The pericardium covers the heart and expands to the pulmonary trunk, the upper caval vein, and the ascending aorta. The pericardial sac consists of an inner visceral and outer parietal layer, which constitute for the pericardial cavity. The parietal pericardium localizes...

Primary gastrointestinal (GI) lymphoma is very rare, constituting 1–4% of all malignancies that affect the GI tract. Stomach is the most common site to be involved (>50%) in GI lymphoma followed by small bowel (20–50%) and colon (4–6%). The majority of primary GI lymphomas are non‐Hodgkin...

Placenta praevia is when the placenta inserts wholly or in part into the lower uterine segment. A placenta extending within 2 cm of the internal cervical os in the late third trimester of pregnancy will likely necessitate caesarean section delivery.  amatically...

The intestinal tract represents the most common site of extragenital endometriosis, with rectosigmoid disease accounting for 70–93% of extragenital endometriotic implants . Bowel endometriosis is currently defined as the presence of endometrial‐like glands and stroma infiltrating the bowel...

An estimated 70 530 new cases of bladder cancer were diagnosed in the USA in 2010, resulting in 14 680 deaths . Initially, 70% of patients present with non‐muscle invasive bladder cancer (NMIBC), and 30% with muscle‐invasive bladder cancer (MIBC) . Despite transurethral resection...

Spigelian hernia (SH) is an uncommon type of abdominal wall defect that is located on the semilunar line. Its content may vary and its severity is mostly due to small bowel (SB) complications. During the last 10 years, the use of computed tomography (CT) has increased dramatically...

Down syndrome is characterized by specific facial features such as a flat face and a small nose. Continuous technical improvements in ultrasound techniques have enabled optimal visualization of these features which, in turn, have evolved into markers currently used as screening tools for the detection...

Despite the widespread use of total mesorectal excision and neoadjuvant therapy, between 2.6 % and 32 % of patients with rectal cancer will develop pelvic recurrence after initial curative surgery . In addition, local recurrence (LR) is seen in up to 20 % of patients who had...

Chronic pancreatitis (CP) is an inflammatory disease characterized by progressive and irreversible structural damage to the pancreas, resulting in permanent impairment of both exocrine and endocrine functions. The diagnosis of CP is usually based on findings of imaging studies such as ultrasonography...

A specialist discusses the factors influencing attendance rates for breast screening, and how these rates can be optimized.

A review of some recently published papers linking use of PACS with improvements in care and productivity.

The morbidity and socioeconomic cost of fractures (broken bones) is considerable. Whilst most fractures unite, between 5% and 10% of long bone fractures are associated with delayed or non-union, resulting in significant morbidity, loss of independence and loss of productivity . The length of time...

In patients with STEMI (ST elevation myocardial infarction), primary and rescue percutaneous coronary intervention (PCI) reduce mortality and the risk of re-infarction and stroke compared with thrombolysis alone. For these reasons, primary and rescue PCI are recommended...

Recent years have evidenced a renewed interest in the blood flow inside the cardiac chambers, especially inside the Left Ventricle (LV) where the fluid dynamics is believed to represent a fundamental factor of its function and its regulatory ability. LV fluid dynamics has...

Increasing doses for prostate cancer have been shown to be associated with improved biochemical control rates in several prospective randomized studies . However, rectal toxicity has also increased significantly. Rectal toxicity is known to be the dose-limiting toxicity in prostate cancer radiotherapy...

An observational study of a consecutive case series of pre-viable PPROM (16-24 gestational weeks) was performed between 2001 and 2007 in a single tertiary centre to identify factors that predict neonatal survival. Methods Detailed obstetric, ultrasound and neonatal data were ed from clinical records....

Abdominal pain is a common presenting complaint in pregnant patients. Non-obstetrical surgery is fairly uncommon and is estimated to complicate 0.2% of pregnancies. Suspected acute appendicitis is the most common indication for surgical intervention during pregnancy, with...

Erectile dysfunction has been successfully treated with penile prosthesis implantation for over 50 years . In 1980, the Jonas prosthesis utilized embedded silver wires in a silicone sheath to improve malleability of the penis . More recently, both American Medical Systems (AMS, Minneapolis, MN, USA)...

Shoulder pain and instability can originate from a number of conditions including rotator cuff abnormalities and glenoid labral tears, including superior labral anterior-to-posterior (SLAP) lesions [, ]. Clinical history and physical examination are used as part of the decision-making...

There might be some heterogeneity between trials. The risk for the low risk population (of patients with follicular lymphoma) was taken from the trial with the highest rates of survival at 5 years (GELF94 trial). The high risk rate is approximately the risk in the CUP-trial, for relapsed patients. No...

For more than 30 years, several devices have been used to close patent ductus arteriosus (PDA) in children. Coils are generally used for small PDAs and occluding devices for larger PDAs . Recently, the new Amplatzer duct occluder II (ADO II), made of a fabric‐free fine nitinol wire net in to two...

The Dutch nationwide breast cancer screening programme was introduced in 1989 and fully implemented in 1997. Originally, the target population consisted of women aged 50-69 but in 1998 the upper age limit was raised to 75 . Every 2 years, eligible women are invited for mammographic screening....

The use of radiotherapy (RT) in the treatment of head and neck (H&N) cancer has significantly improved over the last decade. Two-dimensional, conventional large fields have been extensively replaced by more sophisticated techniques, such as 3D conformal radiotherapy...

In this seven-minute video interview conducted at the American College of Cardiology’s (ACC's) 61st Annual Scientific Session & Expo in Chicago, GetInsideHealth talked to Dr Alain Cribier after his presentation at Thought Leader Theater of the Heart of Innovations.

With the advent of hybrid PET/CT driven by oncology imaging, there are a growing number of centres using cardiac PET with Rb. This short-lived radioisotope (half-life 76.4 s) represents an attractive alternative to clinical imaging, as there is no need for a cyclotron...

Reperfusion therapy has significantly reduced mortality in patients with acute myocardial infarction (AMI). It has been shown that the extent and degree of irreversible myocardial tissue injury after AMI are strong predictors of long-term patient outcomes. Myocardial perfusion...

Why are some afraid of scanning the fetal central nervous system (CNS)? There is no easy answer to this. Perhaps it brings back memories of their medical school days, when neurology and neuroanatomy were challenging subjects.clarification...

Although radiological examinations play an important role in daily medical practice in the hospital setting, patients are not adequately informed about the radiation dose they are exposed to when undergoing a radiological examination. Lee et al found that nearly all patients...

Endovenous laser ablation (ELA) is a well-accepted alternative to surgery for the treatment of superficial venous insufficiency . The procedure is normally performed by using local tumescent anesthesia (TA). TA not only eliminates pain during ELA, but also protects the surrounding...

Breast physical examination, mammography and B-mode ultrasonography (USB) are the triad commonly used for characterization of breast masses and assessment of their risk for malignancy. The diagnostic confirmation of suspicious lesions is established by histopathological...

Gastric adenomas are benign epithelial neoplastic tumors with a glandular organization that are characterized by localized proliferation of adenomatous epithelium with tubular and/or papillary structures.   Non‐invasive carcinomas occasionally coexist within gastric adenomas and demonstrate...

Congenital heart disease is a major cause of infant and childhood mortality,   and is the leading organ‐specific birth defect in the United States. More than half of infants affected with congenital heart disease are born to mothers without any previously known risk factors, emphasizing...

Behçet’s disease (BD) is a systemic vasculitis of unknown etiology mainly characterized by mucocutaneous lesions and also by ocular, articular, neurological and vascular involvement. BD affects almost all types and sizes of blood vessels, and approximately 20 to 30% of these patients will...

The peritoneal cancer index (PCI) provides a measurement of the volume and extent of peritoneal tumor found at laparotomy. The PCI score combines the distribution of peritoneal tumor at 13 abdominal and pelvic regions with the tumor size. The PCI is the most widely validated and precise quantitative...

In the normal aortic arch branching pattern, the right subclavian artery arises from the innominate artery. In a rarer variant, this vessel arises independently as a fourth vessel of the aortic arch, courses behind the trachea and then turns towards the right shoulder. The anomalous course has resulted...

Neonatal weight is an important predictive parameter of neonatal outcome, and its estimation is valuable in planning the mode of delivery and obstetric management of labor . Also, when dealing with anticipated preterm delivery, perinatal counseling on likelihood of survival, the intervention undertaken...

