OBJECTIVE: To compare the image quality of low-tube-voltage and low-iodine-concentration-contrast-medium (LVLC) computed tomography urography (CTU) with iterative reconstruction (IR) with that of conventional CTU. MATERIALS AND METHODS: This prospective, multi-institutional, randomized controlled trial was performed at 16 hospitals using CT scanners from various vendors. Patients were randomly assigned to the following groups: 1) the LVLC-CTU (80 kVp and 240 mgI/mL) with IR group and 2) the conventional CTU (120 kVp and 350 mgI/mL) with filtered-back projection group. The overall diagnostic acceptability, sharpness, and noise were assessed. Additionally, the mean attenuation, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and figure of merit (FOM) in the urinary tract were evaluated. RESULTS: The study included 299 patients (LVLC-CTU group: 150 patients; conventional CTU group: 149 patients). The LVLC-CTU group had a significantly lower effective radiation dose (5.73 ± 4.04 vs. 8.43 ± 4.38 mSv) compared to the conventional CTU group. LVLC-CTU showed at least standard diagnostic acceptability (score ≥ 3), but it was non-inferior when compared to conventional CTU. The mean attenuation value, mean SNR, CNR, and FOM in all pre-defined segments of the urinary tract were significantly higher in the LVLC-CTU group than in the conventional CTU group. CONCLUSION: The diagnostic acceptability and quantitative image quality of LVLC-CTU with IR are not inferior to those of conventional CTU. Additionally, LVLC-CTU with IR is beneficial because both radiation exposure and total iodine load are reduced.
Commerce ; Contrast Media* ; Humans ; Iodine ; Noise ; Prospective Studies ; Radiation Exposure ; Signal-To-Noise Ratio ; Urinary Tract ; Urography*

PURPOSE: PIK3CA is often mutated in a variety of malignancies, including colon, gastric, ovary, breast, and brain tumors. We investigated PIK3CA expression in gastric cancer and explored the relationships between the PIK3CA expression level and clinicopathological features as well as survival of the patients. MATERIALS AND METHODS: We examined PIK3CA expression in a tissue microarray of 178 gastric adenocarcinomas by immunohisto-chemistry and reviewed patients' medical records. RESULTS: In our study, 112 of the 178 gastric cancer patients displayed positive PIK3CA expression. Overexpression of PIK3CA was correlated with low grade differentiation (P=0.001), frequent lymphatic invasion (P=0.032), and high T stage (P=0.040). Patients with positive PIK3CA staining were more likely to display worse overall survival rate than those with negative PIK3CA staining, as determined by Kaplan-Meier survival analysis with log-rank test (P=0.047) and a univariate analysis using the Cox proportional hazard model (hazard ratio=1.832, P=0.051). CONCLUSIONS: Elevated PIK3CA expression was significantly correlated with tumor invasiveness, tumor phenotypes, and poor patient survival.
Adenocarcinoma ; Brain Neoplasms ; Breast ; Colon ; Female ; Humans ; Immunohistochemistry ; Medical Records ; Ovary ; Phenotype ; Proportional Hazards Models ; Stomach Neoplasms* ; Survival Rate

STUDY DESIGN: Retrospective study. PURPOSE: To investigate the relation between the progression of kyphotic deformity and magnetic resonance imaging (MRI) findings in conservatively treated stable thoracolumbar fractures. OVERVIEW OF LITERATURE: When treated conservatively, excessive progression of kyphotic deformity and vertebral compression can emerge during follow-up. We sought to identify predictors of vertebral body deformation using MR images. METHODS: The presence in MR images of anterior longitudinal ligament (AL) or posterior longitudinal ligament (PL) injury, superior or inferior endplate disruption, superior or inferior disc injury in fractured vertebral bodies, the existence of low signal intensity on T2 weighted images, and bone edema of intravertebral bodies were assessed. RESULTS: The presence of superior endplate disruption and a higher level of bone edema were found to cause the progressions of kyphotic angle (KA), wedge angle (WA), and anterior vertebral compression (AVC) rate. When AL or superior disc injury was observed, only KA increased meaningfully. When low signal intensity was present on T2 weighted images WA and AVC increased significantly, but PL injury, inferior endplate disruption, and inferior disc injury showed no notable correlation with kyphotic deformity progression. The risk factors found to be associated with an increase of KA to >5degrees were AL injury, superior endplate disruption, superior disc injury, and a bone edema level of over 1/3, and their associated risks versus no injury cases were 14.1, 3.7, 6.8, and 10.4-fold, respectively. CONCLUSIONS: AL injury, superior endplate and disc injury, or a high level of bone edema, were critical factors that determine kyphotic deformity progression.
Congenital Abnormalities ; Edema ; Follow-Up Studies ; Kyphosis* ; Longitudinal Ligaments ; Magnetic Resonance Imaging* ; Orthotic Devices ; Retrospective Studies ; Risk Factors ; Spinal Fractures

