Journal of Clinical Imaging Science最新文献

Placenta accreta spectrum (PAS) disorder is one of the most dangerous conditions that can affect pregnancy and its incidence is increasing secondary to rising cesarean section rates worldwide. The standard treatment is frequently elective hysterectomy at the time of cesarean delivery; however, uterine and fertility preserving surgery is becoming more common. In the pursuit of a reduction in blood loss and associated maternal morbidity, occlusive vascular balloons are increasingly used at the time of surgery, usually placed with fluoroscopic guidance. Occlusive balloons placed in the infrarenal aorta have been shown in the literature to be superior in terms of blood loss and hysterectomy rates than those placed more distally, such as within iliac or uterine arteries. We present the first five cases performed in Europe of ultrasound-guided infrarenal aortic balloon placement before cesarean for PAS disorder, and describe the technique we used, which provided reduced blood loss, a clearer operating field and avoided fetal and maternal exposure to radiation and intravenous contrast.

Objectives: In the last decade, the incidence of renal cell carcinoma (RCC) has been rising, with the greatest increase observed for solid tumors. Magnetic resonance imaging (MRI) protocols and algorithms have recently been available for classifying RCC subtypes and benign subtypes. The objective of this study was to prospectively validate the MRI algorithm presented by Cornelis et al. for RCC classification.

Material and methods: Over a 7-month period, 38 patients with 44 renal tumors were prospectively included in the study and received an MRI examination in addition to the conventional investigation program. The MRI sequences were: T2-weighted, dual chemical shift MRI, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced T1-weighted in wash-in and wash-out phases. The images were evaluated according to the algorithm by two experienced, blinded radiologists, and the histopathological diagnosis served as the gold standard.

Results: Of 44 tumors in 38 patients, only 8 tumors (18.2%) received the same MRI diagnosis according to the algorithm as the histopathological diagnosis. MRI diagnosed 16 angiomyolipoma, 14 clear cell RCC (ccRCC), 12 chromophobe RCC (chRCC), and two papillary RCC (pRCC), while histopathological examination diagnosed 24 ccRCC, four pRCC, one chRCC, and one mixed tumor of both pRCC and chRCC. Malignant tumors were statistically significantly larger than the benign (3.16 ± 1.34 cm vs. 2.00 ± 1.04 cm, P = 0.006).

Conclusion: This prospective study could not reproduce Cornelis et al.'s results and does not support differentiating renal masses using multiparametric MRI without percutaneous biopsy in the future. The MRI algorithm showed few promising results to categorize renal tumors, indicating histopathology for clinical decisions and follow-up regimes of renal masses are still required.

Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is an uncommon benign disorder characterized by the accumulation of activated histiocytes in affected tissues. While RDD typically involves lymph nodes, it may manifest as extranodal involvement. Breast involvement is an exceedingly rare presentation of this condition with <100 reported cases worldwide. This report presents a case of RDD in a 58-year-old male patient who presented with a palpable breast mass. Mammography and ultrasound imaging studies raised concerns for malignancy, prompting a breast biopsy. Histopathological examination revealed S100-positive pale histiocytes exhibiting emperipolesis, consistent with RDD. The management of extranodal RDD is individualized, as no standardized guidelines are currently available. However, surgical excision is recommended for unicentric breast lesions, which was performed in our case, resulting in complete remission. The patient has remained disease-free under surveillance with computed tomography scans. Our case underscores the importance of considering RDD in the differential diagnoses of breast masses and highlights the utility of surgical excision as an effective treatment option, especially for unicentric breast lesions of RDD.

To evaluate the feasibility of transjugular intrahepatic portosystemic shunt (TIPS) in children with portal hypertensive complications, PubMed and Cochrane Library were queried to identify clinical studies evaluating TIPS in patients <18 years old. Baseline clinical characteristics, laboratory values, and clinical outcomes were extracted. Eleven observational studies totaling 198 subjects were included in the study. The pooled technical success rate and hemodynamic success rate were 94% (95% confidence interval [CI]: 86-99%) and 91% (95% CI: 82-97%), respectively; ongoing variceal bleeding resolved in 99.5% (95% CI: 97-100%); refractory ascites was improved in 96% (95% CI: 69-100%); post-TIPS bleeding rate was 14% (95% CI: 1-33%); 88% of patients were alive or successfully received liver transplant (95% CI: 79-96%); and shunt dysfunction rate was 27% (95% CI: 17-38%). Hepatic encephalopathy occurred in 10.6% (21/198), though 85.7% (18/21) resolved with medical management only. In conclusion, based on moderate levels of evidence, TIPS is a safe and effective intervention that should be considered in pediatric patients with portal hypertensive complications. Future comparative studies are warranted.

