Multidetector CT (MDCT) gastrography has been regarded as a promising technique for the preoperative imaging of gastric cancer. It has the ability to produce various three-dimensional (3D) images. Because 3D reconstruction images are more effective and intuitive for recognizing abnormal changes in the gastric folds and subtle mucosal nodularity than two-dimensional images, 3D MDCT gastrography can enhance the detection rate of early gastric cancer, which, in turn, contributes to the improvement of the accuracy of preoperative tumor (T) staging. In addition, shaded surface display and tissue transition projection images provide a global view of the stomach, with the exact location of gastric cancer, which may replace the need for barium studies. In this article, we discuss technical factors in producing high-quality MDCT gastrographic images and present cases demonstrating the usefulness of MDCT gastrography for the detection and T staging of gastric cancer while emphasizing the significance of preoperative localization of gastric cancer in terms of surgical margin.
Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Neoplasm Staging ; Stomach Neoplasms/pathology/*radiography/surgery ; Tomography, X-Ray Computed

OBJECTIVE: To access the feasibility of clinically available 3T MRI to detect the migration of labeled neural stem cells (NSCs) in intracerebral hemorrhage (ICH) in a rat model. MATERIALS AND METHODS: The ethics committee of our institution approved this study. ICH was induced by the injection of collagenase type IV into the right striatum of ten Sprague-Dawley rats. Human NSCs conjugated with Feridex (super-paramagnetic iron oxide: SPIO) were transplanted into the left striatum one week after ICH induction. MRI was performed on a 3T scanner during the first, second, third, fourth, and sixth weeks post-transplantation. MRI was obtained using coronal T2- and T2*-weighted sequences. Two rats were sacrificed every week after in vivo MRI in order to analyze the histological findings. RESULTS: ICH in the right striatum was detected by MRI one and two weeks after transplantation without migration of the NSCs. There was no migration of the NSCs as seen on the histological findings one week after transplantation. The histological findings two weeks after transplantation showed a small number of NSCs along the corpus callosum. On MRI three weeks after transplantation, there was a hypointense line along the corpus callosum and decreased signal intensity in the right periventricular region. Histological findings three weeks after transplantation confirmed the presence of the hypointense line representing SPIO-labeled NSCs. MRI four and six weeks after transplantation showed a hypointense spot in the right periventricular region. The histological findings four and six weeks after transplantation showed the presence of prominent NSCs in the right periventricular region. CONCLUSION: 3T MRI can detect the migration of NSCs in rats with ICH along the corpus callosum. Therefore, 3T MRI could be feasible for detecting the migration of NSCs in the clinical setting of stem cell therapy.
Animals ; Cell Movement/*physiology ; Cerebral Hemorrhage/*pathology ; Corpus Callosum/pathology ; Humans ; Iron/diagnostic use ; Magnetic Resonance Imaging/*methods ; Neurons/*physiology ; Oxides/diagnostic use ; Rats ; Rats, Sprague-Dawley ; Stem Cell Transplantation ; Stem Cells/*physiology ; Time Factors

PURPOSE: We wanted to evaluate the diagnostic benefits and safety of performing CT-guided transthoracic needle biopsy (TTNB) with using an18-gauge automated cutting needle. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 332 patients who underwent CT-guided transthoracic biopsy with an automated 18-gauge cutting needle for 341 thoracic lesions. The histopathologic results, diagnostic accuracy and complication rate were determined. RESULTS: 316 (92.7%) of 34l lesions were histopathologically diagnosed by CT-guided TTNB. The lesions were malignant in 172 patients and benign in 144 patients. The diagnostic accuracy was 92.9%. The sensitivity and specificity for malignant lesions were 93% and 92.3%, respectively. The sensitivity and specificity for benign lesions were 92.3% and 93%, respectively. TTNB induced complications developed for 54 of 341 (15.8%) procedures. The most frequent complication was pneumothorax (41/341, 12%). Nine patients with pneumothorax (9/41, 22%) required chest tube placement. CONCLUSION: CT-guided TTNB with an 18-gauge automated cutting needle could be useful for making the histopathologic diagnosis of malignant and benign pulmonary lesions as the technique provides a big enough tissue sample for histopathologic examination. The procedure-related complication rate was acceptably low.
Biopsy ; Biopsy, Needle* ; Chest Tubes ; Diagnosis ; Humans ; Medical Records ; Needles* ; Pneumothorax ; Retrospective Studies ; Sensitivity and Specificity

