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Mak J, Gangi A, Chan N, Vittay O, Ashok A, Rogers P, Jehanli L, Dhas K, Wong J, Lam S, Hall-Craggs M. How can the Radiology Academic Network for Trainees (RADIANT) reshape the future of radiology research? A follow-up survey at the RADIANT Annual Meeting 2022. Clin Radiol 2022; 77:e835-e838. [DOI: 10.1016/j.crad.2022.09.116] [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] [Received: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 11/03/2022]
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Rogers P, Walker I, Yeung J, Khan A, Gangi A, Mobashwera B, Ayto R, Shah A, Hermans J, Murchison A, Benger M, Apap Mangion S, Mehta PR, Sztriha L, Ghatorae S, Craven B, Scully M, Bray T, Hall-Craggs M, Von Stempel C. Thrombus Distribution in Vaccine-induced Immune Thrombotic Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination. Radiology 2022; 305:590-596. [PMID: 35699579 PMCID: PMC9219093 DOI: 10.1148/radiol.220365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/11/2022]
Abstract
This case series reports 40 patients (median age, 41 years [interquartile range (IQR) 32- 52, 22 men) with confirmed vaccine-induced immune thrombotic thrombocytopaenia after administration of their first ChAdOx1 nCov-19 (AstraZeneca) vaccine: 80% (n=32) developed symptoms within the first 14 days and 20% (n=8) within 14-28 days. The location and extent of thrombi were evaluated using CT, MRI and ultrasound. Of the 40, 73% (n=29) presented with neurological symptoms and had confirmed cerebral venous sinus thrombosis, 30% (n=12) had extension of their primary thrombus, and 20% (n=8) died. 83% of those who underwent additional imaging (25 of 30) had occult thrombosis.
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Affiliation(s)
- Priya Rogers
- Addenbrooke's Hospital, Cambridge.,Radiology Academic Network for Trainees (RADIANT), UK
| | | | - Jason Yeung
- University College London Hospital, London.,Radiology Academic Network for Trainees (RADIANT), UK
| | - Abeera Khan
- Queen Alexandra Hospital, Portsmouth.,Radiology Academic Network for Trainees (RADIANT), UK
| | - Anmol Gangi
- Queen Alexandra Hospital, Portsmouth.,Radiology Academic Network for Trainees (RADIANT), UK
| | | | | | - Ali Shah
- Nottingham University Hospitals NHS Foundation Trust, Nottingham.,Centre for Medical Imaging, University College London
| | - Joannes Hermans
- Nottingham University Hospitals NHS Foundation Trust, Nottingham
| | - Andrew Murchison
- Oxford University Hospitals NHS Foundation Trust, Oxford.,Radiology Academic Network for Trainees (RADIANT), UK
| | - Matthew Benger
- King's College Hospital, London.,Radiology Academic Network for Trainees (RADIANT), UK
| | | | | | | | | | | | | | - Timothy Bray
- University College London Hospital, London.,Centre for Medical Imaging, University College London.,Radiology Academic Network for Trainees (RADIANT), UK
| | - Margaret Hall-Craggs
- University College London Hospital, London.,Centre for Medical Imaging, University College London.,Radiology Academic Network for Trainees (RADIANT), UK
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- Centre for Medical Imaging, University College London
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Salih S, Grammatopoulos G, Burns S, Hall-Craggs M, Witt J. Do acetabular parameters measured on 2D imaging correlate with CT, and can lateral centre-edge angle predict femoral head coverage? Bone Jt Open 2022; 3:12-19. [PMID: 34985308 PMCID: PMC9047077 DOI: 10.1302/2633-1462.31.bjo-2021-0130.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims The lateral centre-edge angle (LCEA) is a plain radiological measure of superolateral cover of the femoral head. This study aims to establish the correlation between 2D radiological and 3D CT measurements of acetabular morphology, and to describe the relationship between LCEA and femoral head cover (FHC). Methods This retrospective study included 353 periacetabular osteotomies (PAOs) performed between January 2014 and December 2017. Overall, 97 hips in 75 patients had 3D analysis by Clinical Graphics, giving measurements for LCEA, acetabular index (AI), and FHC. Roentgenographical LCEA, AI, posterior wall index (PWI), and anterior wall index (AWI) were measured from supine AP pelvis radiographs. The correlation between CT and roentgenographical measurements was calculated. Sequential multiple linear regression was performed to determine the relationship between roentgenographical measurements and CT FHC. Results CT-measured LCEA and AI correlated strongly with roentgenographical LCEA (r = 0.92; p < 0.001) and AI (r = 0.83; p < 0.001). Radiological LCEA correlated very strongly with CT FHC (r = 0.92; p < 0.001). The sum of AWI and PWI also correlated strongly with CTFHC (r = 0.73; p < 0.001). CT measurements of LCEA and AI were 3.4° less and 2.3° greater than radiological LCEA and AI measures. There was a linear relation between radiological LCEA and CT FHC. The linear regression model statistically significantly predicted FHC from LCEA, F(1,96) = 545.1 (p < 0.001), adjusted R2 = 85.0%, with the prediction equation: CT FHC(%) = 42.1 + 0.77(XRLCEA) Conclusion CT and roentgenographical measurement of acetabular parameters are comparable. Currently, a radiological LCEA greater than 25° is considered normal. This study demonstrates that those with hip pain and normal radiological acetabular parameters may still have deficiencies in FHC. More sophisticated imaging techniques such as 3D CT should be considered for those with hip pain to identify deficiencies in FHC. Cite this article: Bone Jt Open 2022;3(1):12–19.
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Affiliation(s)
- Saif Salih
- Department of Trauma and Orthopaedics, Sheffield Teaching Hospitals, Sheffield, UK
| | | | | | | | - Johan Witt
- University College London Hospital, London, UK
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Choida V, Hall-Craggs M, Jebson BR, Fisher C, Leandro M, Wedderburn LR, Ciurtin C. Biomarkers of Response to Biologic Therapy in Juvenile Idiopathic Arthritis. Front Pharmacol 2021; 11:635823. [PMID: 33603671 PMCID: PMC7884612 DOI: 10.3389/fphar.2020.635823] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/31/2020] [Indexed: 01/22/2023] Open
Abstract
Background: Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory arthritis of childhood, characterized by various clinical phenotypes associated with variable prognosis. Significant progress has been achieved with the use of biologic treatments, which specifically block pro-inflammatory molecules involved in the disease pathogenesis. The most commonly used biologics in JIA are monoclonal antibodies and recombinant proteins targeting interleukins 1 (IL-1) and 6 (IL-6), and tumor necrosis factor α (TNF-α). Several biomarkers have been investigated in JIA. Aims: To assess the level of evidence available regarding the role of biomarkers in JIA related to guiding clinical and therapeutic decisions, providing disease prognostic information, facilitating disease activity monitoring and assessing biologic treatment response in JIA, as well as propose new strategies for biologic therapy-related biomarker use in JIA. Methods: We searched PubMed for relevant literature using predefined key words corresponding to several categories of biomarkers to assess their role in predicting and assessing biologic treatment response and clinical remission in JIA. Results: We reviewed serological, cellular, genetic, transcriptomic and imaging biomarkers, to identify candidates that are both well-established and widely used, as well as newly investigated in JIA on biologic therapy. We evaluated their role in management of JIA as well as identified the unmet needs for new biomarker discovery and better clinical applications. Conclusion: Although there are no ideal biomarkers in JIA, we identified serological biomarkers with potential clinical utility. We propose strategies of combining biomarkers of response to biologics in JIA, as well as routine implementation of clinically acceptable imaging biomarkers for improved disease assessment performance.
