David P Naidich, M.D.

Dual-energy Computed Tomography: Concepts, Performance, and Thoracic Applications
Ko, Jane P; Brandman, Scott; Stember, Joseph; Naidich, David P
2012 Jan;27(1):7-22, Journal of thoracic imaging
Advances in multidetector technology have made dual-energy computed tomography (CT) imaging possible. Dual-energy CT imaging enables tissue characterization in addition to morphologic evaluation of imaged regions. This article reviews current and potential CT technology, technical and workflow considerations when performing dual-energy CT, and clinical applications in the thorax, with an emphasis on the knowledge gained so far
— id: 147706, year: 2012, vol: 27, page: 7, stat: Journal Article,

Imaging of incidental findings on thoracic computed tomography
Alpert, Jeffrey B; Naidich, David P
2011 Mar;49(2):267-289, Radiologic clinics of North America
With continued improvement of high-resolution multidetector computed tomography imaging, there is an increasing number of unsuspected thoracic findings. Although many of these findings are of little clinical significance, other findings such as small incidental lung nodules require additional imaging to exclude more worrisome causes, often resulting in greater exposure to ionizing radiation, increased cost, and patient anxiety. Although greater uniformity among radiologists regarding likely benign findings may help reduce unnecessary imaging studies, the lack of clear follow-up guidelines for many findings suggests that further investigation is needed in some areas
— id: 124103, year: 2011, vol: 49, page: 267, stat: Journal Article,

Lung pathologic findings in a local residential and working community exposed to world trade center dust, gas, and fumes
Caplan-Shaw, Caralee E; Yee, Herman; Rogers, Linda; Abraham, Jerrold L; Parsia, Sam S; Naidich, David P; Borczuk, Alain; Moreira, Andre; Shiau, Maria C; Ko, Jane P; Brusca-Augello, Geraldine; Berger, Kenneth I; Goldring, Roberta M; Reibman, Joan
2011 Sep;53(9):981-991, Journal of occupational & environmental medicine
OBJECTIVE: : To describe pathologic findings in symptomatic World Trade Center-exposed local workers, residents, and cleanup workers enrolled in a treatment program. METHODS: : Twelve patients underwent surgical lung biopsy for suspected interstitial lung disease (group 1, n = 6) or abnormal pulmonary function tests (group 2, n = 6). High-resolution computed axial tomography and pathologic findings were coded. Scanning electron microscopy with energy-dispersive x-ray spectroscopy was performed. RESULTS: : High-resolution computed axial tomography showed reticular findings (group 1) or normal or airway-related findings (group 2). Pulmonary function tests were predominantly restrictive. Interstitial fibrosis, emphysematous change, and small airway abnormalities were seen. All cases had opaque and birefringent particles within macrophages, and examined particles contained silica, aluminum silicates, titanium dioxide, talc, and metals. CONCLUSIONS: : In symptomatic World Trade Center-exposed individuals, pathologic findings suggest a common exposure resulting in alveolar loss and a diverse response to injury
— id: 137445, year: 2011, vol: 53, page: 981, stat: Journal Article,

Dual-energy MDCT: Comparison of pulmonary artery enhancement on dedicated CT pulmonary angiography, routine and low contrast volume studies
Godoy, Myrna C B; Heller, Samantha L; Naidich, David P; Assadourian, Bernard; Leidecker, Christianne; Schmidt, Bernhard; Vlahos, Ioannis
2011 Aug;79(2):e11-e17, European journal of radiology
PURPOSE: The aim of this study was (a) to compare arterial enhancement in simultaneously acquired high- and low-kilovoltage images; and (b) to determine whether low tube-voltage imaging would permit PE evaluation on routine chest CT studies or CTPA studies performed with a low volume of contrast media. MATERIALS AND METHODS: We compared 20 CTPA studies (CTPA group), 20 routine thoracic CT studies (RT group) and 10 CTPA studies performed with reduced volume of contrast media (RC group). HU values were measured in all groups at 80kVp and 140kVp images in multiple pulmonary arterial segments bilaterally. The diagnostic quality of the central and peripheral vascular enhancement and the image noise were evaluated at both energies using a five-point scale. RESULTS: For all patients, the mean CT attenuation values were greater at 80kVp than 140kVp images (p<0.001). At 80kVp, CTPA group attenuation values were greater than RT group (p=0.03) with a similar trend at 140kVp (p=0.08). At both 140kVp and 80kVp, CTPA group attenuation values were greater than RC group (p=0.02 and p=0.03, respectively). Qualitative analysis showed that at 140kVp CTPA studies had better global image quality scores than RT (p=0.003) and RC (p=0.001) groups. However, at 80kVp, there was no significant difference of global image quality between CTPA and the other groups (p=0.4 and p=0.5, respectively). Although measurable image noise was greater at 80kVp than 140kVp (p<0.001), qualitative analysis revealed lower image noise at 80kVp images. CONCLUSION: DECT at 80kVp increases arterial enhancement in both CTPA and routine studies. For routine studies this results in central and peripheral enhancement quality equivalent to that of CTPA studies. Low tube-voltage imaging allows marked contrast volume reduction for CTPA. In selected cases, satisfactory lower radiation dose CT might be achievable using lower kVp imaging alone
— id: 136990, year: 2011, vol: 79, page: e11, stat: Journal Article,

Magnetic resonance imaging of mixed ground glass nodules
Koo C.W.; Chen Q.C.; Sigmund E.E.; Mcgorty K.; Mason D.M.; Naidich D.P.
2011 ;26(3):W111-W111, Journal of thoracic imaging
Purpose: To evaluate mixed ground glass nodules (GGNs) utilizing 3 Tesla (T) MRI and 32-channel torso-array-coil and to correlate non-echo planar diffusion weighted imaging (DWI) and T2^* measurements with pathologic findings. Materials and Methods: Twelve patients with 13 GGNs >1cm in diameter detected on computed tomography were prospectively recruited for this Institutional Review Board approved study. T1-weighted 2D gradient echo (GRE), T2-weighted 2D turbo spin echo with fat saturation, T2^*-weighted multiple GRE, and diffusion weighted single shot twice-refocused spin echo axial images of the GGNs were acquired at end inspiration without intravenous contrast. Apparent diffusion coefficient (ADC) and T2^* values were determined and correlated to pathology. Results: All GGNs were visualized with the T2-weighted 2D TSE sequence providing the best morphologic delineation. Pathology was available for 9 of 13 lesions. ADC ranged from 1.19 to 1.78 mum²/ms (mean 1.45+/-0.19) and T2^* ranged from 6.78 to 27.81 mum²/ms (median 16.13, mean 16.68+/- 7.19) for the 7 malignant lesions. ADC was 1.59 and 1.42 and T2^* was 6.78 and 20.24 for the 2 malignant lesions with positive epidermal growth factor receptors. ADC ranged from 0.9 to 1.47 mum²/ms (mean 1.18 +/-0.4) and T2^* ranged from 6.87 to 10.93 (mean 8.9 +/-2.87) for the 2 benign lesions. Conclusion: 3T MRI with a 32-channel torso-array-coil provides a radiation free means of GGN evaluation. The T2-weighted 2D TSE with fat saturation sequence yields the best lesion visibility. DWI and T2^* measurements may provide quantitative measures for distinguishing malignant from benign nodules
— id: 136977, year: 2011, vol: 26, page: W111, stat: Journal Article,

Reversed halo sign after radiofrequency ablation of a lung nodule
Mango, Victoria L; Naidich, David P; Godoy, Myrna C B
2011 Nov;26(4):W150-W152, Journal of thoracic imaging
We report a case of the 'reversed halo sign' 6 weeks after radiofrequency ablation (RFA) of a lung neoplasm in an 80-year-old man. The 'reversed halo sign,' first described on computed tomography in cryptogenic organizing pneumonia, has later been described as being associated with a wide range of pulmonary pathologies, including paracoccidiodomycosis, tuberculosis, lymphomatoid granulomatosis, Wegener granulomatosis, invasive pulmonary fungal infections, and sarcoidosis. Although a number of computed tomography findings have been reported after RFA of both primary lung tumors and pulmonary metastases, this case demonstrates that the reversed halo sign may also occur after RFA
— id: 139469, year: 2011, vol: 26, page: W150, stat: Journal Article,

A dynamic method for automated lung nodule morphology characterization
Stember J.; Naidich D.; Ko J.; Rusinek H.
2011 ;6:S342-S342, International journal of computer assisted radiology & surgery
Purpose: Many potential lung cancers start out as small pulmonary nodules showing up as incidental findings on chest radiograph or computed tomography (CT) scans. Diagnosis is confirmed via biopsy, usually involving broncoscopy or CT-guided biopsy. However, these are invasive procedures that expose patients to additional risks. An alternative mode of tumor detection lies in administering successive chest CT scans. This has the advantage of avoiding those risks associated with biopsy. Overall, there is growing evidence for the effectiveness of low-dose CT for lung cancer screening. Morphology is an important indicator of malignant potential for lung nodules detected at CT. Automated methods for morphology assessment have previously been described for breast cancer visualized on mammography [1]. The most common measure of nodule shape is area-to-perimeter-length ratio (APR), low APR values being associated with spiculated or lobulated shape. APR is a static measure and thus highly susceptible to alterations by random noise and artifacts in image acquisition. We introduce and analyze the self-overlap (SO) method as a dynamic automated morphological detection scheme. SO measures the rate of change of nodule masks as a function of the radius of the blurring kernel. In other words, SO measures the degree to which a nodule's shape changes or stays intact upon successive pixel averaging that blurs the original image. Irregularities at the surface mean that a significant number of high-attenuation pixels (representing solid nodular tissue) are surrounded by low-attenuation pixels (representing air). Averaging each pixel with its neighboring pixels thus serves to trim back lobulations and spiculations from a nodule image. Hence, comparedto smooth nodules, lobulated and spiculated nodules are subject to more of this trimming upon successive averaging, so that their shape changes more, resulting in lower SO values. Due to its dynamical nature, we hypothesized that SO is more resilient to random image noise than APR. Methods: In experiment 1 we compare our algorithm with APR for nodules simulated using a spherical harmonic model (degree = 0-7) rasterized and contaminated with random noise. In experiment 2 we compare the new measure with a consensus of two expert morphology ratings of 119 nodules from clinical CT exams. Results: Experiment 1 shows that both methods display the desired trend in that APR and SO both decrease with increasing spherical harmonic degree-meaning more lobulations. As such both methods serve as measures of surface smoothness. However, SO displays significantly greater robustness to CT image noise; for both methods, we calculate variability as standard deviation over mean. We find that APR's variability in the face of random noise is on the order of ten times that of SO. This finding suggests that SO is much more robust than APR to the effects of random noise. Using a logistic regression model, in experiment 2 we achieved 89.9% agreement with the consensus assessment of two expert radiologists, versus 87.4% for APR. Conclusion: Simulation nodules show that both our dynamic method (SO) and a representative static method (APR) for automated lung nodule surface morphology determination yield clear trends as functions of surface smoothness. Hence both methods can, with proper fitting and cutoff selection, yield faithful predictions that have over 80% agreement with expert assessment. However, when the simulation nodules are subjected to random noise, SO yields much more consistent and reproducible results than APR. Overall, we conclude that our method, due to its robustness to the random noise and CT artifacts that can plague nodule images, is well suited for clinical application
— id: 136629, year: 2011, vol: 6, page: S342, stat: Journal Article,

Imaging-bronchoscopic correlations for interventional pulmonology
Amdo, Tshering; Godoy, Myrna C B; Ost, David; Naidich, David P
2010 Feb;20(1):103-119, Thoracic surgery clinics
The improvements to patient care that can be achieved by combining advanced imaging techniques and bronchoscopy are considerable. In this regard, CT imaging often plays an indispensable role in both the selection of appropriate candidates tor therapy as well as the choice of optimal interventional techniques. However, it is apparent that alternate methods for evaluating the airways and lung including ultrasound and electromagnetic navigation will likely play an increasingly important diagnostic role, necessitating a thorough understanding of their advantages and limitations. Disease-specific applications for which imaging technologies, including CT and VB, are either currently routinely used or show the greatest promise are for suspected or diagnosed lung cancers, central and peripheral, and emphysema. It may be anticipated that with growing experience, the potential for additional indications of these remarkable technologies are likely to increase in the near future
— id: 109046, year: 2010, vol: 20, page: 103, stat: Journal Article,

Bronchiolar disorders: a clinical-radiological diagnostic algorithm
Devakonda, Arun; Raoof, Suhail; Sung, Arthur; Travis, William D; Naidich, David
2010 Apr;137(4):938-951, Chest
Bronchiolar disorders are generally difficult to diagnose because most patients present with nonspecific respiratory symptoms of variable duration and severity. A detailed clinical history may point toward a specific diagnosis. Pertinent clinical questions include history of smoking, collagen vascular disease, inhalational injury, medication usage, and organ transplant. It is important also to evaluate possible systemic and pulmonary signs of infection, evidence of air trapping, and high-pitched expiratory wheezing, which may suggest small airways involvement. In this context, pulmonary function tests and plain chest radiographs may demonstrate abnormalities; however, they rarely prove sufficiently specific to obviate bronchoscopic or surgical biopsy. Given these limitations, in our experience, high-resolution CT (HRCT) scanning of the chest often proves to be the most important diagnostic tool to guide diagnosis in these difficult cases, because different subtypes of bronchiolar disorders may present with characteristic image findings. Three distinct HRCT patterns in particular are of value in assisting differential diagnosis. A tree-in-bud pattern of well-defined nodules is seen primarily as a result of infectious processes. Ill-defined centrilobular ground-glass nodules point toward respiratory bronchiolitis when localized in upper lobes in smokers or subacute hypersensitivity pneumonitis when more diffuse. Finally, a pattern of mosaic attenuation, especially when seen on expiratory images, is consistent with air-trapping characteristic of bronchiolitis obliterans or constrictive bronchiolitis. Based on an appreciation of the critical role played by HRCT scanning, this article provides clinicians with a practical algorithmic approach to the diagnosis of bronchiolar disorders
— id: 134422, year: 2010, vol: 137, page: 938, stat: Journal Article,

Single-acquisition dual-energy multidetector computed tomography: analysis of vascular enhancement and postprocessing techniques for evaluating the thoracic aorta
Godoy, Myrna C B; Naidich, David P; Marchiori, Edson; Leidecker, Christianne; Schmidt, Bernhard; Assadourian, Bernard; Vlahos, Ioannis
2010 Sep-Oct;34(5):670-677, Journal of computer assisted tomography
PURPOSE:: The objectives of this study were (1) to evaluate the potential of low-peak kilovoltage (kVp) images acquired with dual-energy computed tomography (DECT) to improve aortic attenuation and reduce contrast agent utilization and (2) to evaluate the feasibility of material-specific DECT imaging for evaluating aortic disease. MATERIALS AND METHODS:: Aortic imaging characteristics of 2 groups of patients examined with DECT were compared. In the first group, CT angiography (CTA) was performed in patients with known or suspected aortic disease (CTA group: n = 20, 100-150 mL of contrast at 4.5 mL/s). In the second group, reduced contrast volume CTA was performed in patients with 'routine' indications (RC group: n = 20, 50-60 mL at 3 mL/s followed by a saline chaser). In both groups, aortic attenuation and SD were measured at 80 and 140 kVp, and the image quality was analyzed using a 5-point scale. The use of DECT postprocessing techniques for assessing aortic pathology was also evaluated. RESULTS:: For all patients, the aortic attenuation was significantly higher at 80 kVp than at 140 kVp (P < 0.001). Image noise measured quantitatively was higher at 80 kVp (P < 0.001) but did not affect the perceived image quality (P = 0.3). Using low-peak kilovoltage allowed aortic CTA to be performed with a markedly reduced contrast volume and flow rate, with image quality similar to standard CTA (P = 0.2). In a series of cases with proved aortic disease, comparison of true precontrast and subtraction 'virtual noncontrast' images showed the potential to eliminate aortic precontrast imaging, reducing radiation exposure. CONCLUSIONS:: Single-acquisition DECT combines (1) the benefits of low-kVp vascular imaging (increased iodine conspicuity coupled with a contrast volume/rate reduction) and (2) the use of material-specific imaging techniques to uniquely characterize the aortic pathology
— id: 112567, year: 2010, vol: 34, page: 670, stat: Journal Article,

High-resolution Computed Tomography of the Pulmonary Parenchyma: Past, Present, and Future?
Naidich, David P
2010 Feb;25(1):32-33, Journal of thoracic imaging
— id: 107289, year: 2010, vol: 25, page: 32, stat: Journal Article,

Part-solid nodules: two steps forward...
Naidich, David P
2010 Apr;255(1):16-18, Radiology
— id: 108800, year: 2010, vol: 255, page: 16, stat: Journal Article,

Quantitative Evaluation of Bronchial Enhancement: Preliminary Observations
Odry, B.L.; Kiraly, A.P.; Novak, C.L.; Naidich, D.P.; Godoy, M.C.B.; Schmidt, B.
2010 ;7626(5):76260Z-76260Z, Proceedings of SPIE (The International Society for Optical Engineering)
It has been known for several years that airflow limitations in the small airways may be an important contributor to Chronic Obstructive Pulmonary Disease (COPD). Quantification of wall thickness has lately gained attention thanks to the use of high resolution CT, with novel approaches focusing on automated methods that can substitute for visual assessment. While increased thickening of the wall is considered evidence of inflammatory disease, we hypothesize that there may be additional ways to detect and quantify inflammation, specifically, with the uptake of contrast material. In this preliminary investigation, we selected patients with documented chronic airway inflammation, and for whom pre and post contrast datasets were available. On targeted reconstruction of right upper and lower lobes, we selected airways with minimal connections to surrounding structures, and used a modified Full-Width-Half-Max method for quantification of lumen diameter, wall thickness, and wall density. Matching airway locations on the pre- and post-contrast cases were compared. Airways from patients without airway disease served as a control. Results for the airway disease cases showed an average enhancement of 72 HU +/- 59 HU within the airway walls. In the control group the average enhancement was 16 HU +/- 22 HU. While this study is limited in number of cases, we hypothesize that quantification of contrast uptake is an additional factor that could be considered in assessing airway inflammation. Simultaneously, we are currently investigating whether enhancement can be measured via a 'contrast' map created with dual energy scanning, where a 3-value decomposition algorithm differentiates iodine from other materials. This technique would eliminate both the need for a pre-contrast scan, and the task of matching airway locations on pre- and post- scans
— id: 109861, year: 2010, vol: 7626, page: 76260Z, stat: Journal Article,

