فهرست مطالب

  • Volume:17 Issue: 2, 2020
  • تاریخ انتشار: 1399/02/30
  • تعداد عناوین: 19
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  • Yun Heng Shi, Shu Man Han, Tao Sun, Bao Hai Yu, Hui Zhao Wu, Wen Juan Wu*, Bu Lang Gao Page 1
    Background

    The clinical, imaging and pathological features of telangiectatic osteosarcoma (TOS) in long bones are helpful for differentiation from aneurysmal bone cysts (ABC).

    Objectives

    To investigate the clinical, imaging and pathological features of TOS in comparison with ABC in long bones. Patients and

    Methods

    Seventeen patients with TOS and 17 patients with ABC in our hospital were analyzed in the clinical, imaging and pathological features for proper diagnosis.

    Results

    For plain radiographs in 17 TOS cases, a soft tissue mass was detected in 14 cases, lytic bone destruction in 13, ill-defined border in 12, periosteal reaction in eight, formation of the Codman triangle in five, pathological fracture in three, and calcification in one. In 17 cases with ABC, an ill-defined border was found in fifteen cases, lytic and expansile destruction in eleven, thinned sclerotic rim in twelve, eccentrically location in ten, coarse septations in eight, a soft tissue mass in three, pathological fracture in three, periosteal reaction in two, and ill-defined border in two cases. In CT imaging of TOS, multiple cysts were in twelve cases, and fluidfluid levels in three. In ABC, multiple cysts were in eleven cases while fluid-fluid levels in four. In MRI presentations of TOS, low and medium signal was present in the T1-weighted imaging (T1WI), whereas mixed (9/12) or high signal (3/12) was presented in the T2 WI with inhomogeneous signal. Four cases had multiple cysts and fluid-fluid levels in the bone destruction and soft tissues. The cysts had long T1 and long T2 signal with isointense signal in the septations (5/12). Fat inhibition sequence showed clear cystic changes. In ABC, low complete or incomplete signal was demonstrated in all lesions with a higher incidence of fluid-fluid levels (8/11). The lesion was of low and medium inhomogeneous signal in the T1 WI but mixed signal in T2 WI (6/11) including hyperintense signal in the upper part but mixed signal in the lower part in four cases or hyperintense signal (1/11) in T2 WI. The histopathological features of TOS were bleeding inside the lesion, highly atypia tumor cells of malignancy in the septa and tumorous bone tissue. The septa of ABC were composed of proliferative fibroblasts with dispersed polykaryocytes, reactive woven bone but no atypical cells.

    Conclusion

    The clinical, imaging and pathological characteristics should be combined to make a correct differential diagnosis between telangiectatic osteosarcoma and aneurysmal bone cyst.

    Keywords: Telangiectatic Osteosarcoma, Aneurysmal Bone Cyst, Plain Radiography, Magnetic Resonance Imaging, ComputedTomography
  • Marzieh Motevalli, Farzaneh Akhavan, Ali Mohammadzadeh, Zeinab Norouzi, Navid Abolfathzadeh, Mohammad Ali Mohammadi Vajari, Hamid Reza Pouraliakbar, KiaraRezaei Kalantari, Sanaz Asadian, Aminkasra Kiani, Ghazale Tefagh* Page 2
    Background

    Tetralogy of Fallot (TOF) is considered as the most frequent cyanotic congenital heart disorder. Right ventricular (RV) dysfunction is possible to be observed in patients with repaired TOF. Delayed enhancement (DE) is one of the recommended findings for RV dysfunction.

    Objectives

    This study aimed at investigating the DE and its probable relationship with RV function through cardiac magnetic resonance (CMR). Patients and

    Methods

    In this cross-sectional study, the values of cardiovascular magnetic resonance of 110 symptomatic patients, who had repaired TOF for 35 years, were gathered. We compared cardiac function indices (CFI) in patients with and without DE.

    Results

    The patients had an average age of 21.93 ± 6.94 years (59.12% were male and 40.94% were female). 93.66% of the subjects showed DE and 6.44% of them did not have DE. 78.61% of the samples had DE of the right ventricular outflow tract (RVOT); whereas, 21.39% showed DE of the other sites. The differences between mean regurgitation fraction, average RV end-diastolic volume (RVEDV), average RV end systolic volume (ESV), and average RV ejection fraction in DE positive and negative patients were statistically significant (P values = 0.01, 0.04, 0.04, and 0.01, respectively.)

