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Ultrasonographic Evaluation of Focal Hepatic Lesions : Comparison of Fundamental, Tissue Harmonic, Fundamental Compound and Harmonic Compound Imaging Techniques.

Jung Hee SHIN ; Ji Young HWANG ; Seung Yon BAEK ; Chung Sik RHEE

Journal of the Korean Radiological Society.2002;47(4):365-372. doi:10.3348/jkrs.2002.47.4.365

PURPOSE: To compare the ultrasonographic image quality of fundamental imaging (FI), tissue harmonic imaging (THI), fundamental compound imaging (FCI), and harmonic compound imaging (HCI) in the evaluation of focal hepatic lesions. MATERIALS AND METHODS: Ninety-four focal hepatic lesions (27 hemangiomas, 15 hepatocellular carcinomas, 14 metastases, and 38 cysts) in 74 patients [30 males and 44 females aged 33-82 (mean, 55) years] were included in our study. All patients underwent FI, THI, FCI, and HCI using an HDI 5000 Sono CT scanner (Advanced Technology Laboratories, Bothell, CA., U.S.A.) with a 2-5MHz convex transducer. Images were analysed by two abdominal radiologists who used a 4-point scale and reached a consensus. In the case of solid lesions, four parameters, as follows, were evaluated: lesion conspicuity, internal morphology, overall image quality, and peripheral halo. For cysts, three parameters (internal artifact, sharpness of margin, and posterior enhancement) were assessed. For statistical analysis, the Scheffe method (ANOVA test) was used. RESULTS: For solid lesions (hemangioma, hepatocellular carcinoma, and metastasis), THI, FCI and HCI were superior to FI in terms of lesion conspicuity, internal morphology and overall image quality (p<0.05), though for peripheral halo, the four imaging techniques were not statistically different. For cysts, THI, FCI and HCI revealed clearer internal artifact and better margin sharpness than FI (p<0.05), while in terms of posterior enhancement, THI was superior to both FI and FCI, and HCI was superior to FCI (p<0.05). CONCLUSION: For the evaluation of focal hepatic lesions, harmonic imaging techniques (i.e. THI and HCI) appear to provide better image quality than fundamental imaging techniques (i.e. FI and FCI). There is, however no significant difference in image quality between the two harmonic techniques.
Artifacts ; Carcinoma, Hepatocellular ; Consensus ; Female ; Hemangioma ; Humans ; Male ; Neoplasm Metastasis ; Transducers

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Pleuropulmonary Blastoma: A Case Report.

Gong Yong JIN ; Young Min HAN ; Hark Hoon PARK ; Gyung Ho CHUNG ; Chong Soo KIM

Journal of the Korean Radiological Society.2002;47(4):361-364. doi:10.3348/jkrs.2002.47.4.361

Primary pulmonary neoplasms are uncommon in children. One such tumor, pleuropulmonary blastoma (PPB), is very rare, highly aggressive and malignant, and originates from either the lungs or pleura. It contains both mesenchymal and benign epithelial elements that resemble fetal lung, and occurs mainly in children aged less than five. The clinal symptoms often suggest upper respiratory tract infection or pneumothorax, but ultrasonography and chest CT scans depict both a large mass occupying an almost entire hemithorax, and a simple lung cyst. Contrast-enhanced CT demonstrates hetergeneous attenuation and a whorled appearance.
Child ; Humans ; Lung ; Lung Neoplasms ; Pleura ; Pneumothorax ; Respiratory Tract Infections ; Tomography, X-Ray Computed ; Ultrasonography

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Diffuse Telangiectatic Type of Pulmonary Arteriovenous Malformation Diagnosed with CT Scan using Slab Maximum Intensity Projection Technique: A Case Report.

