James Bell’s scientific contributions

PURPOSE/AIM 1) Describe the imaging experiences of a National Scleroderma Treatment Center 2) Review the basic clinical and pathological findings 3) Outline the new and novel imaging techniques in the diagnosis and prognosis 4) Illustrate a comprehensive pictorial review CONTENT ORGANIZATION Scleroderma can affect a wide range of organs. Manifestations include joint disease, gastrointestinal dysmotility, pulmonary fibrosis, and soft tissue calcification. Various radiological techniques such as HRCT, Barium studies, plain films, and ultrasound are essential for diagnosis and assessment of disease extent. Recently, MRI has assumed a role in disease assessment. As a national center of scleroderma, we will present a pictorial review of our imaging algorithm and findings. SUMMARY -The organic manifestations of Scleroderma are described. -Basic clinical and pathologic findings will be reviewed. -Different imaging modalities used in the assessment and prognosis of scleroderma will be discussed. -The characteristic findings will be demonstrated via a pictorial review.

LEARNING OBJECTIVES To recognise the commoner radiological findings encountered in CVID and allow the general radiologist to consider this heterogenous and under recognised disorder in their differential diagnosis. ABSTRACT Our institution is one of the largest tertiary referral centres for severe immunodeficiency disorders in the UK and therefore has a large number of patients with common variable immunodeficiency (CVID). CVID is the commonestprimary immunodeficiency disorder characterised by hypogammaglobulinaemia and recurrent bacterial infections predominantly affecting the respiratory and gastrointestinal tract. Patients also suffer an increased incidence of autoimmune, granulomatous and neoplastic disorders. The diagnosis of CVID is often difficult and delayed due to its heterogenous presentation and tendancy to mimic other more common disorders. The role of the general CT and MRI radiologist in its diagnosis is therefore paramount and an awareness of its varied manefestations vital. We present a complete pictorial review, to our knowledge the first ever, of the radiological findings encountered and illustrate the range of pathological processes and organs affected.

LEARNING OBJECTIVES At our national referral centre we have broad experience of the multisystem nature of sarcoid. This educational exhibit, illustrated with multiple imaging modalities, will provide the reader with a thorough overview of the imaging manifestations of extrathoracic sarcoidosis. ABSTRACT Sarcoidosis is a multisystemic disorder of unknown aetiology characterized by non-caseating granulomas. Whilst its most common manifestations are intra-thoracic, extra-thoracic manifestations are present in up to 30% of patients. In a significant minority of this group, these extra-thoracic manifestations are the first or only demonstrable imaging features of sarcoidosis. Furthermore, they often predate the clinical suspicion of sarcoidosis. Therefore knowledge of these findings is essential in radiologic practice for timely diagnosis and management. Using our experience as a national centre for sarcoidosis, we present a multimodality review of its various extra-thoracic imaging features, with reference to the abdominal, musculoskeletal, genito-urinary and neurological findings. We highlight many of the imaging pearls and “aunt minnies” in sarcoidosis and demonstrate some of the more atypical pathologically-confirmed cases seen at our institution over the last 15 years.

LEARNING OBJECTIVES 1. To describe the range of radiological findings in cryptococcal disease. 2. To highlight the diagnostic features enabling differentiation from the major differential diagnoses. ABSTRACT Cryptococcus neoformans is a yeast infection that occurs in immunocompromised patients such as HIV, haematological malignancies, diabetes mellitus and cirrhosis. It occurs in up to 15% of patients with AIDS. Often the diagnosis is delayed resulting in increased morbidity and mortality. A clear understanding of the range of pathology and its radiological features is important in facilitating a prompt, accurate diagnosis. Cryptococcosis most commonly affects the CNS, lungs and musculoskeletal system. CNS infection typically causes meningitis and meningo-encephalitis. A delayed diagnosis can result in deafness, cranial nerve palsies, hydrocephalus, dementia and death. Pulmonary manifestations include infiltrates, nodules, and cavitating masses. Cryptococcosis may also affect the liver, kidneys, adrenal glands, prostate and heart. We present a comprehensive review of the radiological features of cryptococcosis. We highlight the important differential diagnoses for each organ system.