    Conclusion

    DE commonly occurs as a complication of surgery to repair TOF and could be used as a factor for impaired RV function and other complications. Using CMR imaging for follow up of these patients could lead to diagnosis of these complications.

    Keywords: Tetralogy of Fallot (TOF), Delayed Enhancement (DE), Cardiac MRI (CMR), Tetralogy of Fallot Total Correction (TFTC)
  • Kadir Oymen Hancerliogullari* Page 3
    Background

    One of the most important urologic emergencies is testicular torsion in children. Elastography is as an objective method in diagnosis and treatment of testicular torsion, with grayscale and colored images. Our study presents an original framework, which may guide certain research and practices in this field.

    Objectives

    The aim of this study was to evaluate the effectiveness of ultrasound (US)-elastography for the diagnostic performance of testicular torsion.

    Materials and Methods

    In this experimental study, 16 male white New Zealand rabbits of the same weight and age were selected and divided into two groups. In group I, the right testicle was fixed, and in group II, the right testicle underwent 720° torsion in a counterclockwise direction and fixed. Following 1 and 2 hours of ischemia, measurements of the right and left testicles were performed simultaneously. The left testicle was measured again after 24 hours in order to better observe the changes that right testicular ischemia might have had on the left testicle.

    Results

    A statistically significant increase was detected in the elastography values of the right testicle at 1, 2, and 24 hours (P < 0.05). Elastography values were significantly increased in the left testicle after 24 hours (P < 0.05). The elastographic measurement values of the testicular tissue increased significantly with the increase in the duration of ischemia.

    Conclusion

    With the width of its imaging window and healthy evaluation opportunity, elastography is a method in determining tissue stiffness of unilateral and contralateral testicular structures. In this study, the efficacy of elastography was evaluated. As a future research, further studies are needed to evaluate the elastography values in epididmo-orchitis and other causes of acute scrotum.

    Keywords: Testicular Torsion, Elastography, Decision Making
  • Dong Han, Weihua Shi, Xiaoxia Chen, Jieli Zhou, Yong Yu, Xin Tian, Jing Chen, Mengting Liu, Taiping He* Page 4
    Background

    The contrast medium (CM) in CT pulmonary angiography may induce adverse effects to patients, and higher CM is associated with higher rates of contrast-induced-nephropathy and mortality. Reduction of CM dosage through improvement of examination techniques may help reduce the occurrence of CM-induced adverse effects and healthcare costs.

    Objectives

    To determine the optimal monochromatic energy levels in dual-energy spectral CT pulmonary angiography (CTPA) with low contrast dosage. Patients and

    Methods

    Thirty patients with suspected pulmonary embolism (PE) underwent dual-energy spectral CTPA with low radiation and low contrast doses with scanning protocol of GSI-36 with 260 mA, and 25 mL contrast (350 mgI/mL) with 4.0ml/s injection speed. The monochromatic images from 60 - 80 keV (interval 5 keV) were reconstructed using a 50% adaptive statistical iterative reconstruction (50% ASiR) algorithm at 1.25 mm slice thickness. The CT attenuation and standard deviation (SD) values of the main, right, left, right lower and left lower pulmonary arteries and the back muscle at the same level were measured on 60 – 80 keV images, and signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated and analyzed. The subjective image quality was evaluated by two experienced radiologists using a 5-level scoring method independently. Measurements were analyzed using IBM SPSS Statistics for Windows, version 25.0. (Armonk, NY: IBM Corp.).

    Results

    CT attenuation values of the pulmonary arteries decreased with the increase of energy level in five-energy groups, with values greater than 300 HU at 60 keV - 70 keV energies. The 65 keV image had the highest SNR, CNR and lowest SD, with significant differences compared with those of other image sets (P < 0.05). The subjective quality scores for the 65 keV image was judged to be the highest by the two radiologists, but it was not significantly different from 60 keV and 70 keV (all P > 0.05).

