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Patel, Bhavik Natvar

Positions:

Assistant Professor of Radiology

Radiology, Abdominal Imaging
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2007

M.D. — University of Alabama School of Medicine

Grants:

External Evaluation of Revoultion 1.5 CT System

Administered By
Radiology, Abdominal Imaging
AwardedBy
GE Healthcare
Role
Principal Investigator
Start Date
September 01, 2015
End Date
September 01, 2016

Image Rich Radiology Reports: A Value-Based Model to Improve Clinical Workflow

Administered By
Radiology, Abdominal Imaging
AwardedBy
Radiological Society of North America
Role
Principal Investigator
Start Date
July 01, 2015
End Date
June 30, 2016

Publications:

Use of a Noise Optimized Monoenergetic Algorithm for Patient-Size Independent Selection of an Optimal Energy Level During Dual-Energy CT of the Pancreas.

To investigate the impact of a second-generation noise-optimized monoenergetic algorithm on selection of the optimal energy level, image quality, and effect of patient body habitus for dual-energy multidetector computed tomography of the pancreas.Fifty-nine patients (38 men, 21 women) underwent dual-energy multidetector computed tomography (80/Sn140 kV) in the pancreatic parenchymal phase. Image data sets, at energy levels ranging from 40 to 80 keV (in 5-keV increments), were reconstructed using first-generation and second-generation noise-optimized monoenergetic algorithm. Noise, pancreatic contrast-to-noise ratio (CNRpancreas), and CNR with a noise constraint (CNRNC) were calculated and compared among the different reconstructed data sets. Qualitative assessment of image quality was performed by 3 readers.For all energy levels below 70 keV, noise was significantly lower (P ≤ 0.05) and CNRpancreas significantly higher (P < 0.001), with the second-generation monoenergetic algorithm. Furthermore, the second-generation algorithm was less susceptible to variability related to patient body habitus in the selection of the optimal energy level. The maximal CNRpancreas occurred at 40 keV in 98% (58 of 59) of patients with the second-generation monoenergetic algorithm. However, the CNRNC and readers' image quality scores showed that, even with a second-generation monoenergetic algorithm, higher reconstructed energy levels (60-65 keV) represented the optimal energy level.Second-generation noise-optimized monoenergetic algorithm can improve the image quality of lower-energy monoenergetic images of the pancreas, while decreasing the variability related to patient body habitus in selection of the optimal energy level.

Authors
Bellini, D; Gupta, S; Ramirez-Giraldo, JC; Fu, W; Stinnett, SS; Patel, B; Mileto, A; Marin, D
MLA Citation
Bellini, D, Gupta, S, Ramirez-Giraldo, JC, Fu, W, Stinnett, SS, Patel, B, Mileto, A, and Marin, D. "Use of a Noise Optimized Monoenergetic Algorithm for Patient-Size Independent Selection of an Optimal Energy Level During Dual-Energy CT of the Pancreas." Journal of computer assisted tomography 41.1 (January 2017): 39-47.
PMID
27560021
Source
epmc
Published In
Journal of Computer Assisted Tomography
Volume
41
Issue
1
Publish Date
2017
Start Page
39
End Page
47
DOI
10.1097/rct.0000000000000492

Image-Rich Radiology Reports: A Value-Based Model to Improve Clinical Workflow.

To determine the value of image-rich radiology reports (IRRR) by evaluating the interest and preferences of referring physicians, potential impact on clinical workflow, and the willingness of radiologists to create them.Referring physicians and radiologists were interviewed in this prospective, HIPAA-compliant study. Subject willingness to participate in the study was determined by an e-mail. A single investigator conducted all interviews using a standard questionnaire. All subjects reviewed a video mockup demonstration of IRRR and three methods for viewing embedded images, as follows: (1) clickable hyperlinks to access a scrollable stack of images, (2) scrollable and enlargeable small-image thumbnails, and (3) scrollable but not enlargeable medium-sized images. Questionnaire responses, free comments, and general impressions were captured and analyzed.Seventy-two physicians (36 clinicians, 36 radiologists) were interviewed. Thirty-one clinicians (86%) expressed interest in using IRRR. Seventy-seven percent of subjects believed IRRR would improve communication. Ten clinicians (28%) preferred method 1, 18 (50%) preferred method 2, and 8 (22%) preferred method 3 for embedding images. Thirty clinicians (83%) stated that IRRR would improve efficiency. Twenty-two radiologists (61%) preferred selecting a tool button with a mouse and right-clicking images to embed them, 13 (36%) preferred pressing a function key, and 11 (31%) preferred dictating series and image numbers. The average time radiologists were willing to expend for embedding images was 66.7 seconds.Referring physicians and radiologist both believe IRRR would add value by improving communication with the potential to improve the workflow efficiency of referring physicians.

Authors
Patel, BN; Lopez, JM; Jiang, BG; Roth, CJ; Nelson, RC
MLA Citation
Patel, BN, Lopez, JM, Jiang, BG, Roth, CJ, and Nelson, RC. "Image-Rich Radiology Reports: A Value-Based Model to Improve Clinical Workflow." Journal of the American College of Radiology : JACR 14.1 (January 2017): 57-64.
PMID
27692807
Source
epmc
Published In
Journal of the American College of Radiology
Volume
14
Issue
1
Publish Date
2017
Start Page
57
End Page
64
DOI
10.1016/j.jacr.2016.07.018

Preoperative multidetector CT diagnosis of extrapancreatic perineural or duodenal invasion is associated with reduced postoperative survival after pancreaticoduodenectomy for pancreatic adenocarcinoma: Preliminary experience and implications for patient care