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Affiliation(s)
- Varvara Choida
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, Division of Medicine, University College London, London, United Kingdom
- Department of Adolescent Rheumatology, University College London Hospital, London, United Kingdom
| | | | - Bethany R. Jebson
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, Division of Medicine, University College London, London, United Kingdom
- University College London Great Ormond Street Institute for Child Health, London, United Kingdom
| | - Corinne Fisher
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, Division of Medicine, University College London, London, United Kingdom
- Department of Adolescent Rheumatology, University College London Hospital, London, United Kingdom
| | - Maria Leandro
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, Division of Medicine, University College London, London, United Kingdom
- Department of Adolescent Rheumatology, University College London Hospital, London, United Kingdom
| | - Lucy R. Wedderburn
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, Division of Medicine, University College London, London, United Kingdom
- University College London Great Ormond Street Institute for Child Health, London, United Kingdom
- NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, United Kingdom
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, Division of Medicine, University College London, London, United Kingdom
- Department of Adolescent Rheumatology, University College London Hospital, London, United Kingdom
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Jones A, Ciurtin C, Kazkaz H, Hall-Craggs M. THU0492 MAGNETIC RESONANCE IMAGING OF THE SACROILIAC JOINTS IN PATIENTS WITH HYPERMOBILITY: A RETROSPECTIVE COHORT STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The incidence of inflammatory and structural lesions on magnetic resonance imaging of sacroiliac joints (MRI SIJs) in patients with hypermobility related disorders has not been fully investigated. Hypermobile patients are more susceptible to pelvic instability and biomechanical stress of the SIJs, leading to MRI SIJ changes similar to those occurring in spondyloarthritis (SpA). Patients with hypermobility and suspected SpA pose a unique challenge owing to the high prevalence of back pain in the hypermobility cohort and the absence of spinal restriction on clinical examination.Objectives:In this study, we aim to investigate the incidence of MRI SIJ lesions in patients with hypermobility.Methods:We performed a retrospective study of all patients with a confirmed diagnosis of hypermobility related disorders (including hypermobility syndrome, hypermobility spectrum disorders and Ehlers-Danlos Syndromes) referred for an MRI lumbar spine and SIJ between 2011 and 2019 to investigate long-standing back pain. MRIs were examined by a musculoskeletal (MSK) radiologist with more than 25 years of experience, who was blinded to the clinical outcome of the patients. MRI SIJs were assessed for the presence of bone marrow oedema, subchondral sclerosis, erosion, fatty change, enthesitis, ankylosis, joint fluid and capsulitis.Results:51 patients with confirmed hypermobility related disorders were referred for MRI SIJ and lumbar spine between 2011 and 2019. 3 patients demonstrated clinical features in keeping with a diagnosis of SpA and were excluded from the study. 15/48 (31.3%) of patients with hypermobility and back pain (but no clinical picture of SpA) were found to have inflammatory and/or structural lesions on MRI SIJ. The most frequent lesions were small foci of bone marrow oedema (16.6%) followed by subchondral sclerosis (12.5%) and fatty change (10.4%). The incidence of erosions was 4.2%.Conclusion:There is a relatively high incidence of inflammatory and structural lesions on MRI SIJ of patients with hypermobility. The presence of hypermobility should be taken into consideration when interpreting MRI changes in patients with suspected SpA. Further research into long-term outcomes of MRI SIJs in patients with hypermobility and back pain is required to establish the clinical significance of these findings.Disclosure of Interests: :Alexis Jones: None declared, Coziana Ciurtin Grant/research support from: Pfizer, Consultant of: Roche, Modern Biosciences, Hanadi Kazkaz: None declared, Margaret Hall-Craggs: None declared
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Choida V, Madenidou AV, Sen D, Hall-Craggs M, Ciurtin C. AB1084 A SYSTEMATIC REVIEW OF THE ABILITY OF WHOLE BODY MRI TO ASSESS DISEASE ACTIVITY AND TREATMENT RESPONSE IN INFLAMMATORY ARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Whole body MRI (WBMRI) is an imaging technique that allows the assessment of the spine and peripheral joints in patients with inflammatory arthritis (IA) in a single examination. Depending on the protocol, it can potentially identify synovitis, enthesitis, spondyloarthritis and chronic structural changes.Objectives:To evaluate the performance of WBMRI in patients with IA for detecting inflammation compared with clinical assessments and to show changes in response to treatment.Methods:We conducted a systematic search of the electronic databases MEDLINE, EMBASE and Cochrane Library. Two authors selected independently the eligible studies, extracted the predefined data and assessed the quality using the QUADAS2 tool. Studies that reported a)disease activity scores, b)patient or physician reported outcomes or c)results from other imaging tests in IA patients who underwent WBMRI were included.Results:Fourteen studies out of 471 met our inclusion criteria. The majority of the studies were performed in Spondyloarthritis [SpA] (n=9), followed by Rheumatoid Arthritis [RA] (n=4) and Psoriatic Arthritis [PsA] patients (n=3). Nine studies provided clinical and MRI outcome measures. There was great heterogeneity in the quality of studies, disease specific outcomes reported and methodology used to compare with MRI findings. One study documented low correlation between 28 swollen/tender joint count and MRI bone marrow oedema (BME)/synovitis in RA patients, whereas another reported that 31% of MRI negative joints (other than hand joints) exhibited tenderness. In PsA, one study demonstrated correlation between 28 swollen joint count and BME (r=0.54,p=0.03). Superiority of WBMRI in the detection of synovitis and enthesitis over clinical examination was documented in two studies with SpA patients. A