Vernet syndrome involves the IX, X, and XI cranial nerves and is most often attributable to malignancy, aneurysm or skull base fracture. Although there have been several reports on Vernet's syndrome caused by fracture and inflammation, cases related to varicella-zoster virus are rare and have not yet been reported in South Korea. A 32-year-old man, who complained of left ear pain, hoarse voice and swallowing difficulty for 5 days, presented at the emergency room. He showed vesicular skin lesions on the left auricle. On neurologic examination, his uvula was deviated to the right side, and weakness was detected in his left shoulder. Left vocal cord palsy was noted on laryngoscopy. Antibody levels to varicella-zoster virus were elevated in the serum. Electrodiagnostic studies showed findings compatible with left spinal accessory neuropathy. Based on these findings, he was diagnosed with Vernet syndrome, involving left cranial nerves, attributable to varicella-zoster virus.
Aneurysm ; Cranial Nerves ; Deglutition ; Ear ; Emergencies ; Herpesvirus 3, Human ; Inflammation ; Laryngoscopy ; Neurologic Examination ; Republic of Korea ; Shoulder ; Skin ; Skull Base ; Uvula ; Vocal Cord Paralysis ; Voice

PURPOSE: To compare the image quality of UGIS (upper gastrointestinal series) obtained by direct radiography with that of UGIS obtained by indirect radiography in a mass screening program for gastric cancer, and to assess the validity of UGIS by indirect radiography. MATERIALS AND METHODS: A total of 994 persons participated in a mass screening test for gastric cancer between March 2003 and April 2003 at the Korea Association of Health Promotion (KAHP). Of these 994 persons, 494 underwent UGIS by direct radiography, while the remaining 500 underwent UGIS by indirect radiography (i.e. photofluorography using a mirror camera and a 100 mm-roll film). We compared the image quality of UGIS obtained by direct and indirect radiography with, in each case, the image quality being graded as 'excellent', 'good', 'fair', 'poor' or 'very poor'. RESULTS: The image quality of UGIS by both direct and indirect radiography was similar: most images in both groups were rated as either 'excellent', 'good', or 'fair', while the incidences of poorly rated images were similar in both cases (5% versus 6%, respectively); and there were no images rated as 'very poor' in either case. For certain sites of the stomach, the image quality of UGIS by direct radiography was superior to that of UGIS by indirect radiography, namely at the cardia (p<0.001) and duodenum (p=0.001). However, for other sites of the stomach, the image quality of UGIS by both direct and indirect radiography was similar, namely at the body (p=0.043) and pylorus (p>0.05). CONCLUSION: There was no significant difference in the image quality between UGIS by indirect and direct radiography. Therefore, UGIS by indirect radiography may be used as a method of mass screening for gastric cancer.
Barium ; Cardia ; Duodenum ; Early Detection of Cancer ; Health Promotion ; Humans ; Incidence ; Korea ; Mass Screening* ; Photofluorography ; Pylorus ; Radiography* ; Stomach ; Stomach Neoplasms*

OBJECTIVE: To determine the accuracy of CT and positron emission tomography (PET) in the diagnosis of recurrent uterine cervical cancer. MATERIALS AND METHODS: Imaging findings of CT and PET in 36 patients (mean age, 53 years) in whom recurrent uterine cervical cancer was suspected were analyzed retrospectively. Between October 1997 and May 1998, they had undergone surgery and/or radiation therapy. Tumor recurrence was confirmed by pathologic examination or follow-up studies. RESULTS: In detecting recurrent uterine cervical cancer, the sensitivity, specificity, and accuracy of CT were 77.8%, 83.3%, and 80.5%, respectively, while for PET, the corresponding figures were 100%, 94.4%, and 97.2%. The Chisquare test revealed no significant difference in specificity (p = .2888), but significant differences in sensitivity (p = .0339) and accuracy (p = .0244). CONCLUSION: PET proved to be a reliable screening method for detecting recurrent uterine cervical cancer, but to determine the anatomical localization of recurrent tumors, and thus decide an adequate treatment plan, CT was eventually needed.
Adult ; Cervix Neoplasms/*radiography/*radionuclide imaging ; Comparative Study ; Contrast Media ; Female ; Fludeoxyglucose F 18/diagnostic use ; Human ; Middle Age ; Neoplasm Recurrence, Local/*radiography/*radionuclide imaging ; Radiopharmaceuticals/diagnostic use ; Sensitivity and Specificity ; *Tomography, Emission-Computed ; *Tomography, X-Ray Computed