    Conclusion

    The 65 keV monochromatic images provided the highest SNR, CNR and subjective scores with the lowest image noise in dual-energy spectral CTPA with low contrast dosage.

    Keywords: Low Contrast Medium Dosage, CT Pulmonary Angiography, Spectral CT, Optimal Monochromatic Energy Level
  • Jee Hyeon Lee, In Jae Lee* Page 5
    Background

    Increasing success rate and reducing complications are important for computed tomography (CT)-guided percutaneous core needle biopsy (PCNB).

    Objectives

    To assess the influence of needle angle and lesion depth on procedural success and complications of CT-guided PCNB for intrapulmonary lesions, performed by a single radiologist. Patients and

    Methods

    A total of 689 cases of PCNB performed under CT guidance were enrolled in this study. The collected data were retrospectively reviewed. The pathologic results and complications were evaluated for each case. Two factors-needle angle and lesion depth-were statistically analyzed to assess the relationship with procedural success and complications of PCNB by using univariate analysis. Post hoc analysis was performed with Bonferroni’s method.

    Results

    The overall success rate was 93.1% (642/689). Procedural success showed no statistically significant association with both needle angle (P = 0.568) and lesion depth (P = 0.144). The overall complication rate was 17.9% (123/689) with 15.7% for minor complications and 2.2% for major complications. The needle angle had no association with complications (P = 0.101). Presence and severity of complications showed a direct relationship with lesion depth (P < 0.01). In fact, more severe complications occurred in deeper located lesions.

    Conclusion

    Needle angle had no effect on both procedural success and complications. Also, there was no significant correlation between lesion depth and procedural success. However, lesion depth was closely correlated with the incidence and severity of complications after PCNB.

    Keywords: Biopsy, lung, complications, CT
  • Sepideh Sefidbakht, Amin Dehdashtian *, Fereshte Bagheri, Neda Rahimirad, Pedram Keshavarz, Bijan Bijan Page 6
    Background

    Pulmonary hypoplasia is a significant decrease in lung volume by any cause in comparison to the normal volume for gestational age.

    Objectives

    To evaluate the application of prenatal magnetic resonance imaging in order to predict pulmonary hypoplasia, measurement of fetal lung volume (FLV) was aimed to establish a reference data in normal fetuses. Patients and

    Methods

    Three hundred forty two fetuses with abnormal ultrasound findings underwent fast spin-echo T2-weighted MR imaging at a single tertiary care hospital (Shahid Faghihi Hospital, Shiraz, Iran). Data of 241 fetuses at 18 - 36 weeks’ gestation without thoracic malformations were obtained for a FLV normative curve. To acquire a best-fit formula for the mean total fetal lung volume based on each gestational week with 95% confidence interval (CI), we used the regression model applied by Rypens et al. This resulted in a formula calculating the expected fetal lung volume based on gestational age. A one-sample t-test was also carried out to compare the mean total fetal lung volume at each gestational week with the expected mean total fetal lung volume predicted by the formula by Rypens et al., Meyers et al., and Osada et al.

    Results

    Normal FLV increased with gestational age as the spread of values. The expected fetal lung volume was derived from the following formula: Fetal lung volume (mL) = 0.002×(gestational age [GA]2.913), in which GA is gestational weeks. FLV in our population had a more consistent correlation with Japanese fetuses than European or American fetuses.

    Conclusion

    In fetuses with normal lungs, FLV distribution against gestational age is simply measured prenatally with MR imaging. A single universal formula might not be suitable for fetuses worldwide. In our region, acquired data were more consistent with Asian normal values.

    Keywords: Lung Volume Measurement, Fetal, MRI, Pulmonary Hypoplasia
  • Chih Yu Liang, Tai Been Chen, Nan Han Lu, Yi Chen Shen, Kuo Ying Liu, Shih Yen Hsu, Chia Jung Tsai, Yi Ming Wang, Chih I Chen, Wei Chang Du, Yung Hui Huang* Page 7
    Background

    Ultrasound imaging has become one of the most widely utilized adjunct tools in breast cancer screening due to its advantages. The computer-aided detection of breast ultrasound is rapid development via significant features extracted from images.

