Clinical Imaging - Articles in Press

Case reports - Corrected Proof

2010-02-01

Corrected Proof

Antonio F. Govoni — 2010-02-01

In this voluminous textbook, the objective of the authors is to help the readers, in particular the gastrointestinal radiologists facing problematic abdominal images, in reaching the correct diagnosis. The book is subdivided into five sections: the first one, “Advanced Modalities as Problem-Solving Tool,” discusses in four chapters the role of ultrasonography, multidetector computed tomography, magnetic resonance imaging, and positron emission tomography. The fifth chapter concludes this section with a very informative review of “A Multidimensional Approach to Abdominal Imaging.” Section 2, “Problem Solving: Disease Categories,” deals with localization and spread of disease; emphasizes the point that often the pathologic process is not localized to a specific organ and its origin may be removed from its present localization; and discusses the discovery by computed tomography of small incidentalomas, incidental asymptomatic lesions, and how to follow them. In “Imaging Evaluation of Acute Abdominal Pain,” the authors review the numerous possible causes and the related different diagnostic conclusions. The chapter “Imaging Evaluation of Trauma” presents the role of the different imaging procedures in the study of a trauma, wherever its location in the abdominal cavity. In “A Brief Guide to Cancer Imaging,” the staging and spread of malignant tumors involving the abdomen and pelvis are discussed. This section ends with a chapter dealing with common inherited and metabolic disorders.

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.

Corrected Proof

Eugenio Borsatti — 2010-01-25

In the last decade, we have seen a diffusion and an exponential growth of diagnostic metabolic imaging by PET and PET/CT, particularly in oncology. This imaging modality has revolutionized and improved the management and sometimes the treatment of several pathologies, not only in oncology. The main reason for its success is that by PET we can image biological functions instead of anatomy. Consequently, nowadays, PET/CT in joining the morphological and functional imaging has, in many cases, replaced conventional CT as an essential diagnostic medium in managing patients with cancer, neurological diseases, and cardiovascular disorders.

Corrected Proof

Pietro Torricelli — 2010-01-25

Cardiac Imaging Direct Diagnosis in Radiology is one of a series named Dx-Direct composed of 12 Thieme books covering the main subspecialties in radiology such as gastrointestinal, musculoskeletal, and interventional radiology. The aim of the “Dx-Direct” is not to present and describe all possible cardiovascular diseases but only the cases radiologists are most likely to see in their typical working day. All the books in the series discuss each condition or disease following the same format: Definitions (Epidemiology, Etiology), Imaging Signs, Clinical Aspects (Typical Presentation, Treatment Options, Course and Prognosis), Differential Diagnosis and key References. All sections are well balanced, easy and fast to read, with just the right level of detail. Since cardiac imaging has typically a multimodality approach, it is worthy of notice to begin each Imaging Sign section indicating the modality of choice which would allow the reader to reach the right diagnosis. Particularly valuable are the What Does the Clinician Want to Know and the Tips and Pitfalls Sections, presented at the end of each case, that discuss those aspects with simplicity, frequently introducing the main clinical data not to be forgotten by the radiologist. The key references are comprehensive and updated.

Meetings and courses - Corrected Proof

2010-01-25

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.

Multimodality imaging of usual and unusual sites of metastasis which occur after definitive therapy for rectal cancer - Corrected Proof

Priya Bhosale, Janio Szklaruk, Revathy Iyer — 2010-01-15

Abstract: Rectal cancer is a common malignancy encountered largely after the fifth decade of life. Due to the recent advances in cancer therapy, which include chemoradiation therapy pre- and postoperatively, survival has improved. Radiologist has become an integral part of the patient management team to diagnose and localize the area of recurrent rectal cancer. Although typical pathways of rectal cancer spread have been described, recurrence may occur in unexpected locations due to the currently available aggressive therapy being able to control local disease. Imaging surveillance should include careful evaluation of expected and unexpected anatomic sites where tumor may recur. This paper will describe the common and uncommon locations of recurrent rectal cancer.

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.

Endometriosis following cesarean section: ultrasonography and magnetic resonance imaging - Corrected Proof

2010-01-06

Abstract: We present three cases of endometriosis developing in the abdominal wall following cesarean section.The patients were examined by Doppler ultrasonography (US) and magnetic resonance imaging (MRI). The object is to describe the US and MRI findings of the lesion and evaluate their role in the diagnosis and management.In our opinion, a single procedure is sufficient in evaluating the lesion and in reaching the diagnosis.

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.

Diffusion-weighted MRI evaluation of breast cancer extension - Corrected Proof

Qiu Long-Hua, Xiao Qin, Yang Wen-Tao, Tang Feng, Shen Kun-Wei, Wu Bin, Gu Ya-Jia — 2009-10-26

Abstract: Aim: To investigate the feasibility of using diffusion-weighted MR imaging (DWI) to accurately measure breast cancer extension.Materials and Methods: The extensions of 59 breast lesions were investigated on DW images and apparent diffusion coefficient (ADC) maps and compared to the pathological exams.Results: Three groups were observed: accurate, overdiagnosis, and false negative. There were no significant differences seen in accurate or false-negative group when b was 500 and 1000 s/mm2 when two lesions in the overdiagnosis group at both b values.Conclusion: DWI and the ADC value have potential for evaluating cancer extension.

