Yi-Chih Hsu

Predictive value of 18F-FDG PET and CT morphologic features for recurrence in pathological stage IA non-small cell lung cancer.

AbstractPatients with pathological stage IA non-small cell lung cancer (NSCLC) may relapse despite complete surgical resection without lymphovascular invasion. A method of selecting a high-risk group for adjuvant therapy is necessary. The aim of this study was to assess the predictive value of 18F-fluorodeoxyglucose (FDG) uptake and the morphologic features of computed tomography (CT) for recurrence in pathological stage IA NSCLC.One hundred forty-five patients with pathological stage IA NSCLC who underwent pretreatment with FDG positron emission tomography and CT evaluations were retrospectively enrolled. The associations among tumor recurrence and patient characteristics, maximal standard uptake value (SUVmax) of primary tumors, and CT imaging features were investigated using univariate and multivariate analyses. A receiver operating characteristic (ROC) curve analysis was performed to quantify the predictive value of these factors.Tumor recurrence developed in 21 (14.5%) of the 145 patients, and the 5-year recurrence-free survival rate was 77%. The univariate analysis demonstrated that SUVmax, the grade of histological differentiation, tumor size, and the presence of bronchovascular bundle thickening were significant predictive factors (P < 0.05). A higher SUVmax (≥2.5) (P = 0.021), a lower ground-glass opacity ratio (⩽17%) (P = 0.014), and the presence of bronchovascular bundle thickening (P = 0.003) were independent predictive factors of tumor recurrence in the multivariate analysis. The use of this predictive model yielded a greater area under the ROC curve (0.877), which suggests good discrimination.The combined evaluation of FDG uptake and CT morphologic features may be helpful in the prediction of recurrence in patients with pathological stage IA NSCLC and in the stratification of a high-risk group for postoperative adjuvant therapy or prospective clinical trials.

Assessment of Cam-Type Femoroacetabular Impingement by Ultrasonography: Value of Anterior Femoral Distance Measurements

PURPOSE To retrospectively determine the reproducibility and performance of a quantitative measurement for cam-type femoroacetabular impingement (FAI) designated as the anterior femoral distance (AFD) of the femoral head-neck junction identified at ultrasonography (US). MATERIALS AND METHODS 72 patients with clinically suspected FAI were retrospectively evaluated, and US studies were performed during a 20-month period. Of these, we selected 53 patients who underwent subsequent magnetic resonance (MR) arthrography and had adequate recorded US images. All the longitudinal US images of the anterior and anterosuperior contours of the femoral head-neck junction were recorded by a radiologist. 33 of these US images were also recorded by a technician. An alpha angle of > 55° on MR arthrography was indicative of cam-type FAI. Two independent radiology residents blinded to the clinical data and MR arthrography measured the maximal femoral head-neck overgrowth defined as the AFD on US (AFD-US). Reproducibility was assessed using intra-class correlation coefficients (ICCs) and Bland-Altman plots, and diagnostic performance was assessed using receiver operating characteristic (ROC) analysis. RESULTS AFD-US showed high intra- and inter-rater agreement (ICC = 0.913 - 0.968) in all measurements and good reproducibility among different operators in the anterior contour measurements (ICC = 0.881) but not in the anterosuperior contour measurements (ICC = 0.196). An AFD-US cut-off value of 4.0 mm in the anterior contour yielded the greatest sensitivity (80.9 %) and specificity (87.5 %) for the diagnosis of cam-type FAI by ROC analysis. CONCLUSION AFD-US of the anterior contour of the femoral head-neck junction is helpful in diagnosing cam-type FAI.

