Ultrasonography (US) has been a primary tool for assessing malignancy risk, fine-needle aspiration (FNA) decision, and management after FNA in patients with thyroid nodules. US also has an essential role for preoperative evaluation of primary tumor and cervical lymph nodes, for surveillance of postoperative patients with thyroid cancer, and for imaging guidance for nonsurgical ablation therapy. In the revised recommendations of Korean Society of Thyroid Radiology (KSThR), Korean Thyroid Imaging Reporting and Data System (K-TIRADS), a revised risk stratification system of thyroid nodules, was suggested to increase the efficacy of FNA and provide supplementary information for thyroid nodules after FNA. The role of US assessment of cervical lymph node needs to be emphasized for optimal management decision of thyroid nodules, preoperative staging, and postoperative surveillance of patients with thyroid cancers, and CT has a complementary role for the diagnosis of metastatic nodes in patients with thyroid carcinomas.
Biopsy ; Biopsy, Fine-Needle ; Diagnosis* ; Humans ; Information Systems ; Lymph Nodes* ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule* ; Ultrasonography*

OBJECTIVE: Although tuberculous lymphadenitis and Kikuchi disease are common causes of cervical lymphadenopathy in Asians and exhibit similar clinical manifestations, their treatment strategies are totally different. The purpose of this study was to identify ultrasonographic features that distinguish these two diseases. MATERIALS AND METHODS: This study was approved by the Institutional Review Board. The study included 77 patients with tuberculous lymphadenitis and 135 patients with Kikuchi disease. The sex and age distributions of the patients were analyzed. The size and shape of lymph nodes (LNs), presence of conglomeration, increased perinodal echogenicity, echogenic hilum, posterior neck involvement, internal calcification, patterns of internal necrosis, laterality of involved LNs, and hilar vascular patterns on ultrasonography were compared between the two groups. Multiple logistic regression analysis was conducted to identify independent findings to discriminate tuberculous lymphadenitis from Kikuchi disease. Finally, diagnostic accuracies were calculated using the independent findings. RESULTS: The presence of an echogenic hilum, internal calcification, patterns of internal necrosis, and LN hilar vascular structures on power Doppler ultrasonography were independent findings that discriminated tuberculous lymphadenitis from Kikuchi disease. The diagnostic accuracy of each of these four factors was 84.9% (181/212), 76.9% (163/212), 84% (178/212), and 89.2% (189/212), respectively. A combination of internal calcification and hilar vascular structures showed the best accuracy of 89.6% (190/212) (sensitivity, 86.7% [117/135]; specificity, 94.8% [73/77]) for diagnosing Kikuchi disease. CONCLUSION: The presence of an echogenic hilum, internal calcification, pattern of internal necrosis, and LN hilar vascular structures are useful ultrasonographic findings to differentiate tuberculous lymphadenitis from Kikuchi disease.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Biopsy ; Calcinosis/pathology ; Child ; Child, Preschool ; Female ; Histiocytic Necrotizing Lymphadenitis/pathology/*ultrasonography ; Humans ; Lymph Nodes/pathology/*ultrasonography ; Male ; Middle Aged ; Neck/ultrasonography ; Necrosis/pathology ; Sensitivity and Specificity ; Tuberculosis, Lymph Node/pathology/*ultrasonography ; Ultrasonography, Doppler ; Young Adult

We report a rare case of petroclival craniopharyngioma with no connection to the sellar or suprasellar region. MRI and CT images revealed a homogenously enhancing retroclival solid mass with aggressive skull base destruction, mimicking chordoma or aggressive sarcoma. However, there was no calcification or cystic change found in the mass. Here, we report the clinical features and radiographic investigation of this uncommon craniopharyngioma arising primarily in the petroclival region.
Cranial Fossa, Posterior/*pathology/radiography/surgery ; Craniopharyngioma/*diagnosis/radiography/surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pituitary Neoplasms/*diagnosis/radiography/surgery ; Skull Base Neoplasms/*diagnosis/radiography/surgery ; Tomography, X-Ray Computed

