Successful Transcatheter Arterial Embolization following Diverticular Bleeding in the Third Portion of the Duodenum:A Case Report

This is a rare case of a 73-year-old male patient who presented with hematochezia and was treated using transcatheter arterial embolization following upper gastrointestinal bleeding in the third portion of the duodenum. The cause of the bleeding was not found on gastrointestinal endoscopy and CT. On the third day of hospitalization, the hemoglobin level continued to decrease. A technetium-99m-labeled red blood cell scan revealed suspicious bleeding in the diverticulum of the third portion of the duodenum. Superior mesenteric artery angiography showed active bleeding from the posteroinferior pancreaticoduodenal artery, which was embolized with N-butyl cyanoacrylate. The patient was discharged on the seventh day after embolization without re-bleeding or complication. We report a rare case of a patient with active bleeding from a duodenal diverticulum that was difficult to diagnose using routine modalities. Herein, we report a rare case of a patient with active bleeding from a duodenal diverticulum that was difficult to diagnose using routine modalities. We also conducted a relavant literature review.

A Comprehensive Review of Percutaneous Nephrostomy and Suprapubic Cystostomy

Percutaneous nephrostomy is widely used for the diagnosis and treatment of various urinary tract diseases, such as ureteral fistula, stenosis, and percutaneous nephrolithotomy, and the relief of urinary obstruction. Suprapubic cystostomy is also known as a good method for bladder drainage in patients with lower urinary tract obstruction or injury and neurogenic bladder. Despite the frequent use of these procedures, reports in the literature are insufficient for an interventional radiologist to understand the procedures easily and thoroughly. In this article, the indication, anatomy, placement, and postoperative management of percutaneous nephrostomy and suprapubic cystostomy have been described, explaining that the procedures are safe and effective.

Splenial Lesions of the Corpus Callosum: Disease Spectrum and MRI Findings

The corpus callosum (CC) is the largest white matter structure in the brain, consisting of more than 200–250 million axons that provide a large connection mainly between homologous cerebral cortical areas in mirror image sites. The posterior end of the CC is the thickest part, which is called the splenium. Various diseases including congenital to acquired lesions including congenital anomalies, traumatic lesions, ischemic diseases, tumors, metabolic, toxic, degenerative, and demyelinating diseases, can involve the splenium of the CC and their clinical symptoms and signs are also variable. Therefore, knowledge of the disease entities and the imaging findings of lesions involving the splenium is valuable in clinical practice. MR imaging is useful for the detection and differential diagnosis of splenial lesions of the CC. In this study, we classify the disease entities and describe imaging findings of lesions involving the splenium of the CC based on our experiences and a review of the literature.

MR Findings of Seizure-Related Cerebral Cortical Lesions during Periictal Period

PURPOSE: This study investigated the MRI, MR angiography (MRA) and MR perfusion findings of seizure-related cerebral cortical lesions during the periictal period. MATERIALS AND METHODS: From a retrospective review of the institutional database between 2011 and 2014, a total of 21 patients were included in this study. Two radiologists assessed periictal MRI, including MRA and MR perfusion, in patients with seizure-related cortical lesions. The parameters examined include: location of cortical abnormality, multiplicity of the affected cortical region, cerebral vascular dilatation, perfusion abnormality and other parenchymal lesions. RESULTS: All patients showed T2 hyperintense cerebral cortical lesions with accompanying diffusion restriction, either unilateral (18/21, 85.7%) or bilateral (3/21, 14.3%). Of the 21 patients enrolled, 10 (47.6%) had concurrent T2 hyperintense thalamic lesions, and 10 (47.6%) showed hippocampal involvement. Of the 17 patients (81%) who underwent MRA, 13 (76.5%) showed vascular dilatation with increased flow signal in the cerebral arteries of the affected cortical regions. On MR perfusion, all 5 patients showed cortical hyperperfusion, corresponding to the region of cortical abnormalities. CONCLUSION: Seizure-related cerebral cortical lesions are characterized by T2 and diffusion hyperintensities, with corresponding cerebral hyperperfusion and vascular dilatation. These findings can be helpful for making an accurate diagnosis in patients with seizure.

