Radiology Bulletin: June 2008

Wednesday 18 June 2008

BMJ Learning module on abdominal X-rays

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Do you sometimes struggle to interpret abdominal x-rays?
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British Journal of Radiology 2008 ; VOL 81 ; PART 965

The Hounsfield Review Series
Harrison , R . M . ; Pilling , D . W .
Page: 361
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Cancer risks from diagnostic radiology
Hall , E . J . ; Brenner , D . J .
Page: 362-378
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Implementing image - guided radiotherapy in the UK : plans for a co - ordinated UK research and development strategy
Price , P . ; Heap , G .
Page: 379-382
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The radiological reporting of lumbar Scheuermann's disease : an unnecessary source of confusion amongst clinicians and patients
Summers , B . N . ; Singh , J . P . ; Manns , R . A .
Page: 383-385
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Hyperattenuating bone marrow abnormalities in myeloma patients using whole - body non - enhanced low - dose MDCT : correlation with haematological parameters
Horger , M . ; Pereira , P . ; Claussen , C . D . ; Kanz , L . ; Vonthein , R . ; Denecke , B .
Page: 386-396
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Superiority of intensity - modulated radiotherapy over three - dimensional conformal radiotherapy combined with brachytherapy in nasopharyngeal carcinoma : a planning study
Taheri - Kadkhoda , Z . ; Pettersson , N . ; Bjork - Eriksson , T . ; Johansson , K . - A
Page: 397-405
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Comparison between margin - growing algorithms in radiotherapy software environments
Smith , D . W . ; Morgan , A . M . ; Pooler , A . M . ; Thwaites , D . I .
Page: 406-412
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The effects of ^ 1 ^ 8 ^ 8rhenium - filled balloon dilation following bare stent placement in a rabbit oesophageal model
Shin , J . - H . ; Lee , S . K . ; Song , H . - Y . ; Kim , J . - S . ; Choe , H . et al
Page: 413-421
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A regional audit of kilovoltage X - rays - a single centre approach
Burton , N . L . A . ; Brimelow , J . ; Welsh , A . D .
Page: 422-426
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Imaging of the petrous apex : a pictorial review
Connor , S . E . J . ; Leung , R . ; Natas , S .
Page: 427-435
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Do patients with fractures see their digital radiographs and does it help ?
Quraishi , N . A . ; Sahu , M . ; Robinson , A . H . N .
Page: 436
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An acute abdomen - with a twist
Eason , D . ; Chandramohan , S .
Page: 437-439
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AJR 2008 ; VOL 190 ; PART 6

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Lurie, Jon D. ; Tosteson, Anna N. ; Tosteson, Tor D. ; Carragee, Eugene ; Carrino, John et al
Reliability of Readings of Magnetic Resonance Imaging Features of Lumbar Spinal Stenosis
Spine. 33(14):1605-1610, June 15, 2008.
Abstract
Study Design. A reliability assessment of standardized magnetic resonance imaging (MRI) interpretations and measurements.Objective. To determine the intra- and inter-reader reliability of MRI features of lumbar spinal stenosis (SPS), including severity of central, subarticular, and foraminal stenoses, grading of nerve root impingement, and measurements of cross-sectional area of the spinal canal and thecal sac.Summary of Background Data. MRI is commonly used to assess patients with spinal stenosis. Although a number of studies have evaluated the reliability of certain MRI characteristics, comprehensive evaluation of the reliability of MRI readings in spinal stenosis is lacking.Methods. Fifty-eight randomly selected MR images from patients with SPS enrolled in the Spine Patient Outcomes Research Trial were evaluated. Qualitative ratings of imaging features were performed according to defined criteria by 4 independent readers (3 radiologists and 1 orthopedic surgeon). A sample of 20 MRIs was reevaluated by each reader at least 1 month later. Weighted [kappa] statistics were used to characterize intra- and inter-reader reliability for qualitative rating data. Separate quantitative measurements were performed by 2 other radiologists. Intraclass correlation coefficients and summaries of measurement error were used to characterize reliability for quantitative measurements.Results. Intra-reader reliability was higher than inter-reader reliability for all features. Inter-reader reliability in assessing central stenosis was substantial, with an overall [kappa] of 0.73 (95% CI 0.69-0.77). Foraminal stenosis and nerve root impingement showed moderate to substantial agreement with overall [kappa] of 0.58 (95% CI 0.53-0.63) and 0.51 (95% CI 0.42-0.59), respectively. Subarticular zone stenosis yielded the poorest agreement (overall [kappa] 0.49; 95% CI 0.42-0.55) and showed marked variability in agreement between reader pairs. Quantitative measures showed inter-reader intraclass correlation coefficients ranging from 0.58 to 0.90. The mean absolute difference between readers in measured thecal sac area was 128 mm2 (13%).Conclusion. The imaging characteristics of spinal stenosis assessed in this study showed moderate to substantial reliability; future studies should assess whether these findings have prognostic significance in SPS patients.

