PURPOSE: To evaluate the CT appearance of normal variations in the minute central skull base foramina in infants and children. MATERIALS AND METHODS: One hundred and fourteen children under the age of 17 years without skull base abnormality underwent CT scanning. A high spatial frequency algorithm was used, and contiguous axial scanning parallel to the orbitomeatal line was performed from the foramen magnum to the orbital roof, with a 1-mm slice thickness. The presence or absence of eight foramina, pseudoforamina, or ossification centers including anterior presphenoidal foramen, posterior presphenoidal foramen, rostro-orbital pseudoforamen, intralateromedial postsphenoidal pseudoforamen, intrapostsphenoidal pseudoforamen, spheno-occipital pseudo-foramen, canalis basilaris medianus and intrasynchondral ossified bodies was analysed according to age. The presence of foramina or pseudoforamina was indicated if a ring-shaped structure was seen on two or more CT scans at the location anatomically predicted, and intrasynchondral ossified bodies were indicated if linear or dot-like structures with high attenuation accompanied spheno-occipital synchondrosis. RESULTS: CT indicated that within a certain age range, various kinds of foramina, pseudoforamina, and ossification centers were frequent. The anterior presphenoidal foramen was most commonly seen in infants aged 1-12 months (16/17, 94 %); the posterior presphenoidal foramen in children less than 2 years old(27/37, 73 % ) ; the rostro-orbital pseudoforamen in children aged 2 -5 years (9/17, 53%); intrapostsphenoidal pseudoforamen in children 6 -12 years old(20/37, 54%) and spheno-occipital pseudoforamen and intrasynchondral ossified bodies in children aged 13 -16 years. The canalis basilaris medianus was identified in about 20 % of all subjects regardless of age. CONCLUSION: Development of the minute central skull base foramina varied greatly according to age. Knowledge of the CT appearances of such embryologic variants of the central skull base should not only help Provide an understanding of complex skull base anatomy but also identify abnormal skull base development.
Child ; Foramen Magnum ; Humans ; Infant ; Orbit ; Skull Base* ; Skull* ; Tomography, X-Ray Computed

PURPOSE:To determine by means of MR imaging the ischemic status of parenchymal lesions in moyamoya disease. MATERIALS AND METHODS: Ninety-two MR images in 50 children with moyamoya disease were retrospectively reviewed. Ischemic parenchymal lesions were categorized according to the signal intensities of cortex and subcortical white matter. We also analyzed enhancement patterns, time sequential changes in the lesions, and the Prognosis for each patient, according to lesion type. RESULTS: Among one hundred and seventeen parenchymal abnormalities, 89 gyral lesions were seen in 43 children (86 %), predominantly in the frontal area (33.1%). Cortical parenchymal lesions were categorized as either type I - intermediate to high signal intensity (SI) on both T2 weighted (T2WI) and proton density images(PDI), and associated with low SI of the subcortical white matter; type II - high SI on T2WI and PDI, without low SI of the subcortical white matter; or type III - high SI on T2WI and iso SI on PDI. Thirty-three lesions were type I, ten were type II, and 43 were type III. Time sequential changes from type I to type II, and then to type III, were observed. The prognoses of patients with a type-I lesion were better than those of patients whose lesions were type II or III. CONCLUSION: Type I lesions presented with abnormal low signal intensity in the subcortical white matter, as seen on T2W1 images. This was the characteristic and earliest finding of ischemic parenchymal lesions in moyamoya disease; sequential MR images showed that type-I lesions progressed to type II or III.
Child* ; Humans ; Magnetic Resonance Imaging* ; Moyamoya Disease* ; Prognosis ; Protons ; Retrospective Studies