Automated CT scoring of airway diseases: preliminary results
Odry, Benjamin L; Kiraly, Atilla P; Godoy, Myrna C B; Ko, Jane; Naidich, David P; Novak, Carol L; Lerallut, Jean-Francois
2010 Sep;17(9):1136-1145, Academic radiology
RATIONALE AND OBJECTIVES: The aim of this study was to retrospectively evaluate an automated global scoring system for evaluating the extent and severity of disease in a known cohort of patients with documented bronchiectasis. On the basis of a combination of validated three-dimensional automated algorithms for bronchial tree extraction and quantitative airway measurements, global scoring combines the evaluation of bronchial lumen-to-artery ratios and bronchial wall-to-artery ratios, as well as the detection of mucoid-impacted airways. The result is an automatically generated global computed tomographic (CT) score designed to simplify and standardize the interpretation of scans in patients with chronic airway infections. MATERIALS AND METHODS: Twenty high-resolution CT data sets were used to evaluate an automated CT scoring method that combines algorithms for airway quantitative analysis that have been individually tested and validated. Patients with clinically documented atypical mycobacterial infections with visually assessed CT evidence of bronchiectasis varying from mild to severe were retrospectively selected. These data sets were evaluated by two independent experienced radiologists and by computer scoring, with the results compared statistically, including Spearman's rank correlation. RESULTS: Computer evaluation required 3 to 5 minutes per data set, compared to 12 to 15 minutes for manual scoring. Initial Spearman's rank tests showed positive correlations between automated and readers' global scores (r = 0.609, P = .01), extent of bronchiectasis (r = 0.69, P = .0004), and severity of bronchiectasis (r = 0.61, P = .01), while mucus plug detection showed a lesser extent of positive correlation between the scoring methods (r = 0.42, P = .07) and wall thickness a negative weak correlation (r = -0.10, P = .40). Further retrospective review of 24 lobes in which wall thickness scores showed the highest discrepancy between manual and automated methods was then performed, using electronic calipers and perpendicular cross-sections to reassess airway measurements. This resulted in an improved Spearman's rank correlation to r = 0.62 (P = .009), for a global score of r = 0.67 (P = .001). CONCLUSION: Automated computerized scoring shows considerable promise for providing a standardized, quantitative method, demonstrating overall good correlation with the results of experienced readers' evaluation of the extent and severity of bronchiectasis. It is speculated that this technique may also be applicable to a wide range of other conditions associated with chronic bronchial inflammation, as well as of potential value for monitoring response to therapy in these same populations
— id: 112028, year: 2010, vol: 17, page: 1136, stat: Journal Article,

Fissural Nodular Densities: Inherent Stability and Benignity and Variability in Descriptive Nomenclature
Pryluck, D; Shiau, M; Wnorowski, A; Naidich, D; Sanger, J; Rom, W
2010 MAY ;194(5):-, American journal of roentgenology
— id: 111950, year: 2010, vol: 194, page: , stat: Journal Article,

Identification of an autoantibody panel to separate lung cancer from smokers and nonsmokers
Rom, William N; Goldberg, Judith D; Addrizzo-Harris, Doreen; Watson, Heather N; Khilkin, Michael; Greenberg, Alissa K; Naidich, David P; Crawford, Bernard; Eylers, Ellen; Liu, Daorong; Tan, Eng M
2010 ;10:234-234, BMC cancer
BACKGROUND: Sera from lung cancer patients contain autoantibodies that react with tumor associated antigens (TAAs) that reflect genetic over-expression, mutation, or other anomalies of cell cycle, growth, signaling, and metabolism pathways. METHODS: We performed immunoassays to detect autoantibodies to ten tumor associated antigens (TAAs) selected on the basis of previous studies showing that they had preferential specificity for certain cancers. Sera examined were from lung cancer patients (22); smokers with ground-glass opacities (GGOs) (46), benign solid nodules (55), or normal CTs (35); and normal non-smokers (36). Logistic regression models based on the antibody biomarker levels among the high risk and lung cancer groups were developed to identify the combinations of biomarkers that predict lung cancer in these cohorts. RESULTS: Statistically significant differences in the distributions of each of the biomarkers were identified among all five groups. Using Receiver Operating Characteristic (ROC) curves based on age, c-myc, Cyclin A, Cyclin B1, Cyclin D1, CDK2, and survivin, we obtained a sensitivity = 81% and specificity = 97% for the classification of cancer vs smokers(no nodules, solid nodules, or GGO) and correctly predicted 31/36 healthy controls as noncancer. CONCLUSION: A pattern of autoantibody reactivity to TAAs may distinguish patients with lung cancer versus smokers with normal CTs, stable solid nodules, ground glass opacities, or normal healthy never smokers
— id: 110098, year: 2010, vol: 10, page: 234, stat: Journal Article,

Computer-aided detection (CAD) of lung nodules in CT scans: radiologist performance and reading time with incremental CAD assistance
Roos, JE; Paik, D; Olsen, D; Liu, EG; Chow, LC; Leung, AN; Mindelzun, R; Choudhury, KR; Naidich, DP; Napel, S; Rubin, GD
2010 MAR ;20(3):549-557, European radiology
The diagnostic performance of radiologists using incremental CAD assistance for lung nodule detection on CT and their temporal variation in performance during CAD evaluation was assessed. CAD was applied to 20 chest multidetector-row computed tomography (MDCT) scans containing 190 non-calcified a parts per thousand yen3-mm nodules. After free search, three radiologists independently evaluated a maximum of up to 50 CAD detections/patient. Multiple free-response ROC curves were generated for free search and successive CAD evaluation, by incrementally adding CAD detections one at a time to the radiologists' performance. The sensitivity for free search was 53% (range, 44%-59%) at 1.15 false positives (FP)/patient and increased with CAD to 69% (range, 59-82%) at 1.45 FP/patient. CAD evaluation initially resulted in a sharp rise in sensitivity of 14% with a minimal increase in FP over a time period of 100 s, followed by flattening of the sensitivity increase to only 2%. This transition resulted from a greater prevalence of true positive (TP) versus FP detections at early CAD evaluation and not by a temporal change in readers' performance. The time spent for TP (9.5 s +/- 4.5 s) and false negative (FN) (8.4 s +/- 6.7 s) detections was similar; FP decisions took two- to three-times longer (14.4 s +/- 8.7 s) than true negative (TN) decisions (4.7 s +/- 1.3 s). When CAD output is ordered by CAD score, an initial period of rapid performance improvement slows significantly over time because of non-uniformity in the distribution of TP CAD output and not to a changing reader performance over time
— id: 107397, year: 2010, vol: 20, page: 549, stat: Journal Article,

Gadolinium-Enhanced Magnetic Resonance Angiography for Pulmonary Embolism A Multicenter Prospective Study (PIOPED III)
Stein, PD; Chenevert, TL; Fowler, SE; Goodman, LR; Gottschalk, A; Hales, CA; Hull, RD; Jablonski, KA; Leeper, KV; Naidich, DP; Sak, DJ; Sostman, D; Tapson, VF; Weg, JG; Woodard, PK
2010 APR 6 ;152(7):434-W143, Annals of internal medicine
Background: The accuracy of gadolinium-enhanced magnetic resonance pulmonary angiography and magnetic resonance venography for diagnosing pulmonary embolism has not been determined conclusively. Objective: To investigate performance characteristics of magnetic resonance angiography, with or without magnetic resonance venography, for diagnosing pulmonary embolism. Design: Prospective, multicenter study from 10 April 2006 to 30 September 2008. (ClinicalTrials.gov registration number: NCT00241826) Setting: 7 hospitals and their emergency services. Patients: 371 adults with diagnosed or excluded pulmonary embolism. Measurements: Sensitivity, specificity, and likelihood ratios were measured by comparing independently read magnetic resonance imaging with the reference standard for diagnosing pulmonary embolism. Reference standard diagnosis or exclusion was made by using various tests, including computed tomographic angiography and venography, ventilation-perfusion lung scan, venous ultrasonography, D-dimer assay, and clinical assessment. Results: Magnetic resonance angiography, averaged across centers, was technically inadequate in 25% of patients (92 of 371). The proportion of technically inadequate images ranged from 11% to 52% at various centers. Including patients with technically inadequate images, magnetic resonance angiography identified 57% (59 of 104) with pulmonary embolism. Technically adequate magnetic resonance angiography had a sensitivity of 78% and a specificity of 99%. Technically adequate magnetic resonance angiography and venography had a sensitivity of 92% and a specificity of 96%, but 52% of patients (194 of 370) had technically inadequate results. Limitation: A high proportion of patients with suspected embolism was not eligible or declined to participate. Conclusion: Magnetic resonance pulmonary angiography should be considered only at centers that routinely perform it well and only for patients for whom standard tests are contraindicated. Magnetic resonance pulmonary angiography and magnetic resonance venography combined have a higher sensitivity than magnetic resonance pulmonary angiography alone in patients with technically adequate images, but it is more difficult to obtain technically adequate images with the 2 procedures
— id: 109138, year: 2010, vol: 152, page: 434, stat: Journal Article,

Computer-Assisted Detection for Lung Nodule Detection Using Compressed CT Data: Benefit to Readers on Thick-Section Images
Sussmann, A; Ko, J; Girvin, F; Naidich, D; Babb, J; Shah, M; Brusca-Augello, G; Anand, V
2010 MAY ;194(5):-, American journal of roentgenology
— id: 111949, year: 2010, vol: 194, page: , stat: Journal Article,

Dual-energy computed tomography imaging of the aorta
Vlahos, Ioannis; Godoy, Myrna C B; Naidich, David P
2010 Nov;25(4):289-300, Journal of thoracic imaging
There are 2 inseparable and complimentary technical advantages of dual-energy computed tomography (CT) imaging of the thoracic aorta. One advantage stems from the simultaneous availability of low and high peak kilovoltage (kVp) spectra data and, in particular, the benefits conferred by the improved conspicuity of iodinated contrast media at lower kVp CT imaging. This, in turn, permits improved aortic visualization or, alternatively, reduction in the volume or rate of contrast administration. Image noise at low kilovoltage does not appear to be a significant issue, with the backup availability of simultaneously acquired high kVp images a distinct advantage over single, low kVp imaging techniques. The second advantage of dual-energy CT imaging stems from the potential to calculate material-specific images derived mathematically from the simultaneous availability of attenuation measurements at 2 distinct energies. These material-specific data sets include virtual noncontrast images, virtual contrast, or 'bone-subtracted' angiographic-like images. These techniques may confer significant advantages in the evaluation of patients with aortic disease, improving interpretation and reducing reconstruction time, while potentially reducing the need for, and associated radiation burden of, precontrast or postcontrast multiphasic imaging
— id: 114185, year: 2010, vol: 25, page: 289, stat: Journal Article,

Imaging-bronchoscopic correlations for interventional pulmonology
Amdo, Tshering; Godoy, Myrna C B; Ost, David; Naidich, David P
2009 Mar;47(2):271-287, Radiologic clinics of North America
The development and rapid advancement of both bronchoscopic, CT and ultrasound imaging technology has had considerable impact on the management of a wide variety of pulmonary diseases. The synergy between these newer imaging modalities and advanced interventional endoscopic procedures has led to a revolution in diagnostic and therapeutic options in patients with both central and peripheral airway disease. Given the broad clinical implications of these technological advances, only the most important areas of interventional pulmonology in which imaging has had a major impact will be selectively reviewed to highlight fundamental principles
— id: 96781, year: 2009, vol: 47, page: 271, stat: Journal Article,

Pulmonary Nodule Evaluation: Current Concepts
Godoy, M; Nonaka, D; Naidich, D
2009 ;192(5):2030-2030, American journal of roentgenology
— id: 100694, year: 2009, vol: 192, page: 2030, stat: Journal Article,

Subsolid pulmonary nodules and the spectrum of peripheral adenocarcinomas of the lung: recommended interim guidelines for assessment and management
Godoy, Myrna C B; Naidich, David P
2009 Dec;253(3):606-622, Radiology
Pulmonary nodule characterization is currently being redefined as new clinical, radiologic, and pathologic data are reported, necessitating a reevaluation of the clinical management, especially of subsolid nodules. These are now known to frequently, although not invariably, fall into the spectrum of peripheral adenocarcinomas of the lung. Strong correlation between the Noguchi histologic classification and computed tomographic (CT) appearances of these lesions, in particular, has been reported. Serial CT findings have further documented that stepwise progression of lesions with ground-glass opacity, manifested as an increase in size or the appearance and/or subsequent increase of solid components, does occur in a select subset of patients. As a consequence, recognition of the potential association between subsolid nodules and peripheral adenocarcinomas requires a review of current guidelines for the management of these lesions, further necessitated by a differential diagnosis that includes benign lesions such as focal inflammation, focal fibrosis, and organizing pneumonia. Specific issues that need to be addressed are the need for consensus regarding an appropriate CT classification, methods for precise measurement of subsolid nodules, including the extent of both ground-glass and solid components, as well as accurate assessment of the growth rates as means for predicting malignancy and prognosis. It is anticipated that interim guidelines may serve to standardize our current management of these lesions, pending further clarification of their natural history. (c) RSNA, 2009
— id: 105523, year: 2009, vol: 253, page: 606, stat: Journal Article,

Basic principles and postprocessing techniques of dual-energy CT: illustrated by selected congenital abnormalities of the thorax
Godoy, Myrna C B; Naidich, David P; Marchiori, Edson; Assadourian, Bernard; Leidecker, Christianne; Schmidt, Bernhard; Vlahos, Ioannis
2009 May;24(2):152-159, Journal of thoracic imaging
Recent technologic advances in multidetector computed tomography have allowed the performance of simultaneous acquisition dual-energy computed tomography (DECT). The advantages of this new technique include simultaneous visualization of lower voltage tube images with improved iodine conspicuity and the performance of material specific imaging, which attempts to differentiate specific materials in the generated images. In this article, we review the concepts and physical principles of DECT using congenital thoracic abnormalities as a substrate for depicting the versatility of DECT
— id: 99222, year: 2009, vol: 24, page: 152, stat: Journal Article,

SPECT in Acute Pulmonary Embolism
Stein, PD; Freeman, LM; Sostman, HD; Goodman, LR; Woodard, PK; Naidich, DP; Gottschalk, A; Bailey, DL; Matta, F; Yaekoub, AY; Hales, CA; Hull, RD; Leeper, KV; Tapson, VF; Weg, JG
2009 DEC ;50(12):1999-2007, Journal of nuclear medicine
The purpose of this review was to evaluate the accuracy of SPECT in acute pulmonary embolism. Sparse data are available on the accuracy of SPECT based on an objective reference test. Several investigations were reported in which the reference standard for the diagnosis of pulmonary embolism was based in part on the results of SPECT or planar ventilation-perfusion (V/Q) imaging. The sensitivity of SPECT in all but one investigation was at least 90%, and specificity also was generally at least 90%. The sensitivity of SPECT in 4 of 5 investigations was higher than that of planar V/Q imaging. The specificity of SPECT was generally higher, equal, or only somewhat lower than that of planar V/Q imaging. Most investigators reported nondiagnostic SPECT V/Q scans in no more than 3% of cases. Methods of obtaining SPECT images, methods of obtaining planar V/Q images, and the criteria for interpretation varied. The general impression is that SPECT is more advantageous than planar V/Q imaging
— id: 105950, year: 2009, vol: 50, page: 1999, stat: Journal Article,

Utility of Virtual Bronchoscopy-Guided Transbronchial Biopsy for the Diagnosis of Pulmonary Sarcoidosis: Report of Two Cases
Godoy, Myrna C B; Ost, David; Geiger, Bernhard; Novak, Carol; Nonaka, Daisuke; Vlahos, Ioannis; Naidich, David P
2008 Sep;134(3):630-636, Chest
Sarcoidosis is a multisystem granulomatous disease of unknown etiology that usually affects the lungs. Although flexible fiberoptic bronchoscopy with transbronchial lung biopsy (TBBx) has a high diagnostic yield in patients with pulmonary sarcoidosis, variously ranging from 40 to 90%, more invasive procedures often prove necessary. We report two cases of successful diagnosis of pulmonary sarcoidosis using a new technique that may increase the accuracy of TBBx. Previously described for diagnosis of peripheral lung cancer, this technique relies on real-time virtual bronchoscopic guidance to biopsy pre-selected peripheral areas of the lung preferentially affected by the disease using a pediatric bronchoscope. In each case, while procedures were performed under direct CT guidance allowing precise confirmation of the tip of the biopsy catheter, it is anticipated that this technique will be primarily used as a guide to bronchoscopic biopsies without the need for direct CT guidance thus increasing routine utilization of multidetector low-dose high resolution CT to improve histological diagnosis
— id: 79236, year: 2008, vol: 134, page: 630, stat: Journal Article,

Transient pulmonary eosinophilia incidentally found on low-dose computed tomography: findings in 40 individuals
Kim, Hyae Young; Naidich, David P; Lim, Kun Young; Lee, Soo-Hyun; Kim, Tae Jung; Hwangbo, Bin; Lee, Joo-Hyuk
2008 Jan-Feb;32(1):101-107, Journal of computer assisted tomography
PURPOSE: To describe computed tomography (CT) findings of transient pulmonary eosinophilia (TPE) incidentally found on low-dose CT (LDCT) and to identify suggestive CT features helpful in initial diagnosis. MATERIALS AND METHODS: We retrospectively reviewed LDCT scans in 40 individuals who met criteria for having TPE. There were 35 men and 5 women (age range, 32-62 years; mean, 48.5 +/- 9 years). Initial LDCT scans were assessed as either (a) nodules, further characterized as either solid, solid associated with a halo of ground-glass attenuation, or pure ground-glass lesions as well as by number, size, and location or (b) ill-defined foci of parenchymal consolidation. RESULTS: A range of focal parenchymal abnormalities (n = 78) were identified-both single (48%) and multiple (52%). Most of these proved to be either solid nodules with discrete ground-glass halos (72%), or poorly defined solid nodules exhibiting a variety of differing morphologies (24%). Ill-defined foci of consolidation were noted in 3 cases (4%). The lesions were predominantly located in the lower lung zone (73%) with peripheral distribution (92%). CONCLUSIONS: Transient pulmonary eosinophilia most often manifests as solid nodules with associated ground-glass halos. Awareness of TPE should serve to limit the number of mistaken diagnoses of early lung cancer
— id: 96783, year: 2008, vol: 32, page: 101, stat: Journal Article,

Computer-aided diagnosis of the airways: beyond nodule detection
Kiraly, Atilla P; Odry, Benjamin L; Godoy, Myrna C B; Geiger, Bernhard; Novak, Carol L; Naidich, David P
2008 May;23(2):105-113, Journal of thoracic imaging
Although to date, the major impetus for the development of computer-assisted diagnosis (CAD) has been the detection of pulmonary nodules, CAD should properly be viewed as a potential tool for assisting radiologic interpretation of the entire gamut of chest diseases, including not just enhanced detection of disease but also characterization and quantification, ideally leading to improved patient management. The use of CAD to improve visualization of the airways using advanced computer techniques, including sophisticated methods for obtaining 3-dimensional segmentation of the central airways and, in particular, the development of virtual bronchoscopy has been recently studied. In this paper, the authors review the development of a specific series of CAD applications enabling automated identification and characterization of chronically inflamed airways. The advantages to the use of computer methodologies to quantify peripheral airway disease include reproducible visualization methods to display the location, severity, and extent of airway dilatation, bronchial wall thickening, and the presence of mucoid impacted airways. Currently, a number of semiquantitative global scoring systems have been proposed to assess disease extent and severity in patients with bronchiectasis. Unfortunately, with the exception of patients with cystic fibrosis, these are rarely if ever employed, largely owing to the considerable inconvenience of measuring individual airway dimensions and computing a global score. It is apparent that for this specific purpose, CAD may be ideally suited. Automated staging allows for more complete assessment of the entire bronchial tree while providing improved standardization and eliminating an otherwise tedious and time-consuming task
— id: 96782, year: 2008, vol: 23, page: 105, stat: Journal Article,

