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1.  Deoxyribonucleic acid damage-associated biomarkers of ionising radiation: current status and future relevance for radiology and radiotherapy 
The British Journal of Radiology  2013;86(1027):20130173.
Diagnostic and therapeutic radiation technology has developed dramatically in recent years, and its use has increased significantly, bringing clinical benefit. The use of diagnostic radiology has become widespread in modern society, particularly in paediatrics where the clinical benefit needs to be balanced with the risk of leukaemia and brain cancer increasing after exposure to low doses of radiation. With improving long-term survival rates of radiotherapy patients and the ever-increasing use of diagnostic and interventional radiology procedures, concern has risen over the long-term risks and side effects from such treatments. Biomarker development in radiology and radiotherapy has progressed significantly in recent years to investigate the effects of such use and optimise treatment. Recent biomarker development has focused on improving the limitations of established techniques by the use of automation, increasing sensitivity and developing novel biomarkers capable of quicker results. The effect of low-dose exposure (0–100 mGy) used in radiology, which is increasingly linked to cancer incidences, is being investigated, as some recent research challenges the linear-no-threshold model. Radiotherapy biomarkers are focused on identifying radiosensitive patients, determining the treatment-associated risk and allowing for a tailored and more successful treatment of cancer patients. For biomarkers in any of these areas to be successfully developed, stringent criteria must be applied in techniques and analysis of data to reduce variation among reports and allow data sets to be accurately compared. Newly developed biomarkers can then be used in combination with the established techniques to better understand and quantify the individual biological response to exposures associated with radiology tests and to personalise treatment plans for patients.
doi:10.1259/bjr.20130173
PMCID: PMC3700735  PMID: 23659923
2.  C-arm CT for histomorphometric evaluation of lumbar spine trabecular microarchitecture: a study on anorexia nervosa patients 
The British Journal of Radiology  2013;86(1027):20120451.
Bone histomorphometry measurements require high spatial resolution that may not be feasible using multidetector CT (MDCT). This study evaluated the trabecular microarchitecture of lumbar spine using MDCT and C-arm CT in a series of young adult patients with anorexia nervosa (AN). 11 young females with AN underwent MDCT (anisotropic resolution with a slice thickness of ∼626 μm) and C-arm CT (isotropic resolution of ∼200 µm). Standard histomorphometric parameters the of L1 vertebral body, namely the apparent trabecular bone volume fraction (BV/TV), trabecular thickness (TbTh), trabecular number (TbN) and trabecular separation (TbSp), were analysed using MicroView software (GE Healthcare, Piscataway, NJ). Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry. Trabecular parameters derived from MDCT and C-arm CT were compared, and their association with BMD parameters was evaluated. Histomorphometric parameters derived from C-arm CT, namely TbTh, TbN and TbSp, were significantly different from the corresponding MDCT parameters. There were no significant correlations between C-arm CT-derived parameters and the corresponding MDCT-derived parameters. C-arm CT-derived parameters were significantly (p<0.001) correlated with anteroposterior L1 spine BMD and Z-scores: TbTh (r=0.723, r=0.744, respectively), TbN (r=−0.720, r=−0.712, respectively) and TbSp (r=0.656, r=0.648, respectively). BV/TV, derived from C-arm CT, was significantly associated with body mass index (r=0.636) and ideal body weight (r=0.730) (p<0.05). These associations were not present in MDCT-derived parameters. This study suggests that the spatial resolution offered by C-arm CT more accurately captures the histomorphometric parameters of trabecular morphology than MDCT in patients with AN.
doi:10.1259/bjr.20120451
PMCID: PMC3922178  PMID: 23640801
3.  Acute pulmonary injury: high-resolution CT and histopathological spectrum 
The British Journal of Radiology  2013;86(1027):20120614.
Acute lung injury usually causes hypoxaemic respiratory failure and acute respiratory distress syndrome (ARDS). Although diffuse alveolar damage is the hallmark of ARDS, other histopathological patterns of injury, such as acute and fibrinoid organising pneumonia, can be associated with acute respiratory failure. Acute eosinophilic pneumonia can also cause acute hypoxaemic respiratory failure and mimic ARDS. This pictorial essay reviews the high-resolution CT findings of acute lung injury and the correlative histopathological findings.
doi:10.1259/bjr.20120614
PMCID: PMC3922179  PMID: 23659926
4.  Assessment of the spine with CT and MRI prior to interspinous/interlaminar spinal procedures: a pictorial review 
The British Journal of Radiology  2013;86(1026):20130066.
