62 results on '"Carmel G. Cronin"'
Search Results
2. An abbreviated MRI protocol for surveillance of cystic pancreatic lesions
- Author
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Carmel G Cronin, Francis T. Delaney, and Helen M. Fenlon
- Subjects
Protocol (science) ,medicine.medical_specialty ,Radiological and Ultrasound Technology ,business.industry ,Urology ,Gastroenterology ,Retrospective cohort study ,Hepatology ,Malignancy ,medicine.disease ,Cystic lesion ,Internal medicine ,medicine ,Standard protocol ,Radiology, Nuclear Medicine and imaging ,Acquisition time ,Radiology ,business ,Prospective cohort study - Abstract
Cystic pancreatic lesions (CPLs) are common and increasingly encountered in clinical radiology practice. The appropriate imaging surveillance strategy for lower-risk CPLs (branch duct—intraductal papillary mucinous neoplasms and indeterminant small cystic lesions) has been a topic of intense study and debate in recent years. MRI is considered the investigation of choice for initial characterisation and follow-up of CPLs. Follow-up intervals for CPLs vary from 6 months to 2 years and surveillance may be lifelong or until the patient is no longer considered fit for potential surgical intervention. This creates a significant burden on MRI resources as a standard protocol pancreatic MRI may have an acquisition time of up to 35–50 min. However, the necessity of contrast-enhanced sequences and diffusion weighted imaging (DWI) for routine follow-up of CPLs has been questioned in recent years. We reviewed the available evidence to determine whether an abbreviated MRI (A-MRI) protocol may be safely adopted for surveillance of CPLs, as has been implemented in other clinical scenarios. A number of recent retrospective studies have indicated that an A-MRI, omitting contrast-enhanced and DWI, may be used for CPL surveillance without any suspicious features or cases of malignancy being missed. Although small number of cases may need to be recalled for additional MR sequences based on the A-MRI findings, there is still a significant overall timesaving. The best available evidence currently suggests that an A-MRI protocol should be considered for routine surveillance of CPLs. Prospective studies are required to ensure the findings reported in these retrospective case studies are backed up in ongoing clinical practice.
- Published
- 2021
3. Peritoneal malignancy: anatomy, pathophysiology and an update on modern day imaging
- Author
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Conor Shields, Jack W Power, Andrew D. Yates, Jurgen Mulsow, Helen M. Fenlon, Philip J Dempsey, and Carmel G Cronin
- Subjects
Radical treatment ,medicine.medical_specialty ,Treatment regimen ,business.industry ,Cytoreduction Surgical Procedures ,Review Article ,General Medicine ,Disease ,Magnetic Resonance Imaging ,Peritoneal malignancy ,Positron-Emission Tomography ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Disease process ,Radiology ,Patient group ,Tomography, X-Ray Computed ,Cytoreductive surgery ,business ,Peritoneal Neoplasms ,Disease burden - Abstract
With increasing subspecialised experience in radical cytoreductive surgery and intra-abdominal chemotherapy for peritoneal malignancy, outcomes have improved significantly in selected patients. The surgery and the treatment regimens are radical and therefore correct patient selection is critical. The radiologist plays a central role in this process by estimating, as precisely as possible, the pre-treatment disease burden. Because of the nature of the disease process, accurate staging is not an easy task. Tumour deposits may be very small and in locations where they are very difficult to detect. It must be acknowledged that no form of modern day imaging has the capability of detecting the smallest peritoneal nodules, which may only be visible to direct inspection or histopathological evaluation. Nonetheless, it behoves the radiologist to be as exact and precise as possible in the reporting of this disease process. This is both to select patients who are likely to benefit from radical treatment, and just as importantly, to identify patients who are unlikely to achieve adequate cytoreductive outcomes. In this review, we outline the patterns of spread of disease and the anatomic basis for this, as well as the essential aspects of reporting abdominal studies in this patient group. We provide an evidence-based update on the relative strengths and limitations of our available multimodality imaging techniques namely CT, MRI and positron emission tomography/CT.
- Published
- 2022
4. Growing Evidence for the Use of an Abbreviated Magnetic Resonance Imaging Protocol in the Surveillance of Pancreatic Intraductal Papillary Mucinous Neoplasms
- Author
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Francis T. Delaney and Carmel G Cronin
- Subjects
Pancreatic Neoplasms ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Pancreatic Ducts ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Magnetic resonance imaging ,Radiology ,business ,Magnetic Resonance Imaging ,Carcinoma, Pancreatic Ductal - Published
- 2021
5. Pragmatic use of short-course radiotherapy, chemotherapy and surgery for stage IV rectal cancer with locally advanced or symptomatic primary tumours
- Author
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Niamh McCawley, Des Toomey, John Aird, Mary Dunne, Martin J Higgins, Conor Shields, John P. Burke, John Conneely, Eleanor Faul, B. O'Neill, Jurgen Mulsow, Carmel G Cronin, and Oonagh Staunton
- Subjects
medicine.medical_specialty ,Chemotherapy ,business.industry ,Colorectal cancer ,Rectal Neoplasms ,medicine.medical_treatment ,Rectum ,Disease ,medicine.disease ,Neoadjuvant Therapy ,Surgery ,Radiation therapy ,medicine.anatomical_structure ,Oncology ,Cohort ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Prospective cohort study ,business ,Pathological ,Retrospective Studies - Abstract
Introduction We assessed management of patients with de novo metastatic rectal cancer, referred for radiotherapy to the rectum, who were candidates for short-course radiotherapy (SCRT) and chemotherapy, followed by resection of all disease. We assessed surgical outcomes, overall survival (OS) and progression-free survival (PFS). Methods Retrospective review of patients meeting criteria: (i) treatment with SCRT to rectum; (ii) locally advanced primary rectal cancer; and (iii) resectable distant metastases at diagnosis. Data were collected from charts, correspondence and electronic patient records. OS and PFS were calculated using the Kaplan-Meier method. Results Between 2016 and 2020, 48 patients with stage IV rectal cancer at diagnosis were treated with SCRT. Only 15 patients (31%) had resectable metastatic disease and were intended for SCRT (25 Gy/5#), then chemotherapy, followed by resection of all sites of disease and are included in our study. 12 of the 15 surgical candidates (80%) had rectal surgery as planned, and 11 of the 15 (73%) had resection of the rectal primary and all metastatic disease. One patient had a pathological complete response (pCR), and 50% of surgical patients had a Mandard TRG of 1 or 2. Median PFS and OS for the 15 surgical candidates were 12.6 and 25.2 months, respectively, with a median FU of 21.2 months. Conclusion For this cohort of patients, our treatment paradigm is pragmatic and results in excellent pathological response. However, the effectiveness of this approach should be the subject of future prospective studies.
- Published
- 2021
6. An abbreviated MRI protocol for surveillance of cystic pancreatic lesions
- Author
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Francis T, Delaney, Helen M, Fenlon, and Carmel G, Cronin
- Subjects
Pancreatic Neoplasms ,Humans ,Prospective Studies ,Pancreatic Cyst ,Magnetic Resonance Imaging ,Retrospective Studies - Abstract
Cystic pancreatic lesions (CPLs) are common and increasingly encountered in clinical radiology practice. The appropriate imaging surveillance strategy for lower-risk CPLs (branch duct-intraductal papillary mucinous neoplasms and indeterminant small cystic lesions) has been a topic of intense study and debate in recent years. MRI is considered the investigation of choice for initial characterisation and follow-up of CPLs. Follow-up intervals for CPLs vary from 6 months to 2 years and surveillance may be lifelong or until the patient is no longer considered fit for potential surgical intervention. This creates a significant burden on MRI resources as a standard protocol pancreatic MRI may have an acquisition time of up to 35-50 min. However, the necessity of contrast-enhanced sequences and diffusion weighted imaging (DWI) for routine follow-up of CPLs has been questioned in recent years.We reviewed the available evidence to determine whether an abbreviated MRI (A-MRI) protocol may be safely adopted for surveillance of CPLs, as has been implemented in other clinical scenarios.A number of recent retrospective studies have indicated that an A-MRI, omitting contrast-enhanced and DWI, may be used for CPL surveillance without any suspicious features or cases of malignancy being missed. Although small number of cases may need to be recalled for additional MR sequences based on the A-MRI findings, there is still a significant overall timesaving.The best available evidence currently suggests that an A-MRI protocol should be considered for routine surveillance of CPLs. Prospective studies are required to ensure the findings reported in these retrospective case studies are backed up in ongoing clinical practice.
- Published
- 2020
7. Multimodality imaging of the gastrointestinal manifestations of scleroderma
- Author
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Ivan Welaratne, Bryan Buckley, Helen M. Fenlon, Carmel G Cronin, and Francis T. Delaney
- Subjects
Connective Tissue Disorder ,medicine.medical_specialty ,Gastrointestinal Diseases ,Disease ,Multimodal Imaging ,Scleroderma ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Atrophy ,Fibrosis ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Multimodal imaging ,Scleroderma, Systemic ,business.industry ,General Medicine ,medicine.disease ,Magnetic resonance enterography ,Magnetic Resonance Imaging ,Functional imaging ,Gastrointestinal Tract ,030220 oncology & carcinogenesis ,Radiology ,business ,Tomography, X-Ray Computed - Abstract
Scleroderma is a complex multisystem connective tissue disorder. Early visceral disease, such as gastrointestinal (GI) involvement, is associated with significant morbidity and a poorer prognosis. Prompt diagnosis is crucial to allow disease modifying therapies be initiated early in the course of the disease. The primary underlying pathophysiology in the GI tract is dysmotility, muscular atrophy, and fibrosis, and this is reflected in the imaging features. In this paper, we demonstrate the imaging appearances of involvement of the GI tract and describe the use of advanced imaging with magnetic resonance enterography (MRE). A multimodal imaging approach is required to identify both characteristic features of scleroderma and potential complications. Traditional fluoroscopic contrast (barium) studies are still commonly performed for assessment of the oesophagus. More recent advances in cross-sectional imaging allow for thorough three-dimensional assessment of the entire GI tract. MRE is particularly useful for small bowel evaluation while also allowing "pseudodynamic" functional imaging and concomitant assessment of the other abdominal viscera and structures.