Evaluation of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition)
Gould, Michael K; Fletcher, James; Iannettoni, Mark D; Lynch, William R; Midthun, David E; Naidich, David P; Ost, David E
2007 Sep;132(3 Suppl):108S-130S, Chest
BACKGROUND: Pulmonary nodules are spherical radiographic opacities that measure up to 30 mm in diameter. Nodules are extremely common in clinical practice and challenging to manage, especially small, 'subcentimeter' nodules. Identification of malignant nodules is important because they represent a potentially curable form of lung cancer. METHODS: We developed evidence-based clinical practice guidelines based on a systematic literature review and discussion with a large, multidisciplinary group of clinical experts and other stakeholders. RESULTS: We generated a list of 29 recommendations for managing the solitary pulmonary nodule (SPN) that measures at least 8 to 10 mm in diameter; small, subcentimeter nodules that measure < 8 mm to 10 mm in diameter; and multiple nodules when they are detected incidentally during evaluation of the SPN. Recommendations stress the value of risk factor assessment, the utility of imaging tests (especially old films), the need to weigh the risks and benefits of various management strategies (biopsy, surgery, and observation with serial imaging tests), and the importance of eliciting patient preferences. CONCLUSION: Patients with pulmonary nodules should be evaluated by estimation of the probability of malignancy, performance of imaging tests to characterize the lesion(s) better, evaluation of the risks associated with various management alternatives, and elicitation of patient preferences for treatment
— id: 96785, year: 2007, vol: 132, page: 108S, stat: Journal Article,

S-adenosylmethionine as a biomarker for the early detection of lung cancer
Greenberg, Alissa K; Rimal, Binaya; Felner, Kevin; Zafar, Subooha; Hung, Jerry; Eylers, Ellen; Phalan, Brendan; Zhang, Meng; Goldberg, Judith D; Crawford, Bernard; Rom, William N; Naidich, David; Merali, Salim
2007 Oct;132(4):1247-1252, Chest
BACKGROUND: S-Adenosylmethionine (AdoMet) is a major methyl donor for transmethylation reactions and propylamine donor for the biosynthesis of polyamines in biological systems, and therefore may play a role in lung cancer development. We hypothesized that AdoMet levels were elevated in patients with lung cancer and may prove useful as a biomarker for early lung cancer. METHODS: High-performance liquid chromatography was used to analyze plasma AdoMet levels in triplicate samples from 68 patients. This included 13 patients with lung cancer, 33 smokers with benign lung disease, and 22 healthy nonsmokers. The three groups of subjects were compared with respect to the distribution of demographic and disease characteristics and AdoMet levels. Distributions were examined using summary statistics and box plots, and nonparametric analysis of variance procedures. RESULTS: Serum AdoMet levels were elevated in patients with lung cancer as compared to smokers with benign lung disorders and healthy nonsmokers. There were no significant correlations between AdoMet levels and tumor cell types, nodule size, or other demographic variables. CONCLUSIONS: Our data demonstrate that plasma levels of AdoMet are significantly elevated in patients with lung cancer. Plasma AdoMet levels may prove to be a useful tool for the diagnosis of early lung cancer, in combination with chest CT. Registered at: clinicaltrials.gov (NCT00301119)
— id: 74778, year: 2007, vol: 132, page: 1247, stat: Journal Article,

Computed tomographic screening for lung cancer: Individualising the benefit of the screening
Henschke C.I.; Yankelevitz D.F.; McCauley D.I.; Sone S.; Hanaoka T.; Markowitz S.; Miller A.; Klingler K.; Scherer T.; Inderbitzi R.; Zulueta J.; Montuenga L.; Bastarrika G.; Giunta S.; Crecco M.; Pugliese P.; Tockman M.; Shaham D.; Rice K.; Aye R.; Roberts H.; Patsios D.; Bauer T.; Lally J.; Austin J.H.M.; Pearson G.D.N.; Naidich D.; McGuinness G.; Rifkin M.; Fiore E.; Kopel S.; Klippenstein D.; Litwin A.; Loud P.A.; Kohman L.J.; Scalzetti E.M.; Khan A.; Shah R.; Smith M.V.; Williams H.T.; Lovett L.; Mendelson D.S.; Thurer R.; Heelan R.T.; Ginsberg M.S.; Sullivan F.; Ottinger M.; Vafai D.; Matalon T.A.S.; Odzer S.-L.; Liu X.; Sheppard B.; Cole E.; Wiernik P.H.; Ray D.; Pass H.; Endress C.; Mullen D.; Kalafer M.; Grannis F.; Rotter A.; Thorsen M.K.; Hansen R.; Camacho E.; Luedke D.
2007 ;30(5):843-847, European respiratory journal
Individuals concerned about their risk of lung cancer are recommended to talk with their physicians about computed tomographic screening for lung cancer. To provide the necessary information, the survival benefit of the screening, specific to a particular person for a particular round of screening, is needed. The probability of survival gain from the first, baseline, round of screening was addressed as the product of: 1) the screening resulting in a diagnosis of lung cancer; 2) not dying from some other cause for a sufficiently long period of time; and 3) cure resulting from pre-symptomatic treatment of lung cancer. These probabilities were estimated using the International Early Lung Cancer Action Program data on individuals aged 40-85 yrs with a cigarette smoking history of 0-150 pack-yrs. The estimated probability of survival gain ranged from 0.4% for a 60-yr-old with a 10-pack-yr smoking history who quit smoking 20 yrs ago, to 3.1% for a 70-yr-old current smoker with a 100 pack-yr history and 2.0% for an 85-yr-old current smoker with a 150-pack-yr history. When seeking counsel about initiation of screening for lung cancer, an estimate of the probability of survival gain from the first round of computed tomographic screening, specific to the person's age and history of smoking, can be provided. CopyrightcopyrightERS Journals Ltd 2007
— id: 76019, year: 2007, vol: 30, page: 843, stat: Journal Article,

Boundary-specific cost functions for quantitative airway analysis
Kiraly, Atilla P; Odry, Benjamin L; Naidich, David P; Novak, Carol L
2007 ;10(Pt 1):784-791, Medical image computing & computer-assisted intervention : MICCAI
Computed tomography (CT) images of the lungs provide high resolution views of the airways. Quantitative measurements such as lumen diameter and wall thickness help diagnose and localize airway diseases, assist in surgical planning, and determine progress of treatment. Automated quantitative analysis of such images is needed due to the number of airways per patient. We present an approach involving dynamic programming coupled with boundary-specific cost functions that is capable of differentiating inner and outer borders. The method allows for precise delineation of the inner lumen and outer wall. The results are demonstrated on synthetic data, evaluated on human datasets compared to human operators, and verified on phantom CT scans to sub-voxel accuracy
— id: 96784, year: 2007, vol: 10, page: 784, stat: Journal Article,

Computed tomography and magnetic resonance of the thorax
Naidich, David P; Srichai, Monvadi B
Philadelphia : Lippincott Williams & Wilkins, 2007,
— id: 1398, year: 2007, vol: , page: , stat: ,

Benefit of CT venography for the diagnosis of thromboembolic disease
Rhee, Kyung Hwa; Iyer, Ramesh S; Cha, Susan; Naidich, David P; Rusinek, Henry; Jacobowitz, Glenn R; Ko, Jane P
2007 Jul-Aug;31(4):253-258, Clinical imaging
OBJECTIVE: The aim of this study was to determine the benefit of lower extremity CT venography (CTV) with pulmonary CT angiography (CTA) for diagnosing thromboembolic (TE) disease. SUBJECTS AND METHODS: Reports of all CTAs and CTVs over a 3-year interval (Group I) and CTAs, CTVs, and lower extremity Doppler ultrasounds (US) over a 1 1/2-year subset (Group II) were reviewed. Patient population was inpatients and emergency department patients who were assessed for pulmonary embolism (PE) and deep venous thrombosis (DVT) at a tertiary care hospital. Reported results for CTA or CTV were categorized as positive (CTA(P), CTV(P)), negative (CTA(N), CTV(N)), or indeterminate for PE or DVT. When CTV and US results were discrepant, medical records were reviewed for clinical management. Additional benefit of CTV was assessed by chi-square analysis. RESULTS: In Group I, 737 (81.1%) of 909 CTAs from combined CTA/CTV studies were negative. The diagnosis rate of TE disease increased from 13.0% to 17.3% with the addition of CTV(P)s (P=.01). Of the 119 cases in Group II undergoing combined CTA, CTV, and US, CTV and US were both positive in eight and both negative in 88. Of the seven discordant CTVs and USs with clinical follow-up, five CTVs were positive while USs were negative, three of which were treated clinically for TE disease, while two were considered falsely positive. As CTA also proved positive in one of the three, CTV therefore affected management in two of these five cases and increased the rate of thromboembolism diagnosis from 21.0% to 22.6%; however, this was not significant (P>.05). Two CTV(N)s were managed as false negatives. CONCLUSIONS: The combined use of CTA and CTV significantly increases the rate of TE disease over CTA alone. In cases in which ultrasound is performed, however, there is no significant advantage to performing combined CTA/CTV studies
— id: 73253, year: 2007, vol: 31, page: 253, stat: Journal Article,

Adenocarcinoma of the lung: current concepts in radiologic diagnosis and management
Shiau, Maria C; Bonavita, John; Naidich, David P
2007 Jul;13(4):261-266, Current opinion in pulmonary medicine
PURPOSE OF REVIEW: Since the introduction especially of multidetector computed tomography scanners, detection of peripheral pulmonary nodules as small as 2-3 mm is now a frequent event even in individuals without a significant smoking history. This preponderance of small indeterminate nodules has necessitated reconsideration of the natural history of malignant lung tumors, in particular peripheral adenocarcinomas, as well as current clinical and radiologic guidelines to aid in the management of these lesions. RECENT FINDINGS: New information within the radiologic, pathologic and surgical literature is currently redefining nodule characterization. Most important has been the growing awareness of the prevalence of 'so-called' sub-solid pulmonary nodules, with important implications for revising our understanding of the natural history of these lesions as it impacts guidelines for nodule management. SUMMARY: Reassessment of our approach to small pulmonary nodules, while controversial, is now requisite as newer insights into the computed tomography appearance and natural history of small adenocarcinomas of the lung become apparent. Recognition of suspicious morphology and accurate measurements of volume doubling time, in particular, should aid in the management of these lesions
— id: 74111, year: 2007, vol: 13, page: 261, stat: Journal Article,

The role of chest radiography and computed tomography in the diagnosis and management of asthma
Sung, A; Naidich, D; Belinskaya, I; Raoof, S
2007 JAN ;13(1):31-36, Current opinion in pulmonary medicine
Purpose of review The management of asthma is guided by clinical symptoms, physiological measurements, and response to therapy, Recent advances in computed tomography imaging promise to add a new dimension to our diagnostic armamentarium. Accurate representation of airway pathology, visualized by high-resolution chest computed tomography scan, helps to improve the understanding of the pathophysiology of asthma. In addition, findings on computed tomography may help to guide therapies for asthma. As radiologists provide us with sophisticated modalities that may also have a bearing on treatment, clinicians should stay abreast of this evolving noninvasive technology. Recent findings This review focuses on the findings seen on computed tomography imaging as related to asthma. Airway wall thickness is discussed and how it relates to disease progression and pulmonary function test. In addition, indirect findings such as bronchial dilatation and mosaic attenuation, both consequences of air-trapping, are discussed. Other investigational tools, such as endobronchial ultrasound and positron emission tomography, are described. Summary New modalities in radiology hold promise to aid in the understanding and treatment of small-airway disease. Although still considered investigational modalities, research evidence is fast accumulating. It behooves the clinician to have a heightened awareness regarding further advancements in this field
— id: 69822, year: 2007, vol: 13, page: 31, stat: Journal Article,

Transbronchial needle aspiration in HIV-infected patients with intrathoracic adenopathy: A 15-year experience at a major teaching hospital
Herscovici, P; Harkin, TJ; Naidich, DP; Rom, WN; Addrizzo-Harris, DJ
2006 ;130(4):275S-275S, Chest
— id: 134681, year: 2006, vol: 130, page: 275S, stat: Journal Article,

Effect of blood vessels on measurement of nodule volume in a chest phantom
Ko, Jane P; Marcus, Rachel; Bomsztyk, Elan; Babb, James S; Stefanescu, Cornel; Kaur, Manmeen; Naidich, David P; Rusinek, Henry
2006 Apr;239(1):79-85, Radiology
PURPOSE: To identify, by using a chest phantom, whether vessels that contact lung nodules measuring less than 5 mm in diameter will affect nodule volume assessment. MATERIALS AND METHODS: Forty synthetic nodules (20 with ground-glass attenuation and 20 with solid attenuation) that measured less than 5 mm in diameter were placed into a chest phantom either adjacent to (n = 30) or isolated from (n = 10) synthetic vessels. Nodules were imaged by using low-dose (20 mAs) and diagnostic (120 mAs) multi-detector row computed tomography (CT). Nodules that were known to lie in direct contact with vessels were confirmed by visual inspection. Nontargeted 1.25 x 1.00-mm sections were analyzed with a three-dimensional computer-assisted method for measuring nodule volume. A mixed-model analysis of variance was used to examine the influence of several factors (eg, the presence of adjacent vessels; tube current-time product; and nodule attenuation, diameter, and location) on measurement error. RESULTS: The mean absolute error (MAE) for all nodules adjacent to vessels was 2.3 mm(3), which was higher than the MAE for isolated nodules (1.9 mm(3)) (P < .001). This difference proved significant only for diagnostic CT (2.2 mm(3) for nodules adjacent to vessels vs 1.3 mm(3) for nodules isolated from vessels) (P < .05). A larger MAE was noted for nodules with ground-glass attenuation (2.3 mm(3)) versus those with solid attenuation (2.0 mm(3)), for increasing nodule volume (1.66 mm(3) for nodules smaller than 20 mm(3) vs 2.83 mm(3) for nodules larger than 40 mm(3)), and for posterior nodule location (P < .05). CONCLUSION: The presence of a vessel led to a small yet significant increase in volume error on diagnostic-quality images. This represents less than one-third of the overall error, even for nodules larger than 40 mm(3) or approximately 4 mm in diameter. This increase, however, may be more important for smaller nodules with errors of less than 3 mm(3)
— id: 64205, year: 2006, vol: 239, page: 79, stat: Journal Article,

Pictorial essay: multinodular disease: a high-resolution CT scan diagnostic algorithm
Raoof, Suhail; Amchentsev, Alexey; Vlahos, Ioannis; Goud, Ajay; Naidich, David P
2006 Mar;129(3):805-815, Chest
The evaluation of patients presenting with multinodular pulmonary disease provides an important clinical challenge for physicians. The differential diagnosis includes an extensive list of benign and malignant processes making the management of these cases frequently problematic. With the introduction of high-resolution CT (HRCT) scanning, the ability to assess various patterns of diffuse multinodular disease has evolved into an essential part of the diagnostic process. The purpose of this article is to develop an approach to the diagnosis of multinodular parenchymal disease using HRCT scan pattern recognition as a point of departure
— id: 96786, year: 2006, vol: 129, page: 805, stat: Journal Article,

Effect of CT image compression on computer-assisted lung nodule volume measurement
Ko, Jane P; Chang, Jeffrey; Bomsztyk, Elan; Babb, James S; Naidich, David P; Rusinek, Henry
2005 Oct;237(1):83-88, Radiology
PURPOSE: To evaluate the effect of two-dimensional wavelet-based computed tomographic (CT) image compression according to the Joint Photographic Experts Group (JPEG) 2000 standard on computer-assisted assessment of nodule volume. MATERIALS AND METHODS: This HIPAA-compliant study was approved by the research board at the authors' institution; patients' informed consent was not required. Fifty-one nodules in 23 patients (seven men, 16 women; mean age, 59 years; age range, 39-75 years) were selected on low-dose CT scans that were compressed to levels of 10:1, 20:1, 30:1, and 40:1 by using a two-dimensional JPEG 2000 wavelet-based image compression method. Nodules were classified according to size (< or = 5 mm or > 5 mm in diameter), location (central, peripheral, or abutting pleura or fissures), and attenuation (solid, calcified, or subsolid). Regions of interest were placed on the original images and transposed onto compressed images. Nodule volumes on original (noncompressed) and compressed images were measured by using a computer-assisted method. A mixed-model analysis of variance was conducted for statistical evaluation. RESULTS: Nodule volumes averaged 388.1 mm3 (range, 34-3474 mm3). There were three calcified, 33 solid noncalcified, and 15 subsolid nodules (13 with ground-glass attenuation). Average volume decreased with increasing compression level, to 383 mm3 (10:1), 370 mm3 (20:1), 360 mm3 (30:1), and 354 mm3 (40:1). No significant difference was identified between measurements obtained on original images and those compressed to a level of 10:1. Significant differences were noted, however, between original images and those compressed to a level of 20:1 or greater (P < .05). Compression level significantly interacted with nodule size, location, and attenuation (P < .001). The effect of compression was greater for nodules with ground-glass attenuation than for those with higher attenuation values. The difference in mean volumes between original images and those compressed to a level of 20:1 was 34.9 mm3 for nodules with ground-glass attenuation, compared with 8.3 mm3 for higher-attenuation nodules, a 4.2-fold difference. CONCLUSION: Nodule volumes measured on images compressed to a level of 20:1 differed significantly from those measured on noncompressed images, especially for nodules with ground-glass attenuation. This difference could affect the assessment of nodule change in size as measured with computer-assisted methods
— id: 58740, year: 2005, vol: 237, page: 83, stat: Journal Article,

Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society
MacMahon, Heber; Austin, John H M; Gamsu, Gordon; Herold, Christian J; Jett, James R; Naidich, David P; Patz, Edward F Jr; Swensen, Stephen J
2005 Nov;237(2):395-400, Radiology
Lung nodules are detected very commonly on computed tomographic (CT) scans of the chest, and the ability to detect very small nodules improves with each new generation of CT scanner. In reported studies, up to 51% of smokers aged 50 years or older have pulmonary nodules on CT scans. However, the existing guidelines for follow-up and management of noncalcified nodules detected on nonscreening CT scans were developed before widespread use of multi-detector row CT and still indicate that every indeterminate nodule should be followed with serial CT for a minimum of 2 years. This policy, which requires large numbers of studies to be performed at considerable expense and with substantial radiation exposure for the affected population, has not proved to be beneficial or cost-effective. During the past 5 years, new information regarding prevalence, biologic characteristics, and growth rates of small lung cancers has become available; thus, the authors believe that the time-honored requirement to follow every small indeterminate nodule with serial CT should be revised. In this statement, which has been approved by the Fleischner Society, the pertinent data are reviewed, the authors' conclusions are summarized, and new guidelines are proposed for follow-up and management of small pulmonary nodules detected on CT scans
— id: 79178, year: 2005, vol: 237, page: 395, stat: Journal Article,

