Ductal carcinoma in situ within a fibroadenoma: A case report and review of literature

BACKGROUND

Fibroadenoma (FA) is the most common tumor found in young women, although it can occur in any age group. Ductal carcinoma in situ (DCIS) that is confined in a FA is rare; it is most frequently reported as an incidental finding.

CASE SUMMARY

We report a case of DCIS within a FA in a 46-year-old female without cancer-related personal and family histories. The patient was diagnosed with a breast conglomerate of nodules and was followed for 1 year. In the current control image study, we found suspicious microcalcification, as a new finding, within one of the nodules. Consequently, a core biopsy of the tumor, which appeared hypoechoic, oval, and circumscribed, was performed. The pathological diagnosis was ductal carcinoma in situ within a fibroepithelial lesion. The patient underwent breast-conserving surgery and received radiotherapy as well as endocrine therapy (tamoxifen).

CONCLUSION

We recommend a multidisciplinary approach for adequate treatment and follow-up.

Evaluating pediatric ureteropelvic junction obstruction: Dynamic magnetic resonance urography vs renal scintigraphy 99m-technetium mercaptoacetyltriglycine

BACKGROUND

Ureteropelvic junction obstruction (UPJO) is a common congenital urinary tract disorder in children. It can be diagnosed as early as in utero due to the presence of hydronephrosis or later in life due to symptomatic occurrence.

AIM

To evaluate the discrepancy between dynamic contrast-enhanced magnetic resonance urography (dMRU) and scintigraphy 99m-technetium mercaptoacetyltriglycine (MAG-3) for the functional evaluation of UPJO.

METHODS

Between 2016 and 2020, 126 patients with UPJO underwent surgery at Robert Debré Hospital. Of these, 83 received a prenatal diagnosis, and 43 were diagnosed during childhood. Four of the 126 patients underwent surgery based on the clinical situation and postnatal ultrasound findings without undergoing functional imaging evaluation. Split renal function was evaluated preoperatively using scintigraphy MAG-3 (n = 28), dMRU (n = 53), or both (n = 40). In this study, we included patients who underwent surgery for UPJO and scintigraphy MAG-3 + dMRU but excluded those who underwent only scintigraphy MAG-3 or dMRU. The patients were divided into groups A (< 10% discrepancy) and B (> 10% discrepancy). We examined the discrepancy in split renal function between the two modalities and investigated the possible risk factors.

RESULTS

The split renal function between the two kidneys was compared in 40 patients (28 boys and 12 girls) using scintigraphy MAG-3 and dMRU. Differential renal function, as determined using both modalities, showed a difference of < 10% in 31 children and > 10% in 9 children. Calculation of the relative renal function using dMRU revealed an excellent correlation coefficient with renal scintigraphy MAG-3 for both kidneys.

CONCLUSION

Our findings demonstrated that dMRU is equivalent to scintigraphy MAG-3 for evaluating split renal function in patients with UPJO.

Chronic pancreatitis: Pain and computed tomography/magnetic resonance imaging findings

Chronic pancreatitis (CP) is a fibroinflammatory disease characterized by irreversible destruction of pancreatic tissue. With the development of the disease, it may lead to exocrine and/or endocrine insufficiency. CP is one of the common diseases that cause abdominal pain, which will not get permanent spontaneous relief as the disease evolves. The American College of Gastroenterology clinical guidelines recommend computed tomography or magnetic resonance imaging as the first-line examination for the diagnosis of CP. CP common imaging findings include pancreatic atrophy, irregular dilatation of the pancreatic duct, calcification of pancreatic parenchyma, pancreatic duct stones, etc. In clinical practice, whether any correlations between CP-induced abdominal pain patterns (no pain/constant/intermittent pain) and corresponding imaging findings present are not well known. Therefore, this review aims to comprehensively sort out and analyze the relevant information by collecting lots of literature on this field, so as to construct a cross-bridge between the clinical manifestations and imaging manifestations of CP patients. Also, it provides an imaging basis and foundation for the classification and diagnosis of abdominal pain types in clinical CP patients.

Artificial intelligence for disease diagnostics still has a long way to go

Artificial intelligence (AI) can sometimes resolve difficulties that other advanced technologies and humans cannot. In medical diagnostics, AI has the advantage of processing figure recognition, especially for images with similar characteristics that are difficult to distinguish with the naked eye. However, the mechanisms of this advanced technique should be well-addressed to elucidate clinical issues. In this letter, regarding an original study presented by Takayama et al, we suggest that the authors should effectively illustrate the mechanism and detailed procedure that artificial intelligence techniques processing the acquired images, including the recognition of non-obvious difference between the normal parts and pathological ones, which were impossible to be distinguished by naked eyes, such as the basic constitutional elements of pixels and grayscale, special molecules or even some metal ions which involved into the diseases occurrence.

Outcomes and efficacy of magnetic resonance imaging-compatible sacral nerve stimulator for management of fecal incontinence: A multi-institutional study

BACKGROUND

Fecal incontinence (FI) is an involuntary passage of fecal matter which can have a significant impact on a patient's quality of life. Many modalities of treatment exist for FI. Sacral nerve stimulation is a well-established treatment for FI. Given the increased need of magnetic resonance imaging (MRI) for diagnostics, the InterStim which was previously used in sacral nerve stimulation was limited by MRI incompatibility. Medtronic MRI-compatible InterStim was approved by the United States Food and Drug Administration in August 2020 and has been widely used.

AIM

To evaluate the efficacy, outcomes and complications of the MRI-compatible InterStim.

METHODS

Data of patients who underwent MRI-compatible Medtronic InterStim placement at UPMC Williamsport, University of Minnesota, Advocate Lutheran General Hospital, and University of Wisconsin-Madison was pooled and analyzed. Patient demographics, clinical features, surgical techniques, complications, and outcomes were analyzed. Strengthening the Reporting of Observational studies in Epidemiology(STROBE) cross-sectional reporting guidelines were used.

RESULTS

Seventy-three patients had the InterStim implanted. The mean age was 63.29 ± 12.2 years. Fifty-seven (78.1%) patients were females and forty-two (57.5%) patients had diabetes. In addition to incontinence, overlapping symptoms included diarrhea (23.3%), fecal urgency (58.9%), and urinary incontinence (28.8%). Fifteen (20.5%) patients underwent Peripheral Nerve Evaluation before proceeding to definite implant placement. Thirty-two (43.8%) patients underwent rechargeable InterStim placement. Three (4.1%) patients needed removal of the implant. Migration of the external lead connection was observed in 7 (9.6%) patients after the stage I procedure. The explanation for one patient was due to infection. Seven (9.6%) patients had other complications like nerve pain, hematoma, infection, lead fracture, and bleeding. The mean follow-up was 6.62 ± 3.5 mo. Sixty-eight (93.2%) patients reported significant improvement of symptoms on follow-up evaluation.

CONCLUSION

This study shows promising results with significant symptom improvement, good efficacy and good patient outcomes with low complication rates while using MRI compatible InterStim for FI. Further long-term follow-up and future studies with a larger patient population is recommended.

Computed tomography-based nomogram of Siewert type II/III adenocarcinoma of esophagogastric junction to predict response to docetaxel, oxaliplatin and S-1

BACKGROUND

Neoadjuvant chemotherapy (NAC) has become the standard care for advanced adenocarcinoma of esophagogastric junction (AEG), although a part of the patients cannot benefit from NAC. There are no models based on baseline computed tomography (CT) to predict response of Siewert type II or III AEG to NAC with docetaxel, oxaliplatin and S-1 (DOS).

AIM

To develop a CT-based nomogram to predict response of Siewert type II/III AEG to NAC with DOS.

METHODS

One hundred and twenty-eight consecutive patients with confirmed Siewert type II/III AEG underwent CT before and after three cycles of NAC with DOS, and were randomly and consecutively assigned to the training cohort (TC) (n = 94) and the validation cohort (VC) (n = 34). Therapeutic effect was assessed by disease-control rate and progressive disease according to the Response Evaluation Criteria in Solid Tumors (version 1.1) criteria. Possible prognostic factors associated with responses after DOS treatment including Siewert classification, gross tumor volume (GTV), and cT and cN stages were evaluated using pretherapeutic CT data in addition to sex and age. Univariate and multivariate analyses of CT and clinical features in the TC were performed to determine independent factors associated with response to DOS. A nomogram was established based on independent factors to predict the response. The predictive performance of the nomogram was evaluated by Concordance index (C-index), calibration and receiver operating characteristics curve in the TC and VC.

RESULTS

Univariate analysis showed that Siewert type (52/55 vs 29/39, P = 0.005), pretherapeutic cT stage (57/62 vs 24/32, P = 0.028), GTV (47.3 ± 27.4 vs 73.2 ± 54.3, P = 0.040) were significantly associated with response to DOS in the TC. Multivariate analysis of the TC also showed that the pretherapeutic cT stage, GTV and Siewert type were independent predictive factors related to response to DOS (odds ratio = 4.631, 1.027 and 7.639, respectively; all P < 0.05). The nomogram developed with these independent factors showed an excellent performance to predict response to DOS in the TC and VC (C-index: 0.838 and 0.824), with area under the receiver operating characteristic curve of 0.838 and 0.824, respectively. The calibration curves showed that the practical and predicted response to DOS effectively coincided.

CONCLUSION

A novel nomogram developed with pretherapeutic cT stage, GTV and Siewert type predicted the response of Siewert type II/III AEG to NAC with DOS.

From strength to precision: A systematic review exploring the clinical utility of 7-Tesla magnetic resonance imaging in abdominal imaging

BACKGROUND

After approval for clinical use in 2017 early investigations of ultra-high-field abdominal magnetic resonance imaging (MRI) have demonstrated the feasibility as well as diagnostic capabilities of liver, kidney, and prostate MRI at 7-Tesla. However, the elevation of the field strength to 7-Tesla not only brought advantages to abdominal MRI but also presented considerable challenges and drawbacks, primarily stemming from heightened artifacts and limitations in Specific Absorption Rate, etc. Furthermore, evidence in the literature is relatively scarce concerning human studies in comparison to phantom/animal studies which necessitates an investigation into the evidence so far in humans and summarizing all relevant evidence.

AIM

To offer a comprehensive overview of current literature on clinical abdominal 7T MRI that emphasizes current trends, details relevant challenges, and provides a concise set of potential solutions.