Osteosarcoma is the most common malignant bone tumor in adolescents and young adults. The long-term survival of osteosarcoma patients has been significantly improved by combining neo-adjuvant chemotherapy and surgical resection . The goal of preoperative chemotherapy is to treat the micrometastatic...

Although congenital coronary artery anomalies are relatively uncommon, they are the second most common underlying cause associated with sudden cardiac arrest (SCA) and sudden cardiac death (SCD) among athletes, accounting for 15-25% of cases . These anomalies can be relatively difficult to...

Colorectal cancer has been recognized as the second most common cause of cancer-related death in the United States, and it is known to progress through stages of low-grade dysplasia (both polypoid and flat) to high grade and ultimately to invasive carcinoma . Small, distal hyperplastic polyps traditionally...

Although G‐band karyotyping is the predominant technique for prenatal diagnosis of karyotypic abnormalities, most chromosome banding techniques are time‐consuming, and are limited to a resolution of 10 Mb. Molecular cytogenetic techniques such as fluorescent in situ hybridisation (FISH),...

Early and accurate detection of fetal growth failure is important for prenatal and early postnatal care [, ]. Small size for gestational age fetuses are at increased risk of perinatal morbidity and mortality. It has also been suggested that fetal growth restriction is associated with cardiovascular...

The term haemangioma is used, somewhat confusingly, to describe various lesions in adults and children . Inexact terminology has in the past led to confusion about imaging findings and treatment algorithms. The term infantile haemangioendothelioma was widely used in the past, sometimes...

Abstract

Introduction Over the past several decades, liposomes have been used in a variety of applications, from delivery vehicles to cell membrane models. In terms of pharmaceutical use, they can offer control over the release of active agents encapsulated into their lipid bilayer or aqueous core, while providing protection from degradation in the body.

Abstract  

The aim of this study is to clarify the prognostic value of the pathological overall tumor cellularity after neoadjuvant chemotherapy for locally advanced hypopharyngeal cancer.

Abstract

Objective To analyze the correlation therapeutic effects of first sufficiency ¹³¹I therapy in Graves’ disease patients and improve its one-time curative ratio.

A specialist reviews differences between men and women in the presentation, assessment, and treatment of cardiovascular disease.

Why are current guidelines on the management of cardiovascular disease (CVD) "not yet fit for women"? Why should postmenopausal women be routinely assessed for CVD? Dr Janneke Wittekoek answers these and other questions in this video interview conducted exclusively for GetInsideHealth in March 2011.

Why are current guidelines on the management of cardiovascular disease (CVD) "not yet fit for women"? Why should postmenopausal women be routinely assessed for CVD? Dr Janneke Wittekoek answers these and other questions in this video interview conducted exclusively for GetInsideHealth in March 2011.

Twin pregnancies comprise approximately 1–2% of all conceptions and are continuing to increase in frequency because of assisted reproductive technologies and advancing maternal age1, 2. Multiple pregnancies are scanned frequently because of the increased risk for discordant anomalies, aneuploidy...

Enhanced glycolysis is a common characteristic of many malignancies1 and has been studied in animals and humans with PET using fluorine‐18 (18F)‐fluoro‐deoxyglucose (18F‐FDG‐PET). As a glucose analogue, FDG travels via the blood stream, is transported into cells via specific...

The pooled 2-year clinical experience using three tomotherapy units installed in France in 2007 is presented. Treatment indications and protocols were devised for each disease site and were the result of a consensus. A total of 642 patients were treated for central nervous system, head and neck, thoracic,...

Congenital heart disease (CHD) is a leading cause of neonatal morbidity and mortality, affecting 4 to 13 of 1000 live births (Hoffman, 2002). Its prenatal diagnosis allows for better pregnancy counseling (Volpe et al., 2003; Yates, 2004) and improved neonatal outcome (Bonnet et al., 1999).round-shaped...

Imaging cervical cancer is largely restricted to morphological datasets with computerized tomography (CT) and magnetic resonance imaging (MRI). The 2010 guidelines from the European Society of Urogenital Radiologists currently recommend T2-weighted MRI for cervical cancer staging and follow-up with images...

Magnetic resonance imaging (MRI) is commonly used to diagnose meniscal pathology. Some studies have found that MRI is not superior to physical examination in the diagnosis of meniscal tears [7, 14, 17], whereas others have demonstrated its value as an accurate and noninvasive diagnostic...

Selective cervical nerve root block is widely performed to diagnose the spinal level of cervical radiculopathy and relieve radicular pain, headache, shoulder stiffness, or extremity pain [1–3]. Various complications associated with cervical nerve root block have been reported [4,5]. Intravascular...

DEEP VENOUS THROMBOSIS and pulmonary embolism are two interrelated conditions that involve either propagation or embolization of venous thrombi. The spectrum of pulmonary emboli ranges from the clinically unsuspected, to massive embolisms causing death, which is why noninvasive diagnostic methods for...

Currently, resection is the only curative option available for patients with gastric cancer [1-4]. Accurate assessment of local tumor depth invasion (T), regional lymph node invasion (N), and distant metastases (M) is crucial to appropriate surgical and treatment planning [1, 2, 5]. Understaging...

Purpose of review To present the recent advances in imaging for diagnosis, staging, and follow-up of bladder cancer.Recent findings The use of multidetector 64-slice computed tomography (CT) and diffusion-weighted imaging has enabled higher-resolution imaging of bladder cancer on CT and MRI, respectively,...

Cardiosplenic syndromes are complex multiorgan conditions defined by the arrangement of the thoracic and abdominal viscera across the left–right axis1, 2. In left isomerism, there are paired left-sided viscera while the right-sided viscera may be absent, and in right isomerism, there are paired...

The pyruvate dehydrogenase complex (PDHc) is a mitochondrial matrix multienzyme complex that catalyzes the irreversible oxidative decarboxylation of pyruvate forming acetyl-CoA; this process plays a significant regulatory role in mitochondrial energy metabolism.1 The PDHc is composed of seven gene products...

Limb reduction defects are relatively uncommon congenital malformations.1, 2 The reported incidence is approximately 3.5–6.9 per 10,000 births with a prenatal detection rate of 55%, although this varies considerably depending on the population studied.3–5roducts...

What do the latest data show about the effectiveness of screening for breast and lung cancers?

Newly published evidence and specialist opinion on the role of MR-HIFU in the management of women with fibroids.

We present a round-up of recently published research on MR-HIFU as a non-invasive treatment for uterine fibroids.

How big a problem is it, what are the risk factors, and can the screening of athletes be effective in preventing deaths?

 Laparoscopic gastrectomy with lymph node dissection, such as laparoscopy-assisted distal gastrectomy (LADG), has been widely accepted as the treatment for early gastric cancer with the risk of lymph node metastasis, especially in Asia since 1991.

In this 3.5 minute video interview Prof Michael Knopp discusses the 7T revolution and how as technologies advance in the science of 7T, the vision for taking advanced capabilities and applying them to clinical applications is evolving.

In this 5-minute video interview conducted at the 2011 meeting of the American College of Cardiology, Dr. John Carroll reports that the introduction of new devices for structural heart disease has been accompanied by parallel developments in imaging. However, there is no single type of imaging best in all settings. Rather, physicians will have to understand how to match the best imaging modality with the procedure performed.

A round-up of recently published studies on how imaging techniques can contribute to the management of hepatocellular carcinoma.

The director of a center’s breast cancer program describes the benefits of addressing both the physical and emotional needs of patients.

In this 3.5 minute video interview Prof Michael Knopp discusses the 7T revolution and how as technologies advance in the science of 7T, the vision for taking advanced capabilities and applying them to clinical applications is evolving.

Previous study findings have indicated that MR thermometry on the heart is feasible with ECG and respiratory triggering, but has a limited temporal resolution that makes it difficult to assess the precise thermal dose being delivered. In an effort to overcome this limitation, researchers from centers in Bordeaux, France, investigated a method of monitoring the temperature evolution in the heart at each cardiac cycle.

They combined cardiac triggering and dynamic navigator-based slice tracking with image registration and compensation of susceptibility changes with respiration, and tested this during RF ablation on a sheep heart in vivo. MR-guided RF-heating was performed on the left ventricle of the heart, and real-time MR thermometry was performed during the procedure by acquiring 400 dynamic images.

Previous research has suggested that up to 50% of patients with paroxysmal AF receiving pharmacologic therapy will progress to persistent AF. Risk factors for progression include age, hypertension, a prior transient ischemic event, chronic obstructive pulmonary disease, and heart failure (as indicated by the HATCH score).

