Atrial masses on multidetector computed tomography.

Incidental atrial filling defect on multidetector computed tomography (MDCT) is an important radiological finding, as irrespective of its nature, it may nevertheless be of considerable importance for correct diagnostic workup. MDCT is not the first-line imaging technique of choice for characterization of intra-atrial masses, but is a commonly performed examination and hence offers the opportunity to pick up hitherto unsuspected atrial lesions. This review highlights key CT imaging features that help to differentiate normal variants and artefacts from a true abnormality, distinguish benign from malignant intra-atrial tumours, and characterize non-neoplastic atrial masses.

MRI and CT appearances of cardiac tumours in adults.

Primary cardiac tumours are rare, and metastases to the heart are much more frequent. Myxoma is the commonest benign primary tumour and sarcomas account for the majority of malignant lesions. Clinical manifestations are diverse, non-specific, and governed by the location, size, and aggressiveness. Imaging plays a central role in their evaluation, and familiarity with characteristic features is essential to generate a meaningful differential diagnosis. Cardiac magnetic resonance imaging (MRI) has become the reference technique for evaluation of a suspected cardiac mass. Computed tomography (CT) provides complementary information and, with the advent of electrocardiographic gating, has become a powerful tool in its own right for cardiac morphological assessment. This paper reviews the MRI and CT features of primary and secondary cardiac malignancy. Important differential considerations and potential diagnostic pitfalls are also highlighted.

Atrial septal defects: magnetic resonance and computed tomography appearances.

Atrial septal defects are associated with significant morbidity and mortality. Echocardiography is the first-line imaging modality, but MR and CT imaging can provide complimentary information, especially for the detection of associated anomalies and for assessing changes in the pulmonary vasculature. The aim of this pictorial essay is to review the spectrum of atrial septal defects, with particular reference to their cross-sectional imaging appearances and issues pertaining to management.

MDCT features of cardiothoracic sources of stroke.

Multidetector computed tomography (MDCT) is widely used in the assessment of cardiothoracic disease and provides high-resolution images of the heart, great vessels, and lungs. A range of cardiothoracic conditions can precipitate stroke, including intracardiac thrombus, right-to-left shunts, and diseases of the thoracic aorta. Many of these conditions may be identified on non-electrocardiogram (ECG)-gated studies, but the advent of high temporal resolution ECG-gated MDCT provides superior anatomical delineation. Radiologists should be familiar with the pathogenesis and CT features of cardiothoracic conditions that can precipitate stroke as their early identification to enables appropriate management and prognostic decisions.

Chronic left ventricular failure: the role of imaging in diagnosis and planning of conventional and novel therapies.

Heart failure is the leading cause of hospitalisation in the UK, and its prevalence is expected to increase further in the future due partly to an aging population. Although pharmacological agents remain the mainstay of therapy, an increasing number of surgical and novel minimally invasive interventions have been developed for the treatment of both acute and chronic heart failure. Imaging is essential for diagnosis, guiding therapeutic options, and monitoring therapy and its complications. As a result, radiologists should be familiar with the pathogenesis, treatment options, and imaging-related issues pertaining to the management of these patients.

Can breast MRI help in the management of women with breast cancer treated by neoadjuvant chemotherapy?

Contrast-enhanced (CE) MRI was used to monitor breast cancer response to neoadjuvant chemotherapy. Patients underwent CE MRI before and after therapy, together with conventional assessment methods (CAM). CE MRI was carried out at 1.5 T in the coronal plain with 3D sequences before and after bolus injection. An expert panel determined chemotherapy response using both CE MRI and CAM. Histopathological response in the surgical specimen was then used to determine the sensitivity and specificity of CE MRI and CAM. In total, 67 patients with 69 breast cancers were studied (mean age of 46 years). Tumour characteristics showed a high-risk tumour population: median size 49 mm: histopathological grade 3 (55%): oestrogen receptor (ER) negative (48%). Histopathological response was as follows: - complete pathological response (pCR) 17%; partial response (pPR) 68%; no response (NR) 15%. Sensitivity of CAM for pCR or pPR was 98% (CI 91-100%) and specificity was 50% (CI 19-81%). CE MRI sensitivity was 100% (CI 94-100%), and specificity was 80% (CI 44-97%). The absolute agreement between assessment methods and histopathology was marginally higher for CE MRI than CAM (81 vs 68%; P=0.09). In 71%, CE MRI increased diagnostic knowledge, although in 20% it was judged confusing or incorrect. The 2nd MRI study significantly increased diagnostic confidence, and in 19% could have changed the treatment plan. CE MRI persistently underestimated minimal residual disease. In conclusion, CE MRI of breast cancer proved more reliable for predicting histopathological response to neoadjuvant chemotherapy than conventional assessment methods.

Fluorodeoxyglucose positron emission tomography in clinical oncology: the referrer's perspective.

From January 2000 to April 2002 a prospective audit based on a questionnaire was carried out concerning the attitudes and viewpoints of clinicians referring patients to fluorodeoxyglucose positron emission tomography (FDG PET) scanning. A standard and structured audit form was posted to each referring doctor with the formal clinical report issued by the nuclear medicine consultant. Three hundred and thirty evaluable forms were analysed, a return rate of approximately 22%, from a total of 1500 PET patients studied during this period. FDG PET scanning was deemed by the referring physician to have altered the staging of cancer patients in 39% of all cases. Twenty-five per cent of patients were upstaged with FDG PET and 14% of patients downstaged. Patient management was changed in 39% of cases whilst a change in treatment occurred in 10% of cases. The reported FDG PET study was judged as being helpful in over 75% of all cases. These data further support evidence of the increasing role of FDG studies in the investigation of patients with cancer.

Nuclear medicine in primary breast cancer imaging.

The application of nuclear medicine techniques to study patients with breast cancer has recently raised its profile, particularly in the investigation 'indeterminate mammographic lesions'. This review briefly points out some of the difficulties encountered with other more conventional imaging modalities and describes the radionuclide techniques most frequently employed in the investigation of those patients with breast cancer. Both planar and single photon emission tomography methods are discussed including the use of monoclonal antibodies, perfusion ligands, receptor binding hormones and other specific radiotracers, non-specific tumour markers, as well as deoxyglucose and other amino acids labelled with positron emitting radionuclides.