Clinical Radiology RSS feed: Current Issue. Clinical Radiology is published by Elsevier on behalf of The Royal College of Radiologists. To view other College publications, click here Clinical Radiology is an International Journal bringing you original research, editorials, review articles and case reports on all aspects of diagnostic imaging, including: • computed tomography • magnetic resonance imaging • ultrasonography • digital radiology • interventional radiology • radiography • nuclear medicine Papers on radiological protection, quality assurance, audit in radiology and matters relating to radiological training and education are also included. In addition, each issue contains correspondence, book reviews and notices of forthcoming events. http://www.clinicalradiologyonline.net/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Clinical Radiology0009-9260676June 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.clinicalradiologyonline.net/article/PIIS0009926012001328/abstract?rss=yesContents10.1016/S0009-9260(12)00132-8Clinical Radiology 67, 6 (2012)2012-06-01Clinical Radiology2012-06-01676S0009-9260(12)X0005-9iiiivhttp://www.clinicalradiologyonline.net/article/PIIS0009926011005034/abstract?rss=yesAim: To review the literature on the use of prophylactic balloon occlusion alone and in conjunction with arterial embolization of the internal iliac arteries in women with placenta accreta.Materials and methods: The PubMed, MEDLINE, CINAHL, EMBASE, and Cochrane Library databases were searched for keywords related to this technique and its use in the avoidance of caesarean hysterectomy. The relevant published articles were selected and then searched for further references.Results: The literature search found 15 case reports and five studies for a total of 20 articles. The use of balloon catheters to prevent post-partum haemorrhage in women with placenta accreta is controversial with some investigators reporting reduced blood loss and transfusion requirements while others reporting no benefit. This procedure does not appear to reduce operative time or hospital stay. Some groups have described catheter-related complications, such as maternal thromboembolic events and the need for stent placement and/or arterial bypass. Thus far, there is no reported maternal or foetal mortality related to this procedure.Conclusion: Current evidence is based upon case reports and small retrospective studies. Larger studies or randomized controlled trials are essential in order to demonstrate the safety and efficacy of bilateral iliac balloon occlusion. The creation of a data registry would also facilitate the reporting of this technique.Prophylactic balloon occlusion of internal iliac arteries in women with placenta accreta: Literature review and analysisM.D. Dilauro, S. Dason, S. Athreya10.1016/j.crad.2011.10.031Clinical Radiology 67, 6 (2012)2012-01-04Clinical Radiology2012-01-04676S0009-9260(12)X0005-9Review515520http://www.clinicalradiologyonline.net/article/PIIS0009926012000852/abstract?rss=yesIn this edition of Clinical Radiology Macpherson et al. present a timely and thought-provoking study evaluating the potential benefits of a streamlined diagnostic pathway for patients with suspected lung cancer. The authors propose an imaging algorithm triaging patients, based on strict clinical and plain film criteria, to either up-front 2-[18F]-fluoro-2-deoxy-d-glucose positron-emission tomography computed tomography (PET-CT) or conventional diagnostic workup with CT and subsequent PET-CT in patients who are potentially radically treatable. The diagnostic accuracy and costs of implementing this system were assessed retrospectively on a cohort of 251 patients from a single, high-volume tertiary referral centre. Findings suggest early use of PET-CT in carefully selected patients could improve efficiency and effectiveness without a significant additional cost.Up-front staging of suspected lung cancer with PET-CT – New horizon or false dawn?A.F. Scarsbrook10.1016/j.crad.2011.11.020Clinical Radiology 67, 6 (2012)2012-03-27Clinical Radiology2012-03-27676S0009-9260(12)X0005-9Commentary521522http://www.clinicalradiologyonline.net/article/PIIS0009926011004636/abstract?rss=yesAim: To report the results of a nationwide audit of the accuracy of magnetic resonance imaging (MRI) staging in uterine body cancer when staging myometrial invasion, cervical extension, and lymph node spread.Materials and methods: All UK radiology departments were invited to participate using a web-based tool for submitting anonymized data for a 12 month period. MRI staging was compared