فهرست مطالب

Iranian Journal of Radiology - Volume:13 Issue: 3, 2016
  • Volume:13 Issue: 3, 2016
  • تاریخ انتشار: 1395/06/04
  • تعداد عناوین: 20
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  • Necdet Poyraz*, Ganime Dilek Emlik, Abdussamet Batur, Ebubekir Gundes, Suat Keskin Page 1
    Background
    Granulomatous mastitis is a rare and benign inflammatory breast disease that may clinically and radiologically mimic breast cancer..
    Objectives
    The aim of this study was to evaluate the features of idiopathic granulomatous mastitis (IGM) on breast magnetic resonance imaging (MRI) with mammographic and sonographic findings..
    Patients and
    Methods
    A retrospective analysis was conducted on 20 patients with IGM who had been diagnosed by needle core or excisional biopsy at a single institution between 2006 and 2012. All of the patients underwent MRI for suspicious breast findings prior to biopsy. MRI examinations were performed on a 1.5 T scanner. The MRI findings were evaluated in accordance with the breast imaging-reporting and data system (BI-RADS) MRI lexicon established by the American College of Radiology..
    Results
    MRI detected a total of 29 lesions in the 20 patients. Fourteen of these lesions were seen as mass enhancements, with the remaining 15 identified as non-mass enhancements (NMEs). The median size of all lesions was 3.6 cm (range, 0.7 - 6.7 cm). The most frequently observed features were masses with a round shape (9 out of 14, 64%), smooth contour (11 out of 14, 78%), and a rim enhancement pattern (10 out of 14, 71%). The most common features of the 15 NME lesions were segmental distribution (6 out of 15, 40%) and heterogeneous enhancement patterns (8 out of 15, 53%). The time-intensity curves of the dynamic studies showed benign type one signal intensity (persistent enhancement pattern) in the majority of lesions (10 out of 20, 50%)..
    Conclusion
    Our study suggests that breast MRI findings of IGM have a wide spectrum. Rim enhancement patterns are frequently seen on contrast enhanced images, but the imaging findings are nonspecific and cannot be used definitively to distinguish between benign and malignant lesions..
    Keywords: Breast MRI, Idiopathic Granulomatous Mastitis, BI, RADS
  • Mohammadhashem Hoseini, Sara Zamaheni, Hourieh Bashizadeh Fakhar, Forough Akbari, Javad Chalipa, Afsaneh Rahmati * Page 2
    Background
    Prediction of skeletal growth is necessary for growth modification and surgical orthodontic treatments and is usually done by assessing skeletal maturity indicators in hand-wrist radiographs. The use of growth stages of cervical vertebrae in lateral cephalograms has been suggested to avoid overexposure..
    Objectives
    This study seeks to assess the degree of agreement between hand-wrist and cervical vertebrae maturation stages for skeletal age determination and prediction of the peak growth spurt (PGS)..
    Patients and
    Methods
    This cross-sectional study was conducted with 67 boys and 66 girls between 8 and 18 years of age, divided into 11 age groups; 266 hand-wrist radiographs and lateral cephalograms were obtained and analyzed. Hand-wrist maturation stages were evaluated according to the Grave and Brown, Bjork system (stages 1 - 9). The cervical vertebral maturation stage (CVMS) was determined on lateral cephalograms based on a system described by Baccetti et al. (CVMS 1-5). To apply the Cohen’s kappa index, the stages of growth were reduced to 5 intervals (A - E) to relate the 5 CVMS to the 9 stages of Bjork hand-wrist analysis..
    Results
    In all age groups, the skeletal maturity stages of the hand and wrist bones and the cervical vertebrae of the girls were ahead of the boys. Cohen’s kappa test revealed a low level of agreement between the two methods [Kappa (95% CI) = 0.312 (0.290 - 0.377)]; concordance was slightly higher in males (K = 0.33 for males versus 0.27 for females). Evaluation of concordance coefficients between the stages determined by the two methods indicated the highest concordance in 8- and 9-year-olds and the lowest in 12- and 14-year-olds. The level of agreement between the two methods was only acceptable in 8- and 9-year-olds of both genders and 10-year-old boys. The level of agreement between the two methods in other age groups was not acceptable..
