27 results on '"O'Regan KN"'
Search Results
2. Feasibility of low-dose CT with model-based iterative image reconstruction in follow-up of patients with testicular cancer.
- Author
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Murphy KP, Crush L, O'Neill SB, Foody J, Breen M, Brady A, Kelly PJ, Power DG, Sweeney P, Bye J, O'Connor OJ, Maher MM, and O'Regan KN
- Abstract
Purpose: We examine the performance of pure model-based iterative reconstruction with reduced-dose CT in follow-up of patients with early-stage testicular cancer., Methods: Sixteen patients (mean age 35.6 ± 7.4 years) with stage I or II testicular cancer underwent conventional dose (CD) and low-dose (LD) CT acquisition during CT surveillance. LD data was reconstructed with model-based iterative reconstruction (LD-MBIR). Datasets were objectively and subjectively analysed at 8 anatomical levels. Two blinded clinical reads were compared to gold-standard assessment for diagnostic accuracy., Results: Mean radiation dose reduction of 67.1% was recorded. Mean dose measurements for LD-MBIR were: thorax - 66 ± 11 mGy cm (DLP), 1.0 ± 0.2 mSv (ED), 2.0 ± 0.4 mGy (SSDE); abdominopelvic - 128 ± 38 mGy cm (DLP), 1.9 ± 0.6 mSv (ED), 3.0 ± 0.6 mGy (SSDE). Objective noise and signal-to-noise ratio values were comparable between the CD and LD-MBIR images. LD-MBIR images were superior (p < 0.001) with regard to subjective noise, streak artefact, 2-plane contrast resolution, 2-plane spatial resolution and diagnostic acceptability. All patients were correctly categorised as positive, indeterminate or negative for metastatic disease by 2 readers on LD-MBIR and CD datasets., Conclusions: MBIR facilitated a 67% reduction in radiation dose whilst producing images that were comparable or superior to conventional dose studies without loss of diagnostic utility.
- Published
- 2016
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3. Radiation exposure from diagnostic imaging in young patients with testicular cancer.
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Sullivan CJ, Murphy KP, McLaughlin PD, Twomey M, O'Regan KN, Power DG, Maher MM, and O'Connor OJ
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- Adult, Humans, Male, Radiation Dosage, Diagnostic Imaging, Neoplasms, Germ Cell and Embryonal diagnostic imaging, Testicular Neoplasms diagnostic imaging, Tomography, X-Ray Computed methods
- Abstract
Objectives: Risks associated with high cumulative effective dose (CED) from radiation are greater when imaging is performed on younger patients. Testicular cancer affects young patients and has a good prognosis. Regular imaging is standard for follow-up. This study quantifies CED from diagnostic imaging in these patients., Methods: Radiological imaging of patients aged 18-39 years, diagnosed with testicular cancer between 2001 and 2011 in two tertiary care centres was examined. Age at diagnosis, cancer type, dose-length product (DLP), imaging type, and frequency were recorded. CED was calculated from DLP using conversion factors. Statistical analysis was performed with SPSS., Results: In total, 120 patients with a mean age of 30.7 ± 5.2 years at diagnosis had 1,410 radiological investigations. Median (IQR) surveillance was 4.37 years (2.0-5.5). Median (IQR) CED was 125.1 mSv (81.3-177.5). Computed tomography accounted for 65.3 % of imaging studies and 98.3 % of CED. We found that 77.5 % (93/120) of patients received high CED (>75 mSv). Surveillance time was associated with high CED (OR 2.1, CI 1.5-2.8)., Conclusions: Survivors of testicular cancer frequently receive high CED from diagnostic imaging, mainly CT. Dose management software for accurate real-time monitoring of CED and low-dose CT protocols with maintained image quality should be used by specialist centres for surveillance imaging., Key Points: • CT accounted for 98.3 % of CED in patients with testicular cancer. • Median CED in patients with testicular cancer was 125.1 mSv • High CED (>75 mSv) was observed in 77.5 % (93/120) of patients. • Dose tracking and development of low-dose CT protocols are recommended.
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- 2015
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4. Reduction of guide needle streak artifact in CT-guided biopsy.
