Publications by authors named "Sayf Al-Katib"

26 Publications

  • Page 1 of 1

Anomalous Circumrenal Inferior Vena Cava Associated With Horseshoe Kidney.

Cureus 2021 Oct 15;13(10):e18797. Epub 2021 Oct 15.

Department of Diagnostic Radiology and Molecular Imaging, Beaumont Health, Royal Oak, USA.

A 69-year-old male presented with periumbilical pain radiating across his abdomen, with associated nausea and emesis. CT imaging of his abdomen and pelvis revealed calculi in the right and left ureterovesical junctions with hydroureteronephrosis bilaterally. Furthermore, the imaging revealed that the patient had a horseshoe kidney with an associated anomalous inferior vena cava (IVC) that split superiorly to the horseshoe kidney at the L1 level and rejoined inferior to the horseshoe kidney at the L5 level. The IVC took on a "circumrenal" course, as it traversed the right kidney with an anterior and posterior portion. Furthermore, the patient's right ureter was compressed between the anterior portion of the IVC and the right kidney. We hypothesize that the development of the horseshoe kidney around the 7 to 8th week of gestation created a path of resistance for the forming of IVC around the same time. While surgical correction is not warranted, recognition of this circumrenal IVC variant could have major implications for planning of procedures, such as IVC filter placement.
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http://dx.doi.org/10.7759/cureus.18797DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8592782PMC
October 2021

Risk Factors for Pneumothorax Development Following CT-Guided Core Lung Nodule Biopsy.

J Bronchology Interv Pulmonol 2021 Oct 14. Epub 2021 Oct 14.

Oakland University William Beaumont School of Medicine, Rochester Department of Diagnostic Radiology and Molecular Imaging Division of Pulmonary Critical Care, Beaumont Health System, Royal Oak, MI.

Background: This study aims to correlate nodule, patient, and technical risk factors less commonly investigated in the literature with pneumothorax development during computed tomography-guided core needle lung nodule biopsy.

Patients And Methods: Retrospective data on 671 computed tomography-guided percutaneous core needle lung biopsies from 671 patients at a tertiary care center between March 2014 and August 2016. Univariate and multivariable logistic regression analyses were used to identify pneumothorax risk factors.

Results: The overall incidence of pneumothorax was 26.7% (n=179). Risk factors identified on univariate analysis include anterior [odds ratio (OR)=1.98; P<0.001] and lateral (OR=2.17; P=0.002) pleural surface puncture relative to posterior puncture, traversing more than one pleural surface with the biopsy needle (OR=2.35; P=0.06), patient positioning in supine (OR=2.01; P<0.001) and decubitus nodule side up (OR=2.54; P=0.001) orientation relative to decubitus nodule side down positioning, and presence of emphysema in the path of the biopsy needle (OR=3.32; P<0.001). In the multivariable analysis, the presence of emphysematous parenchyma in the path of the biopsy needle was correlated most strongly with increased odds of pneumothorax development (OR=3.03; P=0.0004). Increased body mass index (OR=0.95; P=0.001) and larger nodule width (cm; OR=0.74; P=0.02) were protective factors most strongly correlated with decreased odds of pneumothorax development.

Conclusion: Emphysema in the needle biopsy path is most strongly associated with pneumothorax development. Increases in patient body mass index and width of the target lung nodule are most strongly associated with decreased odds of pneumothorax.
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http://dx.doi.org/10.1097/LBR.0000000000000816DOI Listing
October 2021

Dynamic lung compliance imaging from 4DCT-derived volume change estimation.

Phys Med Biol 2021 Nov 3;66(21). Epub 2021 Nov 3.

Department of Radiation Oncology, Beaumont Health, OUWB School of Medicine, United States of America.

. Lung compliance (LC) is the ability of the lung to expand with changes in pressure and is one of the earliest physiological measurements to be altered in patients with parenchymal lung disease. Therefore, compliance monitoring could potentially identify patients at risk for disease progression. However, in clinical practice, compliance measurements are prohibitively invasive for use as a routine monitoring tool.. We propose a novel method for computing dynamic lung compliance imaging (LCI) from non-contrast computed tomography (CT) scans. LCI applies image processing methods to free-breathing 4DCT images, acquired under two different continuous positive airway pressures (CPAP) applied using a full-face mask, in order to compute the lung volume change induced by the pressure change. LCI provides a quantitative volumetric map of lung stiffness.. We compared mean LCI values computed for 10 patients with idiopathic pulmonary fibrosis (IPF) and 7 non-IPF patients who were screened for lung nodules. 4DCTs were acquired for each patient at 5 cm and 10 cm H0 CPAP, as the patients were free breathing at functional residual capacity. LCI was computed from the two 4DCTs. Mean LCI intensities, which represent relative voxel volume change induced by the change in CPAP pressure, were computed.The mean LCI values for patients with IPF ranged between [0.0309, 0.1165], whereas the values ranged between [0.0704, 0.2185] for the lung nodule cohort. Two-sided Wilcoxon rank sum test indicated that the difference in medians is statistically significant (value = 0.009) and that LCI -measured compliance is overall lower in the IPF patient cohort.. There is considerable difference in LC scores between patients with IPF compared to controls. Future longitudinal studies should look for LC alterations in areas of lung prior to radiographic detection of fibrosis to further characterize LCI's potential utility as an image marker for disease progression.
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http://dx.doi.org/10.1088/1361-6560/ac29ceDOI Listing
November 2021

