Current Issue : October - December Volume : 2011 Issue Number : 1 Articles : 9 Articles
Background\nThe value of abdominal echography in primary care is great because it is innocuous, inexpensive, easy to perform and provides a great deal of information making this the first examination to be requested in cases of probable abdominal disease. However, too many abdominal echographies are probably requested overcrowding the Departments of Radiodiagnosis with not always justified petitions or with repetition of tests based on little clinical criteria.\n \nMethods/Design\nThe aim of the study is to evaluate the adequacy and quality of abdominal echographies requested by primary care physicians in the Maresme County (North of Barcelona), develop guidelines for indicating echographies and reevaluate this adequacy after implementing these guidelines.\nWe will perform a two-phase study: the first descriptive, and retrospective evaluating the adequacy and quality of petitions for abdominal echographies, and in the second phase we will evaluate the impact of recommendations for indicating abdominal echographies for PC physicians on the adequacy and quality of echography petitions thereafter.\nThis study will be carried out in 10 primary care centres in the Maresme (Barcelona).\n1067 abdominal echographies requested by primary care physicians from the above mentioned centres from January 2007 to April 2010 and referred to the Department of Radiology and the same number of applications after the intervention.\nAll the petitions for abdominal echographies requested will be analysed and the clinical histories will be obtained to determine demographic variables, the reason for the visit and for the echography petition and diagnostic orientation, clinical and echographic data, evaluation of the echographies according to the quality and variables characterising the professionals requesting the echographies including: age, sex, laboral situation, length of time in work post, formation, etc.\nTo achieve a consensus of the adequacy of abdominal echography, a work group including gastroenterologists, radiologists and general practitioners will be created following the nominal group. This will allow the design of guidelines for the indication of abdominal echography and posterior evaluation of their impact among physicians by diffusion and posterior reevaluation of the adequacy of the petitions....
Background\nAs neurophysiologic tests may not reveal the extent of brachial plexus injury at the early stage, the role of early radiological work-up has become increasingly important. The aim of the study was to evaluate the concordance between the radiological and clinical findings with the intraoperative findings in adult patients with brachial plexus injuries.\n \nMethods\nSeven consecutive male patients (median age 33; range 15-61) with brachial plexus injuries, caused by motor cycle accidents in 5/7 patients, who underwent extensive radiological work-up with magnetic resonance imaging (MRI), computed tomography myelography (CT-M) or both were included in this retrospective study. A total of 34 spinal nerve roots were evaluated by neuroradiologists at two different occasions. The degree of agreement between the radiological findings of every individual nerve root and the intraoperative findings was estimated by calculation of kappa coefficient (?-value). Using the operative findings as a gold standard, the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the clinical findings and the radiological findings were estimated.\n \nResults\nThe diagnostic accuracy of radiological findings was 88% compared with 65% for the clinical findings. The concordance between the radiological findings and the intraoperative findings was substantial (? = 0.76) compared with only fair (? = 0.34) for the clinical findings. There were two false positive and two false negative radiological findings (sensitivity and PPV of 0.90; specificity and NPV of 0.87).\n \nConclusions\nThe advanced optimized radiological work-up used showed high reliability and substantial agreement with the intraoperative findings in adult patients with brachial plexus injury....