    Conclusion
    The level of agreement between the two methods was low; thus, they cannot be used alternatively to estimate patients’ skeletal age or to predict the PGS. This may be due to the effect of different maturation levels (influenced by the environment, ethnicity, and gender) on the agreement between methods for skeletal age determination..
    Keywords: Growth, Hand, Wrist, Cervical Vertebrae, Skeletal Age
  • Li Liu, Bo Yin, Dao Ying Geng, Yi Ping Lu, Wei Jun Peng* Page 3
    Background
    Neoadjuvant chemotherapy (NAC) is generally an effective method of reducing locally advanced malignant breast lesions before surgery; assessing the tumor response to NAC is crucial for patient management. T2 relaxation times can reflect biological state of lesions, may prove useful to assess the response to NAC..
    Objectives
    To investigate the lesion T2 relaxation times change in breast cancer neoadjuvant chemotherapy (NAC)..
    Patients and
    Methods
    In total, 26 patients underwent NAC. Magnetic resonance imaging (MRI) T2 mapping was performed before and after NAC. The T2 relaxation times were obtained by using Functool software on an AW 43 workstation. The treatment response was assessed according to the pathological response classification. We aimed to analyze the changes in the T2 relaxation times before and after NAC as well as to study the relationship between the response and the lesion T2 relaxation times after NAC..
    Results
    In 26 cases with NAC, the mean lesion T2 relaxation time before NAC was 81.34 ± 13.68 ms, compared with 64.50 ± 8.71 ms after NAC. Significant differences in the lesion T2 relaxation times existed between the pre- and post-NAC (P
    Conclusion
    In breast cancer after NAC, the lesion T2 relaxation time was reduced in the responders, and this finding is potentially useful to assess the response to NAC..
    Keywords: Breast Neoplasms, MRI, T2 Relaxometry
  • Youn Joo Lee, So Young Choi, Kyu Sun Kim, Po Song Yang* Page 4
    Background
    Ultrasonography (US) is a useful tool for breast imaging, yet is highly operator-dependent..
    Objectives
    We evaluated inter-observer variability and performance discrepancies between faculty members and radiology residents when describing breast lesions, by the fifth edition of breast imaging reporting and data system (BI-RADS)-US lexicon, and then attempted to identify whether inter-observer variability could be improved after one education session..
    Patients and
    Methods
    In total, 50 malignant lesions and 70 benign lesions were considered in our retrospective study. Two faculty members, two senior residents, and two junior residents separately assessed the US images. After the first assessment, the readers received one education session, and then reassessed the images in a random order. Inter-observer variability was measured using the kappa coefficient (κ). Performance discrepancy was evaluated by receiver operating characteristic (ROC) curves..
    Results
    For the faculty members, fair-to-good agreement was obtained in all descriptors and final assessment, while for residents, poor-to-moderate agreement was obtained. The areas under the ROC curves were 0.78 for the faculty members, 0.59 for the senior residents, and 0.52 for the junior residents, respectively. Diagnostic performance was significantly higher in the faculty members than the senior and junior residents (P = 0.0001 and
    Conclusion
    Investigative assessment of breast US by residents is inadvisable. We recommend continued professional resident training to improve the degree of agreement and performance..
    Keywords: Breast, Ultrasonography, Neoplasms, Faculty, Residency
  • Daniel Spira*, Jakub Wiskirchen, Ulrich Lauer, Dominik Ketelsen, Konstantin Nikolaou, Benjamin Wiesinger Page 5
    Background
    The transjugular intrahepatic portosystemic stent-shunt (TIPSS) builds a shortcut between the portal vein and a liver vein, and represents a sophisticated alternative to open surgery in the management of portal hypertension or its complications..
    Objectives
    To describe clinical experiences with a low-profile nitinol stent system in TIPSS creation, and to assess primary and long-term success..
    Patients and
    Methods
    Twenty-six patients (5 females, 21 males; mean age 54.6 years) were treated using a low-profile 6F self-expanding sinus-SuperFlex-Visual stent system. The indication for TIPSS creation was refractory bleeding in 9 of the 26 patients, refractory ascites in 18 patients, and acute thrombosis of the portal vein confluence in one patient. Portosystemic pressure gradients before and after TIPSS, periprocedural and long-term complications, and the time to orthotopic liver transplantation (OLT) or death were recorded..
