PURPOSE: To evaluate the characteristics of magnetic resonance (MR) images in Peyronie's disease and to assess the usefulness of post-erection penile MRI. MATERIALS AND METHODS: We retrospectively reviewed the MR images of seven patients in whom Peyronie's disease was clinically suspected. All seven underwent pre- and post-erectile MRI. After the aquisition of erectile MRI, three patients also underwent contrast-enhanced MRI. We compared image quality and the rate of detection of penile plaque between pre-erectile and post-erectile images. In three patients who underwent contrast- enhanced MRI, we assessed correlation between the contrast enhancement pattern, as seen on MRI, of the plaque and corpus cavernosa and clinical inflammatory signs such as painful erection. RESULTS: In the seven patients, all post-erectile MRI images showed localized thickening and irregularities of the tunica albuginea and the septum penis, suggesting penile plaque. On pre-erectile MRI, however, plaque was detected in five cases. In six of seven cases, plaque as seen on T2-weighted images (T2WI) showed low signal intensity similar to that of the tunica albuginea, and as seen on T1-weighted images (T1W1), a signal intensity of signal intensity similar to or similar to or slightly higher than that of the tunica albuginea. In one case, plaque showed high signal intensity on both T1WI and T2WI. On T1WI, the corpus cavernosa showed homogeneous medium-signal intensity on all pre- and post-erectile MR images. On pre-erectile T2WI, the corpus cavernosa of six patients showed heterogeneous high signal intensity, whereas on post-erectile T2WI the corpus cavernosa of all patients showed homogeneous high signal intensity. Due to the enlarged penis and homogeneous signal intensity of the corpus cavernosa, the image quality of post-erectile images was superior to that of pre-erectile imjages. The images of two of three patients who underwent contrast enhanced MRI showed strong enhancement of the plaque and adjacent corpus cavernosa, while in one case, no enhancement was noted. Independently of the enhancement pattern, these three patients had no active inflammatory clinical signs such as painful erection. CONCLUSION: In Peyronie's disease, all plaque is clearly, visualized on MRI. In terms of image quality and plaque detection, post-erectile penile MR imaging is superiou to pre-erectile imaging.
Humans ; Magnetic Resonance Imaging* ; Male ; Penile Induration* ; Penis ; Retrospective Studies

PURPOSE: To compare single-shot echo-planar MR imaging(EPI) with breath-hold fast T2-weighted imaging(HASTEor Turbo spin-echo T2WI) for evaluation of the role of EPI in distinguishing small hepatocellular carcinoma fromcavernous hemangioma. MATERIALS AND METHODS: We retrospectively evaluated MR images of 35 patients (21 cases ofsmall HCC and 14 cases of cavernous hemangioma). EPI and breath-hold fast T2WI images were obtained and comparedon the basis of lesion detection sensitivity, lesion-to-liver signal intensity ratio(SIR), contrast ratio(CT), andlesion-to-liver contrast to noise ratio(CNR). RESULTS: For the detection of small HCC, the sensitivity of EPI andbreath-hold fast T2WI were equal in 14 of 21 cases(71.4%). The detection sensitivity of cavernous hemangioma withEPI and breath-hold fast T2WI was 100%(14/14). Mean SIR on breath-hold fast T2WI was 2.02+/-0.45 for small HCC and3.65+/-0.97 for cavernous hemangioma; on EPI, the corresponding figures wer 2.91+/-0.57 and 6.98+/-1.37. Mean CR onbreath-hold fast T2WI was 1.16+/-0.58 for small HCC and 2.65+/-0.57 for cavernous hemangioma; On EPI, the figuresobtained were 2.27+/-0.52 and 6.26+/-2.19, respectively. Mean CNR on breath-hold fast T2WI was 14.24+/- 4.098 forsmall HCC and 50.28+/-10.96 for cavernous hemangioma, while on EPI, the corresponding figures were 13.84+/-3.02 and45.44+/-11.21. CONCLUSION: In detecting focal hepatic mass, the sensitivity of EPI and breath-hold fast T2WI arecomparable; for the diagnosis of small HCC and cavernous hemangioma, EPI can provide additional information.
Carcinoma, Hepatocellular ; Diagnosis ; Hemangioma ; Hemangioma, Cavernous* ; Humans ; Magnetic Resonance Imaging* ; Noise ; Retrospective Studies

