Orith Portnoy

Cardiovascular calcifications after radiation therapy for Hodgkin lymphoma: computed tomography detection and clinical correlation.

ObjectiveTo study cardiovascular calcifications, detected by computed tomography, in patients following mediastinal radiation for Hodgkin lymphoma, and correlate them with clinical findings. Materials and methodsFifteen patients, ≤55 years, with computed tomography detected cardiovascular calcifications after mediastinal radiotherapy for Hodgkin lymphoma were identified during a 10-year period. Calcifications were evaluated for site and extent and were correlated with clinical data including symptoms and signs of heart disease, angiographic and surgical findings. ResultsAccelerated calcifications were detected in the coronary arteries (n=11), in the aorta (n=11), and in the aortic valve and the mitral apparatus (n=8). Calcifications were more extensive when radiation was given at a young age. Clinical evidence of cardiovascular disease included coronary events in three patients, valvular dysfunction in two, pericarditis in two and complete atrioventricular block in one. Seven patients had no cardiac symptoms. ConclusionEarly cardiovascular calcifications can be radiation associated. Such calcifications may represent radiation-induced atherosclerosis and can be detected by computed tomography even in asymptomatic patients. The implication of our findings is that spiral computed tomography may serve as a non-invasive modality to detect accelerated cardiovascular calcifications in high-risk asymptomatic patients who survived Hodgkin lymphoma.

Optimization of 64-MDCT urography: effect of dual-phase imaging with furosemide on collecting system opacification and radiation dose.

OBJECTIVE The purpose of this study was to compare opacification of the urinary collecting system and radiation dose associated with three-phase 64-MDCT urographic protocols and those associated with a split-bolus dual-phase protocol including furosemide. MATERIALS AND METHODS Images from 150 CT urographic examinations performed with three scanning protocols were retrospectively evaluated. Group A consisted of 50 sequentially registered patients who underwent a three-phase protocol with saline infusion. Group B consisted of 50 sequentially registered patients who underwent a reduced-radiation three-phase protocol with saline. Group C consisted of 50 sequentially registered patients who underwent a dual-phase split-bolus protocol that included a low-dose furosemide injection. Opacification of the urinary collecting system was evaluated with segmental binary scoring. Contrast artifacts were evaluated, and radiation doses were recorded. Results were compared by analysis of variance. RESULTS A significant reduction in mean effective radiation dose was found between groups A and B (p < 0.001) and between groups B and C (p < 0.001), resulting in 65% reduction between groups A and C (p < 0.001). This reduction did not significantly affect opacification score in any of the 12 urinary segments (p = 0.079). In addition, dense contrast artifacts overlying the renal parenchyma observed with the three-phase protocols (groups A and B) were avoided with the dual-phase protocol (group C) (p < 0.001). CONCLUSION A dual-phase protocol with furosemide injection is the preferable technique for CT urography. In comparison with commonly used three-phase protocols, the dual-phase protocol significantly reduces radiation exposure dose without reduction in image quality.

Contrast-enhanced CT colonography with 64-slice MDCT compared to endoscopic colonoscopy in the follow-up of patients after colorectal cancer resection

BACKGROUND Seventy percent of newly diagnosed colorectal cancer cases are potential candidates for curative surgery, but after resection, in 30%, the tumor will recur. Postoperative follow-up includes endoscopic colonoscopy (EC) and computed tomography (CT). There have been only a few publications on the use of contrast-enhanced CT colonography (CECTC) in the follow-up of these patients. METHODS Twenty-nine consecutive patients after resection of colorectal cancer underwent CECTC and EC on the same day. CECTC studies were reviewed for identification of strictures, recurrence, polyps and metastases. RESULTS The anastomosis was identified in 96% of patients on CECTC and in 82% on endoscopic colonoscopy. One stricture was identified by both techniques. One extraluminal recurrence was depicted only on CECTC. Sensitivity in detecting polyps was per polyp 93% and per patient 100%. CONCLUSION CECTC performed on a 64-slice multidetector CT is reliable in imaging the postoperative colon for the follow-up of patients after resection of colorectal cancer.

