Six patients with twenty histologically proven neurilemmomas of the extremities were studied using magnetic resonance(MR) imaging. The size, number, signal intensity on spin-echo T1WI(TR 500-650ms/TE 14-25ms)and gradient -echo (TR 200-600ms/TE 14-20ms; flip angle 25-30)image, enhancement pattern, detectability of nerve of origin, nerve-lesion relationship, and presence of a capsule were analyzed. The masses ranged from 1 to 12cm in longitudinal diameter and originated from the median nerve, ulnar nerve, sciatic nerve, radial nerve, and tibial nerve. All the nerve tracts except for those of 5 lesions, which could not be detected due to their small diameter, were visualized as low intensity tubular structures. All visible nerve tracts were situated along the periphery of the lesion and this finding was considered to be specific for neurilemmona. All neurilemmomas were isointense with the surrounding muscle on spin-echo T1WI and hyperintense on gradient-echo image. After a GD-DTPA injection, all masses showed moderate or marked enhancement and more prominent inhomogeneity than that on nonenhanced scan. In 19 out of 20 lesions(95%), a low signal intensity capsule surrounding the masses could be seen. Four of the six patients showed multiple masses, which was unusual as neurilemmoma usually arises as a solitary mass. In conclusion, the MR findings, especially the eccentric location of the mass lesion from the nerve of origin and the presence of a capsule, were useful in making a diagnosis of neurilemmoma of the extremity and that multiple neurilemmomas were not uncommon.
Diagnosis ; Extremities* ; Gadolinium DTPA ; Humans ; Median Nerve ; Neurilemmoma* ; Radial Nerve ; Sciatic Nerve ; Tibial Nerve ; Ulnar Nerve

We report the results of field operation of TELEACE system between Kyung-Pook National University Hospital and Ul-Jin Goon Health Care Medical Center from December, 1990 to September, 1991, which had been operated as a kind of Integrated Services Digital Nework projects by KOREA TELECOMMUNICATION Inc. Ul-Jin Goon Health Care Medical Center transmitted 414 plain radiographs to our hospital in speed of 9600BPS. Each image was composed of 1024X1024 pixelsX8 bits/pixel. In our hospital, the image files were displayed on high resolution monitor (1280×1024 pixets). Text files of image interpretations were transmitted to the health care medical center. The two radiologists who had interpreted the transmitted images, went to the health care medical center and read radiographic film with blind test method. We obtained the following results: false negative rate of 6.3%, false postitve rate of 2.4%, mean sensitivity of 81.4%, mean specificity of 96.3%, and mean accuracy of 91.3%. In predictive value of 0.05, there was no significant difference between results of these two types of radiographs. In conclusion, TELEACE system was valuable to the clinicians isolated from services of radiologists.
Delivery of Health Care ; Korea ; Methods ; Sensitivity and Specificity ; Telecommunications ; X-Ray Film

Primary role of ultrasound in patients with thyroid nodule is to determine the multiplicity and detect occult carcinoma. We analyzed US findings of 53 thyroid carcinomas with multiple nodular lesions from january 1988 to december 1991. The results were as follows: 1. 109 malignant nodules in 53 cases and 24 benign in 23 were comfirmed. 2. The nature of the masses were solid in 72 malignant nodules (74.2%), and complex in 25 (25.8%) of which 19 were predominantly solid. 3. The echo pattern of the solid and solid predominant masses were hypoechoic in 78 malignant nodules (80.4%), hyperechoic in 10 (10.3%), and isoechoic in 3 (9.3%) 4. Internal punctate calcifications within the masses were observed in 31 malignant nodules (31.9%). 5. Halo sign was present in 16 malignant nodules(16.5%). 6. The preoperative sonographic diagnosis of thyroid carcinoma was made in 39.4% of 53 cases with multiple nodules on US. In conclusion, the number, and halo formation of nodules were insignificant to differentiate the benign nodule from the malignant. The heterogeneous hypoechoic nodules with size greater than 4cm, multiple stippled calcifications, displacement of the trachea or other surrounding structures of combined lymph node enlargements seem to indicate the possibility of malignancy.
Diagnosis ; Goiter* ; Humans ; Lymph Nodes ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule ; Trachea ; Ultrasonography

