Complete response of mantle cell lymphoma with central nervous system involvement at diagnosis with acalabrutinib - Case report.

Central nervous system (CNS) involvement by mantle cell lymphoma (MCL) is rare and portends a poor prognosis. We describe the first patient to have a complete response with front-line treatment with single-agent acalabrutinib for MCL CNS.

2-deoxy-2[18F]fluoro-D-glucose positron emission tomography-computed tomography in rheumatological diseases.

2-deoxy-2[18F]fluoro-D-glucose (FDG) PET-CT has revolutionized oncological imaging. The cellular processes that make cancer cells visible on FDG PET-CT also occur in a number of inflammatory cells. Exploiting this phenomenon has led to a growth of evidence supporting the use of FDG PET-CT in a wide range of infective and inflammatory diseases. Rheumatological diseases can affect multiple sites within the musculoskeletal system alongside multi-organ extra-articular disease manifestations. Inflammation is central to these diseases, making FDG PET-CT a logical choice. In this review article we describe the various applications of FDG PET-CT in rheumatological diseases using illustrative examples to highlight the beneficial role of FDG PET-CT in each case.

A case-control evaluation of pulmonary and extrapulmonary findings of incidental asymptomatic COVID-19 infection on FDG PET-CT.

OBJECTIVES: To describe the findings of incidental asymptomatic COVID-19 infection on FDG PET-CT using a case-control design. METHODS: Incidental pulmonary findings suspicious of asymptomatic COVID-19 infection on FDG PET-CT were classified as a confirmed (positive RT-PCR test) or suspected case (no/negative RT-PCR test). Control cases were identified using a 4:1 control:case ratio. Pulmonary findings were re-categorised by two reporters using the BSTI classification. SUV metrics in ground glass opacification (GGO)/consolidation (where present), background lung, intrathoracic nodes, liver, spleen and bone marrow were measured. RESULTS: 7/9 confirmed and 11/15 suspected cases (COVID-19 group) were re-categorised as BSTI 1 (classic/probable COVID-19) or BSTI 2 (indeterminate COVID-19); 0/96 control cases were categorised as BSTI 1. Agreement between two reporters using the BSTI classification was almost perfect (weighted κ = 0.94). SUVmax GGO/consolidation (5.1 vs 2.2; p < 0.0001) and target-to-background ratio, normalised to liver SUVmean (2.4 vs 1.0; p < 0.0001) were higher in the BSTI 1 & 2 group vs BSTI 3 (non-COVID-19) cases. SUVmax GGO/consolidation discriminated between the BSTI 1 & 2 group vs BSTI 3 (non-COVID-19) cases with high accuracy (AUC = 0.93). SUV metrics were higher (p < 0.05) in the COVID-19 group vs control cases in the lungs, intrathoracic nodes and spleen. CONCLUSION: Asymptomatic COVID-19 infection on FDG PET-CT is characterised by bilateral areas of FDG avid (intensity > x2 liver SUVmean) GGO/consolidation and can be identified with high interobserver agreement using the BSTI classification. There is generalised background inflammation within the lungs, intrathoracic nodes and spleen. ADVANCES IN KNOWLEDGE: Incidental asymptomatic COVID-19 infection on FDG PET-CT, characterised by bilateral areas of ground glass opacification and consolidation, can be identified with high reproducibility using the BSTI classification. The intensity of associated FDG uptake (>x2 liver SUVmean) provides high discriminative ability in differentiating such cases from pulmonary findings in a non-COVID-19 pattern. Asymptomatic COVID-19 infection causes a generalised background inflammation within the mid-lower zones of the lungs, hilar and central mediastinal nodal stations, and spleen on FDG PET-CT.

Initial experience in staging primary oesophageal/gastro-oesophageal cancer with 18F-FDG PET/MRI.

BACKGROUND: 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI) may improve cancer staging by combining sensitive cancer detection with high-contrast resolution and detail. We compared the diagnostic performance of 18F-FDG PET/MRI to 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for staging oesophageal/gastro-oesophageal cancer. Following ethical approval and informed consent, participants with newly diagnosed primary oesophageal/gastro-oesophageal cancer were enrolled. Exclusions included prior/concurrent malignancy. Following 324 ± 28 MBq 18F-FDG administration and 60-min uptake, PET/CT was performed, immediately followed by integrated PET/MRI from skull base to mid-thigh. PET/CT was interpreted by two dual-accredited nuclear medicine physicians and PET/MRI by a dual-accredited nuclear medicine physician/radiologist and cancer radiologist in consensus. Per-participant staging was compared with the tumour board consensus staging using the McNemar test, with statistical significance at 5%. RESULTS: Out of 26 participants, 22 (20 males; mean ± SD age 68.8 ± 8.7 years) completed 18F-FDG PET/CT and PET/MRI. Compared to the tumour board, the primary tumour was staged concordantly in 55% (12/22) with PET/MRI and 36% (8/22) with PET/CT; the nodal stage was concordant in 45% (10/22) with PET/MRI and 50% (11/22) with PET/CT. There was no statistical difference in PET/CT and PET/MRI staging performance (p > 0.05, for T and N staging). The staging of distant metastases was concordant with the tumour board in 95% (21/22) with both PET/MRI and PET/CT. Of participants with distant metastatic disease, PET/MRI detected additional metastases in 30% (3/10). CONCLUSION: In this preliminary study, compared to 18F-FDG PET/CT, 18F-FDG PET/MRI showed non-significant higher concordance with T-staging, but no difference with N or M-staging. Additional metastases detected by 18F-FDG PET/MRI may be of additive clinical value.

