bluuebunny/crossref_metadata_2025 huggingface dataset:
Adjuvant Post‐Operative Radiotherapy in Rectal Cancer: Results from the ANZ Bowel Cancer Trial (Protocol 8202)
Authors: MAMEGHAN HEDY , GRAY BRUCE N. , ZWART JILL , RICHER RICHARD , BURNS IVON , HURLEY RON , IBISTER WILLIAM H. , REASBECK PHILIP , NEWSTEAD GRAHAM
Published: March 2008

In July 1982 the Gastrointestinal Section of The Clinical Oncological Society of Australia began a multicentre randomized trial to assess the value of post‐operative pelvic radiotherapy in the local control of stage B and C carcinoma of the rectum. Patients who had undergone a potentially curative resection were randomized either to no further treatment (NO RT) or to pelvic radiotherapy (RT), 45 Gy in 25 fractions (plus a perineal boost of 5 Gy in 2 fractions after abdomino‐perineal resection).

The trial was prematurely terminated in December 1985 owing to slow accrual after 70 patients had been randomized: 36 patients to RT and 34 patients to NO RT. Two patients in each group were found to be ineligible after randomization and, for a variety of reasons, thirteen patients who were randomized to RT did not receive that treatment. The incidences of post‐operative complications were comparable in both groups, indicating that radiotherapy produced no additional problems. Radiotherapy‐related morbidity comprised mainly diarrhoea (grade 1 = 2/21; grade 2 = 5/21; grade 3 = 0/21; grade 4 = 1/21). There were no deaths due to radiotherapy and only one patient, with grade 4 diarrhoea, failed to complete the prescribed course of radiotherapy. After an average follow‐up period of 52 months there were 15 local recurrences, 8 in the RT group and 7 in the NO RT group, giving an actuarial 2 year local recurrence rate of 16%. There was no difference in the time to local recurrence, either by randomization group (p=0.50) or by actual treatment received (p=0.91). Distant metastases occurred in 25 patients, 12 in the RT group and 13 in the NO RT group. Thirty one patients have died, 26 from cancer, 3 from intercurrent illness without evidence of cancer and two from surgical complications. There was no difference in survival time between the randomized groups: 16 deaths in the RT group and 15 deaths in the NO RT group (p=0.46). The only important factor predictive of local recurrence was age 65 years and over (p=0.002).
The Treatment of Low Grade Cerebral Astrocytomas by Radiotherapy in Queensland
Authors: FRANKLIN C. I. V.
Published: March 2008

The records of 108 adult patients with supratentorial low grade astrocytoma presenting between 1/1/80 and 31/12/87 were examined for the following factors which might affect survival: patient age, extent of surgical resection, site of tumour, tumour grade, radiation field size and radiation dose. Univariate analysis showed that patient age, field size and radiation dose were significant prognostic factors, but with multivariate analysis only patient age and radiation field size were significant independent variables. It is possible that field size is a proxy variable for tumour size.
A Mattress Suitable for Use with Tilting Tables in a Radiology Department
Authors: CAMERON D.
Published: March 2008

It has been possible to design a comfortable, yet highly practical mattress for use in general purpose screening rooms with tilt tables.

Attention has been paid to materials and fittings and because it is easy for the staff to use it is in constant use. It has become an essential part of our equipment and has considerably improved the comfort of many procedures.
Mammographically Detected Microcalcifications Due to Pseudoxanthoma Elasticum
Authors: ALBERTYN LYNDA E. , DREW ANTON C.
Published: March 2008

Mammographic detection and analysis of microcalcification is a key component in the detection of early breast cancer.

A casting configuration or granular morphology has a strong association with malignancy. These are relatively easily recognised, but with the proliferation of mammographic screening, other varieties of calcification are being encountered which may pose diagnostic dilemmas.

This case report describes the findings in a patient with Pseudoxanthoma Elasticum (PXE) who presented in this way. To our knowledge, this has not previously been documented. Such calcification is not usually visible on conventional radiographs.
Sonographic Diagnosis of a Splenic Artery Pseudoaneurysm Incorporated within an Infected Pancreatic Pseudocyst
Authors: KEDAR R. P. , WAGLE A. S. , MERCHANT S. A.
Published: March 2008

In pancreatitis the involvement of adjacent vessels resulting in pseudoaneurysm formation is well known, though quite rare (Gadacz 1978, Kadell & Riley 1967).

The diagnosis is usually established on angiography or surgery. We report here a case where the diagnosis of a splenic artery pseudoaneurysm incorporated within an infected pseudocyst, was made sonographically.
Polyp Masquerading as Orbital Blowout Fracture
Authors: RUBINSTEIN C. , O'NEILL R. , BROWN P.
Published: March 2008

A case report is presented describing an orbital blowout fracture with a coincidental contra‐lateral maxillary polyp masquerading as a second blowout fracture.
M.R.I. Spectrum of Intrinsic Spinal Cord Lesions
Authors: LOW V. , KHANGURE M.S.
Published: March 2008

We report our experience of 42 patients undergoing magnetic resonance imaging (MRI) studies demonstrating intrinsic lesions of the spinal cord, excluding those secondary to spondylosis, trauma or congenital malformations. Histological confirmation of the radiological diagnosis was obtained in 15 (36%). MRI is more sensitive than either myelography or CT. MRI identified a previously non‐visualised lesion in 17 of 30 cases. In a further 13 cases, MRI contributed by identifying associated features such as cysts and haemorrhage which have aided in the diagnosis and management of the patients. The last 12 cases, which were patients with multiple sclerosis, had MRI as the only neuroradiological examination. These illustrate a range of appearances. The overlap of imaging appearances of the various pathologies implies that a useful diagnosis and differential can only be offered by considering the MRI appearances of a lesion, with its associated features, with the clinical presentation, and with other imaging modalities where appropriate.
Testicular Lymphoma ‐ The Need for a New Approach
Authors: POULSEN M.G. , ROBERTS S.J. , TAYLOR K.
Published: March 2008

