Publications by authors named "Harpreet K Pannu"

48 Publications

The subperitoneal space and peritoneal cavity: basic concepts.

Abdom Imaging 2015 Oct;40(7):2710-22

Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.

The subperitoneal space and peritoneal cavity are two mutually exclusive spaces that are separated by the peritoneum. Each is a single continuous space with interconnected regions. Disease can spread either within the subperitoneal space or within the peritoneal cavity to distant sites in the abdomen and pelvis via these interconnecting pathways. Disease can also cross the peritoneum to spread from the subperitoneal space to the peritoneal cavity or vice versa.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00261-015-0429-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4584112PMC
October 2015

ACR appropriateness Criteria® infertility.

Ultrasound Q 2015 Mar;31(1):37-44

*Mayo Clinic, Rochester, Minnesota; †Rambam Healthcare Campus, Haifa, Israel; ‡Sunnybrook Health Sciences Centre, Bayview Campus, Toronto, Ontario, Canada; §University of Texas MD Anderson Cancer Center, Houston, Texas; ∥Massachusetts General Hospital, Boston Massachusetts; ¶Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; #George Washington University Hospital, Washington, District of Columbia; **Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; ††The Old Vicarage. Worcester Park, United Kingdom; ‡‡Massachusetts General Hospital, Boston Massachusetts; §§Memorial Sloan Kettering Cancer Center, New York, New York; ∥∥Brigham & Women's Hospital, Boston, Massachusetts, American College of Obstetrics and Gynecology; ¶¶Mallinckrodt Institute of Radiology, St. Louis, Missouri; ##Columbia University, New York, New York, American College of Obstetrics and Gynecology; ***University of Maryland School of Medicine, Baltimore, Maryland; and †††Valley Hospital, Ridgewood, New Jersey, American College of Obstetrics and Gynecology.

Appropriate imaging for women undergoing infertility workup depends upon the clinician's suspicion for potential causes of infertility. Transvaginal US is the preferred modality to assess the ovaries for features of polycystic ovary syndrome (PCOS), the leading cause of anovulatory infertility. For women who have a history or clinical suspicion of endometriosis, which affects at least one third of women with infertility, both MRI and pelvic US can provide valuable information. If tubal occlusion is suspected, whether due to endometriosis, previous pelvic inflammatory disease, or other cause, hysterosalpingogram (HSG) is the preferred method of evaluation. To assess for anatomic causes of recurrent pregnancy loss (RPL) such as Müllerian anomalies, synechiae, and leiomyomas, saline infusion sonohysterography, MRI and 3-D US are most appropriate. Up to 10% of women suffering recurrent pregnancy loss have a congenital Müllerian anomaly. When assessment of the pituitary gland is indicated, MRI is the imaging exam of choice.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/RUQ.0000000000000132DOI Listing
March 2015

ACR Appropriateness Criteria pelvic floor dysfunction.

J Am Coll Radiol 2015 Feb 31;12(2):134-42. Epub 2014 Oct 31.

University of Maryland School of Medicine, Baltimore, Maryland.

Pelvic floor dysfunction is a common and potentially complex condition. Imaging can complement physical examination by revealing clinically occult abnormalities and clarifying the nature of the pelvic floor defects present. Imaging can add value in preoperative management for patients with a complex clinical presentation, and in postoperative management of patients suspected to have recurrent pelvic floor dysfunction or a surgical complication. Imaging findings are only clinically relevant if the patient is symptomatic. Several imaging modalities have a potential role in evaluating patients; the choice of modality depends on the patient's symptoms, the clinical information desired, and the usefulness of the test. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions; they are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals, and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jacr.2014.10.021DOI Listing
February 2015

CT features of low grade serous carcinoma of the ovary.

Authors:
Harpreet K Pannu

Eur J Radiol Open 2015 3;2:39-45. Epub 2015 Feb 3.

Department of Radiology, Memorial Sloan Kettering Cancer Center, United States.

Objective: To evaluate the CT features of pathologically proven low grade serous carcinoma (LGSC) of the ovary.

Methods: Patients with a pathologic diagnosis of LGSC and CT prior to oophorectomy were retrospectively identified. The CT scans in 14 patients were available and were analyzed for an adnexal mass, peritoneal mass and ascites. The adnexal mass was characterized as complex primarily cystic, mixed cystic solid, or primarily solid. Calcification in the adnexal and peritoneal masses and nodes was noted.

Results: Pathology revealed 6 patients had LGSC and 8 patients had a combined diagnosis of LGSC and serous borderline tumor (SBT) of the ovary. Of the 6 patients with only LGSC, 4 had primarily solid or mixed solid cystic adnexal masses and 5 had peritoneal masses. Calcification was present in the adnexal and peritoneal masses in 4 patients, and in nodes in 2 patients. Of the 8 patients with co-existing LGSC and SBT, 7 had complex primarily cystic adnexal masses and 6 had peritoneal masses. Calcification was present in the adnexal and peritoneal masses in 5 patients and in nodes in 2 patients.

Conclusion: LGSC can appear as a solid, mixed solid cystic, or complex primarily cystic ovarian mass, and the appearance may be due to a co-existing SBT. Calcification of the adnexal and peritoneal masses appears to be common. LGSC is a diagnostic consideration in patients with a calcified adnexal mass and concurrent peritoneal masses or calcified nodes on CT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejro.2015.01.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4750573PMC
March 2016

ACR Appropriateness Criteria® pretreatment evaluation and follow-up of endometrial cancer.

