PMCC PMCC

Search tips
Search criteria

Advanced
Results 1-25 (1274)
 

Clipboard (0)
None

Select a Filter Below

Journals
Year of Publication
issn:1748-880
3.  Neuroimaging findings in sickle cell disease 
The British Journal of Radiology  2014;87(1040):20130699.
At least 25% of individuals with sickle cell disease will have a neurological complication over their lifetime, often as early as in childhood. Neuroradiological findings in patients with sickle cell disease are common and include acute territorial infarction, silent ischaemia and intracranial haemorrhage. Imaging abnormalities are typically, but not always, manifestations of the underlying vasculopathy. Coexisting acute and chronic pathology may pose challenges to interpretation.
doi:10.1259/bjr.20130699
PMCID: PMC4112221  PMID: 24847772
4.  Feasibility of a radiation dose conserving CT protocol for myocardial function assessment 
The British Journal of Radiology  2014;87(1040):20130755.
Objective:
Assessment of myocardial function can be performed at higher noise levels than necessary for coronary arterial evaluation. We evaluated image quality and radiation exposure of a dose-conserving function-only acquisition vs retrospectively electrocardiogram(ECG)-gated coronary CTA with automatic tube current modulation.
Methods:
Of 26 patients who underwent clinically indicated coronary CTA for coronary and function evaluation, 13 (Group I) underwent prospectively ECG-triggered coronary CTA, followed by low-dose retrospectively ECG-gated scan for function (128-slice dual-source, 80 kVp; reference tube current, 100 mA; 8-mm-thick multiplanar reformatted reconstructions) performed either immediately (n = 6) or after 5- to 10-min delay for infarct assessment (n = 7). 13 corresponding controls (Group II) underwent retrospectively ECG-gated protocols (automatic tube potential selection with CARE kV/CARE Dose 4D; Siemens Healthcare, Forchheim, Germany) with aggressive dose modulation. Image quality assessment was performed on the six Group I subjects who underwent early post-contrast dedicated function scan and corresponding controls. Radiation exposure was based on dose–length product.
Results:
Contrast-to-noise ratio (CNR) was preserved throughout the cardiac cycle in Group I and varied according to dose modulation in Group II. Visual image quality indices were similar during end systole but were better in Group II at end diastole. Although the total radiation exposure was equivalent in Group I and Group II (284 vs 280 mGy cm), the median radiation exposure associated with only the dedicated function scan was 138 mGy cm (interquartile range, 116–203 mGy cm).
Conclusion:
A low-dose retrospective ECG-gated protocol permits assessment of myocardial function at a median radiation exposure of 138 mGy cm and offers more consistent multiphase CNR vs traditional ECG-modulation protocols. This is useful for pure functional evaluation or as an adjunct to single-phase scan modes.
Advances in knowledge:
Radiation exposure can be limited with a tailored myocardial function CT protocol while maintaining preserved images.
doi:10.1259/bjr.20130755
PMCID: PMC4112222  PMID: 24884727
5.  A polymorphism in the DNA repair domain of APEX1 is associated with the radiation-induced pneumonitis risk among lung cancer patients after radiotherapy 
Li, H | Liu, G | Xia, L | Zhou, Q | Xiong, J | Xian, J | Du, M | Zhang, L | Liao, L | Su, X | Li, Z | Luo, Q | Cheng, Y | Zhang, T | Wang, D | Yang, Z-Z
The British Journal of Radiology  2014;87(1040):20140093.
Objective:
To examine the association of tag single nucleotide polymorphisms (tagSNPs) (rs1130409, rs1760944, rs2307486 and rs3136817) in APEX1 with the risk of severe radiation-induced pneumonitis (RP) after radiotherapy among Han Chinese patients with lung cancer.
Methods:
A total of 168 patients with lung cancer who were receiving radiotherapy were prospectively recruited. RP was evaluated according to the Radiation Therapy Oncology Group. A case–control study was performed. The case group included patients with RP grade of ≥3, while the control group comprised patients with RP grades <3. Four tagSNPs of APEX1 were genotyped in 126 patients with complete follow-up by multi-SNaPshot® (Genesky Biotechnologies Inc., Shanghai, China) genotyping assays. Results were assessed by a logistic regression model for RP risk and Mantal–Cox log-rank test for the cumulative RP probability by the genotypes.
