Clinical Imaging - Articles in Press

Malignant lesions on mammography: accuracy of two different computer-aided detection systems - Corrected Proof

2012-05-21

Abstract: We retrospectively compared the accuracy of two computer-aided detection (CAD) systems for the detection of malignant breast lesions on full-field digital mammograms. Mammograms of 326 patients were analyzed (117 patients with breast cancer, 209 negative cases), and each set of cases was read by two CAD systems (Second Look versus AccuDetect Galileo). True-positive fractions per image and case for soft densities, microcalcifications, and total cancers were assessed. Study results showed better overall performance of AccuDetect Galileo (when compared to Second Look) in detecting masses, microcalcifications, and all cancer types, especially in extremely dense breast parenchyma.

Malignant primary chest wall neoplasms: a pictorial review of imaging findings - Corrected Proof

2012-05-16

Abstract: Malignant primary chest wall neoplasms (MCWN) are uncommon. Although benign chest wall neoplasms are most commonly asymptomatic, MCWN typically manifest as painful, fast growing masses. While the imaging features of malignant masses can be nonspecific, knowledge of the typical radiologic manifestations of MCWN may suggest a specific diagnosis. We review imaging features of the most common MCWN with images collected at an outpatient academic oncologic center.Objective: While the imaging features of patients with malignant masses can be nonspecific, knowledge of the typical radiologic manifestations of MCWN may suggest a specific diagnosis. We review distinguishing imaging features of the most common MCWN, including epithelial and mesenchymal malignancies, with images collected at an outpatient oncologic center.Conclusion: Chest wall neoplasms encompass 5% of all thoracic tumors, with nearly half of chest wall neoplasms being malignant. Out of these malignant neoplasms, 50% are primary and the commonest one is chondrosarcoma. Although distinguishing imaging features may suggest a specific diagnosis in the majority of MCWN, most affected patients undergo biopsy for a definitive diagnosis.

Signal intensity of decussation of the superior cerebellar peduncle on sagittal T1WI: correlation with age and gender - Corrected Proof

Deting Ma, Cheng Liu, Qingkui Kong, Yuanzhong Xie, Xuzhu Chen — 2012-05-10

Abstract: Purpose: Decussation of the superior cerebellar peduncle (DSCP) usually shows low signal intensity (SI) on midsagittal T1-weighted imaging (T1WI) in neurologically normal brain. However, the SI change of DSCP with age and gender is not identified. This study aimed to investigate the relationship between SI of the DSCP and age and gender in healthy subjects.Materials and methods: Spin-echo (SE) midsagittal T1WI of 120 neurologically normal subjects (52 men, 68 women; age range: 4–64 years, mean age: 31 years) were evaluated retrospectively. Contrast-to-noise ratio (CNR) of the DSCP compared with that of the superior midbrain was calculated. One-way analysis of variance and bivariate correlation analysis were performed to evaluate the effects of gender and age.Results: The CNR was significantly lower in the DSCP than in the superior midbrain (P<.001). The CNR of DSCP was not correlated with gender (P=.118) and age (P=.764).Conclusion: The low SI of DSCP on midsagittal T1WI showed no correlation with gender or age in healthy subjects.

Comparison of strain ratio with elastography score system in differentiating malignant from benign thyroid nodules - Corrected Proof

Hui Wang, Douglas Brylka, Li-Na Sun, Yuan-Qiang Lin, Guo-Qing Sui, Jing Gao — 2012-05-10

Abstract: Background: To prospectively compare strain ratio to elastography score system in distinguishing between malignant and benign thyroid nodules.Methods: The local institutional review board approved the study, and all patients provided written informed consent. We examined 168 thyroid nodules (52 malignant and 116 benign) with freehand elastography. The elastogram was performed with both the five-degree elastography score system and thyroid tissue-to-nodule strain ratio before core biopsies as standard reference. The area under the curve (AUC) and the best cut-off point were both obtained using receiver-operating characteristic (ROC) curve analysis. The sensitivity, specificity, and accuracy of both techniques were compared with the χ2 test. Furthermore, strain ratio distribution was also compared with histopathological result. P .05).Conclusion: Strain ratio is more specific than conventional elastography score system in differentiating malignant from benign thyroid nodules.

Management of cervical cancer detected during pregnancy: role of magnetic resonance imaging - Corrected Proof

2012-05-10

Abstract: Objective: The aims of the present study were to assess the role of magnetic resonance imaging (MRI) in the staging and follow-up of uterine cervical cancers discovered during pregnancy and to evaluate the role of MRI in decision making regarding treatment options for patients with uterine cervical cancer during pregnancy.Method: Twelve pregnant women with cervical cancer were included. Two populations of patients were distinguished: localized cervical cancer discovered on the Pap smear during the first trimester of pregnancy, at an early stage (n=5), and invasive cervical cancer revealed later, during the second or third trimester (n=7). Abdominal and pelvic MRI sequences were acquired with a phased-array coil. Magnetic resonance results were correlated with the physical examination, Pap smear, and pathology.Results: In the first population, MRI was normal or detected a small lesion (stage IB1), and pregnancies were allowed to continue. In the second population, MRI detected a lesion in every case (mean size, 62 mm; 30–110 mm), and positive lymph nodes were depicted in 2 cases. The pregnancy was interrupted in four patients: one interruption in localized cervical cancer group and three in invasive cervical group). In all other cases, a cesarean section was done after the 30th week. In one case, MRI assessed response after chemotherapy administered during pregnancy.Conclusion: MRI is an essential examination for planning the treatment of cervical cancers diagnosed during pregnancy.

