Diagnostic performance of contrast-enhanced and unenhanced combined pulmonary artery MRI and magnetic resonance venography techniques in the diagnosis of venous thromboembolism.

OBJECTIVE:: We aimed to determine the diagnostic performance of the contrast-enhanced and unenhanced combined pulmonary arterial MRI and magnetic resonance venography techniques in the diagnosis of venous thromboembolism (VTE). METHODS:: 44 patients who underwent CT pulmonary angiography (CTPA) for suspected PE constituted the study population. Patients underwent combined pulmonary and lower extremity MRI, and Doppler ultrasonography within 72 h after CTPA. Combined MRI included two sequences: unenhanced steady-state free precession (SSFP) and contrast-enhanced three-dimensional (3D) gradient echo (GRE). The presence of emboli in pulmonary arteries and thrombi in lower extremity veins on 3D-GRE and SSFP sequences was recorded. RESULTS:: CTPA showed a total of 244 emboli in 33 (75%) patients whereas contrast-enhanced 3D-GRE MRI showed deep vein thrombosis (DVT) in 34 (77%) subjects. Sensitivities for SSFP vs 3D-GRE MRI respectively in PE detection were 87.9 vs 100% on a per-patient basis, and 53.7 vs 73% on a per-embolus basis. Of 34 patients with established DVT, 31 (91%) were detected by Doppler ultrasound and 29 (85%) were detected by SSFP technique respectively. CONCLUSION:: Both contrast-enhanced and unenhanced combined MRI of acute PE and DVT are feasible one-stop-shopping techniques in patients with suspected thromboembolism. ADVANCES IN KNOWLEDGE:: Pulmonary VTE is a common disease with high mortality. Non-invasive techniques withhigh accuracy are required for the assessment of VTE. CT-related radiation and contrast material risks cause concerns. MRI is a radiation-free technique evaluating the vessels with and without contrast. Combined contrast enhancedor unenhanced pulmonary and lower extremity MRI is feasible in patients with suspected thromboembolism.

Unenhanced and Contrast-Enhanced MR Angiography and Perfusion Imaging for Suspected Pulmonary Thromboembolism.

OBJECTIVE: This article discusses the basics of unenhanced MR angiography (MRA) and MR venography (MRV), time-resolved contrast-enhanced (CE) MRA and dynamic first-pass CE perfusion MRI, and unenhanced and CE MRV, in addition to assessing the clinical relevance of these techniques for evaluating patients with suspected pulmonary thromboembolism and deep venous thrombosis. CONCLUSION: Since the 1990s, the efficacy of MRA or MRV and dynamic perfusion MRI for patients with suspected pulmonary thromboembolism and deep venous thrombosis has been evaluated. On the basis of the results of single-center trials, comprehensive MRI protocols, including pulmonary unenhanced and CE MRA, perfusion MRI, and MRV, promise to be safe and time effective for assessing patients with suspected pulmonary thromboembolism, although future multicenter trials are required to assess the real clinical value of MRI.

Environmental asbestos disease: pleural plaque volume measurement with Chest Tomography is there a correlation between pulmonary function?

Objectives: Chest X-ray is correlated with pulmonary function of asbestos related disease. These correlations limited by low specific and sensitive. Computed tomography (CT) more sensitive. There was no adopted for the measurement of CT. Our aim in this study was to determine correlation between pleural plaque (PP) volume and lung function for use improving classification with CT. Methods: The study included 75 patients with environmental asbestos exposure. PP areas measured in patients were divided by the patient lung area to determine PP ratio with CT. Diffusing capacity and six minute walking distance (6MWD) measured and evaluated quality of life. Results:PP identified in 66 (88%) of the patients with CT. PP most frequently noted in the front right quadrant and had an average plaque volume of 7729,17 mm3. Plaque ratio taken as the percentage of the ratio to the lung volume, mean plaque percentage was 0,37±0,45% (0,003-2,3). In 12(18,1%) of the patients, asbestosis not seen with chest X-ray was detected with CT. Conclusions: PP volume and ratios were not statistically significantly correlated with respiratory functions, exercise capacity, cumulative amount of exposure. Patient of asbestos disease total lung capacity was lower, 6MWD distance was shorter and quality of life was poorer. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 336-342).

