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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Calcified pseudoneoplasms of the neuraxis, benign lesions of the central nervous system, are extremely rare. Although their pathogenesis is unclear, they can be treated by complete resection. We present the case of a 68-year-old man with headache over a period of approximately 10 years. Computed tomography and magnetic resonance imaging revealed a small calcified lesion in the right cerebellopontine angle of the brain.
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Short-T1 epidermoid cysts (or white epidermoid cysts) are a rare type of epidermoid cyst that do not display a classic appearance on magnetic resonance imaging. We report a rare pediatric case of a short-T1 epidermoid cyst in the posterior cranial fossa with extension to the foramen magnum. In our case, the short-T1 epidermoid cysts' T1-weighted magnetic resonance images had a high signal intensity, which could have resulted from high protein content or hemorrhage.
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We present a rare case of an 8-year-old boy with a solitary large tumor in the right upper thoracopulmonary region. The tumor was pathologically confirmed to be an extraosseous Ewing sarcoma. To our knowledge, only a few cases of primary thoracopulmonary extraosseous Ewing sarcoma have been reported. We also discuss a broad spectrum of diseases that can be included in the differential diagnosis of an intrathoracic mass.
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Lymphoepithelioma-like hepatocellular carcinoma (LEL-HCC) of the liver is a rare undifferentiated carcinoma characterized by the presence of abundant lymphoid infiltrates. We report a 45-year-old man who presented with the incidental finding of a left hepatic tumor that was initially diagnosed as hepatocellular carcinoma in magnetic resonance imaging. He underwent laparoscopic left hepatic lateral segmentectomy, and the pathology revealed LEL-HCC. Here, we present the imaging findings and clinicopathological features of this case and review the few cases present in the literature.
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Pseudoaneurysm of the cystic artery is rare in patients presenting with acute cholecystitis. Clinical presentation of coffee-ground emesis and melena raises clinical suspicion for the presence of cystic artery pseudoaneurysm. Diagnosis is possible through a combination of angiography and contrast-enhanced computed tomography. Appropriate management includes embolization of the pseudoaneurysm, followed by definitive cholecystectomy and removal of the involved vasculature. This case report demonstrates that percutaneous selective transarterial embolization is a potentially efficient temporary measure for patients who cannot immediately receive surgical intervention. A high index of suspicion is crucial for favorable outcomes in this fatal condition.
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PURPOSE. Computed tomography (CT) screening of the lung and surgical resection of lung nodules using video-assisted thoracoscopic surgery (VATS) are the mainstay for diagnosis and surgical intervention of early lung cancer. This work investigated the morphology of ground-glass nodules (GGNs) on lung CT images and differentiated minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IA) from preinvasive lesions, including atypical adenomatous hyperplasia (AAH) and adenocarcinoma in situ (AIS). MATERIALS AND METHODS. Between November 2013 and December 2015, 28 lung GGNs in 28 patients (18 women and 10 men, median age = 58 years) were excised using VATS at a tertiary center in Taiwan. CT images, clinical data, and pathological reports were reviewed. The CT findings of the following GGN characteristics, namely location, size, mean attenuation, shape, margin, internal air bronchogram, bubble-like lucency, and GGN-vessel relationship, were analyzed for identification of invasive lung adenocarcinoma (including MIA and IA). The results and complications of preoperative CT-guided localization of GGNs were also analyzed. RESULTS. Among 28 lung GGNs, the final pathological diagnoses comprised 1 case of organizing pneumonia (3.57%), 3 cases of AAH (10.71%), 3 cases of AIS (10.71%), 9 cases of MIA (32.14%), and 12 cases of IA (42.86%). Significant differences among preinvasive lesions, MIA, and IA were noted with respect to both the margin and GGN-vessel relationship (p = 0.016 and 0.004, respectively). MIA tended to exhibit lobulated margins (77.77%), and IA featured lobulated (58.33%) or spiculated (41.67%) margins. Type III (44.44%) and IV (44.44%) GGN-vessel relationships were predominantly observed in MIA. A Type IV GGN-vessel relationship was the most prevalent in IA (83.33%). The cutoff diameter of 7.75 mm revealed a sensitivity of 71.4% and a specificity of 85.7%, and the cutoff value of average attenuation of -562.10 HU determined a sensitivity of 66.7% and a specificity of 71.4% in differentiating preinvasive lesions, MIA, and IA. The technical success rate of preoperative CT-guided localization in this cohort was 100%. Intervention complications were generally mild and infrequent. CONCLUSION. Mean attenuation, margin, and GGN-vessel relationship on CT images can be used to differentiate among preinvasive lesions, MIA, and IA. CT-guided localization of lung nodules is a safe and an efficient procedure.
