Browse Health
Radiologist
25 years of experience
Accepting new patients

Education ?

Medical School Score
Thomas Jefferson University (1985)
  • Currently 2 of 4 apples

Awards & Distinctions ?

Appointments
Univ Of Pa Medcial Center (1991 - 2001)
Nyu Medical Center (2001 - Present)
New York University School of Medicine
Associate Professor Director of Cardiac Imaging
Associations
American Board of Radiology

Affiliations ?

Dr. Jacobs is affiliated with 10 hospitals.

Hospital Affilations

Score

Rankings

  • Nyu Hospital For Joint Diseases
    301 E 17th St, New York, NY 10003
    • Currently 4 of 4 crosses
    Top 25%
  • NYU Hospitals Center
    550 1st Ave, New York, NY 10016
    • Currently 4 of 4 crosses
    Top 25%
  • Hospital of the University of PA
    3400 Spruce St, Philadelphia, PA 19104
    • Currently 4 of 4 crosses
    Top 25%
  • Ny Hospital Medical Ctr Of Queens,The
    5645 Main St, Flushing, NY 11355
    • Currently 3 of 4 crosses
    Top 50%
  • Bellevue Hospital Center
    462 1st Ave, New York, NY 10016
    • Currently 3 of 4 crosses
    Top 50%
  • New York University
  • Presbyterian Hospital
  • Tisch Hospital
    550 1st Ave, New York, NY 10016
  • Rusk Institute of Rehabilitation Medicine
    400 E 34th St, New York, NY 10016
  • New York University Hospital
  • Publications & Research

    Dr. Jacobs has contributed to 50 publications.
    Title Evaluation of the Mitral and Aortic Valves with Cardiac Ct Angiography.
    Date May 2010
    Journal Journal of Thoracic Imaging
    Excerpt

    Cardiac computed tomographic angiography (CTA) using multidetector computed tomographic scanners has proven to be a reliable technique to image the coronary vessels. CTA also provides excellent visualization of the mitral and aortic valves, and yields useful information regarding valve anatomy and function. Accordingly, an assessment of the valves should be performed whenever possible during CTA interpretation. In this paper, we highlight the imaging features of common functional and structural left-sided valvular disorders that can be seen on CTA examinations.

    Title Aberrant Crossed Left Circumflex and Left Anterior Descending Arteries: Diagnosis with Multidetector Cardiac Ct Angiography.
    Date April 2009
    Journal Journal of Computer Assisted Tomography
    Excerpt

    The multidetector coronary computed tomography angiogram findings of a rare variant crossed left circumflex and left anterior descending artery are presented. In this patient, multidetector coronary computed tomography angiogram enabled clear delineation of the aberrant coronary artery anatomy, including an estimation of patency during systole and diastole. To our knowledge, this is only the second reported case of this particular coronary artery anomaly in the world literature.

    Title Dual-source Versus Single-source Cardiac Ct Angiography: Comparison of Diagnostic Image Quality.
    Date April 2009
    Journal Ajr. American Journal of Roentgenology
    Excerpt

    Dual-source CT improves temporal resolution, and theoretically improves the diagnostic image quality of coronary artery examinations without requiring preexamination beta-blockade. The purpose of our study was to show the improved diagnostic image quality of dual-source CT compared with single-source CT despite the absence of preexamination beta-blockade in the dual-source CT group.

    Title Consensus Update on the Appropriate Usage of Cardiac Computed Tomographic Angiography.
    Date January 2008
    Journal The Journal of Invasive Cardiology
    Title Acr Practice Guideline for the Performance and Interpretation of Cardiac Computed Tomography (ct).
    Date August 2007
    Journal Journal of the American College of Radiology : Jacr
    Excerpt

    Cardiac computed tomography (CT) is an evolving modality that includes a variety of examinations to assess the anatomy and pathology of the cardiac chambers, valves, myocardium, coronary arteries and veins, pericardium, aortic root, and central great vessels. The development of multidetector CT scanners with increasing numbers of detector rows, narrow section thicknesses, increasing scanner speeds, the ability for electrocardiographic gating, and radiation dose modulation allows the performance of CT coronary arteriography. Computed tomography coronary arteriography enables the assessment of multiple types of cardiac pathology, including intraluminal coronary arterial plaque formation, coronary artery stenosis, congenital anomalies, coronary artery aneurysms, sequelae of cardiac ischemia, and the assessment of prior vascular interventions, while providing information about cardiac and valvular function. Noncardiac structures included in cardiac CT examinations must also be evaluated. This guideline attempts to maximize the probability of detecting cardiac abnormalities with cardiac CT. American College of Radiology requirements for physicians and personnel performing examinations are also addressed and will become applicable by July 1, 2008.

    Title Coronary Ct Angiography with 64-mdct: Assessment of Vessel Visibility.
    Date August 2006
    Journal Ajr. American Journal of Roentgenology
    Excerpt

    OBJECTIVE: The objective of our study was to evaluate the image quality of 64-MDCT for coronary angiography. SUBJECTS AND METHODS: Fifty consecutive CT coronary angiograms obtained on a 64-MDCT scanner were independently reviewed by two reviewers. Segments were scored as showing no motion (score of 1), minimal motion (2), moderate motion (3), respiratory motion (4), or vessel blurring (5). Opacification was graded as good (score of 1) or limited (2). Segments < 2 mm were graded as well seen; or as poorly seen or not seen. The scores for motion artifact, opacification, and visibility were combined for overall vessel assessment. Segments with a motion score of 1 or 2 that had good opacification and were well seen were judged to be assessable. RESULTS: A total of 714 segments were analyzed in 50 patients. Seven hundred segments were assessed in all patients (segments 1-3, 11-20, 4, or 27), and a ramus intermedius segment was evaluated in 14 patients. Combining the scores for both reviewers, the average motion score was 1 for 619 segments (86.7%), the average motion score for all segments in an individual patient was 1.14 (range, 1-3.35), and the average opacification score for all segments in a patient was 1.02 (range, 1-1.38). A total of 374 segments were less than 2 mm in diameter. Combining the scores for both reviewers, an average of 36 segments (5.0% of 714) could not be identified by the reviewers, 319.5 segments (85.4%) were well seen, and 18.5 segments (4.9%) were poorly seen. Overall, an average of 637 segments (89.2%) were judged assessable by the reviewers. On a per-patient basis, 10 or more vessel segments were judged assessable in 47 patients (94%). CONCLUSION: On 64-MDCT, 89% of coronary artery segments are assessable. Ten or more vessel segments are assessable in 94% of patients.

