Biportal endoscopic paraspinal decompressive foraminotomy for lumbar foraminal stenosis: clinical outcomes and factors influencing unsatisfactory outcomes.

BACKGROUND: Lumbar foraminal stenosis (LFS) is an important pathologic entity that causes lumbar radiculopathies. Unrecognized LFS may be associated with surgical failure, and LFS remains challenging to treat surgically. This retrospective cohort study aimed to evaluate the clinical outcomes and prognostic factors of decompressive foraminotomy performed using the biportal endoscopic paraspinal approach for LFS. METHODS: A total of 102 consecutive patients with single-level unilateral LFS who underwent biportal endoscopic paraspinal decompressive foraminotomy were included. We evaluated the Visual Analogue Scale (VAS) score and the Oswestry Disability Index (ODI) before and after surgery. Demographic, preoperative data, and radiologic parameters, including the coronal root angle (CRA), were investigated. The patients were divided into Group A (satisfaction group) and Group B (unsatisfaction group). Parameters were compared between these two groups to identify the factors influencing unsatisfactory outcomes. RESULTS: In Group A (78.8% of patients), VAS and ODI scores significantly improved after biportal endoscopic paraspinal decompressive foraminotomy (p < 0.001). However, Group B (21.2% of patients) showed higher incidences of stenosis at the lower lumbar level (p = 0.009), wide segmental lordosis (p = 0.021), and narrow ipsilateral CRA (p = 0.009). In the logistic regression analysis, lower lumbar level (OR = 13.82, 95% CI: 1.33-143.48, p = 0.028) and narrow ipsilateral CRA (OR = 0.92, 95% CI: 0.86-1.00, p = 0.047) were associated with unsatisfactory outcomes. CONCLUSIONS: Significant improvement in clinical outcomes was observed for a year after biportal endoscopic paraspinal decompressive foraminotomy. However, clinical outcomes were unsatisfactory in 21.2% of patients, and lower lumbar level and narrow ipsilateral CRA were independent risk factors for unsatisfactory outcomes.

Saline Load Test and Quilting Sutures to Treat Intractable Lateral Malleolar Bursitis.

The purpose of this study was to evaluate the clinical outcomes of patients with intractable lateral malleolar bursitis who were treated using the intraoperative saline load test to find communication between the bursal sac and the ankle joint and the quilting sutures after bursectomy to reduce the dead space. We reviewed a total of 28 patients who had been treated with quilting sutures after bursectomy between April 2014 and June 2017. When there was capsular opening detected with the saline load test, it was closed with sutures or augmented with periosteum. On the final follow-up office visit, the lateral malleolus was examined for the recurrence of bursitis. Patient medical records were reviewed for postoperative wound dehiscence, skin necrosis, infections, and nerve symptoms. The saline load test was positive in 11 (42%) cases. The mean foot function index improved from 25.94 ± 20.46 to 11.73 ± 5.27 (p = .003). Fourteen (54%) patients were very satisfied with the results, 9 (35%) were satisfied, 2 (8%) rated their satisfaction as fair, and 1 (4%) was dissatisfied. No cases required skin graft or flap surgery. Intractable lateral malleolar bursitis was successfully treated using the saline load test and quilting sutures after bursectomy. Closure of the capsular opening prevented fluid drainage around the wound. Quilting sutures after bursectomy reduced dead space underneath the wound to prevent fluid accumulation and promoted healing of the skin on the underlying soft tissue.

Tumor response assessment by the single-lesion measurement per organ in small cell lung cancer.

BACKGROUND: The criterion of two target lesions per organ in the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 is an arbitrary one, being supported by no objective evidence. The optimal number of target lesions per organ still needs to be investigated. We compared tumor responses using the RECIST 1.1 (measuring two target lesions per organ) and modified RECIST 1.1 (measuring the single largest lesion in each organ) in patients with small cell lung cancer (SCLC). METHODS: We reviewed medical records of patients with SCLC who received first-line treatment between January 2004 and December 2014 and compared tumor responses according to the two criteria using computed tomography. RESULTS: There were a total of 34 patients who had at least two target lesions in any organ according to the RECIST 1.1 during the study period. The differences in the percentage changes of the sum of tumor measurements between RECIST 1.1 and modified RECIST 1.1 were all within 13%. Seven patients showed complete response and fourteen showed partial response according to the RECIST 1.1. The overall response rate was 61.8%. When assessing with the modified RECIST 1.1 instead of the RECIST 1.1, tumor responses showed perfect concordance between the two criteria (k=1.0). CONCLUSIONS: The modified RECIST 1.1 showed perfect agreement with the original RECIST 1.1 in the assessment of tumor response of SCLC. Our result suggests that it may be enough to measure the single largest target lesion per organ for evaluating tumor response.

