Transcranial cerebral oximetry has been successfully used in a variety of neurosurgical conditions, primarily those associated with disturbed cerebral circulation. It has been also used in intraoperative monitoring of aortic dissection and surgical procedures performed under deep hypothermia and circulatory arrest. During disending aortic arch exposure, sudden cerebral oxygen saturation change from 63% to 48% was detected. After therapeutic bypass, cerebral oxygen saturation was increased to 65%. During aortic arch repair, deep hypothermic circulatory arrest with retrograde cerebral perfusion was applied for 130 min and cerebral oxygen saturation slowly decreased from 65% to 52%. Patient was discharged from hospital without neurologic complication and cognitive funtion disturbance.
Aorta, Thoracic ; Circulatory Arrest, Deep Hypothermia Induced ; Humans ; Hypothermia ; Monitoring, Intraoperative ; Oximetry ; Oxygen* ; Perfusion

PURPOSE: Authors reviewed CT and MR findings of patients with parapharyngeal masses, and their incidence and characteristic findings were studied. MATERIALS AND METHODS: We reviewed 27 CT and 9 MR of pathologically proven 29 patients with primary parapharyngeal mass Neurogenic tumor (17 cases) and other rare masses (3 carotid body tumors, 2 pleomorphic adenomas, 2 cavernous hemangiomas, 1 cavernous lymphangioma, 2 carotid artery pseudoaneurysms, 1 non-Hodgkin's lymphoma, 1 idiopathic cervical fibrosis) were included and the characteristic CT and MR findings were studied. RESULTS: Neurilemmoma was seen as a well-demarcated, solid mass of heterogeneous attenuation or intensity, so that pleomorphic adenoma of minor salivary gland origin could not be differentiated by demarcation, attenuation, or signal intensity of the tumor itself. The direction of carotid artery displacement was not constant in cases of neurilemmomas while the styloid process was constantly displaced laterally in all cases. Characteristic CT and MR findings of other rare tumors were described. CONCLUSION: Neurogenic tumor is the most common parapharyngeal space mass and the direction of displacement of styloid process might be helpful in differential diagnosis from pleomorphic adenoma. Other rare tumors showed very characteristic CT and MR finidings and could be differentiated easily.
Adenoma, Pleomorphic ; Aneurysm, False ; Carotid Arteries ; Carotid Body Tumor ; Diagnosis, Differential ; Hemangioma, Cavernous ; Humans ; Incidence ; Lymphangioma ; Lymphoma, Non-Hodgkin ; Neurilemmoma ; Salivary Glands, Minor

PURPOSE: This study describes the CT and MR findings of mucoceles occurred in the post-operative maxillary sinuses. MATERIALS AND METHODS: CT and/or MR of 19 maxillary mucoceles in 16 patients who had been operated by CaldwelI-Luc procedure were reviewed. CT scans were performed after contrast enhancement in axial and coronal planes with 5mm thickness. Three cases were studied with a 2.0 T or 0.5 T MRI, which demonstrated multi-compartment lesions. RESULTS: The lesions were bilateral in 3 cases. Compartmentalization of the antral cavity was seen in 7 out of 19 involved sinuses. Surgical bone defect of the anterior wall was the most frequent route of extension (11 cases) and extension into the infratemporal fossa with erosion of posterolateral wall was seen in 7 lesions. In 6 cases, the lesions involved orbit. The expansile and erosive bone changes were localized in every case. In one case with multi-compartment lesion, both T1- and T2-weighted MR images showed different signal intensities in each compartment which represented different protein concentration. CONCLUSION: Post-operative maxillary mucocele showed CT findings of localized erosion and bulging most frequently at the anterior wall in which the bone windows were made during the previous surgery. Post-operative compartmentalization of maxillary antrum may cause eccentric expansion of mucocete and each compartment may show different signal intensities on MR.
Humans ; Magnetic Resonance Imaging ; Maxillary Sinus* ; Mucocele* ; Orbit ; Tomography, X-Ray Computed

