PURPOSE: To determine the relation between characteristic findings of hepatic arteriography and nontumorous perfusion defects which on CT arterioportography (CTAP) had been inadequately described. MATERIALS AND METHODS: To identify pseudolesions, the CTAP results of 46 patients with perfusion defects which were not recognized on conventional CT or ultrasonography were reviewed and compared with MRI, iodized-oil CT, surgical findings, and histopathologic reports. Typical and atypical pseudolesions were divided according to location, shape and cause, as revealed in previous reports. The number, shape and the location of pseudolesion seen on CTAP were determined and hepatic arteriography correlatively reviewed to determine vascular change in the corresponding area. RESULTS: Seventy-two additional lesions of 46 patients were detected. Among these, 12 cases were true lesions. Sixty pseudolesions were divided into typical (n = 18) and atypical (n = 42) ; the typical pseudolesions were found in familiar locations adjacent to the porta hepatis, falciform ligament or gall bladder and except for increased vascular staining around the gall bladder in two lesions, specific vascular changes were not seen. The shapes of the atypical pseudolesion were wedged (n = 22), nodular (n = 15) and flat (n = 5). They were located subcapsularly (n= 30) or nonspecifically within liver parenchyma (n = 12). The early appearance of a small portal vein branch with subsequent focal hepatic parenchymal staining, which suggests a small AP shunt, was identified on the hepatic arteriography, and on CTAP matched the areas of 96% atypical pseudolesions (26/34) which were more than 1cm in size. CONCLUSION: A small AP shunt should be regarded as a cause of nontumorous, nonsegmental perfusion defectson CTAP.
Angiography* ; Humans ; Ligaments ; Liver* ; Magnetic Resonance Imaging ; Perfusion* ; Portal Vein ; Portography* ; Ultrasonography ; Urinary Bladder

No abstract available.
Craniocerebral Trauma* ; Head* ; Hematoma*

No abstract available.
Frontal Bone* ; Humans

BACKGROUND: Pontine infarction extending to the basal surface has been reported to possess different characteristics from deep pontine infarction without extending to the basal surface. METHODS AND RESULTS: We studied 54 patients ; 30 patients with pontine infarction extending to the basal surface (group SE) and 24 patients with deep pontine infarction without extension (group DL) based on the site of the infarcts on precontrast sagittal T2WI. We assessed angiographic findings(MRA, 54; DSA, 31), risk factors, clinical features and the effectiveness of the intraluminal signal changes on spin-echo MRI in the diagnosis of occlusion or stenosis of the basilar artery. The incidence of basilar artery stenosis or occlusion in MRA or DSA in group SE(60%) was significantly more frequent than group DL(12.5%), whereas the incidence of vertebral artery stenosis or occlusion was not different between two groups. A noteworthy finding was that five patients (17%) of the group SE had not been extended to the basal surface on axial T2WI. The risk factors were similarly distributed between the two groups. The effectiveness of abnormal signal void of axial MRI was poor in the diagnosis of basilar artery occlusion or stenosis. CONCLUSIONS: Our results suggest that the two types of pontine infarction may be caused by different arterial pathology. Although the presence of abnormal flow void on MRI cannot predict the stenosis or occlusion of basilar artery, sagittal T2WI and angiographic study help to evaluate the patients with pontine infarction.
Basilar Artery* ; Constriction, Pathologic ; Diagnosis ; Humans ; Incidence ; Infarction* ; Magnetic Resonance Imaging ; Pathology ; Risk Factors ; Vertebrobasilar Insufficiency

Rhino-orbito-cerebral mucormycosis is an uncommon fulminant fungal infection that occurs usually in debilitated or immune suppressed patients. Intracranial lesions such as cerebral ischemia mostly develop secondary to vascular injuries like thrombosis of cavernous sinus or internal carotid artery and also from arteritis. However, intracranial hemorrhage complicated by mucormycosis is very rare. We report a patient with a fatal complicaton of intracranial hemorrhage presumably due to arteritis by mucormycosis. A 66-year-old female patient with uncontrolled diabetes mellitus developed complete ophthalmoplegia in her left eye for two days. Rhinoscopic examination revealed black necrotic turbinate. Orbital CT scan and Brain MRI showed soft tissue material at the left orbital apex and mild deformities in the left lateral cavernous sinus. On the basis of radiological evidence and biopsy, a diagnosis of mucormycosis was established, and the patient underwent surgical debridement followed by an Amphotericin B infusion. On the following day, she suddenly developed a right hemiparesis and stupor. An immediate brain CT scan revealed a large intracranial hemorrhage in the left frontal head region. Removal of the hematoma and a biopsy was performed immediately. A pathological examination revealed a fungal invasion of the small arterial wall and an acute inflammatory reaction of the surounding tissues.
Aged ; Amphotericin B ; Arteritis ; Biopsy ; Brain ; Brain Ischemia ; Carotid Artery, Internal ; Cavernous Sinus ; Congenital Abnormalities ; Debridement ; Diabetes Mellitus ; Diagnosis ; Female ; Head ; Hematoma ; Humans ; Intracranial Hemorrhages* ; Magnetic Resonance Imaging ; Mucormycosis* ; Ophthalmoplegia ; Orbit ; Paresis ; Stupor ; Thrombosis ; Tomography, X-Ray Computed ; Turbinates ; Vascular System Injuries