PURPOSE: To determine whether preoperative CT is helpful in predicting the development of recurrent tumor following surgical resection in patients with esophageal cancer. MATERIALS AND METHODS: Thirty patients with esophageal cancer in whom preoperative CT of the chest had been performed were included in the study. All had undergone esophagectomy, esophagogastrostomy and lymph node dissection at our institution between 1995 and 1997. They were divided into two groups according to the development of tumor recurrence during the follow-up period of three years. Sixteen patients (group I) suffered tumor recurrence, while the other 14 (group II) remained tumor-free after surgery. In each group, a review of the preoperative CT scans indicated the length, thickness, location and margin of the tumor, and the presence or absence of lymphadenopathy in the mediastinum and/or upper abdomen. Differences in preoperative CT findings between the two groups were assessed by statistical testing. RESULTS: Lymphadenopathy of the mediastinum and/or upper abdomen was seen in 11 (69%) of 16 patients in group I and three (21%) of 14 in group II (p<.05). The tumor margin was indistinct in seven patients (44%) in group I and in one (7%) in group II (p<.05). The average length and thickness of esophageal tumors were 5.2 and 1.4 cm, respectively, in group I, and 3.5 and 1.5 cm, respectively, in group II (p>.05). In group I, five esophageal tumors were located in the middle esophagus and eleven in the lower esophagus. In group II, such tumor was located one in the upper esophagus, six in the middle esophagus, and seven in the lower esophagus (p>.05). CONCLUSION: Patients with preoperative CT findings of lymphadenopathy and/or an indistinct primary tumor margin are more likely to develop tumor recurrence following surgical resection than those without these findings.
Abdomen ; Esophageal Neoplasms ; Esophagectomy ; Esophagus ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymphatic Diseases ; Mediastinum ; Recurrence* ; Thorax ; Tomography, X-Ray Computed

Susceptibility-weighted imaging (SWI) is well known for detecting the presence of hemorrhagic transformation, microbleeds and the susceptibility of vessel signs in acute ischemic stroke. But in some cases, it can provide the tissue perfusion state as well. We describe a case of a patient with hyperacute ischemic infarction that had a slightly hypodense, patchy lesion at the left thalamus on the initial SWI, with a left proximal posterior cerebral artery occlusion on a magnetic resonance (MR) angiography and delayed time-to-peak on an MR perfusion performed two hours after symptom onset. No obvious abnormal signals at any intensity were found on the initial diffusion-weighted imaging (DWI). On a follow-up MR image (MRI), an acute ischemic infarction was seen on DWI, which is the same location as the lesion on SWI. The hypointensity on the initial SWI reflects the susceptibility artifact caused by an increased deoxyhemoglobin in the affected tissue and vessels, which reflects the hypoperfusion state due to decreasing arterial flow. It precedes the signal change on DWI that reflects a cytotoxic edema. This case highlights that, in some hyperacute stages of ischemic stroke, hypointensity on an SWI may be a finding before the hyperintensity is seen on a DWI.
Angiography ; Artifacts ; Edema ; Follow-Up Studies ; Humans ; Infarction ; Ischemia ; Magnetic Resonance Imaging ; Perfusion ; Posterior Cerebral Artery ; Stroke ; Thalamus

Granulocytic sarcoma is a manifestation of myelogenous leukemia, which means a solid mass consisting of primitive precursors of the granulocytic series of white blood cells. We present CT and MR imaging findings of bilateral sino-orbital granulocytic sarcoma in a 22-month-old boy. The mass involved bilateral orbital fossa which resulted in bilateral proptosis. Moreover, the mass extended to the almost skull base including paranasal sinuses, maxilla, temporal bone, zygomatic bone, sphenoid bone, ethmoid, and palatine bone. The adjacent dura was continuously thickened and the lower half of cavernous sinus was also involved. The patient was diagnosed as AML (M5) with t(8,21) translocation through a chromosome study from the bone marrow.
Bone Marrow ; Cavernous Sinus ; Ethmoid Bone ; Exophthalmos ; Humans ; Infant ; Leukemia ; Leukemia, Myeloid ; Leukemia, Myeloid, Acute ; Leukocytes ; Maxilla ; Orbit ; Orbital Neoplasms ; Palate, Hard ; Paranasal Sinuses ; Sarcoma, Myeloid ; Skull Base ; Sphenoid Bone ; Temporal Bone

