Computerized tomography-guided transthoracic needle biopsy (CT-TTNB) plays an important role in the diagnostic work-up of lung lesions. The literature reports varying results on complication rates, severity of complications, and diagnostic yield. To evaluate CT-TTNB as a radiological outpatient clinic procedure and explore diagnostic yield and complication rates. Between January 2017 and October 2019, a total of 559 patients underwent CT-TTNB. Patient records and CT scans were retrospectively reviewed and patient characteristics, lesion characteristics, biopsy procedure, and per- and post-procedural complications, as well as pathological diagnosis, were registered. Of 559 patients included, 511 had biopsies performed. Thereby, 48 biopsies (8.6%) were discontinued because of patient compliance issues and/or the occurrence of pneumothorax before the biopsy was performed. The overall pneumothorax rate was 49.2% (n = 275 of 559 patients). Insertion of a drainage catheter was needed in 85 of the 275 patients with pneumothorax. Parenchymal bleeding was seen in 26.5% of the patients and haemoptysis in 5.5%. No cases of bleeding or haemoptysis required intervention or admission. Small mean lesion size and increased distance from pleura to the lesion were associated with a higher occurrence of complications. A conclusive pathological diagnosis was obtained in 278 of 511 (54.4%) biopsies. No patients were re-admitted after the two-hour observational period in the radiological department. CT-TTNB as an outpatient clinic procedure is feasible but has a moderate diagnostic yield and relatively high complication rates for minor complications.
CT-guided percutaneous bone biopsy is a minimally invasive and effective procedure for evaluating and diagnosing bone lesions. To evaluate the diagnostic yield, tumor types, and complication rates of CT-guided percutaneous bone biopsy procedures at a single tertiary institution. This retrospective study analyzed 508 biopsy procedures performed on 473 patients between March 2019 and March 2024. Patients were identified through the RIS/PACS system at Aarhus University Hospital. Data on diagnostic yield, tumor types, and complications were retrospectively reviewed and collected from electronic health and histopathology records. Complications were classified according to the Society of Interventional Radiology (SIR) and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification systems. The most common findings were metastatic lesions (n = 234), with breast cancer being the most frequent primary tumor. The procedures resulted in an overall diagnostic yield of 88.7% and a total complication rate of 5.5%. This study demonstrates that CT-guided percutaneous bone biopsy is a reliable method with a high diagnostic yield and a low complication rate. These findings support its continued role as a key diagnostic tool in the clinical management of bone lesions.
Calcification of abdominal arteries is an important risk marker in vascular disease. Automated, objective quantification methods could improve reproducibility and reduce observer dependency in clinical practice. To develop and evaluate a deep learning method for quantifying abdominal arterial calcification from contrast-enhanced CT angiography (CTA). We retrospectively collected 223 CTA volumes, divided into 147 training and 76 test cases. Ground truth calcification segmentations were manually annotated, while vessel segmentations were generated by a previously trained neural network and manually refined. Two nnU-Net models were trained, one for artery segmentation and one for calcification segmentation. Renal, mesenteric, and common iliac arteries were shortened algorithmically. Performance of the models was evaluated using Dice score, volumetric similarity, sensitivity, precision, and Jaccard index. Calcification burden was defined as the ratio of calcified volume to artery volume. The amount and the average size of calcification clusters were investigated. The performance of the method was benchmarked against an idealized threshold-based approach and a more clinically realistic approach. The neural network achieved performance comparable to the optimized threshold-based method, with slight improvements across several segmentation metrics. Dice scores and volumetric similarity demonstrated reliable vessel and calcification detection. The predicted calcification burden score showed high correlation with the ground truth calcification burden score. The proposed deep learning tool enables fast, reproducible, and observer-independent quantification of calcification in major abdominal vessels, offering a practical alternative to manual or threshold-based scoring methods.
A 41-year-old woman with placenta previa and a prior cesarean delivery presented with placenta accreta spectrum (PAS). MRI at 26 weeks of gestation demonstrated an intraplacental hypointense region on diffusion-weighted imaging corresponding to diffusion lacunae (DL). Additionally, irregular hypointense areas on T2-weighted imaging corresponding to T2 dark bands were observed. The entire placenta and uterine wall were sectioned through close collaboration between pathologists and radiologists to match the axial MRI slice plane. MR-pathologic correlation was performed using representative axial MRI and histopathologic findings. Histopathology revealed that DL corresponded to villous-devoid areas suggesting placental lacunae with recent thrombi, whereas T2 dark bands predominantly represented thrombi with lines of Zahn, reflecting the gradual development of thrombi under conditions of blood stasis with residual blood flow. These two MRI findings may therefore represent sequential stages within the same pathological process in PAS.
Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis. Mixed ECD-Langerhans cell histiocytosis (LCH) is uncommon, with fewer than 200 cases reported. Diagnosis is challenging and relies on clinical, radiological, and histopathological correlation. We present the case of a 61-year-old man with night sweats, weight loss, and recently diagnosed type 2 diabetes. Imaging revealed cystic lung lesions, perirenal infiltration, and circumferential aortic wall thickening. FDG PET-CT demonstrated multifocal hypermetabolism involving lymph nodes, perirenal soft tissues, and the aortic wall, but no bone involvement. These lesions were shown to progress on subsequent imaging. A lymph node and perirenal biopsies confirmed a mixed form of ECD-LCH with BRAFV600 E mutation and associated chronic myelomonocytic leukemia. The patient was started on targeted therapy with cobimetinib, a MEK inhibitor. Mixed ECD-LCH is a rare entity that typically demonstrates more frequent and widespread organ involvement, particularly affecting the lungs. Its clinical and radiological presentation can have features of both disorders, such as bone, lung, kidney, and vascular involvement. The diagnosis is challenging and requires biopsy with histopathology and genetic testing to be confirmed. Treatment is generally targeted therapy guided by the driver mutations that are identified. We present a rare case of mixed ECD-LCH with thoraco-abdominal and pulmonary involvement. Comprehensive diagnostic workup including histopathology and molecular profiling is crucial for accurate diagnosis and initiation of targeted therapy.
Musculoskeletal complications secondary to pancreatitis, including polyarthritis, panniculitis, and bone infarction (Pancreatitis Panniculitis Polyarthritis syndrome), are rare and under-recognized. We report a case of a 31-year-old man with alcohol use disorder who initially presented with acute pancreatitis. Two months later, he developed migratory polyarthritis and subcutaneous nodules. Radiographs revealed permeative bone lesions, and MRI demonstrated multiple bone infarcts. Subcutaneous biopsy confirmed panniculitis. His clinical course was complicated by infected pancreatic necrosis and splanchnic vein thromboses. Joint symptoms improved with aggressive treatment of pancreatitis. Early imaging evaluation is essential in patients with pancreatitis and musculoskeletal symptoms. Recognition of bone infarctions and panniculitis should prompt consideration of systemic pancreatic complications.
Although intraoperative magnetic resonance imaging (iMRI) is well established in neurosurgery, its role in musculoskeletal oncology remains unclear. To assess the feasibility and safety of iMRI in bone and soft tissue tumor surgery, focusing on giant cell tumor of bone (GCTB) after denosumab. Fourteen patients (12 GCTB, 1 undifferentiated pleomorphic sarcoma [UPS], 1 chondroblastoma) underwent tumor resection with intraoperative 0.4 T MRI between 2017 and 2024. Outcomes included residual tumor detection, recurrence, and safety. iMRI identified residual tumor in 7 of 12 GCTB patients (58.3%), all histologically confirmed. At a median follow-up of 42 months, recurrence occurred in one GCTB case (8.3%). iMRI guided complete resection in a femoral head chondroblastoma, enabling full functional recovery. Soft tissue assessment was limited in the UPS case. No iMRI-related complications occurred. iMRI is a feasible and safe adjunct in bone tumor surgery, enhancing detection of residual tumor and supporting joint-preserving procedures, particularly in GCTB after denosumab.
Gastroepiploic artery aneurysms (GEAAs) and their rupture are very rare but often serious. However, emergency management has yet to be standardized. To clarify the clinical features of GEAAs and outcomes of transcatheter arterial embolization (TAE). This is a retrospective, single-center 12 case series of GEAAs experienced between 2006 and 2023. We reviewed medical records to determine the case background, angiographic images, TAE techniques and success rate, and outcomes. Abdominal angiography was performed via the femoral artery to identify the inflow and outflow vessels of the GEAAs. Subsequently, a microcatheter was advanced to the target site, and embolization was performed with microcoils and/or NBCA-Lipiodol mixture. Nine ruptured and one unruptured pseudo-GEAA cases were treated by emergency TAE, while the remaining two unruptured cases were treated electively. The average diameter of the ruptured GEAAs was 7.9 mm. The most common underlying diseases were segmental arterial mediolysis in 4 cases. Morphological classification revealed 5 cases of dissecting, 4 of pseudo, and 3 of true. TAE was successful in seven of the nine ruptured and in all three unruptured cases. Two patients with ruptured GEAAs after unsuccessful TAE were subsequently saved by surgery. TAE using the triple coaxial catheter system was performed in 7 cases with good results. Even small-diameter GEAAs can rupture, resulting in life-threatening conditions, but emergency TAE is safe and effective. However, there are some cases in which TAE fails, so it is important to make a prompt decision to proceed to surgical treatment.
