The British journal of radiology (Br J Radiol)
The British Journal of Radiology is the official peer reviewed journal of the British Institute of Radiology covering all clinical and technical aspects of diagnostic imaging, radiotherapy and radiobiology.
Journal Impact: 2.22*
Journal impact history
|2016 Journal impact||Available summer 2017|
|2015 Journal impact||2.22|
|2014 Journal impact||2.65|
|2013 Journal impact||2.07|
|2012 Journal impact||1.28|
|2011 Journal impact||1.58|
|2010 Journal impact||1.65|
|2009 Journal impact||1.85|
|2008 Journal impact||1.79|
|2007 Journal impact||1.09|
Journal impact over time
|Website||British Journal of Radiology website|
|Other titles||British journal of radiology (Online), The British journal of radiology, BJR|
|Material type||Document, Periodical, Internet resource|
|Document type||Internet Resource, Computer File, Journal / Magazine / Newspaper|
Publications in this journal
- [Show abstract] [Hide abstract] ABSTRACT: Objectives: Hypertension is the leading attributable cause of cardiovascular mortality worldwide. Hypertensive patients have multiple co-morbidities including high rates of concomitant renal disease. Current pharmacological approaches are inadequate in the treatment of resistant hypertension. Renal sympathetic denervation (RDN) has been shown to effectively treat resistant hypertension. The traditional use of iodinated contrast in RDN is contraindicated in patients with significant renal insufficiency. In patients with renal impairment carbon dioxide (CO2) angiography can be used as an alternative contrast material for RDN. This article describes the technical aspects of renal sympathetic denervation using CO2 angiography. Methods: Our centre is experienced in the innovative RDN procedure using CO2 angiography. We describe the protocol for CO2 angiography for RDN using a homemade CO2 delivery system and the Symplicity(TM) catheter (Medtronic) device. Conclusions: Carbon dioxide (CO2) angiography for RDN is a safe and effective alternative to iodinated contrast. RDN using CO2 angiography is an easy and feasible procedure that can be used in patients with renal insufficiency or iodinated contrast allergies. Advances in knowledge: There is a paucity of descriptive reports for CO2 angiography for RDN and we provide details of the optimal protocol for the procedure. In particular, we describe the use of a Symplicity Spyral(TM) catheter (Medtronic), which has not been reported to date for use in this procedure.
- [Show abstract] [Hide abstract] ABSTRACT: Objectives: Cockayne syndrome (CS) is a rare disorder characterized by severe brain atrophy, white matter hypomyelination, and basal ganglia calcifications. This study aimed to quantify atrophy and white matter abnormalities using diffusion tensor imaging (DTI) and volumetric analysis, to evaluate possible differences between CS subtypes, and to determine if DTI findings may correspond to a hypomyelinating disorder. Methods: Fourteen CS patients and 14 controls underwent brain MRI including DTI and a volumetric 3D T1-weighted sequence. DTI analysis was made through ROIs within the whole brain to obtain fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values, and in the left centrum semiovale to obtain DTI eigenvalues. A Student's t-test was used to compare patients and controls, and CS subtypes. Given the small number of CS patients, they were pooled in two groups: moderate (CS1/CS3) and severe (CS2/COFS (cerebro-oculo-facio-skeletal syndrome)). Results: Total brain volume in CS was reduced by 57%, predominantly in the infratentorial area (68%) (p <0.001). Total brain volume reduction was greater in the severe group, but there was no difference in the degree of infratentorial atrophy in the two groups (p = 0.7). Mean FA values were lower, whereas ADC was higher in most of the white matter in CS patients (p <0.05). ADC in the splenium of the corpus callosum and the posterior limb of the internal capsule, and FA in the cerebral peduncles were significantly different between the two groups (p <0.05). Mean ADC values corresponded to a hypomyelinating disorder. All DTI eigenvalues were higher in CS patients, mainly for transverse diffusivity (+51%) (p <0.001). Conclusions: DTI and volumetric analysis provide quantitative information for the characterization of CS, and may be particularly useful for evaluating therapeutic intervention. Advances in knowledge: DTI combined with volumetric analysis provides additional informations useful not only for characterization of Cockayne syndrome and distinction of clinical subtypes but also to monitor therapeutic interventions.
