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British Journal of Radiology [journal]
- Paediatric Post-septal and Pre-septal Cellulitis: 10-year Experience at a Tertiary-level Children's Hospital. [JOURNAL ARTICLE]
- Br J Radiol 2013 Nov 28.
Aims:To assess the incidence and complications of pre-septal (Pre-SC) and post-septal cellulitis (Post-SC) over 10 years. Pre-SC and Post-SC are also known as peri-orbital and orbital cellulitis respectively.Methods:Retrospective analysis of CT scans. Data included presence of Pre-SC and Post-SC, paranasal-sinus disease (PNS) and complications.Results:Among 125 patients scanned for these suspected diagnoses, 67 had both Pre-SC and Post-SC, 37 had Pre-SC and 4 had Post-SC; there were 17 normal scans. 110 had PNS. 68/71 (96%) patients with Post-SC had PNS. Post-SC complications included orbital and/or sub-periosteal abscess (50/71: 30 medial orbital, 10 supero-medial, 3 lateral, 2 antero-medial, 2 infero-medial, 1 superior and 1 antero-superior), cavernous sinus thrombosis (CST)(1), superior ophthalmic vein (SOV) thrombosis (4) and subdural frontal empyema (2); 1 patient had SOV and cavernous sinus thrombosis and subdural empyema.Conclusions:71/125 (57%) had Post-SC. 50/125 (40%) patients imaged for Pre-SC/Post-SC had orbital abscess, of which 44/50 (88%) involved the medial orbit. Patients can develop solely superior or inferior abscesses that are difficult to identify by axial imaging alone, hence coronal reformatted imaging is essential. 5/125 (4%) patients developed major complications (SOV/CST/empyema), hence imaging review of the head and cavernous sinus region is essential. A diagnosis of Post-SC on CT should alert the radiologist because this diagnosis can be associated with an increased incidence (5/71, 7%) of complications.Advances in knowledge:We recommend that all patients with a suspected diagnosis of Post-SC should undergo CT scan (post-contrast orbits and post-contrast head, with multi-planar reformats and a careful review of the SOV and the cavernous sinus). Particular attention should be paid to exclude intracranial complications including subdural empyema and cerebral abscess. As soon as a diagnosis of Post-SC is made, in addition to informing the referring clinical team, urgent opinion should be sought from ENT, Neurology and Ophthalmology with a view to urgent drainage of the paranasal sinuses.
- Gadoxetic Acid-Enhanced MR Imaging for T-Staging of Gallbladder Carcinoma: Emphasis on Liver Invasion. [JOURNAL ARTICLE]
- Br J Radiol 2013 Nov 28.
Objectives:To evaluate diagnostic performance of gadoxetic acid-enhanced MR imaging with an emphasis on the usefulness of hepatobiliary phase (HBP) in T-staging of gallbladder carcinoma.Methods:Sixty-six patients with surgically-confirmed gallbladder carcinoma underwent MR imaging. Two radiologists independently reviewed two sets of gadoxetic acid-enhanced MR imaging without/with HBP. Local tumour spread was evaluated according to the T-staging, and the results were compared with pathologic findings. The diagnostic performance of two image sets to differentiate each T-stage was compared.Results:The sensitivities of MR imaging with HBP to differentiate T1 versus = T2 lesions, = T2 versus = T3 lesions, and = T3 versus T4 lesions were 96.3%, 85.7%, and 100% for observer 1, and 92.6%, 95.2%, and 100% for observer 2, respectively (P < 0.0001). By adding HBP, the sensitivities to differentiate = T2 versus = T3 lesions were increased from 66.7% to 85.7% for observer 1 and from 81.0% to 95.2% for observer 2, although there was no significant difference (P > 0.05). The overall accuracies for T-staging were increased from 80.3% to 86.4% for observer 1, a statistically significant degree (P = 0.046), and from 83.8% to 87.9% for observer 2 (P > 0.05). The k value for the two observers indicated excellent agreement.Conclusions:Gadoxetic acid-enhanced MR imaging provided acceptable diagnostic performance for T-staging of gallbladder carcinoma. Addition of HBP aids in detection of liver invasion.Advances in KnowledgeIn the T-staging of gallbladder carcinoma, gadoxetic acid-enhanced MR imaging with HBP may enhance detection of liver invasion.
- Evaluation of 99mTc-peptide-ZHER2:342 Affibody Molecule for in vivo Molecular Imaging. [JOURNAL ARTICLE]
- Br J Radiol 2013 Nov 22.