© RSNA, 2016.Purpose: To test the hypothesis that patients with pancreatic adenocarcinoma who otherwise are viewed to have resectable disease but have preoperative findings of extrapancreatic perineural invasion (EPNI) and/or duodenal invasion at multidetector computed tomography (CT) have reduced postoperative survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (PDAC). Materials and Methods: This study was approved by the institutional review board and complied with HIPAA. The authors retrospectively evaluated 76 consecutive patients with PDAC who underwent preoperative multidetector CT and subsequent pancreaticoduodenectomy. Two radiologists blinded to surgical pathology results and clinical outcome evaluated multidetector CT images for evidence of EPNI and duodenal invasion; discrepancies were resolved by consensus. Also determined for each patient were resected lymph node status, tumor size, surgical margin status, time to progression, and time to death. Data were assessed with the Goodman-Kruskal gamma for correlations among indicators and the log-rank test, Kaplan-Meier estimates, and multivariate Cox proportional hazards regression for survival analysis. Results: In univariate analysis, duodenal invasion and/or EPNI on preoperativemultidetector CT images was associated with significantly decreased progression-free survival (P <0001) and overall survival (P = .0013), and the clinical indicators (lymph node status, tumor size, and surgical margin status) as well as duodenal invasion and/or EPNI showed correlation with each other. In multivariate regression that included multidetector CT findings as well as the three traditional clinical indicators, only duodenal invasion and/or EPNI showed significant independent association with reduction in both modes of survival (P <0001 and P = .014, respectively). Interobserver agreement was substantial with respect to EPNI and duodenal invasion (k = 0.691 and 0.682, respectively). Conclusion: Patients with evidence of EPNI and/or duodenal invasion on preoperative multidetector CT images have significantly reduced survival after pancreaticoduodenectomy for PDAC.

Authors
Chang, ST; Jeffrey, RB; Patel, BN; DiMaio, MA; Rosenberg, J; Willmann, JK; Olcott, EW
MLA Citation
Chang, ST, Jeffrey, RB, Patel, BN, DiMaio, MA, Rosenberg, J, Willmann, JK, and Olcott, EW. "Preoperative multidetector CT diagnosis of extrapancreatic perineural or duodenal invasion is associated with reduced postoperative survival after pancreaticoduodenectomy for pancreatic adenocarcinoma: Preliminary experience and implications for patient care." Radiology 281.3 (December 1, 2016): 816-825.
Source
scopus
Published In
Radiology
Volume
281
Issue
3
Publish Date
2016
Start Page
816
End Page
825
DOI
10.1148/radiol.2016152790

Dual-energy CT workflow: multi-institutional consensus on standardization of abdominopelvic MDCT protocols.

To standardize workflow for dual-energy computed tomography (DECT) involving common abdominopelvic exam protocols.9 institutions (4 rsDECT, 1 dsDECT, 4 both) with 32 participants [average # years (range) in practice and DECT experience, 12.3 (1-35) and 4.6 (1-14), respectively] filled out a single survey (n = 9). A five-point agreement scale (0, 1, 2, 3, 4-contra-, not, mildly, moderately, strongly indicated, respectively) and utilization scale (0-not performing and shouldn't; 1-performing but not clinically useful; 2-performing but not sure if clinically useful; 3-not performing it but would like to; 4-performing and clinically useful) were used. Consensus was considered with a score of ≥2.5. Survey results were discussed over three separate live webinar sessions.5/9 (56%) institutions exclude large patients from DECT. 2 (40%) use weight, 2 (40%) use transverse dimension, and 1 (20%) uses both. 7/9 (78%) use 50 keV for low and 70 keV for medium monochromatic reconstructed images. DECT is indicated for dual liver [agreement score (AS) 3.78; utilization score (US) 3.22] and dual pancreas in the arterial phase (AS 3.78; US 3.11), mesenteric ischemia/gastrointestinal bleeding in both the arterial and venous phases (AS 2.89; US 2.79), RCC exams in the arterial phase (AS 3.33; US 2.78), and CT urography in the nephrographic phase (AS 3.11; US 2.89). DECT for renal stone and certain single-phase exams is indicated (AS 3.00).DECT is indicated during the arterial phase for multiphasic abdominal exams, nephrographic phase for CTU, and for certain single-phase and renal stone exams.

Authors
Patel, BN; Alexander, L; Allen, B; Berland, L; Borhani, A; Mileto, A; Moreno, C; Morgan, D; Sahani, D; Shuman, W; Tamm, E; Tublin, M; Yeh, B; Marin, D
MLA Citation
Patel, BN, Alexander, L, Allen, B, Berland, L, Borhani, A, Mileto, A, Moreno, C, Morgan, D, Sahani, D, Shuman, W, Tamm, E, Tublin, M, Yeh, B, and Marin, D. "Dual-energy CT workflow: multi-institutional consensus on standardization of abdominopelvic MDCT protocols." Abdominal radiology (New York) (November 25, 2016).
PMID
27888303
Source
epmc
Published In
Abdominal radiology (New York)
Publish Date
2016

Introduction to Business Strategy

Authors
Patel, BN; Cespedes, FV
MLA Citation
Patel, BN, and Cespedes, FV. "Introduction to Business Strategy." Journal of the American College of Radiology 13.6 (June 2016): 747-749.
Source
crossref
Published In
Journal of the American College of Radiology
Volume
13
Issue
6
Publish Date
2016
Start Page
747
End Page
749
DOI
10.1016/j.jacr.2015.11.019

Effect of a Noise-Optimized Second-Generation Monoenergetic Algorithm on Image Noise and Conspicuity of Hypervascular Liver Tumors: An In Vitro and In Vivo Study.

