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Publications (124)
The timed barium study (TBS) is used to assess esophageal emptying in patients with achalasia. Improvement in emptying correlates with outcome after endoscopic therapy, but the results of the TBS have been variable after myotomy. Our aim was to evaluate a new method for assessing improvement in emptying after myotomy.
A TBS was performed before and...
To increase patient safety of keyhole surgery, flexible endoscopy was augmented using magnetic resonance imaging (MRI). For this purpose MR-compatible 9-Fr. flexible endoscopes were developed and tested. Instrument visualisation was achieved using miniature MR tracking coils mounted either on top of the endoscope's tip or inside the working channel...
Describes a new type of medical information environment which is fully web-enabled. The system can handle any type of medical information including text, physiological waveforms, images and moving images, etc. The key to the PiRiLiS design is advanced web-browser based software integrated with a full Dicom library covering all modalities. This has...
Positron emission tomography (PET) is an emerging clinical imaging technique that is facing the challenges of expansion in a period of imminent health care contraction and reform. Although PET began showing utility in clinical medicine in the mid-1980s [1], its proliferation into mainstream medical practice has not matched that of other new imaging...
The value of color Doppler sonography in evaluating newly diagnosed Budd-Chiari syndrome in five patients was studied. Hepatic venous findings included absence of vessels (one patient), flow reversal (two patients), narrowing (four patients), and tortuosity (three patients). Detected collaterals included hepatic venous to hepatic venous (four patie...
Sixteen patients with hepatocellular carcinoma (HCC) were assessed with color Doppler sonography (CDS) for flow compared to normal hepatic parenchyma. Nine showed moderate increased flow, and two revealed marked increased flow. In most instances, the increased flow was peripheral. Color Doppler was also useful in assessing seven patients with porta...
Nine patients who had undergone end-to-side portocaval shunts were assessed using a sector real-time color Doppler sonography system. Shunt patency was demonstrated in 8 of 9 patients by detection of color-coded flow within the portal vein, in the anastomotic region, and in the inferior vena cava adjacent to the shunt. Color flow could not be detec...
Clinical diagnosis of patients with acute scrotal pain is frequently imperfect. Imaging, using nuclear medicine scintigraphy and hand-held continuous-wave Doppler ultrasound devices, has been used in these patients.
We retrospectively analyzed 28 consecutive patients referred for scrotal sonography, all of whom had been imaged using color Doppler s...
High-resolution real-time sonography not only provides a noninvasive means of diagnosing hip effusions, but also provides easy access for arthrocentesis. Nineteen sonographically guided hip arthrocentesis were performed in 18 patients. In 13 of 19 patients aspirated, capsular distension was present. In 10 of 19 patients, fluid could be aspirated fr...
Our data, because of the design limitations of this study, do not provide a reliable assessment of the accuracy of color Doppler sonography in diagnosing suspected intrahepatic biliary dilatation. Nevertheless, color Doppler sonography appears to be sensitive in detecting dilated intrahepatic ducts. Color Doppler also allows an easier and more conf...
A prospective analysis of the hepatoduodenal ligament (HDL) in 205 patients with abdominal pulsed Doppler sonography supports the conclusion that Doppler ultrasound is a useful adjunct to routine scanning in this area. Abdominal pulsed Doppler sonography allows reliable differentiation among the HDL structures by identifying and characterizing flow...
Epithelioid hemangioendothelioma (EHE) is a rare, malignant neoplasm of vascular origin arising in soft tissues, lung, and liver. Four cases of hepatic EHE are reported, and 49 previously reported cases are reviewed. The tumor occurs in adults of all ages; 66% of patients are women. The prognosis is variable. Computed tomographic findings suggest t...
Focal gallbladder tenderness is the most important physical finding in suspected acute cholecystitis. We describe a technique using palpation of the abdomen with the placement of a radioactive marker on the point of maximum tenderness. Correlation of the marked area to the location of the gallbladder fossa is made. This integration of palpation and...
A new type of ultrasound signal processing (“FM sonography”) appears to be beneficial compared to conventional ultrasound (“AM sonography”) in some applications (e.g., diffuse liver disease and prostatic carcinoma). Despite these possible advantages, it is doubtful FM sonography will be widely used unless it is at least as useful as conventional (A...
