Clinical Radiology - Articles in Press

Ketamine-associated lower urinary tract destruction: a new radiological challenge - Corrected Proof

K. Mason, A.M. Cottrell, A.G. Corrigan, D.A. Gillatt, A.E. Mitchelmore — 2010-07-30

Aim: Ketamine is a short-acting dissociative anaesthetic whose hallucinogenic side effects have led to an increase in its illicit use amongst club and party goers. There is a general misconception amongst users that it is a safe drug with few long term side effects, however ketamine abuse is associated with severe urinary tract dysfunction. Presenting symptoms include urinary frequency, nocturia, dysuria, haematuria and incontinence.Materials and methods: We describe the radiological findings found in a series of 23 patients, all with a history of ketamine abuse, who presented with severe lower urinary tract symptoms (LUTS). Imaging techniques used included ultrasonography (US), intravenous urography (IVU), and computed tomography (CT). These examinations were reviewed to identify common imaging findings. All patients with positive imaging findings had also undergone cystoscopy and bladder wall biopsies, which confirmed the diagnosis. The patients in this series have consented to the use of their data in the ongoing research into ketamine-induced bladder pathology.Results: Ultrasound demonstrated small bladder volume and wall thickening. CT revealed marked, generalized bladder wall thickening, mucosal enhancement, and perivesical inflammation. Ureteric wall thickening and enhancement were also observed. In advanced cases ureteric narrowing and strictures were identified using both CT and IVU. Correlation of clinical history, radiological and pathological findings was performed to confirm the diagnosis.Conclusion: This case series illustrates the harmful effects of ketamine on the urinary tract and the associated radiological findings. Delayed diagnosis can result in irreversible renal tract damage requiring surgical intervention. It is important that radiologists are aware of this emerging clinical entity as early diagnosis and treatment are essential for successful management.

Corrected Proof

H.H. Tam — 2010-07-30

Ultrasound images are often perceived by clinicians and new radiology trainees as being difficult to interpret, due to the unfamiliarity of the anatomy depicted. This difficulty is compounded by the ability of the operator to obtain ultrasound images freely in any scan plane rather than the axial, coronal, sagittal planes typically offered by conventional computed tomography (CT) and magnetic resonance imaging (MRI)—an advantage in experienced hands but an obstacle for newcomers to the technique. Diagnostic and surgical imaging anatomy: ultrasound by Ahuja et al. is an invaluable aid in overcoming this obstacle.

Re: Measurement of defect angle in superior semicircular canal dehiscence. A reply - Corrected Proof

G. Lip, D.M. Nichols — 2010-07-30

We read with interest Dr Boeddinghaus’s letter regarding our paper and are grateful for the informative contribution clarifying details of the technique used in the studies undertaken by his group, which were based on wider larger experience than ours.

Incidental bony pathology when reporting trauma orthopantomograms - Corrected Proof

M. Macanovic, S. Gangidi, G. Porter, S. Brown, D. Courtney, J. Porter — 2010-07-30

Radiologists frequently report orthopantomograms (OPTs) and other views of the mandible, most often in patients who have suffered facial trauma. These examinations may reveal incidental pathology. It is important that radiologists are aware of the radiological appearances and the clinical significance of these lesions. In this review we will present examples of the more common odontogenic lesions including: radicular cyst, odontogenic keratocyst, dentigerous cyst, ameloblastoma, and also examples of non-odontogenic pathology: bisphosphonate-related osteonecrosis of the jaw (BRONJ) and chronic osteomyelitis. Although some of the lesions will require computed tomography (CT) or magnetic resonance imaging (MRI) for further lesion characterization and evaluation of the surrounding tissues, we are going to focus on the plain film appearances. We will also briefly discuss the pathogenesis, epidemiology, and treatment of these lesions.

Re: Measurement of defect angle in superior semicircular canal dehiscence - Corrected Proof

R. Boeddinghaus — 2010-07-30

Sir—I was interested to read the Technical Report by Lip and Nichols in the Journal. As the radiologist involved in two recent studies looking at the importance of the size of the dehiscence (one of which Lip and Nichols referred to), I feel bound to reply and explain the reasons for choosing a simple linear measurement of the size of the dehiscence. Alternative methods considered were to measure the angle subtended by the arc of the dehiscent segment (as these authors have done), or the (curvilinear) length along the segment of the circumference of the canal.

