Canadian Association of Radiologists Journal RSS feed: Current Issue. Scientific review of radiology in Canada. http://www.carjonline.org/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. Canadian Association of Radiologists Journal0846-5371631February 2012 © 2012 Published by Elsevier Inc. healthpermissions@elsevier.comhttp://www.carjonline.org/article/PIIS0846537111001665/abstract?rss=yesAlone we can do so little, together we can do so much.Helen Keller, American author and political activist (1880-1968) The Canadian Association of Radiologists Journal (CARJ) continues to move forward, with 2011 being a good year overall. Submissions to the Journal have continued to increase, with more than 115 manuscript submissions during the 2011 year. The increased number of submissions has put us in the situation in which we have had to increase the rejection rate of manuscripts, which has also, unfortunately, resulted in something of a backlog of manuscripts for publication; however, this is less an alarming situation than when the current editorial team had taken over the Journal more than 2 years ago. At that time, there were barely enough manuscripts available for the next issue of the Journal. I am also pleased to report that the overall quality of submissions has increased, and, it is hoped that, in the coming years, the impact factor of the Journal will reflect this.CARJ Continues to Move Forward: New Things to Look for in 2012Peter L. Munk, Savvas Nicolaou, Kieran Murphy, David A. Valenti10.1016/j.carj.2011.12.005Canadian Association of Radiologists Journal 63, 1 (2012)2012-02-01Canadian Association of Radiologists Journal2012-02-01631S0846-5371(11)X0006-2Editorial / Éditorial11http://www.carjonline.org/article/PIIS0846537110001415/abstract?rss=yesA 30-year-old woman with irregular menses is planning a pregnancy. Ultrasound shows a 6-cm intramural fibroid. She asks whether myomectomy or uterine artery embolization (UAE) is the treatment of choice. Friends of hers have had UAE, and she has looked at the Society of Interventional Radiology (SIR) Web site. What would you advise? Many women present in this fashion to general practitioners or gynaecologists or directly to interventional radiologists. Expert opinions differ. The SIR states that there have been numerous reports of pregnancies after UAE. The British Society of Interventional Radiology is more cautious and states that there is insufficient data at this time to ensure that UAE is safe for women who may wish to become pregnant in the future, because few studies have assessed the effect of embolization on pregnancy-related outcomes. As radiologists, we wanted to establish the best current evidence.Your Patient Has Symptomatic Fibroids and Would Like to Have a Baby: What Treatment Should You Advise?Dearbhail O’Driscoll, Dermot E. Malone, Ciaran Johnston10.1016/j.carj.2010.08.003Canadian Association of Radiologists Journal 63, 1 (2012)2010-09-14Canadian Association of Radiologists Journal2010-09-14631S0846-5371(11)X0006-2Critically Appraised Topic / Évaluation critique24http://www.carjonline.org/article/PIIS0846537110001944/abstract?rss=yesHuman brucellosis is a multisystemic disease. The disease is caused by a gram-negative coccobacilli of the genus Brucella . There are 4 types of species that cause brucellosis in humans: Brucella melitensis, found in camels and sheep; Brucella abortus in cattle; Brucella canis in dogs; and Brucella suis in hogs. B. melitensis is the most virulent and invasive . Brucellosis is endemic in Saudi Arabia. Morbidity in the Saudi population continues to be reported with increasing frequency from various regions of the country, particularly in the rural areas. The reported human infection range is 1.6%-2.6% . The disease can present in any sex or age with varied manifestation. Any body part can be involved, but the musculoskeletal system, particularly the spine, is most commonly affected. Brucellosis remains a huge problem and a public health issue in many regions, particularly in the Mediterranean, the Middle East, parts of South and Central America, and many parts of Western Africa . It has also been reported to have involved multiple organ systems in 1 patient in whom there had been Brucella hepatitis, myocarditis, acute disseminate encephalitis, and renal failure, with low attenuating, low agglutinating titers .The Spectrum of Imaging Findings of Brucellosis: A Pictorial EssayNizar A. Al-Nakshabandi10.1016/j.carj.2010.09.011Canadian Association of Radiologists