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LETTER TO THE EDITOR
Year : 2016  |  Volume : 53  |  Issue : 4  |  Page : 621-622
 

The value a radiologist brings to a multidisciplinary team: Case in point


Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India

Date of Web Publication21-Apr-2017

Correspondence Address:
A Mahajan
Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.204904

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How to cite this article:
Mahajan A, Kawthalkar A, Sable N, Thakur M, Desai S. The value a radiologist brings to a multidisciplinary team: Case in point. Indian J Cancer 2016;53:621-2

How to cite this URL:
Mahajan A, Kawthalkar A, Sable N, Thakur M, Desai S. The value a radiologist brings to a multidisciplinary team: Case in point. Indian J Cancer [serial online] 2016 [cited 2020 May 30];53:621-2. Available from: http://www.indianjcancer.com/text.asp?2016/53/4/621/204904


Sir,

Radiologists form key members of multidisciplinary specialty teams and disease management groups, who with their reporting and communication skills with clinicians, make a major impact on patient management and influence treatment decisions.[1],[2],[3] A recent case highlighting this point at our institute is presented.

A 45-year-old premenopausal female, who underwent right modified radical mastectomy for ductal carcinoma in situ(DCIS) in 2005, presented to our institute in September of 2015 (disease-free interval of 10 years) with symptoms of a headache and sudden onset giddiness. On examination, her GC was good and she had no neurological deficit. She was subsequently referred for magnetic resonance imaging (MRI) of the brain. The MR showed a predominantly peripherally enhancing lesion with perilesional edema in the subcortical white matter of the postcentral gyrus. It measured hardly a centimeter in size and on diffusion-weighted imaging showed mild restricted diffusion. The preliminary report given was of a solitary brain metastasis. Subsequently a positron emission tomography-computed tomography was performed that was negative for any other lesions in the body. The neurosurgeons decided that the cerebral lesion was not amenable to resection; hence, external beam radiotherapy was suggested. The patient underwent a planning MRI and was referred to a Joint Clinic (multidisciplinary disease management group) prior to starting therapy.

In our tertiary cancer institute, a Joint Clinic is held weekly where cases are discussed between the onco-surgeon, oncologist, radiologist, radiotherapist, and pathologist before initiating therapy. An extensive review of the imaging features on the planning MRI and clinical data in the Joint Clinic pointed to the presence of an incomplete ring enhancing postcontrast T1 hyperintense lesion with an enhancing eccentrically placed scolex-like area within the lesion, which was better appreciated on the planning MRI. This combined with the long disease-free interval pointed towards a diagnosis of the colloidal vesicular stage of neurocysticercosis [Figure 1]. The patient was started on anthelmintic therapy and on further follow-up imaging the edema surrounding the lesion had decreased, and the cyst had partially collapsed. The enhancement of the lesion had also decreased, and the scolex showed no postcontrast enhancement s/o dead parasite [Figure 2]. Features confirmed the diagnosis of neurocysticercosis and its response to anthelmintic treatment.
Figure 1: Axial T1 magnetic resonance imaging shows a well defined hypointense lesion in the right postcentral gyrus (a) which is hyperintense on T2-weighted images and shows a hypointense scolex within (b). Postcontrast T1-axial images show incomplete ring enhancement and an eccentric enhancing scolex-like area within (c). There is associated mild perilesional edema. On exponential apparent diffusion coefficient images mild restriction is seen in the ring enhancing component of the lesion with areas of facilitated diffusion around it suggestive of perilesional edema (d)

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Figure 2: The cyst has decreased in size with decrease in its peripheral edema with significant regression in the enhancement and also the restricted diffusion of the lesion (axial T1, axial T2, postcontrast, and exponential apparent diffusion coefficient diffusion-weighted images a-d, respectively). The eccentric scolex was nonenhancing s/o dead parasite. Features are suggestive of neurocysticercosis and its response to anthelmintic treatment

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This knowledge of imaging combined with clinical details and pathophysiology of the disease (in this case DCIS of the breast) proved a timely intervention by the Radiologist for the benefit of the patient and avoided wastage of finances and resources for the patient as well as the institute. DCIS rarely metastasizes with sparse cases of metastatic DCIS reported in literature, that too after a decade-long disease-free interval.[4],[5],[6]

Thus, radiologists form vital cogs in the multidisciplinary clinical machinery, who with meticulous attention to detail and a sound clinical as well as radiological knowledge can shift the entire management of patients from one treatment path to another.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Leslie A, Jones AJ, Goddard PR. The influence of clinical information on the reporting of CT by radiologists. Br J Radiol 2000;73:1052-5.  Back to cited text no. 1
    
2.
Balasubramaniam R, Subesinghe M, Smith JT. The proliferation of multidisciplinary team meetings (MDTMs): How can radiology departments continue to support them all? Eur Radiol 2015;25:3679-84.  Back to cited text no. 2
    
3.
Kane B, Luz S, O'Briain DS, McDermott R. Multidisciplinary team meetings and their impact on workflow in radiology and pathology departments. BMC Med 2007;5:15.  Back to cited text no. 3
    
4.
Kimura-Hayama ET, Higuera JA, Corona-Cedillo R, Chávez-Macías L, Perochena A, Quiroz-Rojas LY, et al. Neurocysticercosis: Radiologic-pathologic correlation. Radiographics 2010;30:1705-19.  Back to cited text no. 4
    
5.
Roses RE, Arun BK, Lari SA, Mittendorf EA, Lucci A, Hunt KK, et al. Ductal carcinoma-in-situ of the breast with subsequent distant metastasis and death. Ann Surg Oncol 2011;18:2873-8.  Back to cited text no. 5
    
6.
Saha P, Amico AL, Olopade OI. Long-term disease-free survival in a young patient with hormone receptor-positive breast cancer and oligometastatic disease in the brain. Clin Breast Cancer 2016. pii: S1526-820930033-7.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]

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