Purpose: The aim of this study was to evaluate the efficacy of ethanol ablation (EA) in the treatment of cystic thyroid nodules using low-dose ethanol regardless of the initial volume of the nodule or properties of the aspirate. Methods: Sixty-one nodules in 60 patients were treated with EA from October 2013 to January 2020. In each patient, EA was performed only once, using less than 5 mL of ethanol (99.5%) instilled and removed completely after a few minutes of retention. Nodule volume, the symptom score, the cosmetic score, and complications were evaluated before and after treatment. The therapeutic success rate (TSR) and volume reduction rate (VRR) according to nodule volume and properties of the aspirate were evaluated. Therapeutic success was defined as the absence of any residual fluid or sufficient volume reduction (≥50%) with improvement of nodule-related symptoms. Results: The 61 nodules comprised 38 pure cysts and 23 predominantly cystic nodules. The initial nodule volume was 21.9±15.2 mL (range, 4.4 to 77.2 mL). The TSR was 88.5% (100% in pure cysts and 69.6% in predominantly cystic nodules, P<0.001). The TSR of pure cysts was 100% regardless of nodule volume and properties of the aspirate. In predominantly cystic nodules, the TSR and VRR gradually decreased as volume increased. One patient experienced arrhythmia during the procedure, but completely recovered without sequelae. Conclusion Single-session EA using low-dose ethanol might be effective for the treatment of symptomatic cystic thyroid nodules regardless of the initial cyst volume and properties of the aspirate, especially in pure cysts.

Mucin-hypersecreting biliary neoplasm excretes excessive mucin that fills the biliary tree and results in marked dilatation of the bile ducts and obstructive jaundice. In these neoplasm, the mucin produced by the tumor rather than the tumor itself plays an important role in clinical course and radiologic patterns. The purpose of this paper is to report characteristic radiologic patterns of mucin-hypersecreting biliary neoplasms in two cases. These neoplasms were characterized by not only multilocular cystic hepatic mass or extra-hepatic bile duct mass resulting in marked biliary dilatation distal to the mass on US or CT, but also change of shape and extent of amorphous filling defects in the markedly dilated bile duct on serial cholangiograms.
Bile Ducts ; Biliary Tract ; Dilatation ; Jaundice, Obstructive ; Mucins

OBJECTIVE: We wanted to evaluate the degree of conformity of papillary carcinoma and follicular carcinoma to the reported ultrasonographic findings of malignant thyroid tumor. MATERIALS AND METHODS: Between January 2003 and December 2004, fine needle aspiration biopsy was performed in 1,036 patients with palpable and non-palpable thyroid lesions. We retrospectively reviewed the ultrasonographic findings of patients with papillary carcinomas (n = 127) and follicular carcinomas (n = 23) that were proven by operation or fine needle aspiration biopsy. We analyzed the ultrasonographic findings of these nodules based on the reported ultrasonographic findings of malignant thyroid tumor: hypoechogenicity, a taller than wide orientation, a microlobulated or irregular margin, a thick hypoechoic rim (halo sign), microcalcification and cystic change. RESULTS: The echogenicity was hypoechoic in 72.4% (92/127) of the papillary carcinomas, but it was isoechoic in 65.2% (15/23) of the follicular carcinomas (p < 0.001). The nodule shape was tall or round in 74.1% of the papillary carcinomas, but it was flat in 72.7% of the follicular carcinomas (p < 0.001). The tumor margin was microlobulated or irregular in 92.9% of the papillary carcinomas and in 60.9% of the follicular carcinomas (p < 0.001). A hypoechoic rim was seen in 26% of the papillary carcinomas (thin rim: 13.4%, thick rim: 12.6%) and in 86.6% of the follicular carcinomas (thin rim: 39.1%, thick rim: 47.8%, p < 0.001). Microcalcifications were demonstrated in 33.9% of the papillary carcinomas and in none of the cases of follicular carcinoma (p < 0.001). A solid mass without cystic change were seen in 98.4% of the papillary carcinomas and in 82.6% of the follicular carcinomas (p < 0.001). CONCLUSION: The previously reported ultrasonography findings of malignant thyroid tumor are in conformity with most of the papillary carcinomas, but not with follicular carcinomas. The current ultrasonographic features for thyroid malignancy should be cautiously applied as the indication for needle aspiration biopsy so that follicular carcinomas are not missed by too narrow and strict biopsy criteria.
Adenocarcinoma, Follicular/*ultrasonography ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biopsy, Fine-Needle ; Calcinosis/ultrasonography ; Carcinoma, Papillary/*ultrasonography ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Thyroid Gland/pathology ; Thyroid Neoplasms/*ultrasonography