Neurology. 70(22, Parts 1 and 2): May 27, 2008

Link to journal
Wermer, Marieke J.H. ; Koffijberg, Hendrik ; van der Schaaf, Irene C.
Effectiveness and costs of screening for aneurysms every 5 years after subarachnoid hemorrhage
p. 2053-2062
Abstract
Background: Patients who survive after subarachnoid hemorrhage (SAH) are at risk for a recurrence despite successful treatment of the ruptured aneurysm and may therefore benefit from screening for new aneurysms.Methods: We screened 610 patients with SAH with CT angiography 2-18 years after clipping of the aneurysms. Results of screening were used as input for a Markov decision model. We compared the expected number of recurrent hemorrhages, life expectancy, quality-adjusted life-years (QALYs), and costs associated with the strategies "screening every 5 years" and "no screening."Results: Screening individuals with previous SAH prevented almost half of the recurrences, slightly increased life expectancy (from 21.06 to 21.08 years), but reduced QALYs (from 12.18 to 12.04) and increased costs (from $2,750 to $4,165 per patient). Screening was cost-saving without increasing QALYs in patients with a more than twofold risk above baseline of both aneurysm formation and rupture and it was cost-saving while increasing QALYs if both risks were at least 4.5 times higher. In patients with reduced quality of life because of fear for a recurrence, screening increased QALYs at a maximum cost of $17,422 per QALY.Conclusions: In general, screening patients with previous subarachnoid hemorrhage (SAH) cannot be recommended. Screening can save costs and increase quality-adjusted life-years (QALYs) in patients with a relatively high risk of both aneurysm formation and rupture, and increases QALYs at acceptable costs in patients with fear for a recurrence. More data are needed on risk factors for aneurysm formation and rupture in patients with previous SAH and on management of fear for a recurrence to identify patients who can benefit from screening.

Kipps, C M. ; Nestor, P J. ; Dawson, C E. ; Mitchell, J ; Hodges, J R.
Measuring progression in frontotemporal dementia: Implications for therapeutic interventions.
p. 2046-2052
Abstract
Background: There is a need for instruments which can measure progression of disease in frontotemporal dementia (FTD), particularly with respect to the assessment of potential therapeutic agents.Methods: The Cambridge Early Onset Dementia Clinic database was reviewed for all prospectively enrolled cases of FTD with documented scores on the Mini-Mental State Examination (MMSE) or Addenbrooke's Cognitive Examination (ACE) on at least two occasions. We identified 50 cases fulfilling these criteria: pathologic confirmation was present in 11 of 16 patients who had died, 12 of the remainder had imaging abnormalities on their initial scans, and 22 had structural scans no different from controls. We compared these groups to a cohort with early AD (n = 25) and healthy controls (n = 10).Results: There was clear cognitive decline (measured by the MMSE and ACE) in patients who had died, and those with documented atrophy on initial MRI scan. In contrast, patients with FTD with normal scans showed no change in cognitive scores over a much longer interval, and serial ACE measurements paralleled those of controls. Power calculations showed that the inclusion of these patients with FTD would significantly increase the number of cases needed in any therapeutic trial.Conclusion: Addenbrooke's Cognitive Examination is a simple monitoring tool which can detect progression of disease in frontotemporal dementia over a 1- to 2-year interval without the need for serial imaging. We estimated that a clinical trial that enrolled subjects with abnormal MR scans would require 135 subjects per group to detect a small effect, and 35 for a medium effect.

