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Ryan J, Broe MP, Moran D, Mulvin D, Heffernan E, Swan N, Moran DE. Prostate cancer detection with magnetic resonance imaging (MRI)/cognitive fusion biopsy: Comparing standard and targeted prostate biopsy with final prostatectomy histology. Can Urol Assoc J 2021; 15:E483-E487. [PMID: 33591900 DOI: 10.5489/cuaj.6951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The use of multiparametric magnetic resonance imaging (MRI) with targeted biopsies of the prostate improves the diagnosis of clinically significant prostate cancer. Recent studies have shown that targeted prostate biopsies also more accurately predict final histopathology after radical prostatectomy (RP). There are three broad techniques for performing MRI-targeted prostate biopsy: cognitive MRI/ultrasound (US) fusion, software MRI/US fusion, and in-bore MRI-guided. Current practices recommend that a standard systematic 12-core prostate biopsy be performed, as well as targeted biopsies in patients with positive MRI findings. This study aimed to evaluate the accuracy of histological grading of cognitive MRI/US fusion prostate biopsy by comparing the histology from the targeted biopsy specimens (TB), standard systematic specimens (SB), and the combination of both (CB) specimens with the final histological grade from subsequent prostatectomy. METHODS A retrospective, single-center review of 115 patients who underwent standard systematic and cognitive MRI/US-targeted biopsy of the prostate before undergoing a RP between 2016 and 2019 was performed. MRI findings, biopsy, final histology International Society of Urological Pathology (ISUP) grades, and patient demographics were collected. Cochran's Q test and McNemar test were used to compare the differences in upgrading, downgrading, and concordance between each biopsy group. RESULTS The concordance between SB, TB, and CB biopsy were 28.7%, 49.6%, and 50.4%, respectively. There was no significant difference in concordance between TB and CB. Patients were more likely to be downgraded on the final histology when comparing CB with TB alone (26.1% vs. 16.5%, p<0.05). In cases where an ISUP grade 1 cancer was diagnosed on TB (n=24), there was a 62.5% chance that the final histology would be upgraded. In the same sample, when combined with a SB, the risk of upgrading on final histology reduced to 37.5%. CONCLUSIONS Although grading concordance between TB and CB were similar, the concomitant use of a SB significantly reduced the rate of upgrading in the final RP histopathology. CB may result in better decision-making regarding treatment options and also have implications for intraoperative planning.
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Affiliation(s)
- James Ryan
- Urology Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Mark P Broe
- Urology, St. Vincent's University Hospital, Dublin, Ireland
| | - Diarmaid Moran
- Urology, St. Vincent's University Hospital, Dublin, Ireland
| | - David Mulvin
- Urology, St. Vincent's University Hospital, Dublin, Ireland
| | - Eric Heffernan
- Radiology, Vincent's University Hospital, Dublin, Ireland
| | - Niall Swan
- Pathology, Vincent's University Hospital, Dublin, Ireland
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Redmond CE, Healy GM, Fleming H, McCann JW, Moran DE, Heffernan EJ. The Integration of Active Learning Teaching Strategies Into a Radiology Rotation for Medical Students Improves Radiological Interpretation Skills and Attitudes Toward Radiology. Curr Probl Diagn Radiol 2019; 49:386-391. [PMID: 31375296 DOI: 10.1067/j.cpradiol.2019.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/07/2019] [Accepted: 07/08/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE In recent years, there has been increased recognition of the benefits of teaching by active learning. However, there is a paucity of experimental studies utilizing active learning in undergraduate radiology rotations, which is traditionally a passive learning experience. We designed a new radiology rotation that integrated teaching by active learning. We prospectively examined the efficacy of this new rotation compared to our standard rotation in terms of students' radiological competency and attitudes toward radiology, as well as impact on departmental efficiency. METHODS This was a prospective cohort study involving fourth year medical students completing a 1-week radiology rotation at our department between January and April 2018. One cohort completed a rotational model which incorporated active learning sessions (integrated cohort) while the remainder were taught using traditional passive learning methods (standard cohort). All participants completed a radiology examination before and after the rotation and were surveyed on their attitudes toward radiology. RESULTS A total of 105 students enrolled in the study. The mean postrotation competency score obtained by the integrated cohort was significantly higher than that obtained by the standard cohort (82% vs 62%; P < 0.001). The integrated rotation freed up 7 hours of radiologists' time per week. While the students completing the integrated rotation had a more positive perception of radiology, they were no more likely to express a desire to pursue a career in radiology. CONCLUSIONS The integration of active learning sessions into an undergraduate radiology rotation results in an improvement in students' postrotation radiological competency and attitudes toward radiology.