Journal 63, 1 (2012)2010-11-15Canadian Association of Radiologists Journal2010-11-15631S0846-5371(11)X0006-2Critically Appraised Topic / Évaluation critique511http://www.carjonline.org/article/PIIS0846537110001439/abstract?rss=yesAbstract: Purpose: We described the demographic, clinical, and attitudinal profiles of patients awaiting magnetic resonance imaging (MRI) at a private and at a hospital-based facility, and hypothesized that they would not differ significantly.Methods: A survey of patients attending a hospital facility and a privately owned venue in an Ontario city. Descriptive, bivariate, and logistic regression analyses were performed.Results: A total of 314 patients provided data, with a higher response rate at the private clinic than at the hospital-based clinic (97% vs 60%). For the majority of patients (58%), the MRI was scheduled to follow up known disease; 55.8% waited more than 4 weeks; 6.4% waited more than 6 months. One-third of patients expressed a willingness to travel to the United States and pay for the MRI, 41% expressed a willingness to pay within Ontario, and 66% were willing to travel elsewhere in Ontario. They were more likely to be at the hospital-based MRI if they were being followed up for known disease and had a diagnosis of cancer, whereas those patients at the private MRI facility reported significantly more pain; 59% of the hospital-based sample and 72% of the private clinic sample reported significantly reduced quality of life because of their health problem.Discussion: These data provide interesting insights into the characteristics of patients awaiting an MRI and the attitudes of patients towards public and private MRI clinics. There were significant attitudinal differences between those patients attending the 2 facilities. Pain, coupled with a long wait, may create an incentive for patients to conclude that private clinics should be permitted if the hospital environment is unable to improve access times.Résumé: Objectif: Nous avons décrit les profils démographique, clinique et attitudinal des patients en attente d’un examen d’imagerie par résonance magnétique (IRM) dans deux milieux, en clinique privée et en milieu hospitalier, en formulant l’hypothèse qu’il n’y avait pas de différence significative entre les patients des deux établissements.Méthodes: Une enquête auprès de patients fréquentant un établissement hospitalier public ou un établissement privé situés dans une ville ontarienne. Des analyses descriptives, bivariées et de régression logistique ont été réalisées.Résultats: Au total, 314 patients ont fourni des données. Le taux de réponse était plus élevé à la clinique privée qu’en milieu hospitalier (97 % contre 60 %). Pour la majorité des patients (58 %), l’IRM était prévue dans le cadre du suivi d’une maladie connue; 55,8 % ont attendu plus de quatre semaines; 6,4 % ont attendu plus de six mois. Le tiers des patients ont affirmé être prêts à se rendre aux États‑Unis pour subir l’examen et à en débourser eux-mêmes les frais, 41 % ont affirmé être prêts à payer l’IRM qu’ils subiraient en Ontario et 66 % ont indiqué être prêts à se rendre ailleurs dans la province pour subir l’examen. Les patients faisant l’objet d’un suivi pour une maladie connue et ayant reçu un diagnostic de cancer étaient plus susceptibles de fréquenter la clinique d’IRM en milieu hospitalier. Le degré de douleur signalé par les patients fréquentant la clinique privée était significativement plus élevé; 59 % des patients en milieu hospitalier et 72 % des patients de la clinique privée ont indiqué que leur problème de santé avait entraîné une diminution significative de leur qualité de vie.Discussion: Ces données offrent une perspective intéressante des caractéristiques des patients en attente d’un examen d’IRM et des attitudes des patients envers les cliniques d’IRM privées et les établissements publiques. Des différences significatives dans les attitudes des patients ont été observées entre les patients des deux milieux. Conjuguée à une longue période d’attente, la douleur peut pousser les patients à conclure que les cliniques privées devraient être autorisées si le milieu hospitalier est incapable d’améliorer l’accès aux services.Public or Private Magnetic Resonance Imaging: What Do the Patients Think?Gordon Cheng, Wilma M. Hopman, Omar Islam, Samuel Shortt10.1016/j.carj.2010.08.005Canadian Association of Radiologists Journal 63, 1 (2012)2010-10-25Canadian Association of Radiologists Journal2010-10-25631S0846-5371(11)X0006-2Health Policy