104 results on '"David J. Grand"'
Search Results
2. Gastrointestinal Bleeding at CT Angiography and CT Enterography: Imaging Atlas and Glossary of Terms
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Don C. Yoo, Ashish Khandelwal, Seong Ho Park, Farnoosh Sokhandon, David J. Grand, Brian C. Allen, Olga R. Brook, Michael L. Wells, Avneesh Gupta, Jorge A. Soto, Lisa L. Strate, Alvaro Huete, David H. Bruining, Jeff L. Fidler, Flavius F. Guglielmo, Mark Anderson, Vijay Ramalingam, Martin L. Gunn, and Michael S. Gee
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medicine.medical_specialty ,Gastrointestinal bleeding ,medicine.diagnostic_test ,Glossary ,CT enterography ,Computed Tomography Angiography ,Gastrointestinal Diseases ,business.industry ,Angiography ,MEDLINE ,Multidisciplinary Collaboration ,medicine.disease ,Endoscopy, Gastrointestinal ,medicine.anatomical_structure ,Atlas (anatomy) ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Radiology ,Gastrointestinal Hemorrhage ,Tomography, X-Ray Computed ,business - Abstract
Gastrointestinal (GI) bleeding is a common potentially life-threatening medical condition frequently requiring multidisciplinary collaboration to reach the proper diagnosis and guide management. GI bleeding can be
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- 2021
3. Management of gastrointestinal bleeding: Society of Abdominal Radiology (SAR) Institutional Survey
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Lisa L. Strate, Vijay Ramalingam, Mark Anderson, Flavius F. Guglielmo, Jorge A. Soto, Alvaro Huete, Brian C. Allen, Olga R. Brook, Michael S. Gee, Don C. Yoo, David J. Grand, Jeff L. Fidler, Seong Ho Park, Michael L. Wells, Ashish Khandalwal, Martin L. Gunn, Farnoosh Sokhandon, Avneesh Gupta, and David H. Bruining
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Gastrointestinal bleeding ,medicine.medical_specialty ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,CT enterography ,business.industry ,Urology ,Gastroenterology ,Colonoscopy ,Hepatology ,medicine.disease ,Occult ,law.invention ,Capsule endoscopy ,law ,Internal medicine ,Angiography ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,business ,Computed tomography angiography - Abstract
Despite guidelines developed to standardize the diagnosis and management of gastrointestinal (GI) bleeding, significant variability remains in recommendations and practice. The purpose of this survey was to obtain information on practice patterns for the evaluation of overt lower GI bleeding (LGIB) and suspected small bowel bleeding. A 34-question electronic survey was sent to all Society of Abdominal Radiology (SAR) members. Responses were received from 52 unique institutions (40 from the United States). Only 26 (50%) utilize LGIB management guidelines. 32 (62%) use CT angiography (CTA) for initial evaluation in unstable patients. In stable patients with suspected LGIB, CTA is the preferred initial exam at 21 (40%) versus colonoscopy at 24 (46%) institutions. CTA use increases after hours for both unstable (n = 32 vs. 35, 62% vs. 67%) and stable patients (n = 21 vs. 27, 40% vs 52%). CTA is required before conventional angiography for stable (n = 36, 69%) and unstable (n = 15, 29%) patients. 38 (73%) institutions obtain two post-contrast phases for CTA. 49 (94%) institutions perform CT enterography (CTE) for occult small bowel bleeding with capsule endoscopy (n = 26, 50%) and CTE (n = 21, 40%) being the initial test performed. 35 (67%) institutions perform multiphase CTE for occult small bowel bleeding. In summary, stable and unstable patients with overt lower GI are frequently imaged with CTA, while CTE is frequently performed for suspected occult small bowel bleeding.
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- 2021
4. Review of CT-guided trans-osseous biopsies
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Andrew S. Mark, Adib R. Karam, and David J. Grand
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medicine.medical_specialty ,Percutaneous ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Urology ,Gastroenterology ,Percutaneous techniques ,Hepatology ,musculoskeletal system ,030218 nuclear medicine & medical imaging ,Mediastinoscopy ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Internal medicine ,Histological diagnosis ,Biopsy ,medicine ,Abdomen ,Radiology, Nuclear Medicine and imaging ,Radiology ,business ,Pelvis - Abstract
Percutaneous image-guided biopsy is an invaluable technique in the management of a myriad of different conditions; however, percutaneous access to some targets remains challenging. Trans-osseous biopsy provides safe, high-yield access to many challenging lesions in the chest, abdomen, and pelvis which might otherwise require more invasive procedures, such as mediastinoscopy or surgery to establish a histological diagnosis. Additionally, trans-osseous biopsy is well tolerated and may reduce the risk of injury to intervening vital structures as compared to other percutaneous techniques. In this article we review the indications, technical challenges, alternative techniques, and potential complications of trans-sternal, trans-costal, trans-scapular, trans-vertebral, trans-iliac, and trans-sacral biopsies.
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- 2021
5. MRE Evaluation of Intestinal Inflammation
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David J. Grand, Jordi Rimola, and Parakkal Deepak
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Inflammation ,Pathology ,medicine.medical_specialty ,medicine.diagnostic_test ,Gastrointestinal Diseases ,business.industry ,Crohn disease ,Magnetic resonance imaging ,Magnetic resonance enterography ,Magnetic Resonance Imaging ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Intestinal inflammation ,medicine ,Quantitative assessment ,Humans ,Radiology, Nuclear Medicine and imaging ,medicine.symptom ,business ,Active inflammation ,030217 neurology & neurosurgery ,Bowel wall - Abstract
Magnetic resonance enterography (MRE) is a powerful tool for evaluation and management of patients with Crohn disease. Changes of active inflammation of the small bowel can reliably and reproducibly be detected and monitored. Findings indicative of active inflammation include bowel wall thickening, intramural edema and mural hyperenhancement. These changes are most commonly reported qualitatively; however, quantitative indices have also been developed and validated to measure and monitor inflammation both for clinical care and research purposes. This article describes the essential findings of active inflammation on MRE as well as the fundamentals of both qualitative and quantitative assessment and reporting.
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- 2021
6. Small Bowel Crohn Disease at CT and MR Enterography: Imaging Atlas and Glossary of Terms
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Jonathan R. Dillman, Sudha A. Anupindi, Bachir Taouli, Michael S. Gee, Kassa Darge, Manjil Chatterji, Chenchan Huang, Mark E. Baker, Flavius F. Guglielmo, Stuart A. Taylor, Jorge A. Soto, Jordi Rimola, Seong Ho Park, Joel G. Fletcher, Namita S. Gandhi, Tracy A. Jaffe, Jeff L. Fidler, David H. Bruining, Mahmoud M. Al-Hawary, Joseph R. Grajo, and David J. Grand
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medicine.medical_specialty ,CT enterography ,medicine.diagnostic_test ,Glossary ,business.industry ,Crohn disease ,food and beverages ,Magnetic resonance imaging ,Magnetic Resonance Imaging ,digestive system diseases ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Crohn Disease ,X ray computed ,Terminology as Topic ,030220 oncology & carcinogenesis ,MR Enterography ,Intestine, Small ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Radiology ,Tomography, X-Ray Computed ,business - Abstract
Representatives from the Society of Abdominal Radiology Crohn's Disease-Focused Panel, the Society for Pediatric Radiology, the American Gastroenterological Association, and other international experts recently reported consensus recommendations for standardized nomenclature for the interpretation and reporting of CT enterography and MR enterography findings of small bowel Crohn disease. The consensus recommendations included CT enterography and MR enterography bowel wall findings that are associated with Crohn disease, findings that occur with penetrating Crohn disease, and changes that occur in the mesentery related to Crohn disease. Also included were recommended radiology report impression statements that summarize the findings of small bowel Crohn disease at CT enterography and MR enterography. This article, authored by the Society of Abdominal Radiology Crohn's Disease-Focused Panel, illustrates the imaging findings and recommended radiology report impression statements described in the consensus recommendations with examples of CT enterography and MR enterography images. Additional interpretation guidelines for reporting CT enterography and MR enterography examinations are also presented. The recommended standardized nomenclature can be used to generate radiology report dictations that will help guide medical and surgical management for patients with small bowel Crohn disease.
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- 2020
7. Management of gastrointestinal bleeding: Society of Abdominal Radiology (SAR) Institutional Survey
- Author
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Jeff L, Fidler, Flavius F, Guglielmo, Olga R, Brook, Lisa L, Strate, David H, Bruining, Avneesh, Gupta, Brian C, Allen, Mark A, Anderson, Michael L, Wells, Vijay, Ramalingam, Martin L, Gunn, David J, Grand, Michael S, Gee, Alvaro, Huete, Ashish, Khandalwal, Farnoosh, Sokhandon, Seong Ho, Park, Don C, Yoo, and Jorge A, Soto
- Subjects
Radiography, Abdominal ,Humans ,Gastrointestinal Hemorrhage ,Radiology ,Tomography, X-Ray Computed ,Capsule Endoscopy - Abstract
Despite guidelines developed to standardize the diagnosis and management of gastrointestinal (GI) bleeding, significant variability remains in recommendations and practice. The purpose of this survey was to obtain information on practice patterns for the evaluation of overt lower GI bleeding (LGIB) and suspected small bowel bleeding. A 34-question electronic survey was sent to all Society of Abdominal Radiology (SAR) members. Responses were received from 52 unique institutions (40 from the United States). Only 26 (50%) utilize LGIB management guidelines. 32 (62%) use CT angiography (CTA) for initial evaluation in unstable patients. In stable patients with suspected LGIB, CTA is the preferred initial exam at 21 (40%) versus colonoscopy at 24 (46%) institutions. CTA use increases after hours for both unstable (n = 32 vs. 35, 62% vs. 67%) and stable patients (n = 21 vs. 27, 40% vs 52%). CTA is required before conventional angiography for stable (n = 36, 69%) and unstable (n = 15, 29%) patients. 38 (73%) institutions obtain two post-contrast phases for CTA. 49 (94%) institutions perform CT enterography (CTE) for occult small bowel bleeding with capsule endoscopy (n = 26, 50%) and CTE (n = 21, 40%) being the initial test performed. 35 (67%) institutions perform multiphase CTE for occult small bowel bleeding. In summary, stable and unstable patients with overt lower GI are frequently imaged with CTA, while CTE is frequently performed for suspected occult small bowel bleeding.