    Results
    The portosystemic pressure gradient was significantly reduced, from 20.9 ± 6.3 mmHg before to 8.2 ± 2.3 mmHg after TIPSS creation (P
    Conclusion
    The sinus-SuperFlex-Visual stent system can be safely deployed as a TIPSS device. The pressure gradient reduction was clinically sufficient to treat the patients’ symptoms, and periprocedural complications were due to the TIPSS procedure per se rather than to the particular stent system employed in this study..
    Keywords: TIPSS, Self, Expandable Stent, Low, Profile Stent System
  • Mahsa Raisi, Nafchi, Fariborz Faeghi*, Alireza Zali, Hamidreza Haghighatkhah, Jalal Jalal, Shokouhi Page 6
    Background
    Diffusion-weighted imaging (DWI) is a form of magnetic resonance imaging (MRI) based on measuring the random Brownian motion of water molecules within the biological tissues and is particularly useful in tumor characterization..
    Objectives
    The purpose of this study was to evaluate the diagnostic value of DW MRI and the apparent diffusion coefficient (ADC) for preoperative grading of astrocytic supratentorial brain tumors..
    Patients and
    Methods
    Twenty-three patients (14 females, 9 males, mean age 43 years) with astrocytic supratentorial brain tumors underwent preoperative conventional MR imaging and DW MRI. The minimum, maximum and mean ADC values and the minimum, maximum and mean DWI signal intensities of each tumor were taken by placing several regions of interest in the tumor on DWI images and ADC maps. To assess the relationship between these values and the tumor grade, we used the Mann-Whitney U test and the Spearman correlation. Receiver operating characteristic (ROC) analysis was used to determine the cutoff value of the minimum, maximum and mean ADC values and the minimum, maximum and mean DWI signal intensities that had the best composition of sensitivity and specificity for differentiating low-grade and high-grade astrocytic brain tumors..
    Results
    According to the pathology reports, 10 patients had low-grade astrocytomas (grades I, II) and 13 patients had high-grade astrocytomas (grades III, IV). The minimum ADC value showed a significantly inverse correlation with astrocytic tumor grade (P = 0.006). The correlation between the maximum ADC value and the maximum DWI signal intensity with tumor grade was direct (P = 0.013, P = 0.035). According to the ROC analysis, the cutoff values of 0.843 × 10-3 mm2/s, 2.117 × 10-3 mm2/s and 165.2 for the minimum ADC, maximum ADC and maximum DWI respectively, obtained the best combination of sensitivity and specificity for distinguishing low-grade and high-grade astrocytomas..
    Conclusion
    Measuring minimum ADC, maximum ADC and maximum DWI signal intensity can provide valuable information for grading of astrocytic supratentorial brain tumors before surgery.
    Keywords: Diffusion Magnetic Resonance Imaging, Diffusion Weighted MRI, Cerebral Astrocytoma, Neoplasm Grading, Tumor Grading
  • Pelin Seher Oztekin*, Gamze Durhan, Pinar Nercis Kosar, Serap Erel, Sema Hucumenoglu Page 7
    Background
    Granulomatous mastitis (GM) is a rare inflammatory breast disease that may mimic the clinical characteristics and radiologic imaging findings of breast carcinoma. Considering the importance of making a correct diagnosis, careful radiologic evaluations and recognition of imaging features are necessary..
    Objectives
    The aim of this study was to review the radiological findings and diagnostic value of the imaging in GM..
    Patients and
    Methods
    This retrospective study involved a total of 29 patients who were diagnosed with GM between 2009 and 2013 and who underwent mammography (MG) and/or ultrasound (US) examination in addition to magnetic resonance imaging (MRI) before diagnosis..
    Results
    Among 14 patients over 35 years of age who underwent MG imaging, focal asymmetric, ill-defined nodular, or diffusely increased densities were detected in nine (64.3%), two (14.3%), and one (7.1%) subjects, respectively, while there were no pathological findings in two (14.3%) patients. In the overall group of 29 patients, US showed heterogeneous hypoechoic lesions with tubular extensions in 16 (55.2%), well-demarcated heterogeneous hypoechoic lesions in eight (27.6%), parenchymal heterogeneous appearance in three (10.3%), and a heterogeneous hypoechoic lesion with irregular margins in one (3.4%), with another (3.4%) patient having normal US findings. MRI findings included lesions consistent with solitary or multiple separate or confluent abscesses with marked peripheral ring enhancement in 25 (86.2%) patients, accompanied by intensity changes suggesting edematous inflammation in the peripheral parenchyma, as well as non-mass-like heterogeneous segmental and regional contrast enhancement. Four (13.8%) patients had non-mass-like segmental and regional contrast enhancement only. A histopathological diagnosis of GM was established in all patients with biopsy..
