear/cytoplasmic ratios, round nuclei, minimal anisonucleosis, finely granular nuclear chromatin, fine cytoplasmic vacuoles, and only rare osteoid. Small cell osteosarcoma shares many of the well-described cytomorphologic features of classic osteosarcoma, but the relatively small cells, round hyperchromatic nuclei, and scant osteoid constitute the common denominator. Correlation with radiographic findings and ancillary tests can aid in definitive diagnosis.
    American Journal of Clinical Pathology 05/2010; 133(5):756-61. DOI:10.1309/AJCPO07VGDZCBRJF · 3.01 Impact Factor
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    ABSTRACT: OBJECTIVE: The purpose of this article is to review the CT findings associated with superior vena cava obstruction and to illustrate collateral venous pathways bypassing the obstruction as shown on MDCT. CONCLUSION: Multiple collateral venous pathways can form to bypass an obstruction of the superior vena cava. With its ability to acquire near isotropic data, MDCT allows high-quality reformations and thus exquisitely displays these venous collaterals and has the potential to aid in planning therapy to bypass the obstruction.
    American Journal of Roentgenology 04/2010; 194(4):W336-46. DOI:10.2214/AJR.09.2894 · 2.74 Impact Factor
  • Sheila Sheth
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    ABSTRACT: Ultrasonography (US) is the single-most valuable imaging modality in the evaluation of the thyroid gland. This review discusses the US appearances of thyroid nodules, emphasizing sonographic features associated with potentially malignant or, at the other end of the spectrum, likely benign nodules. Diffuse thyroid abnormalities have also been reviewed. The technique of ultrasound-guided fine-needle aspiration biopsy and the emerging role of elastography in characterizing thyroid nodules have also been addressed.
    Otolaryngologic Clinics of North America 04/2010; 43(2):239-55, vii. DOI:10.1016/j.otc.2010.02.001 · 1.34 Impact Factor
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    ABSTRACT: The purpose of the present study was to determine the utility of routine dissection of level II-B and level V-A in patients with papillary thyroid cancer (PTC) undergoing lateral neck dissection for ultrasound-guided fine-needle aspiration (FNA)-confirmed lateral nodal metastasis in at least one neck nodal level. In a retrospective review, we studied the charts of 53 consecutive patients (February 2002-December 2007) with PTC who had undergone therapeutic lateral neck dissection that included at least level II-(A and B) and/or level V-(A and B). The levels were designated as such in situ prior to surgical pathology specimen processing. Reports of the preoperative FNA cytopathologic findings, the extent of lateral neck dissection by levels, and the postoperative final histopathologic examination were reviewed. A total of 53 patients underwent therapeutic lateral neck dissection for FNA-confirmed nodal metastasis of PTC at a minimum of one lateral neck level. All 53 patients had preoperative ultrasonography and FNA confirmation of lateral neck disease: 46 patients had PTC, 5 had the tall cell variant of PTC, and 2 had the follicular variant of PTC on final surgical pathology. Ten patients underwent neck dissection at the time of thyroidectomy, and 43 patients underwent neck dissection for lateral neck recurrence/persistence of PTC following a previous thyroidectomy and radioactive iodine +/- previous neck dissection. A total of 46 patients underwent unilateral neck dissection and 7 patients underwent bilateral neck dissection; thus 60 neck dissection specimens were evaluated. Level II (A and B) was excised in 59/60 neck dissections, with 33 of 59 specimens (33/59 = 60%) positive for metastasis. Level II-B was positive 5 times (5/59; 8.5-95% CI: 2.4, 20.4), and each time level II-B was positive, level II-A was also grossly (and histopathologically--seen at the time of surgery) positive for metastasis. Level III was excised 58 times and was positive in 38 specimens (38/58 = 66%). Level IV was excised 58 times and was positive in 29 specimens (29/58 = 50%). Level V (A and B) was excised 40 times and was positive in 16 specimens (16-40 = 40%). Level V-A did not account for any of the positive level V results (0%). Cervical lateral neck metastases in PTC occur in a predictable pattern, with levels III, II-A, and IV most commonly involved. Patients with PTC who undergo lateral neck dissection for FNA-confirmed nodal metastases might harbor disease in level II-B, especially if level II-A is involved. We recommend elective dissection of level II-B only when level II-A is involved, based on FNA confirmation, or when it is grossly involved on intraoperative evaluation. Routine dissection of level V-B is recommended in this patient population, while elective dissection of level V-A is not necessary.
