DOI:10.1259/bjr/28107585

出版商:British Institute of Radiology    

年代:2003

数据来源: WILEY

摘要:

The objective of this review is to describe characteristic MR mammographic findings for signal increase and morphological patterns of enhancement in pure ductal carcinomain situ(DCIS) and to differentiate between high grade and non-high grade lesions. The dynamic MR examination (1.5 T unit, contrast enhancedT1weighted two dimensional fast field echo, 96 ms repetition time, 5.0 ms echo time, 80° flip angle) of 39 consecutive patients with pure DCIS was evaluated retrospectively. Categories were defined for signal increase (C1=normal, C2=slow, continuous, C3=strong initial and slow further increase, C4=strong initial increase followed by a plateau phenomenon, and C5=strong initial increase followed by a washout phenomenon) and morphological patterns (M0=no pattern observed, M1=linear or linear-branched, M2=segmental dotted or granular, M3=segmental homogeneous, and M4=focal spot-like). Time–intensity curves showing a C4 and C5 signal increase were considered suspicious for malignancy. All cases were correlated with histology. 62% of all tumours had a plateau or washout (C4, C5), 77% showed a strong initial signal increase (C3–C5). On evaluation of time–intensity curves alone MR mammography (MRM) findings were suspicious for malignancy in 62% of all DCIS cases. A segmental enhancement was found in 82% of all enhancing tumors and the M2 pattern in 73%. In a combined analysis of signal increase and morphology, 70% of non-high grade and 92% of high grade DCISs were correctly described as suspicious. The difference between non-high grade and high grade DCIS was not significant (p=0.148), while significant differences were found between G1 and G3 DCISs and between G1 and G2 DCISs (p<0.05). All G2 and G3 DCISs showed noticeable signal enhancement. The mean histological tumour size of non-high grade DCISs was smaller than that for high grade DCIS (p<0.05). The hallmark of DCIS on dynamic MRM was unilateral segmental enhancement, most commonly with a granular dotted morphology (M2). Hormone effects need to be considered as the main differential diagnosis. Signal enhancement kinetics similar to invasive carcinoma were seen in the majority of cases. A combined analysis of morphological pattern and signal enhancement considerably improved rate of detection. G2 and G3 DCISs were correctly diagnosed with a significantly higher rate of detection (92%) than G1 DCIS (53%) (p<0.05). Different average size of G1, G2 and G3 DCIS on pathology cannot be excluded as a reason for differences found. Normal MRM seems to exclude high grade DCIS.

DOI:10.1259/bjr/14883856

出版商:British Institute of Radiology    

年代:2003

数据来源: WILEY

摘要:

The location, tissue background and imaging characteristics of true positive and false negative screens of breast cancers have been studied. This data can aid decisions in optimizing the display of mammographic information with the objective of minimizing false negative screens. Screening mammograms for four groups of women were digitized; those with screen detected cancers, those with false negative interval cancers, and matched normals for both groups. The optical density (OD) distribution in the main breast region of each mammogram was determined. The OD in three regions of interest around the cancers was also measured. Cancer locations were mapped and warped onto a typical image to show their spatial distribution. Where a cancer was detectable by calcifications alone it had a relatively low probability of being a false negative interval cancer. The mean OD differences between the cancer and the cancer background region (excluding calcifications) were approximately a factor of two lower in dense breasts compared with other breast types. Poorly defined masses that became interval cancers had mean OD differences that were approximately a factor of 0.1 OD lower than those that were detectable by screening. 22% of false negative cancers were located near the chest wall edge of the mammograms compared with 10% of the true positives. The results indicate the importance of effectively displaying information in the lighter areas of the mammogram, corresponding to glandular tissues, with sufficient contrast for suspicious mammographic details to be detected. Where the mean OD differences between the cancer and its background region are low, as measured for some poorly defined masses, there is an increased risk of a false negative interval cancer. Particular attention should be given to the chest wall area of the film, especially in the lower retroglandular region, during routine screening.

