فهرست مطالب

Iranian Journal of Radiology - Volume:15 Issue: 2, 2018
  • Volume:15 Issue: 2, 2018
  • تاریخ انتشار: 1397/02/31
  • تعداد عناوین: 21
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  • Hatice Kaplanoglu, Engin Dinc Page 1
    Background
    Transradial approach (TRA) is widely used all around the world in coronary angiography and percutaneous coronary interventions. Ulnar artery (UA) access can be used as an alternative to TRA in coronary catheterization. Transulnar approach (TUA) is as effective and safe as TRA in coronary angiography and angioplasty.
    Objectives
    The aim of the present study was to evaluate the effects of unilateral reciprocal compression of radial artery (RA) and ulnar artery (UA) on arterial diameter, flow velocity, and volume flow in healthy individuals.
    Patients and
    Methods
    A total of 210 extremity arteries of 105 consecutive cases were evaluated using Doppler ultrasonography. At the wrist level, UA and RA were sequentially compressed for 60 seconds. The diameter, peak systolic velocity (PSV), and volume flow (VF) were evaluated during UA and RA compressions.
    Results
    The mean baseline RA diameter was 2.04 ± 0.33 mm and the mean baseline UA diameter was 1.92 ± 0.38 mm, indicating a significantly greater RA diameter than the UA diameter (P = 0.005). Baseline diameters, PSV, and VF of the RA and UA significantly increased during reciprocal compression (P
    Conclusion
    The present study results showed significant increases in the diameters, PSV, and VF values of both RA and UA during reciprocal compression, compared to baseline values. The increases in the diameter, velocity and volume flow of the UA from baseline were more prominent compared to the RA. Our study results showed that an ultrasonographic measurement of diameter, PSV and VF would still be necessary in preoperative period.
    Keywords: Radial Artery, Ulnar Artery, Doppler Ultrasonography, Hemodynamics
  • Seyyed Mohammad Ghodsi, Alireza Khoshnevisan, Mahdi Arjipour, Hossein Ghanaati, Kavous Firouznia *, Amir Hossein Jalali, Madjid Shakiba, Nafiseh Ghavami Page 2
    Background
    Pre-operative glial brain tumor grading could determine the management. Perfusion weighted magnetic resonance imaging (PWMRI) is a promising modality for assessment and management of brain lesions.
    Objectives
    In this study, we assessed the diagnostic efficacy of this method in the grading of supratentorial gliomas using 3 Tesla MRI.
    Patients and
    Methods
    Using a 3 Tesla MRI unit, 35 (20 male, and 15 female) patients with glioma were examined one month before surgery. Imaging protocol was: 615 slices, field of view (FOV) 22 × 22 cm2 T1W spin echo: repetition time (TR) 500 -echo time (TE) 30 and (FOV) 22 × 22 cm2 T2W Turbo spin echo: TR 5000 -TE 90. Then 15 cc gadolinium was injected at the rate of 3cc/s and imaging was repeated with: TR: 2360 TE: 45, flip angle 90, band width 1346 echo planar imaging (EPI) 128 measurement 50. Mean transit time (MTT), cerebral blood flow (CBF) and cerebral blood volume (CBV) were measured at enhancing and edematous regions compared to contralateral white matter. Then, an appropriate biopsy was performed from different sites of the tumor during surgical excision. Standard hispathological examination that was assessed in a double-blinded manner, was considered as gold standard.
    Results
    Patients’ tumor distribution was grade IV in 14 (40%), grade II in 14 (40%), grade III in six (17.1%) and grade I in one (2.9%). Relative CBF (rCBF), and rCBV was significantly more in high-grade glioma (HGG) versus low-grade glioma (LGG) (P
    Conclusion
    PWMRI is more accurate than conventional MRI for noninvasive discrimination of low-grade glioma (LGG) and high-grade glioma (HGG) that could be helpful for neurosurgeons in decision making dealing with the most common tumor of the brain.