Differentiation between right tubo-ovarian abscess and appendicitis using CT—A diagnostic challenge

AIM To determine CT features that can potentially differentiate right tubo-ovarian abscess (TOA) from acute appendicitis (AA; including abscess formation). MATERIALS AND METHODS The abdominal computed tomography (CT) images of 48 patients with right-sided TOA (average age 39.3 ± 9.8 years) and 80 patients (average age 53.5 ± 19.9 years) with AA (24 with peri-appendicular abscess) were retrospectively evaluated. Two experienced radiologists evaluated 12 CT signs (including enlarged, thickened wall ovary, appendix diameter and wall thickness, peri-appendicular fluid collection, adjacent bowel wall thickening, fat stranding, free fluid, and extraluminal gas) in consensus to categorize the studies as either TOA or AA. The diagnosis and the frequency of each of the signs were correlated with the surgical and clinical outcome. RESULTS Reviewers classified 92% cases correctly (TOA=85%, AA=96.3%), 3% incorrectly (TOA=6.3%, AA=1.3%); 5% were equivocal (TOA=8.3%, AA=2.5%). In the peri-appendicular abscess group reviewers were correct in 100%. Frequent findings in the TOA group were an abnormal ovary (87.5%), peri-ovarian fat stranding (58.3%), and recto-sigmoid wall thickening (37.5%). An abnormal appendix was observed in 2% of TOA patients. Frequent findings in the AA group were a thickened wall (32.5%) and distended (80%) appendix. Recto-sigmoid wall thickening was less frequent in AA (12.5%). The appendix was not identified in 45.8% of the TOA patients compared to 15% AA. CONCLUSIONS In the presence of a right lower quadrant inflammatory mass, peri-ovarian fat stranding, thickened recto-sigmoid wall, and a normal appearing caecum, in young patients favour the diagnosis of TOA. An unidentified appendix does not contribute to the differentiation between TOA and peri-appendicular abscess.

Gas in the kidney: CT findings

Gas in the renal parenchyma is a rare finding seen best with computed tomography (CT). It can be encountered in a wide range of clinical conditions, some of them life-threatening like emphysematous pyelonephritis, whereas in others, it may represent a postoperative or procedure outcome. The latter are not usually a clinical emergency (for example, after nephrostomy insertion or in a urinary intestinal connection). Due to the increasing use of abdominal CT examinations, radiologists, especially in emergency setting, should be aware of this rare finding and be familiar with its differential diagnosis.

Multislice CT compared to small bowel follow-through in the evaluation of patients with Crohn disease.

BACKGROUND Patients with Crohn disease (CD) often undergo both multislice computed tomography (MSCT) and small bowel follow-through (SBFT) for evaluation of their disease. We compared the findings on computed tomography (CT) and SBFT in patients with CD to determine whether MSCT can be the modality of choice in the evaluation of these patients. METHODS We reviewed the CT and SBFT studies of 41 patients with CD. The findings were evaluated by three experienced abdominal imagers. RESULTS There was no statistical difference in the detection of mural involvement of the small bowel. The CT showed additional involvement of the colon, mesenteric involvement, and extraenteric complications. CONCLUSION Multislice CT is a reliable modality in demonstrating enteric as well as extraenteric pathological findings in patients with CD. We suggest that MSCT can replace SBFT in the evaluation of patients with CD.

Correlation between MRI and double-balloon urethrography findings in the diagnosis of female periurethral lesions

This study aims to evaluate the correlation of MRI findings with double-balloon urethrography (DBU) in diagnosing female urethral diverticula and other periurethral lesions. In this retrospective study, females with clinically suspected periurethral lesions who underwent both MRI and DBU between 2008 and 2012 were evaluated. MRI was performed on a 1.5 Tesla unit using a pelvic phased array coil. Protocol included small FOV pelvic images, multiplanar T2-w, T1-w with and without contrast injection. DBU was performed by a dedicated catheter. Images were evaluated in consensus by two readers. Diverticula were evaluated by, size, number, complexity, location and connection to urethra, and other periurethral lesions were evaluated by size, location and connection. Supplement clinical and surgical data were retrieved from medical records and telephone interviews. Seventeen females (mean age 44 years, range 20-69) were included in the study. Diverticula were diagnosed by both modalities (9 cases), by neither (6 cases, 88% correlation) by MRI alone (1 case) and by DBU alone (1 case). Among diverticula, correlation of number, complexity, location and demonstration of connection to urethra was 89%, 67%, 67%, and 56%, respectively. Alternative diagnosis solely by MRI included vaginal wall cysts (3 cases), endometriosis (1 case) and ectopic ureter (1 case). No periurethral lesion was found by either modality in 2 cases. The correlation between MRI and DBU in diagnosing female periurethral lesions is very good for anatomical delineation of diverticula. MRI, which does not involve radiation, may also indicate alternative diagnoses that can contribute to proper patient management.