PURPOSE: To evaluate the degree of contrast enhancement of intracranial tumors on delayed (6-8min.) MR imaging after administration of Gd-DTPA. MATERIALS AND METHODS: Both immediate and delayed post-contrast MR imagings were studied prospectively in 35 patients. with brain tumors (11 gliomas, 6 meningiomas, 4 neurinomas, 5 parencymal metastases, 5 hemangioblastoma, 4 others) at either 0.5 T or 2.0 T unit. After precontrast TI-, proton-density, and T2-weighted spin echo images were obtained, each patient underwent Tl-weighted imaging immediately following infusion of 0.1 mmol/Kg of Gd-DTPA. Subsequently, the second postcontrast Tl-weighted images were obtained with no additional injection of the contrast media. Time-interval between the postcontrast immediate and the delayed images was approximately 6-8 minutes. Degree of contrast enhancement of the lesions was assessed both visually and quantitatively. For quantitative study, contrast enhancement ratio(CER) of tumors was calculated in both immediate and delayed post-contrast images. RESULTS: There was stronger visual enhancement in 7 of 11 cases with gliomas and 3 of 5 cases with parenchymal metastasis on delayed images when compared with immediate images, whereas all 10 cases of extraaxial tumors(meningiomas and neurinomas) showed decreased enhancement on delayed images. Quantitatively, mean CERs of gliomas and metastases were higher on delayed study than on immediate study by 20. 5% and 49.2%, respectively. Extraaxial tumors showed decrease of CER on delayed study by 19.7% as compared with that of immediate study. Hemangioblastomas showed visually poor enhancement on delayed image in 4 cases and equal enhancement on both immediate and delayed images in remaining one case, and quantitatively demonstrated decrease of CER on delayed study by 15.4%. CONCLUSION: Since there was more conspicuous contrast enhancement in many intraaxial tumors such as gliomas and metastases on 6-8 minutes delayed post-contrast MR study, the delayed post-contrast study may be needed in some intraaxial tumors for their characterization, and may also be helpful for the differential diagnosis between intraaxial and extraaxial tumors.
Brain Neoplasms* ; Brain* ; Contrast Media ; Diagnosis, Differential ; Gadolinium DTPA ; Glioma ; Hemangioblastoma ; Humans ; Magnetic Resonance Imaging* ; Meningioma ; Neoplasm Metastasis ; Neurilemmoma ; Prospective Studies

PURPOSE: To describe the MR features of intraspinal cysticercosis. MATERIALS AND METHODS: Medical records and MR images of four cases of intraspinal cysticercosis were retrospectively reviewed. The MR findings were described with regard to the location and signal intensity of the lesions, contrast enhancement, presence or absence of associated intracranial cysticerci, and other findings. RESULTS: There were three cases of subarachnoidal form and one case of intramedullary form. Cysticerci of subarachnoidal form in three cases were located in retromedullary space at C2 level, anterior to cord at C1 -C6 levels, and lumbosacral area, respectively. The signal intensities of the lesions were same as those of CSF. Localized arachnoidal enhancement was found in all three cases. In one case there was a large area of high signal intensity within the spinal cord on T2 weighted image suggesting either ischemia secondary to vascular compromise or inflammatory edema. All of these three cases accompanied intracranial cysticercosis. Intramedullary cysticercosis in one case was shown as a single I cm cystic lesion at C2 level, which showed hypointense signal on T1 weighted image, hyperintense signal on T2-weighted image, and signet-ring-like enhancement. This lesion did not accompany intracranial cysticerci. CONCLUSION: lntraspinal cysticercosis manifested as single or multiple cysts within either spinal cord or subarachnoid space, and were frequently associated with arachnoiditis.
Arachnoid ; Arachnoiditis ; Cysticercosis* ; Edema ; Ischemia ; Magnetic Resonance Imaging* ; Medical Records ; Retrospective Studies ; Spinal Cord ; Subarachnoid Space

PURPOSE: The purpose of this study is to describe the anglographic findings of collateral vessels in cervicofacial vascular lesions with previously ligated carotid arteries and to evaluate the extent of anglographic assessmant needed before embolization. MATERIALS AND METHODS: We retrospectively reviewed 10 cervicofacial vascular lesions with previously ligated carotid artery, which were 6 cases of arteriovenous malformation, 2 cases of carotid cavernous fistula, 1 case of hemangioma and 1 case of arteriovenous realformation with carotid cavernous fistula. The previously ligated arteries are proximal external carotid artery (n=5), branches of external carotid artery (n=2) and common carotid artery (n=3). Common carotid artery or internal carotid artery (n=9), vertebral artery (n=5), ipsilateral external carotid artery (n=4), contralateral external carotid artery (n=5), costocervical trunk (n=2), thyrocervical trunk (n=2) were assessed by conventional angiography. Angiography of both carotid and vertebral arteries was performed in 5 cases. RESULTS: The collateral vascular channels were inferolateral trunk of internal carotid artery (n=8), vertebral artery (n=5), contralateral external carotid artery (n=5), ipsilateral external carotid artery (n=4), deep cervical artery (n=2) and ascending cervical artery (n=l). Embolizations were performed in 9 cases with operative cannulation(n=4), embolization via collateral branches of ipsilateral external carotid artery (n=l), embolization via collateral branches of contralateral external carotid artery (n=3) and balloon occulusion via direct puncture (n=l). CONCLUSION: The collateral channels in cervicofacial vascular lesions with previouly ligated carotid artery were inferolateral trunk of internal carotid artery, contralateral or ipsilateral external carotid artery, vertebral artery, deep cervical artery and ascending cervical artery on angiography. Complete anglographic assessment of possible collateral channels is mandatory for the effective and safe embolization.
Angiography ; Arteries ; Arteriovenous Malformations ; Carotid Arteries* ; Carotid Artery, Common ; Carotid Artery, External ; Carotid Artery, Internal ; Fistula ; Hemangioma ; Punctures ; Retrospective Studies ; Vertebral Artery