Thirteen cases of malignant lymphoma of the testis were referred to the Queensland Radium Institute between 1975 and 1989. The age varied from 43 years to 84 years and the histology was intermediate to high grade in all cases. Seven patients had Stage I/II and 6 had Stage III/IV. The 4 year survival was only 16%. Half of the relapses were systemic, 1 was in the paraaortic nodes (unirradiated) and 2 were in the opposite testicle. Adjuvant radiotherapy to paraaortic nodes and mild chemotherapy have produced disappointing results. A new approach using aggressive combination chemotherapy and adjuvant scrotal irradiation is proposed for early stage disease.
Unilateral Breast Edema in Congestive Heart Failure ‐ A Mimic of Diffuse Carcinoma
Authors: DOYLE ANTHONY JAMES
Published: March 2008

Mammography in a patient with congestive heart failure showed unilateral skin thickening and a reticular pattern mimicking diffuse carcinoma. Resolution after treatment of the heart failure established the abnormality as secondary to dependent edema.
Magnetic Resonance Imaging of Peripheral T‐Cell Lymphoma
Authors: YUH W.T.C. , WEN B.C. , ARGENYI Z.B. , MAYR N.A. , MOORE T.E.
Published: March 2008

We report magnetic resonance (MR) findings of two unusual cases of peripheral T‐cell lymphoma, one initially presenting as a soft‐tissue mass in the neck and the other in the foot. MR imaging provides better tissue contrast and lesion delineation than CT. However, MR signal characteristics cannot differentiate this lymphoma from other soft‐tissue tumours. Although it is rare, peripheral T‐cell lymphoma should be included in the differential diagnosis of a soft‐tissue mass.
Cost Considerations in the Provision of Magnetic Resonance Imaging Services
Authors: HAILEY DAVID M. , CROWE BERNARD L.
Published: March 2008

Data from the Australian MRI Assessment Program, which involved five public hospitals, are presented covering the second year of operation at each MRI unit when stable conditions of service provision had become established. The data relate to two 15T super conductive units, one 1.OT super conductive unit and two 0.3T resistive magnetic resonance imaging units. A review of the cost data suggests the need for the operation of expensive facilities for extended periods with careful patient selection in order to reduce the average cost per scan and to maximise the clinical benefit to patients. There were variations in the conditions of use of the equipment between the differing centres and there will be a need for a consensus on optimum levels of matters such as operating times and staffing levels. As the results from the MRI Assessment Program were obtained in a teaching hospital environment with a particular referral pattern, the benefits of the technology in other situations will need further consideration.
MR Imaging of Abdominal Aortic Aneurysm
Authors: LOW V. , KHANGURE M.S.
Published: March 2008

Eight patients with abdominal aortic aneurysms were evaluated with magnetic resonance imaging (MRI). The MRI findings were verified by surgery in five, compared with ultrasonography in eight, with computed tomography in four and with angiography in eight patients. The size and extent of aneurysm, presence of thrombus, size of the residual lumen and involvement of branch vessels were readily demonstrated by MRI. Whilst sonography should remain the screening procedure of choice in patients with suspected abdominal aortic aneurysms, this early experience suggests that MRI may prove to be a noninvasive and adequate means of evaluating patients prior to surgery.
Sonographic Gallbladder Wall Thickening in Children: Association with Acute Hepatitis A
Authors: FOULNER DERYCK
Published: March 2008

Sonographic gallbladder wall thickening is a nonspecific finding with numerous causes. It is uncommon in children and usually associated with disease not localised to the gallbladder.

Three paediatric cases of sonographic gallbladder wall thickening in association with acute Hepatitis A are presented. Sonographic resolution, coinciding with clinical improvement, occurred in each case without specific therapy or harmful sequelae.
The Role of CT in the Diagnosis and Management of Childhood Pineal Region Tumours
Authors: CAMPO MARGARET P. DE , DAVIS MARTIN D.
Published: March 2008

As one treatment option for pineal region tumours is based on the accurate prediction of histology by CT, the scans of 11 children with biopsy proven pineal region tumours were reviewed, and poor correlation found with the “classical” appearances previously described.

Accurate diagnosis and appropriate treatment are best achieved when CT is combined with serum tumour markers, CSF cytology and tumour biopsy/debulking/resection.
Reporting: The Neglected Aspect of the New Imaging Modalities
Authors: ALBERTYN LYNDA E.
Published: March 2008

Introduction of the new imaging modalities has led to reports with a high potential information content and the promise of improved pathological correlation. These reports require planning and structure. Key Considerations are discussed and a broad outline suggested.
Ultrasound of Intussusception with Lead Points
Authors: LAM ALBERT H. , FIRMAN KEMAS
Published: March 2008

Ultrasonography of 4 cases of intussusception in children with proven lead points were reviewed retrospectively. The lead points were due to lymphosarcoma, inverted Meckel's diverticulum, jejunal polyps and an inverted appendiceal stump. The lead points form a complex mass in the centre of the intussusception in both transverse and longitudinal sections, distinct from primary intussusception. The presence of such ultra‐sonographic findings are suggestive of secondary intussusception with a lead point and surgical reduction rather than hydrostatic reduction should be considered.
Reliability of Transabdominal Ultrasound in the Measurement of Prostate Size
Authors: HOUGH D.M. , LIST A.
Published: March 2008