DOI:10.1259/bjr/80482243

出版商:British Institute of Radiology    

年代:2003

数据来源: WILEY

摘要:

The aim of this study is to present the abdominal CT findings of patients with familial Mediterranean fever (FMF) examined during an acute abdominal attack. CT scans of 17 patients (10 women and 7 men; age range 11–45 years) were retrospectively reviewed. Attention was directed to mesenteric or peritoneal abnormalities and to the presence of appendiceal pathology. Patients were divided into two groups; group A (n=14) consisted of patients with an acute abdominal attack caused by FMF, and group B (n=3) consisted of patients whose attack proved to be owing to a separate pathology requiring surgery. Characteristic CT findings of acute abdomen in FMF included mesenteric pathology (n=12), mainly of engorged vessels with thickened mesenteric folds, mesenteric lymphadenopathy (n=6) and ascites (n=6). Signs of focal peritonitis were found in four patients. Radiologists should be familiar with such CT findings of peritoneal irritation in patients with FMF during an acute attack, and may suggest this clinical diagnosis in the proper clinical setting in a patient who has not been previously diagnosed. Alternatively, the radiologist should be aware of the possibility of a concurrent acute appendicitis or other acute abdominal pathology in patients with known FMF and should search for it.

DOI:10.1259/bjr/32051823

出版商:British Institute of Radiology    

年代:2003

数据来源: WILEY

摘要:

The purpose of this study was to evaluate the efficiency and safety of oesophageal balloon dilatation in strictures secondary to surgical treatment of oesophageal atresia in 25 children. Patients comprised 15 males and 10 females, aged 1–36 months. Median age was 4 months (interquartile range (IQR)=19). The strictures were more than 50% of oesophageal lumen and the delay from surgical treatment to balloon dilatation varied from 1 month to 36 months. Associated gastroesophageal reflux was noted in 15 patients. All procedures were performed under sedation using fluoroscopic guidance. Balloons of increasing diameter, 4–20 mm were used. Water soluble contrast swallow was performed after each dilatation session. A total of 115 balloon dilatation sessions were performed with a range of 1–14 procedures per patient (median 4 dilatations, IQR=4.5). Dilatation relieved the stricture in all patients over a follow-up period varying from 4 months to 33 months. The best results were noted in children under 6 months, who needed two or few dilatation sessions, with relative risk (RR) of 0.52 and 95% confidence interval of 0.29–0.92. The presence of associated gastroesophageal reflux indicated a high risk (RRof 12,p<0.001) for undergoing more than two balloon dilatation sessions. The only serious complications observed were two cases of oesophageal perforation, which were treated conservatively. Fluoroscopically guided balloon dilatation is a safe and effective treatment in the management of strictures secondary to surgical repair of oesophageal atresia, especially when started early (within 6 months of surgery) and not associated with gastroesophageal reflux.

DOI:10.1259/bjr/64412147

出版商:British Institute of Radiology    

年代:2003

数据来源: WILEY

摘要:

Entrance skin doses, dose–area product (DAP) values, fluoroscopy times and digital cine acquisition data were measured for 86 patients undergoing intracoronary brachytherapy procedures with beta sources, to estimate risk of skin injuries. Interventions were carried out in three dedicated X-ray interventional cardiology rooms equipped with X-ray systems operating in pulsed modes, with high filtration and edge filter options. Skin dose distribution was analysed in detail in 56 patients using slow films and thermoluminescent dosimetry. Digital recording of Digital Imaging and Communications in Medicine cine images also allowed analysis of the technical parameters used throughout the procedures. A protocol for clinical follow-up of these patients at the cardiology service is also presented, which prescribes special attention when a threshold dose is reached. Median values for DAP, fluoroscopy time and number of frames were 81.2 Gy cm2, 17.5 min and 1569 frames, respectively, and maximum values were 323.3 Gy cm2, 46.2 min and 3213 frames, respectively. In two cases, maximum skin doses in a procedure reached 3.5 Gy and 4.6 Gy. Comparing median values in this study, intracoronary brachytherapy involved approximately two-fold the DAP used in percutaneous transluminal coronary angioplasty procedures performed during the same period in the same catheterization laboratories, as a consequence of the need to monitor the radioactive source location used for the treatment of stenoses and the intravascular ultrasound. Special care must be paid in those cases of high dose in relation to potential patient skin injuries and late effects.

