Arfa Khan - Academia.edu (original) (raw)

Papers by Arfa Khan

Journal of Thoracic Imaging, 2013

Dyspnea, described as breathlessness or shortness of breath, is usually caused by cardiopulmonary... more Dyspnea, described as breathlessness or shortness of breath, is usually caused by cardiopulmonary disease. The role of imaging in chronic dyspnea (>1 mo in duration) with suspected pulmonary origin is reviewed as suggested by the American College of Radiology Appropriateness Criteria s Expert Panel on Thoracic Imaging. The American College of Radiology Appropriateness Criteria s are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Journal of the American College of Radiology, 2007

The solitary pulmonary nodule is traditionally defined as a relatively spherical opacity 3 cm or ... more The solitary pulmonary nodule is traditionally defined as a relatively spherical opacity 3 cm or less in diameter surrounded by lung parenchyma. The choice of imaging test to evaluate solitary nodules is extensive. However, only 2 findings are considered to be sufficient to preclude further evaluation: calcification in a benign pattern and stability in size for more than 2 years.

Radiology, 2021

Background Solid costal pleura-attached noncalcified nodules (CP-NCNs) less than 10.0 mm with len... more Background Solid costal pleura-attached noncalcified nodules (CP-NCNs) less than 10.0 mm with lentiform, oval, or semicircular (LOS) or triangular shapes and smooth margins on baseline low-dose CT scans from the Mount Sinai Early Lung and Cardiac Action Program (MS-ELCAP) were reviewed, and it was determined that they can be followed up at the first annual screening rather than having a shorter-term work-up. Purpose To determine whether the same criteria could be used for solid CP-NCNs newly identified at annual screening examinations. Materials and Methods With use of the same MS-ELCAP database, all new solid CP-NCNs measuring 30.0 mm or less were identified at 4425 annual screening examinations between 2010 and 2019. In addition, to ensure that no malignant CP-NCNs met the criteria, all solid malignant CP-NCNs of 30.0 mm or less in the International Early Lung Cancer Action Program, or I-ELCAP, database of 111 102 annual screening examinations from the 76 participating institutions between 1992 and 2019 were identified; Mount Sinai is one of these institutions. All identified solid CP-NCNs were reviewed-with the radiologists blinded to diagnosis-for shape (triangular, LOS, polygonal, round, or irregular), margin (smooth or nonsmooth), pleural attachment (broad or narrow), and the presence of emphysema and/or fibrosis within 10.0 mm of each CP-NCN. Intra- and interreader readings were performed, and agreements were determined by using the B-statistic. Results Of the 76 new solid CP-NCNs, 21 were lung cancers. Benign CP-NCNs were smaller than malignant ones (median diameter, 4.2 mm vs 11 mm; P < .001), had a different shape distributions, more frequently had smooth margins (67% vs 14%; P < .001), and less frequently had emphysema (38% vs 81%; P = .003) or fibrosis (3.6% vs 19%; P = .045) within a 10.0 mm radius. All 22 solid CP-NCNs less than 10.0 mm in average diameter with triangular or LOS shapes and smooth margins were benign, and none of the 21 solid malignant CP-NCNs had these characteristics. Intra- and interobserver agreement for triangular or LOS-shaped CP-NCNs with smooth margins was almost perfect (0.77 and 0.69, respectively). Conclusion The same follow-up recommendation developed for baseline costal pleura-attached noncalcified nodules (CP-NCNs) can be used for CP-NCNs newly identified at annual screening rounds. © RSNA, 2021.