PURPOSE: To evaluate the diagnostic value of CT-guided percutaneous biopsy of inflammatory and tumorous lesions of the spine and paraspinal soft tissue. MATERIALS AND METHODS: Twenty-three patients underwent CT-guided percutaneous biopsy of the spine and paraspinal soft tissue. Tentative clinical diagnoses determined before biopsy were tuberculous spondylitis (n=5), pyogenic spondylitis (n=4), butterfly vertebra (n=1), old compression fracture (n=3), discitis (n=1), hemangioma (n=1), metastasis (n=7) and multiple myeloma (n=1). Biopsy was performed at the following levels: cervical-(n=1), thoracic-(n=9), and lumbar-spine(n=13). The approach to biopsy of the spine and paraspinal soft tissue lesions was posterolateral (n=11), posterior (n=2), or transpedicular (n=10). RESULTS: Tissue considered adequate by the pathologist involved was obtained in 21 (91%) of the 23 cases. In 19 cases, pathologic findings supported the clinical diagnoses determined before biopsy. In two cases, pathologic and clinical diagnoses differed. Complications such as severe pain, bleeding, infection, neurologic deficit or damage to internal organs were detected neither during or after the procedure. CONCLUSION: CT-guided percutaneous biopsy is a safe and reliable method of obtaining a diagnosis in many cases involving different spinal and paraspinal lesions.
Biopsy* ; Butterflies ; Diagnosis ; Discitis ; Fractures, Compression ; Hemangioma ; Hemorrhage ; Humans ; Multiple Myeloma ; Neoplasm Metastasis ; Neurologic Manifestations ; Spine* ; Spondylitis

PURPOSE: To evaluate the MR findings of extra-abdominal fibromatosis and the role of MRI in primary diagnosis MATERIALS AND METHODS: Fifteen cases in of histologically proven extra-abdominal fibromatosis in 13 patients were retrospectively reviewed. T1-weighted and T2-weighted images were obtained in axial, coronal and sagittal planes. Gd-enhancement was performed in 14 cases, and dynamic enhancement studies in two. All lesions were evaluated for mass shape and margin definition. RESULTS: Among the 15 cases, tumors of the buttock accounted for five, and tumor of the thigh for two. In eight cases tumors were intermuscular and in six cases were intramuscular. In ten cases (67 %) the mass extended along the long axis of the body and in 14 of 15 cases (93%) focal infiltration of adjacent structures was visible. The signal intensity of the lesion was in all cases inhomogeneous on both T1 and T2 weighted images. As seen on Gd-DTPA enhanced scans, the masses were inhomogeneously enhanced. In all cases MRI revealed star-shaped linear strands or a band-like low signal area in the mass. These features were not enhanced and were arranged along the long axis of the mass. CONCLUSION: MR findings of extra-abdominal fibromatosis were relatively characteristic and helpful for primary diagnosis of the condition.
Axis, Cervical Vertebra ; Buttocks ; Diagnosis ; Fibroma* ; Gadolinium DTPA ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies ; Thigh

PURPOSE: Various mechanical causes which induce shoulder impingement syndrome have been identified with the help of MRI. The aim of this study is to evaluate the incidence of such causes. MATERIALS AND METHODS: A total of 54 patients with clinically confirmed shoulder impingement syndrome and a normal control group(n=20) without symptoms were included. We evaluated the incidence of hook shaped acromion, low lying acromion, downward slope of the acromion, subacromial spur, acromioclavicular joint hypertrophy, coracoacromial ligament hypertrophy, high cuff muscle bulk, and os acromiale. RESULTS: Among the 54 patients, the following conditions were present: acromioclavicular joint hypertrophy(n=36), coracoacromial ligament hypertrophy(n=20), subacromial spur(n=18), downward sloping of the acromion(n=16), hook shaped acromion(n=11), relatively high cuff muscle bulk(n=6), low lying acromion relative to the clavicle(n=3), and os acromiale(n=1). In the normal control group there were nine cases of acromioclavicular joint hypertrophy, nine of coracoacromial ligament hypertrophy, nine of downward sloping acromion, and three of low lying acromion, but hook shaped acromion, high cuff muscle bulk, and os acromiale were not found. Among 54 patients, the syndrome was due to five simultancous causes in one patient, four causes in two, three causes in 12, two causes in 22, and one cause in 17. CONCLUSION: Hook shaped acromion and subacromial spur are the statistically significant causes of shoulder impingement syndrome. In 69 % of patients, the condition was due to more than one cause.
Acromioclavicular Joint ; Acromion ; Deception ; Humans ; Hypertrophy ; Incidence ; Ligaments ; Magnetic Resonance Imaging* ; Shoulder Impingement Syndrome* ; Shoulder*