Fetal magnetic resonance imaging (MRI) has become a valuable noninvasive method for evaluating congenital anomalies of the fetus and can serve as an important adjunct to the prenatal ultrasound, particularly where the ultrasound is unable to exclude or detect fetal abnormalities. This pictorial review will describe the utilization of three-dimensional fast imaging employing steady-state acquisition (3D-FIESTA) in various clinical entities, specifically at 3T, and how to generate clinically valuable information.
Sacroiliac joint (SIJ) disorders are among the most common causes of chronic low back pain. Imaging-guided SIJ injections are widely used as an early diagnostic tool, with corticosteroid often added to provide a therapeutic component. Evidence of factors predicting the therapeutic outcome of these injections remains scarce. To evaluate the effect of SIJ osteoarthritis and other potentially relevant demographic, imaging, and procedural factors on the patient-reported therapeutic outcome of imaging-guided SIJ injection. This retrospective single-center study included 101 patients who underwent specialist-referred imaging-guided SIJ injection between 2010 and 2023. Medical records and procedural reports were reviewed to collect relevant patient information, and associated SIJ MRIs and CT scans were reanalyzed for osteoarthritis, sacroiliitis, and bone marrow edema by an experienced musculoskeletal radiologist. The association of demographic, imaging, and procedural factors with the therapeutic injection outcome was assessed using logistic regression modeling. Of 101 patients who underwent an imaging-guided SIJ injection, 72 (71.3%) met the inclusion criteria. The mean age was 52.2 (SD 14.2) years, and 30 patients (41.7%) achieved a positive therapeutic response. Increasing age was significantly associated with a lower likelihood of a positive outcome, with the probability decreasing on average by 9.4% for each additional year of age (OR 0.91 [95% CI 0.84-0.99]). Neither SIJ osteoarthritis grade nor other demographic, imaging, or procedural factors showed a significant association with injection outcome. Increasing age was significantly associated with a lower likelihood of achieving a positive therapeutic SIJ injection outcome, while SIJ osteoarthritis grade showed no association.
Magnetic resonance imaging (MRI) enables the non-invasive assessment of myocardial tissue properties through the T1, T2, and T2* relaxation mapping. Establishing population-specific normal reference values enhances diagnostic accuracy. To study the effect of sex and age on the T1, T2, and T2* relaxation time constants in a healthy Finnish population. We recruited 47 healthy volunteers aged 18-60 years from Eastern Finland from 2023 to 2024 and categorised them by sex and age (18-30 years, 31-41 years, and 42-60 years). The participants underwent a comprehensive screening process to eliminate the possibility of cardiac disease. MRI scans were conducted on 40 participants at 1.5 T. The T1, T2, and T2* relaxation time constants were calculated for basal, mid-ventricular, and apical short-axis slices. The T1 and T2 relaxation time constants were higher in females than males (T1: 1040 ± 29 vs 1020 ± 17 ms, p < .01; T2: 51 ± 4 vs 48 ± 3 ms, p < .001). The 95% normal T1 range was 981-1098 ms for females and 985-1054 ms for males. The normal T2 range was 44-58 ms for females and 43-53 ms for males. No sex differences were found in the T2* relaxation times. The septal T2* across the whole population was 36 ± 7 ms (95% normal limit: 22-49 ms). This study established age-independent and sex-specific reference values for the native myocardial T1, T2, and T2* relaxation time constants at 1.5 T. Females had higher T1 and T2 values than males, and age did not affect these values.
Extrapulmonary tuberculosis represents 15-20% of all tuberculosis infections and can involve nearly any organ, earning tuberculosis a reputation as one of the great mimickers in medicine. Imaging plays a critical role in diagnosing extrapulmonary tuberculosis, which presents with a wide range of manifestations. We present a pictorial essay comprising cases from Asia, where tuberculosis remains endemic, illustrating the imaging characteristics of extrapulmonary tuberculosis with a focus on thoracoabdominal pathology. Differential diagnoses that exhibit similar imaging findings are also discussed. We aim to raise awareness among radiologists about the importance of considering extrapulmonary tuberculosis for accurate diagnosis and timely management.