Results:
rs1130409 was associated with severe RP. GT genotype of rs1130409 was significantly higher in patients with RP than in those of the control group [68.8% vs 41.8%; p = 0.025; resulting odds ratio (OR), 5.98]. Patients with lung cancer bearing the G allele had a 5.83-fold higher risk of RP than those with the wild TT genotype [OR = 5.83; 95% confidence interval (CI), 1.27–26.90; p = 0.024], and this was further confirmed by the binary regression adjusted by some confounding factors, including Karnofsky performance scale, concurrent chemotherapy–radiotherapy and lung volume receiving >30 Gy (OR = 6.96; 95% CI, 1.36–35.77; p = 0.02). rs1130409 was also associated with the time to occurrence of severe RP (p = 0.04). Three-dimensional model APEX1 protein showed that rs1130409 is located in the random coil structure corresponding to the DNA repair function region.
Advances in knowledge:
rs1130409 of APEX1 can be a predictor of RP grades ≥3 among patients with lung cancer.
doi:10.1259/bjr.20140093
PMCID: PMC4112388  PMID: 24884729
6.  Diagnostic accuracy of integrated 18F-FDG PET/CT for restaging patients with malignant germ cell tumours 
The British Journal of Radiology  2014;87(1040):20140263.
Objective:
Evaluation of utility of fluorine-18 fludeoxyglucose (18F-FDG) positron emission tomography/CT (PET/CT) for restaging patients with primary malignant germ cell tumours (GCTs).
Methods:
Data of 92 patients (age, 31.94 ± 10.1 years; male/female, 86/6) with histopathologically confirmed malignant GCTs (gonadal, 88; mediastinal, 4; seminomatous, 47 and non-seminomatous, 45) who underwent 18F-FDG PET/CT for restaging (suspected recurrence/post-therapy evaluation) were retrospectively analysed. Two experienced nuclear medicine physicians reviewed the PET/CT images in consensus, qualitatively and semi-quantitatively [maximum standardized uptake value (SUVmax)]. Histopathology (if available) and clinical/imaging/biochemical follow-up (minimum of 6 months) were employed as the reference standard.
Results:
18F-FDG PET/CT was interpreted as positive in 59 and negative in 33 patients. Local disease was seen in 5, nodal disease in 50 and distant metastasis in 22 patients. PET/CT was true positive in 49, false positive in 10, true negative in 30 and false negative in 3 patients. 18F-FDG PET/CT showed sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 94.2%, 75.0%, 83.0%, 90.9% and 85.8% overall; 90.0%, 74.0%, 72.0%, 90.9% and 80.8% in seminomatous GCT; and 96.8%, 76.9%, 91.1%, 90.9% and 91.1% in non-seminomatous GCT, respectively. Difference in PET/CT accuracy for seminomatous and non-seminomatous GCTs was not significant (p = 0.263). PET/CT demonstrated disease in 13 patients with negative/equivocal conventional imaging findings and in 9 patients with normal tumour markers. No site- or histology-based difference was seen in SUVmax.
Conclusion:
18F-FDG PET/CT demonstrates high diagnostic accuracy for restaging patients with malignant GCTs. It has comparable diagnostic performance in both seminomatous and non-seminomatous malignant GCTs.
Advances in knowledge:
The present article demonstrates high diagnostic accuracy of 18F-FDG PET/CT for restaging both seminomatous and non-seminomatous malignant GCTs in a large patient population.
doi:10.1259/bjr.20140263
PMCID: PMC4112389  PMID: 24896199
7.  Imaging of acute stroke prior to treatment: current practice and evolving techniques 
The British Journal of Radiology  2014;87(1040):20140216.
Standard imaging in acute stroke is undertaken with the aim of diagnosing the underlying cause and excluding stroke mimics. In the presence of ischaemic stroke, imaging is also needed to assess patient suitability for treatment with intravenous thrombolysis. Non-contrast CT is predominantly used, but MRI can also exclude any contraindications to thrombolysis treatment. Advanced stroke imaging such as CT and MR angiography and perfusion imaging are increasingly used in an acute setting. In this review, we discuss the evidence for the application of these advanced techniques in the imaging of acute stroke.
doi:10.1259/bjr.20140216
PMCID: PMC4112390  PMID: 24936980
8.  The value of pre-operative multicompartment pelvic floor ultrasonography: a 1-year prospective study 
The British Journal of Radiology  2014;87(1040):20140145.
Objective:
Comprehensive assessment of the pelvic floor (PF) provides information and diagnoses of coexisting abnormalities that may affect operative decisions. Our aim was to establish if pre-operative PF ultrasonography (PFUS) in patients complaining of PF dysfunction can complement clinical findings and contribute to additional management strategies.
