Clinical Imaging - Articles in Press

Congenital maturing immature intraventricular teratoma - Corrected Proof

Liyuan Yu, Satish Krishnamurthy, Howard Chang, John J. Wasenko — 2010-03-08

Abstract: We report a case of a maturing immature intraventricular teratoma in a neonate. The computed tomography and magnetic resonance imaging and pathologic findings are described. The relevant literature is reviewed and management is discussed.

CT Imaging findings of malignant neoplasms arising in the epigastric region in children - Corrected Proof

Claudia Martinez Rios Arellano, Supika Kritsaneepaiboon, Edward Y. Lee — 2010-02-24

Abstract: The purpose of this article was to review the spectrum of common and rare malignant neoplasms arising in the epigastric region in children and to illustrate their characteristic computed tomography (CT) imaging features. Understanding the characteristic CT appearance of various malignant neoplasms, which can occur in the epigastric region in children, aids in accurate diagnosis and optimizes pediatric patient care.

Three-tesla diffusion tensor imaging of Meyer's loop by tractography, color-coded fractional anisotropy maps, and eigenvectors - Corrected Proof

Matthew L. White, Yan Zhang — 2010-02-22

Abstract: The aim of this study was to evaluate Meyer's loop by 3-T MRI with fiber tractography, color-coded fractional anisotropy maps, and eigenvector maps. The anteroposterior distance from the anterior bundle of the Meyer's loop to temporal pole ranged from 26.3 to 34 mm, overlapping with the previously published anatomical dissection studies. Diffusion tensor imaging with fiber tractography, color-coded FA maps, and color maps of the principal eigenvector at 3 T appear to be promising techniques for the virtual dissection of Meyer's loop.

Do all mucocele-like lesions of the breast require surgery? - Corrected Proof

2010-02-22

Abstract: Aim: The objective of this study is to review the imaging features and percutaneous biopsy findings of mucocele-like lesions (MLLs) of the breast and correlate these with histopathology at surgical excision (SE), where available, to determine whether all MLLs of the breast require surgery for management.Materials and Methods: A search of two pathology databases was performed to identify 44 patients who had been diagnosed with MLL of the breast and who had corresponding imaging findings available for review. These patients' medical records were reviewed to determine patient age at diagnosis, site of disease/affected breast, symptoms at diagnosis, mammographic and sonographic findings and methods used for histopathologic diagnosis (percutaneous biopsy and/or SE).Results: The mean age of all patients was 56 years (range, 35–76 years). Sixteen patients had MLLs diagnosed by core needle biopsy (CNB) or fine needle aspiration biopsy followed by SE. Eighteen patients had CNB without SE and had clinical and imaging follow-up. Ten patients had MLL diagnosed at SE without prior percutaneous biopsy. In total, 29 patients (66%) had MLLs without atypia, while 10 patients had MLLs associated with atypical ductal hyperplasia (ADH) (23%) and five patients had MLLs associated with ductal carcinoma in situ (DCIS) (11%). Findings were upgraded at SE following the percutaneous biopsy from ADH to DCIS in 19% (3/16) of patients.Conclusion: Surgical excision following the identification of MLL is warranted to exclude coexisting in situ carcinoma in specific situations where CNB detects the presence of associated ADH or where a mass with indistinct or irregular margins is shown by mammography or sonography.

Polysplenia syndrome accompanied with situs inversus totalis and annular pancreas in an elderly patient - Corrected Proof

Arda Kayhan, Hatice Lakadamyali, Jacob Oommen, Aytekin Oto — 2010-02-11

Abstract: Polysplenia syndrome (PS) is rarely encountered in elderly. It is characterized by multiple spleens associated with various cardiac and gastrointestinal abnormalities including partial or complete agenesis of dorsal pancreas. Situs inversus totalis (SIT) is a rare congenital anomaly with mirror image of viscera combined with dextrocardia. Occurrence of SIT and PS in the same patient is exceedingly rare. We present the first case of adult PS with SIT accompanied with annular pancreas.

Sonography in the 29th Olympic and Paralympic Games: a retrospective analysis - Corrected Proof

Wen He, Dong-ying Xiang, Jian-ping Dai — 2010-01-27

Abstract: Objective: The purpose of this study was to evaluate the application of sonography at the polyclinic of the Olympic/Paralympic village during the Olympic/Paralympic Games.Methods: We retrospectively reviewed 759 consecutive patients who underwent sonography at the ultrasound division of the polyclinic in the Olympic/Paralympic village from July 20, 2008, to September 20, 2008. Prevalence of emergency sonography after sports injury and non-sports-related urgent conditions during the games was analyzed. The benefit of sonographic services in large sporting events was discussed.Results: There were 759 patients (484 athletes, 101 coaches, 88 team officials, and 86 volunteers; 462 men and 297 women) in the ultrasound division at the polyclinic. The indications for sonography included abdominal pain (315 cases, 41.50%), muskuloskeletal disorders (228 cases, 30.04%), gynecology related (104 cases, 13.70%), cardiac conditions (49 cases, 6.46%), small parts (29 cases, 3.82%), and vascular problems (34 cases, 4.48%). The rates of positive findings on sonography were 46.03% in the abdomen, 70.17% in musculoskeleton, 41.34% in gynecology, 10.20% in the heart, 75.86% in small parts, and 38.24% in vessels, respectively.Conclusion: Sonography plays an important role in the medical services at the polyclinic in the Olympic/Paralympic village. The benefits of sonography in such large sporting events are accuracy, fast result, portability, and noninvasiveness.