PURPOSE: To assess the diagnostic accuracy and limitations of double contrast esophagography in patients with superficial esophageal cancer, as compared with endoscopic, gross and microscopic findings. MATERIALS AND METHODS: In 43 patients with pathologically proven superficial esophageal cancer, the detection rate and diagnostic accuracy of double contrast esophagography and endoscopy were compared. The depth of invasion revealed by esophagography, and grossly and microscopically in resected specimens, was compared. RESULTS: The detection rate and diagnostic accuracy were, respectively, 86.0% and 76.7% for esophagography, and 100% and 95.3% for endoscopy. In addition, very different detection rates (54.6% and 100%, respectively) were noted for epithelial and mucosal lesions. In flat-type cases (0-IIb), esophagography showed limited ability to detect lesions, but the accuracy of this modality in predicting the depth of tumor invasion was relatively high (94.6%). CONCLUSION: In cases of superficial esophageal cancer, double contrast esophagography showed a lower detection rate and lower diagnostic accuracy than endoscopy, and this was especially so for epithelial and mucosal lesions. The modality was able, however, to reliably predict the depth of tumor invasion.
Diagnosis* ; Endoscopy* ; Esophageal Neoplasms* ; Humans

PURPOSE: The purpose of our study was to identify the CT findings that help detect pleural dissemination from lung cancer and to evaluate the usefulness of selected diagnostic criteria. MATERIALS AND METHODS: After a computerized database search of 606 patients who had undergone thoracotomy for primary lung cancer, 23 patients were identified as h aving surgically documented pleural dissemination. From the same database, 50 patients without pleural dissemination during thoracotomy were randomly selected as controls. Preoperative CT scans and medical records were rev i ewed retrospectively, and findings were compared between the two groups. RESULT: One or more of three types of pleural thickening (plaque-like, nodular, and fissural) were identified on CT as the most discriminating finding (sensitivity, 74 % ; specificity, 60 %; p = 0.007). The following findings were also significantly discriminating (p<0.05): contiguity of primary tumor with the pleural surface as seen on CT; adenocarcinoma in cell type; and a peripheral tumor defined as one in which bronchoscopy revealed no endobronchial lesion. The use of combinations of these findings in addition to pleural thickening rendered diagnostic criteria more specific at the cost of the sensitivity. CONCLUSION: During preoperative CT evaluation of lung cancer, the recognition of subtle pleural thickening helps detect pleural dissemination. The likelihood that subtle pleural thickening represents pleural dissemination is increased when a primary tumor is contiguous with the pleural surface, is an adenocarcinoma, or is peripherally located.
Adenocarcinoma ; Bronchoscopy ; Humans ; Lung Neoplasms* ; Lung* ; Medical Records ; Retrospective Studies ; Sensitivity and Specificity ; Thoracotomy ; Tomography, X-Ray Computed

