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Radiology - Disease Topic Overview

Radiology is the science that studies, and medical specialty that uses radiography; which includes techniques for producing images of the internal structure of a patient with X-rays. It also includes other non-radiographic techniques of medical imaging, such as ultrasound or magnetic resonance imaging (MRI).

The inventor of the first X-rays was the German professor Wilhelm Roentgen (1845-1923).1 During his work, he discovered an unknown type of radiation which passed through the glass and paper, but was stopped by lead and platinum.1 He decided to name this radiation by the letter of the mathematical unknown; X-ray. In 1895, Roentgen made history when he used his wife’s hand to create the first X-ray image.¹

The medical community quickly realised the critical potential of rapid access to X-ray imaging.¹ The first medical imaging services opened in early 1896 and the technique was quickly and widely adopted. Few other medical innovations have been adopted so quickly.¹

In early 1970 X-rays began to be used for computed tomography (CT) scaning.¹ Developed by Hounsfield and Cormack, this technique electronically combines multiple X-rays to create a three-dimensional image. This novel use of the X-ray scanner has become the best tool for diagnosis in modern medicine.¹ Since radiation is hazardous to health, the lower doses of radiation necessary for CT scans allowed greater X-ray safety.²

Medical imaging is now used to detect, diagnose, treat, monitor and evaluate response to treatment for all serious medical conditions. Developments in imaging continue to improve the quality and detail, which in turn improves the accuracy of diagnosis and treatment.¹

1. Dixon A.K. Editorial for Anniversary Issue of European Radiology. European Radiology. January 2001 ; 21 (3) : 447-448.
2. Devred P. et al. Centennial of the French Society of Radiology and JFR 2009: Past, Present and Future. Journal de Radiologie. December 2009 ; 90 (12) : 1781-1782.

Gastrointestinal Stromal Tumours
Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal (GI) tract. Before the current definition of GIST evolved, GISTs were classified as benign or malignant smooth muscle tumours including true smooth muscle tumours (leiomyomas, leiomyoblastomas, leiomyosarcomas) and neuronal tumours (schwannomas)^1,2.

Patients with GIST may be asymptomatic (31%) or symptomatic.³ Asymptomatic GISTs can be discovered incidentally during endoscopy or laparoscopy as well as during computed tomography (CT)⁴. Symptomatic GIST patients may present with a range of symptoms associated with the location of the tumour, growth pattern, and size.

The diagnosis of GIST relies on standard histologic examination and immunohistochemical analysis of several markers, including KIT. Equivocal cases should be submitted to a central review by an expert in sarcoma pathology, experienced in the diagnosis of GIST.

Before the availability of Glivec, the only treatments for GIST other than surgery were conventional chemotherapy and radiation therapy^5,6. The role of chemotherapy and radiation therapy has been limited by a lack of efficacy and intolerable toxicity, currently surgery is Standard of Care for Resectable Primary GIST.

GIST is now recognised as having a much higher incidence than previously thought. Under the current, widely accepted definition of GIST as a distinct molecular and pathologic entity, the incidence of GIST is in the range of 10-20 cases per million persons per year ^7-11. The prevalence of GIST in a population-based study was estimated to be 129 cases per million persons¹¹. GIST tumours occur at a median age of 60 years and are slightly more predominant in men than women⁹.

