Vietnamese Journal of Radiology and Nuclear Medicine

THE ROLE OF MULTI-DETECTOR THORACIC COMPUTED TOMOGRAPHY IN ASSESSMENT OF EARLY STAGE LUNG CANCER

Ngọc Hà Trương — 2025-06-24

Objective: To characterize multi-detector computed tomography (MDCT) images of the chest and initially determine the T,N stage of early lung cancer on MDCT images. Methods: A transverse, prospective descriptive study of 53 patients diagnosed with early-stage lung cancer based on MDCT images at K hospital between January 1, 2022 and January 1, 2023, underwent surgery and had postoperative pathology results. Results: Early-stage lung cancer was more common over 50-year-olds (92.5 percent), more common in men (73.6 percent) than in women (26.4 percent). The most frequent histopathological type was adenocarcinoma (77.4%). Early lung tumors are common in the upper lobe of the right lung (32.1%), both adenocarcinoma and squamous carcinoma are characterized mainly by solid form (66.7% and 65.8%), spiculated margin (69.3% and 66.7%), polygonal shape (70.7% and 77.8%). Cavitary lesions were more common in squamous carcinoma (22.2%). Assessment of stage T of lung cancer based on MDCT has a good consensus compared with postoperative pathology results (Kappa Index = 0.771). MDCT is a tool which has high sensitivity (73.3%) and specificity (84.2%) in pretreatment ganglion evaluation for patients. Conclusion: MDCT is high value in the diagnosis of stage T, determining the status of regional lymph node metastases of patients with early- stage lung cancer which is the basis for selecting the most appropriate treatment methods for patients. Keywords: early- stage lung cancer, MDCT

ANALYSIS OF FACTORS INFLUENCING THE OUTPATIENT PATIENT EXPERIENCE DURING MRI AT QUANG NINH GENERAL HOSPITAL

CN Văn Thường Phan — 2025-06-24

Abstract Introduction: Magnetic Resonance Imaging (MRI) is an advanced imaging technique that is increasingly applied in medical diagnostics. In addition to its technical expertise, the patient experience during MRI, particularly among outpatient patients, is a critical factor influencing satisfaction and engagement with healthcare facilities. This study aims to analyze the factors affecting the outpatient patient experience at Quảng Ninh General Hospital and to propose solutions to enhance the overall quality of healthcare services. Objectives: This study aims to assess the level of outpatient experience and to examine the factors that influence patient experience during magnetic resonance imaging (MRI) procedures. Methods: This is a cross-sectional descriptive study conducted on 230 outpatient patients aged ≥18, who were prescribed MRI without the use of contrast agents at Quảng Ninh General Hospital from March to September 2024. Results: The average waiting time was 57.1 ± 45.1 minutes, and the average scanning time was 8.8 ± 2.4 minutes. The overall patient experience score was 4.2 ± 0.7, with 87.9% of patients reporting being satisfied or very satisfied. The experience score for staff guidance and explanation was 4.6 ± 0.5, patient positioning was 4.4, lighting was 4.3, temperature was 4.2, and noise was 3.7 (p < 0.0001). Additionally, 98.7% of patients were willing to undergo MRI if clinically necessary, and 61.3% would definitely return and recommend the MRI service to others. Conclusion: The patient experience during MRI is influenced by a variety of technical and psychological factors, with communication from healthcare staff and the MRI environment playing key roles. To enhance the positive experience, it is necessary to optimize technical procedures, reduce noise, improve healthcare staff communication skills, and manage waiting times more efficiently.

CHARACTERISTICS OF LUNG LESIONS ON HIGH-RESOLUTION COMPUTED TOMOGRAPHY (HRCT) IN NEW PULMONARY TUBERCULOSIS AFB(-) PATIENTS

Dr Dinh Nghia Huynh — 2025-06-24

Objective: to determine HRCT imaging features in new pulmonary tuberculosis AFB(-) patients and correlate these features with culture results. Meterial and method: We conducted a study on 130 active pulmonary tuberculosis patients with bacteriological evidence by Gene Xpert test but AFB (-) sputum examination were divided into two groups according to sputum culture results. ,described HRCT characteristics. Results: Average age 58.3±14.9, male/female =2.6, average BMI 17.3 ±2.6 HRCT characteristics: centrilobular nodules 86.2%, tree in bud 77.6%, large nodule 66.2%, consolidation 47.7%, cavity 45.4%, ground glass opacity 20%, mediastinal lymphadenopathy 4.6%, pleural effusion 3.8%. Location of injury: Right upper lobe 82.3%, left upper lobe 73.8%, right lower lobe 59.2%, left lower lobe 56.9%, right middle lobe 52.3%, distributed in the right lung 82.3%, left lung 73.8%, both lungs 71.5%. Conclusion: There are no significant differences in high-resolution computed tomography imaging characteristics in patients with active pulmonary tuberculosis with positive and negative culture results. Keywords: HRCT, Tuberculosis

