Journal of Clinical Imaging Science最新文献

Objectives: Leiomyomatosis peritonealis disseminata (LPD) is a rare and specific type of leiomyomatosis that is often misdiagnosed as malignant tumor with peritoneal metastasis, and accurate diagnosis is critical to treatment planning. The purpose of this study is to investigate the radiological features of LPD, analyze, and summarize its differential diagnosis and clinical features to improve the understanding of this rare disease.

Material and methods: A retrospective analysis was conducted on clinical and radiological features from 10 patients with pathologically confirmed LPD between 2012 and 2024. The computed tomography (CT) and magnetic resonance imaging (MRI) findings were examined, focusing on parameters such as location, morphology, size, quantity, enhancement patterns, and their relationship with adjacent organs. In addition, the radiological features and the key points of differential diagnosis were summarized.

Results: All the 10 LPD patients presented with multifocal lesions in the abdomen and pelvis, and 7 of them had a history of hysteromyoma surgery. The number of lesions was all ≥2, most of them were round or quasi-circular, with clear boundaries and smooth edges, did not invade the neighboring parenchymal organs, with a length of about 1.5~16.8 cm. The lesions were located in the pelvic cavity in 6 cases, the abdominal wall in 6 cases, the intestinal wall in 3 cases, the rectouterine pouch in 1 case, the omentum in 5 cases, the abdominal cavity in 1 case, and the mesentery in 1 case. There were 7 cases with minimal pelvic fluid and 1 case with liver spread. CT showed circular solid nodules with clear boundaries. The density of small lesions was homogeneous. Cystic changes were observed in some large lesions. On MRI, T1-weighted imaging showed hypo to isointense, T2-weighted imaging (T2WI) mostly showed hypointense, and T2WI in some large lesions showed slightly high signal intensity, diffusion-weighted imaging signal intensity was not higher than that of myometrium, apparent diffusion coefficient showed isointense, and solid components of the lesions were significantly more homogeneous enhanced after enhancement, and the enhancement degree was similar to that of normal myometrium.

Conclusion: Although the imaging findings of LPD are similar to malignant tumors with peritoneal implantation and metastasis, they have certain characteristics, which are helpful for differential diagnosis combined with the clinical history of patients.

Cardiac sarcoidosis (CS) represents a rare yet potentially life-threatening condition characterized by non-specific clinical symptoms that maybe easily missed by clinicians. In this case series, the clinical presentations, various imaging modalities' characteristics, and the management of four patients, each with distinct phenotypes of CS confirmed through endomyocardial biopsy, are discussed. Advanced imaging techniques, including positron emission tomography, revealed the focal septal uptake of ¹⁸F fluorodeoxyglucose, which suggests an ongoing inflammation, whereas contrast-enhanced cardiac magnetic resonance demonstrates septal late gadolinium enhancement, which indicates replacement fibrosis. These features of multimodality imaging in CS can assist in patient diagnosis and treatment.

Objectives: We aim to investigate the predictive value of [^99mTc] pertechnetate thyroid scintigraphy in determining the permanence of congenital hypothyroidism (CH).

Material and methods: A retrospective analysis of [^99mTc] pertechnetate thyroid scans performed for evaluation of CH at the Nuclear Medicine Unit of a hospital in Hong Kong between January 1, 2008, and December 31, 2018, was conducted. Scintigraphic findings and parameters at diagnosis, including thyroid stimulating hormone (TSH), free thyroxine (fT4), gender, and gestational age, were reviewed. The need for lifelong thyroxine replacement therapy was reviewed.

Results: The study included 85 subjects, with 74 (87.1%) presenting with eutopic thyroid and 11 (12.9%) showing thyroid dysgenesis. Patients with scintigraphic evidence of thyroid dysgenesis required permanent thyroid hormone replacement therapy. Among the patients with eutopic thyroid, a higher TSH level was associated with the need for lifelong thyroid hormone replacement therapy (cutoff TSH value 18.72 mIU/L, sensitivity 77.3% and specificity 53.8%). Gender, gestational age, and fT4 did not show significant differences between the transient and permanent CH groups in patients with eutopic thyroid.

Conclusion: Scintigraphic findings of thyroid dysgenesis indicate a high prevalence of permanent CH. In patients with eutopic thyroid, higher TSH levels predict the requirement for lifelong thyroid hormone replacement therapy. These results provide insights into the prediction of CH and aid in individualized treatment decisions for patients with CH.

Objectives: The objective of this study was to evaluate the relationship between the aortomesenteric angle at end-inspiration and end-expiration and its variation rate with several anthropometric parameters.

Material and methods: Sagittal reconstructed computed tomography (CT) images of 59 patients who underwent contrast-enhanced CT at end-inspiration and end-expiration between 2015 and 2020 were reviewed. All these patients underwent dynamic contrast CT during both inspiration and expiration for adrenal venous sampling purposes. Two experienced radiologists measured the aortomesenteric angle during both end-inspiration and end-expiration, and its variation rate. Pearson's or Spearman's correlation analysis was used to assess correlations between the angle or variation rate and height, weight, body mass index (BMI), visceral fat, subcutaneous fat, and diaphragm motion.

