F-18 FDG PET/CT Imaging in Normal Variants, Pitfalls and Artifacts in the Abdomen and Pelvis

Since its introduction into clinical practice, multimodality imaging has revolutionized diagnostic imaging for both oncologic and non-oncologic pathologies. 18F-fluorodeoxyglucose (18F-FDG) PET/CT imaging which takes advantage of increased anaerobic glycolysis that occurs in tumor cells (Warburg effect) has gained significant clinical relevance in the management of most, if not all oncologic conditions. Because FDG is taken by both normal and abnormal tissues, PET/CT imaging may demonstrate several normal variants and imaging pitfalls. These may ultimately impact disease detection and diagnostic accuracy. Imaging specialists (nuclear medicine physicians and radiologists) must demonstrate a thorough understanding of normal and physiologic variants in the distribution of 18F-FDG; including potential imaging pitfalls and technical artifacts to minimize misinterpretation of images. The normal physiologic course of 18F-FDG results in a variable degree of uptake in the stomach, liver, spleen, small and large bowel. Urinary excretion results in renal, ureteric, and urinary bladder uptake. Technical artifacts can occur due to motion, truncation as well as the effects of contrast agents and metallic hardware. Using pictorial illustrations, this paper aims to describe the variants of physiologic 18F-FDG uptake that may mimic pathology as well as potential benign conditions that may result in misinterpretation of PET/CT images in common oncologic conditions of the abdomen and pelvis.

Unusual presentations of ‘‘left ventricular non compaction’’- A rare form of cardiomyopathy

Left ventricular non-compaction is an overall rare form of non-ischemic cardiomyopathy. The true prevalence of left ventricular non compaction (LVNC) is unclear, but it has been reported in 0.014–0.05% of adults and even less in paediatric population [1]. We present the case series of the patients who presented with varied clinical presentation and diagnosed to have left ventricular non-compaction on imaging. We have reviewed the literature regarding diagnostic imaging criteria and imaging pitfalls of this condition.

Structural imaging in neuropsychiatry

This chapter looks into the imaging modalities available in clinical practice, with a brief note on the evolution of the commonly used imaging modalities and their clinical applications. Indications for imaging in neuropsychiatry, with typical examples of some commonly seen clinical conditions, are discussed, including imaging pitfalls and diagnostic dilemmas.

CT-Angiogram Appearance of Iatrogenic Azygos Vein Perforation

An elderly woman underwent placement of a pacemaker lead which was complicated by accidental azygos vein cannulation and perforation. However not a very uncommon complication, we report here several findings on CT-angiogram which highlight imaging pitfalls of this entity. We also review how the case was clinically managed.

Diagnosis Performance of Cerebral Venous Thrombosis with Magnetic Resonance Imaging and Magnetic Resonance Venography in Zahedan (Southeast of Iran): A Series of 57 Patients

BACKGROUND: Cerebral venous sinus thrombosis (CVST) is a scarce disease with poor prognosis and its diagnosis often challenges physicians due to nonspecific symptoms and widespread clinical manifestations. AIM: To investigate the findings of magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) of patients with CVST diagnosis in Ali Ebne Abitaleb Hospital in Zahedan during 2013–2016 and to evaluate imaging pitfalls involving in late diagnosis, complications, and even death. METHODS: This retrospective descriptive study was done on 57 patients with confirmed CVST during 2013–2016 in Ali Ebne Abitaleb Hospital in Southeast of Iran (Zahedan). The MRI and MRV findings and related diagnostic pitfalls were evaluated. Twenty-one patients are pediatrics and 33 patients are adults. RESULTS: Of 57 patients, evidences of cerebral edema were found in 33 patients, among whom 2 patients showed parenchymal edema (cerebral edema) without infarction, and 31 patients exhibited parenchymal edema with infarction. The frequency of involvement in descending order was as followed; transverse sinus (96.49%), sigmoid sinus (49.12%), superior sagittal sinus (29.82%), jugular vein (19.29%), internal cerebral veins (7.01%), straight sinus (5.2%), and cortical veins (5.2%). Diagnostic pitfalls were also found in 8 patients. Seven patients exhibited acute and subacute thrombosis mimicked normal sinus flow void in T2-weighted images. No filling defect was seen on gadolinium-enhanced T1-weighted image in the other patient due to the sub-acute phase of thrombosis. CONCLUSION: The delayed diagnosis of CVST originating from nonspecific clinical features and diagnostic imaging pitfalls can result in poor outcomes in patients. To prevent the diagnostic pitfalls, the clinician should give a brief history and clinical data and radiologist(s) should interpret the findings in addition to the use of advanced MR sequences.

Atypical benign angioproliferative lesion in a cat: Diagnostic imaging pitfalls

The authors present a case report of an atypical liver vascular malformation in a cat. The lesion was diagnosed first by ultrasound, fine needle aspiration and computed tomographic examination, which revealed the presence of a thin-walled single echogenic oval structure in the caudate lobe of the liver without visible flow in Doppler examination and with content similar to blood. The echogenicity of the lesion was variable, which depended on its size and time after aspiration. Initially, atypical haemangioma was suspected. After surgical removal, histopathological examinations were performed. The final diagnosis was a benign angioproliferative lesion.

Top-Ten Pitfalls in Rotator Cuff Ultrasound

Shoulder ultrasound is a commonly performed imaging study that can accurately determine the presence of rotator cuff tendinosis and tears, as well as subacromial-subdeltoid bursal and long head of biceps tendon pathology. High accuracy depends on an awareness of imaging pitfalls that can be encountered and lead to over- or underdiagnosis of rotator cuff pathology. Ten common pitfalls of rotator cuff ultrasound scanning are presented along with ways to avoid these pitfalls.