Purpose: Macular edema including cystoid macular edema is one of the main causes of unfavorable visual outcomes after cataract surgery. The macular thickness and the occurrence of macular edema after uncomplicated cataract surgery was evaluated using optical coherence tomography (OCT) in this study. Methods: Macular map images were taken by OCT before surgery and at 1 week, 1 month, and 2 months postsurgery. The subjects were classified into two groups (group 1, patients with no macular edema; group 2, patients with macular edema). Group 2 was defined as increase in central macular thickness (CMT) by 30% compared with that before surgery. The risk factors for macular edema were evaluated. Group 2 was divided into two subgroups: subclinical macular edema (group 2A) and cystoid macular edema (group 2B) and they were assessed in terms of the clinical course of best-corrected visual acuity and CMT. Results: A total of 376 patients were enrolled in this study, of which 36 (9.57%, group 2) showed macular edema measured by OCT after the surgery. Univariate analysis for group 1 and 2 revealed that intracameral injection of epinephrine during phacoemulsification was associated with the development of macular edema. In group 2, five patients (1.33%) developed cystoid macular edema. Statistically significant differences in the clinical course of CMT were observed at 2 months (201.2 ± 23.1, 250.0 ± 29.8, and 371.0 ± 160.3 in group 1, group 2A, and group 2B, respectively; p < 0.001) and 1 month postoperatively (198.5 ± 23.6, 237.8 ± 40.9, and 314.0 ± 104.5 in group 1, group 2A, and group 2B, respectively; p < 0.001). Group 2B required additional treatment and eventually achieved best-corrected visual acuity of >0.2 with CMT in the normal range. Conclusions The intracameral injection of epinephrine may cause macular edema after uncomplicated cataract surgery. Examination of CMT using OCT is recommended for the early detection of macular edema.

Pancreatic surgery remains the only curative treatment for pancreatic neoplasms, and plays an important role in the management of medically intractable diseases. Since the original Whipple operation in the 20th century, surgical techniques have advanced, resulting in decreased postoperative complications and better clinical outcomes. Normal postoperative imaging findings vary greatly depending on the surgical technique used. Radiologists are required to be familiar with the normal postoperative imaging findings, in order to distinguish from postoperative complications or tumor recurrence. In this study, we briefly review a variety of surgical techniques for the pancreas, and present the normal postoperative computed tomography findings.
Pancreas ; Pancreatic Neoplasms ; Postoperative Complications ; Recurrence

OBJECTIVE: To validate the diffusion-weighted MRI (DWI) for differentiation of benign from malignant portal vein thrombosis. MATERIALS AND METHODS: The Institutional Review Board approved this retrospective study and waived informed consent. A total of 59 consecutive patients (52 men and 7 women, aged 40-85 years) with grossly defined portal vein thrombus (PVT) on hepatic MRI were retrospectively analyzed. Among them, liver cirrhosis was found in 45 patients, and hepatocellular carcinoma in 47 patients. DWI was performed using b values of 50 and 800 sec/mm2 at 1.5-T unit. A thrombus was considered malignant if it enhanced on dynamic CT or MRI; otherwise, it was considered bland. There were 18 bland thrombi and 49 malignant thrombi in 59 patients, including 8 patients with simultaneous benign and malignant PVT. Mean apparent diffusion coefficients (ADCs) of benign and malignant PVTs were compared by using Mann-Whitney U test. Diagnostic accuracy was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: The mean ADC ± standard deviation of bland and malignant PVT were 1.00 ± 0.39 × 10(-3) mm2/sec and 0.92 ± 0.25 × 10(-3) mm2/sec, respectively; without significant difference (p = 0.799). The area under ROC curve for ADC was 0.520. An ADC value of > 1.35 × 10(-3) mm2/sec predicted bland PVT with a specificity of 94.6% (95% confidence interval [CI]: 84.9-98.9%) and a sensitivity of 22.2% (95% CI: 6.4-47.6%), respectively. CONCLUSION: Due to the wide range and considerable overlap of the ADCs, DWI cannot differentiate the benign from malignant thrombi efficiently.
Carcinoma, Hepatocellular ; Diagnosis ; Diffusion ; Diffusion Magnetic Resonance Imaging ; Ethics Committees, Research ; Female ; Humans ; Informed Consent ; Liver Cirrhosis ; Magnetic Resonance Imaging* ; Male ; Portal Vein* ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Thrombosis ; Venous Thrombosis*

