High-Grade Surface Osteosarcoma of the Rib Mimicking a Neurogenic Tumor: Radiologic and Pathologic Findings.

Osteosarcoma commonly occurs in the intramedullary cavity of long bones such as the femur, tibia, and humerus in children and adolescents. Osteosarcoma occurring as a primary tumor in the chest wall is rare. Only a limited number of such cases have been documented in the existing literature. Herein, we present radiologic and pathologic findings of a high-grade surface osteosarcoma of the rib mimicking a neurogenic tumor in a 44-year-old woman.

A Case of Biliary Cast Syndrome with Cholangiocarcinoma-like Lesion in a Patient with No History of Liver Transplantation.

Background and Objectives: Biliary cast syndrome, which was first reported in 1975, is a rare disease that occurs after liver transplantation. The incidence is even lower in patients who have not undergone liver transplantation. This study reports a rare case of biliary cast syndrome with cholangiocarcinoma-like lesions in a patient who did not undergo liver transplantation. Case Report: Herein, we report a case of a 69-year-old man with right upper quadrant pain and elevated levels of alkaline phosphatase and gamma-glutamyl transferase, who had a history of total gastrectomy for gastric cancer and laparoscopic cholecystectomy for acute cholecystitis. Computed tomography (CT) revealed longitudinal bile stones in the extrahepatic and intrahepatic bile ducts and abrupt narrowing of the left main bile duct accompanied by a narrowing of the upstream bile duct in the left lobe of the liver. Based on the CT findings, the removal of the bile stones in the bile duct and additional examinations of the suspected cholangiocarcinoma were performed. The patient's symptoms improved, and examinations for suspected cholangiocarcinoma showed no abnormal findings, and he was discharged one month later. Conclusions: The purpose of this case report is to share a rare case of Biliary Cast Syndrome (BCS) occurring without liver transplantation. Additionally, the report aims to share image findings that mimic cancer in BCS, with the goal of reducing unnecessary repetitive biopsies, minimizing patient discomfort, and decreasing unnecessary costs by aiding in the diagnosis of BCS.

Kikuchi-Fujimoto Disease in the Axilla after COVID-19 Vaccination: A Case Report.

BACKGROUND: Kikuchi-Fujimoto disease (KFD) is a rare, self-limiting inflammatory condition of unknown etiology that is characterized by fever and painful lymphadenopathy. KFD commonly involves the posterior cervical region and very rarely occurs in the axilla. CASE PRESENTATION: We report on a case of KFD that presented 3 weeks after receiving the messenger ribonucleic acid-based coronavirus disease 2019 (COVID-19) vaccine. In this case, we suspected the lesions as COVID-19 vaccination-related lymphadenopathy on the initial ultrasonographic examination. CONCLUSION: Through this case report, we highlight that KFD should be considered in the differential diagnosis of patients with axillary lymphadenopathy who have undergone COVID-19 vaccination, as unusual side effects of COVID-19 vaccination have been increasingly reported in the literature owing to the rapid development of various COVID-19 vaccines during the pandemic period. In addition, we emphasize the importance of clinical suspicion in diagnosing KFD due to the fact that axillary involvement of KFD is extremely rare.

Left-Side Contrast-Injection-Induced Pseudopathologic Vertebral Enhancement in Oncology Patients without Venous Obstruction: A Report of Two Cases.

The appearance of sclerotic bone lesions in contrast-enhanced computed tomography (CT) scans is often a significant concern for the possible presence of metastatic disease, especially in individuals with a known history of cancer. Prior research has demonstrated that in cases where patients suffer from thrombosis in major veins like the superior vena cava or the brachiocephalic vein, vertebral venous congestion can create imaging patterns on CT scans that resemble sclerotic bone metastases. However, instances of such imaging findings in patients without any form of venous obstruction are not commonly reported. In this study, we present cases of pseudopathologic vertebral enhancement observed consistently following left-side contrast injections in cancer patients devoid of venous obstruction. We aim to discuss and propose a potential mechanism for this phenomenon, drawing attention to a less commonly recognized diagnostic consideration in oncological imaging.