- Published
- 2021
8. Image-Guided Cholecystostomy Tube Placement: Short- and Long-Term Outcomes of Transhepatic Versus Transperitoneal Placement
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David J. Grand, Michael D. Beland, Lakir Patel, and Sun H Ahn
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Male ,medicine.medical_specialty ,Transperitoneal approach ,medicine.medical_treatment ,Radiography, Interventional ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Cholecystitis ,medicine ,Long term outcomes ,Humans ,Percutaneous cholecystostomy ,Radiology, Nuclear Medicine and imaging ,Cholecystostomy ,Ultrasonography, Interventional ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Gallbladder ,General Medicine ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Fluoroscopy ,030220 oncology & carcinogenesis ,Tube placement ,Female ,business - Abstract
Image-guided percutaneous cholecystostomy may be performed by a transhepatic or transperitoneal approach. We compared the short- and long-term outcomes of percutaneous cholecystostomy related to route of catheter placement.A retrospective observational study of image-guided percutaneous cholecystostomy was performed from 2004 to 2016. A search of the hospital's radiology information service was performed using the keywords "percutaneous cholecystostomy," "gallbladder drain," and "cholecystostomy tube" and the relevant Current Procedural Terminology codes. All search results were reviewed to identify the cohort of 373 patients who underwent initial percutaneous cholecystostomy catheter placement. Imaging was reviewed to determine the method and route of percutaneous cholecystostomy and complications. A chart review was performed to determine clinical outcomes. Differences were examined using a generalized linear model assuming a binary distribution and logit function.Percutaneous cholecystostomy catheter placement was performed using ultrasound guidance alone in 229 patients, ultrasound access with fluoroscopic guidance in 129 patients, CT guidance in 14 patients, and fluoroscopic guidance in one patient. The trocar technique was used for 183 patients, and the Seldinger technique was used for 190 patients. Two hundred eighteen percutaneous cholecystostomy catheters were placed via the transhepatic route, and 153 were placed via the transperitoneal route. The most common catheter sizes used were 8.5 French (n = 234) and 10 French (n = 124). No significant differences were observed between transperitoneal and transhepatic placement with regard to the frequency of pain, clogging, skin infection, bleeding, biloma, cholangitis, leakage, abscess, unplanned catheter removal, or need for replacement (p0.05).No evidence of a difference in outcomes was observed for transhepatic cholecystostomy tube placement over transperitoneal placement. The route that appears safer and less technically challenging should therefore be chosen.
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- 2019
9. Analysis of Abdominal Radiology fellowship website content and comprehensiveness
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Jack H. Ruddell, David J. Grand, Ankush Bajaj, Adam E.M. Eltorai, and Zachary Hartley-Blossom
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Radiography, Abdominal ,medicine.medical_specialty ,Urology ,education ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Salary ,Fellowships and Scholarships ,Social information ,Curriculum ,health care economics and organizations ,Accreditation ,Internet ,Radiological and Ultrasound Technology ,business.industry ,Gastroenterology ,Program director ,Education, Medical, Graduate ,030220 oncology & carcinogenesis ,Radiology ,business - Abstract
Fellowship programs’ online content plays a key role in prospective Abdominal Radiology applicants’ evaluation of programs. The purpose of this study is to examine the online accessibility of Abdominal Radiology fellowships, the comprehensiveness of the program websites’ content, and evaluate whether specific program characteristics are associated with differentiated website comprehensiveness. A list of 67 Abdominal Radiology fellowship programs was obtained from the Society of Abdominal Radiology (SAR) website. Each of the 65 publicly-available fellowship websites was scored for the presence of 19 binary variables related to the program’s attributes and curriculum to assess informational comprehensiveness. Comprehensiveness scores were compared by program characteristics (accreditation status, region, and size) using Kruskal–Wallis and two-tailed t tests. Mean comprehensiveness score of Abdominal Radiology fellowship websites as measured by online criteria met was 52.6% (10.0 ± 3.0/19). Application requirements and information, rotation scheduling, and program director contact were found on more than 87.5% of the 65 websites, whereas salary and benefits, social information, and alumni were listed on fewer than 33.8% (22/65) of websites. Program accreditation status, region, and size were not associated with difference in mean comprehensiveness scores. There is a discrepancy between information commonly sought by prospective Abdominal Radiology fellowship applicants and what is available on fellowship program websites. Programs and applicants alike may benefit from programs strengthening their online material.
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- 2018
10. CT-guided biopsy of pulmonary nodules ≤10 mm: Diagnostic yield based on nodules' lobar and segmental distribution
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Lillian Dominguez-Konicki, Michael Furman, David J. Grand, and Adib R. Karam
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Adult ,Image-Guided Biopsy ,Male ,Percutaneous ,Lung Neoplasms ,Lung biopsy ,030218 nuclear medicine & medical imaging ,Surgical pathology ,03 medical and health sciences ,0302 clinical medicine ,Biopsy ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Lung cancer ,Lung ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Benignity ,Biopsy, Needle ,Nodule (medicine) ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Multiple Pulmonary Nodules ,Female ,medicine.symptom ,Nuclear medicine ,business ,Tomography, X-Ray Computed ,Precancerous Conditions - Abstract
Purpose The aim of our study is to evaluate the diagnostic performance of CT-guided biopsy of lung nodules ≤10 mm based on their lobar and segmental location. Materials and methods This was a retrospective study performed on 193 CT-guided percutaneous transthoracic needle biopsies of lung nodules ≤10 mm in greatest dimension, between January 1, 2013 and April 30, 2019. Biopsies were classified as either diagnostic or non-diagnostic based on final cytology and surgical pathology reports. Diagnostic results were those that met parameters for malignancy or a specific benign diagnosis, whereas atypical cells, non-specific benignity, or insufficient specimen were considered non-diagnostic. Results A total of 1577 CT-guided percutaneous transthoracic needle biopsies were reviewed. Of these, 193 nodules (12.24%) measured ≤10 mm and were selected for further analysis. Of the 193 biopsies, 138 yielded diagnostic results while 56 yielded nondiagnostic results (71% vs 29%, respectively). When analyzed by nodule location, the superior segments of the lower lobes boasted the highest diagnostic yield compared to nodules located in the basal segments of the lower lobes which had the lowest diagnostic yield (84.2% vs 64.7%, respectively). Nodules in the upper lobes and in the middle lobes had a diagnostic yield of 70% and 66.7%, respectively. Conclusion The diagnostic performance of CT-guided biopsy of lung nodules ≤10 mm in diameter may be affected by lobar and segmental location. While the overall performance was good (diagnostic yield of 71%), the yield varied nearly 20% depending on location.
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- 2020
11. Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn’s Disease
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Jorge A. Soto, Michael S. Gee, Daniel J. Podberesky, Stuart A. Taylor, Sudha A. Anupindi, Joel F. Platt, Joel G. Fletcher, Amy K. Hara, Edward V. Loftus, Tracy A. Jaffe, Mahmoud M. Al-Hawary, Jordi Rimola, Cary G. Sauer, David H. Bruining, Alec J. Megibow, Kassa Darge, Mark E. Baker, Scott A. Strong, Ellen M. Zimmermann, Seong Ho Park, Falvius Guglielmo, David J. Grand, William J. Sandborn, Jonathan R. Dillman, Dushyant V. Sahani, Jeff L. Fidler, Dean D. T. Maglinte, and David M. Einstein
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medicine.medical_specialty ,Consensus ,Computed tomography ,Disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Crohn Disease ,Predictive Value of Tests ,Intestine, Small ,medicine ,Humans ,In patient ,Crohn's disease ,Evidence-Based Medicine ,Hepatology ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Reproducibility of Results ,Disease monitoring ,Prognosis ,medicine.disease ,Magnetic resonance enterography ,Magnetic Resonance Imaging ,digestive system diseases ,Pediatric Radiology ,Predictive value of tests ,030211 gastroenterology & hepatology ,Radiology ,Tomography, X-Ray Computed ,business - Abstract
Computed tomography and magnetic resonance enterography have become routine small bowel imaging tests to evaluate patients with established or suspected Crohn's disease, but the interpretation and use of these imaging modalities can vary widely. A shared understanding of imaging findings, nomenclature, and utilization will improve the utility of these imaging techniques to guide treatment options, as well as assess for treatment response and complications. Representatives from the Society of Abdominal Radiology Crohn's Disease-Focused Panel, the Society of Pediatric Radiology, the American Gastroenterological Association, and other experts, systematically evaluated evidence for imaging findings associated with small bowel Crohn's disease enteric inflammation and established recommendations for the evaluation, interpretation, and use of computed tomography and magnetic resonance enterography in small bowel Crohn's disease. This work makes recommendations for imaging findings that indicate small bowel Crohn's disease, how inflammatory small bowel Crohn's disease and its complications should be described, elucidates potential extra-enteric findings that may be seen at imaging, and recommends that cross-sectional enterography should be performed at diagnosis of Crohn's disease and considered for small bowel Crohn's disease monitoring paradigms. A useful morphologic construct describing how imaging findings evolve with disease progression and response is described, and standard impressions for radiologic reports that convey meaningful information to gastroenterologists and surgeons are presented.
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- 2018
12. 593 Impact of Computed Tomography Angiography-First Approach on Length of Stay and Time to Definitive Therapy in Patients Presenting for Lower GI Bleed
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Steven E. Reinert, Eric Vecchio, Joao Filipe G. Monteiro, Chiazotam Ekekezie, Valerie Carter, Erick A. Argueta, Lanre Jimoh, Harlan Rich, and David J. Grand
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medicine.medical_specialty ,Hepatology ,medicine.diagnostic_test ,business.industry ,Definitive Therapy ,Gastroenterology ,medicine ,In patient ,Radiology ,Bleed ,business ,Computed tomography angiography - Published
- 2019
13. 'Heavy hearted havoc' – A case series of petrified myocardium
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Michael S. Furman, Michael K. Atalay, Saurabh Agarwal, Terrance T. Healey, and David J. Grand
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Adult ,Male ,business.industry ,Myocardium ,Calcinosis ,Middle Aged ,Ancient history ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Child, Preschool ,Humans ,Medicine ,Female ,Radiology, Nuclear Medicine and imaging ,030216 legal & forensic medicine ,030212 general & internal medicine ,Cardiomyopathies ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Published
- 2018
14. CT-guided percutaneous lung biopsy: Correlation between diagnostic yield, lung lesion size, and lobar distribution
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Matthew Wilson, Grayson L. Baird, David J. Grand, Michael Furman, and Adib R. Karam
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Lung ,Percutaneous ,medicine.diagnostic_test ,business.industry ,Benignity ,General Medicine ,Lung biopsy ,medicine.disease ,Malignancy ,Lesion ,medicine.anatomical_structure ,Biopsy ,Medicine ,medicine.symptom ,business ,Lung cancer ,Nuclear medicine - Abstract
Objectives: The aim of this retrospective study was to investigate the relationship between lung lesion lobar distribution, lesion size, and lung biopsy diagnostic yield. Material and Methods: This retrospective study was performed between January 1, 2013, and April 30, 2019, on CT-guided percutaneous transthoracic needle biopsies of 1522 lung lesions, median size 3.65 cm (range: 0.5– 15.5 cm). Lung lesions were localized as follows: upper lobes, right middle lobe and lingual, lower lobes superior segments, and lower lobes basal segments. Biopsies were classified as either diagnostic or non-diagnostic based on final cytology and/or pathology reports. Results were considered diagnostic if malignancy or a specific benign diagnosis was established, whereas atypical cells, non-specific benignity, or insufficient specimen were considered non-diagnostic. Results: The positive predictive value (PPV) of a diagnostic yield was 85%, regardless of lobar distribution. Because all PPVs were relatively high across locations (84–87%), we failed to find statistically significant difference in PPV between locations (P = 0.79). Furthermore, for every 1 cm increase in target size, the odds of a diagnostic yield increased by 1.42-fold or 42% above 85%. Although target size increased the diagnostic yield differently by location (between 1.4- and 1.8-fold across locations), these differences failed to be statistically significant, P = 0.55. Conclusion: Percutaneous transthoracic needle biopsy of lung lesions achieved high diagnostic yield (PPV: 84– 87%) across all lobes. A 42% odds increase in yield was achieved for every 1 cm increase in target size. However, this increase in size failed to be statistically significant between lobes.
