Bernard A Birnbaum, M.D.

Multi-detector row CT attenuation measurements: assessment of intra- and interscanner variability with an anthropomorphic body CT phantom
Birnbaum, Bernard A; Hindman, Nicole; Lee, Julie; Babb, James S
2007 Jan;242(1):109-119, Radiology
PURPOSE: To determine the dependence of absolute computed tomographic (CT) attenuation values on multi-detector row CT scanner type, convolution kernel, and tube current by using an anthropomorphic phantom. MATERIALS AND METHODS: A customized phantom was designed with tissue-equivalent materials to simulate contrast material-enhanced liver, spleen, pancreas, aorta, kidney, 0- and 50-HU cylindric renal cysts, muscle, and fat. The phantom was scanned with five multi-detector row CT scanners (LightSpeed QXi, GE Healthcare, Milwaukee, Wis; MX8000, Philips Medical Systems, Best, the Netherlands; and Volume Zoom, Sensation 16 and Sensation 64, Siemens Medical Solutions, Forchheim, Germany) on five separate occasions with 120 kVp, low and high tube current settings, 3.00-3.75-mm section thickness, 50% overlap, and standard and high-spatial-resolution kernels. Standardized regions of interest (ROIs) were used to obtain 3510 attenuation measurements. Attenuation dependence on scanner, kernel, and tube current was evaluated by using F tests derived with mixed-model regression. Within the mixed-model framework, the Tukey honestly significant difference procedure and a Bonferroni multiple comparison correction were used to assess differences among imaging regimens and tube current settings, respectively, in terms of tissue attenuation and ROI standard deviation. RESULTS: Tube current had no significant effect (P>.4) on observed tissue attenuation. Significant (P<.0001) differences were observed between imaging regimens with respect to mean attenuation for each tissue type. Convolution kernel modification had an inconsistent effect on tissue attenuation, depending on the scanner. All multi-detector row CT scanners displayed intrascanner variability in tissue attenuation (minimum range: 8.4 HU for fat tissue with the Sensation 16; maximum range: 63.4 HU for liver tissue with the Sensation 64). The scanners behaved differently at the lower range of the CT number scale, where 0-HU cyst attenuation ranged from -15.7 to 23.9 HU and one vendor's equipment showed significantly lower mean attenuation values. CONCLUSION: CT attenuation values vary significantly between different manufacturers' multi-detector row CT scanners, among different generations of multi-detector row CT scanning equipment, and with individual combinations of scanner and convolution kernel. Supplemental material: http://radiology.rsnajnls.org/cgi/content/full/242/1/109/DC1
— id: 70204, year: 2007, vol: 242, page: 109, stat: Journal Article,

Renal cyst pseudoenhancement: influence of multidetector CT reconstruction algorithm and scanner type in phantom model
Birnbaum, Bernard A; Hindman, Nicole; Lee, Julie; Babb, James S
2007 Sep;244(3):767-775, Radiology
PURPOSE: To prospectively determine the dependence of renal cyst pseudoenhancement on multidetector computed tomographic (CT) scanner type and convolution kernel in a phantom model. MATERIALS AND METHODS: A customized anthropomorphic phantom was created to accept interchangeable 40-, 140-, and 240-HU renal inserts that contained stacked 0- and 50-HU cylindric cysts measuring 7, 10, and 15 mm in diameter. Each phantom and insert was scanned with five different multidetector CT scanners on five separate occasions by using 120 kVp, low and high tube current settings, 3.00-3.75-mm collimation, and standard and high-spatial-resolution kernels. A total of 2340 CT attenuation measurements were obtained by using standardized regions of interest. The effect of multidetector CT imaging regimen, tube current, cyst diameter, and renal attenuation on pseudoenhancement incidence was assessed by using generalized estimating equations based on a binary logistic regression model. Within this framework, a Bonferroni multiple comparison correction was used to assess pseudoenhancement frequency differences among imaging regimens. RESULTS: Pseudoenhancement occurred in both 0- and 50-HU cysts; was significantly correlated with multidetector CT imaging regimen (P<.0001), cyst diameter (P<.0001), and renal attenuation (P<or=.032); and was independent of tube current (P>.3). When convolution kernels on specific scanners were compared, significant differences (P<.04) between kernels were identified with all five scanners in terms of observed pseudoenhancement incidence. Generational differences in equipment were noted, with pseudoenhancement incidence ranging from 1.7% to 8.3%, 1.7% to 16.7%, and 18.3% to 56.7% across relevant kernels for three scanners from one manufacturer. CONCLUSION: Pseudoenhancement is strongly dependent on multidetector CT convolution kernel. Varying this parameter may mitigate this phenomenon, which is independent of volume-averaging effects
— id: 73897, year: 2007, vol: 244, page: 767, stat: Journal Article,

CT of Meckel's diverticulitis in 11 patients
Bennett, Genevieve L; Birnbaum, Bernard A; Balthazar, Emil J
2004 Mar;182(3):625-629, American journal of roentgenology
OBJECTIVE: This study reviews the CT findings of Meckel's diverticulitis in 11 patients and, to our knowledge, represents the largest series of such cases reported to date. CONCLUSION: The inflamed Meckel's diverticulum may be visualized on CT in most patients, appearing as a blind-ending pouch of variable size and mural thickness and containing fluid, air, or particulate material with surrounding mesenteric inflammation. The location of the diverticulum may vary from the right lower quadrant to the mid abdomen, with most cases in this series located near midline. Optimal luminal opacification of the ileocecal bowel with oral contrast material facilitated detection of the diverticulum and also proved invaluable in enabling identification of the normal appendix. The diagnosis is most difficult in the setting of secondary intestinal obstruction
— id: 42587, year: 2004, vol: 182, page: 625, stat: Journal Article,

CT of the acute abdomen: gynecologic etiologies
Bennett, G L; Harvey, W B; Slywotzky, C M; Birnbaum, B A
2003 May;28(3):416-432, Abdominal imaging
— id: 34855, year: 2003, vol: 28, page: 416, stat: Journal Article,

Benign and malignant lesions of the stomach: evaluation of CT criteria for differentiation
Insko, Erik K; Levine, Marc S; Birnbaum, Bernard A; Jacobs, Jill E
2003 Jul;228(1):166-171, Radiology
PURPOSE: To determine the sensitivity and specificity of computed tomographic (CT) criteria for differentiating benign from malignant stomach lesions in patients with a thickened gastric wall at CT. MATERIALS AND METHODS: A radiology department file search revealed 36 patients with a thickened gastric wall at CT who underwent double-contrast barium suspension upper gastrointestinal tract examinations within 6 weeks before or after CT. The authors reviewed the CT images without knowledge of the final radiologic, endoscopic, or pathologic findings to determine the degree of gastric wall thickening and the symmetry, distribution, and enhancement of the thickened wall. The sensitivity and specificity of these findings for detection of malignancy were calculated. RESULTS: Two of 36 patients had two gastric abnormalities each. The final diagnoses in the 38 cases were gastritis in 19, hiatal hernia in four, benign ulcer in three, benign (n = 3) or malignant (n = 8) gastric neoplasm in 11, and no gastric abnormality in one case. Mean wall thickness was 1.5 cm (range, 0.7-7.5 cm). The finding of gastric wall thickness of 1 cm or greater had a sensitivity of 100% but a specificity of only 42% for detection of malignant or potentially malignant stomach lesions. The finding of focal, eccentric, or enhancing wall thickening had a sensitivity of 93%, 71%, or 43%, respectively, and a specificity of 8%, 75%, or 88%, respectively, for detection of these lesions. Gastric wall thickening that was 1 cm or greater and was focal, eccentric, and enhancing had a specificity of 92% but a sensitivity of only 36% for detection of these lesions. CONCLUSION: Gastric wall thickness of 1 cm or greater at CT had a sensitivity of 100% but a specificity of less than 50% for detection of malignant or potentially malignant stomach lesions that necessitated further diagnostic evaluation
— id: 61188, year: 2003, vol: 228, page: 166, stat: Journal Article,

CT imaging in acute appendicitis: techniques and controversies
Jacobs, Jill E; Birnbaum, Bernard A
2003 May;24(2):96-100, Seminars in ultrasound CT & MR
— id: 46067, year: 2003, vol: 24, page: 96, stat: Journal Article,