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References

1. Fletcher CDM, Berman JJ, Gorstein F, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol. 2002;33:459-465.
2. Connolly EM, Gaffney E, Reynolds JV. Gastrointestinal stromal tumours,Br J Surg. 2003;90:1178-1186.
3. Kindblom LG. Gastrointestinal stromal tumors: diagnosis, epidemiology, prognosis. Available at: www.asco.org. Accessed July 13, 2007.
4. Joensuu H, Fletcher C, Dimitrijevic S, Silberman S, Roberts P, Demetri G. Management of malignant gastrointestinal stromal tumours. Lancet Oncol. 2002;3:655-664.
5. Eisenberg BL, Judson I. Surgery and imatinib in the management of GIST: emerging approaches to adjuvant and neoadjuvant therapy. Ann Surg Oncol. 2004;11:464-475.
6. Dematteo RP, Heinrich MC, El-Rifai WM, Demetri G. Clinical management of gastrointestinal stromal tumors: before and after STI-571. Hum Pathol. 2002;33:466-477.
7. Goettsch WG, Bos SD, Breekveldt-Postma N, Casparie M, Herings RM, Hogendoorn PC. Incidence of gastrointestinal stromal tumours is underestimated: results of a nation-wide study. Eur J Cancer. 2005;41:2868-2872.
8. Joensuu H. Current perspectives on the epidemiology of gastrointestinal stromal tumours. Eur J Cancer. 2006;4(suppl 1):4-9.
9. Blay JY, Bonvalot S, Casali P, et al. Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20-21 March 2004, under the auspices of European Society for Medical Oncology. Ann Oncol. 2005;16:566-578.
10. Miettinen M, Lasota J. Gastrointestinal stromal tumors--definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Arch. 2001;438:1-12.
11. Nilsson B, Bumming P, Meis-Kindblom JM, et al. Gastrointestinal stromal tumors: The incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era. Cancer. 2005;103:821-829

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Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal (GI) tract. Before the current definition of GIST evolved, GISTs were classified as benign or malignant smooth muscle tumours including true smooth muscle tumours (leiomyomas, leiomyoblastomas, leiomyosarcomas) and neuronal tumours (schwannomas)

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Multiple Sclerosis
The hallmark of multiple sclerosis (MS) as revealed by magnetic resonance imaging (MRI) is the white matter plaque, which represents an area of demyelination and axonal loss. MS can produce lesions throughout the central nervous system (CNS).

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The hallmark of multiple sclerosis (MS) as revealed by magnetic resonance imaging (MRI) is the white matter plaque, which represents an area of demyelination and axonal loss.

MS can produce lesions throughout the central nervous system (CNS), but certain sites appear to be especially vulnerable, such as the optic nerve, brain stem, spinal cord and periventricular regions. Involvement is often bilateral and symmetrical. Lesions are broadly divided into two types: acute and chronic.

Acute lesions are inflammatory in nature and exhibit infiltration by T-lymphocytes, B-lymphocytes and macrophages, which may be filled with myelin debris from the breakdown of myelin sheaths. Proliferation of astrocytes is also usually evident, accompanied by oligodendrocyte loss.

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Niemann-Pick type C
Niemann-Pick type C disease is a rare genetic lysosomal storage disorder that causes severe, progressive neurological symptoms. It is a very serious, life-threatening condition that can affect infants, children and adults. NP-C is characterized by cellular accumulation of lipids, in particular unesterified cholesterol and glycosphingolipids, in many parts of the body including brain, liver and spleen.

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Niemann-Pick type C disease is a rare genetic lysosomal storage disorder that causes severe, progressive neurological symptoms. It is a very serious, life-threatening condition that can affect infants, children and adults. NP-C is characterized by cellular accumulation of lipids, in particular unesterified cholesterol and glycosphingolipids, in many parts of the body including brain, liver and spleen.

The variability of NPC presentations provides a wide range of life expectancy. In general, early-onset patients tend to die during childhood or early adolescence, while patients with later-onset disease who appear to be less drastically affected can live into late adulthood.

Accurate diagnosis of NPC requires awareness of many clinical phenotypes, narrowing of differential diagnosis by ancillary testing and final confirmation by biochemical testing – the current mainstay of primary diagnosis in NPC.

The prevalence of NPC has undoubtedly been underestimated in the past due to a mixture of factors including confusing terminology, prior lack of specific biochemical or genetic tests, varied pathology, and the many variant clinical manifestations of the disease.

Current, non-specific treatments for NPC focus mainly on supportive care, aimed toward managing the symptoms of the disease. As such, these treatments have no effect on disease progression or long-term outcomes.