- Published
- 2020
8. What the Radiologist Should Know About Treatment of Peritoneal Malignancy
- Author
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Jurgen Mulsow, Conor J. Shields, Emily A Aherne, Carmel G Cronin, and Helen M. Fenlon
- Subjects
medicine.medical_specialty ,Peritoneal cancer ,Sensitivity and Specificity ,030218 nuclear medicine & medical imaging ,Diagnosis, Differential ,Peritoneal malignancy ,03 medical and health sciences ,Peritoneal Neoplasm ,0302 clinical medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Physician's Role ,Peritoneal Neoplasms ,PET-CT ,Evidence-Based Medicine ,business.industry ,Reproducibility of Results ,Patient survival ,General Medicine ,Evidence-based medicine ,Image Enhancement ,United States ,Treatment Outcome ,030220 oncology & carcinogenesis ,Radiology ,Differential diagnosis ,Cytoreductive surgery ,business - Abstract
OBJECTIVE. The purpose of this article is to discuss the role of the radiologist in the treatment of peritoneal cancer, with focus placed on advanced treatment options and selection of patients with resectable disease for whom complete cytoreduction can be achieved. CONCLUSION. Peritoneal cancers traditionally have been associated with significant morbidity and universal mortality; however, the management of such cancers has evolved substantially. Advanced treatment options, including cytoreductive surgery and intraperitoneal chemotherapy, are associated with significantly improved long-term patient survival. To ensure that patients benefit from aggressive multimodality treatments, the radiologist plays a pivotal role in the multidisciplinary team to ensure careful patient selection, identifying individuals with resectable disease for whom complete cytoreduction can be achieved.
- Published
- 2017
9. Radiological evaluation of adrenal incidentalomas – Current methods and future prospects
- Author
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Michael A. Blake, Carmel G. Cronin, Shaunagh McDermott, and Owen J. O'Connor
- Subjects
Fluorine Radioisotopes ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Adrenal Gland Neoplasms ,Computed tomography ,Endocrinology ,Adrenal Glands ,medicine ,Humans ,Tomography, Emission-Computed, Single-Photon ,Incidental Findings ,medicine.diagnostic_test ,business.industry ,Adrenal gland ,Magnetic resonance imaging ,Magnetic Resonance Imaging ,3-Iodobenzylguanidine ,medicine.anatomical_structure ,Positron emission tomography ,Positron-Emission Tomography ,Radiological weapon ,Radiology ,Tomography ,Radiopharmaceuticals ,Tomography, X-Ray Computed ,Nuclear medicine ,business - Abstract
Incidental adrenal lesions are very common. Computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) all have a role to play in characterizing adrenal lesions. The purpose of this review is to discuss the rationale behind both established and emerging imaging techniques. We also discuss how to follow up incidentally found lesions.
- Published
- 2012
10. Incidental Pulmonary Nodules Detected on Abdominal Computed Tomography
- Author
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Elkan F. Halpern, Julia T. Chu, Carmel G. Cronin, Carol C. Wu, Jo-Anne O. Shepard, Matthew D. Gilman, and Dushyant V. Sahani
- Subjects
Adult ,Male ,Radiography, Abdominal ,medicine.medical_specialty ,Lung Neoplasms ,Malignancy ,Cohort Studies ,Diagnosis, Differential ,Age Distribution ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Lung ,Aged ,Retrospective Studies ,Aged, 80 and over ,Solitary pulmonary nodule ,business.industry ,Solitary Pulmonary Nodule ,Retrospective cohort study ,Nodule (medicine) ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Female ,Radiology ,medicine.symptom ,Abdominal computed tomography ,Differential diagnosis ,Tomography, X-Ray Computed ,business ,Follow-Up Studies ,Cohort study - Abstract
OBJECTIVES: To review the characteristics and outcome of incidental pulmonary nodules reported on abdominal computed tomography (CT). METHODS: A database search of abdominal CTs from January 1, 2004, to December 31, 2006, revealed 413 patients with incidental pulmonary nodules and at least one follow-up chest CT. Demographic information, nodule characteristics, and eventual outcome of the nodules were analyzed. RESULTS: Of the 413 patients, 56% had benign nodules, 11% had malignant nodules, and the remaining 33% had insufficient follow-up. There was a statistically significant difference (P < 0.05) in the age of the patients, history of malignancy, and size of the incidental nodule between benign and malignant groups. No malignant nodules were found in patients younger than 59 years who did not have a known or suspected malignancy. CONCLUSION: Small pulmonary nodules (
- Published
- 2012
11. Advanced multimodality imaging of inflammatory bowel disease in 2015: An update
- Author
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Heather Moriarty, Carmel G Cronin, and Emma Stanley
- Subjects
Crohn's disease ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Minireviews ,Gold standard (test) ,medicine.disease ,Ulcerative colitis ,Inflammatory bowel disease ,030218 nuclear medicine & medical imaging ,Endoscopy ,03 medical and health sciences ,0302 clinical medicine ,Positron emission tomography ,Biopsy ,medicine ,030211 gastroenterology & hepatology ,Radiology ,business - Abstract
The diagnosis and effective management of inflammatory bowel disease (IBD) requires a combination clinical, endoscopic, histological, biological, and imaging data. While endoscopy and biopsy remains the gold standard for diagnosis of IBD, imaging plays a central role in the assessment of extra mural disease, in disease surveillance and in the assessment of response to medical treatments, which are often expensive. Imaging is also vital in the detection and diagnosis of disease related complications, both acute and chronic. In this review, we will describe, with illustrative images, the imaging features of IBD in adults, with emphasis on up-to-date imaging techniques focusing predominantly on cross sectional imaging and new magnetic resonance imaging techniques.
- Published
- 2015
12. Case 38-2011
- Author
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John A. Branda, Edward T. Ryan, and Carmel G Cronin
- Subjects
medicine.medical_specialty ,Pediatrics ,Weakness ,business.industry ,General Medicine ,Hypokalemia ,Surgery ,Diarrhea ,Case records ,Chronic diarrhea ,Weight loss ,medicine ,Leukocytosis ,medicine.symptom ,General hospital ,business - Abstract
A 34-year-old man was admitted to the hospital because of weakness, chronic diarrhea, and weight loss. Initial laboratory evaluation revealed a leukocytosis and hypokalemia. A diagnostic procedure was performed.
- Published
- 2011
13. Interventional Radiology in the Management of Abdominal Collections After Distal Pancreatectomy: A Retrospective Review
- Author
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Ronald S. Arellano, Carmel G. Cronin, Debra A. Gervais, Peter R. Mueller, and Carlos Fernandez-del Castillo
- Subjects
Adult ,Male ,medicine.medical_specialty ,Percutaneous ,Adolescent ,medicine.medical_treatment ,Suction ,Radiography, Interventional ,Young Adult ,Pancreatectomy ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Drainage ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,General surgery ,Ascites ,Interventional radiology ,Retrospective cohort study ,General Medicine ,Middle Aged ,Surgery ,Catheter ,Treatment Outcome ,medicine.anatomical_structure ,Abdomen ,Female ,business ,Distal pancreatectomy - Abstract
The purpose of this study was to assess the technical and clinical success and complications of imaging-guided percutaneous catheter drainage of peripancreatic fluid collections after distal pancreatectomy.Between January 2001 and February 2009, the cases of patients who underwent distal pancreatectomy were selected from a surgical database, and the cases of those who underwent subsequent interventional radiologic percutaneous drainage were identified. Details of percutaneous catheter drainage were recorded, and technical and clinical success was determined. Technical success was defined as successful percutaneous imaging-guided placement of a drainage catheter. Primary clinical success was defined as resolution of peripancreatic fluid collection with percutaneous drainage only. Secondary clinical success was defined as resolution of peripancreatic fluid collection with percutaneous drainage and additional manipulations (i.e., tube repositioning, additional catheter drainage) and no surgical débridement. Multifactor logistic regression analysis was used to identify predictors of drain failure.Between January 2001 and February 2009, 365 patients underwent distal pancreatectomy. Of these, 51 patients (14%; 25 men, 26 women; mean age, 53.4 years; range, 18-81 years) underwent 57 CT-guided percutaneous procedures for drainage of postsurgical peripancreatic fluid collection. The mean interval between surgery and drainage was 23.5 days (median, 17 days; range, 2-120 days), and the mean collection size was 7.3 cm in transverse dimension (median, 6.9 cm; range, 2.3-16 cm). The mean duration of catheter drainage was 39.7 days (median, 24 days; range, 3-220 days). The technical success rate was 100%, primary clinical success rate was 60%, and primary and secondary clinical success rates together were 95%. Three of the 51 patients (6%) needed surgery for definitive management of the collection. One of 51 patients (2%) had a complication of the interventional radiologic procedure. Catheter size and the need for additional catheter manipulation were significantly associated with drainage failure (p0.05).Catheter drainage of peripancreatic fluid collections after distal pancreatectomy is a technically safe and clinically effective procedure. Although extra manipulations may be needed to achieve clinical success, the combined primary and secondary clinical success rates are high.
