Current Medical Imaging - Volume 18, Issue 11, 2022

Objectives: Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) has been recognised in recent years, and there is extensive ongoing research. Although the exact mechanism and cause are still unclear, we now know that the disease is more associated with textured implants. To the best of our knowledge, no previous studies investigating the radiological differential of various implants have been conducted. In this essay, we aimed to demonstrate dicriminating in vitro and in vivo imaging features of variuos types of breast implant devices using mammography, ultrasound, and Magnetic Resonance Imaging (MRI). Methods: Five different implant devices from various manufacturers with various surface textures, including smooth, micro-textured, regular macro-textured, lightweight macro-textured, and polyurethane- coated were used. In vitro mammography was performed with a digital mammogram (Amulet Innovality, Fuji, Japan), and in vitro and in vivo sonography were performed with Esaote MyLab9 using a 7.5 MHz linear probe. In vitro MRI was performed with a 1.5T magnet (Symphony TIM upgrade and Aera, Siemens Healthcare, Erlangen, Germany) with a 7-channel breast coil (Sense coil, Innova, Germany). MRI studies included fat sat T2 weighted sequences (T2WS), non-fat sat T2WS, and silicone only sequences. Results: Each imaging technique had different contributions to dealing with this challenge. Mammography and MRI were limited to identifying the capsule’s double bands. We could only differentiate the lightweight macro-textured implant on the mammogram as the borosilicate microspheres were represented by tiny, round lucencies within the gel. Ultrasound imaging with the proper technique was very helpful in identifying the surface. The inner capsule (implant shell) was identified as parallel double echogenic bands on the in vitro sonogram. Bands of the smooth implant were better delineated compared to the textured implants. The double echogenic bands of the polyurethane-coated implant were not even identified individually. The reverberation artifact caused by the smooth implant was the main discriminating in vivo sonographic feature of smooth implants. The hyperintense polyurethane-coated capsule was identified on fat-saturated T2WS and non-fat-saturated T2WS via in vitro MRI. The tiny hypointense microspheres of the lightweight implant were also identified on the silicone-only sequence of the in vitro MRI. Conclusion: In this study, we have shown that breast implant material and type may differ with the help of in vitro and in vivo imaging characteristics on different radiological modalities. These different imaging features could be used for recognising and labelling the implant type, especially macrotextured implants that are reported to be more associated with breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) compared to other types. We believe evaluating these imaging characteristics during daily practice will help radiologists become aware of the implant type and possible complications or diseases associated with that type.

Information-based image processing and computer vision methods are utilized in several healthcare organizations to diagnose diseases. The irregularities in the visual system are identified over fundus images with a fundus camera. Among ophthalmology diseases, glaucoma is the most common case leading to neurodegenerative illness. The unsuitable fluid pressure inside the eye within the visual system is described as the major cause of those diseases. Glaucoma has no symptoms in the early stages, and if it is not treated, it may result in total blindness. Diagnosing glaucoma at an early stage may prevent permanent blindness. Manual inspection of the human eye may be a solution, but it depends on the skills of the individuals involved. The diagnosis of glaucoma by applying a consolidation of computer vision, artificial intelligence, and image processing can aid in the prevention and detection of those diseases. In this review article, we aim to introduce numerous approaches based on peripapillary atrophy segmentation and classification that can detect these diseases, as well as details regarding the publicly available image benchmarks, datasets, and measurement of performance. The review article highlights the research carried out on numerous available study models that objectively diagnose glaucoma via peripapillary atrophy from the lowest level of feature extraction to the current direction based on deep learning. The advantages and disadvantages of each method are addressed in detail, and tabular descriptions are included to highlight the results of each category. Moreover, the frameworks of each approach and fundus image datasets are provided. Our study would help in providing possible future work directions to diagnose glaucoma.