Methods:
Females were recruited from the urogynaecology/gynaecology clinics between July and October 2009 and underwent pelvic organ prolapse quantification (POPQ) by an independent examiner. PFUS was performed using two-dimensional (2D) transperineal ultrasound (TPUS), high-frequency 2D/three-dimensional (3D) endovaginal ultrasound (EVUS) using a biplane probe with linear and transverse arrays and a 360° rotational 3D-EVUS. The clinician performing PFUS was blinded to POPQ results. POPQ and PFUS were repeated at 1 year. Two clinicians analysed the scans independently.
Results:
158 of 160 females had a POPQ and PFUS. 105 females had pelvic organ prolapse and/or incontinence and 53 asymptomatic females were controls. 26 additional ultrasound diagnoses were noted at baseline and 46 at 1 year using 2D-TPUS and EVUS. Only one female with additional diagnoses on PFUS needed surgical intervention for this condition.
Conclusion:
Multicompartment PFUS identifies additional conditions to that diagnosed on clinical assessment. However, it neither changes the initial surgical management nor the management at 1-year follow-up and therefore clinical assessment should not be substituted by PFUS.
Advances in knowledge:
PFUS can be helpful in providing additional information; however, it does not change the initial management of the patient and therefore should not replace clinical assessment.
doi:10.1259/bjr.20140145
PMCID: PMC4112391  PMID: 24959953
9.  The challenge of segmental small bowel motility quantitation using MR enterography 
The British Journal of Radiology  2014;87(1040):20140330.
Objective:
Analysis of “cine” MRI using segmental regions of interest (ROIs) has become increasingly popular for investigating bowel motility; however, variation in motility in healthy subjects both within and between scans remains poorly described.
Methods:
20 healthy individuals (mean age, 28 years; 14, males) underwent MR enterography to acquire dynamic motility scans in both breath hold (BH) and free breathing (FB) on 2 occasions. Motility data were quantitatively assessed by placing four ROIs per subject in different small bowel segments and applying two measures: (1) contractions per minute (CPM) and (2) Jacobian standard deviation (SD) motility score. Within-scan (between segment) variation was assessed using intraclass correlation (ICC), and repeatability was assessed using Bland–Altman limits of agreement (BA LoA).
Results:
Within-scan segmental variation: BH CPM and Jacobian SD metrics between the four segments demonstrated ICC R = 0.06, p = 0.100 and R = 0.20, p = 0.027 and in FB, the CPM and Jacobian SD metrics demonstrated ICC R = −0.26, p = 0.050 and R = 0.19, p = 0.030. Repeatability: BH CPM for matched segments ranged between 0 and 14 contractions with BA LoA of ±8.36 and Jacobian SD ranged between 0.09 and 0.51 with LoA of ±0.33. In FB data, CPM ranged between 0 and 10 contractions with BA LoA of ±7.25 and Jacobian SD ranged between 0.16 and 0.63 with LoA = ±0.28.
Conclusion:
The MRI-quantified small bowel motility in normal subjects demonstrates wide intersegmental variation and relatively poor repeatability over time.
Advances in knowledge:
This article presents baseline values for healthy individuals of within- and between-scan motility that are essential for understanding how this process changes in disease.
doi:10.1259/bjr.20140330
PMCID: PMC4112392  PMID: 24919500
10.  Photon counting spectral CT component analysis of coronary artery atherosclerotic plaque samples 
The British Journal of Radiology  2014;87(1040):20130798.
Objective:
To evaluate the capabilities of photon counting spectral CT to differentiate components of coronary atherosclerotic plaque based on differences in spectral attenuation and iodine-based contrast agent concentration.
Methods:
10 calcified and 13 lipid-rich non-calcified histologically demonstrated atheromatous plaques from post-mortem human coronary arteries were scanned with a photon counting spectral CT scanner. Individual photons were counted and classified in one of six energy bins from 25 to 70 keV. Based on a maximum likelihood approach, maps of photoelectric absorption (PA), Compton scattering (CS) and iodine concentration (IC) were reconstructed. Intensity measurements were performed on each map in the vessel wall, the surrounding perivascular fat and the lipid-rich and the calcified plaques. PA and CS values are expressed relative to pure water values. A comparison between these different elements was performed using Kruskal–Wallis tests with pairwise post hoc Mann–Whitney U-tests and Sidak p-value adjustments.
Results:
Results for vessel wall, surrounding perivascular fat and lipid-rich and calcified plaques were, respectively, 1.19 ± 0.09, 0.73 ± 0.05, 1.08 ± 0.14 and 17.79 ± 6.70 for PA; 0.96 ± 0.02, 0.83 ± 0.02, 0.91 ± 0.03 and 2.53 ± 0.63 for CS; and 83.3 ± 10.1, 37.6 ± 8.1, 55.2 ± 14.0 and 4.9 ± 20.0 mmol l−1 for IC, with a significant difference between all tissues for PA, CS and IC (p < 0.012).
