Stefan Heinze

Comparative effectiveness of radial probe endobronchial ultrasound versus CT-guided needle biopsy for evaluation of peripheral pulmonary lesions: A randomized pragmatic trial

In many patients the optimal method of investigation of peripheral pulmonary lesions (PPL) is not clear. We performed a prospective randomized pragmatic trial to determine the comparative effectiveness of endobronchial ultrasound-guided transbronchial lung biopsy (EBUS-TBLB) and CT-guided percutaneous needle biopsy (CT-PNB) for the investigation of PPL. Overall complication rates were higher in those undergoing CT-PNB (27% v 3%, p = 0.03), while diagnostic accuracy of EBUS-TBLB was shown to be non-inferior to that of CT-PNB. Expected diagnostic accuracy and complication rates are likely to differ for individual patients on the basis of specific complex clinicoradiologic factors, which will influence the cost-benefit analysis between EBUS-TBLB and CT-PNB for individual patients. Further studies are required to examine the effect of these factors on clinical decision-making.

Blood loss during radical retropubic prostatectomy: relationship to morphologic features on preoperative endorectal magnetic resonance imaging

OBJECTIVES To determine whether morphologic features at preoperative magnetic resonance imaging (MRI) are related to intraoperative blood loss during radical retropubic prostatectomy. METHODS Endorectal MRI was performed in 143 patients with newly diagnosed prostate cancer before radical retropubic prostatectomy. Two independent readers rated the prominence of the periprostatic veins (on the basis of number and size) at four anatomic sites on a 3-point scale. Other features analyzed were prostate volume and interspinous diameter. RESULTS A prominence of the anterior and posterior apical periprostatic veins was positively associated with blood loss (correlation coefficient = 0.22 and 0.17 and P <0.01 and <0.05, respectively). Blood loss was not related to prostate volume (correlation coefficient = 0.02, P = 0.8) or interspinous diameter (correlation coefficient = 0.01, P = 0.9). The site-specific scores of both readers demonstrated positive agreement, with Pearsons correlation coefficients of 0.51 to 0.65 (P <0.01). CONCLUSIONS A marked prominence of the apical periprostatic veins on preoperative MRI is associated with greater intraoperative blood loss during radical retropubic prostatectomy. Other morphologic factors appear unrelated to the amount of intraoperative blood loss.

ENDORECTAL MAGNETIC RESONANCE IMAGING STAGING OF PROSTATE CANCER

Background:  There are important treatment and prognostic implications in distinguishing between organ‐confined prostate cancer that has spread locally outside the capsule and that which has spread into the seminal vesicles. This study is the first Australian study to report local accuracy for the locoregional staging of prostate cancer with endorectal magnetic resonance imaging (MRI).

Routine editing of trainee-generated radiology reports: effect on style quality.

RATIONALE AND OBJECTIVES The authors performed this study to determine the effect of routine editing on the style quality of trainee-generated radiology reports. MATERIALS AND METHODS Trainee-generated reports of 50 body computed tomographic scans obtained at a tertiary care cancer center were edited in a routine fashion by one of two attending radiologists. Three physicians and four radiologists each independently evaluated the randomized unedited and edited reports (n = 100) and rated each report for clarity, brevity, readability, and quality of the impression by using a five-point scale. RESULTS Editing significantly improved mean ratings for clarity (4.6 after editing vs 4.2 before editing, P < .007), brevity (4.6 vs 4.2, P < .007), readability (4.4 vs 4.1, P < .007), and quality of the impression (4.5 vs 4.3, P < .007). CONCLUSION Routine editing of trainee-generated reports significantly improves the perceived report quality. This finding suggests that greater emphasis should be placed on stylistic aspects of reporting during training to improve report style quality at dictation.

Lateral lumbar X-ray assessment of abdominal aortic calcification in Australian haemodialysis patients

Aim:  Vascular calcification is prevalent in patients with chronic kidney disease. Abdominal aortic calcification (AAC) can be detected by X‐ray, although AAC is less well documented in anatomical distribution and severity compared with coronary calcification. Using simple radiological imaging we aimed to assess AAC and determine associations in prevalent Australian haemodialysis (HD) patients.