Radiology plays a key role in the diagnosis of arthritis. We herein suggest an algorithmic approach to diagnosing arthritis. First, the number of joint involvements is reviewed. Monoarticular arthritis includes septic arthritis, pigmented villonodular synovitis, and synovial chondromatosis. Second, polyarticular arthritis can be categorized by its characteristics: erosive, productive, and mixed. Erosive disease includes rheumatoid arthritis, hemophilia, and amyloidosis, while productive disease includes osteoarthritis and hemochromatosis. Third, mixed diseases are subcategorized by symmetricity. Ankylosing spondylitis and inflammatory bowel disease related arthritis affect joints symmetrically, while psoriatic arthritis, reactive arthritis, and crystalline arthropathy are asymmetric. Adjacent soft tissue density, periostitis, and bone density are ancillary findings that can be used as additional differential diagnostic clues. The final step in identifying the type of arthritis is to check whether the location is a site frequently affected by one particular disease over another. This systematic approach would be helpful for radiologists in diagnosing arthritis.

Background: Dual-Energy Computed Tomography (DECT) enables the direct measurement of iodine accumulation in the extracellular space. Objective: To compare measures of liver fibrosis and function with Extracellular Volume (ECV) from iodine/water images using DECT. Methods: Data was obtained from 119 consecutive patients who underwent abdominal DECT. A region of interest was set in the right lobe of the liver, pancreas, spleen, and aorta on iodine density images. ECV was calculated using the following formula: ECV = (1 − hematocrit) × [iodine concentration in the liver (or pancreas, spleen) / iodine concentration in the aorta]. The severity of liver fibrosis was estimated using the aminotransferase/platelet ratio index (APRI) and the Fibrosis-4 (FIB-4) index. Liver function was assessed by the Child-Pugh classification and albumin-bilirubin (ALBI) grade. Data were analyzed by the Spearman rank correlation coefficient, one-way analysis of variance, and post hoc analysis. Results: The correlation between ECV and fibrosis indices (APRI and FIB-4) was only significant, with a weak magnitude for liver ECV quantification at the equilibrium phase (r=0.25 and r=0.20, respectively). The correlations between liver function index and ECV quantification were more robust than with fibrosis index. The highest correlations (r=0.50) were found between ALBI grade and liver ECV at the equilibrium phase. Liver ECV values at the equilibrium phase had a significant difference between ALBI grade 1 vs. 2 and grade 1 vs. 3. Conclusion: Liver ECV quantification by DECT is more suitable for evaluating liver function than liver fibrosis severity.

Background: Prognostic evaluation for Hepatocellular Carcinoma (HCC) after Transcatheter Arterial Chemoembolization (TACE) using Drug-Eluting Beads (DEBs) is essential for guiding the personalized treatment and follow-up strategy. Apparent Diffusion Coefficient (ADC) has been reported as a biomarker in conventional TACE. Objective: This study aimed to evaluate the diagnostic value of ADCbaseline, ADC change, and ADCratio in predicting the early objective response for HCC after DEB-TACE. Methods: This prospective single-center study included 32 consecutive patients undergoing dynamic contrast-enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging before and 1 month after DEB-TACE. After DEB-TACE, patients were grouped based on the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria into responders (complete response [CR], partial response [PR]) and nonresponders (stable disease [SD], progressive disease [PD]). The Mann– Whitney U test and receiver operating characteristic (ROC) curves were performed to assess the statistical differences in ADCbaseline, ADC change, and ADCratio between responders and nonresponders. Results: At post-DEB-TACE follow-up MRI, 62.5% (n = 20, 11 CRs, and 9 PRs) of patients showed objective response, and 37.5% (n = 12, 7 SDs, and 5 PDs) did not respond to chemoembolization. Nonresponders had a significantly higher ADCbaseline value than responders (p < 0.001). The ROC for identifying the response to chemoembolization demonstrated that the threshold ADCbaseline value of 0.920 × 10⁻³ mm²/s had 100% sensitivity and 70% specificity. The ADC change and ADCratio of responders were higher than that of nonresponders (p < 0.001). Conclusion: ADCbaseline, ADC change, and ADCratio may be utilized as a noninvasive biomarker for predicting the early response of HCC to DEB-TACE.

