The ASEAN Journal of Radiology

AMBER: FOR CHEST, LARYNX AND ABDOMINAL RADIOGRAPHY

Patchrin PEKANAN — 2023-03-30

Conventional radiography is limited by the small useful exposure range of radiographic film. The wide variation in absorption thickness of different parts of the body results in areas of under-and over exposure. An advanced multiple beam equalization system, AMBER, controls local exposure delivered to the film. The system has a row of 20 modulators in front of the x-ray tube, each able to change the height of the local slit beam during scanning. Changes are made in response to measurements from a linear detector array in front of the film cassette. This array consists of 20 individually functioning detectors coupled through electronic feedback loops to the 20 modulators. A scan is obtained in 0.8 second with a local exposure time of approximately 50 msec. AMBER results in radiographs with sig- nificantly improved exposure of the mediastinum without overexposure of the lungs. Originally, this system was aimed to use for the chest radiography, however, abdominal radiography and laryngeal radiography was used by us to illustrate the images produced by this machine.

A REPORTED CASE OF PULMONARY SPARGANOSIS : RADIOLOGICAL ASPECT AND REVIEW OF ARTICLES.

Jaturat KANPITTAYA — 2023-03-30

Human sparganosis is a rare parasitic infestation caused by the migratory second stage larvae (plerocercoid) of the Pseudophyllidean cestode of genus Spirometra (Mueller, 1973). The first report of human sparganosis was made by Patrick Manson in a Chinese patient in 1882 (Beaver, 1984). The distribution of the cases was sporadically worldwide, but most commonly from East and Southeast Asia (Japan, China, Korea, Taiwan, Vietnam and Thailand). There were some reports from the Southern part of the United States and Europe (Mueller et al, 1975). Sparganosis was commonly reported to involve subcutaneous tissue, muscle, ocular and visceral organs including the central nervous system. Pulmonary involvement is extremely rare. A case of pulmonary sparganosis was presented with chronic hemoptysis and abnormal lung shadows. The diagnosis could not be made by radiological image and bronchoscopic examination. The patient received an antituberculous drug without response. Finally the diagnosis was confirmed by open lung biopsy which the plerocercoid larvae of sparganum was found.

PULMONARY ACTINOMYCOSIS: PLAIN FILMS AND CT IMAGES

Patchrin PEKANAN — 2023-03-30

A case report of pulmonary actinomycosis in a middle aged diabetic patient was presented. Plain chest film and CT scan of the lesion showed right lower lobe in location. The lesion presented as a mass lesion with small cavities and surrounding alveolar infiltration. The pleural space and bony parts were not involved due to partial treatment. Inadequate treat- ment showed worse progression. Needle aspiration was suggested for early diagnosis and treatment.

CT IMAGING OF MADELUNG DISEASE: A CASE REPORT

atchrin PEKANAN — 2023-03-30

Madelung Disease was first described by Launois and Bensaude in 1898 (1). Its synonyms are Launois-Bensaude disease, Buschke disease, cervical lipomatosis, Madelung neck and multiple symmetrical lipomatosis (2). It is characterized by progressive growth of fat masses which are located symmetrically at the neck, shoulders, chest, abdomen and groin (3). The disease seems to be more frequent in the Mediterranean regions, and approximately 97% of those affected are men.
We report a case of Madelung disease in a 38 years-old Thai male patient.

DIAGNOSTIC IMAGING OF THE LATERAL NECK MASSES IN ADULTS: A STUDY IN RAMATHIBODI HOSPITAL.

Kunchitthape TANPOAPONG — 2023-03-30

The retrospective study of roentgenographic evaluation for solely lateral neck mass in 146 adult patients at ENT clinic, Ramathibodi Hospital, during 1987-94 prior to panendoscopy with random-guided- directed biopsy of upper aerodigestive tract was proposed. X-ray chest (PA view) showed abnormal in 21.3%. Tuberculosis, non-tuberculosis, pulmonary mass, hilar or mediastinal mass and miliary infiltration were 5.5,6.2,2.7, 6.2 and 0.7% respectively. Panendocopic finding was abnormal only in 1 case. Barium swallowing in 67 cases had sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 50.0,96.6,91.1,66.7 and 93.4%. It was necessary to be done in swallowing disorder patients. CT scan of the head and neck region in 18 patients, 16 had abnormal findings; it was rec- ommended in suspected nasopharyngeal cases or lessions difficult to be palpated. Other investigations such as thyroid scan, neck ultrasonography, sialography or angiography was used when they were indicated. Roentgenographic cost had an importnat role in order to choose the suitable investigation and gave maximal benefit for patients.

