Thoracic radiologists welcome IDoR 2013 celebrations

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The International Day of Radiology (IDoR) takes place in just a couple of days’ time, on November 8, and this year the focus is on lung imaging. The ESR chose to approach this theme by creating a book on the subject, with the help of the European Society of Thoracic Imaging (ESTI), which will be published to coincide with this year’s IDoR.

ESTI board members, including several contributors to the forthcoming book, gathered in Vienna recently to discuss plans for their society, so we took the opportunity to ask them why it is necessary to inform the public of the importance of radiology in healthcare.

“Doctors form a team, and in this team radiologists are a very important group, but their role is not so well known. A lot of people think that we are only photographers, but we have a crucial role in making a diagnosis. It’s important for the public to know what role we play,” said Doctor Eva CastaÑer González, a radiologist working at the Corporació Parc Taulí in Sabadell, Spain.

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Dr. Pepe’s Diploma Casebook: Case 45 – SOLVED!

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Dear Friends,

Today I am presenting the case of a 73-year-old woman who had preoperative radiographs for haemorrhoid treatment.

Check the two images below and leave me your comments and diagnosis in the comments. Come back on Friday for the answer!

Diagnosis:
1. Cyanotic heart disease
2. Acyanotic heart disease
3. No heart disease
4. None of the above

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IDoR and patients’ organisations: new collaborations to benefit all

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In the course of preparing a book on lung imaging that will be published to mark the International Day of Radiology (IDoR), the ESR spoke to Nicola Bedlington, executive director of the European Patients’ Forum (EPF), who shared her views on healthcare in the EU and explained why she chose to participate in IDoR 2013.

ESR: What is the overall aim of your organisation?

Nicola Bedlington: Our vision is high quality, patient-centred and equitable healthcare for all patients throughout the European Union.
The European Patients’ Forum is an umbrella organisation that works with patients’ groups in public health and health advocacy across Europe. Our members represent specific chronic disease groups at EU level, or are national coalitions of patients. We currently represent almost 60 such organisations.
Our mission is to be the collective patients’ voice at EU level, manifesting the solidarity, power and unity of the EU patients’ movement, and to provide a strong and united patients’ voice in order to put patients at the centre of EU health policy and programmes. In this regard we are the key interlocutor with EU institutions on cross-cutting issues affecting all patients.

Nicola Bedlington, executive director of the European Patients’ Forum (EPF)

Nicola Bedlington, executive director of the European Patients’ Forum (EPF)

ESR: What exactly does your organisation do to meet this aim?

NB: The EPF helps to empower patients’ organisations through educational seminars, policy initiatives and projects. We coordinate best practice exchanges between patient organisations at European and national levels. Our programmes also help to strengthen organisational and advocacy capacity.

ESR: Your organisation has experience working with various chronic disease groups. Do many patients suffer from chronic diseases in the EU?

NB: Following consultation with our members we estimate there are at least 150 million patients with chronic conditions across the European Union. This figure is likely to increase given the ageing population.

ESR: Many EU countries face significant health budget cuts, leading to shorter hospital stays and less access to modern equipment (i.e. long waiting lists for MRI exams). How can patient care be promoted in this context?

NB: The EPF is working with its member organisations to ensure health is seen as an investment, and patients are not perceived as purely cost drivers. Major health inequalities exist across the EU which impact enormously on patients’ access to care.
Building on the three pillars of quality information, health literacy and empowerment, patients can be agents of change and sources of innovation, particularly in terms of equity and sustainability of care. There need to be meaningful opportunities for patient involvement throughout the healthcare sector. We promote meaningful patient involvement in all forms of innovation, whether it is in high or low technology, pharmaceuticals, information technology, social change or systems change. The patient community seeks partnerships with researchers, policy-makers and industry in order to achieve greater impact in this arena.

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Caceres’ Corner Case 78 (Update: Solution)

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Dear Friends,

Muppet saw this case while looking at daily chest radiographs and it caught his attention. We looked at the patient’s history and found that she was a 64-year-old female with back pain, who had a well-differentiated liposarcoma removed from her right thigh seven years earlier.

Do you see anything?
What do you think it is?

Check the images below and leave your thoughts in the comments section. The answer will be posted on Friday.