- Published
- 2011
14. Treatment of Deep Intramuscular and Musculoskeletal Abscess: Experience With 99 CT-Guided Percutaneous Catheter Drainage Procedures
- Author
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Peter F. Hahn, Carmel G. Cronin, Peter R. Mueller, Alexander R. Guimaraes, Ronald S. Arellano, and Debra A. Gervais
- Subjects
Adult ,Male ,medicine.medical_specialty ,Percutaneous ,Radiography ,Radiography, Interventional ,Malignancy ,Catheterization ,Cohort Studies ,Young Adult ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Musculoskeletal Diseases ,Abscess ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Retrospective cohort study ,Interventional radiology ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Catheter ,Treatment Outcome ,medicine.anatomical_structure ,Drainage ,Abdomen ,Female ,Radiology ,Tomography, X-Ray Computed ,business - Abstract
The purpose of this article is to describe our experience draining deep muscular and musculoskeletal abscess collections with CT guidance, emphasizing clinicopathologic factors associated with drain failure, and to further analyze patient outcomes according to whether the process involves muscle alone or also involves adjacent bone or joint (skeletal involvement).The details of percutaneous catheter drainage were retrospectively recorded for all drainages performed over a 9-year period. The technical and clinical successes of percutaneous catheter drainage were determined. Multifactor logistic regression analysis was used to identify predictors of drain failure (malignancy, age, chemotherapy, surgery, infection, complexity, size, days in situ, and skeletal involvement). These parameters were assessed in all patients, those with muscle involvement alone and those with musculoskeletal collections.Eighty-nine of 94 patients underwent one percutaneous drainage procedure and 5 of 94 patients underwent two drainages for a total of 99 drainages in 94 patients (one drainage [n = 89] and two drainages [n = 5]). There were 62 men and 32 women with a mean age of 58.5 years (age range [±SD], 22.3-88.0 ± 16 years). The abscess diameters ranged from 1.8 to 13 cm (mean, 5.3 ± 2.5 cm), volume aspirated ranged from 0 to 200 mL (mean, 45 ± 44 mL), and mean duration of drainage was 16.2 days (range, 2-110 ± 18.7 days). The iliopsoas muscle was the most common site of drainage, accounting for 87.8% of the total. Catheter insertion was possible in all patients, with the muscular component successfully drained in 82% (81/99) overall: 85% (46/54) of those with muscle involvement alone and 77% (35/45) of those with musculoskeletal collections. Catheter drainage and antibiotic administration resulted in 65.6% (65/99) not requiring any surgical intervention and resolution of abnormal white cell count or fevers in 98.8% (79/80) of those with abnormal parameters before treatment. Skeletal infection was associated with increased risk of drainage failure (p = 0.0001).Percutaneous imaging-guided musculoskeletal drainage is clinically useful, safe, and effective for draining complex musculoskeletal collections. It is highly effective for draining collections involving muscle alone; however, skeletal infection is associated with a higher risk of drain failure.
- Published
- 2011
15. Multitechnique Imaging Findings of Prolene Plug Hernia Repair
- Author
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Onofrio A. Catalano, Carmel G. Cronin, Mukesh G. Harisinghani, and Michael A. Blake
- Subjects
Diagnostic Imaging ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Hernia, Inguinal ,General Medicine ,Surgical Mesh ,Polypropylenes ,medicine.disease ,Hernia repair ,Surgery ,Inguinal hernia ,Postoperative Complications ,Recurrence ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Medical history ,Hernia ,business ,Disease staging ,Prolene - Abstract
OBJECTIVE. The objective of this article is to illustrate the spectrum of imaging findings of polypropylene (Prolene) plug hernia repair.CONCLUSION. Knowledge of patient history and awareness of postsurgical imaging appearances are of importance because Prolene plugs are often incidentally encountered and if misdiagnosed may lead to erroneous patient disease staging and management.
- Published
- 2010
16. Incidental Adrenal Lesions: Accuracy of Characterization with Contrast-enhanced Washout Multidetector CT—10-minute Delayed Imaging Protocol Revisited in a Large Patient Cohort
- Author
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Giles W. Boland, Elkan F. Halpern, Minal Jagtiani Sangwaiya, Carmel G. Cronin, Peter F. Hahn, and Michael A. Blake
- Subjects
Male ,medicine.medical_specialty ,media_common.quotation_subject ,Adrenal Gland Neoplasms ,Contrast Media ,Multidetector ct ,Sensitivity and Specificity ,Cohort Studies ,Lesion ,Humans ,Medicine ,Contrast (vision) ,Delayed imaging ,Radiology, Nuclear Medicine and imaging ,media_common ,Incidental Findings ,business.industry ,Incidence ,Incidentaloma ,Reproducibility of Results ,Washout ,Middle Aged ,Iopamidol ,Adrenocortical Adenoma ,Cohort ,Female ,Radiology ,Tomography ,medicine.symptom ,Tomography, X-Ray Computed ,business ,Nuclear medicine - Abstract
To reassess the accuracy of the 10-minute delayed scan to differentiate both lipid-rich and lipid-poor lesions in a large cohort of patients.This HIPAA-compliant retrospective study had institutional review board approval; the need for informed consent was waived. A multidetector computed tomography (CT) adrenal protocol (unenhanced, dynamic contrast material-enhanced, and 10-minute delayed CT) was used in 314 consecutive patients (201 women, 113 men; mean age, 63.6 years) for the period from January 2006 through February 2009. The mean adrenal attenuation during all three CT phases was measured by two readers, and the relative percentage washout (RPW) and absolute percentage washout (APW) values were calculated. APW and RPW receiver operating characteristic (ROC) analysis was performed to evaluate the strength of the tests.There were 323 adrenal lesions (213 left, 110 right) consisting of 307 adenomas and 16 nonadenomas. The sensitivity, specificity, and accuracy for the RPW test at a washout threshold of 50% were 55.7%, 100%, and 57.9%, respectively; at 40% were 76.9%, 93.7%, and 77.7%; and at 35% were 81.4%, 93.7%, and 82.0%. The sensitivity, specificity, and accuracy for the APW test at a 60% threshold were 52.1%, 93.3%, and 54.0%, respectively; at 55% were 62.5%, 93.3%, and 64.0%; and at 50% were 71.3%, 80.0%, and 71.7%. Areas under the ROC curve were 0.85 (95% confidence interval: 0.75, 0.95) and 0.91 (95% confidence interval: 0.85, 0.97) for the APW and RPW tests, respectively, to detect adenomatous disease.The 10-minute delayed adrenal enhancement washout test has reduced sensitivity for the characterization of adrenal adenomas compared with results from prior studies.
- Published
- 2010
17. Normal small bowel wall characteristics on MR enterography
- Author
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Eithne DeLappe, Joseph M. Murphy, Clare Roche, Carmel G. Cronin, and Derek G. Lohan
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Duodenum ,Population ,Contrast Media ,Ileum ,digestive system ,Gastroenterology ,Jejunum ,Young Adult ,Internal medicine ,Intestine, Small ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,education ,Aged ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,digestive, oral, and skin physiology ,Magnetic resonance imaging ,General Medicine ,Middle Aged ,Magnetic Resonance Imaging ,Small intestine ,Endoscopy ,medicine.anatomical_structure ,MR Enterography ,Female ,Nuclear medicine ,business - Abstract
Purpose To assess the normal small bowel parameters, namely bowel diameter, bowel wall thickness, number of folds (valvulae connivientes) per 2.5 cm (in.), fold thickness and interfold distance per small bowel segment (duodenum, jejunum, proximal ileum, distal ileum and terminal ileum) on MR enterography. Materials and methods Between September 2003 and January 2008, 280 MR enterography examinations were performed for investigation of known or suspected small bowel pathology. 120 of these examinations were normal. Sixty-five (m = 29, f = 36, mean age = 34 years, range = 17–73 years) of 120 examinations without a prior small bowel diagnosis, with no prior or subsequent abnormal radiology or endoscopy examinations, no prior small bowel surgery and with a minimum 3 years follow-up demonstrating normality were retrospectively evaluated for the described small bowel parameters. Results We found the mean diameter of the duodenum to be 24.8 mm (S.D. = 4.5 mm), jejunum to be 24.5 mm (S.D. = 4.2 mm), proximal ileum to be 19.5 mm (S.D. = 3.6 mm), distal ileum to be 18.9 mm (S.D. = 4.2 mm) and terminal ileum to be 18.7 mm (S.D. = 3.6 mm). The number of folds per 2.5 cm varied from 4.6 in the jejunum to 1.5 in the terminal ileum. The fold thickness varied from 2.1 mm in the duodenum to 1.8 mm in the terminal ileum. The small bowel parameters gradually decreased in size from the duodenum to the smallest measurements which were in the terminal ileum. The bowel wall is similar in size throughout the small bowel measuring 1.5 ± 0.5 mm. Conclusion These results provide the mean, range of normality and standard deviation of the small bowel parameters per segment on the current population on MR enterography. From our experience, knowledge of these parameters is extremely helpful and essential in the everyday assessment of MR enterography studies.
- Published
- 2010
18. Oral and IV Contrast Agents for the CT Portion of PET/CT
- Author
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Carmel G. Cronin, Michael A. Blake, and Priyanka Prakash
- Subjects
PET-CT ,medicine.diagnostic_test ,business.industry ,Administration, Oral ,Contrast Media ,Cancer ,General Medicine ,medicine.disease ,Lymphoma ,Lesion ,Positron emission tomography ,Positron-Emission Tomography ,Injections, Intravenous ,Parenchyma ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Tomography ,medicine.symptom ,Tomography, X-Ray Computed ,business ,Nuclear medicine ,Diverticulum - Abstract
W5 the lesion and adjacent structures and CT enhancement characteristics such as phase and pattern. Most parenchymal organs and the lesions affecting them have similar attenuation values, which lie within a relatively narrow range, typically 30–80 HU. IV contrast material is used to increase the attenuation difference between normal and abnormal tissue. The result is increased lesion conspicuity, which is of particular importance in lesions in which FDG does not accumulate (Figs. 1–3). Furthermore, IV contrast enhancement can help differentiate benign from malignant lesions that have nonspecific FDG PET uptake. Similarly, IV contrast material may outline lesions within vascular structures (Figs. 1 and 4) and localize lesions that have increased FDG uptake but that would not be clearly seen on unenhanced CT images because of absence of a contour abnormality due to their size or would have similar attenuation to the surrounding structures (Fig. 5). The pyeloureteral system may not be well visualized at PET/CT because urinary excretion of FDG masks lesions. In addition, some renal lesions do not exhibit substantial FDG uptake (Fig. 6). Asymmetric FDG uptake should raise suspicion of transitional cell cancer, renal cancer, lymphoma, and ureteric obstruction or diverticulum. Asymmetric lack of uptake raises suspicion of renal cell cancer and renal cysts (Fig. 7).
