bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic imaging and interventional therapy of hepatocellular carcinoma.
Authors: Palma L D
Published: June 2014

Diagnostic imaging has many important roles in the management of patients with hepatocellular carcinoma (HCC). In diagnosis, lipiodol CT (LCT) has been shown to be the most sensitive imaging modality (90-97%) for all sizes of lesions; all other modalities have high sensitivities for lesions 1-3 cm but low sensitivities for lesions < 1 cm (ultrasound 33-37%, conventional CT 20-42% and digital subtraction angiography 40-55%). All imaging modalities understage HCC. Once again LCT is the most accurate method of evaluating the extent of tumour, but even this method does not identify all satellite nodules. Ultrasound has been proposed as a screening method, but this cannot be justified on the basis of its results or cost benefit analysis. Both CT and dynamic MRI play useful roles in evaluating the efficacy and follow-up of patients undergoing chemoembolization (TACE) and percutaneous ethanol injection (PEI). Although surgery remains the best treatment of HCC, it is unsuitable in most of the cases which would be better treated with interventional therapy. This article presents a review of the literature regarding the use of TACE, PEI or a combination of both procedures in the treatment of HCC. A multicentric study has shown that patients with monofocal lesions less than 5 cm in diameter are better treated with PEI, which is therefore a good alternative to the surgical treatment; patients with multifocal lesions (maximum of three lesions) show a better survival with TACE. Combined treatment with TACE and PEI proves to be effective in patients with large HCC.
Three-dimensional fast fluid attenuated inversion recovery (3D fast FLAIR): a new MRI sequence which increases the detectable cerebral lesion load in multiple sclerosis.
Authors: Tubridy N , Barker G J , Macmanus D G , Moseley I F , Miller D H
Published: June 2014

Two-dimensional (2D) fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging is superior to T2 weighted conventional spin echo (CSE), in certain areas of the brain but not in others, in detecting the lesions of multiple sclerosis (MS). The present study evaluates the ability of a recently developed three-dimensional fast FLAIR (3D fast FLAIR) sequence in detecting and quantifying the brain lesions of multiple sclerosis. The lesion volumes measured on the 3D fast FLAIR sequence with 1.5 mm thick slices were compared with those obtained from CSE brain images with 5 mm thick slices. The findings seen in 3D fast FLAIR brain images in 10 normal control subjects are also described. 3D fast FLAIR images showed an overall increase of 34% in lesion volume compared with CSE. The increase was most marked in the periventricular and "discrete" areas of the cerebral hemispheres. Lesion volumes seen in the subcortical areas were similar in both sequences. The CSE images displayed higher lesion volumes in the posterior cranial fossa. It is concluded that 3D fast FLAIR is a promising technique for quantifying cerebral pathology in MS which is not accessible to 2D CSE.
Lipoblastomatosis of the shoulder: unusual MR appearance.
Authors: Wang S F , Chang C Y , Wu H D
Published: June 2014

Lipoblastomatosis is a rare benign lipomatous tumour of childhood and infancy, classically showing high signal identical to fat on T1 weighted images. A case of histologically proven lipoblastomatosis in an infant is presented, in which MRI showed low signal on T1 weighted images identical to that of muscle instead of high signal. This appearance has not been previously reported.
A comparison of a non-ionic dimer, iodixanol with a non-ionic monomer, iohexol in low dose intravenous urography.
Authors: Skehan S J , Rasmussen F , Gibney R G , Lindequist S , Moller-Nielsen S , Svaland M G , Kampenes V B , Bjartveit K , Greaney T , Carlsen S D , Masterson J
Published: June 2014

A prospective, double-blind study of 392 patients randomized into four groups was performed to establish whether diagnostic intravenous urograms could be obtained with a lower dose of iodine when using the dimeric, non-ionic contrast medium iodixanol compared with the monomeric, non-ionic iohexol. Patients received iodixanol or iohexol containing either 9 or 12 g of iodine (gI). The primary parameter was the diagnostic quality of the 6 min film, assessed in a blinded fashion, by consensus, by four radiologists. Iodixanol at both doses was diagnostic in over 90% of cases. Iohexol was only diagnostic in 74% (9 gI) and 81.8% (12 gI). Pairwise comparisons revealed that iodixanol 9 gI was significantly better than both iohexol 9 gI (p = 0.0005) and 12 gI (p = 0.014). No significant difference was present for different doses within the same contrast medium group. Iodixanol resulted in poorer bladder distension than iohexol. Iodixanol caused significantly less discomfort than iohexol.
Diagnosis of osteoporosis by planar bone densitometry: can body size be disregarded?
Authors: Pors Nielsen S , Kolthoff N , Bärenholdt O , Kristensen B , Abrahamsen B , Hermann A P , Brot C
Published: June 2014

