bluuebunny/crossref_metadata_2025 huggingface dataset:
Plasma cell neoplasms in the young.
Authors: Geetha N , Jayaprakash M , Rekhanair A , Ramachandran K , Rajan B
Published: June 2014

Multiple myeloma, a disease of the elderly, is extremely rare in those below 30 years of age. Two patients with multiple myeloma diagnosed at 20 years and 18 years are described. Both presented with extradural cord compression, lytic bone lesions and bone marrow plasmacytosis. One patient received combination chemotherapy and radiotherapy and survived for 14 years. A literature review is presented.
Positron emission tomography in breast cancer: a clinicopathological correlation of results.
Authors: Rostom A Y , Powe J , Kandil A , Ezzat A , Bakheet S , el-Khwsky F , el-Hussainy G , Sorbris R , Sjoklint O
Published: June 2014

We conducted a retrospective study to evaluate the sensitivity, specificity and accuracy of positron emission tomography (PET) scans in 109 patients with primary recurrent or metastatic breast cancer. All patients had a PET scan, X-ray or CT scan of the chest, an ultrasound or CT scan of the liver and a bone scan. Mammography was available for 86 patients. Correlation between the PET scan result and histological findings were made. The sensitivity, specificity and accuracy of the PET scan were calculated for both the primary tumour (T) and lymph nodes (N). In patients with metastasis (M) the accuracy of the PET scan was compared with other imaging modalities. Histological results of the site in question were available in only 105 patients. Information for the primary tumour was available for 93 patients and for nodes in 74. The PET scan was accurate in 89.2% for (T), with 3.2% false positive and 7.6% false negative. For (N) the PET scan was accurate in 90.5% with 9.5% false negative. In the 86 patients who underwent both mammography and PET scanning, the PET scan was more accurate in 89.5% versus 72% (p = 0.0003). In the 19 patients with metastasis, the PET scan was in agreement with other imaging modalities in 100% of cases. PET scanning is the only non-invasive imaging procedure that will detect tumours in the breast, lymph nodes, lung, liver, bone and bone marrow with high sensitivity, specificity and accuracy. It is a valuable tool in the management of patients in all stages of breast cancer for diagnosis, staging and following treatment response.
Gamma-ray scattering for mandibular bone density measurement.
Authors: Morgan H M , Shakeshaft J T , Lillicrap S C
Published: June 2014

There has been considerable interest in the measurement of bone density in the mandible, either to study bone resorption following tooth loss or to determine the relationship between mandibular and skeletal bone mineral density. Measurements mostly have been made on dental radiographs but more significant correlations between mandibular and skeletal bone density have been obtained when more sophisticated techniques have been used, such as quantitative CT and dual energy X-ray absorptiometry. The present work investigates the feasibility of using gamma-ray scattering measurements to estimate mandibular bone density. Using a phantom to simulate the jaw, an 241Am source and a hyperpure germanium detector it is shown that bone density may be measured with a precision of about 1%.
Comparison of proton therapy and conformal X-ray therapy in non-small cell lung cancer (NSCLC).
Authors: Lee C H , Tait D , Nahum A E , Webb S
Published: June 2014

This study compares the performance of one proton and four conformal X-ray planning techniques in treating non-small cell lung cancer (NSCLC). The treatment volumes for 13 NSCLC patients undergoing radical radiotherapy were planned using the five different techniques and dose-volume histograms (DVH) were used extensively in the comparative analysis. The minimum dose to the phase 2 target volume was escalated to 90 Gy, or until the point at which pre-set tolerance limits of spinal cord or lung were exceeded. The proton plan could treat nine of the 13 patients up to a dose of 90 Gy. Among the four X-ray techniques, performance varied enormously. One of them could not treat any of the patients, even to the conventional 60 Gy level, without failing to meet one or more of the criteria, whilst another one could treat 10 out of the 13 patients, although with this technique only four were permitted to have the dose escalated to 90 Gy. It was also found that two of the 13 patients could not be treated by any of the proton or X-ray plans to the conventional level, and were therefore considered unsuitable for radical radiotherapy. Various issues in conformal NSCLC radiotherapy including organ movement, tumour control, other possible organs at risk etc., are also discussed.
An investigation into the use of polymer gel dosimetry in low dose rate brachytherapy.
Authors: Farajollahi A R , Bonnett D E , Ratcliffe A J , Aukett R J , Mills J A
Published: June 2014

An investigation has been carried out into the properties of the BANG polymer gel and its use in the dosimetry of low dose rate brachytherapy. It was discovered that the response of the gel was reproducible and linear to 10 Gy. The gel was found to be tissue equivalent with a response independent of energy to within experimental accuracy (standard error of measurement +/- 5%). The slope of the calibration curve was found to increase from 0.28 +/- 0.01 s-1 Gy-1 to 0.50 +/- 0.02 s-1 Gy-1 for an increase in monomer concentration from 6 to 9%. Absorbed dose distributions for a straight applicator containing 36 137Cs sources were measured using the gel and the results compared with measurements made with thermoluminescent dosemeters (TLDs) and calculated values. Good agreement was found for the relative measurements. The root mean square residual percentage errors were 3%, 1% and 4% for the gel and the two groups of TLDs, respectively. There were some significant differences in absolute values of absorbed dose in the gel, possibly owing to the effects of oxygen. Measurements of a complex gynaecological insert were also made and compared with isodose curves from a planning system (Helax TMS), and in areas unaffected by oxygen diffusion the isodose levels from 100 to 50% agreed to within less than 0.5 mm.
Determination of colony numbers in pig epidermis as an estimate for radiosensitivity. A rapid assay based on in vitro BrdU-labelling.
Authors: van den Aardweg G J , Mooi W J
Published: June 2014

