Vietnamese journal of radiology and nuclear medicine
Vietnmese Society of Radiology and Nuclear Medicine
Applications of Zero Echo-Time MRI in Musculoskeletal and Neurological Diagnosis
Zero echo-time (ZTE) MRI is a new imaging technique that uses ultrafast readings to capture signals from short T2 tissues. Additional advantages of the pulse sequence include fast acquisition times, silent scanning, and artifact resistance. A powerful application of this technology is imaging the cortical bone without the use of ionizing radiation, thus presenting a viable alternative to CT for rapid screening and “one-stop” MRI. ZTE is increasingly used in musculoskeletal imaging, neuroimaging applications. In this article, we review the imaging physics of ZTE including pulse sequence options, practical limitations, and image reconstruction., image optimization including acquisition, processing, segmentation, synthetic CT generation, and artifact correction. We also introduce clinical applications of ZTE such as imaging related to malformations, trauma, tumors, and interventional procedures,...
Langerhans Cell Histiocytosis Of The Spine: Report Of Two Clinical Cases
Langerhans cell histiocytosis (LCH) is a rare disease characterized by abnormal proliferation of Langerhans-like cells, which can involve multiple organs. The skeletal system is the most commonly affected site, accounting for approximately 60–80% of cases, with spinal involvement reported in 6.5–25% and carrying a high risk of severe neurological complications. Imaging plays a crucial role in the detection and assessment of lesions, with characteristic findings including vertebra plana, lytic bone lesions with or without paravertebral soft-tissue masses, and typical signal changes on magnetic resonance imaging. However, because these features may overlap with other conditions such as infection or malignancy, histopathological biopsy remains the gold standard for definitive diagnosis.
Diffuse Small Intestinal Submucosal Lipomatosis A Rare Case and Review of Literature
Lipoma is a common benign tumor that can occur in various organs, particularly within the gastrointestinal tract. However, diffuse submucosal lipomatosis of the intestine is an exceptionally rare condition, with no previously reported cases in Vietnam. The etiology of this disease remains unclear, although several studies have suggested potential associations with genetic mutations. The pathogenesis is characterized by diffuse proliferation and infiltration of mature adipose tissue within the submucosal layer of the intestinal wall. The condition is often asymptomatic and usually discovered incidentally; however, in some cases, it can progress to severe complications such as intestinal obstruction, intussusception, gastrointestinal bleeding, or perforation. Imaging play a crucial role in establishing the diagnosis. We report a case of diffuse submucosal intestinal lipomatosis involving the entire intestine, which was diagnosed and managed at Ba Ria General Hospital.
Budd-Chiari Syndrome Role of Imaging Through A Case Serie
Budd-Chiari syndrome is a rare entity caused by obstruction of the hepatic venous outflow. The obstruction can be located in the venules up to the inferior vena cava into the right atrium. The causes of the disease are diverse and the distribution varies by geographical region. Depending on the cause, the progression, prognosis and treatment options will also be different. Therefore, we would like to introduce 3 clinical cases of Budd-Chiari syndrome caused by 3 different causes to illustrate the diversity of manifestations of this syndrome as well as the role of imaging in the diagnosis and management of this disease.
Clinical Case Report: Zenker’s Esophageal Diverticulum in A 63-Year-Old Female Patient
Introduction: Zenker’s diverticulum is a rare pharyngoesophageal outpouching, most often seen in elderly men, with an incidence of 0.01–0.11% [1]. Diagnosis is usually made with barium swallow and endoscopy, while ultrasound is rarely emphasized. Case presentation: We report a 63-year-old female with progressive dysphagia for 6 months. An initial neck ultrasound revealed a cystic lesion with an air-fluid level and layered wall structure posterior to the thyroid lobe, suggestive of an esophageal diverticulum. Further evaluation with barium esophagography, contrast-enhanced CT, and upper endoscopy confirmed Zenker’s diverticulum. The patient underwent endoscopic surgery, with histopathology confirming the diagnosis. Conclusion: This case highlights the adjunctive role of neck ultrasound in detecting Zenker’s diverticulum, a rare but important cause of dysphagia in elderly patients.
Primary Klebsiella Pneumoniae Liver Abscess from the Viewpoint of Radiologist: 3 Case Reports and Literature Review
Background: Klebsiella pneumoniae (K. pneumoniae) liver abscess is increasingly prevalent as the leading cause of pyogenic liver abscesses in certain Asian countries, can present with metastatic infections associated with poor prognosis and outcomes when diagnosis is delayed. We report three cases of primary K. pneumoniae liver abscess and highlight specific imaging features in these cases. Case presentation: Three cases involved a 44-year-old man, a 50-year-old man, and a 71-year-old woman who were hospitalized due to severe fever lasting 4-5 days prior to admission. All patients’ laboratory tests showed elevations in serum alanine and aspartate aminotransferases, bilirubin as well as leucocyte count, and C-reactive protein. Imaging revealed a large single abscess without “double-target sign” and some similar features: a thin-walled multiloculated “pseudosolid” with “turquoise sign”, suggesting a pyogenic liver abscess caused by K. pneumoniae. No underlying hepatobiliary disease was found. Blood and abscess pus cultures confirmed K. pneumoniae as the causative organism. No distant infection lesions were found. Conclusion: Recognizing key imaging features of K. pneumoniae liver abscess, such as a unifocal, thin-walled multiloculated "pseudosolid" abscess with the "turquoise sign" and no underlying hepatobiliary disease, aids radiologists in early diagnosis and treatment, leading to better outcomes and fewer metastatic infections.
