Radiology Medical and Health News Headlines

The role of radiology in the management of systemic sclerosis.

Clin Radiol. 2008 Sep;63(9):959-67

Authors: Madani G, Katz RD, Haddock JA, Denton CP, Bell JR

Systemic sclerosis is a multisystem connective tissue disorder. Radiology plays an integral part in its management, guiding the clinician concerning the onset and severity of visceral involvement. After skin involvement, the gastrointestinal tract is the most commonly affected system; contrast radiography and magnetic resonance imaging (MRI) play a role in diagnosis. Non-specific interstitial pneumonia is the most frequent respiratory disease and high-resolution computed tomography (CT) is the cornerstone of management. In common with other rheumatic disorders, the role of cardiac MRI is expanding. Radiography remains the main technique in the investigation of skeletal involvement, although MRI is useful as a problem-solving tool. Neurological involvement is increasingly recognized and the major role of radiology is the exclusion of coexistent pathology. We present a thorough review of the role of radiology in the management of systemic sclerosis.

PMID: 18718225 [PubMed - in process]

Grey-scale and colour Doppler sonography in the evaluation of children with suspected bowel inflammation: correlation with colonoscopy and histological findings.

Clin Radiol. 2008 Sep;63(9):968-78

Authors: Epifanio M, Baldisserotto M, Spolidoro JV, Gaiger A

AIM: To evaluate the correlation of grey-scale and colour Doppler sonography with colonoscopy and histology to detect bowel inflammation in children. MATERIAL AND METHODS: The records of 72 patients with suspected bowel inflammation were reviewed retrospectively. Patients were included in the study if sonography had been performed up to 30 days before colonoscopy. Grey-scale and colour Doppler sonography were used to evaluate bowel wall thickness and vascularity for the detection of distal bowel inflammation. Findings were correlated with colonoscopy and histological findings. The sensitivity and specificity of sonographic wall thickness to detect inflammation was determined. Spearman's coefficient (rs) was used to determine the correlation of Doppler findings with colonoscopy/histology. RESULTS: Sonograms of 372 bowel segments were evaluated and results were correlated with colonoscopy and histological findings of 352 segments. The sensitivity and specificity of sonographic bowel thickness to detect inflammation in the terminal ileum and the right colon were high; in the other segments, specificity was high but sensitivity was low. The correlation of Doppler sonography with colonoscopy and histology to detect inflammation in the terminal ileum was strong (rs: 0.84; p<0.001) and in the other segments, weak to moderate; when the interval between examinations was shorter than 10 days, the correlation was stronger in all segments. Of nine patients with abnormal small bowel sonograms but normal colonoscopies, three had Crohn's disease. CONCLUSION: Sensitivity and specificity of grey-scale sonography to detect inflammation in the terminal ileum and the right colon were high, and the correlation of Doppler with colonoscopy and histology was very strong in the same segments.

PMID: 18718226 [PubMed - in process]

CT-guided percutaneous core biopsy of deep face and skull-base lesions.

Clin Radiol. 2008 Sep;63(9):986-94

Authors: Connor SE, Chaudhary N

AIM: To evaluate the diagnostic accuracy of deep face and skull-base computed tomography (CT)-guided core biopsy. MATERIALS AND METHODS: Seventeen patients underwent CT-guided percutaneous core biopsies of deep face and skull-base lesions. One biopsy was repeated due to a non-diagnostic sample so 18 biopsy procedures were evaluated. The 17 lesions were centred within the central skull base (n=2), parapharyngeal (n=3), retropharyngeal spaces (n=4), masticator (n=3), pterygopalatine fossa (n=1), and deep lobe of parotid (n=4). Subzygomatic (n=7), retromaxillary (n=9), suprazygomatic (n=1), and transparotid (n=1) needle approaches were used. The diagnostic accuracy was either assessed by a positive histological result from the operative specimen or based on treatment response and clinical follow-up. RESULTS: No immediate or delayed procedural complications were encountered. A histological diagnosis was obtained in 16 of the 18 biopsies (89% diagnostic yield). The pathological diagnosis was confirmed by surgical excision (5/18 biopsies) and by predicted treatment response or clinical follow-up (10/18 biopsies). Diagnosis could not be confirmed for three of the 18 biopsies. The diagnostic accuracy of core biopsy was 13 of 15 (87%) for all samples. CONCLUSION: CT-guided percutaneous deep face core biopsy is a safe technique with good diagnostic accuracy, allowing diagnosis of benign disease and classification of malignant disease.

PMID: 18718228 [PubMed - in process]

CT and histopathological correlation of congenital cystic pulmonary lesions: a common pathogenesis?

