William Simpson

Pulmonary artery and aortic sarcomas: cross-sectional imaging.

Sarcomas of the major arteries are rare tumors often misdiagnosed due to nonspecific symptomatology. The authors present three cases of pulmonary artery and aortic sarcomas that were initially believed to be more common diseases. Modern imaging techniques including helical computed tomography (CT) and magnetic resonance imaging (MRI) are increasing the frequency of premortem diagnosis of these entities and aided surgical planning.

Imaging Manifestations of Niemann-Pick Disease Type B

OBJECTIVE The purpose of this article is to illustrate the various imaging manifestations of Niemann-Pick disease type B using various imaging techniques emphasizing cross-sectional imaging. CONCLUSION Niemann-Pick disease type B is a multisystem disease that affects the pulmonary, cardiovascular, abdominal, and skeletal systems. Cross-sectional imaging is well suited for detecting and assessing the various manifestations of this disease, which can be highly suggestive of the diagnosis when seen in combination.

Imaging of Male Infertility: Pictorial Review

OBJECTIVE This article will review the workup of infertility in a male. The imaging of common conditions associated with infertility, including varicocele, ejaculatory duct obstruction, seminal vesicle agenesis, and undescended testis, will be shown, as well as other conditions that can be incidentally seen. CONCLUSION The analysis of infertility in males has become more common in recent years. The practicing radiologist should be familiar with the evaluation of the infertile man and the common radiologic findings and disease processes associated with infertility.

Skeletal changes in patients on regular hemodialysis.

Abstract Regular hemodialysis at Newcastle upon Tyne has been shown to be associated with the progressive development of bone pain and radiological abnormalities, the most prominent being alteration of the trabecular pattern (seen best in the hands), a reduction in cortical thickness, and pathological fractures (seen most commonly in the ribs) which remained unhealed for long periods. Subarticular sclerosis developed in most patients. The usual features of hyperparathyroidism were inconspicuous, and those patients who demonstrated them usually did not have fractures. These changes are attributable to a combination of osteomalacia, osteoporosis, and hyperparathyroidism. There is some evidence that the local water supply has something to do with it.

Imaging of Gaucher disease

Gaucher disease is the prototypical lysosomal storage disease. It results from the accumulation of undegraded glucosylceramide in the reticuloendothelial system of the bone marrow, spleen and liver due to deficiency of the enzyme glucocerebrosidase. This leads to hematologic, visceral and skeletal maifestions. Build up of glucosylceramide in the liver and spleen results in hepatosplenomegaly. The normal bone marrow is replaced by the accumulating substrate leading to many of the hematologic signs including anemia. The visceral and skeletal manifestations can be visualized with various imaging modalities including radiography, computed tomography, magnetic resonance imaging (MRI) and radionuclide scanning. Prior to the development of enzyme replacement therapy, treatment was only supportive. However, once intravenous enzyme replacement therapy became available in the 1990s it quickly became the standard of care. Enzyme replacement therapy leads to improvement in all manifestations. The visceral and hematologic manifestations respond more quickly usually within a few months or years. The skeletal manifestations take much longer, usually several years, to show improvement. In recent years newer treatment strategies, such as substrate reduction therapy, have been under investigation. Imaging plays a key role in both initial diagnosis and routine monitoring of patient on treatment particularly volumetric MRI of the liver and spleen and MRI of the femora for evaluating bone marrow disease burden.

Implementation and evaluation of a performance improvement intervention to address physician documentation deficiencies in abdominal ultrasound.