No abstract available.
Sertoli-Leydig Cell Tumor*

PURPOSE: In advanced prostate cancer, malignant cells generally tend to spread into the bone, and metastasis into nonregional lymph nodes (NRLNs) at the time of initial diagnosis is relatively rare. We investigated the prognostic significance of NRLN metastasis in patients receiving hormonal therapy and chemotherapy. MATERIALS AND METHODS: From February 2005 to August 2011, we identified 105 patients who had metastatic prostate cancer. First, we assessed the prognostic effect of NRLN metastasis on the prostate-specific antigen response through logistic regression and the progression-free time to castration-resistant prostate cancer (CRPC) by using the Cox proportional hazard regression model. Second, we investigated the prognostic influence of NRLN metastasis on the chemotherapy response through logistic regression and on cancer-specific survival of CRPC patients receiving chemotherapy by using Cox proportional analysis. RESULTS: Of these 105 patients, 12 patients (11.4%) had only NRLN metastases without bone metastases. Progression-free time to CRPC was significantly less in patients with NRLN metastases by Cox proportional hazard regression multivariate analysis (p=0.020). However, NRLN metastasis was not an independent factor for predicting the response to chemotherapy in CRPC patients, and NRLN metastasis did not reduce cancer-specific survival in the multivariate analysis. CONCLUSIONS: Twelve (11.4%) of 105 patients with NRLN metastases had lymph node metastases without bone metastases. In addition, NRLN metastasis was a significant prognostic factor for predicting reduced progression-free time to CRPC. Thus, although we speculate that prostate cancer with NRLN metastasis exhibits unique tumor biology, additional molecular and genetic studies are needed.
Biology ; Humans ; Logistic Models ; Lymph Nodes ; Lymphatic Metastasis ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms

PURPOSE: Prognosis of papillary thyroid carcinoma (PTC) is very favorable, but PTC frequently invade adjacent soft tissue and metastases to cervical lymph node. We evaluated the pattern of cervical neck lymph node metastasis in PTC according to tumor size. METHODS: From August 2005 to January 2009, 353 patients were underwent surgery for PTC. Among these patients, total thyroidectomy with cervical neck lymph node dissection were done in 266 patients. We subdivided patients into four groups according to size and compared the clinicopathologic characters between groups. And we confirmed the factors affecting central neck node metastasis. RESULTS: The mean age of patients of diagnosis was 49.1 years and female to male ratio was 5.8:1. Cervical lymph node metastasis were in 47.0% of the total cases. Cervical lymph node metastases and invasion to adjacent structure increased with tumor size. But, there were no significant differences in tumor size, invasion to adjacent structure, multifocality or bilaterality according to cervical lymph node metastasis. Early diagnostic age and sexuality were significantly related to cervical lymph node metastasis of PTC. CONCLUSION: PTC showed the aggressiveness with increasing tumor size. Tumor size was not related to cervical lymph node metastasis. These findings suggest that tumor size can help treat PTC, can`t be used by prediction factor of cervical lymph node metastasis.
Diagnosis ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Male ; Neck* ; Neoplasm Metastasis* ; Prognosis ; Sexuality ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: Perianal lesions are common in Crohn disease, but their clinical course is unpredictable. Nevertheless, predicting the clinical course after surgery for perianal Crohn disease (PCD) is important because repeated operations may decrease patient's quality of life. The aim of this study was to predict the risk of reoperation in patients with PCD. METHODS: From September 1994 to February 2010, 377 patients with PCD were recruited in twelve major tertiary university-affiliated hospitals and two specialized colorectal hospitals in Korea. Data on the patient's demographics, clinical features, and surgical outcomes were analyzed. RESULTS: Among 377 patients, 227 patients were ultimately included in the study. Among the 227 patients, 64 patients underwent at least one reoperation. The median period of reoperation following the first perianal surgery was 94 months. Overall 3-year, 5-year, and 10-year cumulative rates of reoperation-free individuals were 68.8%, 61.2%, and 50.5%, respectively. In multivariate analysis (Cox-regression hazard model), reoperation was significantly correlated with an age of onset less than 20 years (hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.07-3.48; P = 0.03), history of abdominal surgery (HR, 1.99; 95% CI, 1.08-3.64; P = 0.03), and the type of surgery. Among types of surgery, fistulotomy or fistulectomy was associated with a decreased incidence of reoperation in comparison with incision and drainage (HR, 0.19; 95% CI, 0.09-0.42; P < 0.001). CONCLUSION: Young age of onset and a history of abdominal surgery were associated with a high risk of reoperation for PCD, and the risk of reoperation were relatively low in fistulotomy or fistulectomy procedures.
Age of Onset ; Crohn Disease ; Demography ; Drainage ; Humans ; Incidence ; Inflammatory Bowel Diseases* ; Korea ; Multivariate Analysis ; Quality of Life ; Recurrence ; Reoperation* ; Risk Factors*

