BACKGROUND:Previous studies have investigated the concordance between pre-TAVI coronary CT angiography (CTA) and invasive coronary angiography (ICA). PURPOSE:To evaluate the agreement between pre-TAVI coronary CTA and ICA and to determine the relationship between coronary artery disease and one-year survival: MATERIALS AND METHODS: Coronary CTA findings were compared with invasive coronary angiography in patients undergoing TAVI for severe aortic stenosis at our tertiary care center between November 2023 and November 2024, with 50% and 70% stenosis used as diagnostic cut-off values. RESULTS:Ninety-five patients who underwent both coronary CTA and invasive coronary angiography prior to TAVI were included. Obstructive CAD was defined as ≥ 70% stenosis in the right coronary, left anterior descending, or circumflex artery, or ≥ 50% stenosis in the left main coronary artery. CTA findings showed strong agreement with invasive coronary angiography across all coronary arteries. At the 70% stenosis threshold, CTA demonstrated high sensitivity and specificity, with excellent interobserver agreement. Obstructive CAD was present in 82.1% of patients, with single-, two-, and three-vessel disease observed in 15.8%, 18.9%, and 47.4%, respectively. Severe carotid artery stenosis (> 70%) was observed in a minority of patients. One-year survival was 93.7% and was not associated with the presence of CAD (p = 0.466). CONCLUSION:Pre-TAVI coronary CTA shows strong agreement with invasive coronary angiography for detecting obstructive coronary stenosis and represents a practical, noninvasive option for coronary assessment before TAVI.
RATIONALE AND OBJECTIVES:This study aimed to evaluate the relationship between mild autonomous cortisol secretion (MACS) caused by adrenal adenomas and hepatic fat fraction (HFF) measured by dual-echo Dixon chemical shift-encoded MRI (dual-echo CSE-MRI). METHODS:This retrospective study included 151 patients with 169 adrenal adenomas evaluated between November 2023 and November 2025. According to post-1 mg dexamethasone suppression test (DST) cortisol levels, patients were classified as having MACS or non-functioning adrenal incidentalomas (NFAI). HFF was quantitatively assessed using dual-echo CSE-MRI. Clinical, biochemical, and imaging findings were analyzed. Correlation analyses and multivariate regression models were used to identify factors associated with hepatic fat fraction and MACS. RESULTS:Forty-five adrenal adenomas (26.6%) were classified as MACS. HFF was significantly higher in patients with MACS compared with those with NFAI (16.0% ± 13.3% vs. 7.1% ± 7.6%, p < 0.001). HFF showed a significant positive correlation with post-DST cortisol levels (r = 0.316, p < 0.001) and fasting glucose levels (r = 0.312, p < 0.001). In multivariate logistic regression analysis, hepatic fat fraction remained independently associated with MACS (OR: 1.084, p < 0.001). Multivariate linear regression analysis demonstrated that post-DST cortisol levels, fasting glucose levels, and age were independently associated with HFF. CONCLUSION:Hepatic fat fraction measured by dual-echo CSE-MRI is increased in patients with MACS and is associated with cortisol excess.
Uterine artery embolisation (UAE) is an evidence-based treatment for symptomatic fibroids and adenomyosis. Ultrasound is commonly utilised for assessment post UAE given its wide availability and low cost; however, contemporary studies describing the typical ultrasound findings post UAE are limited, with a preference for discussion of Magnetic Resonance Imaging (MRI) findings over recent years. However, MRI is not funded in many jurisdictions, leaving patients to bear the costs. As such, there remains an important role for ultrasound follow-up in this cohort. This article presents the common and expected ultrasound appearances after UAE. At 6 months post-treatment, fibroids are expected to have decreased in volume by 40%-70%, have no central vascularity, and appear heterogeneous but generally more hypoechoic than pre-treatment. Based on first principles, adenomyosis features, including myometrial-endometrial junctional thickening and myometrial thickening, may diminish after UAE, along with infarction of an adenomyoma if present. Retrospective review of 107 primary uterine artery embolisation cases in patients with symptomatic uterine fibroids (n = 95) and/or adenomyosis (n = 17) demonstrated a significant correlation between persistent vascularity in a fibroid or adenomyoma and seeking further treatment due to ongoing symptoms (p < 0.01). Significant correlation was also demonstrated with post-treatment volume change of a dominant fibroid or adenoma. There was no significant correlation with the hypoechoic appearance of the dominant fibroid. While the mainstay of follow-up evaluation after UAE for symptomatic fibroids and adenomyosis is clinical assessment of symptoms by the treating Interventional Radiologist, ultrasound imaging features provide an important adjunct in clinical decision-making.