Bone densitometry using dual energy X-ray absorptiometry (DXA) is frequently used to diagnose osteoporosis and to identify patients at risk of later fractures. The parameters of interest are bone mineral content (BMC) and bone mineral areal density (BMD). Bone densitometry results have a large overlap between normals and patient with fractures. This would suggest that other factors are important for the development of fractures or that bone densitometry is not used optimally. It is generally believed that the conversion of BMC to BMD by division of the former by the projected bone area is a good normalization procedure. Other normalization procedures have been attempted in the past with little success. We hypothesized that this might be due to a blurring effect of time since menopause, and that body size could be demonstrated to have an effect on measured BMC and BMD, if this time effect could be eliminated. The results of this study, comprising 1625 early post-menopausal women studied at virtually the same time since menopause, confirm that this is the case. Body surface area was the parameter among conventional body size variables showing the highest correlation with BMC and BMD. It was clearly shown that low values of BMD were seen more often in the lowest than in the highest body surface area quartile. The difference between quartiles was statistically significant. Simple division of BMC by actual body surface area or division of BMD by the square root of body surface removed the uneven distribution between the body surface area quartiles for lumbar spine and femoral neck measurements, and reduced it at peripheral measuring sites. It is suggested that BMC and BMD of the lumbar spine and the femoral neck should be normalized as described to avoid overdiagnosis of osteoporosis in persons of petite body stature and underdiagnosis in tall ones.
Dose-area product readings for fluoroscopic and plain film examinations, including an analysis of the source of variation for barium enema examinations.
Authors: Warren-Forward H M , Haddaway M J , Temperton D H , McCall I W
Published: June 2014

This paper contains the results of an investigation undertaken between 1994 and 1996 using dose-area product (DAP) meters for monitoring radiation doses from six types of simple examinations and seven types of complex examinations. Mean hospital DAP levels have been compared with National Reference Levels (NRL), with most departments producing levels lower than NRLs. DAP readings have allowed the proposal of provisional Reference Levels (RL) to be set for simple and complex examinations. The results were also compared with recently published data from the National Radiological Protection Board (NRPB), highlighting those hospitals which need to make changes in radiographic technique. The study of DAP reference doses also confirms that dose levels for complex investigations are clearly related to technique, in terms of screening time and number of films. Although the use of increased screening tube kilovoltage may be relevant, the overall effect is small. The results suggest that there is still a need to optimize the protocols for these examinations. The use of digital equipment has been shown to have a complex effect on dose, particularly in the case of investigations involving both films and fluoroscopy.
Renal cell carcinoma with a fatty component mimicking angiomyolipoma on CT.
Authors: Roy C , Tuchmann C , Lindner V , Guth S , Vasilescu C , Saussine C , Jacqmin D
Published: June 2014

A very unusual CT appearance of renal cel carcinoma is presented, in which the fatty density mimicked a benign angiomyolipoma.
Stereotactic excisional breast biopsy performed by interventional radiologists using the advanced breast biopsy instrumentation system.
Authors: Damascelli B , Frigerio L F , Lanocita R , Patelli G , Viganotti G , Di Tolla G , Magnoni S , Ticha V , Galante E , Attili A , Saccozzi R , Tomasich G
Published: June 2014

The Advanced Breast Biopsy Instrumentation (ABBI) system, which uses surgical cannulas up to 20 mm in diameter, is an alternative to conventional surgical biopsy for the diagnosis of non-palpable breast lesions. Since the need for radiological skill outweighs the surgical content of the technique, we evaluated the feasibility of complete management of the procedure by interventional radiologists. 35 of the 111 patients originally scheduled for the procedure were excluded, three because the lesion could not be visualized and 32 because of insufficient thickness of the compressed breast. The procedure had to be abandoned in one case due to a technical failure. 77 stereotactic excisional breast biopsy procedures were performed using the ABBI system in 75 patients with suspicious non-palpable mammographic lesions. The procedure was carried out under local anaesthesia in the radiology department, using a dedicated Lorad (R) radiographic system. 31 (40%) masses without calcifications, 11 (14%) masses with calcifications and 35 (46%) clusters of microcalcifications without tumour mass were sampled. 43 (56%) benign lesions and 34 (44%) malignant lesions were diagnosed. The overall mean diameter of the lesions was 8.7 mm (range 3-22 mm). All 34 patients with malignancies and lobular carcinoma in situ subsequently underwent surgery, the results of which are reported. Three (4%) haematomas were detected and aspirated percutaneously. Two technical problems occurred: an ABBI cannula malfunction, and a computer failure of the digital imaging system during the procedure. The average procedure time was 80 min and the cost of each procedure was 2,800,000 Italian lire (1555 US$). It is concluded that tissue sampling with the ABBI system can be performed entirely by radiologists without significant problems. The procedure was well tolerated by all patients. The quality of the biopsy specimen was identical to that of a surgical specimen but with the advantages of stereotactic precision for localization of the lesion.
General practitioner requests for upper abdominal ultrasound: their effect on clinical outcome.
Authors: Connor S E , Banerjee A K
Published: June 2014

