ISRN Radiology http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Assessment of T2-Weighted Coronal Magnetic Resonance Images in the Investigation of Pituitary Lesions Sun, 23 Mar 2014 08:17:31 +0000 http://www.hindawi.com/journals/isrn.radiology/2014/650926/ Magnetic resonance imaging is the most important diagnostic method in the investigation of the pituitary lesions. Our aim is to determine whether T2-weighted coronal images may be helpful in the evaluation of the pituitary gland with suspected pituitary adenomas. One hundred and sixty-seven patients were examined prospectively with T2-weighted coronal and T1-weighted coronal images enhanced with intravenous contrast material. The images were evaluated for the presence, the size, the location, and the ancillary signs including sellar floor erosion or ballooning, infindibulary deviation, convexity of the superior border of the gland, diffuse enlargement of the gland, and the invasion of the cavenous sinuses on both images. In forty-six (28%) patients lesions were revealed on both sequences. In twenty-one (12%) patients the lesions that were revealed on the T1-weighted images were not detected on the T2-weighted images. Positive predictive value, negative predictive value, sensitivity, specificity, and diagnostic accuracy rates of T2-weighted coronal images on the detection of the presence of lesions were 100%, 17.4%, 68.7%, 100%, and 87.4%, respectively. Both T2-weighted coronal and T1-weighted coronal images enhanced with intravenous gadolinium-based contrast material are important in the diagnosis of pituitary adenomas. T2-weighted coronal images could be used as a screening tool for the primary evaluation of the pituitary gland. Ruken Yuksekkaya, Levent Aggunlu, Yusuf Oner, Halil Celik, Sergin Akpek, and Fatih Celikyay Copyright © 2014 Ruken Yuksekkaya et al. All rights reserved. Diagnostic Accuracy of Contrast-Enhanced FLAIR Magnetic Resonance Imaging in Diagnosis of Meningitis Correlated with CSF Analysis Thu, 20 Mar 2014 10:05:03 +0000 http://www.hindawi.com/journals/isrn.radiology/2014/578986/ Purpose. To determine the diagnostic accuracy of contrast enhanced FLAIR sequence of MRI brain in the diagnosis of meningitis. Subjects and Methods. A prospective study of 57 patients with signs and symptoms of meningitis, referred to the radiology department for MRI examination. Out of these, there were 30 males and 27 females. They underwent MRI brain with contrast including postcontrast T1W and FLAIR sequences. Cerebrospinal fluid (CSF) analysis obtained by lumbar puncture after MRI was considered the “reference standard” against which MRI findings were compared. Results. Of 57 patients, 50 were diagnosed as having meningitis on subsequent CSF analysis. Out of these 50, 49 were positive on postcontrast FLAIR images and 34 were positive on postcontrast T1W images. One patient was labeled false positive as CSF analysis showed malignant cells (leptomeningeal carcinomatosis). In the diagnosis of meningitis, the sensitivity of postcontrast FLAIR sequence was 96% and specificity 85.71%, whereas the sensitivity of postcontrast T1W sequence was 68% and specificity 85.71%. Conclusion. Contrast-enhanced FLAIR sequence is more sensitive and specific than contrast-enhanced T1W sequence in the diagnosis of meningitis. It should be routinely used in suspected cases of meningitis. Aneel Kumar Vaswani, Waseem Mehmood Nizamani, Muhammad Ali, Geeta Aneel, Bhesham Kumar Shahani, and Sajjad Hussain Copyright © 2014 Aneel Kumar Vaswani et al. All rights reserved. Diagnostic Performance and Additional Value of Elastosonography in Focal Breast Lesions: Statistical Correlation between Size-Dependant Strain Index Measurements, Multimodality-BI-RADS Score, and Histopathology in a Clinical Routine Setting Sun, 09 Mar 2014 13:34:00 +0000 http://www.hindawi.com/journals/isrn.radiology/2014/396368/ Objective. To evaluate the diagnostic benefit of real-time elastography (RTE) in clinical routine. Strain indices (SI) for benign and malignant tumors were assessed. Methods. 100 patients with 110 focal breast lesions were retrieved. Patients had mammography (MG), ultrasound (US), and, if necessary, MRI. RTE was conducted after ultrasound. Lesions were assessed with BI-RADS for mammography and ultrasound. Diagnosis was established with histology or follow-up. Results. SI for BI-RADS 2 was . Higher SI was observed for BI-RADS 3 lesions. SI of BI-RADS 4 and 5 lesions were significantly higher and . 31 malignant tumors exhibited an average SI of ; SI of benign lesions was ( value ). ROC analysis threshold was >3.8 for malignant disease. Sensitivity of sonography was 90.3% (specificity 78.5%). RTE showed a sensitivity of 87.1% (specificity 79.7%). Accuracy of all modalities combined was 96.8%. In BI-RADS 3 lesions RTE was able to detect all malignant lesions (sensitivity 100%, specificity 92.9%, and accuracy 93.9%). Conclusions. RTE increased sensitivity and specificity for breast cancer detection when used in combination with ultrasound. Lukas Ebner, Harald M. Bonel, Adrian Huber, Steffen Ross, and Andreas Christe Copyright © 2014 Lukas Ebner et al. All rights reserved. Evaluating the Use of a Negative D-Dimer and Modified Low Wells Score in Excluding above Knee Deep Venous Thrombosis in an Outpatient Population, Assessing Need for Diagnostic Ultrasound Sun, 09 Mar 2014 07:41:23 +0000 http://www.hindawi.com/journals/isrn.radiology/2014/519875/ Aims. Colour doppler ultrasonography (CDUS) is widely used in the diagnosis of deep venous thrombosis (DVT); however, the number of scans positive for above knee DVT is low. The present study evaluates the reliability of the D-dimer test combined with a clinical probability score (Wells score) in ruling out an above knee DVT and identifying patients who do not need a CDUS. Materials and Method. This study is a retrospective audit and reaudit of a total of 816 outpatients presenting with suspected lower limb DVT from March 2009 to March 2010 and from September 2011 to February 2012. Following the initial audit, a revised clinical diagnostic pathway was implemented. Results. In our initial audit, seven patients (4.9%) with a negative D-dimer and a low Wells score had a DVT. On review, all seven had a risk factor identified that was not included in the Wells score. No patient with negative D-dimer and low Wells score with no extra clinical risk factor had a DVT on CDUS (negative predictive value 100%). A reaudit confirmed adherence to our revised clinical diagnostic pathway. Conclusions. A negative D-dimer together with a low Wells score and no risk factors effectively excludes a lower limb DVT and an ultrasound is unnecessary in these patients. Maryam Rahiminejad, Anshul Rastogi, Shirish Prabhudesai, David Mcclinton, Peter MacCallum, Sean Platton, and Emma Friedman Copyright © 2014 Maryam Rahiminejad et al. All rights reserved. Digital Breast Tomosynthesis Changes Management in Patients Seen at a Tertiary Care Breast Center Mon, 03 Mar 2014 13:36:50 +0000 http://www.hindawi.com/journals/isrn.radiology/2014/658929/ Objectives. To study factors that predict changes in management with digital breast tomosynthesis (DBT). Methods. The Institutional Review Board approved this HIPAA compliant study. 996 patients had DBT with full field digital mammography (FFDM). Univariate analysis evaluated predictors of management change and cancer detection. Results. DBT changed management in 109 of 996 (11%); 77 (71%) required less imaging. Recalled patients after abnormal FFDM screen were most likely to have management change—25% (24 of 97 patients) compared to 8% (13/163) of symptomatic patients and 10% (72/736) of screening patients (). Dense breasted patients had a higher likelihood of having DBT change management: 13% (68/526) compared to 9% (41/470) (). Of the 996 patients, 19 (2%) were diagnosed with breast cancer. 15 cancers (83%) were seen on FFDM and DBT; 3 (17%) were diagnosed after DBT (0.3%, 95%CI: 0.1–0.9%). One recurrence was in the skin and was not seen on DBT nor was it seen on FFDM. The increase in cancer detection rate was 17% for asymptomatic patients, 0% for symptomatic patients, and 100% for recalled patients. Conclusions. DBT increased cancer detection rate by 20% and decreased the recall rate in 8–25%. Advances in Knowledge. DBT led to a doubling of the cancer detection rate in recalled patients. L. Margolies, A. Cohen, E. Sonnenblick, J. Mandeli, P. H. Schmidt, J. Szabo, N. Patel, G. Hermann, C. Weltz, and E. Port Copyright © 2014 L. Margolies et al. All rights reserved. Assessment of Apparent Diffusion Coefficient Values as Predictor of Aggressiveness in Peripheral Zone Prostate Cancer: Comparison with Gleason Score Sun, 09 Feb 2014 09:02:56 +0000 http://www.hindawi.com/journals/isrn.radiology/2014/263417/ Purpose. To determine association between apparent diffusion coefficient value on diffusion-weighted imaging and Gleason score in patients with prostate cancer. Methods. This retrospective case series was conducted at Radiology Department of Aga Khan University between June 2009 and June 2011. 28 patients with biopsy-proven prostate cancer were included who underwent ultrasound guided sextant prostate biopsy and MRI. MRI images were analyzed on diagnostic console and regions of interest were drawn. Data were entered and analyzed on SPSS 20.0. ADC values were compared with Gleason score using one-way ANOVA test. Results. In 28 patients, 168 quadrants were biopsied and 106 quadrants were positive for malignancy. 89 lesions with proven malignancy showed diffusion restriction. The mean ADC value for disease with a Gleason score of 6 was 935 mm2/s ( mm2/s); Gleason score of 7 was 837 mm2/s ( mm2/s); Gleason score of 8 was 614 mm2/s ( mm2/s); and Gleason score of 9 was 571 mm2/s ( mm2/s). Inverse relationship was observed between Gleason score and mean ADC values. Conclusion. DWI and specifically quantitative ADC values may help differentiate between low-risk (Gleason score, 6), intermediate-risk (Gleason score, 7), and high-risk (Gleason score 8 and 9) prostate cancers, indirectly determining the aggressiveness of the disease. Shayan Sirat Maheen Anwar, Zahid Anwar Khan, Rana Shoaib Hamid, Fahd Haroon, Raza Sayani, Madiha Beg, and Yasir Jamil Khattak Copyright © 2014 Shayan Sirat Maheen Anwar et al. All rights reserved. Role of Cardiac Magnetic Resonance in the Evaluation of Dilated Cardiomyopathy: Diagnostic Contribution and Prognostic Significance Tue, 04 Feb 2014 12:46:28 +0000 http://www.hindawi.com/journals/isrn.radiology/2014/365404/ Dilated cardiomyopathy (DCM) represents the final common morphofunctional pathway of various pathological conditions in which a combination of myocyte injury and necrosis associated with tissue fibrosis results in impaired mechanical function. Recognition of the underlying aetiology of disease and accurate disease monitoring may be crucial to individually optimize therapeutic strategies and stratify patient’s prognosis. In this regard, CMR has emerged as a new reference gold standard providing important information for differential