No abstract

Recall of structured radiology reports is significantly superior to recall of unstructured reports immediately after reading the report. Advances in knowledge: A structured radiology report format can positively impact the referring clinician's ability to recall the critical findings with statistically significance.

Extraosseous radiotracer uptake during bone scintigraphy must be carefully assessed and it offers the potential to detect previously undiagnosed disease processes. A range of neoplastic, metabolic, traumatic, ischaemic and inflammatory disorders can cause soft tissue accumulation of bone avid radiopharmaceuticals. Accordingly, cardiac uptake in bone scintigraphy has a broad differential diagnosis and is commonly attributed to ischaemia/infarction related to coronary artery disease. However, there has been renewed focus on incidental cardiac uptake in recent years in light of significant developments in the diagnosis and management of cardiac amyloidosis.

Scleroderma is a complex multisystem connective tissue disorder. Early visceral disease, such as gastrointestinal (GI) involvement, is associated with significant morbidity and a poorer prognosis. Prompt diagnosis is crucial to allow disease modifying therapies be initiated early in the course of the disease. The primary underlying pathophysiology in the GI tract is dysmotility, muscular atrophy, and fibrosis, and this is reflected in the imaging features. In this paper, we demonstrate the imaging appearances of involvement of the GI tract and describe the use of advanced imaging with magnetic resonance enterography (MRE). A multimodal imaging approach is required to identify both characteristic features of scleroderma and potential complications. Traditional fluoroscopic contrast (barium) studies are still commonly performed for assessment of the oesophagus. More recent advances in cross-sectional imaging allow for thorough three-dimensional assessment of the entire GI tract. MRE is particularly useful for small bowel evaluation while also allowing "pseudodynamic" functional imaging and concomitant assessment of the other abdominal viscera and structures.

Malignant pleural effusion (MPE) is a common clinical problem, which causes significant morbidity and has a variable prognosis. This is the largest series to date evaluating the survival of patients with MPE according to their underlying cell type. Methods We prospectively collected data on patients presenting with MPE from two large pleural services over a 3 year period. All patients gave written informed consent. Patients were followed up for a minimum of 9 months or until death or loss to follow up (whichever was sooner). For survival analysis, the log rank (MantelCox) test was applied to Kaplan Meier survival curves. Results Data was collected on 466 patients. The median age of the patients was 71 (IQR 65-79) and 63% were male. 56% of effusions were right sided and 41% patients had an effusion occupying >50% of the hemithorax. 73% of patients had confirmation of pleural malignancy based on cytology or pleural biopsy, 21% had a presumed malignant effusion with confirmed malignancy elsewhere and 6% had a radiological diagnosis. Patients with a pleural effusion secondary to mesothelioma (n=148) had the longest median survival (MS) at 339 days. This is significantly longer than those effusions caused by lung cancer (n= 127, MS 71 days) (95% CI -0.56-4.45, p<0.0001). Cell types with an intermediate survival, included gynaecological malignancy (n=33; MS=268 days), urological cancer (n=11; MS=220 days), gastrointestinal malignancy (n=16; MS 268 days), haematological malignancy (n=27; median survival 204 days) and breast cancer (n=48; MS 204 days). Lung cancer, adenocarcinoma of unknown primary (n=9; MS 87 days) and sarcoma (n=6, MS 65.5 days) had the shortest survival.The Kaplan-Meier survival curve for the 3 largest groups is shown in the figure. Conclusions Selecting the most appropriate strategy for management of malignant pleural effusion depends on patient choice, their clinical condition and the perceived prognosis. This data confirms that the survival of patients with malignant pleural effusion varies widely depending on the site of their primary malignancy. Accounting for this may help to better inform patients of their prognosis and aid clinical decision making. S16 IS CONTRAST-ENHANCED COMPUTED TOMOGRAPHY (CT) SCORING Royal Preston Hospital, Preston, UKBackground CT and Thoracoscopy are useful tools in the evaluation of patients with pleural diseases. Previous studies have shown that certain features on CT may help in differentiating malignant and benign pleura and these may correlate with thoracoscopic findings. We aimed to assess whether a simple scoring system based on CT appearance criteria could be used to predict the likelihood of pleural malignancy. Methods 104 patients who underwent semi-rigid thoracoscopy between January 2008 and April 2012 were studied. The scans were reviewed by the Chest Radiologist who was blinded to the thoracoscopic findings and pleural biopsy results. Five CT features were given a score of 1-3, where 3 suggested a feature was present, 1 not present and 2 if uncertain. An ...