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Viteri Jusué A, Domínguez Fernández S, Pérez Persona E, Poza de Celis R. Urgent and unexpected findings in oncology and hematology patients: A practical approach to imaging. RADIOLOGIA 2022; 64:464-472. [PMID: 36243446 DOI: 10.1016/j.rxeng.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/09/2021] [Indexed: 06/16/2023]
Abstract
Urgent and unexpected findings are very common in oncology and haematology patients. This article reviews the most important points included in the European Society of Radiology's guidelines and proposes a practical approach to reporting and communicating these findings more efficiently. This approach is explained with illustrative examples. Radiologists can provide added value in the management of these findings by helping referring clinicians reach the best decisions. To this end, it is essential to know the imaging manifestations of the most common findings that must be reported urgently, such as the specific toxicity of different treatments, the complications of tumours and catheters, infections, and thrombosis. Moreover, it is crucial to consider the individual patient's treatment, risk factors, clinical situation, and immune status.
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Affiliation(s)
- A Viteri Jusué
- Servicio de Radiodiagnóstico, Hospital Universitario Araba, Vitoria-Gasteiz, Spain.
| | | | - E Pérez Persona
- Servicio de Hematología, Hospital Universitario Araba, Vitoria-Gasteiz, Spain
| | - R Poza de Celis
- Servicio de Oncología Radioterápica, Hospital Universitario Araba, Vitoria-Gasteiz, Spain
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Viteri Jusué A, Domínguez Fernández S, Pérez Persona E, Poza de Celis R. Urgent and unexpected findings in oncology and hematology patients: a practical approach to imaging. RADIOLOGIA 2021; 64:S0033-8338(21)00086-2. [PMID: 33985767 DOI: 10.1016/j.rx.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022]
Abstract
Urgent and unexpected findings are very common in oncology and hematology patients. This article reviews the most important points included in the European Society of Radiology's guidelines and proposes a practical approach to reporting and communicating these findings more efficiently. This approach is explained with illustrative examples. Radiologists can provide added value in the management of these findings by helping referring clinicians reach the best decisions. To this end, it is essential to know the imaging manifestations of the most common findings that must be reported urgently, such as the specific toxicity of different treatments, the complications of tumors and catheters, infections, and thrombosis. Moreover, it is crucial to consider the individual patient's treatment, risk factors, clinical situation, and immune status.
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Affiliation(s)
- A Viteri Jusué
- Servicio de Radiodiagnóstico, Hospital Universitario Araba, Vitoria-Gasteiz, España.
| | | | - E Pérez Persona
- Servicio de Hematología, Hospital Universitario Araba, Vitoria-Gasteiz, España
| | - R Poza de Celis
- Servicio de Oncología Radioterápica, Hospital Universitario Araba, Vitoria-Gasteiz, España
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de Silva S, Lockhart K, Aslan P, Nash P, Hutton A, Malouf D, Lee D, Cozzi P, Maclean F, Thompson J. Chemical shift imaging in the identification of those renal tumours that contain microscopic fat and the utility of multiparametric MRI in their differentiation. J Med Imaging Radiat Oncol 2020; 64:762-768. [PMID: 32743914 DOI: 10.1111/1754-9485.13082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/18/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of this study was to assess the qualitative and MRI findings of renal tumours, to determine which lesions contain microscopic fat, one of the potential differentiating factors between tumour types. METHODS 73 patients who underwent 3 Tesla MRI including chemical shift imaging, with subsequent biopsy or excision for histopathological diagnosis, were included in the study. The images were reviewed for a decrease in signal intensity (SI) on the opposed phase compared with the in-phase gradient echo T1 images, indicating the presence of microscopic fat. The chemical shift index was then calculated as a percentage of SI change and compared with the pathological diagnosis. RESULTS In total, 38 (52%) of lesions demonstrated a decrease in SI, consistent with microscopic fat. Microscopic fat was found in 28 (80%) clear cell renal cell carcinomas (RCCs), 6 (66.7%) angiomyolipomas, 2 (20%) papillary RCCs, 1 (20%) chromophobe RCC and 1 (9.1%) oncocytoma. Pairwise comparison of means indicated that the amount of microscopic fat was significantly larger only for angiomyolipomas compared with clear cell RCCs (P < 0.001) and other renal lesions (P < 0.001). CONCLUSIONS A decrease in SI on opposed phase compared with in-phase chemical shift imaging favours the diagnosis of either clear cell RCC or an angiomyolipoma. When combined with other parameters in mpMRI, this may aid differentiation of benign from malignant tumours and differentiation of aggressive from indolent RCC subtypes. This may be of value where biopsy is non-diagnostic, not feasible due to location or in high-risk patients.
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Affiliation(s)
- Suresh de Silva
- Faculty of Medicine, University of NSW, Sydney, New South Wales, Australia.,Department of Radiology, I-MED Radiology Network, Sydney, New South Wales, Australia
| | - Kathleen Lockhart
- Department of Urology, St George Hospital, Sydney, New South Wales, Australia
| | - Peter Aslan
- Department of Urology, St George Hospital, Sydney, New South Wales, Australia
| | - Peter Nash
- Department of Urology, St George Hospital, Sydney, New South Wales, Australia
| | - Anthony Hutton
- Faculty of Medicine, University of NSW, Sydney, New South Wales, Australia.,Department of Urology, St George Hospital, Sydney, New South Wales, Australia
| | - David Malouf
- Department of Urology, St George Hospital, Sydney, New South Wales, Australia
| | - Dominic Lee
- Department of Urology, St George Hospital, Sydney, New South Wales, Australia
| | - Paul Cozzi
- Faculty of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Fiona Maclean
- Department of Anatomical Pathology, Sonic Healthcare, Sydney, New South Wales, Australia
| | - James Thompson
- Faculty of Medicine, University of NSW, Sydney, New South Wales, Australia.,Department of Urology, St George Hospital, Sydney, New South Wales, Australia
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