PURPOSE: Breast conserving surgery (BCS) followed by chemotherapy (CTx.) and radiation therapy (RT) is widely performed for the treatment of early breast cancer. This retrospective study was undertaken to evaluate our interim results in terms of failure patterns, survival and relative risk factors. MATERIALS AND METHODS: From January 1999 through December 2003, 129 patients diagnosed with invasive breast cancer and treated with BCS followed by RT were subject to retrospective review. The median age of the patients was 45 years (age distribution, 27~76 years). The proportions of patients according to their tumor, nodes, and metastases (TNM) stage were 65 (50.4%) in stage I, 41 (31.7%) in stage IIa, 13 (10.1%) in stage IIb, 9 (7.0%) in stage III, and 1 patient (0.8%) in stage IIIc. For 32 patients (24.8%), axillary node metastasis was found after dissection. BCS consisted of quadrantectomy in 115 patients (89.1%) and lumpectomy in 14 patients (10.6%). Axillary node dissection at axillary level I and II was performed for 120 patients (93%). For 7 patients (5.4%), only sentinel node dissection was performed with BCS. For 2 patients (1.6%) axillary dissection of any type was not performed. Postoperative RT was given with 6 MV X-rays. A tumor dose of 50.4 Gy was delivered to the entire breast area using a tangential field with a wedge compensator. An aditional dose of 9~16 Gy was given to the primary tumor bed areas with electron beams. In 30 patients (23.3%), RT was delivered to the supraclavicular node. Most patients had adjuvant CTx. with 4~6 cycles of CMF (cyclophosphamide, methotrexate, 5-fluorouracil) regimens. The median follow-up period was 50 months (range: 17~93 months). RESULTS: The actuarial 5 year survival rate (5Y-OSR) was 96.9%, and the 5 year disease free survival rate (5Y-DFSR) was 93.7%. Local recurrences were noted in 2 patients (true: 2, regional node: 1) as the first sign of recurrence at a mean time of 29.3 months after surgery. Five patients developed distant metastases as the first sign of recurrence at 6~33 months (mean 21 months). Sites of distant metastatic sites were bone in 3 patients, liver in 1 patient and systemic lesions in 1 patient. Among the patients with distant metastatic sites, two patients died at 17 and 25 months during the follow-up period. According to stage, the 5Y-OSR was 95.5%, 100%, 84.6%, and 100% for stage I, IIa, IIb, and III respectively. The 5Y-DFSR was 96.8%, 92.7%, 76.9%, and 100% for stage I, IIa, IIb, and III respectively. Stage was the only risk factor for local recurrence based on univariate analysis. Ten stage III patients included in this analysis had a primary tumor size of less than 3 cm and had more than 4 axillary lymph node metastases. The 10 stage III patients received not only breast RT but also received posterior axillary boost RT to the supraclavicular node. During the median 53.3 months follow-up period, no any local or distant failure was found. Complications were asymptomatic radiation pneumonitis in 10 patients, symptomatic pneumonitis in 1 patient and lymphedema in 8 patients. CONCLUSION: Although our follow up period is short, we had excellent local control and survival results and reaffirmed that BCS followed by RT and CTx. appears to be an adequate treatment method. These results also provide evidence that distant failure occurrs earlier and more frequent as compared with local failure. Further studies and a longer follow-up period are needed to assess the effectiveness of BCS followed by RT for the patients with less than a 3 cm primary tumor and more than 4 axillary node metastases.
Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Drug Therapy* ; Follow-Up Studies ; Humans ; Liver ; Lymph Nodes ; Lymphedema ; Mastectomy, Segmental* ; Methotrexate ; Neoplasm Metastasis ; Pneumonia ; Radiation Pneumonitis ; Recurrence ; Retrospective Studies ; Risk Factors ; Survival Rate