Small bowel diverticulitis - Spectrum of CT findings and review of the literature.

Clin Imaging 2021 Oct 6;78:240-246. Epub 2021 May 6.

Beaumont Health System, Oakland University William Beaumont School of Medicine, Department of Diagnostic Radiology and Molecular Imaging, 3601 W 13 Mile Rd, Royal Oak, MI, 48073. Electronic address:

Purpose: To review the CT findings and complications of small bowel diverticulitis (SBD) and discuss clinical presentations and outcomes.

Methods: A text search of radiology reports within our health system for cases of small bowel diverticulitis yielded 95 cases. All cases were reviewed by an abdominal radiologist with equivocal cases reviewed by a second abdominal radiologist for consensus. Retrospective analysis of CT imaging findings was performed on 67 convincing cases of SBD.

Results: Small bowel diverticulitis most often affected the jejunum (58%) and the duodenum (26%). The most common imaging feature was peridiverticular inflammation manifested by peridiverticular edema, diverticular wall thickening, bowel wall thickening, and fascial thickening. Edema was typically seen along the mesenteric border of the bowel with relative sparing of the anti-mesenteric side. When a prior CT was available, the affected diverticulum was identified in 95% of cases. Fecalized content within the affected diverticulum was observed in 51% of cases. Perforation (6%) and abscess (6%) were the most common complications.

Conclusion: Small bowel diverticulitis is an uncommon cause of abdominal pain which can mimic an array of abdominal pathologies, although the reported mortality rate of 40-50% may no longer be accurate. The "fecalized diverticulum" sign can be helpful in identifying the culprit diverticulum and aid diagnosing SBD. Findings of perforation and or abscess formation are critical as they may impact management.
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http://dx.doi.org/10.1016/j.clinimag.2021.05.004DOI Listing
October 2021

A prospective study to validate pulmonary blood mass changes on non-contrast 4DCT in pulmonary embolism patients.

Clin Imaging 2021 Oct 5;78:179-183. Epub 2021 Mar 5.

Department of Radiation Oncology, Beaumont Health System, OUWB School of Medicine, United States of America; Department of Computational and Applied Mathematics, Rice University, United States of America. Electronic address:

Purpose: Limited diagnostic options exist for patients with suspected pulmonary embolism (PE) who cannot undergo CT-angiogram (CTA). CT-ventilation methods recover respiratory motion-induced lung volume changes as a surrogate for ventilation. We recently demonstrated that pulmonary blood mass change, induced by tidal respiratory motion, is a potential surrogate for pulmonary perfusion. In this study, we examine blood mass and volume change in patients with PE and parenchymal lung abnormalities (PLA).

Methods: A cross-sectional analysis was conducted on a prospective, cohort-study with 129 consecutive PE suspected patients. Patients received 4DCT within 48 h of CTA and were classified as having PLA and/or PE. Global volume change (VC) and percent global pulmonary blood mass change (PBM) were calculated for each patient. Associations with disease type were evaluated using quantile regression.

Results: 68 of 129 patients were PE positive on CTA. Median change in PBM for PE-positive patients (0.056; 95% CI: 0.045, 0.068; IQR: 0.051) was smaller than that of PE-negative patients (0.077; 95% CI: 0.064, 0.089; IQR: 0.056), with an estimated difference of 0.021 (95% CI: 0.003, 0.038; p = 0.0190). PLA was detected in 57 (44.2%) patients. Median VC for PLA-positive patients (1.26; 95% CI: 1.22, 1.30; IQR: 0.15) showed no significant difference from PLA-negative VC (1.25; 95% CI: 1.21, 1.28; IQR: 0.15).

Conclusions: We demonstrate that pulmonary blood mass change is significantly lower in PE-positive patients compared to PE-negative patients, indicating that PBM derived from dynamic non-contrast CT is a potentially useful surrogate for pulmonary perfusion.
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http://dx.doi.org/10.1016/j.clinimag.2021.02.023DOI Listing
October 2021

Pulmonary Blood Mass and Quantitative Lung Function Imaging in Idiopathic Pulmonary Fibrosis.

