Journal of Radiological Science/放射線學雜誌
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社團法人中華民國放射線醫學會,正常發行
選擇卷期
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Tandem lesions refer to the simultaneous presence of an intracranial occlusion within the anterior circulation and high-grade ipsilateral stenosis or occlusion of the cervical internal carotid artery. Intracranial thrombectomy is central to treating tandem lesions. However, it is not known whether performing the intracranial thrombectomy before or after dealing with the cervical lesion leads to different outcomes. In addition, there is no consensus in choosing an optimal treatment strategy, whether it be acute stenting, angioplasty, or conservative treatment for the cervical lesion. We report the procedure and outcome of a case with tandem lesions at the M1 segment of the right middle cerebral artery and innominate artery that was treated with an intracranial-first thrombectomy. Initially, the pre-procedure therapeutic strategy for this case was to treat the cervical tandem occlusion extracranially first, but this was unsuccessful. The intracranial thrombus was resolved; however, the extracranial thrombus in the innominate artery remained because we failed to retrieve it. Therefore, we present this case report with a literature review describing therapeutic strategies for tandem lesion occlusions. The published literature revealed no consensus or optimized protocol for treating tandem occlusions; this issue thus requires further study.
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PURPOSE. Magnetic resonance imaging (MRI)-guided vacuum-assisted breast biopsy (VAB) is used for suspicious malignant lesions that are detectable only with MRI. The purpose of this study was to investigate the malignancy rate of MRI-guided VAB in a single health center in Taiwan. MATERIALS AND METHODS. A total of 47 MRI-guided VABs for MRI-only lesions, consecutively performed from April 2017 to March 2020 were reviewed. MRI-guided VAB was performed on a 1.5 T-system with a 10 G EnCor device. All lesions detected with MRI could not be detected by mammogram or second-look ultrasonography. RESULTS. All MRI biopsies were technically successful in this study. The 47 lesions were assessed as Breast Imaging Reporting and Data System category 4 or 5. The average lesion size of a mass enhancement was 1.2 cm, and the average lesion size of a nonmass enhancement was 2.6 cm. The median time required to perform the VAB was 40 min. The biopsy was successfully performed without serious complications in all patients. The histopathologic diagnosis was malignant in 12 (25.5%), high risk in 7 (14.9%), and benign in 28 (59.6%) patients. CONCLUSION. MRI-guided breast biopsy is an advisory, well-tolerated, and safe procedure to diagnose MRI-detectable lesions only.
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A 43-year-old man presented with numbness and pain in both ankles and feet for 4 years. Bilateral tibial nerves and left sural nerve showed decreased nerve conduction velocities. Magnetic resonance imaging (MRI) of the right ankle detected a muscular structure in the right tarsal tunnel compressing the right posterior tibial nerve. The right flexor digitorum accessorius longus muscle was diagnosed and confirmed by surgery. Decompression of the tarsal tunnel and resection of the accessory muscle were performed by a neurosurgeon. Right ankle pain and numbness resolved following surgery. MRI of the left ankle was scheduled within a short time.
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Osteonecrosis is the consequence of decreased blood flow and leads to an irreversible hypoxic change of bone. Osteonecrosis typically presents with two serpiginous lines. However, imaging features in the early phase are poorly recognized, and the clinical symptoms are often non-specific. The imaging finding of this case is not presenting as ordinary osteonecrosis, and radiologists should be aware of the imaging diagnosis, even when the finding is atypical.
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PURPOSE. Blood blister-like aneurysms (BBAs) are a unique type of aneurysm, forming a small and broad base shape at the supraclinoid segment of the internal carotid artery (ICA). Our purpose in this study is to review the treatment procedure and outcome of the BBA cases in our center in order to identify some useful recommendations for treating this disease. MATERIALS AND METHODS. We enrolled cases of BBA at supraclinoid ICA admitted to our center from 2017 to 2020. We collected and analyzed the medical history, treatment methods, complications, and clinical outcomes. RESULTS. We included 4 men and 6 women with a mean age of 52.8 years. Treatment of the BBAs consisted of stent-assisted coiling in 7 patients, flow diverter and coiling in 1 patient, and double-stent-assisted coiling in 1 patient. One patient died before any treatment. Rescue treatment was required in 4 patients, involving coiling in 2 cases, surgical trapping in 1 case, and endovascular trapping in the other one case. A good outcome (modified Rankin scale [mRS]: 0-2) was found in 30% of patients, poor function (mRS: 3-5) was found in 40% of patients, and the mortality rate was 30%. CONCLUSION. BBAs require short-term follow-up if no aneurysm is identified on initial angiography and also a short-term postembolization follow-up to rule out rapid recurrence. ICA trapping appears to be a promising strategy if the balloon occlusion test reveals satisfactory results.
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Gangliocytic paraganglioma (GP) is a rare benign tumor of neuroectodermal or neuroendodermal origin predominantly occurring in the duodenum. Here, we present the case of an incidental left superior mediastinal mass in a 57-year-old female patient with pathologically proven mediastinal GP (MGP). The tumor had a hypervascular structure with classic triphasic epithelioid, Schwannian, and gangliocytic cell types haphazardly arranged. Heterogeneity on contrast-enhanced computed tomograph and magnetic resonance imaging (MRI) T2-weighted (WI) highlighted the various cellular portions of MGP where the salt and pepper pattern signified vascular-rich characteristics. To our knowledge, the MRI salt and pepper sign of MGP has not been previously reported.
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PURPOSE. This retrospective study investigates the associations between the imaging parameters of renal conventional B-mode ultrasound (US) and shear wave elastography (SWE) with chronic kidney disease (CKD) stages and their progression MATERIALS AND METHODS. From December 2015 to March 2017, 38 consecutive patients underwent renal conventional B-mode US and SWE in our department. Their demographics and CKD stages were recorded at the time of the renal SWE. We also followed up their CKD stages regularly for the progression of CKD stages. The CKD stages were recorded at progression. The association between the imaging parameters of the renal elastography and CKD stages, as well as the progression of CKD stages, were analyzed. RESULTS. Of the 38 enrolled patients, 8 patients were male, and 30 were female. The patients had a median age of 40.5 years. There were no significant differences in the kidney length, width, and parenchymal thickness between CKD stages 3b-5 and 1-3a. By contrast, there was a significant difference in the renal shear wave velocity (SWV) between initial CKD stages 3b-5 and 1-3a (1.82 vs. 2.57 m/s, p = 0.02). In total, 18 (47.4 %) of the 38 patients showed CKD stage progression during follow-up, and renal SWV ≥ 2.95 m/s was associated with CKD stage progression. CONCLUSION. A higher SWV measured by the renal SWE was associated with an earlier CKD stage, and patients with higher SWV measurements may be prone to CKD stage progression. Renal SWE may have the potential for evaluating CKD stages and monitoring their course.
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Paragangliomas in the pancreas are extremely rare and usually difficult to distinguish from other pancreatic or retroperitoneal neoplasms. They may present asymptomatically or be detected incidentally. On images, paragangliomas are observed as well-defined hypervascular tumors with the occasional draining vessel. These features may aid in the diagnosis of pancreatic paragangliomas.