A rapid assay has been developed for the quantitation of colonies arising from surviving clonogenic cells in pig epidermis after irradiation. The number of surviving clonogenic cells per unit area was related to the epidermal in vivo response of moist desquamation. After irradiation with single doses, ranging from 20 to 36 Gy, skin biopsies were taken and incubated in dispase for enzymatic separation of the epidermis and dermis. Full thickness epidermal sheets were labelled with bromodeoxyuridine (BrdU) in vitro. Proliferating cells were visualized using standard immunohistochemical procedures. Cell groups containing > or = 16 cells were counted as colonies. These colonies were first seen on day 14/15 after irradiation. The number of colonies per cm2, as a function of skin surface dose, yielded a cell survival curve with a D0 (+/- SE) of 3.87 +/- 0.57 Gy. The ED50 for the epidermal in vivo reaction of moist desquamation corresponded with a colony density of 2.7 colonies per cm2. After higher doses, abundant smaller colonies of 4-8 BrdU-positive cells were seen and these were more radioresistant, as represented by higher D0 values.
Conversion of multiple solid testicular teratoma metastases to fatty and cystic liver masses following chemotherapy: CT evidence of "maturation".
Authors: Connor S , Guest P
Published: June 2014

Testicular germ cell tumour metastases may undergo "retroconversion" to mature differentiated teratoma following chemotherapy or irradiation. We report a patient with testicular germ cell liver metastases in whom computed tomography (CT) scans following chemotherapy demonstrated a reduction in CT attenuation of the liver lesions to that of cystic and fatty density. This is believed to represent CT evidence of liver metastasis "retroconversion", which offers the potential for non-invasive monitoring of histological progression.
CT evaluation of gastric wall pathology.
Authors: Merino S , Saiz A , Moreno M J , Parlorio E , Pedrosa I , Yus M
Published: June 2014

The purpose of this study is to show the CT features of common and infrequent pathological lesions of the gastric wall. Although CT features are not often specific, familiarity with the most frequent pathological gastric findings on CT can assist in differential diagnosis.
Design and use of internal receiver coils for magnetic resonance imaging.
Authors: Gilderdale D J , deSouza N M , Coutts G A , Chui M K , Larkman D J , Williams A D , Young I R
Published: June 2014

This review describes coils for MRI that are inserted into the body through natural orifices. It covers the design and implementation of small internal receiver coils for use in the pelvis and gastrointestinal tract. Normal anatomy delineated by the high resolution obtained by using these coils and the appearances in a number of disease states for each clinical application are described.
A comparison of 14 and 12 gauge needles for core biopsy of suspicious mammographic calcification.
Authors: Evans A J , Whitlock J P , Burrell H C , Pinder S E , Ellis I O , Geraghty J G , Lee A H , Wilson A R
Published: June 2014

This study was carried out to compare the efficacy of 14 vs 12 G needles in stereotactic core biopsy of mammographic calcification. A consecutive series of 100 impalpable mammographic calcifications, without an associated mass and requiring stereotactic core biopsy were randomly allocated to either 14 G or 12 G needle sampling. All biopsies were performed using an upright stereotactic digital unit (Senovision GE) and a Bard automated biopsy gun. Core biopsy results were categorized as either normal, benign, atypical ductal hyperplasia, suspicious of ductal carcinoma in situ (DCIS), DCIS or invasive cancer. The radiographic calcification retrieval rates, complete and absolute sensitivity for malignancy of DCIS and DCIS with an invasive focus were obtained by comparison of core results with surgical histology. Radiographic calcification retrieval was achieved in 86% when using 14 G and 12 G needles. The absolute sensitivity and complete sensitivity for diagnosing DCIS were the same with 12 G and 14 G needles (72% versus 71% and 93% versus 94%, respectively). The use of 12 G needles does not appear to confer benefit over the use of 14 G needles in the diagnosis of mammographic calcification.
Differentiation of recurrent rectal cancer and scarring with dynamic MR imaging.
Authors: Dicle O , Obuz F , Cakmakci H
Published: June 2014

The accuracy of dynamic contrast enhanced magnetic resonance (MR) imaging in the differentiation of malignant and benign pelvic lesions during follow-up of patients with treated colorectal tumours was evaluated prospectively. 19 patients (11 men, 8 women; age range 35-70 years; mean 57 years) with suspected local recurrence of colorectal malignancy were evaluated with MR imaging. Dynamic MR imaging with axial Turbo-FLASH gradient echo imaging and bolus injection of contrast medium was performed. Dynamic images, each consisting of one slice in the same location, were acquired at 5, 10, 15, 20 and 30 s, and at 1, 2, 3, 4, 5 and 10 min. The maximum change in signal intensity (Emax), the acceleration rate of the time-intensity curve (TIC) and the ratio of the signal intensity of the lesions to the signal intensity of the iliac artery (SIL/SIA) were used as the enhancement parameters. The TIC and SIL/SIA ratio at 60 s were found to be valuable in the differential diagnosis; Emax had no significance in differentiating benign and malignant lesions. Sensitivity was 83% for each calculated parameter. SIL/SIA has the highest specificity and accuracy among the parameters.
Pneumothorax post CT-guided lung biopsy: a comparison between detection on chest radiographs and CT.
Authors: Bungay H K , Berger J , Traill Z C , Gleeson F V
Published: June 2014