Clinical Imaging, 2021

PURPOSE Chronic Obstructive Pulmonary Disease (COPD) includes chronic bronchitis, small airways d... more PURPOSE Chronic Obstructive Pulmonary Disease (COPD) includes chronic bronchitis, small airways disease, and emphysema. Diagnosis of COPD requires spirometric evidence and may be normal even when small airways disease or emphysema is present. Emphysema increases the risk of exacerbations, and is associated with all-cause mortality and increased risk of lung cancer. We evaluated the prevalence of emphysema in participants with and without a prior history of COPD. METHODS We reviewed a prospective cohort of 52,726 subjects who underwent baseline low dose CT screening for lung cancer from 2003 to 2016 in the International Early Lung Cancer Action Program. RESULTS Of 52,726 participants, 23.8%(12,542) had CT evidence of emphysema. Of these 12,542 participants with emphysema, 76.5%(9595/12,542) had no prior COPD diagnosis even though 23.6% (2258/9595) had moderate or severe emphysema. Among 12,542 participants, significant predictors of no prior COPD diagnosis were: male (OR = 1.47, p < 0.0001), younger age (ORage10 = 0.72, p < 0.0001), lower pack-years of smoking (OR10pack-years = 0.90, p < 0.0001), completed college or higher (OR = 1.54, p < 0.0001), no family history of lung cancer (OR = 1.12, p = 0.04), no self-reported cardiac disease (OR = 0.76, p = 0.0003) or hypertension (OR = 0.74, p < 0.0001). The severity of emphysema was significantly lower among the 9595 participants with no prior COPD diagnosis, the OR for moderate emphysema was ORmoderate = 0.58(p = 0.0007) and for severe emphysema, it was ORsevere = 0.23(p < 0.0001). CONCLUSION Emphysema was identified in 23.8% participants undergoing LDCT and was unsuspected in 76.5%. LDCT provides an opportunity to identify emphysema, and recommend smoking cessation.

PURPOSE/AIM •To understand a basic classification of vasculitis involving the pulmonary system •T... more PURPOSE/AIM •To understand a basic classification of vasculitis involving the pulmonary system •To review the radiologic findings of commonly encountered vasculidities •To review pertinent history and laboratory findings in order to appreciate that proper diagnosis of these entities involves correlating this data with radiologic findings CONTENT ORGANIZATION •Epidemiology of Vasculitis •Review of the plain film and CT findings in the chest related to this group of diseases •Discussion of a classification system which allows one to group these diseases in a logical and organized manner •Associations such as history of asthma or recent environmental exposures, and abnormalities in laboratory values such as p-ANCA, c-ANCA, Rheumatoid factor, eosinophil count, and pulmonary function tests are discussed. SUMMARY Major teaching points: •Vasculitis has varying presentations in the chest •An organized classification system of vasculitis is made by correlation with the underlying pathologic ...

PURPOSE/AIM The purpose of this exhibit is: 1. To demonstrate the various imaging findings of chr... more PURPOSE/AIM The purpose of this exhibit is: 1. To demonstrate the various imaging findings of chronic pulmonary embolism that help distinguish it from acute pulmonary embolism. 2. To emphasize the utility of multiplanar and 3D reformations for demonstration of these findings. CONTENT ORGANIZATION 1. Background 2. Pathophysiology 3. Imaging findings: • Eccentric thrombus • Hyperattenuating thrombus • Calcified thrombus • Web or flap within pulmonary artery • Enlarged pulmonary vasculature • Asymmetric pulmonary vasculature (unilateral disease) • Right heart enlargement • Bronchial and intercostal artery enlargement from collateral circulation • Mosaic perfusion • Bronchiectasis 4. Treatment 5. Conclusion SUMMARY Chronic PE’s have several distinctive features that can help in distinction from acute PE. Recognition of this entity can significantly improve patient outcome since chronic pulmonary embolism is amenable to surgical thrombolectomy. Distinctive features include: 1. Eccentric ...

Chest, 1984

Sinus Histlocytosis Presenting as Mediastinal Mass (Friedman et a!) cell disease in order to esta... more Sinus Histlocytosis Presenting as Mediastinal Mass (Friedman et a!) cell disease in order to establish indications for CMV vaccination in this group of patients.

