Tạp chí Điện quang & Y học hạt nhân Việt Nam

ROLE OF MULTIDETECTOR COMPUTED TOMOGRAPHY IN ASSESSMENT OF LARYNGEAL CANCER AT HUE CENTRAL HOSPITAL: SHARING EXPERIENCES FROM A SINGLE CENTER FROM 31 CASES

BS Nguyen Thi Phuoc Loc — 2021-12-31

Background: The role of multidetector computed tomography (MDCT) in diagnosing and staging 31 patients with laryngeal carcinoma. Methods: Patients with laryngeal carcinoma were diagnosed at Hue central hospital from February 2019 to July 2020. Patients were clinically diagnosed patients of laryngeal masses, were first evaluated under indirect laryngoscopy, and then sent for Computed Tomography (CT). Postimaging biopsy was undertaken via direct laryngoscopy. Imaging features of the tumor such as site, level of invasion and staging of tumor were analyzed. Results: The mean age was 61±11 with 90% of patients are male. The risk of laryngeal cancer for those patients who were active smokers (93.5%), and alcohol consumers (67.7%). The most common symptom was hoarseness (93.5%). In CT image, more than half of the cancers were carcinoma of the glottis (29%) and two regions supraglottis and glottis (22,6%), while the less common cancers were the subglottic (3.2%) and all three regions (9.7%) carcinoma, especially true vocal cord (67,7%) is the most common site starting carcinoma. The percentage of tumors spreading to paraglottic space and pre-epiglottic space was 50% and 30.6% respectively. The most common stage of laryngeal cancer in CT was T3 stage (35,5%). There is a weak agreement (Kappa=0.518) in staging in laryngeal cancer in CT compared to laryngoscopy. Conclusion: MDCT is better in staging laryngeal cancer in T3, T4 stages as compared to laryngoscopy.

DIAGNOSIS OF CORONARY ARTERY FISTULAS BY MULTI DETECTOR COMPUTED TOMOGRAPHY

BS Ngoc Phung Bao — 2021-12-31

Objective: To evaluate the imaging characteristics of coronary artery fistulas (CAFs) by multidetector computed tomography (MDCT). Materials and Methods: a prospective descriptivestudy from January 2019 to September 2020 enrolled 31 patients (11 males, mean age 56 years) detected CAFs on MDCT at Radiology Centre of Bach Mai hospital. The origin, size, and drainage site of CAFs were analyzed. Results: 31 (0.93%) CAFs were detected with 3322 patients underwent CCTA. 18 (58.1%) patients had multiple fistulas and 13 (41.9%) patients had single communication. 6.5% originated from the right coronary, 35.5% from the left coronary artery system, and 58.5% from both the right and left coronary artery. 87.1% of fistulas drain to the right side of the circulation (74.2% drain to pulmonary artery). 1 patient (3.2%) had fistula drain to the left side of the circulation (bronchial artery). 3 patients (9.7%) had fistulas drain to both the right and left side of the circulation (pulmonary artery and bronchial artery). 10 patients had large fistulas (32.3%), 21 patients had small fistulas (67.7%). 19 (61.3%) patients had an asscociated aneurysm of fistulas . 38.7% of cases were diagnosed with CAFs by echocardiography (38.7%). 6 patients were examined by CAG: 2 patients were not detected origin of fistulas by CAG, 3 patients were not detected drainage of fistulas by CAG. Conclusion: DSCT is a noninvasive and useful modality for the diagnosis of CAFs.

ASSESSMENT LEFT VENTRICULAR FUNCTION AND REGIONAL WALL MOTION BY 256-SLICE DUALSOURCE CORONARY CT ANGIOGRAPHY: A COMPARISON WITH 2D TRANSTHORACIC ECHOCARDIOGRAPHY

