Alec J Megibow, M.D., M.P.H

Iodine Quantification With Dual-Energy CT: Phantom Study and Preliminary Experience With Renal Masses
Chandarana, Hersh; Megibow, Alec J; Cohen, Benjamin A; Srinivasan, Ramya; Kim, Danny; Leidecker, Christianne; Macari, Michael
2011 Jun;196(6):W693-W700, American journal of roentgenology
OBJECTIVE: The purpose of this study was to validate the utility of dual-source dual-energy MDCT in quantifying iodine concentration in a phantom and in renal masses. MATERIALS AND METHODS: A series of tubes containing solutions of varying iodine concentration were imaged with dual-source dual-energy MDCT. Iodine concentration was calculated and compared with known iodine concentration. Single-phase contrast-enhanced dual-source dual-energy MDCT data on 15 patients with renal lesions then were assessed independently by two readers. Dual-energy postprocessing was used to generate iodine-only images. Regions of interest were placed on the iodine image over the lesion and, as a reference, over the aorta, for recording of iodine concentration in the lesion and in the aorta. Another radiologist determined lesion enhancement by comparing truly unenhanced with contrast-enhanced images. Mixed-model analysis of variance based on ranks was used to compare lesion types (simple cyst, hemorrhagic cyst, enhancing mass) in terms of lesion iodine concentration and lesion-to-aorta iodine ratio. RESULTS: In the phantom study, there was excellent correlation between calculated and true iodine concentration (R(2) = 0.998, p < 0.0001). In the patient study, 13 nonenhancing (10 simple and three hyperdense cysts) and eight enhancing renal masses were evaluated in 15 patients. The lesion iodine concentration and lesion-to-aorta iodine ratio in enhancing masses were significantly higher than in hyperdense and simple cysts (p < 0.0001). CONCLUSION: Iodine quantification with dual-source dual-energy MDCT is accurate in a phantom and can be used to determine the presence and concentration of iodine in a renal lesion. Characterization of renal masses may be possible with a single dual-source dual-energy MDCT acquisition without unenhanced images or reliance on a change in attenuation measurements
— id: 132885, year: 2011, vol: 196, page: W693, stat: Journal Article,

Common Incidental Findings on MDCT: Survey of Radiologist Recommendations for Patient Management
Johnson, Pamela T; Horton, Karen M; Megibow, Alec J; Jeffrey, R Brooke; Fishman, Elliot K
2011 Nov;8(11):762-767, Journal of the American College of Radiology : JACR
PURPOSE: The aim of this study was to evaluate for agreement with respect to how radiologists report incidental findings encountered on CT. METHODS: A multiple-choice survey was designed to query radiologists about how they handle 12 incidental findings on body CT, assuming the patient is a 45-year-old woman with no history of malignancy. Included were a 1-cm thyroid nodule, a 5-mm noncalcified lung nodule, coronary artery calcification, a 2-cm adrenal nodule, a 2-cm pancreatic cyst, a 1-cm enhancing liver lesion, a 2-cm high-density renal cyst, short-segment small bowel intussusception, a 1-cm splenic cyst, focal gallbladder wall calcification, and a 3-cm ovarian cyst in both a premenopausal woman and a postmenopausal woman. Choices ranged from 'do not report' to advising interventional procedures tailored to the organ. Surveys were administered to body CT attending radiologists at 3 academic institutions. RESULTS: Twenty-seven radiologists completed the survey. The mean experience level was 15.7 years after training. Seventy percent or greater agreement on interpretation was identified for only 6 findings: recommend ultrasound for a 1-cm thyroid nodule, recommend ultrasound for a 3-cm cyst in postmenopausal woman, follow Fleischner Society recommendations for a 5-mm lung nodule, describe only coronary calcification, and describe as likely benign both short-segment small bowel intussusception and a 1-cm splenic cyst. CONCLUSIONS: Agreement is lacking, both across institutions and within departments, for the management of 6 commonly encountered incidental findings on body CT. Individual departments should develop internal guidelines to ensure consistent recommendations based on existing evidence
— id: 141867, year: 2011, vol: 8, page: 762, stat: Journal Article,

Frequency of Intraductal Papillary Mucinous Neoplasm in Patients with and without Pancreas Cancer
Macari M; Eubig J; Robinson E; Megibow A; Newman E; Babb J; Pachter HL; Hajdu C
2011 Jan 21;10(6):734-741, Pancreatology
Purpose: To determine the frequency of intraductal papillary mucinous neoplasm (IPMN) in patients with and without invasive ductal adenocarcinoma (IDAC). Methods: 82 patients underwent pancreatectomy for pancreas adenocarcinoma. 68/82 subjects underwent at least one preoperative imaging study including CT (n = 43), MRI (n = 25), or both (n = 12). Imaging studies were retrospectively evaluated to determine if IPMN was present in the gland at a location distant from IDAC. In 183 different adult patients undergoing MRI for renal mass, images were evaluated to determine the frequency of IPMN. Fisher's exact test was used to test whether the prevalence of IPMN was greater among patients with pancreas cancer than those without. Results: Five of 68 (7.3%) patients who underwent pancreatic resection for IDAC had IPMN at a site distant from the cancer. Two of 182 (1.1%) patients undergoing MRI for renal cancer had imaging evidence of IPMN. There was a significant difference (p = 0.017) in the prevalence of IPMN between patients with and without IDAC. The odds ratio for IPMN as a predictor of pancreas cancer was estimated as 7.18. Conclusion: IPMN occurs with increased frequency in patients with pancreas cancer as opposed to those without pancreas cancer. and IAP
— id: 121309, year: 2011, vol: 10, page: 734, stat: Journal Article,

CT Colonography in Senior versus Nonsenior Patients: Extracolonic Findings, Recommendations for Additional Imaging, and Polyp Prevalence
Macari M; Nevsky G; Bonavita J; Kim DC; Megibow AJ; Babb JS
2011 Jun;259(3):767-774, Radiology
Purpose: To retrospectively evaluate the frequency of recommendations for additional imaging (RAIs) for important extracolonic findings and polyp prevalence among a cohort of seniors (age >/= 65 years) and nonseniors (age < 65 years) undergoing low-dose computed tomographic (CT) colonography. Materials and Methods: Institutional review board approval was obtained for this HIPAA-compliant retrospective study. Four hundred fifty-four patients (204 nonseniors: mean age, 52 years; 250 seniors: mean age, 69 years) underwent CT colonography at an outpatient facility. Cases were prospectively reported by one of four abdominal radiologists with expertise in CT colonography. The dictated reports were reviewed to determine the frequency of polyps (>/=6 mm), the number of extracolonic findings, and the number of RAIs generated. The Fisher exact test was used to compare the percentage of seniors and nonseniors with at least one reported polyp, with at least one extracolonic finding, as well as the frequency of RAIs. Results: The percentage of patients with at least one reported polyp was 14.2% (29 of 204) for the nonsenior group and 13.2% (33 of 250) for seniors, which was not significantly different (P = .772). The percentage of patients with at least one extracolonic finding was 55.4% (113 of 204) for nonseniors and 74.0% (185 of 250) for seniors (P < .0001). The percentage of patients in which an RAI was suggested was 4.4% (nine of 204) for nonseniors and 6.0% (15 of 250) for seniors, which was not significantly different (P = .450). Conclusion: Extracolonic findings were more frequent in seniors than in nonseniors; however, there was no significant difference in the frequency of RAIs between the two groups. (c) RSNA, 2011 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11102144/-/DC1
— id: 130256, year: 2011, vol: 259, page: 767, stat: Journal Article,

Focal Cystic Pancreatic Lesions: Variability in Radiologists' Recommendations for Follow-up Imaging
Macari, Michael; Megibow, Alec J
2011 Apr;259(1):20-23, Radiology
— id: 129324, year: 2011, vol: 259, page: 20, stat: Journal Article,

Preface imaging of incidentalomas
Megibow, Alec J
2011 Mar;49(2):xi-xii, Radiologic clinics of North America
— id: 124102, year: 2011, vol: 49, page: xi, stat: Journal Article,

The incidental pancreatic cyst
Megibow, Alec J; Baker, Mark E; Gore, Richard M; Taylor, Andrew
2011 Mar;49(2):349-359, Radiologic clinics of North America
The discovery of a pancreatic cyst in an asymptomatic patient presents an immediate challenge to the interpreting radiologist, the clinician who manages the patient, and patients themselves. When a cyst is discovered on imaging in a patient without symptoms directly referable to the pancreas, the following questions are immediately raised: can the lesion be accurately diagnosed or is the appropriate management clear from the examination, is the best management approach to suggest watchful waiting with follow-up imaging, what is the best method for imaging follow-up, and what is the optimal frequency of follow-up? This article recommends an approach to analyzing patients with incidental pancreatic cysts
— id: 124104, year: 2011, vol: 49, page: 349, stat: Journal Article,

Multidetector CT appearance of leiomyosarcoma of the splenic vein
Niver, B E; Megibow, A J; Faust, M J; Rosenkrantz, A B
2011 Jul;66(7):688-690, Clinical radiology
— id: 133460, year: 2011, vol: 66, page: 688, stat: Journal Article,

Dual-energy Computed Tomography Applications in Uroradiology
Park J; Chandarana H; Macari M; Megibow AJ
2011 Feb;13(1):55-62, Current urology reports
The introduction of dual-energy computed tomography systems (ie, scanners that can simultaneously acquire images at different energies) has significant and unique applications for urologists. Imaging data from these scanners can be used to evaluate composition of urinary calculi and, by 'removing' iodine from an image, significantly decrease radiation dose to patients referred for hematuria. Further, the ability to create a virtual noncontrast image obviates the need for repeated scanning in patients with incidentally detected renal and adrenal masses. Finally, the ability to quantify the regional concentration of iodine in a renal neoplasm may provide a method to monitor effectiveness of therapy before size changes become apparent
— id: 141866, year: 2011, vol: 13, page: 55, stat: Journal Article,

Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee
Berland, Lincoln L; Silverman, Stuart G; Gore, Richard M; Mayo-Smith, William W; Megibow, Alec J; Yee, Judy; Brink, James A; Baker, Mark E; Federle, Michael P; Foley, W Dennis; Francis, Isaac R; Herts, Brian R; Israel, Gary M; Krinsky, Glenn; Platt, Joel F; Shuman, William P; Taylor, Andrew J
2010 Oct;7(10):754-773, Journal of the American College of Radiology : JACR
As multidetector CT has come to play a more central role in medical care and as CT image quality has improved, there has been an increase in the frequency of detecting 'incidental findings,' defined as findings that are unrelated to the clinical indication for the imaging examination performed. These 'incidentalomas,' as they are also called, often confound physicians and patients with how to manage them. Although it is known that most incidental findings are likely benign and often have little or no clinical significance, the inclination to evaluate them is often driven by physician and patient unwillingness to accept uncertainty, even given the rare possibility of an important diagnosis. The evaluation and surveillance of incidental findings have also been cited as among the causes for the increased utilization of cross-sectional imaging. Indeed, incidental findings may be serious, and hence, when and how to evaluate them are unclear. The workup of incidentalomas has varied widely by physician and region, and some standardization is desirable in light of the current need to limit costs and reduce risk to patients. Subjecting a patient with an incidentaloma to unnecessary testing and treatment can result in a potentially injurious and expensive cascade of tests and procedures. With the participation of other radiologic organizations listed herein, the ACR formed the Incidental Findings Committee to derive a practical and medically appropriate approach to managing incidental findings on CT scans of the abdomen and pelvis. The committee has used a consensus method based on repeated reviews and revisions of this document and a collective review and interpretation of relevant literature. This white paper provides guidance developed by this committee for addressing incidental findings in the kidneys, liver, adrenal glands, and pancreas
— id: 131924, year: 2010, vol: 7, page: 754, stat: Journal Article,

Role of multislice computed tomography in the diagnosis of gene-mutation-associated pancreatitis (GMAP)
Graziani, R.; Manfredi, R.; Cicero, C.; Contro, A.; Brandalise, A.; Tapparelli, M.; Frulloni, L.; Vantini, I.; Megibow, A.; Mucelli, R. Pozzi
2010 SEP ;115(6):875-888, Radiologia medica
Purpose. The aim of this study was to review the computed tomography (CT) features of the pancreatic parenchyma and ducts in patients with gene-mutation-associated pancreatitis (GMAP). Materials and methods. Twenty-five patients with GMAP were included in this retrospective study. Patients were divided into two groups according to the time interval between the onset of symptoms and the first CT examination (group A <= 24 months and group B >25 months). Results. On qualitative image assessment, in group A patients, pancreatic duct stones were detected in 2/13 with GMAP. All stones were calcified and homogenous. Enhancement of the pancreatic parenchyma was hypovascular in 7/13 patients. In group B patients, pancreatic duct stones were detected in 12/12 with GMAP. Stones were calcified in 10/12 cases and noncalcified (protein plugs) in 2/12; in 5/10 cases, the calcified stones were heterogeneous with noncalcified central core (bull's-eye appearance). Enhancement of the pancreatic parenchyma was hypovascular in 12/12 patients. On quantitative image assessment, in group A patients, the mean diameter of duct stones was 0.6 mm (range 0-5 mm). Mean diameter of the main duct in the pancreatic head and body/tail was 4.8 mm and 4.9 mm, respectively. In group B patients, the mean diameter of duct stones was 21.9 mm (range 2-50 mm). Mean diameter of the main duct in the pancreatic head and body/tail was 18.8 mm and 13.9 mm, respectively. Conclusions. In patients with GMAP and time interval between symptom onset and first CT scan <= 24 months (group A), CT identified normal or slightly increased parenchymal thickness and a main pancreatic duct of normal calibre and without duct stones. In contrast, in patients with GMAP and time interval between symptom onset and first CT scan >25 months (group B), it identified large-calibre duct stones with bull's-eye appearance
— id: 113907, year: 2010, vol: 115, page: 875, stat: Journal Article,

Comparison of a unidirectional panoramic 3D endoluminal interpretation technique to traditional 2D and bidirectional 3D interpretation techniques at CT colonography: preliminary observations
Lenhart, D K; Babb, J; Bonavita, J; Kim, D; Bini, E J; Megibow, A J; Macari, M
2010 Feb;65(2):118-125, Clinical radiology
AIM: To compare the evaluation times and accuracy of unidirectional panoramic three-dimensional (3D) endoluminal interpretation to traditional two-dimensional (2D) and bidirectional 3D endoluminal techniques. MATERIALS AND METHODS: Sixty-nine patients underwent computed tomography colonography (CTC) after bowel cleansing. Forty-five had no polyps and 24 had at least one polyp > or = 6 mm. Patients underwent same-day colonoscopy with segmental unblinding. Three experienced abdominal radiologists evaluated the data using one of three primary interpretation techniques: (1) 2D; (2) bidirectional 3D; (3) panoramic 3D. Mixed model analysis of variance and logistic regression for correlated data were used to compare techniques with respect to time and sensitivity and specificity. RESULTS: Mean evaluation times were 8.6, 14.6, and 12.1 min, for 2D, 3D, and panoramic, respectively. 2D was faster than either 3D technique (p < 0.0001), and the panoramic technique was faster than bidirectional 3D (p = 0.0139). The overall sensitivity of each technique per polyp and per patient was 68.4 and 76.7% for 2D, 78.9 and 93.3% for 3D; and 78.9 and 86.7% for panoramic 3D. CONCLUSION: 2D interpretation was the fastest overall, the panoramic technique was significantly faster than the bidirectional with similar sensitivity and specificity. The sensitivity for a single reader was significantly lower using the 2D technique. Each reader should select the technique with which they are most successful
— id: 106503, year: 2010, vol: 65, page: 118, stat: Journal Article,

Dual-source dual-energy MDCT of pancreatic adenocarcinoma: initial observations with data generated at 80 kVp and at simulated weighted-average 120 kVp
Macari, Michael; Spieler, Bradley; Kim, Danny; Graser, Anno; Megibow, Alec Jeffrey; Babb, James; Chandarana, Hersh
2010 Jan;194(1):W27-W32, American journal of roentgenology
OBJECTIVE: The purpose of this study was to determine whether the conspicuity of malignant tumors of the pancreas at dual-source dual-energy CT is better with 80-kVp acquisition than with 120-kVp acquisition simulated with a weighted average. MATERIALS AND METHODS: Fifteen patients with pancreatic adenocarcinoma underwent contrast-enhanced dual-source dual-energy CT. The abdominal diameter of all patients was 35 cm or less. Data were reconstructed as a weighted average of the 140- and 80-kVp acquisitions, simulating 120 kVp, and as a pure 80-kVp data set. A region-of-interest cursor was placed within the tumor and the adjacent normal parenchyma, and attenuation differences and contrast-to-noise ratios were calculated for pancreatic tumors at 80 kVp and with the weighted-average acquisition. The 80-kVp and weighted-average images were subjectively compared in terms of lesion conspicuity, image quality, and duct visualization. An exact Wilcoxon's matched pairs signed rank test was used to test whether differences in attenuation, contrast-to-noise ratio, and subjective assessment were greater at 80 kVp. RESULTS: The mean difference in attenuation for each pancreatic tumor and adjacent portion of normal pancreas was 83.27+/-29.56 (SD) HU at 80 kVp and 49.40+/-23.00 HU at weighted-average 120 kVp. Adenocarcinoma attenuation differences were significantly greater at 80 kVp than at 120 kVp (p=0.00006). Contrast-to-noise ratio was significantly higher at 80 kVp than at 120 kVp (p=0.00147). Subjective analysis showed lesion conspicuity (p=0.001) and duct visualization (p=0.0156) were significantly better on the 80-kVp images. CONCLUSION: At portal venous phase dual-source dual-energy CT, the conspicuity of malignant tumors of the pancreas is greater at 80 kVp than with weighted-average acquisition
— id: 105989, year: 2010, vol: 194, page: W27, stat: Journal Article,

Are we really closer to predicting the development of pancreatic cancer?
Megibow, Alec J
2010 Mar;254(3):642-646, Radiology
— id: 107387, year: 2010, vol: 254, page: 642, stat: Journal Article,

Imaging of the pancreas : acute and chronic pancreatitis
Balthazar, Emil J; Megibow, Alec J; Mucelli, Roberto Pozzi
Berlin : Springer, 2009,
— id: 2080, year: 2009, vol: , page: , stat: ,

Applications of Computed Tomography to the Gastrointestinal Tract
Horton KM; Johnson PT; Fishman EK; Megibow AJ
Textbook of gastroenterology Hoboken, NJ : Blackwell Pub., 2009,
— id: 5206, year: 2009, vol: , page: ?, stat: Chapter,

Is gadolinium necessary for MRI follow-up evaluation of cystic lesions in the pancreas? Preliminary results
Macari, Michael; Lee, Terrence; Kim, Sooah; Jacobs, Stacy; Megibow, Alec J; Hajdu, Cristina; Babb, James
2009 Jan;192(1):159-164, American journal of roentgenology
OBJECTIVE: The purpose of our study was to determine whether gadolinium is necessary in the follow-up evaluation of pancreatic cystic lesions. MATERIALS AND METHODS: Fifty-six patients with pancreatic cystic lesions detected on initial MRI and who underwent follow-up MRI were identified. Mean cyst size was 1.9 cm, and mean follow-up was 9.1 months. MRI included multiacquisition T1- and T2-weighted sequences before contrast administration and 3D fat-suppressed T1-weighted images before and after gadolinium administration. Two radiologists independently reviewed the entire initial examination and follow-up MRI using only unenhanced T1- and T2-weighted sequences from the second examination. Each radiologist made one of three recommendations: 1, no follow-up necessary or follow-up imaging in 6-12 months; 2, cyst aspiration; or 3, cyst resection. Four weeks later, imaging studies were reevaluated with the contrast-enhanced images from the second examination. A second recommendation using the same outcomes was made. Interobserver and intraobserver variations for the same patient were summarized in terms of kappa coefficients and the percentage of times the decisions were concordant. A 95% CI for the percentage of times management decisions would change without and with gadolinium was calculated. RESULTS: Concordance between the two different readers for the interpretations (when using the same MRI interpretation technique for follow-up surveillance) was 87.5% with a kappa coefficient to assess interobserver variation of 0.075, suggesting only slight agreement between the two readers. However, treatment recommendations provided by a single reader with and without information from the contrast-enhanced images were discordant only 4.5% of the time. Recommendations were concordant without and with gadolinium 95.5% (107/112; kappa=0.67) of the time, suggesting substantial agreement. A retrospective consensus review of the five cases in which gadolinium effected a change in the observer's recommendation was performed. There was nothing on the gadolinium-enhanced sequences that would specifically alter a change in a management decision, and it is likely that the changes in management decisions in these five cases were simply related to expected variations in categorizing lesions rather than to the use of gadolinium. CONCLUSION: The use of gadolinium has minimal impact in the follow-up MR assessment of pancreatic cystic lesions
— id: 92182, year: 2009, vol: 192, page: 159, stat: Journal Article,