CT and US findings of ovarian torsion within an incarcerated inguinal hernia.

Inguinal hernia is relatively common in children. Although inguinal hernia is not frequently encountered in girls in comparison to boys, there are occasional cases of uterine or ovarian herniation in female indirect inguinal hernia. Incarcerated ovary in hernia sac has the risk of torsion and strangulation. We present an 8-year-old girl with painful mass in her left groin. With computed tomography (CT) and ultrasonography (US), we made the diagnosis of ovarian strangulation within an incarcerated inguinal hernia. Since ultrasound is primarily used for evaluation of groin mass, CT findings of an incarcerated inguinal hernia is rarely reported.

Morphologic classification of congenital short pancreas on multidetector computed tomography.

OBJECTIVE: The objective of this study was to assess the imaging characteristics and classify congenital short pancreas on the basis of morphologic features on multidetector computed tomography (MDCT) and to determine the associated diseases and congenital anomalies of each type. METHODS: We conducted a retrospective search from 2006 to 2012 using the keywords "short pancreas," "agenesis or hypoplasia of the dorsal pancreas," or "hypoplasia of the ventral pancreas." Clinical data and images were analyzed; finally, 24 patients with congenital short pancreas were included in this study. Imaging features of the 3 types of congenital short pancreas and their associated anomalies on MDCT were evaluated. RESULTS: Congenital short pancreas was classified into type 1 (agenesis or hypoplasia of the dorsal pancreas): no congenital anomaly but presence of diabetes mellitus (45%); type 2 (agenesis or hypoplasia of the pancreatic uncinate process): intestinal malrotation (100%); and type 3 (combined hypoplasia or agenesis of the uncinate process and dorsal pancreas): a spectrum of various congenital anomalies, including abdominal heterotaxy and abnormal spleen (100%). CONCLUSIONS: Recognizing the spectrum of agenesis or hypoplasia of the pancreas and morphologic classification of congenital short pancreas on MDCT may help radiologists detect and understand disease associated with congenital short pancreas.

Correlation between metabolic syndrome and knee osteoarthritis: data from the Korean National Health and Nutrition Examination Survey (KNHANES).

BACKGROUND: This study was designed to investigate the correlations of knee osteoarthritis (OA) with metabolic syndrome (MetS) and MetS parameters in Korean subjects. METHODS: This study included data from 270 subjects with knee OA and 1964 control subjects with a mean age of 54.56 (SD 11.53) years taken from the Korean National Health and Nutritional Examination Survey (KNHANES) 2008. Multivariate logistic regression analysis was conducted to examine possible associations for knee OA with MetS and MetS parameters. RESULTS: MetS was shown to be associated with an increased risk of knee OA in female subjects in unadjusted analysis (OR 1.798, 95% CI 1.392, 2.322), but this significance disappeared when adjusted for confounding factors (OR 1.117, 95% CI 0.805, 1.550). No significant association between MetS and knee OA was found in male subjects. Among parameters of MetS, only high waist circumference (WC) in female subjects was significantly associated with an increased prevalence of knee OA, even after adjusting for confounding factors, while no other significant associations were found in both male and female subjects. CONCLUSION: We found that WC was associated with knee OA in female subjects, but neither MetS nor any parameters thereof were shown to be associated with knee OA in the Korean subjects of this study. Although we found no relationship between a pre-inflammatory state of MetS and knee OA, we believe further investigation of this relationship in various aspects is warranted, as MetS may also be a risk factor for complications in knee OA related procedures.

Radiologic Findings of Polyacrylamide Gel Mammoplasty and Its Complications: A Report of Four Case Series and Review of Literature.

