PURPOSE: To evaluate the efficacy and clinical results of percutaneous insertion of inferior vena cava(IVC) filter. MATERIALS AND METHODS: Over a two year period, eight IVC filters were placed in eight patients with pulmonary thromboembolism resulting from deep vein thrombosis of the legs. The indications for placement were contraindication to anticoagulation(3), and recurrent pulmonary embolism during anticoagulant therapy(5). Both femoral(7) and jugular(1) routes were used for percutaneous transvenous insertion. To delineate the caval anatomy and to ensure placement just caudal to the renal vein, a cavogram was obtained before filter placement. Bird's Nest (7) and Greenfield (1) filters were inserted. Follow-up information was obtained by means of duplex sonography, CT scan, abdominal radiograph, and perfusion scan of the lungs, followed by clinical evaluation. RESULTS: In all cases, procedures were technically successful. Placement complications occurred in three patients. In one, the filter was inadvertently placed above the iliac bifurcation; in the other two, prolapse of the Bird's Nest filter wire occurred. Occlusion of IVC occurred in two patients, and recurrent pulmonary embolism was suspected in one, who suffered from chest pain and shortness of breath. In the other patients, there was no clinical evidence of recurrence of the pulmonary embolism. CONCLUSION: Insertion of an inferior vena cava filteris a safe and effective method for the prevention of pulmonary embolism when anticoagulant therapy is either ineffective or contraindicated.
Chest Pain ; Dyspnea ; Follow-Up Studies ; Humans ; Leg ; Lung ; Perfusion ; Prolapse ; Pulmonary Embolism ; Recurrence ; Renal Veins ; Tomography, X-Ray Computed ; Vena Cava Filters* ; Vena Cava, Inferior* ; Venous Thrombosis

PURPOSE: To evaluate long-term survival rates and prognostic factors of patients with hepatocellularcarcinoma after TAE. MATERIALS AND METHODS: 225 patients with hepatocellular carcinoma treated with TAE between January 1988 and December 1994 were studied. Hepatocellular carcinoma was diagnosed either histologically(n=13) orclinically on the basis of findings characteristic for hepatocellular carcinoma obtained using such as diagnostic imaging methods such as ultrasonography, CT, MRI, and angiography as well as on the basis of high serumalpha-fetoprotein level(n=212). TAE was carried out between one and six times(mean, 1.4 time) using a mixture of lipiodol and Adriamycin, together with Gelfoam. Cumulative survival rates from the day of the first TAE were obtained by the Kaplan-Meier method. Parameters likely to influence the prognosis were subjected to univariate analysis using the log-rank test RESULTS: Cumulative survival rates at the end of the first, second, third, fourth, and fifth year were 55.9%, 32.6%, 21.9%, 17.9%, and 15.0%, respectively. The mean survival time was 727+/-76 days. Several factors, including Child-Pugh classification, Okuda's stage, tumor size, presence of portalvein invasion by tumor, of arterio-portal shunt, and of extra hepatic metastases, catheter selection level, and number of TAE showed significant correlation with the outcome. Degrees of Lipiodol accumulation in a tumor onfollow up CT were also correlated with survival rates. CONCLUSION: TAE is an effective measure for prolonging the patient's life expectancy and evaluation of prognostic factor is helpful for prognosis and in deciding on the optimal therapeutic modality.
Angiography ; Carcinoma, Hepatocellular* ; Catheters ; Classification ; Doxorubicin ; Ethiodized Oil ; Fibrinogen ; Gelatin Sponge, Absorbable ; Humans ; Life Expectancy ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Prognosis ; Survival Rate ; Ultrasonography

The gallbladder (GB) is a rare site of renal cell carcinoma (RCC) metastasis. To the best of our knowledge, only a few reports of CT findings of GB metastasis exist in the literature. Herein, we report a case of histologically proven GB metastasis of RCC in a 55-year-old male who underwent CT for an intraluminal polypoid mass simulating a primary GB lesion.

The gallbladder (GB) is a rare site of renal cell carcinoma (RCC) metastasis. To the best of our knowledge, only a few reports of CT findings of GB metastasis exist in the literature. Herein, we report a case of histologically proven GB metastasis of RCC in a 55-year-old male who underwent CT for an intraluminal polypoid mass simulating a primary GB lesion.

