Current Issue : January - March Volume : 2017 Issue Number : 1 Articles : 7 Articles
We report here a case of an inflammatory myofibroblastic tumor in the retroperitoneum,\nwhich mimicked a germ cell tumor of the undescended testis. A 75-year-old\nhealthy man presented with a palpable abdominal mass. On the computed tomography\nimage, there was large, well-defined soft tissue mass in the left side of the retroperitoneum,\nand there was no visible left testis or seminal vesicle. After contrast enhancement,\nthe mass appeared to be relatively homogeneous, considering its large\nsize. With ultrasonography, it appeared as a well-defined, hypoechoic mass with\nintratumoral vascularity. This solid mass was surgically diagnosed as an inflammatory\nmyofibroblastic tumor....
Background: This study aims to evaluate immediate changes in perfusion parameters in hepatocellular carcinoma\n(HCC) to transarterial chemoembolization (TACE) in C-arm computed tomography (CT) and volume perfusion CT\n(VPCT) and prediction of midterm tumor response.\nMethods: Twenty-five patients (median age 66, range 61 to 75 years) with 62 HCC lesions undergoing TACE\nreceived immediate pre- and post-interventional assessment by C-arm CT and VPCT. Cross-sectional imaging was\nanalyzed at baseline and approximately 12 weeks after TACE according to modified RECIST criteria. Outcome was\ndefined as objective response (OR, > 30 % reduction of viable tumor) or non-OR. Perfusion parameters were\nevaluated in C-arm CT [parenchymal blood volume (PBV)] and VPCT [blood volume (BV) and blood flow (BF)]. Ratios\nof perfusion parameters before and after TACE within the tumor and the non-affected liver parenchyma were\ncalculated.\nResults: Correlation between tumor PBV and BV revealed a moderate correlation (rho = 0.45, p = 0.005). In nonaffected\nliver parenchyma, a significant decrease in PBV was seen, compared to a significant increase in BF and BV.\nPerfusion ratios in HCC lesions were significantly (p < 0.05) increased in OR group compared to non-OR patients in\nC-arm CT and VPCT: PBV ratio (0.95 (0.06) to 0.67 (0.38), BV ratio 0.63 (0.34) to 0.15 (0.6), and BF ratio 0.6 (0.32) to 0.\n22 (0.51). Logistic regression including PBV and BF allowed prediction of OR (sensitivity 88 %/specificity of 83 %).\nConclusions: Perfusion parameters acquired by C-arm CT and VPCT cannot simply be substituted by each other,\nbut show similar capability in prediction of midterm tumor response....
Pulmonary embolism (PE) is potentially life threatening condition which requires adequate diagnosis.\nSince computerized tomography pulmonary angiography (CTPA) described the presence of\na clot subjectively, an objective and quantification method to characterize plural parenchymal\nabnormality, pulmonary vessels and heart is needed (in order to diagnose PE). This study was directed\nto investigate whether the presence of plural parenchymal findings correlates with the PE\nand as well, it was designed to answer two basic questions based on CTPA findings done for clinical\nsuspicion of PE: firstly, what are the plural parenchymal abnormalities associated with PE; secondly,\ncorrelation of PE with the presence of heart changes and pulmonary vessels measurements.\nCTPA scans were acquired for 55 patients suspected of having PE and another 50 subjects who\nwere considered as control. The clinical signs and pleuroparenchymal abnormalities, pulmonary\nartery tree measurements, right ventricle and atrium diameters, Inter ventricular septum width\nas well as the myocardium thickening were characterized and correlated with PE. The results\nshowed that the PE patients group has more dilated measurements than the normal control subjects.\nThe right ventricle diameter changes were found to be significantly related to the presence\nof PE at p 0.001. Significant changes at p 0.005 were also noticed in the pulmonary trunk diameter\nas well as the right and left main pulmonary arteries with no significant changes detected\nin the distal portion of both pulmonary arteries diameters. The common complaints from PE patients\nwere chest pain, shortness of breathing, lower limb swelling, tachycardia and syncope. Consolidation,\nground glass opacifications, mosaic, right ventricle morphological changes and pleural\neffusion were present in the majority of patients undergoing CTPA for the clinical suspicion of PE.\nCTPA is considered as the diagnostic modality of choice in characterization of pulmonary vessels,\natrium and ventricle changes as well as pleura parenchymal abnormalities in patients with or without\nPE...
Background. To retrospectively determine the diagnostic value of computed tomography arthrography (CTA) of the ankle in\nthe evaluation of (osteo)chondral lesions in comparison to conventional magnetic resonance imaging (MRI) and intraoperative\nfindings. Methods. A total of...
