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Clinical Imaging

Simone Cappelletti, Costantino Ciallella
The use of terms "body packing" and "body pushing", both encompassed in the idiomatic expression "body packing", is still misunderstood by clinicians. "Body packing" is a general term used to indicate the internal transportation of drug packages within the gastrointestinal tract; while "Body pushing" refers to the insertion of drugs in anatomical cavities or body orifices, such as the anus, the vagina, and the ears. With the present paper, we would like to analyze and clarify some issues concerning the confounding definitions of body packing and the main reasons why some drug packages may be undetected at plain abdominal radiography, providing important false negative findings, as in the case commented...
May 15, 2017: Clinical Imaging
Steve M Nelson, Derek A Mathis, Joseph K Hobbs, Vincent M Timpone
We present a case of a 57-year-old female with four-months of diplopia and vertigo. MRI revealed a mixed cystic and solid partially enhancing lesion of the 4th ventricle, foramen of Luschka and cerebellopontine angle. Preoperative differential diagnosis favored ependymoma. Biopsy revealed a neurenteric cyst, a benign developmental lesion that rarely occurs intracranially. This case highlights several atypical manifestations of intracranial neurenteric cyst, with regions of histologically benign solid enhancement, multicompartmental extra-axial location mimicking an ependymoma, and rapid recurrence without evidence of underlying malignancy...
May 10, 2017: Clinical Imaging
Yan Epelboym, Abhishek R Keraliya, Sree Harsha Tirumani, Jason L Hornick, Nikhil H Ramaiya, Atul B Shinagare
PURPOSE: Compare imaging features of indolent and non-indolent mastocytosis. METHODS: For 29 patients, imaging features, imaging indications, and distribution of indolent and non-indolent mastocytosis subtypes were analyzed. RESULTS: 16/29 (55%) patients had three distinct patterns of osseous abnormality, not significantly differing between cohorts. Non-indolent disease was more likely to present with hepatomegaly (p=0.0004), splenomegaly (p=0...
May 6, 2017: Clinical Imaging
Toshinori Nishizawa, Soichiro Yoshida, Fumitaka Koga, Hiroshi Tanaka, Mihiro Kaga, Kotaro Watanabe, Hiroshi Fukushima, Yasukazu Nakanishi, Minato Yokoyama, Junichiro Ishioka, Yoh Matsuoka, Kazutaka Saito, Yasuhisa Fujii, Kazunori Kihara
PURPOSE: We investigated whether the standardized apparent diffusion coefficient (ADC) value reflects bladder cancer characteristics across different centers. METHODS: Ninety-eight bladder cancer patients underwent MRI at two institutions. Standardized tumor ADC (sT-ADC) was calculated by dividing absolute tumor ADC (aT-ADC) by that of gluteus maximus. We compared ADCs between MRI protocols according to grade and T-stage. RESULTS: The differences in aT-ADC between MRI protocols were negated by sT-ADC...
May 5, 2017: Clinical Imaging
Jennifer Wells Eaton, Michele B Drotman, Rachel M Sales, Elizabeth Kagan Arleo
In this case report, the history and imaging of two patients with invasive lobular carcinoma (ILC) in the skin are presented, followed by a discussion of both benign and malignant intradermal findings on breast ultrasound. Although the majority of dermal findings are benign, these cases are a reminder that malignancy can manifest within the skin. The purpose of presenting these cases together is to remind breast imagers of the importance of considering malignancy in the differential diagnosis of intradermal lesions on breast ultrasound, especially in special circumstances such as a personal history of breast cancer or associated clinical findings...
May 5, 2017: Clinical Imaging
Etan Dayan, Hongfa Zhu, Alan B Copperman, Sara Lewis, Amita Kamath
The authors report and discuss a rare case of a gastrointestinal stromal tumor (GIST) in a 35-year-old female, which was pre-procedurally characterized as a right ovarian mass by magnetic resonance imaging (MRI) features. This manuscript reviews the imaging and clinical features of GISTs with pathologic correlation, and emphasizes how this entity may present a diagnostic challenge in certain anatomic regions owing in large part to its exophytic nature. This case is unique among similarly reported cases in that there was a "claw sign" with the right ovary, which provided convincing evidence of its point of origin...
May 5, 2017: Clinical Imaging
Kirema Garcia-Reyes, Heather I Greenwood, Elissa R Price
PURPOSE: To evaluate outcomes of lymph node sampling in patients with suspicious axillary nodes without a diagnosis of breast cancer. MATERIALS AND METHODS: We retrospectively identified all axillary ultrasound-guided sampling performed at our institution from 2003 to 2016 in patients. without malignancy. RESULTS: Seventy-eight lymph nodes met inclusion criteria. Two of the 78 sampled nodes (2.6%) were malignant. CONCLUSION: Sampling of suspicious nodes in patients without a history of breast cancer rarely yields malignancy...
