The feasibility of T2 mapping in the assessment of hepatic steatosis, inflammation, and fibrosis in patients with non-alcoholic fatty liver disease: a preliminary study.

AIM: To determine the feasibility of magnetic resonance imaging T2 mapping in the quantification of liver steatosis in patients with biopsy-proven non-alcoholic fatty liver disease (NAFLD), and to assess the effect of inflammation and fibrosis on T2 values of the liver. MATERIAL AND METHODS: Twenty-three consecutive patients with biopsy-proven NAFLD who underwent T2 mapping between December 2013 and September 2014 were included in this study. All patients underwent fast spin echo multi-echo sequence with eight echoes for T2 measurements. RESULTS: The mean liver T2 value and percentage of histological steatosis was 64.9 ± 7.4 ms and 46.5 ± 27.6%, respectively. There was a good correlation between the liver T2 value and histology-determined steatosis (r = 0.780, p<0.001) and grade of steatosis (rs = 0.779, p<0.001). The mean T2 value in patients with definitive non-alcoholic steatohepatitis (NASH) was significantly higher in comparison with patients without NASH (69 ± 7.37 versus 61.73 ± 5.99 ms, p=0.016). The correlation between T2 value and NAFLD activity score (NAS) was significant (rs = 0.443, p=0.034); however, the correlation disappeared after adjustment for hepatic steatosis and fibrosis (r=0.131, p=0.572). There was a close inverse correlation between T2 value and fibrosis stage after adjusting for hepatic steatosis (r=-0.536, p=0.012). CONCLUSION: T2 mapping can be used for quantification of hepatic steatosis, as there is a close correlation between T2 relaxation values and histology-determined steatosis. Patients with definite NASH have increased T2 values and there is an inverse correlation between the T2 value and fibrosis stage of the liver. T2 mapping in NAFLD may be a useful clinical tool for disease assessment and prognostication.

The prevalence and distribution of the atherosclerotic plaques in the abdominal aorta and its branches.

BACKGROUND: The aim of our study was to determine the existence, distribution, type and burden of the atherosclerotic plaques which are found in the abdominal aorta, its branches and the branching points. MATERIALS AND METHODS: Two hundred and sixty-one patients (117 female, 144 male; mean age 53.34 ± 16.02, range 12-84) who underwent dual-source computed tomography angiography (CTA) were retrospectively analysed. The prevalence and distribution of the plaques in the proximal, middle and distal parts of abdominal aorta and its branches; coeliac trunk, superior and inferior mesenteric arteries, renal arteries, splenic artery and common, external and internal iliac arteries and in the aortic orifices, the type and severity of these plaques and their relations with age and gender were studied. RESULTS: In our study, 69.3% of the patients had atherosclerotic plaques, mostly at the distal part of abdominal aorta. The existence of the plaques increased with age. The types of these plaques were mixed (43%), calcified (24%) and soft (3%). Mixed and calcified plaques were more common in the abdominal aorta and its branches, respectively. All of the arteries except for inferior mesenteric artery mostly had mild plaques. The plaques at the branching points, which were most frequently localised in the aortic bifurcation, were found in the 41.8% of the patients. The plaques in the branches were usually accompanied by atherosclerosis of abdominal aorta. CONCLUSIONS: Dual-source CTA enables mapping of atherosclerotic burden in abdominal arteries. Knowing the localisation, type and severity of the atherosclerotic plaques can be important to predict the clinical results and choose the proper treatment.

Radiological manifestations of abdominopelvic nerve tumours seen in neurofibromatosis type 1.

Neurofibromatosis type 1 (NF1) is the most common of the phakomatoses, which is inherited in an autosomal dominant pattern. Neurofibromas arise from Schwann cells and fibroblasts and plexiform neurofibromas are pathognomonic for NF1, which may arise in any peripheral nerve. The clinical expression of NF1 is extremely variable and gastrointestinal manifestations of NF1 are relatively uncommon. The purpose of this article is to illustrate the abdominal ultrasound, computed tomography, and magnetic resonance imaging findings of abdominopelvic nerve tumours seen in NF1 in both paediatric and adult patients.

Radiotherapy in congenital vulvar lymphangioma circumscriptum.

Congenital lymphangioma circumscriptum (LC) of the vulva is a rare disorder with unknown etiology. Treatment options include ablative approaches such as laser therapy, sclerotherapy, and surgery. Radiotherapy has been shown to be effective in the management of congenital lymphangioma especially in the thoracic and abdominal lesions. In this report, we describe a patient with persistent vulvar LC despite sclerosing therapy and several surgical excisions. She was treated with a course of external radiotherapy and showed a dramatic objective response with relief of all symptoms.

Preoperative evaluation of hilar vessel anatomy with 3-D computerized tomography in living kidney donors.

