Abdominal Imaging

The Section Faculty consists of Fergus Coakley (Chief), Bonnie Joe, Aliya Qayyum, Emma Webb, Antonio Westphalen and Ben Yeh. Shared Faculty include Seera Aziz (primarily ultrasound), Richard Breiman (primarily Director of the Radiology Learning Center), Liina Poder (primarily ultrasound), Rizwan Aslam (primarily VAMC), and Richard Sollitto (primarily Chief of Ambulatory Care and Mount Zion Imaging services). Ocassional clinical/volunteer faculty include Judy Choe, Gerry Lee, Maya Meux, and Doug Sheft. Faculty members are dedicated to teaching, and have a broad mix of clinical and research experience. Dr. Coakley's previous affiliation at Memorial Sloan-Kettering Cancer Center and Dr. Qayyum's experience at the Royal Marsden Hospital in England bring special expertise in oncologic imaging. Dr. Yeh has substantial experience in 3D imaging, and was instrumental in introducing virtual colonoscopy and CT cholangiography into clinical practice at UCSF. Dr. Joe has a PhD and brings particular expertise in basic science aspects of abdominal imaging research, including the development of new in vivo and ex vivo applications of MR spectroscopy in the abdomen and pelvis. Drs. Webb and Westphalen joined the faculty in July of 2006, and are developing new teaching and research resources. The section is dedicated to excellence in clinical, training, and research activities.
(See "What’s new in Abdominal Imaging" article.)

Teaching and Sectional Resources

Office Telephone: (415) 353 1821 - FAX: (415) 476-0616
Analyst: Melinda Parangan-Chu
Administrative Assistant: Cheree Fernandez

Clinical Activities The Abdominal Imaging section is responsible for all of the following studies: CT of the abdomen & pelvis performed in adults including 3D applications and virtual colonoscopy. MRI of the abdomen and pelvis, including hepatic, pancreatic, renal, gynecologic, and prostatic studies. CT and MR angiography of the abdomen and pelvis (except for studies requested by vascular surgery – these are performed and interpreted by Interventional Radiology). Performance and interpretation of gastrointestinal and genitourinary fluoroscopy studies, including barium examinations, Hypaque examinations, and hysterosalpingograms. Interpretation of ERCPs and fluoroscopic GU studies performed by the gastroenterology and urology departments, respectively. Interpretation of plain abdominal X-rays. The bulk of the work from the section consists of CT (40 to 60 cases per day) and MRI (5-10 per day).

Fellowship Training

The Abdominal Imaging fellowship provides advanced training in the performance and interpretation of all forms of Abdominal Imaging and exposes Fellows to a large and diverse Abdominal Imaging workload. Fellows receive comprehensive and supervised training in CT of the abdomen and pelvis, MRI of the abdomen and pelvis (including liver, pancreas, prostate and genitourinary applications), CT-guided needle biopsies, non-catheter angiography, virtual colonoscopy, and GI and GU fluoroscopic examinations (including barium studies, and hysterosalpingography). In addition, Fellows rotate through the Ultrasound Section (Ruth Goldstein, Chief, Ultrasound). The ultrasound workload includes general abdominal, genitourinary, and obstetric imaging. The department employs state of the art equipment, including PACS, Advantage Windows 3D workstations, digital fluoroscopy, multi-detector spiral CT, high resolution ultrasound scanners with color and power Doppler, high field strength MRI scanners with spectroscopic capability, and a recently installed interventional MRI scanner. A lecture series in Abdominal Imaging is provided for clinical fellows in the section. The section handbook is available online and provides an important educational resource (http://www.radiology.ucsf.edu/instruction/abdominal/ab_handbook/).

2001 - 2002	2002 - 2003	2003 - 2004
2004 - 2005	2005 - 2006	2006 - 2007
2007 - 2008

Fellows are involved in all aspects of Abdominal Imaging, and fully participate in the clinical, teaching, and research activities of the department. Teaching duties include interdisciplinary tumor boards, clinicoradiological meetings, and resident and medical student conferences. The Section is strongly committed to medical student training, and the faculty and fellows share responsibility for the R140.03 medical student training modules in gastrointestinal and genitourinary radiology. Each module consists of 3 one-hour sessions, and the modules are given monthly from February to April and July to November. Dedicated research time and mentoring is provided. The section has a strong record of success in trainee-lead research. Numerous opportunities exist for collaborative work with clinical colleagues and basic scientists. For example, the Section is actively involved in developing endorectal MRI and MRSI of the prostate, and in exploring new abdominal applications of spectroscopy.