Clin Radiol. 2008 Sep;63(9):995-1005

Authors: Griffin N, Devaraj A, Goldstraw P, Bush A, Nicholson AG, Padley S

AIM: To determine whether similarities exist in both the imaging and histopathological features of congenital cystic lung lesions and whether a more appropriate classification would be to adopt the theory of "malinosculation". MATERIAL AND METHODS: From the histopathology and computed tomography (CT) database, 24 patients (16 male, median age 3 years) with congenital cystic lung lesions were identified. CT studies were reviewed for site and characteristics of the lesions, parenchymal features, bronchial anatomy, and the presence of a feeding systemic vessel. Individual histopathological parameters were also correlated with CT data. RESULTS: There were five type 1 congenital cystic adenomatoid malformations (CCAMs), six type 2 CCAMs, one type 4 CCAM, one bronchial atresia, four pleuropulmonary blastomas (PPBs), and seven sequestrations. CCAMs (types 1, 2 and 4), sequestrations and PPBs appeared as cystic lesions, with cyst size less than 2cm in type 2 CCAMs. Sequestrations were distinguished radiologically from CCAMs by systemic vessels. Reduced pulmonary attenuation was seen in bronchial atresia, type 2 CCAMs and in sequestrations. Histopathology showed an overlap in entities with sequestrations demonstrating CCAM type 2 histology and segmental atresia noted in both type 2 CCAMs and sequestrations. PPBs showed histological and imaging overlap with type 4 CCAMs and were distinguished on histology by the presence of blastematous proliferation. CONCLUSIONS: This study demonstrates overlap in the CT appearances of congenital cystic lesions. The similarity in CT and histopathology findings across the spectrum of developmental lesions supports the hypothesis of a common aetiology.

PMID: 18718229 [PubMed - in process]

Solid pseudopapillary carcinoma of the pancreas: differentiation from benign solid pseudopapillary tumour using CT and MRI.

Clin Radiol. 2008 Sep;63(9):1006-14

Authors: Lee JH, Yu JS, Kim H, Kim JK, Kim TH, Kim KW, Park MS, Kim JH, Kim YB, Park C

AIM: To describe the computed tomography (CT) and magnetic resonance imaging (MRI) findings that differentiate solid pseudopapillary carcinomas (SPC) from benign solid pseudopapillary tumours (SPT) of the pancreas. MATERIALS AND METHODS: Preoperative CT or MRI images for 26 patients (eight patients with SPC and 18 patients with SPT) were retrospectively reviewed. In addition to the general morphological features, the presence of pancreatic duct dilation, vascular invasion, and extrapancreatic metastases were comparatively assessed. RESULTS: There were no significant differences between pancreatic SPC and benign SPT with respect to tumour size, location, capsule thickness, internal composition, and pattern of calcification, nor was there any correlation with the age and gender of the patients. Pancreatic duct dilation was present in four of the eight (50%) SPC patients, and was absent in all benign SPT patients (p=0.005). Vascular encasement by the tumour (n=2) and hepatic metastases (n=2) were also exclusively demonstrated in SPC patients. Multivariate logistic regression analysis showed that pancreatic duct dilation (p=0.001), vessel encasement (p=0.027), and metastasis (p=0.027) were the variables that can be used to differentiate SPC from benign SPT. CONCLUSION: SPC of the pancreas may help to differentiate from benign SPT using the imaging features of aggressive behaviour of pancreatic duct dilation and vessel encasement with or without extrapancreatic metastases.

PMID: 18718230 [PubMed - in process]

Sex-related differences in the anteroposterior diameter of the foetal cisterna magna.

Clin Radiol. 2008 Sep;63(9):1015-8

Authors: Tao G, Yew DT, Gu T, Liu S, Ma Z, Zhan X, Cheng L, Li C

AIM: To measure the anteroposterior diameter of the foetal cisterna magna and observe whether there are differences according to sex. MATERIALS AND METHODS: Three hundred and thirty-seven Chinese women with low-risk pregnancies and a singleton foetus between 22 and 38 weeks' gestational age were included in this retrospective study. Informed consent of the volunteer subjects and hospital authority approval were first obtained. Double-blinded for gender, the anteroposterior diameter of the cisterna magna of the foetuses was measured by transabdominal sonography. Magnetic resonance imaging (MRI) was used for those foetuses with mega cisterna magna. All of the foetuses were healthy by prenatal and postnatal examination, including physical and imaging examination. RESULTS: The mean anteroposterior diameter of the cisterna magna of all foetuses was 8.01+/-1.79mm. The anteroposterior diameter of the cisterna magna had no obvious correlation with the gestational age. The mean anteroposterior diameter of the cisterna magna of 179 male foetuses was 8.63+/-2.16mm, and the mean anteroposterior diameter of the cisterna magna of 158 female foetuses was 7.87+/-1.74mm. The size difference was statistically significant (p<0.001). In the 33 foetuses with mega cisterna magna, the number of male foetuses was greater than female foetuses, and the proportion of the foetuses with mega cisterna magna in the male group was significantly higher than the foetuses in the female group (p<0.05). CONCLUSION: Male foetuses had slightly larger anteroposterior diameters of the cisterna magna than female foetuses. The study would be useful for creating normal range values for the cisterna magna of male and female foetuses.

