Frieda Feldman

New York Presbyterian Hospital, New York City, New York, United States

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Publications (65)192.75 Total impact

  • Fabrizio Remotti, Frieda Feldman
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    ABSTRACT: The skeletal system may be affected by a variety of nonneoplastic lesions, which may potentially be confused with primary bone tumors on clinical, radiologic, and pathologic grounds. These conditions include fractures, infections, and reactive and degenerative processes, as well as an array of quasineoplastic entities, such as intramedullary cystic lesions like unicameral and aneurysmal bone cysts; fibro-osseous lesions, such as fibrous dysplasia; and exophytic entities, like osteochondromas. To review clinical, radiographic, and histologic features of nonneoplastic lesions of bone, discussing the difficulties in diagnosis and the differential diagnosis with primary neoplasms of bone. The sources include the more relevant medical literature on the different subjects and case-derived material. Because many nonneoplastic bone lesions may require biopsy or resection, the general surgical pathologist must be familiar with these lesions and be aware that review of hematoxylin-eosin slides is only one of the many steps in the diagnostic process, which also includes review of imaging studies and all available clinical information. Morphologic analysis disconnected from the clinical and radiographic context may lead to misinterpretation.
    Archives of pathology & laboratory medicine 07/2012; 136(7):772-88. DOI:10.5858/arpa.2011-0557-RA · 2.88 Impact Factor
  • Frieda Feldman
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    ABSTRACT: Post menopausal osteoporotic fractures are a major public health concern worldwide with oral bisphosphonates favored for their prevention and treatment. Recent interest has centered on clinically observed, unusually sited femoral diaphyseal fractures, particularly attributed to alendronate. Their imaging presentations on routine radiographs, alternate imaging modalities, and associated pitfalls in nine fractures in six patients are selectively illustrated by seven fractures in four patients that serve to emphasize the following: (1) Bisphosphonates other than alendronate have been used for treating various bone diseases in children and men as well as osteoporotic women. (2) Effects may differ with each bisphosphonate's route of administration and prolongation of activity, despite discontinuation. Prior investigations and theoretical mechanisms of bisphosphonates as a class rather than with a specific alendronate association are reviewed to provide a broader basis for evaluating their recently observed clinical and radiographic complications.
    Skeletal Radiology 03/2011; 41(1):75-81. DOI:10.1007/s00256-011-1130-6 · 1.74 Impact Factor
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    ABSTRACT: Most patients with primary hyperparathyroidism in the 1980s do not have evidence of bone disease when they are evaluated by conventional radiography. We sought to determine whether skeletal involvement can be appreciated when more sensitive techniques, such as bone densitometry and bone biopsy, are utilized. We investigated 52 patients with primary hyperparathyroidism. They had mild hypercalcemia, 2.8 +/- 0.03 mmol/liter (11.1 +/- 0.1 mg/dl), low normal phosphorus, 0.9 +/- 0.03 mmol/liter (2.8 +/- 0.1 mg/dl), and no symptoms or specific radiological signs of skeletal involvement. The greatest reduction in bone mineral density was found at the site of predominantly cortical bone, the radius (0.54 +/- 0.1 g/cm; 79 +/- 2% of expected), whereas the site of predominantly cancellous bone, the lumbar spine (1.07 +/- 0.03 g/cm2), was normal (95 +/- 3% of expected). The site of mixed composition, the femoral neck (0.78 +/- 0.14 g/cm2), gave an intermediate value (89 +/- 2% of expected). Preferential involvement of cortical bone with apparent preservation of cancellous bone in primary hyperparathyroidism was confirmed by percutaneous bone biopsy. Over 80% of patients had a mean cortical width below the expected mean, whereas cancellous bone volume in over 80% of patients was above the expected mean. The results indicate that the majority of patients with asymptomatic primary hyperparathyroidism have evidence by bone densitometry and bone biopsy for cortical bone disease. The results also indicate that the mild hyperparathyroid state may be protective of cancellous bone. The therapeutic implications of these observations await further longitudinal experience with this study population.