Conclusion:
This study demonstrates the capability of energy-sensitive photon counting spectral CT to differentiate between calcifications and iodine-infused regions of human coronary artery atherosclerotic plaque samples by analysing differences in spectral attenuation and iodine-based contrast agent concentration.
Advances in knowledge:
Photon counting spectral CT is a promising technique to identify plaque components by analysing differences in iodine-based contrast agent concentration, photoelectric attenuation and Compton scattering.
doi:10.1259/bjr.20130798
PMCID: PMC4112393  PMID: 24874766
11.  Monte Carlo simulations will change the way we treat patients with proton beams today 
The British Journal of Radiology  2014;87(1040):20140293.
Within the past two decades, the evolution of Monte Carlo simulation tools, coupled with our better understanding of physics processes and computer technology has enabled accurate and efficient prediction of particle interactions with tissue. Monte Carlo simulations have now been applied for routine clinical applications. This commentary outlines how simulations have the potential to change clinical practice particularly in proton therapy. Specifically, Monte Carlo simulations will impact treatment outcome analysis, reduce treatment volumes and help understand proton-induced radiation biology.
doi:10.1259/bjr.20140293
PMCID: PMC4112394  PMID: 24896200
12.  The average receiver operating characteristic curve in multireader multicase imaging studies 
The British Journal of Radiology  2014;87(1040):20140016.
Objective:
In multireader, multicase (MRMC) receiver operating characteristic (ROC) studies for evaluating medical imaging systems, the area under the ROC curve (AUC) is often used as a summary metric. Owing to the limitations of AUC, plotting the average ROC curve to accompany the rigorous statistical inference on AUC is recommended. The objective of this article is to investigate methods for generating the average ROC curve from ROC curves of individual readers.
Methods:
We present both a non-parametric method and a parametric method for averaging ROC curves that produce a ROC curve, the area under which is equal to the average AUC of individual readers (a property we call area preserving). We use hypothetical examples, simulated data and a real-world imaging data set to illustrate these methods and their properties.
Results:
We show that our proposed methods are area preserving. We also show that the method of averaging the ROC parameters, either the conventional bi-normal parameters (a, b) or the proper bi-normal parameters (c, da), is generally not area preserving and may produce a ROC curve that is intuitively not an average of multiple curves.
Conclusion:
Our proposed methods are useful for making plots of average ROC curves in MRMC studies as a companion to the rigorous statistical inference on the AUC end point. The software implementing these methods is freely available from the authors.
Advances in knowledge:
Methods for generating the average ROC curve in MRMC ROC studies are formally investigated. The area-preserving criterion we defined is useful to evaluate such methods.
doi:10.1259/bjr.20140016
PMCID: PMC4112395  PMID: 24884728
13.  Platelet factor 4 protects bone marrow mesenchymal stem cells from acute radiation injury 
The British Journal of Radiology  2014;87(1040):20140184.
Objective:
The aim of this study was to find a new radiation protector, platelet factor 4 (PF4) and to identify its effect on haemopoietic microenvironment in vitro and in vivo.
Methods:
Radiation damage on bone marrow mesenchymal stem cells ex and in vitro was set up as models. Growth curve analysis, clonogenic survival assay, FACSCalibur™ (BD Immunocytometry Systems, San Jose, CA), 5-ethynyl-2′-deoxyuridine immunofluorescence staining and quantitative reverse transcription–polymerase chain reaction were employed to assess the characterization of bone marrow mesenchymal stem cells (BMSCs), proliferation, apoptosis, cell cycle and gene expression.
Results:
A dose- and time-dependent enhancement of cell viability and survival was observed for PF4 treatment along with 500 cGy γ-radiation in vitro. The same phenomena were noted in vivo, including enhancement of adherence and proliferation ability while inhibition of cell apoptosis, which were associated with a short-term decrease in the G0/G1 ratio owing to S phase arrest. These were accompanied with enhanced Bcl-2 expression and p53/p21 loss.
Conclusion:
These results uncover that PF4 might be a novel therapeutic approach, which could reduce DNA damage and increase survival of BMSCs, in part, by inhibiting p53/p21 axis and facilitating DNA damage repair.
Advances in knowledge:
This study explores the feasibility of a new radioprotector and hence may be clinically important.
doi:10.1259/bjr.20140184
PMCID: PMC4112396  PMID: 24922360
14.  Non-cutaneous melanoma: is there a role for 18F-FDG PET-CT? 
The British Journal of Radiology  2014;87(1040):20140324.