BACKGROUNDS:During the past two decades, a dramatic increase has been seen in the diagnosis and treatment of alkaline reflux gastritis (ARG). Recently, the number of symptomatic, medically resistant postgastrectomy patients with ARG experiencing enterogastric reflux has increased as documented by clinical symptoms, gastroscopy, quantitative radionuclide biliary scanning, and biochemical study. Even the number of asymptomatic patients experiencing enterogastris refluy or ARG after gastrectomy has increased. METHODS: In a retrospective study, we evaluated an efficacy of an additional Braun enteroenterostomy (BEE) in preventing the ARG by diverting bile away from the stomach in 72 patients with gastric cancer (51 with BEE and a control of 21 without BEE) who underwent a subtotal gastrectomy. The BEE was performed about 20 to 30 cm from the gastrojejunostomy. Seventy-two patients had their clinical symptoms recorded and underwent radiologic study, gastroscopy, and biopsy. RESULTS: The present study demonstrated the following:1) Of the 51 patients who underwent BEE, twelve (23.5%) developed ARG symptoms and required medication. Of the 21 control patients without BEE, twelve (54.6%) developed ARG symptoms and required medical treatment. 2) The postoperative gastroendoscopic findings in the 51 patients who underwent BEE were grade 1 in 27 (52.9%) patients, grade 2 in 16 (31.4%) patients and grade 3 in only one patient versus grade 1 in 5 (22.7%) patients, grade 2 in 13 (59.1%) patients and grade 3 (9.1%) patients without BEE. CONCLUSIONS: BEE was an effective procedure for reducing the risk of ARG caused by reflux of bile.
Bees ; Bile ; Biopsy ; Diagnosis ; Gastrectomy* ; Gastric Bypass ; Gastritis ; Gastroscopy ; Humans ; Retrospective Studies ; Stomach ; Stomach Neoplasms

We have experienced two cases of mycotic aneurysms of the superior mesenteric artery. The first case originated from septic embolism of infective endocarditis and the second case originated from salmonella enteritis eight months before. The aneurysms were diagnosed by abdominal ultrasonography and comfirmed by computed tomogram and angiography but the blood culture was negative in both cases at the time of the surgery. Both patient were successfully treated by resection only and the restorations of vascular continuity were not neccesary because of adequate collateral circulations to the intestine. Both patient's postoperative courses were uneventful after the follow up of one year and nine months, respectively.
Aneurysm ; Aneurysm, Infected* ; Angiography ; Collateral Circulation ; Embolism ; Endocarditis ; Enteritis ; Follow-Up Studies ; Humans ; Intestines ; Mesenteric Artery, Superior* ; Salmonella ; Ultrasonography

We present a retrospective analysis of arterial embolectomies performed at the Inje University Seoul Paik Hospital. During the period of March 1987 - Feburary 1996 twenty-six patients underwent embolectomies, eighteen patients were male and eight patients were female, mean age of patients was 56.8 years. Rest pain was the chief complaint in 24 patients, the remaining two patients complained of long term history of claudication after recovery of acute symtoms. But only 10 patients had sensory/motor symtoms. Heart was the most common source of embolization and frequent predisposing factor of embolism was ischemic heart disease in 8 cases and valvular heart disease in 11 cases. The sites of embolization were upper extremities artery in 6 cases, saddle embolism in 2 cases, lower extremities artery in 18 cases and the most common site of embolism was femoral artery in 11 cases. Preoperative angiography was taken in the diagnosis and planning of the embolectomy in 13 patients while in the other patient preoperative angiography was not taken. Only two cases were operated within the golden period of 6 hours and other cases were operated in more than 6 hours after embolization. In all patients, the Fogarty embolectomy catheter was used without bypass surgery via bachial ateriotomy in the embolism of upper extremities artery, bilateral groin approaches in the saddle embolism and transfemoral approach in the embolism of lower extremities artery. However 3 patients were re-operated via transpopliteal approach in the distal poplitiotibial embolism. Eighteen patients received perioperative anticoagulation therapy by heparin or fraxiparine and wafarin was used in 17 patients at the time of discharge and the indication of anticogulation was patients of valvular heat disease and/or atrial fibrillation, peripheral artery atherosclerosis and recurrent embolism. Postoperative results of the embolectomy were as follows: fouteen pateints had excellent results, five cases had symtom improvement after re-operation, B.K. amputation in 1 case who had sever atherosclerosis of lower extremities, recurrent embolism in 1 case and death in 2 cases the cause of death were acute renal failure and cerebral artery embolism, respectively. The complications of the embolectomy were reperfusion syndrome, pseudoaneurysm and intimal dissection in one case each. Conclusively the problems of embolism is delayed diagnosis and increasing number of old aged patient who had suffered ischemic heart diease. Preoperative angiography was not always needed for embolectomy. Selective anticoagulation therapy can decrease incidence of re-embolism. In the distal poplitiotibial embolism, seletive embolectomy of tibial artery was difficult.
Acute Kidney Injury ; Amputation ; Aneurysm, False ; Angiography ; Arteries* ; Atherosclerosis ; Atrial Fibrillation ; Catheters ; Causality ; Cause of Death ; Cerebral Arteries ; Delayed Diagnosis ; Diagnosis ; Embolectomy* ; Embolism ; Extremities* ; Female ; Femoral Artery ; Groin ; Heart ; Heart Valve Diseases ; Heparin ; Hot Temperature ; Humans ; Incidence ; Lower Extremity ; Male ; Myocardial Ischemia ; Nadroparin ; Reperfusion ; Retrospective Studies ; Seoul ; Tibial Arteries ; Upper Extremity

