Iranian Journal of Radiology
Volume:15 Issue: 3, Jul 2018

CT techniques and procedures have been expanded in the past decades, leading to an increase in the use of CT. At the same time, the radiation dose to the patient and the concern surrounding this issue has also increased.
The goal of this study was to assess clinical image quality and x-ray dose from various computed tomography (CT) scanners in order to identify the CT scanners that produce the least radiation dose to patients with exact acceptable image quality for diagnosis.
Patients and Non-randomized clinical image data were collected from six hospitals on 16, 32 and 64 slice CT scanners. A total of 900 patients who underwent chest, abdomen, and brain scans were used for image quality evaluation and dose assessment. The image qualities were evaluated by five observers on 1 - 5 visual grading scale. The CT dose volume index (CTDIv) and dose length product (DLP) was documented from the image display.
The averaged CTDIv was 64.96, 70.2, and 75 mGy for the brain, 11.65, 15.53 and 17.11 mGy for the chest, and 13.41, 18.44, and 19.42 mGy for the abdomen from 16, 32 and 64 slice scanners respectively. The averaged image quality scores were 3.68, 3.82, and 4.81 for the abdomen, 3.01, 4.27, and 4.42 for the chest, and 4.92, 4.94, and 4.99 for the brain from 16, 32 and 64 slice scanners respectively.
Sixteen slice CT scanner delivered the minimum radiation dose to patients in contrast with the 32 and 64 slice CT scanners, and the image quality was adequate for diagnosis. Both 32 and 64 slice CT scanners produced more than acceptable image quality as well as more than needed dose to patients. The patient dose from the 32 and 64 slice scanners may be reduced by dropping their image quality to close to the 16 slice CT scanner.

The effect of various environmental and intrinsic stimulators on the development of brown adipose tissue (BAT) has been widely investigated by PET-based researches. However, evidence regarding the influencing factors on the level of BAT metabolic activity is scarce.
The aim of the present study was to evaluate the frequency of cancer-related characteristics in addition to anthropometrics and demographics in BAT-bearing cancer patients at 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan and any correlation between the level of BAT metabolic activity and the influencing factors.
Patients and Reports from a total of 3762 F-18 FDG PET/CT scans were retrospectively reviewed to identify BAT-bearing cancer population. Demographic, anthropometric and cancer related characteristics were recorded. Maximum standardized uptake values (SUVmax) was measured separately for each anatomical region. Descriptive quantitative variables were expressed as either frequency or mean. Independent T test, Mann-Withney U test, Pearson correlation coefficients, one-way analysis of variance and linear regression test (IBM SPSS version 23) were used as appropriate (P value Sixty-two F-18 FDG PET/CT studies demonstrated BAT related 18-F FDG uptake (1.6%, 32% male, 68% female, P = 0.007, mean age 22.9). Lymphoma (43.5%) and treatment response evaluation (54.54%) were the most frequent type of cancer and reason for referral, respectively. Most patients were in status partial or complete metabolic response to treatment. Fifty-four point eight percent of patients had at least one metabolically active cancer-related lesion. BAT detection rate was higher in females in all adult age groups, younger age ( The present study provided evidence for age and chemotherapeutic agents on the level of BAT metabolism. In addition, there is a suggestion for different pathways involved in BAT development and regulation of the level of metabolic activity.