BS Le Lien Le Thi Thuy — 2021-12-31

Objective: To compare the left ventricular (LV) function (dimensions, ejection fraction (EF), end-diastolic volume (EDV), endsystolic volume (ESV)), and regional wall motion analyzed by 256-slice Dual-source coronary angiography CT (DSCT) with 2D transthoracic echocardiography (TTE). Materials and Methods: One-hundred twelve patients suspected of coronary artery disease underwent DSCT and 2D-TTE within 1 week for LV dimensions, EF, EDV, and ESV. Correlation between DSCT and 2D-TTE measurements was analyzed through linear regression and BlandAltman analysis. Regional wall motion visually scored as 3 points scale (1, normal, 2, hypokinesia, 3, dysphagia, or akinesia). Results: Average LVEF was 66,24± 13,52% (range 23-85%) on DSCT, compared with 65,72±11,31% (range 25-84%) on 2D transthoracic echocardiography. Evaluation of LVEF showed a good correlation between DSCT and 2D-TTE (r=0,715; p<0.001). Good correlations between DSCT and 2D-TTE were demonstrated for the assessment of LVEDV (r=0,732; P < 0.001) and LVESV (r= 0,841; P < 0.001). Mean differences (±SD) of 1,78 ± 24,10 mL (p <0 .05) and 0,766 ± 13,7 mL (p < 0.05) were observed between DSCT and 2D-echocardiography for LVEDV and LVESV, respectively. LVEF was slightly overestimated with DSCT (0.52 ± 9,59%; p < 0.05). Even the LVEF calculated by DSCT and echocardiography were similer but EDV and ESV from DSCT were statistically higher than those from 2D-TTE (p < 0.05). Agreement between DSCT and 2D-TTE in regional wall motion is 96,4%, k=0,840. Conclusion: 256-slice DSCT can provide comparable results to those using 2D-TTE for LV function measurement include EF, EDV, ESV, and regional wall motion assessment in a heterogeneous population.

EVALUATION OF 18FLUORINFLUOROTHYMIDINE UPTAKE IN BREAST AND LUNG-TUMOR BEARING MICE

BS Nguyen Thi Kim Dung — 2021-12-31

Background: PET (positron emission tomography) techniques and radiopharmaceutical tracers are becoming increasingly common in clinical practice. Since 1991, 3’-deoxy-3’-18Fluorine-Fluorothymidine (18F-FLT) has been studied as a PET tracer for tumor proliferation assessment. The purpose of this study was to assess tracer uptake (%ID/g) in tumor-bearing mice and the relationship between uptake values and Ki-67 expression. Materials and methods: two cell lines including breast cancer cell line 4T1 and lung cancer cell line LLC were inoculated into BALB/c mice. The radiotracer was then injected, and tumor resection was performed 20, 40, 60, and 90 minutes later. Gamma-ray spectrometer was used to calculate uptake values. Results: The data show that the tumor’s %ID/g were 5.52 ± 0.23 and 4.66 ± 0.49 for the 4T1 and LLC tumors, respectively, at 90 minutes after injection. The LLC tumors presented a higher Ki-67 index than the 4T1 tumors (90.16 ± 2.93% vs 71.83 ± 3.54%). Conclusion: In our model experiment, accumulation of the tracer in the tumor samples correlates with its malignancy which indicates that 18F-FLT could be a feasible PET tracer.

TEXTURE ANALYSIS OF MAGNETIC RESONANCE T1 MAPS AND EXTRACELLULAR VOLUME IN HEART FAILURE COMPARED WITH NORMAL CONTROLS

BS Chau Thi Ngoc Anh — 2021-12-31

Objective: To assess the T1 and extracellular volume (ECV) maps of left ventricle (LV) of patients with non-ischemic heart failure (NIHF) by cardiac MRI Materials & Methods: This retrospective study included 23 NIHF (mean age = 48.1 years, 12 M), 25 matched healthy control (HC) performed CMR on 3T scanner (Skyra, Siemens). NIHF was diagnosed by echocardiography, coronary artery angiogram and myocardial perfusion SPECT. Native T1 map was obtained by modified MOLLI 5-3 sequence and ECV was calculated 12 min. after GBCA 1.5 dose with 4-3-2 sequence on 4C view. Texture analysis was performed with LIFEx(www.lifexsoft. org). We also measured the wall thickness (WT) and outer diameter (OD) of LV. Results: NIHF had larger OD of LV (78 +/- 16 mm) than the HC (57+/-6 mm) (P,0.001) while the WT had no difference (10.9 +/- 3.4 mm vs. 10.2 +/- 2.6 mm, p=0.41). Native T1 was significantly higher in NIHF patients (1310+/- 48 ms) compared to HC (1208+/- 72 ms) (p<0.001), while the ECV showed no difference (29+/- 4.8% vs. 27+/- 5%, p=0.30). The texture analysis of T1 and ECV map¬¬¬s showed no difference in the first-order textures and had significant difference in several second-order textures, such as GLRLM, GLZLM. There was inverse correlation of ECV and WT of LV in NIHF (r=-0.61, p=0.002). Conclusions: In NIHF with preserved WT of LV, texture analysis of T1 and ECV maps showed difference in the mean value of native T1 and texture features, which is promising as a base for machine learning with future larger cohort.

