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Effect of flip angle for optimization of image quality of gadoxetate disodium-enhanced biliary imaging at 1.5 T

Kim, Sooah; Mussi, Thais C; Lee, Lawrence J; Mausner, Elizabeth V; Cho, Kyunghee C; Rosenkrantz, Andrew B
OBJECTIVE: The purpose of this study was to perform a qualitative and quantitative comparison of image quality of gadoxetate disodium-enhanced imaging of the biliary system acquired using different flip angles (FAs). MATERIALS AND METHODS: Thirty-two patients (21 men and 11 women; mean [+/- SD] age, 51 +/- 16 years) who underwent gadoxetate disodium-enhanced 1.5-T MRI were included. A 3D fat-suppressed T1-weighted gradient-echo sequence was acquired during the hepatobiliary phase using FAs of 12 degrees , 25 degrees , and 40 degrees . One radiologist, who was blinded to FA, measured signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) of the biliary tree. Two other blinded radiologists assessed subjective biliary duct clarity, overall image quality, background signal suppression, and ghosting artifact from the biliary tree using a scale of 1 to 4. RESULTS: SNRs and CNRs of the common bile duct were significantly higher for FAs of 25 degrees (227.5 +/- 113.2 and 191.0 +/- 102.2, respectively) and 40 degrees (239.6 +/- 118.7 and 201.7 +/- 107.7, respectively) than for 12 degrees (168.9 +/- 73.9 and 126.7 +/- 59.7, respectively; all p < 0.001). There were no significant differences in SNR or CNR between FAs of 25 degrees and 40 degrees (p >/= 0.360). Clarity of first-, second-, and third-order intrahepatic ducts, background signal suppression, and overall image quality were significantly higher for both readers for FAs of 25 degrees and 40 degrees than for 12 degrees (all p /= 0.091), aside from improved depiction of third-order ducts at 40 degrees for one reader (p = 0.030). Biliary ghosting artifact was significantly worse at 40 degrees than at 12 degrees for both readers (p
PMID: 23255746
ISSN: 0361-803x
CID: 204132

Differentiating pancreatic cystic neoplasms from pancreatic pseudocysts at MR imaging: value of perceived internal debris

Macari, Michael; Finn, Myra E; Bennett, Genevieve L; Cho, Kyunghee C; Newman, Elliot; Hajdu, Cristina H; Babb, James S
PURPOSE: To retrospectively evaluate the sensitivity and specificity of several morphologic findings that may be seen with cystic pancreatic lesions, in the diagnosis of pseudocyst at magnetic resonance (MR) imaging. MATERIALS AND METHODS: This study was institutional review board approved and HIPAA compliant. From January 1, 2005, to December 31, 2007, electronic radiology and pathology databases were searched to identify patients with pancreatic cystic neoplasms or pseudocysts who underwent pancreatic MR imaging. Twenty-two patients with cystic pancreatic neoplasms that were confirmed at surgical resection (n = 12) or endoscopic ultrasonography (US) with cystic fluid analysis (n = 10) were identified. Of 20 patients with pancreatic pseudocysts, seven had pseudocysts that were identified at pathologic resection and 13 had a clinical history of pancreatitis, with initial computed tomography (CT) revealing no pancreatic cyst and subsequent follow-up MR imaging depicting cystic lesions. Two abdominal radiologists independently and randomly evaluated each case for presence or absence of septa and internal dependent debris and for external cyst morphology on axial and coronal T2-weighted images and three-dimensional gradient-echo T1-weighted images obtained before and after intravenous contrast agent administration. Logistic regression for correlated data was used to assess the usefulness of internal debris, external morphology, and septa for differentiating cystic neoplasms from pseudocysts. RESULTS: The readers' assessments of the presence or absence of cystic debris were concordant for 40 (95%) of the 42 patients, with a kappa coefficient of 0.889, which indicated nearly perfect agreement. Thirteen (93%) of 14 lesions found to have debris by either or both readers were pseudocysts, and only one (4%) of the 22 cystic neoplasms had debris. Both readers were more likely to identify septa within cystic neoplasms than within pseudocysts; however, the difference was not significant for either reader. The readers were more likely to observe microlobulated morphology in cystic neoplasms than in pseudocysts, with the difference between these lesion types, in terms of prevalence of microlobulated morphology, exhibiting a trend toward-but not reaching-statistical significance (P = .0627). CONCLUSION: Presence of internal dependent debris appears to be a highly specific MR finding for the diagnosis of pancreatic pseudocyst
PMID: 19332847
ISSN: 1527-1315
CID: 97865

