فهرست مطالب

Iranian Journal of Radiology - Volume:15 Issue: 4, 2018
  • Volume:15 Issue: 4, 2018
  • تاریخ انتشار: 1397/08/24
  • تعداد عناوین: 20
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  • Arvin Arian , Zinat Ghanbari , * , Nastaran Chegini , Melina Hosseiny Page 1
    Background
    Ultrasound has emerged as a valuable complimentary tool for assessment of pelvic organ prolapse (POP).
    Objectives
    The present study aimed to evaluate the correlation between ultrasound measures and clinical staging in patients with suspected POP. Patients and Methods: Forty women with clinical suspicion of POP were enrolled in this cross-sectional study between November 2011 and April 2012. Pelvic organ prolapse quantification (POP-Q) system was used for clinical staging. Perineal ultrasound was performed both at rest and during Valsalva maneuver after proper preparation. On mid sagittal view, two reference lines were drawn; midpelvic line (MPL) was defined as the inferior horizontal tangent of symphysis pubis and H line was drawn from the most inferior part of symphysis pubis to the anorectal junction. Spearman’s correlation coefficient and Kappa coefficient of agreements were used for statistical analysis.
    Results
    Forty women with the mean age of 49.9 ± 10.07 years were enrolled. Excellent correlation was seen between MPL and H line (rho = 0.91, 0.93 and 0.88 in anterior, apical and posterior compartments, respectively). POP-Q had good-to-excellent correlation with ultrasound (rho = 0.84, 0.78 and 0.63 for H line and rho = 0.89, 0.82, 0.71 for MPL in anterior, apical and posterior compartments respectively). In anterior and apical compartments, high agreement was seen between clinical and ultrasound staging methods when grouping patients to no prolapse/mild vs. moderate/severe. In the posterior compartment, this agreement was significant when grouping was done based on the presence or absence of POP.
    Conclusion
    Ultrasound has high correlation with POP-Q staging in all compartments for staging of pelvic organ prolapse. Ultrasound might be useful in the diagnosis of pop in those with negative clinical examination.
    Keywords: Pelvic Organ Prolapse, Trans Perineal Ultrasonound, Physical Examination, POP-Q, Agreement
  • Jungho Jang , Dae Seob Choi*, Hwa Seon Shin , Hye Jin Baek , Ho Cheol Choi , Sung Eun Park , Ji Eun Kim , Mi Jung Park Page 2
    Background
    Cerebral venous thrombosis (CVT) is difficult to diagnose because of the variety of its clinical and imaging findings and the many anatomical variations in the cerebral venous system.
    Objectives
    We aimed to investigate the clinical and radiological CVT and to evaluate differences in their findings, according to the presence or absence of cortical vein involvement (CVI). Patients and Methods: From the 13 years database of our institution, forty-nine patients were enrolled in the study. In all patients, CVT was confirmed on CT venography, MR venography and/or digital subtraction angiography (DSA). We retrospectively reviewed the clinical presentations and CT and MR findings of the patients and compared their findings, according to the presence or absence of CVI.
    Results
    CVI was detected in 31 patients (63.3%). The most common clinical symptom was headache (61.2%), followed by focal neurologic deficit (FND) (49.0%), seizure (40.8%), and altered consciousness (18.4%). FND was frequent in the CVI group (67.7 vs. 16.7%, P = .001). On CT (n = 49) and/or MR (n = 38), intracranial hemorrhage was present in 33 patients (67.3%) and parenchymal hyperintensity was detected in 24/38 (63.2%). Subarachnoid hemorrhage (SAH) was frequent in the CVI group (51.6 vs. 16.7%, P = .018). The cortical vein (CV) was the most common site of CVT (63.3%), followed by superior sagittal (61.2%), transverse (53.1%), sigmoid (42.9%), and straight (20.4%) sinuses. The superior sagittal sinus thrombosis was frequently associated with concomitant CV thrombosis (74.2 vs. 38.9%, P = .032).
    Conclusion
    CVT commonly involved the CV. Although its clinical manifestation was diverse, FND was common in the CVI group. Intracranial hemorrhage and parenchymal hyperintensity were common CT and MR findings and SAH was commonly associated in the CVI group.
