A 62-year-old woman with hereditary hemorrhagic telangiectasia(HHT) or Osler-Weber-Rendu disease involving the liver is presented. Imaging findings including color Doppler sonograph and CT findings are described.
Female ; Humans ; Liver* ; Middle Aged

The use of advanced imaging techniques in computed tomography(CT) and magnetic resonance imaging (MRI) has established the appearance of most common liver neoplasms. There are, however, considerable overlaps In the appearances of various pathologic entities on CT and MRI, and certain hepatic lesions can show unusual characteristics that may lead to misinterpretation, so it is important for the radiologist to be aware of these uncommon appearances. The purpose of this article is to illustrate the spectra of uncommon patterns and various diagnostic pitfalls encountered on CT and MRI of liver neoplasms.
Liver Neoplasms* ; Liver* ; Magnetic Resonance Imaging*

PURPOSE: Metabolic syndrome (MS) is a clinical condition that shares many common characteristics with diabetes. However, unlike diabetes, the usefulness of MS as a prognostic entity in peripheral arterial disease is uncertain. This study evaluated the prognostic usefulness of MS in critical lower limb ischemia (CLI) patients. MATERIALS AND METHODS: We compared the 2-year clinical outcomes in 101 consecutive CLI patients (66+/-14 years; 78% men) with 118 affected limbs treated with percutaneous transluminal angioplasty (PTA) according to the presence of MS and diabetes. RESULTS: The number of MS patients was 53 (52%), of which 45 (85%) had diabetes. During a 2-year follow-up, the incidence of clinical outcomes, including reintervention, major amputation, minor amputation, and survival, was not significantly different between MS and non-MS patients; however, the incidence of minor amputation was significantly higher in diabetic than in non-diabetic patients (42% vs. 17%; p=0.011). Cox regression analysis for the 2-year primary patency demonstrated no association between MS and 2-year primary patency [hazard ratio (HR), 1.02; 95% confidence interval (CI), 0.45-2.30; p=0.961], whereas there was a significant association between diabetes and 2-year primary patency (HR, 2.81; 95% CI, 1.02-7.72; p=0.046). Kaplan-Meier analysis revealed no significant difference in the 2-year primary patency between MS and non-MS patients; however, the 2-year primary patency was lower in diabetic than in non-diabetic patients (p=0.038). CONCLUSION: As a prognostic concept, MS might conceal the adverse impact of diabetes on the prognosis of CLI patients treated with PTA.
Aged ; Aged, 80 and over ; Angioplasty/*methods ; Diabetes Mellitus/*therapy ; Female ; Humans ; Ischemia/*therapy ; Lower Extremity/*blood supply ; Male ; Metabolic Syndrome X/*therapy ; Middle Aged ; Republic of Korea ; Retrospective Studies

PURPOSE: To compare the usefulness of echo-planar imaging (EPI) and fast spin-echo (FSE) in routine brain MR imaging. MATERIALS AND METHODS: Twenty-five patients with various intracranial diseases were prospectively examined with T2-weighted MR imaging on a 1.5T unit using FSE, spin echo singl-shot EPI (SS-EPI) and multi-shot EPI (MS-EPI) techniques. For qualitative assessment, overall image quality, discrimination between cortical gray-white matter and between basal ganglia-white matter, lesion conspicuity, image distortion and artifacts (motion, ghost, flow, and susceptibility) were all evaluated using a subjective scoring system ranging from 1 to 4 (1 for the worst and 4 for the best). For quantitative assessment, contrast and contrast-to-noise ratio (CNR) were calculated for cortical gray-white matter, basal ganglia-white matter, and lesion-white matter. RESULTS: Overall image quality, discrimination between cortical gray-white matter, basal ganglia-white matter, and lesion-white matter, lesion conspicuity, image distortion and susceptibility artifacts showed the highest value in FSE and the lowest in SS-EPI. Motion artifacts were seen only in FSE, while flow and ghost artifacts were most commonly seen in SS-EPI. Contrast and CNR of anatomical and pathologic structures showed the highest value in FSE, especially for cortical gray-white matter and basal ganglia-white matter . CONCLUSION: With regard to overall image quality, image distortion, susceptibility artifacts, contrast and CNR, EPI is far inferior to FSE. In routine brain MR imaging., the usefulness of EPI techniques would therefore be very limited.
Artifacts ; Brain* ; Discrimination (Psychology) ; Echo-Planar Imaging ; Humans ; Magnetic Resonance Imaging* ; Prospective Studies