Retroperitoneal fibrosis is a fibroproliferative process involving the retroperitoneum. It may be idiopathic or can be caused by methysergide ingestion, perianeurysmal inflammation, a leaking aneurysm, urinoma or irradiation. The symptoms and signs of retroperitoneal fibrosis are variable, and for diagnosis, imaging is therefore essential. The typical imaging finding is a fibrotic lesion in front of the lower vertebrae with ureteral obstruction. Atypical lesions, however, may occur in other parts of the retroperitoneum. The aim of this report is to describe the clinical features and various imaging findings of etroperitoneal fibrosis.
Aneurysm ; Diagnosis ; Eating ; Fibrosis ; Inflammation ; Methysergide ; Retroperitoneal Fibrosis* ; Spine ; Ureteral Obstruction ; Urinoma

Zollinger-Ellison syndrome (ZES) involves hypergastinemia produced by a gastrin-secreting tumor. Not only can it cause an ulcer but may also behave as a malignant lesion, metastasizing to the liver or other organs. The development of potent antisecretory agents for controlling acid secretion as well as techniques for localizing these islet cell tumors, has led to greatly improved survival rates. We describe a case of Zollinger-Ellison syndrome, emphasising the radiologic findings, and including a review of the literature.
Adenoma, Islet Cell ; Liver ; Survival Rate ; Ulcer ; Zollinger-Ellison Syndrome*

PURPOSE: To evaluate the efficacy of color and pulsed Doppler ultrasound (US) for the detection of arterial revascularization of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). MATERIALS AND METHODS: One hundred and four histologically proven HCCs (0.7-12.5 cm, mean 4.14 cm) of 87 consecutive patients who had undergone TACE using a Lipiodol-chemoagent suspension were examined using color Doppler equipment. The criteria for diagnosing arterial revascularization of HCC were detection of inward blood vessels within HCC and demonstration by spectral Doppler US of pulsatile arterial flow within the vessel. Color Doppler US was prospectively performed using a multi-Hertz probe (2.5-5 Hz), and was followed by digital subtraction angiography (DSA). RESULTS: In 37 of 104 HCCs in 87 patients treated with TACE, color and spectral Doppler US demonstrated intratumoral arterial flows, with peak systolic velocity of 4.2-220 (mean, 59) cm/sec. DSA revealed neovascularity or tumor stains in 38 HCCs (3.4-12.5 cm, mean 5.9 cm in size) including 37 which on Doppler US showed arterial flow. The remaining 66 of 104 HCCs (0.7-6.3 cm, mean 3.2 cm) did not stain during DSA. Doppler US showed a false negative result in only one HCC (4.6 cm, located at segment VII of the Couinaud classification), which stained faintly during DSA. The sensitivity, specificity, and accuracy of color and spectral Doppler US used for the detection of recurrent HCC were 97.4%, 100%, and 99%, respectively. CONCLUSIONS: Color and spectral Doppler US is an effective method for the evaluation of arterial revascularization of HCC after TACE.
Angiography, Digital Subtraction ; Blood Vessels ; Carcinoma, Hepatocellular* ; Coloring Agents ; Humans ; Prospective Studies ; Recurrence* ; Sensitivity and Specificity ; Ultrasonography*

