Biomedical subjects

D B Finlay

Publications and source records attributed to D B Finlay.

At least 19 recordsLinked to original sources

PubMed2001

Error review: can this improve reporting performance?

AIM: This study aimed to assess whether error review can improve radiologists' reporting performance. MATERIALS AND METHODS: Ten Consultant Radiologists reported 50 plain radiographs, in which the diagnoses were established. Eighteen of the radiographs were normal, 32 showed an abnormality. The radiologists were shown their errors and then re-reported the series of radiographs after an interval of 4-5 months. The accuracy of the reports to the established diagnoses was assessed. Chi-square test was used to calculate the difference between the viewings. RESULTS: On re-reporting the radiographs, seven radiologists improved their accuracy score, two had a lower score and one radiologist showed no score difference. Mean accuracy pre-education was 82.2%, (range 78-92%) and post-education was 88%, (range 76-96%). Individually, two of the radiologists showed a statistically significant improvement post-education (P < 0.01,P < 0.05). Assessing the group as a whole, there was a trend for improvement post-education but this did not reach statistical significance. Assessing only the radiographs where errors were made on the initial viewing, for the group as a whole there was a 63% improvement post-education. CONCLUSION: We suggest that radiologists benefit from error review, although there was not a statistically significant improvement for the series of radiographs in total. This is partly explained by the fact that some radiologists gave incorrect responses post-education that had initially been correct, thus masking the effect of the educational intervention.

Clinical Competence↗

PubMed2000

Correlation of bone scintigraphy and histological findings in medial tibial syndrome.

OBJECTIVE: To correlate bone scintigraphy and histopathological findings in patients with medial tibial syndrome. METHODS: Twenty patients (32 limbs) with a clinical diagnosis of medial tibial syndrome had surgery. Bone scintigraphy before the operation was compared with the histological appearance of bone and periosteal specimens obtained at surgery. RESULTS: Delayed bone scintigraphy showed normal appearance in 11 limbs, characteristic diffuse tubular pattern uptake in 16 limbs, and focal uptake in five. Periosteal histology disclosed fibrous thickening as the most common finding associated with increased vascularity, occasionally with chronic inflammatory cell infiltration, haemosiderin, and acid mucopolysaccharide deposition. Loss of osteocytes was the main finding of bone histology associated with some enlargement of lacunae and lamellar structure disruption. A grading system was used to score normal and abnormal histological appearance. For analysis the findings were regrouped to provide tables using Fisher's exact test. There was no correlation between bone scintigraphy and the histology of bone and periosteum, but two interesting observations were noted. Those cases with periosteal thickening had mostly normal bone scan appearance (p = 0.0028). Those cases with low levels of osteocyte loss had mostly abnormal bone scintigraphy. CONCLUSION: Abnormal histological appearance of bone and periosteum is a feature of medial tibial syndrome. These histological findings show poor correlation with bone scintigraphy. The exact pathogenesis of this syndrome remains unclear.

Adult↗

PubMed1999

Ankle effusions following acute ankle injury.

We prospectively studied 56 patients with an acute ankle injury and an effusion to determine the significance of the ankle effusion to functional outcome. The average size of effusion was 15 mm. Most injuries occurred following a fall (73%) and most (73%) were inversion injuries. At 6 months all but two patients had returned to their normal activities with no further problems. No correlation was found with size of effusion and the functional and clinical outcome. We conclude that an ankle effusion does not reliably distinguish which injuries require further investigations and unless there are clinical indications further investigations are not indicated.

Acute Disease↗

PubMed1999

Is there an improvement in performance when radiographs are re-reported at 24 hours?

This study was designed to assess the accuracy and intraobserver variability when plain radiographs are re-reported after 24 h, in order to determine if there was a change in observer performance. Five consultant radiologists reported 50 plain radiographs on patients in whom the diagnosis had been established. The radiographs were reviewed by each radiologist after an interval of 24 h. The same clinical information was available on both occasions. 32 of the radiographs showed an abnormality and 18 were normal. The accuracy of the report in relation to the established diagnosis was assessed, intraobserver agreement being calculated using kappa (kappa) statistics. The kappa-value for intraobserver agreement was in the range 0.33-0.88. Accuracy showed a range of 78-90% on the first viewing and 80-92% on the subsequent viewing. ROC curves were produced for each viewing for the group as a whole. The areas under the curves were 0.88 and 0.9 respectively. For the group, the accuracy increased on the second occasion, but this did not reach statistical significance.

Clinical Competence↗

PubMed1997

An audit of knee radiographs performed for general practitioners.