with histopathological staging using target accuracies of 85, 86, and 70% respectively.Results: Of the departments performing MRI staging of endometrial cancer, 37/87 departments contributed. Targets for MRI staging were achieved for two of the three standards nationally with diagnostic accuracy for depth of myometrial invasion, 82%; for cervical extension, 90%; and for pelvic nodal involvement, 94%; the latter two being well above the targets. However, only 13/37 (35%) of individual centres met the target for assessing depth of myometrial invasion, 31/36 (86%) for cervical extension and 31/34 (91%) for pelvic nodal involvement. Statistical analysis demonstrated no significant difference for the use of intravenous contrast medium, but did show some evidence of increasing accuracy in assessment of depth of myometrial invasion with increasing caseload.Conclusion: Overall performance in the UK was good, with only the target for assessment of depth of myometrial invasion not being met. Inter-departmental variation was seen. One factor that may improve performance in assessment of myometrial invasion is a higher caseload. No other clear factor to improve performance were identified.Staging cancer of the uterus: A national audit of MRI accuracyK.A. Duncan, K.J. Drinkwater, C. Frost, D. Remedios, S. Barter10.1016/j.crad.2011.10.019Clinical Radiology 67, 6 (2012)2012-03-09Clinical Radiology2012-03-09676S0009-9260(12)X0005-9Original Papers523530http://www.clinicalradiologyonline.net/article/PIIS0009926011005009/abstract?rss=yesAim: To outline the pitfalls for image-guided percutaneous removal of foreign bodies (FBs).Materials and methods: Three hundred and fifty prospective patients were referred for ultrasound imaging for FB diagnosis and percutaneous removal during 2008–2010. Those patients with suitable FBs were offered guided percutaneous removal. The procedural methods and difficulties were recorded and all outcomes were noted, including surgical success and complications.Results: Sixty-three patients had a negative ultrasound for FB and they were discharged with no subsequent attendances. Of the remaining 287 patients, 12 were deemed unsuitable for percutaneous removal, 15 attempted percutaneous removals failed, and eight were not attempted due to lack of symptoms. The remaining 252 patients underwent successful retrieval and there were no procedural complications. The procedural limitations were mainly related to the anatomical site, type of FB, instrumentation, bubbles, ultrasound beam width, and mobility of the FB.Conclusion: Ultrasound-guided percutaneous removal of FBs is a safe and viable approach to the management of FBs achieving at least 88% success overall and with attention to the pitfalls, the learning curve should improve the success rate.Image-guided soft-tissue foreign body extraction — Success and pitfallsMike Bradley10.1016/j.crad.2011.10.029Clinical Radiology 67, 6 (2012)2011-12-30Clinical Radiology2011-12-30676S0009-9260(12)X0005-9Original Papers531534http://www.clinicalradiologyonline.net/article/PIIS0009926011005010/abstract?rss=yesAim: To evaluate the role of 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography (PET)/ computed tomography (CT) in the current multidisciplinary management of anal cancer, both in initial staging and in follow-up post-treatment.Materials and methods: All patients referred to the region-wide multidisciplinary meeting for anal cancer during the study period received PET/CT imaging in addition to conventional imaging [CT and magnetic resonance imaging (MRI)]. Whether PET/CT altered the stage of the tumour from that suggested by conventional imaging was retrospectively assessed. The effect on management was evaluated.Results: Fifty PET/CT examinations were performed on 44 patients with anal cancer. Thirty were part of initial staging, and 20 were post-chemo/radiotherapy or surgery. Two PET/CTs produced inadequate contemporaneous conventional imaging to allow comparison. Overall PET/CT increased the stage of the anal cancer in 17% of cases (8/48), decreased the stage in 19% (9/48), and did not alter the stage in 65% (31/48). The tumour stage was altered more frequently in initial staging than in follow up imaging. The PET/CT findings altered patient management in 29% (14/48) of cases. The majority (11) of these were cases in which PET/CT was used as part of initial staging.Conclusion: PET/CT alters the initial staging sufficiently frequently that it should be used routinely in anal cancer, where it is available. The role of PET/CT in the follow-up of anal cancer is not