Anmol Malhotra

• FRCR
• Consultant at Royal Free London NHS Foundation Trust

Background: The increasing detection of non-palpable breast lesions necessitates accurate preoperative localization to ensure complete excision while preserving healthy tissue and optimizing cosmetic outcomes. Traditional wire-guided localization (WL) has been the gold standard; however, it has several drawbacks, including patient discomfort and sc...

Background: The increasing detection of non-palpable breast lesions necessitates accurate preoperative localization to ensure complete excision while preserving healthy tissue and optimizing cosmetic outcomes. Traditional wire-guided localization (WL) has been the gold standard; however, it has several drawbacks, including patient discomfort and sc...

Simple Summary Preoperative chemotherapy significantly improves response rates in early breast cancer, challenging the traditional approach of invasive axillary surgery in patients presenting with node-positive disease. Wire-free localisation markers can successfully mark lymph nodes at diagnosis. Our findings demonstrate that these markers are suc...

Breast implant augmentation is a low-risk procedure with few life-threatening complications, most commonly rupture or leakage and contraction of the capsule. Breast implant-associated (BIA) malignancies are rare. Anaplastic large cell lymphoma (ALCL) is the most well-known neoplastic condition associated with breast augmentation. Carcinomas arising...

Bone is the most common site for breast cancer metastases, occurring in up to 70% of patients, who have metastatic disease. The treatment of advanced breast cancer with bony metastases has significant health and economic implications including the costs of imaging, systemic therapy, and hospital admission. Therefore, accurate interpretation of resp...

Introduction Ventral wall hernia often causes significant morbidity and requires complex abdominal wall reconstruction (AWR). In this study, we sought to determine whether subcutaneous abdominal fat thickness (AFT) measured with preoperative CT scans could predict postoperative outcomes in patients undergoing AWR. Methods A retrospective cohort st...

Aim Abdominal wall reconstruction (AWR) is a surgical technique used to manage recurrent incisional hernias, which cause significant morbidity and are difficult to treat. In this study, we sought to determine whether subcutaneous abdominal fat thickness (AFT) measured at the xiphoid process, umbilicus, and pubic tubercle using preoperative CT scans...

Breast tuberculosis is an extremely rare entity representing less than 0.1% of all breast disease in developed countries ¹ . Tuberculous infections within the United Kingdom have seen a steady decline with the highest rates present within North West London where infection rates reach 24.8 per 100000 ² . The presentation can mimic malignancy and lym...

A number of COVID-19 vaccines have been approved worldwide to help tackle the pandemic. As with many vaccines, this causes a reactive axillary lymphadenopathy which can mimic potentially metastatic disease in a breast screening patient. It is therefore important to be aware of this side-effect of the vaccination when evaluating the axilla in a brea...

Wire-guided localisation (WGL) has been the mainstay for localising non-palpable breast lesions before excision. Due to its limitations, various wireless alternatives have been developed. In this prospective study, we evaluate the role of radiation-free wireless localisation using the SAVI SCOUT® system at the London Breast Institute. A total of 72...

We present a multimodality pictorial review of axillary lymphadenopathy in patients recently vaccinated against COVID-19. As the mass vaccination programme continues to be rolled out worldwide in an effort to combat the pandemic, it is important that radiologists consider recent COVID-19 vaccination in the differential diagnosis of unilateral axill...

We report a case series of biopsy-proven reactive axillary lymph nodes, which were avid on FDG PET/CT in breast cancer patients post COVID-19 vaccination. With 4 cases presenting in a consecutive 10-day period, it became apparent that metabolically active axillary lymphadenopathy is an adverse effect of COVID-19 vaccines, currently being deployed w...

Magnetic resonance imaging (MRI) in patients with breast cancer to assess extent of disease or multifocal disease can demonstrate indeterminate lesions requiring second-look ultrasound and ultrasound or MRI-guided biopsies. Prone positron emission tomography-computed tomography (PET-CT) is a dedicated acquisition performed with a breast-supporting...

Magnetic resonance imaging (MRI) in patients with breast cancer to assess extent of disease or multifocal disease can demonstrate indeterminate lesions requiring second-look ultrasound and ultrasound or MRI-guided biopsies. Prone positron emission tomography-computed tomography (PET-CT) is a dedicated acquisition performed with a breast-supporting...

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Background: Wire-guided localization (WGL) has been the mainstay for localizing non-palpable breast lesions before excision. Due to its limitations, various wireless alternatives have been developed. In this prospective study, we evaluate the role of radiation-free wireless localization using the SAVI SCOUT® localization at a European centre. Pat...

COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A global pandemic was declared by the World Health Organisation on 11 March 2020. Approximately 30% of infected individuals are asymptomatic.¹ We present the case of a 68-year-old female who underwent outpatient breast magnetic resonance (MR) i...

Photodynamic therapy (PDT) is a technique for producing localized necrosis with light after prior administration of a photosensitizing agent. This study investigates the nature, safety, and efficacy of PDT for image-guided treatment of primary breast cancer. We performed a phase I/IIa dose escalation study in 12 female patients with a new diagnosis...

