Tạp chí Điện quang & Y học hạt nhân Việt Nam

CASE REPORT: RARE CASE OF PNEUMOCYTOMA

BS Le Van Giao — 2024-01-03

Pulmonary sclerosing (Pneumocytoma) is a rare benign pulmonary tumor of primitive epithelial origin. Because of the unspecific radiological features mimicking malignancies and their histological heterogeneity, the differential diagnosis with adenocarcinoma and carcinoid tumors is still challenging. We report a case of sclerosing pneumocytoma, as well as a review of the literature. Immunohistochemical findings showed intense staining of the cuboidal epithelial cells for cytokeratin-pool and TTF-1, with focal positivity for progesterone receptors. Round and spindle cells expressed positivity for vimentin, TTF-1, and focally for the progesterone receptor. Since the pre- and intraoperative diagnosis should guide surgical decision-making, obtaining a sufficient specimen size to find representative material in the cell block is of paramount importance. This overview highlights what physicians need to know regarding clinical manifestations, radiological and histological features as well as recent advances in immunohistochemistry in the diagnosis of this disease.

THE LEFT ATRIAL APPENDAGE MORPHOLOGY IN PATIENTS WITH ATRIAL FIBRILLATION BY CARDIAC COMPUTED TOMOGRAPHY

BS Truong Thi Thanh — 2023-12-28

THE VALUE OF HIGH-RESOLUTION T2-WEIGHTED MRI TO EVALUATE LOCAL STAGING OF RECTAL CANCER

BS Pham Thi Men — 2023-12-28

EVALUATION OF OROPHARYNGEAL DYSPHAGIA USING THE VIDEO-FLUOROSCOPIC SWALLOWING STUDY IN STROKE PATIENTS

BS Nguyen Thi Thanh Nhan — 2023-12-28

Purpose: This study aimed to describe imaging characteristics of oropharyngeal dysphagia on a video-fluoroscopic swallowing study (VFSS) using an assessment questionnaire in post-stroke patients. Materials and methods: We assessed the oropharyngeal dysphasia in post-stroke patients using an assessment questionnaire with the modified barium swallow impairment profile (MBSImP) and penetration aspiration scale (PAS) at Bach Mai Hospital from January 2020 to June 2023. Results: The study was conducted on 26 post-stroke patients (17 men and 9 women), consisting of 12 patients who have oral phase dysphagia (46%), 6 patients with pharyngeal phase (23%), 3 patients with oral and pharyngeal phase dysphagia (12%), 5 patients without dysphagia. Twelve patients had penetration aspiration (46,2%), of which 4 patients had a risk of aspiration (15,4%) and 8 patients had positive aspiration (30,8%). Conclusion: Swallowing disorders are common in patients with stroke. The VFSS is an examination method with tools that help assess the stage of swallowing disorders and aspiration, especially silent aspiration.

RIGHT VENTRICULAR FUNCTION ASSESSMENT BY SPECKLE TRACKINGECHOCARDIOGRAPHY IN PATIENTS ON REGULAR HEMODIALYSIS WITH PRESERVED LEFT VENTRICULAR EJECTION FRACTION

PGS Nguyen Thi Thu Hoai — 2023-12-28

Aims: To investigate right ventricular function in hemodialysis patients with preserved left ventricular ejection fraction (LVEF) using twodimensional speckle tracking echocardiography. Methods: Patients with end-stage kidney disease (ESKD) who were on regular hemodialysis and had preserved LVEF and a group of age- and sex-matched control subjects were recruited for the study in Bach Mai Hospital. All subjects were interviewed and examined comprehensively. Echocardiography was performed in all patients and controls. Right ventricular function was evaluated using conventional and speckletracking echocardiography. Estimate glomerular filtration rate (eGFR) was calculated according to the MDRD GFR equation. Results: From 6/2022 to 11/2022, a total of 61 ESKD receiving hemodialysis regularly and 32 controls were evaluated. The mean age of the hemodialysis patients was 51.2±13.8. Men account for 54.1% (33/61). Hemodialysis patients had larger right ventricular diameters, lower RV fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE), and decreased S velocities of the tricuspid valve compared to the controls (p<0.05 for all). Systolic pulmonary artery pressure (sPAP) of the hemodialysis group was higher when compared to the controls (p<0.05 for all). Absolute values of right ventricular global strain (RVGS) and right ventricular free wall strain (RVFWS) were significantly lower in the hemodialysis group than in the control (p<0.05 for all). Absolute values of RVGS and RVFWS inversely correlated to LV mass index (r = -0.42, p<0.05 and r=-0.46, p<0.05, respectively) while they positively correlated to eGFR (r = 0.57, p<0.05 and r = 0.59, p<0.05, respectively), hemoglobin level (r = 0.41, p<0.05 and r = 0.43, p<0.05, respectively), RVFAC (r = 0.54, p<0.05 and r = 0.51, p<0.05, respectively). Conclusion: Right ventricular function assessed by speckle tracking echocardiography reduced in hemodialysis patients. Right ventricular myocardial strain strongly correlated with glomerular filtration rate, RVFAC, and moderately correlated with hemoglobin level and LV mass index..