Organizing hematoma mimicking brain tumor - Corrected Proof

Ahmet Turan Ilica, Fausto Rodrigues, Fernando Maluf, Nafi Aygun — 2012-05-10

Abstract: A 64-year-old man was referred to our hospital with progressive loss of function in his right upper and lower extremities. Unenhanced computed tomographic showed a high-density nodular lesion in the left basal ganglion with surrounding hypoattenuation. Brain magnetic resonance imaging demonstrated a predominantly cystic mass with multiple internal septa and an eccentric solid component showing enhancement. Histological examination revealed organizing blood clot and piloid gliosis. This unusual appearance of a mass-like organizing blood clot should be considered in the differential diagnosis when an encapsulated cystic mass with nodular component following the signal characteristics of old blood on MRI is encountered.

Rotator cuff tears: association with acromion angulation on MRI - Corrected Proof

Joseph C. McGinley, Sundeep Agrawal, Sandip Biswal — 2012-05-10

Abstract: Objective: Using magnetic resonance imaging (MRI), evaluate the correlation of acromion angulation with thickening of the coracoacromial ligament (CAL) and narrowing of the subacromial space resulting in impingement upon the rotator cuff tendons.Materials and methods: Eighty-nine shoulder MRI studies performed on a 3T scanner were retrospectively analyzed by two blinded independent reviewers. Measurements of the acromion angle (delta angle), CAL thickness and distance between the CAL and humeral head were obtained. The data were categorized into two groups, delta angle less that and greater than 7.5°. The presence or absence of full thickness (FT) or near full thickness (NFT) rotator cuff tears was noted.Results: In group 1, the acromion angle varied from -6.8 to 6.8° (1.7±3.5°) with a CAL thickness of 0.91±0.20 mm and a subacromial distance of 6.47±0.88 mm. Group 2 acromion angle varied from 7.6° to 46.8° (18.0°±8.1°) with a CAL of 1.77±0.51 mm and a subacromial distance of 4.52±0.82 mm. The difference in CAL thickness and subacromial distance were significantly different between the two groups (P<.001). In Group 1, 3 out of 51 patients had a FT or NFT tear of the rotator cuff compared to 20 out of 38 in Group 2 (P<.001). There was no significant interobserver variability.Conclusion: Steep acromion angulation is associated with CAL thickening and narrowing of the subacromial space. Patients with a steep acromion angle had a statistically increased incidence of rotator cuff tears.

Retroperitoneal mature cystic teratoma arising from intra-abdominal undescended testis in an adult - Corrected Proof

Huseyin Toprak, Musa Atay, Issam Cheikh Ahmad, Ercan Kocakoc — 2012-05-10

Abstract: Teratomas are a type of germ-cell tumour which may contain embryological tissues from more than one germ-cell layer, usually occurring in the gonads. Primary retroperitoneal teratomas account for 1–11% of retroperitoneal neoplasms and are most commonly found in neonates and young adults. In the clinical literature, retroperitoneal mature cystic teratoma arising from an intra-abdominal undescended testis in adult males has been very rarely reported. We report a case of surgically proven retroperitoneal mature cystic teratoma arising from an intra-abdominal undescended testis in an adult male by multislice helical computed tomography and magnetic resonance imaging.

Lumbar vertebral chordoma: diffusion-weighted imaging findings are helpful to narrow the differential diagnosis. A case report - Corrected Proof

2012-05-07

Abstract: Solitary vertebral chordoma presents as an intra- and extraosseous tumour with typical bright signal on T2-weighted images and moderate inhomogeneous enhancement on T1 postcontrast images. The diffusion weighted imaging (DWI) characteristics of this histologically proven third lumbar vertebra chordoma are reported for the first time. The DWI hyperintensity with increased apparent diffusion coefficient (ADC) values strongly supports the preoperative diagnosis of a vertebral chordoma, allows for careful preoperative planning of the surgical procedure, and helps to narrow the differential diagnosis.

Evaluation of symptomatic uterine fibroids in candidates for uterine artery embolization: comparison between ultrasonographic and MR imaging findings in 68 consecutive patients - Corrected Proof

2012-05-07

Abstract: Ultrasonographic and magnetic resonance (MR) imaging examinations of 68 women with uterine fibroids were reviewed to determine whether MR imaging may alter the therapeutic approach based on ultrasonography alone before uterine embolization. Therapeutic decisions based on ultrasonography alone were compared to those obtained after MR imaging. Discordant findings between both examinations involved 51 women (75%), and 19 (28%) had their therapeutic approaches based on ultrasonography alone altered by MR imaging. Ultrasonography and MR imaging showed concordant findings in 17 women (25%) for whom no changes in therapeutic option were made. MR imaging alters the therapeutic approach based on ultrasonography alone in 28% of candidates for uterine artery embolization.

Magnetic resonance enterography and wireless capsule endoscopy in the evaluation of patients with inflammatory bowel disease - Corrected Proof

2012-05-07

Abstract: Background: Magnetic resonance enterography (MRE) is increasingly used in children due to growing concerns of radiation.Objective: To determine the performance of MRE, imaging findings were compared to wireless capsule endoscopy (WCE) and histology results in children with/or suspected inflammatory bowel disease (IBD).Materials and methods: Pathology and WCE reports were retrospectively reviewed in 23 patients who had MRE.Results: The sensitivity of MRE was 75.0% while the sensitivity of WCE was 77.8%.Conclusion: MRE and WCE are complementary techniques in evaluation of the small bowel in IBD.

A case of paradoxical air embolism in the coronary artery through a patent foramen ovale demonstrated by coronary CT angiography - Corrected Proof

Hwa Yeon Lee, Seung Min Yoo — 2012-05-07

Abstract: We present a case of paradoxical air embolism (PAE) in the distal right coronary artery identified by coronary CT angiography. The underlying cause of PAE in the distal right coronary artery was a patent foramen ovale because the typical CT findings of a patent foramen ovale (i.e., combination of findings of the presence of a slit-like contrast column in the interatrial septum and a contrast jet through the septum) were identified by coronary CT angiography.

