Publications by authors named "Alla Godelman"

17 Publications

  • Page 1 of 1

Can Discrepancies Between Coronary Computed Tomography Angiography and Cardiac Catheterization in High-Risk Patients be Overcome With Consensus Reading?

J Comput Assist Tomogr 2017 Jan;41(1):159-164

From the Departments of *Radiology, †Medicine, and ‡Epidemiology and Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.

Objective: To assess the incidence and cause of discrepancies between coronary computed tomography angiography (CTA) and catheterization in a high-risk, diverse, predominantly overweight inner-city population.

Methods: Ninety-two patients who underwent coronary CTA and catheterization on March 2007 to December 2012 were retrospectively identified. Clinical coronary CTA interpretation and reinterpretation by a review panel was compared with catheterization results.

Results: Severe stenosis was present on catheterization in 65% (60/92). Clinical coronary CTA was concordant with catheterization for severe stenosis in 78% (72/92), whereas panel interpretation was concordant in 77% (70/91). Sensitivity and specificity of clinical and panel coronary CTA interpretations were 92% (55/60) and 53% (17/32) versus 82% (48/59) and 68% (22/32), respectively.

Conclusions: Both coronary CTA interpretations were concordant with catheterization for severe stenosis in three quarters of patients. However, the diagnostic profile of the 2 interpretations differed, with higher sensitivity for the clinical report. This supports the clinical practice, which favored overestimation of difficult to quantify stenoses.
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http://dx.doi.org/10.1097/RCT.0000000000000481DOI Listing
January 2017

Giant Left Ventricular Pseudoaneurysm and Myocardial Dissection as a Complication of Multiple Ventricular Tachycardia Ablations in a Patient with Cardiac Sarcoidosis.

Clin Med Insights Cardiol 2015 9;9:105-7. Epub 2015 Nov 9.

Department of Medicine, Cardiology Division, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, USA.

Late development of left ventricular (LV) pseudoaneurysms after ventricular tachycardia (VT) catheter ablation is a rare phenomenon, and very few cases have been reported in the medical literature. We describe the case of a giant LV pseudoaneurysm as a late complication of multiple epicardial and endocardial VT ablations in a female in her 50s with known cardiac sarcoidosis.
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http://dx.doi.org/10.4137/CMC.S23863DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4640425PMC
November 2015

Computed tomography screening for lung cancer: preliminary results in a diverse urban population.

J Thorac Imaging 2015 Mar;30(2):157-63

Departments of *Radiology †Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.

Purpose: The purpose of this study was to describe the baseline characteristics and results of the initial 18 months of our clinical computed tomography (CT) lung cancer screening program in an ethnically diverse, poor, predominantly overweight, and obese population, which differs dramatically from the National Lung Screening Trial population.

Materials And Methods: All patients had a physician referral for CT lung cancer screening and met National Lung Screening Trial eligibility criteria. Infrastructure developed for the program included a standardized results report [Bronx score of 1 to 5 (modeled on BI-RADS)] for the electronic medical record and a dedicated bilingual screening coordinator. If the patient's insurance did not cover CT screening, a fee of $75 was charged.

Results: A total of 320 patients [54% (174) men, mean age 64 y] underwent initial CT lung cancer screening from December 18, 2012 to July 3, 2014. The median pack-years was 47, and 68% (218) were current smokers. Twenty-six percent (84) were white, and 70% (223) were overweight (101) or obese (122). The lung cancer prevalence was 2.2% (7/320). Seventy-eight percent (7/9) of patients with CT findings positive for lung cancer (score 5a, 5b) had proven lung cancer; 1 had stage 1 (1B) disease, and 6 had stage IIA or higher disease. The false-positive rate for a Bronx score ≥3 was 19% (60). Medicare and Medicaid insure 80% of the institution's overall population but only 38% (121) of the CT screening patients.

Conclusions: CT screening is feasible in a diverse inner-city population with the support of a robust infrastructure. Further study is needed to determine whether CT screening will confer a mortality benefit in this population.
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http://dx.doi.org/10.1097/RTI.0000000000000123DOI Listing
March 2015

CT pulmonary angiography in pregnant and postpartum women: low yield, high dose.

Clin Imaging 2015 Mar-Apr;39(2):251-3. Epub 2014 Nov 18.

Montefiore Medical Center, Department of Radiology.

