ACTA Radiologica (Test)

Acta Radiologica, Ahead of Print. <br/>BackgroundHepatic hemangiomas are the most common benign liver tumors. It is important to know the imaging features of hemangiomas on gadoxetic acid (GA)-enhanced magnetic resonance imaging (MRI).PurposeTo evaluate the qualitative and quantitative imaging features of hemangiomas on GA-enhanced MRI, and to compare imaging features of hemangiomas with and without pseudo-washout sign (PWS).Material and MethodsWe retrospectively included 93 cases of hemangioma that underwent GA-enhanced MRI. The presence of an enhancement pattern in the arterial phase (AP) and PWSs in the transitional phase (TP) were evaluated. Signal-to-norm ratios (SINorm) of hemangiomas, liver parenchyma, and portal vein (PV) as well as contrast-to-norm ratio (CNorm) were assessed. Additionally, hemangiomas with and without PWSs were defined as two separate subgroups, and imaging features were compared.ResultsOf the 93 cases of hemangiomas, 49 (52.6%) had PWSs in the TP. The mean SINorms of hemangiomas showed the highest value in the AP (P < 0.05). The mean CNorms showed positive values in the AP, and gradually decreased (P < 0.05). Hemangiomas with PWSs were significantly rapidly enhanced and smaller in size (P < 0.05), and the mean SINorms was lower in the TP (P = 0.023). While the mean CNorms showed a significant difference in the AP between subgroups (P < 0.001), the enhancement pattern was equal to that of the PV.ConclusionWhen evaluating GA-enhanced MRI, radiologists should utilize quantitative measures in addition to qualitative assessment and should be aware that SI matching with PV in all phases can be a distinguishing finding in the diagnosis of hemangioma.

Acta Radiologica, Ahead of Print. <br/>BackgroundThe extent of renal angiomyolipoma (AML) volume reduction after renal transcatheter arterial embolization (TAE) varies between patients, with no predictive measure available.PurposeTo determine whether the serum lactate dehydrogenase (LDH) concentration shortly after TAE correlates with the extent of tumor shrinkage.Material and MethodsIn a cohort of 36 patients undergoing prophylactic renal TAE for unruptured renal AML, we retrospectively acquired data from patient medical records, including serum LDH before and within 7 days after TAE and the tumor volume before and 12–36 months after TAE. The relationship between the serum level of LDH and reduction in tumor volume was evaluated using Spearman correlation analysis.ResultsThe median LDH concentration was significantly higher after TAE than before (909.0 U/L vs. 186.5 U/L). This early post-TAE serum LDH level and LDH index (post-TAE LDH / pre-TAE LDH) correlated significantly and positively with the absolute decrease in tumor volume (both P < 0.0001). We observed no significant correlation between the relative tumor volume reduction and serum LDH level or LDH index.ConclusionSerum LDH elevation occurs shortly after TAE and correlates with the extent of absolute decrease in AML volume at 12–36 months after TAE. Further large-scale studies are warranted to confirm the predictive role of post-TAE serum LDH level and LDH index in tumor shrinkage in patients with unruptured renal AML.

Acta Radiologica, Ahead of Print. <br/>BackgroundDouble reading of screening mammograms is associated with a higher rate of screen-detected cancer than single reading, but different strategies exist regarding reader pairing and blinding. Knowledge about these aspects is important when considering strategies for future use of artificial intelligence in mammographic screening.PurposeTo investigate screening outcome, histopathological tumor characteristics, and mammographic features stratified by the first and the second reader in a population based screening program for breast cancer.Material and MethodsThe study sample consisted of data from 3,499,048 screening examinations from 834,691 women performed during 1996–2018 in BreastScreen Norway. All examinations were interpreted independently by two radiologists, 272 in total. We analyzed interpretation score, recall, and cancer detection, as well as histopathological tumor characteristics and mammographic features of the cancers, stratified by the first and second readers.ResultsFor Reader 1, the rate of positive interpretations was 4.8%, recall 2.3%, and cancer detection 0.5%. The corresponding percentages for Reader 2 were 4.9%, 2.5%, and 0.5% (P < 0.05 compared with Reader 1). No statistical difference was observed for histopathological tumor characteristics or mammographic features when stratified by Readers 1 and 2. Recall and cancer detection were statistically higher and histopathological tumor characteristics less favorable for cases detected after concordant positive compared with discordant interpretations.ConclusionDespite reaching statistical significance, mainly due to the large study sample, we consider the differences in interpretation scores, recall, and cancer detection between the first and second readers to be clinically negligible. For practical and clinical purposes, double reading in BreastScreen Norway is independent.