99mTc-MAA SPECT/CT IMAGING FOR TREATMENT RESPONSE PREDICTION AFTER 90Y-RADIOEMBOLIZATION IN HCC PATIENTS: COMPARISON WITH POSTTREATMENT 90Y PET/CT

BS Mai Hong Son — 2021-12-31

90Y PET/CT imaging is performed after radioembolization to re-evaluate the resin microsphere distribution and estimate the absorbed radiation dose of target tumor. However, the distribution of 90Y resin microsphere on PET/CT was different from that of 99mTc-MAA simulation and additive role of PET/CT was not well established until now. The purpose of our study is to validate the utility of 90Y PET/CT compared to SPECT/CT simulation in dosimetry and prediction of treatment response. Material and method: Thirty-four consecutive HCC patients, intermediate and advanced stage who underwent 90Y resin microsphere transarterial embolization (TARE) were recruited in the study. Lung shunt fraction (LSF), tumor to-normal liver uptake ratio (TNr) and absorbed dose for target tumors were estimated on 99m Tc-MAA SPECT/CT and 90Y PET/ CT. The patients were followed up after treatment within 3 months (2.8 mo ± 0.84) on contrast- enhanced CT to assess treatment response using mRECIST criteria. Results: The imaging characteristics of thrombosis uptake was better delineated on PET/CT imaging than SPECT/CT. The agreement and correlation of TNr on PET/CT and SPECT/CT were stronger. Dose delivery to tumor (Dtumor) threshold of 125 Gy estimated on 99mTc-MAA SPECT/CT was more accurate than PET/CT for prediction of treatment response after 90Y-radioembolization in HCC patients with sensitivity of 87.5% and specificity of 90%. Conclusions: 99mTc-MAA SPECT/CT is superior to PET/CT to predict treatment response after 90Y resin microsphere treatment.

ENDOCARDIAL 2D SPECKLE-TRACKING ECHOCARDIOGRAPHY IN PATIENTS WITH CORONARY ARTERY DISEASE

BS Nguyen Le Hoang Minh — 2021-12-31

Objectives: study the left ventricular myocardial function with twodimensional speckle tracking echocardiography and the agreement between endocardial 2DSTE and coronary angiography on the localization of coronary artery stenosis. Subjects and methods: A cross-sectional study was conducted on 60 patients with coronary artery disease at Hue University Hospital. All of them were examined 2DSTE (using endocardial layer strain analysis) and coronary angiography. Results: 60 patients (34 men, 26 women, 69,08 ± 12,44 yrs), Statistically significant 2D-STE reduction of the deformation parameters: global longitudinal strain (GLS) (−8.84% ± 4,74, P <0.05); global circumferential strain (GCS) (−12.49% ± 6,02, P < .05). The agreement of the GLS segment and coronary artery stenosis by coronary angiography were k=0.34 (p<0,05) at anterior wall, k= 0,53 (p<0,05) at lateral wall, k= 0,24 (p<0,05) at inferior wall. Conclusions: The study using strain on 2DSTE shows the left ventricular systolic function reduced in patients with CAD. There is various agreement (not good) about the location of coronary lesions between 2D STE (endocardial strain analysis) and coronary angiography.

COLOR DOPPLER ULTRASOUND WITH DSA CORRELATION IN TYPE 2 DIABETIC PERIPHERAL ARTERIAL DISEASE OF LOWER EXTREMITY

BS Ngo Dac Hong An — 2021-12-31

Objectives: Describe imaging characteristics of Duplex ultrasound (DUS) and correlation with digital subtraction angiography (DSA) in the diagnosis of peripheral arterial disease (PAD) of lower extremity in type 2 diabetic patients. Materials and Methods: cross sectional study with 40 patients diagnosed with type 2 diabetes and PAD on DUS. The image findings of both techniques were used to evaluate the diagnosis accuracy of DUS and the correlation with DSA. Results: The sensitivity, specificity, positive predictive value and negative predictive value of DUS in PAD is 80,65%, 92,83%, 86,21% and 89,61% respectively. DSA complemented for DUS with 6,36% additional cases of >50% stenosis or complete occlusion and 5,49% cases of low flow in occlusion suspected arteries. DSA revealed an additional of 81% collaterals in occluded arteries compared to DUS. Conclusion: DUS has high diagnostic value in PAD of lower extremities in diabetes patients. DSA has high complementary value for DUS in the diagnosis of PAD of lower extremities, with the highest value at belowknee arteries.