Surgically staged focal liver lesions: accuracy and reproducibility of dual-phase helical CT for detection and characterization
Kamel, Ihab R; Choti, Michael A; Horton, Karen M; Braga, H J V; Birnbaum, Bernard A; Fishman, Elliot K; Thompson, Richard E; Bluemke, David A
2003 Jun;227(3):752-757, Radiology
PURPOSE: To assess the accuracy and reproducibility of dual-phase helical computed tomography (CT) in enabling preoperative detection and characterization of surgically staged focal liver lesions. MATERIALS AND METHODS: Surgically and histopathologically proven liver lesions were evaluated by three experienced CT readers. These lesions were present in 77 patients who underwent dual-phase helical CT. Images were interpreted separately by the three blinded reviewers. Each lesion was graded on a nine-point scale of confidence, with 1 being definitely benign, 9 being definitely malignant, and 5 being indeterminate. The chi2 test was used to determine if the distribution of lesion classifications was different between readers. RESULTS: There was a total of 237 lesions: 73 were benign and 164 were malignant. Sensitivity for lesion detection was 69%, 70%, and 71% for the three reviewers, respectively. Specificity was 91%, 86%, and 90%, and the area under the curve for the alternative-free response receiver operating characteristic curve was 0.84, 0.83, and 0.85, respectively. The difference in the distributions of lesion classification between the three reviewers was not statistically significant (P =.67) as determined by chi2 analysis. CONCLUSION: Dual-phase CT has sensitivity of 69%-71% and high specificity (86%-91%) in enabling the detection and characterization of focal liver lesions. Interpretation is highly reproducible, as there is minimal variation between experienced reviewers
— id: 61187, year: 2003, vol: 227, page: 752, stat: Journal Article,

Helical CT of the right lower quadrant
Birnbaum BA
Body CT: Categorical Course Syllabus [s.l] : American Roentgen Ray Society, 2002,
— id: 3776, year: 2002, vol: , page: 89, stat: Chapter,

Body CT: Categorical Course Syllabus
Birnbaum, Bernard A.; Brink, James; Johnson, C. Daniel; Kazerooni, Ella
[s.l] : American Roentgen Ray Society, 2002,
The goals of this program are to review the basic principles of single and multidetector CT and to evaluate the current status of helical CT in the diagnosis and clinical management of patients with cardiovascular, thoracic, abdominal and musculoskeletal disorders. After completion of the program, the learner should be able to understand the basic principles of single and multidetector CT and appreciate the impact of this technology on radiation dose to the patient; identify both beginning and advanced techniques for cardiothoracic, abdominal and musculoskeletal CT applications; evaluate the current role of helical CT in the diagnosis of cardiothoracic, gastrointestinal, genitourinary and musculoskeletal diseases; optimize helical CT data acquisition for CT angiography procedures; and discuss the evolving role of helical CT as a screening tool to evaluate coronary artery disease, colon cancer and lung cancer
— id: 856, year: 2002, vol: , page: , stat: ,

Renal cyst pseudoenhancement: evaluation with an anthropomorphic body CT phantom
Birnbaum, Bernard A; Maki, Daniel D; Chakraborty, Dev P; Jacobs, Jill E; Babb, James S
2002 Oct;225(1):83-90, Radiology
PURPOSE: To determine the effects of cyst diameter and location (intrarenal, exophytic), renal attenuation, section collimation, and computed tomographic (CT) interscanner variability on renal cyst pseudoenhancement in a phantom model. MATERIALS AND METHODS: A customized anthropomorphic phantom was designed to accept 40-, 140-, and 240-HU renal inserts containing intrarenal and exophytic 7-, 10-, and 15-mm cysts. Each phantom and insert were scanned with five different helical CT scanners by using 1.0-1.5-mm, 2.50-3.75-mm, 5.0-mm, 7.0-8.0-mm, and 10.0-mm section collimation. Means and SDs of CT number measurements were obtained for each cyst within each variably 'enhanced' renal insert. Mixed-model analysis of variance accommodating heteroscedasticity of data was used to assess the effect of scanner type, section collimation, and cyst diameter on cyst attenuation. RESULTS: Pseudoenhancement (range, 10.3-28.3 HU), observed by using effective section collimation equal to or less than 50% of cyst diameter, occurred in 34 (38%) of 90 intrarenal cyst measurements. Pseudoenhancement was observed with all five CT scanners, though the magnitude of the effect was nonuniform. Significant interactions were noted between renal cyst diameter, background renal attenuation, and CT scanner type in terms of their effects on cyst attenuation. No appreciable pseudoenhancement was observed with exophytic cysts. CONCLUSION: Pseudoenhancement is maximal when small (< or = 1.5-cm) intrarenal cysts are scanned during maximal levels of renal parenchymal enhancement. The magnitude of this effect varies with scanner type but may be large enough to prevent accurate lesion characterization, despite use of a thin-section helical CT data acquisition technique
— id: 61190, year: 2002, vol: 225, page: 83, stat: Journal Article,

Spectrum of CT findings in acute pyogenic pelvic inflammatory disease
Sam, Joseph W; Jacobs, Jill E; Birnbaum, Bernard A
2002 Nov-Dec;22(6):1327-1334, Radiographics
Pelvic inflammatory disease (PID) is a common medical problem, affecting nearly 1 million women each year. Although the radiology literature is replete with discussions of the sonographic manifestations of PID, little has been published regarding the computed tomographic (CT) appearances of this entity. CT findings in early PID include obscuration of the normal pelvic floor fascial planes, thickening of the uterosacral ligaments, cervicitis, oophoritis, salpingitis, and accumulation of simple fluid in the endometrial canal, fallopian tubes, and pelvis. As the disease progresses, this simple fluid may become complex and the inflammatory changes may progress to frank tubo-ovarian or pelvic abscesses. Reactive inflammation of adjacent structures is common and can manifest as small or large bowel ileus or obstruction, hydroureter and hydronephrosis, right upper quadrant inflammation (Fitz-Hugh-Curtis syndrome), or peritonitis. Familiarity with the CT appearances of these manifestations is important for timely diagnosis and treatment of PID and its complications
— id: 61189, year: 2002, vol: 22, page: 1327, stat: Journal Article,

Computed tomography evaluation of acute pancreatitis
Jacobs JE; Birnbaum BA
2001 Apr;36(2):92-98, Seminars in roentgenology
— id: 61194, year: 2001, vol: 36, page: 92, stat: Journal Article,

Acute appendicitis: comparison of helical CT diagnosis focused technique with oral contrast material versus nonfocused technique with oral and intravenous contrast material
Jacobs JE; Birnbaum BA; Macari M; Megibow AJ; Israel G; Maki DD; Aguiar AM; Langlotz CP
2001 Sep;220(3):683-690, Radiology
PURPOSE: To compare the diagnostic accuracy of focused helical computed tomography (CT) with orally administered contrast material with that of nonfocused helical CT with orally and intravenously administered contrast material. MATERIALS AND METHODS: After receiving oral contrast material, 228 patients with clinically suspected appendicitis underwent focused appendiceal CT (5-mm section thickness, 15-cm coverage in the right lower quadrant). Immediately thereafter, helical CT of the entire abdomen and pelvis was performed following intravenous administration of contrast material (abdomen, 7-mm section thickness; pelvis, 5-mm section thickness). Studies were separated and independently interpreted by three observers who were blinded to patient names. Diagnoses were established by means of surgical and/or clinical follow-up findings. RESULTS: Fifty-one (22.4%) of 228 patients had acute appendicitis. Readers diagnosed appendicitis with 83.3%, 73.8%, and 71.4% sensitivity and 93.0%, 92.3%, and 97.9% specificity with focused nonenhanced appendiceal CT. Readers diagnosed appendicitis with 92.9%, 92.9%, and 88.1% sensitivity and 93.7%, 95.1%, and 96.5% specificity with nonfocused enhanced CT. Summary areas under the receiver operating characteristic curve estimates for focused nonenhanced and nonfocused enhanced CT were 0.916 and 0.964, respectively; the differences were statistically significant (P <.05) for two of three readers. All readers demonstrated higher sensitivities for detecting the inflamed appendix with nonfocused enhanced CT. Appendicitis was missed with focused CT in two patients whose inflamed appendix was not included in the imaging of the right lower quadrant. All readers were significantly more confident in diagnosing alternative conditions with nonfocused enhanced CT. CONCLUSION: Diagnostic accuracy of helical CT for acute appendicitis improved significantly with use of intravenous contrast material
— id: 43662, year: 2001, vol: 220, page: 683, stat: Journal Article,

Quantitative and qualitative evaluation of volume of low osmolality contrast medium needed for routine helical abdominal CT
Megibow AJ; Jacob G; Heiken JP; Paulson EK; Hopper KD; Sica G; Saini S; Birnbaum BA; Redvanley R; Fishman EK
2001 Mar;176(3):583-589, American journal of roentgenology
OBJECTIVE: The purpose of our study was to determine the minimum optimal dose of IV contrast medium for helical CT that can preserve image quality while reducing cost. SUBJECTS AND METHODS: Four hundred sixty-three patients from six centers were enrolled in a prospective trial in which patients were randomized into one of four weight-based dose categories of iopromide, 300 mg I/mL: 1.25, 1.50, 1.75, and 2.0 mL/kg. Six of 463 patients were excluded from analysis. A radiologist at each center who was unaware of the volume of contrast medium administered determined whether the scans were acceptable. The responses were analyzed by dose, in aggregate, and by weight. Enhancement values (in Hounsfield units) in regions of interest in the liver, pancreas, aorta, and kidneys were obtained at a single time during the scan. The participating radiologist was unaware of these values. Finally, three additional nonparticipating site observers assessed the images for acceptability, diagnostic quality, and overall level of confidence. A cost model comparing incurred charges in using 150 or 100 mL, or 1.5 mL/kg, of low osmolality contrast medium was developed from experience in an additional 303 patients. RESULTS: We found no clinically significant difference in acceptability of scans at doses greater than 1.5 mL/kg. However, significant variability occurred among the centers. The use of 1.5 mL/kg led to a savings of $9927.16 for 303 patients when compared with the use of 150 mL at list price. The cost is the same for 1.5 mL/kg or use of 100 mL of contrast medium. CONCLUSION: A weight-based dose at 1.5 mL/kg of low osmolality contrast medium can provide acceptable scans in most patients, with a significant cost savings
— id: 21245, year: 2001, vol: 176, page: 583, stat: Journal Article,