- [Show abstract] [Hide abstract] ABSTRACT: Objectives: To investigate the efficacy of the Radial Acquisition Regime (RADAR) for acquiring head and neck MR images. Methods: Fifteen healthy volunteers underwent imaging with 4 sequences (fast spin-echo [FSE] -T2WI, RADAR-T2WI, Single-shot [SS] -EPI-DWI, and RADAR-DWI). Both standard images and images during periodic mouth motion were acquired. Two radiologists scored the overall image artifacts and detectability of several anatomical structures without knowledge of sequence type. For each sequence, image distortion was quantitatively compared by the anterior-posterior to right-left ratio of several anatomical structures. Mean scores of artifacts and distortion of several anatomical structures were compared using the multiple comparison test. The detectabilities were compared using the Wilcoxon signed-rank test. Results: Regardless of mouth motion, RADAR-T2WI was significantly superior to FSE-T2WI in artifacts and oral-area detectability (p<0.01), and RADAR-DWI was significantly superior to SS-EPI-DWI in terms of artifacts (p<0.01). In terms of image distortion, RADAR-DWI were significantly superior to SS-EPI-DWI (p<0.01). Conclusion: RADAR-T2WI could replace FSE-T2WI as a conventional T2WI protocol for the head and neck. For the RADAR-DWI sequence, validation studies are needed. Advances in knowledge: RADAR-T2WI was superior to FSE-T2WI with regard to artifacts and detectability, and RADAR-DWI was superior in terms of artifacts compared with SS-EPI-DWI.
- [Show abstract] [Hide abstract] ABSTRACT: Objectives: There is no consensus approach to covering skull-base meningeal reflections - and CSF therein - of posterior fossa cranial nerves (CN's VII-XII), when planning RT for medulloblastoma and ependymoma. We sought to determine whether MRI and specifically FIESTA sequences can answer this anatomical question and guide RT planning. Methods: Ninety-six posterior fossa FIESTA sequences were reviewed. Following exclusions, measurements were made on the following scans for each foramen respectively (left, right); internal acoustic meatus (IAM) (86, 84), jugular foramen (JF) (83, 85) and hypoglossal canal (HC) (42, 45). A protocol describes measurement procedure. Two observers measured distances for 5 cases and agreement was assessed. One observer measured all the remaining cases. Results: IAM and JF measurement inter-observer variability was compared. Mean measurement difference, between observers was -0.275mm (s.d. 0.557). IAM and JF measurements were normally distributed. Mean IAM distance was 12.2mm (95% CI 8.8 - 15.6), JF was 7.3mm (95% CI 4.0 - 10.6). The HC was difficult to visualise on many images and data followed a bimodal distribution. Conclusions: Dural reflections of posterior fossa CN's are well demonstrated by FIESTA MRI. Measuring CSF extension into these structures is feasible and robust; mean CSF extension into IAM and JF was measured. We plan further work to assess coverage of these structures with photon and proton RT plans. Advances in knowledge: We have described CSF extension beyond the internal table of the skull into the IAM, JF & HC. Oncologists planning RT for patients with medulloblastoma and ependymoma may use this data to guide contouring.