MR Findings of Seizure-Related Cerebral Cortical Lesions during Periictal Period

PURPOSE: This study investigated the MRI, MR angiography (MRA) and MR perfusion findings of seizure-related cerebral cortical lesions during the periictal period. MATERIALS AND METHODS: From a retrospective review of the institutional database between 2011 and 2014, a total of 21 patients were included in this study. Two radiologists assessed periictal MRI, including MRA and MR perfusion, in patients with seizure-related cortical lesions. The parameters examined include: location of cortical abnormality, multiplicity of the affected cortical region, cerebral vascular dilatation, perfusion abnormality and other parenchymal lesions. RESULTS: All patients showed T2 hyperintense cerebral cortical lesions with accompanying diffusion restriction, either unilateral (18/21, 85.7%) or bilateral (3/21, 14.3%). Of the 21 patients enrolled, 10 (47.6%) had concurrent T2 hyperintense thalamic lesions, and 10 (47.6%) showed hippocampal involvement. Of the 17 patients (81%) who underwent MRA, 13 (76.5%) showed vascular dilatation with increased flow signal in the cerebral arteries of the affected cortical regions. On MR perfusion, all 5 patients showed cortical hyperperfusion, corresponding to the region of cortical abnormalities. CONCLUSION: Seizure-related cerebral cortical lesions are characterized by T2 and diffusion hyperintensities, with corresponding cerebral hyperperfusion and vascular dilatation. These findings can be helpful for making an accurate diagnosis in patients with seizure.

Functional Magnetic Resonance Imaging with Arterial Spin Labeling: Techniques and Potential Clinical and Research Applications

PURPOSE: To describe technical methods for functional magnetic resonance imaging (fMRI) study with arterial spin labeling (ASL) compared to blood oxygenation level-dependent (BOLD) technique and discuss the potential of ASL for research and clinical practice. MATERIALS AND METHODS: Task-based (n = 1) and resting-state fMRI (rs-fMRI) (n = 20) were performed using ASL and BOLD techniques. Results of both techniques were compared. RESULTS: For task-based fMRI with finger-tapping, the primary motor cortex of the contralateral frontal lobe and the ipsilateral cerebellum were activated by both BOLD and ASL fMRI. For rs-fMRI of sensorimotor network, functional connectivity showed similar results between BOLD and ASL. CONCLUSION: ASL technique has potential application in clinical and research fields because all brain perfusion imaging, CBF measurement, and rs-fMRI study can be performed in a single acquisition.

Functional Magnetic Resonance Imaging with Arterial Spin Labeling: Techniques and Potential Clinical and Research Applications

PURPOSE: To describe technical methods for functional magnetic resonance imaging (fMRI) study with arterial spin labeling (ASL) compared to blood oxygenation level-dependent (BOLD) technique and discuss the potential of ASL for research and clinical practice. MATERIALS AND METHODS: Task-based (n = 1) and resting-state fMRI (rs-fMRI) (n = 20) were performed using ASL and BOLD techniques. Results of both techniques were compared. RESULTS: For task-based fMRI with finger-tapping, the primary motor cortex of the contralateral frontal lobe and the ipsilateral cerebellum were activated by both BOLD and ASL fMRI. For rs-fMRI of sensorimotor network, functional connectivity showed similar results between BOLD and ASL. CONCLUSION: ASL technique has potential application in clinical and research fields because all brain perfusion imaging, CBF measurement, and rs-fMRI study can be performed in a single acquisition.

Susceptibility Vessel Sign for the Detection of Hyperacute MCA Occlusion: Evaluation with Susceptibility-weighted MR Imaging

