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 determine the diagnositic value of multi-shot echo-planar MR imaging (EPI) in focal hepaticlesions by quantitatively comparing this with other standard MR sequences such as FSE(fast spin echo) T2WI,SE(spin echo) T1WI with and without Gd enhancement, FMPSPGR(fast multiplanar spoiled GRASS) with and without Gdenhancement. MATERIALS AND METHODS: Seventeen patients with 18 focal hepatic lesions were retrospectivelyreviewed by two abdominal radiologists. The pathological or clinical results of hepatic lesions were nine cases ofhemangioma, four of hepatocellular carcinoma, one of peripheral cholangiocarcinoma, one of simple cyst, and ofhemangioma. By dividing the data acquisition period into eight interleaved segments, multi-shot EPI images wereobtained. This T2W spin echo eight-shot EPIs of the liver in one 18 second breath hold was compared with otherpulse sequences. The foci of review were lesion detectablity and characterization. For the former, SNR(signal tonoise ratio) of the liver and CNR(contrast to noise ratio) of the lesion to the liver were calculated ;to evaluatethe latter, a separate calculation of lesion to liver CNR for each solid and nonsolid lesion group was performed. RESULTS: Among six pulse sequences, multi-shot EPI provided the poorest liver SNR (p<.01). With regard to lesionto liver CNR, EPI was superior to FMPSPGR, SE, and Gd SE, but inferior to FSE, Gd FMPSPGR(p<.01). For nonsolidlesions(hemangioma, cyst), EPI provided higher liver CNR than FMPSPGR, SE, or Gd-SE, but one that was poorer thanthat provided by FSE and Gd-FMPSPGR(p<.05). Among six pulse sequences, there was no statistically significantdifference in lesion to liver CNR in solid lesions. In the evaluation of liver to lesion CNR, multi-shot EPI wasalways inferior to FSE. CONCLUSION: We concluded that with regard to sensitivity and suseptibility, multi-shotEPI is inferior to T2W FSE. For SNR, EPI was the least satisfactory, though with the exception of FSE, EPIprovided a higher or comparable CNR than other pulse sequences, and this made lesion depiction easy, especially innonsolid lesions. It was, however, difficult to characterize lesions by using EPI alone to determine whether alesion was solid or nonsolid.
Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Diagnosis* ; Humans ; Liver ; Magnetic Resonance Imaging* ; Noise

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

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

PURPOSE: The purpose of this study was to determine the proton MR spectroscopic features of liver cirrhosis and the different proton MR spectroscopic features between liver cirrhosis and the normal human liver by comparing the two different conditions. MATERIALS AND METHODS: The investigation involved 30 cases of in-vivo proton MR spectra obtained from 15 patients with liver cirrhosis demonstrated on the basis of radiologic and clinical findings, and from 15 normal volunteers without a past or current history of liver disease. MR spectroscopy involved the use of a 1.5T GE Signa Horizon system (GE Medical Systems, Milwaukee, U.S.A.) with body coil. STEAM (STimulated Echo-Aquisition Mode) with 3000/30 msec of TR/TE was used for signal acquisition; patients were in the prone position and respiration was not interrupted. Cases were assigned to either the cirrhosis or normal group, and using the proton MR spectra of cases of in each group, peak changes occurring in lipids (at 1.3ppm), glutamate and glutamine (at 2.4 -2 .5ppm), phosphomonoesters (at 3.0 -3 .1ppm), and glycogen and glucose (at 3.4 -3 .9ppm) were evaluated. Mean and standard deviation of the ratio of glutamate + glutamine/lipids, phospho-monoesters/lipids, glycogen + glucose/lipids were calculated from the area of their peaks. The ratio of various metabolites to lipid content was compared between the normal and cirrhosis group. RESULTS: The main characteristic change in proton MR spectra in cases of liver cirrhosis compared with normal liver was decreased relative intensity of lipid peak. Mean and standard deviation of ratio of glutamate + g-lutamine/ lipids, phosphomonoesters/lipids, glycogen + glucose/lipids calculated from the area of their peaks of normal and cirrhotic liver were 0.0204 +/-0.0067 and 0.0693 +/-0.0371 (p<0.05), 0.0146 +/-0.0090 and 0.0881 +/-0.0276 (p<0.05), 0.0403 +/-0.0267 and 0.2325 +/-0.1071 (p<0.05), respectively. The other character-istic feature of proton MR spectra of liver cirrhosis was the peak detected at 3.9 - 4.1 ppm with unknown nature. Mean and standard deviation of area ratio of the unknown peak to lipid peak in proton MR spectra of liver cirrhosis was 0.1504 +/-0 . 0 3 5 5 . CONCLUSION: Proton MR spectra of liver cirrhosis revealed decreased intensity of lipid with statistical signifi-cance compared with that of normal liver, and peak at 3.9 -4.1 ppm with unknown nature. In conclusion, liver cirrhosis can be diagnosed non-invasively by the analysis of observed proton MR spectroscopic features.
Fibrosis ; Glucose ; Glutamic Acid ; Glutamine ; Glycogen ; Healthy Volunteers ; Humans ; Liver Cirrhosis* ; Liver Diseases ; Liver* ; Magnetic Resonance Spectroscopy ; Prone Position ; Protons* ; Respiration ; Steam