    Keywords: Glioma, Grading, Magnetic Resonance Imaging (MRI), Perfusion
  • Hee Jin Park, So Yeon Lee *, Yoon Jung Choi, Jai Hyung Park, Eugene Kim Page 3
    Background
    We use MRI to determine the mean acromiohumeral distance (AHD) in subacromial impingement (SI) and to identify which part of the subacromial space has the strongest effect on impingement.
    Objectives
    To assess the association between AHD and SI and to determine which subacromial site most strongly correlates with impingement.
    Patients and
    Methods
    The patient population was composed of 56 (70%) men and 24 (30%) women; 45 patients had SI and 35 did not. We measured the shortest distance from the outer margin of the inferior cortex of the acromion to the upper cortex of the humeral head at a total of six points. The mean AHD at each location was compared between patients with and without SI using Mann-Whitney tests. To define the optimal cutoff value at each location for the diagnosis of SI, we applied a receiver operating characteristic (ROC) curve and maximum Youden index.
    Results
    Mean AHDs in patients with SI were smaller than those of normal patients. Differences in the length of the lateral and central portions were statistically significant (P
    Conclusion
    Patients with SI had narrower AHDs than patients without impingement, and specifically, the lateral and central portions of the acromion played an important role in the development of SI.
    Keywords: MRI, Shoulder, Impingement, Acromion, Supraspinatus Tendon
  • Rezvan Ravanfar Haghighi *, Sabyasachi Chatterjee, Vardahan.C. Vani, Pratik Kumar, Milo Tabin, Ruma Ray, Reza Jalli, Sepide Sefidbakht, Fariba Zarei, Ali Reza Shakibafard, Somayeh Gholami Bardeji, Mahdi Dodangeh, Bijan Bijan Page 4
    Background
    Inversion of dual-energy computed tomography (DECT) data for obtaining the electron density and effective atomic number of substances has been a work in progress for the past forty years. It has been the practice to characterize the material in terms of Hounsfield Unit (HU) values obtained by two different energies.
    Objectives
    Since HU values are equipment-dependent quantities, it is necessary to develop a method that characterizes the substance in terms of certain physical quantities that are equipment independent.
    Materials And Methods
    The process that we adopt is to find a calibration method by which all equipment-dependent quantities are eliminated and we directly deal with quantities that are representative of the sample, namely its electron density and effective atomic number. We collect the DECT data from 21 samples of non-calcified coronary artery plaques in human cadavers.
    Results
    With our standardized inversion method, we have obtained the electron density and effective atomic number of these samples. With physical models of lipids and proteins, it becomes possible to conclude that non-calcified plaque samples can have calcium dispersed in the lipid part of the plaque in trace amounts that cannot be observed by light based microscopy or by CT images alone.
    Conclusion
    This characterization, may give a new insight in characterization of non-calcified coronary artery plaque and in medical diagnostics.
    Keywords: Dual, Energy Computed Tomography, Non, Calcific Plaque, Plaque Characterization, Coronary Artery Disease
  • Nasrin Ahmadinejad, Maryam Jafari *, Maryam Rahmani, Kiara Rezaei-Kalantari, Madjid Shakiba Page 5
    Background
    Groups of microcalcifications are the most frequent recognized features of ductal carcinoma on mammograms. However, heterogeneity (in size, morphology and density) and number of microcalcification groups as well as presence of accompanied soft-tissue density are not included in breast imaging reporting and data system (BI-RADS) descriptors.
    Objectives
    The study purposes to determine the malignancy risk of microcalcification groups regarding these characteristics and also compare the 4th and 5th versions of BI-RADS.
    Patients and
    Methods
    In a cross sectional study, 88 patients with microcalcification groups (age range, 26 - 80 years; mean, 53.4 years) who had undergone mammographically guided biopsy between March 2013 and March 2015 were evaluated. The overall number of microcalcification groups in each patient, number of deposits within each group, group location and heterogeneity in size, density and morphology were assessed and subsequently BI-RADS descriptors for 4th and 5th editions were recorded separately. Finally, correlation with histopathology was performed.
