bluuebunny/crossref_metadata_2025 huggingface dataset:
Rapid direct reversal photography
Authors: ChB J ROCHE , ARNOLD K
Published: March 2008

This is a description of a method which enables fast, direct‐reversal photography of radiological images for slides and was designed to retain: (i) continued use of an existing small darkroom; (ii) use of Kodak Rapid Process copy film; and (iii) use of standard X‐ray processors. By adaptation of a commercial photographic flash power pack, a flash head and a reflector it is possible to achieve a somewhat expensive but very successful system which enables the very rapid production of good quality image slides for lectures.
Ocular involvement in primary central nervous system lymphoma: An increasing clinical problem?
Authors: ROOS DANIEL E , O'BRIEN PETER C , CROMPTON JOHN L
Published: March 2008

A case of unilateral vitreous relapse in a patient with primary central nervous system lymphoma (PCNSL) following sequential systemic chemotherapy and radiotherapy is reported. A literature review reveals that ocular involvement may occur in up to 15–25% of cases during the course of this disease. Full ophthalmological assessment, including slit lamp examination, should be included in the routine staging of PCNSL at the time of initial diagnosis and subsequently if relapse occurs.
Hepatic uptake of a bone scan agent (99mTc‐MDP) in a patient with amyloidosis associated with plasma cell dyscrasia
Authors: JONES D N , LEW W , WYCHERLEY A G
Published: March 2008

This case report describes diffuse hepatic uptake of a diphosphonate bone scan agent (Technetium‐99m‐MDP) in a patient with amyloidosis associated with a plasma cell dyscrasia. Amyloid infiltration is one of the more rare, but well recognized, causes of hepatic uptake of bone scan tracer. Other causes are also discussed in this case report.
The falling anterior labrum
Authors: PIERCE MARK E , ASHMAN BRYAN
Published: March 2008

Two cases of a falling anterior glenoid labrum are presented. The anterior labrum appears normal on supine double contrast computed tomographic arthrography (DCCTA). However, on prone DCCTA the anterior labrum falls away from the glenoid. The addition of prone DCCTA in these two cases reveals a labral tear, occult on routine supine DCCTA.
Intracranial aspergillosis producing cavernous sinus syndrome and rupture of internal carotid artery
Authors: BREADMORE ROSS , DESMOND PATRICIA , OPESKIN KENNETH
Published: March 2008

A case of invasive, intracranial aspergillosis in a non‐immunocompromised patient, complicated by rupture of the internal carotid artery due to fungal arteritis, is presented. The computed tomography and magnetic resonance imaging findings are discussed. This is a rare condition with a poor prognosis and requires a high level of suspicion when paranasal sinus disease is detected.
Hodgkins disease: Clinical and radiological prognostic factors in a laparotomy series
Authors: PENDLEBURY SUSAN C , KOUTTS JERRY , BOYAGES JOHN
Published: March 2008

From July 1979 to June 1988, 62 patients managed at Westmead Hospital underwent a staging laparotomy (LAP) for Hodgkins disease. Fifty‐four patients were clinical stage (CS) I or II and eight were CS III.

The sensitivities of the imaging modalities of computed tomography (CT), Gallium and bipedal lymphangiogram (LAG) were assessed for their predictive value for abdominal disease in patients who underwent a LAP. The most sensitive combination for predicting a negative laparotomy (78%) was a negative abdominal CT and a negative Gallium scan. Upstaging occurred in two of 16 Stage I patients (13%) and nine of 38 Stage II patients (24%). Of the 11 patients upstaged, the spleen was involved in 10 (91%). Factors which predicted for upstaging in a univariate analysis were: age greater than 40 years (P= 0.02), mixed cellularity or lymphocyte depleted histology (P= 0.02), and more than three sites involved above the diaphragm (P= 0.008). In a multivariate analysis, the only significant predictor was the number of sites of involvement (P= 0.007). Two subgroups who had a low probability of upstaging were favourable histology patients with up to two sites of involvement (0%) and females with up to two sites of involvement (0%).

We conclude that abdominal imaging is associated with a high false‐negative rate, particularly for CS II disease.
Echogenic splenic tumours in Type B Niemann‐Pick disease
Authors: SCHUBERT F
Published: March 2008

A case is presented of echogenic tumours in the spleen of a patient with Niemann‐Pick disease of the type B (or adult) type. A search of the literature revealed that a similar appearance has previously been reported in only one other case of Niemann‐Pick disease, which was a type C.
The role of Gallium‐67 scanning in febrile patients
Authors: MOURATIDIS B , LOMAS F
Published: March 2008

The source of sepsis in febrile patients can be a difficult diagnostic problem. Gallium‐67 has been utilized as a diagnostic tool in the evaluation of these patients. A retrospective review was done of 47 patients who presented with pyrexia of unknown origin (27 patients), postoperative fever (11 patients), septicaemia (4 patients) and miscellaneous sepsis (5 patients). Whole body imaging with Gallium‐67 gave an overall sensitivity and specificity of 86 and 77%, respectively, which compares favourably with previous studies. The sensitivity and specificity was similar in all patient subgroups. Gallium‐67 allowed for more effective and directed use of organ‐specific imaging modalities, such as computed tomography, ultrasound and guided intervention, in localizing and defining the source of sepsis. Where more than one possible source of fever was present, Gallium‐67 scanning correctly identified the activity of the different foci. Gallium‐67 scanning should be used early in the evaluation of patients presenting with fever of uncertain origin.
Hajdu–Cheney syndrome in a 3 1/2 year old girl
Authors: ZEMAN J , HOUSTKOVA H , KOZLOWSKI K
Published: March 2008