- Published
- 2021
15. Society of abdominal radiology gastrointestinal bleeding disease-focused panel consensus recommendations for CTA technical parameters in the evaluation of acute overt gastrointestinal bleeding
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Martin L. Gunn, Ashish Khandalwal, Seong Ho Park, Jorge A. Soto, Alvaro Huete, Flavius F. Guglielmo, Jeff L. Fidler, Michael S. Gee, Vijay Ramalingam, Brian C. Allen, Michael L. Wells, Farnoosh Sokhandon, David J. Grand, Mahmoud M. Al-Hawary, Olga R. Brook, and Christina A. LeBedis
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medicine.medical_specialty ,Gastrointestinal bleeding ,Consensus ,GI bleeding ,Computed Tomography Angiography ,Urology ,Delphi method ,Disease ,Patient care ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Societies, Medical ,Computed tomography angiography ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,medicine.disease ,Gastrointestinal Tract ,030220 oncology & carcinogenesis ,Angiography ,Acute Disease ,Radiology ,business ,Gastrointestinal Hemorrhage - Abstract
To formulate consensus recommendations for CT angiography technical parameters used to evaluate overt gastrointestinal (GI) bleeding. An electronic questionnaire consisting of 17 questions was sent to a panel of 16 radiologists with expertise on the imaging of GI bleeding from the Society of Abdominal Radiology GI Bleeding disease-focused panel to obtain consensus agreement on issues related to CTA technical parameters for imaging overt GI bleeding. A multi-round Delphi method of voting was performed to obtain consensus which was defined as ≥ 80% agreement. Consensus agreement was reached in 15/17 (89%) of the questions including the technique for the administration of IV contrast, the number of phases, scan timing, and image reconstruction. A panel of experts on the imaging of GI bleeding from the Society of Abdominal Radiology was able to reach consensus on the majority of technical parameters used for CTA of overt GI bleeding. These recommendations should improve the quality of patient care by adopting these minimal technical requirements for optimal exam performance and lead to less variation in the performance of these exams which will facilitate collecting and comparing published data from different centers. These recommendations will need revisions as additional scientific data become available.
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- 2019
16. Identification of Nonalcoholic Fatty Liver Disease following Pancreatic Surgery in a Western Cohort Using a Novel Radiographic Technique
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Sidney Olefson, Kevin P. Charpentier, Melissa Jackson, Kittichai Promrat, Nirav Makwana, and David J. Grand
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medicine.medical_specialty ,Malabsorption ,Hepatology ,business.industry ,medicine.medical_treatment ,Distal pancreatectomy ,Retrospective cohort study ,Retrospective cohort ,Whipple ,Single Center ,medicine.disease ,Pancreaticoduodenectomy ,Gastroenterology ,Surgery ,medicine.anatomical_structure ,NAFLD ,Internal medicine ,Cohort ,Nonalcoholic fatty liver disease ,medicine ,Abdomen ,Original Article ,Metabolic syndrome ,business - Abstract
Background and Aims: While traditional risk factors for the development of nonalcoholic fatty liver disease (NAFLD) relate to metabolic syndrome, several Asian studies have suggested a high rate of de novo NAFLD following pancreaticoduodenectomy (PD). The aim of this study is to identify de novo NAFLD after pancreatic surgery and its associated risk factors. Methods: A retrospective cohort of patients at a single center that underwent PD or distal pancreatectomy (DP) over 7 years was identified. Pre- and postoperative contrast-enhanced computed tomography scans of the abdomen were reviewed, including attenuation measurements of the liver, spleen, and muscle. Primary outcomes included hepatic attenuation, liver to muscle ratio (LMR), and liver to spleen ratio (LSR). Results: Of the 96 patients (mean age 64.3) included, 70% underwent PD, and 30% underwent DP. The mean LMR decreased significantly from 1.81 to 1.66 (p=0.02), noted only in men. No interaction effect with LMR was observed with surgical type, chemotherapy, blood loss, pancreatic enzyme replacement, or transaminases. LMR decreased in 55% of subjects. Conclusions: Increased fatty infiltration, as evidence by decreased LMR, was found among men that underwent PD and DP within a year of surgery. This may be related to weight loss and malabsorption and deserves further investigation.
- Published
- 2015
17. A Simple Endoscopic Score Modified for the Upper Gastrointestinal Tract in Crohn's Disease [UGI-SES-CD]: A Report From the ImageKids Study
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Martin Wasser, Osnat Konen, David R Mack, Bob Baldassano, Oren Ledder, Maarten H. Lequin, Jorge Davila, J. Hyams, Johanna C. Escher, Tony Otley, Lissy de Ridder, Shehzad Ahmed Saeed, Emily J. Stenhouse, Daniel A. Lemberg, Victor Navas, Jessie M. Hulst, Eric I Benchimol, Ted Denson, Jared Silverstein, Kathy O'Brien, Anat Ilivitzki, Judith Kelsen, Izabela Herman-Sucharska, Frank M. Ruemmele, Neal Leleiko, Lucia Riaza, Sibylle Koletzko, Elhamy Bekhit, Raanan Shamir, David J. Grand, Doug Moote, Daniel Moses, Sudha Anupindi, Richard K. Russell, Dan Turner, Laureline Berteloo, and Michal Amitai
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Male ,Crohn’s disease ,medicine.medical_specialty ,paediatric ,Adolescent ,Gastroenterology ,Severity of Illness Index ,03 medical and health sciences ,0302 clinical medicine ,Crohn Disease ,Predictive Value of Tests ,Internal medicine ,medicine ,Upper gastrointestinal ,Humans ,Clinical significance ,Endoscopy, Digestive System ,Prospective Studies ,endoscopy ,Child ,Antrum ,Crohn's disease ,medicine.diagnostic_test ,business.industry ,Age Factors ,General Medicine ,medicine.disease ,Magnetic resonance enterography ,Faecal calprotectin ,Endoscopy ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Child, Preschool ,Duodenum ,030211 gastroenterology & hepatology ,Female ,business - Abstract
Objective: There is no standardized endoscopic description of upper gastrointestinal [UGI] disease in Crohn's disease [CD]. We prospectively applied the Simple Endoscopic Score for CD [SES-CD] to the UGI tract as a planned sub-study of the multicentre prospective ImageKids study. We aimed to assess the utility of the UGI-SES-CD and its clinical significance in paediatric CD. Design: Patients underwent an oesophagogastroduodenoscopy [EGD], ileocolonoscopy, and magnetic resonance enterography [MRE] with explicit clinical data recorded. SES-CD was scored at each region [oesophagus, stomach body, antrum, and duodenum]. Half of the patients were followed for 18 months, when a repeat MRE was performed. Results: A total of 202 children were included 56% males, mean age 11.5 +/- 3.2 years, median weighted Paediatric Crohn's Disease Activity Index [wPCDAI 25]). UGI-SES-CD score ranged 0-17, with 95 [47%] having a UGI-SES-CD = 1; no narrowing was detected. UGI-SES-CD = 1 was associated with higher: wPCDAI [32.5 vs 20; p = 0.03]; Physician's Global Assessment [PGA] of inflammation (45 mm visual analogue score [VAS] vs 30 mm VAS; p = 0.04); ileocolonoscopic SES-CD [10 vs 7; p = 0.004], faecal calprotectin [717 mu g/g vs 654 mu/g; p= 0.046]; and radiological global assessment of damage by MRE [7 mm VAS vs 0; p = 0.04]. In all, 81 patients were followed for 18 months and no association was identified between initial UGI SES-CD and markers of disease course such as surgery, MRE assessment, or treatment escalation. Conclusion: UGI-SES-CD is an easily reported objective scoring system and is associated with a more severe disease phenotype but not with disease course.