Diagnosis of focal liver lesions suspected of metastases by diffusion-weighted imaging (DWI): systematic comparison favors free-breathing technique - Corrected Proof

2012-05-03

Abstract: Two echo planar imaging diffusion-weighted imaging (DWI) techniques [one breath hold (DWIbh), repetition time/echo time (TR/TE) 2100/62 ms; one at free breathing (DWIfb), TR/TE 2000/65 ms] were compared regarding diagnosis of focal liver lesions (FLLs) in 45 patients with suspected liver metastasis without prior treatment. Apparent diffusion coefficient values of 46 benign and 67 malignant FLLs were analyzed by receiver operating characteristics (ROC) analysis. DWIfb detected more malignant lesions than DWIbh (P=.002). Lesion size ≤10 mm was associated with FLLs missed by DWIbh (P=.018). Area under the ROC curve of DWIfb (0.801) was higher compared to that of DWIbh (0.669, P<.0113), demonstrating the diagnostic superiority of DWIfb.

Preoperative evaluation of perinephric fat invasion in patients with renal cell carcinoma: correlation with pathological findings - Corrected Proof

2012-05-03

Abstract: The purpose of this study was to evaluate the role of computed tomography (CT) and magnetic resonance imaging (MRI) scans in predicting perinephric fat invasion. Preoperative CT and MRI scans of 109 patients were assessed retrospectively by two radiologists focusing on perinephric fat invasion. Findings were correlated with histopathology. Perinephric fat involvement on imaging was reported in 55 cases, and postoperative pathology record confirmed it in 32 patients. The sensitivity, specificity, positive predictive value, and negative predictive value were 82%, 63%, 48%, and 89%, respectively, with a P value of .001. To conclude, cross-sectional imaging techniques can reliably predict perinephric fat invasion in renal carcinomas preoperatively.

How to do it: ultrasound-guided fine-needle aspiration of thyroid nodules that commonly result in inappropriate cytology - Corrected Proof

Dong Wook Kim — 2012-05-03

Abstract: Ultrasound (US)-guided fine-needle aspiration (US-FNA) is widely used for the diagnosis of thyroid nodules and other neck masses, and it is now considered the most simple, safe, accurate, and minimally invasive procedure for this purpose. The aim of this article was to present US-FNA for thyroid nodules with difficult or unusual sampling conditions. A better understanding of a wide range of US-FNA techniques will be helpful to the practicing and experienced doctors for diagnosing thyroid nodules or neck masses that are difficult to sample accurately.

Cystic abdominal masses in children: a pictorial essay - Corrected Proof

Mehmet Ruhi Onur, Unal Bakal, Ercan Kocakoc, Tugay Tartar, Ahmet Kazez — 2012-05-03

Abstract: Cystic abdominal masses in children are not an infrequently encountered condition of childhood. These lesions usually present with large size and mimick each other with similar presenting symptoms. Imaging examinations have an important role to determine the type of the cystic abdominal masses, which is crucial for management of patients and presurgical planning. In this pictorial essay, we summarized the imaging features of common cystic abdominal masses of children, including cystic lesions arising from liver, biliary ducts, kidney, pancreas, bowel, ovary, mesentery, and miscellaneous tissues.

Imaging findings of atypical mycobacterial infection in the temporal bone - Corrected Proof

Sandrine Yazbek, Amit Aggarwal, David M. Simpson, Peter M. Som — 2012-04-30

Abstract: Atypical mycobacterial (AM) infection of the temporal bone is rare, and its early diagnosis is critical for a good patient outcome. The imaging findings of AM infection have been only briefly reported. We present the computed tomographic and magnetic resonance findings of AM involvement of the entire temporal bone in an immunocompromised patient, and we discuss the differential diagnosis. The scattered areas of both bone sclerosis and erosion may help the radiologist suggest the diagnosis of an indolent process such as tuberculosis or AM and allow initiation of early treatment.

In vivo cell tracking via 18F-fluorodeoxyglucose labeling: a review of the preclinical and clinical applications in cell-based diagnosis and therapy - Corrected Proof

2012-04-30

Abstract: The rising interest in using functional cells for diagnosis and treatment has created an urgent need for in vivo cell-tracking techniques. Certain advanced techniques, such as those involving reporter genes or nanoparticles, are still awaiting confirmation of their safety and feasibility in human patients. Tracking cells by labeling them with 18F-fluorodeoxyglucose, a tracer clinically used in positron emission tomography (PET), may be one way to rapidly translate some of these principles from bench to bedside. The preliminary results are exciting, although further development, optimization, and validation are required. Here, several applications of the technique are surveyed: finding inflammatory foci, targeting cancer immunotherapies, tracking transplanted islet cells, and monitoring cardiac stem cells. Advantages, limitations, and prospects of the technique are discussed. These early experiences only highlight the existing need to improve cell-labeling techniques using PET tracers. This method may finally lead to the development of effective and convenient methods for clinical cell-tracking techniques involving PET/computed tomography.

Polyorchidism: color Doppler ultrasonography and magnetic resonance imaging findings - Corrected Proof

Atilla Arslanoglu, Sedat Alparslan Tuncel, Mehmet Hamarat — 2012-04-30

Abstract: Polyorchidism, the presence of more than two testes, is a very rare anomaly. We report the color Doppler ultrasonography and magnetic resonance imaging findings of the case of a 20-year-old man with polyorchidism, presenting with an asymptomatic scrotal mass. Ultrasonography showed double testes with double separate epididymides sharing a common vas deferens in the left side of the scrotum. The double testes demonstrated similar echo texture and vascular flow as the normal testis, but smaller in size. Magnetic resonance imaging showed three testes very clearly and confirmed the diagnoses. After 2 years of follow-up, he was managed with surgical intervention. Pathology report revealed polyorchidism.