Radiol Cardiothorac Imaging 2020 Jun 25;2(3):e200003. Epub 2020 Jun 25.

Division of Pulmonary and Critical Care (G.B.N.), Department of Radiology and Molecular Imaging (S.A.K.), and Department of Radiation Oncology (E.C.), Beaumont Health System, Oakland University William Beaumont School of Medicine, 3535 W 13 Mile Rd, Suite 502, Royal Oak, MI 48073.

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http://dx.doi.org/10.1148/ryct.2020200003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7977694PMC
June 2020

Quantifying pulmonary perfusion from noncontrast computed tomography.

Med Phys 2021 Apr 11;48(4):1804-1814. Epub 2021 Mar 11.

Department of Radiation Oncology, Beaumont Health, Royal Oak, MI, USA.

Purpose: Computed tomography (CT)-derived ventilation methods compute respiratory induced volume changes as a surrogate for pulmonary ventilation. Currently, there are no known methods to derive perfusion information from noncontrast CT. We introduce a novel CT-Perfusion (CT-P) method for computing the magnitude mass changes apparent on dynamic noncontrast CT as a surrogate for pulmonary perfusion.

Methods: CT-Perfusion is based on a mass conservation model which describes the unknown mass change as a linear combination of spatially corresponding inhale and exhale HU estimated voxel densities. CT-P requires a deformable image registration (DIR) between the inhale/exhale lung CT pair, a preprocessing lung volume segmentation, and an estimate for the Jacobian of the DIR transformation. Given this information, the CT-P image, which provides the magnitude mass change for each voxel within the lung volume, is formulated as the solution to a constrained linear least squares problem defined by a series of subregional mean magnitude mass change measurements. Similar to previous robust CT-ventilation methods, the amount of uncertainty in a subregional sample mean measurement is related to measurement resolution and can be characterized with respect to a tolerance parameter . Spatial Spearman correlation between single photon emission CT perfusion (SPECT-P) and the proposed CT-P method was assessed in two patient cohorts via a parameter sweep of . The first cohort was comprised of 15 patients diagnosed with pulmonary embolism (PE) who had SPECT-P and 4DCT imaging acquired within 24 h of PE diagnosis. The second cohort was comprised of 15 nonsmall cell lung cancer patients who had SPECT-P and 4DCT images acquired prior to radiotherapy. For each test case, CT-P images were computed for 30 different uncertainty parameter values, uniformly sampled from the range [0.01, 0.125], and the Spearman correlation between the SPECT-P and the resulting CT-P images were computed.

Results: The median correlations between CT-P and SPECT-P taken over all 30 test cases ranged between 0.49 and 0.57 across the parameter sweep. For the optimal tolerance τ = 0.0385, the CT-P and SPECT-P correlations across all 30 test cases ranged between 0.02 and 0.82. A one-sample sign test was applied separately to the PE and lung cancer cohorts. A low Spearmen correlation of 15% was set as the null median value and two-sided alternative was tested. The PE patients showed a median correlation of 0.57 (IQR = 0.305). One-sample sign test was statistically significant with 96.5 % confidence interval: 0.20-0.63, P < 0.00001. Lung cancer patients had a median correlation of 0.57(IQR = 0.230). Again, a one-sample sign test for median was statistically significant with 96.5 percent confidence interval: 0.45-0.71, P < 0.00001.

Conclusion: CT-Perfusion is the first mechanistic model designed to quantify magnitude blood mass changes on noncontrast dynamic CT as a surrogate for pulmonary perfusion. While the reported correlations with SPECT-P are promising, further investigation is required to determine the optimal CT acquisition protocol and numerical method implementation for CT-P imaging.
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http://dx.doi.org/10.1002/mp.14792DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252085PMC
April 2021

An assessment of the correlation between robust CT-derived ventilation and pulmonary function test in a cohort with no respiratory symptoms.

Br J Radiol 2021 Feb 15;94(1118):20201218. Epub 2020 Dec 15.

Department of Radiation Oncology, Beaumont Health, OUWB School of Medicine, Auburn Hills, MI, USA.

Objective: To evaluate CT-ventilation imaging (CTVI) within a well-characterized, healthy cohort with no respiratory symptoms and examine the correlation between CTVI and concurrent pulmonary function test (PFT).

Methods: CT scans and PFTs from 77 Caucasian participants in the NORM dataset (clinicaltrials.gov NCT00848406) were analyzed. CTVI was generated using the robust Integrated Jacobian Formulation (IJF) method. IJF estimated total lung capacity (TLC) was computed from CTVI. Bias-adjusted Pearson's correlation between PFT and IJF-based TLC was computed.