Purpose: To compare the diagnostic utility of computed tomography pulmonary angiography (CTPA) in pregnant/postpartum women with age-matched controls.

Materials: We performed a retrospective case-control series of pregnant/postpartum women and control women who underwent CTPA from 2008 to 2011.

Results: The study included 34 pregnant women, 16 postpartum women, and 50 controls. CTPAs were positive in 2% of pregnant/postpartum women and 16% of controls (P=.003). The main pulmonary artery mean opacification was 271 Hounsfield units (HU) for pregnant/postpartum women vs. 303 HU (P=.12). Radiation exposure was high in both groups but lower in pregnant/postpartum women, 10 vs. 14 mSv (P=.003).

Conclusion: CTPA in pregnant and postpartum women had low yield and remained high dose.
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http://dx.doi.org/10.1016/j.clinimag.2014.11.006DOI Listing
October 2015

Orthotopic heart transplantation in patients with persistent left superior vena cava: bicaval and biatrial techniques.

Ann Thorac Surg 2014 Mar;97(3):1085-7

Department of Cardiothoracic Surgery, Montefiore Medical Center, Bronx, New York. Electronic address:

Persistent left superior vena cava (LSVC) is the most common congenital venous abnormality. With the increasing number of children who survive into adulthood with congenital heart malformations, the recognition of persistent LSVC among patients with advanced heart failure is likely to rise. We present two cases of orthotopic heart transplantation in the setting of LSVC successfully managed with biatrial and bicaval techniques.
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http://dx.doi.org/10.1016/j.athoracsur.2013.07.033DOI Listing
March 2014

Evaluation of the cardiac chambers on axial CT: comparison with echocardiography.

J Comput Assist Tomogr 2014 Jan-Feb;38(1):53-60

From the *Departments of Radiology, †Medicine, Division of Cardiology, ‡Medicine, and §Family and Social Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.

Objective: To evaluate qualitative and simple quantitative measures of all 4 cardiac chamber sizes on computed tomography (CT) in comparison with transthoracic echocardiography (TTE).

Methods: We retrospectively identified 104 adults with electrocardiographically gated cardiac CT and TTE within 3 months. Axial early diastolic (75% R-R) CT images were reviewed for qualitative chamber enlargement, and each chamber was measured linearly. Transthoracic echocardiography was reviewed for linear, area, and volume measurements. Interrater agreement was calculated using Cohen κ and Pearson correlation.

Results: There were significant correlations between linear left atrium and left ventricle sizes by CT and TTE (r = 0.686 and r = 0.709, respectively). Correlations for right atrium and right ventricle measurements were lower (r = 0.447 and r = 0.492, respectively). Agreement between CT and TTE for qualitative chamber enlargement was poor (highest κ = 0.35). Computed tomography sensitivity was ≤ 62% for enlargement of all chambers.

Conclusions: Linear CT measurements of left-sided chamber sizes correlate well with TTE. Right heart measurements and qualitative assessments agreed poorly with TTE.
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http://dx.doi.org/10.1097/RCT.0b013e3182a75fbeDOI Listing
March 2014

Retained fibrin sheaths: chest computed tomography findings and clinical associations.

J Thorac Imaging 2014 Mar;29(2):118-24

Departments of *Radiology §Medicine ∥Family and Social Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx †Department of Radiology, Staten Island University Hospital, Staten Island, NY ‡Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

Purpose: Fibrin sheaths may develop around long-term indwelling central venous catheters (CVCs) and remain in place after the catheters are removed. We evaluated the prevalence, computed tomographic (CT) appearance, and clinical associations of retained fibrin sheaths after CVC removal.

Materials And Methods: We retrospectively identified 147 adults (77 men and 70 women; mean age 58 y) who underwent CT after CVC removal. The prevalence of fibrin sheath remnants was calculated. Bivariate and multivariate analyses were performed to assess for associations between sheath remnants and underlying diagnoses leading to CVC placement; patients' age and sex; venous stenosis, occlusion, and collaterals; CVC infection; and pulmonary embolism.

Results: Retained fibrin sheaths were present in 13.6% (20/147) of cases, of which 45% (9/20) were calcified. Bivariate analysis revealed sheath remnants to be more common in women than in men [23% (16/70) vs. 5% (4/77), P=0.0018] and to be more commonly associated with venous occlusion and collaterals [30% (6/20) vs. 5% (6/127), P=0.0001 and 30% (6/20) vs. 6% (7/127), P=0.0003, respectively]. Other variables were not associated. Multivariate analysis confirmed the relationship between fibrin sheaths and both female sex (P=0.005) and venous occlusion (P=0.01).