PURPOSE: To evaluate the MR imaging findings of chondroblastic osteosarcoma. MATERIALS AND METHODS: Weincluded 11patients (8 men, 3 women, mean age of 19 years) with pathologically proven chondroblastic osteosarcomaand, as a control group, 20 patients with conventional osteosarcoma. We obtained pre- and post-enhanced MR imagesof all patients and retrospectively reviewed the signal intensity and enhancement pattern of tumors. MR imageswere correlated with histopathology. RESULT: In chondroblastic osteosarcomas, the major portion (< 75%) of thetumor showed low signal intensity on T1-weighted images and homogeneous high signal intensity on T2-weightedimages, but did not show enhancement. The margin of the area showed a lobular pattern. Enhanced nodules (n=11) andstrands (n=8) were seen in the nonenhanced portion. Histopathologically, the nonenhanced portion, nodules, andstrands revealed a chondroid matrix, hypercellular area, and fibrovascular septa, respectively. Conventionalosteosarcomas showed heterogeneous enhancement ; six showed a focal (<25%) nonenhanced area representing necrosis. CONCLUSION: Chondroblastic osteosarcoma showed characteristic MR imaging findings.
Chondrocytes* ; Female ; Humans ; Magnetic Resonance Imaging* ; Male ; Necrosis ; Osteosarcoma* ; Retrospective Studies

PURPOSE: To evaluate the MR imaging findings of liposarcomas of different histologic subtypes. MATERIALS AND METHODS: We evaluated MR images of 21 patients (5 men and 16 women, mean age, 55 years) with liposarcoma andcorrelated the findings with the results of histopathology. In the study group seven liposarcomas werewell-differentiated, seven were myxoid, three were mixed, two were pleomorphic, and one was round cell. RESULTS: On T1 -and T2 - weighted images, six of seven well-differentiated liposarcomas showed signal intensity equal tothe fat and hypointense septa, while the other showed low signal intensity on a T1 -weighted image, heterogeneoushigh signal intensity on a T2- weighted image, heterogeneous enhancement after the administration of contrastmedia and was dedifferentiate. Nine masses in seven patients with myxoid liposarcoma showed low signal intensityon T1-weighted images, six of the nine showed lace-like foci of high signal intensity. On T2 -weighted images, allmasses showed homogeneous high signal intensity. After administration of contrast media, five of seven massesshowed heterogeneous enhancement. Two of three mixed form were well-differentiated and myxoid types, and twosubtypes were separable on MR. Pleomorphic, round cell, mixed type myxoid and pleomorphic and unclassified casesshowed low signal intensity on T1-weighted images, heterogeneous high signal intensity on T2-weighted andheterogeneous enhancement. CONCLUSION: Using MR imaging, well-differentiated and myxoid liposcarcomas may bedifferentiated from other types.
Contrast Media ; Female ; Humans ; Liposarcoma* ; Liposarcoma, Myxoid ; Magnetic Resonance Imaging ; Male

PURPOSE: To evaluate MR imaging findings of joint involvement in patients with osteosarcoma MATERIALS AND METHODS: Among 166 patients with osteosarcoma treated between January 1993 and July 1998, 67(44 men and 23 women,mean age 20 years) whose tumors had invaded the epiphysis were included in this study. Those with preserved normalbone marrow signal intensity between the tumor and cortical bone were excluded. Tumors were located around theknee (n=52), the hip (n=7), the shoulder (n=5), the ankle (n=2), or the wrist (n=1). For all patients,pre-operative spin echo pre- and post-contrast enhanced MR images were obtained. In all cases, we assessed thepresence or abscence of intrasynovial mass, intraarticular disruption of cortical bone and articular cartilage,and joint effusion, and also evaluated the mass around the cruciate ligaments of the knee. All patients underwentsurgery and MR findings were correlated with the results of pathologic examinations. RESULTS: In six patients thetumor was found to involve the knee joint. Sensitivity and specificity for the intrasynovial mass (n= 6),intraarticular disruption of cortical bone and articular cartilage (n= 19), mass around the cruciate ligaments (n=7), and joint effusion (n= 12) were 83.3%, 100%, 83.3%, 33.3% and 98.4%, 78.7%, 95.6%, 83.6%, respectively, whileaccuracy for the intrasynovial mass and mass around the cruciate ligaments was 97% and 94.2% respectively. CONCLUSION: If MR imaging indicates the presence of a mass in the synovial cavity or around the cruciateligaments, this is suggestive MR findings of joint involvement.
Ankle ; Bone Marrow ; Bone Neoplasms ; Cartilage, Articular ; Epiphyses ; Hip ; Humans ; Joints* ; Knee ; Knee Joint ; Ligaments ; Magnetic Resonance Imaging* ; Male ; Osteosarcoma* ; Sensitivity and Specificity ; Shoulder ; Wrist