Byeong Seong KANG ; Joon Beom SEO ; In Sun LEE ; Kyung Hyun DO ; Jin Seong LEE ; Koun Sik SONG ; Tae Hwan LIM

Journal of the Korean Radiological Society.2002;47(4):357-360. doi:10.3348/jkrs.2002.47.4.357

Diffuse telangiectatic type of pulmonary arteriovenous malformation (AVM) is an uncommon disease entity in which numerous small arteriovenous connections occur throughout the lungs. It has rarely been confirmed by pulmonary angiography. We report a case of diffuse telangiectatic pulmonary AVM occurring in a patient with dyspnea and confirmed by CT using the slab maximum intensity projection (MIP) technique and conventional direct pulmonary angiography.
Angiography ; Arteriovenous Malformations* ; Dyspnea ; Humans ; Lung ; Tomography, X-Ray Computed*

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Radiographic Findings of Miliary Tuberculosis: Difference in Patients with and those without Associated Acute Respiratory Failure.

Min Jeong KIM ; Jin Seong LEE ; Yoon Seok KO ; In Sun LEE ; Joon Beom SEO ; Koun Sick SONG ; Tae Hwan LIM

Journal of the Korean Radiological Society.2002;47(4):351-356. doi:10.3348/jkrs.2002.47.4.351

Purpose: To determine the differences in the radiographic findings of miliary tuberculosis between patients with and without associated acute respiratory failure (ARF). MATERIALS AND METHODS: We retrospectively reviewed 32 patients in whom miliary tuberculosis had been diagnosed, and assigned them to one of two groups: with ARF (n=10), and without ARF (n=22). Chest radiographic findings such as the presence of miliary nodules, cosolidation, ground-glass opacity (GGO), pleural effusion, small calcified nodules and linear opacities were assessed, the size and profusion of nodules in each of four zones were analyzed and scored using the standard radiographs of the International Labor Organization, and the extent of consolidation and GGO were scored according to the percentage of involved lung. We compared the radiologic findings between the two groups. RESULTS: Ground-glass opacity, consolidation, and pleural effusion were seen more frequently in miliary tuberculosis patients with ARF than in those without ARF. Although the size and profusion of nodules were similar in both groups (p>0.05), consolidation and ground-glass opacity in cases of miliary tuberculosis with ARF were significantly more extensive than in those without ARF (p<0.005). CONCLUSION: GGO and consolidation were more extensive in miliary tuberculosis patients with ARF. A finding of ground-glass opacity in miliary tuberculosis patients might be an early indication of developing ARF.
Humans ; Lung ; Pleural Effusion ; Radiography, Thoracic ; Respiratory Insufficiency* ; Retrospective Studies ; Tuberculosis, Miliary* ; Tuberculosis, Pulmonary

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Influential Factors of Clinical Outcome of Local Intra-Arterial Thrombolysis using Urokinase in Patients with Hyperacute Ischemic Stroke.

Jae Min SONG ; Woong YOON ; Jae Kyu KIM ; Jeong Jin SEO ; Sook Hee HEO ; Jin Gyoon PARK ; Yong Yeon JEONG ; Heoung Keun KANG

Journal of the Korean Radiological Society.2002;47(4):343-350. doi:10.3348/jkrs.2002.47.4.343