diagnosis and new insight about individual risk stratification. The present review article will focus on the role of CMR in the evaluation of present condition, analysing respective strengths and limitations in the light of current literature and technological developments. Marco Francone Copyright © 2014 Marco Francone. All rights reserved. Venous Drainage Patterns in Carotid Cavernous Fistulas Thu, 30 Jan 2014 14:07:12 +0000 http://www.hindawi.com/journals/isrn.radiology/2014/760267/ Purpose. The carotid-cavernous fistula (CCF) is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach. We evaluated drainage patterns of CCFs by digital subtraction angiography (DSA) and categorized drainage pathways according to their types and etiology. Materials and Methods. Venous drainage patterns of 13 CCFs from 10 subjects were studied and categorized as anterior, posterior, superior, inferior, and contralateral on DSA. Drainage patterns were correlated to types and etiology of CCFs. Diagnosis of CCFs was first made by noninvasive imaging techniques. Results. On DSA, traumatic CCFs were usually high flow, direct type while spontaneous CCFs were usually slow flow, indirect type. Bilaterality and mixed types were observed among the indirect spontaneous CCFs. In all CCFs, anterior and inferior drainages were the most common. Contrary to the literature, posterior and superior drainages were noted only in high flow and long standing direct fistulas. Contralateral drainage was not observed in all, supporting plausible compartmentalization of cavernous sinuses. Conclusion. Types, etiology, and duration of the CCFs may affect their drainage patterns. DSA is valuable for categorization of CCFs and verification of drainage patterns. Drainage pathways may affect the clinic presentation and also change treatment approach. Ayse Aralasmak, Kamil Karaali, Can Cevikol, Utku Senol, Timur Sindel, Huseyin Toprak, Huseyin Ozdemir, and Alpay Alkan Copyright © 2014 Ayse Aralasmak et al. All rights reserved. 3D Rotational Angiography in Follow-Up of Clipped Intracranial Aneurysms Mon, 20 Jan 2014 11:05:12 +0000 http://www.hindawi.com/journals/isrn.radiology/2014/935280/ Introduction. 3D Rotational Angiography (RA) is indispensable for evaluation of intracranial aneurysms, providing infinite viewing angles and defining the aneurysm morphology. Its role in follow-up of clipped aneurysms remains unclear. We aimed to compare the aneurysm residue/recurrence detection rate of 3D RA with 2D digital subtraction angiography (DSA). Methods. 47 patients harboring 54 clipped aneurysms underwent both 2D DSA and 3D RA. The residual/recurrent aneurysms were classified into five grades and the images of both modalities were compared. Results. The residual/recurrent aneurysm detection rate was 53.70% (29/54 aneurysms) with 2D DSA and 66.67% (36/54 aneurysms) with 3D RA (). In 12 aneurysms, 3D RA upgraded the residue/recurrence among which nine had been completely not detected on 2D DSA and were found to have grade one or two residual necks on the 3D RA, and, in three cases, a small neck on 2D DSA turned out to be aneurysm sac on 3D RA. In a total of 5 aneurysms, the classification was downgraded by 3D RA. Conclusion. 3D RA picks up more aneurysm residue/recurrence; hence, both 2D DSA and 3D RA should be performed in follow-up evaluation of clipped aneurysms. Subhash Kumar, Shailesh B. Gaikwad, and Nalini Kant Mishra Copyright © 2014 Subhash Kumar et al. All rights reserved. Association of Mandible Anatomy with Age, Gender, and Dental Status: A Radiographic Study Wed, 18 Dec 2013 19:19:30 +0000 http://www.hindawi.com/journals/isrn.radiology/2013/453763/ Introduction. Gonial angle and antegonial region are important landmarks in mandible which is influenced by gender, age, and dental status. The objective of this study was to evaluate the gonial angle, antegonial angle, and antegonial depth and to investigate their relationship to gender, age group, and dental status. Materials and Methods. A total of 1060 panoramic radiographs were evaluated: the dentulous group, 854 subjects and the edentulous group, 206 subjects. The patients were grouped into six age groups of 10-years each. Gonial angle, antegonial angle, and antegonial depth were measured from panoramic radiographs. Results and Discussion. Corelation of age with gonial angle, antegonial angle and antegonial depth was not significant. Significant difference in mandibular angle was found between males and females. Males had significantly smaller antegonial angle and greater antegonial depth than females. Significant difference was found for gonial angle, antegonial angle, and antegonial depth between right and left sides of mandible. Conclusion. Gonial angle, antegonial angle, and antegonial depth can be implicated as a forensic tool for gender determination but not suitable for age determination. Revant H. Chole, Ranjitkumar N. Patil, Swati Balsaraf Chole, Shailesh Gondivkar, Amol R. Gadbail, and Monal B. Yuwanati Copyright © 2013 Revant H. Chole et al. All rights reserved. The Application of Use Case Modeling in Designing Medical Imaging Information Systems Wed, 27 Nov 2013 14:16:51 +0000 http://www.hindawi.com/journals/isrn.radiology/2013/530729/ Introduction. The essay at hand is aimed at examining the application of use case modeling in analyzing and designing information systems to support Medical Imaging services. Methods. The application of use case modeling in analyzing and designing health information systems was examined using electronic databases (Pubmed, Google scholar) resources and the characteristics of the modeling system and its effect on the development and design of the health information systems were analyzed. Results. Analyzing the subject indicated that Provident modeling of health information systems should provide for quick access to many health data resources in a way that patients’ data can be used in order to expand distant services and comprehensive Medical Imaging advices. Also these experiences show that progress in the infrastructure development stages through gradual and repeated evolution process of user requirements is stronger and this can lead to a decline in the cycle of requirements engineering process in the design of Medical Imaging information systems. Conclusion. Use case modeling approach can be effective in directing the problems of health and Medical Imaging information systems towards understanding, focusing on the start and analysis, better planning, repetition, and control. Reza Safdari, Jebraeil Farzi, Marjan Ghazisaeidi, Mahboobeh Mirzaee, and Azadeh Goodini Copyright © 2013 Reza Safdari et al. All rights reserved. Alzheimer’s Disease Detection in Brain Magnetic Resonance Images Using Multiscale Fractal Analysis Tue, 29 Oct 2013 13:49:11 +0000 http://www.hindawi.com/journals/isrn.radiology/2013/627303/ We present a new automated system for the detection of brain magnetic resonance images (MRI) affected by Alzheimer’s disease (AD). The MRI is analyzed by means of multiscale analysis (MSA) to obtain its fractals at six different scales. The extracted fractals are used as features to differentiate healthy brain MRI from those of AD by a support vector machine (SVM) classifier. The result of classifying 93 brain MRIs consisting of 51 images of healthy brains and 42 of brains affected by AD, using leave-one-out cross-validation method, yielded classification accuracy, 100% sensitivity, and specificity. These results and a processing time of 5.64 seconds indicate that the proposed approach may be an efficient diagnostic aid for radiologists in the screening for AD. Salim Lahmiri and Mounir Boukadoum Copyright © 2013 Salim Lahmiri and Mounir Boukadoum. All rights reserved. Whole Body MRI at 3T with Quantitative Diffusion Weighted Imaging and Contrast-Enhanced Sequences for the Characterization of Peripheral Lesions in Patients with Neurofibromatosis Type 2 and Schwannomatosis Mon, 07 Oct 2013 10:34:00 +0000 http://www.hindawi.com/journals/isrn.radiology/2013/627932/ Purpose. WB-MRI is mainly used for tumor detection and surveillance. The purpose of this study is to establish the feasibility of WB-MRI at 3T for lesion characterization, with DWI/ADC-mapping and contrast-enhanced sequences, in patients with neurofibromatosis type 2 (NF-2) and schwannomatosis. Materials and Methods. At 3T, WB-MRI was performed in 11 subjects (10 NF-2 and 1 schwannomatosis) with STIR, T1, contrast-enhanced T1, and DWI/ADC mapping (, 400, 800 s/mm2). Two readers reviewed imaging for the presence and character of peripheral lesions. Lesion size and features (signal intensity, heterogeneity, enhancement characteristics, and ADC values) were recorded. Descriptive statistics were reported. Results. Twenty-three lesions were identified, with average size of  cm. Lesions were characterized as tumors (21/23) or cysts (2/23) by contrast-enhancement properties (enhancement in tumors, no enhancement in cysts). On T1, tumors were homogeneously isointense (5/21) or hypointense (16/21); on STIR, tumors were hyperintense and homogeneous (10/21) or heterogeneous (11/21); on postcontrast T1, tumors enhanced homogeneously (14/21) or heterogeneously (7/21); on DWI, tumor ADC values were variable (range 0.8–2.7), suggesting variability in intrinsic tumor properties. Conclusion. WB-MRI with quantitative DWI and contrast-enhanced sequences at 3T is feasible and advances the utility of WB-MRI not only to include detection, but also to provide additional metrics for lesion characterization. Laura M. Fayad, Jaishri Blakeley, Scott Plotkin, Brigitte Widemann, and Michael A. Jacobs Copyright © 2013 Laura M. Fayad et al. All rights reserved. Radiographic Contrast-Media-Induced Acute Kidney Injury: Pathophysiology and Prophylactic Strategies Mon, 16 Sep 2013 14:12:02 +0000 http://www.hindawi.com/journals/isrn.radiology/2013/496438/ Contrast-induced acute kidney injury (CI-AKI) is one of the most widely discussed and debated topics in cardiovascular medicine. With increasing number of contrast-media- (CM-) enhanced imaging studies being performed and growing octogenarian population with significant comorbidities, incidence of CI-AKI remains high. In this review, pathophysiology of CI-AKI, its relationship with different types of CM, role of serum and urinary biomarkers for diagnosing CI-AKI, and various prophylactic strategies used for nephroprotection against CI-AKI are discussed in detail. Umar Sadat Copyright © 2013 Umar Sadat. All rights reserved. Overjet and Overbite Influence on Cyclic Masticatory Movements: A CT Study Thu, 05 Sep 2013 11:13:13 +0000 http://www.hindawi.com/journals/isrn.radiology/2013/932805/ Aim. To determine whether a relationship exists between the linear measurements of overjet and overbite and the interincisal space delimited by the morphology of the upper and lower incisors. Method and Materials. 