Medtronic CapSureFix MRI 5086 pacing lead (5086; Medtronic, Inc., Minneapolis, MN, USA) has been reported to be associated with increased cardiac perforation and lead dislodgement. This study aimed to compare the incidence of cardiac perforation and lead dislodgement within 30 days after pacemaker implantation between 5086 MRI lead and previous Medtronic CapSureFix Novus 5076 non-MRI pacing lead. This was a nationwide, multicenter retrospective study in which we compared the incidence of adverse events between 277 patients implanted with 5086 lead and 205 patients implanted with 5076 lead between March 2009 and September 2014. Cardiac perforation within 30 days of pacemaker implantation occurred in 4 patients (1.4%) with the 5086 lead and in no patient with the 5076 lead (P = 0.084). Lead dislodgement occurred in 8 patients (2.9%) with the 5086 lead and in 5 patients (2.4%) with the 5076 lead (P = 0.764). On multivariate logistic regression analysis, age was significantly associated with cardiac perforation. Congestive heart failure and implantation of right atrial (RA) lead at RA free wall or septum were significant factors for the incidence of lead dislodgement and lead revision. The incidence of cardiac perforation and lead dislodgement were not statistically different between the patients with 5086 lead and the patients with 5076 lead. However, careful attention for cardiac perforation may be needed when using the 5086 MRI lead, especially in elderly patients.
Aged ; Heart Failure ; Humans ; Incidence ; Logistic Models ; Magnetic Resonance Imaging ; Retrospective Studies

Chronic subdural hematoma (CSDH) is a collection of old blood and its breakdown products between the surface of the brain parenchyma and the outermost layer called the dura. The most common treatment option for primary CSDH is burr-hole trephination; however, the treatment method for recurrent CSDH is still widely debated. An arachnoid cyst (AC) is a sac filled with cerebrospinal fluid located between the brain or spinal cord and the arachnoid membrane, which is one of the three meninges covering the brain or spinal cord. Although it is rare, the cyst is associated with CSDH in juveniles, and the recurrence rate of CSDH increases in such cases. Much of the literature has supported the preventive role of middle meningeal artery (MMA) embolization in recurrent CSDH. We report a 13-year-old male patient with recurrent CSDH and AC where the early intervention of MMA embolization was proven effective in preventing the further recurrence of CSDH.
Adolescent ; Arachnoid Cysts ; Arachnoid* ; Brain ; Cerebrospinal Fluid ; Early Intervention (Education) ; Embolization, Therapeutic ; Hematoma, Subdural, Chronic* ; Humans ; Male ; Membranes ; Meningeal Arteries* ; Meninges ; Recurrence ; Spinal Cord ; Trephining

PURPOSE: To investigate the optimal blending percentage of adaptive statistical iterative reconstruction (ASIR) in a reduced radiation dose while preserving a degree of image quality and texture that is similar to that of standard-dose computed tomography (CT). MATERIALS AND METHODS: The CT performance phantom was scanned with standard and dose reduction protocols including reduced mAs or kVp. Image quality parameters including noise, spatial, and low-contrast resolution, as well as image texture, were quantitatively evaluated after applying various blending percentages of ASIR. The optimal blending percentage of ASIR that preserved image quality and texture compared to standard dose CT was investigated in each radiation dose reduction protocol. RESULTS: As the percentage of ASIR increased, noise and spatial-resolution decreased, whereas low-contrast resolution increased. In the texture analysis, an increasing percentage of ASIR resulted in an increase of angular second moment, inverse difference moment, and correlation and in a decrease of contrast and entropy. The 20% and 40% dose reduction protocols with 20% and 40% ASIR blending, respectively, resulted in an optimal quality of images with preservation of the image texture. CONCLUSION: Blending the 40% ASIR to the 40% reduced tube-current product can maximize radiation dose reduction and preserve adequate image quality and texture.
*Algorithms ; Artifacts ; Contrast Media/diagnostic use ; Humans ; *Phantoms, Imaging ; Radiation Dosage ; Radiographic Image Interpretation, Computer-Assisted/*methods ; Signal-To-Noise Ratio ; Tomography, X-Ray Computed

In the field of contrast-enhanced ultrasonography (US), contrast agents are classified as either first- or second-generation agents depending on the gas within the microbubbles. In the case of first-generation contrast agents, a high-mechanical-index technique is used and only intermittent scanning is possible due to the early destruction of the microbubbles during the scanning. The use of second-generation contrast agents in a low-mechanical-index technique enables continuous scanning. Besides the detection and characterization of focal liver lesions, contrast-enhanced US is helpful in the monitoring of radiofrequency ablation therapy and in the targeting step of an US-guided biopsy. Recently, there has been a demand for new criteria to evaluate the treatment response obtained using anti-angiogenic agents because morphologic criteria alone may not reflect the treatment response of the tumor and contrast-enhanced US can provide quantitative markers of tissue perfusion. In spite of the concerns related to its cost-effectiveness, contrast-enhanced US has the potential to be more widely used as a complimentary tool or to substitute the current imaging modalities in some occasions.
Abdomen ; Biopsy ; Catheter Ablation ; Contrast Media ; Image Enhancement ; Liver ; Microbubbles ; Perfusion ; Ultrasonography*