and Practice / Santé : politique et pratique médicale1217http://www.carjonline.org/article/PIIS0846537110001373/abstract?rss=yesAbstract: Pain on the ulnar side of the wrist is a complex diagnostic dilemma. This is mainly due to the small size and complexity of the anatomical structures. The issue is compounded by the occurrence of positive imaging findings that are clinically asymptomatic. This pictorial essay deals with the imaging manifestations of different causes of ulnar-sided wrist pain.Résumé: Les cas de douleur du côté cubital du poignet sont difficiles à diagnostiquer, principalement en raison de la petite taille et de la complexité des structures anatomiques. La difficulté s’accentue dans les cas présentant des résultats positifs à l’imagerie sans symptôme clinique. Cet article descriptif traite des manifestations des différentes causes de la douleur du côté cubital du poignet à l’imagerie.Imaging of Ulnar-Sided Wrist PainRory Porteous, Srinivasan Harish, Naveen Parasu10.1016/j.carj.2010.07.007Canadian Association of Radiologists Journal 63, 1 (2012)2010-09-28Canadian Association of Radiologists Journal2010-09-28631S0846-5371(11)X0006-2Musculoskeletal Radiology / Radiologie musculo-squelettique1829http://www.carjonline.org/article/PIIS0846537110001397/abstract?rss=yesRenal cell carcinoma accounts for 2% of all adult malignancies . This cancer exhibits a highly variable constellation of presenting signs and symptoms, and, in 25%–40% of cases, is actually diagnosed as an incidental finding . In patients with localized disease at presentation and who are treated surgically, distant metastases still develop in 20%–50% . Although 85% of relapses occur within 3 years, recurrence may occur over an unpredictable time frame, up to and beyond 10 years after resection . Common sites of recurrence include lung, liver, bone, and brain. However, this cancer also has a predilection for reappearing in unusual sites, presenting both clinical and radiologic diagnostic challenges if the original diagnosis is not borne in mind. If detected in a timely manner, then such isolated metastases may be curatively resected . Survival advantage is conferred on those with a longer disease-free interval and a single site of recurrence . This pictorial review of unusual sites of disease recurrence, both local and metastatic, diagnosed at our institution, highlights the need for an awareness of the variety of atypical manifestations of renal cell carcinoma recurrence.Imaging Patterns of Atypical Renal Cell Carcinoma Recurrence: A Pictorial ReviewNaomi Campbell, Sarah Barrett, Darragh Halpenny, Fawzia Tahir, R.P. Manecksha, John Feeney, Samuel Hamilton, William C. Torreggiani10.1016/j.carj.2010.08.001Canadian Association of Radiologists Journal 63, 1 (2012)2010-09-09Canadian Association of Radiologists Journal2010-09-09631S0846-5371(11)X0006-2Computed Tomography / Tomodensitométrie3038http://www.carjonline.org/article/PIIS0846537110001750/abstract?rss=yesOrbital masses form a heterogeneous group of lesions that create many challenges with regard to diagnosis, management, and treatment. The high-resolution detail provided by magnetic resonance imaging (MRI), combined with the use of surface coils, have markedly improved soft-tissue resolution and thus allowed for better lesion characterization. The orbital space has 4 distinct compartments: the globe, the intraconal and extraconal spaces, and the optic nerve sheath complex. The muscle cone is formed by the 4 recti muscles and their respective fasciae, with the globe as its base and the optic canal as its apex. The globe is enveloped by the Tenon capsule and has 3 main layers: the sclera, uvea, and retina. The extraconal space contains the superior and inferior oblique muscles, levator muscle complex, the lacrimal gland, and orbital fat. The sagittal, coronal, and axial views in T1 and T2 MR (magnetic resonance) images of the normal orbit are shown in . The signal intensity (colour) of the vitreous determines the type of MR sequence used (vitreous is black in T1 and white in T2). Orbital fat appears white, whereas the muscles and nerve appear black in T1. The muscle cone can best be appreciated in the coronal plane, whereas the lacrimal gland can be seen extraconally and on the lateral and superior aspects of the orbit in the sagittal view.Adult Orbital Masses: A Pictorial ReviewNaveen Mysore, Fabrício Guimarães Gonçalves, Jeffrey Chankowsky, Raquel del Carpio-O'Donovan10.1016/j.carj.2010.09.003Canadian Association of