Inaccurate Citations in Biomedical Journalism: Effect on the Impact Factor of the American Journal of Roentgenology.

OBJECTIVE: The aim of this study is to investigate the frequency of incorrect citations and its effects on the impact factor of a specific biomedical journal: the American Journal of Roentgenology. MATERIALS AND METHODS: The Cited Reference Search function of Thomson Reuters' Web of Science database (formerly the Institute for Scientific Information's Web of Knowledge database) was used to identify erroneous citations. This was done by entering the journal name into the Cited Work field and entering "2011-2012" into the Cited Year(s) field. The errors in any part of the inaccurately cited references (e.g., author names, title, year, volume, issue, and page numbers) were recorded, and the types of errors (i.e., absent, deficient, or mistyped) were analyzed. Erroneous citations were corrected using the Suggest a Correction function of the Web of Science database. The effect of inaccurate citations on the impact factor of the AJR was calculated. RESULTS: Overall, 183 of 1055 citable articles published in 2011-2012 were inaccurately cited 423 times (mean [± SD], 2.31 ± 4.67 times; range, 1-44 times). Of these 183 articles, 110 (60.1%) were web-only articles and 44 (24.0%) were print articles. The most commonly identified errors were page number errors (44.8%) and misspelling of an author's name (20.2%). Incorrect citations adversely affected the impact factor of the AJR by 0.065 in 2012 and by 0.123 in 2013. CONCLUSION: Inaccurate citations are not infrequent in biomedical journals, yet they can be detected and corrected using the Web of Science database. Although the accuracy of references is primarily the responsibility of authors, the journal editorial office should also define a periodic inaccurate citation check task and correct erroneous citations to reclaim unnecessarily lost credit.

Diffusion-weighted MRI of pulmonary lesions: Comparison of apparent diffusion coefficient and lesion-to-spinal cord signal intensity ratio in lesion characterization.

PURPOSE: To evaluate the diagnostic performance of minimum apparent diffusion coefficient (ADCmin ) and lesion-to-spinal cord signal intensity ratio (LSR) in the differentiation of benign and malignant pulmonary lesions. MATERIALS AND METHODS: Forty-seven patients (36 men, 11 women; range, 17-81 years) with 62 pulmonary lesions underwent magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) performed using a 1.5T scanner during free-breathing using b 600 s/mm2 . The ADCmin values and LSR were calculated. A receiver operating characteristic (ROC) curve analysis was performed to detect the threshold value of the ADCmin and LSR values for discrimination between benign and malignant pulmonary lesions. RESULTS: There were 42 malignant (33 primary tumors, 9 metastases) and 20 benign lesions. The mean ADCmin ± standard deviations (×10-3 mm2 /s) were 1.45 ± 0.33 for malignant tumors, and 2.4 ± 0.69 for benign lesions (P < 0.001). The mean LSR ± standard deviations for lung cancer was 1.24 ± 0.78, and for benign lesions was 0.55 ± 0.57 (P < 0.001). The area under the ROC curve for ADCmin (0.931; 95% confidence interval [CI]: 0.868-0.993) was greater than that for LSR (0.801; 95% CI: 0.675-0.926) (P = 0.029). For benign/malignant discrimination, the ROC curve showed threshold value of ADCmin to be 1.78 × 10-3 mm2 /s and that of LSR to be 0.86. Using these cutoff values, accuracy of ADCmin and LSR were 89%, 74%, respectively (P = 0.383). CONCLUSION: Being a contrast-free and radiation-free technique, DWI allows discrimination of benign and malignant lung lesions. The ADCmin value performed marginally better than LSR values in distinction of benign and malignant lesions. LEVEL OF EVIDENCE: 1 J. Magn. Reson. Imaging 2017;45:845-854.

Evaluation of Free Breathing Versus Breath Hold Diffusion Weighted Imaging in Terms Apparent Diffusion Coefficient (ADC) and Signal-to-Noise Ratio (SNR) Values for Solid Abdominal Organs.

BACKGROUND: Our aim was to compare the apparent diffusion coefficient (ADC) values of normal abdominal parenchymal organs and signal-to-noise ratio (SNR) measurements in the same patients with breath hold (BH) and free breathing (FB) diffusion weighted imaging (DWI). MATERIAL/METHODS: Forty-eight patients underwent both BH and FB DWI. Spherical region of interest (ROI) was placed on the right hepatic lobe, spleen, pancreas, and renal cortices. ADC values were calculated for each organ on each sequence using an automated software. Image noise, defined as the standard deviation (SD) of the signal intensities in the most artifact-free area of the image background was measured by placing the largest possible ROI on either the left or the right side of the body outside the object in the recorded field of view. SNR was calculated using the formula: SNR=signal intensity (SI)(organ)/standard deviation (SD)(noise). RESULTS: There were no statistically significant differences in ADC values of the abdominal organs between BH and FB DWI sequences (p>0.05). There were statistically significant differences between SNR values of organs on BH and FB DWIs. SNRs were found to be better on FB DWI than BH DWI (p<0.001). CONCLUSIONS: Free breathing DWI technique reduces image noise and increases SNR for abdominal examinations. Free breathing technique is therefore preferable to BH DWI in the evaluation of abdominal organs by DWI.

Emphysematous aortitis leading to esophagopleural fistula.

Emphysematous aortitis is a form of septic aortitis. It is a rare disease with a high mortality rate, necessitating prompt diagnosis and aggressive treatment. We present the computed tomography features of emphysematous aortitis leading to esophageal rupture and esophageal-pleural fistula in a 76-year-old female with rheumatoid arthritis.

Perirenal Involvement of Mantle Cell Lymphoma: Imaging Features.

Perirenal lymphoma is a rare disease and accounts for less than 10% of all malignant lymphomas. Mantle cell lymphoma (MCL) is the rarest but 1 of the most aggressive non-Hodgkin's lymphoma subtype. The perirenal involvement of MCL has not been reported previously. A 69-year-old male, who had been diagnosed as having MCL 1 year ago, presented with recent-onset right back pain. Herein we present the key imaging findings of perirenal soft tissue manifestation of MCL.

CT evaluation of medial clavicular epiphysis as a method of bone age determination in adolescents and young adults.

PURPOSE: We aimed to investigate the use of computed tomography (CT) staging of the medial clavicular epiphysis ossification in forensic bone age determination, and find a CT criterion to determine whether an individual is adult or not. METHODS: Chest CT and pulmonary CT angiography exams of 354 patients between 10 and 30 years of age (mean, 21.4 years) were retrospectively evaluated for epiphyseal ossification phase of the bilateral medial clavicles (708 clavicles) and compared with the sex and chronologic age of the individuals. The ossification phase of the medial clavicular epiphyses was classified from stage I to stage V using a modified staging system. RESULTS: Epiphyseal ossification center appeared from 11 to 21 years of age. Partial fusion occurred between 16 and 23 years of age. Complete fusion was first achieved at the ages of 18 and 19 years for male and female individuals, respectively. The probability of an individual being ≥18 years old was 70.8% in stage III A and 100% in stages III B, IV, and V in females and males. CONCLUSION: CT evaluation of the medial clavicular epiphysis is helpful in forensic age determination and stage III B can be used as a criterion to make the prediction that an individual is older than 18 years.

Pylephlebitis Complicating Acute Appendicitis: Prompt Diagnosis with Contrast-Enhanced Computed Tomography.

BACKGROUND: Pylephlebitis, a rare complication of abdominal infections, is a septic thrombophlebitis of the portal venous system with high rates of morbidity and mortality. CASE REPORT: We present a case of pylephlebitis complicating acute appendicitis and report the utility of a computed tomography scan in the diagnosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The prompt diagnosis and appropriate treatment of pylephlebitis are crucial to reduce morbidity and mortality, but clinical presentation is often nonspecific. A computed tomography scan is instrumental in the early diagnosis of pylephlebitis because it readily reveals the thrombus in the mesenteric or portal vein in the setting of acute appendicitis. Early and aggressive treatment with broad-spectrum antibiotics is necessary, and anticoagulation therapy can also be used to prevent bowel ischemia.