Kwee, R M.; van Oostenbrugge, R J. , PhD; Hofstra, L ; Teule, G J. ; van Engelshoven, J et al Identifying vulnerable carotid plaques by noninvasive imaging
p. 2401-2409, June 10, 2008.
Abstract
Stroke results in considerable morbidity and mortality. Prevention is therefore of particular importance. On the basis of large clinical trials, carotid endarterectomy (CEA) is performed in selected patient groups to prevent stroke. Patient symptomatology and degree of carotid stenosis are the main clinical grounds to perform CEA. However, many individual patients undergo surgery with its attendant risks without taking advantage of it, whereas in others CEA is probably incorrectly withheld. There is therefore an urgent need for new adjuncts to identify high-risk subgroups of patients who particularly benefit from potentially hazardous interventions. Multiple noninvasive imaging modalities have shown their potential to differentiate high-risk, vulnerable carotid plaques from stable plaques. The ultimate goal is to implement one or a combination of these imaging modalities in daily clinical practice. This review gives an up-to-date overview of the clinical potential of these imaging modalities in identifying patients with carotid atherosclerosis who are at high risk for developing stroke. Advantages and limitations of each imaging technique are outlined. Additionally, recommendations for future research are presented.GLOSSARY: CEA = carotid endarterectomy; CCA = common carotid artery; GSM = gray-scale medium; ICA = internal carotid artery; IJV = internal jugular vein; MDCT = multidetector-row CT; MES = microembolic signal; RR = relative risk; TCD = transcranial Doppler; TFE = turbo field echo; TSE = turbo spin echo; USPIO = ultrasmall particles of iron oxide.

Kang, Suk Y. ; Kim, Jong S.
Anterior cerebral artery infarction: Stroke mechanism and clinical-imaging study in 100 patients.
p. 2386-2393, June 10, 2008.
Abstract
Background: Stroke mechanisms and clinical features of anterior cerebral artery (ACA) territory infarction have rarely been investigated using MRI.Objectives: To verify stroke mechanisms and to make clinical imaging correlation.Methods: Clinical, MRI, and angiographic findings of 100 consecutive patients with ACA infarction were studied.Results: Motor dysfunction (n = 91) was the most common symptom, and severe motor dysfunction was related to supplementary motor area/paracentral lobule involvement (p = 0.016). Hypobulia/apathy (n = 43) was related to involvement of fontal pole (p = 0.002), corpus callosum/cingulate gyrus (p = 0.003), and superior frontal gyrus (p < n =" 30)" n =" 25)" p =" 0.035)." n =" 20)," n =" 20)," n =" 12)," n =" 9)." p =" 0.077)" p =" 0.016)">

BMC Medical Imaging 2008, 8:9 (23 May 2008

Research article Automatic volumetry on MR brain images can support diagnostic decision makingHeckemann RA, Hammers A, Rueckert D, Aviv RI, Harvey CJ, Hajnal JV
BMC Medical Imaging 2008, 8:9 (23 May 2008)[Abstract] [Provisional PDF] [PubMed]

