Publications by authors named "Lejla Aganovic"

27 Publications

  • Page 1 of 1

Incidental Liver Findings on Cross-sectional Imaging.

Radiol Clin North Am 2021 Jul;59(4):569-590

Department of Radiology, University of California San Diego, UCSD Medical Center, 200 West Arbor Drive, #8756, San Diego, CA 92103, USA. Electronic address:

Hepatic incidental findings often are seen on cross-sectional imaging examinations of the chest, spine, pelvis, or other nondedicated hepatic imaging. Radiologists are tasked with appropriately triaging, which requires further evaluation, even in the setting of an otherwise limited evaluation. This article reviews common benign entities encountered on ultrasound, computed tomography, or magnetic resonance imaging, along with their characteristic imaging features. Imaging features that are suspicious for malignancy or suggest the need for further evaluation also are discussed. Two algorithms are proposed to guide radiologists in their recommendations based on patient risk factors, focal hepatic abnormality size, and available imaging features.
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http://dx.doi.org/10.1016/j.rcl.2021.03.007DOI Listing
July 2021

Follicular pancreatitis: A rare pancreatic inflammatory pseudotumor.

Clin Imaging 2020 Jan 25;59(1):39-44. Epub 2019 Oct 25.

Department of Radiology, University of California San Diego, San Diego, CA, USA; Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA.

Inflammatory pseudotumors imitate neoplasms on imaging but actually represent focal inflammation. We report a case of follicular pancreatitis, which is a recently recognized distinct form of mass-forming focal chronic pancreatitis pathologically characterized by lymphoid infiltration with abundant reactive germinal centers. In our patient, follicular pancreatitis manifested as a pancreatic tail mass that was resected due to imaging findings, which were suggestive of pancreatic malignancy. We performed a literature review of this rare condition and present a summary of reported imaging findings. The most distinguishing feature from pancreatic adenocarcinoma is the enhancement pattern, as follicular pancreatitis enhances more than the surrounding pancreatic parenchyma on delayed post-contrast images which is unusual for pancreatic adenocarcinoma. If this benign diagnosis is suggested on imaging, unnecessary surgery and its potential complications may be avoided.
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http://dx.doi.org/10.1016/j.clinimag.2019.08.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6938461PMC
January 2020

Diagnosis, management, and follow-up of upper tract urothelial carcinoma: an interdisciplinary collaboration between urology and radiology.

Abdom Radiol (NY) 2019 12;44(12):3893-3905

Department of Urology, Moores UCSD Cancer Center, UC San Diego, 3855 Health Sciences Drive, Mail Code: 7897, La Jolla, CA, 92093-7897, USA.

Upper tract urothelial carcinoma (UTUC) is a common and lethal malignancy. Patients diagnosed with this illness often face invasive workups, morbid therapies, and prolonged post-operative surveillance. UTUC represents approximately 5-10% of urothelial malignancies in the United States and affect 4600-7800 new patients annually. Various environmental exposures as well as smoking have been implicated in the development of UTUC. The diagnosis and workup of UTUC relies on heavily on imaging studies, a close working relationship between Urologists and Radiologists, and invasive procedures such as ureteroscopy. Treatments range from renal-sparing endoscopic surgery to radical extirpative surgery depending on the specific clinical situation. Follow-up is crucial as UTUC has a high recurrence rate. Here we review the epidemiology, diagnosis, management strategies, and follow-up of UTUC from an interdisciplinary perspective.
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http://dx.doi.org/10.1007/s00261-019-02293-9DOI Listing
December 2019

Introduction to the special section on urothelial imaging.

Authors:
Lejla Aganovic

Abdom Radiol (NY) 2019 12;44(12):3785

Department of Radiology, University of California San Diego, 200 West Arbor Dr, San Diego, CA, 92103, USA.

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http://dx.doi.org/10.1007/s00261-019-02219-5DOI Listing
December 2019

CT urography: how to optimize the technique.