Hajdu–Cheney acro‐osteolysis is reported in a 3 1/2 year old girl whose mother has the syndrome. Acroosteolysis was shown to be absent at the age of 2 1/2 years. It was demonstrated on hand X‐rays performed a year later. This is the youngest case of Hajdu–Cheney acro‐osteolysis reported in the literature.
A review of magnetic resonance imaging in spinal trauma
Authors: DAVIS S J , KHANGURE M S
Published: March 2008

One hundred and ninety‐five magnetic resonance (MR) images (1.5 Tesla) of 167 patients with neurological impairment following spinal trauma were reviewed.

Acute cord injury produces central haemorrhagic necrosis that extends transversely and longitudinally with time and increased injury severity. Oedoma is more homogeneous, extensive and dominant in minimal lesions. Magnetic resonance appearances correlate with neurological status and outcome. Patients with MR evidence of cord blood had severe clinical lesions and failed to show useful clinical improvement. Patients with homogeneous ‘oedema’improved to useful function. Lesion signal inhomogeneity relates to a worse prognosis. The clinical level correlates closely with cord blood or signal in homogeneity but imprecisely with homogeneous oedema. Disc herniations require differentiation from epidural blood and venous engorgement, which are prominent with bone displacement. Magnetic resonance is recommended in incomplete cord syndromes and in cord injuries with no apparent fracture, particularly if clinically deteriorating.

Chronic injury consists of cavitation, extensive gliosis, cord atrophy and leptomeningeal fibrosis. Progressive myelopathy may result from cystic or non‐cystic intramedullary lesions. Cord cysts are common and cyst fluid signal should closely follow cerebrospinal fluid. Turbulent cyst fluid motion is commoner in larger cysts and may predict those cysts more prone to propagate. Progressive syrinxes show typical appearances, usually with transverse septa. Atrophy and propagating syrinxes usually take years to develop. Leptomeningeal cysts and spinal stenosis caused by bone displacement and accelerated adjacent disc disease may cause late deterioration. In progressive myelopathy following injury, surgically drainable cysts are clearly differentiable from cord gliosis and atrophy.
Segmental trends in cancellous bone structure in the thoracolumbar spine: Histological and radiological comparisons
Authors: EDMONDSTON STEPHEN J , BREIDAHL WILLIAM H , SINGER KEVIN P , DAY ROBERT E , PRICE ROGER I
Published: March 2008

Segmental variations in vertebral body cancellous bone architecture throughout the thoracolumbar spine were examined using histomorphometry and microradiography, and compared to bone mass measured using dual energy X‐ray absorptiometry. In six human vertebral columns (T1 to L5) bone mineral content (BMC) and bone mineral density (BMD) of each vertebral body was determined in the lateral projection. Sagittal plane cancellous bone architecture was assessed from two‐dimensional surface stained images and microradiographs of two 1 mm thick sections at each vertebral level. Computer‐assisted image analysis was used to measure the total bone area (TBA), mean trabecular width (MTW) and trabecular number (TbN) from the stained images, and the skeletonized network length (SNL) from the radiographic images. Consistent segmental trends were observed for all structural parameters across the six columns examined. Higher TBA and TbN values were observed in the upper thoracic segments and decreased caudally. The MTW was relatively constant in the thoracic vertebrae before increasing in the lumbar spine. Pooled correlations between TBA and the bone density measurements were poor (BMC: r=0.17, BMD: r= 0.25), while the TBA and SNL were only moderately correlated (r= 0.42). In conclusion, histomorphometric and radiological measurements appear to provide different information about cancellous bone structure. Bone structure is poorly correlated to integral measurements of bone mass. The consistent segmental variations in bone architecture appear to reflect a skeletal response to the relative extent of habitually applied loads in different regions of the spine.
Evaluation of the healing process in fractures using early and delayed bone scanning
Authors: MONDAL A , BHATNAGAR A , SHARMA R , BEHARI V , SAWROOP K , KHANNA C M
Published: March 2008

Fifty‐two fracture sites were evaluated by bone scintigraphy after acquiring similar views of the lesions at 4 and 24 h following technetium‐99 m methylene diphosphonate administration. After calculating 24/4 h radio‐uptake ratio (RUR) and using 1.15 as the critical point of separation, fresh healing lesions could be separated from old healed fractures persisting as ‘hot spots’with a sensitivity of 100% and specificity of 82%.

The 24/4 h RUR technique is a new approach in measuring the osteoblastic activity at the lesion site. The technique appears to have clinical significance in the detection and follow up of the healing status of occult fractures where radiological procedures are of limited value.
Radiotherapy planning for lung cancer: Can we do better?
Authors: ATKINSON C H , HAMILTON C S , WYNNE C J
Published: March 2008

Modern radiotherapy planning and treatment techniques allow the delivery of treatment with considerable geographic and dosimetric precision. Uncertainties and variability in the radiotherapy process prior to this stage, that is, localization of the target volume, has received little systematic study. The results of a planning study in non‐small cell carcinoma of the lung are presented to highlight the possible variability in the planning process, both at an inter‐clinician and intra‐clinician level. The implications of this survey, both in terms of treatment outcome and training issues, are discussed.
Colour Duplex Ultrasound: A screening modality for femoropopliteal disease in patients with intermittent claudication
Authors: LINKE R J , DAVIES R P , GILES A J , WALSH J A , THOMPSON B W
Published: March 2008