- Published
- 2018
18. SAR GI Bleeding DFP Annual Report
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Vijay Ramalingam, Avneesh Gupta, David H. Bruining, Olga R. Brook, Jeff L. Fidler, Flavius F. Guglielmo, Brian C. Allen, Farnoosh Sokhandon, Michael L. Wells, Mike Gee, Jorge A. Soto, Alvaro Huete, Mahmoud M. Al-Hawary, Lisa L. Strate, Seong Ho Park, Martin L. Gunn, Ashish Khandelwal, and David J. Grand
- Subjects
medicine.medical_specialty ,Radiological and Ultrasound Technology ,GI bleeding ,business.industry ,Urology ,Internal medicine ,Gastroenterology ,medicine ,Radiology, Nuclear Medicine and imaging ,Annual report ,business - Published
- 2019
19. Opportunistic screening for bone disease using abdominal CT scans obtained for other reasons in newly diagnosed IBD patients
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Renee Bright, Michael D. Beland, Jason T. Machan, D. Anjelly, Heather Moniz, Neal S. Leleiko, Samir A. Shah, Meaghan Mallette, Bruce E. Sands, David J. Grand, M. S. Furman, Jason Shapiro, Dionne Rebello, and Marjorie Merrick
- Subjects
Adult ,Male ,medicine.medical_specialty ,Bone density ,Bone disease ,Adolescent ,Endocrinology, Diabetes and Metabolism ,Osteoporosis ,Inflammatory bowel disease ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Bone Density ,Medicine ,Humans ,Mass Screening ,Registries ,Glucocorticoids ,Aged ,Bone mineral ,Aged, 80 and over ,Crohn's disease ,Lumbar Vertebrae ,business.industry ,Incidence ,Rhode Island ,Middle Aged ,medicine.disease ,Inflammatory Bowel Diseases ,Ulcerative colitis ,digestive system diseases ,Osteopenia ,Bone Diseases, Metabolic ,Early Diagnosis ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Female ,Radiology ,business ,Tomography, X-Ray Computed ,Follow-Up Studies - Abstract
Bone disease is prevalent among patients with inflammatory bowel disease (IBD), though bone density screening remains underutilized. We used CT scans performed for other indications in IBD patients to identify and monitor osteopenia using CT attenuation values at the lumbar spine. Significant rates of bone disease were detected which would have otherwise gone undiagnosed.Osteoporosis affects about 14-42% of patients with IBD. Though screening is recommended in IBD patients with risk factors, it remains underutilized. In patients with newly diagnosed IBD, we used CT scans performed for other indications to identify and monitor progression of osteopenia.Using the Ocean State Crohn's and Colitis Area Registry, we identified adult patients with one or more abdominal CT scans. Each patient had two age- and gender-matched controls. Radiologists measured attenuation through trabecular bone in the L1 vertebral body recorded in Hounsfield units (HU). Generalized estimating equations were used to measure how HU varied as a function of gender, type of IBD, and age.One hundred five IBD patients were included, and 72.4% were classified as "normal" bone mineral density (BMD) and 27.6% as potentially osteopenic: 8.6% with ulcerative colitis and 19.0% with Crohn's disease. We found a decrease in bone density over time (p 0.001) and that BMD decreases more in Crohn's disease than in ulcerative colitis (p 0.004). Sixty patients had two CT scans, and mean loss of 9.3 HU was noted. There was a non-significant decrease in BMD over time in patients exposed to 31 days of steroids and BMD was stable with 30 days of steroid exposure (p 0.09).Using CT scans obtained for other indications, we found low rates of osteopenia and osteoporosis that may otherwise have gone undiagnosed. Refinement of opportunistic screening may have advantages in terms of cost-savings and earlier detection of bone loss.
- Published
- 2017
20. MRI: first-line imaging modality for pregnant patients with suspected appendicitis
- Author
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David J. Grand, Joseph Konrad, and Ana Lourenço
- Subjects
Adult ,medicine.medical_specialty ,Urology ,Appendix ,Sensitivity and Specificity ,Diagnosis, Differential ,Surgical pathology ,Pregnancy ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Medical diagnosis ,Retrospective Studies ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Ultrasound ,Gastroenterology ,Magnetic resonance imaging ,Retrospective cohort study ,General Medicine ,Appendicitis ,medicine.disease ,Magnetic Resonance Imaging ,Pregnancy Complications ,medicine.anatomical_structure ,Acute Disease ,Female ,Radiology ,Differential diagnosis ,business - Abstract
The purpose of our study was to evaluate the sensitivity, specificity, and accuracy of ultrasound (US) as compared to magnetic resonance imaging (MRI) in pregnant patients with suspected appendicitis for visualization of the appendix, accuracy at diagnosing acute appendicitis, the ability of each modality to identify alternate diagnoses of pain and whether gestational age (GA) has an association with appendix identification rates. We retrospectively reviewed the records of 140 pregnant patients with suspected appendicitis to determine the efficacy of US and MRI to identify the appendix, diagnose or exclude acute appendicitis, identify alternative etiologies for clinical presentation, and the affect of GA on identification of the appendix. Imaging results were correlated with surgical pathology in patients who underwent surgery. The electronic medical record was used to assess clinical outcomes in patients who did not undergo surgery. The appendix was visualized in 7% (8/117) of US exams and in 80% (91/114) of MRI exams. Alternate etiologies of pathology were determined in 3% (3/117) of US exams and 12% (14/114) of MRI exams. The sensitivity and specificity of MRI for acute appendicitis were both 100% and 98%, respectively, as compared to 18% and 99%, respectively, with US. GA did not affect MRI or ultrasound visualization rates of the appendix. Given the low likelihood of visualization of the appendix at US, the excellent accuracy of MRI and the ability of MRI to identify alternate diagnoses, we suggest that at certain institutions MRI may be considered a first-line imaging modality for pregnant patients of any GA with suspected appendicitis.
- Published
- 2015
21. MR enterography in Crohn’s disease: current consensus on optimal imaging technique and future advances from the SAR Crohn’s disease-focused panel
- Author
-
Mahmoud M. Al-Hawary, David J. Grand, and Flavius F. Guglielmo
- Subjects
medicine.medical_specialty ,Consensus ,Urology ,Contrast Media ,Gadolinium ,Crohn Disease ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Crohn's disease ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Crohn disease ,Gastroenterology ,Reproducibility of Results ,Magnetic resonance imaging ,General Medicine ,Image enhancement ,Image Enhancement ,medicine.disease ,Magnetic Resonance Imaging ,Intestines ,MR Enterography ,Practice Guidelines as Topic ,Imaging technique ,Radiology ,business - Abstract
MR enterography is a powerful tool for the non-invasive evaluation of patients with Crohn's disease (CD) without ionizing radiation. The following paper describes the current consensus on optimal imaging technique, interpretation, and future advances from the Society of Abdominal Radiology CD-focused panel.
- Published
- 2015
22. Prostate MRI to Evaluate Extra-Prostatic Disease: A Single Center Analysis
- Author
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Ommega Internationals, Jodi Lyn Layton, Anthony Mega, Joseph F. Renzulli, Michael Furman, Kenneth D. Bishop, and David J. Grand
- Subjects
medicine.medical_specialty ,medicine.anatomical_structure ,Prostate ,Prostatic disease ,business.industry ,Urology ,medicine ,Single Center ,business - Published
- 2015
23. Management of Nodules with Initially Nondiagnostic Results of Thyroid Fine-Needle Aspiration: Can We Avoid Repeat Biopsy?
- Author
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Grayson L. Baird, John J. Cronan, Thomas J. T. Anderson, Michael K. Atalay, David J. Grand, and Michael D. Beland
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Unnecessary Procedures ,Malignancy ,Sensitivity and Specificity ,Young Adult ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Thyroid Nodule ,Child ,skin and connective tissue diseases ,Endoscopic Ultrasound-Guided Fine Needle Aspiration ,False Negative Reactions ,neoplasms ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,Repeat biopsy ,business.industry ,Thyroid ,Reproducibility of Results ,Middle Aged ,medicine.disease ,body regions ,surgical procedures, operative ,medicine.anatomical_structure ,Fine-needle aspiration ,Female ,Radiology ,business - Abstract
To identify demographic and ultrasonographic (US) features associated with malignancy after initially nondiagnostic results of fine-needle aspiration (FNA) to help clarify the role of repeat FNA, surgical excision, or serial US in these nodules.This study was HIPAA compliant and institutional review board approved; informed consent was waived. Thyroid nodules (n = 5349) that underwent US-guided FNA in 2004-2012 were identified; 393 were single nodules with nondiagnostic FNA results but adequate cytologic, surgical, or US follow-up. Demographic information and diameters and volume at US at first biopsy were modeled with malignancy as outcome through medical record review. Exact logistic regression was used to model malignancy outcomes, demographic comparisons with age were made (Student t test, Satterthwaite test), and proportion confidence intervals (CIs) were estimated (Clopper-Pearson method).Of 393 nodules with initially nondiagnostic results, nine malignancies (2.3%) were subsequently diagnosed with repeat FNA (n = 2, 0.5%) or surgical pathologic examination (n = 7, 1.8%), 330 (84.0%) were benign, and 54 (13.7%) were stable or decreased in size at serial US (mean follow-up, 3.0 years; median, 2.5 years; range, 1.0-7.8 years). Patients with malignancies were significantly older (mean age, 62.7 years; median, 64 years; range, 47-77 years) than those without (mean age, 55.4 years; median, 57 years; range, 12-94 years; P = .0392). Odds of malignancy were 4.2 times higher for men versus women (P = .045) and increased significantly for each 1-cm increase in anteroposterior, minimum, and mean nodule diameter (1.78, 2.10, and 1.96, respectively). In 393 nodules, no malignancies were detected in cystic or spongiform nodules (both, n = 11, 2.8%; 95% CI: 1.4%, 5.0%), nodules with eggshell calcifications (n = 9, 2.3%; 95% CI: 1.1%, 4.3%), or indeterminate echogenic foci (n = 39, 9.9%; 95% CI: 7.2%, 13.3%).Very few malignancies were diagnosed with repeat FNA following nondiagnostic FNA results (two of 336, 0.6%); therefore, clinical and US follow-up may be more appropriate than repeat FNA following nondiagnostic biopsy results.
- Published
- 2014
24. JOURNAL CLUB: Gastric Band Slippage: A Case-Controlled Study Comparing New and Old Radiographic Signs of This Important Surgical Complication
- Author
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Brian Murphy, David W. Swenson, David J. Grand, Jason A. Pietryga, Kevin J. Chang, and Thomas K. Egglin
- Subjects
Adult ,Male ,medicine.medical_specialty ,Gastroplasty ,Radiography ,Fleiss' kappa ,Asymptomatic ,Postoperative Complications ,Positive predicative value ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Laparoscopy ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,digestive, oral, and skin physiology ,Case-control study ,Retrospective cohort study ,Equipment Design ,Prostheses and Implants ,General Medicine ,Middle Aged ,Obesity, Morbid ,Prosthesis Failure ,Surgery ,Case-Control Studies ,Female ,Slippage ,Radiology ,medicine.symptom ,business - Abstract
The purpose of this study was to compare the diagnostic performance of four radiographic signs of gastric band slippage: abnormal phi angle, the "O sign," inferior displacement of the superolateral gastric band margin, and presence of an air-fluid level above the gastric band.A search of the electronic medical record identified 21 patients with a surgically proven slipped gastric band and 63 randomly-selected asymptomatic gastric band patients who had undergone barium swallow studies. These studies were evaluated for the four signs of band slippage by two independent radiologists who were blinded to clinical data. Sensitivity, specificity, and positive and negative predictive values were calculated for each radiographic sign of band slippage. Interobserver agreement between radiologists was assessed using the Fleiss kappa statistic.In evaluating for gastric band slippage, an abnormal phi angle greater than 58° was 91-95% sensitive and 52-62% specific (κ = 0.78), the O sign was 33-48% sensitive but 97% specific (κ = 0.84), inferior displacement of the superolateral band margin by more than 2.4 cm from the diaphragm was 95% sensitive and 97-98% specific (κ = 0.97), and the presence of an air-fluid level was 95% sensitive and 100% specific (κ = 1.00).We report two previously undescribed radiographic signs of gastric band slippage that are both sensitive and specific for this important surgical complication and recommend that these signs should be incorporated into the imaging evaluation of gastric band patients.
