Purpose To analyze the sources of errors and discuss the techniques to eliminate pitfalls in detecting deep vein thrombosis (DVT) of the proximal lower extremities with color duplex ultrasonography (CDUS). Methods Sixty-eight cases with initial and repeat venous CDUS of the proximal lower extremities were retrospectively reviewed. The repeat was done within 24 hours after initial CDUS scanning. Comparing repeated images to initial ones, the pitfalls and sources of error in CDUS of the proximal lower extremities were discussed. Results In total 68 repeat studies, there were 62 results as same as initials and 4 cases of false negative DVT and 2 cases of false positive DVT. Conclusion Venous CDUS in detecting DVT is observer dependent. Some pitfalls and errors can be eliminated and corrected with proper scan techniques. CDUS is the most valuable imaging modality for assessing suspected DVT in the proximal lower extremities.

OBJECTIVE: To evaluate the usefulness of MR imaging for diseases of the small intestine, emphasizing a comparison with CT. MATERIALS AND METHODS: Thirty-four patients who underwent both CT and MR imaging using FLASH 2D and HASTE sequences were analyzed. All patients had various small bowel diseases with variable association of peritoneal lesions. We compared the detectabilities of CT and MR imaging using different MR pulse sequences. The capability for analyzing the characteristics of small intestinal disease was also compared. RESULTS: MR imaging was nearly equal to CT for detecting intraluminal or peritoneal masses, lesions in the bowel and mesentery, and small bowel obstruction, but was definitely inferior for detecting omental lesions. The most successful MR imaging sequence was HASTE for demonstrating bowel wall thickening, coronal FLASH 2D for mesenteric lesions, and axial FLASH 2D for omental lesions. MR imaging yielded greater information than CT in six of 12 inflammatory bowel diseases, while it was equal to CT in six of seven neoplasms and inferior in five of seven mesenteric ischemia. In determining the primary causes of 15 intestinal obstructions, MR imaging was correct in 11 (73%) and CT in nine (60%) patients. CONCLUSION: MR imaging can serve as an alternative diagnostic tool for patients with suspected inflammatory bowel disease, small intestinal neoplasm or obstruction. is a high-speed, heavily T2-weighted sequence with a great sensitivity for fluid (11). This advance may make it possible to use breath-hold turbo spin-echo MR.
Comparative Study ; Female ; Human ; Inflammatory Bowel Diseases/*diagnosis ; Intestinal Neoplasms/*diagnosis ; Intestinal Obstruction/*diagnosis ; Intestine, Small/*pathology ; *Magnetic Resonance Imaging ; Male ; Middle Age ; *Tomography, X-Ray Computed

Cavernous hemangioma is the most common benign hepatic tumor. Typically, the most common features revealed by ultrasound(US) include its small size(4cm or less in diameter), uniform hyperechogenicity, welldefined margins, position in the subcapsular region of the right lobe of the liver, and some posterior echo enhancement. In addition, follow-up scanning may reveal changes in size, though this is rare. The US findings of hepatic hemangiomas may vary, however, especially when lesions are large and/or multiple. For that reason, differential diagnosis between this condition and hepatocellular carcinomas, metastatic lesions, lymphomas and other tumors is difficult. An understanding of the various sonographic findings of hepatic hemangioma can facilitate the early detection of the condition.
Carcinoma, Hepatocellular ; Classification* ; Diagnosis, Differential ; Follow-Up Studies ; Hemangioma* ; Hemangioma, Cavernous ; Liver ; Lymphoma ; Ultrasonography

Vascular complications after liver transplantation may involve the hepatic artery, and hepatic and portal veins. Arterial complications are common and significant vascular complications include thrombosis or stenosis, as well as pseudoaneurysms. Venous complications include thrombisis or stenosis of the inferior vena cana, or hepatic or portal vein. Since recent evidence has shown that emergent revascularization leads to improved graft salvage and patient survival with a relatively low rate of late biliary complications, accurate and pronpt di-agnosis of hepatic arterial complications is important. Doppler US is a relatively inexpensive, accurate, and non-invasive method of diagnosing the vascular complications which may arise from liver transplantation.
Aneurysm, False ; Constriction, Pathologic ; Hepatic Artery ; Humans ; Liver Transplantation* ; Liver* ; Portal Vein ; Thrombosis ; Transplants