Thirty‐eight patients underwent transabdominal sonographic measurement of their prostate by two different sonographers. Prostatic weight was estimated by the ellipsoid method. In 47% of the cases the second estimate of weight was within 5g of the first and in 84% of cases the second estimate was within 1% of the first. 95% of the time the second estimate was within 16g of the first. The differences in estimated weight between the two observers ranged from lg to 22g with a mean of 6g. The estimated prostatic weight differed from the mean prostatic weight by more than 20% in 58% of cases. (Mean prostatic weight = the mean of the two weights estimated for each patient). Measurement error was less significant in the larger prostates. The accuracy is probably satisfactory in routine clinical practice when the aim is to demonstrate the presence and degree of prostatic enlargement but the error may be significant in pre‐operative assessment of prostate size and measurement prior to stenting the prostatic urethra. The error, if not accounted for, could compromise a clinical trial involving serial prostatic measurements.
Olfactory Neuroblastoma ‐ Management of a rare tumour at the Queensland Radium Institute and literature review
Authors: AHERN V.A. , POULSEN M.G.
Published: March 2008

Olfactory neuroblastoma (esthesioneuroblastoma) is an extremely rare tumour arising from the olfactory epithelium of the nasal cavity close to the cribriform plate. Most institutions will have little experience in recognisi the clinical and histological features, or management of this tumour and reliance is placed on researching the literature when the individual patient presents. This study reviews seven patients with olfactory neuroblastoma treated at the Queensland Radium Institute from 1971 to January 1990. The overall local contrd rate in this series is 57% (four of seven patients) and 43% of patients (three of seven) remain alive. Conservative surgery and post‐operative radiotherapy is recommended for early disease and more radical surgery with post‐operative radiotherapy for advanced disease.
Nasopharyngeal Carcinoma: Treatment of Neck Node Recurrence by Radiotherapy
Authors: SHAM JONATHAN S.T. , CHOY D.
Published: March 2008

The records of 91 nasopharyngeal carcinoma patients who were treated with external radiotherapy for recurrent neck node disease were reviewed. All patients had received prior radiotherapy for cervical nodal disease or prophylactic neck irradiation. The node size (product of the greatest perpendicular diameters) at the time of treatment for nodal relapse ranged from 1cm2to 35cm2(median 2.25cm2). The radiation dose ranged from 823 RETs to 1949 RETs (median 1520 RETs). The recurrent node size and radiation dose were found significant prognostic factors for local control. The local tumour control for nodes 4cm3or smaller was 51% at five years, for nodes greater than 4cm3was 16% at 18 months (p=0.0'l). The overall 5 year survival was 19.7%. Radiation dose greater than 1600 RETs was significantly associated with better survival for patients with recurrent nodes measured 4cm or smaller, but higher radiation dose did not improve the survival of patients with recurrent nodes greater than 4cm2. Because of the dilemma of suboptimal control resulting from inadequate radiation dose when compared with surgical treatment, and possible radiation complication from higher dose, surgery should be the treatment of choice for neck node recurrence after primary radiotherapy for nasopharyngeal carcinoma.
Shades of Gray: A Personal View of Palliation by Radiotherapy*
Authors: BOURNE R G
Published: March 2008

Palliation is a significant part of the work of a radiation oncologist and yet is discussed infrequently. All too often it is considered simple when in many cases the contrary is the case.

The philosophy of palliation is discussed and is defined as non‐curative treatment. Further sub‐division into symptom control, growth restraint/local control is helpful.

The aim of palliation must be clearly defined if it is to be achieved? taking into account not only the lesion causing the problem but also many other factors including the patient's general condition, the clinical evolution of the tumour, previous treatment and social factors. The aim should be communicated to the patient and relatives.

Doses for effective palliation vary from low to high and require different fractionation regimens. Examples are given from clinical practice with emphasis on difficult and controversial areas.

There are as many diseases as patients and the need to individualise treatment is stressed.
Ureteral Obstruction in Hydatid Disease
Authors: MERCHANT SULEMAN A. , PATEL VIMAL H. , RELEKAR RAJAN , BAPAT RAVINDRA D.
Published: March 2008

A case of ureteric obstruction in renal hydatid disease is reported. This unusual complication possibly occurred following surgery. To the best of our knowledge, this has not been previously reported.
CT Demonstration of Complex Dorsal Spinal Dysraphism
Authors: GUPTA RAKESH K. , PHADKE RAJENDRA V. , SRIVASTAVA DEEP N. , JAIN VUENDRA K. , GUJRAL RATNI B.
Published: March 2008

An unusual a, qe of dorsal spinal dysraphisrn in a four yar old child is presented. Various abnormalities including diasternatomyelia, an extradural arachnoid cyst arising from one of the two dural tubes, and lipomeningomyelocele with a related rib‐like bony structure were demonstrated with Iohexol CT and subsequently confirmed at surgery.
Malignant Mesothelioma of the Tunica Vaginalis Testis
Authors: ADLER B.D. , KELSEY. P.J.
Published: March 2008

A patient is described with an indolent scrotal mass complicated by acute hydroeoele which was proven to be due to malignant mesothelioma of the tunica vaginalis testis. Although uncommon, the possibility of scrotal mass lesion should be eonsidered in ultrasound examination of hydrocoeles with atypical presentations.
Hepatocellular Carcinoma: MR Imaging
Authors: SINGCHAROEN THANIT , UDOMPANICH ORACHART , CHAKKAPHAK KANNKAR
Published: March 2008