Conclusions: Retained fibrin sheaths were seen on CT in a substantial minority of patients after CVC removal; nearly half of them were calcified. They were more common in women and associated with venous occlusion.
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http://dx.doi.org/10.1097/RTI.0b013e318299ff22DOI Listing
March 2014

A new, simple method for estimating pleural effusion size on CT scans.

Chest 2013 Apr;143(4):1054-1059

Department of Radiology, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY; Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY.

Background: There is no standardized system to grade pleural effusion size on CT scans. A validated, systematic grading system would improve communication of findings and may help determine the need for imaging guidance for thoracentesis.

Methods: CT scans of 34 patients demonstrating a wide range of pleural effusion sizes were measured with a volume segmentation tool and reviewed for qualitative and simple quantitative features related to size. A classification rule was developed using the features that best predicted size and distinguished among small, moderate, and large effusions. Inter-reader agreement for effusion size was assessed on the CT scans for three groups of physicians (radiology residents, pulmonologists, and cardiothoracic radiologists) before and after implementation of the classification rule.

Results: The CT imaging features found to best classify effusions as small, moderate, or large were anteroposterior (AP) quartile and maximum AP depth measured at the midclavicular line. According to the decision rule, first AP-quartile effusions are small, second AP-quartile effusions are moderate, and third or fourth AP-quartile effusions are large. In borderline cases, AP depth is measured with 3-cm and 10-cm thresholds for the upper limit of small and moderate, respectively. Use of the rule improved interobserver agreement from κ = 0.56 to 0.79 for all physicians, 0.59 to 0.73 for radiology residents, 0.54 to 0.76 for pulmonologists, and 0.74 to 0.85 for cardiothoracic radiologists.

Conclusions: A simple, two-step decision rule for sizing pleural effusions on CT scans improves interobserver agreement from moderate to substantial levels.
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http://dx.doi.org/10.1378/chest.12-1292DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616681PMC
April 2013

Acute aortic syndromes: a second look at dual-phase CT.

AJR Am J Roentgenol 2013 Apr;200(4):805-11

Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 East 210th St, Gold Zone, Bronx, NY 10467, USA.

Objective: The purpose of this article is to assess the diagnostic performance of the unenhanced and contrast-enhanced phases separately in patients imaged with CT for suspected acute aortic syndromes.

Materials And Methods: All adults (n = 2868) presenting to our emergency department from January 1, 2006, through August 1, 2010, who underwent unenhanced and contrast-enhanced CT of the chest and abdomen for suspected acute aortic syndrome were retrospectively identified. Forty-five patients with acute aortic syndrome and 45 healthy control subjects comprised the study population (55 women; mean age, 61 ± 16 years). Unenhanced followed by contrast-enhanced CT angiography (CTA) images were reviewed. Contrast-enhanced CTA examinations of case patients and control subjects with isolated intramural hematoma were reviewed. Radiation exposure was estimated by CT dose-length product.

Results: Forty-five patients had one or more CT findings of acute aortic syndrome: aortic dissection (n = 32), intramural hematoma (n = 27), aortic rupture (n = 10), impending rupture (n = 4), and penetrating atherosclerotic ulcer (n = 2). Unenhanced CT was 89% (40/45) sensitive and 100% (45/45) specific for acute aortic syndrome. Unenhanced CT was 94% (17/18) and 71% (10/14) sensitive for type A and type B dissection, respectively (p = 0.142). Contrast-enhanced CTA was 100% (8/8) sensitive for isolated intramural hematoma. Mean radiation effective dose was 43 ± 20 mSv.

Conclusion: Unenhanced CT performed well in detection of acute aortic syndrome treated surgically, although its performance does not support its use in place of contrast-enhanced CTA. Unenhanced CT may be a reasonable first examination for rapid triage when IV contrast is contraindicated. Contrast-enhanced CTA was highly sensitive for intramural hematoma, suggesting that unenhanced imaging may not always be needed. Acute aortic syndrome imaging protocols should be optimized to reduce radiation dose.
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http://dx.doi.org/10.2214/AJR.12.8797DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3685820PMC
April 2013

Resting cardiac 64-MDCT does not reliably detect myocardial ischemia identified by radionuclide imaging.