Thymic cyst arising in the middle mediastinum posterior to the left atrium—a peculiar location - Corrected Proof

Lyndon Luk, Pierre D. Maldjian, Abhishek Kumar, Stephen Peters — 2012-04-25

Abstract: While masses of thymic origin are commonly located within the anterior mediastinum, abnormal migration of thymic tissue during development can result in thymic lesions in other intrathoracic locations. Ectopic thymic lesions in the middle mediastinum are extremely rare. We present a case of a calcified thymic cyst located posterior to the left atrium entirely within the caudal aspect of the middle mediastinum, a location not previously reported.

The discovery of a Persian family with a form of Birt–Hogg–Dubé syndrome lacking the typical cutaneous stigmata of the syndrome - Corrected Proof

2012-04-25

Abstract: Purpose: This study was performed in 24 members of a family with spontaneous pneumothorax to test clinical suspicion of Birt–Hogg–Dubé syndrome (BHDS).Methods: Computed tomography scan was performed for confirmation of pneumothorax, while genetic tests were done using real-time quantitative polymerase chain reaction.Results: Genetic studies showed a deletion of exon 1 in the FLCN gene in the index case as well as nine other individuals, including two with clinical phenotypes of pneumothorax and seven who are symptom-free to date.Conclusions: Proper imaging and taking accurate family history could be the keys to test clinical suspicion in some syndromes, including BHDS.

Thoraco-omphalopagus conjoined twins: impact of ultrasound assessment on successful surgical separation - Corrected Proof

2012-04-25

Abstract: In this case report, we present a case of thoraco-omphalopagus conjoined twins who were successfully separated and had long-term survival. We performed ultrasound assessment and found that the twins shared the liver and that the fusion site of their liver had gross communication of blood vessel. Ultrasound cardiogram examination showed that the anomalous vessels that connected their hearts drained from the number 1 infant to the number 2 infant. The ultrasound assessment has significant impact on the successful surgical separation of the thoraco-omphalopagus twins.

Can MRI predict the clinical instability and loss of the screw home phenomenon following ACL tear? - Corrected Proof

2012-04-20

Abstract: Our purpose was to determine the relationship between tibiofemoral translation on magnetic resonance imaging and clinical instability of the knee following anterior cruciate ligament (ACL) injury. Within 66 patients (43 males, 23 females, mean age 30.25 years), 15 of 19 patients (80%) with an intact ACL had a demonstrable normal screw home movement, while 24 of 47 patients (51%) with an ACL tear had absence of the screw home movement. Patients with clinical instability had greater tibial translation and excursion at the lateral compartment (P=.0001). Following ACL injury, there is demonstrable absence of the normal screw-home movement with anterior tibial translation and excursion related to presence of clinical instability.

Power Doppler ultrasonography for assessment of rheumatoid synovitis: comparison with dynamic magnetic resonance imaging - Corrected Proof

2012-04-11

Abstract: Purpose: The aim of this study was to compare the effectiveness of power Doppler ultrasonography (PDUS) with that of dynamic magnetic resonance imaging (MRI) for detecting active synovitis in the hands of rheumatoid arthritis (RA) patients.Materials and Methods: PDUS and dynamic MRI were performed for a total of 220 finger joints with active RA. Each synovial blood flow by PDUS and dynamic MRI was measured and categorized into four grades.Results: Taking dynamic MRI as a reference, PDUS showed a sensitivity of 94%, a specificity of 95%, and an accuracy of 95%.Conclusion: PDUS is useful for detection of active synovitis in the overall-grade RA patients.

MRI perfusion in determining pseudoprogression in patients with glioblastoma - Corrected Proof

2012-04-11

Abstract: We examine the role of dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) perfusion in differentiating pseudoprogression from progression in 20 consecutive patients with treated glioblastoma. MRI perfusion was performed, and relative cerebral blood volume (rCBV), relative peak height (rPH), and percent signal recovery (PSR) were measured. Pseudoprogression demonstrated lower median rCBV (P=.009) and rPH (P<.001), and higher PSR (P=.039) than progression. DSC MRI perfusion successfully identified pseudoprogression in patients who did not require a change in treatment despite radiographic worsening following chemoradiotherapy.

Detection of axillary node metastasis using diffusion-weighted MRI in breast cancer - Corrected Proof

2012-04-05

Abstract: Breast magnetic resonance imagings (MRIs) including diffusion-weighted MRI (DWI) of 110 breast cancers (26 with pathologically proven axillary node metastasis and 84 without metastasis) were retrospectively studied. Axillary nodes were detected as high-signal-intensity areas on DWI in 71 cancers (24 with metastasis and 47 without) and not detected in 39 cancers (2 with metastasis and 37 without). The ADC of metastatic nodes was significantly greater than that of the benign ones (1.08±0.18×10−3 mm2/s vs. 0.92±0.22×10−3 mm2/s, P=.004). When detectability of axillary nodes on DWI and ADC over 1.05×10−3 mm2/s was applied as a threshold, 53.8% sensitivity, 86.9% specificity, and 79.1% accuracy were provided.

Diffusion-weighted whole-body imaging with background body signal suppression in Castleman disease - Corrected Proof

Georges Khalil, Dany Gaspard, Mario Jreige, Georges Nawfal — 2012-04-05

Abstract: Castleman's disease (CD) is a rare lymphoproliferative disease characterized by angiofollicular lymph node hyperplasia. The case of a 74-year-old man with multicentric CD of the plasma cell type is described. The imaging findings on diffusion-weighted whole-body imaging with background body signal suppression at diagnosis and after treatment are reported.