Many radiology departments offer direct access upper abdominal ultrasound (US) scanning to general practitioners (GPs). We aimed to examine the influence of the scan results on the subsequent management and clinical outcome of these patients. A retrospective review was performed on all the patients referred for primary upper abdominal US (n = 82) from a single Birmingham GP practice, of 10,000 patients, between 1991 and 1996. The follow-up period from US was mean 27.9 months, SD 18.2 months. 79 referrals complied with published guidelines. 77 referrals were for suspected gallstone disease. 23 (28%) patients had clinically relevant positive findings. 18 of the positive scans. 16 of whom had gallstones, were subsequently referred to hospital. Of those with gallstones, 15 underwent cholecystectomy, of whom 12 had no further upper abdominal symptoms. Of the 59 negative scans, eight cases (14%) were subsequently referred to hospital. Treatment was changed as a result of review and investigation in only two of these eight cases. The remaining 51 were diagnosed solely on history and clinical examination. 28 of the 51 had self-limiting symptoms which required minor or no treatment. In conclusion, direct access upper abdominal US is considerably reducing the requirement for hospital outpatient referrals from GPs. Positive scans are generally followed by referral to secondary care services with good clinical outcome.
Analysis of the status of X-ray diagnosis in Ghana.
Authors: Schandorf C , Tetteh G K
Published: June 2014

In Ghana's healthcare system there are about 4200 people to each physician. The annual frequency of X-ray examinations during the period 1990 to 1996 ranges from six to 11 per thousand population. Chest radiograph examinations account for 46.5% of the annual frequency. The survey revealed that there are no established acceptance testing procedures for newly installed X-ray equipment. Neither institutional level performance checks following major repairs of faulty equipment, nor routine checks at regular intervals to ensure self-consistency of equipment performance are conducted. The results of the film retake analysis undertaken indicates a need for quality assurance programmes to be taken seriously to avert considerable cost and high patient doses. Radiographers and X-ray-technical officers who physically perform X-ray examinations should receive adequate training in the selection of procedures so as to ensure that doses to patients are as low as reasonably practicable in order to achieve the desired diagnostic objective.
Evaluation of an anatomical filter-based exposure equalization technique in mammography.
Authors: Panayiotakis G , Skiadopoulos S , Solomou E , Pierrakeas C , Costaridou L , Kalogeropoulou C P , Dimopoulos J
Published: June 2014

An anatomical filter-based exposure equalization technique in mammography is clinically evaluated. An observer performance comparative study, between this technique and the conventional one, is carried out on the basis of the visualization of six anatomical features situated at the breast periphery. The effect of parenchymal breast patterns and compressed breast thickness in the visualization of these features is studied. 533 craniocaudal mammograms were interpreted by two radiologists independently, using a five-point rating scale. Use of the Wilcoxon ranking test for unpaired data shows statistically highly significant improvement (p < 0.0001) in the visualization of the nipple, areola, skin and subcutaneous fat in all cases, for the equalization technique. The improvement is dependent on parenchymal breast patterns and compressed breast thickness for peripheral Cooper's ligaments and peripheral surface veins. In the case of total fatty replacement and/or thin breasts neither technique seems to be superior (p > 0.05) with respect to these two features. Clinical results indicate the value of this technique in clinical routine.
Linearity and accuracy errors in bone densitometry.
Authors: Pors Nielsen S , Bärenholdt O , Diessel E , Armbrust S , Felsenberg D
Published: June 2014

This investigation was undertaken to quantify accuracy errors and identify possible linearity errors in dual energy X-ray absorptiometry (DXA) of bone, based on studies of commercially available bone densitometers for planar densitometry. The following was found in a combination of in vitro phantom studies and in vivo investigations of human volunteers: (1) Pronounced differences between the instruments when measuring vertebral size and contours of the projected bone regions. (2) Falsely low bone mineral content (BMC in terms of g) in cases of low nominal bone mass, due to the fact that edge regions were omitted by the calculation software of some devices. (3) An increase in the projected bone area secondary to an increase in nominal bone mass with some instruments. (4) Clinically and statistically significant errors of accuracy of BMC and to a lesser extent bone mineral density (BMD). (5) Substantial linearity errors with some osteodensitometers for BMC, a phenomenon that reduces the usefulness of this parameter. It is concluded that DXA devices are affected by a combination of accuracy errors and linearity errors, some more than others, and that linearity errors influence their ability to monitor change in BMC and to a lesser extent in BMD, making system intercomparison difficult.
A comparison of conventional and conformal radiotherapy of the oesophagus: work in progress.
Authors: Guzel Z , Bedford J L , Childs P J , Nahum A E , Webb S , Oldham M , Tait D
Published: June 2014

A retrospective treatment planning study was carried out in five patients to assess the effectiveness of conformal radiotherapy of the oesophagus. A two-phase conventional treatment plan was created for each patient, with a prescribed dose of 55 Gy. This plan was compared with a single-phase conformal plan consisting of the same field arrangement as the second phase of the conventional treatment, but with conformal blocks shaped to the beam's eye view of the planning target volume. A further comparison was made between the conventional plan and a two-phase plan using the same beam angles and weights as the conventional plan, but with conformal field shapes. The effectiveness of each treatment plan was assessed using dose--volume histograms and normal tissue complication probabilities for the lungs. On average, the single-phase conformal technique increased the mean lung dose from 22.5% (+/- 6.2 SD) of the prescribed dose to 29.5% (+/- 5.2 SD) compared with the conventional technique (p = 0.0001). This indicates that this technique did not offer any benefit in terms of reducing the risk of pneumonitis. However, the two-phase conformal technique reduced the mean lung dose from 22.5% (+/- 6.2 SD) of the prescribed dose to 19.8% (+/- 4.6 SD)(p = 0.03), showing that this technique should reduce the risk of pneumonitis. Further work is underway to study more patients and to investigate tumour control probability and dose escalation.
Scintigraphic evaluation of craniopagus twins.
Authors: Sathekge M M , Venkannagari R R , Clauss R P
Published: June 2014

