Summary of Journal of Interventional Radiology

T. Livraghi, S. Lazzaroni*, L. Civelli, M. Marks, F. Meloni, C. VettoriDivisione di Radiologia, Ospedale Civile, Mercate. Milano and * Divisione di Medicina, Ospedale S.Biagio Bergamo. Italy     

Determination of the Cause of Edema

Currently. neither external detection nor~1 dilution methods can differentiate among cardiac, overhydration (including renal failure) and capillary permeability edema. New techniques designed to detect 2~increased pem-     

On the Principle of Treatment of Burn Wound

The article expounds the therapeutic features of the Moist Exposed Burn Therapy(MEBT)in the treatment of-burn injuries by means of experimental research data and clinical application experiences about MEBT and confirmsthat the principle and method of conventional dry therapy for burn injuries is contrary to burn pathogenesis,whileMEBT is an effective medical technique which is in conformity with burn pathogenesis at present.Histogical studies confirmed:microscopical examination of wound tissue treated with dry exposure therapyshowed that the granulation tissue was atrophic,in which the lobocytes exudated,collagenous fibers wereeosinophilous.An inanimate sign was emerged in the granulation tissue.The wound tissue treated with MEBT wasfull of vitality,fibroblasts proliferated actively and there were aboundant blood vessels.The comparison study be-tween amnion overlying therapy and MEBT in the treatment of superfcialⅢ°burnt wound confrmed that the latercould make the wound heal through epidermization.The     

Structured reporting of MRI of the shoulder – improvement of report quality?

Objectives

To evaluate the effect of structured reports (SRs) in comparison to non-structured narrative free text (NRs) shoulder MRI reports and potential effects of both types of reporting on completeness, readability, linguistic quality and referring surgeons’ satisfaction.

Methods

Thirty patients after trauma or with suspected degenerative changes of the shoulder were included in this study (2012–2015). All patients underwent shoulder MRI for further assessment and possible surgical planning. NRs were generated during clinical routine. Corresponding SRs were created using a dedicated template. All 60 reports were evaluated by two experienced orthopaedic shoulder surgeons using a questionnaire that included eight questions.

Results

Eighty per cent of the SRs were fully complete without any missing key features whereas only 45% of the NRs were fully complete (p?<?0.001). The extraction of information was regarded to be easy in 92% of the SRs and 63% of the NRs. The overall quality of the SRs was rated better than that of the NRs (p?<?0.001).

Conclusions

Structured reporting of shoulder MRI improves the readability as well as the linguistic quality of radiological reports, and potentially leads to a higher satisfaction of referring physicians.

Key Points

? Structured MRI reports of the shoulder improve readability. ? Structured reporting facilitates information extraction. ? Referring physicians prefer structured reports to narrative free text reports. ? Structured MRI reports of the shoulder can reduce radiologist re-consultations.

     

Accuracy of outside radiologists’ reports of computed tomography exams of emergently transferred patients

Purpose

Growing numbers of patient with advanced imaging being transferred to trauma centers has resulted in increased numbers of outside CT scans received at trauma centers. This study examines the degree of agreement between community radiologists’ interpretations of the CT scans of transferred patients and trauma center radiologists’ reinterpretation.

Methods

All CT scans of emergency transfer patients received over a 1 month period were reviewed by an emergency radiologist. Patients were classified as trauma or non-trauma and exams as neuro or non-neuro. Interpretive discrepancies between the emergency radiologist and community radiologist were classified as minor, moderate, or major. Major discrepancies were confirmed by review of a second emergency radiologist. Discrepancy rates were calculated on a per-patient and per exam basis.

Results

Six hundred twenty-seven CT scans of 326 patients were reviewed. Major discrepancies were encountered in 52 (16.0%, 95% CI 12.2–20.5) patients and 53 exams (8.5%, 95% CI 6.5–10.5). These were discovered in 46 trauma patients (21.6%, 95% CI 16.4–27.9) compared to six non-trauma patients (5.3%, 95% CI 2.2–11.7) (P?<?0.001). A significant difference in the major discrepancy rate was also found between non-neuro and neuro exams (12.4 vs 3.3%, respectively, P?<?0.001), primarily due to discrepancies in trauma patients, rather than non-trauma patients.

