Welcome to brand new Ask the Fish. Post your questions in different boards to get in touch with CTisus team & Dr. Elliot K. Fishman!
Our old Ask the Fish forum can be still viewed as an archive at https://ctisus.com/redesign-askfish/index.html.
We encourage all the users to register in this new forum to get answers to their questions since the posts in old forum will no longer be reviewed!
Thank you for visiting & looking forward to your feedback!

Recent Posts

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CT Scan Protocols / IV size for CTP
« Last post by lbraikov22 on January 18, 2019, 11:13:54 am »
What is the iv size you are using for CTA Brain Perfusion?
Do you use a 20g if an 18g is unattainable?

We currently request 18g antecubital iv from our Neuro ICU, however, they often complain that they can not obtain an 18g and want us to do it with a 20G, we have done it in the past but we find the scans not as good and often at 5cc/sec the iv blows.

Thank you
Case Studies / Re: Looking for a second opinion
« Last post by Elliot K. Fishman, MD on January 17, 2019, 03:28:19 pm »
happy to look at the images.
my email is [email protected]
CT Scan Protocols / Re: TAVR protocol
« Last post by Elliot K. Fishman, MD on January 17, 2019, 03:27:11 pm »
you must gate the chest like a cardiac CT for a TAVR study. If you do not you have motion and the measurement for the TAVR will be incorrect.
Case Studies / Looking for a second opinion
« Last post by tunnellight on January 17, 2019, 04:12:46 am »
Hi Dr. Fishman,

My wife was diagnosed with urogenital tuberculosis in August 2018 and she has been taking TB drugs since then. Recently, she has had some recurring symptoms (cystitis: hematuria, dysuria, nocturia, urgency, frequency) and the doctors cannot determine the cause or willing to change the TB therapy, which is under WHO supervision. We have been to many local urologists who keep sending us to gynecologists, who in their turn send us back to urologists. We live in Uzbekistan. I'm trying to get my wife diagnosed and treated correctly as we have doubts about the diagnosis and treatment regimen done so far. I've been reading/watching about her disease on the Internet, where I came across your YT video on hematuria. Can you help us or know someone who could? She did CT urography scan in August 2018. I would be glad to share the link with you privately if you can take a look.


Journal Club / Imaging of acute ischemic stroke
« Last post by Lilly Kauffman on January 16, 2019, 02:55:45 pm »
Imaging of acute ischemic stroke

Rudkin S1, Cerejo R2, Tayal A2, Goldberg MF3.


For decades, imaging has been a critical component of the diagnostic evaluation and management of patients suspected of acute ischemic stroke (AIS). With each new advance in the treatment of AIS, the role of imaging has expanded in scope, sophistication, and importance in selecting patients who stand to benefit from potential therapies. Although the field of stroke imaging has been evolving for many years, there have been several major recent changes. Most notably, in late 2017, the window for treatment expanded to 24 h from onset of stroke symptoms in selected patients. Furthermore, for those patients in expanded time windows, guidelines issued in early 2018 now recommend the use of “advanced” imaging techniques in the acute setting, including CT perfusion and MRI, to guide therapeutic decision-making. With these and other changes, the emergency radiologist must be prepared to handle a growing volume and complexity of AIS imaging. This article reviews the various imaging modalities and techniques employed in the imaging of AIS patients, with an emphasis on recommendations from recent randomized controlled trials and national consensus guidelines.

DOI: https://doi.org/10.1007/s10140-018-1623-x


What are your thoughts?  Comments?
CT Scan Protocols / TAVR protocol
« Last post by [email protected] on January 16, 2019, 09:17:00 am »
Are TAVR protocols usually gated for better image quality of the aortic valve?
Imaging of Cancer Immunotherapy: Current Approaches and Future Directions.

Radiology. 2019 Jan;290(1):9-22. doi: 10.1148/radiol.2018181349. Epub 2018 Nov 20.
Nishino M1, Hatabu H1, Hodi FS1.


Cancer immunotherapy using immune-checkpoint inhibitors has emerged as an effective treatment option for a variety of advanced cancers in the past decade. Because of the distinct mechanisms of immunotherapy that activate the host immunity to treat cancers, unconventional immune-related phenomena are encountered in terms of tumor response and progression, as well as drug toxicity. Imaging plays an important role in objectively characterizing immune-related tumor responses and progression and in detecting and monitoring immune-related adverse events. Moreover, emerging data suggest a promise for molecular imaging that can visualize the specific target molecules involved in immune-checkpoint pathways. In this article, the background and current status of cancer immunotherapy are summarized, and the current methods for imaging evaluations of immune-related responses and toxicities are reviewed along with their limitations and pitfalls. Emerging approaches with molecular imaging are also discussed as a future direction to address unmet needs.

DOI: https://doi.org/10.1148/radiol.2018181349


What are your thoughts?  Comments?
CTisus iOS Apps / Just Updated! CTisus iQuiz
« Last post by Lilly Kauffman on January 09, 2019, 11:51:33 am »
CTisus iOS Apps / Just Updated! CTisus iLectures
« Last post by Lilly Kauffman on January 09, 2019, 11:51:12 am »
Crohn Disease: A 5-Point MR Enterocolonography Classification Using Enteroscopic Findings.

AJR Am J Roentgenol. 2019 Jan;212(1):67-76. doi: 10.2214/AJR.17.18897. Epub 2018 Nov 13.
Kitazume Y1, Fujioka T1, Takenaka K2, Oyama J1, Ohtsuka K2, Fujii T2, Tateisi U1.


OBJECTIVE: The objectives of our study were to establish the efficacy of a 5-point MR enterocolonography classification for assessing Crohn disease (CD) activity, compare this classification with a validated MRI score (i.e., the MR index of activity [MaRIA]), and compare both with endoscopic findings, which were assessed using the Crohn disease endoscopic index of severity (CDEIS).

MATERIALS AND METHODS: Seventy (derivation cohort) and 50 (validation cohort) patients with CD were retrospectively enrolled in this study. We developed a 5-point MR enterocolonography classification that consists of visual assessments alone. MR enterocolonography results were evaluated for each bowel segment (rectum; sigmoid, descending, transverse, and ascending colon; terminal and proximal ileum; and jejunum) by one observer in the derivation phase and independently by three observers in the validation phase using the 5-point MR enterocolonography classification lexicon and MaRIA. Areas under the ROC curves (AUCs) in discriminating endoscopic deep ulcers were compared between the MR enterocolonography classification and MaRIA. Interobserver reproducibility was assessed using weighted kappa coefficients.

RESULTS: The AUCs of the MR enterocolonography classification were 89.0% in the derivation phase and 88.5%, 81.0%, and 77.3% for the three observers in the validation phase. The AUCs of the MR enterocolonography classification were statistically noninferior to those of MaRIA (p < 0.001). The cross-validation accuracy was 81.9% in the derivation phase and 81.5% in the validation phase. The MR enterocolonography classification showed good reproducibility.

CONCLUSION: The 5-point MR enterocolonography classification was shown to be effective for evaluating CD activity in the large and small bowel.

DOI: https://doi.org/10.2214/AJR.17.18897


What are your thoughts?  Comments?
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