    Keywords: Cerebral Venous Thrombosis, Intracranial Hemorrhage, CT, MR, CT Venography, MR Venography
  • Serap Dogan , * , Soner Ozmen , Bahadir Oz , Hakan Imamoglu , Guven Kahriman , Gokmen Zararsiz , Mustafa Ozturk Page 3
    Background
    Breast cancer is a heterogeneous disease with different molecular and histologic subtypes, clinical behaviors and prognosis. The same stage of disease and similar histopathological characteristics may show different treatment responses. Identification of breast cancer subtypes has become important for planning the targeted therapy and personalized management of patients.
    Objectives
    To compare the clinicopathologic findings, dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) characteristics and associated MRI findings among breast cancer molecular subtypes. Patients and Methods: 267 pathologically proven invasive breast cancers in 263 patients were included. Clinicopathological findings, DCE-MRI findings and associated MRI findings were retrospectively evaluated and compared among breast cancer subtypes.
    Results
    Invasive ductal carcinoma was the most common histological tumor type (87.6%). There were 222 (83.1%) masses and 45 (16.9%) non-mass enhancements. The molecular subtypes were luminal A in 174 (65.1%), luminal B in 45 (16.9%), human epidermal growth factor receptor 2 (HER2) positive in 24 (9%) and triple negative (TN) in 24 (9%) of the lesions. Spiculated mass margin was significantly associated with luminal A breast cancer (45.2%) and irregular shape was significantly more common in luminal A (86.3%) and luminal B lesions (95.1%) (P < 0.001). Larger mass size (P = 0.027), non-mass enhancement (P = 0.005), perilesional + prepectoral edema and skin + perilesional + prepectoral edema were significantly associated with HER2 positive breast cancer (P = 0.001). Higher histological grade, oval mass shape, circumscribed mass margin, intratumoral high/very high signal intensity on T2 weighted image (T2WI) were significantly associated with TN breast cancer (P < 0.001).
    Conclusion
    Histological grade, size and morphological features of masses on DCE-MRI, intratumoral signal intensity on T2WI and edema pattern would be helpful to distinguish breast cancer subtypes.
    Keywords: Breast Cancer, Dynamic-Contrast Enhanced Breast MRI, Molecular Subtypes
  • Abbas Arjmand Shabestari , Robab Anbiaee , Taraneh Faghihi Langroudi , Hooman Bakhshandeh , Maryam Heidari, Sooreshjaani * Page 4
    Background
    Adjuvant radiation therapy (RT) improves the prognosis of breast cancer (BC); nevertheless, causes post-RT complications. One of the most life-threatening complications of RT in BC patients is atherosclerotic coronary artery disease (CAD). Compared with old two-dimensional RT (2D-RT), newer three-dimensional conformal radiotherapy (3D-CRT) protects normal tissues including the heart from irradiation. Early detection of plaques using coronary artery calcium score (CACS) could improve the post-RT BC survivors’ outcomes.
    Objectives
    This study assessed CACS in BC patients who underwent 3D-CRT to find whether there is any significant difference between their CACS and those of non-BC patients. Patients and Methods: CACS of fifty BC patients with different intervals from RT - case - and fifty women with no history of BC or RT - control - using 64-slice ECG-gated CT scan were assessed as Agatston score (AS). The risk factors of CAD, the Framingham’s 10-year risk score, and the age-matched CACS percentiles were evaluated.
    Results
    No AS difference between the case and control was found. No correlation between AS and RT-to-follow-up time interval, laterality of BC, Framingham’s 10-year risk score or traditional CAD risk factors were detected. Increase in CACS related to the senile atherosclerotic process was shown (P < 0.001).
    Conclusion
    No significant difference in CACS was found in BC patients treated by 3D-CRT in comparison with those of non-BC individuals or BC patients who treated by 2D-RT. This finding may be the result of either the non-calcified nature of radiation-induced CAD plaques or reduced cardiac radiation in 3D-CRT, leading to myocardial microvascular disease rather than senile calcified atherosclerotic plaques. CACS may not be an appropriate screening test to detect early CAD in these patients.
    Keywords: Breast Cancer, Three-Dimensional Conformal Radiotherapy, Calcium Score, Coronary Artery Disease
  • Wen, Ling Hsu, Shu, Min Chang , Shiang, Bin Jong , Ying, Fong Huang , Chin, Chuan Chang * Page 5
    Background
    Technetium-99m diethylene triaminepentaacetic acid (Tc-99m DTPA) renal scintigraphy using modified Gate’s method is commonly adopted to calculate glomerular filtration rate (GFR).
