Comparative Analysis of Image Quality and Adverse Events between Iopamidol 250 and Ioversol 320 in Hepatic Angiography for Transcatheter Arterial Chemoembolization

PURPOSE@#This study aimed to compare the image quality and adverse events between Iopamidol 250 and Ioversol 320 usage during transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).@*MATERIALS AND METHODS@#Medical records and hepatic angiography from 113 patients who underwent TACE with Iopamidol 250 (44 patients) and Ioversol 320 (69 patients) were retrospectively reviewed. Vessel perception on hepatic angiography was graded into three categories by two radiologists for hepatic subsegmental arteries, the right gastroepiploic artery, right gastric artery, and pancreaticoduodenal artery. Imaging concordance was assessed by comparing the number of detected HCCs on hepatic angiography and CT. The adverse events before and after hepatic angiography were evaluated.@*RESULTS@#The mean vessel perception scores were 2.92 and 2.94 for Iopamidol 250 and Ioversol 320, respectively. The imaging concordance was 31 (70.5%) and 46 (66.7%) patients for Iopamidol 250 and Ioversol 320, respectively. There were no statistical differences in vessel perception or imaging concordance (p > 0.05). One and six patients experienced nausea for Iopamidol 250 and Ioversol 320, respectively. There was no statistical difference in adverse events (p = 0.24).@*CONCLUSION@#Iopamidol 250 can be used in hepatic angiography for TACE without significant difference in image quality or occurrence of adverse events from Ioversol 320.

Clinically Occult Diffuse Large B-Cell Lymphoma of the Middle Turbinate Identified Using ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography: A Case Report

We report a case of clinically occult diffuse large B-cell lymphoma (DLBCL) of the middle turbinate (MT) identified by ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) in a 71-year-old man along with imaging findings. DLBCL was presented with a hypermetabolic right MT [maximum standardized uptake values (SUV(max)) = 8.8 gm/dL] on ¹⁸F-FDG PET/CT, while rhinologic examination was normal. CT showed nothing but slightly more intense enhancement of the right MT compared with the opposite side. The disease progressed during next 7 months until follow-up CT demonstrated solidly enhancing mass occupying entire right nasal cavity which was intensely hypermetabolic (SUV(max) = 12.8 gm/dL). Surgical biopsy confirmed the diagnosis. Follow-up CT and 18F-FDG PET/CT performed after chemotherapy demonstrated complete resolution of DLBCL of the right nasal cavity including the right MT. This is thought to be the first case report in the literature concerning clinically occult DLBCL presenting as a hypermetabolic MT on ¹⁸F-FDG PET/CT.

Soft Tissue Metastasis in Patients with Primary Malignancies; Magnetic Resonance Imaging and Clinical Evaluations

PURPOSE@#The purpose of this study was to evaluate the clinical and magnetic resonance imaging (MRI) findings of soft tissue metastases distinct from benign soft tissue lesions.@*MATERIALS AND METHODS@#We retrospectively analyzed the MRI findings of soft tissue lesions found incidentally in patients with primary carcinoma and those without primary carcinoma from 2002–2015. To evaluate the features of soft tissue metastases distinct from benign soft tissue lesions, patients with benign soft tissue lesions were randomly selected and statistically analyzed for the distinctive features of the two groups.@*RESULTS@#A total of 47 patients (mean age 46.2 years) and 36 controls (mean age 46.2 years) were enrolled. Thirty six of the 47 patients were diagnosed with soft tissue metastasis, most commonly as the primary cancer (31%). The most common site of soft tissue metastasis was the lower extremities (36%) followed by the upper extremities (31%). Soft tissue metastasis was statistically significantly different from benign soft tissue lesions according to patient age, lesion size, margin, presence of degenerative changes in lesions, and presence of edema around the mass.@*CONCLUSION@#If the incident soft tissue lesion shows malignant features on MRI in patients with primary carcinoma or in patients over 40 years of age, the radiologist should consider the possibility of metastatic cancer.