PURPOSE: We wanted to evaluate the safety and effectiveness of superselective transarterial embolization for the management of gastrointestinal bleeding. MATERIALS AND METHODS: We evaluated 97 of 115 patients who had undergone diagnostic angiography and transarterial embolization for gastrointestinal bleeding from February 2001 to July 2004, and they subsequently underwent superselective transarterial embolization. Their ages ranged from 17 to 88 years (mean age: 58.5 years), and 73 were men and 24 were women. The etiologies were a postoperative condition (n=31), ulcer (n=23), Mallory-Weiss syndrome (n=3), trauma (n=3), pseudoaneurysm from pancreatitis (n=3), diverticula (n=2), inflammatory bowel disease (n=2), tumor (n=2), Behcet's disease (n=2), hemobilia (n=1), and unknown origin (n=25). The regions of bleeding were the esophagus (n=3), stomach and duodenum (n=41), small bowel (n=38) and colon (n=15). All the patients underwent superselective transarterial embolization using microcoils, gelfoam or a combination of microcoils and gelfoam. Technical success was defined as devascularization of targeted vascular lesion or the disappearance of extravasation of the contrast media, as noted on the angiography after embolization. Clinical success was defined as the disappearance of clinical symptoms and the reestablishment of normal cardiovascular hemodynamics after transarterial embolization without any operation or endoscopic management. RESULTS: The technical success rate was 100%. The primary clinical success rate was 67% (65 of 97 patients). Of the 32 primary failures, fourteen patients underwent repeat embolization; of these, clinical success was achieved in all the patients and so the secondary clinical success rate was 81% (79 of 97 patients). Of the 18 patients with primary failures, five patients underwent operation, one patient underwent endoscopic management and the others died during the observation period due to disseminated coagulopathy or complications of their underlying diseases. During the follow up period, six patients of the 79 clinically successful patients died due to disseminated coagulopathy or complications of their underlying diseases, and so the total mortality rate was 19% (18 of 97 patients). Postembolization complications such as bowel ischemia or infarction did not occur during the observation period. CONCLUSION: Superselective transarterial embolization is an effective therapy for treating acute gastrointestinal hemorrhage, and it has a high technical rate and clinical success rate, and a low complication rate.
Aneurysm, False ; Angiography ; Colon ; Contrast Media ; Diverticulum ; Duodenum ; Esophagus ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage ; Gelatin Sponge, Absorbable ; Hemobilia ; Hemodynamics ; Hemorrhage* ; Humans ; Infarction ; Inflammatory Bowel Diseases ; Ischemia ; Male ; Mallory-Weiss Syndrome ; Mortality ; Pancreatitis ; Stomach ; Ulcer

PURPOSE: The aim of this study was to determine a safe gastrointestinal contrast agent that could be used in various clinical situations where there is a risk of aspiration using a rabbit model. MATERIALS AND METHODS: 30 healthy white rabbits were used. The rabbits were divided into 5 groups containing six animals each, one control group (anesthesia only) and 4 groups receiving various contrast agents [Solotop (Barium sulphate suspension), Gastrografin (Sodium and meglumine amidotrizoate), and Telebrix (Meglumine ioxitalamate), Visipaque (Iodixanol)]. The contrast agents were injected selectively into a main bronchus via a catheter inserted under fluoroscopy guidance. The rabbits were sacrificed either 1 day or 7 days after injecting the contrast agents, and the tissue reaction of the bronchi and lungs were examined both macro- and microscopically. The level of alveolar septal thickening, peribronchiolar lymphocytic infiltration, pulmonary congestion and edema, inflammatory exudate in the alveoli or bronchiolar lumina, microabscess formation, necrosis, pigmentation of materials injected, and fibropurulent pleurisy were evaluated and graded according to the severity as follows: no change, mild, moderate, marked in degree. RESULTS: The common microscopic findings were alveolar septal thickening and peribronchiolar lymphocytic infiltration. Pulmonary congestion and edema, inflammatory exudate in the alveoli or bronchiolar lumina were observed in 21 out of 24 rabbits receiving the contrast agents. Pigmentation of the materials injected was observed only in the group receiving Solotop. An inflammatory exudate in the alveoli and bronchiolar/bronchial lumina, microabscess formation, and necrosis were noted in most groups, but was more frequent and severe in the group receiving Gastrografin. CONCLUSION: The histopathological reactions of the rabbit lungs after the intrabronchial application of a contrast agent showed variable degrees of inflammatory reactions. Gastrografin produced most severe and extensive reaction, Solotop and Telebrix a moderate reaction, and Visipaque a minimal reaction. Therefore, a non-ionic dimeric contrast agent such as Visipaque may be the safest contrast agent in the lung when a GI tract examination is performed in clinical situations where there is a risk of aspiration.
Animals ; Bronchi ; Catheters ; Contrast Media* ; Diatrizoate Meglumine ; Edema ; Estrogens, Conjugated (USP) ; Exudates and Transudates ; Fluoroscopy ; Gastrointestinal Tract ; Lung* ; Meglumine ; Necrosis ; Pigmentation ; Pleurisy ; Rabbits

PURPOSE: We wanted to evaluate the potential role of dynamic incremental computed tomography (CT) for making the diagnosis of malignant solitary pulmonary nodule (SPN) by investigating the dynamic enhancement patterns. MATERIALS AND METHODS: Forty patients with presumed malignant SPN (diameter < 30 mm) were selected for dynamic incremental chest CT scanning. Histopathologic diagnoses of the malignant SPNs were obtained by surgical excision (n=8) and transthoracic needle biopsy (n=32), and they were squamous cell carcinoma (n=16), adenocarcinoma (n=14), small cell carcinoma (n=5), bronchioloalveolar carcinoma (n=3), and large cell carcinoma (n=2). CT scans were performed at the region of interest (ROI) of the lung nodule before and after contrast enhancement. The dynamic incremental CT scans after contrast enhancement were performed at 15 seconds, 30 seconds, 45 seconds, 60 seconds, 90 seconds, 2 minutes, 3 minutes and 4 minutes. The degree of contrast enhancement according to the time course and the time of maximum enhancement of the malignant nodules were recorded by measuring the Hounsfield Unit (HU) of the nodules at the ROI. We assessed the differences of the contrast enhancement patterns among the histopathologic subtypes of malignant SPN. RESULTS: In malignant SPN, the average time of maximum contrast enhancement was 62.2+/-16.2 seconds, and the average degree of maximum contrast enhancement was 66.4+/-22.17 HU. Most primary lung cancer showed rapid contrast enhancement with slow washout. The differences of the enhancement patterns among the histopathologic subtypes were not statistically significant (p > 0.05). CONCLUSION: Dynamic incremental chest CT was useful for making the diagnosis of malignant SPN that showed an established dynamic contrast enhancement pattern regardless of the histopatholgic subtypes.
Adenocarcinoma ; Adenocarcinoma, Bronchiolo-Alveolar ; Biopsy, Needle ; Carcinoma, Large Cell ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Humans ; Lung ; Lung Neoplasms ; Solitary Pulmonary Nodule* ; Tomography, X-Ray Computed

PURPOSE: The author compared three-dimensional computed tomographic angiography with combined volume rendering technique (3D-CTA VR) with three-dimensional digital subtraction angiography (3D-DSA) in the detection and characterization of intracranial aneurysms, in order to assess the diagnostic capability of 3D-CTA VR. MATERIALS AND METHODS: This study included 50 patients with suspected intracranial aneurysm who underwent both 3D-CTA VR and 3D-DSA, and who were subsequently confirmed as having aneurysms by intracranial operation or other neurointerventional procedures. The detectability and the characteristics of the aneurysms, such as their aneurysmal neck, direction, and vasospasm of the adjacent vessels, were evaluated retrospectively. RESULTS: Sixty-five intracranial aneurysms were detected through surgery or other interventional procedures. 3D-DSA was more sensitive (96.92%) than 3D-CTA VR in the detection of the aneurysms. All of the aneurysms that were more than 3mm in size were detected with both techniques. 3D-DSA failed to reveal one posterior communicating artery aneurysm, while 3D-CTA VR missed three aneurysms. The aneurysmal necks were clearly visualized in 58 of 61 aneurysms (95.1%) on 3D-CTA VR, but all of the aneurysmal necks(100%) were clearly identified on 3D-DSA. CONCLUSION: 3D-CTA combined with VR technique showed good sensitivity for the depiction of intracranial aneurysms greater than 3 mm in size, and its usefulness in characterizing the aneurysms for surgical or endovascular treatment planning was equal to or less than that of 3D-DSA.
Aneurysm ; Angiography* ; Angiography, Digital Subtraction* ; Humans ; Intracranial Aneurysm* ; Neck ; Retrospective Studies

