Current Medical Imaging - Volume 18, Issue 7, 2022

Shoulder pain is an extremely common condition. The painful shoulder may be the result of a wide spectrum of underlying pathological conditions, including calcific tendinopathy of the rotator cuff, subacromial-subdeltoid bursitis, acromioclavicular or glenohumeral arthritis, tenosynovitis of the long biceps tendon, rotator cuff lesions, and many other less common conditions. Ultrasound imaging is an effective tool for the diagnosis and also for the image guidance of treatment of the majority of these conditions. Several ultrasound-guided procedures are effective for pain relief, such as percutaneous irrigation, intra-bursal or intra-articular drugs injection, fluid aspiration, neural block. This review article aims to summarize and discuss the most common treatment possibilities with ultrasound guidance for the painful shoulder.

Radiology has undeniably played a pivotal role in the COVID-19 pandemic. Radiologists as well as radiographers have relentlessly put their best foot forward in serving the people. Till date there are relatively few articles which describe the A-to-Z role of radiology in COVID pandemic and what a radiologist must know, suggest and report in such times. This article is a comprehensive narrative Review article with pictorial illustrations of cases from GSL medical college and hospital (COVID care centre)in India, intending to prepare and equip radiologist/resident, with the knowledge of basics to fight respiratory pandemics like COVID-19, in the present and any future respiratory pandemic. This article aims to bring under one roof comprehensively all the precious studies by various researchers all over the world, by covering all areas, seeing no leaf unturned by covering Pearls and Pitfalls of various imaging modalities, Imaging in Special groups of population, differential diagnoses of COVID, Role of radiology in non-respiratory manifestations, Post-COVID/ sequelae.

Background: Seizure control (SC) is often poor in cases of magnetic resonance imaging- negative epilepsy after resection surgery. Objective: This study aimed to evaluate the therapeutic efficacy of depth-electrode-guided stereotactic radiofrequency thermocoagulation (RFTC) applied to the amygdalohippocampal complex (AHC) for the treatment of patients with MRI-negative medial temporal lobe epilepsy. Methods: A total of 62 cases with magnetic resonance imaging-negative medial temporal lobe epilepsy were retrospectively studied after the application of depth-electrode-guided RFTC to the AHC. Single-target coagulations were applied to all patients, and multi-target coagulations were applied to those patients who did not experience significant reductions in discharges after the first target ablation. Bilateral-target coagulations were applied to bilateral medial temporal lobe epilepsy patients, using single target ablation applied to each side. Results: After 24-83 months of follow-up, 32/62 (51.61%) patients became seizure-free, and 35/62 (56.45%) patients reported significant reductions in seizure episodes. The total effective rate was 69.35% (43/62). No significant differences were observed for SC among the single-target, multi-target, and bilateral-target groups. However, a significant difference was observed for the reduction in epileptic discharges after coagulations between those patients who became seizure-free and those who did not. Magnetic resonance imaging-negative medial temporal lobe epilepsy patients can benefit from RFTC applied to the AHC. A significant reduction in epileptic discharges observed during operations after RFTC is applied may predict good SC. Conclusion: RFTC applied to the AHC could be considered a promising method for the treatment of magnetic resonance imaging-negative medial temporal lobe epilepsy patients.

Background: Dynamic magnetic resonance imaging (dMRI) plays an important role in cardiac perfusion and functional clinical exams. However, further applications are limited by the speed of data acquisition. Objective: A low-rank plus sparse decomposition approach is often introduced for reconstructing dynamic magnetic resonance imaging (dMRI) from highly under-sampling K-space data. In this paper, the reconstruction problem of DMR is transformed into a low-rank tensor plus sparse tensor recovery problem. Methods: A sequentially truncated higher-order singular value decomposition method is proposed to quickly approximate the low-rank tensor space structure and learn sparse components by adding a tensor kernel norm to the low-rank tensor and a l1 norm to the sparse tensor to constrain the two parts at the same time. The optimization problem is solved by using the iterative soft-thresholding algorithm; therefore, under the premise of ensuring the accuracy of the data, the amount of computation can be effectively reduced. Results: Compared with the state-of-the-art methods, the experimental results show that the proposed method can achieve better performance in terms of reconstruction speed and reconstruction quality on 3D and 4D dMRI datasets. Conclusion: The multidimensional MRI time series is represented by the tensor tool and decomposed into low rank tensor terms and sparse tensor terms. The low rank spatial structure is captured by the adaptive ST-HOSVD for fast approximation and the sparse component is constrained efficiently with a sparsity transform and l1 norm. The optimization problem is solved by an iterative soft-thresholding algorithm. Through extensive 3D and 4D dMRI experiments, it is demonstrated that our method can achieve superior reconstruction performance and efficiency compared with the other three state-of-theart methods reported in the literature.

