Radiology

Change in hepatic hemodynamics assessed by hepatic arterial blood pressure and computed tomography during hepatic angiography with the double balloon technique Abstract Purpose To assess the change in hepatic arterial blood pressure (HABP) and computed tomography during hepatic arteriography (CTHA) using the double balloon technique. Materials and methods Nine patients with hepatocellular carcinoma (HCC) were enrolled. We inserted a 5.2-Fr balloon catheter into the common or proper hepatic artery and a 1.8-Fr microballoon catheter into the lobar or segmental artery feeding the HCC. HABPs were measured with the 1.8-Fr microballoon catheter (usual-HABP), with the 1.8-Fr balloon inflated (B-HABP), and with both the 5.2-Fr and 1.8-Fr balloons inflated (BB-HABP). CTHAs were performed via a 1.8-Fr microcatheter (usual-CTHA), with the 1.8-Fr balloon inflated (B-CTHA selective), with both the 5.2-Fr and 1.8-Fr balloons inflated (BB-CTHA selective), and via the 5.2-Fr catheter with the 1.8-Fr balloon inflated (B-CTHA whole) and with both the 5.2-Fr and 1.8-Fr balloons inflated (BB-CTHA whole). Results In all cases, B-HABP was lower than usual-HABP. There was a decrease in BB-HABP in comparison with B-HABP in cases with occlusion of the proper hepatic artery. The contrast effect of B-CTHA selective increased in four cases. The contrast effect on B-CTHA whole remained in all cases. Conclusion This technique can be useful in decreasing HABP and collateral blood flow from the adjacent hepatic segment.

T2*-weighted MR imaging findings of giant cell tumors of bone: radiological–pathological correlation Abstract Purpose To assess the correlation between T2*-weighted MR imaging and pathological findings of giant cell tumors (GCT) of bone. Methods Of the 33 patients with histopathologically proven GCT of bone, 12 were examined using 1.5-T MR imaging, including T2*-weighted imaging, and were included in this study. The imaging and pathological findings of GCTs were compared between GCTs with and without hypointensity on T2*-weighted images (T2* hypointensity). Results T2* hypointensity was observed in 6 out of 12 (50%) GCTs. Septal formation (83% vs. 17%; p < 0.05) and cystic formation (67% vs. 0%; p < 0.05) on T2-weighted images was significantly more frequent in the GCTs with T2* hypointensity compared with those without T2* hypointensity. Among the six GCTs with T2* hypointensity, a large amount of hemosiderin deposition was pathologically observed in five (83%) cases, whereas small amounts of hemosiderin deposition was seen in one (17%) case. In contrast, among the six GCTs without T2* hypointensity, a small amount of hemosiderin deposition was pathologically observed in all six (100%). Conclusion Half of the GCTs showed T2* hypointensity, which is characteristic of hemosiderin deposition; whereas, the other half did not show T2* hypointensity due to a small amount of hemosiderin deposition.

Distinction between benign and malignant breast masses at breast ultrasound using deep learning method with convolutional neural network Abstract Purpose We aimed to use deep learning with convolutional neural network (CNN) to discriminate between benign and malignant breast mass images from ultrasound. Materials and Methods We retrospectively gathered 480 images of 96 benign masses and 467 images of 144 malignant masses for training data. Deep learning model was constructed using CNN architecture GoogLeNet and analyzed test data: 48 benign masses, 72 malignant masses. Three radiologists interpreted these test data. Sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) were calculated. Results The CNN model and radiologists had a sensitivity of 0.958 and 0.583–0.917, specificity of 0.925 and 0.604–0.771, and accuracy of 0.925 and 0.658–0.792, respectively. The CNN model had equal or better diagnostic performance compared to radiologists (AUC = 0.913 and 0.728–0.845, p = 0.01–0.14). Conclusion Deep learning with CNN shows high diagnostic performance to discriminate between benign and malignant breast masses on ultrasound.

