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Diagnosis of Double-Chambered Right Ventricle With Dynamic Cardiac CT

PURPOSE. Double-chambered right ventricle (DCRV) is a disorder when hypertrophied muscle bundles divide the right ventricle into two chambers, causing a variable degree of obstruction. When treated properly with surgery, DCRV is a disease with great prognosis. This study is aimed to investigate if dynamic cardiac computed tomography (CCT) improves the diagnostic accuracy of DCRV as compared to transthoracic echocardiography and static CCT, and to establish a diagnosing criterion. MATERIALS AND METHODS. Retrospective measurement of subinfundibular right ventricular outflow tract (RVOT) diameters during end-systole and end-diastole on dynamic CCT of 60 children with ventricular septal defects (VSDs) was conducted in a single institution. Transthoracic echocardiography, static CCT and surgical records of the 60 patients were also reviewed and analyzed. RESULTS. One-third (n = 20) of the patients had associated DCRV according to their surgical findings. The most effective single factor to predict DCRV was when the height (mm)-corrected subinfundibular RVOT diameter (mm) during end-systole became less than 0.008 (sensitivity = 80.0%; specificity = 97.4%). All parameters measured during end-systole have a relatively better DCRV diagnostic value than those measured during end-diastole. Transthoracic echocardiography, static CCT and dynamic CCT showed respective diagnostic accuracies of 78.3, 80.0 and 91.7%. CONCLUSION. Dynamic CCT with end-systolic measurements proved to be the better imaging modality for the diagnosis of DCRV with higher accuracy, as compared to transthoracic echocardiography and static CCT.

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Primary Gastrointestinal Stromal Tumor (GIST) of the Liver: A Rare Case Report

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Stomach and small intestine are the most common sites and rarely appear outside the digestive tract. We report a case of primary GIST in the liver of a 59-year-old man. Our patient had a good prognosis after complete surgical resection and oral imatinib adjuvant therapy (200 mg/day) for 2 years in spite of the classification as a high-risk tumor. He remained disease-free during 7 years post-operative follow-up, and alive well at the completion of this report.

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Acute Adverse Reactions to Gadolinium-Based Contrast Agents: Based on 17,276 Contrast-Enhanced MR Examinations

PURPOSE. We report gadolinium-based contrast agents (GBCAs) acute adverse drug reactions (ADRs) occurred in a regional teaching hospital and analyze the pattern and incidence of ADRs. MATERIALS AND METHODS. We analyzed all ADRs occurred in 17,276 patients who underwent contrast-enhanced magnetic resonance examination from April 1, 2014 to February 28, 2019. GBCAs used in this study included Gd-BOPTA, Gd- BTDO3A and Gd-DOTA. ADRs were classified mild, moderate, and severe according to the criteria issued by the American College of Radiology. RESULTS. A total of 43 (0.25%) patients had ADRs: 42 (0.24%) mild reaction, 1 moderate reaction. Incidence of ADR were 0.39, 0.23, and 0.18% for Gd-BOPTA, Gd-BTDO3A and Gd-DOTA, respectively. Previous history of allergy to food or drug was found in 35% of our patients with ADRs. The symptoms and signs in 22 patients resolved spontaneously, and other 21 cases resolved after treatment. None of these patient had sequelae. CONCLUSION. The ADRs induced by GBCAs are mainly mild. Only 1 moderate reaction and no severe ADRs are observed in this study. Close observation or premedication to patients with prior history of allergy to food or drugs may be considered because more than one third of our patients with ADRs had history of allergy to food or drug.

