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Magnetic Resonance Imaging Features of Primary Breast Angiosarcomas

PURPOSE. The purpose of this study was to review the contrast-enhanced magnetic resonance imaging (CE-MRI) of pathologically proven primary breast angiosarcomas (PBAs) from our data from 2009 to 2019. MATERIALS AND METHODS. We reviewed the CE-MRI features of PBA including tumor size, margin, intensity, enhancement pattern, skin invasion, and intratumoral associated findings with the consensus of two radiologists. RESULTS. A total of 5 PBA patients (mean age: 36.6 years) (mean diameter: 10.5 cm; range: 5.4-19.0 cm) were enrolled for analysis, two of which were associated with pregnancy. All the PBAs were large, manifested as rapidly enlarged breasts or masses, and featured irregular (4 cases) or circumscribed (1 case) outlines with skin invasion (2 cases). All showed hypointensity on T1-weighted images and inhomogeneous hyperintensity on T2-weighted short-time inversion recovery on non-contrast MRI, and all were inhomogeneously enhanced with type 1 (2 cases) or type 3 (3 cases) kinetic curves. Intratumoral features revealed serpentine tubular defects and hematomas in 4 and 3 cases, respectively. CONCLUSION. PBAs clinically manifest as rapidly enlarged breasts or masses. CE-MRI can display the morphological features of irregular outlines and inhomogeneous enhancement with either intratumoral hematoma or serpentine defects that facilitate the differential diagnosis.

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Impact Analysis of Systemic-Pulmonary Arterial Shunt Creation on Patients With Tetralogy of Fallot

PURPOSE. The systemic-pulmonary arterial shunt is a standard palliative procedure for Tetralogy of Fallot (TOF). We used computed tomography (CT) to determine post-surgical outcomes of this procedure. MATERIALS AND METHOD. In this retrospective study, we used CT scans of patients with TOF who received a systemic-pulmonary arterial shunt before total correction (the closure of the ventricular septal defect and the reconstruction of the right ventricular outflow tract) during 2000 and 2020 in one tertiary referring hospital. A total of 38 patients and 76 exams (mean age of shunt installment: 33 days; average follow-up time: 212 days; range: 9-638 days) were included in this study. We analyzed the following parameters: initial pulmonary artery condition, operation age, the shunt size, the proximal origin site, the distal insertion of the shunt, and the period of the shunt. We also separated patients with shunt patency to assess the most crucial factors that caused an increase in the McGoon ratio. RESULTS. The mean McGoon ratio before shunt placement was 1.2. We found that the proximal and distal anastomotic sites and the shunt stenosis conditions were associated with an increased McGoon ratio. Twelve patients with patent shunts were selected for further analysis to exclude any effects of shunt stenosis. We identified that the shunt size, distal anastomotic site, and pulmonary trunk’s initial size had increased the McGoon ratio. We determined that the most important factor leading to a statistical increase in the McGoon ratio was the location of shunt insertion, e.g., a shunt placed using a central insertion leading to a significant increase in the McGoon ratio (p ＜ 0.05). CONCLUSION. We concluded that the central shunt was more effective than the peripheral shunt (modified Blalock-Taussig shunt) in promoting an increase in the McGoon ratio. This means that a patient with adequate pulmonary flow can receive a total correction operation earlier.

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Criss-Cross Heart, a Rare Congenital Anomaly: A Case Report

Criss-cross heart (CCH) is a rare congenital heart malformation. We describe a case of CCH combined with situs inversus, a double-outlet right ventricle, and intra-arterial and interventricular defects. The diagnosis of CCH was first suspected by echocardiography and confirmed by electrocardiographic-gated cardiac computed tomography (CT) for surgical planning. The imaging characteristics of the case included the counterclockwise-rotated right ventricle being right superior and anterior to the left ventricle and crossing atrioventricular connections. In such complicated congenital heart anomalies, cardiac CT could be a useful diagnostic tool by providing better spatial resolution in heart structures and great vessels, thus assisting surgical planning.