PURPOSE: Susceptibility vessel sign (SVS) on gradient echo image, which is caused by MR signal loss due to arterial thrombosis, has been reported in acute middle cerebral artery (MCA) infarction. However, the reported sensitivity and diagnostic accuracy of SVS have been variable. Susceptibility-weighted imaging (SWI) is a newly developed MR sequence. Recent studies have found that SWI may be useful in the field of cerebrovascular diseases, especially for detecting the presence of prominent veins, microbleeds and the SVS. The purpose of this study was to evaluate the diagnostic values of SWI for the detection of hyperacute MCA occlusion. MATERIALS AND METHODS: Sixty-nine patients (37 males, 32 females; 46-89 years old [mean, 69.1]) with acute stroke involving the MCA territory underwent MR imaging within 6 hours after the symptom onset. MR examination included T2, FLAIR (fluid-attenuated inversion recovery), DWI, SWI, PWI (perfusion-weighted imaging), contrast-enhanced MR angiography (MRA) and contrast-enhanced T1. Of these patients, 28 patients also underwent digital subtraction angiography (DSA) within 2 hours after MR examination. Presence or absence of SVS on SWI was assessed without knowledge of clinical, DSA and other MR imaging findings. RESULTS: On MRA or DSA, 34 patients (49.3%) showed MCA occlusion. Of these patients, SVS was detected in 30 (88.2%) on SWI. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of SWI were 88.2%, 97.1%, 96.8%, 89.5% and 92.8%, respectively. CONCLUSION: SWI was sensitive, specific and accurate for the detection of hyperacute MCA occlusion.

Evaluation of Hippocampal Volume Based on Various Inversion Time in Normal Adults by Manual Tracing and Automated Segmentation Methods

PURPOSE: To investigate the value of image post-processing software (FreeSurfer, IBASPM [individual brain atlases using statistical parametric mapping software]) and inversion time (TI) in volumetric analyses of the hippocampus and to identify differences in comparison with manual tracing. MATERIALS AND METHODS: Brain images from 12 normal adults were acquired using magnetization prepared rapid acquisition gradient echo (MPRAGE) with a slice thickness of 1.3 mm and TI of 800, 900, 1000, and 1100 ms. Hippocampal volumes were measured using FreeSurfer, IBASPM and manual tracing. Statistical differences were examined using correlation analyses accounting for spatial interpretations percent volume overlap and percent volume difference. RESULTS: FreeSurfer revealed a maximum percent volume overlap and maximum percent volume difference at TI = 800 ms (77.1 +/- 2.9%) and TI = 1100 ms (13.1 +/- 2.1%), respectively. The respective values for IBASPM were TI = 1100 ms (55.3 +/- 9.1%) and TI = 800 ms (43.1 +/- 10.7%). FreeSurfer presented a higher correlation than IBASPM but it was not statistically significant. CONCLUSIONS: FreeSurfer performed better in volumetric determination than IBASPM. Given the subjective nature of manual tracing, automated image acquisition and analysis image is accurate and preferable.

Associated Brain Parenchymal Abnormalities in Developmental Venous Anomalies: Evaluation with Susceptibility-weighted MR Imaging

PURPOSE: The purpose of this study was to evaluate the associated brain parenchymal abnormalities of developmental venous anomalies (DVA) with susceptibility-weighted image (SWI). MATERIALS AND METHODS: Between January 2012 and June 2013, 2356 patients underwent brain MR examinations with contrast enhancement. We retrospectively reviewed their MR examinations and data were collected as per the following criteria: incidence, locations, and associated parenchymal signal abnormalities of DVAs on T2-weighted image, fluid-attenuated inversion recovery (FLAIR), and SWI. Contrast enhanced T1-weighted image was used to diagnose DVA. RESULTS: Of the 2356 patients examined, 57 DVAs were detected in 57 patients (2.4%); 47 (82.4%) were in either lobe of the supratentorial brain, 9 (15.7%) were in the cerebellum, and 1 (1.7%) was in the pons. Of the 57 DVAs identified, 20 (35.1%) had associated parenchymal abnormalities in the drainage area. Among the 20 DVAs which had associated parenchymal abnormalities, 13 showed hemorrhagic foci on SWI, and 7 demonstrated only increased parenchymal signal abnormalities on T2-weighted and FLAIR images. In 5 of the 13 patients (38.5%) who had hemorrhagic foci, the hemorrhagic lesions were demonstrated only on SWI. CONCLUSION: The overall incidence of DVAs was 2.4%. Parenchymal abnormalities were associated with DVAs in 35.1% of the cases. On SWI, hemorrhage was detected in 22.8% of DVAs. Thus, we conclude that SWI might give a potential for understanding of the pathophysiology of parenchymal abnormalities in DVAs.

