Publications by authors named "Douglas S Katz"

186 Publications

Mentorship in Radiology and in Life.

Radiographics 2021 Jul-Aug;41(4):E98-E99

From the Department of Radiology, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201 (O.A.A.); and Department of Radiology, New York University Winthrop Hospital, Mineola, NY (D.S.K.).

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http://dx.doi.org/10.1148/rg.2021210099DOI Listing
July 2021

Imaging evaluation of uterine perforation and rupture.

Abdom Radiol (NY) 2021 Jun 15. Epub 2021 Jun 15.

Department of Radiology, University of Washington Medical Center, 1959 N.E. Pacific Street, Seattle, WA, 98195, USA.

Uterine perforation and rupture, denoting iatrogenic and non-iatrogenic uterine wall injury, respectively, are associated with substantial morbidity,and at times mortality. Diverse conditions can result in injury to both the gravid and the non-gravid uterus, and imaging plays a central role in diagnosis of such suspected cases. Ultrasound (US) is the initial imaging modality of choice, depicting the secondary signs associated with uterine wall injury and occasionally revealing the site of perforation. Computed tomography can be selectively used to complement US findings, to provide a more comprehensive picture, and to investigate complications beyond the reach of US, such as bowel injury. In certain scenarios, magnetic resonance imaging can be an important problem-solving tool as well. Finally, catheter angiography is a valuable tool with both diagnostic and therapeutic capability, with potential for fertility preservation. In this manuscript, we will highlight the clinical and imaging approach to uterine perforation and rupture, while emphasizing the value of various imaging modalities in this context. In addition, we will review the multi-modality imaging features of uterine perforation and rupture and will address the role of the radiologist as a crucial member of the management team. Finally, a summary diagrammatic depiction of imaging approach to patients presenting with uterine perforation or rupture is provided.
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http://dx.doi.org/10.1007/s00261-021-03171-zDOI Listing
June 2021

Role of Imaging in Obstetric Interventions: Criteria, Considerations, and Complications.

Radiographics 2021 Jul-Aug;41(4):1243-1264. Epub 2021 Jun 11.

From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143-0628 (P.J., V.A.F.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Radiology, Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington, Seattle, Wash (M.M.).

US has an established role in the prenatal detection of congenital and developmental disorders. Many pregnant women undergo US at 18-20 weeks of gestation for assessment of fetal anatomy and detection of structural anomalies. With advances in fetoscopy and minimally invasive procedures, in utero fetal interventions can be offered to address some of the detected structural and physiologic fetal abnormalities. Most interventions are reserved for conditions that, if left untreated, often cause in utero death or a substantially compromised neonatal outcome. US is crucial for preprocedural evaluation and planning, real-time procedural guidance, and monitoring and assessment of postprocedural complications. Percutaneous needle-based interventions include in utero transfusion, thoracentesis and placement of a thoracoamniotic shunt, vesicocentesis and placement of a vesicoamniotic shunt, and aortic valvuloplasty. Fetoscopic interventions include myelomeningocele repair and tracheal balloon occlusion for congenital diaphragmatic hernia. In rare cases, open hysterotomy may be required for repair of a myelomeningocele or resection of a sacrococcygeal teratoma. Monochorionic twin pregnancies involve specific complications such as twin-twin transfusion syndrome, which is treated with fetoscopic laser ablation of vascular connections, and twin reversed arterial perfusion sequence, which is treated with radiofrequency ablation. Finally, when extended placental support is necessary at delivery for repair of congenital high airway obstruction or resection of lung masses, ex utero intrapartum treatment can be planned. Radiologists should be aware of the congenital anomalies that are amenable to in utero interventions and, when necessary, consider referral to centers where such treatments are offered. RSNA, 2021.
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http://dx.doi.org/10.1148/rg.2021200163DOI Listing
June 2021

How Do You Solve a Problem like Incidentalomas (version 2.0)?

Radiol Clin North Am 2021 Jul 3;59(4):xv-xvi. Epub 2021 May 3.

Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 270 Park Avenue, Huntington, NY 11743, USA. Electronic address:

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http://dx.doi.org/10.1016/j.rcl.2021.04.001DOI Listing
July 2021

Incidental Pancreatic Cysts on Cross-Sectional Imaging.

Radiol Clin North Am 2021 Jul;59(4):617-629

Department of Radiology, UC Davis, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA.