Ultrasound Q 2014 Mar;30(1):21-8

*University of Washington School of Medicine, Seattle, Washington; †Walter Reed National Military Medical Center, Bethesda, Maryland; ‡University of Utah Medical Center, Salt Lake City, Utah; §Sunnybrook Health Sciences Centre, Bayview Campus, Toronto, Ontario, Canada; ∥Henry Ford Health System, Detroit, Michigan; ¶Tufts Medical Center, Boston, Massachusetts, Society of Gynecologic Oncologists; #Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts; **Memorial Sloan Kettering Cancer Center, New York, New York; ††Mallinckrodt Institute of Radiology, St. Louis, Missouri, Society of Nuclear Medicine and Molecular Imaging; ‡‡Brigham & Women's Hospital, Boston, Massachusetts, American College of Obstetrics and Gynecology; §§Mallinckrodt Institute of Radiology, St. Louis, Missouri; ∥∥Columbia University, New York, New York, American College of Obstetrics and Gynecology; ¶¶University of Nebraska Medical Center, Omaha, Nebraska; ##University of Miami, Miami, Florida; and ***Valley Hospital, Ridgewood, New Jersey, American College of Obstetrics and Gynecology.

Endometrial cancer is the most common gynecologic and the fourth most common malignancy in women in the United States. Cross-sectional imaging plays a vital role in pretreatment assessment of endometrial cancers and should be viewed as a complementary tool for surgical evaluation and planning of these patients. Although transvaginal US remains the preferred examination for the screening purposes, MRI has emerged as the modality of choice for the staging of endometrial cancer and imaging assessment of recurrence or treatment response. A combination of dynamic contrast-enhanced and diffusion weighted MRI provides the highest accuracy for the staging. Both CT and MRI perform equivalently for assessing nodal involvement or distant metastasis. PET-CT is more appropriate for assessing lymphadenopathy in high-grade FDG-avid tumors or for clinically suspected recurrence after treatment. An appropriate use and guidelines of imaging techniques in diagnosis, staging, and detection of endometrial cancer and treatment of recurrent disease are reviewed.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/RUQ.0000000000000068DOI Listing
March 2014

ACR appropriateness Criteria® second and third trimester bleeding.

Ultrasound Q 2013 Dec;29(4):293-301

*Baptist Hospital of Miami/South Miami Center for Women and Infants, Miami, Florida; †Walter Reed National Military Medical Center, Bethesda, Maryland; ‡Sunnybrook Health Sciences Centre, Bayview Campus, Toronto, Ontario, Canada; §University of Washington School of Medicine, Seattle, Washington; ∥Massachusetts General Hospital, Boston Massachusetts; ¶Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; #George Washington University Hospital, Washington, District of Columbia; **Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; ††Massachusetts General Hospital, Boston Massachusetts; ‡‡Memorial Sloan Kettering Cancer Center, New York, New York; §§Brigham & Women's Hospital, Boston, Massachusetts, American College of Obstetrics and Gynecology; ∥∥Mallinckrodt Institute of Radiology, St. Louis, Missouri; ¶¶Columbia University, New York, New York, American College of Obstetrics and Gynecology; ##Mayo Clinic, Rochester, Minnesota; ***University of Maryland School of Medicine, Baltimore, Maryland; and †††Valley Hospital, Ridgewood, New Jersey, American College of Obstetrics and Gynecology.

Vaginal bleeding occurring in the second or third trimesters of pregnancy can variably affect perinatal outcome, depending on whether it is minor (i.e. a single, mild episode) or major (heavy bleeding or multiple episodes.) Ultrasound is used to evaluate these patients. Sonographic findings may range from marginal subchorionic hematoma to placental abruption. Abnormal placentations such as placenta previa, placenta accreta and vasa previa require accurate diagnosis for clinical management. In cases of placenta accreta, magnetic resonance imaging is useful as an adjunct to ultrasound and is often appropriate for evaluation of the extent of placental invasiveness and potential involvement of adjacent structures. MRI is useful for preplanning for cases of complex delivery, which may necessitate a multi-disciplinary approach for optimal care.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/RUQ.0000000000000044DOI Listing
December 2013

ACR appropriateness criteria staging and follow-up of ovarian cancer.

J Am Coll Radiol 2013 Nov;10(11):822-7

Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. Electronic address:

Imaging is used to detect and characterize adnexal masses and to stage ovarian cancer both before and after initial treatment, although the role for imaging in screening for ovarian cancer has not been established. CT and MRI have been used to determine the resectability of tumors, the candidacy of patients for effective cytoreductive surgery, the need for postoperative chemotherapy if debulking is suboptimal, and the need for referral to a gynecologic oncologist. Radiographic studies such as contrast enema and urography have been replaced by CT and other cross-sectional imaging for staging ovarian cancer. Contrast-enhanced CT is the procedure of choice for preoperative staging of ovarian cancer. MRI without and with contrast may be useful after equivocal CT, but is usually not the best initial procedure for ovarian cancer staging. Fluorine-18-2-fluoro-2-deoxy-D-glucose-PET/CT may not be needed preoperatively, but its use is appropriate for detecting and defining post-treatment recurrence. Ultrasound is useful for evaluating adnexal disease, but has limited utility for staging ovarian cancer. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jacr.2013.07.017DOI Listing
November 2013

ACR Appropriateness Criteria® growth disturbances - risk of intrauterine growth restriction.