RADIOGRAPHIC APPEARANCE OF THE INTRATHORACIC TUBERCULOSIS IN 20 HIV-POSITIVE PATIENTS

Supranee NIRAPATHPONGPORN — 2023-03-30

Retrospective analysis of the roentgen findings in intrathoracic tuberculosis of 20 HIV positive patients were performed. Prominent features were mediastinal and hilar lymphadenopathy. Pulmonary infiltration had more or less interstitial component. Cavi- tation was rare. Pleural effusion was quite common. The pulmonary infiltration involved both upper and lower lung zones, diffuse and perihilar distribution; however, the upper lung zones still predominated.

CT FINDINGS IN HYPERTENSIVE INTRACRANIAL PARENCHYMA HEMORRHAGE

Wiwatana THANOMKIAT — 2023-03-30

A retrospective study of the CT scans of the patients with hypertensive intracranial parenchymal bleeding, was performed in 141 patients. Bleeding at the putamen/ external capsule, thalamus, subcortical white matter, cerebellum, brain stem and internal capsule was seen in 42, 26, 12, 10, 9 and 1 percents of cases respectively. The incidence of rupture of the hematoma into the ventricles from the sites mentioned above was 44, 75, 41,43,30 and 0 percents of the total hematomas at each site respectively.

EVALUATION FOR CT CRITERIA OF GRANULOMATOUS INFECTION AND TUMOUR OF SPINE

Napaporn CHOTIKA — 2023-03-30

To develop criteria to distinguish between granulomatous infection and neoplastic process in the spine by mean of the computed tomography scan (CT scan), the authors retrospectively analyzed 31 cases of granulomatous infection and 13 cases of neoplastic dis- case. The result was that the reliable criteria for granulomatous infection were diffuse bony destruction, contiguous levels of spinal involvement, absence of posterior element involve- ment, presence of "complete" pattern of prevertebral soft tissue, and presence of disc involvemant. Neoplastic diseases were characterized by focal bony destruction, seperated levels of spinal involvement, presence of posterior element involvement, "partial" pattern of prevertebral soft tissue, and absence of disc involvement. Blinded testing of these criteria is potential for improving diagnostic accuracy in clinical practice.

INTRAVENTRICULAR MENINGEAL HEMANGIOPERICYTOMA CT DIAGNOSIS.

Patchrin PEKANAN — 2023-03-30

A report case of hemangiopericytoma detected by CT scan in a 59-year old patient was performed. The tumor was partly in left posterior horn of the lateral ventricle and partly in the deep left parietal lobe. The tumor was lobulated and solid. The density was isodensity with central low density. The enhancement was dense at the isodensity area. The left choroidal vessel at the medial part of the mass, facing the posterior horn was dilated. There was a moderate degree of peritumoral white matter edema. Meningeal hemangiopericytoma should be kept in mind if the appearance of the CT scanwas similar to this case and the pathological report was that of meningioma. More aggressive treatment and follow up should be offered to the patient.

"GAS IN THE AORTIC WALL": A CT FINDING IN SALMONELLA ABDOMINAL AORTIC ANEURYSM.

Komgrit TANISARO — 2023-03-30

Two cases of Salmonella Abdominal Aortic Aneurysm (AAA) in diabetic elderly are presented. CT scan in both cases reveal "gas in the aortic wall" which were seldom reported in Salmonella infection. This sign and other CT findings of Salmonella AAA are reviewed and discussed.

RETROPHARYNGEAL SPACE, PREVERTEBRAL SPACE INFECTION AND EPIDURAL ABSCESS:MULTI-IMAGING-MODALITIES- DEMONSTRATION IN A DIABETIC PATIENT.

Wiwattana TANOMKIAT — 2023-03-30

A case of pyogenic infection in retropharyngeal and prevertebral space with epidural abscess in a diabetic adult patient was reported. The infectious process began as an acute osteomyelitis of the great toe's phalanges. Plain film, CT scan and MRI studies showed the spread extension nicely in different aspects.