Incidental pancreatic cysts are commonly encountered in radiology practice. Although some of these are benign, mucinous varieties have a potential to undergo malignant transformation. Characterization of some incidental pancreatic cysts based on imaging alone is limited, and given that some pancreatic cysts have a malignant potential, various societies have created guidelines for the management and follow-up of incidental pancreatic cysts. This article reviews the imaging findings and work-up of pancreatic cysts and gives an overview of the societal guidelines for the management and follow-up of incidental pancreatic cysts.
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http://dx.doi.org/10.1016/j.rcl.2021.03.010DOI Listing
July 2021

Editorial Comment: Low Radiation Dose is Comparable to Conventional CT for Right Colonic Diverticulitis.

Authors:
Douglas S Katz

AJR Am J Roentgenol 2021 May 12. Epub 2021 May 12.

Department of Radiology, NYU Langone - Long Island Hospital, 259 First Street, Mineola, NY 11501.

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http://dx.doi.org/10.2214/AJR.21.26116DOI Listing
May 2021

The Magnet Is Sometimes "Off"-Practical Strategies for Optimizing Challenging Musculoskeletal MR Imaging.

Curr Probl Diagn Radiol 2021 Mar 17. Epub 2021 Mar 17.

Mayo Clinic Arizona, Department of Radiology, Phoenix, AZ.

To describe practical solutions to the unique technical challenges of musculoskeletal magnetic resonance imaging, including off-isocenter imaging, artifacts from motion and metal prostheses, small field-of-view imaging, and non-conventional scan angles and slice positioning. Unique challenges of musculoskeletal magnetic resonance imaging require a collaborative approach involving radiologists, physicists, and technologists utilizing optimized magnetic resonance protocols, specialized coils, and unique patient positioning, in order to reliably diagnose critical musculoskeletal MR image findings.
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http://dx.doi.org/10.1067/j.cpradiol.2021.03.007DOI Listing
March 2021

A comprehensive radiologic review of abdominal and pelvic torsions.

Abdom Radiol (NY) 2021 06 2;46(6):2942-2960. Epub 2021 Jan 2.

Department of Radiology, University of Washington, 1959 NE Pacific Street, Room BB308, Box 357115, Seattle, WA, 98195, USA.

The clinical manifestations of abdominal and pelvic organ torsion can often be non-specific and can affect a wide range of ages and demographic groups. Radiologists have a key role in not only establishing the diagnosis of organ torsion, but also in the assessment of potential complications. As multiple imaging modalities may be utilized in the evaluation of abdominal and pelvic pain, recognizing the various appearances of organ torsion is important to ensure early diagnosis and thereby reducing patient morbidity and mortality, particularly since abdominal and pelvic organ torsion may not be clinically suspected at the time of initial patient presentation.
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http://dx.doi.org/10.1007/s00261-020-02868-xDOI Listing
June 2021

The practice of emergency radiology throughout Europe: a survey from the European Society of Emergency Radiology on volume, staffing, equipment, and scheduling.

Eur Radiol 2021 May 5;31(5):2994-3001. Epub 2020 Nov 5.

Department of Health Sciences, Radiology Section, University of Genoa, Genoa, Italy.

Objectives: To obtain information from radiology departments throughout Europe regarding the practice of emergency radiology METHODS: A survey which comprised of 24 questions was developed and made available online. The questionnaire was sent to 1097 chairs of radiology departments throughout Europe using the ESR database. All data were collected and analyzed using IBM SPSS Statistics software, version 20 (IBM).

Results: A total of 1097 radiologists were asked to participate, 109 responded to our survey. The response rate was 10%. From our survey, 71.6% of the hospitals had more than 500 beds. Ninety-eight percent of hospitals have an active teaching affiliation. In large trauma centers, emergency radiology was considered a dedicated section. Fifty-three percent of institutions have dedicated emergency radiology sections. Less than 30% had all imaging modalities available. Seventy-nine percent of institutions have 24/7 coverage by staff radiologists. Emergency radiologists interpret cross-sectional body imaging, US scans, and basic CT/MRI neuroimaging in more than 50% of responding institutions. Cardiac imaging examinations/procedures are usually performed by cardiologist in 53% of institutions, while non-cardiac vascular procedures are largely performed and interpreted by interventional radiologists. Most people consider the European Diploma in Emergency Radiology an essential tool to advance the education and the dissemination of information within the specialty of emergency radiology.