More about the Department of Radiology's Research Training Program.

Research Directions:
Research in the Section is dedicated to promoting excellence in the application, performance, and interpretation of abdominal imaging studies. Two dominant themes characterize the research projects that are fostered within the section:

• The development of new or improved techniques and applications for abdominal CT or MRI. Examples include MRI and MRSI in diffuse liver disease, MRI and MRSI of prostate cancer, fetal MRI, and CT cholangiography.
• The promotion of evidence-based abdominal imaging, including systematic validation or debunking of commonly held opinions or assumptions. Examples include the investigation of small indeterminate hypodensities in the liver, minor morphological abnormalities of the adrenal glands, and style guidelines for radiology reports.

Current research directions within the section include:

• Combined MR imaging and MR spectroscopic imaging in the localization and staging of prostate cancer.
• Advanced hepatic imaging, including multi-detector CT, CT cholangiography, new hepatobiliary MR contrast agents, and MR cholangiopancreatography.
• Evaluation of prostate cancer with MR spectroscopic imaging (MRSI): a prospective multi-institutional clinicopathologic study
• Radiological evaluation of diffuse liver disease, including cirrhosis, pseudocirrhosis, and non-alcoholic steatohepatitis.
• 3D rendering of CT and MR images, including projectional and volumetric applications and CT colonography.

Active Grants
The section has several active grants. Many of these grants are collaborative efforts with Drs. Kurhanewicz and Vigneron of the Magnetic Resonance Science Center, emphasizing the close integration of the clinical and basic science faculty within the UCSF Radiology department. Such integration is a major strength of the department, since it allows rapid translation of innovative imaging technologies to clinical implementation.

• Evaluation of Fetal Lung Maturity by MRI and MRS. Principal Investigator: Fergus Coakley M.D. UCSF Radiology Department Seed Grant # 02-04.
• Improved MRI/MRSI for Biopsy Guidance of Prostate Cancer. Principal Investigator: John Kurhanewicz, Ph.D. Agency: National Cancer Institute, NIH R33 (CA88214) 7/1/00-6/30/03. Co-investigator: Fergus Coakley.
• Monitoring Radiation Therapy of Prostate Cancer by MRSI. Principal Investigator: John Kurhanewicz, Ph.D. Agency: National Cancer Institute, NIH R01 CA79980-01) 2/5/99-1/31/04. Co-investigator: Aliya Qayyum.
• Metabolic Imaging of the Prostate Using 3-D MRSI. Principal Investigator: Daniel Vigneron, Ph.D. Agency: National Cancer Institute, NIH R01 (CA59897) 3/21/01-2/28/06. Co-investigator: Aliya Qayyum.
• Biliary anastomotic stricture after liver transplantation: non-invasive evaluation by MR cholangiography. Principal Investigator: Aliya Qayyum M.D. Agency: UCSF Radiology Department Seed Grant #02-14.
• Contrast-enhanced Preoperative Non-invasive Imaging for Right Lobe Living-related Donor Liver Transplantation. Principal Investigator: Benjamin Yeh M.D. Agency: UCSF Radiology Department Seed Grant # 02-13.

Publications (2006-07):

