OBJECTIVE: To prospectively investigate predictors for good restoration of blood flow of below-the-knee (BTK) chronic total occlusions (CTOs) after endovascular therapy in diabetes mellitus (DM) patients. MATERIALS AND METHODS: A total of 120 long-segmental (≥ 5 cm) BTK, CTOs in 81 patients who underwent recanalization were included in this study. After angioplasty, blood-flow restoration was assessed using modified thrombolysis in myocardial ischemia grades and classified as good flow (grade 3) and poor flow (grade 1/2). One hundred and six CTOs with successful recanalization were divided into a good flow group (GFG; n = 68) and poor flow group (PFG; n = 38). Multivariate logistic regression analyses were undertaken to determine independent predictors of blood-flow restoration. Receiver operating characteristic curves were constructed to determine the best cutoff value. The prevalence of target-lesion restenosis during follow-up was compared between two groups. RESULTS: Univariate analyses suggested that CTOs in GFG were characterized by lighter limb ischemia (p = 0.03), shorter course of ischemic symptoms (p < 0.01) and lesion length (p = 0.04), more frequent use of intraluminal angioplasty (p = 0.03), and higher runoff score (p < 0.01) than those in PFG. Multivariate regression analyses suggested that distal runoffs (p = 0.001; odds ratio [OR], 10.32; 95% confidence interval [CI]: 4.082–26.071) and lesion length (p < 0.001; OR, 1.26; 95% CI: 1.091–1.449) were independent predictors for good flow restoration. Kaplan-Meier analyses at 12 months showed a higher prevalence of non-restenosis in GFG (p < 0.01). CONCLUSION: Distal runoffs and lesion length are independent predictors for good flow restoration for long-segmental BTK, CTOs in DM patients who receive endovascular therapy.
Angioplasty ; Diabetes Mellitus ; Extremities ; Follow-Up Studies ; Humans ; Ischemia ; Logistic Models ; Myocardial Ischemia ; Odds Ratio ; Prevalence ; Prospective Studies ; ROC Curve

Chlorfenapyr is a widely used, moderately hazardous pesticide. Previous reports have indicated that chlorfenapyr intoxication can be fatal in humans. We reported the first non-fatal case of chlorfenapyr-induced toxic leukoencephalopathy in a 44-year-old female with resolution of extensive and abnormal signal intensities in white matter tracts throughout the brain, brain stem, and spinal cord on serial magnetic resonance imaging.
Adult ; Brain/*radiography ; Brain Stem/radiography ; Female ; Humans ; Insecticides/*toxicity ; Leukoencephalopathies/*etiology/radiography ; *Magnetic Resonance Imaging ; Pyrethrins/*toxicity ; Spinal Cord/*radiography ; White Matter/radiography

Multidetector CT (MDCT) gastrography has been regarded as a promising technique for the preoperative imaging of gastric cancer. It has the ability to produce various three-dimensional (3D) images. Because 3D reconstruction images are more effective and intuitive for recognizing abnormal changes in the gastric folds and subtle mucosal nodularity than two-dimensional images, 3D MDCT gastrography can enhance the detection rate of early gastric cancer, which, in turn, contributes to the improvement of the accuracy of preoperative tumor (T) staging. In addition, shaded surface display and tissue transition projection images provide a global view of the stomach, with the exact location of gastric cancer, which may replace the need for barium studies. In this article, we discuss technical factors in producing high-quality MDCT gastrographic images and present cases demonstrating the usefulness of MDCT gastrography for the detection and T staging of gastric cancer while emphasizing the significance of preoperative localization of gastric cancer in terms of surgical margin.
Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Neoplasm Staging ; Stomach Neoplasms/pathology/*radiography/surgery ; Tomography, X-Ray Computed

Ultrasound-guided percutaneous radiofrequency (RF) ablation has become one of the most promising local cancer therapies for both resectable and nonresectable hepatic tumors. Although RF ablation is a safe and effective technique for the treatment of liver tumors, the outcome of treatment can be closely related to the location and shape of the tumors. There may be difficulties with RF ablation of tumors that are adjacent to large vessels or extrahepatic heat-vulnerable organs and tumors in the caudate lobe, possibly resulting in major complications or treatment failure. Thus, a number of strategies have been developed to overcome these challenges, which include artificial ascites, needle track ablation, fusion imaging guidance, parallel targeting, bypass targeting, etc. Operators need to use the right strategy in the right situation to avoid the possibility of complications and incomplete thermal tissue destruction; with the right strategy, RF ablation can be performed successfully, even for hepatic tumors in high-risk locations. This article offers technical strategies that can be used to effectively perform RF ablation as well as to minimize possible complications related to the procedure with representative cases and schematic illustrations.
Ascites ; Bile Duct Diseases/etiology ; Carcinoma, Hepatocellular/*surgery/ultrasonography ; Catheter Ablation/adverse effects ; Humans ; Liver Neoplasms/*surgery/ultrasonography ; Neoplasm, Residual/etiology