Diagnostic radiology by the use of ionizing radiation plays a main contribution in the collective dose of human population. Knowing the radiation dose received by patients during a radiological examination is essential to prevent the excess health risk of exposure.
The aim of this study was to estimate the collective dose and calculate the cancer risk probability due to common radiological procedures in four radiology imaging centers of Iran.
Patients and Four hundred seventy patients who underwent different radiological examinations including the skull, chest, abdomen, pelvis, lumbar, cervical and thoracic regions in four radiology centers of Hamadan, Iran were studied. The patients’ entrance surface dose (ESD) was measured, and eventually, the effective dose (ED) was calculated. These parameters were compared with the reported values and international standard levels. Finally, the risk of cancer was determined by two different methods proposed in international commission on radiological protection (ICRP) 103.
Mean values of ESD for chest, abdomen, pelvis, lumbar region, skull, cervical and thoracic regions were 0.43 ± 0.09, 2.51 ± 0.19, 2.47 ± 0.02, 3.21 ± 0.17, 2.15 ± 0.11, 1.35 ± 0.15, and 2.51 ± 0.19 mGy, respectively. The mean values of ED were 0.05, 0.33, 0.25, 0.42, 0.02, 0.05 and 0.24 mSv, respectively for these organs. The cancer risk probability as a function of cumulative dose was 0.20, 1.21, 0.08, 1.32, 0.01, 0.01 and 0.04 (person - Sv × 5% per Sievert) for the interested organs, respectively. The risk of cancer as a function of age and sex for male patients was 0.86, 1.47, 0.59, 0.02, 0.16, 1.96 and 0.76 (in 103 person) for the bladder, colon, liver, thyroid, esophagus, lung and stomach, respectively. These values were, 0.34 (or 2.12), 0.73 (or 4.47), 0.98, 0.43, 0.72, 0.19, 0.25, 0.26 and 1.20 (in 103 persons) for breast, lung, bladder, ovary, colon, liver, thyroid, esophagus and stomach for females.
Results show that the estimated health risk based on ICRP health risk of 500 cases per 10000 person - Sv (5% per Sievert) was in total about 2 cases for seven examinations in 2016. Risks of cancer as a function of age and sex for male patients were higher for lung and colon cancers and for females, it was higher for breast and lung cancers.

During the past decade, coronary computed tomographic angiography (CCTA) has become the primary non-invasive imaging technique for the assessment of myocardial bridging (MB).
Objectivs: The aim of this study was to evaluate the ability of CCTA to predict myocardial ischemia in patients with MB.
Patients and A total of 32 MB patients (21 males and 11 females) participated in this study. Eleven MB parameters were measured to assess the ability of CCTA to predict MB patients with ischemia. In order to evaluate ischemia, all the patients underwent single positron emission computed tomography-myocardial perfusion imaging (SPECT-MPI) examination.
Ischemia was observed in 17 patients (53.1%), while 15 patients (46.9%) did not show signs of ischemia. Out of the 32 patients, superficial MB was observed in 15 patients while deep MB was identified in 12, and borderline was observed in five patients. All MB examined parameters were found to be significantly different between ischemic and non-ischemic patients, except for the location and tunnel artery diameter in diastole. Moreover, a cut-off value of 0.65 mm was able to discriminate ischemia with a sensitivity of 100%, specificity of 93%, and yield area under the receiver operating characteristic (ROC) curve (AUC) of 0.996. Also, by considering the depth cut-off value of 1.75 mm, ischemia can be distinguished with sensitivity and specificity of 100%. MB length had a lower discrimination power, with a cut off value of 22.5 mm yield, 76% sensitivity, 67% specificity, and AUC = 0.810 in the diagnosis of ischemia.
CCTA was a reliable modality with high accuracy to depict MB, identify high risk MB, and prevent unnecessary SPECT-MPI examination.

Molecular imaging with nanoparticles makes non-invasive monitoring of target cells without sacrifice of subjects and repeated evaluation possible.
To evaluate the imaging feasibility of a rat animal model with erectile dysfunction (ED) by bilateral cavernosal nerve injury using human mesenchymal stem cells (MSCs) labeled with superparamagnetic iron oxide (SPIO) and simultaneously to evaluate the beneficial effect of MSCs on ED.
Thirty-six rats were injected with MSCs labeled with SPIO particle into the corpus cavernosum after bilateral cavernosal nerve injury. In vivo MR imaging was serially performed up to 16 weeks using 1.5 T clinical scanner. After MR imaging, the penile specimens were evaluated for the expression of transforming growth factor-β1 (TGF-β1) by polymerase chain reaction.
MR imaging showed a drop in signal intensity at the injection site in the stem cell-injected group. The size of hypointensity was decreased in MSC-injected group in a time-dependent manner; whereas, signal void was not detected at the injection site in the control group. In addition, polymeric chain reaction (PCR) analyses of penile tissues from both groups revealed that the mRNA expression of TGF-β1 was significantly decreased in MSC-injected groups after 4 weeks of injection compared to the control group.
MSCs’ beneficial effects on ED was monitored with MR imaging, which might be a valuable tool for tracking and therapeutic monitoring in the future clinical study of stem cell therapy in ED.