Radiation with concomitant superselective intra-arterial cisplatin infusion for maxillary sinus squamous cell carcinoma Abstract Purpose To assess the efficacy and prognostic factors after superselective intra-arterial chemoradiation (RADPLAT) for maxillary sinus squamous cell carcinoma (MS-SCC). Materials and methods Prognostic significance of age, gender, T and N factors, gross tumor volume of the primary-site (GTV), total cisplatin dosage, and total cisplatin dosage per GTV (CDDP/GTV) for primary-site recurrence-free survival rate (PRFS) were analyzed. RADPLAT was administered to 27 patients. The median follow-up period was 42.1 months. Results The 3-year rates of overall survival and PRFS were 59.2% and 53.9%, respectively. In univariate analysis, age, male, and total cisplatin dosage were significant factors for PRFS. In multivariate analysis, lymph node metastasis was significant factors for PRFS, and gender and total cisplatin dosage weakly influenced PRFS. In acute phase, no patient showed ≥ grade 3 hematologic toxicity, and grade 3 mucositis developed in 5 patients. Late toxicities were recognized in 3 patients (grade 2 phlegmon of the face, grade 3 maxillofacial osteonecrosis, and retinopathy). Twelve patients (44%) experienced recurrences. Of them, 8 patients showed recurrence at the primarysite. Conclusion RADPLAT was effective for MS-SCC, with acceptable toxicity. Total cisplatin dosage is suggested to be important for primary tumor control.

Detectability of the choroid plexus of the third ventricle with magnetic resonance ventriculography Abstract Purpose To clarify the detectability of the choroid plexus of the third ventricle (ChPl3V) with magnetic resonance ventriculography (MRVn) employing a steady-state free precession (SSFP) sequence in comparison to surgical endoscopic movies as a golden standard, as we encountered some clinical cases of total agenesis of corpus callosum (ACC) where we could not recognize the choroid plexus of the third ventricle and found no previous article addressing this problem. Materials and methods This retrospective study included consecutive patients from 2010 to 2016 for whom endoscopic evaluation of the third ventricle was conducted. The anterior portion of the right and left streaks of ChPl3V was evaluated in 8 patients on 16 sites, while the posterior portion of both streaks of ChPl3V was evaluated in 13 patients on 26 sites. Sensitivity of MRVn to visualize ChPl3V with endoscopic movies as the golden standard was calculated. Results Sensitivity of MRVn in visualizing the anterior portion of ChPl3V was 0.813, and that for the posterior portion 0.692. The anterior portion of ChPl3V was visualized in all cases where no tumor contacted the foramen of Monro. Conclusion MRVn visualizes the anterior portion of ChPl3V with significant sensitivity and the posterior portion with lower one.

Changes in tissue gadolinium biodistribution measured in an animal model exposed to four chelating agents Abstract Purpose This study investigated the potential to reduce gadolinium levels in rodents after repetitive IV Gadodiamide administration using several chelating agents. Materials and methods The following six groups of rats were studied. Group 1: Control; Group 2: Gadodiamide only; Group 3: Meso-2,3-Dimercaptosuccinic acid (DMSA) + Gadodiamide; Group 4: N-Acetyl-l-cysteine (NAC) + Gadodiamide; Group 5: Coriandrum sativum extract + Gadodiamide; and Group 6: Deferoxamine + Gadodiamide. Brain, kidney, and blood samples were evaluated via inductively coupled plasma mass spectrometry. The brain was also evaluated histologically. Results Kidney gadolinium levels in Groups 4 and 5 were approximately double that of Group 2 (p = 0.033 for each). There was almost no calcification in rat hippocampus for Group 4 rodents when compared with Groups 2, 3, 5 and 6. Conclusion Our preliminary study shows that excretion to the kidney has a higher propensity in NAC and Coriandrum sativum groups. It may be possible to change the distribution of gadolinium by administrating several agents. NAC may lower Gadodiamide-induced mineralization in rat hippocampus.

Ethanol fixation method for heart and lung imaging in micro-CT Abstract Purpose The soft tissue imaging in micro-CT remains challenging due to its low intrinsic contrast. The aim of this study was to create a simple staining method omitting the usage of contrast agents for ex vivo soft tissue imaging in micro-CT. Materials and methods Hearts and lungs from 30 mice were used. Twenty-seven organs were either fixed in 97% or 50% ethanol solution or in a series of ascending ethanol concentrations. Images were acquired after 72, 168 and 336 h on a custom-built micro-CT machine and compared to scans of three native samples. Results Ethanol provided contrast enhancement in all evaluated fixations. Fixation in 97% ethanol resulted in contrast enhancement after 72 h; however, it caused hardening of the samples. Fixation in 50% ethanol provided contrast enhancement after 336 h, with milder hardening, compared to the 97% ethanol fixation, but the visualization of details was worse. The fixation in a series of ascending ethanol concentrations provided the most satisfactory results; all organs were visualized in great detail without tissue damage. Conclusions Simple ethanol fixation improves the tissue contrast enhancement in micro-CT. The best results can be obtained with fixation of the soft tissue samples in a series of ascending ethanol concentrations.