    World Journal of Surgery 07/2009; 33(8):1680-3. DOI:10.1007/s00268-009-0071-x · 2.35 Impact Factor
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    Brad P. Barnett, Sheila Sheth, Syed Z. Ali
    01/2009; 53:672-678. DOI:10.1159/000325409
  • Brad P Barnett, Sheila Sheth, Syed Z Ali
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    ABSTRACT: To analyze the cytopathologic findings of a series of paratracheal space (PTS) masses in the context of clinicoradiologic correlation. Retrospective review of our cytopathology files revealed 131 cases of PTS lesions in a 14-year period (1991-2005). Cytologic material was obtained under radiologic guidance. Radiologic findings, clinical data and subsequently performed tissue biopsies were reviewed and correlated. Radiologic imaging disclosed masses in the PTS ranging from 1 to 7 cm. Of the 131 cases, 103 (79%) were deemed diagnostic. Of these, 41 (40%) revealed nonneoplastic lesions, and 62 (60%) yielded malignant neoplasms. Nonneoplastic entities included: 31 (73%) hyperplastic lymph nodes and 10 (24%) sarcoidosis. Of the malignant cases, 45 (73%) were metastatic tumors: adenocarcinoma (ACA) 19, small cell carcinoma 12, squamous cell carcinoma (SQCC) 11 and other tumors, from lung 34, esophagus 4 and other sites. Malignant neoplasms from local spread included lung non-small cell carcinoma 6, SQCC 3 and ACA 3, papillary thyroid carcinoma 3 and other 2. Fine needle aspiration (FNA) of PTS has a high diagnostic yield (79%) with a sensitivity of 97% and specificity of 100%. The most common diagnosis is a malignant tumor (60%), with metastatic carcinoma (73%) the most common neoplasm (lung ACA the most common primary source). The most common benign entity is a hyperplastic lymph node (24%). Ancillary studies (immunoctyochemistry, fluorescence in situ hybridization and electron microscopy) were helpful and provided definitive diagnosis in 30% of the initially nondiagnostic FNA samples.
    Acta cytologica 01/2009; 53(6):672-8. · 1.56 Impact Factor
  • Sheila Sheth, Ulrike M Hamper
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    ABSTRACT: High-resolution neck ultrasound plays a vital role in the evaluation and management of patients after total thyroidectomy for thyroid cancer. This technique is increasingly used by endocrinologists and head and neck surgeons to detect potential locoregional recurrences or metastases and map malignant lymph nodes before reoperation. It is also invaluable as guidance for fine-needle aspiration of suspicious lesions.Thorough knowledge of the compartments of the neck and meticulous scanning technique are essential for success.The purpose of this article is to review the common pattern of recurrences of differentiated thyroid cancer, describe our scanning protocol, and depict the characteristics of benign, indeterminate, and suspicious lesions in the postthyroidectomy neck.
    Ultrasound quarterly 10/2008; 24(3):147-54. DOI:10.1097/RUQ.0b013e31818625ce · 1.40 Impact Factor
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    ABSTRACT: Objectives 1) Patterns of cervical metastasis in PTC. 2) Importance of elective dissection of levels II-B & V-A.