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McWilliams SR, Murphy KP, Golestaneh S, O'Regan KN, Arellano RS, Maher MM, and O'Connor OJ
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- Biopsy, Large-Core Needle instrumentation, Biopsy, Large-Core Needle methods, Biopsy, Needle, Image-Guided Biopsy instrumentation, Image-Guided Biopsy methods, Observer Variation, Phantoms, Imaging, Artifacts, Image Processing, Computer-Assisted methods, Tomography, X-Ray Computed methods
- Abstract
Purpose: Computed tomography (CT)-guided core needle biopsy (CNB) can be affected by streak artifact obscuring the needle tip. This study investigates factors that influence the occurrence and severity of streak artifact during CNB., Materials and Methods: Eight coaxial guide needles of two sizes from two manufacturers with and without stylets were imaged in a CT phantom, with CT reconstructed with adaptive statistical iterative reconstruction and filtered back projection. CNB-related streak artifact was quantified with profile analysis in an image-processing program. Differences between maximum attenuation at the needle tip and minimum attenuation in the streak artifact were compared for each variable. Diagnostic acceptability and streak artifact were subjectively assessed on each phantom image and on 40 clinical CNB procedures by three independent blinded reviewers following training case review., Results: Artifact was significantly less with the central stylet removed versus in situ (median, 1,145 HU vs 3,390 HU; P < .001) for all needles, and less for 19-gauge needles versus 17-gauge needles (median, 1,334 HU vs 2,780 HU, respectively; P = .006). There were no differences based on manufacturer (P = .906) or reconstruction algorithm (P = .524). Independent reviews found that streak artifact was significantly reduced when the central stylet was removed (κ = 0.875-1.0; P < .001), and needle tip position was better in cases in which the stylet was removed (κ = 0.231-0.711; P < .001)., Conclusions: Streak artifact can be reduced and needle tip visualization improved by confirming final biopsy needle position with the central stylet removed on CT and using smaller-gauge guide needles., (Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.)
- Published
- 2014
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5. Characteristics of modern Gleason 9/10 prostate adenocarcinoma: a single tertiary centre experience within the Republic of Ireland.
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O'Kelly F, Elamin S, Cahill A, Aherne P, White J, Buckley J, O'Regan KN, Brady A, Power DG, O'Brien MF, Sweeney P, Mayer N, and Kelly PJ
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- Aged, Biopsy, Humans, Incidence, Ireland, Male, Middle Aged, Neoplasm Grading, Neoplasm Metastasis, Prostate pathology, Retrospective Studies, Adenocarcinoma pathology, Prostatic Neoplasms pathology, Tertiary Care Centers
- Abstract
Introduction: The 2005 international society of urological pathology consensus statement on Gleason grading in prostate cancer revised Gleason scoring in clinical practice. The potential for grade migration with this refinement poses difficulties in interpreting historical series. We report the characteristics of a recent cohort of consecutive Gleason score 9 or 10 prostate cancers in our institution. The purpose of this study was to define the clinicopathologic variables and staging information for this high-risk population, and to identify whether traditional prostate staging techniques are adequate for this subcohort of men., Materials and Methods: A computational review of our pathology database was performed. Between May 2010 and September 2012, 1,295 consecutive biopsies were undertaken, 168 of which were high-grade tumours (12.97 %). This group were divided into two cohorts of which 84 (12.05 %) had a highest reported Gleason score of 9 (N = 79) or 10 (N = 5) and 84 were reported as Gleason 8. All biopsies were double-reported by pathologists with a special interest in uropathology., Results: Men diagnosed with a Gleason pattern 5 tumour were statistically far more likely to have advanced disease on direct rectal examination of the prostate compared with Gleason sum 8 tumours (p < 0.001) and a positive first-degree family history of prostate cancer (p < 0.001). Overall, Gleason sum 9/10 prostate cancers were also found to be statistically more aggressive than Gleason sum 8 tumours on TRUS core biopsy analysis with significantly higher levels of perineural invasion (p < 0.0001) and extracapsular extension (p = 0.001) as well as a higher levels of tumour found within the core biopsy sample. Those men diagnosed with Gleason pattern 5 prostate cancer also had radiological indicators of increased tumour aggressiveness compared with Gleason sum 8 cancer with respect to bone (p = 0.0002) and visceral (p = 0.044) metastases at presentation., Conclusions: This series of Gleason score 9/10 prostate cancers serves to highlight the large disease burden, adverse pathologic features, and locally advanced nature of this aggressive subtype, which has previously been under-described in the literature, and differs from historical series in having a large high-grade cohort demonstrating high rates of metastatic disease. A history of prostate cancer amongst first-degree relatives was particularly prevalent in this population raising the issue of screening in a high-risk population. The high incidence of visceral metastatic disease at presentation supports upfront staging with CT thorax, abdomen, and pelvis in patients with Gleason 9 or 10 prostate cancers.
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- 2014
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6. New-onset mediastinal and central nervous system sarcoidosis in a patient with metastatic melanoma undergoing CTLA4 monoclonal antibody treatment.