Magnetic Resonance Imaging Features of a Case Series of Intraductal Papillary Neoplasms of the Bile Duct
Background: Intraductal papillary neoplasm of the bile duct (IPNB) consists of papillary or villous proliferations of neoplastic epithelium within the bile duct lumen, supported by a thin fibrovascular stalk. Case Presentation: We report five cases of IPNB that underwent magnetic resonance imaging (MRI) at Bach Mai Hospital. Clinical data, liver enzyme test results, detailed hepatobiliary MRI findings, and histopathological outcomes (from either biopsy or surgery) are presented for each case. Conclusion: This case series further supports the notion that IPNB is a disease that can be diagnosed by MRI, featuring characteristic imaging patterns and morphological classifications that aid in deeper diagnostic orientation. The integration of imaging-based assessment and interventional planning plays a crucial role in the diagnosis, treatment, and prognosis of patients with IPNB.
Role of Dual-Energy CT in Evaluating Urinary Stones
Objectives: To evaluate the detectability of urinary stones on DECT virtual nonenhanced images and examine the diagnostic performance of dual-energy computed tomography (DECT) in characterization of in vivo renal stone composition. Methods: Cross-sectional study from 05/2022 to 10/2023, at Nguyen Tri Phuong Hospital, Ho Chi Minh City. DECT images of 197 patients with postsurgical-proven urinary stones were analyzed. All patients were examined with DECT urography in 3 phases: true nonenhanced (TNE) image, pyelographic phase and excretory phase. The contrast medium in the renal pelvis and ureters was virtually removed from pyelographic phase and excretory-phase images by using postprocessing software, resulting in virtual nonenhanced (VNE) images. The sensitivity regarding the detection of calculi on VNE images compared with true nonenhanced (TNE) images was determined. Results of the stone compositions were identified on DECT and then were compared to postoperative infrared spectroscopy stone analysis as the standard reference. Results: The sensitivity, specificity of VNE created from pyelographic phase for detecting urinary stones were 95,4% and 100%. The sensitivity, specificity of VNE created from excretoryphase were 83,2% and 94,6%. Most urinary stones detected on VNE appeared smaller. VNE had a moderate detection rate for small stones (<5mm) with the sensitivity of VNE created from the pyelographic phase was 74,2% and the sensitivity of VNE created from excretory-phase was 31,4%. Most undetected stones were in the urinary calyx with the sensitivity of VNE created from the pyelographic phase was 93,05% and the sensitivity of VNE created from excretory phase was 77,7%. In term of identifying renal stone composition, the accuracy of DECT was 74,1%. The agreement between DECT and infrared spectroscopy was 0,72. The effective atomic number Zeff helped to identified Canxi Oxalate with high accuracy (83,3%). The HU ratio cut off to differentiate Struvite stones from Canxi Oxalate stones was 1.32 with high sensitivity (95%) and high specificity (72%). Conclusions: VNE can detect large (>5mmmm) calculi with good reliability. VNE created from the pyelographic phase has a higher detectability than VNE created from the excretory phase. DECT was able to determine the composition of urinary tract stones with fair accuracy, especially Canxi oxalate stones. DECT could also differentiate Canxi oxalate stone and Struvite stone.
Relationship between EGFR mutation and computed tomography features in patients with non-small cell lung cancer
Objective: The aim of this study is to investigate the relationship between EGFR mutation and computed tomography (CT) features in patients with non-small cell lung cancer (NSCLC). Methods: Ninety-eight patients who was diagnosed with nonsmall cell lung cancer (NSCLC) between January 2023 and May 2025 at Thai Nguyen National hospital, had undergone a chest CT and EGFR mutation testing were enrolled in this study. The 98 recruited non small cell lung cancer patients were divided into two groups according to EGFR mutation status: patients with EGFR mutations (n=35) and non-mutated (n=63). The clinical characteristics and CT imaging features of two groups were recorded and compared. Chi-square test was used to evaluate the colleration between categorical variables. Logistic regression analysis was performed to identify the independent risk factors relevant to EGFR gene mutation. Results: Of 98 patients, 35 (35.7%) were EGFR mutation-positive. Chi-square test revealed that EGFR mutation appeared more frequently in female (p=0.007), patient with adenomcarcinoma lung cancer (p=0.028), tumors showing halo sign (p=0.000), pleural retraction (p=0.044) and pleural effusion (p=0.001). Logistic regression analysis indicated that female gender (OR 3.306), lung CT features of halo sign (OR 5.186), pleural retraction (OR 2.779) and pleural effusion (OR 4.15) were independent risk factors relevant to EGFR mutation. Conclusion: Female patients with lung CT features of halo sign, pleural retraction and pleural effusion are more prone to harbor EGFR gene mutation and are more likely to benefit from targeted therapy.
