Jill E Jacobs, M.D.

Coronary cta assessment of coronary anomalies
Pursnani A.; Jacobs J.E.; Saremi F.; Levisman J.; Makaryus A.N.; Capunay C.; Rogers I.S.; Wald C.; Azmoon S.; Stathopoulos I.A.; Srichai M.B.
2012 ;6(1):48-59, Journal of Cardiovascular Computed Tomography
Coronary anomalies occur in <1% of the general population and can range from a benign incidental finding to the cause of sudden cardiac death. The coronary anomalies are classified here according to the traditional grouping into those of origin and course, intrinsic arterial anatomy, and termination. Classic coronary anomalies of origin and course include those in which a coronary artery originates from the contralateral aortic sinus or the pulmonary artery with anomalous course. Single coronary artery anomalies, in which single coronary artery branches to supply the entire coronary tree, are also included in this category. Anomalies of intrinsic arterial anatomy are a broad class that includes myocardial bridges, coronary ectasia and aneurysms, subendocardial coursing arteries, and coronary artery duplication. Coronary anomalies of termination are those in which a coronary artery terminates in a fistulous connection to a great vessel or cardiac chamber. In the case of those anomalies associated with a risk of sudden cardiac death, the relevant imaging features on CT angiography (CTA) associated with poorer prognosis are reviewed. Recent guidelines and appropriateness criteria favor the use of coronary CTA for the evaluation of coronary anomalies. Although invasive angiography has historically been used to diagnose coronary anomalies, multidetector CT imaging techniques have now become an accurate noninvasive alternative. Cardiac CTA provides excellent spatial and temporal resolution, allowing accurate anatomical assessment of these anomalies. 2012 Society of Cardiovascular Computed Tomography
— id: 150871, year: 2012, vol: 6, page: 48, stat: Journal Article,

Reply
Nevsky G.; Jacobs J.E.; Srichai M.B.
2011 ;197(5):W967-W967, American journal of roentgenology
— id: 141501, year: 2011, vol: 197, page: W967, stat: Journal Article,

Sex-Specific Normalized Reference Values of Heart and Great Vessel Dimensions in Cardiac CT Angiography
Nevsky, Gregory; Jacobs, Jill E; Lim, Ruth P; Donnino, Robert; Babb, James S; Srichai, Monvadi B
2011 Apr;196(4):788-794, American journal of roentgenology
OBJECTIVE: Published cardiac CT angiography (CTA) reference measurements for the cardiac chambers, aorta, and pulmonary artery (PA) are incomplete and compromised by study population, coronary artery disease (CAD), or its risk factors. The purpose of our study was to establish sex-specific normalized ranges of cardiac chamber size, wall thickness, ejection fraction (EF), and aorta and PA diameter on cardiac CTA in a population without CAD or its risk factors. MATERIALS AND METHODS: Seventy-six patients (38 men and 38 women) without known diabetes; hypertension; smoking history; or evidence of structural heart, vascular, or coronary artery diseases underwent 64-MDCTA. Obtained left atrial (LA) size, left ventricular (LV) volumes, LV wall thickness, thoracic aorta, and PA diameter measurements were normalized to body surface area (BSA). RESULTS: There were statistically significant differences noted between men and women for all measured left-sided heart and great vessel measurements. After normalization to BSA, only chamber dimensions and ascending aorta and left PA sizes remained significantly different. Selected normalized measurements for men versus women, respectively, include LA area, 10.6 +/- 2.1 versus 12.3 +/- 2.1 cm(2)/m(2); LV end-diastolic size, 72.4 +/- 15.1 versus 60.9 +/- 13.3 mL/m(2); EF, 67% +/- 7% versus 72% +/- 8%; aortic sinus, 1.6 +/- 0.2 versus 1.7 +/- 0.2 cm/m(2); ascending aorta, 1.4 +/- 0.2 versus 1.6 +/- 0.2 cm/m(2); descending aorta, 1.1 +/- 0.1 versus 1.2 +/- 0.1 cm/m2; main PA, 1.3 +/- 0.1 versus 1.4 +/- 0.1 cm/m(2); right PA, 1.1 +/- 0.1 versus 1.1 +/- 0.2 cm/m(2); and left PA, 1.0 +/- 0.1 versus 1.1 +/- 0.1 cm/m(2). CONCLUSION: Cardiac CTA measurements of the left cardiac chambers, thoracic aorta, and pulmonary arteries were established for a population without CAD or its risk factors
— id: 128808, year: 2011, vol: 196, page: 788, stat: Journal Article,