Ultrasound Q 2013 Sep;29(3):147-51

Valley Hospital, Paramus, NJ 07652, USA.

Fetal growth disturbances include fetuses at risk for intrauterine growth restriction. These fetuses may have an estimated fetal weight at less than the 10% or demonstrate a plateau of fetal growth with an estimated fetal growth greater than the 10%. Uteroplacental insufficiency may play a major role in the etiology of intrauterine growth restriction. Fetuses at risk for intrauterine fetal growth restriction are susceptible to the potential hostility of the intrauterine environment leading to fetal hypoxia and fetal acidosis. Fetal well-being can be assessed using biophysical profile, Doppler velocimetry, fetal heart rate monitoring, and fetal movement counting.Fetal growth disturbances include fetuses at risk for intrauterine growth restriction. These fetuses may have an estimated fetal weight at less than the 10% or demonstrate a plateau of fetal growth with an estimated fetal growth greater than the 10%. Uteroplacental insufficiency may play a major role in the etiology of intrauterine growth restriction. Fetuses at risk for intrauterine fetal growth restriction are susceptible to the potential hostility of the intrauterine environment leading to fetal hypoxia and fetal acidosis. Fetal well-being can be assessed using biophysical profile, Doppler velocimetry, fetal heart rate monitoring, and fetal movement counting.The ACR Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/RUQ.0b013e31829ea221DOI Listing
September 2013

ACR appropriateness Criteria® first trimester bleeding.

Ultrasound Q 2013 Jun;29(2):91-6

University of Maryland School of Medicine, Baltimore, Maryland, USA.

Vaginal bleeding is not uncommon in the first trimester of pregnancy. Ultrasound is the foremost modality for evaluating normal development of the gestational sac and embryo and for discriminating the causes of bleeding. While correlation with quantitative βHCG and clinical presentation is essential, sonographic criteria permit diagnosis of failed pregnancies, ectopic pregnancy, gestational trophoblastic disease and spontaneous abortion. The American College of Radiology Appropriateness Criteria guidelines have been updated to incorporate recent data. A failed pregnancy may be diagnosed when there is absence of cardiac activity in an embryo exceeding 7 mm in crown rump length or absence of an embryo when the mean sac diameter exceeds 25 mm. In a stable patient with no intrauterine pregnancy and normal adnexae, close monitoring is advised. The diagnosis of ectopic pregnancy should be based on positive findings rather than on the absence of an intrauterine sac above a threshold level of βHCG. Following abortion, ultrasound can discriminate retained products of conception from clot and arteriovenous fistulae. The American College of Radiology Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/RUQ.0b013e31829158c2DOI Listing
June 2013

Enhancement of ovarian malignancy on clinical contrast enhanced MRI studies.

ISRN Obstet Gynecol 2013 13;2013:979345. Epub 2013 Feb 13.

Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.

Purpose. To assess if there is a significant difference in enhancement of high grade serous carcinoma of the ovary compared with other ovarian malignancies on clinically performed contrast enhanced MRI studies. Methods. In this institutional-review-board-approved study, two radiologists reviewed contrast enhanced MRI scans in 37 patients with ovarian cancer. Readers measured the signal intensity (SI) of ovarian mass and gluteal fat pre- and postcontrast administration. Percentage enhancement (PE) was calculated as [(post-pre)/precontrast SI] × 100. Results. Pathology revealed 19 patients with unilateral and 18 patients with bilateral malignancies for a total of 55 malignant ovaries-high grade serous carcinoma in 25/55 ovaries (45%), other epithelial carcinomas in 12 ovaries (22%), nonepithelial cancers in 8 ovaries (14%), and borderline tumors in 10 ovaries (18%). Enhancement of high grade serous carcinoma was not significantly different from other invasive ovarian malignancies (Reader 1 P = 0.865; Reader 2 P = 0.353). Enhancement of invasive ovarian malignancies was more than borderline tumors but did not reach statistical significance (Reader 1P = 0.102; Reader 2 P = 0.072). Conclusion. On clinically performed contrast enhanced MRI studies, enhancement of high grade serous ovarian carcinoma is not significantly different from other ovarian malignancies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2013/979345DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586516PMC
March 2013

ACR Appropriateness Criteria® clinically suspected adnexal mass.

Ultrasound Q 2013 Mar;29(1):79-86

Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.

Adnexal masses are a common problem clinically and imaging-wise, and transvaginal US (TVUS) is the first-line imaging modality for assessing them in the vast majority of patients. The findings of US, however, should be correlated with the history and laboratory tests, as well as any patient symptoms. Simple cysts are uniformly benign, and most warrant no further interrogation or treatment. Complex cysts carry more significant implications, and usually engender serial ultrasound(s), with a minority of cases warranting a pelvic MRI.Morphological analysis of adnexal masses with gray-scale US can help narrow the differential diagnosis. Spectral Doppler analysis has not proven useful in most well-performed studies. However, the use of color Doppler sonography adds significant contributions to differentiating between benign and malignant masses and is recommended in all cases of complex masses. Malignant masses generally demonstrate neovascularity, with abnormal branching vessel morphology. Optimal sonographic evaluation is achieved by using a combination of gray-scale morphologic assessment and color or power Doppler imaging to detect flow within any solid areas.The ACR Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/RUQ.0b013e3182814d9bDOI Listing
March 2013

ACR Appropriateness Criteria® Multiple gestations.