    Otolaryngology Head and Neck Surgery 08/2008; 139(2):P135-P135. DOI:10.1016/j.otohns.2008.05.350 · 1.72 Impact Factor
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    ABSTRACT: Although long recognized as a nosocomial organism, methicillin-resistant Staphylococcus aureus (MRSA) has been noted to have an increasing incidence in both immunocompromised and otherwise healthy people in the community. Community-acquired MRSA (CA-MRSA) is genetically distinct from hospital-acquired MRSA and frequently expresses the Panton-Valentine leukocidin toxin, which confers an aggressive necrotizing phenotype and is accompanied by a poor prognosis. We present a case of CA-MRSA pneumonia with the aim to alert the radiologist of the radiographic manifestations of this increasingly encountered and frequently fatal disease.
    Emergency Radiology 03/2008; 16(2):159-62. DOI:10.1007/s10140-008-0706-5
  • Sheila Sheth, Elliot K Fishman
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    ABSTRACT: OBJECTIVE: The purpose of this pictorial essay is to illustrate the role of MDCT in the diagnosis of disease processes affecting the inferior vena cava (IVC). CONCLUSION: High-speed MDCT has the potential to replace traditional imaging techniques in the evaluation of pathologic processes involving the IVC. The ability to acquire near-isotropic data allows high-quality reconstructions in the sagittal and coronal planes and thus overcomes one of the major limitations of CT in evaluating the IVC.
    American Journal of Roentgenology 12/2007; 189(5):1243-51. DOI:10.2214/AJR.07.2133 · 2.74 Impact Factor
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    ABSTRACT: Background The aim of this study was to review our experience with reoperative thyroid bed surgery (RTBS) for recurrent/persistent papillary thyroid cancer (PTC), and present an algorithm for safe and effective RTBS.Methods This is a retrospective study. Records of 33 consecutive patients who underwent RTBS for recurrent/persistent PTC in a previously operated thyroid bed, and were operated upon by the senior author (R.P.T.) July 2001 to January 2006 were reviewed. Reports of the pre- and post-RTBS serum thyroglobulin (TG) levels, the high-resolution thyroid bed ultrasound examination, pre-RTBS FNA cytopathology, as well as the post-RTBS final histopathology were reviewed. Recurrent laryngeal nerve (RLN) monitoring was used for all patients. Reports of the intra-RTBS condition of the RLN and any reported surgical complications were reviewed. In addition, reports of the pre- and post-RTBS fiberoptic laryngoscopy as well as pre- and post-RTBS serum calcium levels were reviewed.ResultsIn our study, 33 consecutive patients underwent RTBS for recurrent/persistent PTC with or without lateral neck dissection. In 30 patients, recurrent/persistent PTC was suspected because of rising serum TG levels, interpreted in conjunction with serum anti-TG-antibody titers by the endocrinology service at our institution. Three patients had serum anti-TG antibodies and their disease was detected and FNA confirmed by a regularly scheduled surveillance ultrasound examination. All patients underwent pre-RTBS high-resolution thyroid bed ultrasound examination and FNA for all suspicious masses. All patients had FNA-confirmed PTC in the thyroid bed. All patients had detailed diagrams localizing areas of FNA-confirmed PTC in the thyroid bed provided to the surgeon. In all study patients, post-RTBS histopathologic findings confirmed sites of recurrent/persistent PTC determined by pre-RTBS US guided FNA. All RLNs (53/53) that were at risk were successfully identified. In 3 patients, the RLN was electively resected because of the envelopment by a large paratracheal mass or tumor densely adherent to the RLN insertion point at the cricothyroid region. There was no incidence of unexpected RLN injury, permanent hypocalcemia, or any other surgery-related complication. Post-RTBS serum TG levels were significantly decreased or undetectable in most patients (2 patients had concurrent lung metastases), when compared with pre-RTBS levels. No patient exhibited thyroid bed recurrent/persistent PTC in the post-RTBS period based on semiannual high resolution neck ultrasound examination with a median follow-up of 2 years.Conclusions Safe and effective RTBS is based on a multidisciplinary approach that enables the identification and localization of recurrent/persistent PTC. The surgical algorithm for RTBS described, provides a pathway that all endocrine-head and neck surgeons can comfortably utilize to treat this complex and challenging patient population. © 2007 Wiley Periodicals, Inc. Head Neck 2007
    Head & Neck 12/2007; 29(12):1069 - 1074. DOI:10.1002/hed.20634 · 3.01 Impact Factor
  • Sheila Sheth, Katarzyna Macura
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    ABSTRACT: Pelvic sonography remains the imaging modality of choice for initial evaluation of myometrial pathology. The advent of vaginal sonography and color Doppler sonography have allowed for major refinements in detection and accurate diagnoses of common disorders affecting the uterus, particularly myomas and adenomyosis. Pelvic MR imaging plays an important role in gynecologic imaging because it depicts details of myometrium and junctional zone, is more reproducible, and is less operator-dependent compared with sonography. Because of its higher cost and lesser availability, MR imaging is usually reserved for pretreatment planning and for problem solving in patients for whom the ultrasound is inconclusive, not feasible, or technically suboptimal.