Thirty patients with hepatocellular carcinoma (HCC) were examined by MRI. Distinctive findings of HCC such as the presence of fatty degeneration, a capsule, mosaic pattern, daughter nodules and tumor thrombi in major veins were noted in 6, 13, 1, 10 and 9 cases or 20%, 43%, 3%, 33% and 30% respectively.
Primary Hypothyroidism with Pituitary Enlargement and a Visual Field Abnormality
Authors: FULCHER GREGORY , ROCHE JAMES , McELDUFF AIDAN
Published: March 2008

A 23 year old man presented with classical hypothyroidism of 9 years duration. This was associated with pituitary enlargement, documented on magnetic resonance imaging (MRI), and abnormal half‐field visual evoked responses (VERs). Following the initiation of thyroxine therapy the pituitary enlargement and the VER abnormalities resolved. The final diagnosis was of primary hypothyroidism with secondary pituitary hyperplasia.
Magnetic Resonance Imaging in Carotid Dissection
Authors: NELSON J.R. , BOUNDY K.L.
Published: March 2008

Magnetic Resonance Imaging was performed in two cases of suspected internal carotid artery dissection. In both cases it was possible to demonstrate the dissection. It is suggested that magnetic resonance imaging (MRI) could replace more invasive techniques in the diagnosis of this condition.
CT in Complete Congenital Eventration of Diaphragm with Aplasia of Lung
Authors: BUXI TARVINDER B.S. , SHUBHRA  , KHANNA VIRENDER K. , SAXENA USHA , DUITA TRIPTA
Published: March 2008

Complete eventration of the diaphragm and pulmonary aplasia, though rare anomalies, should be considered in new‐borns with respiratory distress. Such anomalous conditions occurring either alone or in combination elude diagnosis and pose problems for management. CT is a very effective, non invasive means of diagnosis which in the past depended largely on invasive procedures such as bronchography, angiograpby and thoracotomy.
Gastric Dilatation and Necrosis in Bulimia: A Case Report
Authors: BEILES C.B. , ROGERS G. , UPJOHN J. , WISE A.G.
Published: March 2008

Gastric dilatation and perforation is a rare complication in anorexialbulimia sufferers. We describe a 24 year old female who presented with severe abdominal pain and vomiting, in whom radiographs demonstrated gross gastric dilatation and subsequent perforation. Although gastric perforation is rare, one can anticipate a rising incidence, with the apparent increase in the incidence of bulimia.
Inadvertent Duodenal Stenting: A Case Report
Authors: ROY SUMIT , BAIJAL. S.S. , PHADKE R.V. , CHOUDHURI G.
Published: March 2008

A Gianturco type metallic stent placed in the common bile duct migrated into the duodenum. The device remains in situ, and has caused no ill‐effects to date. This raises the possibility that such stents may be deployed in the gastrointestinal tract
Percutaneous Lung Aspiration Biopsy: A Comparison Between Two Fine Needles
Authors: CHEONG WING‐YEE , THOMAS ANJULA , CHEE SWEE‐GUAN , TAN KIM‐PING
Published: March 2008

Fine needle lung aspiration biopsy is now a well established method of obtaining tissue for histopatho‐logical diagnosis. It is fast, simple and reliable, and has a very low complication rate. We report our experience using two fine needles, the Turner and the EZ‐EM Cut‐Biopsy needles, comparing their yield and complication rates. We found that both needles had comparable diagnostic yields (65% with the Turner, and 71% with the EZ‐EM) and complication rates. We also found that in most cases, aspirates alone were sufficient for diagnosis, and that obtaining tissue cores with larger bore EZ‐EM needles did not significantly influence the diagnostic outcome. We conclude that both the Turner and the EZ‐EM needles are equally effective and safe in percutaneous lung aspiration biopsy. The least traumatic needle should be used except when the cytological diagnosis is nonspecific inflammatory cells or inadequate, in which case a repeat with a cutting needle is advised to obtain a core of tissue.
Multifocal Osteosarcoma with Extensive Pleural Metastatic Disease
Authors: HOUGH D.M.
Published: March 2008

An eighteen year old female presented with multifocal synchronous osteosarcoma, with multiple skeletal foci of tumour in long bones, pelvis and spine. The radiographically dominant lesion was in the right ilium, and this was considered to be the primary site. There was an extensive osseous pleural plaque and there were also metastases to lungs, peritoneum, abdominal wall, adrenal gland and lymph nodes. A review of the literature reveals that multifocal osteosarcoma is an uncommon condition and is probably due to metastatic disease and not multiple primary lesions. Pleural metastatic disease in osteosarcoma has been seldom reported.
A Case of Hepatic Hydrothorax Due to a Large Diaphragmatic Defect
Authors: LAU K.K. , ARKLES B. , McKENZIE A.
Published: March 2008

Hepatic hydrothorax is an infrequent complication of cirrhosis. The source of pleural fluid has been the subject of considerable speculation. A case of hepatic hydrothorax is discussed which illustrates a large diaphragmatic defect as the cause of ascitic fluid passing into the pleural cavity.
Lymphomatoid Granulomatosis
Authors: VOWODIC F. , WHYTE A.
Published: March 2008

A case of lymphomatoid granulomatosis is presented demonstrating the most common chest radiograph findings as well as some infrequent but recognized associations. The clinical presentation and pathogene‐sis are discussed. The difficulty in radiological diagnosis is highlighted.
A Comparison Between M.R.I. and C.T. in the Investigation of Neurological Deterioration in Longstanding Spinal Trauma
Authors: SILBERSTEIN MORRY , HENNESSY OLIVER , TRESS BRIAN
Published: March 2008

MRI at 0.3 T and CT with myelo‐graphic contrast (CTM) were compared in the retrospective evaluation of 35 patients investigated for the development of new neurological symptoms following longstanding spinal cord injury.

