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BACKGROUND AND PURPOSE: Lumbar disc herniation, potentially leading to nerve root compression and cauda equina syndrome, is typically evaluated using MR imaging. However, the limited availability of MR imaging outside regular hours in certain health care systems poses considerable challenges. This purpose of this study was to prospectively evaluate the diagnostic accuracy of an optimized CT lumbar spine protocol as a potential alternative to MR imaging in assessing suspected neural compression. MATERIALS AND METHODS: Patients presenting to the emergency department with suspected cauda equina syndrome or acute radicular symptoms secondary to lumbar disc herniation referred for MR imaging were prospectively enrolled for an additional CT optimized to assess spinal stenosis. An expert radiologist, blinded to clinical data, graded canal stenosis at each lumbar level on CT. The same grading process was applied to MR imaging after a 4-week interval to maintain blinding. RESULTS: Fifty-nine individuals were included in the final analysis. In 22 (39%) cases, no significant stenosis was identified. In a further 22 (37%) cases, disc pathology was identified that was managed conservatively. Thirteen (22%) individuals proceeded to urgent surgical decompression. In 1 (2%) instance, an alternative diagnosis was identified. Compared with MR imaging, the sensitivity, specificity, and positive and negative predictive values for CT in detecting disc pathology in patients presenting with symptoms suggestive of acute neural compression were 97% (95% CI, 82%-99%), 97% (95% CI, 83%-99%), 97% (95% CI, 92%-99%), and 97% (95% CI, 83%-99%), respectively. CT accurately identified all cases requiring urgent decompression. CONCLUSIONS: CT accurately predicted MR imaging findings in patients with suspected cauda equina and nerve root compression, demonstrating its utility as an adjunct tool for patient triage in emergency settings with limited MR imaging access. This protocol could enhance the allocation of emergency resources by appropriately selecting patients for emergent MR imaging.
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The management of patients with colorectal liver metastases (CRLM) has transformed over the past two decades. Advances in surgical techniques, systemic therapies and local treatments have resulted in a paradigm shift. Disease that would once have been considered terminal is now frequently treated aggressively with both a disease-free and overall survival benefit. In line with the expanding range of treatment options, there has been an increase in the volume and complexity of imaging required in the management of these patients to ensure optimal patient selection and outcome. The radiologist plays a pivotal role in interpreting these studies, conveying the relevant information and informing the discussion at multidisciplinary team meetings (MDM). The purpose of this review is to provide an update for radiologists on the current surgical management of patients with CRLM highlighting specific imaging information that is required by the MDT when assessing resectability and/or the need for additional liver-directed therapies.
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PURPOSE: To compare the performance of multiple international guidelines in selecting patients for head CT prior to lumbar puncture (LP) in suspected meningitis, focusing on identification of potential contraindications to immediate LP. METHODS: Retrospective study of 196 patients with suspected meningitis presenting to an emergency department between March 2013 and March 2023 and undergoing head CT prior to LP. UK Joint Specialist Society Guidelines (UK), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Infectious Diseases Society of America (IDSA) guidelines were evaluated by cross-referencing imaging criteria with clinical characteristics present at time of presentation. Sensitivity of each guideline for recommending neuroimaging in cases with brain shift on CT was evaluated, along with the number of normal studies and incidental or spurious findings. RESULTS: 2/196 (1%) patients had abnormal CTs with evidence of brain shift, while 14/196 (7%) had other abnormalities on CT without brain shift. UK, ESCMID and IDSA guidelines recommended imaging in 10%, 14% and 33% of cases respectively. All three guidelines recommended imaging pre-LP in 2/2 (100%) cases with brain shift. IDSA guidelines recommended more CT studies with normal findings (59 vs 16 and 24 for UK and ESCMID guidelines respectively) and CT abnormalities without brain shift (4 vs 1 and 2 respectively) than the other guidelines. CONCLUSION: UK, ESCMID and IDSA guidelines are all effective at identifying the small cohort of patients who benefit from a head CT prior to LP. Following the more selective UK/ESCMID guidelines limits the number of normal studies and incidental or spurious CT findings.