third study in SpA showed a ranging agreement of 49 to 100% between clinical and WBMRI enthesitis.Treatment response to biologics was assessed by WBMRI in 7 studies (5 in SpA, 2 in RA). In RA, one study showed numerical (but not statistically significant) reduction of WBMRI joint count at week 16 and 52 of Adalimumab treatment, whereas the reduction was statistically significant for the subset of patients achieving good EULAR response at week 16. The other study demonstrated a reduction in WBMRI synovitis and bone oedema scores after 1 year of anti-TNF or Tocilizumab treatment (median DAS28 score decreased from 5.1 to 2.1). A multicentre open label study reported a reduction in the number of MRI enthesitis lesions, spinal and sacroiliac joint scores at week 48, year 2 and 3 of Etanercept treatment in SpA patients. The mean BASDAI score decreased from 5.4 at baseline to 1.5 at year 2 and 2.2 at year 3. Improvement in WBMRI scores in SpA was also documented in one Adalimumab and one further Etanercept study.Conclusion:There was a variable level of correlation between clinical and WBMRI outcome measures across the included studies. The clinical significance of inflammation detected by WBMRI in some studies remains unclear. Many of the devised WBMRI scores appear to decrease after biologic treatment. Further studies are needed to determine the accuracy of WBMRI in detecting inflammation and its potential utility for clinical practice.Disclosure of Interests:Varvara Choida: None declared, Anastasia-Vasiliki Madenidou: None declared, Debajit Sen: None declared, Margaret Hall-Craggs: None declared, Coziana Ciurtin Grant/research support from: Pfizer, Consultant of: Roche, Modern Biosciences
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Arthurs O, Goh V, Hoggard N, Booth T, Messiou C, The J, Plumb A, Bidaut L, Turmezei T, Jethwa K, Robinson P, Hall-Craggs M. Professional development and research are being neglected: a commentary on the 2019 RCR radiologists' supporting professional activities (SPA) survey. Clin Radiol 2020; 75:348-350. [DOI: 10.1016/j.crad.2020.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 11/16/2022]
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Ciurtin C, Sin F, Hall-Craggs M, Sen D. Hard lumps under the skin. Assoc Med J 2019. [DOI: 10.1136/bmj.l2291] [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: 11/04/2022]
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9
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Westerland OA, Pratt G, Kazmi M, El-Najjar I, Streetly M, Yong K, Morris M, Mehan R, Sambrook M, Hall-Craggs M, Silver D, Goh V. National survey of imaging practice for suspected or confirmed plasma cell malignancies. Br J Radiol 2018; 91:20180462. [PMID: 30102561 PMCID: PMC6319860 DOI: 10.1259/bjr.20180462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/29/2018] [Accepted: 08/07/2018] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE: Cross-sectional imaging is now recommended by the National Institute for Health and Care Excellence (NICE) for patients with suspected and newly diagnosed myeloma instead of skeletal survey. The objectives of this study were: (1) To evaluate compliance of current UK imaging practice with reference to National Institute for Health and Care Excellence best-practice clinical guidelines for plasma cell malignancies. (2) To identify factors which may influence diagnostic imaging choices. METHODS: We conducted a national online survey to assess compliance with guidelines and to identify challenges to implementation (endorsed by Myeloma UK, UK Myeloma Forum and the British Society of Skeletal Radiologists). RESULTS: Responses were received from 31 district general and 28 teaching hospitals. For suspected and confirmed myeloma, skeletal survey remained the most frequent first-line imaging test (suspected myeloma 44.3%, confirmed myeloma 37.7%). Only 9.8 % of responders offered first-line whole body MRI. CONCLUSION: Significant challenges remain to standardisation of imaging practice in accordance with national best-practice guidelines. ADVANCES IN KNOWLEDGE: This is the first publication to date evaluating current UK imaging practice for assessing myeloma since the publication of new guidelines recommending use of advanced cross-sectional imaging techniques. Skeletal survey remains the most commonly performed first-line imaging test in patients with suspected or confirmed myeloma and this is largely due to resource limitations within radiology departments.
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Affiliation(s)
- Olwen Amy Westerland
- Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Guy Pratt
- Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Majid Kazmi
- Clinical Haematology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Inas El-Najjar
- Clinical Haematology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Matthew Streetly
- Clinical Haematology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | | | | | - Rakesh Mehan
- British Society of Skeletal Radiologists, London, UK
| | | | | | - David Silver
- British Society of Skeletal Radiologists, London, UK
| | - Vicky Goh
- Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
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van Beek EJR, Kuhl C, Anzai Y, Desmond P, Ehman RL, Gong Q, Gold G, Gulani V, Hall-Craggs M, Leiner T, Lim CCT, Pipe JG, Reeder S, Reinhold C, Smits M, Sodickson DK, Tempany C, Vargas HA, Wang M. Value of MRI in medicine: More than just another test? J Magn Reson Imaging 2018; 49:e14-e25. [PMID: 30145852 DOI: 10.1002/jmri.26211] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/16/2018] [Indexed: 02/06/2023] Open
Abstract
There is increasing scrutiny from healthcare organizations towards the utility and associated costs of imaging. MRI has traditionally been used as a high-end modality, and although shown extremely important for many types of clinical scenarios, it has been suggested as too expensive by some. This editorial will try and explain how value should be addressed and gives some insights and practical examples of how value of MRI can be increased. It requires a global effort to increase accessibility, value for money, and impact on patient management. We hope this editorial sheds some light and gives some indications of where the field may wish to address some of its research to proactively demonstrate the value of MRI. Level of Evidence: 5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;49:e14-e25.