Ultrasound Q 2012 Jun;28(2):149-55

Georgetown University Hospital, Washington, District of Columbia, USA.

Multiple gestations are high-risk compared with singleton pregnancies. Prematurity and intrauterine growth restrictions are the major sources of morbidity and mortality common to all twin gestations. Monochorionic twins are at a higher risk for twin-twin transfusion, fetal growth restriction, congenital anomalies, vasa previa, velamentous insertion of the umbilical cord and fetal death. Therefore, determination of multiple gestation, amnionicity and chorionicity in the first trimester is important. Follow up examinations to evaluate fetal well-being include assessment of fetal growth and amniotic fluid volume, umbilical artery Doppler, nonstress test and biophysical profile. To date, there is a paucity of literature regarding imaging schedules for follow-up. At the very least, antepartum testing in multiple gestations is recommended in all situations in which surveillance would ordinarily be performed in a singleton pregnancy.The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed biennially by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/RUQ.0b013e31824bfc06DOI Listing
June 2012

MRI diagnosis of pelvic organ prolapse compared with clinical examination.

Acad Radiol 2011 Oct 26;18(10):1245-51. Epub 2011 Jul 26.

Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.

Rationale And Objectives: The aims of this study were to determine agreement between clinical examination and magnetic resonance imaging (MRI) (rectal contrast and noncontrast MRI) for pelvic organ prolapse using both the pubococcygeal line (PCL) and the midpubic line (MPL) and to assess the relationship between measurements performed relative to each line.

Materials And Methods: Dynamic MRI exams in 88 women (with rectal contrast, n = 39; noncontrast, n = 49) were evaluated, followed by review of clinical exam notes. Agreement between clinical exam and MRI and the difference between PCL and MPL measurements were evaluated.

Results: Agreement of rectal contrast MRI with clinical exam was 79% for PCL and 85% for MPL (P = .17) for cystoceles, 50% for PCL and 59% for MPL (P = .20) for vaginal prolapse, 56% for PCL for enteroceles, and 61% for rectoceles. Agreement of noncontrast MRI with clinical exam was 67% for PCL and 78% for MPL (P = .19) for cystoceles, 58% for PCL and 71% for MPL (P = .10) for vaginal prolapse, 65% for enteroceles, and 40% for rectoceles. The average difference between the PCL and the MPL was 3.12 ± 0.24 cm at the bladder base and 4.88 ± 0.37 cm at the vaginal apex.

Conclusions: Agreement of MRI with clinical exam was highest for cystoceles. There was no significant difference in agreement using the MPL or PCL, suggesting that either line can be used on MRI. The average differences between the PCL and MPL at the bladder base and vaginal apex were approximately 3 and 5 cm, respectively.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.acra.2011.05.010DOI Listing
October 2011

Radiological assessment of gynecologic malignancies.

Obstet Gynecol Clin North Am 2011 Mar;38(1):45-68, vii

Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York City, NY 10065, USA.

Patients with gynecologic malignancies are evaluated with a combination of imaging modalities including ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging. US has a primary role in detecting and characterizing endometrial and adnexal pathology. CT is one of the primary modalities in staging malignancy and detecting recurrence. MR imaging is characterized by superior contrast resolution and specificity. This article reviews the role of radiologic imaging for the characterization of gynecologic masses and for staging, planning, and monitoring treatment, as well as for the assessment of tumor recurrence of the most common gynecologic malignancies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ogc.2011.02.003DOI Listing
March 2011

Radiological Assessment of Gynecologic Malignancies.

PET Clin 2010 Oct 4;5(4):407-23. Epub 2010 Aug 4.

Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York City, NY 10065, USA.

Patients with gynecologic malignancies are evaluated with a combination of imaging modalities including ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging. US has a primary role in detecting and characterizing endometrial and adnexal pathology. CT is one of the primary modalities in staging malignancy and detecting recurrence. MR imaging is characterized by superior contrast resolution and specificity. This article reviews the role of radiologic imaging for the characterization of gynecologic masses and for staging, planning, and monitoring treatment, as well as for the assessment of tumor recurrence of the most common gynecologic malignancies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cpet.2010.07.002DOI Listing
October 2010

IV contrast infusion for coronary artery CT angiography: literature review and results of a nationwide survey.

AJR Am J Roentgenol 2009 May;192(5):W214-21

The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 601 N Caroline Street, Baltimore, MD 21287, USA.

Objective: The purpose of our study was to review investigations that evaluated contrast infusion using MDCT with submillimeter detector configuration for coronary artery CT angiography (CTA). Published data are supplemented with 2006 survey results from centers practicing 64-MDCT coronary artery angiography.