- Published
- 2010
19. Does MRI with oral contrast medium allow single-study depiction of inflammatory bowel disease enteritis and colitis?
- Author
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Derek G. Lohan, Clare Roche, Joseph M. Murphy, Carmel G. Cronin, and Ann Michelle Browne
- Subjects
medicine.medical_specialty ,Administration, Oral ,Contrast Media ,Colonoscopy ,Sensitivity and Specificity ,Inflammatory bowel disease ,Intestine, Small ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Intestine, Large ,Colitis ,Neuroradiology ,Observer Variation ,medicine.diagnostic_test ,business.industry ,Interventional radiology ,Magnetic resonance imaging ,General Medicine ,Gold standard (test) ,Inflammatory Bowel Diseases ,medicine.disease ,Magnetic Resonance Imaging ,Enteritis ,digestive system diseases ,Radiography ,Contrast medium ,Radiology ,business - Abstract
To assess the feasibility and utility of magnetic resonance (MR) imaging of the bowel in concurrent small- and large-bowel evaluation for the presence of inflammatory bowel disease (IBD). Over a 5-year period, 62 MR examinations performed on 53 patients demonstrated evidence of IBD. Sixteen of these 53 (30.1%) patients had imaging findings of colonic disease and underwent 19 formal MR small bowel examinations. These were further evaluated for bowel distention and image quality. The sensitivity and specificity of the technique compared with colonoscopy as the ‘gold standard’ was evaluated. Simultaneous imaging of the colon is feasible at MR small bowel follow-through with moderate-to-excellent colonic visibility and colon distention obtained when the contrast medium is present in the colon at the time of image acquisition. MR imaging had a sensitivity of 80% (0.56–0.93), specificity of 100% (0.77-1.00), positive predictive value (PPV) of 1 and a negative predictive value (NPV) of 0.8 for the identification of colitis (based on available concurrent correlation of 38/62 examinations with colonoscopy). Small and large bowel MR imaging with orally consumed contrast medium represents a promising, feasible, non-invasive, non-radiating single mode of assessment of the entire gastrointestinal tract, performed at a single sitting.
- Published
- 2010
20. Magnetic Resonance Enterography in the Evaluation of the Small Bowel
- Author
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Joseph M. Murphy, Clare Roche, Carmel G. Cronin, Derek G. Lohan, and Ann Michelle Browne
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business.industry ,Contrast Media ,Image Enhancement ,Magnetic resonance enterography ,Magnetic Resonance Imaging ,Diagnosis, Differential ,Intestinal Diseases ,Nuclear magnetic resonance ,Intestine, Small ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Artifacts ,business - Published
- 2009
21. Evaluation of the effects of oral water and low-density barium sulphate suspension on bowel appearance on FDG-PET/CT
- Author
-
Carmel G. Cronin, Alan J. Fischman, Peter R. Mueller, Nagaraj-Setty Holalkere, Mannudeep K. Kalra, Michael A. Blake, Bindu N. Setty, and Dushyant V. Sahani
- Subjects
Male ,medicine.medical_specialty ,Administration, Oral ,Contrast Media ,Distension ,Sensitivity and Specificity ,chemistry.chemical_compound ,Fluorodeoxyglucose F18 ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Neuroradiology ,PET-CT ,medicine.diagnostic_test ,business.industry ,Fdg uptake ,Ultrasound ,Reproducibility of Results ,Water ,General Medicine ,Image Enhancement ,Molecular Weight ,Barium sulfate ,chemistry ,Positron emission tomography ,Barium sulphate suspension ,Positron-Emission Tomography ,Subtraction Technique ,Female ,Radiology ,Barium Sulfate ,Radiopharmaceuticals ,Tomography, X-Ray Computed ,business ,Nuclear medicine - Abstract
The purpose of this study is to assess which of five bowel preparation regimes offers superior bowel distension and to assess if these regimes adversely affect FDG activity on PET/CT imaging. The study conformed to HIPAA regulations. Ninety patients were divided into five groups of 18 who received no oral contrast agent (group A); 900 ml of water orally (group B); or 900, 1,350, or 1,800 ml of LDB (groups C, D, E, respectively). PET/CT examinations were assessed quantitatively (bowel diameter, SUV) and qualitatively (visual assessment grading scale) for bowel distension and FDG activity by two blinded readers. ANOVA was utilized to determine if a statistically significant difference (SSD) existed between the groups in terms of distension and FDG uptake. Qualitatively superior bowel distension was observed in group C (LDB) compared to B (water) and greater distension was noted with increased volumes of LDB in C, D, and E. Quantitatively there was an SSD in mean distension between groups C and B (P0.001 except duodenum). Qualitatively and quantitatively there was no significant difference in bowel FDG uptake among the groups (P0.05). LDB as an oral contrast agent provides superior bowel distension over water and does not induce increased FDG bowel activity.
- Published
- 2009
22. MR Small-Bowel Follow-Through for Investigation of Suspected Pediatric Small-Bowel Pathology
- Author
-
Clare Roche, Ann Michelle Browne, Joseph M. Murphy, David O'Keeffe, Carmel G. Cronin, and Derek G. Lohan
- Subjects
Male ,medicine.medical_specialty ,Pathology ,Adolescent ,Administration, Oral ,Contrast Media ,Diagnosis, Differential ,Image Interpretation, Computer-Assisted ,Intestine, Small ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Child ,Retrospective Studies ,Crohn's disease ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Retrospective cohort study ,General Medicine ,medicine.disease ,Magnetic Resonance Imaging ,Radiography ,Intestinal Diseases ,El Niño ,Tolerability ,Coronal plane ,Population study ,Female ,Radiology ,Differential diagnosis ,business - Abstract
The purpose of our study was to evaluate the potential role of an MR small-bowel follow-through (SBFT) technique in the investigation of suspected pediatric small-bowel abnormalities.Between September 2003 and January 2008, 280 MR SBFT examinations were performed for investigation of known or suspected small-bowel abnormalities, including 19 of 280 examinations in 17 children (mean age, 13 years; age range 6-17 years), representing the current study population. A standardized technique was used in all cases, including axial and coronal steady-state free precession acquisitions at successive time intervals until completion. Retrospective analysis of the studies obtained was performed by two radiologists, who blindly and independently scored predefined small-bowel segments according to the degree of luminal distention achieved. Any pathologic lesions detected were also noted. Indicators of examination success as a whole (volume, tolerability, and side effects of oral contrast material) were also noted, as were details pertaining to examination duration (number of visits to the MR table, total table time).Oral contrast medium was ingested and subsequent imaging was possible in all patients; 84.2% of patients tolerated the oral contrast material well and 15.8% showed moderate tolerance. The MR table time ranged from 2 to 4 minutes, without early termination of the examination in any case. The average number of visits to the MR table was 1.3 (range, 1-3). The mean duration for complete small-bowel evaluation was 25 minutes (range, 20-60 minutes). The mean distention scores were well within the diagnostic range in all small-bowel segments for both observers, with a substantial degree of interobserver agreement in score assignment (kappa = 0.73). Pathologic lesions were identified in 53% of studies.MR SBFT represents a promising, and perhaps optimal, technique for pediatric small-bowel evaluation for a variety of reasons, including its high tolerability, lack of ionizing radiation, avoidance of duodenojejunal intubation, and excellent luminal distention achieved. Furthermore, this technique allows "pseudodynamic" functional imaging while also showing extraluminal disease, without known biologic risk.
- Published
- 2009
23. Positron Emission Tomography/Computerized Tomography for the Gastroenterologist and Hepatologist
- Author
-
Carmel G. Cronin, Michael A. Blake, and Michael Moore
- Subjects
Fluorodeoxyglucose ,Endoscopic ultrasound ,medicine.medical_specialty ,Hepatology ,medicine.diagnostic_test ,Gastrointestinal Diseases ,business.industry ,Liver Diseases ,Gastroenterology ,Radiography ,Functional imaging ,Positron emission tomography ,Positron-Emission Tomography ,medicine ,Humans ,Radiology ,Tomography ,Nuclear medicine ,business ,Inactive disease ,Preclinical imaging ,Chemoradiotherapy ,medicine.drug - Abstract
Combined positron emission tomography/computerized tomography (PET/CT) imaging with fluorine 18 fluorodeoxyglucose (FDG) allows fusion of structural and attenuation information provided by CT with functional imaging derived from PET, improving the radiologic assessment of normal anatomic structures and pathologic lesions. PET/CT allows accurate location of hypermetabolic foci identified at PET with its morphologic structure on CT, reducing the incidence of falsepositive and false-negative imaging findings with PET alone. CT, because of its lack of metabolic information, is unable to distinguish fibrotic tissue; a common finding after chemoradiotherapy and/or surgery from residual neoplastic disease and thus may fail in posttreatment assessment. The ability and role of PET/CT in distinguishing active from inactive disease has revolutionized the assessment of gastrointestinal and hepatobiliary malignancies.
- Published
- 2009
24. Duodenal Abnormalities at MR Small-Bowel Follow-Through
- Author
-
Clare Roche, Derek G. Lohan, Joseph M. Murphy, Eithne DeLappe, and Carmel G. Cronin
- Subjects
Adult ,Male ,medicine.medical_specialty ,Duodenum ,business.industry ,digestive, oral, and skin physiology ,General Medicine ,Middle Aged ,Magnetic Resonance Imaging ,Patient diagnosis ,medicine.anatomical_structure ,medicine ,Humans ,Female ,Radiology, Nuclear Medicine and imaging ,Radiology ,Duodenal Diseases ,Isotonic Solutions ,business ,Aged - Abstract
OBJECTIVE. The cross-sectional characterization of duodenal abnormalities is plagued with inadequacy, a reflection of the meandering course of this segment of the bowel. We consider the imaging appearance of such abnormalities at MRI small-bowel follow-through, illustrating the typical manifestations of each pathologically confirmed condition.CONCLUSION. MRI small-bowel follow-through allows confident duodenal evaluation because of a combination of sufficient luminal distention and multiplanar versatility. Diseases of the duodenum may have a variety of manifestations at MRI small-bowel follow-through, the knowledge of which may aid in confident noninvasive patient diagnosis.