Results: IJF- and PFT-measured TLC showed a good correlation for both males and females [males: 0.657, 95% CI (0.438-0.797); females: 0.667, 95% CI (0.416-0.817)]. When adjusting for age, height, smoking, and abnormal CT scan, correlation moderated [males: 0.432, 95% CI (0.129-0.655); females: 0.540, 95% CI (0.207-0.753)]. Visual inspection of CTVI revealed participants who had functional defects, despite the fact that all participant had normal high-resolution CT scan.

Conclusion: In this study, we demonstrate that IJF computed CTVI has good correlation with concurrent PFT in a well-validated patient cohort with no respiratory symptoms.

Advances In Knowledge: IJF-computed CTVI's overall numerical robustness and consistency with PFT support its potential as a method for providing spatiotemporal assessment of high and low function areas on volumetric non-contrast CT scan.
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http://dx.doi.org/10.1259/bjr.20201218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934322PMC
February 2021

Discrepant Reporting Style Preferences Between Clinicians and Radiologists.

Curr Probl Diagn Radiol 2021 Nov-Dec;50(6):779-783. Epub 2020 Nov 24.

Department of Diagnostic Radiology and Molecular Imaging, Beaumont Health, Royal Oak, MI.

Rationale And Objectives: To compare preferences in reporting styles between radiologists and clinicians in structured vs unstructured reporting styles in order to facilitate better communication.

Methods: An online survey was distributed to 5280 clinicians, radiologists, and physicians in training surveying respondent preference for three different reporting styles: expanded structured, minimized structured, and unstructured.

Results: A 7.5% response rate was achieved. Overall, the expanded structured reporting style was the most preferred (47%, 186/394). This contrasted with radiologists who preferred the unstructured reporting style (41%), whereas nonradiologists preferred the expanded structured reporting style (51%; P < 0.001). There was significance in emergency medicine physicians preferring the minimized structured reporting style (51%, 27/43), whereas all other specialties preferred the expanded structured report (49%, 168/341; P = 0.0038).

Discussion: There is a discrepant reporting style preference between clinicians and radiologists. A structured reporting style with expanded standard statements is preferred by most physicians. Radiologists could consider using a structured reporting style with minimized normal statements in the emergency room setting.
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http://dx.doi.org/10.1067/j.cpradiol.2020.10.014DOI Listing
October 2021

Emergence of overt myeloma in a patient with chronic lymphocytic leukemia on ibrutinib therapy.

Clin Case Rep 2020 Sep 15;8(9):1797-1801. Epub 2020 Jul 15.

Van Elslander Cancer Center Grosse Pointe Woods MI USA.

Ibrutinib is approved for chronic lymphocytic leukemia (CLL). However, its role in the treatment of multiple myeloma (MM) is not clear and is under investigation. We report a case of CLL that developed MM while on therapy with ibrutinib indicating that this drug may not be active against MM.
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http://dx.doi.org/10.1002/ccr3.3019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7495781PMC
September 2020

Pneumothorax Rate and Diagnostic Adequacy of Computed Tomography-guided Lung Nodule Biopsies Performed With 18 G Versus 20 G Needles: A Cross-Sectional Study.

J Thorac Imaging 2020 Jul;35(4):265-269

Diagnostic Radiology and Molecular Imaging.

Purpose: Conflicting data exist with regard to the effect of needle gauge on outcomes of computed tomography (CT)-guided lung nodule biopsies. The purpose of this study was to compare the complication and diagnostic adequacy rates between 2 needle sizes: 18 G and 20 G in CT-guided lung nodule biopsies.

Materials And Methods: This retrospective cohort study examined CT-guided lung biopsies performed between March 2014 and August 2016 with a total of 550 patients between the ages of 30 and 94. Biopsies were performed using an 18-G or a 20-G needle. Procedure-associated pneumothorax and other complication rates were compared between the 2 groups. Univariate and multiple logistic regression analyses were performed.

Results: There was no significant difference in pneumothorax rate between 18 G (n=125) versus 20 G (n=425) (rates: 25.6% vs. 28.7%; P=0.50; odds ratio [OR]=0.86; 95% confidence interval [CI]=0.54-1.35), chest tube insertion rate (4.8% vs. 5.6%; P=0.71; OR=0.84; 95% CI=0.34-2.11), or diagnostic adequacy (95% vs. 93%; P=0.36; OR=1.51; 95% CI=0.61-3.72). Multiple logistic regression analysis demonstrated emphysema along the biopsy path (OR=3.12; 95% CI=1.63-5.98) and nodule distance from the pleural surface ≥4 cm (OR=1.85; 95% CI=1.05-3.28) to be independent risk factors for pneumothorax.