Pneumothorax is reported to be a more common complication of lung biopsy performed under computed tomography (CT) than under fluoroscopic guidance. This may simply reflect the greater sensitivity of CT over chest radiographs (CXRs) in the detection of small pneumothoraces. This study aimed to determine the incidence of pneumothorax detected by CXR and by CT after CT-guided biopsy of non-pleurally based pulmonary masses, and to compare these incidences with previous reports in the literature of pneumothorax incidence post fluoroscopic biopsy. 88 consecutive CT-guided lung biopsies of masses not abutting the pleural surface were included. Immediate post-biopsy CT images, and 1 and 4 h CXRs were assessed independently by two observers for the presence and size of pneumothorax. 72 biopsies were fine needle aspirations (FNAs) performed with 22 G spinal needles only, seven were cutting needle biopsies (CNBs) performed with 18 G cutting needles only, and nine were both. 37 patients (42%) developed a pneumothorax. 35 were detected on CT (40%) and 22 on CXR (25%). None required tube drainage. Of the patients in whom CT demonstrated a pneumothorax, the average depth of this was significantly greater for those in whom CXR also detected a pneumothorax compared with those in whom CXR was negative (7.3 mm versus 3.4 mm, p < 0.05). The incidence of pneumothorax detected on CXR post CT-guided biopsy is similar to the reported incidence post fluoroscopic biopsy.
Colour Doppler ultrasound for the evaluation of bowel wall thickening.
Authors: Shirahama M , Ishibashi H , Onohara S , Dohmen K , Miyamoto Y
Published: June 2014

We performed colour Doppler ultrasound to evaluate bowel wall thickening and to determine the effectiveness of this modality. 42 patients (aged 8-83 years old, mean age 43.5 years) with bowel disease underwent both grey scale and colour Doppler ultrasound examinations. The diagnoses were classified into three categories: inflammation, vasculitis or ischaemia. The bowel wall thickness, wall echotexture and location of the involved portion were all recorded by grey scale ultrasound, while the presence of an intramural colour Doppler flow and arterial signal was evaluated by colour Doppler ultrasound. The colour Doppler flow was graded as "absent", "mild", or "abundant", and the resistive index was also calculated. Bowel wall thickening was observed in the bowel diseases demonstrating inflammation, vasculitis and ischaemia. Patients with ischaemia were significantly older than those with inflammation. The difference in bowel wall thickness was not significant among the disease categories. Differences in bowel wall echotexture, colour Doppler flow, arterial signal and resistive index among the disease categories were significant. The absence of a colour Doppler flow and of an arterial signal suggested ischaemia, while in younger patients, an abundant colour Doppler flow and a stratified echotexture suggested inflammation. The mean resistive index in the ischemic group was significantly higher than that in the inflammatory group. In conclusion, both grey scale and colour Doppler ultrasound are considered to provide useful information for evaluating and differentiating bowel wall thickening in various bowel diseases.
Improved trigeminal and facial nerve tolerance following fractionated stereotactic radiotherapy for large acoustic neuromas.
Authors: Kalapurakal J A , Silverman C L , Akhtar N , Andrews D W , Downes B , Thomas P R
Published: June 2014

The purpose of this study was to demonstrate improved cranial nerve tolerance following fractionated stereotactic radiotherapy for large acoustic neuromas, defined as tumours with pons-petrous distance (A) > 1 cm and midporous transverse diameter (A + Y) > 2 cm. Of 28 patients with acoustic neuromas treated with fractionated stereotactic radiotherapy, 19 had large tumours at high risk for radiosurgery-induced cranial neuropathy. Six patients received 36 Gy in six, weekly, fractions and 13 patients received 30 Gy in six, weekly, fractions. 15 patients had evaluable trigeminal nerve function and 16 had evaluable facial nerve function. At a median follow-up of 4.5 years, tumour shrinkage was seen in 10 patients and tumour size was stable in nine. None of the patients developed any evidence of transient, or permanent, trigeminal or facial neuropathy at any time during their follow-up period. Fractionated stereotactic radiotherapy may offer a superior therapeutic ratio to single fraction stereotactic radiosurgery in the management of large acoustic neuromas, as evidenced by the absence of post-treatment trigeminal and facial neuropathy.
Lung metastasis invading the left atrium--CT diagnosis.
Authors: Zissin R , Shapiro-Feinberg M , Rachmani R , Kots E
Published: June 2014

A case of metastatic colonic adenocarcinoma invading the left atrium is reported in a patient with clinical signs of cardiac tamponade. The intracavitary extension of the tumour was clearly demonstrated by contrast enhanced CT. As CT plays an important role in the evaluation of patients with intrathoracic masses, intravenous contrast medium is recommended in those cases with associated clinical symptoms of heart disease or pericardial effusion. Its use may establish the diagnosis of cardiac involvement.
MR findings in degenerated ovarian leiomyoma.
Authors: Kohno A , Yoshikawa W , Yunoki M , Yanagida T , Fukunaga S
Published: June 2014