- Published
- 2008
25. Retroperitoneal Fibrosis: A Review of Clinical Features and Imaging Findings
- Author
-
Michael A. Blake, Carmel G. Cronin, Derek G. Lohan, Peter McCarthy, Clare Roche, and Joseph M. Murphy
- Subjects
Diagnostic Imaging ,medicine.medical_specialty ,Pathology ,business.industry ,Incidence ,Optimal treatment ,Contrast Media ,Retroperitoneal Fibrosis ,General Medicine ,medicine.disease ,Retroperitoneal fibrosis ,Diagnosis, Differential ,Fibrosis ,Vascular Disorder ,medicine ,Medical imaging ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Radiology ,medicine.symptom ,business - Abstract
OBJECTIVE. Retroperitoneal fibrosis is a rare collagen vascular disorder of unclear cause. Both benign and malignant associations have been described, rendering differentiation of these entities of paramount importance because sinister pathology alters the diagnosis. Thus, a high level of diligence is required in the investigation of this condition, particularly in patients with concomitant systemic conditions.CONCLUSION. Familiarity with the realm of imaging manifestations of retroperitoneal fibrosis is vital to ensure correct diagnosis and optimal treatment.
- Published
- 2008
26. Anatomy, pathology, imaging and intervention of the iliopsoas muscle revisited
- Author
-
Carmel G. Cronin, Gerard J. O’Sullivan, Peter McCarthy, Derek G. Lohan, Raymond McLoughlin, Conor P. Meehan, and Eithne DeLappe
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pathology ,Adolescent ,business.industry ,Iliopsoas Muscle ,Disease ,Anatomy ,Middle Aged ,Young Adult ,Child, Preschool ,Intervention (counseling) ,Emergency Medicine ,Humans ,Medicine ,Initial treatment ,Female ,Radiology, Nuclear Medicine and imaging ,Radiology ,Iliopsoas ,Tomography, X-Ray Computed ,business ,Aged ,Psoas Muscles - Abstract
The apparent incidence of iliopsoas muscle abnormalities is currently rapidly increasing secondary to the increased number of immuno-compromised patients, malignancies, chemotherapy, immunotherapy, multi-systemic disease and the wide availability of cross-sectional imaging. Disease of the iliopsoas compartment can present with non-specific or indolent clinical features, particularly where normal immune responses are attenuated. Delay in diagnosis can lead to inappropriate initial treatment and, in some cases, serious complications. Wider availability and application of modern cross-sectional imaging offers rapid, confident diagnosis. An understanding of iliopsoas compartment anatomy and pathways of disease spread are essential to recognising these clinically important conditions. We review the anatomy, clinical presentation and common imaging findings of iliopsoas disease as it presents through the emergency room.
- Published
- 2008
27. Injuries to the Carpal Bones Revisited
- Author
-
Declan Sheppard, Derek G. Lohan, Sinead Walsh, Carmel G. Cronin, David O'Keeffe, and Conor P. Meehan
- Subjects
Emergency rooms ,medicine.medical_specialty ,business.industry ,Hand Injuries ,Wrist Injuries ,Magnetic Resonance Imaging ,Carpal bones ,Carpal region ,medicine.anatomical_structure ,Radiological weapon ,Humans ,Radiographic Image Interpretation, Computer-Assisted ,Medicine ,Accidental Falls ,Radiology, Nuclear Medicine and imaging ,Body region ,Radiology ,Tomography, X-Ray Computed ,business ,Carpal Bones - Abstract
Falls on the outstretched hand, with resultant pain in the carpal region, account for a significant number of referrals to emergency rooms worldwide. Not only do they represent a significant proportion of the radiological workload arising from emergency rooms, interpretation of the images acquired is often difficult due to the complex anatomy of this region, compounded by an inability to obtain adequate views due to patient discomfort. Often, despite apparently normal radiological examinations, patient discomfort persists, prompting a need for further imaging. It is vital that the radiologist be entirely familiar with the bony and ligamentous anatomy of this body region, as well as possess an understanding of the frequent mechanisms of injury. Using a variety of imaging techniques, we illustrate a spectrum of carpal injuries, common and otherwise, explaining the mechanism and typical appearances of each.
- Published
- 2007
28. Prevalence and Significance of Asymptomatic Venous Thromboembolic Disease Found on Oncologic Staging CT
- Author
-
Clare Roche, Derek G. Lohan, Carmel G. Cronin, Maccon Keane, and Joseph M. Murphy
- Subjects
Adult ,Male ,Thorax ,medicine.medical_specialty ,Comorbidity ,Risk Assessment ,Inferior vena cava ,Risk Factors ,Neoplasms ,Prevalence ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Aged ,Neoplasm Staging ,Cancer staging ,Venous Thrombosis ,Incidental Findings ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Thrombosis ,Pulmonary embolism ,Surgery ,Venous thrombosis ,medicine.anatomical_structure ,Embolism ,medicine.vein ,Abdomen ,Female ,Radiology ,Tomography, X-Ray Computed ,business ,Ireland - Abstract
The purpose of our study was to determine the prevalence of unsuspected venous thromboembolic disease--specifically, of pulmonary embolism (PE) and of inferior vena cava (IVC), iliac, and iliofemoral deep venous thromboses (DVTs)--in oncology patients on staging CT scans of the thorax, abdomen, and pelvis.Retrospective analysis was performed on 435 consecutive staging CT thorax, abdomen, and pelvis scans performed on a variety of oncology patients for the presence of venous thromboembolic disease. The patient group consisted of 198 men and 237 women who ranged in age from 20 to 79 years (mean, 55 years). Disease type, stage, concomitant surgery or chemoradiation therapy regimes, anticoagulation status, and 6-month clinical and radiologic follow-up findings were recorded.We found a prevalence of 6.8% (23/339) unsuspected iliofemoral, 1.2% (4/339) unsuspected common iliac, and 0.3% (1/315) unsuspected IVC DVTs and 3.3% (13/397) unsuspected PEs occurring in patients with a wide range of malignancies. The overall prevalence of unsuspected venous thromboembolism (i.e., DVT, PE, or both) was 6.3% (25/397). DVT, PE, and venous thromboembolic disease were more common in inpatients (p = 0.002, 0.004, 0.023; relative risk [RR] = 1.6, 2.1, 1.4, respectively) and in those with advanced disease (p = 0.001, 0.01, 0.001; RR = 2.2, 1.8, 2.0, respectively).Although there is a known increased risk of thromboembolism (DVT and PE) in oncology patients, many cases are not diagnosed, which can prove fatal. Staging CT simultaneously affords one sole investigation of the pulmonary, IVC, iliac, and upper femoral veins, thereby providing an important diagnostic opportunity. Assessment for DVT and PE is important when reviewing staging CT scans.
- Published
- 2007
29. Stent Implantation across the Ostia of the Renal Veins Does Not Necessarily Cause Renal Impairment when Treating Inferior Vena Cava Occlusion
- Author
-
Niall Gough, Derek A. Lohan, Gerard J. O’Sullivan, Eithne DeLappe, and Carmel G. Cronin
- Subjects
medicine.medical_specialty ,Contrast Media ,Renal function ,Vena Cava, Inferior ,Constriction, Pathologic ,Kidney Function Tests ,urologic and male genital diseases ,Inferior Vena Cava Occlusion ,Inferior vena cava ,Renal Veins ,chemistry.chemical_compound ,Edema ,medicine ,Humans ,Stent implantation ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Vascular Patency ,Creatinine ,business.industry ,Renal vein thrombosis ,Phlebography ,medicine.disease ,Magnetic Resonance Imaging ,Surgery ,Treatment Outcome ,medicine.vein ,chemistry ,cardiovascular system ,Stents ,Radiology ,medicine.symptom ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business - Abstract
The effect of inferior vena cava (IVC) stents crossing the ostia of the renal veins on renal function has not been reported. The purpose of this study is to report a single-institution experience with four cases of IVC stent implantation for malignant compression and/or invasion of the IVC causing severe lower-extremity edema. The patients' symptoms were successfully relieved, and follow-up imaging and serum creatinine measurements for the remainder of their lives revealed no evidence of renal impairment or renal vein thrombosis.
- Published
- 2007
30. Sacral insufficiency fracture complicated by epidural haematoma and cauda equina syndrome in a patient with multiple myeloma
- Author
-
Derek G. Lohan, Carmel G. Cronin, Clare Roche, Joseph M. Murphy, Margaret Murray, and Ronan T. Swords
- Subjects
Gadolinium DTPA ,Sacrum ,medicine.medical_specialty ,Bone disease ,Contrast Media ,Cauda equina syndrome ,Diagnosis, Differential ,Insufficiency fracture ,Back pain ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Polyradiculopathy ,Bone pain ,Multiple myeloma ,business.industry ,Cauda equina ,Middle Aged ,Hematoma, Epidural, Spinal ,medicine.disease ,Magnetic Resonance Imaging ,Surgery ,medicine.anatomical_structure ,Emergency Medicine ,Spinal Fractures ,Female ,Radiology ,medicine.symptom ,Multiple Myeloma ,business - Abstract
We report the case of a patient with multiple myeloma (MM) and extensive lytic bone disease who presented with a short history of back pain and leg weakness. Magnetic resonance imaging (MRI) of the lumbar spine revealed a sacral insufficiency fracture complicated by an epidural haematoma. Bleeding tendency in this case can be accounted for by platelet function defects, often described in plasma cell disorders in the absence of obvious coagulation abnormalities. Surgical intervention was contraindicated as a result of poor overall patient performance status (poor surgical candidate due to extensive myelomatous bone disease, previous vertebral compression fractures requiring orthopaedic stabilisation, and requiring opiate analgesia for bone pain) and management was conservative. Patients presenting with back pain and documented bone disease in the setting of myeloma should be managed with a high index of clinical suspicion and considered for urgent MR imaging to avoid missing this serious and potentially reversible complication. We report the undescribed causative association between sacral insufficiency fracture and lumbo-sacral epidural haematoma. We illustrate the MRI signal and contrast enhancement pattern of an acute presentation of epidural haematoma.
