PURPOSE: To evaluate the relative value of arterial, portal venous and delayed phase images of spiral CT in the detection of metastatic tumor of the liver. MATERIALS AND METHODS: Forty-three metastatic tumors in twelve patients were underwent tri-phasic spiral CT examination with injection of 120 ml ionic contrast material (36 g of iodine) at the rate of 3 ml/sec. Arterial, portal venous and delayed phase CT images were obtained 35, 65, and 360 seconds after the start of contrast injection, respectively. RESULTS: Arterial phase images detected 35(81%), portal venous phase images 43(100%), and delayed phase images 34(79%) lesions, respectively(p<0.05). All masses larger than 2cm(n=23) were detected in all three phases, whereas 60%, 100%, 55%of the masses smaller than 2cm(n=20) were detected in arterial, portal venous and delayed phase CT, respectively. The best contrast between masses and the hepatic parenchyma was in portal venous phase followed by arterial and delayed phase(p<0.01). In two hypervascular masses, the contrast was better in arterial phase. CONCLUSION: Portal venous phase of spiral CT is optimal in the detection of metastatic tumor of the liver. Arterial phase may be helpful for the detection of hypervascular metastasis. Delayed phase should be used restrictively.
Humans ; Liver* ; Neoplasm Metastasis ; Tomography, Spiral Computed*

PURPOSE: To verify the usefulness of left portal vein angle (LPVA) on CT scan in the diagnosis of liver cirrhosis and to compare its diagnostic value with that of caudate to right lobe ratio (C/RL ratio). MATERIALS AND METHODS: LPVA, an angle formed by a vertical line and a line connecting the center of the vertebral body to the umbilical point of the left portal vein, and C/RL ratio were measured on CT scans of 100 cirrhotic and 100 normal livers. Diagnostic values of LPVA and C/RL ratio were compared statistically. RESULTS: The mean of LPVA was 18.9 degrees(SD; 7.6) for normal livers and 25.8 degreesSD; 8.4) for cirrhotic livers (P<0.001). The mean of C/RL ratio was 0.47(SD; 1.10) for normal livers and 0.58(SD;0.14) for cirrhotic livers (P<0.001). When LPVA was greater than 30 degreesliver cirrhosis was diagnosed with 36% sensitivity and 92% specificity. When C/RL ratio was greater than 0.60, the diagnose of liver cirrhosis was with 41% sensitivity and 90% specificity. There was no significant difference of the diagnostic accuracy between LPVA and C/R L ratio in ROC analysis. CONCLUSION: Both LPVA and C/RL ratio are useful diagnostic indices of liver cirrhosis on CTscan. LPVA is more convenient to measure than C/RL ratio.
Diagnosis* ; Fibrosis ; Liver Cirrhosis* ; Liver* ; Portal Vein* ; ROC Curve ; Sensitivity and Specificity ; Tomography, X-Ray Computed

PURPOSE: To evaluate the diagnostic value of radiologic studies in the Cushing's disease MATERIALS AND METHODS: We analyzed retrospectively the CT(n=19, dynamic CT was not perfomed), MR (n=23, dynamic MR in 2 cases), and the results of inferior petrosal sinus sampling(IPSS)(n=13) in 25 patients(19 women, 6men, age range 16-58, mean 32.2) with pathologically-confirmed ACTH secreting pituitary adenoma. We analyzed the radiologic findings and determined how accurately each method could detect and lateralize the lesion within the pituitary gland. The results were compared with the surgical findings and with each other. RESULTS: Seven patients(28%) out of 25 had macroadenomas and the lesions were detected and correctly diagnosed by CT and MR in all. Eighteen patients(72%) had microadenoma. In patients with microadenoma the sensitivity was 38.5%(5/13) in CT, 64.7%(11/17) in MR, 90.9%(10/11) in IPSS. In two patients with dynamic MR, in whom the conventional Gd-enhanced MR showed false negative results, the lesions were detected as low signal intensity mass and correctly lateralized. Considering the results of both MR and IPSS, the sensitivity increased up to 94.1%(17/18). CONCLUSION: Considering the invasiveness of IPSS, Gd-enhanced MR, preferably dynamic, seems to be an imaging modality of choice in Cushing's disease. Combined use of IPSS in selected patients further increases the accuracy of diagnosis and lateralization.
ACTH-Secreting Pituitary Adenoma ; Diagnosis ; Female ; Humans ; Pituitary Gland ; Retrospective Studies