Conclusion: No statistically significant difference in pneumothorax rate or diagnostic adequacy was found between 18-G versus 20-G core biopsy needles. Independent risk factors for pneumothorax include emphysema along the biopsy path and nodule distance from the pleural surface.
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http://dx.doi.org/10.1097/RTI.0000000000000481DOI Listing
July 2020

Cholecystohepatic Duct: A Biliary Duct Variant Resulting in Postcholecystectomy Bile Leak-Case Report and Review of Normal and Common Variant Biliary Anatomy.

Case Rep Radiol 2019 17;2019:6812793. Epub 2019 Jun 17.

Beaumont Hospital, Oakland University William Beaumont School of Medicine, Department of Diagnostic Radiology and Molecular Imaging, 3601 W 13 Mile Rd, Royal Oak, MI 48073, USA.

Although relatively infrequent, bile duct leaks are among the primary complications of hepatobiliary surgery and cholecystectomy given the large number of these operations performed annually around the world. Variant biliary anatomy increases the risk of surgical complications, especially if unrecognized on preoperative imaging or intraoperatively. Presented here is a case of a patient with an unrecognized cholecystohepatic duct at the time of surgery leading to bile leak after cholecystectomy. Numerous factors made for a technically difficult surgery with obscuration of the true anatomy, ultimately resulting in transection of the cholecystohepatic duct. Understanding normal and variant biliary anatomy will help prevent avoidable complications of hepatobiliary surgery.
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http://dx.doi.org/10.1155/2019/6812793DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6601483PMC
June 2019

Lymphomatoid Granulomatosis in a Patient with Chronic Lymphocytic Leukemia and Rapidly Progressing Peribronchovascular Pulmonary Infiltrates.

Case Rep Pulmonol 2019 21;2019:9870494. Epub 2019 Jan 21.

Wayne State University School of Medicine, Lymphoma Research Laboratory, 540 E Canfield Room No. 8829, Detroit, MI 48202, USA.

Lymphomatoid granulomatosis (LG) is an EBV-associated angiodestructive lymphoproliferative disease with multiorgan involvement that predominantly affects the lungs. We present a case of a 72-year-old man with a history of chronic lymphocytic leukemia who presented with upper respiratory symptoms and multiple erythematous skin papules. Chest CT showed ill-defined, irregular solid pulmonary nodules with peripheral ground-glass opacities in a peribronchovascular distribution. The differential for this pattern of lung disease is vast which includes but is not limited to infection, vasculitis, sarcoidosis, lymphoma, and Kaposi sarcoma. Subsequent PET/CT showed rapid progression of lung opacities and marked FDG uptake of pulmonary opacities and skin nodules, which raised the question of Richter syndrome. Wedge biopsy under video-assisted thoracoscopic surgery was performed. Pathology showed an extensive lymphoid infiltrate involving lymphatic and bronchovascular bundles and consisting of a mixture of large lymphocytes and inflammatory cells. Special stains showed that the large lymphocytes expressed B-cell markers and EBV virus. Overall, the findings were consistent with LG.
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http://dx.doi.org/10.1155/2019/9870494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6363242PMC
January 2019

Mass-Like Ground-Glass Opacities in Sarcoidosis: A Rare Presentation Not Previously Described.

Case Rep Radiol 2018 14;2018:5686915. Epub 2018 Aug 14.

Beaumont Hospital, Oakland University William Beaumont School of Medicine, Department of Diagnostic Radiology and Molecular Imaging, 3601 W 13 Mile Rd, Royal Oak, MI 48073, USA.

Various typical and atypical imaging findings for pulmonary sarcoidosis have been described in the literature. Ground-glass opacities are one of the atypical manifestations, reported as diffuse or patchy ill-defined opacities frequently associated with additional findings and interstitial nodules. We performed a literature review to determine if our case had previously been described. The literature describes cases of mass-like consolidations, but there are no reports of mass-like ground-glass opacities. The appearance of the ground-glass opacities in our case is unique, appearing as discrete well-defined mass-like ground-glass opacities in a peribronchovascular distribution without additional parenchymal findings typically seen in sarcoidosis.
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http://dx.doi.org/10.1155/2018/5686915DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6112079PMC
August 2018

A practical guide to managing CT findings in the breast.

Clin Imaging 2020 Apr 24;60(2):274-282. Epub 2018 Jul 24.

Beaumont Health, Oakland University William Beaumont School of Medicine, Department of Diagnostic Radiology and Molecular Imaging, 3601 W 13 Mile Rd, Royal Oak, MI 48073, United States of America.