- [Show abstract] [Hide abstract] ABSTRACT: Objective: Compared to echo planar (EP) diffusion-weighted imaging (DWI), three-dimensional (3D) turbo field echo with diffusion-sensitized driven-equilibrium (DSDE-TFE) preparation DWI obtains images with higher spatial resolution and less susceptibility artifacts. The purpose of this study was to evaluate feasibility of DSDE-TFE to visualize retinoblastomas compared to EP imaging. Methods: This retrospective study was approved by our institutional review boards. Eight patients with retinoblastomas (five boys and three girls; age range 0-87 month old; median 21 month) were studied. For the DSDE-TFE, motion probing gradients (MPGs) were conducted at one direction with b-values of 0 and 500 s/mm(2) and a voxel size of 1.5×1.5×1.5 mm(3). For the EP imaging, MPGs were conducted at three directions with b-values of 0 and 1000 s/mm(2) and a voxel size of 1.4×1.8×3 mm(3). The apparent diffusion coefficients (ADCs) of each lesion were measured. Statistical analyses were performed with Pearson R and linear correlation coefficients. Results: Intraocular lesions were clearly visualized on the DSDE-TFE without obvious geometrical distortion, whereas all showed deformity on EP images. On the DSDE-TFE, the ADCs of the lesions ranged from 0.83×10(-3) mm(2)/s to 2.93×10(-3) mm(2)/s (mean ± SD; 1.73±0.73×10(-3) mm(2)/s). On the EP images, the ADCs ranged from 0.53×10(-3) mm(2)/s to 2.03×10(-3) mm(2)/s (0.93±0.53×10(-3) mm(2)/s). There was a significant correlation in ADC measurement between the DSDE-TFE and EP imaging (r = 0.81, p < 0.05). Conclusion: With its insensitivity to field inhomogeneity and high spatial resolution, the 3D DSDE-TFE technique enabled us to assess diffusivity in retinoblastomas. Advances in knowledge: DSDE-TFE could enable us to assess ADC of retinoblastomas without obvious geometrical distortion.
- [Show abstract] [Hide abstract] ABSTRACT: Objectives: During precision irradiation of a preclinical lung tumor model, the tumor is subject to breathing motion and it can partially move out of the irradiation field. This work aimed to perform a quantitative analysis of the impact of respiratory motion on a mouse lung tumor irradiation with small fields. Methods: A 4D digital mouse whole body (MOBY) phantom with a virtual 4 mm spherical lung tumor at different locations in both lungs is used to simulate a breathing anesthetized mouse in different breathing phases representing a full breathing cycle. The breathing curve is determined by fluoroscopic imaging of an anesthetized mouse. Each MOBY time frame is loaded in a dedicated treatment planning system (SmART-Plan) and is irradiated by a full arc with a 5 mm circular collimator. Mean and time-dependent organ doses are calculated for the tumor, heart and spinal cord. Results: Depending on the location of the lung tumor, an overestimation of the mean tumor dose up to 11% is found. The mean heart dose could be both over or underestimated because the heart moves in or out of the irradiation field depending on the beam target location. The respiratory motion does not affect the mean spinal cord dose. A dose gradient is visible in the time-dependent tumor dose distribution. Conclusions: In the future new methods need to be developed to track the lung tumor motion before pre-clinical irradiation to adjust the irradiation plan. Margins, collimator diameter and target dose could be changed easily, but they all have their drawbacks. State-of-the-art clinical techniques as respiratory gating or motion tracking may offer a solution for the cold spots in the time-dependent tumor dose. Advances in knowledge: A suitable method is found to quantify changes in organ dose due to respiratory motion in mouse lung tumor image-guided precision irradiation.
