Bhavya Rehani

Comparison of arterial and venous pH, bicarbonate, Pco2 and Po2 in initial emergency department assessment

Objective: To determine the agreement between arterial and venous samples in a pathologically diverse patient population presenting at an emergency department (ED) with a view to obviating the need for arterial blood gas (ABG) analysis in initial ED evaluation. Methods: Prospective study of 95 patients (69 males, 26 females, mean (SD) age 52 (1.6) years) with diverse medical conditions, presenting at a tertiary health centre ED and deemed by the treating physician to require an ABG analysis. Arterial and venous samples for gas analysis were taken as close in time to each other as possible. The data thus obtained were analysed for agreement between pH, Pco2, Po2 and bicarbonate using the Bland–Altman method. Results: The arterial and venous values of pH, bicarbonate and Pco2 show acceptably narrow 95% limits of agreement using the Bland–Altman method (0.13 to −0.1, 4.3 to −5.8 and 6.8 to −7.6, respectively). Agreement in Po2 measurements was poor (95% limits of agreement 145.3 to −32.9). Conclusion: Venous blood gas analysis for pH, bicarbonate and Pco2 may be a reliable substitute for ABG analysis in the initial evaluation of an adult patient population presenting to the ED.

Association Between Visceral Adiposity and Colorectal Polyps on CT Colonography

OBJECTIVE The purpose of this article is to determine whether there is an association between visceral adiposity measured on CT colonography (CTC) and colorectal polyps. MATERIALS AND METHODS Patients who underwent CTC and same-day optical colonoscopy (n = 1186) were analyzed. Visceral adipose tissue volumes and volume percentages relative to total internal body volume were measured on slices in the L2-L3 regions on supine CTC scans with validated fully automated software. Student t test, odds ratio, logistic regression, and receiver operating characteristic analyses were performed. RESULTS For subjects with (n = 345) and without (n = 841) adenomatous polyps, the mean (± SD) volume percentages were 31.2% ± 10.8% and 28.2% ± 11.3%, respectively (p < 0.0001). For subjects with (n = 244) and without (n = 942) hyperplastic polyps, the volume percentages were 31.8% ± 10.7% and 28.3% ± 11.2%, respectively (p < 0.0001). Comparing the lowest and highest quintiles of volume percentage, the odds ratios for having at least one adenomatous polyp or hyperplastic polyp versus no polyp were 2.06 (95% CI, 1.36-3.13) and 1.71 (95% CI, 1.08-2.71), and the prevalence of having adenomatous polyps or hyperplastic polyps increased by 14% and 8%, respectively. CONCLUSION Subjects with higher visceral adiposity measurements on CTC have a greater risk for the presence of colonic polyps.

CT Colonography Computer-Aided Polyp Detection: Effect on Radiologist Observers of Polyp Identification by CAD on Both the Supine and Prone Scans

RATIONALE AND OBJECTIVES To determine whether the display of computer-aided detection (CAD) marks on individual polyps on both the supine and prone scans leads to improved polyp detection by radiologists compared to the display of CAD marks on individual polyps on either the supine or the prone scan, but not both. MATERIALS AND METHODS The acquisition of patient data for this study was approved by the Institutional Review Board and was Health Insurance Portability and Accountability Act-compliant. Subsequently, the use of the data was declared exempt from further institutional review board review. Four radiologists interpreted 33 computed tomography colonography cases, 21 of which had one adenoma 6-9 mm in size, with the assistance of a CAD system in the first reader mode (ie, the radiologists reviewed only the CAD marks). The radiologists were shown each case twice, with different sets of CAD marks for each of the two readings. In one reading, a true-positive CAD mark for the same polyp was displayed on both the supine and prone scans (a double-mark reading). In the other reading, a true-positive CAD mark was displayed either on the supine or prone scan, but not both (a single-mark reading). True-positive marks were randomized between readings and there was at least a 1-month delay between readings to minimize recall bias. Sensitivity and specificity were determined and receiver operating characteristic (ROC) and multiple-reader multiple-case analyses were performed. RESULTS The average per polyp sensitivities were 60% (38%-81%) versus 71% (52%-91%) (P = .03) for single-mark and double-mark readings, respectively. The areas (95% confidence intervals) under the ROC curves were 0.76 (0.62-0.88) and 0.79 (0.58-0.96), respectively (P = NS). Specificities were similar for the single-mark compared with the double-mark readings. CONCLUSION The display of CAD marks on a polyp on both the supine and prone scans led to more frequent detection of polyps by radiologists without adversely affecting specificity for detecting 6-9 mm adenomas.

Lead poisoning from a gunshot wound.

Lead poisoning from gunshot wounds is unusual. Awareness of this rare but serious complication can guide the physician in making a prompt diagnosis. We present a case of a 30-year-old male who had a remote history of a gunshot wound in the right knee and presented with right knee pain. Plain film showed intrarticular invasion of the bullet fragments. He was also found to have microcytic anemia with high blood lead levels. Chelation therapy was immediately started, followed with surgical removal of the bullet fragments. Lead intoxication is a rare but fatal complication of gunshot wounds. After a timely diagnosis, chelation therapy should be immediately started.