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Affiliation(s)
- Ciaran E Redmond
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland.
| | - Gerard M Healy
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Hannah Fleming
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Jeffrey W McCann
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Deirdre E Moran
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Eric J Heffernan
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
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Heffernan EJ, Moran DE, Gerstenmaier JF, McCarthy CJ, Hegarty C, McMahon CJ. Accuracy of 64-section MDCT in the diagnosis of cruciate ligament tears. Clin Radiol 2017; 72:611.e1-611.e8. [PMID: 28214478 DOI: 10.1016/j.crad.2017.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/29/2016] [Accepted: 01/15/2017] [Indexed: 11/19/2022]
Abstract
AIM To evaluate the accuracy of non-arthrographic 64-section multidetector computed tomography (CT) in the assessment of cruciate ligament tears. A secondary goal was to determine its accuracy in the diagnosis of additional soft-tissue injuries around the knee. MATERIALS AND METHODS Forty consecutive outpatients underwent same-day magnetic resonance imaging (MRI) and 64-slice multidetector CT (MDCT) of the knee in this prospective study. MDCT images were independently evaluated for integrity of the anterior (ACL) and posterior cruciate ligaments (PCL), medial and lateral menisci, and medial and lateral collateral ligaments. Recognised secondary signs of ACL tears were also documented. MRI images were subsequently assessed by two radiologists and a consensus reached. RESULTS The sensitivity of MDCT for ACL tears was 87.5-100%, with a specificity of 100%. The presence of one or more secondary signs of ACL tears on MDCT had a sensitivity of 50-87.5% with a specificity of 100%. The sensitivity of MDCT for PCL tears was 0-25% with a specificity of 100%. The sensitivity for meniscal tears was 9.1-23.1% with a specificity of 96.3-100%. CONCLUSION 64-section MDCT has very high sensitivity and specificity for ACL tears and, as on MRI, secondary signs, such as buckling of the PCL, are also useful in their diagnosis. MDCT has a low sensitivity for other soft-tissue injuries at the knee; however, its high specificity indicates that apparent PCL, meniscal, and collateral ligament tears can reliably be treated as true-positive findings.
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Affiliation(s)
- E J Heffernan
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
| | - D E Moran
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - J F Gerstenmaier
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - C J McCarthy
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - C Hegarty
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - C J McMahon
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
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McEvoy SH, McCarthy CJ, Lavelle LP, Moran DE, Cantwell CP, Skehan SJ, Gibney RG, Malone DE. Authors’ Response. Radiographics 2013; 33:1670-1. [DOI: 10.1148/radiographics.33.6.3361670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Chan VO, Moran DE, Shine S, Eustace SJ. Medial joint line bone bruising at MRI complicating acute ankle inversion injury: What is its clinical significance? Clin Radiol 2013; 68:e519-23. [PMID: 23849561 DOI: 10.1016/j.crad.2013.05.093] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 04/10/2013] [Accepted: 05/22/2013] [Indexed: 12/26/2022]
Affiliation(s)
- V O Chan
- Department of Radiology, Cappagh National Orthopaedic Hospital, Dublin, Ireland.
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McEvoy SH, McCarthy CJ, Lavelle LP, Moran DE, Cantwell CP, Skehan SJ, Gibney RG, Malone DE. Hepatocellular Carcinoma: Illustrated Guide to Systematic Radiologic Diagnosis and Staging According to Guidelines of the American Association for the Study of Liver Diseases. Radiographics 2013; 33:1653-68. [DOI: 10.1148/rg.336125104] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Chan VO, Moran DE, Mwangi I, Eustace SJ. Prevalence and clinical significance of chondromalacia isolated to the anterior margin of the lateral femoral condyle as a component of patellofemoral disease: observations at MR imaging. Skeletal Radiol 2013; 42:1127-33. [PMID: 23689689 DOI: 10.1007/s00256-013-1640-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 04/17/2013] [Accepted: 04/28/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the prevalence of chondromalacia isolated to the anterior margin of the lateral femoral condyle as a component of patellofemoral disease in patients with anterior knee pain and to correlate it with patient demographics, patellar shape, and patellofemoral alignment. MATERIALS AND METHODS Retrospective study over a 1-year period reviewing the MR knee examinations of all patients who were referred for assessment of anterior knee pain. Only patients with isolated lateral patellofemoral disease were included. Age, gender, distribution of lateral patellofemoral chondromalacia, and grade of cartilaginous defects were documented for each patient. Correlation between the distribution of lateral patellofemoral chondromalacia and patient demographics, patellar shape, and indices of patellar alignment (femoral sulcus angle and modified Q angle) was then ascertained. RESULTS There were 50 patients (22 males, 28 females) with anterior knee pain and isolated patellofemoral disease. The majority of the patients (78 %) had co-existent disease with grade 1 chondromalacia. No significant correlation was found between patients with chondromalacia isolated to the anterior margin of the lateral femoral condyle and age, gender, patellar shape, or modified Q angle (p > 0.05). However, patients with chondromalacia isolated to the anterior margin of the lateral femoral condyle had a shallower femoral sulcus angle (mean 141.8°) compared to the patients with lateral patellar facet disease (mean 133.8°) (p = 0.002). CONCLUSIONS A small percentage of patients with anterior knee pain have chondromalacia isolated to the anterior margin of the lateral femoral condyle. This was associated with a shallower femoral sulcus angle.