INTRODUCTION:Elderly patients make up a large proportion of those diagnosed with glioblastoma. There are multiple treatment options available for elderly patients including conventional and hypofractionated chemoradiotherapy, chemotherapy monotherapy and best supportive care; therefore, management decision-making can be complex. This retrospective study aims to compare overall survival (OS) and review prognostic factors in patients aged 65 and above who received either long-course or short-course chemoradiotherapy in regional New Zealand. METHOD:A regional New Zealand Neurosurgical database identified patients aged ≥ 65 who received the EORTC-NCIC long-course radiotherapy (60Gy in 30 fractions) or the NCIC-CTG short-course radiotherapy (40Gy in 15 fractions), both with concomitant and adjuvant temozolomide. RESULTS:76 patients diagnosed between 2006 and 2018 were included for analysis. Median OS for those receiving long-course (n = 59) was 15.4 months and for those receiving short-course (n = 17) was 16.9 months. 12-month estimated OS probability was 73% for long-course and 65% for short-course. 24-month estimated OS probability was 22% for long-course and 18% for short-course. There was no statistically significant difference in OS between the two treatment regimes. In a median-regression testing analysis there was insufficient evidence to show that extent of surgical resection, timing of radiotherapy from surgery and use of steroids during radiotherapy were prognostic factors. MGMT methylation status was seldom available for patients during this time. CONCLUSION:In this study, median OS of elderly patients receiving long-course or short-course chemoradiotherapy was similar. Short-course chemoradiotherapy should routinely be considered in all elderly patients.
BACKGROUND:Isolated fetal pyelectasis is a common finding on second-trimester ultrasound; however, optimal follow-up strategies remain variable, often leading to inconsistent use of imaging and specialist services. This study aimed to evaluate clinical management pathways and outcomes and to identify factors associated with persistence. METHODS:A retrospective cohort study was performed of 221 pregnancies with isolated fetal pyelectasis detected on routine second-trimester ultrasound within a large tertiary healthcare network. RESULTS:Final outcome data were available in 214 cases. At initial third-trimester follow-up, pyelectasis had resolved in 167/214 cases (74.2%), increasing to 180/214 cases (84.1%) by final antenatal follow-up. Persistence was observed in 34/214 cases (15.9%). Male foetuses demonstrated significantly higher persistence rates than female foetuses (20.4% vs. 7.7%; OR 3.07, 95% CI 1.16-8.12, p = 0.022), while persistent cases had larger median renal pelvic diameters than resolved cases (5.6 mm [IQR 5.0-8.0] vs. 4.7 mm [IQR 4.2-5.3], p = 0.0003). CONCLUSION:Isolated fetal pyelectasis demonstrates a high rate of spontaneous resolution, with relatively low persistence on follow-up imaging. These findings support a more risk-based approach to follow-up, with potential to reduce unnecessary imaging and optimise utilisation of specialised fetal diagnostic services.
