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Biomedical subjects

A R Padhani

Publications and source records attributed to A R Padhani.

At least 55 records · Page 3Linked to original sources
PubMed1998

Magnetic resonance imaging of prostate cancer: comparison of image quality using endorectal and pelvic phased array coils.

OBJECTIVE: To compare endorectal coil (ERC) and pelvic phased array (PPA) coil magnetic resonance imaging for delineation of the prostate gland and seminal vesicles. To compare ERC images at different inflation volumes of the ERC air balloon. MATERIALS AND METHODS: Twenty-one patients underwent T2-weighted examinations using PPA and ERC. The ERC evaluations were performed at three balloon inflation volumes (60, 100 and 140 ml). All patients had proven prostate cancer. Images were analysed for visibility of anatomic structures, gland distortion, tumour visualization, artefacts (coil flare, coil-related artefact and rectal movement) and overall image quality. A grading system was used for each parameter. RESULTS: ERC assessments at increasing balloon inflations showed equivalent anatomical detail and overall image quality. However, increasing gland distortion and decreasing coil related flare was found with higher air inflations (P = 0.13 and P = 0.006, respectively). When compared with ERC images, visibility of the anterior gland and neurovascular bundles was better with the PPA coil (P = 0.0001 and 0.002, respectively). The overall image quality was superior with the PPA coil (P = 0.0001). However, no significant difference in visualization of tumour or delineation of tumour extent was observed between the two techniques. CONCLUSIONS: PPA imaging of the prostate gland provides images of superior quality compared with the ERC. This is mainly due to fewer artefacts with the PPA coil and improved anterior gland visibility. When ERC is used, air inflation to at least 100 ml reduces coil flare artefact.

Aged↗
PubMed1998

Spiral CT: thoracic applications.

Volumetric CT data acquisition has had a major impact on the practice of computed tomography. This article reviews the current state of knowledge of the applications of this technique to the chest disease summarising its clinical impact on the assessment of lung and airways diseases, mediastinal abnormalities (excluding vascular disorders which are covered elsewhere), and in the evaluation of lung cancer patients. The impact of spiral CT on the non-invasive detection of pulmonary thrombo-embolic disease is also considered.

Humans↗
PubMed1998

Metastatic cardiac osteosarcoma--imaging features.

There are several reports of osteosarcoma metastases to the heart. A rare case of a metastatic osteosarcoma to the endocardium of the left atrium in a 17 year old patient is described. The radiological features are discussed in detail.

Adolescent↗
PubMed1998

Mediastinal venous anomalies: potential pitfalls in cancer diagnosis.

Mediastinal venous anomalies encountered during CT assessments of cancer patients are often unsuspected and may be misinterpreted, particularly in the presence of intrathoracic disease. Errors in diagnosis result from a lack of intravenous contrast, concomitant mediastinal lymphadenopathy and primary intrathoracic tumour. The small calibre of vessels, previous mediastinal surgery and poor mediastinal planes are other confounding factors. An awareness of the anatomical features and optimal scanning technique are required to avoid misinterpretation.

Humans↗
PubMed1998

Radiation induced liver injury detected by particulate reticuloendothelial contrast agent.

Radiation induced liver injury detected by a particulate reticuloendothelial MR contrast agent is described in a patient with metastatic colon cancer. The irradiated hepatic parenchyma failed to darken after ferumoxide administration. This finding suggests that detection of metastatic disease after ferumoxide contrast agents may be impaired in patients who have previously received upper abdominal radiation treatment.

Aged↗
PubMed1997

Problem in diagnostic imaging: behind the left renal vein.

This study presents, as diagnostic problems, computed tomographic scans from a selection of patients with suspected or known tumors, primary or secondary, in the retroperitoneal area, at the level of the renal hila. The study emphasizes the value of serial CT scans, and of three-dimensional reconstructions made from them, in distinguishing between tumor and incidental venous anomalies in this region, principally those involving communications between the left renal vein and the ascending lumbar vein.

Contrast Media↗
PubMed1997

Evaluation by magnetic resonance imaging of the inferior vena cava in patients with non-seminomatous germ cell tumours of the testis metastatic to the retroperitoneum.

OBJECTIVE: To assess the role of magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) in evaluating suspected occlusion of the inferior vena cava (i.v.c.) in patients with abdominal nodal metastases from non-seminomatous germ cell tumours, thus giving information that may be helpful in planning surgery and for determining the need for anticoagulant therapy. PATIENTS AND METHODS: Five patients with abdominal nodal metastases in whom occlusion of the i.v.c. was suspected on computed tomography (CT) were imaged using a 1.5 T MRI scanner. The MRI findings were compared with those from CT. RESULTS: The MR images successfully and clearly detected partial and total occlusions of the i.v.c. by both intraluminal thrombus and extrinsic compression. The technique also clearly detected extensive collateral venous circulation in several cases and in one a cavernous transformation of the i.v.c. In all patients, the MRI studies provided better information than that from CT. CONCLUSION: MRI, and particularly MRA, is a comparatively new technique that is non-invasive and offers the potential of evaluating vascular structures with no need for ionizing radiation or contrast media. This technique, if available, should be chosen for imaging the i.v.c. in patients suspected of having compression or occlusion of the i.v.c.