Polyacrylamide gel (PAAG) has been used for augmentation mammoplasty in certain countries, such as China or Eastern European countries. However, owing to various complications, its use is currently banned in most countries. Nevertheless, because of the migratory stream of female from these countries, we also encounter patients with PAAG mammoplasty in Korea. Owing to the various imaging features of PAAG mammoplasty, it may interfere with the identification of malignancy or other pathologic conditions. Therefore, it is important to identify the imaging findings related to PAAG mammoplasty. However, there is limited literature on the radiologic findings of complications related to PAAG mammoplasty in Korea. Herein we report four cases of PAAG mammoplasty, the complications faced, and depict various radiologic features through multimodality imaging.

Establishing a low-risk zone for a temporary extra-articular calcaneo-tibial pin fixation in an unstable ankle or subtalar joint.

This study aimed to establish a low-risk zone to avoid neurovascular injury during a temporary extra-articular calcaneo-tibial pin fixation in an unstable ankle or subtalar joint. A line from the calcaneal tuberosity center to the lateral end of the posterior malleolus at the ankle joint level defines the lateral border of this zone. Another line from the calcaneal tuberosity center to the midpoint of the anterior distal tibial articular surface at the joint level defines its medial border. This region was assumed to have a low neurovascular injury risk upon pin insertion. Fifty ankles from 50 patients who had undergone magnetic resonance imaging (MRI) for ankle disorders were assessed. T1-weighted oblique axial MRI slices were oriented to the pin trajectory. The mean distances between the sural nerve and the lateral border of the low-risk zone and between the posterior tibial neurovascular structures and the medial border of the low-risk zone were 15.0 ± 2.5 (range 9.1 to 21.1) and 12.8 ± 2.6 (6.3 to 20.8) mm, respectively. No neurovascular structures were identified within the low-risk zone. These findings demonstrated that an unstable ankle or subtalar joint can be temporarily fixated with an extra-articular calcaneo-tibial pin at a defined zone with a low neurovascular injury risk.

Children and adolescent patients with goiter and normal thyroid function: US findings related to underlying autoimmune thyroid diseases.

This study was conducted to investigate and compare thyroid ultrasonography (US) findings in children and adolescents with goiter and normal thyroid function with positive or negative thyroid autoimmunity. From 2000 to 2020, we reviewed initial thyroid US images in 33 autoimmune thyroid diseases (AITDs) patients and 52 nonAITD patients. Our review of the images focused on thyroid parenchymal hypoechogenicity and heterogeneous echopattern subdivided into 2 groups according to severity: hypoechogenicity 1 and 2 (HO1 and HO2) and heterogeneity 1 and 2 (HE1 and HE2). HO1 and HE1 were observed more frequently in the nonAITD group (86.5% and 42.3%, respectively), while HO2 and HE2 were observed more frequently in the AITDs group (36.4% and 81.8%, respectively). More patients in the AITDs group showed change of both US groups and thyroid function state within the follow-up periods than in nonAITD group (33.3% and 5.77%, respectively). Children and adolescent AITDs patients showed more severe parenchyma hypoechogenicity and heterogeneous echopattern compared with nonAITD patients with goiter and normal thyroid function.

Ultrasound and MR findings in sclerosing perineurioma.

Perineurioma is an unusual benign peripheral nerve sheath tumor that includes intraneural, soft tissue (conventional), reticular and sclerosing types. Sclerosing perineurioma is a recently described distinctive variant occurring nearly exclusively on the hands of young adults, in which it presents as a small, painless, dermal or subcutaneous mass. The only report of imaging findings in sclerosing perineurioma was by Miyake et al., who described the MR findings in 2006. However, there have been no reports of the ultrasound features. We report a 22-year-old man with sclerosing perineurioma and describe the lesion's ultrasound and MR features.

[Transition of the Korean Name for the Department of Radiology and Korean Medical Terminology: A Note Ahead of Publication for the Sixth Edition of the Korean Medical Terminology]. / 영상의학과의 한글 ëª ì¹­ê³¼ 한글 의학용어의 변천 ê³¼ì •: 의학용어집 ì œ6판의 출간에 붙임.

The author was a member of the Medical Terminology Committee of the Korean Society of Radiology and the Korean Medical Association Working Committee on Medical Terms for the publication of the sixth edition of the Korean Medical Association. The author participated in the revision of the sixth-edition medical terminology from July 2015 to January 2020. Based on that experience, this special article was written to share the changes in the Korean medical terminology and the name of the department of radiology.