Craniopagus twinning is a rare congenital abnormality, occurring at a frequency of 4-6 per 10 million births. A case is reported in which separation was successful for both twins. The importance of pre-operative radionuclide assessment of crucial organ function (liver, kidneys, heart, brain) and crossed circulation is stressed. The scintigraphic results were in keeping with radiographic, operative, and clinical findings. The routine use of radionuclide studies in the investigation of conjoined twins is recommended in order to delineate individual organ function, degree of fusion and measurement of cross-circulation.
Prostate specific antigen level and Gleason score in predicting the stage of newly diagnosed prostate cancer.
Authors: Spencer J A , Chng W J , Hudson E , Boon A P , Whelan P
Published: June 2014

The purpose of this study was to determine the utility of prostate specific antigen (PSA) level and Gleason score in the prediction of disease stage in men with newly diagnosed prostate cancer. 102 consecutive men, newly diagnosed with prostate cancer and candidates for radical therapy, underwent contrast enhanced pelvic CT and skeletal scintigraphy. Staging examinations used the TNM classification and were reported prospectively with the radiologist blinded to the patient's Gleason score and level of PSA. Lymph node metastasis was confirmed by CT guided biopsy, lymphadenectomy or response to therapy in some cases of massive disease. There were significant differences between the mean PSA values of 18 men with and 84 men without skeletal metastases (p = 0.01) and between men with locally confined and non-confined disease (p = 0.02). There was no difference between PSA values of 13 men with and 89 men without lymph node metastasis (p = 0.9). Only one man with CT evidence of nodal metastasis (N + ve) had a PSA value below 20 ng ml-1. Two men with Gleason scores below 6 were N + ve and both had PSA values over 20 ng ml-1. One man with skeletal metastasis had a PSA value below 20 ng ml-1 but had bone pain. For this study group if only those men with PSA values over 20 ng ml-1 had been examined, sensitivity for lymphatic and skeletal metastasis would have been 92%. Using this threshold about one-third would have been spared imaging investigation. In conclusion, pelvic CT and skeletal scintigraphy are unlikely to show metastatic disease in a man newly diagnosed with prostate cancer who has no suggestive clinical features, a PSA level below 20 ng ml-1 and a Gleason score below 6.
Ventilatory effects of radiographic contrast media.
Authors: Laude E A , Emery C J , Morcos S K
Published: June 2014

Respiratory adverse reactions have been reported with the use of contrast media. This study investigates the effects of different radiographic contrast media (RCM) on ventilation and blood gases. Tidal volume and respiratory rate of male Wistar rats anaesthetised with Inactin (100 mg kg-1 intraperitoneally), were measured continuously by integration of tracheal airflow. Contrast media (diatrizoate 370, ioxaglate 320 and iopromide 300) or mannitol controls matched for volume, pH and osmolarity (4 ml kg-1) were administered via a jugular cannula (n > or = 6 per group). Carotid artery blood was sampled at 2, 7, 12, 17, 25 and 30 min post-injection for PaO2, PaCO2 and pH. Systemic blood pressure was monitored from the same cannula. No significant reduction was observed in minute ventilation (tidal volume x respiratory rate per minute) with any of the contrast media. All contrast media and control solutions produced a fall in PaO2 within 4 min; returning to basal levels at 10 min (diatrizoate 35.6% (p < 0.05), ioxaglate 15.2% (p < 0.02), iopromide 16.2% (p < 0.01); controls: 17.3% (p < 0.01), 13.5% (p < 0.02) and 12.0% (NS), respectively). The fall in PaO2 induced by diatrizoate was significantly (p < 0.05) larger in comparison to the other groups. Ioxaglate, iopromide and their mannitol controls induced a comparable fall in PaO2. There was a concurrent rise in PaCO2 and fall in pH that reached significance for diatrizoate (p < 0.01). The changes in blood gases with RCM administration cannot be explained by changes in ventilation and may be due to an effect on pulmonary perfusion.
A phantom based study on the effect of subject positioning on morphometric X-ray absorptiometry using the Lunar Expert-XL.
Authors: Thorpe J A , Steel S A , Langton C M
Published: June 2014

