Paediatric acquired pathological vertebral collapse.

Vertebral collapse is a significant event in the paediatric patient with a real potential for associated deformity and morbidity. While in adults the causes tend towards the malignant, particularly metastatic and metabolic disease, the paediatric population demonstrates a different range of diagnoses. This article reviews the typical imaging findings of the more common underlying acquired pathological causes of vertebral collapse in children, including Langerhans cell histiocytosis, chronic recurrent multifocal osteomyelitis, osteogenesis imperfecta. Other causes include pyogenic osteomyelitis and tuberculosis and neoplastic lesions, either primary, metastatic or of haematological origin.

Diagnosing pelvic osteomyelitis in patients with pressure ulcers: a systematic review comparing bone histology with alternative diagnostic modalities.

Accurate diagnosis of osteomyelitis underlying pressure ulcers is essential, as overdiagnosis exposes patients to unnecessary and prolonged antibiotic therapy, while failure to diagnose prevents successful treatment. Histopathological examination of bone biopsy specimens is the diagnostic gold standard. Bone biopsy can be an invasive procedure, and, for this reason, other diagnostic modalities are commonly used. However, their accuracy is questioned in literature. This systematic review aims to assess accuracy of various modalities (clinical, microbiological and radiological) for the diagnosis of pelvic osteomyelitis in patients with pressure ulcers as compared to the gold standard. A systematic literature search was conducted in July 2019 using the MEDLINE (Medical Literature Analysis and Retrieval System - MEDLARS - Online) and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases. The search terms were "decubitus ulcer", "pressure ulcer", "pressure sore", "bedsore" and "osteomyelitis". The inclusion criteria were original full-text articles in English comparing the results of bone histology with those of other diagnostic modalities in adult patients with pelvic pressure ulcers. Six articles were included in the systematic review. Clinical diagnosis was found to be neither specific nor sensitive. Microbiological examination, and in particular cultures of bone biopsy specimens, displayed high sensitivity but low specificity, likely reflecting contamination. Radiological imaging in the form of X-ray and CT (computed tomography) scans displayed high specificity but low sensitivity. MRI (magnetic resonance imaging), bone scanning and indium-labelled scintigraphy displayed high sensitivity but low specificity. Our systematic review did not find any diagnostic method (clinical, microbiological or radiological) to be reliable in the diagnosis of pelvic osteomyelitis associated with pressure ulcers as compared to bone histology.

Effect of PET Image Reconstruction Techniques on Unexpected Aorta Uptake

Objectives: To determine if unexpected aorta uptake seen in some patients is influenced by popular modern reconstruction algorithms using semi-quantitative and qualitative analysis. Methods: Twenty-five consecutive patients without suspected vascular disease were selected for 18F-FDG positron emission tomography/ computed tomography (PET/CT) scanning and images of the aorta were created using iterative reconstruction (IT), IT + time of flight (TOF), IT + TOF + point spread function correction (referred collectively as UHD) with and without metal artefact reduction (MAR) algorithms. An experienced radiologist created aorta and blood pool (BP) regions of interests then copied these to all reconstructions for accurate positioning before recording target aorta standardized-uptake-values (SUVmax) and background BP SUVmean. Furthermore, target-to-background ratio (TBRmax) was defined by aorta SUVmax-to-BP SUVmean ratio for more analysis. Results: For aorta SUVmax with IT, IT + TOF, UHD, UHD + MAR reconstructions the mean ± standard deviation recorded were 2.15±0.43, 2.25±0.51, 2.25±0.45 and 2.09±0.4, respectively. Values for BP SUVmean were 1.61±0.31, 1.58±0.28, 1.58±0.28 and 1.47±0.25, respectively. Likewise, for TBRmax these were 1.35±0.19, 1.43±0.21, 1.43±0.19, 1.43±0.18, respectively. ANOVA analysis revealed no significant differences for aorta SUVmax (F(0.86) p=0.46), BP SUVmean (F(1.22) p=0.31) or TBRmax (F(0.99) p=0.4). However, the qualitative visual analysis revealed significant differences between IT + TOF with UHD (p=0.02) or UHD + MAR (p=0.02). Conclusion: Reconstruction algorithm effect on aorta SUVmax or BP SUVmean or TBRmax was not statistically significant. However, qualitative visual analysis showed significant differences between IT + TOF as compared with UHD or UHD + MAR reconstructions. Harmonization of techniques with a larger patient cohort is recommended in future clinical trials.

Metastatic renal cell carcinoma presenting with mediastinal eggshell calcification.

An 81-year-old South Asian man normally resident in the UK presented with night sweats for over 2 months on a background of weight loss of 4 kg in 6 months. His medical history was significant for metastatic renal cell carcinoma treated 5 years previously with cytoreductive nephrectomy and adjuvant chemotherapy. Following an abnormal chest radiograph showing an ill-defined right paratracheal mass, a CT scan showed eggshell calcification (circumferential calcification) of enlarged low right paratracheal lymph nodes. An endobronchial ultrasound-guided transbronchial needle aspiration of an involved large paratracheal lymph node showed cytology consistent with metastatic renal cell carcinoma.

Synchronous Orbital and Gastrointestinal Metastases from Breast Cancer: A Case Report and Review of Literature.

Breast cancer is the most common malignancy among women and is a significant cause of morbidity and mortality worldwide. With the advent of improved imaging techniques and screening programmes, only a small proportion of women present with metastatic disease. Metastases involving the gastrointestinal (GI) tract and orbit are rare occurrences. We describe the case of a woman with simultaneous GI and orbital metastases from breast cancer who initially presented with abdominal pain and blurred vision and also summarise a review of the literature.

Nuclear medicine in the management of thyroid disease.

Thyroid disease management has changed little over the last 60 years and recent work suggests that the older approach remains the most effective. Treatment of benign hyperthyroidism has shown that functional imaging is essentially linked to therapy and uptake of iodine-131 ((131)I) cannot be assumed but should be tested by pre-imaging with radio-isotopes as 10% of patients may not be suitable for (131)I therapy and 1% may have a co-existent cancer. Differentiated thyroid cancer remains unique in that it is almost alone among common solid tumors in that it is routinely cured even if cannot all be removed by surgery. This is achieved in the majority of patients by a treatment introduced in the 1940s and does not involve the use of chemotherapy drugs but a simple and cheap isotope preparation; (131)I. However, in some differentiated thyroid cancers there is no accumulation of (131)I and we know this is due to the loss, or downregulation of the sodium iodide symporter gene. This has led to the development of several strategies to overcome this loss/downregulation, for example with the use of lithium or retinoids or gene treatment. However, all these approaches have yet to be proved in a randomized controlled trial. Advances in imaging especially using (18)F-fluorodeoxy-glucose PET has enabled patients with thyroid cancer to be more accurately imaged, resulting in a greater chance of cure through surgery and external-beam radiotherapy, especially if uptake of (131)I is poor. Another approach has been the idea of using radiolabeled somatostatin analogs, which are able to demonstrate uptake in the tumor and, more recently, beta-emitting isotopes have been used for therapy when other options have failed. Therefore, whilst the treatment of differentiated thyroid cancer is, to some degree, 60 years old, new methods have been proposed and are now being tested in this disease.