Don't be short-sighted: cervical incompetence in a pregnant patient with acute appendicitis

Publication date: September–October 2018
Source:Clinical Imaging, Volume 51
Author(s): Lindsey M. Negrete, Lucy B. Spalluto
Delay in diagnosis of cervical incompetence can be detrimental to the fetus. Up to 20–25% of miscarriages in the second trimester can be attributed to the incompetent cervix. Given the profound impact of cervical incompetence on obstetric outcomes, careful attention should be given to evaluation of the cervix on MRI studies in pregnant patients. We present a case of incompetent cervix diagnosed incidentally at the time of MRI performed to evaluate for acute appendicitis.



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Association between epicardial fat volume and fractional flow reserve: An analysis of the determination of fractional flow reserve (DeFACTO) study

Publication date: September–October 2018
Source:Clinical Imaging, Volume 51
Author(s): Ashley Beecy, Bríain Ó. Hartaigh, Joshua Schulman-Marcus, Khalil Anchouche, Heidi Gransar, Subhi Al'Aref, Kimberly Elmore, Fay Y. Lin, James K. Min, Jessica M. Peña
BackgroundThis study examines the relationship between epicardial fat volume (EFV) and lesion-specific ischemia by fractional flow reserve (FFR).MethodsIn a study of 173 patients (63.0 ± 8.3 years) undergoing FFR, EFV was determined using cardiac computed tomography. Relationships between EFV and FFR were assessed using multivariable linear and logistic regression.ResultsUsing multivariable linear and logistic regression, no association between EFV and FFR was observed (β [SE] = −0.001 [0.003], P = 0.6, OR [95% CI]: 1.02 [0.94–1.11], P = 0.64, respectively).ConclusionIn patients with suspected or known coronary artery disease undergoing invasive angiography, EFV was not associated with FFR.



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Inter-operator variability in compartmental kinetic analysis of 18F-fluoromisonidazole dynamic PET

Publication date: May–June 2018
Source:Clinical Imaging, Volume 49
Author(s): Sadek A. Nehmeh, Jazmin Schwartz, Milan Grkovski, Ivan Yeung, Charles M. Laymon, Mark Muzi, John L. Humm
PurposeTo assess the inter-operator variability in compartment analysis (CA) of dynamic-FMISO (dyn-FMISO) PET.MethodsStudy-I: Five investigators conducted CA for 23 NSCLC dyn-FMISO tumor time-activity-curves. Study-II: Four operators performed CA for four NSCLC dyn-FMISO datasets. Repeatability of Kinetic-Rate-Constants (KRCs) was assessed.ResultsStudy-I: Strong correlation (ICC > 0.9) and interchangeable results among operators existed for all KRCs. Study-II: Up to 103% variability in tumor segmentation, and weaker ICC in KRCs (ICC-VB = 0.53; ICC-K1 = 0.91; ICC-K1/k2 = 0.25; ICC-k3 = 0.32; ICC-Ki = 0.54) existed. All KRCs were repeatable among the different operators.ConclusionsInter-operator variability in CA of dyn-FMISO was shown to be within statistical errors.



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A comparison of contrast-free MRA at 3.0T in cases of intracranial aneurysms with or without subarachnoid hemorrhage

Publication date: May–June 2018
Source:Clinical Imaging, Volume 49
Author(s): Ruifang Yan, Bo Zhang, Long Wang, Qiang Li, Fengmei Zhou, Jipeng Ren, Zhansheng Zhai, Zheng Li, Hongkai Cui
PurposeTo determine the diagnostic accuracy of contrast-free MRA at 3.0T for detection of intracranial aneurysms in patients with subarachnoid hemorrhage.Methods411 patients (183 with SAH and 228 with non-SAH) underwent MRA. Accuracy, sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) were measured and compared with DSA.ResultsExcept for a slight difference in sensitivity in patient-based and aneurysm-based evaluations (P=0.037), there were no other significant differences in accuracy, specificity, PPV, and NPV.ConclusionVR 3D-TOF-MRA is a non-invasive approach with high accuracy in the diagnosis of intracranial aneurysms.



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Scimitar-like ossification of patellae led to diagnosis of Zellweger syndrome in newborn: a case report

Publication date: May–June 2018
Source:Clinical Imaging, Volume 49
Author(s): Anilawan Smitthimedhin, Hansel J. Otero
Zellweger syndrome is the most severe form of a group of autosomal recessive disorders with defective peroxisomes. We report a case of Zellweger syndrome in a newborn baby, which was first suspected by the presence of scimitar-like patella seen on skeletal survey. The subsequent brain MRI showed germinolytic cysts and polymicrogyria, which furthered the suspicion. Laboratory and genetic results confirmed the diagnosis. To date, there are a limited number of case reports of this rare disease. We emphasize skeletal findings that can lead to targeted genetic and laboratory testing and hence earlier diagnosis.



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Ultrasonic histogram assessment of early response to concurrent chemo-radiotherapy in patients with locally advanced cervical cancer: a feasibility study

Publication date: May–June 2018
Source:Clinical Imaging, Volume 49
Author(s): Yan Xu, Tong Ru, Lijing Zhu, Baorui Liu, Huanhuan Wang, Li Zhu, Jian He, Song Liu, Zhengyang Zhou, Xiaofeng Yang
PurposeTo monitor early response for locally advanced cervical cancers undergoing concurrent chemo-radiotherapy (CCRT) by ultrasonic histogram.MethodsB-mode ultrasound examinations were performed at 4 time points in thirty-four patients during CCRT. Six ultrasonic histogram parameters were used to assess the echogenicity, homogeneity and heterogeneity of tumors.ResultsIpeak increased rapidly since the first week after therapy initiation, whereas Wlow, Whigh and Ahigh changed significantly at the second week. The average ultrasonic histogram progressively moved toward the right and converted into more symmetrical shape.ConclusionUltrasonic histogram could be served as a potential marker to monitor early response during CCRT.



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Atypical 18F-FDG PET-CT uptake in the head and neck; a case-based pictorial review

Publication date: May–June 2018
Source:Clinical Imaging, Volume 49
Author(s): Lucy Childs, Andrew Thompson, Huw Jones, Ayshea Hameeduddin, Khalid Ghufoor, Ashok Adams
Positron emission tomography - computed tomography (PET-CT) with fluorine-18-fluorodeoxy-d-glucose (¹⁸F-FDG) has an increasing role in head and neck imaging. Interpretation of ¹⁸F-FDG-tracer uptake in the head and neck requires an understanding of normal physiological patterns of tracer uptake, as well as knowledge of potential pitfalls and atypical patterns. This article presents a select series of unusual patterns of ¹⁸F-FDG uptake on PET-CT imaging of the head and neck.



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