PURPOSE: We investigated the ultrasonographic (US) appearance of metaplastic squamous breast carcinoma with the pathologic correlation. MATERIALS AND METHODS: During an 8-year period, the US appearances of 10 patients with metaplastic squamous breast carcinoma were retrospectively analyzed on the basis of the Breast Imaging and Reporting Data System (BI-RADS) - US lexicon. These 10 patients included 9 patients having invasive adenocarcinomas of the breast with more than 30% squamous metaplasia, and one patient had pure primary squamous cell carcinoma. We correlated the US findings with the pathologic findings. RESULTS: On US, the majority of the tumors showed oval shapes (70%), indistinct margins (50%), parallel orientation (80%), echogenic halos (60%), complex echogenicity with solid and cystic components (60%), and posterior enhancement (70%). The findings of calcifications (20%) and metastatic axillary lymph nodes (10%) were rare. On pathologic examination, half of the tumors showed infiltrative microscopic margins. All six cases showing complex echogenicity with solid and cystic components on US were pathologically related to the cystic or necrotic portion, and three of these cases had hemorrhage. CONCLUSION:On US, metaplastic squamous breast carcinoma mainly manifested as oval, complex, echoic masses with indistinct margins and posterior enhancement that was pathologically related to the cystic or necrotic portions.
Adenocarcinoma ; Breast Neoplasms* ; Breast* ; Carcinoma, Squamous Cell ; Hemorrhage ; Humans ; Information Systems ; Lymph Nodes ; Metaplasia ; Retrospective Studies

PURPOSE: To identify the characteristic ultrasonographic findings of the normal appendix in children in order to detect it more easily and so to exclude acute appendicitis from a diagnosis with more confidence. MATERIALS AND METHODS: Among 64 patients presenting with right lower quadrant pain, 44 patients, excluding 15 patients diagnosed as acute appendicitis and 5 patients with non-visualization of the appendix due to severe ileus and obesity, were evaluated for the point of incidence, the thickness and the presence of folding of the inner hypoechoic band of the normal appendix. The age of the patients ranged from 3 to 15 years with a mean age of 6.5 years. Two patients were operated on and we correlated the preoperative ultrasonographic findings with the histologic findings. RESULTS: In all the cases of the 44 patients with normal appendix, the inner hypoechoic band was discovered, which was seen as a linear structure without folding along the whole length of appendix. This measured as 0.75 mm (0.3-1.5 mm) for the mean thickness. The inner hypoechoic band corresponded to the mucosal layer that had abundant lymphoid tissue on the histologic examination. CONCLUSION:For the pediatric normal appendix, the inner hypoechoic band without folding is present, and this corresponds to the mucosal layer with abundant lymphoid tissue.
Appendicitis ; Appendix* ; Child* ; Diagnosis ; Humans ; Ileus ; Incidence ; Lymphoid Tissue ; Obesity ; Ultrasonography*

PURPOSE: We wished to assess the merits and weaknesses of postcontrast fat-suppression (FS) brain MR imaging in children for the evaluation of various enhancing lesions as compared with postcontrast conventional T1-weighted or magnetization transfer (MT) imaging. MATERIALS AND METHODS: We reviewed the records of those patients with enhancing lesions on brain MR imaging who had undergone both FS imaging and one of the conventional T1-weighted or MT imaging as a postcontrast T1-weighted brain MR imaging. Thirty-one patients (21 male, 10 female; mean age, 8.7 years) with 38 enhancing lesions (18 intra-axial, 16 extra-axial and 4 orbital locations) were included in this study. There were 27 pairs of FS and conventional imagings, and 13 pairs of FS and MT imagings available for evaluation. Two radiologists visually assessed by consensus the lesions' conspicuity, and they also looked for the presence of flow or susceptibility artifacts in a total of 40 pairs of MR imagings. For 19 measurable lesions (14 pairs of FS and conventional T1-weighted imagings, 5 pairs of FS and MT imagings), the contrast ratios between the lesion and the normal brain ([SIlesion-SIwater]/[SInormal brain-SIwater]) were calculated and compared. RESULTS: Compared with conventional imaging, the lesion conspicuity on FS imaging was better in 10 cases (7 extra-axial lesions, 2 orbital lesions and 1 fat-containing intra-axial lesion), equal in 16 cases, and worse in one case. Compared with MT imaging, the lesion conspicuity on FS imaging was better in 3 cases (2 extra-axial lesions and 1 intra-axial lesion), equal in 8 cases, and worse in 2 cases. Image quality of FS imaging was compromised by flow or susceptibility artifacts for 7 patients. The contrast ratios for FS imaging were not significantly different from those for conventional imaging (2.2+/-0.7 vs. 2.2+/-0.6, respectively, p=0.914) and they were significantly lower than those for MT imaging (2.4+/-0.8 vs. 4.5+/-1.5, respectively, p=0.018). CONCLUSION:Postcontrast FS brain MR imaging appears to be better than the conventional T1-weighted imaging and comparable to MT imaging for the visual assessment of enhancing lesions. Especially, the FS imaging has the merit to delineate orbital and extra-axial enhancing lesions or fat-containing lesions, whereas it is disadvantageous when flow or susceptibility artifacts occur.
Artifacts ; Brain* ; Child ; Consensus ; Female ; Humans ; Magnetic Resonance Imaging* ; Male ; Orbit