Prognostic Value of Tumor-to-Mediastinal Lymph Node SUVmax Ratio on PET/CT in Predicting Nodal Metastasis in Patients with Non-Small Cell Lung Cancer
Objective: This study aimed to evaluate the prognostic value of the tumor-to-mediastinal lymph node SUVmax ratio (T/LN SUVmax) compared to the standalone lymph node SUVmax in predicting mediastinal lymph node metastasis in patients with non-small cell lung cancer (NSCLC). Methods: A retrospective descriptive study was conducted on 74 NSCLC patients who underwent whole-body 18F-FDG PET/CT prior to surgery, followed by tumor resection and mediastinal lymph node dissection. A total of 311 mediastinal lymph nodes were identified on PET/CT, of which 178 showed increased FDG uptake. For each suspicious lymph node, both the node’s SUVmax and that of the primary tumor were recorded to calculate the T/LN SUVmax ratio. Receiver operating characteristic (ROC) analysis was used to compare the diagnostic performance of T/LN SUVmax versus lymph node SUVmax alone and to determine the optimal cut-off values. Results: Among the 178 FDG-avid lymph nodes, 32 (17.98%) were confirmed as metastatic by histopathology. The median SUVmax of metastatic nodes was 6.14, significantly higher than that of non-metastatic nodes (3.14; p < 0.01). A strong correlation was observed between lymph node and tumor SUVmax in metastatic nodes (rs = 0.69; p < 0.001), compared to a weaker correlation in non-metastatic nodes (rs = 0.27; p = 0.001). The T/LN SUVmax ratio showed superior discriminatory performance, with an optimal cut-off value of 2.45, achieving a sensitivity of 86.3%, specificity of 93.7%, and area under the ROC curve (AUC) of 0.931 (p < 0.001). In contrast, lymph node SUVmax alone, with a cutoff of 4.77, provided a higher sensitivity (93.8%) but lower specificity (76.7%), with an AUC of 0.877 (p < 0.001). Conclusion: The T/LN SUVmax ratio demonstrated significantly higher accuracy than lymph node SUVmax alone in predicting mediastinal lymph node metastasis in NSCLC. A cut-off value of 2.45 offers high specificity while maintaining acceptable sensitivity. T/LN SUVmax is a reliable and promising parameter that should be considered in lymph node staging using PET/CT.
Comparison of Computed Tomography Characteristics between Pulmonary Adenocarcinoma and Squamous Cell Carcinoma at Bach Mai Hospital
Objective: To compare the CT imaging features of lung adenocarcinoma and squamous cell carcinoma. Methods: This was a descriptive cross-sectional and retrospective study conducted on 407 patients diagnosed with lung adenocarcinoma or squamous cell carcinoma confirmed by histopathology. All patients underwent chest CT scans between January 2022 and July 2024 at Bach Mai Hospital. Imaging characteristics analysed included tumour size, density, margin, calcification, cavitation, anatomical location, bronchial involvement, and invasion of adjacent structures, alongside epidemiological features such as age and sex. Data were processed using SPSS version 20.0. Results: Adenocarcinomas were predominantly located peripherally (43.8%). Squamous cell carcinomas were more frequently central (43.2%), had a larger mean tumour size (48.5 mm vs. 39.7 mm), a higher rate of bronchial invasion (15.9%), and a higher proportion of male patients (86.4%). No statistically significant differences were observed between the two groups regarding lobar location, tumour margin, calcification or cavitation. Conclusion: CT imaging can delineate several features that help distinguish between the two histological types, thereby aiding in diagnostic orientation and the development of an appropriate treatment plan.
Treatment Outcomes of Ultraselective Transarterial Chemoembolization for Hepatocellular Carcinoma at Bach Mai Hospital
Objective: To evaluate the therapeutic efficacy, safety, and local recurrence of ultraselective conventional transarterial chemoembolization (ultraselective cTACE) in the treatment of hepatocellular carcinoma (HCC). Methods: A retrospective study was conducted on patients with BCLC stage A–B HCC who underwent ultraselective cTACE at the Department of Radiology, Bach Mai Hospital, from January 2022 to December 2023. The cTACE procedure was performed at an ultraselective level, with slow injection of lipiodol–chemotherapy emulsion until portal vein visualization around the tumor was achieved. Portal vein visualization grade, post-embolization syndrome, and major complications were recorded. Treatment response was assessed at 1 month. Local recurrence rates were evaluated at 6 and 12 months. Results: Thirty-five tumors in 30 patients were included (mean age, 58 ± 9.3 years; mean tumor diameter, 26.5 ± 8.4 mm). During embolization, 6 tumors showed portal vein visualization grade 0, 11 tumors grade 1, and 18 tumors grade 2. No major complications occurred; only mild-to-moderate post-embolization syndrome was observed. The complete response rate according to mRECIST was 97.1% (34/35). Local recurrence rates were 11.8% (4/34) at 6 months and 23.5% (8/34) at 12 months. Tumors with grade 2 portal vein visualization had the lowest recurrence rate (0% at 6 months; 5.6% at 12 months), which was significantly lower compared with grade 0 (60% at 6 months; 80% at 12 months, p < 0.01), but not significantly different compared with grade 1 (9.1% at 6 months; 27.3% at 12 months). Conclusion: Ultraselective cTACE for early- and intermediatestage HCC achieved high local tumor control and excellent safety. This technique is nearly equivalent to a curative treatment option for small HCC in patients who are not candidates for surgery or radiofrequency ablation (RFA).