Non-cutaneous melanomas (NCM) are diverse and relatively uncommon. They often differ from cutaneous melanomas in their epidemiology, genetic profile and biological behaviour. Despite the growing body of evidence regarding the utility of positron emission tomography (PET)/CT in cutaneous melanoma, the data on its use in NCM are scarce. In this review, we will summarize the existing literature and present cases from our experience with NCM to illustrate current knowledge on the potential role and limitations of fluorine-18 fludeoxyglucose PET/CT in NCM.
doi:10.1259/bjr.20140324
PMCID: PMC4112397  PMID: 24901893
15.  Helical tomotherapy with simultaneous integrated boost dose painting for the treatment of synchronous primary cancers involving the head and neck 
The British Journal of Radiology  2014;87(1040):20130697.
Objective:
To demonstrate the feasibility of helical tomotherapy (HT)-based intensity-modulated radiotherapy (IMRT) for the treatment of synchronous primary cancers arising from the head and neck.
Methods:
14 consecutive patients with histologically proven squamous cell carcinoma of the head and neck were determined to have a second primary cancer in the upper aerodigestive tract on further evaluation and were treated with HT using simultaneous integrated boost IMRT. Megavoltage CT scans were acquired daily as part of an image-guided registration protocol. Concurrent platinum-based systemic therapy was given to nine patients (64%).
Results:
HT resulted in durable local control in 21 of the 28 primary disease sites irradiated, including a complete clinical and radiographic response initially observed at 17 of the 20 sites with gross tumour. The mean displacements to account for interfraction motion were 2.44 ± 1.25, 2.92 ± 1.09 and 2.31 ± 1.70 mm for the medial–lateral (ML), superior–inferior (SI) and anteroposterior (AP) directions, respectively. Table shifts of >3 mm occurred in 19%, 20% and 22% of the ML, SI and AP directions, respectively. The 2-year estimates of overall survival, local-regional control and progression-free survival were 58%, 73% and 60%, respectively.
Conclusion:
The effectiveness of HT for the treatment of synchronous primary cancers of the head and neck was demonstrated.
Advances in knowledge:
HT is a feasible option for synchronous primary cancers of the head and neck and can result in long-term disease control with acceptable toxicity in appropriately selected patients.
doi:10.1259/bjr.20130697
PMCID: PMC4112398  PMID: 24884726
16.  Radiographers' professional knowledge regarding parameters and safety issues in plain radiography: a questionnaire survey 
The British Journal of Radiology  2014;87(1040):20140090.
Objective:
To review the knowledge of radiographers and examine the possible sociodemographic and situational contributors to this knowledge.
Methods:
A questionnaire survey was devised and distributed to a cohort of 120 radiographers. Each questionnaire contained two sections. In the first section, background data, including sex, age, highest academic level, grade point average (GPA), length of time from graduation, work experience as a radiographer and the status of previous refresher course(s), were collected. The second section contained 17 multiple-choice questions concerning radiographic imaging parameters and safety issues.
Results:
The response rate was 63.8%. In univariate analytic model, higher academic degree (p < 0.001), higher GPA (r2 = 0.11; p = 0.001), academic workplace (p = 0.04) and taking previous refresher course(s) (p = 0.01) were significantly associated with higher knowledge score. In multivariate analytic model, however, higher academic degree (B = 1.62; p = 0.01), higher GPA (B = 0.50; p = 0.01) and taking previous refresher course(s) (B = −1.26; p = 0.03) were independently associated with higher level of knowledge. Age, sex, length of time from graduation and work experience were not associated with the respondents' knowledge score.
Conclusion:
Academic background is a robust indicator of a radiographer's professional knowledge. Refresher courses and regular knowledge assessments are highly recommended.
Advances in knowledge:
This is the first study in the literature that examines professional knowledge of radiographers in terms of technical and safety issues in plain radiography. Academic degree, GPA and refresher courses are independent predictors of this knowledge. Regular radiographer professional knowledge checks may be recommended.
doi:10.1259/bjr.20140090
PMCID: PMC4112399  PMID: 24827380
17.  CT and MRI of primary and metastatic fibrolamellar carcinoma: a case series of 37 patients 
The British Journal of Radiology  2014;87(1040):20140024.
Objective:
Fibrolamellar carcinoma (FLC) is a rare disease, with limited radiographic reported information. We assessed the imaging patterns of primary and metastatic FLC.
Methods:
CT and MR examinations of patients with FLC were retrospectively reviewed. Imaging features were assessed for primary and recurrent liver tumours, including dimension, enhancement characteristics, and presence or absence of central scars. Locations of nodal and extranodal metastases were also recorded.
