PURPOSE: To characterize the MRI appearance of the peripherally located schwannoma as compared with pathologic findings. MATERIALS AND METHODS: 11 cases of 13 lesions of the schwannoma confirmed by pathology were analyzed, retrospectively. T11 T2 and Gadolinium-enhanced T1 weighted sagittal and axial images were obtained. The signal intensity, contour of lesion, and relationship with surrounding tissue were analyzed. All cases were correlated with MRI and pathologic findings. RESULTS: In 9 out of the 11 cases, schwannoma was connected to the main nerve trunk. Among them, tumors were located centrally in 6 cases and eccentrically in 3 cases. MR findings of schwannoma were iso signal intensity on T1WI(8 cases) with muscle intensity, high signal intensity on T2WI(all cases), strong heterogenous enhancement in all cases. 8 cases showing heterogenous appearance on T2WI, showed mixture of Antoni-A and B area and multifocal hemorrhage. Central low and peripheral high signal intensity on T2Wl(Target sign) was mainly high cellular component in the central portion and diffuse myxoid degeneration at the periphery, pathologically. Reversed target appea.rance(central high, peripheral low on T2WI) revealed central cystic degeneration with low cellular component and hemorrhage in the central portion, and high cellular component at the periphery. Linear band-like low signal intensity on T2WI, suggesting capsule of the schwannoma, was not the true capsule proven by pathology. Thin true capsule was not visualized on T2WI. CONCLUSION: MR appearance of schwannoma was non-specific. The signal intensity on T2 weighted MR imaging was determined by the presence of multifocal hemorrhage, focal cystic and myxoid degeneration, admixture of Antoni-A and B area.
Hemorrhage ; Magnetic Resonance Imaging* ; Neurilemmoma* ; Pathology ; Retrospective Studies

PURPOSE: To characterize the MRI appearance of the peripherally located schwannoma as compared with pathologic findings. MATERIALS AND METHODS: 11 cases of 13 lesions of the schwannoma confirmed by pathology were analyzed, retrospectively. T11 T2 and Gadolinium-enhanced T1 weighted sagittal and axial images were obtained. The signal intensity, contour of lesion, and relationship with surrounding tissue were analyzed. All cases were correlated with MRI and pathologic findings. RESULTS: In 9 out of the 11 cases, schwannoma was connected to the main nerve trunk. Among them, tumors were located centrally in 6 cases and eccentrically in 3 cases. MR findings of schwannoma were iso signal intensity on T1WI(8 cases) with muscle intensity, high signal intensity on T2WI(all cases), strong heterogenous enhancement in all cases. 8 cases showing heterogenous appearance on T2WI, showed mixture of Antoni-A and B area and multifocal hemorrhage. Central low and peripheral high signal intensity on T2Wl(Target sign) was mainly high cellular component in the central portion and diffuse myxoid degeneration at the periphery, pathologically. Reversed target appea.rance(central high, peripheral low on T2WI) revealed central cystic degeneration with low cellular component and hemorrhage in the central portion, and high cellular component at the periphery. Linear band-like low signal intensity on T2WI, suggesting capsule of the schwannoma, was not the true capsule proven by pathology. Thin true capsule was not visualized on T2WI. CONCLUSION: MR appearance of schwannoma was non-specific. The signal intensity on T2 weighted MR imaging was determined by the presence of multifocal hemorrhage, focal cystic and myxoid degeneration, admixture of Antoni-A and B area.
Hemorrhage ; Magnetic Resonance Imaging* ; Neurilemmoma* ; Pathology ; Retrospective Studies

