Congenital neonatal pyriform aperture stenosis (CNPAS) is a rare but potentially lethal condition that causes respiratory distress. The characteristic narrowing of the pyriform aperture along with other associated craniofacial dysmorphism is diagnosed using cross-sectional imaging such as computed tomography (CT) and magnetic resonance imaging. CT scan is the imaging of choice for confirming and characterizing CNPAS. Infants are obligate nasal breathers in the first 5 months of life. Hence, a high degree of clinical suspicion, prompt imaging diagnosis and adequate respiratory support is critical to help reduce the morbidity of this condition.
The aim of this study was to evaluate the correlation and accuracy of depth of invasion (DOI) measurement from preoperative contrast-enhanced computed tomography (CECT) scans in comparison to histopathological examination (HPE) in oral tongue squamous cell carcinoma (OTSCC). Preoperative CT scans of 18 OTSCC patients were reviewed retrospectively by a single observer to measure the DOI on axial and coronal sections; these were then compared to the HPE report. Mean DOI was compared between CECT and HPE using repeated measures ANOVA. The strength of correlation of CT-derived tumour depth was determined using the intra-class correlation coefficient (ICC) followed by assessment of accuracy by Bland-Altman plot. In general, the measurement of DOI was smaller on CECT, with a mean difference of 0.743mm on axial CT and 1.106mm on coronal CT. Regarding the correlation between CECT and HPE tumour depths, ICC was 0.956 for axial CT and 0.965 for coronal CT. Bland-Altman analysis showed that DOI from CECT and histopathological depth were in agreement with each other. In conclusion, there was excellent correlation and accurate measurement of DOI from CECT.
This phantom study was designed to compare the radiation dose in thoracic and abdomen-pelvic CT scans with and without use of tube current modulation (TCM). Effective dose (ED) and size-specific dose estimation (SSDE) were calculated with the absorbed doses measured at selective radiosensitive organs using a thermoluminescence dosimeter-100 (TLD-100). When compared to protocols without TCM, the ED and SSDE were reduced significantly with use of TCM for both the thoracic and abdomen-pelvic CT. With use of TCM, the ED was 6.50±0.29 mSv for thoracic and 6.01±0.20 mSv for the abdomen-pelvic CT protocols. However without use of TCM, the ED was 20.07±0.24 mSv and 17.30±0.41 mSv for the thoracic and abdomen-pelvic CT protocols, respectively. The corresponding SSDE was 10.18±0.48 mGy and 11.96±0.27 mGy for the thoracic and abdomen-pelvic CT protocols with TCM, and 31.56±0.43 mGy and 33.23±0.05 mGy for thoracic and abdomen-pelvic CT protocols without TCM, respectively. The highest absorbed dose was measured at the breast with 8.58±0.12 mGy in the TCM protocols and 51.52±14.72 mGy in the protocols without TCM during thoracic CT. In the abdomen-pelvic CT, the absorbed dose was highest at the skin with 9.30±1.28 mGy and 29.99±2.23 mGy in protocols with and without use of TCM, respectively. In conclusion, the TCM technique results in significant dose reduction; thus it is to be highly recommended in routine thoracic and abdomen-pelvic CT. PACS numbers: 87.57.Q-, 87.57.qp, 87.53.Bn.
This paper presents a multitasking electrical impedance tomography (EIT) system designed to improve the flexibility and durability of an existing EIT system. The ability of the present EIT system to detect, locate, and reshape objects was evaluated by four different experiments. The results of the study show that the system can detect and locate an object with a diameter as small as 1.5 mm in a testing tank with a diameter of 134 mm. Moreover, the results demonstrate the ability of the current system to reconstruct an image of several dielectric object shapes. Based on the results of the experiments, the programmable EIT system can adapt the EIT system for different applications without the need to implement a new EIT system, which may help to save time and cost. The setup for all the experiments consisted of a testing tank with an attached 16-electrode array made of titanium alloy grade 2. The titanium alloy electrode was used to enhance EIT system's durability and lifespan.
Pulmonary sequestration is defined as a segment of ç separated from the tracheobronchial tree and receiving its blood supply from a systemic artery rather than a pulmonary arterial branch. Classically, it has been described in two forms: (1) intralobar sequestration (ILS), in which the sequestrated part of lung lies within normal pulmonary visceral pleura, and (2) extralobar sequestration (ELS), in which the abnormal segment of lung is completely separate and enclosed in its own pleural investment. The term sequestration was coined by Pryce in 1946 to describe a disconnected bronchopulmonary mass or cyst with an anomalous systemic artery. Since this original description, terminology has become confusing as investigator has recognized many variants of sequestration not strictly meeting the original description. The spectrum now recognized as a continuum, with normal vessels supplying abnormal lung at one end and abnormal vessels supplying normal lung at the other end. Recently, we incidentally found an asymptomatic, intralobar pulmonary sequestration during CT pneumocolon.