    Results
    Overall, positive predictive value (PPV) of suspicious microcalcifications was 22.4%. PPVs of morphology descriptors were as follows: amorphous, 7.9%; coarse heterogeneous, 17.8%; fine pleomorphic, 63.2%; fine linear/fine linear branching, 100%; (P
    Conclusion
    The risk of malignancy increased with the heterogeneity of microcalcifications, especially in the groups with heterogeneity in density, however with no statistically significant difference. BI-RADS 5th edition could predict the likelihood of malignancy as well as 4th version.
    Keywords: BI, RADS, Suspicious Microcalcifications, Mammography
  • Mehmet Burak Ozkan*, Meltem C. Bilgici, Esra Eren, Gonul Caltepe Page 6
    Background
    Elastography is used to determine tissue stiffness.
    Objectives
    The aim of the study was (i) to determine the normal values of liver and splenic stiffness in a pediatric population, (ii) to assess if these values are comparable or not when the linear probe is used, and finally (iii) to assess the impact of potential confounding factors such as age, and gender.
    Patients and
    Methods
    This prospective study consists of 97 healthy volunteers between 6 months and 14 years of age. These volunteers were divided into four groups based on age. The shear wave velocities (SWVs) were obtained from each hepatic lobe and splenic parenchyma by each transducer (linear 9L4 and convex 4C1).
    Results
    Splenic parenchyma values were significantly higher than the liver parenchyma regardless of the probe used (P = 0.001). There was no statistically significant differences obtained when using the 9L4 probe for both hepatic lobes and the splenic parenchyma under the age of 2 years (P = 0.352, 0.898 and 0.876). The variance was similar in both lobes with the 4C1 probe (t = 0.6471, non-significant). Whereas, with the 9L4 probe, the variance was slightly higher in the left lobe (t = -4.16, P = 0.01). Gender had no effect on SWV (P ≥ 0.1 for all sites).
    Conclusion
    The velocity values obtained from the different parts of the liver and spleen could be used as reference values to enlighten further studies. For children under the age of 2 years, a linear probe could be a better choice for assessing liver and splenic parenchymal tissue stiffness.
    Keywords: p, SWE Imaging, Elastography, Reference Values, Liver, Spleen
  • Pinggui Lei, Jun Jiao, Xiaolin Wang *, Qinghong Duan, Xun Zou, Hui Feng, Jujiang Mao, Pingxian Wang Page 7
    Background
    As cross-sectional images expanded in clinical practice, the number of renal lesions discovered incidentally has been increasing. CT protocols for renal mass evaluation may include pre- and post-contrast phase. However, a major concern with respect to those multiphase techniques is often the radiation dose. One further critical issue is how to minimize the radiation dose while image quality is optimized in routine daily clinical practice.
    Objectives
    To evaluate the image quality and radiation dose of renal artery CT angiography (CTA) with optimal sinogram affirmed iterative reconstruction (SAFIRE) strength level at 80 kVp for optimizing the scan and reconstruction parameters of renal artery CTA, in comparison to 120 kVp acquisition with filtered back projection (FBP).
    Patients and
    Methods
    Sixty consecutive patients were classified into three groups prospectively in this study: 1) 80 kVp group (n = 30) with FBP and 2) 80 kVp group with SAFIRE (S4) and 3) 120 kV group (n = 30) with FBP. CT values and noise were measured, contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) of the renal artery CTA were calculated for quantitative assessment. Subjective image quality was evaluated by two experienced abdominal radiologists with a five-point scale in a blinded and randomized setting for qualitative assessment. Volume CT dose index (CTDIvol) and size-specific dose estimate (SSDE) were calculated and estimated for each subject presented in this study.
    Results
    As for quantitative assessment, CNR, SNR and CT values of renal artery in 80kVp group with SAFIRE strength levels or FBP were higher than those of 120 kVp group with FBP (all Ps
    Conclusion
    In patients with BMI lower than 28 kg/m2, renal artery CTA at 80 kVp with SAFIRE is feasible and can provide satisfactory images for clinical applications. This method also provides reduction in radiation dose. SAFIRE strength level 4 is recommended for reconstructing renal artery CTA.