Abdom Radiol (NY) 2019 12;44(12):3786-3799

Department of Radiology, University of California, San Diego, 200 W. Arbor Drive, San Diego, CA, 92103, USA.

Purpose: Computed tomography urography (CTU) has emerged as the modality of choice for imaging the urinary tract within the past few decades. It is a powerful tool that enables detailed anatomic evaluation of the urinary tract in order to identify primary urothelial malignancies, benign urinary tract conditions, and associated abdominopelvic pathologies. As such, there have been extensive efforts to optimize CTU protocol.

Methods: This article reviews the published literature on CTU protocol optimization, including contrast bolus timing, dose reduction, reconstruction algorithms, and ancillary practices.

Conclusion: There have been many advances in CTU techniques, which allow for imaging diagnosis of a wide spectrum of diseases while minimizing radiation dose and maximizing urinary tract distension and opacification.
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http://dx.doi.org/10.1007/s00261-019-02111-2DOI Listing
December 2019

What a difference a delay makes! CT urogram: a pictorial essay.

Abdom Radiol (NY) 2019 12;44(12):3919-3934

Department of Radiology, University of California, San Diego Health, San Diego, USA.

Purpose: The aim of this pictorial essay is to demonstrate several cases where the diagnosis would have been difficult or impossible without the excretory phase image of CT urography.

Methods: A brief discussion of CT urography technique and dose reduction is followed by several cases illustrating the utility of CT urography.

Results: CT urography has become the primary imaging modality for evaluation of hematuria, as well as in the staging and surveillance of urinary tract malignancies. CT urography includes a non-contrast phase and contrast-enhanced nephrographic and excretory (delayed) phases. While the three phases add to the diagnostic ability of CT urography, it also adds potential patient radiation dose. Several techniques including automatic exposure control, iterative reconstruction algorithms, higher noise tolerance, and split-bolus have been successfully used to mitigate dose. The excretory phase is timed such that the excreted contrast opacifies the urinary collecting system and allows for greater detection of filling defects or other abnormalities. Sixteen cases illustrating the utility of excretory phase imaging are reviewed.

Conclusions: Excretory phase imaging of CT urography can be an essential tool for detecting and appropriately characterizing urinary tract malignancies, renal papillary and medullary abnormalities, CT radiolucent stones, congenital abnormalities, certain chronic inflammatory conditions, and perinephric collections.
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http://dx.doi.org/10.1007/s00261-019-02086-0DOI Listing
December 2019

Renal tumor structured reporting including nephrometry score and beyond: what the urologist and interventional radiologist need to know.

Abdom Radiol (NY) 2019 01;44(1):190-200

Department of Radiology, University of California, San Diego, USA.

The purpose of this paper is to describe cross-sectional imaging anatomic and morphologic parameters of solid renal tumors that urologists and interventional radiologists need for precise management, review the commonly used terms and descriptors of those parameters, and suggest a comprehensive reporting system for detected masses.
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http://dx.doi.org/10.1007/s00261-018-1691-0DOI Listing
January 2019

Can multiphase CT scan distinguish between papillary renal cell carcinoma type 1 and type 2?

Turk J Urol 2018 Jul;44(4):316-322

Department of Urology, UC San Diego Health System, La Jolla, California, USA.

Objective: To investigate the utility of multiphase computed tomography (CT) and percutaneous renal mass biopsy (PRMB) in differentiating between papillary renal cell carcinoma (pRCC)-Type 1 and -Type 2, as emerging data have suggested differential enhancement patterns in different renal tumor histologies.

Material And Methods: Retrospective analysis of 51 patients (23 pRCC-Type 1/28 pRCC-Type 2) who underwent multiphase CT followed by surgery from July 2011 to April 2016 was performed. Data were analyzed between subgroups based on histology. Multiphase CT was analyzed for tumor size, and attenuation [Hounsfield Units (HU)]. Change in HU (ΔHU) was calculated between noncontrast (NC), corticomedullary (CM), nephrographic (N), and delayed (D) phases. Subset analysis was carried out on patients who underwent PRMB prior to surgery.

