The Role of Interventional Radiology in the Diagnosis and Treatment of Pulmonary Arteriovenous Malformations.

Pulmonary arteriovenous malformations (PAVMs) are uncommon, predominantly congenital direct fistulous connections between the pulmonary arteries and pulmonary veins, resulting in a right to left shunt. Patients with PAVMs are usually asymptomatic with lesions detected incidentally when radiological imaging is performed for other indications. In this review, we discuss the classification and radiological features of PAVMs as well as their treatment and follow-up options, with a particular focus on percutaneous endovascular techniques and the evolution of the available equipment for treatment.

Interobserver Variability of Hip Dysplasia Indices on Sweep Ultrasound for Novices, Experts, and Artificial Intelligence.

BACKGROUND: Ultrasound for developmental dysplasia of the hip (DDH) is challenging for nonexperts to perform and interpret. Recording "sweep" images allows more complete hip assessment, suitable for automation by artificial intelligence (AI), but reliability has not been established. We assessed agreement between readers of varying experience and a commercial AI algorithm, in DDH detection from infant hip ultrasound sweeps. METHODS: We selected a full spectrum of poor-to-excellent quality images and normal to severe dysplasia, in 240 hips (120 single 2-dimensional images, 120 sweeps). For 12 readers (radiologists, sonographers, clinicians and researchers; 3 were DDH subspecialists), and a ultrasound-FDA-cleared AI software package (Medo Hip), we calculated interobserver reliability for alpha angle measurements by intraclass correlation coefficient (ICC2,1) and for DDH classification by Randolph Kappa. RESULTS: Alpha angle reliability was high for AI versus subspecialists (ICC=0.87 for sweeps, 0.90 for single images). For DDH diagnosis from sweeps, agreement was high between subspecialists (kappa=0.72), and moderate for nonsubspecialists (0.54) and AI (0.47). Agreement was higher for single images (kappa=0.80, 0.66, 0.49). AI reliability deteriorated more than human readers for the poorest-quality images. The agreement of radiologists and clinicians with the accepted standard, while still high, was significantly poorer for sweeps than 2D images (P<0.05). CONCLUSIONS: In a challenging exercise representing the wide spectrum of image quality and reader experience seen in real-world hip ultrasound, agreement on DDH diagnosis from easily obtained sweeps was only slightly lower than from single images, likely because of the additional step of selecting the best image. AI performed similarly to a nonsubspecialist human reader but was more affected by low-quality images.

The effectiveness of the Safety in Interventional Radiology (SIR) Shield in reducing droplet transmission and its effect on image quality and radiation dose.

OBJECTIVE: To evaluate the efficacy of a barrier shield in reducing droplet transmission and its effect on image quality and radiation dose in an interventional suite. METHODS: A human cough droplet visualisation model in a supine position was developed to assess efficacy of barrier shield in reducing environmental contamination. Its effect on image quality (resolution and contrast) was evaluated via image quality test phantom. Changes in the radiation dose to patient post-shield utilisation was measured. RESULTS: Use of the shield prevented escape of visible fluorescent cough droplets from the containment area. No subjective change in line-pair resolution was observed. No significant difference in contrast-to-noise ratio was measured. Radiation dosage to patient was increased; this is predominantly attributed to the increased air gap and not the physical properties of the shield. CONCLUSION: Use of the barrier shield provided an effective added layer of personal protection in the interventional radiology theatre for aerosol generating procedures. ADVANCES IN KNOWLEDGE: This is the first time a human supine cough droplet visualisation has been developed. While multiple types of barrier shields have been described, this is the first systematic practical evaluation of a barrier shield designed for use in the interventional radiology theatre.

Comparison of visibility of ulnar sided triangular fibrocartilage complex (TFCC) ligaments between isotropic three-dimensional and two-dimensional high-resolution FSE MR images.