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Diagnostic Impact of MDCTU for Diagnosing Bladder Tumors Using Different Reconstructed Image Section Widths and Intervals

PURPOSE. To analyze the diagnostic value of multidetector computed tomography urography (MDCTU) for bladder tumors using different reconstructed section widths as evaluated by different readers. MATERIALS AND METHODS. Thirty-four prospectively-enrolled subjects, suspected of bladder tumors, underwent MDCTU, followed by a conventional cystoscopy (within 2 weeks). Thereafter, two independent readers, with different experience levels, blindly recorded the presence and number of bladder tumors using three reconstructed MDCTU-sets (1-, 3-, and 5-mm). The MDCTU diagnostic value for bladder tumors was analyzed and compared based on histological results, as well as the subjective image quality of the three image-sets. RESULTS. Of the 34 patients, 29 exhibited a total of 95 bladder tumors. Overall, the areas under the receiver operating characteristic curves (AUCs) of bladder tumors related to MDCTU ranged from 0.672 to 1.000 and 0.535 to 0.850 in perpatient and per-lesion analyses, respectively. The 3-mm image-set reported the largest AUCs for diagnosing bladder tumors, however, the subjective image quality of the 3- and 5-mm sets did not significantly differ however, were significantly higher than that of the 1-mm set. CONCLUSION. Of the three image-sets, the 3-mm was ideal to diagnose bladder tumor on MDCTU, providing a sufficient image quality without substantial partial volume averaging.

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Aggressive Behavior of Typical Pulmonary Carcinoids: A Rare Case

Typical pulmonary carcinoids (TCs) are pulmonary carcinoids that are relatively benign in nature compared with atypical pulmonary carcinoids (ACs). Lymph node metastasis occurs less frequently in TCs, comprising only up to 15% of the cases, whereas 50% of ACs are known to be associated with regional or distant metastasis. Nevertheless, TCs can still exhibit a malignant and aggressive behavior at initial presentation as do ACs. Here we report a rare case of TCs in a 41-year-old female who had a primary tumor in the lingular lobe with three other small metastatic or synchronous tumors in both lungs as well as metastatic lymphadenopathy in the mediastinum.

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Gray-White Matter Differentiation of Cervical Spinal Cord Using MRI: Comparison Between Gradient-Echo and Fast Spin-Echo T2-Weighted Sequences

PURPOSE. To compare the gray-white matter differentiation of the cervical spinal cord between using T2*-weighted gradient-echo (GRE) sequence and T2-weighted fast spin-echo (FSE) sequence. MATERIALS AND METHODS. We retrospectively analyzed the magnetic resonance (MR) data of 71 patients, in whom 37 patients were imaged on a 3 T scanner and 34 patients were imaged on a 1.5 T scanner. Axial T2*-weighted GRE images (3 T: multi-echo data image combination; 1.5 T: fast field echo) and T2-weighted FSE images of the cervical spinal cord were performed and compared. Two neuroradiologists independently assessed the scans and rated visual score on 3-point scales (grade 3, well distinguishable; grade 2, partially distinguishable; and grade 1, indistinguishable). A gray-white matter intensity ratio (G/W intensity ratio) was calculated for comparison between GRE and FSE sequences in each scanner group. RESULTS. In comparison with FSE sequence, GRE sequence provided higher visual score (3 T: grade 3, medium, p ＜ 0.010; 1.5 T: grade 2, medium, p ＜ 0.010) and G/W intensity ratio (3 T: 1.25 ± 0.08, p ＜ 0.010; 1.5 T: 1.40 ± 0.16, p ＜ 0.010) on both 3 T and 1.5 T MR systems. The 3 T-GRE sequence provided higher visual score (grade 3, p ＜ 0.010) but lower G/W intensity ratio (1.25 ± 0.08, p ＜ 0.010) than did the 1.5 T-GRE sequence. No significant difference of visual score or G/W intensity ratio was found between 3 T-FSE and 1.5 T-FSE sequences. CONCLUSION. The T2*-weighted GRE sequence provided better gray-white matter differentiation compared with T2- weighted FSE sequence in the cervical spinal cord MR imaging.