Results:
Of 37 patients (18 males and 19 females; average age, 23.5 years) with FLC, 24 had imaging of their primary tumour; 13 had metastases at presentation and 7 developed metastases on follow-up. The remaining 13 patients had follow-up imaging of metastatic disease. Primary FLC had a mean diameter >11 cm, with central scars in ten (46%) patients. Most tumours enhanced heterogeneously (96%) and showed arterial enhancement (81%). On MRI, 62% of FLCs were hypointense on T1 weighted imaging and 54% were hyperintense on T2 weighted imaging. 13 patients (54%) had nodal metastases at presentation, mostly in the upper abdomen (92%) and commonly in the chest (38%). Extrahepatic metastases were most frequently pulmonary or peritoneal. Predominantly small and homogeneous intrahepatic recurrences were detected on follow-up in 15 patients.
Conclusion:
FLC often presents as a large hepatic tumour with nodal and distant metastases. Thoracic adenopathy and lung metastases were frequently found in our series, suggesting the need for pre-operative and follow-up chest imaging.
Advances in knowledge:
Thoracic nodal and lung metastases are common in FLC; therefore, dedicated chest imaging should be part of the evaluation of a patient with FLC.
doi:10.1259/bjr.20140024
PMCID: PMC4112400  PMID: 24896196
18.  Retinal imaging as a source of biomarkers for diagnosis, characterization and prognosis of chronic illness or long-term conditions 
The British Journal of Radiology  2014;87(1040):20130832.
The black void behind the pupil was optically impenetrable before the invention of the ophthalmoscope by von Helmholtz over 150 years ago. Advances in retinal imaging and image processing, especially over the past decade, have opened a route to another unexplored landscape, the retinal neurovascular architecture and the retinal ganglion pathways linking to the central nervous system beyond. Exploiting these research opportunities requires multidisciplinary teams to explore the interface sitting at the border between ophthalmology, neurology and computing science. It is from the detail and depth of retinal phenotyping that novel metrics and candidate biomarkers are likely to emerge. Confirmation that in vivo retinal neurovascular measures are predictive of microvascular change in the brain and other organs is likely to be a major area of research activity over the next decade. Unlocking this hidden potential within the retina requires integration of structural and functional data sets, that is, multimodal mapping and longitudinal studies spanning the natural history of the disease process. And with further advances in imaging, it is likely that this area of retinal research will remain active and clinically relevant for many years to come. Accordingly, this review looks at state-of-the-art retinal imaging and its application to diagnosis, characterization and prognosis of chronic illness or long-term conditions.
doi:10.1259/bjr.20130832
PMCID: PMC4112401  PMID: 24936979
19.  Detectability of simulated interstitial pneumonia on chest radiographs: comparison between irradiation side sampling indirect flat-panel detector and computed radiography 
The British Journal of Radiology  2014;87(1040):20140075.
Objective:
To compare the detectability of simulated interstitial pneumonia on chest radiographs between an irradiation side sampling indirect flat-panel detector (ISS-FPD) and computed radiography (CR).
Methods:
Simulated interstitial pneumonia findings (ground-glass opacity, reticular opacity and honeycomb lung) were superimposed on an anthropomorphic chest phantom. Chest radiographs were acquired under three exposure levels (4.0, 3.2 and 2.0 mAs) with an ISS-FPD and with CR. 5 thoracic radiologists evaluated 72 images for the presence or absence of a lesion over each of 6 areas. A total of 1296 observations were analysed in a receiver–operating characteristic analysis. A jackknife method was used for the statistical analysis.
Results:
The areas under the curves (AUCs) for the detection of simulated honeycomb lung obtained with the ISS-FPD were significantly larger than those obtained with CR at all exposure conditions. For the detection of simulated ground-glass opacity and reticular opacity, there were no significant differences between the two systems. In addition, the AUCs for the detectability of simulated honeycomb lung obtained with the ISS-FPD at all exposure levels were significantly larger than those obtained with CR at 4 mAs.
Conclusion:
The ISS-FPD was superior to CR for the detection of simulated honeycomb lung. Provided that the chosen model is representative of interstitial pneumonia, the use of an ISS-FPD might reduce a patient's exposure dose during the detection of interstitial pneumonia.
Advances in knowledge:
The ISS-FPD has shown its advantage compared with CR in the detection of honeycombing, one sign of interstitial pneumonia.
doi:10.1259/bjr.20140075
PMCID: PMC4112402  PMID: 24874767
20.  Breast cancer detection in digital breast tomosynthesis and digital mammography—a side-by-side review of discrepant cases 
The British Journal of Radiology  2014;87(1040):20140080.
Objective:
To analyse discrepant breast cancer detection in digital breast tomosynthesis (DBT) and digital mammography (DM).