Appearance of primary lymphoid malignancies on lymphotropic nanoparticle-enhanced magnetic resonance imaging using ferumoxtran-10 - Corrected Proof

2010-01-15

Abstract: Patients with pathologically confirmed lymphoma/leukemia were retrospectively identified from a large single-institution phase III clinical trial with ferumoxtran-10. Five (2.3%) of 220 patients had lymphoid malignancies involving lymph nodes. A subset of patients (n=27) with biopsy-proven nodal metastases from genitourinary or breast cancer was selected as control group. Ferumoxtran-10 enhancement patterns and signal-to-noise ratios of lymph nodes involved by metastases and lymphoid malignancy were assessed. Like nodal metastases, nodes involved by lymphoid malignancies demonstrate persistent high T2*-signal intensity on lymphotropic nanoparticle-enhanced magnetic resonance imaging.

Solid-pseudopapillary neoplasm of the pancreas: spectrum of findings on multidetector CT - Corrected Proof

2010-01-15

Abstract: Solid-pseudopapillary neoplasms of the pancreas are uncommon and usually occur in young women. They are generally large, encapsulated masses with mixture of solid, cystic, and hemorrhagic components. Some cases have atypical features; for example, they can form a small predominantly solid mass and produce dilatation of the main pancreatic duct. In this article we discuss and illustrate the spectrum of the appearances of this distinctive neoplasm on multidetector CT.

Efficacy of dual-source CT coronary angiography in evaluating coronary stenosis: initial experience - Corrected Proof

2010-01-15

Abstract: Objective: To retrospectively assess the diagnostic efficacy of dual-source CT angiography (DSCTA) in detecting and grading coronary stenosis.Methods: Institutional review board approval and informed consent were obtained. One hundred ten patients were performed with both DSCTA and conventional coronary angiography (CCA) without heart rate or rhythm control in 1 week. Regarding CCA as the gold standard, the assessable rate of coronary arteries and diagnostic value of coronary stenosis using DSCTA were analyzed, respectively. The intermodality agreement between DSCTA and CCA in grading coronary stenosis was assessed using κ test. The value of DSCTA in diagnosing >50% coronary stenoses was also assessed.Results: The overall assessable rate of DSCTA was 98.6% in detecting coronary arteries; there was no significant difference between assessable rates from different groups of heart rate (χ2=0.45, P > .05). The efficacy of DSCTA was of 97.9% sensitivity, 97.3% specificity, 90.4% positive predictive value, and 99.4% negative predictive value for coronary stenosis; and 94.7% sensitivity, 96.8% specificity, 83.7% positive predictive value, and 99% negative predictive value for >50% stenoses. The intermodality agreement in diagnosing coronary stenosis was satisfactory (k=0.87, u=58.46, P<.01).Conclusions: As an effective noninvasive diagnostic tool, DSCTA yields a promising accuracy and reliability in assessing coronary stenosis. It may be recommended as a valuable screening tool for coronary artery disease, and a potential challenge to CCA as well.

Impact of age on FDG uptake in the liver on PET scan - Corrected Proof

2010-01-11

Abstract: Purpose: The intensity of physiological 18F-2-deoxy-D-glucose (FDG) uptake in the liver varies. It is important to be familiar with the varying degree of FDG accumulation in the liver that represents normal distribution and physiological changes, before attempting to interpret whole-body positron emission tomography (PET) imaging for malignancy detection. The aim of this study is to evaluate the possible factors influencing the intensity of physiological FDG uptake in the liver on FDG PET imaging.Materials and Methods: From 2005 to 2007, a total of 339 consecutive healthy subjects, referred from the Department of Community Medicine and Health Examination Center of our hospital for health screening, were retrospectively recruited for analysis. Demographic data were collected from chart records. Whole body FDG PET imaging and serologic determination of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection status were performed on all subjects. The mean and maximum standard uptake values (SUVs) of the liver were calculated. The relationships between sex, age, HBV and HCV infection status, and SUVmax and SUVmean of the liver on FDG PET imaging were evaluated.Results: There was no statistically significant relationship between sex, HBV and HCV infection status and maximum standard uptake value (SUVmax) or mean standard uptake value (SUVmean) of the liver. After adjusting for covariables, age was a statistically significant predictor of SUVmax (B=0.18; P= .001) and SUVmean (B=0.16; P= .004) of the liver on FDG PET imaging.Conclusion: Age has a significant and positive impact on both maximum and mean standard uptake values of the liver on FDG PET imaging. High physiological background FDG uptake will reduce diagnostic sensitivity and accuracy for malignancy detection in the liver.

Use of a hemostasis introducer sheath to guide clip delivery during stereotactic directional vacuum-assisted breast biopsy when the biopsy system malfunctions - Corrected Proof

Jane Wang, Chun-Ju Chang — 2010-01-11

Abstract: Stereotactic directional vacuum-assisted breast biopsy (ST DVAB) is an accurate biopsy method. Marking the biopsy site with a clip is mandatory after ST DVAB, in case excision is required. With the ST DVAB system we use, clip was delivered through the biopsy probe. We report a case with malfunctioning of the ST DVAB system during the procedure, and thus the clip could not be placed through the biopsy probe. To salvage the procedure, we placed the clip to the biopsy site via a hemostasis introducer sheath.