In a new study, specialists from the University of Michigan, in Ann Arbor, investigated the effect of RFA on the progression of paroxysmal AF in 504 patients (mean age 58 years). Just over one-third of the patients (38%) had a repeat RFA procedure.

Specialists from University RWTH Aachen, in Germany, compared five different techniques in 49 consecutive patients with severe aortic stenosis who were due to undergo TAVI: angiography, 2D transthoracic echocardiography (TTE), 2D transesophageal echocardiography (TEE), 3D TEE, and dual-source CT (DSCT).

The researchers found that the sagittal diameters measured by all five techniques were smaller than the coronal diameters that could be determined by angiography, 3D TEE and DSCT.

Researchers from specialist cardiology centres in New York evaluated the utility of FT-MRI measures of LV global and regional strain in patients with prior MI.

In a new study presented at the ACC conference, researchers from the Harbor UCLA Medical Center in Torrance, California, investigated the use of 64-slice multidetector CCTA to detect the presence of infarction, comparing it with nuclear myocardial perfusion imaging (MPI).

In this 4-minute video interview conducted at the 2011 meeting of the American College of Cardiology, Prof. David Erlinge from Lund University in Sweden reports on the progress so far in developing hypothermia as a tool to limit the damage to heart muscle from an acute myocardial infarction (MI). Hypothermia is already being used to prevent muscle damage during heart transplant and reduce brain damage in post cardiac arrest, and the potential for benefit in acute MI, based on experimental studies, is substantial.

GetInsideHealth covers the 19th annual meeting of The International Society for Magnetic Resonance in Medicine in Montreal May 7-13, bringing you on-site reviews, interviews, video, and poster presentations.

Previous research has suggested that up to 50% of patients with paroxysmal AF receiving pharmacologic therapy will progress to persistent AF. Risk factors for progression include age, hypertension, a prior transient ischemic event, chronic obstructive pulmonary disease, and heart failure (as indicated by the HATCH score).

In a new study, specialists from the University of Michigan, in Ann Arbor, investigated the effect of RFA on the progression of paroxysmal AF in 504 patients (mean age 58 years). Just over one-third of the patients (38%) had a repeat RFA procedure.

Researchers from Stony Brook University Medical Center, New York, evaluated the first 1,089 CCTAs performed at a large emergency department dealing with 90,000 visits per year. A control group comprised 4,556 other patients with acute chest pain who attended the emergency department in the same time period but who did not undergo CCTA.

All patients in the study had a negative initial ECG and troponin I level, and were considered to be low-risk chest pain patients. Patients known to have coronary artery disease were excluded from having CCTA. A 50% luminal diameter stenosis in any major vessel on CCTA was used as the threshold distinguishing obstructive from non-obstructive cases.

FDG-PET has been validated as a measure of carotid inflammation, but relatively little is understood about whether FDG uptake can also be used to evaluate inflammatory activity in atherosclerotic segments of the aorta. Although atherosclerotic inflammation is known to occur predominantly within lipid-rich plaques in the lesser curvature of the ascending aorta, providing an opportunity for FDG PET studies to quantify disease activity in these areas, it was unclear whether potential obstacles, such as peri-aorta fat, might limit accuracy or reproducibility.

The researchers, from centers in Boston and New York, performed both MRI and FDG-PET in 15 subjects with atherosclerosis (the mean age of the subjects was 65 years). FDG update was measured within the aortic wall at 30-degree intervals on axial images. Lipid-rich plaques were defined as wall regions that were hyper-intense on both T1 and TOF [time of flight] MRI, and peri-aortic fat was also identified on MRI.

Researchers from NHS Tayside in Dundee, UK, studied use of a digital dosimeter worn on top of the lead apron, providing live information on exposure during fluoroscopy. They compared fluoroscopy usage in the 6 months before the introduction and implementation of the dosimeter, and in the 6 months afterwards.

A total of 208 pacemaker implantation procedures were performed in the study period. The mean X-ray screening time was reduced significantly with use of the dosimeter, from 3.7 min to 3.0 min. Similarly, the dose area product (DAP) for each procedure was reduced from a mean of 247 microGray/cm2 to 185 microGray/cm².

The group of researchers from the University of Munich in Germany, led by Dr. Martin Hadamitzky, assessed the value of CCTA data in addition to clinical risk predictors and CASC in the prediction of severe cardiac events.

A group of researchers from the University of Ottawa Heart Institute, Ottawa, Canada, have compared the accuracy of 2 different algorithms to predict mortality risk in octogenarian patients undergoing aortic valve replacement (AVR) or AVR plus coronary artery bypass grafting (CABG). 

A total of 394 patients (mean age 83 years, 53% male) undergoing AVR or AVR/CABG were included in the study. Expected hospital mortality was predicted using 2 risk-prediction algorithms: the STS predictive risk of mortality algorithm, and the LES algorithm. Patients were classified as low-, medium-, or high-risk, according to the criteria of the different algorithms, and were followed up for a mean of 4.7 years. Observed/expected (O/E) mortality ratios were calculated.

The coronary atherosclerotic plaque burden is known to be associated with the risk of contrary events, but it has been unclear whether non-invasive methods such as multidetector CT can effectively detect subtle changes in plaque burden over time.

To investigate, researchers from centers in Brazil and the USA compared quantitative plaque volume measurements obtained by 64-slice multidetector CT (MDCT) with those obtained by virtual histology intravascular ultrasound (VH). A total of 20 patients referred for percutaneous coronary intervention underwent MDCT before the procedure and VH during it, and both tests were repeated after a mean period of 9.3 months.

Previous research has demonstrated an association between obstructive sleep apnea and AF, but no studies have investigated whether treating sleep apnea, with CPAP therapy, can reduce the risk of AF. To rectify this, specialists from the sleep center at the Toranomon Hospital in Tokyo, Japan, studied the effect of CPAP therapy on P-wave duration - a prolonged P-wave duration being a marker of left atrial abnormality and understood to be a strong predictor of AF.

The specialists from the University of Toyama, Japan, conducted a study in 26 patients with acute coronary syndrome in order to investigate the relationship of macrophage accumulation and intraplaque hemorrhage to vulnerable plaque morphology. According to the senior author of the study, Dr. Takao Sato, previous work with virtual histology intravascular ultrasound (VH-IVUS), using spectral analysis of radiofrequency ultrasound backscatter signals "has been used to identify components of atherosclerotic plaque."

Specialists from centers in Adelaide, Australia, evaluated 362 consecutive patients referred to a tertiary cardiology center for stress perfusion CMR. Almost one-third of the patients had a history of previous myocardial infarction or percutaneous coronary intervention (PCI). Perfusion imaging was performed at stress (with adenosine 140 mcg/kg/min) and at rest on a 1.5T machine, and late enhancement was assessed with dual pass gadolinium at a total dose.

In this audio interview conducted exclusively for GetInsideHealth in March 2011, Professor Pierre Jaïs provides expert insights into recent developments in catheter ablation for atrial fibrillation (AF).

Listen to Dr Nick Perry of the London Breast Institute report on 11 years of experience with digital mammography in this audio interview conducted exclusively for GetInsideHealth on 23 March 2011.

An important challenge in cardiac CT is to minimize the radiation dose while maintaining and optimizing image quality. How this can be achieved is discussed in a new GetInsideHealth audio interview conducted with Dr Gilbert Raff, medical director of the Ministrelli Center for Advanced Cardiovascular Imaging at the William Beaumont Hospital in Royal Oak, Michigan, USA.

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Over the past years, cardiovascular magnetic resonance (CMR) has proven its efficacy in large clinical trials, and consequently, the assessment of function, viability, and ischaemia by CMR is now an integrated part of the diagnostic armamentarium in cardiology. By combining these CMR applications, coronary artery disease (CAD) can be detected in its early stages and this allows for interventions with the goal to reduce complications of CAD such as infarcts and subsequently chronic heart failure (CHF). As the CMR examinations are robust and reproducible and do not expose patients to radiation, they are ideally suited for repetitive studies without harm to the patients. Since CAD is a chronic disease, the option to monitor CAD regularly by CMR over many decades is highly valuable. Cardiovascular magnetic resonance also progressed recently in the setting of acute coronary syndromes. In this situation, CMR allows for important differential diagnoses. Cardiovascular magnetic resonance also delineates precisely the different tissue components in acute myocardial infarction such as necrosis, microvascular obstruction (MVO), haemorrhage, and oedema, i.e. area at risk. With these features, CMR might also become the preferred tool to investigate novel treatment strategies in clinical research. Finally, in CHF patients, the versatility of CMR to assess function, flow, perfusion, and viability and to characterize tissue is helpful to narrow the differential diagnosis and to monitor treatment.