In patients presenting with intermittent claudication, Colour Duplex Ultrasound (CDU) examination of the femoro‐popliteal segment has been proposed as a screening modality. Those patients with atheromatous lesions suitable for percutaneous transluminal angioplasty (PTA) could proceed to diagnostic angiography. Patients with long segment occlusive disease demonstrated by CDU, who were not considered suitable candidates for surgery, would not require angiographic examination. This prospective study was performed on 46 limbs in 25 consecutive patients who presented for investigation of claudication. There was close correlation between the two methods in the demonstration of high‐grade stenoses and occluded segments. Using angiography as the ‘gold standard’this study indicated a diagnostic accuracy for CDU of 93% with a sensitivity of 89% and a specificity of 95%. Angiography tended to show longer occluded segments than CDU. Colour Duplex Ultrasound shows promise as a screening investigation in patients with intermittent claudication to detect lesions that may be suitable for PTA.
Distended iliopsoas bursa: Case reports and anatomical dissection
Authors: LONERAGAN ROBERT , ANDERSON JAMES , TAYLOR JAMES
Published: March 2008

Distension of the iliopsoas bursa is usually seen in association with underlying hip joint disease. The computed tomography (CT) appearance is characteristic and allows a diagnosis to be readily made. Computed tomography will also facilitate needle placement for aspiration of bursa contents and the injection of water‐soluble contrast media for CT bursography. Three cases of iliopsoas bursa enlargement of varying underlying aetiology are presented. The dissection of seven cadavers demonstrated the anatomy of the normal bursa and highlighted its important role in the normal functioning of the iliopsoas muscle.
The effects of X‐ray contrast media on bacterial growth
Authors: Blake MP , Halasz SJ
Published: March 2008

Six widely used X‐ray contrast media (XRC) were tested against nine commonly isolated organisms to determine the practicality of using XRC to outline body spaces prior to obtaining specimens for culture and to assess the feasibility of using XRC in divided doses to reduce cost. Preparations of Escherichia coli, Klebsiella pneumoniae, Enterococcus faecalis, Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Candida albicans, Streptococcus pyogenes and Streptococcus milleri in two approximate concentrations of 104 and 108 colony forming units/mL (cfu/mL) were inoculated into the following XRC: Conray 280, Hexabrix 320, lopamiro 370, Omnipaque 350, Ultravist 300 and Optiray 320 each in two concentrations. Sampling was performed in triplicate at 0, 2, 4 and 20 h with the 20 h counts made after exposure at both 22°C and 4°C. There were 16 significant interactions, predominantly with the Gram‐negative organisms. Conray 280 produced the greatest number of effects. Most effects were bacteriostatic. Organisms were most susceptible at low concentration and after prolonged contact with XRC. No effect was seen with dilute XRC. All weekly sterility checks were negative. Non‐ionic XRC have no significant effect on the growth of Gram‐positive organisms and little effect on Gram‐negative organisms if processing is performed promptly. Using standard aseptic technique, no contamination of XRC occurred, suggesting multi‐dosing may be a safe and cost‐effective method of XRC utilization.
Mammographic appearances of mammary duct ectasia that mimic carcinoma in a screening programme
Authors: Sweeney DJ , Wylie EJ
Published: March 2008

The aim of this study is to demonstrate the spectrum of mammographic appearances of mammary duct ectasia that mimic carcinoma in a breast cancer screening programme. Between February 1989 and March 1993, 40 003 women underwent screening mammography as part of the Western Australia Women's Cancer Prevention Unit screening programme. Fine needle aspiration or excisional biopsy was performed on 1437 women, and 12 cases of cytologically or histologically confirmed mammary duct ectasia were detected. A total of 14 mammographic abnormalities from 12 asymptomatic female patients were biopsied, and confirmed to represent mammary duct ectasia. The mammographic spectrum included eight areas of microcalcification (two of which were extensive), three spiculated masses and three lobulated, partially smooth masses. Five of these women showed no other mammographic stigmata of mammary duct ectasia in either breast. Additional features of mammary duct ectasia, including nipple retraction, retro‐areolar duct dilatation or macrocalcification were identified in seven women. Mammographic features of mammary duct ectasia are frequently detected in asymptomatic women undergoing screening mammography and cause no diagnostic dilemma. Occasionally mammary duct ectasia will have a mammographic appearance that is indistinguishable from carcinoma, necessitating breast biospy. In this study 40% of those women with mammary duct ectasia that were submitted for biopsy had no other feature of mammary duct ectasia that could have suggested the pre‐operative diagnosis.
Paget's disease of the breast: What the radiologist may expect to find
Authors: Rickard MT , Selopranoto US
Published: March 2008

Paget's disease of the nipple is characterized by the presence of Paget's cells in the epidermis of the nipple or areola. Two case reports of Paget's disease are described and used to highlight unusual features of the disease. The literature on the radiographic and pathologic findings of this disease is reviewed.
Magnetic resonance imaging of cerebrotendinous xanthomatosis
Authors: Tai KS , Brockwell J , Chan FL , Janus ED , Lam KSL
Published: March 2008

Cerebrotendinous xanthomatosis is a rare familial sterol storage disease with accumulation of cholestanol and cholesterol particularly in xanthomas, bile and brain. Magnetic resonance imaging is a useful modality for imaging the affected tissues. It contributes to the evaluation and management of the disease.
Unusual computed tomography appearances of acute cholangitis
Authors: Gandhi MR , Andersen JA , Coyne B , Richardson D
Published: March 2008

This case describes some unusual computed tomography findings in a patient with an acute ascending cholangitis and pancreatitis due to a calculus impacted in the distal common bile duct.
Stent placement in coeliac and superior mesenteric arteries to restore vascular perfusion following aortic dissection
Authors: Connell DA , Thomson KR , Gibson RN , Wall AJ
Published: March 2008

The main trunks of both coeliac and superior mesenteric arteries were sheared off the abdominal aorta by an anterior dissection that spared the renal arteries. Both vessels were cannulated and a Walstent inserted across the false lumen to restore normal coeliac and superior mesenteric perfusion. This produced a successful haemodynamic and angiographic result with improvement in the patient's clinical condition.
Stenosis of the accessory renal artery: Doppler ultrasound findings
Authors: Hall NJ , Thorpe RJ , MacKechnie SG
Published: March 2008

Stenosis of an accessory renal artery has been cited as a significant source of false‐negative results with conventional renal artery Duplex sonography in the investigation of renal artery stenosis. Two case reports of accessory renal artery stenosis that were detectable using the newer intrarenal Doppler ultrasound technique with sampling from both poles and the hilum are presented. The cases illustrate a further advantage of Doppler ultrasound of the intrarenal arteries over the conventional technique.
A case of acquired renal cystic disease with unusually large cysts
Authors: Lee M , Caterson R
Published: March 2008

The case of a woman who presented with acquired renal cystic disease with loin pain due to bleeding into an unusually large cyst is described.
Dense artery sign of the middle cerebral artery: Traumatic cause
Authors: Shuaib IL , Crotch‐Harvey MA
Published: March 2008

Dense artery sign of the middle cerebral artery on non‐enhanced computed tomography is recognized as an early sign of ensuing major cerebral infarction and is usually a consequence of thrombosis or embolism of an ischaemic stroke. A case is described resulting from trauma that correlated with angiographic and Doppler ultrasound findings and the significance of this sign in this case is discussed.
Intracranial meningioma with hepatic metastases and hypoglycaemia treated by selective hepatic arterial chemo‐embolization
Authors: Ferguson JM , Flinn J
Published: March 2008

Meningiomas rarely give rise to metastases despite frequent dural invasion. A rare case of symptomatic hypoglycaemia due to extensive liver metastases from an angioblastic meningioma is described along with the use of hepatic arterial chemo‐embolization to effect palliation by reduction in tumour bulk.
Analgesia and sedation in interventional radiological procedures
Authors: Hiew C‐Y , Hart GK , Thomson KR , Hennessy OF
Published: March 2008

The use of intravenous analgesia and anxiolytics in interventional radiology improves the patient's tolerance of potentially painful and prolonged procedures and allows the radiologist better control of the course of the procedure being undertaken. Monitoring of the patient's oxygen saturation, pulse rate, respiration, blood pressure and cardiac rhythm during a procedure is essential. Fentanyl and midazolam is a combination that is effective and convenient to use because both agents are relatively short acting, have little cardiovascular depression and are easily reversible (with naloxone and flumazenil). They are a better alternative to pethidine and diazepam because they can be more tightly titrated and controlled and are safer and more suitable for use in outpatients. Monitoring for respiratory depression is important and special care must be taken in the elderly and patients with hepatic, renal or chronic airways disease. General anaesthesia may be unavoidable in patients who are unstable, unco‐operative or who have raised intracranial pressure.
How much now to tell? Patients' attitudes to an information sheet prior to angiography and angioplasty
Authors: Phatouros CC , Blake MP
Published: March 2008

A prospectively controlled pilot study of 100 patients undergoing an invasive radiological procedure was undertaken to test patients' acceptance of risk disclosure and whether this increases anxiety and rate of procedure cancellation. Two sheets with differing amounts of information on adverse outcome were randomly allocated and patients provided a graded response to statements following the procedure. Eighty‐one completed questionnaires were received (brief sheet n= 40; long sheet n= 41). There were 19 non‐compliers with main causes either due to lack of interest or problems such as language difficulties, visual impairment and dementia. There were no significant differences between the two groups with respect to subjective anxiety caused by the information or risk of procedure cancellation. This preliminary work has shown that information sheets are well accepted and provide a simple, standardized format for risk disclosure.
Epidural spinal tuberculoma
Authors: Bhatoe HS
Published: March 2008

Epidural tuberculoma in the spine is a rare lesion and its pre‐operative distinction from tumour is usually not possible. One such case who presented with radiological appearance suggestive of spinal tumour is described.
The bipartite tarsal navicular bone: Radiographic and computed tomography findings
Authors: Shawdon A , Kiss ZS , Fuller P
Published: March 2008

Two cases of bipartite tarsal navicular bone are presented. The radiographic and computed tomography (CT) findings of this anatomical variant are described. Correct recognition of this entity is important, both because it may be the cause of symptoms perse, and because it may be misdiagnosed as a fracture. When plain films are not diagnostic, CT scanning is helpful in distinguishing between a fracture and this variant.
Ultrasound screening of families with abdominal aortic aneurysm
Authors: Larcos G , Gruenewald SM , Fletcher JP
Published: March 2008