Leiomyoma is one of the rarest solid tumours of the ovary. We report a case of a degenerated ovarian leiomyoma associated with pregnancy. MR findings are identical to those of degenerated uterine leiomyoma and it is difficult to differentiate between them. Ovarian leiomyoma should therefore be included in the differential diagnosis of subserosal uterine leiomyoma.
Ocular metastasis of choriocarcinoma.
Authors: Gangadharan V P , Prakash N P , Chitrathara K , Sasidharan K , Ramachandran K
Published: June 2014

Metastatic tumours of the eye commonly occur from primaries of the breast or lung. The prognosis is poor and the mean life expectancy is 6.5 months from diagnosis. Although metastatic tumours of the eye are not a rarity, ocular metastasis from choriocarcinoma has not been reported previously. We report a case of gestational choriocarcinoma with ocular metastasis.
Acute hyperthermia following stereotactic radiosurgery for pituitary adenoma.
Authors: Kalapurakal J A , Silverman C L , Akhtar N , Downes B , Andrews D W , Laske D W , Thomas P R
Published: June 2014

A 71-year-old male presented with a large pituitary adenoma with superior extension into the optic chiasm and suprasellar cistern. He was treated with stereotactic radiosurgery to a dose of 16 Gy. Approximately 1 h after radiosurgery he developed fever; his temperature peaked at 105.1 degrees F and normalized about 20 h later. This case demonstrates that acute hyperthermia is a potential complication following high dose stereotactic radiosurgery for large pituitary tumours.
Paediatric sedation for CT scanning: the safety and efficacy of quinalbarbitone in a district general hospital setting.
Authors: Simpson J H , West C D , Law P J
Published: June 2014

The aim of this study was to review retrospectively the safety and efficacy of a paediatric sedation protocol in a district general hospital radiology department. 256 children attended for CT scanning over a 40-month period. 40 children required sedation and were given quinalbarbitone. 34 (85%) of this group were adequately sedated. Of the children who received quinalbarbitone, 35 were under 5 years of age. 32 of this group (91.4%) were adequately sedated. Failures in children under 5 years were all caused by problems with administration whilst failures in the older children were due to paradoxical excitement. No problems with respiratory depression were encountered. Sedation can be safely performed in a district general hospital radiology department if a structured protocol is adhered to. Quinalbarbitone is a safe, effective oral agent in children under the age of 5 years.
Differential effects of menopause and metabolic disease on trabecular and cortical bone assessed by peripheral quantitative computed tomography (pQCT).
Authors: Tsurusaki K , Ito M , Hayashi K
Published: June 2014

The usefulness of peripheral quantitative computed tomography (pQCT) was investigated in the diagnosis of metabolic bone diseases, including osteoporosis, and especially in the different diagnostic values in trabecular and cortical components. The subjects were 460 Japanese women aged 20-86 years, including 318 healthy volunteers, 58 osteoporotics with fracture and 84 patients with diseases including amenorrhoea, steroid-induced osteoporosis, renal osteodystrophy (ROD) and primary hyperparathyroidism. Bone mineral density (BMD) was measured for more than 4 years in 74 of the healthy volunteers. BMD was measured by spinal QCT, dual X-ray absorptiometry (DXA) of the spine, radius, and heel, and pQCT of the radius and tibia. High resolution images were obtained for geometry of the radius. Radial pQCT showed a higher correlation with radial DXA than with spinal QCT, and spinal QCT showed a higher correlation with spinal DXA than with radial pQCT. The annual bone loss rates at predominantly trabecular bone sites were accelerated in both the axial and appendicular skeleton. In the fracture study, radial pQCT showed a higher odds ratio (OR = 4.4) than radial DXA, and cortical area ratio seemed to be a good predictor of fracture risk (OR = 5.2). Amenorrhoea and steroid-induced osteoporosis predominantly affected trabecular bone, ROD predominantly affected cortical bone and hyperparathyroidism affected both components, especially the cortical component. pQCT is useful for assessing both trabecular and cortical bone, to provide information on individual bone changes in metabolic bone disease and to estimate the risk of fracture.
Skin sparing in interventional radiology: the effect of copper filtration.
Authors: Nicholson R , Tuffee F , Uthappa M C
Published: June 2014

Complex and lengthy interventional radiological techniques have resulted in a number of patients developing skin reactions in recent years. To safeguard against these side effects, we have investigated the degree to which entrance skin dose can be reduced by inserting 0.18 mm and 0.35 mm copper filtration in the incident beam. The potential reduction was measured on a 22 cm water phantom for each of eight models of a fluoroscopy unit. Using the catheter laboratory fluoroscopy unit on which radiofrequency ablations are routinely performed, we assessed the relative effectiveness of adding filtration and increasing the kV:mA ratio. Image quality was subjectively assessed for diagnostic and therapeutic acceptability in two groups of 10 patients undergoing radiofrequency ablations, pacemaker insertions or electrophysiology studies. One of the groups was screened with 0.35 mm copper filtration in place and the other group acted as the control. Maximum patient skin dose proved difficult to measure directly because of the unpredictable dose pattern. This pattern was studied in four patients using a film method in conjunction with thermoluminescent dosemeters. Copper filtration 0.35 mm thick inserted in the beams of the eight fluoroscopy units produced a mean reduction in entrance dose to the phantom of 58% with a mean increase in tube loading of 29%. At 100 kV the increased loading on the X-ray tube was equivalent to increasing the anteroposterior separation of the patient by 2 cm. Measurements on the catheter laboratory unit showed that the tube voltage would need to be raised above the normal diagnostic range to obtain an equivalent entrance dose reduction without the filter. The blackening of films under the patients showed complex patterns, but the estimated skin doses were consistent with those predicted by the phantom experiments. All six cardiologists considered there to be insignificant detriment to image quality in the procedures investigated.
Thrombosis of mechanical heart valve prostheses: revisiting the role of fluoroscopy.
Authors: Montorsi P , Cavoretto D , Ballerini G
Published: June 2014