Cardiovascular disease remains the leading cause of mortality, morbidity and disability in the developed world, predominantly affecting the adult population. In the early 1990s coronary heart disease (CHD) was established as affecting one in two men and one in three women by the age of forty. Despite the dramatic progress in the field of cardiovascular medicine in terms of diagnosis and treatment of heart disease, modest improvements have only been achieved when the reduction of cardiovascular mortality and morbidity indices are assessed. To better understand coronary atherosclerosis, new imaging modalities have been introduced. These novel imaging modalities have been used in two ways: (1) for the characterization of plaque types; (2) for the assessment of the progression and regression of tissue types. These two aspects will be discussed in this review.

Introduction

In the year 2010, the International Journal of Cardiovascular Imaging received very interesting contributions dealing with a wide variety of imaging modalities. Papers came from all corners of the world and dealt with both experimental and clinical observations. Since we deal today with image-guided diagnoses, therapies and interventions, there is a growing interest in the increasing capabilities of the existing imaging modalities. Developments in imaging are therefore not only interesting to imaging experts themselves, but in particular to medical specialists such as cardiologists, radiologists, nuclear medicine specialists, and internal medicine specialists. Improvements in imaging capabilities may directly lead to improved health care. Within the whole spectrum from primary prevention to intervention, myocardial imaging becomes an indispensible tool. Both patients with suspected and known cardiovascular disease may benefit from the tremendous achievements in cardiac and vascular imaging.

Imaging has a central role in the evaluation of patients with heart failure (HF). Cardiovascular magnetic resonance (CMR) is rapidly evolving as a versatile imaging modality that often provides additional information to echocardiography in patients with suspected or known HF. CMR is the only imaging modality that has the ability to assess, without exposure to ionizing radiation, cardiac function, structure (tissue characterization), perfusion, and viability. Moreover, magnetic resonance spectroscopy techniques can assess the pathophysiologic role of deranged cardiac energetics in HF. In this review we discuss the role of CMR in the evaluation of patients with HF giving particular emphasis to recent developments and the additional information that can be obtained with this imaging modality, over and above standard echocardiography.

Recent advances in fatty acid (FA) imaging using positron emission tomography (PET) include the development of a method to assess endogenous triglyceride metabolism and the design of new fluorine-18 labeled tracers. Studies of patients with diabetes have shown that the heart is resistant to insulin-mediated glucose uptake and that metabolism of nonesterified FA is upregulated.

Motivated by the promise to transform preclinical research and clinical care, cardiovascular molecular imaging has made advances toward targeting coronary atherosclerosis and heart failure. Here, we discuss recent progress in the field, highlight how molecular imaging may facilitate preventive patient care, and review specific challenges associated with coronary and heart failure imaging. Practical considerations stress the potential of fluorescence imaging for basic research and discuss hybrid protocols such as FMT-CT and PET-MRI.

Procedure time, fluoroscopy time, dose area product (DAP), and contrast media volume were used as indicators of quality of performance. We analyzed data from 4,200 coronary angiographies. Performance curves of seven trainees were compared with recommended reference levels and to those of seven interventional cardiologists.

Background and Objective The current standard for diagnosis of skin cancers is visual inspection followed by biopsy and histopathology. This process can be invasive, subjective, time consuming, and costly. Optical techniques, including Optical Coherence Tomography (OCT) and Raman Spectroscopy (RS), have been developed to perform non-invasive characterization of skin lesions based on either morphological or biochemical features of disease. The objective of this work is to report a clinical instrument capable of both morphological and biochemical characterization of skin cancers with RS-OCT.

Purpose   The ability of PET to aid in the diagnosis and management of recurrent and/or disseminated metastatic prostate cancer may be enhanced by the development of novel prognostic imaging probes. Accumulating experimental evidence indicates that overexpression of integrin α₂β₁ may correlate with progression in human prostate cancer. In this study, ⁶⁴Cu-labeled integrin α₂β₁-targeted PET probes were designed and evaluated for the imaging of prostate cancer.

Abstract

Purpose To demonstrate dynamic imaging of a diffusible perfusion tracer, hyperpolarized [¹³C]urea, for regional measurement of blood flow in preclinical cancer models.

Abstarct

Background Cervical carcinoma is the only gynecological tumor still being staged mainly by clinical examination and only a limited use of diagnostic radiology. Cross sectional imaging is increasingly used as an aid in the staging procedure. We wanted to assess the impact of magnetic resonance imaging (MRI) in addition to the clinical staging of patients with carcinoma of the uterine cervix.

Abstarct

Background   Primary malignant neoplasms of the small bowel comprise only 1-3% of all gastrointestinal malignancies. Small bowel cancers pose a significant diagnostic challenge. The recent development of video capsule endoscopy (VCE) and device-assisted enteroscopy (DAE) have greatly facilitated evaluation of the small bowel.

Abstract

Background The purpose of this study was to compare 5-field and 7-field intensity-modulated radiation therapy (IMRT) techniques in terms of xerostomia and related quality of life in patients with nasopharyngeal cancer.

Abstract

Background The prognostic and predictive value of magnetic resonance (MR) investigations in clinical oncology may be improved by implementing strategies for discriminating between viable and necrotic tissue in tumors. The purpose of this preclinical study was to investigate whether the extent of necrosis in tumors can be assessed by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and/or T₂-weighted MR imaging.

Over one-third of patients with low-risk prostate cancer patients are getting radiographic imaging scans that are not recommended by treatment guidelines, while nearly 40% of high-risk patients who should be receiving the tests aren't getting them, according to a study of 30,183 patients reported here at the Genitourinary Cancers Symposium.

Abstract

Ablation Without Fluoroscopy in Pregnancy.
Background Management of symptomatic atrial arrhythmia in pregnancy remains a challenge. In this case report, a pregnant woman with incessant tachycardia underwent successful left atrial ablation. The entire procedure was performed without fluoroscopy.

Abstract

Background A study was undertaken to investigate the detection of relapse and survival outcomes in patients with cervical cancer treated with curative intent chemoradiotherapy, and evaluated with a post-therapy ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) scan.

Abstract

Background Fat transfer to healthy breasts, that is, in women with no history of breast disease, particularly breast cancer, is becoming increasingly popular. The main issue remains whether the transfer of fat cells to the native breast hampers breast imaging. This pilot study aimed to assess the effectiveness of radiographic evaluation after breast lipomodeling and to propose objective elements for the detection of mammographic signs, and for postoperative evaluation of breast density and Breast Imaging Reporting and Data System (American College of Radiology) classification.

Abstract

Introduction The evaluation of breast symptoms during pregnancy or lactation can be challenging but prompt, appropriate assessment of symptoms may lead to earlier cancer detection.

Abstract

Background   Near-infrared (NIR) fluorescent sentinel lymph node (SLN) mapping in breast cancer requires optimized imaging systems and lymphatic tracers.

Purpose   The objective of this study was to identify features of preoperative computed tomography (CT) scans that can best predict outcomes of primary cytoreductive surgery in ovarian cancer patients.

Abstract

Mammographic density (MD), a strong marker of breast cancer risk, is influenced by genetic, environmental, and hormonal factors. Cadmium, a persistent and widespread environmental pollutant, has been associated with risk of breast cancer, and laboratory evidence suggests cadmium is a carcinogen in the breast.

Abstract

Introduction Positron emission tomography (PET) is a state‐of‐the‐art functional imaging technique used in the accurate detection of cancer. The main problem with the tumours present in the lungs is that they are non‐stationary during each respiratory cycle. Tumours in the lungs can get displaced up to 2.5 cm during respiration. Accurate detection of the tumour enables avoiding the addition of extra margin around the tumour that is usually used during radiotherapy treatment planning.

Abstract

Purpose   Although a site common for pathology and of great importance to the neurosurgeon, the three-dimensional (3D) morphometry of the anterior communicating artery (ACoA) has had incomplete descriptions in the literature.

Abstract

Objectives This study aimed to evaluate an atraumatic prototype electrode carrier for cochlear implantation, the FLEX^{EAS 20} electrode. This electrode is designed to preserve hearing and to achieve a 360-degree insertion.

Abstract

Purpose   To describe the morphologic evolution of lung tumors treated with radiofrequency ablation (RFA) by way of computed tomography (CT) images and to investigate patterns of incomplete RFA at the site of ablation.

