Castleman Disease Presenting with Pseudotumour Cerebri and Myasthenia Gravis: A Case Report and Literature Review.

Castleman disease (CD) is a rare lymphoproliferative disorder that may present with various autoimmune, inflammatory, or neurologic syndromes. This is a case of a 21-year-old woman who presented with signs and symptoms of pseudotumour cerebri (PTC) who subsequently developed myasthenia gravis (MG), and was incidentally found to have a large mass in the posterior mediastinum. Upon resection, the mass was classified as unicentric CD involved with follicular dendritic cell sarcoma.

Methods and challenges in quantitative imaging biomarker development.

Academic radiology is poised to play an important role in the development and implementation of quantitative imaging (QI) tools. This article, drafted by the Association of University Radiologists Radiology Research Alliance Quantitative Imaging Task Force, reviews current issues in QI biomarker research. We discuss motivations for advancing QI, define key terms, present a framework for QI biomarker research, and outline challenges in QI biomarker development.

Clinical utility of quantitative imaging.

Quantitative imaging (QI) is increasingly applied in modern radiology practice, assisting in the clinical assessment of many patients and providing a source of biomarkers for a spectrum of diseases. QI is commonly used to inform patient diagnosis or prognosis, determine the choice of therapy, or monitor therapy response. Because most radiologists will likely implement some QI tools to meet the patient care needs of their referring clinicians, it is important for all radiologists to become familiar with the strengths and limitations of QI.

Complications from computed tomography-guided core needle biopsy for patients receiving stereotactic body radiation therapy for early-stage lesions of the lung.

Background: Obtaining a tissue diagnosis has traditionally been standard practice before initiating therapy for early-stage non-small-cell lung cancer (NSCLC). In several recent studies from Europe and Asia, a substantial proportion of patients have received stereotactic body radiation therapy (SBRT) based only on the imaging characteristics of the suspicious lesion. The underlying assumption is that the risk of percutaneous needle biopsy may outweigh the benefits in a population that generally has underlying pulmonary dysfunction and other medical comorbidity.

Measurement of cardiac output from dynamic pulmonary circulation time CT.

Purpose: To introduce a method of estimating cardiac output from the dynamic pulmonary circulation time CT that is primarily used to determine the optimal time window of CT pulmonary angiography (CTPA).

Methods: Dynamic pulmonary circulation time CT series, acquired for eight patients, were retrospectively analyzed. The dynamic CT series was acquired, prior to the main CTPA, in cine mode (1 frame/s) for a single slice at the level of the main pulmonary artery covering the cross sections of ascending aorta (AA) and descending aorta (DA) during the infusion of iodinated contrast.

A case of hut lung: scanning electron microscopy with energy dispersive x-ray spectroscopy analysis of a domestically acquired form of pneumoconiosis.

Hut lung is a pneumoconiosis caused by exposure to smoke derived from biomass fuels used for cooking in poorly ventilated huts. We report, to our knowledge, the first analysis of the dust deposited in the lungs in hut lung by scanning electron microscopy with energy dispersive x-ray spectroscopy (SEM/EDS). A Bhutanese woman presented with shortness of breath and an abnormal chest radiograph.

KERMA ratios in pediatric CT dosimetry.

Background: Patient organ doses may be estimated from CTDI values. More accurate estimates may be obtained by measuring KERMA (Kinetic Energy Released in Matter) in anthropomorphic phantoms and referencing these values to free-in-air X-ray intensity.

Objective: To measure KERMA ratios (R(K)) in pediatric phantoms at CT.

In-patient to isocenter KERMA ratios in CT.

Purpose: To estimate in-patient KERMA for specific organs in computed tomography (CT) scanning using ratios to isocenter free-in-air KERMA obtained using a Rando phantom.

Method: A CT scan of an anthropomorphic phantom results in an air KERMA K at a selected phantom location and air kerma K(CT) at the CT scanner isocenter when the scan is repeated in the absence of the phantom. The authors define the KERMA ratio (R(K)) as K∕ K(CT), which were experimentally determined in a Male Rando Phantom using lithium fluoride chips (TLD-100).

Diagnosis of pulmonary Langerhans cell histiocytosis by CT-guided core biopsy of lung: a report of three cases.

A pathological diagnosis of pulmonary Langerhans cell histiocytosis (PLCH) usually requires a surgical lung biopsy. To date, diagnosis of PLCH by core needle biopsy has not been reported. Three cases are presented of PLCH diagnosed by CT-guided core biopsy in adult female smokers found to have multiple small bilateral lung nodules.

