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1.  Incidental uterine mass 
The British Journal of Radiology  2009;82(984):1043-1045.
PMCID: PMC3473392  PMID: 19934071
2.  Retroperitoneal ectopic pancreas: imaging findings 
The British Journal of Radiology  2009;82(984):e253-e255.
Ectopic pancreas is relatively uncommon and usually occurs in the stomach or duodenum. Retroperitoneal ectopic pancreas has not previously been documented. We report the case of a 48-year-old man with retroperitoneal ectopic pancreas that imitated bilateral adrenal tumours on ultrasound and MRI. Subsequent CT-guided biopsies confirmed an ectopic pancreas. The lesions remained stable during follow-up for 7 years. In retrospect, the similarity in signal intensities and enhancement pattern between the retroperitoneal masses and the pancreas may have been a clue to the diagnosis of this rare entity.
PMCID: PMC3473376  PMID: 19934067
3.  Assessment of early treatment response after CT-guided radiofrequency ablation of unresectable lung tumours by diffusion-weighted MRI: a pilot study 
The British Journal of Radiology  2009;82(984):989-994.
The aim of this study was to evaluate prospectively the early treatment response after CT-guided radiofrequency ablation (RFA) of unresectable lung tumours by MRI including diffusion-weighted imaging (DWI). The study protocol was approved by the ethics committee of our hospital and signed consent was obtained from each patient. We studied 17 patients with 20 lung lesions (13 men and 4 women; mean age, 69±9.8 years; mean tumour size, 20.8±9.0 mm) who underwent RFA using a LeVeen electrode between November 2006 and January 2008. MRI was performed on a 1.5T unit before and 3 days after ablation. We compared changes in the apparent diffusion coefficient (ADC) on DWI and response evaluation based on subsequent follow-up CT. 14 of the 20 treatment sessions showed no local progression on follow-up CT, whereas 6 treatment sessions showed local progression (range, 3–17 months; mean, 6 months). For the no-progression group, the ADC pre- and post-RFA were 1.15±0.31 × 10−3 mm2 s−1 and 1.49±0.24 × 10−3 mm2 s−1, respectively, while the respective ADC values for those that showed local progression were 1.05±0.27 × 10−3 mm2 s−1 and 1.24±0.20 × 10−3 mm2 s−1. The ADC of the ablated lesion was significantly higher than before the procedure (p<0.05). There was a significant difference in the ADC post-RFA between no-progression and local progression groups (p<0.05). Our prospective pilot study showed that the ADC without local progression was significantly higher than with local progression after RFA, suggesting that the ADC can predict the response to RFA for lung tumours.
PMCID: PMC3473377  PMID: 19470575
4.  Epithelioid angiomyolipoma: imaging appearances 
The British Journal of Radiology  2009;82(984):e249-e252.
Epithelioid angiomyolipoma is a recently described rare variant of renal angiomyolipoma. It can occur in patients with or without tuberous sclerosis, and may potentially be malignant. We report the imaging findings from two cases of epithelioid angiomyolipoma: the first in a patient with tuberous sclerosis complex, arising in a horse-shoe kidney and growing into the inferior vena cava and right atrium; the second in a 62-year-old hypertensive man.
PMCID: PMC3473378  PMID: 19934066
5.  The intravertebral cleft in benign vertebral compression fracture: the diagnostic performance of non-enhanced MRI and fat-suppressed contrast-enhanced MRI 
The British Journal of Radiology  2009;82(984):976-981.
We compared the diagnostic performance of non-enhanced MRI and fat-suppressed contrast-enhanced MRI (CEMRI) in diagnosing intravertebral clefts in benign vertebral compression fractures (VCFs). We retrospectively reviewed 99 consecutive patients who had undergone percutaneous vertebroplasty for VCFs. A cleft was defined as a signal void or hyperintense area on non-enhanced MRI (T1 and T2 weighted imaging) or as a hypointense area within a diffusely enhanced vertebra on CEMRI. A cleft was confirmed as a solid opacification on post-procedural radiographs. The interobserver reliability and MRI diagnostic performance were evaluated. The interobserver reliability of non-enhanced MRI was substantial (k _ 0.698) and the interobserver reliability of CEMRI was almost perfect (k _ 0.836). Post-procedural radiographs showed solid cleft opacification in 32 out of the 99 cases. The sensitivity and specificity of non-enhanced MRI were 0.72 and 0.82 (observer 1) and 0.63 and 0.87 (observer 2), respectively. The sensitivity and specificity of CEMRI were 0.94 and 0.63 (observer 1) and 0.85 and 0.60 (observer 2), respectively. The sensitivity of CEMRI was significantly higher than that of non-enhanced MRI, and the specificity of non-enhanced MRI was higher than that of CEMRI. CEMRI was highly reliable and sensitive, and non-enhanced MRI was specific for intravertebral clefts. Therefore, spine MRIs, including CEMRI, could provide useful information about intravertebral clefts before percutaneous vertebroplasty.