Attenuation of hepatic fibrosis through ultrasound-microbubble-mediated HGF gene transfer in rats - Corrected Proof

2012-04-05

Abstract: Objective: The objective was to explore the feasibility of ultrasound-microbubble-mediated hepatocyte growth factor (HGF) gene transfer for treating rat hepatic fibrosis induced by CCl4.Methods: Forty-eight male SD rats were divided into ultrasound-microbubble-HGF group (U-M-HGF group), ultrasound-HGF group (U-HGF group), microbubble-HGF group (M-HGF group), HGF group (HGF group), CCl4 group (control group), and normal group. The serum levels of alanine transaminase (ALT), aspartate transaminase (AST), total protein, albumin (ALB), and globulin (GLB) and the ratio of ALB/GLB were determined after treatment. The degree of hepatic fibrosis was evaluated by histopathological numerical scores. The protein expressions of HGF, collagen I, collagen III, and α-smooth muscle antibody (α-SMA) were detected by immunohistochemistry.Results: Ultrasound-microbubble-mediated HGF therapy significantly reduced the serum level of ALT and AST to 59.88% and 49.18% of the control group, respectively. Ultrasound-microbubble-mediated HGF therapy prevented liver fibrosis, with an obvious decrease in fibrosis areas and extracellular matrix production of collagen I, collagen III, and α-SMA. The gene therapy could induce HGF delivery into the fibrotic liver effectively.Conclusions: Ultrasound-microbubble-mediated HGF gene therapy can reduce liver fibrosis, which provides a novel strategy for gene therapy of chronic liver disease.

Isolated interrupted aortic arch accompanied by type B aortic dissection and extensive collateral arteries diagnosed with MDCT angiography - Corrected Proof

Li-Qing Peng, Zhi-Gang Yang, Jian-Qun Yu, Long Zhao, Sudarshan Kushwaha — 2012-03-29

Abstract: Interrupted aortic arch (IAA) is a rare congenital cardiovascular condition. A patient with uncorrected IAA accompanied by rich collateral arteries can survive to adulthood asymptomatically. However, IAA complicated by aortic dissection is life threatening. Herein, we report a rare case of an isolated IAA accompanied by type B aortic dissection and extensive collateral arteries detected by multidetector computed tomography in a 38-year-old man. The imaging findings of the case are presented, and the utility of multidetector computed tomography in the evaluation of this condition is discussed.

Role of perfusion CT in differentiating between various cerebral masses using normalized permeability surface area product and cerebral blood volume - Corrected Proof

Youn-Joo Lee, Kook-Jin Ahn, Bum-Soo Kim, Won-Jong Yoo — 2012-03-29

Abstract: Objective: The objective was to assess usefulness of a combined analysis using the perfusion computed tomography parameters permeability surface area product (PS) and cerebral blood volume (CBV) in the differential grouping of various cerebral masses.Methods: Thirty patients who had a cerebral mass, confirmed by pathologic verification, were included. We classified PS and CBV results for various cerebral masses by visual as well as semiquantitative assessment. To verify statistically significant differences between the groups, one-way analysis of variance was performed.Results: Patients were categorized into five groups with statistically significant differences (P<.01).Conclusions: PS and CBV were useful in the differential diagnosis of cerebral masses.

A case of atypical fibroxanthoma of subungual type: ultrasound and magnetic resonance imaging findings - Corrected Proof

Seunghun Lee, Kyung Bin Joo, Chan-Keum Park, Tae-Seung Kim, Jiyoon Bae — 2012-03-29

Abstract: Subungual atypical fibroxanthoma is a rare mesenchymal skin tumor of intermediate malignancy. It classically presents as a relatively nondescript, erythematous nodule; it may ulcerate and bleed, but pain and pruritus are uncommon. In the differential diagnoses of subungual tumors, glomus tumor, soft tissue chondroma, keratoacanthoma, hemangioma, lobular capillary hemangioma, epidermal and mucoid cysts, squamous cell carcinoma, and malignant melanoma have been suggested. But atypical fibroxanthoma has not been included in the differential diagnoses. We report a case that occurred in a 56-year-old man with subungual atypical fibroxanthoma mimicking malignant soft tissue tumor in the right fifth toe.

Parathyroid adenoma screening efficacies of different imaging tools and factors affecting the success rates - Corrected Proof

2012-03-29

Abstract: Purpose: We aimed to compare the efficacy of three different parathyroid adenoma screening tools—high-resolution ultrasonography (USG), technetium Tc 99m-methoxyisobutylisonitrile (MIBI) parathyroid scintigraphy, and magnetic resonance imaging (MRI)—and we evaluated the factors affecting the detection success rates.Methods: Parathyroid imaging was evaluated by USG, double-phase 99mTc-MIBI parathyroid scintigraphy, and cervical MRI in patients with hyperparathyroidism (n=39).Results: Among the 39 patients, USG, parathyroid scintigraphy, and MRI correctly identified 35 adenomas (89.7%), 28 adenomas (71.8%), and 26 adenomas (66.7%), respectively. Positive predictive values for USG (34/35), scintigraphy (27/28), and cervical MR (26/26) imaging were 97.1%, 96%, and 100%, respectively. Parathyroid adenomas were detected with 92.3% (36/39) certainty when both USG and scintigraphy modalities were applied together. Minimally invasive parathyroidectomy under local anesthesia with unilateral incision was successfully performed in 24 (61.5%) patients.Conclusions: Minimally invasive surgery for parathyroid adenomas has been developed and has equal success with traditional surgery. However, accurate localization of adenomas should be obtained prior to surgery. In this study, ultrasound was found to be effective in localizing adenomas for successful surgery. Adding other imaging modalities does not improve localizing the parathyroid adenomas.