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Oct 2013
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ECR 2013 Rec: Computed tomography of the bowel: a prospective comparison study between four techniques #B0948 #SS1801a

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B-0948 Computed tomography of the bowel: a prospective comparison study between four techniques

M. Revelli, F. Paparo, L. Bacigalupo, A. Garlaschi, L. Cevasco, E. Biscaldi, G. Rollandi | Monday, March 11, 14:00 – 15:30 / Room E2

Purpose: Our purposes were to compare the grade of bowel distension obtained with four different CT techniques dedicated for examination of small intestine (CT-enteroclysis and CT-enterography), colon (CT with water enema), or both (CT-enterography with water enema) and to assess patient tolerance towards each protocol.
Methods and Materials: We recruited four groups of 30 patients. Each group corresponded to a specific CT technique, for a total of 120 consecutive patients (65 male, 55 female; mean age 51.09±13.36 years). CT studies were evaluated in consensus by two gastrointestinal-dedicated radiologists who performed quantitative and qualitative analysis of bowel distension. Presence and type of adverse effects were recorded.
Results: CT-enteroclysis provided the best distension of jejunal loops (median diameter 27mm; range 17-32mm) compared with all other techniques (p<0.0001). Frequency of patients with an adequate distension of the terminal ileum was not significantly different among the four groups (p=0.0608). At both quantitative and qualitative analysis CT with water enema and CT-enterography with water enema determined a greater and more consistent luminal filling of the large intestine compared with the one provided by both CT-enteroclysis and CT-enterography (p<0.0001 for all colonic segments). Adverse effects were more frequent in patients from the CT-enteroclysis group (p<0.0028).
Conclusion: CT-enteroclysis allows an optimal distension of jejunal loops, but it is the most uncomfortable CT protocol. When performing CT with water enema, an adequate retrograde distension of the terminal ileum was provided in a high percentage of patients. CT-enterography with water enema provides a simultaneous optimal distension of both small and large bowel.

ECR 2013 Rec: Imaging features of acinar cell cystadenoma: can we differentiate them from branch duct IPMNs? #B0576 #SS901

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B-0576 Imaging features of acinar cell cystadenoma: can we differentiate them from branch duct IPMNs?

C. Delavaud, G. D’Assignies, J. Cros, P. Ruszniewski, P. Hammel, A. Couvelard, V. Vilgrain, M.-P. Vullierme

Purpose: Acinar cystic cystadenoma (ACC) of the pancreas is a rare benign entity first described in 2002, defined by histological criteria. Radiographic appearance had almost not been described so far. Most of the patients underwent surgical resection under the preoperative diagnosis of intraductal papillary mucinous neoplasms. The aims of this study are to define imaging diagnostic criteria of ACC based on radiopathological confrontation and to compare clinical, biological and imaging data between patients with ACC and with branch ducts IPMN.
Methods and Materials: All patients with ACC who underwent pancreatic surgery for suspicion of IPMN and the 20 last patients with histologically proven branch ducts IPMN were retrospectively included. Clinical and biological information were collected from the medical reports. Radiological and histological documents were reviewed in order to define imaging diagnostic criteria of ACC. Data were compared using the Chi-square test or Fisher’s exact test.
Results: ACC was symptomatic in all but one patient. There were no statistical difference between ACC and IPMN group with regard to clinical and biological data. Combination of four radiological criteria allowed differentiating ACC from IPMN: cyst calcification, presence of more than 5 cysts, clustered peripheral small cyst, and absence of communication with main pancreatic duct. Sensibility and specificity were, respectively, 75 and 100 % with combination of at least three of these criteria.
Conclusion: ACC is a rare benign pancreatic tumour with specific imaging features despite some similarities with IPMN. Recognition of this entity may help us to propose the diagnosis and prevent extensive surgery.

Dr. Pepe’s Diploma Casebook: Case 44 – SOLVED!

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Dear Friends,

Presenting the case of a 45-year-old man with fever, one week after coronary surgery. I apologise for the poor quality of the PA radiograph, but it does not influence the diagnostic evaluation.