Renal aneurysms and pseudoaneurysms - Corrected Proof

2010-01-11

Abstract: Pseudoaneurysms and aneurysms are abnormal dilatations of the vessel lumen. Pseudoaneurysm is a perfused hematoma contained by the adventitia and perivascular tissues that is in communication with the lumen of an adjacent artery or vein. Aneurysm is a dilatation of the vessel lumen involving all three layers of the blood vessel wall. Renal artery aneurysms (RAA) are uncommon but the widespread use of cross-sectional imaging and incidental detection of RAA may result in an increasing number of cases diagnosed. Renal artery pseudoaneurysms are suspected in bleeding patients after penetrating renal trauma. Imaging plays a major role in the detection of renal pseudoaneurysms and aneurysms and diagnoses aneurysm rupture and active bleeding. Computed tomography (CT), magnetic resonance imaging, and digital subtraction angiography can characterize lesion size, shape, and location and identify other aneurysms and pseudoaneurysms, helping to narrow the differential diagnosis and to understand the vascular anatomy for guiding proper treatment. Endovascular treatments have contributed considerably in the management of renal pseudoaneurysms and aneurysms. The use of coil embolization or covered stent placement prevents the mortality and mobility of surgery. The article describes imaging features and the endovascular therapies to treat these vascular processes and their possible complications.

CT evaluation of pulmonary venous anatomy variation in patients undergoing catheter ablation for atrial fibrillation - Corrected Proof

2010-01-11

Abstract: To characterize pulmonary vein (PV) anatomy and the relative position of the PV ostia to the adjacent thoracic vertebral bodies, two readers reviewed 176 computed tomography pulmonary venous studies. PV ostial dimensions were measured and PV ovality assessed. Anatomical variations in PV drainage were noted. The position of the PV ostium relative to the nearest vertebral body edge was recorded. Right PV ostia were significantly more circular than the left (p<.001). Anatomical variability was greater for right PVs: 82% of patients had 2 ostia, 17% had 3 ostia, 0.5% had 4 ostia and 0.5% a common ostium. For left PVs, 91% of patients had 2 ostia, 8.5% a common ostium and 0.5% 3 ostia. Mean ostial distances from vertebral margin were: right PVs 3.62±7.48 mm; left PVs 3.84±8.46 mm (p=.72). 65% of right upper PV, 60.5% of right lower PV, 51% of left upper PV and 57% of left lower PV ostia were positioned lateral to vertebral bodies. Right PV ostia are rounder than left-sided and right PV drainage is more variable. As a significant proportion of PV ostia overlap the vertebral bodies, prior anatomical evaluation by CT can assist catheter ablation procedures for atrial fibrillation (AF), especially when performed under fluoroscopy.

MRI features of lipoblastoma: differentiating from other palpable lipomatous tumor in pediatric patients - Corrected Proof

2010-01-11

Abstract: The purpose of this study was to describe the magnetic resonance imaging (MRI) features of lipoblastomas in pediatric patients and to differentiate them from other palpable benign lipomatous tumors. The relatively specific MRI features of nonenhancing cystic change and enhancing soft tissue nodules seen in lipoblastoma may help to differentiate it from other types of lipomatous tumor in pediatric patients.

Characterization of pancreatic metastases from primary lung cancer using magnetic resonance imaging - Corrected Proof

Sun Xi-wen, Chen Shu-zhen — 2010-01-06

Abstract: Aim: To evaluate magnetic resonance (MR) imaging of pancreatic metastases secondary to primary lung cancers.Materials and methods: Eleven cases included T1-weighted, T2-weighted, and spectral presaturation attenuated inversion recovery T2-weighted images.Results: Of the 21 total pancreatic lesions evaluated, 10 exhibited a peripheral rim of high signal intensity, 9 displayed a homogeneous signal intensity, and 2 lesions demonstrated a heterogeneous pattern of contrast enhancement.Conclusion: Limitations in evaluating pancreatic metastases by MR imaging require definitive diagnoses to rely on both clinical data and MR imaging.

Two rare cases of spontaneous splenic rupture - Corrected Proof

2010-01-04

Abstract: The rupture of the spleen, not secondary to external trauma, is rare. Two cases are reported. The first case occurred in a patient with an aggressive form of lymphoma, and the second in a patient following a colonoscopy. In the rare occurrences of spontaneous rupture, radiological imaging, in particular by computed tomography, will lead to the diagnosis and help in deciding the correct treatment.

False Positive for Malignancy of a Lung Nodule on FDG PET/CT scans—A lesion with high FDG Uptake but Stable in Size - Corrected Proof

David Q. Wan, Alan D. Xu, Charles E. Manner — 2010-01-04

Abstract: A highly F-18 fluorodeoxyglucose-avid lung nodule was stable in both size and metabolic activity over 4 months. This was most likely nonneoplastic because a true tumor would grown in volume overtime. The high level of energy consumption was contributing functional activities or by inflammatory cells. Because the speed of tumor growth is proportional to its energy consumption, we consider the higher the metabolic activity of a lesion, the less likely of malignant if it was stable in size over time.

An unusual case of primary mesenchymal chondrosarcoma in orbit with intracranial extension - Corrected Proof

Mingming Liu, Wei Qin, Zhengqin Yin — 2010-01-04

Abstract: An unusual case of primary orbital mesenchymal chondrosarcoma with intracranial extension is reported, with special emphasis on the radiological findings.