Prospective ECG triggering versus low-dose retrospective ECG-gated 128-detector CT coronary angiography: comparison of image quality and radiation dose - Corrected Proof

Q. Feng, Y. Yin, X. Hua, R. Zhu, J. Hua, J. Xu — 2010-07-23

Aim: To evaluate image quality and radiation dose for 128-detector prospective electrocardiogram (ECG)-gated computed tomography coronary angiography (CTCA) compared with a low-dose retrospective ECG-gated imaging protocol.Materials and methods: Thirty-one and 47 patients suspected of having coronary artery disease were enrolled into groups examined using prospective and low-dose retrospective ECG-gated CT protocols respectively. All examinations were performed on a 128-detector CT system (Definition AS, Siemens Healthcare, Forchheim, Germany). Prospective CTCA was performed using following parameters: tube voltage 100kV; tube current 205mAs; centre of acquisition window 70% of the RR interval. The tube current for low-dose retrospective ECG-gated CTCA was full dose during 40–70% of the RR interval and partial dose for the rest of RR interval. The pitch varied between 0.2 and 0.5 depending on heart rate and patient size. Image quality of coronary arteries was evaluated using a four-point grading scale. The signal-to-noise ratios (SNRs) of enhanced arteries and myocardium were also measured, corresponding contrast-to-noise ratios (CNRs) were calculated, and the radiation doses received were recorded.Results: There was a significant difference in the image quality scores between the retrospective and prospective gating protocols (Chi-square=15.331, p=0.009). There was no significant difference between the SNRs of the contrasted artery and myocardium in these two groups, but the CNRs were increased in the prospective group. The mean radiation dose of prospective gating group was 2.71±0.67mSv (range, 1.67–3.59mSv), which was significantly lower than that of the retrospective group (p<0.001).Conclusion: Prospective CT angiography can achieve lower radiation dose than that of low-dose retrospective CT angiography, with preserved image quality.

Into the sunset - Corrected Proof

Bob Bury — 2010-07-23

The past four years have, predictably, passed very quickly — it seems like only yesterday that I was thanking David Hansell for his kind words on handing over to me. I am pleased to confirm that my successor in the editorial chair will be Professor Derrick Martin. Derrick is highly-regarded in the fields of radiology research and teaching, and is now into his second term as a member of the Editorial Board. He will be well-known to most readers, particularly those with an interest in gastrointestinal radiology. I have no doubt that his editorial, research, and publishing skills and experience will be of enormous benefit to the Journal over the next 4 years.

Unusual appearance of bowel anastomosis staple line mimicking a retained surgical swab - Corrected Proof

S. Mathur, M. Madan, K. Uzoka — 2010-07-22

Intra-operatively retained surgical sponges are a cause of both medical and medico-legal problems. Unresolving postoperative sepsis associated with a suspicious radiological finding raises the possibility of a retained surgical sponge. Computed tomography (CT) is the technique of choice for recognition of retained sponges, although the appearance can be highly variable. On imaging, a retained surgical sponge can be mimicked by radio-opaque materials intentionally employed during operation, making it important for radiologists and surgeons to be aware of them.

MRI findings in the painful hemiplegic shoulder - Corrected Proof

D.G.F. Távora, R.L. Gama, R.C. Bomfim, M. Nakayama, C.E.P. Silva — 2010-07-22

Aim: To evaluate the magnetic resonance imaging (MRI) findings in painful hemiplegic shoulder (PHS) in hemiplegic post-stroke patients.Materials and methods: Patients with hemiplegia following their first cerebrovascular accident who were admitted to the Sarah Network of Hospitals for Rehabilitation were studied. Forty-five patients with pain in the hemiplegic shoulder and 23 post-stroke patients without shoulder pain were investigated. MRI and radiographic findings of the hemiplegic and contralateral asymptomatic shoulders were evaluated.Results: Some MRI findings were more frequent in PHS group, including synovial capsule thickening, synovial capsule enhancement, and enhancement in the rotator cuff interval.Conclusions: Adhesive capsulitis was found to be a possible cause of PHS.

Correlation between kinking and coiling of the carotid arteries as assessed using MDCTA with symptoms and degree of stenosis - Corrected Proof

L. Saba, G. Mallarini — 2010-07-21

Aim: To evaluate whether the presence of kinking and coiling of the carotid arteries is associated with symptoms and an increased degree of carotid artery stenosis.Materials and methods: One hundred and fifty-three consecutive patients examined using multidetector-row computed tomography angiography (MDCTA) were studied retrospectively. The arterial phase was obtained by injecting 4–6ml/s of contrast material. A total of 306 carotid arteries were assessed for the presence of tortuosity. The degree of carotid artery stenosis was measured according to North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Logistic regression analysis was performed to determine whether an independent association existed between the presence of vessel tortuosity, symptoms, and the degree of carotid artery stenosis.Results: Kinking was detected on 37 occasions (12.1%) and coiling on 20 occasions (6.5%). Using Yates’s corrected chi-square test, an association between kinking and symptoms (p=0.002) was observed, but not between coiling and symptoms (p=0.31). Logistic regression confirmed that the strongest association was present between stenosis degree and symptoms (p=0.001), but kinking (p=0.009) and age (p=0.001) were also significantly associated with symptoms. A Mann–Whitney test did not demonstrate correlation between coiling (p=0.16) or kinking (p=0.22) and increased degree of carotid artery stenosis.Conclusion: The results suggest that kinking may be associated with symptoms, whereas coiling does not appear to be associated with symptoms. The degree of carotid artery stenosis severity is not related to the presence of vessel tortuosity.