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Affiliation(s)
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, University of Aachen, Aachen, Germany
| | - Yoshimi Anzai
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Patricia Desmond
- Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Garry Gold
- Department of Radiology, Engineering and Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Vikas Gulani
- Departments of Radiology, Urology and Biomedical Imaging, Case Western Reserve University, University Hospitals of Cleveland, Cleveland, Ohio, USA
| | - Margaret Hall-Craggs
- Department of Medical Imaging and Radiology, University College Hospital NHS Trust, London, UK
| | - Tim Leiner
- Department of Radiology and Nuclear Medicine, University Medical Centre, Utrecht, The Netherlands
| | - C C Tschoyoson Lim
- Department of Neuroradiology, National Neuroscience Institute and Duke NUS Medical School, Singapore, Singapore
| | - James G Pipe
- Department of Imaging Research, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Scott Reeder
- Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine and Emergency Medicine, University of Madison, Madison, Wisconsin, USA
| | - Caroline Reinhold
- Department of Radiology, McGill University Health Center, Montreal, Canada
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Daniel K Sodickson
- Department of Radiology, New York University Langone Health, New York, New York, USA
| | - Clare Tempany
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - H Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Meiyun Wang
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, Henan, China
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Latifoltojar A, Hall-Craggs M, Bainbridge A, Rabin N, Popat R, Rismani A, D'Sa S, Dikaios N, Sokolska M, Antonelli M, Ourselin S, Yong K, Taylor SA, Halligan S, Punwani S. Whole-body MRI quantitative biomarkers are associated significantly with treatment response in patients with newly diagnosed symptomatic multiple myeloma following bortezomib induction. Eur Radiol 2017; 27:5325-5336. [PMID: 28656463 PMCID: PMC5674123 DOI: 10.1007/s00330-017-4907-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/13/2017] [Accepted: 05/23/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate whole-body MRI (WB-MRI) parameters significantly associated with treatment response in multiple myeloma (MM). METHODS Twenty-one MM patients underwent WB-MRI at diagnosis and after two cycles of chemotherapy. Scans acquired at 3.0 T included T2, diffusion-weighted-imaging (DWI) and mDixon pre- and post-contrast. Twenty focal lesions (FLs) matched on DWI and post-contrast mDixon were selected for each time point. Estimated tumour volume (eTV), apparent diffusion coefficient (ADC), enhancement ratio (ER) and signal fat fraction (sFF) were derived. Clinical treatment response to chemotherapy was assessed using conventional criteria. Significance of temporal parameter change was assessed by the paired t test and receiver operating characteristics/area under the curve (AUC) analysis was performed. Parameter repeatability was assessed by interclass correlation (ICC) and Bland-Altman analysis of 10 healthy volunteers scanned at two time points. RESULTS Fifteen of 21 patients responded to treatment. Of 254 FLs analysed, sFF (p < 0.0001) and ADC (p = 0.001) significantly increased in responders but not non-responders. eTV significantly decreased in 19/21 cases. Focal lesion sFF was the best discriminator of treatment response (AUC 1.0). Bone sFF repeatability was excellent (ICC 0.98) and better than bone ADC (ICC 0.47). CONCLUSION WB-MRI derived focal lesion sFF shows promise as an imaging biomarker of treatment response in newly diagnosed MM. KEY POINTS • Bone signal fat fraction using mDixon is a robust quantifiable parameter • Fat fraction and ADC significantly increase in myeloma lesions responding to treatment • Bone lesion fat fraction is the best discriminator of myeloma treatment response.
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Affiliation(s)
- Arash Latifoltojar
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
| | - Margaret Hall-Craggs
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
- Department of Radiology, University College London Hospital, London, UK
| | - Alan Bainbridge
- Department of Medical Physics and Bioengineering, University College London Hospital, London, UK
| | - Neil Rabin
- Department of Haematology, University College London Hospital, London, UK
| | - Rakesh Popat
- Department of Haematology, University College London Hospital, London, UK
| | - Ali Rismani
- Department of Haematology, University College London Hospital, London, UK
| | - Shirley D'Sa
- Department of Haematology, University College London Hospital, London, UK
| | - Nikolaos Dikaios
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
| | - Magdalena Sokolska
- Department of Medical Physics and Bioengineering, University College London Hospital, London, UK
| | - Michela Antonelli
- Translational Imaging Group, Centre for Medical Imaging Computing, University College London, London, UK
| | - Sebastien Ourselin
- Translational Imaging Group, Centre for Medical Imaging Computing, University College London, London, UK
| | - Kwee Yong
- Department of Haematology, University College London Hospital, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
- Department of Radiology, University College London Hospital, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
- Department of Radiology, University College London Hospital, London, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE.
- Department of Radiology, University College London Hospital, London, UK.
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Walters U, Fisher C, Bray T, Hall-Craggs M, Sen D. 018. Dedicated adolescent protocol MRI improves diagnostic accuracy in adolescents with back pain. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex356.002] [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: 11/12/2022] Open
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Walters U, Fisher C, Bray T, Hall-Craggs M, Sen D. 02. Sacroiliac joint imaging in adolescent back pain: Discrepancy between clinical features and MRI findings. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex356.048] [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: 11/13/2022] Open
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14
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Eminowicz G, Hall-Craggs M, Diez P, McCormack M. Improving target volume delineation in intact cervical carcinoma: Literature review and step-by-step pictorial atlas to aid contouring. Pract Radiat Oncol 2016; 6:e203-e213. [DOI: 10.1016/j.prro.2016.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 12/21/2015] [Accepted: 01/08/2016] [Indexed: 10/22/2022]
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15
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Fisher C, Bourke L, Radziszewska A, Jadon D, Sengupta R, Bray T, Hall-Craggs M, Sen D, Ioannou Y. THU0217 DKK-1 Levels Are Elevated in Patients with Enthesitis Related Arthritis without Sacroiliac Joint Fusion. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.6050] [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: 11/04/2022]
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Affiliation(s)
- Deborah Burstein
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02115, USA.
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Huizing E, Anninga B, Young P, Monypenny I, Hall-Craggs M, Douek M. 4. Analysis of void artefacts in post-operative breast MRI due to residual SPIO after magnetic SLNB in SentiMAG Trial participants. Eur J Surg Oncol 2015. [DOI: 10.1016/j.ejso.2015.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Bender WL, Whelton A, Beschorner WE, Darwish MO, Hall-Craggs M, Solez K. Nonspecificity of the renal lesion of fenoprofen nephropathy. Contrib Nephrol 2015; 42:253-9. [PMID: 6335869 DOI: 10.1159/000409985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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19
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Grootendorst M, Pouw J, Bezooijen R, Klaazen C, de Bruin W, Klaase J, Hall-Craggs M, Haken BT, Douek M. Feasibility of preoperative localisation of sentinel lymph nodes in patients with breast cancer using SPIO-enhanced MR lymphography. European Journal of Surgical Oncology 2014. [DOI: 10.1016/j.ejso.2014.02.175] [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: 10/25/2022]
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Douek M, Klaase J, Monypenny I, Garmo H, Kothari A, Zechmeister K, Brown D, Wyld L, Drew P, Panqhurst Q, Anninga B, Grootendorst M, ten Haken B, Hall-Craggs M, Purushotham A, Pinder S. The SentiMAG multicentre trial: Sentinel node biopsy using a magnetic technique versus the standard technique. Eur J Surg Oncol 2013. [DOI: 10.1016/j.ejso.2013.07.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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21
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Nakhal RS, Hall-Craggs M, Freeman A, Kirkham A, Conway GS, Arora R, Woodhouse CRJ, Wood DN, Creighton SM. Evaluation of Retained Testes in Adolescent Girls and Women with Complete Androgen Insensitivity Syndrome. Radiology 2013; 268:153-60. [DOI: 10.1148/radiol.13121068] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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22
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Nakhal RS, Cutner AS, Hall-Craggs M, Creighton SM. Remnant Functioning Cervical Tissue After Laparoscopic Removal of Cavitated Noncommunicating Rudimentary Uterine Horn. J Minim Invasive Gynecol 2012; 19:768-71. [DOI: 10.1016/j.jmig.2012.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 07/25/2012] [Accepted: 07/26/2012] [Indexed: 11/26/2022]
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23
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Douek M, Johnson L, Parikh J, Charles-Eduards G, Hall-Craggs M. P3-07-48: Axillary Imaging with Dynamic MRI Following Subcutaneous Injection of Superparamagnetic Iron Oxide Nanoparticles. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-07-48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Surgical axillary staging with sentinel node biopsy in clinically node negative patients is standard of care in the management of breast cancer. However sentinel node biopsy is associated with morbidity including a 5% risk of lymphoedema. Superparamagnetic iron oxide (SPIO) enhanced axillary MRI is a promising novel imaging modality that could be used to characterize sentinel nodes non-invasively. We evaluated subcutaneous SPIO enhanced axillary MRI for pre-operative axillary imaging.
