W L Foster’s research while affiliated with Duke University and other places

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Publications (22)


The emphysemas: radiologic-pathologic correlations
  • Literature Review

April 1993

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22 Reads

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178 Citations

Radiographics

W L Foster

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E I Gimenez

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M A Roubidoux

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[...]

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P C Pratt

There are several forms of emphysema that should be considered as distinct disease entities. No university accepted classification system of these forms exists, but correlations of autopsy findings in 1,823 cases over a 12-year period confirm that the radiographic and pathologic features of the emphysemas are readily understood when centrilobular, panlobular, paracicatricial, and localized types of the disease are recognized. Centrilobular emphysema associated with cigarette smoking is the most common form. Panlobular emphysema is associated with alpha 1-protease inhibitor deficiency and pathologically produces uniform enlargement of all air spaces, with a mild basilar predominance. Paracicatricial emphysema is seen adjacent to areas of parenchymal scarring. Localized emphysema represents focal enlargement or destruction of air spaces with otherwise normal lung. A clear understanding of the computed tomographic appearance of all forms of emphysema is essential for the correct diagnosis of parenchymal lung abnormalities.


Fig. 1.-A, Unenhanced CT scan at level of lower pole of right kidney shows opaque rim of Dacron mesocaval shunt (arrowheads) just craniad to 
Paraprosthetic-duodenal fistula involving a mesocaval shunt
  • Article
  • Full-text available

January 1990

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45 Reads

American Journal of Roentgenology

Download


Computed tomography of the rectum

August 1987

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261 Reads

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8 Citations

Radiographics

CT is an important diagnostic procedure in patients with suspected or known disease of the rectum. Knowledge of proper technique for CT of the rectum, as well as an understanding of normal pelvic anatomy, is essential to its effective use. CT can demonstrate the extent of perirectal and pararectal abnormalities detected on barium enema. While routine preoperative staging of rectal cancer is not justified, CT can be used to solve specific problems. Perhaps the most important role of rectal CT is in evaluating postoperative rectosigmoid cancer patients in an attempt to detect early asymptomatic recurrences and, thereby, prolong patient survival.


Esophageal cancer staging by CT: Long-term follow-up study

November 1986

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17 Reads

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59 Citations

Radiology

To evaluate the utility of computed tomographic (CT) staging in patients with esophageal cancer, the length of patient survival was compared with pretherapy CT findings in 89 patients. Regardless of therapy, patients with evidence of mediastinal invasion, liver metastases, or abdominal adenopathy had a statistically shortened survival (P less than .05). Specific CT criteria that predicted a shortened survival included evidence of tracheal, aortic, or pericardial invasion. Patients with evidence of both mediastinal invasion and abdominal metastases had a mean survival of 180.4 days; those with no evidence, 479.6 days. The presence of enlarged upper abdominal lymph nodes indicated the worst prognosis (mean survival, 90 days). The patients with squamous cell tumors were classified by the CT staging system, and survival data were compared according to surgical procedure. Patients who underwent attempted curative surgery did not have a statistically significant difference in survival by analysis of survival curves but demonstrated a longer mean survival than those who underwent palliative or no surgery.


Centrilobular emphysema: CT-pathologic correlation

May 1986

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39 Reads

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156 Citations

Radiology

Over a 5-year period, 25 patients who had undergone chest computed tomography (CT) died and were autopsied. Their lungs were fixed in the inflated state and were assessed for the presence and severity of centrilobular emphysema (CLE). Three radiologists independently evaluated the CT scans for nonperipheral low-attenuation areas, peripheral low-attenuation areas, pulmonary vascular pruning, pulmonary vascular distortion, and pulmonary density gradient. The CT criterion that best correlated with the presence and severity of CLE was the nonperipheral low-attenuation area. With this CT criterion, lung destruction was correctly identified in 13 of 15 cases. The absence of this criterion resulted in correct identification of eight of ten normal lungs. These preliminary data suggest that CLE can be reliably identified and quantified with current CT scanners.


