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Morgan J, Potter S, Sharma N, McIntosh SA, Coles CE, Dodwell D, Elder K, Gaunt C, Lyburn ID, McIntosh SA, Morgan J, Paramasivan S, Pinder S, Pirrie S, Potter S, Rea D, Roberts T, Sharma N, Stobart H, Taylor-Phillips S, Wallis M, Wilcox M. The SMALL Trial: A Big Change for Small Breast Cancers. Clin Oncol (R Coll Radiol) 2019; 31:659-663. [PMID: 31160130 DOI: 10.1016/j.clon.2019.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/16/2019] [Accepted: 05/13/2019] [Indexed: 11/16/2022]
Affiliation(s)
- J Morgan
- University of Sheffield, FU32, The Medical School, Sheffield, UK
| | - S Potter
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK; Bristol Breast Care Centre, Southmead Hospital, Bristol, UK
| | - N Sharma
- Breast Unit, St James Hospital, Leeds, UK
| | - S A McIntosh
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK.
| | | | | | - K Elder
- Western General Hospital, Edinburgh, UK
| | - C Gaunt
- CRCTU, University of Birmingham, UK
| | | | | | | | | | | | - S Pirrie
- CRCTU, University of Birmingham, UK
| | | | - D Rea
- University of Birmingham, UK
| | | | - N Sharma
- St James's University Hospital, Leeds, UK
| | - H Stobart
- Independent Cancer Patients' Voice, UK
| | | | - M Wallis
- Addenbrooke's Hospital, Cambridge, UK
| | - M Wilcox
- Independent Cancer Patients' Voice, UK
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2
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Greenwood C, Clement JG, Dicken AJ, Evans JPO, Lyburn ID, Martin RM, Rogers KD, Stone N, Adams G, Zioupos P. The micro-architecture of human cancellous bone from fracture neck of femur patients in relation to the structural integrity and fracture toughness of the tissue. Bone Rep 2015; 3:67-75. [PMID: 28377969 PMCID: PMC5365242 DOI: 10.1016/j.bonr.2015.10.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 11/29/2022] Open
Abstract
Osteoporosis is clinically assessed from bone mineral density measurements using dual energy X-ray absorption (DXA). However, these measurements do not always provide an accurate fracture prediction, arguably because DXA does not grapple with ‘bone quality’, which is a combined result of microarchitecture, texture, bone tissue properties, past loading history, material chemistry and bone physiology in reaction to disease. Studies addressing bone quality are comparatively few if one considers the potential importance of this factor. They suffer due to low number of human osteoporotic specimens, use of animal proxies and/or the lack of differentiation between confounding parameters such as gender and state of diseased bone. The present study considers bone samples donated from patients (n = 37) who suffered a femoral neck fracture and in this very well defined cohort we have produced in previous work fracture toughness measurements (FT) which quantify its ability to resist crack growth which reflects directly the structural integrity of the cancellous bone tissue. We investigated correlations between BV/TV and other microarchitectural parameters; we examined effects that may suggest differences in bone remodelling between males and females and compared the relationships with the FT properties. The data crucially has shown that TbTh, TbSp, SMI and TbN may provide a proxy or surrogate for BV/TV. Correlations between FT critical stress intensity values and microarchitecture parameters (BV/TV, BS/TV, TbN, BS/BV and SMI) for osteoporotic cancellous tissue were observed and are for the first time reported in this study. Overall, this study has not only highlighted that the fracture model based upon BMD could potentially be improved with inclusion of other microarchitecture parameters, but has also given us clear clues as to which of them are more influential in this role. first time ever study to relate microarchitecture to the fracture toughness of cancellous bone from the femoral head of FNF victims reduction in bone mass relates to a reduction in the number of trabeculae and trabecular thickness and an increase in trabeculae spacing bone loss observed appears to be a consequence of thinning of the trabeculae in males and perforation of the trabeculae in females study hints that TbTh, TbSp, SMI and TbN may provide a proxy or surrogate for BV/TV fracture models can be improved by including microarchitecture, BMD and the bone mineral quality of osteoporotic cancellous bone
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Affiliation(s)
- C Greenwood
