John J. Pagani

CT manifestations of radiation-induced change in chest tissue

The computed tomographic appearance of acute and chronic radiation change in the thorax is described. Acute radiation pneumonitis demonstrates patchy, confluent regions of increased pulmonary attenuation. Chronic changes include soft tissue density fibrotic changes that blend smoothly with the pleural surfaces and adjacent mediastinal structures. Also seen are bronchiectatic changes and distortion of normal intrathoracic anatomic relationships. Both the acute and chronic changes usually make linear lateral margins with adjacent aerated lung. Development of a discrete mass or focal cavitation after the radiation changes have become stable is suspect for recurrent tumor or infection.

Solid Renal Mass in the Cancer Patient: Second Primary Renal Cell Carcinoma Versus Renal Metastasis

Most renal metastases are asymptomatic, occur with widespread metastatic disease, and are too small to be detected with computed tomography (CT). Rarely they form large masses. These are typically angiographically hypovascular and show only minimal CT contrast enhancement. Renal carcinoma as a second primary malignancy in the cancer patient is 4.5 times more common than mass-like renal metastases and demonstrates two CT contrast enhancement patterns. The latter include either minimal enhancement or irregular regions of intense enhancement. These CT contrast enhancement patterns of both renal carcinoma and metastasis can be used to direct the further diagnostic evaluation of these masses and distinguish between a renal metastasis or a second primary renal carcinoma in the cancer patient.

Pancreatic Castleman disease simulating pancreatic carcinoma on computed tomography.

A patient with a pancreatic body and tail mass caused by Castleman disease and visible on computed tomography is described. This entity simulated pancreatic carcinoma in this clinical setting. Theories of etiology of Castleman disease and differential diagnosis of pancreatic masses are discussed. Proper examination technique is stressed.

Incidence and significance of serendipitous CT findings in the oncologic patient.

One-thousand computed tomograms of the abdomen, chest, and pelvis in oncologic patients were reviewed to determine the incidence of serendipitous findings and their impact on clinical management. The incidence of serendipitous findings was 30% in thorax, 24% in both genitourinary and osseous structures, 23% in the abdomen, and 21% in the retroperitoneum. These serendipitous abnormalities changed clinical management or required further diagnostic procedures (thus, they were considered significant) in less than 1% of the abdominal to 12% in osseous findings.

Deformable anatomic templates embed knowledge into patient's brain images: Part 1. construction and display

Objective This paper describes the methods used to create annotated deformable anatomic templates (DATs) and display them in a patient’s axial 2-dimensional and reformatted volume brain images. Methods A senior neuroradiologist annotated and manually segmented 1185 color-coded structures on axial magnetic resonance images of a normal template brain using domain knowledge from multiple medical specialties. Besides the visible structures, detailed pathways for vision, speech, cognition, and movement were charted. This was done by systematically joining visible anatomic anchor points and selecting the best fit based on comparisons with cadaver dissections and the constraints defined on the companion 2-dimensional images. Results The DAT is commercially available for use on a picture archiving and communication system or as a standalone workstation. Conclusions The DAT can quickly embed extensive, clinically useful functional neuroanatomic knowledge into the patient’s brain images. Besides labeling visible structures, DAT displays clinically important, previously uncharted subdivisions of the fiber tracts.

Deformable anatomic templates embed knowledge into brain images: part 2. Validation using functional magnetic resonance imaging of the motor hand.

Objective This study evaluated the concordance between the Deformable Anatomic Template (DAT)–identified origin of motor hand fibers and localization of the motor cortex of the hand by functional magnetic resonance imaging (fMRI). Methods Preoperative fMRI during hand motor tasks was performed on 36 hemispheres in 26 patients with gliomas in or near eloquent areas. Reformatted volume-rendered surface images were labeled with the DAT’s hand motor fibers and fMRI data. Five reviewers assessed the data for concordance. Results Available fMRI data were diagnostically usable in 92% (33/36 analyzed hemispheres), with DAT anatomic accuracy in the remaining cases. The DAT prediction and fMRI findings were concordant in all 9 normal hemispheres and in 20 (83%) of 24 glioma-bearing hemispheres. The 4 discordant cases resulted from substantial mass effect by large frontal tumors. Conclusions This study validated DAT’s anatomic atlas and alignment process for the expected position of the motor cortex of the hand.