Morphometric X-ray absorptiometry (MXA) relies on accurate measurement of vertical dimensions of vertebrae from a lateral perspective. Deviations resulting from scoliotic curvature or poor patient positioning produce distortions of visible vertebral dimensions and may lead to analysis error. This study utilized a phantom developed at this centre to assess the effect of vertebral malalignment on the accuracy of the MXA technique on the Lunar Expert-XL. Measured vertebral heights were found to be consistently underestimated by an average of 3.7%. Precision ranged from 0.79% for anterior height measurement to 1.03% for middle height measurement. Vertebral malalignment was investigated as the effect of rotation around the anteroposterior, lateral and superoinferior axes. Rotation around the lateral axis produced little discernible effect. However, superoinferior axial rotation showed a change of more than two standard deviations in the mid/posterior ratios of biconcave vertebrae at comparatively small angles of rotation. Anteroposterior axial rotation produced an increase in observed height at small angles of rotation, and a rapid decrease in vertebral height as rotation increased. The results suggest that whilst kyphosis or lordosis of up to at least 5.8 degrees has a minimal effect on MXA, scoliosis of 4.6 degrees or above produces a distinctive effect on the defining crush height ratios.
The effect of background structure on the detection of low contrast objects in mammography.
Authors: Kotre C J
Published: June 2014

The visual task of mammographic interpretation is considered in terms of the detection of a signal in the presence of noise, where the noise is taken to include a structure noise contribution from those areas of the imaged breast which do not contain the signal. The structure noise in a variety of typical mammographic parenchymal patterns was quantified and related to the area under observation using a statistical analysis of digitized image samples. Images of an anthropomorphic phantom were also analysed to establish it as a suitable test background for a series of contrast detail detection experiments. These experiments were performed with and without a structured background over a wide range of film dose, but at a fixed average film optical density. The presence of structure noise was found to reduce the detectability of low contrast objects, the effect becoming progressively smaller as the object size is reduced. Where the structured background was used, even large changes in dose to the film were found to produce little change in the overall contrast detail result except at the smallest detail diameters. These results are discussed in relation to existing theories of visual perception. It is suggested that the correlation between patient dose and cancer detection rate may be poorer than previously thought, as the detection task for objects larger than approximately 1 mm in diameter is dominated by the structure noise of the background parenchymal pattern rather than quantum noise.
Radiosensitive human tumour cell lines show misrepair of DNA termini.
Authors: Powell S N , Mills J , McMillan T J
Published: June 2014

Physical measures of the rejoining of radiation-induced breaks in DNA strands are limited in terms of sensitivity and the fact that they do not assess the fidelity with which the rejoining occurs. In this report, transfection of cleaved plasmid has been used as a probe for repair in three radiosensitive tumour cell lines and shown them to have low repair fidelity compared with resistant cells. Errors in the repair of linear plasmid were found by Southern analysis, in keeping with the measured repair fidelity. Radiosensitive tumour cells showed few errors in the uptake and integration of circular plasmid, in contrast to ataxia-telangiectasia (A-T) cells. In the neuroblastoma HX142, the repair of blunt-ended linear plasmid was associated with deletions of > 1 kb; staggered-ended linear plasmid was repaired with small insertions and circular plasmid integration was intact in > 60% of the copies. The neuroblastoma SKN.SH, processed staggered-ended plasmid by insertions of a variety of sizes, but processed circular plasmid largely error-free. In contrast, A-T cells (AT5BIVA) had the same spectrum of errors irrespective of the form of plasmid transfected. Cell fusion between HX142 and AT5BIVA showed complementation to a resistant phenotype, suggesting that misrepair in the tumour cell did not result from somatic mutation in the ATM gene. In conclusion, radiosensitive tumours show evidence of misrepair of DNA termini, with a mechanism which is functionally and genetically distinct from that in A-T cells.
An investigation of X-ray equipment factors influencing patient dose in radiography.
Authors: Williams J R , Catling M K
Published: June 2014

Dose audit is a quality control tool for assessing whether patient doses are kept as low as reasonably practicable. Limitations of audit for radiographic patients are the inherent imprecision in assessment and the lack of information provided for the identification of high levels of dose. In this report, four equipment parameters are identified as influencing entrance surface dose (ESD). They are film speed, radiation quality represented by the X-ray transmission through a 20 mm aluminium filter, attenuation of the table top and grid, and a geometric factor to account for inverse square law attenuation. They have been combined into a system speed index (SSI). This was measured for 17 X-ray installations. To test the influence of SSI on dose, ESD was measured using a phantom to simulate the attenuation for an anteroposterior view of the lumbar spine. A radiographic dose index (RDI) was defined as the ESD required to produce a reference optical density of 1.2 at 80 kV. For the measurements it was found that RDI was equal to 16.1/SSI (r = 0.960). The report recommends the use of SSI as an index of dose efficiency which can be used to interpret the results of patient dose audits and determine priorities for dose saving strategies.
Congenital bilateral cystic neuroblastoma with liver metastases and massive intracystic haemorrhage.
Authors: Lee S Y , Chuang J H , Huang C B , Hsiao C C , Wan Y L , Ng S H , Lee T Y , Ko S F
Published: June 2014

A case of bilateral cystic neuroblastoma with liver metastases in a newborn is reported. CT showed a 10 cm right suprarenal multicystic mass and numerous hepatic cystic masses with intracystic fluid-fluid levels. Multiple smaller cystic lesions were also present in the left adrenal gland. To our knowledge, the CT findings of neonatal bilateral cystic neuroblastoma with liver metastasis and massive acute intracystic haemorrhage has not been previously documented.
Comparison of three-dimensional virtual endoscopy with bronchoscopy in patients with oesophageal carcinoma infiltrating the tracheobronchial tree.
Authors: Rapp-Bernhardt U , Welte T , Budinger M , Bernhardt T M
Published: June 2014