METHODS

This systematic review adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A PubMed search, utilizing Medical Subject Headings terms such as "7-Tesla" and organ-specific terms, was conducted for articles published between January 1, 1985, and July 25, 2023. Eligibility criteria included studies exploring 7T MRI for imaging human abdominal organs, encompassing various study types (in-vivo/ex-vivo, method development, reviews/meta-analyses). Exclusion criteria involved animal studies and those lacking extractable data. Study selection involved initial identification via title/abstract, followed by a full-text review by two researchers, with discrepancies resolved through discussion. Data extraction covered publication details, study design, population, sample size, 7T MRI protocol, image characteristics, endpoints, and conclusions.

RESULTS

The systematic review included a total of 21 studies. The distribution of clinical 7T abdominal imaging studies revealed a predominant focus on the prostate (n = 8), followed by the kidney (n = 6) and the hepatobiliary system (n = 5). Studies on these organs, and in the pancreas, demonstrated clear advantages at 7T. However, small bowel studies showed no significant improvements compared to traditional MRI at 1.5T. The majority of studies evaluated originated from Germany (n = 10), followed by the Netherlands (n = 5), the United States (n = 5), Austria (n = 2), the United Kingdom (n = 1), and Italy (n = 1).

CONCLUSION

Further increase of abdominal clinical MRI field strength to 7T demonstrated high imaging potential, yet also limitations mainly due to the inhomogeneous radiofrequency (RF) excitation field relative to lower field strengths. Hence, further optimization of dedicated RF coil elements and pulse sequences are expected to better optimize clinical imaging at high magnetic field strength.

Anti-N-methyl-D-aspartate receptor-associated encephalitis: A review of clinicopathologic hallmarks and multimodal imaging manifestations

Anti-N-methyl-D-aspartate receptor-associated encephalitis (NMDARE) is a rare immune-mediated neuroinflammatory condition characterized by the rapid onset of neuropsychiatric symptoms and autonomic dysfunction. The mechanism of pathogenesis remains incompletely understood, but is thought to be related to antibodies targeting the GluN1 subunit of the NMDA receptor with resultant downstream dysregulation of dopaminergic pathways. Young adults are most frequently affected; the median age at diagnosis is 21 years. There is a strong female predilection with a female sex predominance of 4:1. NMDARE often develops as a paraneoplastic process and is most commonly associated with ovarian teratoma. However, NMDARE has also been described in patients with small cell lung cancer, clear cell renal carcinoma, and other benign and malignant neoplasms. Diagnosis is based on correlation of the clinical presentation, electroencephalography, laboratory studies, and imaging. Computed tomography, positron emission tomography, and magnetic resonance imaging are essential to identify an underlying tumor, exclude clinicopathologic mimics, and predict the likelihood of long-term functional impairment. Nuclear imaging may be of value for prognostication and to assess the response to therapy. Treatment may involve high-dose corticosteroids, intravenous immunoglobulin, and plasma exchange. Herein, we review the hallmark clinicopathologic features and imaging findings of this rare but potentially devastating condition and summarize diagnostic criteria, treatment regimens, and proposed pathogenetic mechanisms.

Deep learning-based magnetic resonance imaging reconstruction for improving the image quality of reduced-field-of-view diffusion-weighted imaging of the pancreas

BACKGROUND

It has been reported that deep learning-based reconstruction (DLR) can reduce image noise and artifacts, thereby improving the signal-to-noise ratio and image sharpness. However, no previous studies have evaluated the efficacy of DLR in improving image quality in reduced-field-of-view (reduced-FOV) diffusion-weighted imaging (DWI) [field-of-view optimized and constrained undistorted single-shot (FOCUS)] of the pancreas. We hypothesized that a combination of these techniques would improve DWI image quality without prolonging the scan time but would influence the apparent diffusion coefficient calculation.

AIM

To evaluate the efficacy of DLR for image quality improvement of FOCUS of the pancreas.

METHODS

This was a retrospective study evaluated 37 patients with pancreatic cystic lesions who underwent magnetic resonance imaging between August 2021 and October 2021. We evaluated three types of FOCUS examinations: FOCUS with DLR (FOCUS-DLR+), FOCUS without DLR (FOCUS-DLR-), and conventional FOCUS (FOCUS-conv). The three types of FOCUS and their apparent diffusion coefficient (ADC) maps were compared qualitatively and quantitatively.

RESULTS

FOCUS-DLR+ (3.62, average score of two radiologists) showed significantly better qualitative scores for image noise than FOCUS-DLR- (2.62) and FOCUS-conv (2.88) (P < 0.05). Furthermore, FOCUS-DLR+ showed the highest contrast ratio (CR) between the pancreatic parenchyma and adjacent fat tissue for b-values of 0 and 600 s/mm2 (0.72 ± 0.08 and 0.68 ± 0.08) and FOCUS-DLR- showed the highest CR between cystic lesions and the pancreatic parenchyma for the b-values of 0 and 600 s/mm2 (0.62 ± 0.21 and 0.62 ± 0.21) (P < 0.05), respectively. FOCUS-DLR+ provided significantly higher ADCs of the pancreas and lesion (1.44 ± 0.24 and 3.00 ± 0.66) compared to FOCUS-DLR- (1.39 ± 0.22 and 2.86 ± 0.61) and significantly lower ADCs compared to FOCUS-conv (1.84 ± 0.45 and 3.32 ± 0.70) (P < 0.05), respectively.

CONCLUSION

This study evaluated the efficacy of DLR for image quality improvement in reduced-FOV DWI of the pancreas. DLR can significantly denoise images without prolonging the scan time or decreasing the spatial resolution. The denoising level of DWI can be controlled to make the images appear more natural to the human eye. However, this study revealed that DLR did not ameliorate pancreatic distortion. Additionally, physicians should pay attention to the interpretation of ADCs after DLR application because ADCs are significantly changed by DLR.

Factors associated with gastrointestinal stromal tumor rupture and pathological risk: A single-center retrospective study

BACKGROUND

Gastrointestinal stromal tumor (GIST) is a rare gastrointestinal mesenchymal tumor with potential malignancy. Once the tumor ruptures, regardless of tumor size and mitotic number, it can be identified into a high-risk group. It is of great significance for the diagnosis, treatment, and prognosis of GIST if non-invasive examination can be performed before surgery to accurately assess the risk of tumor.

AIM

To identify the factors associated with GIST rupture and pathological risk.

METHODS

A cohort of 50 patients with GISTs, as confirmed by postoperative pathology, was selected from our hospital. Clinicopathological and computed tomography data of the patients were collected. Logistic regression analysis was used to evaluate factors associated with GIST rupture and pathological risk grade.

RESULTS

Pathological risk grade, tumor diameter, tumor morphology, internal necrosis, gas-liquid interface, and Ki-67 index exhibited significant associations with GIST rupture (P < 0.05). Gender, tumor diameter, tumor rupture, and Ki-67 index were found to be correlated with pathological risk grade of GIST (P < 0.05). Multifactorial logistic regression analysis revealed that male gender and tumor diameter ≥ 10 cm were independent predictors of a high pathological risk grade of GIST [odds ratio (OR) = 11.12, 95% confidence interval (95%CI): 1.81-68.52, P = 0.01; OR = 22.96, 95%CI: 2.19-240.93, P = 0.01]. Tumor diameter ≥ 10 cm, irregular shape, internal necrosis, gas-liquid interface, and Ki-67 index ≥ 10 were identified as independent predictors of a high risk of GIST rupture (OR = 9.67, 95%CI: 2.15-43.56, P = 0.01; OR = 35.44, 95%CI: 4.01-313.38, P < 0.01; OR = 18.75, 95%CI: 3.40-103.34, P < 0.01; OR = 27.00, 95%CI: 3.10-235.02, P < 0.01; OR = 4.43, 95%CI: 1.10-17.92, P = 0.04).

CONCLUSION

Tumor diameter, tumor morphology, internal necrosis, gas-liquid, and Ki-67 index are associated with GIST rupture, while gender and tumor diameter are linked to the pathological risk of GIST. These findings contribute to our understanding of GIST and may inform non-invasive examination strategies and risk assessment for this condition.

Methods for improving colorectal cancer annotation efficiency for artificial intelligence-observer training

BACKGROUND

Missing occult cancer lesions accounts for the most diagnostic errors in retrospective radiology reviews as early cancer can be small or subtle, making the lesions difficult to detect. Second-observer is the most effective technique for reducing these events and can be economically implemented with the advent of artificial intelligence (AI).

AIM

To achieve appropriate AI model training, a large annotated dataset is necessary to train the AI models. Our goal in this research is to compare two methods for decreasing the annotation time to establish ground truth: Skip-slice annotation and AI-initiated annotation.

METHODS

We developed a 2D U-Net as an AI second observer for detecting colorectal cancer (CRC) and an ensemble of 5 differently initiated 2D U-Net for ensemble technique. Each model was trained with 51 cases of annotated CRC computed tomography of the abdomen and pelvis, tested with 7 cases, and validated with 20 cases from The Cancer Imaging Archive cases. The sensitivity, false positives per case, and estimated Dice coefficient were obtained for each method of training. We compared the two methods of annotations and the time reduction associated with the technique. The time differences were tested using Friedman's two-way analysis of variance.

RESULTS

Sparse annotation significantly reduces the time for annotation particularly skipping 2 slices at a time (P < 0.001). Reduction of up to 2/3 of the annotation does not reduce AI model sensitivity or false positives per case. Although initializing human annotation with AI reduces the annotation time, the reduction is minimal, even when using an ensemble AI to decrease false positives.

CONCLUSION

Our data support the sparse annotation technique as an efficient technique for reducing the time needed to establish the ground truth.

Association between late gadolinium enhancement and outcome in dilated cardiomyopathy: A meta-analysis

BACKGROUND

The prognostic value of late gadolinium enhancement (LGE) derived from cardiovascular magnetic resonance (CMR) is well studied, and several new metrics of LGE have emerged. However, some controversies remain; therefore, further discussion is needed, and more precise risk stratification should be explored.

AIM

To investigate the associations between the positivity, extent, location, and pattern of LGE and multiple outcomes in dilated cardiomyopathy (DCM).

METHODS

PubMed, Ovid MEDLINE, and Cochrane Library were searched for studies that investigated the prognostic value of LGE in patients with DCM. Pooled hazard ratios (HRs) and 95% confidence intervals were calculated to assess the role of LGE in the risk stratification of DCM.