Radioactive Iodine-Refractory Differentiated Thyroid Cancer with Brain Metastasis: A Clinical Case Report
Background: Differentiated thyroid cancer (DTC) is mainly treated with surgery and radioactive iodine (RAI), and typically has a favorable prognosis. Cases with distant metastasis often have a poorer prognosis and are at risk of becoming resistant to radioactive iodine. Progressive radioactive iodine-refractory DTC with brain metastasis is extremely rare and carries a grave prognosis, requiring a multimodal treatment approach. This report describes a typical clinical case, emphasizing diagnostic and therapeutic strategies. Case Description: A 65-year-old female patient, diagnosed with papillary thyroid carcinoma, underwent total thyroidectomy and received four RAI treatments (total dose: 600 mCi) for lung and left 7th rib metastases. The patient was confirmed RAIrefractory and subsequently developed local recurrence and progressive brain metastasis during follow-up. Systemic therapy with lenvatinib and whole brain radiotherapy were administered. Results: After one year of treatment, the brain lesions reduced in size, thyroglobulin levels progressively decreased, and the patient remained clinically stable. Conclusion: RAI-refractory DTC with brain metastasis is rare and associated with a poor prognosis. Systemic therapy combined with localized treatment modalities can effectively control disease progression
Management of Non-Mass Enhancement on Breast MRI: Diagnostic Challenges and Clinical Strategies
Non-mass enhancement (NME) on breast magnetic resonance imaging (MRI) is a diagnostically challenging entity that can be easily confused with background parenchymal enhancement and physiological changes. This article provides an overview of the concept, imaging features, and diagnostic challenges of NME according to BI-RADS, while also analyzing clinical management strategies based on multimodality correlation and histopathological results. Sources include the American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS, 5th edition, 2013), recent international studies, and illustrative clinical cases from local practice. The article highlights the role of risk stratification (BI-RADS 3, 4a, 4b), indications for MRI-guided biopsy versus alternative modalities such as ultrasound and mammography, as well as the value of short-term follow-up in reducing unnecessary biopsies. Future research prospects focus on refining grading criteria for NME and standardizing MRI-guided biopsy protocols. In conclusion, the management of NME requires a comprehensive approach, taking into account clinical context and individual risk factors to optimize diagnostic accuracy and treatment outcomes.
Comparison of Left Atrial Volume, Left Atrial Appendage Volume, and Epicardial Adipose Tissue Volume Between Patients with Paroxysmal and Persistent Atrial Fibrillation
Objective: This study aimed to evaluate differences in left atrial volume (LAV), left atrial appendage volume (LAAV), and epicardial fat volume (EFV) between patients with paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PersAF), while analyzing the association of these factors with disease progression. Methods: A cross-sectional study was conducted on 58 AF patients undergoing radiofrequency ablation, who underwent cardiac multidetector computed tomography (MDCT) at Bach Mai Hospital from January 2024 to May 2025. Left atrial, left atrial appendage, and epicardial fat volumes were measured using Syngo.via software. Results: The study included 58 AF patients (72.4% PAF, 27.6% PersAF) with a mean age of 60.5 ± 9.2 years, revealing significant anatomical differences. The PersAF group had significantly larger LAV (126.6 ± 51.0 ml vs. 83.4 ± 19.6 ml, p < 0.001) and LAAV (18.3 ± 9.7 ml vs. 12.7 ± 6.2 ml, p = 0.004) compared to the PAF group. Multivariate regression analysis adjusted for confounders confirmed that PersAF independently increased LAV by 22.5 ml (95% CI 13.1–31.9, p < 0.001) and LAAV by 4.25 ml (95% CI 0.16–8.34, p= 0.041). Notably, although initial differences in EFV and left atrial–specific EFV (LA-EFV) were observed (p < 0.05), these became non-significant after adjustment (EFV: β = 6.3, p = 0.166; LA-EFV: β = 2.4, p = 0.093). Independent predictors of increased EFV and LA-EFV included male sex, higher BMI, and hypertension (p < 0.05). These findings provide evidence of cardiac remodeling in PersAF and suggest a complex pathogenesis involving anatomical and metabolic factors. Conclusion: The study confirms significant differences in LAV and LAAV between PAF and PersAF patients. However, the association between epicardial fat volume and AF subtype remains unclear, warranting further investigation.
Initial Results of Safety and Efficacy of Artificial Ascites - Assisted Thermal Ablation of Hepatocellular Carcinoma at High Risk Location
Introduction: Primary hepatocellular carcinoma (HCC) is a common malignancy worldwide with high mortality. Thermal ablation is a potentially curative therapy, but ultrasound-guided ablation of tumors in high-risk locations is often limited by poor visualization and risk of thermal injury to adjacent organs. Artificial ascites offers a simple and effective solution to improve safety. This study evaluated the efficacy, safety, local recurrence, and clinical outcomes of artificial ascites-assisted thermal ablation for high-risk HCC. Methods: We conducted a retrospective case series of patients diagnosed with HCC in high-risk sites who underwent thermal ablation with artificial ascites assistance. Results: A total of 12 patients with hepatocellular carcinoma underwent thermal ablation. The mean age was 66.5 ± 9.07 years (range, 49–79), with a male-to-female ratio of 2:1. Of these, seven patients were treated with microwave ablation and five with radiofrequency ablation. The mean distance between the tumor and critical adjacent organs was 4.25 ± 2.73 mm (range, 1–8 mm). Artificial ascites was successfully created via a 6F angiosheath in all cases (technical success rate: 100%), with a mean infused volume of 1054.2 ± 423.97 ml (range, 500–2000 ml). No major complications occurred following the procedure. Conclusion: Artificial ascites-assisted thermal ablation is a safe and effective approach for treating primary HCC in high-risk locations, reducing the risk of collateral injury and improving treatment feasibility.