Adolescent↗
PubMed1997

The value of immediate cytologic evaluation for needle aspiration lung biopsy.

RATIONALE AND OBJECTIVES: The authors evaluate the role of immediate cytologic evaluation (ICE) with fine-needle aspiration biopsy (FNAB) for lung lesions at highest risk for pneumothorax. METHODS: A prospective randomized study was conducted of 80 patients with lung lesions surrounded by aerated parenchyma undergoing FNAB with and without ICE (47 and 33 patients, respectively). An analysis of needle passes, procedure time, complications, specimen adequacy, diagnostic yield, and accuracy of procedure was made. RESULTS: There was an increased number of needle passes with ICE (> or = three passes: 23% [11 biopsies] versus 3% [1 biopsy]; P = 0.01). Fluoroscopic procedures took longer with ICE (median time: 15 versus 9 minutes; P = 0.002) with no difference in complication rates. Specimen adequacy was similar (74% and 64%) and the procedure was diagnostic in 79% (37 biopsies) with ICE and in 70% (33 biopsies) without ICE. There were no significant differences in the sensitivity, specificity, or accuracy of the biopsy. CONCLUSIONS: Immediate cytologic evaluation improved results marginally with increased procedure time and needle passes. Immediate cytologic evaluation may be most useful for lesions at lowest risk of complications to assure that a second procedure is not required.

Biopsy, Needle↗
PubMed1996

Pulmonary sarcoidosis mimicking cryptogenic fibrosing alveolitis on CT.

AIM: The high resolution CT (HRCT) characteristics of fibrosing alveolitis and sarcoidosis are well established, and HRCT has been shown to have a high diagnostic accuracy in these two conditions. We report two cases of sarcoidosis with features in common with the usual appearances of cryptogenic fibrosing alveolitis (CFA). PATIENTS AND METHODS: Two adult male patients with sarcoidosis established by transbronchial biopsy or open lung biopsy who had undergone HRCT scanning were reviewed. At presentation both cases had an atypical pattern of radiological abnormality more in keeping with the features of CFA. Two observers independently assessed the CT scans for accepted features of CFA and sarcoidosis. RESULTS: In both cases CFA was the most likely radiological diagnosis based on the accepted HRCT criteria for this condition. In neither patient were the appearances suggestive of sarcoidosis. In both cases the predominant distribution of abnormality was peripheral, subpleural and in the lower lung zones rather than peribronchial, central and in the mid and upper lung zones. Nodular opacities were not present in either case. CONCLUSION: HRCT is an accurate and reliable method of suggesting or confirming the diagnosis of CFA and sarcoidosis. In a very small number of cases, sarcoidosis may produce HRCT appearances almost identical to CFA.

Aged↗
PubMed1995

Squamous oesophageal cancer can be downstaged using protracted venous infusion of 5-fluorouracil with epirubicin and cisplatin (ECF).

21 patients with squamous oesophageal carcinoma were treated with a new regimen designed in our unit and effective in treating gastric adenocarcinoma, consisting of continuous venous infusion of 5-fluorouracil for up to 24 weeks (200 mg/m2/day) with epirubicin (50 mg/m2) and cisplatin (60 mg/m2) every 3 weeks. 12 patients (57%) had an objective response. The median relapse free period was 7 months, median survival from start of chemotherapy 8.4 months, and median survival from diagnosis, 14 months. Symptomatic improvements were reported by 10/11 patients with pain (91%), 8/9 with anorexia (89%), 8/10 with reflux (80%) and 10/14 with dysphagia (71%). Grade 3 or 4 toxicity was reported by 11 patients: 5 had haematological toxicity, 3 vomiting, 2 infection and 1 diarrhoea. One patient developed peripheral neuropathy, 1 renal impairment and another peripheral vascular disease. Following chemotherapy, surgery was attempted in 5 patients. One remains well 3 years on, 2 had macroscopic clearance of tumour but died of postoperative complications. In 2, disease was irresectable. This regimen of moderate toxicity is effective at improving symptoms in the majority of patients. In some patients, tumours are briefly downstaged so that inoperable tumours may become operable.

Adult↗
PubMed1992

Chest radiography for general practitioners: scope for change?

