Horner's syndrome following excision of a vagal paraganglionoma.

We report a case of excision of a vagal paraganglionoma resulting in Horner's syndrome. The case was initially misdiagnosed as a carotid body tumour and demonstrates the need for adequate preoperative imaging and patient counselling for likely complications of surgery.

Error review: can this improve reporting performance?

AIM: This study aimed to assess whether error review can improve radiologists' reporting performance. MATERIALS AND METHODS: Ten Consultant Radiologists reported 50 plain radiographs, in which the diagnoses were established. Eighteen of the radiographs were normal, 32 showed an abnormality. The radiologists were shown their errors and then re-reported the series of radiographs after an interval of 4-5 months. The accuracy of the reports to the established diagnoses was assessed. Chi-square test was used to calculate the difference between the viewings. RESULTS: On re-reporting the radiographs, seven radiologists improved their accuracy score, two had a lower score and one radiologist showed no score difference. Mean accuracy pre-education was 82.2%, (range 78-92%) and post-education was 88%, (range 76-96%). Individually, two of the radiologists showed a statistically significant improvement post-education (P < 0.01,P < 0.05). Assessing the group as a whole, there was a trend for improvement post-education but this did not reach statistical significance. Assessing only the radiographs where errors were made on the initial viewing, for the group as a whole there was a 63% improvement post-education. CONCLUSION: We suggest that radiologists benefit from error review, although there was not a statistically significant improvement for the series of radiographs in total. This is partly explained by the fact that some radiologists gave incorrect responses post-education that had initially been correct, thus masking the effect of the educational intervention.

Is there an improvement in performance when radiographs are re-reported at 24 hours?

This study was designed to assess the accuracy and intraobserver variability when plain radiographs are re-reported after 24 h, in order to determine if there was a change in observer performance. Five consultant radiologists reported 50 plain radiographs on patients in whom the diagnosis had been established. The radiographs were reviewed by each radiologist after an interval of 24 h. The same clinical information was available on both occasions. 32 of the radiographs showed an abnormality and 18 were normal. The accuracy of the report in relation to the established diagnosis was assessed, intraobserver agreement being calculated using kappa (kappa) statistics. The kappa-value for intraobserver agreement was in the range 0.33-0.88. Accuracy showed a range of 78-90% on the first viewing and 80-92% on the subsequent viewing. ROC curves were produced for each viewing for the group as a whole. The areas under the curves were 0.88 and 0.9 respectively. For the group, the accuracy increased on the second occasion, but this did not reach statistical significance.

Bowel lesions: percutaneous US-guided 18-gauge needle biopsy--preliminary experience.

Ultrasonography-guided percutaneous biopsy was performed with local anesthesia and an 18-gauge needle in 10 patients with bowel-wall lesions. All patients underwent clinical review within 1 month. Biopsy was diagnostic in all patients. There were no complications, and all patients tolerated the procedure well. The technique appears to be safe and had an excellent diagnostic yield in our series.

The role of bone scintigraphy and plain radiography in intractable plantar fasciitis.

The objective of this study was to assess the role of bone scintigraphy and plain film radiography in intractable plantar fasciitis. The bone scintigrams, radiographs and clinical histories of 33 patients with chronic plantar fasciitis were reviewed. These patients were refractory to conservative treatments and were being considered for surgical plantar fascia release. Twenty-eight patients had increased uptake on scintigraphy at the medial calcaneal tubercle, while a plantar spur was seen in 21 patients. Seventy-five percent of patients with increased uptake had a calcaneal spur; 95% of patients with a spur had increased uptake on scintigraphy. It would appear that plantar calcaneal spurs are more prevalent in this group of patients than in the general population and, although they may not be the primary cause of pain, they may predispose to it. Scintigraphy was helpful in patients without a spur or with atypical symptoms or signs. It did not provide any further information on the group of patients with a spur.

An assessment of inter-observer agreement and accuracy when reporting plain radiographs.

This study investigates the inter-observer agreement and accuracy of plain radiograph reporting. Five consultant radiologists were asked to report 50 plain radiographs where the diagnosis had been established. Thirty-one of the radiographs showed an abnormality; 19 were normal. The radiographs were viewed on two separate occasions, 5 months apart. Initially clinical details were omitted but on the second occasion they were available. The accuracy of the report to the known diagnosis was assessed using McNemar test and inter-observer agreement was assessed using Kappa statistics. The precision (mean accuracy) improved in the light of the clinical information from 77% (range 62% to 86%) to 80% (range 78% to 84%), although this improvement did not reach statistical significance. Sensitivity improved from 80% to 83% and specificity from 72% to 76%. The Kappa value for inter-observer agreement improved from 0.31 to 0.58 for all radiographs, from 0.40 to 0.70 for the abnormal radiographs and from 0.24 to 0.43 for the normal radiographs. There was a trend to improved accuracy of diagnosis and inter-observer agreement with knowledge of clinical details.

The value of indium-111-labelled leucocyte imaging and ultrasonography in the investigation of pyrexia of unknown origin.

The aim of this study was to assess indium-111 leucocyte imaging and ultrasound in the investigation of pyrexia of unknown origin (PUO), as well as the predictive value of available clinical information on the radiological outcome. 256 111In leucocyte scans performed over a 5 year period were reviewed. There were 59 scans in 58 patients who fulfilled recognized criteria for true PUO; 47 of these patients had ultrasound. In 15 patients the fever settled and no diagnosis was made; the source of PUO was infective in 20 and non-infective in 24. In the group as a whole, the sensitivities of leucocyte scan and ultrasound were 25% and 23% with specificities of 100% and 83%, respectively. In infective cases of PUO, the sensitivities were 20% for both modalities. There was no correlation between leucocyte count or differential, C reactive protein or the presence or absence of antibiotics. In the cases where the leucocyte scan led to the diagnosis of infection, the scan was performed within 4 weeks of the onset of symptoms. The results show that an infective cause for PUO is established in less than 50% of cases. The leucocyte scan is specific and although not very sensitive can often be a guide to subsequent cross-sectional imaging. If an infective cause for the PUO is strongly suspected, 111In leucocyte scanning may be more sensitive if performed in the first few weeks of fever.