as clear. Routine follow-up with PET/CT may not be justified, but selected use is of definite benefit in problem solving or if salvage surgery is planned, after multidisciplinary discussion.PET/CT in anal cancer — is it worth doing?I.T. Wells, B.M. Fox10.1016/j.crad.2011.10.030Clinical Radiology 67, 6 (2012)2012-01-03Clinical Radiology2012-01-03676S0009-9260(12)X0005-9Original Papers535540http://www.clinicalradiologyonline.net/article/PIIS0009926011005022/abstract?rss=yesAim: To retrospectively evaluate the efficacy of embolotherapy in patients with iatrogenic traumatic uterine arteriovenous malformations (AVMs).Materials and methods: A retrospective review of all patients who underwent uterine arterial embolization in Peking Union Medical College Hospital between January 2000 and December 2010 was performed. Forty-two patients were diagnosed with a uterine vascular malformation. All patients had obstetric manipulations before. Serial beta-human chorionic gonadotropin (β-HCG) levels were measured to exclude gestational trophoblastic neoplasia. All patients underwent transcatheter embolization of bilateral uterine arteries. The complications, control of haemorrhage, and outcome of subsequent pregnancies were assessed.Results: A total of 49 embolization procedures were performed in 42 patients. Seven patients required repeated embolizations for recurrence of bleeding. The technical success rate of embolization was 100%. Bleeding was controlled in 35 of 42 patients (83%) after the first embolization procedures, and bleeding was controlled in another two patients who underwent repeat embolization at a median follow-up of 29 months (range 3 months to 5 years). The overall clinical success rate was 88% (37/42). Thirteen patients subsequently became pregnant and eight of 13 patients had uneventful intrauterine pregnancies carried to term. Seven patients had post-embolization syndrome and no other complication occurred.Conclusion: Percutaneous embolotherapy is a safe and effective treatment for traumatic AVMs. Future pregnancy is still possible after embolization.Efficacy and safety of embolization in iatrogenic traumatic uterine vascular malformationsZ. Wang, J. Chen, H. Shi, K. Zhou, H. Sun, X. Li, J. Pan, X. Zhang, W. Liu, N. Yang, Z. Jin10.1016/j.crad.2011.11.002Clinical Radiology 67, 6 (2012)2012-01-19Clinical Radiology2012-01-19676S0009-9260(12)X0005-9Original Papers541545http://www.clinicalradiologyonline.net/article/PIIS0009926011005204/abstract?rss=yesAim: To describe the post-chemoradiotherapy magnetic resonance imaging (MRI) features of locally advanced rectal carcinoma (LARC) in which there has been a complete histopathological response to neoadjuvant chemoradiotherapy (CRT).Materials and methods: This retrospective cohort study was performed between January 2005 and November 2009 at a regional cancer centre. Consecutive patients with LARC and a histopathological complete response to long-course CRT were identified. Pre- and post-treatment MRI images were reviewed using a proforma for predefined features and response criteria. ymrT0 was defined as the absence of residual abnormality on MRI.Results: Twenty patients were included in the study. Seven (35%) ypT0 tumours were ymrT0. All 13 ypT0 tumours not achieving ymrT0 appearances had a good radiological response, with at least 65% tumour reduction. The appearances were heterogeneous: in 11/13 patients the tumour was replaced by a region of at least 50% low signal on MRI, with 8/13 having ≥80% low signal, and 3/13 with 100% low signal.Conclusion: MRI may be useful in identifying a complete histopathological response. However, the MRI appearances of ypT0 tumours are heterogeneous and conventional MRI complete response criteria will not detect the majority of patients with a complete histopathological response.MRI features of the complete histopathological response of locally advanced rectal cancer to neoadjuvant chemoradiotherapyJ.M. Franklin, E.M. Anderson, F.V. Gleeson10.1016/j.crad.2011.11.004Clinical Radiology 67, 6 (2012)2012-01-04Clinical Radiology2012-01-04676S0009-9260(12)X0005-9Original Papers546552http://www.clinicalradiologyonline.net/article/PIIS0009926011005216/abstract?rss=yesAim: To evaluate the usefulness of small intestine contrast-enhanced ultrasonography (SICUS) using an oral contrast agent in routine clinical practice by assessing the level of agreement with the established techniques, small bowel follow-through (SBFT) and computed tomography (CT), and diagnostic accuracy compared with the final diagnosis in the detection of small bowel Crohn’s disease (CD) and luminal complications in a regional centre.Materials and methods: All symptomatic known or suspected cases of CD who underwent SICUS were retrospectively reviewed. The level of agreement between SICUS and SBFT, CT, histological findings, and C-reactive protein (CRP) level was assessed using kappa (κ) coefficient. Sensitivity was demonstrated using the final diagnosis as the reference standard defined by the outcome of clinical assessment, follow-up, and results of investigations other than SICUS.Results: One hundred and forty-three patients underwent SICUS of these 79 (55%) were female. Eighty-six (60%) were known to have CD and 57 (40%) had symptoms suggestive of intestinal disease with no previous diagnosis. Forty-six (55%) of the known CD patients had had at least one previous surgical resection. The sensitivity of SICUS in detecting active small bowel CD in known CD and undiagnosed cases was 93%. The kappa coefficient was 0.88 and 0.91 with SBFT and CT, respectively. SICUS detected nine patients who had one or more small bowel strictures and six patients with a fistula all detected by SBFT or CT.Conclusion: SICUS is not only comparable to SBFT and CT but avoids radiation exposure and should be more widely adopted in the UK as a primary diagnostic procedure and to monitor disease complications in patients with CD.Diagnostic accuracy of small intestine ultrasonography using an oral contrast agent in Crohn’s disease: Comparative study from the UKS. Chatu, J. Pilcher, S.K. Saxena, D.H. Fry, R.C.G. Pollok10.1016/j.crad.2011.11.005Clinical Radiology 67, 6 (2012)2012-01-04Clinical Radiology2012-01-04676S0009-9260(12)X0005-9Original Papers553559http://www.clinicalradiologyonline.net/article/PIIS0009926011005277/abstract?rss=yesAim: To determine the agreement and diagnostic accuracy of three-dimensional gadolinium-enhanced magnetic resonance venography (3D-Gd-MRV) in central venous steno-occlusive disease (CVSD) in haemodialysis patients.Materials and methods: Fourteen consecutive haemodialysis patients underwent interventional procedures to evaluate or treat CVSD. 3D-Gd-MRV was performed before the procedures and the results were compared with digital subtraction angiography (DSA).Results: DSA showed >50% stenosis in all 14 patients, 13 of whom were diagnosed correctly using 3D-Gd-MRV. Moderate stenosis was missed at 3D-Gd-MRV in one case whereby the indwelling dialysis central venous catheter may have caused an artefact on the images and hindered the accuracy of the result. The sensitivity of 3D-Gd-MRV in revealing stenosis was 93% (13/14). No complications caused by contrast agent toxicity occurred in any patient.Conclusion: 3D-Gd-MRV employing a non-breath-hold technique is highly sensitive in the diagnosis of CVSD and may be an alternative technique to DSA for the visualization of central veins.Three-dimensional gadolinium-enhanced MR venography to evaluate central venous steno-occlusive disease in hemodialysis patientsK. Gao, H. Jiang, R.Y. Zhai, J.F. Wang, B.J. Wei, Q. Huang10.1016/j.crad.2011.11.010Clinical Radiology 67, 6 (2012)2012-01-04Clinical Radiology2012-01-04676S0009-9260(12)X0005-9Original Papers560563http://www.clinicalradiologyonline.net/article/PIIS0009926012000049/abstract?rss=yesAims: PET-CT scans are routinely performed in patients with lung cancer after investigation by chest x-ray (CXR) and CT scan, when these have demonstrated potentially curable disease. If the majority of patients with lung cancer potentially suitable for curative treatment could be identified earlier in the diagnostic pathway on the basis of CXR findings they could be referred for PET-CT imaging without a prior CT scan. We investigated the clinical and financial implications of adopting such a strategy.Materials and methods: The details of 1187 patients referred with suspected lung cancer between July 2006 and August 2009 were analysed. The initial CXR and subsequent imaging of patients fit for curative treatment (Performance Status 0/1, FEV1 > 1.0) were reviewed (n = 251). The clinical and financial implications of referring patients for first line PET-CT if deemed potentially curable based on CXR findings were assessed.Results: 107 of 1187 patients had potentially curable lung cancer on PS, lung function, CT and PET-CT. 96 of these 107 patients (90%) were correctly identified on CXR. 149 patients overall were diagnosed as potentially curable on CXR. Referring suitable patients for an immediate PET-CT scan resulted in a reduction in the time to complete staging investigations.Conclusions: Early PET-CT scanning for patients