PURPOSE: To evaluate the clinical usefulness of 2-D Cine PC (phase contrast) technique in visualizing the pattern and the site of abnormal CSF flow and to assess the effect of a third ventriculostomy in patients with hydrocephalus. MATERIALS AND METHODS: The study group consisted of three normal controls and 13 patients with hydrocephalus, as shown on CT or MRI, and two patients who had undergone their third ventriculostomy. The technique was EKG-gated 2-D Cine PC MRI with velocity encoding 5cm/sec, TR 80msec, TE 12.3-15msec, and flip angle 15-60 degrees. Image quality was analyzed for variable sequences, and CSF flow was observed along the CSF flow pathway. We analyzed continuity and intensity of the CSF flow signal, and obstruction site and flow velocity degree were then defined. RESULTS: Systolic high and diastolic low signal intensity along the CSF flow-pathway, with normal asynchronicity and continuation, were clearly seen in normal controls. In three patients, there was obstruction at the ventricular level while others were either normal or showed a normal pattern with a weak signal. 'Normal' was defined as noncommunicating hydrocephalus and the latter as communicating hydrocephalus. In the two patients who had undergone ventriculostomy, a signal was in one case detected at the site of the third operation. CONCLUSION: A 2-D Cine PC CSF flow study enables us to see CSF flow signals noninvasively and to detect the site of obstruction of a CSF flow-pathway. It can therefore be useful for determining the application of a ventriculoperitoneal shunt and assessing the effect of a third ventriculostomy.
Humans ; Hydrocephalus ; Magnetic Resonance Imaging ; Ventriculoperitoneal Shunt ; Ventriculostomy

PURPOSE: To recognize foraminal variants of the foraminae of the skull base in the middle cranial fossa, and to thus understand and distinguish normal and potentially abnormal structures. MATERIALS AND METHODS: We analysed 163 patients without intracranial disease who had undergone CT scanning. These comprised 82 men and 81 women with a mean age of 39 years (range, 4|73 years). HRCT was performed, using a GE 9800 scanner. All CT scans were obtained 6-7 slices at the base of the skull, with 1.5 mm collimation at 1.5 mm intervals parallel to the infraorbital line. We analysed the foraminae by closesly correlating imaging findings and established anatomic knowledge. RESULTS: In 45 cases (27.6 %) the foramen ovale was 5-10 mm in diameter and asymmetrical. Deficiency of the medial bony wall including persistent foramen lacerum medius was seen in five cases (3.1 %). Confluence of the foramen ovale and the foramen spinosum was seen in 13 cases (8 %) and confluence of the foramen ovale and the foramen of Vesalius in 23 (14.1 %). Posterolateral groove for the accessory meningeal artery was observed in 36 cases (22 %). The foramen spinosum was asymmetrical in 42 cases (25.8 %). A small or absent foramen spinosum with a larger ipsilateral foramen ovale was observed in 11 cases (6.7 %). Medial bony defect was seen in 16 cases (9.8%). The foramen spinosum was absent in four cases (2.5 %). In 74 cases (45.4 %), the foramen of Vesalius was absent ; it was present unilaterally and bilaterally in 55 (33.7 %) and 34 cases (20.9 %), respectively. Five cases showed duplicated foramina. Canaliculus innominatus was seen in 14 cases (8.9 %) and was present bilaterally in three (1.8 %). CONCLUSION: HRCT clearly delineates bony structure and is well able to display the rich spectrum of anatomic variation found in the base of the skull. The recognition of these normal variants will result in a better understanding of skull base neurovascular anatomy and diminish speculation as to their true nature during the interpretation of CT images.
Anatomic Variation ; Cranial Fossa, Middle* ; Female ; Foramen Ovale ; Humans ; Male ; Meningeal Arteries ; Skull ; Skull Base ; Tomography, X-Ray Computed

The authors studied one case with rhabdomyolysis associated with acute renal failure, which followed acute CO intoxication. Oliguria, hyperkalemia developed within one day of rhabdomyolysis on left extremities. During the first three days of hospitalization, rapid increase in serum BUN, serum creatinine and serum muscle enzymes (CPK, LDH, GPT, GOT) were noted. Renal failure was controlled by artifiral kidney. Several areas of increased uptake of technetium-99m DP were noticed on bone scan. Electron microscopic examinations of biopsied muscle consist of disarrangement of myofibrils, loss or destruction of Z-line, difficulties in distinguishing A-band from I-band, and swelling of mitochondrias. These findings suggest that acute CO poising may be followed by severe muscle destruction and renal damage.
Acute Kidney Injury* ; Creatinine ; Extremities ; Hospitalization ; Hyperkalemia ; Kidney ; Mitochondria ; Myofibrils ; Oliguria ; Poisoning* ; Renal Insufficiency ; Rhabdomyolysis*