Large gastroduodenal artery pseudoaneurysm, arterioportal fistula and portal vein stenosis in chronic pancreatitis treated using combined transarterial embolization and transportal stenting: A case report.

RATIONALE: Chronic pancreatitis is an ongoing fibroinflammatory disease of the pancreas characterized by irreversible damage to the pancreatic parenchyma and ductal system. Besides, chronic pancreatitis can present with a variety of life-threatening complications. PATIENT CONCERNS: The patients visited our hospital due to abdominal pain and anemia, and had chronic pancreatitis as an underlying disease. DIAGNOSES: Computed tomography showed a large gastroduodenal artery pseudoaneurysm, arterioportal vein fistula, and portal vein stenosis. INTERVENTIONS: We would like to report the successful use of the coils, and N-butyl cyanoacrylate glue for the therapeutic embolization of the pseudoaneurysm and fistula between the gastroduodenal artery and the portal vein, and stenting for portal vein stenosis. OUTCOMES: On the day following the endovascular management, the patient reported remission of abdominal pain, and hemoglobin level returned to normal after transfusion. It was confirmed that it was still well maintained in the follow-up examination after 1 month. LESSONS: Although chronic pancreatitis causes many vascular complications, simultaneous occurrence of these lesions is extremely rare. Herein, we share our experience with a unique case of an extrahepatic arterioportal fistula induced by the rupture of gastroduodenal artery pseudoaneurysm with concomitant portal vein stenosis. In these complex cases, combined transarterial embolization and transportal stenting can be helpful.

Transcatheter Arterial Embolization for Spontaneous Hepatic Rupture Associated with HELLP Syndrome: A Case Report.

Background: Spontaneous hepatic rupture associated with the syndrome characterized by hemolysis, elevated liver enzymes, and a low platelet count (HELLP syndrome) is a rare and life-threatening condition, and only a few cases regarding the management of this condition through transcatheter arterial embolization (TAE) have been previously reported. Case summary: Herein, we report a case involving a 35-year-old pregnant woman who presented at 28 weeks of gestation with right upper quadrant pain, hypotension, and elevated levels of liver enzymes. Transabdominal ultrasound revealed fetal death. She required an emergency cesarean section, and hepatic rupture was identified after the fetus had been delivered. Hepatic packing and TAE were performed. The postprocedural course was uneventful, and the patient was discharged 14 days after she had been admitted to our hospital. Conclusions: Spontaneous hepatic rupture associated with HELLP syndrome is a very serious condition that requires prompt and decisive management. The high maternal and fetal mortality rates associated with this condition can be reduced through early accurate diagnosis and adequate management. The findings in the reported case indicate that TAE may be an attractive alternative to surgery for the management of spontaneous hepatic rupture associated with HELLP syndrome.

Prevalence and Clinical Implications of Incidentally Detected Parotid Lesions as Blind Spot on Brain MRI: A Single-Center Experience.

Background and objective: This study was conducted to assess the prevalence and clinical implications of parotid lesions detected incidentally during brain magnetic resonance imaging (MRI) examination. Materials and Methods: Between February 2016 and February 2021, we identified 86 lesions in the brain MRI reports of 84 patients that contained the words "parotid gland" or "PG". Of these, we finally included 49 lesions involving 45 patients following histopathological confirmation. Results: Based on the laboratory, radiological or histopathological findings, the prevalence of incidental parotid lesions was low (1.2%). Among the 45 study patients, 41 (91.1%) had unilateral lesions, and the majority of the lesions were located in the superficial lobe (40/49, 81.6%). The mean size of the parotid lesions was 1.3 cm ± 0.4 cm (range, 0.5 cm-2.8 cm). Of these, 46 parotid lesions (93.9%) were benign, whereas the remaining three lesions were malignant (6.1%). Conclusions: Despite the low prevalence and incidence of malignancy associated with incidental parotid lesions detected on brain MRI, the clinical implications are potentially significant. Therefore, clinical awareness and appropriate imaging work-up of these lesions are important for accurate diagnosis and timely management.