PMCID: PMC3473379  PMID: 19581311
6.  Radiation dose evaluation in 64-slice CT examinations with adult and paediatric anthropomorphic phantoms 
The British Journal of Radiology  2009;82(984):1010-1018.
The objective of this study was to evaluate the organ dose and effective dose to patients undergoing routine adult and paediatric CT examinations with 64-slice CT scanners and to compare the doses with those from 4-, 8- and 16-multislice CT scanners. Patient doses were measured with small (<7 mm wide) silicon photodiode dosemeters (34 in total), which were implanted at various tissue and organ positions within adult and 6-year-old child anthropomorphic phantoms. Output signals from photodiode dosemeters were read on a personal computer, from which organ and effective doses were computed. For the adult phantom, organ doses (for organs within the scan range) and effective doses were 8–35 mGy and 7–18 mSv, respectively, for chest CT, and 12–33 mGy and 10–21 mSv, respectively, for abdominopelvic CT. For the paediatric phantom, organ and effective doses were 4–17 mGy and 3–7 mSv, respectively, for chest CT, and 5–14 mGy and 3–9 mSv, respectively, for abdominopelvic CT. Doses to organs at the boundaries of the scan length were higher for 64-slice CT scanners using large beam widths and/or a large pitch because of the larger extent of over-ranging. The CT dose index (CTDIvol), dose–length product (DLP) and the effective dose values using 64-slice CT for the adult and paediatric phantoms were the same as those obtained using 4-, 8- and 16-slice CT. Conversion factors of DLP to the effective dose by International Commission on Radiological Protection 103 were 0.024 mSv⋅mGy−1⋅cm−1 and 0.019 mSv⋅mGy−1⋅cm−1 for adult chest and abdominopelvic CT scans, respectively.
PMCID: PMC3473380  PMID: 19934069
7.  Dose estimation by chromosome aberration analysis and micronucleus assays in victims accidentally exposed to 60Co radiation 
The British Journal of Radiology  2009;82(984):1027-1032.
The objective of this study was to assess the radiation exposure levels in victims of a 60Co radiation accident using chromosome aberration analysis and the micronucleus assay. Peripheral blood samples were collected from three victims exposed to 60Co 10 days after the accident and were used for the chromosome aberration and micronucleus assays. After in vitro culture of the lymphocytes, the frequencies of dicentric chromosomes and rings (dic+r) and the numbers of cytokinesis blocking micronuclei (CBMN) in the first mitotic division were determined and used to estimate radiation dosimetry. The Poisson distribution of the frequency of dic+r in lymphocytes was used to assess the uniformity of the exposure to 60Co radiation. Based on the frequency of dic+r in lymphocytes, estimates of radiation exposure of the three victims were 5.61 Gy (A), 2.48 Gy (B) and 2.68 Gy (C). The values were estimated based on the frequencies of CBMN, which were 5.45 Gy (A), 2.78 Gy (B) and 2.84 Gy (C). The estimated radiation dosimetry demonstrated a critical role in estimating the radiation dose and facilitating an accurate clinical diagnosis. Furthermore, the frequencies of dir+r in victims A and B deviated significantly from a normal Poisson distribution. Chromosome aberration analysis offers a reliable means for estimating biological exposure to radiation. In the present study, the micronucleus assay demonstrated a high correlation with the chromosome aberration analysis in determining the radiation dosimetry 10 days after radiation exposure.
PMCID: PMC3473381  PMID: 19366736
8.  Abnormally increased uptake of 18F-FDG in the forearm and hand following intra-arterial injection — hot forearm and hot hand signs 
The British Journal of Radiology  2009;82(984):995-999.