While it is well accepted that CT is not an optimal imaging study to evaluate the breasts, findings on chest CT may be the first indication of an occult malignancy. The nonspecific appearance of breast findings and the lack of consensus guidelines for managing incidental breast findings may dissuade radiologists from thoroughly evaluating the breasts on CT. We review commonly encountered breast findings on CT and present an algorithm for managing incidentally detected breast findings.
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http://dx.doi.org/10.1016/j.clinimag.2018.07.009DOI Listing
April 2020

Aggressive Renal Angiomyolipoma in a Patient With Tuberous Sclerosis Resulting in Pulmonary Tumor Embolus and Pulmonary Infarction.

Urology 2018 Sep 7;119:e1-e2. Epub 2018 Jun 7.

Beaumont Health, Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, 3601 W 13 Mile Rd, Royal Oak, MI 48073.

Renal angiomyolipoma (AML) is the most commonly encountered mesenchymal tumor of the kidney which can present spontaneously or in association with tuberous sclerosis complex. Rarely, renal AMLs may demonstrate aggressive features such as renal vein invasion. This common entity and its uncommon complications are diagnosed based on physical examination and computed tomography results. Here we report imaging findings of a renal AML with renal vein and inferior vena cava invasion resulting in pulmonary tumor embolus and pulmonary infarction.
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http://dx.doi.org/10.1016/j.urology.2018.05.022DOI Listing
September 2018

Intravascular Large B-Cell Lymphoma Presenting with Diffuse Gallbladder Wall Thickening: A Case Report and Literature Review.

Case Rep Radiol 2018 22;2018:2494207. Epub 2018 Apr 22.

Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Beaumont Health, Royal Oak, MI, USA.

Intravascular large B-cell lymphoma is a rare subtype of extranodal diffuse B-cell lymphoma characterized by proliferation of neoplastic cells within the lumen of small and medium sized vessels. Clinical and imaging findings are nebulous as the intravascular subtype of lymphoma can involve a multitude of organs. Involvement of the gallbladder is extremely uncommon, and imaging findings can be easily confused for more prevalent pathologies. We report a case of intravascular large B-cell lymphoma in an 83-year-old male and review clinical presentation and imaging findings on CT, ultrasound, hepatobiliary iminodiacetic acid (HIDA) scan, and MRI. It is important for the radiologist to know about this disease as the imaging findings are atypical of other types of lymphoma, and this may lead to a delay in diagnosis and treatment.
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http://dx.doi.org/10.1155/2018/2494207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937617PMC
April 2018

Outcomes of ultrasound guided renal mass biopsies.

J Ultrasound 2018 Jun 25;21(2):99-104. Epub 2018 Apr 25.

Beaumont Health Research Institute, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, USA.

Purpose: The purpose of this study was to evaluate the rate of nondiagnostic ultrasound-guided renal mass biopsies (RMBs) at our institution and to determine what patient, procedural, and focal renal mass (FRM) factors were associated with nondiagnostic ultrasound-guided RMBs.

Methods: Eighty-two ultrasound-guided renal mass biopsies performed between January 2014 and October 2016 were included in our study. Biopsy outcomes (diagnostic vs. nondiagnostic) and patient, procedural, and FRM characteristics were retrospectively reviewed and recorded. Univariate statistical analyses were performed to identify biopsy characteristics that were indicative of nondiagnostic biopsy.

Results: Ultrasound-guided RMBs were diagnostic in 70 out of 82 cases (85%) and non-diagnostic in 12 cases (15%). Among the diagnostic biopsies, 54 (77%) were malignant cases, 94% of which were renal cell carcinoma (RCC). Of the 12 nondiagnostic cases, the final diagnosis was RCC in 4 cases and angiomyolipoma in one case; seven of the nondiagnostic cases were lost to follow-up. A weak association (p = 0.04) was found between the number of needle passes and the biopsy outcome. None of the remaining collected RMB characteristics showed a significant correlation with a diagnostic or nondiagnostic RMB. Six patients (7%) experienced complications.

Conclusion: Ultrasound-guided renal mass biopsy is a safe and effective method for the diagnosis of renal masses with a low rate of nondiagnostic outcomes. A nondiagnostic biopsy should not be treated as a surrogate for a diagnosis since a significant number of patients with nondiagnostic biopsies have subsequently been shown to have renal malignancies. Repeat biopsy should be considered in such cases.
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http://dx.doi.org/10.1007/s40477-018-0299-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5972109PMC
June 2018

Perforated Meckel's Diverticulitis.

J Gastrointest Surg 2017 Dec 25;21(12):2126-2128. Epub 2017 Jul 25.

Diagnostic Radiology and Molecular Imaging, Beaumont Health, Oakland University William Beaumont School of Medicine, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, USA.