EVALUATION OF THE ROLE OF PET/CT IN DETECTING BONE METASTASES IN PATIENTS WITH LUNG CANCER AT K TAN TRIEU HOSPITAL

Cẩm Tú Trịnh — 2025-06-24

Abstract Objective: This study aims to evaluate the role of PET/CT in detecting bone metastasis in lung cancer patients. Materials and Methods: A cross-sectional descriptive study was conducted on 72 lung cancer patients who underwent PET/CT scans at K Tan Trieu Hospital from April 1, 2024 to March 31, 2025. Results: A total of 54.2% of patients presented with multiple bone lesions (two or more), while 45.8% had solitary bone lesions. In total, 172 bone metastatic lesions were identified, all demonstrating increased 18F-FDG uptake on PET/CT imaging. The most frequently involved site was the spine (97.2%), including the cervical (22.2%), thoracic (36.1%), and lumbar (38.9%) regions. Metastases involving the rib–sternum complex and the pelvic–sacral region were each observed in 44.4% of cases. Less common sites included the skull (6.9%) and clavicle (2.8%). The mean maximum standardized uptake value (SUVmax) was 12.86 ± 8.32, with a range from 3.4 to 57.8. Conclusion: PET/CT is an effective imaging modality for detecting bone metastases in lung cancer patients, offering detailed information on lesion number, location, metabolic activity, and overall disease spread Keywords: PET/CT, Lung cancer, Bone metastases.

Imaging Characteristics of Dural Arteriovenous Fistulas with Occlusive Stenosis Transverse-Sigmoid Sinus on Digital Subtraction Angiography

VĂN KHOA LÊ — 2025-06-24

Background: Dural arteriovenous fistulas account for about 10% of intracranial vascular malformations. In particular, fistulas related to the transverse sinus and sigmoid sinus have the second frequency of occurrence, only after the cavernous sinus in Vietnam. The pathogenesis of dural fistula at this location is often related to chronic venous sinus stenosis. The purpose of our study is to evaluate the imaging characteristics of transverse- sigmoid sinus dural arteriovenous fistulas (TSS-DAVFs) according to Cognard classification as well as venous sinus stenosis to stratify risk, at Cho Ray Hospital. Materials and methods: Report on a series of cases of patients with TSS-DAVFs who underwent DSA performed at Cho Ray Hospital from 1/2018 to 1/2024. Results: In 47 patients with TSS-DAVFs who underwent DSA: average age was 53 years old, female/male ratio was 2.1/1, lateral fistula was found in 40/7 cases, bilateral fistula was found in 7/47 cases, feeder artery is popular the meningeal branch of the external carotid artery, classified as Cognard IIa 23.4%, Cognard IIb 17.1%, Cognard IIa+IIb 31.8%, Cognard III 12.7%% and Cognard IV 15.0%. Regarding stenosis TSS, the chronic complete occlusion of lateral TSS accounts for the majority with 55.3%, TSS stenosis 19.1%, and stenosis bilateral TSS 25.5%. Conclusion: DSA is the gold standard in diagnosis and risk stratification according to Cognard as well as venous sinus stenosis and occlusion, thereby have appropriate managing or treatment strategies for the patients.

EFFICACY AND SAFETY OF CT-GUIDED CORE NEEDLE BONE BIOPSY

THÀNH LUÂN PHẠM — 2025-06-24

Purpose: To evaluate the results of core needle bone biopsy under CT guidance at Military Hospital 175. Subject and method: A descriptive, retrospective and prospective study was conducted on 131 patients undergoing the above biopsy technique from 09/2019 to 06/2024. Results: The success rate of obtaining diagnostic tissue samples was 100%. The average specimen size was 15.1 ± 7.8 mm. The mean number of CT scans performed was 2.8 ± 2.4, with 50.3% of patients undergoing 2 to 3 scans. The mean duration of the biopsy procedure was 29.4 ± 10.0 minutes. Biopsies performed on the spine had a longer average procedure time (32.2 ± 7.4 minutes) compared to those at other anatomical sites (15.1 ± 5.6 minutes). The rate of malignant diagnosis was 53.4%. The average pain score reported by patients was 4.6 ± 2.0. Minor local bleeding occurred in 25 cases (19.1%). One patient undergoing biopsy at the L3 vertebral level experienced transient leg numbness and hypoesthesia, which resolved spontaneously within 3 hours of observation. Conclusion:CT-guided percutaneous core bone biopsy is accurate, safe and feasible in clinical practice.