The Royal College of Radiologists (RCR) has published guidelines concerning indications for imaging investigations. These include plain radiography of the knee, the indications for which are locking or signs of restricted movement. This audit consisted of 1153 knee radiographs in a 9 month period, results of a questionnaire sent to general practitioners (GPs), analysis of radiological reports and returned questionnaires (55% of cases), and subsequent comments from the GPs on receiving these results. Only 50% of cases fall within RCR guidelines, 90% of radiographs were normal or showed degenerative change. In 42% of cases, knee radiographs were requested to confirm previously expected degenerative change, and in 30% patient pressure was a significant factor. Most knee radiographs (87%) result in no significant change in management apart from continuation of symptomatic measures. Application of current guidelines, however, would miss some important diagnoses manifest clinically by persistent pain or effusion, for example loose body or Brodie's abscess. In cases of locking, where a radiograph may miss significant soft tissue abnormality, there was concern that reassurance was often gained by a normal examination. This audit shows that many knee radiographs are unnecessary. The guidelines appear appropriate with the proviso that persistent pain and effusion should be included as indications for investigation. Many GPs report medico-legal considerations as important reasons for unnecessary referrals, although the application of guidelines should be protection against this. The referral rate for knee radiographs before and after the communication of these results has not altered.

Adolescent↗

PubMed1997

Knee tumours--duration and nature of symptoms prior to investigation.

The incidence of most musculoskeletal neoplasms is highest around the knee. Royal College of Radiologists Guidelines for diagnostic imaging state that plain radiographs are not routinely indicated for knee pain without restriction of movement or symptoms of locking. The notes of 19 patients with knee tumours presenting over a 5 year period were analysed. Irrespective of age or the grade of malignancy the majority of patients had symptoms for around 6 months prior to the initial radiograph. Only four patients had symptoms which would have merited radiological investigation under the present Guidelines. Even in these patients the symptoms prior to either pathological fracture or locking would not have come under the Guidelines. There is a case for regarding persistent, unilateral knee pain for longer than 6 weeks as an indication for imaging.

Adolescent↗

PubMed1997

The value of indium-111-labelled leucocyte imaging and ultrasonography in the investigation of pyrexia of unknown origin.

The aim of this study was to assess indium-111 leucocyte imaging and ultrasound in the investigation of pyrexia of unknown origin (PUO), as well as the predictive value of available clinical information on the radiological outcome. 256 111In leucocyte scans performed over a 5 year period were reviewed. There were 59 scans in 58 patients who fulfilled recognized criteria for true PUO; 47 of these patients had ultrasound. In 15 patients the fever settled and no diagnosis was made; the source of PUO was infective in 20 and non-infective in 24. In the group as a whole, the sensitivities of leucocyte scan and ultrasound were 25% and 23% with specificities of 100% and 83%, respectively. In infective cases of PUO, the sensitivities were 20% for both modalities. There was no correlation between leucocyte count or differential, C reactive protein or the presence or absence of antibiotics. In the cases where the leucocyte scan led to the diagnosis of infection, the scan was performed within 4 weeks of the onset of symptoms. The results show that an infective cause for PUO is established in less than 50% of cases. The leucocyte scan is specific and although not very sensitive can often be a guide to subsequent cross-sectional imaging. If an infective cause for the PUO is strongly suspected, 111In leucocyte scanning may be more sensitive if performed in the first few weeks of fever.

Fever of Unknown Origin↗

PubMed1996

Hypertrophic osteoarthropathy in staging skeletal scintigraphy for lung cancer.

AIM: To assess the prognostic significance of hypertropic osteoarthropathy (HOA) discovered on routine staging bone scintigraphy in patients with lung cancer. PATIENTS AND METHODS: Between 1989 and 1992 all 99mTc-MDP bone scintigrams performed for the staging of bronchogenic carcinoma were reviewed. HOA was diagnosed by the observation of cortical/periosteal increased uptake in the extremities of the long bones. Follow-up and confirmation of the diagnosis was obtained by hospital computer, histology records, operative records, patient notes and radiological data where available. RESULTS: 164 staging scintigrams for lung cancer were identified. Twenty-eight patients (17%) were observed to have HOA. Patients with and without HOA were well matched for age and sex. There was little difference in the distribution of cell type but the HOA groups has a greater incidence of peripheral tumours. There was no significance in survival between the two groups. Two of three long-term survivors had clinically overt HOA and one presented with arthralgia. CONCLUSION: HOA is often seen on skeletal scintigraphy for staging of lung cancer and has no prognostic significance. The data also support current teaching that a high index of suspicion for HOA, as a cause of arthralgia may lead to early diagnosis of a potentially resectable lung carcinoma.