Conclusion: Emergency radiologists have an active role in the emergency medical team. Indeed, based upon our survey, they have to interact with emergency physicians and surgeons in the management of critically ill patients. A broad skillset from ultrasonography and basic neuroimaging is required.

Key Points: • At most major trauma centers in Europe, emergency imaging is currently performed by all radiologists in specific units who are designated in the emergency department. • Radiologists in the emergency section at present have a broad skillset, which includes cross-sectional body imaging, ultrasonography, and basic neuroimaging of the brain and spine. • A dedicated curriculum that certifies a subspecialty in emergency radiology with a diploma offered by the European Society of Emergency Radiology demonstrates a great interest by the vast majority of the respondents.
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http://dx.doi.org/10.1007/s00330-020-07436-xDOI Listing
May 2021

Imaging Evaluation of Abdominopelvic Gunshot Trauma.

Radiographics 2020 Oct;40(6):1766-1788

From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (F.S., A.M., M.V.R.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.O.M.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.); Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (J.S.P.); and Department of Radiology and Biomedical Imaging, Yale New Haven Hospital, New Haven, Conn (A.M.).

Firearm-related injuries, or gunshot wounds (GSWs), are among the most important worldwide public health problems, resulting in considerable annual morbidity, disability, and mortality. GSWs to the abdomen and pelvis are associated with substantial injuries to multiple organs and tissues. Imaging plays an important role in identifying these injuries, dictating nonoperative management, and determining imaging and clinical follow-up, as well as helping manage potential long-term complications. CT is the primary imaging modality used to evaluate these injuries and their complications, including use of reconstructed multiplanar volume-rendered images. The authors discuss the ballistics and mechanisms of firearm injury, CT findings, trajectory analysis, and applications of different imaging modalities above and beyond CT in evaluation of GSWs. Imaging findings and classifications of the severity of injuries to solid and hollow organs and vascular, musculoskeletal, and neurologic systems are reviewed. Key complications associated with gunshot injuries to the abdomen and pelvis are presented. The challenges of imaging in the acute trauma setting and potential pitfall mimics at imaging, particularly at CT, are also described. A step-by-step guide for thorough and comprehensive evaluation of GSWs to the abdomen and pelvis is introduced, with tips for optimizing effective communication with the clinical team. RSNA, 2020.
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http://dx.doi.org/10.1148/rg.2020200018DOI Listing
October 2020

Imaging Evaluation of Fallopian Tubes and Related Disease: A Primer for Radiologists.

Radiographics 2020 Sep-Oct;40(5):1473-1501. Epub 2020 Aug 21.

From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (L.M.G.); and Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.O.M.).

A wide range of benign and malignant processes can affect one or both fallopian tubes. Familiarity with and recognition of the characteristic imaging features of these diseases and conditions are imperative for accurate diagnosis and prompt patient management. Disorders including pelvic inflammatory disease (hydrosalpinx and pyosalpinx in particular), isolated tubal torsion and ovarian torsion with fallopian tube involvement, endometriosis manifesting as hematosalpinx and adhesions, ectopic pregnancy, and malignancies are the most important entities that radiologists should be familiar with when assessing the fallopian tubes. Some fallopian tube diseases are self-limiting, while others can result in infertility or even potentially life-threatening infection or bleeding if left untreated. Therefore, correct diagnosis is important for appropriate life-saving treatment and preserving fertility. Understanding the physiologic features of the fallopian tube and the role of this organ in the pathogenesis of pelvic neoplasms is equally important. Knowledge of what to expect in a patient who has undergone uterine and fallopian tube interventions, such as uterine ablation and fallopian tube ligation, and of the potential associated complications (eg, postablation sterilization syndrome) also is pertinent. The imaging modalities used for the evaluation of fallopian tube disease and patency range from commonly used examinations such as US, CT, and MRI to other modalities such as hysterosalpingography and hysterosonography performed by using US contrast material. The ability to differentiate fallopian tube conditions from other adnexal and pelvic pathologic entities by using a variety of imaging modalities allows the radiologist to make a timely diagnosis and ensure proper clinical management. RSNA, 2020.
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http://dx.doi.org/10.1148/rg.2020200051DOI Listing
July 2021

Hypercoagulability in Patients With Coronavirus Disease (COVID-19): Identification of Arterial and Venous Thromboembolism in the Abdomen, Pelvis, and Lower Extremities.

