bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of magnetic resonance imaging in a teaching hospital on patient management
Authors: HAILEY D M , CROWE B L , BURGESS I A , KHANGURE M S , MORRIS I
Published: March 2008

An observational study was undertaken to obtain measures of the impact of magnetic resonance imaging (MRI) on diagnosis, patient management and patient outcome. A minimum data set at the time of examination was used for 1119 consecutive patients referred by specialists for MRI of the brain or spine. Three month follow up of 707 brain examinations and 235 spinal examinations was undertaken using a questionnaire on diagnosis and patient management.

Magnetic resonance imaging made a dominant contribution to final diagnoses of neoplasia and vascular disorders, but was less significant for white matter disease. In a high proportion of cases other types of examination also influenced the final diagnosis. Magnetic resonance imaging affected patient management in a high proportion of spinal examinations and in cases of cerebral neoplasm, with lesser contributions to cases of cerebrovascular disorder and white matter disease. While MRI was considered superior to other imaging methods, which it could often replace, in practice it will form only one input to the diagnostic decision.
Clival chordomas
Authors: SCHAMSCHULA R G , SOO M Y S
Published: March 2008

Three cases of clival chordomas are reviewed and the findings are compared to those in the recent literature. In the first case the tumour arose from the basion, spreading downwards to invade the upper cervical canal and the paravertebral fascial planes. The second case is a rare case since it affects a 12 year old pre‐adolescent boy. The third case showed the characteristic features of petro‐clival erosion and a large extracranial component in the nasopharynx.

In all three cases, computed tomography was an excellent modality for demonstrating bone destruction, sequestra and calcification but inferior to magnetic resonance imaging (MRI) in demonstrating the soft tissue extent of the tumour. The multiplanar capability of MRI was found to be particularly useful for planning treatment. Vertebral angiography can demonstrate the tumours by vessel displacement, encasement and vascular staining. Two cases had angiography and demonstrated tumour blush. Pre‐operative embolization was helpful in one case.
Gallium‐67 scintigraphy in borderline lepromatous leprosy
Authors: MOURATIDIS B , LOMAS F E
Published: March 2008

A middle aged woman with a pyrexia of unknown origin was shown to have borderline lepromatous leprosy. Early gallium‐67 scintigraphy demonstrated increased uptake in the subcutaneous tissues of the face and thighs. As a result of these findings skin biopsy was obtained from the right thigh which gave a diagnosis of borderline lepromatous leprosy. The authors have been unable to find other reports of gallium‐67 scintigraphy in leprosy but the pattern of gallium‐67 distribution should suggest the diagnosis.
Intramedullary enterogenous cyst
Authors: KHANDELWAL N , MALIK N , KHOSLA V K , RADOTRA B
Published: March 2008

A case of intramedullary enterogenous cyst in the thoracic region is reported. Computed tomography findings are highlighted with a brief review of the literature.
Imaging of the ureters on intravenous urography: Does a valsalva help?
Authors: BATES NGAIRE R , DAVIS RICHARD
Published: March 2008

A prospective trial, comparing filling of the ureters on routine urography with ureteric filling following a valsalva manoeuvre, was performed. A significantly greater length of ureter was filled by the study patients than controls, allowing this frequently poorly imaged structure to be visualized more consistently.
Unusual complications of pancreatitis
Authors: BUXI TARVINDER B S , SUJATHA Y , VOHRA RAKESH B , SINGH TRILOCHAN , BYOTRA SHRISTI P
Published: March 2008

The computed tomography (CT) appearances of varying grades of severity of acute pancreatitis, and its complications, have been described. Bodywall ecchymosis in the periumbilical region (Cullen's sign) and loins (Grey Turner's sign), though rare, are frequently mentioned in the clinical literature. Massive, exclusively retroperitoneal, involvement is also exceedingly rare. Computed tomography depiction of these signs is sparsely documented. The CT documentation, with clinico‐surgical correlation, of two cases of severe acute pancreatitis with these unusual complications, is presented.
Acardiac twins
Authors: ACTON C M , WOODWARD C S
Published: March 2008

Three cases of twin pregnancy complicated by an acardiac twin are reported. This is a rare abnormality of twins. A vascular communication exists between the twins and the usually normal twin or so called ‘pump’twin may develop cardiac failure as a result of perfusion of the abnormal twin. The acardiac twin is, generally, grossly abnormal with reduction anomalies, particularly of the upper part of the body, and gross oedema. Unless this abnormality is recognized the misdiagnosis of fetal death in utero may be made and the complications of the ‘pump’twin may not be predicted. Three cases are presented with only one survivor.
Torsion of accessory fallopian tube: Ultrasound findings in two premenarchal girls
Authors: THONELL SVEN H , KAM ANDREW , RESNICK GAIL
Published: March 2008

The ultrasound findings of two cases of fallopian tube duplication, both of which had undergone torsion, are described. Two premenarchal girls were examined with ultrasound because of clinical evidence of pelvic pathology. Both were found to have complex cystic structures that on surgery and subsequent pathological examination were shown to be twisted accessory fallopian tubes. Accessory fallopian tubes have been reported to occur in 6–13% of selected patient groups. To our knowledge, torsion of an accessory tube has not been reported in the literature.
Comparison of magnetic resonance imaging and computed tomographic discography in the assessment of lumbar disc degeneration
Authors: LONERAGAN ROBERT , KHANGURE MAKHAN S , MCCORMICK CLEM , HARDCASTLE PHILIP
Published: March 2008