PURPOSE: It is known that due to both their imaging and pathologic features, the accurate differentiation ofchondrosarcoma from chordoma is difficult. Through an analysis of MR and CT findings, this study aims to determinethe differential points between these two tumors. MATERIALS AND METHODS: In 21 patients, CT and MR imagingstudies of chordoma(n=12) and chondrosarcoma(n=9) at the base of the skull were retrospectively reviewed.Diagnosis had been established by histologic examination of surgically removed specimens. Eleven of the chordomaswere subclassified as 'conventional' and one as 'chondroid'; eight chondrosarcoma were 'conventional' andone was 'myxoid'. Four chordoma patients underwent CT and MR ; in six, only MR was performed ; and in two, onlyCT. Eight chondrosarcoma patients underwent both CT and MR, while in one, only CT was performed. All scans wereretrospectively evaluated for the location(midline/off-midline), direction of extension, margin and shape, bonydestruction and calcification, MR signal intensity and enhancement patterns of the tumors. Degree of calcificationwas graded from I to III. RESULTS: The epicenter of the mass of ten chordomas (83%) was midline, in twochondrosarcomas(22%), this was off-midline. Foci of calcification were observed in three of eleven chordomas(27%),and heavy calcification (grade III) was observed in one. In contrast to these findings, foci of calcificationswere observed in eight of nine chondrosarcomas (89%) and grade III calcification was observed in five. In bothtumors, calcification was coarse. Between the two kinds of tumor, there were no significant difference in MRsignal intensity and enhancement patterns, margin and shape, or direction of extension. CONCLUSIONS: Although MRand CT findings were similar in both types of tumor, location and degree of calcification may be features whichusefully distinguish chordoma from chondrosarcoma.
Chondrosarcoma* ; Chordoma* ; Humans ; Retrospective Studies ; Skull Base* ; Skull*

PURPOSE: Accurate evaluation of side branch (SB) ostium could be critical to the treatment of bifurcation lesions. We compared measured and calculated values of side branch ostial length (SBOL) in coronary bifurcation lesions with intravascular ultrasound (IVUS). MATERIALS AND METHODS: Pre-intervention and post-intervention IVUS was performed in 113 patients who underwent stent implantation of bifurcation lesions. For the IVUS longitudinal reconstruction of the bifurcation lesions, SBOL, SB diameter, and the angle between the distal portion of the main vessel (MV) and SB were directly measured. In addition, SBOL was calculated as: SB diameter/sin (angle between distal MV and SB). The relationship between measured and calculated SBOL was then evaluated. RESULTS: The angled between the distal MV and SB were 57.3+/-12.4degrees at pre-intervention and 59.4+/-12.6degrees at post-intervention. The mean measured and calculated SBOL values were 2.91+/-0.86 mm and 3.06+/-0.77 mm at pre-intervention and 2.79+/-0.82 mm and 2.92+/-0.69 mm at post-intervention, respectively. Differences between measured and calculated SBOL were 0.15+/-0.44 mm at pre-intervention and 0.13+/-0.41 mm at post-intervention. We found that calculated SBOL was correlated with measured SBOL (pre-intervention r=0.863, p<0.001; post-intervention r=0.868, p<0.001). CONCLUSION: There was a good correlation between measured and calculated SBOLs of the bifurcation lesions in IVUS longitudinal reconstruction. SBOL in the bifurcation lesions can therefore be estimated using the SB diameter and the angle between distal MV and SB.
Aged ; Angioplasty, Balloon, Coronary ; Coronary Angiography ; Coronary Artery Disease/surgery/*ultrasonography ; Coronary Vessels/*ultrasonography ; Female ; Humans ; Male ; Middle Aged ; Ultrasonography, Interventional

BACKGROUND AND OBJECTIVES: With recent advances in equipment and techniques, infrapopliteal angioplasty has shown results that are comparable to those of surgical bypass in patients with critical limb ischemia (CLI). In this study, we evaluated the efficacy and the feasibility of infrapopliteal angioplasty in patients with CLI. SUBJECTS AND METHODS: Between March 2002 and May 2008, infrapopliteal angioplasty was performed on 118 limbs of 101 patients (79 males; mean age 66 years) with CLI (Rutherford category 4, 5 or 6). Freedom from reintervention, limb salvage, and overall survival were analyzed. RESULTS: The median follow-up duration was 30 months. Initial technical and clinical success rates were 69.5% and 83.1%, respectively. No major complication requiring surgical intervention developed after angioplasty. Among 82 limbs with initial technical success, the rate of freedom from any reintervention at 2 years was 70.7% and that from limb salvage was 97.6%. Young age and Rutherford category 6 at initial presentation were independent predictors associated with poor 2 year primary patency in these patients with CLI. Overall survival at 1 year was 86.4% and that at 2 years 76.3%. A history of cerebrovascular accident was an independent predictor associated with poor 2 year survival in these patients. CONCLUSION: Infrapopliteal angioplasty as a primary choice of treatment in CLI patients showed favorable clinical outcomes and feasibility.
Angioplasty ; Extremities ; Follow-Up Studies ; Freedom ; Humans ; Ischemia ; Limb Salvage ; Stroke ; Tibial Arteries