Monitoring of fatigue in radiologists during prolonged image interpretation using fNIRS Abstract Purpose To determine whether functional near-infrared spectroscopy (fNIRS) allows monitoring fatigue in radiologists during prolonged image interpretation. Materials and methods Nine radiologists participated as subjects in the present study and continuously interpreted medical images and generated reports for cases for more than 4 h under real clinical work conditions. We measured changes in oxygenated hemoglobin concentrations [oxy-Hb] in the prefrontal cortex using 16-channel fNIRS (OEG16ME, Spectratech) every hour during the Stroop task to evaluate fatigue of radiologists and recorded fatigue scale (FS) as a behavior data. Results Two subjects showed a subjective feeling of fatigue and an apparent decrease in brain activity after 4 h, so the experiment was completed in 4 h. The remaining seven subjects continued the experiment up to 5 h. FS decreased with time, and a significant reduction was observed between before and the end of image interpretation. Seven out of nine subjects showed a minimum [oxy-Hb] change at the end of prolonged image interpretation. The mean change of [oxy-Hb] at the end of all nine subjects was significantly less than the maximum during image interpretation. Conclusion fNIRS using the change of [oxy-Hb] may be useful for monitoring fatigue in radiologists during image interpretation.

Cryoablation of renal cell carcinoma for patients with stage 4 or 5 non-dialysis chronic kidney disease Abstract Purpose To evaluate the safety and efficacy of cryoablation for renal cell carcinoma (RCC) in patients with stage 4 or 5 non-dialysis chronic kidney disease (CKD). Materials and methods This retrospective multicenter study included patients with maximum tumor diameter ≤ 4 cm, estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73 m2, in whom cryoablation was performed percutaneously with curative intent between July 2011 and May 2016. Results Of 541 patients who underwent renal tumor cryoablation, 17 (3.1%; 4 women, 13 men; mean age 70.1 ± 10.6 years) with stage 4 or 5 non-dialysis CKD were included in this study. The pre-cryoablation eGFR was 22.5 ± 6.3 ml/min/1.73 m2. The mean tumor diameter was 2.8 ± 0.7 cm. No Grade 3 or higher adverse events occurred post-cryoablation. The eGFR at each time point was significantly lower than that before treatment. One patient required hemodialysis initiation at 21 months post-procedure. None of the patients showed residual RCC at their last follow-up. Conclusion Cryoablation of RCC is safe in patients with stage 4 or 5 non-dialysis CKD and yields treatment results comparable to those in patients without CKD. This treatment could be completed without the early initiation of hemodialysis after the procedure.

Cinematic rendering: a new imaging approach for ulcerative colitis Abstract Purpose Cinematic rendering (CR) is a new technique for visualizing volumetric three-dimensional data. The purpose of this study was to investigate the added value of CR to conventional computed tomography (CT) in the diagnosis and evaluation of ulcerative colitis (UC). Materials and methods We retrospectively evaluated the CT data of 48 patients (33 men, 15 women; mean age, 44.35 years) with a definitive diagnosis of UC. All patients underwent conventional CT and CR, and had colonoscopy results. Two radiologists independently reviewed the conventional CT images first without and then with CR. Then, the imaging value of CR was evaluated by both radiologists together. The readers were blinded to the disease extent. The diagnostic performance of CR for both readers was assessed by receiver-operating characteristic (ROC) curve analysis. Results There were 23 cases of mild to moderate UC and 25 cases of severe UC, which were divided into two groups. Both readers showed improved diagnostic performance with the addition of CR (the area under the ROC curve improved from 0.676 to 0.804, P = 0.0255, and from 0.679 to 0.826, P = 0.0049, for readers 1 and 2, respectively). Full view of the lesion and contrast enhancement was not significantly different between the two groups (P > 0.05). Increased mesenteric vascularity and the comb sign on CR were more clearly observed in the severe group (P < 0.05). Conclusion Adding CR to conventional CT improved the diagnostic performance of evaluating the extent of UC.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com