Pulmonary nodules on multi-detector row CT scans: performance comparison of radiologists and computer-aided detection
Rubin, Geoffrey D; Lyo, John K; Paik, David S; Sherbondy, Anthony J; Chow, Lawrence C; Leung, Ann N; Mindelzun, Robert; Schraedley-Desmond, Pamela K; Zinck, Steven E; Naidich, David P; Napel, Sandy
2005 Jan;234(1):274-283, Radiology
PURPOSE: To compare the performance of radiologists and of a computer-aided detection (CAD) algorithm for pulmonary nodule detection on thin-section thoracic computed tomographic (CT) scans. MATERIALS AND METHODS: The study was approved by the institutional review board. The requirement of informed consent was waived. Twenty outpatients (age range, 15-91 years; mean, 64 years) were examined with chest CT (multi-detector row scanner, four detector rows, 1.25-mm section thickness, and 0.6-mm interval) for pulmonary nodules. Three radiologists independently analyzed CT scans, recorded the locus of each nodule candidate, and assigned each a confidence score. A CAD algorithm with parameters chosen by using cross validation was applied to the 20 scans. The reference standard was established by two experienced thoracic radiologists in consensus, with blind review of all nodule candidates and free search for additional nodules at a dedicated workstation for three-dimensional image analysis. True-positive (TP) and false-positive (FP) results and confidence levels were used to generate free-response receiver operating characteristic (ROC) plots. Double-reading performance was determined on the basis of TP detections by either reader. RESULTS: The 20 scans showed 195 noncalcified nodules with a diameter of 3 mm or more (reference reading). Area under the alternative free-response ROC curve was 0.54, 0.48, 0.55, and 0.36 for CAD and readers 1-3, respectively. Differences between reader 3 and CAD and between readers 2 and 3 were significant (P < .05); those between CAD and readers 1 and 2 were not significant. Mean sensitivity for individual readings was 50% (range, 41%-60%); double reading resulted in increase to 63% (range, 56%-67%). With CAD used at a threshold allowing only three FP detections per CT scan, mean sensitivity was increased to 76% (range, 73%-78%). CAD complemented individual readers by detecting additional nodules more effectively than did a second reader; CAD-reader weighted kappa values were significantly lower than reader-reader weighted kappa values (Wilcoxon rank sum test, P < .05). CONCLUSION: With CAD used at a level allowing only three FP detections per CT scan, sensitivity was substantially higher than with conventional double reading
— id: 62328, year: 2005, vol: 234, page: 274, stat: Journal Article,

CT screening for lung cancer: suspiciousness of nodules according to size on baseline scans
Henschke, Claudia I; Yankelevitz, David F; Naidich, David P; McCauley, Dorothy I; McGuinness, Georgeann; Libby, Daniel M; Smith, James P; Pasmantier, Mark W; Miettinen, Olli S
2004 Apr;231(1):164-168, Radiology
PURPOSE: To assess the frequency with which a particular, possibly optimal work-up of noncalcified nodules less than 5.0 mm in diameter identified on initial computed tomographic (CT) images at baseline screening leads to a diagnosis of malignancy prior to first annual repeat screening, compared with a possibly optimal work-up of larger nodules. MATERIALS AND METHODS: Two series of baseline CT screenings in high-risk people were retrospectively reviewed. The first series (n = 1,000) was performed in 1993-1998; the second (n = 1,897), in 1999-2002. In each series, cases in which the largest noncalcified nodule detected was less than 5.0 mm in diameter and those in which it was 5.0-9 mm were reviewed to determine whether diagnostic work-up prior to first annual repeat screening showed or would have shown nodule growth and led or would have led to a diagnosis based on biopsy or surgical specimens. RESULTS: The frequency with which malignancy was or could have been diagnosed when the largest noncalcified nodule was less than 5.0 mm in diameter was 0 of 378, whereas when the largest noncalcified nodule was 5.0-9 mm in diameter, the frequency was 13 or 14 of 238. If persons with only nodules smaller than 5.0 mm had merely been referred for first annual repeat screening without immediate further work-up, the referrals for such work-up would have been reduced by 54% (from 817 [28%] to 385 [13%] of 2,897). CONCLUSION: In modern CT screening for lung cancer at baseline, detected noncalcified nodules smaller than 5.0 mm in diameter do not justify immediate work-up but only annual repeat screening to determine whether interim growth has occurred
— id: 44814, year: 2004, vol: 231, page: 164, stat: Journal Article,

CT screening for lung cancer Assessing a regimen's diagnostic performance
Henschke, Claudia I; Yankelevitz, David F; Smith, James P; Libby, Daniel; Pasmantier, Mark; McCauley, Dorothy; McGuinness, Georgeann; Naidich, David P; Farooqi, Ali; Vasquez, Madeline; Miettinen, Olli S
2004 Sep-Oct;28(5):317-321, Clinical imaging
PURPOSE: The purpose of this study was to characterize the diagnostic performance of a regimen of CT screening for lung cancer. METHODS: Using a common protocol/regimen of screening, 2968 asymptomatic persons at high risk for lung cancer were enrolled in two studies [Early Lung Cancer Action Projects (ELCAP) I and II] for baseline and annual repeat screening. A total of 4538 annual repeat screenings were performed. The regimen's diagnostic performance was characterized in terms of frequency of positive result of the initial CT as well as of screen-diagnosis and Stage I screen-diagnosis among all diagnoses (interim-diagnoses included), all separately for baseline and annual repeat screenings. RESULTS: The proportions with positive result of the initial CT were 12% and 6% in the baseline and repeat screenings, respectively. The proportions of screen-diagnoses among all diagnoses (interim-diagnoses included) were 97% and 99% in the baseline and repeat cycles, respectively. The corresponding proportions of pre-surgical Stage I screen-diagnoses were 95% and 93%. CONCLUSION: The performance of the ELCAP regimen is quite satisfactory in avoiding over many positive results of the initial CT, and it produces highly promising diagnostic results as for the attainment of cure by early intervention
— id: 68280, year: 2004, vol: 28, page: 317, stat: Journal Article,

Computer-aided diagnosis and the evaluation of lung disease
Ko, Jane P; Naidich, David P
2004 Jul;19(3):136-155, Journal of thoracic imaging
— id: 43865, year: 2004, vol: 19, page: 136, stat: Journal Article,

Imaging of unusual diffuse lung diseases
Raoof, Sabiha; Raoof, Suhail; Naidich, David P
2004 Sep;10(5):383-389, Current opinion in pulmonary medicine
PURPOSE OF REVIEW: Computed tomography scans are commonly used in imaging lung diseases. As more information accumulates, patterns of rare or new diseases on CT scans are being increasingly reported. Several pulmonary diseases have distinguishing features, which are better delineated on high resolution CT scans than plain chest radiographs. The radiographic features of unusual diffuse lung diseases published in the past two years are described. RECENT FINDINGS: Severe acute respiratory syndrome generally manifests as focal or diffuse bilateral areas of consolidation on chest radiography and reticulation with ground-glass attenuation commonly seen on CT scans. A normal HRCT rules out the diagnosis of Pneumocystis carinii pneumonia while a normal chest radiograph does not. Immunocompromised patients without AIDS, who have CMV pneumonia, generally demonstrate a combination of ground-glass attenuation, air-space consolidation, and small nodules on HRCT. Nodules less than 10 mm in size in immunocompromised patients are highly suggestive of viral infections. Bronchial wall thickening on HRCT associated with cavitating nodules is suggestive of Wegner granulomatosis in the appropriate clinical setting. Small cysts may be seen in a minority of patients with subacute hypersensitivity pneumonitis and centrilobular emphysema in chronic farmer's lung. Reversed halo sign has a high specificity for cryptogenic organizing pneumonia. The triad of ground-glass opacities, ill-defined centrilobular nodules and cysts and focal areas of air trapping is highly suggestive of subacute hypersensitivity pneumonitis. SUMMARY: Familiarizing with radiographic and CT scan patterns may help the clinician to exclude certain diagnoses and narrow the differential diagnosis for others
— id: 44943, year: 2004, vol: 10, page: 383, stat: Journal Article,

Automated assessment of small airway disease on lung CT : a preliminary study
Dittmer-Roche B; Rusinek H; Ko J; McGuiness C; Naidich D
2003 ;5030:41-50, Medical imaging (SPIE)
Air trapping is a prominent finding in small airway disease (SAD)of the lungs. To investigate the feasibility of accurate, automated assessment of air-trapping from low-dose CT, we compare visual scoring by expert radiologists to a conventional method of automated assessment as well as two novel methods. The conventional method,the markdensity maskmark method, has been reported to correlateweakly but significantly with visual scoring on normal-dose CT.While we were unable to reproduce these results on our low-dose scans, our two novel methods showed some promise. More study on larger data sets is required to determine the optimal analysis method.
— id: 44187, year: 2003, vol: 5030, page: 41, stat: Journal Article,

Lung nodule detection and characterization with multislice CT
Ko, Jane P; Naidich, David P
2003 May;41(3):575-97, vi, Radiologic clinics of North America
The ability to identify and characterize pulmonary nodules has been dramatically increased by the introduction of multislice CT (MSCT) technology. Using high-resolution sections, MSCT allows considerable improvement in assessing nodule morphology, enhancement patterns, and growth. MSCT also has facilitated the development and potential of clinical application of computer-assisted diagnosis
— id: 43868, year: 2003, vol: 41, page: 575, stat: Journal Article,

Small pulmonary nodules: volume measurement at chest CT--phantom study
Ko, Jane P; Rusinek, Henry; Jacobs, Erika L; Babb, James S; Betke, Margrit; McGuinness, Georgeann; Naidich, David P
2003 Sep;228(3):864-870, Radiology
Three-dimensional methods for quantifying pulmonary nodule volume at computed tomography (CT) and the effect of imaging variables were studied by using a realistic phantom. Two fixed-threshold methods, a partial-volume method (PVM) and a variable method, were used to calculate volumes of 40 plastic nodules (largest dimension, <5 mm: 20 nodules with solid attenuation and 20 with ground-glass attenuation) of known volume. Tube current times (20 and 120 mAs), reconstruction algorithms (high and low frequency), and nodule characteristics were studied. Higher precision was associated with use of a PVM with predetermined pure nodule attenuation, high-frequency algorithm, and diagnostic CT technique (120 mAs). A PVM is promising for volume quantification and follow-up of nodules
— id: 43798, year: 2003, vol: 228, page: 864, stat: Journal Article,

Wavelet compression of low-dose chest CT data: effect on lung nodule detection
Ko, Jane P; Rusinek, Henry; Naidich, David P; McGuinness, Georgeann; Rubinowitz, Ami N; Leitman, Barry S; Martino, Jennifer M
2003 Jul;228(1):70-75, Radiology
PURPOSE: To assess the effect of using a lossy Joint Photographic Experts Group standard for wavelet image compression, JPEG2000, on pulmonary nodule detection at low-dose computed tomography (CT). MATERIALS AND METHODS: One hundred sets of lung CT data ('cases') were compressed to 30:1, 20:1, and 10:1 levels by using a wavelet-based JPEG2000 method, resulting in 400 test cases. Each case consisted of nine 1.25-mm sections that had been obtained with 20-40 mAs. Four thoracic radiologists independently interpreted the test case images. Performance was measured by using area under the receiver operating characteristic (ROC) curve (Az) and conventional sensitivity and specificity analyses. RESULTS: There were 51 cases with and 49 without lung nodules. Az values were 0.984, 0.988, 0.972, 0.921, respectively, for original and 10:1, 20:1, and 30:1 compressed images. Az values decreased significantly at 30:1 (P =.014) but not at 10:1 compression, with a trend toward significant decrease at 20:1 (P =.051). Specificity values were unaffected by compression (>98.0% at all compression levels). Sensitivity values were 86.3% (176 of 204 test cases with nodules), 77.9% (159 of 204 cases), 76.5% (156 of 204 cases), and 70.1% (143 of 204 cases), respectively, for original and 10:1, 20:1, and 30:1 compressed images. Results of logistic regression model analysis confirmed the significant effects of compression rate and nodule attenuation, size, and location on sensitivity (P <.05). CONCLUSION: While no reduction in nodule detection at 10:1 compression levels was demonstrated by using ROC analysis, a significant decrease in sensitivity was identified. Further investigation is needed before widespread use of image compression technology in low-dose chest CT can be recommended
— id: 43799, year: 2003, vol: 228, page: 70, stat: Journal Article,

Contrast enhancement in the evaluation of thoracic disease... includes discussion
Naidich DP
2003 ;Supplement:20-7 Dec, Applied radiology
With multidetector technology and optimal contrast enhancement, CT is stretching its reach in thoracic imaging
— id: 80321, year: 2003, vol: Supplement, page: 20, stat: Journal Article,

Interferon-induced sarcoidosis
Rubinowitz, Ami N; Naidich, David P; Alinsonorin, Cesar
2003 Mar-Apr;27(2):279-283, Journal of computer assisted tomography
Interferons have been used as therapy of both malignant and nonmalignant diseases and commonly in the treatment of hepatitis C virus infection. Although the most commonly encountered side effects of interferon therapy include nonspecific constitutional symptoms, pulmonary involvement is rare. Here, we provide two documented cases of sarcoidosis appearing in patients receiving interferon therapy for hepatitis C infection, because there have only been a few reports of this association. Physicians should be aware of this uncommon yet clinically important complication, because imaging these patients may obviate more invasive procedures
— id: 44944, year: 2003, vol: 27, page: 279, stat: Journal Article,

CT of airways disease and bronchiectasis
McGuinness, Georgeann; Naidich, David P
2002 Jan;40(1):1-19, Radiologic clinics of North America
High-resolution CT is accepted as an accurate noninvasive means of diagnosing bronchiectasis. A wide spectrum of abnormalities may be identified at HRCT in patients with airway disease, including various distinctive patterns of bronchiectasis in specific clinical settings, such as ABPA, MAC infection, AIDS, and CF. Characteristic CT findings occasionally suggest a specific diagnosis that may not have been under clinical consideration. HRCT also provides significant clinical use in assessing the degree and extent of airway disease, and allows noninvasive monitoring of disease progression, regression, or response to therapy
— id: 44945, year: 2002, vol: 40, page: 1, stat: Journal Article,

Early Lung Cancer Action Project: A summary of the findings on baseline screening
Henschke, CI; McCauley, DI; Yankelevitz, DF; Naidich, DP; McGuinness, G; Miettinen, OS; Libby, D; Pasmantier, M; Koizumi, J; Altorki, N; Smith, JP
2001 Mar;6(2):147-152, Oncologist
Purpose. The Early Lung Cancer Action Project (ELCAP) is designed to evaluate baseline and annual repeat screening by low radiation dose computed tomography (low-dose CT) in persons at high-risk for lung cancer. Methods. Since starting in 1993, the ELCAP has enrolled I W asymptomatic persons, 60 years of age or older, with at least 10 pack-years (1 pack per day for 10 years, or 2 packs per day for 5 years) of cigarette smoking, no prior cancer, and medically fit to undergo thoracic surgery. After a structured interview and informed consent, baseline chest radiographs and low-dose CT were obtained on each subject. The diagnostic work-up of screen-detected noncalcified pulmonary nodules (NCN) was guided by ELCAP recommendations which included short-term high-resolution CT follow-up for the smallest nodules. Baseline Results. On low-dose CT at baseline compared to chest radiography, NCN were detected three times as commonly (23% versus 7%), malignancies four times as commonly (2.7% versus 0.7%), and stage I malignancies six times as commonly (23% versus 0.4%). Of the 27 CT-detected cancers, 96% (26/27) were resectable; 85% (23/27) were stage I, and 83% (19 of the 23 stage 1) were not seen on chest radiography. Following the ELCAP recommendations, biopsies were performed on 28 of the 233 subjects with NCN; 27 had a malignant and one a benign NCN. Another three individuals underwent biopsy outside of the ELCAP recommendations; all had benign NCNs. No one had thoracotomy for a benign nodule. Conclusion. Baseline CT screening for lung cancer provides for detecting the disease at earlier and presumably more commonly curable stages in a cost- effective manner
— id: 27520, year: 2001, vol: 6, page: 147, stat: Journal Article,

Early Lung Cancer Action Project - Initial findings on repeat screening
Henschke, CI; Naidich, DP; Yankelevitz, DF; McGuinness, G; McCauley, DI; Smith, JP; Libby, D; Pasmantier, M; Vazquez, M; Koizumi, J; Flieder, D; Altorki, N; Miettinen, OS
2001 JUL 1 ;92(1):153-159, Cancer
BACKGROUND. The Early Lung Cancer Action Project (ELCAP) was designed to evaluate the usefulness of annual computed tomography (CT) screening for lung carcinoma. With the baseline results having been reported previously, the focus of the current study was on the early results of the repeat screenings. METHODS. A cohort of 1000 high-risk individuals was recruited for baseline and annual repeat CT screening. At last follow-up, a total of 1184 annual repeat screenings had been performed. A positive result from the screening test was defined as newly detected, one to six noncalcified pulmonary nodules with interim growth. The diagnostic workup of the individuals was guided by recommendations supplied by the ELCAP investigators to the collaborating clinicians. RESULTS. Of the 1184 repeat CT screenings, the test result was positive in 30 (2.5%). In 2 of these 30 cases, the individual died (of an unrelated cause) before diagnostic workup and the nodule(s) resolved in another 12 individuals. In the remaining 16 individuals, the absence of further growth was documented by repeat CT in 8 individuals and further growth was documented in the remaining 8 individuals. All eight individuals with further nodular growth underwent biopsy and malignancy was diagnosed in seven. Six of these seven malignancies were nonsmall cell carcinomas (five of which were Stage IA and one of which was Stage IIIA) and the one small cell carcinoma was found to be of limited stage. The median size dimension of these malignancies was 8 mm. In another two subjects, symptoms prompted the interim diagnosis of lung carcinoma. Neither of these malignancies was nodule-associated but rather were endobronchial; one was a Stage IIB nonsmall cell carcinoma and the other was a small cell carcinoma of limited stage. CONCLUSIONS. False-positive screening test results are uncommon and usually manageable without biopsy; compared with no screening, such screenings permit diagnosis at substantially earlier and thus more curable stages. Annual repetition of CT screening is sufficient to minimize symptom-prompted interim diagnoses of nodule-associated malignancies. Cancer 2001;92:153-9. (C) 2001 American Cancer Society
— id: 55014, year: 2001, vol: 92, page: 153, stat: Journal Article,

Volume quantitation of small pulmonary nodules on low-dose chest
Ko, JP; Rusinek, H; Chandra, R; McGuinness, G; Betke, M; Naidich, DP
2001 NOV ;221(2):312-312, Radiology
— id: 73267, year: 2001, vol: 221, page: 312, stat: Journal Article,

Hut lung. A domestically acquired particulate lung disease [In Process Citation]
Gold JA; Jagirdar J; Hay JG; Addrizzo-Harris DJ; Naidich DP; Rom WN
2000 Sep;79(5):310-317, Medicine (Baltimore)
We report an illustrative case of advanced 'hut lung,' or domestically acquired particulate lung disease (DAPLD), in a recently emigrated nonsmoking Bangladeshi woman with a history of 171 hour-years of exposure to biomass smoke. She presented with symptoms of chronic cough, dyspnea, and early parenchymal lung disease. High-resolution computed tomography (CT) of the chest demonstrated numerous 2- to 3-mm nodules, sparing the pleural surface. To our knowledge, this is the first such report of CT findings in the literature. Bronchoscopy yielded typical anthracotic plaques and diffuse anthracosis with interstitial inflammation on histopathologic examination of biopsy specimens. DAPLD is potentially the largest environmentally attributable disorder in the world, with an estimated 3 billion people at risk. Caused by the inhalation of particles liberated from the combustion of biomass fuel, DAPLD results in significant morbidity from infancy to adulthood. Clinically, DAPLD manifests a broad range of disorders from chronic bronchitis and dyspnea to advanced interstitial lung disease and malignancy. While a detailed environmental history is essential for making the diagnosis in most individuals, for patients with advanced DAPLD, invasive modalities such as bronchoscopy with transbronchial biopsy and examination of bronchoalveolar lavage fluid help differentiate it from other diseases. Recognition of this syndrome and removal of the patient from the environment is the only treatment. The development of well-controlled interventional trials and the commitment of sufficient resources to educate local populaces and develop alternative fuel sources, stove designs, and ventilation are essential toward reducing the magnitude of DAPLD
— id: 15397, year: 2000, vol: 79, page: 310, stat: Journal Article,

