Radiology

How accurate is axillary ultrasound? Comparing pre-operative ultrasound assessments to post-operative axillary node status in breast cancer positive patients (2025)

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Type of publication:

Conference abstract

Author(s):

*Chai A.; Walajahi F.

Citation:

Breast Cancer Research. Conference: British Society of Breast Radiology Annual Scientific Meeting 2024. Liverpool United Kingdom. 27(Supplement 1) (no pagination), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background: The cortical thickness of axillary lymph nodes has been linked to nodal metastasis, with smaller measurements associated with lower rates of metastasis. There is currently no international standard used to define a safe threshold for cortical thickness. In this analysis, we compare three proposed safe thresholds of 2.30 mm, 2.50 mm, and 3.00 mm, and observe how axillary node involvement changes between each group. Methods: Retrospective review of all known breast cancer patients who underwent node surgery in October 2023 at our center. Cortical thickness and final nodal status were collected. 91 Patients were divided into 4 groups from their cortical thickness measurements. These groups were < 2.30 mm (n = 65), 2.30-2.49 mm (n = 5), 2.50-3.00 (n = 4), and > 3.00 mm (n = 17). Results 91 patients (57.82} 11.13 years) underwent WLE or ANC. 26 (28.57%) patients were node positive at surgery. When split into their groups,12 (18.46%) patients in the < 2.30 mm group were node positive, 1 (20%) in the 2.30-2.49 mm group, 2 (50%) in the 2.50-3.00 group, and 11 (64.71%) in the > 3.00 mm group. OR = 1.97 (95%CI, 1.21-3.20) was found when using 2.30 mm as the safe threshold, OR = 2.01 (95%CI, 1.16-3.48) at 2.50 mm, and OR = 2.26 (95%CI, 1.18-4.34) at 3.00 mm. Preliminary multiple regressions were run, with thickness as both a continuous and categorical variable. As a continuous variable, cortical thickness produced OR = 2.67 (95%CI, 1.60-4.46) (p = < 0.01). The categorical model further concluded that OR = 10.05 (95%CI, 2.78-36.31) (p = < 0.01) when cortical thickness is > 3.00 mm. Discussion: Further research with more robust regressions and sample size is warranted to continue investigating the value of cortical thickness.

DOI: 10.1186/s13058-025-02023-8

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The significance of breast lesions identified incidentally on Lung Health Check CT (2025)

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Type of publication:

Conference abstract

Author(s):

*Chai A.; Hutchison G.;

Citation:

Breast Cancer Research. Conference: British Society of Breast Radiology Annual Scientific Meeting 2024. Liverpool United Kingdom. 27(Supplement 1) (no pagination), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background The Targeted Lung Health Check Programme offers low-dose CT scans to populations at higher risk of lung cancer. Like other forms of crosssectional imaging, this can produce incidental findings, resulting in onward referral to specialist services and increased patient anxiety which may be unnecessary. We investigated the frequency of incidental breast lesions found through this programme. Method: A retrospective review of all patients with breast findings detected by LDCT from November 2019 and July 2024. Their referral method for breast assessment, findings on breast imaging, and biopsy results were recorded. Results 52 patients (64.19 5.84 years) had breast lesions reported. Of these, 50 (96%) were female. 39 cases were first discussed with a breast radiologist, 26 (66%) of which were referred for triple assessment. 13 cases did not have initial input from a breast specialist, 10 (77%) of which were referred for assessment. The average number of days between LDCT and breast assessment was 35.89 19.64 days, and the highest score on imaging was 2.79 1.40. 8 patients were biopsied, with 5 having malignant findings. All 5 malignant cases had been discussed with a breast radiologist prior to breast clinic referral. Discussion(s): Lower referral rates were seen when a breast specialist opinion was requested prior to referral. This allowed savings in clinic capacity and reduction in patient anxiety caused by unnecessary referral.

DOI: 10.1186/s13058-025-02023-8

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Missed on X-ray, Found on CT: A Retrospective Study on the Diagnostic Yield and Clinical Consequences of Occult Posterior Malleolus Fractures in Tibial Shaft Fractures (2025)

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Type of publication:

Journal article

Author(s):

Kanesan, Hariprasath; Choudhary, Zain; Singal, Sachin; *Kanesan, Mahesh; Hang-Kin Nam, Ronald; Radhamony, Niranj Ganeshan; Hamadto, Mohamed.

Citation:

Cureus. 17(10):e94260, 2025 Oct.