Acta Radiologica, Ahead of Print. <br/>BackgroundIn recent years, many studies have proven that percutaneous thermal ablation is an effective second-line treatment method with low complication rates in early-stage non-small cell lung carcinoma and lung metastases. Radiofrequency ablation and microwave ablation are commonly used for this purpose.PurposeTo evaluate the factors affecting the success of the percutaneous thermal ablation treatment with technical success, complication rates, and long-term follow-up results in metastatic lung lesions.Material and MethodsComputed tomography (CT)-guided percutaneous ablation was performed for 70 metastatic lung lesions in 35 patients (22 men, 13 women; mean age = 61.34 years; age range = 41–75 years). Radiofrequency ablation was performed in 53/70 (75.7%) lesions and microwave ablation in 17/70 (24.3%) lesions.ResultsThe technical success rate was 98.6%. Median overall survival, progression-free survival, and local recurrence-free survival of the patients were 33.9 months (range=25.6–42.1 months), 12 months (range=4.9–19.2 months), and 24.2 months (range=8.2–40.1 months), respectively. One- and two-year overall survival rates were 84% and 74%, respectively. Median progression-free survival times were 20.3 months and 11.4 months, respectively, according to the number of metastatic lung lesions being single and multiple, and the difference was statistically significant (P = 0.046). According to the number of lesions ≤3 and >3, the difference was also found statistically significant (P = 0.024) (14.3 months and 5.7 months, respectively).ConclusionIn conclusion, CT-guided percutaneous thermal ablation is a safe and effective treatment method in metastatic lung lesions. The number of lesions is the most important factor in predicting treatment success.

Acta Radiologica, Ahead of Print. <br/>BackgroundThe calcaneal vascular remnant, first described by Fleming et al. in 2005, is a benign intramedullary lesion of the calcaneus with a vascular origin.PurposeTo determine the prevalence and magnetic resonance imaging (MRI) characteristics of incidental calcaneal vascular remnant on routine ankle MRI.Material and MethodsWe retrospectively reviewed 457 ankle MRI scans for the presence of calcaneal vascular remnant. MRI was considered positive when a focal cyst-like area was seen on a T2-weighted sequence, and a low signal intensity was identified on a T1-weighted image beneath the calcaneal sulcus. Patients with calcaneal vascular remnants were further evaluated for age, gender, right or left foot location, size, and lesion characteristics.ResultsThe prevalence of incidental calcaneal vascular remnant was 21.7% on our consecutive ankle MR examinations. The average lesion size was 5.5 mm. No statistically significant difference was noted in the frequency of lesion detection between gender, age, and side of the lesions (P > 0.05). Multilobulated lesions were detected predominantly in women (P = 0.013) and classic type lesions were detected predominantly in men (P = 0.036).ConclusionThis report is the first to determine the prevalence and MRI characteristics of calcaneal vascular remnants. Detecting and reporting this lesion on routine MRI is essential to avoid confusion with other pathologic entities.