The relationship between ultrasound findings and thyroid function in children and adolescent autoimmune diffuse thyroid diseases.

To evaluate the association between thyroid echogenicity and heterogeneity seen on ultrasonography (US) and thyroid function in pediatric and adolescent populations with autoimmune diffuse thyroid diseases (AITD). From 2000 to 2020, we reviewed thyroid ultrasound (US) images and thyroid function statuses in 133 children and adolescent AITD patients. Our review of the images focused on decreased echogenicity and heterogeneity, which were classified into four grades. Among patients with overt hypothyroidism or overt hyperthyroidism, 94.2% (65/69) showed a US grade of 3 or 4. In patients with subclinical hyper/hypothyroidism or euthyroidism, 45.3% (29/64) showed grades 1 or 2. There were no overt hyper/hypothyroidism patients with US grade 1. When we compared US grades according to thyroid status, more severe thyroid dysfunction was significantly associated with higher US grade (p = 0.047). Thyroid stimulating hormone (TSH) level differed significantly according to US grades when we evaluated hyperthyroid (p = 0.035) and hypothyroid (p = 0.027) states independently. 11 patients showed both US grade and thyroid function status changes on follow-up US. In children and adolescent AITD patients, there was an association between decreased echogenicity and heterogeneity on US and thyroid dysfunction.

Angiomyxolipoma (vascular myxolipoma) of the knee in a 9-year-old boy.

Angiomyxolipoma (vascular myxolipoma) is a very rare variant of lipoma. This tumor is characterized by mature adipose tissue mixed with myxoid stroma and vascular vessels. To date, nine cases have been reported, all of them occurring in adults. Herein, we report a unique case of a 9-year-old boy presenting with a solitary painful mass on the right medial thigh and illustrate the imaging characteristics of this rare tumor.

Lobular capillary hemangioma in the soft tissue of the finger: sonographic findings.

OBJECTIVE: The purpose of this study was to describe the sonographic findings of pathologically confirmed subcutaneous lobular capillary hemangioma of the finger in six patients. MATERIALS AND METHODS: The clinical records were reviewed for data, including the patients' age and gender, the clinical presentation, a history of trauma, and the tumor site. The sonographic findings were retrospectively analyzed for the specific location within the superficial tissue, the tumor's size, shape, and margin, the internal echogenicity, the internal echo texture, the presence of calcification, the presence of a hypoechoic rim, and the internal vascularity. RESULTS: The study group consisted of three men and three women, and the six patients' mean age was 39 years (age range: 13-67 years). All the patients were admitted with a painful nodule or a painless protruding nodule in the finger with easy bleeding on contact. In all cases, there was no history of trauma. The mean size of the tumors was 0.85 cm. All the tumors were ill-defined, oval, subcutaneous nodules without calcifications or any hypoechoic rim. Color Doppler sonography showed marked internal vascularity in both the central and peripheral tumor regions in three cases and scanty vascularity in the peripheral region in three cases. CONCLUSIONS: Subcutaneous lobular capillary hemangioma should be considered when an ill-defined, oval, vascular subcutaneous nodule without calcifications or a hypoechoic rim is seen in the soft tissue of the finger, especially if this tumor is a painful small nodule or a painless protruding small nodule with easy bleeding on contact.

Tendon Regeneration After Partial-Thickness Peroneus Longus Tendon Harvesting: Magnetic Resonance Imaging Evaluation and In Vivo Animal Study.