We present a retrospective analysis of arterial embolectomies performed at the Inje University Seoul Paik Hospital. During the period of March 1987 - Feburary 1996 twenty-six patients underwent embolectomies, eighteen patients were male and eight patients were female, mean age of patients was 56.8 years. Rest pain was the chief complaint in 24 patients, the remaining two patients complained of long term history of claudication after recovery of acute symtoms. But only 10 patients had sensory/motor symtoms. Heart was the most common source of embolization and frequent predisposing factor of embolism was ischemic heart disease in 8 cases and valvular heart disease in 11 cases. The sites of embolization were upper extremities artery in 6 cases, saddle embolism in 2 cases, lower extremities artery in 18 cases and the most common site of embolism was femoral artery in 11 cases. Preoperative angiography was taken in the diagnosis and planning of the embolectomy in 13 patients while in the other patient preoperative angiography was not taken. Only two cases were operated within the golden period of 6 hours and other cases were operated in more than 6 hours after embolization. In all patients, the Fogarty embolectomy catheter was used without bypass surgery via bachial ateriotomy in the embolism of upper extremities artery, bilateral groin approaches in the saddle embolism and transfemoral approach in the embolism of lower extremities artery. However 3 patients were re-operated via transpopliteal approach in the distal poplitiotibial embolism. Eighteen patients received perioperative anticoagulation therapy by heparin or fraxiparine and wafarin was used in 17 patients at the time of discharge and the indication of anticogulation was patients of valvular heat disease and/or atrial fibrillation, peripheral artery atherosclerosis and recurrent embolism. Postoperative results of the embolectomy were as follows: fouteen pateints had excellent results, five cases had symtom improvement after re-operation, B.K. amputation in 1 case who had sever atherosclerosis of lower extremities, recurrent embolism in 1 case and death in 2 cases the cause of death were acute renal failure and cerebral artery embolism, respectively. The complications of the embolectomy were reperfusion syndrome, pseudoaneurysm and intimal dissection in one case each. Conclusively the problems of embolism is delayed diagnosis and increasing number of old aged patient who had suffered ischemic heart diease. Preoperative angiography was not always needed for embolectomy. Selective anticoagulation therapy can decrease incidence of re-embolism. In the distal poplitiotibial embolism, seletive embolectomy of tibial artery was difficult.
Acute Kidney Injury ; Amputation ; Aneurysm, False ; Angiography ; Arteries* ; Atherosclerosis ; Atrial Fibrillation ; Catheters ; Causality ; Cause of Death ; Cerebral Arteries ; Delayed Diagnosis ; Diagnosis ; Embolectomy* ; Embolism ; Extremities* ; Female ; Femoral Artery ; Groin ; Heart ; Heart Valve Diseases ; Heparin ; Hot Temperature ; Humans ; Incidence ; Lower Extremity ; Male ; Myocardial Ischemia ; Nadroparin ; Reperfusion ; Retrospective Studies ; Seoul ; Tibial Arteries ; Upper Extremity