Abdominal bulging affects up to one-fourth of patients after flank incision, with half experiencing impaired quality of life. Identifying patients at risk for morbid bulge could improve preventive and supportive care. To characterise muscular changes related to postoperative abdominal bulging and design a visual scoring system to grade bulge on postoperative CT scans. Patients treated with open partial nephrectomy via a flank incision between 2005 and 2016 at the University Hospital of Umeå were included. Pre- and postoperative CT scans of the first 50 consecutive patients were used to characterise imaging features of the postoperative abdominal wall. From these features, a four-tiered scoring system for abdominal bulge was designed. Two independent observers tested the system on CT scans from the 50 next patients. Inter-rater reliability was assessed using Fleiss' Kappa. Common features of abdominal bulging were extracted and a four-tier visual score ranging from normal abdominal wall to severe bulge was developed. Among the patients, ∼70% had a normal abdominal wall, ∼25% had bulge score 1, ∼7% score 2, and ∼1% score 3. Inter-rater agreement was 73.5%, with Fleiss' Kappa 0.44. Features of bulge were reduced muscle thickness and ipsilateral gravitational slump affecting part or all of the lateral abdominal wall. The proposed scoring system demonstrated only moderate inter-rater reliability in this pilot setting. Further research on postoperative abdominal wall changes is needed before implementing imaging-based assessments in clinical care.
We report a case demonstrating the evolution of diffusion lacunae (DL) into thrombus, supported by serial MRI and MR-pathologic correlation. A 36-year-old woman with a pregnancy achieved via frozen-thawed embryo transfer presented with complete placenta previa and vaginal bleeding. MRI at 27 weeks of gestation revealed an irregular intraplacental hypointense area on diffusion-weighted imaging corresponding to DL. Follow-up MRI at 32 weeks showed that the DL had become less discernible and appeared hyperintense, similar to the surrounding placenta. On the following day, the patient developed hemorrhagic shock and underwent emergency cesarean delivery, without evidence of placental adherence and decidual deficiency, indicating that the DL represented a placental lake rather than placental lacunae. Histopathologic examination demonstrated a paucity of chorionic villi and thrombus formation with lines of Zahn in the DL area. These findings provide direct evidence that DL may undergo thrombus formation over time, reflecting dynamic changes related to blood flow stasis within the placenta.
Hip dysplasia (HD) is a prevalent cause of non-traumatic hip pain, which may result in osteoarthritis. Radiological measurements of HD exhibit variability based on reader and imaging modality, why it is important to know the agreement between different measurement methods. To estimate agreement between measurements of lateral center edge angle (LCEA) and acetabular inclination angle (AIA) made, respectively, on Computed Tomography (CT) scans by humans and radiographs analyzed by an algorithm. To estimate impact of pelvic rotation on agreement between CT and radiographic measurements. CT measurements were retrospectively extracted from 172 radiology reports. Radiographs were analyzed using an algorithm. Bland-Altman analysis assessed agreement between CT and radiographic measurements. Regression analyses estimated impact of pelvic rotation on inter-modality agreement. Mean measured bias (95% confidence interval [CI]) between CT and radiographs for LCEA of right/left hip was 5.53° (95% CI: 4.81 to 6.24) and 5.13 (95% CI: 4.43 to 5.83), respectively. Corresponding values for right/left AIA were 1.08 (95% CI: 0.49 to 1.67) and -0.03 (95% CI: -0.60 to 0.05). Pelvic rotation affected right LCEA and AIA measurements, with a change in obturator foramen index of, respectively, 0.35 and 0.6 resulting in approximately 2° change in values. There was a significant difference in agreement of 5° between CT and radiographs for the LCEA bilaterally. The difference for the AIA was between 0 and 1°, probably of little clinical significance. Pelvic rotation slightly affected bias of the right LCEA, suggesting minimal clinical impact of a slightly rotated pelvis.
Drug-coated balloons (DCB) are used for vascular access interventional therapy (VAIVT). However, few studies on patients with repeated short-term restenosis after VAIVT using a standard balloon (SB) have been reported, and the effect of DCB use on patency in these patients remains unclear. This study aimed to evaluate the efficacy of DCB in patients with repeated short-term restenosis after VAIVT with SB. This was a single-center retrospective study. We enrolled 50 consecutive patients who suffered two consecutive restenosis episodes within 6 months after VAIVT with SB. In the third session, patients were treated with DCB or SB. Target lesion revascularization (TLR) was evaluated for 1 year after the third session, with the primary endpoint being the TLR-free rate at 6 months after VAIVT. At the third procedure, 24 patients were treated with DCB (DCB group), whereas 26 were treated with SB (SB group). The TLR-free rates at 6 months and 1-year were significantly higher in the DCB group than in the SB group (79.2% vs 26.9%, p < .001; and 41.7% vs 7.7%, p = .005). In the DCB group, a significant correlation was observed between the TLR duration from VAIVT with DCB and the prerestenosis duration before DCB treatment. Among patients with repeated short-term restenosis after VAIVT, DCB use significantly improved short-term patency compared with that after SB use. DCB may help extend the period between sessions, which are repeated in the short term, to an acceptable length.