    Conclusion
    GM presents with a wide range of conventional radiological findings, hampering the diagnosis. In patients with inconclusive conventional findings, MRI may assist in the differential diagnosis and assessment of the extent of disease. However, a definitive diagnosis and relevant treatment require histopathological confirmation..
    Keywords: Granulomatous Mastitis, Breast, Mammography, Ultrasonography
  • Sima Nikneshan, Mahmood Reza Aghamiri, Ehsan Moudi, Nika Bahemmat, Hoora Hadian* Page 8
    Background
    Marketing new radiography devices necessitates documenting their absorbed X-ray doses. Since the current literature lacks studies on new devices, we assessed the doses of two new devices that had not previously been assessed..
    Objectives
    The new devices were compared to the Promax three dimensional (3D) scanner at two fields of view (FOV) in nine critical head and neck tissues and organs..
    Materials And Methods
    Seventeen thermoluminescence dosimeters positioned in an average-sized male RANDO phantom were used to determine the dosimetry of the three cone beam computerized tomography devices (NewTom VGi, NewTom 5G, and Promax 3D) at two field of views (FOVs), one small and one large. The exposure by each device per FOV was performed five times (30 exposures). The absorbed and effective doses were calculated for the thyroid, parotid, submandibular gland, sublingual gland, calvarium, cervical vertebra, trunk of the mandible, and mandibular ramus. The doses pertaining to the different devices, the FOVs, and the tissues were compared using the Kruskal-Wallis, Mann-Whitney U, and Wilcoxon tests..
    Results
    The average absorbed doses, respectively, for the large and small FOVs were 17.19 and 28.89 mGy in the Promax 3D, 19.25 and 35.46 mGy in the NewTom VGi, and 18.85 and 30.63 mGy in the NewTom 5G. The absorbed doses related to the FOVs were not significantly different (P value = 0.1930). However, the effective doses were significantly greater at the smaller FOVs / higher resolutions (P = 0.0039). The doses of the three devices were not significantly different (P = 0.8944). The difference among the nine organs/tissues was significant (Kruskal-Wallis P=0.0000)..
    Conclusion
    The absorbed doses pertaining to the devices and the FOVs were not significantly different, although the organs/tissues absorbed considerably different doses..
    Keywords: Cone Beam Computed Tomography, Dosimetry, Field of View, Resolution, Absorbed Dose, Effective Dose
  • Sima Nikneshan, Solmaz Valizadeh, Anahita Javanmard, Leila Alibakhshi * Page 9
    Background
    Selecting a voxel size that yields minimal radiation dose with no significant compromise of the diagnostic accuracy of cone beam computed tomography (CBCT) is particularly important..
    Objectives
    This study aimed to assess the effect of voxel size on detection accuracy of simulated external root resorption defects using NewTom CBCT system..
    Materials And Methods
    In this diagnostic study, the roots of 90 extracted human central incisors were hypothetically divided into cervical, middle, and apical thirds. Variable-size defects were prepared in the buccal and lingual surfaces of the roots and CBCT scans were obtained with four different voxel sizes (150, 200, 250, and 300). Presence or absence of defects on CBCT scans was determined by three radiologists and the results were compared with the gold standard (actual size and depth of defects). Sensitivity and specificity values were calculated and reported for different groups..
    Results
    In the lingual surfaces, the highest specificity and sensitivity belonged to 300µm voxel size (92.9%), and 200 and 250µm voxel sizes (both 97.4%) in the cervical third, respectively. In the middle third, the highest specificity and sensitivity belonged to 250 and 200µm voxel sizes (84.6% and 100%, respectively). In the apical third, the highest specificity and sensitivity belonged to 300 µm voxel size (100% and 97.9%, respectively). In the buccal surfaces, the highest specificity and sensitivity belonged to 150 (75.0%), 300 and 250 µm voxel sizes (100%) and the minimum values belonged to 200 µm voxel size (60% and 97.3%) in the cervical third. In the apical third, the highest specificity and sensitivity were noted in 300 µm voxel size (100% and 97.6%, respectively) and the minimum values were seen in 200 and 150 µm voxel sizes (93.8%, 90.5%, respectively). In the middle third, 300, 250 and 200 µm voxel sizes yielded the highest specificity (88.9%), while 150 µm voxel size yielded the highest sensitivity (98.8%)..