Plantar fascia is a thick connective tissue on the plantar side of the foot, which provides the normal shape of the longitudinal arch. Plantar fasciitis is an inflammation on the medial tuberosity of calcaneus on the inferior side that may cause heel pain. Imaging plays an important role in the diagnosis of heel pain. Ultrasonography has been recognized as an effective imaging tool for assessing plantar fascia thickness, monitoring the effect of different interventions and guiding therapeutic interventions in patients with plantar fasciitis. Operator dependency is a major limitation for the common use of ultrasound.
The purpose of the present study was to evaluate intra and inter-rater reliability of ultrasound in measurements of the thickness of plantar fascia in different points of plantar fascia.
Patients and Twelve healthy (without any lower extremity disorder) young (above 18) volunteers were recruited. Both heels were scanned in the sagittal plane by two raters. Subjects lied prone. Thickness of the plantar fascia was measured at the insertion point of the calcaneus, 5 and 10 mm from insertion of the calcaneus. For statistical analysis, intraclass correlation coefficients (ICC), 95% confidence intervals (CI), and linear mixed model ANOVA effects were run.
Our results showed that both intra and inter-rater reliability of plantar fascia thickness, measured by ultrasound, have high reproducibility (ICC > 0.821, ICC > 0.849). The linear mixed model suggested that neither rater nor time had a significant effect on the rater’s measurements.
The results of the present study indicate that both intra and inter-rater of measuring plantar fascia thickness at three points using ultrasound seemed to be high.

Using a low volume of contrast medium and tube voltage may enhance the opacification of pulmonary arteries and thrombus detection without decreasing the image quality. In addition, this protocol can also ensure that exposure of the patient to the contrast medium and radiation dose may be significantly reduced.
The purpose of this study was to investigate the efficiency of low tube voltage and low dose iodine-based contrast medium in computed tomography pulmonary angiography (CTPA) and optimize its use in the diagnosis of pulmonary thromboembolism (PTE).
Patients and We included a total of 100 patients undergoing CTPA with an initial diagnosis of PTE into two groups: group A (n = 50) was given a contrast medium (CM) dose of 0.5 mL/kg at 80 kV while group B (n = 50) was given a CM dose of 1 mL/kg at 100 kV. Bolus tracking technique was used. Attenuation values were measured from the center of different pulmonary arterial segments. Values over 350 Hounsfield unit (HU) were accepted as significant. Image qualities of all pulmonary arterial segments were sufficient for diagnosis. The mean and effective doses of radiation received by patients in the two groups were compared.
PTE was detected in twenty-one patients (21%) in both groups. Total mean attenuation values for pulmonary arteries were significantly higher in group A than in group B (532.7 ± 243 HU vs. 380.6 ± 232 HU respectively, P CTPA may be obtained using an imaging protocol with low kV and reduced volume of contrast medium in the diagnosis of PTE.

Non-invasive evaluation of hepatic fibrosis, especially serum biomarkers and ultrasound elastography, has vigorously developed during the past decades.
The purpose of this study was to evaluate the diagnostic performance of the latest generation of ultrasound elastography- two-dimensional real-time shear wave elastography (SWE) in accessing liver fibrosis progression in comparison with serologic tests in a rat model.
Liver fibrosis was induced in 108 rats (control group: 18 rats, experiment group: 90 rats) by intraperitoneal injection of thioacetamide (300mg/kg, twice a week for 12 weeks). SWE examination was done by two operators. Hyaluronic acid (HA), aspartate aminotransferase (AST) to platelet (PLT) ratio index (APRI), AST to alanine aminotransferase (ALT) ratio (AAR) were used for serology tests. Histological fibrosis stages (F0-F4) according to the Scheuer scoring system were referred as the gold standard. Diagnostic performance of elastography and serology methods were determined by the areas under receiver operating characteristic curve (AUROC).
Liver stiffness values increased with the progression of hepatic fibrosis. Liver stiffness assessed by SWE exhibited a strong positive correlation with histological fibrosis stages (r = 0.849, P Ultrasound elastography SWE technique is a reliable method for noninvasive evaluation of liver fibrosis in comparison with the serological biomarkers, HA, APRI, and AAR.