Conclusion: Literature and survey results suggest a consensus for the use of IV contrast volumes < 100 mL, infusion rate of 5 mL/s, and a saline chaser. A range of concentrations can be used to attain target coronary artery attenuation levels.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2214/AJR.08.1347DOI Listing
May 2009

Comparison of supine magnetic resonance imaging with and without rectal contrast to fluoroscopic cystocolpoproctography for the diagnosis of pelvic organ prolapse.

J Comput Assist Tomogr 2009 Jan-Feb;33(1):125-30

Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.

Purpose: To compare supine magnetic resonance imaging (MRI), with and without rectal contrast, with fluoroscopic cystocolpoproctography (CCP) for the diagnosis of pelvic organ prolapse.

Materials And Methods: Supine MRI and CCP studies were reviewed in 82 patients. All patients were women with an average age of 58.8 years, and the studies were done a mean of 25 days apart. Magnetic resonance imaging was performed with rectal contrast (n = 35) and without rectal contrast (n = 47). Fluoroscopic cystocolpoproctography was performed with rectal (n = 82), vaginal (n = 82), small bowel (n = 81), and bladder (n = 78) contrast, and images were corrected for magnification. Each study was independently reviewed by 2 readers, and outcome variables were presence/absence of cystocele, vaginal prolapse, enterocele, sigmoidocele, and anterior rectocele. Sigmoidoceles were included with enteroceles for data analysis.

Results: For the entire patient group, the prevalence of cystoceles was 89% on CCP and 80% on MRI; vaginal prolapse was 81% on CCP and 56% on MRI; enteroceles, 38% on CCP and 24% on MRI; and anterior rectoceles, 45% on CCP and 37% on MRI. There were significantly more cystoceles (odds ratio [OR] 4.7, P = 0.003), vaginal prolapses (OR 5.2, P < 0.0005), and enteroceles (OR 3.8, P< 0.0005) on CCP than on MRI. For MRI with rectal contrast versus CCP, the prevalence of cystoceles was 94% on CCP and 91% on MRI; vaginal prolapse, 74% on CCP and 70% on MRI; enteroceles, 36% on CCP and 19% on MRI; and anterior rectoceles, 51% on CCP and 59% on MRI. There was statistical significance only for enteroceles, more of which were found on CCP (OR 7.4, P = 0.003). For MRI without rectal contrast versus CCP, the prevalence of cystoceles was 85% on CCP and 72% on MRI; vaginal prolapse, 86% on CCP and 46% on MRI; enteroceles, 40% on CCP and 28% on MRI; and anterior rectoceles, 39% on CCP and 21% on MRI. There were significantly more cystoceles (OR 6.6, P = 0.003), vaginal prolapses (OR 20.8, P < 0.0005), enteroceles (OR 2.9, P = 0.015), and rectoceles (OR 4.9, P = 0.001) on CCP than on noncontrast MRI.

Conclusions: Magnetic resonance imaging without rectal contrast showed statistically fewer pelvic floor abnormalities than CCP. Except for enteroceles, MRI with rectal contrast showed statistically similar frequency of pelvic organ prolapse as CCP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/RCT.0b013e318161d739DOI Listing
March 2009

64 Slice multi-detector row cardiac CT.

Emerg Radiol 2009 Jan 22;16(1):1-10. Epub 2008 Oct 22.

The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA.

Cardiac imaging is feasible with multi-detector row (MDCT) scanners. Coronary arterial anatomy and both non-calcified and calcified plaques are depicted at CT coronary angiography. Vessel wall pathology and luminal diameter are depicted, and secondary myocardial changes may also be seen. Diagnostic capacity has increased with technological advancement, and preliminary investigations confirm the utility of 64-MDCT in low- and intermediate-risk patients who present to the emergency department with acute chest pain. The clinical indications, 64-MDCT technique, and MDCT findings in coronary artery disease are reviewed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10140-008-0760-zDOI Listing
January 2009

Evaluation of the effectiveness of oral Beta-blockade in patients for coronary computed tomographic angiography.

J Comput Assist Tomogr 2008 Mar-Apr;32(2):247-51

The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.

Objective: To determine the effectiveness of oral medications in lowering the resting heart rate (HR) for coronary computed tomographic angiography (CTA).

Background: The protocol of premedication for cardiac CTA is variable in terms of type, dose, route, and timing of administration.

Methods: Nursing records were retrospectively reviewed in 238 consecutive patients having coronary CTA and 217 patients evaluated for type and amount of oral medication administered. The HR on arrival to computed tomography (CT) and 30 and 60 minutes after medication was noted.

Results: One hundred twenty-three patients (56.6%) had a mean HR of 78.3 +/- 9.4 beats per minute (bpm) on arrival and were given medication. One hundred fourteen patients (92.6%) were given 50 mg of oral metoprolol, with the remaining receiving 25 to 100 mg and 1 patient receiving 30 mg of oral diltiazem. Sixty-eight patients (55.2%) were monitored for less than 1 hour and had a mean HR of 73.1 +/- 5.1 bpm on arrival, a 9.8 +/- 4.7-bpm decrease in HR at 30 minutes, and an HR of 56.5 +/- 7.2 bpm during CT. Thirty-nine patients (31.7%) had a mean HR of 81.3 +/- 7.2 bpm on arrival, a 9.8 +/- 7.4-bpm decrease in HR at 30 minutes, a 16.9 +/- 6.3-bpm decrease in HR at 60 minutes, and an HR of 59.8 +/- 4.8 bpm during CT. Sixteen patients were monitored for more than 1 hour, followed by intravenous metoprolol. These patients had a baseline HR of 93.5 +/- 8.9 bpm, a 13.1 +/- 6.4-bpm decrease in HR at 30 minutes, a 15.9 +/- 6.8-bpm decrease in HR at 60 minutes, and an HR of 68.1 +/- 7.9 bpm during CT. There were no complications due to metoprolol.