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Murphy KP, Kennedy MP, Barry JE, O'Regan KN, and Power DG
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- Adrenal Cortex Hormones therapeutic use, Adult, Antibodies, Monoclonal immunology, Antibodies, Monoclonal therapeutic use, Antineoplastic Agents adverse effects, Antineoplastic Agents immunology, Antineoplastic Agents therapeutic use, Arthritis, Bone Neoplasms secondary, CTLA-4 Antigen immunology, Central Nervous System Diseases diagnosis, Central Nervous System Diseases drug therapy, Humans, Ipilimumab, Male, Mediastinal Diseases diagnosis, Mediastinal Diseases therapy, Melanoma secondary, Sarcoidosis diagnosis, Sarcoidosis drug therapy, Skin Neoplasms drug therapy, Skin Neoplasms pathology, Synovitis, Treatment Outcome, Uveitis, Antibodies, Monoclonal adverse effects, Bone Neoplasms drug therapy, CTLA-4 Antigen antagonists & inhibitors, Central Nervous System Diseases chemically induced, Mediastinal Diseases chemically induced, Melanoma drug therapy, Sarcoidosis chemically induced
- Abstract
Background: Ipilimumab, a cytotoxic monoclonal antibody that inhibits cytotoxic T lymphocyte-associated antigen-4 (CTLA-4), has been established as an effective therapy in the management of advanced melanoma. Immune-mediated adverse events are a common side effect., Case Report: A 37-year-old male patient was diagnosed with nodal and osseous metastatic melanoma 15 months after the initial surgical treatment for lower limb melanoma. Therapy with the anti-CTLA-4 antibody, ipilimumab, was started. Follow-up staging imaging after treatment initiation showed symmetrical bihilar adenopathy. Transbronchial biopsy showed sarcoidosis. The patient had associated systemic symptoms of fatigue, joint pains, anorexia and weight loss. Brain magnetic resonance imaging (MRI), which was performed for the investigation of headaches, showed abnormal enhancing tissue in the sella turcica and adjacent to the pituitary infundibulum, consistent with neurosarcoidosis. The condition was successfully treated with corticosteroids., Conclusions: We report a case of immunotherapy-induced mediastinal/hilar sarcoidosis, with pituitary involvement, mimicking tumour progression. This highlights the need for awareness amongst radiologists and oncologists of the mechanism of action and potential side effects of new immunotherapies., (© 2014 S. Karger GmbH, Freiburg.)
- Published
- 2014
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7. Cost of the cure.
- Author
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Crowley MP, O'Neill SB, O'Regan KN, and O'Shea DM
- Subjects
- Female, Humans, Male, Neoplasms physiopathology, Neoplasms psychology
- Published
- 2013
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8. Gastrointestinal stromal tumors (GIST): lesser known facts.
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O'Regan KN, Shinagare AB, Saboo SS, Ramaiya NH, Jagannathan JP, and Tirumani SH
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- Adult, Carney Complex classification, Carney Complex drug therapy, Carney Complex pathology, Child, Female, Gastrointestinal Neoplasms drug therapy, Gastrointestinal Neoplasms pathology, Gastrointestinal Stromal Tumors drug therapy, Gastrointestinal Stromal Tumors pathology, Humans, Male, Molecular Targeted Therapy, Neurofibromatosis 1 classification, Neurofibromatosis 1 drug therapy, Neurofibromatosis 1 pathology, Gastrointestinal Neoplasms classification, Gastrointestinal Stromal Tumors classification
- Abstract
In an era of molecular targeted therapy, patients with advanced gastrointestinal stromal tumor (GIST) are living longer and are often followed with imaging. Therefore, it is important for the radiologists to be aware of the atypical subtypes of GIST, implications of molecular makeup, its behavior, and the uncommon metastatic sites. The aim of this pictorial review is to illustrate the lesser-known aspects of GIST including histological and molecular classifications, syndromes associated with GIST, and uncommon metastatic sites., (Copyright © 2013 Elsevier Inc. All rights reserved.)
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- 2013
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9. Positron emission tomography/computed tomography imaging in Merkel cell carcinoma: a study of 270 scans in 97 patients at the Dana-Farber/Brigham and Women's Cancer Center.
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Hawryluk EB, O'Regan KN, Sheehy N, Guo Y, Dorosario A, Sakellis CG, Jacene HA, and Wang LC
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- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Retrospective Studies, Carcinoma, Merkel Cell diagnostic imaging, Multimodal Imaging, Positron-Emission Tomography, Skin Neoplasms diagnostic imaging, Tomography, X-Ray Computed
- Abstract
Background: Merkel cell carcinoma (MCC) is a rare and lethal cutaneous neuroendocrine carcinoma. Imaging is crucial for accurate staging, which remains a strong predictor of survival, as well as earlier detection of recurrence and progression, which are common despite aggressive management. There is no consensus on the role of initial and subsequent imaging for MCC., Objective: We sought to evaluate the use of 2-fluoro-[(18)F]-deoxy-2-D-glucose (FDG)-positron emission tomography (PET)/computed tomography (CT) in the management of MCC., Methods: In all, 270 FDG-PET/CT studies were performed in 97 patients with pathology-proven MCC at the Dana-Farber/Brigham and Women's Cancer Center, Boston, Mass, from August 2003 to December 2010., Results: FDG-PET/CT scans were obtained as part of the initial (61 scans in 61 patients) and subsequent (209 scans in 79 patients) treatment strategies. MCCs were FDG-avid with a mean maximum standardized uptake value of primary lesions of 6.5 (range 1.3-12.9) and a mean maximum standardized uptake value of regional and distant metastases of 7.2 (range 1.5-9.9). FDG-PET/CT upstaged 16% of patients who underwent baseline scans. FDG-PET/CT studies showed that bone and bone-marrow metastases were more common than previously reported, and were often undetected by CT., Limitations: Our study is limited by its retrospective design, and potential referral bias associated with a tertiary care center., Conclusions: FDG-PET/CT performed as part of the initial management strategy tended to upstage patients with more advanced disease. FDG-PET/CT performed as part of the subsequent treatment strategy identified metastatic disease, particularly in bone/bone marrow, which was not seen on CT. FDG-PET/CT imaging is a valuable staging and restaging tool in MCC management., (Copyright © 2012 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)
- Published
- 2013
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10. Investigation of the role of computed tomography as an adjunct to autopsy in the evaluation of stillbirth.