Objective: To investigate the role of whole-brain volume computed tomography (CT) perfusion in assessing early ischemic cerebrovascular diseases. Materials and Methods: Seventy-two patients with early ischemic cerebrovascular diseases who had undergone routine CT scan and 320-row volume CT whole-brain perfusion imaging within 8 h after admission were retrospectively enrolled in this one-center case-sectional study. The perfusion parameters of cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and dynamic CT angiogram (4D-CTA) were obtained and analyzed. Results: Among 72 patients, 29 cases with 37 cerebral ischemic lesions were found in plain CT scan, whereas 51 cases with 76 lesions were found in whole-brain CT perfusion, with 30.6% more patients being detected. The CBF value was significantly lower in the abnormal than normal corresponding perfusion area in the healthy hemisphere (P<0.05), while the MTT and TTP values were significantly higher in the abnormal than the normal corresponding area (P<0.05). 4D-CTA image suggested that 59 cases had different degrees of stenosis or occlusion, including 11 mild, 18 moderate, 21 severe, and 9 occlusive cases. Four-D-CTA imaging could detect significantly (P<0.05) more patients with abnormal perfusion in severe cerebral vascular stenosis or occlusion than those with no, mild or moderate stenosis (93.33% vs. 16.67%) (P<0.05). The stenosis of intracranial and carotid arteries was positively correlated with MTT and TTP values (P<0.05). Conclusion: Whole-brain volume CT angiography can comprehensively display early cerebral ischemic lesions, cerebral blood perfusion status, and cerebral vascular stenosis, providing valuable information for early detection of ischemic cerebral diseases and appropriate treatment planning.

Objective: This study aimed at exploring the impact of patient-related, vessel-related, image quality-related and cardiovascular risk factors on coronary computed tomographic angiography (CCTA) interpretability using 256-detector row computed tomography (CT). Methods: One hundred ten patients who underwent CCTA and Invasive Coronary Angiography (ICA) were consecutively, retrospectively enrolled from January 2018 to October 2018. Using ICA as the reference standard, ≥50% diameter stenosis was defined as the cut-off criterion to detect the diagnostic performance of CCTA. Diagnostic reproducibility was investigated by calculating the interrater reproducibility of CCTA. Multiple logistic regression models were performed to evaluate the impact of 14 objective factors. Results: A total of 1019 segments were evaluated. The per-segment sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CCTA were 76.8%, 93.7%, 91.2%, 67.8%, and 95.9%, respectively. The per-segment diagnostic reproducibility was 0.44 for CCTA. Regarding accuracy, a negative association was found for stenosis severity, calcium load, and hyperlipidaemia. Regarding sensitivity, calcium load and diabetes mellitus (DM) were positively related. Regarding specificity, a negative correlation was observed between stenosis severity and calcium load. Regarding interrater reproducibility, stenosis severity and calcium load were negatively associated, whereas male sex and the signal-to-noise ratio (SNR) were positively related (all p<0.05). Conclusion: Per-segment 256-detector row CCTA performance was optimal in stenosis-free or occluded segments. Heavier calcium load was associated with poorer CCTA interpretability. On the one hand, our findings confirmed the rule-out value of CCTA; on the other hand, improvements in calcium subtractions and deep learning-based tools are suggested to improve CCTA diagnostic interpretability.