The Value of Computed Tomography in the Diagnosis of Adnexal Torsion
Objective: To determine the diagnostic value of computed tomography (CT) in detecting adnexal torsion. Methods: A retrospective, case-control study was conducted, including 110 surgical cases involving the adnexa, among which 55 cases were confirmed to have adnexal torsion. CT imaging findings were recorded and analyzed using the Chi-square test, receiver operating characteristic (ROC) curve analysis, and multivariate logistic regression to assess diagnostic value and develop a diagnostic model for adnexal torsion. Results: Adnexal torsion predominantly occurred in patients under 50 years old and was more frequently found on the right side. Malignant histopathological results accounted for approximately 8,9%. The CT features associated with adnexal torsion included eccentric wall thickening, whirlpool sign, mass sign, navel sign, crescent sign, hemorrhage, uterine deviation, and non-enhancing tissue (p < 0,05). Among these, the whirlpool sign showed the highest specificity and positive predictive value in diagnosing adnexal torsion (96,4% and 93,6%, respectively). The diagnostic model for adnexal torsion based on four key features –whirlpool sign, mass sign, non-enhancing tissue, and navel sign – demonstrated good performance, with an area under the curve (AUC) of 0,88, sensitivity of 83,6%, and specificity of 89,3%. Conclusion: CT is a valuable imaging modality for diagnosing adnexal torsion. The diagnostic model based on four key features –whirlpool sign, mass sign, non-enhancing tissue, and pedicle sign – provides significant support in diagnosing the condition.
The Value of Apparent Diffusion Coefficient in Determining Gleason Score of Prostate Cancer
Objective: Evaluate the correlation and value of apparent diffusion coefficient (ADC) in determining the Gleason score of prostate cancer (PC). Methods: From January 2023 to December 2024, 39 patients were diagnosed and had histopathological results of PC, who had undergone prostate MRI before. We evaluated the correlation between the ADC value and the Gleason score using Spearman’s correlation coefficient, then compared the ADC value between two groups of clinical insignificance (Gleason =6) and clinical significance PC (Gleason >6) by using Mann-Whitney U test. The ROC curve was used to find the ADC value in distinguishing clinical insignificance and significance PC. Results: The average age of patients was 75.8 ± 7.3 years. The mean gland volume was 48.4 ± 25.4 grams. 62% of PC originated from the peripheral region, 38% originated from the central glandular region. 7.7% of patients had a Gleason score = 6, 92.3% of patients had a Gleason score > 6. The ADC value at the lesion was strongly negatively correlated with the Gleason score, with Spearman’s correlation coefficient = -0.619 (p = 0.000). The mean ADC value of the Gleason =6 group was 1194.33 ± 41.9 s/mm2, statistically higher than that of the Gleason >6 group at 802.3 ± 115.4 s/mm2 (p <0.05). ROC curve analysis showed that with an ADC threshold of 1093.5 s/mm2, diffusion MRI was able to differentiate clinically insignificant and significant PC with a sensitivity of 100% and a specificity of 97.2%. Conclusion: ADC values were significantly correlated with Gleason scores and were able to predict clinically insignificant and significant PC.
Initial Evaluation of the Safety And Efficacy of Transarterial Chemoembolization in the Management Of Hepatocellular Carcinoma at E Hospital
Objective: To evaluate the safety and initial effectiveness of chemical embolization in the treatment of hepatocellular carcinoma (HCC) and some related factors. Methods: Cross-sectional retrospective study on 41 patients diagnosed with HCC treated with trans arterial chemoembolisation, followed clinical and paraclinical findings after intervention between April 2024 and May 2025 in Department of Radiology – E Hospital. Results: the mean participant age was 63.05 ± 10.2 years; 39 were men (95%). The proportion of Child–Pugh A patients was the highest with 40 patients (97.5%); the peak level of AST/ALT 1 week after treatment was 237.2 ± 390.3 UI/L and 259.3 ± 415.1 UI/L for DE B-TACE versus 180 ± 259.5 UI/L and 162.6 ± 206.5 UI/L for cTACE (p >.05). Abdominal pain is the most common symptom following the intervention, with a higher incidence in the DEB-TACE group for tumors < 5 cm (57.1%) compared to 33.3% in the cTACE group. Regarding treatment efficacy, the rate of tumor control after 1 month was good in both DEB-TACE and cTACE groups (92% and 100%, respectively). For tumors <5 cm, the disease control rate (DCR) was better in the cTACE group at 100%. For tumors > 5 cm, the overall response rate (ORR) in the DEB-TACE group (76.5%) was higher compared to cTACE (40%). Additionally, the study showed that for advanced stage BCLC C tumors, the overall response rate (ORR) in the DEB-TACE group was better at 83.3%. Conclusions: Both DEB-TACE and cTACE have good initial efficacy and safety in treating HCC who were not eligible for curative surgery. For patients with larger tumors and advanced stage (BCLC C), DEB-TACE demonstrates better efficacy. For patients with smaller tumors, cTACE shows advantages with a higher disease control rate and fewer side effects, particularly when performed using superselective catheterization techniques.