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Altered Functional Connectivity in the Basal Ganglia Network and Executive Network in Parkinson's Disease Patients With Impulse-Control Disorder

PURPOSE. Impulse-control disorder (ICD) is one of the most debilitating symptoms in Parkinson's disease (PD). The development of such a disorder is partially attributed to dopaminergic medications. Studies have shown more structural and functional brain alterations in PD patients with impulse-control disorder (PD-ICD) compared to PD patients without ICD. In this study, we aimed to investigate the differences in brain networks among PD-ICD, PD without ICD, and normal control subjects. MATERIALS AND METHODS. In total, 28 PD patients (8 PD-ICD patients and 20 PD patients without ICD) and 22 sex- and age-matched healthy subjects were enrolled. Detailed neuro-psychological testing using the Wechsler Adult Intelligence Scale-III, Cognitive Abilities Screening Instrument, and magnetic resonance imaging (MRI) 3.0 Tesla GE Signa whole-body MRI system was conducted for all subjects. Resting state network assessments for basal ganglia and bilateral executive control networks were analyzed among different groups and medication status. RESULTS. PD patients without ICD had decreased functional connectivity (FC) over their basal ganglia networks compared to normal controls, while the PD-ICD group did not show such a difference. PD-ICD patients exhibited increased FC in the right executive control network compared to healthy controls, regardless of medication status, and the FC in the right executive control network in PD patients without ICD was found to be affected by medication. CONCLUSION. In this study, we found distinct network differences between PD-ICD and PD without ICD patients in the basal ganglia and executive networks. These network differences may contribute to their different clinical presentations.

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Arterial Spin-Labeling MRI of Neonates: Quantification of Cerebral Blood Flow With Individualized Parameters

PURPOSE. We aimed to compare cerebral blood flow (CBF) quantification when adopting default adult parameters and CBF quantification when adopting individualized neonatal parameters. MATERIALS AND METHODS. Arterial spin-labeling perfusion magnetic resonance studies of 32 neonates were analyzed. CBF quantifications were performed with offline calculation (Mpld) adopting default adult parameters to demonstrate the measurement results of Functool software, and these were compared to measurements resulting from the use of 3 different calculations (M1, M2, and M3) that adopted the subject-specific parameters of neonates, specifically the T1 of blood and the blood-brain partition coefficient. Co-registration and gray matter (GM) segmentation were performed to extract cerebral GM-CBF values. We assessed the agreement of CBF measurements between Mpld, M1, M2, and M3 by using Bland-Altman analysis. RESULTS. Negative mean differences were found in Mpld minus M1 (mean difference = 6.115 mL/100g/min [29.16%]), Mpld minus M2 (4.782 [21.44%]), and Mpld minus M3 (6.879 [34.04%]). CONCLUSION. In neonates, quantifying CBF by adopting adult parameters results in a 21.44%-34.04% overestimation of CBF.

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The Efficacy of Artificial Intelligence in Detecting Lung Nodules on Low-Dose Computed Tomograms

PURPOSE. This study aimed to investigate the performance of vessel-suppressed computer-aided detection (VS-CAD) artificial intelligence (AI) in detecting and characterizing lung nodules on low-dose computed tomography (LDCT) images. MATERIALS AND METHODS. From September 2014 to July 2019, 70 patients with 111 lung nodules detected by LDCT who subsequently underwent pulmonary wedge resection were enrolled. The pre-operative LDCT images of the 70 patients were retrospectively and separately interpreted by a third-year radiology resident and a senior thoracic radiologist by using both the traditional method and an AI-based method. The AI-based system consisted of a vessel-suppression function for producing a vessel-suppressed (VS) image and a deep-learning-based VS-CAD analyzer. In the AI-based method, the VS-LDCT images were used as the primary source for interpretation and the original LDCT images were used for reference. The reading time and detected target nodules for each reading mode were recorded for comparison. RESULTS. A total of 111 nodules from 70 patients were confirmed by surgical pathology. All the 111 nodules were successfully detected by the two observers using the traditional method. Only two benign nodules featuring as ground glass nodules were not detected on the VS-LDCT images by either of the two observers. The reading time was significantly shorter by using the AI-based method than the traditional method (mean ± SD: 115.15 ± 73.50 vs. 301.90 ± 138.47 seconds, p ＜ 0.001). CONCLUSION. The AI system, which was composed of a VS-CAD analyzer, allows easier and significantly faster nodule detection via VS-LDCT images. AI is beneficial to radiologists in detecting lung nodules on LDCT images.