CT and MRI findings of cirrhosis-related benign nodules with ischaemia or infarction after variceal bleeding - Corrected Proof

Y.K. Kim, G. Park, C.S. Kim, Y.M. Han — 2010-07-21

Aim: To present computed tomography (CT) and magnetic resonance imaging (MRI) findings of cirrhosis-related benign nodules with ischaemia or infarction.Materials and methods: Sixteen consecutive patients (14 men and two women) who had been diagnosed with cirrhosis-related benign nodules with ischaemia or infarction after variceal bleeding based on the results of dynamic CT (n=15) and MRI (n=8) were included in this study. Five patients had histopathological confirmation via liver transplantation (n=2) and percutaneous biopsy (n=3). Images were analyzed for the enhancement pattern, signal intensities, location, and configuration of the lesions.Results: Most of the lesions were depicted as multifocal discrete or clustered nodules with some irregular patchy areas (size range 3–28mm). They were predominantly found in subcapsular area or caudate lobe. Most nodular lesions were seen as hypoattenuating (hypointense) nodules with rim enhancement during dynamic CT or MRI. On T2-weighted images, nodular lesions were predominantly seen as target appearing hyperintense nodules. On follow-up images (range 2–24 months), most of the lesions disappeared or decreased in size.Conclusion: CT and MRI can be used to demonstrate characteristic findings of cirrhosis-related benign nodules with ischaemia or infarction. Rapid resolution of the nodules at follow-up imaging can also be helpful for diagnosing these lesions.

Detection of coronary artery anomalies by dual-source CT coronary angiography - Corrected Proof

Z. Cheng, X. Wang, Y. Duan, L. Wu, D. Wu, C. Liang, C. Liu, Z. Xu — 2010-07-21

Aim: To retrospectively evaluate the clinical value of dual-source computed tomography (DSCT) coronary angiography in the diagnosis of coronary artery anomalies.Materials and methods: A large cohort of 3625 consecutive patients, who underwent DSCT coronary angiography in our institute, was reviewed for coronary artery anomalies. All images were evaluated by two experienced readers using axial source images, multi-planar reformations (MPR), maximum intensity projections (MIP) and volume rendering (VR). Coronary artery anomalies were found in 36 patients (male 20, female 16, mean age 48 years, range 15–76 years). Of the 36 patients, 19 patients also underwent conventional coronary angiography (CCA).Results: The incidence of coronary artery anomalies was 0.99% (36/3625). Six different types of coronary artery anomalies were diagnosed by DSCT coronary angiography: (1) 11 anomalies of the right coronary artery; (2) five anomalies of the left coronary artery; (3) 10 anomalies of the left circumflex artery; (4) two single coronary artery; (5) one anomalous pulmonary origin of the coronary artery; (6) seven coronary artery fistula. Evaluation of the CCA resulted in a precise diagnosis in 53% (10/19) patients.Conclusion: DSCT coronary angiography is a good diagnostic tool to examine coronary artery anomalies.

Diagnostic precision of CT in local staging of colon cancers: a meta-analysis - Corrected Proof

S. Dighe, S. Purkayastha, I. Swift, P.P. Tekkis, A. Darzi, R. A’Hern, G. Brown — 2010-07-12

Aim: To determine the accuracy of computed tomography (CT) in detecting disease with invasion beyond the muscularis propria (MP) and malignant lymph nodes.Materials and methods: A literature search of Ovid, Embase, the Cochrane database, and Medline using Pubmed, Google™ Scholar and Vivisimo™ search engines was performed to identify studies reporting on the accuracy of CT to predict the staging of colonic tumours. Publication bias was demonstrated by Funnel plots. The sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated using a bivariate random effects model and hierarchical summary operating curves (HSROC) were generated.Results: Nineteen studies fulfilled all the necessary inclusion criteria. The pooled sensitivity, specificity, DOR for detection of tumour invasion were 86% (95% CI: 78–92%); 78% (95% CI: 71–84%); 22.4 (95% CI: 11.9–42.4). Similarly, the values for nodal detection were 70% (95% CI: 63–73%); 78% (95% CI: 73–82%); 8.1(95% CI: 4.7–14.1). In the subgroup analysis, the best results were obtained in studies utilizing multidetector CT (MDCT).Conclusion: Preoperative staging CT accurately distinguishes between tumours confined to the bowel wall and those invading beyond the MP; however, it is significantly poorer at identifying nodal status. MDCT provides the best results.