RESULTS

Nineteen studies involving 7330 patients with DCM were included in this meta-analysis and covered a wide spectrum of DCM, with a mean left ventricular ejection fraction between 21% and 50%. The meta-analysis revealed that the presence of LGE was associated with an increased risk of multiple adverse outcomes (all-cause mortality, HR: 2.14; arrhythmic events, HR: 5.12; and composite endpoints, HR: 2.38; all P < 0.001). Furthermore, every 1% increment in the extent of LGE was associated with an increased risk of all-cause mortality. Analysis of a subgroup revealed that the prognostic value varied based on different location and pattern of LGE. Additionally, we found that LGE was a stronger predictor of arrhythmic events in patients with greater left ventricular ejection fraction.

CONCLUSION

LGE by CMR in patients with DCM exhibited a substantial value in predicting adverse outcomes, and the extent, location, and pattern of LGE could provide additional information for risk stratification.

Radiomics analysis with three-dimensional and two-dimensional segmentation to predict survival outcomes in pancreatic cancer

BACKGROUND

Radiomics can assess prognostic factors in several types of tumors, but considering its prognostic ability in pancreatic cancer has been lacking.

AIM

To evaluate the performance of two different radiomics software in assessing survival outcomes in pancreatic cancer patients.

METHODS

We retrospectively reviewed pretreatment contrast-enhanced dual-energy computed tomography images from 48 patients with biopsy-confirmed pancreatic ductal adenocarcinoma who later underwent neoadjuvant chemoradiation and surgery. Tumors were segmented using TexRad software for 2-dimensional (2D) analysis and MIM software for 3D analysis, followed by radiomic feature extraction. Cox proportional hazard modeling correlated texture features with overall survival (OS) and progression-free survival (PFS). Cox regression was used to detect differences in OS related to pretreatment tumor size and residual tumor following treatment. The Wilcoxon test was used to show the relationship between tumor volume and the percent of residual tumor. Kaplan-Meier analysis was used to compare survival in patients with different tumor densities in Hounsfield units for both 2D and 3D analysis.

RESULTS

3D analysis showed that higher mean tumor density [hazard ratio (HR) = 0.971, P = 0.041)] and higher median tumor density (HR = 0.970, P = 0.037) correlated with better OS. 2D analysis showed that higher mean tumor density (HR = 0.963, P = 0.014) and higher mean positive pixels (HR = 0.962, P = 0.014) correlated with better OS; higher skewness (HR = 3.067, P = 0.008) and higher kurtosis (HR = 1.176, P = 0.029) correlated with worse OS. Higher entropy correlated with better PFS (HR = 0.056, P = 0.036). Models determined that patients with increased tumor size greater than 1.35 cm were likely to have a higher percentage of residual tumors of over 10%.

CONCLUSION

Several radiomics features can be used as prognostic tools for pancreatic cancer. However, results vary between 2D and 3D analyses. Mean tumor density was the only variable that could reliably predict OS, irrespective of the analysis used.

Imaging assessment of photosensitizer emission induced by radionuclide-derived Cherenkov radiation using charge-coupled device optical imaging and long-pass filters

BACKGROUND

Radionuclides produce Cherenkov radiation (CR), which can potentially activate photosensitizers (PSs) in phototherapy. Several groups have studied Cherenkov energy transfer to PSs using optical imaging; however, cost-effectively identifying whether PSs are excited by radionuclide-derived CR and detecting fluorescence emission from excited PSs remain a challenge. Many laboratories face the need for expensive dedicated equipment.

AIM

To cost-effectively confirm whether PSs are excited by radionuclide-derived CR and distinguish fluorescence emission from excited PSs.

METHODS

The absorbance and fluorescence spectra of PSs were measured using a microplate reader and fluorescence spectrometer to examine the photo-physical properties of PSs. To mitigate the need for expensive dedicated equipment and achieve the aim of the study, we developed a method that utilizes a charge-coupled device optical imaging system and appropriate long-pass filters of different wavelengths (manual sequential application of long-pass filters of 515, 580, 645, 700, 750, and 800 nm). Tetrakis (4-carboxyphenyl) porphyrin (TCPP) was utilized as a model PS. Different doses of copper-64 (64CuCl2) (4, 2, and 1 mCi) were used as CR-producing radionuclides. Imaging and data acquisition were performed 0.5 h after sample preparation. Differential image analysis was conducted by using ImageJ software (National Institutes of Health) to visually evaluate TCPP fluorescence.

RESULTS

The maximum absorbance of TCPP was at 390-430 nm, and the emission peak was at 670 nm. The CR and CR-induced TCPP emissions were observed using the optical imaging system and the high-transmittance long-pass filters described above. The emission spectra of TCPP with a peak in the 645-700 nm window were obtained by calculation and subtraction based on the serial signal intensity (total flux) difference between 64CuCl2 + TCPP and 64CuCl2. Moreover, the differential fluorescence images of TCPP were obtained by subtracting the 64CuCl2 image from the 64CuCl2 + TCPP image. The experimental results considering different 64CuCl2 doses showed a dose-dependent trend. These results demonstrate that a bioluminescence imaging device coupled with different long-pass filters and subtraction image processing can confirm the emission spectra and differential fluorescence images of CR-induced TCPP.

CONCLUSION

This simple method identifies the PS fluorescence emission generated by radionuclide-derived CR and can contribute to accelerating the development of Cherenkov energy transfer imaging and the discovery of new PSs.

Two-point Dixon and six-point Dixon magnetic resonance techniques in the detection, quantification and grading of hepatic steatosis

BACKGROUND

Hepatic steatosis is a very common problem worldwide.

AIM

To assess the performance of two- and six-point Dixon magnetic resonance (MR) techniques in the detection, quantification and grading of hepatic steatosis.

METHODS

A single-center retrospective study was performed in 62 patients with suspected parenchymal liver disease. MR sequences included two-point Dixon, six-point Dixon, MR spectroscopy (MRS) and MR elastography. Fat fraction (FF) estimates on the Dixon techniques were compared to the MRS-proton density FF (PDFF). Statistical tests used included Pearson's correlation and receiver operating characteristic.

RESULTS

FF estimates on the Dixon techniques showed excellent correlation (≥ 0.95) with MRS-PDFF, and excellent accuracy [area under the receiver operating characteristic (AUROC) ≥ 0.95] in: (1) Detecting steatosis; and (2) Grading severe steatosis, (P < 0.001). In iron overload, two-point Dixon was not evaluable due to confounding T2* effects. FF estimates on six-point Dixon vs MRS-PDFF showed a moderate correlation (0.82) in iron overload vs an excellent correlation (0.97) without iron overload, (P < 0.03). The accuracy of six-point Dixon in grading mild steatosis improved (AUROC: 0.59 to 0.99) when iron overload cases were excluded. The excellent correlation (> 0.9) between the Dixon techniques vs MRS-PDFF did not change in the presence of liver fibrosis (P < 0.01).

CONCLUSION

Dixon techniques performed satisfactorily for the evaluation of hepatic steatosis but with exceptions.

Does the use of computed tomography scenogram alone enable diagnosis in cases of bowel obstruction?

BACKGROUND

Ileus is a pathological condition of the abdomen that presents as a medical emergency. It is characterized by potential complications such as perforation and ischemia, which can lead to significant morbidity and mortality if not promptly addressed. The successful management of ileus relies heavily on the timely and precise identification of the condition. While conventional radiography (CR) is commonly used as the primary diagnostic tool, its accuracy in identifying obstructions ranges from 46% to 80%. Furthermore, the diagnostic accuracy of identifying the location and etiology of intestinal obstruction by CR is limited, therefore making computed tomography (CT) the ideal imaging modality in this regard.

AIM

To determine the presence of acute bowel obstruction (BO) on abdominal CT scenogram images and the accuracy of determining its possible location, taking into account the experience of the observers.

METHODS

A retrospective screening was conducted on an ensemble of 46 individuals who presented to the emergency department between January 2021 and January 2022 with severe abdominal pain and were subsequently monitored for suspected ileus. The abdominal CT scans of these patients were assessed by three radiologists with varying levels of experience (1, 3, and 10 years) at different intervals (1 mo apart). The evaluation focused on determining the presence or absence of BO, as well as identifying the potential location of the obstruction (small bowel or large bowel). The study employed Kappa statistics to assess inter-observer variances, while the McNamer test was used to evaluate obstruction and segmentation discrepancies between observations. A significance level of P < 0.05 was determined to indicate statistical significance.

RESULTS

Out of the total sample size of 46 patients, 15 individuals (32.6%) were identified as female, while the remaining 31 individuals (67.4%) were identified as male. The ultimate diagnosis of 42 instances (91.3%) indicated ileus resulting from mechanical obstruction (MO). Among these patients, 14 (33%) experienced obstruction in the large bowel (LB), while 28 (66%) experienced obstruction in the small bowel (SB). The initial evaluation yielded sensitivity rates of 76.19%, 83.31%, and 83.33%, and diagnostic accuracy rates of 69.56%, 76.08%, and 80.43% for the detection of BO among the three observers. The initial study revealed that the average sensitivity of three observers in detecting the presence of ileus caused by MO was 80.94%, while the diagnostic accuracy was 75.35%. Based on the first evaluation, the senior observer demonstrated the highest sensitivity (85.71%), negative predictive value (92.60%), and diagnostic accuracy (80.43%) when accurately estimating the thick and thin segmentation, as per the final diagnosis. There was no statistically significant disparity observed in the sensitivities pertaining to the identification of ileus during the second assessment, as well as the precise determination of the segment level inside the LB or SB, when comparing the second and third observers. Nevertheless, although there was no statistically significant alteration in the detection rate of ileus by the first observer, there was a notable rise in the accuracy rate of segment estimating (73.91%). The senior assessor had a higher level of accuracy in assessing the existence of ileus and segmentation compared to the other evaluators in both evaluations.

CONCLUSION

The findings of our study indicate that the sensitivity and accuracy rates of abdominal CT scenogram scans in diagnosing acute MOs are similar to or greater than those of CR. Additionally, the study revealed that radiologists with more experience demonstrated a higher likelihood of accurately predicting the existence and potential localization of MO compared to their less experienced counterparts.