Among the various types of congenital meniscal anomalies, the double-layered lateral meniscus is extremely rare. The double-layered meniscus consists of both the upper additional and the lower normal meniscus. As the upper additional meniscus is mobile, it can be easily displaced, while the lower lateral meniscus is usually normal in shape and volume. A 42-year-old woman suffering from pain and locking of her left knee underwent Magnetic resonance imaging (MRI) examination and an arthroscopic surgery. A rare meniscal abnormality was seen in her left knee, which presented as a double-layered lateral meniscus with displacement. It was remarkable that the upper additional meniscus was displaced over the intercondylar eminence of the tibia and it mimicked a bucket-handle tear. Even though it is rare, it is necessary to consider the possibility of displaced double-layered meniscus in the differential diagnosis of a bucket-handle tear. Here, we report the MRI and arthroscopic findings of a displaced double-layered lateral meniscus, which was similar to the bucket-handle tear.
Adult ; Arthroscopy ; Diagnosis, Differential ; Female ; Humans ; Knee ; Magnetic Resonance Imaging ; Menisci, Tibial* ; Tears* ; Tibia

Short inversion time inversion recovery (STIR) is widely used for spinal magnetic resonance imaging (MRI) because the pulse sequence of STIR is insensitive to magnetic field inhomogeneity and can be used to scan a large field of view. In this case report, we present a case of spinal epidural hematoma with unexpected signal decrease on a STIR image. The MRI showed an epidural mass that appeared with high signal intensity on both T1- and T2-weighted images. However, a signal decrease was encountered on the STIR image. This nonspecific decrease of signal in tissue with a short T1 relaxation time that is similar to that of fat (i.e., hemorrhage) could lead to a diagnostic pitfall; one could falsely diagnose this decrease of signal as fat instead of hemorrhage. Awareness of the nonselective signal suppression achieved with STIR pulse sequences may avert an erroneous diagnosis in image interpretation.
Diagnosis ; Hematoma, Epidural, Spinal ; Hemorrhage ; Magnetic Fields ; Magnetic Resonance Imaging ; Relaxation ; Spine

PURPOSE: To compare the diagnostic accuracy of US/CT with US/CT/¹⁸F-FDG PET-CT in the diagnosis of cervical lymph nodes metastasis in papillary thyroid carcinoma. METHODS: From July 2008 to May 2010, 36 patients with papillary thyroid carcinoma, confirmed by aspiration cytology analysis, underwent neck US, neck CT and ¹⁸F-FDG PET-CT preoperatively. The sensitivity, specificity and diagnostic accuracy of the US/CT, US/CT/PET-CT was analyzed according to lymph node level (all: levels I~VI, central: level VI, lateral: levels I~V). RESULTS: At all lymph nodes group (level I~VI), US/CT/ PET-CT showed a sensitivity of 66.6%, a specificity of 61.9% and a diagnostic accuracy of 63.8%. The corresponding values for US/CT were 60.0%, 85.7%, 75.0% respectively. Considering the central cervical nodes group (level VI), US/CT/PET-CT showed a sensitivity of 57.1%, a specificity of 68.1%, and a diagnostic accuracy of 63.8%. The corresponding values of US/CT were 57.1%, 90.9%, 77.7% respectively. Considering the lateral cervical nodes group (level I~V), US/CT/PET-CT showed a sensitivity of 100%, a specificity of 84.3%, and a diagnostic accuracy of 86.1%. The corresponding values of US/CT were 75.0%, 84.3%, 83.3% respectively. The diagnostic results of US/ CT, US/CT/PET-CT in initial evaluation of the cervical nodes metastasis did not differ significantly. CONCLUSION: Our preliminary results suggest that additional PET-CT evaluation in US/CT does not provide statistically significant benefit for initial diagnosis of cervical lymph nodes metastasis in papillary thyroid carcinoma.
Diagnosis* ; Humans ; Lymph Nodes* ; Neck ; Neoplasm Metastasis* ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Neoplasms