- Cranfield Forensic Institute, Cranfield University, Defence Academy of the UK, Shrivenham, UK
| | - J G Clement
- Forensic Odontology, Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - A J Dicken
- The Imaging Science Group, Nottingham Trent University, Nottingham, UK
| | - J P O Evans
- The Imaging Science Group, Nottingham Trent University, Nottingham, UK
| | | | - R M Martin
- Social and Community Medicine, Bristol University, Bristol, UK
| | - K D Rogers
- Cranfield Forensic Institute, Cranfield University, Defence Academy of the UK, Shrivenham, UK
| | - N Stone
- Physics and Astronomy, Exeter University, Exeter, UK
| | - G Adams
- Cranfield Forensic Institute, Cranfield University, Defence Academy of the UK, Shrivenham, UK
| | - P Zioupos
- Cranfield Forensic Institute, Cranfield University, Defence Academy of the UK, Shrivenham, UK
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3
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Dicken AJ, Evans JPO, Rogers KD, Stone N, Greenwood C, Godber SX, Prokopiou D, Clement JG, Lyburn ID, Martin RM, Zioupos P. X-ray diffraction from bone employing annular and semi-annular beams. Phys Med Biol 2015; 60:5803-12. [PMID: 26159892 DOI: 10.1088/0031-9155/60/15/5803] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is a compelling need for accurate, low cost diagnostics to identify osteo-tissues that are associated with a high risk of fracture within an individual. To satisfy this requirement the quantification of bone characteristics such as 'bone quality' need to exceed that provided currently by densitometry. Bone mineral chemistry and microstructure can be determined from coherent x-ray scatter signatures of bone specimens. Therefore, if these signatures can be measured, in vivo, to an appropriate accuracy it should be possible by extending terms within a fracture risk model to improve fracture risk prediction.In this preliminary study we present an examination of a new x-ray diffraction technique that employs hollow annular and semi-annular beams to measure aspects of 'bone quality'. We present diffractograms obtained with our approach from ex vivo bone specimens at Mo Kα and W Kα energies. Primary data is parameterized to provide estimates of bone characteristics and to indicate the precision with which these can be determined.
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Affiliation(s)
- A J Dicken
- Imaging Science Group, Nottingham Trent University, Nottingham, UK
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4
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Arnold DT, Hooper CE, Morley A, White P, Lyburn ID, Searle J, Darby M, Hall T, Hall D, Rahman NM, De Winton E, Clive A, Masani V, Dangoor A, Guglani S, Jankowska P, Lowndes SA, Harvey JE, Braybrooke JP, Maskell NA. The effect of chemotherapy on health-related quality of life in mesothelioma: results from the SWAMP trial. Br J Cancer 2015; 112:1183-9. [PMID: 25756395 PMCID: PMC4385962 DOI: 10.1038/bjc.2015.77] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 01/25/2015] [Accepted: 02/01/2015] [Indexed: 12/19/2022] Open
Abstract
Background: The effect of chemotherapy on health-related quality of life (HRQoL) in malignant pleural mesothelioma (MPM) is poorly understood. Patient-individualised prognostication and prediction of treatment response from chemotherapy is useful but little evidence exists to guide practice. Method: Consecutive patients with MPM who were fit for first-line chemotherapy with pemetrexed and cisplatin\carboplatin were recruited and followed up for a minimum of 12 months. This study focussed on the HRQoL outcomes of these patients using the EQ-5D, EORTC QLQ-C30 and LC13. Results: Seventy-three patients were recruited of which 58 received chemotherapy and 15 opted for best supportive care (BSC). Compliance with HRQoL questionnaires was 98% at baseline. The chemotherapy group maintained HRQoL compared with the BSC group whose overall HRQoL fell (P=0.006) with worsening dyspnoea and pain. The impact of chemotherapy was irrespective of histological subtype although those with non-epithelioid disease had worse HRQoL at later time points (P=0.012). Additionally, those with a falling mesothelin or improvement on modified-RECIST CT at early follow-up had a better HRQoL at 16 weeks. Conclusions: HRQoL was maintained following chemotherapy compared with a self-selected BSC group. Once chemotherapy is initiated, a falling mesothelin or improved RECIST CT findings infer a quality-of-life advantage.