Conclusions

Potentially management-changing interpretive changes affected 16% of transferred patients and 8.5% of CT exams over a 1 month period. Trauma center reinterpretations of community hospital CT scans of transferred patients provide valuable additional information to the clinical services caring for critically ill patients.

     

Risk coefficient of radon-induced lung cancer and combined effect of arsenic in miners of Yunnan tin mine of China

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Possible role of elevation of glutathione in the acquisition of enhanced proliferation of mouse splenocytes exposed to small-dose γ-rays

Purpose : To examine the relation between the induction of an increased glutathione level and the elevated proliferative response of mouse splenocytes by a small dose of γ-rays. Materials and methods : Male ICR strain mice, 7 weeks of age, were divided into irradiated and non-irradiated control groups. Irradiation was done with γ-rays from a 137 Cs source at a dose of 50cGy (1.11Gy/min). Glutathione content in the splenocytes was measured using a modified spectrophotometric technique. Concanavalin A (Con A)-induced proliferative response of the splenocytes after whole-body γ-ray irradiation was estimated from the 3 H-thymidine incorporation into the cells. Results : The glutathione level in mouse splenocytes increased 2h after whole-body γ-ray irradiation at 50 cGy, peaked at 4h and thereafter decreased almost to the zero-time level by 12-h postirradiation. A significant enhancement of Con A-induced proliferation was observed in the splenocytes obtained from the wholebody-irradiated animals between 2h and 6h post-irradiation. Glutathione exogenously added to splenocytes obtained from normal mice enhanced the Con A-induced proliferation of splenocytes in a dose-dependent manner. This enhancement was completely blocked by buthionine sulfoximine, a specific inhibitor of the de novo pathway of glutathione synthesis. Conclusions : The induction of endogenous glutathione immediately after low-dose γ-ray irradiation is at least partially responsible for the enhancement of immune function, and may throw light on the mechanisms of carcinostatic effects induced by low dose ionizing radiation.     

Sonography of injury of the ulnar collateral ligament of the elbow—initial experience

Objective The purpose of this study is to describe the sonographic appearance of injuries of the ulnar collateral ligament (UCL) of the elbow.Design and patients Eight non-professional male baseball pitchers, ages 13–35 years, with medial elbow pain and clinical suspicion of ulnar collateral ligament injury, were referred for imaging. All eight underwent sonography of the affected and contralateral asymptomatic elbow, and six also underwent MR imaging. Neither valgus stress nor power Doppler was used during the sonographic examinations. Time from onset of symptoms to imaging was 1.5 weeks to 6 months. Three patients had surgical confirmation of their injuries, with time from imaging to surgery of 2 days to 9 months.Results In four patients, the UCL was ruptured, manifest sonographically in three cases as discontinuity of the normally hyperechoic ligament with anechoic fluid in the gap and in one case as non-visualization of the ligament with heterogeneous echogenicity in the expected location of the ligament. Two adolescent patients had avulsions of the UCL from the medial epicondyle, with sonographic demonstration of the avulsed echogenic bony fragment in both cases. One patient had a mild sprain, manifest as mild thickening and decreased echogenicity of the ligament sonographically compared with the contralateral normal elbow, with mild surrounding hypoechoic edema. The eighth patient had a small partial tear of the deep surface of the distal aspect of the ligament, visualized as a hypoechoic focus between the deep surface of the ligament and its ulnar attachment.Conclusion Tears of the ulnar collateral ligament are manifested sonographically as non-visualization of the ligament or alteration of the normal morphology.     