A Meckel's diverticulum is a vestigial remnant present in approximately 2% of the population. Fewer than 10% of patients with a Meckel's diverticulum develop clinical complications, and such findings are exceedingly rare in the geriatric population. We present a case of perforated Meckel's diverticulitis with a fistulous tract involving the anterior abdominal wall in an 85-year-old male.
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http://dx.doi.org/10.1007/s11605-017-3511-1DOI Listing
December 2017

Radiologic Assessment of Native Renal Vasculature: A Multimodality Review.

Radiographics 2017 Jan-Feb;37(1):136-156

From the Department of Diagnostic Radiology and Molecular Imaging (S.A., M.S., S.Z.H.J.) and Department of Urology (S.M.A.J.), Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, 3601 W 13 Mile Rd, Royal Oak, MI 48073.

A wide range of clinically important anatomic variants and pathologic conditions may affect the renal vasculature, and radiologists have a pivotal role in the diagnosis and management of these processes. Because many of these entities may not be suspected clinically, renal artery and vein assessment is an essential application of all imaging modalities. An understanding of the normal vascular anatomy is essential for recognizing clinically important anatomic variants. An understanding of the protocols used to optimize imaging modalities also is necessary. Renal artery stenosis is the most common cause of secondary hypertension and is diagnosed by using both direct ultrasonographic (US) findings at the site of stenosis and indirect US findings distal to the stenosis. Fibromuscular dysplasia, while not as common as atherosclerosis, remains an important cause of renal artery hypertension, especially among young female individuals. Fibromuscular dysplasia also predisposes individuals to renal artery aneurysms and dissection. Although most renal artery dissections are extensions of aortic dissections, on rare occasion they occur in isolation. Renal artery aneurysms often are not suspected clinically before imaging, but they can lead to catastrophic outcomes if they are overlooked. Unlike true aneurysms, pseudoaneurysms are typically iatrogenic or posttraumatic. However, multiple small pseudoaneurysms may be seen with underlying vasculitis. Arteriovenous fistulas also are commonly iatrogenic, whereas arteriovenous malformations are developmental (ie, congenital). Both of these conditions involve a prominent feeding artery and draining vein; however, arteriovenous malformations contain a nidus of tangled vessels. Nutcracker syndrome should be suspected when there is distention of the left renal vein with abrupt narrowing as it passes posterior to the superior mesenteric artery. Filling defects in a renal vein can be due to a bland or tumor thrombus. A tumor thrombus is most commonly an extension of renal cell carcinoma. When an enhancing mass is located predominantly within a renal vein, leiomyosarcoma of the renal vein should be suspected. RSNA, 2017.
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http://dx.doi.org/10.1148/rg.2017160060DOI Listing
September 2017

Multidetector CT enterography of focal small bowel lesions: a radiological-pathological correlation.

Abdom Radiol (NY) 2017 05;42(5):1319-1341

Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, USA.

Focal small bowel lesions present a diagnostic challenge for both the radiologist and gastroenterologist. Both the detection and characterization of small bowel masses have greatly improved with the advent of multidetector CT enterography (MD-CTE). As such, MD-CTE is increasingly utilized in the workup of occult gastrointestinal bleeding. In this article, we review the spectrum of focal small bowel masses with pathologic correlation. Adenocarcinoma, the most common primary small bowel malignancy, presents as a focal irregular mass occasionally with circumferential extension leading to obstruction. Small bowel carcinoid tumors most commonly arise in the ileum and are characterized by avid enhancement and marked desmoplastic response of metastatic lesions. Aneurysmal dilatation of small bowel is pathognomonic for lymphoma and secondary findings of lymphadenopathy and splenomegaly should be sought. Benign small bowel masses such as leiomyoma and adenoma may be responsible for occult gastrointestinal bleeding. However, primary vascular lesions of the small bowel remain the most common cause for occult small bowel gastrointestinal bleeding. The arterial phase of contrast obtained with CTE aids in recognition of the vascular nature of these lesions. Systemic conditions such as Peutz-Jeghers syndrome and Crohn's disease may be suggested by the presence of multiple small bowel lesions. Lastly, potential pitfalls such as ingested material should be considered when faced with focal small bowel masses.
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http://dx.doi.org/10.1007/s00261-016-1015-1DOI Listing
May 2017

MRI for appendicitis in pregnancy: is seeing believing? clinical outcomes in cases of appendix nonvisualization.

Abdom Radiol (NY) 2016 12;41(12):2455-2459

Beaumont Health, Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Royal Oak, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, USA.

Purpose: The primary objective of this study was to determine the clinical outcomes in cases of appendix nonvisualization with MRI in pregnant patients with suspected appendicitis and the implications of appendix nonvisualization for excluding appendicitis.