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O'Donoghue K, O'Regan KN, Sheridan CP, O'Connor OJ, Benson J, McWilliams S, Moore N, Murphy MJ, Chopra R, Higgins JR, and Maher MM
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- Cause of Death, Feasibility Studies, Female, Humans, Infant, Newborn, Pregnancy, Pregnancy Trimester, Third, Radiographic Image Interpretation, Computer-Assisted, Retrospective Studies, Statistics, Nonparametric, Autopsy methods, Stillbirth, Tomography, X-Ray Computed methods
- Abstract
Introduction: The number of parents agreeing to autopsy following stillbirth is declining, which has undermined clinicians' ability to assess causes of intrauterine death and can impact counselling regarding recurrence. Post-mortem radiological imaging is a potential alternative method of investigating perinatal loss. The aim of this study was to assess the role of multi-detector computed tomography (MDCT) in the investigation of stillbirth., Study Design: Following ethical approval and written consent, parents were offered MDCT of the stillborn infant. MDCT was performed with 3D reconstruction, and images were analysed for image quality, anthropomorphic measurements and pathologic findings. Body part and organ-specific measurements were performed; including head, chest and abdominal circumferences, and muscle and liver mass was also measured. Findings were correlated with obstetric history, post-mortem skeletal survey (plain radiography), and formal autopsy., Results: Fourteen third-trimester stillborn infants were scanned. Image quality was moderate to excellent for most body structures. CT was better than plain radiography for imaging skeletal structures and large solid organs and demonstrated a range of pathologies including renal vein thrombosis, mesenteric calcification and skeletal hyperostosis that were not seen on plain radiographs. MDCT did not overlook autopsy findings and provided some additional information., Conclusion: This study confirms the feasibility of MDCT in the investigation of third trimester stillbirth. MDCT image quality is acceptable and the examination can demonstrate a range of anatomic and pathologic findings. Initially, its value may be as an important adjunct to conventional autopsy., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2012
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11. Uterine sarcomas: then and now.
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Shah SH, Jagannathan JP, Krajewski K, O'Regan KN, George S, and Ramaiya NH
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- Adenocarcinoma diagnosis, Adenocarcinoma pathology, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Carcinosarcoma diagnosis, Carcinosarcoma pathology, Chemotherapy, Adjuvant, Diagnosis, Differential, Diagnostic Imaging methods, Female, Humans, Hysterectomy, Leiomyosarcoma diagnosis, Leiomyosarcoma pathology, Longitudinal Studies, Lymphatic Metastasis, Neoplasm Recurrence, Local diagnosis, Neoplasm Recurrence, Local therapy, Neoplasm Staging, Ovariectomy, Radiographic Image Enhancement, Sarcoma pathology, Sarcoma secondary, Uterine Neoplasms pathology, Sarcoma diagnosis, Sarcoma therapy, Uterine Neoplasms diagnosis, Uterine Neoplasms therapy
- Abstract
Objective: The purpose of this article is to provide an updated review of uterine sarcomas. The traditionally described neoplasms are reviewed as well as several recently characterized entities in terms of their imaging and clinical aspects. We attempt to provide a longitudinal imaging overview, from initial presentation to follow-up. Imaging features are also described of response to traditional therapeutic agents and newer targeted agents., Conclusion: A greater understanding of the pathogenesis has improved our ability to image and treat uterine sarcomas, both at initial staging and on follow-up. Targeted therapy is assuming an increasingly important role in the management of these lesions. It is imperative for radiologists to be aware of response characteristics and potential complications of these agents as well as conventional chemotherapeutic agents.
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- 2012
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12. Imaging features of primary and secondary malignant tumours of the sacrum.