PURPOSE: To determine the usefulness of three-dimensional CT angiography using multidetector-row CT (MDCT) for delineating the arterial anatomy of the liver. MATERIALS AND METHODS: Hepatic arterial three-dimensional CT angiography was performed using MDCT (Lightspeed Qx/I; GE Medical Systems, Milwaukee, Wis., U.S.A.) in 45 patients with HCC undergoing conventional angiography for transcatheter hepatic arterial chemoembolization. The scanning parameters during the early arterial phase were 2.5 mm slice thickness, 7.5 mm rotation of table speed, and a pitch of 3. Images were obtained by one radiologist using maximum intensity projection from axial CT images obtained during the early arterial phase. Two radiologists blinded to the findings of conventional angiography independently evaluated the hepatic arterial anatomy and the quality of the images obtained. RESULTS: Compared with conventional angiography, reader A correctly evaluated the hepatic arterial anatomy depicted at three-dimensional CT angiography. Reader B's evaluation was correct in 40 of 45 patients. Interobserver agreement was good (kappa value, 0.73), and both readers assessed the quality of three-dimensional CT angiography as excellent. CONCLUSION: Three-dimensional CT angiography using MDCT was accurate for delineating the arterial anatomy of the liver, and interobserver agreement was good. The modality may provide, prior to conventional angiography, valuable information regarding a patient's hepatic arterial anatomy.
Angiography* ; Hepatic Artery* ; Humans ; Liver

PURPOSE: To investigate the efficacy of Gelfoam single use for the management of hemoptysis by analyzing patients with recurrence in embolized artery and other artery, respectively. MATERIALS AND METHODS: Between 1992 and 2000, 131 patients (104 men and 27 women, mean age: 54.4 years) with hemoptysis underwent BAE using gelatin sponge only. After puncturing the femoral artery using the Seldinger method, angiographies of the thoracic aorta, the bronchial arteries, the intercostal arteries, and the systemic collaterals which were suspected of bleeding focus and embolization were performed. Gelfoam was used 1x3 mm and 2x3 mm or 2x5 mm by the diameter of feeding arteries. The cumulative hemoptysis control rate and recurrence rate were analyzed from the previously embolized vessels. RESULTS: Hemoptysis were recurred among 34 of 131 patients. Twenty-two patients had a recurrence from the same vessels and 12 from the different ones. Using the Kaplan-Meier method, the cumulative hemoptysis control rate was obtained in the patients with a recurrence from the same vessels: 88.8% in 1 month, 79.9% in 1 year, and 77.3% in 2 year. The reasons for recurrences of the same lesions are as follows; due to the tortuosity of the vessel (n=3); partial embolization through the common trunk formation between bronchial and anterior spinal artery (n=3); by vessel spasms or autogenous thrombus (n=2); due to the contrast media hypersensitivity (n=1). These 9 patients were not treated successfully. In the remaining 13 cases, hemoptysis were recurred due to recanalization of embolized vessels. Among 161 procedure, complications consisted of fever (n=8), dyspnea (n=8), mild chest discomfort (n=7), lower back pain (n=1), and transient lower leg paralysis (n=1), which were improved within several days. There was no serious complication in this study. CONCLUSION: Bronchial artery embolization using Gelfoam alone maybe effective and safe to control hemoptysis.
Angiography ; Aorta, Thoracic ; Arteries* ; Bronchial Arteries* ; Contrast Media ; Dyspnea ; Female ; Femoral Artery ; Fever ; Gelatin ; Gelatin Sponge, Absorbable* ; Hemoptysis* ; Hemorrhage ; Humans ; Hypersensitivity ; Leg ; Low Back Pain ; Male ; Paralysis ; Porifera ; Recurrence ; Spasm ; Thorax ; Thrombosis