P rimary lung cancer is the leading cause of cancer-related death worldwide (1). Treatment of primary lung cancers includes surgical resection, radiation therapy, chemotherapy, and thermal ablation. Surgical resection remains the treatment of choice for patients with early stage non-small cell lung cancer (NSCLC) (2). However, primary lung cancers are generally diagnosed in advanced stages. Moreover, due to the high incidence of associated comorbidities and limited pulmonary reserve, most patients are considered ineligible for surgery (3,4).In addition to primary cancers, lungs are the second most frequent site of metastatic disease. In selected patients with metastatic lung cancer, surgical resection is the preferred treatment. However, even patients who have undergone a complete resection have a high incidence of recurrence and may require multiple surgeries (5). Repeat thoracotomy leads to further removal of functional pulmonary tissue. Surgical resection might not be possible in patients with certain comorbidities and limited pulmonary reserve.Patients with pulmonary colorectal metastases constitute a significant portion of metastatic lung tumor group. Approximately 10% of patients with colorectal cancer develop pulmonary metastases during the course of disease (6). It has been reported that in patients with limited colorectal pulmonary metastases and no extrapulmonary disease, five-year survival following surgical resection is approximately 35%-45% (7). However, many patients are not suitable candidates for surgery. PURPOSEWe aimed to evaluate the survival benefit achieved with radiofrequency (RF) ablation of primary and metastatic lung tumors and determine significant prognostic factors for recurrence-free survival. METHODSForty-nine patients with lung cancer (10 primary and 39 metastatic) underwent computed tomography-guided percutaneous RF ablation between June 2005 and October 2013. A total of 112 tumors (101 metastatic and 11 primary non-small cell lung cancer) were treated with RF ablation. Tumor diameter ranged from 0.6 to 4 cm (median 1.5 cm). Effectiveness of treatment, complications, and survival were analyzed. RESULTSPrimary success rate was 79.5% and local tumor progression occurred in 23 tumors. Among tumors showing progression, 10 were re-treated with RF ablation and secondary success rate was 87.5%. One-, two-, and three-year overall survival rates of 10 patients with primary lung cancer were 100%, 86%, and 43%, respectively. One-, two-, three-, four-, and five-year overall survival rates for 39 patients with metastatic lung tumors were 90%, 73%, 59%, 55%, and 38%, respectively. One-, two-, three-, and four-year overall survival rates for 16 patients with colorectal pulmonary metastases were 94%, 80%, 68%, and 23%, respectively. Complications occurred in 30 sessions (24.6%). Pneumothorax occurred in 19 sessions with seven requiring image-guided percutaneous chest tube drainage. Tumor status (solitary or multiple) and presence of extrapulmonary metastasis at initial RF ablation were significa...

It is important for radiologist to know that os intermetatarseum can be presented as dorsal foot pain. Due to its position, it is difficult to demonstrate os intermetatarseum in plain radiographs, CT and MRI should be performed in clinically suggestive cases.