PURPOSE: The purpose of this study was to evaluate basic experimental data for the clinical application of a self-expandable stainless steel intravascular Hanaro spiral stent. MATERIALS AND METHODS: For evaluation of thephysical properties of the Hanaro stent, hoop strength, radioopacity, longitudinal flexibility, and foreshortening were measured. Twelve intravascular Hanaro spiral stents were placed in the infrarenal abdominal aorta (n=6) and comon iliac artery (n=6) in six mongrel dogs. Angiography and light microscopic examination were performed after one, two and eight months of placement of the stents. RESULTS: The stent had good radioopacity and was deployed with minimal foreshortening. Hoop strength of a 6mm-interval bend was found to be superior to that of 8mm- and 10mm-bend stent. On angiography the patency rate and thrombosis rate were 100% and 0% in the abdominal aorta and 50% and 50% in the common iliac artery, respectively. Minimal corrosion was seen in all stents, and they appearedto be biocompatible. The stent wires were covered with well-developed neointima which after one month had mostly fibroblast and collagen tissue; the thickness of the neointima increased gradually during a period of eightmonths. At the end of that period, collagen fibres in the neointima were denser and showed a more paralled configuration than at one month. CONCLUSION: The Hanaro stent has good physical properties and also has a high patency rate, and good biocompatibilities. The stent may therefore be reliably and safely deployed in the humanvascular system.
Angiography ; Animals ; Aorta, Abdominal ; Atherosclerosis ; Collagen ; Corrosion ; Dogs ; Iliac Artery ; Neointima ; Pliability ; Stainless Steel ; Stents ; Thrombosis

PURPOSE: To evaluate the efficacy of two-phase dynamic helical CT, including the gastric mucosal phase, for the detection of atypical non-hyperattenuating early gastric carcinoma (EGC). MATERIALS AND METHODS: In 32 patients, we evaluated the two-phase helical CT findings of endoscopically suspected EGC for changes of the inner hyperattenuating mucosal layer, the hypoattenuating outer layer and the serosal surface. Two gastrointestinal radiologists working together reached their conclusions before pathologic diagnosis had been made. The first, so-called gastric mucosal, phase was obtained 38 -45 sec after the start of IV injection of 150 ml/sec contrast material at a rate of 4 ml/sec to obtain maximum enhancement of the mucosal layer. RESULTS: Among 32 patients, EGC was confirmed in 30 and AGC (T2) in two. Using two-phase helical CT, the detection rate for typical hyperattenuating EGC was 27 % (8/30). Lesions showing focal interruption of the mucosal layer without abnormal enhancement of the outer layer (EGC atypical enhancement pattern type 1) were detected in five patients during the mucosal phase, and were pathologically confirmed as 3 EGC IIc+III, 1IIc+IIa, and I IIb+IIc. Lesions showing a locally protuding lesion of the inner and preserved outer layers, with a smooth serosal surface (EGC atypical enhancement pattern type 2) and which could be distinguished from normal folds, were detected in six patients during the mucosal phase, and were pathologically confirmed as 2 EGC IIb+IIc, 1 IIc+IIa, and 3 IIc+IIb. Lesions were less distinct during the equilibrium phase, and there was no change in the enhancement pattern. The overall detection rate for EGC in which an atypical enhancement pattern was added to the typical one showed improvement (19/30, 63 % ). CONCLUSION: Helical CT using a two-phasic scan technique including the mucosal phase was efficient for various combinations of EGC II and/or III, including IIc. The findings were atypical and non-hyperattenvating, but reliable, and improved the overall detection rate.
Diagnosis ; Humans ; Stomach Neoplasms* ; Tomography, Spiral Computed*

PURPOSE: The purpose of this study is to introduce the experience of 31 patients who had renovascular hypertension and underwent percutaneous transluminal angioplasty of renal artery (PTA). MATERIALS AND METHODS: The subjects were 31 patients with hypertension and stenotic renal artery or arteries on angiography. The criteria of stenosis is more than 50% narrowing of the artery. The technical results were considered to be successful if residual stenosis is less than 50%. The clinical results were classified as cure, improvement and fail. And clinical results were analyzed according to the follow-up duration, short term (< or = 6 mo) and long term (< 6 mo). RESULTS: Technical success rate was 90.2% (37/41) and clinical success rate were 82.8% (24/29) on short term follow-up and 84.2% (16/19) on long term follow-up. Recurred cases were 7 cases. CONCLUSION: PTA is a safe and effective therapeutic modality on renovascular hypertension.
Angiography ; Angioplasty* ; Arteries ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Hypertension ; Hypertension, Renovascular ; Renal Artery*