Role of pulmonary perfusion magnetic resonance imaging for the diagnosis of pulmonary hypertension: A review

Among five types of pulmonary hypertension, chronic thromboembolic pulmonary hypertension (CTEPH) is the only curable form, but prompt and accurate diagnosis can be challenging. Computed tomography and nuclear medicine-based techniques are standard imaging modalities to non-invasively diagnose CTEPH, however these are limited by radiation exposure, subjective qualitative bias, and lack of cardiac functional assessment. This review aims to assess the methodology, diagnostic accuracy of pulmonary perfusion imaging in the current literature and discuss its advantages, limitations and future research scope.

Distinctive magnetic resonance imaging features in primary central nervous system lymphoma: A case report

BACKGROUND

Primary central nervous system lymphoma (PCNSL) is a rare malignant tumor originating from the lymphatic hematopoietic system. It exhibits unique imaging manifestations due to its biological characteristics.

CASE SUMMARY

Magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), and magnetic resonance spectroscopy was performed. The imaging findings showed multiple space-occupying lesions with low signal on T1-weighted imaging, uniform high signal on T2-weighted imaging, and obvious enhancement on contrast-enhanced scans. DWI revealed diffusion restriction, PWI demonstrated hypoperfusion, and spectroscopy showed elevated choline peak and decreased N-acetylaspartic acid. The patient's condition significantly improved after hormone shock therapy.

CONCLUSION

This case highlights the distinctive imaging features of PCNSL and their importance in accurate diagnosis and management.

Rare portal hypertension caused by Abernethy malformation (Type IIC): A case report

BACKGROUND

Abernethy malformation is a rare congenital vascular malformation with a portosystemic shunt that may clinically manifest as cholestasis, dyspnea, or hepatic encephalopathy, among other conditions. Early diagnosis and classification are very important to further guide treatment. Typically, patients with congenital portosystemic shunts have no characteristics of portal hypertension. Herein, we report an 18-year-old female with prominent portal hypertension that manifested mainly as rupture and bleeding of esophageal varices. Imaging showed a thin main portal vein, no portal vein branches in the liver, and bleeding of the esophageal and gastric varices caused by the collateral circulation upwards from the proximal main portal vein. Patients with Abernethy malformation type I are usually treated with liver transplantation, and patients with type II are treated with shunt occlusion, surgery, or transcatheter coiling. Our patient was treated with endoscopic surgery combined with drug therapy and had no portal hypertension and good hepatic function for 24 mo of follow-up.

CASE SUMMARY

This case report describes our experience in the diagnosis and treatment of an 18-year-old female with Abernethy malformation type IIC and portal hypertension. This condition was initially diagnosed as cirrhosis combined with portal hypertension. The patient was ultimately diagnosed using liver histology and subsequent imaging, and the treatment was highly effective. To publish this case report, written informed consent was obtained from the patient, including the attached imaging data.

CONCLUSION

Abernethy malformation type IIC may develop portal hypertension, and traditional nonselective beta-blockers combined with endoscopic treatment can achieve high efficacy.

Appearance of aseptic vascular grafts after endovascular aortic repair on [(18)F]fluorodeoxyglucose positron emission tomography/computed tomography

BACKGROUND

Diagnosis of prosthetic vascular graft infection with [(18)F]fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) allows for early detection of functional changes associated with infection, based on increased glucose utilization by activated macrophages and granulocytes. Aseptic vascular grafts, like all foreign bodies, can stimulate an inflammatory response, which can present as increased activity on 18F-FDG PET/CT. Consequently, distinguishing aseptic inflammation from graft infection, though important, can be difficult. In the case of endovascular aneurysm repair (EVAR), a minimally invasive procedure involving the transfemoral insertion of an endoprosthetic stent graft, the normal postoperative appearance of these grafts on 18F-FDG PET/CT can vary over time, potentially confounding study interpretation.

AIM

To investigate the visual, semiquantitative, and temporal characteristics of aseptic vascular grafts in patients status post EVAR.

METHODS

In this observational retrospective cohort study, patients with history of EVAR who underwent 18F-FDG PET/CT for indications other than infection were identified retrospectively. All patients were asymptomatic for graft infection - no abdominal pain, fever of unknown origin, sepsis, or leukocytosis - at the time of imaging and for ≥ 2 mo after each PET/CT. Imaging studies such as CT for each patient were also reviewed, and any patients with suspected or confirmed vascular graft infection were excluded. One hundred two scans performed on 43 patients (34 males; 9 females; age = 77 ± 8 years at the time of the final PET/CT) were retrospectively reviewed. All 43 patients had an abdominal aortic (AA) vascular graft, 40 patients had a right iliac (RI) limb graft, and 41 patients had a left iliac (LI) limb graft. Twenty-two patients had 1 PET/CT and 21 patients had from 2 to 9 PET/CTs. Grafts were imaged between 2 mo to 168 mo (about 14 years) post placement. Eight grafts were imaged within 6 mo of placement, including three that were imaged within three months of placement. The mean interval between graft placement and PET/CT for all 102 scans was 51 ± 39 mo. PET/CT data was reconstructed with region-of-interest analysis of proximal, mid and distal portions of the grafts and background ascending aorta. Maximum standardized uptake value (SUVmax) was recorded for each region. SUVmax-to-background uptake ratios (URs) were calculated. Visual assessment was performed using a 2-pattern grading scale: Diffuse (homogeneous uptake less than liver uptake) and focal (one or more areas of focal uptake in any part of the graft). Statistical analysis was performed.

RESULTS

In total, there were 306 AA grafts, 285 LI grafts, 282 RI grafts, and 306 ascending aorta background SUVmax measurements. For all 102 scans, mean SUVmax values for AA grafts were 2.8-3.0 along proximal, mid, and distal segments. Mean SUVmax values for LI grafts and RI grafts were 2.7-2.8. Mean SUVmax values for background were 2.5 ± 0.5. Mean URs were 1.1-1.2. Visual analysis of the scans reflected results of quantitative analysis. On visual inspection, 98% revealed diffuse, homogeneous 18F-FDG uptake less than liver. Graft URs and visual pattern categories were significantly associated for AA graft URs (F-ratio = 21.5, P < 0.001), LI graft URs (F-ratio = 20.4, P < 0.001), and RI graft URs (F-ratio = 30.4, P < 0.001). Thus, visual patterns of 18F-FDG uptake corresponded statistically significantly to semiquantitative URs. The age of grafts showing focal patterns was greater than grafts showing diffuse patterns, 87 ± 89 vs 50 ± 37 mo, respectively (P = 0.02). URs were significantly associated with graft age for AA grafts (r = 0.19, P = 0.001). URs were also significantly associated with graft age for LI grafts (r = 0.25, P < 0.0001), and RI grafts (r = 0.31, P < 0.001). Quartiles of similar numbers of graft (n = 25-27) grouped by graft age indicated that URs were significantly higher for 4th quartile vs 2nd quartile URs (F-ratio = 19.5, P < 0.001). When evaluating URs, graft SUVmax values within 10%-20% of the ascending aorta SUVmax is evident in aseptic grafts, except for grafts in the oldest quartiles. In this study, grafts in the oldest quartiles (> 7 years post EVAR) showed SUVmax up to 30% higher than the ascending aorta SUVmax.

CONCLUSION

Characteristics of an aseptic vascular stent graft in the aorta and iliac vessels on 18F-FDG PET/CT include graft SUVmax values within 10%-20% of the ascending aorta background SUVmax. The SUVmax of older aseptic grafts can be as much as 30% above background. The visual uptake pattern of diffuse, homogeneous uptake less than liver was seen in 98% of aseptic vascular grafts, making this pattern particularly reassuring for clinicians.

Can the change of vasomotor activity in irritable bowel syndrome patients be detected via color Doppler ultrasound?

BACKGROUND

Irritable bowel syndrome (IBS) is one of the most frequently referred conditions to the gastrointestinal outpatient clinic. The pathophysiology of IBS has not been determined with certainty. Visceral hypersensitivity is indicated as one of the pathophysiologies. The sympathetic nervous system is primarily in charge of controlling the arteries, and its effect is vasospasm in the medium and large arteries, resulting in decreased blood flow.

AIM

To demonstrate, using Doppler evaluation of the brachial artery, that sympathetic activity impairs vasomotor performance due to autonomic neuropathy, which we believe is associated with IBS.

METHODS

There were 58 participants in the study. The control group consisted of 29 healthy patients, while the remaining 29 patients had been diagnosed with IBS. Patients who met the Rome IV criteria and had IBS were included in the study. People with known polyneuropathy or non-IBS chronic conditions that can progress were excluded from the trial, as were those with essential hypertension, diabetes mellitus, cardiovascular disease, or peripheral arterial disease, and patients diagnosed with anxiety or depression. Those with moderate to severe carpal tunnel syndrome or a median nerve lesion due to trauma were also excluded from the trial. A Doppler probe was used to measure the baseline diameter and flow rates of the brachial artery from 2 cm superior to the antecubital fossa. The Doppler probe remained stationary throughout the experiment, allowing for continuous measurements. Then, to activate the sympathetic fibers, an electrical stimulus for 5 s with an intensity of 10 mA and a frequency of 1 Hz was applied to the median nerve at the wrist level via the bipolar stimulus electrode. The artery diameter and flow rates were measured again immediately following the fifth stimulus.

RESULTS

In healthy persons with no history of chronic illness, there was a statistically significant decrease in flow rate after stimulation (P < 0.001). In addition, stimulation resulted in a statistically significant reduction in the diameter of the brachial artery (P < 0.001). Patients diagnosed with IBS had statistically significant vasodilation and an increase in flow rate.

CONCLUSION

Sympathetic stimulation causes a reduction in vascular diameter and blood flow, whereas it has the reverse effect on IBS patients. In investigating the involvement of autonomic neuropathy in the development of IBS, significant changes in brachial artery Doppler parameters were observed before and after stimulation of the median nerve with low-current sensory stimulation. This method is thought to be more user-friendly and comfortable than other methods described in the literature.

Invasive rhinocerebral mucormycosis: Imaging the temporal evolution of disease in post COVID-19 case with diabetes: A case report

BACKGROUND

Rhinocerebral mucormycosis (RCM) is a rare, fatal, invasive fungal infection infecting mainly patients with immunocompromised conditions, such as diabetes mellitus, hematologic malignancies, and organ transplantations. Coronavirus disease 2019 (COVID-19) disease in these patients further weakens the immune system due to several factors, including hypoxia, corticosteroid usage (further increasing hyperglycemic status), mechanical ventilation, increased serum ferritin levels, endothelitis due to free radicals, and glucose receptor protein upregulation. Timely diagnosis, judicious treatment decisions, and diabetes control with proper treatment guidelines in patients with coexisting COVID-19 disease can reduce complication rates and improve survival.