LEARNING OBJECTIVES To present the typical and atypical imaging features of pancreatic neuroendocrine tumours at a national referral centre. ABSTRACT Our institution is the largest tertiary referral centre in the UK for neuroendocrine tumours. Pancreatic islet cell tumours include insulinomas, gastrinomas, glucagonomas, non-functioning islet cell tumours, VIPomas and somatostatinomas. We present our centre�s experience of these relatively rare tumours and demonstrate the spectrum of morphological and endocrine imaging findings, including unusual and extrapancreatic manifestations. Knowledge of these findings is essential to allow an early diagnosis of these rare but treatable tumours.

LEARNING OBJECTIVES 1. To understand the radiological appearances of opportunistic infection associated immune restoration disorder.2. To understand the radiological differences between immune restoration disorder and non-IRD opportunistic infections. ABSTRACT Antiretroviral therapy (ART) has revolutionised the treatment of HIV infection, resulting in a fall in morbidity and mortality. However, 10% of patients who achieve rapid immunological and virological improvements in response to ART, develop inflammatory processes, at the site of pre-existing or subclinical opportunistic infections (OIs). This phenomena of immune restoration disease (IRD) has been described in association with many OIs, including mycobacterium tuberculosis and avium-intracellularae, pneumocystis carinii, cerebral cryptococomas and toxoplasmosis. The significant morbidity of ARD presents clinicians with a major treatment dilemma as ART discontinuation may result in HIV treatment failure. The specific radiological features of IRD associated opportunistic infections, as opposed to those seen in the general HIV population are, as yet, not clarified. We present the first, to our knowledge, systematic radiological characterization of IRD.

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 HIV related renal disease (a) HIV associated immune mediated renal disease (b) HIV associated nephropathy (c) opportunistic infections affecting the renal tract seen in patients with HIV e.g renal PCP, MAI and renal cortical infections e.g candida (d) HIV associated renal lymphoma (e) antiretroviral associated nephropathy. 3. Sample cases. 4. Discussion SUMMARY The major teaching points of this exhibit are 1. Renal disease is a relatively common complication in patients with HIV. Here we give an overview of the various renal pathologies encountered in patients with HIV. 2. There are various radiological features that are encountered in each pathology as illustrated. 3. Renal disease is important to recognise in HIV patients as it is a major cause of morbidity and mortality in this group of patients.

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 above. CONTENT ORGANIZATION 1. Current prostate cancer treatment options. 2. Review of spectrum of expected normal imaging findings post treatment including MRI signal changes both in the prostate following biopsy, and in the bones following radiotherapy and normal multi-modality imaging appearances following radical prostatectomy. 3. Summary of complications of therapy for prostate cancer including ureteric, rectal and pelvic floor injuries, with multi-modality illustrations. 4. Imaging features of recurrence. SUMMARY Awareness of the spectrum of imaging findings following treatment for prostate cancer is of utmost importance for clinicians and radiologists alike. Particular emphasis is often given to the imaging of complications of therapy, but knowledge of the normal post-treatment appearances and of the features of disease recurrence is also essential.

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. CONTENT ORGANIZATION ∬ Pathophysiology of extra-renal tract mimics of renal stone disase. ∬ Radiological features of extra-renal tract mimics of renal stone disease on low-dose MDCT KUB. ∬ Sample cases. ∬ Literature review of the role of low-dose MDCT in diagnosing extra-renal pathology. ∬ Summary or imaging features. ∬ Conclusions from literature review. SUMMARY The major teaching points of this exhibit are: 1. MDCT KUB can detect extra-renal tract mimics of renal colic, even at low dose. 2. Alternative causes for suspected renal colic must be sought since these can be life threatening. 3. When evaluating MDCT in patients with suspected renal colic, it is vital that the reader has a broad radiological expertise to avoid overlooking extra-renal tract pathology.

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 anatomy. 2. Imaging features of expected postoperative findings. 3. Imaging features of frequently encountered post-operative complications. 4. Pitfalls to avoid. 5. Cases. 6. Discussion. SUMMARY It is important for training radiologists to appreciate normal postoperative anatomy in order to be able to recognise complications as these represent a major cause of morbidity and mortality. We illustrate characteristic features following hepato-biliary and pancreatic surgery, e.g. cholecystectomy, hepatic resections, Whipple's procedure and other examples. In addition, we review the radiological features of frequently encountered post operative complications and pitfalls to avoid.