Eighteen patients with chronic low back pain were studied with magnetic resonance imaging (MRI) and computed tomographic (CT) discography. Each study was classified as being normal, showing early disc degenerative changes including annular tear, showing established disc degeneration or disc herniation. There was comparable information in over 90% of the MRI studies when compared to CT discography, without reliance on pain provocation or carrying out an invasive procedure. The axial and sagittal T1 weighted images were used to exclude other causes of pain, such as foraminal stenosis and disc herniation. The midsagittal T2 weighted image used in this study was considered to be, in part, responsible for the underestimation of disc degeneration because it did not allow visualization of the lateral aspects of the discs.
Tuberculous radiculomyelitis (arachnoiditis): Myelographic (and CT myelographic) appearances
Authors: PHADKE R V , KOHLI A , JAIN V K , GUPTA R K , KUMAR S , GUJRAL R B
Published: March 2008

Tuberculous radiculomyelitis (arachnoiditis) remains one of the important causes of paraplegia in India. The diagnosis usually rests on clinical history and examination, and on laboratory findings in the cerebro‐spinal fluid (CSF).

Few descriptive reports are available of the myelographic appearance, with water‐soluble contrast media, in tuberculous radiculomyelitis (arachnoiditis). A retrospective review of 21 myelograms and 10 computed tomographic (CT) myelograms, in 14 patients with tuberculous radiculomyelitis, was carried out, with a view to describing, in detail, the radiographic features. An attempt was made to assess the use of the radiologic procedures in diagnosis and follow up in these patients.

Conventional myelographic findings included block (8/14), irregular sub‐arachnoid space (9/14), filling defects (8/14), sluggish contrast flow (2/14), root thickening (3/14) and atrophic cord (2/14). Computed tomographic myelography showed reduced contrast density in portions of the opacified CSF ring around the cord in affected region (6/7) and, in addition, demonstrated septa and adhesions. Intravenous contrast CT was not found to be useful (2/2). Follow‐up studies showed partial resolution (3/6), deterioration (1/6) and status quo of radiological findings (2/6).

Although these changes can be seen in chronic radiculomyelitis (arachnoiditis) from other causes, such as leukaemic infiltration/lymphoma, other chronic central nervous system infections and latrogenic causes, including repeated intrathecal injections, conventional myelography appeared to be useful for diagnosis and follow up in tuberculous radiculomyelitis (arachnoiditis).
Doses in mammography: From the phantom to the patient
Authors: CROSS PETER
Published: March 2008

While the use of a reference phantom is essential for dosimetry in acceptance testing and in regular quality control checks of a mammographic X‐ray unit, it is also of importance to be able to estimate the patient dose in each individual investigation.

Radiographic and physical data were analysed for a total of 212 women who between them were screened at three locations participating in a breast screening programme. The radiologists made estimates of the individual breast composition (% glandular/adipose ratio) at the film reporting sessions, and then the glandular doses were calculated by the auditor according to the NCRP 85 methodology.

Arising from the data analysis of this dosimetry survey, a method is proposed to determine objectively patient breast composition from the photo‐timed mAs for a given film optical density setting. This permits the NCRP calculations to be extended from breasts of ‘average’(50/50) composition to breasts of individually determined composition.

The diversity of the results between the three locations emphasises the need for regular audits of a mammographic X‐ray unit's performance by an experienced radiological physicist, at least annually or after any major interventional service on the unit.
Technetium‐99m DTPA renography and angiography in renal artery stenoses of varying severity
Authors: YOUNG NOEL , GRUENEWALD SIMON M , WONG KAI PING
Published: March 2008

Thirty‐five hypertensive patients, consecutively studied between 1986 and 1991, were retrospectively reviewed, to compare Technetium‐99m (99mTc) DTPA renal scanning for renal artery stenosis with angiography. Ten patients were on chronic angiotensin converting enzyme (ACE) inhibitor medication and 20 underwent angioplasty of their stenoses. In patients not on ACE inhibitors the renal scan specificity was 83%, sensitivity 82%, negative predictive value 89% and positive predictive value 74%. In the 10 patients on ACE inhibitors the specificity was 67% (relatively more stenoses of < 50% were reported in this group), sensitivity 100%, negative predictive value 100% and positive predictive value 60%. Low levels of function (<10mL/min/1.73m2) in 9 kidneys did not militate against diagnoses that correlated well with angiography. Hence, renal scanning, particularly with ACE inhibition, is efficacious in the evaluation of possible renal artery stenosis.

With a mean follow‐up period of 29 months after percutaneous transluminal angioplasty (PTA), four patients had clinical improvement of hypertension control. Each had pre‐PTA total glomerular filtration rates (GFR) of approximately 75mL/min/1.73m2. No improvement was detected in cases with pre‐PTA total GFR of <50mL/min/1.73m2. This may be the level of renal function below which PTA therapy or surgery will not provide benefit.
The hypo‐echoic cortical rim in lupus nephritis
Authors: SLATER S P , HELLER C A , NANRA R S , JONES W S
Published: March 2008

Hypo‐echoic cortical rims are an unusual ultrasound finding in patients with renal disease. A case report is presented of a patient with lupus nephritis who demonstrated hypo‐echoic cortical rims. A brief review of the pathological causes of hypo‐echoic cortical rims is given.
Appendicitis: An unusual cause of infected abdominal aortic aneurysm
Authors: GARB MINNIE
Published: March 2008