PURPOSE: To evaluate the clinical outcome and other relevant factors in cases where local intra-aterial thrombolysis (LIT) is used for the threatment of hyperacute ischemic stroke. MATERIALS AND METHODS: Forty-eight hyperacute ischemic stroke patients were treated by LIT, using urokinase, within six hours of ictus, and for evaluation of their neurological status, the National Institutes of Health Stroke Scale (NIHSS) score was used. Angiographic recanalization was classified according to Mori recanalization grades. Three months after LIT, the outcome was assessed by clinical examination using the modified Rankin scale (good outcome: RS=0-3; poor outcome: RS=4-6). In all patients, the findings of pre- and post- LIT CT, and angiography, as well as neurological status and hemorrhagic complications, were also analysed. RESULTS: Thirty-three patients had occlusions of the middle cerebral artery (MCA), and 15, of the internal carotid artery (ICA). The NIHSS score averaged 16.9 at the onset of therapy and 13.5 at 24 hours later. Successful recanalization (Mori grade 3,4) was achieved in 28 (58.3%) of 48 patients, but in 20 (41.7%) the attempt failed. Twenty-two (45.8%) of the 48 patients had a good outcome, but in (54.2%) the outcome was poor. Thirteen (40.6%) of 32 patients with MCA occlusions and 13 (81.2%) of 16 with ICA occlusions had a poor outcome. Eight patients (16.7%) died. Overall, hemorrhages occured in 20 (41.7%) of 48 patients, with symptomatic hemorrhage in ten. Five (50%) of these ten died. CONCLUSION: LIT using urokinase for hyperacute ischemic stroke is feasible; patients with MCA occlusions had better outcomes than those with ICA occlusions. Hemorrhagic complications of LIT were frequent, and in cases of symptomatic hemorrhage a fatal outcome may be expected.
Angiography ; Carotid Artery, Internal ; Fatal Outcome ; Hemorrhage ; Humans ; Middle Cerebral Artery ; National Institutes of Health (U.S.) ; Stroke* ; Urokinase-Type Plasminogen Activator*

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Human Breast Cancer: In Vivo And In Vitro H MR Spectroscopy.

Tae Woong CHUNG ; Heoung Keun KANG ; Gwang Woo JEONG ; Jin Gyoon PARK ; Jeong Jin SEO ; Jung Hee LEE

Journal of the Korean Radiological Society.2001;44(2):267-275. doi:10.3348/jkrs.2001.44.2.267

PURPOSE: The purpose of this study was to determine, using in vivo and in vitro 1H MRS (MR spectroscopy), the characteristic biochemical metabolites related with breast cancer, and to assess the clinical usefulness and limitations of this modality. MATERIALS AND METHODS: For in vivo 1H MRS, nine patients with breast cancer and two normal volunteers were examined on a 1.5 T MR imager equipped with facilities for spectroscopy. In order to localize the breast lesion, axial and sagittal T1-weighted images and fat-suppressed T2-weighted images were obtained just prior to MRS; MR spectra were acquired at TR=3000 msec and TE=144 msec. For in vitro 1H MRS, breast tumor and adja-cent normal tissue were extracted from 13 patients with breast cancer, and in two of these, both in vivo and in vitro 1H MRS were performed. All in vitro 1H MRS specimens were immediately immersed in liquid nitrogen, and then in a preparation of perchloric acid. For quantitative analysis of the MR spectra of cancerous and normal breast tissue, the paired t-test was used (p < 0.05). RESULTS: At1H MRS in vivo, choline and two lipids were identified at 3.21 ppm, and 1.33 ppm and 0.9 ppm, re-spectively. The distinction between cancerous and normal breast tissue was based on the higher level of choline (3.21 ppm) present in the former. At 1H MRS in vitro, on the other hand, mean and standard deviation (% standard deviation) for the various metabolites in cancerous and normal breast tissue were as follows: choline, 30.195 +/- 2.448(8.108) and 22.648 +/- 1.938(8.556); trimethylamine, 3.425 +/- 0.335(9.769) and 0.640 +/- 0.066(10.325); sarcosine, 3.425 +/- 0.335(9.769) and 0.640 +/- 0.099(15.394); lactate, 16.388 +/- 1.134(6.922) and 9.715 +/- 0.385(3.965); inositol, 1.970 +/- 0.282(14.334) and 3.859 +/- 0.502(13.020); and taurine, 6.614 +/- 0.556(8.412) and 10.748 +/- 1.206(11.222). High levels of choline (p=0.026), trimethylamine (p=0.001), sarco-sine (p=0.009), and lactate (p=0.009), and lower levels of inositol (p=0.006) and taurine (p=0.008) were char-acteristic findings in cancerous as compared with normal breast tissue, with significantly different results. CONCLUSION: 1H MRS both in vitro and in vivo showed that increased choline levels were present in cancerous breast tissue, but that normal tissue does not contain choline. The presence of choline could therefore be used as a marker for malignancy in breast lesions. Information provided by in vitro 1H MRS, together with the development of in vivo 1H MRS with high field strength and high resolution, may be very useful for the diagnosis of breast cancer.
Breast Neoplasms* ; Breast* ; Choline ; Diagnosis ; Hand ; Healthy Volunteers ; Humans* ; Inositol ; Lactic Acid ; Magnetic Resonance Spectroscopy* ; Nitrogen ; Sarcosine ; Spectrum Analysis ; Taurine