Melanotic neuroectodermal tumor of infancy: report of one calvarial lesion with T1 shortening and one maxillary lesion - Corrected Proof

2010-01-04

Abstract: Melanotic neuroectodermal tumor of infancy (MNTI) is a rare tumor which commonly involves the mandible, maxilla and calvarium. We report two infants with this rare tumor. T1 shortening due to melanin content has been rarely described in MNTI. The calvarial MNTI showed T1 shortening which was helpful in diagnosis.

Multidetector CT findings of right intrahepatic portosystemic venous shunt - Corrected Proof

2009-12-31

Abstract: Purpose: To evaluate multidetector CT features of right intrahepatic portosystemic venous shunt (IPSVS).Materials and Methods: Pathways of right IPSVS were evaluated from 20 patients. Diameters of right portal veins were measured in IPSVS patients, 30 cirrhotic and 30 healthy patients.Result: Among 22 IPSVSs, shunt between posterior branch and inferior phrenic vein was most common. Diameters of the posterior branch were larger in IPSVS patients than in other groups.Conclusion: Most right IPSVSs drain to inferior phrenic vein through dilated posterior branch.

Graph-matching-based computed tomography angiography in peripheral arterial occlusive disease - Corrected Proof

2009-12-07

Abstract: The objective of this study is to compare a graph-matching-based software and a conventional tool for postprocessing of computed tomography angiography (CTA) in correlation with the gold standard digital subtraction angiography. Sensitivity, specificity, accuracy, and interobserver agreement increased from 80.3% to 92.9%, from 69.1% to 92.4%, from 73.5% to 92.8%, and from 0.45 to 0.96, respectively, using the graph-matching-based technique. Graph-matching-based CTA increases sensitivity, specificity, accuracy, and interobserver agreement in comparison to a conventional bone elimination tool in the assessment of peripheral arterial occlusive disease.

Idiopathic lymphocytic pleuritis: radiographic and high-resolution CT appearances and changes in response to therapy in two adults - Corrected Proof

2009-12-03

Abstract: Inflammatory conditions of the pleura characterized by a predominantly lymphocytic infiltrate are described in several disorders. The commonest underlying aetiologies include tuberculous infection, autoimmune disorders (particularly Sjogren's syndrome), and post coronary artery bypass graft surgery. Idiopathic lymphocytic pleuritis (ILP) is a rare form of diffuse pleural inflammation characterized by extensive lymphocytic infiltration for which no cause is found. Radiological descriptions of ILP are limited. We describe the radiographic and high-resolution computed tomography (HRCT) imaging features and response to corticosteroid therapy of ILP in two adults. Both patients presented with bilateral diffuse pleural thickening of >10 mm thickness extending >10 cm craniocaudally with small focal areas of atelectasis. Both cases demonstrated marked improvement in the degree and extent of pleural thickening and rounded atelectasis following corticosteroid therapy. HRCT provided a useful noninvasive method of assessing disease response to therapy.

Anomalous origin of the coronary arteries in children: diagnostic role of three-dimensional coronary MR angiography - Corrected Proof

2009-12-03

Abstract: When the anomalous origin of coronary arteries (AOCA) is suspected in children (especially athletes), due to signs and symptoms of myocardial ischemia or on the basis of echocardiographic assessment, three-dimensional coronary magnetic resonance angiography (3D-CMRA) can be proposed for the fine morphological evaluation of coronary branches anatomy and course.We tested the diagnostic potential of CMRA angiography in a prospective study on AOCA in young patients. Between July 2005 and June 2008, 15 patients aged 6–29 years (mean age, 13.5 years±5.6 S.D.; median, 14) with clinical and echocardiographic suspicion of AOCA underwent CMRA (1.5 T), 3D whole-heart, free-breathing technique, without the use of contrast medium and β-blockers, with a mean examination time of 30 min. We acquired a second scan of all patients to ameliorate the quality of the acquisition and to improve our experience.AOCA was confirmed by 3D-CMRA in 8 out of 15 cases (53%) and three different anatomical variants were demonstrated, that is, ectopic origin of the left circumflex artery arising from the right coronary artery with retro-aortic course in four cases, single coronary artery arising from the right sinus of Valsalva with interarterial course in one case, ectopic right coronary artery arising from the left sinus of Valsalva with interarterial course in one case; in two patients without anomalies of origin of the coronary arteries, elongated LMCA with angulation of the proximal segment of the left circumflex artery was present.When AOCA is suspected particularly in children (especially athletes), CMRA without the use of contrast medium is an effective diagnostic technique, which is useful to clarify the spatial position of the anomalous course of the main coronary branches in order to suggest the most convenient management of the disease. CMRA does not need contrast medium, needles, and β-blockers; is repeatable in the same examination without the exposure to X-rays; allows a parent to stay near the child; and needs low collaboration in low-stress conditions.