Subject(s)
Meningitis , Practice Guidelines as Topic , Spinal Puncture , Tomography, X-Ray Computed , Humans , Tomography, X-Ray Computed/methods , Retrospective Studies , Male , Female , Adult , Meningitis/diagnostic imaging , Middle Aged , Emergency Service, Hospital , Aged , AdolescentABSTRACT
Appendiceal mucinous neoplasms are rare and can be associated with the development of disseminated peritoneal disease known as pseudomyxoma peritonei (PMP). Mucinous tumours identified on appendicectomy are therefore followed up to assess for recurrence and the development of PMP. In addition, individuals who initially present with PMP and are treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) are followed up to assess for recurrence. However, despite the concerted efforts of multiple expert groups, the optimal imaging follow-up protocol is yet to be established. The purpose of this article is to review the available evidence for imaging surveillance in these populations to identify the optimum post-resection imaging follow-up protocol.
Subject(s)
Appendiceal Neoplasms , Peritoneal Neoplasms , Pseudomyxoma Peritonei , Humans , Pseudomyxoma Peritonei/diagnostic imaging , Pseudomyxoma Peritonei/therapy , Appendiceal Neoplasms/diagnostic imaging , Appendiceal Neoplasms/therapy , Appendiceal Neoplasms/pathology , Peritoneal Neoplasms/diagnostic imaging , Peritoneal Neoplasms/therapy , Adenocarcinoma, Mucinous/diagnostic imaging , Adenocarcinoma, Mucinous/therapy , Adenocarcinoma, Mucinous/pathology , Cytoreduction Surgical Procedures/methods , Neoplasm Recurrence, Local/diagnostic imaging , Hyperthermic Intraperitoneal Chemotherapy , Neoplasm Grading , Appendectomy , Magnetic Resonance Imaging/methodsABSTRACT
OBJECTIVES: Hydrogel spacers aim to separate the rectum from the prostate during radiation therapy for patients with prostate cancer to decrease the radiation dose and thus toxicity to the rectum. The aim of this study was to evaluate the distribution of the hydrogel spacer between the rectum and the prostate, to assess for hydrogel rectal wall infiltration and to assess for immediate complications. METHODS: Retrospective study of 160 patients who had undergone hydrogel spacer placement. Distribution of the hydrogel was assessed on MRI. MRI images were reviewed for rectal wall injection or other malplacement of gel. Early post-procedure complications were recorded. RESULTS: 117 (73.1%) patients had a symmetrical distribution of the hydrogel spacer. The mean anteroposterior rectoprostatic separation was 10.2 ± 3.7 mm (range 0-27 mm). Seven (4.3%) patient had minimal rectal wall infiltration and one (0.6%) patient had moderate infiltration. One (0.6%) patient had an intraprostatic injection of hydrogel. Two (1.3%) patients required treatment in the emergency department: one for urinary retention and one for pain. CONCLUSIONS: Transperineal hydrogel placement separates the prostate from the rectum with a symmetrical distribution in the majority of cases prior to radiation therapy with a low rate of rectal wall injection and immediate complications. ADVANCES IN KNOWLEDGE: SpaceOAR hydrogel can be safely injected into radiation naive patients with low- or intermediate-risk organ-confined prostate cancer. The spacer separates the prostate from the rectum with a symmetrical distribution in the majority of cases prior to radiation therapy.
Subject(s)
Hydrogels , Prostatic Neoplasms , Male , Humans , Retrospective Studies , Prostatic Neoplasms/radiotherapy , Prostatic Neoplasms/drug therapy , Prostate , Rectum , Radiotherapy Dosage , Hydrogel, Polyethylene Glycol Dimethacrylate/therapeutic useABSTRACT
OBJECTIVE: The purpose of this study was to evaluate the technical success and complication rates of image-guided lumbar puncture (IGLP) and to evaluate for differences in approach employed to help establish the optimum technique. METHODS: A retrospective search of the hospital picture archiving and communications system was performed to identify all IGLPs that had taken place over a 5-year period. Radiology reports and the electronic medical record were examined to identify technical parameters and complications associated with each procedure. RESULTS: The technical success rate was 96% (219/228). 69.4% (n = 161) had a previously failed bedside attempt. The rate of complications was 0.01% (n = 2). No major complications were observed. There was no difference in the rates of failure (2.4% vs 3.6%, p = 0.68) or complications (0.008% vs 0.012%, p = 1) between interlaminar and interspinous approaches. CONCLUSION: IGLP is a safe procedure with a high rate of technical success. Where a difficult bedside attempt is anticipated, it is reasonable to forego this and proceed directly to IGLP. ADVANCES IN KNOWLEDGE:: This paper helps to confirm what is already assumed about a common radiological procedure. This is important as there has been a shift from bedside technique to most lumbar punctures being performed via image guidance.
