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Medical Imaging
Review Article
CT perfusion in acute stroke calls: A pictorial review and differential diagnoses
Corresponding author: Dr Albert H Chiu, Neurological Intervention and Imaging Service
of WA (NIISwa), Sir Charles Gairdner Hospital, Nedlands, WA
CT perfusion is increasingly utilised in hyperacute stroke to facilitate diagnosis and patient selection for reperfusion therapies. This review article demonstrates eight
examples of how CT perfusion can be used to diagnose stroke mimics and small volume infarcts, which can be easily missed on non-contrast CT, and to suggest the
presence of an ischaemic penumbra. Radiologists involved in stroke management must understand the importance of rapid imaging acquisition and be confident in the
prospective interpretation of this powerful diagnostic tool as we move into a new era of hyperacute stroke care.
Medical Imaging
Original Article
Radiology in the Christchurch earthquake of 22 February 2011: Challenges, interim processes and clinical priorities
Corresponding author: Dr Jude Gregan, Radiology Department, Christchurch Hospital, Christchurch, New Zealand.
Introduction: The Canterbury earthquake of 22 February 2011 initiated a mass casualty event for Christchurch Hospital, which suffered damage itself, and faced logistical
difficulties in continued operation. Radiology was part of the hospital-wide response. This paper reviews the radiology department response and surveys opinions of
emergency doctors to provide an overview of events of the day and thoughts regarding any potential future response.
Methods: Two main approaches were undertaken: (i) informal data gathering and discussions with staff including radiographers, sonographers, radiologists, emergency
doctors and others present on the day regarding their experiences; and (ii) survey of emergency doctors regarding their experiences and recommendations. A comparison
with other similar events was also conducted.
Results: (1) Diagnostic radiology services were initially constrained by a lack of power and lift access. Usual imaging and reporting pathways were interrupted. Alternative
processes were initiated to ensure an ongoing radiology service with available resources. Lessons were learned and changes implemented locally.(2) Survey data confirmed
several primary outcomes: (i) Ultrasound was crucial while CT was down; (ii) all available imaging modalities remain important in a disaster response; and (iii) preliminary
reports from radiologists in the emergency department (ED) were useful in the immediate post-earthquake period.
Radiation Oncology Article
Original Article
Predictors and rate of adjuvant radiation therapy following radical prostatectomy: A report from the Prostate Cancer Registry
Corresponding author: Dr Christopher P Daniels, Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC.
Introduction: Long-term data from three randomized trials have demonstrated that adjuvant radiation therapy (ART) reduces the rate of biochemical failure in high-risk
men following radical prostatectomy (RP). One of these trials has shown a survival advantage. We investigated the rate of ART in Victoria and the predictors for this
treatment.
Methods: We analysed data from eligible patients who were notified to the Victorian Prostate Cancer Registry (PCR) by 37 Victorian hospitals between 1 August 2008
and 31 October 2011. We defined ART as radiation therapy (RT) delivered within 6 months of RP. Predictors of ART receipt were modelled using adjusted and unadjusted
logistic regression.
Results: There were 4626 eligible cases from which 2018 underwent RP with recorded date of surgery. Of these eligible prostatectomy cases, a total of 89 received ART.
A subgroup of 833 men had an adverse pathologic feature, of whom 78 received ART. In a multivariate model, pathologic tumour stage pT3a (odds ratio (OR) 2.64; 95%
confidence interval (CI) 1.4–5.00; P=0.003), pT3b (OR 4.58; 95% CI 2.12–9.89; P=0.000), a positive surgical margin (OR 8.91; 95% CI 4.61–17.2; P=0.000) and pathologic
Gleason grade >7 (OR 7.18; 95% CI 1.54–33.6; P=0.012) predicted receipt of ART.
Conclusion: Adverse pathologic features and high pathologic Gleason score predict for receiving ART in Victorian men after RP, but overall, ART is not commonly
prescribed. This finding is consistent with other published series and may reflect clinician scepticism regarding the benefit of ART over salvage RT and concern about
toxicity and the risk of over treatment.
Radiation Oncology Article
Original Article
Stage IB cervix cancer with nodal involvement treated with primary surgery or primary radiotherapy: Patterns of failure and outcomes in
a contemporary population
Corresponding author: Dr Carminia Lapuz, Alfred Health Radiation Oncology, The Alfred, Road, Melbourne, VIC
Introduction: The purpose of this study is to evaluate patterns of failure, overall survival (OS), disease-free survival (DFS), prognostic factors and late toxicities in node
positive International Federation of Gynaecology and Obstetrics (FIGO) stage IB cervix cancer treated with curative intent.
Methods: Patients with FIGO stage IB cervix cancer and positive nodes were identified from the Peter MacCallum Cancer Centre prospective gynaecology database.
Patients were treated with primary surgery and adjuvant radiotherapy (S+RT) or primary radiotherapy (primary RT). Prognostic factors examined were tumour size,
histology, grade, lymphovascular invasion or corpus uterine invasion, MRI tumour volume, number of nodes involved, highest site of nodal involvement, treatment
modality, age and smoking.
Results: Of the 103 eligible patients, 43 patients had S+RT and 60 patients had primary RT. Tumours were significantly smaller in the S+RT group (mean 3.0cm vs. 4.5cm,
P<0.001). Five-year OS (95% confidence interval) and DFS (95% confidence interval) for the whole cohort was 67.6% (56.5–76.4%) and 66.1% (55.7–74.6%), respectively.
Tumour diameter and number of positive nodes were significant prognostic factors for OS and DFS and smoking was related to DFS. Treatment modality was not a
significant prognostic factor in OS and DFS. Of 33 patients that relapsed, 32 patients relapsed outside the pelvis. One patient failed in the pelvis only.
Conclusions: Early stage cervix cancer with nodal involvement is associated with excellent pelvic disease control following curative intent treatment. Almost all relapses
occurred beyond the pelvis and therefore more aggressive local treatment is unlikely to improve survival in these patients.
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