Papers by Christina Lebedis
International Journal of Cancer, 2002
The regional lymph nodes draining primary breast carcinomas are generally the first site to be in... more The regional lymph nodes draining primary breast carcinomas are generally the first site to be invaded by disseminating tumor cells. The extent of lymph node involvement remains the most reliable indicator for staging and prognosis of breast cancer. We have investigated host-tumor interactions between breast carcinoma cells and the lymph node stroma, which may control the outcome of lymph node infiltration. In a previous study, we identified integrin-mediated cell adhesion as a correlate of the metastatic potential of human and rat carcinoma cells. Our present objective was to determine whether lymphatic stromal cells can affect cancer cell growth through the elaboration of growth-modulating factors. Two lymphatic stromal cell lines, ST-A4 and ST-B12, were established from normal rat lymph node stromal cell cultures.
Written for the Dept. of Surgery, Division of Surgical Research. Thesis (M.Sc.). Includes bibliog... more Written for the Dept. of Surgery, Division of Surgical Research. Thesis (M.Sc.). Includes bibliographical references.
Emergency Radiology, 2014
The purpose of this study was to determine the efficacy of CT to predict the development of bile ... more The purpose of this study was to determine the efficacy of CT to predict the development of bile leaks in hepatic trauma. This HIPAA-compliant retrospective study was IRB approved and consent was waived. All patients who sustained hepatic trauma between January 1, 2006, and January 31, 2012, and who underwent CT and hepatobiliary scans during the same hospital admission were included. One hundred and thirty-two patients met the inclusion criteria. Comparison between the presence of biliary injury relative to American Association for the Surgery of Trauma (AAST) hepatic injury grade and mean distance of the hepatic laceration to the inferior vena cava (IVC) was made. The ability of free fluid to predict bile injury was analyzed. Forty-one (31 %) of the 132 patients had positive hepatobiliary scans. Of these 41 patients, seven (17 %) sustained low-grade and 34 (83 %) sustained high-grade hepatic injury compared with the 37 (41 %) low-grade and 54 (59 %) high-grade hepatic injuries in the negative hepatobiliary scan group. The mean distance to the IVC was 2.4 cm (SD 2.9 cm) and 3.6 cm (SD 3.3 cm) in patients with and without bile leaks, respectively. A statistically significant difference in the proportion of highgrade injuries and the mean distance from the IVC between the two groups was identified. The presence of free fluid on CT is sensitive, but not specific, for detecting a bile leak. CT findings, including AAST liver injury grade and location of the liver laceration, are able to predict which patients are at risk for developing bile leaks as seen on hepatobiliary scintigraphy, whereas the presence of free fluid is not.
MedEdPORTAL Publications, 2014
Magnetic Resonance Imaging Clinics of North America, 2016
Radiology, 2014
To determine whether the addition of arterial phase computed tomography (CT) to the standard comb... more To determine whether the addition of arterial phase computed tomography (CT) to the standard combination of portal venous and delayed phase imaging increases sensitivity in the diagnosis of active hemorrhage and/or contained vascular injuries in patients with splenic trauma. The institutional review board approved this HIPAA-compliant retrospective study; the requirement to obtain informed consent was waived. The study included all patients aged 15 years and older who sustained a splenic injury from blunt or penetrating trauma and who underwent CT in the arterial and portal venous phases of image acquisition during a 74-month period (September 2005 to November 2011). CT scans were reviewed by three radiologists, and a consensus interpretation was made to classify the splenic injuries according to the American Association for the Surgery of Trauma splenic injury scale. One radiologist independently recorded the presence of contained vascular injuries or active hemorrhage and the phase or phases at which these lesions were seen. Clinical outcome was assessed by reviewing medical records. The relationship between imaging findings and clinical management was assessed with the Fisher exact test. One hundred forty-seven patients met the inclusion criteria; 32 patients (22%) had active hemorrhage and 22 (15%) had several contained vascular injuries. In 13 of the 22 patients with contained injuries, the vascular lesion was visualized only at the arterial phase of image acquisition; the other nine contained vascular injuries were seen at all phases. Surgery or embolization was performed in 11 of the 22 patients with contained vascular injury. The arterial phase of image acquisition improves detection of traumatic contained splenic vascular injuries and should be considered to optimize detection of splenic injuries in trauma with CT.