Traumatic brain injury (TBI) can result from blunt trauma or acceleration/deceleration force and is considered to be one of the most important public health problems. Many patients of TBI lose professional competence and independence. They may eventually suffer serious sequelae, such as cognitive impairment, memory loss, and long-term headache. In craniocerebral trauma patients, mild traumatic brain injury accounts for 70% - 80% of the cases. Early diagnosis and intervention can decrease the post-concussional sequelae for mild TBI (mTBI).
To investigate the value of diffusion kurtosis imaging (DKI) in mild traumatic brain injury (mTBI) patients.
Patients and Conventional MRI sequences (T1 and T2 weighted images) and DKI scans of 25 healthy controls and 24 mTBI patients were obtained. Regions of interests (ROIs) were drawn and analyzed on several planes including white matter, deep gray matter nuclei, peri-contusion and contusion lesion on fused fractional anisotropy (FA), mean diffusion (MD) maps, and mean kurtosis (MK) maps, respectively. FA, MD, and MK values were measured in a certain region (he area of bilateral centrum semiovale (CS), corona radiate (CR), caudate nucleus head (CNH), genu of corpus callosum (CCG), corpus callosum splenium (CCS), anterior limb of the internal capsule (ALIC), posterior limb of internal capsule (PLIC), external capsule (EC), lenticular nucleus (LN), and thalamus). Student’s t test was used to compare the average values of FA, MD, and MK between mTBI patients and healthy controls. Paired t-test was also used to compare contusion lesions and mirror symmetrical areas.
FA and MK values were significantly different in all of the white matter and grey matter, while MD values among the various ROIs were insignificantly different in the healthy control group. In mTBI patients, the FA values of genu of corpus callosum, splenium of corpus callosum, and external capsule were decreased. Whereas, MD value of genu of corpus callosum in trauma group was increased. Except for the head of the caudate nucleus and posterior limb of the internal capsule, the MK values of the rest of the ROIs in the trauma group decreased significantly. Moreover, compared with the contra-lateral, there were more significant contusion lesions of FA and MK reductions than increased MD values. FA and MD values of peri-contusion had no significant difference compared with the contra-lateral while MK values decreased significantly.
Compared with conventional MRI sequences, DKI can detect micro white matter injury, and MK parameter is more sensitive than FA and MD. In addition, DKI can find these changes not only in the white matter but also in deep gray matter nucleus, making it a promising imaging tool to assist the detection of mild traumatic brain injury.

Radiofrequency ablation (RFA) and microwave ablation (MWA) are the most common thermal ablation methods. Studies evaluating the effectiveness of these techniques have been carried out in recent years.
Evaluation of local therapeutic effectiveness of imaging guided percutaneous thermal ablation methods, short-middle term radiologic and clinical outcomes and to compare the effectiveness of treatment between two MWA and RFA methods.
Patients and We retrospectively browsed clinical-radiologic-pathologic-demographic parameters of patients who had undergone RF or MW treatment due to HCC between January 2012 and January 2015. Twelve females (30%) and 28 males (70%) who had at least 6 months follow-up were included. We evaluated the risk factors which we considered to affect the prognosis by means of Log-Rank (Mantel-Cox) analysis. Complications rates, ablative effectiveness, local progression free and disease free survival rates for 6 months and 1 year periods were calculated by Kaplan Meier test for each group separately. The results of two groups were compared by chi-square test.
6-month, 1-year and 2-year survival rates for thermal ablation were 84.6%, 78.7% and 65% for general; 76.3%, 55.2%, 33% for disease free and 78.9%, 76.2%, 37.3% for local progression free respectively. Size and number of lesions were the only parameters that effective for all type of survival rates. In addition, Child-Pugh classification, AFP (alpha-fetoprotein) level and gender were found to affect just; general, disease free and local progression free survival rates respectively. No statistically significant difference was found in complication, ablative effectiveness, 6 month and 1 year general, disease free and progression free survival rates between RF and MW separately.
RF and MW ablation methods have similar complication rates, tumor ablation efficiency and survival rates for treatment in HCC patients.