    Title Gated Cardiac Imaging of the Aortic Valve on 64-slice Multidetector Row Computed Tomography: Preliminary Observations.
    Date July 2006
    Journal Journal of Computer Assisted Tomography
    Excerpt

    PURPOSE: To conduct a pilot study to determine the feasibility of evaluating aortic valve morphology and motion on electrocardiogram-gated 64-slice cardiac MDCT. METHODS: Four-dimensional images of the aortic valve were reviewed in 20 consecutive patients who underwent computed tomography (CT) coronary angiography. A consensus reading of 3 readers was performed of valve visibility, number of leaflets, valve motion, and calcification. Visibility of the valve leaflets and visualization of opening and closing of the valve leaflets were graded as well seen or suboptimally seen. The number of valve leaflets (3 or 2) and presence of valvular calcification were noted. RESULTS: The aortic valve was well seen in all 20 patients. Three leaflets were identified in all cases, and no calcifications were seen. Valve movement with opening and closure of the leaflets during the cardiac cycle was also well seen in all cases. CONCLUSIONS: Visualization of the aortic valve and valvular motion during the cardiac cycle is feasible on CT studies performed for coronary angiography. CT has a potential role in the assessment of aortic valvular pathology.

    Title Ct of Gi Trauma.
    Date November 2004
    Journal Critical Reviews in Computed Tomography
    Excerpt

    Traumatic bowel and mesenteric injuries are notoriously difficult to diagnose. CT has become the modality of choice for evaluating stable trauma patients for the presence of intra-abdominal injury. This article will summarize the CT findings useful for detecting bowel and mesenteric injury.

    Title Focal Fatty Sparing of the Pancreatic Head in Cystic Fibrosis: Ct Findings.
    Date February 2004
    Journal Abdominal Imaging
    Excerpt

    The most common imaging appearance of the pancreas in cystic fibrosis is diffuse, complete fatty replacement. We present a case of complete fatty replacement of the pancreatic body and tail with total sparing of the pancreatic head. To our knowledge, this pattern of fatty sparing and its associated computed tomographic appearance have not been previously reported in cystic fibrosis.

    Title Ct Imaging in Acute Appendicitis: Techniques and Controversies.
    Date January 2004
    Journal Seminars in Ultrasound, Ct, and Mr
    Title Benign and Malignant Lesions of the Stomach: Evaluation of Ct Criteria for Differentiation.
    Date July 2003
    Journal Radiology
    Excerpt

    PURPOSE: To determine the sensitivity and specificity of computed tomographic (CT) criteria for differentiating benign from malignant stomach lesions in patients with a thickened gastric wall at CT. MATERIALS AND METHODS: A radiology department file search revealed 36 patients with a thickened gastric wall at CT who underwent double-contrast barium suspension upper gastrointestinal tract examinations within 6 weeks before or after CT. The authors reviewed the CT images without knowledge of the final radiologic, endoscopic, or pathologic findings to determine the degree of gastric wall thickening and the symmetry, distribution, and enhancement of the thickened wall. The sensitivity and specificity of these findings for detection of malignancy were calculated. RESULTS: Two of 36 patients had two gastric abnormalities each. The final diagnoses in the 38 cases were gastritis in 19, hiatal hernia in four, benign ulcer in three, benign (n = 3) or malignant (n = 8) gastric neoplasm in 11, and no gastric abnormality in one case. Mean wall thickness was 1.5 cm (range, 0.7-7.5 cm). The finding of gastric wall thickness of 1 cm or greater had a sensitivity of 100% but a specificity of only 42% for detection of malignant or potentially malignant stomach lesions. The finding of focal, eccentric, or enhancing wall thickening had a sensitivity of 93%, 71%, or 43%, respectively, and a specificity of 8%, 75%, or 88%, respectively, for detection of these lesions. Gastric wall thickening that was 1 cm or greater and was focal, eccentric, and enhancing had a specificity of 92% but a sensitivity of only 36% for detection of these lesions. CONCLUSION: Gastric wall thickness of 1 cm or greater at CT had a sensitivity of 100% but a specificity of less than 50% for detection of malignant or potentially malignant stomach lesions that necessitated further diagnostic evaluation.

    Title Pneumatosis Intestinalis in Patients with Ischemia: Correlation of Ct Findings with Viability of the Bowel.
    Date April 2003
    Journal Ajr. American Journal of Roentgenology
    Excerpt

    OBJECTIVE: The purpose of our study was to reassess the CT finding of pneumatosis in intestinal ischemia to determine whether it indicates transmural necrosis versus partial mural ischemia and also to determine whether other CT findings can be used to predict which patients with pneumatosis are likely to have viable bowel. CONCLUSION: The CT finding of pneumatosis does not always indicate transmural infarction of the bowel in intestinal ischemia. Patients with associated portomesenteric venous gas are more likely to have transmural infarction than those with pneumatosis alone.