Assessment of patient dose and image quality for cardiac CT with breast shields

Breast shielding can reduce dose to the female breast, a radiosensitive organ receiving significant radiation during computed tomography (CT) chest examinations, particularly in cardiac CT, where Electrocardiogram dose modulation currently precludes the use of radial dose modulation to reduce breast dose. However, breast shields may produce artefacts affecting interpretation of coronary arteries. This study explores the dose savings and the effect of breast shields on image quality with torso and CT dose index body phantoms and an organ dose calculator. Change in dose calculated: 53-63 % (female breast), 82-85 % (lung), 79-84 % (oesophagus) and 76-80 % (effective dose) with larger dose reductions at lower kVp. Image quality is preserved when breast shields are placed after the scout no closer than 10 mm from the skin. Therefore, breast shields can be used in cardiac CT to reduce breast dose without compromising image quality. Revised conversion factors for dose length product to effective dose are suggested for cardiac CT without and with breast shields.

OPTIMIZING THE APPROACH TO PATIENTS WITH POTENTIALLY RESECTABLE LIVER METASTASES FROM COLORECTAL CANCER

Liver metastases are a common event in colorectal carcinoma. Significant advances have been made in managing these patients in the last decade, including improvements in staging and surgical techniques, an increasing armamentarium of chemotherapeutics and multiple local ablative techniques. While combination chemotherapy significantly improves median patient survival, surgical resection provides the only prospect of cure and is the focus of this review. Interpretation of published work in this field is challenging, particularly as there is no consensus to what is resectable disease. Of particular interest recently has been the use of neoadjuvant treatment for downstaging and downsizing disease in patients with initially unresectable liver metastases, in the hope of response leading to potentially curative surgery. This review summarizes the recent developments and consensus guidelines in the areas of staging, chemotherapy, local ablative techniques, radiation therapy and surgery, emphasizing the multidisciplinary approach to this disease and ongoing controversies in this field and examines the changing paradigms in the management of colorectal hepatic metastases.

Implications of the diagnostic criteria of idiopathic pulmonary fibrosis in clinical practice: Analysis from the Australian Idiopathic Pulmonary Fibrosis Registry: Implications of IPF diagnostic criteria

Current guidelines for the diagnosis of idiopathic pulmonary fibrosis (IPF) provide specific criteria for diagnosis in the setting of multidisciplinary discussion (MDD). We evaluate the utility and reproducibility of these diagnostic guidelines, using clinical data from the Australian IPF Registry.

CT-Fluoroscopic Guidance for Performance of Targeted Transbronchial Cryobiopsy: A Preliminary Report

Background: Bronchoscopic transbronchial cryobiopsy is increasingly used for the histological assessment of diffuse parenchymal lung disease. Diagnostic performance may be improved by more accurate targeting of biopsy to radiologic abnormalities, and complication rates may be reduced by avoiding biopsy of pleura or larger vessels. Objectives: To report the preliminary experience of using CT-fluoroscopic guidance for accurate targeting of bronchoscopic transbronchial cryobiopsy. Methods: Bronchoscopic cryobiopsy was performed in a hybrid CT theatre. 3D CT images were acquired following positioning of the cryoprobe in a distal airway segment. Where cryoprobe position was observed to be too close to the chest wall/diaphragm pleura, or not within the region of interest within the lung parenchyma, re-positioning of probe was undertaken and repeat 3D images were acquired to confirm positioning prior to cryobiopsy. Results: CT-fluoroscopic transbronchial cryobiopsy was successfully performed in 4 patients: 3 patients with interstitial lung infiltrates, and one with an enlarging left upper lobe mass. Images were reviewed following each acquisition to accurately assess the probe position within the lung parenchyma, and relative to other thoracic structures. Intra-procedural imaging was of sufficient quality to allow the accurate positioning of the cryoprobe tip with respect to both the parenchymal region of interest and pleural surfaces. No complications were experienced, and all procedures yielded diagnostic specimens. Conclusions: Our preliminary experience confirms the feasibility of performing transbronchial cryobiopsy under CT-fluoroscopic guidance. Accurate targeting of transbronchial cryobiopsy may be achieved using CT-fluoroscopic guidance. Positioning of the probe tip, both with respect to parenchymal region of interest and to pleural surfaces, can be established with high accuracy.

The many faces of lung adenocarcinoma: A pictorial essay

Lung adenocarcinoma has a spectrum of appearances on CT, many of which mimic non‐malignant processes. The general radiologist has a major role in guiding the management of abnormalities detected on chest CT and an awareness of these appearances is vital. We describe the protean imaging manifestations of lung adenocarcinoma.