The purpose of this study is to investigate whether the reduction in noise using a second-generation monoenergetic algorithm can improve the conspicuity of hypervascular liver tumors on dual-energy CT (DECT) images of the liver.An anthropomorphic liver phantom in three body sizes and iodine-containing inserts simulating hypervascular lesions was imaged with DECT and single-energy CT at various energy levels (80-140 kV). In addition, a retrospective clinical study was performed in 31 patients with 66 hypervascular liver tumors who underwent DECT during the late hepatic arterial phase. Datasets at energy levels ranging from 40 to 80 keV were reconstructed using first- and second-generation monoenergetic algorithms. Noise, tumor-to-liver contrast-to-noise ratio (CNR), and CNR with a noise constraint (CNRNC) set with a maximum noise increase of 50% were calculated and compared among the different reconstructed datasets.The maximum CNR for the second-generation monoenergetic algorithm, which was attained at 40 keV in both phantom and clinical datasets, was statistically significantly higher than the maximum CNR for the first-generation monoenergetic algorithm (p < 0.001) or single-energy CT acquisitions across a wide range of kilovoltage values. With the second-generation monoenergetic algorithm, the optimal CNRNC occurred at 55 keV, corresponding to lower energy levels compared with first-generation algorithm (predominantly at 70 keV). Patient body size did not substantially affect the selection of the optimal energy level to attain maximal CNR and CNRNC using the second-generation monoenergetic algorithm.A noise-optimized second-generation monoenergetic algorithm significantly improves the conspicuity of hypervascular liver tumors.

Authors
Marin, D; Ramirez-Giraldo, JC; Gupta, S; Fu, W; Stinnett, SS; Mileto, A; Bellini, D; Patel, B; Samei, E; Nelson, RC
MLA Citation
Marin, D, Ramirez-Giraldo, JC, Gupta, S, Fu, W, Stinnett, SS, Mileto, A, Bellini, D, Patel, B, Samei, E, and Nelson, RC. "Effect of a Noise-Optimized Second-Generation Monoenergetic Algorithm on Image Noise and Conspicuity of Hypervascular Liver Tumors: An In Vitro and In Vivo Study." AJR. American journal of roentgenology 206.6 (June 2016): 1222-1232.
PMID
27058192
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
206
Issue
6
Publish Date
2016
Start Page
1222
End Page
1232
DOI
10.2214/ajr.15.15512

Deal or No Deal? Negotiation 101.

Authors
Patel, BN; Rubin, GD
MLA Citation
Patel, BN, and Rubin, GD. "Deal or No Deal? Negotiation 101." Journal of the American College of Radiology : JACR 13.6 (June 2016): 756-758.
PMID
27262058
Source
epmc
Published In
Journal of the American College of Radiology
Volume
13
Issue
6
Publish Date
2016
Start Page
756
End Page
758
DOI
10.1016/j.jacr.2016.03.029

MDCT Diagnosis of Perineural Invasion Involving the Celiac Plexus in Intrahepatic Cholangiocarcinoma: Preliminary Observations and Clinical Implications.

The purpose of this study was to test the hypothesis that soft-tissue infiltration along the celiac plexus and delayed enhancement exceeding two-thirds of the tumor area on preoperative MDCT correlate with histologic evidence of perineural invasion in resected intrahepatic cholangiocarcinomas.Two experienced abdominal radiologists retrospectively reviewed preoperative multiphasic MDCT scans of 20 patients who underwent resection of intrahepatic cholangiocarcinoma, identifying soft-tissue infiltration along the celiac plexus, delayed enhancement exceeding two-thirds of the tumor area, and maximum tumor diameter. Consensus findings were compared with intratumoral perineural invasion in resected intrahepatic cholangiocarcinomas using the Fisher exact test.Six patients had histologic intratumoral perineural invasion, five of whom had soft-tissue infiltration along the celiac plexus on preoperative MDCT, with corresponding 83.3% sensitivity and 92.9% specificity for perineural invasion and significant association between these MDCT and histologic findings (p = 0.002). No patients with histologic perineural invasion had enhancement exceeding two-thirds of the tumor area on MDCT; sensitivity was 0.0% for this finding. Tumor diameter on MDCT was not significantly associated with perineural invasion at histopathology (p = 0.530).Soft-tissue infiltration along the celiac plexus on MDCT is an indicator of perineural invasion in patients with intrahepatic cholangiocarcinoma. The data did not confirm an association between delayed enhancement exceeding two-thirds of the tumor area and perineural invasion. Because perineural invasion from intrahepatic cholangiocarcinoma is associated with a very poor prognosis and is generally a contraindication to surgery, the MDCT diagnosis of celiac plexus perineural invasion in patients with intrahepatic cholangiocarcinoma may have important implications for prognosis and treatment planning.

Authors
Raghavan, K; Jeffrey, RB; Patel, BN; DiMaio, MA; Willmann, JK; Olcott, EW
MLA Citation
Raghavan, K, Jeffrey, RB, Patel, BN, DiMaio, MA, Willmann, JK, and Olcott, EW. "MDCT Diagnosis of Perineural Invasion Involving the Celiac Plexus in Intrahepatic Cholangiocarcinoma: Preliminary Observations and Clinical Implications." AJR. American journal of roentgenology 205.6 (December 2015): W578-W584.
PMID
26587947
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
205
Issue
6
Publish Date
2015
Start Page
W578
End Page
W584
DOI
10.2214/ajr.15.14607

Sonographic Detection of Extracapsular Extension in Papillary Thyroid Cancer.

To identify and evaluate sonographic features suggestive of extracapsular extension in papillary thyroid cancer.Three board-certified radiologists blinded to the final pathologic tumor stage reviewed sonograms of pathologically proven cases of papillary thyroid cancer for the presence of extracapsular extension. The radiologists evaluated the following features: capsular abutment, bulging of the normal thyroid contour, loss of the echogenic capsule, and vascularity extending beyond the capsule.A total of 129 cases of pathologically proven thyroid cancer were identified. Of these, 51 were excluded because of lack of preoperative sonography, and 16 were excluded because of pathologic findings showing anaplastic carcinoma, follicular carcinoma, or microcarcinoma (<10 mm). The final analysis group consisted of 62 patients with papillary thyroid carcinoma, 16 of whom had pathologically proven extracapsular extension. The presence of capsular abutment had 100% sensitivity for detection of extracapsular extension. Conversely, lack of capsular abutment had a 100% negative predictive value (NPV) for excluding extracapsular extension. Contour bulging had 88% sensitivity for detection of extracapsular extension and when absent had an 87% NPV. Loss of the echogenic capsule was the best predictor of the presence of extracapsular extension, with an odds ratio of 10.23 (P = .034). This sonographic finding had 75% sensitivity, 65% specificity, and an 88% NPV. Vascularity beyond the capsule had 89% specificity but sensitivity of only 25%.Sonographic features of capsular abutment, contour bulging, and loss of the echogenic thyroid capsule have excellent predictive value for excluding or detecting extracapsular extension and may help in biopsy selection, surgical planning, and treatment of patients with papillary thyroid cancer.