May 5, 2017: Clinical Imaging
Mohammad Ali Husainy, Farhina Sayyed, Praveen Peddu
Focal liver lesions are routinely encountered by clinical radiologists and represent a wide spectrum of pathology. Majority of these lesions are likely to be benign in nature, especially in the absence of chronic liver disease or primary cancer. A radiologist must be aware of common and uncommon imaging features of benign lesions across the various imaging modalities. This review discusses pathognomonic imaging features of common benign focal liver lesions seen on ultrasound, computed tomography and magnetic resonance, and adds to existing knowledge with the recent updates to have emerged in this area...
May 4, 2017: Clinical Imaging
Shao Z Chen, Adam L Shimer, Nicholas C Nacey
Spinal subdural abscess is a rare central nervous system infection with just over a hundred cases reported. It is much less common than spinal epidural abscess. While most case reports have focused on route of infection and treatment options, there have not been any reports that focused on the unique MRI findings of spinal subdural abscess. We describe a case of spinal subdural abscess diagnosed by MRI in a 33-year-old male who presented with headaches after undergoing a microdiscectomy procedure, and review the underlying anatomic features of the spinal meninges which produce the appearance of a spinal subdural abscess...
April 27, 2017: Clinical Imaging
Ryan Hutten, Laurie M Lomasney, Vasilios Vasilopoulos, Albert Song, Andrew Chiang, Mitchell Bernstein, Hobie Summers
OBJECTIVE: We assess the utility of transparent 3D reconstructed CT images for evaluation of traumatic pelvic bony injuries compared to traditional radiographs. METHODS: Radiographs and 3D reconstructed CT were anonymized and randomized before review by 4 board certified physicians using a standardized questionnaire and compared to a gold-standard axial CT by a fifth board certified physician. RESULTS: 49 patients were included. We found significant agreement (K=[0...
April 27, 2017: Clinical Imaging
Kevin W Taylor, Michael M Moore, James Brian, Sosamma Methratta, Stephanie Bernard
OBJECTIVES: Evaluate the impact of wrist MRI in children on clinical diagnosis and management. MATERIALS AND METHODS: Four year retrospective analysis including demographics, MRI diagnoses, and effect on diagnoses and management were determined. RESULTS: 101 patients were included. Wrist MRI altered management in 86% (95% CI: 77-92%) and diagnosis in 46% (36-56%) of patients. MRI changed both diagnosis and management in 41% (31-51%), changed management only in 46% (35-56%), changed diagnosis only in 5% (2-12%), and had no change in diagnosis or management in 9% (95% CI: 4-17%)...
April 22, 2017: Clinical Imaging
Christopher Sami Oustwani, Alexander William Korutz, Malisa Siri Lester, Yasaman Kianirad, Tanya Simuni, Tarek Aref Hijaz
PURPOSE: To determine if loss of the swallow tail sign (STS) can distinguish Parkinson Disease (PD) from the Parkinson-Plus syndromes. METHODS: Twenty-five patients with PD, 21 with Parkinson-Plus syndromes, and 14 control patients were included. Presence of the STS was assessed. RESULTS: The STS was present in 79% of controls, statistically greater than the PD/Parkinson-Plus patients. There was no difference in the presence of the STS between the PD/Parkinson-Plus subgroups or when scanning at 1...
April 20, 2017: Clinical Imaging
Yonah B Esterson, Vihas Patel, Jeffrey Nicastro, Barak Friedman
Body packing refers to the intracorporeal concealment of illicit drugs. Here we report the case of a 55-year-old body packer who presented with palpitations, visual hallucinations, and a sense of impending death. Abdominal radiography demonstrated five ovoid foreign bodies overlying the rectum. At subsequent gastrotomy and cecotomy, thirty-eight cocaine-containing packets were retrieved from the stomach and ascending colon as well as from the rectum. As the contraband market evolves new techniques to evade detection, evaluation of the burden of body packer ingestion has become increasingly challenging...