Background: Since the emergence of coronavirus disease 2019 (COVID-19), several journals have established a dedicated resource center for all the articles published on COVID-19. Our study compared the altmetric impact captured by articles published in journals having a COVID-19 resource center. Methods: We used the Web of Science database to assess radiology journals publishing the most common articles on COVID-19. We used the dimensions database to assess citations received and altmetric attention score for each article. For each article, we extracted several citations received and altmetric attention scores. To account for the variation in strength and exposure between included journals, we adopted a normalization strategy and regression analysis in our statistical analysis. Results: A total of 494 articles were included in the current assessment, including 334 (67.6%) articles published in journals with the dedicated COVID-19 resource center, including European radiology, American Journal of Roentgenology, Radiology, and Journal of the American college of radiology, while European Journal of Nuclear Medicine and Molecular Imaging, Academic Radiology did not have COVID-19 resource center. Journals with COVID-19 resource center had a mean normalized altmetric attention score of 0.38 higher (95% CI 0.25 to 0.50; p< 0.001) and a mean normalized citation count of 6.73 higher (95% CI 3.99 to 9.48; p< 0.001) than those without COVID-19 resource center. Conclusion: Radiology journals that provided COVID-19 articles in a dedicated resource center within its homepage had greater attention and higher citation for their COVID-19 articles than journals that did not have such a dedicated resource center.

Background and Aim: The study aims to investigate the feasibility of further radiation dose reduction via the application of a high iodine delivery rate combined with automatic current modulation technology (high noise index) in head and neck computed tomography angiography. Methods: Sixty-four patients who underwent routine head and neck computed tomographic angiography were randomly divided into two groups: a low-dose group of 32 cases and an ultra-low-dose group of 32 cases. The same image reconstruction technique was applied in both groups using the 50% adaptive statistical iterative reconstruction method. Quantitative and qualitative image quality assessment of the carotid artery, computed tomographic dose index volume, dose length product, and effective dose of the two groups were analyzed. Results: The two groups were not significantly (P>0.05) different in age, gender, and body mass index. Significant (P<0.001) reduction of radiation dose was observed in all the parameters of computed tomographic dose index volume (18.12%), dose length product (19.91%), and effective dose (19.84%) in the ultra-low-dose group. Quantitative and qualitative image assessment produced similar results between the two groups, except for the higher mean vascular computed tomographic values found in the ultra-low dose group. Conclusion: Application of a higher iodine delivery rate combined with automatic current modulation technology (high noise index) in an existing low tube voltage protocol can further decrease the radiation dose and the total volume of contrast agent while maintaining similar image quality for patients undergoing computed tomography angiography of the head and neck, which can be recommended as the conventional scanning method.

Background: Klippel-Trénaunay-Syndrome (KTS) is characterized by a triad of varicose veins, port-wine stain and soft tissue or bony hypertrophy, and the diagnosis of KTS can be made if any two of these three features are present. Hemangiomas in various locations, e.g., skull, brain, epidural and vertebral hemangioma, mediastinal, colonic hemangioma, intraneural/intramuscular hemangiomas, are reported with KTS. Case Presentation: Benign vascular tumors may rarely develop malignant transformation as Bugarin- Estrada et al. reported breast angiosarcoma in a patient diagnosed as Klippel-Trenaunay-Syndrome. We reported a case of a 40-year-old female with a known case of Klipple-Trenaunay-Syndrome with left leg varicosities, cutaneous nevus, as well as unfortunate development of deep venous thrombosis and markedly enlarged right breast hemangioma. Due to low incidence or lack of early detection of breast hemangioma, its diagnosis is challenging. Conclusion: The history of the patient and multi-modality imaging utilization can help in early and accurate diagnosis of diseases leading to better prognosis.

Background: Cardiac tumors have heterogeneous and unspecific clinical presentations which is why their diagnosis is difficult. Case Report: A middle-aged woman presented to the emergency department with unspecific symptoms developing over 2 weeks. Multimodality imaging revealed a large mass filling the left atrium with a large base adherent to the fossa ovalis and flow obstruction. After surgical extraction, the anatomopathological analysis was compatible with a primary benign cardiac tumor. Conclusion: Clinical presentation of cardiac tumors is usually unspecific and multimodality imaging is crucial in the diagnostic workflow. Surgical excision should be performed as quickly as possible.