Virtual endoscopy (VE) is a technique for performing simulated bronchoscopy using helical CT data of the tracheobronchial tree. In order to evaluate a virtual three-dimensional (3D) endoluminal procedure for the tracheobronchial tree, comparison was made between bronchoscopy, axial CT images and minimal intensity projections (MIP). 21 patients were referred for helical CT because of oesophageal carcinoma shown by bronchoscopy to infiltrate into the trachea or bronchi. Axial CT images obtained on a helical scanner were transferred to a Sparc20 workstation. VE was compared with the axial CT images and the MIP concerning additional information on the location and degree of stenosis gained after 3D reconstruction of the inner surface of the tracheobronchial tree. The accuracy of this VE system was compared with bronchoscopy. Follow-up was performed in two patients to evaluate the tracheobronchial system after stent implantation. All stenoses were identified by VE with no statistically significant difference in detection of location or grading of the stenosis to real time bronchoscopy. Passage of subtotal stenosis was only possible with VE. VE is suitable for following up stent implantation. Submucosal lesions of the tracheobronchial tree could not be detected by VE. There was no statistically significant difference regarding the location of the stenoses between VE, axial CT slices, MIP and bronchoscopy. The VE showed only a statistically significant difference with regard to the degree of stenosis which was underrated on axial CT slices and MIPs. Pitfalls including mucus plugs and wall defects due to the wrong threshold value were a limitation of VE. VE is presently too time-consuming to use in every patient with an infiltrating tumour into the tracheobronchial tree. In conclusion, while VE cannot replace endoscopy of the tracheobronchial tree or the oesophagus, it is an accurate and non-invasive method for identifying endoluminal tumours, grading stenoses and visualizing the tracheobronchial tree beyond stenoses in a small number of patients who are not amenable to endoscopy.
Effective dose to the patient undergoing superior vena cava stent.
Authors: O'Driscoll D , McNeil E A , Ferrando J , Slaney P
Published: June 2014

Metallic stents have been recently introduced for treating superior vena cava (SVC) obstruction. Dose data, in terms of dose-area product (DAP), from 44 patients referred for SVC stent placement on a digital unit have been retrospectively analysed in terms of their fluoroscopic and radiographic components. The mean DAP for the 44 examinations was 42 Gy cm2 and the effective dose was estimated to be 5.8 mSv. The fluoroscopic component was approximately 80%, with a mean screening time for these examinations of 17 min. The mean number of digital exposures was 86.
Colour Doppler induced streaming: an indicator of the liquid nature of lesions.
Authors: Chatterton B E , Spyropoulos P
Published: June 2014

As sound waves traverse tissue, interaction with reflecting or absorbing obstacles results in a transfer of momentum from the wave to the medium. This generates a local force in the direction of propagation. If this occurs in a fluid medium, sufficient pressure may be generated to cause flow--"streaming". Generally, it is difficult to demonstrate this streaming in images using the usual diagnostic B-mode intensities, but the increased intensities in a colour Doppler (or power) region of interest enhance the phenomenon. This allows streaming to be both visualized by the motion of small particles and detected by colour change on the colour Doppler B-mode image. Borders of streaming between the simple grey scale image and the colour region may be easily seen, with retrograde flow in the regions subjected to a lower intensity. This phenomenon has been demonstrated in ocular, scrotal, thyroid, breast, ovarian and inflammatory collections or lesions, confirming the liquid nature, occasionally of fluid which is very echogenic due to contained debris. The technique is recommended as another tool which is available to most general ultrasound departments and will assist in the characterization of tissue.
Congenital Ewing's sarcoma of the humerus.
Authors: Hsieh H Y , Hsiao C C , Chen W S , Lin J W , Chen W J , Wan Y L , Ng S H , Lee T Y , Ko S F
Published: June 2014

We report an extremely rare case of Ewing's sarcoma (ES) of the humerus in a Chinese neonate. Plain radiography and magnetic resonance imaging showed extensive neoplastic involvement of the humeral diaphysis and adjacent soft tissues, confirmed on histology and immunohistochemistry as being due to ES. This is the first report of congenital ES in a long bone. Since ultrasound at 20 weeks gestation showed a normal fetal skeleton, the ES may have begun to develop in the late middle or third trimester.
CT appearances of hepatic involvement in systemic varicella-zoster.
Authors: Ruehm S G , Trojan A , Vogt P , Krause M , Krestin G P
Published: June 2014

In a patient suffering from T-cell non-Hodgkin's lymphoma and systemic varicella-zoster, contrast enhanced CT showed multiple hypodense nodular lesions in the liver which corresponded to areas of focal liver necrosis. This appearance on CT may be characteristic of varicella-zoster involvement of the liver.
The diagnosis of cirrhosis by high resolution ultrasound of the liver surface.
Authors: Simonovský V
Published: June 2014