Radiologic and endoscopic diagnosis of Crohn's disease
Rubesin SE; Scotiniotis I; Birnbaum BA; Ginsberg GG
2001 Feb;81(1):39-70, viii, Surgical clinics of North America
This article reviews the radiologic and endoscopic diagnosis of Crohn's disease. Radiographic and endoscopic findings of Crohn's disease are discussed; a practical approach to the selection of radiologic modalities is presented; and the role of endoscopy in diagnosis and treatment is explained
— id: 61195, year: 2001, vol: 81, page: 39, stat: Journal Article,

The importance of morphine-augmented cholescintigraphy for the diagnosis of a subtle cholecystocolic fistula
Sam JW; Ghesani N; Alavi A; Rubesin SE; Birnbaum BA
2001 Jun;26(6):552-554, Clinical nuclear medicine
— id: 61193, year: 2001, vol: 26, page: 552, stat: Journal Article,

Omental infarction as a delayed complication of abdominal surgery
Schwartzman GJ; Jacobs JE; Birnbaum BA
2001 Sep-Oct;25(5):341-343, Clinical imaging
Omental infarction, an uncommon cause of acute abdominal pain, is the result of compromised perfusion to the greater omentum. Although its etiology remains uncertain, predisposing factors include obesity [Surg. Today 30 (2000) 451], strenuous activity [N. Z. Med. J. 111 (1998) 211], trauma, and idiopathic omental torsion. Often confused with acute appendicitis or cholecystitis on clinical grounds [Surg. Today 30 (2000) 451], its diagnosis has traditionally been one of exclusion, based on intraoperative and pathologic findings. This diagnosis can be made radiologically based on the characteristic findings of an inflammatory mass containing fat and fluid. We describe a case of right lower quadrant omental infarction temporally related to bowel surgery
— id: 61192, year: 2001, vol: 25, page: 341, stat: Journal Article,

Disseminated aspergillosis inciting intestinal ischaemia and obstruction
Shah SS; Birnbaum BA; Jacobs JE
2001 Dec;74(888):1145-1147, British journal of radiology
Invasive aspergillosis is an opportunistic infection that characteristically affects the immunocompromised host, resulting in a high degree of morbidity and mortality. Although the portal of entry is usually pulmonary, there are rare reports of invasive aspergillosis localized to the gastrointestinal tract. In addition, haematological spread may develop, with life threatening disseminated infection involving the vital organs and the gastrointestinal tract. Although disseminated infection is well recognized, the CT findings of gastrointestinal disease have not been reported to our knowledge. We describe the CT findings in a patient with invasive aspergillosis involving the gastrointestinal tract, which resulted in intestinal ischaemia complicated by small bowel obstruction
— id: 61191, year: 2001, vol: 74, page: 1145, stat: Journal Article,

Appendicitis at the millennium
Birnbaum BA; Wilson SR
2000 May;215(2):337-348, Radiology
Acute appendicitis is a common clinical problem. Accurate and prompt diagnosis is essential to minimize morbidity. While the clinical diagnosis may be straightforward in patients who present with classic signs and symptoms, atypical presentations may result in diagnostic confusion and delay in treatment. Helical computed tomography (CT) and graded compression color Doppler ultrasonography (US) are highly accurate means of establishing the diagnosis. These imaging modalities have now assumed critical roles in the treatment of patients suspected to have appendicitis. The purpose of this article is threefold: to provide an update on new information regarding the pathophysiology, clinical diagnosis, and laparoscopic treatment of acute appendicitis; to describe the state-of-the art use of CT and US in diagnosing this disease entity; and to address the role of medical imaging in this patient population
— id: 61196, year: 2000, vol: 215, page: 337, stat: Journal Article,

The costs of CT procedures in an academic radiology department determined by an activity-based costing (ABC) method
Nisenbaum HL; Birnbaum BA; Myers MM; Grossman RI; Gefter WB; Langlotz CP
2000 Sep-Oct;24(5):813-823, Journal of computer assisted tomography
PURPOSE: The purpose of this work was to determine the costs of computed tomography (CT) procedures in a large academic radiology department, including both professional (PC) and technical (TC) components, by analyzing actual resource consumption using an activity-based costing (ABC) method and comparing them with Medicare payments. METHOD: Over a 12 month period from July 1, 1996, to June 30, 1997, 1,011 CT procedures, representing 16 Physicians' Current Procedural Terminology (CPT) codes and 98.3% of CT studies performed, were carefully observed by a research assistant trained in ABC methodology. Information collected during these time and motion studies included personnel/machine time and direct materials used. Actual resource units used during the different activities in each CT procedure were valued using appropriate cost drivers. Unit values for both direct and overhead costs were calculated: the cost of an individual procedure equaled the sum of component costs. Costs were compared with PC and TC payments according to the 1997 Medicare Fee Schedule. RESULTS: Total costs of CPT codes 70450 (CT Head unenhanced), 71260 (CT Chest enhanced), and 74160 (CT Abdomen enhanced), which represented 71.2% of CT studies performed, were $189.19, $273.53, and $343.20, respectively. For all 16 nonmodified CPT codes analyzed, Medicare's professional reimbursement was less than the professional cost, whereas its technical reimbursement exceeded respective cost in 14 of the 16 codes. CONCLUSION: In the setting and time period studied, Medicare underreimbursed professional costs while overreimbursing technical costs
— id: 24404, year: 2000, vol: 24, page: 813, stat: Journal Article,

Thin-section CT imaging of patients suspected of having appendicitis or diverticulitis
Rowling SE; Jacobs JE; Birnbaum BA
2000 Jan;7(1):48-60, Academic radiology
— id: 61198, year: 2000, vol: 7, page: 48, stat: Journal Article,

Isolated infarction of the cecum: CT findings in two patients
Simon AM; Birnbaum BA; Jacobs JE
2000 Feb;214(2):513-516, Radiology
Colonic ischemia isolated to the cecum is a rare entity. The authors evaluated two patients who underwent computed tomography (CT) because appendicitis was suspected at clinical examination. CT findings were suggestive of isolated cecal ischemia or infarction. Surgical-histopathologic findings helped confirm the presumptive CT diagnoses. Isolated cecal infarction should be included in the differential diagnosis of acute right lower quadrant pain
— id: 61197, year: 2000, vol: 214, page: 513, stat: Journal Article,

Assessment of a bolus-tracking technique in helical renal CT to optimize nephrographic phase imaging
Birnbaum BA; Jacobs JE; Langlotz CP; Ramchandani P
1999 Apr;211(1):87-94, Radiology
PURPOSE: To evaluate a bolus-tracking technique in helical computed tomography (CT) for identifying the onset of the nephrographic phase and to determine the effect of varying the volume and injection rate of contrast material on nephrographic phase onset. MATERIALS AND METHODS: Seventy-five patients underwent bolus tracking of contrast material followed by helical renal CT. In 50 patients, 150 mL of 60% iodinated contrast material (iohexol or iothalamate meglumine) was injected at either 2 mL/sec (25 patients [group 1]) or 3 mL/sec (25 patients [group 2]). In 25 patients who had previously undergone nephrectomy, 100 mL of 60% iodinated contrast material was injected at 3 mL/sec (group 3). Nephrographic phase onset was determined by visually assessing the transition to a homogeneous nephrogram during a monitoring scan series starting 40 seconds after injection. RESULTS: Nephrographic phase onset ranged from 60 to 136 seconds (mean, 89 seconds +/- 17 [+/- SD]). Statistically significant differences in mean onset times were observed among groups 1 (103 seconds +/- 12), 2 (91 seconds +/- 16), and 3 (75 seconds +/- 9) (P < .001). Multiple regression analysis showed patient age, contrast material volume, and injection rate to be independent predictors of nephrographic phase onset. Contrast material volume, patient age, and patient weight were independent predictors of the degree of renal enhancement. CONCLUSION: Nephrographic phase onset is highly dependent on methods of contrast material administration and patient characteristics
— id: 61202, year: 1999, vol: 211, page: 87, stat: Journal Article,