- [Show abstract] [Hide abstract] ABSTRACT: Objectives: To compare signal-to-noise-ratio (SNR), contrast-to-noise-ratio (CNR), conspicuity values as well as subjective image quality characteristics of Silent MRI and conventional MRI in vascular and neoplastic brain disorders at 3 Tesla. Methods: 26 patients with neurological symptoms were prospectively examined with a 3T wide bore MRI. New Silent Scan technology was added to standardized MR protocol with conventional MR sequences. Silenz T1w and Silent T2w Propeller sequences were compared to standard T1w and T2w sequences. Evaluation of images was performed quantitatively by calculation of SNR, CNR, conspicuity values and also by visual assessment on a 4-point scale with regard to visibility and delineation of lesions, grey-white differentiation and diagnostic usefulness. Quantitative data was analysed using a Wilcoxon signed-rank test. Visual assessment data was analysed using a Sign test. p ≤ 0.05 was considered to be statistically significant. Results: Silent MRI demonstrated decreased SNR and increased CNR on Silenz T1w compared to standard T1w, with statistically significant differences in SNRparenchyma and SNRlesion ( p=0.000) as well as CNRlesion (p=0.003). Silent T2w showed significantly better SNR and CNR values than did standard T2w imaging (SNRparenchyma, p=0.014; SNRlesion, p=0.005; CNRlesion, p=0.005). Conspicuity values on Silenz T1w and Silent T2w were not significantly different from conventional T1w and T2w imaging. Analysis of visual image quality assessment (merged from ratings by three readers using a majority decision) revealed Silenz T1w imaging to be significantly superior in terms of grey-white-differentiation (p=0.000), lesion visibility (p=0.003) and overall diagnostic usefulness (p=0.001) in favour of Silenz T1w versus T1w. In terms of Silent T2w versus T2w, there was a significant difference in grey-white differentiation in favour of Silent T2w (p=0.016). In the other categories no significance was detected. Conclusions: Silent Scan technology is suitable for 3T MRI. It demonstrates comparable image quality characteristics to conventional MR sequences. Advances in knowledge: Newly available Silent Scan for brain MR imaging has comparable diagnostic value to conventional MR sequences. In contrast to conventional MR imaging, it has the advantage of a quiet MR examination by its scan design which might improve patients' MR experience.
- [Show abstract] [Hide abstract] ABSTRACT: Objective: A long-lasting concern has prevailed for the identification of predictive biomarkers for high-grade gliomas (HGGs) using magnetic resonance (MR) imaging. However, a consensus of which imaging parameters assemble a significant survival model is still missing in the literature; we investigated the significant positive or negative contribution of several MR biomarkers in these tumors prognosis. Methods: A retrospective cohort of supratentorial HGGs (11 GBM and 17 anaplastic astrocytomas) included 28 patients (females and males, 9 and 19 respectively, with a mean age of 50.4 years, SD: 16.28; range: 13 - 85 y). Edema and viable tumor measurements were acquired using ROIs in T1-w, T2-w, Flair, apparent diffusion coefficient (ADC) and MR Spectroscopy. We calculated Kaplan-Meier curves and obtained Cox´s proportional hazards. Results: During the follow-up period (3 to 98 months) 17 deaths were recorded. The median survival time was 1.73 years (range, 0.287-8.947 years). Only 3 out of 20 covariates (Choline-to-N-acetyl aspartate and lipids-lactate-to-creatine ratios, and age) showed significance to explain the variability in the survival hazards model, score test: χ(2) (3) = 9.098, p = .028. Conclusions: MR-spectroscopy metabolites overcome volumetric parameters of peritumoral edema and viable tumor, as well as tumor-regions ADC measurements. Specific MRS ratios (Cho/Naa, L-L/Cr) might be considered in a regular follow-up for these tumors. Advances in knowledge: Cho/Naa ratio is the strongest survival predictor with a log-hazard function of 2.672 in GBM. Low levels of lipids-lactate/Cr ratio represents up to a 41.6% reduction in the risk of death in GBM.