    Conclusion
    Considering the similar diagnostic efficacy of all voxel sizes, 300 µm voxel size can be used with adequate efficacy for detection of external root resorption defects with minimal patient radiation dose and the shortest scanning time..
    Keywords: Accuracy, Cone, Beam Computed Tomography, Root Resorption
  • Tevfik Guzelbey, Bengi Gurses *, Erman Ozturk, Olcay Ozveren, Aysegul Sarsilmaz, Ebru Karasu Page 10
    Background
    Beta-thalassemia major (β-TM) patients need blood transfusions, which result in iron deposition. To regulate chelation therapy, iron load has to be measured. With MRI, the amount of signal loss and T2* decay time shortening are used for iron quantification..
    Objectives
    The aim was to measure adrenal iron load with T2* relaxometry using MRI, and to compare it with liver and cardiac iron and serum ferritin, and to find out whether adrenal iron could be predicted from those parameters..
    Patients and
    Methods
    Between October 2014 and March 2015, MRI was performed in 21 patients with β-TM, recieving blood transfusions and chelation therapy. The control group (n = 11) included healthy volunteers with no known history of adrenal, hematologic, chronic disease, and blood transfusion..
    Results
    Among patients, there was no significant correlation between plasma ferritin and adrenal T2*. Significant difference was detected among T2* values of adrenals between the patient and control groups. There was no significant correlation between adrenal gland and liver T2* in β-TM patients, moderate correlation was detected between adrenal T2* and cardiac T2*..
    Conclusion
    Adrenal iron in β-TM can be reliably measured in 3 Tesla MRI. The results highlight the absence of correlation between adrenal iron deposition both with serum ferritin and hepatic iron..
    Keywords: Adrenal Glands, Magnetic Resonance Imaging, Thalassemia, Relaxation
  • Rita Olivia Siverino, Alessandra Uccello, Maria Luisa Giunta, Mario Uccello*, Placido Amadio, Giuseppe Petrillo Page 11
    Testicular cancer typically spreads to the lymph nodes, but hematogenous dissemination to distant organs can also occur. Bone metastasis is uncommon and is thought to be a poor prognostic indicator. Jaw metastasis is exceedingly rare but is of great clinical significance, since it may be the first sign of an occult testicular cancer or the first evidence of relapse of a known tumor. Herein, we report the first case describing the imaging and clinical findings of a non-seminomatous germ cell tumor with jaw metastasis at diagnosis..
    Keywords: Jaw, Bone, Metastasis, Testicular Cancer, Germ Cell Tumors
  • Suha Akpinar, Guliz Yilmaz* Page 12
    Dissection of the internal carotid artery (ICA) is a rare condition that accounts for a significant proportion of ischemic strokes in young adults. Iatrogenic dissection as a complication of neurointerventional procedures is a traumatic dissection which has been reported relatively rare in the literature. In this report, a case of dissection of the ICA is reported that was caused by repetitive movement of the balloon guiding catheter during stent-assisted thrombectomy (SAT), resulting in occlusion of the ICA.
    Keywords: Dissection, Internal Carotid Artery, Neurointerventional Procedure, Magnetic Resonance Angiography
  • Joon Young Park, Jin Gyoon Park, Seung Jin Lee* Page 13
    Hemangioma of the rib is a rare benign vascular tumor. Herein, we report a 63-year-old man presenting with hemangioma of the left sixth rib. An osteolytic eccentric expansive mass with calcification and focal cortical disruption was detected on chest computed tomography (CT). The mass showed low 2-deoxy-2-[18F]-fluoro-D-glucose (18F-FDG) avidity on positron emission tomography. The patient underwent resection of the left sixth rib. Based on the histopathology findings, a diagnosis of cavernous hemangioma was made. Rib hemangiomas and malignant lesions appear similar on CT scans; therefore, most cases of rib hemangiomas reported in the literature were treated with rib resection. However, rib hemangiomas should be included in the differential diagnosis of an asymptomatic patient if an osteolytic expansive lesion containing sunburst calcifications with low 18F-FDG avidity is observed on a CT scan.