Sir, We would like to share our experience on a rare presentation of Takayasu arteritis (TA). A 32 year old male presented with chest pain from 3 days worsening on exertion and associated with shortness of breath. He is a chronic smoker and has a history of hyperlipidaemia. His examination was significant for diminished pulse in left upper limb and BP in the right upper limb was 150/90 mm of Hg. On auscultation cardiovascular and respiratory systems were unremarkable. His ECG showed diffuse ischemia (ST depression in infero-lateral leads). His cardiac enzymes (Troponin-T and CPK-MB) were negative. His ESR was high at 66mm/1st hr and C-reactive protein was 102mg/dl.2D echo revealed no regional wall motion abnormalities and ejection fraction of 63%. He was treated with antiplatelet therapy, heparin, nitroglycerin, Oxygen, ACE inhibitor and beta blocker. His coronary angiogram showed a normal LMCA, a diffusely diseased LAD-type III vessel; non-dominant LCX with two OMs all diffusely diseased having a beaded appearance (Figure-1). Aortitis was also distinctly evident from the irregular contour of the aorta (Figure-2). Diagnosed of TA, he was conservatively treated with steroids and anti-anginal medications and on follow up after 2 months he was significantly pain and symptom free along with normalized ESR and CRP. Coronary involvement in Takayasu arteritis (also called as Morterell syndrome or occlusive thromboaortopathy) is reported to be 9% to 11%.2 Pathologically coronary lesions may be classified as type 1- stenosis or occlusion of the coronary ostia and the proximal segments of the coronary arteries; type 2- diffuse or focal coronary arteritis, with skip lesions; type 3- coronary aneurysm and while all three may be seen in TA, type1 is more common.3 The extension of inflammation, which induces intimal proliferation and fibrous contraction in the ascending aorta around the coronary ostia is the proposed mechanism. Enhanced atherosclerosis accelerates the jeopardy of the vasculitis process. The biopsy might show intimal hyperplasia and a transmural lymphoplasmacytic infiltrate. Tunica media may be disorganized/ replaced by collagen and may feature patchy necrosis. Distorted and fragmented elastic fibers may predispose to dissection. The late “burned out” stage is marked by fibrous scarring, leading to intimal and adventitial thickening with dystrophic calcification. Steroids may achieve a 40% to 60% remission rate and about 40% of steroid-resistant patients respond with the addition of cytotoxic agents (20% are resistant to any kind of treatment).4 Apart from stenting, CABG, patch angioplasty of the LMCA ostium (ostioplasty using autologous pericardium/ saphenous vein graft/ internal thoracic artery), and transaortic coronary ostial endarterectomy and hybrid procedures (on porcelain aorta) are the available surgical options (to be avoided during the active stage of inflammation unless complicated by unstable angina).5 In a case of TA in a young female, an arterial Y graft was used with good results (probably from longer term graft patency).2 TA is an entity of substantial morbidity especially with coronary involvement and prompt immunosuppression and interventions (if necessary) can be life-saving....
Background\nIncreased mammographic breast density is a moderate risk factor for breast cancer. Different scales have been proposed for classifying mammographic density. This study sought to assess intra-rater agreement for the most widely used scales (Wolfe, Tab�¡r, BI-RADS and Boyd) and compare them in terms of classifying mammograms as high- or low-density.\n \nMethods\nThe study covered 3572 mammograms drawn from women included in the DDM-Spain study, carried-out in seven Spanish Autonomous Regions. Each mammogram was read by an expert radiologist and classified using the Wolfe, Tab�¡r, BI-RADS and Boyd scales. In addition, 375 mammograms randomly selected were read a second time to estimate intra-rater agreement for each scale using the kappa statistic. Owing to the ordinal nature of the scales, weighted kappa was computed. The entire set of mammograms (3572) was used to calculate agreement among the different scales in classifying high/low-density patterns, with the kappa statistic being computed on a pair-wise basis. High density was defined as follows: percentage of dense tissue greater than 50% for the Boyd, \"heterogeneously dense and extremely dense\" categories for the BI-RADS, categories P2 and DY for the Wolfe, and categories IV and V for the Tab�¡r scales.\n \nResults\nThere was good agreement between the first and second reading, with weighted kappa values of 0.84 for Wolfe, 0.71 for Tab�¡r, 0.90 for BI-RADS, and 0.92 for Boyd scale. Furthermore, there was substantial agreement among the different scales in classifying high- versus low-density patterns. Agreement was almost perfect between the quantitative scales, Boyd and BI-RADS, and good for those based on the observed pattern, i.e., Tab�¡r and Wolfe (kappa 0.81). Agreement was lower when comparing a pattern-based (Wolfe or Tab�¡r) versus a quantitative-based (BI-RADS or Boyd) scale. Moreover, the Wolfe and Tab�¡r scales classified more mammograms in the high-risk group, 46.61 and 37.32% respectively, while this percentage was lower for the quantitative scales (21.89% for BI-RADS and 21.86% for Boyd).\n \nConclusions\nVisual scales of mammographic density show a high reproducibility when appropriate training is provided. Their ability to distinguish between high and low risk render them useful for routine use by breast cancer screening programs. Quantitative-based scales are more specific than pattern-based scales in classifying populations in the high-risk group....
Glomus tumors are uncommon tumors which can occur anywhere within the gastrointestinal tract but have been shown to occur most commonly in the gastric antrum. On CT, these tumors demonstrate hyperenhancement which may help distinguish them from other gastric masses....