- Published
- 2014
25. Ovarian torsion: Case–control study comparing the sensitivity and specificity of ultrasonography and computed tomography for diagnosis in the emergency department
- Author
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Alison G. Killelea, David W. Swenson, Ana Lourenço, David J. Grand, Alyson J. McGregor, and Francesca L. Beaudoin
- Subjects
Adult ,Emergency Medical Services ,Torsion Abnormality ,medicine.medical_specialty ,Adolescent ,Ovary ,Computed tomography ,Pelvic Pain ,Sensitivity and Specificity ,Young Adult ,parasitic diseases ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Ovarian Diseases ,Ultrasonography ,medicine.diagnostic_test ,business.industry ,Pelvic pain ,Ultrasound ,Ovarian torsion ,Case-control study ,Reproducibility of Results ,Retrospective cohort study ,General Medicine ,Emergency department ,Middle Aged ,medicine.disease ,body regions ,medicine.anatomical_structure ,Case-Control Studies ,Female ,Radiology ,medicine.symptom ,Emergency Service, Hospital ,Tomography, X-Ray Computed ,business - Abstract
Objective Evaluate the sensitivity and specificity of pelvic ultrasound (US) and abdominopelvic computed tomography (CT) for the identification of ovarian torsion in women presenting to the emergency department with acute lower abdominal or pelvic pain. Materials and methods This is a retrospective study of 20 cases of ovarian torsion and 20 control patients, all of whom had both US and CT performed in the emergency department. Two radiologists who were blinded to clinical data interpreted all studies as (1) demonstrating an abnormal ovary or not, and (2) suggestive of torsion or not. Sensitivity, specificity and interobserver variation were calculated for each imaging modality. Results Pelvic US was interpreted as demonstrating an abnormal ovary in 90.0% of ovarian torsion cases by reader 1, and in 100.0% by reader 2, whereas CT was interpreted as revealing an abnormal ovary in 100.0% of torsion cases by both readers. Pelvic US for ovarian torsion was 80.0% sensitive (95% CI, 58.4–91.9%) and 95.0% specific (95% CI, 76.4–99.1%) for reader 1, while 80.0% sensitive (95% CI, 58.4–91.9%) and 85.0% specific (95% CI, 64.0–95.0%) for reader 2. Interobserver agreement for pelvic US was fair (Kappa = 0.60). Abdominopelvic CT for ovarian torsion was 100.0% sensitive (95% CI, 83.9–100.0%) and 85.0% specific (95% CI, 64.0–94.5%) for reader 1, while 90.0% sensitive (95% CI, 69.9–97.2%) and 90.0% specific (95% CI, 69.9–97.2%) for reader 2. Interobserver agreement was excellent (Kappa = 0.85). Conclusion The diagnostic performance of CT is not shown to be significantly different from that of US in identifying ovarian torsion in this study. These results suggest that when CT demonstrates findings of ovarian torsion, the performance of another imaging exam (i.e. US) that delays therapy is unlikely to improve preoperative diagnostic yield.
- Published
- 2014
26. Sa1566 – Fecal Microbiota Transplantation in Nonalcoholic Steatohepatitis: A Case Series
- Author
-
Kittichai Promrat, David J. Grand, Manida Wungjiranirun, Colleen R. Kelly, Yesenia Risech-Neyman, and Charles Wang
- Subjects
Nonalcoholic steatohepatitis ,medicine.medical_specialty ,Hepatology ,business.industry ,Internal medicine ,Gastroenterology ,Medicine ,Fecal bacteriotherapy ,business - Published
- 2019
27. Morphologic Features of 211 Adrenal Masses at Initial Contrast-Enhanced CT: Can We Differentiate Benign From Malignant Lesions Using Imaging Features Alone?
- Author
-
William W. Mayo-Smith, Michael D. Beland, Kevin J. Chang, David J. Grand, Julie H. Song, and Jason T. Machan
- Subjects
Male ,medicine.medical_specialty ,Adrenal Gland Neoplasm ,Adrenal Gland Neoplasms ,Contrast Media ,Adrenal neoplasm ,Sensitivity and Specificity ,Diagnosis, Differential ,Lesion ,Adrenal masses ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Adrenal gland ,General Medicine ,Middle Aged ,medicine.anatomical_structure ,Positron emission tomography ,Positron-Emission Tomography ,Radiographic Image Interpretation, Computer-Assisted ,Female ,Radiology ,Tomography ,Differential diagnosis ,medicine.symptom ,Tomography, X-Ray Computed ,business - Abstract
The objective of our study was to determine whether morphologic features of adrenal masses detected at initial contrast-enhanced MDCT can differentiate benign from malignant disease.Two hundred eleven adrenal masses (1-4 cm) detected during standard contrast-enhanced MDCT with a proven final diagnosis were retrospectively identified in 188 patients through a computer search of CT, PET/CT, and pathology reports. Three authors blinded to the diagnoses independently reviewed the contrast-enhanced MDCT images of the adrenal masses and evaluated their morphologic features: lesion margin (smooth, lobulated, or irregular), density (homogeneous or heterogeneous), and additional features of central low density and enhancing rim. Using these criteria, the readers categorized each mass as probably benign, indeterminate, or suspicious.There were 171 (81%) benign and 40 (19%) malignant adrenal masses. All malignant masses were metastases diagnosed in patients with known extraadrenal malignancy. For individual morphologic features in diagnosing malignancy, irregular margins had 30-33% sensitivity and 95-96% specificity and an enhancing rim had 5-13% sensitivity and 98-99% specificity. None of the imaging features was reliable in predicting benignity. When an adrenal mass was deemed suspicious by a reader, the sensitivities for malignancy ranged from 54% to 74% and specificities from 96% to 97%. Notably, no malignant lesions occurred in patients without a known history of cancer.At routine contrast-enhanced MDCT, adrenal masses with irregular margins or a thick enhancing rim are likely to be malignant. Smooth margins and homogeneous density can be seen in both benign and malignant adrenal masses and are insufficient for characterization.
- Published
- 2013
28. Imaging Inflammatory Bowel Disease with CT and MR Enterography
- Author
-
David J. Grand and Piotr Starakiewicz
- Subjects
medicine.medical_specialty ,Crohn's disease ,medicine.diagnostic_test ,business.industry ,Lumen (anatomy) ,Magnetic resonance imaging ,Disease ,medicine.disease ,Magnetic resonance enterography ,Inflammatory bowel disease ,MR Enterography ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Active inflammation ,business - Abstract
Radiologic imaging plays a crucial role in the diagnosis and management of Crohn’s disease (CD). With cross-sectional imaging techniques in particular, the bowel lumen, wall, and extraintestinal manifestations of the disease can be visualized efficiently and noninvasively. Computed tomography enterography (CTE) and magnetic resonance enterography (MRE) are the new gold standards of imaging inflammatory bowel disease, replacing the small-bowel follow-through as the first-line imaging test of choice. The choice between modalities is largely one of availability, experience and institutional or individual preference. CTE may be preferred in older patients and those presenting with acute symptoms, due to its low cost, ease of execution/interpretation, and greater availability. Magnetic resonance imaging (MRI) is often favored in young patients to minimize exposure to ionizing radiation. The efficacy of both CTE and MRE has been repeatedly proven; the future of radiographic imaging of CD lies in the ability to differentiate between active inflammation and fibrosis, as well as to monitor the effectiveness of treatment.
- Published
- 2013
29. Risk factors for radiation exposure in newly diagnosed IBD patients
- Author
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Julie Giacalone, Edmund Wu, Zahid Samad, Marjorie Merrick, Jason Shapiro, Meaghan Mallette, Adam Harris, Sylvan Wallenstein, Renee Bright, Neal S. Leleiko, Bruce E. Sands, Heather Moniz, David J. Grand, and Samir A. Shah
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Urology ,Population ,Disease ,Gastroenterology ,Inflammatory bowel disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Registries ,Colitis ,education ,Prospective cohort study ,Child ,Crohn's disease ,education.field_of_study ,Radiological and Ultrasound Technology ,business.industry ,Hepatology ,Radiation Exposure ,medicine.disease ,Inflammatory Bowel Diseases ,Ulcerative colitis ,030211 gastroenterology & hepatology ,Female ,business ,Tomography, X-Ray Computed - Abstract
Patients with inflammatory bowel disease (IBD) may be exposed to high doses of diagnostic radiation. The purpose of this study is to identify subsets of this population at risk for significant radiation exposure. This HIPAA compliant, IRB approved study consists of 336 patients (237 adult and 99 pediatric) within the Ocean State Crohn’s & Colitis Area Registry (OSCCAR). All were newly diagnosed with IBD and prospectively enrolled between 1/2008 and 12/2012. Comprehensive chart review was performed. 207 (61.6%) patients were diagnosed with Crohn’s disease (CD), 120 (35.7%) with ulcerative colitis (UC), and 9 (2.7%) with inflammatory bowel disease, type unspecified (IBDU). 192 (57.1%) patients were exposed to GI-specific radiation. Average GI-specific radiation dose for adult IBD patients was 14.1 mSV and was significantly greater among adult CD than adult UC patients (p = 0.01). Pediatric patients underwent fewer CT scans (p
- Published
- 2016
30. Quantitative analysis of ultrasound images for computer-aided diagnosis
- Author
-
Jie Ying Wu, Joseph Konrad, David V. Glidden, Adam Tuomi, Derek Merck, Michael D. Beland, and David J. Grand
- Subjects
medicine.medical_specialty ,shape analysis ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Rare Diseases ,Region of interest ,medicine ,Radiology, Nuclear Medicine and imaging ,Adenomyosis ,texture analysis ,030219 obstetrics & reproductive medicine ,Receiver operating characteristic ,business.industry ,ultrasound ,Ultrasound ,Pattern recognition ,medicine.disease ,Computer-Aided Diagnosis ,machine learning ,Computer-aided diagnosis ,Biomedical Imaging ,Support system ,computer-aided diagnosis ,Artificial intelligence ,Radiology ,business ,Digestive Diseases ,Shape analysis (digital geometry) - Abstract
We propose an adaptable framework for analyzing ultrasound (US) images quantitatively to provide computer-aided diagnosis using machine learning. Our preliminary clinical targets are hepatic steatosis, adenomyosis, and craniosynostosis. For steatosis and adenomyosis, we collected US studies from 288 and 88 patients, respectively, as well as their biopsy or magnetic resonanceconfirmed diagnosis. Radiologists identified a region of interest (ROI) on each image. We filtered the US images for various texture responses and use the pixel intensity distribution within each ROI as feature parameterizations. Our craniosynostosis dataset consisted of 22 CT-confirmed cases and 22 age-matched controls. One physician manually measured the vectors from the center of the skull to the outer cortex at every 10deg for each image and we used the principal directions as shape features for parameterization. These parameters and the known diagnosis were used to train classifiers. Testing with cross-validation, we obtained 72.74% accuracy and 0.71 area under receiver operating characteristics curve for steatosis ([Formula: see text]), 77.27% and 0.77 for adenomyosis ([Formula: see text]), and 88.63% and 0.89 for craniosynostosis ([Formula: see text]). Our framework is able to detect a variety of diseases with high accuracy. We hope to include it as a routinely available support system in the clinic.