    Keywords: Rib Resection, Hemangioma, Tumor
  • Asuman Nur Karhan*, Tutku Soyer, Altan Gunes, Beril Talim, Ibrahim Karnak, Berna Oguz, Inci Nur Saltik Temizel Page 14
    Omental and mesenteric cysts are both rare pathologies in children. Children who have omental cysts usually display symptoms of abdominal distension, with or without a palpable mass. The mass can simulate ascites on clinical observation, or tuberculosis on radiological images. The optimal treatment for this condition is complete resection. The presenting symptoms of abdominal distension and the simulation of septated ascites and abdominal tuberculosis are unusual. Reported cases in the literature usually display symptoms of abdominal distension, abdominal pain, painless mass or possible ascites. We describe the clinical presentation of a five-and-a-half-year-old boy who was treated for a diagnosis of abdominal tuberculosis and ascites at another hospital. After three years, he underwent abdominal surgery, and an omental cyst was found intraoperatively. The diagnosis was confirmed by pathological examination..
    Keywords: Omentum, Cyst, Lymphangioma, Ascites, Tuberculosis, Child
  • Maria Del Mar Travieso Aja *, Purificacion Munoz, Mario Rodriguez Rodriguez, Victor Vega Benitez, Octavio P. Luzardo Page 15
    Up to 19% of breast malignancies may be missed by conventional imaging techniques, especially when they are concurrent or co-located with other benign lesions. However, more sensitive techniques, such as magnetic resonance imaging (MRI), are often too expensive for routine use in developing countries. Contrast-enhanced, dual-energy digital mammography (CESM) is a recently introduced imaging modality whose performance has been reported to be similar to that of MRI. Being much cheaper, CESM may constitute a good alternative for improving diagnostic sensitivity in these countries. In this paper, we present a challenging case of the concurrent and co-located presentation of a fibroadenoma and a triple negative invasive carcinoma of no special type (TNBC-NST). The malignancy was indistinguishable from the fibroadenoma by mammography. By ultrasound, a suspicious area was observed and biopsied, but the histopathology did not confirm a cancer diagnosis. As the suspicion was not confirmed, a second stage of the imaging diagnosis using CESM was recommended. This technique allowed clear visualization of the malignancy, which was finally excised by breast-conserving surgery. This case reveals the potential of CESM as an easy, rapid and inexpensive new technique for the diagnosis of malignancies that might easily remain occult to mammography plus breast ultrasound (BUS)..
    Keywords: Radiographic Image Enhancement, Triple Negative Breast Neoplasms, Contrast Media, Developing Countries, Subtraction Technique
  • Ho Kyun Kim, Mun Han, Hui Joong Lee* Page 16
    A 36-year-old woman, diagnosed with systemic lupus erythematosus (SLE), showed bulbar symptoms including impaired memory, slurred speech and swallowing difficulty 7 days before admission. Magnetic resonance imaging (MRI) showed symmetric confluent hyperintensities in the bilateral cerebral white matter on T2 weighted imaging (T2-WI), extended into the genu of the internal capsule and the crus cerebri of the midbrain. MR spectroscopy showed increased choline and decreased N-acetyl aspartate (NAA) peak and positron emission computed tomography (PET CT) showed decreased fluorodeoxyglucose (FDG) uptake on the lateral portion of the frontal lobe, suggesting demyelination of the white matter. The value of apparent diffusion coefficient, fractional anisotropy, tensor linear, tensor planar and relative anisotropy of the corticobulbar tract (CBT) were lower than those of the corticospinal tract. This is the first case report of CBT involvement in a patient with neuropsychiatric SLE (NPSLE) as far as we know. The findings of T2-WI and diffusion tensor imaging (DTI) showed precise anatomical location of neuronal damage of CBT. In addition, magnetic resonance spectroscopy (MRS), PET-CT and parameters of DTI supported the explanations of the inflammatory process and metabolic change of the white matter caused by NPSLE..