MRI of the kidney—state of the art

Ultrasound and computed tomography (CT) are modalities of first choice in renal imaging. Until now, magnetic resonance imaging (MRI) has mainly been used as a problem-solving technique. MRI has the advantage of superior soft-tissue contrast, which provides a powerful tool in the detection and characterization of renal lesions. The MRI features of common and less common renal lesions are discussed as well as the evaluation of the spread of malignant lesions and preoperative assessment. MR urography technique and applications are discussed as well as the role of MRI in the evaluation of potential kidney donors. Furthermore the advances in functional MRI of the kidney are highlighted.     

Visions of normality? Early experiences of radiographic reporting

This article reflects on my early [student] experiences in learning to undertake radiographic reporting and uses critical incidents to highlight two areas of error during this period. These errors include perceptual (optical illusions and, in particular, the Mach band effect) and lack of subject specific knowledge (specifically anatomical knowledge—especially of normal anatomical variants). These two errors are analysed in the wider context of radiological error and the difficulty in reaching consensus even between experienced reporters.     

“Handedness” of spiral fractures of the tibia

Handedness is a basic property of spirals. In many cases it is possible to determine whether spiral fractures are right or left handed by analysis of radiographs. Spiral fractures of the tibia show striking bilateral symmetry, with right-handed spirals predominating on the left side of the body, and left-handed spirals on the right.     

Can Assessment of the Tongue on Brain MRI Aid Differentiation of Seizure from Alternative Causes of Transient Loss of Consciousness?

BACKGROUND AND PURPOSE:Transient loss of consciousness is commonly evaluated in the emergency department. Although typically caused by epileptic seizure, syncope, or psychogenic nonepileptic seizure, the underlying etiology is frequently misdiagnosed. Lateral tongue bites are reportedly a specific clinical finding of seizure. We have observed tongue signal abnormality suggesting bite injury on brain MR imaging after seizures. We hypothesized an association between tongue signal abnormality and seizure diagnosis among patients in the emergency department imaged for transient loss of consciousness. Our purposes were to determine the prevalence of tongue signal abnormality among this population and the predictive performance for seizure diagnosis.MATERIALS AND METHODS:For this retrospective study including 82 brain MR imaging examinations, 2 readers independently assessed tongue signal abnormality on T2-weighted and T2-weighted FLAIR images. Discrepancies were resolved by consensus, and interrater reliability (Cohen κ) was calculated. The final diagnosis was recorded. Proportions were compared using the Fisher exact test.RESULTS:Tongue signal abnormality was present on 19/82 (23%) MR imaging examinations. Interrater reliability was “substantial” (κ = 0.77). Seizure was diagnosed among 18/19 (95%) patients with tongue signal abnormality and 29/63 (46%) patients without it (P < .001). In our cohort, tongue signal abnormality conveyed 97% specificity, 95% positive predictive value, and 63% accuracy for seizure diagnosis.CONCLUSIONS:Tongue signal abnormality was observed in 23% of the study cohort and conveyed 97% specificity and 95% positive predictive value for seizure diagnosis. By assessing and reporting tongue signal abnormality, radiologists may facilitate a timely and accurate diagnosis of seizure among patients imaged for transient loss of consciousness.

