The imaging findings of a case of metastasing meningioma are described. The case illustrates a number of rare and interesting features. The patient presented with haemoptysis 22 years after the initial resection of an intracranial meningioma. CT demonstrated heterogeneous masses with avid peripheral enhancement without central enhancement. Blood supply to the larger lesion was partially from small feeding vessels from the inferior pulmonary vein. These findings correlate with a previously published case in which there was avid uptake of fluoro-18-deoxyglucose peripherally with lesser uptake centrally. The diagnosis of metastasing meningioma was confirmed on percutaneous lung tissue biopsy.
Poster: EuroSafe Imaging 2019 / ESI-0022 / Body mass index- based estimation of individualized patient radiation doses during abdominal CT by: B. Carey1, C. Kennedy1, R. Kavanagh2, N. Moore2, M. A. Maher1, O. O’Connor1, S. O'Neill3; 1 Cork/IE, 2Cork University Hospital Cork/IE, 3University College Cork Cork/IE
Magnetic resonance imaging (MRI) is the mainstay method for the radiological imaging of the small bowel in patients with inflammatory bowel disease without the use of ionizing radiation. There are circumstances where imaging using ionizing radiation is required, particularly in the acute setting. This usually takes the form of computed tomography (CT). There has been a significant increase in the utilization of computed tomography (CT) for patients with Crohn’s disease as patients are frequently diagnosed at a relatively young age and require repeated imaging. Between seven and eleven percent of patients with IBD are exposed to high cumulative effective radiation doses (CEDs) (>35–75 mSv), mostly patients with Crohn’s disease (Newnham E 2007, Levi Z 2009, Hou JK 2014, Estay C 2015). This is primarily due to the more widespread and repeated use of CT, which accounts for 77% of radiation dose exposure amongst patients with Crohn’s disease (Desmond et al., 2008). Reports of the projected cancer risks from the increasing CT use (Berrington et al., 2007) have led to increased patient awareness regarding the potential health risks from ionizing radiation (Coakley et al., 2011). Our responsibilities as physicians caring for these patients include education regarding radiation risk and, when an investigation that utilizes ionizing radiation is required, to keep radiation doses as low as reasonably achievable: the “ALARA” principle. Recent advances in CT technology have facilitated substantial radiation dose reductions in many clinical settings, and several studies have demonstrated significantly decreased radiation doses in Crohn’s disease patients while maintaining diagnostic image quality. However, there is a balance to be struck between reducing radiation exposure and maintaining satisfactory image quality; if radiation dose is reduced excessively, the resulting CT images can be of poor quality and may be nondiagnostic. In this paper, we summarize the available evidence related to imaging of Crohn’s disease, radiation exposure, and risk, and we report recent advances in low-dose CT technology that have particular relevance.
Increasing integration of computed tomography (CT) into routine patient care has escalated concerns regarding associated radiation exposure. Specific patient cohorts, particularly those with cystic fibrosis (CF) and Crohn's disease, have repeat exposures and thus have an increased risk of high lifetime cumulative effective dose exposures.Thoracic CT is the gold standard imaging method in the diagnosis, assessment and management of pulmonary disease. In the setting of CF, CT demonstrates increased sensitivity compared with pulmonary function tests and chest radiography. Furthermore, in specific cases of Crohn's disease, CT demonstrates diagnostic superiority over magnetic resonance imaging (MRI) for radiological evaluation.Low dose CT protocols have proven beneficial in the evaluation of CF, Crohn's disease and renal calculi, and in the follow up of testicular cancer patients. For individuals with chronic conditions warranting frequent radiological follow up, the focus must continue to be the incorporation of appropriate CT use into patient care. This is of particular importance for the paediatric population who are most susceptible to potential radiation induced malignancy.CT technological developments continue to focus on radiation dose optimisation. This article aims to highlight these advancements, which prioritise the acquisition of diagnostically satisfactory images with the least amount of radiation possible.
Thyroid drains following thyroid surgery are routinely used despite minimal supportive evidence. Our aim in this study is to determine the impact of routine open drainage of the thyroid bed postoperatively on ultrasound-determined fluid accumulation at 24 hours. We conducted a prospective randomised clinical trial on patients undergoing thyroid surgery. Patients were randomly assigned to a drain group (n = 49) or a no-drain group (n = 44) immediately prior to wound closure. Patients underwent a neck ultrasound on day 1 and day 2 postoperatively. After surgery, we evaluated visual analogue scale pain scores, postoperative analgesic requirements, self-reported scar satisfaction at 6 weeks and complications. There was significantly less mean fluid accumulated in the drain group on both day 1, 16.4 versus 25.1 ml (P-value = 0.005), and day 2, 18.4 versus 25.7 ml (P-value = 0.026), following surgery. We found no significant differences between the groups with regard to length of stay, scar satisfaction, visual analogue scale pain score and analgesic requirements. There were four versus one wound infections in the drain versus no-drain groups. This finding was not statistically significant (P = 0.154). No life-threatening bleeds occurred in either group. Fluid accumulation after thyroid surgery was significantly lessened by drainage. However, this study did not show any clinical benefit associated with this finding in the nonemergent setting. Drains themselves showed a trend indicating that they may augment infection rates. The results of this study suggest that the frequency of acute life-threatening bleeds remains extremely low following abandoning drains. We advocate abandoning routine use of thyroid drains. ISRCTN94715414
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