    Title Cystic Pancreatic Neoplasms: Ct Appearances.
    Date February 2003
    Journal Critical Reviews in Computed Tomography
    Title Spectrum of Ct Findings in Acute Pyogenic Pelvic Inflammatory Disease.
    Date January 2003
    Journal Radiographics : a Review Publication of the Radiological Society of North America, Inc
    Excerpt

    Pelvic inflammatory disease (PID) is a common medical problem, affecting nearly 1 million women each year. Although the radiology literature is replete with discussions of the sonographic manifestations of PID, little has been published regarding the computed tomographic (CT) appearances of this entity. CT findings in early PID include obscuration of the normal pelvic floor fascial planes, thickening of the uterosacral ligaments, cervicitis, oophoritis, salpingitis, and accumulation of simple fluid in the endometrial canal, fallopian tubes, and pelvis. As the disease progresses, this simple fluid may become complex and the inflammatory changes may progress to frank tubo-ovarian or pelvic abscesses. Reactive inflammation of adjacent structures is common and can manifest as small or large bowel ileus or obstruction, hydroureter and hydronephrosis, right upper quadrant inflammation (Fitz-Hugh-Curtis syndrome), or peritonitis. Familiarity with the CT appearances of these manifestations is important for timely diagnosis and treatment of PID and its complications.

    Title Renal Cyst Pseudoenhancement: Evaluation with an Anthropomorphic Body Ct Phantom.
    Date October 2002
    Journal Radiology
    Excerpt

    PURPOSE: To determine the effects of cyst diameter and location (intrarenal, exophytic), renal attenuation, section collimation, and computed tomographic (CT) interscanner variability on renal cyst pseudoenhancement in a phantom model. MATERIALS AND METHODS: A customized anthropomorphic phantom was designed to accept 40-, 140-, and 240-HU renal inserts containing intrarenal and exophytic 7-, 10-, and 15-mm cysts. Each phantom and insert were scanned with five different helical CT scanners by using 1.0-1.5-mm, 2.50-3.75-mm, 5.0-mm, 7.0-8.0-mm, and 10.0-mm section collimation. Means and SDs of CT number measurements were obtained for each cyst within each variably "enhanced" renal insert. Mixed-model analysis of variance accommodating heteroscedasticity of data was used to assess the effect of scanner type, section collimation, and cyst diameter on cyst attenuation. RESULTS: Pseudoenhancement (range, 10.3-28.3 HU), observed by using effective section collimation equal to or less than 50% of cyst diameter, occurred in 34 (38%) of 90 intrarenal cyst measurements. Pseudoenhancement was observed with all five CT scanners, though the magnitude of the effect was nonuniform. Significant interactions were noted between renal cyst diameter, background renal attenuation, and CT scanner type in terms of their effects on cyst attenuation. No appreciable pseudoenhancement was observed with exophytic cysts. CONCLUSION: Pseudoenhancement is maximal when small (< or = 1.5-cm) intrarenal cysts are scanned during maximal levels of renal parenchymal enhancement. The magnitude of this effect varies with scanner type but may be large enough to prevent accurate lesion characterization, despite use of a thin-section helical CT data acquisition technique.

    Title Disseminated Aspergillosis Inciting Intestinal Ischaemia and Obstruction.
    Date January 2002
    Journal The British Journal of Radiology
    Excerpt

    Invasive aspergillosis is an opportunistic infection that characteristically affects the immunocompromised host, resulting in a high degree of morbidity and mortality. Although the portal of entry is usually pulmonary, there are rare reports of invasive aspergillosis localized to the gastrointestinal tract. In addition, haematological spread may develop, with life threatening disseminated infection involving the vital organs and the gastrointestinal tract. Although disseminated infection is well recognized, the CT findings of gastrointestinal disease have not been reported to our knowledge. We describe the CT findings in a patient with invasive aspergillosis involving the gastrointestinal tract, which resulted in intestinal ischaemia complicated by small bowel obstruction.

    Title Omental Infarction As a Delayed Complication of Abdominal Surgery.
    Date December 2001
    Journal Clinical Imaging
    Excerpt

    Omental infarction, an uncommon cause of acute abdominal pain, is the result of compromised perfusion to the greater omentum. Although its etiology remains uncertain, predisposing factors include obesity [Surg. Today 30 (2000) 451], strenuous activity [N. Z. Med. J. 111 (1998) 211], trauma, and idiopathic omental torsion. Often confused with acute appendicitis or cholecystitis on clinical grounds [Surg. Today 30 (2000) 451], its diagnosis has traditionally been one of exclusion, based on intraoperative and pathologic findings. This diagnosis can be made radiologically based on the characteristic findings of an inflammatory mass containing fat and fluid. We describe a case of right lower quadrant omental infarction temporally related to bowel surgery.

    Title Acute Appendicitis: Comparison of Helical Ct Diagnosis Focused Technique with Oral Contrast Material Versus Nonfocused Technique with Oral and Intravenous Contrast Material.
    Date September 2001
    Journal Radiology
    Excerpt