EFFICACY OF PERCUTANEOUS VERTEBROPLASTY IN THE TREATMENT OF VERTEBRAL COMPRESSION FRACTURES WITH INTRAVERTEBRAL CLEFT

Văn Tú Nguyễn — 2025-06-24

Background: Intravertebral cleft (IVC) is frequently observed in patients with painful chronic, mainly cause of pseudoarthrosis osteoporotic vertebral compression fracture (OVCF). Objectives: The purpose of this study was to evaluate the clinical and radiographic results of percutaneous vertebroplasty (PVP) in the treatment of OVCF with IVC. Subjects and methods: A retrospective review of 100 patients who underwent percutaneous vertebroplasty to treat osteoporotic compression fractures, IVC sign was observed of 45 patients. Back pain was measured using a visual analog scale (VAS) and physical disability was assessed using the Oswestry Disability Index (ODI). Augmentation of cement injected per vertebral body. Changes of the vertebral body height were assessed on X-ray film in comparison between pre- and postintervention. Results of the intervention were assessed by Macnab standards. Complications during and after intervention were recorded. Results: in 44 patients with IVC (08 males, 36 females) with an average age of 74,5 (range 57– 91 years). The most common location of collapsed vertebral are L1 with 37,05%. Vertebral collapse with air is the most common with 58,8%, collapse with fluid and both fluid and air are 23,5% and 17,7% respectively. An average volume of 4ml (2-8ml) of cement injected per vertebral body. There were 13,6% of cases with leakage of cement out of vertebral body. The mean values for the VAS and ODI were 6,77 and 3,48 before PVP, versus 1,73 and 1,8 at the final follow-up; showed no significant difference between IVC and non-IVC fracture patients. The postoperative vertebral body height were improved with 8,93mm. According to MacNab's classification, postoperative outcomes were rated as good and very good in 79,5% of patients. Conclusion: Percutaneous Vertebroplasty to treat OVCF with IVC is a safely procedures, fewer complications, that reducing back pain and improving the quality of life.

Preoperative lung nodule localization using Hookwire, an approach to early diagnosis and treatment of lung cancer – Literature review and case series report.

Cung Van Cong Cung — 2025-06-24

In clinical practice of respiratory diseases, we often encounter solitary pulmonary nodules (SPN). SPNs have 3 main forms: (1) Solid nodules (SN); (2) Part-solid nodules (PS); (3) Ground glass opacity (GGO); (4) Cyst nodules (CN). There have been many guidelines from different societies/society around the world on the management of SPN (NCCN; Fleischner; ATS; ERS...). However, these instructions are general in nature and do not address the issue of individualization. To be able to treat/cure lung cancer well, early detection and choosing appropriate treatment methods play a decisive role. Association guidelines are based on size, structure and risk factors to devise a management strategy for solitary nodules, which factors in nodule size at first detection as well as subsequent screenings plays a key role. According to NCCN: (1) SN, ≥ 8mm to > 15 mm in subjects at high risk of lung cancer should be monitoring by LDCT every 3 months or PET scan; Nodules ≥ 15 mm should have a contrast CT scan/PET scan/tissue sampling. If the results indicate high suspicion of LC, the biopsy/nodular excision is indicated; (2) PS nodules when the solid part is ≥ 8mm, at high risk subjects can be applied above techniques; (3) GGO < 20 mm, monitoring by LDCT once a year; > 20 mm every 6 months, no recommendation for biopsy or resection. Thus, if this recommendation is applied correctly, there will be many cancerous nodules under the above sizes that will be "nourished" until they meet treatment standards, which will inevitably reduce the chance of being diagnoses and early treatment, losing the opportunity to "cure" the patient. Another common situation: A single nodule/mass on one side of the lung is still amenable to surgery, but another single nodule appears in the same lung on the same side but in a different lobe or on the opposite lung. So, very important to confirm the nodule is secondary/non-secondary before lobectomy containing the primary lesion. In this situation, according to our knowledge, there is no any guideline to recomendation. We report 22 cases in which lung nodules were located before thoracoscopic surgery (VAST) using Hookwire, many of which were assigned an "individualized" approach (not recommendation) and gave surprising results. Discussion is based on analysis of image characteristics and pathological results and recommends the idea of "individualizing" each case for colleagues to refer to.