- Published
- 2007
31. Massive pulmonary embolus with hemodynamic compromise: therapeutic options
- Author
-
Stephen T. Kee, Conor P. Meehan, Ian R. Davidson, Gerard J. O’Sullivan, Derek G. Lohan, Carmel G. Cronin, and Michael D. Dake
- Subjects
Male ,medicine.diagnostic_test ,business.industry ,Anticoagulants ,Treatment options ,Interventional radiology ,Pulmonary Artery ,Radiology, Interventional ,medicine.disease ,Pulmonary embolism ,Radiography ,Hemodynamic compromise ,Electrocardiography ,PULMONARY EMBOLUS ,Echocardiography ,Emergency Medicine ,medicine ,Humans ,Female ,Thrombolytic Therapy ,Radiology, Nuclear Medicine and imaging ,Medical emergency ,Pulmonary Embolism ,business - Abstract
Recent advances in pharmacotherapeutics and interventional techniques have resulted in resurgence in interest regarding the optimal means of management of hemodynamically significant pulmonary embolic disease. However, these various techniques have many associated disadvantages, and it is of paramount importance that the responsible physician has a detailed understanding of each of these so that the appropriate intervention be requested and performed. By way of background discussion and relevant cases in point, we consider each of these management options in turn, with particular reference to the advantages, disadvantages, and application of each.
- Published
- 2006
32. Potential role of Calogen as an oral contrast medium in the evaluation of the gastric wall at MRI
- Author
-
Derek G. Lohan, Sinead Walsh, Conor P. Meehan, Peter McCarthy, Carmel G. Cronin, Joseph M. Murphy, and Ruaridh H. Allen
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Gastric distension ,Stomach ,Ultrasound ,Administration, Oral ,Contrast Media ,Interventional radiology ,General Medicine ,Magnetic Resonance Imaging ,Contrast medium ,Localized disease ,medicine ,Humans ,Plant Oils ,Ingestion ,Radiology, Nuclear Medicine and imaging ,Radiology ,Peanut Oil ,medicine.symptom ,Artifacts ,business ,Peristalsis ,Neuroradiology - Abstract
Evaluation of gastric wall pathology using cross-sectional imaging has proved difficult, particularly in the imaging of early, localized disease. The properties of Calogen as a negative oral contrast agent for the evaluation of the upper gastro-intestinal tract and retroperitoneum in CT has been well described. We assess the suitability of this agent as an oral contrast medium for use in MRI examination of the gastric wall, finding the mean scores for Calogen and water with regard to gastric distension to be 8.46 and 5.49, respectively (P
- Published
- 2006
33. A Comparison of Whole-Body MRI and CT for the Staging of Lymphoma
- Author
-
Darren D. Brennan, Tadhg G. Gleeson, Stephen Eustace, D. Carney, Carmel G. Cronin, and L. E. Coate
- Subjects
Adult ,Male ,Lymphoma ,Whole body mri ,Contrast Media ,Sensitivity and Specificity ,Predictive Value of Tests ,Tumor stage ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Stage (cooking) ,Neoplasm Staging ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,Female ,Lymph ,Bone marrow ,Tomography, X-Ray Computed ,Nuclear medicine ,business ,Whole body - Abstract
OBJECTIVE. Our objective was to compare whole-body MRI and CT for the staging of lymphoma.CONCLUSION. Whole-body MRI represents an alternative to CT in the staging of lymphoma, with an ability to stage disease, identify lymph nodes greater than 1.2 cm, and the additional ability to evaluate for the presence or absence of disease spread to bone marrow. CT allows detection of more nodes (< 1.2 cm) than MRI but this does not alter tumor stage.
- Published
- 2005
34. A rare testicular vein anatomical variant contributes to right-sided varicocoele formation and leads to the diagnosis of renal cell carcinoma
- Author
-
Sandra Graham, James W. Ryan, Carmel G Cronin, and Gavin Sugrue
- Subjects
Male ,0301 basic medicine ,endocrine system ,medicine.medical_specialty ,Testicular vein ,urologic and male genital diseases ,Asymptomatic ,Renal Veins ,Article ,03 medical and health sciences ,Renal cell carcinoma ,Testis ,Varicocele ,Scrotum ,medicine ,Carcinoma ,Humans ,Carcinoma, Renal Cell ,Spermatic Cord ,Incidental Findings ,Ultrasonography, Doppler, Duplex ,Kidney ,urogenital system ,business.industry ,Ultrasound ,Venous plexus ,General Medicine ,Anatomy ,Middle Aged ,medicine.disease ,Kidney Neoplasms ,medicine.anatomical_structure ,medicine.vein ,030101 anatomy & morphology ,Radiology ,medicine.symptom ,business - Abstract
A man in his 60s presented for a testicular ultrasound due to asymptomatic scrotal swelling. Ultrasound showed a right-sided varicocoele (figure 1). A varicocoele is an abnormal dilatation of the pampiniform venous plexus in the scrotum. A renal ultrasound demonstrated a heterogeneous mass arising from the right kidney (figure 2). Histology subsequently revealed a renal cell carcinoma. CT identified duplication of the right testicular vein (figure 3). The first emptied into the inferior venacava (IVC) as expected. The second had a tortuous course arcing over the upper pole of the right kidney and emptying into the right renal vein (figure 4). Tumour extension …
- Published
- 2017
35. Evaluation of imaging quality of pulmonary 64-MDCT angiography in pregnancy and puerperium
- Author
-
Jennifer NiMhuircheartaigh, Carmel G. Cronin, Joseph M. Murphy, Derek G. Lohan, Ann Michelle Browne, John J. Morrison, and Carol Donagh
- Subjects
Adult ,medicine.medical_specialty ,Adolescent ,Iohexol ,Contrast Media ,Diagnosis, Differential ,Pregnancy ,medicine.artery ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,reproductive and urinary physiology ,Mdct angiography ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Significant difference ,Postpartum Period ,Angiography ,General Medicine ,Middle Aged ,medicine.disease ,Control subjects ,Pulmonary embolism ,Imaging quality ,Case-Control Studies ,Pulmonary artery ,Female ,Radiology ,business ,Pulmonary Embolism ,Tomography, X-Ray Computed - Abstract
The aim of this study was to quantitatively and qualitatively evaluate pulmonary 64-MDCT angiography image quality in pregnancy and puerperium, compared with female nonpregnant control subjects.The study group comprised 124 consecutive pregnant and postpartum women and 124 female nonpregnant control subjects who presented with suspected pulmonary embolism. The individual studies were evaluated for subjective and objective diagnostic quality.Objective measurements of the arterial enhancement in the pulmonary trunk and left and right pulmonary arteries found that there was no statistically significant difference in attenuation values between the pregnant and puerperium group and the control group for pulmonary artery opacification. The mean attenuation in the pulmonary trunk was 270.54 HU in the pregnant group, 277.53 HU in the puerperium group, and 293.90 HU in the control group.We found no significant difference in diagnostic quality of pulmonary CT angiography using MDCT between the study and control groups. The use of MDCT acquisition, faster injection rates, higher contrast medium concentration, and higher trigger levels may decrease the number of nondiagnostic studies in this population. MDCT may be a worthwhile investigation in the majority of pregnant patients with suspected pulmonary embolism.
- Published
- 2013
36. PET/CT in the imaging of ovarian Cancer
- Author
-
Priyanka Prakash, Michael A. Blake, Shaunagh McDermott, Owen J. O'Connor, and Carmel G. Cronin
- Subjects
medicine.medical_specialty ,endocrine system diseases ,PET-CT ,Computed tomography ,Review ,Multimodal Imaging ,General Biochemistry, Genetics and Molecular Biology ,Fluorodeoxyglucose positron emission tomography ,Ovarian cancer ,Fluorodeoxyglucose F18 ,Gynecologic cancer ,Medicine ,Humans ,In patient ,Neoplasm Staging ,Ovarian Neoplasms ,General Immunology and Microbiology ,medicine.diagnostic_test ,business.industry ,medicine.disease ,FDG- PET ,Oncology ,Positron emission tomography ,Positron-Emission Tomography ,Female ,Tomography ,Radiology ,Neoplasm Recurrence, Local ,business ,Tomography, X-Ray Computed - Abstract
Ovarian cancer is responsible for the largest proportion of deaths among patients with gynecologic cancer. This paper discusses fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in the imaging of ovarian cancer. We discuss and demonstrate how FDG PET/CT can be used to appropriately guide clinical management decisions in patients with ovarian cancer. In particular, FDG PET/CT shows great promise for the preoperative evaluation of women with primary ovarian cancer and for subsequent postoperative assessment for recurrence.
- Published
- 2013
37. Crohn’s Disease: MR Enterography
- Author
-
Joseph Murphy, Clare Roche, and Carmel G. Cronin
- Subjects
Crohn's disease ,medicine.medical_specialty ,business.industry ,MR Enterography ,Medicine ,Radiology ,business ,medicine.disease - Published
- 2013
38. Utility of positron emission tomography/CT in the evaluation of small bowel pathology
- Author
-
Carmel G. Cronin, Michael A. Blake, Shaunagh McDermott, Onofrio A. Catalano, James A. Scott, Dushyant V. Sahani, and Avinash Kambadakone
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pathology ,Diagnostic accuracy ,Review Article ,Multimodal Imaging ,Sensitivity and Specificity ,Fluorodeoxyglucose F18 ,Intestinal Neoplasms ,Intestine, Small ,medicine ,Recurrent disease ,Humans ,Radiology, Nuclear Medicine and imaging ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,General Medicine ,Middle Aged ,medicine.disease ,Response to treatment ,Lymphoma ,Positron emission tomography ,Positron-Emission Tomography ,Adenocarcinoma ,Female ,Radiology ,Management principles ,Radiopharmaceuticals ,business ,Tomography, X-Ray Computed - Abstract
We describe the management principles and different roles of positron emission tomography (PET)/CT in the evaluation of patients with small bowel tumours (adenocarcinoma, gastrointestinal stromal tumour, lymphoma, metastases) from initial staging, monitoring response to treatment, to detection of recurrent disease. We also discuss the various non-malignant aetiologies of small bowel fludeoxyglucose (FDG) PET uptake, and other pitfalls in FDG PET/CT interpretation. Awareness of the imaging appearances of small bowel tumours, patterns of disease spread and potential PET/CT interpretation pitfalls are of paramount importance to optimise diagnostic accuracy.