    Keywords: SLE, Corticobulbar Tract, MRI, Diffusion Tensor, MR Spectroscopy, PET CT
  • Ji Min Kim, Shin Young Kim*, Mee Hye Oh, Jong Eun Lee Page 17
    Invasive apocrine carcinoma (IAC) of the breast is a rare subtype of breast malignancy. Its incidence is not well known, but it is approximately less than 1% to 4%. For these reasons, there are few reports and little information on the radiologic appearance of IAC. Furthermore, most of the case reports show malignant features which are similar to invasive ductal carcinoma (IDC). We present a rare case of IAC without typical malignant feature on mammography, and ultrasonography (USG). Imaging findings on computed tomography (CT), magnetic resonance imaging (MRI), and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT are also presented. The nodule in our case showed a relatively benign feature on USG and it is the first case of IAC with unusual findings. Therefore, this report may encourage radiologists to consider the malignant potential and perform pathologic correlation even if a newly developed nodule does not present with a typical malignant feature on USG..
    Keywords: Breast, Breast Neoplasms, Apocrine Glands, Mammography, Ultrasonography
  • Il, Young Cho, Jae, Wook Kim, Hak, Jin Kim, Kyu, Sup Cho* Page 18
    Choanal polyps are a form of nasal polyps that grow toward the choana with a single stalk. Septochoanal polyp is a rare entity that originates from the mucosa of the nasal septum with choanal extension. The most common site of its origin is mainly the superior aspect of the posterior portion of the nasal septum. However, metaplastic ossification is a rare event in nasal polyp and to the best of our knowledge, septochoanal polyp with metaplastic ossification has not been reported in the literature. Herein, we report a case of huge septochoanal polyp with metaplastic ossification obstructing both the nasal cavity and nasopharynx, which was successfully removed via transnasal endoscopic approach.
    Keywords: Nasal Polys, Nasal Septum, Heterotopic Ossification, Metaplasia, Nasal Obstruction
  • Young Seon Kim* Page 19
    AlloDerm® (LifeCell Corp.; Brancburg, NJ) is an acellular dermal matrix (ADM) that serves as an immunologically inert scaffold in plastic surgery. In breast reconstruction, it is used as a filler for lumpectomy defects and can be used to create the inferolateral portion of the tissue expander pocket or implant pocket in postmastectomy patients. However, there are limited reports of the radiologic findings of AlloDerm® in patients who have undergone postmastectomy reconstruction. Familiarity with the imaging features of AlloDerm® is essential for correct diagnosis. We report the ultrasonography features of AlloDerm® in a 43-year-old female patient 3 months after postmastectomy reconstruction. It may help distinguish AlloDerm® from tumor recurrence or other foreign body materials such as gossypiboma. This is important as misdiagnosis can often lead to unnecessary surgical intervention.
    Keywords: Alloderm®, Breast Reconstruction, Mastectomy, Ultrasonography
  • Hasan Erdinc Kocer, Kerim Kursat Cevik *, Mesut Sivri, Mustafa Koplay Page 20
    Background
    Developmental dysplasia of the hip (DDH) can be detected with ultrasonography (USG) images. However, the accuracy of this method is dependent on the skill of the radiologist. Radiologists measure the hip joint angles without computer-based diagnostic systems. This causes mistakes in the diagnosis of DDH.

    Objectives
    In this study, we aimed to automate segmentation of DDH ultrasound images in order to make it convenient for radiologic diagnosis by this recommended system.

    Materials and Methods
    This experiment consisted of several steps, in which pure DDH and various noise-added images were formed. Then, seven different filters (mean, median, Gaussian, Wiener, Perona and Malik, Lee, and Frost) were applied to the images, and the output images were evaluated. The study initially evaluated the filter implementations on the pure DDH images. Then, three different noise functions, speckle, salt and pepper, and Gaussian, were applied to the images and the noisy images were filtered. In the last part, the peak signal to noise ratio (PSNR) and mean square error (MSE) values of the filtered images were evaluated. PSNR and MSE distortion measurements were applied to determine the image qualities of the original image and the output image. As a result, the differences in the results of different noise removal filters were observed.

    Results
    The best results of PSNR values obtained in filtering were: Wiener (43.49), Perona and Malik (27.68), median (40.60) and Lee (35.35) for the noise functions of raw images, Gaussian noise added, salt and pepper noise added and speckle noise added images, respectively. After the segmentation process, it was seen that applying filtering to DDH USG images had low influence. We correctly segmented the ilium zone with the active contour model.

    Conclusion
    Various filters are needed to improve the image quality. In this study, seven different filters were implemented and investigated on both noisy and noise-free images.
    Keywords: Ultrasonography, Image Processing, Developmental Dysplasia of the Hip, Filtering