Evaluation of serial changes of pancreatic branch duct intraductal papillary mucinous neoplasms by follow-up with magnetic resonance imaging
Guarise, Alessandro; Faccioli, Niccolo; Ferrari, Mauro; Salvia, Roberto; Mucelli, Roberto Pozzi; Morana, Giovanni; Megibow, Alec J
2008 ;8:220-228, Cancer Imaging
The purpose of this study was to clarify the biological behaviour of branch duct type intraductal papillary mucinous neoplasm (IPMN) by evaluating serial changes at magnetic resonance cholangiopancreatography (MRCP). Fifty-two patients with a diagnosis of branch duct IPMN based on either endoscopic retrograde cholangiopancreatography (ERCP) (9/52) and/or MRCP examination (43/52), were followed up over a mean period of 31.2 months (range 12-108). All imaging data were retrospectively reviewed by two radiologists in order to evaluate serial changes in the maximum diameter of the cystic lesion, in the presence of main pancreatic duct dilatation (MPD), and filling defects within the lesion. Statistical analysis was performed using the Fisher exact probability test. Serial MRCP proved growth in seven cases. In two cases the size decreased; in the remaining 43 there was no change in size. Lesions greater than 3 cm at presentation and the presence of MPD dilatation or filling defects at imaging were most likely to grow. Only 2/37 cystic lesions less than 3 cm in diameter grew in size over the period of observation. No cystic lesion showed changes in morphology and structure. Branch duct IPMNs smaller than 3 cm, without associated filling defects, tend to be stable, making 'watch and wait' management possible
— id: 95423, year: 2008, vol: 8, page: 220, stat: Journal Article,

Update in imaging of cystic pancreatic masses for gastroenterologists
Megibow, Alec J
2008 Nov;6(11):1194-1197, Clinical Gastroenterology & Hepatology
Cystic pancreatic masses are increasingly recognized as a direct consequence of widespread imaging. Once detected, there is controversy as to further management. This review briefly describes the radiologic appearance of these lesions on computed tomography or magnetic resonance imaging. Recommendations for management based on the imaging findings are discussed
— id: 95424, year: 2008, vol: 6, page: 1194, stat: Journal Article,

Standardized algorithms for management of anastomotic leaks and related abdominal and pelvic abscesses after colorectal surgery
Phitayakorn R.; Delaney C.P.; Reynolds H.L.; Champagne B.J.; Heriot A.G.; Neary P.; Senagore A.J.; Ambrosetti P.; Bailey C.; Billingham R.P.; Braga M.; Buie W.D.; Darzi A.W.; Douglas P.R.; Dozois E.J.; Fearnhead N.S.; Frizelle F.A.; Gearhart S.L.; Gonzalez Q.H.; Haaga J.R.; Harris G.J.; Horgan A.F.; Horgan P.G.; Kehlet H.; Kim S.H.; Lacy A.M.; Leroy J.; Lopez-Kostner F.; Ludwig K.A.; Marks J.; Megibow A.J.; Merlino J.I.; Monson J.R.; Motson R.W.; Nakamoto D.A.; Newstead G.L.; O'Connell P.R.; Panis Y.; Penninckx F.; Rajput A.; Seow Choen F.; Stamos M.J.; Vignali A.; Wexner S.D.; Wong K.S.
2008 ;32(6):1147-1156, World journal of surgery
Background: The risk factors and incidence of anastomotic leak following colorectal surgery are well reported in the literature. However, the management of the multiple clinical scenarios that may be encountered has not been standardized. Methods: The medical literature from 1973 to 2007 was reviewed using PubMed for papers relating to anastomotic leaks and abdominal abscess, with a specific emphasis on predisposing factors, prevention strategies, and treatment approaches. A six-round modified Delphi research method was utilized to find consensus among a group of expert colorectal surgeons and interventional radiologists regarding standardized management algorithms for anastomotic leaks. Results: Management scenarios were divided into those for intraperitoneal anastomoses, extraperitoneal (low pelvic) anastomoses, and anastomoses with proximal diverting stomas. Management options were then based on the clinical presentation and radiographic findings and organized into three interconnected algorithms. Conclusions: This process was a useful first step toward establishing guidelines for the management of anastomotic leak. copyright 2008 Societe Internationale de Chirurgie
— id: 79429, year: 2008, vol: 32, page: 1147, stat: Journal Article,

Nonfunctioning pancreatic endocrine neoplasm presenting as asymptomatic, isolated pancreatic duct stricture: a case report and review of the literature
Powell, Anathea C; Hajdu, Cristina H; Megibow, Alec J; Shamamian, Peter
2008 Feb;74(2):168-171, American surgeon
Morphologic irregularities of the pancreatic duct are often noted on abdominal imaging studies obtained for unrelated symptoms or conditions. We report the case of a patient who was found to have an incidental, isolated pancreatic duct dilatation on multiple imaging studies and who was found to have a nonfunctioning pancreatic endocrine neoplasm at resection. His prognosis is excellent based on the histology of the lesion and a curative resection. This case highlights the importance of fully investigating incidental pancreatic duct abnormalities regardless of the setting in which they are found
— id: 78362, year: 2008, vol: 74, page: 168, stat: Journal Article,

Comparison of contrast-enhanced sonography and MRI in displaying anatomic features of cystic pancreatic masses
D'Onofrio, Mirko; Megibow, Alec J; Faccioli, Niccolo; Malago, Roberto; Capelli, Paola; Falconi, Massimo; Mucelli, Roberto Pozzi
2007 Dec;189(6):1435-1442, American journal of roentgenology
OBJECTIVE: The purpose of this study was to compare the accuracy rates of unenhanced sonography, contrast-enhanced sonography, and MRI in displaying the anatomic features of cystic pancreatic masses larger than 1.5 mm in diameter. MATERIALS AND METHODS: Unenhanced and contrast-enhanced sonographic and MRI examinations of 33 patients who underwent resection of a cystic pancreatic mass were retrospectively reviewed. Two radiologists blinded to the final histologic diagnosis reviewed the images, specifically assessing the presence of intralesional mural nodules and septa. Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated on the basis of correlation with surgical findings. Results of unenhanced sonography, contrast-enhanced sonography, and MRI were compared by McNemar test. Correlation of unenhanced and contrast-enhanced sonographic versus pathologic results was established with Spearman's test. Interobserver variability was determined. RESULTS: Contrast-enhanced sonography correctly depicted intralesional septa in 14 of 15 lesions (sensitivity, 93.3%; specificity, 88.8%; positive predictive value, 87.5%; negative predictive value, 94.1%; accuracy, 90.9%) and nodules in six of eight lesions (sensitivity, 75%; specificity, 96%; positive predictive value, 85.7%; negative predictive value, 92.3%; accuracy, 90.9%). MRI correctly depicted intralesional septa in 14 of 15 lesions (sensitivity, 93.3%; specificity, 61.1%; positive predictive value, 66.6%; negative predictive value, 91.6%; accuracy, 75.7%) and nodules in seven of eight lesions (sensitivity, 87.5%; specificity, 80%; positive predictive value, 58.3%; negative predictive value, 95.2%; accuracy, 81.8%). The difference between the diagnostic accuracy of contrast-enhanced sonography and that of MRI was not significant (p = 0.05, McNemar test) in the identification of septa and nodules. The correlation between contrast-enhanced sonographic findings and pathologic results (Rs = 0.93; p < 0.001) was significantly better than that between sonographic and pathologic results (Rs = 0.52; p < 0.0001). Interobserver agreement had a kappa value of 0.86-0.94. CONCLUSION: Contrast-enhanced sonography compares favorably with MRI in displaying the anatomic features of cystic pancreatic masses seen on transabdominal sonography
— id: 95425, year: 2007, vol: 189, page: 1435, stat: Journal Article,

A pattern approach to the abnormal small bowel: observations at MDCT and CT enterography
Macari, Michael; Megibow, Alec J; Balthazar, Emil J
2007 May;188(5):1344-1355, American journal of roentgenology
OBJECTIVE: Imaging of the vast array of pathologic processes occurring in the small bowel has been facilitated by recent advances, including the use of MDCT scanners that acquire isotropic data and neutral oral contrast agents that improve small-bowel distention. CONCLUSION: This review shows how a systematic pattern approach can be used to narrow the differential diagnosis when an abnormal small-bowel loop is detected on MDCT
— id: 71932, year: 2007, vol: 188, page: 1344, stat: Journal Article,

Diagnosis of medullary sponge kidney by computed tomographic urography
Maw, Anna M; Megibow, Alec J; Grasso, Michael; Goldfarb, David S
2007 Jul;50(1):146-150, American journal of kidney diseases
The diagnosis of medullary sponge kidney traditionally was established by means of intravenous pyelography. Beginning in the mid-1990s, intravenous pyelography rapidly was supplanted by computed axial tomography as the preferred imaging study for evaluating patients with renal stone disease. Conventional computed tomographic imaging has not been satisfactory for diagnosing medullary sponge kidney. The introduction of multidetector-row computed tomography in 1999 allowed radiologists to acquire images composed of elements allowing the creation of high-resolution 3-dimensional displays. Computed tomographic urography is an imaging technique that provides both cross-sectional displays and images of the contrast-filled renal collecting systems, ureters, and urinary bladder that are the equivalent of intravenous pyelography. We report a case of medullary sponge kidney diagnosed by means of 3-dimensional multidetector-row computed tomographic urography.
— id: 72972, year: 2007, vol: 50, page: 146, stat: Journal Article,

Diagnostic endoscopy: 2020 vision
Cotton, Peter B; Barkun, Alan; Ginsberg, Gregory; Hawes, Robert H; Atkin, Wendy; Bjorkman, David J; Dykes, Cathy; Elta, Grace; Farrell, James; Fleischer, David; Ganz, Robert; Glenn, Tammy; Janowski, Doug; Johnson, David; Kochman, Michael; Kowalski, Thomas; Megibow, Alec J; McQuaid, Kenneth; Sasa, Hiro; Thompson, Chris C; Vargo, John; Woods, Karen
2006 Sep;64(3):395-398, Gastrointestinal endoscopy
— id: 95426, year: 2006, vol: 64, page: 395, stat: Journal Article,

Evaluation of bowel distention with a neutral contrast agent: Some statistical concerns - Response
Megibow, AJ
2006 DEC ;241(3):947-947, Radiology
— id: 69449, year: 2006, vol: 241, page: 947, stat: Journal Article,

Evaluation of bowel distention and bowel wall appearance by using neutral oral contrast agent for multi-detector row CT
Megibow, Alec J; Babb, James S; Hecht, Elizabeth M; Cho, Jennie J; Houston, Carmela; Boruch, Michael M; Williams, Archie B
2006 Jan;238(1):87-95, Radiology
PURPOSE: To prospectively evaluate the performance of an orally administered 0.1% barium suspension, Volumen, as a bowel-marking agent for multi-detector row computed tomography (CT). MATERIALS AND METHODS: This HIPAA-compliant study was approved by the Institutional Review Board and conformed to the institutional standards for research funded by a commercial sponsor. A total of 60 patients (33 women, 27 men; average age, 58.2 years) who were referred for multi-detector row CT of the pancreas were randomized into two groups. Prior to examination, group 1 consumed 1200 mL of Volumen over a 30-minute period and group 2 consumed 1200 mL of a solution containing three parts water and one part methylcellulose over a 30-minute period. Results were independently reviewed by two radiologists who were unaware of the contrast agent used. The degree of distention and the visualization of mural detail were qualitatively scored on a five-point scale. Differences were evaluated by using the Mann-Whitney test at a confidence level of 95%. RESULTS: There was significantly better distention in the stomach (P = .013), duodenum (P = .006), jejunum (P = .029), and ileum (P = .140) in group 1 compared with group 2. Significant distention was also evident by comparing the products of the widest cross-sectional diameters in duodenum (P = .143), jejunum (P < .001), and ileum (P < .001). Group 1 also demonstrated significantly better visualization of mural features in the duodenum (P = .003), jejunum (P = .024), and ileum (P = .01) and a trend toward better visualization of mural features in the stomach (P = .092). CONCLUSION: Oral administration of Volumen provided excellent distention and excellent visualization of mural features in the gastrointestinal tract
— id: 62370, year: 2006, vol: 238, page: 87, stat: Journal Article,

Stercoral colitis leading to fatal peritonitis: CT findings
Heffernan, Cathleen; Pachter, H Leon; Megibow, Alec J; Macari, Michael
2005 Apr;184(4):1189-1193, American journal of roentgenology
OBJECTIVE: Stercoral colitis is an inflammatory process involving the colonic wall related to fecal impaction. Our purpose was to describe the imaging findings of stercoral colitis and ulceration and to emphasize the potential serious clinical implications of the condition. CONCLUSION: Fecal impaction may lead to ischemic pressure necrosis and subsequent colonic perforation. In the appropriate clinical setting, the imaging findings that should prompt the radiologist to consider this diagnosis are the presence of fecal impaction, focal colonic wall thickening, and adjacent stranding of the fat. If the fecal impaction is not promptly relieved, the condition can lead to colonic perforation, peritonitis, and patient demise
— id: 52632, year: 2005, vol: 184, page: 1189, stat: Journal Article,

Value of the single-phase technique in MDCT assessment of pancreatic tumors
Imbriaco, Massimo; Megibow, Alec J; Ragozzino, Alfonso; Liuzzi, Raffaele; Mainenti, Pierpaolo; Bortone, Sara; Camera, Luigi; Salvatore, Marco
2005 Apr;184(4):1111-1117, American journal of roentgenology
OBJECTIVE: The purpose of our study was to determine the diagnostic value of single-phase MDCT in patients with suspected pancreatic carcinoma. SUBJECTS AND METHODS: Seventy-one patients (41 men, 30 women; mean age, 63 years; range, 29-80 years) with suspected pancreatic tumor underwent MDCT. Scanning was performed on an MDCT scanner with 0.5-sec gantry rotation and acquisition of 4 slices per rotation. Unenhanced scanning was followed by one set of scanning in the caudocranial direction from the inferior hepatic margin to the diaphragm with a scanning delay of 60 sec after the IV injection of 150 mL of contrast material delivered at 3 mL/sec. Two reviewers independently scored images in a blinded fashion for the presence of tumor and assessment of resectability. Receiver operating characteristic analysis was performed. RESULTS: A final histopathologic diagnosis derived from surgical findings was obtained in 42 patients; in the remaining 29 patients, percutaneous fine-needle aspiration biopsy coupled with a 1-year clinical follow-up to determine development of local, regional or distant neoplasm served as gold standard proof of diagnosis. Final diagnosis was pancreatic cancer in 40 patients (27 ductal adenocarcinoma, nine mucinous cystoadenocarcinoma, two neuroendocrine tumors, one lymphoma, and one papillary cystoadenocarcinoma) and chronic pancreatitis in 31. The mean tumor size was 2.4 cm (range, 4-1 cm). Values for the area under the curve (A(z)) for the assessment of tumor detection were 0.97 for reviewer 1 and 0.96 for reviewer 2 (p = not significant). A(z) values for tumor resectability were 0.90 for reviewer 1 and 0.90 for reviewer 2 (p = not significant). No statistically significant differences were observed between superior mesenteric artery and vein opacification with the hepatic parenchyma enhanced at a time closer to the peak hepatic enhancement, optimizing the detection of hepatic lesions. CONCLUSION: Thin-section single-phase MDCT is an accurate technique for the diagnosis and assessment of resectability in patients with a suspected pancreatic neoplasm. This technique provides optimal tumor-to-pancreas contrast and maximal pancreatic parenchymal and peripancreatic vascular enhancement. It allows visualization of the entire liver and the whole upper abdomen during the portal phase for accurate identification of liver metastases and peritoneal seeding
— id: 95427, year: 2005, vol: 184, page: 1111, 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,

Frequency and relevance of the "small-bowel feces" sign on CT in patients with small-bowel obstruction
Lazarus, Dawn E; Slywotsky, Chrystia; Bennett, Genevieve L; Megibow, Alec J; Macari, Michael
2004 Nov;183(5):1361-1366, American journal of roentgenology
OBJECTIVE: We sought to determine the incidence of the 'small-bowel feces' sign (SBFS) in patients with small-bowel obstruction (SBO) and whether it can be used to accurately locate the point of obstruction. SUBJECTS AND METHODS: From November 2002 until March 2003, 34 consecutive adult patients with CT findings of small-bowel obstruction were prospectively evaluated. The CT findings used to diagnose small-bowel obstruction were a dilated proximal small bowel and a collapsed distal small bowel and colon. CT scans were evaluated to determine the degree of obstruction (mild, moderate, or high-grade), the presence or absence of the SBFS (defined as particulate-type material in the dilated small bowel), the location of the SBFS in relation to the transition zone, and the cause of the obstruction. Mild obstruction was defined as a slight discrepancy between the caliber of the proximal and that of the distal small bowel; moderate SBO was defined as a discrepancy of 50% or more between the calibers of the proximal and the distal small bowel; and high-grade SBO was considered to be present if the distal small bowel and the colon had collapsed. The cause of the obstruction was determined from surgical findings or a combination of CT findings, follow-up barium studies, and clinical assessment. RESULTS: The SBFS was present in 19 (55.9%) of 34 patients with SBO. The degree of SBO was mild in six, moderate in 11, and high-grade in 17 of the patients. The SBFS was present in one of the six patients (16.6%) with mild, eight (72.7%) of the 11 with moderate, and 10 (58.8%) of the 17 with high-grade SBO. In all patients in whom the SBFS was present, the particulate material could be traced to the point of transition and was most conspicuous in the transition zone. The length of fecallike material ranged from 2 to 25 cm and was longer in moderate and high-grade SBO than in mild SBO. The cause of the SBO was an adhesion in 20 patients, a hernia in four patients, Crohn's disease in four patients, a tumor in three patients, and other miscellaneous causes in three patients. CONCLUSION: When present on CT, the SBFS can be used to help locate the transition zone in patients with SBO. The sign is present more frequently in patients with moderate and high degrees of SBO
— id: 47832, year: 2004, vol: 183, page: 1361, stat: Journal Article,

CT colonography. Current and emerging applications
Macari M; Megibow AJ
2004 ;2004(2):115-115, Azarbaycan tibb jurnali / Azarbaycan Respublikasi, Sahiyya Nazirliyi = Azerbaijan medical journal
— id: 46299, year: 2004, vol: 2004, page: 115, stat: Journal Article,

Colorectal polyps and cancers in asymptomatic average-risk patients: evaluation with CT colonography
Macari, Michael; Bini, Edmund J; Jacobs, Stacy L; Naik, Sanjay; Lui, Yvonne W; Milano, Andrew; Rajapaksa, Roshini; Megibow, Alec J; Babb, James
2004 Mar;230(3):629-636, Radiology
PURPOSE: To compare thin-section multi-detector row computed tomographic (CT) colonography with conventional colonoscopy in the evaluation of colorectal polyps and cancer in asymptomatic average-risk patients. MATERIALS AND METHODS: Sixty-eight asymptomatic men (age > 50 years) scheduled to undergo screening colonoscopy were enrolled in this study. CT colonography was followed by conventional colonoscopy, performed on the same day. Supine and prone CT colonography were performed after colonic insufflation with room air. A gastroenterologist measured all polyps, which were categorized as 1-5, 6-9, or over 10 mm. Biopsy and histologic evaluation were performed of all polyps. CT colonography and colonoscopy results were compared for location, size, and morphology of detected lesions. Point estimates and 95% CIs were provided for specificity and sensitivity of CT by using results at conventional colonoscopy as the reference standard. RESULTS: At colonoscopy, 98 polyps were identified in 39 patients; 21 (21.4%) of 98 were detected at CT colonography. Sensitivity was 11.5% (nine of 78) for polyps 1-5 mm, 52.9% (nine of 17) for polyps 6-9 mm, and 100% (three of three) for polyps over 10 mm. Results at colonoscopy were normal in 29 (42.6%) of 68 patients; at CT colonography, results were correctly identified as normal in 26 of these 29 patients. In one of these patients, a lesion larger than 10 mm was detected at CT colonography. The per-patient specificity of CT was 89.7% (26 of 29; 95% CI: 72.7%, 97.8%). The mean time for CT image interpretation was 9 minutes. CONCLUSION: In patients at average risk for colorectal cancer, CT colonography is a sensitive and specific screening test for detecting polyps 10 mm or larger; the sensitivity for detecting smaller polyps is decreased. Examination findings can be interpreted in a clinically feasible amount of time
— id: 42610, year: 2004, vol: 230, page: 629, stat: Journal Article,