CORONARY COMPUTED TOMOGRAPHY ANGIOGRAP
Srichai-Parsia, Monvadi Barbara; Lim, Ruth P.; Mannelli, Lorenzo; Donnino, Robert; Hiralal, Rajesh; Ho, Corey K.; Babb, James S.; Jacobs, Jill E.
2011 APR 5 ;57(14):E672-E672, Journal of the American College of Cardiology
— id: 134896, year: 2011, vol: 57, page: E672, stat: Journal Article,

Evaluation of the Mitral and Aortic Valves With Cardiac CT Angiography
Chheda, Samir V; Srichai, Monvadi B; Donnino, Robert; Kim, Danny C; Lim, Ruth P; Jacobs, Jill E
2010 Feb;25(1):76-85, Journal of thoracic imaging
Cardiac computed tomographic angiography (CTA) using multidetector computed tomographic scanners has proven to be a reliable technique to image the coronary vessels. CTA also provides excellent visualization of the mitral and aortic valves, and yields useful information regarding valve anatomy and function. Accordingly, an assessment of the valves should be performed whenever possible during CTA interpretation. In this paper, we highlight the imaging features of common functional and structural left-sided valvular disorders that can be seen on CTA examinations
— id: 107290, year: 2010, vol: 25, page: 76, stat: Journal Article,

Computed tomographic evaluation of the normal cardiac anatomy
Jacobs, Jill E
2010 Jul;48(4):701-710, Radiologic clinics of North America
Accurate interpretation of cardiac computed tomography requires fundamental knowledge of the normal cardiac anatomy and its common variations. This article reviews the normal anatomy of the coronary arteries, cardiac chambers, and cardiac valves
— id: 111967, year: 2010, vol: 48, page: 701, stat: Journal Article,

Preface
Jacobs, Jill E
2010 Jul;48(4):xiii-xiii, Radiologic clinics of North America
— id: 111830, year: 2010, vol: 48, page: xiii, stat: Journal Article,

Cardiac Events Predicted by Computed Tomography Coronary Angiography
Donnino, R; Jacobs, JE; Doshi, JV; Pursnani, S; Babb, JS; Kim, DC; Sedlis, SP; Srichai, MB
2009 MAR 10 ;53(10):A272-A272, Journal of the American College of Cardiology
— id: 97556, year: 2009, vol: 53, page: A272, stat: Journal Article,

Dual-source versus single-source cardiac CT angiography: comparison of diagnostic image quality
Donnino, Robert; Jacobs, Jill E; Doshi, Jay V; Hecht, Elizabeth M; Kim, Danny C; Babb, James S; Srichai, Monvadi B
2009 Apr;192(4):1051-1056, American journal of roentgenology
OBJECTIVE: Dual-source CT improves temporal resolution, and theoretically improves the diagnostic image quality of coronary artery examinations without requiring preexamination beta-blockade. The purpose of our study was to show the improved diagnostic image quality of dual-source CT compared with single-source CT despite the absence of preexamination beta-blockade in the dual-source CT group. MATERIALS AND METHODS: We performed a retrospective analysis of consecutive patients who underwent coronary artery evaluation with either single-source CT or dual-source CT at our institution between February 2005 and October 2006. Examination reports were analyzed for the presence of image artifacts, and image quality was graded on a 3-point scale (no, mild, or severe artifact). Type of artifact (motion, calcium, quantum mottle) was also noted. RESULTS: Examinations (339 single-source CT and 126 dual-source CT) of 465 patients were analyzed. Artifact was reported in 39.8% of examinations using single-source CT and in 29.4% of examinations using dual-source CT (p < 0.05). The number of examinations with motion artifact was significantly higher with single-source CT than with dual-source CT (15.9% vs 4.8%; p < 0.001) despite significantly higher heart rates in the dual-source CT group (59.4 +/- 8.4 vs 68.6 +/- 14.6 beats per minute; p < 0.001). No patients in the dual-source CT group received preexamination beta-blockade compared with 81% of patients in the single-source CT group. The presence of severe (nondiagnostic) calcium artifact was also significantly reduced in the dual-source CT group (13.0% vs 3.2%; p < 0.001). CONCLUSION: Dual-source CT provides significantly better diagnostic image quality than single-source CT despite higher heart rates in the dual-source CT group. These findings support the use of dual-source CT for coronary artery imaging without the need for preexamination beta-blockade
— id: 97842, year: 2009, vol: 192, page: 1051, stat: Journal Article,