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Thornton E, Krajewski KM, O'Regan KN, Giardino AA, Jagannathan JP, and Ramaiya N
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- Adolescent, Adult, Aged, Bone Neoplasms secondary, Chordoma secondary, Diagnosis, Differential, Humans, Magnetic Resonance Imaging, Middle Aged, Osteosarcoma secondary, Positron-Emission Tomography, Tomography, X-Ray Computed, Young Adult, Bone Neoplasms pathology, Chordoma pathology, Hematologic Neoplasms pathology, Lymphoma pathology, Osteosarcoma pathology, Sacrum
- Abstract
Malignant tumours of the sacrum may be primary or secondary. While sacral metastases are frequently encountered, a diagnostic dilemma can present when there is a single sacral bone tumour with no history or evidence of malignancy elsewhere in the body. Familiarity with the imaging features and clinical presentations of primary malignant bone tumours is helpful in narrowing the differential. This pictorial review will illustrate with both common and uncommon malignant sacral tumours CT, MRI and positron emission tomography/CT, highlighting the specific features of each.
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- 2012
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13. Imaging of desmoplastic small round cell tumour in adults.
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Kis B, O'Regan KN, Agoston A, Javery O, Jagannathan J, and Ramaiya NH
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- Adult, Contrast Media, Diagnosis, Differential, Female, Fluorodeoxyglucose F18, Humans, Magnetic Resonance Imaging methods, Male, Multimodal Imaging methods, Positron-Emission Tomography, Radiopharmaceuticals, Tomography, X-Ray Computed methods, Desmoplastic Small Round Cell Tumor diagnosis
- Abstract
Desmoplastic small round cell tumour (DSRCT) belongs to the histological descriptive category of small round blue cell tumours. DSRCT primarily occurs in adolescents and young adults between the ages of 15 and 25 years and has a male predominance. DSRCT is an aggressive disease with a poor prognosis; timely diagnosis is therefore critical to the management of these patients. Although their radiographic appearances overlap with other aggressive malignancies, there are certain imaging features that can suggest the diagnosis and expedite the initiation of appropriate therapy. The aim of our pictorial review is to describe the imaging findings of primary and metastatic DSRCT in adults.
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- 2012
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14. Evaluation of the efficacy and safety of percutaneous biopsy of lung.
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McSweeney SE, O'Regan KN, Mc Laughlin PD, Crush L, and Maher MM
- Abstract
Introduction: Percutanous needle biopsy of the lung (PNBL), under image guidance, has established itself as a safe and effective minimally-invasive method of obtaining a tissue diagnosis of pulmonary lesions, for selected patients with suspected pathologic processes. The purpose of this study was to evaluate the diagnostic yield and safety of percutaneous core biopsy of the lung (PCBL) without Fine Needle Aspiration Biopsy (FNAB), with specific attention to potential risk factors that may predict post-biopsy pneumothorax., Materials and Methods: A retrospective analysis of 75 consecutive PCBL procedures between January 2006 to March 2008 involving 72 patients with a documented pulmonary nodule or mass lesion on CT scan of Thorax. The study population included 38 males (52.8%) and 34 females (47.2%) aged 20-85 years (mean age 63.6 years). A co-axial cutting system with a 19-gauge outer needle and a 20-gauge inner automated cutting needle (Temno, Allegiance Healthcare Corporation, Ohio, USA) was used in all patients., Results: Lesions varied in size from 0.7cm to 10.7cm (mean maximum trans-axial diameter 3.1cm). The mean number of core biopsy samples obtained was 3.1 (range 1-5). Of the 75 PCBL procedures, 71 yielded specimens adequate for histopathologic evaluation, consistent with a technical success rate of 95%. Malignancy was detected in 48 specimens (64%) and benign diagnoses were identified in 23 specimens (31%). As mentioned, 4 specimens (5%) were nondiagnostic. The most common biopsy-induced complication was pneumothorax, occurring in 15 patients (20%), with 4 (5.3%) requiring thoracostomy tube placement., Conclusion: PCBL without FNAB, under CT fluoroscopy guidance, has an excellent diagnostic accuracy in obtaining a conclusive histologic diagnosis of thoracic lesions and is comparable to FNAB in terms of safety and rates of occurence of complications.
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- 2012
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15. Spleen in haematological malignancies: spectrum of imaging findings.
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Saboo SS, Krajewski KM, O'Regan KN, Giardino A, Brown JR, Ramaiya N, and Jagannathan JP
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- Adult, Aged, Female, Hematologic Neoplasms diagnosis, Humans, Male, Middle Aged, Lymphoma diagnosis, Magnetic Resonance Imaging, Multimodal Imaging, Positron-Emission Tomography, Splenic Neoplasms diagnosis, Tomography, X-Ray Computed
- Abstract
Imaging morphology and metabolic activity of splenic lesions is of paramount importance in patients with haematological malignancies; it can alter tumour staging, treatment protocols and overall prognosis. CT, MRI and positron emission tomography (PET)/CT have been shown to be powerful tools for the non-invasive assessment of splenic involvement in various haematological malignancies. Since many haematological malignancies and non-neoplastic conditions can involve the spleen and imaging manifestations can overlap, imaging and clinical findings outside of the spleen should be looked for to narrow the differential diagnosis; confirmation can be obtained by pathological findings. Radiologists should be familiar with the cross-sectional imaging patterns of haematological malignancies involving the spleen as well as non-neoplastic splenic findings common in these patients to facilitate their care and follow-up. This pictorial review provides the common and uncommon imaging appearances and complications of various haematological malignancies involving the spleen on CT, MRI and PET/CT, and common pitfalls in diagnosis.