Specific therapies for the intended treatment of NPC are based on targeting known pathophysiological and/or biochemical defects involved in the pathogenesis of the disease. While earlier attempts proved largely ineffective, more recent efforts indicate possible hope for the future.

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Prostate Cancer
Prostate cancer is the most frequently diagnosed non-cutaneous malignancy in men, accounting for one in five male cancers.¹ The introduction of prostate-specific antigen (PSA) screening, has led to an increase in the detection of asymptomatic prostate cancer, and subsequently an increase in incidence and survival rates.^1,2

There are only three well established risk factors for prostate cancer; age, family history and ethnicity.³ In contrast to many other types of tumour, smoking, alcohol and a sedentary lifestyle are not currently thought to be involved in the development of prostate cancer.⁴

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Prostate cancer is the most frequently diagnosed non-cutaneous malignancy in men, accounting for one in five male cancers.¹ The introduction of prostate-specific antigen (PSA) screening, has led to an increase in the detection of asymptomatic prostate cancer, and subsequently an increase in incidence and survival rates.^1,2

There are only three well established risk factors for prostate cancer; age, family history and ethnicity.³ In contrast to many other types of tumour, smoking, alcohol and a sedentary lifestyle are not currently thought to be involved in the development of prostate cancer.⁴

Classification of prostate cancer can take two forms; histological classification is used to generate a Gleason score,⁵ while the spread of the disease is classified using the tumour-node-metastasis (TNM)system.³

The majority of prostate cancer diagnoses are made following screening as most patients are asymptomatic.^3,6 However further investigations should be conducted if a patient presents with symptoms. Numerous management options are available dependent on the stage at which a patient presents with prostate cancer, however as most men do not die from prostate cancer it is important to determine which patients will benefit from therapy.^5,7

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References

1. Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P. Estimates of the Cancer Incidence and Mortality in Europe in 2006. Ann Oncol. 18:581-92; 2007
2. World Health Organization. The Global Burden of Disease: 2004 Update. Geneva: WHO; 2004
3. European Association of Urology. Guidelines on Prostate Cancer, 2010.
4. Grönberg H. Prostate Cancer Epidemiology. Lancet. 361:859-64; 2003
5. Kirby RS, Patel MI. Fast facts: prostate cancer (5th ed). Health Press Ltd: Oxford; 2008.
6. American Urological Association. Prostate-specific antigen best practice statement: 2009 update; 2009
7. Coleman MP, Quaresma M, Berrino F; CONCORD Working Group. Cancer survival in five continents: a worldwide population-based study (CONCORD). Lancet Oncol. 9:730-56; 2008

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Renal Cell Carcinoma
Kidney cancer is the 14th most common cancer and there were approximately 200,000 new kidney cancer cases worldwide in 2002. RCC is a global problem, but its incidence varies considerably by geographical location. Rates of RCC are high in North America, Europe and Australia, whereas rates are low in Africa, India and China.

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Kidney cancer is the 14th most common cancer and there were approximately 200,000 new kidney cancer cases worldwide in 2002. RCC is a global problem, but its incidence varies considerably by geographical location. Rates of RCC are high in North America, Europe and Australia, whereas rates are low in Africa, India and China. Until recently, the worldwide incidence of RCC has increased by approximately 2% every year.

It is estimated that there will be 54,390 new cases of kidney cancer and 13,010 kidney cancer-related deaths in the US in 2008 alone. Global incidence data on mRCC are lacking, but can be estimated from figures for overall RCC rates.

In 2006, there were estimated to be 63,300 new cases of kidney cancer (tenth most common cancer in the European Union [EU]¹) and 26,400 kidney cancer-related deaths in the EU. The Czech Republic, Estonia and Iceland have the highest RCC rates in Europe. Although the worldwide incidence of RCC is thought to be increasing,² data from a recent European study, which analysed kidney cancer incidence in 1980– 2004, indicate a shift towards stabilization or a decrease in incidence in recent years in both sexes. Recently, kidney cancer incidence rates also have decreased or stabilized in some countries in Northern Europe, except for England, Scotland and Ireland, whereas incidence in Eastern Europe has generally increased (except for women in the early 2000s). The highest sustained decreases in incidence rates were seen in Sweden; declines were observed in both sexes throughout the 25-year study period.