An unusual case of appendicitis, which presented as an infected aortic aneurysm is described. Gas was noted in the wall of the aneurysm on abdominal radiographs and computed tomography, due to the formation of an appendico‐aortic fistula. Computed tomography also demonstrated a contained rupture of the aneurysm.
Atypical fat necrosis of the breast: The ‘mycetoma’appearance
Authors: GELDEREN W F C VAN
Published: March 2008

A very unusual appearance of fat necrosis in the breast is described. The low density/hypo‐echoic rim and high density/hyperechoic central part are shown on mammography and ultrasound, respectively. The mass had the appearance of a ‘mycetoma’in a cavity in the lung. The radiological diagnosis of fat necrosis was confirmed by histopathology.
Vanishing pleural fluid collections in cardiac failure simulating lung tumours
Authors: GELDEREN W F C VAN
Published: March 2008

Vanishing fluid collections in interlobar fissures, associated with congestive cardiac failure, are uncommon but well‐recognized. Previous studies have highlighted the occurrence of solitary vanishing ‘tumours’, but in the study reported here 7 out of 12 consecutive patients presented with more than one interlobar fluid collection simulating pulmonary tumours. In most cases a lateral radiograph confirmed the correct diagnosis and in all cases follow‐up radiographs demonstrated resolution of all pleural fluid collections. In one case ultrasound was helpful. Making the correct diagnosis is very important inorder to prevent inappropriate investigations and treatment such as biopsy or surgery. It is suggested that unusual pleural fluid collections may be more common in communities where pleural disease following stab wounds or tuberculosis are more prevalent.
Extratesticular lesions: A radiological and pathological correlation
Authors: HOLDEN ANDREW , LIST ALAN
Published: March 2008

It is often difficult to make an exact pathological diagnosis of extratesticular lesions detected on ultrasound. This study aimed to clarify the sonographic criteria required for a more accurate diagnosis by performing a correlative study of the ultrasonographic findings and pathologic diagnosis.

Of the 268 scrotal ultrasound examinations with extratesticular lesions reviewed, 81 had the diagnosis confirmed on pathological or clinical grounds. The major pathological entities reviewed in the study were epididymitis, hydrocele, cystic lesions of the epididymis, post‐vasectomy lesions and solid extratesticular lesions.

The sonographic appearances in both acute and chronic epididymitis were reviewed. Chemical epididymitis had a typical clinical presentation and distribution confined to the epididymal tail and ductus deferens. This should allow a specific diagnosis to be made. Cystic lesions of the epididymis included true epididymal cysts and spermatoceles, but these entities were not distinguishable from each other sonographically.

Late complications of vasectomy have been recognized clinically as the ‘Late Post‐Vasectomy Syndrome’, and the pathological changes have also been described. In this study the corresponding sonographic appearances of sperm granulomata, dilated efferent ducts and spermatoceles are documented.

Most solid extratesticular lesions are areas of fibrosis termed ‘fibrous pseudotumours’, but adenomatoid tumours and papillary cytstadenomata are the most common neoplastic lesions.

By obtaining pathological correlations for many sonographic extratesticular abnormalities, we have clarified a number of issues and made several new observations.
Accuracy of stereolithographic models of human anatomy
Authors: BARKER T M , EARWAKER W J S , LISLE D A
Published: March 2008

A study was undertaken to determine the dimensional accuracy of anatomical replicas derived from X‐ray 3D computed tomography (CT) images and produced using the rapid prototyping technique of stereolithography (SLA). A dry bone skull and geometric phantom were scanned, and replicas were produced. Distance measurements were obtained to compare the original objects and the resulting replicas. Repeated measurements between anatomical landmarks were used for comparison of the original skull and replica. Results for the geometric phantom demonstrate a mean difference of + 0.47 mm, representing an accuracy of 97.7–99.12%. Measurements of the skull produced a range of absolute differences (maximum +4.62 mm, minimum +0.1 mm, mean +0.85 mm). These results support the use of SLA models of human anatomical structures in such areas as pre‐operative planning of complex surgical procedures. For applications where higher accuracy is required, improvements can be expected by utilizing smaller pixel resolution in the CT images. Stereolithographic models can now be confidently employed as accurate, three‐dimensional replicas of complex, anatomical structures.
Multiple doses of contrast medium from a single container: Bacteriological studies
Authors: TRESS B M , HELLYAR A G , PENNINGTON J , THOMSON K R , DESMOND P M , MARTINKUS J , LAVAN J J
Published: March 2008

Preparations of lopromide (Ultravist 370; Schering Pty Ltd, Sydney, NSW, Australia), brain/heart infusion broth (BHI; positive growth control) and distilled water (negative control) were inoculated with 103 to 104Pseudomonas aeruginosa, Escherichia coli or Staphylococcus aureus cells and incubated at 37°C. Slow decreases (up to one log) were observed in each organism's count in Iopromide and distilled water at room temperature and in S. aureus and E. coli in Iopromide and distilled water at 35°C until 6–8 h, when counts stabilized. BHI cultures showed logarithmic increases. P. aeruginosa counts increased (half log over 8 h) in Ultravist at 37°C.

Radiology laboratories were shown to have similar airborne bacterial loads to operating theatres. Samples from repeatedly entered Iopromide bottles showed no contamination.