No abstract available.
Nephritis, Interstitial* ; Yersinia pseudotuberculosis* ; Yersinia*

No abstract available.
Aging* ; Erythrocytes* ; Humans ; Lipid Peroxidation*

PURPOSE: We analysed CT findings of thyroid mass to determine the difference between a benign and a malignant mass and to evaluate the differential findings, if any. MATERIALS AND METHODS: The subjects were 87 cases with apathologically proven thyroid mass (malignancy in 66 cases, benign mass in 21 cases). CT findings were retrospectively analysed. For the primary masses, bilaterality, size, margin, attenuation of the mass, spotty portion with distinct high attenuation(which may suggest calcification), necrosis, cystic change, solid portion within the cyst, and invasion of adjacent structures were evaluated. For the lymph nodes, size, high attenuated spotty portion, necrosis, cystic change, and solid portion within the cyst were evaluated. CT findings of thyroid masses and lymph nodes were evaluated in order to determine whether these were benign or malignant. Statistical analysis was performed using the Mann-Whitney U-Wilcoxon rank sum test. RESULTS: In malignant masses, compared with benign, an indistinct margin of the mass(48% vs 19%), invasion of adjacent structures(53% vs 0%), and associated lymph node enlargement(50% vs 0%) were more frequent. With regard to bilaterality, size, attenuation, high-attenuated spotty portion(which may suggest calcification), necrosis, cystic change, and solid portion within the cyst, there was no significant difference between benign andmalignant masses. In masses of the former type, enlarged lymph node or invasion of adjacent structure were not seen at all. When the papillary solid portionwithin the cystic mass was additionally evaluated, papillany carcinoma was the most common finding(77% 14\18). CONCLUSION: General findings of malignancy such as margin, invasion of the mass, and lymph node enlargement are of help in the differential diagnosis of a malignant mass. High attenuated spotty portion, which may suggest calcification within the mass, or size of the mass are non-specific findings, and are not helpful in differential diagnosis. The papillary solid portion within the cyst of the mass could suggest papillary carcinoma as a first possibility and could be helpful in differential diagnosis.
Carcinoma, Papillary ; Diagnosis, Differential* ; Lymph Nodes ; Necrosis ; Thyroid Gland*

PURPOSE: To determine the MR imaging findings of synovial sarcoma, with emphasis on the signal characteristicsof pathologically correlated T2-weighted images. MATERIALS AND METHODS: MR images of 14 cases ofpathologically-proven synovial sarcomas were retrospectively reviewed and correlated with the histopathologicfindings. We analyzed the signal intensity of T1- and T2-weighted images and the incidence of triple signalintensity, and evaluated the frequency of fluid-fluid levels, internal fibrous septa, calcification, the invasionof bone or neurovascular bundles and the involvement of joint capsules, as well as the size, location and marginof the tumors and pattern of contrast enhancement. RESULTS: Necrosis, cystic change or hemorrhage was suggested in11 cases, ten of which showed triple signal intensity, and in all cases, was pathologically confirmed. Fluid-fluidlevels were found in three cases and internal septa in ten. In four cases, maximum diameter was less than 5cm, andin nine, was greater than this. No mass was detected in one case. The tumor was located in the low extremity(n=9),pelvic girdle and hip joint area(n=2), scapular(n=1), shoulder joint area(n=1), and scalp(n=1). Eleven casesshowed a relatively well-defined margin and nine showed lobulation. Except in the area of necrosis and cysticchange, the pattern of contrast enhancement was diffuse and inhomogenous. Bony invasion was detected in two cases,neurovascular encasement in four, calcification in four, and joint capsule invasion in four. CONCLUSION: OnT2-weighted images, synovial sarcoma frequently showed triple signal intensity and internal septa with fluid-fluidlevels ; this was induced by cystic changes due to necrosis and hemorrhage.
Hemorrhage ; Hip Joint ; Incidence ; Joint Capsule ; Magnetic Resonance Imaging* ; Necrosis ; Retrospective Studies ; Sarcoma, Synovial* ; Shoulder Joint