Background: Suspected recurrence of thyroid carcinoma is a diagnostic challenge when findings of both a radio\niodine whole body scan and ultrasound are negative. PET/CT and MRI have shown to be feasible for detection of\nrecurrent disease. However, the added value of a consensus reading by the radiologist and the nuclear medicine\nphysician, which has been deemed to be helpful in clinical routines, has not been investigated. This study aimed to\ninvestigate the impact of combined FDG-PET/ldCT and MRI on detection of locally recurrent TC and nodal\nmetastases in high-risk patients with special focus on the value of the multidisciplinary consensus reading.\nMaterials and methods: Forty-six patients with suspected locally recurrent thyroid cancer or nodal metastases\nafter thyroidectomy and radio-iodine therapy were retrospectively selected for analysis. Inclusion criteria comprised\nelevated thyroglobulin blood levels, a negative ultrasound, negative iodine whole body scan, as well as combined\nFDG-PET/ldCT and MRI examinations.\nNeck compartments in FDG-PET/ldCT and MRI examinations were independently analyzed by two blinded\nobservers for local recurrence and nodal metastases of thyroid cancer. Consecutively, the scans were read in\nconsensus. To explore a possible synergistic effect, FDG-PET/ldCT and MRI results were combined. Histopathology\nor long-term follow-up served as a gold standard.\nFor method comparison, sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy\nwere calculated.\nResults: FDG-PET/ldCT was substantially more sensitive and more specific than MRI in detection of both local\nrecurrence and nodal metastases. Inter-observer agreement was substantial both for local recurrence (�º = 0.71) and\nnodal metastasis (�º = 0.63) detection in FDG-PET/ldCT. For MRI, inter-observer agreement was substantial for local\nrecurrence (�º = 0.69) and moderate for nodal metastasis (�º = 0.55) detection. In contrast, FDG-PET/ldCT and MRI\nshowed only slight agreement (�º = 0.21). However, both imaging modalities identified different true positive results.\nThus, the combination created a synergistic effect. The multidisciplinary consensus reading further increased\nsensitivity, specificity, and diagnostic accuracy.Conclusions: FDG-PET/ldCT and MRI are complementary imaging modalities and should be combined to improve\ndetection of local recurrence and nodal metastases of thyroid cancer in high-risk patients. The multidisciplinary\nconsensus reading is a key element in the diagnostic approach....
Objective. To evaluate the clinical, laboratory, and radiological presentation of 16 cases of brucellar spondylitis. Methods.The clinical\nmanifestations, laboratory tests, and imaging findings of 16 patients (aged from 24 to 66 years) with brucellar spondylitis treated\nbetween September 2012 and September 2014 at the Second Affiliated Hospital of Xi�an Jiaotong University (Xi�an, China) were\nretrospectively analyzed. Results. Clinical manifestations included high fever, severe pain, sweating, and fatigue. One patient had\nepididymitis, and two showed clear signs of spinal nerve damage. Laboratory tests showed elevated erythrocyte sedimentation\nrate (ESR) and C-reactive protein content. Serum brucella agglutination tests were positive, and 11 brucella blood cultures were\npositive. Imagingmanifestationsmainly consisted of abnormal signals in the intervertebral space or abnormal signals in the adjacent\nvertebral bodies (16/16, 100%) in magnetic resonance imaging (MRI), disc space narrowing (14/16, 88%) in X-ray and MRI, or bone\ndestruction and sclerosis around the damaged zone (13/16, 81%) in computed tomography, with rare cases of psoas abscess (2/16,\n13%) and sequestrum(1/16, 6%). Conclusion. Since brucellar spondylitis exhibited characteristic clinical and imagingmanifestations,\nit could be diagnosed with specific laboratory tests. Early MRI examination of suspected cases could improve rapid diagnosis....
The spleen is one of the most frequently affected organs in sickle cell anemia (SCA). This study\naims to characterize the spleen in sickle cell anemia patients using contrast enhanced computerized\ntomography scanning (CECT). 67 patients with SCA from different Saudi Arabian areas were\nenrolled; ages are ranged from 10 months to 28 years old. The spleen was assessed with CT for\nabdominal pain and/or unexplained fever. The evaluation was done at different contrast enhancement\nscanning phases. The study showed that the least number of affected patients was\nfrom Eastern Saudi Arabia (1.5%) followed by Asseer (16.4%) then Gazan representing 82.1%.\nThe most common type of SCA affected the Saudi children is Hemoglobin SS Disease (Hb SS) constituting\n41 (61.2%). The spleen size, lymph nodes size, spleen Hounsfield (HU), splenic vein diameter\nand the correlation with the associated findings were evaluated for all of the patients. In\nchildren affected with SCA: 26 (38.8%) have splenomegaly, 18 (26.9%) have atrophied spleen and\n2 (3.0%) are with very small tissue like structure. Lesions found in the spleen were abscess, infarction,\ncyst, and calcifications. At the spleen hilum region; dilated splenic vein, presence of multiple\ncollaterals, and thrombus were also been detected. Significantly correlations were noticed\nbetween lesions type, child age, enlargement of spleen and splenic lymph nodes at P 0.033, P \n0.010 and P 0.012 respectively and showed an evidence that the reduction of the HU and advanced\nage have significant relation with changing of the spleen size at P 0.004 and P \nrespectively. Spleen lesions� enhancement pattern is well emerged in both venous and delay phase\nand it was significantly related with the scanning phase at P 0.000 and with different types of\nSCA at P , and P 0.055 in venous and delay phase in respectively. CECT offers a number of\nmorphological criteria that can be applied to differentiate hypodense lesions of the spleen in SCA.\nCT characterization criteria of hypodense splenic lesions are acknowledged to aid interpretation\nduring evaluation of abdominal CT images of the spleen in symptomatic patients with sickle cell\nanemia....
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