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Primary Cutaneous Meningioma on the Scalp of an Infant: A Case Report.

Su Jeong KIM ; Ji Yeon LIM ; Sung Mee KIM ; Eun Ae YOO

Journal of the Korean Radiological Society.2001;44(2):263-265. doi:10.3348/jkrs.2001.44.2.263

During childhood, meningioma is an uncommon tumor, and in infants, extracranial meningioma is very rare. We report a case of primary cutaneous menigioma occurring on the scalp of a ten-month-old girl.
Female ; Humans ; Infant* ; Meningioma* ; Scalp*

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CT Findings of Acute Pyelonephritis in Children:Correlation with Clinical Manifestations.

Jeong Kyong LEE ; Sun Wha LEE ; Jung Eun KIM ; Seung Joo LEE

Journal of the Korean Radiological Society.2001;44(2):257-261. doi:10.3348/jkrs.2001.44.2.257

PURPOSE: The purpose of this study was to evaluate the CT findings of acute pyelonephritis (APN) in children and to assess the correlation between these findings, clinical parameters and renal scar development, as seen on follow-up CT scans. MATERIALS AND METHODS: Contrast-enhanced CT scans of thirty children in whom APN had been diagnosed were assigned to one of three groups according to whether an abscess had formed, and then to subgroups on the basis of the number of lesions in the renal parenchyme. Initial CT findings were retrospectively correlated with five clinical parameters (maximal body temperature, fever duration, leukocytosis, pyuria and admission period) and renal scar development, as seen on follow-up CT (n=12). RESULTS: CT scans demonstrated linear, wedge-shaped, low-density renal parenchymal lesions in 35 kidneys of 25 patients and abscesses in seven kidneys of seven patients, but no abnormal lesions in five patients. In the three groups there was correlation between these findings and some clinical parameters (maximal body temperature, fever duration and admission period), but no subgroup showed significant correlation with any clini-cal parameter. Renal cortical scars detected by follow-up CT were more prevalent in patients in whom initial CT demonstrated the presence of an abscess. CONCLUSION: Clinical parameters correlated with the presence of renal parenchymal hypoenhancing lesions and abscess formation, as seen on CT scans, rather than the number of renal parenchymal lesions. Renal cortical scars were more prevalent in patients in whom initial CT revealed the presence of an abscess. Enhanced CT is thought to be useful both for diagnosing APN and for predicting its clinical course in children.
Abscess ; Body Temperature ; Child ; Cicatrix ; Fever ; Follow-Up Studies ; Humans ; Kidney ; Leukocytosis ; Pyelonephritis* ; Pyuria ; Retrospective Studies ; Tomography, X-Ray Computed

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Reversible Posterior Leukoencephalopathy Syndrome in Children: MR Imaging Findings.

Sang Kwon LEE ; Soon Hak KWON ; Yong Sun KIM

Journal of the Korean Radiological Society.2001;44(2):249-256. doi:10.3348/jkrs.2001.44.2.249

