Diagnosing unilateral primary aldosteronism - comparison of a clinical prediction score, computed tomography and adrenal venous sampling.

Context: In patients with primary aldosteronism (PA), adrenalectomy is potentially curative for those correctly identified as having unilateral excessive aldosterone production. It has been suggested that a recently developed and published clinical prediction score (CPS) may correctly identify some patients as having unilateral disease, without recourse to adrenal venous sampling.

Objective: We have applied the CPS to a large cohort of PA patients with defined and documented outcomes.

Diffusion-weighted imaging in the assessment of tumour grade in endometrial cancer.

Objective: Endometrial cancer is the most common gynaecological malignancy in developed countries. Histological grade and subtype are important prognostic factors obtained by pipelle biopsy. However, pipelle biopsy "samples" tissue and a high-grade component that requires more aggressive treatment may be missed.

A prospective evaluation of postural stimulation testing, computed tomography and adrenal vein sampling in the differential diagnosis of primary aldosteronism.

Context: In primary aldosteronism (PA), discriminating unilateral from bilateral disease is crucial because adrenalectomy is frequently curative in the former case but rarely helps in the latter. Various series have reported the utility of postural stimulation testing (PST), cross-sectional imaging and adrenal vein sampling (AVS) in the assessment of PA, but most of these studies were retrospective.

Objective: To prospectively determine the diagnostic utility of PST, AVS and computed tomography (CT) using a radiological scoring system in the assessment of PA in a tertiary centre, as well as to document the incidence of autonomous cortisol cosecretion.

CT, MRI and PET imaging in peritoneal malignancy.

Imaging plays a vital role in the evaluation of patients with suspected or proven peritoneal malignancy. Nevertheless, despite significant advances in imaging technology and protocols, assessment of peritoneal pathology remains challenging. The combination of complex peritoneal anatomy, an extensive surface area that may host tumour deposits and the considerable overlap of imaging appearances of various peritoneal diseases often makes interpretation difficult.

Adrenocortical carcinoma: the range of appearances on CT and MRI.

Objective: Adrenocortical carcinoma (ACC) is a rare, aggressive tumor arising from the adrenal cortex that typically presents late with a large mass. The increased use of cross-sectional imaging for unrelated reasons has led to a greater number of ACCs being detected incidentally at an earlier stage. Recognition of the typical clinical, biochemical, and imaging findings is imperative for rapid diagnosis, prompt intervention, and early use of the appropriate therapy.

Ovarian Cancer Management: the role of imaging and diagnostic challenges.

Worldwide, ovarian cancer accounts for 4% of all female cancers with over 190,000 new cases diagnosed each year. The incidence rates vary considerably across the globe with the highest rates seen in Europe and the USA and low rates in Africa and Asia. Ovarian cancer has been termed a 'silent' killer with the majority of patients presenting with advanced disease due to the vague, non-specific nature of the presenting symptoms such as abdominal discomfort and bloating in 50%.

Gynecological cancers.

The clinical problems raised in patients presenting with all forms of gynecological malignancy are currently addressed using conventional cross-sectional imaging, usually MRI. In general, F-18 FDG PET-CT has not been shown to have a clinical role in any of these cancers at presentation, although studies are under way to use this form of metabolic imaging to predict prognosis and the response to treatment. Although F-18 FDG PET-CT is superior to conventional imaging techniques, it is only moderately sensitive in demonstrating lymph node metastasis preoperatively, and is inadequate for local staging of patients with endometrial cancer.

Imaging of endometrial and cervical cancer.

In this article we review the ever increasing role of imaging in endometrial and cervical cancer. Magnetic resonance imaging (MRI) has emerged as the most widely used technique in the management of women with gynaecological cancer. In endometrial cancer, MRI is reliable in identifying myometrial and cervical invasion and extra-uterine disease, thereby informing preoperative surgical planning.

MRI appearances of uterine malignant mixed müllerian tumors.

Objective: Uterine malignant mixed müllerian tumors (MMMTs) are rare aggressive tumors with a high incidence of lymphatic, peritoneal, and pulmonary metastases. Preoperative differentiation from endometrial adenocarcinoma would be beneficial because their prognoses differ.

Materials And Methods: We retrospectively reviewed MRI examinations of 51 histologically confirmed MMMTs.

Perforation of a malignant ovarian tumor into the recto-sigmoid colon.

Ovarian cancer often presents at an advanced stage, but tends to be an intra-peritoneal disease that respects peritoneal planes. Thus, colo-rectal perforation of the tumor is an extremely rare presentation. The surgical treatment of malignant colo-ovarian fistula should include complete cyto-reduction at the same time as the treatment of the fistula.