Results: There was no difference in median tumor size (pRCC-Type 1 2.8 vs. pRCC-Type 2 2.6 cm, p=0.832). In addition to tumor size being similar between groups, distribution of tumor stages between groups was also similar (p=0.651). Greater proportion of high-grade tumors (III/IV) was noted in pRCC-Type 2 (42.9% vs. 8.7%) (p=0.011). There was no difference in HU values for NC (p=0.961), CM (p=0.118), N (p=0.277), and D (p=0.256) phases, and in ΔHU between CM-NC (p=0.278), N-NC (p=0.316), and D-NC (p=0.103). Thirteen patients underwent percutaneous biopsy, 11 of whom had diagnostic samples. Examination of 10/11 (90.9%) samples accurately predicted correct histology, and of 6/11 (54.5%) samples correctly identified high-vs. low-grade histology.

Conclusion: Our findings suggest substantial overlap of CT findings, despite pRCC-Type 2 having greater proportion of high-grade tumors. Utility of CT is limited in the differentiation between pRCC subtypes. Patients with suggested pRCC on CT imaging being considered for a non-extirpative strategy should undergo PRMB for risk stratification.
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http://dx.doi.org/10.5152/tud.2018.28938DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016655PMC
July 2018

Infection: A Clandestine Cause of Sterile Pyuria?

Open Forum Infect Dis 2018 Feb 9;5(2):ofy015. Epub 2018 Feb 9.

Department of Medicine, VA San Diego Healthcare System and University of California, San Diego, School of Medicine, San Diego, California.

is an underappreciated cause of urinary tract infections (UTIs) in older adults. The diagnosis may be missed due to difficulty isolating and identifying the organism. Complications can result because the organism is intrinsically resistant to 2 commonly used drugs to treat UTI, as illustrated by this case.
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http://dx.doi.org/10.1093/ofid/ofy015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5808804PMC
February 2018

The Radiogenomic Risk Score: Construction of a Prognostic Quantitative, Noninvasive Image-based Molecular Assay for Renal Cell Carcinoma.

Radiology 2015 Oct 19;277(1):114-23. Epub 2015 Aug 19.

From the Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Box 951721, CHS 17-135, 10833 LeConte Ave, Los Angeles, CA 90095-1721 (N.J., M.Z., S.B., M.D.K.); Department of Genitourinary Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Tex (E.J.); Department of Radiology, Hospital of Veterans Affairs, University of California-San Diego, San Diego, Calif (M.Z., L.A.); Scottsdale Medical Imaging, Scottsdale, Ariz (R.K.); Department of Urology, Stanford University School of Medicine, Stanford, Calif (H.Z., J.D.B.); Department of Surgical and Perioperative Sciences, Urology and Andrology, Umea Hospital, Umea, Sweden (R.T.S., B.L.); and Department of Statistics, Stanford University, Stanford, Calif (R.J.T.).

Purpose: To evaluate the feasibility of constructing radiogenomic-based surrogates of molecular assays (SOMAs) in patients with clear-cell renal cell carcinoma (CCRCC) by using data extracted from a single computed tomographic (CT) image.

Materials And Methods: In this institutional review board approved study, gene expression profile data and contrast material-enhanced CT images from 70 patients with CCRCC in a training set were independently assessed by two radiologists for a set of predefined imaging features. A SOMA for a previously validated CCRCC-specific supervised principal component (SPC) risk score prognostic gene signature was constructed and termed the radiogenomic risk score (RRS). It uses the microarray data and a 28-trait image array to evaluate each CT image with multiple regression of gene expression analysis. The predictive power of the RRS SOMA was then prospectively validated in an independent dataset to confirm its relationship to the SPC gene signature (n = 70) and determination of patient outcome (n = 77). Data were analyzed by using multivariate linear regression-based methods and Cox regression modeling, and significance was assessed with receiver operator characteristic curves and Kaplan-Meier survival analysis.