    PURPOSE: To compare the diagnostic accuracy of focused helical computed tomography (CT) with orally administered contrast material with that of nonfocused helical CT with orally and intravenously administered contrast material. MATERIALS AND METHODS: After receiving oral contrast material, 228 patients with clinically suspected appendicitis underwent focused appendiceal CT (5-mm section thickness, 15-cm coverage in the right lower quadrant). Immediately thereafter, helical CT of the entire abdomen and pelvis was performed following intravenous administration of contrast material (abdomen, 7-mm section thickness; pelvis, 5-mm section thickness). Studies were separated and independently interpreted by three observers who were blinded to patient names. Diagnoses were established by means of surgical and/or clinical follow-up findings. RESULTS: Fifty-one (22.4%) of 228 patients had acute appendicitis. Readers diagnosed appendicitis with 83.3%, 73.8%, and 71.4% sensitivity and 93.0%, 92.3%, and 97.9% specificity with focused nonenhanced appendiceal CT. Readers diagnosed appendicitis with 92.9%, 92.9%, and 88.1% sensitivity and 93.7%, 95.1%, and 96.5% specificity with nonfocused enhanced CT. Summary areas under the receiver operating characteristic curve estimates for focused nonenhanced and nonfocused enhanced CT were 0.916 and 0.964, respectively; the differences were statistically significant (P <.05) for two of three readers. All readers demonstrated higher sensitivities for detecting the inflamed appendix with nonfocused enhanced CT. Appendicitis was missed with focused CT in two patients whose inflamed appendix was not included in the imaging of the right lower quadrant. All readers were significantly more confident in diagnosing alternative conditions with nonfocused enhanced CT. CONCLUSION: Diagnostic accuracy of helical CT for acute appendicitis improved significantly with use of intravenous contrast material.

    Title Computed Tomography Evaluation of Acute Pancreatitis.
    Date August 2001
    Journal Seminars in Roentgenology
    Title Isolated Infarction of the Cecum: Ct Findings in Two Patients.
    Date March 2000
    Journal Radiology
    Excerpt

    Colonic ischemia isolated to the cecum is a rare entity. The authors evaluated two patients who underwent computed tomography (CT) because appendicitis was suspected at clinical examination. CT findings were suggestive of isolated cecal ischemia or infarction. Surgical-histopathologic findings helped confirm the presumptive CT diagnoses. Isolated cecal infarction should be included in the differential diagnosis of acute right lower quadrant pain.

    Title Thin-section Ct Imaging of Patients Suspected of Having Appendicitis or Diverticulitis.
    Date February 2000
    Journal Academic Radiology
    Title Renal Cyst Pseudoenhancement: Beam-hardening Effects on Ct Numbers.
    Date December 1999
    Journal Radiology
    Excerpt

    PURPOSE: To determine if simple renal cysts may be accurately characterized with helical computed tomography (CT) during peak levels of renal enhancement. MATERIALS AND METHODS: Water-filled "cysts" were suspended in varying concentrations of iodine solution, meant to simulate varying levels of renal enhancement, within an abdominal phantom. Volume-averaging effects were minimized by scanning cylindric 5-30-mm cysts with a helical technique (collimation, 5 mm; pitch, 1:1). Axial and helical techniques were then compared, and volume-averaging effects were evaluated by scanning 10- and 20-mm round cysts with 3-, 5-, and 7-mm collimation at background attenuation levels of 100 and 200 HU. RESULTS: Cylindric cyst attenuation increased consistently with increasing background attenuation. As background attenuation increased by 90 HU, attenuation increased by 11-17 HU in small (5- or 10-mm) cysts, and by 7-9 HU in large (15-30-mm) cysts. As background attenuation increased by 180 HU, attenuation increased by 18-28 HU in small cysts and by 10-15 HU in large cysts. Spherical cyst attenuation differences were maximized when smaller cysts were imaged with larger collimation, which is when volume-averaging effects became apparent. Axial and helical CT numbers did not differ substantially. Computer simulation studies showed that the observed effect could not be explained by beam hardening alone. CONCLUSION: Pseudoenhancement of renal cysts may occur if helical CT is performed during peak renal enhancement. CT algorithm modification may be necessary to correct for this effect, which is likely related to an inadequate algorithmic correction for beam hardening.

    Title Assessment of a Bolus-tracking Technique in Helical Renal Ct to Optimize Nephrographic Phase Imaging.
    Date April 1999
    Journal Radiology
    Excerpt

    PURPOSE: To evaluate a bolus-tracking technique in helical computed tomography (CT) for identifying the onset of the nephrographic phase and to determine the effect of varying the volume and injection rate of contrast material on nephrographic phase onset. MATERIALS AND METHODS: Seventy-five patients underwent bolus tracking of contrast material followed by helical renal CT. In 50 patients, 150 mL of 60% iodinated contrast material (iohexol or iothalamate meglumine) was injected at either 2 mL/sec (25 patients [group 1]) or 3 mL/sec (25 patients [group 2]). In 25 patients who had previously undergone nephrectomy, 100 mL of 60% iodinated contrast material was injected at 3 mL/sec (group 3). Nephrographic phase onset was determined by visually assessing the transition to a homogeneous nephrogram during a monitoring scan series starting 40 seconds after injection. RESULTS: Nephrographic phase onset ranged from 60 to 136 seconds (mean, 89 seconds +/- 17 [+/- SD]). Statistically significant differences in mean onset times were observed among groups 1 (103 seconds +/- 12), 2 (91 seconds +/- 16), and 3 (75 seconds +/- 9) (P < .001). Multiple regression analysis showed patient age, contrast material volume, and injection rate to be independent predictors of nephrographic phase onset. Contrast material volume, patient age, and patient weight were independent predictors of the degree of renal enhancement. CONCLUSION: Nephrographic phase onset is highly dependent on methods of contrast material administration and patient characteristics.

    Title Comparison of Resistive Index Versus Pulsatility Index in Assessing the Benign Etiology of Adnexal Masses.
    Date December 1998
    Journal Clinical Imaging
    Excerpt

    Retrospective analysis of pelvic sonograms with colorguided spectral Doppler evaluation of 189 adnexal masses yielded four malignancies, 20 benign neoplasms, 32 cysts, and 14 endometriomas. Fifty-eight masses were presumed benign on additional imaging. Pulsatility index (PI) < 1.0 was seen in 70% neoplasms, 63% benign cysts and 50% endometriomas. Thirteen percent of benign cysts and no neoplasms had resistive index (RI) < 0.4. Fifty percent malignancies had PI < 1.0. None had RI < 0.4. Both thresholds lack sufficient sensitivity and specificity for distinguishing benign and malignant lesions.

