The Grand Round: September 2013

Topics for the forthcoming Grand Round in September include:

11th September: A presentation from Radiology.j0289527

18th September: A presentation by Dr A Heald

25th September: A presentation from Orthopaedics

More information available from




European Radiology, July 2012; Imaging vascular function for early stage clinical trials …

Imaging vascular function for early stage clinical trials using dynamic contrast-enhanced magnetic resonance imaging
Citation: European Radiology, July 2012, vol./is. 22/7(1451-1464), 0938-7994;1432-1084 (July 2012)
Author(s): Leach M.O.; Morgan B.; Tofts P.S.; Buckley D.L.; Huang W.; Horsfield M.A.; Chenevert T.L.; Collins D.J.; Jackson A.; Lomas D.; Whitcher B.; Clarke L.; Plummer R.; Judson I.; Jones R.; Alonzi R.; Brunner T.; Koh D.M.; Murphy P.; Waterton J.C.; Parker G.; Graves M.J.; Scheenen T.W.J.; Redpath T.W.; Orton M.; Karczmar G.; Huisman H.; Barentsz J.; Padhani A.

Abstract: Many therapeutic approaches to cancer affect the tumour vasculature, either indirectly or as a direct target. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has become an important means of investigating this action, both pre-clinically and in early stage clinical trials. For such trials, it is essential that the measurement process (i.e. image acquisition and analysis) can be performed effectively and with consistency among contributing centres. As the technique continues to develop in order to provide potential improvements in sensitivity and physiological relevance, there is considerable scope for between-centre variation in techniques. A workshop was convened by the Imaging Committee of the Experimental Cancer Medicine Centres (ECMC) to review the current status of DCEMRI and to provide recommendations on how the technique can best be used for early stage trials. This review and the consequent recommendations are summarised here. Key Points Tumour vascular function is key to tumour development and treatment Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can assess tumour vascular function Thus DCE-MRI with pharmacokinetic models can assess novel treatments Many recent developments are advancing the accuracy of and information from DCE-MRI Establishing common methodology across multiple centres is challenging and requires accepted guidelines.

European Society of Radiology 2012.

Publication Type: Journal: Article
Source: EMBASE

Radiology; Nov 2012; Advanced solid tumors treated with cediranib: …. 2012

This journal article “Advanced solid tumors treated with cediranib: Comparison of dynamic contrast-enhanced MR imaging and CT as markers of vascular activity” was published in Radiology, November 2012, vol./is. 265/2(426-436), 0033-8419;1527-1315 (November 2012)

Author(s):   Messiou C.,Orton M.,Ang J.E.,Collins D.J.,Morgan V.A.,Mears D.,Castellano I.,Papadatos-Pastos D.,Brunetto A.,Tunariu N.,Mann H.,Tessier J.,Young H.,Ghiorghiu D.,Marley S.,Kaye S.B.,DeBono J.S.,Leach M.O.,DeSouza N.M.
Abstract:  Purpose: To assess baseline reproducibility and compare performance of dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging versus DCE computed tomographic (CT) measures of early vascular response in the same patients treated with cediranib (30 or 45 mg daily). Materials and Methods: After institutional review board approval, written informed consent was obtained from 29 patients with advanced solid tumors who had lesions 3 cm or larger and in whom simultaneous imaging of an adjacent artery was possible. Two baseline DCE MR acquisitions and two baseline DCE CT acquisitions 7 days or fewer apart (within 14 days of starting treatment) and two posttreatment acquisitions with each modality at day 7 and 28 (+/-3 days) were obtained. Nonmodeled and modeled parameters were derived (measured arterial input function [AIF] for CT, population-based AIF for MR imaging; temporal sampling rate of 0.5 second for CT, 3-6 seconds for MR imaging). Baseline variability was assessed by using intra- and intersubject analysis of variance and Bland-Altman analysis; a paired t test assessed change from baseline to after treatment. Results: The most reproducible parameters were DCE MR imaging enhancement fraction (baseline intrapatient coefficient of variation [CV] = 8.6%), volume transfer constant (CV = 13.9%), and integrated area under the contrast uptake curve at 60 seconds (CV = 15.5%) and DCE CT positive enhancement integral (CV = 16.0%). Blood plasma volume was highly variable and the only parameter with CV greater than 30%. Average reductions (percentage change) from baseline were consistently observed for all DCE MR imaging and DCE CT parameters at day 7 and 28 for both starting-dose groups (45 and 30 mg), except for DCE CT mean transit time. Percentage change from baseline for parameters reflecting blood flow and permeability were comparable, and reductions from baseline at day 7 were maintained at day 28. Conclusion: DCE MR imaging and DCE CT can depict vascular response to antiangiogenic agents with response evident at day 7. Improved reproducibility with MR imaging favors its use in trials with small patient numbers. RSNA, 2012.

David James Moore et al; BMJ, Case Report; Nov 2012

Case Report: Sequential bilateral femoral fractures

BMJ 2012; 345 doi: (Published 14 November 2012)

David Moore is a Consultant Radiologist at East Cheshire NHS Trust

A 78 year old woman presented to the emergency department with an off-ended, shortened, anteriorly deviated, long oblique fracture of the right femoral diaphysis. She had been experiencing thigh pain for several weeks before this acute presentation and analgesia had been prescribed.

She described feeling the bone “crack” as she turned around. There was no history of trauma. The fracture was surgically treated with an intramedullary nail.

Six months earlier she had sustained a similar fracture of the midshaft of her left femur. Again, there was no trauma and she described feeling the bone “crack” as she twisted slightly to go through her front door. She was unable to reach a telephone to call for help and spent some time on the ground before a passer by called an ambulance. After initial treatment with a Thomas splint, she was treated surgically with an intramedullary nail. After two weeks of rehabilitation she returned home to live independently and was able to go out with one stick to do her shopping.

Her medical history included osteoporosis and hypovitaminosis D. The diagnosis of osteoporosis was made after she sustained a vertebral crush fracture. She had been receiving bisphosphonates to prevent further fractures for nearly five years.

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