Results: Our SOMA faithfully represents the tissue-based molecular assay it models. The RRS scaled with the SPC gene signature (R = 0.57, P < .001, classification accuracy 70.1%, P < .001) and predicted disease-specific survival (log rank P < .001). Independent validation confirmed the relationship between the RRS and the SPC gene signature (R = 0.45, P < .001, classification accuracy 68.6%, P < .001) and disease-specific survival (log-rank P < .001) and that it was independent of stage, grade, and performance status (multivariate Cox model P < .05, log-rank P < .001).

Conclusion: A SOMA for the CCRCC-specific SPC prognostic gene signature that is predictive of disease-specific survival and independent of stage was constructed and validated, confirming that SOMA construction is feasible.
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http://dx.doi.org/10.1148/radiol.2015150800DOI Listing
October 2015

Catch a Wave: Doppler US Quiz: Resident and Fellow Education Feature.

Radiographics 2015 May-Jun;35(3):899-900

From the Department of Radiology, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA 92161 (T.S., F.C., L.A.); and Department of Radiology, University of California-San Diego, San Diego, CA (T.S., F.C., L.A., K.R.).

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http://dx.doi.org/10.1148/rg.2015140124DOI Listing
February 2016

MRI of the epididymis: can the outcome of vasectomy reversal be predicted preoperatively?

AJR Am J Roentgenol 2014 Jul;203(1):91-8

1 Department of Radiology, University of California, San Diego, San Diego, CA 92161.

Objective: The purpose of this study is to describe the MRI findings seen with tubular ectasia of the epididymis and investigate whether MRI may predict vasal/epididymal tubular occlusion before vasectomy reversal.

Materials And Methods: First, we compared epididymal T1 signal intensity (measured as percentage change relative to ipsilateral testis) in 24 patients with sonographically established tubular ectasia compared with 22 control patients (sonographically normal epididymides). Second, in a subset of patients with tubular ectasia who subsequently underwent surgery to restore fertility (n = 10), we examined the relationship between epididymal T1 signal intensity and surgical outcome. Vasovasostomy (simple vas deferens reanastomosis with high success rate) was possible when viable sperm were detected in the vas deferens intraoperatively. When no sperm were detected, vasal/epididymal tubular occlusion was inferred and vasoepididymostomy (vas deferens to epididymal head anastomosis, a technically challenging procedure with poorer outcome) was performed.

Results: In tubular ectasia, we found increased epididymal T1 signal intensity (0-77%) compared with normal epididymides (-27 to 20%) (p < 0.0001). In patients with tubular ectasia who underwent surgery (n = 10), we found higher T1 epididymal signal intensity in cases of vasal/epididymal occlusion (0-70%) relative to cases in which vasal/epididymal patency was maintained (0-10%) (p = 0.01). By logistic regression, relative epididymal T1 signal intensity increase above 19.4% corresponded to greater than 90% probability of requiring vasoepididymostomy.

Conclusion: Increased epididymal T1 signal intensity (likely due to proteinaceous material lodged within the epididymal tubules) at preoperative MRI in patients undergoing vasectomy reversal suggests vasal/epididymal tubular occlusion and requirement for vasoepididymostomy rather than vasovasostomy.
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http://dx.doi.org/10.2214/AJR.13.11619DOI Listing
July 2014

Delayed imaging in routine CT examinations of the abdomen and pelvis: is it worth the additional cost of radiation and time?

AJR Am J Roentgenol 2014 Feb;202(2):329-35

1 All authors: Departments of Radiology, University of California, San Diego, Medical Center, and San Diego VA Healthcare System, 3350 La Jolla Village Dr, San Diego, CA 92161.

Objective: The purpose of this study was to retrospectively assess the potential benefits of delayed phase imaging series in routine CT scans of the abdomen and pelvis.