THORACOLUMBAR VERTEBRAL HEIGHT RATIO: NORMAL VALUE IN THAI POPULATION AND SIGNIFICANCE

Pimjai SIRIWONGPAIRAT — 2023-03-30

The vertebral height (anterior height, central height and posterior height) of thoracolumbar spine, Th12 to L4, were measured in 398 normal subjects by standard lateral radiographs, and the vertebral height ratios were calculated in both females and males to evaluate normal value in Thai population. A fracture was considered to be present if the anterior or central height was decreased by 20% comparing to the posterior height.

MRI OF MARROW CHANGES IN THE VERTEBRAL BODIES ADJACENT TO ENDPLATES IN DEGENERATIVE LUMBAR DISC DISEASE.

Krisna CHITAREE — 2023-03-30

MR studies of the lumbar spine in 57 patients [285 disc spaces] were analyzed, to assess the appearance and frequency of the bone marrow signal changes in the vertebral bodies adjacent to the normal and degenerative discs. Degenerative changes were found in 144 of 285 discs. Signal abnormalities of bone marrow adjacent to the endplates were identified in 52 of 144 discs (36.1%). In 44 of 52 discs [84.6%], there is an area of relatively increased signal intensity in T1WI & T2WI in the vertebral bodies adjacent to the endplates. In 6 of 52 [11.5%] decreased signal intensity on both T1WI & T2WI was noted in focal and bandlike appearance. In the other 2 discs [3.9%] decreased signal was noted on T1WI and increased signal evidence in T2WI. These marrow changes were not present adjacent to the normal discs. The signal alteration suggests three patterns of bone marrow change; fat phase, sclerotic phase and edematous phase respectively. The ages of the patients with marrow changes in edematous phase (41 and 43 years old) are less than the mean ages of the other two groups (65.52 and 59.4 years respectively).
We conclude that bandlike and focal areas of signal changes in the bone marrow adjacent to degenerative intervertebral discs can occur on MR images of the lumbar spine and should not be confused with signal changes from tumor or infectious process involving the disc space and adjacent vertebral endplates.

NEUROCUTANEOUS MELANOSIS: MRI FINDINGS IN THE BRAIN WITH REVIEW OF ARTICLES

Patchrin PEKANAN — 2023-03-30

MRI findings in a 5 years-old boy with neurocutaneous melanosis was described. Melanocytic nodules were shown in the brain parenchyma, meninges and perivascular space. They were seen as hypersignal lesions on T1W1, iso to hyposignal lesions on T2W1. There was no significant enhancement of the nodules. Literatures were reviewed concerning this con- dition.

DUCTAL LUCENCY IN X-RAY MAMMOGRAPHY

Suphaneewan JAOVISIDHA — 2023-03-30

x-ray mammography is a widely performed procedure in the diagnosis of the diseases of the breast, and is able to reveal ductal abnormalities such as ductal dilatation & calcification. We, hereby, report a case of ductal lucency demonstrated by X-ray mammography, which is an uncommon finding. It may represent normal physiology or pathological processes.

BENIGN BREAST MASSES SIMULATING CARCINOMA: MAMMOGRAPHIC FINDINGS

Malai MUTTARAK — 2023-03-30

Mammography is now a more widely used procedure in the diagnosis of breast disease. The only breast diagnosis of importance is carcinoma because it can cause a woman's death. The pitfalls of mammographic diagnosis are increasingly recognised. The roentgen appearance of some benign disease process may simulate carcinoma. Accurate diagnosis depends on a wide knowledge of various disease processes. We present 23 cases of different benign lesions that may be easily confused with carcinoma.

CARCINOMA OF THE BREASTS: THE IMPORTANCE OF BREAST-PALPATION AND THE DETECTION OF THE CANCER LESIONS BY X-RAY AND ULTRASONOGRAPHIC MAMMOGRAPHY.

Supranee NIRAPATHPONGPORN — 2023-03-30

A retrospective study of 26 breast cancer-cases in Samitivej hospital was performed to determine the importance of breast palpation and the detection of the cancer lesions by x-ray and ultrasonographic mammography. The patient's age was 30-76 years old. The main presenting symptom was palpable mass. Twenty-nine percents of the lesions could be detected by every modality, 14% could be detected only by palpation and more lesions could be detected by ultrasonography compared with x-ray mammography. Microcalcification was the only finding that x-ray mammography was more superior than the palpation and ultrasonography by this study. Biopsy was suggested in every palpated lesion though the lesion could not be visualized by x-ray and ultrasonographic mammography. Needle guided biopsy was useful for the lesions containing microcalcification.