A 59-year-old man was admitted with unresolved chest pain after coronary artery bypass graft surgery that had been performed 3 years earlier; aorta-obtuse marginalis, and aorta-posterior descending artery with the use of a saphenous vein graft and left anterior descending arteryleft internal mammary artery (LIMA). He reported recurrent angina pectoris and cerebral symptoms, including dizziness and drop attacks, especially when moving his left arm. When he stopped moving his left upper extremity, these symptoms were spontaneously resolved within minutes.On physical examination, pulse rate was regular at 72 beats/min, and there was a significant blood pressure difference between the right and the left arm (135/ 85 mm Hg and 95/65 mm Hg, respectively). On auscultation, there was a marked bruit at the left supraclavicular region. The results of transthoracic echocardiography were within normal limits. We performed coronary computed tomography angiography to display the cause of ischemic symptoms. Coronary computed tomography angiography revealed that the left subclavian artery was totally occluded 2 cm from its origin ( Figure 1A), but all grafts and the left vertebral artery were patent ( Figure 1B). It was also shown that the distal part of the occluded left subclavian artery was filling with contrast media, which made us think about retrograde flow from the left vertebral artery and/or the LIMA. Therefore, cardiac MRI was also performed to evaluate flow directions at the LIMA and left vertebral artery. Phase-contrast velocity mapping of the right internal mammary artery and the LIMA graft in the transaxial plane (Figure 2A) showed antegrade caudally directed flow in the right internal mammary artery, but predominantly retrograde flow in the cranial direction in the LIMA ( Figure 2B). With the use of the same technique, it was also showed the right and left vertebral arteries in the transaxial plane ( Figure 3A) and antegrade cranially Figure 1. A, Three-dimensional reconstruction from CCTA revealing that the left subclavian artery is totally occluded 2 cm from its origin (arrowhead). B, Threedimensional reconstruction from CCTA revealing the LIMA graft, the left vertebral artery, and their courses in comparison with the occluded segment of the subclavian artery (asterisk). CCTA indicates coronary computed tomography angiography; LIMA, left internal mammary artery.From the Departments of Cardiology (U.N.K., B.E., S.O., K.A., A.O.) and Radiology (I.C.K., T.H.), Hacettepe University Faculty of Medicine, Ankara, Turkey.The online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl

Objective:To determine the effect of “Iterative Reconstruction in Image Space” (IRIS) on image quality by comparing reconstructions of both medium and sharp kernels when evaluating coronary calcifications or stents during coronary computed tomography (CT) angiography.Methods:Thirty one consecutive patients were scanned with an electrocardiogram-gated helical technique on a dual-source CT system. Image reconstruction was performed using standard filtered back projection (FBP) and IRIS algorithm on both medium and sharp kernels (B26f, I26f, B46f, I46f). Each reconstruction was derived from the same raw data. Two blinded readers graded image quality using a five-point scale. Noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) were obtained. Noise was derived from the ascending aorta and left ventricle. SNR was obtained from sinus Valsalva, interventricular septum, and coronary vessels. CNR was obtained from septum, coronary vessels, and left ventricle. Comparisons of paired results between FBP and IRIS images were analyzed using the repeated measures analysis of variance method. Interreader correlation was assessed using weighted Kappa statistic.Results:Noise values of the ascending aorta and left ventricle were significantly lower in the images reconstructed with IRIS than those reconstructed with FBP for the evaluation of the same filters. SNR and CNR values were higher in the IRIS images (p<0.05). Interreader agreement for four reconstructions was interpreted as moderate (κ=0.40–0.59).Conclusion:IRIS significantly reduced image noise and improved imaging of coronary calcifications or stents. When combined with a sharp kernel, IRIS can improve image quality by reducing the negative effects of decreased signal that may result from using a sharp kernel.

Background: We aimed to determine if the ratio of the upper to the lower diameter of the ureter could have any predictive value for ureteral stone impaction. Materials and methods: Patients who had a solitary unilateral ureteric stone, determined by noncontrast computerized tomography, were assessed if they had undergone ureteroscopic lithotripsy. A total of 111 patients, 84 males (76%), and 27 females (24%), were recruited to the study. Demographic data of the patients and preoperative radiological parameters based on noncontrast computerized tomography were recorded. The impaction status was also assessed during the operation. Results: Of the 111 patients, ureteral stones in 63 (57%) patients were determined to be impacted, and ureteral stones in 48 (43%) were nonimpacted. Impacted stones were more common in older patients, female patients, and patients with an American Society of Anesthesiologists score of 2. Conclusions: Significant relationships were found between the impaction status and transverse stone length, longest stone length, upper diameter of the ureter, ratio (upper diameter of the ureter/lower diameter of the ureter), and anteroposterior diameter of the pelvis. These parameters were higher in patients with impacted stones.

We retrospectively reviewed neuroradiology database at our tertiary-care hospital to search for patients with metaphoric or descriptive signs on brain computed tomography or magnetic resonance imaging. Only patients who had clinical or pathological definitive diagnosis were included in this review.