Mediastinal hemangioendothelioma: radiologic--pathologic correlation
Rubinowitz AN; Moreira AL; Naidich DP
2000 Sep-Oct;24(5):721-723, Journal of computer assisted tomography
— id: 23325, year: 2000, vol: 24, page: 721, stat: Journal Article,

Lung nodule enhancement at CT: multicenter study
Swensen SJ; Viggiano RW; Midthun DE; Muller NL; Sherrick A; Yamashita K; Naidich DP; Patz EF; Hartman TE; Muhm JR; Weaver AL
2000 Jan;214(1):73-80, Radiology
PURPOSE: To test the hypothesis that absence of statistically significant lung nodule enhancement (< or =15 HU) at computed tomography (CT) is strongly predictive of benignity. MATERIALS AND METHODS: Five hundred fifty lung nodules were studied. Of these, 356 met all entrance criteria and had a diagnosis. On nonenhanced, thin-section CT scans, the nodules were solid, 5-40 mm in diameter, relatively spherical, homogeneous, and without calcification or fat. All patients were examined with 3-mm-collimation CT before and after intravenous injection of contrast material. CT scans through the nodule were obtained at 1, 2, 3, and 4 minutes after the onset of injection. Peak net nodule enhancement and time-attenuation curves were analyzed. Seven centers participated. RESULTS: The prevalence of malignancy was 48% (171 of 356 nodules). Malignant neoplasms enhanced (median, 38.1 HU; range, 14.0-165.3 HU) significantly more than granulomas and benign neoplasms (median, 10.0 HU; range, -20.0 to 96.0 HU; P < .001). With 15 HU as the threshold, the sensitivity was 98% (167 of 171 malignant nodules), the specificity was 58% (107 of 185 benign nodules), and the accuracy was 77% (274 of 356 nodules). CONCLUSION: Absence of significant lung nodule enhancement (< or = 15 HU) at CT is strongly predictive of benignity
— id: 8595, year: 2000, vol: 214, page: 73, stat: Journal Article,

Multinodular disease: anatomic localization at thin-section CT--multireader evaluation of a simple algorithm
Gruden JF; Webb WR; Naidich DP; McGuinness G
1999 Mar;210(3):711-720, Radiology
PURPOSE: To evaluate the interobserver variability and accuracy of an algorithm for anatomic localization of small nodules evident on thin-section computed tomographic (CT) images of the lungs. MATERIALS AND METHODS: Four experienced chest radiologists independently evaluated thin-section CT images in 58 patients by using an algorithm and a standard score sheet. Nodules were placed into four possible anatomic locations or categories: perilymphatic, random, associated with small airways disease, or centrilobular. Algorithm accuracy was assessed by comparing the localization by the observers to that expected for each specific disease in the study group on the basis of reports in the literature. Interobserver variability was assessed by placing cases into one of three groups: (a) complete concordance, (b) triple concordance, and (c) discordant. RESULTS: All observers agreed in 79% (46 of 58) of the cases with regard to nodule localization; three of the four concurred in an additional 17% (10 of 58). The observers were correct in 218 (94%) of 232 localizations in the 58 cases. There were no apparent differences in the number of either discordant or incorrect localizations between the observers. The most noteworthy source of error and of disagreement between observers was the confusion of perilymphatic and small airways disease-associated nodules in a small number of cases. CONCLUSION: The proposed algorithm is reproducible and accurate in the majority of cases and facilitates nodule localization at thin-section CT
— id: 38849, year: 1999, vol: 210, page: 711, stat: Journal Article,

Early Lung Cancer Action Project: overall design and findings from baseline screening
Henschke, CI; McCauley, DI; Yankelevitz, DF; Naidich, DP; McGuinness, G; Miettinen, OS; Libby, DM; Pasmantier, MW; Koizumi, J; Altorki, NK; Smith, JP
1999 JUL 10 ;354(9173):99-105, Lancet
Background The Early Lung Cancer Action Project (ELCAP) is designed to evaluate baseline and annual repeat screening by low-radiation-dose computed tomography (low-dose CT) in people at high risk of lung cancer. We report the baseline experience. Methods ELCAP has enrolled 1000 symptom-free volunteers, aged 60 years or older, with at least 10 pack years of cigarette smoking and no previous cancer, who were medically fit to undergo thoracic surgery. After a structured interview and informed consent, chest radiographs and low-dose CT were done for each participant. The diagnostic investigation of screen-detected non-calcified pulmonary nodules was guided by ELCAP recommendations, which included short-term high-resolution CT follow-up for the smallest non-calcified nodules. Findings Non-calcified nodules were detected in 233 (23% [95%; CI 21-26]) participants by low-dose CT at baseline, compared with 68 (7% [5-9]) by chest radiography. Malignant disease was detected in 27 (2.7% [1.8-3.8]) by CT and seven (0.7% [0.3-1.3]) by chest radiography, and stage malignant disease in 23 (2.3% [1.5-3.3]) and four (0.4% [0.1-0.9]), respectively. Of the 27 CT-detected cancers, 26 were resectable. Biopsies were done on 28 of the 233 participants with non-calcified nodules; 27 had malignant non-calcified nodules and one had a benign nodule. Another three individuals underwent biopsy against the ELCAP recommendations; all had benign non-calcified nodules. No participant had thoracotomy for a benign nodule. Interpretation low-dose CT can greatly improve the likelihood of detection of small non-calcified nodules, and thus of lung cancer at an earlier and potentially more curable stage. Although false-positive CT results are common. they can be managed with little use of invasive diagnostic procedures
— id: 54006, year: 1999, vol: 354, page: 99, stat: Journal Article,

Computed tomography and magnetic resonance of the thorax
Naidich, David P
Philadelphia : Lippincott-Raven, c1999,
— id: 603, year: 1999, vol: , page: , stat: ,

Computed tomography and magnetic resonance of the thorax, Third edition
Naidich, David P; Mueller, Nestor L; Zerhouni, Elias A; Webb, W Richard; Krinsky, Glenn A; Siegelman, Stanley S
Philadelphia : Lippincott-Raven, 1999,
This book is a comprehensive textbook organized around the major anatomic subunits of the thorax. The ten chapters focus on the principles and techniques of thoracic computed tomography and magnetic resonance, the mediastinum, the airways, focal lung disease, lung cancer, diffuse lung disease, pulmonary complications of AIDS, the arteries and veins, the chest wall, and the diaphragm. Each chapter contains an outline, references, and diagrams illustrating computed tomography and magnetic resonance. The book also contains a subject index and prefaces to the first and third editions. This book targets medical students and others interested in computed tomography and magnetic resonance of the thorax
— id: 626, year: 1999, vol: , page: , stat: ,

Transbronchial needle aspiration (TBNA) in patients infected with HIV
Harkin TJ; Ciotoli C; Addrizzo-Harris DJ; Naidich DP; Jagirdar J; Rom WN
1998 Jun;157(6 Pt 1):1913-1918, American journal of respiratory & critical care medicine
Transbronchial needle aspiration (TBNA) of intrathoracic lymph nodes has been shown to be useful in the diagnosis and staging of bronchogenic carcinoma. With the exception of sarcoidosis, the usefulness of TBNA has not been widely investigated in other clinical settings. We investigated the utility of TBNA with a 19-gauge histology needle in HIV-infected patients with mediastinal and hilar adenopathy at Bellevue Hospital Center. We performed 44 procedures in 41 patients. Adequate lymph node sampling was obtained in 35 of 44 (80%), and diagnostic material was obtained in 23 of 44 (52%) procedures. TBNA was the exclusive means of diagnosis in 13 of 41 (32%) patients. Of the 44 procedures, 23 (52%) were performed in patients with mycobacterial disease, with TBNA providing the diagnosis in 20 of 23 (87%). In these patients, positive TBNA specimens included smears of aspirated materials for acid-fast bacilli in 11, mycobacterial culture in 14, and histology in 15. In other diseases, TBNA diagnosed sarcoidosis with noncaseating granulomata in 2 of 4 patients and non-small cell lung cancer in 1 of 2 patients. TBNA was not helpful in other diseases including Pneumocystis carinii pneumonia, infection with Cryptococcus or Nocardia, bacterial pneumonia, viral pneumonia, and Kaposi's sarcoma. No pulmonary diagnosis was established in five patients. No complications of TBNA occurred. We conclude that TBNA through the flexible bronchoscope is safe and effective in the diagnosis of intrathoracic adenopathy in HIV-infected patients, and is particularly efficacious in the diagnosis of mycobacterial disease. Furthermore, TBNA may provide the only diagnostic specimen in almost one-third of HIV-infected patients, thereby sparing these patients more invasive procedures such as mediastinoscopy
— id: 8034, year: 1998, vol: 157, page: 1913, 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,

Thoracic complications of AI
McGuinness, G; Gruden, JF; Garay, SM; Naidich, DP
1998 AUG ;19(5):543-560, Seminars in respiratory & critical care medicine
Despite encouraging recent treatment advances, HIV and AIDS-related pulmonary complications will continue to present a diagnostic and therapeutic challenge. Streamlined, cost-effective management of these patients is increasingly important in the current medical economic environment. This article presents an approach to the diagnosis of AIDS-related pulmonary disease, emphasizing optimal integration of imaging modalities into specific, practical, cost-effective pathways. The imaging findings of common diseases, both infectious and noninfectious, are summarized, The importance of clinical and demographic information to accurate radiographic interpretation and diagnostic evaluation is emphasized
— id: 53684, year: 1998, vol: 19, page: 543, stat: Journal Article,

Pulmonary nodule detection: low-dose versus conventional CT
Rusinek H; Naidich DP; McGuinness G; Leitman BS; McCauley DI; Krinsky GA; Clayton K; Cohen H
1998 Oct;209(1):243-249, Radiology
PURPOSE: To quantitate the effectiveness of low-dose computed tomography (CT) in the identification of pulmonary nodules while controlling for anatomic nodule characteristics and to establish what factors lead to reduced diagnostic sensitivity at low-dose CT. MATERIALS AND METHODS: Each of six participating radiologist independently rated 200 image panels by using a four-point confidence scale. Conventional images were obtained at 200 mAs; low-dose images were obtained at 20 mAs. To fully control their characteristics, nodules were simulated with a given diameter, shape, and section thickness while preserving the resolution, noise level, and reconstruction artifacts of the original images. Panels were matched so that nodules on low-dose and conventional images had equivalent sizes, locations, and relationships to blood vessels. RESULTS: Among 864 positive panels, 259 (60%) of 432 low-dose panels and 272 (63%) of 432 conventional panels were correctly interpreted (P = .259). Lowering the x-ray dose significantly reduced the detectability of peripheral nodules (P = .019) and nodules separated from blood vessels (P = .044). Surprisingly, 3-mm nodules were detected with approximately equal sensitivity (P = .181) at conventional and low-dose CT. The specificity of low-dose images was 88% (148 of 168 panels) versus 91% (153 of 168 panels) for conventional images (P = .372). CONCLUSION: Low-dose CT is acceptable for pulmonary nodule identification, making it suitable for primary screening. These results confirm the strong effect of size, location, and angiocentricity on the sensitivity of nodule detection with conventional CT
— id: 7773, year: 1998, vol: 209, page: 243, stat: Journal Article,

Pulmonary aspergilloma and AIDS. A comparison of HIV-infected and HIV-negative individuals
Addrizzo-Harris DJ; Harkin TJ; McGuinness G; Naidich DP; Rom WN
1997 Mar;111(3):612-618, Chest
OBJECTIVE AND METHODS: While pulmonary aspergilloma has been well described in immunocompetent hosts, to date and to our knowledge, there has not been a description of pulmonary aspergilloma in the HIV-infected individual. A retrospective review of cases seen by the Bellevue Hospital Chest Service from January 1992 through June 1995 identified 25 patients with aspergilloma. To investigate the impact of HIV status on pulmonary aspergilloma, we compared clinical presentation, progression of disease, treatment, and outcome in the HIV-infected patient vs the HIV-negative patient with aspergilloma. RESULTS: Of the 25 patients identified, 10 were HIV-infected and 15 were HIV-negative. Predisposing diseases included tuberculosis (18/25, 72%), sarcoidosis (4/25, 16%), and Pneumocystis carinii pneumonia (3/25, 12%). All 25 patients had evidence of aspergilloma on chest CT. In addition, 17 of 25 patients had evidence of Aspergillus species in fungal culture, pathologic specimens, or immunoprecipitins. Hemoptysis was present in 15 of 25 (60%) (11/15 [73%] of the HIV-negative group vs 4/10 [40%] of the HIV-infected group). Severe hemoptysis (> 150 mL/d) occurred in 5 of 15 (33%) of the HIV-negative group vs 1 of 10 (10%) of the HIV-infected group. Disease progression occurred more frequently among the HIV-infected group (4/8, 50% vs 1/13, 8% in HIV-negative individuals). All patients with disease progression had lymphocyte subset CD4+ < 100 cells per microliter. Four of eight (50%) of the HIV-infected group vs 1 of 13 (8%) of the HIV-negative group died. SUMMARY AND CONCLUSIONS: We conclude the following: (1) although tuberculosis and sarcoidosis are the most prevalent predisposing diseases, P carinii pneumonia in the HIV-infected individual is a risk factor for pulmonary aspergilloma; (2) HIV-infected individuals with CD4+ < 100 cells per microliter are more likely to have disease progression despite treatment; and (3) HIV-negative patients are more likely to have hemoptysis requiring intervention
— id: 12362, year: 1997, vol: 111, page: 612, stat: Journal Article,

AIDS-related airway disease
McGuinness G; Gruden JF; Bhalla M; Harkin TJ; Jagirdar JS; Naidich DP
1997 Jan;168(1):67-77, American journal of roentgenology
To our knowledge, the importance of airway disease in HIV-positive patients has been infrequently noted. This deficit likely reflects a combination of factors including lack of familiarity with recent changes in clinical and epidemiologic patterns of pulmonary manifestations of HIV infection and documented limitations of chest radiography for identifying and differentiating airway disease from other causes of pulmonary disease in HIV-positive patients. Familiarity with the imaging findings for these various entities should facilitate prompt diagnosis and treatment. The accuracy of CT in detecting airway disease [55-59] is well established and should be of value in excluding more common diseases that may be initially confused with airway abnormalities [60, 61]. Small airways disease, in particular, which may be occult or mimic an interstitial infiltrate on chest radiography, can be recognized with CT as likely representing infectious bronchitis or bronchiolitis. Patients with findings suggesting bacterial infections may benefit from empiric antibiotic therapy. CT also may be valuable for differentiating between various noninfectious pulmonary diseases, allowing a presumptive diagnosis of parenchymal Kaposi's sarcoma in the appropriate clinical context. In distinction, by detecting localized endobronchial or parenchymal abnormalities in patients with mycobacterial or fungal infections or lymphoma, CT may be valuable for deciding between various invasive methods of obtaining either histologic or bacteriologic diagnoses
— id: 7082, year: 1997, vol: 168, page: 67, stat: Journal Article,

Volumetric (helical/spiral) CT (VCT) of the airways
Naidich DP; Gruden JF; McGuinness G; McCauley DI; Bhalla M
1997 Jan;12(1):11-28, Journal of thoracic imaging
Volumetric computed tomography (VCT) represents an important improvement over conventional CT for assessing most airway abnormalities. Elimination of misregistration due to variations in respiration coupled with decreased motion artifact and the ability to obtain routine overlapping sections allow a more confident estimation of the presence and extent of disease. Recently, attention has focused on newer reconstruction techniques including: multiplanar reconstructions (MPRs), including curved multiplanar reformations; multiplanar volume reconstructions (MPVRs) using ray projection techniques, such as maximum and minimum projection imaging; external rendering, or 3D-shaded surface displays; and, most recently, internal rendering or so-called 'virtual bronchoscopy'. Given the often redundant nature of many of these methodologies determining indications for their use remains to be established, especially by comparison to axial imaging. The purpose of this article is to review these various reconstruction techniques and, based on current knowledge, place them in an appropriate clinical context
— id: 12432, year: 1997, vol: 12, page: 11, stat: Journal Article,

Glossary of terms for CT of the lungs: Recommendations of the Nomenclature Committee of the Fleischner Society
Austin, JHM; Muller, NL; Friedman, PJ; Hansell, DM; Naidich, DP; RemyJardin, M; Webb, WR; Zerhouni, EA
1996 AUG ;200(2):327-331, Radiology
— id: 52855, year: 1996, vol: 200, page: 327, stat: Journal Article,

Diffuse lung disease: assessment with helical CT--preliminary observations of the role of maximum and minimum intensity projection images [see comments]
Bhalla M; Naidich DP; McGuinness G; Gruden JF; Leitman BS; McCauley DI
1996 Aug;200(2):341-347, Radiology
PURPOSE: To evaluate assessment of diffuse lung disease with helical computed tomography (CT) and maximum intensity projection (MIP) and minimum intensity projection images. MATERIALS AND METHODS: Six patients with suspected lung disease (the control group) and 20 patients with documented disease underwent axial helical CT through the upper and lower lung fields. Findings on the MIP and minimum intensity projection images of each helical data set were compared with findings on the thin-section scan obtained at the midplane of the series. RESULTS: Owing to markedly improved visualization of peripheral pulmonary vessels (n = 26) and improved spatial orientation, MIP images were superior to helical scans to help identify pulmonary nodules and characterize them as peribronchovascular (n = 2) or centrilobular (n = 7). Minimum intensity projection images were more accurate than thin-section scans to help identify lumina of central airways (n = 23) and define abnormal low (n = 15) and high (ground-glass) (n = 8) lung attenuation. Conventional thin-section scans depicted fine linear structures more clearly than either MIP or minimum intensity projection images, including the walls of peripheral, dilated airways (n = 3) and interlobular septa (n = 3). MIP and minimum intensity projection images added additional diagnostic findings to those on thin-section scans in 13 (65%) of 20 cases. CONCLUSION: MIP and minimum intensity projection images of helical data sets may help diagnosis of a wide spectrum of diffuse lung diseases
— id: 6982, year: 1996, vol: 200, page: 341, stat: Journal Article,

Images in clinical medicine. Midtracheal stricture [see comments]
Doerfler ME; Naidich DP
1996 Dec 19;335(25):1879-1879, New England journal of medicine
— id: 12446, year: 1996, vol: 335, page: 1879, stat: Journal Article,

Differentiation of the ILO boundary chest roentgenograph (0/1 to 1/0) in asbestosis by high-resolution computed tomography scan, alveolitis, and respiratory impairment
Harkin TJ; McGuinness G; Goldring R; Cohen H; Parker JE; Crane M; Naidich DP; Rom WN
1996 Jan;38(1):46-52, Journal of occupational & environmental medicine
High-resolution computed tomography (HRCT) scans have been advocated as providing greater sensitivity in detecting parenchymal opacities in asbestos-exposed individuals, especially in the presence of pleural fibrosis, and having excellent inter- and intraobserver reader interpretation. We compared the 1980 International Labor Organization (ILO) International Classification of the Radiographs of the Pneumoconioses for asbestosis with the high-resolution CT scan using a grid scoring system to better differentiate normal versus abnormal in the ILO boundary 0/1 to 1/0 chest roentgenograph. We studied 37 asbestos-exposed individuals using the ILO classification, HRCT grid scores, respiratory symptom questionnaires, pulmonary function tests, and bronchoalveolar lavage. We used Pearson correlation coefficients to evaluate the linear relationship between outcome variables and each roentgenographic method. The normal HRCT scan proved to be an excellent predictor of 'normality,' with pulmonary function values close to 100% for forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), total lung capacity (TLC), and carbon monoxide diffusing capacity (DLCO) and no increase in BAL inflammatory cells. Concordant HRCT/ILO abnormalities were associated with reduced FEV1/FVC ratio, reduced diffusing capacity, and alveolitis consistent with a definition of asbestosis. In our study, the ILO classification and HRCT grid scores were both excellent modalities for the assessment of asbestosis and its association with impaired physiology and alveolitis, with their combined use providing statistical associations with alveolitis and reduced diffusing capacity
— id: 56819, year: 1996, vol: 38, page: 46, stat: Journal Article,