Susceptibility-Weighted MR Imaging for the Detection of Developmental Venous Anomaly: Comparison with T2 and FLAIR Imaging

PURPOSE: We evaluated the diagnostic value of susceptibility-weighted imaging (SWI) for the detection of developmental venous anomaly (DVA). MATERIALS AND METHODS: Retrospective review of 1068 brain MR examinations found 28 DVAs in 28 patients (2.6%) on contrast-enhanced T1-weighted images. SWI, T2, and FLAIR images of 28 patients with DVA and 28 sex- and age-matched control patients without DVA were analyzed by blinded readers on each type of sequences. All images were independently reviewed by two radiologists who were blinded to other MR imaging finding. In cases of discrepancy, two reviewers reached a consensus later. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each MR sequence for the detection of DVA were determined. Statistical analysis was performed by using the Mcnemar test. The significance level was p < 0.05. RESULTS: The sensitivity, specificity, PPV, and NPV of SWI for the detection of DVA were 85.7%, 92.9%, 92.3%, and 86.7%, respectively. T2 and FLAIR images showed sensitivity of 35.7% and 35.7%, specificity of 92.9% and 96.4%, PPV of 83.3% and 90.9%, and NPV of 59.1% and 60.0%, respectively. On SWI, the sensitivity and NPV for the detection of DVAs were significantly higher than those of T2 and FLAIR images (p < 0.05). CONCLUSION: SWI was sensitive and specific for the detection of DVA.

Asymptomatic Left Ventricular Pseudoaneurysm Evaluated With Multimodality Cardiac Imaging

No abstract available.

Delayed Ventricular Septal Rupture Following Blunt Chest Trauma

Cardiac injury is a common but occasionally serious complication of blunt chest trauma. A ventricular septal rupture (VSR) is a rare complication and is variable in its presentation, temporal course and severity. Here, we report a rare case of 75-year-old man who developed delayed VSR following blunt chest trauma.

Assessing stent restenosis using 64-multidetector computed tomography coronary angiography / 대한내과학회지

BACKGROUND/AIMS: Multidetector computed tomography (MDCT) is considered to be a noninvasive, alternative method for evaluating stent restenosis. However, the diagnostic accuracy of 16-channel MDCT for stent stenosis is reported to have severe limitations because of high-attenuation stent-related artifacts. 64-channel MDCT, which recently became available in clinical practice, has better spatial and temporal resolution than 16-channel MDCT. The diagnostic accuracy of 64-channel MDCT for stent restenosis (in-segment and in-stent) was assessed by comparing it with conventional coronary angiography. METHODS: In-segment and in-stent restenosis (> or =50% in diameter) were evaluated in 96 stent segments in 68 patients [61+/-12 years, 51 (75%) male] using both 64-channel MDCT and conventional coronary angiography. The in-stent analysis was confined to the portion of the artery covered by the stent and the in-segment analysis included the stent and 5 mm proximal or distal to the stent edges. RESULTS: The 64-channel MDCT could evaluate stent restenosis in 93 of 96 (97%) stent segments. Quantitative conventional coronary angiography found in-segment restenosis (> or =50% in diameter) in 16 of 68 (23%) patients and 16 of 96 (17%) segments. For the patients with interpretable stent segments, the sensitivity, specificity, positive predictive value, and negative predictive value of 64-channel MDCT for in-segment restenosis per patient were 63, 96, 83, and 89%, respectively; per segment they were 63, 97, 83, and 93%, respectively; and for in-stent restenosis per stent they were 82, 98, 82, and 98%, respectively. CONCLUSIONS: The diagnostic accuracy of 64-channel MDCT for assessing stent restenosis had high specificity and negative predictive value in the clinical setting. The 64-channel MDCT may be a promising, less-invasive imaging tool for stent restenosis, especially for the purpose of excluding stent restenosis.

A Case of Allergic Contact Dermatitis to Duoderm Extrathin(R) Dressing / 대한피부과학회지

Even though hydrocolloid dressings have been widely used for the past 15 years in the treatment of various types of wounds; allergic contact dermatitis to these dressings have been rarely reported. Duoderm(R) is representative agent of hydrocolloid dressing, and Duoderm Extrathin(R) is a new formulation of Duoderm(R) that contains pentaerythritol ester as a tacking agent, a substance used in several other adhesives. In Korean dermatologic literature, only 1 case of the allergic contact dermatitis due to Duoderm CGF(R) has been reported. However allergic contact dermatitis due to Duoderm Extrathin(R) has not been reported. We report a case of allergic contact dermatitis in a 22-year-old female during wound management using Duoderm Extrathin(R).