Prosthetic valve thrombosis is a rare but potentially fatal complication of heart valve replacement. Symptoms may be misleading, yet the condition may rapidly lead to death. A prompt diagnosis is therefore crucial. Ultrasound is the most often used technique for evaluating prosthesis dysfunction. We describe two cases of prosthesis thrombosis with negative Doppler results but with distinctly abnormal leaflet motion at fluoroscopy. A correct diagnosis would have been missed if the Doppler evaluation alone was relied on. Fluoroscopy should always form part of the diagnostic work-up in patients with artificial heart valves.
Struma ovarii: MRI findings.
Authors: Matsuki M , Kaji Y , Matsuo M , Kobashi Y
Published: June 2014

We describe the MRI findings in three cases of struma ovarii. In all three cases, MRI showed a multilocular cystic mass with a variable signal intensity within loculi. Some loculi or small cysts within septations showed low signal intensity on T1 weighted images and very low signal intensity on T2 weighted images, corresponding pathologically to gelatinous colloid material in large follicles. In one case, with Gd-DTPA enhanced T1 weighted images, the thick septations and locally thickened wall showed marked enhancement, corresponding microscopically to thyroid tissue.
Localization of breast lesions shown only on MRI--a review for the UK Study of MRI Screening for Breast Cancer. Advisory Group of MARIBS.
Authors: Warren R M , Hayes C
Published: June 2014

The UK study of screening for breast cancer compares mammography and dynamic contrast enhanced MRI of the breast in women at high genetic risk of developing cancer. Owing to the high sensitivity of MR in the breast, it is anticipated that some lesions will be visible only on MR. A key issue for the study is how to localize these lesions for histological verification and removal. This article reviews available methods and describes the current UK expertise and recent European developments. The use of MR compatible wires and markers has been explored in a phantom. The use of these markers in vivo is demonstrated in a case imaged by MR and mammography and further discussed. The susceptibility artefacts produced on MRI, and technical properties associated with these needles, wires and markers are discussed. The clinical pathway by which these lesions will be worked up for the study, and the quality control procedures for keeping the number of such biopsies to a minimum, are described. There is an urgent need for further centres in the UK to become proficient at removing lesions found only on MRI in support of this study and other breast MRI applications. The management of these lesions must be resolved in order to realize the full potential of MRI for screening for breast cancer in women at genetic risk, and for other diagnostic applications.
HyCoSy--as good as claimed?
Authors: Stacey C , Bown C , Manhire A , Rose D
Published: June 2014

Hysterosalpingo contrast sonography (HyCoSy) has been compared favourably in the literature with hysterosalpingography (HSG). It does not require ionizing radiation and demonstrates the uterus and ovaries. HyCoSy is reported as being a safe, well tolerated, quick and easy investigation of Fallopian tube patency. Over a 1-year period HyCoSy was performed by two operators on 118 consecutive women who were thought likely to have patent Fallopian tubes. The examinations were graded using a local scale to assess discomfort and were correlated with tubal patency. HSG was performed on 116 patients by the same operators and discomfort recorded. 15 patients underwent both examinations. The degree of pain or reaction was graded 0 (no pain) to 4 (maximum) according to a locally devised scale. Costs of the two examinations were estimated. 89 patients examined by HyCoSy were graded 0-2. However, 23 had severe protracted pain and/or vasovagal reactions with bradycardia and hypotension. Of these, seven required resuscitation owing to prolonged symptoms, requiring treatment with atropine. 19 of the 23 had bilaterally patent Fallopian tubes. Where subsequent HSG was performed, tubal occlusion was confirmed in 8 of 15 women. Other pathologies were noted in 29 of the HyCoSy patients and there were six technical failures. During the same period no severe adverse reactions occurred in 116 patients having HSG performed by the same operators. Three of the HSG examinations were technically unsuccessful. Discomfort following HyCoSy was much greater than that reported previously. Possible mechanisms are discussed but it does not appear to be related to tubal occlusion. Diagnostic accuracy, costs and discomfort compare unfavourably with HSG.
Upright dynamic MR defaecating proctography in an open configuration MR system.
Authors: Lamb G M , de Jode M G , Gould S W , Spouse E , Birnie K , Darzi A , Gedroyc W M
Published: June 2014

We describe our experience evaluating an MR proctography technique using an open 0.5 T MR system. Evacuation of a gadolinium-containing rectal contrast agent was dynamically imaged in the upright position using a fast gradient echo sequence. Anatomical and functional abnormalities were documented. Results from 40 patients who underwent this technique are reported. The method is proposed as an alternative to conventional fluoroscopic proctography.
Changed delivery of boron to tumours using electroporation for boron neutron capture therapy with BSH.
Authors: Cemazar M , Skrk J , Mitrovic B , Sersa G
Published: June 2014