Diffusion-weighted MRI with parallel imaging technique: apparent diffusion coefficient determination in normal kidneys and in nonmalignant renal diseases - Corrected Proof

2009-11-23

Abstract: The purpose of the study was to assess the capability and the reliability of apparent diffusion coefficient (ADC) measurements in the evaluation of different benign renal abnormalities. Twenty-five healthy volunteers and 31 patients, divided into seven different groups (A–G) according to pathology, underwent diffusion-weighted magnetic resonance imaging (DW MRI) of the kidneys using 1.5-T system. DW images were obtained in the axial plane with a spin-echo echo planar imaging single-shot sequence with three b values (0, 300, and 600 s/mm2). Before acquisition of DW sequences, we performed in each patient a morphological study of the kidneys. ADC was 2.40±0.20×10−3 mm2 s−1 in volunteers. A significant difference was found between Groups A (cysts=3.39±0.51×10−3 mm2 s−1) and B (acute/chronic renal failure=1.38±0.40×10−3 mm2 s−1) and between Groups A and C (chronic pyelonephritis=1.53±0.21×10−3 mm2 s−1) (P .05). A considerable correlation between glomerular filtration rate and ADC was found (P=.04). In conclusion, significant differences were detected among different patient groups, and this suggests that ADC measurements can be useful in differentiating normal renal parenchyma from most commonly encountered nonmalignant renal lesions.

Preoperative staging of renal cell carcinoma using magnetic resonance imaging: comparison with pathological staging - Corrected Proof

Martina Spero, Boris Brkljacic, Branko Kolaric, Miljenko Marotti — 2009-11-16

Abstract: We have retrospectively assessed the accuracy of our MRI protocol on 1.0-T MRI system for preoperative staging of renal cell carcinoma using the 2002 TNM staging system and pathological staging as the gold standard.Medical records of 48 patients (mean age, 56.28 years) with 57 renal tumors were reviewed: 52 malignant renal tumors were found; most of the patients were staged T1N0M0. In our study, κ test revealed excellent agreement between all three classes of the TNM staging system.

Cerebral pulsatility index by transcranial Doppler sonography predicts the prognosis of patients with fulminant hepatic failure - Corrected Proof

Manri Kawakami, Masahiko Koda, Yoshikazu Murawaki — 2009-11-13

Abstract: Aim: Cerebral hemodynamic derangement is well known in patients with fulminant hepatic failure. The advent of transcranial Doppler sonography (TCD) enabled noninvasive observation of cerebral hemodynamics. To evaluate its clinical usefulness, we examined longitudinal cerebral hemodynamic parameters in patients with fulminant hepatic failure and severe acute hepatitis.Methods: The six subjects were four patients with fulminant hepatic failure, one with severe acute hepatitis and one with severe acute exacerbation on chronic hepatitis. The pulsatility indices of the right middle cerebral artery were used as parameters of cerebral hemodynamics.Results: The pulsatility indices of the two patients with a deteriorating course had elevated to >1.00, whereas those of the two patients undergoing recovery were within normal limits, as well as of the patients with acute hepatitis or acute exacerbation on chronic hepatitis.Conclusion: Cerebral pulsatility measured by TCD may be a real-time and useful tool to assess and monitor patients with fulminant hepatic failure.

Ground-glass nodules found in two patients with malignant melanomas: different growth rate and different histology - Corrected Proof

Mi-Jin Kang, Min A Kim, Chang Min Park, Chang-Hyun Lee, Jin Mo Goo, Hyun Ju Lee — 2009-11-13

Abstract: We report two pathologically proven pure ground-glass nodules found in two patients with malignant melanoma. In one patient, the nodule showed no growth over 2 months and was found to be bronchioloalveolar carcinoma, whereas in the other patient, a nodule grew rapidly over 3 months and was histologically confirmed to be metastatic melanoma.

Renal hemodynamic changes with aging: a preliminary study using CT perfusion in the healthy elderly - Corrected Proof

Hong Zhao, Jingshan Gong, Yan Wang, Zuoquan Zhang, Peixin Qin — 2009-11-09

Abstract: Objective: To investigate renal blood flow perfusion parameter changes associated with aging using multislice spiral computed tomography (CT).Methods: This prospective study was approved by the institute's ethics committee for clinical study and written informed consent was obtained from all subjects. Forty-two consecutive patients who underwent abdominal CT without obvious renal abnormality at plain scanning were enrolled in this study. The renal perfusion scan was carried out using 16-slice spiral CT. The Pearson correlation coefficient was used to examine the correlation between perfusion parameter changes with aging.Results: In both the cortex and medulla, blood flow (BF) and blood volume (BV) were negatively correlated with age, while time-to-peak (TTP) value and mean transit time (MTT) showed a positive correlation with age. Changes in BF, TTP, and MTT were found to have a statistically significant correlation with age in both the cortex and medulla, while the correlation between BV and age showed no statistical significance.Conclusion: It is feasible to assess renal hemodynamics changes with aging in the elderly using the current clinically available CT perfusion imaging technology in vivo. It may be helpful in the management of aged patients to familiarize with the renal hemodynamics changes in clinical work-up.

Radiologic findings of lung lobe torsion in reconstructed multidetector computed tomography image lead to early detection - Corrected Proof

2009-11-09

Abstract: Torsion of the remaining lung lobe after lobectomy is a rare complication, and sometimes, diagnosis can be difficult. But early detection is important to prevent resection and fatal complication. We present a case of left lower lobe torsion with reconstructed image of multidetector computed tomography (MDCT) findings, which propose a possibility of early detection on retrospective review after surgical reduction. Multiplanar reconstruction of MDCT image, 3-dimensional CT angiography, and CT bronchography could provide important diagnostic clues.

