We describe a 7-year-old child who presented with a soft fluctuant swelling on the neck which became more prominent during the Valsalva manoeuvre. He underwent adeno-tonsillectomy based on a mistaken diagnosis of ballooning of the pharynx secondary to enlarged adenoids and tonsils obstructing the nasopharyngeal and oropharyngeal airways. Investigations revealed the swelling to be a markedly dilated internal jugular vein. We discuss the diagnostic features and mode of treatment of this condition so as to avoid unnecessary and dangerous surgical intervention.

The purpose of this study was to evaluate the degree of contrast enhancement and image quality of computed tomography (CT) thorax examination using different contrast administration protocols. Data was retrospectively collected from 140 patients from two centres; 70 patients (Group A) from Advanced Medical and Dental Institute (IPPT), Universiti Sains Malaysia [19 males, 51 females; mean age ± standard deviation (SD) 53.6 ± 11.2 years; mean weight ± SD 54.04 ± 13.77 kg] using automatic bolus tracking (ABT) with weight-based contrast volume (WBV) administration, and 70 patients (Group B) from Hospital Pulau Pinang (HPP), Ministry of Health Malaysia [24 males, 46 females; mean age ± SD 54.5 ± 13.2 years] using fixed time-delay (FTD) with fixed contrast volume (FV) technique. The degree of enhancement was quantified by measuring Hounsfield unit (HU) values in different arteries and veins, and rated on a 5-point scale (1 = very poor, 5 = excellent) for qualitative assessment. The mean enhancement values in Group B were found to be higher than those in Group A (P < 0.001). There was no statistically significant difference between mean qualitative scores on a 5-point scale in both groups (P = 0.185). A weak correlation was seen between HU values with administered contrast volume (r = 0.1152). Overall, FTD with FV protocol was found to have higher degree of contrast enhancement for routine CT thorax examination. The qualitative assessment showed no significant difference between both protocols although higher mean grading in CT image quality was given by assessors for ABT with WBV technique.

Dense artery sign of the middle cerebral artery on non-enhanced computed tomography is recognized as an early sign of ensuing major cerebral infarction and is usually a consequence of thrombosis or embolism of an ischaemic stroke. A case is described resulting from trauma that correlated with angiographic and Doppler ultrasound findings and the significance of this sign in this case is discussed.

The aim of this study was to evaluate the application of monoenergetic (ME) extrapolation technique of dual-energy computed tomography (DECT) for metal artefact reduction using phantom study. This study involved phantom study with a customized phantom consisting different types of metal implant such as titanium and stainless steel. The phantom was scanned using a single-source DECT scanner (SOMATOM Definition AS+, Siemens Healthcare, Germany) with dual-energy mode of 140/80 kV spectrum. The commercially available post-processing software (Syngo DE, Siemens) was applied to generate ME image datasets with different extrapolated energies ranged from 55 to 160 keV. The reduction of artefacts was measured qualitatively and quantitatively using region of interests (ROIs) statistical analysis. The results show 60% of metal streak regions were reduced significantly at higher extrapolated energy which is 160 keV. Quantitative analysis also resulted in lower HU readings within the region of artefact for 160 keV. However, higher extrapolated energy resulted in higher noise and lower signal-to-noise (SNR) value. ME images at 160 keV appear noisier while ME images at 64, 70 and 80 keV appear smoother. Metal artefacts induced by both metal implants were reduced significantly using DECT ME extrapolation and diagnostic quality of CT images also improved. It can be achieved by using higher ME of DECT. However, image noise is higher, and SNR is reduced with higher ME extrapolated energy.

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