No abstract available.
Blepharoptosis* ; Dermoid Cyst* ; Humans

Fibrous pseudotumors are rare, benign fibroproliferative tumor-like lesions in the scrotum, and they most commonly arise from the tunica vaginalis testis (75%). There have been few reported cases of the fibrous pseudotumor of the tunica vaginalis testis with the radiologic findings, so we report on this rare case with focusing on the ultrasonographic findings. A 20-year-old man was admitted with a palpable mass in the right scrotum. On ultrasonography, multiple nodules were seen together with posterior shadowing along the inner surface of the scrotal wall. Fibrous pseudotumor arising from the tunica vaginalis testis was pathologically confirmed after surgical excision.
Humans ; Scrotum ; Shadowing (Histology) ; Testis ; Young Adult

PURPOSE: There are numerous opinions about the methods and usefulness of minimizing leg length discrepancies after hip arthroplasty. In this study, we tried to evaluate the usefulness of an intraoperative x-ray in addition to preoperative templating for minimizing leg length discrepancy. MATERIALS AND METHODS: We reviewed pre- and post-operative pelvis AP x-rays of 46 patients who underwent hip arthroplasty due to a traumatic femoral neck fracture or intertrochanteric fracture between May 2008 and February 2009. A leg length discrepancy is the difference in vertical distance between a horizontal line drawn along the bottom of the ischial tuberosities and the most inferior points of the lesser trochanter. It was measured in a pelvis AP x-ray. In each case, pre-operative templating was performed and an intraoperative pelvis AP x-ray was taken again to assess the accuracy of preoperative planning. Implant positions were readjusted when necessary. RESULTS: The mean post-operative leg-length discrepancy was 0.3 mm (SD, 3.1 mm). The range was from -5.8 mm to +5.9 mm. CONCLUSION: Combining preoperative templating and intraoperative x-rays is a useful method of minimizing leg length discrepancy during hip arthroplasty.
Arthroplasty ; Femoral Neck Fractures ; Femur ; Hip ; Humans ; Leg ; Pelvis

PURPOSE: We evaluated the usefulness of radiographic parameters for osteoporosis by analyzing the results of radiographic parameters determined by digital hip radiographs and bone mineral density T-scores, as assessed by Dual Energy X-ray Absorptiometry (DEXA). MATERIALS AND METHODS: The authors reviewed 100 subjects in the hip fracture group and 50 in the non-fracture control group. Digital hip radiographs were assessed to determine the values of Singh index, Canal-to-Calcar Ratio, and Cortical Thickness Index (CTI). Bone mineral density was assessed by DEXA. RESULTS: Intraclass Correlation Coefficient (ICC) results of the CTI were above 0.8 in the fracture group. Compared to the control group, the fracture group showed higher ICCs. Interobserver ICCs were especially lower in the control group. There were statistically significant correlations between CTI and DEXA (r=0.50~0.58, p<0.05). In the analysis of ROC curves, a mean threshold for CTI set a value of 0.54 (0.53~0.55), and mean sensitivity and specificity were 75.5% (69~79%) and 67.8% (65~78%), respectively. CONCLUSION: CTI showed reasonable reliability and correlation with DEXA results. CTI was a useful radiographic parameter to alert the surgeon to recommend referral for osteoporosis evaluation in elderly hip fracture patients.
Absorptiometry, Photon ; Aged ; Bone Density ; Hip ; Humans ; Osteoporosis ; Referral and Consultation ; ROC Curve ; Sensitivity and Specificity