Multiple intravenous doses from a single bottle of non‐ionic contrast medium can safely be used as a costsaving measure provided scrupulous attention is paid to aseptic preparation. Unused decanted contrast medium should be discarded after 4 h.
Beckwith‐Wiedemann syndrome: Antenatal diagnosis
Authors: WHISSON CHRISTOPHER C , FDSRCS ANDREW WHYTE , ZIESING PATRICK
Published: March 2008

The Beckwith‐Wiedemann syndrome is an unusual complex with variable features. The major findings include abdominal wall defects, macroglossia and visceromegaly. These features should be amenable to antenatal ultrasound detection. Only a few such cases have been reported to date. Antenatal diagnosis allows optimum perrinatal care. Hypoglycaemia in the neonatal period is common in these babies and requires early detection and appropriate management to prevent long‐term intellectual complications. We present a case where the diagnosis was suggested prior to delivery.
Tubular ectasia of the rete testis
Authors: LONERAGAN ROBERT , PARRISH MARK
Published: March 2008

Tubular ectasia of the rete testis is an uncommon entity that is usually discovered incidentally during ultrasound evaluation of epididymal abnormalities. The characteristic ultrasound appearance, its frequent association with spermatoceles and the lack of a palpable mass are the main features that permit identification of this entirely benign lesion.
Imaging of thoracic aortic dissection
Authors: VU FH , YOUNG N , SOO Y S
Published: March 2008

Acute thoracic aortic dissection has a high mortality if untreated, so the diagnosis must be rapidly made if mortality is to be lowered significantly. Multiple imaging techniques are often used. This retrospective study from 1988 to 1993 assesses the usefulness in diagnosis of chest X‐rays, computed tomography (CT) scanning, aortography, magnetic resonance imaging (MRI), trans‐thoracic (TTE) and trans‐oesophageal (TOE) echocardiography.

Forty‐two patients with a final clinical diagnosis of dissection were studied. The diagnosis was confirmed in 16 (13 at surgery and three at autopsy). Three died with dissection given as the only cause for death. Chest X‐ray abnormalities were seen in all 19 patients with surgery or death from dissection, with a widened mediastinum and/or dilated aorta being present in 17. In the group of 16 patients with surgery or autopsy proof, CT scans found dissections in 9 of 12 patients studied and correctly classified the type in only five. Aortography was performed in five, with accurate depiction of dissection and type in all. TTE found dissections in three of eight patients imaged by this method. MRI and TOE were performed each on two patients, with accurate depiction of dissection and type in each.

Because of the relatively low sensitivity of CT scanning in defining aortic dissections Westmead Hospital is currently assessing the use of TOE as the prime imaging modality prior to surgical intervention.
Cushing's disease: Pituitary imaging
Authors: TRIPATHI S , AMMINI A C , BHATIA R , GUPTA R , BERRY M , SARKAR C , MAHAJAN H
Published: March 2008

Fourteen patients with adrenocorticotropic hormone (ACTH)‐dependent hypercortisolism underwent pituitary scanning with computed axial tomography (CT) and magnetic resonance imaging (MRI). Computed tomography revealed pituitary macroadenomas in two patients, pituitary hyperplasia in one and a suspicion of pituitary microadenoma in one. Thirteen patients underwent MRI. One with a macroadenoma diagnosed on CT did not undergo MRI. The MRI revealed a pituitary macroadenoma in one, microadenoma in three and hyperplasia in two cases. Magnetic resonance imaging following gadolinium diethylene triamine penta acetic acid (gd‐DTPA) enhancement revealed four more pituitary microadenomas. All patients who had pituitary adenomas (micro and macro) and hyperplasia underwent trans‐sphenoidal pituitary surgery. One of the two patients, who had an enlarged pituitary on imaging but no demonstrable adenoma, was found to have a microadenoma at surgery. Patients with ACTH‐dependent hypercortisolism should undergo MRI of the pituitary gland to identify/localize corticotroph pituitary adenomas. The study should include gd‐DTPA enhancement in cases where the scan is normal.
The value of ultrasound‐guided fine needle aspiration in the assessment of solid breast lumps
Authors: PHILLIPS GARETH , MCGUIRE LLOYD , CLOWES DAVID
Published: March 2008

To assess the value of routine ultrasound‐guided fine needle aspiration (US‐FNA) of solid mass lesions of the breast, all such patients presenting to the breast clinic over a 5 month period were offered US‐FNA in addition to standard imaging.

One thousand, three hundred and eighty‐six consecutive patients were assessed and 77 solid mass lesions identified. US‐FNA was performed in 49 of these. Sixteen demonstrated cytological features of malignancy that was confirmed at surgery.

US‐FNA did not diagnose malignancy in cases with typical benign imaging features. It did alter diagnosis from an equivocal suspicious mass lesion to a definite diagnosis of malignancy in four cases (25%). It also altered diagnosis from an equivocal, probably benign, diagnosis to a more confident diagnosis of benign disease in 18 (58%) of benign cases. US‐FNA confirmed the diagnosis of malignancy in four cases where a suspicious mass could only be imaged by ultrasound.