    Keywords: Radiation Dose, Image Quality, Renal Artery, CT Angiography, Iterative Reconstruction, Optimization
  • Mina Taghavi, Seyed Ali Alamdaran*, Ali Feizi Page 8
    Background
    Clinical diagnosis of malrotation is difficult to achieve, especially in older children and adults as its nonspecific presentations at this stage are usually neglected leading to delayed diagnosis of these cases.
    Objectives
    In this study, we aimed to evaluate the diagnostic values of ultrasound and upper gastrointestinal (GI) series in patients with suspected intestinal malrotation.
    Patients and
    Methods
    This six-year cross-sectional, prospective study was conducted in Dr. Sheikh Children’s Hospital affiliated to Mashhad University of Medical Sciences, Mashhad, Iran from 2009 to 2015. Totally, 67 children (aged
    Results
    Of the 67 enrolled participants with clinical findings or suspected radiological signs of intestinal malrotation, about half (52.2%) were male. Patients were 2 days to 16 years (mean, 2.5 years) old. Associated anomalies were observed in 47.7% of cases. Sensitivity and specificity were 82.5% and 85.7%, respectively for GI series findings and 82.3% and 54.5%, respectively for ultrasound compared with surgical findings as a gold standard.
    Conclusion
    Ultrasound has a similar diagnostic value compared to upper GI series. They are complementary examinations and negative ultrasound or GI series results do not necessarily rule out intestinal malrotation. Mesenteric vessels ultrasound could be used as more specific diagnostic method for the detection of intestinal rotational disorders.
    Keywords: Intestinal Malrotation, Children, Ultrasound, GI series
  • Tripathi Pratik, Weifeng Guo, Chun Yang, Rai Bimal, Mengsu Zeng * Page 9
    Background
    MRI predicted distance of mesorectal extension (mrDME) in rectal cancer is one of the independent risk factors for recurrence and poor overall survival. In T3 rectal cancer, if no lymph node or distant metastasis is seen, the selection of optimum treatment is based on the distance of mesorectal extension. Therefore, it is very crucial to investigate the reproducibility of DME in T3 rectal cancer.
    Objectives
    To investigate the reproducibility of the distance of mesorectal extension by tumor invasion in T3 stage rectal cancer by evaluating sub-stages T3a, T3b T3c and T3d individually versus T3a, T3b (T3ab) and T3c, T3d (T3cd) combined together using MRI.
    Patients and
    Methods
    From July 2014 to December 2015, 188 patients with surgically and histologically confirmed T3 rectal cancer who underwent preoperative MRI were enrolled into this study. Two blinded radiologists evaluated the maximum distance of mesorectal extension (mrDME) in T2 weighted image in MRI. The study population was sub classified into T3a ( 15 mm) according to the distance of mesorectal extension by tumor invasion. The inter-observer and intra-observer agreements were then assessed using kappa (k) coefficient of agreement and intraclass correlation coefficient (ICC).
    Results
    Difference in the value of inter-/intra-observer kappa, and inter-/intra-observer ICC between the two groups was very distinct. In the individual group (T3a, T3b, T3c and T3d), the inter-observer and intra-observer (k) for the mrDME was 0.700 and 0.718 respectively; the inter-observer and intra-observer ICC was 0.772 and 0.786 respectively. In the combined group (T3ab and T3cd), the inter-observer and intra-observer kappa (k) for the mrDME was 0.819 and 0.883 respectively; the inter-observer and intra-observer ICC was 0.829 and 0.796 respectively.
    Conclusion
    There was a distinct increase in the kappa and ICC value in the combined group compared with the individual group. This high reproducibility result suggested that it is more reliable to measure T3ab and T3cd combined together than individually. This finding can play a crucial role in the management of rectal cancer and clinical decision making for non-expert radiologists in non-academic setting.
    Keywords: Rectal Cancer, T3 Sub, Staging, Reproducibility Test, MRI, Distance of Mesorectal Extension, mrDME
  • Liangguo Fa, Guangrui Shao *, Linlin Meng, Linlin Wang Page 10
    Objectives
    To evaluate the reliability of Tönnis angle and modified Tönnis angle on pelvic radiographs in adults.