The aim of this study is to describe the appearance of intra-arterial administration of 18F-fluorodeoxyglucose (18F-FDG). The effect of this finding on the standard uptake values (SUVs) is also briefly discussed. Three cases of 18F-FDG positron emission tomography (PET) scans, detected over 2 years (2004–2006), with different presentations producing hot forearm and hot hand signs are described. It was shown that intra-arterial injections of 18F-FDG producing “the hot forearm sign” and the hot hand sign” are similar to the glove pattern of uptake noted following intra-arterial administration of technetium-99m methylene diphosphonate. Following intra-arterial injection, uptake of 18F-FDG is accentuated by hypoxia and exercise. A comparison is also made with the pattern of soft-tissue uptake seen following true intravenous injections with similar pre-injection vein enhancement techniques to the intra-arterial injections. Evaluation of the maximum intensity projection (MIP) and transaxial PET/CT fusion images of the arm, forearm and hand helps to confirm the diagnosis. Hands are often not included in PET/CT imaging and therefore cases might be missed. In conclusion, intra-arterial injection of 18F-FDG produces a “hot forearm sign” and “hot hand sign”. Hands are often not included in PET/CT imaging, and therefore the presence of hot forearm sign should suggest further investigation. It should be mentioned in the radiology report, as it may alter the sensitivity and specificity of the SUV value.
PMCID: PMC3473382  PMID: 19470569
9.  The effect of concurrent androgen deprivation and 3D conformal radiotherapy on prostate volume and clinical organ doses during treatment for prostate cancer 
The British Journal of Radiology  2009;82(984):1019-1026.
In this study, we investigated the shrinking effect of concurrent three-dimensional conformal radiotherapy (3D-CRT) and androgen deprivation (AD) on prostate volume, and its possible impact on the dose received by the rectum and bladder during the course of 3D-CRT. The difference between the prostatic volumes determined on pre-treatment planning CT (PL-CT) and post-treatment CT (PT-CT) following a 3D-CRT course was assessed in 52 patients with localised prostate carcinoma. The changes in mean prostate volume when compared with PL-CT and PT-CT-based measurements were assessed. The pre- and post-treatment mean prostate volumes for the whole study population were 49.7 cm3 and 41.0 cm3 (p _ 0.02), respectively. The study cohort was divided into two groups depending on the duration of neoadjuvant androgen deprivation (NAD): 23 patients (44.7%) were designated as “short NAD” (≤3 months; SNAD) and the remaining 29 (55.3%) as “long NAD” (>3 months; LNAD). Patients on SNAD experienced a significantly greater reduction in prostate volume compared with those on LNAD (14.1% vs 5.1%; p _ 0.03). A significant increase in rectum V40–60 values in PT-CT compared with PL-CT was demonstrated. LNAD patients had significantly higher rectal V50–70 values at PT-CT compared with the SNAD group. There was a significant decline in V30–V75 bladder values in PT-CT compared with PL-CT in the SNAD group. In conclusion, a higher prostate volume reduction during 3D-CRT was demonstrated when RT planning was performed within 3 months of NAD. However, this reduction and daily organ motion may lead to an unpredictable increase in rectal doses.
PMCID: PMC3473383  PMID: 19581310
10.  Book reviews 
The British Journal of Radiology  2009;82(984):1046-1048.
PMCID: PMC3473384
11.  Comparison between the image quality of multisegment and halfscan reconstructions of non-invasive CT coronary angiography 
The British Journal of Radiology  2009;82(984):969-975.
The purpose of this study was to compare the image quality of multisegment and halfscan reconstructions of multislice computed tomography (MSCT) coronary angiography. 126 patients with suspected coronary artery disease and uninfluenced heart rates were examined by 16-slice CT before they underwent invasive coronary angiography. Multisegment and halfscan reconstructions were performed in all patients, and subjective image quality, overall vessel length, vessel length free of motion artefacts and contrast-to-noise ratios (CNRs) were compared for both techniques. The diagnostic accuracy of both approaches was compared with the results of invasive coronary angiography. Overall image quality scores of multisegment reconstruction were superior to those of halfscan reconstruction (13.3±2.1 vs 11.9±2.9; p<0.001). Multisegment reconstruction depicted significantly longer overall coronary vessel lengths (p<0.001) and larger vessel proportions free of motion artefacts in three of the four main coronary arteries. CNRs in the left main, left anterior descending and left circumflex coronary arteries were significantly higher when multisegment reconstruction was used (p<0.001). Overall accuracy was higher for multisegment reconstruction compared with halfscan reconstruction (87% vs 62%). In conclusion, multisegment reconstruction significantly improves image quality and diagnostic accuracy of MSCT coronary angiography compared with standard halfscan reconstruction, resulting in vessel lengths depicted free of motion comparable to those of CT performed in patients given β-blockers to lower heart rates.
PMCID: PMC3473385  PMID: 19505967
12.  Radiology trainees in the UK and Ireland: academic background, publication rates and research plans 
The British Journal of Radiology  2009;82(984):1033.