Cookie bite cortical osteolytic lesions: a hint of skeletal metastasis from bronchogenic carcinoma

Learning point for clinicians Cookie bite lesions indicate focal eccentric osteolytic destruction of the external cortex of a long tubular bone. These lesions are suggestive of cortical metastasis typically originating from bronchogenic carcinoma. Therefore, the lung should be the first target of investigation in patients with cookie bite cortical lesions. A cookie bite lesion indicates focal eccentric intracortical osteolytic destruction of a long tubular bone. Deutsch and Resnick1 coined the term to describe cortical bone metastases from bronchogenic carcinoma. Although cookie bite metastasis can develop from other primary sources, the most common primary is bronchogenic carcinoma.2,3 Here, we present a case of adenocarcinoma of the lung presenting with cookie bite cortical metastatic lesions involving bilateral tibia. A 39-year-old woman visited a local clinic complaining of right leg pain for 6 months. She had no past …

Spontaneous Achilles tendon rupture in a diabetic neuropathy patient on long-term hemodialysis

A 65-year-old male presented with a slowly-growing mass over the right heel region in previous 6 months. No pain, disability or limited range of motion was reported as compared with usual daily activities. He has history of non-insulin-dependent diabetes mellitus for 20 years. Diabetic neuropathy resulted in progressive decline in his sensory and motor function of lower extremities in recent 6 years. He underwent regular hemodialysis three times per week for end-stage renal disease in past 10 years. On account of tertiary hyperparathyroidism, …

Diffusion tensor imaging findings of the median nerve before and after carpal tunnel corticosteroid injection in patients with carpal tunnel syndrome: a preliminary study:

Background Corticosteroid injections are a popular technique for carpal tunnel syndrome (CTS) treatment and are believed to provide rapid symptom relief. Purpose To use magnetic resonance diffusion tensor imaging (MR-DTI) to determine the association between diffusion values of the median nerve (MN) at several anatomic locations and symptom relief in patients with CTS following corticosteroid injection. Material and Methods MR-DTI was performed on 15 wrists of 12 patients with CTS before and two weeks after ultrasound-guided corticosteroid injections. We recorded the patients’ clinical data including sex, age, side of injection, satisfaction, and symptom relief. Satisfaction and symptom relief were rated using a Likert scale and the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scale. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of the MN at the levels of the distal radioulnar joint (DRUJ), pisiform bone, and hamate bone were determined. Results All patients had ≥50% satisfaction on the injection side. In comparison with baseline values, post-injection ADC was significantly lower (P = 0.001) but FA was not significantly higher (P = 0.11) at the pisiform bone level on the injected wrists. At the DRUJ and hamate bone levels, no obvious inter-scan change in FA and ADC (P > 0.05) was observed. The decrease in ADC at the pisiform bone level strongly correlated with the decrease in BCTQ scores (r = 0.628; P = 0.012). Conclusion Symptom relief in patients with CTS receiving corticosteroid injection is related to the change in ADC of the median nerve at the level of the pisiform bone, as determined using MR-DTI.

Assessment of factors that could affect the success of US-guided contrast injection for hip MR arthrography

Background To retrospectively evaluate the association between possible influencing factors and failed first attempts to inject a contrast agent intra‐articularly under ultrasound (US)‐guidance for direct magnetic resonance (MR) arthrography of the hip joint. Methods Ninety consecutive patients (38 women and 52 men; mean age, 42 years) undergoing US‐guided hip MR arthrography (3 bilaterally) were retrospectively included in this study. The potential influencing factors were sex, age, body mass index (BMI), side of injection, target site, trajectory of the needle, additional use of needle tip rotation, failed first‐attempt, and capsule elongation at the site of needle insertion. Results First‐attempt failure was significantly associated with reduced capsule elongation at the target site and no additional use of needle tip rotation (OR 10.708; 95% CI 1.847–62.059; OR 3.518; 95% CI 1.120–11.047). Capsule elongation (sufficient for needle bevel insertion) was significantly larger at the femoral head‐neck junction (5.2 ± 1.5 mm) than at the femoral head (2.9 ± 1.3 mm) (p < 0.001). Conclusion Less capsular elongation of the femoral head and no additional use of needle tip rotation to reduce the difficulty in contrast material delivery can increase the first‐attempt failure rate in patients undergoing US‐guided hip arthrography.

Visualization of Ectopic Ureteral FDG Retention in an Incidental Case of Duplex Renal Collecting System

Ureteral duplication anomaly is usually diagnosed by ultrasound, voiding cystourethrography, radioisotope renography and sometimes excretory urogram, but there have been not many cases of F-18 FDG PET-demonstrated ureteral duplex. We describe a 68-year-old female without history of abdominal-pelvic malignancy. Under health examination, F-18 FDG PET showed extraordinarily ureteral FDG activity connecting to the upper pole of kidney. Co-registered CT scan displayed duplex renal collecting system by presenting Y-shaped ureter.

