Radiology - Research Publications

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    Causes of hepatic capsular retraction: a pictorial essay
    Tan, GXV ; Miranda, R ; Sutherland, T (SPRINGER HEIDELBERG, 2016-12-01)
    UNLABELLED: Hepatic capsular retraction refers to the loss of the normal convex hepatic contour, with the formation of an area of flattening or concavity. This can result from myriad causes, including intrinsic hepatic conditions such as cirrhosis, biliary obstruction, benign tumours, malignancy and infections, as well as extrahepatic causes such as trauma. This article aims to provide familiarity with this wide spectrum of conditions, including mimics of hepatic capsular retraction, by highlighting the anatomic, pathologic and imaging features that help distinguish these entities from one another. TEACHING POINTS: • Hepatic capsular retraction can occur due to various intrinsic or extrinsic hepatic causes. • Hepatic capsular retraction is observed in both benign and malignant conditions. • Recognising associated imaging features can help elicit causes of hepatic capsular retraction.
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    Radiological diagnosis of perinephric pathology: pictorial essay 2015
    Mitreski, G ; Sutherland, T (SPRINGEROPEN, 2017-02-01)
    UNLABELLED: The perinephric space, shaped as an inverted cone, sits between the anterior and posterior renal fasciae. It can play host to a variety of clinical conditions encountered daily in the reporting schedule for a radiologist. Lesions may be classified and diagnosed based on their imaging characteristics, location and distribution. A broad range of differential diagnoses can be attributed to pathology sitting within this space, often without clinical signs or symptoms. An understanding of commonly encountered conditions affecting the perinephric space, along with characteristic imaging findings, can illustrate and often narrow the likely diagnosis. The aim of this essay is to describe commonly encountered neoplastic and non-neoplastic entities involving the perinephric space and to describe their key imaging characteristics. TEACHING POINT: • Despite often a bulky disease, perinephric lymphoma does not produce obstruction or stenosis. • In primarily fatty masses, defects within the renal capsule likely represent angiomyolipoma. • Consider paraganglioma if biopsy is planned; biopsy may lead to catecholamine crisis.
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    Mass-forming renal Crohn's disease: a case report with multimodality imaging
    van Tonder, F ; Seale, M ; Yong, E ; Hill, P ; Darby, J ; Sutherland, T (BRITISH INST RADIOLOGY, 2016-01-01)
    The most common extraintestinal manifestations of Crohn's disease involve the eyes, skin, hepatobiliary tract, and the musculoskeletal and respiratory systems. Mass-forming granulomatous inflammation in extraintestinal organs is extremely rare and there are only a few reports of patients with Crohn's disease presenting with inflammatory pseudotumours of the liver, pancreas and kidneys. We present a case of a mass-forming renal granulomatous inflammation in an adult female with Crohn's disease. The clinical, pathological and imaging features of this case illustrate that renal inflammatory pseudotumour is a rare but important differential diagnosis of a renal mass in patients with Crohn's disease and that radiologists should be aware of its existence when considering other more common pathologies, such as focal pyelonephritis and renal tumours. Renal inflammatory pseudotumour may have relatively non-specific imaging features and a biopsy may be required to make the diagnosis.
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    Spontaneous infarction within a meningioma with negative DWI: an imaging pattern in patients with acute neurological deterioration
    Hall, J ; Wang, YY ; Smith, P ; Sutherland, T (BRITISH INST RADIOLOGY, 2015-01-01)
    Despite being slow growing and presenting with insidious symptoms, patients with a meningioma can have rapid neurological deterioration as a result of increased intracranial pressure (ICP). The cause of raised ICP is often the development of peritumoral oedema, although the mechanism remains poorly understood. Infarction of meningiomas has been reported. The authors report a series of two cases in which spontaneous meningioma infarction and the development of peritumoral oedema resulted in increased ICP, neurological deterioration and presentation.
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    The artefacts of death: CT post-mortem findings
    Sutherland, T ; O'Donnell, C (WILEY, 2018-04-01)
    Post-mortem CT is an increasingly used tool for investigating cause of death. While sharing many similarities with pre-mortem imaging, a number of unique artefacts occur at post-mortem CT, and these have the potential to mask underlying disease processes. It is vital that the artefacts associated with the process of dying and decompositional changes are recognised to avoid misdiagnosis. The following pictorial review discusses and illustrates the important and common post-mortem changes.