Methods:
From a previous detection study comparing DBT and DM, 26 discrepant cases were extracted, 19 detected by DBT only and 7 by DM only. An expert panel of three radiologists reviewed these cases and documented the level of discrepancy, lesion visibility, radiographic pattern and lesion conspicuity and assessed the reason for non-detection. Differences between groups were tested using the Wilcoxon rank sum test, the Kruskal–Wallis test and visual grading characteristics.
Results:
The proportion of lesion periphery in fatty tissue was statistically significantly larger, and there were significantly more spiculated masses in DBT compared with DM in the DBT only group (p = 0.018; p = 0.015). The main reasons for missing a lesion were poor lesion visibility when using DM and interpretative error when using DBT.
Conclusion:
Lesion visualization is superior with DBT, particularly of spiculated tumours. A major reason for non-detection in DBT seems to be interpretative error, which may be due to lack of experience.
Advances in knowledge:
Our findings suggest that DBT is better than DM in visualizing breast cancer and that non-detection when using DBT is related to interpretative error regarding clearly visible lesions.
doi:10.1259/bjr.20140080
PMCID: PMC4112403  PMID: 24896197
21.  Feasibility study on energy prediction of microwave ablation upon uterine adenomyosis and leiomyomas by MRI 
The British Journal of Radiology  2014;87(1040):20130770.
Objective:
To evaluate the feasibility of energy prediction of percutaneous microwave ablation (PMWA) upon uterine leiomyomas and adenomyosis by MRI.
Methods:
63 patients (49 patients with 49 uterine leiomyomas and 14 patients with adenomyosis) who underwent ultrasound-guided PMWA treatment were studied during the period from June 2011 to December 2012. Before PMWA, contrast-enhanced MRI (ceMRI) was performed for all of the patients. Based on the signal intensity (SI) of T2 weighted MRI, uterine leiomyomas were classified as hypointense, isointense and hyperintense. During ablation, the output energy of the microwave was set at 50 W, and T11a microwave antennas were used. ceMRI was performed within 7 days after PMWA treatment. Non-perfused volume and energy required per unit volume were analysed statistically.
Results:
When unit volume of lesions was ablated, uterine adenomyosis needed more energy than did uterine leiomyomas, and hyperintense uterine leiomyomas needed more energy than did hypointense pattern.
Conclusions:
MRI SI of uterine leiomyomas and uterine adenomyosis can be used to predict PMWA energy.
Advances in knowledge:
The conclusions indicate that MRI SI can be used to perform pre-treatment planning, which will make the treatment more precise.
doi:10.1259/bjr.20130770
PMCID: PMC4112404  PMID: 24947033
22.  Apparent diffusion coefficient measurements to support a diagnosis of intracranial hypotension 
The British Journal of Radiology  2014;87(1040):20140131.
Objective:
Intracranial hypotension (ICH) can be a challenging diagnosis, as cerebrospinal fluid leaks may be difficult to confirm, patients may have other causes for clinical symptoms and imaging findings can be non-specific, particularly in the setting of comorbidities. We investigate the use of brain diffusion measurements [apparent diffusion coefficient (ADC) values] in the assessment of ICH.
Methods:
13 cases of ICH were identified retrospectively based on imaging findings and their clinical histories were compared with 13 control subjects. Regional ADC values and average diffusion constant (Dav) from brain slice ADC histograms were measured.
Results:
ADC values trended higher in all brain regions in patients with ICH than those in control subjects, with statistically significant differences in frontal white matter, mid-brain and deep grey structures. Dav determined by a single-slice ADC histogram was significantly higher in patients with ICH than in the control group (p = 0.008). In two cases followed longitudinally, Dav correlated with the patient's symptoms and decreased towards normal value with blood patch. In one case, decreased Dav correlated with the formation of subdural collections.
Conclusion:
Cerebral oedema as assessed by increased ADC is strongly correlated with ICH (10 of 13 cases). Histographic analysis of ADC values may offer increased accuracy of ADC measurement. ADC value assessment in the determination of ICH may be particularly useful in complex clinical cases, where treatment is followed over time or where gadolinium is not used and meningeal enhancement cannot be assessed.
Advances in knowledge:
This article investigates the use of brain diffusion measurements in the assessment of ICH in the clinical setting.
doi:10.1259/bjr.20140131
PMCID: PMC4112405  PMID: 24896198
23.  Enhanced susceptibility-weighted angiography (ESWAN) of cerebral arteries and veins at 1.5 Tesla 
The British Journal of Radiology  2014;87(1039):20130486.