Imaging of skull-base cephalocoeles and cerebrospinal fluid leaks - Corrected Proof

S.E.J. Connor — 2010-07-12

Skull-base cephalocoeles and cerebrospinal fluid (CSF) leaks may be congenital, spontaneous, or secondary. A classification of congenital lesions is formulated and the imaging features are illustrated. The concept of spontaneous skull-base CSF leaks and the significance of aberrant arachnoid granulations in imaging these patients are explored. The majority of secondary lesions relate to trauma; however, other potential causes of secondary skull-base cephalocoeles and CSF leaks are discussed. Imaging evaluation in these clinical scenarios may be complex and the role of each imaging method is reviewed.

Corrected Proof

A. Horton, G. Munneke — 2010-07-12

Another readable slim hardback to complement the series. This 181 page volume edited by David MacVicar showcases the talent the Royal Marsden Hospital has to offer. There are 10 chapters covering pathology, clinical features, staging, imaging of metastases, surgery, radiotherapy, chemotherapy, clinical follow-up and imaging of treated cancer. There are contributions from radiation and medical oncologists, surgeons, pathologists, and radiologists, with the editor contributing two chapters. The text is very well written and edited, and is a joy to read. It is well structured and organized, and there are numerous specific sections dedicated to answering questions of importance to all reporting radiologists. The chapter on diagnosis illustrates this point, with concise sections on the relative merits of all imaging methods in diagnosis including an up-to-date comment on virtual cystoscopy. In addition there is a worthwhile section on imaging characteristics of different histological subtypes. This and all the other imaging chapters (of which there are three) are expertly illustrated with relevant, high-quality radiological images.

CT findings in autoimmune pancreatitis: assessment using multiphase contrast-enhanced multisection CT - Corrected Proof

K. Suzuki, S. Itoh, T. Nagasaka, H. Ogawa, T. Ota, S. Naganawa — 2010-07-12

Aim: To assess the spectrum of findings using multiphase contrast-enhanced computed tomography (CT) in patients with autoimmune pancreatitis (AIP).Materials and methods: Fifty patients (four female and 46 male, mean age 65 years) were retrospectively identified from consecutive patients with abnormal CT findings of the pancreas and negative work-up for known causes. These patients had at least one finding supporting the diagnosis of AIP: serological abnormality, histopathological abnormality, or response to steroid. Two radiologists evaluated multiphase contrast-enhanced CT images in consensus.Results: The pancreas showed diffuse enlargement (n=16; 32%), focal enlargement (n=18; 36%), or no enlargement (n=16; 32%). Forty-nine (98%) patients showed abnormal contrast enhancement in the affected pancreatic parenchyma, including hypoattenuation during the pancreatic phase (n=45; 90%) and hyperattenuation during the delayed phase (n=39; 87%). The following findings were also seen in the pancreas: a capsule-like rim (n=24; 48%); no visualization of the main pancreatic duct lumen (n=48; 96%); ductal enhancement (n=26; 52%); upstream dilatation of the main pancreatic duct (n=27; 54%); upstream atrophy of the pancreatic parenchyma (n=27; 54%); calcification (n=7; 14%); and cysts (n=5; 10%). Forty-two (84%) patients showed one or more of the following extrapancreatic findings: biliary duct or gallbladder abnormality (n=40; 80%); peripancreatic (n=8; 16%) or para-aortic (n=10; 20%) soft-tissue proliferation; and renal involvement (n=15; 30%).Conclusion: Patients with AIP presented with a variety of CT findings in the pancreas and the extrapancreatic organs. The present study highlights pancreatic ductal enhancement in a subset of patients with AIP.

