Rectal tumour volume (GTV) delineation using T2-weighted and diffusion-weighted MRI: Implications for radiotherapy planning.

PURPOSE: To compare the rectal tumour gross target volume (GTV) delineated on T2 weighted (T2W MRI) and diffusion weighted MRI (DWI) images by two different observers and to assess if agreement is improved by DWI. MATERIAL AND METHODS: 27 consecutive patients (15 male, range 27.1-88.8 years, mean 66.9 years) underwent 1.5T MRI prior to chemoradiation (45Gy in 25 fractions; oral capecitabine 850mg/m(2)), including axial T2W MRI (TR=6600ms, TE=90ms) and DWI (TR=3000ms, TE=77ms, b=0, 100, 800s/mm(2)). 3D tumour volume (cm(3)) was measured by volume of interest (VOI) analysis by two independent readers for the T2W MRI and b800 DWI axial images, and the T2W MRI and DWI volumes compared using Mann-Whitney test. Observer agreement was assessed using Bland-Altman statistics. Significance was at 5%. RESULTS: Artefacts precluded DWI analysis in 1 patient. In the remaining 26 patients evaluated, median (range) T2W MRI MRI and DWI (b=800s/mm(2)) 3D GTVin cm(3) were 33.97 (4.44-199.8) and 31.38 (2.43-228), respectively, for Reader One and 43.78 (7.57-267.7) and 42.45 (3.68-251) for Reader Two. T2W MRI GTVs were slightly larger but not statistically different from DWI volumes: p=0.52 Reader One; p=0.92 Reader Two. Interobserver mean difference (95% limits of agreement) for T2W MRI and DWI GTVs were -9.84 (-54.96 to +35.28) cm(3) and -14.79 (-54.01 to +24.43) cm(3) respectively. CONCLUSION: Smaller DWI volumes may result from better tumour conspicuity but overall observer agreement is not improved by DWI.

Prostate MRI: who, when, and how? Report from a UK consensus meeting.

The current pathway for men suspected of having prostate cancer [transrectal biopsy, followed in some cases by magnetic resonance imaging (MRI) for staging] results in over-diagnosis of insignificant tumours, and systematically misses disease in the anterior prostate. Multiparametric MRI has the potential to change this pathway, and if performed before biopsy, might enable the exclusion of significant disease in some men without biopsy, targeted biopsy in others, and improvements in the performance of active surveillance. For the potential benefits to be realized, the setting of standards is vital. This article summarizes the outcome of a meeting of UK radiologists, at which a consensus was achieved on (1) the indications for MRI, (2) the conduct of the scan, (3) a method and template for reporting, and (4) minimum standards for radiologists.

Pseudothrombosis of the iliac vein in patients following combined kidney and pancreas transplantation.

Pseudothrombosis of the infrarenal inferior vena cava is a well recognized sign seen on helical CT of the abdomen. We report on pseudothrombosis of the iliac vein related to combined kidney and pancreas transplantation in the pelvis.

Endoanal ultrasound.

This pictorial review demonstrates the normal anatomy and abnormalities that are readily demonstrated with endoanal ultrasound of the anal sphincters.

Alcohol and radiographs in the accident and emergency department.

OBJECTIVE: To investigate the contribution of alcohol ingestion to the radiological workload of an inner city accident and emergency (A&E) department. METHODS: A prospective survey of patients presenting to A&E who required radiographs was performed over a seven day period. The A&E clinician questioned patients about alcohol intake during the six hours before the onset of the presenting complaint or injury, and made an objective assessment of signs of alcohol ingestion or intoxication. An assessment was made also of the relative contribution of alcohol as a cause of patients' injuries. RESULTS: A total of 419 patients who had radiography fulfilled the inclusion criteria, and a questionnaire was completed for 351 (84%). Forty (11%) of 351 were found to have ingested alcohol. Thirty five (87%) of 40 patients who had ingested alcohol were radiographed for trauma, as compared with 171 (55%) of the 311 who had not (p<0.001). Alcohol was considered to have been causative of injury in 30% and a contributory factor in an additional 58%. Radiographs of the skull, face and jaw accounted for 18 (33%) of 55 radiographs from trauma patients who had ingested alcohol compared with 20 (9%) of 212 radiographs from those who had not (p<0.001). There was no significant difference in the proportion of abnormal radiographs between these two groups (27% of radiographs from trauma patients who had ingested alcohol compared with 23% of radiographs from those who had not, p>0.2). CONCLUSION: Patients with alcohol related injuries requiring radiography have a significant impact on the radiological workload of an A&E department, although the prevalence of alcohol ingestion detected in this study was less than expected from previous studies.

The natural history of the multicystic dysplastic kidney in children.

The objective of this study was to examine the natural history of the multicystic dysplastic kidney and the use of sonography for follow-up studies. A retrospective study was performed on 66 children with a radiological diagnosis of multicystic kidney. The change in size demonstrated on sonograms was examined. Adequate follow-up was available on 55 children over a period of 32 months (range 2-69 months). 40/55 of the kidneys underwent a reduction in size, including 22 which were no longer detectable by ultrasound. 10/55 kidneys showed an increase in size and 5/55 showed no change. Reduction in size occurred at a mean age of 84 weeks (range 20-120 weeks). In conclusion, most multicystic kidneys undergo partial or complete involution over the first 2 years of life. The mean size of the multicystic kidney at diagnosis is a poor predictor of eventual outcome.