The Value of Clinical Risk Strati. cation by the Morise Score in Assessing the Presence of Obstructive and Nonobstructive Coronary Artery Disease in Symptomatic Women
Hong, SN; Mieres, JH; Jacobs, JE; Patel, P; Pearte, CA; Srichai, MB
2009 MAR 10 ;53(10):A269-A269, Journal of the American College of Cardiology
— id: 97555, year: 2009, vol: 53, page: A269, stat: Journal Article,

Aberrant crossed left circumflex and left anterior descending arteries: diagnosis with multidetector cardiac CT angiography
Shepard, Timothy F; Srichai, Monvadi B; Kim, Danny; Lim, Ruth; Jacobs, Jill E
2009 Mar-Apr;33(2):211-214, Journal of computer assisted tomography
The multidetector coronary computed tomography angiogram findings of a rare variant crossed left circumflex and left anterior descending artery are presented. In this patient, multidetector coronary computed tomography angiogram enabled clear delineation of the aberrant coronary artery anatomy, including an estimation of patency during systole and diastole. To our knowledge, this is only the second reported case of this particular coronary artery anomaly in the world literature
— id: 97866, year: 2009, vol: 33, page: 211, stat: Journal Article,

Dual-source computed tomography angiography image quality in patients with fast heart rates
Srichai, Monvadi B; Hecht, Elizabeth M; Kim, Danny; Babb, James; Bod, Jessica; Jacobs, Jill E
2009 Sep-Oct;3(5):300-309, Journal of Cardiovascular Computed Tomography
BACKGROUND: Dual-source computed tomography (DSCT) provides diagnostic quality images of the coronary arteries over a wide range of heart rates (HRs). Current dose reduction techniques, including electrocardiographic (ECG) dose modulation and prospective triggering, are optimized for use in patients with relatively slow (<70 beats/min) HRs by limiting radiation dose to the ideal phases of image acquisition. OBJECTIVE: We evaluated coronary vessel image quality (IQ) at different reconstruction phases in patients with fast HRs (>80 beats/min) to assess potential feasibility of prospective triggering techniques on DSCT. METHODS: Patients (n=101) underwent 64-slice DSCT with retrospective ECG-gating without beta-blocker premedication. Image reconstructions were performed at 10% R-R wave phase intervals (0%-90%). Patients were grouped by mean HR: group A, <60 beats/min (n=22); group B, 60-80 beats/min (n=57); group C, >80 beats/min (n=22). Coronary artery IQ was assessed by 2 readers in consensus on a 5-point scale. RESULTS: Optimal IQ occurred at 70% phase for all arteries in groups A and B. In group C, optimal IQ occurred at 30% and 40% phases. The 70% phase achieved diagnostic IQ in 97% of group A and 86% of group B. A widened reconstruction window (30%-50%) was necessary for diagnostic IQ in a similar high proportion (84%) of group C. CONCLUSION: Optimal IQ occurs during late-systolic phases for patients with fast HRs (>80 beats/min). Late-systolic phase prospective triggering is potentially feasible in these patients; however, given the widened reconstruction windows required, a higher radiation dose may be required compared with patients with slower HRs (<80 beats/min)
— id: 104344, year: 2009, vol: 3, page: 300, stat: Journal Article,