The only potential curative therapy for gastric cancer is the resection of both the tumor and the regional lymph nodes at the early stage of the disease. The majority of patients with gastric cancer in Malaysia have an advanced disease at initial diagnosis, and curative surgery is possible in less than 20% of operated cases. Acurate preoperative staging is crucial in determining the most suitable therapy and avoiding unnecessary attempts at curative surgery. While computed tomography remains as the most widely used imaging modality for gastric cancer staging, its ability to detect local invasion, peritoneal and liver metastases is limited. In the recent years laparoscopy has become an important component in the staging algorithm of gastric cancer. The aim of this review is to evaluate the efficacy of routine preoperative laparoscopic staging in the management of gastric cancer, and in particular describe the Malaysian experience.
The case report describes the presentation of a 19-year old female with tuberous sclerosis who presented with progressive dyspnoea over 2 days.
Chest radiograph revealed bilateral pneumothorax. Computed tomography showed features of pulmonary lymphangioleiomyomatosis and bilateral renal angiomyolipomas. The coexistence of both conditions may cause devastating morbidity and mortality.
We present a case of 80-year-old man with two-year history of hoarseness of voice secondary to left vocal cord paralysis. CT scanning revealed a saccular thoracic aneurysm compressing the left recurrent laryngeal nerve. A review of literature on Ortner's or cardiovocal syndrome is presented.
Pumpkin products confer natural sweetness, desirable flavours and β-carotene, a vitamin A precursor when added as ingredients to extruded snacks. Therefore, a potential use for dried pumpkin flour is as an ingredient in ready-to-eat (RTE) snack foods. Growth in this market has driven food manufacturers to produce a variety of new high value snack foods incorporating diverse ingredients to enhance the appearance and nutritional properties of these foods. Ready-to-eat snacks were made by extruding corn grits with 5%, 10%, 15% and 20% of pumpkin flour. Snacks made from 100% corn grits were used as control products for this work. The effect of formulation and screw speeds of 250 rpm and 350 rpm on torque and specific mechanical energy (SME, kWh/kg), physical characteristics (expansion ratio, bulk density, true density and hardness) and the microstructure of the snacks were studied. Increasing the screw speed resulted in a decrease of torque for all formulations. When pumpkin flour was added the specific mechanical energy (SME) decreased by approximately 45%. Increasing the percentage of pumpkin flour at the higher screw speed resulted in a harder texture for the extruded products. X-ray tomography of pumpkin flour-corn grit snacks showed that increased levels of pumpkin flour decreased both the bubble area and bubble size. However, no significant differences (p > 0.05) in bubble wall thickness were measured. By understanding the conditions during extrusion, desirable nutritional characteristics can be incorporated while maximizing expansion to make a product with low bulk density, a fine bubble structure and acceptable organoleptic properties.
Extracranial aneurysms are a rare presentation accounting for only less than 5% of all peripheral artery
aneurysms. The left common carotid artery aneurysm is considered even rarer. We present a case of a 46-year-old gentleman who presented to casualty unit with a neck mass, stridor and acute respiratory distress. Prior to this admission patient was being investigated for Takayasu arteritis (TA). Patient was subsequently intubated due to respiratory compromise. A CT angiography of the thorax was done
showed a proximal left common carotid artery aneurysm with contained leakage of aneurysm with
severe compression of the trachea. Patient was subsequently transferred to the vascular team in National Heart Institute for further management.
The optimal treatment for thoracolumbar fractures (TLF) without neurological deficit remains controversial. Majority of the systematic reviews and meta-analyses have evaluated open operative approaches but have yet to compare the outcomes of minimally invasive percutaneous pedicle fixation (MIPPF) versus non-operative treatment. A retrospective cohort study was performed to compare clinical and radiological outcomes between MIPPF and conservative groups for TLF AO Type A1 to Type B2 during a 2-year follow-up period. Pre-operative plain and CT films were evaluated and decision made for short segment (non-fusion) MIPPF. Patients who refused operation were treated conservatively with three months of body cast, brace, or corset. MIPPF group showed earlier Visual Analog Score(VAS) improvement at six months post-injury (0 vs 6.0- p<0.001), as well as better functional and radiological outcomes (p<0.050) at final follow-up. Progressions of regional kyphosis (RK) were noted in both groups but there was no significant difference within and between them(p>0.050). MIPPF as a method of internal bracing can be pursued in the treatment of TLF, with larger future cohorts and RCTs being called for to support and explore new findings.
Right iliac fossa pain can often be misdiagnosed as something sinister or benevolent despite assistance with state of the art imaging techniques. This is particularly more challenging in the female gender whereby the error of managing a right iliac fossa pain may approach forty percent. A 66-year-old lady, ten years post-menopause, presented with a week history of progressively worsening right iliac fossa pain. Malignancy was suspected with a palpable abdominal mass. Computed tomography was suggestive of an abscess collection, but a needle aspirate produced brown faecal material suggestive of a diverticulitis. An exploratory appendisectomy revealed a non malignant appendicular abscess. In conclusion, when clinical and imaging assessments are inconclusive, an exploratory laparotomy for a surgical excision is warranted primarily if malignancy is suspected.
