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RE: Diffusion-Weighted Magnetic Resonance Imaging: A New Approach in Imaging-Guided Biopsies of Cervical Lesions Suspicious for Malignancy.

Marcos Duarte GUIMARAES ; Alex Dias de OLEVEIRA ; Eduardo Bruno Lobato MARTINS ; Rubens CHOJNIAK

Korean Journal of Radiology.2013;14(4):697-699. doi:10.3348/kjr.2013.14.4.697

No abstract available.
Biopsy, Needle/*methods ; Female ; Head and Neck Neoplasms/*pathology ; Humans ; Male ; Radiography, Interventional/*methods ; Tomography, X-Ray Computed/*methods

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Uncommon of the Uncommon: Malignant Perivascular Epithelioid Cell Tumor of the Lung.

Hyun Ju LIM ; Ho Yun LEE ; Joungho HAN ; Yong Soo CHOI ; Kyung Soo LEE

Korean Journal of Radiology.2013;14(4):692-696. doi:10.3348/kjr.2013.14.4.692

A perivascular epithelioid cell (PEC) tumor is a rare mesenchymal tumor characterized by abundant cytoplasmic Periodic acid-Schiff positive glycogen (also called sugar tumor or clear cell tumor of the lung for this characteristic) and is mostly benign. We report a case of a 63-year-old man who presented with an enlarging mass on chest radiograph. After a thorough workup, diagnosis of malignant pulmonary PEC tumor with lung to lung metastases was established. Herein, the difficulties of diagnosis and management we confronted are described.
Diagnosis, Differential ; Follow-Up Studies ; Humans ; Lung Neoplasms/*diagnosis/surgery ; Male ; Middle Aged ; Perivascular Epithelioid Cell Neoplasms/*diagnosis/surgery ; Pneumonectomy ; Positron-Emission Tomography/*methods ; Thoracic Surgery, Video-Assisted/methods ; Tomography, X-Ray Computed/*methods

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A Comparison of Two Commercial Volumetry Software Programs in the Analysis of Pulmonary Ground-Glass Nodules: Segmentation Capability and Measurement Accuracy.

Hyungjin KIM ; Chang Min PARK ; Sang Min LEE ; Hyun Ju LEE ; Jin Mo GOO

Korean Journal of Radiology.2013;14(4):683-691. doi:10.3348/kjr.2013.14.4.683

OBJECTIVE: To compare the segmentation capability of the 2 currently available commercial volumetry software programs with specific segmentation algorithms for pulmonary ground-glass nodules (GGNs) and to assess their measurement accuracy. MATERIALS AND METHODS: In this study, 55 patients with 66 GGNs underwent unenhanced low-dose CT. GGN segmentation was performed by using 2 volumetry software programs (LungCARE, Siemens Healthcare; LungVCAR, GE Healthcare). Successful nodule segmentation was assessed visually and morphologic features of GGNs were evaluated to determine factors affecting segmentation by both types of software. In addition, the measurement accuracy of the software programs was investigated by using an anthropomorphic chest phantom containing simulated GGNs. RESULTS: The successful nodule segmentation rate was significantly higher in LungCARE (90.9%) than in LungVCAR (72.7%) (p = 0.012). Vascular attachment was a negatively influencing morphologic feature of nodule segmentation for both software programs. As for measurement accuracy, mean relative volume measurement errors in nodules > or = 10 mm were 14.89% with LungCARE and 19.96% with LungVCAR. The mean relative attenuation measurement errors in nodules > or = 10 mm were 3.03% with LungCARE and 5.12% with LungVCAR. CONCLUSION: LungCARE shows significantly higher segmentation success rates than LungVCAR. Measurement accuracy of volume and attenuation of GGNs is acceptable in GGNs > or = 10 mm by both software programs.
Adult ; Aged ; *Algorithms ; Female ; Humans ; Lung Neoplasms/diagnosis ; Male ; Middle Aged ; Multidetector Computed Tomography/*methods ; *Phantoms, Imaging ; Reproducibility of Results ; Retrospective Studies ; *Software ; Solitary Pulmonary Nodule/*radiography

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Length and Volume of Morphologically Normal Kidneys in Korean Children: Ultrasound Measurement and Estimation Using Body Size.