Xanthogranulomatous Pancreatitis Mimicking a Pancreatic Cancer on CT and MRI: a Case Report and Literature Review

Xanthogranulomatous inflammation is a rare benign condition involving various organs. However, its pancreas involvement is very rare. To the best of our knowledge, only 17 cases have been described in the literature. Interestingly, all reported 17 cases due to various causes underwent surgical resection. Here, we present a case of xanthogranulomatous pancreatitis in a 63-year-old man. He presented with epigastric pain and solid mass mimicking ductal adenocarcinoma in the body and tail of pancreas on magnetic resonance imaging. The patient was diagnosed as xanthogranulomatous pancreatitis via endoscopic ultrasound-guided fine needle aspiration. After that, he was followed up and monitored without any surgical treatment. Here, we show imaging findings and serial image changes of xanthogranulomatous pancreatitis for this case.

Prediction of Chronicity of Anterior Cruciate Ligament Tear Using MRI Findings

BACKGROUND: The estimation of anterior cruciate ligament (ACL) tear is required in certain cases involving legal and financial administration, such as the worker's compensation and/or insurance. The aim of this study is to propose and evaluate a quantitative evaluation instrument to estimate the chronicity of the ACL tear, based on the four magnetic resonance imaging (MRI) findings. METHODS: One hundred and fifty one cases of complete ACL tear confirmed by arthroscopy were divided into 4 groups according to the time from ACL injury to MRI acquisition: acute ( 1 year). The four MRI findings including ACL morphology, joint effusion, posterior cruciate ligament angle, and bone bruise were analyzed for temporal changes among the 4 groups. Binary logistic regression equations were formulated using the MRI findings to estimate the chronicity of ACL tear in a quantitative manner, and the accuracy of the formulated regression equations was evaluated. RESULTS: The four MRI findings showed substantial temporal correlation with the time-limits of ACL injury to be included in the estimation model. Three predictive binary logistic equations estimated the probability of the ACL injury for the three cutoff time-limits of 6 weeks, 3 months, and 1 year with accuracies of 82.1%, 89.4%, and 89.4%, respectively. CONCLUSIONS: A series of predictive logistic equations were formulated to estimate the chronicity of ACL tear using 4 MRI findings with chronological significance.

Venous Thromboembolism in Korean Patients Undergoing Major Orthopedic Surgery: A Prospective Observational Study using Computed Tomographic (CT) Pulmonary Angiography and Indirect CT Venography

In patients undergoing major orthopedic surgery, data of deep venous thrombosis (DVT) and pulmonary embolism (PE) are lacking as studied by computed tomographic (CT) pulmonary angiography and indirect CT venography (CTPA-CTV). A prospective observational study was performed for 363 Korean patients undergoing major orthopedic surgery to determine the incidence of venous thromboembolism (VTE), especially proximal DVT and PE. The incidence of VTE was 16.3% (n=59). Of them, 8 patients (2.2%) were symptomatic. The rate of VTE was the highest in patients who underwent total knee replacement (40.4%), followed by hip fracture surgery (16.4%), and total hip replacement (8.7%; P or =65 yr were significant risk factors for proximal DVT or PE in patients undergoing major orthopedic surgery (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.1-5.1; P=0.025; and OR, 2.1; 95% CI, 1.0-4.4; P=0.046, respectively). Taken together, the overall incidence of PE was 6.6% and rate of symptomatic PE rate was 1.1%. Knee joint replacement and age > or =65 yr were significant risk factors for proximal DVT or PE.