Computer-aided detection of lung nodules by SVM based on 3D matrix patterns - Corrected Proof

Qingzhu Wang, Wenwei Kang, Chunming Wu, Bin Wang — 2012-03-29

Abstract: Objective: The objective was to prevent loss of some implicit structural and local contextual information of lung nodules by current one- (1D) or two-dimensional (2D) schemes.Materials and methods: The testing data set used in this study consisted of computed tomographic scans from 196 different patients in Jilin Tumor Hospital, which consisted of 8428 sections including 108 nodules. By the proposed support vector machine based on three dimensional matrix patterns (SVM3Dmatrix) which improves the classifier of SVM, 3D volume of interest of suspected lung nodules can be used directly as the training samples. The 3D scheme may effectively reduce the large numbers of false positives (FPs) by current 1D and 2D schemes.Result: Five computer-aided diagnosis (CAD) schemes were investigated for the same 196-case database. SVM3Dmatrix achieved a 98.2% overall sensitivity with 9.1 FPs per section, which was in general superior compared to the other four CAD schemes for our application.

Follow-up examination of 12 heart transplant recipients with cardiac CT - Corrected Proof

Duan Shaoyin, Yin Yongmei, Sui Tong, Cai Guoxiang, Liao Chongxian — 2012-03-29

Abstract: Objective: The aims of this study were to observe the changes of a transplanted heart with cardiac computed tomography (CT) and to evaluate the clinical application of the examination.Methods: Cardiac CT was performed on 12 heart transplant recipients, of which 4 cases were also examined by echocardiography. Coronary arteries, the cardiac chamber, and the wall were shown with three-dimensional imaging techniques, and their changes were analyzed and discussed.Results: Twelve heart transplant recipients were successfully examined by CT. All transplanted hearts were found with good anastomosis at the great vessels and atria. Coronary allograft vasculopathy was found in 7 cases, of which 4 cases were found with ventricular dilation or ventricular septum thickening and 1 with tricuspid regurgitation. Ventricular dilation was found in other 3 cases, of which 1 was found with ventricular septum thickening and 1 with tricuspid regurgitation. No abnormality was found by cardiac CT in the rest 2 cases, which were found with mitral regurgitation by echocardiography.Conclusion: Cardiac CT can clearly and directly display the changes in the shape of a transplanted heart and coronary artery abnormalities. It will become an ideal noninvasive follow-up method for the heart transplant recipients.

Primary spinal chondrosarcoma: radiological manifestations with histopathological correlation in eight patients and literature review - Corrected Proof

Guobing Liu, Guangyao Wu, Prasanna Ghimire, Haopeng Pang, Zaipeng Zhang — 2012-03-29

Abstract: Purpose: The aim of this study was to delineate radiological–pathological correlation in primary vertebral chondrosarcoma.Methods: Eight histopathologically confirmed cases were analyzed for pathological and radiological characteristics.Results: Magnetic resonance images of three conventional and one clear cell cases showed lobulated or irregular masses with line or septa enhancement. Two conventional lesions showed signal intensity of high water content on T2-weighted images, in which aneurismal bone cysts were confirmed. The myxoid lesion showed a relatively diffuse signal and enhancement. Marked masses were found in the two mesenchymal patients, either dumbbell-like or round-like.Conclusion: Primary spinal chondrosarcomas have certain radiological findings that may correlate to the pathological subtypes.

Extracranial skeletal Langerhans cell histiocytosis: MR imaging features according to the radiologic evolutional phases - Corrected Proof

2012-03-19

Abstract: Purpose: The purpose was to describe the magnetic resonance (MR) findings of extracranial skeletal Langerhans cell histiocytosis according to the radiologic evolutional phases.Materials and methods: Twenty-two patients with pathologically confirmed extracranial skeletal Langerhans cell histiocytosis were included. The lesions were classified as early, mid, and late phases according to the radiologic evolutional phases. MR images were retrospectively analyzed regarding signal intensity, internal hypointense band, fluid levels, periosteal reaction, adjacent bone marrow and soft tissue abnormal signal, and patterns of contrast enhancement in each phase.Results: According to the radiologic evolutional phases, there were 4 patients with early phase, 16 with mid phase, and 2 with late phase. All cases showed hypointense to intermediate signal intensity on T1-weighted images. On T2-weighted images, 12 (55%) of the 22 lesions were hyperintense, and 10 (45%) showed intermediate signal. All lesions showed diffusely heterogeneous signal on T2-weighted images. Internal low-signal bands of the lesions were observed in 13 cases (59%). There were two cases with fluid levels in mid phase. Periosteal reaction was observed in 13 (59%) cases. Adjacent bone marrow or soft tissue abnormal signal was observed in 20 cases (91%), respectively. According to early, mid, and late phases, bone marrow and soft tissue abnormal signals were observed in 100%, 100%, and 0% cases, respectively. Soft tissue mass was seen in eight cases (36%). Ten (46%) lesions showed cortical destruction, including one patient with a pathologic fracture. Among 21 patients with contrast infusion, diffuse enhancement was observed in 19 patients (90%), and marginal and septal enhancement was seen in 2 patients (10%).Conclusion: MR imaging was helpful in the diagnosis of extracranial skeletal Langerhans cell histiocytosis, particularly in early and mid phases.

MRI and pelvic abscesses: a pictorial review - Corrected Proof

2012-03-19

Abstract: Objective: The purpose of our article was to review the magnetic resonance imaging (MRI) features of pelvic abscesses. Pelvic abscesses account for a wide range of abnormalities from various etiologies.Conclusion: MRI is being increasingly used for pelvic exploration. Radiologists must thus be aware of their features and characteristics.