Abstract

Objectives   In this retrospective study the success and complication rates after radiologically guided port catheter implantation were evaluated.

Abstract

Uterine leiomyomata, or fibroids, although benign, cause debilitating symptoms in many women. Symptoms are often nonspecific and may be the presenting complaint in a number of other conditions. Furthermore, because the presence of fibroids may be coincident with other symptomatic conditions that result in similar complaints, there may be diagnostic difficulty and consequent difficulty in planning therapeutic strategy.

Abstract

Objectives   To evaluate whether a pharmacokinetic analysis is useful for both predicting and monitoring the response to chemoradiotherapy (CRT) in oral cancer.

Introduction

Quality-improvement practices and research are important in radiology for multiple reasons [1-9]. For all of us involved in medical imaging, regardless of the type of practice, part of our vision and mission is improving the health of all patients through imaging delivery. While certainly this involves direct patient care, improving the practice of medical imaging delivery as well as sharing clinical experiences can expand our vision and our mission beyond the immediate patients we are serving. In addition, patients as well as regulatory bodies are increasingly demanding that physicians practice quality improvement through mechanisms such as the maintenance of certification [10] and the potential maintenance of licensure. It can also be argued that participation in quality-improvement and research activities can increase work satisfaction and engagement of radiologists. Finally, active quality-improvement and research programs are essential for radiology to preserve its leadership role in medical imaging [1-6]. At our institution, we have put in place a Quality Improvement in Research and Imaging (QuIRI) program. The purpose of this manuscript is to describe the QuIRI process and how it has positively affected our research and quality-improvement program.

Abstract

Objective Cerebrovascular disease is 1 of the possible mechanisms of the previously reported relationship between Mediterranean-type diet (MeDi) and Alzheimer's disease (AD). We sought to investigate the association between MeDi and MRI infarcts.

Is "a small revolution in screening for colon cancer" underway, as some specialists recently concluded? To mark National Colorectal Cancer Awareness Month in the USA, we look at the latest published clinical data on colorectal cancer screening.

In a review paper published at the end of 2010, specialists from the Unit Of Medical Oncology at the Ospedali Riuniti di Bergamo, Italy, wrote that "a small revolution in screening for colon cancer is in the making".

Why are current guidelines on the management of cardiovascular disease (CVD) "not yet fit for women"? Why should postmenopausal women be routinely assessed for CVD? Dr Janneke Wittekoek answers these and other questions in this video interview conducted exclusively for GetInsideHealth in March 2011.

In this audio interview conducted exclusively for GetInsideHealth on 23 February 2011, Dr William G Bradley, Jr, discusses how MR-guided focused ultrasound (MRgFUS) is currently being used in clinical practice, and provides insights into likely future uses of the technique based on the findings of cutting-edge research.

In recent months several important new papers have been published relating to the diagnosis and management of ductal carcinoma in situ (DCIS) – the pathology that accounts for about one in five of all screen-detected breast cancers. Here we present a round-up of some of the main findings and the implications for clinical practice and future research.

Should low-dose helical CT now be the method of choice for lung cancer screening? In November 2010 the USA’s National Cancer Institute (NCI) released early findings from the National Lung Screening Trial (NLST) showing that screening with low-dose helical CT was associated with a significant mortality benefit compared with chest X-ray screening, in older current and former heavy smokers. Overall, there were 20% fewer lung cancer deaths in the population screened using CT than in the population screened using X-ray.

The first real-time 3D (RT3D) echocardiographic methodology was introduced in the early 1990s and circumvented the need for 3D image reconstruction from a series of 2D slices.²
During the last decades, among the many technological and software improvements in the acquisition of 3D images, the latest generation of scanners involves the use of more than 3,000 scanning elements, compared with 256 in the earlier versions. This allows for the production of pyramidal 3D datasets, permitting the real-time visualization of heart chambers and valve structures.¹

The importance of considering quality of life in women with gynecologic cancer.

Recent developments have highlighted the continuing and growing importance of considering quality of life (QoL) in women with cancer, and gynaecologic cancer in particular.

An imaging specialist discusses cardiac CT, including new clinical guidance and future applications of the technique. In this exclusive audio interview for GetInsideHealth, conducted in January 2011, Dr Morten Bøttcher of Aarhus University Hospital, Denmark, discusses the use of cardiac CT in daily clinical practice. The interview includes discussion of the updated “Appropriate Use Criteria” for cardiac CT published in October 2010 by a consortium of professional societies. Originally published in 2006, the updated guidance increases the number of appropriate uses, taking into account the expanding evidence base.

Abstract

Rapid technetium-99 m methoxyisobutylisonitrile (99 mTc-MIBI) washout has been shown to occur in impaired myocardia. This study is based on the hypothesis that scintigraphy can be applied to calculate the myocardial 99 mTc-MIBI washout rate (WR) to diagnose and evaluate heart failure severity and other left ventricular functional parameters specifically in idiopathic dilated cardiomyopathy (IDCM) patients.

Abstract

Purpose To prospectively determine the most reproducible approach for left-atrial size assessment using cardiovascular magnetic resonance (CMR) imaging in patients with atrial fibrillation and its value for prediction of pulmonary vein isolation (PVI) treatment success.

Abstract

Background:  The transradial approach for coronary procedures is associated with a low complication rate, but specific training is considered mandatory.

Abstract

Introduction Lipomatous hypertrophy of the interatrial cardiac septum is a benign disorder. In rare cases, the disorder can cause obstruction of atrial inflow, causing symptoms of heart failure, or cardiac arrhythmias resulting from the involvement of the atrial wall and atrioventricular conduction pathways.

Abstract

Introduction Early repolarization (ERep) abnormalities on electrocardiogram (ECG) are common immediately following cardiac arrest. We characterized and correlated electrocardiographic repolarization abnormalities immediately after cardiac arrest with acute coronary angiography.

Abstract

Purpose of the Report This study tested the feasibility of C11-acetate (acetate) positron emission tomography (PET) imaging to assess response to therapy in men with bone metastatic prostate cancer and compared results for disease detection and response evaluation with F-18 fluorodeoxyglucose (FDG) PET.

Abstract

A key aspect for the postoperative prognosis of patients with head and neck cancer is complete tumor resection. In current practice, the intraoperative assessment of the tumor-free margin is dependent on visual appearance and palpation of the tumor. Optical imaging has the potential of traversing the gap between radiology and surgery by providing real-time visualization of the tumor, thereby allowing for image-guided surgery. The use of the near-infrared light spectrum offers 2 essential advantages: increased tissue penetration of light and an increased signal-to-background ratio of contrast agents.

Abstract

Background No universal consensus of optimal radiation target coverage for oral tongue cancer exists, and there is wide variability in practice. Some centers use intensity-modulated radiotherapy (IMRT) to selectively target only certain regions at risk while sparing others; however, patterns of failure after such selective targeting are rarely reported.

Abstract

Background Tumor grade, age, extent of resection, and performance status are established prognostic factors for survival in primary brain tumor (PBT) patients. Development of disease-related symptoms is predictive of tumor recurrence in other cancers but has not been reported in the PBT population.

Abstract

Objective To evaluate the accuracy of ¹⁸F-fluoride PET/computed tomography (CT) to detect bone metastases (BMs) in a breast and prostate cancer population, using magnetic resonance imaging (MRI) or thin-slice CT as a gold standard.

Abstract

Introduction To determine the best imaging modality for preoperative detection, characterization and measurement of colorectal liver metastases (CRLM) after neoadjuvant chemotherapy (NAC).

Abstract

Purpose To assess the correlations between parameters measured on dynamic contrast-enhanced magnetic resonance imaging and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in rectal cancer.

Abstract

Objective We evaluated the neuropsychological outcome of children with proven congenital cytomegalovirus (CMV) infection and normal consecutive fetal neurosonographic examinations.

Abstract

Objectives To prospectively compare clinical breast examination, mammography, ultrasonography, and contrast-enhanced magnetic resonance imaging (MRI) in a multicenter surveillance of high-risk women.

Abstract

Objectives The aim of this study was to present our results of the sonographic measurement of the fetal iliac angle during the first and second trimesters of pregnancy.

Abstract

Mammographic density (MD) adjusted for age and body mass index (BMI) is a strong heritable breast cancer risk factor; however, its biological basis remains elusive. Previous studies assessed MD-associated histology using random sampling approaches, despite evidence that high and low MD areas exist within a breast and are negatively correlated with respect to one another.

