Faculty Bibliography

OBJECTIVE: The purpose of this study was to determine the value of clinical parameters and radiologic findings on unenhanced CT to the choice between interventional and conservative management for patients with acute renal colic. MATERIALS AND METHODS: Unenhanced CT records of 183 consecutive patients with acute renal colic were retrospectively reviewed. Urolithiasis was confirmed at both unenhanced CT and clinical follow-up findings of 80 patients (study group). Clinical parameters (signs of infection and renal indexes) and unenhanced CT findings (tissue rim sign, hydronephrosis, perinephric and periureteral edema, ureteral dilatation, renal attenuation, and stone characteristics) were graded and correlated with the choice of clinical management. ROC analysis was constructed for the most statistically significant parameters. RESULTS: Forty-two patients (52%) were treated conservatively and 38 (48%) underwent interventional treatments. The relationship between shivering, fever, and leukocytosis and interventional treatment had low sensitivity (29%, 26%, and 16%, respectively) but very high specificity (98%, 95%, and 98%, respectively) (p < 0.05). Stone size and density were statistically significantly different between patients treated conservatively and those treated interventionally (size, 4.6 vs 6.7 mm; density, 730 vs 910 HU; p < 0.01). Stones larger than 6.5 mm with an attenuation value greater than 1100 HU and that were proximally located were more likely to be treated interventionally. CONCLUSION: Larger stone size, higher density, proximal location, and complaints of shivering, fever, and leukocytosis are the most important parameters for predicting invasive management of acute renal colic. Other clinical and radiologic information may be useful as supportive findings but do not predict the choice of patient management.

Purpose To assess the diagnostic value of apparent diffusion coefficients (ADCs) in spontaneous intracranial abscesses compared with those occurring after primary neurosurgery. Materials and Methods This retrospective comparative study was approved by the local institutional review board. The requirement to obtain written informed consent was waived. A total of 73 consecutive patients who underwent preoperative diffusion-weighted magnetic resonance (MR) imaging from February 2005 to May 2015 were divided into two cohorts depending on whether the abscess was identified after a primary neurosurgical procedure (n = 43) or was a spontaneous abscess (n = 30). Abscesses were assessed for ADC by two readers independently. ADCs were described as medians with interquartile range. The Mann-Whitney and chi(2) tests were used to compare ADCs between the two cohorts, and chi(2) automatic interaction detection analysis was used to classify the ADCs into categories according to the cohorts. Results The median ADC of postoperative abscesses was 1.34 x 10(-3) mm(2)/sec (interquartile range, 1.00-1.62 x 10(-3) mm(2)/sec), which was significantly higher than the median ADC of spontaneous abscesses, 0.68 x 10(-3) mm(2)/sec (interquartile range, 0.58-0.79 x 10(-3) mm(2)/sec; P < .001). Twenty four (83%) of the abscesses with ADCs less than 0.79 x 10(-3) mm(2)/sec were found to be spontaneous, while only six (27%) abscesses with ADCs between 0.79 and 1.33 x 10(-3) mm(2)/sec and no abscesses with ADCs greater than 1.33 x 10(-3) mm(2)/sec were spontaneous (P < .001). Conclusion Significantly higher ADCs were found in postoperative abscesses compared with those in spontaneous abscesses. Diffusion-weighted imaging with ADC mapping is not sufficient for excluding postoperative intracranial abscess and should not be used as the key diagnostic modality in this situation. ((c)) RSNA, 2016.

OBJECTIVE: The purpose of this study was to retrospectively assess the role of early postmortem CT in evaluating support-line misplacement to improve future treatment in the trauma setting. MATERIALS AND METHODS: We included all postmortem CT examinations that were performed for trauma patients within the 1st hour after declaration of death in our tertiary medical center between August 1, 2008, and August 31, 2013. Correct placement of the following support lines was evaluated: endotracheal tubes (ETTs), chest drains, central venous catheters (CVCs), and nasogastric tubes (NGTs). Prehospital resuscitation efforts were started in all cases. RESULTS: Early postmortem CT was performed on average 22 minutes after declaration of death in 25 consecutive patients with severe trauma. Overall, 14 subjects (56%) had suboptimal or misplaced support lines. Of ETTs inserted into 18 trauma victims; three (17%) were mislaid in the right main bronchus and five (28%) were near or at the level of the carina. Of chest drains inserted into 13 subjects, 10 were suboptimally positioned (77%). Of CVCs inserted into eight subjects (seven femoral and one brachiocephalic), one femoral CVC (13%) was malpositioned in the soft tissues of the pelvis. Of NGTs inserted in five trauma victims, one was folded within the pharynx. CONCLUSION: Early postmortem CT for patients who have experienced severe poly-trauma can be of important educational value to radiologists and the trauma teams, providing immediate feedback regarding the location of the support lines and possibly contributing to improved training and command of the learning curve by medical staff.