Imaging of the spine is increasingly available, whether as dedicated spine examinations or as studies that include the spine in the images obtained (e.g. CT abdomen). This pictorial review discusses imaging of the spine with CT and MRI and how prior review of this imaging can be helpful with potentially difficult spinal procedures. Pathologies illustrated include osteoarthritis, scoliosis, inflammatory spondyloarthropathies and post-operative spines.
doi:10.1259/bjr.20130066
PMCID: PMC3664985  PMID: 23568363
5.  CT colonography for investigation of patients with symptoms potentially suggestive of colorectal cancer: a review of the UK SIGGAR trials 
The British Journal of Radiology  2013;86(1026):20130137.
This paper argues for the use of CT colonography (CTC) to investigate patients with symptoms potentially suggestive of colorectal cancer. It describes the rationale for the UK Special Interest Group in Gastrointestinal and Abdominal Radiology (SIGGAR) randomised controlled trials that compared CTC with barium enema (BE) or colonoscopy for diagnosis of colorectal cancer or large polyps in symptomatic patients. Diagnostic outcomes from the trials are detailed for both intra- and extracolonic disease, along with psychological reactions of patients to the tests, and cost-effectiveness of the different diagnostic strategies. The author concludes that BE should be replaced by CTC immediately and that CTC is a sensitive, acceptable and equally cost-effective alternative to colonoscopy in patients in whom colonoscopy is contraindicated or undesirable.
doi:10.1259/bjr.20130137
PMCID: PMC3664986  PMID: 23568360
6.  Improving radiotherapy quality assurance in clinical trials: assessment of target volume delineation of the pre-accrual benchmark case 
The British Journal of Radiology  2013;86(1024):20120398.
As the complexity of radiotherapy (RT) trials increases, issues surrounding target volume delineation will become more important. Some form of outlining assessment prior to trial entry is increasingly being mandated in UK RT trials. This document produced by the Outlining and Imaging Subgroup (OISG) of the National Cancer Research Institute will address methods to reduce interobserver variation in clinical trials and how to conduct an assessment of outlining through a pre-accrual benchmark case. We review currently available methods of describing the variation and identify areas where further work is needed. The OISG would encourage ongoing discussion with chief investigators in order to provide advice on individual aspects of benchmark case assessment for current and future trials.
doi:10.1259/bjr.20120398
PMCID: PMC3635785  PMID: 23392188
7.  High-intensity focused ultrasound: advances in technology and experimental trials support enhanced utility of focused ultrasound surgery in oncology 
The British Journal of Radiology  2013;86(1024):20130044.
High-intensity focused ultrasound (HIFU) is a rapidly maturing technology with diverse clinical applications. In the field of oncology, the use of HIFU to non-invasively cause tissue necrosis in a defined target, a technique known as focused ultrasound surgery (FUS), has considerable potential for tumour ablation. In this article, we outline the development and underlying principles of HIFU, overview the limitations and commercially available equipment for FUS, then summarise some of the recent technological advances and experimental clinical trials that we predict will have a positive impact on extending the role of FUS in cancer therapy.
doi:10.1259/bjr.20130044
PMCID: PMC3635791  PMID: 23403455
8.  Breast cancer subtypes: response to radiotherapy and potential radiosensitisation 
The British Journal of Radiology  2013;86(1023):20120601.
Radiotherapy (RT) is of critical importance in the locoregional management of early breast cancer. Over 50% of patients receive RT at some time during the treatment of their disease, equating to over 500 000 patients worldwide receiving RT each year. Unfortunately, not all patients derive therapeutic benefit and some breast cancers are resistant to treatment, as evidenced by distant metastatic spread and local recurrence. Prediction of individual responses to RT may allow a stratified approach to this treatment permitting those patients with radioresistant tumours to receive higher doses of RT (total and/or tumour cavity boost doses) and/or radiosensitising agents to optimise treatment. Also, for those patients unlikely to respond at all, it would prevent harmful side effects occurring for no therapeutic gain. More selective targeting would better direct National Health Service resources, ease the burden on heavily used treatment RT machines and reduce the economic cost of cancer treatment. Unfortunately, there are no robust and validated biomarkers for predicting RT outcome. We review the available literature to determine whether classification of breast cancers according to their molecular profile may be used to predict successful response to, or increased morbidity from, RT. Class-specific biomarkers for targeting by radiosensitising agents are also discussed.
doi:10.1259/bjr.20120601
PMCID: PMC3608055  PMID: 23392193
9.  Quantitative parametric MRI of articular cartilage: a review of progress and open challenges 
The British Journal of Radiology  2013;86(1023):20120163.