    Objectives
    The purpose of this study was to find the correlations between GFRs, which are calculated by the in-house and non-in-house workstations from gamma cameras (GC) manufactured by different firms. Patients and Methods: Medical records of patients receiving Tc-99m DTPA renal scan between January and December 2016 were analyzed. Patients were allocated randomly to a GC (1 or 2). The calculated GFRs were conducted by the in-house workstation (group A: workstation 1/ GC 1; group B: workstation2/ GC 2) and the non-in-house workstation from the GC (group C: workstation 2/ GC 1; group D: workstation 1/ GC 2). All patients had their creatinine levels checked to calculate the estimated GRF (eGFR) as the reference data. Comparison of correlation and difference between GFR calculations (group A, B, C and D), eGFRs and clinical parameters was analyzed.
    Results
    Forty patients (24 men, 16 women) were enrolled in this study. The average of eGFRs was 63.0 ± 38.5 mL/min/1.73m2. The GFRs (group A to D) calculated were all significantly correlated with the eGFR. However, there was a significant difference between group C and eGFR (P = 0.0021), and group D and eGFR (P = 0.0262). Eight patients (20%) had changed stage of chronic kidney disease when using non-in-house workstations, compared to in-house workstations from GC.
    Conclusion
    GFRs calculated by the non-in-house workstation were significantly different from eGFR. Use of workstation and GC from the same manufacturer would provide more accurate data in the clinical setting.
    Keywords: Tc-99m DTPA, Glomerular Filtration Rate, Different Workstations, Gamma Camera, Chronic Kidney Disease
  • Ali Mohammadzadeh , Zahra Maleki , Ali Nahardani , Maryam Mohammadzadeh * Page 6
    Background
    Scar tissue formation is a common phenomenon in myocardial infarctions. Contrast-enhanced cardiac magnetic resonance imaging is the modality of choice to evaluate the location and size of the scar tissue. Nevertheless, in patients with severe kidney impairment, administration of gadolinium is contraindicated.
    Objectives
    So the aim of this study was to substitute a safe way for myocardial infarction assessments in patients with a history of renal function impairment. We assessed the T2* quantitative value changes in myocardial infarction-related scar tissue and compared them with normal/remote myocardial tissue T2* values to evaluate its application in non-contrast cardiac magnetic resonance imaging viability assessments. Patients and Methods: Twenty patients with a previous history of non ST-elevation myocardial infarction (NSTEMI) underwent cardiac magnetic resonance (CMR) examination with a 1.5T MR imaging scanner (Avanto, Siemens AG Healthcare Sector, Erlangen, Germany). The time interval between myocardial infarction occurrence and CMR assessment was at least six months. All the patients had normal kidney function. The imaging protocol consisted of three steps: the functional left-ventricular imaging; 8-echoes gradient recalled echo T2* mapping; and delayed/late gadolinium-enhancement imaging. The left-ventricle functional and T2* mapping assessments were done by CMR42 image analysis software (Circle Cardiovascular Imaging, Calgary, Canada). T2* values were calculated for 49 regions of interests (ROIs) at the infarction (14 ROIs), peri-infarction (12 ROIs), and remote/normal myocardial tissues (23 ROIs), and their means were compared statistically by the Leven’s test. Finally, the receiver operator characteristics curve was calculated.
    Results
    T2* (mean ± SD) values of the normal/remote, peri-infarction, and infarcted myocardial tissues were calculated as 29.42 ± 4.50, 30.71 ± 4.86, and 35.46 ± 3.61, respectively. There was a significant alteration in the post-infarction scar tissue’s myocardial T2* values by comparison with the normal/remote myocardium (P < 0.001). No significant differences were noticed between the normal/remote and peri-infarction regions’ T2* relaxation times (P > 0.05). Area under the curve was 81% for patients evaluated for scars. Cutoff value of 31.70 yielded 92% sensitivity and 72% specificity.
    Conclusion
    T2* relaxation time can provide useful and sensitive information on scar tissue formation location, and can offer a greater sensitivity into the non-contrast CMR imaging viability assessments besides other relaxation phenomena, especially the longitudinal relaxation time.
    Keywords: Cardiac Magnetic Resonance Imaging, T2* Mapping, Delayed Gadolinium-Enhancement Imaging, Myocardial Infarction
  • Hwayoung Song , In Jae Lee * Page 7
    Background
    There are many more trials for low-dose chest computed tomography (LDCT) screening than for chest radiography, as a recent study shows that low-dose chest CT screening for smokers may reduce lung cancer mortality.