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- 2012
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16. Peritoneal relapse of testicular seminomatous germ cell tumor treated successfully with salvage chemotherapy and autologous stem cell transplantation.
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Sneag DB, Ramaiya N, O'Regan KN, Jagannathan JP, Hornick JL, Ho VT, and Hayes JH
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- Cisplatin administration & dosage, Humans, Ifosfamide administration & dosage, Male, Middle Aged, Paclitaxel administration & dosage, Peritoneal Neoplasms secondary, Seminoma secondary, Testicular Neoplasms pathology, Transplantation, Autologous, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Peritoneal Neoplasms therapy, Salvage Therapy, Seminoma therapy, Stem Cell Transplantation, Testicular Neoplasms therapy
- Published
- 2011
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17. Extrahepatic spread of hepatocellular carcinoma: spectrum of imaging findings.
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Sneag DB, Krajewski K, Giardino A, O'Regan KN, Shinagare AB, Jagannathan JP, and Ramaiya N
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- Bone Neoplasms diagnosis, Bone Neoplasms secondary, Contrast Media, Humans, Lung Neoplasms diagnosis, Lung Neoplasms secondary, Lymphatic Metastasis diagnosis, Neoplasm Staging, Prognosis, Vascular Neoplasms diagnosis, Vascular Neoplasms secondary, Carcinoma, Hepatocellular pathology, Diagnostic Imaging, Liver Neoplasms pathology
- Abstract
Objective: The purpose of this article is to describe the imaging findings of extrahepatic spread of hepatocellular carcinoma (HCC)., Conclusion: Detecting extrahepatic metastases in HCC is critical in determining the optimal treatment plan for patients. Identifying the presence of extrahepatic metastases in patients with advanced disease may eliminate unnecessary surgery, such as liver transplantation or partial hepatic resection, and help direct the appropriate therapy.
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- 2011
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18. Radiologic aspects of immune-related tumor response criteria and patterns of immune-related adverse events in patients undergoing ipilimumab therapy.
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O'Regan KN, Jagannathan JP, Ramaiya N, and Hodi FS
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- Drug-Related Side Effects and Adverse Reactions immunology, Humans, Ipilimumab, Melanoma immunology, Melanoma pathology, Neoplasm Staging, Skin Neoplasms immunology, Skin Neoplasms pathology, Antibodies, Monoclonal adverse effects, Drug-Related Side Effects and Adverse Reactions diagnostic imaging, Immunotherapy adverse effects, Melanoma drug therapy, Skin Neoplasms drug therapy, Tomography, X-Ray Computed
- Abstract
Objective: The objective of this article is to illustrate examples of radiologic immune-related response criteria and toxicity in patients with advanced melanoma treated with the immunotherapeutic agent ipilimumab., Conclusion: Novel immune-related tumor response criteria should be applied to patients undergoing therapy with ipilimumab for advanced melanoma. Ipilimumab also produces a spectrum of immune-related adverse effects that can be recognized radiologically.
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- 2011
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19. Imaging of liposarcoma: classification, patterns of tumor recurrence, and response to treatment.
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O'Regan KN, Jagannathan J, Krajewski K, Zukotynski K, Souza F, Wagner AJ, and Ramaiya N
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- Aged, Female, Humans, Male, Middle Aged, Prognosis, Treatment Outcome, Liposarcoma diagnosis, Liposarcoma therapy, Magnetic Resonance Imaging methods, Neoplasm Recurrence, Local diagnosis, Neoplasm Recurrence, Local therapy, Tomography, X-Ray Computed methods
- Abstract
Objective: The purpose of this study was to illustrate the subtypes of liposarcoma (LPS) and the significance of the nonlipomatous tumor components using multiple imaging modalities., Conclusion: The subtypes of LPS with greater nonlipomatous soft-tissue components on imaging studies tend to show less differentiation and are usually more aggressive both histologically and clinically. Imaging plays an important role in the diagnosis, surveillance, and response assessment of LPS.
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- 2011
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20. Primary pleural lymphoma without associated pyothorax.
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Giardino A, O'Regan KN, Hargreaves J, Jagannathan J, Park D, Ramaiya N, and Fisher D
- Subjects
- Aged, Humans, Lymphoma complications, Lymphoma drug therapy, Male, Pleural Neoplasms complications, Pleural Neoplasms drug therapy, Positron-Emission Tomography, Tomography, X-Ray Computed, Empyema, Pleural etiology, Lymphoma diagnosis, Pleural Neoplasms diagnosis
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- 2011
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21. Unexpected late radiation neurotoxicity following bevacizumab use: a case series.
