Ultrasonography led multimodal diagnostic pathway for giant cell arteritis.

Objectives: To establish the sensitivity and negative predictive value of a multimodal pathway incorporating ultrasonography, 18-fluorodeoxyglucose labelled positron emission tomography computed tomography and temporal artery biopsy for the diagnosis of giant cell arteritis.

Methods: 1000 consecutive referrals for a new diagnosis of giant cell arteritis were analysed. All patients had a protocolized examination.

Incidence of primary large vessel vasculitis in Norfolk, UK from 2011 to 2020.

Objectives: To report the annual incidence of primary large vessel vasculitis (LVV) in the adult population of Norfolk County, UK, including giant cell arteritis (GCA) (in those ≥50 years) and Takayasu arteritis (TAK).

Methods: Individuals diagnosed by histology or imaging who lived in NR1-NR30 postcode districts were included. Validated criteria from 1990 and 2022 were applied for final classification.

Effectiveness of SPECT/CT Imaging for Sentinel Node Biopsy Staging of Primary Cutaneous Melanoma and Patient Outcomes.

Purpose: Coregistered SPECT/CT can improve accuracy of sentinel node biopsy (SNB) for staging melanoma. This benefit has implications for pathology services and surgical practice with increased diagnostic and surgical workload. The purpose of this study was to investigate the effectiveness of SPECT/CT imaging.

Erdheim-Chester Disease: Two cases from an ophthalmic perspective.

Purpose: We report two patients who presented initially to ophthalmology clinics with symptoms and signs of orbital inflammation that led to a diagnosis of Erdheim-Chester Disease (ECD).

Observations: ECD is a rare form of non-Langerhans cell histiocytosis (LCH) which is characterised by multi-system organ involvement and poor prognosis with standard therapies. Both patients were positive for the V600E mutation on genetic testing and were treated with the inhibitors Vemurafenib and Dabrafenib respectively.

Effect of delay between nuclear medicine scanning and sentinel node biopsy on outcome in patients with cutaneous melanoma.

Background: Sentinel lymph node biopsy (SLNB) is an important staging tool for the management of melanoma. A multicentre study was done to validate previous findings that the timing of lymphoscintigraphy influences the accuracy of SLNB and patient outcomes, particularly survival.

Methods: Data were reviewed on patients undergoing SLNB for melanoma at three centres in the UK and Sweden, examining the effect of timing of SLNB after nuclear medicine scanning.

Parotid incidentalomas on positron emission tomography: what is their clinical significance?

Objective And Aim: The increased use of PET/CT in cancer staging has resulted in more incidental findings in unexpected locations, making this a challenge for the radiologist interpreting the study. Our aim was to determine the frequency of parotid incidentalomas and to assess the ability of PET/CT to characterize them.

Patients And Methods: At the Norfolk and Norwich University Trust, in between October 2010 to October 2015, 4044 patients had a PET/CT examination.

Survival outcomes and interval between lymphoscintigraphy and SLNB in cutaneous melanoma- findings of a large prospective cohort study.

Introduction: Sentinel lymph node biopsy (SLNB) in cutaneous melanoma (CM) is performed to identify patient at risk of regional and distant relapse. We hypothesized that timing of lymphoscintigraphy may influence the accuracy of SLNB and patient outcomes.

Methods: We reviewed prospective data on patients undergoing SLNB for CM at a large university cancer-center between 2008 and 2015, examining patient and tumor demographics and time between lymphoscintigraphy (LS) and SLNB.

MicroRNA expression in a phosphaturic mesenchymal tumour.

Phosphaturic mesenchymal tumours are a heterogeneous set of bone and soft tissue neoplasms that can cause a number of paraneoplastic syndromes such as tumour induced osteomalacia. The term phosphaturic comes from the common finding that these tumours secrete high levels of fibroblast growth factor 23 which causes renal phosphate wasting leading to hypophosphatemia. Phosphaturic mesenchymal tumours are rare and diagnosis is difficult.

Technetium-99m Methylene Diphosphonate Single-photon Emission Computed Tomography/Computed Tomography of the Foot and Ankle.

The complex anatomy and function of the foot and ankle can make it difficult to determine the cause of symptoms in patients with foot and ankle pathology. Following initial clinical and radiographic assessment, additional imaging with magnetic resonance imaging may be required, which is often seen as the modality of choice. Although sensitive to pathological changes in bone metabolism and vascularity, technetium-99m (Tc-99m) bone scintigraphy often lacks the specificity and resolution required to evaluate the structures of the foot and ankle.

Positron Emission Tomography Computed Tomography: A Guide for the General Radiologist.

Cancer remains a leading cause of death in Canada and worldwide. Whilst advances in anatomical imaging to detect and monitor malignant disease have continued over the last few decades, limitations remain. Functional imaging, such as positron emission tomography (PET), has improved the sensitivity and specificity in detecting malignant disease.

Does 99mTc-MDP bone scintigraphy add to the investigation of patients with symptomatic unicompartmental knee replacement?

Aim: The purpose of this study was to determine whether nuclear medicine (99m)Tc-Methyl diphosphonate bone scintigraphy ((99m)Tc-MDP bone scintigraphy) added information over plain radiographs loosening infection in symptomatic unicompartmental knee replacements (UKRs).