Imaging Features of Arrhythmogenic Mitral Valve Prolapse: Clinical Cases and Literature Review

Thị Lan Hương Lê — 2025-06-24

Mitral valve prolapse (MVP) is one of the leading causes of primary mitral regurgitation. In addition to complications arising from valvular insufficiency, MVP can also progress to arrhythmias, ranging from premature ventricular contractions to potentially lifethreatening episodes such as non-sustained ventricular tachycardia or malignant ventricular arrhythmias. Recently, the term "arrhythmic mitral valve prolapse syndrome" has been reported as a potential cause of sudden cardiac death. Consequently, there has been increasing research interest in this condition, accompanied by updated guidelines from various cardiovascular societies. Arrhythmic MVP is classified as a distinct subgroup characterized by frequent or complex ventricular arrhythmias without underlying structural arrhythmogenic substrate, with or without mitral annular disjunction (MAD). Studies have demonstrated that MAD is associated with an increased risk of arrhythmias and sudden cardiac death in patients with MVP. Advances in cardiac imaging, particularly cardiac magnetic resonance (CMR), now enable comprehensive evaluation of this condition. Moreover, CMR plays a pivotal role in arrhythmic risk stratification and in identifying high-risk myocardial fibrosis patterns. This article presents a series of clinical cases along with a literature review to provide additional information and updated insights into this condition.

A RARE CASE OF URINARY IMAGING TOWARDS ZINNER SYNDROME AT 103 MILITARY HOSPITAL

Duy Chí Lê — 2025-06-24

Introduction:Zinner’s syndrome is a rare congenital anomaly characterized by ipsilateral renal agenesis and seminal vesicle cysts. This case is among the few reported instances in Vietnam. Case Presentation:A 28-year-old male patient underwent a general health check-up at the Military Hospital 103. Ultrasound findings revealed the absence of the right kidney in the renal fossa and abdominal cavity, along with a cystic mass located in the right hypogastric region. Abdominal computed tomography confirmed right renal agenesis and a right seminal vesicle cyst measuring 30 × 80 mm, consistent with a diagnosis of Zinner’s syndrome. The patient was advised periodic monitoring and follow-up. Conclusion: The integration of medical history, clinical examination, and diagnostic imaging facilitates accurate diagnosis and patient management. Regular monitoring for urological symptoms and timely surgical intervention when symptoms arise are essential in the management of Zinner’s syndrome.

Dural arteriovenous fistula in the anterior cranial fossa with feeder from the ophthalmic artery: 4 cases report were treated with endovascular treatment

VĂN KHOA LÊ — 2025-06-24

Background: Dural arteriovenous fistula (DAVF) in the anterior cranial fossa is rare with 5% compared to intracrainal DAVF, but the risk of cerebral hemorrhage is higher than in other locations. DAVF in anterior fossa usually has a feeder from the ethmoidal branch of the ophthalmic artery and therefore transarterial embolization must be possible to occlude the fistula site and preserve the central retinal artery. Materials and methods: Report with 4 cases of DAVF anterior cranial fossa who received endovascular treatment at Cho Ray Hospital from 1/2021 to 1/2024. Results: These cases had the common characteristics of being hospitalized because of low vision, 1 case of cerebral hemorrhage and 1 case of bulging eyes. CT/MRI confirmed that the feeder artery was from the ethmoid branch of the ophthalmic artery with large dilatation of venous drainage. Endovascular treatment approached the ophthalmic artery in 4 cases, of which 1 case had to approach the bilateral ophthalmic arteries, 1 case had to approach the meningeal branch of the external carotid artery. Technical success with complete occlusion of the fistula site and preservation of the central retinal artery in all cases. The microcatheters used were Apollo detachable tip in 3 cases, Marathon in 1 case, Onyx 18 embolic agent was used in all cases. Procedural complications related to 1 case was invasive onyx into the superior sagittal sinus, however the limitaion was small and did not affect the flow of the vein. Followed up after 90 days of treatment, no recurrence was noted, and vision improved significantly in 3/4 cases. Conclusion: Transarterial embolization with approach from the ophthalmic artery in DAVF anterior cranial fossa is a reasonable, safe and effective treatment that have high capable of occluding the fistula site and preserving the central retinal artery.

CLINICAL CASE REPORT ON RECOVERY OUTCOMES IN PATIENTS WITH LOW ASPECTS SCORE AFTER MECHANICAL THROMBECTOMY FOR ACUTE ISCHEMIC STROKE

Ngọc Từ — 2025-06-24

Mechanical thrombectomy is generally recommended in patients with an Alberta Stroke Program Early CT Score (ASPECT) score of 6 or higher. However, some recent studies have shown that the benefit of reperfusion is not entirely dependent on the ASPECT score. We report a male patient with a low initial ASPECTS score (4) who underwent thrombectomy and stenting of the internal carotid artery. The results showed significant improvement in both imaging and clinical symptoms. This suggests that thrombectomy may benefit ischemic stroke patients with low initial ASPECTS scores. The decision to treat should also be considered on individual patient characteristics and the benefits and risks of treatment.