PURPOSE: To evaluate the role of enhanced MR imaging in monitoring tumor response to preoperativechemotherapy for osteosarcomas. MATERIALS AND METHODS: Fo r t y - s even patients (30 males and 17 females, witha mean age 17 years ; range 8 -44 years) with osteosarcomas were included in this study. We obtained spin echoT1-, T2-, and enhanced T1-weighted images before and after pre-operative chemotherapy and in all patientscorrelated changes in MR parameters with histopathologic response. We also obtained 19 specimen MR images,correlating these with histopathologic results in order to estimate tissue specific signals. Patients with morethan 10% viable tumor in the resected specimen were considered poor respon-ders(n=26), while those with 10% orless viable tumor were considered good respon-ders(n=21). RESULTS: Four distinct patterns of signal intensitycorresponded, respectively to dead bone and dense fibrosis (low on T1- and T2-weighted images), viable tumor cells(in-termediate on T1- and high on T2-weighted images), necrosis (low on T1- and high on T 2 - weighted images),and hemorrhage (high on T1- and T2-weighted images), but a wide range of overlap was noted. In all four groups,viable tumor cells remained. Increased tumor vo l u m e, stable or increased edema and enhancement were goodpre-dictors of poor response (predictive values of 83%, 77%, and 89%, respectively). Decreased enhancement was theonly reliable predictor of good response (predictive value, 73%). Changes in tumor margin, homogeneity, signalintensity, and joint effu-sion did not correlate with histopathologic response. CONCLUSION: Signal intensities donot reflect histologic nature. Enhanced MR imaging is a useful predictor of tumor response to preoperativechemotherapy.
Drug Therapy* ; Edema ; Female ; Fibrosis ; Hemorrhage ; Humans ; Joints ; Magnetic Resonance Imaging* ; Male ; Necrosis ; Osteosarcoma*

PURPOSE: To evaluate factors influencing the CT assessment of mediastinal lymph node metastasis in patientswith non-small cell lung cancer. MATERIALS AND METHODS: CT scans of 198 patients who had undergone thoracotomyand mediastinal lymph node dissection for non-small cell lung cancer were retrospectively evaluated using a sizecriterion of > or = 10mm in the short axis. To evaluate the accuracy of CT in diagnosing lymph node metastasis on anodal station-by-station basis, CT and pathological results were correlated. Analysis included a comparison of thesensitivity and specificity of CT according to 1) cell type of tumor, squamous cell carcinoma versusadenocarcinoma (excluding bronchioloalveolar cell carcinoma) ; 2) histologic differentiation;3) tumor size;4)central and peripheral of the tumor;5) the presence or absence of obstructive pneumonitis and/or atelectasis;6)the presence or absence of prior granulomatous disease. RESULTS: The overall sensitivity, Specificity, positive predictive value, and negative predictive value of CT in diagnosing mediastinal lymph node metastasis were 65%,84%, 43%, and 93%, respectively. Sensitivity for squamous cell carcinoma (72%) was significantly higher than thatfor adenocarcinoma(44%)(p<0.01). Higher specificities were noted in patients without obstructive pneumonitisand/or atelectasis(91% versus 75%)(P<0.01), and with a peripherally located tumor (90% versus 82%)(P<0.01).sensitivity and specificity were not appreciably altered by other variables. CONCLUSION: In the CT assessment ofmediastinal lymph node metastasis the cell type of adenocarcinoma adversely affected sensitivity, with a highfrequency of normal-sized metastatic nodes. Obstructive pneumonitis caused by central tumor adversely affectedspecificity with the frequent occurrence of hyperplastc nodes.
Adenocarcinoma ; Axis, Cervical Vertebra ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Humans ; Lung Neoplasms* ; Lung* ; Lymph Node Excision ; Lymph Nodes* ; Neoplasm Metastasis* ; Pneumonia ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed