Radiology MOC

Abstract Purpose  Excretory-phase CT urography (CTU) may replace excretory urography in patients without urinary tumors. However, radiation exposure is a concern. We retrospectively compared upper urinary tract (UUT) delineation in low-dose and standard CTU. Material and methods  CTU (1-2 phases, 120 KV, 4 × 2.5 mm, pitch 0.875, i.v. non-ionic contrast media, iodine 36 g) was obtained with standard (14 patients, n = 27 UUTs, average 175.6 mAs/slice, average delay 16.8 min) or low-dose (26 patients, n = 86 UUTs, 29 mAs/slice, average delay 19.6 min) protocols. UUT was segmented into intrarenal collecting system (IRCS), upper, middle, and lower ureter (UU,MU,LU). Two independent readers (R1,R2) graded UUT segments as 1-not delineated, 2-partially delineated, 3-completely delineated (noisy margins), 4-completely delineated (clear margins). Chi-square statistics were calculated for partial versus complete delineation and complete delineation (clear margins), respectively. Results  Complete delineation of UUT was similar in standard and low-dose CTU (R1, p > 0.15; R2, p > 0.2). IRCS, UU, and MU clearly delineated similarly often in standard and low-dose CTU (R1, p > 0.25; R2, p > 0.1). LU clearly delineated more often in standard protocols (R1, 18/6 standard, 38/31 low-dose, p > 0.1; R2 18/6 standard, 21/48 low-dose, p < 0.05). Conclusions  Low-dose CTU sufficiently delineated course of UUT and may locate obstruction/dilation, but appears unlikely to find intraluminal LU lesions.

• Content Type Journal Article
• DOI 10.1007/s00330-010-1935-z
• Authors
  • Ulrike L. Mueller-Lisse, Department of Urology, University of Munich, Munich, Germany
  • Eva M. Coppenrath, Department of Radiology, University of Munich, Munich, Germany
  • Thomas Meindl, Department of Radiology, University of Munich, Munich, Germany
  • Christoph Degenhart, Department of Radiology, University of Munich, Munich, Germany
  • Michael K. Scherr, Department of Radiology, University of Munich, Munich, Germany
  • Christian G. Stief, Department of Urology, University of Munich, Munich, Germany
  • Maximilian F. Reiser, Department of Radiology, University of Munich, Munich, Germany
  • Ullrich G. Mueller-Lisse, Department of Radiology, University of Munich, Munich, Germany

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

Abstract  We present the first report of a patient with angiomatoid fibrous histiocytoma of bone in the radiology literature. This tumor initially eluded diagnosis due to its similarities with chronic hematoma and aneurysmal bone cyst. Only two cases of angiomatoid fibrous histiocytoma have been reported in the radiology literature and both of these lesions were in the soft tissues. The fairly distinctive findings in our patient of multiple large cystic chambers with fluid-fluid levels are similar to the findings in the two soft tissue case reports, suggesting that imaging may be used to suggest this specific diagnosis regardless of location, especially in the clinical setting of unexplained hematoma or anemia. Mention of this diagnosis in the radiology report may aid in the final diagnosis at pathology, because special techniques, including fluorescent in situ hybridization, must be applied in order to fully evaluate for the diagnosis.

• Content Type Journal Article
• DOI 10.1007/s00256-010-1023-0
• Authors
  • W. Banks Petrey, Department of Radiology, UVA Health System, Box 800170, Charlottesville, VA 22908, USA
  • Robin D. LeGallo, Department of Pathology, UVA Health System, 1215 Lee St., Charlottesville, VA 22908, USA
  • Michael G. Fox, Department of Radiology, UVA Health System, Box 800170, Charlottesville, VA 22908, USA
  • Cree M. Gaskin, Department of Radiology, UVA Health System, Box 800170, Charlottesville, VA 22908, USA

• Journal Skeletal Radiology
• Online ISSN 1432-2161
• Print ISSN 0364-2348

Abstract Objective  To derive an MRI score for assessing severity, therapeutic response and prognosis in acute severe inflammatory colitis. Methods  Twenty-one patients with acute severe colitis underwent colonic MRI after admission and again (n = 16) after median 5 days of treatment. Using T2-weighted images, two radiologists in consensus graded segmental haustral loss, mesenteric and mural oedema, mural thickness, and small bowel and colonic dilatation producing a total colonic inflammatory score (TCIS, range 6–95). Pre- and post-treatment TCIS were compared, and correlated with CRP, stool frequency, and number of inpatient days (therapeutic response marker). Questionnaire assessment of patient worry, satisfaction and discomfort graded 1 (bad) to 7 (good) was administered Results  Admission TCIS correlated significantly with CRP (Kendall’s tau=0.45, 95% confidence interval [CI] 0.11–0.79, p = 0.006), and stool frequency (Kendall’s tau 0.39, 95% CI 0.14-0.64, p = 0.02). TCIS fell after treatment (median [22 range 15–31]) to median 20 [range 8–25], p = 0.01. Admission TCIS but not CRP or stool frequency was correlated with length of inpatient stay (Kendall’s tau 0.40, 95% CI 0.11–0.69, p = 0.02). Patients reported some discomfort (median score 4) during MRI. Conclusions  MRI TCIS falls after therapy, correlates with existing markers of disease severity, and in comparison may better predict therapeutic response.