Nasogastric administration of activated charcoal is effective in decreasing the half-life of amitriptyline. A case is reported in which this therapy for amitriptyline overdose led to charcoal bezoar formation and small-bowel obstruction. Amitriptyline's atropinic side effects on the gut make this a possible complication in such patients.
CT findings in 23 patients with amebic liver abscess were analyzed retrospectively. A solitary abscess was present in 17 patients. Five patients had two to five lesions. One patient, a male homosexual, had 15 abscesses. Of the 46 abscesses, 74% occurred in the right lobe. The lesions were generally round or oval. One-half of the abscesses were 2-6...
Magnetic resonance imaging (MRI) was performed in 22 patients at various times (0-3) years) following radiation therapy to the spine. T1 and T2 weighted images were obtained at 0.5 Tesla. Increased signal was seen after 800-6000 rads (8-60 Gy). Marrow effects corresponded to radiation ports. Recurrent tumor was clearly separated from fatty replacem...
Graves disease is a common diffuse abnormality of the thyroid gland usually characterized by thyrotoxicosis. We performed color-flow Doppler sonography in 16 patients with Graves disease and compared the results with those in 15 normal volunteers and 14 patients with other thyroid diseases (eight with multinodular goiter, four with focal masses, an...
Nasogastric administration of activated charcoal is effective in decreasing the half-life of amitriptyline. A case is reported in which this therapy for amitriptyline overdose led to charcoal bezoar formation and small-bowel obstruction. Amitriptyline's atropinic side effects on the gut make this a possible complication in such patients.
Focal gallbladder tenderness is the most important physical finding in suspected acute cholecystitis. We describe a technique using palpation of the abdomen with the placement of a radioactive marker on the point of maximum tenderness. Correlation of the marked area to the location of the gallbladder fossa is made. This integration of palpation and...
Emphysematous cholecystitis is an uncommon form of acute cholecystitis that is characterized radiographically by the presence of gas in the lumen and/or wall of the gallbladder. It differs from acute cholecystitis in its greater relative frequency in men and diabetics and in its graver prognosis. Ischemia is believed to be a more important pathogen...
Hepatic magnetic resonance (MR) imaging was performed in 12 patients with 13 amebic liver abscesses. While no specific image or intensity pattern was noted, most lesions were round or oval with smooth, well-defined margins; had decreased signal intensity compared with that of liver parenchyma on T1-weighted images and increased signal intensity on...
Although amebic liver abscess can virtually always be successfully treated medically, percutaneous drainage has been advocated recently. In 96 recently treated patients, therapeutic aspiration and percutaneous drainage were rarely needed. Most cases were correctly diagnosed by means of clinical, laboratory, and sonographic findings. Abscesses in on...
Scintiangiography and hepatobiliary scintigraphy were performed in 45 patients with abdominal trauma. There were 18 gunshot wounds, six stab wounds, and 21 blunt injuries. Thirty-one of 45 patients showed abnormalities (69%). There were nine bilomas (4 with leaks), three leaks without biloma, (7 total leaks), five liver hematomas, three liver infar...
To evaluate the frequency of retroperitoneal hemorrhage related to renal biopsy, we prospectively assessed 182 patients (200 biopsies) using state-of-the-art CT and ultrasound. Our study revealed definite CT evidence of hemorrhage after 90.9% of biopsies. In a blinded analysis of images obtained in biopsied patients and in unbiopsied control patien...
The Kock continent ileal urinary reservoir (Kock pouch) is a new form of urinary diversion that, due to its advantages over previous techniques of urinary bypass, will probably become widespread in urologic practice. When bone imaging is performed in the presence of the Kock pouch, the unusual configuration of the pouch may obscure or simulate osse...
We blindly compared the sonographic findings in amebic (112 lesions) and pyogenic (30 lesions) liver abscesses. Two sonographic features were significantly more prevalent in amebic abscesses: the lesions had a round or oval shape and the lesions had an echogenicity that was lower than that of normal liver and were internally homogeneous on high-gai...
In five patients with agenesis of the right lobe of the liver, computed tomography or sonography demonstrated absence of the right lobe with compensatory hypertrophy of other segments. In three patients, the caudate lobe was also absent. The radiologic differential diagnosis includes lobar atrophy due to cirrhosis or hilar cholangiocarcinoma. Ninet...
Acalculous inflammatory disease of the biliary tree is a recently recognized complication of acquired immunodeficiency syndrome (AIDS). Two men with AIDS and elevated serum alkaline phosphatase levels are reported. Computed tomography and cholangiography demonstrated biliary disease resembling sclerosing cholangitis.