Treatment advances for medically inoperable non-small-cell lung cancer: emphasis on prospective trials.

Advances in technology have changed the treatment of patients with early stage non-small-cell lung cancer who are not healthy enough for standard surgical resection. Previously, patients with severe underlying cardiopulmonary dysfunction were often dissuaded from pursuing definitive therapy, even though most patients died from their lung cancer and not as a result of comorbid medical illness. Recent advances in the technology to treat early stage disease have led to new-found enthusiasm for treating and studying high-risk patients.

Definitive treatment of poor-risk patients with stage I lung cancer: a single institution experience.

Purpose: Lung cancer remains the leading cause of cancer death in both men and women. A substantial number of patients with early stage non-small cell lung cancer (NSCLC) are unfit for standard surgery due to cardiopulmonary dysfunction and/or other comorbidity. The appropriate management for this population has not been defined.

A method to obtain mean organ doses in a RANDO phantom.

A quantitative method of obtaining average organ dose from point measurements made in the male RANDO phantom is described for 24 compact organs of interest in patient dosimetry. A three-dimensional Cartesian coordinate system was created by considering each of the 36 RANDO phantom sections as the z coordinate, and using a rectangular frame to assign x and y coordinates relative to the center of each section. Anatomical atlases and clinical experience were used to identify the location and extent of each organ and tissue in the RANDO phantom.

How do lesion size and random noise affect detection performance in digital mammography?

Rationale And Objectives: We investigated the effect of random noise and lesion size on detection performance in mammography.

Materials And Methods: Digital mammograms were obtained of an anthropomorphic breast phantom with and without simulated mass lesions. Digital versions of the mass lesions, ranging in size from 0.

Thyroid involvement with Langerhans cell histiocytosis in a 3-year-old male.

We report on the thyroid involvement with Langerhans cell histiocytosis (LCH) in a 3-year-old male. The patient presented with goiter and primary hypothyroidism. His goiter caused life-threatening airway obstruction.

Protective pneumothorax for needle biopsy of mediastinum and pulmonary hilum.

The risk of performing CT-guided transthoracic needle biopsy of some mediastinal and pulmonary hilar masses is increased by the presence of intervening lung. A series of patients is presented in whom a protective pneumothorax provided access for biopsy of masses in the mediastinum and pulmonary hilum. Review of Interventional Radiology records revealed 24 patients who had biopsies of mediastinum or pulmonary hilum, in whom protective pneumothorax was used, or attempted, to provide percutaneous access for biopsy.

Performance of a single lookup table (LUT) for displaying chest CT images.

Rationale And Objectives: To evaluate the ability to view mediastinal and lung information on one window setting by processing images with a bilinear lookup table (LUT).

Materials And Methods: Chest computed tomography (CT) studies were obtained from 32 consecutive adult patient studies, which included 7 iodine contrast studies. From each CT examination, four sections were selected containing the suprasternal notch, carina, right inferior pulmonary vein, and the dome of the lower hemidiaphragm.

Patient size and x-ray transmission in body CT.

Physical characteristics were obtained for 196 patients undergoing chest and abdomen computed tomography (CT) examinations. Computed tomography sections for these patients having no evident pathology were analyzed to determine patient dimensions (AP and lateral), together with the average attenuation coefficient. Patient weights ranged from approximately 3 kg to about 120 kg.

Use of the VIP-Man model to calculate energy imparted and effective dose for x-ray examinations.

A male human tomographic model was used to calculate values of energy imparted (epsilon) and effective dose (E) for monoenergetic photons (30-150 keV) in radiographic examinations. Energy deposition in the organs and tissues of the human phantom were obtained using Monte Carlo simulations. Values of E/epsilon were obtained for three common projections [anterior-posterior (AP), posterior-anterior (PA), and lateral (LAT)] of the head, cervical spine, chest, and abdomen, respectively.

How do radiographic techniques affect image quality and patient doses in CT?

The radiation dose received by patients who undergo CT examinations has become a subject of considerable interest. Adult effective doses for head CT examinations are of the order of 1 to 2 mSv, and for single body examinations, patient doses are typically between 4 and 6 mSv. These doses are high in comparison to most other types of radiological examinations that use ionizing radiation.

How good is the ACR accreditation phantom for assessing image quality in digital mammography?

Rationale And Objectives: The purpose of this study was to evaluate the American College of Radiology (ACR) accreditation phantom for assessing image quality in digital mammography.

Materials And Methods: Digital images were obtained of an ACR accreditation phantom at varying mAs (constant kVp) and varying kVp (constant mAs). The average glandular dose for a breast with 50% glandularity was determined for each technique factor.