Abdominal actinomycosis is a chronic, progressive, suppurative disease with a fa-vorable response tointravenous treatment with penicillin. In many instances, howev-er, its clinical and radiological findings mayoverlap with those of other inflammatory and neoplastic conditions, and the familiarity with the variousradiological features can thus avoid diagnostic delay s. The purpose of this paper is to describe and discuss theCT findings of abdominal actinomycosis.
Actinomycosis* ; Penicillins ; Recognition (Psychology)

Zollinger-Ellison syndrome (ZES) involves hypergastinemia produced by a gastrin-secreting tumor. Not only can it cause an ulcer but may also behave as a malignant lesion, metastasizing to the liver or other organs. The development of potent antisecretory agents for controlling acid secretion as well as techniques for localizing these islet cell tumors, has led to greatly improved survival rates. We describe a case of Zollinger-Ellison syndrome, emphasising the radiologic findings, and including a review of the literature.
Adenoma, Islet Cell ; Liver ; Survival Rate ; Ulcer ; Zollinger-Ellison Syndrome*

PURPOSE: To determine differences in angiographic variations of the circle of Willis between atherosclerosis and normal groups. MATERIALS AND METHODS: In 289 patients we reviewed complete cerebral angiograms obtained using biplane digital subtraction angiography. Atherosclerosis was diagnosed in 189 patients, while 100 were normal. Patients were divided into four subgroups according to the relative size of each segment and the presence of cross-filling of opposite-sided vessels. When the circle was completely present, we determined whether or not it was balanced, and statistically compared variation patterns between the two groups. RESULTS: In the atherosclerosis group, the anterior half of the circle was complete in 74% of cases(139/189), and the posterior half in 38% (72/189). In the normal group, the anterior half was complete in 90% of cases, and the posterior half in 63%. An incomplete circle was more common in the atherosclerosis group than among normal subjects (26% vs 10%, p<.05; 62% vs 37%, p<.001). In the atherosclerosis group with incomplete circle, agenesis was found in the anterior communicating artery in 19% of cases (36/189), the A1 segment in 7% (14/189), the posterior communicating artery in 58% (109/189), and the P1 segment in 7% (14/189). In the normal group with incomplete circle, agenesis was seen in the anterior communicating artery in 9% of cases, in the A1 segment in 1%, in the posterior communicating artery in 36%, and in the P1 segment in 3%. Agenesis of the anterior communicating artery (19% vs 9%, p<.05), the A1 segment (7% vs 1%, p<.05), or the posterior communicating artery (58% vs 36%, p<.001) was more common in the atherosclerosis group than in the normal group. Unbalanced type with a size discrepancy between A1 segments was also more common in the atherosclerosis group (19% vs 8%, p<.05). There was no significant difference between the two groups regarding posterior communicating arteries equal to or larger than the P1 segment (42% vs 27%, p>.05) and agenesis of the P1 segment (7% vs 3%, p>.05). CONCLUSION: An incomplete and unbalanced circle of Willis was more common in the atherosclerosis group than in the normal group. Agenesis of the anterior communicating artery, the A1 segment, or the posterior communicating artery was common in the atherosclerosis group, as was size discrepancy between A1 segments.
Angiography, Digital Subtraction ; Arteries ; Atherosclerosis* ; Circle of Willis* ; Humans ; Intracranial Arteriosclerosis

PURPOSE: To evaluate angiographic variations of the circle of Willis in a normal group, and to compare thepattern of these variations between normal and aneurysm groups. MATERIALS AND METHODS: We reviewed 220 cases inwhich subjects had undergone digital subtraction cerebral angiography which showed the circle of Willis in itsentirety. One hundred patients were diagnosed as normal, and 110 had an aneurysm. We reviewed the absence orpresence and relative size of each segment, and the configuration of the distal basilar artery. Where the circlewas complete, we evaluated whether or not the circle was balanced. And we compared the pattern of these variationsbetween the two groups. RESULTS: In the normal group, the most common pattern was a small anterior communicatingartery with symmetrically large A1 segments in the anterior circulation (27%) and symmetrically small posterior communicating arteries with large P1 segments in the posterior circulation (39%). The anterior half of the circlewas complete in 90% of cases, and the posterior half in 63%. In cases in which it was incomplete, there wasagenesis of the anterior communicating artery in 9% of cases, of the A1 segment in 1%, of the posterior communicating artery in 36%, and of the P1 segment in 3%. Unilateral absence of the posterior communicating arteryand P1 segment was noted in two cases. In the distal basilar artery, symmetric cranial fusion was most common,accounting for 77% of cases. In contrast, incomplete circles with agenesis of the A1 (1% vs 12%, p<.05) or P1segment (3% vs 10%, p<.05) were more common in the aneurysm group than among normal subjects. Unbalanced typeswith a size discrepancy between A1 segments (8% vs 18%, p<.05), or posterior communicating arteries equal to orlarger than the P1 segment (27% vs 46%, p<.05) were also more common. In the distal basilar artery, symmetriccranial fusion was most common, and accounted for 69% of cases. CONCLUSION: A complete and balanced circle wasmore common in the normal group. The most common pattern was a small anterior communicating artery withsymmetrically large A1 segments and symmetrically small posterior communicating arteries with large P1 segments.In contrast, incomplete or unbalanced circles were more common in the aneurysm group.
Aneurysm* ; Arteries ; Basilar Artery ; Cerebral Angiography ; Circle of Willis* ; Humans ; Intracranial Aneurysm