DOI:10.1259/bjr/33961719

出版商:British Institute of Radiology    

年代:2003

数据来源: WILEY

摘要:

We describe a novel method for the calculation of endothelial permeability surface area product from dynamic contrast enhanced MRI. The technique uses iterative estimation to automatically decompose tissue residue function into intravascular and extravascular components, which are subsequently used to generate tumour blood volume, which is equal to relative cerebral blood volume calculated fromT1weighted images and corrected for contamination by contrast agent leakage (\batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \({\rm rCBV}_{{\rm corrected}}^{\it T_{\rm 1} } \) \end{document}), and endothelial permeability (kfp) maps. The technique was assessed in patients with cerebral glioma (n=5) by examining the reproducibility of endothelial permeability and\batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \({\rm rCBV}_{{\rm corrected}}^{\it T_{\rm 1} } \) \end{document}between two separate examinations conducted with a 2-day interval. The technique produces maps of endothelial permeability that appear to be free of any contribution from intravascular contrast agent. Maps of\batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \({\rm rCBV}_{{\rm corrected}}^{\it T_{\rm 1} } \) \end{document}show close correlation with maps of blood volume calculated from independently acquired dynamic susceptibility weighted MRI examinations, with no evidence of residual permeability effects. The results were highly reproducible with strong intra-class correlation between the two examinations for mean values and for 97.5 percentiles of endothelial permeability and\batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \({\rm rCBV}_{{\rm corrected}}^{\it T_{\rm 1} } \) \end{document}. The excellent reproducibility of this technique and the ability to calculate endothelial permeability and\batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \({\rm rCBV}_{{\rm corrected}}^{\it T_{\rm 1} } \) \end{document}values from rapidly acquired data sets offer considerable advantages over conventional approaches and support the use of this methodology for therapeutic monitoring or trials of novel therapeutic agents.

DOI:10.1259/bjr/31662734

出版商:British Institute of Radiology    

年代:2003

数据来源: WILEY

摘要:

A method for the systematic selection of paediatric CT technique factors is described. The approach is based on the assumption that the level of image noise acceptable for a given adult CT image is also acceptable for the equivalent paediatric examination. A simple exponential attenuation model is proposed. Effective linear attenuation coefficients were initially established from a series of phantom measurements simulating head, chest and abdomen examinations at 120 kVp, then extended for a range of tube potentials and beam qualities using a beam spectral model. Application of the method is demonstrated using phantoms representing head, chest and abdomen sections for neonate and ages 1 year, 5 years, 10 years, 15 years and adult.

DOI:10.1259/bjr/53215511

出版商:British Institute of Radiology    

年代:2003

数据来源: WILEY

摘要:

Two specially trained radiographers at York District Hospital have been reporting appendicular plain radiograph X-ray examinations for Accident and Emergency (A&E) patients since February 1995. This study explores the potential for further expanding their reporting role. This was achieved by assessing the two radiographers' and a group of consultant radiologists' ability to report on a retrospectively selected random stratified sample of 400 A&E and General Practitioner (GP) plain radiograph X-ray examinations for all body areas. Using receiver operating characteristic (ROC) curve analyses there was no statistically significant difference at the 5% level between the area under the ROC curves for the radiographers and consultant radiologists when reporting A&E or GP plain radiographs. It may be feasible to expand the reporting role of suitably trained radiographers to include plain radiograph X-ray examinations for all A&E patients and for GP patients, with no detriment to the quality of reports.

DOI:10.1259/bjr/68918327

出版商:British Institute of Radiology    

年代:2003

数据来源: WILEY

摘要:

Primitive neuroectodermal tumour (PNET) is very rare, especially in adults. We report a 60-year-old man presented with a PNET. The symptoms at the time of diagnosis were intense headache, Broca's aphasia and right hemiparesis. Only an open biopsy was performed. Irradiation of the primary tumour was the main treatment (total tumour dose 59.8 Gy) because of serious haematological side effects due to chemotherapy. The patient tolerated radiation therapy extremely well and his neurological symptoms were improved. 1 month after completion of radiotherapy, MRI showed no regression of the tumour. Clinical deterioration was observed 10 months after the initial diagnosis and the patient died 2 months later. In cases of PNET, initial therapy is surgical bulk reduction whenever possible. Irradiation of the cerebrospinal axis is justified as a routine treatment but, owing to the radioresistance of the tumour, the addition of multiregimen chemotherapy appears to improve survival, according to the literature.

DOI:10.1259/bjr/47707206

出版商:British Institute of Radiology    

年代:2003

数据来源: WILEY