Aging and cortical bone density of mandible with CBCT

Purpose: To investigate changes of mandibular cortical bone with age using cone-beam computed tomography (CBCT).Materials and methods: We reviewed the CBCT images of 202 patients who were examined in mandibular region by CBCT. The patients were classified into 2 age groups: young group (≦50 years; 51 male (age range 13-50 years, mean age 27.6 years) and 73 female (age range 11-50 years, mean age 30.0 years)) and elderly group (＞50 years; 22 male (age range 53-74 years, mean age 63.8 years) and 56 female (age range 51-82 years, mean age 66.3 years)). The relationship between age and mandibular cortical bone radiographic density as gray values using CBCT was assessed by Pearson's rank correlation test. Regarding age groups, mandibular cortical bone radiographic density using CBCT was performed with one-way repeated measures analysis of variance with Tukey's HSD test.Results: Cortical bone radiographic density in female using CBCT was significantly correlated to age (Y = -6.741X + 1946, R2 = 0.351, P = .000). Furthermore, the cortical bone radiographic density in young female (1754 ± 144) was significantly higher than that in young male (1554 ± 164, P = .000), elderly male (1533 ± 115, P = 0.000) and elderly female (1484 ± 228, P = 0.000).Conclusions: The present study confirmed the changes of mandibular cortical bone with age in female using CBCT. Furthermore, the evaluation of mandibular cortical bone using CBCT can be helpful in intercepting patients at risk of reduced bone mineral density.

Imaging finding in diabetic mastopathy: A case report

Diabetic mastopathy is an uncommon immunologic breast disease occurring usually in patients under long-term insulin treatment. It can pose a question of differential diagnosis with breast cancer especially in case of family history of breast cancer. We report the radiological diagnostic approach of a case of diabetic mastopathy with family history of breast cancer. The mammogram was nonspecific. Ultrasound showed two suspicious masses of right breast without suspicious enhancement on MRI. Diabetic mastopathy was confirmed on histology without cancer cells. Diabetic mastopathy is a diagnostic challenge and needs to be suspected in all patients with type I diabetes. Image-guided biopsy confirmation remains mandatory. The literature is briefly reviewed.

Comparison of image quality of an abdominal acquisition mode of angiography systems from four major manufacturers

Objective: The aim of this study was to compare image quality of different abdominal acquisition modes under conditions simulating obese patients whose images suffer more from noise and scatter radiation. Images were acquired in clinically used acquisition modes on the static and dynamic phantom for four angiography systems.Methods: A LEGO cart with 34 cm of PMMA and Pro-RTG Fluo18 phantom were used to simulate obese patients. The low-contrast resolution was assessed subjectively by two readers and objectively using signal-difference-to-noise ratio (SDNR) and using SDNR to air kerma rate. The line-pair resolution was assessed using the transmitted contrast value for line-pair groups.Results: Systems use different exposure parameters and dose but they differ in postprocessing too. Qualitative and quantitative assessments of noise produced similar results, images produced by systems A and C were noisier than by systems B and D. Highest SDNR was provided by System B, whilst System A produced the lowest values, which were almost the same for objects with different contrast. The image quality was affected mainly by frame lengths and postprocessing, but also by the dose. The images of the static phantom were better compared to the images of the dynamic phantom, which was an expected result.Conclusions: It was possible to identify image quality differences and to characterize features of postprocessing from measurements on standardized objects. A potential for optimization on some systems was identified, although further work, including assessment of clinical images, would be needed as part of the optimization process.

Foetal vascular lesion-Case report

Frequency and preciseness of prenatal detection of foetal tumours increases due to improvement of sophisticated imaging methods. As correct diagnosis impacts the course of care in utero, it is essentially to improve diagnostic workout in a case of detected foetal anomalies. Here we report the case of partly involuting congenital haemangioma of foetus, which antenataly caused foetal secondary cardiomegaly. Pregnant woman was referred to Riga Maternity Hospital with unexplained tumour on the surface of foetal head at 24+2 weeks of gestation. Ultrasound exam revealed tubular structure without solid components between calvarium and skin under the left ear with very rich vascularization. Magnetic Resonance Image demonstrated enhancing multi-cystic lobulated mass. Hypertrophic secondary cardiomegaly was present without any additional structural abnormality. The foetus remained stable until 36+4 weeks of gestation, when the size of tumour succeeded 85 mm × 46 mm. Haemangioma was confirmed after delivery as round raised and infiltrating vascular lesion. After birth MRI demonstrated its connection with a. carotis externa. Propranolol was recommended with continuing follow-up. At 2 years and 3 months of age the lesion decreased by size noticeably, but still persists. Accurate diagnosis lets obstetricians to optimize antenatal care by providing an opportunity for planning deliveries, preparing family and medical staff for appropriate postpartum therapy and management.