CT and MR imaging of Susac syndrome in a young male presenting with acute disorientation - Corrected Proof

Andrew M. Allmendinger, Vadim Spektor, Sylvie Destian — 2009-10-26

Abstract: Susac syndrome is a rare neurologic disorder first described by Susac et al. in 1979. Clinically, Susac syndrome consists of a triad including encephalopathy, branch retinal artery occlusion, and sensorineural hearing loss. Microinfarction is believed to be the basic histologic feature and MR is considered the best imaging modality. This case documents the typical imaging findings of Susac syndrome, as well as the unique MR imaging finding of cranial nerve enhancement.

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.

Use of diffusion-weighted imaging in recurrent central nervous system Whipple's disease: a case report and review of the literature - Corrected Proof

2009-09-17

Abstract: A case of Whipple's disease with development of antibiotic resistance is reported. The patient's symptomatology correlated with evolution of diffusion abnormality rather than with lesion enhancement. The lesion demonstrated no hyperperfusion, moderately elevated choline, and decreased N-acetylaspartate.Conventional magnetic resonance (MR) imaging findings of central nervous system Whipple's disease are nonspecific and may mimic neoplasm. MR perfusion and spectroscopy findings are reported, which may assist in diagnosis. Change in diffusion restriction appears to be a potential imaging indicator of clinical progression and response to therapy.

Positive predictive values of sonographic features of solid thyroid nodule - Corrected Proof

2009-09-14

Abstract: Aim: The purpose of this study was to assess the positive predictive value of the suspicious sonographic features of solid nodules of the thyroid.Materials and methods: After approval by our institutional review board, we evaluated 594 sonographically detected nodules on which fine needle aspiration biopsy had been performed from January to December 2005. Among these, pure cystic lesions and inadequate pathologic results were excluded. The remaining 530 solid thyroid nodules were analyzed by two radiologists. Each lesion was classified based on four sonographic features that suggested malignancy: microcalcifications; an irregular or microlobulated margin; marked hypoechogenicity; and a shape that was taller than wide. The sensitivity, specificity, positive predictive value, and negative predictive value of the each sonographic feature were calculated.Results: Final pathologic results showed that 97 (18.3%) of 530 nodules were malignant. The positive predictive values for malignancy in each sonographic feature were microcalcifications, 38.6% (39/101); an irregular or microlobulated margin, 28.2% (70/248); marked hypoechogenecity, 49.4% (38/77); taller than wide shape, 59.8% (49/82). In terms of relative risk, microcalcification [P<.01, relative risk (RR)=3.115, 95% CI: 1.724–5.628], hypoechogenecity (P<.01, RR=2.510, 95% CI: 1.290–4.881). The shape of nodule which was taller than wide (P<.01, RR=7.624, 95% CI: 4.156–13.986) revealed the highest predictive sonographic finding suggesting malignancy. However, margin is the least significant feature of detection of thyroid malignancy (P=.27, RR=1.395, 95% CI: 0.777–2.505).Conclusion: The three sonographic features of solid thyroid nodule, that is, microcalcifications, marked hypoechogenecity, and a taller than wide shape are meaningful findings in the diagnosis of thyroid malignancy. The shape that was taller than wide was the most reliable sonographic feature for predicting malignancy.

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.

Solid pseudopapillary tumor of the pancreas in children: typical radiological findings and pathological correlation - Corrected Proof

2009-08-28

Abstract: We report a case series of three children with solid pseudopapillary tumor of the pancreas (SPT) in which a complete radiological work-up, including ultrasound, computed tomography scans, and MRI, has been carried out. The aim of this article is to highlight the characteristic imaging findings of SPT in the pediatric age group and to establish a correlation with typical histopathological findings of the lesion.

Myocardial bridging on dual-source computed tomography: degree of systolic compression of mural coronary artery correlating with length and depth of the myocardial bridge - Corrected Proof

Shi-he Liu, Qing Yang, Jiu-hong Chen, Xi-ming Wang, Min Wang, Cheng Liu — 2009-08-28

Abstract: Objective: To investigate the correlation between the degree of systolic compression of mural coronary artery (MCA) and the length and depth of myocardial bridging (MB) with dual-source computed tomography (DSCT).Methods: The length and depth of MB were measured from diastolic phase. All datasets were reconstructed in 5% steps of R-R interval. The optimum phases were chosen where the maximal and minimal diameters were shown. The degree of systolic compression of MCA was calculated. The correlation between length and depth of MB and the degree of systolic compression of MCA were analyzed by Pearson test.Results: The minimal diameters were found in 27 sites (90.0%) from 30% to 35% R-R interval, and the maximal diameters were found in 27 sites (90.0%) from 70% to 80% R-R interval. The correlation between systolic compression of MCA and length of MB was not significant (r=0.096, P=.613); however, the correlation between systolic compression of MCA and the depth of MB was significant (r=0.675, P<.01).Conclusion: The minimal and maximal diameters of MCA are usually demonstrated in 30–35% and 70–80% R-R reconstruction interval, respectively. The degree of systolic compression of MCA correlates well with the depth of MB.

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.