Recent observations suggest that first degree relatives of patients with an abdominal aortic aneurysm (AAA) are also at risk for the development of this disorder. The first degree relatives of 130 adults with known AAA were invited to attend for an ultrasound examination. Fifty‐two eligible relatives (mean age 53 years, range 41–73) from 38 families underwent sonographic screening. Using standard ultrasound criteria no participants were identified with an asymptomatic AAA. Thus, ultrasound of families of patients with AAA has a low yield and may not be useful for screening purposes.
Imaging patterns in melioidosis
Authors: Tan APA , Pui MH , Tan LKA
Published: March 2008

Melioidosis is an infectious disease caused by Pseudomonas pseudomallei. It is seldom diagnosed promptly and, if untreated, can lead to an 80–100% mortality rate. Twenty‐eight patients with melioidosis were identified over a 6 year period, and their imaging patterns were analysed. Respiratory infections were the commonest form of presentation, frequently shown as diffuse airspace consolidation, and accounted for the highest mortality. Visceral and musculoskeletal infections were associated with chronicity and a high relapse rate. Multifocal splenic abscesses were a common occurence. Septic arthritis of the knee was frequently seen. The majority of patients had diabetes mellitus and chronic ill‐health. An increased awareness of the disease can contribute to its early detection and appropriate treatment.
Hepatic focal nodular hyperplasia: Colour Doppler ultrasound can be diagnostic
Authors: Stephenson NJH , Gibson RN
Published: March 2008

Focal nodular hyperplasia (FNH) is a rare, benign, hepatic mass lesion that is usually found in young adult females. It is sometimes an incidental finding on abdominal sonography or computed tomography. Its appearance on these studies is not characteristic however, thereby creating a diagnostic problem.1 This report is of a case which showed a centrifugal, spokewheel pattern of pulsatile blood supply on colour Doppler US. This finding, we suggest, is sufficiently diagnostic to avoid the need for further investigation in some patients, and to direct further imaging more appropriately in others.
Haematopoietic marrow hyperplasia simulating transarticular skip metastasis in osteosarcoma
Authors: Pui MH , Tan MH , Kuan JHY , Pho RWH
Published: March 2008

A case is presented of osteosarcoma with haematopoietic marrow hyperplasia simulating transarticular skip metastasis on computed tomography and magnetic resonance imaging.
Foreign body removal with fine‐nosed forceps and assistance of image intensification
Authors: Mykytowycz M , Allen RJ
Published: March 2008

Foreign body removal has been developed as a routine radiology department service. Techniques, indications and hazards are described.
A home‐made phantom for learning ultrasound‐guided invasive techniques
Authors: N Robert , Gibson Katrina I
Published: March 2008

An ultrasound phantom is described which allows practice of ultrasound‐guidance of needle placement over variable depths and into targets of variable size. The phantom mimics a solid organ in its echogenicity and can be cheaply and easily made from resources of the domestic kitchen.
Non‐functional malignant extra‐adrenal retroperitoneal paraganglioma
Authors: Holden Andrew
Published: March 2008

A case of malignant non‐functional extra‐adrenal retroperitoneal paraganglioma is presented. The mass was located in the peri‐renal space, simulating a renal cell carcinoma. The radiological and pathological findings are discussed.
Duodenal haemorrhage resulting from renal cell carcinoma metastases
Authors: Black JAR , Mendelson RM
Published: March 2008

A case of duodenal haemorrhage resulting from renal cell carcinoma metastases is presented. This is an uncommon method of presentation and is often difficult to diagnose requiring multiple imaging regimes. This case demonstrates the problems that may be encountered in identifying the source of bleeding.
Use of a Strecker oesophageal stent in the treatment of benign oesophageal stricture
Authors: Foster DR
Published: March 2008

The use of self‐expanding prostheses in the management of malignant oesophageal strictures has become well established. The majority of benign peptic oesophageal strictures can be successfully managed using endoscopic or fluoroscopically guided balloon oesophageal dilatation combined with long‐term drug therapy, particularly using proton pumper inhibitors. Although endoscopic oesophageal dilatation can be performed on an outpatient basis, it requires repeated hospital visits. There is a small risk of oesophageal perforation whilst cardio‐respiratory complications may be encountered during the use of intravenous sedation in an elderly population. The use of a self‐expanding Strecker stent in a 98 year old woman with a benign oesophageal stricture is described.
Distinguishing between cystic teratomas and endometriomas of the ovary using chemical shift gradient echo magnetic resonance imaging
Authors: Ishijima Hideyuki , Ishizaka Hiroshi , Inoue Tomio
Published: March 2008

The purpose of this study was to evaluate the efficacy of chemical shift gradient echo magnetic resonance imaging (MRI) in distinguishing between cystic teratomas and endometriomas of the ovary, using a 1.5T magnet. The study included 22 patients with 31 ovarian lesions (15 cystic teratomas and 16 endometriomas), which showed high signal intensity on T1‐weighted spin echo images. Chemical shift gradient echo images with three different echo times (TE = 2.5, 4.5 and 6.5 ms) were obtained in all cases. Indices were calculated on the basis of the signal intensities of lesions on the chemical shift gradient echo images. All endometriomas had signal intensity indices of less than 2.1, while all cystic teratomas had signal intensity indices of 18.1 or greater. Chemical shift gradient echo imaging is an alternative method that is useful and simple for distinguishing between cystic teratomas and endometriomas of the ovary.
Ultrasound of malignant breast microcalcifications: Role in evaluation and guided procedures
Authors: Rickard Mary T
Published: March 2008