Abdominal CT in patients with arms down positioning: Effect of virtual monoenergetic reconstruction on diagnostic image quality.

PURPOSE: To evaluate effect of virtual monoenergetic reconstruction on contrast-enhanced abdominal CT obtained using a dual-layer detector CT (DLCT) in patients with arms-down positioning, in comparison with conventional 120-kVp image. METHODS: A total of 162 consecutive patients who underwent abdominal CT scans using a DLCT with arms-down positioning were retrospectively enrolled. 120-kVp image and virtual monoenergetic images (VMIs) at 40-100 keV were compared for arm-induced artifact reduction capability and image quality through objective and subjective assessments. Diagnostic performance was compared between VMI with the best quality and 120-kVp image. RESULTS: VMIs at 60-100 keV showed significantly lower (p < 0.001) artifact index than 120-kVp image. Subjective severity of arm-induced streak artifacts was significantly (p < 0.001) lower in VMIs at 70-100 keV than in 120-kVp image. CNRs measured in artifact and reference areas were superior (p < 0.05) in 40-70 keV to those in 120 kVp. Overall image quality was superior (p < 0.05) in 60-90 keV to 120 kVp. 70-keV VMI was chosen as the best image by two independent readers. In ROC analysis of lesion detection in the liver, spleen, and kidneys, the AUC was significantly higher for 70-keV VMI (reader 1, 0.962; p = 0.011; reader 2, 0.981; p = 0.012) than that for 120-kVp image (reader 1, 0.891; reader 2, 0.922). CONCLUSION: The70-keV VMI from DLCT could improve abdominal CT images by reducing streak artifacts and increasing image contrast in patients who could not elevated their arms. The 70-keV VMI showed better diagnostic performance than the conventional 120 kVp image.

Rosai-Dorfman disease with infiltration of IgG4-bearing plasma cells presenting as laryngeal-nasal masses and cervical lymphadenopathy: A case report.

RATIONALE: Rosai-Dorfman disease (RDD) is a rare and self-limiting condition caused by the non-neoplastic proliferation of histiocytes/phagocytes in the sinusoids of lymph nodes and in extranodal tissues. Of the extranodal involvement, laryngeal involvement is extremely rare. Because of its rarity and nonspecific clinicoradiologic features, RDD is often difficult to differentiate from other benign or malignant lymphoproliferative diseases. We present a case of RDD with infiltration of IgG4-bearing plasma cells manifesting laryngeal and nasal masses with cervical lymphadenopathy. PATIENT CONCERNS: A 45-year-old male patient presented with recurrent epistaxis and airway disturbance. DIAGNOSES: On endoscopy, there were submucosal masses in both nasal cavities and both sides of subglottic larynx. On neck CT, there were well-defined, enhancing soft tissue masses in both nasal cavities and both sides of subglottic larynx, resulting in mild airway narrowing. In addition, multiple enlarged lymph nodes showing homogeneous enhancement were noted in both parotid glands and both internal jugular chains. All lesions demonstrated marked FDG-uptake on PET/CT. Therefore, the initial radiologic differential diagnoses included lymphoma and IgG4-related disease. Biopsy was performed on the nasal and laryngeal lesions, and they revealed RDD with infiltration of IgG4-bearing plasma cells. INTERVENTION: The patient underwent surgical resection of the masses in the nasal cavity and larynx to relieve airway narrowing. OUTCOMES: After surgery, airway obstruction was much improved and the patient was asymptomatic. On outpatient follow-up, he exhibited a stable condition and had no dyspnea on exercise. LESSONS: Clinical awareness and suspicion are important for the accurate diagnosis and management of patients with homogeneous masses in the larynx or nasal cavity, even if there is no combined cervical lymphadenopathy.