Abstract

Objective  Appendicitis is the most common surgical emergency in pregnancy. Acute appendicitis is often difficult to diagnose clinically, and concerns regarding antenatal CT imaging limit its use resulting in high false negative rates at laparotomy. MRI has recently been reported as a reasonable alternative to CT imaging in cases of suspected appendicitis. Our objective was to perform a meta-analysis of recently published data regarding the utility of MR imaging in cases of antenatal suspected acute appendicitis.

Abstract

Purpose To evaluate the ability of diffusion tensor imaging (DTI) to predict the transrectal ultrasound (TRUS) biopsy outcomes in persons who have no history of previous TRUS biopsy and present with elevated prostate-specific antigen (PSA) levels.

Abstract

Objective   To asses the features and explore the clinical relevance of popliteal lymph nodes (PLNs) detected on MRI examination for different pathologies of the knee.

The goal of the Alliance for Radiation Safety in Pediatric Radiology’s Image Gently campaign is to promote radiation protection for children undergoing imaging examinations that use ionizing radiation. The campaign creates awareness, develops educational content toward this goal, and more recently has advocated for change in equipment design to better meet the needs of pediatric patients. A previous meeting sponsored by the Alliance, the Image Gently CT Vendor Summit in 2008, urged manufacturers to standardize the CT dose display and nomenclature across vendors and promoted the adoption of a more accurate dose display or patient dose index to account for the wide range of size variability among pediatric patients. The campaign held a second meeting, the Image Gently Pediatric Digital Radiography Summit, building on the work of Drs. Charles E. Willis and Thomas L. Slovis, co-chairs of the 2004 conference, the ALARA Concept in Pediatric CR and DR: Dose Reduction in Pediatric Exams [1].

Abstract

Objectives/hypothesis Although precise localization of obstruction sites in the upper airway during sleep is essential in subjects with obstructive sleep apnea syndrome (OSAS), no gold standard diagnostic method has been established. This study aimed to evaluate the dynamic collapse inside the upper airway by using cine magnetic resonance imaging (MRI), also called sleep MRI.

Abstract

Purpose To investigate differences in perfusion profiles between degenerative endplate marrow changes and normal vertebral marrow in relation to spinal level, age, and sex with dynamic contrast-enhanced magnetic resonance imaging (DCE MRI).

Abstract

Introduction The purpose is to evaluate ¹⁸F-fluorodeoxy glucose-positron emission tomography (PET)/computed tomography (CT) for the detection of cervical carcinoma of the International Federation of Gynecology and Obstetrics stages Ib and IIa.

Abstract

Background   The purpose of this study is to analyze the diagnostic accuracy of MSCT in the identification of para-aortic lymph node metastases from gastric cancer.

Is the demand for catheter ablation for atrial fibrillation (AF) likely soon to exceed supply? In the past few months, several papers have been published that point to significant benefits from use of the technique and an increasing demand. At the same time there are suggestions from surveying physicians that this increasing demand for catheter ablation for AF is not being matched by an increase in the provision of electrophysiology services.

What has the recently published research shown? In one study published last year in the journal Heart, specialists investigated the long-term efficacy of catheter ablation for AF in a total of 285 patients who underwent 530 procedures (an average of 1.9 per patient – 1.7 for paroxysmal AF and 2.0 for persistent AF). The patients were followed up for an average of 2.7 years (range 0.2 to 7.4 years) after the last procedure.

Chronic cerebrospinal venous insufficiency (CCSVI) is a putative new theory that has been suggested by some to have a direct causative relation with the symptomatology associated with multiple sclerosis (MS) [1].

Background and Purpose We compared the effectiveness of using computed tomographic angiography and venography (CTAV) with digital subtraction angiography (DSA) in young or nonhypertensive patients with acute spontaneous intracerebral hemorrhage.

Background and objectives Type-2 diabetic patients constitute a high-risk population for atherosclerosis. Primary prevention, although recommended, is not well funded. Our aim was to evaluate the degree of subclinical atherosclerosis, in asymptomatic diabetic patients, using coronary multi-slice computed tomography (MSCT) angiography.

Background The Intracardiac Echocardiography Guided Cardioversion Helps Interventional Procedures study evaluated the concordance of intracardiac echocardiography (ICE) with transesophageal echocardiography (TEE) in patients with atrial fibrillation (AF).

Carotid thickening and plaque detected by B-mode imaging ultrasound are useful to improve the ischemic risk evaluation in asymptomatic subjects over and beyond the traditional cardiovascular risk factors. Some plaque’s echographic parameters help describing the vascular risk. We hypothesized that the stenosis degree, plaque surface irregularity, echolucency and texture, compounded in a Total Plaque Risk Score (TPRS), are predictors of the ischemic events in the San Daniele study, a general population-based study of 1,348 subjects followed for 12 years in average. In the 171 subjects with at least one plaque at baseline, high TPRS was the most powerful independent predictor of cerebrovascular events, which occurred in 115 subjects. Addition of plaque characteristics significantly increased the area under the ROC curve (0.90 vs. 0.88, p = 0.04) versus the Framingham risk score alone. The TPRS is a potential new tool to improve the stroke risk prediction.

Background Unstable carotid plaques that consist of large lipid pool and intraplaque hemorrhage are more likely to cause cerebral infarction. We previously developed an integrated backscatter (IBS) ultrasound color-coded mapping method to evaluate the tissue characteristics of plaques. The purpose of this study was to determine whether 3-dimensional IBS color-coded mapping and signal intensity ratio (SIR) from magnetic resonance imaging (MRI) could distinguish the early symptomatic plaques from late symptomatic plaques.

Background Advances in contrast-enhanced multidetector CT enable detailed characterization of the left ventricular myocardium. Myocardial scar and border zone (BZ), as the target of ventricular tachycardia ablations, displays abnormal anatomic, dynamic, and perfusion characteristics during first-pass CT. This study assessed how contrast-enhanced CT can predict voltage-defined scar and BZ and integrate its scar reconstructions into clinical mapping systems to guide ventricular tachycardia ablations.

Purpose Gastro-entero-pancreatic (GEP) endocrine tumours are a heterogenous group of tumours of variable localization and prognosis. It has been suggested that positron emission tomography (PET) using 2-[¹⁸F]fluoro-2-deoxy-D-glucose (¹⁸F-FDG) may have a prognostic value and help to identify patients at risk of progression. [¹⁸F]fluoro-3′-deoxy-3′-L-fluorothymidine (¹⁸F-FLT) has been recently developed as a PET proliferation tracer. At present, there are no studies investigating its role in GEP. The aim of this prospective study was to assess the value of ¹⁸F-FLT-PET for the evaluation of GEP.

Purpose To evaluate the correlation of the mean and minimal apparent diffusion coefficient values (ADC_mean, ADC_minimal) and dynamic magnetic resonance imaging (MRI) findings with prognostic factors in invasive ductal carcinoma.

Purpose   Positron emission tomography (PET)/CT has become a widely used technology for preoperative staging of non-small cell lung cancer (NSCLC). Two recent randomized controlled trials (RCT) have established its efficacy over conventional staging, but no studies have assessed its cost-effectiveness. The objective of this study was to assess the cost-effectiveness of PET/CT as an adjunct to conventional workup for preoperative staging of NSCLC.

Background and Objectives: Radiation dermatitis occurs in a majority of patients with breast cancer who receive radiation therapy (RT), causes significant pain, and may necessitate treatment delay. Light emitting diode (LED) photomodulation has been reported to minimize radiation dermatitis. This study sought to further evaluate the efficacy of LED photomodulation in lessening radiation dermatitis.

Objectives: To prospectively determine the feasibility of diffusion tensor imaging (DTI) with fibre tractography as a tool for the three-dimensional (3D) visualisation of normal pelvic floor anatomy.

Background   Twin reversed arterial perfusion sequence (TRAP) is a rare complication in multifetal monochorionic pregnancies in which a normal “pump” twin provides circulation to an abnormal acardiac co-twin, resulting in high-output cardiac dysfunction in the pump twin.

Purpose of review To describe the current role of radiation therapy and specific types of radiation therapy used in the management of early stage, locoregionally advanced, and metastatic breast cancer.

Introduction. Over the past two decades, an expanding body of research has examined women's and men's genital self‐image. Support for the reliability and validity of the 7‐item Female Genital Self‐Image Scale (FGSIS) has been found in a convenience sample of women.