CASE SUMMARY

A 75-year-old male patient with diabetes and hypertension diagnosed with COVID-19 presented to the emergency department. Laboratory examinations revealed elevated blood glucose levels, as well as ketone bodies in the urine. He was treated with oxygen and steroids, as well as insulin to correct blood glucose levels. He complained of a headache 10 d later, and imaging demonstrated mucosal thickening in bilateral sphenoidal, ethmoidal, and maxillary sinuses with hyperdense foci in the right maxillary sinus but without central nervous system involvement. Surgical debridement was performed, and a histopathological study revealed fungi hyphae. Systemic antifungals (amphotericin b and posaconazole) were administered. Subsequently, on 15^th day he developed right lower limb weakness and left lateral rectus palsy. There was slow but steady progress, and he was discharged. However, he presented to emergency department 1mo later with altered sensorium and poor control of diabetes resulted in an intracranial spread of mucormycosis, which ultimately led to the patient’s poor prognosis and slow recovery.

CONCLUSION

Prompt early diagnosis, judicious treatment decisions, and diabetes control with proper treatment guidelines are necessary in patients with COVID-19 associated invasive RCM to reduce complication rates and improve patient survival.

Progress of magnetic resonance imaging radiomics in preoperative lymph node diagnosis of esophageal cancer

Esophageal cancer, also referred to as esophagus cancer, is a prevalent disease in the cardiothoracic field and is a leading cause of cancer-related mortality in China. Accurately determining the status of lymph nodes is crucial for developing treatment plans, defining the scope of intraoperative lymph node dissection, and ascertaining the prognosis of patients with esophageal cancer. Recent advances in diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging (MRI) have improved the effectiveness of MRI for assessing lymph node involvement, making it a beneficial tool for guiding personalized treatment plans for patients with esophageal cancer in a clinical setting. Radiomics is a recently developed imaging technique that transforms radiological image data from regions of interest into high-dimensional feature data that can be analyzed. The features, such as shape, texture, and waveform, are associated with the cancer phenotype and tumor microenvironment. When these features correlate with the clinical disease outcomes, they form the basis for specific and reliable clinical evidence. This study aimed to review the potential clinical applications of MRI-based radiomics in studying the lymph nodes affected by esophageal cancer. The combination of MRI and radiomics is a powerful tool for diagnosing and treating esophageal cancer, enabling a more personalized and effectual approach.

Role of contrast-enhanced serial/spot abdominal X-rays in perioperative follow-up of patients undergoing abdominal surgery: An observational clinical study

BACKGROUND

Many imaging methods such as ultrasonography, computed tomography (CT), magnetic resonance imaging, and endoscopy are used to identify the problems or complications that occur in the perioperative period and to determine the appropriate therapeutic approach. Specialists at surgical clinics and intensive care units sometimes need diagnostic procedures that can give quick results or reveal unexpected results. In particular, rapid on-site evaluation of patients followed under intensive care conditions has several advantages.

AIM

To determine the problems developing in patients in the perioperative period by contrast-enhanced abdominal X-ray (CE-AXR), revealing their current status or defining the effectiveness of CE-AXR.

METHODS

The files of the patients who underwent hepatopancreatobiliary or upper gastrointestinal surgery, whose CE-AXR film was taken, were reviewed retrospectively. Abdominal X-ray radiographs taken after ingestion of a water-soluble contrast agent (iohexol, 300 mg, 50 cc vial) and its application in a drain, nasogastric tube, or stent were evaluated. The contribution of the data obtained in patients who underwent CE-AXR to the diagnosis, follow-up, and treatment processes and the effectiveness of the application were investigated.

RESULTS

CE-AXR was applied to 131 patients in our clinic, most of whom underwent hepatopancreatobiliary or upper gastrointestinal surgery. It was determined that the data obtained from CE-AXR films taken in 98 (74.8%) of the patients contributed to the diagnosis, treatment, and follow-up expectations and positively affected the clinical processes.

CONCLUSION

CE-AXR is a simple procedure that can be applied anywhere, especially in intensive care patients and at bedside, with a portable X-ray device. The simplicity of the procedure, less radiation exposure for the patients, less time wastage, reduction in the CT and endoscopy procedure burden and costs, quick results, rapid assessment of the situation, and enabling the monitoring of processes with repetitive procedures are important advantages. X-rays taken will be useful in terms of being a reference value during the follow-up period of the patient and determining the situation in medicolegal processes.

Interobserver reliability of computed tomography angiography in the assessment of ruptured intracranial aneurysm and impact on patient management

BACKGROUND

Aneurysmal subarachnoid hemorrhage is an emergency that can lead to a high mortality rate and many severe complications. It is critical to make a rapid radiological evaluation of ruptured intracranial aneurysms (RIAs) to determine the appropriate surgical treatment.

AIM

To assess the reliability of computed tomography angiography (CTA) in assessing different features of ruptured intracranial aneurysm and its impact on patient management.

METHODS

The final cohort of this study consisted of 146 patients with RIAs (75 male and 71 female) who underwent cerebral CTA. Their age ranged from 25 to 80, and the mean age ± SD was 57 ± 8.95 years. Two readers were asked to assess different features related to the aneurysm and perianeurysmal environment. Inter-observer agreement was measured using kappa statistics. Imaging data extracted from non-contrast computed tomography and CTA were considered to categorize the study population into two groups according to the recommended therapeutic approach.

RESULTS

The inter-observer agreement of both reviewers was excellent for the detection of aneurysms (K = 0.95, P = 0.001), aneurysm location (K = 0.98, P = 0.001), and (K = 0.98, P = 0.001), morphology (K = 0.92, P = 0.001) and margins (K = 0.95, P = 0.001). There was an excellent interobserver agreement for the measurement of aneurysm size (K = 0.89, P = 0.001), neck (K = 0.85, P = 0.001), and dome-to-neck ratio (K = 0.98, P = 0.001). There was an excellent inter-observer agreement for the detection of other aneurysm-related features such as thrombosis (K = 0.82, P = 0.001), calcification (K = 1.0, P = 0.001), bony landmark (K = 0.89, P = 0.001) and branch incorporation (K = 0.91, P = 0.001) as well as perianeurysmal findings including vasospasm (K = 0.91, P = 0.001), perianeurysmal cyst (K = 1.0, P = 0.001) and associated vascular lesions (K = 0.83, P = 0.001). Based on imaging features, 87 patients were recommended to have endovascular treatment, while surgery was recommended in 59 patients. 71.2% of the study population underwent the recommended therapy.

CONCLUSION

CTA is a reproducible promising diagnostic imaging modality for detecting and characterizing cerebral aneurysms.

Radiological parameters to predict pancreatic texture: Current evidence and future perspectives

Preoperative prediction of the postoperative pancreatic fistula risk is critical in the current era of minimally invasive pancreatic surgeries to tailor perioperative management, thereby minimizing postoperative morbidity. Pancreatic duct diameter can be readily measured by any routine imaging used to diagnose pancreatic disease. However, radiological evaluation of pancreatic texture, an important determinant of pancreatic fistula, has not been widely used to predict the risk of postoperative pancreatic fistula. Qualitative and quantitative assessment of pancreatic fibrosis and fat fraction provides the basis for predicting pancreatic texture. Traditionally computed tomography has been utilized in identifying and characterizing pancreatic lesions and background parenchymal pathologies. With the increasing utilisation of endoscopic ultrasound and magnetic resonance imaging for evaluating pancreatic pathologies, elastography is emerging as a promising tool for predicting pancreatic texture. Also, recent studies have shown that early surgery for chronic pancreatitis is associated with better pain relief and preservation of pancreatic function. Pancreatic texture assessment can allow early diagnosis of chronic pancreatitis, facilitating early intervention. The present review outlines the current evidence in utilizing various imaging modalities for determining the pancreatic texture based on different parameters and image sequences. However, multidisciplinary investigations using strong radiologic-pathologic correlation are needed to standardize and establish the role of these non-invasive diagnostic tools in predicting pancreatic texture.

Computed tomography angiographic study of surgical anatomy of thyroid arteries: Clinical implications in neck dissection

BACKGROUND

The course and variations of thyroid arteries must be understood by surgeons to prevent bleeding during operative procedures of the thyroid gland. There is limited scientific literature regarding the radiological anatomy of thyroid arteries in this geographical area, the Garhwal region of Sub-Himalayan belt, which is considered to be the endemic belt of goiter. Computed tomography angiography provides a three-dimensional orientation of the vascular and surgical anatomy of the entire cervical region.

AIM

To estimate the proportion of variation in origin of thyroid arteries using Computed Tomography Angiography.

METHODS

Using Computed Tomography Angiography, the presence and origin of the superior thyroid artery, inferior thyroid artery, and thyroid ima artery were observed and assessed.

RESULTS

Out of total 210 subjects, superior thyroid artery was seen to be emerging from external carotid artery in 77.1% cases. The artery was found to be originating at the level of bifurcation of common carotid artery in 14.3% cases, whereas in 8.6% cases, it emerged as a direct branch of the common carotid artery. Similarly, the inferior thyroid artery was observed to be emerging from thyrocervical trunk, subclavian artery and vertebral artery in 95.7% cases, 3.3% and 1% cases, respectively. Thyroid ima artery was also reported in a subject, arising from the brachiocephalic trunk.

CONCLUSION

To avoid vascular injuries, excessive and uncontrollable bleeding, intra-operative difficulties, and post-operative issues, it is imperative for surgeons to be aware of the course and variations of thyroid arteries

Acute pancreatitis: Structured report template of magnetic resonance imaging

Acute pancreatitis (AP) is a common acute abdomen disease of the digestive system. It has a potentially fatal risk because of its variable severity and various complications. With the widespread application of the Revised Atlanta Classification, new requirements for AP imaging reports are introduced. Experts in abdominal radiology and pancreatology in the United States published the first structured computed tomography reporting template for AP in 2020. However, there is no corresponding structured magnetic resonance imaging (MRI) reporting template globally. Therefore, this article focuses on the structured MRI report of AP images from our pancreatitis imaging center, which is intended to improve the systematic understanding of this disease and standardize the writing of MRI structured reports. In the meantime, we aim to promote the clinical diagnosis and assessment of MRI efficacy for AP and its multiple complications. It is further intended to facilitate academic exchanges and scientific research between different medical centers.