The MRI appearances of early vertebral osteomyelitis and discitis - Corrected Proof

J.A.T. Dunbar, J.A.T. Sandoe, A.S. Rao, D.W. Crimmins, W. Baig, J.J. Rankine — 2010-07-08

Aim: To describe the magnetic resonance imaging (MRI) appearances in patients with a clinical history suggestive of vertebral osteomyelitis and discitis who underwent MRI very early in their clinical course.Materials and methods: A retrospective review of the database of spinal infections from a spinal microbiological liaison team was performed over a 2 year period to identify cases with clinical features suggestive of spinal infection and an MRI that did not show features typical of vertebral osteomyelitis and discitis. All patients had positive microbiology and a follow up MRI showing typical features of spinal infection.Results: In four cases the features typical of spinal infection were not evident at the initial MRI. In three cases there was very subtle endplate oedema associated with disc degeneration, which was interpreted as Modic type I degenerative endplate change. Intravenous antibiotic therapy was continued prior to repeat MRI examinations. The mean time to the repeat examination was 17 days with a range of 8–22 days. The second examinations clearly demonstrated vertebral osteomyelitis and discitis.Conclusion: Although MRI is the imaging method of choice for vertebral osteomyelitis and discitis in the early stages, it may show subtle, non-specific endplate subchondral changes; a repeat examination may be required to show the typical features.

Cardiac and pericardial calcifications on chest radiographs - Corrected Proof

E.C. Ferguson, E.A. Berkowitz — 2010-07-01

Many types of cardiac and pericardial calcifications identified on chest radiographs can be recognized and distinguished based on characteristic locations and appearances. The purpose of this review is to emphasize the importance of detecting cardiac and pericardial calcifications on chest radiographs, and to illustrate and describe the various types of calcifications that may be encountered and how they may be differentiated from one another. Each type of cardiac and pericardial calcification is discussed, its location and appearance described, and its significance explained. Recognizing and understanding these calcifications is important as they are often encountered in daily practice and play an important role in patient care.

Characterization of liver metastases: the efficacy of biphasic magnetic resonance imaging with ferucarbotran-enhancement - Corrected Proof

H.S. Hong, J.H. Byun, H.J. Won, K.W. Kim, S.S. Lee, M.G. Lee, S.C. Yun — 2010-06-28

Aim: To retrospectively evaluate the efficacy of biphasic magnetic resonance imaging (MRI) of the liver with ferucarbotran-enhancement for the characterization of hepatic metastases.Materials and methods: Thirty-six patients underwent MRI of the liver with separate acquisition of double-contrast enhancement consisting of gadolinium and ferucarbotran. A total of 106 focal hepatic lesions (51 metastases, 31 cysts, 23 haemangiomas, and one eosinophilic abscess) were included. Two sets of MRI were analysed: (1) ferucarbotran set: ferucarbotran-enhanced T1-weighted (T1W) dynamic imaging combined with ferucarbotran-enhanced T2∗-weighted (T2∗W) delayed imaging and (2) double set: gadolinium-enhanced T1W dynamic imaging combined with ferucarbotran-enhanced T2∗W delayed imaging. The diagnostic accuracy of the two sets was evaluated using alternative free-response receiver operating characteristic curve analysis. Sensitivity and specificity were compared using the McNemar test. The enhancement pattern of focal hepatic lesions was analysed on gadolinium and ferucarbotran-enhanced T1W dynamic imaging.Results: There was no significant difference in the accuracy of characterizing hepatic metastases between the two sets. Sensitivity and specificity were not significantly different between the sets (p>0.05). Peripheral rim enhancement was exhibited in 57% of metastatic lesions on ferucarbotran-enhanced T1W dynamic imaging. The majority (96%) of hepatic haemangiomas demonstrated typical peripheral nodular enhancement with progression on ferucarbotran-enhanced T1W dynamic imaging and were easily differentiated from metastases.Conclusion: Biphasic MRI of the liver with ferucarbotran-enhancement alone provided comparable diagnostic efficacy to double-contrast MRI for the characterization of hepatic metastases.

Distribution of abdominal adipose tissue as a predictor of hepatic steatosis assessed by MRI - Corrected Proof

2010-06-21

Aim: To evaluate the relationship between the distribution of visceral and subcutaneous adipose tissue and hepatic steatosis assessed using magnetic resonance imaging (MRI).Materials and methods: One T1-weighted, in-/out-of-phase, single-section sequence at the L3/L4 level and one multi-echo gradient MRI (MGRE) sequence were performed on 65 patients [19 females and 46 males; age 57±9.5 years; body mass index (BMI) 31±5.1kg/m2]. Visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) surfaces, and hepatic steatosis were automatically calculated using in-house software. Weight, height, BMI, waist circumference, hip circumference, and waist:hip ratio were recorded. The probability of having a steatosis greater than 10% on MRI was evaluated by receiver operating characteristic (ROC) curves.Results: The anthropometric parameter best correlated to hepatic steatosis was the waist-to-hip ratio (r=0.301). VAT and proportion of VAT were correlated to liver fat content (r=0.307 and r=0.249, respectively). No significant correlations were found for BMI, hip circumference, and SAT. The area under the receiver operating characteristics (AUROCs) for the relationship between liver steatosis and BMI, waist circumference, waist:hip ratio, VAT surface, and proportion of VAT, were respectively 0.52, 0.63, 0.71, 0.73 and 0.75.Conclusion: Adipose tissue distribution is more relevant than total fat mass when assessing the possibility of liver steatosis in overweight patients.

