Diffuse idiopathic skeletal hyperostosis (DISH) is a multifactorial disease with a high prevalence and that is frequently detected incidentally in imaging tests. Most of its diagnostic criteria are focused on axial involvement and more specifically on the spine. However, peripheral involvement in DISH is less well known despite its non insignificant frequency. DISH can be associated with serious complications, the most severe being vertebral fractures in low energy trauma and dysphagia or airway obstruction in cervical involvement. Knowing how to identify the patterns of peripheral involvement of DISH and its complications helps in the radiological and clinical management of patients with this disease.
Radiology departments have traditionally observed fasting protocols for patients undergoing radiological studies with intravenous contrast. However, there is no scientific evidence to support these protocols.
This practice has potentially harmful consequences, such as interruptions to long-term medication, dehydration, hypoglycaemia, test delays or anxiety, and has no benefits in terms of study interpretation or patient safety.
Numerous studies now suggest the need to review these protocols, as reflected in the updated policies of our specialty's main societies, such as the European Society of Urogenital Radiology (ESUR) and the American College of Radiology (ACR).
In this article, we review the available scientific evidence on this topic, and present our centre's experience of eliminating fasting prior to contrast-enhanced imaging studies.
Assess whether contrast-enhanced mammography (CEM) enables an evaluation of the residual size of breast tumours following neoadjuvant systemic therapy (NAST) in patients initially marked with magnetic seed.
This single-centre prospective study was performed between March 2022 and April 2023 with patients with invasive breast carcinoma and lesional marking with magnetic seed. CEM was performed before and after NAST. The lesion size in CEM after NAST was compared to the pathological examination after surgery. Differences between sizes were evaluated and we determined the diagnostic capability indices.
The breast lesions marked with magnetic seed were successfully localised in the preoperative stage for the 42 patients included in the study and selective surgical excision was also achieved in all cases. Tumour diameter after NAST was determined by comparing enhancement on combined CEM images from before and after NAST. The mean diameter was 13.6 mm while post-surgical pathological examination determined the mean diameter to be 12.9 mm. There were therefore no statistically significant differences between the measurements.
There is a positive correlation and similarity between CEM and pathological examination with regards to the detection of residual disease after NAST, with high specificity and positive predictive value.