Clinical experience with distal transradial access for endovascular treatment of various noncoronary interventions in a multicenter study.

BACKGROUND: Transradial access is a well-known alternative to conventional transfemoral access for interventional procedures. Recently, transradial access through the "snuffbox", which lies in the radial dorsal aspect of the hand, has been introduced as a new technique with positional versatility. In this study, we aimed to evaluate the clinical feasibility and safety of distal transradial access for interventional procedures in a retrospective, multicenter study. MATERIAL & METHODS: Distal transradial access was attempted in 46 patients (36 men and 10 women; mean age, 64 years) who underwent 47 consecutive procedures from January 2018 to December 2019. Procedures included chemoembolization (19/47, 40.4%), bronchial artery embolization (7/47, 14.9%), renal intervention (3/47, 6.4%), arteriovenous fistula angioplasty (7/47, 14.9%), subclavian artery stenting (5/47, 10.6%), other embolization (5/47, 10.6%), and uterine artery embolization (1/47, 2.1%). We recorded the success rate of the procedures, complications, and postprocedural hemostasis time during the follow-up period. RESULTS: The technical success of distal transradial access without major complications was 97.9% (46/47). Of the 46 patients, one patient (2.2%) had a minor complication, which was a thrombotic segmental occlusion of the distal radial artery. Of the enrolled patients, only one patient did not complete the transradial access procedure via the snuffbox because the left proximal subclavian artery was occluded and a crossover to conventional transfemoral access was performed. The mean postprocedural hemostasis time was 131.7 minutes (range, 120-360 minutes). CONCLUSION: Distal transradial access can be a valid option for the endovascular treatment of various noncoronary interventions with technical feasibility and safety.

Clinical Feasibility of Reduced Field-of-View Diffusion-Weighted Magnetic Resonance Imaging with Computed Diffusion-Weighted Imaging Technique in Breast Cancer Patients.

BACKGROUND: We evaluated the feasibility of the reduced field-of-view (rFOV) diffusion-weighted imaging (DWI) with computed DWI technique by comparison and analysis of the inter-method agreement among acquired rFOV DWI (rFOVA), rFOV DWI with computed DWI technique (rFOVS), and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) in patients with breast cancer. METHODS: A total of 130 patients with biopsy-proven breast cancers who underwent breast MRI from April 2017 to December 2017 were included in this study. The rFOVS were reformatted by calculation of the apparent diffusion coefficient curve obtained from rFOVA b = 0 s/mm2 and b = 500 s/mm2. Visual assessment of the image quality of rFOVA b = 1000 s/mm2, rFOVS, and DCE MRI was performed using a four-point grading system. Morphologic analyses of the index cancer was performed on rFOVA, rFOVS, and DCE MRI. The signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and contrast of tumor-to-parenchyma (TPC) were calculated. RESULTS: Image quality scores with rFOVA, rFOVS, and DCE MRI were not significantly different (p = 0.357). Lesion analysis of shape, margin, and size of the index cancer also did not show significant differences among the three sequences (p = 0.858, p = 0.242, and p = 0.858, respectively). SNR, CNR, and TPC of DCE MRI were significantly higher than those of rFOVA and rFOVS (p < 0.001, p = 0.001, and p = 0.016, respectively). Significant differences were not found between the SNR, CNR, and TPC of rFOVA and those of rFOVS (p > 0.999, p > 0.999, and p > 0.999, respectively). CONCLUSION: The rFOVA and rFOVS showed nearly equivalent levels of image quality required for morphological analysis of the tumors and for lesion conspicuity compared with DCE MRI.

Feasibility Study of Synthetic Diffusion-Weighted MRI in Patients with Breast Cancer in Comparison with Conventional Diffusion-Weighted MRI.

