Background Suspected cholesteatoma recurrence is commonly investigated with magnetic resonance imaging (MRI) of the temporal bone. Non-echo planar diffusion-weighted imaging (non-EP DWI) has become the sequence of choice. Purpose To assess the agreement between an MRI protocol incorporating both non-EP DWI and contrast-enhanced sequences, and a shortened protocol without contrast-enhanced sequences in the assessment of suspected cholesteatoma recurrence. Materials and methods One hundred consecutive MRIs, consisting of T2-weighted, non-EP DWI and pre- and post-contrast T1-weighted sequences, were reviewed by two radiologists at a tertiary referral centre. Agreement between the two protocols was assessment by means of a weighted Cohen kappa coefficient. Results We found a near perfect agreement between the two protocols (kappa coefficient with linear weighting 0.98; 95% confidence interval 0.95–1.00). There were two cases in which the two protocols were discordant. In both cases, the lesion measured <3 mm and images were degraded by artefact at the bone–air interface. The shortened protocol without post-contrast sequences yielded a 32% reduction in acquisition time. Conclusion When non-EP DWI is available, contrast-enhanced sequences can be omitted in the vast majority of cases without compromising diagnostic accuracy. Contrast-enhanced sequences may provide additional value in equivocal cases with small (<3 mm) lesions or in cases where images are degraded by artefact.

Background and Purpose— The diagnosis of giant-cell arteritis (GCA) is challenging. Superficial temporal artery biopsy and ultrasound are positive in only 50%. We evaluated computed tomographic angiography (CTA) of the head in GCA. Methods— This case-control study was performed using a prospective GCA registry. Cases presented with stroke symptoms, had a CTA, and were subsequently diagnosed with GCA. Age- and sex-matched controls presented with stroke symptoms, had a CTA, and were not diagnosed with GCA. CTAs were evaluated for the presence of superficial temporal artery abnormalities. Results— Fourteen cases met the inclusion criteria and were matched with 14 controls. Blurred vessel wall margins and perivascular enhancement was found in 10 cases (71.4%) and 2 controls (14.3%). CTA has an accuracy of 78.6%, sensitivity of 71.4%, and a specificity of 85.7% for GCA. Conclusions— CTA detects superficial temporal artery abnormalities in GCA. This may facilitate early diagnosis and prompt implementation of potentially sight-saving and stroke-preventing treatment.

AimsTo determine whether specific magnetic resonance enterography (MRE) findings can predict outcome following commencement of antitumor necrosis factor (aTNF) in small bowel Crohn's disease (CD)Patients and methodsThis was a single-centre retrospective study of patients with CD who commenced aTNF (infliximab or adalimumab) between 2007 and 2013. Patients who had an MRE within 6 months before commencing aTNF were included. The primary end-point was the need for CD-related surgery. The secondary end-points were time to surgery and time to treatment failure. The relationship between these end-points, clinical variables and specific MRE findings were studied.ResultsFour hundred and eighteen patients commenced aTNF for CD during the study period. Seventy-five patients had an MRE within 6 months before commencing aTNF (30 infliximab; 45 adalimumab). The median time from MRE to commencing aTNF was 43 days (IQR 19.5-87 days). Eighteen of 75 (24%) had surgery during a median follow-up of 16.7 months (IQR 9.0-30.1 months). Patients with small bowel stenosis (SBS) on MRE were at a significantly higher risk of requiring surgery: 12/18 (66.7%) versus 6/57 (10.5%) (P<0.001). Time to surgery was significantly shorter in patients with SBS on MRE (P<0.001). In a multivariate analysis, SBS (P<0.0001, hazard ratio 26.45, 95% confidence interval 5.45-128.49) and presence of penetrating complications (P=0.003, hazard ratio 36.53, 95% confidence interval 3.40-393.19) were associated independently with time to surgery.ConclusionSBS and penetrating complications on MRE are associated independently with a need for early surgery and treatment failure in patients commencing aTNF. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.

Magnetic resonance enterography (MRE) has a growing role in imaging small bowel Crohn's disease (SBCD), both in diagnosis and assessment of treatment response. Certain SBCD phenotypes respond well to biologic therapy and others require surgery; MRE has an expanding role in triaging these patients. In this review, we evaluate the MRE signs that subclassify SBCD using evidence-based medicine (EBM) methodology and provide a structured approach to MRE interpretation. (C) 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Introduction MRE has been increasingly adopted as the imaging modality of choice for patients with small bowel Crohn's disease, replacing barium studies and CT. MRE has similar sensitivity to CT for detection of small bowel inflammatory changes but has the advantage of no exposure to ionising radiation. Aims/Background We aimed to evaluate whether the availability of MRE has diminished or eliminated avoidable radiation exposure related to diagnostic imaging in this patient group. Method Retrospective analysis of a database of 3000 patients with IBD in a large tertiary referral hospital was performed. All patients diagnosed with Crohn's disease during the period of 01-01-2009 until 15-10-2012 were identified. A review was performed of all abdominal imaging done at the study centre–MRE, abdominal CT and barium small bowel studies. Results 122 patients had a new diagnosis of Crohn's disease. 58 (47.5%) were female. Median age at diagnosis was 28 years (IQR 23–40). A total of 62 MRE studies were performed in 52 patients (42.6%). 26 patients (21%) had a barium small bowel examination. A total of 83 abdominal CT studies were performed in 52 patients (42.6%). 35 (42%) of these were performed as an emergency investigation. 18 patients had 2 or more abdominal CT studies performed (range 2–6). 55 patients (45%) had an abdominal CT or barium examination performed in a non-emergency setting. Conclusion This study shows that there is still significant use of ionising radiation, sometimes performed repeatedly, in a non-emergency setting. 45% of this young patient cohort received avoidable radiation exposure related to diagnostic imaging.