Hepatolithiasis is rare in western countries, but is fairly common in East Asia, including Japan, China, and Taiwan. Calcium bilirubinate stones account for the majority of intrahepatic calculi, while intrahepatic cholesterol stones are very rare, the incidence being 0.37% of all gallstones. However, several investigators have recently reported an increased incidences of cholesterol gallstones in hepatolithiasis cases and have discussed the differing mechanisms for their formation in the intrahepatic biliary tree of patients with calcium bilirubinate stones and cholesterol stones. We report two cases of intrahepatic cholesterol stone, with emphasis on the radiologic findings, and review the literature.
Biliary Tract ; Bilirubin ; Calculi ; China ; Cholesterol* ; Far East ; Gallstones ; Humans ; Incidence ; Japan ; Research Personnel ; Taiwan

PURPOSE: To describe the CT and ERCP findings of mass-forming chronic pancreatitis. MATERIALS AND METHODS: CT and ERCP features were assessed in 13 patients suffering from mass-forming chronic pancreatitis. Diagnosis was on the basis of surgery (n=5), percutaneous needle biopsy (n=3), and clinical follow-up (n=5). Contrast-enhanced CT was available for all patients: five underwent dynamic study and ERCP was performed in 12. On CT and ERCP, both groups were evaluated with regard to the presence and degree of pancreatic ductal dilatation (greater or less than 50 % of total gland width), double duct sign, enhancement pattern, pancreatic parenchymal calcification (site and distribution pattern), mass identification, the direction of infiltration, pancreatic parenchymal atrophy, configuration at the site of obstruction in the pancreatic and common bile duct, lymphadenopathy, vascular encasement, and vascular engorgement or increased collateral vessels in the peripancreatic space. RESULTS: Seven of 13 patients had suffered chronic alcoholism. Serum CA19-9 levels were normal in all patients except one. Common CT and ERCP findings of mass-forming chronic pancreatitis included pancreatic duct dilatation (92.3%), double duct sign(69.2%), inhomogeneous enhancement of the mass (69.2%), and the presence of calcification (61.5%). Patterns of pancreatic duct dilation were irregular in five patients (38.4%) and smooth in three (23.1 %).In all patients, duct dilatation was less than 50 % of total gland width. Enhancement patterns of the pancreatic mass were inhomogeneous (69.2%), a nonenhancing low attenuation mass (15.3%), and homogeneous enhancement (15.3 %). Configuration at the site of obstruction in the pancreatic duct was abrupt termination in two patients (15.4 %) and smooth termination in two (15.4 %). The common bile duct teminated abruptly in three patients (23.1%), and in four (30.8 %) smooth narrowing was abserved. CONCLUSION: Common findings of mass-forming chronic pancreatitis were duct dilatation of less than 50 % of total gland width, double duct sign, inhomogeneous enhancement of the mass, and the presence of calcification. These were combined with observation of clinical findings such as chronic alcoholism and CA19-9 levels, which are useful indicators for differentiating mass-forming chronic pancreatitis from pancreatic cancer.
Alcoholism ; Atrophy ; Biopsy, Needle ; Cholangiopancreatography, Endoscopic Retrograde* ; Common Bile Duct ; Diagnosis ; Dilatation ; Follow-Up Studies ; Humans ; Lymphatic Diseases ; Pancreas ; Pancreatic Ducts ; Pancreatic Neoplasms ; Pancreatitis, Chronic* ; Tomography, X-Ray Computed