The characterization of brachial plexus (BP) pathology can be perplexing for the radiologist, especially due to varying combination of sensory and motor symptoms depending on the extent of disease and the level of disease process. Localization can be difficult due to inherently complex anatomy of the BP complicated by a variety of benign and malignant disease processes. Infrequently requested imaging of the BP, can be a challenge to both the novice and experienced reader. Invasive methods of diagnosis, such as biopsy, yield variable results and carry the risk of causing permanent sensory and/or motor deficit and may also cause long-term neuralgic pain. The purpose of this article is to provide a straightforward review of BP pathology as seen by conventional magnetic resonance imaging and to illustrate the value of this noninvasive technique in guiding management.
Objective: Transarterial chemo-embolization (TACE) is a palliative treatment option for hepatocellular carcinoma (HCC) with improved patient survival. The aim of the study was to see the outcome of our patients at our institution 2 years post TACE. Patients and Methods: Electronic records were retrospectively reviewed for patients who had TACE from 1st November 2009 – 31st October 2012. Baseline imaging, multidisciplinary team (MDT) and clinical notes, pathology labs, TACE angiograms and follow up imaging were reviewed for 2 years after first TACE. Procedure complications, clinical status and findings at follow up CT were reviewed and analyzed in SPSS version 19. Survival was assessed using Kaplan Meier curves. Results: A total of 104 patients had TACE for HCC. Amongst these 21 patients were lost to follow up and could not be contacted to reconfirm the outcome and had to be excluded to minimize bias. Amongst the included 83 patients, 57 (68.7%) were male and 65 (78.4%) were 51-70 years of age at time of first TACE. The commonest cause for HCC was HCV in 74 (89.2%) patients. Target lesion size at baseline CT was < 5 cm in 38 (45.8%) patients, 5-10 cm in 37 (44.6%) patients and >10 cm in 8 (9.6%) patients. A total of 25 (30%) patients needed more than 1 session of TACE. On post TACE CT, 46 (55.4%) patients had good packing of lipoidol in the lesion. A total of 18 (21.7%) patients progressed in TACED lesions while another 21 (25%) progressed with new lesions. One patient had metastasis to adrenal gland. Only 8 (9.6%) patients had liver failure after TACE and 1 patient had hepatorenal syndrome. Only 1 patient died within 30 days after TACE. Two years post TACE, 47 (56.6%) patients were alive indicating good outcome. Conclusion: TACE improves survival in HCC; 1 year survival was 80% and 2 year survival was 56.6%.
Suprasellar meningiomas make a relevant differential when it comes to sellar/suprasellar masses. The most common pathology in this location is pituitary adenomas. It is imperative to differentiate the two entities based on imaging as the clinical picture, and sometimes the biochemical profile can show significant overlap. It is also essential for the neurosurgeons to have a preoperative diagnosis as the behavior of both tumors is different. This piece will give a pictorial review of the imaging features of suprasellar meningiomas, in patients who presented to us with sellar/suprasellar masses. The aim is to help the radiologists as well as fellow clinicians to diagnose this entity with confidence based on imaging.
Purpose: The Canadian Association of Radiologists (CAR) Endometriosis Working Group developed a national survey to evaluate current practice patterns associated with imaging endometriosis using advanced pelvic ultrasound and MRI to inform forthcoming clinical practice guidelines for endometriosis imaging. Methods: The anonymous survey consisted of 36 questions and was distributed electronically to CAR members. The survey contained a mix of multiple choice, Likert scale and open-ended questions intended to collect information about training and certification, current practices and protocols associated with imaging endometriosis, opportunities for quality improvement and continuing professional development. Descriptive statistics were used to summarize the results. Results: Canadian radiologists were surveyed about their experience with imaging endometriosis. A total of 89 responses were obtained, mostly from Ontario and Quebec. Most respondents were community radiologists, and almost 33% were in their first five years of practice. Approximately 38% of respondents reported that they or their institution performed advanced pelvic ultrasound for endometriosis, with most having done so for less than 5 years, and most having received training during residency or fellowship. 70% of respondents stated they currently interpret pelvic endometriosis MRI, with most having 1-5 years of experience. Conclusion: Many radiologists in Canada do not perform dedicated imaging for endometriosis. This may be due to a lack of understanding of the benefits and limited access to training. However, dedicated imaging can improve patient outcomes and decrease repeated surgeries. The results highlight the importance of developing guidelines for these imaging techniques and promoting a multidisciplinary approach to endometriosis management.
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