Abstract:

Background Posterior malleolus fractures (PMFs) are common in distal tibial shaft fractures yet are frequently occult on plain radiographs. Accurate preoperative characterization on CT may improve surgical planning and functional recovery. Methods We conducted a retrospective cohort study of consecutive adults (>=18 years) with mid- or distal tibial shaft fractures treated at a major trauma center (January 2022-December 2024). Demographics, imaging, fracture characteristics, management, and outcomes were abstracted. PMF detection was compared across radiography, CT, and intraoperative findings. Predictors of a posterior malleolus (PM) fragment being missed on radiography were evaluated with multivariable logistic regression. Among operatively treated cases, the effect of fixation strategy on postoperative full weight-bearing (FWB) was analyzed with a logistic model including fixation, PM status, and their interaction; pairwise, covariate-adjusted contrasts (emmeans with Tukey correction) compared strategies. An exploratory random forest provided permutation-importance rankings. Findings PMFs were present in 147/387 fractures (38.0%), more often in women (60.5%), closed injuries (76.9%), and distal fractures (98.0%). Radiography identified 116/147 PMFs (78.9%), and CT 120/147 (81.6%); 29/147 (19.7%) fragments were missed on radiographs but detected on CT or intraoperatively. Missed fragments were most frequent in undisplaced and intermediate-sized (33-50%) fragments; CT identified all posteromedial and >50% fragments. In adjusted analyses, fracture morphology was the principal correlate of radiographic omission: oblique patterns were less likely to be missed (adjusted odds ratio 0.18, 95% CI 0.04-0.60), whereas other demographic and injury variables were not significant. Among operatively managed fractures, intramedullary nailing was associated with the highest likelihood of achieving FWB and was statistically superior to plate and external fixation in pairwise, covariate-adjusted comparisons; the relative ranking of fixation methods did not differ by PM involvement. Neither PMF location (posteromedial, posterolateral, or undisplaced) nor fragment size independently predicted FWB, infection, or mal-/non-union. Conclusions Approximately two in five distal tibial shaft fractures harbour a PM fragment, and nearly one in five PMFs are occult on initial radiographs, particularly when undisplaced or of intermediate size. CT modestly increases detection and ensures complete characterisation of posteromedial and large fragments, supporting a low threshold for pre-operative CT in distal tibial fractures.

DOI: 10.7759/cureus.94260

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CT guided percutaneous lung biopsy - self-audit (2025)

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Type of publication:

Audit

Author(s):

*Abayaratne, Chulangani

Citation:

Shrewsbury and Telford Hospital NHS Trust, 2025

Abstract:

CT-guided percutaneous lung biopsy is a widely practiced interventional radiology procedure for
obtaining tissue samples from pulmonary lesions. Regular self-audit of such procedures is good
clinical practice and is recommended to ensure high diagnostic adequacy and low complication
rates, in line with national benchmarks.

In the UK, the British Thoracic Society (BTS) and the Royal College of Radiologists (RCR)
recommend regular audits to evaluate local diagnostic yield and complication rates and compare
them with national standards.

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Improving compliance to follow-up alerts in chest X-rays with consolidation through clinician education (2025)

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Type of publication:

Conference abstract

Author(s):

*Adeniran-Babatunde S.F.; *Gbede O.; *Oguntoye O.; *Alkhouly M.

Citation:

Clinical Radiology. Conference: RCR Audit & QI ePoster Competitions 2024. InterContinental Hotel, Dubai Festival City United Arab Emirates. 83(Supplement 1) (no pagination), 2025. Article Number: 106889. Date of Publication: 01 May 2025.

Abstract:

Category: Chest Background to the audit: Timely follow-up of abnormal chest X-rays (CXRs) showing consolidation as recommended by the radiologist can aid prompt diagnosis and treatment of other serious conditions with subsequent good outcomes. Research has shown that significant morbidity can occur from delay and lack of follow-up in patients with consolidation or other abnormalities on initial CXR, which is why the British Thoracic Society (BTS) recommends follow-up CXRs at around six weeks after completing treatment for all patients with consolidation on CXR to ensure resolution. This formed the premise for our audit looking into how to improve compliance to this protocol in our trust and thereby improve patient safety. Standard: BTS recommendation. Indicator: We assessed source of referral. We assessed if repeat CXR has been performed as suggested by the radiologist. We assessed the time frame suggested for the repeat CXR. We compared the actual time frame of the repeat imaging with the time frame suggested. Target: 100% compliance to follow-up alert. 100% compliance to recommended time frame. Methodology: In the first round, retrospective review of random 100 CXRs done in the trust with follow-up alert. Data collected include patient's referral source, date of the initial image, recommended time frame for repeat image and date of the follow-up CXR. The data were analysed and presented in percentages. The exact similar process was repeated for the second round three months after the intervention. Results of first audit round: 43% of the patients were referred from emergency department (ED), 39% from GP and 18% from the wards. 79% of the patients had repeat CXRs, 14% did not and 7% had died. Of those that had repeat CXRs, 46% had it done at the recommended time, 43% were done at a later date and 11% were done earlier. First action plan: Audit was presented at clinical meetings to educate clinicians on the need to request follow-up CXRs to ensure patient safety. Results of second audit round: 54% were from ED, 31% from GP and 15% from the wards. 95% had repeat CXRs while the remaining 5% had died. 78% had repeat CXRs within the recommended time, 14% were done later and 8% were done earlier. Second action plan: Presentation and teaching at clinical meetings to further reinforce and improve on follow-up compliance.

Radiological and Imaging Evidence in the Diagnosis and Management of Microbial Infections: An Update (2023)

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Type of publication:
Journal article

Author(s):
Vaishnav, Aditya; *Gurukiran, Gurukiran; Ighodaro, Osazuwa; Kandi, Venkataramana

Citation:
Cureus. 15(11):e48756, 2023 Nov.

