Abstract / Clinical Radiology 69 (2014) S1eS10S8

Conclusion: Radiology departments are under increasing financial andworkload pressure. Many hospitals have introduced measures such asservice-line reporting. In order to optimally request investigations withinthese financial constraints, good knowledge of the cost of radiologicalstudies is of paramount importance.

Transient hyperintensity in corpus callosum: may not be confined tosplenium alone!

Authors: Saravana Kumar Swaminathan*, Vasu K. Sharma, Marielle V.Fortier

Purpose: Reversible lesions of the corpus callosum, specifically affectingthe splenium are seen in several clinical conditions. We report six furthercases, two of which are atypical with involvement of the genu of corpuscallosum. Their clinical presentations and prognoses are reinforced.Methods and materials: Patients with circumscribed lesion in the corpuscallosumwere reviewed. Follow-upMR imaging andmedical records wereexamined.Results: Six paediatric patients were identified. Four of them had iso-lated splenial lesion. One had isolated genu while another had bothgenu and splenial involvement. All these lesions had T2 prolongation,restricted diffusion and no enhancement. Three patients had follow-upMRI that proved reversibility of the lesion. Clinically, all these patientshad encephalitis/ encephalopathy and all but one had completerecovery.Conclusion: Transient corpus callosum lesions are rare and are seen inconditions like MERS, epilepsy and metabolic derangement. Severalsuch lesions involving the splenium have previously been reportedalthough the rostrum and genu were characteristically spared. Thiswas ascribed to the distinct properties of splenium that makes itvulnerable. Our cases suggest that the lesions within the genu aresimilar to the splenial lesions and probably share the same etio-pathogenesis. Awareness of such lesions is important to avoid unnec-essary investigation and treatment as their prognosis is excellent.

The use of intravenous gadolinium in children with an incidental MRIfinding of a syrinx e is it justified?

Authors: Cairine Probert*, Karen Chetcuti, Caren Landes

Purpose: A paper published in 1987 recommended IV contrast for patients>1y of age with an incidental MRI finding of a syrinx, in order to excludeassociated pathology. This practice continues to this day but there are nocurrent national or international guidelines available. There are a numberof disadvantages to using Gadolinium and the aim of this review was todetermine whether the practice is justified.Methods and materials: We reviewed 464 MRI Spine studies per-formed at Alder Hey Children’s Hospital over a six month period fromJanuary to June 2013. 71/464 showed a new or previously known syrinx.Each case was reviewed to establish whether IV contrast had beenadministered.Results: Previously known syringes (47/71):22/47 received Gadolinium previously25/47 scans received no Gadolinium previously5/25 had initial imaging when the child was <1 year old and no imagingwith IV contrast since.New syringes (24/71):In 8/24 cases of new syringes the child was <1 year old.In 6/24 cases, Gadolinium was given. In 3/24 cases, no Gadolinium wasgiven.No associated tumours were found in the 71 MRI studies with a syrinx.

* Guarantor and correspondent: Saravana Kumar Swaminathan* Guarantor and correspondent: Cairine Probert* Guarantor and correspondent: Georgina Stewart* Guarantor and correspondent: Shayan Ahmed* Guarantor and correspondent: Syed Zama Ali

Conclusion: None of the reviewed MRI spine studies showed a syrinx thatwas associated with other pathology, independent of the use of IV gado-linium and the use of Gadolinium in childrenwith a ‘simple’ syrinx on MRIis not justified.

Identifying the cause of low back pain using SPECT-CT

Authors: Georgina Stewart*, Russell Young, Michael Foy, Anthony Fogg

Purpose: SPECT CT is being used more frequently to investigate thecause of low back pain, as it can provide anatomical and functionalinformation. This study aimed to evaluate whether this relatively newimaging technique was changing the management of patients with lowback pain.Methods and materials: All thoraco-lumbar spine SPECT CT scans, per-formed between September 2012 and January 2014, were reviewedretrospectively. Clinical history and previous surgical and radiologicalmanagement, before and after the scan, were examined.Results: 29 SPECT CT scans were evaluated in patients who had mainlylow back pain. 6 cases showed pain originating from the facet joints, 1case from the SI joints, 1 from a Bertolotti joint; none of these patientshad surgery. 7 cases showed discogenic pain (1 with L5 pars defects)and all of these patients had or were advised surgery. 3 cases wereused to rule out infection. 6 cases showed increased activity in facetjoints on the opposite side of symptoms, and 5 cases showed noincreased activity. 2 cases of non-union identified on the CT did notshow increased activity, and both these patients were advised to havesurgery.Conclusion: SPECT CT was found to changemanagement in 76% of cases. Itwas useful at identifying discogenic and joint pain, and ruling out infec-tion. It was not useful for identifying the source of pain in non-union, andin half of the cases of facet joint pain; increased activity was seen on theopposite side of symptoms.

The role of PET-CT in detecting disease recurrence in thyroid cancer

Authors: Shayan Ahmed*, Ewa Nowosinska, John Buscombe

Purpose: Thyroid cancer accounts for 1-3% of all cancers worldwide.Treatment remains surgical resection followed by radioiodine therapywith interval measurements of serum thyroglobulin levels to monitordisease recurrence. Not all recurrent thyroid tumours show iodine-avidityand can be missed on post-operative radioiodine scans making it difficultto assess disease recurrence.Our aim was to assess the usefulness of PET/CT in detecting diseaserecurrence in patients with raised serum thyroglobulin levels and anegative radioiodine scan.Methods and materials: A 3 year retrospective analysis of all PET/CTstudies performed in 23 thyroid cancer patients following a negativeradioiodine scan and raised serum thyroglobulin levels to determine ifPET/CT could detect disease recurrence missed on post-operative radio-iodine studies.Results: 23 patients were evaluated (male ¼ 11, female 12) with a meanage of 54.2. PET/CT detected recurrent thyroid lesions or distant metas-tases not seen on radioiodine studies in 12 patients (52.2%) and influencedmanagement in 13 patients (56.5%). Furthermore there was a statisticallysignificant difference in the serum thyroglobulin levels between patientswith a positive lesion on PET/CT and those without.Conclusion: PET/CT can accurately detect recurrent thyroid disease notdemonstrated by radioiodine scans. We recommend the concurrent use ofPET/CT with radioiodine therapy to assess disease recurrence in thyroidcancer.