    Journal of Bone and Mineral Research 06/2009; 4(3):283-91. DOI:10.1002/jbmr.5650040302 · 6.59 Impact Factor
  • Frieda Feldman, Ronald Vanheertum, Chitra Saxena
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    ABSTRACT: To determine the contribution of 18fluoro-deoxyglucose positron emission tomography (18FDG PET) in distinguishing benign from malignant osteochondromas. From 2000 to 2004, 10 patients (4 females, 6 males, 12 to 64 years old) with osteochondromas were referred for whole body PET by clinicians for metabolic evaluation before planned surgery for pain or cosmesis. Two PET readers and 1 pathologist, blinded to their diagnoses and imaging studies (except for radiographs), correlated results post surgery. The PET average and maximum standard uptake value (SUV) generated by computer for Regions of Interest and correlated with radiographs, were based on axial 3.37 mm thick, 3 x 3 mm pixel images. Since SUVs vary from site to site depending on scanning devices and techniques, a 2.0 maximum cutoff SUV separated benign and malignant osteochondromas based on our standard protocols and specific equipment (Siemens Ecat Exact Knoxville, Tenn) used with our prior oncological studies. Results showed that no definitive statistical conclusions could be drawn due to the small number of patients involved, but they were, nevertheless, deemed promising. The 18FDG whole body PET aided the identification of malignant osteochondromas, their local recurrence and metastases by both displaying and quantifying their metabolic activity. Although the current study is limited by a small cohort, which precludes statistical analysis, additional experience with PET analysis of osteochondromas may further support its value as a physiological parameter supplementing anatomically based imaging modalities most often used for their evaluation.
    Journal of Computer Assisted Tomography 01/2006; 30(5):858-64. DOI:10.1097/01.rct.0000228160.86096.ca · 1.60 Impact Factor
  • Frieda Feldman, Ronald Bernard Staron
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    ABSTRACT: PURPOSE To demonstrate MRI findings in tumoral calcinois of the cervical spine compared with CT and radiographic studies. METHOD AND MATERIALS Eight patients, 45-60 years of age were studied with MRI utilizing superconductive 1.5T magnets[GE signa,GE Medical Systems, Milaukee, Wisc.], dedicated quadriture spine coils with T1, T2w, FSE fat suppressed T2w sequences and 3mm axial and 4mm sagittal orientations. RESULTS Intra and extra-articular calcific masses involved the cervical spine and neighboring posterior soft tissues with large, lobulated masses appearing as signal voids on T1 and T2w images with and without fluid levels. Radiographs confirmed the presence of amorphous mineral compatible with tumoral calcinoisis which was secondary to renal disease and dialysis in most cases. However, 50% of patients had a less well known causitive etiology of collagen vascular disease resulting in functional spinal canal stenosis. CONCLUSION Large mineral deposits within the cervical canal as well as the surrounding soft tissues should suggest its less well association with collagen vascular diseases in the appropriate clinical setting.
    Radiological Society of North America 2005 Scientific Assembly and Annual Meeting; 11/2005
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    ABSTRACT: We report an unusual case of extranodal Rosai-Dorfman disease presenting in a 36-year-old man with lesions of bone, subcutaneous tissue of the arm and maxillary sinus mucosa unassociated with lymphadenopathy or systemic symptoms. These lesions appeared metachronously within a 6-month period. The diagnostic light microscopic and immunohistochemical findings and pathogenesis of this interesting disease are discussed.
    Skeletal Radiology 11/2005; 34(10):653-7. DOI:10.1007/s00256-005-0953-4 · 1.74 Impact Factor
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    ABSTRACT: To assess the value of [18F]fluoro-2-deoxy-D-glucose positron emission tomography (18FDG-PET) in defining aggressive cartilage neoplasms, particularly those with problematic or borderline histologic, imaging and clinical characteristics. From 2000 to 2003, 29 cartilage lesions were studied with whole-body 18FDG-PET scans (Siemens Ecat Exact, Knoxville, Tenn.). Analyses of data in 20 females and nine males, 11-85 years old, were based on maximum standard uptake values (SUVs) in regions of interest (ROIs) on axial 3.37 mm thick, 3x3 pixel images. A statistically significant maximum SUV cutoff of 2.0 was used to distinguish benign from malignant cartilage neoplasms and correlated with the postoperative histopathologic findings. In 26 operated cases the overall sensitivity of whole-body 18FDG-PET in separating benign and malignant lesions was 90.9% (10/11), specificity 100% (18/18) and accuracy 96.6%. Whole-body 18FDG-PET is a valuable adjunct in identifying primary, recurrent and metastatic cartilage malignancies. It supplements classic histology and morphologic imaging with functional data which may facilitate management in individual cases.