AJR Am J Roentgenol 2013 Feb;200(2):337-42

Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th St, Bronx, NY 10467-2490, USA.

Objective: CT myocardial perfusion imaging is an emerging diagnostic modality that is under intensive study but not yet widely used in clinical practice. The purpose of this study is to evaluate the performance of resting 64-MDCT in revealing ischemia identified on radionuclide myocardial perfusion imaging (MPI).

Materials And Methods: We retrospectively identified 35 patients (20 women and 15 men; mean age, 52 years) with myocardial ischemia found on MPI who underwent retrospectively gated CT within 90 days of MPI. Myocardial perfusion on CT was evaluated using both a visual (n = 35) and an automated (n = 34) method. For the visual method, myocardial segments were evaluated qualitatively in systole and diastole. For the automated method, subendocardial perfusion of the standard 17 American Heart Association segments was measured using a commercially available tool in both systole and diastole. Differences between systolic and diastolic perfusion were computed.

Results: Five hundred eighty myocardial segments were evaluated, 152 of which were ischemic on MPI. Visual analysis had a sensitivity of 16% (24/152), specificity of 92% (393/428), positive predictive value of 40% (24/60), and negative predictive value of 75% (392/520) in systole, and a sensitivity of 18% (27/152), specificity of 89% (382/428), positive predictive value of 37% (27/73), and negative predictive value of 75% (382/507) in diastole, as compared with MPI. There was no significant difference in subendocardial perfusion between ischemic and nonischemic segments by the automated method. There was no significant difference in CT perfusion between patients with and without obstructive coronary artery disease on CT angiography using the visual or automated methods.

Conclusion: Resting 64-MDCT is unsuitable for clinical use in revealing ischemia seen on MPI.
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http://dx.doi.org/10.2214/AJR.11.8171DOI Listing
February 2013

Postlobectomy chest radiographic changes: a quantitative analysis.

Can Assoc Radiol J 2011 Nov 29;62(4):280-7. Epub 2011 Sep 29.

Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.

Purpose: To provide a quantitative analysis of postlobectomy chest radiographic changes and to evaluate whether the scarring from prior sternotomy affects the size of the hemithorax and the duration of air leak in patients with subsequent lobectomy.

Methods: In this retrospective case-controlled series, 10 consecutive patients who had a lobectomy after a prior sternotomy and 30 controls, 3 for each case, matched for lobectomy site were identified. Pre- and postoperative chest radiographs were quantitatively analysed for diaphragmic elevation, size of each hemithorax, mediastinal shift, and the presence of pneumothorax. Charts were reviewed for air-leak duration, surgical complications, and duration of hospitalization.

Results: There was no difference between patients with lobectomy and with and without prior sternotomy for the following variables expressed as mean (SD): hemidiaphragm elevation (1.5 ± 2.5 vs 0.5 ± 2.0 cm; P = .2), change of hemithorax size (mean transverse, 0.99 ± 0.05 vs 0.97 ± 0.07; P = .5; craniocaudal, 0.93 ± 0.08 vs 0.91 ± 0.08; P = .4) and mediastinal shift (upper, 1.2 ± 0.4 vs 1.3 ± 0.6; P = .5; lower, 1.2 ± 0.4 vs 1.2 ± 0.3; P = .8), the latter 2 were expressed as the ratio of post- to preoperative measurements. These postlobectomy radiographic findings varied, depending on the resected lobe, and became progressively more pronounced during the first 12 months after surgery. There was no difference in pneumothorax duration (mean [SD]) (9.5 ± 21 days vs 6.4 ± 7.5 days; P = .5), air leak duration (mean [SD]) (0.7 ± 0.8 days vs 1.3 ± 3.9 days; P = .6), complication rate (20% vs 30%; P = .5), or hospital stay (mean [SD]) (6.0 ± 1.7 days vs 6.9 ± 4.7 days; P = .6).

Conclusion: There are specific patterns of volume loss, mediastinal shift, and hemidiaphragm displacement that can be quantified on postlobectomy chest radiographs. Prior sternotomy did not affect postlobectomy radiographic changes or patient outcome.
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http://dx.doi.org/10.1016/j.carj.2010.12.005DOI Listing
November 2011

Should CT play a greater role in preventing the resection of granulomas in the era of PET?