A national UK survey of radiology trainees special interest choices: what and why?

OBJECTIVES: A national survey was designed to better understand factors influencing special interest choices, future aspirations of UK radiology trainees and perceptions of breast radiology. METHODS: A SurveyMonkey questionnaire was developed and distributed to all radiology trainees in the UK through the British Institute of Radiology, RCR Junior Radiologists Forum and by directly contacting UK training schemes as well as by social media between December 2015 and January 2016. RESULTS: From 21 training schemes across the UK, 232 responses were received. Over half entered radiology after foundation training and 62% were ST1-3; one-fifth of trainees intended to leave the NHS. The most popular special interests were musculoskeletal (18%), abdominal imaging (16%) and neuroradiology (13%). Gynaecological and oncological imaging proved to be the least popular. Strong personal interest, a successful rotation during training, a mix of imaging modalities, direct impact on patient care and job prospects were the most popular factors influencing career choice. Research and potential for private income were the least influential factors. Respondents detailed their perceptions of breast radiology, selecting an awareness of career prospects (41%) and a better trainee experience (36%) as factors that would increase their interest in pursuing it as a career. CONCLUSION: Understanding the factors that influence special interest choice is essential to addressing the alarming staffing shortfalls that will befall certain radiology special interests. Addressing trainee's preconceptions and improving the trainee experience are key to attracting trainees to breast radiology. Advances in knowledge: This is the first survey of its kind in the UK literature designed to evaluate special interest career choices and the factors that influence those among radiology trainees.

Assessment of referrals into the soft tissue sarcoma service: evaluation of imaging early in the pathway process.

Purpose. To prospectively evaluate regional referrals into a soft tissue sarcoma service from outside the tertiary centre with local hospital imaging. Materials and Methods. Consecutive referrals were prospectively assessed for: patient demographics, source, referral date, date received by Multidisciplinary Team (MDT), lesion size, local radiology, MDT radiology and final diagnoses. Radiology diagnosis was categorised benign, indeterminate or malignant by consensus. Delays were defined as >10 days. Results. 112 patients were included with high correlation between local and MDT radiology categrorisation and histology (P = 0.54 and P = 0.49, resp.). There was only a trend for MDT radiology diagnosis to downgrade local imaging diagnosis (n = 15, P > 0.05). 48 cases (43%) had ultrasound and MRI at referral and 20 (18%) ultrasound only. 85% of cases were benign (lipoma most common), 15% malignant (sarcoma most common). Delay occurred in 34% of cases. Discussion. In comparison to previous series these results show a reduction in benign lesions, increased biopsy and malignancy rate for lesions referred to a tertiary centre when imaging is performed and reviewed by local radiologists. Advances in Knowledge. Imaging triage of soft tissue masses can decrease benign referral rates and increase the proportion of indeterminate and malignant lesions referred to specialist centres.

Forgotten indwelling stent in a transplanted kidney: a case report.

INTRODUCTION: Forgotten or retained ureteric stents are a well-recognised phenomenon with the potential to cause a range of complications, the most dangerous of which is obstructive nephropathy. These risks are potentially devastating when the patient has a single functioning transplanted kidney. Here we describe the case of a renal transplantation patient with a forgotten ureteric stent of 10 years, who presented with irritative bladder symptoms and was successfully managed using a multimodal urological approach with specialist advice on antibiotic prophylaxis. To the best of our knowledge this is the longest documented time period for a forgotten ureteric stent in a transplantation patient and is unusual in that obstructive nephropathy did not occur. * CASE PRESENTATION: A 32-year-old man with a history of end stage renal failure of unknown aetiology received a cadaveric renal transplant in 1995. An indwelling JJ stent was placed at the time of transplant to protect the vesicoureteric anastomosis. The patient made an unremarkable recovery and initially attended regular follow up in the renal transplant clinic. He was subsequently lost to transplant clinic follow up. In 2005 at the age of 42 he was referred to a nephrologist with irritative bladder symptoms. Renal tract imaging with ultrasound and a plain film demonstrated a retained encrusted ureteric stent. * CONCLUSION: The removal of a retained encrusted ureteric stent always provides a urological challenge. This case demonstrates that multimodal treatment involving a combination of endourological and percutaneous techniques can be employed with success even when the patient has a heavily encrusted stent for a single functioning transplanted kidney. Involvement of a microbiologist to advise on prophylactic antibiotics is deemed especially useful, as the immunosuppressed transplant patient is at particular risk of sepsis secondary to bacteraemia as a result of the endoscopic manipulation of the colonised encrusted stent. This case also provides further evidence to highlight the potential benefits of a stent registry.

Extensor tendon injury to the index and middle finger secondary to Kirschner wire insertion for a distal radial fracture.

We describe a case with the highly unusual complication of attritional ruptures to both the extensor tendons to the index and middle finger following Kirschner wire placements for a distal radial fracture. This particular complication has never been previously described in the literature. We also review the literature, identifying certain techniques in the management of distal radial fractures with Kirschner wires which are considered to increase the risk of tendonous or neurovascular injury. Finally, recommendations are made that should reduce the complications of iatrogenic soft tissue injury associated with this very common procedure.