Extravasation detection accessory: clinical evaluation in 500 patients
Birnbaum BA; Nelson RC; Chezmar JL; Glick SN
1999 Aug;212(2):431-438, Radiology
PURPOSE: To assess the ability of an extravasation detection accessory (EDA) to detect clinically important (> or = 10 mL) extravascular injection of iodinated contrast material delivered with an automated power injector. MATERIALS AND METHODS: Five hundred patients referred for contrast material-enhanced body computed tomography (CT) participated in a prospective, multi-institutional, observational study in which the EDA was used to identify and interrupt any injection associated with clinically important extravasation. The presence or absence of extravasation was definitively established with helical CT at the injection site (injection rate, from 1.0 to 5.0 mL/sec; mean, 2.9 mL/sec; median, 3.0 mL/sec). RESULTS: There were four true-positive (extravasation volumes, 13-18 mL), 484 true-negative, 12 false-positive, and no false-negative cases. The prevalence of overall and clinically important (> or = 10 mL) extravasation was 3.6% (18 of 500 cases) and 0.8% (four of 500 cases), respectively. The EDA had a sensitivity of 100% (four of four cases; 95% CI: 51%, 100%) and a specificity of 98% (484 of 496 cases; 95% CI: 96%, 99%) in the detection of clinically important extravasation. CONCLUSION: The EDA is easy to use, safe, and accurate in the monitoring of intravenous injections for extravasation, which could prove especially useful in high-flow-rate CT applications
— id: 61201, year: 1999, vol: 212, page: 431, stat: Journal Article,

The hypertrophied antral-pyloric fold: CT appearance
Harvey RT; Levine MS; Birnbaum BA
1999 May;72(857):505-506, British journal of radiology
We report a patient found to have a hypertrophied antral-pyloric fold on barium study, in whom CT demonstrated a smooth soft tissue mass on the anterior wall of the pre-pyloric antrum. When this finding is encountered on CT, a double-contrast upper GI study should be performed as the next diagnostic test. Endoscopy can probably be avoided if the barium study shows the typical findings of a hypertrophied antral-pyloric fold
— id: 61200, year: 1999, vol: 72, page: 505, stat: Journal Article,

Clinical imaging of the small intestine
Herliner, Hans; Maglinte Dean DT; Birnbaum, Bernhard A
New York : Springer, c1999,
— id: 855, year: 1999, vol: , page: , stat: ,

Renal cyst pseudoenhancement: beam-hardening effects on CT numbers
Maki DD; Birnbaum BA; Chakraborty DP; Jacobs JE; Carvalho BM; Herman GT
1999 Nov;213(2):468-472, Radiology
PURPOSE: To determine if simple renal cysts may be accurately characterized with helical computed tomography (CT) during peak levels of renal enhancement. MATERIALS AND METHODS: Water-filled 'cysts' were suspended in varying concentrations of iodine solution, meant to simulate varying levels of renal enhancement, within an abdominal phantom. Volume-averaging effects were minimized by scanning cylindric 5-30-mm cysts with a helical technique (collimation, 5 mm; pitch, 1:1). Axial and helical techniques were then compared, and volume-averaging effects were evaluated by scanning 10- and 20-mm round cysts with 3-, 5-, and 7-mm collimation at background attenuation levels of 100 and 200 HU. RESULTS: Cylindric cyst attenuation increased consistently with increasing background attenuation. As background attenuation increased by 90 HU, attenuation increased by 11-17 HU in small (5- or 10-mm) cysts, and by 7-9 HU in large (15-30-mm) cysts. As background attenuation increased by 180 HU, attenuation increased by 18-28 HU in small cysts and by 10-15 HU in large cysts. Spherical cyst attenuation differences were maximized when smaller cysts were imaged with larger collimation, which is when volume-averaging effects became apparent. Axial and helical CT numbers did not differ substantially. Computer simulation studies showed that the observed effect could not be explained by beam hardening alone. CONCLUSION: Pseudoenhancement of renal cysts may occur if helical CT is performed during peak renal enhancement. CT algorithm modification may be necessary to correct for this effect, which is likely related to an inadequate algorithmic correction for beam hardening
— id: 61199, year: 1999, vol: 213, page: 468, stat: Journal Article,

CT and sonographic evaluation of acute right lower quadrant abdominal pain
Birnbaum BA; Jeffrey RB Jr
1998 Feb;170(2):361-371, American journal of roentgenology
— id: 61208, year: 1998, vol: 170, page: 361, stat: Journal Article,

Bronchogenic cyst appearing as a retroperitoneal mass
Buckley JA; Siegelman ES; Birnbaum BA; Rosato EF
1998 Aug;171(2):527-528, American journal of roentgenology
— id: 61206, year: 1998, vol: 171, page: 527, stat: Journal Article,

Contrast media reactions and extravasation: relationship to intravenous injection rates
Jacobs JE; Birnbaum BA; Langlotz CP
1998 Nov;209(2):411-416, Radiology
PURPOSE: To evaluate the belief that the frequencies of contrast material extravasation and minor, nonidiosyncratic contrast material reactions correlate with intravenous injection rates. MATERIALS AND METHODS: Complications of 6,660 consecutive injections of contrast material for computed tomography were prospectively recorded. Ionic (n = 4,851) or nonionic (n = 1,809) contrast material was injected at 0.5-4.0 mL/sec. The injection rate was 1.9 mL/sec or less in group 1 (n = 2,899), 2.0-2.9 mL/sec in group 2 (n = 2,475), and 3.0-4.0 mL/sec in group 3 (n = 1,286). RESULTS: The extravasation rate (0.6%) did not differ significantly between the groups. The reaction rate (8.4%) also did not differ significantly between the groups. The rate of minor reactions (8.0%) was higher with ionic (9.9%) than nonionic (2.9%) contrast material (relative risk = 3.4). The rate of major reactions (0.4%) did not vary significantly with type of contrast material. The rate of nausea or vomiting (3.8%) did not differ significantly between the groups but was higher with ionic (4.9%) than nonionic (1.1%) contrast material (relative risk = 4.5). The rate of severe warmth (2.1%) was significantly higher in group 3 (2.8%) than group 1 (2.0%) or 2 (1.8%). CONCLUSION: No correlations exist between injection rate and extravasation rate or overall reaction rate
— id: 61204, year: 1998, vol: 209, page: 411, stat: Journal Article,

Diagnostic criteria for fatty infiltration of the liver on contrast-enhanced helical CT
Jacobs JE; Birnbaum BA; Shapiro MA; Langlotz CP; Slosman F; Rubesin SE; Horii SC
1998 Sep;171(3):659-664, American journal of roentgenology
OBJECTIVE: The purpose of the study was to develop quantitative and qualitative criteria for diagnosing fatty liver on contrast-enhanced helical CT. SUBJECTS AND METHODS: Differential liver-spleen attenuation was evaluated between 80 and 120 sec after injection in 76 patients who underwent contrast-enhanced helical CT. Unenhanced CT images had earlier established fatty liver when the liver minus spleen attenuation difference was less than or equal to -10 H (n = 18). Four observers who had not seen the unenhanced images used contrast-enhanced CT images to assess the presence of fatty liver on a five-point Likert scale, the presence of geographic areas spared from fatty infiltration, and the relative liver-spleen attenuation. The diagnostic accuracies of various imaging criteria were compared using McNemar's chi-square test (for sensitivity and specificity) and analysis of receiver operating characteristic curves. RESULTS: Sensitivity, specificity, and receiver operating characteristic curve areas for observers' qualitative judgments were 54%, 95%, and .91, respectively; for quantitative differential liver-spleen attenuation (80-100 sec; -20.5 H discriminatory value), the values were 86%, 87%, and .94, respectively; and for quantitative differential liver-spleen attenuation (101-120 sec; -18.5 H discriminatory value), the values were 93%, 93%, and .98, respectively. Differential liver-spleen attenuation was time-dependent; overlap was noted between healthy subjects and patients with fatty liver. Qualitatively, geographic sparing was highly specific (94%) for fatty liver, whereas liver attenuation greater than or equal to spleen attenuation excluded fatty liver in all but one case. CONCLUSION: Although quantitative and qualitative criteria for diagnosing fatty liver on helical CT can be determined, they are protocol-specific. Limited unenhanced hepatic CT remains the optimal technique for detection of fatty infiltration of the liver
— id: 61205, year: 1998, vol: 171, page: 659, stat: Journal Article,

Contrast media extravasation during dynamic CT: detection with an extravasation detection accessory
Nelson RC; Anderson FA Jr; Birnbaum BA; Chezmar JL; Glick SN
1998 Dec;209(3):837-843, Radiology
To detect extravasation of contrast media during mechanical power injection at dynamic computed tomography, a 5 x 8-cm pliable adhesive patch was applied to the skin over the intravenous cannula and connected to the power injector with a cable to monitor electrical skin impedance. If the rate of change or the slope of impedance over time indicated an extravasation event, the power injector was set into a pause mode. In animal and human studies, monitoring with the device was successful. Extravasation of ionic contrast agents decreased impedance and that of nonionic agents increased impedance
— id: 61203, year: 1998, vol: 209, page: 837, stat: Journal Article,