Materials And Methods: Routine contrast-enhanced abdominopelvic CT scans of 1000 consecutively examined patients (912 men, 88 women; average age, 60 years; range, 22-94 years) were retrospectively evaluated, and the added benefits of the delayed phase series through the abdomen were recorded for each examination. Examinations performed for indications requiring multiphasic imaging were excluded. Images were reviewed by two fellowship-trained abdominal radiologists, who were blinded to official CT reports. All examinations were performed between July 2008 and February 2010 at a single institution. Radiation doses for both the portal venous and delayed phases, when available, were analyzed to assess the effect of the delayed phase on overall radiation exposure.

Results: Forty-two patients (4.2%) had findings that were further characterized or were observed only in the delayed phase. Most were incidental findings that could have been confirmed at noninvasive follow-up imaging, such as sonography or unenhanced CT or MRI. The most common findings were liver hemangioma (n = 12), adrenal adenoma (n = 12), and parapelvic renal cysts (n = 6). The most important finding was detection of a renal mass in one patient (0.1%). The mass was seen only on the delayed phase images but was difficult to appreciate in the portal venous phase. In the other 958 patients (95.8%), delayed imaging was of no benefit. In addition, use of the delayed phase resulted in a mean 59.5% increase in effective radiation dose.

Conclusion: An additional delayed phase through the abdomen in routine contrast-enhanced CT examinations of the abdomen and pelvis is of low yield, particularly if reliable follow-up imaging to further elucidate uncertain findings is available.
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http://dx.doi.org/10.2214/AJR.12.10468DOI Listing
February 2014

Magnetic resonance imaging for intratesticular and extratesticular scrotal lesions.

Can J Urol 2013 Aug;20(4):6855-9

Division of Urology, University of California San Diego Medical Center, San Diego, CA, USA.

Introduction: To evaluate magnetic resonance imaging (MRI) utility in intratesticular and extratesticular scrotal diseases.

Materials And Methods: Two radiologists retrospectively reviewed images of patients who underwent ultrasound followed by MRI, categorizing them as intratesticular or extratesticular and malignant, benign, indeterminate, or inadequate study. For patients who underwent surgical excision, pathologic results were also correlated to the presurgical ultrasound and MRI diagnoses.

Results: Of 69 cases, 38 were intratesticular lesions and 31 were extratesticular lesions. MRI and ultrasound diagnoses were discordant in 21 (55.32%) intratesticular and 19 (61.3%) extratesticular lesions. MRI diagnosis was malignant after an indeterminate ultrasound in 0 and 4 (12.9%) intratesticular and extratesticular lesions, respectively. MRI diagnosis was benign after an indeterminate ultrasound in 18 (47.43%) and 14 (45.2%) intratesticular and extratesticular lesions, respectively. A malignant ultrasound diagnosis was reversed to benign MRI diagnosis in one (2.6%) intratesticular and one (3.2%) extratesticular lesion. In no case was a benign lesion on ultrasound read as malignant on MRI in either group. The cohort of patients with intratesticular lesions received a mean clinical and radiographic follow up of 2.49 ± 1.97 and 1.85 ± 1.46 years, respectively. The patients with extratesticular lesions received a mean clinical and radiographic follow up of 1.30 ± 1.08 and 2.00 ± 1.28 years, respectively. In no case did repeat imaging change the diagnosis after initial MRI and ultrasound evaluation.

Conclusions: MRI was effective at characterizing both intratesticular and extratesticular lesions in the majority of cases.
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August 2013

Differentiation of clear from non-clear cell renal cell carcinoma using CT washout formula.

Can J Urol 2013 Jun;20(3):6790-7

Division of Urology/Department of Surgery, University of California San Diego School of Medicine, La Jolla, CA 92093-0987, USA.

Introduction: To further elucidate potential patterns of contrast enhancement for renal neoplasm subtypes, we investigated utility of contrast washout formula to differentiate renal tumor histology after multiphase computerized tomography (CT).