Future of prostate imaging: Artificial intelligence in assessing prostatic magnetic resonance imaging

Prostate cancer (Pca; adenocarcinoma) is one of the most common cancers in adult males and one of the leading causes of death in both men and women. The diagnosis of Pca requires substantial experience, and even then the lesions can be difficult to detect. Moreover, although the diagnostic approach for this disease has improved significantly with the advent of multiparametric magnetic resonance, that technology has certain unresolved limitations. In recent years artificial intelligence (AI) has been introduced to the field of radiology, providing new software solutions for prostate diagnostics. Precise mapping of the prostate has become possible through AI and this has greatly improved the accuracy of biopsy. AI has also allowed for certain suspicious lesions to be attributed to a given group according to the Prostate Imaging-Reporting & Data System classification. Finally, AI has facilitated the combination of data obtained from clinical, laboratory (prostate-specific antigen), imaging (magnetic resonance), and biopsy examinations, and in this way new regularities can be found which at the moment remain hidden. Further evolution of AI in this field is inevitable and it is almost certain to significantly expand the efficacy, accuracy and efficiency of diagnosis and treatment of Pca.

Chronic thromboembolic pulmonary hypertension is associated with a loss of total lung volume on computed tomography

BACKGROUND

Although lung volumes are usually normal in individuals with chronic thromboembolic pulmonary hypertension (CTEPH), approximately 20%-29% of patients exhibit a restrictive pattern on pulmonary function testing.

AIM

To quantify longitudinal changes in lung volume and cardiac cross-sectional area (CSA) in patients with CTEPH.

METHODS

In a retrospective cohort study of patients seen in our hospital between January 2012 and December 2019, we evaluated 15 patients with CTEPH who had chest computed tomography (CT) performed at baseline and after at least 6 mo of therapy. We matched the CTEPH cohort with 45 control patients by age, sex, and observation period. CT-based lung volumes and maximum cardiac CSAs were measured and compared using the Wilcoxon signed-rank test and the Mann-Whitney u test.

RESULTS

Total, right lung, and right lower lobe volumes were significantly reduced in the CTEPH cohort at follow-up vs baseline (total, P = 0.004; right lung, P = 0.003; right lower lobe; P = 0.01). In the CTEPH group, the reduction in lung volume and cardiac CSA was significantly greater than the corresponding changes in the control group (total, P = 0.01; right lung, P = 0.007; right lower lobe, P = 0.01; CSA, P = 0.0002). There was a negative correlation between lung volume change and cardiac CSA change in the control group but not in the CTEPH cohort.

CONCLUSION

After at least 6 mo of treatment, CT showed an unexpected loss of total lung volume in patients with CTEPH that may reflect continued parenchymal remodeling.

Detection of tracheal branching with computerized tomography: The relationship between the angles and age-gender

BACKGROUND

The data obtained on the anatomical knowledge of the tracheobronchial system can be used for diagnosis, treatment and interventional interventions in areas such as anesthesia, thoracic surgery, pulmonary physiology.

AIM

To determine the tracheobronchial branching angles in pediatric and adult populations by using the multislice computed tomography (CT) and minimum intensity projection (MinIP) technique, which is a non-invasive method.

METHODS

Our study was carried out retrospectively. Patients who underwent contrast and non-contrast CT examination, whose anatomically and pathophysiologically good tracheobronchial system and lung parenchyma images were obtained, were included in the study. Measurements were made in the coronal plane of the lung parenchyma. In the coronal plane, right main bronchus-left main bronchus angle, right upper lobe bronchus-intermedius bronchus angle, right middle lobe bronchus-right lower lobe bronchus angle, left upper lobe bronchus-left lower lobe bronchus angle were measured.

RESULTS

The study population consisted of 1511 patients, 753 pediatric (mean age: 13.4 ± 4.3; range: 1-18 years) and 758 adults (mean age: 54.3 ± 17.3; range: 19-94 years). In our study, tracheal bifurcation angle was found to be 73.3° ± 13.7° (59.6°-87°) in the whole population. In the pediatric group, the right-left main coronal level was found to be higher in boys compared to girls (74.6° ± 12.9° vs 71.2° ± 13.9°, P = 0.001). In the adult group, the right-left main coronal level was found to be lower in males compared to females (71.9° ± 12.9° vs 75.8° ± 14.7°, P < 0.001).

CONCLUSIONS

Our study, with the number of 1511 patients, is the first study in the literature with the largest number of patient populations including pediatric and adult demographic data, measuring the angle values of the tracheobronchial system using multislice CT and MinIP technique. Study data will not only be a guide during invasive procedures, but it can also guide studies to be done with imaging methods.

Does sevoflurane sedation in pediatric patients lead to "pseudo" leptomeningeal enhancement in the brain on 3 Tesla magnetic resonance imaging?

BACKGROUND

Prominent leptomeningeal contrast enhancement (LMCE) in the brain is observed in some pediatric patients during sedation for imaging. However, based on clinical history and cerebrospinal fluid analysis, the patients are not acutely ill and do not exhibit meningeal signs. Our study determined whether sevoflurane inhalation in pediatric patients led to this pattern of 'pseudo' LMCE (pLMCE) on 3 Tesla magnetic resonance imaging (MRI).

AIM

To highlight the significance of pLMCE in pediatric patients undergoing enhanced brain MRI under sedation to avoid misinterpretation in reports.

METHODS

A retrospective cross-sectional evaluation of pediatric patients between 0-8 years of age was conducted. The patients underwent enhanced brain MRI under inhaled sevoflurane. The LMCE grade was determined by two radiologists, and interobserver variability of the grade was calculated using Cohen's kappa. The LMCE grade was correlated with duration of sedation, age and weight using the Spearman rho rank correlation.

RESULTS

A total of 63 patients were included. Fourteen (22.2%) cases showed mild LMCE, 48 (76.1%) cases showed moderate LMCE, and 1 case (1.6%) showed severe LMCE. We found substantial agreement between the two radiologists in detection of pLMCE on post-contrast T1 imaging (kappa value = 0.61; P < 0.001). Additionally, we found statistically significant inverse and moderate correlations between patient weight and age. There was no correlation between duration of sedation and pLMCE.

CONCLUSION

pLMCE is relatively common on post-contrast spin echo T1-weighted MRI of pediatric patients sedated by sevoflurane due to their fragile and immature vasculature. It should not be misinterpreted for meningeal pathology. Knowing pertinent clinical history of the child is an essential prerequisite to avoid radiological overcalling and the subsequent burden of additional investigations.

Evaluation of causal heart diseases in cardioembolic stroke by cardiac computed tomography

Cardioembolic stroke is a potentially devastating condition and tends to have a poor prognosis compared with other ischemic stroke subtypes. Therefore, it is important for proper therapeutic management to identify a cardiac source of embolism in stroke patients. Cardiac computed tomography (CCT) can detect the detailed visualization of various cardiac pathologies in the cardiac chambers, interatrial and interventricular septum, valves, and myocardium with few motion artifacts and few dead angles. Multiphase reconstruction images of the entire cardiac cycle make it possible to demonstrate cardiac structures in a dynamic manner. Consequently, CCT has the ability to provide high-quality information about causal heart disease in cardioembolic stroke. In addition, CCT can simultaneously evaluate obstructive coronary artery disease, which may be helpful in surgical planning in patients who need urgent surgery, such as cardiac tumors or infective endocarditis. This review will introduce the potential clinical applications of CCT in an ischemic stroke population, with a focus on diagnosing cardioembolic sources using CCT.

Radiomic advances in the transarterial chemoembolization related therapy for hepatocellular carcinoma

Radiomics is a hot topic in the research on customized oncology treatment, efficacy evaluation, and tumor prognosis prediction. To achieve the goal of mining the heterogeneity information within the tumor tissue, the image features concealed within the tumoral images are turned into quantifiable data features. This article primarily describes the research progress of radiomics and clinical-radiomics combined model in the prediction of efficacy, the choice of treatment modality, and survival in transarterial chemoembolization (TACE) and TACE combination therapy for hepatocellular carcinoma.

Multi-modality parathyroid imaging: A shifting paradigm

The goal of parathyroid imaging in hyperparathyroidism is not diagnosis, rather it is the localization of the cause of hyperparathyroidism for planning the best therapeutic approach. Hence, the role of imaging to accurately and precisely localize the abnormal parathyroid tissue is more important than ever to facilitate minimally invasive parathyroidectomy over bilateral neck exploration. The common causes include solitary parathyroid adenoma, multiple parathyroid adenomas, parathyroid hyperplasia and parathyroid carcinoma. It is highly imperative for the radiologist to be cautious of the mimics of parathyroid lesions like thyroid nodules and lymph nodes and be able to differentiate them on imaging. The various imaging modalities available include high resolution ultrasound of the neck, nuclear imaging studies, four-dimensional computed tomography (4D CT) and magnetic resonance imaging. Contrast enhanced ultrasound is a novel technique which has been recently added to the armamentarium to differentiate between parathyroid adenomas and its mimics. Through this review article we wish to review the imaging features of parathyroid lesions on various imaging modalities and present an algorithm to guide their radiological differentiation from mimics.

Hepatocellular carcinoma: State of the art diagnostic imaging

Primary liver cancer is the fourth most common malignancy worldwide, with hepatocellular carcinoma (HCC) comprising up to 90% of cases. Imaging is a staple for surveillance and diagnostic criteria for HCC in current guidelines. Because early diagnosis can impact treatment approaches, utilizing new imaging methods and protocols to aid in differentiation and tumor grading provides a unique opportunity to drastically impact patient prognosis. Within this review manuscript, we provide an overview of imaging modalities used to screen and evaluate HCC. We also briefly discuss emerging uses of new imaging techniques that offer the potential for improving current paradigms for HCC characterization, management, and treatment monitoring.

Magnetic resonance imaging findings of spontaneous pyomyoma in a premenopausal woman managed with myomectomy: A case report

BACKGROUND

Acute fibroid complications are rare. However, failure to recognize and treat acute complications expeditiously when they occur can lead to catastrophic, even deadly, complications. Pyomyoma is a rare but potentially fatal condition resulting from infarction and infection of a fibroid through bacterial seeding and direct, hematogenous, or lymphatic dissemination. Even though the diagnosis is established through clinical and laboratory findings, imaging is an important complementary method to support the suspected diagnosis.