Can quantitative dynamic contrast-enhanced MRI independently characterize an ovarian mass?

Objectives: Our aim was to establish threshold criteria based on quantitative DCE-MRI data as independent predictors of malignancy in a complex (solid, solid/cystic) ovarian mass.

Methods: The MRI of 26 lesions in 25 patients with a complex ovarian mass (age range, 17-80 years; mean 43 years) was retrospectively reviewed and correlated with histology following resection. Cases with solid tumour components, definitive histology and relevant dynamic imaging were included.

The indeterminate adrenal lesion.

With the increasing use of abdominal cross-sectional imaging, incidental adrenal masses are being detected more often. The important clinical question is whether these lesions are benign adenomas or malignant primary or secondary masses. Benign adrenal masses such as lipid-rich adenomas, myelolipomas, adrenal cysts and adrenal haemorrhage have pathognomonic cross-sectional imaging appearances.

Diagnosis and localisation of insulinoma: the value of modern magnetic resonance imaging in conjunction with calcium stimulation catheterisation.

Context: Preoperative localisation of insulinoma improves cure rate and reduces complications, but may be challenging.

Objective: To review diagnostic features and localisation accuracy for insulinomas.

Design: Cross-sectional, retrospective analysis.

SDHD-related chromaffin tumours: disease localisation to genetic dysfunction.

Background/aims: To describe the management of a subject with multiple chromaffin tumours found to have a novel succinate dehydrogenase D (SDHD) mutation.

Case: A 15-year-old boy with marked hypertension was found to have elevated urinary catecholamines and initial imaging thought to represent bilateral adrenal phaeochromocytomas. An adrenal venous catheter was required to clarify a right adrenal phaeochromocytoma and a left abdominal paraganglioma, distinct from the left adrenal gland.

Pearls and pitfalls of MR lymphography in gynecologic malignancy.

Dissemination of tumor to lymph nodes is one of the principal routes of metastatic disease. The presence or absence of nodal disease is an important prognostic factor in gynecologic malignancies; thus, nodal staging is an integral part of the pretreatment assessment. It is vital that pretreatment nodal staging be accurate and reliable.

Multidetector computed tomography of the acute abdomen in the immunocompromised host: a pictorial review.

Immunocompromised patients include those receiving chemotherapy for malignant disease, post-transplant patients, patients with acquired immunodeficiency syndrome (AIDS), and those receiving steroids for autoimmune diseases. Advances in transplantation, oncology, and the treatment of AIDS have extended these patients' life expectancies and thereby increased the immunocompromised population. Classical clinical signs of abdominal sepsis may be absent in the immunocompromised host.

Magnetic resonance lymphography: a novel technique for lymph node assessment in gynecologic malignancies.

Lymph node status determines both prognosis and treatment choice in gynecological malignancies. Both CT and MRI are standard techniques used to detect lymph node involvement but these techniques have low sensitivity and specificity. Magnetic resonance lymphography (MRL) using iron oxide nanoparticles is a new technique for lymph node assessment which has shown much promise.

MRI appearances of borderline ovarian tumours.

This review was performed to describe the range of magnetic resonance imaging (MRI) appearances of borderline ovarian tumours. The MRI findings in 26 patients with 31 borderline ovarian tumours (mean age: 40.1 years, range: 14-85 years) were retrospectively reviewed.

Results of a national survey of radiotherapy planning and delivery in the UK in 2007.

Aims: Technical developments in radiotherapy have increased very rapidly over recent years, resulting in the processes of radiotherapy planning and delivery changing significantly. It is essential that alongside these developments, optimal methods for accurate target volume definition become a priority. The Radiotherapy Imaging for Delivery of Radiotherapy Working Party was formed to create a framework for imaging for radiotherapy planning and delivery: the areas of interest were interpretation of imaging for planning, optimum acquisition of imaging for radiotherapy planning and training and assessment across all staff groups involved with radiotherapy planning.

Contrasting clinical manifestations of SDHB and VHL associated chromaffin tumours.

Mutations in succinate dehydrogense-B (SDHB) and the von Hippel-Lindau (VHL) genes result in an increased risk of developing chromaffin tumours via a common aetiological pathway. The aim of the present retrospective study was to compare the clinical phenotypes of disease in subjects developing chromaffin tumours as a result of SDHB mutations or VHL disease. Thirty-one subjects with chromaffin tumours were assessed; 16 subjects had SDHB gene mutations and 15 subjects had a diagnosis of VHL.