Material and methods: Patients scheduled for sentinel node biopsy as part of surgical management of early breast cancer were invited to undergo pre-operative axillary MRI. All images were acquired on a 1.5T scanner using a surface coil. The initial 7 scans were acquired on a Siemens Avanto and the later scans on a Achieva MRI scanner (Philips Best, Netherlands). Following a T2-weighted morphological scan, patients were injected with 2ml of SPIO (4ml in the final 3 patients) subcutaneously into the circumareolar margin in the upper outer quadrant of the affected breast. Post injection, a slightly T2*-weighted dynamic scan was performed (gradient echo, TE = 1.53ms, TR=2.9ms, flip angle 7 degrees, 3mm slice thickness). In addition to the dynamic scan, in 16 patients, a T2 mapping sequence was performed at 10minutes and 120 minutes post injection (turbo spin echo, 8 equi-spaced TEs from 10 to 80ms, TR=2136ms, 3mm slices with an in plane resolution of 1.4×1.4mm). Image analysis was undertaken using Osirix (v3.8, 64-bit). Two consultant radiologists experienced at reading breast and axillary MRI reported all scans. Results: A total of 23 patients underwent axillary MRI with subcutaneous SPIO. Of these in 18 patients (78%), uptake of SPIO was seen in sentinel nodes and lymphatic tracts. At least 1 sentinel node was identified in 17 patients (74%). A total of 106 nodes were identified (4.6 ± 1.7 nodes per patient) and of these 40 demonstrated a significant drop in signal intensity following SPIO injection (1.7 ± 1.3 nodes per patient). All 3 involved nodes were seen to contain a metastatic deposit on MRI.
Discussion: Axillary MRI with subcutaneous SPIO injection is a robust method for imaging sentinel nodes. The normal node count of the axillary basin is lower than expected on histology, suggesting that only the larger nodes and those that take up SPIO are visualized on MRI.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-48.
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Affiliation(s)
- M Douek
- 1King's College London, London, United Kingdom; Guy’ and St Thomas’ Hospitals, London, United Kingdom; University College Hospital, London, United Kingdom
| | - L Johnson
- 1King's College London, London, United Kingdom; Guy’ and St Thomas’ Hospitals, London, United Kingdom; University College Hospital, London, United Kingdom
| | - J Parikh
- 1King's College London, London, United Kingdom; Guy’ and St Thomas’ Hospitals, London, United Kingdom; University College Hospital, London, United Kingdom
| | - G Charles-Eduards
- 1King's College London, London, United Kingdom; Guy’ and St Thomas’ Hospitals, London, United Kingdom; University College Hospital, London, United Kingdom
| | - M Hall-Craggs
- 1King's College London, London, United Kingdom; Guy’ and St Thomas’ Hospitals, London, United Kingdom; University College Hospital, London, United Kingdom
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Dandachli W, Islam SU, Liu M, Richards R, Hall-Craggs M, Witt J. Three-dimensional CT analysis to determine acetabular retroversion and the implications for the management of femoro-acetabular impingement. ACTA ACUST UNITED AC 2009; 91:1031-6. [PMID: 19651829 DOI: 10.1302/0301-620x.91b8.22389] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study examined the relationship between the cross-over sign and the true three-dimensional anatomical version of the acetabulum. We also investigated whether in true retroversion there is excessive femoral head cover anteriorly. Radiographs of 64 hips in patients being investigated for symptoms of femoro-acetabular impingement were analysed and the presence of a cross-over sign was documented. CT scans of the same hips were analysed to determine anatomical version and femoral head cover in relation to the anterior pelvic plane after correcting for pelvic tilt. The sensitivity and specificity of the cross-over sign were 92% and 55%, respectively for identifying true acetabular retroversion. There was no significant difference in total cover between normal and retroverted cases. Anterior and posterior cover were, however, significantly different (p < 0.001 and 0.002). The cross-over sign was found to be sensitive but not specific. The results for femoral head cover suggest that retroversion is characterised by posterior deficiency but increased cover anteriorly.
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Affiliation(s)
- W Dandachli
- Department of Orthopaedic, Surgery, Imperial College Hospitals, Fulham Palace Road, London W68RF, UK.
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25
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Walsh SB, Altmann P, Pattison J, Wilkie M, Yaqoob MM, Dudley C, Cockwell P, Sweny P, Banks LM, Hall-Craggs M, Noonan K, Andrews C, Cunningham J. Effect of Pamidronate on Bone Loss After Kidney Transplantation: A Randomized Trial. Am J Kidney Dis 2009; 53:856-65. [DOI: 10.1053/j.ajkd.2008.11.036] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 11/26/2008] [Indexed: 11/11/2022]
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26
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Dandachli W, Kannan V, Richards R, Shah Z, Hall-Craggs M, Witt J. Analysis of cover of the femoral head in normal and dysplastic hips: new CT-based technique. ACTA ACUST UNITED AC 2008; 90:1428-34. [PMID: 18978260 DOI: 10.1302/0301-620x.90b11.20073] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [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]
Abstract
We present a new CT-based method which measures cover of the femoral head in both normal and dysplastic hips and allows assessment of acetabular inclination and anteversion. A clear topographical image of the head with its covered area is generated. We studied 36 normal and 39 dysplastic hips. In the normal hips the mean cover was 73% (66% to 81%), whereas in the dysplastic group it was 51% (38% to 64%). The significant advantage of this technique is that it allows the measurements to be standardised with reference to a specific anatomical plane. When this is applied to assessing cover in surgery for dysplasia of the hip it gives a clearer understanding of where the corrected hip stands in relation to normal and allows accurate assessment of inclination and anteversion.