Preoperative and postoperative CT staging of sigmoid carcinoma

May 1986

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286 Reads

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162 Citations

American Journal of Roentgenology

This study reports a 4 year experience using CT for preoperative staging and for evaluation of patients with rectal and sigmoid carcinoma after surgery. All patients were evaluated on a GE 8800 scanner using 1 cm contiguous slices. Only 15 of the 25 preoperative patients were staged correctly. The other 10 patients were understaged by CT. The accuracy of detecting local invasion was 70%, but only seven (35%) of 20 patients had accurate assessment of lymph nodes. The overall accuracy of CT staging in the 46 postoperative patients was 87%, with a sensitivity of 91% and a specificity of 72%. Most recurrences were found in the pelvis; 16 patients had liver metastases, and metastatic disease obstructing the ureters was detected in eight patients. On the basis of these results, it was concluded that CT should not be used routinely to preoperatively stage patients with rectosigmoid carcinoma. However, all patients who have undergone resection for rectal or sigmoid carcinoma should have aggressive CT evaluation including a baseline study at 2-4 months and then follow-up studies at every 6 months for at least 2 years. All new or enlarging masses should have CT-guided biopsies. This approach may prolong survival by detecting early asymptomatic recurrences.


Fig. 1 .-Low-kVp 
TABLE 2 : Scores of Individual Reviewers: T-Test for Paired Means 
TABLE 3 : Results of Paired Evaluation of Radiographs Technique used (n = 28) 
Figure 4 of 4
Optimal cholangiographic technique for detecting bile duct stones

April 1986

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632 Reads

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5 Citations

American Journal of Roentgenology

Twenty-eight patients with proven bile duct stones were evaluated during either operative or T-tube cholangiography. Two radiographs were obtained for each patient without changing patient position between films. The first was performed with low peak kilovoltage (75-80 kVp) and 15% iodinated contrast medium and the second with high kVp (110) and 38% iodinated contrast. Seven radiologists evaluated the radiographs individually and in matched pairs for ductal filling, ductal penetration, motion unsharpness, overall quality, and stone detectability. The high-kVp radiographs were rated significantly better overall than the low-kVp studies (p less than 0.001) for all five criteria. In the second evaluation, which compared the pairs from the same patients, the 28 high-kVp radiographs were considered superior to the 28 low-kVp studies by the radiologists in almost two-thirds of the comparisons (ductal filling, 68%; penetration, 59%; less motion unsharpness, 65%; overall quality, 77%; stone detection, 62%). On the basis of the results of this study, high-kVp technique with full-strength contrast medium for operative and T-tube cholangiography is recommended.



The radiologic evaluation of gross cecal distension: Emphasis of cecal ileus

January 1986

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224 Reads

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122 Citations

American Journal of Roentgenology

A retrospective review of plain abdominal radiographs in 46 patients with gross cecal distension (greater than 10 cm) was performed. In 25 (54%) of 46 patients, the cecum was dilated out of proportion to the rest of the colon and was rotated anteromedially. The term cecal ileus is used to describe this situation. Five (20%) of 25 patients with cecal ileus developed perforation. Four of these patients died as a result of the perforation. The risk of perforation was related more to duration of cecal distension than to absolute cecal size. Aggressive decompressive measures, including consideration of cecostomy, appear warranted in patients with gross cecal distension, especially when it is dilated out of proportion to the rest of the colon and has persisted for several days.


Citations (17)


... EMH has also been observed in the posterior mediastinum, kidney, central nervous system and peripheral nerves, meninges, middle ear, pancreas, urethra, thyroid and adrenal glands, gastrointestinal tract, pharynx, lung, pleura and pericardium, heart, peritoneum and retroperitoneum, skin, kidney, breast, ovary, prostate gland, endometrium, epididymis and thymus [1,[3][4][5][6]. ...

Reference:

Extramedullary Hematopoiesis Mimicking a Neoplasm in a Goeldi’s Monkey (Callimico goeldii)
Focal intrahepatic extramedullary hematopoiesis mimicking neoplasm

American Journal of Roentgenology

... The remaining 65 articles were selected for close review of the full article, after which 45 articles were excluded. Nineteen of these articles were excluded because the analysis of rectal tumors could not be separated from the analysis of colon tumors [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] (Fig. 1). In total, 20 articles were included for the final analysis [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]. ...