Granulocytic sarcoma is a manifestation of myelogenous leukemia, which means a solid mass consisting of primitive precursors of the granulocytic series of white blood cells. We present CT and MR imaging findings of bilateral sino-orbital granulocytic sarcoma in a 22-month-old boy. The mass involved bilateral orbital fossa which resulted in bilateral proptosis. Moreover, the mass extended to the almost skull base including paranasal sinuses, maxilla, temporal bone, zygomatic bone, sphenoid bone, ethmoid, and palatine bone. The adjacent dura was continuously thickened and the lower half of cavernous sinus was also involved. The patient was diagnosed as AML (M5) with t(8,21) translocation through a chromosome study from the bone marrow.
Bone Marrow ; Cavernous Sinus ; Ethmoid Bone ; Exophthalmos ; Humans ; Infant ; Leukemia ; Leukemia, Myeloid ; Leukemia, Myeloid, Acute ; Leukocytes ; Maxilla ; Orbit ; Orbital Neoplasms ; Palate, Hard ; Paranasal Sinuses ; Sarcoma, Myeloid ; Skull Base ; Sphenoid Bone ; Temporal Bone

PURPOSE: The purpose of this study was to investigate the accuracy and reliability of the semi-automated ultrasonographic volume measurement tool, virtual organ computer-aided analysis (VOCAL), for measuring the volume of parathyroid glands. METHODS: Volume measurements for 40 parathyroid glands were performed in patients with secondary hyperparathyroidism caused by chronic renal failure. The volume of the parathyroid glands was measured twice by experienced radiologists by two-dimensional (2D) and three-dimensional (3D) methods using conventional sonograms and the VOCAL with 30°angle increments before parathyroidectomy. The specimen volume was also measured postoperatively. Intraclass correlation coefficients (ICCs) and the absolute percentage error were used for estimating the reproducibility and accuracy of the two different methods. RESULTS: The ICC value between two measurements of the 2D method and the 3D method was 0.956 and 0.999, respectively. The mean absolute percentage error of the 2D method and the 3D VOCAL technique was 29.56% and 5.78%, respectively. For accuracy and reliability, the plots of the 3D method showed a more compact distribution than those of the 2D method on the Bland-Altman graph. CONCLUSION: The rotational VOCAL method for measuring the parathyroid gland is more accurate and reliable than the conventional 2D measurement. This VOCAL method could be used as a more reliable follow-up imaging modality in a patient with hyperparathyroidism.
Follow-Up Studies ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Secondary* ; Imaging, Three-Dimensional ; Kidney Failure, Chronic ; Methods* ; Organ Size ; Parathyroid Glands ; Parathyroidectomy ; Ultrasonography

Computed tomography (CT) is an important imaging modality in evaluating thoracic malignancies. The clinical utility of dual-energy spectral computed tomography (DESCT) has recently been realized. DESCT allows for virtual monoenergetic or monochromatic imaging, virtual non-contrast or unenhanced imaging, iodine concentration measurement, and effective atomic number (Zeff map). The application of information gained using this technique in the field of thoracic oncology is important, and therefore many studies have been conducted to explore the use of DESCT in the evaluation and management of thoracic malignancies. Here we summarize and review recent DESCT studies on clinical applications related to thoracic oncology.

Ultrasound (US)-guided fine needle aspiration (US-FNA) has played a crucial role in managing patients with thyroid nodules, owing to its safety and accuracy. However, even with US guidance, nondiagnostic sampling and infrequent complications still occur after FNA. Accordingly, the Task Force on US-FNA of the Korean Society of Thyroid Radiology has provided consensus recommendations for the US-FNA technique and related issues to improve diagnostic yield. These detailed procedures are based on a comprehensive analysis of the current literature and from the consensus of experts.
Biopsy, Fine-Needle/*methods ; Consensus ; Fibrinolytic Agents/adverse effects/therapeutic use ; Humans ; Radiology ; Sensitivity and Specificity ; Thyroid Nodule/*diagnosis/therapy/*ultrasonography