Corrected Proof

A. George, D. Burling — 2010-06-18

The A–Z of abdominal radiology is a new edition to the A–Z series of books and provides a radiological overview of relevant common gastrointestinal, urological, and gynecological conditions. The topics and images included in this publication have been appropriately selected by the authors, making it a comprehensive guide, best aimed at both junior radiology trainees and non-radiology trainees (including both trainee surgeons/physicians and medical students). Information is presented in a clear, unambiguous, and concise manner enabling those readers with very little experience in radiology to rapidly assimilate the salient facts. However, at times we found it a little difficult to determine who would benefit most from this book, for example, there is excessive discussion about characterization of adrenal adenoma (perhaps relevant only to radiologists), whereas we considered there to be a paucity of information about the follow-up of splenic trauma (important for radiologists and non-radiologists alike).

A retrospective analysis of selective internal radiation therapy (SIRT) with yttrium-90 microspheres in patients with unresectable hepatic malignancies - Corrected Proof

2010-06-17

Aim: To evaluate the efficacy and safety of selective internal radiation therapy (SIRT).Materials and methods: A retrospective analysis was undertaken of all patients who underwent SIRT at a single institution. Diagnostic and therapeutic angiograms, computed tomography (CT) images, positron-emission tomography (PET) images, and planar isotope images were analysed. The response to SIRT was analysed using radiological data and tumour markers. Overall survival, complications, and side effects of SIRT were also analysed.Results: The initial 12 patients were included on an intention-to-treat basis, between 21/09/2005 and 07/05/2008. All patients had advanced disease and multiple prior courses of chemotherapy. One patient did not receive yttrium-90 due to complex vascular anatomy; the remaining 11 patients underwent 13 SIRT treatment episodes following work-up angiography. A response was seen using PET in 80% of patients. Using CT, the response of the tumour to therapy in the treated hepatic segments demonstrated a 20% partial response, stable disease in 50%, and progressive disease in 30%. Estimated median survival was 229 days, with 64% of patients still alive at the time of writing. No major complications were observed, although 82% of patients experienced side-effects following SIRT, mainly nausea, vomiting, and abdominal pain.Conclusions: There have been no complications in the 12 SIRT patients. Tumour response was seen in four out of five patients who underwent PET. Objective CT response rates were mixed and are perhaps partially explained by advanced disease and limitations of using measurements to assess response. This complex and potentially hazardous service has been successfully and safely established.

FDG PET/CT in oncology: “raising the bar” - Corrected Proof

C.N. Patel, A.R. Goldstone, F.U. Chowdhury, A.F. Scarsbrook — 2010-06-14

Integrated positron-emission tomography/computed tomography (PET/CT) with 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) has revolutionized oncological imaging in recent years and now has a firmly established role in a variety of tumour types. There have been simultaneous step-wise advances in scanner technology, which are yet to be exploited to their full potential in clinical practice. This article will review these technological developments and explore how refinements in imaging protocols can further improve the accuracy and efficacy of PET/CT in oncology. The promises, and limitations, of emerging oncological applications of FDG PET/CT in radiotherapy planning and therapy response assessment will be explored. Potential future developments, including the use of FDG PET probes in oncological surgery, advanced data analysis techniques, and the prospect of integrated PET/magnetic resonance imaging (PET/MRI) will be highlighted.

Phalangeal fractures of the hand - Corrected Proof

P. Yoong, R.W. Goodwin, A. Chojnowski — 2010-06-14

The present review systematically describes common fractures of the phalanges with reference to the anatomy and the pertinent radiological classifications; in particular, the role of radiology in indicating prognosis, guiding treatment, and revealing subtle injuries, which may cause permanent loss of function.

Multi-technique imaging of sarcoidosis - Corrected Proof

A. Balan, E.T.D. Hoey, F. Sheerin, A. Lakkaraju, F.U. Chowdhury — 2010-06-14

Sarcoidosis is a multisystem granulomatous disorder of unknown aetiology. The diagnosis is suggested on the basis of wide ranging clinical and radiological manifestations, and is supported by the histological demonstration of non-caseating granulomas in affected tissues. This review highlights the multisystem radiological features of the disease across a variety of imaging methods including multidetector computed tomography (CT), magnetic resonance imaging (MRI) as well as functional radionuclide techniques, particularly 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT). It is important for the radiologist to be aware of the varied radiological manifestations of sarcoidosis in order to recognize and suggest the diagnosis in the appropriate clinical setting.