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Kelly PJ, Dinkin MJ, Drappatz J, O'Regan KN, and Weiss SE
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- Adult, Aged, Antibodies, Monoclonal, Humanized, Bevacizumab, Bone Neoplasms secondary, Breast Neoplasms pathology, Female, Humans, Magnetic Resonance Imaging methods, Male, Middle Aged, Retrospective Studies, Angiogenesis Inhibitors adverse effects, Antibodies, Monoclonal adverse effects, Bone Neoplasms chemically induced, Glioblastoma chemically induced
- Abstract
The purpose of this case series is to report the unexpected occurrence of four cases of late radiation-induced neurotoxicity with bevacizumab use following radiotherapy to the CNS. We retrospectively reviewed the case records of four patients, three with glioblastoma and one with bone metastases secondary to metastatic breast cancer, who were treated with radiotherapy and developed late radiation-induced neurotoxicity following bevacizumab use. Three cases of optic neuropathy in glioblastoma patients and a single case of Brown-Séquard syndrome in the thoracic spine of a patient with metastatic breast cancer are reported. We hypothesize that bevacizumab use following radiotherapy to the CNS may inhibit vascular endothelial growth factor-dependent repair of normal neural tissue, and thus may increase the risk of late radiation neurotoxicity. Phase III data on the safety and efficacy of bevacizumab use with radiation in the setting of glioblastoma is awaited.
- Published
- 2011
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22. Rapid progression of combined hepatocellular carcinoma and cholangiocarcinoma.
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Saboo SS, Krajewski KM, Jagannathan JP, O'Regan KN, Odze R, Ramaiya N, and Wolpin BM
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- Aged, Bile Duct Neoplasms therapy, Carcinoma, Hepatocellular therapy, Chemoembolization, Therapeutic, Cholangiocarcinoma therapy, Disease Progression, Fatal Outcome, Humans, Liver Neoplasms therapy, Male, Bile Duct Neoplasms diagnosis, Bile Ducts, Intrahepatic pathology, Carcinoma, Hepatocellular diagnosis, Cholangiocarcinoma diagnosis, Liver Neoplasms diagnosis, Neoplasms, Multiple Primary diagnosis
- Abstract
Combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CC) is a rare entity comprising 1-14.2% of all primary liver carcinomas. In this report, we present a case of rapid progression of cHCC-CC, a rare tumor in a 77-year-old Caucasian male patient with hepatitis B-induced cirrhosis, moderately elevated alpha fetoprotein, and imaging and pathologic features of a mixed liver tumor. There was no evidence of metastatic disease in the chest, abdomen or pelvis by computed tomography (CT) scan at the time of diagnosis. Needle biopsy of the segment 8 lesion revealed two discrete histologic components to the tumor: well-differentiated HCC and poorly differentiated adenocarcinoma, consistent with intrahepatic CC.The patient rapidly developed metastatic disease after initial local therapy with hepatic arterial chemoembolization and percutaneous cryoablation, dying within 5 months of diagnosis. Radiofrequency ablation, cryoablation and radioembolization with yttrium-90 microspheres remain possible treatment strategies for patients with cHCC-CC unable to undergo surgical resection. The diagnosis and treatment of cHCC-CC can be challenging due to clinical, imaging and histological features that overlap with pure HCC and CC.
- Published
- 2011
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23. Association between preoperative magnetic resonance imaging, pain intensity and quantitative sensory testing in patients awaiting lumbar diskectomy.
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Hegarty D, O'Connor OJ, Moore M, O'Regan KN, Shorten G, and Maher MM
- Subjects
- Adolescent, Adult, Aged, Female, Humans, Male, Middle Aged, Patient Selection, Preoperative Care methods, Prognosis, Reproducibility of Results, Sensitivity and Specificity, Young Adult, Diskectomy, Intervertebral Disc Displacement diagnosis, Intervertebral Disc Displacement surgery, Lumbar Vertebrae surgery, Pain Measurement methods
- Abstract
Introduction: Magnetic resonance imaging (MRI) offers important information regarding the morphology, location and size of a herniated disc, which influences the decision to offer lumbar diskectomy (LD). This study aims to examine the association between clinical neurophysiologic indices including pain intensity and quantitative sensory testing (QST), and the degree of lumbar nerve root compromise depicted on magnetic resonance (MR) in patients awaiting LD., Methods: With institutional ethical approval, 16 patients (American Society of Anaesthesiologists Grades I-II, 18-65 years) with radicular pain for greater than 3 months undergoing elective LD were studied. Preoperative pain was assessed using (i) a visual analogue scale measuring pain intensity at rest and with movement and (ii) by quantifying pain sensory thresholds (St), pain perception thresholds (PPt), and pain tolerance threshold (PTt) using QST. MR images were independently graded by two radiologists blinded to the clinical data using the Pfirrmann grading system. Statistical analyses using Student's t-tests and Pearson's correlation were preformed where appropriate., Results: This study showed that: (i) findings on MR imaging corresponded with the symptomatic side and distribution of the pain; (ii) the degree of nerve root compromise, detected on MRI correlated with increased pain intensity at rest; and (iii) QST identified a trend towards higher St, PPt and PTt in patients with higher Pfirrmann grades., Conclusions: The Pfirrmann grading system of nerve root compromise may be clinically useful preoperatively as a method of identifying individuals who would benefit most from LD. However, additional studies with greater patient numbers and longer follow-up are required to definitively confirm the findings of this study., (© 2011 The Authors. Journal of Medical Imaging and Radiation Oncology © 2011 The Royal Australian and New Zealand College of Radiologists.)