Jun Hwee KIM ; Myung Joon KIM ; Sok Hwan LIM ; Jieun KIM ; Mi Jung LEE

Korean Journal of Radiology.2013;14(4):677-682. doi:10.3348/kjr.2013.14.4.677

OBJECTIVE: To evaluate the relationship between anthropometric measurements and renal length and volume measured with ultrasound in Korean children who have morphologically normal kidneys, and to create simple equations to estimate the renal sizes using the anthropometric measurements. MATERIALS AND METHODS: We examined 794 Korean children under 18 years of age including a total of 394 boys and 400 girls without renal problems. The maximum renal length (L) (cm), orthogonal anterior-posterior diameter (D) (cm) and width (W) (cm) of each kidney were measured on ultrasound. Kidney volume was calculated as 0.523 x L x D x W (cm3). Anthropometric indices including height (cm), weight (kg) and body mass index (m2/kg) were collected through a medical record review. We used linear regression analysis to create simple equations to estimate the renal length and the volume with those anthropometric indices that were mostly correlated with the US-measured renal sizes. RESULTS: Renal length showed the strongest significant correlation with patient height (R2, 0.874 and 0.875 for the right and left kidneys, respectively, p < 0.001). Renal volume showed the strongest significant correlation with patient weight (R2, 0.842 and 0.854 for the right and left kidneys, respectively, p < 0.001). The following equations were developed to describe these relationships with an estimated 95% range of renal length and volume (R2, 0.826-0.884, p < 0.001): renal length = 2.383 + 0.045 x Height (+/- 1.135) and = 2.374 + 0.047 x Height (+/- 1.173) for the right and left kidneys, respectively; and renal volume = 7.941 + 1.246 x Weight (+/- 15.920) and = 7.303 + 1.532 x Weight (+/- 18.704) for the right and left kidneys, respectively. CONCLUSION: Scatter plots between height and renal length and between weight and renal volume have been established from Korean children and simple equations between them have been developed for use in clinical practice.
Adolescent ; *Body Size ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Kidney/growth & development/*ultrasonography ; Male ; Organ Size ; Reference Values ; Republic of Korea ; Retrospective Studies

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Inflammatory Pseudotumor in the Mediastinum: Imaging with 18F-Fluorodeoxyglucose PET/CT.

Seok Ho YOON ; Sungsoo LEE ; Kyung Sook JO ; Dong Hyun LEE ; Young Sil AN ; Joon Kee YOON ; Su Jin LEE

Korean Journal of Radiology.2013;14(4):673-676. doi:10.3348/kjr.2013.14.4.673

Mediastinal inflammatory pseudotumor is a rare benign disease with its capability for local invasion and rapid growth. We present a case of middle-mediastinal inflammatory pseudotumor and report its contrast-enhanced chest computed tomography, 18F-fluorodeoxyglucose positron emission tomography/computed tomography and pathologic findings.
Adult ; Diagnosis, Differential ; Fluorodeoxyglucose F18/*diagnostic use ; Granuloma, Plasma Cell/*diagnosis ; Humans ; Male ; Mediastinal Diseases/*diagnosis ; Positron-Emission Tomography/*methods ; Radiopharmaceuticals/*diagnostic use ; Tomography, X-Ray Computed/*methods

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True Progression versus Pseudoprogression in the Treatment of Glioblastomas: A Comparison Study of Normalized Cerebral Blood Volume and Apparent Diffusion Coefficient by Histogram Analysis.

Yong Sub SONG ; Seung Hong CHOI ; Chul Kee PARK ; Kyung Sik YI ; Woong Jae LEE ; Tae Jin YUN ; Tae Min KIM ; Se Hoon LEE ; Ji Hoon KIM ; Chul Ho SOHN ; Sung Hye PARK ; Il Han KIM ; Geon Ho JAHNG ; Kee Hyun CHANG