Recent research in systemic lupus erythematosus (SLE) yielded new antigens and antibodies in SLE patients. We describe the various autoantibodies that can be detected in patients with SLE. A literature review, using the terms “autoantibody” and “systemic lupus erythematosus”, was conducted to search for articles on autoantibodies in SLE, their target antigens, association with disease activity and other clinical manifestations. One hundred and eighty autoantibodies were so far described in SLE patients. These include autoantibodies that target nuclear antigens, cytoplasmic antigens, cell membrane antigens, phospholipid-associated antigens, blood cells, endothelial cells, and nervous system antigens, plasma proteins, matrix proteins, and miscellaneous antigens. The target of an autoantibody, the autoantigen properties, autoantibody frequencies in SLE, as well as clinical associations, and correlation with disease activity are described for all 180 autoantibodies. SLE is so far the autoimmune disease with the largest number of detectable autoantibodies. Their production could be antigen-driven, the result of a polyclonal B cell activation, impaired apoptotic pathways, or the outcome of an idiotypic network dysregulation.

Several studies have shown that more than half of cancer patients have unrecognized renal insufficiency (RI), which is a reduced glomerular filtration rate (GFR) with normal serum creatinine. The aim of this study was to determine whether unrecognized RI is associated with an increased risk for chemotherapy-associated adverse effects in breast cancer patients treated with combined doxorubicin and cyclophosphamide treatment. GFR was estimated for 95 breast cancer patients from January 2005 to August 2009 using the Cockcroft-Gault formula. Unrecognized RI was defined as GFR less than 75 ml/min/1.73 m and the patients were grouped according to their estimated GFR. Logistic regression models were used to assess the effect of GFR on clinical outcomes. In total, 49 (52%) patients experienced at least one of the following chemotherapy-associated adverse effects during the course of treatment: an episode of neutropenic fever with hospital admission, a delay in chemotherapy treatment for a medical reason, a need for dose adjustment because of toxicity of the chemotherapeutic drugs, and the need for use of granulocyte colony-stimulating factor. The incidence of these adverse effects occurred more frequently in patients with GFR less than 75 compared with patients with GFR at least 75 (64 vs. 42%, odds ratio 5.29, 95% confidence interval 2.10-13.33) and remained statistically significant after adjustment for age, BMI, and initial doses of chemotherapeutic drugs (odds ratio 3.56, 95% confidence interval 1.08-11.67). Neutropenic fever, dose delay, and dose adjustment as separate outcomes occurred more frequently in the GFR less than 75 group but lost statistical significance after adjustment. Our results demonstrate that unrecognized RI is associated with an increased risk for chemotherapy-associated adverse events in this patient population. Further prospective studies are required to determine whether a dose reduction in patients with unrecognized RI reduces adverse effects without adversely affecting the benefit of treatment.

A 59-year-old female with history of progressive scleroderma and pulmonary fibrosis was referred for biopsy of a pulmonary nodule that was discovered on computed-tomography (CT) chest surveillance, not present on prior CT- scan. Imaging was suspicious for granuloma, malignancy or aneurysm. CT- Angiography (CTA), performed immediately before the procedure, did not show enhancement of the mass, followed by placement of coaxial-needle into the mass. Suspicion of aneurysm was again raised and repeat CTA demonstrated contrast filling of the aneurysm. With the coaxial-needle in the aneurysm, embolization of the sac was performed using microfibrillar collagen, followed by confirmation of containment and thrombosis with CT.