    Title Contrast Media Reactions and Extravasation: Relationship to Intravenous Injection Rates.
    Date December 1998
    Journal Radiology
    Excerpt

    PURPOSE: To evaluate the belief that the frequencies of contrast material extravasation and minor, nonidiosyncratic contrast material reactions correlate with intravenous injection rates. MATERIALS AND METHODS: Complications of 6,660 consecutive injections of contrast material for computed tomography were prospectively recorded. Ionic (n = 4,851) or nonionic (n = 1,809) contrast material was injected at 0.5-4.0 mL/sec. The injection rate was 1.9 mL/sec or less in group 1 (n = 2,899), 2.0-2.9 mL/sec in group 2 (n = 2,475), and 3.0-4.0 mL/sec in group 3 (n = 1,286). RESULTS: The extravasation rate (0.6%) did not differ significantly between the groups. The reaction rate (8.4%) also did not differ significantly between the groups. The rate of minor reactions (8.0%) was higher with ionic (9.9%) than nonionic (2.9%) contrast material (relative risk = 3.4). The rate of major reactions (0.4%) did not vary significantly with type of contrast material. The rate of nausea or vomiting (3.8%) did not differ significantly between the groups but was higher with ionic (4.9%) than nonionic (1.1%) contrast material (relative risk = 4.5). The rate of severe warmth (2.1%) was significantly higher in group 3 (2.8%) than group 1 (2.0%) or 2 (1.8%). CONCLUSION: No correlations exist between injection rate and extravasation rate or overall reaction rate.

    Title Diagnostic Criteria for Fatty Infiltration of the Liver on Contrast-enhanced Helical Ct.
    Date September 1998
    Journal Ajr. American Journal of Roentgenology
    Excerpt

    OBJECTIVE: The purpose of the study was to develop quantitative and qualitative criteria for diagnosing fatty liver on contrast-enhanced helical CT. SUBJECTS AND METHODS: Differential liver-spleen attenuation was evaluated between 80 and 120 sec after injection in 76 patients who underwent contrast-enhanced helical CT. Unenhanced CT images had earlier established fatty liver when the liver minus spleen attenuation difference was less than or equal to -10 H (n = 18). Four observers who had not seen the unenhanced images used contrast-enhanced CT images to assess the presence of fatty liver on a five-point Likert scale, the presence of geographic areas spared from fatty infiltration, and the relative liver-spleen attenuation. The diagnostic accuracies of various imaging criteria were compared using McNemar's chi-square test (for sensitivity and specificity) and analysis of receiver operating characteristic curves. RESULTS: Sensitivity, specificity, and receiver operating characteristic curve areas for observers' qualitative judgments were 54%, 95%, and .91, respectively; for quantitative differential liver-spleen attenuation (80-100 sec; -20.5 H discriminatory value), the values were 86%, 87%, and .94, respectively; and for quantitative differential liver-spleen attenuation (101-120 sec; -18.5 H discriminatory value), the values were 93%, 93%, and .98, respectively. Differential liver-spleen attenuation was time-dependent; overlap was noted between healthy subjects and patients with fatty liver. Qualitatively, geographic sparing was highly specific (94%) for fatty liver, whereas liver attenuation greater than or equal to spleen attenuation excluded fatty liver in all but one case. CONCLUSION: Although quantitative and qualitative criteria for diagnosing fatty liver on helical CT can be determined, they are protocol-specific. Limited unenhanced hepatic CT remains the optimal technique for detection of fatty infiltration of the liver.

    Title Hepatic Infarction Secondary to Arterial Insufficiency in Native Livers: Ct Findings in 10 Patients.
    Date July 1998
    Journal Radiology
    Excerpt

    PURPOSE: To describe the computed tomographic (CT) appearance of hepatic infarcts resulting from arterial insufficiency in native livers. MATERIALS AND METHODS: The authors retrospectively reviewed the clinical and imaging findings in 10 patients (five men, five women; age range, 28-70 years) with 14 hepatic infarcts seen over 3 years. CT scans were analyzed for infarct appearance, vessel patency, and evolution of infarct pattern over time. RESULTS: Hepatic infarction resulted from hepatobiliary surgery (n = 6), radiologic intervention (n = 3), and celiac occlusion secondary to antiphospholipid syndrome (n = 1). All 14 infarcts were of low attenuation, peripheral, and wedge-shaped. Occluded arterial vessels were identified in eight patients. Follow-up CT revealed infarct diminution with parenchymal atrophy and scarring (n = 5), progressive liquefaction (n = 2), or both parenchymal atrophy and progressive liquefaction (n = 1). CONCLUSION: Sudden interruption of hepatic arterial flow may cause acute native liver infarction. Patients at risk include those with underlying vascular disease who undergo complicated surgical procedures and those undergoing peripheral arterial embolization.

    Title Abdominal Visceral Calcification in Primary Amyloidosis: Ct Findings.
    Date September 1997
    Journal Abdominal Imaging
    Excerpt

    The computed tomographic (CT) findings of extensive visceral calcification involving both the liver and spleen in a patient with primary amyloidosis are presented. Although the CT imaging appearances of amyloidosis are often nonspecific, visceral calcification represents an important diagnostic clue for differentiating this entity from other infiltrative parenchymal diseases.