30 subjects (age range from 14.1 to 34.8 years, with a median age of 23.5 years and sex ratio F/M: 5/10) with overjet and overbite equal to 2 mm were selected from a group of 381 individuals with a full and well-aligned dentition, no previous dental treatment, and no signs or symptoms indicative of temporomandibular disorder. Computed Tomography images of vinyl polysiloxane impressions of the 30 subjects’ anterior teeth were acquired. The interincisal space was defined as Immediate Overjet Angle and was calculated on the Computed Tomography images. Results. Although the 30 subjects presented overlapping measures of overjet and overbite, the values of the Immediate Overjet Angles were different in a range of a minimum value of 12° and a maximum value of 54°. Conclusion. This study reveals that (1) only 30 (7.9%) of the 381 individuals considered have values of overjet and overbite equal to 2 mm and (2) the Immediate Overjet Angle values of the 30 subjects are not related to the values of overjet and overbite. Ingrid Tonni, Massimo Pregarz, Giulio Ciampalini, Fulvia Costantinides, and Christiane Bodin Copyright © 2013 Ingrid Tonni et al. All rights reserved. Abdominal Manifestations of Lymphoma: Spectrum of Imaging Features Mon, 02 Sep 2013 15:46:56 +0000 http://www.hindawi.com/journals/isrn.radiology/2013/483069/ Non-Hodgkin and Hodgkin lymphomas frequently involve many structures in the abdomen and pelvis. Extranodal disease is more common with Non-Hodgkin’s lymphoma than with Hodgkin's lymphoma. Though it may be part of a systemic lymphoma, single onset of nodal lymphoma is not rare. Extranodal lymphoma has been described in virtually every organ and tissue. In decreasing order of frequency, the spleen, liver, gastrointestinal tract, pancreas, abdominal wall, genitourinary tract, adrenal, peritoneal cavity, and biliary tract are involved. The purpose of this review is to discuss and illustrate the spectrum of appearances of nodal and extranodal lymphomas, including AIDS-related lymphomas, in the abdominopelvic region using a multimodality approach, especially cross-sectional imaging techniques. The most common radiologic patterns of involvement are illustrated. Familiarity with the imaging manifestations that are diagnostically specific for lymphoma is important because imaging plays an important role in the noninvasive management of disease. Adonis Manzella, Paulo Borba-Filho, Giuseppe D'Ippolito, and Marcella Farias Copyright © 2013 Adonis Manzella et al. All rights reserved. Magnetoencephalography: Fundamentals and Established and Emerging Clinical Applications in Radiology Mon, 12 Aug 2013 17:27:30 +0000 http://www.hindawi.com/journals/isrn.radiology/2013/529463/ Magnetoencephalography is a noninvasive, fast, and patient friendly technique for recording brain activity. It is increasingly available and is regarded as one of the most modern imaging tools available to radiologists. The dominant clinical use of this technology currently centers on two, partly overlapping areas, namely, localizing the regions from which epileptic seizures originate, and identifying regions of normal brain function in patients preparing to undergo brain surgery. As a consequence, many radiologists may not yet be familiar with this technique. This review provides an introduction to magnetoencephalography, discusses relevant analytical techniques, and presents recent developments in established and emerging clinical applications such as pervasive developmental disorders. Although the role of magnetoencephalography in diagnosis, prognosis, and patient treatment is still limited, it is argued that this technology is exquisitely capable of contributing indispensable information about brain dynamics not easily obtained with other modalities. This, it is believed, will make this technology an important clinical tool for a wide range of disorders in the future. Sven Braeutigam Copyright © 2013 Sven Braeutigam. All rights reserved. B-Mode and Elastosonographic Evaluation to Determine the Reference Elastosonography Values for Cervical Lymph Nodes Wed, 07 Aug 2013 13:11:29 +0000 http://www.hindawi.com/journals/isrn.radiology/2013/895287/ Background. It is crucial to differentiate between reactive and malignant lymphadenopathies. Elastosonography measures the elasticity of the tissue. Having a reference value for benign lymph nodes (LNs) is important in interpretation. The purpose of this study is to determine the reference elastosonography values of cervical LNs. Methods. 97 LNs were evaluated by B-mode and elastosonography. Depth, length, width, length to width ratio, hilar-cortical thickness, strain ratio, and elasticity scores were measured. Results. In 18.6% of the cervical LNs cortical thickness was less than the hilar thickness (group A) and in 81.4% it was equal or more (group B). 69.1% of LNs showed strain ratio (SR) less than 3 (group 1) and 30.9% equal to or more than 3 (group 2). 