Radiology of tuberculosis
McGuiness, Georgeann; Naidich, David P
Tuberculosis Boston : Little Brown, 1996,
— id: 4837, year: 1996, vol: , page: ?, stat: Chapter,

Airways and lung: CT versus bronchography through the fiberoptic bronchoscope
Naidich DP; Harkin TJ
1996 Sep;200(3):613-614, Radiology
— id: 7023, year: 1996, vol: 200, page: 613, stat: Journal Article,

Spiral CT with multiplanar and three-dimensional reconstructions accurately predicts tracheobronchial pathology - Commentary
Naidich, DP
1996 SEP ;62(3):817-817, Annals of thoracic surgery
— id: 52818, year: 1996, vol: 62, page: 817, stat: Journal Article,

Review: pneumothorax in patients with AIDS-related Pneumocystis carinii pneumonia
Pastores SM; Garay SM; Naidich DP; Rom WN
1996 Nov;312(5):229-234, American journal of the medical sciences
A retrospective review was performed to describe the clinical characteristics, course, and outcome of pneumothorax for all patients admitted to Bellevue Hospital, New York, with AIDS who had Pneumocystis carinii pneumonia (PCP) diagnosed between January 1985, through July 1991. Of 1360 patients with AIDS and PCP, 67 patients (4.9%) were identified with pneumothorax; a group of 50 is the subject of this review. Of these 50 patients, 22 patients (44%) developed spontaneous pneumothorax, 15 patients (30%) developed pneumothorax during mechanical ventilation, and 13 patients (26%) had pneumothorax after an invasive procedure. Of the 22 patients with spontaneous pneumothorax, 8 had cystic parenchymal abnormalities on the chest radiograph and 6 had a history of PCP. The majority of patients were treated with tube thoracostomy and/or surgical intervention. All 15 patients who developed pneumothorax during mechanical ventilation died. Results of pathologic studies revealed varying degrees of interstitial inflammation and fibrosis interspersed with areas of hemorrhage and necrosis, and presence of P carinii cysts. Autopsy specimens obtained in two cases demonstrated multiple parenchymal cavities and evidence of an alveolar eosinophilic exudate with P carinii organisms. Spontaneous pneumothorax in patients with AIDS usually occurs in association with PCP and is associated with significant morbidity. Patients at risk include those with cystic lesions on chest radiograph and those patients with a history of PCP. Patients with AIDS and PCP who develop pneumothorax during mechanical ventilation have a poor outcome
— id: 12507, year: 1996, vol: 312, page: 229, stat: Journal Article,

High-resolution CT of the lung
Webb, W. Richard; Muller, Nestor Luiz; Naidich, David P
Philadelphia : Lippincott-Raven, c1996,
— id: 531, year: 1996, vol: , page: , stat: ,

Hemoptysis : CT/Fiberoptic bronchoscopic (FOB) correlations in an outpatient population
Garay SM; Naidich DP; Lin WC; O'Brian JK; Lowy J; Kamelhar D; Sloane M; McGuiness G
1995 ;108:175S-175S, Chest
— id: 78682, year: 1995, vol: 108, page: 175S, stat: Journal Article,

T2-weighted MR imaging of the chest: comparison of electrocardiograph-triggered conventional and turbo spin-echo and nontriggered turbo spin-echo sequences
Haddad JL; Rofsky NM; Ambrosino MM; Naidich DP; Weinreb JC
1995 May-Jun;5(3):325-329, Journal of magnetic resonance imaging
In 22 patients with a diverse range of thoracic abnormalities, T2-weighted magnetic resonance (MR) images of the chest were obtained with electrocardiograph (ECG)-triggered turbo spin-echo (TSE), ECG-triggered conventional spin-echo (CSE), and nontriggered TSE sequences, and the images were compared. A 5-point rating scale was used by three radiologists experienced in MR imaging of the chest to independently evaluate the images for (a) freedom from ghosting, (b) clarity of heart wall and cardiac chambers, (c) clarity of mediastinal structures, (d) conspicuity of abnormalities, and (e) overall image quality. Evaluations were analyzed with statistical methods. For freedom from ghosting, clarity of heart wall and cardiac chambers, clarity of mediastinal structures, and overall image quality, the ECG-triggered TSE images were rated higher than the TSE images, which, in turn, were rated higher than the ECG-triggered CSE images at the P = .05 level of significance. No significant differences were seen between the pulse sequences in the conspicuity of abnormalities, although some differences were observed in individual cases. Our results suggest that ECG-triggered TSE imaging provides improved, time-efficient T2-weighted images of the chest
— id: 56760, year: 1995, vol: 5, page: 325, stat: Journal Article,

Bronchiectasis: CT/clinical correlations [published erratum appears in Semin Ultrasound CT MR 1996 Apr;17(2):92]
McGuinness G; Naidich DP
1995 Oct;16(5):395-419, Seminars in ultrasound CT & MR
The association between bronchiectasis and human immunodeficiency virus infection, the resurgence of tuberculosis, especially in urban and immunocompromised patients, and the recognition of bronchiectasis as a manifestation of rejection in the transplant population are emerging clinical settings in which establishing the diagnosis of bronchiectasis is becoming increasingly important. High-resolution CT, by virtue of its well-established accuracy, is currently accepted as the optimal noninvasive means of diagnosing bronchiectasis. However, reliable diagnosis requires meticulous attention to technique and a thorough knowledge of potential pitfalls. These include, among others, respiratory and cardiac motion artifacts as well as effects of collimation and electronic windowing. It also is important to recognize diseases that may mimic the appearance of bronchiectasis as well as unusual manifestations of bronchiectasis that may obscure the diagnosis
— id: 7215, year: 1995, vol: 16, page: 395, stat: Journal Article,

Unusual lymphoproliferative disorders in nine adults with HIV or AIDS: CT and pathologic findings
McGuinness G; Scholes JV; Jagirdar JS; Lubat E; Leitman BS; Bhalla M; McCauley DI; Garay SM; Naidich DP
1995 Oct;197(1):59-65, Radiology
PURPOSE: To identify characteristic computed tomographic (CT) findings in unusual pulmonary lymphoproliferative disorders seen in adults with the human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). MATERIALS AND METHODS: The authors retrospectively reviewed the CT scans and pathologic specimens from nine patients with pulmonary lymphoproliferative disorders. CT scans were evaluated for nodules, reticulation, areas of ground-glass attenuation, consolidation, and bronchial disease. Changes seen in pathologic specimens were classified as consistent with classic lymphocytic interstitial pneumonitis (LIP), mucosa-associated lymphoid tissue lymphoma (MALTOMA), or atypical lymphoproliferative disorder (ALD). Immunopathologic results were reviewed when available. RESULTS: Eight patients had AIDS. Five patients had classic LIP. One patient had MALTOMA, and three patients had ALD. Altogether, 2-4-mm-diameter nodules were the predominant CT finding in eight patients; these were peribronchovascular in four patients. The presence of interstitial nodules correlated with the pathologic finding of nodular disease in seven patients. CONCLUSION: Familiarity with these AIDS-related disorders and their CT appearance should assist in the differential diagnosis
— id: 6844, year: 1995, vol: 197, page: 59, stat: Journal Article,

Airways and lung: correlation of CT with fiberoptic bronchoscopy [see comments]
Naidich DP; Harkin TJ
1995 Oct;197(1):1-12, Radiology
Recent advances in computed tomography (CT) and fiberoptic bronchoscopy (FOB) have led to confusion concerning the optimal use of these modalities, especially with regard to each other. The present review summarizes the current understanding of the role of CT in relation to FOB. Emphasis is placed on optimization of CT technique and basic principles of interpretation of the images. In addition, an in-depth evaluation is presented of the advantages and limitations of CT and FOB in the analysis of both focal and diffuse diseases of the airways and lung parenchyma
— id: 8078, year: 1995, vol: 197, page: 1, stat: Journal Article,

US-ASSISTED BRONCHOSCOPY - IS SEEING BELIEVING
HARKIN, TJ; NAIDICH, DP
1994 JAN ;190(1):18-19, Radiology
— id: 52572, year: 1994, vol: 190, page: 18, stat: Journal Article,

Hemoptysis: prospective high-resolution CT/bronchoscopic correlation [see comments]
McGuinness G; Beacher JR; Harkin TJ; Garay SM; Rom WN; Naidich DP
1994 Apr;105(4):1155-1162, Chest
The precise roles of fiberoptic bronchoscopy (FOB) and computed tomography (CT) of the chest in the evaluation of patients presenting with hemoptysis have not been clearly defined. On the assumption that both procedures would likely provide unique and complementary information, a prospective study with blinded interpreters using a modified high-resolution CT technique (HRCT) and FOB was designed to evaluate 57 consecutive patients admitted to Bellevue Hospital with hemoptysis. Etiologies included bronchiectasis (25 percent), tuberculosis (16 percent), lung cancer (12 percent), aspergilloma (12 percent), and bronchitis (5 percent): in an additional 5 percent of cases, hemoptysis proved to be due miscellaneous causes, while in 19 percent hemoptysis proved to be cryptogenic. Patients with lung cancer all were at least 50 years old, smoked an average of 78 pack-years, and had less severe hemoptysis but of longer duration. All had conditions diagnosed both by HRCT and FOB. High-resolution CT proved of particular value in diagnosing bronchiectasis and aspergillomas, while FOB was diagnostic of bronchitis and mucosal lesions such as Kaposi's sarcoma. Fiberoptic bronchoscopy localized bleeding in only 51 percent of cases. The high sensitivity of CT in identifying both the intraluminal and extraluminal extent of central lung cancers in conjunction with its value in diagnosing bronchiectasis suggest that CT should be obtained prior to bronchoscopy in all patients presenting with hemoptysis
— id: 6451, year: 1994, vol: 105, page: 1155, stat: Journal Article,

Cytomegalovirus pneumonitis: spectrum of parenchymal CT findings with pathologic correlation in 21 AIDS patients
McGuinness G; Scholes JV; Garay SM; Leitman BS; McCauley DI; Naidich DP
1994 Aug;192(2):451-459, Radiology
PURPOSE: To identify characteristic features of cytomegalovirus (CMV) pneumonitis at computed tomography (CT), particularly markers that may help differentiate CMV from Pneumocystis carinii pneumonia. MATERIALS AND METHODS: Bronchoalveolar lavage (BAL) and biopsy results in 21 patients with acquired immunodeficiency syndrome, cytopathologic evidence of CMV infection without other infections, and available CT scans were retrospectively evaluated. CT findings were correlated with radiographic and pathologic findings when available. RESULTS: BAL findings were positive for CMV in only six cases, 13 patients had extrathoracic CMV infection, and 10 had Kaposi sarcoma. CT findings included ground-glass attenuation, dense consolidation, bronchial wall thickening or bronchiectasis, and interstitial reticulation without air-space disease (12 patients had discrete pulmonary nodules or masses). Biopsy revealed air-space disease as the dominant process in eight cases. Histopathologic findings correlated well with CT appearances. CONCLUSION: CMV pneumonitis should be suspected in patients with either extrathoracic CMV or documented Kaposi sarcoma, especially when radiographic or CT evidence of pulmonary nodules or masses exists
— id: 6452, year: 1994, vol: 192, page: 451, stat: Journal Article,

Helical computed tomography of the thorax. Clinical applications
Naidich DP
1994 Jul;32(4):759-774, Radiologic clinics of North America
Intuitively, any technique that minimizes the effects of respiratory motion, eliminates misregistration between scans, minimizes intravenous contrast requirements, and allows high quality multiplanar and 3-D image reconstruction is likely to have a tremendous impact on conventional notions concerning routine thoracic CT. Helical scanning is already of proved efficacy for vascular and airway imaging as well as for identifying and characterizing pulmonary nodules. It may be anticipated that the indications for the use of helical imaging will continue to expand. Of particular interest is the ongoing development of reconstruction algorithms that allow high-quality images to be obtained with rapid table incrementation while simultaneously reducing radiation exposure. Given the intrinsically high contrast of structures within the thorax coupled with the disadvantages that result from respiratory motion, it is not unreasonable to conclude that within the near future volumetric techniques will be the standard for nearly all CT applications within the thorax
— id: 12954, year: 1994, vol: 32, page: 759, stat: Journal Article,

Is thoracic CT performed often enough?
Naidich DP; Pizzarello D; Garay SM; Muller NL
1994 Aug;106(2):331-332, Chest
— id: 34068, year: 1994, vol: 106, page: 331, stat: Journal Article,

TRANSBRONCHIAL NEEDLE ASPIRATION IN THE DIAGNOSIS OF MEDIASTINAL MYCOBACTERIAL INFECTION
HARKIN, TJ; KARP, J; CIOTOLI, C; FISHMAN, C; NAIDICH, DP; GRAAP, W; ROM, WN
1993 APR ;147(4):A801-A801, American review of respiratory disease
— id: 54169, year: 1993, vol: 147, page: A801, stat: Journal Article,

AIDS associated bronchiectasis: CT features
McGuinness G; Naidich DP; Garay S; Leitman BS; McCauley DI
1993 Mar-Apr;17(2):260-266, Journal of computer assisted tomography
The occurrence of bronchiectasis has only rarely been noted among the protean manifestations of HIV infection in the lungs. We retrospectively identified bronchiectasis on CT scans in 12 HIV + and/or AIDS patients in the absence of either documented mycobacterial infection or a history of prior recurrent pyogenic infection. Pneumonitis was documented in 10 of 12 cases. In eight cases, bronchiectasis was associated with episodes of pyogenic infection; four of these patients also had documented opportunistic infections, including three cases of Pneumocystis carinii pneumonia (PCP). Two patients had infection due solely to PCP. In two cases, bronchiectasis was found in association with one case each of lymphocytic interstitial pneumonitis and nonspecific interstitial pneumonitis, respectively. Although the true incidence of bronchiectasis in this population remains to be established, in our experience bronchiectasis should be considered among the varied pulmonary manifestations of HIV infection. Furthermore, the seemingly rapid development and extent of bronchiectasis in this population suggest an accelerated form of the disease
— id: 8061, year: 1993, vol: 17, page: 260, stat: Journal Article,

Accessory cardiac bronchus: CT features and clinical significance
McGuinness G; Naidich DP; Garay SM; Davis AL; Boyd AD; Mizrachi HH
1993 Nov;189(2):563-566, Radiology
PURPOSE: The accessory cardiac bronchus is a rare congenital anomaly of the tracheobronchial tree that arises from the medial wall of the bronchus intermedius. This report documents the computed tomographic (CT) appearance of this anomaly. MATERIALS AND METHODS: Six patients with this anomaly were identified. All six underwent CT; three underwent correlative bronchoscopy, and one had both bronchoscopic and surgical confirmation. RESULTS: In all six cases, a distinct airway could be identified originating from the medial wall of the bronchus intermedius. Associated lung parenchymal tissue was identified in four cases, while in three cases a discrete soft-tissue mass was seen, presumably representing vascularized bronchial or vestigial parenchymal tissue. In two cases, the lumen of the airway was filled with debris. CONCLUSION: Recognition of this anomaly is important, as associated clinical complications, including recurrent episodes of both infection and hemoptysis, may be anticipated in a small percentage of patients
— id: 6450, year: 1993, vol: 189, page: 563, stat: Journal Article,

Bronchiectasis: CT evaluation
McGuinness G; Naidich DP; Leitman BS; McCauley DI
1993 Feb;160(2):253-259, American journal of roentgenology
CT is the imaging method of choice after standard chest radiography for examining patients with suspected bronchiectasis. In most institutions throughout the world, CT has largely eliminated the need for bronchography in the diagnosis of bronchiectasis. Nonetheless, controversy persists concerning the overall accuracy of CT. In an effort to improve overall diagnostic accuracy, we review the wide range of CT appearances of this protean disorder, and emphasize potential problems and technical pitfalls that may arise in routine clinical imaging
— id: 13274, year: 1993, vol: 160, page: 253, stat: Journal Article,

Volumetric scans change perceptions in thoracic CT
Naidich DP
1993 Apr;15(4):70-74, Diagnostic imaging
— id: 13217, year: 1993, vol: 15, page: 70, stat: Journal Article,

Variables affecting pulmonary nodule detection with computed tomography: evaluation with three-dimensional computer simulation
Naidich DP; Rusinek H; McGuinness G; Leitman B; McCauley DI; Henschke CI
1993 Fall;8(4):291-299, Journal of thoracic imaging
To meaningfully evaluate factors determining the overall accuracy of computed tomography (CT) for identifying pulmonary nodules, computer-generated nodules were superimposed on normal CT scans and interpreted independently by three experienced chest radiologists. Variables evaluated included nodule size, shape, number, density, location, edge characteristics, and relationship to adjacent vessels, as well as technical factors, including slice thickness and electronic windowing. The overall sensitivity in identifying nodules was 62% and the specificity was 80%. On average, the observers identified 56, 67, and 63% of nodules on 1.5-, 5-, and 10-mm-thick sections, respectively (p = 0.037). Nodules were more difficult to identify on 1.5-mm-thick sections. On average, observers identified 1, 48, 82, and 91% of nodules < 1.5, < 3, < 4.5, and < 7 mm in diameter, respectively (p < 0.001). Other factors that made a significant contribution (p < 0.01) in identifying nodules, as determined by linear discriminant function analysis, included nodule location, angiocentricity, and density. We concluded that computer-generated nodules can be used to assess a large number of imaging variables. We anticipate that this approach will be of considerable utility in assessing the accuracy of interpretation of a wide range of pathologic entities as well as in optimizing three-dimensional scan protocols within the thorax
— id: 56568, year: 1993, vol: 8, page: 291, stat: Journal Article,

Intrathoracic adenopathy associated with pulmonary tuberculosis in patients with human immunodeficiency virus infection
Pastores SM; Naidich DP; Aranda CP; McGuinnes G; Rom WN
1993 May;103(5):1433-1437, Chest
The role of computed tomography (CT) in the diagnosis of mediastinal tuberculous lymphadenitis was evaluated retrospectively in 25 human immunodeficiency virus (HIV)-infected patients (19 had AIDS). In all cases, the diagnosis of tuberculosis was established by mycobacterial culture and/or histologic evaluation. The most characteristic CT finding was the presence of low-density mediastinal and hilar lymph nodes in 16 of 19 (84 percent) patients with AIDS and four of six (67 percent) HIV-seropositive patients without AIDS. Marked enhancement of the periphery of nodes was identified in five cases, all in patients with documented AIDS. In most cases, lymphadenopathy proved to be massive, presenting as extensive, heterogenous soft-tissue lesions, presumably the result of coalescence of groups of matted nodes. We conclude that low-density mediastinal and/or hilar lymph nodes on CT, while not pathognomonic, is sufficiently characteristic for tuberculosis to warrant empiric antituberculosis therapy pending results of cultures
— id: 15402, year: 1993, vol: 103, page: 1433, stat: Journal Article,