With increasing life expectancies and the desire to maintain active lifestyles well into old age, the impact of the debilitating disease osteoarthritis (OA) and its burden on healthcare services is mounting. Emerging regenerative therapies could deliver significant advances in the effective treatment of OA but rely upon the ability to identify the initial signs of tissue damage and will also benefit from quantitative assessment of tissue repair in vivo. Continued development in the field of quantitative MRI in recent years has seen the emergence of techniques able to probe the earliest biochemical changes linked with the onset of OA. Quantitative MRI measurements including T1, T2 and T1ρ relaxometry, diffusion weighted imaging and magnetisation transfer have been studied and linked to the macromolecular structure of cartilage. Delayed gadolinium-enhanced MRI of cartilage, sodium MRI and glycosaminoglycan chemical exchange saturation transfer techniques are sensitive to depletion of cartilage glycosaminoglycans and may allow detection of the earliest stages of OA. We review these current and emerging techniques for the diagnosis of early OA, evaluate the progress that has been made towards their implementation in the clinic and identify future challenges in the field.
doi:10.1259/bjr.20120163
PMCID: PMC3608060  PMID: 23407427
10.  Occupational radiation dose to eyes from endoscopic retrograde cholangiopancreatography procedures in light of the revised eye lens dose limit from the International Commission on Radiological Protection 
The British Journal of Radiology  2013;86(1022):20120289.
Objective:
Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure that combines the use of X-ray fluoroscopy and endoscopy for examination of the bile duct. Published data on ERCP doses are limited, including staff eye dose from ERCP. Occupational eye doses are of particular interest now as the International Commission on Radiological Protection (ICRP) has recommended a reduction in the dose limit to the lens of the eye. The aim of this study was to measure occupational eye doses obtained from ERCP procedures.
Methods:
A new eye lens dosemeter (EYE-D™, Radcard, Krakow, Poland) was used to measure the ERCP eye dose, Hp(3), at two endoscopy departments in Ireland. A review of radiation protection practice at the two facilities was also carried out.
Results:
The mean equivalent dose to the lens of the eye of a gastroenterologist is 0.01 mSv per ERCP procedure with an undercouch X-ray tube and 0.09 mSv per ERCP procedure with an overcouch X-ray tube. Staff eye dose normalised to patient kerma area product is also presented.
Conclusion:
Staff eye doses in ERCP have the potential to exceed the revised ICRP limit of 20 mSv per annum when an overcouch X-ray tube is used. The EYE-D dosemeter was found to be a convenient method for measuring lens dose. Eye doses in areas outside of radiology departments should be kept under review, particularly in light of the new ICRP eye dose limit.
Advances in knowledge:
Occupational eye lens doses from ERCP procedures have been established using a new commercially available dedicated Hp(3) dosemeter.
doi:10.1259/bjr.20120289
PMCID: PMC3608047  PMID: 23385992
11.  Imaging of scleroma in the head and neck 
The British Journal of Radiology  2012;85(1020):1551-1555.
We review the appearance of scleroma in the head and neck on imaging. Scleroma is a chronic granulomatous disease that primarily affects the nasal cavity, but the pharynx and larynx may also be involved. On imaging, nasal scleroma appears as bilateral or unilateral expanded homogeneous nasal masses that may exhibit hyperintense signal on T1 weighted images. Pharyngeal scleroma commonly narrows the pharyngeal lumen and may involve the soft and hard palate. Imaging is essential to detect the extent of subglottic stenosis in patients with laryngeal scleroma. Rarely, scleroma may involve the orbit or the middle ear. Imaging is essential for the early diagnosis of scleroma and for differentiating it from other granulomatous and neoplastic lesions. Also, imaging is important for treatment planning and follow-up of patients after therapy.
doi:10.1259/bjr/15189057
PMCID: PMC3611713  PMID: 22898154
12.  Battlefield radiology 
The British Journal of Radiology  2012;85(1020):1556-1565.
