The ASEAN Journal of Radiology

Returning to the pre-pandemic situation but still in the years of infections

Wiwatana Tanomkiat, M.D. — Thu, 31 Aug 2023 00:00:00 +0700

Tuberculosis: Important lessons from AOCR 2023, Bangkok, Thailand

Thu, 31 Aug 2023 00:00:00 +0700

The Asian Symposia at the AOCR 2023 discussed the situation and role of radiology in tuberculosis. The scientific committee of the Asian Oceanian Congress of Radiology (AOCR) established the Asian Symposia in order to discuss important and relevant health topics with participating Asian radiological societies. At the AOCR 2023 Asian Symposia I: Situation and Imaging Innovation in Tuberculosis, different views, initiatives, and ideas were presented by representatives from various societies.

The preoperative factors associated with underestimation of invasive breast cancer in stereotactic vacuum-assisted biopsy-diagnosed DCIS patients

Somchanin Pipatpajong, M.D., Rachata Tangkulboriboon, M.D. — Thu, 31 Aug 2023 00:00:00 +0700

Abstract

Objective: To determine preoperative factors associated with underestimation of invasive breast cancer, where stereotactic vacuum-assisted biopsy (VAB) diagnosed as ductal carcinoma in situ (DCIS).

Materials and Methods: Data from 95 patients diagnosed with DCIS by stereotactic VAB, including their clinical, radiological, and pathological findings between November 2010 and May 2021, were analyzed retrospectively. The clinical, radiological, and pathological features were analyzed.

Results: The underestimation rate was 30.5 %. Three preoperative features were significantly associated with theunderestimation of invasive breast cancer in multivariable analysis, including palpability (OR, 11.51; 95% CI: 1.817-72.897; P = 0.009), BI-RADS category (OR, 3.705; 95% CI: 1.214-11.303; P = 0.021), and visibility of a mammographically detected lesion at ultrasonography (OR, 7.115; 95% CI: 1.977-25.611; P = 0.003). The calcification morphology was statistically significant in an univariable analysis but not in a multivariable analysis.

Conclusion: Preoperative variables significantly associated with underdiagnosis of invasive breast cancer, including palpability, BI-RADS category, and visibility of mammographically detected lesions at ultrasonography, could aid in assessing the risk of developing invasive breast cancer and conducting treatment selection.

Factors related to bone mineral density in female patients receiving TSH-suppressive doses of levothyroxine for thyroid cancer

Araya Boonyaleepan M.D., Tarit Taerakul M.D. — Thu, 31 Aug 2023 00:00:00 +0700

Background: Patients with thyroid cancer receive a high-dose thyroid hormone therapy after total thyroidectomy for suppression of thyroid stimulating hormone (TSH); this may affect bone mineral density (BMD). Identifying the common factors that affect BMD (including the duration of a high dose of thyroid hormone treatment) may, therefore, aid the delivery of appropriate and comprehensive care in such cases.

Objective: To identify the factors related to BMD in female patients with thyroid cancer.

Materials and Methods: This cross-sectional study evaluated data pertaining to the BMD and demographic characteristics of female patients with thyroid cancer. The patients were aged at least 40 years and received a high-dose thyroid hormone replacement therapy after total thyroidectomy at the Rajavithi Hospital between January 2004 and December 2019. The relationships between BMD and associated factors were analyzed using Pearson’s correlation and multiple linear regression. A p-value of less than 0.05 was considered statistically significant.

Results: A total of 100 female patients with a mean age of 55.37 ± 11.36 (40-82) years and mean body mass index (BMI) of 24.8 ± 4.96 (15-40) were included; 60 and 56 of them were postmenopausal and coffee drinkers, respectively. High-dose thyroid hormone replacement therapy was received for a mean duration of 94.59±50.36 (3-210) months and 13 patients had a history of fractures; 60%, 30%, and 10% had normal BMD, osteopenia, and osteoporosis, respectively. The factors affecting BMD included the BMI (p-value <0.001) and postmenopausal status(p-value <0.001). Subgroup analyses showed the BMI to be the factor affecting BMD in the premenopausal group (p-value <0.001). Age, BMI, and calcium supplement intake were found to have an effect on the BMD in the postmenopausal group (p-value= 0.003, 0.002, and 0.020, respectively). The duration of high-dose thyroid hormone intake had no effect on the BMD in both the overall population (p-value= 0.558) and the subgroups based on the menopausal status (p-value = 0.437 and 0.380 in premenopausal and postmenopausal groups, respectively).

Conclusion: In female patients who were treated for thyroid cancer, the factors affecting the BMD included the BMI in the premenopausal group and the age, BMI, and calcium supplementation in the postmenopausal group.