Aortic aneurysm and dissection: normal MR imaging and CT findings after surgical repair with the continuous-suture graft-inclusion technique
Rofsky NM; Weinreb JC; Grossi EA; Galloway AC; Libes RB; Colvin SB; Naidich DP
1993 Jan;186(1):195-201, Radiology
The normal range of postoperative imaging findings are described in 34 asymptomatic patients studied 5-66 months (mean, 28 months) after undergoing the continuous-suture graft-inclusion technique for repair of aortic aneurysms (n = 20) and dissections (n = 14) involving the ascending aorta. All 34 patients underwent magnetic resonance (MR) imaging, and 24 patients also underwent computed tomography (CT). Perigraft thickening was seen in 19 patients (56%) with MR imaging and in eight patients (33%) with CT. Flow outside the graft but contained within the native wrap was noted in five patients (15%) with MR imaging and in four patients (17%) with contrast material-enhanced CT. Thrombus was identified outside the graft and within the wrap in seven patients (21%) with MR imaging and in six patients (25%) with CT. Mass effect on the graft was depicted in four patients (12%) with MR imaging and in three patients (13%) with CT. Of the 14 patients who underwent repair of aortic dissections, an intimal flap was seen distal to the graft in seven of the 14 (50%) evaluated with MR imaging and in four of the 10 (40%) evaluated with contrast-enhanced CT. An accurate postoperative imaging evaluation requires precise knowledge of the surgical technique performed and its anatomic consequences
— id: 13311, year: 1993, vol: 186, page: 195, stat: Journal Article,

The left atrial catheter: its uses and complications
Leitman BS; Naidich DP; McGuinness G; McCauley DI
1992 Nov;185(2):611-612, Radiology
The authors describe the radiographic appearance of the left atrial catheter, a widely used postsurgical intracardiac device. Recognition of the characteristic appearance of this catheter should be of value in detection of potential complications, including line fracture with resultant retention and/or embolization, infection, prosthetic valve dysfunction, and even cardiac tamponade
— id: 13380, year: 1992, vol: 185, page: 611, stat: Journal Article,

High resolution CT findings in miliary lung disease
McGuinness G; Naidich DP; Jagirdar J; Leitman B; McCauley DI
1992 May-Jun;16(3):384-390, Journal of computer assisted tomography
High-resolution CT (HRCT) and chest radiographs were compared in nine patients with miliary lung disease. In all cases, miliary disease was documented to be infectious in etiology; six of these patients proved to be human immunodeficiency virus (HIV) positive. A mixture of both sharply and poorly defined 1-3 mm nodules was seen in all cases, many of the latter having an appearance indistinguishable from airspace nodules. Other features attributable to the presence of nodules included nodular interlobular septae, nodular irregularity of vessels, subpleural dots, and studded fissures. Diffuse intra- and interlobular septal thickening also proved common, seen in all but one case (91%). Based on limited HRCT-pathologic correlation, CT findings appear primarily to be due to granulomatous foci developing in a seemingly random distribution involving both pulmonary airspaces as well as the interstitium. It is concluded that in the appropriate clinical setting this constellation of findings is characteristic of miliary disease; the role of HRCT especially in the early diagnosis of miliary disease in HIV positive patients remains to be determined prospectively
— id: 13608, year: 1992, vol: 16, page: 384, stat: Journal Article,

THORACIC DISEASE IN THE IMMUNOCOMPROMISED PATIENT
MCLOUD, TC; NAIDICH, DP
1992 MAY ;30(3):525-554, Radiologic clinics of North America
— id: 51963, year: 1992, vol: 30, page: 525, stat: Journal Article,

High-resolution CT of the lung
Webb, W. Richard; Muller, Nestor Luiz; Naidich, David P
New York : Raven Press, c1992,
— id: 382, year: 1992, vol: , page: , stat: ,

CYSTIC-FIBROSIS - SCORING SYSTEM WITH THIN-SECTION CT
Bhalla, M; Turcios, N; Aponte, V; Jenkins, M; Leitman, BS; Mccauley, DI; Naidich, DP
1991 Jun;179(3):783-788, Radiology
The progression of lung disease in patients with cystic fibrosis (CF) was evaluated with chest radiography. The severity and extent of the various radiographic changes were scored with the Chrispin or the Birmingham method, which involves the use of imprecise and subjective terms, such as line shadows, large pulmonary shadows, and nodular cystic lesions. Although computed tomography (CT) has been shown to be helpful in the evaluation of lung disease in CF, no scoring system or other objective criteria have been developed for the evaluation of the wide range of pulmonary changes in these patients. A CT scoring system was devised that incorporates all of the changes seen in the lungs of patients with CF. Such a scoring system may facilitate objective evaluation of existing and newly developed therapeutic regimens and may be a valuable tool in the preoperative evaluation of patients being considered for lobectomy or bullectomy and in the selection of patients for lung transplantation
— id: 32176, year: 1991, vol: 179, page: 783, stat: Journal Article,

High-resolution computed tomography of cystic lung disease
Naidich DP
1991 Apr;26(2):151-174, Seminars in roentgenology
— id: 14085, year: 1991, vol: 26, page: 151, stat: Journal Article,

Radiographic evaluation of focal lung disease
Naidich DP; Garay SM
1991 Mar;12(1):77-95, Clinics in chest medicine
Optimal clinical management of patients with focal lung pathology necessitates thorough familiarity with basic concepts in imaging. Over the past decade, radiologic evaluation has undergone rapid change, reflecting considerable growth in imaging technology. As this article discusses and illustrates at length, improvements in computed tomography technology in particular have resulted in a significant alteration in our approach to both the diagnosis and treatment of patients with focal lung disease
— id: 14107, year: 1991, vol: 12, page: 77, stat: Journal Article,

Pulmonary manifestations of AIDs. CT and radiographic correlations
Naidich DP; McGuinness G
1991 Sep;29(5):999-1017, Radiologic clinics of North America
To date, few reports have attempted to correlate plain radiographic findings with computed tomography (CT) in assessing pulmonary disease in patients who have acquired immunodeficiency syndrome (AIDS). This report focuses on the most common pulmonary manifestations, with particular emphasis placed on those entities for which there is a potential role for CT. This includes identification of occult disease, especially the early diagnosis of Pneumocystis carinii pneumonia, as well as identification of unsuspected lung abscesses and cavities; characterization of diffuse parenchymal disease in patients who have abnormal radiographs; identification and characterization of mediastinal lymphadenopathy, especially in differentiating between neoplastic and non-neoplastic causes; and finally, use of CT to perform CT-guided transthoracic needle biopsies
— id: 13920, year: 1991, vol: 29, page: 999, stat: Journal Article,

Imaging strategies in pulmonary disease
Naidich, David P.; Garay, Stuart M
Philadelphia, PA : W.B. Saunders, 1991,
— id: 281, year: 1991, vol: , page: , stat: ,

IMAGING STRATEGIES IN PULMONARY-DISEASE - PREFACE
NAIDICH, DP; GARAY, SM
1991 MAR ;12(1):R9-R10, Clinics in chest medicine
— id: 51721, year: 1991, vol: 12, page: R9, stat: Journal Article,

Thoracic magnetic resonance imaging
Weinreb, J C; Naidich, D P
1991 Mar;12(1):33-54, Clinics in chest medicine
In our experience, MR has served largely as a problem-solving device, especially in those cases in which CT has proved equivocal. Magnetic resonance has been especially efficacious in evaluating cardiovascular pathology. Virtually the entire spectrum of aortic disease can be assessed accurately, making MR a reasonable alternative to CT or angiography in most cases. Indications for the use of MR in patients with thoracic neoplasia have also emerged. Magnetic resonance is more accurate than CT in assessing invasion of the chest wall and mediastinum. As a consequence, MR should be considered the imaging procedure of choice in patients with suspected Pancoast tumors. In some patients with lymphoma, MR can make a unique contribution by evaluating the response to therapy. Magnetic resonance also can be of value in assessing patients with signs of venous obstruction, especially when there is a contraindication to the use of intravenous contrast medium. Magnetic resonance is as accurate as CT in assessing most benign mediastinal pathology. The former study can easily differentiate atherosclerotic vessels or aneurysms from enlarged lymph nodes or masses, frequently obviating a more invasive study. It is especially efficacious in evaluating patients with cystic lesions, especially those with complex cysts not clearly of water density. In the hilum, MR can differentiate prominent hilar vessels from adenopathy or masses as reliably as CT. Again, in patients with renal failure or those who have documented allergies to iodinated contrast medium, MR should be the imaging procedure of choice to evaluate suspicious hila identified on plain chest radiographs. Magnetic resonance also can be used to differentiate central obstructing hilar tumors from peripheral collapsed lung. In certain cases, these findings may help determine resectability by demonstrating encasement of hilar and mediastinal vessels as well as the central airways. It should be anticipated that as technologic improvements continue to be made, MR will assume an increasingly important role in the imaging of thoracic disease
— id: 140470, year: 1991, vol: 12, page: 33, stat: Journal Article,

LUNG HERNIA - RADIOGRAPHIC FEATURES
BHALLA, M; LEITMAN, BS; FORCADE, C; STERN, E; NAIDICH, DP; MCCAULEY, DI
1990 JAN ;154(1):51-53, American journal of roentgenology
— id: 51515, year: 1990, vol: 154, page: 51, stat: Journal Article,

Counting ribs on chest CT
Bhalla, M; McCauley, D I; Golimbu, C; Leitman, B S; Naidich, D P
1990 Jul-Aug;14(4):590-594, Journal of computer assisted tomography
— id: 101741, year: 1990, vol: 14, page: 590, stat: Journal Article,

Constrictive pericarditis masquerading as extracardiac tumor
Freedberg RS; Schulman IC; Naidich D; Weinreb J; Culliford A; Kronzon I
1990 Aug;120(1):227-229, American heart journal
— id: 45690, year: 1990, vol: 120, page: 227, stat: Journal Article,

COMPUTED-TOMOGRAPHY AND BRONCHOSCOPY IN CHEST RADIOGRAPHICALLY OCCULT MAIN-STEM NEOPLASM DIAGNOSIS AND ND-YAG LASER TREATMENT IN 8 PATIENTS
GELB, AF; ABERLE, DR; SCHEIN, MJ; NAIDICH, DP; EPSTEIN, JD; TASHKIN, DP
1990 OCT ;153(4):385-389, Western journal of medicine
— id: 51467, year: 1990, vol: 153, page: 385, stat: Journal Article,

Hemoptysis: CT-bronchoscopic correlations in 58 cases
Naidich DP; Funt S; Ettenger NA; Arranda C
1990 Nov;177(2):357-362, Radiology
Computed tomographic (CT) and chest radiographic findings were retrospectively correlated with those found at fiberoptic bronchoscopy (FOB) in 58 patients presenting with hemoptysis. Abnormalities involving the airways were depicted by CT in a total of 28 cases (48%). In 18 of these (31% of the total group of 58), focal abnormalities involving the central airways were identified (17 were subsequently proved to be malignant) and in 10 (17% of the total), CT showed bronchiectasis. Focal airway abnormality was shown by FOB in 18 cases (31%); all of these were depicted with CT. Malignancy was diagnosed in 24 patients, including three in whom results of FOB were normal but malignant cells were identified at transbronchial biopsy. CT abnormalities were identified in all cases of malignancy. In 10 of 21 cases (48%) of non-small cell lung cancer, CT allowed definitive staging by documenting either direct mediastinal invasion and/or metastatic disease, while FOB allowed definitive staging in only three cases. CT studies provided no false-negative results. It is concluded that when carefully performed, CT may be an effective modality for evaluating patients presenting with hemoptysis
— id: 14296, year: 1990, vol: 177, page: 357, stat: Journal Article,

MR imaging of pulmonary parenchyma: comparison with CT in evaluating cadaveric lung specimens
Naidich, D P; Weinreb, J C; Schinella, R
1990 Jul-Aug;14(4):595-599, Journal of computer assisted tomography
Magnetic resonance (MR) images (0.5 and 1.5 T) and thin section CT scans were obtained in 17 cadaveric lungs (11 fixed, 6 both pre and post fixation). Standard T1-weighted spin echo (SE) sequences were used for all lungs. In six lungs, additional gradient-refocused echo (GRE) sequences were also obtained. The MR images and CT scans were compared to corresponding gross and microscopic pathologic sections. In all cases, MR SE sequences proved comparable to CT for delineation of normal anatomic structures as well as a range of pathologic conditions, including both air space and interstitial disease. Although image quality was markedly degraded on GRE compared to SE images, they did permit visualization of pulmonary vasculature and focal pathology
— id: 132489, year: 1990, vol: 14, page: 595, stat: Journal Article,

CT MR CORRELATION IN THE EVALUATION OF TRACHEOBRONCHIAL NEOPLASIA
NAIDICH, DP
1990 MAY ;28(3):555-571, Radiologic clinics of North America
— id: 51486, year: 1990, vol: 28, page: 555, stat: Journal Article,

LOW-DOSE CT OF THE LUNGS - PRELIMINARY-OBSERVATIONS
Naidich, DP; Marshall, CH; Gribbin, C; Arams, RS; Mccauley, DI
1990 Jun;175(3):729-731, Radiology
— id: 31873, year: 1990, vol: 175, page: 729, stat: Journal Article,

Pulmonary artery sarcoma: evaluation using Gd-DTPA
Weinreb, J C; Davis, S D; Berkmen, Y M; Isom, W; Naidich, D P
1990 Jul-Aug;14(4):647-649, Journal of computer assisted tomography
Primary malignant tumors of the pulmonary arteries occur infrequently and diagnosis is often delayed since symptoms are nonspecific. We present a case of pulmonary artery sarcoma and its interesting magnetic resonance findings
— id: 140471, year: 1990, vol: 14, page: 647, stat: Journal Article,

Septic pulmonary emboli: CT-radiographic correlation
Huang RM; Naidich DP; Lubat E; Schinella R; Garay SM; McCauley DI
1989 Jul;153(1):41-45, American journal of roentgenology
Radiographic and CT findings in 15 patients with clinically documented septic pulmonary emboli were compared retrospectively. In most cases, radiographic changes were nonspecific. In comparison, on CT a combination of specific signs could be identified in all patients. These included peripheral nodules with clearly identifiable feeding vessels associated with metastatic lung abscesses (10 [67%] of 15 cases), and subpleural, wedge-shaped densities with and without necrosis caused by septic infarcts (11 [73%] of 15 cases). Ancillary pleural, mediastinal, axillary, and pericardial abnormalities also were more easily identified with CT. We conclude that CT is complementary to other imaging techniques in the recognition of septic pulmonary emboli
— id: 10558, year: 1989, vol: 153, page: 41, stat: Journal Article,

PULMONARY HISTIOCYTOSIS-X - COMPARISON OF RADIOGRAPHIC AND CT FINDINGS
Moore, ADA; Godwin, JD; Muller, NL; Naidich, DP; Hammar, SP; Buschman, DL; Takasugi, JE; Decarvalho, CRR
1989 Jul;172(1):249-254, Radiology
— id: 31632, year: 1989, vol: 172, page: 249, stat: Journal Article,

Pulmonary parenchymal high-resolution CT: to be or not to be
Naidich DP
1989 Apr;171(1):22-24, Radiology
— id: 10688, year: 1989, vol: 171, page: 22, stat: Journal Article,

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

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,

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

Unusual cardiac metastasis in hypernephroma: the complementary role of echocardiography and magnetic resonance imaging
Gindea AJ; Gentin B; Naidich DP; Freedberg RS; McCauley D; Kronzon I
1988 Nov;116(5 Pt 1):1359-1361, American heart journal
— id: 10902, year: 1988, vol: 116, page: 1359, stat: Journal Article,

COMPUTED-TOMOGRAPHY OF PECTORAL FLAPS
LEITMAN, BS; NAIDICH, DP; MCCAULEY, DI
1988 MAY-JUN ;12(3):392-393, Journal of computer assisted tomography
— id: 51356, year: 1988, vol: 12, page: 392, stat: Journal Article,

Congenital anomalies of the lungs in adults: MR diagnosis
Naidich DP; Rumancik WM; Ettenger NA; Feiner HD; Harnanz-Schulman M; Spatz EM; Toder ST; Genieser NB
1988 Jul;151(1):13-19, American journal of roentgenology
Over an 18-month period, 11 adults with congenital pulmonary anomalies within the sequestration spectrum, identified either surgically or radiographically by CT and/or angiography, were evaluated with MR. These included seven patients with bronchogenic cysts, two with intralobar pulmonary sequestrations, one with scimitar syndrome, and one with bronchial atresia. In each case, MR showed at least some findings indicative of the correct diagnosis. MR proved especially effective in the detection of abnormal fluid collections (nine cases) and the identification of anomalous vessels (three cases). Fluid collections were easily identified in all cases, including four cases with high-density collections on CT (two with bronchogenic cysts and two with intralobar pulmonary sequestration), especially when single-level, multiecho T2-weighted sequences were obtained. Calculated T2 values ranged from 78 to 439 msec (average, 223 +/- 123 msec). Although T2 values were statistically significant for differentiating fluid from muscle (p = .0012) and fat (p = .0046), they were not sufficiently specific to allow precise fluid characterization. Significant limitations were also apparent, such as an inability to detect alterations in the parenchymal architecture of the lungs (three cases) or intrapulmonary vascularity (one case). Despite this, we conclude that MR may be of considerable value in the assessment of congenital pulmonary anomalies and in select cases obviate more invasive diagnostic procedures
— id: 11044, year: 1988, vol: 151, page: 13, stat: Journal Article,

Solitary pulmonary nodules. CT-bronchoscopic correlation
Naidich DP; Sussman R; Kutcher WL; Aranda CP; Garay SM; Ettenger NA
1988 Mar;93(3):595-598, Chest
The possible contribution of computed tomography (CT) in the management of patients with solitary pulmonary nodules (SPNs) or masses was reviewed retrospectively in 65 patients undergoing fiberoptic bronchoscopy (FOB). Nodules were evaluated by size, location, surface contour, and the presence in cross-section of a bronchus leading to or contained within the nodule or mass, a 'positive bronchus sign.' Thirty-five lesions were associated with a positive bronchus sign; 21 of 35 (60 percent) were diagnosed endoscopically, (p = .027); of 30 cases with a negative bronchus sign, only ten (30 percent) had a diagnosis made by FOB (p = .034). It is concluded that CT may be of use in the routine evaluation of pulmonary nodules, prior to bronchoscopy, especially in cases for which histologic evaluation is essential, especially to determine the presence or absence of a CT bronchus sign
— id: 11167, year: 1988, vol: 93, page: 595, stat: Journal Article,

Basilar segmental bronchi: thin-section CT evaluation
Naidich DP; Zinn WL; Ettenger NA; McCauley DI; Garay SM
1988 Oct;169(1):11-16, Radiology
Thin (1.5- and 5.0-mm) section contiguous computed tomographic (CT) scans obtained through the basilar segmental bronchi in 31 patients were reviewed in order to delineate normal anatomy and common variations of lower lobe airways. In each case, the frequency with which individual segmental and subsegmental bronchi were seen was established, as were variations in branching patterns. All basilar segmental bronchi were identified except in one case in which images of the left lung were obscured due to respiratory and cardiac motion. In the right lung, a division into subsegmental bronchi was identified in 84 of 150 (56%) visualized segmental bronchi. Six separate patterns of basilar segmental subdivision were found. In the left lung, subsegmental bronchi were identified arising from 51 of 145 (35%) visualized segmental bronchi. Five separate patterns of bronchial subdivision were found in the left lung. It is concluded that thin-section CT allows precise identification of all basilar segmental bronchi and, consequently, can play a significant role in the cross-sectional evaluation of lower lobe bronchial and parenchymal abnormalities
— id: 10937, year: 1988, vol: 169, page: 11, stat: Journal Article,