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Gastrointestinal Melanoma With Multifocal Small Bowel Intussusceptions: A Rare Case Report and Literature Review

Primary or secondary melanoma of the small intestine is rare. Here, we present a case of a 57-year-old female patient with melena and microcytic anemia. Computed tomography (CT) showed a submucosal tumor of the duodenum, the circumferential thickening of the jejunum wall, and multiple simultaneous small bowel intussusceptions without significant bowel obstruction. Endoscopy showed a pigmented submucosal tumor in the duodenum. Malignant melanoma was confirmed through biopsy. There was no definitely identifiable cutaneous lesion.

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Immunoglobulin G4-Related Lung Disease Presenting With Multiple Solid and Subsolid Nodules: A Case Report

Immunoglobulin G4 (IgG4)-related disease features the proliferation of IgG4-positive plasma cells and lymphocyte infiltration accompanied with fibrosis in target organs. The presentations of IgG4-related lung disease in imaging are variable, with manifestations of solid nodules, round ground-glass opacities, alveolar interstitial cells, and bronchovascular patterns caused by inflammation along the entire intrapulmonary connective tissue reported in the literature. We report a case of IgG4-related lung disease manifesting as multiple solid and subsolid nodules in the bilateral lungs. Initial imaging differential diagnoses were broad, with the final diagnosis produced on the basis of the pathologic examination of obtained specimens via wedge resection.

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Factors in Predicting Compression of the Left Main Bronchus in Patients With Aortic Coarctation

PURPOSE. Left main bronchus (LMB) narrowing occurs more frequently in patients of coarctation spectrum, even after arch surgery, which might be preventable and correctable, so we aimed to investigate the factors predicting LMB compression after arch surgery. MATERIALS AND METHODS. We enrolled patients with coarctation and its variants undergoing routine preoperative or postoperative cardiac computed tomography (CT) and aortic arch surgery at our hospital. Several parameters were easily measured on the axial CT images, including the position of the descending aorta related to the spine at the carina and LMB branching levels, the retrosternal distance index, and the interaortic distance index. Linear regression and Pearson's correlation were used for analyzing these parameters, which were significantly correlated with the degree of LMB stenosis. RESULTS. Interaortic distance index was the most significant factor contributing to preoperative LMB stenosis (p = 0.04). Increment of the angle of the descending aorta related to the vertebral body at the carina level after surgical repair on the diseased arch had the most significant impact on reducing LMB narrowing (p = 0.006). CONCLUSION. We found some possible critical parameters that can be easily measured on axial CT images to suggest the surgical method for correction of the aortic coarctation if there is possibility of airway narrowing.

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Chronic Sclerosing Sialadenitis of the Submandibular Gland: A Case Report

A 76-year-old male patient presented with a nontender and firm left chin mass for 3 weeks. Ultrasonography revealed a 2.9 cm hypoechoic mass with minimal interior Doppler signal in the left submandibular gland. Contrast-enhanced computed tomography demonstrated a 2.9 cm homogeneous contrast-enhanced mass in the left submandibular gland; a left submandibular gland tumor was suspected. A total resection of the left submandibular gland tumor was performed. Immunohistochemical studies revealed strong positive staining for immunoglobulin (Ig) G4. A pathological diagnosis of IgG4- related sclerosing disease was made.