Cardiac drugs used in cross-sectional cardiac imaging: what the radiologist needs to know - Corrected Proof

P. McParland, E.D. Nicol, S.P. Harden — 2010-06-01

The demand for cross-sectional imaging of the heart is increasing dramatically and in many centres these imaging techniques are being performed by radiologists. Although radiologists are familiar with the computed tomography (CT) and magnetic resonance imaging (MRI) techniques to generate high-quality images and with using contrast agents, many are less familiar with administering the drugs necessary to perform CT coronary angiography and cardiac MR reliably. The aim of this article is to give an overview of the indications for and the contraindications to administering cardiac drugs in cross-sectional imaging departments. We also outline the complications that may be encountered and provide advice on how to treat these complications when they occur.

Re: Tuberculosis in the head and neck–a forgotten differential diagnosis - Corrected Proof

N. Venkatanarasimha — 2010-05-24

I read with great interest the comprehensive review article by Vaid et al. on tuberculosis (TB) in the head and neck. I would like to highlight certain key points related to TB lymph nodes in human immunodeficiency virus (HIV)-positive patients started on HAART (highly active antiretroviral therapy), which the authors fail to discuss. The phenomenon referred to as IRIS (immune restoration inflammatory syndrome) is a paradoxical development of new or worsening opportunistic infections or malignancies despite improvements in the surrogate markers of HIV infection and is related to reconstitution of pathogen-specific cellular immunity against antigens that were present previously, but clinically occult. It is usually reported to occur within the first 12 weeks of initiation of therapy with an incidence of 10–20%. The reported incidence of mycobacterial TB (MTB) IRIS lymphadenopathy is up to 37%. Differentiation of MTB IRIS from tuberculosis is important as treatment differs. Patients with MTB IRIS are usually treated with a combination of anti-TB chemotherapy, anti-inflammatory drugs, and possibly immunomodulation. However, the imaging features of the MTB IRIS lymph nodes can be similar to that seen in non-HIV patients. In addition, on imaging alone it may be difficult to differentiate from the other causes of IRIS lymphadenopathy, which include Mycobacterium avium, Cryptococcus, cytomegalovirus, Kaposi’s sarcoma, and lymphoma. The diagnosis is usually confirmed by a combination of clinical history, tissue biopsy, and laboratory results. The radiologists can suggest the diagnosis in the presence of ancillary imaging features, such as evidence of previous pulmonary TB on chest radiography. Finally, abacavir (anti-HIV)-related drug hypersensitivity lymphadenopathy should be considered in the differential diagnosis and distinction from MTB IRIS is essential as misdiagnosis with continued abacavir treatment can be fatal. In these cases, the clinical history and laboratory findings are more important.

Re: Non-invasive evaluation of liver cirrhosis using ultrasound. A reply - Corrected Proof

N. Goyal, N. Jain, V. Rachapalli, D.L. Cochlin, M. Robinson — 2010-05-18

Sir—We are grateful to Fernando and colleagues for providing valuable comments on our recent review of the role of ultrasound in imaging of patients with liver cirrhosis. They have highlighted several important points in relation to ultrasound imaging and we would like to reinforce those. Reduction in liver volume is also seen in patients with subacute liver failure. This emphasizes the importance of assessing several parameters when assessing a patient for liver cirrhosis, including blood tests, rather than relying on a single parameter such as liver size.

Sporadic lymphangioleiomyomatosis with multiple atypical adenomatoid hyperplasia: differentiation from multifocal micronodular pneumocyte hyperplasia - Corrected Proof

H.-H. Cho, S.S. Shim, Y. Kim, W.S. Han — 2010-05-12

Lymphangioleiomyomatosis (LAM), a rare disorder of unknown cause that occurs exclusively in women of childbearing years, is characterized microscopically by abnormal smooth muscle proliferation in the lungs, kidneys, and lymphatic system. A diagnosis of pulmonary LAM is usually made on the basis of clinical history and lung biopsy or computed tomographic (CT) demonstration of pulmonary cysts. The hallmark radiological feature of LAM is well-circumscribed, thin-walled lung cysts; other reported findings in the lung include pneumothorax, thoracic duct dilatation, and pleural effusion. LAM may occur without evidence of other diseases (sporadic LAM) or in conjunction with tuberous sclerosis complex (TSC/LAM). Small, non-calcified pulmonary nodules in LAM have been reported; Avila et al. reported that the frequency of multifocal, non-calcified nodules was higher in TSC/LAM (12%) than in sporadic LAM (1%). The nodules in that study were likely the result of multifocal micronodular pneumocyte hyperplasia (MMPH), although a surgical biopsy was not conducted. To the best of the authors' knowledge, there has been no report of sporadic LAM with atypical adenomatoid hyperplasia (AAH), and only one case of sporadic LAM with bronchioloalveolar carcinoma (BAC) has been described in the literature. Herein, we present a case of pathologically confirmed nodular lesions identified as AAH in a patient with sporadic-type LAM.