BACKGROUND: Periventricular white matter changes(PVWC) in chronic cerebrovascular disease are regarded to be caused by chronic low perfusion and as forms of small arterial disease of cerebral circulation. In some reports, these are suggested to be concerned with the fluctuation of blood pressure. The purpose of this study was to elucidate the diurnal pattern of BP in chronic cerebrovascular disease and the relationship between severity of PVWC and decrement of nocturnal dip through the ambulatory 24 hour blood pressure monitoring (ABPM). Subjects and METHODS: ABPM were carried out every 30 minutes in 36 patients with chronic cerebrovascular disease, prospectively. Twenty-five had PVWCS and/or multiple lacunar infarction (MLI) with various grades, 11 had large artery territorial infarction (LATI) without PVWC. The patterns of ABPM in each group were analyzed by disease entity and severity of PVWC. RESULTS: There was no differences in the two groups; PVWC/MLl and LATI, in properties(age, sex, etc.) and possible stroke risk factors (hypertension, diabetes mellitus, hypercholesterolemia, smoking, etc.) (P<.05). The pattern of ABPM of PVWC/MLl group showed the decrement of nocturnal dip of BP unlike LATI group (P<.05). The decrement of nocturnal dip of BP correlated with severity of PVWC (P<.05). CONCLUSION: We conclude that the diurnal pattern of BP in small artery disease is different from that of large arterial disease group and related to the severity of PVWC.
Arteries ; Blood Pressure Monitors* ; Blood Pressure* ; Diabetes Mellitus ; Humans ; Hypercholesterolemia ; Infarction ; Perfusion ; Prospective Studies ; Risk Factors ; Smoke ; Smoking ; Stroke ; Stroke, Lacunar

Acase of 14-year-old student is presented with the complaint of recurrent attack of transient quadriparesis during hyperextension of the neck. On 3-dimensional spinal CT and MRI, the authors confirmed intrusion of posterior tubercle of the atlas with increased signal on T1- and T2- weighted image was found. The clinical manifestations were improved without having cervical instability after a posterior laminectomy of the atlas.
Adolescent ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Neck ; Quadriplegia*

We had experienced a case of hematogenous brain abscess which occurred at the site of spontaneous intracerebral hemorrhage. The 41-year-old patient was admitted with sponetaneous intracerebral hemorrhage on left basal ganglia and sepsis. Brain abscess was incidentally detected by stereotactic aspiration of intracerebral hemorrhage, followed by the gram staining and culture of aspirated material.
Adult ; Basal Ganglia ; Brain Abscess* ; Brain* ; Cerebral Hemorrhage* ; Humans ; Sepsis

BACKGROUND: Living related liver transplantation (LRLT) has gained acceptance as treatment modality for children with end-stage liver disease. The left lobe used in LRLT doesn't provide adequate parenchymal mass for its application to adults. We have used right lobe for LRLT in adults. Some criticism has been aroused becuase of the potential significant risk to the donors. METHODS: We analyzed the surgical risk and the stress to 20 donors in a right lobectomy for LRLT. We also analyzed anatomical points for safe harvest, and we describe techincal points based on anatomical variations. RESULTS: There were no deaths, and 6 major complications (3 bleeding, 1 perihepatic fluid collection, 1 pleural effusion, and 1 bile peritonitis after removal of the T-tube) occurred in 6 patients. Liver function was normalized within 2 weeks. There were anatomical variations in the hepatic vein, the portal vein, and the bile duct, especially the right inferior hepatic vein (55%), trifurcation of the portal vein (10%), low inserion of the right posterior bile duct into the common hepatic duct (10%), and separate insertion of the right anterior bile duct and right posterior bile duct into the hepatic duct (10%). We made a vena cava patch for the right inferior hepatic vein. In cases of the low insertion of the right posterior hepatic duct into the common hepatic duct, the cholecystectomy should be done carefully so as not to injure the right posterior hepatic duct. We ligated and divided the right posterior bile duct before dissection of the hepatic artery and the portal vein. In cases of trifurcation of the portal vein, closure of the left portal vein should be done to prevent the narrowing of the left portal vein lumen. CONCLUSIONS: Our results suggest that a right lobectomy for LRLT is safe for donors. However, anatomical variations in the bile duct, the hepatic vein, and the portal vein should be kept in mind to ensure a safe and successful operation.
Adult* ; Bile ; Bile Ducts ; Child ; Cholecystectomy ; Hemorrhage ; Hepatic Artery ; Hepatic Duct, Common ; Hepatic Veins ; Humans ; Liver Diseases ; Liver Transplantation* ; Liver* ; Living Donors* ; Peritonitis ; Pleural Effusion ; Portal Vein ; Tissue Donors

OBJECTIVE: The purpose of this study is to evaluate complications in 70 patients who had underwent endovascular treatment to occlude cerebral aneurysms. METHODS: From May 1999 to December 2002, we treated 70 patients by endovascular treatment or by combination of endovascular treatment and surgery. Complications have been developed in fifteen patients. Twelve patients had anterior circulation aneurysms: 4 posterior commmuncating artery ; 2 anterior communicating artery ; 2 paraclinoid artery ; 2 anterior choroidal artery ; 1 distal internal carotid artery ; 1 middle cerebral artery ; 1 pericallosal artery and three patients had posterior circulation aneurysms: 3 basilar artery tip. RESULTS: The complications related to the coil embolization were the thromboembolic event in 9 cases, rupture of the aneurysm in 3 cases, coil prolapse in 3 cases and coil migration in 1 case. CONCLUSION: The coil embolization can be a alternative good modality in the treatment of cerebral aneurysms. But careful attention should be required to reduce the various complications of procedures and to improve the prognosis of aneurysmal treatment. Effort to overcome the technical problem and to develop more comfortable device are needed for the better results of endovascular treatment.
Aneurysm ; Arteries ; Basilar Artery ; Carotid Artery, Internal ; Choroid ; Embolization, Therapeutic ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Prognosis ; Prolapse ; Rupture