Hepatic infarction secondary to arterial insufficiency in native livers: CT findings in 10 patients
Smith GS; Birnbaum BA; Jacobs JE
1998 Jul;208(1):223-229, Radiology
PURPOSE: To describe the computed tomographic (CT) appearance of hepatic infarcts resulting from arterial insufficiency in native livers. MATERIALS AND METHODS: The authors retrospectively reviewed the clinical and imaging findings in 10 patients (five men, five women; age range, 28-70 years) with 14 hepatic infarcts seen over 3 years. CT scans were analyzed for infarct appearance, vessel patency, and evolution of infarct pattern over time. RESULTS: Hepatic infarction resulted from hepatobiliary surgery (n = 6), radiologic intervention (n = 3), and celiac occlusion secondary to antiphospholipid syndrome (n = 1). All 14 infarcts were of low attenuation, peripheral, and wedge-shaped. Occluded arterial vessels were identified in eight patients. Follow-up CT revealed infarct diminution with parenchymal atrophy and scarring (n = 5), progressive liquefaction (n = 2), or both parenchymal atrophy and progressive liquefaction (n = 1). CONCLUSION: Sudden interruption of hepatic arterial flow may cause acute native liver infarction. Patients at risk include those with underlying vascular disease who undergo complicated surgical procedures and those undergoing peripheral arterial embolization
— id: 61207, year: 1998, vol: 208, page: 223, stat: Journal Article,

Abdominal computed tomography of intensive care unit patients
Jacobs JE; Birnbaum BA
1997 Apr;32(2):128-141, Seminars in roentgenology
— id: 61210, year: 1997, vol: 32, page: 128, stat: Journal Article,

Abdominal visceral calcification in primary amyloidosis: CT findings
Jacobs JE; Birnbaum BA; Furth EE
1997 Sep-Oct;22(5):519-521, Abdominal imaging
The computed tomographic (CT) findings of extensive visceral calcification involving both the liver and spleen in a patient with primary amyloidosis are presented. Although the CT imaging appearances of amyloidosis are often nonspecific, visceral calcification represents an important diagnostic clue for differentiating this entity from other infiltrative parenchymal diseases
— id: 61209, year: 1997, vol: 22, page: 519, stat: Journal Article,

Ectopic pancreas complicated by pancreatitis and pseudocyst formation mimicking jejunal diverticulitis
Rubesin SE; Furth EE; Birnbaum BA; Rowling SE; Herlinger H
1997 Mar;70:311-313, British journal of radiology
Clinical symptoms are rarely produced by ectopic pancreas arising in the jejunum. We report a case of a patient with left lower quadrant abdominal pain due to jejunal ectopic pancreas complicated by acute pancreatitis and pseudocyst formation
— id: 61211, year: 1997, vol: 70, page: 311, stat: Journal Article,

Multiphasic renal CT: comparison of renal mass enhancement during the corticomedullary and nephrographic phases
Birnbaum BA; Jacobs JE; Ramchandani P
1996 Sep;200(3):753-758, Radiology
PURPOSE: To evaluate thin-section computed tomography (CT) performed during the corticomedullary and nephrographic phases of contrast material enhancement in the characterization of renal masses. MATERIALS AND METHODS: A prospective study of 30 patients was undertaken with CT to characterize 31 'indeterminate' renal masses. In all patients, 5-mm-thick, contiguous, high-tube-current (320-340-mA) scans were obtained through the kidneys before (axial mode), during (helical mode, 25-second delay, corticomedullary-phase images), and after (axial mode, 120-second delay, nephrographic-phase images) administration of a 117-second biphasic injection of intravenous contrast material. RESULTS: Eight of 16 neoplasms measured less than 20 HU on CT scans obtained without contrast material enhancement; measurements of two of these corresponded to 'cyst attenuation' during the corticomedullary phase. Enhancement of 10 HU or greater was demonstrated in 11 neoplasms during the corticomedullary phase and in all neoplasms in the nephrographic phase. No enhancement was seen in 15 radiologically benign cysts. Both renal neoplasms and normal renal cortex demonstrated significantly greater enhancement in the nephrographic phase compared with that in the corticomedullary phase (P = .0002 and P < .0001, respectively). CONCLUSION: Enhancement of renal neoplasms is time dependent and may not be evident in hypovascular tumors analyzed during the early corticomedullary phase. Reliance on absolute CT attenuation measurements, without use of internal standards as controls, may lead to misdiagnosis of neoplasms as cysts
— id: 61214, year: 1996, vol: 200, page: 753, stat: Journal Article,

Heterotopic ossification of midline abdominal incisions: CT and MR imaging findings
Jacobs JE; Birnbaum BA; Siegelman ES
1996 Mar;166(3):579-584, American journal of roentgenology
OBJECTIVE: Heterotopic ossification of a midline surgical incision in a form of myositis ossificans traumatica in which osseous, cartilaginous, and, occasionally, myelogenous elements develop within an abdominal wound. When large amounts of internal ossification are present, the scar may demonstrate a complex radiologic appearance and potentially may be misinterpreted as a retained foreign body or incisional neoplastic recurrence. This report describes the CT and MR imaging findings of this entity. SUBJECTS AND METHODS: The authors retrospectively reviewed the cross-sectional imaging findings of 11 patients with ossified midline abdominal wounds. All but one of the patients were men, and the median age at diagnosis was 40 years old (range, 20-76 years old). Initial imaging was performed 7 days to 36 months after surgery (mean, 6.7 months). CT and MR imaging scans were reviewed, and lesion size, location, distance from the xiphoid, shape, and stability were assessed. Pathologic proof was obtained in one patient. RESULTS: CT and MR imaging examination in all patients showed ossified surgical scars, with the attenuation or signal intensity of the ossified components equivalent to that of the spine. Intralesional, fat-density components suggestive of marrow were present in two patients. All scars were located in the upper abdomen between the anterior abdominal fascia and the peritoneal surface, at the level of or inferior to the xiphoid process. Scars ranged in length from 0.7 to 13.4 cm (mean, 6.9 cm). Distances from the inferior tip of the xiphoid to the superior aspect of the ossified scar ranged from 0 to 4.9 cm (mean, 2.2 cm). Time from surgery to the initial postoperative demonstration of scar ossification ranged from 11 days to 36 months (mean, 6.8 months). None of the five patients who underwent preoperative CT examinations had abnormalities in the location of subsequent scar ossification. Of the nine patients with multiple postoperative examinations, scar size and appearance remained stable in six. In the remaining three patients, scar size was stable but showed progressive internal ossification. CONCLUSION: Heterotopic ossification within midline abdominal scars can be diagnosed by both CT and MR imaging examination. Recognition of the imaging appearances of such ossification should help prevent diagnostic confusion when attending postoperative patients
— id: 61216, year: 1996, vol: 166, page: 579, stat: Journal Article,

Omental caking in Hodgkin's disease. Computed tomography findings
Jacobs JE; Salhany KE; Fox KR; Birnbaum BA
1996 Oct-Dec;20(4):253-255, Clinical imaging
Neoplastic infiltration of the greater omentum is most commonly caused by metastatic ovarian, gastric, colonic, or pancreatic carcinoma. Because the omentum lacks lymphoid elements, lymphomatous infiltration is uncommon. To date, omental involvement by lymphoma has been reported exclusively in patients with non-Hodgkin's lymphomas. In this report, the computed tomography findings of omental caking caused by Hodgkin's lymphoma are described. Although rare, both Hodgkin's and non-Hodgkin's lymphomas should be included in the differential diagnosis of omental caking
— id: 61213, year: 1996, vol: 20, page: 253, stat: Journal Article,

Adrenal masses: correlation between CT attenuation value and chemical shift ratio at MR imaging with in-phase and opposed-phase sequences
Outwater EK; Siegelman ES; Huang AB; Birnbaum BA
1996 Sep;200(3):749-752, Radiology
PURPOSE: To correlate attenuation values at computed tomography (CT) with signal intensity at chemical-shift magnetic resonance (MR) imaging in adrenal masses. MATERIALS AND METHODS: Thirty-eight patients with 47 adrenal lesions underwent MR imaging and unenhanced CT examinations. MR examinations, performed at 1.5 T, included T1-weighted imaging with fat and water in phase and gradient-echo imaging with fat and water out of phase (repetition time, 45-180 msec; echo time, 1.4-3.1 msec). Lesion-to-spleen signal intensity ratios were calculated for the in-phase and opposed-phase images. The chemical-shift ratio, a measure of signal intensity loss between in-phase and opposed-phase images, and the CT attenuation value (in Hounsfield units) were determined for each lesion. RESULTS: A statistically significant correlation (0.85) was found between attenuation and chemical-shift-ratio values (P < .000001). Attenuation in six benign lesions was within 2 standard deviations of the mean attenuation in malignant lesions, and the chemical-shift ratio in eight benign lesions was within 2 standard deviations of the mean chemical-shift ratio in malignant lesions. Six of these eight lesions were misclassified on the basis of both attenuation and chemical-shift-ratio values. CONCLUSION: CT attenuation values are highly correlated with chemical-shift ratios. Both values were indeterminate for a similar subset of benign lesions
— id: 61215, year: 1996, vol: 200, page: 749, stat: Journal Article,

Clinical image. Shoulder harness seatbelt injury: CT appearance of hepatic avulsion with active arterial hemorrhage
Steinberg ML; Birnbaum BA; Jacobs JE; Schwab CW
1996 Nov-Dec;20(6):938-939, Journal of computer assisted tomography
— id: 61212, year: 1996, vol: 20, page: 938, stat: Journal Article,