- Published
- 2012
39. Brown fat at PET/CT: correlation with patient characteristics
- Author
-
Carmel G. Cronin, Gilbert H. Daniels, Priyanka Prakash, Michael A. Blake, Elkan F. Halpern, Mannudeep K. Kalra, Edwin L. Palmer, and Giles W. Boland
- Subjects
Male ,medicine.medical_specialty ,Cost effectiveness ,Adipose tissue ,Patient characteristics ,Multimodal Imaging ,Correlation ,Sex Factors ,Adipose Tissue, Brown ,Fluorodeoxyglucose F18 ,Neoplasms ,Prevalence ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Stage (cooking) ,PET-CT ,Analysis of Variance ,Chi-Square Distribution ,medicine.diagnostic_test ,business.industry ,Iopamidol ,Positron emission tomography ,Case-Control Studies ,Positron-Emission Tomography ,Female ,Radiology ,Barium Sulfate ,Radiopharmaceuticals ,business ,Tomography, X-Ray Computed ,Body mass index - Abstract
To assess the prevalence of brown fat in patients with cancer, compare demographic characteristics of those with and those without brown fat, and correlate these characteristics with the mean and maximum standardized uptake values of brown fat.This case-control study was institutional review board approved and HIPAA compliant. Informed consent was waived. Reports of 12 195 consecutive positron emission tomography/computed tomography examinations performed in 6867 patients between January 2004 and November 2008 were reviewed for documented fluorodeoxyglucose (FDG) uptake in brown fat (n = 298). Control patients (n = 298) without brown fat were chosen and matched for age, sex, and month and year of examination. Age, sex, weight, body mass index, ethnicity, and examination stage (initial vs restaging) were compared between groups. Paired Student t test, χ(2) test, Pearson correlation coefficient, and analysis of variance were used for statistical analysis.Uptake of FDG in brown fat was demonstrated in 298 of 6867 (4.33%) patients. Prevalence of brown fat was significantly higher in female (5.9% [211 of 3587]) than in male patients (2.65% [87 of 3280]; P.001). Those with brown fat had significantly lower body weight (147.5 lb ± 3.8 vs 168.61 lb ± 5.0; P.001) and body mass index (24.3 ± 0.54 vs 27.6 ± 0.77; P.001) than control patients. There was no significant difference in the prevalence of brown fat among ethnic groups. The maximum standardized uptake value of brown fat had a significant inverse correlation with age (r = -0.3, P.001).Patients with brown fat were more likely to be female and thinner than those without brown fat. Younger patients were more likely to have higher maximum standardized uptake values of brown fat.
- Published
- 2012
40. Case records of the Massachusetts General Hospital. Case 38-2011. A 34-year-old man with diarrhea and weakness
- Author
-
Edward T, Ryan, Carmel G, Cronin, and John A, Branda
- Subjects
Adult ,Diarrhea ,Male ,Protozoan Infections ,Coccidiosis ,HIV Infections ,Hypokalemia ,Diagnosis, Differential ,Intestines ,Radiography ,Feces ,Ileus ,Chronic Disease ,Sarcocystidae ,Humans ,Paralysis - Published
- 2011
41. Imaging-guided suprapubic bladder tube insertion: experience in the care of 549 patients
- Author
-
Priyanka Prakash, Peter F. Hahn, Peter R. Mueller, Debra A. Gervais, Ronald S. Arellano, Carmel G. Cronin, and Alexander Guimares
- Subjects
Adult ,Male ,medicine.medical_specialty ,Percutaneous ,Adolescent ,Technical success ,urologic and male genital diseases ,Radiography, Interventional ,Clinical success ,Bladder outlet obstruction ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Tube (fluid conveyance) ,Urinary Bladder, Neurogenic ,Aged ,Pain Measurement ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Mean age ,General Medicine ,Equipment Design ,Middle Aged ,Surgery ,Urinary Bladder Neck Obstruction ,Logistic Models ,Treatment Outcome ,Tube placement ,Female ,business ,Urinary Catheterization - Abstract
Symptomatic bladder outlet obstruction and neurogenic bladder are common conditions that frequently necessitate suprapubic insertion of a bladder tube. The purpose of this study was to describe an experience with minimally invasive imaging-guided percutaneous suprapubic bladder tube placement and the clinical and technical success and complications encountered.A total of 585 primary suprapubic bladder tube insertions and 439 exchanges of suprapubic bladder tubes were performed on 549 patients (469 men, 80 women; mean age, 66 years; range, 15-106 years). The details of percutaneous tube placement (indication, tube type, size at insertion and change, and method of insertion) were retrospectively recorded.The technical success rate for primary suprapubic bladder tube insertion was 99.6% (547/549) and for exchanges was 92.3% (405/439). The clinical success rate for primary insertion was 98.1% (572/583), and symptoms were unresolved in 1.9% (11/583). Minor complications occurred in 7.2% (42/583) of cases at tube insertion and in 4.8% (21/439) at exchange. There was one major complication (a patient needed surgery because the small bowel was traversed by a catheter), and there was no procedure-related mortality.Radiologic imaging-guided percutaneous suprapubic bladder tube placement is a safe and effective procedure.
- Published
- 2010
42. PET/CT for adrenal assessment
- Author
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Priyanka Prakash, Carmel G. Cronin, and Michael A. Blake
- Subjects
PET-CT ,business.industry ,Adrenal gland ,Fdg uptake ,Adrenal Gland Diseases ,General Medicine ,Adrenal masses ,medicine.anatomical_structure ,Positron-Emission Tomography ,Subtraction Technique ,Adrenal Glands ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Nuclear medicine ,business ,Tomography, X-Ray Computed - Abstract
W91 Imaging Features Normal Adrenal Gland The normal adrenal gland is larger than the spatial resolution of PET; however, it is usually barely visible on FDG PET. Combined PET/ CT can show normal mild FDG uptake in the location of the glands visible on the coregistered CT (Figs. 1 and 2). The average mean and maximum standardized uptake values (SUVs) are 0.90 ± 0.15 (SD) and 0.83 ± 0.17, respectively, for the right adrenal and 1.10 ± 0.15 and 0.946 ± 0.15 for the left adrenal. The maximum SUVs of normal adrenal glands range from 0.95 to 2.46 [4]. An adrenal is usually considered malignant if its intensity is higher than that of the liver; however, because the average mean SUV of the liver is 1.5–2.0, physiologic adrenal uptake may, in some cases, be in the range of malignant lesions.
- Published
- 2010
43. Role of PET/CT in ovarian cancer
- Author
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Michael A. Blake, Carmel G. Cronin, and Priyanka Prakash
- Subjects
Oncology ,medicine.medical_specialty ,Sensitivity and Specificity ,Diagnosis, Differential ,Fluorodeoxyglucose F18 ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Cause of death ,Neoplasm Staging ,Ovarian Neoplasms ,PET-CT ,business.industry ,General Medicine ,medicine.disease ,Patient management ,Recurrent Ovarian Cancer ,Predictive value of tests ,Neoplasm staging ,Female ,Radiology ,Differential diagnosis ,Neoplasm Recurrence, Local ,Radiopharmaceuticals ,Ovarian cancer ,business ,Tomography, X-Ray Computed ,Tomography, Emission-Computed - Abstract
OBJECTIVE. The purpose of this article is to review the role of FDG PET/CT in ovarian cancer, which is the leading cause of death among gynecologic cancers.CONCLUSION. FDG PET/CT can significantly modify the assessment of the extent of primary and recurrent ovarian cancer and, hence, often alters patient management substantially. FDG PET/CT has thus become a critical tool for the preoperative evaluation of women with primary ovarian cancer and for postoperative follow-up assessment for evidence of recurrence in these patients.
- Published
- 2010
44. Adrenal imaging
- Author
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Michael A. Blake, Carmel G. Cronin, and Giles W. Boland
- Subjects
Diagnostic Imaging ,Lymphoma ,Adrenal Gland Neoplasms ,Contrast Media ,General Medicine ,Pheochromocytoma ,Magnetic Resonance Imaging ,Diagnosis, Differential ,Adrenocortical Carcinoma ,Humans ,Radiology, Nuclear Medicine and imaging ,Radiopharmaceuticals ,Tomography, X-Ray Computed ,Tomography, Emission-Computed - Abstract
Adrenal nodules are frequently encountered on current high-resolution imaging, and accurate characterization of such lesions is critical for appropriate patient care. Our article highlights how imaging techniques such as CT densitometry, CT washout characteristics, chemical shift MRI, PET, and PET/CT help characterize most adrenal lesions. We focus on these techniques as well as specifically, because of space constraints, the varied imaging appearances of adrenocortical carcinoma, pheochromocytoma, and lymphoma on these techniques.The imaging characterization of adrenal lesions has continued to advance over the past decade as new technologies have evolved. CT, MRI, PET, and PET/CT are now established clinical techniques capable of differentiating benign from malignant adrenal lesions.