An unusual case of pulmonary hypertension with multiple osteosclerotic lesions

A 47-year-old married woman with underlying sensorimotor polyneuropathy presented to our emergency department with a 2-week history of fatigue, legs edema and exertional dyspnea. On physical examination, elevated jugular vein pressure, a grade III pansystolic murmur at the left lower sternal border and peripheral edema were noted. Chest radiography revealed cardiomegaly, enlargement of the central pulmonary vessels and bilateral pleural effusions (Figure 1). Electrocardiograms showed right axis deviation. An echocardiogram demonstrated pericardial effusion, severe tricuspid regurgitation, pulmonary hypertension (pulmonary artery pressure was 78 mmHg) and normal left ventricular systolic function (the estimated ejection fraction was 77%). Contrast-enhance chest CT showed no evidence of intraluminal thrombi in the pulmonary arteries but central pulmonary artery dilatation (Figure 2). Chest CT image in a bone window setting showed osteosclerotic lesions in the vertebral body of the thoracic spine (arrow head) and sternum (white arrow), as well as proliferative new bone formation over the right transverse process (black arrow) (Figure 3). She was admitted and initially treated as having pulmonary hypertension with right heart failure. Figure 1. Chest radiograph demonstrates cardiomegaly, enlargement of the central pulmonary vessels and bilateral pleural effusions with more on …

Is subcutaneous local anesthesia necessary in ultrasound-guided hip magnetic resonance arthrography?

Background: Ultrasound (US)-guided injection is increasingly used for magnetic resonance (MR) arthrography of the hip. There is no information regarding the utility of anesthetizing the needle path before joint puncture. Thus, the aim of this study was to retrospectively compare the efficacy of the technique and discomfort in patients undergoing US-guided arthrography of the hip using a fixed guide, with or without the use of subcutaneous local anesthesia. Materials And Methods: Eighty-two patients underwent anterior US-guided MR arthrography of the hip, of whom 33 had received anesthesia and 49 had not; these patients were compared for differences in the efficacy of arthrography and the subsequent complications. They were also asked to report the intensity of discomfort using a visual analog scale (VAS). Results: Hip joint arthrography was successful in all cases with no complications. There were no significant differences between the anesthetized and non-anesthetized groups in terms of sex, age, body mass index, side, success rate on first attempt, and extra-articular contrast leakage on MR ( P > 0.05). The mean VAS scores were 23.3 (median 25.0; SD 13.3) in anesthetized patients versus 23.6 (median 20.0; SD 19.2) in those who were not anesthetized ( P = 0.12, Mann-Whitney U test). Conclusion: Routine local anesthesia is possibly unnecessary in US-guided MR arthrography of the hip using a fixed guide.

Aggressive Right Atrial Tumor with Extensive FDG-avid Metastases in a Case of Cardiac Angiosarcoma

Primary cardiac tumors are rare and only a quarter of them are malignant with the vast majority being angiosarcomas. Prognosis of cardiac angiosarcoma is very poor, with median survival of less than 1 year. Patients with complete surgical resection of tumor might have longer survival, but it is feasible only in absence of metastasis. However, metastatic cardiac angiosarcoma via hematogenous routes to the lungs, bones and liver are not unusual. Because of rarity of cardiac angiosarcoma, the literature regarding with its metastases demonstrated on FDG PET/CT is only anecdotal. Herein, we described the PETICT features of multiple extracardiac FDG-avid metastases in a case of cardiac tumor, misdiagnosed as hemangioma after initial resection but finally revised as angiosarcoma when metastasis became evident within several weeks post-operation. Also because of disseminated metastases and expected poor survival, the patient opted not further treated. Our experience with this case suggests that the regular use of FDG PET/CT may provide not only additional but essential information to facilitate a correct diagnosis of cardiac tumor and can avoid medical malpractice.