PURPOSE: Macro language was programmed to analyze and process on Macintosh personal computers GE MR imagesdigitally transferred from the MR main computer, with special interest in the interpretation of information such as patients data and imaging parameters under each image header. By this method, raw data(files) of certain patients may be digitally stored on a hard disk or CD ROM, and the quantitative analysis, interpretation anddisplay is possible. MATERIALS AND METHODS: Patients and images were randomly selected. 4.X MR images were transferred through FTP using the ethernet network. 5.X and SPECT images were transferred using floppy diskets. Toprocess transferred images, an freely distributed software for Macintosh namely NIH Image, with its macrolanguage, was used to import images and translate header information. To identify necessary information, aseparate window named "Info-txt", was made for each image series. MacLC, Centris650, and PowerMac 6100/CD,7100/CD, 8100/CD models with 256 color and RAM over 8 Mbyte were used. RESULTS: Different versions of MR images and SPECT images were displayed simultaneously and a separate window named "Info-txt" was used to show all necessary information(name of the patient, unit number, date, TR, TE, FOV etc.). Additional information(diagnosis,pathologic report etc.) was stored in another text box in "Info-txt". The size of the file for each image planewas about 149 Kbytes and the images were stored in a step-like file folders. CONCLUSION: 4.X and 5.X GE Signa 1.5T images were successfully processed with Macintosh computer and NIH Image. This result may be applied to manyfields and there is hope of a broader area of application with the linkage of NIH Image and a database program.
Hope ; Humans ; Microcomputers* ; Tomography, Emission-Computed, Single-Photon* ; Information Storage and Retrieval

OBJECTIVE: This study is aimed to evaluate the efficacy of transnasal repair of cerebrospinal fluid(CSF) rhinorrhea. METHODS: Thirteen patients with traumatic noniatrogenic CSF fistulas were included in the retrospective analysis. High-resolution thin-section computed tomographic cisternography was helpful in localization of the CSF leakage site. The most frequent leakage site was the sphenoid sinus. The transnasal approach(TNA), comprised of endonasal endoscopic surgery(EES) or transseptosphenoidal surgery(TSS), was mainly used for smaller fistulas. Total or selected ethmoidectomy depended on the localization of the leakage. Wide sphenoidotomy enabled detection and repair of CSF leaks from the sphenoid cavity. Three patients also underwent transcranial approach(TCA) because of the large or multi-fragmented bony defect and the need for further exposure for repair. Five patients developed ascending meningitis in the preoperative period with antibiotic prophylaxis. RESULTS: Twenty-five leaks were initially repaired using one of three techniques:EES alone in eight patients, EES plus TCA in three, and TSS alone in two. Ten patients who solely underwent the TNA did not experience the complications of the traditional TCA. One recurrent sphenoid fistula was successfully treated by TSS. After a follow-up from 12 to 88 months(mean 32.7), the overall success rate for 25 CSF fistulas was 100%. CONCLUSION: The transnasal repair is a safe, successful, and alternative approach for the surgical repair of traumatic CSF rhinorrhea, and also could be combined to TCA.
Antibiotic Prophylaxis ; Cerebrospinal Fluid Rhinorrhea* ; Fistula ; Follow-Up Studies ; Humans ; Meningitis ; Preoperative Period ; Retrospective Studies ; Sphenoid Sinus

PURPOSE: To evaluate prognosis-related CT findings in hypoxic ischemic encephalopathy. MATERIALS AND METHODS: For the purpose of prognosis, 28 children with a clinical history and CT findings suggestive of hypoxic ischemic encephalopathy (HIE) were restrospectively reviewed. The diagnostic criteria for HIE, as seen on CT scanning, were as follows : 1, ventricular collapse ; 2, effacement of cortical sulci ; 3, prominent enhancement of cortical vessels ; 4, poor differentiation of gray and white matter ; 5, reversal sign ; 6, obliteration of perimesencephalic cistern ; 7, high density on tentorial edge, as seen on precontrast scans ; and 8, low density in thalamus, brain stem and basal ganglia. On the basis of clinical outcome, we divided the patients into three groups, as follows : group I(good prognosis) ; group II(neurologic sequelae), and group III(vegetative state or expire), and among these, compared CT findings. RESULTS: There were thirteen patients in group I, six in group II, and nine in group III. Ventricular collapse, effacement of cortical sulci, and prominent enhancement of cortical vessels were noted in all groups, whereas poor differentiation of gray and white matter, reversal sign, obliteration of perimesencephalic cistern, high density on tentorial edge, on precontrast scan, and low density in brain stem and basal ganglia were observed only in groups II and III. CONCLUSION: CT findings showed distinct differences between groups in whom prognosis was good, and in whom it was poor. An awareness of poor prognostic CT findings may be clinically helpful in the evaluation of patients with hypoxic ischemic encephalopathy.
Basal Ganglia ; Brain Stem ; Child* ; Humans ; Hypoxia-Ischemia, Brain* ; Prognosis* ; Thalamus ; Tomography, X-Ray Computed