with suspected lung cancer, potentially suitable for curative therapy could result in more efficient staging with little additional cost.A proposed new imaging pathway for patients with suspected lung cancerR. Macpherson, R. Benamore, N. Panakis, R. Sayeed, D. Breen, K. Bradley, R. Carter, D. Baldwin, J. Craig, F. Gleeson10.1016/j.crad.2011.10.032Clinical Radiology 67, 6 (2012)2012-02-02Clinical Radiology2012-02-02676S0009-9260(12)X0005-9Original Papers564573http://www.clinicalradiologyonline.net/article/PIIS0009926012000438/abstract?rss=yesAim: To evaluate the occurrence of alterations to diagnostic information from radiological studies, which are altered by person-to-person communication and/or faulty recall, and whether they affect patient managementMaterials and methods: A structured telephone survey was conducted at a large tertiary care medical centre of house staff managing inpatients who had undergone chest, abdominal, or pelvic computed tomography (CT) or magnetic resonance imaging (MRI) and remained in the hospital at least 2 days later. Fifty-six physicians were surveyed regarding 98 patient cases. Each physician was asked how he or she first became aware of the results of the study. Each was then asked to recall the substance of radiological interpretation and to compare it with the radiology report. Each was then asked to assess the level of difference between the interpretations and whether management was affected. Results were correlated with the route by which interviewees became aware of the report, the report length, and whether the managing service was medical or surgical.Results: In nearly 15% (14/98) of cases, differences between the recalled and official results were such that patient management could have been (11.2%) or had already been affected (3.1%). There was no significant correlation between errors and either the route of report communication or the report length.Conclusion: There was a substantial rate of error in the recall and/or transmission of diagnostic radiological information, which was sufficiently severe to affect patient management.Management-changing errors in the recall of radiologic results — A pilot studyM. Brus-Ramer, V. Yerubandi, J.H. Newhouse10.1016/j.crad.2011.07.054Clinical Radiology 67, 6 (2012)2012-03-01Clinical Radiology2012-03-01676S0009-9260(12)X0005-9Original Papers574578http://www.clinicalradiologyonline.net/article/PIIS0009926011004600/abstract?rss=yesExtrahepatic cholangiocarcinoma (CCA) is a primary bile duct malignant tumour with poor prognosis. Familiarity with their varied imaging characteristics can be helpful in developing a correct diagnosis and in optimal treatment planning, and thus contribute to a better prognosis. The purpose of this article is to illustrate the typical appearances of extrahepatic CCA on magnetic resonance cholangiopancreatography (MRCP) and three-dimensional (3D) LAVA (liver acquisition with volume acceleration) sequences at 3 T magnetic resonance imaging (MRI), and to discuss the superiority of the two techniques in the diagnosis of CCA.MRCP and 3D LAVA imaging of extrahepatic cholangiocarcinoma at 3 T MRIN. Li, C. Liu, W. Bi, X. Lin, H. Jiao, P. Zhao10.1016/j.crad.2011.10.016Clinical Radiology 67, 6 (2012)2011-12-05Clinical Radiology2011-12-05676S0009-9260(12)X0005-9Pictorial Reviews579586http://www.clinicalradiologyonline.net/article/PIIS0009926011004995/abstract?rss=yesRespiratory disease is a significant cause of morbidity and mortality amongst patients with primary immunodeficiency disorders. Computed tomography (CT) plays an important role in the multidisciplinary approach to these conditions, in detecting, characterizing, and quantifying the extent of lung damage and in directing treatment. The aim of this review is to classify the primary immunodeficiency disorders and describe the thoracic complications and the associated CT findings whilst discussing the role of radiology in diagnosis and surveillance.Respiratory disease in common variable immunodeficiency and other primary immunodeficiency disordersF.A. Hampson, A. Chandra, N.J. Screaton, A. Condliffe, D.S. Kumararatne, A.R. Exley, J.L. Babar10.1016/j.crad.2011.10.028Clinical Radiology 67, 6 (2012)2012-01-09Clinical Radiology2012-01-09676S0009-9260(12)X0005-9Pictorial Reviews587595http://www.clinicalradiologyonline.net/article/PIIS0009926011005198/abstract?rss=yesThe purpose of this article is to review and illustrate the spectrum of computed tomography (CT) appearances of abdominal tuberculosis. Tuberculosis can affect any organ or tissue in the abdomen, and can be mistaken for other inflammatory or neoplastic conditions. The most common sites of tuberculosis in the abdomen include lymph nodes, genitourinary tract, peritoneal cavity and gastrointestinal tract. The liver, spleen, biliary tract, pancreas and adrenals are rarely affected, but are more likely in HIV-seropositive patients and in miliary tuberculosis. This article should alert the radiologist to consider abdominal tuberculosis in the correct clinical setting to ensure timely diagnosis and enable appropriate treatment.CT appearances of abdominal tuberculosisW.