The role of image in the diagnosis of pseudotumor lesions: a pictorial essay

Introduction: The clinical-radiological differentiation between neoplastic and pseudotumoral lesions has an important role in therapeutic approach, with repercussions on the conduct to be taken. When facing an expansive lesion, in addition to neoplasms, a list of differential diagnoses must be considered, including inflammatory, infectious, hemorrhagic lesions, among others. In this context, the role of imaging methods is highlighted in order to anticipate surgical management in the presumption of an aggressive neoplasm or, on the other hand, avoid an unnecessary invasive procedure. Objectives: To identify the warning signs of pseudotumor lesions in imaging studies. Methodology: Retrospective pictorial review of the archives of Diagnostic Imaging service of Santa Casa de São Paulo, between 2010 and 2020. Results: The warning signs that indicate a probable pseudotumoral lesion include spontaneous hypersignal in T1, marked hyposignal in T2, absence of significant expansive effect, cavitated lesion with high signal in diffusion, incomplete ring impregnation, restricted peripheral ring diffusion and spectral relations (choline / creatine) lower than 2. Each of these distinguishing features is discussed and exemplified. Conclusions: Although the distinction between expansive neoplastic and pseudotumoral lesions is not always direct, the systematic use of the exposed criteria allows greater assertiveness in the differential diagnosis. If the diagnostic doubt persists, therapeutic proof tests have a fundamental role in this context and, unfortunately, in some cases the final diagnosis will only be possible with biopsy.

Escalation and de-escalation of the radiology response to COVID-19 in a tertiary hospital in South London: The King’s College Hospital experience

The pandemic of COVID-19 presented an enormous challenge to the medical world in terms of diagnosis, treatment and health-care management as well as service organisation and provision. This novel virus and its spread affected every aspect of modern medical practice, ranging from investigating transmission of this new pathogen, antigen testing of symptomatic patients, imaging, assessing different treatment regimens and the production of a new vaccine. Imaging played a crucial role in the diagnosis of COVID-19-related lung disease, with plain radiography and CT being the main diagnostic modalities, with ultrasound a useful bedside imaging tool. The accurate and early diagnosis of the disease was not the only issue faced by Radiology Departments across the world; prevention of nosocomial infection, creating capacity with elective imaging suspension, management and protection of the workforce being few of the numerous challenges. The purpose of this manuscript is to present the steps that the Radiology Department of a large urban tertiary facility with a local vulnerable population, undertook to adapt the imaging service and structure, both initially escalating and then de-escalating a response to the COVID-19 pandemic. A step-by-step management strategy, effective and sustained staff deployment, imaging management are presented and discussed, to provide a guide for managing a major incident in a radiology department.

Emergency Radiology During the COVID-19 Pandemic: The Canadian Association of Radiologists Recommendations for Practice

Coronavirus Disease 2019 (COVID-19) is the disease caused by the novel coronavirus officially named the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), declared as a pandemic by the World Health Organization on March 11, 2020. The COVID-19 pandemic presents an unprecedented challenge to emergency radiology practice. The continuity of an effective emergency imaging service for both COVID-19 and non-COVID-19 patients is essential, while adhering to best infection control practices. Under the direction of the Board of the Canadian Association of Radiologists, this general guidance document has been synthesized by collaborative consensus of a group of emergency radiologists. These recommendations aim to assist radiologists involved in emergency diagnostic imaging to help mitigate the spread of COVID-19 and continue to add value to patient care in the emergency setting.

Vacuum phenomena on spinal CT scans and its association with intervertebral disc disease in dogs

Vacuum phenomenon (VP) refers to the presence of gas in joint spaces, including those in the spinal column. The phenomenon is associated with progressive and chronic diseases, such as intervertebral disc disease (IVDD). We reviewed 55 canine spinal CT images for the presence of VP, and studied its association with IVDD to determine the association between the VP and the clinical signs exhibited by the patients at the time of exam. All images were obtained between January 2016 and July 2018, at the Diagnostic Imaging Service of a Veterinary Hospital. Image consistent with VP was observed in 7 (12.7%) of the 55 cases. Of these 7 animals, pain and paresis was reported in 3, pain with plegia in 1, and plegia without pain in 3 dogs. One dog did not have a confirmed diagnosis of IVDD. Further studies with larger samples are still needed to confirm the relevance of this phenomenon in the diagnosis of IVDD in dogs.