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ABSTRACT: To assess the impact on patient management of formal neuroradiology "second reading" of computed tomography (CT) and magnetic resonance imaging (MRI) images initially interpreted by general radiologists.
Second opinion reports during the calendar year 2004 were compared with the original report and assessed for major or minor discrepancies. A major discrepancy was separated from a minor discrepancy whereby a change in opinion significantly affected patient management.
There were 506 second opinions during 2004 given by three consultant neuroradiologists. Incomplete data were found in 141. Forty-one percent were CT images and the remainder MRI. The majority of second opinions were requested by neurologists. Most of the remaining referrals were from neurosurgeons or the primary radiologist. There was a 13% major and a 21% minor discrepancy rate. The remaining 66% were in complete agreement. There was a mixture of overcalls, misinterpretation, and undercalls. There were similar rates of minor and major discrepancies in both CT and MRI.
There is a significant major discrepancy rate between specialist neuroradiology second opinion and general radiologists. The benefit of a formal specialist second opinion service is clearly demonstrated; however, it is time-consuming.
Clinical Radiology 08/2008; 63(7):791-5. · 1.95 Impact Factor
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ABSTRACT: A rare case of unilateral benign essential tremor is presented that responded to surgical excision of a posterior fossa arachnoid cyst.
British Journal of Neurosurgery 05/2005; 19(2):191-2. · 0.88 Impact Factor
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British Journal of Neurosurgery 11/2003; 17(5):471-2. · 0.88 Impact Factor
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Journal of Medical Genetics 05/2001; 38(4):238-40. · 6.36 Impact Factor
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Clinical Radiology 04/2001; 56(3):247-9. · 1.95 Impact Factor
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ABSTRACT: Temporomandibular joint arthroscopy has been associated with various vascular injuries including haemorrhage, pseudoaneurysm and fistula. We describe the endovascular balloon embolization of a traumatic superficial temporal arteriovenous fistula that complicated TMJ arthroscopy. We conclude that suspected vascular injuries after this procedure should be investigated by arteriography, and that embolization is a safe and effective treatment for superficial temporal artery fistulas.
British Journal of Oral and Maxillofacial Surgery 05/1999; 37(2):127-8. · 1.95 Impact Factor
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ABSTRACT: A retrospective analysis was carried out of how magnetic resonance imaging (MRI) is used as a pre-operative screening investigation in patients with a clinical diagnosis of medically intractable temporal lobe epilepsy (TLE). Up to 65% of such patients are said to have hippocampal sclerosis (HS).
Forty-six patients in a 26-month period underwent MR examination on a 1.5 T scanner according to a routine protocol. Each patient had coronal T1-weighted and oblique coronal T2-weighted scans performed. Hippocampal volume was calculated from the T1-weighted images, the T2-weighted images being assessed for relative hippocampal signal intensity. Each individual patient's medical records were audited.
Thirty per cent of patients in our study had a diagnosis of HS made on their MR scan. No patient had a diagnosis of HS made without prior clinical evidence of seizure lateralization. Sixty-eight per cent of patients with clinical evidence of a unilateral seizure focus had HS diagnosed by MR scanning. Forty-three per cent of patients did not have clinical evidence of an unilateral seizure focus. It was found that over 25% of patients referred to the unit did not fit the criteria of having medically intractable TLE. Nine per cent of patients had previously stated that they did not want epilepsy surgery.
The lower than expected diagnostic rate of HS in this patient population reflects the broad criteria used in referring patients for imaging studies. This is likely to mirror the initial investigation of these patients outside specialist units where more extensive investigation prior to MRI is available. However, when MRI is used as an initial screening investigation, this study indicates that implementation of simple clinical criteria should significantly reduce the number of unnecessary scans.
Clinical Radiology 06/1998; 53(5):353-6. · 1.95 Impact Factor
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The Ulster medical journal 12/1996; 65(2):162-4.
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ABSTRACT: Guidelines for lumbar spine radiography were agreed by consultation between staff in the radiology, accident and emergency and neurosurgical departments of a large teaching hospital. Study of 322 consecutive patients over an eight month period showed that the proportion of patients referred for radiography was reduced from 48.4% to 27.2% following introduction of the guidelines (p = 0.0002). Successful use of such guidelines requires cooperation between clinical and radiological staff and frequent review of performance.
The Ulster medical journal 05/1994; 63(1):12-7.
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ABSTRACT: In 216 consecutive patients investigated for subarachnoid haemorrhage, 44 (20.3%) of cerebral angiograms were either normal or equivocal for the presence of aneurysm. Arteriography was repeated in 30 patients and an aneurysm was demonstrated in 10 cases. Repeat arteriography is recommended in proven subarachnoid haemorrhage even when the initial study is normal, and in this study achieved a reduction in overall negative rate to 15.6%.
British Journal of Neurosurgery 02/1994; 8(2):141-6. · 0.88 Impact Factor
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The Ulster medical journal 05/1993; 62(1):101-4.
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The Ulster medical journal 05/1992; 61(1):116-8.
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Journal of Neurology Neurosurgery & Psychiatry 12/1991; 54(11):1016-7. · 4.76 Impact Factor
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The Ulster medical journal 11/1990; 59(2):122-30.
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ABSTRACT: Giant serpentine aneurysms form a subgroup of giant intracranial aneurysms with specific radiological and surgical features. Previous reports have stressed the predilection of these lesions for the carotid circulation, particularly the middle cerebral artery. Two cases of serpentine aneurysm affecting the posterior circulation are reported and the problems of diagnosis and treatment of this lesion are discussed.
British Journal of Neurosurgery 02/1990; 4(3):217-23. · 0.88 Impact Factor
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ABSTRACT: To assess the accuracy of CT in diagnosis and staging of renal cell carcinoma, the surgical findings and CT scans were compared retrospectively in 21 patients. In 17 cases diagnosed as renal cell carcinoma by CT criteria, 14 were verified at surgery and accurate staging information was given in 11. In four cases renal cell carcinoma was given as a differential diagnosis by CT and none had the tumour.
European Journal of Radiology 09/1987; 7(3):165-8. · 2.61 Impact Factor
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ABSTRACT: Forty patients, mainly post-operative, were examined for suspected leakage from the oesophagus and/or stomach using iopamidol. Oesophageal leaks were demonstrated in seven patients, tracheo-oesophageal fistulae in two and an unsuspected gastro-jejunostomy intusussception in one. Only two cases were regarded as technically unsatisfactory due to poor coating. Normal examinations were found in 28 (70%) patients. This was confirmed by the subsequent clinical course. Aspiration into the bronchial tree occurred in five (12.5%) patients without ill-effects. Furthermore no adverse side effects as a result of the administration of iopamidol were recorded. It is concluded that a non-ionic medium such as iopamidol is the agent of choice in the detection of oesophageal and gastric perforation, particularly in post-operative patients where there is an increased risk of aspiration.
Clinical Radiology 04/1987; 38(2):165-8. · 1.95 Impact Factor