Transient loss of consciousness (TLoC) is defined as a spontaneous, temporary loss of consciousness with complete recovery.¹ TLoC is estimated to affect up to 50% of individuals at some point in their lives¹ and to account for up to 3% of emergency department (ED) visits.² Although >90% of cases of TLoC are known to be caused by epileptic seizure (ES), syncope, or psychogenic nonepileptic seizure (PNES),³ confident determination of the underlying etiology in any given patient remains difficult. In fact, it is estimated that the underlying cause of TLoC is misdiagnosed in 20%–30% of cases.^4-7 A timely and accurate diagnosis of seizure identifies patients with TLoC who may benefit from antiepileptic therapy, whereas an incorrect diagnosis may result in inaccurate, inefficient, and delayed care.The terminology associated with 2 of the most common causes of TLoC (ES, PNES) is potentially confusing. Thus, clarification is offered on the use of ES and PNES throughout this article. The International League Against Epilepsy defines ES as “a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.”⁸ Most important, the term ES—commonly shortened to seizure—does not imply that the seizure is caused by or the patient has an epilepsy syndrome. Rather, the intent is to differentiate ES from other physical or psychological sudden events that may resemble ES in some ways but which have causes other than abnormal excessive or synchronous neuronal activity in the brain,⁸ for example PNES, “an event resembling ES but caused by psychological processes”⁹ and historically also referred to as “pseudoseizure.”Lateral tongue bites have been described as a specific clinical finding of ES.^10-14 Some data suggest that bite injuries limited to the tip of the tongue are specific for syncope;^10,15,16 however, this pattern of injury has also been observed in ES¹¹ and PNES.¹⁴ On brain MR imaging, we have observed tongue signal abnormality (TSA), which was subsequently proved to correspond to tongue bite injury and was used to support a clinical diagnosis of unrecognized seizure. Neuroimaging is commonly performed in the evaluation of TLoC,¹⁷ and the presence of TSA may implicate ES as the underlying etiology. We hypothesized a positive association between TSA and the clinical diagnosis of ES. The purposes of this study were the following: 1) to determine the prevalence of TSA among patients in the ED undergoing brain MR imaging for TLoC, and 2) to assess associations between TSA and a final clinical diagnosis of seizure.     

Monitoring of the medical radiological exposures of the population of the Emilia–Romagna Region

PURPOSE: The Italian Decree of Law 187/2000 provides for many fulfilments relevant to justification and optimisation of medical exposures that can complicate the daily work of radiology departments if considered as mere legal requirements. On the contrary, this law should be regarded as a good opportunity to analyse and optimise working practices. To this end, the Emilia- Romagna Region carried out an initial assessment of medical exposures to its population in 2001 followed by a second survey taking into account new dosimetric evaluations. This paper illustrates the results of this second survey and analyses the most significant parameters in comparison with similar studies reported in the literature. MATERIALS AND METHODS: We first determined the examinations to be considered: 12 easily identifiable examinations divided into macroaggregates were selected for conventional radiography and computed tomography (CT). Hospitals of the Emilia-Romagna Region were directly asked to provide the number of examinations performed subdivided by type and grouped by nomenclature code, some technical parameters related to both examination protocol and equipment and the value of dose quantities as measured by local medical physicists. RESULTS: Study of distribution of the entrance skin dose for different examinations in single hospitals showed no systematic differences in kilovoltage settings versus dose whereas the number of examinations tended to be inversely proportional to dose. These trends could be explained by the fact that in hospitals where many examinations of the same type are performed, operators, equipment and procedures are well integrated, leading to a level of specialisation that allows efficient interaction in order to deliver an "optimal dose". Analysis of the "entrance skin dosemax"/"entrance skin dosemin" ratios for various projections and comparison with literature data seem to show that a "scale factor" has a fundamental role in the variability of entrance skin dose values amongst hospitals and that "chest" examinations are the most critical, with the greatest differences in entrance skin doses. CONCLUSIONS: The evaluations performed in this study show that this type of analysis heavily relies not only on the cooperation of all professionals responsible for patient radiation protection but also on the experience gained during previous surveys because data collection is a very critical process that can invalidate, if not carefully performed, all subsequent processing.     

Utility of dynamic perfusion PET using ¹³N-ammonia in diagnosis of asymptomatic recurrence of fibrosarcoma

Fibrosarcoma is a rare tumor involving the musculoskeletal system. Anatomic imaging modalities like CT and MRI are useful in characterization and staging of the tumor. FDG PET has variable sensitivity in evaluation of these tumors. Alternative tracers like FLT have been tried. It is a well-known fact that sarcomas are highly vascular. We report the utility of dynamic perfusion PET imaging using N13-ammonia in diagnosing a case of asymptomatic recurrence of fibrosarcoma in a 45-year-old patient. Despite very faint FDG avidity, ammonia perfusion imaging showed hypervascularity and allowed identification of the asymptomatic early recurrence.