Objective:The aim of this study was to develop an improved method for labeling ZHER2:342 with 99mTc using Gly-(D) Ala-Gly-Gly as a chelator and to evaluate the feasibility of its use for visualization of HER2 expression in vivo.Methods:The Affibody molecule ZHER2:342 was synthesized by Fmoc/tBu solid phase synthesis. The chelator, Gly-(D) Ala-Gly-Gly, was introduced by manual synthesis as the N-terminal extensions of ZHER2:342. The labeling efficiency, radiochemical purity and in vitro stabilities of the labeled molecular probe were analyzed by RP-HPLC. Biodistribution and molecular imaging using 99mTc-peptide-ZHER2:342 were performed.Results:The molecular probe was successfully synthesized and labeled with 99mTc with the labeling efficiency of 98.10 ± 1.73% (n = 5). The radiolabeled molecular probe remained highly stable in vitro. The molecular imaging showed high uptake in HER-expressing SKOV-3 xenografts, whereas the MDA-MB-231 xenografts with low HER2 expression were not clearly imaged at any time after the injection of 99mTc-peptide-ZHER2:342. The predominant clearance pathway for 99mTc-peptide-ZHER2:342 was through the kidneys.Conculsions:99mTc-peptide-ZHER2:342 using Gly-(D) Ala-Gly-Gly as a chelator is a promising tracer agent with favorable biodistribution and imaging properties that may be developed as a radiopharmaceutical for detection of HER2-positive malignant tumors.Advanced in knowledge:he 99mTc-peptide-ZHER2:342 molecular probe is a promising tracer agent and the results in this study provide a foundation for the future development of protocols for earlier visual detection of cancer in the clinical setting.
- Reduced Z-axis Coverage in Multi-Detector-Row CT Pulmonary Angiography Decreases Radiation Dose and Diagnostic Accuracy of Alternative Diseases. [JOURNAL ARTICLE]
- Br J Radiol 2013 Nov 20.
Objectives:to investigate the effect of a two-thirds reduction of the scanned length (i.e. 10-cm) on diagnosis of both pulmonary embolism (PE) and alternative diseases.Methods:Two hundred and forty seven consecutive patients suspected of acute PE had a CTPA of the thorax (standard length) (L). Based on this acquisition, a second set of images was created to obtain a scan length of 10 cm caudally to the aortic arch (l). Images were anonymized, randomized, and interpreted by two independent readers. Enhancement quality, presence of PE, and possible alternative and/or complementary diagnoses were recorded. A McNemar exact test investigated differences in discrepancies between readers and between scan lengths.Results:Fifty-seven (23%) patients had an acute PE. Among l sets, PE was missed by both readers in one (1.8%) patient because the unique clot was localized in a subsegmental artery out of the 10 cm range. There were discrepancies between L and l sets in nine (3.6%) and 11 (4.5%) patients, by reader 1 and 2 (p=0.820), respectively. Discrepancies between readers of L sets and those between both sets were not different regardless of the reader (p>0.99). There were discrepancies between both sets for alternative and/or complementary diagnoses in 43 (17.2%) patients.Conclusion:Although its performance in diagnosing PE is maintained, CTPA should not be restricted to a range of 10 cm centred the pulmonary hilum because alternative and/or complementary diagnoses could be missed.
- Transcatheter aortic valve insertion (TAVI): a review. [JOURNAL ARTICLE]
- Br J Radiol 2013 Nov 20.
The introduction of transcatheter aortic valve insertion (TAVI) has transformed the care of patients with severe aortic stenosis. The uptake of this procedure is increasing rapidly and clinicians from all disciplines are increasingly likely to encounter patients being assessed for, or having undergone this intervention.Successful TAVI relies heavily on careful and comprehensive imaging assessment, before, during and after the procedure, using a range of modalities. This review outlines the background and development of TAVI, describes the nature of the procedure and considers the contribution of imaging techniques, both to successful intervention and to potential complications.
- Radiological and Clinical Characterization of the Lysosomal Storage Disorders: Non-Lipid Disorders. [JOURNAL ARTICLE]
- Br J Radiol 2013 Nov 14.
Objectives and Methods:Lysosomal storage diseases (LSDs) are a large group of genetic metabolic disorders that result in the accumulation of abnormal material, such as mucopolysaccharides, glycoproteins, amino acids and lipids within cells. Since many LSDs manifest in infancy or early childhood, with potentially devastating consequences if left untreated, timely identification is imperative to prevent irreversible damage and early death. In this review, the key imaging features of the non-lipid or extra-lipid LSDs are examined and correlated with salient clinical manifestations and genetic information. Disorders are stratified based on the type of excess material causing tissue or organ dysfunction, with descriptions of the mucopolysaccharidoses, mucolipidoses, alpha mannosidosis, glycogen storage disorder II and cystinosis. In addition, similarities and differences in radiological findings between each of these LSDs are highlighted in order to facilitate further recognition.Results and Conclusions:Given the rare and extensive nature of the lysosomal storage disorders, mastery of their multiple clinical and radiologic traits may seem challenging. However, an understanding of the distinguishing imaging characteristics of LSDs and their clinical correlates may allow radiologists to play a key role in early diagnosis of these progressive and potentially fatal disorders.