CT-Urography: Comparison of different methods for increasing the intra-abdominal pressure

Objective: Investigating the influence of increasing the intraabdominal pressure by Valsalva maneuvers and/or abdominal compression to reach best visualization of the entire urinary tract in computed tomography urography (CTU).Methods: After split-bolus technique, Valsalva maneuvers, compression or a combination of both were applied in 60 patients before late phase images were acquired. The degree of opacification and distension of three segments of the urinary tract were evaluated.Results: After split-bolus CT no significant difference among the groups regarding distention and opacification. A significant increase in distension and opacification was found during Valsalva and the combination of Valsalva and compression.Conclusions: A CTU protocol including a late phase scan with prior application of compression, Valsalva maneuvers or a combination of both showed beneficial effects for the distension and opacification, a significant difference was found by taking location as a covariate.

Changes of cerebrospinal fluid in the upper neck area with age using diffusion weighted MR imaging

Purpose: Few studies have concerned the absolute apparent diffusion coefficient (ADC) values in the normal cerebrospinal fluid in the upper neck area and the effect of aging on diffusion. The purpose of this study was to evaluate changes of cerebrospinal fluid in the upper neck area with age using diffusion weighted MR imaging (DWI).Methods and methods: Our study included 160 patients who underwent MR imaging for oral and maxillofacial diseases. All patients were examined by DWI with 2 b values (0 and 800 sec/mm2) at 1.5 Tesla and ADC maps. The cerebrospinal fluid and spinal cord in the upper neck area were analyzed using the ADC values and age.Results: ADC value of cerebrospinal fluid was significantly correlated to ADC value of spinal cord (R2 = 0.141, p = .000). ADC value of spinal cord had no relation to age (R2 = 0.015, p = .125). ADC value of cerebrospinal fluid had significant relation to age (R2= 0.026, p = .042).Conclusions: We indicated the changes of cerebrospinal fluid in the upper neck area with age using DWI. The data reported herein are representative, and the ADC values can be used for reference in future studies and in clinical settings.

Atypical skull base osteomyelitis in the intensive care unit: A case report

Base of skull osteomyelitis is commonly seen as a complication of malignant otitis externa, involving the temporal bone. It initially presents with aural symptoms such as ear ache and discharge and cranial nerve palsies. We report an atypical presentation of skull base osteomyelitis that did not show signs of otitis externa. The patient presented with severe headache, drowsiness and signs of bulbar weakness including pooling of oropharyngeal secretions. Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) studies showed a bony erosion of the left side of base of skull involving the sphenoid bone and surrounding foramina, left sided coalescent mastoiditis and inflammation of the left parapharyngeal space. There was also inflammation of the tissues encasing the internal carotid artery and jugular veins and thrombosis of left jugular vein. These imaging findings along with cranial nerve palsies were suggestive of malignancy. However, tissue biopsy was negative for malignancy. The growth of Pseudomonas aeruginosa in the biopsy material as well as nasopharyngeal and blood cultures along with elevated Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) levels led to a diagnosis of base of skull osteomyelitis. Hence diagnosis in such cases requires that biopsy material be sent for microbiological analysis, in addition to histology.

Recurrent hemopericardium with cardiac tamponade as an initial presentation of cardiac sarcoidosis

This case report illustrates an unusual presentation of recurrent hemopericardium with cardiac tamponade secondary to pulmonary sarcoidosis with extra-pulmonary cardiac involvement. It also demonstrates the usefulness of cardiac magnetic resonance (CMR) imaging as a non-invasive modality for the diagnosis of cardiac sarcoidosis.

Sonographic assessment of thyroid gland in patients with chronic kidney disease undergoing hemodialysis

Background: Thyroid gland morphology and disorders were affected with chronic kidney diseases (CKD). The study aims to assess thyroid gland disorders and morphology in patients with CKD on regular hemodialysis.Materials and methods: A cross-sectional study included 71 participants divided into two groups. The study group included 51 patients with known chronic kidney disease on hemodialysis and healthy group included 20 participants. The exclusion criteria were thyroid disorders. The thyroid gland was scanned with ultrasound using a 7 MHz probe.Results: The thyroid is enlarged in 21.57% of patients and heterogeneous echotexture in 31.4%. The prevalence of thyroid nodules and cysts were 9.8% and 7.8% respectively. A positive linear correlation existed between duration of hemodialysis and thyroid volume. Thyroid volume and echotexture were significantly increased with duration of hemodialysis (p = .001 and .00 respectively). Thyroid nodules and cysts were not significantly correlated with duration of hemodialysis (p = .06 and .28 respectively).Conclusions: In conclusion, enlargement of thyroid gland and heterogeneity of thyroid tissue were the most common morphological changes in patients with chronic renal failure undergoing hemodialysis. The prevalence increased with longer duration of hemodialysis. Periodic ultrasound assessment of thyroid volume and texture are recommended in hemodialyzed patients to avoid complications.

A variation of colon cut off sign in acute pancreatitis and its mechanism: Double cut-off sign

The colon cutoff sign is a single air-filled loop of transverse colon with abrupt termination of the distal colon. We report an acute pancreatitis case with colon “double” cut-off sign appears both on abdominal radiograph and computed tomography.