Aged↗

PubMed1996

The correlation of bone scintigraphy and histological findings in patellar tendinitis.

Patellar tendinitis is a chronic overuse injury causing pain and tenderness over the proximal insertion of the patellar tendon. Its management is usually conservative, but in intractable cases surgery is effective. Bone scintigraphy has been suggested as a useful investigation in these patients, although we are aware of no large series supporting this. Thirty-four patients with intractable symptoms of patellar tendinitis were treated surgically. The operative specimens were graded histologically and compared with preoperative radionuclide bone scans. The histological findings confirmed tendon and or tendon sheath abnormalities in all the samples. The predominant abnormalities were increased vascularity, fibroblast proliferation, acid mucopolysaccharide and haemosiderin deposition. Bone scintigraphy showed 24 (71%) patients to have abnormalities on the delayed images, 8 with diffusely increased activity in the patella and 16 with increased activity localized to the lower pole. Patients with abnormal bone scans had significantly more severe histological changes in their tendons. These findings support the use of radionuclide bone scans in the pre-operative assessment of patellar tendinitis correlating well with histopathological severity of the disease process. The 10 false-negative cases (29%), however, suggest that bone scans are unhelpful in the routine diagnosis and management of this condition.

Adolescent↗

PubMed1996

Multifocal skeletal tuberculosis: bone scan appearances.

Bone scans are not generally required in the investigation of tuberculosis. The most common reason for the request is bone pain, which may precede the diagnosis of tuberculosis. The finding of multifocal areas of increased uptake on a bone scan may be due to a number of causes, the most common of which is metastatic bone disease. Therefore, there is a risk that those caused by tuberculosis may be misdiagnosed. We report six such bone scans occurring over 5 years which were found to be due to skeletal tuberculosis. Five patients were of Asian descent, four of whom had had bone biopsies confirming the presence of mycobacterium tuberculosis. The sixth patient, a Caucasian, had a bone biopsy which isolated mycobacterium bovis. Although skeletal tuberculosis is generally secondary to a primary pulmonary focus, all six patients had a normal chest X-ray.

Adult↗

PubMed1995

A study of metatarsal fractures in children.

The purpose of our study was to document the sites and distribution of mid-foot and fore-foot fractures in children, relating them to the pattern of injury with particular reference to the first metatarsal. The clinical records and radiographs of 388 children with foot injuries were examined. A total of 62 metatarsal and seven tarsal fractures were identified in 60 children. The commonest fracture was of the fifth metatarsal, 45 per cent overall; 90 per cent of these children were over 10 years old. In children under 5 years old, first metatarsal fractures accounted for 73 per cent, but in children over 5 years old, these fractures accounted for only 12 per cent of the total. In all, 6.5 per cent of all fractures and 20 per cent of first metatarsal fractures went unrecognized at the initial attendance.

Adolescent↗

PubMed1995

Childhood ossification of the anterior longitudinal ligament of the cervical spine.

Two paediatric cases of acquired ossification of the cervical anterior longitudinal ligament are described. This has not been previously reported in childhood. The first was associated with corrosive ingestion requiring oesophagectomy and colonic interposition and the second with acute lymphoblastic leukaemia initially presenting as idiopathic hypereosinophilic syndrome. Possible mechanisms are discussed.

Cervical Vertebrae↗

PubMed1995

Direct and indirect MRI findings in ganglion cysts of the common peroneal nerve.

MRI findings in three cases of ganglion cyst of the common peroneal nerve are presented. In each case the cyst was imaged as an oval structure in transverse section section adjacent to the fibular neck. The cyst extended in a tubular fashion over several slices with an inferior extension towards the superior tibiofibular joint. Signal intensity was intermediate on T1- and high on T2-weighted images. In addition, increased signal on both T1- and T2-weighted images was noted throughout the peroneal compartment and was associated with clinical and EMG evidence of denervation. This has not been previously described but may be an important indirect sign which, when seen, should prompt a careful search in the region of the fibular neck for an underlying ganglion cyst of the common peroneal nerve.

Adolescent↗

PubMed1995

The aetiology and distinguishing features of solitary spinal hot spots on planar bone scans.