Radiology education in Europe: Analysis of results from 22 European countries

AIM To assess the state of radiology education across Europe by means of a survey study. METHODS A comprehensive 23-item radiology survey was distributed via email to the International Society of Radiology members, national radiological societies, radiologists and medical physicists. Reminders to complete the survey were sent and the results were analyzed over a period of 4 mo (January-April 2016). Survey questions include length of medical school and residency training; availability of fellowship and subspecialty training; number of residency programs in each country; accreditation pathways; research training; and medical physics education. Descriptive statistics were used to analyze and summarize data. RESULTS Radiology residency training ranges from 2-6 years with a median of 5 years, and follows 1 year of internship training in 55% (12 out of 22) European countries. Subspecialty fellowship training is offered in 55% (12 out of 22) European countries. Availability for specialization training by national societies is limited to eight countries. For nearly all respondents, less than fifty percent of radiologists travel abroad for specialization. Nine of 22 (41%) European countries have research requirements during residency. The types of certifying exam show variation where 64% (14 out of 22) European countries require both written and oral boards, 23% (5 out of 22) require oral examinations only, and 5% (1 out of 22) require written examinations only. A degree in medical physics is offered in 59% (13 out of 22) European countries and is predominantly taught by medical physicists. Nearly all respondents report that formal examinations in medical physics are required. CONCLUSION Comparative learning experiences across the continent will help guide the development of comprehensive yet pragmatic infrastructures for radiology education and collaborations in radiology education worldwide.

Multiple intraosseous lipomatosis: a case report.

IntroductionIntraosseous lipoma is an uncommon entity that presents almost exclusively as a solitary lesion. Multiple intraosseous lipomas are exceedingly rare with only a few cases being reported in the literature.Case presentationWe present a case of 43-year-old African American female who presented with left leg and left wrist pain. The initial radiographs revealed well-defined radiolucent lesions in multiple bones involving the left wrist and the left lower limb. The magnetic resonance demonstrated multiple lesions, which showed high signal on the T1 and low signal on the fat suppressed T2 images. This favored the diagnosis of intraosseous lipomatosis that was confirmed by biopsy.ConclusionMultiple intraosseous lipomatosis is an uncommon but important differential for multiple radiolucent lesions on the plain radiographs. This condition can lead to pathological fractures. Magnetic resonance imaging can aid in providing an accurate diagnosis. The awareness of this condition can help the clinician in guiding the correct diagnosis and management.

Radiology Education in Africa: Analysis of Results From 13 African Countries

INTRODUCTION Rapid innovation in radiology has led to continual advances in subspecialty knowledge, with significant implications for radiology teaching.Radiology training programs around the world face a challenging task in both teaching a common knowledge base across all the imaging modalities and in imparting deep subspecialty knowledge within each imaging domain. There is a lack of literature about the radiology education infrastructure in Africa. This gap in the literature can be challenging for radiologists who would like to collaborate, contribute, and learn from differences, similarities, and challenges in radiology education systems outside their countries. There is a wide range of training infrastructure and assessment methods across the globe with respect to preclinical qualifications, radiology residency structure, on-call requirements, access to teaching, and certifying national or board examinations [1]. Learning about variations in residency training may encourage exchange of comparative experiences to better prepare trainees for an everevolving practice environment. The aim of our study is to analyze country-specific data in Africa about radiology residency and subspecialty education, research needs, and opportunities to collaborate.

Advanced adenoma diagnosis with FDG PET in a visibly normal mucosa: a case report

BackgroundAn accurate, early diagnosis and treatment of adenomatous polyp can curtail progression to colorectal cancer. F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET) reveals the biochemical changes associated with the development of many cancers which precede the appearance of gross anatomical changes that may be visualized during surgical resection or via imaging with MR or CT.InterventionWe detail the history of a 64 year old female who had a whole-body FDG PET scan as a part of an employee wellness program. A dose of 12.2 mCi of F-18 labeled FDG was administered.ResultsA focal cecal uptake with a standardized uptake value (SUV) of 8.9 was found on the PET scan. Conversely, only normal mucosa was observed during a colonoscopy done 2 months after the PET scan. Motivated by the PET scan finding, the colonoscopist performed a biopsy which revealed a villous adenoma without high grade dysplasia. Pathology from tissue extracted during an exploratory laparatomy completed one month later found the lesion to be a villous adenoma with high grade dysplasia.ConclusionWhole-body FDG PET scan revealed the biochemical metabolic changes in malignancy that preceded the appearance of any gross anatomical abnormality. A positive FDG PET scan indicative of colorectal cancer should be followed up with a colonoscopy and biopsy even in a visibly normal mucosa.

Diagnostic Performance of Brain MRI in Immune Reconstitution Inflammatory Syndrome

Central nervous system immune reconstitution inflammatory syndrome (CNS‐IRIS) significantly negatively impacts the human immunodeficiency virus (HIV)‐infected population on combination antiretroviral therapy (cART). We sought to determine the diagnostic performance of several magnetic resonance imaging (MRI) features for CNS‐IRIS in a cohort of HIV+ patients recently started on cART.

Rosai-Dorfman Disease Isolated to the Thoracic Epidural Spine

Rosai-Dorfman disease is a rare benign histiocytic disease that infrequently presents in the spine. We report a case of Rosai-Dorfman disease isolated to the epidural thoracic spine in a 26-year-old male. To our knowledge, this is the 15th reported case of isolated spinal disease and only the fourth case of isolated thoracic epidural disease. Given its rarity as well as non-specific symptoms and imaging findings, Rosai-Dorfman disease is often not considered and misdiagnosed on imaging studies. To help improve awareness of Rosai-Dorfman spinal disease, we review the literature and discuss the epidemiology, clinical presentation, imaging features, and treatment considerations for this condition.