CTA solidifies role in the evaluation of pancreatic disease... includes discussion
Megibow AJ
2004 ;Supplement:21-9,3 Dec, Applied radiology
By extracting information from the CT data set using 3-dimensional interactive workstations, radiologists can evaluate the pancreatic gland, the pancreatic and biliary ducts, and peripancreatic vasculature, all from a single acquisition
— id: 51755, year: 2004, vol: Supplement, page: 21, stat: Journal Article,

Gastrointestinal infection in the immunocompromised (AIDS) patient
Reeders, J W A J; Yee, J; Gore, R M; Miller, F H; Megibow, A J
2004 Mar;14 Suppl 3(1):E84-102, European radiology
In the past two decades acquired immunodeficiency syndrome (AIDS) has become one of the most devastating illnesses in human history. As the epidemic continues to spread increasingly, AIDS patients are no longer confined to a few specialized AIDS hospitals and are now seen in general hospitals and clinics everywhere. Radiologists need to recognize the appearances, to understand how-safely-to care for patients with this disease, and to know enough about the illness to be able to counsel their patients. This article presents a review of current knowledge about the wide range of gastrointestinal hepatic, splenic, biliary, and retroperitoneal manifestations in AIDS, and how the role of modern medical imaging techniques and diagnosis and treatment can be applied. The imaging aspects (conventional double-contrast gastrointestinal studies, ultrasound, CT, and MR) of the diseases of the luminal gastrointestinal tract, liver, spleen, biliary tract, and retroperitoneum will be systematically discussed. Candidiasis, herpes, cytomegalovirus, cryptosporidiosis, histoplasmosis, isosporiasis, salmonellosis, toxoplasmosis, unusual mycobacteria, and viral infections account for the majority of non-neoplastic disorders
— id: 48202, year: 2004, vol: 14 Suppl 3, page: E84, stat: Journal Article,

Image interpretation session
Federle, MP; Megibow, AF; Laing, FC; Curtin, HD; Klein, FS; Towbin, RB
2003 NOV-DEC ;23(6):1703-1713, Radiographics
— id: 55458, year: 2003, vol: 23, page: 1703, stat: Journal Article,

Duodenal diverticula mimicking cystic neoplasms of the pancreas: CT and MR imaging findings in seven patients
Macari, Michael; Lazarus, Dawn; Israel, Gary; Megibow, Alec
2003 Jan;180(1):195-199, American journal of roentgenology
OBJECTIVE: Duodenal diverticula are common and are typically asymptomatic. When filled with gas or a combination of fluid and gas, duodenal diverticula are easily recognized on CT or MR imaging. However, a duodenal diverticulum that is entirely filled with fluid may mimic a cystic neoplasm arising from the head of the pancreas. We present seven cases of patients with duodenal diverticula in whom initial findings on CT or MR imaging were suggestive of a cystic neoplasm in the head of the pancreas. In all patients, this structure was ultimately proven to be a duodenal diverticula. CONCLUSION: When filled with only fluid, a duodenal diverticulum may mimic a cystic neoplasm in the head of the pancreas. Recognizing the location in which this entity characteristically arises and identifying small amounts of intradiverticular gas when it is present may aid in establishing the correct diagnosis in patients with duodenal diverticula
— id: 43656, year: 2003, vol: 180, page: 195, stat: Journal Article,

Principles of radiology
Megibow AJ
Gastrointestinal cancers : companion to Sleisenger & Fordtran's gastrointestinal and liver disease Edinburgh : Saunders, 2003,
— id: 3284, year: 2003, vol: , page: ?, stat: Chapter,

Imaging of the pancreas : cystic and rare tumors
Procacci C; Megibow AJ; Bassi C
Berlin : Springer, 2003,
— id: 777, year: 2003, vol: , page: , stat: ,

CT findings in acute gangrenous cholecystitis
Bennett, Genevieve L; Rusinek, Henry; Lisi, Virna; Israel, Gary M; Krinsky, Glenn A; Slywotzky, Chrystia M; Megibow, Alec
2002 Feb;178(2):275-281, American journal of roentgenology
OBJECTIVE: The purpose of this study was to determine the CT findings in acute gangrenous cholecystitis. MATERIALS AND METHODS: Four observers retrospectively reviewed CT scans in 75 patients (23 with acute gangrenous cholecystitis, 25 with acute non-gangrenous cholecystitis, and 27 without cholecystitis). The following findings were evaluated: distention, mural thickening, wall enhancement, irregular wall, wall striation, intraluminal membranes, pericholecystic inflammation, gallstones, pericholecystic fluid, enhancement of liver parenchyma, pericholecystic abscess, and gas in the wall or lumen. Sensitivity and specificity of CT for gangrenous cholecystitis and for each finding were calculated. Two reviewers in consensus measured gallbladder dimension and wall thickness. Logistic regression models were used to predict gangrenous versus non-gangrenous cholecystitis. RESULTS: Sensitivity, specificity, and accuracy of CT for acute cholecystitis were 91.7%, 99.1%, and 94.3%, respectively, and for acute gangrenous cholecystitis were 29.3%, 96.0%, and 64.1%, respectively. Findings with the highest specificity for gangrenous cholecystitis were gas in the wall or lumen (100%), intraluminal membranes (99.5%), irregular or absent wall (97.6%), and abscess (96.6%). The difference between the mean gallbladder wall thickness and the short-axis dimension for the two groups with cholecystitis was statistically significant. In three patients with gangrenous cholecystitis, no mural enhancement was seen. Pericholecystic fluid also achieved statistical significance for the diagnosis of gangrene. Multivariate logistic regression analysis showed that the overall accuracy of CT for gangrenous cholecystitis was 86.7%. CONCLUSION: CT findings most specific for acute gangrenous cholecystitis are gas in the wall or lumen, intraluminal membranes, irregular wall, and pericholecystic abscess. Gangrenous cholecystitis is associated with a lack of mural enhancement, pericholecystic fluid, and a greater degree of gallbladder distention and wall thickening
— id: 26484, year: 2002, vol: 178, page: 275, stat: Journal Article,

Dual-phase versus single-phase helical CT to detect and assess resectability of pancreatic carcinoma
Imbriaco, Massimo; Megibow, Alec J; Camera, Luigi; Pace, Leonardo; Mainenti, Pier Paolo; Romano, Maurizio; Selva, Guerino; Salvatore, Marco
2002 Jun;178(6):1473-1479, American journal of roentgenology
OBJECTIVE: The aim of this study was to compare dual-phase and single-phase helical CT for the detection and assessment of resectability of pancreatic adenocarcinoma. SUBJECTS AND METHODS: We studied 60 patients (31 men, 29 women; age range, 31-84 years; mean age, 62 years) with suspected pancreatic malignancy. Patients were randomly assigned to one of two groups. For group A (n = 30), unenhanced scans through the liver and pancreas were followed by two separate acquisitions (dual-phase) at 20-25 and at 60-80 sec after IV contrast administration. For group B (n = 30), unenhanced scans were followed by one set of scans (single-phase) acquired caudocranially (from the inferior hepatic margin to the diaphragm) starting 50 sec after IV contrast administration. Two observers independently scored images for the presence of tumor and for assessment of tumor resectability. RESULTS: Comparison of dual-phase versus single-phase helical CT for tumor detection showed a diagnostic accuracy for observer 1 of 87% and 90%, respectively, and for observer 2, of 90% and 87%, respectively. For both helical CT techniques, the overall agreement between the two observers was 83% (kappa = 0.73 +/- 0.03) for single-phase helical CT and 90% (kappa = 0.89 +/- 0.03) for dual-phase helical CT. The assessment of resectability was affected by the low number of resectable tumors (n = 8). CONCLUSION: Single-phase helical CT is effective for the diagnosis and assessment of resectability of patients with suspected pancreatic carcinoma. Advantages are the lower radiation dose and fewer images to film and store
— id: 43660, year: 2002, vol: 178, page: 1473, 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,

Colorectal neoplasms: prospective comparison of thin-section low-dose multi-detector row CT colonography and conventional colonoscopy for detection
Macari, Michael; Bini, Edmund J; Xue, Xiaonan; Milano, Andrew; Katz, Seth S; Resnick, Daniel; Chandarana, Hersh; Krinsky, Glen; Klingenbeck, Klaus; Marshall, Christopher H; Megibow, Alec J
2002 Aug;224(2):383-392, Radiology
PURPOSE: To prospectively compare thin-section low-dose multi-detector row computed tomographic (CT) colonography with conventional colonoscopy for the detection of colorectal neoplasms. MATERIALS AND METHODS: One hundred five patients underwent CT colonography immediately before colonoscopy. Supine and prone CT colonographic acquisitions to image the region during a 30-second breath hold were performed. CT colonographic images were prospectively interpreted for the presence, location, size, and morphologic features of polyps. The time of image interpretation was noted. Sensitivity, specificity, and positive and negative predictive values of CT colonography were calculated, with 95% CIs, by using colonoscopic findings as the reference standard. The weighted CT dose index was calculated on the basis of measurements in a standard body phantom. Effective dose was calculated by using commercially available software. RESULTS: Median CT data interpretation time was 12 minutes. One hundred thirty-two polyps in 59 patients were identified at colonoscopy; no polyps were detected in 46 patients. Sensitivities for detection of polyps smaller than 5 mm, 6-9 mm, and larger than 10 mm in diameter were 12% (11 of 91 polyps), 70% (19 of 27 polyps), and 93% (13 of 14 polyps), respectively. Estimated overall specificity was 97.7% (515 of 527 imaging results). The total weighted CT dose index for combined supine and prone CT colonography was 11.4 mGy. The effective doses for combined CT colonography were 5.0 mSv and 7.8 mSv for men and women, respectively. CONCLUSION: Low-dose multi-detector row CT colonography has excellent sensitivity and specificity for detection of colorectal neoplasms 10 mm and larger
— id: 32913, year: 2002, vol: 224, page: 383, stat: Journal Article,

Mesenteric adenitis: CT diagnosis of primary versus secondary causes, incidence, and clinical significance in pediatric and adult patients
Macari, Michael; Hines, John; Balthazar, Emil; Megibow, Alec
2002 Apr;178(4):853-858, American journal of roentgenology
OBJECTIVE: Our objective was to determine the clinical significance of mesenteric adentitis when detected on CT. MATERIALS AND METHODS: Mesenteric adenitis was considered present if a cluster of three or more lymph nodes measuring 5 mm or greater each was present in the right lower quadrant mesentery. If no other abnormality was detected on CT, then mesenteric adenitis was considered primary. If a specific inflammatory process was detected in addition to the lymphadenopathy, then mesenteric adenitis was considered secondary. Patients with a known neoplasm or HIV infection were excluded. Three separate groups of patients were examined for the presence and cause of mesenteric adenitis. Group 1 consisted of 60 consecutive patients prospectively identified with mesenteric adenitis on CT examinations. Group 2 consisted of 60 consecutive patients undergoing abdominal and pelvic CT for evaluation of blunt or penetrating abdominal trauma. Group 3 consisted of 60 consecutive patients undergoing abdominal and pelvic CT with acute abdominal symptoms. In all patients, the indication for imaging was documented, and the size of the largest lymph node, when present, was measured. In patients with mesenteric adenitis, the CT findings, clinical history, and clinical or surgical follow-up were subsequently evaluated to determine the cause of mesenteric adenitis. RESULTS: In the 60 patients prospectively identified with CT findings of mesenteric adenitis (group 1), 18 (30%) of 60 had primary mesenteric adenitis. The remaining 42 patients (70%) had an associated inflammatory condition that was established on CT as the likely cause of mesenteric adenitis. Mesenteric adenitis was present in none (0%) of the 60 patients in group 2 and in five (8.3%) of 60 patients in group 3. CONCLUSION: The incidence of mesenteric adenitis in patients with and those without abdominal pain is low. When evidence of mesenteric adenitis is present on CT examinations, usually a specific diagnosis can be established as its cause
— id: 43661, year: 2002, vol: 178, page: 853, stat: Journal Article,

Computed tomography diagnosis utilizing compressed image data: an ROC analysis using acute appendicitis as a model
Megibow, Alec J; Rusinek, Henry; Lisi, Virna; Bennett, Genevieve L; Macari, Michael; Israel, Gary M; Krinsky, Glenn A
2002 Jun;15(2):84-90, Journal of digital imaging
Using receiver-operating characteristic (ROC) methodology, the ability to diagnose acute appendicitis with computed tomography (CT) images displayed at varying levels of lossy compression was evaluated. Nine sequential images over the ileocecal region were obtained from 53 consecutive patients with right lower quadrant pain who were clinically suspected to have acute appendicitis. Thirty were proven surgically to have acute appendicitis, alternative diagnoses confirmed in 23. The image sets were subjected to a lossy wavelet-based compression algorithm 'Embedded Predictive Wavelet Image Coder' (EPWIC). Compression levels were: none, 8:1, 16:1, and 24:1, resulting in 4 sets of images per patient. Image sets were randomized and evaluated separately by 4 body radiologists on a 1,024 x 768-pixel SVGA color PC monitor in 512 x 512 format. The readers were aware of the clinical suspicion of appendicitis but were unaware of the positive fraction of cases. Individual and combined reader ROC and c2 analyses of sensitivity, specificity, and accuracy were determined. For all readers, sensitivity decreases at 16:1 and 24:1 levels (P <0.01, P <0.001, respectively). Accuracy decreased at 24:1 levels (P <0.01). Specificity was unaffected. By ROC analysis there was statistically significantly decreased area under the curve at 24:1 levels (P <0.02) as compared with uncompressed images. Finite levels of lossy wavelet compression may be applied to CT images without compromising diagnostic performance
— id: 43659, year: 2002, vol: 15, page: 84, stat: Journal Article,

Spiral computed tomography assessment of resectability of pancreatic ductal adenocarcinoma: analysis of results
Procacci, C; Biasiutti, C; Carbognin, G; Bicego, E; Graziani, R; Franzoso, F; Pesci, A; Megibow, A J
2002 Oct;34(10):739-747, Digestive & liver disease
BACKGROUND: Despite more recent technical advances, single detector spiral computed tomography is still the most widely used imaging technique for the detection and staging of pancreatic adenocarcinoma. Many reports have recently focused on single detector spiral computed tomography imaging findings indicative of unresectability AIM: To evaluate the ability of single detector spiral computed tomography in the pre-operative staging of ductal adenocarcinoma of the pancreas in selecting surgically resectable versus unresectable cases, considering different parameters (vascular and local infiltration, liver metastases, lymphadenopathy, and peritoneal carcinomatosis). PATIENTS AND METHODS: A total of 100 patients diagnosed with ductal adenocarcinoma of the pancreas, pathologically verified, and examined with single detector spiral computed tomography were considered. Of these, 63 underwent surgery; 37 were excluded (imaging evidence of unresectability in biopsy-proven adenocarcinomas). Single detector spiral computed tomography studies, performed at the time of surgery, were retrospectively reviewed by two radiologists. The final results were reached by consensus, without being aware of the operation. All prospective clinical readings were also considered, and tabulated. RESULTS: In the patients undergoing surgery, 44 proved to be unresectable and 19 resectable. Considering the above-mentioned parameters, the prospective assessment of resectability demonstrated a rather low sensitivity (68%), with high specificity (95%). Accordingly, a high positive predictive value (97%) was achieved, while the negative predictive value was 56%. After the retrospective evaluation, the value of sensitivity increased (84%) to the expense of the specificity (84%). Moreover, a positive predictive value of 92.5%, and a negative predictive value of 69.5% were obtained. CONCLUSIONS: The demonstration of many signs of unresectability of pancreatic ductal adenocarcinoma reported in the literature yields a better sensitivity in the diagnosis, but unfortunately, is associated with an inevitable reduction in specificity
— id: 43657, year: 2002, vol: 34, page: 739, 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,

Infrarenal abdominal aortic aneurysms at multi-detector row CT angiography: intravascular enhancement without a timing acquisition
Macari M; Israel GM; Berman P; Lisi M; Tolia AJ; Adelman M; Megibow AJ
2001 Aug;220(2):519-523, Radiology
In 70 patients referred for evaluation of aortoiliac aneurysm disease, multi-detector row computed tomography was performed with a uniform 25-second delay from the initiation of intravenous administration of a 150-mL bolus of contrast material at 4 mL/sec. In all patients, adequate enhancement (>200 HU) of the aorta and intense enhancement of iliofemoral runoff was achieved without venous contamination
— id: 26720, year: 2001, vol: 220, page: 519, stat: Journal Article,

Effect of different bowel preparations on residual fluid at CT colonography
Macari M; Lavelle M; Pedrosa I; Milano A; Dicker M; Megibow AJ; Xue X
2001 Jan;218(1):274-277, Radiology
The effect of different bowel preparations on residual fluid during computed tomographic (CT) colonography was evaluated. Forty-two patients received either a polyethylene glycol electrolyte solution preparation or a phospho-soda preparation the day prior to CT colonography. The amount of residual fluid was calculated for each patient. On average, a phospho-soda preparation provided significantly less residual fluid than a polyethylene glycol electrolyte solution preparation
— id: 21257, year: 2001, vol: 218, page: 274, stat: Journal Article,

Imaging of suspected acute small bowel obstruction
Macari M; Megibow A
2001 Apr;36(2):108-117, Seminars in roentgenology
— id: 20694, year: 2001, vol: 36, page: 108, stat: Journal Article,

Pitfalls of using three-dimensional CT colonography with two-dimensional imaging correlation
Macari M; Megibow AJ
2001 Jan;176(1):137-143, American journal of roentgenology
— id: 21259, year: 2001, vol: 176, page: 137, 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,

Cystic tumors of the pancreas: the radiologist
Megibow AJ; Lavelle MT; Rofsky NM
2001 Jun;81(3):489-495, Surgical clinics of North America
In this article, the author reviews the effect of contemporary imaging techniques on the diagnosis of various pancreatic neoplasms. Histologic detail and the relationship to other means of diagnosis are included
— id: 26725, year: 2001, vol: 81, page: 489, stat: Journal Article,

MR imaging of the pancreas
Megibow AJ; Lavelle MT; Rofsky NM
2001 Apr;81(2):307-20, ix, Surgical clinics of North America
Current MR imaging technology offers the surgeon diagnostic information about pancreatic diseases. This article reviews the basics of MR imaging formation and the rationale for the different types of imaging sequences that comprise a comprehensive pancreaticobiliary examination. Clinical examples include evaluation of pancreatic neoplasms, acute and chronic pancreatitis, and congenital abnormalities
— id: 20623, year: 2001, vol: 81, page: 307, stat: Journal Article,

Cystic pancreatic masses: cross-sectional imaging observations and serial follow-up
Megibow AJ; Lombardo FP; Guarise A; Carbognin G; Scholes J; Rofsky NM; Macari M; Balthazar EJ; Procacci C
2001 Nov-Dec;26(6):640-647, Abdominal imaging
BACKGROUND: We retrospectively reviewed the imaging features of a series of patients with cystic pancreatic masses, the majority of whom underwent imaging surveillance. METHODS: Imaging data from 30 patients with known cystic pancreatic masses were reviewed. Nine patients had surgical and/or cytologic classification. Of the 21 who were not operated on, all underwent serial imaging surveillance. Of these, five had corroborative endoscopic retrograde cholangiopancreatography and 16 were followed by only computed tomography and/or magnetic resonance imaging. RESULTS: In the nonoperated group, mean follow-up time was 30 months (3-144 months). Two patients demonstrated growth, and the remainder remain stable. In the patients who underwent surgery, invasive carcinoma was found in those with lesions larger than 4 cm, involvement of the main pancreatic duct, or visible solid components on the imaging study. Smaller lesions were benign. CONCLUSION: In patients with suspected cystic pancreatic neoplasms, surveillance might be possible if lesions are smaller than 2.5 cm, spare the main pancreatic duct, and demonstrate no solid components
— id: 32122, year: 2001, vol: 26, page: 640, stat: Journal Article,