Nearly, 20% of renal allografts fail after 5 years resulting in a return to hemodialysis. These patients subsequently undergo withdrawal of immunosuppressant therapy, and the failed allograft is left in situ. However, many patients (40%) develop graft intolerance syndrome, characterized by fever, pain, and hematuria. Conventionally, this is managed with low-dose maintenance immunosuppressant therapy, however, that is not without notable adverse risk. In refractory patients, transplant nephrectomy is the treatment of choice; however, this caries significant morbidity and mortality. Interventional radiology plays a substantial role of treating graft intolerance syndrome while delivering improved patient outcomes.

Objectives: This study compared the diagnostic value of 3D T1-weighted (T1W) gradient-echo (GRE) and 2D T1W in-phase and out-of-phase GRE sequences for appendicitis diagnosis in pregnant women.

Material and methods: This retrospective study included 25 pregnant patients with suspected appendicitis who underwent 1.5 Tesla abdominal magnetic resonance imaging and had definitive diagnoses. Four doctors approached four separate imaging groups: A (only T2-weighted image [T2WI] sequences), B (T2WI and 3D T1W GRE sequences), C (T2WI and T1W in-phase and out-of-phase GRE sequences), and D (T2WI, 3D T1W GRE, and T1W in-phase and out-of-phase GRE sequences). The kappa (κ) index was used to compare the appendicitis diagnostic results between groups. The diagnostic value of these sequences in the diagnosis of pregnancy appendicitis was also evaluated.

Results: Groups A and C had average consistency with definitive diagnosis (κ = 0.6), lower than Groups B and D (κ = 0.865), indicating a high definite diagnosis consistency. Groups B and D had similarly high sensitivity (80%), specificity (100%), positive predictive value (100%), negative predictive value (95.2%), and accuracy (ACC) (96%), higher than Groups A and C (60%, 95%, 75%, 90.5%, and 88%, respectively).

Conclusion: 3D T1W-GRE sequences improve appendicitis diagnosis in pregnancy compared to T2W sequences alone. Adding in and out phase GRE sequences do not increase diagnostic ACC.

Benign metastasizing leiomyoma (BML) is a rare finding of histologically benign smooth muscle tumors in extrauterine locations, most commonly the lungs. We report a case of BML found incidentally on pre-operative imaging in a 42-year-old patient. BML is found in premenopausal women with a history of leiomyoma and, often, hysterectomy. As in our case, the metastatic pulmonary nodules are not hypermetabolic on 18F-fluorodeoxyglucose Positron emission tomography/computed tomography. BML may be clinically malignant or asymptomatic. Since the imaging appearance of BML simulates metastatic disease of more malignant etiology, awareness of its multimodality imaging appearance and presentation can aid in diagnosis.

Budd-Chiari syndrome is a complex clinical disorder of hepatic venous outflow obstruction, originating from the accessory hepatic vein (HV), large HV, and suprahepatic inferior vena cava (IVC). This disorder includes both HV and IVC obstructions and hepatopathy. This study aimed to conduct a systematic review of the survival rate and clinical success of different types of endovascular treatments for Budd-Chiari syndrome (BCS). All participant studies were retrieved from four databases and selected according to the eligibility criteria for systematic review of patients with BCS. The survival rate, clinical success of endovascular treatments in BCS, and survival rates at 1 and 5 years of publication year were calculated accordingly. A total of 3398 patients underwent an endovascular operation; among them, 93.6% showed clinical improvement after initial endovascular treatment. The median clinical success rates for recanalization, transjugular intrahepatic portosystemic shunt (TIPS), and combined procedures were 51%, 17.50%, and 52.50%, respectively. The median survival rates at 1 and 5 years were 51% and 51% for recanalization, 17.50% and 16% for TIPS, and 52.50% and 49.50% for combined treatment, respectively. Based on the year of publication, the median survival rates at 1 and 5 years were 23.50% and 22.50% before 2000, 41% and 41% in 2000‒2005, 35% and 35% in 2006‒2010, 51% and 48.50% in 2010‒2015, and 56% and 55.50% after 2015, respectively. Our findings indicate that the median survival rate at 1 and 5 years of recanalization treatment is higher than that of TIPS treatment, and recanalization provides better clinical improvement. The publication year findings strongly suggest progressive improvements in interventional endovascular therapy for BCS. Thus, interventional therapy restoring the physiologic hepatic venous outflow of the liver can be considered as the treatment of choice for patients with BCS which is a physiological modification procedure.

Lemmel syndrome is a pancreaticoduodenal disease caused by compression of the mid or distal common bile duct by a periampullary diverticulum. This condition should be considered a rare complication of a duodenal diverticulum and an unusual cause of obstructive jaundice. Because of its infrequent occurrence and non-specific clinical presentation, Lemmel syndrome can mimic other conditions. We herein report the clinical and imaging findings (computed tomography, magnetic resonance imaging) of a patient who presented with intermittent abdominal pain and jaundice. Large air-filled outpouching lesions of the duodenum compressed the biliary duct, resulting in upstream biliary ductal dilatation that led to the diagnosis of Lemmel syndrome.