Materials And Methods: Single center retrospective cohort study of 163 patients with multiphase CT for renal masses obtained October 2007 to July 2012. Pathology confirmed clear cell (CC-RCC; n = 92), papillary (Pa-RCC; n = 43), chromophobe (Ch-RCC; n = 6), oncocytoma (OC; n = 11), or angiomyolipoma (AML; n = 11) histology. Two radiologists in consensus and blinded to histology recorded tumor size, morphology, and attenuation measurements in Hounsfield Units (HU). Data were analyzed between subgroups based on histology. Enhancement washout of the tumor was calculated by the formula (Mass nephrographic HU-Mass delayed HU)/(Mass nephrographic HU-Mass non-contrast HU) and used to calculate sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).

Results: Tumor size was largest among CC-RCC (p < 0.001). Homogeneous composition was more common among Pa-RCC and Ch-RCC (p < 0.001). Median washout for Ch-RCC (0.27) was significantly different from that of OC (0.54, p = 0.05). Overall 25 (15.3%) of tumors had washout < 0. Tumors with washout value < 0 were Pa-RCC 24/43 (56%), and Ch-RCC 1/6 (14%). Washout value < 0 had a specificity of 99.2% for Pa-RCC and 100% for non-CC-RCC. Washout value ≥ 0 had a sensitivity and NPV of 100% for CC-RCC, OC, and AML. Washout value ≥ 0 had a specificity of 35.2% and a PPV of 66.7% for CC-RCC.

Conclusions: Enhancement washout value < 0 is highly specific for Pa-RCC and non-CC-RCC. Washout value ≥ 0 is highly sensitive for CC-RCC, OC, and AML while there was a significant difference in median washout between OC and Ch-RCC. Further prospective investigation is requisite to confirm these findings.
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June 2013

Imaging of the scrotum.

Radiol Clin North Am 2012 Nov;50(6):1145-65

Department of Radiology, VA Hospital, University of California San Diego, San Diego, CA 92161, USA.

Ultrasonography is currently the imaging modality of choice when assessing scrotal lesions. Ultrasound findings are sometimes inconclusive, in which case magnetic resonance (MR) imaging might yield additional important information. This article reviews ultrasound and MR imaging features of various intratesticular and extratesticular lesions including acute and nonacute conditions of the scrotum. Nonneoplastic lesions that can mimic scrotal malignancy are discussed. Normal anatomy and imaging techniques are also presented.
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http://dx.doi.org/10.1016/j.rcl.2012.08.003DOI Listing
November 2012

A probable case of Hand-Schueller-Christian's disease in an Egyptian mummy revealed by CT and MR investigation of a dry mummy.

Coll Antropol 2012 Mar;36(1):281-6

University of Zagreb, Dubrava University Hospital, Department of Diagnostic and Interventional Radiology, Zagreb, Croatia.

The challenging mission of paleopathologists is to be capable to diagnose a disease just on the basis of limited information gained by means of one or more paleodiagnostic techniques. In this study a radiologic, anthropologic and paleopathologic analysis of an ancient Egyptian mummy through X-rays, CT and MR was conducted. An Ancient Egyptian mummy ("Mistress of the house", Archeological Museum, Zagreb, Croatia) underwent digital radiography, computed tomography and magnetic resonance imaging employing 3-dimensional ultra-short-echo time (UTE) sequence, that allows to image ancient dry tissue. Morphological observations on the skull and pelvis, the stages of epiphyseal union and dental wear indicated that the remains are those of a young adult male. Multiple osseous lytic lesions were observed throughout the spine as well as on the frontal, parietal, and occipital bone, orbital wall and the sella turcica of the sphenoid. Considering the sex and age of the individual and the features of the lesions, the authors propose the diagnosis of Hand-Schueller-Christian's disease. This is the first study to have effectively used MR images in the differential diagnosis of a disease. It also confirmed the CT value in revealing central nervous system involvement just by detecting skeletal lesions. Although the mummy was previously dated to 3rd century B.C. based on the properties of the sarcophagi, the sex of the mummy suggests that it was most probably transferred into these sarcophagi in later times. The mummification techniques used and radiometric data (C14) dated it to 900-790. B.C.
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March 2012

Ureteral intussusception: a case report and literature review.