33% of LNs displayed elasticity score (ES) 1; 30.9% ES 2; 22.7% ES 3, and 13.4% ES 4. There was a significant correlation between thickness ratios and elasticity scores (P: 0.011). A significant correlation was also demonstrated between SR groups and elasticity scores. Conclusion. A simple, reproducible, noninvasive imaging technique for diagnosis of malignant LNs is necessary. Elastosonography can aid in the differentiation of benign versus malignant cervical LNs, thus help reduce the number of unnecessary biopsies for benign processes. Aydin Kurt, Idil Gunes Tatar, Ali Ipek, and Baki Hekimoglu Copyright © 2013 Aydin Kurt et al. All rights reserved. Synergistic Radioprotection by Gamma-Tocotrienol and Pentoxifylline: Role of cAMP Signaling Sun, 07 Jul 2013 11:26:54 +0000 http://www.hindawi.com/journals/isrn.radiology/2013/390379/ Purpose. This study was designed to determine the efficacy and mechanisms of radioprotection by the combination of gamma-tocotrienol (GT3) and pentoxifylline (PTX) against acute radiation injury. Materials and Methods. Post-irradiation survival was monitored to determine the most efficacious dose and time of administration of PTX. Dose reduction factor (DRF) was calculated to compare the radioprotective efficacy of the combination. To determine the mechanism of synergistic radioprotection by the combination, mevalonate or calmodulin were coadministered with the GT3-PTX combination. Mevalonate was used to reverse the inhibitory effect of GT3 on 3-hydroxy-3-methyl-glutaryl-CoA reductase (HMGCR), and calmodulin was used to reverse the inhibition of phosphodiesterase (PDE) by PTX. Results. The combination was most effective when 200 mg/kg of PTX was administered 15 min before irradiation along with 200 mg/kg of GT3 (−24 h) and resulted in a DRF of 1.5. White blood cells and neutrophil counts showed accelerated recovery in GT3-PTX-treated groups compared to GT3. Mevalonate had no effect on the radioprotection of GT3-PTX; calmodulin abrogated the synergistic radioprotection by GT3-PTX. Conclusion. The mechanism of radioprotection by GT3-PTX may involve PDE inhibition. Shilpa Kulkarni, Kushal Chakraborty, K. Sree Kumar, Tzu-Cheg Kao, Martin Hauer-Jensen, and Sanchita P. Ghosh Copyright © 2013 Shilpa Kulkarni et al. All rights reserved. Understanding the Role of Hemodynamics in the Initiation, Progression, Rupture, and Treatment Outcome of Cerebral Aneurysm from Medical Image-Based Computational Studies Tue, 02 Jul 2013 08:43:45 +0000 http://www.hindawi.com/journals/isrn.radiology/2013/602707/ About a decade ago, the first image-based computational hemodynamic studies of cerebral aneurysms were presented. Their potential for clinical applications was the result of a right combination of medical image processing, vascular reconstruction, and grid generation techniques used to reconstruct personalized domains for computational fluid and solid dynamics solvers and data analysis and visualization techniques. A considerable number of studies have captivated the attention of clinicians, neurosurgeons, and neuroradiologists, who realized the ability of those tools to help in understanding the role played by hemodynamics in the natural history and management of intracranial aneurysms. This paper intends to summarize the most relevant results in the field reported during the last years. Marcelo A. Castro Copyright © 2013 Marcelo A. Castro. All rights reserved. Usefulness of the Bolus-Tracking Baseline Scan for the Diagnosis of Hepatic Steatosis in Abdominal Computed Tomography: A Feasibility Study Sat, 27 Apr 2013 15:51:00 +0000 http://www.hindawi.com/journals/isrn.radiology/2013/147632/ Nonalcoholic fatty liver disease (NAFLD) is a common pathology in western societies. Unenhanced computed tomography (CT) of the liver is a valuable tool in determining the presence of steatosis hepatis, but in most departments standard CT protocols of abdomen often do not include unenhanced scans anymore. In a small series of 22 patients the liver density was measured in the acquired low-dose baseline scan for bolus tracking and was compared to the measurement in a regular unenhanced CT scan of the upper abdomen. The mean difference between the unenhanced CT scan and the low-dose baseline scan was 3.4 HU (range 0.2–8.6 HU); the difference between these two scans was 5 HU or smaller in 82% of the patients. There was a significant difference between the two used CT scanners; this has to be kept in mind before implementing this approach into daily practice. All but one patient with fatty liver disease on unenhanced CT were diagnosed using the baseline scan. The baseline scan for bolus tracking may be useful for the diagnosis or in the followup of fatty liver disease. J. Gossner and S. Schäfer Copyright © 2013 J. Gossner and S. Schäfer. All rights reserved. Retrievable Inferior Vena Cava Filters for Venous Thromboembolism Mon, 22 Apr 2013 14:56:14 +0000 http://www.hindawi.com/journals/isrn.radiology/2013/959452/ Inferior vena cava (IVC) filters are used as an alternative to anticoagulants for prevention of fatal pulmonary embolism (PE) in venous thromboembolic disorders. Retrievable IVC filters have become an increasingly attractive option due to the long-term risks of permanent filter placement. These devices are shown to be technically feasible in insertion and retrieval percutaneously while providing protection from PE. Nevertheless, there are complications and failed retrievals with these retrievable filters. The aim of the paper is to review the retrievable filters and their efficacy, safety, and retrievability. Han Ni and Lei Lei Win Copyright © 2013 Han Ni and Lei Lei Win. All rights reserved. Investigating γH2AX as a Biomarker of Radiosensitivity Using Flow Cytometry Methods Wed, 10 Apr 2013 08:14:56 +0000 http://www.hindawi.com/journals/isrn.radiology/2013/704659/ Background and Purpose. This project examined the in vitro  γH2AX response in lymphocytes of prostate cancer patients who had a radiosensitive response after receiving radiotherapy. The goal of this project was to determine whether the γH2AX response, as measured by flow cytometry, could be used as a marker of individual patient radiosensitivity. Materials and Methods. Patients were selected from a randomized clinical trial evaluating the optimal timing of Dose Escalated Radiation and short-course Androgen Deprivation