With the increasing tempo of military conflicts in the last decade, much has been learnt about imaging battlefield casualties in the acute setting. Ultrasound in the form of focused abdominal sonography in trauma (FAST) has proven invaluable in emergency triage of patients for immediate surgery. Multidetector CT allows accurate determination of battlefield trauma injuries. It permits the surgeons and anaesthetists to plan their interventions more thoroughly and to be made aware of clinically occult injuries. There are common injury patterns associated with blast injury, gunshot wounds and blunt trauma. While this body of knowledge is most applicable to the battlefield, there are parallels with peacetime radiology, particularly in terrorist attacks and industrial accidents. This pictorial review is based on the experiences of a UK radiologist deployed in Afghanistan in 2010.
doi:10.1259/bjr/33335273
PMCID: PMC3611714  PMID: 22806621
13.  The many faces of posterior reversible encephalopathy syndrome 
The British Journal of Radiology  2012;85(1020):1566-1575.
The classic imaging findings of posterior reversible encephalopathy syndrome (PRES) are of bilateral parietal and occipital subcortical vasogenic oedema, and are well established in the literature. As experience with PRES grows, varied and atypical presentations are being increasingly described. This pictorial review illustrates the variable presentations of PRES, including cases with atypical imaging findings. We illustrate cases of PRES with varying distributions of vasogenic oedema as well as cases with atypical imaging findings, such as variations of haemorrhage and restricted diffusion. Atypical imaging findings should not dissuade the diagnosis of PRES in the appropriate clinical situation, and knowledge of the varied appearance and atypical findings of PRES allows the radiologist to make this diagnosis.
doi:10.1259/bjr/25273221
PMCID: PMC3611715  PMID: 23175479
14.  Radiation-induced cancer: a modern view 
The British Journal of Radiology  2012;85(1020):e1166-e1173.
Diagnostic medical radiation has been the most rapidly increasing component of population background radiation exposure in Western countries over the past decade. This trend is set to increase as CT scanning is readily available with burgeoning use in everyday clinical practice. Consequently, the issue of cancer induction from the doses received during diagnostic medical exposures is highly relevant. In this review we explain current understanding of potential cancer induction at low doses of sparsely ionising radiation. For cancers that may be induced at low doses, a mechanistic description of radiation-induced cancer is discussed, which, in combination with extrapolation of data based on population cohort studies, provides the basis of the currently accepted linear no-threshold model. We explore the assumptions made in deriving risk estimates, the controversies surrounding the linear no-threshold model and the potential future challenges facing clinicians and policy-makers with regards to diagnostic medical radiation and cancer risk, most notably the uncertainties regarding deriving risk estimates from epidemiological data at low doses.
doi:10.1259/bjr/25026140
PMCID: PMC3611719  PMID: 23175483
15.  Takayasu arteritis: imaging spectrum at multidetector CT angiography 
The British Journal of Radiology  2012;85(1020):e1282-e1292.
Takayasu arteritis is a chronic, idiopathic, inflammatory disease that primarily affects large vessels, such as the aorta and its major branches and the pulmonary and coronary arteries. The non-specific inflammation of involved vessels usually leads to concentric wall thickening, fibrosis and thrombus formation. Diseased arteries become stenotic or occluded, undergo vascular remodelling or develop aneurysms. According to the involvement of arteries, six types of Takayasu arteritis are documented. The purpose of this pictorial review is to illustrate the various multidetector CT angiography appearances of Takayasu arteritis and to discuss the differential diagnosis.
doi:10.1259/bjr/25536451
PMCID: PMC3611735  PMID: 23175494
16.  Pre-operative CT angiography and three-dimensional image post processing for deep inferior epigastric perforator flap breast reconstructive surgery 
The British Journal of Radiology  2012;85(1020):e1293-e1297.
Autologous breast reconstructive surgery with deep inferior epigastric artery (DIEA) perforator flaps has become the mainstay for breast reconstructive surgery. CT angiography and three-dimensional image post processing can depict the number, size, course and location of the DIEA perforating arteries for the pre-operative selection of the best artery to use for the tissue flap. Knowledge of the location and selection of the optimal perforating artery shortens operative times and decreases patient morbidity.
doi:10.1259/bjr/30590223
PMCID: PMC3611736  PMID: 23175495
17.  Skeletal muscle disease: patterns of MRI appearances 
The British Journal of Radiology  2012;85(1020):e1298-e1308.