Nowadays, volumetric data acquisition has allowed for the accurate quantification of volumetric tumor burden. However, few studies have focused on the relationship between neuroblastoma tumor volume and relevant clinical parameters.
The purpose of this study was to investigate the relationship of initial computed tomography - measured primary tumor volume (CTPTV) with 24 - hour urine vanillylmandelic acid (VMA) level and stage in patients with neuroblastoma.
Patients and This retrospective study included 24 patients. The patients’ age, gender, urine VMA levels and stage at diagnosis were collected, and the CTPTVs were calculated. The correlation between urine VMA level and CTPTV was assessed. The differences in CTPTVs with respect to age of the patients (≤ 1.5 and > 1.5 years old), gender, urine VMA levels (≤ 9.8 and > 9.8 mg/24 hours) and stage (stage 4 and non - stage 4) were analyzed. Multivariate linear regression was conducted to estimate the effect of age, gender, urine VMA level, and stage at diagnosis for CTPTV. Finally, a comparison of demographic characteristics and stage between various CTPTV ranges ( A moderate correlation was observed between urine VMA level and CTPTV in patients with neuroblastoma (r = 0.673). The median CTPTVs were significantly larger in patients with urine VMA > 9.8 mg (P = 0.03) and in patients who were diagnosed with stage 4 (P = 0.002). The most effective variable for CTPTV was urine VMA level. When the urine VMA level increases 1 mg every 24 hours, the CTPTV will increase 4.85 cm3. Among the patients with a CTPTV ≥ 35 cm3, the median age was significantly higher (P = 0.011), and median urine VMA level was significantly higher (P = 0.001) than in patients with a CTPTV A moderate positive quantitative correlation was observed between 24 - hour urine VMA levels and initial CTPTV. A CTPTV ≥ 35 cm3 may therefore be used as an indicator of advanced tumor stage in neuroblastoma.

The eye lens and thyroid gland are sensitive to radiation and have a risk of being exposed to primary beams and scattered radiation during dental radiographic examinations.
The present study was aimed to evaluate the effectiveness of bismuth shielding in decreasing eye lens and thyroid radiation dose in periapical radiography (PR), orthopantomography (OPTG), and cone beam computed tomography (CBCT) examinations. There is no information in relevant literature regarding the use of bismuth shielding in dental radiology.
Dose measurements for PR, OPTG and CBCT were conducted by placing thermoluminescent dosimeter chips on the eye and thyroid location in a standard head phantom. Each one of the scan techniques was performed without any bismuth shielding, and they were then repeated with bismuth shielding in place. The percent dose reduction from bismuth shielding was calculated by dividing the dose measured with bismuth shielding by the dose measured without bismuth shielding.
The eye dose was observed to decrease in bismuth shielding group in PR, however it was not statistically significant. The thyroid dose was found to be significantly decreased in PR (P 0.05).
This study demonstrated higher thyroid and eye lens dose with the use of bismuth shielding in OPTG and CBCT scanning. However, due to the significantly decreased thyroid dose in PR, it may be recommended as an alternative to leaded shielding in periapical radiographic examinations.

The exact anus reconstruction is critical in patients with imperforated anus. It is related to the correct diagnosis of sphincter complex.
The aim of this study was accurate investigation of the perineal region for ultrasound detection of the location and pathway of sphincter muscle complex.
Patients and This descriptive cross-sectional study was performed at Mashhad University of Medical Sciences in 2016. Transperineal sonography was done in ten patients (6 - 12 week age, 8 males and 2 females) with imperforate anus.
The shortest distance between the rectal pouch and skin was 8 to 20 mm, but the distance between the rectal pouch and skin via the anal sphincter path was longer (11 to 23 mm). The multi-layer view of anal pit was seen in all patients except one. It had a curved and occasionally parasagittal path and it is more eccentric than the muscle complex. Thickness of the anal muscle sphincter complex could be seen in all patients with 2 - 3.6 mm, occasionally asymmetric.
The multi-layer view of anal pit and the anal sphincter complex are the two important sonographic findings that can better differentiate the level of anal malformation and act as an indicator for the location of pull through procedure.

Brachial plexus magnetic resonance (MR) examination of an adult female synchronized swimmer, who was suffering from right-sided arm pain and weakness while making a stroke, showed an aberrant “subclavius posticus muscle” in the parascapular region on the right side. The muscle had an attachment anteriorly on the first rib and posteriorly on to the scapula. The belly of this aberrant muscle showed proximity to the brachial plexus. Presence of such an anomalous muscle has been recognized as a possible cause of neurovascular compression or thoracic outlet syndrome (TOS). Radiologists and surgeons should be familiar with this rare entity and consider it in the differential diagnosis of TOS.

Idiopathic granulomatous lobular mastitis (IGLM) that mimics breast cancer both clinically and radiologically is a chronic inflammatory condition of the breast without a known etiology. It usually affects childbearing women and is associated with pregnancy, lactation, or use of oral contraceptives. IGLM in a male breast is extremely rare, and only two case reports have been published. A 60-year-old man was referred to our hospital for right breast mass. He had right breast pain with a small palpable lump for 2 weeks. Ultrasonography (US) was performed with color Doppler US and US elastography. The lesion was diagnosed as IGLM pathologically by 14 gauge core needle biopsy. We describe a very rare case of IGLM arising from a male breast based on ultrasonographic and pathologic findings. IGLM should be considered as a differential diagnosis in male breast diseases, although the imaging findings may not be comparable with typical IGLM.

