Differentiation Between Radiation Necrosis and True Tumour Progression After Radiotherapy to Intracranial Metastases.

Differentiating between radiation necrosis and true tumour progression after radiotherapy is challenging due to overlapping imaging appearances. This review outlines useful techniques and imaging features for making this distinction, as well as potential pitfalls. Both radiation necrosis and true tumour progression commonly manifest as peripherally enhancing lesions on post-contrast T1-weighted imaging, but the enhancing rim should be thin in radiation necrosis, while more discrete nodular enhancement suggests active tumour.

Prospective Comparison of T1-SPACE and MPRAGE for the Identification of Intrinsic T1 Hyperintensity in Patients with Intracranial Melanoma Metastases.

Background And Purpose: Volumetric TSE (3D-TSE) techniques are increasingly replacing volumetric magnetization-prepared gradient recalled-echo (3D-GRE) sequences due to improved metastasis detection. In addition to providing a baseline for assessing postcontrast enhancement, precontrast T1WI also identifies intrinsic T1 hyperintensity, for example, reflecting melanin or blood products. The ability of precontrast 3D-TSE to demonstrate intrinsic T1 hyperintensity is not clear from the literature; thus, this study compares precontrast 3D-TSE and 3D-GRE sequences for identifying intrinsic T1 hyperintensity in patients with metastatic melanoma.

Persistent median artery on computed tomographic arteriovenous fistulograms in patients on haemodialysis.

Introduction: Cadaveric studies suggest an increasing prevalence of the persistent median artery (PMA) over a prolonged timeframe. The aim of this retrospective cross-sectional study was to evaluate the PMA prevalence in haemodialysis patients who had computed tomographic fistulograms (CTFs), and if present, their calibres and origins.

Methods: All consecutive adult patients referred for an upper limb CTFs for assessment of arteriovenous fistula (AVF) dysfunction from 2006 to 2021 were included.

Improving the diagnosis of radiation necrosis after stereotactic radiosurgery to intracranial metastases with conventional MRI features: a case series.

Background: The distinction between true disease progression and radiation necrosis after stereotactic radiosurgery to intracranial metastases is a common, but challenging, clinical scenario. Improvements in systemic therapies are increasing the importance of this distinction. A variety of imaging techniques have been investigated, but the value of any individual technique is limited.

Relationship Between Interpersonal Depressive Symptoms and Reduced Amygdala Volume in People with Multiple Sclerosis: Considerations for Clinical Practice.

Background: The lifetime prevalence of depression in people with multiple sclerosis (MS) is approximately 50% compared with around 15% in the general population. There is a relationship between depression and quality of life in people with MS and evidence that depression may contribute to disease progression.

Methods: This cross-sectional pilot study assessed the association between depression and regional brain atrophy, including amygdala and hippocampal volume.

Error and cognitive bias in diagnostic radiology.

Errors in diagnostic radiology are not infrequent. Patient harm related to these errors is however less common and may be avoided via various preventative mechanisms within the medical system including, but not limited to, multidisciplinary meetings, second opinions, subspecialty expertise and clinician experience. Failure at a number of points in the system is often required to result in patient harm.

Detection of multiple sclerosis lesions in the cervical cord: which of the MAGNIMS 'mandatory' non-gadolinium enhanced sagittal sequences is optimal at 3T?

Background And Purpose: The magnetic resonance imaging in multiple sclerosis consensus guidelines currently mandate three sagittal non-contrast enhanced sequences of T2-weighted fast spin echo, proton density-weighted fast spin echo and short tau inversion recovery; however, these particular three sequences have not previously been compared at 3T. This study compared T2-weighted fast spin echo, proton density-weighted fast spin echo, short tau inversion recovery as well as the double inversion recovery sequence for the sagittal detection of multiple sclerosis lesions in the cervical spinal cord at 3T.

Methods: Nineteen multiple sclerosis patients underwent magnetic resonance imaging with 3T sagittal T2-weighted fast spin echo, proton density-weighted fast spin echo, short tau inversion recovery and double inversion recovery between November 2012 and April 2013.

When should we image our patients? Appropriate use of imaging in inpatient psychiatry.

Objective: Injudicious use of medical imaging may be associated with harm to patients and increased downstream healthcare costs. Guidance on the use of imaging in common psychiatric inpatient scenarios is inconsistent or absent. This paper explores three common clinical scenarios facing adult psychiatrists and provides guidance about the appropriate use of imaging.

The clinical utility of structural neuroimaging in first-episode psychosis: A systematic review.

Background: Australian and US guidelines recommend routine brain imaging, either computed tomography or magnetic resonance imaging, to exclude structural lesions in presentations for first-episode psychosis. The aim of this review was to examine the evidence for the appropriateness and clinical utility of this recommendation by assessing the frequency of abnormal radiological findings in computed tomography and magnetic resonance imaging scans among patients with first-episode psychosis.

Methods: PubMed and Embase database were searched from inception to April 2018 using appropriate MeSH or Emtree terms.

Neuroprotective Benefits of Antidepressants in Multiple Sclerosis: Are We Missing the Mark?

