Repeatability and reproducibility of apparent diffusion coefficient and fat fraction measurement of focal myeloma lesions on whole body magnetic resonance imaging

Objective: To assess intra- and inter-reader variability of apparent diffusion coefficient (ADC) and fat fraction (FF) measurement in focal myeloma bone lesions and the influence of lesion size. Methods: 22 myeloma patients with focal active disease on whole body MRI were included. Two readers outlined a small (5–10 mm) and large lesion (>10 mm) in each subject on derived ADC and FF maps; one reader performed this twice. Intra- and inter-reader agreement for small and large lesion groups were calculated for derived statistics from each map using within-subject standard deviation, coefficient of variation, interclass correlation coefficient measures, and visualized with Bland–Altman plots. Results: For mean ADC, intra- and inter-reader repeatability demonstrated equivalently low coefficient of variation (3.0–3.6%) and excellent interclass correlation coefficient (0.975–0.982) for both small and large lesions. For mean FF, intra- and inter-reader repeatability was significantly poorer for small lesions compared to large lesions (intra-reader within-subject standard variation estimate is 2.7 times higher for small lesions than large lesions (p = 0.0071), and for inter-reader variations is 3.8 times higher (p = 0.0070)). Conclusion: There is excellent intra- and inter-reader agreement for mean ADC estimates, even for lesions as small as 5 mm. For FF measurements, there is a significant increase in coefficient of variation for smaller lesions, suggesting lesions >10 mm should be selected for lesion FF measurement. Advances in knowledge: ADC measurements of focal myeloma have excellent intra- and inter-reader agreement. FF measurements are more susceptible to lesion size as intra- and inter-reader agreement is significantly impaired in lesions less than 10 mm.

Atherosclerotic Plaque Locations may be Related to Different Ischemic Lesion Patterns

Background: Atherosclerosis of the internal carotid artery (ICA) are an important cause of ischemic stroke. Artery-to-artery embolism is the major stroke mechanism in patients with atherosclerotic carotid disease. We hypothesized that the atherosclerotic ICA geometry and plaque location would be associated with the lesion pattern in acute ischemic stroke.Methods: Ischemic stroke patients with symptomatic proximal ICA disease (> 50% diameter stenosis) were enrolled. The carotid plaque location was divided into high-apical and low-body types. The geometric parameters of the ICA (angles between arteries) were measured; moreover, ischemic lesion patterns were classified according to the number, location, and size of the lesions. Factors associated with plaque location and lesion pattern (dichotomized by size) were investigated.Results: A total of 93 patients (31 high-apical plaques and 62 low-body plaques) were investigated. In patients with low-body plaques, hyperlipidemia was more prevalent and the common carotid artery (CCA)-ICA angle was wider (162.3 ± 9.8° vs. 167.7 ± 10.4°, p = 0.019). Low-body plaques more frequently appeared as small scattered or cortical lesions (54.8% vs. 32.3%, p = 0.040), whereas high-apical plaques more frequently appeared as a large lesion with additional lesions (38.7% vs. 11.3%, p = 0.002). Low-body plaques (odds ratio 3.106, 95% confidence interval 1.105–8.728, p = 0.032) was independently associated with the small lesions only pattern.Conclusions: Low-body plaques more frequently present small-scattered lesions, whereas high-apical plaques more frequently present a large lesion with additional lesions. A wide CCA-ICA angle is associated with low-body plaque of the carotid artery.

Kista radikuler besar yang melibatkan dasar cavum nasalis

Objectives: This case will present a radicular cyst and its expansion effect, seen from cone beam CT (CBCT) 3D radiograph. Case Report: A 32-year-old patient complained about discoloration of her upper anterior teeth and swollen gums. Periapical radiograph for preliminary examination revealed a large radiolucent area with well-defined cortical border in periapical 21. In coronal view, the lesion extends to 22 also causes the destruction of the nasal cavity floor and palatal cortical bone. Endodontic, cyst enucleation, and bone graft was performed to the patient. After endodontic treatment, CBCT examination was performed to determine the extent of cyst lesions. Conclusion: Large lesion needs an adequate radiographic technique to examine anatomical structure involvement. In large cysts, CBCT examination is matter to consider.

Successful Treatment of Gastrosplenic Fistula Arising from Diffuse Large B-Cell Lymphoma with Chemotherapy: Two Case Reports

Gastrosplenic fistula (GSF) is a rare condition arising from gastric or splenic lymphomas. Surgical resection is the most common treatment, as described in previous reports. We report two cases of GSF in diffuse large B-cell lymphoma (DLBCL) patients that were successfully treated with chemotherapy and irradiation without surgical resection. Case 1 was of a 63-year-old man who had primary gastric DLBCL with a large lesion outside the stomach wall, leading to a spontaneous fistula in the spleen. Case 2 was of a 59-year-old man who had primary splenic DLBCL, which proliferated and infiltrated directly into the stomach. In both cases, chemotherapy comprising rituximab + dose-adjusted EPOCH regimen (etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin) was administered. Case 1 had significant bleeding from the lesion of the stomach during the treatment cycle; however, endoscopic hemostasis was achieved. Case 2 developed a fistula between the stomach and the spleen following therapeutic chemotherapy; however, no complications related to the fistula were observed thereafter. In both cases, irradiation was administered, and complete remission was achieved.