Purpose To determine whether single time-point single-photon emission computed tomography—computed tomography (SPECT/CT) somatostatin receptor imaging can replace traditional dual time-point planar and SPECT somatostatin receptor scintigraphy for evaluation of neuroendocrine tumors.

Objectives Oxygen (O₂) is a cornerstone in the treatment of critically ill patients, and the guidelines prescribe 10–15 l of O₂/min even to those who are initially normoxic. Studies using indirect or invasive methods suggest, however, that supplemental O₂ may have negative cardiovascular effects. The aim of this study was to test the hypothesis, using noninvasive cardiac magnetic resonance imaging, that inhaled supplemental O₂ decreases cardiac output (CO) and coronary blood flow in healthy individuals.

Background The diagnosis of patients with acute dyspnoea is challenging, as clinical history and physical examination are often nondiagnostic and inaccurate. Consequently, clinicians often rely on the results of chest radiography (CXR) to determine the initial intervention and guide further treatment.

Increasing knowledge, interest, and visibility in the field of sports medicine has equipped clinicians in the field with a novel array of diagnostic and therapeutic options but has also provided a higher level of complexity in patient care. True understanding of the vast spectrum of radiographic technology available to the sports clinician has become more critical than ever.

Abstract

Objectives The purpose of this study was to determine if visualization of discrete sacral foramina on bone scintigraphy can be used as an adjunct criterion supportive of a superscan diagnosis.

Objective This study aimed to correlate magnetic resonance (MR) findings and discography with pain response at provocative discography in patients with low back pain.

Purpose   Imaging with positron emission tomography (PET) using 18F-2-fluoro-2-deoxy-D-glucose (FDG) plays an increasingly important role for response assessment in oncology. Several methods for quantifying FDG PET results exist. The goal of this study was to analyse and compare various semi-quantitative measures for response assessment with full kinetic analysis, specifically in assessment of novel therapies.

Background and objectives Type-2 diabetic patients constitute a high-risk population for atherosclerosis. Primary prevention, although recommended, is not well funded. Our aim was to evaluate the degree of subclinical atherosclerosis, in asymptomatic diabetic patients, using coronary multi-slice computed tomography (MSCT) angiography.

In a new review paper – available as a free PDF download with this article – specialists have made recommendations on how to minimize the radiation dose in multidetector computed tomography coronary angiography (CTCA) while maintaining image quality.

The specialists, from the Department of Medical Imaging’s Division of Cardiothoracic Imaging at Toronto General Hospital, Ontario, Canada, offer their recommendations in three categories: patient preparation, inside the CT suite, and after image acquisition.

In the recent 2009 update of the FIGO staging for cervical cancer, while diagnostic imaging to assess primary tumour size was not made mandatory, it was encouraged. Especially in the early stages of cervical cancer, lymph node metastasis is an indicator of poor prognosis, with the status of the para-aortic lymph nodes being considered perhaps the most important prognostic factor.² While lymph nodal assessment was also not included in the updated FIGO staging, the FIGO committee did also encourage the use of imaging techniques to evaluate lymph node status.

In this audio interview conducted exclusively for GetInsideHealth on 20 December 2010, Dr Alan Groves discusses the cardiovascular causes of neurological disorders observed in preterm neonates, and how imaging techniques such as echocardiography and MRI are helping to advance our understanding.

Dr Groves discusses:
The role of circulatory factors in the pathophysiology of brain injury resulting in poor long-term outcomes in preterm infants.
The indicators/variables that specialists are monitoring in order to assess circulatory adequacy in neonatal units.
The insights being provided by cardiac MRI in preterm neonates.

Although PET was found to be useful for the functional visualisation of anatomical structures, the accurate localization of structures remained problematic, due to patient movement, and particularly when dealing with the more flexible parts of the body which are prone to involuntary movement. Initially, PET images were aligned with computed tomography (CT) images using sophisticated software, but a major advance in accuracy was achieved with the introduction of combined modality PET/CT scanners.² 

In the assessment of osteoporosis, the most widely used technique is measurement of BMDa using dual energy X-ray absorptiometry (DXA).² In post-menopausal women and men over the age of 50 years, the WHO FRAX algorithm has been introduced to quantify the 10-year probability of a hip or major osteoporotic fracture, taking into account a number of factors including femoral neck BMD, gender, body mass index, prior fractures, and history of parental hip fractures.³

Background   Echocardiography provides both morphological and functional information offering a potential advantage over nuclear medicine gated blood pool scans which only estimate ejection fraction. This additional information may be relevant to management of patients receiving potentially cardiotoxic cancer treatment.

Background   Sentinel lymph node (SLN) mapping in colorectal cancer may have prognostic and therapeutic significance; however, currently available techniques are not optimal. We hypothesized that the combination of invisible near-infrared (NIR) fluorescent light and ex vivo injection could solve remaining problems of SLN mapping in colorectal cancer.

Dr. Carrascosa explains that physicians are often uncertain about what test to perform next in patients with normal perfusion studies who continue to report symptoms. Based on results of her study, CT angiography was found to be a valuable tool.

In this study, 47 women with a mean age of 58 years were evaluated with dual energy X-ray absorptiometry (DEXA) and CT screening. DEXA served as the reference standard for comparing QCT and a single trabecular measure of CT attenuation at L1 with CT colonography (CTC).

In this study, 304 patients undergoing screening mammography also underwent automated 3D US examination. The conventional mammography images were assessed by one independent examiner and the 3D images were assessed by two additional independent examiners. Conventional mammography was employed as the reference standard in order to calculate the sensitivity and specificity of the automated 3D technique.

The imaging study was conducted in 27 consecutive patients who were undergoing  TAVI due to severe aortic valve stenosis. Imaging studies were conducted with ECG-gated MDCT before and after Dyna-CT.

Dr. Moulik explains that current picture archiving and communications systems (PACS) already provide 3D images but in a limited form without stereoscopic viewing that provides visual depth. In addition to stereoscopic views, Dr. Moulik has been pursuing strategies to actually isolate organs within the image in order to move them independent of surrounding anatomy.

Specialists at Henry Ford Hospital, West Bloomfield, Michigan, suggest that RFA could become the primary treatment for small, functional adrenal neoplasms in the future, based on the results of their study, which they presented at the RSNA conference.

The study enrolled 13 consecutive patients with symptomatic functional adrenal tumors (diameter < 3.2 cm), who were treated with RFA over 7 years. Cross-sectional imaging, clinical symptoms, and adrenal biochemical markers were available for patients who met inclusion criteria. 10 patients (77%) had aldosteronoma and one patient each had a cortisol-secreting tumor, testosterone-secreting tumor, or pheochromocytoma.

Dr. Capunay started his presentation by pointing out that, “previous studies in patients with suspected CAD and normal functional studies showed that CTCA can recognize a wide range of anatomic observations.”

Dr. Capunay and colleagues used CTCA to evaluate the presence and severity of coronary stenosis in 36 patients with normal cardiac functional studies (CFS). All patients were referred for exclusion of CAD. 

Alexander Fingerle, MD, Klinikum rechts der Isar, Munich, Germany, and colleagues conducted a prospective study involving 40 patients with suspected pulmonary embolism. The scientists used iodine distribution maps acquired with a dual-layer, dual-energy MDCT to detect pulmonary embolism in the entire chest, including the lung periphery.

To investigate whether CT can provide similar information to MR regarding pericardial thickness and delayed enhancement, specialists at the Mayo Clinic in Rochester, Minnesota, searched hospital records for MR examinations of the heart or chest with an indication including “pericardium”, “pericardial”, “pericarditis”, or “constrictive” over a period of 5 years. Results were cross-referenced to identify patients who had undergone pericardiectomy and also had a preoperative CT scan of the chest for any indication.

Dr. Schwab explains that several other methods, such as assessment of chromosomal damage, have been used to evaluate the damaging effects of very high doses of radiation, but these are not sensitive enough as surrogates for measuring potentially damaging effects from low doses of radiation, such as those used in diagnostic studies.

The study was done by John Nance, MD, and colleagues at the Medical University of South Carolina, Charleston, South Carolina, who used cCTA to evaluate patients with acute chest pain and then correlated the findings with clinical outcomes.

Dr. Nance’s team enrolled 286 consecutive patients (33% male, mean age 55±11 years) who presented with acute chest pain and underwent contrast-enhanced cCTA for the assessment of atherosclerotic lesions.

In the study, specialists at Chulalongkorn University, Bangkok, Thailand, compared multi-isocenter IMRT and 3D conventional radiation in terms of target coverage, homogeneity and normal organs avoidance in patients undergoing CSI.