Clinical and Paraclinical Characteristics, and Treatment Outcomes of I-131-Refractory Differentiated Thyroid Cancer at Vietnam National Cancer Hospital
Objective: This research aim to evaluate clinical, paraclinical characteristics and treatment outcomes in patients with I-131 refractory differentiated thyroid cancer at Vietnam National Cancer Hospital (K hospital). Methods: descriptive study on 27 patients with differentiated thyroid cancer, I-131 refractory from January 2020 to October 2023. Results: The mean age of patient was 50.26 ± 15.5 years old; the female/male ratio was 3/1. Histology: 19 patients (70.4%) were papillary, 07 patients (25.9%) were follicular, 01 patient (3.7%) was papillaryfollicular. The mean of treatment dose until defined I-131 refractory was 396.2 ± 156.7mCi. According to the 2015 ATA I-131 refractory criteria, there were 14 patients (51.9%) in group I (no uptake I-131 at the first WBS), 7 patients ( 25.9%) in group II (the tumor tissue loses the ability to concentrate I-131 after previous evidence of I-131-avid disease), 5 patients (18.5%) in group III (I-131 is concentrated in some lesions but not in others), 01 patient (3.7%) in group IV (metastatic disease progresses despite a significant concentration of I-131). There were 04 patients (14.8%) who received surgery for metastatic lesions, 09 patients (33.3%) received further treatment with I-131, 10 patients (37%) did not receive any treatment and continued to follow monitoring and TSH suppression, the remaining 02 patients (7.4%) received external radiotherapy and treated with Lenvatinib. There were 06 patients (22.2%) achieved complete response, 07 patients (25.9%) achieved biochemical incomplete response, 03 patients (11.1%) achieved unclear response, structural incomplete response in 11 patients (40.7%). Conclusion: I-131 refractory differentiated thyroid cancer is a new area. Treatment requires a combination of methods and individualization. When the disease is widespread, targeted therapy such as Lenvatinib helps improve survival and alleviate symptoms.
Imaging Characteristics of Pulmonary Metastases on Computed Tomography and Outcomes of Radiofrequency Ablation for Local Treatment of Pulmonary Metastases Under Robot Maxio Guidance
Objective: To characterize the imaging features of pulmonary metastases on computed tomography (CT) and to evaluate the outcomes of radiofrequency ablation (RFA) for local treatment of pulmonary metastases using Maxio robot guidance. Methods: The study was a combined prospective and retrospective descriptive analysis conducted on 60 patients with pulmonary metastatic lesions, of whom 30 underwent radiofrequency ablation (RFA) under the guidance of the Maxio robotic system at the 108 Military Central Hospital between June 2021 and June 2025 Results: Most patients presented with multiple metastatic nodules rather than solitary ones. The most common sites were the right upper lobe and the lower lobes of both lungs. The mean tumor diameter was 25 ± 4.5 mm. The majority of lesions were solid nodules (86.7%). Radiofrequency ablation (RFA) was performed once in 19 patients, twice in 7 patients, and three times in 4 patients. The disease control rate reached 86.7%, with tumor necrosis observed at 6 months. One case of life-threatening massive hemoptysis was recorded. Conclusion: Pulmonary metastatic lesions typically present as multiple, solid nodules, commonly located in the lower lobes of both lungs and the right upper lobe. Radiofrequency ablation of pulmonary metastases under Maxio robotic guidance demonstrated favorable initial efficacy with a low complication rate.
Initial Treatment Outcomes of Radiofrequency Ablation for Papillary Thyroid Microcarcinoma at Bach Mai Hospital
Objective: To evaluate the initial outcomes of radiofrequency ablation (RFA) for the treatment of papillary thyroid microcarcinoma (PTMC) at Bach Mai Hospital. Methods: A retrospective and prospective cross-sectional descriptive study was conducted on all patients who underwent RFA for PTMC at Bach Mai Hospital between October 1, 2022, and December 31, 2024. All patients were followed for a minimum of 6 months after the procedure. Results: The study included 32 patients (3 males and 29 females) with a mean age of 44,69 ± 13,42 years (range: 24–75). The mean tumor volume was 0,064 ± 0,079 ml. All patients underwent RFA for PTMC. The mean follow-up duration was 16,29 ± 8,04 months. The complete disappearance rate of tumors increased over time: 0% at 3 months, 14,3% at 6 months, 31,8% at 12 months, 81,8% at 18 months, and 100% at 24 months of follow-up. Only one patient (3,1%) experienced transient hoarseness; no delayed complications or permanent injuries were observed. Conclusion: RFA is a minimally invasive, effective, and safe treatment option for PTMC.
Evaluation of the Value of ¹⁸F-FDG PET/CT in Identifying Recurrent Breast Cancer Lesions
Objective: To assess the role of ¹⁸F-FDG PET/CT in detecting recurrent lesions in breast cancer patients following curative-intent treatment at K Hospital. Methods: A cross-sectional descriptive study was conducted on 115 female breast cancer patients who were clinically or paraclinically suspected of recurrence at least six months after completion of curativeintent therapy at K Hospital between November 2021 and December 2023. All participants underwent ¹⁸F-FDG PET/CT for assessment evaluation. Results: The mean age was 53.7 ± 10.1 years. Invasive ductal carcinoma of no special type comprised 83.5% of cases, and the ERpositive/HER-2-negative phenotype was present in 43.7%. ¹⁸F-FDG PET/ CT yielded a sensitivity of 91.8%, specificity of 93.3%, positive predictive value of 90.9%, negative predictive value of 92.2%, and overall accuracy of 92.2% for recurrence detection. The mean SUVₘₐₓ of recurrent lesions was 10.4 ± 4.7. ROC analysis revealed an AUC of 0.92. Among 56 patients with histopathologically confirmed recurrence, PET/CT detected an additional 28 unsuspected lesions (50%), achieving the highest PPV among all modalities evaluated. Conclusion: ¹⁸F-FDG PET/CT demonstrates high accuracy in diagnosing recurrent breast cancer compared with other modalities, with SUVₘₐₓ values at readily detectable levels and the capacity to identify additional lesions.
