Declared competing interests of authors: ARP has received reporting fees from Nuada Medical Prostate Care for patients with prostate cancer who were scanned at their medical facilities. JR has received consultancy honoraria and payment for lectures, expert testimony and travel/accommodation/meetings expenses from GlaxoSmithKline, and consultancy honoraria, payment for lectures and travel/ accommodation/meetings expenses from Ipsen. TS has received payment for travel/accommodation/ meeting expenses from multiple sources and his institution has received payment from Siemens Healthcare for a research collaboration. Published May 2013 DOI: 10.3310/hta17200This report should be referenced as follows:Mowatt G, Scotland G, Boachie C, Cruickshank M, Ford JA, Fraser C, et al. The diagnostic accuracy and cost-effectiveness of magnetic resonance spectroscopy and enhanced magnetic resonance imaging techniques in aiding the localisation of prostate abnormalities for biopsy: a systematic review and economic evaluation. Health Technol Assess 2013;17(20). This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/). Health Technology Assessment is indexed and abstracted inEditorial contact: nihredit@southampton.ac.ukThe full HTA archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hta. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Technology Assessment journalReports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: www.hta.ac.uk/ This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 09/146/01. The contractual start date was in August 2010. The draft report began editorial ...

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Conventional fluoroscopy is an accurate, safe, and low-dose alternative modality to CT to obtain an image-guided histological diagnosis of pulmonary lesions.

IntroductionSolitary pulmonary nodules (SPNs) are common on CT. The most cost-effective investigation algorithm is still to be determined. Dynamic contrast-enhanced CT (DCE-CT) is an established diagnostic test not widely available in the UK currently.Methods and analysisThe SPUtNIk study will assess the diagnostic accuracy, clinical utility and cost-effectiveness of DCE-CT, alongside the current CT and 18-flurodeoxyglucose-positron emission tomography) (18FDG-PET)-CT nodule characterisation strategies in the National Health Service (NHS). Image acquisition and data analysis for 18FDG-PET-CT and DCE-CT will follow a standardised protocol with central review of 10% to ensure quality assurance. Decision analytic modelling will assess the likely costs and health outcomes resulting from incorporation of DCE-CT into management strategies for patients with SPNs.Ethics and disseminationApproval has been granted by the South West Research Ethics Committee. Ethics reference number 12/SW/0206. The results of the trial will be presented at national and international meetings and published in an Health Technology Assessment (HTA) Monograph and in peer-reviewed journals.Trial registration numberISRCTN30784948; Pre-results.

Introduction:We examined the relationship between the size and nature of renal masses in term of malignant potential, histological grading, pathological staging and presence of necrosis and sarcomatoid changes.Materials and Methods:Retrospectively, we reviewed 323 consecutive nephrectomies between 2000 and 2010. Final pathology was correlated with tumour size. The renal tumours were stratified into three groups according to the largest diameter, defined as 4 cm or smaller, greater than 4 cm to 7 cm, and greater than 7 cm. We recorded the proportion of benign tumours, tumour grade and stage, presence of necrosis and sarcomatoid change.Results:Small renal masses ≤4 cm (SRMs) were more likely to be localised to the kidney (90%) and of lower histological grade (75%). The proportion of benign tumours in SRMs (15%) was higher than other two groups with the majority of benign tumours being oncocytomas. There was a statistically significant trend with greater necrosis and sarcomatoid change for the large size group.Conclusions:SRMs are likely to be low grade and organ confined with little or no adverse pathological features. There is increased likelihood of benignity in SRTs with the majority of benign tumours being oncocytomas.

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BACKGROUNDWhile tuberculosis (TB) itself is a common disease, isolated TB of the liver is a rare entity. The presented case demonstrates the diffi culty of diagnosing this condition in spite of a complete investigation, due to its non-specifi c clinical and radiological appearances. CASE PRESENTATIONA 46-year-old Information Technology analyst fi rst presented with 3 months complaints of low-grade fever, night sweats and mild exertional breathlessness. The symptoms worsened over time and were accompanied by fatigue and loss of weight of approximately 3 kg. There were no specifi c clinical fi ndings. Haematology, coagulation profi le, liver and renal functions were within normal limits.At this stage the differential diagnosis of lymphoma with B symptoms was considered and a CT scan was requested. Viral hepatitis was ruled out by serological testing (ELISA), and although possibility of other parasitic and helminthic infestations was considered, it was a lower priority at this stage due to absence of a signifi cant contributory history of exposure. INVESTIGATIONSPlain CT scan of the abdomen showed an 8 cm solid, poorly enhancing mass in segment II and IV of the liver, which extended into the liver capsule. The mass was contiguous with a 30 mm × 37 mm lymph node mass in the gastrohepatic ligament which encased the left gastric artery. The adjacent wall of the lesser curve of the stomach was Unusual association of diseases/symptoms

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