J Comput Assist Tomogr 2012 Mar-Apr;36(2):261-4

Department of Radiology, University of California San Diego Medical Center, San Diego, CA, USA.

We present the case of a 64-year-old man with intussusception of the right ureter as a complication of an underlying transitional cell carcinoma. To our knowledge, this is the first case report that illustrates ureteral intussusception by both multidetector computerized tomography and magnetic resonance imaging. Although ureteral intussusceptions are thought to be associated with benign masses, our comprehensive review of the literature demonstrates that almost half of the cases are associated with underlying malignancy.
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http://dx.doi.org/10.1097/RCT.0b013e31824677a5DOI Listing
May 2012

Plugoma: CT findings after prosthetic plug inguinal hernia repairs.

J Am Coll Surg 2010 Oct 1;211(4):481-4. Epub 2010 Aug 1.

Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA.

Background: Unrecognized CT findings of a prosthetic plug used in inguinal hernia repair can lead to incorrect diagnosis or unnecessary workup of a patient. The objective of this study is to review the expected CT findings present in patients with a history of plug repair.

Study Design: Retrospective cohort study retrieving clinical and image data from a single-institution database. Patients who underwent prosthetic plug hernia repair during a 5-year period at our institution had their records queried for subsequent abdominal CT scans. These CT scans were reviewed by 2 radiologists for findings referable to the hernia repair.

Results: Five-hundred and sixty-four consecutive patients underwent prosthetic plug hernia repair during a 5-year period. Fifty-one patients who had had 55 surgical procedures had subsequent CT scans, none in the early postoperative period. Readers identified 100% of the plugs, 68% of which were described as round or oval in shape. All the plugs were in close proximity to the inferior epigastric artery and were of low density on CT images. Surgical scar was identifiable in 87% of patients. Thirty-two patients (63%) had a second CT scan, demonstrating no change in size and location of the plugoma.

Conclusions: A prosthetic mesh plug is easily seen on CT images, typically appearing as a smooth round or oval hypodense mass close to the inferior epigastric artery, deep to a surgical scar, and stable over time. It can usually be distinguished from pathologic findings. It is important that the radiologist be familiar with the patient's surgical history when interpreting these images.
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http://dx.doi.org/10.1016/j.jamcollsurg.2010.06.001DOI Listing
October 2010

MR imaging of scrotal tumors and pseudotumors.

Radiographics 2010 May;30(3):665-83

Departments of Radiology, VA Medical Center/University of California, San Diego, 3350 La Jolla Village Dr, San Diego, CA 92161, USA.

Magnetic resonance (MR) imaging is an important imaging technique in the evaluation of scrotal masses, providing a useful adjunct to ultrasonography (US). Although US is the modality of choice for initial evaluation of scrotal pathologic conditions because of its wide availability, low cost, and high sensitivity for detection of testicular and paratesticular disease processes, US findings may occasionally be inconclusive. MR imaging may provide additional information in these cases, often affecting patient management. This article reviews and illustrates the MR imaging features of solid extratesticular and intratesticular benign and malignant scrotal tumors, as well as nonneoplastic lesions that can mimic neoplasia. Normal scrotal MR anatomic features and optimal MR imaging technique are also presented.
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http://dx.doi.org/10.1148/rg.303095049DOI Listing
May 2010

Recurrent non-surgical pneumoperitoneum due to jejunal diverticulosis.

J Emerg Med 2012 Sep 24;43(3):e175-9. Epub 2010 Apr 24.

Department of Radiology, University of California Medical Center, San Diego, California, USA.

Background: The presence of free intraperitoneal gas usually warrants emergent surgery. In rare instances, however, non-surgical conditions such as jejunal diverticulosis can cause pneumoperitoneum and do not require intervention.