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Affiliation(s)
- D T Arnold
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol BS10 5NB, UK
| | - C E Hooper
- 1] Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol BS10 5NB, UK [2] North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
| | - A Morley
- North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
| | - P White
- Applied Statistics Group, University of West of England (UWE), Bristol BS16 1QY, UK
| | - I D Lyburn
- Cobalt Health, Thirlestaine Road, Cheltenham GL53 7AS, UK
| | - J Searle
- Cobalt Health, Thirlestaine Road, Cheltenham GL53 7AS, UK
| | - M Darby
- Department of Radiology, Southmead Hopsital, North Bristol NHS Trust, Bristol BS10 5NB, UK
| | - T Hall
- Department of Radiology, Royal United Hospital Bath, Bath BA1 3NG, UK
| | - D Hall
- Cobalt Health, Thirlestaine Road, Cheltenham GL53 7AS, UK
| | - N M Rahman
- Oxford Respiratory Clinical Trial Unit (Funded by the NIHR Biomedical Research Centre), Churchill Hospital, Oxford OX3 7LJ, UK
| | - E De Winton
- Department of Oncology, Royal United Hospital Bath, Bath BA1 3NG, UK
| | - A Clive
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol BS10 5NB, UK
| | - V Masani
- Department of Respiratory Medicine, Royal United Hospital Bath, Bath BA1 3NG, UK
| | - A Dangoor
- Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8ED, UK
| | - S Guglani
- Department of Oncology, Cheltenham General Hospital, Cheltenham GL53 7AN, UK
| | - P Jankowska
- Department of Oncology, Musgrove Park Hospital, Taunton, Severn TA1 5DA, UK
| | - S A Lowndes
- Department of Oncology, Great Western Hospital, Swindon SN3 6BB, UK
| | - J E Harvey
- North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
| | - J P Braybrooke
- Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8ED, UK
| | - N A Maskell
- 1] Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol BS10 5NB, UK [2] North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
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5
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Kecler-Pietrzyk A, Kok HK, Lyburn ID, Torreggiani WC. Dialysis related amyloid arthropathy on ¹⁸FDG PET-CT. Ulster Med J 2014; 83:117-8. [PMID: 25075142 PMCID: PMC4113157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- A Kecler-Pietrzyk
- Department of Radiology, Tallaght Hospital, Dublin, Ireland,Correspondence to: Dr Aneta Kecler-Pietrzyk E-mail:
| | - HK Kok
- Department of Radiology, Tallaght Hospital, Dublin, Ireland
| | - ID Lyburn
- Department of Molecular Imaging, Cobalt Imaging Centre, Cheltenham, UK
| | - WC Torreggiani
- Department of Radiology, Tallaght Hospital, Dublin, Ireland
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6
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Kok HK, Fitzgerald L, Campbell N, Lyburn ID, Munk PL, Buckley O, Torreggiani WC. Multimodality imaging features of hereditary multiple exostoses. Br J Radiol 2013; 86:20130398. [PMID: 24004486 DOI: 10.1259/bjr.20130398] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Hereditary multiple exostoses (HME) or diaphyseal aclasis is an inherited disorder characterised by the formation of multiple osteochondromas, which are cartilage-capped osseous outgrowths, and the development of associated osseous deformities. Individuals with HME may be asymptomatic or develop clinical symptoms, which prompt imaging studies. Different modalities ranging from plain radiographs to cross-sectional and nuclear medicine imaging studies can be helpful in the diagnosis and detection of complications in HME, including chondrosarcomatous transformation. We review the role and imaging features of these different modalities in HME.
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Affiliation(s)
- H K Kok
- Department of Radiology, Tallaght Hospital, Dublin, Ireland.