    Skeletal Radiology 08/2005; 34(7):367-74. DOI:10.1007/s00256-005-0894-y · 1.74 Impact Factor
  • Frieda Feldman, Ronald B Staron
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    ABSTRACT: OBJECTIVE: The objective of this article is to show that greater trochanteric fractures commonly perceived on routine radiographs as isolated are often neither isolated nor minor and that MR images can serve as a basis for more informed treatment by revealing the actual extent of such fractures in acute posttraumatic settings. CONCLUSION: A pitfall in diagnosing seemingly isolated greater trochanteric fractures on routinely used imaging techniques lies in the fact that the injuries usually involve a large anatomic area. In our experience, MRI more accurately defines the true geographic extent of greater trochanteric fractures sustained through acute trauma than do radiography and bone scintigraphy and thus could provide a more reliable basis for anticipating complications and for planning appropriate treatment.
    American Journal of Roentgenology 09/2004; 183(2):323-9. DOI:10.2214/ajr.183.2.1830323 · 2.74 Impact Factor
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    ABSTRACT: The purpose of this prospective study was to determine the level of interobserver and intraobserver agreement among orthopedic surgeons and radiologists when computed tomography (CT) scans are used with plain radiographs to evaluate intertrochanteric fractures. In addition, the prognostic value of current classifications systems concerning quality of life was evaluated. Sixty-one patients who presented with intertrochanteric fractures received open reduction and internal fixation with compression hip screw. Three orthopedic surgeons and 2 radiologists independently classified the fractures according to 2 systems: Evans-Jensen and AO (Arbeitsgemeinschaft für Osteo-synthesefragen). Fractures were initially graded with plain radiographs and then again in conjunction with CT. Results were analyzed using the (kappa) kappa coefficient. The 36-item Short-Form Health Survey was administered at baseline, 3 months, and 1 year, and results were correlated with fracture grade. Mean kappa coefficients when comparing radiography alone with radiography and CT scan were 0.63 for the AO system and 0.59 for the Evans-Jensen system. Both represent "fair" agreements. Mean overall interobserver kappa coefficients were 0.67 for radiologists and 0.57 for orthopedic surgeons. Radiologists also had higher intraobserver kappa coefficients. No significant relationships were found between follow-up Short Form Health Survey results and intraoperative grading of fractures. When these classification schemes are compared, interobserver agreement does not appear to change dramatically when information from CT scans is added. This may suggest that (1) more data have been provided by CT with greater possibilities for misinterpretation and (2) these classification schemes may not be comprehensive in describing fracture pattern and displacement. Finally, both systems failed to provide any prognostic value.
    American journal of orthopedics (Belle Mead, N.J.) 10/2003; 32(9):443-9.
  • Frieda Feldman, Ronald van Heertum, Chitra Manos
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    ABSTRACT: To describe the technique, applications and advantages of (18)FDG PET scanning in detection, analysis and management of musculoskeletal lesions. Forty-five patients (19 males,26 females) aged 9 to 81 years had radiographs, routine radionuclide scans, CT and/or MRI of clinically suspected active benign or malignant musculoskeletal lesions. (18)FDG scans with a Siemens ECAT EXACT 921 dedicated PET unit (Knoxville, Tenn.) and FWH=6 mm images acquired as a 5-6 bed examination (6 min emission and 4 min transmission) used OSEM iterative reconstruction with segmented transmission attenuation correction and a Gaussian filter (cutoff 6.7 mm). Region of interest (ROI) 3x3 pixel image analysis based on transverse whole body images (slice thickness 3.37 mm) generated Maximum Standard Uptake Values (Max SUV) with a cutoff of 2.0 used to distinguish benign and malignant lesions. Thirty-nine studies were available for SUV ROI analysis. Overall sensitivity for differentiating malignant from benign osseous and non-osseous lesions was 91.7% (22/24), overall specificity was 100% (11/11) with an accuracy of 91.7%. All aggressive lesions had a Max SUV >2.0. Data separating benign from malignant lesions and aggressive from benign lesions were statistically significant ( P<0.001) in both categories. There was no statistically significant difference in distinguishing aggressive from malignant lesions ( P, ns). (18)FDG PET contributes unique information regarding metabolism of musculoskeletal lesions. By supplying a physiologic basis for more informed treatment and management, it influences prognosis and survival. Moreover, since residual, recurrent or metastatic tumors can be simultaneously documented on a single whole body scan, PET may theoretically prove to be cost-effective.
