Interventional radiology continued to develop in the 1990s. Reviews were made by J Byrne of Oxford on the endovascular treatment of intracranial aneurysms (Byrne BJR 1996; 69(826): 891-899) and by JF Dyet on the endovascular repair of abdominal aortic aneurysms (Dyet BJR 1996: 69(827): 1069-1074).
CT was being increasingly used for the management of the acute patient instead of being seen as a cancer scanner. JH Small and others from Cambridge described their experience of fast CT for the diagnosis of acute dissection of the aorta (Small, Dixon, Coulden, Flower and Housden BJR 1996; 69(826): 900-905). This trend for the increasing use of CT scanning in the management of the acutely ill patient has continued to accelerate.
Image source: Byrne BJR 1996; 69(826): 891-899
Magnetic resonance imaging
As the 1990s progressed there appeared an increasing number of papers on MRI and its clinical utilisation. The January 1990 issue opened with an interesting review by Ian Young from the NMR Unit at the Hammersmith Hospital in London (Young BJR 1990; 63(745):1-13). The article is the text of his 1989 Silvanus Thompson Memorial Lecture and Ian Young reviewed the future possibilities of MRI and possible boundaries. The term NMR standing for Nuclear Magnetic Resonance was now obsolete since the use of the term ‘nuclear’ was considered inappropriate. The same group at the NMR Unit at the Hammersmith Hospital and the GEC Hirst Research Centre described fat suppression in MRI in February 1992 (Baudouin, Bryant and Young BJR 1992; 65(770): 132-136). Chemical shift imaging is the general term used to describe magnetic resonance techniques that depend on differences in the resonant frequencies of different molecular species. These fat suppression techniques are of considerable clinical value.
In June 1990 there appeared a paper from Peter Mansfield and the group from the Queen’s Medical Centre and the University of Nottingham (Stehling, Charnley, Blamire, Ordidge, Coxon, Gibbs, Hardcastle and Mansfield BJR 1990; 63(750): 430-437) on ultra-fast scanning of the liver with echo-planar imaging. They published an interesting paper on echo-planar imaging of the fetus in October 1990 (Mansfield, Stehling, Ordidge, Coxon, Chapman, Blamire, Gibbs, Johnson, Symonds, Worthington, and Coupland BJR 1990; 63(755): 833-841). Because it does not involve ionising radiation MRI is useful in pregnancy. The MRI equipment at Nottingham was home-built and improvements allowed them to produce snap-shot images and so avoided fetal movement degradation. In February 1991 they wrote an interesting paper looking at CSF flow (Stehling, Firth, Worthington, Guilfoyle, Ordidge, Coxon, Blamire, Gibbs, Bullock, and Mansfield BJR 1991; 64(758): 89-97).
MRA of abdominal vessels (Vock, Terrier, Wegmuller, Mahler, Gertsch and Dumoulin BJR 1991; 64(757): 10-16) is described by P Vock and others in this early study giving promise of what was to come in the future.
Image source: Vock, Terrier, Wegmuller, Mahler, Gertsch and Dumoulin BJR 1991; 64(757): 10-16
MRI as a technique matured quite rapidly
In April 1993 CW Heron from St George’s Hospital (Heron BJR 1993; 66(784): 292-302) reviewed MRI of the knee. The images are now of high quality and MRI was to become of increasing utility in the investigation of musculoskeletal disease.
In January 1994 SM Forbat and others from the Royal Brompton National Heart and Lung Hospital (Forbat, Karwatowski, Gatehouse, Firmin, Longmore and Underwood BJR 1994; 67(793): 86-90) produced an exciting technical note on the rapid measurement of left ventricular mass by spin echo magnetic resonance imaging.
By January 1995 M Gibson and others from St. Mary’s Hospital in London (Gibson, Cook and Gedroyc BJR 1995; 68(805): 89-92) were producing magnetic resonance angiographic images in renal artery stenosis that were superior to conventional angiography.