AJR Am J Roentgenol 2011 Apr;196(4):795-800

Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210 St, Bronx, NY 10467, USA.

Objective: PET cannot distinguish between bronchogenic carcinoma and granuloma, but positive scans may prompt surgery. We systematically evaluated the CT appearance of resected carcinomas and granulomas to identify features that could be used to reduce granuloma resections.

Materials And Methods: We retrospectively identified 93 consecutive patients between January 2005 and November 2008 who had resection of a pulmonary nodule pathologically diagnosed as bronchogenic carcinoma or granuloma and preoperative imaging with CT and PET. Each nodule was evaluated on CT for size, doubling time, location, borders, shape, internal characteristics, calcification, clustering, air bronchograms, and cavitation. A diagnostic impression was rendered. Bivariate and logistic regression analyses were performed. Pre-PET data regarding the proportion of resected granulomas and carcinomas between January 1995 and December 1996 were reviewed.

Results: Sixty-eight percent (65/96) of nodules were carcinomas and 32% (31/96) were granulomas. The CT impression was benign in 65% (20/31) of granulomas and 5% (3/65) of carcinomas (p < 0.0001; negative predictive value [NPV], 87% [20/23]). Specific CT features significantly associated with granuloma were clustering, cavitation, irregular shape, lack of pleural tags, and solid attenuation. The combination of nonspiculated borders, irregular shape, and solid attenuation had an NPV of 86% (12/14). Granulomas represented 18% (9/50) of resected nodules in 1995 and 1996 (p = 0.066).

Conclusion: CT findings reduce but cannot eliminate the possibility that a nodule is malignant. Outcomes-based clinical trials are needed to determine whether CT features of benignity can guide less-invasive initial management and reverse a concerning trend in granuloma resection.
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http://dx.doi.org/10.2214/AJR.10.5190DOI Listing
April 2011

Chest radiographs are valuable in demonstrating clinically significant pacemaker complications that require reoperation.

Can Assoc Radiol J 2011 Nov 29;62(4):288-95. Epub 2010 Jun 29.

Department of Radiology, Albert Einstein College of Medicine, Bronx, NY, USA.

Purpose: To evaluate the utility of chest radiography in demonstrating clinically significant pacemaker complications that required reoperation.

Methods: In this retrospective case-controlled series, we identified 14 consecutive adults who required pacemaker reoperation and who had chest radiographs available for review (6 men, 8 women; mean age, 71 years [range, 43-95 years]). Ten patients had pacemakers implanted at our institution, and 4 were referred for reoperation. Forty-two controls, 3 for each patient, had postoperative chest radiographs and normal device function (25 men, 17 women; mean age 76 years [range, 37-96 years]). All postoperative chest radiographs, including 1-year follow-ups, were blindly reviewed by at least 2 of 4 radiologists for lead perforation and position of right atrial and right ventricular leads. Follow-up radiographs were assessed for lead perforation, lead displacement, and lead fracture. Data were analysed by using the Fisher exact test.

Results: Of the patients, 1.7% (10/581) required reoperation for pacemaker dysfunction (noncapture, oversensing, abnormal atrial and ventricular thresholds, failing impedance), extracardiac stimulation, and lead perforation and/or displacement. There were no lead fractures. Chest radiographs demonstrated pacemaker complications in 57% of patients (8/14) at a median of 2 days (<1-32 days) after implantation and in 5% of the controls (2/42) (P < .0001). None of the abnormalities were noted on the official reports. Among subgroups, chest radiographs were abnormal for the following indications: pacemaker dysfunction in 4 of 7 patients versus 0 of 21 controls (P = .0017), extracardiac stimulation in 1 of 3 patients vs 0 of 9 controls (P = .25), and lead perforation and/or displacement in 3 of 4 patients vs 2 of 12 controls (P = .06).

Conclusions: Chest radiographs are useful after pacemaker placement and demonstrate the majority of complications that require reoperation. Familiarity with the expected normal position of the leads, appearances of pacemaker complications, and comparison with prior radiographs is crucial in rendering a correct diagnosis that guides patient management.
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http://dx.doi.org/10.1016/j.carj.2010.04.016DOI Listing
November 2011

Anomalies of visceroatrial situs.