A total of 13 patients were treated with CSI using both 3D conventional and multi-isocenter IMRT. Planning target volume (PTV brain, PTV spinal sac) and organs-at-risk (OARs: heart, lungs, liver and both kidneys) were contoured.

“Left ventricular diastolic dysfunction has prognostic implications for various cardiac diseases, such as ischemic heart disease, heart failure, cardiomyopathy, and atrial fibrillation,” said Zhaoying Wen, MD, Beijing Anzhen Hospital, Beijing, China, who presented the study. “But it is invasive to measure left ventricular diastolic function using a catheter,” he added. “However, left atrial size and function has been proposed to reflect left ventricular diastolic function sensitively, and this can be assessed using MDCT,” Dr. Wen explained.

In their study, Dr. Wen and colleagues enrolled 73 patients who had been referred to CT coronary angiography. All patients were examined by MDCT and real-time 3D echocardiography (RT-3DE) on the same day.

“This work is quite a novel approach in that success of screening is usually measured in terms of reduction in mortality from breast cancer,” said Nicholas Perry, MD, of The London Breast Institute, London, UK. “We are not aware of any other studies in this age group comparing success in terms of breast preservation,” he added.

In their study, Dr. Perry and colleagues compared mastectomy rates following breast cancer diagnosis at a UK center in women aged 40-50 with a prior mammogram within the previous year to those with longer interval or no previous mammography.

Multi-phasic CT examinations of the liver can be used to detect malignant liver lesions; however, they can deliver doses of radiation that may increase a patient’s lifetime cancer risk.

To investigate whether it is possible to reduce the level of exposure while maintaining diagnostic accuracy, specialists at Royal Brisbane & Women's Hospital, Moorooka, Australia, performed a study using a CT liver lesion phantom consisting of a soft-tissue-equivalent disk with spherical lesions (9.5mm and 4.8mm diameter, each with a density 10 HU below background).

Prof. Ratib explains that this hybrid technology is being pursued by several device manufacturers and has significant advantages when it is important to combine information from MRI and PET to understand pathology in greater detail. Prof. Ratib presented his results with the hybrid device during several presentations at the 2010 RSNA.

Specialists at the Department of Radiology, Seoul National University Hospital, Seoul, Korea, have been able to identify key lesion characteristics revealed by CT examination that can enable clinicians to predict very accurately whether PSNs would be transient or persistent on follow-up CTs.

“Part-solid nodules have been reported to indicate a high probability of early lung cancer in many previous studies,” said Yong Sub Song, MD, who presented the research. “However, we observed that a substantial proportion of PSNs detected at screening CT could be transient because of inflammation or hemorrhage,” Dr. Song noted.

“PTLD is a rare, but serious and potentially lethal complication of solid organ transplantation,” said Homeira Zahiri, MD, University of Nebraska Medical Center, Omaha, Nebraska, who presented the study. “FDG-PET has proven useful for staging high and intermediate-grade lymphoma. However, the accuracy of FDG-PET for staging PTLD is unknown,” she added.

To investigate the usefulness of FDG-PET in the early detection, staging, and treatment of PTLD after solid organ transplantation, Dr. Zahiri’s team performed a study involving 16 transplant recipients with histologically confirmed PTLD.

Dr. Rajiah explains that although the diagnosis of constrictive pericarditis is straightforward when the symptoms are characteristic and consistent with echocardiography, the majority of patients either have atypical signs or imaging that is not definitive. This can lead to an expensive use of multiple imaging modalities and a delay in diagnosis and treatment.

Prof. Daly explains that the concept of iterative reconstruction was first introduced at the very introduction of CT scanning, but computers were not sufficiently powerful at that point to generate quality images. That has changed.

Dr. Talanow explains that the dramatic increase in the use of imaging technologies that expose patients to radiation is now considered a small but measurable cause of cancers. While imaging is a critical tool, awareness of the dangers is appropriate for prudent use.

“RFA is a safe and effective nonsurgical treatment for symptomatic benign thyroid nodules,” said Jung-Yin Huh, MD, Gangnam CHA General Hospital, Seoul, Korea, who presented the results.

Dr. Huh’s team evaluated the efficacy of single- vs. dual-session RFA treatment in patients with BTN in a prospective randomized trial. 30 outpatients were randomly assigned to one session of RFA (RFA-1, n=15) or two sessions of RFA (RFA-2, n=15) and were subsequently followed for a period of at least 6 months.

RFA was performed under continuous ultrasound- (US) guidance with an 18-gauge internally cooled electrode. Dependent variables included nodule volume, cosmetic score and symptom score.

The study was performed by specialists at Hull Royal Infirmary, in Hull, UK, to explore the factors influencing the experience of patients undergoing interventional radiological procedures.  

The researchers sent out questionnaires to 315 patients undergoing interventional vascular procedures prior to treatment, immediately following treatment, as well as 4 weeks and 3 months after the procedure.

The questionnaires were aimed at surveying the patients’ understanding of the procedure, their level of anxiety, and the amount of pain they were experiencing. The latter was assessed using a visual analog scoring system (VAS). The short form 36 (SF 36) health survey questionnaire was used to evaluate quality of life changes associated with the procedure.

The use of CT perfusion has been proposed for pancreatic lesion characterization; however, differences in scan standardization and analysis make it difficult to compare the numerical data obtained.

In an attempt to overcome these difficulties, scientists at the University of Verona, Italy, evaluated the use of time-density curves obtained from MDCT perfusion scans of the pancreas for the characterization of normal parenchyma, adenocarcinoma, chronic pancreatitis and endocrine tumors.

Lead investigator Antonella Filippone, MD, and colleagues used diffusion-weighted imaging (DWI) to assess response to CRT in patients with LARC. A total of 28 patients underwent magnetic resonance imaging (MRI) prior to and 8 weeks after treatment, including T2-weighted and an echo-planar DWI-sequence with 6 b-values (0 to 1000 mm2/sec), from which the apparent diffusion coefficient (ADC) was calculated.

“Multiple sclerosis is a demyelinating disease, the hallmark of which are the lesions that can be seen on conventional MRI scans,” said Fernanda Rueda Lopes, MD, who presented the research. “These lesions are usually classified as acute, subacute, or chronic, and they can also be in a process of de-myelination or re-myelination,” Dr. Lopes explained. “If a tool could be developed to identify and map these lesions, clinicians would be able to tell if a treatment is working or not,” she added.

The study was conducted by researchers at Stanford University, Stanford, California, and involved a review of Medicare claims submitted between 1998 and 2005 for over 10 million people, focusing on the well-characterized patient group of older adults, who are most frequently imaged. The data were analyzed in two temporally differentiated cohorts: 1998-2001 (N = 5,267,230) and 2002-2005 (N = 5,555,345).

The study, conducted by specialists at the Medical University of South Carolina, Charleston, South Carolina, evaluated the feasibility of adenosine-stress myocardial perfusion imaging, using 128-slice dual-source CT, for the qualitative and quantitative assessment of myocardial blood flow (MBF) compared to stress perfusion and viability MRI.

The researchers enrolled 20 patients (14 male, 6 female; mean age 60±11 years) who underwent a standardized cardiac CT protocol consisting of prospectively ECG-triggered coronary CT angiography, dynamic adenosine-stress myocardial perfusion imaging using a “shuttle” mode, and delayed enhancement acquisitions.

Dr. Michel and colleagues evaluated the accuracy of 4,879,715 preliminary radiological studies that were interpreted between 1/1/2007 and 12/31/2009. “Our study is the largest retrospective analysis of the accuracy of interpretation in a teleradiology practice,” Dr. Michel noted.

The study by Dr. Callstrom and colleagues enrolled 62 adult patients with painful bone metastases who had either failed or were poor candidates for conventional radiation treatment or chemotherapy. All patients were treated with CT-guided cryoablation using one or more cryoprobes under general anesthesia or conscious sedation. Osteolytic metastases involving or abutting bone were treated.

“Until now, trans-thoracic echocardiography has been the most widely used method for the diagnosis of AMIS,” Dr. Joe noted. However, the diagnostic accuracy of TTE is not very high, and it has limited value for detailed morphological assessment,” he added.

In an effort to help reduce similar errors in the future, Dr. Mansfield's team reviewed 656 radiological exams with delayed diagnoses that were collected from July 2002 to January 2010 at BAMC. Each case was reviewed by two radiologists and the diagnostic errors were classified based on the type of error.