PURPOSE: To evaluate the CT findings of perihepatic tuberculous abscesses. MATERIALS AND METHODS: The CT scans of 11 patients (6 females and 5 males) with 14 pathologically proven perihepatic tuberculous abscess were retrospectively evaluated in terms of the morphological characteristics of the abscesses and changes in other abdominal organs and at other sites. RESULTS: A total of 14 absceses were noted in 11 patients. Six (43%) were in the right subphrenic space, three(21%) in the right perihepatic space, three (21 %) in the left subphrenic space, and two (14%) in the left perihepatic space. The right side was predominant. The abscesses ranged in size from 1 to 10 (mean, 5) cm in diameter, with a wall thickness of 2 - 7 (mean, 3) mm. Of the 14 abscesses, 13 were oval, and one spherical. CT findings were as follows: a smooth abscess margin with even wall thickness in seven of the eleven patients (64%); calcification of the wall in two (18%) ; internal septa in seven (64 %) ; localized fluid collection in nine (82%) ; lymphadenopathy in five (45 %) ; and peritoneal enhancement in seven (64%). Lesions suggesting tuberculous infection coexisted at other sites in eight patients. These included the lung in six patients (55%) , the neck in three (27 %), an axilla in two (18 %), the liver in two (18 %), the spleen in one (9 %), and the gastroin-testinal tract in one (9%). CONCLUSION: CT scanning is useful for establishing the diagnosis of perihepatic tuberculous abscesses by evaluating the morphological characteristics of the mass and by observing changes in other abdominal organs and at other sites.
Abscess* ; Axilla ; Diagnosis ; Female ; Humans ; Liver ; Lung ; Lymphatic Diseases ; Neck ; Retrospective Studies ; Spleen ; Tomography, X-Ray Computed ; Tuberculosis, Gastrointestinal

PURPOSE: To distinguish the spiral CT findings of Borrmann type IV adenocarcinoma from those of gastric lymphoma with diffuse gastric wall thickening. MATERIALS AND METHODS: We retrospectively reviewed the spiral CT scans of 30 patients with Borrmann type IV adenocarcinoma and nine with gastric lymphoma with diffuse gastric wall thickening. In all patients the respective condition was pathologically confirmed by gastrectomy. CT scanning was performed after peroral administration of 500-700ml of water. A total of 120-140ml bolus of nonionic contrast material was administered intravenously at a flow rate of 3ml/sec and two-phase images were obtained at 35-45 sec(early phase) and 180 sec(delayed phase) after the start of bolus injection. Spiral CT was performed with 10mm collimation, 10mm/sec table feed and 10mm reconstruction. We evaluated the degree and homogeneity of enhancement of thickened entire gastric wall, and the enhancement pattern of gastric inner layer, as seen on earlyphase CT scans. On early and delayed views, the thickness of gastric wall and the presence of perigastric fat infiltration were determined. The enhancement patterns of gastric inner layer were classified as either continuous or discontinuous thick enhancement, thin enhancement, or nonenhancement. RESULTS: The thickness of gastric wall was 1.2-3.5cm(mean 2.2cm) in cases of adenocarcinoma and 1.2-7.6c m (mean 4cm) in lymphoma. Perigastric fat infiltration was seen in 24 patients with adenocarcinoma(80 %) and four with lymphoma(44%). In those with adenocarcinoma, the degree of enhancement of entire gastric wall was hyperdense in fifteen patients(50%) and isointense in eleven (37 %). Seven patients with lymphoma(78 % ) showed hypodensity. In those with adenocarcinoma, continuous thick enhancement of gastric inner layer was seen in 18 patients(60 %) and discontinuous thick enhancement in nine(30%). In lymphoma cases, no thick enhancement was observed. Thin enhancement of gastric inner layer was demonstrated in three patients with adenocarcinoma( 10 %) and two with lymphoma(22 %). In seven patients with lymphoma(78 %), there was no enhancement. CONCLUSION: The following early-phase findings are highly suggestive of gastric lymphoma: a gastric wall thickness of more than 3 cm; no or minimal perigastric fat infiltration, hypodense enhancement of thickened entire gastric wall; and no or thin enhancement of gastric inner layer.
Adenocarcinoma* ; Gastrectomy ; Humans ; Lymphoma* ; Retrospective Studies ; Tomography, Spiral Computed* ; Tomography, X-Ray Computed ; Water