PURPOSE: The purpose of this study is to set guidelines for the management of renal angiomyolipoma (AML), clinical prognosis according to tumor size, in association with tuberous sclerosis complex (TSC), multiplicity, radiographic finding, and treatment modality. MATERIALS AND METHODS: Between March 1998 and October 2008, 129 out of 254 patients with AML who underwent surgical intervention or angioembolization were enrolled. Diagnosis of AML was determined by the presence of a low attenuated component on CT imaging or by pathological confirmation. Indications of treatment were intractable pain, hematuria, suspicion of malignancy, large tumor size, spontaneous rupture, and radiographically equivocal tumors in which a differential diagnosis was needed to rule out malignancy. Parameters including age, sex, tumor size, multiplicity, radiographic characteristics, association with TSC, and treatment modality were reviewed. RESULTS: Age at presentation was 50.6 years and mean tumor size was 3.5 cm. Presentation symptoms were flank pain, hematuria, spontaneous rupture, and fatigue. 97 (75.2%) patients were incidentally discovered. 100 (77.5%) were females. 68 (52.7%) underwent nephron-sparing surgery (NSS), 35 (27.1%) radical nephrectomy, and 26 (20.2%) angioembolization. TSC was accompanied in 12 (9.3%) patients. No patient developed renal function impairment during the mean follow-up period of 64.8 months. Patients with TSC presented at a younger age, along with larger, bilateral, and multiple lesions. CONCLUSION: Significant differences in clinical manifestations and treatment outcomes were noted in respect to tumor characteristics, association with TSC, and treatment modality. Considering the benign nature of AML, these parameters ought to be considered when deciding upon active surveillance or prophylactic intervention.
Adult ; Angiomyolipoma/*pathology/*surgery/therapy ; Female ; Humans ; Kidney Neoplasms/*pathology/*surgery/therapy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Rapidly destructive coxarthrosis may be caused by osteoarthritis, osteonecrosis of the femoral head and rheumatoid arthritis, but its etiology has not been clarified. Rapidly destructive coxarthrosis generally occurs in old age patients and the patients clinically show severe pain, but a relatively preserved range of motion. Rapidly destructive coxarthrosis is characterized by a rapid destruction, resorption and subluxation of the femoral head, destruction of the articular area in the acetabulum, above 50% or 2 mm/year loss of the joint space and minimal osteophyte formation. The radiologic changes are dramatic and they may mimic neuropathic or septic arthritis. We report here on three cases of rheumatoid arthritis that had acute destruction of the hip joint and rapid resorption of the femoral head, and we also review the relevant medical literature. We recommend taking repetitive radiographs for rheumatoid arthritis patients who suffer with continuing severe hip pain.
Acetabulum ; Arthritis, Infectious ; Arthritis, Rheumatoid ; Head ; Hip ; Hip Joint ; Humans ; Hydrazines ; Joints ; Osteoarthritis ; Osteoarthritis, Hip ; Osteonecrosis ; Osteophyte ; Range of Motion, Articular

PURPOSE: We compared the efficacy of urine cytology, nuclear matrix protein 22 (NMP22), and fluorescence in situ hybridization (FISH) for the detection of bladder cancer. MATERIALS AND METHODS: Washing urine samples from 156 patients were evaluated for the detection of bladder cancer. Patients were divided into 3 groups. Group 1 was 106 patients with bladder cancer, group 2 was 30 patients with benign prostatic hyperplasia who underwent transurethral resection of the prostate without bladder cancer, and group 3 had gross hematuria without bladder cancer. The sensitivity and specificity of cytology, NMP22, and FISH were compared. NMP22 positivity was defined as > or =10U/ml. FISH was done with the UroVysion(R) system and FISH positivity was defined as > or =2 abnormal urothelial cells with an abnormal signal from any out of 4 probes. RESULTS: The overall sensitivity of urine cytology, NMP22, and FISH was 60.4%, 75.5%, and 84.9%, respectively (p<0.001). The overall specificity of cytology, NMP22, and FISH was 96.7%, 83.3%, and 93.3%, respectively (p=0.168). In group 3, the false-positive rates of cytology, NMP22, and FISH were 20.0%, 55.0%, and 10.0%, respectively. In these patients with gross hematuria, the false-positive rate with NMP22 was significantly higher than with cytology or FISH (p=0.004). The sensitivity of cytology, NMP22, and FISH in low-grade bladder cancer patients was 25.9%, 51.9%, and 77.8%, respectively, and that in pTa-1 bladder cancer patients was 40.6%, 65.6%, and 78.1%, respectively. In low-grade or in pTa-1 patients, the sensitivity of the three diagnostic tools was significantly different (low grade; p<0.001, pTa-1; p<0.001). CONCLUSIONS: FISH is more sensitive in low-grade bladder cancer than is urine cytology and can be used as a diagnostic tool for the detection of primary and recurrent bladder cancer. NMP22 was affected by gross hematuria and thus has limitations for screening of bladder cancer. However, it can be used to follow-up bladder cancer.
Carcinoma, Transitional Cell ; Fluorescence ; Hematuria ; Humans ; In Situ Hybridization ; In Situ Hybridization, Fluorescence ; Mass Screening ; Nuclear Matrix ; Nuclear Proteins ; Prostate ; Prostatic Hyperplasia ; Sensitivity and Specificity ; Urinary Bladder ; Urinary Bladder Neoplasms