CT interpretation utilizing compressed image data: Acute appendicitis as a model for assessing diagnostic quality
Megibow, AJ; Rusinek, H; Lisi, V; Macari, MJ; Bennett, GL; Israel, GM
2001 NOV ;221(2):377-377, Radiology
— id: 73268, year: 2001, vol: 221, page: 377, stat: Journal Article,

Evaluation of left lower quadrant pain. American College of Radiology. ACR Appropriateness Criteria
Balfe DM; Levine MS; Ralls PW; Bree RL; DiSantis DJ; Glick SN; Megibow AJ; Saini S; Shuman WP; Greene FL; Laine LA; Lillemoe K
2000 Jun;215 Suppl(1):167-171, Radiology
— id: 43672, year: 2000, vol: 215 Suppl, page: 167, stat: Journal Article,

Imaging strategies in the initial evaluation of the jaundiced patient. American College of Radiology. ACR Appropriateness Criteria
Balfe DM; Ralls PW; Bree RL; DiSantis DJ; Glick SN; Levine MS; Megibow AJ; Saini S; Shuman WP; Greene FL; Laine LA; Lillemoe K; Kidd R
2000 Jun;215 Suppl(1):125-133, Radiology
— id: 43677, year: 2000, vol: 215 Suppl, page: 125, stat: Journal Article,

Suspected liver metastases. American College of Radiology. ACR Appropriateness Criteria
Bree RL; Greene FL; Ralls PW; Balfe DM; DiSantis DJ; Glick SN; Kidd R; Levine MS; Megibow AJ; Mezwa DG; Saini S; Shuman WP; Laine LA; Lillemoe K
2000 Jun;215 Suppl(1):213-224, Radiology
— id: 43665, year: 2000, vol: 215 Suppl, page: 213, stat: Journal Article,

Evaluation of patients with acute right upper quadrant pain. American College of Radiology. ACR Appropriateness Criteria
Bree RL; Ralls PW; Balfe DM; DiSantis DJ; Glick SN; Levine MS; Megibow AJ; Saini S; Shuman WP; Greene FL; Laine LA; Lillemoe K
2000 Jun;215 Suppl(1):153-157, Radiology
— id: 43674, year: 2000, vol: 215 Suppl, page: 153, stat: Journal Article,

Imaging evaluation of the palpable abdominal mass. American College of Radiology. ACR Appropriateness Criteria
DiSantis DJ; Ralls PW; Balfe DM; Bree RL; Glick SN; Kidd R; Levine MS; Megibow AJ; Mezwa DG; Saini S; Shuman WP; Greene FL; Laine LA; Lillemoe K
2000 Jun;215 Suppl(1):201-202, Radiology
— id: 43668, year: 2000, vol: 215 Suppl, page: 201, stat: Journal Article,

The patient with suspected small bowel obstruction: imaging strategies. American College of Radiology. ACR Appropriateness Criteria
DiSantis DJ; Ralls PW; Balfe DM; Bree RL; Glick SN; Levine MS; Megibow AJ; Saini S; Shuman WP; Greene FL; Laine LA; Lillemoe K
2000 Jun;215 Suppl(1):121-124, Radiology
— id: 43678, year: 2000, vol: 215 Suppl, page: 121, stat: Journal Article,

Screening for colorectal cancer. American College of Radiology. ACR Appropriateness Criteria
Glick SN; Ralls PW; Balfe DM; Bree RL; DiSantis DJ; Kidd R; Levine MS; Megibow AJ; Mezwa DG; Saini S; Shuman WP; Greene FL; Laine LA; Lillemoe K
2000 Jun;215 Suppl(1):231-237, Radiology
— id: 43663, year: 2000, vol: 215 Suppl, page: 231, stat: Journal Article,

Imaging recommendations for patients with newly suspected Crohn's disease, and in patients with known Crohn's disease and acute exacerbation or suspected complications. American College of Radiology. ACR Appropriateness Criteria
Kidd R; Mezwa DG; Ralls PW; Balfe DM; Bree RL; DiSantis DJ; Glick SN; Levine MS; Megibow AJ; Saini S; Shuman WP; Greene FL; Laine LA; Lillemoe K
2000 Jun;215 Suppl(1):181-192, Radiology
— id: 43670, year: 2000, vol: 215 Suppl, page: 181, stat: Journal Article,

Imaging recommendations for patients with dysphagia. American College of Radiology. ACR Appropriateness Criteria
Levine MS; Ralls PW; Balfe DM; Bree RL; DiSantis DJ; Glick SN; Kidd R; Megibow AJ; Mezwa DG; Saini S; Shuman WP; Greene FL; Laine LA; Lillemoe K
2000 Jun;215 Suppl(1):225-230, Radiology
— id: 43664, year: 2000, vol: 215 Suppl, page: 225, stat: Journal Article,

Comparison of time-efficient CT colonography with two- and three-dimensional colonic evaluation for detecting colorectal polyps
Macari M; Milano A; Lavelle M; Berman P; Megibow AJ
2000 Jun;174(6):1543-1549, American journal of roentgenology
OBJECTIVE: We compared the findings of time-efficient CT colonography with complete two-dimensional (2D) and three-dimensional (3D) CT colonography and conventional colonoscopy in detecting colorectal polyps. SUBJECTS AND METHODS: Forty-two patients undergoing colonoscopy screening were examined with CT colonography before endoscopy. Data were examined following one of two methods. In method 1, axial 2D data sets were examined in a cine mode. If findings were suggestive of abnormality, focal areas were examined with 3D CT colonography. In method 2, data sets were examined exactly as in method 1, and subsequent to that review, data sets were examined with simultaneous 3D 'fly-through' CT colonography (surface-rendered images) and multiplanar reformatted images. The time required to examine CT colonography using each technique was recorded and abnormal findings were documented. Results of methods 1 and 2 were compared with findings on colonoscopy. RESULTS: Colonoscopy detected 16 polyps in 13 patients (polyp size, 2-10 mm). Ten polyps measured 5 mm or less, five measured between 6 and 9 mm, and one measured 10 mm or more. Using method 1, two of 10 polyps measuring less than 5 mm, three of five polyps measuring between 6 and 9 mm, and one polyp measuring 10 mm were detected. We noted no false-positive polyps. Average evaluation time was 16 min. With method 2, the same polyps were seen as with method 1. No additional polyps were detected, and the average evaluation time was 40 min. CONCLUSION: Axial 2D CT colonography can be performed quickly and is comparable with complete 2D and 3D CT colonography in detecting colorectal polyps
— id: 11651, year: 2000, vol: 174, page: 1543, stat: Journal Article,

Acute pancreatitis. American College of Radiology. ACR Appropriateness Criteria
Megibow AJ; Ralls PW; Balfe DM; Bree RL; DiSantis DJ; Glick SN; Kidd R; Levine MS; Mezwa DG; Saini S; Shuman WP; Greene FL; Laine LA; Lillemoe K
2000 Jun;215 Suppl(1):203-207, Radiology
— id: 43667, year: 2000, vol: 215 Suppl, page: 203, stat: Journal Article,

Pre-treatment staging of colorectal cancer. American College of Radiology. ACR Appropriateness Criteria
Megibow AJ; Ralls PW; Balfe DM; Bree RL; DiSantis DJ; Glick SN; Levine MS; Saini S; Shuman WP; Greene FL; Laine LA; Lillemoe K; Mezwa D
2000 Jun;215 Suppl(1):135-142, Radiology
— id: 43676, year: 2000, vol: 215 Suppl, page: 135, stat: Journal Article,

Evaluation of acute right lower quadrant pain. American College of Radiology. ACR Appropriateness Criteria
Ralls PW; Balfe DM; Bree RL; DiSantis DJ; Glick SN; Levine MS; Megibow AJ; Saini S; Shuman WP; Greene FL; Laine LA; Lillemoe K
2000 Jun;215 Suppl(1):159-166, Radiology
— id: 43673, year: 2000, vol: 215 Suppl, page: 159, stat: Journal Article,

Liver lesion characterization. American College of Radiology. ACR Appropriateness Criteria
Saini S; Ralls PW; Balfe DM; Bree RL; DiSantis DJ; Glick SN; Kidd R; Levine MS; Megibow AJ; Mezwa DG; Shuman WP; Greene FL; Laine LA; Lillemoe K
2000 Jun;215 Suppl(1):193-199, Radiology
— id: 43669, year: 2000, vol: 215 Suppl, page: 193, stat: Journal Article,

Suspected abdominal abscess. American College of Radiology. ACR Appropriateness Criteria
Saini S; Ralls PW; Balfe DM; Bree RL; DiSantis DJ; Glick SN; Levine MS; Megibow AJ; Shuman WP; Greene FL; Laine LA; Lillemoe K; Brown M; Berland L
2000 Jun;215 Suppl(1):173-179, Radiology
— id: 43671, year: 2000, vol: 215 Suppl, page: 173, stat: Journal Article,

Imaging evaluation of patients with acute abdominal pain and fever. American College of Radiology. ACR Appropriateness Criteria
Shuman WP; Ralls PW; Balfe DM; Bree RL; DiSantis DJ; Glick SN; Kidd R; Levine MS; Megibow AJ; Mezwa DG; Saini S; Greene FL; Laine LA; Lillemoe K
2000 Jun;215 Suppl(1):209-212, Radiology
— id: 43666, year: 2000, vol: 215 Suppl, page: 209, stat: Journal Article,

Imaging of blunt abdominal trauma. American College of Radiology. ACR Appropriateness Criteria
Shuman WP; Ralls PW; Balfe DM; Bree RL; DiSantis DJ; Glick SN; Levine MS; Megibow AJ; Saini S; Greene FL; Laine LA; Lillemoe K; Berland L
2000 Jun;215 Suppl(1):143-151, Radiology
— id: 43675, year: 2000, vol: 215 Suppl, page: 143, stat: Journal Article,

The accordion sign at CT: a nonspecific finding in patients with colonic edema
Macari M; Balthazar EJ; Megibow AJ
1999 Jun;211(3):743-746, Radiology
PURPOSE: To determine whether the 'accordion sign' is a specific computed tomographic (CT) sign of Clostridium difficile colitis. MATERIALS AND METHODS: Fifty-seven patients with CT evidence of severe colitis, as judged by colonic wall thickening, an abnormal haustral pattern, the target sign, and stranding of the pericolic fat, were identified from a computerized CT database for 25 months. CT images were retrospectively evaluated for the presence of oral contrast material in the colon and for the accordion sign. The medical and laboratory records of all patients were reviewed and correlated with CT findings to establish the cause of colitis. RESULTS: Oral contrast material had reached the colon in 35 of 57 patients at the time of the CT examination. The images in 15 of these patients demonstrated the accordion sign, and those in 20 patients did not. C difficile colitis was documented in four of the 15 cases displaying the accordion sign. In the remaining 11 patients, a different cause was documented. Oral contrast material had not reached the colon in the remaining 22 patients. Within this group with findings similar to the accordion sign, five patients had documented C difficile colitis, and four had colitis from other causes. CONCLUSION: The accordion sign is indicative of severe colonic edema or inflammation, but it is not specific for C difficile colitis
— id: 6127, year: 1999, vol: 211, page: 743, stat: Journal Article,

Usefulness of CT colonography in patients with incomplete colonoscopy
Macari M; Berman P; Dicker M; Milano A; Megibow AJ
1999 Sep;173(3):561-564, American journal of roentgenology
OBJECTIVE: Our objective was to investigate the use of CT colonography in patients who have undergone incomplete colonoscopy. CONCLUSION: CT colonography is effective in evaluating portions of the colon not seen during colonoscopy and may have an adjunctive role
— id: 6189, year: 1999, vol: 173, page: 561, stat: Journal Article,

Characterization of cystic tumors of the pancreas: CT accuracy
Procacci C; Biasiutti C; Carbognin G; Accordini S; Bicego E; Guarise A; Spoto E; Andreis IA; De Marco R; Megibow AJ
1999 Nov-Dec;23(6):906-912, Journal of computer assisted tomography
PURPOSE: The purpose of this work was to evaluate the capabilities of CT to accurately characterize cystic tumors of the pancreas. METHOD: Two observers retrospectively evaluated the CT exams of 100 cystic masses of the pancreas, with pathological confirmation. The two observers, blinded about clinical information and the final diagnosis, tried to categorize the lesions according to well established morphologic features. Statistical analysis was performed to measure the agreement between each radiologist and the consensus diagnosis and to evaluate the usefulness of certain CT findings in differentiating one type of cystic pancreatic neoplasm from another. RESULTS: Serous cystadenoma was better diagnosed by CT [Youden misclassification index (Ymi) = 0.72] than mucinous cystic tumor (Ymi = 0.44) and solid pseudopapillary tumor (cystic variant) (Ymi = 0.47). CONCLUSION: As patients with previous history of pancreatitis were excluded from the study, CT findings allowed correct characterization of only 60% of cystic pancreatic masses. Among the remaining 40%, 15-20% of the wrong diagnoses could not be corrected by means of CT, given the patterns shown by the tumors. In 20-25% of the cases, a nonspecific diagnosis of cystic mass was made
— id: 43679, year: 1999, vol: 23, page: 906, stat: Journal Article,

Intraductal papillary mucinous tumor of the pancreas: a pictorial essay
Procacci C; Megibow AJ; Carbognin G; Guarise A; Spoto E; Biasiutti C; Pistolesi GF
1999 Nov-Dec;19(6):1447-1463, Radiographics
Intraductal papillary mucinous tumor (IPMT) of the pancreas was identified and classified only recently. IPMT has a primarily intraductal, papillomatous growth pattern, which is associated with excessive mucin secretion and results in progressive ductal dilatation or cyst formation. The tumor occurs in four forms: segmental or diffuse involvement of the main pancreatic duct and macrocystic or microcystic involvement of a branch duct. In the past, many IPMTs may have been misdiagnosed as chronic pancreatitis because of their generally benign behavior. The correct diagnosis, once achieved only with endoscopic retrograde cholangiopancreatography (ERCP), can now be made with noninvasive imaging modalities, particularly computed tomography (CT) and magnetic resonance (MR) imaging. ERCP remains the imaging modality of choice for diagnosis of IPMT. With ERCP, the communication between the cystically dilated ductal segment or branch duct and the main pancreatic duct is easily demonstrated. However, reflux of contrast material due to an excess of mucin or an enlarged papillary orifice hinders filling of the ductal tree. Filling defects due to mucin globs or mural nodules are also important clues to the diagnosis. Bulging of the papilla into the duodenal lumen is virtually pathognomonic of IPMT and is well demonstrated with CT or MR imaging
— id: 43680, year: 1999, vol: 19, page: 1447, stat: Journal Article,

Small-bowel obstruction associated with sigmoid diverticulitis: CT evaluation in 16 patients
Kim AY; Bennett GL; Bashist B; Perlman B; Megibow AJ
1998 May;170(5):1311-1313, American journal of roentgenology
OBJECTIVE: The purpose of this study was to identify acute sigmoid diverticulitis as a cause of small-bowel obstruction and to describe the CT findings. CONCLUSION: CT scanning enabled accurate preoperative diagnosis of colonic diverticulitis as the cause of the small-bowel obstruction, thereby allowing proper management and surgical planning
— id: 7627, year: 1998, vol: 170, page: 1311, stat: Journal Article,

Non-small cell lung carcinoma: usefulness of unenhanced helical CT of the adrenal glands in an unmonitored environment
Macari M; Rofsky NM; Naidich DP; Megibow AJ
1998 Dec;209(3):807-812, Radiology
PURPOSE: To evaluate routine non-contrast material-enhanced helical computed tomography (CT) of the adrenal glands in patients with non-small cell lung carcinoma to facilitate characterization of adrenal masses detected in an unmonitored environment (i.e., the radiologist on duty did not look at the acquired images before the patient left the scanner). MATERIALS AND METHODS: One hundred consecutive patients with non-small cell lung carcinoma were referred for CT evaluation of the chest; chest and abdomen; or chest, abdomen, and brain. All underwent unenhanced CT of the adrenal glands before the requested CT examination. The morphologic features, size, and attenuation values of the adrenal masses were calculated. Attenuation values of adrenal masses from prior imaging, if available, were compared with those at follow-up imaging to classify these masses. Variable unit cost increase in obtaining these additional images was estimated. RESULTS: Fifteen adrenal masses were identified in 13 patients. In one patient, bilateral ill-defined adrenal masses were present. In 12 patients, 13 masses were sharply circumscribed: Seven were less than 10 HU and six were 20 HU or greater at unenhanced CT. Nine of these 12 patients received iodinated contrast material. Without the unenhanced CT, 10 adrenal masses in these nine patients would have been indeterminate for malignancy. In six of these nine patients, the adrenal mass was the only potential site of metastatic disease. The unenhanced CT data helped classify three of these masses as benign-10 HU or less- and three as indeterminate-greater than 10 HU. CONCLUSION: Unenhanced CT of the adrenal glands can prospectively characterize adrenal masses and obviate further examination in patients with lung carcinoma
— id: 7396, year: 1998, vol: 209, page: 807, stat: Journal Article,

CT of small-bowel lymphoma in immunocompetent patients and patients with AIDS: comparison of findings
Balthazar EJ; Noordhoorn M; Megibow AJ; Gordon RB
1997 Mar;168(3):675-680, American journal of roentgenology
OBJECTIVE: The purpose of this study was to describe and analyze the CT features of small-bowel lymphoma, compare those features with the radiographic presentation in immunocompetent patients and patients with AIDS, and discuss the role of CT in the initial detection and evaluation of this disease. MATERIALS AND METHODS: Abdominal CT examinations of 42 consecutive patients with proven small-bowel lymphoma were retrospectively reviewed. In 19 patients, small-bowel examinations were also available for review. The 42-patient study group was divided into two subgroups: 22 patients with AIDS and 20 immunocompetent patients. RESULTS: Primary small-bowel lymphoma was present in 37% of patients and was equally distributed between the two subgroups. The histologic types included non-Hodgkin's lymphoma in 33 patients, Burkitt's lymphoma in seven patients, Hodgkin's lymphoma in one patient, and mucosa-associated lymphoid tissue-type lymphoma in one patient. Solid organ involvement (liver, splee, kidney, or adrenal glands) was detected in 22% of patients with AIDS and in 10% of the immunocompetent patients. We saw two main patterns of CT appearance. In the first pattern, single or multiple segments had circumferential wall thickening, homogeneous in attenuation, that ranged from 1.5 cm to 7 cm (mean, 2.6 cm) in 33 patients. In the second pattern, single or multiple cavitary lesions were revealed as nodular and grossly enlarged intestinal lumen with bowel wall thickening in 13 patients. A polypoid mass that was entirely intraluminal was seen in one patient. Heterogeneous areas of low attenuation were revealed in two intestinal tumors of HIV-positive patients. Mesenteric or retroperitoneal lymphadenopathy was seen in 45% of patients with AIDS and 60% of the immunocompetent patients. The gross morphologic features, distribution. pattern of CT presentation, degree of wall thickening, and length of involvement were all similar in the two subgroups. CONCLUSION: More than half (52%) of the individuals with small-bowel lymphoma diagnosed at our institution in the last 4 years were patients with AIDS. The features revealed by CT scans were characteristic or highly suggestive of small-bowel lymphoma. We saw no significant differences in the radiographic features of patients with AIDS and immunocompetent patients
— id: 12374, year: 1997, vol: 168, page: 675, stat: Journal Article,

The role of radiology in the diagnosis of small-bowel obstruction
Maglinte DD; Balthazar EJ; Kelvin FM; Megibow AJ
1997 May;168(5):1171-1180, American journal of roentgenology
— id: 43682, year: 1997, vol: 168, page: 1171, stat: Journal Article,

Lessons learned from CT provide guide for the '90s
Megibow A
1997 Aug;19(8):43-5, 47, Diagnostic imaging
— id: 43681, year: 1997, vol: 19, page: 43, stat: Journal Article,