Heat stroke is the outcome of over heat stress that results in multiorgan dysfunction with a tendency for central nervous system damage. Brain is very sensitive to hyperthermia, especially the cerebellum that has selective vulnerability to heat stroke. There is complex interaction between heat cytotoxicity, coagulation disorder, cytotoxine - mediated systemic inflammatory response causing multiorgan failure, metabolic derangement, and circulatory insufficiency. We reviewed the literature and discussed brain MRI and MR spectroscopy findings of heat stroke, detailed the pathophysiology underlying brain involvement and proposed excitotoxic injury as an alternative mechanism of brain damage in heat stroke.

Solitary fibrous tumor (SFT) is an uncommon neoplasm of mesenchymal origin, and it most often occurs in the pleura. Mammary gland involvement is extremely rare in this disease. Herein, we report a case of SFT that presented as a slowly growing large mass in the breast of a 64-year-old man. On ultrasonographic examination, the mass was oval and circumscribed with heterogeneous echogenicity and increased intralesional blood flow. Moreover, the mass showed hard elasticity as revealed by shear-wave elastography (SWE), which has not been reported in English literature so far. We also briefly review the literature on the radiologic findings. Because of the nonspecific imaging findings and difficulty in its differentiation from other soft tissue tumors, complete excision with detailed immunohistochemistry is essential.

Hemorrhagic cystitis (HC) following radiation therapy of pelvic malignancy is a serious and sometimes life-threatening complication. Various methods including bladder irrigation, fulguration, intravesical instillation, oral or systemic agents, hyperbaric oxygen therapy and surgical methods have been proposed to control hematuria. However, there is no consensus on the optimal therapeutic strategy for radiation-induced HC. We recently performed superselective embolization of the bilateral inferior vesical arteries in a patient with radiation-induced HC refractory to conventional treatment methods. This technique is effective for achieving the control of refractory hemorrhage and can be considered an option for the treatment of radiation-induced HC.

Thin-walled cavitary lung adenocarcinoma is not common. When cavitary lung cancer was classified as a histologic subtype, squamous cell carcinoma was the most common, followed by adenocarcinoma and finally large cell carcinoma. Cavitation was not found in small cell lung cancer. Some cases of thin-walled cavitary lung adenocarcinoma have been reported. Thin-walled cavitary lung cancer can be detected by the following radiological signs: irregular thickening of the cavity wall, wall nodule formation, the presence of compartments in the cavity, increased standard uptake values (SUVs) on positron emission tomography (PET). A thin‑walled cavity accompanied by mediastinal lymph node or distant metastasis, or enlargement of the lesion on long term follow-up. We report on a case of thin walled cavitary lung cancer whose cavity tended to enlarge during a 10-month follow-up, but no other evidence of imaging finding indicated potential lung cancer. It suggests that the unidirectional check-valve mechanism could make enlarging thin walled cavitary lesion due to lepidic growth pattern.

Papillary carcinoma of the breast is a rare malignant tumor that is known to account for only approximately 1% - 2% of breast carcinomas in women. Among papillary carcinomas, solid papillary carcinoma (SPC) is a rare breast carcinoma that occurs primarily in elderly women. It is known that approximately 95% of the cases occur in a unilateral breast. The imaging findings for SPCs are not well established, and most of the published articles are about pathological findings. Moreover, there have been no reports of SPCs occurring in both breasts at the same time. We report here a case of three synchronous bilateral breast SPCs in patient with palpable mass, each showing different radiologic findings. Although imaging findings that distinguish between malignant and benign papillary lesions are unclear, familiarity with the features of SPCs may be helpful in establishing imaging findings for these lesions.

A left inferior vena cava (IVC) is an IVC anomaly with a prevalence of 0.2% - 0.5%. Typically, the left IVC joins the left renal vein, crosses anterior to the aorta, and unites with the right renal vein to form a normal right IVC. We report a case of an unusual left IVC with retrohepatic crossing over and intrahepatic venocaval shunts. In addition, situs ambiguous and polysplenia accompanied the anomaly. Though most IVC anomalies are discovered incidentally on imaging without relevant symptoms, knowledge about its variants is important to avoid misinterpretation on diagnostic imaging and to plan for surgical and interventional procedures.