Ninety patients undergoing Tc-99m disofenin hepatobiliary scintigraphy for suspected acute cholecystitis were assessed for enterogastric reflux. Seventy-seven cases showed bowel activity by one hour and were included in the study. Twenty-six percent (20/77) showed definite enterogastric reflux. The gastric activity tended to clear rapidly, even tho...
Three patients with cavitating gastric or duodenal metastases are presented. Metastatic disease, either by direct extension or by hematogenous spread, should be included in the differential diagnosis of an excavated exoenteric gastric or duodenal mass.
A case of hepatolithiasis complicated by intrahepatic cholangiocarcinoma is reported. Awareness of this association is important for the radiologist, who may detect clinically occult malignancy in patients with intrahepatic biliary calculi.
Radionuclide angiography and cholescintigraphy were performed with a bolus injection of technetium-99m disofenin in 65 patients with suspected acute cholecystitis. Acute cholecystitis was surgically confirmed in 23 of 25 cases in which radionuclide angiographic findings were positive (i.e., showed focal increased flow to the gallbladder region) (po...
Benign cystic teratoma of the omentum is a rare gynecologic condition. No cases have been diagnosed preoperatively; six cases have been reported in association with an ovarian teratoma. We report a seventh case in which ultrasound and CT were used preoperatively.
Computed tomography (CT) is often the first imaging modality used in the diagnosis of patients with suspected abdominal disease. While it is known that early generation CT scanners often detect gallstones, the detection rate of newer equipment is not widely known. Abdominal CT scans of 226 patients who had undergone ultrasonographic (US) studies of...
Three patients (2 males and 1 female), aged 17-28 years, with tumor thrombosis of the inferior vena cava due to retroperitoneal germ cell tumor are reported. Diagnostic and therapeutic implications of this condition are discussed.
The Kock continent ileal urinary reservoir (Kock pouch) is a new urinary bypass system that can overcome some of the principal complications associated with other forms of urinary diversion. It is important to understand the anatomy and radiology of this new technique since radiologists play an important role in evaluating the function of the Kock...
FM sonography - a signal-processing technique that uses frequency and phase information as well as amplitude data - shows promise in evaluation of patients with diffuse liver disease. In a prospective blinded review of 37 patients with biopsy-proved liver disease and 42 healthy volunteers, FM sonography was clearly superior to traditional amplitude...
A comatose patient on a ventilator suffered circulatory collapse while undergoing abdominal computed tomography. The computed tomography findings are presented, and the means for prompt recognition of this catastrophe are discussed.
A retrospective analysis of preoperative biliary imaging and ultrasound in 22 patients with surgically proven choledocholithiasis was performed. Ultrasound detected dilated ducts greater than 7 mm in 11 of 14 jaundiced patients (79%). Hepatobiliary imaging was able to detect either absent or delayed bowel visualization or prominent bile ducts in 13...
Findings on cholescintigraphy in gallbladder carcinoma are described in five patients. Four patients presenting with acute cholecystitis had nonvisualization of the gallbladder with normal hepatoenteric transit time. One of these had a large portal mass and two had liver metastasis as additional findings. The fifth patient was jaundiced, and showed...
During a 2 1/2-year period, 10 patients with suspected pheochromocytoma were evaluated by unenhanced computed tomography (CT). Six adrenal masses, one hyperplastic adrenal gland, and two extraadrenal retroperitoneal masses were detected in seven patients; CT of the adrenals and retroperitoneum was normal in three patients. Scintigraphy with iodine-...
Colonoscopy is a widely used procedure with low morbidity and mortality. A case of cecal volvulus following colonoscopy is presented. This potentially lethal complication should be considered in patients with persistent abdominal pain following colonoscopy because it is easily diagnosed radiographically and requires emergency surgical intervention.
Sonographic findings in 497 patients with suspected acute cholecystitis were analyzed prospectively. Combined use of primary and secondary sonographic signs led to excellent positive and negative predictive values. Positive predictive values for stones combined with either a positive sonographic Murphy sign (92.2%) or with gallbladder wall thickeni...
The authors present two cases involving rupture of the triceps tendon that was initially diagnosed on radiographs.
Tendon ruptures have been radiographically diagnosed before but only once by a fractured osteophyte of the triceps tendon, to our knowledge.