OBJECTIVES: Digital subtract angiography is the gold standard for anatomic assessment of renal vasculature for living renal donors. However, multidetector-row computerized tomography (MDCT) is less invasive than digital subtract angiography and provides information of kidney stones and other intra-abdominal organs. In this study, preoperative MDCT angiography results were compared with the peroperative findings to evaluate the accuracy of MDCT for the evaluation of renal anatomy. METHODS: From December 2002 to May 2007, all 60 consecutive living kidney donors were evaluated with MDCT angiography preoperatively. We reported the number and origin of renal arteries, presence of early branching arteries, and any intrinsic renal artery disease. Renal venous anatomy was evaluated for the presence of accessory, retroaortic, and circumaortic veins using venous phase axial images. The calyces and ureters were assessed with delayed topograms. The results of the MDCT angiography were compared with the peroperative findings. RESULTS: A total of 67 renal arteries were seen peroperatively in 60 renal units. Preoperative MDCT angiography detected 64 of them. The two arteries not detected by MDCT had diameters less than 3 mm. Anatomic variations were present in nine veins, five of which were detected by CT angiography. Sensitivity of MDCT angiography for arteries and veins was 95% and 93%, respectively. Positive predictive values were 100% for both arteries and veins. CONCLUSION: MDCT angiography offers a less invasive, rapid, and accurate preoperative investigation modality for vascular anatomy in living kidney donors. It also provides sufficient information about extrarenal anatomy important for donor surgery.

Oncogenic activation of the alphaPDGFR defines a domain that negatively regulates receptor dimerization.

The alpha platelet derived growth factor receptor (alphaPDGFR) extracellular Immunoglobulin (Ig) like domains 1-3 contain major determinants for ligand interaction. We now report that a deletion of Ig-like loop 3, but not Ig-like loop 1 or 2, of the alphaPDGFR causes ligand-independent transformation in NIH3T3 cells. Biochemical analyses of alphaPDGFR mutants lacking Ig-like loop 3 indicate that cellular transformation is mediated by ligand-independent activation of the alphaPDGFR tyrosine kinase activity as determined by receptor autophosphorylation both in vivo and in vitro. Moreover, cross-linking analysis of alphaPDGFR mutants expressed ectopically in NIH3T3 cells indicate that deletion within extracellular domain 3 leads to ligand-independent receptor dimerization. All of these findings suggest that the Ig-like loop 3 of the alphaPDGFR contains the major determinants which inhibit receptor dimerization in the quiescent cells and that the ligand binding induces receptor activation by neutralizing the inhibitory effect of this domain.

CT presentation of Wegener's granulomatosis in a child: rapidly progressive changes of pulmonary nodules to cavities.

We present a child with Wegener's granulomatosis who showed lung lesions progressing from nodules to cavities within a 1-month period on CT.

Endovascular treatment of kissing aneurysms at the fenestrated basilar artery. Case report with literature review.

BACKGROUND: Basilar artery fenestrations are most commonly located in the proximal basilar trunk close to the vertebrobasilar junction and may harbor saccular aneurysms. Surgical treatment of such aneurysms has been reported in several cases previously, despite the difficulty of the surgical approach. Endovascular treatment may provide a more convenient treatment alternative in such cases. This case is also interesting in that two discrete aneurysms arise from each limb of the fenestration. CASE REPORT: A 20-year-old man presented with acute subarachnoid hemorrhage. He had two kissing aneurysms at the fenestrated proximal basilar artery as demonstrated by MRA and selective angiography. The two aneurysms were successfully treated with GDCs via the contralateral vertebral arteries. One-year control angiogram showed stable occlusion. CONCLUSION: Aneurysms at the fenestrated basilar artery may be effectively treated with endovascular coil occlusion. The occurrence of multiplicity and the treatment alternatives are discussed, with relevant literature review.

Incidentally detected congenital giant left atrial appendage aneurysm in a child: MRI findings.

Left atrial appendage aneurysms are usually congenital and are very infrequent anomalies of the heart. They are very rarely diagnosed during childhood, with most cases symptomatic between the 2nd and 4th decades of life. Diagnosis is vitally important due to potential life-threatening complications. Surgical excision is the treatment of choice. Surgery reduces the risks of cardiac arrest, respiratory distress, arrhythmia, heart failure, thromboembolism, or rupture. We report the case of a 3-year-old boy with incidental diagnosis of a giant aneurysm of the left atrial appendage that was confirmed with magnetic resonance imaging and treated with surgery.

Multidetector CT of hepatic artery pathologies.

The hepatic artery can be involved by a variety of pathology and diseases.Today MDCT enables high quality imaging of the hepatic artery using axial, MIP and volume rendered images. We illustrate MDCT findings of anatomical variations, aneurysm, dilatation, dissection, arteriovenous fistula, thrombosis and stenosis. Aneurysms can be saccular, fusiform and multiple and may develop due to atherosclerosis, vasculitis, trauma and biopsy. Dilatation of hepatic artery can be seen in portal hypertension, Osler-Weber-Rendu disease and hemangiomatosis. Hepatic artery can be occluded after trauma and transplantation. Dissection develops due to atherosclerosis, Marfan and Ehler Danlos syndromes and during pregnancy. Arteriovenous fistula can be congenital and acquired. We conclude that various hepatic artery pathologies can be confidently diagnosed by MDCT.