AJR Am J Roentgenol 2021 Jan 22;216(1):104-105. Epub 2020 Sep 22.

Department of Radiology, NYU Winthrop, Mineola, NY.

The purpose of this article is to describe arterial and venous thromboembolism in the abdomen, pelvis, and lower extremities in patients with coronavirus disease (COVID-19). Eighty-two patients with COVID-19 who underwent abdominal ultrasound or CT were retrospectively compared with 82 patients without COVID-19 for thromboembolism and solid-organ infarction. Nine (11%) patients with COVID-19 had thromboembolic findings, with medium to large arterial thrombi in five. One patient without COVID-19 had known portal vein thrombus on CT. Thromboembolic findings occurred more frequently in patients with than without COVID-19 ( = 0.02).
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http://dx.doi.org/10.2214/AJR.20.23617DOI Listing
January 2021

Computed Tomography of Common Bowel Emergencies.

Semin Roentgenol 2020 04 18;55(2):150-169. Epub 2019 Nov 18.

Department of Radiology, NYU Winthrop, Mineola, NY; Renaissance School of Medicine at Stony Brook University, Stony Brook, NY. Electronic address:

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http://dx.doi.org/10.1053/j.ro.2019.11.005DOI Listing
April 2020

Unexpected Findings of Coronavirus Disease (COVID-19) at the Lung Bases on Abdominopelvic CT.

AJR Am J Roentgenol 2020 Sep 22;215(3):603-606. Epub 2020 Apr 22.

Department of Radiology, NYU Winthrop, Mineola, NY.

The purpose of this study is to report unanticipated lung base findings on abdominal CT in 23 patients concerning for coronavirus disease (COVID-19). In these patients, who were not previously suspected of having COVID-19, abdominal pain was the most common indication for CT ( = 19), and 11 patients had no extrapulmonary findings. Seventeen patients underwent polymerase chain reaction testing, which returned positive results for all 17. Unsuspected coronavirus disease may be strongly suggested on the basis of lung findings on abdominopelvic CT.
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http://dx.doi.org/10.2214/AJR.20.23240DOI Listing
September 2020

Imaging findings in association with altered maternal alpha-fetoprotein levels during pregnancy.

Abdom Radiol (NY) 2020 10;45(10):3239-3257

Department of Radiology, University of Washington Medical Center, Seattle, WA, USA.

Maternal serum alpha-fetoprotein is a valuable laboratory test used in pregnant women as an indicator to detect certain clinical abnormalities. These can be grouped into four main categories: fetal factors, pregnancy complications, placental abnormalities, and maternal factors. Imaging is an invaluable tool to investigate the various etiologies leading to altered maternal serum alpha-fetoprotein. By reading this article, the radiologist, sonologist, or other health care practitioner should be able to define the probable pathology leading to the laboratory detected abnormal maternal serum levels, thus helping the clinician to appropriately manage the pregnancy and counsel the patient.
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http://dx.doi.org/10.1007/s00261-020-02499-2DOI Listing
October 2020

How to Read, Write, and Review the Imaging Literature.

Curr Probl Diagn Radiol 2021 Mar-Apr;50(2):109-114. Epub 2020 Jan 9.

Department of Radiology, NYU Winthrop Hospital, Mineola, NY. Electronic address:

Everyone at all levels in academic radiology is supposed to know how to read an original research article or a review article and to evaluate it critically, to participate in writing such manuscripts, and, as one becomes more senior, to participate in the peer review process, yet there is little formal teaching in our experience as to how to do these inter-related activities throughout radiology training. The purpose of this review article is therefore to provide our perspective - from the junior trainee to the senior radiology attending - as to how one should be reading, reviewing, and writing the imaging literature, and also providing guidance from other thought leaders in this area, and from the literature itself. We hope to inspire radiology trainees and radiologists at all levels, particularly those in academic careers, to more fully participate in peer review and in radiology publication.
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http://dx.doi.org/10.1067/j.cpradiol.2020.01.002DOI Listing
January 2020

An Algorithmic Approach to Complex Fetal Abdominal Wall Defects.

AJR Am J Roentgenol 2020 01 12;214(1):218-231. Epub 2019 Nov 12.