Small masses in the kidney
Birnbaum BA
1995 Apr;164(4):1019-1020, American journal of roentgenology
— id: 61221, year: 1995, vol: 164, page: 1019, stat: Journal Article,

Glutaraldehyde colitis: radiologic findings
Birnbaum BA; Gordon RB; Jacobs JE
1995 Apr;195(1):131-134, Radiology
PURPOSE: Two percent glutaraldehyde on colonic mucosa may result in a toxic colitis, and the clinical features may mimic those of colonic ischemia. The study was performed to determine the radiologic appearance of glutaraldehyde-induced toxic colitis. MATERIALS AND METHODS: A retrospective review was performed with the clinical and imaging findings in four patients with glutaraldehyde-induced colitis seen during a 6-year period. RESULTS: Patients developed a self-limited syndrome of cramps and abdominal pain, tenesmus, and rectal bleeding within 48 hours of uncomplicated sigmoidoscopy or colonoscopy. Sample cultures excluded enteric pathogens. Computed tomography (CT) demonstrated circumferential thickening of the colonic wall in a left-sided distribution in all patients. Heterogeneous mural enhancement (target-sign appearance) was noted in two patients. Follow-up CT studies confirmed resolution of mural wall thickening with conservative management. CONCLUSION: The clinical and radiologic features of glutaraldehyde-induced toxic colitis may mimic those of colonic ischemia. This complication should be suspected in patients who develop hemorrhagic colitis immediately after undergoing colonoscopy
— id: 61219, year: 1995, vol: 195, page: 131, stat: Journal Article,

Hepatic enhancement during helical CT: a comparison of moderate rate uniphasic and biphasic contrast injection protocols
Birnbaum BA; Jacobs JE; Yin D
1995 Oct;165(4):853-858, American journal of roentgenology
OBJECTIVE. The purpose of this study was to compare the degree and timing of peak hepatic enhancement, optimal scanning intervals, and optimal delay times of moderate-rate uniphasic and biphasic contrast material injection protocols for hepatic helical CT. MATERIALS AND METHODS. One hundred fifty patients were randomized into three injection protocols, receiving 42.3 g iodine (150 ml iothalamate meglumine) delivered using 3 ml/sec uniphasic, 2 ml/sec uniphasic, or biphasic (3 ml/sec [50 ml], 1 ml/sec [100 ml]) technique. Statistically fitted aortic and hepatic enhancement curves were generated from dynamic incremental CT data for each patient. Protocols were compared by maximum hepatic enhancement, and contrast enhancement indices were modeled for a 38-sec helical acquisition. RESULTS. The 3 ml/sec and 2 ml/sec uniphasic protocols produced higher peak hepatic enhancement (64 +/- 15 H and 62 +/- 15 H [mean +/- 1 SD]) than the 3 ml/sec biphasic protocol (52 +/- 10 H; p < .001). Contrast enhancement indices for the 3 ml/sec uniphasic and 2 ml/sec uniphasic protocols (385 +/- 398 H/sec and 397 +/- 412 H/sec) were significantly greater than the index for the 3 ml/sec biphasic protocol (123 +/- 194 H/sec; p < .0001) at a 50-H threshold. Optimal scan delay times were 50 +/- 8, 75 +/- 7, and 119 +/- 8 sec, respectively, for the 3 ml/sec uniphasic, 2 ml/sec uniphasic, and 3 ml/sec biphasic techniques. CONCLUSION. The moderate-rate uniphasic injections studied provided greater hepatic enhancement throughout the helical acquisition without requiring the prohibitively long delay time necessitated by the moderate-rate biphasic injection. These findings differ from prior results that showed that a uniphasic injection may provide comparable levels of hepatic enhancement when compared with a high-flow-rate biphasic injection
— id: 61218, year: 1995, vol: 165, page: 853, stat: Journal Article,

Small renal parenchymal neoplasms: further observations on growth [see comments]
Bosniak MA; Birnbaum BA; Krinsky GA; Waisman J
1995 Dec;197(3):589-597, Radiology
PURPOSE: To determine the growTH rate and behavior of small (< or = 3.5-cm diameter) incidentally detected renal parenchymal neoplasms. MATERIALS AND METHODS: Forty renal parenchymal tumors in 37 adult patients (mean age, 65.5 years) were observed with computed tomography (CT) and ultrasound for 1.75-8.5 years (mean, 3.25 years). Surgical removal was performed of 26 tumors proved and graded at pathologic examination. Fourteen tumors with CT criteria of neoplasm are being followed up. RESULTS: The overall growth rate of neoplasms was 0-1.1 cm/y (mean, 0.36 cm/y). Thirty tumors grew 0.5 cm/y or less and 19 grew very slowly (< or = 0.35 cm/y). No patient developed metastatic disease. Nine (24%) had multiple neoplasms. CONCLUSION: Most small, incidentally discovered, well-marginated renal parenchymal neoplasms grow slowly and are not an immediate threat to a patient's life. Watchful waiting might be appropriate instead of surgical removal, especially in patients who are elderly or may not survive surgery
— id: 6890, year: 1995, vol: 197, page: 589, stat: Journal Article,

Computed tomography imaging of focal hepatic lesions
Jacobs JE; Birnbaum BA
1995 Oct;30(4):308-323, Seminars in roentgenology
— id: 61217, year: 1995, vol: 30, page: 308, stat: Journal Article,

CT of inflammatory disease of the colon
Jacobs JE; Birnbaum BA
1995 Apr;16(2):91-101, Seminars in ultrasound CT & MR
CT plays an important role in the evaluation of patients with suspected colonic inflammation. High-resolution, thin-section imaging of the gastrointestinal tract allows assessment of both the intraluminal and extraluminal components of colonic disease, thereby enabling radiologists to detect and stage colonic pathology accurately. In addition, CT can be used to guide percutaneous drainage of abscess collections, often obviating the need for surgical intervention. This article describes CT techniques for diagnosing inflammatory diseases of the colon as well as the typical CT appearances
— id: 61220, year: 1995, vol: 16, page: 91, stat: Journal Article,

Acute appendicitis: CT and US correlation in 100 patients
Balthazar EJ; Birnbaum BA; Yee J; Megibow AJ; Roshkow J; Gray C
1994 Jan;190(1):31-35, Radiology
PURPOSE: To compare the accuracy of computed tomography (CT) and ultrasonography (US) in the diagnosis of acute appendicitis. MATERIALS AND METHODS: One hundred consecutive patients were examined with US and CT, and the results, independently reported, were correlated with surgical and histopathologic findings (69 patients) and data from other laboratory and clinical follow-up (31 patients). RESULTS: Fifty-four patients had acute appendicitis; 46 patients did not. Analysis of the data for CT and US, respectively, revealed sensitivity, 96% versus 76%; specificity, 89% versus 91%; accuracy, 94% versus 83%; positive predictive value, 96% versus 95%; and negative predictive value, 95% versus 76%. In the 46 patients without appendicitis, an alternative diagnosis was made with CT in 22 patients and with US in 15. CT scans showed abscesses and/or phlegmons in 28% of patients with appendicitis versus 17% at US. Results of CT and US were discordant in 20 patients; CT findings were correct in 17 and US findings in three. CONCLUSION: CT is more accurate than US in diagnosis of acute appendicitis
— id: 6316, year: 1994, vol: 190, page: 31, stat: Journal Article,

CT of appendicitis and diverticulitis
Birnbaum BA; Balthazar EJ
1994 Sep;32(5):885-898, Radiologic clinics of North America
CT scans have made a significant impact on the diagnosis and staging of those gastrointestinal disorders that are associated with perienteric inflammatory extension. Appendicitis and diverticulitis are examples of such diseases, and this article reviews the current role of CT scans in the diagnosis and management of patients with these conditions
— id: 43887, year: 1994, vol: 32, page: 885, stat: Journal Article,

Renal cell carcinoma: correlation of CT findings with nuclear morphologic grading in 100 tumors
Birnbaum BA; Bosniak MA; Krinsky GA; Cheng D; Waisman J; Ambrosino MM
1994 May-Jun;19(3):262-266, Abdominal imaging
The contrast-enhanced preoperative computed tomographic (CT) scans and microscopic slides of 94 patients with 100 surgically resected renal cell carcinomas (RCCs) were retrospectively and independently reviewed in order to correlate the CT imaging findings of RCC with nuclear grading. As nuclear grade increased, RCCs were more likely to be of higher stage and greater size at presentation, and appeared more heterogeneous and less marginated. Of the features analyzed, tumor margination most closely correlated with nuclear grade. Overlap in the CT appearance of individual tumors limited the potential of CT to differentiate RCCs of varying grade. Small, well-marginated, homogeneous tumors, however, were either grade I or II, and were distinguishable from the more aggressive grade III lesions, which generally displayed irregular margins and greater inhomogeneity
— id: 12974, year: 1994, vol: 19, page: 262, stat: Journal Article,