    Patients and
    Methods
    Conventional anterior-posterior pelvic radiographs of patients were selected from the picture archiving communication system (PACS) in the department of medical radiology of the Second Hospital of Shandong University. Tönnis angle and modified Tönnis angle were measured. All measurements were performed by two experienced observers who worked independently of each other. These measurements were performed again after one month. They were performed digitally using tools of the PACS. Reliability of Tönnis angle and modified Tönnis angle was assessed by intraclass correlation coefficients and Bland-Altman plot.
    Results
    A total of 142 patients (79 females and 63 males) with 284 hips were selected. Tönnis angle and modified Tönnis angle were measured on the 284 hips by two observers. Intraclass correlation coefficients (ICCs) for intraobserver agreement of measurements were 0.962 and 0.983 for Tönnis angle, and 0.971 and 0.984 for modified Tönnis angle. ICCs for interobserver agreement of measurements were 0.936 for Tönnis angle and 0.932 for modified Tönnis angle. Bland-Altman plot suggested good interobserver agreement of measurements for Tönnis angle and modified Tönnis angle.
    Conclusion
    Reliability of Tönnis angle and modified Tönnis angle was good according to ICCs and the Bland-Altman plot.
    Keywords: Acetabulum, Radiography, Diagnosis, Hip Dislocation
  • Jae Hyun Kwon *, Dae Bong Kim, Yoon Hee Han, Yoon Ki Cha, Jeung Sook Kim Page 11
    Background
    Thyroid nodules are a common clinical problem and ultrasound-guided fine needle aspiration (US-FNA) biopsy is widely used for evaluation of thyroid nodules. However, few studies have addressed the contributing factors to hemorrhage after US-FNA of thyroid nodules.
    Objectives
    To assess the contributory factors related to patient characteristics, ultrasound (US) features of the thyroid nodules, and the US-FNA procedures to affect hemorrhage complications after US-FNA of thyroid nodules.
    Patients and
    Methods
    Between March 2014 and April 2015, 366 consecutive patients who underwent US-FNA of thyroid nodules were enrolled in this retrospective study. The characteristics of hematomas, including the location, maximum size, and clinical course, were assessed. The relationships between hematomas and factors related to the medical characteristics of patients, US characteristics of the nodules, and FNA procedural factors were analyzed.
    Results
    Data on 365 nodules in 321 patients who underwent US-FNA of thyroid nodules were analyzed. Minor hemorrhagic complications developed in 14 (3.8%) of the 365 nodules. There were no statistically significant differences between patients taking or not taking an anticoagulant or antithrombotic (P = 0.270). Factors related to increased risk of hematoma were male sex (P = 0.031), larger maximum size (P = 0.002), a cystic or predominantly cystic nodule (P
    Conclusion
    US-FNA can be performed safely even in patients taking anticoagulant or antithrombotic agents. Factors related to hemorrhagic complications are male sex, larger nodules, cystic or predominantly cystic nodules, probably benign nodules, thicker needles and a greater number of needle passes.
    Keywords: Thyroid Nodule, Ultrasound, Fine, Needle Aspiration, Hemorrhage, Complications
  • Goran J. Djuricic *, Jelena S. Vasiljevic, Dusan J. Ristic, Relja Z. Kovacevicc, Dalibor V. Risti?, Nebojsa T. Milosevic, Marko Radulovic, Jelena P. Sopta Page 12
    Background
    Due to the high level of cytogenetic heterogeneity in osteosarcoma, personalized treatment is the promising strategy for the improvement in outcomes. This is currently not possible due to the absence of targeted therapies and reliable predictors for response to induction chemotherapy.
    Objectives
    To investigate the predictive value of computational analysis of osteosarcoma magnetic resonance (MR) images.
    Patients and
    Methods
    Multifractal analysis was performed on MR images of primary osteosarcoma of long tubular bones prior to OsteoSa induction chemotherapy. A total of 900 images derived from 67 good and poor responder patients were classified and compared to the actual retrospective outcome.