Authors
Kamaya, A; Tahvildari, AM; Patel, BN; Willmann, JK; Jeffrey, RB; Desser, TS
MLA Citation
Kamaya, A, Tahvildari, AM, Patel, BN, Willmann, JK, Jeffrey, RB, and Desser, TS. "Sonographic Detection of Extracapsular Extension in Papillary Thyroid Cancer." Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine 34.12 (December 2015): 2225-2230.
PMID
26518279
Source
epmc
Published In
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
Volume
34
Issue
12
Publish Date
2015
Start Page
2225
End Page
2230
DOI
10.7863/ultra.15.02006

How the radiologist can add value in the evaluation of the pre- and post-surgical pancreas.

Disease involving the pancreas can be a significant diagnostic challenge to the interpreting radiologist. Moreover, the majority of disease processes involving the pancreas carry high significant morbidity and mortality either due to their natural process or related to their treatment options. As such, it is critical for radiologists to not only provide accurate information from imaging to guide patient management, but also deliver that information in a clear manner so as to aid the referring physician. This is no better exemplified than in the case of pre-operative staging for pancreatic adenocarcinoma. Furthermore, with the changing healthcare landscape, it is now more important than ever to ensure that the value of radiology service to other providers is high. In this review, we will discuss how the radiologist can add value to the referring physician by employing novel imaging techniques in the pre-operative evaluation as well as how the information can be conveyed in the most meaningful manner through the use of structured reporting. We will also familiarize the radiologist with the imaging appearance of common complications that occur after pancreatic surgery.

Authors
Patel, BN; Gupta, RT; Zani, S; Jeffrey, RB; Paulson, EK; Nelson, RC
MLA Citation
Patel, BN, Gupta, RT, Zani, S, Jeffrey, RB, Paulson, EK, and Nelson, RC. "How the radiologist can add value in the evaluation of the pre- and post-surgical pancreas." Abdominal imaging 40.8 (October 19, 2015): 2932-2944. (Review)
PMID
26482048
Source
epmc
Published In
Abdominal Imaging
Volume
40
Issue
8
Publish Date
2015
Start Page
2932
End Page
2944

The role of CT-guided percutaneous drainage of loculated air collections: an institutional experience.

The purpose of this study is to describe our experience with the role of CT-guided percutaneous drainage of loculated intra-abdominal collections consisting entirely of gas.An IRB-approved retrospective study analyzing patients with air-only intra-abdominal collections over an 8-year period was undertaken. Seven patients referred for percutaneous drainage were included. Size of collections, subsequent development of fluid, and microbiological yield were determined. Clinical outcome was also analyzed.Out of 2835 patients referred for percutaneous drainage between 2004 and 2012, seven patients (5M, 2F; average age 63, range 54-85) met criteria for inclusion with CT showing air-only collections. Percutaneous drain placement (five 8 Fr, one 10 Fr, and one 12 Fr) using Seldinger technique was performed. Four patients (57%) had recently undergone surgery (2 Whipple, 1 colectomy, 1 hepatic resection) while two (29%) had a remote surgery (1 abdominoperineal resection, 1 sigmoidectomy). Despite the lack of detectable fluid on the original CT, 6 patients (86%) had air and fluid aspirated at drainage, 5 (83%) of the aspirates developed positive microbacterial cultures. Four patients (57%) presented with fever at the time of the initial scan, all of whom had positive cultures from aspirated fluid. Four patients (57%) had leukocytosis, all of whom had positive cultures from aspirated fluid.Although relatively rare in occurrence, patients with air-only intra-abdominal collections with signs of infection should be considered for percutaneous management similar to that of conventional infected fluid collections. Although fluid is not visible on CT, these collections can produce fluid that contains organisms.

Authors
Patel, BN; Morgan, M; Tyler, D; Paulson, E; Jaffe, TA
MLA Citation
Patel, BN, Morgan, M, Tyler, D, Paulson, E, and Jaffe, TA. "The role of CT-guided percutaneous drainage of loculated air collections: an institutional experience." Abdominal imaging 40.8 (October 2015): 3257-3264.
PMID
26329977
Source
epmc
Published In
Abdominal Imaging
Volume
40
Issue
8
Publish Date
2015
Start Page
3257
End Page
3264
DOI
10.1007/s00261-015-0537-2

Dual-Energy Multidetector-Row Computed Tomography of the Hepatic Arterial System: Optimization of Energy and Material-Specific Reconstruction Techniques.

To investigate the optimal dual-energy reconstruction technique for the visualization of the hepatic arterial system during dual-energy multidetector computed tomographic (MDCT) angiography of the liver.Twenty-nine nonconsecutive patients underwent dual-energy MDCT angiography of the liver. Synthesized monochromatic (40, 50, 60, and 80 keV) and iodine density data sets were reconstructed. Aortic attenuation, noise, and contrast-to-noise ratio (CNR) were measured. In addition, volume-rendered images were generated and qualitatively assessed by 2 independent readers, blinded to technique. The impact of body size on the readers' scores was also assessed.Aortic attenuation, noise, and CNR increased progressively with decreasing keV and were significantly higher between 40 and 60 keV (P < 0.001). There was a significant improvement of readers' visualization of arterial anatomy at lower monochromatic energies (P < 0.001). Iodine density images yielded significantly higher CNR compared with all monochromatic data sets (P < 0.001). However, iodine density images were scored nondiagnostic by the 2 readers.Synthesized monochromatic images between 40 and 60 keV maximize the magnitude of arterial enhancement and improve visualization of hepatic arterial anatomy at dual-energy MDCT angiography of the liver. Larger body sizes may counteract the benefits of using lower monochromatic energies.