Stroke - online articles May 2008

Link to journal
Burgess, Richard E. ; Warach, Steven ; Schaewe, Timothy J. et al
Development and Validation of a Simple Conversion Model for Comparison of Intracerebral Hemorrhage Volumes Measured on CT and Gradient Recalled Echo MRI.
Stroke.
Publish Ahead of Print, published online before print, 15 May 2008
Abstract
Background and Purpose-: Gradient recalled echo MRI (GRE) has been shown to be as accurate as CT for the detection of acute intracerebral hemorrhage (ICH). However, because of the differences in the signal parameter being detected, apparent hemorrhage size is expected to vary by imaging modality, with GRE providing larger volumes attributable to susceptibility effects.Methods-: Image data from patients participating in 3 ICH studies were retrospectively reviewed. Patients with acute ICH were included if (1) concurrent MRI and CT were performed within 72 hours of symptom onset, and (2) each modality was performed within 240 minutes of each other. ICH volumes were calculated using a semiautomated image analysis program. The least squares method was used to develop a conversion equation based on a linear regression of GRE volume on CT volume.Results-: Thirty-six patients met inclusion criteria. MRI was performed first in 18, CT first in 18. Mean hemorrhage volume was 25.2cc (range 0.1 to 83.9cc) on CT and 32.7cc (range 0.1 to 98.7cc) measured on GRE. A linear relationship defined by CT Volume=GRE Volume*0.8 (Spearman's correlation coefficient=0.992, P<0.001) volume="0.8*GRE" r="0.83," r="0.80," ci="0.81" ci="0.70">

Mandell, Daniel M. ; Han, Jay S. ; Poublanc, Julien ; Crawley, Adrian P. et al
Mapping Cerebrovascular Reactivity Using Blood Oxygen Level-Dependent MRI in Patients With Arterial Steno-occlusive Disease: Comparison With Arterial Spin Labeling MRI.
Status Publish Ahead of Print, published online before print, 1 May 2008
Abstract Background and Purpose-: Blood oxygen level-dependent MRI (BOLD MRI) of hypercapnia-induced changes in cerebral blood flow is an emerging technique for mapping cerebrovascular reactivity (CVR). BOLD MRI signal reflects cerebral blood flow, but also depends on cerebral blood volume, cerebral metabolic rate, arterial oxygenation, and hematocrit. The purpose of this study was to determine whether, in patients with stenoocclusive disease, the BOLD MRI signal response to hypercapnia is directly related to changes in cerebral blood flow.Methods-: Thirty-eight patients with steno-occlusive disease underwent mapping of CVR by both BOLD MRI and arterial spin labeling MRI. The latter technique was used as a reference standard for measurement of cerebral blood flow changes.Results-: Hemispheric CVR measured by BOLD MRI was significantly correlated with that measured by arterial spin labeling MRI for both gray matter (R=0.83, P<0.0001) r="0.80," ci="0.81" ci="0.70">
Citation 8. Accession Number 00007670-900000000-98761. Author Freund, Wolfgang MD; Kassubek, Jan MD; Aschoff, Andrik J. MD; Huber, Roman MD; Institution From the Department of Diagnostic and Interventional Radiology (W.F., A.J.A.), University Hospitals, Ulm, Germany; and the Department of Neurology (J.K., R.H.), University of Ulm, Germany. Title MRI-Based Separation of Congenital and Acquired Vertebrobasilar Artery Anomalies in Ischemic Stroke of the Posterior Circulation.[Letter] Source Stroke. Status Publish Ahead of Print, published online before print, 5 June 2008 Abstract Background and Purpose-: Stroke MRI protocols provide useful information about underlying vessel pathologies in the anterior circulation by means of intracranial time-of-flight angiography. However, these protocols mostly fail in the posterior circulation to differentiate between congenital variants and secondary thrombosis. Therefore, a high-resolution anatomic True Fast Imaging in Steady State Precession sequence, added to a commonly used stroke imaging protocol, was evaluated.Methods-: MRIs of all emergency admissions to the stroke unit over 2 months were analyzed. Variations in the posterior circulation as displayed by time-of-flight and by the True Fast Imaging in Steady State Precession sequence, respectively, were graded by 2 readers blinded to the diagnosis.Results-: In the time-of-flight angiography, 50% of patients presented with distinctive vertebrobasilar alterations. Half of these were judged as high-grade anomalies, of which the True Fast Imaging in Steady State Precession sequence identified 25% as hypoplasia. In 40% of all patients with posterior ischemia, the True Fast Imaging in Steady State Precession sequence confirmed an acquired occlusion of the vertebrobasilar arteries.Conclusions-: The addition of an anatomic (True Fast Imaging in Steady State Precession) to a functional sequence (time-of-flight) in stroke MRI protocols enables the differentiation between artery occlusions and hypoplastic variants of the vertebral arteries.