- Clinical and research applications of simultaneous Positron Emission Tomography- Magnetic Resonance Imaging (PET-MRI). [JOURNAL ARTICLE]
- Br J Radiol 2013 Nov 14.
Evaluation of the molecular processes responsible for disease pathogenesis and progression represents the new frontier of clinical radiology. Multi-modality imaging lies at the cutting edge; combining the power of magnetic resonance imaging for tissue characterisation, microstructural appraisal and functional assessment; together with new positron emission tomography tracers designed to target specific metabolic processes.The recent commercial availability of an integrated clinical whole-body Positron Emission Tomography-Magnetic Resonance Imaging (PET-MRI) provides a hybrid platform for exploring and exploiting the synergies of multi-modal imaging. First experiences on the clinical and research application of hybrid PET-MRI are emerging. This article reviews the rapidly evolving field and speculates on potential future direction.
- Virtual anthropology and forensic identification using multidetector computed tomography. [JOURNAL ARTICLE]
- Br J Radiol 2013 Nov 14.
Virtual anthropology is made possible by modern cross-sectional imaging. Multislice computed tomography (MSCT) can be used for comparative bone and dental identification, reconstructive identification and lesion identification. Comparative identification, the comparison of ante- and post-mortem imaging data, can be performed on both teeth and bones. Reconstructive identification, a considerable challenge for the radiologist, identifies the deceased by determining sex, geographical origin, stature and age at death. Lesion identification combines virtual autopsy and virtual anthropology. MSCT can be useful in paleopathology, seeking arthropathy, infection, oral pathology, trauma, tumours, haematological disorders, stress indicators or occupational stress in bones and teeth. We examine some of the possibilities offered by this new radiological subspeciality that adds a new dimension to the work of the forensic radiologist. A multidisciplinary approach is crucial and involves communication and data exchange between radiologists, forensic pathologists, anthropologists and radiographers.
- Advantage of 3D volumetric dosemeter in delivery quality assurance of dynamic arc therapy: comparison of pencil beam and Monte Carlo calculations. [Journal Article, Research Support, Non-U.S. Gov't]
- Br J Radiol 2013 Dec; 86(1032):20130353.
To evaluate the accuracy of pencil beam calculation (PBC) and Monte Carlo calculation (MCC) for dynamic arc therapy (DAT) in a cylindrically shaped homogenous phantom, by comparing the two plans with an ion chamber, a film and a three-dimensional (3D) volumetric dosemeter.For this study, an in-house phantom was constructed, and the PBC and MCC plans for DAT were performed using iPlan® RT (BrainLAB®, Heimstetten, Germany). The A16 micro ion chamber (Standard Imaging, Middleton, WI), Gafchromic® EBT2 film (International Specialty Products, Wayne, NJ) and ArcCHECK™ (Sun Nuclear, Melbourne, FL) were used for measurements. For comparison with each plan, two-dimensional (2D) and 3D gamma analyses were performed using 3%/3 mm and 2%/2 mm criteria.The difference between the PBC and MCC plans using 2D and 3D gamma analyses was found to be 7.85% and 28.8%, respectively. The ion chamber and 2D dose distribution measurements did not exhibit this difference revealed by the comparison between the PBC and MCC plans. However, the 3D assessment showed a significant difference between the PBC and MCC (62.7% for PBC vs 93.4% for MCC, p = 0.034).Evaluation using a 3D volumetric dosemeter can be clinically useful for delivery quality assurance (QA), and the MCC should be used to achieve the most reliable dose calculation for DAT.(1) The DAT plan calculated using the PBC has a limitation in the calculation methods, and a 3D volumetric dosemeter was found to be an adequate tool for delivery QA of DAT. (2) The MCC was superior to PBC in terms of the accuracy in dose calculation for DAT even in the homogenous condition.
- Advances in post-mortem CT-angiography. [JOURNAL ARTICLE]
- Br J Radiol 2013 Dec 2.
Performing a post-mortem multidetector CT (MDCT) scan has already become routine in some institutes of forensic medicine. To better visualize the vascular system, different techniques of post-mortem CT-angiography have been explored, which can essentially be divided into partial- and whole-body angiography techniques. Probably the most frequently applied technique today is the so-called multiphase post-mortem CT-angiography (MPMCTA) a standardized method for investigating the vessels of the head, thorax and abdomen. Different studies exist, describing its use for medicolegal investigations, and its advantages as well as its artefacts and pitfalls. With the aim to investigate the performance of PMCTA and to develop and validate techniques, an international working group was created in 2012 called the "Technical Working Group Post-mortem Angiography Methods" (TWGPAM). Beyond its primary perspective, the goals of this group include creating recommendations for the indication of the investigation and for the interpretation of the images and to distribute knowledge about PMCTA. This article provides an overview about the different approaches that have been developed and tested in recent years and an update about ongoing research in this field. It will explain the technique of MPMCTA in detail and give an outline of its indications, application, advantages and limitations.