Therapy. Of 438 patients, 3% developed Grade 3 late radiation proctitis and were considered to be radiosensitive. Blood was drawn from 10 of these patients along with 20 matched samples from patients with Grade 0 proctitis. Dose response curves up to 10 Gy along with time response curves after 2 Gy (0–24 h) were generated for each sample. The γH2AX response in lymphocytes and lymphocyte subsets was analyzed by flow cytometry. Results. There were no significant differences between the radiosensitive and control samples for either the dose course or the time course. Conclusions. Although γH2AX response has previously been demonstrated to be an indicator of individual patient radiosensitivity, flow cytometry lacks the sensitivity necessary to distinguish any differences between samples from control and radiosensitive patients. Lindsay A. Beaton, Leonora Marro, Shawn Malone, Sara Samiee, Scott Grimes, Kyle Malone, and Ruth C. Wilkins Copyright © 2013 Lindsay A. Beaton et al. All rights reserved. Hemosuccus Pancreaticus: 15-Year Experience from a Tertiary Care GI Bleed Centre Thu, 28 Feb 2013 12:09:09 +0000 http://www.hindawi.com/journals/isrn.radiology/2013/191794/ Background. Hemosuccus pancreaticus (HP) is a very rare and obscure cause of upper gastrointestinal bleeding. Due to its rarity, the diagnostic and therapeutic strategy for the management of this potentially life threatening problem remains undefined. The objective of our study is to highlight the challenges in the diagnosis and management of HP and to formulate a protocol to effectively and safely manage this condition. Methods. We retrospectively reviewed the records of all patients who presented with HP over the last 15 years at our institution between January 1997 and December 2011. Results. There were a total of 51 patients with a mean age of 32 years. Nineteen patients had chronic alcoholic pancreatitis; twenty-six, five, and one patient had tropical pancreatitis, acute pancreatitis, and idiopathic pancreatitis, respectively. Six patients were managed conservatively. Selective arterial embolization was attempted in 40 of 45 (89%) patients and was successful in 29 of the 40 (72.5%). 16 of 51 (31.4%) patients required surgery. Overall mortality was 7.8%. Length of followup ranged from 6 months to 15 years. Conclusions. Upper gastrointestinal bleeding in a patient with a history of chronic pancreatitis could be caused by HP. All hemodynamically stable patients with HP should undergo prompt initial angiographic evaluation, and if possible, embolization. Hemodynamically unstable patients and those following unsuccessful embolization should undergo emergency haemostatic surgery. Centralization of GI bleed services along with a multidisciplinary team approach and a well-defined management protocol is essential to reduce the mortality and morbidity of this condition. Ashwin Rammohan, Ravichandran Palaniappan, Sukumar Ramaswami, Senthil Kumar Perumal, Anand Lakshmanan, U. P. Srinivasan, Ravi Ramasamy, and Jeswanth Sathyanesan Copyright © 2013 Ashwin Rammohan et al. All rights reserved. Automated Determination of Bone Age in a Modern Chinese Population Mon, 25 Feb 2013 14:14:34 +0000 http://www.hindawi.com/journals/isrn.radiology/2013/874570/ Rationale and Objective. Large studies have previously been performed to set up a Chinese bone age reference, but it has been difficult to compare the maturation of Chinese children with populations elsewhere due to the potential variability between raters in different parts of the world. We re-analysed the radiographs from a large study of normal Chinese children using an automated bone age rating method to establish a Chinese bone age reference, and to compare the tempo of maturation in the Chinese with other populations. Materials and Methods. X-rays from 2883 boys and 3143 girls aged 2–20 years from five Chinese cities, taken in 2005, were evaluated using the BoneXpert automated method. Results. Chinese children reached full maturity at the same age as previously studied Asian children from Los Angeles, but 0.6 years earlier than Caucasian children in Los Angeles. The Greulich-Pyle bone age method was adapted to the Chinese population creating a new bone age scale BX-China05. The standard deviation between BX-China05 and chronologic age was 1.01 years in boys aged 8–14, and 1.08 years in girls aged 7–12. Conclusion. By eliminating rater variability, the automated method provides a reliable and efficient standard for bone age determination in China. Shao-Yan Zhang, Gang Liu, Chen-Guo Ma, Yi-San Han, Xun-Zhang Shen, Rui-Long Xu, and Hans Henrik Thodberg Copyright © 2013 Shao-Yan Zhang et al. All rights reserved. Imaging of Focal Autoimmune Pancreatitis and Differentiating It from Pancreatic Cancer Wed, 16 Jan 2013 08:13:53 +0000 http://www.hindawi.com/journals/isrn.radiology/2013/569489/ Autoimmune pancreatitis (AIP) is an inflammatory disorder of pancreas. Two types have been identified: the diffuse and the focal or mass forming. Clinical presentation of AIP overlaps that of pancreatic cancer (PC). Sometimes serum IgG4 and CA 19-9 levels are unable to differentiate AIP from PC. Various series have shown that 5%–21% of resected pancreatic masses for suspected malignancy turned out to be AIP. Accurate diagnosis of focal AIP can avoid unnecessary surgeries. This paper elaborates the various imaging modalities useful in differentiating focal AIP from PC. Abhishek Vijayakumar and Avinash Vijayakumar Copyright © 2013 Abhishek Vijayakumar and Avinash Vijayakumar. All rights