    Objectives

    The main aim was to identify features of breast ultrasound image that can facilitate reasonable classification of ultrasound images between malignant and benign lesions. Patients and

    Methods

    This research was a retrospective study in which 85 cases (35 malignant (positive group) and 50 benign (negative group) with diagnostic reports) with ultrasound images were collected. The B-mode ultrasound images have manually selected regions of interest (ROI) for estimated features of an image. Then, a fractal dimensional (FD) image was generated from the original ROI by using the box-counting method. Both FD and ROI images were extracted features, including mean, standard deviation, skewness, and kurtosis. These extracted features were tested as significant by t-test, receiver operating characteristic (ROC), and Kappa coefficient.

    Results

    The statistical analysis revealed that the mean texture of images performed the best in differentiating benign versus malignant tumors. As determined by the ROC analysis, the appropriate qualitative values for the mean and the LR model were 0.85 and 0.5, respectively. The sensitivity, specificity, accuracy, positive predicted value (PPV), negative predicted value (NPV), and Kappa for the mean was 0.77, 0.84, 0.81, 0.77, 0.84, and 0.61, respectively.

    Conclusion

    The presented method was efficient in classifying malignant and benign tumors using image textures. Future studies on breast ultrasound texture analysis could focus on investigations of edge detection, texture estimation, classification models, and image features.

    Keywords: Breast B-Mode Ultrasound, Fractal Dimension, Image Texture
  • Mehrzad Lotfi, Mohammad Reza Rouhezamin *, Bijan Bijan, Sepideh Sefidbakht, Mehran Karimi, Amin Dehdashtiyan Page 8
    Background

    Thalassemia is a common hemoglobinopathy in our region. Iron overload is a major complication of thalassemia, and an accurate quantification of iron deposition is the mainstay of treatment planning. The liver is the main organ for storage of iron, and quantification of hepatic siderosis is a reliable estimation of total iron overload.

    Objectives

    The aim of this study was to determine the accuracy of chemical shift sequences (CSS), especially a water only sequence (WOS), to estimate hepatic siderosis in thalassemia patients. Patients and

    Methods

    During a seven-month period, from May to December 2016, one hundred and two known cases of thalassemia major and intermedia underwent liver MRI. The liver iron concentration was estimated using T2* MR relaxometry. The iron signal percentage and fraction were calculated using chemical shift sequences and correlated with estimated liver iron concentration (LIC).

    Results

    The correlation coefficient of in-phase and opposed-phase sequences was 0.566 in estimating hepatic siderosis, which was improved by employing water only sequence (0.640). The sensitivity, specificity and positive predictive value were 90.5%, 94.4% and 98.7% for the in-phase and opposed-phase sequences and 82.1%, 94.4% and 98.6% for the water only sequence, respectively.

    Conclusion

    Chemical shift sequences, including a water only sequence, are accurate for the assessment of hepatic siderosis. Water only sequences can effectively minimize the confounding effect of fatty liver.

    Keywords: Magnetic Resonance Imaging, Thalassemia, Liver, Siderosis
  • Jie Li, Ping He, Xingqi Lu, Ying Yang, Yun Guo, Li Li, Yuming Yin, Guoxiong Li, Jianping Ding* Page 9
    Background

    The efficacy of the treatment for irritable bowel syndrome (IBS) with the combination of anxiolytic/antidepressant has been confirmed by clinical studies, but the central mechanism is unclear.

    Objectives

    To investigate the effects of flupentixol-melitracen, a mixture of tricyclic antidepressant and a classical antipsychotic component, on resting-state brain function in IBS patients by using functional magnetic resonance imaging (fMRI). Patients and

    Methods

    Thirty-two patients with IBS were randomly divided into an observation group (OG, n = 16) and control group (CG, n = 16). All patients in both groups were given spasmolytic agent (pinaverium bromide). For the OG group, flupentixolmelitracen was added. FMRI scans were performed in all patients before and four weeks after the therapy. The scores of gastrointestinal symptom rating scale (GSRS), Hamilton depression scale (HAMD-17) and anxiety scale (HAMA-14) were evaluated at the same time. FMRI regional homogeneity (ReHo) parameters were compared between the two groups before and after treatment using a 2 (therapy) × 2 (time) mixed model analysis of variance (ANOVA) statistical method, and were correlated with the changes of GSRS, HAMD and HAMA scores in the two groups.