- Published
- 2016
31. Feasibility of Using MR Enterography for the Assessment of Terminal Ileitis and Inflammatory Activity in Children With Crohn Disease
- Author
-
Samir A. Shah, David J. Grand, David Kawatu, Jared Silverstein, Jill A. Steinkeler, and Neal S. Leleiko
- Subjects
medicine.medical_specialty ,Adolescent ,Biopsy ,Colonoscopy ,Gadolinium ,Sensitivity and Specificity ,Severity of Illness Index ,Gastroenterology ,Crohn Disease ,Ileum ,Predictive Value of Tests ,Internal medicine ,Severity of illness ,medicine ,Humans ,Ileitis ,Child ,Radionuclide Imaging ,Retrospective Studies ,Inflammation ,Gastrointestinal tract ,medicine.diagnostic_test ,business.industry ,Water ,Magnetic resonance imaging ,Retrospective cohort study ,medicine.disease ,Magnetic Resonance Imaging ,Predictive value of tests ,Pediatrics, Perinatology and Child Health ,Radiology ,business - Abstract
Radiation exposure increases cancer risk in children with Crohn disease (CD). Magnetic resonance enterography (MRE) can image the gastrointestinal tract without exposure to radiation. The aim of the present study was to determine whether our MRE protocol could diagnose terminal ileitis and the degree of inflammatory activity in children with CD.Retrospective review of patients 18 years of age or younger who underwent MRE for known or suspected CD from June 15, 2007 to April 1, 2010. MRE was performed with Volumen and water as oral contrast and gadolinium-based intravenous contrast. No antiperistaltic agent was used. Each MRE was compared with ileal biopsies obtained within 90 days. Severity of inflammation on MRE was scored and compared with the Pediatric Crohn Disease Activity Index (PCDAI).Seventy-two patients underwent 80 MREs during the study period. Forty-two of the 72 patients (58.3%) underwent colonoscopy within 90 days of MRE, and the terminal ileum was intubated in 33. Compared with histology, MRE had a sensitivity of 71.4% and a specificity of 100% for terminal ileitis. The positive and negative predictive values were 100% and 70%, respectively. PCDAI was calculated in 39 of the 72 patients (54.2%) and had a statistically significant positive correlation with MRE score of 0.37 (P = 0.020426).In children with known or suspected CD, our MRE protocol has a high specificity and positive predictive value for terminal ileitis. Severity of inflammation on MRE had a statistically significant positive correlation with PCDAI.
- Published
- 2012
32. Imaging for Luminal Disease and Complications: CT Enterography, MR Enterography, Small-Bowel Follow-Through, and Ultrasound
- Author
-
Adam Harris, David J. Grand, and Edward V. Loftus
- Subjects
Diagnostic Imaging ,medicine.medical_specialty ,CT enterography ,business.industry ,Ultrasound ,Gastroenterology ,Disease ,Magnetic Resonance Imaging ,Response to treatment ,Triage ,Disease activity ,Surgical therapy ,Crohn Disease ,Fluoroscopy ,MR Enterography ,medicine ,Humans ,Radiology ,Tomography, X-Ray Computed ,business ,Ultrasonography - Abstract
The advent of cross-sectional enterography has revolutionized small-bowel imaging, providing comprehensive, reproducible evaluation of CD and its complications. Continued collaboration between radiologists and gastroenterologists is critical to ensure further progress toward the common goals of classifying disease activity, predicting response to treatment, and appropriate triage to medical versus surgical therapy.
- Published
- 2012
33. MR enterography correlates highly with colonoscopy and histology for both distal ileal and colonic Crohn's disease in 310 patients
- Author
-
William Tzu-Liang Chen, Adam Harris, Vinay Kampalath, Murray B. Resnick, Ajay Patel, David J. Grand, Samir A. Shah, Jason T. Machan, and Michael D. Beland
- Subjects
Adult ,Male ,medicine.medical_specialty ,Statistics as Topic ,Colonoscopy ,Disease ,Sensitivity and Specificity ,Gastroenterology ,Young Adult ,Crohn Disease ,Internal medicine ,Biopsy ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Young adult ,Aged ,Aged, 80 and over ,Crohn's disease ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,Rhode Island ,Histology ,General Medicine ,Gold standard (test) ,Ileitis ,Middle Aged ,Colitis ,medicine.disease ,Magnetic Resonance Imaging ,Endoscopy ,Radiology ,business - Abstract
Background and aims To evaluate the efficacy of MR enterography (MRE) in patients with known or suspected Crohn's disease without the use of anti-peristaltic pharmacologic agents compared to colonoscopy and histology. Methods A retrospective review of 850 consecutive patients who underwent routine MRE to evaluate known or suspected Crohn's disease was performed. Of these, 310 patients also underwent colonoscopy with biopsy(s) within 90 days. The results of the MRE were compared to the colonoscopy and pathology reports to determine the presence or absence of disease in evaluable bowel segments. Individual imaging parameters (including wall thickening, enhancement, T2 signal, mesenteric vascular prominence and adenopathy) were also separately analyzed to determine their independent predictive value. Results In 310 patients, the overall sensitivity and specificity of MRE (using endoscopy as a gold standard) were 85% and 80% respectively (kappa = 0.65). The sensitivity of MRE for detection of pathologically severe disease was 87% in the terminal ileum (TI) and 88% in the colon. In the subset of 162 patients who underwent colonoscopy within 30 days of MRE, the overall sensitivity remained 85% but the specificity increased to 85% (kappa = 0.69). Wall thickening and abnormal enhancement were sensitive indicators of Crohn's disease (75% and 78%), while abnormal T2 signal, mesenteric vascular prominence and adenopathy were specific (86%, 91% and 93%). Conclusion MRE compares favorably to colonoscopy for evaluation of known or suspected Crohn's disease noninvasively and without the exposure to ionizing radiation associated with CT enterography (CTE).
- Published
- 2012
34. Opportunistic Screening for Bone Disease Using Abdominal CT Scans Obtained for other Reasons in Newly Diagnosed IBD Patients
- Author
-
Jason T. Machan, Heather Moniz, Meaghan Mallette, Jason Shapiro, Bruce E. Sands, Marjorie Merrick, David J. Grand, Dionne Rebello, David Anjelly, Renee Bright, and Samir A. Shah
- Subjects
medicine.medical_specialty ,Hepatology ,Bone disease ,business.industry ,Abdominal ct ,Gastroenterology ,medicine ,Newly diagnosed ,Radiology ,medicine.disease ,business ,Opportunistic screening - Published
- 2017
35. Imaging Crohn’s disease: comparing the benefits of CT and MR enterography
- Author
-
William W. Mayo-Smith and David J. Grand
- Subjects
Crohn's disease ,Radiological and Ultrasound Technology ,CT enterography ,business.industry ,MR Enterography ,Medicine ,Radiology, Nuclear Medicine and imaging ,business ,Nuclear medicine ,medicine.disease - Published
- 2011
36. Incidence of Multiple Sporadic Renal Cell Carcinomas in Patients Referred for Renal Radiofrequency Ablation: Implications for Imaging Follow-Up
- Author
-
Damian E. Dupuy, Michael D. Beland, William W. Mayo-Smith, Farrah J. Wolf, and David J. Grand
- Subjects
Adult ,Male ,Reoperation ,medicine.medical_specialty ,Radiofrequency ablation ,Biopsy ,medicine.medical_treatment ,Contrast Media ,urologic and male genital diseases ,Nephrectomy ,law.invention ,Renal cell carcinoma ,law ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Carcinoma, Renal Cell ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Incidence ,Incidence (epidemiology) ,Mean age ,General Medicine ,Middle Aged ,Renal tumor ,medicine.disease ,Kidney Neoplasms ,female genital diseases and pregnancy complications ,Treatment Outcome ,surgical procedures, operative ,Catheter Ablation ,Female ,Radiology ,Tomography, X-Ray Computed ,business ,therapeutics - Abstract
The objective of our study was to report the incidence of multiple sporadic primary renal cell carcinomas (RCCs) in patients referred for radiofrequency ablation (RFA).A retrospective search identified 162 patients (104 men and 58 women; mean age, 74 years) without a history of von Hippel-Lindau disease with a total of 175 tumors treated with RFA for biopsy-proven primary renal malignancies at our institution from 1998 to 2009. Three groups of patients with multiple RCCs were identified: patients with a history of nephrectomy for RCC who had been referred for RFA of a new renal tumor, patients who presented with multiple renal tumors at the time of referral for RFA, and patients who were shown to have developed a new renal tumor on follow-up imaging after RFA.Twenty-eight patients (17%) had multiple biopsy-proven RCCs. Eighteen patients (11%) had undergone prior nephrectomy for surgically proven RCC. The mean interval between prior nephrectomy and RFA referral was 122 months (range, 12-456 months). Seven patients (4%) without a history of nephrectomy presented with two biopsy-proven RCCs at RFA referral. Three patients (2%) who had not undergone nephrectomy and had a solitary RCC at the time of RFA had developed a new biopsy-proven RCC separate from the original treatment site on follow-up imaging after RFA. The mean time to diagnosis from the initial RFA treatment was 52 months (range, 25-89 months).Imaging surveillance of patients referred for renal RFA may be important not only to assess treatment success but also to detect new RCCs.