For effective boron neutron capture therapy (BNCT) it is important that a sufficient concentration of boron (10B) is present in the tumour during irradiation. This requirement represents a specific problem. The aim of this study was to test whether electroporation can be used as a non-specific drug delivery system to increase the delivery of sodium borocaptate-10B (BSH) into MCF7 (breast carcinoma) and B16F1 (melanoma) tumour cells in vitro and in B16F1 tumours in vivo. For the in vitro determination of 10B uptake, the cells were incubated in medium containing BSH and exposed to electric pulses. Boron levels were determined by inductively coupled plasma atomic emission spectrometry. In vivo, tumours were exposed to electric pulses 3 min after intravenous BSH injection. At different times after exposure the 10B concentration was determined in tumours and in blood. A difference in the 10B accumulation in the two cell lines was observed after continuous incubation of cells with BSH. No accumulation of 10B was observed in MCF7 cells, whereas in B16F1 cells, 10B accumulated well and reached a plateau within 30 min. Electroporation of these cells resulted in an accumulation of 10B into MCF7 cells up to the level of 10B in B16F1 cells. In vivo, the application of electric pulses increased and prolonged the entrapment of 10B (BSH) in the B16F1 melanoma tumours. A sufficient concentration of 10B was present in the tumour exposed to electric pulses for up to 24 h. Boron was quickly washed out from the blood and the level was below the concentrations in the tumours exposed to electric pulses at 2 h. The results of this study show that electroporation may provide a tool to increase boron concentration in the cells that have impaired transport of BSH through the plasma membrane. Furthermore, prolonged entrapment of BSH in tumours in vivo may, in addition to electroporation, be caused by the modifying effect of electric pulses on blood flow.
Atypical presentation of pleural tuberculosis: CT findings.
Authors: Ariyürek O M , Cil B E
Published: June 2014

Contrast enhanced CT examination of a 22-year-old male with pleuritic chest pain showed pleural-based nodular thickening and masses without any parenchymal involvement or mediastinal lymphadenopathy. Pathological examination following right parietal pleural decortication showed multiple granulomas with caseation necrosis typical of tuberculosis. Pleural tuberculosis presenting with multiple pleural nodules and masses without parenchymal involvement or lymphadenopathy has, to our knowledge, never been reported in the English literature.
Acquired anomalous intrapulmonary venous connection secondary to pulmonary venous stenosis.
Authors: Yoshida S , Akiba H , Tamakawa M , Takeda M , Yama N , Hareyama M , Takagi N , Kikuchi S , Abe T
Published: June 2014

An unusual case of acquired development of anomalous intrapulmonary venous connection with pulmonary venous stenosis is presented. Appearances on a chest radiograph resembled the "scimitar" sign in a patient with previous surgery for partial anomalous pulmonary venous return. Spiral CT and pulmonary arteriography showed stenosis of the right upper pulmonary vein and an anomalous intrapulmonary venous connection between the right upper pulmonary vein and the right lower pulmonary vein. We consider the slow progression of pulmonary vein stenosis led to anomalous intrapulmonary venous connection as an intrapulmonary collateral.
MRI screening for acoustic neuroma: a comparison of fast spin echo and contrast enhanced imaging in 1233 patients.
Authors: Zealley I A , Cooper R C , Clifford K M , Campbell R S , Potterton A J , Zammit-Maempel I , Baudouin C J , Coulthard A
Published: June 2014

Gadolinium enhanced MRI is the gold standard investigation for the detection of acoustic neuroma. Non-contrast MRI sequences have been suggested as an alternative for screening examinations. In order to determine the utility of fast spin echo imaging, both gadolinium enhanced T1 weighted images and fast spin echo T2 weighted images were acquired in 1233 consecutive patients referred for exclusion of acoustic neuroma. Two radiologists independently recorded their findings. Fast spin echo T2 weighted images were evaluated with respect to the visibility of nerves within the internal auditory canals and allocated a confidence score for the presence or absence of acoustic neuroma. 33 acoustic neuromas were identified. Only 56% were confidently identified on fast spin echo T2 weighted images alone; gadolinium enhanced T1 weighted images were required to confirm the diagnosis in 44% of the cases, including 9 of the 10 intracanalicular tumours. However, when identification of two normal intracanalicular nerves is employed as the criterion of normality, the single fast spin echo T2 weighted sequence excluded acoustic neuroma in 59% of this screened population. It is concluded that an imaging strategy intended to identify small intracanalicular acoustic neuromas cannot rely on fast spin echo T2 weighted imaging alone. Gadolinium enhanced T1 weighted imaging could be restricted to patients where fast spin echo images do not exclude acoustic neuroma but this strategy requires continuous supervision by an experienced radiologist. In most practices the screening examination should continue to include a gadolinium enhanced sequence in order to optimize the detection of small acoustic neuromas.
Incidence and significance of demonstrating the meniscofemoral ligament on MRI.
Authors: Lee B Y , Jee W H , Kim J M , Kim B S , Choi K H
Published: June 2014