    Title Sonography of Transjugular Intrahepatic Portosystemic Shunts: Detection of Elevated Portosystemic Gradients and Loss of Shunt Function.
    Date September 1997
    Journal Journal of Vascular and Interventional Radiology : Jvir
    Excerpt

    PURPOSE: To evaluate the role of ultrasound (US) in the detection of elevated portosystemic gradients and loss of shunt function in patients with a transjugular intrahepatic portosystemic shunt (TIPS). MATERIALS AND METHODS: The authors' prospectively compared 151 Doppler hepatic sonograms with follow-up portal venograms in 64 patients with TIPS. Sonographic data from within the portal system, hepatic arteries, and three areas within the TIPS were collected. Statistical analysis of these parameters was used to establish the US criteria for shunt dysfunction. RESULTS: Midshunt velocity thresholds of less than 50 and less than 60 cm/sec yielded sensitivities and specificities of 46% and 93%, and 57% and 89%, respectively, for the detection of portosystemic gradients exceeding 15 mm Hg. Use of a threshold midshunt velocity of less than 60 cm/sec or main portal vein velocity of less than 40 cm/sec raised the shunt dysfunction detection sensitivity to 86%, with a specificity of 54%. CONCLUSION: Doppler US is an effective noninvasive screening tool for detecting elevated portosystemic gradients and evaluating the functional status of a TIPS. Midshunt velocities of less than 60 cm/sec or main portal vein velocities less than 40 cm/sec are a useful threshold for detecting shunt dysfunction.

    Title Abdominal Computed Tomography of Intensive Care Unit Patients.
    Date July 1997
    Journal Seminars in Roentgenology
    Title Hiv Colitis: Clinical and Radiographic Findings.
    Date April 1997
    Journal Ajr. American Journal of Roentgenology
    Title Omental Caking in Hodgkin's Disease. Computed Tomography Findings.
    Date February 1997
    Journal Clinical Imaging
    Excerpt

    Neoplastic infiltration of the greater omentum is most commonly caused by metastatic ovarian, gastric, colonic, or pancreatic carcinoma. Because the omentum lacks lymphoid elements, lymphomatous infiltration is uncommon. To date, omental involvement by lymphoma has been reported exclusively in patients with non-Hodgkin's lymphomas. In this report, the computed tomography findings of omental caking caused by Hodgkin's lymphoma are described. Although rare, both Hodgkin's and non-Hodgkin's lymphomas should be included in the differential diagnosis of omental caking.

    Title High-resolution Computed Tomography of the Female Pelvis: Spectrum of Normal Appearances.
    Date February 1997
    Journal Seminars in Roentgenology
    Title Intrauterine Low Density in Women over 50. Assessment of Significance and Recommendations for Follow-up.
    Date January 1997
    Journal Clinical Imaging
    Excerpt

    Patients over 50 years old with intrauterine low density on enhanced computed tomography were analyzed. Uterine volume and volume of intrauterine low density were calculated. Intrauterine low density was expressed as a percent of uterine volume. At 1-year follow-up, 23 (63.9%) had uterine malignancy and 13 (36.2%) had benign findings. All patients whose intrauterine low density exceeded 35% of the total uterine volume had a malignancy (p < 0.001). If intrauterine low density exceeds 35% of uterine volume, evaluation of uterine malignancy should be performed regardless of symptoms.

    Title Clinical Image. Shoulder Harness Seatbelt Injury: Ct Appearance of Hepatic Avulsion with Active Arterial Hemorrhage.
    Date December 1996
    Journal Journal of Computer Assisted Tomography
    Title Multiphasic Renal Ct: Comparison of Renal Mass Enhancement During the Corticomedullary and Nephrographic Phases.
    Date September 1996
    Journal Radiology
    Excerpt

    PURPOSE: To evaluate thin-section computed tomography (CT) performed during the corticomedullary and nephrographic phases of contrast material enhancement in the characterization of renal masses. MATERIALS AND METHODS: A prospective study of 30 patients was undertaken with CT to characterize 31 "indeterminate" renal masses. In all patients, 5-mm-thick, contiguous, high-tube-current (320-340-mA) scans were obtained through the kidneys before (axial mode), during (helical mode, 25-second delay, corticomedullary-phase images), and after (axial mode, 120-second delay, nephrographic-phase images) administration of a 117-second biphasic injection of intravenous contrast material. RESULTS: Eight of 16 neoplasms measured less than 20 HU on CT scans obtained without contrast material enhancement; measurements of two of these corresponded to "cyst attenuation" during the corticomedullary phase. Enhancement of 10 HU or greater was demonstrated in 11 neoplasms during the corticomedullary phase and in all neoplasms in the nephrographic phase. No enhancement was seen in 15 radiologically benign cysts. Both renal neoplasms and normal renal cortex demonstrated significantly greater enhancement in the nephrographic phase compared with that in the corticomedullary phase (P = .0002 and P < .0001, respectively). CONCLUSION: Enhancement of renal neoplasms is time dependent and may not be evident in hypovascular tumors analyzed during the early corticomedullary phase. Reliance on absolute CT attenuation measurements, without use of internal standards as controls, may lead to misdiagnosis of neoplasms as cysts.

    Title Heterotopic Ossification of Midline Abdominal Incisions: Ct and Mr Imaging Findings.
    Date June 1996
    Journal Ajr. American Journal of Roentgenology
    Excerpt