    Objectives
    To assess the differences of low-dose CT imaging features between smokers and non-smokers. Patients and Methods: A retrospective review of all current smokers who visited our hospital between August 2015 and May 2016 to quit smoking and who had received chest LDCT was conducted. The patients had received an LDCT screening during the same period; non-smokers were considered as the control group. The retrospective interpretation for the nodule numbers and size, lymphadenopathy, emphysema, bronchiectasis, as well as coronary artery calcifications was performed at univariate and multivariate analyses.
    Results
    Among 304 patients (130 in the non-smoker group and 174 in the smoker group), the number and diameter of nodules, pleural lesions, lymphadenopathy, and bronchiectasis were not significantly different between the smoker and non-smoker groups. Emphysema was detected in 11 (8.5%) patients in the non- smoker group and 75 (43.1%) in the smoker group. Coronary artery calcifications developed in 22 patients (16.9%) in the non-smoker group and 60 patients (34.5%) in the smoker group. Respiratory bronchiolitis developed in two patients (1.5%) in the non-smoker group and 13 patients (7.5%) in the smoker group. With an increase in the smoking period, emphysema and coronary artery calcifications significantly increased (P = 0.002 and P = 0.007, respectively).
    Conclusion
    In the LDCT findings, emphysema, coronary artery calcifications, and respiratory bronchiolitis were significantly different between smokers and non-smokers. In multivariate analysis, emphysema was only significantly different between smokers and non-smokers. With an increase in the smoking period, the occurrence of emphysema and coronary artery calcifications increased as well at univariate and multivariate analysis.
    Keywords: Smoking Cessation, Emphysema, Coronary Artery Disease, Computed Tomography
  • Seung Hee Han , Bong Joo Kang*, Ji Eun Baek , Hyun Sil Lee , Sung Hun Kim Page 8
    Background
    Mammographic screening for breast cancer has been proved to reduce mortality. However, because of the potential harm of ionizing radiation, radiation dose management has been issued.
    Objectives
    We investigated the influence of several factors on the radiation dose change in full-field digital mammography (FFDM) using a radiation dose management system in Korean women. Patients and Methods: Using an existing radiation dose management system (RadimetricsTM), radiation dose tracking, monitoring, and statistical analyses were conducted. Information including parameters, utilization data, and a dose report were sent to the conventional picture archiving, communication system, and radiation dose management system. We reviewed the data and compared the parameters (exposure, glandular dose, compression thickness, and compression force) between two different devices, among classifications (plain, spot and magnification view, and implant), and between control modes (auto and manual). An association between compression thickness and glandular dose was evaluated. Finally, the glandular dose differences based on age, device, classification, control mode, exposure, compression thickness, and compression force were additionally investigated.
    Results
    From February 25th to June 30th, 2015, a total of 15665 mammogram images of 3958 patients were performed and sent to the conventional picture archiving and communication system (PACS) and the radiation dose management system. A significant difference was observed in glandular dose, compression thickness, compression force, and exposure depending on the type of device (P < 0.05). There were significant differences in all of the parameters among the plain view, spot and magnification view, and implant image (P < 0.05). There was a significant difference in compression thickness and compression force depending on the control mode. A strong association was observed between the compression thickness and glandular dose (P < 0.05).
    Conclusion
    There was glandular dose difference according to specific factors including device type, classification, and control mode. Radiation dose management system is useful for identifying factors that affect radiation dose.
    Keywords: Radiation Dosage, Digital Mammography, Breast
  • Nariman Nezami , Mohammad Naghavi, Behzad , Reza Piri*, Behzad Salari , Steve Hool , Mohammad Khalid Mojadidi , Sona Ghorashi , Mohammad Kazem Tarzamni , Bijan Bijan Page 9
    Background
    Multi-detector computed tomography (MDCT) angiography is a non-invasive imaging modality, and is replacing the invasive conventional angiography in preoperative studies of vascular anatomy.
    Objectives
    To determine the accuracy of MDCT in diagnosis of the renal arterial and venous anatomy, urinary collecting system and kidney anatomy itself in living kidney donors. Patients and Methods: In the present prospective single-center study, 134 potential kidney donors (age: 25.65 ± 3.37 years) underwent MDCT and MDCT angiography in a single center (Aug 2012 - Oct 2013). The bolus tracking method was used. Arterial and venous anatomical variations and kidney size were assessed and compared with the surgical findings.