Purpose For ultrasound reports to meet criteria for coding as abdomen complete (USABC), 8 elements are required: liver, bile ducts, gallbladder, spleen, kidneys, pancreas, inferior vena cava (IVC), and aorta. Failure to document all 8 results in coding as ultrasound abdomen limited. The purposes of our study were to identify deficiencies in documentation, implement a performance improvement intervention to address deficiencies, and evaluate the intervention. Methods In the first phase, 50 consecutive USABC reports performed as part of routine medical care were retrospectively analyzed for the presence or absence of the 8 elements required for USABC coding. Subsequently, education regarding current procedural terminology coding in abdominal ultrasound and standardized macros was provided to radiologists. In the second, postintervention phase, an additional 50 consecutive USABC reports were analyzed for the presence or absence of the 8 elements. Results In the first phase, none (0%) of 50 reports met criteria for USABC. The most commonly omitted elements were IVC (present in 2% of reports) and aorta (present in 6%). After intervention, there was an increase to 37 reports (74%) meeting criteria for USABC. The most commonly omitted elements were IVC (present in 76%) and aorta (present in 86%). Lack of 100% compliance was secondary to failure to update a macro and inaccurately scheduled studies (focused right lower quadrant/appendicitis study scheduled as USABC). Conclusions We improved USABC documentation from 0% to 74%. Our compliance rate after intervention was similar to the 75.1% of previously published larger studies. Our study illustrates the efficacy of simple performance improvement interventions to improve abdominal ultrasound documentation.

Lymph nodes can accurately be measured on PET-CT for lymphoma staging/restaging without a concomitant contrast enhanced CT scan

Abstract Dual imaging with both contrast enhanced CT scan and PET-CT is recommended for evaluation of lymphoma. We compared the performance in identification and size measurements of involved lymph nodes in FDG-avid lymphomas on the low dose non-contrast enhanced CT of a PET-CT scan with those on a diagnostic contrast enhanced CT scan. The size of FDG-avid lymph nodes was measured in both the short and long axis on both the low dose non-contrast CT of the PET-CT and the contrast enhanced CT by two independent readers. A total of 307 FGD avid lymph nodes were identified in 52 patients. There was no statistically significant differences in the measured size of the nodes on the non-contrast and contrast enhanced scans (p = 0.21). Baseline staging and restaging of FDG-avid lymphomas can be performed with one test, PET-CT, without an accompanying contrast enhanced CT scan, with no effect on the measured nodal size.

Anatomy and pathology of the canal of Nuck

The canal of Nuck is the female equivalent of the processus vaginalis in the male but is less well known than its male counterpart. It is a rare entity not commonly encountered by radiologists, particularly in the adult population. Knowledge of the embryology and anatomy of the canal of Nuck is essential for identification of the various pathologic conditions that may occur in this location. Moreover, radiologists should be familiar with this entity to compose an appropriate and thorough differential diagnosis of a labial mass/swelling. In this review, we discuss both the anatomy and the more common pathology that can be encountered within it.

Radiologic Differentiation of Adrenal Lesions and Its Impact on Patient Management

Adrenal lesions are a relatively common incidental finding and are estimated to be present in 4.4% of all abdominal CT scans.1 The detection of an adrenal lesion often necessitates a thorough clinical evaluation that frequently requires a comprehensive patient history, biochemical studies, and radiologic studies such as dedicated adrenal protocol CT or MRI. The primary goal of additional radiologic studies is to differentiate benign from malignant adrenal lesions. It is, therefore, important for the radiologist to be familiar with a variety of benign and malignant adrenal lesions and to recognize distinctive imaging characteristics that can help make this distinction. This article reviews typical and useful imaging features of more commonly encountered benign and malignant adrenal lesions.

Isolated fallopian tube torsion: two case reports of a rare entity

Isolated fallopian tube torsion is a rare entity that is difficult to diagnose, as its clinical presentation is often highly nonspecific. Early diagnosis is important to avoid damage or loss of the fallopian tube or even the ovary, as this diagnosis occurs predominantly in women of child-bearing age. Imaging may be helpful in suggesting this difficult diagnosis, with confirmation of this entity made in the operating room. Treatment can range from detorsing the tube to salpingectomy or even salpingo-oopherectomy. Here, we present two cases of isolated fallopian tube torsion, followed by a discussion of its imaging findings.