BACKGROUND: In recent years, the use of the anterior half of the peroneus longus tendon (AHPLT) as an autograft source for ligament reconstruction has gained popularity. However, no reports are available regarding tendon regeneration after harvesting of the AHPLT. HYPOTHESIS: When half of the tendon is preserved during tendon harvesting, the quality of the regenerated tendon is better than that of the regenerated tendon after full-thickness harvesting. STUDY DESIGN: Case series; Level of evidence, 4; controlled laboratory study. METHODS: A total of 21 patients who underwent AHPLT harvesting for lower extremity ligament reconstruction participated in the magnetic resonance imaging (MRI) study to evaluate tendon regeneration 1 year after the harvesting. An in vivo animal study was performed to compare the quality of the regenerated tendon after partial-thickness and full-thickness tendon harvesting. A total of 30 adult female Sprague-Dawley rats were allocated to 2 groups-15 rats underwent partial-thickness Achilles tendon harvesting (partial-thickness harvesting [PTH] group), and 15 rats underwent full-thickness Achilles tendon harvesting (full-thickness harvesting [FTH] group). The quality of the regenerated tendons was compared 180 days after tendon harvesting. RESULTS: All 21 patients showed regeneration of the peroneus longus tendon (PLT) (homogeneously dark on both T1- and T2-weighted sequences). The cross-sectional area of the regenerated tendon divided by that of the preoperative tendon was 92.6% and 84.5% at 4 cm and 9 cm proximal to the tip of the distal fibula, respectively. In the animal study, the mean histologic score was better for the PTH group compared with the FTH group (9.17 ± 1.35 vs 14.72 ± 0.74; P < .001). The ultimate strength and the stiffness of the regenerated Achilles tendon were significantly higher for the PTH group compared with the FTH group (35.5 ± 8.3 vs 22.4 ± 8.3 N, P = .004; and 31.6 ± 7.7 vs 23.5 ± 4.8 N/mm, P = .016). CONCLUSION: The PLT was found to regenerate after partial-thickness harvesting on MRI. In the animal study, the quality of the regenerated tendon when half of the tendon was preserved during tendon harvesting was better than that after full-thickness tendon harvesting.

Usefulness of ultrasonography in determining the surgical excision margin in non-melanocytic skin cancer: A comparative analysis of preoperative ultrasonography and postoperative histopathology.

ABSTRACT: Skin cancer diagnoses are rising due to increasing ultraviolet ray exposure and an aging population. The complete surgical excision of skin cancer, including a normal tissue, has been the widely performed and determining the adequate safety margin is essential. In this study, we compared the preoperative thickness and width of skin cancer by ultrasonography with the measurements by histopathologic findings.A total of 211 patients were enrolled in this study and ultrasonography was performed on 30 patients. The width (long and short axis) and thickness of the skin cancers were measured using electronic calipers of ultrasonographic calipers preoperatively and microscope postoperatively.The skin cancers were basal cell carcinoma (n = 17), squamous cell carcinoma (n = 10), Merkel cell carcinoma (n = 1), mucinous carcinoma (n = 1), and sebaceous carcinoma (n = 1). The mean width (long and short axis) and thickness of the cancers measured by ultrasonography was 1.25 (0.76) cm, 0.96 (0.65) cm, and 0.37 (0.28) cm. The measurements by histopathology was 1.24 (0.84) cm, 0.95 (0.65) cm, and 0.27 (0.24) cm. Kendall's tau-b correlation coefficient between measurements by ultrasonography and histopathology was as follows: long axis, r = 0.733, P < .001; short axis, r = 0.671, P < .001; thickness, r = 0.740, P < .001. Spearman's rank correlation coefficient between measurements by ultrasonography and histopathology was as follows: long axis, r = 0.865, P < .001; short axis, r = 0.829, P < .001; thickness, r = 0.842, P < .001. The difference in mean thickness between the total excised tissue and the skin cancer was 0.29 (0.43) cm (range 0.05-0.40 cm) in basal cell carcinoma and 0.56 (0.58) cm (range 0.05-2.22 cm) in squamous cell carcinoma.Ultrasonography can accurately measure the width and thickness of skin cancer and predict the safety margins of the wide excision. Preoperative ultrasonography is a good diagnostic tool for surgical planning. Additional studies with larger populations are needed to quantify the range of vertical safety margins.

Femoral component fracture due to osteolysis after cemented mobile-bearing total knee arthroplasty.

A 58-year-old man with osteoarthritis in the left knee underwent a total knee arthroplasty with a New Jersey anterior-posterior gliding low contact stress mobile-bearing implant. All femoral, tibial, and patellar components were implanted with bone cement. Pain developed at 43 months postsurgery, and plain radiography revealed a vertical crack in the femoral component and osteolysis at the medial femoral condyle. The femoral and tibial components were revised, and the bone defect at the medial femoral condyle was reconstructed using an allogeneic strut bone graft. Microscope examination identified polyethylene particles with foreign body granulomatous reaction, and scanning electron microscopy revealed fatigue failure of the femoral component. Osteolysis due to polyethylene particles can lead to fracture of the femoral component after cemented anterior-posterior gliding low contact stress mobile-bearing total knee arthroplasty.