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Affiliation(s)
- W Dandachli
- Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
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27
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Abstract
In 2001, reference to the use of imaging in the British Committee for Standards in Haematology guidelines for the diagnosis and management of myeloma was confined to the standard use of plain X-rays in the diagnostic skeletal survey and emergency use of computed tomography (CT) and magnetic resonance (MR) imaging in the setting of cord compression. Since then, there has been a steady rise in interest in the use of various imaging techniques in the management of myeloma. The purpose of imaging in the management of myeloma includes the assessment of the extent and severity of the disease at presentation, the identification and characterisation of complications, and the assessment of response to therapy. Plain radiography, CT, and MR imaging are generally established examination techniques in myeloma whilst positron emission tomography (PET) and (99)Technetium sestamibi (MIBI) imaging are promising newer scanning techniques under current evaluation. These stand-alone imaging guidelines discuss recommendations for the use of each modality of imaging at diagnosis and in the follow up of patients with myeloma.
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Affiliation(s)
- Shirley D'Sa
- Department of Haematology, University College Hospital, London, UK.
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28
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Abstract
The increasing use of magnetic resonance imaging in the diagnosis of musculoskeletal injuries has alerted clinicians to the phenomenon of bone bruising. This article will outline the current knowledge and treatment implications of these interesting radiological findings.
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29
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Warren R, Hayes C, Pointon L, Hoff R, Gilbert FJ, Padhani AR, Rubin C, Kaplan G, Raza K, Wilkinson L, Hall-Craggs M, Kessar P, Rankin S, Dixon AK, Walsh J, Turnbull L, Britton P, Sinnatamby R, Easton D, Thompson D, Lakhani SR, Leach MO. A test of performance of breast MRI interpretation in a multicentre screening study. Magn Reson Imaging 2006; 24:917-29. [PMID: 16916709 DOI: 10.1016/j.mri.2006.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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: 01/21/2006] [Accepted: 03/29/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to assess the consistency and performance of radiologists interpreting breast magnetic resonance imaging (MRI) examinations. MATERIALS AND METHODS Two test sets of eight cases comprising cancers, benign disease, technical problems and parenchymal enhancement were prepared from two manufacturers' equipment (X and Y) and reported by 15 radiologists using the recording form and scoring system of the UK MRI breast screening study [(MAgnetic Resonance Imaging in Breast Screening (MARIBS)]. Variations in assessments of morphology, kinetic scores and diagnosis were measured by assessing intraobserver and interobserver variability and agreement. The sensitivity and specificity of reporting performances was determined using receiver operating characteristic (ROC) curve analysis. RESULTS Intraobserver variation was seen in 13 (27.7%) of 47 of the radiologists' conclusions (four technical and seven pathological differences). Substantial interobserver variation was observed in the scores recorded for morphology, pattern of enhancement, quantification of enhancement and washout pattern. The overall sensitivity of breast MRI was high [88.6%, 95% confidence interval (CI) 77.4-94.7%], combined with a specificity of 69.2% (95% CI 60.5-76.7%). The sensitivities were similar for the two test sets (P=.3), but the specificity was significantly higher for the Manufacturer X dataset (P<.001). ROC curve analysis gave an area under the curve of 0.85 (95% CI 0.79-0.92) CONCLUSIONS Substantial variation in all elements of the scoring system and in the overall diagnostic conclusions was observed between radiologists participating in MARIBS. High overall sensitivity was achieved with moderate specificity. Manufacturer-related differences in specificities possibly occurred because the numerical thresholds set for the scoring system were not optimised for both equipment manufacturers. Scoring systems developed on one equipment software may not be transferable to other manufacturers.
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Affiliation(s)
- Ruth Warren
- Department of Radiology, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK
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31
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Miller RF, Isaacson PG, Hall-Craggs M, Lucas S, Gray F, Scaravilli F, An SF. Cerebral CD8+ lymphocytosis in HIV-1 infected patients with immune restoration induced by HAART. Acta Neuropathol 2004; 108:17-23. [PMID: 15085359 DOI: 10.1007/s00401-004-0852-0] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [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: 12/03/2003] [Revised: 01/15/2004] [Accepted: 02/20/2004] [Indexed: 10/26/2022]
Abstract
In HIV infected persons, highly active antiretroviral therapy (HAART) has reduced both the morbidity and incidence of several disorders. Its effects on direct HIV-induced damage to the CNS remain controversial. In addition, HAART may provoke an "immune reconstitution inflammatory syndrome" (IRIS). Herein we report two patients who, despite HAART, developed a diffuse encephalopathy. Their clinical, radiological and neuropathological features are described. Immunohistochemical and PCR analyses were used to detect HIV and to exclude other viruses in brain tissue. The unusual inflammatory reaction in the brain tissue was defined by immunohistochemistry. Both patients had advanced HIV disease with low CD4 counts and high HIV "viral loads" before starting HAART. In both, HAART induced an increase in CD4 count and a marked reduction in HIV viral load, which was accompanied, in patient one, by worsening of pre-existing, and, in patient two, by development of, acute encephalopathy. At post-mortem examination, the brain of patient one showed HIV encephalitis. In addition, the brains of both patients revealed HIV-DNA by PCR, diffuse microglial hyperplasia and massive and diffuse perivascular and intraparenchymal infiltration by CD8+/CD4- lymphocytes. We suggest that the rapid immune reconstitution induced by HAART in these two patients led to a redistribution of lymphocytes into peripheral blood. This was followed by recruitment of CD8+ lymphocytes into the brain, which resulted in the diffuse infiltration described. The appearances in patient two further suggest that HIV brain infection, even without encephalitis, is sufficient to trigger this response.
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Affiliation(s)
- Robert F Miller
- Department of Primary Care and Population Sciences, Centre for Sexually Transmitted Diseases, UCL, London, UK
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32
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Strauss SJ, McTiernan A, Driver D, Hall-Craggs M, Sandison A, Cassoni AM, Kilby A, Michelagnoli M, Pringle J, Cobb J, Briggs T, Cannon S, Witt J, Whelan JS. Single center experience of a new intensive induction therapy for ewing's family of tumors: feasibility, toxicity, and stem cell mobilization properties. J Clin Oncol 2003; 21:2974-81. [PMID: 12885818 DOI: 10.1200/jco.2003.04.106] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To examine the feasibility, tolerability, and toxicity of an intensified induction regimen (vincristine, ifosfamide, doxorubicin, and etoposide [VIDE]) in patients with newly diagnosed Ewing's family of tumors (EFT); to assess ability to maintain dose-intensity, and predictability of peripheral-blood stem cell mobilization. PATIENTS AND METHODS Thirty patients were treated with vincristine 1.4 mg/m2 (maximum 2 mg) on day 1, doxorubicin 20 mg/m2, ifosfamide 3 g/m2 plus mesna and etoposide 150 mg/m2 on days 1 to 3. Cycles were given every 21 days for up to six cycles. RESULTS One-hundred and seventy cycles of VIDE were given. The median treatment interval was 21 days (21 to 42) and nadir count: hemoglobin 8.3 (6.3 to 11.9), neutrophils 0.045 (0.0 to 2.1), and platelets 45 (3 to 343). There were 96 episodes of infection requiring hospitalization (56%). Growth factor support reduced infectious complications by 34%. Etoposide dose was reduced, or omitted, in 24% of cycles. Four patients did not complete six cycles due to unacceptable toxicity and one patient progressed on treatment. Twenty patients underwent peripheral-blood stem cell harvesting, 15 after cycle 3, and five after cycle 4. Median CD34+ yield was 4.6 x 106/kg per patient (1.8 to 14.5). Overall response to treatment, measured in 24 patients, was 88%. Seven of 11 patients undergoing surgery achieved greater than 90% necrosis of tumor (64%). CONCLUSION VIDE is an effective induction regimen with substantial but acceptable toxicity that allows predictable mobilization of stem cells. Maintenance of dose-intensity is feasible in the majority of patients. Growth factors play a role in maintaining dose-intensity and reduce infectious complications.
