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Quantitative Measurement of Brain Iron Deposition in Patients Undergoing Peritoneal Dialysis Using Susceptibility Mapping

PURPOSE. To evaluate the different susceptibilities of various brain structures in patients with chronic kidney disease (CKD) undergoing peritoneal dialysis (PD) and in healthy controls using quantitative susceptibility mapping (QSM) and to determine the correlations of those susceptibilities with clinical data. MATERIALS AND METHODS. We prospectively enrolled 26 CKD patients (13 men and 13 women; mean age = 54.46 years) undergoing PD and 26 age- and sex-matched healthy controls (12 men and 14 women; mean age = 55.65 years) in this study. QSM images were reconstructed from susceptibility-weighted imaging to quantify differences in iron deposition between the patients and healthy controls in subcortical white matter and deep gray nuclei. Cognitive functioning was assessed in both groups. Partial correlations between the susceptibilities of various brain regions, neuropsychiatric test results, and clinical parameters were calculated. RESULTS. Higher susceptibilities of the bilateral caudate head, putamen, substantia nigra, red nucleus, and dentate nucleus were noted in the PD patients than in the healthy controls. Increased total Kt/V and 4-hour creatinine dialysis/plasma were associated with higher susceptibilities in the right caudate head and right red nucleus. There is negative correlation between susceptibility of left substantia nigra and executive functions (p = 0.022), speech and language functions (p = 0.044), and visuospatial functions. Negative correlation was found between the susceptibility of right putamen and visuospatial functions (p = 0.024). CONCLUSION. CKD patients undergoing PD have increased brain iron deposition in deep gray nuclei, which might contribute to neuropsychological consequences. Better PD efficiency, peritoneal function, and lower serum total iron-binding capacity levels might further exacerbate iron accumulation in the brain.

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CT-Guided Microwave Tumor Ablation in a Patient With Incisional Hernia: The Use of Manual Compression Technique

Mobile abdominal mass is difficult for needle to penetrate in interventional procedure. In the case report, we describe this challenging situation encountered in a 46-year-old woman with incisional hernia during computed tomography-guided microwave ablation for her retroperitoneal liposarcoma and report the manual compression technique that successfully assisted the antenna penetration.

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Balloon Angioplasty as a Bail-Out Procedure for Those With Failed Thrombolytic Therapy for Acute Superior Mesenteric Artery Thrombosis

PURPOSE. Acute occlusion of the superior mesentery artery (SMA) causes extensive bowel necrosis, resulting in a poor prognosis with an extremely high mortality rate. To demonstrate SMA balloon angioplasty as a rescue procedure for those who were refractory to thrombolysis. MATERIALS AND METHODS. In the past five years, we total collected ten patients who suffered from acute SMA occlusion and three of them were refractory to local thrombolytic therapy. RESULTS. We used Scepter balloon catheter to perform balloon angioplasty and obtained well patency of the SMA main trunks eventually. CONCLUSION. SMA balloon angioplasty used as a rescue method for those refractory to local thrombolytic therapy is a feasible and effective management.

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Bilateral Femoral Hernias: A Case Report

An 84-year-old male patient had suffered from generalized weakness and conscious change for one hour. A palpable, irreducible and painless mass was found in right groin for 30 years. The laboratory data showed elevated blood liver enzyme (glutamic oxaloacetic transaminase [GOT] = 50 U/L), decreased hemoglobin level (10.8 vs. 13.6 g/dL performed 8 days ago), and normal urine analysis. Contrast-enhanced computed tomography (CT) of the abdomen showed a 7.2 cm, oval, wall thickened mass of fluid density connecting to the urinary bladder with a funnel-shaped neck in right groin, coursing medial to the right inferior epigastric vessels and posterior to right inguinal ligament. A short segment of ileum was found in left groin with a course similar to the right-sided lesion. Therefore, CT diagnosis of right incarcerated femoral bladder hernia and left femoral bowel hernia was made. Attempt for manual reduction of the right incarcerated femoral hernia was failed. Surgical intervention was planned. However, the patient and his family refused operation. The patient was discharged with regular outpatient follow-up.

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An Alternative to Stereotactic Breast Biopsy: Wire Localization Followed by Sonography-Guided Vacuum-Assisted Biopsy, Our Experience With 125 Cases

PURPOSE. To assess the performance and clinical value of mammographicallyguided hookwire localization and sonographically guided vacuum-assisted biopsy (VAB) of non-palpable breast lesions. MATERIALS AND METHODS. From 2014 January to 2016 October, 126 patients underwent mammography and were found to have cluster microcalcifications. These were subsequently determined to be category 3 and 4 according to Breast Imaging-Reporting and Data System and underwent mammography-guided hookwire localization and then ultrasound-guided VAB. Specimen mammography was taken to ensure microcalcifications were obtained. RESULTS. A total of 125 patients had VABs performed after hookwire localization. The mean procedural time was 24 minutes and microcalcification retrieval rate was 98.4% (123/125). Fifteen were found to be malignant, which included 5 invasive ductal carcinomas, and 10 ductal carcinomas in situ. Eleven high risk lesions were found, and these included 6 atypical ductal hyperplasia, 4 flat atypia, and 1 lobular carcinoma in situ. The other 99 biopsies yielded a mixed group of benign lesions which included 81 fibrocystic disease, 10 adenosis, 5 ductal hyperplasia, 2 apocrine metaplasia, and 1 papilloma. Complications included two cases of hematomas and one case of mastalgia, none were serious and required no further intervention. CONCLUSION. While unorthodox, mammographic hookwire localization and sonographically guided VAB seem to offer nearly comparable performance with stereotactic vacuum assisted biopsy, and may be a valid substitute in certain situations.