Background/aim: Wire-guided localisation (WGL) has been the mainstay for localisation of clinically occult breast lesions before excision. However, it has restrictive scheduling requirements, and causes patient discomfort. This has prompted the development of various wireless alternatives. In this prospective study we shall evaluate the role of ra...

Background: Wire-guided localisation (WGL) remains the most widely used technique to guide surgical excision of non-palpable breast lesions worldwide. However, recent technological advances have led to the advent of less invasive radiation-free localisation methods to overcome the limitations of WGL. Patients and methods: This study prospectivel...

The radiological features of systematic disease may mimic those of breastmalignancy givingrise todiagnostic challenges, even if the underlying disease is known. Features of systematic disease may be apparent on mammography, ultrasound, CT and MRI. It is therefore importantfor radiologists to distinguish some of the key imaging features associated w...

Chest wall lesions may be caused by a range of entities including neoplastic, vascular and inflammatory. Due to the intimate anatomical relationship between the chest wall and the breast, chest wall lesions may be inadvertently referred to breast clinic as a suspected breast lump. In these instances, clarification of the exact anatomical origin o...

ILC of the breast is the 2nd most common histological type of breast carcinoma and demonstrates a variable prevalence accounting for approximately 10% of all breast cancers. Diagnosis can be problematic as lesions are often multicentric and poorly circumscribed, failing to form discrete masses. Lesions may appear benign, or on occassion be complet...

Breast carcinoma metastasis to the thyroid

DIEP failures despite imaging. cause?

Background: Photodynamic therapy (PDT) has been used to treat skin metastases from breast cancer. We investigated the use of PDT for the treatment of primary breast cancer. Trial design: Phase I/IIA, open label, non-randomised, single site, light dose escalation trial in patients with primary breast cancer using verteporfin as the photosensitiser....

Invasive breast cancers can be mammographically occult and can present with benign features on ultrasound. Breast MRI detects most invasive breast cancers but it is important to recognise that there are a small number of false negatives.

The latissimus dorsi flap, first performed by Tansini in 1892, was popularised for use by Olivari in 1976. The successful transfer of a latissimus dorsi flap during breast reconstruction has previously been thought to be dependent on having an intact thoracodorsal pedicle to ensure flap survival. It is well documented that the flap may also survive...

Aims: To define the clinical benefits to the patient of preoperative imaging planning for deep inferior epigastric perforator (DIEP) flap reconstruction. Materials and methods: Since 2009 computed tomography angiography (CTA) has been provided for the preoperative planning of DIEP flap breast reconstruction in the largest plastic surgery unit in...

Currently, there is a lack of data on the role of combined positron emission tomography-computed tomography (PET-CT) in the staging of early invasive primary breast cancer. We therefore evaluated the role of (18)F-fluorodeoxyglucose ((18)F-FDG)-PET-CT in this patient population. We prospectively recruited 70 consecutive patients (69 women, one man;...

Tumour angiogenesis is an independent and strong prognostic factor in early breast carcinoma. We performed this study to investigate the ability of (18)F-FDG to detect angiogenesis in early breast carcinoma using PET/CT. Twenty consecutive patients with early (T1-T2) breast carcinoma were recruited prospectively for 18F-FDG PET/CT. The PET/CT data...

Primary hepatic lymphoma is a rare presentation of a common disease. Diagnosis is difficult due to the risks of liver biopsy. We report the clinico-pathologic features of this presentation and specifically the utility of image-guided biopsy as a safe method of diagnosis. We retrospectively studied patients diagnosed with 'hepatic lymphoma' at a sin...

Primary central nervous system lymphoma (PCNSL) comprises 5% of all primary brain tumours. PCNSL demonstrates a variety of well-documented imaging findings, which can vary depending on immune status and histological type. Imaging features of PCNSL may overlap with other tumours and infection making definitive diagnosis challenging. In addition, sev...

Purpose: There is a need for new treatments for Hodgkin and T-cell lymphoma due to the development of drug resistance in a proportion of patients. This phase I study of radioimmunotherapy used CHT-25, a chimeric antibody to the α-chain of the interleukin-2 receptor, CD25, conjugated to iodine-131 (131I) in patients with refractory CD25-positive lym...

Renal disease in patients with acquired immunodeficiency syndrome was described before even human immunodeficiency virus was demonstrated to be the causative agent, when the now known human immunodeficiency virus associated nephropathy was first described. Several other pathologic processes mostly relating to the immunodeficiency caused by the viru...

The detection of gastric neoplasia has traditionally been limited to barium examination and direct visualization at endoscopy. The rapid development of techniques such as multidetector computed tomography (MDCT) and endoscopic ultrasound (EUS) has resulted in more accurate diagnosis and staging of gastric neoplasia. In this review we describe the n...

Continuous ambulatory peritoneal dialysis (CAPD) is used to treat end-stage renal failure in an increasing number of patients. CAPD has an advantage over hemodialysis in that it allows patients greater freedom to perform daily activities; it also provides other clinical benefits. However, the long-term effectiveness of CAPD is limited by complicati...