Heparin-induced thrombocytopenia (HIT) causing portosplenic, superior mesenteric, and splenic vein thrombosis resulting in splenic rupture and pulmonary emboli formation - Corrected Proof

Jeanne C. Lammering, David S. Wang, Lewis K. Shin — 2012-03-19

Abstract: Heparin-induced thrombocytopenia (HIT) is a life-threatening complication of heparin administration. Of the few reported cases of HIT-associated intra-abdominal thrombosis, none to our knowledge provide multidetector-row computed tomography (MDCT) imaging findings or emphasize its utility in diagnosis. We describe a case of HIT with MDCT images demonstrating extensive intra-abdominal thrombosis and end-organ complications including splenic rupture and pulmonary emboli. This case emphasizes the potential role of MDCT in the rapid detection of HIT-related thromboembolic complications in patients with nonspecific abdominal pain.

Imaging late complications of cholecystectomy - Corrected Proof

2012-03-19

Abstract: Objective: To review the imaging findings in late complications of cholecystectomy.Conclusions: Late postcholecystectomy complications include papillary stenosis, choledocholithiasis, biliary stricture, remnant gallbladder, and dropped gallstones. Such complications can cause substantial morbidity, and knowledge of the imaging appearances can facilitate expeditious diagnosis and treatment.

Isolated unilateral absence of pulmonary artery mimicking chronic pulmonary embolism at chest X-ray: multidetector-row CT angiographic findings - Corrected Proof

2012-03-19

Abstract: Unilateral absence of pulmonary artery (UAPA) is a rare congenital anomaly which can seldom be isolated (1:200,000) and incidentally discovered in adulthood. We describe the case of a 54-year-old male patient who was found to have isolated UAPA (IUAPA) during the clinical and radiological investigation of a single episode of hemoptysis. Although abnormal, chest X-ray findings differed considerably from those previously reported and the diagnosis was only achieved by multidetector-row computed tomography angiography and later confirmed by bed-side echocardiography. Further clinical and instrumental investigation revealed systemic hypertension (158/95 mmHg) and bilateral mild hydronephrosis which both remitted after transurethral prostatic adenomyomectomy.

Acute ischemic cholecystitis after transarterial chemoembolization with drug-eluting beads - Corrected Proof

Bülent Karaman, Bilal Battal, Nisa Cem Ören, Bahri Üstünsöz, Gökhan Yağci — 2012-03-19

Abstract: Transarterial chemoembolization (TACE) is a widely used treatment choice for hepatocellular cancer. DC Bead microspheres are a new embolic material for TACE that doxorubicin can be loaded to. The tumor response rate of this well-tolerated treatment was changed between 60% and 81.8%. We report a case of ischemic cholecystitis after TACE with drug-eluting beads (DEB) that required cholecystectomy. The possibility of cholecystitis is always remembered during TACE-DEB for tumors in segment IV and/or V. Although selective catheterization is related with a lower risk for ischemic cholecystitis, the anatomic and vascular variability in patients with malignancy may lead to some unexpected conditions.

Branchial fistula arising from pyriform fossa: CT diagnosis of a case and discussion of radiological features - Corrected Proof

Narvir Singh Chauhan, Yash Paul Sharma, Tilak Bhagra, Bindu Sud — 2012-03-19

Abstract: Anomalies of third or fourth branchial apparatus origin are very uncommon and present as recurrent neck infections or thyroiditis with a predominant left-sided involvement. Radiological diagnosis requires a high index of suspicion and is critical for initiation of proper treatment. We describe a case of branchial sinus of pyriform fossa with external fistulization that presented in adulthood and was diagnosed on computed tomographic scan. The radiological features of this rare anomaly are revisited.

Invasive thymoma with venous intraluminal extension: CT and MRI findings - Corrected Proof

2012-03-19

Abstract: We herein report an unusual case of invasive thymoma with venous intraluminal extension. The thymoma extended into the superior vena cava, the left brachiocephalic vein, and the proximal portion of the left jugular and subclavian veins intraluminally. It was suggested that the tumor had a discrete intravascular growth via the thymic vein into the left brachiocephalic vein and extended into the proximal portion of the left jugular and subclavian veins in the opposite direction of the venous stream.

Xanthogranulomatous prostatitis: a rare entity resembling prostate adenocarcinoma with magnetic resonance image picture - Corrected Proof

2012-03-19

Abstract: Granulomatous prostatitis, characterized by chronic granulomatous inflammation in the prostate, is rare. Xanthogranulomatous prostatitis is an even rarer granulomatous inflammation. We present a 74-year-old man who presented with lower urinary tract symptoms and elevated prostate specific antigen. A transrectal ultrasonography-guided prostate biopsy was performed, and pathological results showed foamy macrophage and inflammatory cell infiltrates, which were a distinctive feature of xanthogranulomatous prostatitis. We also present the characteristics of magnetic resonance imaging in xanthogranulomatous prostatitis which has never been previously described.

Imaging findings of Nasu–Hakola disease: a case report - Corrected Proof

Seyda Andac Kilic, A. Yusuf Oner, Cemal Yuce, Ilksen Canpolat Ozlu — 2012-03-19

Abstract: Nasu–Hakola disease (NHD), also known as polycystic lipomembranous osteodysplasia and sclerosing leukoencephalopathy, is a rare and fatal hereditary disease with less than 200 cases reported in the literature [Madry H, Prudlo J, Grgic A, Freyschmidt J. Nasu–Hakola disease (PLOSL): report of five cases and review of the literature. Clin Orthop Relat Res 2007;454:262–269]. This progressive disease is characterized by multiple cystic bone lesions, complicated with pathologic fractures and progressive dementia. Here in this article we report the imaging findings including magnetic resonance imaging of a newly diagnosed NHD case, with emphasis on the awareness of the radiologist for prompt recognition of this rare entity.