Congenital chloride diarrhea (CLD) is a rare autosomal recessive disease that is difficult to diagnose. CLD requires early treatment to correct electrolyte imbalance and alkalosis and to prevent severe dehydration. Renal injury is clearly associated with defective electrolyte balance induced by CLD, particularly during the first months or years of life. A 7-year-old boy was diagnosed with CLD following detection of a homozygous mutation (c.2063-1G>T) in SLC26A3 at 6 months of age. During treatment with electrolyte supplements, mild proteinuria was detected at 8 months of age, and is still present. Renal biopsy showed the presence of focal renal dysplasia, with metaplastic cartilage and mononuclear cell infiltration, calcification, and fibrosis in the interstitium. Up to two-thirds of the glomeruli exhibited global obsolescence, mostly aggregated in the dysplastic area. In nondysplastic areas, the glomeruli were markedly increased in size and severely hypercellular, with increased mesangial matrix, and displayed segmental sclerosis. The marked glomerular hypertrophy with focal segmental glomerulosclerosis suggested a compensatory reaction to the severe nephron loss or glomerular obsolescence associated with renal dysplasia, with superimposed by CLD aggravating the tubulointerstitial damage.
Alkalosis ; Biopsy ; Cartilage ; Child ; Dehydration ; Diarrhea* ; Fibrosis ; Glomerulosclerosis, Focal Segmental ; Humans ; Hypertrophy ; Male ; Nephrons ; Proteinuria ; Sclerosis ; Water-Electrolyte Balance

OBJECTIVE: To determine the diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and DCE ultrasound (DCE-US) for predicting response to neoadjuvant chemotherapy (NAC) in breast cancer patients. MATERIALS AND METHODS: This Institutional Review Board-approved prospective study was performed between 2014 and 2016. Thirty-nine women with breast cancer underwent DCE-US and DCE-MRI before the NAC, follow-up DCE-US after the first cycle of NAC, and follow-up DCE-MRI after the second cycle of NAC. DCE-MRI parameters (transfer constant [Ktrans], reverse constant [kep], and leakage space [Ve]) were assessed with histograms. From DCE-US, peak-enhancement, the area under the curve, wash-in rate, wash-out rate, time to peak, and rise time (RT) were obtained. After surgery, all the imaging parameters and their changes were compared with histopathologic response using the Miller-Payne Grading (MPG) system. Data from minor and good responders were compared using Wilcoxon rank sum test, chi-square test, or Fisher's exact test. Receiver operating characteristic curve analysis was used for assessing diagnostic performance to predict good response. RESULTS: Twelve patients (30.8%) showed a good response (MPG 4 or 5) and 27 (69.2%) showed a minor response (MPG 1–3). The mean, 25th, 50th, and 75th percentiles of Ktrans and Kep of post-NAC DCE-MRI differed between the two groups. These parameters showed fair to good diagnostic performance for the prediction of response to NAC (AUC 0.76–0.81, p ≤ 0.007). Among DCE-US parameters, the percentage change in RT showed fair prediction (AUC 0.71, p = 0.023). CONCLUSION: Quantitative analysis of DCE-MRI and DCE-US was helpful for early prediction of response to NAC.
Breast Neoplasms* ; Breast* ; Drug Therapy* ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Prospective Studies ; ROC Curve ; Ultrasonography*