Ultrasound examination will not always identify the malignant calcifications of ductal carcinoma in situ. However, the potential benefits of ultrasound examination of suspicious breast microcalcifications lie first in identifying a mass lesion associated with the calcifications and second in guiding fine needle cytology, core biopsy and hookwire localization. Because of these benefits it is recommended that ultrasound examination be performed as part of the evaluation of mammographic microcalcifications which are considered suspicious or diagnostic of malignancy.
Clinical audit in radiation oncology: Results from one centre
Authors: FRACR G Stevens , PhD. I Firth
Published: March 2008

This study aims to determine workload statistics and to document patterns of fractionation in a single centre in two time periods separated by 4 years. Patient, tumour and treatment‐related data were collected for courses of radiation treatment that were commenced within two 6‐month periods in both 1988 and 1993. In both time periods, 45–49% of patients were treated with curative intent. Of these, one‐third were irradiated definitively and two‐thirds in an adjuvant setting. Most of the remainder were treated with palliative intent. A few were treated for non‐neoplastic conditions. The re‐treatment rate in 1993 was 13%. In both time periods, breast and lung tumours represented approximately 20% each of the total treatment courses. Skin, head and neck, gynaecological, urological and haematological primary tumours accounted for 5–10% each. Treatment intents differed markedly for different primary sites. For example, in 1993 65% of patients with breast primaries were treated curatively compared with 6% of patients with lung primaries. Treatment schedules for curative intent were similar in both time periods and for the majority of treatment sites. Median fraction numbers were 25 (excluding skin primaries), reflecting conventional daily fractionation. Treatment schedules for palliation showed greater variation and there was a trend towards shorter treatment courses in 1993. For palliative treatment of bone, brain and lung, from either primary or metastatic disease, treatment schedules with 10–15 fractions were used most frequently in 1988. In 1993, however, the majority of patients received 1–5 fractions. In 1993, the breakdown of techniques according to treatment intent showed that for treatment with curative intent, single, parallel opposed and more complex field arrangements were used in 27% (includes skin primaries), 12% and 61% of treatment courses, respectively, compared with 29%, 59% and 12%, respectively, for palliative treatment courses. In 1993, one‐third of patients receiving radiation treatment lived in the local health area. Patients living in areas with rural postcodes were more likely to receive palliative irradiation and had a higher incidence of melanoma than patients living in areas with Sydney metropolitan postcodes. As approximately 50% of patients were treated with palliative intent, changes in the fractionation patterns used can alter significantly the utilization and availability of megavoltage equipment. However, any reduction in attendances caused by hypofractionation for palliation may be offset by the trend to use hyperfractionation for curative treatments. The data support the hypothesis of reduced availability and use of radiation therapy in patients with cancer from rural areas.
Necrotizing fasciitis: Fatal complication of migrated biliary stent
Authors: JWP Marsman MD, PhD  , Hoedemaker HPNW
Published: March 2008

The major drawbacks of biliary stents are occlusion and migration. Most distally migrated stents pass spontaneously. In the presented case, however, the migrated stent perforated the sigmoid colon and led to necrotizing fasciitis.
Giant growth‐hormone secreting pituitary tumour with extracranial extension
Authors: Ip Tai Pang , Chan Fu Luk , Chee Kung Annie Wai , Lam Karen Siu Ling
Published: March 2008

A 19 year old female patient with typical features of acromegaly was found to have an extensive pituitary tumour with suprasellar, lateral and inferior extensions. Magnetic resonance imaging (MRI) also showed a portion of the tumour extending from the right cavernous sinus through the foramen ovale to become extracranial. Serum growth hormone (GH) was 52.6 mU/L basally and remained elevated after oral glucose, confirming the diagnosis of acromegaly. Treatment with the long‐acting somatostatin analogue, octreotide, for 6 months led to a 30% reduction in tumour volume of the intracranial portion but no effect on the extracranial and sphenoidal extensions. She was subsequently treated with trans‐sphenoidal surgery followed by external irradiation. The possibility of perineural spread of the tumour was considered.
Atlanto‐axial rotatory fixation: Improved demonstration using spiral CT
Authors: Cowan IA , Inglis GS
Published: March 2008

Atlanto‐axial rotatory fixation (AARF) is an uncommon condition which is often missed at presentation because of its rarity and the relative subtlety of plain film X‐ray findings, but early detection and appropriate management are vital for a cure. We describe three cases in which the use of spiral computed tomography scanning with 3D and sagittal reconstructions greatly aided diagnosis and management. The 3D images gave a more graphic picture of the overall alignment of the upper cervical spine and the skull base, while the sagittal reconstructions demonstrated the presence or absence of compensatory atlanto‐occipital subluxation. The literature is briefly reviewed.
Low dose rate teletherapy: Updated tumour response
Authors: Denham JW , Hamilton CS , Simpson SA , O'Brien M
Published: March 2008

This report presents an update of tumour response experience in patients with locally advanced head and neck cancer treated on the low dose rate teletherapy project at the Mater Misericordiae Hospital, Newcastle.

Long‐term progression‐free survival figures are disappointing in all dose rate/total dose groupings and offer little encouragement that an improvement in therapeutic ratio can be achieved for head and neck cancer patients using teletherapy apparatus adjusted to treat at low and intermediate dose rates.
Mesenteric plexiform neurofibroma: Computed tomography appearance
Authors: Jain Rajeev , Sawhney Sukhpal , Berry Manorama
Published: March 2008

Gastrointestinal involvement in von Recklinghausen's disease is usually in the form of neurofibromas and leiomyomas. Very rarely, plexiform neurofibromas may be seen involving the bowel wall and myenteric plexus with secondary minor involvement of the mesentery. This report describes the computed tomography morphology of a plexiform neurofibroma extensively involving the mesentery with minor involvement of the bowel wall.
Ultrasound appearance of pseudomembranous colitis
Authors: Thomas SM , Howlett DC , Hearn FJ
Published: March 2008

A case illustrating that ultrasound can be useful in the diagnosis of pseudomembranous colitis is reported. Diagnosis of pseudomembranous colitis is usually made from microbiological or histopathological investigations. The ultrasound appearance of grossly thickened bowel wall with luminal narrowing is non‐specific, but in the correct clinical context should suggest the diagnosis of pseudomembranous colitis.
Liposarcoma of the hypopharynx
Authors: Wambeek NDK , Mendelson RM
Published: March 2008

A case of the unusual condition of liposarcoma of the hypopharynx extending submucosally down the oesophagus in a 64 year old male is reviewed. The clinical, radiological and pathological features are presented and the role of various radiological modalities is discussed.
Extraskeletal Ewing's sarcoma presenting with pulmonary embolism
Authors: Chang Sew Kee , Wang Tiak Lim , Teh Ming
Published: March 2008

Small round cell tumours with the morphologic characteristics of Ewing's sarcoma arise rarely in soft tissues of the extremities, retroperitoneum, chest and orbit. Patients usually present with symptoms arising from the swelling at the primary site. We report on a patient with a retroperitoneal extraskeletal Ewing's sarcoma who presented with massive tumour embolism to the pulmonary vasculature. To our knowledge, this is the first report of extraskeletal Ewing's sarcoma presenting with pulmonary tumour embolism.
Central neurocytoma occurring in the thalamus: CT and MRI findings
Authors: FRACR. Ying‐Kei Cheung
Published: March 2008

A case of central neurocytoma occurring in the thalamus, confirmed by electron microscopy and immunohistochemistry, is reported. Computed tomography demonstrated a hypodense mass with an irregular margin arising from the right thalamus, extending into the lateral ventricle and crossing the midline. It contained areas of calcification and showed slight enhancement after contrast injection. On magnetic resonance imaging (MRI) scan, the tumour was hypointense to the brain in T1‐weighted images and was heterogeneously hyperintense to the brain in T2‐weighted images.
Primary bone lymphoma (osteolymphoma)
Authors: Christie David RH , Cahill Stephen P , Barton Michael B
Published: March 2008

Seventeen patients with primary lymphoma of bone are reviewed. In 15 patients treated with radical radiotherapy, local progression or recurrence occurred in four. The results support the use of radiotherapy alone, using doses of 45‐50 Gy. Although small numbers prevent firm conclusions, the inclusion of the whole bone or regional nodes in the irradiated volume did not appear to improve results. Eight patients received systemic chemotherapy with no apparent improvement in rates of relapse. Two patients suffered pathological fractures after radiotherapy in the absence of recurrence at the fracture site; however, osteomyelitis, older age, Paget's disease, high‐dose prednisolone and whole‐bone radiotherapy may have added to the risk of fracture. Because of the many complex names and selection criteria applied to this condition, literature searching and comparison between studies was difficult. The simple term osteolymphoma is proposed, consistent with other primary bone conditions.
Arterial complications of pancreatitis and their radiological management
Authors: Sawlani V , Phadke RV , Baijal SS , Kumar S , Roy S , Gupta P , Gujral RB
Published: March 2008

Arterial haemorrhage from pseudoaneurysm in pancreatitis patients is a formidable complication with a high mortality rate. We encountered six patients in whom a pseudoaneurysm was demonstrated at angiography. Drainage of associated pseudocyst facilitated visualization in one patient. Four patients had pseudoaneurysms arising from the proximal part of the major peripancreatic vessels and were treated by steel coil embolization (n= 3) and surgically (n= 1). There was no episode of rebleeding in these patients during a follow‐up period of 10–18 months. Of the two patients with distal small peripancreatic branch vessel involvement hydrogel particle and gelfoam embolization was successful only temporarily in one patient and unsuccessful in the other patient. The literature is reviewed and the efficacy of steel coil embolization is emphasized.
Breast MRI: Early experience with a 3‐D fat‐suppressed Gradient Echo Sequence in the evaluation of breast lesions
Authors: Holden A , Anderson JEM , Ives FJ , Taylor D , FRACR EJ Wylie , Adamson R
Published: March 2008

The early clinical experience with a 3‐Dimensional Fourier Transform Gradient Echo sequence with fat suppression in the evaluation of breast masses is reported. Ten female patients with breast malignancies were pre‐operatively evaluated with this sequence and the results compared with the pathological specimens. The scanning protocol included a noncontrast sequence followed by an immediate post‐contrast sequence (completed 4.5 min after intravenous contrast injection) and a delayed sequence. Images were assessed for maximum lesion and parenchymal enhancement, lesion size and additional enhancing abnormalities. In six patients, malignant masses enhanced maximally on the immediate post‐contrast sequence with parenchyma enhancing maximally on delayed images. In three cases, there was preferential enhancement of malignant lesions over normal parenchyma but to a similar degree on both post‐contrast sequences. In one case, both the lesion and parenchyma enhanced maximally on the delayed sequence. Magnetic resonance assessed lesion size accurately and also detected satellite malignancies in one case. However, lesion grade, associated in situ carcinoma and lymphovascular invasion did not impact on lesion enhancement. In this small series, a contrast‐enhanced, fat‐suppressed 3‐D Gradient Echo Sequence detected breast carcinoma with high sensitivity. The technique holds promise but further evaluation is required.
Paediatric tracheobronchomalacia and its assessment by tracheobronchography
Authors: Little AF , Phelan EM , Boldt DW , Brown TCK
Published: March 2008