Prospective Clinical Research of the Efficacy of Platelet-rich Plasma in the Outpatient-based Treatment of Rotator Cuff Tendinopathy.

BACKGROUND: The purpose of this study is to compare the clinical outcomes of the control group and platelet-rich plasma (PRP) group among the patients who failed to respond to conservative treatment as outpatient-based therapy for rotator cuff tendinopathy, and to compare the clinical results of leukocyte-poor (LP) PRP and leukocyte-rich (LR) PRP. METHODS: Inclusion criteria are (1) over 18-year-old, (2) patients with rotator cuff tendinopathy, no rotator cuff tear by radiologic diagnosis (ultrasonography or magnetic resonance imaging) within the last 3 months, and (3) not effective to conservative treatment for more than 1 month. Of the final 60 subjects, 33 patients in the exercise treatment group and 27 patients in the PRP injection group (LP-PRP, 13; LR-PRP, 14) were included. Clinical evaluation was carried out by assessing the outcomes of treatment using the Numeric Rating Scale pain score, the American Shoulder and Elbow Society (ASES) score, and the Constant score at baseline and at 3 and 6 months after the procedure. RESULTS: There was a statistically significant difference in ΔASES3months (ASES3months-ASESfirst) score between the control and PRP groups (p=0.006). However, there was no statistical significance between LP-PRP and LR-PRP groups (p>0.05). CONCLUSIONS: This study showed that PRP injection was more effective than exercise therapy for the first 3 months. However, there was no difference between the LP-PRP group and the LR-PRP group. Regardless of the type of PRP, clinical application of PRP injection in patients with rotator cuff tendinopathy seems to be effective in early treatment.

Imaging findings of primary well-differentiated liposarcoma of the liver: a case report.

Primary liposarcoma of the liver is extremely rare. We report here on a case of primary well-differentiated liposarcoma in the left hepatic lobe of a 63-year-old woman. Abdominal ultrasonography showed a well-defined, echogenic, round mass. Abdominal computed tomography (CT) and magnetic resonance (MR) images showed an almost fatty, lobulated mass with a few, random distributed vascular structures and a small area of nodular enhancement. The resected tumor appeared as a well-defined, round, tan-yellow mass. Histological analysis showed a well-differentiated liposarcoma.

Intra-Appendiceal Air at CT: Is It a Useful or a Confusing Sign for the Diagnosis of Acute Appendicitis?

OBJECTIVE: To investigate the significance of intra-appendiceal air at CT for the evaluation of appendicitis. MATERIALS AND METHODS: We retrospectively analyzed 458 patients (216 men, 242 women; age range, 18-91 years) who underwent CT for suspected appendicitis. Two independent readers reviewed the CT. Prevalence, amount, and appearance of intra-appendiceal air were assessed and compared between the patients with and without appendicitis. Performance of CT diagnosis was evaluated in two reading strategies: once ignoring appendiceal air (strategy 1), and the other time considering presence of appendiceal air as indicative of no appendicitis in otherwise indeterminate cases (strategy 2), using receiver operating characteristic (ROC) analysis. RESULTS: Of the 458 patients, 102 had confirmed appendicitis. The prevalence of intra-appendiceal air was significantly different between patients with (13.2%) and without (79.8%) appendicitis (p < 0.001). The amount of appendiceal air was significantly lesser in patients having appendicitis as compared with the normal group, for both reader 1 (p = 0.011) and reader 2 (p = 0.002). Stool-like appearance and air-fluid levels were more common in the appendicitis group than in the normal appendix for both readers (p < 0.05). Areas under the ROC curves were not significantly different between strategies 1 and 2 in reader 1 (0.971 vs. 0.985, respectively; p = 0.056), but showed a small difference in reader 2 (0.969 vs. 0.986, respectively; p = 0.042). CONCLUSION: Although significant differences were seen in the prevalence, amount, and appearance of intra-appendiceal air between patients with and without appendicitis, it has a limited incremental value for the diagnosis of acute appendicitis.