X-ray appearance of subcutaneous gemstones as part of alternative/holistic medicine: a case report and review of the literature - Corrected Proof

Jerri McLemore, Aaron L. Hallengren — 2009-10-26

Abstract: The authors present a case of a deceased man with numerous subcutaneous nodules identified as foreign bodies on radiographic films. The foreign bodies were gemstones inserted underneath the skin as a form of holistic medicine. The X-ray findings of this case and a review of the literature for similar subcutaneously implanted foreign bodies used in holistic, alternative, or folk medicine are presented.

Detection of lymph nodes in pelvic malignancies with computed tomography and magnetic resonance imaging - Corrected Proof

2009-10-15

Abstract: Thirty patients with prostate or bladder cancer underwent CT and MRI for nodal staging. CT detected 189 nodes, and MRI detected 271 nodes. This difference was statistically significant in the external iliac (CT/MRI=73/87 nodes), obturator (CT/MRI=48/75 nodes), and internal iliac (CT/MRI=24/46 nodes) nodal chains. Based on size, the number of nodes detected by CT and MRI were as follows: 1–5 mm, CT/MRI=91/166; 6–10 mm, CT/MRI=91/98; >10 mm, CT/MRI=7/7 nodes. MRI detected significantly more lymph nodes in the size range of 1–5 mm.

Giant right atrial myxoma: characterization with cardiac magnetic resonance imaging - Corrected Proof

2009-10-09

Abstract: A 53-year-old woman presented to the emergency department with a 2-week history of dyspnoea and chest pain. Computed tomography pulmonary angiography was performed to exclude acute pulmonary embolism (PE). This demonstrated a large right atrial mass and no evidence of PE. Transthoracic echocardiography followed by cardiac magnetic resonance imaging confirmed a mobile right atrial mass. Surgical resection was then performed confirming a giant right atrial myxoma. We describe the typical clinical, radiologic, and pathologic features of right atrial myxoma.

Diffusion-weighted whole-body imaging with background body signal suppression facilitates detection and evaluation of an anterior rib contusion - Corrected Proof

Thomas C. Kwee, Taro Takahara, Tetsu Niwa — 2009-10-09

Abstract: We report the magnetic resonance imaging (MRI) findings in a 29-year-old woman with anterior chest wall pain following blunt trauma, with special emphasis on the value of diffusion-weighted whole-body imaging with background body signal suppression (DWIBS). Although a rib contusion could be depicted at (fat-suppressed) T2-weighted MRI, anatomical localization and assessment of lesion extent were superior and more straightforward at DWIBS. Thus, this report shows the utility of adding DWIBS to an MRI protocol for anterior chest wall evaluation.

Multidetector computed tomography evaluation of secondary hepatopulmonary fusion in a neonate - Corrected Proof

Umakanth Khatwa, Edward Y. Lee — 2009-10-05

Abstract: Hepatopulmonary fusion is a rare condition in which a dense adhesion occurs between the right lung and herniated hepatic parenchyma in patients with right-sided congenital diaphragmatic hernia. Plain radiographic and magnetic resonance imaging (MRI) findings of hepatopulmonary fusion in a neonate have been reported in a retrospective study with a small patient population and a case report. However, to our knowledge, there is no report regarding the secondary hepatopulmonary fusion (after right-sided congenital diaphragmatic hernia repair) evaluated with multidetector computed tomography (MDCT) in a neonate. We report a case of secondary hepatopulmonary fusion in a neonate, in which multiplanar and three-dimensional (3D) images were helpful in delineating the precise anatomy for preoperative evaluation. Understanding the diagnostic limitations of plain radiographs and MRI, the use of MDCT with its multiplanar and 3D imaging may emerge as a useful noninvasive imaging modality in the evaluation of possible hepatopulmonary fusion in pediatric patients with right-sided congenital diaphragmatic hernia.

Dynamic close-mouth view radiograph method for the diagnosis of lateral dynamic instability of the atlantoaxial joint - Corrected Proof

2009-10-05

Abstract: The purpose of the current study is to establish the dynamic close-mouth view radiograph method. Seven healthy volunteers were enrolled. Dynamic open-mouth and close-mouth view radiographs were obtained. The odontoid lateral mass interval and the dynamic atlantodental lateral shift (ADLS) were measured. The ADLS was 9.4±5.3% by the close-mouth view, showing a significantly greater percentage than that of 5.3±4.0% by the open-mouth view. The dynamic close-mouth view can be useful for diagnosis of atlantoaxial lateral instability.

Imaging manifestations of malignant neoplasia mimicking pyogenic osteodiscitis - Corrected Proof

2009-10-05

Abstract: Malignant neoplasia involving contiguous vertebrae and the corresponding intervertebral discs is a rare occurrence that has similar imaging manifestations as pyogenic osteodiscitis. The authors describe the imaging manifestations of two cases of malignant neoplasia mimicking pyogenic osteodiscitis. We present a case of an 83-year-old male with metastatic non-small cell lung carcinoma and an 82-year-old female with a plasmacytoma, both within the thoracic spine. These cases illustrate how the imaging features of pyogenic osteodiscitis may parallel those of malignant neoplasia.