OBJECTIVE: To compare gadoxetic acid injection rates of 0.5 mL/s and 1 mL/s for hepatic arterial-phase magnetic resonance (MR) imaging. MATERIALS AND METHODS: In this prospective study, 101 consecutive patients with suspected focal liver lesions were included and randomly divided into two groups. Each group underwent dynamic liver MR imaging using a 3.0-T scanner after an intravenous injection of gadoxetic acid at rates of either 0.5 mL/s (n = 50) or 1 mL/s (n = 51). Arterial phase images were analyzed after blinding the injection rates. The signal-to-noise ratios (SNRs) of the liver, aorta, portal vein, hepatic vein, spleen, and pancreas were measured. The contrast-to-noise ratios (CNRs) of the hepatocellular carcinomas (HCC) were calculated. Finally, two experienced radiologists were independently asked to identify, if any, HCCs in the liver on the images and score the image quality in terms of the presence of artifacts and the proper enhancement of the liver, aorta, portal vein, hepatic vein, hepatic artery, spleen, pancreas, and kidney. RESULTS: The SNRs were not significantly different between the groups (p = 0.233-0.965). The CNRs of the HCCs were not significantly different (p = 0.597). The sensitivity for HCC detection and the image quality scores were not significantly different between the two injection rates (p = 0.082-1.000). CONCLUSION: Image quality and sensitivity for hepatic HCCs of arterial-phase gadoxetic acid-enhanced MR were not significantly improved by reducing the contrast injection rate to 0.5 mL/s compared with 1 mL/s.
Adult ; Aged ; Aged, 80 and over ; Artifacts ; Carcinoma, Hepatocellular/*radiography ; Contrast Media/*administration & dosage/*diagnostic use ; Dose-Response Relationship, Drug ; Female ; Gadolinium DTPA/*administration & dosage/*diagnostic use ; Hepatic Artery ; Humans ; Liver Neoplasms/*radiography ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; Prospective Studies ; Sensitivity and Specificity ; Signal-To-Noise Ratio

A case of intracranial ganglioneuroma arising from the trigeminal nerve in the pontine and cerebellopontine angle cistern, in a 44-year-old female, is presented with an emphasis on diffusion-weighted imaging findings. We will discuss on how the tumor in the very unusual location should be differentiated particularly focused on diffusion-weighted imaging findings.
Adult ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Diffusion Magnetic Resonance Imaging/*methods ; Female ; Ganglioneuroma/*pathology/surgery ; Humans ; Trigeminal Nerve/*pathology/surgery

OBJECTIVE: The purpose of this study was to establish a minimally invasive and reproducible protocol for estimating the gastrointestinal (GI) transit time in mice using barium and radiopaque markers. MATERIALS AND METHODS: Twenty 5- to 6-week-old Balb/C female mice weighing 19-21 g were used. The animals were divided into three groups: two groups that received loperamide and a control group. The control group (n = 10) animals were administered physiological saline (1.5 mL/kg) orally. The loperamide group I (n = 10) and group II (n = 10) animals were administered 5 mg/kg and 10 mg/kg loperamide orally, respectively. Thirty minutes after receiving the saline or loperamide, the mice was administered 80 microL of barium solution and six iron balls (0.5 mm) via the mouth and the upper esophagus by gavage, respectively. Afterwards, the mice were continuously monitored with fluoroscopic imaging in order to evaluate the swallowing of the barium solution and markers. Serial fluoroscopic images were obtained at 5- or 10-min intervals until all markers had been excreted from the anal canal. For analysis, the GI transit times were subdivided into intestinal transit times (ITTs) and colon transit times (CTTs). RESULTS: The mean ITT was significantly longer in the loperamide groups than in the control group (p < 0.05). The mean ITT in loperamide group II (174.5 +/- 32.3) was significantly longer than in loperamide group I (133.2 +/- 24.2 minute) (p < 0.05). The mean CTT was significantly longer in loperamide group II than in the control group (p < 0.05). Also, no animal succumbed to death after the experimental procedure. CONCLUSION: The protocol for our study using radiopaque markers and barium is reproducible and minimally invasive in determining the GI transit time of the mouse model.
Analysis of Variance ; Animals ; Barium Sulfate/pharmacology ; Contrast Media/administration & dosage ; Female ; Fluoroscopy ; Gastrointestinal Transit/*physiology ; Iron ; Loperamide/administration & dosage ; Mice ; Mice, Inbred BALB C ; Microscopy, Electron, Scanning ; Prostheses and Implants ; Reproducibility of Results ; Sodium Chloride/administration & dosage ; Surface Properties