The potential of antidepressant medication to have a neuroprotective effect for people with multiple sclerosis (MS) has received increased interest in recent years. The possibility of antidepressants, particularly fluoxetine, for potential repurposing to treat primary progressive and secondary progressive MS is of interest as a result of the relative lack of disease-modifying medications for these subtypes. A number of animal studies have found positive results for a neuroprotective effect of antidepressant use in MS, with human studies showing mixed results.

Arytenoid cartilage movements are hypokinetic in Parkinson's disease: A quantitative dynamic computerised tomographic study.

Background: Voice change is one of the earliest features of Parkinson's disease. However, quantitative studies of vocal fold dynamics which are needed to provide insight into disease biology, aid diagnosis, or track progression, are few.

Methods: We therefore quantified arytenoid cartilage movements and glottic area during repeated phonation in 15 patients with Parkinson's disease (symptom duration < 6 years) and 19 controls, with 320-slice computerised tomography (CT).

Morphologic patterns of noncontrast-enhancing tumor in glioblastoma correlate with IDH1 mutation status and patient survival.

Glioblastomas with a substantial proportion of noncontrast-enhancing tumour (nCET) have a variety of imaging appearances. We aimed to determine whether glioblastomas demonstrating a substantial proportion (>33%) of nCET can be sub-classified by different morphologic pattern of nCET. We then assessed whether this improves the ability of MRI to predict isocitrate dehydrogenase-1 (IDH1) mutation status and whether this has prognostic significance independent of IDH1 mutation status.

Diffusion and Perfusion MR Imaging in Acute Stroke: Clinical Utility and Potential Limitations for Treatment Selection.

Magnetic resonance (MR) diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) offer unique insight into acute ischemic stroke pathophysiology. These techniques may offer the ability to apply pathophysiology to accurately individualize acute stroke reperfusion treatment, including extending the opportunity of reperfusion treatment to well beyond the current time-based treatment windows.This review examines the use of DWI and PWI in the major stroke trials, their current clinical utility, and potential limitations for reperfusion treatment selection.

Reliability of noncontrast-enhancing tumor as a biomarker of IDH1 mutation status in glioblastoma.

Isocitrate dehydrogenase 1 (IDH1) mutations in gliomas have been associated with a frontal lobe location and a greater proportion of noncontrast-enhancing tumour (nCET). The purpose of our study was to validate the utility of MRI imaging features in predicting IDH1 mutations in glioblastomas. Pre-operative MRIs of new glioblastoma patients, consisting of at least FLAIR and T1-weighted post-contrast sequences, were reviewed by a neuroradiologist based primarily on the VASARI feature set.

The incidence and significance of multicentric noncontrast-enhancing lesions distant from a histologically-proven glioblastoma.

Improvements in imaging are increasing the detection of multiple lesions in the setting of glioblastoma. Occasionally distant non-enhancing lesions may be identified which have the appearances of a multicentric low-grade glioma. We aimed to determine the incidence, prognostic significance and diagnostic value of this appearance in new glioblastoma patients.

Multifocal and multicentric glioblastoma: Improved characterisation with FLAIR imaging and prognostic implications.

Glioblastoma usually presents on imaging as a single peripherally enhancing lesion, but multiple enhancing lesions can occur, termed multifocal if there is a connection between enhancing lesions, or multicentric when no communication is demonstrated. We aim to determine the incidence and prognostic implications of multifocal and multicentric glioblastoma in the era of modern MRI, focusing on the added benefit of T2-weighted fluid-attenuated inversion recovery (FLAIR) imaging. Patients with a new diagnosis of glioblastoma were identified.

Incidence and prognostic significance of non-enhancing cortical signal abnormality in glioblastoma.

Introduction: The presence of non-enhancing cortical signal abnormality is useful for differentiating between glioblastoma and metastatic disease, but its significance has not been studied. We aimed to determine the incidence and prognostic implications of non-enhancing cortical signal abnormality in glioblastomas.

Methods: Patients with a new diagnosis of glioblastoma between September 2007 and December 2010 were identified.

Large anterior temporal Virchow-Robin spaces: unique MR imaging features.

Introduction: Large Virchow-Robin (VR) spaces may mimic cystic tumor. The anterior temporal subcortical white matter is a recently described preferential location, with only 18 reported cases. Our aim was to identify unique MR features that could increase prospective diagnostic confidence.

An endless line on the chest radiograph.

A 40-year-old male patient had his right femoral vein catheterised following admission with altered conscious state from polypharmacy overdose. The procedure was documented as successful and uncomplicated. A postprocedural chest radiograph demonstrated a linear metallic opacity projecting over the superior vena cava and inferior vena cava (SVC and IVC, respectively), with superior and inferior ends not visualised.

Retroperitoneal sarcomas: a review of disease spectrum, radiological features, characterisation and management.

Retroperitoneal sarcomas are a rare disease. The overall 5-year survival rate for these lesions remains low, and surgical management offers the only option for effective treatment and potential for cure. Radiotherapy is increasingly being employed in addition to standard surgical treatment.

Dimensions of subcortical infarcts associated with first- to third-order branches of the basal ganglia arteries.

Background: It has been described that lacunar infarct is characterized by its smallish size (15-20 mm) in the axial plane. However, the size of the basal ganglia artery responsible for this type of infarct is uncertain. Detection of small arterial occlusion is not possible with current angiography, hindering correlation of arterial occlusion with subcortical infarct size.