PURPOSE: To assess the utility of spin-echo magnetic resonance(MR) imaging in the evaluation of thoracic and abdominal aortic aneurysm. MATERIALS AND METHODS: The spin-echo MR images of 27 aortic aneurysms in 22 patients were analyzed and correlated with angiography and/or operative findings retrospectively. Evaluations included location, type, and maximum diameter of the aneuyusm, mural thrombus, major branch involvement, and relationship with adjacent organ. RESULTS: The location of aneurysms was ascending thoracic aorta in seven cases, ascending thoracic aorta and aortic arch in one, descending thoracic aorta in six, thoracoabdominal aorta in three, and abdominal aorta in eight. Nineteen were fusiform, and eight were saccular. The mean of maximum diameters of the aneurysms was 7.9cm (4-10cm) on MR and 7.3cm (3-10cm) on angiography. Mural thrombus were noted in 13 cases on MR imaging and seven cases on angiograhpy. Angiography also underestimated the amount of mural thrombus. Eight cases involved major aortic branches. Although MR imaging and angiography were equal in the assessment of major abdominal aortic branches, MR imaging could not clearly demonstrate arch vessels, especially left subclavian artery, in aortic arch aneurysms. Among seven ascending thoracic aneurysms, six had aortic regurgitation. MR imaging showed left ventricular enlargement in all six cases. There was pericardial effusion in four cases which were noted only on MR imaging. MR imaging demonstrated hydronephrosis and renal atrophy in two cases of abdominal aortic aneurysms respectively. CONCLUSION: In the assessment of size of the aneurysm, mural thrombus, and relation with adjacent organs, MR imaging was better than angiography. MR and anglographic findings were equal in the assessment of the location and type of the aneurysm. Angiography was better than MR imaging in the assessment of major branch involvement, especially left subclavian artery.
Aneurysm ; Angiography ; Aorta ; Aorta, Abdominal ; Aorta, Thoracic ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal* ; Aortic Valve Insufficiency ; Atrophy ; Humans ; Hydronephrosis ; Magnetic Resonance Imaging ; Pericardial Effusion ; Retrospective Studies ; Subclavian Artery ; Thrombosis

as useful as the conventional suction technique for the cytopathological evaluation of thyroid nodules.
Suction ; Thyroid Gland* ; Thyroid Nodule*

Xanthogranulomatous cholecystitis (XGC) is a rare inflammatory disease of the gallbladder. Not only does XGC occasionally present as a mass formation with adjacent organ invasion like a malignant neoplasm, it can also infrequently be associated with gallbladder cancer. In the situation, it is difficult to make a differential diagnosis between the diseases. Here, we describe a case of a simultaneous XGC and a carcinoma of the gallbladder in a 61-year-old woman. To the best of our knowledge, there are only a small number of reports on this combination of diseases.
Adenocarcinoma/complications/diagnosis/*pathology/surgery ; Biopsy, Needle ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystitis/complications/diagnosis/*pathology/surgery ; Endosonography ; Female ; Gallbladder Neoplasms/complications/diagnosis/*pathology/surgery ; Granuloma/complications/diagnosis/*pathology ; Humans ; Immunohistochemistry ; Middle Aged ; Neoplasm Staging ; Prognosis ; Risk Assessment ; Tomography, X-Ray Computed ; Xanthomatosis/complications/diagnosis/*pathology

Extrahepatic metastasis of hepatocellular carcinoma (HCC) can be found in various organs, but metastasis to the female genital tract is extremely rare. A 48-year-old woman who had undergone curative left lobectomy for small HCC 4 years earlier was admitted because of sequential alpha-fetoprotein elevation. Upon abdominal MRI and hepatic angiography, no evidence of HCC recurrence was found in the remnant liver. However, a positron emission tomography CT scan showed a hypermetabolic lesion in the uterine fundus, which was revealed as metastatic HCC after total hysterectomy. This is, to our knowledge, the first documented case of metastatic uterine tumor that originated from HCC without intrahepatic recurrence.
alpha-Fetoproteins ; Angiography ; Carcinoma, Hepatocellular ; Female ; Humans ; Hysterectomy ; Liver ; Middle Aged ; Neoplasm Metastasis ; Positron-Emission Tomography ; Recurrence ; Uterine Neoplasms