Comparison of contrast enhanced CT and Mn-DPDP enhanced MRI for detection of focal hepatic lesions. Initial findings
Birnbaum BA; Weinreb JC; Fernandez MP; Brown JJ; Rofsky NM; Young SW
1994 Jan-Mar;18(1):21-27, Clinical imaging
Twenty-nine patients with known or suspected focal hepatic disease were evaluated in a retrospective multi-institutional study comparing T1-weighted manganese (II) N,N'-dipyridoxylethylenediamine-N,N'-diacetate 5,5'-bis (phosphate) (DPDP) enhanced magnetic resonance imaging (MRI) with dynamic sequential bolus contrast enhanced computed tomography (DBCT) for the detection of focal liver lesions. The patients were divided into four dose groups, receiving 3, 5, 8, or 10 mumol/kg of Mn-DPDP, delivered either via intravenous bolus (0.25 ml/sec) or infusion (1 ml/sec). Each of three readers, with varying levels of expertise in interpreting hepatic MRI and CT studies, identified more lesions on the Mn-DPDP enhanced MRI than the contrast enhanced CT images. Mn-DPDP enhanced MRI depicted the presence of extensive metastatic disease not seen with DBCT in three patients with fatty liver. The most experienced MRI reader saw more lesions per patient on the Mn-DPDP enhanced MRI than with DBCT, while the opposite held true for the most experienced CT reader. The best single exam for detection of hepatic lesions may be determined by the experience of the reader
— id: 6325, year: 1994, vol: 18, page: 21, stat: Journal Article,

Acute cholangitis: CT evaluation
Balthazar EJ; Birnbaum BA; Naidich M
1993 Mar-Apr;17(2):283-289, Journal of computer assisted tomography
The CT findings of 23 patients with proven acute ascending cholangitis were retrospectively evaluated. Computed tomography confirmed the clinical diagnosis and detected the site and etiology of the obstructive process in the majority of patients. Biliary dilatation consistent with the clinical suspicion of acute cholangitis was present in 18 patients (78%), the level of the obstruction was detected in 15 patients, and the etiology of the obstructive process was visualized in 14 cases. Five patients presented with air in the biliary tree and three patients had liver abscesses. There was no good correlation established between jaundice, biliary infection, and the presence or degree of biliary dilatation. Biliary obstruction and acute cholangitis can develop before biliary dilatation is detected. In addition, CT showed limitations in establishing the etiology of the obstructive process, particularly in failing to detect 7 of 17 cases of cholesterol biliary stones
— id: 13226, year: 1993, vol: 17, page: 283, stat: Journal Article,

Graphical interface for medical image processing
Noz ME; Maguire GQ Jr; Birnbaum BA; Sanger JJ; Kramer EL; Chapnick JV; Kaminer EA
1993 Feb;17(1):1-16, Journal of medical systems
We have developed a graphical interface which allows users of varying levels of computer experience and proficiency to manipulate medical image-processing data with 'point-and-click' ease. The power which had formerly been associated with protocols and shell scripts has been combined with the flexibility and 'user-friendliness' of buttons and dialog boxes
— id: 25912, year: 1993, vol: 17, page: 1, stat: Journal Article,

Closed-loop and strangulating intestinal obstruction: CT signs [see comments]
Balthazar EJ; Birnbaum BA; Megibow AJ; Gordon RB; Whelan CA; Hulnick DH
1992 Dec;185(3):769-775, Radiology
In 19 patients with closed-loop intestinal obstruction, including 16 patients with strangulating obstruction, the findings at examination with computed tomography (CT) were retrospectively correlated with the surgical and pathologic findings and evaluated by two radiologists. Signs of closed-loop obstruction, present in 15 patients, were associated with the configuration of the incarcerated loop of small bowel, abnormalities detected at the site of obstruction, or both. These abnormalities were the following: a U-shaped, distended, fluid-filled bowel loop; the whirl sign; the beak sign; a triangular loop; two adjacent collapsed loops of bowel at the site of obstruction; or all of these. CT signs of strangulation, seen in 10 of the 16 patients with ischemic or infarcted bowel, were associated with the appearance of the bowel wall (thickening, high attenuation, and the target sign), abnormalities in the attached mesentery, or both. In mechanical obstruction of the small bowel, detection of ischemic changes in the bowel wall or mesentery with CT indicates strangulation. Absence of CT findings of ischemia or infarction does not rule out strangulation
— id: 13358, year: 1992, vol: 185, page: 769, stat: Journal Article,

High-attenuation lymphadenopathy in AIDS patients: significance of findings at CT
Herts BR; Megibow AJ; Birnbaum BA; Kanzer GK; Noz ME
1992 Dec;185(3):777-781, Radiology
A retrospective evaluation was performed of the location and attenuation characteristics of abdominal and pelvic lymphadenopathy, identified at dynamic sequential bolus computed tomography (CT) in 69 patients with acquired immunodeficiency syndrome (AIDS). Lymph node appearance at CT was characterized as hyperattenuating, isoattenuating, or hypoattenuating relative to the iliopsoas muscle. The significance of finding hyperattenuating adenopathy in the patient population was evaluated. Thirty-three patients had hyperattenuating adenopathy, including 26 with the epidemic form of Kaposi sarcoma (KS). Of 38 patients with epidemic KS, 26 had hyperattenuating, 11 had isoattenuating, and one had hypoattenuating lymphadenopathy. The positive predictive value of hyperattenuating adenopathy for epidemic KS was 79%. These findings were statistically significant at the 95% confidence interval (P < .005). Hyperattenuating lymphadenopathy, identified on dynamic sequential bolus CT scans in AIDS patients, was seen with disseminated KS in approximately 80% of cases
— id: 13357, year: 1992, vol: 185, page: 777, stat: Journal Article,

Appendicitis: prospective evaluation with high-resolution CT
Balthazar EJ; Megibow AJ; Siegel SE; Birnbaum BA
1991 Jul;180(1):21-24, Radiology
Computed tomography (CT) was used to prospectively evaluate 100 patients with clinical indications for acute appendicitis. Examinations were performed with the terminal ileum and cecum filled with contrast material. Acute appendicitis was diagnosed when an abnormal appendix or inflammatory changes plus an appendicolith were detected. Failure to visualize an abnormal appendix or appendicolith in the presence of pericecal inflammatory changes was considered suspicious but nonspecific. CT results were correlated with surgical and pathologic results (74 patients) and other radiologic and clinical findings (26 patients). CT helped to diagnose appendicitis (64 patients) and nonspecific right lower quadrant inflammation (five patients) and to rule out appendicitis (31 patients). CT had a 98% sensitivity, an 83% specificity, and a 93% accuracy. In 17 of 31 patients without CT evidence of appendicitis, other conditions explaining their symptoms were detected. When the clinical diagnosis is in doubt, CT can be used successfully to evaluate patients with acute appendicitis
— id: 43686, year: 1991, vol: 180, page: 21, stat: Journal Article,

Asymmetry of the renal nephrograms on CT: significance of the unilateral prolonged cortical nephrogram
Birnbaum BA; Bosniak MA; Megibow AJ
1991 ;12(4):173-177, Urologic radiology
The finding of asymmetry in the renal nephrograms as manifested by a unilateral prolonged cortical nephrogram on dynamic contrast-enhanced CT examinations signifies the presence of an abnormality of renal parenchymal perfusion and/or tubular transit. The differential diagnostic possibilities include stenosis or long-standing occlusion of the renal artery, renal vein thrombosis, and urinary tract obstruction
— id: 14160, year: 1991, vol: 12, page: 173, stat: Journal Article,

Hepatic hemangiomas: diagnosis with fusion of MR, CT, and Tc-99m-labeled red blood cell SPECT images
Birnbaum BA; Noz ME; Chapnick J; Sanger JJ; Megibow AJ; Maguire GQ Jr; Weinreb JC; Kaminer EM; Kramer EL
1991 Nov;181(2):469-474, Radiology
A method of image analysis was developed for correlation of hemangiomas detected at computed tomography (CT) and/or magnetic resonance (MR) imaging with increased blood pool activity evident at single photon emission CT (SPECT) performed after labeling of red blood cells with technetium-99m. Image analysis was performed in 20 patients with 35 known hepatic hemangiomas. After section thickness and pixel sizes of the different studies were matched, intrinsic landmarks were chosen to identify anatomically corresponding locations. Regions of interest (ROIs) drawn on the CT and/or MR images were translated, rotated, and reprojected to match the areas of interest on the corresponding SPECT images by means of a two-dimensional polynomial-based warping algorithm. Analysis of ROIs on 30 SPECT-MR and 20 SPECT-CT pairs of registered images provided absolute confirmation that 34 suspected hemangiomas identified on SPECT images correlated exactly with lesions seen on CT and/or MR images. Accuracy of fusion was within an average of 1.5 pixels +/- 0.8 (+/- 1 standard deviation). The technique enabled diagnostic confirmation of hemangiomas as small as 1.0 cm and proved useful for evaluating lesions located adjacent to intrahepatic vessels
— id: 13849, year: 1991, vol: 181, page: 469, stat: Journal Article,