CASE SUMMARY

Herein, we report a case of a pyomyoma in a nulliparous woman previously diagnosed with uterine leiomyomatosis according to ultrasound findings. The patient had previously attended the emergency room due to hypogastric pain unresponsive to analgesics. After a week of persistent pain, she developed sepsis without any identifiable foci. Magnetic resonance imaging revealed findings compatible with uterine myomatosis with red degeneration, and a possible diagnosis of a pyomyoma was made according to the imaging findings along with the patient’s clinical features. We decided to perform myomectomy (which is an infrequently performed surgical treatment due to the procedure’s intrinsic implications) due to the patient’s desire to preserve fertility. Histopathologic results revealed a uterine leiomyoma with coagulative and liquefactive necrosis, while the tissue culture showed gram-negative cocci bacteria, which were successfully treated using antibiotic therapy. The patient’s health status improved after several days.

CONCLUSION

The main diagnostic tools to evaluate pyomyomas are the clinical and laboratory findings as well as tissue cultures. Nonetheless, magnetic resonance imaging can help to corroborate these findings as well as to better characterize myomas with its different complications.

Effects of combining multiple dose reduction techniques on coronary computed tomography angiography

BACKGROUND

Coronary computed tomography angiography (CCTA) is the preferred non-invasive examination method for coronary heart disease. However, the radiation from computed tomography has become a concern since public awareness of radiation hazards continue to increase.

AIM

To explore the value of multiple dose reduction techniques for CCTA.

METHODS

Consecutive normal and overweight patients were prospectively divided into two groups: Group A₁, patients who received multiple dose reduction scans (n = 82); and group A₂, patients who received conventional scans (n = 39). The scan parameters for group A₁ were as follows: Isocentric scan, tube voltage = 80 kV, and tube current control using 80% smart milliampere. The scan parameters for group A₂ were as follows: Normal position, tube voltage = 100 kV, and smart milliampere.

RESULTS

The average effective doses (EDs) for groups A₁ and A₂ were 1.13 ± 0.35 and 3.36 ± 1.30 mSv, respectively. There was a statistically significant difference in ED between the two groups (P < 0.01). Furthermore, noise was significantly lower, and both signal-to-noise ratio and contrast signal-to-noise ratio were higher in group A₂ when compared to group A₁ (P < 0.01). Moreover, the subjective image quality (IQ) scores were excellent in both groups, in which there was no significant difference in subjective IQ score between the two groups (P = 0.12).

CONCLUSION

Multiple dose reduction scan techniques can significantly decrease the ED of patients receiving CCTA examinations for clinical diagnosis.

Imaging of paraduodenal pancreatitis: A systematic review

BACKGROUND

Paraduodenal pancreatitis (PP) represents a diagnostic challenge, especially in non-referral centers, given its potential imaging overlap with pancreatic cancer. There are two main histological variants of PP, the cystic and the solid, with slightly different imaging appearances. Moreover, imaging findings in PP may change over time because of disease progression and/or as an effect of its risk factors exposition, namely alcohol intake and smoking.

AIM

To describe multimodality imaging findings in patients affected by PP to help clinicians in the differential diagnosis with pancreatic cancer.

METHODS

The systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-analyses 2009 guidelines. A Literature search was performed on PubMed, Embase and Cochrane Library using (groove pancreatitis [Title/Abstract]) OR (PP [Title/Abstract]) as key words. A total of 593 articles were considered for inclusion. After eliminating duplicates, and title and abstract screening, 53 full-text articles were assessed for eligibility. Eligibility criteria were: Original studies including 8 or more patients, fully written in English, describing imaging findings in PP, with pathological confirmation or clinical-radiological follow-up as the gold standard. Finally, 14 studies were included in our systematic review.

RESULTS

Computed tomography (CT) findings were described in 292 patients, magnetic resonance imaging (MRI) findings in 231 and endoscopic ultrasound (EUS) findings in 115. Duodenal wall thickening was observed in 88.8% of the cases: Detection rate was 96.5% at EUS, 91.0% at MRI and 84.1% at CT. Second duodenal portion increased enhancement was recognizable in 76.3% of the cases: Detection rate was 84.4% at MRI and 72.1% at CT. Cysts within the duodenal wall were detected in 82.6% of the cases: Detection rate was 94.4% at EUS, 81.9% at MRI and 75.7% at CT. A solid mass in the groove region was described in 40.9% of the cases; in 78.3% of the cases, it showed patchy enhancement in the portal venous phase, and in 100% appeared iso/hyperintense during delayed phase imaging. Only 3.6% of the lesions showed restricted diffusion. The prevalence of radiological signs of chronic obstructive pancreatitis, namely main pancreatic duct dilatation, pancreatic calcifications, and pancreatic cysts, was extremely variable in the different articles.

CONCLUSION

PP has peculiar imaging findings. MRI is the best radiological imaging modality for diagnosing PP, but EUS is more accurate than MRI in depicting duodenal wall alterations.

Advancements of molecular imaging and radiomics in pancreatic carcinoma

Despite the recent progress of medical technology in the diagnosis and treatment of tumors, pancreatic carcinoma remains one of the most malignant tumors, with extremely poor prognosis partly due to the difficulty in early and accurate imaging evaluation. This paper focuses on the research progress of magnetic resonance imaging, nuclear medicine molecular imaging and radiomics in the diagnosis of pancreatic carcinoma. We also briefly described the achievements of our team in this field, to facilitate future research and explore new technologies to optimize diagnosis of pancreatic carcinoma.

Clinical anatomy of hepatic vessels by computed tomography angiography: A minireview

The liver has a complex vascular anatomy with a unique dual blood supply. Clinical conditions of the liver vary widely and include disorders originating in the vascular and biliary systems as well as the parenchyma. In most vascular disorders, the effects on the liver are generally subclinical because of its abundant blood supply. However, early diagnosis of such vascular diseases can significantly reduce patient morbidity and mortality. Because imaging findings of vascular disease are not always readily apparent, diagnosis can be difficult. Computed tomography angiography is an excellent imaging modality for visualizing the vascular anatomy of patients for treatment planning. In this review article, we focus on the vascular anatomy of the liver and the imaging findings in some acute hepatic vascular diseases.

Diagnostic efficacy of diffusion-weighted imaging and semiquantitative and quantitative dynamic contrast-enhanced magnetic resonance imaging in salivary gland tumors

BACKGROUND

Increased use of functional magnetic resonance imaging (MRI) methods such as diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) MRI consisting of sequential contrast series, allows us to obtain more information on the microstructure, cellularity, interstitial distance, and vascularity of tumors, which has increased the discrimination power for benign and malignant salivary gland tumors (SGTs). In the last few years, quantitative DCE MRI data containing T1 perfusion parameters (K_trans, K_ep and V_e), were reported to contribute to the differentiation of benign or malignant subtypes in SGTs.

AIM

To evaluate the diagnostic efficacy of DWI and semiquantitative and quantitative perfusion MRI parameters in SGTs.

METHODS

Diffusion MRI [apparent diffusion coefficient (ADC) value] with a 1.5 T MR machine, semiquantitative perfusion MRI [time intensity curve (TIC) pattern], and quantitative perfusion MRI examinations (K_trans, K_ep and V_e) of 73 tumors in 67 patients with histopathological diagnosis performed from 2017 to 2021 were retrospectively evaluated. In the ADC value and semiquantitative perfusion MRI measurements, cystic components of the tumors were not considered, and the region of interest (ROI) was manually placed through the widest axial section of the tumor. TIC patterns were divided into four groups: Type A = T_peak > 120 s; type B = T_peak ≤ 120 s, washout ratio (WR) ≥ 30%; type C = T_peak ≤ 120 s, WR < 30%; and type D = flat TIC. For the quantitative perfusion MRI analysis, a 3D ROI was placed in the largest solid component of the tumor, and the K_trans, K_ep and V_e values were automatically generated.

RESULTS

The majority of SGTs were located in the parotid glands (86.3%). Of all the SGTs, 68.5% were benign and 31.5% were malignant. Significant differences were found for ADC values among pleomorphic adenomas (PMAs), Warthin's tumors (WTs), and malignant tumors (MTs) (P < 0.001). PMAs had type A and WTs had type B TIC pattern while the vast majority of MTs and other benign tumors (OBTs) (54.5% and 45.5%, respectively) displayed type C TIC pattern. PMAs showed no washout, while the highest mean WR was observed in WTs (59% ± 11%). K_trans values of PMAs, WTs, OBTs, and MTs were not significantly different. K_ep values of PMAs and WTs were significantly different from those of OBTs and MTs. Mean V_e value of WTs was significantly different from those of PMAs, OBTs, and MTs (P < 0.001).

CONCLUSION

The use of quantitative DCE parameters along with diffusion MRI and semiquantitative contrast-enhanced MRI in SGTs could improve the diagnostic accuracy.

Unmasking lower gastrointestinal bleeding under administration of norepinephrine

BACKGROUND

Bleeding in the gastrointestinal tract is common and transarterial embolization enables the clinician to control gastrointestinal bleeding. Contrast extravasation is a prerequisite for successful embolization. Provocative angiography is helpful in the detection of elusive bleeding.

AIM

We performed a retrospective analysis of angiographic treatment in patients with lower gastrointestinal hemorrhage and initially negative angiographies, as well as the role of norepinephrine (NE) in unmasking bleeding.

METHODS

We analyzed 41 patients with lower gastrointestinal bleeding after angiography who had undergone treatment over a period of 10 years. All patients had a positive shock index and needed intensive care.

RESULTS

In three of four patients, angiography disclosed the site of bleeding when NE was used during the procedure for hemodynamic stabilization.

CONCLUSION

We suggest that angiography performed after the administration of NE in unstable patients with gastrointestinal bleeding and an initially negative angiography has the potential to unmask bleeding sites for successful embolization. However, this statement must be confirmed in prospective studies.

Interobserver reliability between pediatric radiologists and residents in ultrasound evaluation of intraventricular hemorrhage in premature infants

BACKGROUND

Germinal matrix intraventricular hemorrhage (IVH) may contribute to significant morbidity and mortality in premature infants. Timely identification and grading of IVH affect decision-making and clinical outcomes. There is possibility of misinterpretation of the ultrasound appearances, and the interobserver variability has not been investigated between radiology resident and board-certified radiologist.

AIM

To assess interobserver reliability between senior radiology residents performing bedside cranial ultrasound during on-call hours and pediatric radiologists.