PURPOSE: To develop a VX-II carcinoma model in the rabbit uterus and to describe the MR imaging findings of an experimentally induced VX-II uterine carcinoma along with the histopathologic findings. MATERIALS AND METHODS: 13 New Zealand rabbits were included in this study. Two pieces of tissue suspension (1 mm3x2) of VX-II carcinoma were loaded in an 18 gauge disposable needle and the tissue embedded in the wall of each horn of the rabbits' uterus. We obtained the MR images at 2 weeks in group A (n=5), or at 2 and 4 weeks in group B (n=8). T2-weighted images were obtained using an extremity coil. On MR imaging, we measured the signal intensity of the tumor and the uterine wall. We also measured the size and shape of the tumor and we compared this with the histopathologic results. RESULTS: On MR images obtained 2 weeks after inoculation, all the rabbit uteruses (group A and B, n=13) show a thick tubular wall, and the uteruses demonstrated a high signal intensity on T2-weighted images. The thickened uterine walls were measured as 3-10 mm (mean: 6.5 mm). Peritoneal nodules were observed in 3/13 rabbits (23%), the nodules measured 1.5-1.8x3.0 cm; uterine masses were observed in 3/13 rabbits (23%), and they measured 0.6-1.5x1.3-1.5 cm. On MR images obtained 4 weeks after the inoculations (group B, n=8), rabbit uteruses that had VX-II carcinoma show thick tubular wall in all cases (n=8, 100%) and round uterine masses (n=6, 75%). The thickened uterine walls measured 5-14 mm (mean 7.6 mm) and uterine masses measured 1.3-3.0x1.5-6.0 cm. All the rabbit uteruses having VX-II carcinoma showed high signal-to-noise ratios along the thickened uterine walls or masses on T2WI. On the histopathologic exam after sacrificing the rabbit, a few viable tumor cells were found because of necrosis in the inner portion of the uterine tumors, and abundant viable tumor cells were found at the periphery of the uterine tumors. CONCLUSION:We can develop an animal model with uterine tumor in rabbit uterus using VX-II carcinoma. Experimentally induced VX-II carcinomas in rabbit uterus demonstrated central necrosis, and MR imagings of experimentally induced uterine VX-II carcinomas were well correlated with the histopathology.
Animals ; Extremities ; Horns ; Magnetic Resonance Imaging* ; Models, Animal ; Necrosis ; Needles ; Rabbits ; Signal-To-Noise Ratio ; Uterus*