Spondyloepiphyseal dysplasia with nephrotic syndrome (Schimke immunoosseous dysplasia).

We report a 3-year-old girl with the association of spondyloepiphyseal dysplasia, nephrotic syndrome, and signs of defective cellular immunity. The findings are similar to those reported by Spranger et al., which have become known as Schimke immunoosseous dysplasia.

Sonographic standards for a single functioning kidney in children.

OBJECTIVE: We investigated the sonographic measurements of the functioning kidney of children who were born with a single functioning kidney. MATERIALS AND METHODS: In 56 children (0-6 years old) with one multicystic dysplastic kidney and one functioning kidney, the length of the functioning kidney was correlated with the child's age, weight, and body surface area. RESULTS: The mean length of the kidney was 51.0 mm in children 2 weeks old, 56.8 mm at 9 weeks, 62.8 mm at 23 weeks, 69.6 mm at 46 weeks, 71.7 mm at 63 weeks, 78.0 mm at 112 weeks, 79.6 mm at 172 weeks, 86.7 mm at 225 weeks, and 91.0 mm at 279 weeks. When these results were compared with existing sonographic standards for bilateral functioning kidneys, the single functioning kidneys were longer by a statistically significant amount. CONCLUSION: Compensatory hypertrophy of single functioning kidneys occurs in utero. In children of the ages we investigated, the size of single functioning kidneys exceeded established standards for the size of bilateral functioning kidneys.

Radiology of pulmonary tuberculosis.

Pulmonary tuberculosis (TB) is a considerable health problem throughout the world, and has increased in incidence over the past 10 years. This article reviews the typical radiographical findings in post-primary TB and reactivation, and describes the less common manifestations of the disease in nonimmuno-compromised and immuno-compromised individuals. Indications for plain radiography, computed tomography and high-resolution computed tomography are also discussed.

Portable chest radiology in intensive care: a comparison of a new dual characteristic film-screen system (Insight) incorporating a flexible grid with a standard film-screen system.

Insight (Insight, Kodak, UK) is a new dual image receptor system which utilizes an asymmetric film screen combination. Conventional radiography was compared with the Insight system, in combination with a cassette incorporating a flexible grid, in fifty patients on the intensive care unit. Radiographs were analysed by intensive care junior medical staff, nursing staff and two groups of radiologists. Insight provided better visualization of lung parenchyma, mediastinal detail and position of endotracheal tubes than conventional radiography. Central venous catheters were generally seen better on conventional radiographs than on Insight. Insight system produces a significant improvement in plain chest radiography in the intensive care unit. In the absence of digital radiography it is a suitable technique for routine radiography in the intensive care unit.

Endosonography of the anal sphincters in solitary rectal ulcer syndrome.

Twenty-one patients with histologically proven solitary rectal ulcer syndrome (SRUS) were examined by anal endosonography (AES) in order to determine the frequency of any ultrasound abnormality. Comparison was made with a group of 17 age and sex matched asymptomatic subjects. Four patients with SRUS had anal sphincter defects on AES. All were of the internal anal sphincter (IAS), which appeared fragmented in two patients with complete rectal prolapse. Measurements of internal and external anal sphincter (EAS) diameter and cross-sectional area were taken, excluding the 4 patients with defects. The submucosa was inhomogeneous (P = 0.0016) and thickness increased in patients with SRUS (median 4.0 mm vs 2.0 mm; P < 0.0001). IAS diameter was increased (median 3.8 mm vs 2.0 mm; P < 0.0001), as was cross-sectional area (median 241 sq mm vs 112 sq mm; P < 0.0001). EAS diameter was also increased (median 8.5 mm vs 7.0 mm; P = 0.0173), as was cross-sectional area (median 905 sq mm vs 594 sq mm; P = 0.0052). The ratio of EAS to IAS thickness was reduced in patients with SRUS (median 2.6 vs 4.0; P = 0.0029). The mechanism of these changes is unclear but apparent muscle hypertrophy on ultrasound may diagnose those patients with SRUS in whom defecatory difficulty is a predominant symptom.

Case report: granulocytic sarcoma of the small bowel--a rare presentation of leukaemia.

Granulocytic sarcoma (GS) is a local tumour mass that is associated with acute leukaemia. It may present simultaneously with leukaemia or may rarely predate it. The following case demonstrates the radiological features of GS and the importance of its recognition in the treatment.

Cyst formation of the craniopharyngeal duct.

The craniopharyngeal duct is the route by which the adenohypophysis ascends from the pharynx to the pituitary fossa. Rathke's cleft cyst represents an expansion of primitive vesicles that lie between the pars intermedia and the pars anterior. These cysts are rare but have been detected more frequently with the more widespread use of CT and MRI. Three cases are described which illustrate the variety of positions that a cystic lesion of the craniopharyngeal duct can occupy. These cases provide a basis for the discussion of the embryological formation of the pituitary, cyst formation of the duct, and CT and MRI appearances of the cysts.