    Results
    MDCT angiography revealed renal arteries, their branching with 100% sensitivity, specificity, positive and negative predictive values. In addition, the sensitivity, specificity, positive predictive value and negative predictive value for MDCT angiography were 85.71%, 100%, 100% and 99.14%, respectively, in diagnosis of venous branching pattern. There is direct linear correlation between MDCT angiography and surgical findings in measuring arterial length and diameter, and kidney size (All P values < 0.001). Only one patient had ureteral duplication.
    Conclusion
    MDCT determines the renal vascular and urinary collecting system anatomy, and kidney characteristics with almost 100% accuracy in kidney donors.
    Keywords: Computed Tomography, Angiography, Kidney, Artery
  • Yigang Pei , Qian Ye , Juxiong Xiao , Hao Shen , Xueying Long , Xianjing Peng * Page 10
    Background
    Improving imaging quality of non-contrast enhanced magnetic resonance angiography (NCE-MRA) is essential to those renal function impairment patients especially patients with renal segmental branch disease in the renal parenchyma.
    Objectives
    To investigate the relation between blood flow velocity (BFV) and blood suppression inversion time (BSP TI) for optimal visualization of the renal artery in NCE-MRA by spatial labeling with multiple inversion pulses (SLEEK) sequence. Patients and Methods: A catheter (simulated renal artery) was used to perform SLEEK with various BSP TI when injected saline with different velocity (simulated BFV). The relationship between BFV and BSP TI was evaluated by measuring signal-to-noise ratio (SNR) and was confirmed in nine hypertensive patients.
    Results
    A negative relationship was found in vitro study between BFV and BSP TI with SLEEK sequence (r = -0.977, P = 0.023). For BSP TI = 200 ms, the simulated renal artery displayed hyper-intensity when simulated BFV = 96 - 128 cm/s and the maximum SNR was found when BFV = 128 cm/s (SNR = 0.927). For BSP TI = 500 ms, high signal appeared with BFV = 64 - 128 cm/s and the greatest SNR was found with BFV = 96 cm/s (SNR = 1.732). For BSP TI = 800 ms and 1100 ms, hyper-intensity arose with BFV = 16 - 128 cm/s and BFV = 6.4 - 128 cm/s separately, the highest SNR was described when BFV = 32 cm/s (SNR = 2.256) and BFV = 16 cm/s (SNR = 1.875). The different optimal BSP TI with best image quality was discovered in nine hypertensive patients.
    Conclusion
    An optimal BSP TI based on BFV can improve the ability of delineating renal artery in SLEEK sequence.
    Keywords: SLEEK, BSP TI, BFV, In Vitro, Renal Artery
  • Reza Javadrashid , Mohammad Kazem Tarzamni , Rosa Golshan Khalili , Mohammad Reza Ghaffari , Khalil Ansarin , Daniel Fadaei Fouladi * Page 11
    Background
    Pulmonary embolism (PE) is a potentially lethal condition if left untreated. There have been many efforts to find prognostic factors in patients with PE. The descending aorta enhancement (DAE) to main pulmonary artery enhancement (MPAE) ratio is a rather new imaging finding that has been suggested for prognostic purposes in such patients.
    Objectives
    To examine the prognostic value of DAE/MPAE in massive/submassive PE. Patients and Methods: A total of 47 patients with massive/submassive acute PE and compromised right ventricular function were studied prospectively. The Hounsfield units of DAE and MPAE were obtained on pulmonary computed tomography angiography (PCTA). The DAE/MPAE ratio was compared between two groups of patients with and without in-hospital major adverse event/30-day mortality.
    Results
    Twenty-four patients (51.1%) were hemodynamically unstable at the time of admission. Endotracheal intubation and cardiopulmonary resuscitation were indicated in 27.7% (n = 13) and 10.6% (n = 5) of patients, respectively. The rate of PE-unrelated adverse events or mortality was 10.6%. High correlations were present between observers in terms of reported DAE and MPAE (intraclass correlation coefficient = 0.99 for both). No significant association was found between DAE/MPAE and the occurrence of PE-related or unrelated in-hospital major adverse event or 30-day mortality. A significant reverse correlation was observed between DAE/MPAE and patients’ age (Pearson r = -0.47, P = 0.001).