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Useful Features on Computed Tomography for Differentiating Benign and Malignant Cystic Adnexal Masses

PURPOSE. The analysis of computed tomography (CT) features of cystic adnexal masses to predict ovarian cancer has rarely been conducted. This study aims to provide radiologists with clues for the differentiation of malignant and benign cystic adnexal lesions. MATERIALS AND METHODS. Fifty-six women with surgical extraction of cystic adnexal masses were the subjects of this institutional review board-approved retrospective study. Their preoperative CT images were evaluated for tumor size, shape, side (unilateral or bilateral), maximal wall thickness, averaged cystic attenuation, and the presence of asymmetric wall thickening, multiple septa (＞ 3), papillary projections, enhanced soft tissue components, calcifications, ascites, and regional lymphadenopathy (LAP). All variables were analyzed using Student’s t and chi-squared tests to compare differences between malignant and benign masses. Logistic regression analysis was used to assess risk factors for cystic ovarian cancer. A p ＜ 0.050 was considered statistically significant. RESULTS. The pathological analysis revealed 26 malignant, 26 benign, and 4 borderline cystic adnexal neoplasms. Asymmetric wall thickening (p ＜ 0.001), papillary projections (p ＜ 0.001), enhanced soft tissue components (p ＜ 0.001), regional LAP (p ＜ 0.001), and ascites (p = 0.004) were more common in malignant than in benign entities. Logistic regression modeling revealed that papillary projections (multivariate odds ratio [OR] = 20.682, p = 0.018) and ascites (OR = 11.887, p = 0.039) were significant risk factors for cystic ovarian cancer. CONCLUSION. Multidetector CT is a useful imaging tool for differentiating malignant and benign cystic ovarian neoplasms. Cystic ovarian cancer is the likelier diagnosis than benign diseases when papillary projections or ascites is observed.

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Subacute Carotid Stent Thrombosis Managed with Sandwich Stenting Technique: A Case Report

In recent years, carotid artery stenting has been increasingly used for treatment of carotid artery stenosis, which had similar outcome compared with carotid endarterectomy. Subacute stent thrombosis is a rare complication of carotid artery stenting. In this report, we present a case of symptomatic subacute stent thrombosis four days following the initial procedure. Intra-arterial tirofiban was used to resolve the clot at first, but in vain. Therefore, an additional stent was implanted by using the sandwich stenting technique with distal protection. Follow-up computed tomography angiography showed successful revascularization and the patient did not have any neurological deficit after the procedure. Management of the carotid stent thrombosis is variable and depends on different clinical circumstance. Sandwich stenting technique is a safe and effective treatment of choice in symptomatic subacute carotid stent thrombosis.

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Blunt Injury of an Accessory Spleen: A Case Report

Accessory spleen injuries are rare. We present a case of accessory spleen blunt injury, diagnosed by contrast-enhanced computed tomography, and received angioembolization. We also discuss the treatment options for this rare condition and the role of the American Association for the Surgery of Trauma scale.

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Analysis of CT Grading and Pancreatic Enzymes of Blunt Pancreatic Injury

PURPOSE. The aims of this study are to evaluate the association of pancreatic enzymes and computed tomography (CT) injury grading with blunt pancreatic injury, and to predict the choice of management. MATERIALS AND METHODS. From January 2010 to December 2017, 48 patients who presented to the emergency department with history of blunt pancreatic trauma were retrieved. Seven patients were excluded by exclusion criteria. The demographics, pancreatic enzymes, CT examination, choice of management, pancreas-related complications and length of stay of 41 patients were retrospectively investigated. Univariate and multivariate analyses as well as receiver operating characteristic curves were used for analyses of the association with grades of injury and prediction of management. RESULTS. The association of major injuries with initial serum amylase ≥ 254 U/L (p = 0.026) and initial serum lipase ≥ 159 U/ L (p = 0.019) was statistically significant. Intervention management was highly associated with major pancreatic injury (p ＜ 0.001) and was significantly associated with elevated initial serum amylase ≥ 260 U/L (p ＜ 0.001) and lipase ≥ 185 U/L (p = 0.005) levels or peak serum amylase ≥ 390 U/L (p ＜ 0.001) and lipase ≥ 700 U/L (p ＜ 0.001) levels. Multivariate logistic regression analysis confirmed that only peak serum amylase level (odds ratio = 1.006; 95% confidence interval [CI] = 1.001-1.011; p = 0.029) and modified CT grades (odds ratio = 501.000; 95% CI = 3.000-95655.000; p = 0.020) were significant predictors of intervention management for blunt pancreatic injury. CONCLUSION. Major pancreatic injury is associated with elevation of initial serum amylase and lipase levels. Major pancreatic injury and peak serum amylase are predictors of intervention management.