- [Show abstract] [Hide abstract] ABSTRACT: Objectives: To investigate the usefulness of fusion imaging of contrast-enhanced ultrasound (CEUS) and CECT/or CEMRI before percutaneous ultrasound (US)-guided radiofrequency ablation (RFA) for liver cancers. Methods: 45 consecutive patients with 70 liver lesions were included between March 2013 and October 2015 and all the lesions were identified on CEMRI/CECT prior to inclusion in the study. Planning US for percutaneous RFA was performed using conventional US, US-CECT/CEMRI and CEUS-CECT/CEMRI fusion imaging respectively during the same session. The numbers of the conspicuous lesions on US and fusion imaging were recorded. RFA was performed according to the results of fusion imaging. Complete response (CR) rate was calculated and the complications were recorded. Results: On conventional US, 25 (35.7%) of the 70 lesions were conspicuous whereas 45 (64.3%) were inconspicuous. US-CECT/CEMRI fusion imaging detected additional 24 lesions thus increased the number of the conspicuous lesions to 49 (70.0%) (70.0% vs. 35.7%; P < 0.001 in comparison with conventional US). With the use of CEUS-CECT/CEMRI fusion imaging, the number of the conspicuous lesions further increased to 67 (95.7%, 67/70) (95.7% vs. 70.0%, 95.7% vs. 35.7%; both P < 0.001 in comparison with US and US-CECT/CEMRI fusion imaging respectively). With the assistance of CEUS-CECT/CEMRI fusion imaging, the confidence level of the operator for performing RFA improved significantly with regard to visualization of the target lesions (P = 0.001). The CR rate for RFA was 97.0% (64/66) in accordance to the CECT/CEMRI results one month later. No procedure-related deaths and major complications occurred during and after RFA. Conclusion: Fusion of CEUS and CECT/CEMRI improves the visualization of those inconspicuous lesions on conventional US. It also facilitates improvement in the RFA operators' confidence and CR of RFA. Advances in knowledge: CEUS-CECT/CEMRI fusion imaging is better than both conventional US and US-CECT/CEMRI fusion imaging for lesion visualization and improves the operator confidence, thus it should be recommended to be used as a routine in US-guided percutaneous RFA procedures for liver cancer.
- [Show abstract] [Hide abstract] ABSTRACT: Objective: To assess the role of contrast enhanced dual energy spectral mammogram (CEDM) as a problem solving tool in equivocal cases. Methods: 44 consented women with equivocal finding on full field digital mammogram underwent CEDM. All the images were interpreted by two radiologists independently. Confidence of presence was plotted on a three point Likert scale and probability of cancer was assigned on BIRADS scoring. Histopathology was taken as gold standard. Statistical analysis of all variables was performed. Result: 44 breast lesions were included in the study, among which 77.3% were malignant/precancerous and 22.7 % were benign/inconclusive. 20 % of lesions were identified only on CEDM. True extent of the lesion was made out in 15.9 % of cases, multifocality was established in 9.1 % of cases and ductal extension was demonstrated in 6.8 % of cases. Statistical p value for CEDM was <0.05, significant. Interobserver kappa value was 0.837. Conclusion: CEDM has a useful role in identifying occult lesions in dense breasts and in triaging lesions. In a mammographically visible lesion, CEDM characterizes the lesion, affirms the finding and better demonstrates response to treatment. Hence we conclude that CEDM is a useful complementary tool to standard mammogram. Advance in knowledge: CEDM can detect and demonstrate lesions even in dense breasts with advantage of feasibility of stereotactic biopsy in the same setting. Hence it has the potential to be a screening modality with need for further studies and validation.