OBJECTIVE: To compare the effectiveness of radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) with surgical resection in patients with a single hepatocellular carcinoma (HCC) ranging from 2 to 5 cm. MATERIALS AND METHODS: The study participants were enrolled over a period of 29 months and were comprised of 37 patients in a combined therapy group and 47 patients in a surgical resection group. RFA was performed the day after TACE, and surgical resection was performed by open laparotomy. The two groups were compared with respect to the length of hospital stay, rates of major complication, and rates of recurrence-free and overall survival. RESULTS: Major complications occurred more frequently in the surgical resection group (14.9%) than in the combined therapy group (2.7%). However, there was no statistical significance (p = 0.059). The rates of recurrence-free survival at 1, 2, 3 and 4 years were similar between the combined therapy group (89.2%, 75.2%, 69.4% and 69.4%, respectively) and the surgical resection group (81.8%, 68.5%, 68.5% and 65%, respectively) (p = 0.7962, log-rank test). The overall survival rates at 1, 2, 3 and 4 years were also similar between groups (97.3%, 86.5%, 78.4% and 78.4%, respectively, in the combined therapy group, and 95.7%, 89.4%, 84.3% and 80.3%, respectively, in the surgical resection group) (p = 0.6321, log-rank test). CONCLUSION: When compared with surgical resection for the treatment of a single HCC ranging from 2 to 5 cm, RFA combined with TACE shows similar results in terms of recurrence-free and overall survival rates.
Carcinoma, Hepatocellular/diagnosis/mortality/*therapy ; Catheter Ablation/*methods ; Chemoembolization, Therapeutic/*methods ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms/diagnosis/mortality/*therapy ; Male ; Middle Aged ; Neoplasm Recurrence, Local/epidemiology ; Neoplasm Staging ; Republic of Korea/epidemiology ; Retrospective Studies ; Survival Rate/trends ; Treatment Outcome

OBJECTIVE: To evaluate the value of apparent diffusion coefficient (ADC) histogram analysis for predicting tumor recurrence in patients with uterine cervical cancer treated with chemoradiation therapy (CRT). MATERIALS AND METHODS: Our institutional review board approved this retrospective study and waived informed consent from each patient. Forty-two patients (mean age, 56 +/- 14 years) with biopsy-proven uterine cervical squamous cell carcinoma who underwent both pre-treatment pelvic magnetic resonance imaging with a 3.0 T magnetic resonance scanner and concurrent CRT were included. All patients were followed-up for more than 6 months (mean, 36.4 +/- 11.9 months; range 9.0-52.8 months) after completion of CRT. Baseline ADC parameters (mean ADC, 25th percentile, 50th percentile, and 75th percentile ADC values) of tumors were calculated and compared between the recurrence and no recurrence groups. RESULTS: In the recurrence group, the mean ADC and 75th percentile ADC values of tumors were significantly higher than those of the no recurrence group (p = 0.043 and p = 0.008, respectively). In multivariate analysis, the 75th percentile ADC value of tumors was a significant predictor for tumor recurrence (p = 0.009; hazard ratio, 1.319). When the cut-off value of the 75th percentile ADC (0.936 x 10-3 mm2/sec) was used, the overall recurrence free survival rate above the cut-off value was significantly lower than that below the cut-off value (51.9% vs. 91.7%, p = 0.003, log-rank test). CONCLUSION: Pre-CRT ADC histogram analysis may serve as a biomarker for predicting tumor recurrence in patients with uterine cervical cancer treated with CRT.
Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents/*therapeutic use ; Biopsy ; Carcinoma, Squamous Cell/*diagnosis/drug therapy/radiotherapy ; Chemoradiotherapy ; Diagnosis, Differential ; Diffusion Magnetic Resonance Imaging/*methods ; Female ; Humans ; Middle Aged ; Neoplasm Recurrence, Local/*diagnosis ; Prognosis ; Retrospective Studies ; Time Factors ; Uterine Cervical Neoplasms/*diagnosis/drug therapy/radiotherapy

Portal vein thrombosis (PVT) is commonly associated with liver cirrhosis, irrespective of the presence of hepatocellular carcinoma (HCC). Given that malignant PVT is a poor prognostic factor in patients with HCC, it is important to differentiate malignant PVT from benign PVT. Because malignant PVT has been reported to be contiguous with parenchymal HCC, in most cases, the presence of PVT alone indicates a benign entity. We report the case of a patient with rapid progression of malignant PVT mimicking benign PVT but without definite parenchymal HCC on imaging modalities.
Carcinoma, Hepatocellular ; Disease Progression ; Humans ; Liver Cirrhosis ; Magnetic Resonance Imaging ; Portal Vein ; Thrombosis