CT diagnosis of mucocele of the appendix in patients with acute appendicitis

Bennett, Genevieve L; Tanpitukpongse, Teerath P; Macari, Michael; Cho, Kyunghee C; Babb, James S
OBJECTIVE: The purpose of this study was to identify the CT features of mucocele of the appendix coexisting with acute appendicitis and to determine whether this entity can be differentiated from acute appendicitis without mucocele. MATERIALS AND METHODS: CT scans of 70 patients (12 with acute appendicitis with mucocele, 29 with acute appendicitis without mucocele, 29 with a normal appendix) were retrospectively interpreted by two readers. The appendix was evaluated for maximal luminal diameter, cystic dilatation, luminal attenuation, appendicolith, mural calcification and enhancement, periappendiceal fat stranding, fluid, and lymphadenopathy. CT findings were compared by use of Mann-Whitney U and Fisher's exact tests. Receiver operating characteristics analysis was performed to assess the diagnostic utility of appendiceal luminal diameter in differentiating acute appendicitis with from that without coexisting mucocele. RESULTS: Cystic dilatation of the appendix and maximal luminal diameter achieved statistical significance (p < 0.05) for the diagnosis of acute appendicitis with mucocele. Mural calcification achieved statistical significance for one reader (p = 0.0049) and a statistical trend for the other (p < 0.1). A maximal luminal diameter greater than 1.3 cm had a sensitivity of 71.4%, specificity of 94.6%, and overall diagnostic accuracy of 88.2% for the diagnosis of acute appendicitis with mucocele. CONCLUSION: Although there is overlap with acute appendicitis without mucocele, CT features suggestive of coexisting mucocele in patients with acute appendicitis include cystic dilatation of the appendix, mural calcification, and a luminal diameter greater than 1.3 cm
PMID: 19234237
ISSN: 1546-3141
CID: 95059

MDCT and superparamagnetic iron oxide (SPIO)-enhanced MR findings of intrapancreatic accessory spleen in seven patients

Kim, Se Hyung; Lee, Jeong Min; Han, Joon Koo; Lee, Jae Young; Kang, Won Joon; Jang, Jin Young; Shin, Kyung-Sook; Cho, Kyunghee C; Choi, Byung Ihn
The aim of this study is to retrospectively evaluate intrapancreatic accessory spleen (IPAS) with mutidetector computed tomography (MDCT) and superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) with emphasis on the role of SPIO-MRI for the diagnosis of IPAS. Seven patients (four men and three women; mean age, 50.7 years) with IPAS underwent quadriphasic MDCT and SPIO-enhanced MRI. IPAS was diagnosed histopathologically (n=2) or by scintigraphy (n=5). Two radiologists evaluated CT and MRI in consensus for the location and size of each lesion and compared its attenuation on CT and signal intensity (SI) on MRI with those of the pancreas and spleen. For quantitative analysis, another radiologist calculated the mean lesional, pancreatic, and splenic attenuations or SIs on MDCT or MRI in each patient. All lesions were located in the pancreatic tail. The average lesion size was 1.5+/-0.5 cm. All IPASs except one appeared high-attenuating to the pancreas and were isoattenuating to the spleen on all dynamic CT phases. The IPASs were hypointense and hyperintense compared with the pancreas on unenhanced T1- and T2-weighted images, respectively, and their SI was similar to that of the spleen. On SPIO-enhanced, T2-weighted images, a similar degree of signal drop to that of the spleen was noted in all lesions. The results of the quantitative analysis were compatible with those of the subjective analysis. In most IPASs, the attenuation on CT and SI on MRI were identical to those of the spleen, and on SPIO-enhanced MRI, the degree of the signal drop in all lesions was similar to that of the spleen
PMID: 16547707
ISSN: 0938-7994
CID: 66707

Hepatitis status, child-pugh classification, and serum AFP levels predict survival in patients treated with transarterial embolization for unresectable hepatocellular carcinoma