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    Hepatic cystic echinococcosis in Australia: an update on diagnosis and management
    Keong, B ; Wilkie, B ; Sutherland, T ; Fox, A (WILEY, 2018-01-01)
    BACKGROUND: Echinococcosis is an uncommonly encountered zoonotic disease caused by the taeniid Echinococcus. The only endemic species in Australia, Echinococcus granulosus, forms cysts in the liver in 70% of cases. The aim of this study was to review the literature to provide an evidence-based narrative update on the diagnosis and management of hepatic cystic echinococcosis in Australia. METHODS: We reviewed the literature, utilizing multiple research databases and citation tracking. Original research and review articles examining the diagnosis and management of hydatid disease in adults, published prior to 2016 and in the English language were included in our review. RESULTS: Ultrasound is the gold-standard screening test, whilst computed tomography has a role in emergency presentations and screening for multi-organ involvement. Magnetic resonance imaging is the preferred second-line imaging and better demonstrates biliary involvement. Medical therapy or PAIR (percutaneous aspiration, irrigation with scolicide and re-aspiration) may be appropriate in selected cases; however, surgery remains the definitive treatment for active, large (>5 cm), symptomatic or complicated cysts. A variety of surgical techniques have been described, including conservative, radical and minimally invasive procedures. There is currently no consensus approach; surgical modality should be tailored to patient factors, relevant anatomy, local facilities and surgeons' expertise. CONCLUSION: Diagnosis and therapy in hepatic hydatid cysts have been significantly advanced by imaging, interventional radiology and surgical approaches in recent years. Surgery remains the mainstay of treatment for large, active, complicated or symptomatic hepatic hydatid cysts.
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    Diffusion-weighted MRI for hepatocellular carcinoma screening in chronic liver disease: Direct comparison with ultrasound screening
    Sutherland, T ; Watts, J ; Ryan, M ; Galvin, A ; Temple, F ; Vuong, J ; Little, AF (WILEY, 2017-02-01)
    INTRODUCTION: Ultrasound is a widely utilized method of screening patients with chronic liver disease for hepatocellular carcinoma (HCC). However, the sensitivity of ultrasound for small tumours is limited. We have prospectively compared ultrasound screening with diffusion-weighted (DWI) MRI for detecting HCC. METHODS: Patients with chronic liver disease referred for ultrasound screening underwent a liver ultrasound and a liver MRI comprising free breathing DWI. Each test was independently read to determine the accuracy of each modality for detecting HCC. RESULTS: One hundred and ninety-two patients were recruited and HCC was diagnosed in six patients (3%); all of whom were detected at ultrasound screening, and five detected at MRI screening. Ultrasound had false-positive studies 20 times (10%) while DWI MRI had three false-positive examinations (2%) p≥0.05. The sensitivity, specificity, positive predictive value and negative predictive values for ultrasound are 100%, 90%, 23% and 100%, respectively, while for MRI are 83%, 98%, 63% and 99%. CONCLUSION: In patients with chronic liver disease undergoing surveillance for hepatocellular carcinoma, DWI MRI screening shows similar sensitivity to screening ultrasound but with a significantly lower false-positive rate.
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    Magnetic resonance enterography for predicting the clinical course of Crohn's disease strictures
    Schulberg, JD ; Wright, EK ; Holt, BA ; Sutherland, TR ; Hume, SJ ; Hamilton, AL ; Ross, AL ; Connell, WC ; Brown, SJ ; Lust, M ; Miller, AM ; Bell, SJ ; Kamm, MA (WILEY, 2019-11-11)
    BACKGROUND AND AIMS: Strictures are the most common Crohn's disease complication, but their natural history is unknown. This study aimed to characterize inflammation, predict prognosis, and understand the impact of drug therapy using magnetic resonance enterography (MRE). METHODS: Patients with a stricture diagnosed on MRE over a 5-year period were reviewed for MRE disease extent and inflammation, clinical course, C-reactive protein, response to anti-TNF therapy, endoscopic dilatation, hospitalization, and surgery. RESULTS: 136 patients had 235 strictures (77, one and 59, ≥ 2 strictures). TREATMENT: 46% of patients underwent surgery after a median 6 months; median follow-up for those not requiring surgery was 41 months. Predictors of surgery: Hospitalization because of obstruction predicted subsequent surgery (OR 2.50; 95% CI 1.06-5.90) while anti-TNF therapy commenced at stricture diagnosis was associated with a reduced risk (OR 0.23; 95% CI 0.05-0.99). MRE characteristics associated with surgery were proximal bowel dilatation ≥ 30-mm diameter (OR 2.98; 95% CI 1.36-6.55), stricture bowel wall thickness ≥ 10-mm (OR 2.42; 95% CI 1.11-5.27), and stricture length > 5-cm (OR 2.56; 95% CI 1.21-5.43). 81% of patients with these three adverse MRE features required surgery versus 17% if none were present (P < 0.001). Accuracy for these three MRE variables predicting surgery was high (AUC 0.76). CONCLUSION: Magnetic resonance enterography findings in Crohn's disease strictures are highly predictive of the disease course and the need for future surgery. MRE may also identify who would benefit from treatment intensification. Anti-TNF therapy is associated with reduced risk of surgery and appears to alter the natural history of this complication.
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    Tension pneumopericardium following blunt chest trauma
    Sutherland, T ; Parsons, S ; Cordner, S ; O'Donnell, C (WILEY, 2019-06-01)