Clinical Application of Wses 2020 for the Evaluation of Acute Colonic Diverticulitis
Purpose: To describe the computed tomography (CT) findings of acute colonic diverticulitis (ACD), and to evaluate its complications by using the World Society of Emergency Surgery (WSES) 2020 guideline. Methods: Data of 70 patients with ACD treated at Hue University of Medicine and Pharmacy Hospital and Hue Central Hospital from 1/2022 to 8/2023 were analyzed. Diagnosis of CD was mainly based on CT while endoscopy and/or surgery were required if CT findings were inconclusive. Clinical manifestations, blood tests, CT findings and treatment methods were documented. Multivariate logistic regression model was run to ascertain predictors of complications of ACD. Results: The median age was 44 (range, 35-55.3) years old, male/female ratio was 2.68, 80% of ACD was right-sided, and 94.3% of patients had diverticulosis, On CT, 100% of ACD showed fat stranding, 85.7% colon wall thickening (in which 90% was circumferential thickening), 24.3% pericolic air bubbles, 31.4% pericolic fluid. Abscess formation was seen in 11.4%, abdominal free air in 5.7%, diffuse abdominal fluid in 8.6%, and fistula in 2.9% of cases. According to WSES 2020, the incidence of uncomplicated (stage 0) ACD was 52.9%; and complicated ACD stages 1A, 1B, 2A, 2B, 3, and 4 were 27.1%, 4.3%, 7.1%, 0%, 2.9%, and 5.7%, respectively. Factors related to complications of ACD were smoking, digestive disorders, rebound tenderness, leukocytosis, elevated NEU, CRP and CT findings including loss of diverticular wall continuity, and length of colon wall thickening. Multivariable regression analysis showed that CRP was an independent predictor of ACD complication (OR 1.016; 95% CI 1.002-1.031; p = 0.028). The cut-off value of CRP for prediction was 89.9 mg/L with sensitivity of 69.7%, specificity of 80.6%, area under the curve of 0.797, p < 0.001. Conclusion: Right-sided ACD is more predominant. Colonic diverticulosis, fat stranding, circumferential colonic wall thickening were common CT findings. The majority of ACD patients were in stages 0 and 1A according to WSES 2020. CRP level >89.9 mg/L was an independent predictor of complications. In patients with suspected ACD who had CRP >89.9 mg/L, CT should be indicated for timely diagnosis and detection of complication.
Expert Consensus on the Role of Hepato-Biliary Specific Contrast Agents in the Diagnosis of Hepatocellular Carcinoma
Hepatocellular carcinoma (HCC) remains a major health burden worldwide, including in Vietnam. Current national guidelines rely on dynamic imaging with CT, MRI, or ultrasound for diagnosis; however, detecting early-stage HCC and lesions with atypical imaging features remains challenging. Gadoxetic acid–enhanced MRI (EOB-MRI) offers advantages by combining dynamic vascular assessment with hepatocyte-specific uptake. During the hepatobiliary phase (15–20 minutes post-injection), lesions with impaired transporter function fail to retain contrast and appear hypointense compared with surrounding parenchyma, thereby improving sensitivity for the detection and characterization of early HCC. On January 26, 2024, a scientific workshop on the use of EOB-MRI in HCC diagnosis was held in Hanoi, organized by the Vietnamese Society of Radiology and Nuclear Medicine with participation from leading experts from Korea and major hospitals across Vietnam. Presentations from radiology, hepatology, and hepatobiliary surgery specialists reached a shared recognition of the clinical value of EOB-MRI. Based on the workshop and supporting international evidence, a draft consensus statement was developed. This document was subsequently revised and finalized at the Society’s Annual Scientific Meeting in August 2024, with contributions from both domestic and international experts. The consensus highlights the pivotal role of EOB-MRI in the diagnosis of HCC and provides recommendations for its clinical application.
Clinical case report: Outcomes of recovery in patients with low ASPECTS score after mechanical thrombectomy for acute ischemic stroke
Mechanical thrombectomy is generally recommended in patients with an Alberta Stroke Program Early CT Score (ASPECT) score of 6 or higher. However, some recent studies have shown that the benefit of reperfusion is not entirely dependent on the ASPECT score. We report a male patient with a low initial ASPECTS score (4) who underwent thrombectomy and stenting of the internal carotid artery. The results showed significant improvement in both imaging and clinical symptoms. This suggests that thrombectomy may benefit ischemic stroke patients with low initial ASPECTS scores. The decision to treat should also be considered on individual patient characteristics and the benefits and risks of treatment.
Dural Arteriovenous Fistula in the Anterior Cranial Fossa with Feeder from the Ophthalmic Artery: 4 Cases Report Were Treated with Endovascular Treatment
Background: Dural arteriovenous fistula (DAVF) in the anterior cranial fossa is rare with 5% compared to intracrainal DAVF, but the risk of cerebral hemorrhage is higher than in other locations. DAVF in anterior fossa usually has a feeder from the ethmoidal branch of the ophthalmic artery and therefore transarterial embolization must be possible to occlude the fistula site and preserve the central retinal artery. So, our study aims to evaluate the efficacy and safety of endovascular treatment for DAVF in the anterior acranial fossa with feeder from ophthalmic artery. Methods: Retrospective study with 4 cases of DAVF anterior cranial fossa who received endovascular treatment at Cho Ray Hospital from 1/2021 to 1/2024. Clinical and imaging characteristics were assessed before intervention, at discharge, and at 3-month follow-up. Results: These cases had the common characteristics of being hospitalized because of low vision, 1 case of cerebral hemorrhage and 1 case of bulging eyes. CT/MRI confirmed that the feeder artery was from the ethmoid branch of the ophthalmic artery with large dilatation of venous drainage. Endovascular treatment approached the ophthalmic artery in 4 cases, of which 1 case had to approach the bilateral ophthalmic arteries, 1 case had to approach the meningeal branch of the external carotid artery. Technical success with complete occlusion of the fistula site and preservation of the central retinal artery in all cases. The microcatheters used were microcatheter detachable tip in 3 cases, Onyx 18 embolic agent was used in all cases. Procedural complications related to 1 case was invasive onyx into the superior sagittal sinus, however the limitaion was small and did not affect the flow of the vein. Followed up after 90 days of treatment, no recurrence was noted, and vision improved significantly in 3/4 cases. Conclusion: Transarterial embolization with approach from the ophthalmic artery in DAVF anterior cranial fossa is a reasonable, safe and effective treatment that have high capable of occluding the fistula site and preserving the central retinal artery.