Korean Journal of Radiology.2013;14(4):662-672. doi:10.3348/kjr.2013.14.4.662

OBJECTIVE: The purpose of this study was to differentiate true progression from pseudoprogression of glioblastomas treated with concurrent chemoradiotherapy (CCRT) with temozolomide (TMZ) by using histogram analysis of apparent diffusion coefficient (ADC) and normalized cerebral blood volume (nCBV) maps. MATERIALS AND METHODS: Twenty patients with histopathologically proven glioblastoma who had received CCRT with TMZ underwent perfusion-weighted imaging and diffusion-weighted imaging (b = 0, 1000 sec/mm2). The corresponding nCBV and ADC maps for the newly visible, entirely enhancing lesions were calculated after the completion of CCRT with TMZ. Two observers independently measured the histogram parameters of the nCBV and ADC maps. The histogram parameters between the true progression group (n = 10) and the pseudoprogression group (n = 10) were compared by use of an unpaired Student's t test and subsequent multivariable stepwise logistic regression analysis to determine the best predictors for the differential diagnosis between the two groups. Receiver operating characteristic analysis was employed to determine the best cutoff values for the histogram parameters that proved to be significant predictors for differentiating true progression from pseudoprogression. Intraclass correlation coefficient was used to determine the level of inter-observer reliability for the histogram parameters. RESULTS: The 5th percentile value (C5) of the cumulative ADC histograms was a significant predictor for the differential diagnosis between true progression and pseudoprogression (p = 0.044 for observer 1; p = 0.011 for observer 2). Optimal cutoff values of 892 x 10-6 mm2/sec for observer 1 and 907 x 10-6 mm2/sec for observer 2 could help differentiate between the two groups with a sensitivity of 90% and 80%, respectively, a specificity of 90% and 80%, respectively, and an area under the curve of 0.880 and 0.840, respectively. There was no other significant differentiating parameter on the nCBV histograms. Inter-observer reliability was excellent or good for all histogram parameters (intraclass correlation coefficient range: 0.70-0.99). CONCLUSION: The C5 of the cumulative ADC histogram can be a promising parameter for the differentiation of true progression from pseudoprogression of newly visible, entirely enhancing lesions after CCRT with TMZ for glioblastomas.
Adult ; Aged ; Brain Neoplasms/*pathology/physiopathology/therapy ; Cerebrovascular Circulation/*physiology ; Combined Modality Therapy ; Diagnosis, Differential ; Diffusion Magnetic Resonance Imaging/*methods ; Disease Progression ; Female ; Glioblastoma/*pathology/physiopathology/therapy ; Humans ; Male ; Middle Aged ; Prognosis ; ROC Curve ; *Regional Blood Flow ; Reproducibility of Results ; Retrospective Studies

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Anterior Commissure - Posterior Commissure Revisited.

Sang Han CHOI ; Je Geun CHI ; Young Bo KIM ; Zang Hee CHO

Korean Journal of Radiology.2013;14(4):653-661. doi:10.3348/kjr.2013.14.4.653

OBJECTIVE: The anterior commissure (AC) and posterior commissure (PC) are the two distinct anatomic structures in the brain which are difficult to observe in detail with conventional MRI, such as a 1.5T MRI system. However, recent advances in ultra-high resolution MRI have enabled us to examine the AC and PC directly. The objective of the present study is to standardize the shape and size of the AC and PC using a 7.0T MRI and to propose a new brain reference line. MATERIALS AND METHODS: Thirty-four, 21 males and 13 females, healthy volunteers were enrolled in this study. After determining the center of each AC and PC, we defined the connection of these centers as the central intercommissural line (CIL). We compared the known extra- and intra-cerebral reference lines with the CIL to determine the difference in the angles. Additionally, we obtained horizontal line from flat ground line of look front human. RESULTS: The difference in angle of the CIL and the tangential intercommissural line (TIL) from the horizontal line was 8.7 +/- 5.1 (11 +/- 4.8) and 17.4 +/- 5.2 (19.8 +/- 4.8) degrees in males and females, respectively. The difference in angle between the CIL and canthomeatal line was 10.1 in both male and female, and there was no difference between both sexes. Likewise, there was no significant difference in angle between the CIL and TIL between both sexes (8.3 +/- 1.1 in male and 8.8 +/- 0.7 in female). CONCLUSION: In this study, we have used 7.0T MRI to define the AC and PC quantitatively and in a more robust manner. We have showed that the CIL is a reproducible reference line and serves as a standard for the axial images of the human brain.
Adult ; Brain/*anatomy & histology ; Brain Mapping/methods ; Female ; Healthy Volunteers ; Humans ; Magnetic Resonance Imaging/*methods ; Male ; Reproducibility of Results ; Young Adult

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Hyperfunction Thyroid Nodules: Their Risk for Becoming or Being Associated with Thyroid Cancers.

