Congenital anomalies of the left brachiocephalic vein detected in adults on computed tomography.

PURPOSE: Anomalous left brachiocephalic vein (BCV) is a rare and less known systemic venous anomaly. We evaluated congenital anomalies of the left BCV in adults detected during computed tomography (CT) examinations. MATERIALS AND METHODS: This retrospective study included 81,425 patients without congenital heart disease who underwent chest CT. We reviewed the recorded reports and CT images for congenital anomalies of the left BCV including aberrant and supernumerary BCVs. The associated congenital aortic anomalies were assessed. RESULTS: Among 73,407 cases at a university hospital, 22 (16 males, 6 females; mean age, 59 years) with aberrant left BCVs were found using keyword research on recorded reports (0.03%). Among 8018 cases at the branch hospital, 5 (4 males, 1 female; mean age, 67 years) with aberrant left BCVs were found using CT image review (0.062%). There were no significant differences in incidences of aberrant left BCV between the two groups. Two cases had double left BCVs. Eleven cases showed high aortic arches. Two cases had the right aortic arch, one case had an incomplete double aortic arch, and one case was associated with coarctation. CONCLUSION: Aberrant left BCV on CT examination in adults was extremely rare. Some cases were associated with aortic arch anomalies.

The Apparent Diffusion Coefficient (ADC) as a Potential Marker of Inflammation Associated with Body Abscesses.

OBJECTIVE: To assess the feasibility of apparent diffusion coefficient analysis in evaluating the inflammatory severity of extracranial abscesses. METHODS: This retrospective study included 23 patients with solitary body abscesses (except those in the brain) who underwent 1.5-T diffusion-weighted magnetic resonance imaging (DWI) at b-values of 0 and 1000 s/mm2. Three types of the Apparent Diffusion Coefficient (ADC) measurements of abscesses were performed: the mean ADC value in region of interest (ROI), volume of interest (VOI), and histogram analysis of the ADC distribution in the VOI. Furthermore, two different areas were used: high-intensity area on b = 0 and b = 1000 s/mm2 images. Subsequently, correlations between ADC data and C-reactive protein (CRP) levels were assessed using Pearson's correlation coefficient (R) analyses. RESULTS: The strongest correlation was observed between the mean ADC value in VOI and CRP level (R = 0.78, P < 0.01), followed by ROI (R = 0.77, P < 0.01) by using the high-intensity area on the b = 0 s/mm2 images. CONCLUSION: The mean ADC value in the ROI encompassing the abscess at a b-value of 0 s/mm2 may be useful to assess the inflammatory activity of an abscess in daily practice.

Partial splenic embolisation using n-butyl cyanoacrylate: intraprocedural evaluation by magnetic resonance imaging.

OBJECTIVES: To evaluate the use of diffusion-weighted imaging (DWI) for estimating infarcted splenic volume during partial splenic embolisation (PSE) using n-butyl cyanoacrylate (NBCA). METHODS: Twenty consecutive patients (57.2 ± 11.7 years) with hypersplenism underwent PSE. Intrasplenic branches were embolised using NBCA via a 2.1-French microcatheter aiming at infarction of 50 to 80 % of total splenic volume. Immediately after PSE, signal intensities (SI) of embolised and non-embolised splenic parenchyma were measured on DWI. Semi-automated volumetry (SAV) on DWI was compared with conventional manual volumetry (MV) on contrast-enhanced CT 1 week after PSE. Platelet counts were recorded before and after PSE. RESULTS: The SI on DWI in the embolised parenchyma decreased significantly (P < 0.01) to 24.7 ± 8.1 % as compared to non-embolised parenchyma. SAV and MV showed a strong correlation (r = 0.913 before PSE, r = 0.935 after PSE, P < 0.01) and significant (P < 0.01) reduction of normal splenic volume was demonstrated on both SAV (71.9 ± 12.4 %) and MV (73.6 ± 9.3 %) after PSE. Based on the initial SAV, three patients (15 %) underwent additional branch embolisation to reach sufficient infarction volume. Platelet counts elevated significantly (522.8 ± 209.1 %, P < 0.01) by 2 weeks after PSE. No serious complication was observed. CONCLUSION: Immediate SI changes on DWI after PSE allowed semi-automated splenic volumetry on site. KEY POINTS: • Partial splenic embolisation (PSE) is an important interventional technique for hypersplenism • Diffusion-weighted MR reveals an immediate decrease in signal in the embolised parenchyma • Such signal reduction permits semi-automated splenic volumetry on site. • This allows precise quantification of the amount of parenchyma infarcted, avoiding additional PSE.