Comparative study of setup errors between new and reused thermoplastic masks in irradiated head and neck cancer patients

Thu, 31 Aug 2023 00:00:00 +0700

Background: The accuracy and precision of patient setup are important in radiotherapy. The thermoplastic mask is used to immobilize head and neck cancer patient. However, the mask is reused for low-income patients. Therefore, the setup error should be evaluated to approve that these patients remain in the exact position during treatment.

Objective: To investigate setup errors with the use of thermoplastic masks in head and neck cancer patients and to compare setup errors of new and reused thermoplastic masks.

Materials and Methods: Eighty patients who underwent volumetric modulated arc radiotherapy (VMAT) for head and neck cancer lesions were retrospectively evaluated. The setup error, population systematic error, and population random error were calculated. Subsequently, setup errors in patients using the new and reused thermoplastic masks were compared.

Results: The population systematic error in the vertical, longitudinal, and lateral directions for new masks was 2.02, 2.27, and 2.13 mm, respectively, and that for reused masks was 2.37, 1.96, and 2.33 mm, respectively. The population random error in the vertical, longitudinal, and lateral direction for new masks was 1.46, 1.54, and 1.57 mm, respectively, and that for reused masks was 1.65, 1.63, and 1.87 mm, respectively. The results showed no statistically significant difference supported by p value > 0.05 in the setup error between using the new and reused thermoplastic masks in all directions.

Conclusion: For head and neck radiotherapy, the population setup errors were < 3 mm in all directions. Moreover, thermoplastic masks can be reused in patients with head and neck cancer.

Acute changes of superior mesenteric artery pressure after intraarterial bolus injection of prostaglandin-E1.

Yukihiro Hama, M.D., Ph.D. — Fri, 01 Sep 2023 00:00:00 +0700

Background: A bolus injection of prostaglandin-E1 (PGE1) into the superior mesenteric artery (SMA) immediately before SMA-portography can effectively visualize the portal vein.

Objective: The purpose of this study was to obtain basic pharmacoangiographical data and evaluate the hemodynamic changes following intra-arterial bolus injection of PGE1.

Materials and Methods: Forty-four consecutive patients undergoing transcatheter arterial chemoembolization (TACE) for liver cancer were retrospectively evaluated. SMA-portography was performed prior to TACE. An intra-arterial bolus injection of PGE1 was performed immediately before SMA-portography. Both SMA pressure and left brachial artery pressure were measured before, 1, 2, 3, 4, and 5 minutes after SMA-portography.

Results: Systolic pressure in the SMA decreased significantly 3 minutes after SMA-portography and remained low for 5 minutes. The maximum reduction rates in systolic and diastolic blood pressure in the SMA were 4.8% (4 minutes after SMA-portography) and 6.8% (5 minutes after SMA-portography), respectively. The left brachial artery pressure decreased similarly to the SMA. There were no significant changes in pulse pressure before or after PGE1 injection in either the SMA or brachial arteries.

Conclusion: A bolus injection of PGE1 into the SMA was shown to decrease blood pressure in the SMA and brachial arteries, but the pulse pressure remained constant.

Superficial siderosis presenting as hemiparesis in a paediatric patient with congenital Factor V deficiency – A case report.

Thu, 31 Aug 2023 00:00:00 +0700

Superficial siderosis is a rare abnormality caused by deposition of hemosiderin in the subpial or subarachnoid spaces of the brain, cranial nerves, and spinal cord. It results from chronic repetitive bleeding in the subpial/subarachnoid space. Magnetic resonance imaging of the brain is the diagnostic modality of choice. We describe a rare case of an 18-month-old male, a known case of congenital Factor V deficiency, who presented with recurrent vomiting, irritability and right-sided hemiparesis. On Magnetic resonance imaging, there was hypointense coating of the surface of the brainstem and cerebellum with ventricular dilatation. This case emphasizes the fact that superficial siderosis should be specifically looked for when evaluating a patient with a history of previous intracranial bleed followed by a thorough search for the source of the hemorrhage.

MEMORIAL: PROFESSOR EMERITUS CHALEOW PIYACHON

Pavarit Piyachon M.D. — Thu, 31 Aug 2023 00:00:00 +0700

Pediatric imaging of neuroblastoma-From classic to atypical

Thu, 31 Aug 2023 00:00:00 +0700

Neuroblastoma (NB) is the most common extracranial solid tumour in children, accounting for approximately eight percent of paediatric cancer and fifteen percent of pediatric cancer deaths. Reaching a correct and timely diagnosis is extremely important, especially in aggressive NB. Prognosis and treatment are based on tumour biology and genetics, patient age and perhaps most importantly, disease stage. The current staging system relies heavily on imaging, and this pictorial essay provides a description of the radiological features of NB, from classic to atypical, and the modalities used to help confirm the diagnosis and staging of NB. Our aim is to provide radiologists with a comprehensive collection of presentations of NB, to help improve diagnostic accuracy and decrease time to diagnose.