- Published
- 2011
- Full Text
- View/download PDF
24. Metastatic meningioma: positron emission tomography CT imaging findings.
- Author
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Brennan C, O'Connor OJ, O'Regan KN, Keohane C, Dineen J, Hinchion J, Sweeney B, and Maher MM
- Subjects
- Aged, Female, Fluorodeoxyglucose F18, Humans, Radiopharmaceuticals, Lung Neoplasms diagnostic imaging, Lung Neoplasms secondary, Meningeal Neoplasms, Meningioma diagnostic imaging, Meningioma secondary, Positron-Emission Tomography methods
- Abstract
The imaging findings of a case of metastasing meningioma are described. The case illustrates a number of rare and interesting features. The patient presented with haemoptysis 22 years after the initial resection of an intracranial meningioma. CT demonstrated heterogeneous masses with avid peripheral enhancement without central enhancement. Blood supply to the larger lesion was partially from small feeding vessels from the inferior pulmonary vein. These findings correlate with a previously published case in which there was avid uptake of fluoro-18-deoxyglucose peripherally with lesser uptake centrally. The diagnosis of metastasing meningioma was confirmed on percutaneous lung tissue biopsy.
- Published
- 2010
- Full Text
- View/download PDF
25. Sonographic features of pectoralis muscle necrosis secondary to gemcitabine-induced radiation recall: case report and review of current literature.
- Author
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O'Regan KN, Nishino M, Armand P, Kelly PJ, Hwang DG, and Di Salvo D
- Subjects
- Adult, Antimetabolites, Antineoplastic adverse effects, Biopsy, Needle, Deoxycytidine adverse effects, Deoxycytidine analogs & derivatives, Hodgkin Disease radiotherapy, Humans, Male, Necrosis, Radiodermatitis chemically induced, Tomography, X-Ray Computed, Gemcitabine, Pectoralis Muscles diagnostic imaging, Pectoralis Muscles pathology, Radiodermatitis complications, Ultrasonography, Doppler, Color
- Published
- 2010
- Full Text
- View/download PDF
26. The role of imaging in the investigation of painless hematuria in adults.
- Author
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O'Regan KN, O'Connor OJ, McLoughlin P, and Maher MM
- Subjects
- Humans, Practice Guidelines as Topic, Ultrasonography, Urinary Tract diagnostic imaging, Urinary Tract pathology, Urologic Diseases diagnosis, Cystoscopy methods, Hematuria complications, Magnetic Resonance Imaging methods, Tomography, X-Ray Computed methods, Urography methods, Urologic Diseases complications
- Abstract
The radiologic investigation of asymptomatic hematuria has changed significantly due to the introduction of new imaging modalities and innovative techniques, such as computed tomography urogaphy, which allows a comprehensive evaluation of the entire urinary tract in a single study. There is still a role for "older" imaging modalities, such as intravenous urography and ultrasound, and their use is still advocated in younger patients with a lower risk of malignancy to minimize radiation dose. Combined modality imaging can also be useful for characterization of lesions. Guidelines have recently been published for the radiologic investigation of hematuria; these are discussed in this article.
- Published
- 2009
- Full Text
- View/download PDF
27. A role for myelography in assessing paraparesis.
- Author
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Merwick A, O'Sullivan SS, O'Regan KN, Marks CJ, Ryders DQ, and Sweeney BJ
- Subjects
- Arachnoid Cysts surgery, Female, Humans, Laminectomy, Magnetic Resonance Imaging, Middle Aged, Paraparesis, Spastic surgery, Spinal Diseases surgery, Treatment Outcome, Arachnoid Cysts complications, Arachnoid Cysts diagnostic imaging, Myelography, Paraparesis, Spastic diagnostic imaging, Paraparesis, Spastic etiology, Spinal Diseases complications, Spinal Diseases diagnostic imaging, Tomography, X-Ray Computed
- Abstract
Imaging of the spine is a fundamental part of assessment of paraparesis. Since the advent of MRI the indications for myelograms have diminished. However, a myelogram, although an invasive test, should still be considered a useful investigation for localising lesions in the spinal cord and for identifying rare causes of myelopathy. This case illustrates how a CT myelogram identified an arachnoid cyst, which is a potentially treatable cause of paraparesis.
- Published
- 2008
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