    Ultrasound Clinics 04/2007; 2(2):267-295. DOI:10.1016/j.cult.2007.08.011
  • Sheila Sheth, Syed Ali, Elliot Fishman
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    ABSTRACT: Extranodal spread of lymphoma often affects the genitourinary system, with the kidneys being the most commonly involved organs. Contrast material-enhanced computed tomography (CT) remains the modality of choice for the detection, diagnosis, staging, and monitoring of renal lymphoma. Magnetic resonance (MR) imaging is particularly useful in patients in whom intravenous administration of iodinated contrast material is contraindicated. Ultrasonography (US), although very valuable for diagnosing lymphoma in the testis or epididymis, is less sensitive than CT and MR imaging for detecting renal lymphoma. Typical imaging findings of renal lymphoma include multiple poorly enhancing or hypoechoic masses, retroperitoneal tumors directly invading the kidneys, bilateral renal enlargement, and perirenal soft-tissue masses. Cystic lesions and tumors predominantly affecting the renal sinus and collecting system are uncommon. Unless the renal lesions manifest in the setting of widespread lymphoma, percutaneous biopsy is indicated to differentiate lymphoma from metastases, hypovascular renal cell carcinoma, uroepithelial carcinoma, or atypical infection, with US routinely being used to guide the procedure. Current immunohistochemical techniques allow accurate diagnosis and characterization of renal lymphoma. Radiologists should be familiar with both typical and atypical manifestations of renal lymphoma and should recommend imaging-guided percutaneous biopsy for diagnostic confirmation to avoid unnecessary nephrectomy.
    Radiographics 07/2006; 26(4):1151-68. DOI:10.1148/rg.264055125 · 2.73 Impact Factor
  • Sheila Sheth, Elliot K. Fishman
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    ABSTRACT: With the advent of MDCT, the role of CT in the diagnosis and pre-surgical planning of RCC has been greatly expanded. Along with these technical improvements, new challenges facing the radiologist have emerged. These challenges include the adoption of scanning protocols designed to maximize diagnostic accuracy while at the same time minimizing radiation to the patient and image overload for the radiologist. Renal CT with multiple-phase image acquisitions as well as 3D reconstructions provides the clinician with all the information necessary for surgical planning.
    12/2005: pages 29-49;

Publication Stats

1k Citations
218.27 Total Impact Points

Institutions

  • 1988–2012
    • Johns Hopkins University
      • • Department of Medicine
      • • Department of Radiology
      Baltimore, Maryland, United States
  • 1970–2012
    • Johns Hopkins Medicine
      • • Department of Radiology and Radiological Science
      • • Department of Pathology
      Baltimore, Maryland, United States
  • 2011
    • Tulane University
      • School of Public Health and Tropical Medicine
      New Orleans, LA, United States
  • 2007
    • University of Maryland, Baltimore
      Baltimore, Maryland, United States