    Results

    The fMRI results of the mixed-model analysis of covariance (ANCOVA) and post analyses were as follows. When the therapeutic factor was the main effect, ReHo was increased in the left superior and middle occipital gyrus, and the left parietal gyrus, and decreased in the left thalamus and the lenticular nucleus in both groups after treatment when compared to the unmedicated state. In addition, the OG group showed decreased ReHo in the left superior temporal gyrus, the right lenticular-putamen nucleus, the right inferior frontal gyrus, the right insula, the right gyrus rectus and subcallosal gyrus. The CG group showed increased ReHo in the right angular gyrus. When the interaction between therapy and time was the main effect, the brain region with different ReHo values was in the left precuneus. In the OG group, the change of ReHo in the left precuneus was negatively correlated with the decrease of HAMD and HAMA scores.

    Conclusion

    Flupentixol-melitracen can effectively improve anxiety, depression and gastrointestinal symptoms in patients with IBS, which may be related to the reversal of abnormal neural activity in the brain regions within the default network and the prefrontal-limbic-temporal emotional circuit in IBS patients.

    Keywords: Anxiolytic, Antidepressant, Irritable Bowel Syndrome, Functional Magnetic Resonance Imaging, Regional Homogeneity
  • Feng Ao*, Xueguo Liu, Mingzhu Liang, Jiebing Gao Page 10
    Background

    Breast cancer and lung cancer are the leading causes of cancer-related mortality in women. CT plays an important role in lung cancer examination but a. unidentified role in breast examination.

    Objectives

    To investigate the feasibility of breast composition categorization according to the fifth edition of Breast ImagingReporting and Data System (BI-RADS) atlas in low-dose computed tomography (CT) screening. Patients and

    Methods

    This was a cross-sectional study completed in The 5th Affiliated Hospital of Sun Yat-sen University, Zhuhai, China. We collected the imaging data of 57 women, who underwent low-dose chest CT scan and mammography within one week from 1st October 2013 to 31st March 2015. Two radiologists independently interpreted the mammograms and chest CT scans and classified the breast composition into categories a, b, c, and d. We also summarized the distribution of breast composition categories by collecting, observing, and classifying the chest CT scans from 1916 female examinees from 1st October 2013 to 31st March 2016.

    Results

    Excellent agreement was observed between the two radiologists, using both low-dose CT scan (κ= 0.91) and mammography (κ = 0.86). Agreement between low-dose chest CT scan and mammography was moderate for radiologist A (κ = 0.50) and radiologist B (κ = 0.43). More breasts were classified in categories a and b on the chest CT scan compared to mammography according to both radiologist A (P < 0.01) and radiologist B (P < 0.01). The proportion of non-dense breast tissues (categories a & b) increased with advancing age, while the proportion of dense breast tissues (categories c & d) decreased (P < 0.05). With advancing age, the probability of non-dense breasts increased, while the probability of dense breasts decreased.

    Conclusions

    Based on the findings, it is feasible to categorize breast composition using low-dose chest CT. In the older age group, the probability of non-dense breasts increased.

    Keywords: Low-Dose CT, Screening, Mammography, Lung Cancer, Breast Cancer
  • Leila Aghaghazvini, Bahman Rasuli *, Hashem Sharifian, Fariba Hashemi, Nasrin Yazdani, Elahe Zaremehrjerdi Page 11
    Background

    Pre-operative differentiation of benign from malignant cervical adenopathies remains a challenge. Several studies indicate parameters to discriminate between benign and malignant lymph nodes, which has not yet been enough.

    Objectives

    The aim of the current study was to assess the diagnostic efficacy of DWI to differentiate benign from malignant cervical lymph nodes. Patients and

    Methods

    In all patients, we assessed axial and coronal fast spin echo T2 and T1-weighted images and T1-weighted after contrast injection. DWI sequences were implemented before contrast injection, in axial and coronal planes (b factor of 50, 500 and 1000 s/mm2 ) and the apparent diffusion coefficient (ADC) maps were reconstructed. Data were assessed in mixed model analysis and results were compared with postoperative histopathologic findings.