The first case demonstrated this while the other showed an avulsion fracture at the tendon's i...
Plain abdominal roentgenograms are usually adequate for the treatment of patients with small-bowel obstruction. There is a select group of patients who may benefit from a more precise diagnosis or by nonoperative therapy for whom contrast roentgenograms may be helpful. Contrast roentgenograms were performed in 68 (21%) of 327 patients who had nondi...
Malacoplakia is an uncommon, pathologically distinct, granulomatous disease most frequently found in the urinary tract. Malacoplakia of the colon may cause abdominal pain, diarrhea, rectal bleeding, and fever. Radiographic features are variable and include polyps, bulky masses, mucosal ulcerations, and fistulae.
One hundred randomly selected inpatients were examined with both double-contrast barium meal and endoscopy in a blinded prospective fashion. All studies were done by staff personnel, with equal clinical information available to both the radiologist and endoscopist. The final diagnosis was made by a review committee of participating radiologists and...
Pulsations of the ascending aorta during fluoroscopy in patients (pts) with aortic insufficiency (AI) have been described. The authors observed a similar phenomenon in pts undergoing scintiangiography who have documented AI. This paper describes a technique to validate and quantitate this observation. The authors studied 17 patients with AI documen...
To determine the sensitivity of sonography in the detection of choledocholithiasis, the sonograms of 138 patients with surgically proven common bile duct stones were reviewed. A definite diagnosis of choledocholithiasis could be made on the basis of the sonograms in 22% of cases. Overall, 23% had common ducts of normal caliber (less than or equal t...
An unusual case of Burkitt lymphoma presenting with an osteolytic pelvic lesion in a homosexual man with acquired immune deficiency syndrome (AIDS) is reported. Computed tomography (CT) demonstrated unsuspected renal involvement and was used for guided percutaneous biopsy. The CT appearance of renal Burkitt lymphoma was similar to that of other typ...
The computed tomographic (CT) findings of pheochromocytoma, adrenal medullary hyperplasia, and medullary thyroid carcinoma in a patient with Sipple syndrome are presented. The CT finding of diffuse enlargement of one or both adrenal glands in a patient with clinical and laboratory evidence of pheochromocytoma should raise the suspicion of adrenal m...
Malacoplakia is an uncommon, pathologically distinct, granulomatous disease most frequently found in the urinary tract. Malacoplakia of the colon may cause abdominal pain, diarrhea, rectal bleeding, and fever. Radiographic features are variable and include polyps, bulky masses, mucosal ulcerations, and fistulae.
Gallbladder hyperemia in acute cholecystitis (AC) has been described pathologically and angiographically. The authors' purpose is to evaluate the use of scintiangiography for the detection of this hypernia as a supporting sign of AC. Ten mCi of Tc 99m disofenin were injected by bolus technique in 64 patients with suspected AC. Sequential 3 second i...
Cholescintigraphy (CS) is currently the most accurate test to detect acute cholecystitis (AC). The authors evaluate the sonographic Murphy's sign (M) along with detection of gallstones (S) in AC. Real time ultrasound (RT) with attention to M and S was performed in 194 patients with suspected AC. CS with Tc-99m disofenin carried out for 4 hours was...
Gray-scale sonography has provided a means of following cases of successfully treated hepatic amebic abscess, allowing new insights into the natural history of this entity. In this study the majority of cases (23 of 32) resolved over a variable time period (1.5-23 months, median 7 months) to a normal sonographic hepatic parenchymal pattern. It is i...
It is important that a routine search be done roentgenographically for intramural intestinal gas. Several different patterns may be present, but unfortunately, classification of the findings is not helpful in predicting either the cause, or the presence, of gangrene. Also, the clinical circumstances in which intramural intestinal gas is discovered...
Posttraumatic intrahepatic biliary cysts or bilomas were once thought to be rare. With increased use of sonography and 99mTc-HIDA cholescintigraphy, this entity will probably be detected more often. Preoperative sonographic diagnosis of posttraumatic biloma was made in five patients. A well circumscribed, anechoic hepatic lesion with excellent dist...
Sonograms of 143 hepatic amebic abscesses in 106 patients were analyzed retrospectively. A strongly suggestive but not pathognomonic pattern was noted in 54 abscesses (37.8%), consisting of (a) lack of significant wall echoes, (b) a round or oval configuration, (c) less echogenicity than the normal parenchyma, with fine, homogeneous low-level echoe...