PURPOSE: To evaluate the usefulness of MRI findings in the differentiation of benign from malignant ovarian lesions. MATERIALS AND METHODS: Using MR findings, 29 surgically proven ovarian masses in 22 patients (14 bilateral tumors) were evaluated Twenty-one benign tumors in 16 patients (5 simple cysts, 4 mucinous cystadenomas, 4 serous cystadenomas, 4 endometriomas, 3 cystic teratomas and 1 tuboovarian abscess), and eight malignant tumors in six patients (4 serous papillary cystadenocarcinomas and 4 mucinous cystadenocarcinomas) were included. MRI was performed with SE T1WI, FSE T2WI and Gd-T1WI. MRI findings of lesion size, thickness of wall and of internal septations, number of internal septations, nodularities, and ancillary findings such as adhesion in the pelvic cavity, dissemination, ascites and lymphadenopathy were retrospectively analyzed. RESULTS: Malignant ovarian lesions were larger (18 cm : 11 cm) and had more internal septations, more solid components and nodularities (63 % : 5 %) than benign lesions. On T1WI, cystic lesions, both benign and malignant, showed low signal intensity. Hemorrhage, fat components and mucin containing lesions showed high signals and solid components and nodularities were isointense with muscle on T1WI. Solid components and nodularities were well-enhanced after gadolinium enhancement. Adhesion (50 % : 10 %), dissemination (38 % : 0 %) and ascites (63 % : 24 %) were more frequent in malignant lesions. CONCLUSION: MRI, especially with gadolinium-enhanced T1W1 is useful in the differentiation of benign from malignant ovarian lesions.
Ascites ; Cystadenocarcinoma, Papillary ; Cystadenoma, Mucinous ; Cystadenoma, Serous ; Endometriosis ; Female ; Gadolinium ; Hemorrhage ; Humans ; Lymphatic Diseases ; Magnetic Resonance Imaging* ; Mucins ; Retrospective Studies ; Teratoma

Purpose: Immune checkpoint inhibitors (ICI) and targeted small-molecule drugs are mainstay elements of lung cancer chemotherapy. However, they are associated with development of pneumonitis, a rare, but potentially life-threatening event. We analyzed lung cancer patients treated with ICI to evaluate the effect of sequential therapeutic administration on the incidence of pneumonitis. Materials and Methods: In this retrospective study, 242 patients were included. Serial radiologic findings taken during and immediately after ICI treatment were reviewed. Factors that increased pneumonitis and the relationship between peri-ICI chemotherapy and the development of pneumonitis were evaluated. Results: Pneumonitis developed in 23 patients (9.5%); severe pneumonitis (grade ≥ 3) occurred in 13 of 23 patients (56%); pneumonitis-related death occurred in six. High-dose thoracic radiation (≥ 6,000 cGy) revealed a tendency toward high risk of pneumonitis (odds ratio, 2.642; 95% confidence interval, 0.932 to 7.490; p=0.068). Among 149 patients followed for ≥ 8 weeks after the final ICI dose, more patients who received targeted agents within 8-weeks post-ICI experienced pneumonitis (3/16, 18.8%) compared with patients who received cytotoxic agents (4/54, 7.4%) or no chemotherapy (4/79, 5.1%) (p=0.162). Targeted therapy was associated with earlier-onset pneumonitis than treatment with cytotoxic agents (35 vs. 62 days post-ICI, p=0.007); the resulting pneumonitis was more severe (grade ≥ 3, 100% vs. 0%, p=0.031). Conclusion Sequential administration of small-molecule targeted agents immediately after ICI may increase the risk of severe pneumonitis. The sequence of chemotherapy regimens that include ICI and targeted agents should be carefully planned to reduce the risk of pneumonitis in lung cancer patients.

PURPOSE: To reduce lung cancer mortality, lung cancer screening was recommended using low-dose computed tomography (LDCT) to high-risk population. A protocol for multicenter lung cancer screening pilot project was developed to evaluate the effectiveness and feasibility of lung cancer screening to implement National Cancer Screening Program in Korea. MATERIALS AND METHODS: Multidisciplinary expert committee was comprised to develop a standardized protocol for Korean Lung Cancer Screening Project (K-LUCAS). K-LUCAS is a population-based single arm trial that targets high-risk population aged 55-74 years with at least 30 pack-year smoking history. LDCT results are reported by Lung-RADS suggested by American Radiology Society. Network-based system using computer-aided detection program is prepared to assist reducing diagnostic errors. Smoking cessation counselling is provided to all currently smoking participants. A small pilot test was conducted to check the feasibility and compliance of the protocols for K-LUCAS. RESULTS: In pilot test, 256 were participated. The average age of participants was 63.2 years and only three participants (1.2%) were female. The participants had a smoking history of 40.5 pack-year on average and 53.9% were current smokers. Among them, 86.3% had willing to participate in lung cancer screening again. The average willingness to quit smoking among current smokers was 12.7% higher than before screening. In Lung-RADS reports, 10 (3.9%) were grade 3 and nine (3.5%) were grade 4. One participant was diagnosed as lung cancer. CONCLUSION: The protocol developed by this study is assessed to be feasible to perform K-LUCAS in multicenter nationwide scale.
Arm ; Compliance ; Diagnostic Errors ; Early Detection of Cancer ; Female ; Humans ; Korea ; Lung Neoplasms ; Lung ; Mass Screening ; Mortality ; Pilot Projects ; Smoke ; Smoking ; Smoking Cessation