Bowel obstruction: evaluation with CT [see comments]
Megibow AJ; Balthazar EJ; Cho KC; Medwid SW; Birnbaum BA; Noz ME
1991 Aug;180(2):313-318, Radiology
Eighty-four computed tomographic (CT) scans from patients referred for bowel obstruction between January 2, 1988, and December 31, 1989, were retrospectively evaluated. A pair of radiologists without knowledge of patient histories determined the presence or absence of bowel obstruction. Sixty-four patients ultimately proved to have intestinal obstruction, and 20 did not. Diagnosis was established by means of surgery (n = 39), barium studies (n = 17), and clinical course (n = 28). Causes of obstruction included adhesions (n = 37), metastases (n = 6), primary tumor (n = 7), Crohn disease (n = 4), hernia (n = 3), hematoma (n = 2), colonic diverticulitis (n = 2), and other (n = 3). In addition, 83 CT examinations in patients with no history or indication of intestinal obstruction were simultaneously reviewed. The overall sensitivity was 94%, specificity was 96%, and accuracy was 95%. The cause of obstruction was correctly predicted in 47 of 64 cases (73%). Intestinal obstruction was not diagnosed in any of the 83 control patients. CT is most useful in patients with a history of abdominal malignancy and in patients who have not been operated on and who have signs of infection, bowel infarction, or a palpable abdominal mass
— id: 13943, year: 1991, vol: 180, page: 313, stat: Journal Article,

Renal lesion characterization with gadolinium-enhanced MR imaging: efficacy and safety in patients with renal insufficiency [see comments]
Rofsky NM; Weinreb JC; Bosniak MA; Libes RB; Birnbaum BA
1991 Jul;180(1):85-89, Radiology
Five patients with renal insufficiency were studied with T1-weighted magnetic resonance (MR) imaging before and after intravenous administration of gadopentetate dimeglumine (0.1 mmol/kg) to characterize renal lesions that were detected with nonenhanced computed tomography (CT) and were considered indeterminate. Four patients demonstrated renal lesions that enhanced after gadolinium administration. A total of five lesions in these four patients were surgically resected and found to be renal cell carcinoma at pathologic examination. The fifth patient was spared surgery because a hyperattenuated lesion noted at nonenhanced CT did not enhance with intravenous gadolinium, indicating a benign cyst. Five incidentally occurring benign cysts removed at the time of nephrectomy in two of the patients did not demonstrate enhancement with gadolinium on MR images. Serial serum creatine levels were obtained before and after gadolinium administration in all patients; no changes were noted after gadolinium administration. Gadolinium-enhanced MR imaging is an effective method for characterizing renal lesions in patients with renal insufficiency. At the usual dosage, there appears to be no nephrotoxic reaction in these patients
— id: 13969, year: 1991, vol: 180, page: 85, stat: Journal Article,

Observations on the growth of renal neoplasms
Birnbaum BA; Bosniak MA; Megibow AJ; Lubat E; Gordon RB
1990 Sep;176(3):695-701, Radiology
A retrospective review of the imaging results of 11 patients with 13 solid renal parenchymal neoplasms was performed, allowing analysis of the linear growth rates of these tumors. The study sample included seven pathologically proved renal adenocarcinomas and six lesions that were indicative of a neoplasm radiologically (enhancing parenchymal mass on computed tomographic [CT] scans with documented interval growth), which were followed up for 2-7.8 years. Variable interval tumor growth was demonstrated in every case except one and ranged from 0 to 1.6 cm/y, with an overall mean linear growth rate of approximately 0.5 cm/y. Ten of 11 'small renal neoplasms' (less than or equal to 3.0 cm in diameter) displayed interval growth, with five ultimately measuring greater than 3.0 cm (size range, 3.5-7.0 cm). While the results are preliminary and reflect observations on a very small study sample, it was noted that five of the seven pathologically proved adenocarcinomas appeared homogeneous and well marginated, and all were low-grade, low-stage carcinomas. These grew more slowly and were generally smaller at initial presentation than higher-grade lesions, which demonstrated a more heterogeneous appearance on CT scans
— id: 43687, year: 1990, vol: 176, page: 695, stat: Journal Article,

Extrarenal genitourinary tuberculosis: CT appearance of calcified pipe-stem ureter and seminal vesicle abscess
Birnbaum BA; Friedman JP; Lubat E; Megibow AJ; Bosniak MA
1990 Jul-Aug;14(4):653-655, Journal of computer assisted tomography
— id: 43688, year: 1990, vol: 14, page: 653, stat: Journal Article,

Definitive diagnosis of hepatic hemangiomas: MR imaging versus Tc-99m-labeled red blood cell SPECT
Birnbaum BA; Weinreb JC; Megibow AJ; Sanger JJ; Lubat E; Kanamuller H; Noz ME; Bosniak MA
1990 Jul;176(1):95-101, Radiology
Thirty-seven patients with 69 suspected hemangiomas found by means of computed tomography (CT) and/or ultrasound were studied with both 0.5-T magnetic resonance (MR) imaging and single photon emission CT (SPECT) with technetium-99m-labeled red blood cells. Using a criterion of 'perfusion-blood pool mismatch,' SPECT readers diagnosed 50 of 64 hemangiomas and all five 'nonhemangiomas' (sensitivity, 78% [95% confidence interval, 0.664 - 0.864]; accuracy, 80% [0.69 - 0.877]). Qualitative analysis of lesion signal intensity on T2-weighted spin-echo MR images allowed readers to diagnose 58 of 64 hemangiomas and four of five nonhemangiomas (sensitivity, 91% [0.814 - 0.96]; accuracy, 90% [0.807 - 0.951]). Because of the significantly higher cost of MR imaging and its inability to categorically differentiate hemangiomas from hypervascular metastases, the authors consider SPECT to be the method of choice for diagnosing hepatic hemangiomas. MR imaging should be reserved for the diagnosis of lesions smaller than 2.0 cm and for those 2.5 cm and smaller adjacent to the heart or major hepatic vessels; in such cases MR imaging was found superior to SPECT
— id: 33316, year: 1990, vol: 176, page: 95, stat: Journal Article,

CT diagnosis of posterior perineal hernia
Lubat E; Gordon RB; Birnbaum BA; Megibow AJ
1990 Apr;154(4):761-762, American journal of roentgenology
— id: 43689, year: 1990, vol: 154, page: 761, stat: Journal Article,

Extrapulmonary Pneumocystis carinii infection in AIDS: CT findings
Lubat E; Megibow AJ; Balthazar EJ; Goldenberg AS; Birnbaum BA; Bosniak MA
1990 Jan;174(1):157-160, Radiology
Clinical and computed tomographic (CT) findings in three cases of extrapulmonary Pneumocystis carinii infection in patients with acquired immunodeficiency syndrome (AIDS) were reviewed. Proved sites of involvement included the spleen (n = 2), bone marrow (n = 1), liver (n = 1), and peritoneal and pleural fluid (n = 1). CT findings included focal low-attenuation splenic lesions that became progressively calcified in rimlike or punctate fashion; punctate calcifications in the liver, renal cortices, and adrenal glands; calcification of lymph nodes; and pleural and peritoneal effusions with subsequent calcifications of the pleural and peritoneal surfaces. Although rare both before and since the onset of the AIDS epidemic, extrapulmonary P carinii infection in AIDS patients has been reported with increasing frequency in recent years, and more cases with radiologic manifestations should be expected
— id: 43693, year: 1990, vol: 174, page: 157, stat: Journal Article,

Kaposi's sarcoma. CT-radiographic correlation
Naidich DP; Tarras M; Garay SM; Birnbaum B; Rybak BJ; Schinella R
1989 Oct;96(4):723-728, Chest
The role of CT in the diagnosis of intrathoracic Kaposi's sarcoma (KS) was evaluated retrospectively in 24 patients, in the absence of coexistent opportunistic infections. In all cases the diagnosis of KS was initially established by histologic evaluation of extrathoracic disease: 15 patients had verified parenchymal KS and nine patients endobronchial KS. (Chest roentgenograms were analyzed separately for each group: in 14 patients serial films were available for review. The predominant radiographic findings was the presence of nonspecific, bilateral, perihilar infiltrates in 22 of 24 cases (92 percent). Corresponding CT scans documented the presence of abnormal hilar densities characteristically extending into the adjacent pulmonary parenchyma along distinctly perivascular and peribronchial pathways. Discrete, poorly marginated nodules were identified radiographically in ten cases (42 percent); these proved to be randomly distributed throughout the parenchyma on CT. Radiographic evidence of mediastinal adenopathy was distinctly unusual, seen in only two cases (8 percent). While CT typically demonstrated shotty adenopathy, significantly enlarged nodes (greater than 1 cm) were rarely identified. We concluded that CT is more specific than routine roentgenograms for identifying pulmonary KS. While not pathognomonic, peribronchial and perivascular disease is sufficiently characteristic to obviate more invasive diagnostic procedures, especially in patients with established KS
— id: 10467, year: 1989, vol: 96, page: 723, stat: Journal Article,