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Affiliation(s)
- V O Chan
- Department of Radiology, Cappagh National Orthopaedic Hospital, Dublin, Ireland.
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Abstract
Transjugular intrahepatic portosystemic shunts (TIPS) are an effective method for treating the complications of portal hypertension. Specific indications for TIPS include secondary prevention of variceal bleeding and refractory ascites. The purpose of this review is to summarize the role of diagnostic radiology in the creation and assessment of TIPS, to highlight the complications that can occur post-TIPS, and to critically evaluate the literature regarding ultrasound evaluation of TIPS.
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Affiliation(s)
- Deirdre E Moran
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA.
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Affiliation(s)
- Deirdre E Moran
- Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland
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Moran DE, O'Neill AC, Heffernan EJ, Skehan SJ. Not Everything that is Hot on a Staging Bone Scan is Malignant: A Pictorial Review of Benign Causes of Increased Isotope Uptake. Can Assoc Radiol J 2012; 63:280-8. [DOI: 10.1016/j.carj.2011.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Revised: 01/08/2011] [Accepted: 02/03/2011] [Indexed: 11/27/2022] Open
Affiliation(s)
- Deirdre E. Moran
- Department of Diagnostic Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - Ailbhe C. O'Neill
- Department of Diagnostic Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - Eric J. Heffernan
- Department of Diagnostic Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - Stephen J. Skehan
- Department of Diagnostic Radiology, St Vincent's University Hospital, Dublin, Ireland
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Moran DE, Gibney RG. Point-of-care ultrasonography. Ir Med J 2011; 104:262. [PMID: 22132591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Moran DE, Donoghue V. Periorbital ecchymosis ('raccoon eyes') as the presenting feature of neuroblastoma. Pediatr Radiol 2010; 40:1710. [PMID: 19946772 DOI: 10.1007/s00247-009-1467-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 10/12/2009] [Accepted: 10/12/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Deirdre E Moran
- Department of Radiology, Children's University Hospital, Temple Street, Dublin 1, Ireland.
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Moran DE, Smith MJ, O'Sullivan MJ, Bannon H, Crotty TB, Collins CD, Skehan SJ, O'Higgins N, McDermott EW, Evoy D, Hill ADK. Sentinel lymph node biopsy in elderly irish patients with malignant melanoma. Ir Med J 2007; 100:422-4. [PMID: 17566474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
In patients with malignant melanoma, Breslow depth increases with age. However, studies suggest that the frequency of sentinel lymph node metastases in malignant melanoma decreases with age. We investigated whether this applied to the cohort of patients undergoing sentinel lymph node biopsy (SLNB) in our institution. In a prospectively accrued database we identified 149 patients undergoing SLNB from 1997 to 2005. Tumour thickness as measured by Breslow depth was assessed in stratified age groups. We assessed the relationship between SLNB positivity and age using the Chi-square for trend. We directly examined the relationship between SLNB positivity in patients aged less than 65 and aged 65 years of age and over. Disease-free and overall survival in patients aged less than 65 and aged 65 years of age and over were also assessed. Comparing the age groups, there was no significant difference identified in Breslow depth (<65 years, median Breslow > or = 1.2 mm (range 0.2-9.7); > or =65 years, median Breslow > or = 1.4 mm (range 0.12-8.5); p > or = 0.06, Mann-Whitney U). Chi-square for trend identified no significant relationship between SLNB positivity and age. We found n=120 patients <65 had SLNB, of which 26 (21.7%) were positive. In patients =65, n=29 had SLNB of which 3 (10.3%) were positive. These differences were not statistically significant (Fisher's exact test, p > or = 0.2). There was no difference in disease-free or overall survival between patients aged <65 or > or =65 who had SLNB (median follow-up 37.5 months (range 5-70); disease-free survival, p > 0.08; overall survival, p > or = 0.3, Logrank test). We did not find that elderly patients with malignant melanoma had a demonstrable difference in tumour thickness when compared to younger patients. In those patients who underwent SLNB there was no significant difference in node positivity between the age groups. Disease-free and overall survival were not significantly different between the age groups. Further study and longer follow-up will help establish the relationship between age and SLNB positivity.
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Affiliation(s)
- D E Moran
- Department of Surgery, Saint Vincent's University Hospital, Elm Park, Dublin
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