US‐FNA is simple, rapid and, unlike large Tru‐Cut biopsies, is not associated with complications. It causes only minimal discomfort to both patient and operator. We recommend that US‐FNA becomes a routine component of the imaging workup of breast mass lesions both to exclude malignancy in equivocal cases and to confirm malignancy when this is expected.
The effect of BW12C on the radiosensitivity and necrosis of murine tissues and tumours
Authors: STEVENS G , HILL S A , JOINER M C , JOINER B , JOHNS H , WILLIAMS K , DENEKAMP J , NETHERSELL A B W
Published: March 2008

BW12C is a drug that has the potential to induce normal tissue and tumour hypoxia by binding to haemoglobin, increasing its affinity for oxygen and thereby reducing oxygen availability to tissues. Initial results suggested that BW12C administration caused significant radioprotection of normal tissues and induced tumour necrosis, but variable results have been reported subsequently. This work was carried to extend the range of observations concerning the ability of BW12C to radioprotect normal tissues and tumours and to induce necrosis of tumours of the mouse.

BW12C was administered as 70 mg/kg i.v. 15 min before irradiation of jejunum in CBA mice and of foot skin in WHT mice with single doses of 240 kVp X‐rays while mice breathed gases of varying oxygen tensions. The radiosensitivities of these tissues were assessed by the crypt survival assay and the acute skin reaction, respectively. The radiosensitivity of CaNT tumours to single fraction irradiation was assessed by the regrowth delay assay following administration of single or multiple doses of BW12C at varying times to air‐breathing CBA mice. The radiation response was compared to the radiosensitivity of clamped tumours. The effect of BW12C alone on tumours was assessed by regrowth delay and histological examination for necrosis.

BW12C did not change the radiosensitivity of jejunal crypts irradiated while mice breathed air or 10%O2, or of foot skin when mice breathed 12%O2. BW12C protected foot skin by a factor of 1.1 when mice breathed air. Single or multiple doses of BW12C did not influence the radiosensitivity of CaNT tumours, although marked radioprotection could be induced by clamping the tumours during irradiation. Multiple doses of BW12C alone led to a slight increase in necrosis of the CaNT tumour but did not alter its growth rate. BW12C alone did not induce necrosis of the murine JT lymphoma.

BW12C did not have a significant effect as a radioprotective or necrotizing agent in these experimental systems. The reported differences in the radiomodifying effects of BW12C are probably tissue‐specific and relate to complex biochemical and physiological interactions.
Variant of the Triple A syndrome
Authors: KHONG P L , PEH W C G , LOW L C K , LEONG L L Y
Published: March 2008

The Triple A syndrome is a rare condition comprising achalasia, alacrima and adrenocorticotrophic hormone (ACTH) insensitivity. A 12 year old Chinese girl with a variant of this syndrome (achalasia and alacrima), presenting with failure to thrive, is reported. Typical appearances of achalasia on barium swallow subsequently led to the correct diagnosis. The radiologist may be the first to recognize this syndrome and hence help anticipate its potentially life‐threatening sequelae.
Computed tomography of von Meyenburg complex simulating micro‐abscesses
Authors: SADA PRIO N , RAMAKRISHNA BANUMATHI
Published: March 2008

A case is presented of a bile duct hamartoma (von Meyenburg complex) in a 44 year old man being evaluated for abdominal pain. The computed tomography findings suggested micro‐abscesses in the liver and a biopsy showed von Meyenburg complex.
Diverticulosis of the appendix: A case report
Authors: LAWLER L J , JACKSON R
Published: March 2008

A case of diverticulosis of the appendix is described. The clinical significance is discussed.
Calcified lymph node metastases in adenocarcinoma of the colon
Authors: SWEENEY DIRK J , LOW VINCENT H S , ROBBINS PETER D , YU SHENG FONG
Published: March 2008

Radiologically demonstrable calcification has been described in a variety of primary tumours and metastatic deposits. Dystrophic calcification in retroperitoneal lymph nodes may occur in malignant lymphoma or metastatic carcinoma, most often after radiotherapy or chemotherapy. However, de novo calcification in retroperitoneal lymph node metastases from carcinoma are very rare. Such a case is presented here.
Bronchial artery embolization to control haemoptysis
Authors: WONG K P , YOUNG N , MARKSEN G
Published: March 2008

This is a retrospective study of 15 patients who had bronchial artery angiography and embolization for life‐threatening haemoptysis in the period January 1986 to March 1993. Eight were male and seven were female, in the age range 32–77 years. Massive haemoptysis has a 50–100% mortality if treated conservatively and surgery has an up to 35% mortality in this high‐risk group.

Nine patients had advanced tumours. Seven had technically successful procedures, with haemoptysis being controlled in six and one patient dying from post‐procedural massive haemoptysis. One of the patients with failed embolization died from massive haemoptysis and the other had spontaneous settling of bleeding.

The other six patients suffered from bronchiectasis (2), aspergilloma involving tuberculous cavity (2), active tuberculosis (1), and abscess cavity presumably due to vasculitis (1). Technically successful embolizations were achieved in all six; three had control of haemoptysis, one required successful re‐embolization after massive bleeding following initial embolization, one suffered continuing non‐massive bleeding and one died soon afterwards from massive haemoptysis.
Carcinoma of the breast with sarcomatous metaplasia
Authors: TAYLOR DONNA B , ADAMSON ROSLYN , MINCHIN DAVID E , READING LEONIE
Published: March 2008

Carcinoma of the breast with sarcomatous metaplasia (CSM) is a rare and interesting tumour with a poorer prognosis than the usual breast malignancies. The mammographic appearances of this lesion have only previously been described once in the literature. A case of CSM is presented with mammographic‐pathological correlation and review of the literature.
Shoulder impingement syndrome: Diagnostic accuracy of magnetic resonance imaging and radiographic signs
Authors: WILLIAMSON M P , CHANDNANI V P , BAIRD D E , REEVES T Q , DEBERARDINO T M , SWENSON G W , HANSEN M F
Published: March 2008