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References

1.Ferlay J, Autier P, Boniol M et al. Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 2007; 18:581-592.
2. Matthew A, Devesa SS, Fraumeni JF, Jr.., Chow WH. Global Increases in kidney cancer incidence, 1973-1992. Eur J Cancer Prev. 2002;11:171-178.

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Soft Tissue Sarcoma
Soft Tissue Sarcomas (STS) are malignant (cancerous) tumors that develop in tissues which connect, support, or surround other structures and organs of the body. Muscles, tendons (bands of fiber that connect muscles to bones), fibrous tissues, fat, blood vessels, nerves, and synovial tissues are types of soft tissue.

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Soft Tissue Sarcomas (STS) are malignant (cancerous) tumors that develop in tissues which connect, support, or surround other structures and organs of the body. Muscles, tendons (bands of fiber that connect muscles to bones), fibrous tissues, fat, blood vessels, nerves, and synovial tissues are types of soft tissue.

Soft tissue sarcomas are grouped together because they share certain microscopic characteristics, have similar symptoms, and are generally treated in similar ways¹. They are usually named for the type of tissue in which they begin.

Every year approximately 13,000 new cases of soft tissue sarcomas are diagnosed in adults and children in Europe. The 5-year survival rate for patients with soft tissue sarcoma is around 90% if the cancer is detected in early phases and before it has spread. However, the 5-year survival rate is 10% to 15% for sarcomas with metastasis.

Management of STS depends on the stage of disease and histological subtype². Surgery is the mainstay of treatment for patients with localised disease and is often curative. However, as recurrence is likely to occur when tumour cells remain after surgery, adjuvant radiotherapy is often also considered, especially for patients with intermediate or high-grade tumours. Radiotherapy is also often administered for patients in whom surgery is inappropriate or who decline surgery.²

There are a number of Associations and Organisations across Europe who strive to inform others of this disease as well as offer help and support to those affected or to those who know and want to help those suffering.

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References

1. Cormier JN, Pollock RE. Soft tissue sarcomas. CA: A Cancer Journal for Clinicians 2004; 54(2):94–109.
2. Clark MA, Fisher C et al. (2005) “Soft-tissue sarcomas in adults.” N Engl JMed 353(7): 701–11.

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Latest Multi Media

An Overview of the Current Advances in Radiology

Radiology Drug Data - A-Z English

Latest Drug News

Brachytherapy associated with twofold increased risk for Mastectomy - 09-12-2011

Compared with women treated with whole-breast irradiation, those treated with brachytherapy experienced a twofold increased risk for losing their breasts, according to results at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium. The study evaluated the Medicare claims of all U.S. female beneficiaries (n=130,535) aged older than 66 years diagnosed with incident-invasive Breast Cancer between 2000 and 2007. Patients were treated with conservative surgery followed by accelerated partial breast brachytherapy alone vs. whole-breast irradiation. Brachytherapy involves temporarily placing a small radioactive source in the breast after lumpectomy. Results show women treated with brachytherapy experience a twofold increased risk for subsequent mastectomy, indicating that women treated with brachytherapy were more likely to lose their breast after their initial breast-conserving therapy. Four percent of patients treated with brachytherapy vs. 2.2 percent of patients treated with whole-breast irradiation underwent a subsequent mastectomy. According to lead researcher Benjamin D. Smith, assistant professor in the department of radiation oncology at MD Anderson Cancer Center in Houston, there was nearly a twofold increased risk for postoperative infection and noninfectious complications in women treated with brachytherapy.