BACKGROUND: In the resection of lung cancer, pneumonectomy occupied 20~35% of all resections, and significantly high operative mortality is reported in right pneumonectomy (10~25%). The aim of this study is to identify the characteristics of morbidity, operative mortality and factors affecting operative mortality after pneumonectomy. MATERIAL AND METHOD: This study recruited the database which performed pneumonectomy for lung cancer in Korea Cancer Center Hospital from Aug 1987 to Apr 2002. RESULT: Total of 386 pneumonectomies were performed in that period. Sidedness were left in 238, right in 148; and the procedures were standard resection in 207, and extended resection in 179. Morbidity occurred in 115 cases (29.8%, 115/386). Mortality occurred in 12 cases (3.1%, 12 in 386). This mortality rate was similar to that of lobectomy (2.1%, 13 in 613) during the same period. Morbidity consisted of 42 hoarseness, 17 (9) pneumonia and ARDS, 8 empyema, 5 (1) broncho-pleural fistula, 5 reoperation for bleeding, 5 (1) arrhythmia, 1 (1) pulmonary edema, and 25 others (The number in the parenthesis is the number of mortality case for that morbidity). Several factors affecting the operative mortality were evaluated. At first, extended procedure (3.3%, 6 in 179) affected the operative mortality similar to the standard procedure (2.9%, 6 in 207)(p=0.812). Second, the rate of operative mortality in an elderly group over 60 years (5.5%, 10 in 182) was significantly higher than the younger group under 60 years (1%, 2 in 204)(p=0.016). Third, sidedness of resection affects to operative mortality. Right pneumonectomy (6.8%, 10 in 148) showed higher operative mortality than that of left pneumonectomy (0.8%, 2 in 238)(p=0.002). The group over 60 years showed higher incidence of respiratory morbidity (11.0%, 20 in 182) than that of the group under 60 years (3.4%, 7 in 204)(p=0.005). Right pneumonectomy also showed significantly higher incidence (11.5%, 17 in 148) than that of left pneumonectomy (4.2%, 10 in 238)(p=0.008). CONCLUSION: Age and sidedness of pneumonectomy were the risk factors of operative mortality and respiratory complications. Therefore, careful selection of patients and more attention perioperatively were demanded in right pneumonectomy. However, because the operative mortality is acceptable, pneumonectomy could be done safely if the pneumonectomy is necessary for curative resection of lung cancer.
Aged ; Arrhythmias, Cardiac ; Carcinoma, Non-Small-Cell Lung* ; Empyema ; Fistula ; Hemorrhage ; Hoarseness ; Humans ; Incidence ; Korea ; Lung Neoplasms ; Mortality ; Pneumonectomy* ; Pneumonia ; Pulmonary Edema ; Reoperation ; Risk Factors*