Authors
Marin, D; Caywood, DT; Mileto, A; Reiner, CS; Seaman, DM; Patel, BN; Boll, DT; Nelson, RC
MLA Citation
Marin, D, Caywood, DT, Mileto, A, Reiner, CS, Seaman, DM, Patel, BN, Boll, DT, and Nelson, RC. "Dual-Energy Multidetector-Row Computed Tomography of the Hepatic Arterial System: Optimization of Energy and Material-Specific Reconstruction Techniques." Journal of computer assisted tomography 39.5 (September 2015): 721-729.
PMID
25938210
Source
epmc
Published In
Journal of Computer Assisted Tomography
Volume
39
Issue
5
Publish Date
2015
Start Page
721
End Page
729
DOI
10.1097/rct.0000000000000259

Organizational behavior: a primer.

Authors
Patel, BN
MLA Citation
Patel, BN. "Organizational behavior: a primer." Journal of the American College of Radiology : JACR 12.8 (August 2015): 805-807.
PMID
26044644
Source
epmc
Published In
Journal of the American College of Radiology
Volume
12
Issue
8
Publish Date
2015
Start Page
805
End Page
807
DOI
10.1016/j.jacr.2015.03.009

Imaging of iatrogenic complications of the urinary tract: kidneys, ureters, and bladder.

Iatrogenic complications of various severities may arise from many, if not all, forms of medical and surgical treatment. Most of these occur in spite of proper precautions. Every system in the human body may be affected, and the urinary tract is no exception. Radiologists are often the first to suspect and identify such iatrogenic injuries and, therefore, awareness of the pertinent imaging findings is vital. This review explores and illustrates many of the common and less common iatrogenic complications affecting the kidney, ureters, and bladder.

Authors
Patel, BN; Gayer, G
MLA Citation
Patel, BN, and Gayer, G. "Imaging of iatrogenic complications of the urinary tract: kidneys, ureters, and bladder." Radiologic clinics of North America 52.5 (September 2014): 1101-1116. (Review)
PMID
25173661
Source
epmc
Published In
Radiologic Clinics of North America
Volume
52
Issue
5
Publish Date
2014
Start Page
1101
End Page
1116
DOI
10.1016/j.rcl.2014.05.013

Sonography of the normal appendix: its varied appearance and techniques to improve its visualization.

The sonographic identification of the normal appendix is crucial to the success of ultrasound as an effective screening method for diagnosing acute appendicitis. The normal appendix can be challenging to identify on sonography, however, because it is a narrow tubular structure and has variable sonographic appearances. Moreover, the tip of the appendix can be quite variable in location. In this article, we review the various sonographic appearances of the normal appendix and highlight strategies to improve its visualization.

Authors
Ung, C; Chang, ST; Jeffrey, RB; Patel, BN; Olcott, EW
MLA Citation
Ung, C, Chang, ST, Jeffrey, RB, Patel, BN, and Olcott, EW. "Sonography of the normal appendix: its varied appearance and techniques to improve its visualization." Ultrasound quarterly 29.4 (December 2013): 333-341. (Review)
PMID
24263759
Source
epmc
Published In
Ultrasound Quarterly
Volume
29
Issue
4
Publish Date
2013
Start Page
333
End Page
341
DOI
10.1097/ruq.0b013e3182a2aa8e

Material density hepatic steatosis quantification on intravenous contrast-enhanced rapid kilovolt (peak)-switching single-source dual-energy computed tomography

PURPOSE: The purpose of this study was to evaluate intravenous (IV) contrast-enhanced single-source rapid kilovolt (peak)-switching dual-energy (RSDE) multidetector computed tomography (CT) material density assessment of hepatic steatosis compared to conventional unenhanced (CU) Multidetector computed tomography (MDCT). MATERIALS AND METHODS: This is an institutional review board-approved intrapatient study of 363 consecutive adults (189 men, 174 women; mean age, 59 years) evaluated with multiphasic IV abdominal RSDE. Material density virtual unenhanced water and fat hepatic parenchymal values were measured and correlated to Hounsfield units (HUs) on CU CT using linear regression. Study population was dichotomized into steatotic or nonsteatotic liver parenchyma on the basis of CU liver-spleen (L-S) difference. The RSDE fat(-iodine) values (in milligram per milliliter) were compared (t test), correlated to the L-S difference in HU, and a milligram-per-milliliter fat threshold for clinically significant steatosis was calculated using receiver operator curve (ROC) analysis. RESULTS: Regression analysis revealed r value of 0.86 for mg/mL water (P < 0.001) and 0.87 for milligram-per-milliliter fat (P < 0.001). Twenty-seven participants were excluded from the L-S analysis (splenectomy). A total of 107 (32%) had steatosis (mean L-S, - 6.3; mean fat(-iodine) milligram per milliliter, 1018.4); 229 (68%) had no steatosis (mean L-S, 9.4; milligram per milliliter, 1028.4 [P < 0.001]). The RSDE fat material density measurement correlated to L-S less than 1 with r value of 0.74 (P < 0.001), with an area under receiver operator curve of 0.847. A threshold of 1023-mg/mL fat had 71% sensitivity and 80% specificity, and a threshold of 1027-mg/mL fat had 90% sensitivity and 61% specificity for steatosis. CONCLUSIONS: The RSDE milligram-per-milliliter fat values correlate well with hepatic steatosis defined by the L-S difference less than 1 on conventional MDCT. A threshold of 1027 mg/mL can identify 90% of steatotic livers when post-IV contrast RSDE is used, without obtaining additional CU scans. However, regression equations were not helpful to convert an individual participant's milligram-per-milliliter fat or milligram-per-milliliter water-derived from RSDE material density images to CU MDCT HU for the estimation of liver fat content. Copyright © 2013 by Lippincott Williams & Wilkins.