Laryngoscope May 2008

Link to journal
Abboud, Bassam; Sleilaty, Ghassan; Rabaa, Lara; Daher, Ronald et al
Ultrasonography: Highly Accuracy Technique for Preoperative Localization of Parathyroid Adenoma
Laryngoscope.
Publish Ahead of Print, POST AUTHOR CORRECTIONS, 9 May 2008
Abstract
Objectives/Hypothesis: This study evaluates the accuracy of ultrasonography in guided unilateral parathyroidectomy to treat primary hyperparathyroidism.Study Design: Retrospective study.Methods: Two hundred fifty-three patients with primary hyperparathyroidism underwent preoperative ultrasonography. Two groups were defined. Group 1 included the patients in whom the preoperative cervical ultrasound localized one abnormal parathyroid gland; these patients underwent unilateral surgical exploration of the neck under local anesthesia. Group 2 included the patients who had a bilateral neck exploration under general anesthesia when the preoperative examination was equivocal or failed to localize the lesion, when concomitant thyroid pathology indicated thyroidectomy, and when justified by the surgical findings.Results: Sensitivity and positive predictive value of ultrasonography in detecting abnormal parathyroid gland were 96% and 98%, respectively. Cervical ultrasound correctly identified, 96% and 85% of abnormal glands in groups 1 and 2, respectively. The presence of thyroid nodular disease did not affect ultrasonographic accuracy. Sonographic examination decreased the operative time of parathyroidectomy to an average of 15 minutes. Mediastinal and retroesophageal localizations of abnormal parathyroid gl and adversely affected the accuracy of the ultrasound. No cervical hematoma was noted. Transient recurrent laryngeal nerve palsy occurred in four patients. Twenty-three patients required postoperative calcium supplementation for 2 to 4 months, and all were normocalcemic at follow-up.Conclusions: Cervical ultrasound is a reliable preoperative exploration allowing parathyroidectomy via unilateral approach under local anesthesia.

Zald, Philip B. ; Hamilton, Bronwyn E. ; Larsen, Michael L. ; Cohen, James I.

The Role of Computed Tomography for Localization of Parathyroid Adenomas.
Laryngoscope.
Publish Ahead of Print, POST AUTHOR CORRECTIONS, 2 June 2008
Abstract
Objective/Hypothesis: The purpose of this study was to evaluate the use of computed tomography (CT) for localization of parathyroid adenomas (PA) when first-line imaging is indeterminate.Study Design: Retrospective case series.Methods: A search of operating room and radiology records identified 223 surgical explorations for primary hyperparathyroidism. Adenoma locations on CT, ultrasound, and nuclear scintigraphy were correlated with an independent review of operative records.Results: The presence of adenoma in the correct side and quadrant of the neck was predicted by CT in 89% and 77% of studies, respectively. When first-line studies were indeterminate, the positive predictive value of CT for localization of PA to the correct side and quadrant of the neck was 87% and 69%, respectively.Conclusions: When first-line localization studies are indeterminate in patients with primary hyperparathyroidism, CT is a valuable, rapid, and widely available imaging modality that can be used to localize PA.

Radiology Bulletin

Wednesday 18 June 2008

BMJ Learning module on abdominal X-rays

British Journal of Radiology 2008 ; VOL 81 ; PART 965

AJR 2008 ; VOL 190 ; PART 6

Neurology. 70(22, Parts 1 and 2): May 27, 2008

BMC Medical Imaging 2008, 8:9 (23 May 2008

Stroke - online articles May 2008

Laryngoscope May 2008

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