April 20, 2017: Clinical Imaging
Yukichi Tanahashi, Satoshi Goshima, Hiroshi Kondo, Yoshifumi Noda, Kota Sakurai, Hiroshi Kawada, Nobuyuki Kawai, Shigeru Furui, Masayuki Matsuo
PURPOSE: To compare diagnostic performance of unenhanced and CTA images (Image set 1) to that of combined unenhanced, CTA, and venous-phase images (Image set 2) for incidentalomas in patients with aortic aneurysm. METHODS: Preoperative CT Images of consecutive 240 patients were reviewed by two observers for incidentalomas. Diagnostic performance was assessed. RESULTS: Sensitivity was higher in Image set 2 than Image set 1 in observer 1 and overall (P=0...
April 13, 2017: Clinical Imaging
Darragh Halpenny, Brian Park, Jeffrey Alpert, Larry Latson, Nancy Kim, James Babb, Maria Shiau, Jane Ko
OBJECTIVE: To assess the effect of low dose computed tomography pulmonary angiography (CTPA) on radiation dose in pregnant patients. MATERIALS AND METHODS: An old CTPA protocol for pregnant patients was compared to a new protocol. Protocol changes included: decreased kVp; increased contrast injection rate; imaging after shallow inspiration. Patients undergoing CTPA before (phase 1 group) or after (phase 2 group) the protocol change, were assessed. RESULTS: Effective dose was lower in the phase 2 group (0...
April 7, 2017: Clinical Imaging
Andrew S Chi, John Kim, Suzanne S Long, William B Morrison, Adam C Zoga
PURPOSE: To investigate non-contrast MRI findings of clinical adhesive capsulitis. METHODS: 31 non-contrast, non-arthrographic, shoulder MRIs were evaluated for coracohumeral ligament thickness, rotator interval infiltration, and axillary recess thickening/edema. RESULTS: In detection of adhesive capsulitis, sensitivity is 76.7% and specificity is 53.3% for coracohumeral ligament thickening, sensitivity is 66.7% and specificity is 55.2% for coracohumeral ligament thickening and rotator interval infiltration, and sensitivity is 23...
April 7, 2017: Clinical Imaging
Sun Hong, Ok Hee Woo, Hye Seon Shin, Soon-Young Hwang, Kyu Ran Cho, Bo Kyoung Seo
Shear wave elastography (SWE) was performed independently by two radiologists in 264 solid breast masses. The images were reviewed for color overlay pattern (COP) classification by the two radiologists, double blinded to any information. The interobserver agreement of the COP was almost perfect (κ=0.908) and high in Emax (ICC=0.89). The AUC value of the COP (0.954) was significantly higher than that of Emax (0.915) (p=0.002) but not significantly different from that of Emax combined with COP (0.957) (p=0.098)...
April 6, 2017: Clinical Imaging
Akshay D Baheti, A Luana Stanescu, Ning Li, Teresa Chapman
BACKGROUND: Hepatoblastoma is the most common hepatic malignancy occurring in the pediatric population. Intratumoral cellular behavior varies, and the small-cell undifferentiated histopathology carries a poorer prognosis than other tissue subtypes. Neoadjuvant chemotherapy is recommended for this tumor subtype prior to surgical resection in most cases. Early identification of tumors with poor prognosis could have a significant clinical impact. Objective The aim of this work was to identify imaging features of small-cell undifferentiated subtype hepatoblastoma that can help distinguish this subtype from more favorable tumors and potentially guide the clinical management...
April 6, 2017: Clinical Imaging
Xiao-Li Song, Gwang-Won Kim, Chung-Man Moon, Gwang-Woo Jeong
PURPOSE: To evaluate the brain activation patterns in response to negative emotion during implicit and explicit memory in patients with schizophrenia. MATERIAL AND METHODS: Fourteen patients with schizophrenia and 14 healthy controls were included in this study. The 3.0T fMRI was obtained while the subjects performed the implicit and explicit retrievals with unpleasant words. RESULTS: The different predominant brain activation areas were observed during the implicit retrieval and explicit with unpleasant words...
April 6, 2017: Clinical Imaging
Misun Hwang, Samuel S Shin, Matthew A Thimm, Anish Ghodadra, Christin L Sylvester, Ken Nischal, Ashok Panigrahy, Giulio Zuccoli
This study speculated that the apparent diffusion coefficient (ADC) of the vitreous humor might be altered in the setting of abusive head trauma (AHT) with retinal hemorrhages (RH). Fourty-four subjects were analyzed (n=20 AHT cases; n=24 controls). There was no statistically significant difference in normalized ADC values between the cases and controls (-0.14 and -0.08 respectively, p=0.46), but analysis of RH by susceptibility weighted imaging (SWI) compared to dilated funduscopic exam demonstrated statistically significant correlation (p=0...
April 3, 2017: Clinical Imaging
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