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Affiliation(s)
- S J Strauss
- Meyerstein Institute of Oncology, Middlesex Hospital, University College London Hospitals National Health Service Trust, Mortimer St, London, United Kingdom
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34
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Vaidya JS, Hall-Craggs M, Baum M, Tobias JS, Falzon M, D'Souza DP, Morgan S. Percutaneous minimally invasive stereotactic primary radiotherapy for breast cancer. Lancet Oncol 2002; 3:252-3. [PMID: 12067688 DOI: 10.1016/s1470-2045(02)00717-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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35
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Greening J, Lynn B, Leary R, Warren L, O'Higgins P, Hall-Craggs M. The use of ultrasound imaging to demonstrate reduced movement of the median nerve during wrist flexion in patients with non-specific arm pain. J Hand Surg Br 2001; 26:401-6; discussion 407-8. [PMID: 11560418 DOI: 10.1054/jhsb.2001.0582] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Following clinical screening, we examined movement of the median nerve at the wrist using high-resolution (10-22 MHz) ultrasound in 16 controls and 12 patients with non-specific arm pain (also referred to as repetitive strain injury). Imaging was performed just proximal to the carpal tunnel with the wrist in neutral, 30 degrees of extension and 30 degrees of flexion. In control subjects the position of the median nerve was 4.8 (SE=0.4) mm more radial with the wrist flexed than with the wrist extended. In the twelve arm pain patients the average change was only 1.2 (SE=0.5) mm. It appears that ultrasound imaging may be helpful in diagnosing non-specific arm pain, a condition for which there are no well-defined diagnostic tests at present. The reduced nerve movement seen with ultrasound imaging confirms previous work with magnetic resonance imaging.
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Affiliation(s)
- J Greening
- Department of Physiology, University College London, London, UK.
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37
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Abstract
OBJECTIVE To evaluate the accuracy of magnetic resonance imaging in assessment of adolescent patients with complex Müllerian anomalies and its contribution towards operative management. DESIGN A retrospective review of magnetic resonance imaging and operative findings. SETTING A London teaching hospital that is a tertiary referral centre for complex reproductive tract disorders. SAMPLE All adolescents referred for assessment of complex Müllerian anomalies, from 1996 to 1999, and undergoing both magnetic resonance imaging and surgical assessment. METHOD In the nine suitable patients magnetic resonance imaging and surgical findings were compared and the role of magnetic resonance imaging in determining the route and type of surgery was evaluated. MAIN OUTCOME MEASURES Magnetic resonance imaging data on reproductive tract anatomy and surgical findings detailing reproductive tract anatomy. RESULTS There was good correlation of magnetic resonance imaging and operative findings in all cases. The best correlation was with uterine structure. In four cases the magnetic resonance imaging findings were essential for the appropriate choice of the surgical approach and type of procedure. CONCLUSIONS Magnetic resonance imaging is a valuable tool in the management of this particular complex group of patients.
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Affiliation(s)
- C L Minto
- Department of Obstetrics and Gynaecology, University College London Hospitals, UK
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38
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Hall-Craggs M. Minimally invasive treatment of the breast. Breast Cancer Res 2000. [PMCID: PMC3300296 DOI: 10.1186/bcr1302] [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: 11/10/2022] Open
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39
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Greening J, Smart S, Leary R, Hall-Craggs M, O'Higgins P, Lynn B. Reduced movement of median nerve in carpal tunnel during wrist flexion in patients with non-specific arm pain. Lancet 1999; 354:217-8. [PMID: 10421305 DOI: 10.1016/s0140-6736(99)02958-x] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Magnetic resonance scans on patients with non-specific arm pain (repetitive strain injury) show reduced median-nerve movement in the carpal tunnel, suggesting that this common condition may involve nerve entrapment.
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40
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Brookes JAS, Hall-Craggs M, Lees WR. Magnetic resonance necropsy is offered routinely in University College London Hospitals. BMJ 1999. [DOI: 10.1136/bmj.319.7201.56] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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41
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Brookes JA, Hall-Craggs M, Lees WR. Magnetic resonance necropsy is offered routinely in university college London hospitals. BMJ 1999; 319:56-7. [PMID: 10390475 PMCID: PMC1116158] [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: 02/13/2023]
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42
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Clark MP, Greenfield B, Hunt N, Hall-Craggs M, McGrouther DA. Function of the nasal muscles in normal subjects assessed by dynamic MRI and EMG: its relevance to rhinoplasty surgery. Plast Reconstr Surg 1998; 101:1945-55. [PMID: 9623842 DOI: 10.1097/00006534-199806000-00027] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The external nose is generally considered to have a relatively static shape. Movement of the nose and the potential for change of external shape and the internal airway have been assessed by (1) cadaver dissection and (2) dynamic studies during a standardized series of facial expressions in 13 subjects; video recording of the movement of skin markers, electromyography, and moving magnetic resonance images. A standard description of muscle anatomy is presented. The dynamic investigations indicated the following. Video analysis showed the components of muscle action: dilatation, constriction of the nostril, depression of the tip, vertical contraction in the bridge, and elevation of the alar, in different expressions. Electromyography confirmed muscle actions during expression and phonation. Magnetic resonance imaging demonstrated large changes in the external shape of the nose and nasal aperture due to muscle actions. Muscle function should be given greater consideration in aesthetic and cleft rhinoplasty.