PURPOSE: To determine the aetiology of solitary spinal hot spots on planar bone scans and to determine which radiographic and scintigraphic features aid in distinguishing benign from malignant lesions. MATERIALS AND METHODS: 81 bone scans showing a solitary hot spot in the spine were identified. Aetiology was determined in 73 based on imaging and clinical findings, including clinical follow-up. The location of the hot spot was classified as paravertebral (related to the lateral spinal margin), panvertebral (diffuse uptake confined within a vertebra), hemivertebral (uptake confined between the midline and lateral spinal margin) or complex (all others). RESULTS: The aetiology of the spinal hot spot was benign in 55 patients and malignant in 18. The latter all belonged to the subgroup of 42 patients with a known malignancy. Only eight of the 18 malignant cases had suggestive plain radiographic findings. There was no significant relationship between aetiology and age. The spinal level of the hot spot was cervical in three (all benign), thoracic in 16 (eight benign) and lumbar in 54 (44 benign). The hot spot was paravertebral in 21 (all benign), panvertebral in 24 (20 benign), hemivertebral in 13 (10 benign) and complex in 15 (only four benign). CONCLUSIONS: Most (75%) solitary spinal hot spots are benign, and even in patients with known malignancy just over half (57%) are benign. Malignant lesions are often (56%) radiographically occult. Thoracic or complex hot spots are more likely to be malignant while paravertebral hot spots are characteristically benign. These features may be helpful in distinguishing benign and malignant lesions in patients with a known malignancy and unremarkable radiographs. Other scintigraphic features are unhelpful in distinguishing benign from malignant lesions.

Adolescent↗

PubMed1995

The value of 99Tcm-MDP bone scans in young patients with exercise-induced lower leg pain.

This study compares the bone scan appearances in 32 patients with medial tibial syndrome (MTS) with the appearance in 28 patients with confirmed chronic compartment syndrome (CCS). A distinctive pattern of uptake was seen in 30 patients, 24 of whom had MTS and 6 of whom had CCS. Of the patients with normal scans, only 4 had MTS, the remaining 15 had CCS. Both of these findings are statistically significant and confirm that bone scans are a useful diagnostic tool in the differential diagnosis of exercise-induced lower leg pain.

Adult↗

PubMed1995

The aetiology of solitary hot spots in the ribs on planar bone scans.

The aim of this study was to determine the aetiology of solitary hot spots in the ribs found at bone scintigraphy in patients with known extraskeletal malignancy. A group of 34 patients whose bone scans showed a solitary hot spot in a rib were identified retrospectively over a 4-year period. They all had a known extraskeletal malignancy. Aetiology of the rib hot spot was established in 26 patients based on a review of clinical features, radiographic findings and clinical follow-up. In eight cases it remained indeterminate. In 14 (41%) cases, the rib lesion was malignant in origin, 9 were due to metastasis and 5 due to direct spread from intrapulmonary malignancy. In 12 (35%) cases, it was benign. In the remaining 8 (24%) cases, the aetiology was indeterminate. In the subgroup of 14 hot spots confined to the anterior rib end, 5 (36%) were due to malignancy, 4 (28%) were benign and 5 (36%) were indeterminate. We conclude that solitary hot spots in the ribs of patients with known extraskeletal malignancy undergoing bone scintigraphy are frequently (41%) malignant in origin. This also applies when the hot spot is in the anterior rib end (36% malignant). Thus, such hot spots are far more sinister than previously reported and require careful clinical and radiographic evaluation.

Adult↗

PubMed1995

Isotope bone scans in patients with painful knee replacements: do they alter management?

A retrospective review of the scintigraphic appearances, clinical findings and outcome in 12 patients presenting with painful knee replacements was made. Three patients required revision surgery; symptoms in the remaining nine patients settled without operative management. Three examinations failed to identify prostheses proven to be infected by aspiration and four were falsely positive for infection without supportive clinical evidence. Four examinations demonstrated loosening and in one patient the bone scan was normal but the prostheses was loose at revision surgery. There were no specific features to predict which prostheses required surgical revision and the ability to diagnose or exclude infection was limited. It is concluded that the results of three phase 99Tcm bone scans in symptomatic knee prostheses are of little assistance in guiding clinical management and that a period of conservative management should be considered prior to operative intervention.

Humans↗

PubMed1995

Single-photon-emission computerised tomography compared with planar bone scan to assess femoral head vascularity.

We performed single-photon-emission CT (SPECT) and planar bone scans to assess femoral head vascularity in ten patients with displaced intracapsular hip fracture. The heads were labelled with tetracycline and after excision at hemiarthroplasty were assessed for tetracycline uptake distribution by fluorescence under UV light. The four which had the greatest tetracycline uptake were normal on SPECT and planar imaging. In two cases the planar bone scans were normal although SPECT suggested avascularity thus giving false-negative results. Surgeons should be aware of this; SPECT may prove to be a more accurate method of assessing vascularity of the femoral head in fractures of the femoral neck.

Arthroplasty↗