Check the images below and leave your opinion in the comments. The answer will be posted on Friday.
Diagnosis:

1. Pericardial fluid
2. Pleural fluid
3. Both
4. Anything else

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ECR 2013 Rec: Dynamic contrast-enhanced MRI can assess vascularity within pseudarthrotic clefts and predicts good clinical outcome #B0188 #SS210

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B-0188 Dynamic contrast-enhanced MRI can assess vascularity within pseudarthrotic clefts and predicts good clinical outcome

M.-A. Weber, K. Bloess, I. Burkholder, D. Bender, G. Schmidmaier, H.-U. Kauczor, O. Schoierer | Thursday, March 7, 14:00 – 15:30 / Room E1

Purpose: To prospectively evaluate whether dynamic contrast-enhanced (DCE) MRI can assess vascularity within pseudarthrotic clefts and predicts clinical outcome better than the clinical non-union scoring system (NUSS).
Methods and Materials: Sixty-four patients (mean age, 49.3 years) with non-union of an extremity fracture in computed-tomography received 3-Tesla MRI including DCE (coronal T1-weighted fat-saturated VIBE, TR/TE=3.76/1.35ms, 17 measurements, 2 mm slice thickness) after 0.1mmol/kg body-weight of gadoterat. We assessed vascularity within the pseudarthrotic cleft using a region-of-interest analysis. Signal intensity curves were subdivided into those with more intense contrast-agent uptake in the pseudarthrotic cleft than in normal adjacent muscle tissue (vascularised non-union) and those with similar or less uptake. The pharmacokinetic parameters of the Tofts model (Ktrans, Kep, iAUC, Ve) were correlated to the clinical outcome at one-year follow-up (n=37).
Results: Despite inserted osteosynthesis material, DCE parameters could be evaluated in n=60 at first visit. Sensitivity/specificity of vascularised non-unions as indicator of good clinical outcome was 77.3%/46.7% compared to 95.5%/26.7% using NUSS. Logistic regression revealed non-significant impact of NUSS on clinical outcome (p=0.27, odds ratio=0.97). At first examination, median iAUC (initial area under the enhancement curve) was 24.13 in patients with good outcome compared with 10.96 in non-responders (p=0.032), while Ktrans, Kep, and Ve were not significantly different. Using a receiver operating characteristic analysis, sensitivity/specificity of iAUC at the optimal cut-off value of 17.5 to predict outcome was 68.2%/76.9%. All pharmacokinetic parameters did not change significantly at the one-year control (n=18).
Conclusion: DCE MRI can assess vascularity in pseudarthrotic clefts. A vascularised non-union indicates good clinical outcome.

ECR 2013 Rec: Increased regional grey matter volume in Parkinson’s disease patients with excessive daytime sleepiness: an MRI study #B0406 #SS611

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B-0406 Increased regional grey matter volume in Parkinson’s disease patients with excessive daytime sleepiness: an MRI study

L.C. Tzarouchi, M. Chondrogiorgi, A. Zikou, P. Kosta, M.I. Argyropoulou, S. Konitsiotis | Friday, March 8, 14:00 – 15:30 / Room B

Purpose: Excessive daytime sleepiness (EDS) is an important non-motor symptom of Parkinson’s disease (PD). The underlying neuropathological mechanism accounting for EDS is not well understood. The purpose of the present study was to determine regional grey matter (GM) volume changes in PD patients with EDS.
Methods and Materials: Seventeen PD patients with EDS (Epworth Sleepiness Scale ESS ≥ 12) (EDS-PD), 17 age and disease duration-matched PD patients (Epworth Sleepiness Scale ESS ≤ 6) and 17 age-matched healthy controls were enrolled in the study. The χ2 and Student’s t tests were used to test for differences in demographic and clinical characteristics between groups. Differences in GM volume between groups were evaluated by applying the voxel-based morphometry (VBM) method.
Results: Total calculated levodopa equivalent dose was higher in EDS-PD when compared to PD patients (p<0.05). Comparison of EDS-PD with PD patients and controls showed increased GM volume bilaterally in the hippocampus, the parahippocampal gyrus, the fusiform gyrus and in cortical areas in the temporal, frontal and parietal lobes (p<0.001).
Conclusion: EDS-PD patients present increased regional GM volume in the mesolimbic/mesocortical dopamine pathway, which is activated during sleep. Drug-induced GM volume increase through a process of neuronal plasticity may represent the underlying mechanism.

Caceres’ Corner Case 77 (Update: Solution)

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Dear Friends,

This week I am presenting radiographs of a 78-year-old male with haemoptysis. Have a look at the images below and leave us your thoughts and diagnosis in the comments section. The answer will be added on Friday.

Diagnosis:

1. Hydropneumothorax in minor fissure
2. Tuberculosis
3. Carcinoma
4. None of the above

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14
Oct 2013
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