PURPOSE: The purpose of this study was to determine, using in vivo and in vitro 1H MRS (MR spectroscopy), the characteristic biochemical metabolites related with breast cancer, and to assess the clinical usefulness and limitations of this modality. MATERIALS AND METHODS: For in vivo 1H MRS, nine patients with breast cancer and two normal volunteers were examined on a 1.5 T MR imager equipped with facilities for spectroscopy. In order to localize the breast lesion, axial and sagittal T1-weighted images and fat-suppressed T2-weighted images were obtained just prior to MRS; MR spectra were acquired at TR=3000 msec and TE=144 msec. For in vitro 1H MRS, breast tumor and adja-cent normal tissue were extracted from 13 patients with breast cancer, and in two of these, both in vivo and in vitro 1H MRS were performed. All in vitro 1H MRS specimens were immediately immersed in liquid nitrogen, and then in a preparation of perchloric acid. For quantitative analysis of the MR spectra of cancerous and normal breast tissue, the paired t-test was used (p < 0.05). RESULTS: At1H MRS in vivo, choline and two lipids were identified at 3.21 ppm, and 1.33 ppm and 0.9 ppm, re-spectively. The distinction between cancerous and normal breast tissue was based on the higher level of choline (3.21 ppm) present in the former. At 1H MRS in vitro, on the other hand, mean and standard deviation (% standard deviation) for the various metabolites in cancerous and normal breast tissue were as follows: choline, 30.195 +/- 2.448(8.108) and 22.648 +/- 1.938(8.556); trimethylamine, 3.425 +/- 0.335(9.769) and 0.640 +/- 0.066(10.325); sarcosine, 3.425 +/- 0.335(9.769) and 0.640 +/- 0.099(15.394); lactate, 16.388 +/- 1.134(6.922) and 9.715 +/- 0.385(3.965); inositol, 1.970 +/- 0.282(14.334) and 3.859 +/- 0.502(13.020); and taurine, 6.614 +/- 0.556(8.412) and 10.748 +/- 1.206(11.222). High levels of choline (p=0.026), trimethylamine (p=0.001), sarco-sine (p=0.009), and lactate (p=0.009), and lower levels of inositol (p=0.006) and taurine (p=0.008) were char-acteristic findings in cancerous as compared with normal breast tissue, with significantly different results. CONCLUSION: 1H MRS both in vitro and in vivo showed that increased choline levels were present in cancerous breast tissue, but that normal tissue does not contain choline. The presence of choline could therefore be used as a marker for malignancy in breast lesions. Information provided by in vitro 1H MRS, together with the development of in vivo 1H MRS with high field strength and high resolution, may be very useful for the diagnosis of breast cancer.
Breast Neoplasms* ; Breast* ; Choline ; Diagnosis ; Hand ; Healthy Volunteers ; Humans* ; Inositol ; Lactic Acid ; Magnetic Resonance Spectroscopy* ; Nitrogen ; Sarcosine ; Spectrum Analysis ; Taurine

During childhood, meningioma is an uncommon tumor, and in infants, extracranial meningioma is very rare. We report a case of primary cutaneous menigioma occurring on the scalp of a ten-month-old girl.
Female ; Humans ; Infant* ; Meningioma* ; Scalp*

PURPOSE: The purpose of this study was to evaluate the CT findings of acute pyelonephritis (APN) in children and to assess the correlation between these findings, clinical parameters and renal scar development, as seen on follow-up CT scans. MATERIALS AND METHODS: Contrast-enhanced CT scans of thirty children in whom APN had been diagnosed were assigned to one of three groups according to whether an abscess had formed, and then to subgroups on the basis of the number of lesions in the renal parenchyme. Initial CT findings were retrospectively correlated with five clinical parameters (maximal body temperature, fever duration, leukocytosis, pyuria and admission period) and renal scar development, as seen on follow-up CT (n=12). RESULTS: CT scans demonstrated linear, wedge-shaped, low-density renal parenchymal lesions in 35 kidneys of 25 patients and abscesses in seven kidneys of seven patients, but no abnormal lesions in five patients. In the three groups there was correlation between these findings and some clinical parameters (maximal body temperature, fever duration and admission period), but no subgroup showed significant correlation with any clini-cal parameter. Renal cortical scars detected by follow-up CT were more prevalent in patients in whom initial CT demonstrated the presence of an abscess. CONCLUSION: Clinical parameters correlated with the presence of renal parenchymal hypoenhancing lesions and abscess formation, as seen on CT scans, rather than the number of renal parenchymal lesions. Renal cortical scars were more prevalent in patients in whom initial CT revealed the presence of an abscess. Enhanced CT is thought to be useful both for diagnosing APN and for predicting its clinical course in children.
Abscess ; Body Temperature ; Child ; Cicatrix ; Fever ; Follow-Up Studies ; Humans ; Kidney ; Leukocytosis ; Pyelonephritis* ; Pyuria ; Retrospective Studies ; Tomography, X-Ray Computed