PURPOSE: To evaluate the effect of Gd-DTPA on signal intensity of diffusion-weighted magnetic resonance (MR) image and apparent diffuse coefficient (ADC) in dog brain with hyperacute stroke. MATERIALS AND METHODS: Experimental canine model of hyperacute cerebral infarction was made by selective intraarterial embolization with particulate embolic material. Diffusion-weighted MR imaging was performed in five dogs at 1 hour after the embolization of internal carotid artery. After intravenous bolus injection of Gd-DTPA, additional 11 diffusion-weighted MR images were serially obtained from 2 minutes to 90 minutes after injection in each dog. The author evaluated findings of hyperacute cerebral infarction on diffusion-weighted MR imaging, and calculated mean signal intensity and mean ADC in infarcted region and contralateral normal region. Statistical analysis of mean signal intensity, mean ADC and contrast-noise ratio before and after Gd-DTPA injection was performed. RESULTS: Hyperacute cerebral infarction developed in all five dogs on diffusion-weighted MR images obtained 1 hour after embolization. The area of hyperacute infarction had steady increase in signal intensity on diffusion-weighted MR image and decrease in ADC. In normal perfusion area, decrease in signal intensity was observed at 2 minutes the Gd-DTPA injection, whereas ADC did not changed. CONCLUSION: Intravenous injection of Gd-DTPA had no influence on ADC in both hyperacute infarction and normally perfused area, but caused initial transient signal reduction in normally perfused area on diffusion-weighted MR image due to susceptibility effect of Gd-DTPA. It is important to calculate ADC in evaluating the effect of diffusion after injection of Gd-DTPA.
Animals ; Brain* ; Carotid Artery, Internal ; Cerebral Infarction ; Diffusion* ; Dogs ; Gadolinium DTPA* ; Infarction ; Injections, Intravenous ; Magnetic Resonance Imaging ; Perfusion ; Stroke*

PURPOSE: To demonstrate a CT technique by which carcinoma of the ampulla of Vater can be more accurately diagnosed, and to describe the radiologic findings this carcinoma. MATERIALS AND METHODS: We retrospectively reviewed CT findings in 26 patients with pathologically proven carcinoma of the ampulla of Vater. One additional cup of diluted oral contrast medium was ingested immediately before the scan. We analysed the difference in detection rate of the mass in the duodenal lumen with and without duodenal luminal opacification of gastrografin.We also evaluated the size and shape of the mass, dilatation of CBD and the pancreatic duct, and lymph node metastasis. In addition, we analyzed multimodality imaging findings ultrasonogram (US) : 13; hypotonic duodenogram (HTDG): 7; ERCP : 17) of carcinoma of the ampulla of Vater. RESULTS: Nodular soft tissue masses protruding into the duodenal lumen were identified in 21 of 26 cases. In 95% of cases (21/22) with favorable opacification and distension of the duodenum, masses were clearly identified on CT imaging. However, in four caseswith poor opacification and distension of the duodenum, masses could not be observed(P=0.000). The mass on CT scanshowed a well-defined margin, round or lobulated contour, and contrast enhancement similar to that of thepancreas. CBD dilatation was identified in 20 cases and pancreatic duct dilatation in 12. On US, protruding massesin the distal CBD were observed in nine of 13 cases(60%) and on HTDG, in six of seven cases(86%). as well-definedfilling defects. Conclusion : Since the accuracy of CT diagnosis of intestinal lesions is directly proportional tothe degree of intestinal distension and opacification with oral contrast, we believe that adequate ct techniquefor distending and opacitying the duodeual lumen are necessary for early diagnosis of carcinoma of the ampulla ofVater.
Ampulla of Vater* ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Dilatation ; Duodenum ; Early Diagnosis ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Pancreatic Ducts ; Phenobarbital ; Retrospective Studies ; Ultrasonography

PURPOSE: The purpose of this study was to determine whether it is possible to differentiate benign from malignant thyroid nodules according to the proportion of sponge-like appearance within the nodules. METHODS: A total of 201 thyroid nodules containing sponge-like appearance from 195 patients (157 women and 38 men) were included this study. Each thyroid nodule was classified into one of three grades by real-time ultrasonography (US) based on the areas with a sponge-like appearance within nodule: grade I had sponge-like areas occupying <50%; grade II, between 50% and 75%; and grade III, >75%. We evaluated whether a correlation existed between these grades and cytopathologic diagnoses. RESULTS: Of the 201 nodules, 196 were benign and five were malignant, and according to the US classification, 101 nodules were grade I, 45 were grade II, and 55 were grade III. Of the five malignant nodules, four were grade I, and one was grade II. No statistically significant difference was found in the rate of malignancy between grade III and grades I and II, due to insufficient statistical power. A sponge-like appearance was correlated with follicles filled with colloid and cholesterol granules in benign nodules and with papillary fronds around the dilated cystic spaces in malignant nodules. CONCLUSION: No malignancies were found in thyroid nodules with >75% sponge-like appearance. Due to the overall low incidence of malignancy and the limited number of patients, a statistically significant difference could not be found in the prevalence of malignancy depending on the proportion of sponge-like areas within the nodule.
Cholesterol ; Classification ; Colloids ; Diagnosis ; Diagnosis, Differential ; Female ; Humans ; Incidence ; Prevalence ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography*