The objective was to assess the clinical usefulness of high resolution ultrasound (US) analysis of the liver surface for the diagnosis of cirrhosis. In a prospective study, US evaluation of the ventral contour of the liver was performed using a 7.5 MHz linear transducer in 100 patients with suspected liver disease. Only reproducible diffuse ventral liver surface irregularities were considered as an objective US sign of cirrhosis. All patients underwent liver biopsy and/or laparoscopy in order to obtain a definitive diagnosis. Disease prevalence for cirrhosis was 49%. In nine cases the visualized US irregularities were both unconvincing and hardly reproducible. Consequently, they were considered as non-diagnostic and excluded from further analysis. On 91 diagnostic studies, the sensitivity of US for cirrhosis was 91.1%, the specificity 93.5% and the accuracy 92.3%. Positive and negative predictive values were 93.2% and 91.5%, respectively. Provided non-diagnostic cases were considered as technically satisfactory studies and included as true-positive and false-positive cases, this would slightly increase the sensitivity but decrease specificity and accuracy to 91.8%, 84.3%, and 88.0%, respectively. High resolution US analysis of the ventral liver contour is a clinically reliable non-invasive test for the diagnosis of cirrhosis.
An anthropomorphic phantom for receiver operating characteristic studies in CT imaging of liver lesions.
Authors: Olerud H M , Olsen J B , Skretting A
Published: June 2014

The purpose of the study was to develop a methodology that allowed quantitative assessment of image quality in CT and its relationship to dose. An anthropomorphic phantom was designed for use in receiver operating characteristic (ROC) studies of the detectability of liver lesions with CT. The lesions were simulated by different mixtures of glycerol and water that were filled into holes of different diameters in a liver tissue substitute. A pilot study was carried out on five different scanners that were operated at various exposure settings. A positive correlation was demonstrated for each of the scanners between the weighted CT dose index (CTDIW) and the area under the ROC curve. For the exposure settings used in the clinical routine in the five laboratories, the CTDIW ranged from 15 to 31 mGy. Three observers who read the corresponding set of five phantom images agreed, as judged from the areas under the ROC curves, that there was a marked difference in quality between the three best images and the other two. The two newest scanners in the study had the lowest CTDIW, and at the same time the best ROC results. The phantom and the ROC methodology may, with a set of suggested improvements, be used for comparison of the performance in different CT laboratories, and to establish the dose needed to ensure adequate image quality for a particular scanner.
Electronic monitoring of clinical experience during undergraduate training in diagnostic radiography.
Authors: Akehurst J C
Published: June 2014

The clinical experience of a student radiographer has traditionally been recorded in a paper log book. Accurate maintenance of the book relied upon the student's diligence. The electronic logbook is a method of accurately recording the clinical experience of the student radiographer by retrieval of information from the database of a hospital information or radiology management system. The system requires minimal software modification in order to incorporate fields defining the ability of the student in association with the degree of infirmity of the patient. Retrieved information is processed by a specially designed software package at the Academic Centre and reports issued to Clinical Tutors. Benefits of the system include easy monitoring of student workload, ensuring that the student receives a wide and varied experience during training; improvement in student motivation; and use of a final report form in the student's portfolio.
CT derived Patlak images of the human kidney.
Authors: Miles K A , Leggett D A , Bennett G A
Published: June 2014

This study aimed to produce Patlak images of the kidney from dynamic CT data and to determine whether such images are substantially affected by fluid movement between renal tubular segments. Renal permeability was measured in 31 kidneys by applying Patlak analysis to time-density data from kidney and aorta during dynamic CT. Permeability parameters were correlated against plasma urea. The renal region (cortex or medulla) with the greatest permeability was determined from parametric images generated using pixel by pixel analysis. The mean value for whole kidney permeability was 517.5 microliters min-1 ml-1. A correlation was found between whole kidney permeability and plasma urea (p < 0.01). Permeability values were highest in the renal medulla in 24 (77%) kidneys. The higher medullary values of permeability are artefactual, resulting from movement of fluid and contrast medium between cortex and medulla. Although Patlak images do not reflect true intrarenal permeability values, the apparent medullary permeability may provide diagnostically useful information about the concentrating ability of the kidney. CT measurements of whole kidney permeability reflect filtration function but the apparent intrarenal variations in permeability will result in measurement errors dependent upon the relative amounts of renal cortex and medulla included in the CT slice studied.
Peritoneal abscess formation as a late complication of gallstones spilled during laparoscopic cholecystectomy.
Authors: Frola C , Cannici F , Cantoni S , Tagliafico E , Luminati T
Published: June 2014

The case is described of a 74-year-old woman who presented with an abdominal abscess 1.5 years after laparascopic cholecystectomy. CT and ultrasound showed the presence of gallstones within the abscess. Spillage of gallstones from perforation of the gallbladder is a well recognized complication of laparascopic cholecystectomy, although subsequent abscess formation is unusual especially after a long delay as in this case.
Persistent hypophyseal (craniopharyngeal) canal.
Authors: Hughes M L , Carty A T , White F E
Published: June 2014

