The British journal of radiology
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Review Case Reports
Case report: Solitary plasmacytoma of bone with oncogenic osteomalacia: recurrence of tumour confirmed by PET/CT. A case report with a review of the radiological literature.
We describe a case of oncogenic osteomalacia secondary to solitary plasmacytoma of the vertebral body of T3. The patient presented with symptoms of hypophosphataemia. Following the initial diagnosis, the lesion was surgically resected with good results, although several follow-up procedures, including bone grafting, were necessary to stabilize the thoracic spine. ⋯ Positron emission tomography (PET/CT) demonstrated a solitary focus of intense fluorodeoxyglucose uptake in the T3 vertebral body, enabling a definitive diagnosis of recurrent plasmacytoma. This case illustrates the diagnostic value of PET/CT in the setting of challenging post-operative changes in the surrounding tissue and in the appearance of the tumour itself. Relevant related imaging literature is also reviewed.
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The purpose of our study was to evaluate the outcomes of neurosurgical and endovascular treatment of ruptured intracranial aneurysms over a lifetime, based on the results of the International Subarachnoid Aneurysm Trial. We performed a decision analysis, using a Markov model, to evaluate outcomes of neurosurgical and endovascular treatment of ruptured intracranial aneurysms that were suitable for both treatments over a lifetime. We chose 50 years as cohort age. ⋯ Compared with neurosurgery, endovascular treatment increased effectiveness by 1.0 QALY (neurosurgery, 13.1 QALYs; endovascular treatment, 14.1 QALYs) and life expectancy by 0.7 years (neurosurgery, 23.2 years; endovascular treatment, 23.9 years), and decreased SAH-related mortality by 0.4% (neurosurgery, 11.5%; endovascular treatment, 11.1%) and SAH-related disability by 5.0% (neurosurgery, 21.3%; endovascular treatment, 16.3%). One-way sensitivity analysis showed that no parameters influenced the effectiveness of endovascular treatment compared with neurosurgery. For ruptured intracranial aneurysms suitable to both neurosurgical and endovascular treatment, endovascular treatment is more effective than neurosurgery over a lifetime.
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Hypovolaemic shock is an infrequently encountered entity found on CT of victims of severe trauma. Early abdominal and pelvic CT can show diffuse abnormalities owing to hypovolaemia that may alert radiologists to the presence of hypovolaemic shock. In this pictorial review, we present the imaging findings of hypovolaemic shock, as seen on CT of the abdomen. ⋯ Hollow visceral abnormalities include diffuse increased mucosal enhancement of both the small and large bowel, diffuse thickening of the small bowel wall, and small bowel dilatation. Solid visceral abnormalities include both decreased and increased end organ enhancement. This report should increase radiologists' awareness of the CT manifestations of hypovolaemic shock.
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Case Reports
Thoracic paravertebral block for analgesia following liver mass radiofrequency ablation.
A 66-year-old man presented for a second attempt of radiofrequency ablation of a metastatic carcinoid liver lesion. The first attempt using intravenous sedation was unsuccessful because of inadequate pain control and subsequent patient combativeness. ⋯ The patient's pain score remained 0 throughout the following day, and no further analgesics were required. Thoracic paravertebral block can provide complete and lasting analgesia following hepatic radiofrequency ablation, and warrants further study for patients undergoing hepatic radiological interventions.
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The purpose of this work was to determine alternative radiotherapy (RT) regimens that are biologically equivalent to clinically proven treatments using different RT modalities or different fractionation schemes. The concept of equivalent uniform dose (EUD) is used with the linear quadratic model to determine equivalent treatment regimens using two representative sets of parameters derived from clinical data: (i) alpha/beta = 3.1 Gy and alpha = 0.15 Gy(-1), and (ii) alpha/beta = 1.5 Gy and alpha = 0.04 Gy(-1). The EUD values for the critical structure (rectum) are also calculated. ⋯ For example, the alternative regimens, calculated with the alpha/beta ratio of 3.1 Gy, that would be biologically equivalent to external beam RT (EBRT) of 76 Gy (38x2.0 Gy) include: EBRT hypofractionation of 21x3.0 Gy; I-125 implant of 156 Gy; Pd-103 implant of 128 Gy; high dose rate (HDR) brachytherapy of 4x10.5 Gy; I-125 implant of 65 Gy combined with EBRT of 23x2.0 Gy; and HDR brachytherapy of 3x5.9 Gy combined with EBRT of 23x2.0 Gy. Similar data for other parameters are also presented. With caution, the data presented may be useful in designing clinical trials to explore new RT strategies, such as image-guided intensity-modulated RT.