Although the presumptive diagnosis of skeletal muscle disease (myopathy) may be made on the basis of clinical–radiological correlation in many cases, muscle biopsy remains the cornerstone of diagnosis. Myopathy is suspected when patients complain that the involved muscle is painful and tender, when they experience difficulty performing tasks that require muscle strength or when they develop various systemic manifestations. Because the cause of musculoskeletal pain may be difficult to determine clinically in many cases, MRI is increasingly utilised to assess the anatomical location, extent and severity of several pathological conditions affecting muscle. Infectious, inflammatory, traumatic, neurological, neoplastic and iatrogenic conditions can cause abnormal signal intensity on MRI. Although diverse, some diseases have similar MRI appearances, whereas others present distinct patterns of signal intensity abnormality. In general, alterations in muscle signal intensity fall into one of three cardinal patterns: muscle oedema, fatty infiltration and mass lesion. Because some of the muscular disorders may require medical or surgical treatment, correct diagnosis is essential. In this regard, MRI features, when correlated with clinical and laboratory findings as well as findings from other methods such as electromyography, may facilitate correct diagnosis. This article will review and illustrate the spectrum of MRI appearances in several primary and systemic disorders affecting muscle, both common and uncommon. The aim of this article is to provide radiologists and clinicians with a collective, yet succinct and useful, guide to a wide array of myopathies.
doi:10.1259/bjr/14063641
PMCID: PMC3611737  PMID: 22960244
18.  Ultrasound elastography for musculoskeletal applications 
The British Journal of Radiology  2012;85(1019):1435-1445.
Ultrasound elastography (EUS) is a method to assess the mechanical properties of tissue, by applying stress and detecting tissue displacement using ultrasound. There are several EUS techniques used in clinical practice; strain (compression) EUS is the most common technique that allows real-time visualisation of the elastographic map on the screen. There is increasing evidence that EUS can be used to measure the mechanical properties of musculoskeletal tissue in clinical practice, with the future potential for early diagnosis to both guide and monitor therapy. This review describes the various EUS techniques available for clinical use, presents the published evidence on musculoskeletal applications of EUS and discusses the technical issues, limitations and future perspectives of this method in the assessment of the musculoskeletal system.
doi:10.1259/bjr/93042867
PMCID: PMC3500785  PMID: 23091287
19.  Pulmonary arterial hypertension: an imaging review comparing MR pulmonary angiography and perfusion with multidetector CT angiography 
The British Journal of Radiology  2012;85(1019):1446-1456.
Pulmonary hypertension (PH) is a progressive disease that leads to substantial morbidity and eventual death. Pulmonary multidetector CT angiography (MDCTA), pulmonary MR angiography (MRA) and MR-derived pulmonary perfusion (MRPP) imaging are non-invasive imaging techniques for the differential diagnosis of PH. MDCTA is considered the gold standard for the diagnosis of pulmonary embolism, one of the most common causes of PH. MRA and MRPP are promising techniques that do not require the use of ionising radiation or iodinated contrast material, and can be useful for patients for whom such material cannot be used. This review compares the imaging aspects of pulmonary MRA and 64-row MDCTA in patients with chronic thromboembolic or idiopathic PH.
doi:10.1259/bjr/28150079
PMCID: PMC3500786  PMID: 22932061
20.  Solid pseudopapillary tumours of the pancreas: spectrum of imaging findings with histopathological correlation 
The British Journal of Radiology  2012;85(1019):e1140-e1144.
Solid pseudopapillary tumour (SPT) is an uncommon cystic exocrine pancreatic neoplasm. The typical patient is a female in the third decade of life presenting with pain and/or palpable mass. Classic imaging characteristics include large size, mixed solid and cystic nature, encapsulation and haemorrhage. A pancreatic mass with these features in a young adult female should raise suspicion for an SPT. Although typically a non-aggressive neoplasm with surgery curative in most cases, SPT may exhibit more aggressive features such as local invasion, metastases or recurrence in up to 20% of cases.
doi:10.1259/bjr/20695686
PMCID: PMC3500814  PMID: 22514105
21.  Differentiation of myocardial scar from potential pitfalls and artefacts in delayed enhancement MRI 
The British Journal of Radiology  2012;85(1019):e1145-e1154.
Delayed enhancement cardiac magnetic resonance (DE-CMR) imaging is used increasingly to identify and quantify focal myocardial scar. Our objective is to describe factors used in the interpretation of DE-CMR images and to highlight potential pitfalls and artefacts that mimic myocardial scar. Inversion recovery gradient recalled echo sequence is commonly accepted as the standard of reference for DE-CMR. There are also alternative sequences that can be performed in a single breath-hold or with free breathing. Radiologists need to be aware of factors affecting image quality, and potential pitfalls and artefacts that may generate focal hyperintense areas that mimic myocardial scar.
doi:10.1259/bjr/25893477
PMCID: PMC3500815  PMID: 23091294
22.  Ultrasound detection of colonic polyps: perspective 
The British Journal of Radiology  2012;85(1019):e1155-e1164.