Compared with MRI, CTM was relatively accurate for the demonstration of spinal cord compression, but failed to identify 23% of patients with spinal cord atrophy, and 43% of patients with post‐traumatic syrinx formation. However, 5 patients had unsatisfactory MR imaging, either due to motion or metallic artifact, and in 3 of these, CTM demonstrated a syrinx.

Although MRI is the method of choice in the investigation of this problem. CTM may still be required for patients with an unsatisfactory MR examination.

Magnetic Resonance (MR) imaging is now an established technique for imaging the spine, with accurate depiction of the spinal cord, as well as the adjacent soft tissues (1, 2). However, the cost of this technique, and its as yet limited availability in Australasia, has resulted in the necessity to demonstrate its superiority over other imaging modalities for any specific clinical problem (3). One of the major areas of impact of MR has been in the investigation of the problem of acute neurological deterioration in patients with past spinal trauma (4, 5, 6). Some of these patients will have treatable causes of deterioration, either a post‐traumatic syrinx, or spinal cord compression (6), and MR can be used to image these conditions (7), which, until recently, were investigated with computed tomography with myelographic contrast medium (CTM), (8, 9).

In the largest reported study comparing MR and CTM, Betz et al (6) reported the results of 43 children who were investigated up to 48 months from original injury, of whom 24 had CTM. They concluded that although MR was indicated for the evaluation of subacute and chronic spinal cord injured patients, CT‐myelography remained essential before considering surgery for spinal cord decompression (6).

We retrospectively evaluated the results of MR and CT‐myelography in 35 patients who developed new symptoms following past spinal cord injury to determine whether there was still any place for CTM in the evaluation of this problem.
Liver CT A Practical Approach to Dynamic Contrast Enhancement
Authors: DITCHFIELD MICHAEL R. , GIBSON ROBERT N. , FARLIE NEIL
Published: March 2008

The aim of this study was to establish a practical, simple protocol that reliably produces high quality dynamic incremental computed tomography (CT) of the liver.

We reviewed 90 patients randomly allocated into six different protocols. All had preliminary unehanced scans followed by a dynamic incremental CT of the liver. An initial delay of 30 seconds was used from the commencement of the injection of Iopamiro 370. The groups were:

Pump infusion

(a) 100 mls at 2 mls/sec scanning inferosuperiorly.

(b) 100 mls at 2 mls/sec scanning superoinferiorly.

(c) 100 mls at 1 ml/sec scanning inferosuperiorly.

(d) 50 mls at 1 ml/sec scanning inferosuperiorly,

40 mls hand injected bolus followed immediately by 60 ml pump infusion at 1.3 mls/sec scanning inferosuperiorly.

50 mls hand injected bolus scanning inferosuperiorly.

The parameters recorded were the degree of hepatic parenchymal and hepatic venous enhancement and the aortic ‐ IVC difference at the last slice through the liver, all measured in Hounsfield units.

The protocols using 100 mls of contrast produced approximately twice the parenchymal and hepatic venous enhancement compared with those using 50 mls. Approximately 60–90% of examinations using 100 rnls produced scans through the entire liver during the bolus or non‐equilibrium phase, deemed the most sensitive for the detection of focal lesions, compared with 13–33% of those using 50 mls. Equally satisfactory results were obtained using the relatively inexpensive Biotel power injector preceded by a 40 ml hand injected bolus, compared with using an Angiomat angiography infusion pump.

We conclude that 100ml of contrast medium is necessary to achieve high quality liver CT scans and that this can be adequately delivered using a combination of a hand injection and an infusion from a relatively inexpensive pump.
The Perivertebral Collar ‐ A New Sign in Lymphoproliferative Malignancies
Authors: ALBERTYN L.E. , CROFT G. , KUSS B. , DALE B.
Published: March 2008

Nine patients with lymphoproliferative malignancies, one of whom had not been previously diagnosed, were found on CT examination for back pain to have partial or complete soft tissue perivertebral collars. The thoracic and or lumbar regions were involved in all. Only 3 had gross bony changes at the time, and in others the changes appeared so innocuous that in combination with the vague clinical symptoms their significance was underestimated. Five patients ultimately had episodes of cord compression, and in all nine the appearance of this spinal lesion appeared to be d grave prognostic significance. All 9 were dead within 1 year of the presentation of their spinal lesions

The observation of a perivertebral collar in the context of a known or suspected lymphoproliferative malignancy should therefore raise the strong suspicion of spinal involvement. The vertebrae should be examined on bone windows and the contents of the spinal canal on narrow windows to assess bony and epidural spread.
Intrathoracic Right Kidney Diagnosed by Ultrasound
Authors: ARCHER R.J.
Published: March 2008

Intrathoracic kidneys are rare. A case is described in which the initial intravenous urogram performed for prostatism appeared to show a non‐functioning right kidney. A subsequent ultrasound examination revealed that the right kidney was situated in the right hemithorax, well above the liver. Pelvic ectopic kidneys are common and standard teaching is to perform a full length film should an immediate or 5 minute renal area radiograph suggest an absent/non‐functioning kidney. With the increasing use of ultrasound in the initial assessment of patients with prostatism, the possible intrathoracic location of a kidney should be remembered when there is failure to demonstrate a kidney in the abdomen or pelvis.
Inferior vena cava “birds nest” filters ‐ 2 year follow‐up
Authors: FIRKIN A. , WALTERS N. , THOMSON K. , ATKINSON N.
Published: March 2008

This study examines long term efficacy and saftey of “birds nest” filters (Cook), and the use of doppler ultrasound to assess patency.