Shoulder impingement syndrome is commonly encountered in orthopaedics. In a blinded retrospective study, magnetic resonance imaging and roentgenographic signs in 41 patients with clinical signs of impingement syndrome were compared with 40 control patients. Statistically significant differences between the groups included the absence of subacromial fat, as well as the presence of a supraspinatus tear, subacromial osteophytes, and a decreased coracohumeral distance. Other signs reported to occur in patients with impingement syndrome did not vary significantly in the population studied.
Sonography of abdomino‐scrotal hydrocele
Authors: RATHOUR D P S , BHARGAVA S K , BAIJAL A
Published: March 2008

A case of abdomino‐scrotal hydrocele diagnosed on sonography without clinical suspicion is reported with a review of the literature.
Allergic bronchopulmonary aspergillosis: A comparative evaluation of computed tomography with plain chest radiography
Authors: SANDHU MANAVJIT , MUKHOPADHYAY SIMA , SHARMA SURENDER K
Published: March 2008

Computed tomography (CT) was done in 15 consecutive patients with allergic bronchopulmonary aspergillosis (ABPA). When compared with chest X‐ray, CT was found to be superior in the diagnosis of bronchlectasis in patients with ABPA. Of the 90 lobes studied, CT detected bronchiectasis in 57 lobes and plain chest X‐ray in 44 lobes. In addition to central bronchiectasis, peripheral bronchiectasis was diagnosed with CT in 18 of the 57 lobes. Follow‐up CT was done in two patients after treatment for detection of progression or regression of bronchiectatic lesions. One patient showed radiological as well as clinical improvement, while the other patient presented with a recurrence of symptoms 4 months after stopping treatment. Computed tomography showed radiological progression of bronchiectasis and the patient was successfully treated with corticosteroids (thus preventing further bronchial damage). It is concluded from this study that CT is superior to plain chest X‐ray in the diagnosis of bronchiectasis in patients with ABPA. Being non‐invasive, it is also helpful in monitoring the course of bronchiectasis in these patients.
Computed tomography in acute small bowel obstruction
Authors: BLAKE MARTIN P , MENDELSON RICHARD M
Published: March 2008

The abdominal computed tomograms of 28 patients with a clinical diagnosis of acute small bowel obstruction were reviewed. Computed tomography accurately identified the presence, severity and level of obstruction. Signs such as angulated bowel loops and adjacent streaks within the mesentery at points of luminal calibre change were recognized in 69% of cases with adhesive obstruction. Computed tomography may reveal non‐adhesive causes and is the modality of choice for investigating patients with higher grades of bowel obstruction where early surgical intervention is contemplated.
Radiotherapy and concurrent chemotherapy for oesophageal carcinoma
Authors: HUI RINA , BULL COLIN A , GEBSKI VAL , O'ROURKE IAN
Published: March 2008

This retrospective non‐randomized study reports the outcome of 67 patients who received radical radiotherapy with or without two courses of concomitant chemotherapy using 5‐fluorouracil and cis‐platin at Westmead Hospital from 1985 to 1992. The overall median survival was 14.0 months, the actuarial 5‐year survival was 18%, and median disease‐free survival was 11.3 months. Forty‐eight per cent of the 67 patients had complete endoscopic response and this resulted in a significantly improved survival for those patients. A pre‐treatment baseline Karnofsky performance ≧ 80, and a baseline swallowing score ≧ 80 also predicted for better survival. The development of acute toxicity did not predict the likelihood of developing chronic toxicity. The incidence of stricture formation (benign and malignant) requiring dilatation was 37%. There was no significant improvement in overall or disease‐free survival, nor significant worsening of toxicity in the group of patients who received concurrent radiotherapy and chemotherapy compared with patients receiving radiotherapy alone.
Mammographic features of adenoid cystic carcinoma
Authors: BOURKE A G , METCALF C , WYLIE E J
Published: March 2008

Adenoid cystic carcinoma of the breast accounts for < 1% of breast malignancies. This case report describes the mammographic features and the pathology. Adenoid cystic carcinoma is a well‐circumscribed carcinoma that has a relatively good prognosis.
Longitudinal stress fracture in the femoral diaphysis
Authors: SCHUBERT F , CARTER S
Published: March 2008

Stress fractures occur in multiple sites but more so in the lower limbs and show a predilection for certain sites. The lower femoral shaft is not a common site and a longitudinal stress fracture is extremely rare. A case is reported of a longitudinal stress fracture in the distal femoral shaft that was not suspected initially despite the patient's athletic activities. Review of the literature did not reveal documentation of any similar case.
Mucinous cystadenoma of the appendix with unusual sonographic appearances
Authors: FALLON MICHAEL J , LOW VINCENT H S , YU LAWRENCE L
Published: March 2008

A case of an appendiceal cystadenoma resulting in a large mucocele in a 35 year old man presenting with abdominal pain is reported. On ultrasonography, an unusual appearance of strand‐like layers of varying echotexture suggesting a solid lesion was seen. On computed tomography, calcification and contrast enhancement of the rim was noted. The spectrum of imaging appearances of appendix mucoceles is reviewed.
Computed tomography demonstration of mosaic oligaemia in pulmonary embolism
Authors: Frazer CK , Cameron DC
Published: March 2008