- Published
- 2011
37. CT-guided percutaneous lung biopsy: Comparison of conventional CT fluoroscopy to CT fluoroscopy with electromagnetic navigation system in 60 consecutive patients
- Author
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Damian E. Dupuy, William W. Mayo-Smith, John J. Cronan, David J. Grand, and Michael A. Atalay
- Subjects
Adult ,Male ,medicine.medical_specialty ,Lung Neoplasms ,Time Factors ,Percutaneous ,Biopsy ,medicine.medical_treatment ,Radiography ,Lung biopsy ,Radiation Dosage ,Radiography, Interventional ,Fiducial Markers ,medicine ,Humans ,Fluoroscopy ,Radiology, Nuclear Medicine and imaging ,Ct fluoroscopy ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Chest tube ,Surgery, Computer-Assisted ,Pneumothorax ,Female ,Radiology ,Tomography, X-Ray Computed ,business ,Fiducial marker ,Electromagnetic Phenomena - Abstract
To determine if use of an electromagnetic navigation system (EMN) decreases radiation dose and procedure time of CT fluoroscopy guided lung biopsy in lesions smaller than 2.5 cm.86 consecutive patients with small lung masses (2.5 cm) were approached. 60 consented and were randomized to undergo biopsy with CT fluoroscopy (CTF) (34 patients) or EMN (26 patients). Technical failure required conversion to CTF in 8/26 EMN patients; 18 patients completed biopsy with EMN. Numerous biopsy parameters were compared as described below.Average fluoroscopy time using CTF was 28.2s compared to 35.0 s for EMN (p=0.1). Average radiation dose was 117 mGy using CTF and 123 mGy for EMN (p=0.7). Average number of needle repositions was 3.7 for CTF and 4.4 for EMN (p=0.4). Average procedure time was 15 min for CTF and 20 min for EMN (p=0.01). There were 7 pneumothoracesin the CTF group and 6 pneumothoraces in the EMN group (p=0.7). One pneumothorax in the CTF group and 3 pneumothoraces in the EMN group required chest tube placement (p=0.1). One pneumothorax patient in each group required hospital admission. Diagnostic specimens were obtained in 31/34 patients in the CTF group and 22/26 patients in the EMN group (p=0.4).EMN was not statistically different than CTF for fluoroscopy time, radiation dose, number of needle repositions, incidence of pneumothorax, need for chest tube, or diagnostic yield. Procedure time was increased with EMN.
- Published
- 2011
38. Dynamic MDCT for Localization of Occult Parathyroid Adenomas in 26 Patients With Primary Hyperparathyroidism
- Author
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Michael D. Beland, Jason T. Machan, William W. Mayo-Smith, Jack M. Monchik, and David J. Grand
- Subjects
Adenoma ,Adult ,Male ,Parathyroidectomy ,medicine.medical_specialty ,endocrine system diseases ,Iohexol ,medicine.medical_treatment ,Contrast Media ,Sensitivity and Specificity ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Four-Dimensional Computed Tomography ,Aged ,Retrospective Studies ,Parathyroid adenoma ,Aged, 80 and over ,Hyperparathyroidism ,business.industry ,Retrospective cohort study ,General Medicine ,Middle Aged ,Hyperplasia ,Hyperparathyroidism, Primary ,medicine.disease ,Occult ,Parathyroid Neoplasms ,Treatment Outcome ,Female ,Radiology ,business ,Primary hyperparathyroidism - Abstract
The objective of our study was to evaluate the accuracy of dynamic contrast-enhanced 4D MDCT in the preoperative identification of parathyroid adenomas in patients with primary hyperparathyroidism (PHPT) and a history of failed surgery or unsuccessful localization on standard imaging.Thirty-four patients with PHPT underwent 4D CT. Retrospective blinded review of the 4D CT examinations was performed by three radiologists for the presence and location of a suspected parathyroid adenoma or adenomas. At the time of the study, 25 patients underwent surgical exploration after 4D CT. Twenty patients had solitary parathyroid adenomas, two patients had two adenomas resected, two patients did not have an adenoma, and one patient had mild four-gland hyperplasia. One patient did not have PHPT on repeat serum biochemistry. Surgical and pathology reports, adenoma enhancement, and biochemical and clinical follow-up were reviewed. Data were compared with 4D CT interpretations and interobserver reliability was calculated.The mean sensitivity and specificity of the three readers for the precise CT localization of adenomas was 82% (range, 79-88%) and 92% (range, 75-100%), respectively. Overall interobserver reliability was excellent (κ = 0.70; range, κ = 0.60-0.79). All adenomas resected at surgery showed a biochemical response and clinical response. The mean densities of the confirmed adenomas were 41, 128, 138, and 109 HU at 0, 30, 60, and 90 seconds, respectively. Level II lymph nodes identified in 10 patients showed significantly less enhancement at 30 (p = 0.0001) and 60 (p = 0.006) seconds compared with surgically proven adenomas.Occult parathyroid adenoma shows characteristic early enhancement. In this subset of patients, 4D CT may improve surgical outcomes and decrease morbidity.
- Published
- 2011
39. Optimum imaging of colorectal metastases
- Author
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William W. Mayo-Smith, Richard B. Noto, Michael D. Beland, and David J. Grand
- Subjects
Surgical resection ,medicine.medical_specialty ,Percutaneous ,business.industry ,Colorectal cancer ,General surgery ,General Medicine ,medicine.disease ,Oncology ,Medical imaging ,Medicine ,Surgery ,business ,Disease burden - Abstract
Dramatic improvements in diagnostic imaging have developed with and enabled increasingly sophisticated treatments for metastatic colorectal cancer. Advances in therapeutic techniques, such as surgical resection and percutaneous therapies, demand that diagnostic imaging provide an accurate assessment of disease burden as well as precise localization. In this article, we present the current state-of-the-art of diagnostic imaging for evaluation of metastatic colorectal cancer. J. Surg. Oncol. 2010;102:909–913. © 2010 Wiley-Liss, Inc.
- Published
- 2010
40. Magnetic resonance enterography for assessing pediatric Crohn’s disease
- Author
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David J. Grand, Neal S. Leleiko, and Jared Silverstein
- Subjects
Crohn's disease ,medicine.medical_specialty ,Pediatric Crohn's disease ,business.industry ,Disease ,medicine.disease ,Magnetic resonance enterography ,Pediatrics ,Chronic inflammatory disorder ,Radiation exposure ,Potential harm ,Pediatrics, Perinatology and Child Health ,Medicine ,Radiology ,business ,Bowel imaging - Abstract
Crohn’s disease is a chronic inflammatory disorder of the GI tract that often presents during childhood and adolescence. Children with Crohn’s disease are often subjected to repeated radiologic examinations throughout the course of their illness, thereby raising great concern over the potential harm of cumulative radiation exposure. Magnetic resonance enterography is a new modality that provides detailed images of the GI tract without exposure to ionizing radiation. This article reviews past methods of bowel imaging, the scope of the problem with regard to radiation exposure, as well as the technical aspects, indications, and current evidence for magnetic resonance enterography in children with Crohn’s disease. Various examples of inflammatory, stricturing and penetrating disease activity are provided.
- Published
- 2010
41. Su1669 COMPUTED TOMOGRAPHY ANGIOGRAPHY-FIRST POLICY AFFECTING HEALTH OUTCOMES IN LOWER GASTROINTESTINAL BLEED
- Author
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Harlan Rich, Lanre Jimoh, David J. Grand, Chiazotam N. Ekekezie, and Joao Filipe G. Monteiro
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Health outcomes ,business ,Gastrointestinal Bleed ,Computed tomography angiography - Published
- 2018
42. Kidney Neoplasms: Renal Halo Sign after Percutaneous Radiofrequency Ablation—Incidence and Clinical Importance in 101 Consecutive Patients
- Author
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Damian E. Dupuy, William W. Mayo-Smith, Michael D. Beland, Todd C Schirmang, and David J. Grand
- Subjects
Adult ,Male ,medicine.medical_specialty ,Percutaneous ,Angiomyolipoma ,Radiofrequency ablation ,medicine.medical_treatment ,Contrast Media ,Catheter ablation ,Kidney ,urologic and male genital diseases ,law.invention ,Diagnosis, Differential ,law ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Halo sign ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Incidence ,Retrospective cohort study ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Kidney Neoplasms ,Surgery ,medicine.anatomical_structure ,Catheter Ablation ,Female ,Radiology ,Neoplasm Recurrence, Local ,medicine.symptom ,business ,Tomography, Spiral Computed - Abstract
To describe the incidence and clinical importance of the renal halo sign after percutaneous radiofrequency ablation (RFA) of renal neoplasms.Institutional review board approval was obtained for this HIPAA-compliant retrospective study. The study population consisted of 101 consecutive patients with 106 solid renal neoplasms that were treated with percutaneous RFA. Postablation computed tomographic (CT) and magnetic resonance (MR) images were retrospectively reviewed by three board-certified radiologists to determine the presence of the renal halo sign. Statistical analyses were performed to determine reader agreement and assess the effect that tumor size and location, radiofrequency (RF) applicator type, RFA treatment time and success, maximum RFA treatment temperature, and number of RF applications performed had on development of the renal halo sign.The renal halo sign developed in 79 (75%) of the 106 ablated tumors. Average imaging follow-up lasted 25 months (range, 1-98 months). The renal halo sign appeared, on average, 6 months (range, 1 month to 3 years) after RFA. The renal halo sign resolved in five (6%) of 79 tumors treated. Interobserver agreement for the presence of the renal halo sign was high. Tumor size and location, RF applicator type, RFA treatment time and success, maximum RFA treatment temperature, and number of RF applications performed were not independent predictors of renal halo sign development.The renal halo sign is seen in 75% of patients after percutaneous RFA of renal neoplasms. It may decrease in size over time; however, it rarely disappears. It is important to recognize this sign, as it can be mistaken for recurrent tumor or angiomyolipoma by radiologists who are not familiar with RFA.