Authors
Patel, BN; Kumbla, RA; Berland, LL; Fineberg, NS; Morgan, DE
MLA Citation
Patel, BN, Kumbla, RA, Berland, LL, Fineberg, NS, and Morgan, DE. "Material density hepatic steatosis quantification on intravenous contrast-enhanced rapid kilovolt (peak)-switching single-source dual-energy computed tomography." Journal of Computer Assisted Tomography 37.6 (November 1, 2013): 904-910.
PMID
24270112
Source
scopus
Published In
Journal of Computer Assisted Tomography
Volume
37
Issue
6
Publish Date
2013
Start Page
904
End Page
910
DOI
10.1097/RCT.0000000000000027

Three-dimensional volume-rendered multidetector CT imaging of the posterior inferior pancreaticoduodenal artery: its anatomy and role in diagnosing extrapancreatic perineural invasion.

Extrapancreatic perineural spread in pancreatic adenocarcinoma contributes to poor outcomes, as it is known to be a major contributor to positive surgical margins and disease recurrence. However, current staging classifications have not yet taken extrapancreatic perineural spread into account. Four pathways of extrapancreatic perineural spread have been described that conveniently follow small defined arterial pathways. Small field of view three-dimensional (3D) volume-rendered multidetector computed tomography (MDCT) images allow visualization of small peripancreatic vessels and thus perineural invasion that may be associated with them. One such vessel, the posterior inferior pancreaticoduodenal artery (PIPDA), serves as a surrogate for extrapancreatic perineural spread by pancreatic adenocarcinoma arising in the uncinate process. This pictorial review presents the normal and variant anatomy of the PIPDA with 3D volume-rendered MDCT imaging, and emphasizes its role as a vascular landmark for the diagnosis of extrapancreatic perineural invasion from uncinate adenocarcinomas. Familiarity with the anatomy of PIPDA will allow accurate detection of extrapancreatic perineural spread by pancreatic adenocarcinoma involving the uncinate process, and may potentially have important staging implications as neoadjuvant therapy improves.

Authors
Patel, BN; Giacomini, C; Jeffrey, RB; Willmann, JK; Olcott, E
MLA Citation
Patel, BN, Giacomini, C, Jeffrey, RB, Willmann, JK, and Olcott, E. "Three-dimensional volume-rendered multidetector CT imaging of the posterior inferior pancreaticoduodenal artery: its anatomy and role in diagnosing extrapancreatic perineural invasion." Cancer imaging : the official publication of the International Cancer Imaging Society 13.4 (January 2013): 580-590.
PMID
24434918
Source
epmc
Published In
Cancer imaging : the official publication of the International Cancer Imaging Society
Volume
13
Issue
4
Publish Date
2013
Start Page
580
End Page
590
DOI
10.1102/1470-7330.2013.0051

Single-source dual-energy spectral multidetector CT of pancreatic adenocarcinoma: Optimization of energy level viewing significantly increases lesion contrast

Aim: To evaluate lesion contrast in pancreatic adenocarcinoma patients using spectral multidetector computed tomography (MDCT) analysis. Materials and methods: The present institutional review board-approved, Health Insurance Portability and Accountability Act of 1996 (HIPAA)-compliant retrospective study evaluated 64 consecutive adults with pancreatic adenocarcinoma examined using a standardized, multiphasic protocol on a single-source, dual-energy MDCT system. Pancreatic phase images (35 s) were acquired in dual-energy mode; unenhanced and portal venous phases used standard MDCT. Lesion contrast was evaluated on an independent workstation using dual-energy analysis software, comparing tumour to non-tumoural pancreas attenuation (HU) differences and tumour diameter at three energy levels: 70 keV; individual subject-optimized viewing energy level (based on the maximum contrast-to-noise ratio, CNR); and 45 keV. The image noise was measured for the same three energies. Differences in lesion contrast, diameter, and noise between the different energy levels were analysed using analysis of variance (ANOVA). Quantitative differences in contrast gain between 70 keV and CNR-optimized viewing energies, and between CNR-optimized and 45 keV were compared using the paired t-test. Results: Thirty-four women and 30 men (mean age 68 years) had a mean tumour diameter of 3.6 cm. The median optimized energy level was 50 keV (range 40-77). The mean ± SD lesion contrast values (non-tumoural pancreas-tumour attenuation) were: 57 ± 29, 115 ± 70, and 146 ± 74 HU (p = 0.0005); the lengths of the tumours were: 3.6, 3.3, and 3.1 cm, respectively (p = 0.026); and the contrast to noise ratios were: 24 ± 7, 39 ± 12, and 59 ± 17 (p = 0.0005) for 70 keV, the optimized energy level, and 45 keV, respectively. For individuals, the mean ± SD contrast gain from 70 keV to the optimized energy level was 59 ± 45 HU; and the mean ± SD contrast gain from the optimized energy level to 45 keV was 31 ± 25 HU (p = 0.007). Conclusion: Significantly increased pancreatic lesion contrast was noted at lower viewing energies using spectral MDCT. Individual patient CNR-optimized energy level images have the potential to improve lesion conspicuity. © 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Authors
Patel, BN; Thomas, JV; Lockhart, ME; Berland, LL; Morgan, DE
MLA Citation
Patel, BN, Thomas, JV, Lockhart, ME, Berland, LL, and Morgan, DE. "Single-source dual-energy spectral multidetector CT of pancreatic adenocarcinoma: Optimization of energy level viewing significantly increases lesion contrast." Clinical Radiology 68.2 (2013): 148-154.
PMID
22889459
Source
scival
Published In
Clinical Radiology
Volume
68
Issue
2
Publish Date
2013
Start Page
148
End Page
154
DOI
10.1016/j.crad.2012.06.108