In order to derive guidelines for general practitioners on the value of chest radiography we prospectively reviewed all chest radiographs over a 10 month period. Radiographic chest examinations (frontal with or without a lateral view) were performed on 2017 patients in the radiology department or at the chest clinic. Patient details were noted, referring practice and waiting times monitored. The adequacy of the referral letter was assessed, and specific predetermined clinical findings were correlated with the radiographic findings. Results were divided into three groups (normal, abnormal with a clinically unrelated or chronic abnormality, and abnormal with a clinically related abnormality). Of these patients, 1245 (62%) had normal examinations and 460 (23%) had clinically related abnormalities. Abnormalities were rare in the 10-29 year age group, and when reassurance was sought for patients with symptoms of non-specific chest pain or general ill health. Patients presenting with haemoptysis or with symptoms of lower respiratory infection, or of chronic airways disease often had an abnormal radiograph. A clinical diagnosis was indicated or implied in 1664 (82%) and confirmed in 876 (53%). The most frequent reason for referral was for reassurance (618 patients). Guidelines based on age and symptoms should rationalize the use of chest radiography by general practitioners.

Adolescent↗
PubMed1992

Computed tomography in blunt abdominal trauma: an analysis of clinical management and radiological findings.

We have retrospectively assessed the computed tomography (CT) findings in 92 patients suffering severe blunt abdominal trauma. Surgical findings and clinical follow-up were correlated with the CT findings. In nine patients CT was first used after emergency surgery and provided baseline data which was useful for further management. In two patients CT did not demonstrate small hepatic lacerations seen during previous surgery. No deaths were recorded. In 16 patients surgery followed CT within 24 h; there was good correlation between the CT and operative findings in 10 patients. However, CT failed to detect significant solid organ injury in five patients and was misleading (false positive) in another patient. There were two deaths amongst these 16 patients. Sixty-seven haemodynamically stable patients were initially managed non-operatively. Fifteen of these 67 patients had normal CT examinations; only one had subsequent laparotomy (for reasons unconnected with the trauma) where no injury was detected; there were no deaths. Of the 52 patients with an abnormal CT examination, 43 were successfully managed non-operatively. There were three deaths, including one where an injury missed at CT contributed to the demise of the patient. After an initial trial of non-operative management, the remaining six patients went to surgery where there was good concordance with the CT findings except for one missed renal injury. Active non-operative management of blunt abdominal trauma is widely accepted in haemodynamically stable patients and this report shows how CT supports this policy of surgical restraint in such cases. However, on review CT missed 13 injuries in nine patients overall; stricter attention to technique and better equipment may lead to improved results in the future.

Abdominal Injuries↗
PubMed1992

Computed tomography in abdominal trauma: an audit of usage and image quality.

The use and quality of computed tomography (CT) in the evaluation of blunt abdominal trauma has been assessed by a retrospective review of 122 patients referred in the first 8 years following the installation of CT of the body. The referral patterns were analysed, and the quality of the images was assessed, with particular reference to unsatisfactory (unacceptable or poor) images. Referrals increased over the 8 years following installation. A large proportion of these examinations were performed outside normal working hours (58/122, 48%). In 64 out of 122 (52%) of examinations the images were considered of unsatisfactory quality with inadequate use of intravenous contrast medium cited as the most common cause for unsatisfactory examinations. Image quality did not improve with time. Image quality was unsatisfactory in a larger proportion of those examinations performed outside normal working hours (35/58, 60%) than those during the routine working day (29/64, 45%), although this difference did not reach statistical significance (0.1 greater than p greater than 0.05). Fewer unsatisfactory examinations were produced by a system dedicated to body CT (31/74, 42%) than by a neuroradiological system (33/48, 69%) (p less than 0.01). The proportion of unsatisfactory abdominal examinations was lower when the CT study concentrated on the abdomen (26/65, 40%) than when multiple regions (head, chest, abdomen, etc.) were examined (38/57, 67%) (p less than 0.01). This audit revealed many unsatisfactory examinations. In order to complete the audit loop we have addressed many of the contributory factors. A new CT system now provides images of high quality and is used for all abdominal work. Guidelines, which describe an optimized technique, have been issued to radiographers and radiologists. In particular, we have emphasized that there is no place for a poorly supervised "quick look" at the abdomen following a cranial or thoracic study.

Abdominal Injuries↗
PubMed1991

Surgical restraint in the management of liver trauma.

Previous experience in Cambridge in the management of liver trauma has led to the evolution of a protocol for surgical intervention to secure control of haemorrhage from the injured liver. We report 80 cases of liver trauma including 12 who were initially managed non-operatively; three of these subsequently required operation. Of the 80, all but five suffered blunt abdominal trauma. Perihepatic packing was used to manage 29 patients, of whom 21 were initially treated elsewhere before being transferred to Cambridge. Six of these required a hemihepatectomy at subsequent exploration. Of the 39 patients who underwent urgent laparotomy and definitive surgery, 11 (28 per cent) died; only three out of 29 (10 per cent) died after initial packing. Only one death from hepatic complications occurred after packing and subsequent transfer.

Hemorrhage↗