Background: Hounsfield Units (HU) values derived from Computerized Tomography (CT) have been used in the diagnosis of osteoporosis in the lumbar spine. Objective: This study aimed to identify anatomical dimensions of lumbar vertebrae on CT images, which were different between older normal, osteopenic, and osteoporotic subjects. Methods: This prospective pilot study enrolled 79 older adults. Based on CT measurements of lumbar vertebrae in HU, participants were classified into three groups: normal (HU > 109), osteopenia (HU: 94-108), and osteoporosis (HU < 93). Altogether, 42 anatomical variables of lumbar vertebrae, L2, L3, L4, and L5, were measured in each participant by CT, including 24 parameters measurable by MRI or plain X-ray and 18 parameters measurable by MRI only. Results: Among the morphological measurements also measurable by MRI and plain X-ray, the length upper curve, 50% and 75% of L5, length upper with the cortex of L4, length center of the cortex of L3, as well as width upper curve 75% of L2, were significantly different between the three groups (p= 0.008, 0.007, 0.035, 0.036, and 0.003 respectively). Among the morphological measurements also measurable by MRI, only the width upper cortex 75% of L5 and the width lower cortex 25% of L3, were significantly different between the three groups (p= 0.031 and 0.020, respectively). Conclusion: Seven CT morphological measurements may be used as “reference standard” CT measurements for preliminarily diagnosing osteoporosis and osteopenia in older adults.

Introduction: Cervical cancer is a high incidence of cancer in women and cervical precancerous screening plays an important role in reducing the mortality rate. Methods: In this study, we proposed a multichannel feature extraction method based on the probability distribution features of the Acetowhite (AW) region to identify cervical precancerous lesions, with the overarching goal to improve the accuracy of cervical precancerous screening. A k-means clustering algorithm was first used to extract the cervical region images from the original colposcopy images. We then used a deep learning model called DeepLab V3+ to segment the AW region of the cervical image after the acetic acid experiment, from which the probability distribution map of the AW region after segmentation was obtained. This probability distribution map was fed into a neural network classification model for multichannel feature extraction, which resulted in the final classification performance. Results: Results of the experimental evaluation showed that the proposed method achieved an average accuracy of 87.7%, an average sensitivity of 89.3%, and an average specificity of 85.6%. Compared with the methods that did not add segmented probability features, the proposed method increased the average accuracy rate, sensitivity, and specificity by 8.3%, 8%, and 8.4%, respectively. Conclusion: Overall, the proposed method holds great promise for enhancing the screening of cervical precancerous lesions in the clinic by providing the physician with more reliable screening results that might reduce their workload.

Objective: During COVID-19 vaccine development studies, vaccines' efficacy and safety profiles should be carefully investigated. Only a few studies have shown that the COVID-19 vaccine can cause axillary lymphadenopathy on the injection arm. This study aimed to investigate the incidence of axillary lymphadenopathy and imaging findings using B-mode and Doppler ultrasonography (US) examinations in volunteers who had recently been vaccinated against COVID-19. Methods: The ipsilateral and contralateral axillae of 101 volunteers who received the COVID-19 vaccine were evaluated using B-mode and Doppler US examinations. The volunteers were asked when and to which arm the vaccine had been applied, and the type and dose of the vaccine were recorded. It was also questioned whether the individual experienced any side effects after vaccination, such as pain, tenderness, fever, and redness at the injection site. In addition, the demographic data of the participants, such as age and gender, were recorded. Results: The B-mode US examinations revealed that the long- and short-axis diameters, size, cortical thickness, and asymmetric cortical thickening of the left axillary lymph nodes were significantly higher compared to the right side in individuals having received the CoronaVac vaccine (p<0.05). When the individuals were evaluated separately according to gender, the frequency of cortical thickness and asymmetric cortical thickening in the left axillary lymph nodes was higher than on the right side in both males and females (p=0.011). Conclusion: It should be kept in mind that ipsilateral reactive lymphadenopathy may develop after the COVID-19 vaccine. This knowledge can prevent unnecessary axillary lymph node biopsies.

Purpose: Intrahepatic Portosystemic Shunts (PSSs) draining to the Inferior Vena Cava (IVC) via the right adrenal vein has been reported as very rare, and all the patients who have been recorded have had hepatic encephalopathy. Here, we present a patient with intrahepatic PSS via the right adrenal vein diagnosed incidentally without encephalopathy. Case Presentation: A 51-year-old patient, who was diagnosed with chronic liver parenchyma disease and a suspecting nodule on the ultrasound was examined by Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). A 4 cm in diameter Hepatocellular Carcinoma (HCC) was detected. In addition to HCC, an abnormal shunt between the right posterior portal vein and the IVC via the right adrenal vein was also detected. Results: To the best of our knowledge, this is the first case with intrahepatic PSS via the right adrenal vein diagnosed incidentally in the absence of encephalopathy and the fourth case with this abnormal shunt in English literature. Conclusion: Intrahepatic PSS via the right adrenal vein is rare. It may be asymptomatic at the time of diagnosis but has the potential to cause various problems, later on, especially hepatic encephalopathy. The radiologist must be aware of this abnormal shunt.

Introduction: Cystic lesions protruding into surrounding anatomical structures may decrease quality of life. Case Presentation: In our case, the cyst was located periarticularly which indicated a potential need for open surgery. We used ultrasound-based minimally invasive arthroscopy technique. A 39-year-oldwoman’s ultrasonographic examination revealed delamination of the acetabular labrum and periarticular cyst located extra-articularly, compressing the iliopsoas muscle. The ultrasound-guided complete removal of the cyst was performed using a shaver blade placed into its lumen through the skin incision. The acetabular labral tear was treated with a classic arthroscopy procedure. 5 weeks after the surgery, the patient reported no pain and no functional impairment was detected. Conclusion: A well-known ultrasound diagnostic technique can save patients from more invasive procedures and can be beneficial for the surgeons.

Purpose: Most common publications are related to COVID-19 diagnosis in hematological malignancy patients. However, here we report a case involving a patient diagnosed with B-cell lymphoma while undergoing treatment for COVID128;19, including the changes in major clinical symptoms and medical examinations, then explain the probable causes of the case. Case Presentation: A 74-year-old woman with a previous history of oesophageal cancer was admitted to the hospital after having cough and sputum for 15 days. Despite the COVID-19 symptoms, this patient did not have a fever at the time of the onset. Results of routine blood tests were normal at first but then declined with persistent fever, and A whole-body C.T. examination ruled out the possibility of tumor-metastasis–related fever. This patient had no hepatosplenomegaly or regional lymphadenopathy, and there was no concrete evidence of haemophagocytic lymphohistiocytosis or lymphoma until bone marrow biopsy results confirmed the latter. Conclusion: We describe an uncommon case of COVID-19 who was finally diagnosed with B-cell lymphoma. An awareness of persistent fever and declined routine blood tests caused by hematological malignancies instead of COVID-19 itself can aid in providing appropriate guidelines for management and treatment.

Purpose: We aimed to present a case who developed intestinal ischemia and associated perforation and abscess due to Superior Mesenteric Vein (SMV) thrombosis caused by post-COVID-19 syndrome and discuss the preoperative Computed Tomography (CT) imaging findings used in diagnosis. Case Presentation: A 58-year-old patient presented to our clinic with a complaint of acute abdominal pain. His CT examination revealed thrombosis in SMV, congestion in the mesenteric venous structures, contamination in the mesentery, and thickening and dilatation of the jejunal loops due to ischemia. The patient had a history of acute COVID-19 infection. He had typical COVID-19 pneumonia findings (peripheral ground-glass opacities in both lung parenchyma predominantly in the lower lobe) on the thorax CT at that time. He was followed up with anticoagulant therapy. During his follow-up, a thoracic and abdominal CT was performed due to recurrent acute abdominal findings. On thorax CT, there was a web-like filling defect consistent with pulmonary embolism, traction bronchiectasis consistent with late findings of COVID-19 pneumonia, and poorly circumscribed subpleural ground glass opacities. On abdominal CT, in addition to mesenteric ischemia findings, loss of wall integrity was observed in the jejunal loops due to perforation and collection areas containing air consistent with an abscess. He was treated with small bowel resection and abscess drainage. Conclusion: Patients with acute COVID-19 infection should be followed up for the early diagnosis of serious symptoms that may develop due to post-COVID-19 syndrome, and contrast-enhanced CT should be the imaging method of choice to detect possible mesenteric vascular thrombosis in patients with acute abdominal symptoms.

Background: Inferior Vena Cava (IVC) agenesis, ectopic ureterocele, and ureteral duplication are very rare congenital anomalies. Case Presentation: A-25-year-old female patient was referred with right flank pain, chills and dysuria. Laboratory tests and CT showed findings consistent with acute pyelonephritis. The medical history revealed only frequent urinary tract infections and Factor V Leiden mutation. The patient was treated with antibiotherapy. CT examination demonstrated IVC Agenesis (IVCA). Urogenital anomalies such as vaginal ectopic ureterocele, ureteral duplication and septate uterine anomaly were also present. Conclusion: We report the first occurrence of IVC agenesis associated with multiple urogenital anomalies in the literature.

Background: Transarterial chemoembolization (TACE) is a globally recognised treatment method for hepatic tumors, especially unresectable hepatocellular carcinoma (HCC). Although the technique is relatively safe, it may cause serious complications, such as liver abscess, liver failure, and non-target embolization. Here, the case of a rare complication of TACE is presented. Case Presentation: A-55-year-old male patient was referred to the interventional radiology department for surgically unresectable HCC. CT scan showed a heterogeneously enhancing lesion with capsular enhancement consistent with HCC. On MRI examination, a central necrotic part was seen within the lesion, and TACE was performed. At the end of the TACE, a pseudoaneurysm of the hepatic artery was detected, which was successfully embolized with pushable micro-coils. Conclusion: To the best of our knowledge, very few cases of pseudoaneurysm of the hepatic artery have been described in the literature, and in those cases, the cause has been thought to be guidewire manipulation. In contrast, in the current case, it was thought that it might occur due to central necrosis and central perfusion insufficiency of the lesion. Pseudoaneurysm is a treatable condition with coil embolization.

Introduction: Angiolipoleiomyoma (ALLM) is a rare hamartomatous tumor of mesenchymal origin composed of smooth muscle, mature adipose tissue, and blood vessels in various proportions. Because of its histologic similarity to renal Angiomyolipoma (AML), it is also called uterine angiomyolipoma. Preoperative diagnosis of uterine ALLM is very challenging due to its uncommon incidence and absence of established characteristic imaging findings. Case Presentation: A 50-year-old multiparous female patient visited our institution for gynecologic screening. Transvaginal Sonography (TVS), Abdominopelvic Computed Tomography (CT), and pelvic Magnetic Resonance Imaging (MRI) revealed large well-defined masses involving the posterior uterine wall with rectal indentation. The patient underwent a total abdominal hysterectomy for this tumor and the histopathological diagnosis was uterine ALLM. Conclusion: This report would contribute to understanding and establishing the radiologic findings of the uterine ALLM. Considering the benign characteristics and favorable prognosis of this rare tumor, familiarity with its imaging findings by radiologists will guide clinicians in better patient management and prevention of unnecessary radical surgery.

Background: Massive Systemic Arterial Air Embolism (SAAE) associated with penetrating trauma is a rare condition. A few cases were reported for massive arterial air embolism in the literature. Computed tomography is a fast and easily accessible modality for detecting air in the vasculature. We report CT findings of a rare case with a thoracic gunshot wound, which demonstrate air almost in all systemic vessels like ‘‘full body pneumoangiography’’. Case Presentation: A 42-year-old male patient with a thoracic gunshot wound was admitted to the Accident and Emergency (A) unit in a state of cardiac arrest. Postmortem Computed Tomography (CT) was performed and extensive air was revealed in several great vessels. Conclusion: We conclude that the underline causes of massive air embolism in our case are two main mechanisms: firstly, massive air enters the vasculature via bronchovascular fistula as there was bilateral lung contusion and directly through cardiac truncus, secondly while CPR was being conducted, massive air was pumped to the systemic circulation.