- Published
- 2010
45. Bone biopsy of new suspicious bone lesions in patients with primary carcinoma: prevalence and probability of an alternative diagnosis
- Author
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Thomas Cashell, Ronan T. Swords, Carmel G. Cronin, Gerard J. O’Sullivan, David O'Keeffe, Jennifer Ni Mhuircheartaigh, and Margaret Murray
- Subjects
Male ,medicine.medical_specialty ,Biopsy ,Bone Neoplasms ,Disease ,Metastasis ,Lesion ,Diagnosis, Differential ,Carcinoma ,medicine ,Insufficiency fracture ,Prevalence ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,medicine.diagnostic_test ,business.industry ,Cancer ,General Medicine ,medicine.disease ,Surgery ,Bone lesion ,Female ,Radiology ,medicine.symptom ,business ,Tomography, X-Ray Computed - Abstract
We sought to assess the probability that a new suspicious bone lesion is an alternative diagnosis, that is, a benign lesion or a second malignant tumor as opposed to metastatic disease from the malignant tumor, in a person with known primary malignant disease.We reviewed the radiologic and pathologic records of bone biopsies scheduled at our institution between 2002 and 2007. The following parameters were recorded: indication, type of primary cancer, date of diagnosis, complications of biopsy, whether the sample was of diagnostic quality, pathologic finding, and thus whether the primary malignant tumor was concordant with the lesion sampled.Fifty-four of 55 patients (17 men, 37 women; mean age, 67 years) with known primary cancer and suspicious bone lesions underwent biopsy. One of the 55 patients did not undergo biopsy because a sacral insufficiency fracture was confidently diagnosed at CT. The primary malignant disease had been diagnosed up to 16 years before the new bone lesion was suspected and bone biopsy performed. Cancer types included those of genitourinary tract, breast, thyroid, gastrointestinal tract, and lung and lymphoma and myeloma. Diagnostic material was obtained in 43 of 54 cases (80%), and nondiagnostic material was obtained in 11 of 54 cases (20%). Forty-two of 43 positive biopsy findings (98%) were consistent with the primary malignant tumor. The other positive finding was a new malignant tumor. This new tumor was myelofibrosis in a man with chronic myelocytic leukemia. The primary diagnosis correlated highly with that of the new bone lesion (Spearman's test, R = 0.842; p0.001). No complications, including hemorrhage, infection, sinus track formation, fracture, and pneumothorax, were encountered.In a patient with known primary malignant disease, the probability is low (2%) that biopsy of a new suspicious bone lesion will show the lesion is other than metastasis from the primary tumor.
- Published
- 2009
46. MR enterography in the evaluation of small bowel dilation
- Author
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Ann Michelle Browne, Abdulnasser Alhajeri, Clare Roche, Derek G. Lohan, Carmel G. Cronin, and Joseph M. Murphy
- Subjects
Adult ,Male ,medicine.medical_specialty ,Hernia ,Ileus ,Contrast Media ,Magnetic Resonance Imaging, Cine ,Distension ,Intestinal Neoplasms ,Intestine, Small ,medicine ,Image Processing, Computer-Assisted ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,General Medicine ,Middle Aged ,medicine.disease ,Enteritis ,Bowel obstruction ,Contrast medium ,Intestinal Diseases ,MR Enterography ,Female ,Radiology ,Nuclear medicine ,business ,Bowel dilation ,Intestinal Obstruction ,Dilatation, Pathologic ,Intestinal Volvulus - Abstract
Magnetic reasonance (MR) enterography enables high contrast resolution depiction of the location and cause of bowel obstruction through a combination of predictable luminal distension and multiplanar imaging capabilities. Furthermore, because the patient is not exposed to ionizing radiation, sequential "dynamic" MR imaging can be performed repeatedly over time further facilitating depiction of the site and/or the cause of obstruction. With increasing availability of MR imaging and standardization of the oral contrast medium regimens, it is likely that this technique will assume an ever-increasing role in the evaluation of small bowel dilation in the coming years. We illustrate the utility of MR enterography in the evaluation of small bowel dilation, whether it be mechanical, functional (e.g., ileus), or related to infiltrative mural disease.
- Published
- 2008
47. Imaging of the gastrointestinal complications of systemic chemotherapy
- Author
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M. O'Connor, John F. Bruzzi, Clare Roche, Derek G. Lohan, Carmel G. Cronin, M. Keane, and Joseph M. Murphy
- Subjects
Adult ,Male ,medicine.medical_specialty ,Gastrointestinal Diseases ,medicine.medical_treatment ,Antineoplastic Agents ,Timely diagnosis ,Gastrointestinal complications ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Stomach Ulcer ,Intensive care medicine ,Enterocolitis, Pseudomembranous ,Aged ,Gastrointestinal tract ,Chemotherapy ,business.industry ,Systemic chemotherapy ,Enterocolitis, Neutropenic ,General Medicine ,Middle Aged ,Intestinal Perforation ,Female ,Radiology ,business ,Complication ,Gastrointestinal Hemorrhage ,Tomography, X-Ray Computed - Abstract
Gastrointestinal complications of chemotherapy may be serious and potentially life-threatening. Familiarity with and awareness of the potential complications associated with various chemotherapeutic agents/regimens is paramount to enable accurate and timely diagnosis. In this article we review the radiological manifestations of the most notable gastrointestinal complications associated with chemotherapeutic administration.
- Published
- 2008
48. Hypotonic MR duodenography with water ingestion alone: feasibility and technique
- Author
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Clare Roche, Geraldine Dowd, Ruaridh H. Allen, Jennifer Ni Mhuircheartaigh, Eithne DeLappe, Joseph M. Murphy, and Carmel G. Cronin
- Subjects
Adult ,Male ,medicine.medical_specialty ,Duodenum ,Administration, Oral ,Distension ,Young Adult ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Neuroradiology ,medicine.diagnostic_test ,business.industry ,Ultrasound ,Water ,Magnetic resonance imaging ,Interventional radiology ,General Medicine ,Image Enhancement ,Magnetic Resonance Imaging ,Contrast medium ,medicine.anatomical_structure ,Hypotonic Solutions ,Tonicity ,Radiology ,business - Abstract
To date, cross-sectional imaging of the duodenum has a number of inadequacies, most likely a reflection of its tortuous and complex anatomical course, resulting in somewhat suboptimal imaging. The purpose of this study was to describe and assess the feasibility of performing a ‘tubeless’, per-oral, single contrast, hypotonic magnetic resonance (MR) duodenography technique. Secondly, to assess the efficacy of intravenous Buscopan in facilitating duodenal distension at cross-sectional MR imaging. Ten healthy volunteers prospectively underwent MR imaging of the duodenum pre- and post-Buscopan immediately after consuming 1,000 ml of water. Images were qualitatively (using a visual assessment grading scale of 1–3) and quantitatively evaluated with regard to degree of small bowel distension by two observers. The contrast medium was successfully ingested and MR examination was completed in all participants. Quantitatively and qualitatively, the per-oral, hypotonic duodenography technique yielded superior distension scores and was significantly greater in diameter in comparison with the per-oral non-hypotonic duodenography technique (p
- Published
- 2008
49. MRI small-bowel follow-through: prone versus supine patient positioning for best small-bowel distention and lesion detection
- Author
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Nasser Alhajeri, Carmel G. Cronin, Clare Roche, Joseph M. Murphy, Jennifer Ni Mhuircheartaigh, Derek G. Lohan, and David A McKenna
- Subjects
Adult ,Male ,medicine.medical_specialty ,Scoring system ,Supine position ,Wilcoxon signed-rank test ,Adolescent ,Patient positioning ,Statistics, Nonparametric ,Lesion ,Intestine, Small ,medicine ,Prone Position ,Supine Position ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Aged ,Crohn's disease ,Lesion detection ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,digestive system diseases ,Intestinal Diseases ,Female ,Radiology ,medicine.symptom ,business - Abstract
The purpose of this study was to assess whether prone or supine imaging provides superior small-bowel loop distention during MRI small-bowel follow-through examinations and whether either position is better with regard to lesion detection and evaluation.Forty consecutively enrolled clinically referred patients with known or suspected small-bowel abnormalities prospectively underwent 62 MRI small-bowel follow-through examinations in both the prone and the supine positions. Images were blindly and independently reviewed by two observers. Each small-bowel segment was assessed with a 3-point scoring system, and differences in bowel distention in the prone and supine positions were evaluated with a paired Wilcoxon's test. Differences between rates of lesion detection and characterization (e.g., ulceration, stricturing) were analyzed with a paired Student's t test. Interobserver agreement was estimated with the kappa coefficient.In both normal and diseased small bowel, the prone position had statistically significantly higher distention scores than did the supine position (p0.05) with a high level of interobserver agreement. This finding, however, did not translate into improved lesion detection or characterization (p0.05).Although use of the prone position results in superior small-bowel distention during MRI small-bowel follow-through, both the prone and supine positions are equal in terms of lesion detection and feature visualization.
- Published
- 2008
50. MR enterography of small-bowel lymphoma: potential for suggestion of histologic subtype and the presence of underlying celiac disease
- Author
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Carmel G. Cronin, Abdulnasser Alhajeri, Clare Roche, Derek G. Lohan, and Joseph M. Murphy
- Subjects
Adult ,Male ,Pathology ,medicine.medical_specialty ,Lymphoma ,Disease ,Sensitivity and Specificity ,Coeliac disease ,Diagnosis, Differential ,Immunopathology ,Intestinal Neoplasms ,Intestine, Small ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Neoplasm Staging ,Aged, 80 and over ,Tumor size ,business.industry ,Cancer ,Reproducibility of Results ,General Medicine ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Celiac Disease ,MR Enterography ,Small Bowel Lymphoma ,Female ,business - Abstract
The objective of our study was to evaluate the morphologic appearances of small-bowel lymphoma using MR enterography to identify key morphologic traits capable of providing an association between imaging manifestations and likely histologic diagnosis.Over a 54-month period, 10 patients with subsequently confirmed small-bowel lymphoma were imaged using a standardized MR enterography technique. Retrospective chart review was performed to detect associated disease processes, such as celiac disease. The morphologic characteristics of each segment with lymphomatous involvement were evaluated with respect to tumor location, tumor size, mural characteristics, fold features, loop dilatation, luminal stricturing, mesenteric or antimesenteric distribution, mesenteric involvement, and signal intensity.Nineteen distinct segments of lymphomatous involvement were identified in 10 patients, and underlying celiac disease was confirmed in six of the 10 patients. This patient group comprised 10 patients with non-Hodgkin's lymphoma (NHL) of various subtypes. No cases of Hodgkin's lymphoma were encountered. Analysis revealed celiac NHL enteropathy to have a tendency toward localization to a single, long (10 cm), smooth continuous bowel segment, often with aneurysmal loop dilatation, in the absence of a distinct mesenteric or antimesenteric distribution. Luminal stricturing was encountered in cases of low-grade lymphoma, whereas mesenteric fat infiltration represented a characteristic of high-grade disease.We describe the characteristics of small-bowel lymphoma on MR enterography, identifying a number of key features that may help the interpreting radiologist in suggesting the underlying histologic subtype and whether the presence of underlying celiac disease is likely.
- Published
- 2008
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