Journal of the Belgian Society of Radiology最新文献

Background: To evaluate the diagnostic accuracy of semi-quantitative adenosine perfusion magnetic resonance imaging (MRI) to determine fractional flow reserve (FFR) ≤ 0.80 intermediate-grade coronary stenoses as compared to visual analysis.

Methods: Forty-six patients (mean age 61 ± 9 years; 33 males) with 49 intermediate-grade stenoses (59 ± 7.6%; range, 42-70% minimal diameter reduction) underwent adenosine perfusion MRI and FFR measurement within four months in this retrospective study. MRI was visually assessed by two experienced readers twice with one-year interval, the second time with the knowledge of the diseased artery. The stress subendocardial myocardial enhancement maximal upslope was evaluated distal to the coronary stenosis (=RISK) and divided by the same value in remote myocardium supplied by normal arteries (=REMOTE) to obtain the relative myocardial perfusion index (RMPI).

Results: The average FFR value was 0.84 ± 0.09 and 15/49(31%) intermediate-grade stenoses were FFR ≤ 0.80. The kappa-values for interobserver agreement assessing inducible perfusion defects on visual readings was 0.20 on the first reading and increased to 0.62 with the knowledge of the stenosis location. Consensus readings had a diagnostic accuracy of 82%(40/49) in identifying FFR ≤ 0.80 stenoses on both blinded and unblinded readings with regards to the knowledge of the stenosis location. Meanwhile, stress subendocardial RMPI had higher accuracy (43/49[88%]) than visual readings to predict FFR ≤ 0.80 stenoses, using a cutoff value of 0.84.

Conclusion: By assessing perfusion changes in remote myocardium, semi-quantitative MRI analysis using stress subendocardial RMPI can provide an equal or more accurate alternative to visual analysis in identifying FFR ≤ 0.80 intermediate-grade stenoses. Larger cohorts of patients are required to validate this approach.

A rare case of spontaneous splenic infarction with polysplenia is presented. The diagnosis was made by confirmed by enhanced computed tomography (CT), which showed multiple spleens in the left abdomen and one of the spleen showing low attenuation areas representing infarct. Polysplenia syndrome is a rare entity associated with heterotaxy syndromes. Radiological examinations help the diagnosis by identifying infarcts in the spleen and other abnormal organs in the chest and abdomen. Teaching Point: We report a rare case of polysplenic syndrome with splenic infarction.

Objectives: Cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy effects on respiratory function, pulmonary exacerbations and quality of life have been well documented. However, CFTR modulator therapy effects on sinus disease have not been so well reported. A previous study reported that ivacaftor improves appearance of sinus disease on Computed Tomography (CT) in cystic fibrosis (CF) patients with G551D mutation. The aim of this study was to evaluate the effect of CFTR modulator therapy in sinus disease using CT scores in a wider CF patient population.

Materials and methods: Forty-eight adult patients with CF underwent at least one CT sinus examination before CFTR modulator therapy (ivacaftor, lumacaftor, ivacaftor/lumacaftor or elexcaftor/tezacaftor/ivacaftor) and one CT sinus examination one year after CFTR modulator therapy initiation. Two radiologists assessed the images in consensus. The Lund-Mackay score (LM score) and the Sheikh-Lind CT sinus disease severity scoring system (SL score) were used. The 22-item SinoNasal Outcome Test (SNOT-22) questionnaire was evaluated before CFTR modulator therapy and one year after CFTR modulator therapy initiation.

Results: CT sinus examination after CFTR modulator therapy showed statistically significant lower mean LM, SL and SNOT-22 scores than CT sinus examination before CFTR modulator therapy (p < 0.001).

Conclusion: Evolution of imaging findings on CT during follow-up closely correlate with improved SNOT-22 score one year after CFTR modulator therapy initiation, indicating that CT may be a useful adjunct during follow-up of CF patients under this treatment as an objective measure of sinonasal disease improvement.

We present an atypical case of a patient with hepatic hemangiomas showing fluid-fluid levels on computed tomography (CT) and magnetic resonance imaging (MRI). None of the lesions showed contrast enhancement, mimicking complicated hepatic cysts or metastasis with hemorrhagic content. On contrast-enhanced ultrasound the lesions showed peripheral nodular enhancement with complete fill-in on late phases, suggestive of hepatic hemangioma. Teaching point: Contrast-enhanced ultrasound (CE-US) may be useful in diagnosing atypical hepatic hemangioma showing fluid-fluid levels on computed tomography (CT) or magnetic resonance imaging (MRI).

Aim: To assess the frequency of bone changes in resected osteonecrotic femoral head (ONFH) specimens at multidetector computed tomography (MDCT) and compare their frequencies between ONFH with limited or advanced collapse.

Method: Fourteen ONFH were imaged using MDCT (n = 14) and microcomputed tomography ([µCT]; n = 8). Preoperative staging was performed using radiographs and MRI. Coronal reformats of MDCT images of the specimens were analyzed using the grid overlay method. There were 2,933 grid boxes containing cortical bone and 10,596 containing trabecular bone. Two MSK radiologists assessed in every grid box the presence of interface-related sclerosis, cortical bone interruption, trabecular bone interruption, and trabecular bone resorption. The frequency of grid boxes with bone changes at MDCT was calculated and compared between ONFH with limited (<1.5 mm) or advanced (≥1.5 mm) collapse.

Results: For both readers R1 and R2, there were 1111/10596 (10.5%) and 1362/10596 (12.9%) grid boxes with interface-related bone sclerosis, 557/2933 (19%) and 413/2933 (14.1%) with cortical bone interruption, 796/10596 (7.5%) and 665/10596 (6.3%) with trabecular bone interruption, and 331/10596 (3.1%) and 595/10596 (5.6%) with trabecular bone resorption. The frequency of grid boxes with cortical interruption and trabecular bone resorption was significantly higher in ONFH with advanced than in ONFH with limited collapse. There was no significant difference in frequency of grid boxes with trabecular interruption and interface-related bone sclerosis between ONFH with advanced or limited collapse.

Conclusion: Cortical interruption and trabecular resorption, but not trabecular interruption, were more frequent in osteonecrotic femoral heads with advanced than with limited collapse.

Teaching Point: Failure to recognize unusual radiological presentations of some lung adenocarcinomas can lead to misdiagnosis and/or delay appropriate treatment.

Teaching Point: The coffee bean sign, the whirl sign, and the bird's beak sign are the key findings on abdominal CT of cecal volvulus.

Teaching Point: Contrast-enhanced FLAIR images have unsurpassed value for the radiological depiction of hypertensive papilledema. FLAIR acquisition should therefore be performed after intravenous contrast, especially in the of work-up of intracranial hypertension and/or tumor.

This case shows the MRI and CT features of a rare entity, namely arachnoiditis ossificans, which should be recognized in patients with long-standing history of multiple spine surgery.