To assess the level of achievement of current trainees, we investigated the academic qualifications, publication rates and future research plans of 240 radiology trainees in the UK and Ireland. All radiology trainees in the UK and Ireland were surveyed by a questionnaire enquiring about academic record and career ambitions. Our study shows that the level of academic achievement of radiology trainees is high, and provides interesting information concerning the current group of radiology trainees in these regions. It will be of interest both to radiology trainers and to doctors hoping to pursue a career in radiology. It also demonstrates that a potential recruitment crisis in academic radiology exists.
PMCID: PMC3473386  PMID: 19934070
13.  Glue ablation of a late-presentation urinary fistula after partial nephrectomy 
The British Journal of Radiology  2009;82(984):e246-e248.
Urinary fistula is an acknowledged complication of partial nephrectomy. We describe a case of a urinary fistula that failed to respond to conventional treatment and the subsequent use of percutaneous Hystoacryl® glue to achieve its resolution.
PMCID: PMC3473387  PMID: 19934065
14.  Multidetector row CT diagnosis of an infected right atrial thrombus following repeated dialysis catheter placement 
The British Journal of Radiology  2009;82(984):e240-e242.
Right atrial thrombus formation is a known complication of dialysis catheter placements. We describe the case of a 61-year-old woman with end-stage renal failure who presented with gram-negative septicaemia. A gas-containing filling defect was noted incidentally in the right atrium during a CT scan of the abdomen and pelvis, indicative of a thrombus infected by a gas-forming organism. The finding correlated with a positive blood culture of Klebsiella pneumoniae and the two-dimensional echocardiography finding of an echogenic atrial thrombus.
PMCID: PMC3473388  PMID: 19934063
15.  Pancreatic mucinous cystadenoma communicating with the main pancreatic duct on MRI 
The British Journal of Radiology  2009;82(984):e243-e245.
We report a case of a mucinous cystadenoma of the pancreas communicating with the main pancreatic duct. To our knowledge, this is the first case in which a communication between the mucinous cystadenoma and the main pancreatic duct could be demonstrated by MRI.
PMCID: PMC3473389  PMID: 19934064
16.  Müllerian duct anomalies: from diagnosis to intervention 
The British Journal of Radiology  2009;82(984):1034-1042.
The purpose of this study was to review the embryology, classification, imaging features and treatment options of Müllerian duct anomalies. The three embryological phases will be described and the appearance of the seven classes of Müllerian duct anomalies will be illustrated using hysterosalpingography, ultrasound and MRI. This exhibit will also review the treatment options, including interventional therapy. The role of imaging is to help detect, classify and guide surgical management. At this time, MRI is the modality of choice because of its high accuracy in detecting and accurately characterising Müllerian duct anomalies. In conclusion, radiologists should be familiar with the imaging features of the seven classes of Müllerian duct anomalies, as the appropriate course of treatment relies upon the correct diagnosis and categorisation of each anomaly.
PMCID: PMC3473390  PMID: 19433480
17.  Medico-legal claims against English radiologists: 1995–2006 
The British Journal of Radiology  2009;82(984):982-988.
A list of claims against radiologists from 1995–2006 was obtained from the NHS Litigation Authority. It shows a total of 440 claims. The largest number of claims (199) related to delayed or missed diagnoses of cancer, and 73 claims related to breast radiology. There is a trend for a mild increase in the number of claims each year. 30 claims were made after a false-positive diagnosis of cancer. Just under £8.5 million has so far been paid in damages, with a further £5 million in legal fees. A claim for multiple missed diagnoses of breast cancer led to a pay-out of £464 000 (£673 000 after legal fees); the largest sum awarded following a delay in the diagnosis of an individual cancer was £300 000. The subtle legal distinction between error and negligence is reviewed here. The reason why breast radiologists are more likely to be sued than any other type of British radiologist is also discussed, along with the implications for UK radiological practice, particularly in light of the recent Chief Medical Officer's report on revalidation. A method is proposed that may protect radiologists from allegations of clinical negligence in the future.
PMCID: PMC3473391  PMID: 19470570
18.  Index to Authors 2009 
The British Journal of Radiology  2009;82(984):1049-1055.
PMCID: PMC3473393
19.  High-precision radiotherapy for craniospinal irradiation: evaluation of three-dimensional conformal radiotherapy, intensity-modulated radiation therapy and helical TomoTherapy 
The British Journal of Radiology  2009;82(984):1000-1009.