Three-dimensional MRI with contrast diagnosis of diseases involving peripheral oculomotor nerve - Corrected Proof

Guixun Hong, Zhiyun Yang, Jianping Chu, Shurong Li, Shaoyan Zheng, Zhou Zhou — 2012-03-19

Abstract: Purpose: The purpose was to evaluate three-dimensional magnetic resonance imaging with contrast (3D-CEMRI) in displaying peripheral oculomotor nerve (PON) and diagnosing peripheral oculomotor nerve diseases (POND).Materials and methods: The MRI findings of 80 patients with POND were reviewed and compared with digital subtraction angiography (DSA), operative or pathological results, and final clinical diagnosis.Results: Twenty-three aneurysms (23/26) confirmed by DSA were detected with Magnetic Resonance Angiography (MRA). Twenty-five inflammatory lesions, 14 malignant lesions, and 5 benign lesions involving PON were shown with 3D-CEMRI corresponding with clinical diagnosis and pathology. Another 13 (13/80, 16.03%) cases were negative on MRI.Conclusion: 3D-CEMRI with MRA could show and diagnose the majority of the diseases involving PON.

MRI and 1H-MRS on diagnosis of pineal region tumors - Corrected Proof

Tong Tong, Yao Zhenwei, Feng Xiaoyuan — 2012-03-19

Abstract: Purpose: The purpose was to analyze characteristic magnetic resonance (MR) imaging of pineal region tumors and to explore the value of diffusion-weighted imaging (DWI) and 1H-MR spectroscopy (1H-MRS) in differential diagnosis among four common solid diseases: germinoma, teratoma, pineoblastoma, and glioma.Methods: Thirty-three patients with pineal region tumors proven by pathology were prospectively studied. All of them underwent MRI SE-T1WI, FSE-T2WI, fluid-attenuated inversion recovery (FLAIR), and postcontrasted MR scan. Minimum apparent diffusion coefficient (ADC) value, and maximum MRS choline/N-acetyl-aspartate (Cho/NAA) and lipid/creatine (Lip/Cr) metabolic peak-height ratios were quantified within each lesion.Results: Most pineal region diseases have their typical morphology, signal intensity, and enhancement style. ADC values were lower in germinoma [(6.98±0.35)⁎10−4] and pineoblastoma [(9.14±0.79)⁎10−4] than in teratoma [(2.80±0.18)⁎10−3] and pineal glioma [(1.63±0.66)⁎10−3] (P<.05). Cho/NAA ratios were higher in germinoma (2.09±0.39), pineoblastoma (4.70±0.82), and pineal glioma (3.54±0.38) than in teratoma (1.52±0.91) (P<.05). Lip/Cr ratios were lower in germinoma (2.52±0.41) than in teratoma (8.47±1.16) (P<.05).Conclusions: Changes in morphologic features, signal intensity, and enhancement style are the most helpful variables for the differential diagnosis of pineal region tumors. To some extent, DWI and 1H-MRS imaging enable distinction among them.

Effectiveness of a breath-hold monitoring system in improving the reproducibility of different breath-hold positions in multiphasic CT imaging - Corrected Proof

Lars J. Grimm, Sebastian Feuerlein, Mustafa Bashir, Rendon C. Nelson — 2012-03-19

Abstract: This study tests whether the utilization of an electronic breath-hold monitoring device improves breath-hold reproducibility during computed tomographic (CT) scanning. Two cohorts of 40 patients underwent dual-phase abdominal CT scans, either with a breath-hold monitoring device or with the standard breath-holding technique. Two blinded readers measured the differences in diaphragmatic position between phases. There was no statistical difference in diaphragmatic position (P=.14) between the monitored (8.5±11.5 mm) and control (5.6±5.2 mm) cohorts. Ten percent of patients from the monitored cohort had greater than 20 mm of deviation, versus 0%–2.5% for the control cohort. Reproduction of breath-holding position remains challenging, even with a monitoring system.

Mammogram-based discriminant fusion analysis for breast cancer diagnosis - Corrected Proof

Jun-Bao Li, Yun-Heng Wang, Lin-Lin Tang — 2012-03-19

Abstract: Mammogram-based classification is an important and effective way for computer-aided diagnosis (CAD)-based breast cancer diagnosis. In this paper, we present a novel discriminant fusing analysis (DFA)-based mammogram classification CAD-based breast cancer diagnosis. The discriminative breast tissue features are exacted and fused by DFA, and DFA achieves the optimal fusion coefficients. The largest class discriminant in the fused feature space is achieved by DFA for classification. Beside the detailed theory derivation, many experimental evaluations are implemented on Mammography Image Analysis Society mammogram database for breast cancer diagnosis.

Combination of high-intensity focused ultrasound with nanoscale ultrasound contrast agent in treatment of rabbit breast VX2 tumors: a pilot study - Corrected Proof

2012-03-19

Abstract: To demonstrate ultrasound contrast agents to be important potentiators of high-intensity focused ultrasound (HIFU), we prospectively assessed the effectiveness of HIFU combined with nanoscale ultrasound contrast agents for the treatment of breast VX2 tumors in rabbits. We found that the change of grayscale value in the target area in the HIFU+nanobubble group was significantly higher than that in the HIFU+phosphate-buffered saline (PBS) group after irradiation (P<.01). The size of coagulation necrosis was also significantly larger in the HIFU+nanobubble group when compared to that in the HIFU+PBS group (P<.001). In conclusion, our study suggested that adding nanoscale ultrasound contrast agents may improve the treatment efficacy of HIFU for breast VX2 tumors in rabbits.