Conclusion: Oral metoprolol given 1 hour before cardiac CT effectively and safely lowers the resting HR in most patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/RCT.0b013e318075e759DOI Listing
May 2008

64-MDCT angiography of the coronary arteries: nationwide survey of patient preparation practice.

AJR Am J Roentgenol 2008 Mar;190(3):743-7

The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 601 N Caroline St., Rm. 3251, Baltimore, MD 21287, USA.

Objective: The purpose of this study was to evaluate the current practice of patient preparation for 64-MDCT angiography (CTA) of the coronary arteries.

Materials And Methods: Sites in the United States that perform 64-MDCT coronary angiography were surveyed by mail in 2006. Information requested included physician specialty; experience level; details about patient preparation, including the use, dose, route, and timing of premedication; and acceptable heart rate and rhythm. A total of 142 surveys were analyzed, with comparison of parameters across specialties (radiology, cardiology, or shared) and experience levels.

Results: All facets of the study (premedication, data acquisition, cardiac interpretation) are performed exclusively by radiologists in 49% of sites and by cardiologists in 14%. All sites administer beta-blockers. Target heart rate was reported as < or = 65 beats per minute (bpm) by 89% of responders. Despite most centers aiming for a heart rate of < or = 65 bpm, the maximum allowable heart rate is > 65 bpm in 80% of centers. Patients with arrhythmia are scanned in at least 25% of sites. Most sites (84%) administer nitroglycerin. Significant differences between specialties were noted for experience levels, timing and route of beta-blocker administration, and for target heart rate. The likelihood of scanning in the setting of arrhythmia and beta-blocker timing correlated with experience levels.

Conclusion: These 64-MDCT coronary artery data from 2006 reveal consensus for a range of patient preparation parameters. Use of beta-blockers and nitroglycerin is routine, and the target heart rate is usually < or = 65 bpm. However, differences were noted for beta-blocker protocols and acceptable heart rate and rhythm, and some differences in practice are associated with experience level and specialty.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2214/AJR.07.2620DOI Listing
March 2008

Early invasive cervical cancer: CT and MR imaging in preoperative evaluation - ACRIN/GOG comparative study of diagnostic performance and interobserver variability.

Radiology 2007 Nov;245(2):491-8

Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.

Purpose: To retrospectively compare diagnostic performance and interobserver variability for computed tomography (CT) and magnetic resonance (MR) imaging in the pretreatment evaluation of early invasive cervical cancer, with surgical pathologic findings as the reference standard.

Materials And Methods: This HIPAA-compliant study had institutional review board approval and informed consent for evaluation of preoperative CT (n = 146) and/or MR imaging (n = 152) studies in 156 women (median age, 43 years; range, 22-81 years) from a previous prospective multicenter American College of Radiology Imaging Network and Gynecologic Oncology Group study of 172 women with biopsy-proved cervical cancer (clinical stage > or = IB). Four radiologists (experience, 7-15 years) interpreted the CT scans, and four radiologists (experience, 12-20 years) interpreted the MR studies retrospectively. Tumor visualization and detection of parametrial invasion were assessed with receiver operating characteristic curves (with P < or = .05 considered to indicate a significant difference). Descriptive statistics for staging and kappa statistics for reader agreement were calculated. Surgical pathologic findings were the reference standard.

Results: For CT and MR imaging, respectively, multirater kappa values were 0.26 and 0.44 for staging, 0.16 and 0.32 for tumor visualization, and -0.04 and 0.11 for detection of parametrial invasion; for advanced stage cancer (> or =IIB), sensitivities were 0.14-0.38 and 0.40-0.57, positive predictive values (PPVs) were 0.38-1.00 and 0.32-0.39, specificities were 0.84-1.00 and 0.77-0.80, and negative predictive values (NPVs) were 0.81-0.84 and 0.83-0.87. MR imaging was significantly better than CT for tumor visualization (P < .001) and detection of parametrial invasion (P = .047).

Conclusion: Reader agreement was higher for MR imaging than for CT but was low for both. MR imaging was significantly better than CT for tumor visualization and detection of parametrial invasion. The modalities were similar for staging, sharing low sensitivity and PPV but relatively high NPV and specificity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1148/radiol.2452061983DOI Listing
November 2007

Clinically significant abnormal findings on the "nondiagnostic" CT portion of low-amperage-CT attenuation-corrected myocardial perfusion SPECT/CT studies.

J Nucl Med 2006 Aug;47(8):1312-8

Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland, USA.

Unlabelled: Attenuation correction is recommended to optimize the performance of cardiac SPECT. The 2.5-mA CT commonly used for this purpose in myocardial perfusion SPECT is generally considered "nondiagnostic" in quality. In other areas of cardiac and hybrid imaging, diagnostically relevant abnormal findings on higher-quality CT studies have been described. The purpose of this study was to establish the frequency and significance of abnormal findings on low-amperage-CT cardiac SPECT/CT scans and to assess whether a systematic review of the nondiagnostic CT findings should be recommended.