Two cases with a broad persistent hypophyseal canal connecting pituitary fossa and nasopharynx are presented. Both had nasopharyngeal surgery in early childhood and presented later with hypopituitarism. Coronal CT demonstrated the defects with no visible pituitary tissue. The spectrum of basal skull defects is discussed. Children with midline nasal polyps should have CT or MRI of the skull base prior to surgery to prevent inadvertent hypophysectomy.
Acute pan-costochondritis demonstrated by gallium scintigraphy.
Authors: Ikehira H , Kinjo M , Nagase Y , Aoki T , Ito H
Published: June 2014

Costochondral inflammation is a rare clinical finding. A case is presented, in which acute chostochondritis is demonstrated by gallium scinitigraphy.
MR imaging of synovial tumours and tumour-like lesions.
Authors: Ritchie D A
Published: June 2014

MR is the imaging method of choice for detection, staging and follow-up of synovial tumours and tumour-like conditions. The majority of lesions have non-specific features but careful analysis of lesion morphology and signal characteristics reduces the differential diagnosis and leads to a specific diagnosis in some cases.
Imaging of patients with severe emphysema considered for lung volume reduction surgery.
Authors: Cleverley J R , Hansell D M
Published: June 2014

Lung volume reduction surgery has recently been reintroduced as a palliative treatment for patients with severe emphysema. Selection criteria vary between centres and imaging is extensively used, but the exact role of individual techniques in the selection process is still emerging.
Estimation of breast volume and its variation during the menstrual cycle using MRI and stereology.
Authors: Hussain Z , Roberts N , Whitehouse G H , García-Fiñana M , Percy D
Published: June 2014

Unbiased estimates of breast volume may be obtained in vivo from systematic series of MR images acquired in accordance with the Cavalieri method of modern design-based stereology. The method does not require any assumptions to be made regarding breast shape. If point counting techniques are used to obtain the required breast section areas estimates, 10-15 min analysis (i.e. counting about 250 points on 12 to 16 images) ensures that the contribution of sectioning and point counting to the coefficient of error (CE) on the volume estimate is less than 3%. The methods were applied to measure breast volume in 15 healthy females aged between 22 and 44 years (mean 31.7 years; SD 8.2 years). One subject was studied on every fourth day during two consecutive cycles. The other 14 subjects were studied on three occasions corresponding to menses, ovulation and pre-menses during a single menstrual cycle. Repeat imaging after repositioning on three occasions within a period of 30 min and also at three different times of day for a single subject, both yielded a coefficient of variation (CV) of less than 3% in the estimation of breast volume. ANOVA indicates that there is no significant difference between the mean volume of the left and the right breast (p = 0.294). The mean volume of the left breast is 561 ml (95% confidence interval (CI): 553 ml, 569 ml) and the mean volume of the right breast is 567 ml (95% CI: 559 ml, 576 ml). There are highly significant differences between the three named stages of the menstrual cycle (p < 0.0005), whereby the mean volume at ovulation is 5.5% less than the mean volume at menses (95% CI: 3.0%, 7.9%) and the mean volume pre-menses is 8.1% greater than the mean volume at menses (95% CI: 5.3%, 10.9%). Overall, the volume of each breast varies by an average of 76 ml (95% CI: 61 ml, 92 ml) during the menstrual cycle, which corresponds to 13.6% of the volume at menses (95% CI: 13.3%, 13.8%). No significant interaction was found between the relative volumes of the left and right breast and the stage of the menstrual cycle (p = 0.277), nor between subjects and stages of cycle (p = 0.296). However, a significant interaction was observed between the volume of the left and right breasts in different subjects (p < 0.005). The average difference in the volume of the left and right breasts of all 15 subjects is 39.7 ml (95% CI: 21.3 ml, 58.1 ml), which is 7% of average breast volume and approximately 50% of the average variation in the volume of the breast during the menstrual cycle.
Does resection of small liver metastases from colorectal cancer improve survival of patients?
Authors: Irie T , Itai Y , Hatsuse K , Mochizuki H
Published: June 2014

Because the size of metastases greatly affects their detection, we retrospectively investigated the influence of the size of liver metastases on survival after hepatic surgery. The subject group study consisted of 77 patients who underwent liver surgery for metastases from colorectal cancer. The survival rate after hepatic surgery was analysed using multivariate Cox's proportional hazards model with the following variables: (1) size of dominant metastases (Small: < 3 cm; Medium: > or = 3 cm and < 6 cm; Large: > or = 6 cm); (2) synchronous versus metachronous resection; (3) solitary versus multiple metastases. The size of dominant metastases (p = 0.035) and synchronous versus metachronous resection (p = 0.0009) were independently associated with survival after liver resection. No association was found, however, for solitary versus multiple metastases. The survival of the Large group was much poorer than that of the Small group (p = 0.0168) and that of the Medium group (p = 0.0205), with statistically significant differences. No statistically significant difference was seen between the Small and the Medium groups (p = 0.7963). This study showed that long-term survival following resection of metastases was much poorer when metastases were 6 cm or greater in diameter. With regard to metastases less than 6 cm in diameter, resection of the smallest of these (less than 3 cm) did not appear to improve survival.