Salmonella- and Shigella-induced ileitis: CT findings in four patients
Balthazar EJ; Charles HW; Megibow AJ
1996 May-Jun;20(3):375-378, Journal of computer assisted tomography
PURPOSE: The purpose of this study is to describe and illustrate the CT appearance of four cases of acute terminal ileitis induced by nontyphoidal Salmonella and Shigella infection and to review the radiographic and endoscopic findings of these entities. METHOD: The medical records, CT examinations, and small bowel examinations of three patients with Salmonella ileitis and one patient with Shigella ileitis were retrospectively reviewed. CT examinations were done in four patients, colonoscopy in three patients, and small bowel examinations in two patients. Stool cultures established the diagnosis of nontyphoidal Salmonella enteritis in three patients and Shigella enteritis in one patient. The patients' symptoms and clinical findings resolved promptly following supportive therapy and appropriate antibiotic therapy. RESULTS: CT showed slight circumferential and homogeneous thickening of the terminal ileum over a segment of 10-15 cm in patients with Salmonella ileitis. Associated mild thickening of the wall of the colon was present in addition. Small bowel examination performed in one patient revealed a spastic terminal ileum with thickened mucosal folds. Colonoscopy revealed acute colitis involving the colon diffusely in one case, but sparing the distal 50 cm of the colon in one case. CT showed more pronounced thickening of the terminal ileum and a target configuration in the patient with Shigella ileitis. Small bowel examination revealed narrowing, irregular contour, several large nodular defects (thumbprinting), and a severely ulcerated mucosa affecting the terminal ileum. Colonoscopy revealed a normal colon and large ulcerations with fibropurulent exudate in the terminal ileum. CONCLUSION: In patients with severe Salmonella or Shigella infections or persistent and/or confusing clinical presentations, CT can play a complementary but important role in the initial diagnostic evaluation. It avoids clinical mismanagement, circumvents unnecessary invasive procedures, and contributes to the efficient workup and therapy in this group of individuals
— id: 6979, year: 1996, vol: 20, page: 375, stat: Journal Article,

CT and MR imaging in the staging of colorectal carcinoma: report of the Radiology Diagnostic Oncology Group II
Zerhouni EA; Rutter C; Hamilton SR; Balfe DM; Megibow AJ; Francis IR; Moss AA; Heiken JP; Tempany CM; Aisen AM; Weinreb JC; Gatsonis C; McNeil BJ
1996 Aug;200(2):443-451, Radiology
PURPOSE: To prospectively evaluate the relative accuracy of computed tomography (CT) and magnetic resonance (MR) imaging in the staging of colorectal carcinoma. MATERIALS AND METHODS: CT and MR studies were independently interpreted in a group of 478 patients with colorectal carcinoma in a study conducted from 1989 to 1993. The accuracy of each modality was assessed in a subset of 365 patients with primary tumors with respect to staging of local extent of tumor, status of local-regional lymph nodes, and the presence of liver metastases. RESULTS: In the staging of local extent of tumor, CT is more accurate than MR imaging, particularly in the definition of penetration of the muscularis propria by rectal cancer (74% vs 58%). Accuracies of CT and MR imaging were equivalent in depiction of transmural extent in colon cancers. CT and MR imaging exhibited accuracies of 62% and 64% in assessment of lymph node involvement with sensitivities of 48% and 22%, respectively. The accuracy of MR imaging and of CT (85% for each) are better for evaluation of liver metastases; lower sensitivities (62% and 70%, respectively) than specificities (97% and 94%, respectively) were demonstrated for both modalities. CONCLUSION: CT was more accurate than MR imaging in detection and characterization of transmural penetration of rectal tumors. Recent technologic advances in MR imaging may affect these results
— id: 43683, year: 1996, vol: 200, page: 443, stat: Journal Article,

CT in patients with scirrhous carcinoma of the GI tract: imaging findings and value for tumor detection and staging [see comments]
Balthazar EJ; Siegel SE; Megibow AJ; Scholes J; Gordon R
1995 Oct;165(4):839-845, American journal of roentgenology
OBJECTIVE. The purposes of this study were to analyze the CT features of scirrhous carcinoma of the gastrointestinal (GI) tract and to assess the usefulness of CT in detecting and staging these lesions. MATERIAL AND METHODS. This is a retrospective evaluation of 31 proven cases of scirrhous carcinoma (linitis plastica) of the GI tract imaged in our institution from 1986 to 1994. Twenty-two patients had primary gastric carcinoma, and nine had carcinoma of the colon (rectosigmoid in eight and right colon in one). CT examinations were reviewed and correlated with pathologic and/or surgical findings in all patients and with barium examinations in 19 cases. A modified Dukes classification was used to stage these lesions without knowledge of the pathologic and surgical results. RESULTS. Four gastric lesions were missed during the initial CT examination. Seventeen patients had extensive circumferential lesions, and five had focal plaquelike lesions. The wall thickness ranged from 1 to 3 cm (mean, 1.8 cm). Homogeneous enhancement was seen in 17 patients, slightly heterogeneous enhancement was seen in one, a target configuration was present in two patients, and intramural calcification was present in one patient. All colonic lesions were circumferential, homogeneously enhancing with a wall thickness ranging from 1 to 3 cm (mean, 2 cm). CT scans showed limitations in evaluating local parameters. Compared with surgical and pathologic staging, CT correctly staged 26 patients, understaged four patients, and overstaged one patient. Among the 19 patients with pathologically proven stage D lesions (61%), CT correctly staged 17 patients (89%) and had a 100% positive predictive value. One case of hepatic metastases, 13 cases of malignant ascites, and 11 cases of omental and peritoneal metastases were found. CONCLUSION. CT is an important complimentary imaging technique to detect scirrhous carcinoma. The sensitivity of detection depends on the size of the lesion and the quality of the examination. CT has limitations in staging early lesions but shows a high sensitivity (89%) in detecting Dukes stage D lesions. Accurate CT staging in these individuals (61% in this series) allows a more adequate treatment strategy and avoids unnecessary exploratory laparotomies
— id: 6804, year: 1995, vol: 165, page: 839, stat: Journal Article,

Pancreatic adenocarcinoma: CT versus MR imaging in the evaluation of resectability--report of the Radiology Diagnostic Oncology Group
Megibow AJ; Zhou XH; Rotterdam H; Francis IR; Zerhouni EA; Balfe DM; Weinreb JC; Aisen A; Kuhlman J; Heiken JP
1995 May;195(2):327-332, Radiology
PURPOSE: To compare findings with computed tomography (CT) and magnetic resonance (MR) imaging in pancreatic adenocarcinoma and to determine optimal pulse sequences for MR imaging. MATERIALS AND METHODS: CT scans and MR images were compared of 189 adult patients with known or suspected adenocarcinoma of the pancreas. Levels of confidence were correlated with surgical and pathologic results. RESULTS: The accuracy of CT was 0.73 and of MR imaging was 0.70. The negative predictive value of CT was 0.28 and of MR imaging was 0.23. The positive predictive value of CT was 0.89 and of MR imaging was 0.88. Gradient-echo and T1-weighted spin-echo sequences ranked equally in evaluation of vascular invasion, T1-weighted spin-echo sequences were preferred for assessing lymphadenopathy, and T2-weighted spin-echo sequences were preferred for detecting hepatic metastases. CONCLUSIONS: Cross-sectional imaging modalities are useful in the identification of unresectable pancreatic carcinoma. CT is recommended for initial imaging assessment
— id: 6690, year: 1995, vol: 195, page: 327, stat: Journal Article,

Value of CT in the diagnosis and management of patients with suspected acute small-bowel obstruction
Taourel PG; Fabre JM; Pradel JA; Seneterre EJ; Megibow AJ; Bruel JM
1995 Nov;165(5):1187-1192, American journal of roentgenology
OBJECTIVE. The purpose of this prospective study was to evaluate the role of CT in the diagnosis of patients with suspected acute small-bowel obstruction in whom clinical and plain radiographic findings were inconclusive. SUBJECTS AND METHODS. Fifty-seven nonconsecutive patients with suspected acute small-bowel obstruction were referred for CT to differentiate small-bowel obstruction from ileus (33 patients) or to establish the cause of obstruction (24 patients). The final diagnosis was established either by surgery (42 patients) or by the clinical evolution (15 patients). The change in the prescan diagnosis as to the presence, cause, and severity (strangulation) of small-bowel obstruction made on the basis of the CT findings was noted. Finally, the changes in therapy resulting from the CT information were recorded. RESULTS. CT correctly distinguished between small-bowel obstruction and ileus in all cases except one. CT enabled us to modify an erroneous clinical diagnosis correctly in 12 (21%) of 57 cases, including eight cases for which pre-CT diagnosis was ileus and four cases for which pre-CT diagnosis was small-bowel obstruction. CT allowed us to predict the cause of obstruction correctly in 33 (85%) of 39 patients with confirmed small-bowel obstruction but it failed to differentiate adhesions from internal hernias and radiation enteritis. The pre-CT diagnosis of the cause of obstruction was correctly changed because of CT findings in 17 (44%) of 39 patients with subsequently proved small-bowel obstruction. CT was able to identify strangulation in nine of the 12 patients with proved strangulation, which altered the pre-CT diagnosis in three patients. CT findings correctly modified the management in 12 (21%) of 57 patients, by changing either a conservative management to an operative one in 10 (18%), or an operative to a conservative one by differentiating ileus from obstruction in two patients. CONCLUSION. Our findings show that CT is a valuable diagnostic procedure in patients with suspected acute small-bowel obstruction. CT not only is useful in distinguishing obstruction from paralytic ileus, but it frequently establishes the cause of the obstruction and the presence of strangulation. CT findings lead to decisions to treat patients surgically in a significant number of patients
— id: 43684, year: 1995, vol: 165, page: 1187, 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,

Abdominal imaging in AIDS
Megibow AJ
1994 Apr-Jun;19(2):162-176, Rays
— id: 6453, year: 1994, vol: 19, page: 162, stat: Journal Article,

Bowel obstruction. Evaluation with CT
Megibow AJ
1994 Sep;32(5):861-870, Radiologic clinics of North America
Recently, CT scans have proved to be useful in revealing the site, level, and cause of bowel obstruction and in displaying signs of threatened bowel viability. This article outlines the utility of CT scans, both in terms of the diagnostic features of bowel obstruction and in the evaluation of its accuracy
— id: 12894, year: 1994, vol: 32, page: 861, stat: Journal Article,

Histoplasmosis of the colon in patients with AIDS: imaging findings in four cases
Balthazar EJ; Megibow AJ; Barry M; Opulencia JF
1993 Sep;161(3):585-587, American journal of roentgenology
OBJECTIVE. The purpose of this study was to describe and illustrate the radiographic findings of colonic histoplasmosis in patients with AIDS. SUBJECTS AND METHODS. Four HIV-positive patients were admitted because of fever, abdominal pain, tenderness, weight loss, and diarrhea. One patient had known disseminated histoplasmosis, one had esophageal moniliasis, and two had no other known opportunistic infections or tumors. All four patients had barium enemas, and two had abdominal CT examinations. The diagnosis was established via colonoscopic biopsy in three patients and with surgery in one patient. RESULTS. Barium enema in two patients showed separate, short, apple-core lesions in the transverse and descending colon. In one patient, a single lesion in the ascending colon mimicked colonic carcinoma. One patient had segmental involvement of the ascending colon, compatible with inflammatory bowel disease. CT examination revealed circumferential thickening of the wall of the colon with adjacent lymphadenopathy of mixed attenuation. Three patients responded to medical therapy, and one patient remained symptomatic and was found on a follow-up CT examination to have significant recurrence of retroperitoneal lymphadenopathy. CONCLUSION. Colonic histoplasmosis in patients with AIDS has protean radiographic features and can mimic colonic carcinoma. In these patients, histoplasmosis should be part of the differential diagnosis, particularly when several colonic lesions are detected, associated regional and retroperitoneal lymphadenopathy is present, and the patient is living or has lived in an endemic area
— id: 13080, year: 1993, vol: 161, page: 585, 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,

Cytomegalovirus gastritis: protean radiologic features
Farman J; Lerner ME; Ng C; Balthazar E; Megibow A; Herlinger H; Grimes M
1992 Summer;17(3):202-206, Gastrointestinal radiology
Infection with cytomegalovirus (CMV) is a major feature of acquired immunodeficiency syndrome (AIDS). Gastrointestinal involvement is being seen more frequently. Our collective experience involves nine patients with stomach involvement. Seven patients were intravenous drug abusers or homosexuals with AIDS. One developed CMV gastritis as a complication of leukemia and one patient was a West African with lymphoma and human immunodeficiency virus (HIV) infection. All our patients had biopsy-proven CMV inclusion bodies. The radiographic appearances varied widely. The findings included markedly thickened edematous folds, erosive gastritis with aphthous ulceration, and superficial and deep ulceration. One patient had deep ulceration with fistula formation. Computed tomographic (CT) scans confirmed the greatly thickened gastric wall and coarsened folds in two patients. Associated gastrointestinal infections included candida and herpes, and, in addition, pneumocystis carinii pneumonia (PCP) was present in two patients. CMV gastritis may mimic several other conditions including erosive gastritis, peptic ulceration, lymphoma, and carcinoma. It should be strongly considered in immunosuppressed patients
— id: 43685, year: 1992, vol: 17, page: 202, 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,

Pancreatic adenocarcinoma: designing the examination to evaluate the clinical questions
Megibow AJ
1992 May;183(2):297-303, Radiology
The dynamic incremental bolus technique and modifications in slice thickness can be used to tailor current computed tomographic (CT) technology to evaluate the extent of pancreatic cancer. Contrast material administered intravenously allows visualization of small lesions, an assessment of vascular invasion versus patency, and maximal conspicuity and detectability of hepatic metastases. CT findings in 104 cases of pancreatic cancer studied during 1979-1982 (group A) were compared with findings in 107 cases of pancreatic cancer studied during 1984-1987 (group B). Masses in the body and tail of the pancreas were recognized in 96% (n = 103) of cases in group B and 89% (n = 93) in group A. Masses in the head of the gland were detectable in 94% (n = 101) of cases in group B and 76% (n = 79) of cases in group A. Hypoattenuating tumors were detectable in 78% (n = 83) of cases in group B, as opposed to 24% (n = 25) in group A. CT is the primary diagnostic technique in the evaluation of pancreatic adenocarcinoma
— id: 13617, year: 1992, vol: 183, page: 297, 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,

Limitations in the CT diagnosis of acute diverticulitis: comparison of CT, contrast enema, and pathologic findings in 16 patients
Balthazar EJ; Megibow A; Schinella RA; Gordon R
1990 Feb;154(2):281-285, American journal of roentgenology
Pitfalls in CT diagnosis of acute diverticulitis were investigated in 16 patients with the disease who had misleading or equivocal CT features. The CT appearance was correlated with contrast enemas (13 cases) and with surgical assessment and pathologic evaluation of resected specimens (12 cases). Limitations in the CT diagnosis were related to (1) marked thickening of the colonic wall, between 1 and 3 cm in cross section simulating colonic neoplasm (all patients); (2) inability to visualize small amounts of fibropurulent exudate in the absence of pericolic inflammatory changes (eight patients); (3) failure to detect discrete intramural abscess (five patients). Resected surgical specimens available in 12 cases proved that colonic wall thickening was caused by muscular hypertrophy and various degrees of submucosal inflammation, edema, fibrosis, or focal organized inflammatory tissue. Contrast enema was useful in 10 out of 13 patients by excluding carcinoma of the colon and confirming the diagnosis of acute diverticulitis
— id: 43692, year: 1990, vol: 154, page: 281, stat: Journal Article,

Acute pancreatitis: value of CT in establishing prognosis
Balthazar EJ; Robinson DL; Megibow AJ; Ranson JH
1990 Feb;174(2):331-336, Radiology
The presence and degree of pancreatic necrosis (30%, 50%, or greater than 50%) was evaluated by means of bolus injection of contrast material and dynamic sequential computed tomography (CT) in 88 patients with acute pancreatitis at initial and follow-up examinations. Pancreatic necrosis was defined as lack of enhancement of all or a portion of the gland. Length of hospitalization, morbidity, and mortality in patients with early or late necrosis (22 patients) were evaluated and compared with the same criteria in the rest of the group. Patients with necrosis had a 23% mortality and an 82% complication rate; patients without necrosis had 0% mortality and 6% morbidity. When only the initial assessment was considered, patients with peripancreatic phlegmons and necrosis had 80% morbidity, compared with 36% morbidity in those with phlegmons and no necrosis. Serious complications occurred in patients who initially had or developed more than 30% necrosis. A CT severity index, based on a combination of peripancreatic inflammation, phlegmon, and degree of pancreatic necrosis as seen at initial CT study, was developed. Patients with a high CT severity index had 92% morbidity and 17% mortality; patients with a low CT severity index had 2% morbidity, and none died
— id: 43690, year: 1990, vol: 174, page: 331, 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,

RENAL-CELL CARCINOMA - EARLIER DISCOVERY AND INCREASED DETECTION - RESPOND
Bosniak, MA; Megibow, AJ; Raghavendra, BN; Hulnick, DH; Horii, SC; Smith, SJ
1990 Jan;174(1):280-281, Radiology
— id: 32032, year: 1990, vol: 174, page: 280, 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,

Visceral and nodal calcification in patients with AIDS-related Pneumocystis carinii infection
Radin DR; Baker EL; Klatt EC; Balthazar EJ; Jeffrey RB Jr; Megibow AJ; Ralls PW
1990 Jan;154(1):27-31, American journal of roentgenology
Clinical and radiologic findings in nine patients with AIDS and disseminated Pneumocystis carinii infection were analyzed retrospectively. The diagnosis was confirmed by autopsy (five patients) and by biopsy (two patients). All nine had a history of P. carinii pneumonia. CT showed parenchymal calcifications in the spleen (seven patients), liver (six patients), kidneys (six patients), abdominal lymph nodes (three patients), adrenal glands (two patients), and mediastinal lymph nodes (one patient). Multiple punctate calcifications in the liver, spleen, kidneys, and/or adrenal glands were visible on plain films in three patients. Sonography showed diffuse tiny echogenic foci without shadowing in the liver, spleen, and kidneys. In one patient, CT showed multiple hypodense lesions in the spleen. P. carinii infection should be included in the differential diagnosis when calcifications or focal lesions are detected at one or more extrapulmonary sites in an immunodeficient patient, even if there is no history or evidence of P. carinii pneumonia
— id: 43694, year: 1990, vol: 154, page: 27, stat: Journal Article,

The value of MR imaging in distinguishing leiomyomas from other solid pelvic masses when sonography is indeterminate
Weinreb JC; Barkoff ND; Megibow A; Demopoulos R
1990 Feb;154(2):295-299, American journal of roentgenology
The differentiation of a uterine leiomyoma from other solid pelvic masses on sonography is usually straightforward. Occasionally, the sonographic appearance of a pedunculated uterine leiomyoma may simulate that of a solid adnexal mass. The purpose of this study was to determine if MR imaging adds specificity to the diagnosis of indeterminate solid pelvic masses visualized with sonography. Nineteen patients were imaged with MR after sonography revealed the presence of a solid pelvic mass adjacent to the uterus but could not be used to determine whether the mass was a leiomyoma or some other type of tumor. The diagnostic criteria for a leiomyoma on MR imaging included (1) the presence of a mass adjacent to the uterus and (2) a mass that was predominantly low signal intensity or isointense compared with normal myometrium on T1-weighted images and predominantly low signal intensity on T2-weighted images. In 11 of 13 patients, the masses that met these MR criteria for leiomyoma were proved to be uterine leiomyomas at surgery. Another mass that met the criteria was shown to be a leiomyoma in the broad ligament; the other was an ovarian fibroma. Of the six cases that did not meet the MR criteria for the diagnosis of leiomyoma, three were proved to be degenerated fibroids, one was squamous cell carcinoma of the cervix, and two were ovarian malignant tumors. Because leiomyomas often have an MR appearance that is distinct from that of solid pelvic malignant tumors, MR imaging can be useful for the diagnosis of some indeterminate solid pelvic masses
— id: 43691, year: 1990, vol: 154, page: 295, stat: Journal Article,