    Conclusion
    DAE/MPAE measured on PCTA may not predict PE-related or PE-unrelated poor outcome in patients with massive or submassive pulmonary embolism.
    Keywords: Multidetector Computed Tomography, Pulmonary Embolism, Prognosis, Enhancement
  • Kyong Tae Moon , Myung, Won You*, Tag Keun Yoo , Eun Kyung Kim Page 12
    Epithelioid hemangioendothelioma (EHE) is a rare vascular endothelial tumor that usually develops in the soft tissues, lung, liver, or bone. Here, we report an incidentally detected adrenal EHE, which was treated by laparoscopic excision. Computed tomography revealed a well-defined solid mass with low washout value in the right adrenal gland, indicating a non adenomatous adrenal tumor. Histologically, the tumor showed endothelial differentiation with cluster of differentiation 31 (CD31) positivity on immunohistochemical staining. Although preoperative diagnosis of adrenal EHE is challenging, the suggestion of a nonadenomatous tumor on adrenal imaging could lead to successful surgical treatment.
    Keywords: Adrenal Gland Neoplasm, Epithelioid Hemangioendothelioma, Adrenalectomy, Laparoscopy, Male, Human
  • Renwei Liu , Yindi Zhang , Jinzhi Fang , Yuzhong Zhang * Page 13
    Kimura disease (KD) is a rare chronic granulomatous inflammation disease with unknown causes, which is common in young Asian males. Local lymph node drainages are characteristic of the disease, the most common of which occur in the salivary glands. Other reported drainages occur in the axilla, popliteal fossa, groin, and upper extremities. Unfortunately, there not many characteristic manifestations that typically present in patients with KD. Sometimes only increased peripheral blood eosinophils and serum IgE concentration are the only positive presentations. Therefore, it is very difficult for physicians to diagnose KD. We report herein on two cases of KD. Both of them presented in the soft tissues of the upper extremities. Special attention was given to the MRI findings of the two patients with a view to disclosing specific characteristics that should help in the realization of clinical diagnosis.
    Keywords: Kimura Disease, Magnetic Resonance Imaging, Upper Extremities
  • Hyo , Jae Lee , Hyun Ju Seon *, Yoo , Duk Choi Page 14
    Minute pulmonary meningothelial - like nodule (MPMN) is a common but poorly understood entity, which is benign or reactive in nature and has unknown etiology. MPMN can show single or multiple involvements associated with malignant conditions including pulmonary adenocarcinoma in some cases. The most common radiologic findings are non - specific small nodules, which often simulate pulmonary hematogeneous metastasis. We report a case of diffuse MPMNs presenting as multiple peribronchial consolidations containing patent air bronchogram, which is quite different from the previously reported radiologic findings.
    Keywords: Minute Pulmonary Meningothelial - Like Nodule (MPMN), Diffuse Pulmonary Meningotheliomatosis, High Resolution Computed Tomography (HRCT), Lung Neoplasms
  • Mohammad Gharib Salehi*, Alireza Rai , Mohammadreza Sobhiyeh , Elham Shobeiri Page 15
    Right internal jugular vein catheterization is a way to establish a temporary dialysis vascular access. Arterial injuries including inadvertent arterial cannulation and/or arteriovenous fistula formation are one of the most clinically important complications of hemodialysis catheter placement. Endovascular management of these conditions is a promising treatment option, especially for aged and co-morbid patients. This report represents a case of internal jugular vein-subclavian artery fistula formed by inadvertently misplaced double lumen tunneled cuffed central venous catheter that was treated successfully with covered stent graft placement.
    Keywords: Arteriovenous Fistula, Central Venous Catheterization, Subclavian Artery, Endovascular Procedures
  • Guyi Wang , Zhenhua Zhao , Jianguo Wei , Jianfeng Yang * Page 16
    Imaging knowledge regarding retroperitoneal primary extraskeletal mesenchymal chondrosarcoma (ESMC) is limited. We report a new case of ESMC originated from the retroperitoneum. The tumor was indicated a well-defined mass with marker calcification, the parenchyma showed gradual enhancement pattern on the biphasic enhanced computed tomography and wash-in-wash-out enhancement pattern on the contrast-enhanced magnetic resonance imaging and hyperintensity on diffusion-weighted imaging which implying the dense cellularity of tumor cells. Sonography indicated an increased echogenicity nodular area in the mass. These imaging features further enriched the imaging knowledge of this rare tumor and presented valuable imaging characteristics to diagnose retroperitoneal primary ESMC.