Myocardial bridging: evaluation using single- and dual-source multidetector cardiac computed tomographic angiography
Jacobs, Jill E; Bod, Jessica; Kim, Danny C; Hecht, Elizabeth M; Srichai, Monvadi B
2008 Mar-Apr;32(2):242-246, Journal of computer assisted tomography
OBJECTIVE: To evaluate the prevalence and characteristics of myocardial bridging in patients who underwent single- or dual-source multidetector cardiac computed tomographic angiography (MDCTA). METHODS: Retrospective review of the imaging characteristics of 57 myocardial bridges in 53 patients who underwent cardiac MDCTA examinations was performed. RESULTS: The prevalence of myocardial bridges was 10.4%, most of which were located in the mid-left anterior descending coronary artery. The average myocardial bridge length was 23.4 mm, and the average tunneled artery depth was 2.6 mm. CONCLUSIONS: Myocardial bridges are commonly found in patients who undergo cardiac multidetector computed tomographic angiograms on both single- and dual-source computed tomographic scanners and are most frequently located in the mid-left anterior descending coronary artery. Increasing utilization of cardiac MDCTA for noninvasive evaluation of coronary artery disease permits recognition, characterization, and functional assessment of this entity in a single examination
— id: 78740, year: 2008, vol: 32, page: 242, stat: Journal Article,

Is it ventricular diverticulum or closed muscular ventricular septal defect? - Reply
Srichai, MB; Phoon, CKL; Jacobs, JE
2008 JUN ;190(6):W375-W375, American journal of roentgenology
— id: 86982, year: 2008, vol: 190, page: W375, stat: Journal Article,

Anatomy of the heart at multidetector CT: what the radiologist needs to know
O'Brien, James P; Srichai, Monvadi B; Hecht, Elizabeth M; Kim, Daniel C; Jacobs, Jill E
2007 Nov-Dec;27(6):1569-1582, Radiographics
Continued improvements in multidetector computed tomographic (CT) scanners have made cardiac CT an important clinical tool that is revolutionizing cardiac imaging. Multidetector CT with submillimeter collimation and gantry rotation times under 0.5 seconds allows the acquisition of studies with high temporal resolution and isotropic voxels. The volumetric data set that is generated can be analyzed with a depth previously not possible, requiring a solid understanding of the cardiac anatomy and its appearance on CT scans and postprocessed images
— id: 75160, year: 2007, vol: 27, page: 1569, stat: Journal Article,

Consensus update on the appropriate usage of cardiac computed tomographic angiography
Poon, Michael; Rubin, Geoffrey D; Achenbach, Stephan; Attebery, Tim W; Berman, Daniel S; Brady, Thomas J; Jacobs, Jill E; Hecht, Harvey S; Lima, Joao A C; Weigold, Wm Guy
2007 Nov;19(11):484-490, Journal of invasive cardiology
— id: 133532, year: 2007, vol: 19, page: 484, stat: Journal Article,

Ventricular diverticula on cardiac CT: more common than previously thought
Srichai, Monvadi B; Hecht, Elizabeth M; Kim, Danny C; Jacobs, Jill E
2007 Jul;189(1):204-208, American journal of roentgenology
OBJECTIVE: We describe the findings of contrast-enhanced gated cardiac CT in 15 patients with 23 incidentally noted cardiac ventricular diverticula. CONCLUSION: Cardiac diverticula most commonly occur in the left ventricle but have been reported to occur in all chambers of the heart. Despite reports of their rare occurrence, cardiac ventricular diverticula are fairly common findings in patients undergoing cardiac MDCT angiography.
— id: 72986, year: 2007, vol: 189, page: 204, stat: Journal Article,