Emergency Radiology, 2016
The objective of this study was to determine the incidence and interobserver agreement of individ... more The objective of this study was to determine the incidence and interobserver agreement of individual CT findings as well as the bowel injury prediction score (BIPS) in surgically proven bowel injury after blunt abdominal trauma. This HIPAA-compliant retrospective study was IRB approved and consent was waived. All patients 14 years or older who sustained surgically proven bowel injury after blunt abdominal trauma between 1/1/2004 and 6/30/2015 were included. Admission trauma MDCT scans were independently interpreted by two abdominal fellowship-trained radiologists who recorded the following CT findings: intraperitoneal fluid, mesenteric hematoma/fat stranding, bowel wall thickening/hematoma, active intravenous contrast extravasation, free intraperitoneal air, bowel wall discontinuity, and focal bowel hypoenhancement. Subsequently, the electronic medical records of the included patients, admission abdominal physical exam results, admission white blood cell count, and findings at exploratory laparotomy of the included patients were recorded. Thirty-three patients met the inclusion criteria. The incidence and interobserver agreement of the CT findings were as follows: intraperitoneal fluid 93.9 %, kappa = 0.784 (good); mesenteric hematoma/fat stranding 84.8 %, kappa = 0.718 (good); bowel wall thickening/hematoma 42.4 %, kappa = 0.491 (moderate); active IV contrast extravasation 36.3 %, kappa = 1.00 (perfect); free intraperitoneal air 21.2 %, kappa = 0.904 (very good), bowel wall discontinuity 6.1 %, kappa = 1.00 (perfect); and focal bowel hypoenhancement 6.1 %, kappa = 0.468 (moderate). An absence of the specified CT findings was encountered in 9.1 % with surgically proven bowel injuries (kappa = 1.00, perfect). In our study, 9/16 patients or 56.3 % had a bowel injury prediction score (BIPS) of 2 or more as defined by McNutt et al. (J Trauma Acute Care Surg 78(1):105-111, 2014). The presence of intraperitoneal fluid and mesenteric hematoma/fat stranding are the most common CT findings in bowel injuries proven at laparotomy. A small percentage of patients have no abnormal CT findings. This grading system did not prove to be useful in our study likely due to our inherently small patient population; however, the use of BIPS deserves further investigation as it may help in identifying blunt bowel and mesenteric injury patients with often subtle or nonspecific CT findings.
Seminars in Roentgenology, 2016
AJR. American journal of roentgenology, 2015
The purpose of this article is to review the biomechanical properties of the rotator cuff and gle... more The purpose of this article is to review the biomechanical properties of the rotator cuff and glenohumeral joint and the pathophysiology, imaging characteristics, and treatment options of rotator cuff tear arthropathy (RCTA). Although multiple pathways have been proposed as causes of RCTA, the exact cause remains unclear. Increasing knowledge about the clinical diagnosis, imaging features, and indicators of severity improves recognition and treatment of this pathologic condition.