CT-SPECT fusion to correlate radiolabeled monoclonal antibody uptake with abdominal CT findings
Kramer EL; Noz ME; Sanger JJ; Megibow AJ; Maguire GQ
1989 Sep;172(3):861-865, Radiology
To enhance the information provided by computed tomography (CT) and single photon emission computed tomography (SPECT) performed with radiolabeled, anti-carcinoembryonic antigen monoclonal antibody (MoAb), the authors performed fusion of these types of images from eight subjects with suspected colorectal adenocarcinoma. Section thickness and pixel size of the two studies were matched, coordinates of corresponding points from each study were identified, and CT sections were translated, rotated, and reprojected to match the corresponding SPECT scans. The CT-SPECT fusion enabled identification of anatomic sites of tumor-specific MoAb accumulation in four cases, showed non-specific MoAb accumulation in two, and helped confirm information only suggested by the two studies separately in one
— id: 25913, year: 1989, vol: 172, page: 861, stat: Journal Article,

Neutropenic typhlitis simulating carcinoma of the cecum
Musher DR; Amorosi EL; Gouge T; Megibow AJ; Press RA
1989 Sep-Oct;35(5):449-451, Gastrointestinal endoscopy
— id: 10496, year: 1989, vol: 35, page: 449, stat: Journal Article,

Adrenal myelolipomas: CT appearance with tiny amounts of fat and punctate calcification
Rofsky NM; Bosniak MA; Megibow AJ; Schlossberg P
1989 ;11(3):148-152, Urologic radiology
Five cases of myelolipoma of the adrenal are presented which contained only tiny foci of fat along with areas of punctate calcification. This computed tomographic (CT) appearance is less common for this neoplasm and has only been described in three of 26 previously published CT cases of this adrenal tumor. The presence of even tiny amounts of fat in an adrenal mass should alert the radiologist to the probable diagnosis of myelolipoma. Small foci of calcification are also frequently associated
— id: 10816, year: 1989, vol: 11, page: 148, stat: Journal Article,

Renal cell carcinoma: earlier discovery and increased detection [see comments]
Smith SJ; Bosniak MA; Megibow AJ; Hulnick DH; Horii SC; Raghavendra BN
1989 Mar;170(3 Pt 1):699-703, Radiology
To document the earlier discovery and increased detection of renal cell carcinoma, the authors reviewed cases of renal cell carcinoma detected at their institution during 1974-1977 and 1982-1985, with particular emphasis on renal tumors 3.0 cm or smaller. Only 5.3% (four of 75) of renal cell carcinomas found during 1974-1977 but 25.4% (31 of 122) found during 1982-1985 were 3.0 cm or smaller, an increase of almost five times. Of the small tumors in the 1982-1985 group 96.7% (30 of 31) were incidentally discovered, and 77.4% (24 of 31) were initially detected with computed tomography (CT) or ultrasound (US). In the later series 48.4% (15 of 31) of the small renal tumors were treated with partial nephrectomy. Follow-up shows no recurrences. Many more small renal tumors are being detected because of the use of CT and US. This will undoubtedly increase the cure rate of renal cell carcinoma because these tumors are being detected when they are small and do not cause symptoms. Partial nephrectomy will increasingly be used in the management of these small tumors
— id: 10710, year: 1989, vol: 170, page: 699, stat: Journal Article,

Computed tomography of the abnormal appendix
Balthazar EJ; Megibow AJ; Gordon RB; Whelan CA; Hulnick D
1988 Jul-Aug;12(4):595-601, Journal of computer assisted tomography
This report describes the CT features of 29 abnormal appendices visualized during abdominal CT examinations. There were 22 cases of acute appendicitis, five mucoceles, and two mucinous adenocarcinomas of the appendix. The inflammed appendix appeared either as a fluid-filled slightly distended structure or as a collapsed small tubular structure. It was visualized on either cross or longitudinal sections and showed slight circumferential wall thickening. Periappendiceal inflammation was detected in 19 cases and intraluminal appendicoliths in six cases. Mucocele appeared as a larger fluid-filled round, oval, or tubular structure having a thin, sharp wall, low density contents, and no periappendiceal inflammation. Mucinous carcinoma appeared either as a single or as multiloculated, irregular shaped cystic lesion with solid elements. Infiltration of cecum and terminal ileum was seen in one case. In five cases the abnormal appendix was not recognized initially and was identified only after repeat 5 X 5 mm sections were obtained. During CT examination, demonstration of an abnormal appendix establishes the source of the abdominal pathology and helps greatly in the differential diagnosis
— id: 11036, year: 1988, vol: 12, page: 595, stat: Journal Article,

Carcinoma of the colon: detection and preoperative staging by CT
Balthazar EJ; Megibow AJ; Hulnick D; Naidich DP
1988 Feb;150(2):301-306, American journal of roentgenology
This report analyzes the detection rate and role of CT in the preoperative evaluation of 90 consecutive, proved cases of colon carcinoma. In this study, the overall detection rate was 84%; however, the rate varied from 68% in unprepared colons to 95% in clean colons that were adequately distended with air. Sensitivity of detection depends mainly on the size of the lesion and the quality of the examination. CT was less sensitive than barium enema in detection, but it had a similar specificity in differentiating neoplastic lesions from inflammatory lesions. On the basis of our criteria of staging, CT evaluation resulted in a sensitivity of 55% for local invasion, 73% for regional nodes, and 79% for liver metastases. Compared with Dukes classification, CT correctly staged 64% of all patients but showed significant variations in staging different groups with lower results in the Dukes A, B, and C patients. CT, however, showed a sensitivity of 81% and a positive predictive value of 100% in detecting Dukes D lesions. In general, although negative CT findings do not help in staging a colonic tumor, positive findings are highly indicative of neoplastic spread. We believe that this feature justifies the use of CT in the preoperative evaluation of colonic tumors
— id: 11199, year: 1988, vol: 150, page: 301, stat: Journal Article,

CT diagnosis of renal angiomyolipoma: the importance of detecting small amounts of fat
Bosniak MA; Megibow AJ; Hulnick DH; Horii S; Raghavendra BN
1988 Sep;151(3):497-501, American journal of roentgenology
Six patients were reviewed who had renal angiomyolipoma (1.2-4.0 cm) in which only minimal amounts of fat were evident on CT. The fat content of the lesion was appreciated because tissue attenuation measurements of small areas of low attenuation within the tumors were performed and because thin-section (5-mm) and nonenhanced CT scans were used. The fat content of the lesions could be identified on 10-mm sections in three cases but only on 5-mm sections in three others. In two cases, fat was seen only on the nonenhanced 5-mm thin sections. Careful sampling of low-density regions within the mass must be performed because a single region of interest over the entire tumor will produce an average attenuation in the soft-tissue range. The use of 5-mm thin sections and thin, nonenhanced CT sections increases spatial and density resolution and decreases susceptibility to partial-volume effects. In a correlative study, no areas of fat were detected in a review of 100 well-circumscribed (4.0 cm or smaller) renal cell carcinomas. Detecting the existence of fat in a renal lesion will establish the diagnosis of angiomyolipoma and is the only radiologic finding that can differentiate it from renal cell carcinoma. Thus, unnecessary surgery will be avoided in these cases
— id: 10981, year: 1988, vol: 151, page: 497, stat: Journal Article,

CT DETECTION OF SMALL AMOUNTS OF FAT TO ESTABLISH THE DIAGNOSIS OF RENAL ANGIOMYOLIPOMA
Bosniak, MA; Megibow, AJ; Hulnick, DH; Horii, SC; Raghavendra, BN
1988 Jul;151(1):209-209, American journal of roentgenology
— id: 31473, year: 1988, vol: 151, page: 209, stat: Journal Article,

Liver and abdominal screening in patients with cancer: CT versus MR imaging
Chezmar JL; Rumancik WM; Megibow AJ; Hulnick DH; Nelson RC; Bernardino ME
1988 Jul;168(1):43-47, Radiology
A prospective multiinstitutional study was performed to compare the ability of dynamic sequential contrast material-enhanced computed tomography (CT), delayed contrast material-enhanced CT, and two T1-weighted magnetic resonance (MR) sequences (spin echo and inversion recovery) to demonstrate metastatic disease in the liver and abdomen in patients with cancer. All four techniques had comparable rates of hepatic lesion detection when compared individually or when the combined CT techniques were compared with the combined MR techniques. The sensitivity to hepatic disease was 96% (27 of 28 patients) for the combined MR techniques versus 93% (26 of 28 patients) for the combined CT techniques. However, CT was statistically superior in the detection of extrahepatic disease, with significant extrahepatic findings demonstrated by CT in only 12 of 59 patients (20%). For this reason, the authors continue to recommend CT in the initial screening of patients with cancer for upper abdominal metastatic disease
— id: 43695, year: 1988, vol: 168, page: 43, stat: Journal Article,

Radiology of AIDS
Federle, Michael P.; Megibow, Alec J.; Naidich, David P
New York : Raven Press, c1988,
— id: 75, year: 1988, vol: , page: , stat: ,

Retroperitoneal fibrosis presenting as colonic dysfunction: CT diagnosis
Hulnick DH; Chatson GP; Megibow AJ; Bosniak MA; Ruoff M
1988 Jan-Feb;12(1):159-161, Journal of computer assisted tomography
In a patient who presented with pelvic pain and changed bowel habits, barium enema and sigmoidoscopic examinations demonstrated a nonspecific asymmetric narrowing of the colon at the rectosigmoid junction with normal mucosal appearance. Computed tomography revealed the etiology to be retroperitoneal fibrosis with pelvic extension and entrapment of the colon at this level. The importance of CT in diagnosis of this unusual manifestation of retroperitoneal fibrosis is discussed
— id: 11224, year: 1988, vol: 12, page: 159, stat: Journal Article,

CT/SPECT FUSION FOR CORRELATION OF MONOCLONAL-ANTIBODY (MOAB) SPECT AND ABDOMINAL CT
KRAMER, EL; NOZ, ME; SANGER, JJ; MAGUIRE, GQ; MEGIBOW, A
1988 JUL ;29(7):1313-1313, Journal of nuclear medicine
— id: 33376, year: 1988, vol: 29, page: 1313, stat: Journal Article,

Accuracy of CT in detection of persistent or recurrent ovarian carcinoma: correlation with second-look laparotomy
Megibow AJ; Bosniak MA; Ho AG; Beller U; Hulnick DH; Beckman EM
1988 Feb;166(2):341-345, Radiology
Computed tomographic (CT) studies in 39 patients with advanced ovarian carcinoma were retrospectively evaluated to assess their accuracy in detection of persistent or recurrent disease as seen at second-look laparotomy (SLL). Twenty patients were studied before June 1983 (group 1), and 19 patients were studied afterward (group 2). There were 16 true-positive, ten true-negative, two false-positive, and 11 false-negative examinations. Five false-negative studies resulted from microscopic disease found at SLL. In group 1, there were eight false-negative studies. In five, macroscopic disease was not recognized. In group 2, there were three false-negative studies; in one, macroscopic disease was not recognized. Statistical analysis showed an observable improvement in the accuracy in group 2. The differences included use of faster scanners, routine use of thin sections for the pelvis, and air-contrast colonic opacification in group 2. These results suggest that carefully performed scanning on state-of-the-art equipment may have a higher accuracy in documenting persistent or recurrent macroscopic tumor
— id: 11191, year: 1988, vol: 166, page: 341, stat: Journal Article,

Cardiovascular disease: evaluation with MR phase imaging
Rumancik WM; Naidich DP; Chandra R; Kowalski HM; McCauley DI; Megibow AJ; Hernanz-Schulman M; Genieser NB
1988 Jan;166(1 Pt 1):63-68, Radiology
Magnetic resonance phase images are derived from conventional spin-echo (SE) pulse sequences and display properties of proton movement that occurs with blood flow. SE magnitude and phase images were obtained and retrospectively evaluated in 21 patients referred for potential cardiovascular abnormalities in which intracardiac or intravascular signal was detected. Abnormalities included intravascular and intracardiac thrombus, aneurysm, aortic dissection, flow alteration, atherosclerotic disease, and congenital cardiac anomaly. Thrombosis (six cases) was successfully differentiated from flow-related signal (15 cases) by comparing phase images with SE magnitude images; in cases of thrombosis, there was no phase shift in corresponding areas of increased signal intensity. In comparison, SE magnitude signal intensities alone were not an accurate indicator in differentiating thrombus from flow-related enhancement. Because phase images are sensitive for identifying flow, the SE magnitude signal of intravascular tumor or thrombus can be differentiated from that of flow effects with more clinical confidence
— id: 11222, year: 1988, vol: 166, page: 63, stat: Journal Article,

The use of computed tomography in the diagnosis of carcinoma of the renal pelvis causing ureteropelvic junction obstruction
Schwartz JM; Bosniak MA; Hulnick DH; Megibow AJ
1988 ;9(4):204-209, Urologic radiology
The computed tomographic (CT) appearance of 5 cases of primary malignancy of the renal pelvis causing ureteropelvic junction (UPJ) obstruction is presented. The tumors appeared as enhancing thickened, nodular, and crescentic masses at the UPJ. Comparison is made to the thin, regular wall of the hydronephrotic pelvis caused by congenital UPJ obstruction. Differentiation from other causes of UPJ obstruction by CT is discussed. A CT scan is particularly valuable when the cause of UPJ obstruction remains elusive after urography and pyelography
— id: 11209, year: 1988, vol: 9, page: 204, stat: Journal Article,

Computed tomography of midline cysts of the prostate
Schwartz JM; Bosniak MA; Hulnick DH; Megibow AJ; Raghavendra BN
1988 Mar-Apr;12(2):215-218, Journal of computer assisted tomography
Midline cysts in the male pelvis are a confusing entity due to their relatively infrequent presentation and the uncertainty as to their origin and classification. We report on CT appearance of four cases of midline prostatic cysts. Ultrasound correlation was available in one case. Two patients presented with lower urinary tract symptoms (hematospermia and/or hematuria), and two were asymptomatic, with one case detected on physical examination and one found incidentally on CT. Computed tomography demonstrated a characteristic sharply marginated, low density, homogeneous midline cyst within the prostate. On ultrasound a well defined midline anechoic cystic mass was seen. These cases are illustrated and a discussion of cystic masses in the male pelvis is included
— id: 11159, year: 1988, vol: 12, page: 215, stat: Journal Article,

Right adrenal pseudotumor caused by colon: CT demonstration
Schwartz JM; Bosniak MA; Megibow AJ; Hulnick DH
1988 Jan-Feb;12(1):153-154, Journal of computer assisted tomography
Multiple adrenal pseudotumors have been previously described on CT and routine radiography. In the following case report we demonstrate interposition of normal colon between the liver, kidney, and adrenal in the hepatorenal recess that produced the CT appearance of a pseudotumor of the right adrenal gland
— id: 11225, year: 1988, vol: 12, page: 153, stat: Journal Article,

Computed tomography of intramural intestinal hemorrhage and bowel ischemia
Balthazar EJ; Hulnick D; Megibow AJ; Opulencia JF
1987 Jan-Feb;11(1):67-72, Journal of computer assisted tomography
The CT findings of eight patients with intramural intestinal hemorrhage are described and illustrated. Two patients had ischemic bowel disease: in the other six cases pertinent clinical histories led to an accurate diagnosis. Computed tomography demonstrated similar findings consisting of circumferential and symmetrical wall thickening homogeneous in density, a slightly narrowed intestinal lumen, and sharp outer contour. The disease had a segmental distribution affecting different parts of the intestinal tract. In six patients edematous and congestive mesenteric changes were seen and in two patients intraperitoneal blood was detected. An adequate history and careful clinical evaluation are crucial in differentiating the more benign forms of intramural hemorrhage from bowel ischemia
— id: 26431, year: 1987, vol: 11, page: 67, stat: Journal Article,

Cecal diverticulitis: evaluation with CT
Balthazar EJ; Megibow AJ; Gordon RB; Hulnick D
1987 Jan;162(1 Pt 1):79-81, Radiology
The findings of computed tomographic (CT) examinations in seven patients with cecal diverticulitis are described and correlated with those of barium studies. The CT findings were linear and streaky densities in the pericecal fat compatible with pericecal inflammation (seven cases), intramural abscess (one case), thickening of the cecal wall (two cases), and cecal diverticulum (one case). Barium studies, available in four patients, led to a correct diagnoses of diverticulitis in two cases. CT scanning is a sensitive means by which to detect cecal diverticulitis. The radiographic appearance of the disease, however, mimics that of appendicitis, unless more specific findings such as cecal diverticula or intramural abscess with adjacent inflammation is detected. CT and barium study are complementary methods of examination that improve our ability to diagnose cecal diverticulitis and its complications
— id: 43699, year: 1987, vol: 162, page: 79, stat: Journal Article,

Cytomegalovirus esophagitis in AIDS: radiographic features in 16 patients
Balthazar EJ; Megibow AJ; Hulnick D; Cho KC; Beranbaum E
1987 Nov;149(5):919-923, American journal of roentgenology
Cytomegalovirus is one of the more common opportunistic organisms implicated in the development of esophagitis in patients with AIDS. A review of the radiographic features of 16 proved cases of cytomegalovirus esophagitis showed a spectrum of abnormalities related to the severity of the inflammatory process. Seven patients had a mild form of esophagitis with segmental involvement characterized by granular mucosa, superficial erosions, and poorly defined, shallow ulcerations. Nine patients had more severe esophagitis with solitary or multiple deep ulcers and a background of normal mucosa. The deep ulcerations were oval in shape and varied in size. Some projected intraluminally and had a thin rim of radiolucency at the base. Short-term follow-up examinations showed progression of the disease in four patients, no change in one patient, and regression without specific therapy in one patient. Although these radiographic features are highly suggestive of cytomegalovirus esophagitis, the diagnosis requires histologic confirmation
— id: 11340, year: 1987, vol: 149, page: 919, stat: Journal Article,

CT evaluation of esophageal varices
Balthazar EJ; Naidich DP; Megibow AJ; Lefleur RS
1987 Jan;148(1):131-135, American journal of roentgenology
CT findings in 20 consecutive patients with proven esophageal varices are reviewed and analyzed. In 85% of patients, abnormalities were seen involving the esophageal wall and/or periesophageal region. In 65%, findings specific to varices were present: thickening of esophageal wall, a scalloped contour, and intraluminal protrusions enhancing after a contrast bolus injection. These findings were seen alone or in association with periesophageal varices, which were seen in 45% of patients; evidence of portal hypertension with varices in the lesser omentum was present in 95%. CT has a sensitivity similar to barium esophagram but evaluates better the presence and extent of periesophageal varices and portal hypertension. Normal CT does not rule out esophageal varices because small varices may escape detection, particularly in scans done without a contrast bolus injection
— id: 23441, year: 1987, vol: 148, page: 131, stat: Journal Article,

Diverticulitis: evaluation by CT and contrast enema
Hulnick DH; Megibow AJ; Balthazar EJ
1987 Sep;149(3):644-646, American journal of roentgenology
— id: 43697, year: 1987, vol: 149, page: 644, stat: Journal Article,

Perforated colorectal neoplasms: correlation of clinical, contrast enema, and CT examinations
Hulnick DH; Megibow AJ; Balthazar EJ; Gordon RB; Surapenini R; Bosniak MA
1987 Sep;164(3):611-615, Radiology
Results of clinical, contrast enema (CE), and computed tomographic (CT) examinations in 39 patients with perforated colorectal neoplasms were retrospectively reviewed. Twenty patients were toxemic at initial presentation, but in only four patients was the diagnosis of perforated colorectal neoplasm initially suspected clinically. CE study was performed in 22 patients and enabled the diagnosis of perforated neoplasm in 11 cases, neoplasm alone in eight, and neither neoplasm nor perforation in three. CT was performed in 38 patients and enabled the diagnosis of perforated neoplasm in 36; pericolic phlegmon but no mass lesion was evident in two. In 16 patients, CT also demonstrated metastatic disease. Because of its reliability in establishing the diagnosis and staging the extent of the inflammatory and neoplastic disease, CT is indicated in cases of suspected or proved perforated colorectal neoplasm and in cases in which CE study findings are indeterminate or suggestive of perforated neoplasm
— id: 43696, year: 1987, vol: 164, page: 611, stat: Journal Article,

Radiology of nonneoplastic gastrointestinal disorders in acquired immune deficiency syndrome
Megibow AJ; Balthazar EJ; Hulnick DH
1987 Jan;22(1):31-41, Seminars in roentgenology
— id: 43698, year: 1987, vol: 22, page: 31, stat: Journal Article,