Pitfalls in Sonographic Evaluation of Thyroid Abnormalities

Ultrasound of the thyroid has become increasingly common, with evaluation of thyroid nodules representing the main indication for its use. While detection of thyroid nodules with modern high-resolution sonographic equipment is generally not a challenge, pitfalls may occur by which normal structures or pathology in neighboring organs are mistaken for thyroid nodules. Numerous reports in the literature describe various sonographic features of nodules in an attempt to stratify lesions into benign or malignant categories. While neither nodule size nor number is reliable, echogenicity, microcalcifcation, shape, and composition have been reported to be helpful in classifying thyroid nodules. No single feature should be used in isolation, and consensus guidelines have been established as to when fine-needle aspiration is indicated. Pitfalls remain in the evaluation of thyroid nodules demonstrating atypical features, such as cystic papillary carcinomas. Focal presentation of typically diffuse processes, such as Graves' disease and Hashimoto thyroiditis, may mimic malignant nodules, but carcinomas occur in these settings as well as in a background of normal thyroid parenchyma. Finally, because ultrasound is commonly used for surveillance of patients with thyroid carcinoma after thyroidectomy, sonographers should be familiar with the ultrasound appearance of disease recurrence and its mimics. © 2013 Elsevier Inc.

Authors
Patel, BN; Kamaya, A; Desser, TS
MLA Citation
Patel, BN, Kamaya, A, and Desser, TS. "Pitfalls in Sonographic Evaluation of Thyroid Abnormalities." Seminars in Ultrasound, CT and MRI 34.3 (2013): 226-235.
PMID
23768889
Source
scival
Published In
Seminars in Ultrasound, CT and MRI
Volume
34
Issue
3
Publish Date
2013
Start Page
226
End Page
235
DOI
10.1053/j.sult.2012.11.001

Radiation necrosis in the brain: Imaging features and differentiation from tumor recurrence

Radiation necrosis in the brain commonly occurs in three distinct clinical scenarios, namely, radiation therapy for head and neck malignancy or intracranial extraaxial tumor, stereotactic radiation therapy (including radiosurgery) for brain metastasis, and radiation therapy for primary brain tumors. Knowledge of the radiation treatment plan, amount of brain tissue included in the radiation port, type of radiation, location of the primary malignancy, and amount of time elapsed since radiation therapy is extremely important in determining whether the imaging abnormality represents radiation necrosis or recurrent tumor. Conventional magnetic resonance (MR) imaging findings of these two entities overlap considerably, and even at histopathologic analysis, tumor mixed with radiation necrosis is a common finding. Advanced imaging modalities such as diffusion tensor imaging and perfusion MR imaging (with calculation of certain specific parameters such as apparent diffusion coefficient ratios, relative peak height, and percentage of signal recovery), MR spectroscopy, and positron emission tomography can be useful in differentiating between recurrent tumor and radiation necrosis. In everyday practice, the visual assessment of diffusion-weighted and perfusion images may also be helpful by favoring one diagnosis over the other, with restricted diffusion and an elevated relative cerebral blood volume being seen much more frequently in recurrent tumor than in radiation necrosis. © RSNA, 2012.

Authors
Shah, R; Vattoth, S; Jacob, R; Manzil, FFP; O'Malley, JP; Borghei, P; Patel, BN; Curé, JK
MLA Citation
Shah, R, Vattoth, S, Jacob, R, Manzil, FFP, O'Malley, JP, Borghei, P, Patel, BN, and Curé, JK. "Radiation necrosis in the brain: Imaging features and differentiation from tumor recurrence." Radiographics 32.5 (2012): 1343-1359.
PMID
22977022
Source
scival
Published In
Radiographics : a review publication of the Radiological Society of North America, Inc
Volume
32
Issue
5
Publish Date
2012
Start Page
1343
End Page
1359
DOI
10.1148/rg.325125002

Carbon dioxide as an intravascular imaging agent: Review

Patients with renal impairment and/or contrast allergies pose a challenge with regard to diagnostic evaluations. CO 2 may serve as a suitable alternative intravascular contrast agent in these patients with arteriographic applications, including evaluation of peripheral vascular disease, and venographic applications, such as transjugular intrahepatic portosystemic shunt procedure, to name a few. Unique properties of CO 2, such as low viscosity, lack of an allergic reaction, and renal toxicity, have afforded it its diagnostic capabilities. However, certain properties of CO 2 also pose a technical challenge in terms of its delivery. Although it remains a relatively safe alternative contrast agent, potential adverse effects have been reported and exist. © 2011 Mosby, Inc.

Authors
Patel, BN; Kapoor, BS; Borghei, P; Shah, NA; Lockhart, ME
MLA Citation
Patel, BN, Kapoor, BS, Borghei, P, Shah, NA, and Lockhart, ME. "Carbon dioxide as an intravascular imaging agent: Review." Current Problems in Diagnostic Radiology 40.5 (2011): 208-217.
PMID
21787987
Source
scival
Published In
Current Problems in Diagnostic Radiology
Volume
40
Issue
5
Publish Date
2011
Start Page
208
End Page
217
DOI
10.1067/j.cpradiol.2011.01.002