A CASE REPORT OF PEDUNCULATED EXTRALUMINAL GASTROINTESTINAL STROMAL TUMOR (GIST)

BS Le Ngoc Tu Tran — 2021-12-31

Gastrointestinal stromal tumors (GISTs) comprise a group of smooth muscle mensenchymal alimentary tract tumors of variable malignancy (1) GISTs may ouccur anywhere along the gastrointestinal tract, they are most commont located in the stomach (5060%) and the small intestine (30-35%), and less frequenty in the colon, rectum and esophagus (2). More rarely, GISTs may arise from other intra-abdoment soft tissues within the abdominal cavity, usually in the omentum, mesentery or the retroperitoneum called extra-Gastrointestinal stromal tumors (EGIST). Three macroscopic growth patterns of GIST: intraluminal, exophytic (extraluminal), and transmural tumors with the distribution was even (3). In this study, we describe case report of 70-year-old man was admitted to our hospital because of abdominal pain over 6 months with no pathological antecedent. Abdominal ultrasound (US) reveal a omental solid mass in left lumbar region, and on CT scan show a solid mass in left lumbar region in front of the descending colon, maesuring around 50x87x133mm with well-circumscribed, slight enhance with intravenous contrast, no hemmorrage or necrosis area, no calcification and not clearly separated from small-bowel. Patient has laparoscopic surgeon, diagnosis was a pedunculated exoluminal gastrointestinal stromal tumor (GIST). Histopathological examination report and the CD-117 immunoreactive score is suitable of endoscopically invisible medium sized.

MESENTERIC LYMPHOMA – A CASE REPORT

BS Minh Le Ba Khanh — 2021-12-31

Mesenteric lymphoma is very rare of mesenteric tumors, approximately 30%–50% of patients with non-Hodgkin lymphoma harbor disease in the mesenteric lymph nodes. We present the case of a 57-year-old male with mild abdominal pain and a history of pulmonary tuberculosis. Abdominal computed tomography revealed a dense tissue replacing mesenteric fat, surrounding loops of bowel. The differential diagnosis between primary mesenteric lymphoma and others peritoneum diseases such as peritoneal carcinomatosis, malignant primary peritoneal mesotheliomas, tuberculous peritonitis, sarcomatosis, diffuse peritoneal leiomyomatosis or benign splenosis, constitutes a major problem in imaging techniques. Our report demonstrates a rare and important differential diagnosis of abdominal pain and the crucial role of surgical excisional biopsy to diagnose mesenteric ly mphoma

LEFT PULMONARY ARTERY SLING: REPORT OF FIVE CASES ON MDCT FROM VIETNAMESE CHILDREN

BS Phung Ngoc Phung Bao — 2021-12-31

Left pulmonary artery sling (LPAS) is a rare congenital anomaly in which the left pulmonary artery originates from the posterior aspect of the right pulmonary artery and courses between the trachea and esophagus to reach the left lung. This anomaly causes distal tracheal and/or right main-stem bronchus compression. Most LPAS cases are associated with early symptom onset, around 2 month-old, and have severe respiratory distress within the first year of life. There are two major types of LPAS based on the location of LPA and abnormal bronchial branching. The diagnosis can be made by using various imaging modalities. Herein, we present the imaging characteristics on multi detectors computed tomography of 5 LPAS cases with respiratory distress (2 months to 12 months).

ACUTE MYOCARDIAL INFARCTION IN PATIENT WITH SINGLE CORONARY ARTERY: A CASE REPORT

BS Nguyen Huyen Nguyen Thi — 2021-12-31

A single coronary artery (SCA) is a rare congenital anomaly. In most cases, it is an incidental finding on coronary angiography and has no clinical significance. However, it can cause angina, myocardial infarction, or even sudden death. Reports of SCA with acute myocardial infarction are very rare in the medical literature. This case study presents a patient with SCA from the right aortic sinus with severe stenosis proximal and distal part of right coronary artery was made using cardiac angiography and cardiac multidetector computed tomography (MDCT) with acute myocardial infarction