CT of appendicitis
Balthazar EJ; Megibow AJ; Hulnick D; Gordon RB; Naidich DP; Beranbaum ER
1986 Oct;147(4):705-710, American journal of roentgenology
The CT findings of 38 consecutive patients with acute appendicitis are analyzed, described, and illustrated. CT showed intraabdominal disease in 92% of patients and made a specific diagnosis of appendicitis in 79% of cases. The most common CT findings were pericecal inflammation (68%), abscess (55%), calcified appendicolith (23%), and an abnormal appendix (18%). CT had a sensitivity similar to that of contrast enema examinations, but it correlated much better with the surgical findings in detecting the precise nature, extent, and location of the disease process. Normal CT does not exclude appendicitis, since mild forms without periappendiceal disease may escape detection
— id: 43700, year: 1986, vol: 147, page: 705, stat: Journal Article,

DIVERTICULITIS EVALUATED BY COMPUTED-TOMOGRAPHY
HULNICK, DH; MEGIBOW, AJ; BALTHAZAR, EJ; HOROWITZ, L
1986 MAY ;90(5):1469-1469, Gastroenterology
— id: 41455, year: 1986, vol: 90, page: 1469, stat: Journal Article,

GASTROINTESTINAL LYMPHOMA - THE ROLE OF CT IN DIAGNOSIS AND MANAGEMENT
MEGIBOW, AJ
1986 MAR ;7(1):43-57, Seminars in ultrasound CT & MR
— id: 41611, year: 1986, vol: 7, page: 43, stat: Journal Article,

CT OF GASTRIC-CARCINOMA - A REVIEW OF 60 PATIENTS
MEGIBOW, AJ; HULNICK, DH; BALTHAZAR, EJ
1986 JUL ;11(3):294-294, Gastrointestinal radiology
— id: 41394, year: 1986, vol: 11, page: 294, stat: Journal Article,

Computed tomography of the gastrointestinal tract
Megibow, Alec J.; Balthazar, Emil J
St. Louis : Mosby, 1986,
— id: 418, year: 1986, vol: , page: , stat: ,

CT demonstration of rapid improvement of retroperitoneal fibrosis in response to steroid therapy
Smith SJ; Bosniak MA; Megibow AJ; Hulnick DH; Smiles S
1986 ;8(2):104-107, Urologic radiology
A case of retroperitoneal fibrosis with hydronephrosis was treated with cortisone therapy. Computed tomographic images recorded marked and rapid reduction in the size of the soft tissue fibrotic mass and resolution of the hydronephrosis
— id: 43701, year: 1986, vol: 8, page: 104, stat: Journal Article,

CT diagnosis of closed loop obstruction
Balthazar EJ; Bauman JS; Megibow AJ
1985 Sep-Oct;9(5):953-955, Journal of computer assisted tomography
A case of closed loop obstruction presenting with unremarkable plain abdominal films and diagnosed by CT is reported. The presence of (a) fluid filled distended small bowel loops; (b) abrupt transition with collapsed distal intestinal loops; and (c) grossly distended fluid filled 'U' shaped loop are diagnostic of this entity. Prompt CT recognition, before signs of intestinal gangrene develop, will lead to immediate surgical decompression and a significant decrease in the morbidity and mortality of this potential abdominal catastrophe
— id: 43703, year: 1985, vol: 9, page: 953, stat: Journal Article,

CT of splenic and perisplenic abnormalities in septic patients
Balthazar EJ; Hilton S; Naidich D; Megibow A; Levine R
1985 Jan;144(1):53-56, American journal of roentgenology
Splenic and perisplenic pathology, demonstrated by CT examination in 14 septic patients, was correlated with the clinical course and with surgical and pathologic findings available. Twelve patients were intravenous drug addicts and two patients developed bacteremia associated with bacterial endocarditis. The CT findings were divided into three groups: (1) Single wedge-shaped peripherally located defects were seen in five patients; there was good response to medical therapy without other complications. (2) Larger and/or multiple, rounded or oval lesions were present in five patients; two of these patients had splenic abscesses proven on subsequent splenectomy. (3) Multiple splenic lesions and fissures associated with perisplenic and subphrenic fluid collections were seen in four patients; infected splenic infarcts, splenic fractures, and infected perisplenic hemorrhagic fluid collections were found in this group of patients. The CT examination in septic patients can reliably demonstrate splenic and perisplenic pathology, and its appearance contributes greatly to the overall clinical assessment and surgical approach
— id: 43710, year: 1985, vol: 144, page: 53, stat: Journal Article,

CT evaluation of pancreatic injury following splenectomy
Balthazar EJ; Megibow A; Rothberg M; Lefleur RS
1985 ;10(2):139-144, Gastrointestinal radiology
A fluid collection in the left subphrenic space immediately after splenectomy is often associated with pancreatic injury. The configuration, location, and vascular supply of the tail of the pancreas explain this postoperative complication. Depending on the degree of injury, the CT findings may show swelling of the tail of the pancreas, ill-defined fluid collections, or a well-encapsulated pancreatic pseudocyst. The diagnosis is confirmed by percutaneous aspiration with amylase determinations and the demonstration of a pancreatic fistula. Failure to diagnose this complication promptly may lead to a protracted postoperative clinical course and the development of a subphrenic abscess or a pancreatic pseudocyst
— id: 23442, year: 1985, vol: 10, page: 139, stat: Journal Article,

Cytomegalovirus colitis in AIDS: radiographic findings in 11 patients
Balthazar EJ; Megibow AJ; Fazzini E; Opulencia JF; Engel I
1985 Jun;155(3):585-589, Radiology
Radiographic findings in 11 proved cases of cytomegalovirus (CMV) colitis were reviewed and correlated with colonoscopic and pathologic findings. Patients were chronically ill homosexual men with multiple systemic opportunistic infections. Endoscopies showed focal or diffuse inflammation, hemorrhagic plaques, and superficial colonic ulcers. Biopsies revealed inflammatory cells associated with cytoplasmic and intranuclear inclusion bodies. Barium enema examinations showed mucosal granularity, superficial erosions, thickened folds, and spasticity. Disease was either diffuse (four patients) or segmental (two patients), or it involved the cecum exclusively (three patients). Two patients had normal barium enema studies. Computed tomography scans in two patients demonstrated marked colonic wall thickening and mucosal ulcerations. In the homosexual population with acquired immunodeficiency syndrome, CMV colitis should be part of the differential diagnosis of diffuse colitis, segmental colitis, or typhlitis
— id: 26432, year: 1985, vol: 155, page: 585, stat: Journal Article,

Cytomegalovirus esophagitis and gastritis in AIDS
Balthazar EJ; Megibow AJ; Hulnick DH
1985 Jun;144(6):1201-1204, American journal of roentgenology
The radiographic features of cytomegalovirus involvement of the upper gastrointestinal tract in four homosexual men with acquired immunodeficiency syndrome (AIDS) are described. Esophageal involvement (three cases) was demonstrated as a localized ulceration or as a more diffuse esophagitis affecting predominantly the distal esophagus. Gastric involvement (two cases) presented as large nodular rugal folds in the fundus or as a circumferentially narrowed antrum deformed by numerous large nodular contour defects. Endoscopy revealed mucosal erosions, serpiginous ulcers, and inflammatory exudate; biopsies documented the presence of typical inclusion bodies in the epithelial and endothelial cells. Although the radiographic findings are nonspecific, the diagnosis of cytomegalovirus esophagitis and gastritis should be suspected when similar abnormalities are present in immunocompromised patients, particularly homosexual men with AIDS
— id: 43706, year: 1985, vol: 144, page: 1201, stat: Journal Article,

Acute pancreatitis: prognostic value of CT
Balthazar EJ; Ranson JH; Naidich DP; Megibow AJ; Caccavale R; Cooper MM
1985 Sep;156(3):767-772, Radiology
In 83 patients with acute pancreatitis, the initial computed tomographic (CT) examinations were classified by degree of disease severity (grades A-E) and were correlated with the clinical follow-up, objective prognostic signs, and complications and death. The length of hospitalization correlated well with the severity of the initial CT findings. Abscesses occurred in 21.6% of the entire group, compared with 60.0% of grade E patients. Pleural effusions were also more common in grade E patients. Grades A and B patients did not have abscesses, and none died, regardless of the number of prognostic signs. Abscesses were seen in 80.0% of patients with six to eight prognostic signs, compared with 12.5% of those with zero to two. The use of prognostic signs with initial CT findings results in improved prognostic accuracy. Early CT examination of patients with acute pancreatitis is a useful prognostic indicator of morbidity and mortality
— id: 43704, year: 1985, vol: 156, page: 767, stat: Journal Article,

COMPUTED-TOMOGRAPHY FOLLOWING BILLROTH-II PARTIAL GASTRECTOMY
Berliner, L; Megibow, AJ; Redmond, P; Balthazar, E
1985 ;10(3):305-305, Gastrointestinal radiology
— id: 30887, year: 1985, vol: 10, page: 305, stat: Journal Article,

Abdominal tuberculosis: CT evaluation
Hulnick DH; Megibow AJ; Naidich DP; Hilton S; Cho KC; Balthazar EJ
1985 Oct;157(1):199-204, Radiology
The computed tomography (CT) scans of 27 patients with abdominal tuberculosis were reviewed retrospectively to determine the range of abdominal involvement. Most patients had been at increased risk because of intravenous drug abuse, alcoholism, acquired immunodeficiency syndrome (AIDS), cirrhosis, or steroid therapy. The etiologic agent was Mycobacterium tuberculosis in 23 patients and M. avium-intracellulare in four patients with AIDS. In five patients, tuberculosis was limited to the abdomen. CT findings included adenopathy, splenomegaly, hepatomegaly, ascites, bowel involvement, pleural effusion, intrasplenic masses, and intrahepatic masses. Characteristic features were a tendency for adenopathy to prominently involve peripancreatic and mesenteric compartments, low-density centers within enlarged nodes, complex nature of the ascites, and adenopathy adjacent to sites of gastrointestinal tract involvement. Recognition of these manifestations and maintenance of an index of suspicion, especially in patients at risk, should help optimize the correct diagnosis and management of intraabdominal tuberculosis
— id: 43702, year: 1985, vol: 157, page: 199, stat: Journal Article,

COMPUTED-TOMOGRAPHY IN THE EVALUATION OF DIVERTICULITIS - REPLY
Hulnick, DH; Megibow, AJ; Balthazar, EJ; Naidich, DP; Bosniak, MA
1985 ;154(3):836-836, Radiology
— id: 30990, year: 1985, vol: 154, page: 836, stat: Journal Article,

CT evaluation of gastrointestinal leiomyomas and leiomyosarcomas
Megibow AJ; Balthazar EJ; Hulnick DH; Naidich DP; Bosniak MA
1985 Apr;144(4):727-731, American journal of roentgenology
Computed tomographic (CT) features in 29 patients with gastrointestinal leiomyomas and leiomyosarcomas were analyzed and compared. Features evaluated included size, shape, homogeneity, response to intravenous contrast material, and presence of calcification. The sarcomas were larger (average, 12 cm) than the myomas (average, 4.8 cm), had an irregular shape, and had a nonhomogeneous appearance both before and after contrast enhancement. Gross features depicted on CT are compared with gross pathologic criteria. Analysis of the CT appearance suggested malignancy in two cases in which microscopic examination was interpreted as benign
— id: 43707, year: 1985, vol: 144, page: 727, stat: Journal Article,

Ovarian metastases: computed tomographic appearances
Megibow AJ; Hulnick DH; Bosniak MA; Balthazar EJ
1985 Jul;156(1):161-164, Radiology
Computed tomographic scans of 34 patients with ovarian metastases were reviewed to assess the radiographic appearances and to correlate these with the primary neoplasms. Primary neoplasms were located in the colon (20 patients), breast (six), stomach (five), small bowel (one), bladder (one), and Wilms tumor of the kidney (one). The radiographic appearance of the metastatic lesions could be described as predominantly cystic (14 lesions), mixed (12 lesions), or solid (seven lesions). There was one false-negative examination which showed no ovarian enlargement, although neoplastic deposits were found on the ovary at laparotomy. The cystic and mixed lesions tended to be larger in overall diameter than the solid. The metastases from gastric carcinoma appeared solid in four of five cases. The metastases from the other neoplasms had variable appearances simulating primary ovarian carcinoma
— id: 43705, year: 1985, vol: 156, page: 161, stat: Journal Article,

Metastatic neoplasm to the kidney studied by computed tomography and sonography
Mitnick JS; Bosniak MA; Rothberg M; Megibow AJ; Raghavendra BN; Subramanyam BR
1985 Jan-Feb;9(1):43-49, Journal of computer assisted tomography
Due to the widespread use of CT for tumor staging and diagnostic workup, the discovery of metastatic neoplasm to the kidney has become a more frequent occurrence. Nine patients with metastatic carcinoma to the kidney have been studied by CT, including six by sonography. Carcinoma of the lung was the primary tumor in eight. Bilateral renal involvement was seen in all cases. The presentation of the clinical and radiologic findings in these cases with differential diagnosis is included
— id: 43709, year: 1985, vol: 9, page: 43, stat: Journal Article,

Pancreatic cancer: a new target for adjuvant therapy and chemotherapy
Muggia FM; Megibow A; Douglass HO Jr
1985 ;201(4):295-300, Progress in clinical & biological research
— id: 43708, year: 1985, vol: 201, page: 295, stat: Journal Article,

Computed tomographic recognition of gastric varices
Balthazar EJ; Megibow A; Naidich D; LeFleur RS
1984 Jun;142(6):1121-1125, American journal of roentgenology
The computed tomographic (CT) findings in 13 consecutive patients with proven gastric varices were analyzed and correlated with the radiographic, angiographic, and gastroscopic evaluations. In 11 patients, CT clearly identified large (five) or smaller (six) varices located mainly along the posteromedial wall of the gastric fundus and proximal body of the stomach. Well defined rounded or tubular densities that enhanced during intravenous administration of contrast material and could not be distinguished from the gastric wall were identified. Dense, enhancing, round or tubular, intraluminal filling defects were seen in the cases where the stomach was distended with water. In two patients, the CT diagnosis of gastric varices could not be confidently made. All patients had associated intraabdominal collateral circulation, situated medial to the stomach within the lesser omentum, along the distribution of the coronary venous system. In seven patients, the CT examination correctly diagnosed the pathogenesis of gastric varices by identifying hepatic cirrhosis, calcific pancreatitis, and carcinoma of the pancreas
— id: 23445, year: 1984, vol: 142, page: 1121, stat: Journal Article,

Anorectal giant condyloma acuminatum (Buschke-Loewenstein tumor): CT and radiographic manifestations
Balthazar EJ; Streiter M; Megibow AJ
1984 Mar;150(3):651-653, Radiology
Giant condyloma acuminatum (Buschke-Loewenstein tumor) is an unusual variety of venereal wart characterized by a large size, cauliflower-like appearance, and locally invasive nature. CT examination of two patients with anorectal giant condylomata revealed the papillomatous and invasive nature of the lesion and the extent of tumor; there was infiltration of the subcutaneous tissue, perirectal fascial planes, and luminal narrowing with marked thickening of the rectal wall. The pathologic specimens showed benign histologic findings in one case and a mixed pattern with areas of malignant degeneration in the other. CT accurately demonstrated the exact location and extent of the lesions. The presence of malignant degeneration in this inherently invasive lesion can be established only on histologic examination
— id: 43717, year: 1984, vol: 150, page: 651, stat: Journal Article,

Spigelian hernia: CT and ultrasonography diagnosis
Balthazar EJ; Subramanyam BR; Megibow A
1984 ;9(1):81-84, Gastrointestinal radiology
The diagnostic potential of CT and sonography in detecting clinically unrecognized cases of spigelian hernia is illustrated and discussed. These imaging modalities can promptly and reliably diagnose spigelian hernia based on the following findings: (1) peritoneal and muscular defect along the spigelian line in the lower abdomen; (2) intraparietal location of the hernial sac; and (3) hernial sac containing omentum and/or mesentery and loops of bowel. Two recently diagnosed cases are presented together with a short review of the literature
— id: 43718, year: 1984, vol: 9, page: 81, stat: Journal Article,

Cryptosporidiosis of the stomach and small intestine in patients with AIDS
Berk RN; Wall SD; McArdle CB; McCutchan JA; Clemett AR; Rosenblum JS; Premkumer A; Megibow AJ
1984 Sep;143(3):549-554, American journal of roentgenology
Cryptosporidiosis is a parasitic disease of the gastrointestinal tract that causes a choleralike diarrhea in patients with the acquired immunodeficiency syndrome (AIDS). Review of barium studies of the stomach and small intestine in 16 AIDS patients with cryptosporidiosis showed that the studies were abnormal in 13. Of these, five had moderate or marked prominence of the mucosal folds, and eight had slight prominence. The jejunum was predominantly involved in nine; the entire small intestine was uniformly affected in the other four. Three of the 16 patients had moderate or marked dilatation of the small intestine. One had marked dilution of the barium, and one had marked fragmentation and flocculation of the barium. There was narrowing and rigidity of the gastric antrum in two patients. These radiographic findings are nonspecific, but are indicative of cryptosporidiosis in a patient with AIDS and protracted diarrhea
— id: 43712, year: 1984, vol: 143, page: 549, stat: Journal Article,

CT findings in acute renal infarction
Hilton S; Bosniak MA; Raghavendra BN; Subramanyam BR; Rothberg M; Megibow AJ
1984 ;6(3-4):158-163, Urologic radiology
CT scans of 12 patients with renal infarcts were reviewed. CT findings along with the clinical presentation were diagnostic in 10 cases. Correlation with angiography (5 cases) and sonography (8 cases) was made. The diagnosis of renal infarction can usually be made on the basis of specific CT findings. Angiography is valuable in helping to establish the cause and direct treatment
— id: 43719, year: 1984, vol: 6, page: 158, stat: Journal Article,

Computed tomography in the evaluation of diverticulitis
Hulnick DH; Megibow AJ; Balthazar EJ; Naidich DP; Bosniak MA
1984 Aug;152(2):491-495, Radiology
Computed tomography (CT) was performed in 43 cases of colonic diverticulitis and compared with the contrast-enema examination (CE) in 37 patients. Findings on CT included inflammation of the pericolic fat in 98% of cases, diverticula in 84%, thickening of the colon wall in 70%, a pericolic abscess in 35%, peritonitis in 16%, a fistula in 14%, colon obstruction in 12%, and intramural sinus tracts in 9%. Secondary findings included a distant abscess in 12% and ureteral obstruction in 7%. In addition to detecting ureteral and bladder involvement and distant abscess formation, CT was preferable for demonstrating the extent of pericolic inflammation, which was underestimated with CE in 41% of patients. Differential diagnosis of the CT findings is discussed. The authors indicate that CT should be the initial procedure in patients with suspected diverticulitis, particularly when CE is contraindicated
— id: 43713, year: 1984, vol: 152, page: 491, stat: Journal Article,

Lumbar artery pseudoaneurysm: CT demonstration
Hulnick DH; Naidich DP; Balthazar EJ; Megibow AJ; Bosniak MA
1984 Jun;8(3):570-572, Journal of computer assisted tomography
A psoas mass in a patient with a history of penetrating trauma to the area was demonstrated by computed tomography (CT) to represent a lumbar artery pseudoaneurysm surrounded by hematoma. This report emphasizes the importance of recognizing the anatomic position of the lumbar arteries on CT images and considering the possibility of pseudoaneurysm in the differential diagnosis of post-traumatic psoas masses
— id: 43715, year: 1984, vol: 8, page: 570, stat: Journal Article,

Pseudomembranous colitis: diagnosis by computed tomography
Megibow AJ; Streiter ML; Balthazar EJ; Bosniak MA
1984 Apr;8(2):281-283, Journal of computer assisted tomography
Although the diagnosis of pseudomembranous colitis is generally straightforward in the appropriate clinical setting, patients may manifest clinical symptoms more suggestive of abdominal infection than of intestinal disease. Because these patients may have computed tomography (CT) as their first examination, it becomes important to recognize colonic changes that may reflect the presence of pseudomembranous colitis. We present two cases of this entity diagnosed by CT findings
— id: 43716, year: 1984, vol: 8, page: 281, stat: Journal Article,