- Published
- 2009
43. Sensitivity and specificity of eight CT signs in the preoperative diagnosis of internal mesenteric hernia following Roux-en-Y gastric bypass surgery
- Author
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B.L. Murphy, Jason D. Iannuccilli, G.D. Roye, David J. Grand, P. Evangelista, and William W. Mayo-Smith
- Subjects
Adult ,Male ,Internal hernia ,medicine.medical_specialty ,Hernia ,Gastric Bypass ,medicine.disease_cause ,Sensitivity and Specificity ,medicine.artery ,Preoperative Care ,Humans ,Medicine ,Mesenteric lymph nodes ,Mesentery ,Single-Blind Method ,Radiology, Nuclear Medicine and imaging ,Superior mesenteric artery ,Observer Variation ,business.industry ,Gastric bypass surgery ,Reproducibility of Results ,General Medicine ,Middle Aged ,medicine.disease ,digestive system diseases ,Surgery ,Bowel obstruction ,medicine.anatomical_structure ,Case-Control Studies ,Duodenum ,Female ,Radiology ,Tomography, X-Ray Computed ,business - Abstract
Aim To evaluate the sensitivity and specificity of eight previously reported computed tomography (CT) signs in diagnosing internal mesenteric hernia following Roux-en-Y gastric bypass surgery. Materials and methods Preoperative CT images of nine patients with surgically proven internal mesenteric hernia as a complication of gastric bypass surgery and 10 matched control patients were reviewed in a blinded fashion by three radiologists. The presence of eight previously reported signs of internal mesenteric hernia was assessed: mesenteric swirl sign, hurricane eye sign, mushroom sign, small bowel obstruction, clustered small bowel loops, small bowel other than duodenum located behind the superior mesenteric artery (SMA), presence of the jejunal anastomosis to the right of the midline, and engorged mesenteric lymph nodes. The sensitivity and specificity were calculated for each sign, as well as inter-observer reliability in recognizing these signs. Results Mesenteric swirl was the most predictive sign of internal hernia (sensitivity 78–100%, specificity 80–90%). Other CT signs showed good specificity (70–100%), but sensitivities were low (0–44%). The presence of a small-bowel obstruction and engorged mesenteric nodes was found to be 100% specific in predicting the presence of an underlying hernia. There was substantial inter-observer agreement in detecting mesenteric swirl sign (κ = 0.48–0.79), but agreement was relatively poor for all other signs. Conclusion Mesenteric swirl is an easily recognized CT sign, and is the best indicator of internal hernia following Roux-en-Y gastric bypass surgery. Other reported CT signs are diagnostically insensitive. The presence of small-bowel obstruction with engorged mesenteric nodes is highly specific in diagnosing internal mesenteric hernia.
- Published
- 2009
44. Quantitative ultrasound texture analysis for clinical decision making support
- Author
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Adam Tuomi, Jie Ying Wu, Michael D. Beland, Joseph Konrad, Derek Merck, David V. Glidden, and David J. Grand
- Subjects
Pixel ,medicine.diagnostic_test ,Computer science ,business.industry ,Filter (signal processing) ,medicine.disease ,Support vector machine ,Computer-aided diagnosis ,Region of interest ,Feature (computer vision) ,Histogram ,Biopsy ,medicine ,Adenomyosis ,Computer vision ,Artificial intelligence ,Steatosis ,business - Abstract
We propose a general ultrasound (US) texture-analysis and machine-learning framework for detecting the presence of disease that is suitable for clinical application across clinicians, disease types, devices, and operators. Its stages are image selection, image filtering, ROI selection, feature parameterization, and classification. Each stage is modular and can be replaced with alternate methods. Thus, this framework is adaptable to a wide range of tasks. Our two preliminary clinical targets are hepatic steatosis and adenomyosis diagnosis. For steatosis, we collected US images from 288 patients and their pathology-determined values of steatosis (%) from biopsies. Two radiologists independently reviewed all images and identified the region of interest (ROI) most representative of the hepatic echotexture for each patient. To parameterize the images into comparable quantities, we filter the US images at multiple scales for various texture responses. For each response, we collect a histogram of pixel features within the ROI, and parameterize it as a Gaussian function using its mean, standard deviation, kurtosis, and skew to create a 36-feature vector. Our algorithm uses a support vector machine (SVM) for classification. Using a threshold of 10%, we achieved 72.81% overall accuracy, 76.18% sensitivity, and 65.96% specificity in identifying steatosis with leave-ten-out cross-validation (p Extending this framework to adenomyosis, we identified 38 patients with MR-confirmed findings of adenomyosis and previous US studies and 50 controls. A single rater picked the best US-image and ROI for each case. Using the same processing pipeline, we obtained 76.14% accuracy, 86.00% sensitivity, and 63.16% specificity with leave-one-out cross-validation (p
- Published
- 2015
45. Enteric Duplication Cyst of the Pancreas: CT Findings
- Author
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David J. Grand, Leslie H. Sobin, and Elliot K. Fishman
- Subjects
Radiology, Nuclear Medicine and imaging - Published
- 2004
46. Injuries from ingesting wire bristles dislodged from grill-cleaning brushes — Providence, Rhode Island, 2009–2012
- Author
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John J. Cronan, Thomas K. Egglin, Julie Gilchrist, William W. Mayo-Smith, and David J. Grand
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Injury control ,Perforation (oil well) ,Severity of injury ,Poison control ,Abdominal Injuries ,Neck Injuries ,medicine ,Humans ,Severe pain ,Cooking ,Child ,Safety, Risk, Reliability and Quality ,business.industry ,Rhode Island ,Middle Aged ,Cooking and Eating Utensils ,Foreign Bodies ,Cooked food ,medicine.disease ,Deglutition ,Surgery ,Radiography ,Hospital system ,Female ,Foreign body ,Emergency Service, Hospital ,business - Abstract
Foreign object ingestion is a common reason for visiting an emergency department; however, wire grill-cleaning brush bristles are an uncommon foreign object. This report describes a series of twelve cases identified in a single hospital system from July 2009 through June 2012. Patients included six males and six females; ages ranged from 11 to 75 (mean: 47 years). The patients all reported recent outdoor residential food grilling and use of commercially available wire grill-cleaning brushes. The severity of injury ranged from puncture of the soft tissues of the neck, causing severe pain on swallowing, to perforation of the gastrointestinal tract requiring emergent surgery. Before cooking, persons should examine the grill surface carefully for the presence of wire bristles that might have dislodged from the grill brush and could embed in cooked food. Alternative residential grill-cleaning methods or products might be considered.
- Published
- 2012
47. Percutaneous ablation for small renal masses-imaging follow-up
- Author
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David J. Grand, Jason D. Iannuccilli, Damian E. Dupuy, and William W. Mayo-Smith
- Subjects
medicine.medical_specialty ,Percutaneous ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Thermal ablation ,Magnetic resonance imaging ,Computed tomography ,Ablation ,Treatment efficacy ,Article ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Surveillance imaging ,Cardiology and Cardiovascular Medicine ,business ,After treatment - Abstract
Image-guided percutaneous thermal ablation is a safe and effective nephron-sparing alternative to surgical resection for the treatment of small renal tumors. Assessment of treatment efficacy relies heavily on interval follow-up imaging after treatment. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) both play a pivotal role in evaluating the treatment zone, identifying residual tumor, and detecting early and delayed procedure-related complications. This article discusses a surveillance imaging protocol for patients who undergo percutaneous thermal ablation of renal tumors, and also illustrates the typical appearances of both successfully treated tumors and residual disease on contrast-enhanced CT or MRI. In addition, it discusses the imaging appearance of potential early and delayed treatment-related complications to facilitate their prompt detection and management.
- Published
- 2014
48. Practical Body MRI : Protocols, Applications and Image Interpretation
- Author
-
David J. Grand, Courtney A. Woodfield, William W. Mayo-Smith, David J. Grand, Courtney A. Woodfield, and William W. Mayo-Smith
- Subjects
- Medical radiology, Whole body imaging, Magnetic resonance imaging, Diagnostic imaging
- Abstract
Practical Body MRI: Protocols, Applications and Image Interpretation demystifies MRI examinations of the abdomen and pelvis, giving the essential knowledge required by radiologists in order to develop and select appropriate protocols, assess scan quality and interpret imaging studies. Each chapter describes why each sequence is performed, what to look for, and how the important findings from each sequence lead to a unique diagnosis. Numerous protocols are included, from the more common, such as liver and renal MRI, to more tailored examinations such as rectal and placental MRI. All protocols are richly illustrated with images of body MR pathology. A separate chapter discusses MRA/MRV and an introductory chapter gives a brief, practical introduction to MRI physics and receiver coils. The authors'expertise and practical, concise explanations of both protocols and image interpretation makes this an essential resource for residents, fellows and experienced radiologists using body MRI for the first time.
- Published
- 2012
49. Resident experience increases diagnostic rate of thyroid fine-needle aspiration biopsies
- Author
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Michael K. Atalay, Thomas J. T. Anderson, Michael D. Beland, John J. Cronan, and David J. Grand
- Subjects
Male ,medicine.medical_specialty ,education ,Sensitivity and Specificity ,Professional Competence ,Internal medicine ,Biopsy ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Thyroid Nodule ,Endoscopic Ultrasound-Guided Fine Needle Aspiration ,Thyroid.FNA ,medicine.diagnostic_test ,business.industry ,General surgery ,Thyroid ,Training level ,Significant difference ,Internship and Residency ,Reproducibility of Results ,Interventional radiology ,Middle Aged ,Surgical training ,medicine.anatomical_structure ,Fine-needle aspiration ,Female ,business - Abstract
The aim of this study was to determine whether the diagnostic yield of thyroid fine-needle aspirations (FNAs) changes over the course of residency training.We identified 5418 ultrasound-guided thyroid nodule FNAs performed in our radiology department from 2004 through 2012. For each FNA, we recorded if the FNA was performed by a resident and if so the name of the resident and supervising attending radiologist. For each resident, we determined the level of training based on their graduation year from our residency program and the date of the FNA as well as prior surgical training and if they completed subsequent interventional radiology fellowship. Pathology reports were reviewed, and FNAs were classified as diagnostic or nondiagnostic (ND). Generalized mixed models were used to assess ND rate with postgraduate years, including residents with and without prior surgical training or if they subsequently completed an interventional radiology fellowship.Of the 5418 thyroid FNAs, 3164 (58.4%) were performed by a radiology resident under the direct supervision of an attending physician. There was a significant decrease in ND rate as postgraduate years increased (P.05). A significant decrease in ND rate was found as postgraduate years increased for residents without prior surgical training (P = .0007) or subsequent training in interventional radiology (P = .0014); however, no significant decrease was found for residents with surgical training (P = .37) or completing an interventional radiology fellowship (P = .08). In addition, no significant difference was found for ND rate between postgraduate year 4 (PGY4) and PGY5 (P.05).ND thyroid FNA rates progressively decrease with training level, suggesting that early and continued participation in procedures throughout residency improves outcomes. This is particularly true for residents without prior surgical training or subsequent interventional radiology fellowship.
- Published
- 2013
50. 'The sandwich sign': mesenteric lymphoma
- Author
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Anna, Ellermeier, Chad, Ellermeier, and David J, Grand
- Subjects
Male ,Humans ,Mesentery ,Tomography, X-Ray Computed ,Lymphoma, Follicular ,Peritoneal Neoplasms ,Aged - Published
- 2013
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