Tracheobronchomalacia (TBM) is a rare condition that results in abnormal compliance of the airways with airway collapse being most marked in expiration. In a series of 28 patients, it was observed that a majority of cases presented with malacia involving the trachea (64%) and the left main bronchus (64%) alone. The right main bronchus was involved in combination with the trachea in 32%, but rarely was involved by itself. Most patients demonstrated associated congenital abnormalities, such as tracheo‐oesophageal fistulae, vascular rings or congenital heart disease (78%). A small proportion were premature infants with no obvious associated abnormality (11%). Evaluation of the dynamic process, tracheobronchomalacia, requires ‘real‐timeinvestigation ‘. While computed tomography (CT) and magnetic resonance imaging (MRI) have their role in the management of chronic airway obstruction in the child, only cine‐CT, bronchoscopy, fluoroscopy and tracheobronchography provide real‐time assessment for the evaluation of a dynamic process such as TBM. In our experience, tracheobronchography provides excellent anatomic, physiologic and therapeutic information in the assessment of those infants with primary or secondary TBM. By using continuous positive airway pressure in incremental doses, the amount of positive pressure required to maintain an open airway in expiration is a valuable adjunct to the clinical management of the patient. When careful attention is paid to technique, tracheobronchography is a safe investigation in experienced hands.
Cranial cystic epidermoid: Report of two cases and review of the literature
Authors: Gupta VK , Khandelwal N , Gupta SK , Ramzan AU , Kak VK
Published: March 2008

Intercranial epidermoid tumours are benign lesions of congenital origin that are potentially curable. Although computerized axial tomography (CT) and magnetic resonance imaging (MRI) are usually diagnostic, a few atypical features sometimes make pre‐operative diagnosis difficult. Two cases of cystic epidermoids with peripheral ring enhancement are reported. Relevant literature has been reviewed.
Two cases of chronic recurrent multifocal osteomyelitis: Radiological and scintigraphic findings
Authors: Tan BS , Nayanar V , Mansberg R , Murray IPC , Rossleigh MA
Published: March 2008

Chronic recurrent multifocal osteomyelitis (CRMO) is an extremely rare condition, of uncertain aetiology. Since first described, in 1972, under 100 cases have been reported. It is being reported with increasing frequency, and many cases of this disease go unreported. It most commonly affects patients in childhood or adolescence. No infective agent has been identified, and antibioticis do not affect the course of the disease. We present the cases of two female children with this disorder, describe the radiological and scintigraphic findings and review the literature. Case 1 is the first reported case to our knowledge of CRMO presenting with cranial nerve palsies.
Intramural aortic dissection
Authors: Wambeek NDK , Cameron DC , Holden A
Published: March 2008

We present 10 cases of intramural aortic dissection. The cases are all characterized by the presence of intramural haematoma without the presence of a patent false lumen. The radiological features and possible aetiologies are discussed. The key radiological finding is the presence of a hyperdense rim in the aortic wall on a non‐contrast‐enhanced computed tomography (CT) scan. In one case, a delayed diagnosis was made using magnetic resonance imaging (MRI). In a further case, the delayed development of a large aortic ulcer was demonstrated. Intramural aortic dissection has only recently been described in the radiological literature. The aetiology of this condition remains controversial. The imaging findings may be subtle and the diagnosis is still frequently being overlooked. We believe CT to be the primary diagnostic test for this condition, and its advantages over MRI and transoesophageal echocardiography (TOE) are discussed.
Concomitant presentation and resolution of a post‐traumatic pneumothorax and pneumopericardium
Authors: Gelderen WFC , Al‐Hindawi M , Archibald FFRad CG
Published: March 2008

The association of a right pneumothorax and a pneumopericardium due to non‐penetrating trauma is exceedingly unusual. A patient with both complications presented 7 hours after a motorcycle accident. These were detected incidentally on a scout film for CT for lumbar fractures and both resolved entirely and simultaneously after chest tube insertion in the right pleural space.
Ultrasonographic study of 793 foetuses: Measurement of normal foetal kidney lengths in Bangladesh
Authors: Ansari Selim M , Saha Madhusudan , Paul Ashoke K , Mia Sayedur Rahman , Sohel Abu , Karim Rezaul
Published: March 2008

It is well known that, structurally, the people of Asia are shorter than Europeans. The size of different organs of the foetus may also vary accordingly. To assess this, 793 foetuses between 16 and 40 weeks’gestation were studied and 1175 kidneys were measured on ultrasonograms. Only normal pregnancies were included in the study. Our results show that, in the main, the mean length of foetal kidneys in the present study is either slightly higher or similar to that previously reported by many authors. In this study, the average kidney length at full term is 3.95 cm. An excellent correlation was seen between gestational age, biparietal diameter, femoral length and renal length measurement.