C-11 choline PET/CT offers benefits for Prostate Cancer patients - 24-10-2011

Three studies highlight the role that C-11 choline positron emission tomography/computerized tomography (PET/CT) scans can play in cancer staging and as a potential therapeutic tool for patients with recurrent Prostate Cancer. The first of the three, released during a meeting of the American Urological Association, reveals that C-11 choline PET/CT scans can play a role as a staging tool instead of multiple x-rays which is the conventional approach. The other studies suggest the use of PET scans to evaluate patients with recurrent Prostate Cancer could be beneficial - important since distinguishing localised disease from systemic recurrence is important for optimising treatment. Finally, compared to conventional technologies, C-11-choline PET/CT seems to enhance the rate of detection of Prostate Cancer lesions by approximately 30%. see "Prospective Evaluation of 11C-Choline Positron Emission Tomography/Computed Tomography and Diffusion-Weighted Magnetic Resonance Imaging for the Nodal Staging of Prostate Cancer with a High Risk of Lymph Node Metastases" Tom Budiharto, Steven Joniau, Evelyne Lerut, Laura Van den Bergh, Felix Mottaghy, Christophe M. Deroose, Raymond Oyen, Filip Ameye, Kris Bogaerts, Karin Haustermans, Hendrik Van Poppel EUROPEAN UROLOGY 60 (2011) 125 – 130 doi:10.1016/j.eururo.2011.01.015

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Surgical cockup or error?
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Latest Clinical Trials

Osteoporosis Among Men Treated With Androgen Deprivation for Prostate Cancer

The purpose of this study is •to determine the rate of osteoporosis among patients with advanced prostate cancer. •to propose an algorithm for early detection of patients with advanced prostate cancer who are at risk of developing osteoporosis

Improving Osteoporosis Care in High-Risk Home Health Patients

We propose a three-year study to develop a high-intensity intervention to improve osteoporosis care and test a novel intervention in a group-randomized trial of 27 home health offices and 1,000 patients referred to home health care with a history of fracture.

Latest Journal Publications

Auris Nasus Larynx

Foreign bodies within the deep spaces of the neck pose infrequent but substantial risks involving migration, including infection, pseudoaneurysm formation, pneumothorax, hemopericardium, and embolization to the central circulation. A rare case of foreign body migration through the parapharyngeal space into the posterior cervical space is described from an intraoral needle shard. A 48-year-old male presented with a right neck tenderness, referred otalgia, and intermittent neck twitching after a needle fragment was lost during an inferior alveolar nerve block. A CT scan six months after the incident revealed migration of the 2.5 cm needle posterolateral to the great vessels into the posterior cervical space. A transcervical approach led to identification and extraction of the foreign body, with resolution of symptoms. Sharp foreign bodies in the head and neck introduce an uncommon but high-impact risk of complications. Migration is often unpredictable in trajectory and time course. Early surgical removal is recommended for persistent symptoms, sustained migration, and localization to sites with critical structures.

Auris Nasus Larynx

Objectives: Thyroid nodular swellings are very common, consisting of both benign and malignant ones. Fine needle aspiration cytology is an excellent diagnostic modality for papillary cancers, medullary cancers, colloid goiter and lymphoma but fails in differentiating follicular adenomas from carcinomas. The purpose of this study was to evaluate role of Dynamic MRI with signal intensity time curve evaluation in differentiating benign from malignant follicular nodules. Materials and methods: This study was carried out in Department of Surgery in collaboration with department of Radiodiagnosis, Maulana Azad Medical College, Delhi. 28 patients with solitary thyroid nodule (STN) having follicular etiologies were included in the study. Dynamic MRI with signal intensity time curve analysis was carried out in all the cases and findings were compared with the final diagnosis based on histopathological examination of surgical specimen. Results: In the present study, rapid enhancement was seen in 87.5% of malignant cases and washout pattern was seen in 87.5% of malignant STN (p = 0.019). Only 20% of the benign lesions showed washout pattern (p = 0.0034). Benign cases demonstrated gradual enhancement in 85% cases as compared to 12.5% in malignant STN (p = 0.0098). Conclusion: This study suggests that signal intensity time curve may help in differentiating benign from malignant follicular thyroid nodules.

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