Radiologists Journal 63, 1 (2012)2011-01-27Canadian Association of Radiologists Journal2011-01-27631S0846-5371(11)X0006-2Neuroradiology / Neuroradiologie3946http://www.carjonline.org/article/PIIS0846537110001269/abstract?rss=yesAppendicitis is the most common cause of acute abdomen, with an estimated lifetime risk of 8% . There are many clinical and imaging mimics of right lower quadrant (RLQ) pain, and a radiologic workup often helps to establish the correct diagnosis. This pictorial essay illustrates the imaging findings of various causes of RLQ pain with an emphasis on clues to reach a diagnosis or narrow the differential diagnosis.Rule Out Appendicitis: “To Be or Not to Be”Vivek Virmani, Demetri Papadatos, Najla Fasih, Ania Kielar, Ajay Gulati, Vineeta Sethi10.1016/j.carj.2010.06.001Canadian Association of Radiologists Journal 63, 1 (2012)2010-07-05Canadian Association of Radiologists Journal2010-07-05631S0846-5371(11)X0006-2Abdominal Imaging / Imagerie abdominale4760http://www.carjonline.org/article/PIIS0846537110001312/abstract?rss=yesAbstract: The purpose of this article is to illustrate the various manifestations that can be encountered on thoracic computed tomography of tuberous sclerosis in adults. The pulmonary findings include lymphangioleiomyomatosis and multifocal micronodular pneumocyte hyperplasia. The extrapulmonary manifestations are divided into cardiac, vascular, mediastinal, osseous, and upper abdominal findings.Résumé: Le présent article vise à illustrer les diverses manifestations thoraciques de la sclérose tubéreuse observées chez des patients adultes lors d'une évaluation par tomodensitométrie. Les trouvailles pulmonaires incluent des cas de lymphangioleiomyomatose et d'hyperplasie multifocale micronodulaire des pneumocytes. Les manifestations extrapulmonaires peuvent être retrouvées parmi les catégories suivantes : cardiaque, vasculaire, médiastinale osseuse, et abdominale supérieure.Thoracic Computed Tomographic Manifestations of Tuberous Sclerosis in AdultsAmr M. Ajlan, Ana Maria Bilawich, Nestor L. Müller10.1016/j.carj.2010.07.001Canadian Association of Radiologists Journal 63, 1 (2012)2010-08-09Canadian Association of Radiologists Journal2010-08-09631S0846-5371(11)X0006-2Thoracic and Cardiac Imaging / Imagerie cardiaque et imagerie thoracique6168http://www.carjonline.org/article/PIIS0846537110001725/abstract?rss=yesA 53-year-old woman with a history of mitral valve prolapse and hyperthyroidism presented to the emergency department with nonradiating chest pain (“pins and needles in the heart”). She also had worsening shortness of breath on exertion and weakness and weight loss over a 3-month period. On physical examination, her heart rate was 110 beats per minute and respiratory rate was 18 per minute. Cardiac auscultation revealed a late systolic murmur over the mitral area that radiated to the axilla. Pulmonary examination was normal.Case of the Month #174: Papillary Fibroelastoma of the Aortic ValveSophie Tremblay-Paquet, Martin Chandonnet, Philippe Romeo, Denis Bouchard, Carl Chartrand-Lefebvre10.1016/j.carj.2010.08.009Canadian Association of Radiologists Journal 63, 1 (2012)2012-02-01Canadian Association of Radiologists Journal2012-02-01631S0846-5371(11)X0006-2Canadian Residents' Corner / Coin canadien des résidents en radiologie6972http://www.carjonline.org/article/PIIS0846537110001270/abstract?rss=yesA 27-year-old man from Ontario was referred to the neurology service for a 2-month history of left-sided headache, slurred speech, and limp. Results of a neurologic examination revealed increased tone on the right, as well as right-sided weakness and clonus of the right ankle reflex. Contrast-enhanced computed tomography (CT) of the head () was performed after a noncontrast study revealed mass lesions in the left cerebral hemisphere and left posterior fossa. A recent chest radiograph () was also available at the time of the CT study.Case of the Month #175: Intracranial BlastomycosisAndrew D. Scott, Anita Dhir10.1016/j.carj.2010.06.002Canadian Association of Radiologists Journal 63, 1 (2012)2012-02-01Canadian Association of Radiologists Journal2012-02-01631S0846-5371(11)X0006-2Canadian Residents' Corner / Coin canadien des résidents en radiologie7376http://www.carjonline.org/article/PIIS0846537112000034/abstract?rss=yesClassified Advertising10.1016/S0846-5371(12)00003-4Canadian Association of Radiologists Journal 63, 1 (2012)2012-02-01Canadian Association of Radiologists Journal2012-02-01631S0846-5371(11)X0006-2FrontmatterA5A7