Of the seventeen “birds nest” filters inserted twelve were available for study. All patients were reviewed for evidence of recurrent pulmonary emboli or filter complication. Mean length of follow up was 10 months, (7 had follow up of > 12 months). Three have had further episodes of deep venous thrombosis, with probable recurrent pulmonary embolism in one. No patient had evidence of thrombosis of the inferior vena cava. No fracture or migration of the “birds nest” filters was found. Ten of the twelve filters studied with ultrasound could be visualized within the cava. In all, turbulent flow was detected with colour and duplex doppler study.

We conclude that insertion and use of the “birds nest” filters is safe, with a high long term patency rate and few initial or long term complications. Doppler ultrasound is a simple and rapid method of assessing venous patency.
Ultrasound, computed tomography and magnetic resonance in the investigation of iliopsoas compartment disease
Authors: DALY B.D. , McPHILLIPS M. , LEUNG A.W. , EVANS R.M. , METREWELI C.
Published: March 2008

The authors reviewed the results of imaging studies performed in 30 patients with diseases involving the iliopsoas compartment (IPC) to assess the role of Ultrasound (US), Computed Tomography (CT) and Magnetic Resonance (MR) in the investigation of these deep seated and offen cliaically undetectable lesions 16 (53%) patients had histologically proven benign or malignant IPC tumours with bacterial infection in 12 (40%) and haemorrhage into the IPC in 2 (7%).

US correctly detected iliopsoas pathdogy in only 9 of 17 cases (53%) and was satisfactory only in limited situations, such as abscess formation in children and haemorrhage in haemophiliacs. CT was much more accurate (16/17, 94%) than US and correctly diagnosed 7 cases overlooked on US, while also offering greater information in 5 cases where both studies were abnormal. CT was particularly helpful for the detection of both abscess formation and calcification within mass lesion. MR was accurate in all 9 cases imaged, and was very helpful in the assessment of associated vertebral, disc or spinal canal involvement by tumour or infection.

A review of the literature, and the results of this study, suggest that CT and MR often have complementary roles where IPC disease is known or suspected. The accuracy of US in IPC disease is limited, preferably being followed by CT or MR imaging.
CT appearances of rounded atelectasis
Authors: STEPHENSON N. , PRICE J.
Published: March 2008

Five patients examined with CT bad lesions fulfilling criteria for a diagnosis of rounded atelectasis (RA) and these were managed with out biopsy. In three patients unsuspected contralateral lesions were identifled as RA variants, and one of these was biopsied at thoracotomy and proved to be benign. All patients remain well at 6–22 months follow‐up.

We concur with recent reports that there is a spectrum of CT appearances of RA and that even atypical lesions seldom need further investigation. We also suggest that the appearances of some atypical lesions add support for the fibrosing theory of pathogenesis of RA.
Traumatic rupture of the aorta
Authors: SACHARIAS N. , KURIATA A.R.
Published: March 2008

In a series of 28 patients with suspected ruptured thoracic aorta, only three were shown to have sustained such an injury. To minimise the number of negative examination, the importance of optimising the initial radiological examination of the chest is discussed along with the importance of visualisation of the descending aorta.

The signs that lead to the suspicion of rupture of the aorta are numerous and non specific and indicate some change in the mediastinum which could be significant in the given clinical context.

This paper wishes to emphasise a negative sign, namely visibility of the descending aorta.
Technical report: fallopian tube recanalization facilitated by a hydrophillic glide wire
Authors: FERNANDO CHARITHA C. , FRASER HAMISH H.
Published: March 2008

Fallopian tube recanalization is now a well established radiological procedure (1). We describe a case in which the tubal obstruction was resistant to the standard technique of recanalization by the passage of a platinum tipped wire but in which we were able to achieve success with the aid of a hydrophillic “glide” wire (Radifocus angled tip, Terumo Corporation, Tokyo, Japan).
Percutaneous ultrasound guided cholecystostomy with double bubble catheter
Authors: HORTON M.D.A. , MORRIS D.L. , GLENN D.W.
Published: March 2008

We have used a prototype double bubble cholecystostomy catheter in four very ill patients. This has been done under local anaesthetic using a Seldinger technique, ultrasound guidance, and a trans‐peritoneal approach to the gallbladder. The catheter provides drainage, cholangiography, and is intended to allow instrumentation of the biliary tract at a later stage.
Assimilation of the atlas with associated syringomyelia and Chiari 1 malformation (Klippel‐Feil Type 2)
Authors: JONES D.N. , DAVIES R. , SAGE M.R. , HANIEH A. , MORRIS L.
Published: March 2008

This case report describes an unusual congenital anomaly of the craniovertebral junction in a 14 year old male. Cervical radio graphs showed the bony anomaly, while thin slice CT (with 2–D and 3–D reformations), MR imaging, and angiography were particularly useful in accurately assessing the bony, soft tissue and vascular anato my, prior to and following surgery.
Cranial dural arteriovenous malformation and fistula. Radiological diagnosis and management. Review of thirty four patients.
Authors: ApSIMON H.T. , IVES F.J. , KHANGURE M.S.
Published: March 2008

The clinical features, imaging and angiographic findings of thirty four patients with cranial dural arteriovenous malformations and fistulae are presented in four groups.