Preoperative and postoperative CT staging of sigmoid carcinoma

American Journal of Roentgenology

... Careful inspection of sequential pictures and multiplanar reconstruction may assist in determining ascites, effusion, or both. Four indicators distinguish effusion from ascites 84 : A) Chest CT shows that PE has peripheral diaphragm fluid, whereas ascites have core fluid. B) PE has fluid expansion posteriorly behind the liver but not centrally. ...

Ascites or pleural effusion? CT differentiation: four useful criteria

Radiographics

... On occasion, cancers invading the airway lumen or a fistula between the esophagus and airway may be visualized on CT; however, confirmatory bronchoscopy with biopsy is necessary. [30] , [32] Pericardial invasion is suspected if pericardial thickening, pericardial effusion, or indentation of the heart with loss of the pericardial fat plane at the level of the cancer are evident. MRI offers no significant advantage over CT. ...

Esophageal cancer staging by CT: Long-term follow-up study
  • Citing Article
  • November 1986

Radiology

... Initially CT scan it was used for the diagnosis of intraacranial pathology only but later on it was realized that it is an important tool in assessing thoracic, abdominal and pelvic reasons also. Together with Allen Cormack, Hounsfield was awarded Nobel Prize in 1979 for his Revolutionary achievement [1] . CT and HRCT how largely replaced radiological procedures such has bronchography and pulmonary angiography for evolution of parenchyma lung diseases. ...

Localized peribronchial thickening: A CT sign of occult bronchogenic carcinoma
  • Citing Article
  • June 1985

American Journal of Roentgenology

... Effects of various surgical procedures for oropharyngeal cancer include a reduced range of oral tongue motion, reduced oral tongue coordination, reduced posterior movement of tongue base, with prolonged bolus transit through the oropharynx, and abnormal swallowing efficiency [2][3][4][5][6][7]. Approximately one-sixth of patients with prior laryngectomy present dysphagia related to the morphofunctional changes carried out on the pharynx during surgery [8][9][10][11][12][13][14][15][16]. A videofluoroscopic study of swallow enables the morphodynamics of the pharyngeal-esophageal tract to be accurately examined in patients with prior surgery. ...

Esophageal lesions after total laryngectomy

American Journal of Roentgenology

... Given this risk patients should be monitored by serial abdominal X-rays every 12 h to 24 h to see the colonic diameter and by laboratory test in the form of full blood count and electrolytes. Initially patients are conservatively managed with IV fluids keeping them nil orally and on NG suction which was performed for our patient [6]. Some of his symptoms were relieved by these actions. ...

The radiologic evaluation of gross cecal distension: Emphasis of cecal ileus
  • Citing Article
  • January 1986

American Journal of Roentgenology

... The attention weights demonstrated a stronger influence for slices in the upper lung in all scan classes, indicating that the model prioritized upper lobe information (Table 3, Fig. 2). This agrees with published literature trends that note an upper lobe predominance for emphysema, particularly centrilobular, the most common phenotype in this dataset [33][34][35][36] . Recall, influence is quantified by three metrics: (1) depth maximum attention of fit curve, (2) weighted average of slice depths weighted by attention, and (3) range of fit curve attention values. ...

Centrilobular emphysema: CT-pathologic correlation
  • Citing Article
  • May 1986

Radiology

... In humans, Computed Tomography (CT) is particularly useful in diagnosing focal and multifocal infectious hepatic processes, and it is considered the main imaging modality for the diagnosis of liver abscesses with a sensitivity of up to 97% versus a sensitivity of 85% in ultrasound [8][9][10][11][12]. The CT features of human pyogenic liver abscesses include well-defined, low-attenuation, round masses with a peripheral contrast-enhancing rim, occasionally containing gas in up to 20% of the cases [3]. ...

The variable CT appearance of hepatic abscesses

American Journal of Roentgenology