AJR Am J Roentgenol 2009 Oct;193(4):1107-17

Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA.

Objective: Visceroatrial situs refers to the position and configuration of the cardiac atria, the tracheobronchial tree, and the thoracoabdominal viscera. Accurate determination of situs is essential because anomalies of situs are associated with an increased incidence of complex congenital heart disease.

Conclusion: We propose a methodical diagnostic approach to determining the visceroatrial situs and cardiac configuration that predicts the probability and types of associated congenital heart disease.
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http://dx.doi.org/10.2214/AJR.09.2411DOI Listing
October 2009

Variants and anomalies of thoracic vasculature on computed tomographic angiography in adults.

J Comput Assist Tomogr 2009 Jul-Aug;33(4):523-8

Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA.

Objective: To determine the prevalence and clinical significance of normal, variant, and anomalous branching patterns of the aortic arch and the central veins on computed tomographic (CT) angiography in adults.

Methods: We retrospectively reviewed 1000 consecutive CT angiograms of the chest in 658 women and 342 men with a median age of 53 years.

Results: A total of 65.9% of patients had both normal aortic arch branching patterns and normal venous anatomy. Variants in the aortic arch branching pattern were present in 32.4% and anomalies in 1.5%. Venous anomalies were present in 0.7%. Review of CT reports showed that cardiothoracic radiologists correctly reported the anomaly more frequently than other radiologists (94% vs 20%, P = 0.003).

Conclusions: Whereas anomalies of the central thoracic vasculature are uncommon, variants in the aortic arch branching pattern are common. An appreciation of the appearance of these entities on CT angiography allows for precise reporting and is useful in preprocedure planning.
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http://dx.doi.org/10.1097/RCT.0b013e3181888343DOI Listing
August 2009

MR imaging in diagnosis and staging of pulmonary carcinoma.

Magn Reson Imaging Clin N Am 2008 May;16(2):309-17, ix

Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA.

Lung cancer is the most common cause of cancer-related death for men and women in the United States. Accurate cancer staging is essential for determining appropriate management and predicting prognosis. CT, along with positron emission tomography with fluorodeoxyglucose, currently is the main imaging modality for staging lung cancer. The role of MR imaging is limited, although improvements in MR imaging technology and contrast media potentially will make MR imaging a viable ionizing-radiation-free alternative.
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http://dx.doi.org/10.1016/j.mric.2008.02.013DOI Listing
May 2008

Outcome of percutaneous surgery stratified according to body mass index and kidney stone size.

Surg Laparosc Endosc Percutan Tech 2007 Jun;17(3):179-83

Departments of Urologic Surgery and Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA.

Objective: To stratify outcome and morbidity of percutaneous nephrostolithotomy (PCNL) with regard to body mass index (BMI) and kidney stone burden.

Methods: The charts of 148 patients who underwent PCNL procedures were reviewed retrospectively. Hospital stay, blood loss, maximal temperature during inpatient stay, and stone-free outcomes were evaluated. Patients were divided into 3 groups depending on their BMIs: <25 kg/m, 25 to 29.9 kg/m, and >30 kg/m. Kidney stone burden was measured in terms of square area in millimeters, as measured by retrospective review of computerized tomography scans. Preoperative computerized tomography scan for measurement of stone burden was available for only 85 patients who are included in the study. Analysis of variance for a single variable was performed with regard to the values of the hospital stay, postoperative maximal temperature, and hemoglobin change.

Results: Of the 85 patients, 37 (43.5%) were obese or morbidly obese (BMI, >30 kg/m), 33 (38.8%) were overweight (BMI, 25 to 29.9 kg/m), and 15 (17.7%) were within or below their ideal weight (BMI, <25 kg/m). No statistically significant difference among the 3 groups was seen for stone-free rate, postoperative fever, or change in hemoglobin when stratified by BMI alone or by BMI and kidney stone burden. However, significantly longer length of stay for the group with BMI <25 kg/m was observed when stratifying either by BMI alone (P=0.01) or by BMI and kidney stone burden (P=0.03).

Conclusions: In this retrospective review of patients with kidney stones undergoing PCNL, the stone-free outcome and associated morbidity of PCNL (except for the length of hospital stay) is independent of both patients' BMI and stone burden when stratifying by commonly defined parameters.
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http://dx.doi.org/10.1097/SLE.0b013e318051543dDOI Listing
June 2007