OBJECTIVES: Assessment of the ulnar attachment of the triangular fibrocartilage complex (TFCC) in a neutral forearm position remains challenging. Our study aims to evaluate the visibility of ulnar sided TFCC on 3 T MRI and compare isotropic 3D FSE sequences utilizing multiplanar reformation (MPR) with standard high-resolution 2D FSE sequences. METHODS: Ninety-nine MRI wrist studies in patients with wrist pain were retrospectively analyzed. Patients were scanned with a neutral forearm position and reviewed with isotropic 3D coronal FSE proton density-weighted images (PDWI) and 2D coronal FSE PDWI. MPR was used for 3D assessment. Visibility of the dorsal radioulnar ligament (DRUL), triangular ligament (TL), and volar radioulnar ligament (VRUL) was assessed by three raters utilizing a five-point grading scale. Grades were compared between 2D and 3D sequences. Intrarater and interrater reliability for the delineation of anatomic structures was measured by Spearman's rank correlation coefficient, Cohen's kappa, and percentage of exact agreement/agreement within a range of ±1 score point. RESULTS: Visibility grades in 3D were statistically significantly higher than those in 2D in all ligaments by all raters (p < 0.01). In Spearman's rank correlation coefficient and Cohen's kappa analysis, interrater correlations and agreements are variable but tended to be higher on 3D than on 2D. Both 2D and 3D sequences showed high intrarater exact agreement in all ligaments (80-91 % on 2D and 88-95 % on 3D). All exact interrater agreements on 3D were acceptable for TL (83-93 %) and acceptable to close to acceptable for VRUL (72-96 %). CONCLUSION: The utilization of isotopic 3D imaging combined with MPR function significantly improves visibility of ulnar attachment of the TFCC.

Case of metastatic small cell carcinoma of the oropharynx successfully treated with image-guided volumetric modulated arc therapy (IG-VMAT): pushing the limits of technology to match treatment intent.

Extrapulmonary small cell carcinomas (EPSCC) are a rare subtype of neuroendocrine tumours which have been documented to arise from a multitude of sites and treatment outcomes are disappointing. The most common site involved in the head and neck region is the larynx and the oropharynx as a primary site has been infrequently reported. The patient presented with bilateral neck swelling and an ulcerated lesion was noted in the base of tongue (BOT). A biopsy revealed small cell carcinoma (SCC) and was confirmed with immunohistochemistry. The final diagnosis after workup was SCC of BOT stage IVc. He received induction chemotherapy to which the tumour responded partially, followed by curative intent chemoradiotherapy and adjuvant chemotherapy. The patient achieved a radiological complete response to treatment and almost all treatment-induced toxicities resolved. An aggressive approach to managing EPSCC is possible with modern radiotherapy techniques, with tolerable treatment-induced toxicities.

Extraintestinal Salmonellosis in the Immunocompromised: An Unusual Case of Pyomyositis.

Salmonella infection can cause a wide range of presentations, predominantly gastrointestinal but occasionally with cardiovascular or other extraintestinal manifestations. The diagnosis of extraintestinal salmonellosis requires a high degree of clinical suspicion and should be considered in patients with deep-seated abscesses especially if they are immunocompromised. We present a case of salmonella causing gastroenteritis complicated by an intramuscular abscess of the left leg. With prompt recognition and multidisciplinary management, the patient recovered with no serious sequela.

A Rare Case of Primary Bilateral Adrenal Lymphoma.

Lymphoma may involve the adrenal glands, but primary lymphoma is rare. Only a few cases have been reported in medical literature. Primary adrenal lymphoma is extremely rare, accounting for <1% of non-Hodgkin lymphomas. We here present a case of a middle-aged female who presented with persistent fever for three weeks. She also reported significant weight loss of more than 10 kgs over the duration of three months. Computed tomography of the thorax and abdomen and pelvis demonstrated bilateral adrenal masses. She underwent short Synacthen test which showed evidence of adrenal insufficiency. She underwent CT-guided adrenal gland biopsy. Histology of adrenal gland biopsy showed features consistent with diffuse large B-cell lymphoma. She was started on R-CHOP chemotherapy and had a good clinical response and remained in complete remission for five months after chemotherapy.

Yttrium-90 radioembolization of liver tumors: what do the images tell us?

Transarterial radioembolization (TARE) with yttrium 90 microspheres is an increasingly popular therapy for both primary and secondary liver malignancies. TARE entails delivery of ß-particle brachytherapy and embolization of the tumor vasculature. The consequent biological sequelae are distinct from those of other transarterial therapies for liver tumors, as reflected in the often baffling post-treatment imaging features. As the clinical use of TARE is increasing, more diverse post-treatment radiological findings are encountered with variable overlap among treatment response, residual disease, reactionary changes and complications. Thus, post-TARE image interpretation is challenging. This review provides a comprehensive description of the different findings seen in post-treatment scans, with the aim of facilitating appropriate radiological interpretation of post-TARE pathologic changes, notwithstanding their existing limitations.