PURPOSE: To assess the efficacy of superselective intra-arterial chemotherapy (SSIAC) via the bilateral uterine arteries in cases of cervical carcinoma. MATERIALS AND METHODS: Eighteen patients with stage IIa (n=10), IIb (n=7), or IIIa (n=1) cervical carcinoma underwent one (n=2) or two (n=16) courses of preoperative SSIAC with Vincristine, Cisplatin, and Mitomycin C. We estimated the extent of reduction of tumor volume and improvement of stage, comparing pre-SSIAC MRI to postoperative results. Tumor vascularity, as seen on uterine arteriography, and procedural complications, were also evaluated. RESULTS: A marked reduction in tumor volume was observed in all patients, an average reduction volume of 94.7%. Improvement of stage was noted in 16 patients, and in six of these, no residual viable tumor or microinvasive residual tumor was seen. On angiography, tumor hypervascularity was demonstrated in seven patients, but its degree was not substantially related to therapeutic response. In no case did significant systemic complications of result from chemotherapy; in one patient, however, we experienced a serious complication of necrotizing cystitis due to malpositioning of a catheter in the superior vesical artery. CONCLUSION: SSIAC via the bilateral uterine arteries is an effective complementary modality for the treatment of various stages of cervical carcinoma.
Angiography ; Arteries ; Catheters ; Cisplatin ; Cystitis ; Drug Therapy* ; Humans ; Magnetic Resonance Imaging ; Mitomycin ; Neoplasm, Residual ; Tumor Burden ; Uterine Artery* ; Vincristine

PURPOSE: To review the simple radiographic and sonographic findings in infants with neonatal sepsis. MATERIALS AND METHODS: We retrospectively analyzed simple chest and abdominal radiographs, and brain sonograms in 36 newborn infants (preterm: term=23:13). With neonatal sepsis diagnosed by blood culture and clinical manifestations. RESULTS: Pulmonary parenchymal infiltrate excluding respiratory distress syndrome and pulmonary edema or atelectasis was found in 22 infants (61%). Paralytic ileus, hepatosplenomegaly, and necrotizing enterocolitis were present in 18 (50%), 9 (25%), and 1 (3%) infants, respectively, while skeletal changes suggesting osteomyelitis were found in three. Brain sonography was performed in 29 infants and in four, abnormalities were seen ; these comprised three germinal matrix hemorrhages and one intraparenchymal hemorrhage. In six patients (17%) radiologic examinations revealed no abnormality. CONCLUSION: In patients with neonatal sepsis, pulmonary infiltrates and paralytic ileus were common abnormalities. Although these were nonspecific, radiologic findings may be used to supplement clinical and laboratory findings in diagnosing neonatal sepsis and planning its treatment.
Brain ; Enterocolitis, Necrotizing ; Hemorrhage ; Humans ; Infant ; Infant, Newborn ; Intestinal Pseudo-Obstruction ; Osteomyelitis ; Pulmonary Atelectasis ; Pulmonary Edema ; Retrospective Studies ; Sepsis* ; Thorax ; Ultrasonography

PURPOSE: The purpose of this study was 1) to describe the thin section helical CT findings of hilar cholangiocarcinoma and of benign stricture, and to discuss the differential points between the two disease entities and 2) using cholangiographic correlation, to evaluate the diagnostic accuracy of helical CT in determining the extent of hilar cholangiocarcinoma. MATERIALS AND METHODS: Twenty-seven patients with hilar cholangiocarcinoma and eight with benign biliary dilatation were studied. All except four with hilar cholangiocarcinoma, who underwent CT using a conventional scanner, were studied with two-phase helical CT. In all patients, cholangiographs were obtained by digital fluoroscopy after the injection of contrast materials into PTBD catheters. The level of obstruction was classified according to Bismuth, and 35 CT scans were studied blindly and retrospectively by two radiologists. The findings were analyzed for the presence of tumor, and then divided into two groups (cholangiocarcinomas and benign strictures), and the positive predictive value was calculated. The CT images of klatskin tumor were analyzed with special emphasis on the level and shape of the hilar obstruction. The level of biliary obstruction and extent of the tumor were carefully correlated with the results of cholangiography. RESULTS: Thin-section spiral CT correctly identified all tumor mass as a focal wall thickening obliterating the lumen. On arterial/portal phase CT scanning, 81% of infilterative tumors showed high attenuation. In all patients, differentiation between benign stricture and klatskin tumor was possible ; correct identification of the level of obstruction and extent of tumor, according to Bismuth's classification, was possible in 63% of cases. CONCLUSION: For correct diagnosis of hilar cholangiocarcinoma and differentiation of benign stricture, helical CT was highly accurate and effective. Because of limital Z-axis resolution, however, the exact intraductalextent of the tumor was less accorately diagnosed.
Bismuth ; Catheters ; Cholangiocarcinoma ; Cholangiography ; Classification ; Constriction, Pathologic* ; Contrast Media ; Diagnosis ; Dilatation ; Fluoroscopy ; Humans ; Klatskin's Tumor* ; Retrospective Studies ; Tomography, Spiral Computed* ; Tomography, X-Ray Computed