Background: Mycosis fungoides (MF) is the most common form of cutaneous T-cell lymphoma with many clinicopathological variants, thus difficult to diagnose in its early stages. Case Presentation: This case report is about a 76 years old Chinese woman presented with 2 years history of erythematous plaque on the lateral right thigh; after combining clinical manifestations with results of pathological examinations, it is consistent with the diagnosis of MF. Discussion: Mycosis fungoides (MF) is the most common form of cutaneous T-cell lymphoma. The patient in this case had a long course of disease and repeated attacks. Ultrasound shows a small patch of liquid dark area of the lesion. Color Doppler image shows rich blood flow, which just looks like lacustrine. Thick and nourishing blood vessels could be seen in the depth. Conclusion: Our case report using ultrasound to observe MF and demonstrate that ultrasound is helpful in diagnosing and evaluating effectiveness in treating MF.

Background: Anti-synthetase syndrome is a rare autoimmune disorder characterized by autoantibodies against aminoacyl-tRNA-synthetases. Inflammatory myopathy and interstitial lung disease could be present among other manifestations. Anti-Jo-1 is the most common antisynthetase antibody and is the most likely to present with the classic triad (interstitial lung disease, myositis, and arthritis), and includes more muscle and joint involvement than patients with other antisynthetase antibodies. Case Report: Here, we present a case of a 60-year-old female patient with a previous diagnosis of myositis, secondary to the anti-synthetase syndrome, a complication of pyogenic myositis. Conclusion: The diagnosis of anti-synthetase syndrome is made by a multidisciplinary approach, and occasionally, muscle and/or lung biopsy is needed. Imaging studies, especially magnetic resonance imaging, based on findings such as muscle and fascial edema, and fatty tissue replacement, allow an optimal approach.

Background: Novel coronavirus disease 2019 (COVID-19) pneumonia remains a matter of concern. Chest CT findings of COVID-19 pneumonia have been reported widely, while there is relatively rare research on chest X-ray (CXR). Objective: The study was aimed to compare the CXR and chest CT findings of patients with confirmed COVID-19 infection and to explore their respective clinical values. Methods: 28 inpatients with COVID-19 pneumonia who underwent both CXR and CT were included. The pulmonary manifestations of the lesions were recorded. Ground-glass opacity (GGO), consolidation, and fibrosis were quantified in CXR and chest CT separately. Consistency was analyzed using Fleiss' kappa and intraclass correlation coefficient. The stages of the disease in CXR and chest CT were evaluated. Results: Approximately 67.9% (19/28) of subjects had abnormal findings on CXR. The common manifestations in CXR were ground-glass opacities (GGO) (100%, 19/19) and consolidation (68.4%, 13/19). 92.9% (26/28) of patients had abnormal manifestations on CT. The common manifestations in CT were GGO (88.5%, 23/26), consolidation (69.2%, 18/26), reticular opacity (69.2%, 18/26) and nodule (46.2%, 12/26). Among the abnormalities between CXR and CT, only consolidation was consistent (Κ=0.510). GGO (ICC=0.501) and consolidation (ICC=0.431) scores were consistent in CXR and chest CT. The results of staging were the same in 14 cases, most of them were in stage I and stage II. While in other cases with inconsistent results, CT was more advanced in the disease stage than CXR, mainly stage III and stage IV. Conclusion: CXR is helpful to observe the change of the pulmonary lesions in patients with confirmed COVID-19 pneumonia. CT can be used for early diagnosis and staging of lesions.

Objective: The objective of the study is to determine the role of Lateral Pterygoid Muscle LPM in the articular disc displacement ADD, which is considered controversial due to the variations in the pattern of insertion of the Superior Lateral Pterygoid Muscle SPLM. Background: It is well understood that the superior head of the lateral pterygoid muscle has only a single insertion pattern among individuals, in which the muscle is attached to the articular disc and capsule. However, recent findings in many studies have shown a noticeable variation in the insertion pattern of the upper LPM. Methods: MRI examinations were collected at King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. Scans of 61 patients (41 females, 20 males; mean age 33 years old) with symptoms of temporomandibular dysfunction were reviewed retrospectively. The direction of their articular disc displacement was evaluated through sagittal and coronal views in both open and closed mouth positions. Results: There was no statistical significance found between the LPM attachment types and TMJ disc position. The chi-square test also showed no significant difference between the type of LPM attachment and the condylar location. Forty-five percent of the articular discs were located between the articular eminence and the glenoid fossa. The majority of the disc displacement was in the anterior direction. Conclusion: There was no statistically significant association found between the type of LPM attachments and the direction of disc displacement.