OBJECTIVE: To investigate the clinical feasibility of synthetic diffusion-weighted imaging (sDWI) at different b-values in patients with breast cancer by assessing the diagnostic image quality and the quantitative measurements compared with conventional diffusion-weighted imaging (cDWI). MATERIALS AND METHODS: Fifty patients with breast cancer were assessed using cDWI at b-values of 800 and 1500 s/mm² (cDWI800 and cDWI1500) and sDWI at b-values of 1000 and 1500 s/mm² (sDWI1000 and sDWI1500). Qualitative analysis (normal glandular tissue suppression, overall image quality, and lesion conspicuity) was performed using a 4-point Likert-scale for all DWI sets and the cancer detection rate (CDR) was calculated. We also evaluated cancer-to-parenchyma contrast ratios for each DWI set in 45 patients with the lesion identified on any of the DWI sets. Statistical comparisons were performed using Friedman test, one-way analysis of variance, and Cochran's Q test. RESULTS: All parameters of qualitative analysis, cancer-to-parenchyma contrast ratios, and CDR increased with increasing b-values, regardless of the type of imaging (synthetic or conventional) (p < 0.001). Additionally, sDWI1500 provided better lesion conspicuity than cDWI1500 (3.52 ± 0.92 vs. 3.39 ± 0.90, p < 0.05). Although cDWI1500 showed better normal glandular tissue suppression and overall image quality than sDWI1500 (3.66 ± 0.78 and 3.73 ± 0.62 vs. 3.32 ± 0.90 and 3.35 ± 0.81, respectively; p < 0.05), there was no significant difference in their CDR (90.0%). Cancer-to-parenchyma contrast ratios were greater in sDWI1500 than in cDWI1500 (0.63 ± 0.17 vs. 0.55 ± 0.18, p < 0.001). CONCLUSION: sDWI1500 can be feasible for evaluating breast cancers in clinical practice. It provides higher tumor conspicuity, better cancer-to-parenchyma contrast ratio, and comparable CDR when compared with cDWI1500.

Preoperative Prophylactic Balloon-Assisted Occlusion of the Internal Iliac Arteries in the Management of Placenta Increta/Percreta.

Background and Objectives: Preoperative prophylactic balloon-assisted occlusion (PBAO) of the internal iliac arteries minimizes blood loss and facilitates surgery performance, through reductions in the rate of uterine perfusion, which allow for better control in hysterectomy performance, with decreased rates of bleeding and surgical complications. We aimed to investigate the maternal and fetal outcomes associated with PBAO use in women with placenta increta or percreta. Material and Methods: The records of 42 consecutive patients with a diagnosis of placenta increta or percreta were retrospectively reviewed. Of 42 patients, 17 patients (40.5%) with placenta increta or percreta underwent cesarean delivery after prophylactic balloon catheter placement in the bilateral internal iliac artery (balloon group). The blood loss volume, transfusion volume, postoperative hemoglobin changes, rates of hysterectomy and hospitalization, and infant Apgar score in this group were compared to those of 25 similar women who underwent cesarean delivery without balloon placement (surgical group). Results: The mean intraoperative blood loss volume in the balloon group (2319 ± 1191 mL, range 1000-4500 mL) was significantly lower than that in the surgical group (4435 ± 1376 mL, range 1500-10,500 mL) (p = 0.037). The mean blood unit volume transfused in the balloon group (2060 ± 1154 mL, range 1200-8000 mL) was significantly lower than that in the surgical group (3840 ± 1464 mL, range 1800-15,200 mL) (p = 0.043). There was no significant difference in the postoperative hemoglobin change, hysterectomy rates, length of hospitalization, or infant Apgar score between the groups. Conclusion: PBAO of the internal iliac artery prior to cesarean delivery in patients with placenta increta or percreta is a safe and minimally invasive technique that reduces the rate of intraoperative blood loss and transfusion requirements.