This study aimed to establish the feasibility of intensity-modulated radiation therapy (IMRT) in craniospinal irradiation (CSI) using conventional linear accelerator (IMRT_LA) and compare it dosimetrically with helical TomoTherapy (IMRT_Tomo) and three-dimensional conformal radiotherapy (3DCRT). CT datasets of four previously treated patients with medulloblastoma were used to generate 3DCRT, IMRT_LA and IMRT_Tomo plans. A CSI dose of 35 Gy was prescribed to the planning target volume (PTV). IMRT_LA plans for tall patients were generated using an intensity feathering technique. All plans were compared dosimetrically using standardised parameters. The mean volume of each PTV receiving at least 95% of the prescribed dose (V95%) was >98% for all plans. All plans resulted in a comparable dose homogeneity index (DHI) for PTV_brain. For PTV_spine, IMRT_Tomo achieved the highest mean DHI of 0.96, compared with 0.91 for IMRT_LA and 0.84 for 3DCRT. The best dose conformity index was achieved by IMRT_Tomo for PTV_brain (0.96) and IMRT_LA for PTV_spine (0.83). The IMRT_Tomo plan was superior in terms of reduction of the maximum, mean and integral doses to almost all organs at risk (OARs). It also reduced the volume of each OAR irradiated to various dose levels, except for the lowest dose volume. The beam-on time was significantly longer in IMRT_Tomo. In conclusion, IMRT_Tomo for CSI is technically easier and potentially dosimetrically favourable compared with IMRT_LA and 3DCRT. IMRT for CSI can also be realised on a conventional linear accelerator even for spinal lengths exceeding maximum allowable field sizes. The longer beam-on time in IMRT_Tomo raises concerns about intrafraction motion and whole-body integral doses.
PMCID: PMC3473394  PMID: 19581313
20.  Capsular retraction: an uncommon imaging finding in hepatic inflammatory pseudotumour 
The British Journal of Radiology  2009;82(984):e256-e260.
Capsular retraction is an infrequent but characteristic feature of malignant liver lesions such as hepatic metastases and intrahepatic cholangiocarcinoma. Rarely, this finding may be observed in association with benign lesions, such as atypical haemangiomas. Capsular retraction has not previously been reported in association with hepatic inflammatory pseudotumour (IPT). Hepatic IPT is an uncommon benign hepatic lesion with a good clinical prognosis. In this report, we discuss the case of a 48-year-old woman with capsular retraction secondary to multifocal hepatic inflammatory IPTs.
PMCID: PMC3473395  PMID: 19934068
21.  Accuracy of dual-source CT in the characterisation of non-calcified plaque: use of a colour-coded analysis compared with virtual histology intravascular ultrasound 
The British Journal of Radiology  2009;82(982):805-812.
Non-invasive assessment of plaque volume and composition is important for risk stratification and long-term studies of plaque stabilisation. Our aim was to evaluate dual-source computed tomography (DSCT) and colour-coded analysis in the quantification and classification of coronary atheroma. DSCT and virtual histology intravascular ultrasound (IVUS-VH) were prospectively performed in 14 patients. 22 lesions were compared in terms of plaque volume, maximal per cent vessel stenosis and percentages of fatty, fibrous or calcified components. Plaque characterisation was performed with software that automatically segments luminal or outer vessel boundaries and uses CT attenuation for a colour-coded plaque analysis. Good correlation was found for per cent vessel stenosis in DSCT (53 ± 13%) and IVUS (51 ± 14%; r2 = 0.70). Mean volumes for entire plaque and non-calcified atheroma were 68.5 ± 33 mm3 and 56.7 ± 30 mm3, respectively, in DSCT and 60.8 ± 29 mm3 and 55.8 ± 26 mm3, respectively, in IVUS. Mean percentages of fatty, fibrous or calcified components were 28.2 ± 6%, 53.2 ± 9% and 18.7 ± 13%, respectively, in DSCT and 29.9 ± 5%, 55.3 ± 12% and 14.4 ± 9%, respectively, in IVUS-VH. Significant overestimation was present for the entire plaque and the volume of calcified plaque (p = 0.03; p = 0.0004). Although good correlation with IVUS was obtained for the entire plaque (r2 = 0.76) and non-calcified plaque volume (r2 = 0.84), correlation proved very poor and insignificant for percentage plaque composition. Interclass correlation coefficients for non-calcified plaque volume and percentages of fatty, fibrous or calcified components were 0.99, 0.99, 0.95 and 0.98, respectively, and intraclass coefficients were 0.98, 0.93, 0.98 and 0.99, respectively. We found that using Hounsfield unit-based analysis, DSCT allows for accurate quantification of non-calcified plaque. Although percentage plaque composition proves highly reproducible, it is not correlated with IVUS-VH.
PMCID: PMC3292046  PMID: 19332517

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