Efthimia Alexopoulou

Patient radiation exposure measurements during interventional procedures: a prospective study.

This is a prospective study with the purpose of assessing patient radiation dose and stochastic risk (risk for fatal cancer) in a patient population undergoing interventional radiological (IR) procedures. Measurements were performed on 36 consecutive patients undergoing percutaneous transluminal angioplasty (PTA, n = 18), transjugular intrahepatic portosystemic shunt (TIPS, n = 3), diagnostic angiography (DA, n = 6), arterial embolization (AE, n = 3), and hepatic neoplasm chemoembolization (HCE, n = 6). Kerma area product (KAP) was used as a measure of x-ray exposure to the patient. Mean KAP value per procedure was 79 ± 50 Gy cm−2 for PTA, 139 ± 55 Gy cm−2 for TIPS, 110 ± 44 Gy cm−2 for DA, 325 ± 145 Gy cm−2 for AE, and 150 ± 76 Gy cm−2 for HCE. Forty-six percent of total KAP value was attributed to fluoroscopy. In conclusion, we showed that a linear correlation between effective dose and KAP was found (r2 = 0.84), which could be used for estimating patient effective dose using KAP measurements. Small changes to the number of digital frames acquired result in substantial change of the total KAP in interventional radiological procedures. Stochastic risk from IR procedures is quite low for the patient. Measuring KAP is a simple and accurate method, which provides the interventional radiologist with a good estimation of the patient’s relative risk for stochastic effects.

Multiparametric Magnetic Resonance Imaging of the Prostate for Tumour Detection and Local Staging: Imaging in 1.5T and Histopathologic Correlation

Purpose The study sought to prospectively evaluate which technique among T2-weighted images, dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI), diffusion-weighted (DW) MRI, or a combination of the 2, is best suited for prostate cancer detection and local staging. Methods Twenty-seven consecutive patients with biopsy-proven adenocarcinoma of the prostate underwent MRI on a 1.5T scanner with a surface phased-array coil prior radical prostatectomy. Combined anatomical and functional imaging was performed with the use of T2-weighted sequences, DCE MRI, and DW MRI. We compared the imaging results with whole mount histopathology. Results For the multiparametric approach, significantly higher sensitivity values, that is, 53% (95% confidence interval [CI]: 41.0-64.1) were obtained as compared with each modality alone or any combination of the 3 modalities (P < .05). The specificity for this multiparametric approach, being 90.3% (95% CI: 86.3-93.3) was not significantly higher (P < .05) as compared with the values of the combination of T2+DCE MRI, DW+DCE MRI, or DCE MRI alone. Among the 3 techniques, DCE had the best performance for tumour detection in both the peripheral and the transition zone. High negative predictive value rates (>86%) were obtained for both tumour detection and local staging. Conclusions The combination of T2-weighted sequences, DCE MRI, and DW MRI yields higher diagnostic performance for tumour detection and local staging than can any of these techniques alone or even any combination of them.

Differential diagnosis of renal mass: question

A 6-year-old girl was admitted because of a low-grade fever of 5 days’ duration. She had an isolated, bulging, block of tender, firm, cervical lymph nodes, without erythema or increased temperature of the overlying skin. A full blood count showed white blood cells of 5.7×10/μl, with neutrophils 39%, lymphocytes 51%, monocytes 6%, and eosinophils 4%; hemoglobin level 12.7 g/dl; hematocrit 37.4%; platelets 340×10/μl. The findings of urine analysis were normal. The child was given clindamycin intravenously for 10 days, and the block of lymph nodes gradually resolved. Looking for abdominal masses or para-aortic lymph nodes, we found a discrete mass in the middle right kidney, incidentally identified by ultrasonography (Fig. 1a). We further explored this finding with color Doppler ultrasonography (Fig. 1b), technetium-99m dimercapto-succinic acid (Tc-DMSA) scan, and magnetic resonance (MR) imaging. Pediatr Nephrol (2010) 25:441–442 DOI 10.1007/s00467-009-1216-8

Transient elevation of the ipsilateral hemidiaphragm associated with pneumonia

Seventeen children with lobar or segmental pneumonia and ispilateral elevation of the diaphragm are described. These children did not differ significantly with respect to clinical and laboratory findings from their counterparts with pneumonia but without elevation of the hemidiaphragm. The elevation was transient and resolved by the time the repeat chest x-ray was taken six to eight weeks later.

Differential diagnosis of renal mass: answer

1. The magnetic resonance (MR) study shows a wedgeshaped area in the right kidney (black arrows), which had homogeneous early arterial enhancement, similar to that of the renal cortex (black arrows). The appearance is consistent with a hypertrophied column of Bertin. Magnetic resonance is helpful in differentiating renal masses that have been found by ultrasound to be suggestive of malignancy. 2. The renal scan shows normal size, shape and contour of both kidneys, with normal homogeneous uptake of the isotope and no photopenic areas. 3. The renal mass represents columns of Bertin, as the wedge-shaped area in the MR study showed arterial enhancement similar to that of the cortex and the renal scan was normal. Commentary