    Results
    Among the six calculated multifractal features, Dqmax exerted the highest predictive value with the prediction accuracy of 74.3%, sensitivity of 72.4% and specificity of 76.2%. The obtained classification accuracy was validated by a ten V-fold split sample cross validation. The area under the curve (AUC) value for the best-performing multifractal Dqmax feature was 0.82 (95% confidence interval, 0.70 - 0.91).
    Conclusion
    These results suggest for the first time that measuring tumor structure by using multifractal geometry can predict an individual patient response to neoadjuvant cytotoxic therapy. Therefore, it potentially allows precise implementation of alternative treatment options. This predictive approach made use of digital data that is routinely collected but currently still underexploited.
    Keywords: Magnetic Resonance Imaging, Fractals, Drug Therapy, Sarcoma, Osteosarcoma, Classification
  • Mohammad Hassani, Mohammad Reza Zafarghandi *, Morteza Taghavi, Javad Salimi, Majid Moini, Amirsina Sharifi, Morteza Noaparast, Mohammad Reza Toubaei, Morteza Shahbandari, Somayeh Alsadat Naserinia, Soheil Saadat, Farzad Biniaz Page 13
    Background
    In the last decade, great attention has been paid to endovascular treatment and now it is considered as a treatment of choice in aortoiliac occlusive disease.
    Objectives
    To report our 2-year follow-up experience in this field.
    Patients and
    Methods
    A retrospective review was conducted on patients who underwent aortoiliac angioplasty with or without stenting from September 2013 to March 2015. Medical profile, clinical signs and symptoms, and technical variables of angioplasty were recorded. Technical success rate and primary patency rate were the main outcome measures.
    Results
    Fifty eight patients (m:f = 53:5) with the mean age of 64.28 ± 10.88 years and the most common initial presentation of intermittent claudication (37.9%) were evaluated. The technical success rate was 100% in each transatlantic inter-society consensus (TASC) subtypes. The mean time of hospital stay was 9.45 ± 7.96 days. The mean follow up period was 14.01 ± 5.87 months (6-27months). The Kaplan-Meier analysis estimated a primary patency rate of TASC subtypes A-D at 1 year as 96.3%, 100%, 66.7%, and 96.3%, respectively. Two years primary patency rates were 96.3%, 100%, 66.7%, and 81.6% for A-D TASC subtypes, respectively. There was no complication or death in the study group.
    Conclusion
    Endovascular treatment for different TASC II subtypes is associated with considerable technical success rate and primary patency rate even in TASC D, which has been previously indicated to be treated with open surgical procedures.
    Keywords: Endovascular Therapy, TASC II Morphological Stratification, Aortoiliac Occlusive Disease, Technical Success Rate, Primary Patency Rate
  • Yoonsoo Kim, Bong Joo Kang *, Sung Hun Kim, Eun Jae Lee Page 14
    Background
    When a suspicios breast lesion is found on MRI but is not observed on conventional imaging, targeted ultrasound of the MRI-detected lesion is commonly performed for its detection and characterization. Nonetheless, there are limitations of handheld ultrasound (HHUS). Another ultrasound modality named automated breast volume scanner (ABVS) has achieved automation and high resolution recently. The detection rate and accuracy of conjunctive and disjunctive combination of each ultrasound modality (HHUS and ABVS) have not yet been evaluated.
    Objectives
    To compare the diagnostic performance using HHUS, ABVS, and the combination method for suspicious lesions found on MRI.
    Patients and
    Methods
    From March to September on 2014, we prospectively enrolled 40 consecutive breast cancer patients who underwent HHUS and ABVS for newly detected suspicious lesions found on MRI. All patients underwent mammography and HHUS before MRI. Whole breast ABVS and another HHUS were performed after MRI. We reviewed the detection rate and diagnostic accuracy of each imaging and analyzed the conjunctive and disjunctive combination results of two ultrasound modalities. We then compared them with or without knowledge of MRI.