Department of Radiology, University of Washington Medical Center, 1959 NE Pacific St, Box 357115, Seattle, WA 98195.

The purpose of this article is to describe the imaging findings associated with complex fetal abdominal wall defects and provide an algorithmic method for arriving at a final diagnosis. Fetal ventral abdominal wall defects are a complex group of conditions with a broad spectrum of associated multisystem anomalies and manifestations. Correct characterization and classification of these defects require not only familiarity with imaging findings but also a systematic approach to avoid diagnostic confusion.
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http://dx.doi.org/10.2214/AJR.19.21627DOI Listing
January 2020

Factors Affecting Response Rates in Medical Imaging Survey Studies.

Acad Radiol 2020 03 1;27(3):421-427. Epub 2019 Jul 1.

Department of Radiology, McMaster University, Hamilton General Hospital, Hamilton, Canada.

Rationale And Objective: To review response rates published in medical imaging journals, and to analyze potential factors which contributed to a low response rate.

Materials And Methods: A literature search was performed in MEDLINE and Embase to identify and assess published medical imaging survey studies. Variables assessed were response rate, incentives such as reminders and remuneration, and rationales provided for a potential low response rate. Statistical significance was calculated using unpaired t tests, ANOVA, Mann-Whitney, and Kruskal-Wallis tests.

Results: Three hundred and fifty-six unique surveys were included for analysis. The mean survey response rate in the current age of predominately electronic surveys was 45%. Factors which statistically significantly demonstrated a difference in response rate were survey location (European countries: 52%, Canada: 47%, United States: 42%; p < 0.05), survey topic (musculoskeletal: 69%, nuclear medicine: 64%, and education: 47%; p < 0.05), survey delivery method (telephone: 76%, email: 41%; p < 0.0001), and survey question type (short answer: 62%, multiple choice: 43%; p < 0.01). Statistically significant linear correlations were observed between the response rate compared to the number of reminders sent (r = 0.27; p < 0.01) and the number of participants (r = -0.26; p < 0.0001).

Conclusion: The survey response rate serves as a surrogate marker for nonresponse bias. Survey response controlled for intrinsic nonadjustable characteristics offer achievable research goals. Adjustable factors to low response, including survey delivery method, question type, and number of reminders demonstrated statistical difference in response rate, and can be utilized by researchers to prospectively minimize nonresponse bias.
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http://dx.doi.org/10.1016/j.acra.2019.06.005DOI Listing
March 2020

Utility of biphasic multi-detector computed tomography in suspected acute mesenteric ischemia in the emergency department.

Emerg Radiol 2019 Oct 25;26(5):523-529. Epub 2019 Jun 25.

NYU Winthrop Hospital, 120 Mineola Blvd., Lower Level & Suite 550, Mineola, NY, 11501, USA.

Purpose: To retrospectively evaluate the utility of biphasic multi-detector computed tomography (MDCT) with arterial and portal venous phases for the detection of suspected acute mesenteric ischemia (AMI) in emergency department (ED) patients compared to limited surgical confirmation.

Methods: A research ethics board (REB)-approved retrospective review of all consecutive adult patients who underwent an emergency biphasic 64-MDCT examination of the abdomen and pelvis due to clinical suspicion for AMI over a 5-year period at a single tertiary-care institution was performed. Patients who underwent biphasic 64-MDCT scans performed for any clinical concern other than suspected acute mesenteric ischemia were excluded. Specifically, reported vascular and bowel findings were used to establish occlusive arterial, venous, and non-occlusive MDCT findings of AMI. Correlation was made with surgical findings in operatively managed patients and with serum lactate values preceding imaging assessment. Diagnostic yield and positive predictive value calculations were performed.

