Background: Extracapsular spread (ECS) of lymph node metastases is associated with poor prognosis and is an indication for adjuvant chemoradiotherapy. Accurately identifying ECS using imaging may allow us to recommend primary chemoradiotherapy to avoid trimodality treatment. We investigated the accuracy of staging CT in diagnosing ECS in P16 + oropharyngeal squamous cell carcinoma (OPSCC). Methods: Patients with pathologically determined cervical nodal metastases from P16 + OPSCC were included. Two blinded radiologists scored images to predict the presence of ECS in comparison to histopathology. Results: Eighty patients with a total of 91 specimens were evaluated. Pathologic ECS was identified in 53.8% of the patients. Sensitivity and specificity of CT for the two observers were 56.5% and 60.9%, and 73.3% and 66.7%, respectively. The presence of perinodal stranding was found to be significantly associated with pathological ECS. Conclusion: Computed tomography displays consistently high specificity, which may be used to rule out the presence of extracapsular spread in cervical nodal metastases of P16 + oropharyngeal squamous cell carcinoma.

Introduction This study assesses the burden, distribution, and evolution of muscle inflammation and damage on MRI among subtypes of idiopathic inflammatory myopathy (IIM). Methods Musculoskeletal MRIs performed in 66 patients with IIM and 10 patients with non‐IIM between 2009 and 2016 were retrospectively graded for muscle edema, fatty replacement (FR), and atrophy. Results Immune‐mediated necrotizing myopathy (IMNM) patients had severe and extensive lower limb muscle edema, FR, and atrophy. The pelvic muscles and adductors were significantly more affected than in patients with dermatomyositis and polymyositis. Inclusion body myositis (IBM) was characterized by marked anterior thigh involvement, which stabilized or progressed at follow‐up imaging. Atrophy and FR grades improved over time in some non‐IBM IIM patients. Discussion Patients with IMNM and IBM have characteristic patterns of muscle MRI abnormalities that may allow them to be differentiated radiologically from other IIM subtypes. Muscle damage in non‐IBM IIM may be reversible.

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Introduction: This study assessed replacing traditional protocol CT-arterial chest and venous abdomen and pelvis, with a single-pass, single-bolus, venous phase CT chest, abdomen and pelvis (CAP) protocol in general oncology outpatients at a single centre.Methods: A traditional protocol is an arterial phase chest followed by venous phase abdomen and pelvis. A venous CAP (vCAP) protocol is a single acquisition 60 s after contrast injection, with optional arterial phase upper abdomen based on the primary tumour. Consecutive eligible patients were assessed, using each patient's prior study as a comparator. Attenuation for various structures, lesion conspicuity and dose were compared. Subset analysis of dual-energy (DE) CT scans in the vCAP protocol performed for lesion conspicuity on 50 keV virtual monoenergetic (VME) images. Results: One hundred and eleven patients were assessed with both protocols. Forty-six patients had their vCAP scans using DECT. The vCAP protocol had no significant difference in the attenuation of abdominal structures, with reduced attenuation of mediastinal structures. There was a significant improvement in the visibility of pleural lesions (p < 0.001), a trend for improved mediastinal nodes assessment, and no significant difference for abdominal lesions. A significant increase in liver lesion conspicuity on 50 keV VME reconstructions was noted for both readers (p < 0.001). There were significant dose reductions with the vCAP protocol. Conclusion: A single-pass vCAP protocol offered an improved thoracic assessment with no loss of abdominal diagnostic confidence and significant dose reductions compared to traditional protocol. Improved liver lesion conspicuity on 50 keV VME images across a range of cancers is promising.

Objective: Access-related hand ischemia (ARHI) is a potentially limbthreatening complication of arteriovenous access for dialysis. The distal revascularization-interval ligation (DRIL) and revision using distal inflow (RUDI) procedures both allow treatment of ischemic symptoms while maintaining fistula patency. Although outcomes with the DRIL are well established, experience with the RUDI for ARHI remains preliminary. We compared outcomes in these procedures with respect to cumulative patency, resolution of symptoms, and patient survival.Methods: A large, prospectively maintained database was used to identify all patients after autogenous arteriovenous fistula construction at two hospitals between 2005 and 2015. Patients with severe (Society for Vascular Surgeons grade 3) ARHI were included for analysis.Results: A total of 2035 autogenous accesses were created during the study period, and 58 (2.8%) developed grade 3 ARHI. Of this cohort, 20 patients underwent RUDI and 21 had a DRIL. The indication for intervention was tissue loss (61%) or ischemic rest pain (39%). Mean age was 57.5 years, and 53.7% of patients were female. Most patients had diabetes (85.3%) and symptomatic peripheral arterial disease (63.4%). The mean digital-brachial index was 0.25 6 0.12. There were no preoperative differences in patient comorbidities between the RUDI and DRIL cohorts. Twelvemonth primary patency (60% vs 67.7%; P ¼ .658) and secondary patency (85% vs 90.5%; P ¼ .592) were similar between groups. Three-year primary patency (55% vs 52.4%; P ¼ .867) and secondary patency (80% vs 90.5%; P ¼ .343) also showed no significant difference. Resolution of ischemic symptoms, including resolution or improvement in pain or healing of ischemic ulcers or amputations, occurred in 90% with RUDI and in 81% with DRIL (P ¼ .131). Survival for the RUDI and DRIL groups at 1 and 3 years was 85% vs 85.7% (P ¼ .948) and 57.9% vs 49.2% (P ¼ .278).Conclusions: Compared with DRIL, RUDI demonstrated equivalent patency, symptom resolution, and survival for the treatment of severe ARHI. Given the poor long-term survival, preoperative risk assessment is critical to procedural decision making.