Previous reports on computed tomography findings in pulmonary embolism have concentrated on describing large peripheral wedged‐shaped opacities thought to represent infarcts, and filling defects in the central vessels presumed to represent emboli. Two cases are presented of mosaic oligaemia with areas of apparent increase in density initially thought to represent infiltrates.
Patterns of fractionation for palliation of bone metastases
Authors: Stevens G , Firth I
Published: March 2008

The patterns of fractionation used to treat bone metastases in a single centre in two time periods were determined. Clinical audit was carried out, for two periods of 6 months each, in 1988 and 1993. Data recorded included patient, tumour and treatment variables. Palliation of bone metastases represented 40% and 44% of palliative treatment courses, and 20% and 21% of total treatment courses, respectively, in both time periods. Shorter treatment schedules were used in 1993 compared to 1988, with mean fraction numbers of 6.4 versus 8.5, respectively (P < 0.001). This reduction in fraction numbers occurred for the common primary tumour sites. In 1993, the mean numbers of fractions used were related to the primary tumour site (7.8 fractions for breast, 5.0 for lung, 6.7 for melanoma, 6.4 for other primary sites, P= 0.05), the treatment site (7.3 fractions for weight‐bearing bones, 4.0 for non‐weight‐bearing bones, P < 0.001) and patient address (6.0 fractions for city postcode vs 7.8 for country postcode, P= 0.02). Treating radiation oncologist (5.7‐7.8 mean fractions, P= 0.06) and patient age (P= 0.56) were not significant factors for the number of fractions used. It is likely that there were multiple causes for a reduction in the number of fractions used to treat bone metastases, including the results of clinical trials and increasing pressure to optimize the use of scarce resources. However, patients who may have a better prognosis (breast primary) and those with metastases in weight‐bearing bones continued to receive longer treatment schedules.
Haemangiopericytoma of the central nervous system
Authors: Borg MF , Benjamin CS
Published: March 2008

The records of four patients presenting with a histological diagnosis of haemangiopericytoma of the central nervous system, in Auckland, New Zealand, between 1970 and 1990 were reviewed retrospectively, with the aim of determining the natural history of the disease and response to various treatment modalities. Three out of the four patients reviewed presented with primary cerebral disease and the fourth with a primary spinal cord tumour. All three cerebral primary patients were initially treated with local surgical excision. All three patients received radical radiotherapy following local recurrence. The first two patients remained disease‐free locally although one patient developed a solitary liver metastasis 5 years after radiotherapy. The third patient was referred with multiple cerebral metastases and failed to respond to radiotherapy. The patient with the primary lesion in the spinal cord was treated with local excision followed by postoperative radiotherapy and remains disease‐free 17 years after treatment. One patient failed to respond to chemotherapy, prescribed to treat a local recurrence adjacent to the previous radiotherapy field. This was successfully excised subsequently. The patient presenting with multiple cerebral metastases was the only patient to die of this disease. Results suggest that local recurrence is avoidable with adequate wide excision of the primary tumour followed by local radical radiotherapy. The role of chemotherapy remains controversial and no conclusion could be drawn regarding the role of palliative radiotherapy from this study. Active treatment and long‐term follow‐up are necessary because of the relative aggressiveness of this disease and the propensity for late relapses.
Post‐orchidectomy radiation therapy alone for patients with early stage non‐seminomatous germ cell tumours of the testis
Authors: Kearsley JH , Tripcony L
Published: March 2008

The aim of this study was to review the patterns of disease relapse and survival outcomes for patients treated postorchidectomy with radiotherapy for early stage (I and IIA) non‐seminomatous germ cell tumors of the testis (NSGCT). The clinical records were reviewed of 117 men consecutively treated at the Queensland Radium Institute from 1960–90 (inclusive) for stage I or MA NSGCT. A total of 108 patients received radiotherapy to the para‐aortic nodes and ipsilateral hemipelvis following orchidectomy; nine patients received radiotherapy to the para‐aortic nodes and whole pelvis. Twenty‐two of 99 (22.2%) stage I and eight of 18 (44.4%) stage MA patients relapsed following definitive radiotherapy. The 5 year overall and recurrence‐free survivals were 84 and 75%, respectively. Factors associated with a significantly worse outcome included: (i) patients with stage IIA disease; (ii) the presence of undifferentiated elements in the operative specimen; (iii) a primary tumor < 5 cm size; and (iv) treatment given prior to 1979. Given the unsatisfactory recurrence rate following radiation therapy alone and the availability of cisplatin‐based chemotherapy regimens, it is recommended that radiation therapy alone for patients with early stage NSGCT be abandoned in favour of other management strategies.
Tropical pyomyositis
Authors: Radvany MG , Chandnani VP
Published: March 2008

A 22 year old male presented with symptoms of diffuse muscle pain and multiple abnormal laboratory findings that were eventually attributed to tropical myositis. Computed tomography scan was more reliable than ultrasound and served as a guide to needle aspiration and pathologic diagnosis.
Malignant granular cell tumour of the sciatic nerve
Authors: Hurrell MA , McLean C , Desmond P , Tress BM , Kaye A
Published: March 2008