Methods: Fifty-eight pregnant patients with suspected appendicitis evaluated with MRI at three centers from a single institution were retrospectively reviewed by three radiologists with varying levels of abdominal imaging experience. All scans were performed on a 1.5-Tesla Siemens unit. Cases were evaluated for diagnostic quality, visualization of the appendix, presence of appendicitis, and alternate diagnoses. Clinical outcomes were gathered from the electronic medical record.

Results: Of the 58 patients who underwent MRI for suspected appendicitis, 50 cases were considered adequate diagnostic quality by all three radiologists. The rate of appendix visualization among the three radiologists ranged from 60 to 76% (p = 0.44). The appendix was nonvisualized by at least one of the three radiologists in 25 cases (50%). Of these, none had a final diagnosis of appendicitis including one patient who underwent appendectomy. MRI suggested an alternate diagnosis in 6 (24%) patients with appendix nonvisualization. For the three reviewers, the agreement level on whether or not the appendix was visualized on the MRI had a Light's kappa value of 0.526, indicating a "moderate" level of agreement (p value < 0.01).

Conclusion: Despite only moderate level of interobserver agreement for appendix visualization, appendix nonvisualization on MRI in pregnant patients with suspected appendicitis confers a significant reduction in the risk of appendicitis compared to all comers as long as the study is adequate diagnostic quality and there are no secondary signs of appendicitis present.
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http://dx.doi.org/10.1007/s00261-016-0864-yDOI Listing
December 2016

Evaluation of a Case of Inflammatory Breast Cancer with 18F-FDG PET/CT.

J Nucl Med Technol 2015 Dec 19;43(4):289-91. Epub 2015 Nov 19.

Department of Diagnostic Radiology and Molecular Imaging, William Beaumont School of Medicine, Oakland University, Royal Oak, Michigan; and.

Inflammatory breast cancer is a rare and aggressive form of cancer characterized by dermal lymphatic invasion and tumor embolization resulting in erythema and edema. In many cases, by the time of diagnosis there is already distant metastasis. Mammography, sonography, CT, and MRI are usually performed for initial staging; however, PET/CT can also be used for initial staging as it offers additional diagnostic information.
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http://dx.doi.org/10.2967/jnmt.114.148494DOI Listing
December 2015

Hepatobiliary Iminodiacetic Acid Scanning Detects High-Grade Biliary Obstruction Secondary to IgG4-Related Sclerosing Cholangitis.

J Nucl Med Technol 2015 Dec 9;43(4):297-8. Epub 2015 Apr 9.

Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Beaumont Health System, Royal Oak, Michigan.

In this report, we present a case of high-grade biliary obstruction discovered on hepatobiliary scintigraphy secondary to IgG4-related sclerosing cholangitis with concomitant autoimmune pancreatitis, a recently described entity that is gaining recognition in the radiology literature. To our knowledge, the scintigraphic findings have yet to be described in the literature. We present the hepatobiliary scintigraphic findings and their correlation to findings on endoscopic retrograde cholangiopancreatography, CT, and MR cholangiopancreatography, with posttreatment follow-up imaging. IgG4-related sclerosing cholangitis is a rare yet important diagnostic consideration when high-grade obstruction is seen on hepatobiliary iminodiacetic acid scanning. We discuss the differential diagnosis of high-grade biliary obstruction seen on hepatobiliary iminodiacetic acid scanning.
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http://dx.doi.org/10.2967/jnmt.115.154708DOI Listing
December 2015

Liver uptake on bone scanning: a diagnostic algorithm.

J Nucl Med Technol 2015 Jun 23;43(2):135-6. Epub 2014 Dec 23.

Beaumont Health System, Royal Oak, Michigan.

In this report, we present a case of liver uptake seen on a bone scan that was due to diffuse metastatic disease from breast carcinoma. We discuss possible etiologies for the uptake and offer an algorithm to narrow the differential diagnosis.
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http://dx.doi.org/10.2967/jnmt.114.146449DOI Listing
June 2015

The Appearance of Maffucci Syndrome on 18F-FDG PET/CT.

J Nucl Med Technol 2015 Jun 23;43(2):131-2. Epub 2014 Dec 23.

Department of Diagnostic Radiology and Molecular Imaging, William Beaumont School of Medicine, Oakland University, Royal Oak, Michigan.

Maffucci syndrome is a rare condition with multiple enchondromas and hemangiomas. Fewer than 200 cases have been reported in the United States. There is a high predilection for neoplastic changes, and PET/CT has an important role in detecting these changes.
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http://dx.doi.org/10.2967/jnmt.114.146480DOI Listing
June 2015
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