REDUCED IODINATED CONTRAST VOLUME AND RADIATION DOSE IN THE NEW PROTOCOL FOR CT CORONARY ANGIOGRAPHY USING DUAL-SOURCE IMAGING WITH LOW TUBE VOLTAGE COMPARED WITH THE CONVENTIONAL PROTOCOL

BS Nguyen Thi Hong Tuy — 2023-12-28

Objective: To assess the effectiveness and utility of a low-contrastvolume, coronary computed tomography angiography (CCTA) protocol that leverages a lower tube peak voltage (80 kVp) compared to the conventionally employed 120 kVp in patients referred for diagnostic coronary CT angiography. Materials and Methods: 120 patients (60 males, between 23 to 86 years) were randomly assigned to two groups (n=60) who were scanned with either the 80 kVp (“Group A”) or the 120 kVp (“Group B”) protocols using retrospective ECG gating. All patients had body mass index (BMI) under 25 kg/m2 and heart rates under 120 beats per minute. On a patient-by-patient and segment-by-segment basis, the signal-to-noise (S/N) and contrast-to-noise (C/N) ratios, effective radiation dose given in mSv, and diagnostic confidence (DC) were assessed for both groups by two independent readers with 8 and 7 years experience in coronary CT angiography. Results: Patients in group A received a significantly reduced radiation dose of 2.57 mSv compared with 7.07 mSv in group B (p < 0.001). The total administered amount of Iodine per scan was also significantly lower in Group A (17.5g) than in Group B (24.5g). A significant reduction in image noise with higher S/N and C/N ratios in coronary vessels was seen in group B (p < 0.001). S/N ratios in group A were 18.7, 18.6, 18.7, and 18.6 for left main, proximal left anterior descending, proximal left circumflex arteries, and proximal right coronary, respectively, and 16.7, 17.4, and 18.3 for distal left anterior descending, distal left circumflex, distal right coronary arteries, respectively, in group A. Conversely, in group B the S/R values were 22.5, 22.0, 22.0, 21.4,19.0, 18.8, and 21.7 in group B patients. C/N ratios were 22.2, 22.1, 21.9, 22.1, 20.5, 21.0, and 21.9 in group A compared with group B patients, who had ratios of 26.6, 26.1, 25.9, 25.5,23.2, 23.0 and 25.6 (in a vessel-by-vessel assessment, each vessel in group B had p < 0.001). No significant difference in DC per patient was seen between the groups (ICC 1.0 for Group A and 0.9 for Group B). Conclusion: The retrospective ECG-gated low-kVp low-volume contrast coronary CT angiography protocol provides angiograms without penalty in diagnostic confidence in patients with BMI up to 25 kg/m2 and heart rates of less than 120 beats/min. It is beneficial for patients whose kidney functions are not good and for those who increased risk for extravasations to diminish the risk of compartment syndrome in severe cases.

EVALUATE THE EFFECTS OF CT-GUIDED SPLANCHNIC NERVE NEUROLYSIS IN PAIN CAUSED BY UPPER ABDOMINAL VISCERAL MALIGNANCIES

BS Tong Ngoc Tien — 2023-12-28

Objective: This study aims to assess the efficacy of CT-guided splanchnic nerve neurolysis in alleviating pain associated with malignancies in the upper abdominal viscera. Methods: A single-arm investigation involved 20 patients diagnosed with upper abdominal visceral malignancies and experiencing pain with a VAS ≥ 7. All participants underwent CT-guided splanchnic nerve neurolysis utilizing absolute alcohol ablation. Pain intensity was measured using the visual analog scale (VAS) one-day post-procedure, at one week, and at one-month follow-up. The primary endpoint was to evaluate the effectiveness of pain relief based on VAS scores. Incidences of intra- and post-procedural complications were meticulously documented. Results: The mean age of participants was 60.7±11.1, with 12 men and 8 women included in the study. Assessment of pain relief, as per the Visual Analogue Scale (VAS) one day following the intervention, revealed a 70% efficacy in the group with substantial relief and 30% with moderate relief. The average VAS score exhibited a significant decrease immediately post-intervention (8.7±1.1 vs. 3.4±1.3, p<0.05). The average VAS scores remained relatively stable at 2.6±1.5 and 2.1±1.5 at the one-week and one-month follow-up, respectively. Common complications included orthostatic hypotension (40%), initial pain (30%), acute intoxication (25%), and diarrhea (15%). No instances of severe complications were recorded. Conclusion: CT-guided splanchnic nerve neurolysis using absolute alcohol is deemed a secure and productive method for promptly mitigating pain and sustaining pain stability for up to one month.