    OBJECTIVE: Heterotopic ossification of a midline surgical incision in a form of myositis ossificans traumatica in which osseous, cartilaginous, and, occasionally, myelogenous elements develop within an abdominal wound. When large amounts of internal ossification are present, the scar may demonstrate a complex radiologic appearance and potentially may be misinterpreted as a retained foreign body or incisional neoplastic recurrence. This report describes the CT and MR imaging findings of this entity. SUBJECTS AND METHODS: The authors retrospectively reviewed the cross-sectional imaging findings of 11 patients with ossified midline abdominal wounds. All but one of the patients were men, and the median age at diagnosis was 40 years old (range, 20-76 years old). Initial imaging was performed 7 days to 36 months after surgery (mean, 6.7 months). CT and MR imaging scans were reviewed, and lesion size, location, distance from the xiphoid, shape, and stability were assessed. Pathologic proof was obtained in one patient. RESULTS: CT and MR imaging examination in all patients showed ossified surgical scars, with the attenuation or signal intensity of the ossified components equivalent to that of the spine. Intralesional, fat-density components suggestive of marrow were present in two patients. All scars were located in the upper abdomen between the anterior abdominal fascia and the peritoneal surface, at the level of or inferior to the xiphoid process. Scars ranged in length from 0.7 to 13.4 cm (mean, 6.9 cm). Distances from the inferior tip of the xiphoid to the superior aspect of the ossified scar ranged from 0 to 4.9 cm (mean, 2.2 cm). Time from surgery to the initial postoperative demonstration of scar ossification ranged from 11 days to 36 months (mean, 6.8 months). None of the five patients who underwent preoperative CT examinations had abnormalities in the location of subsequent scar ossification. Of the nine patients with multiple postoperative examinations, scar size and appearance remained stable in six. In the remaining three patients, scar size was stable but showed progressive internal ossification. CONCLUSION: Heterotopic ossification within midline abdominal scars can be diagnosed by both CT and MR imaging examination. Recognition of the imaging appearances of such ossification should help prevent diagnostic confusion when attending postoperative patients.

    Title Computed Tomography Imaging of Focal Hepatic Lesions.
    Date February 1996
    Journal Seminars in Roentgenology
    Title Strategy for Repeat Biopsy of Patients with Prostatic Intraepithelial Neoplasia Detected by Prostate Needle Biopsy.
    Date January 1996
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We evaluated the strategy for repeat biopsy of patients with prostatic intraepithelial neoplasia without concurrent carcinoma detected on prostate needle biopsy. MATERIALS AND METHODS: Of 1,275 consecutive patients undergoing prostate needle biopsy 61 were identified with prostatic intraepithelial neoplasia but without concurrent prostate carcinoma. Of the 61 patients 53 had undergone repeat biopsy. The medical records, transrectal ultrasound, and operative and pathological reports of these patients were reviewed. RESULTS: Repeat biopsy was done in 53 patients with prostatic intraepithelial neoplasia, yielding carcinoma in 15, prostatic intraepithelial neoplasia without carcinoma in 8 and benign tissue in 30. The yield of carcinoma from repeat biopsy of a prostatic intraepithelial neoplasia site was 8.3% (7 of 84 sites). A total of 18 sites of carcinoma was detected by repeat biopsy of a previous random biopsy site (8), a prostatic intraepithelial neoplasia site only (5), a transrectal ultrasound nodule (3), a palpable nodule and prostatic intraepithelial neoplasia site (1), and a transrectal ultrasound nodule and prostatic intraepithelial neoplasia site (1). Carcinoma was as frequently detected by repeat biopsy of a prostatic intraepithelial neoplasia site (6 patients) as by random repeat biopsy (6 patients). CONCLUSIONS: Repeat prostate needle biopsy of patients with prostatic intraepithelial neoplasia should include random repeat biopsy and repeat biopsy of transrectal ultrasound abnormalities as well as previous sites of prostatic intraepithelial neoplasia.

    Title Hepatic Enhancement During Helical Ct: a Comparison of Moderate Rate Uniphasic and Biphasic Contrast Injection Protocols.
    Date October 1995
    Journal Ajr. American Journal of Roentgenology
    Excerpt

    OBJECTIVE. The purpose of this study was to compare the degree and timing of peak hepatic enhancement, optimal scanning intervals, and optimal delay times of moderate-rate uniphasic and biphasic contrast material injection protocols for hepatic helical CT. MATERIALS AND METHODS. One hundred fifty patients were randomized into three injection protocols, receiving 42.3 g iodine (150 ml iothalamate meglumine) delivered using 3 ml/sec uniphasic, 2 ml/sec uniphasic, or biphasic (3 ml/sec [50 ml], 1 ml/sec [100 ml]) technique. Statistically fitted aortic and hepatic enhancement curves were generated from dynamic incremental CT data for each patient. Protocols were compared by maximum hepatic enhancement, and contrast enhancement indices were modeled for a 38-sec helical acquisition. RESULTS. The 3 ml/sec and 2 ml/sec uniphasic protocols produced higher peak hepatic enhancement (64 +/- 15 H and 62 +/- 15 H [mean +/- 1 SD]) than the 3 ml/sec biphasic protocol (52 +/- 10 H; p < .001). Contrast enhancement indices for the 3 ml/sec uniphasic and 2 ml/sec uniphasic protocols (385 +/- 398 H/sec and 397 +/- 412 H/sec) were significantly greater than the index for the 3 ml/sec biphasic protocol (123 +/- 194 H/sec; p < .0001) at a 50-H threshold. Optimal scan delay times were 50 +/- 8, 75 +/- 7, and 119 +/- 8 sec, respectively, for the 3 ml/sec uniphasic, 2 ml/sec uniphasic, and 3 ml/sec biphasic techniques. CONCLUSION. The moderate-rate uniphasic injections studied provided greater hepatic enhancement throughout the helical acquisition without requiring the prohibitively long delay time necessitated by the moderate-rate biphasic injection. These findings differ from prior results that showed that a uniphasic injection may provide comparable levels of hepatic enhancement when compared with a high-flow-rate biphasic injection.

    Title Ct of Inflammatory Disease of the Colon.
    Date July 1995
    Journal Seminars in Ultrasound, Ct, and Mr
    Excerpt

    CT plays an important role in the evaluation of patients with suspected colonic inflammation. High-resolution, thin-section imaging of the gastrointestinal tract allows assessment of both the intraluminal and extraluminal components of colonic disease, thereby enabling radiologists to detect and stage colonic pathology accurately. In addition, CT can be used to guide percutaneous drainage of abscess collections, often obviating the need for surgical intervention. This article describes CT techniques for diagnosing inflammatory diseases of the colon as well as the typical CT appearances.