CONVENTIONAL RADIOGRAPHY ANALYSIS OF 70 CASES OF PROVED APPENDICULAR-SKELETAL-RELATED OSTEOSARCOMA IN RAMATHIBODI HOSPITAL

Pimjai SIRIWONGPAIRAT — 2023-03-30

A retrospective analysis of conventional radiographic appearance of the appendicu- lar skeletal related osteosarcoma patients, who came for pre-operative chemoembolization was presented in 70 cases. The most common age range was 16-20 years old. Male to female ratio was 1.3 to 1.
The presenting symptoms were pain and soft tissue mass. Central osteosarcoma occupied 90% of cases and the rest was its variant-telangiectatic type. Around knee involvement was the most common area. Long bones predominated with rare flat bones involvement.
Every region of the bone may be involved, but 85% included metaphyseal region. There was no isolated epiphyseal involvement. Usually the radiographic pattern was mixed lytic and blastic and purely lytic lesion. There was no good correlation between the roentgen appearance and the histologic type. The osteoid matrix represented 74%, chondroid matrix 14% and unclassified 13%. 81% had associated mass, and more than half of them were larger than 5 cms. The sunburst or sunray, the Codman's triangle or combined pattern represented 66%, the rest was spiculated pattern and combined spiculated and Codman's triangle. The finding were not different from those reported by previous authors, except epiphyseal plates were involved mainly in young children whose growth plates were not closed.

LOW DOSE RATE BRACHYTHERAPY CAESIUM-137 AFTERLOADING IN THE TREATMENT OF CARCINOMA OF UTERINE CERVIX IN SRINAGARIND HOSPITAL: ANALYSIS OF ACTURIAL SURVIVAL RATE

Montien PESEE — 2023-03-30

From October 1982 to December 1985, 412 patients with invasive uterine cervical carcinoma were treated with radiotherapy alone at the Division of Radiotherapy, Department of Radiology, Faculty of lledicine, Khon Kaen University, Khon Kaen, Thailand. The patients were in stages IB, IIA, IIB, IIIA, IIIB, IVA and IVB with 13, 5, 176, 5, 164, 14 and 15 cases respectively. Treatment methods were external irradiation 5000 cGy in 5 weeks in addition to intracavitary low dose rate brachytherapy 5400 mghr once or 3600 mghr twice after external radiotherapy. 66.4% of patients received brachytherapy after teletherapy more than 2 week interval. The average point A dose was 89.63 Gy and point B dose was 61.59 Gy. The acturial 3 year survival rates for stage IB, IIA, IIB, IIIA, IIIB, IVA and IVB were 89%, 100%, 70%, 60%, 56%, 28%, and 29% respectively. The 5 year acturial survival rates for stage IIB and IIIB which represent the highest number of the populations in this study were 63% and 39% respectively. The 5 year acturial survival rates for small size tumor less than 2 cm in diameter and tumor size larger than 2 cm in diameter were 74% and 56% respectively. Our study had been reported previously about residual tumors and complications.

THYROID NODULES: EVALUATION WITH COLOR DOPPLER ULTRASONOGRAPHY.

Chutiwan VIWATTANASITTIPHONG — 2023-03-30

he aim of this study was to assess prospectively the value of thyroid Color Doppler sonographic examination of the patients with a solitary thyroid nodule and correlation with the fine needle aspiration cytology.
Sixty patients with a solitary thyroid nodule underwent Color Doppler sonography with 7.5 MHz transducer which proved histologically to be 10 (15%) malignant and 50 (85%) benign nodules. Perinodular color flow signal were depicted in 6 out of 10 (60%) malignant nodules and 29 out of 50 (58%) benign lesions. Intranodular color flow signal were exhibited in 3 out of 10 (33%) and 2 out of 50 (4%) of malignant and benign lesions respectively. This left 20 out of 60 (33%) to have absence of color flow signal. The malignant nodule showed greater tendency to exhibit intranodular color flow signal than benign lesion but perinodular color flow signal was found in both benign and malignant nodule equally. The quantitative evaluation of the peak flow velocity obtained from the Doppler wave form shows no significant difference of the peak flow velocity between benign and malignant lesion (mean peak flow velocity 15.85 cm/sec of malignant nodule and 13.37 cm/sec of benign lesion.