Imaging of bladder cancer: update on current approaches for diagnosis.

Imaging plays a mainstay role in evaluation of patients with bladder cancer, especially for diagnosis, local and distant staging and treatment follow up. In this article, we aim to review and to update conventional and functional imaging methods used in clinical management of bladder cancer.

An unusual cause of pelvic hemorrhage: multidetector CT diagnosis of inferior mesenteric vein injury.

Pelvic trauma can lead to uncontrollable bleeding and even death. Although significantly decreased with the application of novel treament modalities and the use of state-of-the-art imaging equipment, pelvic trauma and subsequent bleeding remains to stay as a major source of morbidity and mortality. In this case we present a patient suffering from pelvic bleeding from the inferior mesenteric vein due to sigmoid mesocolon injury. Similar finding has not been reported as an isolated source of pelvic hemorrhage. We also propose that the routine use of reformatted images obtained with multidetector CT scanners in patients with hemoperitoneum may be a highly useful adjunct for the correct identification of the source of hemorrhage.

Non-invasive imaging of aberrant right subclavian artery pathologies and aberrant right vertebral artery.

Here, we review the CT and MR angiography findings of aberrant right subclavian and right vertebral arteries, with emphasis on the differences between these structures. In addition, non-invasive imaging findings of aberrant right subclavian artery pathologies, including arteritis, aneurysm and dissection, are discussed.

Dual energy virtual CT colonoscopy with dual source computed tomography: initial experience.

PURPOSE: To describe the technique of DE MDCT colonoscopy and to assess its feasibility. MATERIALS AND METHODS: 8 patients were scanned with DSCT with a DE scan protocol and dose modulation software. Analysis was performed using dedicated DE software. Prone non-contrast images and DE supine images after contrast injection were obtained. RESULTS: DE colonoscopic images were successfully obtained in 7 patients, but the FOV did not cover all colonic segments in 1 patient, thus resulting in a technical success rate was 87.5 %. Streak artifacts were present in the pelvic region in 2 patients. Virtual unenhanced images and iodine map images were obtained for all patients. In 1 patient a polypoid non-enhancing structure was noted on the iodine map, and conventional colonoscopy revealed impacted stool. Enhancing rectal cancer in 1 patient was correctly shown on the iodine map. Iodine maps helped to differentiate stool fragments/retained fluid by the absence of enhancement when compared to prone CT images. The major advantage of DE colonoscopy was the lack of misregistration. CONCLUSION: DE MDCT colonoscopy is technically feasible and may obviate the need for unenhanced prone images. It may be possible to perform noncathartic DECT colonoscopy. The major limitation is the limited FOV of tube B. The dose should be optimized to reduce streak artifacts in the pelvic region.

Duplicated right coronary artery: multidetector CT angiographic findings.

Multidetector CT is becoming an alternative method for the diagnosis of coronary artery anomalies. We present the multidetector coronary CT angiography findings from a patient with right coronary artery duplication. Two separate right coronary arteries originating from the right aortic sinus were observed. Their anatomical course was well depicted, and atherosclerosis was excluded based on the CT angiography findings.

Unusual presentation of prostate cancer with generalized lymphadenopathy and unilateral leg edema.

Prostate cancer most often metastases to bones and regional lymph nodes. Disseminated metastasis to distant lymph nodes is very rare. We report a case presenting with generalized lymphadenopathy and related left leg edema without any urinary symptoms and finally diagnosed as prostate cancer.

MDCT of inferior mesenteric vein: normal anatomy and pathology.

Multidetector computed tomography (MDCT) is a useful technique for imaging the inferior mesenteric vein. The aim of the present review was to discuss the normal anatomy and the pathologies of the inferior mesenteric vein, including partial or total thrombosis secondary to inflammation (pyophlebitis) and malignancy, occlusion, dilatation and reversed flow, which are rarely encountered. Optimal reconstruction techniques are also discussed. The pathologies of the inferior mesenteric vein can be clearly demonstrated using MDCT using curved-planar reformatted multiplanar reconstruction (MPR) and minimum intensity projection (MIP) images.

Paediatric multidetector CT angiography: spectrum of congenital thoracic vascular anomalies.

Multidetector row CT (MDCT) is a non-invasive and rapid technique used for the evaluation of paediatric vascular diseases as an alternative to conventional angiography. Three-dimensional (3D) images allow excellent display of vascular anomalies that can be used as a vascular road map by surgeons. The aim of this pictorial review is to demonstrate diagnostic MDCT angiographic findings of various congenital thoracic vascular anomalies in paediatric patients. It is important to recognize these anomalies early for proper treatment and follow-up, and also to prevent morbidities and mortalities.