Diffusion-weighted MRI of the liver-Interpretative pearls and pitfalls.

Diffusion-weighted magnetic resonance imaging (DW MRI) is an established technique in neuroradiology and more recently has emerged as a useful adjunct to various oncological applications of MRI. It has an expanding role in the evaluation of liver lesions, offers higher detection rates for small lesions, and can increase confidence in differentiating between benign and malignant lesions. Other applications include assessment of tumour response to therapy, differentiating tumour from bland thrombus, and assessment of liver fibrosis. DW sequences can be performed on most modern MRI machines with relative ease, in a short time period and without the need for contrast medium. DW MRI can be of value in the detection and characterization of hepatic lesions but there are pitfalls, which can potentially cause interpretative difficulty. This article will review the rationale for DW MRI in liver imaging, demonstrate the clinical utility of the technique in a spectrum of hepatic diseases, and illustrate key interpretative pearls and pitfalls.

Optimizing the role of FDG PET-CT for potentially operable metastatic colorectal cancer.

Recent treatment advances now allow a realistic chance of cure in selected patients with metastatic colorectal carcinoma (CRC). Accurate pre-treatment staging is crucial to ensure appropriate management by identification of patients with more advanced disease who will not benefit from surgery. (18)Fluorine 2-fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography (PET-CT) has a firmly established role in staging, restaging, and recurrence detection of a range of tumors. This article will review the role of PET-CT in patients with CRC with a particular emphasis on optimizing the technique in patients with potentially operable metastatic disease.

Patient experience, pain, and quality of life after lower limb angioplasty: a multisite prospective cohort study.

PURPOSE: To explore the experience of patients undergoing endovascular lower limb angioplasty and evaluate the improvements in quality of life and disease-related symptoms after the procedure. METHODS: Patients completed a questionnaire before treatment and three questionnaires after the procedure (immediately after the procedure, and again 4 weeks and 3 months later). Anxiety, patient understanding, procedure-related pain, and disease-related pain were assessed by a visual analog score (VAS). Complications, analgesic requirements, and satisfaction were recorded. Changes to quality of life were assessed by the validated SF36 questionnaire. RESULTS: A total of 88 patients (41%) responded. Overall, disease-related pain decreased over 3 months after the procedure. Smokers had more pain both before and after the procedure (P < 0.05). Explanation was considered better if provided by radiologist (P < 0.05). Sixty-nine percent of patients found the procedures less painful (mean VAS 2.5) than they had anticipated (VAS 5.5). Fifty percent of patients experienced adverse effects related to their puncture site, but this was highest among patients who had undergone the procedure before and smokers. The greatest quality-of-life improvements were in emotional and general health. Higher levels of disease-related pain were associated with worse general, emotional, and physical health (P < 0.05). CONCLUSION: Lower limb angioplasty provides symptomatic and quality-of-life improvements. Implementation of simple measures could improve patient satisfaction-for example, treatment should be explained by the radiologist in advance. Routine prescription of analgesics with particular attention to smokers and those undergoing repeat interventions is suggested.

False-positive uptake on 2-[¹8F]-fluoro-2-deoxy-D-glucose (FDG) positron-emission tomography/computed tomography (PET/CT) in oncological imaging.

With the increasing utilization of integrated positron-emission tomography/computed tomography (PET/CT) using the glucose analogue 2-[¹8F]-fluoro-2-deoxy-D-glucose (FDG) in oncological imaging, it is important for radiologists and nuclear medicine physicians to be aware that FDG uptake is not specific for malignancy, as many different physiological variants and benign pathological conditions can also exhibit increased glucose metabolism. Such false-positive FDG uptake often arises outside the area of primary interest and may mimic malignant disease, thereby confounding accurate interpretation of PET/CT studies. With the use of illustrative clinical cases, this article will provide a systematic overview of potential interpretative pitfalls and illustrate how such unexpected findings can be appropriately evaluated.

Are radiologists able to manage serious anaphylactic reactions and cardiopulmonary arrest?

In this study, we aimed to assess the ability and confidence of radiologists in managing adult life support in cardiopulmonary arrest and acute anaphylaxis reactions. We used a questionnaire survey assessing the knowledge of how to manage and the confidence in managing an adult cardiorespiratory arrest scenario. This was sent to 165 radiology consultants and registrars in 6 NHS trusts in Yorkshire: 105 participated. The questionnaire elicited basic demographic details and included eight questions aimed at assessing recent training, knowledge and confidence in the management of adult resuscitation (Resuscitation Council (UK) 2005 guidelines) and acute anaphylaxis. Despite the fact that 90% of participants stated that they would feel confident to initiate life support, the average score from the questions assessing life support procedure was 2.3 out of 5, with only 13% of participants answering all questions correctly. There was no correlation between grade of radiologist and likelihood of a correct answer, nor was there a correlation between feeling confident and knowing the correct life support procedure. Flaws in training were highlighted, with only 61% of radiologists having attended a life support course in the last 4 years. Those who had attended a course more recently were more likely to perform cardiopulmonary resuscitation correctly (p = 0.02). Individuals who were confident in initialising cardiopulmonary resuscitation were more likely to be confident that other members of staff could assist them (p = 0.028). This study emphasises the need for regular life support training and the need to alter the attitude of radiologists, who must consider it their role to initiate effective life support in the radiology environment.

Congenital talipes equinovarus in Papua New Guinea: a difficult yet potentially manageable situation.

Reports in the literature have suggested a high incidence of congenital deformities, including congenital talipes equinovarus (CTEV), in many Pacific Islands. This study performed a retrospective analysis of cases of CTEV in an isolated region of Papua New Guinea over a 2-year period. Data was collected on the incidence of CTEV, together with an analysis of initial treatment and outcome. The incidence of CTEV was 2.7 per 1,000 live births per year. A peak incidence of CTEV births in September suggested that maternal anaemia secondary to malaria was a significant risk factor. Good functional outcome was confirmed in only 20% of cases following initial treatment. The authors suggest the Ponseti method as a realistic option for treating CTEV in this region and that it could be instigated with minimal resources and training.