-K. Lee, F. Van Tonder, C.J. Tartaglia, C. Dagia, R.L. Cazzato, V.A. Duddalwar, S.D. Chang10.1016/j.crad.2011.11.003Clinical Radiology 67, 6 (2012)2012-01-04Clinical Radiology2012-01-04676S0009-9260(12)X0005-9Pictorial Reviews596604http://www.clinicalradiologyonline.net/article/PIIS0009926011005228/abstract?rss=yesThe aim of this article is to illustrate the spectrum of disease visualized at small bowel magnetic resonance imaging (MRI) in the district general hospital (DGH) setting. The advantages and disadvantages of small bowel MRI, technique, and service implementation are discussed.Small bowel MRI imaging in the DGH — Are you doing it yet?C. Lee-Elliott, R. Ayer10.1016/j.crad.2011.11.006Clinical Radiology 67, 6 (2012)2012-01-09Clinical Radiology2012-01-09676S0009-9260(12)X0005-9Pictorial Reviews605612http://www.clinicalradiologyonline.net/article/PIIS0009926012000037/abstract?rss=yesAt computed tomography (CT) the halo sign represents ground-glass attenuation surrounding a pulmonary nodule or mass on thin-section CT and is associated with a range of pathological entities. The sign is non-specific and the most common neoplastic cause is bronchoalveolar cell carcinoma. We report a rare manifestation of the halo sign due to a squamous cell carcinoma of the lung, and to the authors’ knowledge, this is the first case evolving from a non-solid (pure ground-glass) lesion.The CT halo sign: A rare manifestation of squamous cell carcinoma of the lungS.S. Kaneria, J. Tarkin, G. Williams, G. Bain, M. Quigley10.1016/j.crad.2011.11.012Clinical Radiology 67, 6 (2012)2012-03-22Clinical Radiology2012-03-22676S0009-9260(12)X0005-9Case Reports613615http://www.clinicalradiologyonline.net/article/PIIS0009926012000335/abstract?rss=yesLeiomyomas are by far the most common uterine tumours; they occur in more than 20% of women older than 30 years. We describe a very unusual case of retroperitoneal spread of a uterine leiomyoma with myxoid degeneration mimicking the presence of a retroperitoneal myxoid sarcoma. To the authors’ knowledge no other similar case has been reported in literature.Retroperitoneal growth of degenerated myxoid uterine leiomyoma mimicking sarcomaS. Mazziotti, G. Ascenti, S. Racchiusa, A. Mileto, M. Gaeta10.1016/j.crad.2011.12.008Clinical Radiology 67, 6 (2012)2012-02-16Clinical Radiology2012-02-16676S0009-9260(12)X0005-9Case Reports616617http://www.clinicalradiologyonline.net/article/PIIS0009926012000414/abstract?rss=yesSir — We read with great interest the article by Malone et al. dealing with the association between “bovine arch” and thoracic aortic aneurysm. The authors reported an association between bovine arch and aortic dilation in older patients, and when dilation involves the aortic arch. In our opinion, highlighting certain issues would add to the value of this manuscript.Re: Bovine aortic arch: A novel association with thoracic aortic dilationS. Yildiz, N. Boyacı, O. Karakas, E. Karakas, H. Cece10.1016/j.crad.2012.01.002Clinical Radiology 67, 6 (2012)2012-06-01Clinical Radiology2012-06-01676S0009-9260(12)X0005-9Correspondence618618http://www.clinicalradiologyonline.net/article/PIIS0009926012000426/abstract?rss=yesWe very much appreciate the interest in our recent publication regarding the bovine aortic arch and dilation of the thoracic aorta. We agree that the term “bovine arch” is problematic and, of course, a misnomer as it does not represent the arch anatomy seen in cattle; however, the term has staying power. It is commonly used and widely understood, perhaps because it is more concise and less cumbersome than a proper anatomical description of the aortic arch variant.Response to Letter to the EditorMichael D. Hope10.1016/j.crad.2012.01.003Clinical Radiology 67, 6 (2012)2012-06-01Clinical Radiology2012-06-01676S0009-9260(12)X0005-9Correspondence618618http://www.clinicalradiologyonline.net/article/PIIS000992601200133X/abstract?rss=yesNotices10.1016/S0009-9260(12)00133-XClinical Radiology 67, 6 (2012)2012-06-01Clinical Radiology2012-06-01676S0009-9260(12)X0005-9IIV