Methods: Two hundred consecutive patients who underwent clinical low-amperage-CT attenuation-corrected myocardial perfusion studies acquired on a SPECT/CT system were included in the study. The cardiac CT images were reviewed in consensus by both an experienced CT reader and a nuclear medicine resident less experienced in CT. Abnormal CT findings of varying significance were recorded.

Results: Eighty-one patients had no abnormal CT findings. In the remaining 119 patients, 234 abnormalities were detected. Twenty-five major findings (in 21 patients) were seen, and 16 of these had been previously unrecognized. Sixty-four minor and 131 minimal findings were noted. Fourteen findings were labeled as equivocal (i.e., the CT findings were not definite).

Conclusion: Potentially significant abnormal findings on the nondiagnostic-CT portion of the cardiac SPECT/CT examination were detected in 10.5% of our patients. These data suggest that, in addition to the review of the emission image dataset, low-amperage-CT findings should routinely be assessed for major diagnostic abnormalities.
View Article and Find Full Text PDF

Download full-text PDF

Source
August 2006

Coronary CT angiography with 64-MDCT: assessment of vessel visibility.

AJR Am J Roentgenol 2006 Jul;187(1):119-26

The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2214/AJR.05.0908DOI Listing
July 2006

Gated cardiac imaging of the aortic valve on 64-slice multidetector row computed tomography: preliminary observations.

J Comput Assist Tomogr 2006 May-Jun;30(3):443-6

The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD21287, and Department of Radiology, New York University Medical Center, New York, NY, USA.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/00004728-200605000-00015DOI Listing
July 2006

Beta-blockers for cardiac CT: a primer for the radiologist.

AJR Am J Roentgenol 2006 Jun;186(6 Suppl 2):S341-5

The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA.

Objective: The objective of this article is to describe a protocol for the administration of beta-blockers for cardiac CT. A low and regular heart rate is necessary for optimal visualization of the coronary arteries on CT and can be achieved by the administration of medications.

Conclusion: Beta-blockers can be safely given, orally or IV, to most patients to lower the heart rate for cardiac CT. A protocol can be implemented and patients can be screened for certain contraindications to allow successful administration of these medications by radiologists.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2214/AJR.04.1944DOI Listing
June 2006

Combined PET/CT for detecting recurrent ovarian cancer limited to retroperitoneal lymph nodes.

Gynecol Oncol 2005 Nov 26;99(2):294-300. Epub 2005 Jul 26.

The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Phipps #281, Baltimore, MD 21287, USA.

Objective: To evaluate the utility of combined positron emission tomography/computed tomography (PET/CT) for detecting recurrent epithelial ovarian cancer limited to retroperitoneal adenopathy.

Methods: Fourteen patients (median age = 53 years) with rising serum CA125 levels, and negative or equivocal conventional CT imaging > or = 6 months after primary therapy were retrospectively identified as having recurrent disease limited to retroperitoneal lymph nodes by combined PET/CT and underwent surgical reassessment of targeted nodal basins. Fisher's Exact Test was used to measure the ability of PET/CT to predict isolated retroperitoneal nodal disease.

Results: The median increase in serum CA125 from baseline nadir was 14 U/ml (range = 2-76 U/ml). There were 29 target nodes in 15 nodal basins identified with increased metabolic uptake on combined PET/CT. Eleven patients (78.6%) had recurrent ovarian cancer in retroperitoneal lymph nodes targeted by PET/CT. Of 143 nodes retrieved, 59 contained recurrent ovarian cancer (median nodal diameter = 2.5 cm, range = 0.8-5.2 cm). For all target nodal basins, the sensitivity, specificity, positive and negative predictive values, and accuracy for recurrent ovarian cancer in dissected lymph nodes were: 40.7% (24/59), 94.0% (79/84), 82.8% (24/29), 69.3% (79/114), and 72.0% (103/143) (P < 0.001). PET/CT failed to identify microscopic disease in 59.3% of pathologically positive nodes.

Conclusion: Combined PET/CT demonstrates high positive predictive value in identifying recurrent ovarian cancer in retroperitoneal lymph nodes when conventional CT findings are negative or equivocal. The high incidence of occult disease within the target nodal basins suggests that regional lymphadenectomy may be necessary for complete secondary cytoreduction of recurrent disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ygyno.2005.06.019DOI Listing
November 2005

Imaging of pelvic malignancies with in-line FDG PET-CT: case examples and common pitfalls of FDG PET.

Radiographics 2005 Jul-Aug;25(4):1031-43

Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University, 601 N Caroline St, Rm 3223, Baltimore, MD 21287-0817, USA.

The role of 2-[fluorine 18]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) in combination with computed tomography (CT) in the evaluation of pelvic malignancies has been rapidly growing in recent years. FDG PET has proved to be valuable in the evaluation of a variety of pelvic malignancies, including colorectal cancer, uterine cervical cancer, ovarian cancer, endometrial cancer, and non-Hodgkin lymphoma. However, a number of pitfalls are commonly encountered at FDG PET, including normal physiologic activity in bowel, ovaries, endometrium, and blood vessels and focal retained activity in ureters, bladder diverticula, pelvic kidneys, and urinary diversions. The use of an in-line FDG PET-CT system, with special attention given to proper patient preparation and scanning protocol, often provides valuable information to help localize and define disease and avoid potential diagnostic pitfalls.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1148/rg.254045155DOI Listing
March 2006

Anatomic relationship between the vaginal apex and the bony architecture of the pelvis: a magnetic resonance imaging evaluation.