PURPOSE: Pancreaticoduodenectomy for mass-like lesions that are suspicious of malignancy sometimes reveals only nonneoplastic disease, especially in those cases where adequate tissues for biopsy are unavailable. In this study, we evaluated the outcomes and quality of life (QOL) after pancreaticoduodenectomy for treating nonneoplastic disease. METHODS: The clinical data of 28 patients who underwent pancreaticoduodenectomy for nonneoplatic disease and trauma from Jan. 1992 to Feb. 2006 were reviewed retrospectively. The QOL was evaluated using the FACT-Hep questionnaire. The patients who underwent laparoscopic cholecystectomy for benign gallbladder disease were utilized as the control group. RESULTS: 13.8% (28/203) of all the pancreaticoduodenectomized patients had nonneoplatic disease and trauma. Male patients were predominant (25/28) and all the trauma patients were male. The mean age was 48 (23~72) years old. The indications for surgery included lesions suspicious for malignancy (16 cases), pancreaticoduodenal artery aneurysm (1 case), and pancreatoduodenal injury (11 cases). The histologic findings of the nonneoplastic lesions revealed benign inflammation of the bile duct (6 cases), chronic pancreatitis (8 cases), pancreatic pseudocyst (1 case), and fibrosis of the Ampulla of Vater (1 case). No surgical mortality occurred. However, the trauma patients group had higher morbidity (72.7% Vs 23.5%, respectively, P=0.01) and a longer hospital stay (68.0 days Vs 32.6 days, respectively, P=0.02) after surgery compared to the nonneoplastic disease patient group. The QOL of the patient who underwent pancreaticoduodenectomy for nonneoplatic disease was not different from that of the control group. CONCLUSION: Since pancreaticoduodenectomy for nonneoplastic disease was safe and the QOL of the patients was acceptable, it should be performed more often when malignancies can not be excluded from the differential diagnosis.
Ampulla of Vater ; Aneurysm ; Arteries ; Bile Ducts ; Biopsy ; Cholecystectomy, Laparoscopic ; Diagnosis, Differential ; Fibrosis ; Gallbladder Diseases ; Humans ; Inflammation ; Length of Stay ; Male ; Mortality ; Pancreatic Pseudocyst ; Pancreaticoduodenectomy* ; Pancreatitis, Chronic ; Quality of Life* ; Surveys and Questionnaires ; Retrospective Studies

PURPOSE: To assess the usefulness of digital subtraction contrast-enhanced multi-phase magnetic resonance angiography (MRA) for evaluation of the vessels of the gastrointestinal system. MATERIALS AND METHODS: Twenty-five patients who underwent abdominal MRA for evaluation of the vessels of the gastrointestinal system were included in this study. MRA was performed using a 1.5-T scanner and the 3-D turbo-FLASH sequence. Subtraction images of the arterial and portal venous phases were obtained by subtracting arterial phase images from mask images and portal venous phase images from arterial phase images, respectively. Each set of images was processed using a maximum-intensity projection (MIP) algorithm to produce three-dimensional angiograms. We compared overall image quality and the visibility of normal and abnormal vessels between subtraction and non-subtraction MRA. RESULTS: In terms of subjective image quality, subtraction and non-subtraction MRA was similar both the arterial and portal venous phases (p>0.05). During the arterial phase, subtraction MRA visualized more peripheral branches of the left gastric and superior mesenteric arteries than non-subtraction MRA (p<0.05), and during the portal venous phase, subtraction MRA demonstrated more peripheral branches of the superior mesenteric (p<0.01), splenic (p<0.05) and left portal vein (p<0.05) than non-subtraction MRA. In addition, overall visibility of the arterial and portal venous branches was superior with subtraction MRAs than with non-subtraction MRA. Both of these detected all anomalous arterial branching (n=5) and abnormal (encased or obstructed) portal veins (n=5). Subtraction MRA visualized 17 portal venous collaterals in six patients, whereas non-subtraction MRA visualized only seven collateral veins. CONCLUSION: In contrast-enhanced abdominal MRA, the digital subtraction technique permits visualization of more distal branches of the vessels of both the arterial and portal venous systems without significant degradation of image quality. The technique is particularly useful for the detection of portal venous collaterals in patients with portal hypertension.
Angiography* ; Angiography, Digital Subtraction ; Humans ; Hypertension, Portal ; Magnetic Resonance Angiography ; Masks ; Mesenteric Artery, Superior ; Portal Vein ; Subtraction Technique* ; Veins

PURPOSE: To evaluate the feasibility and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in patients with active variceal bleeding due to liver cirrhosis and pre-existing portal vein thrombosis. MATERIALS AND METHODS: Of a total of 123 patients who underwent TIPS, 14 patients with intractable variceal bleeding due to portal hypertension and portal vein thrombosis were included in this study. Noncavernomatous portal vein occlusion was seen in eight patients, and complete portal vein occlusion with cavernomatous transformation in six. For all patients, the methods used for TIPS placement were the same as those used in patients with patent portal veins. In seven of eight patients with noncavernomatous occlusion, right hepatic vein-right portal vein shunting was performed; in one with noncavernomatous occlusion, a shunt was created between the right hepatic and left portal vein. In five of six patients with cavernomatous occlusion, the right hepatic and main portal vein were connected via a collateral vein. RESULTS: The procedures were technically successful in all except one patient. Immediate hemostasis was achieved after all technically successful procedures, and no significant complications were encountered. Minor complications were noted in six patients (three biliary tree punctures, one transperitoneal puncture, one splenic vein perforation, one hepatic subcapsular hematoma). CONCLUSION: TIPS is a technically feasible and hemodynamically effective procedure, even in patients with active variceal bleeding due to cirrhosis and complete portal vein occlusion.
Biliary Tract ; Esophageal and Gastric Varices* ; Fibrosis ; Hemostasis ; Humans ; Hypertension, Portal* ; Liver Cirrhosis ; Portal Vein* ; Portasystemic Shunt, Surgical* ; Punctures ; Splenic Vein ; Veins ; Venous Thrombosis*