The idiopathic interstitial pneumonias: understanding key radiological features - Corrected Proof

S. Dixon, R. Benamore — 2010-05-10

Many radiologists find it challenging to distinguish between the different interstitial idiopathic pneumonias (IIPs). The British Thoracic Society guidelines on interstitial lung disease (2008) recommend the formation of multidisciplinary meetings, with diagnoses made by combined radiological, pathological, and clinical findings. This review focuses on understanding typical and atypical radiological features on high-resolution computed tomography between the different IIPs, to help the radiologist determine when a confident diagnosis can be made and how to deal with uncertainty.

Duplex sonography in the planning and evaluation of arteriovenous fistulae for haemodialysis - Corrected Proof

S.F. Kerr, S. Krishan, R.C. Lapham, M.J. Weston — 2010-05-10

This paper describes how to perform duplex sonography in the planning and evaluation of arteriovenous fistulae in haemodialysis patients, discusses its roles in these settings, and presents a review of commonly encountered complications.

Jejunal leiomyoma with foreign body abscess: computed tomographic findings with pathological correlation - Corrected Proof

S.W. Kim, C.J. Kim, K.-H. Kang, D.J. Jeong — 2010-05-06

Leiomyomas are one of the submucosal tumours that occur in the gastrointestinal tract; they have smooth muscle differentiation microscopically. Leiomyomas can be differentiated from gastrointestinal stromal tumours (GISTs), which are the most common mesenchymal tumours of the gastrointestinal tract, by negative immunoreactivity for c-kit (CD117). A few cases of mesenchymal tumours with abscess formation have been reported in the stomach. However, only one case of an abscess-forming leiomyoma involving the jejunum has been described, in the Italian literature, before the era of computed tomography (CT). There are no prior reports of leiomyoma with abscess formation induced by a foreign body reaction. Here, we describe the multidetector CT (MDCT) findings of a jejunal leiomyoma with a foreign body abscess and correlate them with the pathological findings.

Re: Tuberculosis in the head and neck — A forgotten differential diagnosis. A reply - Corrected Proof

S. Vaid, Y.Y. Lee, S. Rawat, A. Luthra, D. Shah, A.T. Ahuja — 2010-05-05

Dear Sir—We are aware of and see a lot of immune reconstitution syndromes in our clinical practice as the Department of HIV (Human Immunodeficiency Virus) Medicine in the Grant Medical Foundation's Ruby Hall Clinic has functioned as a TREAT Asia (Therapeutics Research, Education, and AIDS Training in Asia) site in India for HIV research for a period of 7 years. The department handles approximately 600 inpatients and 7500 outpatients annually.

Reversed halo sign: nodular wall as criterion for differentiation between cryptogenic organizing pneumonia and active granulomatous diseases - Corrected Proof

E. Marchiori, G. Zanetti, B. Hochhegger, K.L. Irion — 2010-05-04

Sir—The reversed halo sign (RHS) is defined as a focal, rounded area of ground-glass opacity surrounded by a more or less complete ring of consolidation. This sign was described by Kim et al. as a finding that was relatively specific for a diagnosis of cryptogenic organizing pneumonia (COP). However, various authors later demonstrated the presence of this sign in a wide spectrum of diseases, including infectious and non-infectious processes. Therefore, the RHS must be regarded as a non-specific sign that is encountered in various pulmonary diseases. Publications about RHS are restricted to case reports. To the authors’ knowledge, there are no published series seeking to establish criteria for the differential diagnosis between organizing pneumonia and other diseases.

Re: Non-invasive evaluation of liver cirrhosis using ultrasound - Corrected Proof

R.A.M. Fernando, N. Venkatanarasimha, T.J.S. Cross — 2010-04-28

Sir—We read with interest the review by Goyal and colleagues, but feel that some aspects require further comment. First, the authors describe the ultrasound features suggestive of cirrhosis, including liver size. This finding may be misleading as it is also observed in subacute liver failure, in which a reduction in liver volume is an indicator suggestive of poor prognosis. A failure to be aware of this caveat may result in the patient being disadvantaged, and possibly denied a life-saving emergency liver transplant.