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Reversible cerebral vasoconstriction syndrome (RCVS) represents a group of conditions that exhibit reversible multifocal narrowing of the cerebral arteries, with clinical manifestations typically including thunderclap headache. Here, we report the case of a 53-year-old woman presenting with severe headaches associated with defecation. One month after the onset of the headaches, computed tomography angiography revealed a typical radiological finding of RCVS with multifocal narrowing of cerebral arteries. Normalization of the affected arteries, demonstrated by follow-up computed tomography angiography, may also be employed as an additional diagnostic criterion for RCVS.
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Most hepatic cysts are asymptomatic and do not require further treatment. In our case, a 76-year-old woman had undergone lung cancer surgery. A focal lesion was identified in her right lower lung during postoperative follow-up. Because of its clinical presentation, aggressive tumor recurrence was initially suspected, but the tumor-like lesion decreased in size after 1 week. We diagnosed a simple hepatic cyst in the liver dome that had ruptured into the right lower lung, causing inflammatory consolidation associated with faint ground-glass opacity mimicking recurrent lung cancer.
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PURPOSE. In clinical practice, three-dimensional (3D) registration of medical images is always a challenge because of the movement of the patient. A 3D registration method was applied in this study to extract computed tomography angiography (CTA) images. MATERIALS AND METHODS. A study of 26 slab regions with various ranges of motion from 13 patients (10 men, 3 women; age range, 48-89 years) was approved by our institutional review board and evaluated retrospectively. Noncontrast-enhanced CT (NECT) and CTA images of the same volume data were acquired. Following simple thresholding, centralization, and normalization of the NECT and CTA images, a globally optimized 3D Iterative Closest Point (ICP) point-set registration was used for bone subtraction. Two radiologists conducted clinical evaluations, and the resulting data were analyzed. RESULTS. Significant improvements in motion correction and bony alignment were observed in the NECT and CTA images after the registration (p ＜ 0.001). The resultant images exhibited vascular extraction with bone and calcification elimination. CONCLUSION. A 3D ICP registration method can successfully extract the vascular structures from NECT and CTA images. The method is applicable in a wide variety of medicine and engineering contexts.
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PURPOSE. The aims of this study were to assess the correlation between neuroimaging-detected abnormality and the neurological severity of border-zone infarction in children and to determine the relative clinical significance of border-zone infarction versus that of mixed infarction. MATERIALS AND METHODS. We retrospectively reviewed the magnetic resonance imaging (MRI) findings of 23 children between the ages of 1 month and 14 years who had been diagnosed as having border-zone infarction. An MRI score was calculated for each patient based on the extent of abnormality. Neurological severity was assessed with a scoring system based on the number of abnormal neurological features detected. We compared the neurological severity of border-zone infarction with that of mixed infarction in these children. RESULTS. A significant positive correlation was observed between MRI score and neurological severity score (R = 0.730, p ＜ 0.01, Spearman correlation). Fourteen patients had only border-zone infarcts (border-zone infarction group), 9 had other infarcts in addition to border-zone infarcts (mixed infarction group) in certain areas, including the corpus callosum, the basal ganglion, and vascular territories. Compared with the children in the border-zone infarction group, those in the mixed infarction group had higher neurological severity scores (median, 1.0 versus 3.0; p = 0.047) but not significantly different MRI scores (median, 3.0 versus 3.0; p = 0.35, Mann-Whitney U test). CONCLUSION. Compared with border-zone infarction, mixed infarction was associated with greater neurologically severity. MRI scores were positively correlated with neurological severity scores among the children with border-zone infarcts.