PURPOSE: To find out the characteristic MR findings of reversible posterior leukoen-cephalopathy syndrome (RPLS) due to various causes in children. MATERIALS AND METHODS: Eight children with RPLS underwent MR imaging, and the findings were retrospectively analyzed. All eight were acutely hypertensive at the time of a neurotoxic episode. Three had intra-abdominal tumors (one adrenal pheochromo-cytoma, one para-aortic paraganglioma and one para-aortic ganglioneuroma encasing the left renal artery); three were being treated with cyclosporine; one was being treat-ed with steroid; and one had hemolytic uremic syndrome. Initial cranial MR images were analyzed with particular emphasis on the distribution of the lesions. To assess possible sequelae, follow-up MR images were obtained in seven patients at least one week after the treatment of hypertension. Four underwent proton MR spectroscopy. RESULTS: Characteristic distribution of lesions in the occipital and posterior parietal lobes was identified in all cases regardless of the causes of RPLS. The cerebellum, basal ganglia, anterior parietal, and frontal lobe were involved in four, two, one, and one case, respectively. Cortical gray matter involvement was predominant in six and subcortical white matter involvement predominated in two patients. The distribution of lesions was bilateral and asymmetric. Gyriform enhancement was identified in six cases, and small hemorrhage was noted in one. In seven patients, the clinical and MR findings improved without sequelae on follow-up study. In one, proton MR spectroscopy demonstrated a high lactate peak at the time of the neurologic event. Nearnormal spectra were noted in three children who underwent proton MR spectroscopy after recovery. CONCLUSION: The MR findings of RPLS are characteristic in that lesions are distributed in the posterior region of the brain and they are reversible on follow-up study. In children with RPLS due to unknown causes, the possibility of intra-abdominal tumors should also be considered.
Basal Ganglia ; Brain ; Cerebellum ; Child* ; Cyclosporine ; Follow-Up Studies ; Frontal Lobe ; Ganglioneuroma ; Hemolytic-Uremic Syndrome ; Hemorrhage ; Humans ; Hypertension ; Lactic Acid ; Magnetic Resonance Imaging* ; Magnetic Resonance Spectroscopy ; Paraganglioma ; Parietal Lobe ; Posterior Leukoencephalopathy Syndrome* ; Protons ; Rabeprazole ; Retrospective Studies

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Can Postmortem Fetal MR Imaging Replace Autopsy?.

Jeong Yeon CHO ; Seung Hyup KIM ; Mi Jin SONG

Journal of the Korean Radiological Society.2001;44(2):243-248. doi:10.3348/jkrs.2001.44.2.243

PURPOSE: The purposes of this study were to compare postmortem fetal MRI findings with autopsy findings and to assess whether postmortem MRI can replace autopsy. MATERIALS AND METHODS: The study group consisted of 13 stillborn fetuses, seven that died immediately after birth, and five terminated because of anomalies seen on prenatal sonograms. A total 17 were male, and eight were female, and their gestational ages were from 20 to 41 (average; 28.2) weeks. Spin-echo T1-and T2-weight-ed axial, sagittal, and coronal MR images were obtained, and autopsy findings were divided into major and mi-nor. A major finding was defined as an anomaly or syndrome which caused fetal death or termination of the pregnancy; minor findings were classified, on the basis of gross inspection, as internal or external. MR images were retrospectively analyzed by two radiologists unaware of the autopsy findings, and by comparison with these, the postmortem MRI detection rates for major and minor findings was then determined. RESULTS: In seven of 25 fetuses, MR imaging revealed major findings, a detection rate of 100%. There were two cases of anencephaly, two of trisomy-18, and one each of hydrops fetalis with large cystic hygroma, diaphrag-matic hernia, and Dandy-Walker malformation. Twenty-three of 60 minor findings (38.3%) were detected by MRI. The detection rates for external and internal findings were 29.6%(8/27) and 45.5%(15/33), respectively. CONCLUSION: Although a limitation of our study is the low detection rate for minor findings, postmortem fetal MRI may help diagnose the major cause of fetal death.
Anencephaly ; Autopsy* ; Dandy-Walker Syndrome ; Female ; Fetal Death ; Fetus ; Gestational Age ; Hernia ; Humans ; Hydrops Fetalis ; Lymphangioma, Cystic ; Magnetic Resonance Imaging* ; Male ; Parturition ; Pregnancy ; Retrospective Studies

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