Magnetic resonance imaging of cor triatriatum
Rumancik WM; Hernanz-Schulman M; Rutkowski MM; Kiely B; Ambrosino M; Genieser NB; Naidich DP
1988 ;9(3):149-151, Pediatric cardiology
Magnetic resonance imaging utilizing spin echo sequences was used to demonstrate cor triatriatum in an 18-year-old boy. Phase map images aided the diagnosis by demonstrating the presence of slowly flowing blood in the accessory atrial chamber. Magnetic resonance is an excellent modality for the noninvasive diagnosis of cor triatriatum
— id: 11253, year: 1988, vol: 9, page: 149, 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,

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,

Radiographic manifestations of pulmonary disease in the acquired immunodeficiency syndrome (AIDS)
Naidich DP; Garay SM; Leitman BS; McCauley DI
1987 Jan;22(1):14-30, Seminars in roentgenology
— id: 34074, year: 1987, vol: 22, page: 14, stat: Journal Article,

Comparison of CT and fiberoptic bronchoscopy in the evaluation of bronchial disease
Naidich DP; Lee JJ; Garay SM; McCauley DI; Aranda CP; Boyd AD
1987 Jan;148(1):1-7, American journal of roentgenology
CT was compared to fiberoptic bronchoscopy in a large series of patients to study the value of CT for visualizing bronchial disease. CT scans were available for review in 64 cases in which focal airway disease was identified with fiberoptic bronchoscopy and in 38 patients in whom the airways appeared normal at bronchoscopy. CT was positive in 59 of 64 cases in which lesions were detected endoscopically. If the results are analyzed according to the extent of involvement of individual bronchi, CT successfully identified 88 (90%) of 98 lesions. CT correctly excluded disease in 35 (92%) of 38 cases that were subsequently verified to be normal by fiberoptic bronchoscopy. In no case was the diagnosis of malignancy missed by CT. While extremely accurate in detecting focal lesions, CT was inaccurate in predicting whether a given abnormality was endobronchial, submucosal, or extrinsic (peribronchial). In three cases CT failed to detect submucosal extension into the left mainstream bronchus, which has important implications concerning the value of CT in staging bronchial malignancy. It is concluded that CT is helpful when bronchoscopy is contraindicated or refused. CT may also be used in selected cases when there is low clinical suspicion of endobronchial disease and as a complementary procedure to fiberoptic bronchoscopy for outlining the exact location of major mediastinal and hilar vessels, lymph nodes, and tumor in relation to adjacent airways
— id: 34076, year: 1987, vol: 148, page: 1, stat: Journal Article,

Intralobar pulmonary sequestration: MR evaluation
Naidich DP; Rumancik WM; Lefleur RS; Estioko MR; Brown SM
1987 May-Jun;11(3):531-533, Journal of computer assisted tomography
This report documents the use of magnetic resonance (MR) in evaluation of intralobar pulmonary sequestration. Because of its distinctive multiplanar capabilities and nonreliance on contrast media to visualize blood vessels, MR can be used to define and characterize the size and course of anomalous arterial feeding vessels. Furthermore, MR can be of value in detecting the presence of mucoid-impacted bronchi within abnormal segments of the lung. It is concluded that in select cases MR may obviate the need for more invasive procedures to establish the diagnosis of pulmonary sequestration
— id: 23440, year: 1987, vol: 11, page: 531, stat: Journal Article,

FLUID WITHIN PREEXISTING PULMONARY AIR-SPACES - A POTENTIAL PITFALL IN THE CT DIFFERENTIATION OF PLEURAL FROM PARENCHYMAL DISEASE
ZINN, WL; NAIDICH, DP; WHELAN, CA; LITT, AW; MCCAULEY, DI; ETTENGER, NA
1987 MAY-JUN ;11(3):441-448, Journal of computer assisted tomography
— id: 41708, year: 1987, vol: 11, page: 441, 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,

The Hermansky-Pudlak syndrome: radiographic features
Leitman BS; Balthazar EJ; Garay SM; Naidich DP; McCauley DI
1986 Mar;37(1):42-45, Canadian Association of Radiologists journal
We present the radiologic features of four patients proven to have Hermansky-Pudlak syndrome. All four patients had evidence of pulmonary involvement characterized by a progressive, diffuse, bilateral interstitial fibrosis. Extensive bullous changes were seen in one patient. Two patients with evidence of diffuse colitis exhibited an asymmetrical pattern of focal, superficial, and deep ulcerations similar to that of Crohn's disease. The association of these radiographic abnormalities with albinism, ocular abnormalities, bleeding diathesis, and Puerto Rican ancestry establishes the diagnosis
— id: 34078, year: 1986, vol: 37, page: 42, stat: Journal Article,

THE HERMANSKY-PUDLAK SYNDROME - RADIOGRAPHIC FEATURES
LEITMAN, BS; BALTHAZAR, EJ; GARAY, SM; NAIDICH, DP; MCCAULEY, DI
1986 MAR ;37(1):42-45, Journal of the Canadian Association of Radiologists
— id: 41578, year: 1986, vol: 37, page: 42, stat: Journal Article,

CT OF THE PULMONARY NODULE - A COOPERATIVE STUDY
ZERHOUNI, EA; STITIK, FP; SIEGELMAN, SS; NAIDICH, DP; SAGEL, SS; PROTO, AV; MUHM, JR; WALSH, JW; MARTINEZ, CR; HEELAN, RT; BRANTLY, P; BOZEMAN, RE; DISANTIS, DJ; ETTENGER, N; MCCAULEY, D; AUGHENBAUGH, GL; BROWN, LR; MILLER, WE; LITT, AW; LEO, FP; FISHMAN, EK; KHOURI, NF
1986 AUG ;160(2):319-327, Radiology
— id: 41575, year: 1986, vol: 160, page: 319, 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,

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,

CT diagnosis of cholecystoduodenal fistula
Harkavy LA; Balthazar EJ; Naidich DP
1985 Jul;80(7):569-571, American journal of gastroenterology
— id: 43897, year: 1985, vol: 80, page: 569, 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,

Jejunal perforation by a toothpick: CT demonstration
Strauss JE; Balthazar EJ; Naidich DP
1985 Jul-Aug;9(4):812-814, Journal of computer assisted tomography
Ingested foreign bodies are often seen in clinical practice, but their radiographic demonstration is unusual unless they have a metallic or bony density. This report describes and illustrates a case of small bowel perforation secondary to an ingested wooden toothpick and emphasizes the role of CT in evaluating similar cases
— id: 43896, year: 1985, vol: 9, page: 812, 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,

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,

Late presentation of congenital cystic adenomatoid malformation of the lung
Hulnick, D H; Naidich, D P; McCauley, D I; Feiner, H D; Avitabile, A M; Greco, M A; Genieser, N B
1984 Jun;151(3):569-573, Radiology
Although most often recognized in neonates and young children, congenital cystic adenomatoid malformation of the lung (CCAM) occasionally appears in later years. Three patients, aged 35, 24, and 7 years, are reported. Chest radiographs in each case suggested a localized patchy density, a cystic mass, or a multicystic mass, but computed tomography (CT) best demonstrated the cystic and solid components while ruling out bronchiectasis or major bronchial obstruction. Bronchography contributed no further diagnostic information compared with CT. Each patient underwent lobectomy. Histologically, the characteristic overgrowth of bronchiolar elements replacing normal parenchymal architecture was accompanied by some superimposed inflammatory change. Each patient had a history of pneumonia, and in such patients, characteristic radiographic features should suggest the possibility of late presentation of CCAM
— id: 106955, year: 1984, vol: 151, page: 569, stat: Journal Article,

CT OF LOBAR COLLAPSE
NAIDICH, DP; ETTINGER, N; LEITMAN, BS; MCCAULEY, DI
1984 ;19(3):222-235, Seminars in roentgenology
— id: 41076, year: 1984, vol: 19, page: 222, stat: Journal Article,

THE USE OF COMPUTED-TOMOGRAPHY IN THE ASSESSMENT OF CARDIAC MASSES
Andreou, J; Leitman, BS; Mccauley, DI; Gouliamos, A; Pontifex, G; Naidich, DP
1983 ;7(6):355-359, Computerized radiology
— id: 30590, year: 1983, vol: 7, page: 355, stat: Journal Article,

Localization of impalpable testis by computed tomography
Glasser J; Naidich D; Lefleur R; Al-Askari S
1983 Aug;22(2):206-208, Urology
— id: 23420, year: 1983, vol: 22, page: 206, stat: Journal Article,

Pleural tuberculosis evaluated by computed tomography
Hulnick, D H; Naidich, D P; McCauley, D I
1983 Dec;149(3):759-765, Radiology
Twenty-four cases of pleural tuberculosis (20 active and 4 inactive) were studied with computed tomography (CT). In 14 patients with proved acute tuberculous pleurisy, CT improved diagnostic accuracy by demonstrating small areas of cavitation not apparent on the chest radiograph and by detecting or confirming lymphadenopathy. In 10 patients with chronic tuberculous pleural disease, CT differentiated active from inactive infection by detecting a collection of fluid within the pleural rind. In both groups, CT also demonstrated complications such as bronchopleural fistula and involvement of the chest wall. CT can be beneficial in such cases because of its ability to show the pleural surfaces in transverse section, discriminate parenchymal from pleural disease, and quantify tissue density
— id: 106957, year: 1983, vol: 149, page: 759, stat: Journal Article,

The use of computed tomography in evaluating chest wall pathology
Leitman BS; Firooznia H; McCauley DI; Ettenger NA; Reede DL; Golimbu CN; Rafii M; Naidich DP
1983 Nov;7(4):399-405, Journal of computed tomography
Forty-nine patients with chest wall lesions were evaluated by computed tomography (CT) and conventional radiography. Computed tomography was found to be indispensable for detecting and precisely localizing these lesions. It revealed unsuspected bone destruction and lung, pleural, and mediastinal involvement, as well as invasion of the spinal canal. In more than two thirds of the patients, CT provided additional information of clinical importance in management and, in one third, treatment was altered or the surgical approach modified because of the CT findings. Computed tomography is an essential diagnostic modality in evaluating chest wall lesions
— id: 29087, year: 1983, vol: 7, page: 399, 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,

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,

Computed tomography of lobar collapse: 1. Endobronchial obstruction
Naidich, D P; McCauley, D I; Khouri, N F; Leitman, B S; Hulnick, D H; Siegelman, S S
1983 Oct;7(5):745-757, Journal of computer assisted tomography
The computed tomographic (CT) appearance of lobar collapse has yet to be defined. In an attempt to determine the characteristic appearance of collapse 95 cases were reviewed retrospectively in a wide variety of clinical settings over a 3 year period ending January 1983. In this report 38 cases of lobar collapse secondary to endobronchial occlusion are analyzed; the appearance of collapse without endobronchial obstruction forms the basis of a subsequent report. Computed tomography was accurate in determining the site of bronchial occlusion in all cases. In 36 of 38 cases collapse was caused by endobronchial tumors, including bronchogenic carcinoma, bronchial carcinoids, endobronchial metastases, and lymphoma. Differentiation between these tumors was not feasible with CT. Most cases of collapse were caused by central tumor. In those cases in which a bolus of contrast material was used differentiation between tumor mass and collapsed pulmonary parenchyma was possible. Two of 38 cases were found to have benign bronchial occlusion. In one case a mucous plug obstructing the left lower lobe bronchus was accurately defined. In another case a bronchial stricture occluded the right lower lobe bronchus. This represented the only false positive case in this series. It is concluded that CT is an accurate means for establishing the diagnosis of endobronchial obstruction. In most cases the diagnosis of neoplasia was possible, provided a bolus of contrast material was used to define tumor mass. The potential role of CT in evaluating patients with lobar collapse is discussed
— id: 106959, year: 1983, vol: 7, page: 745, stat: Journal Article,

Computed tomography of lobar collapse: 2. Collapse in the absence of endobronchial obstruction
Naidich, D P; McCauley, D I; Khouri, N F; Leitman, B S; Hulnick, D H; Siegelman, S S
1983 Oct;7(5):758-767, Journal of computer assisted tomography
The computed tomographic appearance of collapse without endobronchial obstruction is reviewed. These 57 cases were classified by the etiology of collapse. The largest group consisted of 29 patients with passive atelectasis, i.e., collapse secondary to fluid, air, or both in the pleural space. Twenty-three of 29 proved secondary to malignant pleural disease. Computed tomography accurately predicted a malignant etiology in 22 of 23 cases. The second largest group of patients had lobar collapse secondary to cicatrization from chronic inflammation. In all cases the underlying etiology was tuberculosis. Radiation caused adhesive atelectasis in six patients secondary to a lack of production of surfactant. In each case a sharp line of demarcation could be defined between normal and abnormal collapsed pulmonary parenchyma. Three cases of unchecked tumor growth caused a peripheral form of collapse (replacement atelectasis). This form of collapse was characterized by an absence of endobronchial obstruction and extensive tumor not delineated by the normal boundaries of the pulmonary lobes
— id: 106958, year: 1983, vol: 7, page: 758, stat: Journal Article,

The impact of CT in clinical management of pelvic and acetabular fractures
Rafii M; Firooznia H; Golimbu C; Waugh T Jr; Naidich D
1983 Sep;(178):228-235, Clinical orthopaedics & related research
Thirty-eight consecutive patients admitted to the hospital with pelvic and acetabular fractures underwent CT examination. The axial plane of CT is shown to be the most suitable for evaluation of these fractures. The fracture pattern is readily demonstrated, facilitating fracture classification. The degree of fracture fragment displacement and rotation, hip joint stability, and intra-articular osseous fragments can be determined. A number of unsuspected fractures were detected, including five sacral and four anterior acetabular wall fractures; the latter were due to extension of superior ramus fractures. Soft tissue injuries included several hematomas, serosanguinous cysts in one patient, and bladder laceration in one patient. It is concluded that in patients with pelvic fracture CT examination is the method of choice following preliminary radiographic evaluation, if further radiographic investigation is deemed necessary
— id: 47525, year: 1983, vol: , page: 228, stat: Journal Article,

Ruptured hydatid cyst with biliary obstruction: diagnosis by sonography and computed tomography
Subramanyam BR; Balthazar EJ; Naidich DP
1983 ;8(4):341-343, Gastrointestinal radiology
Communication between a hydatid cyst of the liver and the right hepatic duct resulted in biliary obstruction by the released cyst contents. Ultrasonography and computed tomography were utilized for preoperative diagnosis
— id: 43908, year: 1983, vol: 8, page: 341, stat: Journal Article,

Ultrasound analysis of solid-appearing abscesses
Subramanyam BR; Balthazar EJ; Raghavendra BN; Horii SC; Hilton S; Naidich DP
1983 Feb;146(2):487-491, Radiology
A retrospective review of 96 abdominal abscesses yielded 11 cases (9%) that were diffusely echogenic on sonograms and that stimulated findings of solid lesions. Sonographic features of these abscesses were analyzed and compared with features of 78 cases of hepatic metastasis. An abscess was considered solid appearing when it contained diffuse internal echoes that were distributed over 90% of the abscess cavity. The visualized internal echoes were of low to medium amplitude, and were generally similar to the normal echogenicity of the parenchymal organs, such as the liver, spleen, or uterus. Distal acoustic enhancement was seen in 91% of the solid abscesses, and it was not seen in hepatic metastases. A distinct echogenic wall was present in 64% of the abscesses (subacute and chronic lesions), but this occurred in less than 4% of metastases. Thin peripheral halos inside or outside of and adjacent to the abscess wall were seen in 36% of abscesses. The peripheral halos seen in metastases were wider and not associated with an echogenic wall. The diagnosis of a diffusely echogenic abscess and differentiation from a neoplasm is possible when the sonographic findings of acoustic enhancement, thin peripheral halo, and echogenic abscess wall are present
— id: 43907, year: 1983, vol: 146, page: 487, stat: Journal Article,

COMPUTED-TOMOGRAPHY OF SPINAL TUBERCULOSIS
Whelan, MA; Naidich, DP; Post, JD; Chase, NE
1983 ;7(1):25-30, Journal of computer assisted tomography
— id: 30682, year: 1983, vol: 7, page: 25, 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,

Radiographic patterns of opportunistic lung infections and Kaposi sarcoma in homosexual men
McCauley, D I; Naidich, D P; Leitman, B S; Reede, D L; Laubenstein, L
1982 Oct;139(4):653-658, American journal of roentgenology
Thirty patients with lung involvement with Pneumocystis carinii and other opportunistic organisms, many of whom also had Kaposi sarcoma, were seen from December 1980 through March 1982. Clinical manifestations consisted of a prodrome of weeks to months with weight loss, fever, and malaise. When clinical pneumonia became apparent, four distinct radiographic patterns were identified. Pneumocystis carinii was uniformly present, and the most common pattern encountered was a relatively symmetric, homogeneous perihilar pneumonia that progressed to diffuse consolidation. Asymmetric and focal infiltrates were seen in patients who proved to have concomitant opportunistic infection, most commonly fungal in all but two cases. A third pattern of nodular and linear densities with or without adenopathy was seen in patients without pneumonia who had biopsy-positive Kaposi sarcoma involving the lung parenchyma. A fourth pattern represented a combination of any of the first three, and these patients had multiple infections as well as Kaposi sarcoma in the lung. Any significant change in the radiograph indicating progression of disease while on therapy prompted a rebiopsy, and in five of 10 patients other infections and/or Kaposi sarcoma were identified
— id: 112542, year: 1982, vol: 139, page: 653, stat: Journal Article,

COMPUTED-TOMOGRAPHY OF BRONCHIECTASIS
Naidich, DP; Mccauley, DI; Khouri, NF; Stitik, FP; Siegelman, SS
1982 ;6(3):437-444, Journal of computer assisted tomography
— id: 30321, year: 1982, vol: 6, page: 437, stat: Journal Article,

COMPUTED-TOMOGRAPHY OF BRONCHIAL ADENOMAS
Naidich, DP; Mccauley, DI; Siegelman, SS
1982 ;6(4):725-732, Journal of computer assisted tomography
— id: 30314, year: 1982, vol: 6, page: 725, stat: Journal Article,

INTRA-THORACIC NEUROFIBROMA OF THE VAGUS NERVE ASSOCIATED WITH BRONCHIAL OBSTRUCTION
ROSS, CR; MCCAULEY, DI; NAIDICH, DP
1982 ;6(2):406-412, Journal of computer assisted tomography
— id: 40438, year: 1982, vol: 6, page: 406, stat: Journal Article,

COMPUTED-TOMOGRAPHY OF THE PULMONARY HILA .1. NORMAL ANATOMY
Naidich, DP; Khouri, NF; Scott, WW; Wang, KP; Siegelman, SS
1981 ;5(4):459-467, Journal of computer assisted tomography
— id: 30202, year: 1981, vol: 5, page: 459, stat: Journal Article,

COMPUTED-TOMOGRAPHY OF THE PULMONARY HILA .2. ABNORMAL ANATOMY
Naidich, DP; Khouri, NF; Stitik, FP; Mccauley, DI; Siegelman, SS
1981 ;5(4):468-475, Journal of computer assisted tomography
— id: 30203, year: 1981, vol: 5, page: 468, stat: Journal Article,