    Results
    In 120 suspicious lesions of 40 patients, seventy-six malignant and 44 nonmalignant lesions were included. With knowledge of MRI, cancer detection sensitivities of HHUS, ABVS, conjunctive and disjunctive combination were higher than those without knowledge of MRI (94.7%, 98.7%, 100%, 93.4% vs. 65.8%, 64.5%, 67.1%, 63.2%). In conjunctive combination of HHUS and ABVS, the detection sensitivities were improved in both cases with and without knowledge of MRI.
    Conclusion
    With knowledge of MRI, HHUS and ABVS imaging detected most lesions and the conjunctive combination showed the highest detection sensitivity.
    Keywords: Breast Cancer, Magnetic Resonance Imaging, Ultrasound
  • Chia-Ying Lin, Yi-Sheng Liu, Ying-Chen Chen, Yu-Hsiang Shih, Chao-Chun Chang, Ming-Tsung Chuang * Page 15
    Background
    Variations in the origin of vertebral arteries (VA) and its entrance level into the transverse foramen are common and important when planning neck and cervical spine interventions.
    Objectives
    The aim of this study was to investigate the prevalence of anatomical variations in the origin of vertebral arteries, and anomalous course of the extracranial vertebral artery using dual energy CT angiography.
    Patients and
    Methods
    Retrospectively, we reviewed head and neck dual energy computed tomography (DECT) angiographies of 1218 consecutive patients during 2010 - 2014. The images were evaluated with exceptional attention to the origin of VA and its level of entrance into and exit out of the transverse foramen of the cervical spine, specific variations of VA including fenestration and intradural course of C1 - C2 VA.
    Results
    We found a rare case of double origin of left VA with bifid origins (one from the aortic arch and the other from the left subclavian artery) and entering the transverse foramen at C6 and C5 levels. The majority of left VA (1173/1219, 96.2%) originated from the left subclavian artery. Most of them (1159/1173, 98.8%) entered the C6 transverse foramen. Forty - six of left VA (46/1219, 3.8 %) originated from the aortic arch and thirty - seven (80.4%) of them entered the C5 transverse foramen. When the left VA arose from the aorta, there was a significant higher rate of anomalous entrance level (C4 or C5) to normal C6 entrance level (P
    Conclusion
    The study showed anatomical variations of the VA in its origin and extracranial course. A pre - operative CT angiography is useful to identify the anomalous extracranial VA course. It reduces the risk of intra - procedure VA injury.
    Keywords: Vertebral Artery, Neck, Computed Tomography Angiography, Anatomy
  • Isil Uzun *, Cenk Sayin, Selen Erzincan, Cihan Inan, Havva Sutcu, Fusun Varol Page 16
    Objectives
    To evaluate the second trimester ultrasound findings of the fetuses with Down syndrome.
    Patients and
    Methods
    We conducted a retrospective analysis of 781 patients who underwent prenatal invasive test between November 2011 and July 2015. Based on the patients’ medical records, the demographic data and second trimester ultrasound findings of the fetuses with Down syndrome were retrospectively analyzed.
    Results
    Trisomy 21 was detected in 26 (3.3%) patients. The median (min-max) maternal age of trisomy 21 cases was 31.9 (17 - 41) years. The karyotype indications were high risk in the combined test, triple test, quadruple test and pathologic findings on the ultrasound examination. One case in the ultrasound group had both of combined test and triple test in the low risk area. In this patient, ultrasound examination revealed talipes equinovarus and delayed chorioamniotic fusion at 27 weeks of gestation. Trisomy 21 was detected in four patients by chorion villus biopsy at the first trimester. Second trimester ultrasound was performed in 22 out of these 26 women. However, there were sonographic findings in only 16 (72.7%) patients. Six (27.2%) fetuses had no minor or major anomaly at the detailed ultrasound examination. The frequency of major cardiac anomaly was 22.7%. Choroid plexus cyst and aberrant right subclavian artery were the single findings in two fetuses at the second trimester ultrasound exam.