Diagnostic Usefulness of Computed Tomography Compared to Conventional Chest X-Ray for Chest Trauma Patients

PURPOSE: Early diagnosis and management of therapeutic interventions are very important in chest trauma. Conventional chest X-rays (CXR) and computed tomography (CT) are the diagnostic tools that can be quickly implemented for chest trauma patients in the emergency department. In this study, the usefulness of the CT as a diagnostic measurement was examined by analyzing the ability to detect thoracic injuries in trauma patients who had visited the emergency department and undergone CXR and CT. METHODS: This study involved 84 patients who had visited the emergency department due to chest trauma and who had undergone both CXR and CT during their diagnostic process. The patients' characteristics and early vital signs were examined through a retrospective analysis of their medical records, and the CXR and the CT saved in the Picture Archiving Communication System (PACS) were examined by a radiologist and an emergency physician to verify whether or not a lesion was present. RESULTS: Pneumothoraxes, hemothoraxes, pneumomediastina, pulmonary lacerations, rib fractures, vertebral fractures, chest wall contusions, and subcutaneous emphysema were prevalently found in a statistically meaningful way (p<0.05) on the CT. Even though their statistical significance couldn't be verified, other disorders, including aortic injury, were more prevalently found by CT than by CXR. CONCLUSION: CT implemented for chest trauma patients visiting the emergency department allowed disorders that couldn't be found on CXR to be verified, which helped us to could accurately evaluate patients.

Feasibility of an Ultrasonographic Categorical Reporting System for Thyroid Incidentaloma

PURPOSE: To evaluate the feasibility of an ultrasonographic category system for the proper management of incidentally found thyroid nodules. MATERIALS and METHODS: We retrospectively evaluated 2,688 patients who had thyroid nodules and underwent ultrasonography-guided fine needle aspiration biopsy. We made an ultrasonographic categorical reporting system by logistic regression analysis for comparison with the pathologic results of cytology and biopsy. RESULTS: The distribution of malignancy probability for benign nodules was 0.07 to 0.23 and for malignant nodules was 0.37 to 0.91 (95% confidence intervals). We stratified the distribution of the probability of malignancy of each nodule into 6 categories (category 0, no nodule; 1, highly suggestive of benignancy; 2, probably benign; 3, indeterminate; 4, probably malignant; and 5, highly suggestive of malignancy) and summarized the representative US findings. We compared the category of each nodule with the pathological results. In nodules with surgically proven pathologic diagnoses, benign lesions were 96.1% (348/361) in category 1 and malignant lesions were 98.6% (139/141) in category 5. CONCLUSION: We suggest that the ultrasonographic category system for thyroid incidentaloma may provide optimal strategies to manage incidentally found thyroid nodules.

Resistive Index Analysis Using Doppler Ultrasonography in Patients with Acute Stroke

PURPOSE: To evaluate the usefulness of resistive index using carotid Doppler sonography for understanding hemodynamics in acute stroke patients. MATERIALS and METHODS: We retrospectively reviewed Doppler sonography in 97 acute stroke patients and 235 asymptomatic patients. We compared the resistive index between the ipsilateral and contralateral internal carotid arteries, and analyzed the relationship between the degree of stenosis and the resistive index of the internal carotid artery using linear regression analysis. We divided our patients into two groups according to the ASPECT score (7 and more and less than 7) determined from diffusion and T2 weighted images. Then we analyzed the difference of Doppler sonographic parameters between these two groups (independent t test). RESULTS: The resistive indices of both the ipsilateral internal carotid arteries of the acute stroke patients and the arteries of the asymptomatic patients showed a positive correlation with their respective degrees of stenosis (R2 = 0.127, p < 0.001; R2 = 0.046, p < 0.001, respectively). However, the resistive index of the contralateral internal carotid arteries was not correlated with their degree of stenosis (R2 = 0.016, p = 0.215). The resistive index of the ipsilateral internal carotid arteries in the acute stroke patients was significantly higher in the patients with ASPECT more than 7 than those with ASPECT score less than 7 (p = 0.002). CONCLUSION: Evaluation of the resistive index of the internal carotid arteries in acute stroke patients may be useful for understanding the cerebral hemodynamics.