Results: Two hundred and twenty-five patients underwent MDCT for suspected occlusive AMI between 10 Jan 2011 and 31Jul 2016. Of these, 200 patients were negative for AMI and 25 patients (mean age 73.5 years; age range 48 to 94 years; 13 men and 12 women) had MDCT findings positive for bowel ischemia (yield of 11.1%). On MDCT, 18/25 (72%) had an occlusive arterial etiology for AMI, 2/25 (8%) had an occlusive venous etiology, and 5/25 (20%) had non-occlusive AMI. Twenty of 25 (80%) patients with positive MDCT findings of AMI also had an elevated serum lactate level, including 14/18 (77.8%) patients with arterial occlusive AMI on MDCT, 2/2 (100%) with venous-occlusive AMI on MDCT, and 4/5 (80%) with non-occlusive AMI on MDCT. Correlation with surgical findings led to a positive predictive value (PPV) of biphasic MDCT for surgically proven all-cause occlusive ischemia of 92.9%. Further substratification revealed PPVs of arterial and venous-occlusive ischemia of 85.7% and 7.1%, respectively. Of the 225 patients MDCT-positive for AMI, 213 had pre-imaging serum lactate assessments. Of 188 patients MDCT-negative for AMI, 85 patients had elevated serum lactate (45.2%). Twenty of the 25 patients with positive MDCT findings of AMI (80%) also had an elevated serum lactate level, including 14/18 (77.8%) patients with arterial occlusive AMI on MDCT, 2/2 (100%) with venous-occlusive AMI on MDCT, and 4/5 (80%) with non-occlusive AMI on MDCT.

Conclusion: Emergent biphasic MDCT demonstrated low but non-trivial yield (11.1%) for the depiction of suspected acute mesenteric ischemia but was particularly low for occlusive venous AMI (0.9%). The relationship between serum lactate elevation and positive MDCT findings of AMI in our study conforms to prior work and cautiously suggests value in routine serum lactate assessment preceding imaging for patient prioritization.
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http://dx.doi.org/10.1007/s10140-019-01698-9DOI Listing
October 2019

Renal Colic Imaging: Myths, Recent Trends, and Controversies.

Can Assoc Radiol J 2019 May 8;70(2):164-171. Epub 2019 Mar 8.

NYU Winthrop-University Hospital, Mineola, New York, USA.

There has been a substantial increase in the utilization of imaging, particularly of multi-detector computed tomography (MDCT), for the evaluation of patients with suspected urolithiasis over the past 2 decades. While the diagnostic accuracy of computed tomography (CT) for urolithiasis is excellent, it has also resulted in substantial medical expenditures and increased ionizing radiation exposure. This is especially concerning in patients with known nephrolithiasis and in younger patients. This pictorial review will focus on recent trends and controversies in imaging of patients with suspected urolithiasis, including the current roles of ultrasound (US), MDCT, and magnetic resonance imaging, the estimated radiation dose from MDCT and dose reduction strategies, as well as imaging of suspected renal colic in pregnant patients. The current epidemiological, clinical, and practice management literature will be appraised.
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http://dx.doi.org/10.1016/j.carj.2018.09.008DOI Listing
May 2019

Infected Renal Cyst as a Complication of Dropped Gallstones during Laparoscopic Cholecystectomy.

Case Rep Gastrointest Med 2018 30;2018:2478245. Epub 2018 Sep 30.

NYU Winthrop Hospital, Department of Radiology, 259 1st Ave, Mineola, NY 11501, USA.

Dropped gallstones are a relatively common complication, occurring in 3% to 32% of laparoscopic cholecystectomies performed, depending on various intraoperative risk factors. However, complications arising from dropped gallstones are relatively rare, occurring in fewer than 1% of such patients, and can include abscesses and inflammatory masses confined to the subhepatic space, presenting days to years later. We report a patient who developed an infected renal cyst as a result of dropped gallstones, which created a fistula from the duodenum to a previously simple right renal cyst, which was initially identified on an abdominal CT scan. Dropped gallstones can result in substantial morbidity in a minority of patients following cholecystectomy performed for cholecystitis, and a high clinical as well as radiological index of suspicion may be required for accurate early recognition and treatment.
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http://dx.doi.org/10.1155/2018/2478245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186367PMC
September 2018

CT Findings of Acute Small-Bowel Entities.

Radiographics 2018 Sep-Oct;38(5):1352-1369

From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.D.S., C.O.M.); Department of Radiology, University of Wisconsin Hospital, Madison, Wis (M.G.L.); Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B., V.M.M.); Stony Brook University School of Medicine, Stony Brook, NY (M.H.K.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.).