How to perform coronary CTA: A to Z
Jacobs JE
2006 ;35(12SUPPL.):10-21, Applied radiology
— id: 70826, year: 2006, vol: 35, page: 10, stat: Journal Article,

How to perform coronary CTA: A to Z... includes discussion
Jacobs JE
2006 ;Supplement:10-21,70 Dec, Applied radiology
— id: 71785, year: 2006, vol: Supplement, page: 10, stat: Journal Article,

CT and sonography for suspected acute appendicitis: a commentary
Jacobs, Jill E
2006 Apr;186(4):1094-1096, American journal of roentgenology
— id: 64389, year: 2006, vol: 186, page: 1094, stat: Journal Article,

ACR practice guideline for the performance and interpretation of cardiac computed tomography (CT)
Jacobs, Jill E; Boxt, Lawrence M; Desjardins, Benoit; Fishman, Elliot K; Larson, Paul A; Schoepf, Joseph
2006 Sep;3(9):677-685, Journal of the American College of Radiology : JACR
Cardiac computed tomography (CT) is an evolving modality that includes a variety of examinations to assess the anatomy and pathology of the cardiac chambers, valves, myocardium, coronary arteries and veins, pericardium, aortic root, and central great vessels. The development of multidetector CT scanners with increasing numbers of detector rows, narrow section thicknesses, increasing scanner speeds, the ability for electrocardiographic gating, and radiation dose modulation allows the performance of CT coronary arteriography. Computed tomography coronary arteriography enables the assessment of multiple types of cardiac pathology, including intraluminal coronary arterial plaque formation, coronary artery stenosis, congenital anomalies, coronary artery aneurysms, sequelae of cardiac ischemia, and the assessment of prior vascular interventions, while providing information about cardiac and valvular function. Noncardiac structures included in cardiac CT examinations must also be evaluated. This guideline attempts to maximize the probability of detecting cardiac abnormalities with cardiac CT. American College of Radiology requirements for physicians and personnel performing examinations are also addressed and will become applicable by July 1, 2008
— id: 73578, year: 2006, vol: 3, page: 677, stat: Journal Article,

Quadricuspid aortic valve: Imaging findings on multidetector helical CT with echocardiographic correlation
Jacobs, Jill E; Srichai, Monvadi; Kim, Danny; Hecht, Elizabeth; Kronzon, Itzhak
2006 Jul-Aug;30(4):569-571, Journal of computer assisted tomography
Cardiac multidetector helical computed tomography angiogram (MDCTA) findings of a quadricuspid aortic valve are presented. MDCTA enabled evaluation of the aortic valve and its function, the coronary arteries, and left ventricular function. This case is, to our knowledge, the first description of the MDCTA imaging appearance of quadricuspid aortic valve
— id: 66760, year: 2006, vol: 30, page: 569, stat: Journal Article,

Gated cardiac imaging of the aortic valve on 64-slice multidetector row computed tomography: preliminary observations
Pannu, Harpreet K; Jacobs, Jill E; Lai, Shenghan; Fishman, Elliot K
2006 May-Jun;30(3):443-446, Journal of computer assisted tomography
PURPOSE: To conduct a pilot study to determine the feasibility of evaluating aortic valve morphology and motion on electrocardiogram-gated 64-slice cardiac MDCT. METHODS: Four-dimensional images of the aortic valve were reviewed in 20 consecutive patients who underwent computed tomography (CT) coronary angiography. A consensus reading of 3 readers was performed of valve visibility, number of leaflets, valve motion, and calcification. Visibility of the valve leaflets and visualization of opening and closing of the valve leaflets were graded as well seen or suboptimally seen. The number of valve leaflets (3 or 2) and presence of valvular calcification were noted. RESULTS: The aortic valve was well seen in all 20 patients. Three leaflets were identified in all cases, and no calcifications were seen. Valve movement with opening and closure of the leaflets during the cardiac cycle was also well seen in all cases. CONCLUSIONS: Visualization of the aortic valve and valvular motion during the cardiac cycle is feasible on CT studies performed for coronary angiography. CT has a potential role in the assessment of aortic valvular pathology
— id: 65799, year: 2006, vol: 30, page: 443, stat: Journal Article,