CHEST Journal, 1975

pneurnothorax requiring a chest tube in slightly less than 10 percent of the cases. With increasi... more pneurnothorax requiring a chest tube in slightly less than 10 percent of the cases. With increasing practice our yield in the diagnosis of localized lung disease is now well over 90 percent. This is a safe simple procedure which can be accomplished in any hospital where image-intensification fluoroscopy and good cytologic services are available. In summary, we feel that the preferred method for obtaining tissue from undiagnosed localized lung lesions is fluoroscopically controlled needle aspiration biopsy. In diffuse lung disease a limited thoracotomy with open lung biopsy is used. We no longer perform cutting needle biopsies.

Journal of the Islamic Medical Association of North America, 1994

DOI: http://dx.doi.org/10.5915/26-2-16757 Reprint permission is granted by Administrative Radiolo... more DOI: http://dx.doi.org/10.5915/26-2-16757 Reprint permission is granted by Administrative Radiology Journal; reprinted from April 1993, Vol. 12, No.4. Surgical excisional biopsy is currcntly the most common type of breast biopsy performed to determine the benign or malignant nature of mammographically detected abnormalities. Approximately 80% to 85% of these lesions prove to be benign by open surgical biopsy. Fine needle aspiration biopsy (FNAB) of breast lesions bas been advocated to reduce the number of unnecessary surgical procedures. The drawbacks of FNAB include insufficient tissue for diagnosis in 6% to 47% of cases, 1% to 31% false negative results, limited ability to make a definite benign diagnosis and difficulty in precise classification of malignant disease. Stereotactic large core biopsy of nonpalpable breast lesions overcomes many of these drawbacks of FNAB. The accuracy of stereotactic large core biopsy is comparable to open surgical biopsy. The advantages of stereotac...

Radiology, 1991

Standard, thin-section, and reference phantom computed tomography (CT) were performed to evaluate... more Standard, thin-section, and reference phantom computed tomography (CT) were performed to evaluate 75 consecutive patients with solitary pulmonary nodules. Follow-up was available for 62 nodules in 59 patients; 53 of the nodules were benign and nine were malignant. Twenty-one of the 62 nodules were assessed as benign with thin-section CT, while 33 of the 62 nodules were assessed as benign with reference phantom CT. Two of the nodules classified as benign with both thin-section and reference phantom CT proved to be malignant (a peripheral, ossified carcinoid and a 3.5-cm-diameter calcified carcinoma). The sensitivity of reference phantom CT (58%) for classification of benign nodules was higher than the sensitivity of thin-section CT (36%). The sensitivity of standard CT was lowest (12%). The presence of fat at thin-section CT was a reliable criterion for benignancy in six hamartomas. While both thin-section and reference phantom CT were useful in the identification of benign pulmonary...

Investigative Radiology, 1989

Investigative Radiology, 1990

Academic Radiology, 1995

To study vascular wall destruction patterns with embolization. MATERIAL AND METHODS: Over 100 tis... more To study vascular wall destruction patterns with embolization. MATERIAL AND METHODS: Over 100 tissue blocks were obtained fi'om embolized kidneys and livers in thirteen domestic swine. H&E and Movat pentaehrome stains were used to evaluate the pattern of wall destruction with PVA and a hydrogel embolie agent. RESULTS: Two mechanisms of vascular wall destruction were encountered, mechanical pressure and inflammation. The hydrogel emboli being more spherical was associated with more wall destruction than the more irregular PVA. Wall destruction occurs with embolization as arterial injury and repair. The inflammatory wall destruction was variable with particle configuration and the ratio of embolic material to thrombosis and its byproducts in the embolized vascular lumen. CONCLUSION: The nature of the vessel wall response to embolie material is dependent on the material and how it fills the lumen of'the vessel. Understanding of these mechanisms has practical importance for the embolization &vascular tumors and arteriovenous malformations. Purpose: Repair of hypervascular skeletal metastases is associated with an average blood loss of 1500-3000 rnl. We assessed whether preoperative embolization can reduce intraoperative blood loss without adverse effects on healing. Methods: Ten patients with 11 hypemephroma metastases were treated. Bight lesions in the femur and one lesion in the humerus presented as pathogical fractures. Two lesions in the sacrum required debulking. All lesions were hypervascular. All lesions received transfemoral superselective embolization with 510-1000 ~tm polyvinyl alcohol particles; two had additional coil occlusion. Surgery was performed 48-120 hours later. Intraoperative blood loss was assessed by chart review. Bony healing was evaluated by X-Ray analysis and clinical follow-up. Results: More than 70% obliteration of tumor stain was achieved in seven patients, 50-60% in two patients, and <50% in two patients. Blood loss ranged from 250-100Oral and was significantly less in patients with >70% tumor obliteration (390 vs 689 ml, p = 0.01). In all patients bony healing was achieved. Coneluslon: Embolization of hypervasculas renal cell metastases to the bone reduces intraoperative blood loss without adverse effects on healing. Best results are achieved when ~more than 70% of the tumor stain can be obliterated.

Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2002

We report a case of a 36-year-old man who developed a lung hernia after a minimally invasive mitr... more We report a case of a 36-year-old man who developed a lung hernia after a minimally invasive mitral valve repair. Lung hernias are uncommon. Most are acquired and may be classified as traumatic, spontaneous, pathologic, or postoperative. In theory, minimal-access surgical techniques should decrease the likelihood of herniation, in comparison with open thoracotomy. Our review of the literature revealed only 2 reports of this sequela in association with this surgical procedure. Repair was performed due to persistent symptoms, including pleurisy and dyspnea, and interference with the patient's daily activities. Surgical repair led to complete resolution of these problems.

PURPOSE/AIM The purpose of this exhibit is: 1.) To discuss the changes in the 2011 classification... more PURPOSE/AIM The purpose of this exhibit is: 1.) To discuss the changes in the 2011 classification as compared with the prior 2004 classification. 2.) To discuss the impact of these changes on CT diagnosis, biopsy, histopathological testing for genetic markers and on treatment. CONTENT ORGANIZATION 1.) Discussing the major changes made in the 2011 classification, in particular, no more bronchioalveolar carcinoma (BAC). (5 slides) 2.) Side by side radiologic-pathologic images and correlation for the following entities: Atypical Adenomatous Hyperplasia (AAH), Adenocarcinoma in situ (AIS), Minimally invasive adenocarcinoma (MIA), lepidic predominant adenocarcinoma(nonmucinous), acinar, papillary, micropapillary or solid predominant adenocarcinoma, and invasive mucinous adenocarcinoma. (8-10 slides). 3.) Size of the invasive component and prognosis (1-2 slides). 4.) Impact on testing for genetic markers and TNM staging of adenocarcinoma (2-4 slides). SUMMARY The 2011 classification clari...

PURPOSE To compare the incidence of acute pulmonary embolism (PE) on CT Pulmonary Angiogram (CTPA... more PURPOSE To compare the incidence of acute pulmonary embolism (PE) on CT Pulmonary Angiogram (CTPA) in young versus older patients and to further stratify the likelihood of a positive study based on risk factors in emergency, in house, and ambulatory patients. METHOD AND MATERIALS A retrospective review of consecutive CTPA reports from May 2003 to June 2006 was conducted. Patients were categorized into emergency patients (ED), inpatients, and outpatients. Each group was then subdivided into group A (age 35 and younger) or group B (older than 35). The incidence of acute pulmonary embolism (PE) as diagnosed by CTPA was calculated in each group and the percentage of cases with acute PE that had known risk factors (prior PE/DVT, recent surgery, immobilization, malignancy, OCP, + D Dimer, hypercoagulability) was compared. RESULTS A total of 3002 cases were reviewed. Overall, 11.4% of all ED patients, 15.4% of all inpatients, and 9.7% of all outpatients were found to have acute PE. Among E...