    Title Glutaraldehyde Colitis: Radiologic Findings.
    Date April 1995
    Journal Radiology
    Excerpt

    PURPOSE: Two percent glutaraldehyde on colonic mucosa may result in a toxic colitis, and the clinical features may mimic those of colonic ischemia. The study was performed to determine the radiologic appearance of glutaraldehyde-induced toxic colitis. MATERIALS AND METHODS: A retrospective review was performed with the clinical and imaging findings in four patients with glutaraldehyde-induced colitis seen during a 6-year period. RESULTS: Patients developed a self-limited syndrome of cramps and abdominal pain, tenesmus, and rectal bleeding within 48 hours of uncomplicated sigmoidoscopy or colonoscopy. Sample cultures excluded enteric pathogens. Computed tomography (CT) demonstrated circumferential thickening of the colonic wall in a left-sided distribution in all patients. Heterogeneous mural enhancement (target-sign appearance) was noted in two patients. Follow-up CT studies confirmed resolution of mural wall thickening with conservative management. CONCLUSION: The clinical and radiologic features of glutaraldehyde-induced toxic colitis may mimic those of colonic ischemia. This complication should be suspected in patients who develop hemorrhagic colitis immediately after undergoing colonoscopy.

    Title Stereotactic Needle Biopsy of Nonpalpable Breast Masses.
    Date July 1994
    Journal Connecticut Medicine
    Excerpt

    One hundred two patients with nonpalpable breast masses that presented as mammographic densities with or without calcification were studied consecutively. Using the Stereotix stereotactic device, fine-needle aspirations were obtained with subsequent hook-wire placement followed by surgical excision. Pathology results were reached separately and then compared to the cytologic diagnoses. For patients with adequate cytologic material, sensitivity was 95% and specificity was 100%. There were six suspicious or equivocal diagnoses: three were determined to be benign, while three were malignant. There was inadequate tissue in 13%. Although this technique had limitations, for patients with adequate cytologic and histologic material the accuracy was excellent.

    Title Follow-up of Benign Hypoechoic Peripheral Zone Lesions of the Prostate Gland: Us Characteristics and Cancer Prevalence.
    Date April 1994
    Journal Radiology
    Excerpt

    PURPOSE: To evaluate the role of biopsy-proved benign peripheral zone hypoechoic lesions of the prostate gland, ultrasonographic (US) characteristics at follow-up, prostate-specific antigen (PSA) levels, and digital rectal examination (DRE) in prediction of cancer risk. MATERIALS AND METHODS: Retrospective analysis was performed for 105 consecutive patients with 148 benign hypoechoic lesions discovered at transrectal US (TRUS) and diagnosed with US-guided needle biopsy. At least one repeat TRUS study was performed in each patient. RESULTS: Among the benign lesions, 72% changed at follow-up TRUS, either disappearing or becoming smaller, less hypoechoic, and more vague. Cancer developed in 13% of patients. In 93% of patients in whom cancer developed, the appearance changed in the peripheral zone at follow-up TRUS. In this patient population, the positive predictive value for development of cancer was 16% with a changing TRUS appearance, 19% with an abnormal DRE result, and 27% with an elevated level of PSA; only the latter was statistically significant. CONCLUSION: The PSA value, alone or in combination with a changing TRUS appearance, is the best indicator for development of cancer.

    Title Pancreatic Sparing of Focal Fatty Infiltration.
    Date February 1994
    Journal Radiology
    Excerpt

    PURPOSE: To describe typical findings of focal fatty sparing of the pancreas. MATERIALS AND METHODS: Computed tomography, ultrasonography, and/or magnetic resonance imaging were performed in seven patients. RESULTS: In these patients, the area of sparing of fatty change was within the head or uncinate process of the pancreas. CONCLUSION: Differentiating pancreatic fatty sparing from true neoplasm by means of cross-sectional imaging obviates the need for invasive diagnostic studies.

    Title Cross-sectional Imaging of Idiopathic Solitary Renal Vein Varix: Report of Two Cases.
    Date October 1991
    Journal Urologic Radiology
    Excerpt

    Two cases of solitary renal vein varices are reported which presented as incidental findings on abdominal computed tomography (CT) and were initially thought to represent retroperitoneal lymph nodes. Contrast-enhanced CT, magnetic resonance imaging (MRI), and Doppler ultrasound (US), all demonstrated the vascular nature of these masses suggesting the correct diagnosis. When a rounded soft tissue density mass is seen on noncontrast-enhanced CT either in or contiguous to the renal hilum, a renal vein varix must be excluded. Doppler US, MRI, or dynamic contrast-enhanced CT should be done to exclude a renal varix as the cause.

    Title Wideband Acoustic Transmission of Human Lungs.
    Date March 1990
    Journal Medical & Biological Engineering & Computing
    Excerpt

    The measurement of sound transmission in human lungs has shown promise to reveal, by noninvasive methods, information about the structure of peripheral airways and lung tissue. The paper gives a detailed explanation of the instrumentation and testing methods developed to measure sound transmission through human lungs and thoracic structures in the 5-20 kHz frequency range and describes in detail experiments comparing the acoustic lung transmission patterns of four different subject groups. The experimental results are compared with those predicted by an acoustical model of sound transmission through lung parenchyma.

    Title Renal Lymphangiomyoma--a Rare Cause of a Multiloculated Renal Mass.
    Date February 1989
    Journal Ajr. American Journal of Roentgenology
    Title Management of an Intrabony Defect Using Osseous Coagulum from a Lingual Torus.
    Date July 1984
    Journal The Compendium of Continuing Education in Dentistry
    Title Noninvasive Automatic Patient Monitoring.
    Date June 1970
    Journal Surgical Forum

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