One-Minute Ultrafast Brain MRI With Full Basic Sequences: Can It Be a Promising Way Forward for Pediatric Neuroimaging?

OBJECTIVE. The long scan time of brain MRI is a major drawback that limits its clinical use for evaluating pediatric patients who are inherently prone to motion and frequently require sedatives. This study investigated the clinical feasibility of a 1-minute ultrafast brain MRI protocol in pediatric patients by assessing its image quality in comparison with that of routine brain MRI. MATERIALS AND METHODS. Twenty-three patients were enrolled who underwent 1-minute ultrafast MRI and routine brain MRI protocols including five essential sequences (T1-weighted imaging, T2-weighted imaging, DWI, FLAIR, and T2*-weighted imaging). Total scan time for the same image contrast levels was 1 minute 11 seconds for ultrafast MRI versus 9 minutes 51 seconds for routine brain MRI. Two readers independently reviewed all images from the two MRI protocols and graded the image quality on a 4-point Likert scale. The Wilcoxon signed rank test was used to compare the readers' ratings; interobserver agreement between the readers was also assessed. RESULTS. Although the mean scores of overall image quality and anatomic delineation in ultrafast brain MR images were significantly lower than those in routine brain MR images, ultrafast brain MRI showed sufficient overall image quality and anatomic delineation with more than 2 points on the 4-point scale. CONCLUSION. The 1-minute ultrafast brain MRI protocol showed at least sufficient image quality compared with routine brain MRI. Therefore, 1-minute ultrafast brain MRI can be a viable first-line neuroimaging study for pediatric patients because of its shorter scan time, absence of radiation hazard, and reduced sedation requirements.

Comprehensive analyses with radiological and biological markers of breast cancer on contrast-enhanced chest CT: a single center experience using dual-layer spectral detector CT.

OBJECTIVES: To evaluate the predictive value of virtual monoenergetic images (VMIs) by assessing tumor conspicuity on dual-layer spectral detector CT (SDCT) and correlate tumor conspicuity on VMI with prognostic biomarkers in patients with breast cancer. METHODS: Sixty-four patients underwent arterial phase and 90-s delayed phase dual-layer SDCT. A retrospective tumor conspicuity analysis of 14 benign tumors and 65 breast cancers was performed using conventional images (CIs) and VMI at 40 keV (VMI40) on arterial and delayed phase scans (CIART, VMI40ART, CIDE, VMI40DE). Mean Hounsfield units (HU) of tumors were measured on VMI40ART and VMI40DE. A receiver operating characteristic (ROC) curve analysis was performed to compare diagnostic accuracy between image sets. Estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki67 levels were evaluated using histopathology. Correlations between VMI analyses and histological characteristics of cancers were analyzed. RESULTS: Cancers on VMI40 had a significantly higher conspicuity score and mean HU than benign tumors (p < 0.001). VMI40DE showed the highest conspicuity for cancers (mean, 3.79) and the greatest area under the ROC curve (0.817; 95% confidence interval 0.745-0.889). VMI40DE yielded significantly higher mean HU for cancers than VMI40ART (p < 0.001). The conspicuity score and mean HU on VMI40ART were significantly higher in cancers with ER negativity, PR negativity, and Ki67 positivity (p < 0.05). CONCLUSIONS: VMI40DE may be useful in the diagnosis of breast cancers due to higher tumor conspicuity and better enhancement than VMI40ART. VMI40ART may be beneficial for the prediction of poor breast cancer prognoses. KEY POINTS: • VMI40 improved conspicuity of breast cancer than CI. • VMI40DEyielded higher diagnostic performance of breast cancer than VMI40ART. • VMI40ARThas an additional benefit in terms of prognosis prediction in patients with breast cancers.

Metabolic and inflammatory links to rotator cuff tear in hand osteoarthritis: A cross sectional study.