PURPOSE: To find out the characteristic MR findings of reversible posterior leukoen-cephalopathy syndrome (RPLS) due to various causes in children. MATERIALS AND METHODS: Eight children with RPLS underwent MR imaging, and the findings were retrospectively analyzed. All eight were acutely hypertensive at the time of a neurotoxic episode. Three had intra-abdominal tumors (one adrenal pheochromo-cytoma, one para-aortic paraganglioma and one para-aortic ganglioneuroma encasing the left renal artery); three were being treated with cyclosporine; one was being treat-ed with steroid; and one had hemolytic uremic syndrome. Initial cranial MR images were analyzed with particular emphasis on the distribution of the lesions. To assess possible sequelae, follow-up MR images were obtained in seven patients at least one week after the treatment of hypertension. Four underwent proton MR spectroscopy. RESULTS: Characteristic distribution of lesions in the occipital and posterior parietal lobes was identified in all cases regardless of the causes of RPLS. The cerebellum, basal ganglia, anterior parietal, and frontal lobe were involved in four, two, one, and one case, respectively. Cortical gray matter involvement was predominant in six and subcortical white matter involvement predominated in two patients. The distribution of lesions was bilateral and asymmetric. Gyriform enhancement was identified in six cases, and small hemorrhage was noted in one. In seven patients, the clinical and MR findings improved without sequelae on follow-up study. In one, proton MR spectroscopy demonstrated a high lactate peak at the time of the neurologic event. Nearnormal spectra were noted in three children who underwent proton MR spectroscopy after recovery. CONCLUSION: The MR findings of RPLS are characteristic in that lesions are distributed in the posterior region of the brain and they are reversible on follow-up study. In children with RPLS due to unknown causes, the possibility of intra-abdominal tumors should also be considered.
Basal Ganglia ; Brain ; Cerebellum ; Child* ; Cyclosporine ; Follow-Up Studies ; Frontal Lobe ; Ganglioneuroma ; Hemolytic-Uremic Syndrome ; Hemorrhage ; Humans ; Hypertension ; Lactic Acid ; Magnetic Resonance Imaging* ; Magnetic Resonance Spectroscopy ; Paraganglioma ; Parietal Lobe ; Posterior Leukoencephalopathy Syndrome* ; Protons ; Rabeprazole ; Retrospective Studies

PURPOSE: The purposes of this study were to compare postmortem fetal MRI findings with autopsy findings and to assess whether postmortem MRI can replace autopsy. MATERIALS AND METHODS: The study group consisted of 13 stillborn fetuses, seven that died immediately after birth, and five terminated because of anomalies seen on prenatal sonograms. A total 17 were male, and eight were female, and their gestational ages were from 20 to 41 (average; 28.2) weeks. Spin-echo T1-and T2-weight-ed axial, sagittal, and coronal MR images were obtained, and autopsy findings were divided into major and mi-nor. A major finding was defined as an anomaly or syndrome which caused fetal death or termination of the pregnancy; minor findings were classified, on the basis of gross inspection, as internal or external. MR images were retrospectively analyzed by two radiologists unaware of the autopsy findings, and by comparison with these, the postmortem MRI detection rates for major and minor findings was then determined. RESULTS: In seven of 25 fetuses, MR imaging revealed major findings, a detection rate of 100%. There were two cases of anencephaly, two of trisomy-18, and one each of hydrops fetalis with large cystic hygroma, diaphrag-matic hernia, and Dandy-Walker malformation. Twenty-three of 60 minor findings (38.3%) were detected by MRI. The detection rates for external and internal findings were 29.6%(8/27) and 45.5%(15/33), respectively. CONCLUSION: Although a limitation of our study is the low detection rate for minor findings, postmortem fetal MRI may help diagnose the major cause of fetal death.
Anencephaly ; Autopsy* ; Dandy-Walker Syndrome ; Female ; Fetal Death ; Fetus ; Gestational Age ; Hernia ; Humans ; Hydrops Fetalis ; Lymphangioma, Cystic ; Magnetic Resonance Imaging* ; Male ; Parturition ; Pregnancy ; Retrospective Studies

PURPOSE: To determine the magnetic resonance (MR) imaging findings of tuberculous arthritis, and the frequency-in such cases-with which tuberculoma occurs. MATERIALS AND METHODS: MR images of 26 patients (M:F, 14:12; mean age, 46.2 years) with pathologically proven tuberculous arthritis were retrospectively reviewed. The presence of joint effusion, subchondral erosion, synovial proliferation and soft tissue abscess, and whether the inner wall of this abscess was smooth, were assessed. In particular, we determined whether a nodular lesion which showed low SI on T1WI, central low SI with peripheral high SI on T2WI, and rim enhancement on contrast study, was a tuberculoma. RESULTS: The joints involved were those of the knee (n=7), hip (n=7), shoulder (n=4), sacroiliac region (n=3), elbow (n=3), and ankle (n=2). Joint effusion was noted in 15 cases (58%), and subchondral erosion in 24(92%). synovial proliferation was found in 23 cases (88%), and soft tissue abscess in 24 (92%). The inner wall of this abscess was irregular in 17 cases (71%). A tuberculoma was present in intra- or extra-articular soft tissue in 18 cases (69%). CONCLUSION: The MR findings of tuberculous arthritis were subchondral erosion, synovial proliferation, and soft tissue abscess. The presence of a tuberculoma in intra- or extra-articular soft tissue, a specific finding in tuberculous arthritis, was noted in 69% of our cases.
Abscess ; Ankle ; Arthritis* ; Elbow ; Hip ; Humans ; Joints ; Knee ; Retrospective Studies ; Shoulder ; Tuberculoma*