PURPOSE:To evaluate the feasibility of 68Ga-FAPI PET/CT in pancreatic cancer by comparing radiotracer uptake, lesion detection, and diagnostic value with 18F-FDG PET/CT. METHODS:Ten participants (seven male, three female; mean age 68 years) with suspected or confirmed pancreatic cancer underwent both 68Ga-FAPI and 18F-FDG PET/CT. Imaging was assessed for uptake, lesion detection, and diagnostic usefulness as determined by clinicians. RESULTS:Ten participants (seven male, three female; mean age 68 years) underwent imaging. Mean SUVmax of the primary lesion was higher for 68Ga-FAPI compared with 18F-FDG in participants with an identifiable primary lesion (n = 9) (13.8 [range 6.2-19.6] vs. 7.0 [range 0.0-12.5]). 68Ga-FAPI identified additional lesions in three participants, resulting in imaging-based upstaging in three cases. Clinicians considered FAPI more diagnostically useful in five participants and equivalent in the remainder, based on comparison of lesion detection, delineation, and staging impact. Increased uptake was also seen in areas of presumed inflammation. No adverse events were reported. CONCLUSIONS:This feasibility study shows that 68Ga-FAPI PET/CT is safe, demonstrates higher uptake than FDG, and can reveal additional lesions that influence staging. Imaging-based upstaging was observed in three participants, supporting further investigation of FAPI as a complementary tool in pancreatic cancer imaging. Larger prospective studies are needed to determine the clinical impact of 68Ga-FAPI PET/CT in pancreatic cancer.
BACKGROUND:Sarcoidosis is a multisystem granulomatous disease that commonly affects the lungs and intrathoracic lymph nodes. On imaging, characteristic patterns of lymphadenopathy, such as the lambda sign on fluorodeoxyglucose positron emission tomography (FDG PET), are considered suggestive of the disease and can assist in differentiating sarcoidosis from differential diagnoses. FDG PET/CT is increasingly used to assess disease extent, identify extrapulmonary involvement, guide biopsy and monitor inflammatory activity. The prevalence and imaging characteristics of the lambda sign and periportal/portocaval lymphadenopathy, termed the 1-2-3-4 sign on FDG PET/CT in sarcoidosis, remain poorly defined. METHODS:A retrospective cohort study was performed of patients with sarcoidosis who underwent FDG PET/CT imaging at a tertiary centre in 2019. PET studies were assessed for the presence of the lambda sign and for FDG-avid periportal and/or portocaval lymph nodes. The frequency of the lambda and 1-2-3-4 sign, nodal distribution, and metabolic activity were analysed, including maximum standardised uptake values (SUVmax). RESULTS:The lambda sign was identified in a substantial proportion of patients. FDG-avid periportal and/or portocaval lymph nodes were observed in a subset of cases, although only one patient demonstrated the complete 1-2-3-4 sign. Periportal and portocaval nodes showed FDG uptake comparable to intrathoracic nodal disease. CONCLUSION:FDG-avid periportal and portocaval lymphadenopathy may occur alongside classic intrathoracic nodal patterns in sarcoidosis, although the complete 1-2-3-4 sign appears uncommon. Recognition of this imaging pattern on FDG PET/CT may support diagnostic confidence in appropriate clinical contexts and help differentiate sarcoidosis from alternative causes of mediastinal and abdominal lymphadenopathy.
INTRODUCTION:To assess the efficacy and safety of interventional radiology-guided covered self-expanding metallic stents (CSEMS) in the management of hepaticojejunostomy (HJ) bile leaks following major hepatic and pancreatic resections. METHODS:A retrospective study was conducted of all patients who developed HJ bile leaks after hepatic and pancreatic resections between January 2020 and February 2025 at a single tertiary referral centre. Analysis was performed on patients managed with percutaneous, IR-guided CSEMS placement. Patient demographics, clinical presentation, procedural details, stent characteristics and outcomes were collected. The primary endpoint was successful radiological resolution of the bile leak. Secondary endpoints included procedural complications and 90-day mortality. RESULTS:Nine patients with HJ leaks were managed with IR-guided CSEMS placement. The index operation was a pancreaticoduodenectomy in 7 of 9 patients and extended hepatectomy with bile duct reconstruction in 2 of 9 patients. The overall success rate for leak resolution was 100%. The median time to radiological resolution was 21.5 days (range, 7-51 days). Complications occurred in 4 of 9 patients, consisting of stent migration in one patient and cholangitis in three patients. No patient required surgical intervention for the HJ leak. CONCLUSION:The use of IR-guided CSEMS for managing HJ bile leaks is a highly effective and minimally invasive treatment. It demonstrates an excellent success rate for leak resolution with a manageable complication profile, representing a reliable alternative to surgical re-intervention in this complex patient population.