    Conclusion
    Although the sensitivity of second trimester genetic ultrasound for detection of fetal Down syndrome at our perinatology unit was rather high, nearly one of three patients with Down syndrome had no detectable sonographic finding. Second trimester ultrasound alone is not strong enough to exclude the diagnosis of Down’s syndrome
    Keywords: Down Syndrome, Sonography, Screenning
  • Ji Soo Song, Jae Do Yang, Woo Sung Moon * Page 17
    Cystic hepatic lesions are commonly encountered in clinical practice. Most of them are simple hepatic cysts such as biliary cysts. However, complicated biliary cysts with hemorrhage, necrosis, and organization pose diagnostic challenges since imaging findings overlap with those of neoplastic cystic lesions. Here, we report a case of biliary cyst complicated by hemorrhage with secondary revascularization with ultrasound, computed tomography, and gadoxetic acid-enhanced magnetic resonance imaging findings mimicking mucin-producing cystic neoplasm.
    Keywords: Biliary Cyst, Complicated Cyst, Revascularization, Organization, Mucinous Cystic Neoplasm
  • Kyu-Chong Lee, Jae Wook Lee *, Hwan Seok Yong, Eun-Young Kang Page 18
    Hemorrhage extending to the pulmonary artery is an uncommon complication of Stanford type A aortic dissection that has a poor prognosis. Diagnosis of this complication is mainly dependent on imaging studies, especially computed tomography. High attenuation can be seen along the wall of the pulmonary artery on the non-enhanced study, while the enhanced study shows luminal narrowing and wall thickening of the pulmonary artery. We report three cases with different imaging findings of hemorrhage extending to the pulmonary artery from Stanford type A aortic dissection.
    Keywords: Hemorrhage Extending to the Pulmonary Artery, Aortic Dissection, Computed Tomography
  • Bum-Sung Choi, Yeon Joo Jeong, Geewon Lee, Seunghwan Song, Min-Jung Cho, Miri Jeong, Ji Won Lee * Page 19
    Anomalous drainage of the inferior vena cava into the left atrium is a rare congenital vascular disorder. It can occur with atrial septal defect, anomalous pulmonary venous drainage, and pulmonary arteriovenous fistula. Hereby we describe the computed tomography (CT) findings of a rare combination of drainage of the inferior vena cava associated with atrial septal defect and partial anomalous pulmonary venous return.
    CT angiography is useful for early detection of this combined anomaly and for proper surgical planning.
    Keywords: Computed Tomography Angiography, Atrial Septal Defect, Partial Anomalous Pulmonary Venous Return, Inferior Vena Cava
  • Ji Eun Shin, Jung Yin Huh *, Hai-Lin Park, Song Mi Noh Page 20
    Charcoal is a biologically inert material used for the preoperative localization of nonpalpable breast lesions; its foreign body reactions have occasionally been reported. Although a few case reports on the formation of charcoal granulomas in the breast because of such reactions exist, to the best of our knowledge, no report includes breast-imaging findings obtained using multiple modalities. Here we report a case of two charcoal granulomas that mimicked breast cancer recurrence and provide breast-imaging findings obtained using mammography, ultrasonography, magnetic resonance imaging, and positron emission tomography/computed tomography. We also discuss the radiological and pathological features of charcoal granulomas. Awareness of breast imaging findings using multiple modalities along with the clinical and pathological features of charcoal granulomas helps in the differential diagnoses of newly detected lesions on postoperative follow-ups and reduces the need of unnecessary invasive procedures.
    Keywords: Breast, Charcoal, Granuloma, Mammography, Ultrasonography, Magnetic Resonance Imaging
  • Taehoon Ahn, Seon-Kwan Juhng *, Guy Mok Lee, Heon Soo Kim Page 21
    A 57-year-old woman with no significant past medical history and normal immunity presented with a slowly growing mass on her finger. MR imaging showed a low signal intensity soft tissue mass on both T1- and T2- weighted images with peripheral contrast enhancement. The mass was diagnosed as chronic granulomatous inflammation with caseous necrosis histopathologically and also Mycobacterium tuberculosis by a polymerase chain reaction about the tissue specimen. Authors thought that it was tuberculous gumma presented in an immunocompetent patient. This paper reports a rare case of tuberculous gumma with radiologic findings in an immunocompetent patient.
    Keywords: Tuberculous Gumma, Immunocompetency, MRI, Soft Tissue Mass