The British Journal of Radiology, 2015
When evaluating the abdomen in the emergency setting, computed tomography (CT) and ultrasound (US... more When evaluating the abdomen in the emergency setting, computed tomography (CT) and ultrasound (US) are the imaging modalities of choice, mainly because of accessibility, speed and lower relative cost. CT has the added benefit of assessing the whole abdomen for a wide spectrum of gastrointestinal disease while US has the benefit of avoiding ionizing radiation. Magnetic resonance imaging (MRI) is another tool that has demonstrated increasing utility in the emergency setting and also avoids the use of ionizing radiation. MRI also has the additional advantage of excellent soft tissue contrast. However, widespread use of MRI in the emergency setting is limited by availability and relative cost. Despite such limitations, advances in MRI technology, including improved pulse sequences and coil technology and increasing clinician awareness of MRI, have led to an increased demand in abdominal MRI in the emergency setting. This is particularly true in the evaluation of acute pancreatitis, choledocholithiasis with or without cholecystitis, acute appendicitis, particularly in pregnant patients, and in some cases Crohn's disease. In cases of pancreatitis and Crohn's disease, MRI also plays a role in subsequent follow up examinations.
American Journal of Roentgenology
The purpose of this article is to review the biomechanical properties of the rotator cuff and gle... more The purpose of this article is to review the biomechanical properties of the rotator cuff and glenohumeral joint and the pathophysiology, imaging characteristics, and treatment options of rotator cuff tear arthropathy (RCTA). Although multiple pathways have been proposed as causes of RCTA, the exact cause remains unclear. Increasing knowledge about the clinical diagnosis, imaging features, and indicators of severity improves recognition and treatment of this pathologic condition.
PURPOSE/AIM To discuss and illustrate established guidelines for imaging based classifications of... more PURPOSE/AIM To discuss and illustrate established guidelines for imaging based classifications of traumatic solid abdominal organ injury. Identify and review suggested new criteria for classification. Illustrate critical imaging findings in solid abdominal organ injury with implications for clinical management and organ injury grading. CONTENT ORGANIZATION Discuss the established injury grading systems, including those put forth the American Association of the Surgery for Trauma, in regards to liver and spleen trauma. Review emerging concepts for imaging based grading organ injury and illustrate the differences from the established criteria. Discuss the clinical implication of imaging findings of vascular injuries such as active hemorrhage and contained vascular injuries and their evolving role in organ injury grading. SUMMARY This educational exhibit reviews the established imaging criteria for grading traumatic solid abdominal organ injury. The limitations of these established ima...
PURPOSE/AIM To discuss the various benefits and limitations of oral contrast for abdominal pain i... more PURPOSE/AIM To discuss the various benefits and limitations of oral contrast for abdominal pain imaging using CT in the ED setting. CONTENT ORGANIZATION 1. Discussion of CT protocol considerations in abdominal pain imaging in the ED setting, focusing on the use of oral contrast material. 2 . Comprehensive literature review of the published data regarding the use of oral contrast for CT imaging of abdominal pain. 3. Clinical cases will be used to illustrate both the advantages and potential disadvantages of foregoing oral contrast in this patient population. 4. Relevant associated CT protocol considerations in oral contrast administration will be discussed, including the differences between various oral contrast agents, the use of intravenous contrast, the time delay associated with an oral contrast preparation, the impact of patient body habitus on interpretation and the effect on a patient's radiation exposure. SUMMARY This educational exhibit reviews the advantages and disadva...
PURPOSE To evaluate the adequacy of CT for imaging suspected cases of anorectal abscess or fistul... more PURPOSE To evaluate the adequacy of CT for imaging suspected cases of anorectal abscess or fistula in the emergent setting. METHOD AND MATERIALS This IRB approved study included all adult patients presenting to the Emergency Department with clinically suspected anorectal abscess or fistula that underwent initial CT imaging. Eighty-six patients (59 male; 27 female; average age, 47 years) were included in this study. In all cases, the electronic medical record and relevant CT and MR imaging studies were reviewed to catalogue the imaging findings as well as subsequent management. Intervention failure was defined as the need for repeat intervention after initial treatment. RESULTS Fifty (58%) of the 86 patients had CT findings suggestive of abscess or fistula, but only three (6%) of these patients underwent subsequent MR imaging. The remaining thirty-six (41%) patients had no signs of fistula or abscess on CT and three of these patients (8%) underwent subsequent MR imaging. Forty-four (...