- [Show abstract] [Hide abstract] ABSTRACT: Objectives: This study aims to assess the effect of sensory stimulation on patient MRI experience, and to assess whether sensory stimulation has a significant effect on MR image quality. Methods: Case-control study conducted over 4 months, involving patients undergoing MRI brain, cervical spine, breast and prostate. N=106 patients, 64 cases and 42 controls. Cases underwent sensory stimulation during the scan in the form of a scented cotton pad placed in the scanner near their head and/or calming bird noises played over headphones. Post scan, participants completed a questionnaire regarding their experience of MRI. Scanning radiographers completed a questionnaire regarding patient tolerance of the scan. All studies were evaluated by 2 radiologists for the presence of movement artefact. Results: 39% of cases and 38% of controls reported anxiety in the days preceding MRI. 6.2% of cases required coaching during image acquisition, while 9.7% of controls required coaching.4.7% of cases and 4.8% controls required sequence repetition due to movement artefact. Mean patient experience score (as graded by the patient) for controls was 1.74 +/-0.63 SD and for cases was 1.67 +/-0.60 SD. (Lower assigned scores equated to a better experience.) Mean patient experience score based on comments on a 5 point scale as graded by two observers was 2.81 +/- 0.70 SD for controls, 2.42+ 0.94 SD for sound intervention and 2.46 +/- 1.01 SD for scent intervention. Mean motion artefact score graded by the two radiologists was 1.13 +/-0.53 SD for controls and 1.08 +/-0.36 SD for cases. (A lower score equated to less movement artefact). We demonstrated a trend towards a relaxing experience in those patients undergoing MRI for the first time who underwent sensory intervention. Participants positive ratings of the smell pleasantness were associated with a reduced likelihood of experiencing anxiety (p=0.13). Results were not statistically significant Conclusion: This study demonstrated a subjectively improved experience of MRI for some patients with the intervention of sound and smell. The study failed to show a significant decrease in patient movement during MRI investigations. This may relate to the small study size and a low level of patient movement in the case group. Advances in knowledge: Sound and olfactory sensory environment interventions at MRI can improve the patient experience. These low cost interventions are well tolerated, may improve acceptance of MRI in patients with anxiety, and offer a competitive advantage to imaging centres.
- [Show abstract] [Hide abstract] ABSTRACT: Objective: Determine the mean and normal range of anterior-posterior diameter (APD) of renal pelves in children. Methods: Patients aged 0-19 years with normal spinal MRIs were identified after IRB approval. Those with dilating uropathy or abdominal surgery/radiation were excluded. The maximum APD was measured. A mixed linear model was fit to determine the relationship between APD and age, adjusted for bladder distention. Left and right kidneys were treated independently. Results: 283 left and 285 right renal units were included. For the left, a 3.5% increase in APD per year was predicted (p<0.0001), with the average APD for infants and 18 year olds with non-distended bladders being 2.5 (95(th) percentile: 7.2) and 4.6 (13.4) mm, respectively. For the right, a 3.9% increase in APD per year was predicted (p<0.0001), with the average APD for infants and 18 year olds with non-distended bladders being 2.8 (8.4) and 5.5 (16.6) mm, respectively. Compared to a non-distended bladder, a distended bladder increased the predicted APD between 23% (right) and 38% (left) (p=0.01 and p<0.0001, respectively). Conclusion: The mean and normal ranges of APD measured by MRI in children is provided. APD increases with age and bladder distension, and is greater on the left. Advances in knowledge: This paper establishes normative ranges for APD, a critical component of genitourinary tract evaluation, and does so using the most precise imaging modality for this condition.
- [Show abstract] [Hide abstract] ABSTRACT: Animal modelling is essential to the study of radiobiology and the advancement of clinical radiation oncology by providing preclinical data. Mouse models in particular, have been highly utilized in the study of both tumour and normal tissue radiobiology because of their cost effectiveness and versatility. Technology has significantly advanced in preclinical radiation techniques to allow highly conformal image guided irradiation of small animals in an effort to mimic human treatment capabilities. However, the biological and physical limitations of animal modelling should be recognized and considered when interpreting preclinical radiotherapy studies. Murine tumour and normal tissue radioresponse has been shown to vary from human cellular and molecular pathways. Small animal irradiation techniques utilize different anatomical boundaries and may have different physical properties than human radiotherapy. This review addresses the difference between the human condition and mouse models and discusses possible strategies for future refinement of murine models of cancer and radiation for the benefit of both basic radiobiology and clinical translation.