Colorectal cancer is often preventable if the precursor adenoma is detected and removed. Although ultrasound is clearly not one of the widely accepted screening techniques, this non-invasive and radiation-free modality is also capable of detecting colonic polyps, both benign and malignant. Such colon lesions may be encountered when not expected, usually during general abdominal sonography. The discovery of large colonic polyps is important and can potentially help reduce the incidence of a common cancer, whereas detection of a malignant polyp at an early stage may result in a curative intervention. This pictorial review highlights our experience of sonographic detection of colonic polyps in 43 adult patients encountered at our institutions over a 2-year period. 4 out of 50 discovered polyps were found to be malignant lesions, 3 polyps were hyperplastic, 1 polyp was a hamartomatous polyp and the rest were benign adenomas. The smallest of the detected polyps was 1.3 cm in diameter, the largest one was 4.0 cm (mean 1.7 cm; median 1.6 cm). In each case, polyps were discovered during a routine abdominal or pelvic examination, particularly when scanning was supplemented by a brief focused sonographic inspection of the colon with a 6–10 MHz linear transducer. In this paper, we illustrate the key sonographic features of different types of commonly encountered colonic polyps in the hope of encouraging more observers to detect these lesions, which may be subtle.
doi:10.1259/bjr/60593124
PMCID: PMC3500816  PMID: 22806624
23.  Utility of positron emission tomography/CT in the evaluation of small bowel pathology 
The British Journal of Radiology  2012;85(1017):1211-1221.
We describe the management principles and different roles of positron emission tomography (PET)/CT in the evaluation of patients with small bowel tumours (adenocarcinoma, gastrointestinal stromal tumour, lymphoma, metastases) from initial staging, monitoring response to treatment, to detection of recurrent disease. We also discuss the various non-malignant aetiologies of small bowel fludeoxyglucose (FDG) PET uptake, and other pitfalls in FDG PET/CT interpretation. Awareness of the imaging appearances of small bowel tumours, patterns of disease spread and potential PET/CT interpretation pitfalls are of paramount importance to optimise diagnostic accuracy.
doi:10.1259/bjr/64534573
PMCID: PMC3487051  PMID: 22919004
24.  An update on radioactive release and exposures after the Fukushima Dai-ichi nuclear disaster 
The British Journal of Radiology  2012;85(1017):1222-1225.
On 11 March 2011, the Richter scale 0.9-magnitude Tokohu earthquake and tsunami struck the northeast coast of Japan, resulting in widespread injury and loss of life. Compounding this tragic loss of life, a series of equipment and structural failures at the Fukushima Dai-ichi nuclear power plant (FDNP) resulted in the release of many volatile radioisotopes into the atmosphere. In this update, we detail currently available evidence about the nature of immediate radioactive exposure to FDNP workers and the general population. We contrast the nature of the radioactive exposure at FDNP with that which occurred at the Chernobyl power plant 25 years previously. Prediction of the exact health effects related to the FDNP release is difficult at present and this disaster provides the scientific community with a challenge to help those involved and to continue research that will improve our understanding of the potential complications of radionuclide fallout.
doi:10.1259/bjr/27017231
PMCID: PMC3487052  PMID: 22919005
25.  The reversed halo sign: update and differential diagnosis 
The British Journal of Radiology  2012;85(1017):1226-1235.
The reversed halo sign is characterised by a central ground-glass opacity surrounded by denser air–space consolidation in the shape of a crescent or a ring. It was first described on high-resolution CT as being specific for cryptogenic organising pneumonia. Since then, the reversed halo sign has been reported in association with a wide range of pulmonary diseases, including invasive pulmonary fungal infections, paracoccidioidomycosis, pneumocystis pneumonia, tuberculosis, community-acquired pneumonia, lymphomatoid granulomatosis, Wegener granulomatosis, lipoid pneumonia and sarcoidosis. It is also seen in pulmonary neoplasms and infarction, and following radiation therapy and radiofrequency ablation of pulmonary malignancies. In this article, we present the spectrum of neoplastic and non-neoplastic diseases that may show the reversed halo sign and offer helpful clues for assisting in the differential diagnosis. By integrating the patient's clinical history with the presence of the reversed halo sign and other accompanying radiological findings, the radiologist should be able to narrow the differential diagnosis substantially, and may be able to provide a presumptive final diagnosis, which may obviate the need for biopsy in selected cases, especially in the immunosuppressed population.
doi:10.1259/bjr/54532316
PMCID: PMC3487053  PMID: 22553298

Results 1-25 (75)