    Results

    Thirty seven subjects were enrolled, 10 with benign lymphadenopathy and 27 patients with malignant lymphadenopathies before treatment. The mean ADC of the benign neck lymph nodes was (1.00 ± 0.34) × 10-3 mm2 /s, while it was (0.76 ± 0.16) × 10-3 mm2 /s in malignant ones (P = 0.058). The mean ADC of the metastatic nodes was (0.81 ± 0.14) × 10-3 mm2 /s, while it was (0.56 ± 0.04) × 10-3 mm2 /s in lymphoma (P < 0.001). The mean ADC of weakly differentiated metastatic nodes was significantly lower than that of good and moderately differentiated ones [(0.86 ± 0.13) × 10-3 mm2 /s vs. (0.66 ± 0.02) × 10-3 mm2 /s respectively; P = 0.001]. The area under the ROC curve of ADC was 0.69 [95%CI = 0.52 - 0.83]. Considering cut off points of 0.6 × 10-3, 0.95 × 10-3, and 1.2 × 10-3 yielded sensitivities were 15%, 92.5%, and 100%, respectively; while, in these cutoff points, specificities were 80%, 50%, and 40%, respectively.

    Conclusion

    DWI could be considered as an important diagnostic tool to differentiate enlarged cervical lymphadenopathies.

    Keywords: Diffusion-Weighted MRI (DWI), Neck, Lymphadenopathy, Lymphoma, Metastasis, Benign, Malignant
  • Qing Zhao, Jianxiong You, Jingbing Wang*, Xindong Fan Page 12
    Background

    Angiodysplasia (AD) is a common cause of otherwise unexplained gastrointestinal bleeding and anemia and it increases in frequency with aging.

    Objectives

    To investigate the safety and efficacy of transcatheter arterial embolization (TAE) in treating gastrointestinal bleeding caused by angiodysplasia. Patients and

    Methods

    A total of 12 patients (five men, seven women; mean age: 50 ± 18 years; range: 31 - 82 years) with gastrointestinal bleeding, who had failed after endoscopic therapy and were not eligible for surgery, were treated via TAE. The presentations of patients included hematemesis (n = 2), melena (n = 7), and hematochezia (n = 5). The details of procedures and follow-up records were reviewed.

    Results

    The procedures of TAE were performed using poly vinyl alcohol particles and/or coils. The procedures were achieved and the hemorrhage was controlled in all cases. In three patients, the small AD lesions were not found during the first session of angiography, but were instead detected on the repeated angiography conducted one week later. All the patients were discharged without any severe complications. No rebleeding occurred within 30 days following the embolization. Hemorrhage recurred in two patients within one year after hospital discharge. TAE procedures were performed once more using microcoils, and the bleeding was controlled.

    Conclusion

    For the patients with refractory and repeated gastrointestinal hemorrhage due to angiodysplasia, TAE seems to be an effective alternative option when endoscopic examination and treatment do not work.

    Keywords: Gastrointestinal Hemorrhage, Embolization, Vascular Malformation, Angiodysplasia, Angiography
  • Selen Bayraktaroglu*, Akın Cinkooglu, Naim Ceylan, Recep Savas Page 13
    Background

    Multidetector computed tomography (MDCT) angiography is considered as the gold standard imaging modality in the evaluation of acute pulmonary embolism. Optimum vascular enhancement is critical for MDCT studies. The suboptimal opacification in pulmonary artery could be salvaged using low-energy virtual monoenergetic images (VMI) at rapid kVP switch dual energy CT.

    Objectives

    To explore the potential improvement in pulmonary artery opacification and to assess the change in image quality parameters in VMI using fast switch kVp dual energy CT. Patients and

    Methods

    The CT images of 877 patients who were referred with a preliminary diagnosis of pulmonary embolism were reviewed. Sixty patients with suboptimal enhancement (< 200 Hounsfeld Unit [HU]) were involved. Standard images (140 kVp) and VMI from 40 to 120 keV were generated. Attenuation, noise, signal to noise ratio (SNR) and contrast to noise ratio (CNR) were measured in the pulmonary artery. Using VMIs, the best image was determined as the image with the main pulmonary artery opacification greater than 200 HU and image quality ≥ 3. Fifty six studies that met these criteria were considered as salvaged. At this best energy level, quantitative parameters were compared with standard images.