Although a broad spectrum of entities can induce acute pathologic changes in the small bowel, there are relatively few imaging features that are characteristic of a specific diagnosis on the basis of CT findings. Specific clinical information, including time course and onset of disease, patient risk factors, and any recent pharmacologic or radiation therapy, is often instrumental in refining the differential diagnosis. A wide spectrum of disorders is reviewed in this article; however, given the breadth of disorders associated with the small bowel, neoplastic and infectious conditions affecting the small bowel that can manifest acutely are not specifically discussed. Vascular diseases that can affect the small bowel regionally or diffusely, including thromboembolic and hypoperfusion phenomena, as well as a spectrum of vasculitides, are reviewed. Iatrogenic causes of small bowel disorders are discussed, including angiotensin-converting enzyme inhibitor-induced angioedema, and chemotherapy- and radiation therapy-associated patterns of disease. Autoimmune and hereditary conditions that can affect the small bowel, including systemic lupus erythematosus and genetic C1 esterase inhibitor deficiency, respectively, are reviewed. RSNA, 2018.
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http://dx.doi.org/10.1148/rg.2018170148DOI Listing
December 2018

Evaluating the frequency and severity of ovarian venous congestion on adult computed tomography.

Abdom Radiol (NY) 2019 01;44(1):259-263

Department of Radiology, NYU Winthrop Hospital, 259 First Street, Mineola, NY, 11501, USA.

Purpose: While pelvic congestion syndrome and chronic pelvic pain are relatively common in women, no large- or medium-sized studies have been conducted to our knowledge to evaluate the frequency and severity of ovarian vein dilatation (OVD) on computed tomography (CT). The purpose of our study was therefore to analyze a large number of consecutive abdominal and pelvic CT scans in adult women to determine OVD frequency and severity.

Methods: An IRB-approved, single-institution retrospective analysis of 1042 consecutive abdominal and pelvic CT scans in women ages 25-65 was performed. Scans were evaluated for the presence and severity of OVD and association with "nutcracker anatomy." A gradation scheme was developed based on quartile analysis.

Results: 143 of the CT scans had OVD (13.7%). Of the positive scans, 96 were bilateral, 29 were left-side only, 18 were right-side only, and 18 had nutcracker-type compression of the left renal vein (14.4% of scans with left or bilateral OVD). In positive scans, the mean and median left OVD were 7.5 and 7 mm, respectively, and right-side were 7.2 and 7 mm, respectively. Based on quartile analysis, OVD grading was mild (< 6 mm), moderate (6-8 mm), or severe (> 8 mm), with moderate including the middle 50% of patients.

Conclusions: OVD was found on 13.7% of 1042 consecutive female abdominal and pelvic CT scans, with "nutcracker anatomy" present in 14.4% of the scans with left OVD. Moderate dilatation was defined as an OVD of 6-8 mm at the iliac crests.
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http://dx.doi.org/10.1007/s00261-018-1707-9DOI Listing
January 2019

Recent Advances in Abdominal Trauma Computed Tomography.

Semin Roentgenol 2018 Apr 9;53(2):178-186. Epub 2018 Feb 9.

Department of Radiology, NYU Winthrop Hospital, Mineola, NY.

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http://dx.doi.org/10.1053/j.ro.2018.02.008DOI Listing
April 2018

Imaging of suspected pulmonary embolism and deep venous thrombosis in obese patients.

Br J Radiol 2018 Sep 27;91(1089):20170956. Epub 2018 Jun 27.

2 Department of Radiology, NYU Winthrop, Stony Brook University School of Medicine , Mineola, NY , USA.

Obesity is a growing problem around the world, and radiology departments frequently encounter difficulties related to large patient size. Diagnosis and management of suspected venous thromboembolism, in particular deep venous thrombosis (DVT) and pulmonary embolism (PE), are challenging even in some lean patients, and can become even more complicated in the setting of obesity. Many obstacles must be overcome to obtain imaging examinations in obese patients with suspected PE and/or DVT, and to ensure that these examinations are of sufficient quality to diagnose or exclude thromboembolic disease, or to establish an alternative diagnosis. Equipment limitations and technical issues both need to be acknowledged and addressed. Table weight limits and scanner sizes that readily accommodate obese and even morbidly obese patients are not in place at many clinical sites. There are also issues with image quality, which can be substantially compromised. We discuss current understanding of the effects of patient size on imaging in general and, more specifically, on the imaging modalities used for the diagnosis and treatment of DVT and PE. Emphasis will be placed on the technical parameters and protocol nuances, including contrast dosing, which are necessary to refine and optimize images for the diagnosis of DVT and PE in obese patients, while remaining cognizant of radiation exposure. More research is necessary to develop consistent high-level evidence regarding protocols to guide radiologists, and to help them effectively utilize emerging technology.
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http://dx.doi.org/10.1259/bjr.20170956DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6223165PMC
September 2018

Non-contrast MDCT for Ureteral Calculi and Alternative Diagnoses: Yield in Adult Women vs in Adult Men.