Clinico-radiologic profile of spinal cord multiple sclerosis in adults

MRI is extremely useful for the assessment of initial disease burden and to identify the dissemination of the multiple sclerosis (MS) in time and space. Though MRI of the spinal cord is not used to establish the diagnosis of MS, spinal cord is frequently involved in this disease and there has been increasing emphasis of the spinal imaging in making clinical decision in the management of MS. We undertook a retrospective study of patients with diagnosed MS: 1) to identify radiologic pattern of spinal cord involvement in MS and 2) to correlate radiologic findings with clinical presentation. We reviewed radiologic records from 2004 to 2009 of patients with abnormal T2 signal intensity of the spinal cord with radiologic concern of demyelinating disease. Patients in this cohort who met the Revised McDonald MS Diagnostic Criteria were included in this study. 166 patients were included in the study. There was preference for cervical spinal cord particularly posterior aspect of the spinal cord. Enhancement of the lesions was rare (4.1%). Mean lesion length was 18.2 mm. The average number of lesions per patient was 2.04. Sensory symptoms were predominating and most of the patients had relapsing-remitting course. Patients with sensory symptoms, bladder and bowel involvement and motor symptoms had almost equally distributed lesions among anterior, posterior and central spinal cord. However, all of the patients presented with posterior column signs and gait abnormality had involvement of the posterior spinal cord. Radiologic manifestation of spinal cord MS is extremely variable and can involve the entire length of the spinal cord. Clinical symptoms may or may not be associated with radiologic presentation of the lesions.

Authors
Bag, AK; Patel, BN; Osman, S; Roberson, GH
MLA Citation
Bag, AK, Patel, BN, Osman, S, and Roberson, GH. "Clinico-radiologic profile of spinal cord multiple sclerosis in adults." Neuroradiology Journal 24.4 (2011): 511-518.
Source
scival
Published In
The Neuroradiology Journal
Volume
24
Issue
4
Publish Date
2011
Start Page
511
End Page
518

Severe Contrast Reaction Emergencies. High-fidelity Simulation Training for Radiology Residents and Technologists in a Children's Hospital

Rationale and Objectives: Severe reactions to radiographic contrast agents can be life threatening, and although they are rare, effective recognition and management are essential to improving outcomes. A high-fidelity radiology simulation course for radiology residents and technologists focusing on severe contrast reactions and immediate treatments was designed to test the hypothesis that knowledge would improve with this educational intervention. Materials and Methods: A prospective pretest and posttest study design was used. Residents and technologists worked in teams of three to five members. Learning objectives focused on demonstrating when and how to use basic life support skills and epinephrine auto-injectors. Each resident and technologist was administered a pretest prior to the start of the case scenarios and a posttest following the debriefing session. Scores from the pretest and posttest for the residents and technologists were compared using a paired-samples t test. Results: Nineteen radiology residents and 11 radiology technologists participated. The average test scores were higher and improved significantly following the simulation experience for both the radiology residents (57% vs 82%, P < .001) and technologists (47% vs 72%, P = .006). Anonymous evaluations demonstrated that the experience was well received by residents and technologists, with 97% of learners (29 of 30) rating the experience as extremely or very helpful. Important learning themes included the knowledge of epinephrine auto-injector use and basic life support skills. Discussion: High-fidelity simulation for radiology residents and technologists focusing on epinephrine auto-injector use and basic life support skills during the first 5 minutes of a severe contrast reaction can significantly improve recognition and knowledge in treating patients having severe contrast reactions. © 2010 AUR.

Authors
Tofil, NM; White, ML; Grant, M; Zinkan, JL; Patel, B; Jenkins, L; Youngblood, AQ; Royal, SA
MLA Citation
Tofil, NM, White, ML, Grant, M, Zinkan, JL, Patel, B, Jenkins, L, Youngblood, AQ, and Royal, SA. "Severe Contrast Reaction Emergencies. High-fidelity Simulation Training for Radiology Residents and Technologists in a Children's Hospital." Academic Radiology 17.7 (2010): 934-940.
PMID
20471871
Source
scival
Published In
Academic Radiology
Volume
17
Issue
7
Publish Date
2010
Start Page
934
End Page
940
DOI
10.1016/j.acra.2010.03.016

Intercostal muscle flap reduces the pain of thoracotomy: A prospective randomized trial

Background: Thoracotomy is associated with significant pain and morbidity. Methods: We performed a prospective randomized trial over 4 months. Patients were randomized to a standard posterior-lateral thoracotomy or an identical procedure, except an intercostal muscle was harvested from the lower rib (to protect the intercostal nerve) before chest retraction. To ensure an equal distribution among both groups, patients were stratified by race, sex, and type of pulmonary resection. All patients received similar pain management. Pain was assessed by using multiple pain scores during hospitalization and after discharge. Outcomes assessed were pain scores, spirometric values, analgesic use, and activity level. Results: There were 114 patients. The median time for intercostal muscle harvesting was 3.7 minutes. The numeric pain scores were lower for the intercostal muscle group on postoperative days 1 and 2 and at weeks 1, 2, 3, 4, 8, and 12 (P < .05 for all). In addition, patients in the intercostal muscle group had a smaller decrease in spirometric values, were less likely to be using analgesics, and were more likely to have returned to normal activity. Conclusions: The harvesting of an intercostal muscle flap before chest retraction decreases the pain of thoracotomy and leads to a lower decrease in spirometry. In addition, patients have less pain at 1, 2, 3, 4, 8, and 12 weeks postoperatively and are less likely to be using narcotics. Finally, it offers a pedicled muscle flap that takes little time to harvest and is able to buttress all bronchi after lobectomy. Copyright © 2005 by The American Association for Thoracic Surgery.

Authors
Cerfolio, RJ; Bryant, AS; Patel, B; Bartolucci, AA
MLA Citation
Cerfolio, RJ, Bryant, AS, Patel, B, and Bartolucci, AA. "Intercostal muscle flap reduces the pain of thoracotomy: A prospective randomized trial." Journal of Thoracic and Cardiovascular Surgery 130.4 (2005): 987-993.
PMID
16214509
Source
scival
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
130
Issue
4
Publish Date
2005
Start Page
987
End Page
993
DOI
10.1016/j.jtcvs.2005.05.052
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