Objectives: The objective of this article is to provide the computed tomography (CT) scan findings of jejunal diverticulosis causing pneumoperitoneum. The article will also discuss other non-surgical causes of spontaneous pneumoperitoneum to increase awareness and avoid unnecessary surgery.

Case Report: We describe a case of recurrent pneumoperitoneum due to jejunal diverticulosis in which the patient remained asymptomatic and free of complications with repeated evaluations in the emergency department over the course of 18 months.

Conclusion: Although spontaneous pneumoperitoneum due to jejunal diverticulosis is a rare finding, when it does occur, this condition must be distinguished from other forms of pneumoperitoneum to avoid unnecessary surgery. CT scan findings of multiple rounded, variably sized jejunal outpouchings filled with oral contrast are helpful in diagnosing jejunal diverticulosis and confirming the decision for conservative management of the patient.
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http://dx.doi.org/10.1016/j.jemermed.2010.01.020DOI Listing
September 2012

Fatty liver disease: MR imaging techniques for the detection and quantification of liver steatosis.

Radiographics 2009 Jan-Feb;29(1):231-60

Department of Radiology, University of California at San Diego, 200 W Arbor Dr, San Diego, CA 92103, USA.

Fatty liver disease is the most common cause of chronic liver disease in the United States. Noninvasive detection and quantification of fat is becoming more and more important clinically, due in large part to the growing prevalence of nonalcoholic fatty liver disease. Steatosis, the accumulation of fat-containing vacuoles within hepatocytes, is a key histologic feature of fatty liver disease. Liver biopsy, the current standard of reference for the assessment of steatosis, is invasive, has sampling errors, and is not appropriate in some settings. Several magnetic resonance (MR) imaging-based techniques--including chemical shift imaging, frequency-selective imaging, and MR spectroscopy--are currently in clinical use for the detection and quantification of fat-water admixtures, with each technique having important advantages, disadvantages, and limitations. These techniques permit the breakdown of the net MR signal into fat and water signal components, allowing the quantification of fat in liver tissue, and are increasingly being used in the diagnosis, treatment, and follow-up of fatty liver disease.
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http://dx.doi.org/10.1148/rg.291075123DOI Listing
March 2009

Saline chasing technique with dual-syringe injector systems for multi-detector row computed tomographic angiography: rationale, indications, and protocols.

Curr Probl Diagn Radiol 2006 Jan-Feb;35(1):1-11

Department of Radiology, Medical University of South Carolina, Charleston, SC 29425, USA.

Computed tomography (CT) technology has significantly changed over the last two decades. The advent of multi-detector row CT (MDCT) has resulted in rapid acquisition times and improved z-axis resolution that paved the way for CT angiography. With MDCT technology, CT angiography has become more dependent upon optimal vessel opacification and, consequently, contrast administration protocols have had to evolve. We examine the use of intravenous contrast from a historical perspective and discuss the latest methodologies, such as saline chasing techniques, that optimize the contrast bolus with CT angiography.
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http://dx.doi.org/10.1067/j.cpradiol.2005.10.001DOI Listing
April 2006

Combined acute traumatic aortic injury and left main bronchus transection in a 5-year-old child.

J Thorac Imaging 2005 Aug;20(3):245-7

Department of Radiology, Medical University of South Carolina, Charleston 29425, USA.

Blunt traumatic aortic and tracheobronchial injuries are extremely rare in children. We report a case of a 5 year old male who suffered both of these rare injuries (traumatic aortic rupture and left mainstem bronchus transaction). To our knowledge this combination of injuries has not been previously described in a child. CT with multiplanar images was critical for the detection of both injuries.
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http://dx.doi.org/10.1097/01.rti.0000155041.89780.e5DOI Listing
August 2005

Hyperintensity of spinal Cryptococcus infection on diffusion-weighted MR images.

AJR Am J Roentgenol 2004 Oct;183(4):1176-7

Medical University of South Carolina Charleston, SC 29425, USA.

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http://dx.doi.org/10.2214/ajr.183.4.1831176DOI Listing
October 2004