The aim was to evaluate how often MRI can detect the meniscofemoral ligament and if there is any relationship with the presence of lateral meniscal tears. Sagittal and coronal MR images of 138 patients with arthroscopically proven meniscal tears were included in this study. MR images were retrospectively reviewed for the presence of a meniscofemoral ligament and a lateral meniscal tear. The chi 2 test was used for statistical analysis. Either one or both meniscofemoral ligaments were shown in 114 (83%) of 138 patients on MR images. In 61 cases with a lateral meniscal tear, the meniscofemoral ligament was present in 82% (50/61) and absent in 18% (11/61). In 77 cases without lateral meniscal tear, the meniscofemoral ligament was present in 83% (64/77) and absent in 17% (13/77). A significant correlation was not established between the meniscofemoral ligament and lateral meniscal tear (p = 0.85).
Radiation doses received in the UK Breast Screening Programme in 1997 and 1998.
Authors: Young K C , Burch A
Published: June 2014

The mean glandular doses (MGDs) to samples of women attending for mammographic screening are measured routinely at screening centres in the UK Breast Screening Programme (NHSBSP). This paper reviews the data collected during screening in the NHSBSP in 1997 and 1998 for 23,752 films, using 171 X-ray sets, for 8745 women. Average MGD was 2.03 mGy per oblique film and 1.65 mGy per craniocaudal film, similar to the MGDs found previously in the NHSBSP for the years 1994 and 1995. MGD was found to increase with compressed breast thickness where the tube potential was selected manually, so that the average dose for 10 cm thick breasts was 2.7 times the average for all breasts. For large breasts (> 70 mm) the use of X-ray sets such as the IGE DMR, which automatically select the beam quality for each breast, resulted in lower doses compared with sets using manual tube potential selection. MGD to the standard breast was found to vary from 0.7 to 2.2 mGy and to be correlated with the average MGD per mediolateral oblique film for the women screened on that system (R = 0.79). No correlation between age and MGD was found within the invited age range of 50-64 years.
Mandibular bone mineral density measured using dual-energy X-ray absorptiometry: relationship to hip bone mineral density and quantitative ultrasound at calcaneus and hand phalanges.
Authors: Pluskiewicz W , Tarnawska B , Drozdzowska B
Published: June 2014

The main aim of this cross-sectional study was the estimation of relationships between mandibular bone mineral density (m-BMD), hip bone mineral densities (BMDs) and quantitative ultrasound at calcaneus and hand phalanges. Correlations between m-BMD and age, years since menopause (YSM) and body size were also evaluated. 42 edentulous persons (36 females and 6 males aged 60.5 +/- 6.9 years) were evaluated. In the group studied no factors affecting bone metabolism (either medical conditions or medications) were noted. Bone status was assessed by dual-energy X-ray absorptiometry (mandible, hip--Lunar DPX-L), and quantitative ultrasound (calcaneus--Lunar Achilles which measures speed of sound (SOS, m s-1) and broadband ultrasound attenuation (BUA, dB MHz-1); and phalanges of the hand--DBM Sonic 1200 which measures amplitude-dependent speed of sound (AD-SOS, m s-1)). CV% for mandibular measurements was 2.06%. m-BMD correlated significantly with the following measurements: femoral neck r = 0.39, p < 0.01; Ward's r = 0.39, p < 0.01; calcaneal BUA r = 0.39, p < 0.01; and phalangeal AD-SOS r = 0.4, p < 0.01. Negative correlation consistent with a significant decrease with age was observed in m-BMD (r = -0.36, p < 0.05) and AD-SOS (r = -0.4, p < 0.01). BMD in the mandible also decreased with YSM (r = -0.47, p < 0.01). m-BMD was correlated with age, YSM, height and weight in stepwise, multiple, linear regression analysis. The following equation was obtained: m-BMD = -2.21 + 0.018 x height (cm) -0.02 x YSM (years) + 0.13 x age (years). It may be concluded that mandibular BMD may be an appropriate measurement site for the evaluation of skeletal status in osteoporosis.
External beam radiotherapy in exudative age-related macular degeneration: a pooled analysis of phase I data.
Authors: Chakravarthy U , MacKenzie G
Published: June 2014

In recent years external beam radiotherapy (EBRT) has been proposed as a treatment for the wet form of age-related macular degeneration (AMD) where choroidal neovascularization (CNV) is the hallmark. While the majority of pilot (Phase I) studies have reported encouraging results, a few have found no benefit, i.e. EBRT was not found to result in either improvement or stabilization of visual acuity of the treated eye. The natural history of visual loss in untreated CNV of AMD is highly variable. Loss of vision is influenced mainly by the presenting acuity, and size and composition of the lesion, and to a lesser extent by a variety of other factors. Thus the variable outcome reported by the small Phase I studies of EBRT published to date may simply reflect the variation in baseline factors. We therefore obtained information on 409 patients treated with EBRT from eight independent centres, which included details of visual acuity at baseline and at subsequent follow-up visits. Analysis of the data showed that 22.5% and 14.9% of EBRT-treated eyes developed moderate and severe loss of vision, respectively, during an average follow-up of 13 months. Initial visual acuity, which explained 20.5% of the variation in visual loss, was the most important baseline factor studied. Statistically significant differences in loss of vision were observed between centres, after considering the effects of case mix factors. Comparisons with historical data suggested that while moderate visual loss was similar to that of the natural history of the disease, the likelihood of suffering severe visual loss was halved. However, the benefit in terms of maintained/improved vision in the treated eye was modest.
MRI of congenital coronary artery aneurysm.
Authors: Meinert D , Mohammed Z
Published: June 2014