Group 1 – Seven patients with anterior cavernous malformations, predominant superior ophthalmic vein drainage, and symptoms and signs of carotico‐cavernous fistula.

Group 2 – Twelve patients with malformations of the superior petrosal, transverse and sigmoid sinus regions, presenting predominantly with bruit.

Group 3 – Seven patients with malformations of the basal sinuses and prominent cortical venous drainage, presenting with intracranial haemorrhage, headache and impaired cortical function. Intracranial haemorrhage never occured in the absence of cortical venous drainage.

Group 4 – Eight patients with infrequent manifestations.

Group 1 and 2 patients are readily recognized and diagnosed. Group 3 and 4 patients are often misdiagnosed.

Treatment modalities comprised embolisation therapy, surgical excision, and carotid compression. Twenty patients were treated by one or more of these modalities with a successful outcome in thirteen patients. Group 1 patients are the most amenable to trans‐arterial embolisation. Carotid compression as the sole modality of treatment was successful in four patients.

Unless the fistula is successfully closed, Group 3 patients and patients who present with cervical or thoracic myelopathy carry a grave prognosis.

There is need for greater radiologist awareness of Group 3 and the rarer presentations, particularly myelopathy.

With the exception of one patient, the morphological features of our cases are consistent with the now‐accepted view that these lesions are acquired arterio‐venous fistulae and not congential malformations.
The value of pulmonary angiograms when lung scans disagree with clinical impressions about emboli
Authors: WATTIE W. JOHN , MARSHALL ROBERT G.
Published: March 2008

When selective magnification pulmonary angiography was done within 48 hours of a Ventilation/Perfusion (VP) scan, disagreement between scan and angiogram findings was common. Correlation was poor in both high and low probability of embolism groups as defined by scan. Analysis of individual scan diagnostic criteria showed them to be as unreliable as all of them taken together.

The patients coming to angiography were those in which the VP scan disagreed with clinical impressions about the probability of embolism. These problem cases have biased the results against scanning, but they reflect how pulmonary angiography is used in clinical practice. North American studies are reviewed in detail, to show that poor correlation between VP scan and angiography is neither a local aberration nor confined to retrospective analyses.

If clinical and scan probabilities of embolism do not agree, pulmonary angiography can safely decide the issue.
Chest radiograph appearances after head and neck flap reconstructive surgery
Authors: PEH WILFRED C. G. , HO C.M. , NGAN HENRY
Published: March 2008

The chest radiographs of 17 patients who had undergone pectoralis major myocutaneous flap (PMMF) reconstruction for head and neck cancers were reviewed. Surgical procedure correlated well with radiographic findings, which consisted of the following signs: abnormal axillary and supraclavicular folds, replacement of normal vertical neck fold by an oblique fold, soft tissue mass and loss of facial plane at base of the neck. Unilateral radiolucent hemithorax was present in 41% of cases. In females, loss of breast shadow simulating the post‐mastectomy appearance was present.
Peri renal extravasation in a case of urethral valves
Authors: MEHROTRA GOPESH , BHARGAVA SATISH K. , KRISHNA ANURAG , SHIV  , TANEJA KARUNA
Published: March 2008

A case is described of urinary ascites and a perinephric urinoma due to obstruction of the urinary tract by posterior urethral valves.
C1‐C2 block vertebra with fusion of anterior arch of atlas and the odontoid
Authors: GUPTA S. , PHADKE R.V. , JAIN V.K.
Published: March 2008

A rare case of atlanto‐axial block vertebra and fusion of anterior arch with the dens, with instability at the atlanto‐occipital joint, is reported. The literature is briefly reviewed.
Cranio‐metaphyseal dysplasia
Authors: GUPTA DEEPIKA , SHARMA O. P. , CHAUDHARY A. K. , GUPTA S. K.
Published: March 2008

Cranio‐metaphyseal dysplasia in two brothers, aged fourteen and twelve, is reported. Both brothers presented with deafness, repeated episodes of cold and cough and mouth breathing. Striking craniofacial configuration consisted of hypertelorism, prominent glabella and zygomatic arches, mandibular prognathism and overgrowth of middle third of face. Both patients had genu valgum deformity. Low intelligence and poor scholastic performance present in both brothers were attributed to deafness. Radiographic features consisted of obtuse mandibular angle, defective dentition, sclerotic frontal sinuses, sclerotic mastoids and temporal bones. Splaying of metaphyses of long bones was associated with mild sclerosis. Mild degree of widening of ribs was also present. One brother also had hallux valgus deformity. The radiographic and clinical differentiation of cranio‐metaphyseal dysplasia and metaphyseal dysplasia (Pyle's disease) is highlighted.
Magnetic resonance imaging of central nervous system haemorrhage
Authors: SILBERSTEIN MORRY , HENNESSY OLIVER
Published: March 2008

The variable magnetic resonance imaging appearances of central nervous system haemorrhage, both intra‐ and extra‐axial, are described. These will vary with the type of image contrast (T1 or T2 weighting), the nature of the imaging sequence (spin‐echo or gradient‐echo) and the time from onset of haemorrhage. Magnetic resonance imaging is a useful technique for imaging haemorrhage in the central nervous system as it yields temporal information about haematoma development, and it is the only non‐invasive means of imaging intraspinal haemorrhage. It is, however, limited in the imaging of haematomas within 24 h of onset and in subarachnoid haemorrhage where computed tomography is the investigation of choice.
Carotid colour Doppler
Authors: DUFFY PETER
Published: March 2008