    Results

    The mean attenuation of pulmonary arteries was 169.80 HU in standard images in patients with suboptimal enhancement. The attenuations of VMIs at 40, 45, 50, 55, 60, 65, and 70 keV were significantly higher than standard images (P < 0.001). Similar findings were observed with SNR and CNR. In the salvaged patients, the average increase in mean pulmonary artery attenuation was 62% (from 172.61 ± 23.4 to 280.55 ± 40.7), the average increase in SNR was 38% (from 12.1 ± 5.3 to 16.7 ± 7.1) and the average increase in CNR was 48% (9.2 ± 4.3 to 13.7 ± 6) (P < 0.001).

    Conclusions

    Low keV VMI reconstructions significantly increase pulmonary artery attenuation, CNR and SNR compared to standard image reconstructions. Suboptimal CT studies could be salvaged using low keV VMIs.

    Keywords: Dual Energy Computed Tomography, Pulmonary Artery, Pulmonary Embolism
  • Alireza Aziz Ahari, Mohammad Ali Mohammadi Vajari, Navid Khatibi Moghadam, Hassan Hash* Page 14
    Background

    Thyroid fine needle aspiration (FNA) is currently the most acceptable method for evaluating thyroid nodules. Nonsatisfactory sample is the main limitation of FNA. It has been shown that spinal needles can reduce the number of non-diagnostic samples.

    Objectives

    In this study, we decided to compare the results obtained using spinal (stylet) needle and simple needle in thyroid nodule FNA according to the agreement between them and with the pathology results as the gold standard. Patients and

    Methods

    Sampling of thyroid nodules of 156 patients was performed by a simple non-stylet 23 gauge needle (A) and a spinal 22 gauge needle with stylet (B). The samples were provided to the pathologist for blind examination. All samples were obtained by an expert radiologist and the pathology examination was also performed by a pathologist expert in thyroid gland diseases. Blind analysis was done using SPSS Statistics for Windows, version 16 (SPSS Inc., Chicago, Ill., USA).

    Results

    The results of FNA with needles A and B were reported unsatisfactory in 11.51 (18 subjects) and 3.84 (six subjects), respectively (P = 0.01). The result in 63.46% (99 subjects) of the participants, in whom FNA was obtained by needle B was introduced as a better sample by the pathologist in comparison with 36.44% (57 subjects) (P < 0.001). Cancer was diagnosed in 9.56 and 7.66 of the samples yielded by needles B and A, respectively, which was not statistically significant (P = 0.54). There was also a significant relationship between thyroid imaging reporting and data system (TI-RADS) score and FNA result.

    Conclusion

    A significant relationship between the adequate sampling results, the qualitative examination result, TI-RADS score and the needle type indicates the importance of needle type on the results of thyroid FNA. Using spinal (stylet) needles may reduce the number of non-diagnostic samples in fine needle aspiration of thyroid nodules and therefore, can have a better effect on the results of this method.

    Keywords: Ultrasound-Guided Fine Needle Aspiration, Thyroid Nodule, Thyroid Diseases
  • Young Hun Jeon, Yu Jin Kim *, Seok Joong Yun, Bum Sang Cho, Ok Jun Lee Page 15

    Congenital segmental giant megaureter (CSGM), which refers to segmental cystic dilatation of the upper collecting system, is extremely rare in the pediatric population. Depending on the etiology, the condition could be categorized as primary or secondary megaureter with three subtypes including refluxing, obstructed, nonrefluxing and nonobstructed types. We report a case in which the CSGM presented as a giant abdominal cystic mass with associated right-sided hydronephrosis that was diagnosed by abdominal ultrasound. Cysticmass and the tubular structure at the caudal side of the cysticmass were demonstrated on abdominal ultrasound. We identified a connection between the cystic mass and the lumen of the tubular structure. Therefore, the cystic mass was reported as CSGM on abdominal ultrasound, especially categorized as the nonrefluxing and nonobstructed type. The percutaneous nephrostomy was performed to relieve hydronephrosis, followed by excision of the dilated segment. CSGM is an extremely rare presentation of megaureter, requiring variable imaging modalities and an appropriate intervention. Especially, careful real-time ultrasound was critical to identify the CSGM promptly and essential for the individual appropriate management.