INTRODUCTION:Contrast-induced encephalopathy (CIE) is an increasingly recognised neurological complication of iodinated contrast administration during neurointerventional procedures. Recently published 2025 Delphi-based diagnostic criteria and management algorithms aim to standardise clinical practice; however, optimal neuroimaging strategies remain undefined. We evaluated the role of dual-energy computed tomography (DECT) as first-line neuroimaging and correlated institutional cases with proposed diagnostic and management frameworks. METHODS:A retrospective review was performed of all patients diagnosed with CIE following elective endovascular intracranial aneurysm treatment at a tertiary neurovascular centre between 2023 and 2025. Inclusion criteria included neurologically asymptomatic patients at presentation who underwent DECT during admission. Cases were assessed against the Delphi diagnostic criteria in consensus with two neurointerventionalists. RESULTS:Six patients met inclusion criteria. Five underwent DECT as first-line neuroimaging. Of these, four (80%) demonstrated parenchymal contrast staining confirmed on iodine overlay imaging, and one was completely normal despite clinical features consistent with CIE. All patients underwent brain MRI during admission. Of these, all patients (100%) demonstrated punctate, non-contributory diffusion changes while two developed confluent diffusion restriction consistent with cerebral ischaemia. Four patients (66.6%) were diagnostically concordant with the Delphi diagnostic criteria. Supportive treatment for suspected CIE did not adversely affect outcomes in patients with concurrent ischaemia. CONCLUSION:DECT appears to be a useful first-line neuroimaging modality for evaluating suspected CIE in patients undergoing elective endovascular aneurysm treatment. MRI remains essential to perform after DECT to assess for concurrent or occult cerebral ischaemia. New diagnostic and management algorithms are useful tools; however, further refinements are recommended.
PURPOSE:SpyGlass-assisted percutaneous transhepatic cholangioscopy is increasingly used to evaluate biliary strictures when standard endoscopic approaches are limited. This study evaluates the clinical indications, diagnostic performance, and safety of SpyGlass-assisted percutaneous transhepatic cholangioscopy with targeted forceps biopsy for biliary strictures at a tertiary centre. MATERIALS AND METHODS:A retrospective single-centre review identified all SpyGlass-assisted percutaneous transhepatic cholangioscopy procedures performed between May 2021 and January 2025 where biopsy of a biliary stricture was attempted. Demographic characteristics, clinical presentation, procedural details, histological findings, and complications were obtained from the hospital's electronic database. The primary outcome was technical and diagnostic success. Technical success required cholangioscope advancement, visualisation of the biliary tree, and attempted biopsy. Diagnostic success required a definitive histopathological diagnosis from the biopsy sample. Secondary outcomes included complication rates, length of hospital stay, and subsequent clinical outcomes. RESULTS:Among 99 total procedures, 39 involved biopsies of biliary strictures. The mean patient age was 67 years, and 66.7% were male. Cholangioscopy was used as the first-line intervention in most procedures (87.2%). Technical success was achieved in all procedures. Diagnostic success was 84.6%, identifying malignancy in 24 procedures and benign pathology in 9. Six biopsies (15.4%) were non-diagnostic due to atypical cells, crush artefact, or insufficient tissue. Two procedures demonstrated discordance, with negative or atypical biopsy results despite later confirmation of malignancy. Complications occurred in 16 procedures, most commonly Grade II, including one procedure-related death. Median hospital stay was 11 days. CONCLUSION:SpyGlass-assisted percutaneous transhepatic cholangioscopy demonstrates high technical success and strong diagnostic performance for biliary strictures. LEVEL OF EVIDENCE: 4:
INTRODUCTION:Birth-related subdural haemorrhages (SDH) are common in asymptomatic neonates. While most resolve without long-term effects, their natural history in moderate-to-late preterm (MLP) neonates remains uncertain. Rebleeding into birth-related SDH is also sometimes suggested as an alternative explanation for SDH findings in suspected abusive head trauma. We aimed to assess the prevalence, distribution, risk factors and temporal evolution of birth-related SDH in asymptomatic MLP neonates, and to compare these to those reported in term neonates. METHOD:We reviewed a cohort of asymptomatic neonates born 32 + 0 to 36 + 6 weeks of gestation who underwent brain MRI scans shortly after birth (scan 1) and at term-equivalent age (scan 2). The presence, location and size of SDH were assessed using Four Quadrant Subdural (FQS) scoring reflecting the sum of the maximal thickness of SDH in each quadrant. Demographic and clinical factors were compared between neonates with and without SDH. RESULTS:SDH was identified in 48/189 neonates (25.4%) at scan 1. Most had multifocal haemorrhages in the posterior cranial fossa or posterior supratentorial regions. Neonates with SDH had higher birth weights than those without SDH and were more likely to be born vaginally. By scan 2, SDH had resolved in 75% and mean FQS score decreased by 71% in the remainder. CONCLUSION:SDH is common in MLP neonates, with a distribution similar to that of term neonates. Risk factors include higher birth weight and vaginal birth. Most birth-related SDH resolves by term-equivalent age, making it an unlikely explanation for SDH in older infants with suspected abusive head trauma.
INTRODUCTION:Transoral robotic surgery (TORS) and radiotherapy are both recognised as effective treatment options for early-stage HPV-associated oropharyngeal squamous cell carcinoma (HPV-OPSCC). TORS offers the benefit of a shorter total treatment duration; however, a proportion of patients require adjuvant radiotherapy with or without concurrent chemotherapy. Given the equivalence in oncological outcomes and difference in potential costs associated with these two treatments, we sought to perform an economic analysis to assess the incremental cost-effectiveness of TORS compared to radiotherapy. METHODS:We developed a Markov model to assess the cost-effectiveness of TORS versus radiotherapy for clinical stage T1-2 N0-1 (AJCC 7th edition) HPV-OPSCC. Utility values for health states were informed by EQ-5D-5L from a TROG 12.01. We adopted the Australian healthcare perspective to measure healthcare costs and outcomes, and costs were valued in 2023 Australian dollars (AUD). The incremental cost-effectiveness ratio (ICER) was calculated as the ratio of incremental cost against the incremental quality-adjusted life years (QALY) between two treatment groups. Parameter uncertainties were assessed through sensitivity analysis. RESULTS:The total costs/QALY for TORS and radiotherapy were $85,317/8.995 QALY and $57,833/8.519 QALY, respectively. This resulted in an ICER of $57,749/QALY gained with TORS. In sensitivity analysis, ICER was highly sensitive to the cost of TORS, distant recurrent disease, probability of salvage surgery after radiotherapy, discount rate, and the locoregional recurrent disease. CONCLUSION:From an Australian healthcare system perspective, TORS is not cost-effective compared to radiotherapy alone for early-stage HPV-OPSCC based on healthcare associated cost.
INTRODUCTION:Financial toxicity refers to the objective financial burden and subjective financial distress caused by medical treatment. Cervical cancer patients experience high financial toxicity internationally, and local evidence suggests similar challenges in New Zealand. This study aimed to measure the prevalence and severity of financial toxicity in patients undergoing radiation treatment for cervical cancer at Wellington Blood and Cancer Centre (WBCC). METHODS:Twelve patients undergoing cervical cancer treatment and 29 patients receiving curative radiation therapy completed surveys including demographics, COST-FACIT measure of financial toxicity and quality of life (EORTC QLQ-C30) at treatment commencement and again at treatment completion. Group comparisons were analysed using repeated measures ANOVA. RESULTS:Cervical cancer patients (n = 10) reported significantly greater financial toxicity than comparison patients (n = 27), with lower COST-FACIT Scores (20.6 vs. 29.7), p = 2. Younger age, greater distance from WBCC and cervical cancer treatment group were independently associated with increased financial toxicity. Global Health Scores, Financial Difficulty Score, Social Functioning Score and symptoms were significantly worse in the cervical cancer group. Eight out of ten participants (80%) From the cervical cancer group met criteria for financial toxicity based on COST-FACIT Score. Median out of pocket costs and income-related loss were $1814NZD (IQR $1041-$2182) for cervical cancer patients, compared to $264NZD (IQR $71-$558 p = 0.006, Mann-Whitney U Test) for others. CONCLUSION:Patients receiving radiation for cervical cancer experience significantly higher financial toxicity than other WBCC patients. Addressing the financial burden of treatment should be a priority in support for this vulnerable group.
