Association of follow-up imaging frequency with temporal incidence and patterns of distant failure following (chemo) radiotherapy for HPV related oropharyngeal cancer.

OBJECTIVES: Emerging data supports radical intent therapy for oligometastatic (OM) relapsed human papilloma virus (HPV+) related oropharyngeal cancer (OPC). We assess the association of follow-up imaging frequency amongst HPV + OPC, with temporal and spatial patterns of distant relapse, to inform rationalisation of routine post-treatment imaging. MATERIALS AND METHODS: A retrospective single centre cohort study was carried out of consecutive HPV + OPC patients treated with radical intent (chemo)radiotherapy ((CT)RT) between 2011 and 2019. OM state was defined as ≤ 5 metastasis, none larger than 3 cm (OMs) or, if interval from last negative surveillance imaging > 6-months, then ≤ 10 metastasis, none larger than 5 cm, (OMp). Patients not meeting OMs / OMp criteria were deemed to have incurable diffuse metastatic disease (DMdiffuse). RESULTS: 793 HPV-OPC patients were identified with median follow-up 3.15years (range 0.2-8.9). 52 (6.6 %) patients had radiologically identified DM at first failure and were considered for analysis. The median time to recurrence was 15.1 months (range: 2.6-63 months). 87 % of distant metastasis (DM) occurred in the first two years after treatment. Twenty-seven (52 %) patients had OM (OMs or OMp) at time of failure, with 31 % having OMs. The median time from completion of treatment to diagnosis of DMdiffuse vs OM was 22.2 months (range: 2.6-63.1 months) vs 11.6 months (range: 3.5-32.5 months). The probability of being diagnosed with OM vs DMdiffuse increased with reducing interval from last negative surveillance scan to imaging identifying DM (≤6 months 88.9 %, 7-12 months 71.4 %, 13-24 months 35 %, > 24 months 22.2 %). CONCLUSION: We demonstrate that a reduced interval between last negative imaging and subsequent radiological diagnosis of DM is associated with increased likelihood of identification of OM disease. Consideration of increased frequency of surveillance imaging during the first two years of follow up is supported, particularly for patients at high risk of distant failure.

Falciform ligament torsion as a rare aetiology of the acute abdomen.

The falciform ligament is a remnant of the embryonic ventral mesentery containing the obliterated umbilical vein and round ligament. It extends from the umbilicus to the superior aspect of the diaphragm. We report about a 53-year-old fit and well patient who presented with acute upper abdominal pain with tenderness to palpation. Ultrasound scan was unremarkable, but blood tests revealed raised inflammatory markers. Thus, computed tomography was performed. This demonstrated acute torsion and fat necrosis of the falciform ligament, which was the aetiology of the upper abdominal pain. Such pathology is rare with 23 previously reported cases. Conservative management is usually proposed, but on occasion, surgical intervention may be warranted in cases that do not respond to initial supportive measures. We describe this case to demonstrate a rare cause of a common presentation to the surgical service.

An Audit to Evaluate the Image Quality of Magnetic Resonance of Knee at Radiology Department of a Tertiary Care Hospital.

light of recommendations of ACR. STUDY DESIGN: Aclinical audit. PLACE AND DURATION OF STUDY: Department of Radiology, Jinnah Hospital, Lahore, from August 2015 to February 2016. METHODOLOGY: Scans of 20 patients who underwent MRI of knee in August 2015 were studied retrospectively to assess the quality of images obtained in the first audit. Based on the findings of this audit, recommendations were made and re audit was done 6 months later in February 2016 to look for improvement in local practice. RESULTS: In the first audit, images were acquired in all the three necessary planes and the sagittal and coronal images had appropriate slice thickness, interslice gap as well as adequate anatomical coverage in all the patients. However, FOV (field of view) was appropriately set in 66% of cases in axial plane, 5% in sagittal plane, and 0% in coronal plane. Also, the anatomical coverage was not upto the mark in axial plane with 13 studies (66%) having adequate superior coverage, and 16 cases (80%) having recommended inferior anatomical coverage. The re audit performed 6 months later showed improvement with 100% compliance to standards. CONCLUSION: The first audit showed many shortcomings in acquiring of MRI data in patients undergoing knee MRI with FOV requiring a decrease in all planes and anatomical coverage increase in axial plane. These recommendations were made in departmental meetings and re-audit was done after 6 months. This second audit showed 100 % compliance.

Validity of resistive index for the diagnosis of malignant ovarian masses.

OBJECTIVE: To evaluate the validity of resistive index (RI) in conjunction to the morphological appearances. METHODS: Prospective cross sectional survey of 37 females with adnexal masses was selected through non probability sampling admitted in Obstetrics units, in a private hosital from January 2009 to March 2010. All women underwent transabdominal and transvaginal ultrasound and ovarian masses were characterized as probably benign or possibly malignant on the basis of their sonographic appearance. The RI was calculated in every case and threshold RI of 0.40 was used to differentiate benign from malignant lesions. Later pathologic proof was obtained in every case. Validity of the RI was calculated considering the histopathology as gold standard. RESULTS: Out of these 37 masses, 19 were morphologically benign and pathology revealed the same results. The RI was less than 0.4 in 3 of these cases. Eighteen lesions were morphologically either malignant (or indeterminate). On pathologic examination, 7 were benign 2 were nonneoplastic masses and 9 were malignant neoplasm. The RI was greater than 0.4 in 8 of these cases and was less than 0.4 in only 2 of the eight lesions. Sensitivity of the RI was 18.18% in diagnosing the malignancy whereas the specificity was only 84.61%. Positive predictive value of RI to differentiate benign from malignant lesions was only 33.33% and negative predictive value was 70.96%. Thus the accuracy of the RI was 64.86% with precision of only 33.33%. CONCLUSION: Resistive index may improve specificity in characterizing malignant ovarian lesions on ultrasound but it can be misleading.