Association of real-time sonoelastography findings with clinical parameters in lateral epicondylitis.

The objective of this study was to investigate the role of real-time sonoelastography (RTSE) in patients with lateral epicondylitis (LE) and whether it is associated with clinical parameters. Seventeen patients with unilateral LE were enrolled in the study. The healthy elbows of the participants constituted the control group. Using B-mode ultrasound, color Doppler ultrasound, and RTSE, we prospectively examined 34 common extensor tendon elbows of 17 patients. Both color scales and strain ratio were used for evaluating RTSE images. Two radiologists evaluated the RTSE images separately. Elbow pain was scored on a 100-mm visual analog scale (VAS). Symptom duration and the presence of nocturnal pain were questioned. Quick disabilities of arm shoulder and hand (DASH) Questionnaire was applied to assess the pain, function, and disability. Nottingham health profile (NHP) was used to determine and quantify perceived health problems. Both color scales and strain ratios of the affected tendon portions were significantly different from that of healthy tendons (p < 0.001). There was no significant association between NHP, VAS, Quick DASH scores, and color scales and strain ratio. Strain ratio of the medial portion of the affected tendon was significantly correlated with symptom duration (rho = -0.61 p = 0.010) and nocturnal pain (rho = 0.522 p = 0.031). Interobserver agreement was substantial for color scales (κ = 0.74, p = 0.001) and strain ratio (ICC = 0.61, p = 0.031). RTSE may facilitate differentiation between healthy and affected elbows as a feasible and practical supplementary method with substantial interobserver agreement. RTSE was superior to B-mode ultrasound and color Doppler ultrasound in discriminating tendons with LE. Strain ratio of the medial portion of the tendon is associated moderately with nocturnal pain and symptom duration. No other associations were present between RTSE findings and clinical or functional parameters.

Inflammatory Myofibroblastic Tumor of the Lung: Unusual Imaging Findings of Three Cases.

BACKGROUND: Inflammatory myofibroblastic tumor (IMT), also known as inflammatory pseudotumor, is a benign disorder composed of fibrous tissues, myofibroblasts and inflammatory cell proliferation with obscure etiology. Although it is the most common lung tumor in children, it is seen rarely in adults constituting less than 1% of adult lung tumors. CASE REPORTS: In this report, we present different and rare CT manifestations of three adult patients with lung IMT. CONCLUSIONS: In conclusion, IMT is a rare lung tumor in adults and may simulate malignancy. It should be considered in the differential diagnosis when a large mass with lobulated contour or harboring coarse calcification is observed.

Correlation of diffusion MRI with the Ki-67 index in non-small cell lung cancer.

BACKGROUND: The primary objective of the study was to evaluate the association between the minimum apparent diffusion coefficient (ADCmin) and Ki-67, an index for cellular proliferation, in non-small cell lung cancers. Also, we aimed to assess whether ADCmin values differ between tumour subtypes and tissue sampling method. METHODS: The patients who had diffusion weighted magnetic resonance imaging (DW-MRI) were enrolled retrospectively. The correlation between ADCmin and the Ki-67 index was evaluated. RESULTS: Ninety three patients, with a mean age 65 ± 11 years, with histopathologically proven adenocarcinoma and squamous cell carcinoma of the lungs and had technically successful DW-MRI were included in the study. The numbers of tumour subtypes were 47 for adenocarcinoma and 46 for squamous cell carcinoma. There was a good negative correlation between ADCmin values and the Ki-67 proliferation index (r = -0.837, p < 0.001). The mean ADCmin value was higher and the mean Ki-67 index was lower in adenocarcinomas compared to squamous cell carcinoma (p < 0.0001). There was no statistical difference between tissue sampling methods. CONCLUSIONS: Because ADCmin shows a good but negative correlation with Ki-67 index, it provides an opportunity to evaluate tumours and their aggressiveness and may be helpful in the differentiation of subtypes non-invasively.