PURPOSE: To evaluate the perioperative changes of the relationship between tibial posterior slope and ground surface and the factors which influence the perioperative changes of the relationship between tibial posterior slope and ground surface following total knee arthroplasty. MATERIALS AND METHODS: Between Sept. 2005 and Feb. 2006, 94 consecutive primary total knee arthroplasty with posterior cruciate ligament-retaining type performed in 50 patients by one surgeon. Posterior slope of the proximal tibia resection in extramedullary guide was fixed at 5degrees. All the retrieved patients wore a 90degrees ankle brace and stood on the ground during radiographic examination. We prospectively analyzed the measurement of tibial posterior slope angle, the angle between tibial posterior slope and ground surface and the angle between a midline from 1st metatarsal shaft to talus and ground surface on preoperative and postoperative 2-weeks radiographs. RESULTS: On preoperative radiograph, average of tibial posterior slope angle is 11.3degrees and 11.5degrees in right and left knee, respectively. Angle between tibial posterior slope and ground surface is an average of 8.8degrees and 9.5degrees in right and left knee, respectively. On postoperative 2-weeks radiograph, tibial posterior slope angle is an average of 9.3degrees and 9.1degrees in right and left knee, respectively. Angle between tibial posterior slope and ground surface is an average of 6.2degrees and 6.4degrees in right and left knee. There are significant differences between tibial posterior slope angle and the angle between tibial posterior slope and ground surface on preoperative and postoperative 2-weeks radiograph (p<0.05). CONCLUSION: According to ankle lateral angle, it is possible that tibial posterior slope associated with the ground surface may decrease at erect posture in total knee arthroplasty. This may lead to overly decrease tibial posterior slope associated with the ground surface at comfortable erect posture in total knee arthroplasty.
Ankle ; Arthroplasty* ; Braces ; Humans ; Knee* ; Metatarsal Bones ; Posture* ; Prospective Studies ; Talus ; Tibia

PURPOSE: To evaluate the factors which influence on the fixation failure after internal fixation using multiple cannulated screws in the patients with femoral neck fracture. MATERIALS AND METHODS: Ninty-six patients (male: 63, female: 33) who underwent closed reduction and internal fixation of femoral neck fracture between Feb. 1994 and Jun. 2002 with use of multiple cannulated screws. The mean age was 68 years (17~90) and mean follow-up period was average 50 months (36 months~6 years). The fixation failure was defined by change in fracture position above 10 mm, change in each screws position above 5%, backing above 20 mm, or perforation of the head, respectively. They were evaluated with the age, gender, fracture type, accuracy of reduction, placement of screws, posterior comminution and also studied the risk factors which influenced nonunion and the development of avascular necrosis. RESULTS: Twenty-four patients out of 96 patients had radiographic signs of fixation failure. The incidence of nonunion in the fixation failure group was 41% (10/24) and AVN was 33% (8/24). There were statistically significant correlations between fixation failure and nonunion and that posterior comminution, poor reduction and improper placement of the screws were the major factors contributing to nonunion. CONCLUSION: In case of femoral neck fracture of internal fixation using multiple cannulated screws, posterior comminution, poor reduction and improper placement of the screws were the major factors contributing to nonunion and fixation failure.
Female ; Femoral Neck Fractures* ; Femur Neck* ; Follow-Up Studies ; Head ; Humans ; Incidence ; Necrosis ; Risk Factors

Gemella morbillorum is a normal flora of the oral cavity, upper respiratory tract, gastrointestinal tract, or genitourinary system. Human infection cause by G. morbillorum is very rare. Known predisposing conditions are intravenous drug abuse, alcoholism, cardiovascular disease, chronic obstructive pulmonary disease, diabetes, renal disease and poor oral hygiene. Most reported cases are infective endocarditis and vasculitis. We experienced a case of liver abscess by G. morbillorum in a healthy young woman, who was treated successfully with antibiotics and drainage. We report this case along with a literature review.
Abscess ; Alcoholism ; Anti-Bacterial Agents ; Cardiovascular Diseases ; Drainage ; Endocarditis ; Female ; Gastrointestinal Tract ; Gemella ; Humans ; Liver ; Liver Abscess ; Mouth ; Oral Hygiene ; Pulmonary Disease, Chronic Obstructive ; Respiratory System ; Substance Abuse, Intravenous ; Urogenital System ; Vasculitis