PMID: 18718231 [PubMed - in process]

Evaluation of the upper urinary tract using transureteric ultrasound - a review of the technique and typical imaging appearances.

Clin Radiol. 2008 Sep;63(9):1026-34

Authors: Ingram MD, Sooriakumaran P, Palfrey E, Montgomery B, Massouh H

Ureteric strictures and pelviureteric junction obstruction often present a diagnostic conundrum to radiologists, particularly after the first-line investigations have failed to provide a definitive answer. Transureteric ultrasonography (TUU) is a relatively novel technique performed by the radiologist, which uses a miniature endoluminal ultrasound probe to interrogate the ureteric anatomy and peri-ureteric soft tissues. In this review, we discuss how TUU is performed, and the normal imaging appearances of the ureter and surrounding anatomical structures. We also focus on the various pathological processes that can be accurately evaluated or diagnosed using TUU including lymphadenopathy, calculi, ureteric neoplasms, ureteritis, crossing vessels and aneurysms. As TUU is not well established in UK practice as yet, we suggest possible indications for its use in the diagnostic work-up of urological patients and future applications.

PMID: 18718233 [PubMed - in process]

Upright positional MRI of the lumbar spine.

Clin Radiol. 2008 Sep;63(9):1035-48

Authors: Alyas F, Connell D, Saifuddin A

Supine magnetic resonance imaging (MRI) is routinely used in the assessment of low back pain and radiculopathy. However, imaging findings often correlate poorly with clinical findings. This is partly related to the positional dependence of spinal stenosis, which reflects dynamic changes in soft-tissue structures (ligaments, disc, dural sac, epidural fat, and nerve roots). Upright MRI in the flexed, extended, rotated, standing, and bending positions, allows patients to reproduce the positions that bring about their symptoms and may uncover MRI findings that were not visible with routine supine imaging. Assessment of the degree of spinal stability in the degenerate and postoperative lumbar spine is also possible. The aim of this review was to present the current literature concerning both the normal and symptomatic spine as imaged using upright MRI and to illustrate the above findings using clinical examples.

PMID: 18718234 [PubMed - in process]

Upright positional MRI of the lumbar spine.

Clin Radiol. 2008 Sep;63(9):1049-50

Authors: Gedroyc WM

PMID: 18718235 [PubMed - in process]

Three-dimensional perfused blood volume in hyperacute stroke using 64-section MSCT.

Clin Radiol. 2008 Sep;63(9):1051-6

Authors: Lu J, Zhang M, Chen J, Li K

PMID: 18718236 [PubMed - in process]

Overdosage of intrathecal gadolinium and neurological response.

Clin Radiol. 2008 Sep;63(9):1063-8

Authors: Li L, Gao FQ, Zhang B, Luo BN, Yang ZY, Zhao J

PMID: 18718238 [PubMed - in process]

Thickening of the peribronchovascular interstitium secondary to acute thoracic aortic dissection-ECG-gated imaging should be considered.

Clin Radiol. 2008 Sep;63(9):1069-70

Authors: Manghat NE

PMID: 18718239 [PubMed - in process]

Ultrasound diagnosis of fibroadenoma - is biopsy always necessary?

Clin Radiol. 2008 Sep;63(9):1070-1

Authors: Hamilton L, Evans A, Cornford E, James J, Burrell H

PMID: 18718240 [PubMed - in process]

[Automated procedure for volumetric measurement of metastases : Estimation of tumor burden.]

Radiologe. 2008 Aug 23;

Authors: Fabel M, Bolte H

Cancer is a common and increasing disease worldwide. Therapy monitoring in oncologic patient care requires accurate and reliable measurement methods for evaluation of the tumor burden. RECIST (response evaluation criteria in solid tumors) and WHO criteria are still the current standards for therapy response evaluation with inherent disadvantages due to considerable interobserver variation of the manual diameter estimations. Volumetric analysis of e.g. lung, liver and lymph node metastases, promises to be a more accurate, precise and objective method for tumor burden estimation.

PMID: 18719876 [PubMed - as supplied by publisher]