OBJECTIVES: To estimate the prevalence and associated factors of rotator cuff tear (RCT) in patients with hand osteoarthritis (HOA). METHODS: Between June 2013 and December 2015, we recruited 1150 participants in rural area of South Korea. Of the 1150 participants, 307 participants with HOA were analyzed. Plain radiography of both hands, magnetic resonance imaging of both shoulders, and serum levels of high-sensitive C-reactive protein (hsCRP) and high-density lipoprotein (HDL) were obtained for all patients. HOA and RCT were diagnosed by clinical and radiologic findings. RESULTS: The prevalence of RCT in patients with HOA (192/307, 62.5%) was higher than that in those without HOA (410/827, 49.5%, p<0.001). Among the 307 patients with HOA, the patients with RCT were older, and had higher hsCRP and lower HDL levels than the patients without RCT. Multiple logistic regression analysis confirmed significant associations of age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02-1.11), serum hsCRP levels ≥0.6mg/L (OR, 1.68; CI, 1.00-2.80), and low HDL levels (male, <50 mg/dL; female, <40 mg/dL) (OR, 1.93; CI, 1.05-3.56) with RCT in patients with HOA. For patients below 60 years old, the prevalence of RCT was 2.8-fold higher in the low HDL group than normal HDL group (p = 0.048). Finally, the prevalence of RCT was 2.6-fold higher in patients with HOA with both elevated hsCRP and low HDL levels compared with those with neither (p<0.05). CONCLUSIONS: Our findings suggest inflammation and metabolic factors were associated with the prevalence of RCT in HOA patients.

Clinical Efficacy of Real-Time Sonoelastography for the Follow-Up of Congenital Sternocleidomastoid Muscle Torticollis.

Purpose: To evaluate the clinical efficacy of real-time sonoelastography (RTS) for the follow-up of congenital muscular torticollis, based on measurements of muscle elasticity. Materials and Methods: Thirty-four infants (23 male, 11 female) with congenital sternocleidomastoid (SCM) muscle torticollis underwent ultrasonography and elastography between November 2012 and December 2014. We evaluated the thickness, morphology (mass-like, fusiform, or overall thickened shape), and echogenicity of the SCM muscle on grayscale images and color patterns (homogeneous blue, mixed green < 50% and ≥ 50%, and green to red) on elastography. Strain ratios were measured using Q-lab software. A clinician classified the degree of neck rotation and side flexion deficits using a 5-point grade system based on angles of neck rotation and side flexion. Correlations between the ultrasonography and clinical findings were evaluated by statistical analysis. Results: Twenty-two infants had right and 12 had left SCM torticollis, respectively. Linear regression analysis showed that involved/contralateral SCM thickness differences, morphology, elasticity color scores, and strain ratios of the affected SCM muscles were significantly correlated with neck rotation and side flexion deficit scores (p < 0.05). The elasticity color score of the affected SCM muscle was the most significant factor. Conclusion: RTS might provide a reliable means for evaluating and monitoring congenital muscular torticollis.

Initial clinical experience of synthetic MRI as a routine neuroimaging protocol in daily practice: A single-center study.

BACKGROUND AND PURPOSE: We investigated the clinical feasibility of synthetic MRI with a 4-min single scan using a 48-channel head coil as a routine neuroimaging protocol in daily practice by assessing its diagnostic image quality. METHODS: We retrospectively reviewed the imaging data of 89 patients who underwent routine brain MRI using synthetic MRI acquisition between February 2017 and April 2017. Image quality assessments were performed by two independent readers on synthetic T1 fluid-attenuated inversion recovery (FLAIR), T2-weighted, T2 FLAIR, and phase-sensitive inversion recovery sequences acquired using multiple-dynamic multiple-echo imaging. Interobserver reliability between the two readers was assessed using kappa (κ) statistics. RESULTS: On a 4-point assessment scale, the overall image quality and anatomical delineation provided by synthetic brain MRI were found to be good with scores of more than 3 points for all sequences except for the T2 FLAIR sequence. The synthetic T2 FLAIR sequence provided sufficient image quality but showed more pronounced artifacts, especially the CSF pulsation artifact and linear hyperintensity along the brain surface. Interobserver agreement for evaluating image quality of all synthetic sequences was good to excellent (κ, 0.61-0.99; P < 0.001). CONCLUSION: Synthetic MRI can be acceptable as a routine clinical neuroimaging protocol with a short scan time. It can be helpful to design customized and flexible neuroimaging protocols for each institution.