INTRODUCTION:Lymphoedema is a significant complication following head and neck cancer (HNC) treatment. We examined the use of computed tomography (CT) to detect internal lymphoedema (IL) based on serial assessments of volumes of swallowing structures before, during, and after radiation treatment. Volume changes were correlated with videomanometry and Functional Lumen Imaging Probe (EndoFLIP) findings to determine whether these assessments might provide insights into the impact of lymphoedema on swallowing dysfunction. METHOD:Data were collected retrospectively from 26 HNC patients who completed manometry, EndoFLIP and Sydney Swallow Questionnaire (SSQ) 12 months after radiotherapy. Seven swallowing structures were contoured on the CT simulation, the last cone-beam CT and the three-month PET/CT scan. Changes in the dimensions of swallowing structures were correlated with swallowing outcomes via linear regression models. RESULTS:There was persistent swelling in three of the seven structures three months post-radiation, compared with baseline. These were the epiglottis (0.77cm3, 95% CI [0.50, 1.04], p < 0.0001), base of tongue (6.92 cm3, [4.82, 9.03], p = 0.0001) and middle pharyngeal constrictors (2.77cm3, [1.63, 3.91], p = 0.0001). Total volume of all structures at three months was positively associated with SSQ scores (β = 31.198, [12.521, 49.875], p = 0.005). There was no significant association between the volume of swallowing structures and manometry or EndoFLIP measures. CONCLUSION:CT is a potentially valuable tool for evaluating IL in HNC patients following radiotherapy. IL of all swallowing structures was associated with worse self-reported dysphagia based on SSQ scores. These exploratory findings highlight the need for validation in a prospective study with a larger sample size.
BACKGROUND:Coronary artery calcification (CAC) is a strong independent predictor of cardiovascular events and can be reliably identified on non-gated thoracic CT (NGTCT). International consensus statements recommend routine reporting of incidental CAC with visual grading and management prompts. However, real-world adherence to these recommendations remains variable, and no data currently exist for New Zealand. METHODS:We conducted a retrospective observational study of patients presenting with acute myocardial infarction (MI) to Tauranga and Whakatāne Hospitals between January 2021 and December 2023. Patients with ST-elevation or non-ST-elevation MI were included; type 2 MI was excluded. Radiology reports from prior NGTCT performed within 5 years of admission were reviewed to assess CAC reporting and grading. Demographic data were obtained from local electronic health records, and cardiovascular risk factors were extracted from the Aotearoa New Zealand All Cardiology Services Quality Improvement registry. RESULTS:After exclusions, 1602 patients were admitted with acute MI, of whom 269 (16.8%) had a prior non-cardiac NGTCT. CAC was reported in 70 reports (26%), with visual severity grading provided in 14 (20%). Only two reports (3%) mentioned CAC in the conclusion, and none included a management recommendation. Most ungraded reports used descriptive terminology rather than standardised severity categories. Modifiable cardiovascular risk factors among those with unreported CAC were common, including current or former smoking (83%), hypertension (57%), elevated total cholesterol (41%), elevated LDL cholesterol (41%) and raised HbA1c (27%). CAC reporting was lower in patients aged < 55 years and did not differ between Māori and New Zealand European/Pākehā patients. CONCLUSION:CAC is infrequently reported and rarely graded on NGTCT in regional New Zealand patients who later present with MI, despite strong international recommendations. Given the high prevalence of modifiable risk factors and the potential impact on cardiovascular risk stratification and prevention, routine standardised CAC reporting with inclusion of brief management guidance should be implemented.