Methods And Materials: A cohort of 39 patients who presented with knee pain following UKR was retrospectively reviewed. All had undergone nuclear medicine bone scans for possible loosening or infection of the prosthesis.

Non-small cell lung carcinoma: accuracy of PET/CT in determining the size of T1 and T2 primary tumors.

Objective: The purpose of this study was to compare the measurements of primary T1 and T2 non-small cell lung carcinomas (NSCLCs) at PET/CT to determine which modality has the more accurate correlation with the histologic findings.

Materials And Methods: A retrospective study was performed with the images of 59 patients who underwent surgical resection of T1 and T2 NSCLC and preoperative PET/CT. The maximum measurement of the primary lung tumor was recorded on the PET and unenhanced CT (soft-tissue and lung windows) scans in the largest plane and compared with the maximum dimensions of the histologic specimen.

Neck dissection can be avoided after sequential chemoradiotherapy and negative post-treatment positron emission tomography-computed tomography in N2 head and neck squamous cell carcinoma.

Aims: This study assessed neck control in patients with N2 head and neck squamous cell carcinoma (HNSCC) treated with sequential chemoradiotherapy (SCRT) and the incidence of neck recurrence when neck dissection was withheld in those with negative post-treatment fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET).

Materials And Methods: Thirty-four consecutive patients with N2 HNSCC who were treated with radical intent using SCRT were included. Twenty-seven patients received concomitant platinum-based chemotherapy with their radiotherapy.

Unexpected changes in clinical diagnosis: early abdomino-pelvic computed tomography compared with clinical evaluation.

Background: To evaluate the value of early computed tomography (CT) on identifying clinically "unexpected" diagnosis in patients presenting with "non specific" acute abdominal pain.

Materials And Methods: All patients presenting to on-call surgeons with acute abdominal pain were eligible study participants. Patients were randomised to CT within one hour of admission or supine abdominal and erect chest radiography.

A randomized, controlled trial of routine early abdominal computed tomography in patients presenting with non-specific acute abdominal pain.

Aim: To compare the effect of an initial early computed tomography (CT) examination versus standard practice (SP) on the length of hospital stay, diagnostic accuracy, and mortality of adults presenting with acute abdominal pain.

Materials And Methods: Two hundred and five adults presenting with acute abdominal pain were randomized to undergo an early CT examination or current SP, which comprised supine abdominal and erect chest radiography. One hundred and ninety-eight patients (99 in each arm) were included in the analysis.

Healthy passive cigarette smokers have increased pulmonary alveolar permeability.

Question: Does passive smoking have a measurable effect on lung function in otherwise healthy subjects? There is current interest concerning passive smoking but no objective evidence showing that it has any impact on lung function.

Methods: The pulmonary clearance rate of (99m)Tc-DTPA was measured in 21 healthy volunteers after inhalation as a radio-aerosol and compared between healthy cigarette smokers, passive smokers and non-smokers. All volunteers had normal lung function.

A simple processing method allowing comparison of renal enhancing volumes derived from standard portal venous phase contrast-enhanced multidetector CT images to derive a CT estimate of differential renal function with equivalent results to nuclear medicine quantification.

As iodinated contrast medium is cleared by glomerular filtration, it should be possible to apply the same principles utilized in radionuclide studies to derive differential renal function by comparison of enhancing renal volumes derived from contrast enhanced multidetector CT (CEMDCT). Having established a technique iteratively which appeared successful, a retrospective study was performed using 25 consecutive patients with a wide range of urological conditions who had undergone both CEMDCT, including the renal area in the portal venous phase, and nuclear medicine (NM) assessment of renal function with no urological intervention between the studies. Proprietary volume software was used to quantify the volume and attenuation of each kidney, the products of which (after subtraction of soft tissue attenuation derived from a region of interest over psoas) gave right and left enhancing renal volumes.

Can 16-detector multislice CT exclude skeletal lesions during tumour staging? Implications for the cancer patient.

Current imaging guidelines recommend that many cancer patients undergo soft-tissue staging by computed tomography (CT) whilst the bones are imaged by skeletal scintigraphy (bone scan). New CT technology has now made it feasible, for the first time, to perform a detailed whole-body skeletal CT. This advancement could save patients from having to undergo duplicate investigations.

Hepatocellular carcinoma tumour thrombus in a re-canalised para-umbilical vein: detection by 18-fluoro-2-deoxyglucose positron emission tomography imaging.

This case report describes an unusual site of tumour thrombus in a re-canalised para-umbilical vein, in a patient with hepatocellular carcinoma (HCC) and cirrhosis. The tumour thrombus was suspected on conventional radiography and confirmed using PET imaging, illustrating the complimentary value of structural and functional imaging in achieving the correct diagnosis.

Polycystic kidneys and renal transplant imaging.

Renal transplantation is an ever-increasing procedure. Baseline DTPA renography is routinely performed in these patients in many centers to assess transplant perfusion and function. This report describes 2 cases of unusual appearance at renography resulting from the native polycystic kidneys.

Classification, staging and prognosis of lung cancer.

Lung cancer has increased in incidence throughout the twentieth century and is now the most common cancer in the Western World. It has a poor prognosis, only 10-15% of patients survive 5 years or longer. Outcome is dependent on clinical stage and cancer cell type.