METHODS

From June 2018 to June 2020, neonatal cranial ultrasound examinations were performed in neonatal intensive care unit. Ultrasound findings were recorded by the residents performing the ultrasound and the pediatric attending radiologists.

RESULTS

In total, 200 neonates were included in the study, with a mean gestational age of 30.9 wk. Interobserver agreement for higher grade (Grade III & IV) IVH was excellent. There was substantial agreement for lower grade (Grade I & II) IVH.

CONCLUSION

There is strong agreement between radiology residents and pediatric radiologists, which is higher for high grade IVHs.

Diagnostic performance of abbreviated gadoxetic acid-enhanced magnetic resonance protocols with contrast-enhanced computed tomography for detection of colorectal liver metastases

BACKGROUND

Although contrast-enhanced magnetic resonance imaging (MRI) using gadoxetic acid has been shown to have higher accuracy, sensitivity, and specificity for the detection and characterization of hepatic metastases compared with other modalities, the long examination time would limit the broad indication. Several abbreviated enhanced MRI (Ab-MRI) protocols without dynamic phases have been proposed to achieve equivalent diagnostic performance for the detection of colorectal liver metastases. However, an optimal protocol has not been established, and no studies have assessed the diagnostic performance of Ab-MRI combined with contrast-enhanced computed tomography (CE-CT), which is the preoperative imaging of colorectal cancer staging in clinical settings, to determine the best therapeutic strategy.

AIM

To compare the diagnostic performance of two kinds of Ab-MRI protocol with the standard MRI protocol and a combination of the Ab-MRI protocol and CE-CT for the detection of colorectal liver metastases.

METHODS

Study participants comprised 87 patients (51 males, 36 females; mean age, 67.2 ± 10.8 years) who had undergone gadoxetic acid-enhanced MRI and CE-CT during the initial work-up for colorectal cancer from 2010 to 2021. Each exam was independently reviewed by two readers in three reading sessions: (1) Only single-shot fast spin echo (FSE) T2-weighted or fat-suppressed-FSE-T2-weighted, diffusion-weighted, and hepatobiliary-phase images (Ab-MRI protocol 1 or 2); (2) all acquired MRI sequences (standard protocol); and (3) a combination of an Ab-MRI protocol (1 or 2) and CE-CT. Diagnostic performance was then statistically analyzed.

RESULTS

A total of 380 Lesions were analyzed, including 195 metastases (51.4%). Results from the two Ab-MRI protocols were similar. The sensitivity, specificity, and positive and negative predictive values from Ab-MRI were non-inferior to those from standard MRI (P > 0.05), while those from the combination of Ab-MRI protocol and CE-CT tended to be higher than those from Ab-MRI alone, although the difference was not significant (P > 0.05), and were quite similar to those from standard MRI (P > 0.05).

CONCLUSION

The diagnostic performances of two Ab-MRI protocols were non-inferior to that of the standard protocol. Combining Ab-MRI with CE-CT provided better diagnostic performance than Ab-MRI alone.

Contrast-enhanced multidetector computed tomography features and histogram analysis can differentiate ameloblastomas from central giant cell granulomas

BACKGROUND

No qualitative or quantitative analysis of contrast-enhanced computed tomography (CT) images has been reported for the differentiation between ameloblastomas and central giant cell granulomas (CGCGs).

AIM

To describe differentiating multidetector CT (MDCT) features in CGCGs and ameloblastomas and to compare differences in enhancement of these lesions qualitatively and using histogram analysis.

METHODS

MDCT of CGCGs and ameloblastomas was retrospectively reviewed to evaluate qualitative imaging descriptors. Histogram analysis was used to compare the extent of enhancement of the soft tissue. Fisher’s exact tests and Mann–Whitney U test were used for statistical analysis (P < 0.05).

RESULTS

Twelve CGCGs and 33 ameloblastomas were reviewed. Ameloblastomas had a predilection for the posterior mandible with none of the CGCGs involving the angle. CGCGs were multilocular (58.3%), with a mixed lytic sclerotic appearance (75%). Soft tissue component was present in 91% of CGCGs, which showed hyperenhancement (compared to surrounding muscles) in 50% of cases, while the remaining showed isoenhancement. Matrix mineralization was present in 83.3% of cases. Ameloblastomas presented as a unilocular (66.7%), lytic (60.6%) masses with solid components present in 81.8% of cases. However, the solid component showed isoenhancement in 63%. No matrix mineralization was present in 69.7% of cases. Quantitatively, the enhancement of soft tissue in CGCG was significantly higher than in ameloblastoma on histogram analysis (P < 0.05), with a minimum enhancement of > 49.05 HU in the tumour providing 100% sensitivity and 85% specificity in identifying a CGCG.

CONCLUSION

A multilocular, lytic sclerotic lesion with significant hyperenhancement in soft tissue, which spares the angle of the mandible and has matrix mineralization, should indicate prospective diagnosis of CGCG.

Reliability of ultrasound ovarian-adnexal reporting and data system amongst less experienced readers before and after training

BACKGROUND

The 2018 ovarian-adnexal reporting and data system (O-RADS) guidelines are aimed at providing a system for consistent reports and risk stratification for ovarian lesions found on ultrasound. It provides key characteristics and findings for lesions, a lexicon of descriptors to communicate findings, and risk characterization and associated follow-up recommendation guidelines. However, the O-RADS guidelines have not been validated in North American institutions or amongst less experienced readers.

AIM

To evaluate the diagnostic accuracy and inter-reader reliability of ultrasound O-RADS risk stratification amongst less experienced readers in a North American institution with and without pre-test training.

METHODS

A single-center retrospective study was performed using 100 ovarian/adnexal lesions of varying O-RADS scores. Of these cases, 50 were allotted to a training cohort and 50 to a testing cohort via a non-randomized group selection process in order to approximately equal distribution of O-RADS categories both within and between groups. Reference standard O-RADS scores were established through consensus of three fellowship-trained body imaging radiologists. Three PGY-4 residents were independently evaluated for diagnostic accuracy and inter-reader reliability with and without pre-test O-RADS training. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), and area under the curve (AUC) were used to measure accuracy. Fleiss kappa and weighted quadratic (pairwise) kappa values were used to measure inter-reader reliability. Statistical significance was P < 0.05.

RESULTS

Mean patient age was 40 ± 16 years with lesions ranging from 1.2 to 22.5 cm. Readers demonstrated excellent specificities (85%-100% pre-training and 91%-100% post-training) and NPVs (89%-100% pre-training and 91-100% post-training) across the O-RADS categories. Sensitivities were variable (55%-100% pre-training and 64%-100% post-training) with malignant O-RADS 4 and 5 Lesions pre-training and post-training AUC values of 0.87-0.95 and 0.94-098, respectively (P < 0.001). Nineteen of 22 (86%) misclassified cases in pre-training were related to mischaracterization of dermoid features or wall/septation morphology. Fifteen of 17 (88%) of post-training misclassified cases were related to one of these two errors. Fleiss kappa inter-reader reliability was ‘good’ and pairwise inter-reader reliability was ‘very good’ with pre-training and post-training assessment (k = 0.76 and 0.77; and k = 0.77-0.87 and 0.85-0.89, respectively).

CONCLUSION

Less experienced readers in North America achieved excellent specificities and AUC values with very good pairwise inter-reader reliability. They may be subject to misclassification of potentially malignant lesions, and specific training around dermoid features and smooth vs irregular inner wall/septation morphology may improve sensitivity.

Augmentation of literature review of COVID-19 radiology

We suggest an augmentation of the excellent comprehensive review article titled “Comprehensive literature review on the radiographic findings, imaging modalities, and the role of radiology in the coronavirus disease 2019 (COVID-19) pandemic” under the following categories: (1) “Inclusion of additional radiological features, related to pulmonary infarcts and to COVID-19 pneumonia”; (2) “Amplified discussion of cardiovascular COVID-19 manifestations and the role of cardiac magnetic resonance imaging in monitoring and prognosis”; (3) “Imaging findings related to fluorodeoxyglucose positron emission tomography, optical, thermal and other imaging modalities/devices, including ‘intelligent edge’ and other remote monitoring devices”; (4) “Artificial intelligence in COVID-19 imaging”; (5) “Additional annotations to the radiological images in the manuscript to illustrate the additional signs discussed”; and (6) “A minor correction to a passage on pulmonary destruction”.

Advanced magnetic resonance imaging findings in salivary gland tumors

Salivary gland tumors (SGTs) make up a small portion (approximately 5%) of all head and neck tumors. Most of them are located in the parotid glands, while they are less frequently located in the submandibular glands, minor salivary glands or sublingual gland. The incidence of malignant or benign tumors (BTs) in the salivary glands varies according to the salivary gland from which they originate. While most of those detected in the parotid gland tend to be benign, the incidence of malignancy increases in other glands. The use of magnetic resonance imaging (MRI) in the diagnosis of SGTs is increasing every day. While conventional sequences provide sufficient data on the presence, localization, extent and number of the tumor, they are insufficient for tumor specification. With the widespread use of advanced techniques such as diffusion-weighted imaging, semi-quantitative and quantitative perfusion MRI, studies and data have been published on the differentiation of malignant or BTs and the specificity of their subtypes. With diffusion MRI, differentiation can be made by utilizing the cellularity and microstructural properties of tumors. For example, SGTs such as high cellular Warthin’s tumor (WT) or lymphoma on diffusion MRI have been reported to have significantly lower apparent diffusion values than other tumors. Contrast agent uptake and wash-out levels of tumors can be detected with semi-quantitative perfusion MRI. For example, it is reported that almost all of the pleomorphic adenomas show an increasing enhancement time intensity curve and do not wash-out. On quantitative perfusion MRI studies using perfusion parameters such as Ktrans, Kep, and Ve, it is reported that WTs can show higher Kep and lower Ve values than other tumors. In this study, the contribution of advanced MRI to the diagnosis and differential diagnosis of SGTs will be reviewed.

Progress in interventional radiology treatment of pulmonary embolism: A brief review

Pulmonary embolism represents a common life-threatening condition. Prompt identification and treatment of this pathological condition are mandatory. In cases of massive pulmonary embolism and hemodynamic instability or right heart failure, interventional radiology treatment for pulmonary embolism is emerging as an alternative to medical treatment (systemic thrombolysis) and surgical treatment. Interventional radiology techniques include percutaneous endovascular catheter directed therapies as selective thrombolysis and thrombus aspiration, which can prove useful in cases of failure or infeasibility of medical and surgical approaches.