Reichman, Trevor W; Bahramipour, Phil; Barone, Alison; Koneru, Baburao; Fisher, Adrian; Contractor, Daniel; Wilson, Dorian; Dela Torre, Andrew; Cho, Kyunghee C; Samanta, Arun; Harrison, Lawrence E
Hepatocellular carcinoma (HCC) represents one of the most prevalent cancers worldwide. Most patients are not surgical candidates, and transarterial embolization (TAE) has been used to treat patients with unresectable HCC. The purpose of this study was to identify factors that predict survival in patients treated with TAE at a Western medical center. Review of a prospective database identified 345 patients treated for HCC at University Hospital (Newark, NJ) between July 1998 and July 2004. Of these patients, 109 patients underwent TAE. Eleven of these patients were subsequently treated surgically and excluded from this study. Of the remaining 98 patients, demographic data and laboratory values were analyzed to predict survival by univariate and multivariate analysis. Several factors, including hepatitis status, Child-Pugh classification, serum alpha fetoprotein levels <500 ng/ml, bilirubin <2.0 mg/dl, prothrombin time <16 seconds, platelet count <200 x 10(9)/l, albumin >3.5 gm/dl, and multiple treatments, predicted survival by univariate analysis. Serum alpha fetoprotein levels, Child-Pugh classification, and hepatitis status were found by multivariate analysis to independently predict survival. These factors may help to select patients with unresectable HCC who might benefit from TAE
PMID: 15862257
ISSN: 1091-255x
CID: 66708

A multicenter evaluation of utility of chest computed tomography and bone scans in liver transplant candidates with stages I and II hepatoma

Koneru, Baburao; Teperman, Lewis W; Manzarbeitia, Cosme; Facciuto, Marcelo; Cho, Kyunghee; Reich, David; Sheiner, Patricia; Fisher, Adrian; Noto, Khristian; Goldenberg, Alec; Korogodsky, Maria; Campbell, Donna
OBJECTIVE: To determine utility of practice of chest computed tomography (CCT) and bone scan (BS) in patients with early-stage hepatoma evaluated for transplantation (LT). SUMMARY BACKGROUND DATA: Consensus-based policy mandates routine CCT and BS in LT candidates with hepatoma. No data exist either to support or refute this policy. METHODS: From January 1999 to December 2002, stages I and II hepatoma patients evaluated at 4 centers were included. Scan interpretation was positive, indeterminate, or negative. Outcomes of evaluation and transplantation were compared between groups based on scans. Total charges incurred were derived from mean of charges at the centers. RESULTS: One hundred seventeen stages I and II patients were evaluated. None had positive scans, 78 had negative, 29 had at least 1 indeterminate, and 10 did not have 1 or both scans. Twelve patients were declined listing, 6 from progression of hepatoma but none from CCT or BS findings. Two listed patients were delisted for progression of the hepatoma. Proportion of patients listed, transplanted, clinical and pathologic stage of hepatoma, and recurrence after LT were similar in groups with negative and indeterminate scans. Indeterminate scans led to 6 invasive procedures, 1 patient died of complications of a mediastinal biopsy, and none of the 6 showed metastases. Charges of $2933 were generated per patient evaluated. CONCLUSIONS: Positive yield of routine CCT and BS in patients with hepatoma is very low despite substantial charges and potential complications. CCT and BS performed only when clinically indicated will be a more cost-effective and safer approach
PMCID:1357066
PMID: 15798464
ISSN: 0003-4932
CID: 66709

Are routine chest computed tomography and bone scan required in patients with hepatoma and cirrhosis undergoing liver transplant evaluation? A cooperative study by the hepatoma and liver transplantation (HALT) [Meeting Abstract]

Koneru, B; Teperman, L; Manzarbeitia, C; Facciuto, M; Cho, K; Reich, D; Campbell, D; Scheiner, P; Fisher, A; Korogodsky, M; Noto, K
ISI:000221322501023
ISSN: 1600-6135
CID: 46605

Images in liver transplantation. Spontaneous portosystemic shunting several years following liver transplantation: successful treatment via percutaneous embolization [Case Report]

Abujudeh, Hani H; Samanta, Arun K; Cho, Kyunghee C; Klein, Kenneth M; Bahramipour, Phillip; Koneru, Baburao
PMID: 14762875
ISSN: 1527-6465
CID: 66710

Locoregional recurrences are frequent after radiofrequency ablation for hepatocellular carcinoma