Background\nThe association between fetal exposure to major radiodiagnostic testing in pregnancyââ?¬â?computed tomography (CT) and radionuclide imagingââ?¬â?and the risk of childhood cancer is not established.\n\nMethods and Findings\nWe completed a population-based study of 1.8 million maternal-child pairs in the province of Ontario, from 1991 to 2008. We used Ontario's universal health careââ?¬â??linked administrative databases to identify all term obstetrical deliveries and newborn records, inpatient and outpatient major radiodiagnostic services, as well as all children with a malignancy after birth. There were 5,590 mothers exposed to major radiodiagnostic testing in pregnancy (3.0 per 1,000) and 1,829,927 mothers not exposed. The rate of radiodiagnostic testing increased from 1.1 to 6.3 per 1,000 pregnancies over the study period; about 73% of tests were CT scans. After a median duration of follow-up of 8.9 years, four childhood cancers arose in the exposed group (1.13 per 10,000 person-years) and 2,539 cancers in the unexposed group (1.56 per 10,000 person-years), a crude hazard ratio of 0.69 (95% confidence interval 0.26ââ?¬â??1.82). After adjusting for maternal age, income quintile, urban status, and maternal cancer, as well as infant sex, chromosomal or congenital anomalies, and major radiodiagnostic test exposure after birth, the risk was essentially unchanged (hazard ratio 0.68, 95% confidence interval 0.25ââ?¬â??1.80).\n\nConclusions\nAlthough major radiodiagnostic testing is now performed in about 1 in 160 pregnancies in Ontario, the absolute annual risk of childhood malignancy following exposure in utero remains about 1 in 10,000. Since the upper confidence limit of the relative risk of malignancy may be as high as 1.8 times that of an unexposed pregnancy, we cannot exclude the possibility that fetal exposure to CT or radionuclide imaging is carcinogenic....
Background\nPlaque imaging based on magnetic resonance imaging (MRI) represents a new modality for risk assessment in atherosclerosis. It allows classification of carotid plaques in high-risk and low-risk lesion types (I-VIII). Type 2 diabetes mellitus (DM 2) represents a known risk factor for atherosclerosis, but its specific influence on plaque vulnerability is not fully understood. This study investigates whether MRI-plaque imaging can reveal differences in carotid plaque features of diabetic patients compared to nondiabetics.\n \nMethods\n191 patients with moderate to high-grade carotid artery stenosis were enrolled after written informed consent was obtained. Each patient underwent MRI-plaque imaging using a 1.5-T scanner with phased-array carotid coils. The carotid plaques were classified as lesion types I-VIII according to the MRI-modified AHA criteria. For 36 patients histology data was available.\n \nResults\nEleven patients were excluded because of insufficient MR-image quality. DM 2 was diagnosed in 51 patients (28.3%). Concordance between histology and MRI-classification was 91.7% (33/36) and showed a Cohen's kappa value of 0.81 with a 95% CI of 0.98-1.15. MRI-defined high-risk lesion types were overrepresented in diabetic patients (n = 29; 56.8%). Multiple logistic regression analysis revealed association between DM 2 and MRI-defined high-risk lesion types (OR 2.59; 95% CI [1.15-5.81]), independent of the degree of stenosis.\n \nConclusion\nDM 2 seems to represent a predictor for the development of vulnerable carotid plaques irrespective of the degree of stenosis and other risk factors. MRI-plaque imaging represents a new tool for risk stratification of diabetic patients....
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Background\nTo investigate the relationship between the magnetic resonance imaging (MRI) features of breast cancer and its clinicopathological and biological factors.\n \nMethods\nDynamic MRI parameters of 68 invasive breast carcinomas were investigated. We also analyzed microvessel density (MVD), estrogen and progesterone receptor status, and expression of p53, HER2, ki67, VEGFR-1 and 2.\n \nResults\nHomogeneous enhancement was significantly associated with smaller tumor size (T1: < 2 cm) (p = 0.015). Tumors with irregular or spiculated margins had a significantly higher MVD than tumors with smooth margins (p = 0.038). Tumors showing a maximum enhancement peak at two minutes, or longer, after injecting the contrast, had a significantly higher MVD count than those which reached this point sooner (p = 0.012). The percentage of tumors with vascular invasion or high mitotic index was significantly higher among those showing a low percentage (= 150%) of maximum enhancement before two minutes than among those ones showing a high percentage (>150%) of enhancement rate (p = 0.016 and p = 0.03, respectively). However, there was a significant and positive association between the mitotic index and the peak of maximum intensity (p = 0.036). Peritumor inflammation was significantly associated with washout curve type III (p = 0.042).\n \nConclusions\nVariations in the early phase of dynamic MRI seem to be associated with parameters indicatives of tumor aggressiveness in breast cancer....
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