Objective:
Enhanced susceptibility-weighted angiography (ESWAN) is a three-dimensional (3D) multi-echo gradient-echo sequence which consists of both magnitude and phase images. This study aims to demonstrate the feasibility of ESWAN for the depiction of both cerebral arteries and veins at 1.5 T by comparing with time-of-flight (TOF) MR angiography (MRA) and MR venography (MRV).
Methods:
13 healthy volunteers underwent both ESWAN and 3D-TOF-MRA examinations. Among them, nine volunteers underwent an additional two-dimensional-TOF-MRV examination. With regard to the ESWAN sequence, both maximum intensity projection (MIP) and minimum intensity projection (mIP) images were reconstructed and compared with MIP reconstructions of the TOF MRA and the TOF MRV.
Results:
Concerning the depiction of the constituent segments of the Circle of Willis, as well as A1, A2, A3 (segments of the anterior cerebral artery), M1, M2 (segments of the middle cerebral artery), P1 and P2 (segments of the posterior cerebral artery), the value of the ESWAN MIP was comparable to that of the TOF MRA without regard to visualization of branches, vessel homogeneity and wall irregularities or slight stenosis. ESWAN-mIP visualized more deep cerebral veins than TOF MRV in this study.
Conclusion:
By use of either mIP reconstruction of a long echo data set or MIP reconstruction of a short echo data set, ESWAN allows simultaneous visualization of both cerebral veins and proximal segments of intracerebral arteries at 1.5 T.
Advances in knowledge:
ESWAN acquires multiple images at different echo times corresponding to different T2* weightings, wherein a short echo TOF-MRA data set and a long echo susceptibility-weighted imaging-MRV data set are obtained simultaneously.
doi:10.1259/bjr.20130486
PMCID: PMC4075571  PMID: 24786315
24.  Mammographic and clinicopathological features of triple-negative breast cancer 
The British Journal of Radiology  2014;87(1039):20130496.
Objective:
Triple-negative breast cancer (TNBC) lacks effective treatment and has a poor prognosis. This study assessed mammographic findings and clinicopathological features of TNBC by comparing with non-TNBC in order to improve clinical diagnosis of TNBC.
Methods:
A total of 426 patients with pathologically confirmed breast cancer were retrospectively assigned into two groups, TNBC (n = 54) and non-TNBC (n = 372), and then analysed.
Results:
TNBC frequently showed a high histological grade, presented with a mass (79.6%) and was less frequently associated with focal asymmetric density (11.1%), microcalcifications (5.6%) and distortion (3.7%) on mammography. TNBC mammographic masses were most frequently round/oval (58.1%) or lobular (30.2%) in shape and were less frequently irregular in shape (11.6%). Masses with circumscribed margins were the most frequent (37.2%), with microlobulated (25.6%) and obscured (16.3%) margins being commonly observed, but masses with spiculated margins were rare (9.3%).
Conclusion:
TNBC could have distinct mammographic and clinicopathological features compared with non-TNBC, and thus mammography may be useful in the diagnosis of TNBC.
Advances in knowledge:
This study demonstrated distinct mammographic and clinicopathological features to help in diagnosis of Chinese patients with TNBC.
doi:10.1259/bjr.20130496
PMCID: PMC4075572  PMID: 24734934
25.  Single-photon emission CT using 99mTc-dimercaptosuccinic acid (DMSA) for characterization of suspected renal masses 
The British Journal of Radiology  2014;87(1039):20130547.
Objective:
A retrospective analysis of the clinical utility of 99mTc-dimercaptosuccinic acid (DMSA) single photon emission CT (SPECT) for characterization of suspected renal masses.
Methods:
15 patients who had undergone 99mTc-DMSA SPECT were identified, and 13 patients also had SPECT/CT. 99mTc-DMSA uptake in the renal lesion was characterized semiquantitatively. Other imaging tests, histology and clinical data were available for correlation.
Results:
99mTc-DMSA was not taken up in all five renal masses with histological confirmation of malignancy (uptake 7–19% of normal renal tissue); in two further masses, which were clinically likely to be malignant; and in one indeterminate mass (lack of sufficiently long follow-up). No renal malignancy was identified in any of the seven patients whose renal masses had normal 99mTc-DMSA uptake (41–130%).
Conclusion:
Although caution with regard to applying those results in clinical practice must be advised, owing to the retrospective nature of this report and the small number of patients included, it seems that 99mTc-DMSA SPECT shows a clinically useful diagnostic accuracy for distinguishing true renal masses (which in many cases require surgery) from pseudomasses.
Advances in knowledge:
99mTc-DMSA SPECT is a clinically useful adjunct test for characterization of suspected renal masses.
doi:10.1259/bjr.20130547
PMCID: PMC4075573  PMID: 24831060

Results 1-25 (1274)