Harrison, Lawrence E; Koneru, Baburao; Baramipour, Phil; Fisher, Adrian; Barone, Alison; Wilson, Dorian; Dela Torre, Andrew; Cho, Kyunghee C; Contractor, Daniel; Korogodsky, Maria
BACKGROUND: Enthusiasm for radiofrequency ablation (RFA) therapy for patients with unresectable hepatocellular carcinoma (HCC) has increased. The data for recurrence after RFA for patients with HCC is not well documented. The purpose of this study was to evaluate tumor recurrence patterns after RFA in patients with unresectable HCC. STUDY DESIGN: Over a 3-year period, 50 patients having RFA for unresectable HCC were identified at a single institution. Medical records and radiologic studies were reviewed and outcomes factors analyzed. RESULTS: Of the entire cohort, 46 patients underwent RFA by a percutaneous approach under CT guidance. Most patients underwent either one (n = 22) or two ablations (n = 23). At the time of this report, 14 patients (28%) were tumor-free by radiologic and biochemical (alpha-fetoprotein) parameters. Eighteen additional patients had persistence of tumor at the ablation site and 14 patients had recurrence in the liver at sites different from the ablation site. An additional four patients had recurrence in extrahepatic sites. Twelve patients underwent orthotopic liver transplantation after RFA. Of these 12, 5 (42%) demonstrated no viable tumor in the explanted liver. Independent predictors of tumor recurrence included tumor size, serum AFP levels, and the presence of hepatitis. CONCLUSIONS: These data suggest that factors such as tumor size should be considered before employing RFA therapy. In addition to treating the primary tumor, other therapies aimed at the liver's inflammatory state might also be important in achieving a durable response after RFA
PMID: 14585410
ISSN: 1072-7515
CID: 66711

Prospective validation of computed tomographic screening of the thoracolumbar spine in trauma

Hauser, Carl J; Visvikis, George; Hinrichs, Clay; Eber, Corey D; Cho, Kyunghee; Lavery, Robert F; Livingston, David H
OBJECTIVE: Concern for thoracolumbar spine (TLS) injuries after major trauma mandates immobilization pending radiographic evaluation. Current protocols use standard posteroanterior and lateral radiographs of the thoracolumbar spine (XR/TLS), but many patients also undergo abdominal or thoracic computed tomographic (CT) scanning. We sought to evaluate whether helical truncal CT scanning performed to evaluate visceral trauma images the spine as well as dedicated XR/TLS. METHODS: We prospectively studied 222 consecutive patients sustaining high-risk trauma requiring TLS screening because of clinical findings or altered mentation. The chest, abdomen, and pelvis were imaged with one intravenous contrast infusion. All patients had CT scan of the chest, abdomen, and pelvis (CT/CAP) and XR/TLS. Initial radiologic diagnoses were compared with the discharge diagnosis of acute fractures confirmed by thin-cut CT scan and/or clinical examination of the patient when alert. RESULTS: Of 222 patients studied, 215 were fully evaluated. Thirty-six (17%) had acute TLS fractures. The accuracy of CT/CAP for TLS fractures was 99% (95% confidence interval [CI], 96-100%). The accuracy of XR/TLS was 87% (95% CI, 82-92%). Sensitivity, specificity, and positive and negative predictive values were better for CT/CAP than for XR/TLS. CT/CAP found acute fractures XR/TLS missed, and correctly classified old fractures XR/TLS read as 'possibly' acute. The total XR/TLS misclassification rate was 12.6% (95% CI, 8.4-19%); for CT/CAP it was 1.4% (95% CI, 0.3-3.3%). No fractures were missed by CT/CAP. No unstable fracture was missed by either technique. CONCLUSION: CT/CAP diagnoses TLS fractures more accurately than XR/TLS. Neither misses unstable fractures, but CT scanning finds small fractures that benefit by treatment and identifies chronic disease better. CT screening is far faster and shortens time to removal of spine precautions. CT scan-based diagnosis does not result in greater radiation exposure and improves resource use. Screening the TLS on truncal helical CT scanning performed for the evaluation of visceral injuries is more accurate than TLS imaging by standard radiography. CT/CAP should replace plain radiographs in high-risk trauma patients who require screening
PMID: 12913630
ISSN: 0022-5282
CID: 66712