Subject(s)
Radiography, Interventional , Spinal Puncture , Humans , Spinal Puncture/methods , Retrospective Studies , Fluoroscopy , Radiography, Interventional/methods , Radiology, InterventionalABSTRACT
OBJECTIVES: Patients with TIA and minor stroke commonly undergo CT and CTA in the emergency department with subsequent MRI with MRA for further workup. The purpose of this study was to review outpatient MRIs for TIA/stroke patients to assess the additional benefit, if any, of the MRA sequence in the detection of intracranial atherosclerotic disease in patients for whom CTA had already been performed. METHODS: The radiology reports of outpatient MRIs of the brain for TIA/minor stroke patients were retrospectively reviewed via the hospital PACS system. Following this, the imaging report from the patient's initial presentation to the emergency department was reviewed. This index imaging and subsequent MRI were compared to assess the incidence of new vascular findings detected on the MRA sequence in patients for whom CTA had already been performed. Where new lesions had been identified at follow-up, the imaging was retroactively reviewed to assess if they were present on the index imaging. RESULTS: Two hundred seven consecutive patients were reviewed. Significant (> 50%) intracranial atherosclerotic disease was present on MRA in 18 patients (8.7%). This was a new finding in 11 patients. Five had initial CTA where the atherosclerosis was not detected. All 5 of these cases were located in the posterior cerebral arteries. Incidental aneurysms were seen in 14 (6.7%); 12 were a new finding at time of MRI. CONCLUSION: The MRA sequence provides additional value by increasing the detection of clinically important intracranial atherosclerotic disease which may inform management in patients with minor stroke and TIA.
Subject(s)
Atherosclerosis , Intracranial Arteriosclerosis , Ischemic Attack, Transient , Stroke , Humans , Ischemic Attack, Transient/complications , Ischemic Attack, Transient/diagnostic imaging , Magnetic Resonance Angiography/methods , Retrospective Studies , Tomography, X-Ray Computed/methods , Stroke/complications , Stroke/diagnostic imaging , Intracranial Arteriosclerosis/diagnosis , Intracranial Arteriosclerosis/diagnostic imagingABSTRACT
Abdominal pain in pregnancy is a diagnostic challenge with many potential aetiologies. Diagnostic imaging is a valuable tool in the assessment of these patients, with ultrasound commonly employed first line. MRI is an excellent problem-solving adjunct to ultrasound and has many advantages in terms of improved spatial resolution and soft tissue characterisation. This pictorial review aims to outline the role of MRI in the work up of acute abdominal pain in pregnancy and provide imaging examples of pathologies which may be encountered.
Subject(s)
Abdomen, Acute , Pregnancy Complications , Abdomen, Acute/diagnostic imaging , Abdomen, Acute/etiology , Abdominal Pain/diagnostic imaging , Abdominal Pain/etiology , Female , Humans , Magnetic Resonance Imaging/methods , Pregnancy , Pregnancy Complications/diagnostic imaging , UltrasonographyABSTRACT
With increasing subspecialised experience in radical cytoreductive surgery and intra-abdominal chemotherapy for peritoneal malignancy, outcomes have improved significantly in selected patients. The surgery and the treatment regimens are radical and therefore correct patient selection is critical. The radiologist plays a central role in this process by estimating, as precisely as possible, the pre-treatment disease burden. Because of the nature of the disease process, accurate staging is not an easy task. Tumour deposits may be very small and in locations where they are very difficult to detect. It must be acknowledged that no form of modern day imaging has the capability of detecting the smallest peritoneal nodules, which may only be visible to direct inspection or histopathological evaluation. Nonetheless, it behoves the radiologist to be as exact and precise as possible in the reporting of this disease process. This is both to select patients who are likely to benefit from radical treatment, and just as importantly, to identify patients who are unlikely to achieve adequate cytoreductive outcomes. In this review, we outline the patterns of spread of disease and the anatomic basis for this, as well as the essential aspects of reporting abdominal studies in this patient group. We provide an evidence-based update on the relative strengths and limitations of our available multimodality imaging techniques namely CT, MRI and positron emission tomography/CT.