Following the introduction of a carotid colour duplex Doppler service, a retrospective survey of the second 100 patients examined was undertaken to determine the accuracy of the examination compared with angiography and surgery, and to assess the clinical efficacy of the results with a review of the final diagnosis, how that diagnosis was achieved and whether the test had helped assess the patient's illness or altered the medical management and/or the outcome of the patient's illness. The results indicated the expected accuracy of over 94% and that the examination helped assess the patient's illness in 92%, altered the management plan in 40% and altered the outcome of the patient's illness in 14% where the disease prevalence was 16%.
Assessment of abdominal lymph nodes in a normal paediatric population: An ultrasound study
Authors: HEALY M V , GRAHAM P M
Published: March 2008

During a 9 month period, 50 consecutive children were evaluated by ultrasound to determine the size, location (mesenteric vs para‐aortic), number, shape and texture of abdominal lymph nodes in a normal paediatric population. High resolution linear array transducers were used with graded compression. Nodes ranging from 10 to 20 mm were recorded in the majority of subjects. In all cases mesenteric lymph nodes were larger and more numerous than para‐aortic nodes. Para‐aortic lymph nodes were not seen in isolation.
Symptom relief and survival after chemo‐embolization with Adriamycin, Lipiodol and Gelfoam for hepatocellular carcinoma
Authors: YOUNG N , HOLLANDS M , WONG K P
Published: March 2008

This is a retrospective study to evaluate the ability of arterial chemo‐embolization with Adriamycin, Lipiodol and Gelfoam to relieve symptoms, primarily abdominal pain, and to prolong survival in patients with hepato‐cellular carcinoma.

Twenty patients were referred from 1986 to 1991 and in 18 the chemo‐embolization procedure was successful. In the follow‐up period to March 1992, 17 patients had died. Their survival times were not found to be significantly different from the reported rates of survival in patients given no therapy. In only one of 10 patients followed with computed tomography was a reduction in tumour size seen.

Nine of 11 patients with pain reported significant relief from pain following treatment. Six patients had repeat embolizations that successfully relieved recurrent pain. In the authors’experience chemo‐embolization was helpful in relieving pain, but did not prolong life.
Alcohol sclerotherapy of simple parenchymal liver cysts
Authors: McCULLOUGH K M
Published: March 2008

Three symptomatic non‐parasitic liver cysts in three patients were treated by the technique of percutaneous aspiration followed by sclerosis of the cyst lining by irrigation with absolute alcohol. In two patients the treatment was fully successful, with partial success in the third case. Two cysts underwent two separate treatments. The technique, which is reviewed, was shown to be a safe and effective alternative to conventional surgical management.
Computed tomography pelvimetry: Accuracy and radiation dose compared with conventional pelvimetry
Authors: MORRIS C W , HEGGIE J C P , ACTON C M
Published: March 2008

Several publications in the past few years have indicated that computed tomography (CT) pelvimetry is preferable to conventional pelvimetry when considering accuracy and radiation dose. Many of the previous publications have, however, compared state of the art CT pelvimetry with outmoded conventional pelvimetry techniques. This study compared both the accuracy and the radiation dose of CT pelvimetry with conventional pelvimetry as practised in two large teaching obstetric hospitals in Melbourne. The study did not demonstrate any significant difference in the accuracy between the two methods. The radiation dose to the fetal gonads was also similar. The radiation dose using CT pelvimetry could be significantly lowered if the axial CT section through the ischial spines were excluded from the CT technique.
The role of ultrasound and computed tomography in the evaluation of parotid masses
Authors: CORR P , CHENG P , METREWELI C
Published: March 2008

A prospective sonographic study of 40 patients with symptomatic parotid masses detected all of their 48 lesions (sensitivity 100%). Computed tomography (CT) detected 47 lesions (sensitivity 97.5%). Ultrasound correctly characterized all benign tumours and inflammatory lesions and four out of five malignant tumours. Deep compartment involvement was accurately delineated in 10 (25%) patients but in two patients the extraparotid tumour origin could only be detected by CT.

Ultrasound is a sensitive, non‐invasive investigation of parotid masses. Computed tomography (CT) or magnetic resonance should be reserved for lesions that involve the deep compartment of the gland and cannot be separated from the parapharyngeal space or skull base.
24 hour/3 hour radio‐uptake technique for differentiating degenerative and malignant bony lesions in bone scanning
Authors: KASHYAP RAVI , BHATNAGAR ASEEM , MONDAL ANUPAM , SAWROOP KRISHAN
Published: March 2008

Differentiating bony metastases from degenerative lesions is of great importance to the oncologist. Routine bone scanning using technetium‐99m methylene diphosphonate is the investigation of choice for detecting bony lesions, but its specificity is low.

Using the difference in radio‐uptake behaviour of metastatic and degenerative lesions as the criterion, a 24/3 h radio‐uptake, lesion to non‐lesion ratio was used to separate out the two types of lesions.

Radio‐uptake ratio (RUR) distribution curves of malignant and degenerative lesions were found to be significantly different (P < 0.001). Taking 1.12 as the critical point, RUR of malignant lesions was found to be more than the critical point, and that of degenerative lesions was found to be less than the critical point. Sensitivity, specificity and accuracy were found to be 68%, 80% and 74%, respectively.
Design of a radiology request/referral form
Authors: SCALLY PETER M
Published: March 2008

A radiology/referral form has been designed and is offered as a basis for modification to meet the specific requirements of any department. The new form elicits more information, is ergonomically superior to the one it replaced, is designed to increase compliance in the completion of all relevant sections by the referring clinician and fulfils an educative function.