PURPOSE The purpose of our study was to determine whether CTV should be routinely performed in pa... more PURPOSE The purpose of our study was to determine whether CTV should be routinely performed in patients receiving CTPA for evaluation of pulmonary embolism. METHOD AND MATERIALS A retrospective analysis of consecutive CTPA reports between May 2003 and June 2006 was conducted at our institution yielding 3002 cases. Of these, 1490 cases received concomitant CTPA and CTV (CTVPA). 175 cases were excluded due to equivocal or nondiagnostic CTV findings. Within the resultant 1315 subset of diagnostic CTVPA cases, patients were stratified into groups according to combinations of PE and DVT findings. The data was then analyzed to further categorize patients by reported risk factors for DVT, including prior history of PE or DVT, hypercoagulability, malignancy, autoimmune status, pregnancy, immobility, recent surgery, oral contraceptive use and lower extremity swelling. RESULTS 683(51.9%) of all 1315 patients undergoing diagnostic CTVPA had risk factors for DVT and 632(48.1%) did not have risk...

Radiology, 2006

To determine the frequency and natural course of mediastinal masses in asymptomatic people at hig... more To determine the frequency and natural course of mediastinal masses in asymptomatic people at high risk for lung cancer who were undergoing computed tomographic (CT) screening. Informed consent and institutional review board approval for this HIPAA-compliant study were obtained at each participating institution. All documented mediastinal masses among the 9263 baseline and 11 126 annual repeat screenings performed in the Early Lung Cancer Action Project (ELCAP) and its successor project, the New York ELCAP, were identified. Two radiologists confirmed all cases, identified the location and measured the diameter (average of length and width) of each mass, and reviewed all subsequent CT and clinical and surgical results. The prevalence and incidence of mediastinal masses were then determined. Of the 9263 individuals, 71 had a mediastinal mass seen at baseline screening (prevalence of 0.77%). Of the 71 masses, 41 were thymic, 16 were thyroidal, two were esophageal cancers, six were tracheal-esophageal diverticula, and six were other masses. Among the 11 126 annual repeat screenings, only one new mediastinal mass was identified (incidence of 0.01%). This suggests a long average duration for mediastinal masses in asymptomatic people. Among the 41 thymic masses, five were larger than 3.0 cm in diameter, and all five were resected; of these five, one was a thymic carcinoma and four were noninvasive thymomas. Of the remaining 36 thymic masses, 25 were evaluated at follow-up CT 1 year later: Five had increased in diameter, two had decreased, and 18 remained unchanged. All 16 thyroid masses were due to goiter; none of these were changed at follow-up CT 1 year later. Mediastinal masses found in the context of CT screening for lung cancer in asymptomatic people should be approached in a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;conservative&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; manner; this includes thymic masses smaller than 3 cm in diameter, as most of these remain unchanged or even decrease in size.

Computerized Medical Imaging and Graphics, Mar 1, 1991

A case of an isolated mesenteric desmoid (tlbroma) is presented with two unusual characteristics.... more A case of an isolated mesenteric desmoid (tlbroma) is presented with two unusual characteristics. First, it arises from the mesentery of the appendix. Second, it presents as a twisted desmoid. The CT and US characteristics are presented. This patient was without risk factors for mesenteric tibrosis such as Gardner's syndrome or previous surgery.

Spine, 1979

It has been our practice to perform total myelography in all cases of lumbar disc disease includi... more It has been our practice to perform total myelography in all cases of lumbar disc disease including the various syndromes of spinal stenosis, because experience has indicated that myelographic abnormalities in the cervical and thoracic areas could have clinical importance despite the presence of gross changes in the lumbar region. Failure to establish a definite diagnosis by restricted lumbar myelography makes it mandatory to evaluate all levels of the spinal axis. Recently, 3 patients with thoracic spinal cord tumors presented with primary signs and symptoms of lumbar spine disorders. Evidence of spinal cord disease was minimal and could be readily overlooked. Total myelography disclosed varying degrees of lumbar spinal pathology, but also showed evidence of lesions in the thoracic region. One proved to be an intramedullary astrocytoma of the spinal cord, and two were schwannomas. The symptoms of low-back pain and lumbar radiculopathy improved after excision of the schwannomas and following x-ray therapy and chemotherapy in the patient with the intramedullary neoplasm.