Curr Probl Diagn Radiol 2019 Mar - Apr;48(2):148-151. Epub 2018 Feb 2.

Department of Radiology, NYU Winthrop Hospital, Mineola, NY, USA.

Purpose: To determine the yield of non-contrast multi-detector computed tomography (MDCT) of the abdomen and pelvis in diagnosing ureteral calculi as well as other alternative acute conditions in male vs in female adult patients presenting to the emergency department with new onset of symptoms.

Methods: Our institutional review board approved a retrospective review of the official reports of the non-contrast MDCT examinations of the abdomen and pelvis performed on adults (18 years and older) presenting to our emergency department with a suspected ureteral calculus from October 1, 2011 to October 30, 2013. Patients with recently documented ureteral calculi, known urinary tract infection, malignancy, and trauma were excluded from the study. From a total of 1097 non-contrast MDCT examinations of the abdomen and pelvis over the 2-year period, 400 randomly selected examinations were reviewed (approximately one-third of all the examinations). We compared the prevalence of ureteral calculi between the male and female population. P values and confidence intervals were determined using software Stata 14. Other acute intra-abdominal and intra-pelvic findings amenable to prompt medical care were also documented and analyzed separately.

Results: The mean patient age was 55.2 years, with a range of 19-90 years. This included 170 female (mean age 56.8 years) and 230 male patients (mean age 54.2 years). Ureteral calculi were detected in 170 (42.5%) of the patients [111 males (48%) and 59 females (34.7%)] with a prevalence which was statistically significantly higher in the male patients compared to in the female patients (P < 0.01, confidence level of 95% and CI of 13.2-13.4). An alternative diagnosis was made based on the MDCT findings in 49 patient cases (12.25 %), including 26 females (15.29%) and 23 males (10.00%). There was no statistically significant difference in alternative acute findings in male compared to in female patients (P > 0.05). This was with the exception of acute pyelonephritis, which was statistically significantly higher in the female patients (P < 0.01).

Conclusion: The likelihood of making the diagnosis of a ureteral calculus on non-contrast MDCT of the abdomen and pelvis was statistically significantly higher in male patients compared with female patients presenting to our emergency department. However, there was no statistically significant difference in the alternative diagnoses, with the exception of pyelonephritis, which was more common in women.
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http://dx.doi.org/10.1067/j.cpradiol.2018.01.009DOI Listing
March 2019

Fetal Urinary Tract Anomalies: Review of Pathophysiology, Imaging, and Management.

AJR Am J Roentgenol 2018 May 15;210(5):1010-1021. Epub 2018 Feb 15.

1 Department of Radiology, University of Washington School of Medicine, Box 357115, 1959 NE Pacific St, Seattle, WA 98195.

Objective: Common fetal anomalies of the kidneys and urinary tract encompass a complex spectrum of abnormalities that can be detected prenatally by ultrasound. Common fetal anomalies of the kidneys and urinary tract can affect amniotic fluid volume production with the development of oligohydramnios or anhydramnios, resulting in fetal pulmonary hypoplasia and, potentially, abnormal development of other fetal structures.

Conclusion: We provide an overview of common fetal anomalies of the kidneys and urinary tract with an emphasis on sonographic patterns as well as pathologic and postnatal correlation, along with brief recommendations for postnatal management. Of note, we render an updated classification of fetal abnormalities of the kidneys and urinary tract based on the presence or absence of associated urinary tract dilation. In addition, we review the 2014 classification of urinary tract dilation based on the Linthicum multidisciplinary consensus panel.
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http://dx.doi.org/10.2214/AJR.17.18371DOI Listing
May 2018

Recipe for a Successful Hybrid Academic-Community Radiology Practice: Canadian Experience.

Acad Radiol 2018 02 7;25(2):240-243. Epub 2017 Nov 7.

Department of Radiology, NYU Winthrop Hospital, Mineola, New York.

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http://dx.doi.org/10.1016/j.acra.2017.08.017DOI Listing
February 2018
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