Introduction: Splenic pseudo-aneurysm is an uncommon complication following splenic injury caused by blunt abdominal trauma. Pseudo-aneurysm is usually treated with splenic arterial embolisation. Spontaneous thrombosis of a splenic pseudo-aneurysm can occur but it is rare. Method: We report a case of spontaneous thrombosis in a post-traumatic splenic pseudo-aneurysm. The patient was managed conservatively as he was haemodynamically stable with a repeat CT scan on the 7th day showing a tubular enhancing structure in the upper pole of the spleen demonstrating the same attenuation value .
Conclusion: This case illustrates a spontaneous resolution of splenic pseudo-aneurysm, which is a rare outcome of the condition.
Thrombosis of the deep cerebral venous system in the absence of superficial sinus thrombosis is a very rare disease. The clinical and radiological findings can be diagnostically challenging due to the subtle appearances on computed tomography (CT) scan. Magnetic resonance imaging (MRI) examination is a preferred imaging modality to complement the CT findings for an accurate diagnosis of venous sinus thrombosis. We present a case of this unusual condition which present as unilateral thalamic lesion on CT scan and the role of contrast enhanced MRI with fast spoiled gradient echo (FSPGR) sequence and 3D reconstruction which led to the diagnosis of thrombosis in the deep cerebral venous system.
A shift to administration of optimal dose of 18F-FDG between 4 and 5 MBq/kg from the current practice of higher doses potentially yields a reasonable-to-excellent PET image. For this purpose, whole-body MIP images of 32 patients (23 men, 9 women, age 51.9 ± 13.7 years), administered with 18F-FDG (activity 5.3 ± 0.5 MBq/kg, 45 minutes uptake time) for whole-body PET/CT examinations, were evaluated. Image quality was assessed visually by two radiologists using a three-point scoring scale: poor, reasonable and excellent. The interobserver agreement revealed a kappa value higher than 0.7. Therefore, the utilisation of 18F-FDG dose between 4 and 5MBq/kg is considered an optimum dose for whole-body PET/CT examination.
Solitary adrenal metastasis is a rare presentation in breast cancer and it presents the clinician with a difficult therapeutic dilemma as there are no existing guidelines for optimal management. On literature review, we only found one published case report of solitary adrenal metastasis from infiltrating ductal carcinoma of the breast. Here we present a case of a 75 year-old lady who presented with a right breast lump which was subsequently confirmed to be infiltrating ductal carcinoma. She underwent a right mastectomy and axillary clearance. Computerised tomography (CT) staging revealed a solitary adrenal metastasis. She was treated with aromatase inhibitors and her tumour markers which were initially raised has now normalised.
The escalating costs of conventional diagnostic technology in oncology have yet to obviate futile surgery intervention and the spiralling treatment cost. The evolution in engineering technology which looks at the correlation of the anatomy and the function of tumours i.e. Positron Emission Tomography-Computed Tomography (PET-CT) have impacted on the improved diagnostic accuracy and treatment in oncology. Clinical data have demonstrated that the information provided by PET/CT often changes patient management. This review addresses the value of PET-CT as a surrogate molecular marker in tumours and to discuss some issues in adopting PET/CT in routine daily practice as supported by the numbers of literature reviews of its application in oncology since it was first commercialised in 2001. The description of the technology used in multimodality imaging has gained encouraging interest among physicians, policy makers and insurance companies on the importance of the PET-CT, for which roles are not limited to the staging, disease prognostication and treatment monitoring with potential impact on treatment cost and justification of radiation safety for the patient. PET/CT is a useful tool in cancer investigation as evidenced by its role as a surrogate marker in underpinning the cellular reprogramming of different pathological entities.
The objective of this study was to compare the acquired image of teflon, human bone equivalent material on a Positron Emission Tomography/Computed Tomography (PET/CT) scanner with Monte Carlo simulation (MCNP). The cylindrical shape teflon phantom with dimensions of 19.5 cm length and 5.0 cm diameter was used for imaging with different settings of kilovolts (kV) and milliamperes (mA) of PET/CT. In this simulation, the photon flux in each pixel was accumulated by the Flux Image Radiograph (FIR) tally as flux image detectors and the image was plotted using Microsoft Office Excel. Results show that MCNP image was comparable with that of CT image and the obtained MCNP image depends on pixels size of the FIR tally.
This retrospective study is aimed at evaluating the role of CT scan in predicting parametrium involvement in early stage of cervical carcinoma. It was conducted in a Gynaecologic Oncology Centre, Hospital Alor Star from January 2004 till December 2008. All patients with operable stage I and II cervical cancer had pelvic CT scan for evaluation of parametrium involvement before undergoing radical hysterectomy and pelvic lymphadenectomy. Parametrial streakiness or presence of infiltration suggested local invasion. Following radical hysterectomy, the specimens sent for histological confirmation and the correlation between the CT scan finding and the histopathology result was studied. The result revealed a total of 104 patients with operable stage cervical carcinoma had pelvic CT scan. The sensitivity and the specificity of CT scan in assessing parametrial involvement was 33.3% and 84.8%, respectively. In conclusion, CT scan had high specificity but low sensitivity in determining parametrial involvement in early stage of cervical cancer. Hence, routine preoperative pelvic CT scan has a limited role in assessing parametrial involvement in early stage cervical carcinoma.