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Should We Rely on Milder or Severer Degree of Coronary Artery Stenosis in Different Cardiac Phases of Coronary Computed Tomography Angiography?

PURPOSE. To compare the reliability of two different cardiac phases in coronary computed tomography angiography (CTA) in predicting further clinical decision. MATERIALS AND METHODS. A total of 19 patients without or with stable chest pain undergoing coronary CTA with two different cardiac phases were included in this retrospective study. The two different cardiac phases were categorized as the milder phase and the severer phase. Forty-seven segments of coronary arteries were analyzed. Both segment-based and patient-based analyses were performed. Whether or not subsequent examinations was arranged was used as gold standard. RESULTS. Under segment-based analysis, there was no significant difference in sensitivity (73.3 vs. 80%, p = 1.000) and specificity (84.4 vs. 71.9%, p = 0.125) with respect to the phases of milder and severer stenosis. Five segments showed discordant results in different cardiac phases and only one of them underwent further invasive coronary angiography, with non-significant stenosis. Under patient-based analysis, similarly, there was no significant difference between the diagnostic performance of the two phases (sensitivity = 100.0 vs. 100.0%; specificity = 64.3 vs. 57.1%, p = 1.000). Only one patient had discordant results in two phases, without further cardiac investigation. CONCLUSION. Despite a lack of significant difference in the ability to predict further clinical decision between milder and severer cardiac phases on coronary CTA, the milder degree of stenosis seems to be more reliable when the results are discordant in different cardiac phases.

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Thoracic Computed Tomography Features of Systemic Lupus Erythematosus

PURPOSE. The purpose of this article is to provide a comprehensive description of the thoracic computed tomographic imaging features of systemic lupus erythematosus (SLE). MATERUALS AND METHODS. Given the broad spectrum of possible intra-thoracic presentations, this article details the computed tomography (CT) imaging features based on anatomical systems. RESULTS. Pulmonary manifestations of SLE include pleuritis (with or without effusion), pneumonitis, infection (particularly in patient's immunosuppressive therapy), interstitial lung disease, alveolar hemorrhage, and a possible increase in risk of lung cancer. Pulmonary vasculature system disease due to SLE include pulmonary hypertension and pulmonary embolism. Cardiovascular manifestations of SLE include pericardial effusion, pericarditis, and vasculitis diseases (coronary vasculitis or aortitis). Disorders of the muscular structures and diaphragm due to SLE include weakness of the respiratory muscles and the shrinking lung syndrome. CONCLUSION. Involvement of thoracic structures-pulmonary, cardiovascular, and respiratory musculature, is commonly encountered in patients with SLE. These organ systems are affected by the presence of disease through various pathogeneses. When SLE patients experience respiratory symptoms, chest pain, or other manifestations of thoracic discomfort, CT is an excellent tool to carry out important investigations into the cause of symptoms, to identify structural abnormalities that have occurred, and the planning of further management.

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A Jejunal Angiodysplasia With Active Bleeding and Changing Position of Extravasation of Contrast Medium on Follow-Up Superior Mesenteric Angiography: A Case Report

Acute massive gastrointestinal (GI) bleeding is a critical situation which must be rapidly to detect the underlying disease and bleeding source. Endoscopy, multiphase computed tomography and catheter angiography are usually used for initial localization of the bleeding site and further treatment of GI bleeding. We reported a case of a 26-year-old woman suffered from massive bloody stool at emergency department. Initial superior mesenteric artery (SMA) angiography and the repeated SMA angiography 70 minutes after initial one showed active extravasation of contrast medium in right and left upper quadrant of abdomen respectively. The pathological diagnosis was angiodysplasia of jejunum. The movement of mesentery and small bowel along SMA and mesenteric root may cause changing position of extravasation of contrast medium on the different sequential SMA angiography.

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R-II C Type Single Right Coronary Artery: A Case Report

Single coronary artery is a rare congenital anomaly. It has a single ostia arising from the aorta and gives rise to the whole coronary circulation. We reported a case of a single right coronary artery (RCA) with the left main coronary artery (LM) arising from the proximal RCA, and its proximal transfer branch was between the aorta and the pulmonary artery with a transseptal course of the middle to distal LM. In view of the aforementioned orientation, it was considered R-II C type in the modified Lipton's classification. Due to persistent chest pain, the patient underwent coronary artery bypass graft (CABG) from the left internal mammary artery to the first diagonal branch. The patient had symptom relief after CABG surgery.

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Magnetic Resonance Imaging Findings of Obstructive Cystic Renal Dysplasia in Two Neonates

Fetal and neonatal cystic renal diseases can be genetic or nongenetic in origin or associated with syndromes. Although ultrasonography (US) is essential for its diagnosis, characterization, and follow-up, magnetic resonance imaging (MRI) plays an important adjunctive role in evaluating other associated abnormalities, characterization of the associated syndromes, and investigating equivocal or inconclusive US findings. We report the MRI findings of obstructive cystic renal dysplasia in two infants aged 6 and 14 days, with underlying urinary tract obstruction. The magnetic resonance images revealed a small renal size with small, scattered, peripheral cortical cysts and hydronephrosis, hydroureter, as well as underlying obstructive urinary tract pathology. Based on our findings, MRI can also be useful in perinatal counseling and guiding perinatal and postnatal management.