Air insufflation of the colon as an adjunct to computed tomography of the pelvis
Megibow AJ; Zerhouni EA; Hulnick DH; Beranbaum ER; Balthazar EJ
1984 Aug;8(4):797-800, Journal of computer assisted tomography
Air insufflation of the colon as an adjunct to pelvic CT examinations was performed in 49 patients for evaluation of a known or suspected pelvic mass or in follow-up of treated pelvic tumors. This safe, simple method of colonic visualization clearly outlines the rectosigmoid colon and permits a reliable assessment of the mucosa, wall thickness, and extrinsic abnormalities, thereby improving diagnostic accuracy in staging pelvic malignancy and evaluating pelvic pathology
— id: 43714, year: 1984, vol: 8, page: 797, stat: Journal Article,

SMALL ANGIOMYOLIPOMA OF THE KIDNEY - SONOGRAPHY - CT EVALUATION
RAGHAVENDRA, BN; BOSNIAK, MA; MEGIBOW, AJ
1984 ;142(1):237-237, American journal of roentgenology
— id: 41035, year: 1984, vol: 142, page: 237, stat: Journal Article,

Metastatic disease to the pancreas: evaluation by computed tomography
Rumancik WM; Megibow AJ; Bosniak MA; Hilton S
1984 Oct;8(5):829-834, Journal of computer assisted tomography
Seven patients with one or more pancreatic masses due to metastases to the pancreatic parenchyma were studied by CT. Two patterns were observed. Three patients had multiple nodules studding the pancreatic surface. Four patients had a solitary focal mass indistinguishable from a primary pancreatic neoplasm. In patients with a solitary focal lesion surgical biopsy may be necessary to differentiate between metastasis and primary pancreatic carcinoma
— id: 43711, year: 1984, vol: 8, page: 829, stat: Journal Article,

Correlation of CT and ultrasound in the evaluation of renal lymphoma
Horii SC; Bosniak MA; Megibow AJ; Raghavendra BN; Subramanyam BR; Rothberg M
1983 ;5(2):69-76, Urologic radiology
In a series of 225 patients with lymphoma studied by computed tomography, involvement of the kidney(s) was found in 11 (4.9%). These cases were then also studied by ultrasound. Because of the characteristic findings of computed tomography and sonography in renal lymphoma, a reliable diagnosis was possible along with an accurate assessment of the incidence and types of renal involvement. Illustration of this material along with a discussion of the clinical implications of these findings is presented
— id: 43728, year: 1983, vol: 5, page: 69, stat: Journal Article,

Computed tomography of gastrointestinal lymphoma
Megibow AJ; Balthazar EJ; Naidich DP; Bosniak MA
1983 Sep;141(3):541-547, American journal of roentgenology
From 275 computed tomographic (CT) examinations with positive findings of abdominal lymphoma, 26 patients were found to have gastrointestinal involvement by the disease. The stomach was most commonly involved, followed by small bowel, colon, and duodenum. CT was found to be accurate in detecting wall thickening and complications such as perforation and fistulization. False-negative examinations occurred in two patients with small submucosal gastric deposits ('bull's-eye' lesions). False-positive examinations were seen in two patients with hypertrophic gastritis. The CT manifestations of gastrointestinal lymphoma, correlated with the barium study appearance, are the subject of this report
— id: 43722, year: 1983, vol: 141, page: 541, stat: Journal Article,

Obturator hernia
Megibow AJ; Wagner AG
1983 Apr;7(2):350-352, Journal of computer assisted tomography
A case of an obturator hernia preoperatively diagnosed by computed tomography is reported and the literature reviewed. The diagnosis is based on demonstration of bowel located between the pectineus muscle and the external obturator muscle. Proximal bowel obstruction may also be present
— id: 43726, year: 1983, vol: 7, page: 350, stat: Journal Article,

Non-functioning adrenal adenomas discovered incidentally on computed tomography
Mitnick JS; Bosniak MA; Megibow AJ; Naidich DP
1983 Aug;148(2):495-499, Radiology
Eighteen patients with unilateral non-metastatic, non-functioning adrenal masses were studied with computed tomography (CT). Pathological examination in 6 cases revealed benign adrenal adenoma. The others were followed up with serial CT scans and found to show no change in tumor size over a period of six months to three years. On the basis of these findings, the authors suggest certain criteria of a benign adrenal mass, including (a) diameter less than 5 cm, (b) smooth contour, (c) well-defined margin, and (d) no change in size on follow-up. Serial CT scanning can be used as an alternative to surgery in the management of many of these patients
— id: 43723, year: 1983, vol: 148, page: 495, stat: Journal Article,

Computed tomography of the diaphragm: peridiaphragmatic fluid localization
Naidich DP; Megibow AJ; Hilton S; Hulnick DH; Siegelman SS
1983 Aug;7(4):641-649, Journal of computer assisted tomography
Fifty-eight consecutive cases of peridiaphragmatic fluid collections were correctly localized by computed tomography. The key to accurate localization of peridiaphragmatic fluid is identification of the hemidiaphragms. Pulmonary consolidation and pleural fluid collections lie adjacent and peripheral to the convexity of the hemidiaphragms. Free pleural fluid distends the posterior pleural recesses, important anatomic landmarks beneath the bases of the lungs. Intra-abdominal fluid collections lie adjacent and central to the convexity of the hemidiaphragms. On the right side intraperitoneal fluid is restricted from contact with the bare area of the liver by the coronary ligaments. It is concluded that peridiaphragmatic fluid collections can generally be readily identified if one is familiar with normal cross-sectional anatomy
— id: 43724, year: 1983, vol: 7, page: 641, stat: Journal Article,

Computed tomography of the diaphragm: normal anatomy and variants
Naidich DP; Megibow AJ; Ross CR; Beranbaum ER; Siegelman SS
1983 Aug;7(4):633-640, Journal of computer assisted tomography
Computed tomographic examinations in 75 normal individuals are analyzed to define the cross-sectional anatomy of the diaphragm. Anatomic relationships among the inferoposterior portions of the lungs, the pleura, and the hemidiaphragms are clarified. The posterior pleural recess, an important potential space, is described and illustrated. The relationships of the crura, arcuate ligaments, and the hemidiaphragms are discussed as well. Awareness of these anatomic relationships forms an important basis in analyzing peridiaphragmatic fluid collections
— id: 43725, year: 1983, vol: 7, page: 633, stat: Journal Article,

Small angiomyolipoma of the kidney: sonographic-CT evaluation
Raghavendra BN; Bosniak MA; Megibow AJ
1983 Sep;141(3):575-578, American journal of roentgenology
Small fat-containing intraparenchymal renal lesions, 0.5 to 1.3 cm in diameter, were detected by sonography and computed tomography in six patients. In five of the six cases, the lesions were found serendipitously. None of the patients underwent surgery. Follow-up studies, performed over a period of 6-24 months, showed no change in the size of the lesions. These small fat-containing nodules, hitherto unrecognized by imaging studies, are not an uncommon finding at routine autopsy. Since these lesions do not show growth in the adult population, surgical intervention does not seem to be indicated
— id: 43721, year: 1983, vol: 141, page: 575, stat: Journal Article,

Sonography of adenomyomatosis of the gallbladder: radiologic-pathologic correlation
Raghavendra BN; Subramanyam BR; Balthazar EJ; Horii SC; Megibow AJ; Hilton S
1983 Mar;146(3):747-752, Radiology
Sonograms of six patients with adenomyomatosis of the gallbladder were reviewed and correlated with oral cholecystographic and pathologic findings. The gallbladder was visualized in four of the six patients by oral cholecystography, which also revealed intramural diverticula. Five of the six patients showed sonographic evidence of diffuse or segmental thickening of the gallbladder wall and intramural diverticula, seen as anechoic or echogenic foci within the wall. Intramural diverticula containing bile appeared as anechoic spaces; those containing biliary sludge or gallstones appeared as echogenic foci with or without acoustic shadows or reverberation artifacts. There was good correlation between sonographic and pathologic findings in three patients. The authors conclude that adenomyomatosis of the gallbladder should be suspected when (a) there is diffuse or segmental thickening of the gallbladder wall and (b) intramural diverticula are seen as anechoic or echogenic foci with or without associated acoustic shadows or reverberation artifacts
— id: 43727, year: 1983, vol: 146, page: 747, stat: Journal Article,

Replacement lipomatosis of the kidney: diagnosis by computed tomography and sonography
Subramanyam BR; Bosniak MA; Horii SC; Megibow AJ; Balthazar EJ
1983 Sep;148(3):791-792, Radiology
The sonographic and computed tomographic features in a case of replacement lipomatosis of the kidney are presented, along with pathologic correlation. Computed tomography demonstrated a staghorn calculus and marked atrophy of the renal parenchyma, along with diffuse increase in renal sinus and perirenal fat. Sonography showed thinning of the renal parenchyma and high-amplitude echoes throughout the kidney, corresponding to the increase in renal sinus fat. The prospective diagnosis of replacement lipomatosis, and differentiation from other causes of nonfunction of the kidney due to staghorn calculus, can be readily made
— id: 43720, year: 1983, vol: 148, page: 791, stat: Journal Article,

Gastric carcinoid tumors: radiographic features in eight cases
Balthazar EJ; Megibow A; Bryk D; Cohen T
1982 Dec;139(6):1123-1127, American journal of roentgenology
A retrospective analysis of eight proven cases of gastric carcinoid tumors is reported with emphasis on the radiographic features. These tumors occur rarely in the stomach and have variable radiographic presentations: (1) intramural defects simulating leiomyomas, (2) multiple gastric polyps, (3) large gastric ulcers, and (4) polypoid intraluminal lesions. In this series, single submucosal lesions located in the fundus and body of the stomach were demonstrated in five patients, adjacent sessile polyps in one patient, and large gastric ulcerations in the other two patients. In five of the cases, ulcerations were clearly visualized radiographically. Three patients had pathologic evidence of metastatic dissemination. The unusual entity of argentaffin-cell adenocarcinoma of the stomach is illustrated and discussed together with a pertinent review of the literature
— id: 43729, year: 1982, vol: 139, page: 1123, stat: Journal Article,

Adrenal pseudotumors on computed tomography
Berliner L; Bosniak MA; Megibow A
1982 Apr;6(2):281-285, Journal of computer assisted tomography
Masses arising in the adrenal gland may be simulated on computed tomography (CT) by a number of anatomical structures and variations, and by certain pathological conditions in adjacent organs. These adrenal pseudotumors include the following: fluid-filled gastric fundus, prominent splenic lobulations, upper pole renal masses, tortuous splenic vessels, and pancreatic masses. These conditions, which represent pitfalls in the diagnosis of adrenal tumors on CT, are demonstrated and discussed. Certain guidelines will be discussed so that these potential pitfalls may be avoided
— id: 43732, year: 1982, vol: 6, page: 281, stat: Journal Article,

Computed tomography of ureteral obstruction
Bosniak MA; Megibow AJ; Ambos MA; Mitnick JS; Lefleur RS; Gordon R
1982 Jun;138(6):1107-1113, American journal of roentgenology
Although hydronephrosis can usually be diagnosed by urography and/or pyelography, the etiology of the obstruction may not be apparent. Computed tomography (CT) is usually helpful in evaluation of these cases. In 36 cases in which CT was performed solely to determine the cause of ureteral obstruction of uncertain etiology, it proved to be of value in 33 instances (91.7%). The disease processes encountered in this series included metastatic carcinoma to the ureter or periureteral tissues(22), lymphoma (one), primary ureteral tumor (two), radiolucent ureteral stone (four), adjacent ileocolitis (two), aortic or iliac artery aneurysm (two), fibrous band(one), urinoma (one), and radiation fibrosis (one). In three cases (8.3%) an etiologic diagnosis could not be made by CT. These patients had radiation therapy to treat malignant disease, and recurrent tumor responsible for ureteral obstruction could not be distinguished from radiation fibrosis
— id: 23451, year: 1982, vol: 138, page: 1107, stat: Journal Article,

CORRELATIONS OF CT AND ULTRASOUND IN THE EVALUATION OF LYMPHOMA OF THE KIDNEYS
Bosniak, MA; Horii, S; Megibow, AJ; Raghavendra, BN; Subramanyam, B; Mitnick, J
1982 ;139(1):207-207, American journal of roentgenology
— id: 30398, year: 1982, vol: 139, page: 207, stat: Journal Article,

Computed tomography of the postoperative abdominal aorta
Hilton S; Megibow AJ; Naidich DP; Bosniak MA
1982 Nov;145(2):403-407, Radiology
Computed tomography (CT) of the abdomen was performed on 46 patients who had undergone graft replacement of abdominal aortic aneurysms. Twelve postoperative complications were found in nine patients. They included hemorrhage, infection, anastomotic pseudoaneurysms, major vessel occlusion, postoperative pancreatitis, and others. The varied appearance of the normal postoperative graft is also presented. It is concluded that CT is a rapid, sensitive, and noninvasive method for detecting or excluding postoperative complications of abdominal aortic surgery
— id: 43730, year: 1982, vol: 145, page: 403, stat: Journal Article,

The contribution of computed tomography to the evaluation of the obstructed ureter
Megibow AJ; Mitnick JS; Bosniak MA
1982 ;4(2-3):95-104, Urologic radiology
— id: 43733, year: 1982, vol: 4, page: 95, stat: Journal Article,

Diagnostic utility of sonography and computed tomography in spontaneous mesenteric hematoma
Raghavendra BN; Grieco AJ; Balthazar EJ; Megibow AJ; Subramanyam BR
1982 Aug;77(8):570-573, American journal of gastroenterology
— id: 18922, year: 1982, vol: 77, page: 570, stat: Journal Article,

CAT scans of inflammatory aneurysms: a new technique for preoperative diagnosis
Ramirez AA; Riles TS; Imparato AM; Megibow AJ
1982 Apr;91(4):390-393, Surgery
— id: 25691, year: 1982, vol: 91, page: 390, stat: Journal Article,

Iatrogenic intussusception: a complication of long intestinal tubes
Redmond P; Ambos M; Berliner L; Pachter HL; Megibow A
1982 Jan;77(1):39-42, American journal of gastroenterology
Intussusception secondary to long intestinal tubes is a relatively uncommon but potentially fatal occurrence. From 1976 to 1979 we have studied five patients with this complication. The mercury-filled bag stimulates peristalsis, the tube is drawn forward, and there is resultant telescoping and 'pleating' of the proximal small bowel. If these pleats become fixed by adhesions, they may act as a lead point for intussusception, even after tube withdrawal. Early diagnosis is essential for effective therapy
— id: 43735, year: 1982, vol: 77, page: 39, stat: Journal Article,

Alimentary tract involvement in Kaposi sarcoma: radiographic and endoscopic findings in 25 homosexual men
Rose HS; Balthazar EJ; Megibow AJ; Horowitz L; Laubenstein LJ
1982 Oct;139(4):661-666, American journal of roentgenology
An outbreak of Kaposi sarcoma has recently occurred among young homosexual men. It differs from the classic form in its virulence and preponderance of systemic manifestations. Twenty-five homosexual men with a mean age of 37 and biopsy-proven Kaposi sarcoma received extensive gastrointestinal evaluations. Twelve patients (48%) had evidence of gastrointestinal involvement by radiography and/or endoscopy. Lesions were found in the larynx, oropharynx, esophagus, stomach, duodenum, and colon. Radiographically they ranged from minimally elevated submucosal lesions, some with central ulceration, to polypoid defects. Abdominal CT was obtained in 18 patients, 11 of whom showed abnormalities. Of those with abnormal CT, 50% had retroperitoneal adenopathy. The gastrointestinal radiographic findings with endoscopic correlation in this unusual group of patients is discussed
— id: 43731, year: 1982, vol: 139, page: 661, stat: Journal Article,

Diffuse xanthogranulomatous pyelonephritis: analysis by computed tomography and sonography
Subramanyam BR; Megibow AJ; Raghavendra BN; Bosniak MA
1982 ;4(1):5-9, Urologic radiology
The sonographic and computed tomographic findings in 3 cases of diffuse xanthogranulomatous pyelonephritis are presented along with correlation with the pathological specimens. The combination of the findings in sonography and computed tomography in this condition enables one to make an accurate preoperative diagnosis. Calyces containing pus and/or xanthomatous tissue produced low-level echoes simulating preservation or thickening of the renal parenchyma on sonography. On CT the central low attenuation areas either gave negative values representing abundant xanthomatous tissue seen on gross pathology, or measured in the water density range representing a combination of pus and less abundant xanthomatous tissue
— id: 43734, year: 1982, vol: 4, page: 5, stat: Journal Article,

THE CONTRIBUTION OF CT TO THE DIAGNOSIS OF HYDRONEPHROSIS OF UNCERTAIN ETIOLOGY
AMBOS, MA; BOSNIAK, MA; MEGIBOW, AJ
1981 JAN 20 ;137(1):200-200, American journal of roentgenology
— id: 98637, year: 1981, vol: 137, page: 200, stat: Journal Article,

ANALYSIS OF 56 PARENCHYMA NEOPLASMS OF THE RENAL PARENCHYMA STUDIED BY CT AND ANGIOGRAPHY
BOSNIAK, MA; AMBOS, MA; MEGIBOW, AJ; LEFLEUR, RS
1981 JAN 20 ;137(1):199-199, American journal of roentgenology
— id: 98636, year: 1981, vol: 137, page: 199, stat: Journal Article,

Computed tomographic demonstration of a spontaneous subcapsular hematoma due to a small renal cell carcinoma
Hilton S; Bosniak MA; Megibow AJ; Ambos MA
1981 Dec;141(3):743-744, Radiology
— id: 43737, year: 1981, vol: 141, page: 743, stat: Journal Article,

Thickening of the celiac axis and/or superior mesenteric artery: a sign of pancreatic carcinoma on computed tomography
Megibow AJ; Bosniak MA; Ambos MA; Beranbaum ER
1981 Nov;141(2):449-453, Radiology
— id: 43738, year: 1981, vol: 141, page: 449, stat: Journal Article,

Case report. Crohn's disease causing hydronephrosis
Megibow AJ; Bosniak MA; Ambos MA; Redmond PE
1981 Dec;5(6):909-911, Journal of computer assisted tomography
— id: 43736, year: 1981, vol: 5, page: 909, stat: Journal Article,

CT in B-thalassemia: iron deposition in the liver, spleen, and lymph nodes
Mitnick JS; Bosniak MA; Megibow AJ; Karpatkin M; Feiner HD; Kutin N; Van Natta F; Piomelli S
1981 Jun;136(6):1191-1194, American journal of roentgenology
The authors report the striking increase in lymph node density due to hemochromatosis observed with computed tomography (CT) in nine patients with Cooley anemia treated with multiple blood transfusions. The CT appearance and pathologic findings of hemochromatosis of the liver and spleen in three of these patients were also observed and correlated with pathologic specimens. CT density of the liver seemed to relate to the degree of hepatic fibrosis or cirrhosis, rather than the amount of iron. Previous reports have not emphasized dense ferritinized lymph nodes in treated Cooley anemia patients
— id: 34985, year: 1981, vol: 136, page: 1191, stat: Journal Article,

Dilute barium as a contrast agent for abdominal CT
Megibow AJ; Bosniak MA
1980 Jun;134(6):1273-1274, American journal of roentgenology
— id: 43739, year: 1980, vol: 134, page: 1273, stat: Journal Article,

Ureteral involvement by metastatic disease
Ambos MA; Bosniak MA; Megibow AJ; Raghavendra B
1979 ;1(2):105-112, Urologic radiology
Ureteral obstruction secondary to metastases from distant primary tumors may be studied by urography, pyelography, venography and lymphagiography. An added dimension to the study of this disease process is obtained by the use of sonography and computed tomography since these techniques are better able to demonstrate the extent of the disease in the retroperitoneum
— id: 43741, year: 1979, vol: 1, page: 105, stat: Journal Article,

Computed tomographic diagnosis of ureteral obstruction secondary to aneurysmal disease
Megibow AJ; Ambos MA; Bosniak MA
1979 80;1(4):211-215, Urologic radiology
Three cases of ureteral obstruction associated with aortoiliac aneurysms were studied with computed tomography. CT was able to document the presence of aneurysm and display the perianeurysmal, fibrotic, contrast-enhancing mass accounting for ureteral obstruction. The value of computed tomography in the diagnosis and evaluation of these cases is described
— id: 43742, year: 1979, vol: 1, page: 211, stat: Journal Article,

Diagnosis of gastrointestinal lipomas by CT
Megibow AJ; Redmond PE; Bosniak MA; Horowitz L
1979 Oct;133(4):743-745, American journal of roentgenology
— id: 43740, year: 1979, vol: 133, page: 743, stat: Journal Article,