PURPOSE: To evaluate CISS MR imaging findings of epidermoid tumor in comparison with conventional spin-echoimages. MATERIALS AND METHODS: We studied 6 cases of epidermoid tumor in the subarachnoid space. We used a 1.5TMR unit to obtain CISS images(TR/TE/FA ; 12.3msec/5.9 msec/700) and T1- and T2-weighted spin-echo images. CISS MRimaging findings were evaluated with respect to tumor's signal intensity, contour, and relation with adjacentstructures. Conspicuity of the tumor was compared between CISS and spin-echo images. A quantitative analysis wasperformed by measuring tumor to CSF contrast. In qualitative analysis, three radiologists independently comparedCISS image and conventional spin-echo images for visibility of the tumor and graded them into three categories(poor, good, and excellent). RESULTS: Epidermoid tumors were located in the cerebellopontine angle in 4 cases, theprepontine cisstern in 1 case, and the cerebellopontine angle-prepontine cistern in 1 case. The tumors werehyperintense relative to brain parenchyma and hypointense relative to CSF on CISS images, were lobulated, encasedadjacent cranial nerve and vessels, and invaginated into brain parenchyma. In qualitative analysis, CISS imagesshowed clear demarcation between tumor and CSF, exact tumor extension, and tumor's relation with cranial nervesand vessels better than conventional spin-echo images. In quantitative analysis, the mean contrast values of tumorto CSF on T1-, T2-weighted images, and CISS images were 0.12, 0.06, and 0.52, respectively. The contrast value forCISS images was significantly higher than that for T1- and T2-weighted images (P<0.05) . CONCLUSIONS: Epidermoid tumors in the subarachnoid space are better demonstrated on CISS images than on conventional spin-echoimages. This special MR sequence can be added as a routine protocol in the diagnosis of subarachnoid epidermoidtumor.
Brain ; Cerebellopontine Angle ; Cranial Nerves ; Diagnosis ; Magnetic Resonance Imaging* ; Subarachnoid Space

OBJECTIVE: The purpose of this study was to determine the anatomic relationships between neurovascular structures and the transverse carpal ligament so as to avoid complications during endoscopic carpal tunnel surgery. METHODS: Twenty-eight patients (age range, 35-69 years) with carpal tunnel syndrome were entered into the study. We examined through wrist magnetic resonance imaging in three different positions (neutral, radial flexion, and ulnar flexion) and determined several anatomic landmark (distance from the hamate hook to the median nerve, ulnar nerve, and ulnar vessel) based on the lateral margin of the hook of the hamate. The median nerve and ulnar neurovascular structure were studied with the wrist in the neutral, ulnar, and radial flexion positions. RESULTS: The ulnar neurovascular structures usually passed just over or ulnar to the hook of the hamate. However, in 12 hands, a looped ulnar artery coursed 0.6-3.3 mm radial to the hook of the hamate and continued to the superficial palmar arch. The looped ulnar artery migrates on the ulnar side of Guyon's canal (-5.2-1.8 mm radial to the hook of the hamate) with the wrist in radial flexion. During ulnar flexion of the wrist, the ulnar artery shifts more radially beyond the hook of the hamate (-2.5-5.7 mm). CONCLUSION: It is appropriate to transect the ligament greater than 4 mm apart from the lateral margin of the hook of the hamate without placing the edge of the scalpel toward the ulnar side. We would also recommend not transecting the transverse carpal ligament in the ulnar flexed wrist position to protect the ulnar neurovascular structure.
Anatomic Landmarks ; Carpal Tunnel Syndrome ; Hamate Bone ; Hand ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Median Nerve ; Ulnar Artery ; Ulnar Nerve ; Wrist

PURPOSE: To assess the usefulness of CISS images in the diagnosis of intraocular lesions, we compared CISSimages with 3mm and 1mm sliced spin-echo T2-weighted images. MATERIALS AND METHODS: In 14 patients with 15intraocular lesions(retinal detachment 10, choroidal melanoma, 2 ; cavernous hemangioma, 1 ; PHPV, 1 ; andretinoblastoma, 1). we used a 1.5T MR unit obtain CISS images and 3mm and 1mm sliced spin-echo T2-weighted images.All lesions were analyzed, and after dividing them into two subgroups(linear lesions, n=11 ; mass lesions, n=4),CISS and spin-echo T2-weighted images were compared for detection rate and conspicuity. RESULTS: With regard tothese two parameters, CISS images were superior to 1mm and 3mm sliced spin-echo T2-weighted images. For theassessment of linear lesions, CISS images (detection rate, 100% ; conspicuity, 2.88) were superior to both 1mm and3mm sliced spin-echo T2-weighted images. For mass lesions CISS images were superior to 3mm sliced spin-echoT2-weighted images, but for conspicuity, there was no significant difference between CISS images (2.75) and 1mmsliced spin-echo T2-weighted images(2.2). CONCLUSION: Due to their higher detection rate and greater conspicuity,CISS images were superior to spin-echo T2-weighted images for the diagnosis of intraocular lesions less than 3mmin diameter ; for the diagnosis of intraocular lesions, they might therefore be a useful adjunct to SE images.
Choroid ; Diagnosis* ; Hemangioma ; Hemangioma, Cavernous ; Humans ; Magnetic Resonance Imaging* ; Melanoma