Subject(s)
Peritoneal Neoplasms , Cytoreduction Surgical Procedures , Humans , Magnetic Resonance Imaging/methods , Peritoneal Neoplasms/diagnostic imaging , Peritoneal Neoplasms/pathology , Positron-Emission Tomography , Tomography, X-Ray Computed/methodsABSTRACT
PURPOSE: In response to the outbreak of COVID-19 in Ireland, the government implemented a nationwide stay-at-home order, with the closure of all non-essential businesses. During this period, there was a significant increase in supermarket expenditure. It has been shown that stress, anxiety and boredom are triggers for unhealthy eating habits. Fat consumption is a risk factor for both the development of gallstones and, additionally, the development of acute calculous cholecystitis. The aim of this study was to assess the incidence of acute calculous cholecystitis during the nationwide lockdown and compare it to the same period one year prior. METHODS: A retrospective review of all emergency abdominal imaging performed during the first 5 weeks of the lockdown was completed using the hospital PACS (picture archiving and communication system). All cases of acute calculous cholecystitis were identified and compared with the same period 1 year prior. RESULTS: Eighteen cases of acute calculous cholecystitis were identified from 24 March to 27 April 2020. Eleven cases were identified during the same period in 2019. This represented an increase of 63%. Non-COVID-19-related emergency presentations decreased during this period, and imaging of emergency presentations decreased by 24%. The rate of scans positive for acute cholecystitis more than doubled (p < 0.037). CONCLUSION: A statistically significant increase in cases of acute calculous cholecystitis was observed during a nationwide lockdown during the COVID-19 pandemic. It is hypothesised that this is due to increased consumption of fatty foods during this period due to stress, anxiety and boredom.
Subject(s)
COVID-19 , Cholecystitis, Acute , Cholecystitis, Acute/diagnostic imaging , Cholecystitis, Acute/epidemiology , Cholecystitis, Acute/etiology , Communicable Disease Control , Humans , Incidence , Pandemics , Retrospective Studies , SARS-CoV-2ABSTRACT
Currently, there is much variation in the terminology used to describe groin pain in athletes. Several groups have attempted to reach consensus on nomenclature in this area. This article outlines the current status of groin pain nomenclature for the radiologist, highlighting inherent heterogeneity, recent attempts to reach a consensus, the need for a radiological consensus and why imprecise terminology should be avoided when reporting.
Subject(s)
Athletic Injuries/diagnostic imaging , Groin/diagnostic imaging , Groin/injuries , Pelvic Pain/diagnostic imaging , Terminology as Topic , HumansABSTRACT
PURPOSE: To date, the majority of chest imaging studies in COVID-19 pneumonia have focused on CT. Evidence for the utility of chest radiographs (CXRs) in this population is less robust. Our objectives were to develop a systematic approach for reporting likelihood of COVID-19 pneumonia on CXRs, to measure the interobserver variability of this approach and to evaluate the diagnostic performance of CXRs compared to real-time reverse transcription polymerase chain reaction (RT-PCR). METHOD: Retrospective review of patients suspected of having COVID-19 pneumonia who attended our emergency department and underwent both CXR and a RT-PCR were included. Two radiologists reviewed the CXRs, blind to the RT-PCR, and classified them according to a structured reporting template with five categories (Characteristic, High Suspicion, Indeterminate, Unlikely and Normal) which we devised. For analysis of diagnostic accuracy, Characteristic and High Suspicion CXRs were considered positive and the remaining categories negative. Concordance between the two assessors was also measured. RESULTS: Of 582 patients (51 +/- 20 years), 143/582 (24.6 %) had a positive RT-PCR. The absolute concordance between the two assessors was 71.1 % (414/582) with a Fleiss-Cohen-weighted Cohen's κ of 0.81 (95 % confidence interval, 0.78-0.85). A patient with a positive CXR had an 88 % (95 % CI 80-96 %) probability of having a positive RT-PCR during a period of high incidence, early in the COVID-19 pandemic. CONCLUSION: Using a structured approach, a positive CXR had a high likelihood of predicting a positive RT-PCR, with good interrater reliability. CXRs can be useful in identifying new cases of COVID-19.
Subject(s)
COVID-19/diagnosis , Lung/diagnostic imaging , Radiography, Thoracic/methods , Adult , Aged , Emergency Service, Hospital , Female , Humans , Male , Middle Aged , Observer Variation , Pandemics , Reproducibility of Results , Retrospective Studies , SARS-CoV-2 , Sensitivity and SpecificityABSTRACT
Image-guided lung intervention in the oncologic patient includes transthoracic needle biopsy, thermal ablation, fiducial placement, and tunneled pleural catheter placement and is made possible by technical advancements in computed tomography, fluoroscopy, and ultrasound technology, as well as the proliferation of available thermal ablation modalities such as radiofrequency, microwave, and cryoablation. With increasingly earlier cancer diagnoses being made and a greater patient demand for minimally invasive therapies, interventional oncology has many options to offer the patient with thoracic malignancies. The indications, technique, outcomes, and complications of these diagnostic and therapeutic procedures are described in detail in this review article.