    Skeletal Radiology 04/2003; 32(4):201-8. DOI:10.1007/s00256-003-0623-3 · 1.74 Impact Factor
  • F Feldman
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    ABSTRACT: Musculoskeletal radiologists, owing to recent advances in imaging technologies and techniques, are playing an increasingly important role in documenting, diagnosing, and treating an increasing variety of bone and soft-tissue lesions. However, improved visualization of anatomic aberrations-"seeing better"-must be paired with "knowing more," on the basis of complete familiarity with all aspects of the biology, physiology, pathophysiology, and static anatomy of the musculoskeletal system. Only with foreknowledge of the latter can the musculoskeletal radiologist fully maximize the benefits of the former.
    Radiology 09/2000; 216(2):309-16. · 6.21 Impact Factor
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    ABSTRACT: Thoracic imaging of a patient treated for pulmonary tuberculosis with oleothorax therapy before the antibiotic era demonstrated a rare complication. Gross invasion by lipid with subsequent pathologic fracture of the adjacent thoracic vertebra may give rise to symptomatic spinal cord compression. Magnetic resonance imaging is a useful modality for help in diagnosing treatment complications of oleothorax.
    Radiology 03/1999; 210(2):515-7. DOI:10.1148/radiology.210.2.r99fe42515 · 6.21 Impact Factor
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    ABSTRACT: This study sought to determine if the presence or absence of meniscofemoral ligaments exerts an influence on the prevalence of tears of the lateral meniscus. We reviewed the sagittal and coronal magnetic resonance images of 173 knees for lateral meniscus tears and the presence of the meniscofemoral ligaments. One or both meniscofemoral ligaments were present in 142 of 173 knees (82%). Fifty-four knees had lateral meniscus tears, 27 of which involved the posterior horn. Thirty-three percent of knees with meniscofemoral ligaments had a lateral meniscus tear, and 23% of knees without meniscofemoral ligaments had a lateral meniscus tear (no significant difference). We found no association between the presence of the meniscofemoral ligaments and tears of the lateral meniscus. Our study questions the importance of preserving or reconstructing these ligaments in instances of meniscal transplantation.
    American journal of orthopedics (Belle Mead, N.J.) 12/1998; 27(11):729-32.
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    ABSTRACT: The purpose of this study is to compare fat-suppressed T2-weighted fast spin-echo sequences with T2-weighted multiplanar gradient-echo sequences in revealing rotator cuff disorders. Oblique coronal fat-suppressed fast spin-echo images and gradient-echo images of 39 patients who underwent surgery of the shoulder were retrospectively reviewed. Images from the two techniques were reviewed separately. Each set of images was interpreted twice by four musculoskeletal radiologists independently and without knowledge of the surgical findings. Sensitivity and specificity for both sequences were determined. The kappa statistic was used to calculate intraobserver and interobserver agreement of interpretations. For detecting any tear, the sensitivity of the four readers was 71-96% using fast spin-echo and 58-100% using gradient-echo imaging. Confidence intervals showed no difference between the two sequences. Sensitivity of detecting full-thickness tears was 83-100% for both sequences. Interobserver agreement was good. T2-weighted gradient-echo and fat-suppressed T2-weighted fast spin-echo sequences depict rotator cuff tears equally well and take less time to acquire than conventional dual-echo spin-echo sequences.