In April 1995 CG Santosh and others from Edinburgh were describing the exciting technique of functional MRI (Santosh, Rimmington and Best BJR 1995; 68(808): 369-374). They were able to visualise the functional activation of the brain using MRI and were able to demonstrate activity in the visual cortex on visual stimulation. WW Orrison gave his 3M Mayneord Lecture on functional brain imaging at the Röntgen Centenary congress in 1995 (Orrison BJR 1996; 69(822): 493-501) . There had been an increasing interest in brain function throughout the 1990s.
In November 1995 GM Bydder at the Hammersmith Hospital gave his Mackenzie Davidson Memorial Lecture on detecting small changes to the brain with serial MRI studies (Bydder BJR 1995; 68(816): 1271-1295). In a few short years the images had improved dramatically.
Contrast media were used in MRI as well as in conventional imaging. In February 1995 R Mathur-De Vré and M Lemort (Mathur-De Vré and Lemort BJR 1995; 68(807): 225-247) reviewed both the biophysical properties and the clinical applications of these agents.
Image source: Mathur-De Vré and Lemort BJR 1995; 68(807): 225-247
WD Jeans from Bristol reviewed the development and use of digital subtraction arteriography (DSA) in March 1990 (Jeans BJR 1990; 63(747): 161-168). Both intravenous and intra-arterial techniques are described. The intravenous techniques proved disappointing. Diagnostic angiography has now been largely replaced by MRA (Vock, Terrier, Wegmuller, Mahler, Gertsch, Souza and Dumoulin BJR, 1991; 64(757): 10-16), CT angiography and ultrasound and DSA is commonly used as part of an interventional procedure.
AM Peters in May 1990 (Peters BJR 1990; 63(750): 411-429) reviewed the developments in nuclear medicine. In the 1990s nuclear medicine was in a time of major developments. There were significant developments in radiopharmaceuticals with technetium-99m labelled agents, complex biological agents and new compounds for labelling with positron emitters. SPECT machines continued to improve and PET was becoming more available. In particular there were significant advances in functional imaging.
As an example FE Pickworth and others (Pickworth, Vivian, Franklin and Brown BJR 1992; 65(769): 21-29) described the recently developed 99Tcm-MAG3 and its use in renal scanning.
I Gordon from the Hospital for Sick Children in London reviewed in November 1993 (Gordon BJR 1993; 66(791): 971-985).
Ultrasound continued to advance through the decade. In February 1991 R Clements and others reviewed transrectal ultrasound in prostate disease (Clements, Griffiths and Peeling BJR 1991; 64(759): 193-200). A better understanding of prostatic anatomy followed by the technique has revolutionised our management of prostatic disease.
The Mackenzie Davidson Memorial Lecture of the BIR was given in 1990 by the ultrasound pioneer HH Holm from Copenhagen (Holm BJR 1991; 64(761): 379-385). Hans Holm gave a masterly account of interventional ultrasound and this technique has continued to grow in utilisation.
A mark of the increasing importance of ultrasound was shown by the July 1992 issue of the BJR being entirely devoted to the modality. Of particular interest was the paper by I Shirley, F Bottomley and VP Robinson from Hillingdon Hospital in Uxbridge (Shirley, Bottomley and Robinson BJR 1992; 65(775): 564-569) on routine radiographer screening for foetal abnormalities in an unselected low risk population. This paper is of interest for a number of reasons. The screening was done by radiographers (now called sonographers) and not doctors, that the population was of low risk and that there are ethical implications of antenatal screening. The group at Hillingdon Hospital had been offering routing ultrasound screening since July 1986. P Twining and J Zuccollo described the ultrasound markers of chromosomal disease in May 1993 (Twining and Zuccollo BJR 1993; 66(785): 408-414).
Image source: Twining and Zuccollo BJR 1993; 66(785): 408-414