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7
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Lyburn ID, Russell HC, Searle J, Croucher C, Hall DO. 3T MR imaging: diffusion-weighted and dynamic contrast-enhanced - relationship of apparent diffusion coefficient value and maximum percentage enhancement in invasive lobular carcinoma of the breast. Breast Cancer Res 2012. [PMCID: PMC3542650 DOI: 10.1186/bcr3277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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8
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Laurence NJ, Searle J, Bristol J, Lyburn ID. Current clinical use of the [18F]FDG PET/CT in breast cancer patients: an audit of local referral patterns. Breast Cancer Res 2010. [PMCID: PMC2978850 DOI: 10.1186/bcr2686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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9
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Affiliation(s)
- R Mason
- Department of Surgery, Cheltenham General Hospital, Cheltenham, United Kingdom
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10
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Stunell H, Buckley O, Lyburn ID, McGann G, Farrell M, Torreggiani WC. The role of computerized tomography in the evaluation of gastrointestinal bleeding following negative or failed endoscopy: a review of current status. J Postgrad Med 2009; 54:126-34. [PMID: 18480529 DOI: 10.4103/0022-3859.40779] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Gastrointestinal bleeding remains an important cause for emergency hospital admission with a significant related morbidity and mortality. Bleeding may relate to the upper or lower gastrointestinal tracts and clinical history and examination may guide investigations to the more likely source of bleeding. The now widespread availability of endoscopic equipment has made a huge impact on the rapid identification of the bleeding source. However, there remains a large group of patients with negative or failed endoscopy, in whom additional techniques are required to identify the source of bleeding. In the past, catheter angiography and radionuclide red cell labeling techniques were the preferred 'next step' modalities used to aid in identifying a bleeding source within the gastrointestinal tract. However, these techniques are time-consuming and of limited sensitivity and specificity. In addition, catheter angiography is a relatively invasive procedure. In recent years, computerized tomography (CT) has undergone major technological advances in its speed, resolution, multiplanar techniques and angiographic abilities. It has allowed excellent visualization of the both the small and large bowel allowing precise anatomical visualization of many causes of gastrointestinal tract (GIT) bleeding. In addition, recent advances in multiphasic imaging now allow direct visualization of bleeding into the bowel. In many centers CT has therefore become the 'next step' technique in identifying a bleeding source within the GIT following negative or failed endoscopy in the acute setting. In this review article, we review the current literature and discuss the current status of CT as a modality in investigating the patient with GIT bleeding.
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Affiliation(s)
- H Stunell
- Department of Radiology, Adelaide and Meath Hospitals incorporating the National Children's Hospital , Tallaght, Dublin 24, Ireland
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11
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Lyburn ID, Torreggiani WC, Munk PL. Images in clinical radiology. Locally advanced testicular seminoma: CT appearances. JBR-BTR 2006; 89:281. [PMID: 17147019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- I D Lyburn
- Department of Radiology, Vancouver General Hospital, Vancouver V5Z 1M9, BC Canada
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12
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Abstract
Generalized thickening of the skull is unusual but has a number of recognized associations such as chronic severe anaemia, Paget disease and phenytoin therapy. We report a case of generalized skull vault thickening seen in association with a large arteriovenous malformation of the brain.
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Affiliation(s)
- P Govender
- Department of Radiology, Adelaide and Meath Hospital, Dublin, Ireland
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13
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Byrne AT, Geoghegan T, Goeghegan T, Govender P, Lyburn ID, Colhoun E, Torreggiani WC. The imaging of intussusception. Clin Radiol 2005; 60:39-46. [PMID: 15642291 DOI: 10.1016/j.crad.2004.07.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [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: 02/08/2004] [Accepted: 07/16/2004] [Indexed: 12/18/2022]
Abstract
Intussusception is defined as the telescoping of one segment of the gastrointestinal tract into an adjacent one. It is relatively common in children and is the second most common cause of an acute abdomen in this age group. It is much less common in adults and accounts for less than 5% of cases of mechanical small bowel obstruction. Whereas the diagnosis is usually already suspected in children before imaging, it is often made unexpectedly in adults. In addition, although in children there is usually no specific underlying cause, an underlying lead point is often present in adults. Plain film radiography, barium studies and ultrasound imaging play major roles in both the diagnosis and management of this condition, and it is increasingly common for the diagnosis to be made by CT and MRI, particularly in adults. This pictorial essay reviews the imaging features that may be found in patients with bowel intussusception. As well as describing the imaging features of the more commonly used tests, we also stress the role of emerging technologies such as MRI using ultrafast half-fourier sequences with single shot turbo spin echo.
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Affiliation(s)
- A T Byrne
- Adelaide and Meath Incorporating the National Children's Hospital, Dublin, Ireland.