PURPOSE:Ileocolic intussusception is a paediatric emergency requiring rapid reduction of the telescoped bowel. Often initial attempts at reduction are conservative, using gas or liquid enema. Our aim is to examine the success of pneumatic reduction over the past 17 years at our centre, compare our rates of success and complication to the published literature, and evaluate the use of delayed repeat reduction attempts (DRRAs). METHODS:A retrospective single centre review of all patients with attempted pneumatic reduction of ileocolic intussusception, between January 2006 and December 2023. Patient demographics, clinical history, number of initial and delayed reduction attempts, and surgical outcomes were reviewed. RESULTS:Three hundred fourteen patients had successful reduction out of a total 375 attempted (success rate 84%). In general, the further the distal extent of the intussusceptum, the decreasing likelihood of successful pneumatic reduction (95% ascending colon; 86% hepatic flexure; 85% transverse colon; 40% splenic flexure; 50% descending colon; 35% sigmoid colon). The success also decreased with each repeat attempt in a single session, but DRRAs showed relatively increased success. Rates of bowel resection in patients transferred to theatre after initial attempts compared with DRRAs were similar (23% vs. 22%). Bowel perforation occurred in 0.8% (all during the first reduction attempt). CONCLUSIONS:This study supports the use of multiple attempts at the pneumatic reduction of ileocolic intussusception, with evidence that subsequent delayed repeat attempts after 4-6 h are effective at reducing operative intervention rates without increasing the risk of bowel perforation or resection.
INTRODUCTION:Percutaneous transhepatic cholangioscopy has emerged as a viable alternative to endoscopic retrograde cholangiopancreatography for the management of biliary duct calculi. This study aimed to evaluate the outcomes of treating biliary duct calculi using SpyGlass-assisted percutaneous transhepatic cholangioscopy. METHODS:A retrospective review was conducted of all patients who underwent SpyGlass-assisted percutaneous transhepatic cholangioscopy at a single-centre between May 2021 and December 2024. Demographic, clinical, imaging, procedural, and adverse event data were collected from electronic medical records. The primary outcome was clinical success, defined as complete resolution of presenting symptoms with associated improvement in biochemical markers. The secondary outcome was technical success, defined as complete clearance of biliary duct calculi on direct visualisation using SpyGlass cholangioscopy and fluoroscopic imaging. Adverse events were recorded and classified according to severity using the Clavien-Dindo classification. RESULTS:Between May 2021 and December 2024, 27 patients underwent 42 SpyGlass-assisted percutaneous transhepatic cholangioscopy procedures for 32 distinct clinical presentations. Clinical success was achieved in all presentations, and technical success was recorded at 83% of procedures. Adverse events occurred in 36% of procedures, the majority of which were minor (Clavien-Dindo classification Grade 1 or 2). There was a single case of procedure-related mortality. CONCLUSION:SpyGlass-assisted percutaneous transhepatic cholangioscopy appears to be a safe and effective alternative for the management of biliary duct calculi, particularly in cases where endoscopic retrograde cholangiopancreatography is unsuccessful or contraindicated.