• Content Type Journal Article
• DOI 10.1007/s00330-010-1934-0
• Authors
  • Rehana Hafeez, Department of Surgery, University College London Hospitals NHS Trust, 235 Euston Road, London, UK NW1 2BU
  • Shonit Punwani, Centre for Medical Imaging, University College London, 250 Euston Road, London, UK NW1 2PG
  • Doug Pendse, Centre for Medical Imaging, University College London, 250 Euston Road, London, UK NW1 2PG
  • Paul Boulos, Department of Surgery, University College London Hospitals NHS Trust, 235 Euston Road, London, UK NW1 2BU
  • Stuart Bloom, Department of Gastroenterology, University College London Hospitals NHS Trust, 235 Euston Road, London, UK NW1 2BU
  • Steve Halligan, Centre for Medical Imaging, University College London, 250 Euston Road, London, UK NW1 2PG
  • Stuart A. Taylor, Centre for Medical Imaging, University College London, 250 Euston Road, London, UK NW1 2PG

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

Abstract Objectives  To establish iodine (I) contrast medium (CM) doses iso-attenuating with gadolinium (Gd) CM doses regarded diagnostic in CTA and percutaneous catheter-angiography/vascular interventions (PCA/PVI) in azotemic patients. Methods  CT Hounsfield units (HU) were measured in 20-mL syringes containing 0.01/0.02,/0.05/0.1 mmol/mL of iodine or gadolinium atoms and placed in phantoms. Relative contrast were measured in 20-mL syringes filled with iohexol at 35/50/70/90/110/140 mg I/mL and 0.5 M gadodiamide using radiofluoroscopy (RF), digital radiography (DX) and x-ray angiography (XA) systems. Clinical doses of Gd-CM at CTA/PCA/PVI were reviewed. Results  At CT 91-116 and 104–125 mg I/mL in the chest and abdominal phantoms, respectively, were iso-attenuating with 0.5 M Gd at 80–140 kVp. At RF/DX/XA systems 35–90 mg I/mL were iso-attenuating with 0.5 M gadodiamide at 60–115 kVp. Clinically, 60 mL 91–125 mg I/mL (5.5–7.5 gram-iodine) at 80–140 kVp CTA and 60 mL of 35–90 mg I/mL (2.1–5.4 gram-iodine) at 60–115 kVp PCA/PVI would be iso-attenuating with 60 mL 0.5 M Gd-CM (=0.4 mmol Gd/kg in a 75-kg person). Conclusions  Meticulous examination technique and judicious use of ultra-low I-CM doses iso-attenuating with diagnostic Gd-CM doses in CTA and PCA/PVI may minimise the risk of nephrotoxicity in azotemic patients, while there is no risk of NSF.

• Content Type Journal Article
• DOI 10.1007/s00330-010-1924-2
• Authors
  • Ulf Nyman, Department of Diagnostic Radiology, Lasarettet Trelleborg, University of Lund, 231 85 Trelleborg, Sweden
  • Barbara Elmståhl, Department of Diagnostic Radiology, Skåne University Hospital, 205 02 Malmö, Sweden
  • Håkan Geijer, Department of Radiology, Örebro University Hospital, 701 85 Örebro, Sweden
  • Peter Leander, Department of Diagnostic Radiology, Skåne University Hospital, 205 02 Malmö, Sweden
  • Torsten Almén, Department of Diagnostic Radiology, Skåne University Hospital, 205 02 Malmö, Sweden
  • Mats Nilsson, Department of Radiation Physics, Skåne University Hospital, 205 02 Malmö, Sweden

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

Abstract  Radiofrequency ablation (RFA) has become a valuable therapeutic modality in cancer treatment over the last decade. In orthopedic surgery, RFA is used for the treatment of benign bone tumors and bone metastases. Complications are rare and, to our knowledge, bone fracture as a complication due solely to RFA has not been reported to date. In this report we describe two patients with a fracture in the calcar region of the femur as a complication of RFA treatment for bone malignancies. Since RFA is applied increasingly often, it is important to report this risk of fracture as a complication of treatment of lesions in the femoral calcar.

• Content Type Journal Article
• DOI 10.1007/s00256-010-1013-2
• Authors
  • Edwin F. Dierselhuis, Department of Orthopedic Surgery, University Medical Center Groningen, Postbus 30.001, 9700 Groningen, The Netherlands
  • Paul C. Jutte, Department of Orthopedic Surgery, University Medical Center Groningen, Postbus 30.001, 9700 Groningen, The Netherlands
  • Pepijn J. M. van der Eerden, Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands
  • Albert J. H. Suurmeijer, Department of Pathology, University Medical Center Groningen, Groningen, The Netherlands
  • Sjoerd K. Bulstra, Department of Orthopedic Surgery, University Medical Center Groningen, Postbus 30.001, 9700 Groningen, The Netherlands

• Journal Skeletal Radiology
• Online ISSN 1432-2161
• Print ISSN 0364-2348

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