Results: The aortomesenteric angle was significantly larger at end-expiration (88.65 ± 25.15, 95% confidence interval [CI] 82.09-95.20) compared to end-inspiration (62.22 ± 21.90, 95% CI 56.51-67.93, P < 0.001). The aortomesenteric angles at both end-inspiration and end-expiration correlated significantly with weight, BMI, visceral fat, and subcutaneous fat. The strongest correlation was between aortomesenteric angle and visceral fat at both end-inspiration (r = 0.523, P < 0.001) and end-expiration (r = 0.546, P < 0.001). The variation rate correlated only with diaphragm motion (r = 0.550, P < 0.001).

Conclusion: The aortomesenteric angle at end-expiration was significantly larger than at end-inspiration, with the strongest correlation found between the angle and visceral fat.

Coronary artery ectasia (CAE) is defined as a dilation exceeding 1.5 times the diameter of an adjacent normal artery, predominantly affecting males. Myocardial bridging (MB) is a condition in which the coronary artery runs intramurally within myocardial tissue. Coronary computed tomography angiography (CCTA) offers high-resolution imaging, facilitating accurate diagnosis of these conditions. This report presents the first documented case of a 78-year-old female with CAE and superficial MB coexisting in the same segment of the left anterior descending artery that was detected incidentally by CCTA.

Objectives: Cardiac computed tomography (CCT) plays a key role in diagnosing congenital heart disease (CHD), emphasizing the need for specialized protocols in newborns due to CHD's complexity. The aim is to explore the relationship between peak enhancement time (PET) and various parameters during CHD assessment with CCT.

Material and methods: The study involved 38 CHD patients undergoing CCT, with observations made on their heart rate, respiratory rate, saturation, cardiac output, weight, height, and age. The PET for each case was determined, and Spearman's rank correlation was employed to evaluate the association between these parameters and the PET.

Results: The median PET was 20.63 s, with a mean aortic Hounsfield unit of 512.16 ± 160.56. A moderate negative correlation was found between PET and both heart rates (r = -0.42, P = 0.009) and respiratory rates (r = -0.41, P = 0.01), whereas a negligible positive correlation (r = 0.19, P = 0.25) was observed with SpO2. A moderate positive correlation was noted between PET and both weight (r = 0.44, P = 0.005) and height (r = 0.40, P = 0.01). In addition, there were significant differences in median PET across different age categories.

Conclusion: The findings conclude that PET during CCT is significantly associated with heart rate and respiratory rate. An increase in these rates corresponds to a notable decrease in PET. Consequently, the study recommends minimizing scan delays in CCT for patients exhibiting higher heart rates.

The realm of precision medicine, particularly its application within various sectors, shines notably in neuroradiology, where it leverages the advancements of three-dimensional (3D) printing technology. This synergy has significantly enhanced surgical planning, fostered the creation of tailor-made medical apparatus, bolstered medical pedagogy, and refined targeted therapeutic delivery. This review delves into the contemporary advancements and applications of 3D printing in neuroradiology, underscoring its pivotal role in refining surgical strategies, augmenting patient outcomes, and diminishing procedural risks. It further articulates the utility of 3D-printed anatomical models for enriched comprehension, simulation, and educational endeavors. In addition, it illuminates the horizon of bespoke medical devices and prosthetics, illustrating their utility in addressing specific cranial and spinal anomalies. This narrative extends to scrutinize how 3D printing underpins precision medicine by offering customized drug delivery mechanisms and therapies tailored to the patient's unique medical blueprint. It navigates through the inherent challenges of 3D printing, including the financial implications, the need for procedural standardization, and the assurance of quality. Prospective trajectories and burgeoning avenues, such as material and technological innovations, the confluence with artificial intelligence, and the broadening scope of 3D printing in neurosurgical applications, are explored. Despite existing hurdles, the fusion of 3D printing with neuroradiology heralds a transformative era in precision medicine, poised to elevate patient care standards and pioneer novel surgical paradigms.

Desmoplastic fibroma (DF) is an uncommon benign bone tumor that typically affects the facial bones, with cerebral cranium involvement being extremely rare. We report a unique case of DF in the parietal bone of a 28-year-old woman, notable for its rapid growth during pregnancy-a phenomenon not previously documented. The imaging features of this case also differ from all but one previously reported case. The patient underwent surgical removal, and histopathology confirmed the diagnosis of DF (collagenous fibroma). After 17 months of follow-up, no local recurrence was observed. We also provide a comprehensive review of 32 cases involving DF of the cerebral cranium, analyzing clinical features, imaging findings, treatment methods, and recurrence patterns. This case highlights the importance of considering DF in the differential diagnosis of cranial lesions, particularly in pregnant patients with rapid tumor growth. Complete surgical resection with a wide margin remains the recommended treatment to minimize recurrence risk.

Dual left anterior descending (LAD) coronary artery is a rare anatomical variant with significant clinical implications. Recognizing this variant is crucial for accurate diagnosis and effective management, particularly in the context of revascularization strategies. We present a 71-year-old male with a history of dyspnea on exertion with baseline wall motion abnormality on a transthoracic stress echocardiography irreversible after exercise. Coronary computed tomography angiography revealed a dual LAD system: The left short LAD (LAD1) originating from the left main coronary artery and the right LAD (LAD2) arising separately from the right coronary cusp, distinct from the right coronary artery ostium. Having different origins and courses, both LADs supply the LAD territory. Our case is notable for two main reasons: The rarity of this particular type of dual LAD anatomy and the unique course of the LAD2, which, to our knowledge, has not been described in any previous case report. Although rare, dual LAD coronary artery should be considered in patients with atypical short LAD. Comprehensive imaging and a thorough understanding of coronary artery variants are essential for accurate diagnosis and effective management.