BACKGROUND:Photon-counting detector CT (PCD-CT) is a technology that directly counts individual photons and their energy, compared to conventional energy-integrating detector CT (EID-CT) which measures the total deposited X-ray energy without distinguishing photon energies. PCD-CT promises to provide higher quality images at equal or reduced radiation doses. We aimed to compare the objective and subjective image quality of PCD-CT to EID-CT for low-dose chest CT. METHODS:Asbestos-exposed participants from the Western Australian Asbestos Review Program underwent paired EID-CT (2023-2024) and PCD-CT (2024-2025) at a reduced radiation dose. Three independent chest radiologists rated relative image quality on a 5-point Likert scale, with higher scores indicating better quality on the right-hand image. Quantitative image noise was measured in the descending thoracic aorta. Interobserver agreement was assessed using κ statistics, intraclass correlation coefficients (ICC), and near-agreement (±1 category). RESULTS:Fifty subjects (median age 77 IQR 10.25 years; 40 men) were included. Across 150 ratings, 88% fell in categories 'somewhat higher' (4) or 'much higher' (5), favouring PCD-CT. The pooled mean score was 4.2. Individual reader mean scores ranged from 3.6 to 4.7. Interobserver agreement was modest by exact κ statistics, but near-agreement (±1 category) was high (80%-98%) and intraclass correlation coefficients demonstrated strong reader consistency. Quantitative analysis showed similar image quality despite approximately 40% reduced radiation dose for PCD-CT. CONCLUSIONS:PCD-CT provides superior subjective image quality to EID-CT for low-dose chest CT, at a substantially reduced radiation dose. TRIAL REGISTRATION:Clinical trial number: ACTRN12621001627842; https://www.anzctr.org.au/.
INTRODUCTION:Endovascular thrombectomy (EVT) is the gold standard treatment for managing emergent large vessel occlusion (LVO) ischaemic stroke. The role of perfusion CT imaging in selecting appropriate candidates for EVT is well established. New understanding of the benefits of EVT in later stages of infarct have raised questions about the requirement of perfusion CT. This study assessed the accuracy of non-perfusion imaging for making appropriate EVT referrals. METHODS:We reviewed 50 consecutive acute stroke presentations with-contrast CT, CTA and perfusion imaging. Observers included two neuroradiologists and two senior radiology registrars. Cases were anonymised, and perfusion data removed. Diagnostic accuracy metrics (sensitivity, specificity, PPV, NPV) for evaluating hyperdense vessel (HV), acute infarct (AI) and LVO were calculated. Interobserver agreement was measured. Sensitivity for recommending IR discussion was compared against clinical outcomes. RESULTS:High interobserver agreement was observed for LVO detection (κ = 0.92) and IR referral (κ = 0.96). Consultants demonstrated higher sensitivity for HV (92%) and AI (76%), while registrars exhibited higher specificity (HV: 94%; AI: 96%). Both groups achieved > 90% accuracy in LVO detection. Sensitivity for IR recommendations was 91.5% for consultants and 96.0% for registrars (p = 0.5). All cases that proceeded for EVT in this cohort were identified by all four reviewers and the same clinical recommendation was made. CONCLUSION:Non-perfusion imaging offers robust diagnostic accuracy for detecting LVO, making it a reliable tool for EVT decision-making in resource-constrained centres. Perfusion imaging enhances diagnostic confidence and clinical planning, particularly in complex cases. Its integration into workflows should remain a priority where feasible.
Introduction Adrenal incidentalomas are common lesions with potential functional activity such as autonomous cortisol secretion (ACS), which influences management. Current diagnosis relies on biochemical testing, notably the dexamethasone suppression test (DST). This study aimed to evaluate whether CT-derived volumetry of adrenal incidentalomas and contralateral adrenal glands-specifically the ratio of adenoma volume to contralateral volume (AV/CV) could serve as a reliable screening marker for ACS. Methods We retrospectively analysed all adult patients referred with unilateral adrenal adenomas between January 2022 and January 2023. Patients with bilateral lesions, metastatic disease, or interfering medications were excluded. All underwent standard hormonal assessment with 1 mg overnight DST and had volumetric analysis of adrenal glands on CT imaging performed independently by two radiologists, calculating AV, CV and their ratio. The correlation between AV/CV and post-DST cortisol levels was assessed using Pearson's coefficient, and ROC analysis evaluated the predictive accuracy. Results Inter-observer variability was r = 0.997 for AV and r = 0.791 for CV. There was no significant correlation between AV/CV ratio and cortisol post-DST. An AV/CV ratio >= 1 demonstrated low sensitivity (52%) and specificity (48%) for ACS prediction. Although a ratio >= 3 was highly specific (> 90%), its sensitivity was limited (17%). Conclusion Our study did not show a correlation between AV/CV ratio and the presence of ACS, contrasting earlier promising studies.