    Keywords: Hydronephrosis, Diagnostic Imaging, Infant, Urogenital Abnormalities, Surgery, Ureteral Obstruction, Congenital
  • Wei Feng Yuan, Xin Xiang Zhao* Page 16

    Keshan disease is an endemic cardiomyopathy with unknown causes. The disease mainly invades the myocardium, manifested by myocardial degeneration, necrosis, repair and other changes. MRI can objectively reflect the above pathological mechanism and characteristics, but there is no relevant literature report at present. A 51-year-old male patient was hospitalized and suspected of suffering from rare cardiomyopathy. Cardiovascular magnetic resonance imaging (CMRI) showed late gadolinium enhancement (LGE) in the areas other than the anterior wall of the left ventricle, accompanied by irregular epicardial LGE mainly in the left ventricular apex. Results of left ventricular function parameters calculated by artificial intelligence (AI) were as follows: end-systolic volume (ESV) 98.14 mL, end-diastolic volume (EDV) 121.59 mL, ejection fraction (EF) 35.13%, end-diastolic dimension (EDD) 47.49 mm, fraction shortening (FS) 24.83%, myocardial mass (MM) 62.74 g, cardiac output (CO) 3.49 L/min, stroke volume (SV) 42.71 mL, and cardiac index (CI) 3.09 L/min.m2 . According to the results of CMRI-LGE and left-ventricular functional parameters based on AI, Keshan disease manifested as enlarged morphology, abnormal cardiac function parameters, decreased myocardial cell activity, degeneration and necrosis, and myocardial interstitial fibrosis formation, which might help to diagnose the disease after excluding ischemic heart disease and primary cardiomyopathy

    Keywords: MRI, Artificial Intelligence, Cardiomyopathy
  • Min Jung Ryu, Youngseon Kim*, Seungeun Lee, d Joon Hyuk Choi Page 17

    Eccrine hidradenoma is a benign tumor of sweat gland origin that rarely occurs in the breast. It is often mistaken for breast cancer on both clinical and radiological examination. We report the case of a 57-year-old woman with a complex cystic and solid mass in the right breast on ultrasonography that was assessed as breast imaging-reporting and data system (BI-RADS) category 4b. Complete excision yielded a final histopathologic diagnosis of eccrine hidradenoma. Knowledge of radiological findings of eccrine hidradenoma of the breast is important for radiologists to distinguish it from malignancy.

    Keywords: Mammography, Ultrasonography, Breast, Neoplasm, Eccrine Hidradenoma
  • Li Zhao, Bo Chen, Ya’nan Huang, Minxia Yang, Jianfeng Yang, Zhenhua Zhao* Page 18

    Coronavirus disease (COVID-19) broke out in Wuhan, China. It was a highly contagious respiratory disease, the basic reproductive number (RO value) for COVID-19 was reported to be 2.68 with an epidemic doubling time of 6.4 days. In this case report, a 50-yearold man presented with a history of fever and chills. Chest radiographs failed to find any abnormality, and computed tomography (CT) showed ground glass shadow of the upper lobe of the left lung. Real-time polymerase chain reaction (RT-PCR) of the patient’s pharyngeal swab was positive for COVID-19 nucleic acid. The course of the disease developed from mild to severe, then improved and recovered. The patient underwent antiviral drugs, low dose of glucocorticoids, symptomatic treatment, and immunoglobulin for human intravenous injection. We report this long time follow-up case of COVID-19.

    Keywords: COVID-19, Pneumonia, Tomography
  • Arash Mahdavi, Nastaran Khalili, Amir H. Davarpanah, Taraneh Faghihi, Ali Mahdavi, Sara Haseli, Ali Sabri, Shahram Kahkouee, Mohammad Ali Kazemi, Payam Mehrian, Farahnaz Falahati, Mehrdad Bakhshayeshkaram *, Morteza Sanei Taheri* Page 19