- [Show abstract] [Hide abstract] ABSTRACT: Contrast-enhanced Ultrasound (CEUS) represents a complementary technique to grey-scale and colour Doppler ultrasonography (US) which allows for real-time visualization and characterization of tissue perfusion. Its inherent advantages in the child makes US an ideal imaging modality; repeatability and good tolerance along with the avoidance of computed tomography (CT), a source of ionizing radiation, renders US imaging desirable. Although currently paediatric CEUS is principally used in an "off-label" manner, US contrast agents have received regulatory approval for assessment of paediatric focal liver lesions in the United States of America. The safety of ultrasound contrast-agents is well documented in adults, as safe as or even surpassing the safety profile of CT and magnetic resonance (MR) contrast agents. Except for the established intracavitary use of CEUS in voiding urosonography, intravenous paediatric applications have been introduced with promising results in abdominal trauma initial diagnosis and follow-up, characterization and differential diagnosis of focal liver lesions, characterization of lung, pleura, renal and splenic pathology. CEUS has also been used to detect complications after paediatric transplantation, evaluate inflammatory bowel disease activity and assess tumour response to antiangiogenic therapy. The purpose of this review is to present these novel intravenous paediatric applications of CEUS and discuss their value.
- [Show abstract] [Hide abstract] ABSTRACT: Objectives: This study aimed to determine whether a reduction in radiation dose was found whilst maintaining a clinically acceptable level of image quality for trans-catheter aortic valve implantation (TAVI) patients using a new cardiac interventional X-ray system with state-of-the-art image enhancement and X-ray optimisation, compared to the cardiac X-ray system which was previously used for TAVI (the reference system). Methods: Patient dose and image data were retrospectively collected from an AlluraClarity (Philips Healthcare) and Axion Artis (Siemens Healthcare), the new and reference X-ray systems respectively. Patient procedure dose area product (DAP) and fluoroscopy duration of 41 patient cases from each X-ray system were compared using a Wilcoxon test on median values. Significant reductions in patient dose (p<0.001) were found for the new system with no significant change in fluoroscopy duration (p=0.052); procedure DAP reduced by 55%, fluoroscopy DAP by 48% and "cine" acquisition DAP by 61%. Ten patient aortograms from each X-ray system (20 total) were scored by 32 observers on a continuous scale to assess the clinical image quality at the given phase of the TAVI procedure. Scores were dichotomised by acceptability and analysed using a Chi-squared test; there was no significant difference between the two X-ray systems (p=0.06). Conclusions: The new cardiac X-ray system demonstrated a very significant reduction in patient dose with no loss of clinical image quality. Advances in knowledge: The huge growth of TAVI may impact on the radiation exposure incurred by cardiac patients and particularly on operators including not only interventional cardiologists, also anaesthetists for TAVI procedures; the cumulative exposure to interventional cardiologists performing high volume TAVI over a 30 - 40 year career may be harmful. The Phillips Clarity upgrade including improved digital image enhancement and optimised X-ray settings significantly reduced the amount of radiation used without reducing clinically acceptable image quality.
- [Show abstract] [Hide abstract] ABSTRACT: Objective: The objectives of this article are: (1) to review common and rare manifestations of systemic and pulmonary Langerhans cell histiocytosis, Rosai-Dorfman disease, Erdheim-Chester disease and juvenile xanthogranuloma; (2) to provide the reader with important pathologic, epidemiologic and clinical features of these diseases. Conclusion: The histiocytoses are a diverse group of diseases which typically manifest with multiorgan involvement. Understanding the pathologic, epidemiologic, and clinical features of these entities can help the radiologist suggest an accurate diagnosis of histiocytosis when typical imaging features are encountered.