A case of malignant granular cell tumour of the sciatic nerve is presented. Computed tomography demonstrated iso‐density with muscle and minimal enhancement. Magnetic resonance demonstrated T1 isointensity with muscle with marked enhancement, and isointensity with fat on proton and T2 images. Pathological evidence is presented for its probable Schwann cell histogenesis.
Invasive pituitary adenoma mimicking meningioma
Authors: Ngu SLC , Palmer FJ
Published: March 2008

It is not always possible to differentiate invasive pituitary adenoma from the other parasellar tumours. A case of an invasive pituitary adenoma mimicking a meningioma is reported. The importance of a correct pre‐operative diagnosis is emphasized.
Myocardial perfusion imaging with technetium‐99m sestamibi SPECT in the evaluation of coronary artery disease
Authors: Mak KH , Ang ES , Goh ASW , Na KX , Sundram FX , Tan ATH
Published: March 2008

Technetium‐99m hexakis‐2‐methoxy‐isobutyl‐isonitrile(99mTc sestamibi) has been used for myocardial perfusion imaging in the evaluation of coronary artery disease (CAD) since 1990. The experience of its use in an Asian population with and without previous myocardial infarction (Ml), diabetes mellitus (DM), hypertension (HPT) and collateral circulation (COL) is reported.

One hundred and thirty‐nine patients who underwent treadmill exercise testing with 99mTc sestamibi single photon emission computed tomography (SPECT) and coronary angiogram were studied. The overall sensitivity for the detection of CAD was 91.0% and specificity was 64.7%. For patients without previous myocardial infarction, the sensitivity was 83.8% and specificity was 83.3%. Patients with COL had a higher sensitivity while those with HPT had a lower specificity. Sensitivity was higher in patients with multi‐vessel disease (MVD) than single vessel disease (SVD). The overall detection for individual artery stenosis was 74.1% with a specificity of 73.1 %. Amongst the three major coronary arteries, sensitivity was highest for the right coronary artery and specificity was highest for the left circumflex artery. Specificity was higher in patients without MI or COL. We found that the agreement between 99mTc sestamibi SPECT and coronary angiogram for the extent of CAD was only 52.5%. The concordance rate was higher for patients with MVD than SVD.

It is concluded that 99mTc sestamibi SPECT is a sensitive and specific test for the detection of CAD and localization of disease to individual coronary arteries in our patients with some differences in the subgroups. Agreement between coronary angiogram and 99mTc sestamibi for the extent of coronary artery disease was also satisfactory.
Ultrasonography, computed tomography and percutaneous intervention in acute pancreatitis: A serial study
Authors: Kumar Prem , Mukhopadhyay Sima , Sandhu Manavjit , Berry Manorama
Published: March 2008

Fifty‐seven patients (45 males, 12 females) with a clinical diagnosis of acute pancreatitis were serially evaluated by ultrasonography (US) and computed tomography (CT). Thirty patients had a single study, 18 had one follow‐up study while 9 had two follow‐up studies. The aetiology was gallstone disease in 26% of patients and a history of chronic alcohol abuse in only 16%. No cause could be identified in 47% of patients; 22% of US scans were unsatisfactory for the evaluation of pancreas whereas CT was uniformly satisfactory. Peripancreatic inflammation was detected in only 29% patients on US compared with 91% on CT. Pancreatic abscesses were detected in 8 patients on CT and gas was present in all of them. Fourteen patients underwent guided interventional procedures (US, 12; CT, 2). On follow up after 3 months, worsening of inflammation was detected in 11% patients on CT, which was not detected on US. It is concluded from this study that CT is far superior to US in the evaluation of acute pancreatitis, detection of peripancreatic inflammation and its extension into the retroperitoneal compartments and mesentery, and also for the evaluation of fluid collections, haemorrhage and abscesses. However, US provides easy guidance for percutaneous interventional procedures and can be used for follow‐up scans.
Abdominal wall endometriosis: Sonographic diagnosis
Authors: Khaleghian R
Published: March 2008

Abdominal wall endometriosis (AWE) often occurs in the surgical scar of a previous Caesarean section. In females with unexplained lower abdominal and pelvic pain who have had a C‐section, the abdominal wall should be carefully examined to rule out AWE.
Obstructive hyperinflation treated by use of self‐expandable stent
Authors: Foster DR
Published: March 2008

A self‐expandable metal stent was used in the management of a young woman who developed respiratory failure as a result of obstructive hyperinflation caused by a bronchogenic tumour.
Incidental detection of skeletal metastases on technetium‐99m DTPA renal scintigraphy
Authors: Prakash R
Published: March 2008

A case is presented where skeletal metastases from a prostate carcinoma were detected during 99mTc DTPA scintigraphy performed for evaluation of renal function. The lumbar vertebrae in camera field of view were intensely perfused on the arterial phase of the radionuclide flow study. Tracer pooling in these vertebrae, visualized on initial serial images, progressively faded over the 30 minute study. Widespread areas of increased radionuclide uptake, consistent with skeletal metastases, were detected on 99mTc MDP bone imaging performed two days later. Subsequent prostatic biopsy revealed a well differentiated primary adenocarcinoma.
Healing of osteoporotic vertebral compression fractures following cure of Cushing's syndrome
Authors: Goswami R , Shah P , Ammini AC , Berry M
Published: March 2008

Reversibility of gross radiologically manifest steroid‐induced osteoporosis is disputable. A young boy with endogenous Cushing's syndrome with severe osteoporosis, demonstrating satisfactory recovery of osteoporotic changes within 2 years after cure of Cushing's syndrome, is described.