Systemic lupus erythematosus (SLE) is an autoimmune disease with multi-organ involvement and results in neurological and psychiatric (NP) symptoms in up to 40% of the patients. To date, the diagnosis of neuropsychiatric systemic lupus erythematosus (NPSLE) poses a challenge due to the lack of neuroradiological gold standards. In this study, we aimed to better localize and characterize normal appearing white matter (NAWM) changes in NPSLE by combining data from two quantitative MRI techniques, diffusion tensor imaging (DTI) and magnetization transfer imaging (MTI). 9 active NPSLE patients (37 ± 13 years, all females), 9 SLE patients without NP symptoms (44 ± 11 years, all females), and 14 healthy controls (HC) (40 ± 9 years, all females) were included in the study. MTI, DTI and fluid attenuated inversion recovery (FLAIR) images were collected from all subjects on a 3 T MRI scanner. Magnetization transfer ratio (MTR), mean diffusivity (MD), fractional anisotropy (FA), radial diffusivity (RD), axial diffusivity (AD) maps and white matter lesion maps based on the FLAIR images were created for each subject. MTR and DTI data were then co-analyzed using tract-based spatial statistics and a cumulative lesion map to exclude lesions. Significantly lower MTR and FA and significantly higher AD, RD and MD were found in NPSLE compared to HC in NAWM regions. The differences in DTI measures and in MTR, however, were only moderately co-localized. Additionally, significant differences in DTI measures, but not in MTR, were found between NPSLE and SLE patients, suggesting that the underlying microstructural changes detected by MD are linked to the onset of NPSLE. The co-analysis of the anatomical distribution of MTI and DTI measures can potentially improve the diagnosis of NPSLE and contribute to the understanding of the underlying microstructural damage.

PURPOSEThe distribution of ischemic changes caused by infarction of the middle cerebral artery (MCA) territories is usually measured using the Alberta Stroke Program Early Computed Tomography Score (ASPECTS). The first interpreter of the brain computed tomography (CT) in the emergency department is the on-call radiology resident. The primary objective of this study was to describe the agreement of the ASPECTS performed retrospectively by the resident compared with expert raters. The second objective was to ascertain the appropriate window setting for early detection of acute ischemic stroke and good interobserver agreement between the interpreters. METHODSWe identified consecutive patients presenting with hemiparesis or aphasia at the emergency department who underwent brain CT and CT angiography. Each scan was rated using ASPECTS by senior radiology resident, neuroradiology fellow, and later by consensus between two expert raters. Statistical analysis included determination of Cohen's kappa (κ) coefficient and intraclass correlation coefficient (ICC). RESULTSA total of 43 patients met our study criteria. Interobserver agreements for ASPECTS varied from 0.486 to 0.678 in Cohen's κ coefficient between consensus of two neuroradiologists and a neuroradiology fellow, and from 0.198 to 0.491 for consensus between two neuroradiologists and a senior radiology resident. ICC among three raters (expert consensus, neuroradiology fellow, and senior radiology resident), was very good when 8 HU window width and 32 HU center level setting was used. CONCLUSION ASPECTS varied among raters. However, when using a narrowed window setting for interpretation, interobserver agreement improved. DOI 10.5152/dir.2018.17336 N oncontrast computed tomography (NCCT) is a fast and accurate imaging technique to exclude intracerebral hemorrhage and evaluate acute stroke in suspected cases (1). Nowadays, distribution of the ischemic changes caused by infarction of the middle cerebral artery (MCA) territories are usually measured using the Alberta stroke program early computed tomography score (ASPECTS), which is a semiquantitative scale (2). For detection of acute ischemic stroke by NCCT, early acute ischemic change was defined as parenchymal hypoattenuation or loss of gray-white differentiation (3). Factors that can affect lesion conspicuity and diagnostic accuracy of CT are window width and window level. For obvious detection of acute ischemic change, a narrowed window setting is recommended (4). Currently, intra-arterial thrombectomy (IAT) for large vessel occlusion (LVO) is becoming the standard of care in comprehensive stroke centers harboring multidisciplinary teams and qualified neurointerventionalists; this approach shows good outcome and is also recommended by the Thai Stroke Guidelines (5). Recent studies show that good outcome after IAT can be predicted from the ASPECTS (6-8). In our practice, we found ASPECTS rated by different reviewers to be variable. Therefore, good interobserver agreement of the ASPECTS should be ascertained...

PurposeTo analyze significant ultrasonographic findings of small malignant breast mass (≤10 mm) which were occult on mammography.MethodsThe study included 190 small breast masses (≤10 mm), demonstrated on breast ultrasonography, but not mammography. Histopathology (when the masses were biopsied) or serial breast ultrasonography (for at least 24 months) were used to confirm benign or malignant condition of the masses. Univariate and multivariate logistic regression analysis were used to identify significant characteristic malignant findings on ultrasonography.ResultsOf 190 masses, 46 were cancer, and 144 were benign. On multivariate analyses, irregular shape (odds ratio [OR], 10.4) and not circumscribed margin (OR, 31.6) were significant features to differentiate between benign and malignant breast masses. However, low width/anteroposterior ratio, echogenic halo, hypoechogenecity and posterior acoustic shadow, which were predictors for malignancy in large breast mass, were not documented in small mass.ConclusionIn conclusion, irregular shape and not circumscribed margin detected during ultrasonography were strong predictive signs of malignancy for small malignant breast mass.