PURPOSE: To determine the influence of manganese dipyridoxyl diphosphate (Mn-DPDP) on MRI and proton MRS. MATERIALS AND METHODS: In an in-vitro study designed to determine changes in the lipid peak at 1.3 ppm, 4.7T MR equipment was used to obtain proton MR spectrographic images of a lipid solution of varying concentration, with and without Mn-DPDP. Before; at 10, 20, and 30 minutes; and at 1, 2, 4, and 24 hours after the IV injection of Mn-DPDP (10umol, 1ml/kg), the concentration of Mn in liver tissue was measured by atomic absorption spectrometry. At the same intervals, T1-weighted MR images were obtained, the signal intensity ofthe liver was thus determined, and the relative enhancement ratio was calculated. MRS of rabbit liver was performed serially at the same intervals, and the peak areas of metabolites, as well as their peak areas relative to lipids, were calculated. The findings were correlated with tissue Mn concentration. RESULTS: At 1.3 ppm with Mn-DPDP, MRS showed that the peak area of the lipid had decreased. Tissue Mn concentration increased just after Mn-DPDP injection and peaked after 20 minutes, decreasing to a level within the normal range after 24 hours. Serial changes in the signal intensity of the liver, as seen at MRI, showed a similar pattern to that of Mn concentration. There was reverse correlation between serial change in the peak area of lipids at 1.3 ppm and Mn concentration after Mn-DPDP injection. CONCLUSION: At T1-weighted MR imaging, the injection of Mn-DPDP led to the enhancement of liver tissue, and at MRS, the lipid peak at 1.3 ppm decreased. There was close correlation between these effects and tissue Mn concentration.
Absorption ; Liver* ; Magnetic Resonance Imaging* ; Magnetic Resonance Spectroscopy* ; Manganese ; Protons* ; Reference Values ; Spectrum Analysis

PURPOSE: The purpose of this study was to evaluate change in the proton MR spectroscopic (1H-MRS) features of the liver according to changes in the severity of the chronic hepatitis spectrum (normal-chronic hepatitis-liver cirrhosis), and to determine the possibility of replacing liver biopsy by1 H-MRS. MATERIALS AND METHODS: Sixty profiles of 1H-MRS features from 15 normal volunteers, 30 cases of chronic hepatitis, and 15 of liver cirrhosis were evaluated. All cases of chronic hepatitis and liver cirrhosis were confirmed by biopsy, and histopathologic disease severity was categorized according to Ludwig 's classification. Using the STEAM(STimulated Echo-Aquisition Mode) sequence, 1H-MRS was performed. The ratios of peak areas of [glutamate+glutamine]/lipid, phosphomonoesters/lipid, [glycogen+glucose]/lipid, and [3.9-4 . 1ppm unknown peak]/lipid and their mean and standard deviation were calculated in normal, chronic hepatitis stages I and II, and early and late liver cirrhosis groups and the results were compared between these groups. One-way variable analysis was applied to the statistics. RESULTS: Mean and standard deviation of phosphomonoesters/lipid in the normal, chronic hepatitis grades I and II, and early and late liver cirrhosis groups were 0.0146 +/-0.0090, 0.0222 +/-0.0170, 0.0341 +/-0.0276, 0 . 0 6 9 8 +/-0.0360, and 0.0881 +/-0.0276, respectively, and [glycogen+ glucose]/lipid were 0.0403 +/-0.0267, 0.0922 +/-0.0377, 0.1230 +/-0.0364, 0.1853 +/-0.0667, and 0.2325 +/-0.1071, respectively. These results implied that the ra-tio of the above metabolites to lipid content increased according to increasing disease severity (p<0.05). For [g-lutamate+glutamine]/lipid however, the ratios for each group were 0.0204 +/-0.0067, 0.0117 +/-0.0078, 0.0409 +/-0.0167, 0.0212 +/-0.0103, and 0.0693 +/-0.0371, respectively, and there was no correlation with disease severity. In the chonic hepatitis grades I and II, and early and late liver cirrhosis groups, the ratios for [3.9 -4.1 ppm un-known peak]/l ipid were 0.0302 +/-0.0087, 0.0513 +/-0.0167, 0.1112 +/-0.0351, and 0.1504 +/-0 . 0 3 5 5 ,and these also increased according to increasing disease severity (p<0.05). On MR spectra of normal livers, an unknown peak at 3.9 -4.1ppm was not detected. CONCLUSION: Changes in MR spectroscopic features in cases of chronic hepatitic and liver cirrhosis correlated with changes in disease severity, and the sensitivity of the unknown peak at 3.9 -4.1ppm changed according to disease severity. It is therefore possible to differentiate between normal liver, chronic hepatitis and liver cirrhosis by analysis of the 1H-MRS features of the liver. These results indicate that in cases of chronic hepatitis and liver cirrhosis, biopsy of the liver can be replaced by 1H-MRS.
Biopsy ; Classification ; Healthy Volunteers ; Hepatitis ; Hepatitis, Chronic* ; Liver Cirrhosis* ; Liver* ; Protons*