Complications after laparoscopic gynecologic procedures: CT findings

Laparoscopic gynecologic surgery has gained worldwide popularity in the past few years, but complications of this new technique do occur. We encountered three patients who developed major complications after laparoscopic gynecologic procedures including perforation of the sigmoid colon, urinary bladder, and ureter. We report the computed tomographic findings of these cases and the diagnostic dilemmas they posed.Laparoscopic gynecologic surgery has gained worldwide popularity in the past few years, but complications of this new technique do occur. We encountered three patients who developed major complications after laparoscopic gynecologic procedures including perforation of the sigmoid colon, urinary bladder, and ureter. We report the computed tomographic findings of these cases and the diagnostic dilemmas they posed.

The Role of Early Postmortem CT in the Evaluation of Support- Line Misplacement in Patients with Severe Trauma

OBJECTIVE The purpose of this study was to retrospectively assess the role of early postmortem CT in evaluating support-line misplacement to improve future treatment in the trauma setting. MATERIALS AND METHODS We included all postmortem CT examinations that were performed for trauma patients within the 1st hour after declaration of death in our tertiary medical center between August 1, 2008, and August 31, 2013. Correct placement of the following support lines was evaluated: endotracheal tubes (ETTs), chest drains, central venous catheters (CVCs), and nasogastric tubes (NGTs). Prehospital resuscitation efforts were started in all cases. RESULTS Early postmortem CT was performed on average 22 minutes after declaration of death in 25 consecutive patients with severe trauma. Overall, 14 subjects (56%) had suboptimal or misplaced support lines. Of ETTs inserted into 18 trauma victims; three (17%) were mislaid in the right main bronchus and five (28%) were near or at the level of the carina. Of chest drains inserted into 13 subjects, 10 were suboptimally positioned (77%). Of CVCs inserted into eight subjects (seven femoral and one brachiocephalic), one femoral CVC (13%) was malpositioned in the soft tissues of the pelvis. Of NGTs inserted in five trauma victims, one was folded within the pharynx. CONCLUSION Early postmortem CT for patients who have experienced severe poly-trauma can be of important educational value to radiologists and the trauma teams, providing immediate feedback regarding the location of the support lines and possibly contributing to improved training and command of the learning curve by medical staff.

Oncologic Outcomes of Partial Nephrectomy for Stage T3a Renal Cell Cancer

&NA; We present our long‐term multicenter experience with partial nephrectomy for locally advanced tumors (stage pT3a) and compare the oncologic outcomes with those of similar patients treated with radical nephrectomy. The cohort size was 134 patients. Surgery type was not a predictor of the oncologic outcomes at the 5‐year follow‐up point. Our findings suggest that partial nephrectomy can be considered for T3a tumors and, thus, avoid the long‐term complications of radical nephrectomy. Future studies are needed for validation. Background: Partial nephrectomy (PN) for clinical stage T3 tumors is controversial. Radical nephrectomy (RN) has been associated with a greater rate of chronic kidney disease, an increased risk of cardiovascular disease, and increased mortality compared with PN. We present our long‐term 2‐center experience with PN for stage pT3a tumors and compare the oncologic outcomes with those of similar patients treated with RN. Materials and Methods: We reviewed the data from all patients who had undergone nephrectomy for renal cell carcinoma from 1987 to 2015 in 2 medical centers. The study included 134 patients with pathologic stage T3a tumors, of whom 48 and 86 underwent PN and RN, respectively. We compared the 2 groups (PN and RN) using univariate and multivariate analyses. Results: The tumors of all patients with pathologic stage T3a who had undergone PN had been pathologically upstaged from clinical stage T1 or T2. Univariate and multivariate analyses revealed tumor size was significantly different statistically between the study groups (median, 7.0 cm in RN group vs. 4.0 cm in PN group; P < .001). Surgery type was not a predictor of local recurrence (P = .978), metastatic progression (P = .972), death from renal cancer (P = .626), or death from all causes (P = .974) at the 5‐year follow‐up point. Conclusion: The results of the present study have shown similar oncologic outcomes between 48 patients with stage pT3a renal cancer who underwent PN and 86 patients who underwent RN. Although PN was not performed on clinical T3a tumors, our findings suggest that PN can also be considered for these tumors and, thus, avoid the long‐term complications of RN. However, strict follow‐up protocols are mandatory.