A Rare Case of Urinary Imaging Suggestive Zinner Syndrome at 103 Military Hospital
Introduction: Zinner’s syndrome is a rare congenital anomaly characterized by ipsilateral renal agenesis and seminal vesicle cysts. This case is among the few reported instances in Vietnam. Case Presentation: A 28-year-old male patient underwent a general health check-up at the Military Hospital 103. Ultrasound findings revealed the absence of the right kidney in the renal fossa and abdominal cavity, along with a cystic mass located in the right hypogastric region. Abdominal computed tomography confirmed right renal agenesis and a right seminal vesicle cyst measuring 30 × 80 mm, consistent with a diagnosis of Zinner’s syndrome. The patient was advised periodic monitoring and follow-up. Conclusion: The integration of medical history, clinical examination, and diagnostic imaging facilitates accurate diagnosis and patient management. Regular monitoring for urological symptoms and timely surgical intervention when symptoms arise are essential in the management of Zinner’s syndrome.
Imaging Features of Arrhythmogenic Mitral Valve Prolapse: Clinical Cases and Literature Review
Mitral valve prolapse (MVP) is one of the leading causes of primary mitral regurgitation. In addition to complications arising from valvular insufficiency, MVP can also progress to arrhythmias, ranging from premature ventricular contractions to potentially lifethreatening episodes such as non-sustained ventricular tachycardia or malignant ventricular arrhythmias. Recently, the term "arrhythmic mitral valve prolapse syndrome" has been reported as a potential cause of sudden cardiac death. Consequently, there has been increasing research interest in this condition, accompanied by updated guidelines from various cardiovascular societies. Arrhythmic MVP is classified as a distinct subgroup characterized by frequent or complex ventricular arrhythmias without underlying structural arrhythmogenic substrate, with or without mitral annular disjunction (MAD). Studies have demonstrated that MAD is associated with an increased risk of arrhythmias and sudden cardiac death in patients with MVP. Advances in cardiac imaging, particularly cardiac magnetic resonance (CMR), now enable comprehensive evaluation of this condition. Moreover, CMR plays a pivotal role in arrhythmic risk stratification and in identifying high-risk myocardial fibrosis patterns. This article presents a series of clinical cases along with a literature review to provide additional information and updated insights into this condition
Preoperative Lung nodule localization using Hookwire, an approach to early diagnosis and treatment of Lung cancer - Literature review and case series report
In clinical practice of respiratory diseases, we often encounter solitary pulmonary nodules (SPN). SPNs have 3 main forms: (1) Solid nodules (SN); (2) Part-solid nodules (PS); (3) Ground glass opacity (GGO); (4) Cyst nodules (CN). There have been many guidelines from different societies/society around the world on the management of SPN (NCCN; Fleischner; ATS; ERS...). However, these instructions are general and do not address the issue of individualization. To be able to treat/cure lung cancer well, early detection and choosing appropriate treatment methods play a decisive role. Association guidelines are based on size, structure, and risk factors to devise a management strategy for solitary nodules, which factors in nodule size at first detection as well as subsequent screenings, play a key role. According to NCCN: (1) SN, ≥ 8mm to > 15 mm in subjects at high risk of lung cancer should be monitored by LDCT every 3 months or PET scan; Nodules ≥ 15 mm should have a contrast CT scan/PET scan/tissue sampling. If the results indicate high suspicion of LC, the biopsy/nodular excision is indicated; (2) PS nodules when the solid part is ≥ 8mm, at high risk subjects can be applied above techniques; (3) GGO < 20 mm, monitoring by LDCT once a year; > 20 mm every 6 months, no recommendation for biopsy or resection. Thus, if this recommendation is applied correctly, there will be many cancerous nodules under the above sizes that will be "nourished" until they meet treatment standards, which will inevitably reduce the chance of being diagnosed and receiving early treatment, losing the opportunity to "cure" the patient. Another common situation: A single nodule/mass on one side of the lung is still amenable to surgery, but another single nodule appears in the same lung on the same side but in a different lobe or on the opposite lung. So, very important to confirm the nodule is secondary/non-secondary before lobectomy containing the primary lesion. In this situation, according to our knowledge, there is no guideline for recommendation. We report 22 cases in which lung nodules were located before thoracoscopic surgery (VAST) using Hookwire, many of which were assigned an "individualized" approach (not a recommendation) and gave surprising results. The discussion is based on an analysis of image characteristics and pathological results and recommends the idea of "individualizing" each case for colleagues to refer to.