    American Journal of Roentgenology 08/1998; 171(1):223-7. DOI:10.2214/ajr.171.1.9648793 · 2.74 Impact Factor
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    American Journal of Roentgenology 01/1998; 169(6):1641-7. DOI:10.2214/ajr.169.6.9393184 · 2.74 Impact Factor
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    ABSTRACT: To investigate gadolinium's role in imaging musculoskeletal infection by comparing the conspicuity and extent of inflammatory changes demonstrated on gadolinium-enhanced fat-suppressed T1-weighted images versus fat-suppressed fast T2-weighted sequences. Eighteen patients with infection were imaged in a 1.5-T unit, using frequency-selective and/or inversion recovery fat-suppressed fast T2-weighted images (T2WI) and gadolinium-enhanced frequency-selective fat-suppressed T1-weighted images (T1WI). Thirty-four imaging planes with both a fat-suppressed gadolinium-enhanced T1-weighted sequence and a fat-suppressed T2-weighted sequence were obtained. Comparison of the extent and conspicuity of signal intensity changes was made for both bone and soft tissue in each plane. In bone, inflammatory change was equal in extent and conspicuity on fat-suppressed T2WI and fat-suppressed T1WI with gadolinium in 19 planes, more extensive or conspicuous on T2WI in three planes, and less so on T2WI in two planes. Marrow was normal on all three sequences in 10 cases. In soft tissue, inflammatory change was seen equally well in 20 instances, more extensively or conspicuously on the T2WI in 11 instances, and less so on T2WI in 2 instances. One case had no soft tissue involvement on any of the sequences. Five abscesses and three joint effusions were present, all more conspicuously delineated from surrounding inflammatory change on the fat-saturated T1WI with gadolinium. The average imaging time for the fat-saturated T1WI with gadolinium was 6.75 min, while that of the T2-weighted sequences was 5.75 min. Routine use of gadolinium is not warranted. Instead, gadolinium should be reserved for clinically suspected infection in or around a joint, and in cases refractory to medical or surgical treatment due to possible abscess formation.
    Skeletal Radiology 12/1997; 26(11):654-8. DOI:10.1007/s002560050305 · 1.74 Impact Factor
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    ABSTRACT: A patient with classic clinical and biochemical features of tumor-induced osteomalacia (hypophosphatemia, phosphaturia, and undetectable serum concentrations of 1,25-dihydroxyvitamin D [1,25(OH)2D]) was studied before and after resection of a benign extraskeletal chondroma from the plantar surface of the foot. Presurgical laboratory evaluation was notable for normal serum concentrations of calcium, intact parathyroid hormone (PTH), parathyroid hormone-related protein (PTHrP), and osteocalcin, increased serum alkaline phosphate activity, and frankly elevated urinary cyclic adenosine monophosphate (cAMP) and pyridinium cross-link excretion. Quantitative histomorphometry showed severe osteomalacia and deep erosions of the cancellous surface by active osteoclasts. After resection, serum 1,25(OH)2D normalized within 24 h, while renal tubular phosphorus reabsorption and serum phosphorus did not normalized until days 2 and 3, respectively; serum Ca declined slightly, and serum intact PTH, osteocalcin, and urinary pyridinium cross-link excretion increased dramatically. Urinary cAMP excretion declined immediately after resection and then began to increase concomitant with the increase in serum intact PTH. A second bone biopsy taken 3 months after resection demonstrated complete resolution of the osteomalacia, increased mineral apposition rate (1.09 mu/day), resorption surface (9.2%), mineralizing surface (71%), and bone formation rate (0.83 mm3/mm2/day), and marked decrease in cancellous bone volume (13.1%) and trabecular connectivity compared with first biopsy. Tumor extracts did not affect phosphate transport in renal epithelial cell lines or 1 alpha-hydroxylase activity in a myelomonocytic cell line. The patient's course suggests that the normal 1,25(OH)2D and phosphorus metabolism is due to a tumor product that may be acting via stimulation of adenylate activity. Increased bone resorption prior to surgical resection suggests that the tumor may also produce an osteoclast activator. The rise in resorption surface and pyridinium cross-link excretion, increase in serum osteocalcin and bone mineralization, normalization of osteoid width, and fall in cancellous bone volume after resection are consistent with healing of osteomalacia by rapid remodeling.