A case is described in which a myocardial infarction in a young woman was associated with a congenital aneurysm of the left coronary artery. Coronary angiography had shown displacement and almost total occlusion of the left circumflex artery. MRI demonstrated that this was owing to an aneurysm of the left circumflex coronary artery.
Quality criteria implementation for brain and lumbar spine CT examinations.
Authors: Calzado A , Rodríguez R , Muñoz A
Published: June 2014

A study was undertaken to implement the quality criteria proposed by the European Commission for brain general and lumbar spine (disc herniation) CT examinations. The proposed criteria were evaluated for samples including 93 brain and 86 lumbar spine CT examinations, with special emphasis on the diagnostic and radiation dose requirements. The extent to which the image criteria had been achieved was evaluated after two independent observers had each read the images twice. Dose measurements were conducted in parallel to estimate the proposed dose quantities needed to obtain the images. For brain examinations, we found that a group of image criteria were largely met, and met uniformly in all sites. One criterion (1.2.5) was frequently fulfilled but had intermediate values for two sites; the remaining criteria were fulfilled to different extents, although for criteria 1.2.1 and 1.2.2, scores were lower than 50% and 70%, respectively. The mean percentage image quality score had values between 57% and 78%, with variation coefficients in the range 30-68%. Mean values of the dose quantities were in the ranges 44-74 mGy for weighted CT dose index (CTDIw), 497-1018 mGy cm for dose-length product (DLP) and 1.1-2.2 mSv for effective dose (E). CTDIw and DLP were not correlated because of significant variations in the scanned length, whereas DLP and E were strongly correlated. A weak relationship between image quality score and DLP was found for the sample as a whole. For lumbar spine examinations, none of the critical reproduction image criteria was systematically achieved. One group of criteria (1.2.7, 1.2.8 and 1.2.9) was fulfilled to a large extent in many departments, but fulfilment of the remainder varied widely. The mean score fluctuated in the range 39-88%, with three groups of differences: low (39-51%), intermediate (67-71%) and high (85-88%). Mean values of the CTDIw varied between sites in the range 27-48 mGy. Mean DLP values varied between 188 mGy cm and 333 mGy cm, and the mean effective dose ranged between 3 mSv and 5 mSv. There were significant differences in effective dose between men and women. By sites, there was no relationship between DLP and mean score, with the highest image score associated with intermediate dose values. The percentage disagreement among the observers about a given criterion ranged between 2% and 22% for brain, and between 3% and 46% for lumbar spine.
Boron neutron capture therapy of the rat 9L gliosarcoma: evaluation of the effects of shark cartilage.
Authors: Morris G M , Coderre J A , Micca P L , Lombardo D T , Hopewell J W
Published: June 2014

A number of anti-angiogenic substances are now under evaluation, both experimentally and clinically, as potential agents for the treatment of cancer. It has recently been demonstrated that anti-angiogenic agents can increase the therapeutic potential of photon irradiation in a range of tumour models. In the present communication a preliminary assessment is made of the effects of shark cartilage on the response of the rat 9L gliosarcoma to boron neutron capture therapy (BNCT). Shark cartilage was administered orally as an aqueous suspension at a daily dose of approximately 2000 mg kg-1 body weight. The mean survival time of rats receiving no treatment was 20.7 +/- 0.5 days post intracranial tumour implantation. Administration of shark cartilage alone extended the survival time. Two of the rats treated with shark cartilage were healthy and fully active at the end of the evaluation period (43 days post implantation). At autopsy the brain tumours of these animals were a factor of approximately 4 smaller than controls. In a repeat study with shark cartilage alone the survival time was extended by approximately 30%. After boronophenylalanine-mediated BNCT, with or without shark cartilage, the survival time of rats that eventually became moribund was increased by a factor of approximately 2 relative to controls. In both treatment groups approximately 20% of rats were healthy at 1 year after BNCT. There was no evidence of residual tumour at post-mortem. It was concluded that shark cartilage, when given alone, significantly increased the survival time of tumour-bearing rats, presumably owing to an anti-angiogenic effect. However, the survival data suggested that boronophenylalanine-mediated BNCT did not appear to be enhanced by the administration of shark cartilage.
Dynamic susceptibility contrast enhanced MRI in reversible posterior leukoencephalopathy syndrome associated with haemolytic uraemic syndrome.
Authors: Taylor M B , Jackson A , Weller J M
Published: June 2014

We describe a case of reversible posterior leukoencephalopathy associated with haemolytic uraemic syndrome. Following remission confirmed on MRI, the patient relapsed several months later. Neuroimaging findings on conventional MRI and FLAIR sequences and dynamic susceptibility contrast enhanced MRI are described. White matter abnormalities may be shown on CT or MRI in this syndrome. However, dynamic susceptibility contrast enhanced MRI showed far more extensive abnormality within the brain. In addition, phase contrast angiographic measurement of flow in the carotid and basilar arteries indicated a significant elevation of cerebral blood flow, suggesting a decrease in global cerebrovascular resistance. These observations support existing theories that the disorder is manifested by autoregulatory disturbance in small cerebral vessels. Our findings suggest that this abnormality is far more extensive than is demonstrated on T2 weighted MR images and that it is associated with global abnormality of cerebrovascular autoregulation.