99mTc-MDP MYOCARDIAL SCINTIGRAPHY IN DIAGNOSIS OF AMYLOID CARDIOMYOPATHY AT FV HOSPITAL, HCM CITY

BS Nguyen Van Te — 2023-12-28

Retrospective study of 99mTc-MDP myocardial scintigraphy for restrictive cardiomyopathy with suspicion of amyloidosis from Feb 2021-Nov 2021 at FV hospital. Total 10 patients (7 male and 3 female patients) of age 37-85 years. Injected dose 15-20 (555-740 MBq), Thorax planar and SPECT/low dose non contrast CT acquisition at 1 hour following tracer injection. Qualitative analysis with Visual score and quantitative H/CL ratio Positive scan is concluded in case of diffuse uptake in myocardium with Visual score 2-3 and H/CL ratio >1.5. The procedure was performed safely with no side effect, no allergic to radiotracer recognized. Results: Two male patients out of ten are positive for TTR-CA, at age 37 and 67. No myocardial biopsy is indicated for differential diagnosis between AL and TTR-CA. Eight patients are negative scintigraphically not specific for TTR-CA with H/CL <1.5 and Visual score 0. Conclusion: 99mTc-MDP cardiac scintigraphy is a safe, reliable, noninvasive nuclear imaging applicated for early and differential diagnosis of cardiac amyloidosis replacing to myocardial biopsy. This approach contributes to reveal an undiagnosed disease at not so advanced cardiac involvement and with the progress of recent medical treatment, the survival is increasing. Other bone-avid tracers are encuraged for myocardial imaging depending on their availability

RECOVERY PROGNOSIS OF ASPECTS IN PATIENTS WITH ACUTE ANTERIOR CIRCULATION CEREBRAL INFARCTION UNDERGOING MECHANICAL THROMBECTOMY

BS Nguyen Thanh Tam — 2023-12-28

VALUE OF DUAL-ENERGY COMPUTED TOMOGRAPHY IN THE ASSESSMENT OF PRIMARY LUNG CANCER

BS Do Dang Khanh — 2023-12-28

Objective: This study aims to observe the value of the dual-energy computed tomography (DECT) technique in the assessment of primary lung cancer. Compare the difference in density of lung tumors on the true non-contrast (TNC) and virtual non-contrast (VNC) images. Investigate the iodine concentration value of lung tumors in differentiating malignant and benign lesions as well as adenocarcinoma and squamous carcinoma in lung cancer. Methods: We conducted a cross-sectional descriptive study in 42 patients with solitary pulmonary nodules proved by pathology underwent doublephase enhanced CT scan at the Diagnostic Imaging Center of K Hospital, Hanoi. Process dual-energy CT data into virtual monoenergetic and virtual non-contrast images, comparing with true non-contrast images. Compare the iodine concentration of malignant and benign lesions, adenocarcinoma, and squamous cell carcinoma lung cancer. The slope rate was calculated from the spectral curve. Patients were divided into an inflammatory group, a malignant group, and a tuberculosis group. The Kruskal–Wallis test and Nemenyi test were performed to compare quantitative parameters among the three groups. Results: The study comprised 42 patients (34 males). The mean age of patients was 56 ±11. 23/42 right lung tumors (accounted for about 55%), 13/33 left lung tumors (about 40%). Pathological results showed that 73.8% (31/42) of the lesions were malignant, and 26.2% were benign. The density of lung tumors on the true non-contrast (TNC) and virtual noncontrast (VNC) images is 43,81 ± 10,90 and 43,32 ± 11,15 HU (p=0,147). The contrast-noise ratio of lung tumors has the highest value in the virtual monochrome image at 65 keV. The iodine concentration of malignant tumors was 0,37±0,15mg/ml, higher than benign lesions. The normalized iodine concentration (nIC) of lung tumors can differentiate malignant from benign lesions with an area under the curve of 0,748, with a best cut-off point of 0,27 mg/ml having a sensitivity is 74,2%, specificity of 81,8%. The normalized iodine concentration (nIC) of lung tumors can also differentiate adenocarcinoma from squamous cell carcinoma with an area under the curve of 0,835, with a best cut-off point of 0,36 mg/ml having a sensitivity is 76,5%, specificity of 100%. The mean slope rate for the inflammatory group was 2,51 ± 0,25, significantly higher than these parameters for the malignant group (p < 0.05), and the parameters for the malignant group were significantly higher than the tuberculosis group (p < 0.05). Conclusion: Virtual non-contrast images can replace the role of true non-contrast images. In virtual monoenergetic, the 65 keV sequence has the best Contrast to Noise Ratio (CNR). Quantitative analysis of iodine concentration in lung tumors can help differentiate malignant and benign lung lesions, adenocarcinoma, and squamous cell carcinoma. HU slope rate showed statistically significant differences, which is helpful in the differential diagnosis among inflammatory, malignant, and tuberculosis lesions.