Eun Sun LEE ; Ji Hoon KIM ; Dong Gyu NA ; Jin Chul PAENG ; Hye Sook MIN ; Seung Hong CHOI ; Chul Ho SOHN ; Ki Hyun CHANG

Korean Journal of Radiology.2013;14(4):643-652. doi:10.3348/kjr.2013.14.4.643

OBJECTIVE: To retrospectively evaluate the risk of thyroid cancer in patients with hyperfunctioning thyroid nodules through ultrasonographic-pathologic analysis. MATERIALS AND METHODS: Institutional review board approval was obtained and informed consent was waived. From 2003 to 2007, 107 patients consecutively presented with hot spots on thyroid scans and low serum thyroid-stimulating hormone levels. Among them, 32 patients who had undergone thyroid ultrasonography were analyzed in this study. Thyroid nodules depicted on ultrasonography were classified based on size and categorized as benign, indeterminate, or suspicious malignant nodules according to ultrasonographic findings. The thyroid nodules were determined as either hyperfunctioning or coexisting nodules and were then correlated with pathologic results. RESULTS: In 32 patients, 42 hyperfunctioning nodules (mean number per patient, 1.31; range, 1-6) were observed on thyroid scans and 68 coexisting nodules (mean, 2.13; range, 0-7) were observed on ultrasonography. Twenty-five patients (78.1%) had at least one hyperfunctioning (n = 17, 53.1%) or coexisting (n = 16, 50.0%) nodule that showed a suspicious malignant feature larger than 5 mm (n = 8, 25.0%), or an indeterminate feature 1 cm or greater (n = 20, 62.5%) in diameter, which could have been indicated by using fine needle aspiration (FNA). Seven patients were proven to have 11 thyroid cancers in 3 hyperfunctioning and 8 coexisting nodules. All of these had at least one thyroid cancer, which could have been indicated by using FNA. The estimated minimal risk of thyroid cancer was 6.5% (7/107). CONCLUSION: Patients with hyperfunctioning nodules may not be safe from thyroid cancer because hyperfunctioning nodules can coexist with thyroid cancer nodules. To screen out these cancers, ultrasonography should be performed.
Adult ; Biopsy, Fine-Needle ; Disease Progression ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Positron-Emission Tomography ; Retrospective Studies ; Risk Factors ; Thyroid Neoplasms/blood/*diagnosis ; Thyroid Nodule/blood/*diagnosis ; Thyrotropin/*blood

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Rapid Intra-Hepatic Dissemination of Hepatocellular Carcinoma with Pulmonary Metastases Following Combined Loco-Regional Therapy.

Uei PUA

Korean Journal of Radiology.2013;14(4):640-642. doi:10.3348/kjr.2013.14.4.640

This manuscript describes an unusual case of rapid intra-hepatic dissemination of hepatocellular carcinoma with pulmonary metastases occurring 1 month after combined chemoembolization and radiofrequency ablation. Inferior vena cava and portal vein invasion tumor thrombus was also detected, possibly accounting for the mechanism of disease dissemination route of disease.
Aged, 80 and over ; Antineoplastic Agents/administration & dosage/*adverse effects ; Biopsy ; Carcinoma, Hepatocellular/diagnosis/*secondary/therapy ; Catheter Ablation/*adverse effects ; Chemoembolization, Therapeutic/*adverse effects ; Cone-Beam Computed Tomography ; Fatal Outcome ; Humans ; Liver Neoplasms/*pathology/therapy ; Lung Neoplasms/diagnosis/*secondary ; Male

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Fluoroscopic Guided Fogarty Embolectomy for an Angio-Seal Embolism in the Popliteal Artery.

Doran HONG ; Seung Hwa LEE ; Hwan Hoon CHUNG ; Bo Kyoung SEO ; Sang Hoon CHA ; Kee Yeol LEE ; Jeong Cheon AHN

Korean Journal of Radiology.2013;14(4):636-639. doi:10.3348/kjr.2013.14.4.636

The Angio-Seal is a widely used arterial closure device that helps achieve faster hemostasis and provide early ambulation to patients. However, it can cause various complications in clinical practice. We present the uncommon complication of popliteal artery occlusion following Angio-Seal deployment, and describe an effective interventional approach to its treatment. Because fluoroscopy-guided Fogarty embolectomy has the advantages of complete removal of the embolus without fragmentation, and clear visualization of the exact location of the embolus during the procedure, it is a suitable method for treating this complication.
Embolectomy/*instrumentation ; Embolism/radiography/*surgery ; Equipment Design ; Fluoroscopy/*methods ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; *Popliteal Artery ; Surgery, Computer-Assisted/*methods

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