Cardiac amyloidosis is an infiltrative cardiomyopathy caused by the deposition of abnormally folded proteins within the myocardium. Several amyloid subtypes have been documented, with diagnosis supported by abnormal serum plasma electrophoresis, multimodality imaging, and endomyocardial biopsy. Herein, we describe the atypical MRI findings of vascular-variant cardiac amyloid supported by histopathological diagnosis. Knowledge of the vascular-variant cardiac amyloid, in which amyloid deposits in the myocardial vasculature rather than the interstitium, will enable clinicians to proceed down appropriate diagnostic and treatment pathways.
Metaplastic breast cancer (MBC) is a rare and heterogeneous malignancy characterized by the presence of both epithelial and mesenchymal elements. Among its variants, MBC with osteoclastic giant cells is extremely uncommon and presents diagnostic challenges because of its diverse histopathological and imaging features. We report the imaging features of a patient with pathologically proven MBC with osteoclastic giant cells as follows: a high-density mass with microcalcification was revealed on mammography; and a microlobulated, mixed cystic and solid mass with posterior acoustic enhancement was revealed on ultrasound. MRI revealed a round mass with circumscribed margins, rim enhancement and high T1-weighted signal intensity due to internal haemorrhage, heterogeneous T2-weighted high-signal intensity and initial fast enhancement and rapid washout kinetics that was classified as BI-RADS 5. Left mastectomy was performed, and the final diagnosis was consistent with that of MBC.
COVID-19 patients may have residual pulmonary alterations after the acute disease, with fibrotic-like alterations. Since metalloproteinases (MMP) and their regulators may be involved in inflammation and abnormal repair processing, we aimed to investigate the correlations between MMP-9, a tissue inhibitor of metalloproteinases (TIMP-1) and chest CT abnormalities in acute phase and mid-term follow-up. COVID-19 patients with plasma analyses and CT scans performed at acute onset and 3 months after discharge (T post) were evaluated. MMP-9, TIMP-1, and MMP-9/TIMP-1 ratio were analyzed. CT extents of COVID-19 pneumonia and fibrotic-like alterations were visually scored (score range 0-25). Spearman rank correlation analysis (p-value <.05) was computed between acute and mid-term plasma analyses and CT scores. 39 patients were enrolled. At hospital admission, MMP-9, TIMP-1, and MMP-9/TIMP-1 had a median of 240.5 ng/mL, 258.8 ng/mL, and 0.9. The median CT global and fibrotic-like scores were 9 and 6. At T post, MMP-9 and TIMP-1 were not statistically different (p-value <.05). There was a reduction of CT global score (p-value = .00007). A significant correlation was found between MMP-9 and CT global score at hospital admission (ρ = 0.456, p-value = .003) and between MMP-9/TIMP-1 ratio and CT global score at hospital admission (ρ = 0.406, p-value = .009). No other significant correlations were found between plasma enzymes and CT alterations, both in acute and mid-term follow-up. MMP-9 plasma levels and MMP-9/TIMP-1 ratio correlate with lung involvement during the acute phase. None of the levels of MMP-9, TIMP-1, and MMP-9/TIMP-1 ratio may be adopted as predictors of residual pulmonary alterations in mid-term follow-up.
Radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) located in the caudate lobe is technically challenging because of the tumor's deep location and proximity to major vascular structures. A 71-year-old woman with a 2-cm HCC in segment I underwent conventional transcatheter arterial chemoembolization (TACE) via the femoral artery. Immediate RFA was not feasible because CT arterial portography revealed no safe puncture route due to surrounding vasculature. On the following day, angiography using a left transradial approach was performed with the patient in the prone position, enabling identification of a safe dorsal puncture path. After creation of an artificial pneumothorax, percutaneous CT-guided RFA was successfully completed without complications. Prone transradial angiography can facilitate safe RFA for hepatic tumors in anatomically challenging locations such as the caudate lobe. This approach may broaden treatment options when conventional supine access is not possible.