• Purcell DD, Coakley FV, Franc BL, Hawkins RA, Boddington SE, Yeh BM. Anterior layering of excreted 18F-FDG in the bladder on PET/CT: frequency and cause. AJR Am J Roentgenol. 2007 Aug;189(2):W96-9. PMID: 17646448 [PubMed - in process]
• Arora SS, Breiman RS, Webb EM, Westphalen AC, Yeh BM, Coakley FV. CT and MRI of congenital anomalies of the seminal vesicles. AJR Am J Roentgenol. 2007 Jul;189(1):130-5. Review. PMID: 17579162 [PubMed - indexed for MEDLINE]
• Ching BH, Yeh BM, Westphalen AC, Joe BN, Qayyum A, Coakley FV. CT differentiation of adenomyomatosis and gallbladder cancer. AJR Am J Roentgenol. 2007 Jul;189(1):62-6. PMID: 17579153 [PubMed - indexed for MEDLINE]
• Kitazono MT, Qayyum A, Yeh BM, Chard PS, Ostroff JW, Coakley FV. Magnetic resonance cholangiography of biliary strictures after liver transplantation: a prospective double-blind study. J Magn Reson Imaging. 2007 Jun;25(6):1168-73. PMID: 17520726 [PubMed - in process]
• Falk MS, Truitt AK, Coakley FV, Kashani-Sabet M, Hawkins RA, Franc B. Interpretation, accuracy and management implications of FDG PET/CT in cutaneous malignant melanoma. Nucl Med Commun. 2007 Apr;28(4):273-80. PMID: 17325590 [PubMed - indexed for MEDLINE]
• Costouros NG, Coakley FV, Westphalen AC, Qayyum A, Yeh BM, Joe BN, Kurhanewicz J. Diagnosis of prostate cancer in patients with an elevated prostate-specific antigen level: role of endorectal MRI and MR spectroscopic imaging. AJR Am J Roentgenol. 2007 Mar;188(3):812-6. PMID: 17312072 [PubMed - indexed for MEDLINE]
• Adler F, Rabban JT, Yeh BM, Qayyum A, Chen LM, Coakley FV. Superficial endometrial spread of squamous cell cervical carcinoma: a diagnostic challenge at magnetic resonance imaging. J Comput Assist Tomogr. 2007 Mar-Apr;31(2):247-50. PMID: 17414762 [PubMed - indexed for MEDLINE]
• Vahidi K, Joe BN, Glenn OA, Barkovich AJ, Filly R, Ball R, Coakley FV. Prenatal imaging of congenital maxillomandibular fusion: case report and review of the literature. J Ultrasound Med. 2007 Mar;26(3):381-9. Review. No abstract available. PMID: 17324991 [PubMed - indexed for MEDLINE]
• Westphalen AC, Qayyum A, Yeh BM, Merriman RB, Lee JA, Lamba A, Lu Y, Coakley FV. Liver fat: effect of hepatic iron deposition on evaluation with opposed-phase MR imaging. Radiology. 2007 Feb;242(2):450-5. PMID: 17255416 [PubMed - indexed for MEDLINE]
• Hom JJ, Coakley FV, Simko JP, Lu Y, Qayyum A, Westphalen AC, Schmitt LD, Carroll PR, Kurhanewicz J. High-grade prostatic intraepithelial neoplasia in patients with prostate cancer: MR and MR spectroscopic imaging features--initial experience. Radiology. 2007 Feb;242(2):483-9. Epub 2006 Dec 19. PMID: 17179396 [PubMed - indexed for MEDLINE]
• Shum DJ, Clifton MS, Coakley FV, Hornberger LK, Joe BN, Goldstein RB, Harrison MR. Prenatal tracheal obstruction due to double aortic arch: a potential mimic of congenital high airway obstruction syndrome. AJR Am J Roentgenol. 2007 Jan;188(1):W82-5. No abstract available. PMID: 17179331 [PubMed - indexed for MEDLINE]
• Coakley FV, Chen I, Qayyum A, Westphalen AC, Carroll PR, Hricak H, Chen MH, Kurhanewicz J. Validity of prostate-specific antigen as a tumour marker in men with prostate cancer managed by watchful-waiting: correlation with findings at serial endorectal magnetic resonance imaging and spectroscopic imaging. BJU Int. 2007 Jan;99(1):41-5. PMID: 17227490 [PubMed - indexed for MEDLINE]
• Qayyum A, Lee GK, Yeh BM, Allen JN, Venook AP, Coakley FV. Frequency of hepatic contour abnormalities and signs of portal hypertension at CT in patients receiving chemotherapy for breast cancer metastatic to the liver. Clin Imaging. 2007 Jan-Feb;31(1):6-10. PMID: 17189839 [PubMed - indexed for MEDLINE]
• Yeh BM, Coakley FV, Westphalen AC, Joe BN, Freise CE, Qayyum A, McTaggart RA, Roberts JP. Predicting biliary complications in right lobe liver transplant recipients according to distance between donor's bile duct and corresponding hepatic artery. Radiology. 2007 Jan;242(1):144-51. PMID: 17185665 [PubMed - indexed for MEDLINE]
• Chan WC, Joe BN, Coakley FV, Prien EL Jr, Gould RG, Prevrhal S, Barber WC, Kirkwood KS, Qayyum A, Yeh BM. Gallstone detection at CT in vitro: effect of peak voltage setting. Radiology. 2006 Nov;241(2):546-53. PMID: 17057073 [PubMed - indexed for MEDLINE]
• Rafaelian O, Coakley FV, Qayyum A, Breiman RS, Yeh BM, Joe BN, Westphalen AC, Feng S. Magnetic resonance imaging of hepatocellular carcinoma mimicking focal nodular hyperplasia: a potential pitfall in patients with cirrhosis? J Comput Assist Tomogr. 2006 Sep-Oct;30(5):796-9. PMID: 16954932 [PubMed - indexed for MEDLINE]
• Hoghooghi D, Coakley FV, Breiman RS, Qayyum A, Yeh BM. Frequency and etiology of midesophageal diverticula at barium esophagography. Clin Imaging. 2006 Jul-Aug;30(4):245-7. PMID: 16814139 [PubMed - indexed for MEDLINE]
• Chang WC, Meux MD, Yeh BM, Qayyum A, Joe BN, Chen LM, Coakley FV. CT and MRI of adnexal masses in patients with primary nonovarian malignancy. AJR Am J Roentgenol. 2006 Apr;186(4):1039-45. PMID: 16554576 [PubMed - indexed for MEDLINE]
• Clifton MS, Joe BN, Zektzer AS, Kurhanewicz J, Vigneron DB, Coakley FV, Nobuhara KK, Swanson MG. Feasibility of magnetic resonance spectroscopy for evaluating fetal lung maturity. J Pediatr Surg. 2006 Apr;41(4):768-73. PMID: 16567191 [PubMed - indexed for MEDLINE]
• Qayyum A, Thoeni RF, Coakley FV, Lu Y, Guay JP, Ferrell LD. Detection of hepatocellular carcinoma by ferumoxides-enhanced MR imaging in cirrhosis: Incremental value of dynamic gadolinium-enhancement. J Magn Reson Imaging. 2006 Jan;23(1):17-22. PMID: 16315209 [PubMed - indexed for MEDLINE]