PURPOSE: To evaluate the MRI appearance of Kienbock's disease and correlate this with radiographic findings. MATERIALS AND METHODS: Thirteen clinically confirmed cases of 12 patients with kienbock's disease wereretrospectively reviewed. The significance of signal intensity and pattern of Kienbock's disease on MR images was evaluated and the findings on MR images were compared with radiographic stages classified by Lichtman. Enhanced MR images were abtained in four cases. RESULTS: Lichtman's stage I accounted for one case; stage II, two; stage III, eight; stage IV, two. On T1-weighted MR images, the lunate showed focal low signal intensity in the stage I caseand in one of the two stage II case. Eleven wrists demonstrated a generalized loss of lunate signal. On T2-weighted images, the stage I case showed focal high signal intensity. In stage II, one showed focal low signal intensity and the other exhibited generalized low signal intensity with a high spot area. In stage III, five ofeight cases showed generalized low signal intensity, and one demonstrated high signal intensity. Two showed a high spot area within the generalized low signal intensity. In stage IV, one showed generalized low signal intensity and the other exhibited high signal intensity. No enhancement was seen in the three lesions with focal orgeneralized low signal intensity both on T1 and T2-weighted images. Conversely, one lesion with low signalintensity on T1-weighted imaes and high signal intensity on T2-weighted images showed contrast enhancement. CONCLUSION: Low signal intensity of the lunate on T1-weighted images is a consistent findings of Kienbock's disease. However, further studies such as follow-up MRIs, or pathologic correlation studies and MR contrast enhancement studies will be necessary to evaluate the sighificance of high signal intensity on T2-weighted images.
Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Osteonecrosis* ; Statistics as Topic ; Wrist

PURPOSE: To correlate MR findings of amount of temporomandibular joint effusion with joint pain and disk displacement. MATERIALS AND METHODS: In 57 patients, 114 temporomandibular joints with symptoms of disorder(presence of clinical pain) were imaged. Closed and open mouth sagittal spin echo (SE) T1-weighted images (WI) and fast spin echo (FSE) T2-WI were obtained. We classified the amount of joint effusion into grades. Joint effusion was classified as either Grade I, II or III, as follours : in sagittal FSE T2-WI, a long diameter of joint effusion shorter than 1/3 of the diameter of the convex margin of temporal eminence was grade I; longer than 2/3 was grade III; between grade I and III was grade II. Disk displacement was classified as either with or without reduction in the open mouth position. These findings were correlated with one another and statistically analyzed. RESULTS: In 29 cases with joint pain (37%) and in 34 cases without pain (63%) there was no evidence of joint effusion; there were, however, more grade I joint effusion cases with pain (14 ; 60.9%) than without pain (9 : 39.1%). Cases of joint pain increased in proportion to grade of joint effusion, which was statistically significant (p<0.05). In joints without disk displacement, the largest grouping was that which showed no effusion (39 ; 72.2%) ; no joints showed grade III effusion. Cases of joint effusion decreased in proportion to grade of effusion. In joints with disk displacement, cases of joint effusion tended to increase in proportion to the grade of effusion. CONCLUSION: MR findings of amount of temporomandibular joint effusion correlate with joint pain and anterior disk displacement.
Arthralgia ; Humans ; Joints* ; Magnetic Resonance Imaging* ; Mouth ; Temporomandibular Joint

PURPOSE: To determine the possible mechanism by which an area of high signal intensity appears on T1-weighted MR images adjacent to a vacuum cleft in intervertebral disks. MATERIALS AND METHODS: We analyzed a total of 14 disks in nine patients in whom a vacuum cleft with T1-signal hyperintensity was observed. Lesions were present from T11-12 to L5-S1 using a 1.5-T whole-body imager, sagittal spine-echo T1-weighted and gradient-echo images (flip angle, 20 'and 60 ) were obtained. In order to identify the vacuum cleft, using plain radiographs in all patients and CT scans in two were also obtained. A 3% agar-gel block containing empty slits to form a magnetic susceptibility difference, a phantom was designed. The air spaces were 1.6 mm in thickness, 25 mm in width, and 20 to 25 mm in depth with 1.6-mm spacing. RESULTS: In all patients, vacuum clefts were confirmed by plain radiographs and CT scans. At the level containing air, T1-weighted images (both spin-echo and gradient-echo) showed a signal void resulting from the intervertebral disk vacuum cleft. A hyperintense band adjacent to the vacuum cleft was, however, observed. A gradient-echo image with a 60 'flip angle showed a brighter signal intensity than one with a 20 'angle. Our phantom study gave the same results. CONCLUSION: The magnetic susceptibility artifact may be responsible for the T1-signal hyperintensity observed adjacent to the vacuum cleft in intervertebral disks. In addition, in order to generate signal hyperintensity, the desiccating disk material must contain a certain amount of water molecules.
Artifacts ; Humans ; Intervertebral Disc* ; Tomography, X-Ray Computed ; Vacuum*