Am J Obstet Gynecol 2005 May;192(5):1544-8

Johns Hopkins Medical Institution, Baltimore, MD, USA.

Objective: This study was undertaken to define anatomic relationships between the vaginal apex and the ischial spines and sacrum for nulliparous women with normal support.

Study Design: We retrospectively evaluated the magnetic resonance images of 11 consecutive women who underwent pelvic imaging at Johns Hopkins. Coordinates were recorded for the posterior fornix, sacrum, ischial spines, and cervical vaginal junctions. We calculated vector distances with means, SDs, and 95% CIs. Intraclass correlation coefficients tested interobserver reliability and the Wilcoxon signed rank test compared right- and left-sided measurements.

Results: Mean age was 30.4 +/- 9.1 years. The cervical vaginal junction was 1.6 +/- 0.5 cm superior, 1.1 +/- 0.5 cm anterior, and 4.7 +/- 0.4 cm medial to the ipsilateral ischial spine. The posterior fornix was 1.0 +/- 1.0 cm anterior and 5.3 +/- 0.8 cm inferior to the second sacral vertebra. There was excellent interobserver reliability (interclass correlation coefficients = 0.997, P < .001) and no detectable difference between sides.

Conclusion: Consistent relationships exist between the vaginal apex and ischial spines and sacrum, which may be useful in reconstructive pelvic surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajog.2004.11.028DOI Listing
May 2005

Optimal contrast agents for vascular imaging on computed tomography: iodixanol versus iohexol.

Acad Radiol 2005 May;12(5):576-84

The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287, USA.

Rationale And Objectives: Dimeric nonionic iodinated contrast has a lower osmolality than monomeric nonionic iodinated contrast but is available at lower iodine concentrations. Less dilution of intravascular fluid by influx from the extravascular space is proposed to occur with decreasing osmolality. The purpose of this study was to determine if a dimeric nonionic iso-osmolar contrast agent (iodixanol) gives equal vascular enhancement compared with a monomeric nonionic hyperosmolar contrast agent (iohexol).

Materials And Methods: A dynamic single-level computed tomography (CT) scan was performed of the abdominal aorta of 12 sedated rabbits using a four-row multidetector CT scanner following injection of 1.5 mL contrast/kg body weight at 2 mL/sec. The rabbits were injected with the dimeric contrast agent iodixanol (Visipaque 320; Amersham Health) or the monomeric contrast agent iohexol (Omnipaque 350; Amersham Health). The order of the type of contrast media injected was randomized for each rabbit, and the interval between injections was 2 weeks. Using the 2.5-mm detectors, four contiguous 3-mm contrast-enhanced scans were obtained at a single level every 5 seconds for 120 seconds (total of 24 scans) with a kVp of 120, mA.s of 110, field of view of 106 mm, and soft tissue reconstruction algorithm. A single level was chosen to measure the attenuation of the abdominal aorta at 5-second intervals. The mean attenuation and standard deviation values were recorded for the whole aorta, for the central half of the vessel, and for the peripheral half of the vessel. A log-log transformation of the data was performed and regression analysis was done on the outcomes of interest (e.g., mean, standard deviation) on time for each region.

Results: There was no statistically significant difference in mean attenuation for the whole aorta for iodixanol and iohexol (P = .918) even though the iodine content was 9.3% less with the dimeric iodixanol. The time-attenuation curve of iodixanol paralleled that of iohexol for all time points. The mean attenuation values of the central half of the aorta (P = .354) and peripheral half of the aorta (P = .758) were also not statistically different for the two contrast agents.

Conclusion: The vascular attenuation provided by a 9.3% lower iodine concentration of iso-osmolar iodixanol is equal to that given by hyperosmolar iohexol. This suggests that there is less intravascular dilution of iso-osmolar contrast. The enhancement across the cross section of the vessel is also similar for both contrast agents. This suggests the vascular studies with iodixanol and iohexol are of equal quality even when a lower dose of iodine is given with iodixanol. It is relevant for patients with borderline or diminished renal function in whom less volume of contrast may be administered.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.acra.2005.01.015DOI Listing
May 2005

MDCT evaluation of the coronary arteries, 2004: how we do it--data acquisition, postprocessing, display, and interpretation.

AJR Am J Roentgenol 2005 May;184(5):1402-12

Department of Radiology and Radiological Science, Johns Hopkins University, 601 N Caroline St., Rm. 3254, Baltimore, MD 21287-0801, USA.

Objective: Cardiac CT is rapidly becoming part of clinical practice. The objective of this article is to discuss and illustrate the current practice of coronary artery MDCT, including data acquisition, postprocessing, image display, and interpretation. The practice described reflects our experience with a series of patients referred in routine clinical practice.

Conclusion: The reader should gain an insight into the current clinical application of coronary artery CT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2214/ajr.184.5.01841402DOI Listing
May 2005