Usefulness of Noncontrast-Enhanced Silent Magnetic Resonance Angiography (MRA) for Treated Intracranial Aneurysm Follow-up in Comparison with Time-of-Flight MRA.

BACKGROUND: Flow visualization in time-of-flight magnetic resonance angiography (TOF MRA) is limited for treated intracranial aneurysms owing to magnetic susceptibility and radiofrequency shielding. OBJECTIVE: To assess the clinical usefulness of noncontrast-enhanced magnetic resonance angiography (MRA) using a silent scan (silent MRA) as a follow-up imaging modality in patients with treated intracranial aneurysms. METHODS: A total of 119 patients with 126 treated aneurysms underwent silent MRA and TOF MRA during the same scan session. Two neuroradiologists independently assessed overall image quality and visualization of the treated site using a 5-point Likert scale to compare the 2 image sets. We used receiver operating characteristic (ROC) curve analysis to investigate the diagnostic performance of the 2 MRA methods in evaluating aneurysm occlusion. Interobserver reliability was also assessed using weighted kappa statistics. RESULTS: The overall image quality scores of silent MRA and TOF MRA were 4.04 ± 0.22 and 4.64 ± 0.48, respectively (P < .001), and interobserver agreement was substantial (P < .001). For the treated site, the score of flow visualization on silent MRA was higher than that on TOF MRA, 3.94 ± 0.94 vs 2.59 ± 1.37 (P < .001), with substantial interobserver agreement (P < .001). ROC curve analysis showed that silent MRA was superior to TOF MRA in diagnostic performance (area under the curve [AUC] = 0.962; 95% CI: 0.931-0.982 vs AUC = 0.843; 95% CI: 0.792-0.886; P < .001). CONCLUSION: Silent MRA can be useful to evaluate treated intracranial aneurysms during follow-up without radiation exposure and use of contrast material. It is characterized by higher diagnostic performance and superior visualization for the treated site.

Clinical feasibility and effectiveness of bedside peripherally inserted central catheter using portable digital radiography for patients in an intensive care unit: A single-center experience.

The aim of this study was to evaluate the clinical feasibility and effectiveness of bedside peripherally inserted central catheter (PICC) using portable digital radiography (DR) in intensive care unit (ICU) patients.Sixty-five ICU patients who underwent PICC were enrolled in this study between May 2016 and May 2017. Of these 65 patients, 45 (69.2%) underwent the procedures bedside in ICU using portable DR, and 20 (30.8%) underwent the procedures at the intervention clinic, both performed by a single interventional radiologist. We retrospectively reviewed electronic medical records for clinical presentation, total procedural time, total radiation dose, total patient transfer time, and clinical outcomes. We performed an independent t test to compare the clinical effectiveness between the 2 groups.The technical and clinical success rates were 100% in both groups, and there were no procedure-related complications. The total radiation dose of bedside PICC at ICU was significantly lower than that of conventional PICC at the intervention clinic (557.9 mGy*cm ± 209.2 vs 985.2 mGy*cm ± 547.6, P < .001). The total procedure time was significantly different between the bedside and conventional PICC groups (26.8 minutes ± 3.9 vs 24.1 minutes ± 5.55, P = .028). The average patient transfer time to the intervention clinic was 26.6 minutes ± 9.8.Bedside PICC using portable DR is a safe and effective procedure option to manage ICU patients in daily clinical practice.