Flow turbulence or twinkling artifact? A primary observation on the intrarenal color Doppler sonography - Corrected Proof

Jing Gao, Amelia Ng, Minh-Nhut Y. Dang, Robert Min — 2009-10-05

Abstract: Objective: The objective of this report was to describe and potentially explain differences of intrarenal color Doppler sonography (CDUS) manifestations between blood flow turbulence and twinkling artifact.Methods: We retrospectively reviewed 32 cases with appearance of focally increased color Doppler signal on intrarenal CDUS from May 1, 2007, to February 28, 2009. Indications for intrarenal CDUS in 32 cases were suspicion of renovascular hypertension, investigation of complications related to renal biopsy, or hematuria. Characteristics of the color Doppler signal, relationship between color Doppler signal and renal vessels, and the spectral Doppler sampled at the anatomic site of the focal color signal were analyzed. The value and pitfall of color Doppler in the diagnosis of the intrarenal vascular abnormality and detection of renal calculus are discussed.Results: Thirty-two cases with focally increased color Doppler during sonography of native or transplanted kidneys were classified into two groups: (1) turbulent blood flow—intrarenal vascular abnormalities including intrarenal arteriovenous fistula (15 cases) and intrarenal artery stenosis (eight cases); and (2) color Doppler artifact—twinkling produced by renal calculus (nine cases). There were differences in the characteristics of the color Doppler signal, the relationship between the color signal and renal vessel, and the spectral waveform on CDUS between flow turbulence and twinkling.Conclusion: Flow turbulence and twinkling artifact on intrarenal CDUS are distinguishable by analyzing the manifestations on intrarenal CDUS. Proper color Doppler setting and spectral Doppler play important roles in differentiation between flow turbulence in renal vascular abnormalities and twinkling produced by renal stones.

Real-time contrast-enhanced ultrasound imaging of focal liver lesions in fatty liver - Corrected Proof

2009-09-25

Abstract: Purpose: The objective of this study was to investigate the contrast-enhanced ultrasound (CEUS) imaging features of focal liver lesions (FLLs) in fatty liver.Method: One hundred FLLs in 98 patients with fatty liver were evaluated with real-time CEUS.Results: All malignant FLLs showed hyperenhancement in arterial phase and contrast washout in portal and late phases. Among the FLLs, 3.3% of hemangiomas, 12.5% of focal nodular hyperplasias (FNHs), and 2.5% of focal fatty sparing lesions showed contrast washout in the late phase. The sensitivity and specificity for the characterization of hepatocellular carcinoma, metastasis, hemangioma, FNH, and focal fatty sparing lesions were 100% and 95.6%, 60% and 100%, 93.3% and 98.6%, 87.5% and 97.8%, and 92.6% and 100%, respectively.Conclusions: Correct characterization of FLLs in fatty liver by CEUS is possible based on their typical enhancement patterns.

Multimodality imaging of a neonatal wandering spleen - Corrected Proof

2009-09-25

Abstract: Wandering spleen, a rare entity, is caused by the absence or laxity of the normal anchoring splenic ligaments. Only three neonatal cases have been reported in the English-language literature. We present the clinical and multimodality imaging findings of a newborn with laceration and hemorrhage of a wandering spleen. The course was complicated by the concurrent diagnosis of glucose-6-phosphate dehydrogenase deficiency, which confused the clinical picture when a falling hematocrit raised the question of rebleeding several days after presentation.

Pictorial essay: multimodality imaging of metastases from pancreatic ductal adenocarcinoma - Corrected Proof

2009-09-17

Abstract: Surgical resection is the only curative therapy available for pancreatic ductal adenocarcinoma. Unfortunately, metastatic disease constitutes an absolute contraindication for surgery. Therefore, the detection of metastatic disease is a critical component of preoperative imaging of pancreatic adenocarcinoma. Computed tomography and magnetic resonance imaging are currently used for the preoperative evaluation of these patients. Positron emission tomography/computed tomography and ultrasonography may also be helpful in the detection of metastatic disease. This pictorial essay reviews the imaging findings of common and uncommon metastases from pancreatic adenocarcinoma.

CT-guided liver biopsy: correlation of procedure time and radiation dose with patient size, weight, and lesion volume and depth - Corrected Proof

Jianhai Li, Unni K. Udayasankar, John Carew, William C. Small — 2009-09-14

Abstract: Purpose: The purpose of this study was to retrospectively evaluate the effect of various factors, including overall patient size, weight, and individual lesion characteristics, on the radiation dose and procedure time required to successfully perform computed tomography (CT)-guided liver lesion biopsies.Materials and Methods: This Institutional-Review-Board-approved study included 209 patients (average age, 59 years; range, 19–86 years; 105 males, 104 females) who underwent CT-guided liver lesion biopsy on a four-slice multidetector row CT scanner (LightSpeed Qx/i; GE Healthcare, Milwaukee, WI). Medical records and images were retrospectively reviewed to obtain the following data: (a) patient weight, (b) patient size, (c) lesion volume, (d) lesion depth, (e) CT dose index (CTDI) and effective radiation dose, and (f) procedure time. Statistical analysis was performed with multiple linear regression to assess the effect of various parameters on radiation dose and procedure time.Results: CTDI was significantly correlated with patient weight (P<.01), size (P=.03), and lesion volume (P<.01). The total effective radiation dose was significantly correlated with patient size (P<.01) and lesion depth (P<.01). Total procedure time was significantly correlated with lesion volume (P<.01) and depth (P<.01). There was a positive correlation between procedure time and effective radiation dose (r2=.57).Conclusion: In the current study, CT-guided liver lesion biopsy patient radiation dose was associated with both overall patient-specific features (weight and size) and specific lesion characteristics; however, the procedure duration was determined by lesion characteristics (lesion volume and depth) alone.