Gynecomastia is an abnormal increase in the volume of the male breast. Surgical techniques include a variety of incisions, excisions, suction-assisted lipopectomy, ultrasound-assisted liposuction, power-assisted liposuction, or some combination of these methods. The purpose of this article is to introduce the authors' method of using power-assisted liposuction and periareolar pull-out technique. Six men were treated from June 2005 through August 2008 for gynecomastia. Fatty breast tissue is removed by power-assisted liposuction. The periareolar pull-out technique is then performed to glandular enlargement. A mean of 120cc of breast tissue was aspirated, and 18.3g of glandular tissue were excised per breast. There were no complications such as skin flap necrosis or hematoma. The cosmetic outcome was good in all and the patients' satisfaction was high. Power-assisted liposuction in combination with periareolar pull-out technique effectively corrects gynecomatia. This combination has little morbidity, minimize scars, and leads to good cosmetic results.
Male ; Humans

Genitourinary tuberculosis is a disease spread hematogenously from a small tuberculous abscess of the lung. The renal cortex is initially involved, and multiple granulomas form. Ultimately the cortex may cavitate and communicate with the collecting system, allowing downward extension of the infection and subsequent focal caliectasis with infundibular stenosis, ureteral fibrosis, and calcifications of urinary tract organs. The female genitourinary organ is also infected by the hematogenous spread of tuberculosis, the most common lesion be-ing hydrosalpynx with salpingitis. The clinical and radiologic features of genitourinary tuberculosis may mimic other acute abdominal diseases, and the diagnosis of tuberculosis remains difficult. This report describes the ways in which computed tomography and magnetic resonance imaging are valuable aids in the recognition and diagnosis of genitourinary tuberculosis.
Abscess ; Constriction, Pathologic ; Diagnosis ; Female ; Fibrosis ; Granuloma ; Humans ; Lung ; Magnetic Resonance Imaging ; Salpingitis ; Tuberculosis* ; Ureter ; Urinary Tract

Cholesteatoma of the urinary tract is an extremely rare disease occurring in the bladder and renal pelvis. We report the radiologic findings in two cases of renal cholesteatoma involving the renal pelvis, calyces and ureter, and correlate these with the histopathologic findings.
Cholesteatoma* ; Kidney Pelvis ; Rare Diseases ; Ureter ; Urinary Bladder ; Urinary Tract

PURPOSE: To know the differences of proton MR spectroscopic features between recurrent rectal cancer and fibrosis in post-operative period, and to evaluate the possibility to discriminate recurrent rectal cancer from post-operative fibrosis by analysis of proton MR spectra. MATERIALS AND METHODS: We evaluated the proton MR spectra from 25 soft tissue masses in perirectal area that developed in post-operative period after operation for the resection of rectal cancer. Our series included 11 cases of recurrent rectal cancer and 14 of fibrotic mass. All cases of recurrent rectal cancer and post-operative fibrosis were confirmed by biopsy. We evaluated the spectra with an attention to the differences of pattern of the curves between recurrent rectal cancer and post-operative fibrosis. The ratio of peak area of all peaks at 1.6 -4.1ppm to lipid (0.9 - 1.6ppm) [P (1.6 -4.1ppm)/P (0.9 -1.6ppm)] was calculated in recurrent rectal cancer and post-operative fibrosis groups, and compared the results between these groups. We also evaluated the sensitivity and specificity for discriminating recurrent rectal cancer from post-operative fibrosis by analysis of 1 H-MRS. RESULTS: Proton MR spectra of post-operative fibrosis showed significantly diminished amount of lipids compared with that of recurrent rectal cancer. The ratio of P (1.6 -4.1ppm)/P (0.9 -1.6ppm) in post-operative fibrosis was much higher than that of recurrent rectal cancer with statistical significance (p < .05) due to decreased peak area of lipids. Mean (standard deviations of P (1.6 -4.1ppm)/P (0.9 -1.6ppm) in post-operative fibrosis and recurrent rectal cancer group were 2.71 +/-1.48 and 0.29 +/- 0.11, respectively. With a cut-off value of 0.6 for discriminating recurrent rectal cancer from post-operative fibrosis, both the sensitivity and specificity were 100% (11/11, and 14/14). CONCLUSION: Recurrent rectal cancer and post-operative fibrosis can be distinguished from each other by analysis of proton MR spectroscopic features, and 1 H-MRS can be a new method for differential diagnosis between recurrent rectal cancer and post-operative fibrosis.
Biopsy ; Diagnosis, Differential ; Fibrosis* ; Magnetic Resonance Spectroscopy* ; Protons* ; Rectal Neoplasms* ; Sensitivity and Specificity