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14
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Affiliation(s)
- I D Lyburn
- Dept. of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
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15
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Buckley O, Geoghegan T, O'Riordain DS, Lyburn ID, Torreggiani WC. Computed tomography in the imaging of colonic diverticulitis. Clin Radiol 2004; 59:977-83. [PMID: 15488845 DOI: 10.1016/j.crad.2004.05.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [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: 08/28/2003] [Revised: 04/13/2004] [Accepted: 05/04/2004] [Indexed: 02/08/2023]
Abstract
Colonic diverticulitis occurs when diverticula within the colon become infected or inflamed. It is becoming an increasingly common cause for hospital admission, particularly in western society, where it is linked to a low fibre diet. Symptoms of diverticulitis include abdominal pain, diarrhoea and pyrexia, however, symptoms are often non-specific and the clinical diagnosis may be difficult. In addition, elderly patients and those taking corticosteroids may have limited findings on physical examination, even in the presence of severe diverticulitis. A high index of suspicion is required in such patients in order to avoid a significant delay in arriving at the correct diagnosis. Imaging plays an important role in establishing an early and correct diagnosis. In the past, contrast enema studies were the principal imaging test used to make the diagnosis. However, such studies lack sensitivity and have limited success in identifying abscesses that may require drainage. Conversely computed tomography (CT) is both sensitive and specific in making a diagnosis of diverticulitis. In addition, it is the imaging technique of choice in depicting complications such as perforation, abscess formation and fistulae. CT-guided drainage of diverticular abscesses helps to reduce sepsis and to permit a one-stage, rather than two-stage, surgical operation. The purpose of this review article is to discuss the role of CT in the imaging of diverticulitis, describe the CT imaging features and complications of this disease, as well as review the impact and rationale of CT imaging and intervention in the overall management of patients with diverticulitis.
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Affiliation(s)
- O Buckley
- Department of Surgery, Adelaide and Meath Incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland
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16
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Byrne A, Al-Agha G, Torreggiani WC, Lyburn ID. Does testicular microlithiasis matter? Clin Radiol 2003; 58:495; author reply 495-6. [PMID: 12788322 DOI: 10.1016/s0009-9260(03)00123-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Lyburn ID, Gleeson RF, Watt I. Case of the month. A lump in the sole of the foot. Br J Radiol 2003; 76:353-4. [PMID: 12763954 DOI: 10.1259/bjr/19104283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- I D Lyburn
- Department of Clinical Radiology, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK
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18
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Abstract
Haematopoietic stem cell transplantation (SCT) is used to treat a wide range of malignant and non-malignant haematological conditions, solid malignancies, and metabolic and autoimmune diseases. Although imaging has a limited role before SCT, it is important after transplantation when it may support the clinical diagnosis of a variety of complications. It may also be used to monitor the effect of therapy and to detect recurrence of the underlying disease if the transplant is unsuccessful. We present a pictorial review of the imaging of patients who have undergone SCT, based upon 15 years experience in a large unit performing both adult and paediatric transplants.
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Affiliation(s)
- A Evans
- Department of Clinical Radiology, University Hospital of Wales, Heath Park, Cardiff, UK.
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19
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Affiliation(s)
- J D Jones
- Department of Radiology, Bristol Royal Infirmary, Bristol BS2 8HW, UK
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20
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Abstract
OBJECTIVES To evaluate the effect of formal radiological reporting of all emergency department (ED) radiographs on clinical practice and patient outcome, and to consider whether a selective reporting policy might prove safe and effective. METHODS All radiographs taken in a single ED over a six month period were prospectively studied simultaneously in both the emergency and radiology departments to detect cases where a radiograph that was considered normal by ED staff was then reported as abnormal by the reporting radiologist. Whenever such a discrepancy occurred the patient's records were scrutinised to ascertain the source of the discrepancy, with a gold standard interpretation derived from senior clinical review and additional investigations where indicated. The clinical impact of the radiologist's formal report was then assessed. Accuracy of interpretation was considered in relation to the grade of ED staff and the radiographic examination obtained. RESULTS During the study period, 19468 new patient attendances to the ED generated 11749 radiographic examinations. Discrepancies were detected in 175 patients (1.5% of all radiographic examinations). Of these, 136 (1.2%) were subsequently shown to have been incorrectly interpreted in the ED (ED false negatives), with 40 patients (0.3%) undergoing a change in management as a result. In the remaining 39 the ED interpretation was judged to be correct (radiology false positives), with 16 patients undergoing further investigations or visits to the ED to confirm this. CONCLUSIONS The formal reporting of ED radiographs by the radiology department detects a number of clinically important abnormalities that have been overlooked. However, this formal reporting also generates a number of incorrect interpretations that may lead to further unnecessary investigations. Some groups of ED radiographs (such as those interpreted by an ED consultant and films of the fingers and toes) may not require formal radiological reporting. The adoption of a selective reporting policy may reduce the reporting workload of the radiology department without compromising patient care.
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Affiliation(s)
- J R Benger
- Emergency Department, Frenchay Hospital, Frenchay, Bristol, UK.