Despite extraordinary recent advances in the management of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome, patients infected with HIV are still susceptible to a variety of complications that stem either from immunodeficiency or from side effects of antiretroviral regimens. Diagnosis is often challenging, since e...

The management of neuroendocrine tumors (NETs) is complex. Although NETs can affect a variety of organ systems, hepatic metastatic disease in particular lends itself to a wide range of interventional treatment options. Prior detailed radiologic assessment and careful patient selection are required. Curative surgery should always be considered but i...

The survival of patients with Hodgkin lymphoma (HL) has improved over recent decades due to advances in therapy and supportive care. The outcome for patients with relapsed or refractory disease, however, is still unsatisfactory. High dose therapy with stem cell support can salvage many patients but results are poor in patients with chemo-resistant,...

The purpose of this study was to evaluate the efficacy and safety of a new hydrodynamic percutaneous thrombectomy catheter in the treatment of thrombosed hemodialysis fistulas and grafts. Twenty-two patients (median age: 47 years; range: 31-79 years) underwent mechanical thrombectomy for thrombosed hemodialysis fistulas or polytetrafluoroethylene (...

An understanding of the embryology of the adrenal glands is necessary to appreciate the location of adrenal ectopic, or rest, tissue which can occur anywhere along the course of gonadal descent. This tissue usually has no clinical significance, but may become hyperplastic in patients with primary or secondary adrenal pathology. In congenital adrena...

PURPOSE Transcaval pancreatic biopsy using a coaxial technique has been previously demonstrated to obtain samples for cytological evaluation. However, we are not aware that mediastinal transcaval lymph node biopsy with a coaxial or trucut biopsy needle has been reported.Radiologists are occasionally asked to obtain tissue for histopathology from me...

LEARNING OBJECTIVES The aims are to illustrate the signs of diaphragmatic rupture at chest radiography, CT, and MR imaging emphasizing the associated injuries with acute and delayed presentation. ABSTRACT Diaphragmatic rupture is reported with increasing frequency and is associated with high morbidity and mortality. Increasingly patients with soli...

Metastases to the breast from extramammary tumours are infrequent. The main challenge in diagnosis is differentiating them from primary breast cancer. Radiologically this can be difficult as there are no specific imaging characteristics for metastases to the breast. Cytopathological evaluation, as well as full radiological assessment, is vital to a...

We studied the effects of oxandrolone on serum concentrations of LH, FSH, testosterone, GH, SHBG, DHEAS, IGF-I and insulin in boys with constitutional delay of growth and puberty. Ten boys with constitutional delay of growth and puberty, mean age 13.8 years (range 12.4-15.5) were studied. Twenty-four-hour serum concentration profiles of GH, LH and...

PURPOSE/AIM 1. To present a comprehensive multi-modality pictorial review of renal osteodystrophy and dialysis related musculoskeletal disorders. 2. To discuss the underlying biochemical disturbances and pathophysiology leading to these various manifestations. CONTENT ORGANIZATION *Background and disease frequency *Review of normal bone physiology...

PURPOSE/AIM 1:To explain the pathophysiology of neuroendocrine tumours (NET) and the significance of fore-gut carcinoid tumours 2:To recognise the challenge of detecting NET and the increasing use of F-18 FDG-PET and Ga-68 Dotatate 3:The pearls and pitfalls of PET tracers 4:Review of PET findings from a tertiary centre managing over 800 patients wi...

PURPOSE/AIM 1. To review the imaging features of focal liver lesions which enhance on the arterial phase scans. 2. To provide key features which help in narrowing the differential diagnosis using representative cases. 3. To understand appearances of benign hypervascular lesions and thereby avoid invasive diagnostic procedures. CONTENT ORGANIZATION...

PURPOSE/AIM 1. To illustrate the radiological features of HIV related renal disease including antiretroviral related nephropathies. 2. To describe and illustrate the histopathological features of HIV related renal disease. CONTENT ORGANIZATION 1. Pathophysiology of HIV related renal disease. 2. Imaging and associated histopathological features of...

PURPOSE/AIM 1. To describe the current treatment options for prostate cancer. 2. To demonstrate the spectrum of imaging findings following treatment for prostate cancer, including normal post-therapy changes and complications. Using our experience as a large regional referral centre we present a comprehensive pictorial review, highlighting the abov...

PURPOSE/AIM The purpose of this exhibit is: 1. To review the radiological features of extra-renal tract pathologies that clinically mimic renal stone disease and can be diagnosed on low dose MDCT KUB. 2. To review the literature evidence on the role of unenhanced low-dose MDCT KUB in the detection of extra-renal tract alternative diagnoses. CONTEN...

PURPOSE/AIM 1. To assist the training radiologist to understand expected MDCT features following hepato-biliary and pancreatic surgery. 2. To illustrate the radiological appearances of commonly encountered complications following hepatobiliary and pancreatic surgery. CONTENT ORGANIZATION 1. Illustration of normal hepato-biliary and pancreatic anat...