Herein, we report on a case of primary torsion of the greater omentum with segmental infarction, which should provide useful information for the preoperative diagnosis of future such cases. Primary torsion of the greater omentum with omental infarction is a rare condition. There are only a few radiological reports of secondary torsion of the greater omentum caused by the hernial sac. During surgical exploration, infarction of the greater omentum was identified, due to the observation of omental torsion without any underlying cause. We describe a patient with characteristic computed tomography (CT) findings of primary omental torsion with segmental infarction, which correlated with the operative and pathologic results.
Diagnosis ; Humans ; Infarction* ; Omentum*

BACKGROUND: Recent advances in laboratory information systems have largely been focused on automation. However, the phlebotomy services have not been completely automated. To address this issue, we introduced an automated reception and turnaround time (TAT) management system, for the first time in Korea, whereby the patient's information is transmitted directly to the actual phlebotomy site and the TAT for each phlebotomy step can be monitored at a glance. METHODS: The GNT5 system (Energium Co., Ltd., Korea) was installed in June 2013. The automated reception and TAT management system has been in operation since February 2014. Integration of the automated reception machine with the GNT5 allowed for direct transmission of laboratory order information to the GNT5 without involving any manual reception step. We used the mean TAT from reception to actual phlebotomy as the parameter for evaluating the efficiency of our system. RESULTS: Mean TAT decreased from 5:45 min to 2:42 min after operationalization of the system. The mean number of patients in queue decreased from 2.9 to 1.0. Further, the number of cases taking more than five minutes from reception to phlebotomy, defined as the defect rate, decreased from 20.1% to 9.7%. CONCLUSIONS: The use of automated reception and TAT management system was associated with a decrease of overall TAT and an improved workflow at the phlebotomy room.
Automation, Laboratory ; Efficiency, Organizational/*standards ; Phlebotomy/*statistics & numerical data ; Republic of Korea ; Time Factors ; Workflow

PURPOSE: Langerhans cell histiocytosis is a heterogenous group of Langerhans cell proliferative disorders and includeseosinophilic granuloma, Letterer-Siwe diseases, and Hand- Schuller Christian disease. We report a case of eosinophilic granuloma on frontal area. METHODS: A 17-year-old male presented with swelling and tenderness on Lt. frontal and periorbital area. CT and MRI showed a 33 x 25 mm sized mass that involved Lt. frontal calvarium, frontotemporal meninges, and orbital roof. RESULTS: Total excision of the mass and adjacent soft tissue, calvarium, and orbital roof was performed. Orbital roof defect was reconstructed with absorbable plate and calvarial defect was done with outer cortex of temporal bone flap. The histology revealed proliferation of histiocytes and eosinophils. Immunologically, these histiocytic cells expressed S-100 protein and CD1a. The patient is currently taking conservative treatment. CONCLUSION: The severity of these disease and their prognosis and treatments are various. For unifocal cranial Langerhans cell histiocytosis, complete excision is the treatment of choice. We report this case with review of literature.
Adolescent ; Eosinophilic Granuloma ; Eosinophils ; Frontal Bone ; Granuloma ; Histiocytes ; Histiocytosis ; Histiocytosis, Langerhans-Cell ; Humans ; Male ; Meninges ; Orbit ; Prognosis ; S100 Proteins ; Skull ; Temporal Bone

PURPOSE: To determine the feasibility of MR spectroscopy in the living human liver, and to evaluate thecorresponding proton MR spectroscopic features. MATERIALS AND METHODS: In fifteen normal volunteers with neitherprevious nor present liver disease the proton MR spectroscopic findings were reviewed. Twelve subjects were maleand three were female ; they were aged between 28 and 32 (mean, 30) years. MR spectroscopy involved the use of a1.5T GE Signa Horizon system with body coil (GE Medical System, Milwaukee, U.S.A). We used STEAM (STimulatedEcho-Aquisition Mode) with 3000/30 msec of TR/TE for signal acquisition, and the prone position withoutrespiratory interruption. Mean and standard deviation of the ratios of glutamate + glutamine/lipids,phosphomonoesters/ lipids, and glycogen + glucose/lipids were calculated from the area of their peaks. RESULTS:The proton MR spectroscopic findings of normal human livers showed four distinctive peaks, i.e. lipids, glutamateand glutamine complex, phosphomonoesters, and glycogen and glucose complex. The mean and standard deviation of theratios of glutamate + glutamine/lipids, phosphomonoesters/lipids, and glycogen + glucose/lipids were 0.02 +/- 0.01,0.01 +/- 0.01, and 0.04 +/- 0.03, respectively. CONCLUSION: In living normal human livers, MR spectroscopy can besuccessfully applied. When applied to a liver whose condition is pathologic, the findings can be used as astandard.
Female ; Glucose ; Glutamic Acid ; Glutamine ; Glycogen ; Healthy Volunteers ; Humans* ; Liver Diseases ; Liver* ; Magnetic Resonance Spectroscopy ; Prone Position ; Protons* ; Steam