Coronary CT angiography with 64-MD
Pannu, HK; Jacobs, JE; Lai, SH; Fishman, EK
2006 JUL ;187(1):119-126, American journal of roentgenology
OBJECTIVE. The objective of our study was to evaluate the image quality of 64-MDCT coronary angiography. SUBJECTS AND METHODS. Fifty consecutive CT coronary angiograms obtained on a scanner were independently reviewed by two reviewers. Segments were scored as no motion (score of 1), minimal motion (2), moderate motion (3), respiratory motion (4), vessel blurting (5). Opacification was graded as good (score of 1) or limited (2). Segments < 2 were graded as well seen; or as poorly seen or not seen. The scores for motion artifact, opacification, and visibility were combined for overall vessel assessment. Segments with a motion of 1 or 2 that had good opacification and were well seen were judged to be assessable. RESULTS. A total of 714 segments were analyzed in 50 patients. Seven hundred segments assessed in all patients (segments 1-3, 11-20, 4, or 27), and a ramus intermedius segment evaluated in 14 patients. Combining the scores for both reviewers, the average motion score I for 619 segments (86.7%), the average motion score for all segments in an individual patient 1.14 (range, 1-3.35), and the average opacification score for all segments in a patient was (range, 1-1.38). A total of 374 segments were less than 2 min in diameter. Combining the for both reviewers, an average of 36 segments (5.0% of 714) could not be identified by the 319.5 segments (85.4%) were well seen, and 18.5 segments (4.9%) were poorly seen. an average of 637 segments (89.2%) were judged assessable by the reviewers. On a per-patient basis, 10 or more vessel segments werejudged assessable in 47 patients (94%). CONCLUSION. On 64-MDCT, 89% of coronary artery segments are assessable. Ten or vessel segments are assessable in 94% of patients
— id: 64822, year: 2006, vol: 187, page: 119, stat: Journal Article,

Comparison of left atrial volume and left atrial appendage contribution in patients with and without persistent atrial fibrillation
Srichai, MB; Jacobs, JE; Bernstein, N; Chinitz, L; Axel, L
2006 FEB 21 ;47(4):125A-125A, Journal of the American College of Cardiology
— id: 63302, year: 2006, vol: 47, page: 125A, stat: Journal Article,

How to do coronary CT angiography: A radiologist's perspective
Jacobs JE
2005 ;34(12SUPPL.):34-40, Applied radiology
— id: 61347, year: 2005, vol: 34, page: 34, stat: Journal Article,

CT of GI trauma
Jacobs, Jill E; Megibow, Alec J
2004 ;45(3):157-180, Critical reviews in computed tomography
Traumatic bowel and mesenteric injuries are notoriously difficult to diagnose. CT has become the modality of choice for evaluating stable trauma patients for the presence of intra-abdominal injury. This article will summarize the CT findings useful for detecting bowel and mesenteric injury
— id: 46086, year: 2004, vol: 45, page: 157, stat: Journal Article,

Focal fatty sparing of the pancreatic head in cystic fibrosis: CT findings
Carucci, L R; Jacobs, J E
2003 Nov-Dec;28(6):853-855, Abdominal imaging
The most common imaging appearance of the pancreas in cystic fibrosis is diffuse, complete fatty replacement. We present a case of complete fatty replacement of the pancreatic body and tail with total sparing of the pancreatic head. To our knowledge, this pattern of fatty sparing and its associated computed tomographic appearance have not been previously reported in cystic fibrosis
— id: 133220, year: 2003, vol: 28, page: 853, 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,

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,

Cystic pancreatic neoplasms: CT appearances
Jacobs, Jill E; Megibow, Alec J
2002 ;43(5):361-381, Critical reviews in computed tomography
— id: 43658, year: 2002, vol: 43, page: 361, 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,

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,

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,

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,

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,

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,

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,

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,

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,

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,