PURPOSE To evaluate the incidence of contrast induced nephropathy (CIN) and the effect of associa... more PURPOSE To evaluate the incidence of contrast induced nephropathy (CIN) and the effect of associated risk factors in patients with a diagnosis with of multiple myeloma undergoing computed tomography with intravenous administration of non-ionic iodinated contrast (CECT). METHOD AND MATERIALS HIPAA compliant review of medical record database to identify patients with a diagnosis of myeloma that completed a CECT of the chest, abdomen, or pelvis between 1/1/2005 and 12/1/2008. Analysis for CIN as defined by rise in post-CT exam creatinine level of ≥ 25% of pre-CT exam creatinine level or absolute increase of 0.5 mg/dL from pre-CT creatinine value both within 48 hours and within 7 days was performed. Statistical correlation between development of CIN and patient location, type and amount of contrast injected, history of diabetes, concurrent dehydration or infection at time of exam, hypercalcemia, Bence Jones proteinuria, β2 microglobulin, albumin, International Staging System (ISS) stage...
PURPOSE/AIM 1) Determine the prevalence of ovarian malignancy in postmenopausal women with simple... more PURPOSE/AIM 1) Determine the prevalence of ovarian malignancy in postmenopausal women with simple ovarian cysts during routine pelvic ultrasound examinations. 2) Analyze the diagnostic role of US, MR and CT for detection of ovarian cystic neoplasms. 3) Develop a management algorithm for postmenopausal females with incidentally found simple ovarian cysts. CONTENT ORGANIZATION 1) Discuss the prevalence of simple ovarian cysts in postmenopausal women. 2) Retrospective analysis of oophorectomy pathology results in postmenopausal patients with simple ovarian cysts. 3) Correlation of oophorectomy data with ovarian cyst imaging characteristics on ultrasound, MR and CT. 4) Assess prevalence of malignancy with respect to ovarian cyst size. 5) Develop a management algorithm for postmenopausal females with incidentally found simple asymptomatic ovarian cysts. SUMMARY The incidence of simple ovarian cysts in post-menopausal females is approximately 20%. Ultrasound demonstrates high sensitivity ...
LEARNING OBJECTIVES 1)Review the radiopharmaceuticals and acquisition protocols for ACE-inhibitor... more LEARNING OBJECTIVES 1)Review the radiopharmaceuticals and acquisition protocols for ACE-inhibitor, cortical, diuretic, and transplant scintigraphy in adults. 2)Discuss clinical indications for renal scintigraphy in daily practice. 3)Illustrate, with cinematic displays and correlative anatomic imaging, representative examples of common GU tract conditions. ABSTRACT Renal scintigraphy is a readily available adjunctive approach for evaluating the adult GU tract. This imaging modality is complementary to U/S, CT and MRI in that it provides valuable physiologic information. This exhibit showcases a spectrum of clinical examples utilizing ACE-inhibitor, cortical, diuretic, and transplant scintigraphy. Specific conditions include renovascular hypertension, renal scarring, obstructive and non-obstructive hydronephrosis, and complications of the transplanted kidney. Renal scintigraphy offers the radiologist the opportunity to provide a more complete evaluation of the GU tract, often guiding ...
Radiologic Clinics of North America, 2015
Pancreatic and duodenal injuries are rare but life-threatening occurrences, often occurring in as... more Pancreatic and duodenal injuries are rare but life-threatening occurrences, often occurring in association with other solid organ injuries. Findings of pancreatic and duodenal trauma on computed tomography and MR imaging are often nonspecific, and high levels of clinical suspicion and understanding of mechanism of injury are imperative. Familiarity with the grading schemes of pancreatic and duodenal injury is important because they help in assessing for key imaging findings that directly influence management. This article presents an overview of imaging of blunt and penetrating pancreatic and duodenal injuries, including pathophysiology, available imaging techniques, and variety of imaging features.
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Papers by Christina Lebedis