Abstract:
Microbial infections are extremely prevalent throughout the world. Bacteria, fungi, parasites, and viruses generally cause them. Most microbial infections spread from humans to humans and from animals to humans. A vast majority of microbial infections are self-limiting. However, some microbial infections result in severe morbidity and mortality. The diagnosis of microbial infections generally depends on the direct demonstration of microbes in human clinical specimens through microscopy followed by culture. Some microbes are uncultivable, and among those that are cultivable, some take a very long time to grow in the laboratory. This causes delays in the diagnosis that may result in poor patient outcomes. Serological and molecular methods like enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR), respectively, have been extensively used to diagnose infectious diseases. However, these require costly infrastructure and adequate personnel training. In this context, alternative, more efficient, and rapid detection methods for the diagnosis of microbial infections are warranted. In this review, we comprehensively discuss the role played by radiological investigations in the diagnosis and management of infectious diseases.

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Accuracy of Radiomics in Predicting IDH Mutation Status in Diffuse Gliomas: A Bivariate Meta-Analysis (2024)

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Type of publication:Journal article

Author(s):Di Salle, Gianfranco; Tumminello, Lorenzo; Laino, Maria Elena; *Shalaby, Sherif; Aghakhanyan, Gayane; Fanni, Salvatore Claudio; Febi, Maria; Shortrede, Jorge Eduardo; Miccoli, Mario; Faggioni, Lorenzo; Cosottini, Mirco; Neri, Emanuele.

Citation:Radiology Artificial intelligence. 2024 Jan;6(1):e220257

Abstract:Purpose To perform a systematic review and meta-analysis assessing the predictive accuracy of radiomics in the noninvasive determination of isocitrate dehydrogenase (IDH) status in grade 4 and lower-grade diffuse gliomas. Materials and Methods A systematic search was performed in the PubMed, Scopus, Embase, Web of Science, and Cochrane Library databases for relevant articles published between January 1, 2010, and July 7, 2021. Pooled sensitivity and specificity across studies were estimated. Risk of bias was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2, and methods were evaluated using the radiomics quality score (RQS). Additional subgroup analyses were performed according to tumor grade, RQS, and number of sequences used (PROSPERO ID: CRD42021268958). Results Twenty-six studies that included 3280 patients were included for analysis. The pooled sensitivity and specificity of radiomics for the detection of IDH mutation were 79% (95% CI: 76, 83) and 80% (95% CI: 76, 83), respectively. Low RQS scores were found overall for the included works. Subgroup analyses showed lower false-positive rates in very low RQS studies (RQS < 6) (meta-regression, z = -1.9; P = .02) compared with adequate RQS studies. No substantial differences were found in pooled sensitivity and specificity for the pure grade 4 gliomas group compared with the all-grade gliomas group (81% and 86% vs 79% and 79%, respectively) and for studies using single versus multiple sequences (80% and 77% vs 79% and 82%, respectively). Conclusion The pooled data showed that radiomics achieved good accuracy performance in distinguishing IDH mutation status in patients with grade 4 and lower-grade diffuse gliomas. The overall methodologic quality (RQS) was low and introduced potential bias.

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Radiology - Breast Screening (2022)

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Type of publication:
Service improvement case study

Author(s):
*Cat Rowlands (Programme Manager), *Lynn Rogers (Office Manager), *Jayne Edwards (Office Supervisor), *Mr Usman (Director of Breast Screening)

Citation:
SaTH Improvement Hub, December 2022

SMART Aim:
In order to reduce the backlog of breast screening appointments, the service was temporarily centralised at RSH and PRH. This reduced the backlog from 17,141 to zero.

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Recurrence of a second trimester fundal uterine rupture at the old scar site: A case report (2022)

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Type of publication:Journal article

Author(s):*Panesar H.; *Patel R.; Dhaliwal H.

Citation:Radiology Case Reports. 17(11) (pp 4445-4448), 2022. Date of Publication: November 2022.

Abstract:Uterine rupture is a rare life-threatening complication. It can occur in all 3 trimesters with the first and the second being a rarity. It mainly occurs in the third trimester or during labor in a previously scarred uterus. It is rare in an unscarred uterus. The risk fold is further enhanced by the induction and augmentation with prostaglandins and oxytocin. The clinical diagnosis at this early gestation can be a dilemma to the attending physician as in this case. (1) The patient was a holidaymaker with no documented evidence of a dating scan to suggest any evidence of an ovarian/placental pathology at that stage. (2) The ultrasound findings in our department did suggest a viable intrauterine pregnancy with free fluid within both the adnexa. A 6 cm solid homogenous mass in the midline/right adnexa suggested an ovarian torsion or bowel pathology. The differentials in this particular case were that of a ruptured hemorrhagic cyst, ovarian torsion and even a heterotrophic pregnancy as there had been a few documented cases in the department. Ultrasound diagnosis of an intrauterine pregnancy together with a fluid collection does not suggest by any means that the uterus is intact or there is no ectopic pregnancy.

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