Three cases of multinodular goiter with intrathoracic extension are presented. The intrathoracic portions simulated other mediastinal masses which resulted in surgical intervention in one case.
Prospective analysis of the efficacy of 99mTc-IDA cholescintigraphy and cholecystosonography showed that both are excellent techniques for assessing patients with suspected acute cholecystitis (accuracy 84.7% and 88.1% respectively). Consequently, the choice of tests selected to evaluate patients with suspected acute cholecystitis depends on severa...
Prospective analysis of the efficacy of /sup 99m/Tc-IDA cholescintigraphy and cholecystosonography showed that both are excellent techniques for assessing patients with suspected acute cholecystitis (accuracy 84.7% and 88.1% respectively). Consequently, the choice of tests selected to evaluate patients with suspected acute cholecystitis depends on...
A retrospective analysis of 71 patients with proven common bile duct obstruction, who had not undergone previous biliary surgery, was performed. To determine optimal criteria for differentiating stone from nonstone obstruction by ultrasonography, five sonographic signs were analyzed as binary variables. These signs are the demonstration of (1) comm...
Pyogenic splenic abscess is an uncommon lesion associated with high mortality. Diagnosis may be difficult, especially in deep-seated abscesses. Plain radiographs and nuclear medicine techniques may be helpful, but can be insufficiently specific. Sonography, which images morphologic changes, is useful in assessing splenic abscesses. Five of six absc...
The sonographic Murphy sign, the presence of maximal tenderness elicited over a sonographically localized gallbladder, has been considered useful in the evaluation of patients with suspected acute cholecystitis. We prospectively evaluated this sign in 427 consecutive patients referred for evaluation of acute cholecystitis. The overall accuracy of t...
Hepatic amebic abscess is a potentially fatal infection which is difficult to diagnose in children. Sonography is an ideal non-invasive imaging tool which can prove invaluable in the diagnosis and management of hepatic amebic abscess. Sonographic findings should suggest the correct diagnosis in most instances. This allows prompt initiation of thera...
The authors describe a new radiographic sign of rupture of the Achilles tendon system. It is a fracture, with separation through an osteophyte at the insertion of this tendon. Previously reported signs are also discussed as well as the present case report.
The sonographic appearance of the normal and dilated common bile duct is described. The normal duct courses dorsally as it goes caudally, making a sharp dorsal bend as it slides over the portal vein. Most dilated main bile ducts display a convex ventral configuration that allows easy differentiation from the portal vein, even in technically difficu...
Sonography is an accurate indicator of the presence of common bile duct obstruction but a poor indicator of the cause. We evaluated the use of three indirect sonographic signs as an adjunct to the direct demonstration of 1) a common duct stone or 2) a nearby mass, in differentiating gallstone from non-stone obstruction. These indirect signs are 1)...
We present a case with an unusual fistulous connection from a left proximal biliary radical to the gastric body in which 99mTc-PIPIDA (paraisopropyliminodiacetic acid) studies were helpful in both pre- and postoperative assessment of biliary drainage.
Retrospective analysis of 22 patients with increased gallbladder wall thickness (4--10 mm) in the absence of gallbladder disease revealed that 19 were hypoalbuminemic (albumin less than 3.6 g/dl). To test the hypothesis that hypoalbuminemia was a causal factor, gallbladder wall thickness was measured in 40 patients selected prospectively solely on...
One hundred clinical abdominal sonographic examinations were assessed to determine the frequency with which various parts of the hepatic artery system were imaged. The common, proper, and right hepatic arteries were seen in a large percentage of cases (92%, 75%, and 73%, respectively). Sixty-one consecutive patients with dilated biliary ducts were...
Demonstration of bile leakage through fistulas with hepatobiliary radiopharmaceuticals was first done with /sup 131/I rose bengal. The improved anatomic detail provided by technetium-99m-labeled iminodiacetic acid compounds gives more detailed information. We present a case with an unusual fistulous connection from a left proximal biliary radical t...
Unusual radiographic manifestations of amebiasis have not previously been emphasized in the literature. These unusual manifestations often mimic other, more common disease entities. A recent case of urinary bladder-cervical amebiasis prompted a review of other unusual manifestations of amebiasis. Over a 25-year period, unusual cases involving the m...