Background: We aim to validate the diagnostic performance of thyroid core needle biopsy (CNB) for diagnosing malignancy in clinical settings to align with the changes made in recently updated thyroid CNB guidelines. Methods: We retrospectively analyzed 1,381 thyroid CNB and 2,223 fine needle aspiration (FNA) samples. The FNA and CNB slides were interpreted according to the Bethesda System for Reporting Thyroid Cytopathology and updated practice guidelines for thyroid CNB, respectively. Results: Compared to FNA, CNB showed lower rates of inconclusive results: categories I (2.8% vs. 11.2%) and III (1.2% vs. 6.2%), and higher rates of categories II (60.9% vs. 50.4%) and IV (17.5% vs. 2.0%). The upper and lower bounds of the risk of malignancy (ROM) for category IV of CNB were 43.2% and 26.6%, respectively. The CNB subcategory IVb with nuclear atypia had a higher ROM than the subcategory without nuclear atypia (40%–62% vs. 23%–36%). In histologically confirmed cases, there was no significant difference in the diagnostic performance between CNB and FNA for malignancy. However, neoplastic diseases were more frequently detected by CNB than by FNA (88.8% vs. 77.6%, P=0.046). In category IV, there was no difference in unnecessary surgery rate between CNB and FNA (4.7% vs. 6.9%, P=0.6361). Conclusion Thyroid CNB decreased the rate of inconclusive results and showed a higher category IV diagnostic rate than FNA. The revised guidelines for thyroid CNB proved to be an excellent reporting system for assessing thyroid nodules.

PURPOSE: To describe the imaging findings at susceptibility weighted imaging (SWI) at 3T in patients with occlusion of middle cerebral artery, and to correlate the absence or presence of arterial bright foci in sylvian fissure, as one of their finding at SWI, with the diffusion weighted imaging (DWI) scores. MATERIALS AND METHODS: We included 12 patients with symptomatic unilateral occlusion of middle cerebral artery. Retrospective review of SWI and DWI was done. On DWI, size of infarction was analyzed according to the ASPECTS grading system. On SWI, presence of hemorrhage, dark blooming of intravascular clot, distension of medullary or cortical vein, and absence or presence of bright arterial foci in sylvian fissure were evaluated. RESULTS: Of 12 patients with symptomatic unilateral MCA occlusion, SWI showed dark blooming of intravascular clot in 8 patients (66.7%), distended medullary or cortical vein in 7 patients (58.3%), nonvisualization of arterial bright signal intensity in sylvian fissure in 7 patients (58.3%), and hemorrhage in one patient (8.3%). In comparison with DWI, patients with sylvian arterial bright signal intensity showed better ASPECTS score (6.4+/-4.1) than patients without arterial bright signal intensity (4.4+/-1.1), yet it was not statistically significant (p=0.267, t-test). CONCLUSION: SWI at 3T provides added diagnostic information including site of occlusion, collateral flow by arterial bright signal intensity in sylvian fissure and early hemorrhagic transformation in patients with symptomatic MCA occlusion.
Diffusion ; Hemorrhage ; Humans ; Infarction ; Infarction, Middle Cerebral Artery ; Middle Cerebral Artery ; Retrospective Studies ; Stroke ; Veins

PURPOSE: To retrospectively evaluate the usefulness of diffusion-weighted images, ADC maps and conventional MR images for determination of brain tumor consistency. MATERIALS AND METHODS: Twenty-three patients with brain tumor underwent MR examinations with T1, T2 and diffusion-weighted images. Regions of interest (ROIs) were drawn in the tumors, and the measured signal intensities (SI) were normalized with the contralateral side. We evaluated the correlation between SI ratios from various images and tumor consistency assessed at surgery. In three patients with both cystic and solid components, each component was evaluated independently. Qualitatively observed SIs were also correlated with tumor consistency. RESULTS: Statistical analysis revealed significant correlation between tumor consistency and ADC ratio (r = -0.586, p = 0.002), SI ratios on T2-weighted images (r = -0.497, p = 0.010), and observed SIs on T2-weighted images (r = -0.461, p = 0.018). The relative ratio of ADC value correlated with tumor consistency most strongly. CONCLUSION: The measured ratio of ADC, SI ratio and observed SI grade on T2-weighted images can provide valuable information about the consistency of brain tumor.
Brain ; Brain Neoplasms ; Humans ; Retrospective Studies