Added Value of Cone-Beam Computed Tomography for Detecting Hepatocellular Carcinomas and Feeding Arteries during Transcatheter Arterial Chemoembolization Focusing on Radiation Exposure.

Background and Objectives: This study aimed to evaluate the added value of cone-beam computed tomography (CBCT) for detecting hepatocellular carcinomas (HCC) and feeding arteries during transcatheter arterial chemoembolization (TACE). Material and methods: Seventy-six patients underwent TACE and CBCT. We subcategorized patients into groups I (61 patients: possible superselection of tumor/feeding arteries) and II (15 patients: limited superselection of tumor/feeding arteries). We evaluated fluoroscopy time and radiation dose during TACE. Two blinded radiologists independently performed an interval reading based on digital subtraction angiography (DSA) imaging only and DSA combined with CBCT in group I. Result: The mean total fluoroscopy time was 1456.3 ± 605.6 s. The mean dose-area product (DAP), mean DAP of CBCT, and mean ratio of DAP of CBCT to total DAP was 137.1 ± 69.2 Gy cm2, 18.3 ± 7.1 Gy cm2, and 13.3%, respectively. The sensitivity for detecting HCC increased after the additional CBCT reading, from 69.6% to 97.3% and 69.6% to 96.4% for readers 1 and 2, respectively. The sensitivity for detecting feeding arteries increased from 60.3% to 96.6% and 63.8% to 97.4% for readers 1 and 2, respectively. Conclusions: CBCT can increase sensitivity for detecting HCCs and feeding arteries without significantly increasing the radiation exposure.

Acute invasive small-bowel Anisakiasis: clinical and CT findings in 19 patients.

PURPOSE: To evaluate the clinical and CT findings in patients with small-bowel Anisakiasis. MATERIALS AND METHODS: Nineteen patients with small-bowel Anisakiasis and who underwent abdominal CT between 2005 and 2012 were enrolled in our study. All of these patients were diagnosed using either a serologic test for Anisakiasis (n = 18) or by pathology (n = 1). Their medical records were reviewed in order to determine the clinical findings. CT images were retrospectively reviewed by two radiologists to evaluate the characteristics of the involved bowel wall and the ancillary findings. RESULTS: All patients had presented with the acute onset of severe abdominal pain as well as a history of having recently eaten raw fish. The mean time interval from eating the fish to the onset of abdominal pain was 1.7 days. Eighteen patients were treated conservatively and experienced resolution of their symptoms within seven days of hospitalization. One patient underwent surgical exploration for presumed small-bowel ischemia. The sites of involvement included the ileum (16/19, 84%) and jejunum (3/19, 16%). All patients had circumferential bowel-wall thickening (mean, 0.8 cm) with an intermediate length of involved bowel (mean, 7.9 cm). Small-bowel obstruction occurred in 16 patients (84%). The target sign was present in 17 patients (89%), ascites, particularly in the perilesional area, in 16 patients (84%), and mesenteric edema in 15 patients (79%). CONCLUSION: Small-bowel Anisakiasis should be considered in the differential diagnosis of acute abdomen in order to avoid unnecessary surgery when patients present with abdominal pain after having recently eaten raw fish, concentric bowel-wall thickening with the target sign in the ileum, perilesional ascites, as well as bowel obstruction seen on CT.

Imaging of intracranial plaques with black-blood double inversion recovery MR imaging and CT.

BACKGROUND: We evaluated the feasibility of black-blood double inversion recovery magnetic resonance imaging (BBDIR) and CT imaging (CTI) for depiction of IAPs. METHODS: We performed BBDIR on 20 control subjects and 13 patients with acute ischemic stroke. We measured the thickness of the normal vessel wall in control subjects and the maximal and minimal thickness of IAPs in patients on BBDIR. We evaluated signal intensity (SI) and the eccentricity of the IAP on BBDIR, and abnormal wall thickening and CT attenuation of IAPs on CTI. We correlated imaging features of BBDIR and CTI in the patients. RESULTS: The difference of wall thickness between control and patient group was statistically significant (control subjects; basilar artery 0.6 mm, MCA 0.51 mm, and patients; maximal 2.34 mm, minimal 1.3 mm, P value≤.001). The IAP showed eccentric remodeling and heterogeneous SI with the regions of high SI on BBDIR. CTI could not reveal abnormality in 10 patients. Suspicious intraplaque hemorrhage and calcification was demonstrated in 3 patients by CTI. CONCLUSIONS: BBDIR could reveal normal and abnormal wall of large intracranial arteries. CTI had limited role for detection of IAP, however, correlation of BBDIR and CTI could provide further characterization of the IAP's in terms of intraplaque calcification and hemorrhage.

CT imaging features of carotidynia: a case report.

Despite denial as a disease entity, carotidynia had shown relatively concordant imaging finding as an inflammatory process surrounding the carotid bifurcation area. We report serial computed tomography (CT) images of a case with carotidynia that showed the layered thickening of the carotid wall with self-limiting disease course.

Two cases of aberrant right subclavian artery and right vertebral artery that originated from the right common carotid artery.

We present here two patients that had an aberrant right subclavian artery and an anomalous origin of the right vertebral artery from the right common carotid artery. We review the previous literature and discuss herein the embryologic mechanism and clinical implications of this variation.

Evaluation of the somatotopic organization of corticospinal tracts in the internal capsule and cerebral peduncle: results of diffusion-tensor MR tractography.

OBJECTIVE: We have used diffusion tensor tractography (DTT) for the evaluation of the somatotopic organization of corticospinal tracts (CSTs) in the posterior limb of the internal capsule (PLIC) and cerebral peduncle (CP). MATERIALS AND METHODS: We imaged the brains of nine healthy right-handed subjects. We used a spin-echo echo-planar imaging (EPI) sequence with 12 diffusion-sensitized directions. DTT was calculated with an angular threshold of 35 degrees and a fractional anistropy (FA) threshold of 0.25. We determined the location of the CSTs by using two regions of interest (ROI) at expected areas of the pons and expected areas of the lateral half of the PLIC, in the left hemisphere of the brain. Fiber tracts crossing these two ROIs and the precentral gyrus (PCG) were defined as CSTs. Four new ROIs were then defined for the PCG, from the medial to lateral direction, as ROI 1 (medial) to ROI 4 (lateral). Finally, we defined each fiber tract of the CSTs between the pons and each ROI in the PCG by using two ROIs methods. RESULTS: In all subjects, the CSTs were organized along the long axis of the PLIC, and the hand fibers were located anterior to the foot fibers. The CSTs showed transverse orientation in the CP, and the hand fibers were located usually medial to the foot fibers. CONCLUSION: Corticospinal tracts are organized along the long axis of the PLIC and the horizontal direction of the CP.

Distinction of reactive joint fluid from pyogenic abscess by diffusion-weighted imaging.

It is difficult to distinguish reactive joint fluid from infectious joint fluid by conventional MR images. In this presented case, we successfully distinguished these two conditions using diffusion-weighted imaging.