reserved. Comparison of Hippocampal Volume in Dementia Subtypes Sun, 02 Dec 2012 16:24:19 +0000 http://www.hindawi.com/journals/isrn.radiology/2013/174524/ Aims. To examine the relationship between different types of dementia and hippocampal volume. Methods. Hippocampal volume was measured using FL3D sequence magnetic resonance imaging in 26 Alzheimer's, vascular dementia, mixed dementia, and normal pressure hydrocephalus patients and 15 healthy controls and also hippocampal ratio, analyzed. Minimental scale was used to stratify patients on cognitive function impairments. Results. Hippocampal volume and ratio was reduced by 25% in Alzheimer’s disease, 21% in mixed dementia, 11% in vascular dementia and 5% in normal pressure hydrocephalus in comparison to control. Also an asymmetrical decrease in volume of left hippocampus was noted. The severity of dementia increased in accordance to decreasing hippocampal volume. Conclusion. Measurement in hippocampal volume may facilitate in differentiating different types of dementia and in disease progression. There was a correlation between hippocampal volume and severity of cognitive impairment. Avinash Vijayakumar and Abhishek Vijayakumar Copyright © 2013 Avinash Vijayakumar and Abhishek Vijayakumar. All rights reserved. Ultrasonographic Features of Kidney Transplants and Their Complications: An Imaging Review Sun, 02 Dec 2012 10:54:51 +0000 http://www.hindawi.com/journals/isrn.radiology/2013/480862/ Renal transplantation is the treatment of choice for managing patients with end-stage kidney disease. Being submitted to a very serious surgical procedure, renal transplant recipients can only benefit from follow-up imaging and monitoring strategies. Ultrasound is considered as the principal imaging test in the evaluation of renal transplants. It is an easily applied bedside examination that can detect possible complications and guide further imaging or intervention. In this imaging review, we present essential information regarding the sonographic features of healthy renal transplants, detailing the surgical technique and how it affects the sonoanatomy. We focus on various complications that occur following renal transplantation and their sonographic features by reviewing pertinent literature sources and our own extensive imaging archives. Chrysafoula Kolofousi, Konstantinos Stefanidis, Demosthenes D. Cokkinos, Dimitrios Karakitsos, Eleni Antypa, and Ploutarhos Piperopoulos Copyright © 2013 Chrysafoula Kolofousi et al. All rights reserved. An Adrenal Incidentaloma: How Often Is It Detected and What Are the Consequences? Wed, 28 Nov 2012 10:47:08 +0000 http://www.hindawi.com/journals/isrn.radiology/2013/871959/ Objectives. The aim of this study was to investigate the detection rate of adrenal incidentalomas and subsequent workup. Design. Retrospective cohort study. Methods. Two investigators evaluated the adrenals on abdominal CT scans. Abnormalities were compared to the original radiology reports and an experienced abdominal radiologist reviewed the CT scans. All additional imaging and laboratory tests were assessed. Results. The investigators detected 44/356 adrenal incidentalomas (12%). In 25 patients an adrenal incidentaloma had been noted in the radiology report. The expert radiologist agreed on 19 incidentalomas in 17 patients, two with bilateral incidentalomas. Of the 25 incidentaloma patients, 4 (16%) patients were screened for hormonal overproduction and 2 (8%) patients had follow-up imaging studies. Conclusions. 12% of the patients had an adrenal incidentaloma (42 of 356). 17 (40%) had initially not been reported by the radiologist. When diagnosed with an adrenal incidentaloma, only a small percentage of patients (16%) is screened or undergoes repeated imaging (8%) as proposed in the National Institutes of Health (NIH) guidelines on adrenal incidentalomas. E. M. Minnaar, K. E. Human, D. Henneman, C. Y. Nio, P. H. Bisschop, and E. J. M. Nieveen van Dijkum Copyright © 2013 E. M. Minnaar et al. All rights reserved. Feasibility of Detecting Pulmonary Embolism Using Noncontrast MRI Wed, 28 Nov 2012 09:54:45 +0000 http://www.hindawi.com/journals/isrn.radiology/2013/729271/ Purpose. The purpose of this study was to evaluate the feasibility of detecting pulmonary emboli utilizing noncontrast magnetic resonance imaging techniques in patients with known pulmonary embolism. Materials and Methods. Eleven patients were enrolled in a study to evaluate right ventricular function by cardiac MRI in patients diagnosed with acute pulmonary embolism on CT pulmonary angiogram. Cardiac MRI was performed as soon as possible following pulmonary embolism detection. Two independent observers reviewed the precontrast portion of each MRI, scoring right, left, and lobar arteries as positive or negative for PE. The CTs were reviewed and interpreted in the same manner. Results. MRI was obtained on average of 40 hours after the CT. Forty-eight vessels were affected by PE on CT, 69% of which were identified on MRI. All eight pulmonary emboli located in the right or left pulmonary arteries were detected on MRI. Of the 15 pulmonary emboli that were not detected on MRI, 7 were subsegmental, 6 were segmental, and 2 were located in a branch not included in the MRI field of view. Conclusions. Most pulmonary emboli detected on CT were identified on noncontrast MRI, even though our MRI protocol was not optimized for pulmonary artery visualization. C. S. Mudge, T. T. Healey, M. K. Atalay, and J. A. Pezzullo Copyright © 2013 C. S. Mudge et al. All rights reserved.