    Journal of Bone and Mineral Research 10/1997; 12(9):1502-11. DOI:10.1359/jbmr.1997.12.9.1502 · 6.59 Impact Factor
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    ABSTRACT: To identify a normal groove in the posterior aspect of the talus as a potential pitfall in interpretation of ankle magnetic resonance (MR) images. In 40 patients, T1-weighted spin-echo and T2-weighted fast spin-echo sagittal MR images were retrospectively reviewed from 47 consecutive routine ankle examinations. The patients were referred for evaluation of ligament and tendon abnormalities, such as tendinitis and tear, and suspected osseous and osteochondral injuries. Images were assessed for the presence of an erosion-like defect in the posterior aspect of the talar dome. Radiographs were available in 13 cases. Sagittal T1-weighted spin-echo sequences were also performed in 14 embalmed cadaveric ankles, followed by sectioning and dissection of three specimens. A defect was seen in 45 of 47 ankle MR imaging examinations. Radiographs did not show the defect. All 14 cadaveric ankles demonstrated the defect at MR imaging. At anatomic dissection, the defect was a normal groove for the passage of the posterior talofibular ligament. The pseudodefect of the talar dome is a normal groove for the posterior talofibular ligament and should not be misinterpreted as an articular erosion or osteochondral defect.
    Radiology 07/1997; 203(3):857-8. DOI:10.1148/radiology.203.3.9169716 · 6.21 Impact Factor
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    ABSTRACT: To determine the prevalence of meniscal protrusion (i.e. location of the outer edge of a meniscus beyond the tibial articular surface), and to determine its relationship with internal derangement, joint effusion, and degenerative arthropathy. Sagittal and coronal MR images of 111 abnormal and 46 normal knees were evaluated for the presence of meniscal protrusion. We set 25% as the minimum amount of displacement considered abnormal because this was the smallest amount of displacement we could confidently discern. Presence of meniscal tear, anterior cruciate ligament (ACL) injury, joint effusion, or osteophytosis was also recorded. Normal examinations demonstrated protrusion of the medial meniscus in 6.5% of sagittal images and 15% of coronal images, and of the lateral meniscus in 2% and 13%, respectively. Fisher's exact test demonstrated a statistically significant difference between the normal and abnormal groups for the medial meniscus on both sagittal (P < 0.0001) and coronal (P = 0.01) images, but not for the lateral meniscus in either plane (P > 0.2). A protruding medial meniscus was associated with effusion and osteophytosis (P < 0.05) but not with meniscal or ACL tear (P > 0.1). Posterior protrusion of the lateral meniscus was only associated with ACL injury (P < 0.0001); protruding anterior horns and bodies of lateral menisci were not associated with any of the four abnormalities. It is concluded that the medial meniscus may occasionally protrude more than 25% of its width, but protrusion is more often due to effusion and osteophytes. Protrusion of the posterior horn of the lateral meniscus is associated with ACL insufficiency, while protrusion of the body and anterior horn of the lateral meniscus is a normal variant.
    Skeletal Radiology 07/1997; 26(7):424-7. DOI:10.1007/s002560050259 · 1.74 Impact Factor
  • Academic Radiology 12/1996; 3(12):1065. DOI:10.1016/S1076-6332(96)80104-8 · 2.08 Impact Factor

Publication Stats

1k Citations
192.75 Total Impact Points

Institutions

  • 1981–2011
    • New York Presbyterian Hospital
      • Department of Radiology
      New York City, New York, United States
    • St. Vincent Medical Center
      • Department of Radiology
      Bridgeport, Connecticut, United States
  • 1979–2009
    • Columbia University
      • • College of Physicians and Surgeons
      • • Department of Radiology
      New York City, New York, United States
  • 1994–2003
    • CUNY Graduate Center
      New York City, New York, United States
    • Albert Einstein College of Medicine
      • Department of Radiology
      New York City, NY, United States
  • 1993
    • Mid-Columbia Medical Center
      DLS, Oregon, United States
  • 1991
    • Aurora St. Luke's Medical Center
      Milwaukee, Wisconsin, United States