- [Show abstract] [Hide abstract] ABSTRACT: Objective: To estimate the risks and benefits of breast screening in terms of number of deaths due to radiation-induced cancers and the number of lives saved due to modern screening in the National Health Service Breast Screening Programme (NHSBSP) in England. Methods: A radiation risk model, patient dose data and data from national screening statistics were used to estimate the number of deaths due to radiation induced breast cancers in the NHSBSP in England. Dose and dose effectiveness factors (DDREFs) equal to one and two were assumed. The breast cancer mortality reduction in the invited population due to screening and the percentage of women diagnosed with symptomatic breast cancer, who die from the breast cancer were collated from the literature. The number of lives saved due to screening was calculated. Results: Assuming, a total of 1,770,436 women between the ages of 50-70 years were screened each year, and a breast cancer mortality reduction of 20% due to screening in the invited population, the number of screen-detected cancers annually was 14,872 resulting in 1071 lives saved. Conversely, for the same mortality reduction, the number of radiation-induced cancers was 36 and 18 for DDREFs of 1 and 2 respectively. This resulted in 7 and 3 deaths due to radiation induced cancers annually for DDREFs of 1 and 2 respectively. The ratios of lives saved due to screening to radiation-induced cancers were 30:1 and 60:1 for DDREFs of 1 and 2. The ratios of lives saved due to screening to deaths due to radiation-induced cancers were 156:1 and 312:1 for DDREFs of 1 and 2. For the 1.8% of the screening population with very thick breasts, the latter ratios decrease to 94:1 and 187:1 for DDREFs of 1 and 2. Conclusion: The breast cancer mortality reduction due to screening greatly outweighs the risk of death due to radiation-induced cancers. Advances in knowledge: Estimation of the radiation risk for modern breast screening in England using digital mammography.
- [Show abstract] [Hide abstract] ABSTRACT: Objectives: To assess the clinical feasibility of whole body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) for diagnosis and prediction of complete tumour resection in patients with suspected recurrent ovarian cancer. Methods: Fifty-one women clinically suspected for ovarian cancer recurrence underwent 3-Tesla WB-DWI/MRI in addition to contrast-enhanced computed tomography (CT). WB-DWI/MRI was assessed for detection of tumour recurrence, -prediction of tumour extent and complete resection compared to CT. Tumour presence was confirmed by pathology obtained by surgery or biopsy, or by imaging follow-up. Results: WB-DWI/MRI showed 94% accuracy for detecting ovarian cancer recurrence, compared to78% for CT (p=0.008). WB-DWI/MRI showed better sensitivity (Sens (%) [95% CI]) than CT for detecting involvement of surgically-critical tumour sites including mesenteric root infiltration (92 [62-100] versus 31 [10-61]), small bowel (93 [64-100] versus 21 [6-51]),colon carcinomatosis (91 [57-100] versus 27 [7-61]) and irresectable distant metastases (90 [54-99] versus 20 [4-56]). WB-DWI/MRI correctly predicted complete resection in 33 of 35 (94%) patients eligible for salvage surgery compared 17 of 35 (49%) for CT (p<0.001). Conclusions: WB-DWI/MRI allowed better detection of ovarian cancer recurrence and better prediction of complete resection compared to CT. Advances in knowledge: WB-DWI/MRI could assist in optimizing treatment planning for recurrent ovarian cancer, particularly by improving patient selection for salvage surgery, thus giving eligible patients the highest chance on prolonged survival and refraining patients who would not benefit from extensive surgery reducing related morbidity and mortality.
- [Show abstract] [Hide abstract] ABSTRACT: Intracranial arterial pathology has traditionally been evaluated with luminal imaging. Recently, high-resolution vessel wall imaging (HR-VWI) with MRI has facilitated sub-millimeter evaluation of the arterial walls. This technique can help differentiate various causes of intracranial steno-occlusive disease, identify culprit atherosclerotic plaques with a recent cerebral infarct, locate vessel wall pathology in areas with minimal or no narrowing on luminal imaging, predict aneurysm stability, and identify a ruptured aneurysm when multiple aneurysms are present. Interpretation of HR-VWI exams requires a solid understanding of the pathophysiology, clinical features, serum and CSF laboratory findings, treatment administered, and fundamental patterns of vessel wall imaging abnormalities that may be encountered with the intracranial vasculopathies. This pictorial essay aims to illustrate the essential findings of common conditions encountered with HR-VWI including intracranial atherosclerosis, moyamoya disease, intracranial vasculitis, varicella zoster vasculopathy, reversible cerebral vasoconstriction syndrome, and aneurysms.
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