Annual Earl Miller Memorial Lecture

The Earl Miller Lecture is the Annual named oration in Abdominal Imaging at UCSF. Earl Miller was one of the outstanding radiologists of his generation, and was the second Chairman of Radiology at UCSF. He was born in 1907 in Milwaukee, Wisconsin, and received a BA and MA in Physics from the University of Wisconsin between 1925 and 1931. In 1931, he worked at the Rockefeller Research Institute as a Biophysics Laboratory Technician. He then attended the Medical School University of Wisconsin from 1932 to 1936. He undertook a Residency in Radiology at Stanford University Hospital between1936 and 1939, and then served as an Instructor in Radiology at Yale University from 1939 to 1940, becoming Board Certified in Radiology in 1940. He then returned to the West Coast, rising from the rank of Instructor to full Professor at UCSF between 1940 and 1949, serving as Chairman between 1943 and 1945. He retired from the faculty in 1974, and passed away in 1995. Other notable lifetime achievements included:

• 1943-45: Director, Health Physics, Manhattan Project, Berkeley
  
• 1950: Fellow of the American College of Radiology
  
• 1954-57: Member, board of Chancellors, ACR
  
• 1957-58: Chairman, board of Chancellors, ACR
  
• 1958-74: Director, Radiological Research Laboratory, UCSF
  
• 1957-65: Commission on Education, ACR
  
• 1960-65: Chairman, Commission of Education, ACR
  
• 1972: Gold Medal, ACR
  
• 1974: Professor Emeritus, UCSF
  
• 1978: Regents name Earl Miller Radiologic Imaging Laboratory

Recent speakers for this prestigious Annual Lecture have been:

• 2002: Clare Tempany-Afdhal MB BCh, Harvard Medical School
  
• 2003: Julia Fielding MD, University of North Carolina
  
• 2004: Jay Heiken MD, Washington University School of Medicine
  
• 2005: Vivian Lee MD, PhD, New York University Medical Center
  
• 2006: Jelle Barentsz MD PhD, University Hospital Nijmegen, Netherlands
  
• 2007: Peter Choyke MD, National Cancer Institute