OBJECTIVE: The purpose of this study was to compare the in vivo anti-tumor efficacy of a mucoadhesive, lipid-based, oral paclitaxel formulation (DHP107) with traditional, intraperitoneal (IP) paclitaxel using an orthotopic mouse model of chemotherapy-sensitive SKOV3ip1 ovarian cancer. METHODS: To determine the optimal therapeutic dose of oral paclitaxel, DHP107 was administered per os to female athymic nude mice at 0, 25, or 50 mg/kg twice per week. Control mice received 100 microL saline once per week. IP injections of paclitaxel at 5 mg/kg once per week were used for comparison. To evaluate the potential therapeutic effect of metronomic DHP107 chemotherapy, mice received DHP107 50 mg/kg once per week per os, which was compared with 25 mg/kg twice per week and with vehicle-treated controls. RESULTS: Low-dose DHP107 (25 mg/kg) twice per week was as effective as IP paclitaxel (5 mg/kg once a week) but high-dose DHP107 (50 mg/kg once per week) was less effective at inhibiting tumor growth in an orthotopic mouse model (88%, 82%, and 36% decrease in tumor weight, respectively). Mice that received 25 mg/kg DHP107 twice per week or 50 mg/kg DHP107 once per week per os had a significant decrease in tumor weight compared with vehicle-treated controls (p<0.01, both doses). CONCLUSION: Metronomic oral chemotherapy with DHP107 showed anti-tumor efficacy in vivo similar to IP paclitaxel in an orthotopic mouse model.
Animals ; Drug Therapy ; Female ; Humans ; Mice* ; Mice, Nude ; Ovarian Neoplasms* ; Paclitaxel* ; Tumor Burden

PURPOSE: To assess the usefulness of rectal filling using ultrasonographic gel in patients with lower rectal cancer. MATERIALS AND METHODS: Twenty five patients with lower rectal cancer were enrolled. High resolution pelvic MR was performed twice before and after gel filling. Independently and retrospectively, two radiologists reviewed each set of MR images using five-grade scales for sphincter involvement, CRM (circumferential resection margin) involvement and depiction of the tumor. Same two radiologists retrospectively performed consensus review of each set of MR images for tumor distance from the anal verge and T&N staging. RESULTS: Tumor depiction scores from MR with gel filling were significantly higher than those of MR without distention (p<0.001). Compared to MR without distension, MR with gel filling had no significant differences in prediction of CRM or sphincter involvement (p>0.05). Distance from the anal verge was significantly different between MR with gel filling and rigid endoscopy (6.8 +/- 1.6 cm vs. 5.8 +/- 1.6 cm, p=0.001). There were no significant differences between pathological staging and MR staging with or without gel filling. CONCLUSION: MR with gel filling improved tumor depiction. And also MR with gel filling revealed same ability for the predictions of CRM or sphincter invasion in patients with lower rectal cancer, comparing with MR without gel filling.
Consensus ; Endoscopy ; Humans ; Rectal Neoplasms* ; Rectum ; Retrospective Studies ; Weights and Measures

OBJECTIVE: To evaluate the feasibility of sinogram-affirmed iterative reconstruction (SAFIRE) and automated kV modulation (CARE kV) in reducing radiation dose without increasing image noise for abdominal CT examination. MATERIALS AND METHODS: This retrospective study included 77 patients who received CT imaging with an application of CARE kV with or without SAFIRE and who had comparable previous CT images obtained without CARE kV or SAFIRE, using the standard dose (i.e., reference mAs of 240) on an identical CT scanner and reconstructed with filtered back projection (FBP) within 1 year. Patients were divided into two groups: group A (33 patients, CT scanned with CARE kV); and group B (44 patients, scanned after reducing the reference mAs from 240 to 170 and applying both CARE kV and SAFIRE). CT number, image noise for four organs and radiation dose were compared among the two groups. RESULTS: Image noise increased after CARE kV application (p < 0.001) and significantly decreased as SAFIRE strength increased (p < 0.001). Image noise with reduced-mAs scan (170 mAs) in group B became similar to that of standard-dose FBP images after applying CARE kV and SAFIRE strengths of 3 or 4 when measured in the aorta, liver or muscle (p > or = 0.108). Effective doses decreased by 19.4% and 41.3% for groups A and B, respectively (all, p < 0.001) after application of CARE kV with or without SAFIRE. CONCLUSION: Combining CARE kV, reduction of mAs from 240 to 170 mAs and noise reduction by applying SAFIRE strength 3 or 4 reduced the radiation dose by 41.3% without increasing image noise compared with the standard-dose FBP images.
Adult ; Aged ; Aged, 80 and over ; *Algorithms ; Equipment Design ; Female ; Humans ; Male ; Middle Aged ; Multidetector Computed Tomography/adverse effects/*instrumentation ; Radiation Dosage ; Radiation Injuries/etiology/*prevention & control ; Radiographic Image Interpretation, Computer-Assisted/*methods ; Radiography, Abdominal/adverse effects/*methods ; Retrospective Studies