    Keywords: Retroperitoneum, Mesenchymal, Chondrosarcoma, Computed Tomography, X-Ray, Contrast-Enhanced, Magnetic Resonance Imaging
  • Soo Yeon Jeong , Se Jeong Jeon*, Youe Ree Kim , See Sung Choi Page 17
    Metronidazole-induced encephalopathy is a rare neurologic adverse effect of an antibiotic drug ‘metronidazole’. Although it is usually reversible with immediate cessation of the drug, it can also be fatal when used continuously. Here, we present a 72- year-old female who was on metronidazole for a total of 46 consecutive days. Her initial MRI on the 22nd day of medication use revealed a typical involvement of the cerebellar dentate nuclei, corpus callosum splenium, and periaqueductal midbrain, suggesting metronidazole-induced encephalopathy. However, she continued the medication for another 24 days, until she revisited our emergency department with mental status change. Her consecutive MRI showed diffuse cerebral and brainstem involvement, as well as a more prominent involvement of the dentate nuclei and splenium. We present this case to highlight that it is possible for metronidazole-induced toxic encephalopathy to worsen without immediate withdrawal of the offending drug.
    Keywords: Metronidazole, Toxic Encephalopathy, Neurotoxicity
  • Seung Soo Kim*, Jeong Ah Hwang , Hyeong Cheol Shin , Soon Auck Hong , Sung Shick Jou , Woong Hee Lee , Chan Ho Park , Seo, Youn Choi Page 18
    Scirrhous hepatocellular carcinoma (HCC) is a subtype of HCC that is characterized by abundant fibrous stroma admixed with tumor cells. Although imaging findings of scirrhous HCC differ from those of classic HCC, it is difficult to diagnose this rare neoplasm. Like classic HCC, scirrhous HCC frequently develops in patients with liver cirrhosis, but there has been no report of synchronous occurrence of classic and scirrhous HCCs. Here, we report synchronous classic and scirrhous HCCs in a 62-year-old man with early liver cirrhosis who underwent gadoxetic acid-enhanced and diffusion-weighted magnetic resonance imaging.
    Keywords: Hepatocellular carcinoma, Neoplasms, Multiple Primary, ‘Scirrhous’ type, MRI
  • Codruta Badescu , Liliana Gheorghe Moisii*, Laurentiu Badescu , Ciprian Rezus Page 19
    Lipomas are rarely encountered in the thoracic cavity. A pleural origin of lipoma is extremely rare. In fewer occasions it infiltrates the intercostal space and has an hourglass development. Therefore, the intrathoracic and extrathoracic dumbbell-shaped lipoma is a very rare finding. We present the case of a 77-year-old Caucasian woman with an hourglass-shaped lipoma originating from the left parietal pleura and passing outside the thorax through the first intercostal space. The one-year follow-up revealed no changes. Intrathoracic and extrathoracic hourglass type lipomas are a very rare pathology. When they occur, a non-surgical approach may be adopted as long as compression symptoms are absent and the follow-up imaging examinations reveal no lesion growth. In our case, the patient’s history and the imaging investigations support the benign nature of the tumor. Particularly, in our case, the size of the lipoma was small compared to the long duration of its evolution and there were no signs and symptoms of intra-thoracic compression. The taken therapeutic approach complies with the patient’s options and fits in the current generally accepted recommendations.
    Keywords: Thoracic Lipoma, Hourglass Lipoma
  • Sara Haseli, Siamak Malekpour, Seyed Hamed Jafari * Page 20

    Giant cell tumor (GCT) is one of the most common benign bone tumors that can metastase to distant organs such as lungs as the most common site; however, pulmonary metastasis does not mean poor prognosis. We report a case of lung metastasis of giant cell tumor with varicose vessels within them, which is an extremely rare radiological appearance. Varicose vessels within these metastases have the same radiologic appearance resembling arteriovenous malformation (AVM), and if diagnosed inaccurately it can affect patient management significantly. As these varicose vessels have a potential risk of bleeding during biopsy or even spontaneously that can lead to hemothorax, we recommend contrast enhanced computed tomography scan (CT scan) after detecting lung metastasis in patients with giant cell tumor. We report here a case of varicose vessels within lung metastasis of giant cell tumor, which is a rare radiologic manifestation.

    Keywords: Giant Cell Tumor, Pulmonary Metastasis, Varicose Vessels