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Affiliation(s)
- M P Clark
- Eastman Dental Hospital, the Middlesex Hospital, and the University College of London Medical School, England
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43
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Douek M, Davidson T, Hall-Craggs M, Benjamin E, Wilkinson I, Davies M, Mumtaz H, Taylor I. Contrast enhancement patterns in subtraction breast MRI correlate with tumour angiogenesis in breast cancer. Breast 1997. [DOI: 10.1016/s0960-9776(97)90039-4] [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: 11/28/2022] Open
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Warren JW, Muncie HL, Magaziner J, Hall-Craggs M. Organ-limited autopsies. Obtaining permission for postmortem examination of the urinary tract. Arch Pathol Lab Med 1995; 119:440-3. [PMID: 7748072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To develop a systematic pre- and postmortem program for obtaining permission for autopsies limited to the urinary tract. DESIGN Comparison versus historical control of autopsy permission using a new process comprising premortem education, modification of the permission process, and autopsy limited to the urinary tract. PARTICIPANTS AND SETTING Patients, family members, and healthcare providers associated with a nursing home. INTERVENTION Education of healthcare providers and family members and modification of autopsy consent and performance. MAIN OUTCOME MEASURE Permission rate and demographic characteristics of patients and family members giving permission. RESULTS Of the 361 patients who died during the study, we received permission for postmortem examination of the urinary tract for 129 (36%). This was substantially better than the autopsy rate in the year prior to the study, 0.6%. A significantly higher permission rate was associated with patients and contact persons of white race, a higher level of education of the contact person, a nonrelative contact person, and two or fewer individuals making the decision. CONCLUSION Permission for organ-limited autopsies can be obtained with a systematic approach.
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Abstract
OBJECTIVE To determine the prevalences of chronic pyelonephritis and chronic renal inflammation in elderly nursing home patients at the time of death and to assess correlation with urethral catheterization and other putative risk factors. DESIGN Prospective assessment of risk factors with the prevalences of chronic pyelonephritis and renal inflammation at autopsy. SETTING A 240-bed long-term care facility. PARTICIPANTS All residents > or = 65 years old who died and were autopsied during a 2-year period. MEASUREMENTS Antemortem assessment of risk factors for renal inflammation, including a search for any urethral catheterization in the person's life. Prospective assessment of urethral catheterization, catheter obstruction, and use of anti-inflammatory medications and urine cultures. Urinary tract pathology was assessed for gross and microscopic evidence of inflammation and urinary tract stones. RESULTS The duration of catheterization was significantly associated with increasing prevalence of bacteriuria, polymicrobial bacteriuria, chronic pyelonephritis, and chronic renal inflammation. The prevalence of chronic pyelonephritis at death was 10 percent (5/52) for patients catheterized > 90 days during their last year of life and zero (0/65) when catheterized < or = 90 days (P < 0.02; Fisher's exact test). Chronic pyelonephritis was significantly associated with renal stones and hydronephrosis. The prevalence of chronic renal inflammation without chronic pyelonephritis was significantly greater than that of chronic pyelonephritis: the prevalence was 43 percent (20/47) when catheterized > 90 days and 18 percent (12/65) when < or = 90 days (P < 0.05). Chronic renal inflammation was associated with hydronephrosis, ureteral dilatation, acute pyelonephritis and diastolic hypertension. CONCLUSION Chronic pyelonephritis and chronic renal inflammation are associated with long-term catheterization.
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Affiliation(s)
- J W Warren
- Department of Medicine, University of Maryland School of Medicine, Baltimore 21201
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Affiliation(s)
- P M Bouloux
- Division of Endocrinology, University College London Medical Schools, Royal Free Hospital, UK
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Johnson DE, Lockatell CV, Hall-Craggs M, Warren JW. Mouse models of short- and long-term foreign body in the urinary bladder: analogies to the bladder segment of urinary catheters. Lab Anim Sci 1991; 41:451-5. [PMID: 1666147] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Catheter-associated bacteriuria is the most common infection occurring in hospitals, where urethral catheters are generally in place for a few days, and in nursing homes, where catheters may be in place for months or years. We developed murine models with intrabladder urinary catheters for studying complications of bacteriuria in short- and long-term catheterization. In the short-term model, a catheter segment was inserted transurethrally and lay free within the bladder lumen. Half of the animals expelled segments during a 2-to-7-day period, durations similar to catheterizations in hospitalized patients. For studies of long-term catheter use, the catheter segment was secured within the bladder by a single suture for up to 12 months. Antibiotics administered for 7 days after catheter placement and housing mice in cages with wire screen floors reduced spontaneous bacteriuria to an acceptably low incidence rate of only 7%. Proteus mirabilis bacteriuria of high concentration provoked the same complications that are common in patients with long-term catheters: acute pyelonephritis, chronic renal inflammation, and struvite stone formation. These models allow inoculation of the bacteria of interest and are suitable for studies of short- and long-term foreign body-associated bacteriuria and its complications.
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Affiliation(s)
- D E Johnson
- Department of Medicine, University of Maryland School of Medicine, Baltimore
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Warren JW, Muncie HL, Hall-Craggs M. Acute pyelonephritis associated with bacteriuria during long-term catheterization: a prospective clinicopathological study. J Infect Dis 1988; 158:1341-6. [PMID: 3198942 DOI: 10.1093/infdis/158.6.1341] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Bacteriuria is virtually universal in long-term catheterized patients. This blinded autopsy study of 75 aged nursing home patients demonstrated that acute inflammation of the renal parenchyma was present in 38% of patients with a urinary catheter in place at death versus 5% of noncatheterized patients (P = .004). Of a number of clinical and demographic variables studied, only catheterization was significantly related to acute renal inflammation. Acute cystitis was uncommon, but each case was associated with inflammation of at least one kidney. The majority of kidneys showing acute inflammation (21 [68%] of 31) were not accompanied by acute pyelitis. Acute renal inflammation with or without pelvic inflammation is a common finding in nursing home patients dying with urethral catheters in place. This finding provides additional support for the development of alternatives to the indwelling urethral catheter.
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Affiliation(s)
- J W Warren
- Department of Medicine (Division of Infectious Diseases), University of Maryland School of Medicine, Baltimore
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Abstract
A unique case of accelerated hypertension and acute anuria in a 24-year-old man is presented. Clinically, the patient was found to have obstruction of both main renal arteries caused by extensive bilateral thrombosis. Microscopically, a healing panarteritis involving only the main renal arteries was found. This was associated with acute renal infarction and tubular atrophy in the left kidney. This appears to be an unusual variant of polyarteritis nodosa limited to both main renal arteries.
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Affiliation(s)
- L A Hoover
- Department of Pathology, University of Maryland Hospital, Baltimore
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Abstract
We have presented the case of a 13-year-old boy who had an apparent hemolytic-uremic syndrome, with hemolytic anemia, thrombocytopenia, and acute renal failure. Subsequent laboratory investigations indicated poststreptococcal glomerulonephritis as the cause of renal failure. The triad of hemolytic anemia, thrombocytopenia, and renal failure has not been previously reported in a case of proven poststreptococcal glomerulonephritis.
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