Acta Radiologica, Ahead of Print. <br/>

Acta Radiologica, Ahead of Print. <br/>BackgroundThe imaging diagnosis of Poland syndrome is mostly computed tomography (CT) or magnetic resonance imaging (MRI), whereas high-frequency ultrasound for the diagnosis of Poland syndrome is relatively rare.PurposeTo investigate the diagnostic value of high-frequency ultrasound for Poland syndrome.Material and MethodsA retrospective analysis of 15 patients diagnosed with Poland syndrome was performed, and the characteristics of ultrasound images were summarized.ResultsHigh-frequency ultrasound clearly depict the anatomical structures of each layer of the chest wall in patients with Poland syndrome. Ultrasonography mainly showed partial or total absence of the pectoralis major muscle on the affected side, and some of which were combined with the absence of the pectoralis minor muscle. The difference was statistically significant in the thickness of the affected chest wall compared with the healthy side (P < 0.01). Out of 15 cases with Poland syndrome, 11 were associated with ipsilateral brachydactyly or syndactyly, and high-frequency ultrasonography showed that the bifurcation position of the common palmar digital artery on the affected finger was lower than that on the healthy side.ConclusionHigh-frequency ultrasound is an effective imaging method for the diagnosis of Poland syndrome.

Acta Radiologica, Ahead of Print. <br/>BackgroundBreast cancer mainly affects women aged >50 years; however, younger women may also have advanced breast cancer, so early detection is important.PurposeTo collect and review the imaging findings of women aged <30 years with breast cancer to find better diagnostic approaches for the early diagnosis of breast cancer in young women.Material and MethodsIn this study, 45 patients aged <30 years with a diagnosis of breast cancer were evaluated. Imaging assessments were performed based on ultrasound, mammography, and magnetic resonance imaging (MRI) findings. Finally, the findings were compared with the pathological results.ResultsPredominant findings in ultrasound included irregular spiculated mass in 59.4%. In mammography, irregular high-density mass (46.5%) and suspicious micro calcification (42.8%) were the most common findings. In MRI, the predominant feature was a heterogeneous enhancing mass with an irregular shape and irregular margin (81%) with a 45% plateau and 36% washout kinetic pattern. In the pathology assessment, invasive ductal carcinoma was the most common finding (84.4%). All three modalities—MRI, ultrasonography, and mammography—are valuable, with sensitivities of 100%, 93.3%, and 90%, respectively.ConclusionUltrasound, mammography, and MRI are highly sensitive and accurate tools for detecting breast cancer lesions in young women. Regular clinical breast examination with breast self-examination, and in suspected cases, ultrasound as the first imaging modality followed by mammography and/or MRI are the preferred diagnostic approach.

Acta Radiologica, Ahead of Print. <br/>

Acta Radiologica, Ahead of Print. <br/>BackgroundThe reference protocol for the quantification of coronary artery calcium (CAC) should be updated to meet the standards of modern imaging techniques.PurposeTo assess the influence of filtered-back projection (FBP), hybrid iterative reconstruction (IR), and three levels of deep learning reconstruction (DLR) on CAC quantification on both in vitro and in vivo studies.Material and MethodsIn vitro study was performed with a multipurpose anthropomorphic chest phantom and small pieces of bones. The real volume of each piece was measured using the water displacement method. In the in vivo study, 100 patients (84 men; mean age = 71.2 ± 8.7 years) underwent CAC scoring with a tube voltage of 120 kVp and image thickness of 3 mm. The image reconstruction was done with FBP, hybrid IR, and three levels of DLR including mild (DLRmild), standard (DLRstd), and strong (DLRstr).ResultsIn the in vitro study, the calcium volume was equivalent (P = 0.949) among FBP, hybrid IR, DLRmild, DLRstd, and DLRstr. In the in vivo study, the image noise was significantly lower in images that used DLRstr-based reconstruction, when compared images other reconstructions (P < 0.001). There were no significant differences in the calcium volume (P = 0.987) and Agatston score (P = 0.991) among FBP, hybrid IR, DLRmild, DLRstd, and DLRstr. The highest overall agreement of Agatston scores was found in the DLR groups (98%) and hybrid IR (95%) when compared to standard FBP reconstruction.ConclusionThe DLRstr presented the lowest bias of agreement in the Agatston scores and is recommended for the accurate quantification of CAC.