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21
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Abstract
Computed tomography (CT) can provide essential anatomic and physiologic information required to determine management of intraabdominal and retroperitoneal injuries sustained during blunt abdominal trauma. It can help in evaluation of the type and severity of parenchymal injury, the extent of perirenal hemorrhage and parenchymal devascularization, and the presence of urinary extravasation. CT can help confirm the presence of major injuries to the vascular pedicle and depict occult renal pathologic conditions. Principal indications for the use of CT in the evaluation of blunt renal trauma include (a) the presence of gross hematuria, (b) microscopic hematuria associated with shock (systolic blood pressure <90 mm Hg), and (c) microscopic hematuria associated with a positive result of diagnostic peritoneal lavage. The majority of renal injuries sustained during blunt abdominal trauma are contusions and minor parenchymal lacerations amenable to nonoperative management. Deep parenchymal lacerations, urinary extravasation, and mild to moderate degrees of parenchymal devascularization may also be treated conservatively. Radiologists should look for coexisting renal lesions such as tumors and traumatic false aneurysms that may alter management.
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Affiliation(s)
- A C Harris
- Department of Radiology, Vancouver General Hospital, 855 W 12th Ave, Vancouver, British Columbia, Canada V5Z 1M9
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22
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Torreggiani WC, Liu DM, Lyburn ID, Rowley VA, Munk PI. Serendipitous computed tomographic diagnosis of an underlying cause for diabetes mellitus. Hosp Med 2001; 62:508-9. [PMID: 11530594 DOI: 10.12968/hosp.2001.62.8.1632] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 62-year-old man presented with non-specific abdominal pain, which was most marked in the left iliac fossa. He had a 15-year history of diabetes and had been jointly managed by an endocrinologist and his family physician. He was known to have mild renal impairment, which was felt to be secondary to his diabetes. He also had a past history of diverticular disease that had been diagnosed clinically without the use of imaging and had been managed conservatively.
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Affiliation(s)
- W C Torreggiani
- Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia
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23
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Lyburn ID, Torreggiani WC, Harris AC, Zwirewich CV. The white chest. Chest 2001; 120:649-51. [PMID: 11502671 DOI: 10.1378/chest.120.2.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- I D Lyburn
- Department of Radiology, Vancouver General Hospital, Vancouver, BC Canada
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24
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Affiliation(s)
- W C Torreggiani
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
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Abstract
Fractures of the thoracic and lumber spine are well recognized following an epileptic seizure. Fractures of the cervical spine are not. The rare occurrence of a displaced odontoid fracture type 2, secondary to a grand mal seizure is presented. To our knowledge, this association has not been described previously in the English literature.
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Affiliation(s)
- W C Torreggiani
- Department of Radiology, Vancouver General Hospital, 899 West 12th Avenue, Vancouver, V5Z 1V7, British Columbia, Canada.
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Torreggiani WC, Lyburn ID, Harris AC, Zwirewich CV. A simple method to minimize spillage on retrograde examination of the bowel in patients with an ileostomy or colostomy: technical note. Can Assoc Radiol J 2001; 52:196-7. [PMID: 11436416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Affiliation(s)
- W C Torreggiani
- Department of Radiology, Abdominal Division, Vancouver General Hospital, Vancouver, BC
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Harris AC, Torreggiani WC, Lyburn ID, Zwirewich CV, Ho SG, Munk PL. CT and sonography of traumatic fat embolism in the common femoral vein. AJR Am J Roentgenol 2000; 175:1741-2. [PMID: 11090413 DOI: 10.2214/ajr.175.6.1751741] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- A C Harris
- All authors: Department of Radiology, Vancouver General Hospital, 899 W. 12th Ave., Vancouver, B. C., V5Z 1M9 Canada
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Torreggiani WC, Lyburn ID, Harris AC, Rowley VA. Duchenne-Landouzy dystrophy: CT explanation of low serum creatinine level. AJR Am J Roentgenol 2000; 174:1467-8. [PMID: 10789819 DOI: 10.2214/ajr.174.5.1741467a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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30
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Abstract
We describe a case of poisoning with 3,4-methylenedioxymet-amphetamine Ecstasy that presented with all the features suggestive of a fatal outcome, including a creatinine phosphokinase level markedly higher than any previously reported. The patient, a paraplegic, was treated with dantrolene and made a full recovery.
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Affiliation(s)
- A P Hall
- Adult Intensive Therapy Unit, University Hospital, Queen's Medical Centre, Nottingham, UK
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