Burn injury by nuclear magnetic resonance imaging - Corrected Proof

Ernst G. Eising, Justin Hughes, Frank Nolte, Walter Jentzen, Andreas Bockisch — 2009-08-28

Abstract: Nuclear magnetic resonance imaging has become a standard diagnostic procedure in clinical medicine and is well known to have hazards for patients with pacemaker or metallic foreign bodies. Compared to CT, the frequency of MRI examinations is increasing due to the missing exposure of the patients by X-rays. Furthermore, high-field magnetic resonance tomograph (MRT) with 3 T has entered clinical practice, and 7-T systems are installed in multiple scientific institutions. On the other hand, the possibility of burn injuries has been reported only in very few cases.Based on a clinical finding of a burn injury in a 31-year-old male patient during a routine MRI of the lumbar spine with standard protocol, the MR scanner was checked and the examination was simulated in an animal model.The patient received a third-degree burn injury of the skin of the right hand and pelvis in a small region of skin contact. The subsequent control of the MRI scanner indicated no abnormal values for radiofrequency (RF) and power. In the subsequent animal experiment, comparable injuries could only be obtained by high RF power in a microwave stove.It is concluded that ‘tissue loops’ resulting from a contact between hand and pelvis must be avoided. With regard to forensic aspects, the need to inform patients of such a minimal risk can be avoided if the patients are adequately positioned using an isolating material between the hands and pelvis. These facts must be emphasized more in the future, if high-field MRI with stronger RF gradients is available in routine imaging.

Computed tomographic peritoneography prior to intraperitoneal chemotherapy in advanced müllerian cancer: a pilot study - Corrected Proof

2009-08-12

Abstract: Objective: The objective of this study was to utilize computed tomographic peritoneography (CTP) to assess distribution prior to intraperitoneal chemotherapy for advanced müllerian cancer.Methods: Nineteen patients were submitted to CTP. A novel 6-point peritoneal distribution index was developed and applied to the patients prospectively.Results: The median peritoneal distribution index was 6 (range, 4–6). The most common region for incomplete peritoneal distribution correlated to the right subphrenic space.Conclusion: Further studies are needed to determine the impact of inadequate distribution on recurrence and survival.

Determination of accurate stent graft configuration in abdominal aortic aneurysm using computed tomography: a preliminary study - Corrected Proof

2009-07-23

Abstract: An aortic stent graft is frequently used to cure an abdominal aortic aneurysm (AAA). It is critical to accurately fit the size and shape of the stent graft to the target region on the aorta. Proper sizing and shaping require the measurement of the orthogonal diameter of the target region from medical images. The present study aimed to acquire an accurate three-dimensional (3D) reconstruction of the aorta to determine the shape of the cross-sectional area where the stent graft would be implanted. A conventional geometric-active contour model was enhanced to prevent blurring and to improve edge detection with high noise resistivity. After the segmentation of two-dimensional (2D) images using the model, a 3D-reconstructed configuration of the aorta was achieved using a surface-rendering technique. The model could segment several selected synthetic images more accurately than conventional methods. Also, a 3D-reconstructed configuration of the abdominal aorta could be achieved using boundary coordinates extracted from 2D image segmentation. This preliminary study indicates the utility of the approach in optimizing stent graft configuration for AAA patients, thus enhancing stent graft healing.

Can plasma D-dimer predict the result of a ventilation–perfusion scan? - Corrected Proof

Thomas Grüning, Mehrdad Khonsari, Gillian C. Vivian, Tim Nokes — 2009-07-10

Abstract: The use of plasma D-dimer assay has been advocated for the exclusion of pulmonary embolism. We retrospectively looked at 840 patients in whom both ventilation–perfusion scan and D-dimer assay were performed within 48 h. The negative predictive value of a negative D-dimer assay was 96% for emergency admissions and 98% for inpatients. We present the cases of two patients with negative D-dimer assay results who had a high-probability lung scan, and we have found a further three patients with negative D-dimer assay results who had an intermediate-probability lung scan.

Assessment of COPD severity by computed tomography: correlation with lung functional testing - Corrected Proof

2009-07-10

Abstract: CT scans of 474 patients with suspected chronic obstructive pulmonary disease (COPD) were retrospectively evaluated by automated software. There was a correlation between the total lung capacity (TLC) and the total lung volume (TLV) (r=.675, P<.001), between the TLC and the total emphysema volume (r=.571, P<.001), as well as between the TLC and the emphysema index (r=.532, P<.001), respectively. The correlation between the TLC and the TLV was dependent on the COPD severity according to the Global Initiative for Chronic Obstructive Lung Disease classification (χ2=6.3079, P=.043). The TLC allows a prediction of clinical illness severity.

CT features of intrapulmonary lymph nodes confirmed by cytology - Corrected Proof

2009-07-10

Abstract: We retrospectively assessed the computed tomography features of intrapulmonary lymph nodes confirmed by cytology in 18 patients. The median size of the lymph nodes was 5.8 mm (range=3.3–8.5 mm). All were below the carina, and only one nodule, which was associated with an interlobar fissure, was over 20 mm from the chest wall. The nodules were oval, round, triangular, or trapezoidal; had sharply defined borders; were solid and homogenous; and were without calcification. Six nodules (33.3%) had a discrete thin tag extending to the pleura. Intrapulmonary lymph nodes can reliably be confirmed by fine needle aspiration with cytological diagnosis.