MR Findings of Flexor Hallucis Longus Dysfunction

PURPOSE: To find the MR findings and evaluate the usefulness of MR in flexor hallucis longus(FHL) dysfunction. MATERIALS AND METHODS: From 1992 to 2003, fourty patients were found to have surgically confirmed FHL dysfunction. 24 cases of 22 patients who had performed MR were included in this study. We analyzed the signal intensity of FHL tendon and muscle, tendon sheath, sheath effusion, and bone lesions, retrospectively. RESULTS: Non-specific, increased sheath effusion of FHL tendon was seen in 12 cases (50%). Large amount of sheath effusion(grade 3) was observed in 5 cases (21%). The signal intensity of FHL tendon was normal in all cases. High signal intensity at the FHL muscle, proximal to musculotendinous junction was seen in 1 case (4%). One case (4%) of marrow edema of the talus and another one case (4%) of osteochondritis dissecans of the talus was seen. CONCLUSION: Non-specific, increased sheath effusion of FHL tendon was observed on MR in FHL dysfunction patients. Therfore, MR has a limited role in diagnosis of FHL dysfunction and is useful to exclude other bone and tendon diseases causing medial ankle pain.

Significance of Nephrectomy in Renal Tuberculosis Patients with Negative Urine (AFB) Culture and Asymptomatic Nonfunctioning Kidney / 대한비뇨기과학회지

PURPOSE: The aim of this study was to evaluate the surgical treatment of incidentally detected, asymptomatic, unilateral nonfunctioning tuberculous kidney. MATERIALS AND METHODS: Thirty-three patients with incidentally detected, asymptomatic, unilateral nonfunctioning kidney, negative urine AFB culture and radiologic diagnosis of renal tuberculosis were reviewed. They were divided into three groups: surgical, medical, and observation groups. Twelve patients in the surgical group were nephrectomized at initial diagnosis. Eleven patients in the medical group received anti-tuberculous medication with isoniazid, rifampin, and pyrazinamide for 4 months. Ten patients in the observation group remained under observation. RESULTS: There was no evidence of decreased renal function or recurrence of renal tuberculosis in the surgical and medical groups. Pathologic confirmation of renal tuberculosis was obtained in all nephrectomy patients. The follow-up loss rate of the surgical group (7.7%) was lower than that of the other groups (p<0.05). CONCLUSIONS: Nephrectomy is more acceptable than either medicine or observation. (1) Because preoperative chemotherapy was not justified in the case of negative urine AFB culture, pathologic confirmation was necessary. (2) Nephrectomy associated morbidity was quite low. (3) The follow-up loss rate of the surgical group was lower than that of the other groups. Short course anti-tuberculous medication should be administered after nephrectomy.

Case-Control Study for Contralateral Vesicoureteral Reflux in Patient with Unilateral Cohen's Reimplantation: Is Contralateral Vesicoureteral Reflux Caused by Postoperative Trigonal Distortion? / 대한비뇨기과학회지

PURPOSE: The development of contralateral reflux after successful unilateral antireflux surgery has led to controversy regarding etiology. Our aim was to analyze the incidence of newly developed contralateral reflux after successful unilateral Cohen's reimplantation in patients with grade III and IV reflux and to explain the postoperative trigonal distortion responsible for new contralateral reflux with case-control study. MATERIALS AND METHODS: We compared the incidence and outcome of contralateral reflux between the medical group with prophylactic antibiotics and the surgical group with unilateral Cohen's reimplantation in patients with unilateral vesicoureteral reflux. We retrospectively reviewed the records of 84 children seen in a 17-year period who had grade III (48 patients) and IV (36 patients) primary unilateral vesicoureteral reflux. Unilateral Cohen's reimplantation was done in 48 patients and prophylactic chemotherapy was done in 36 patients. RESULTS: Overall contralateral reflux developed in 13.8% of patients who underwent medical treatment and 14.6% of patients who underwent unilateral Cohen's reimplantation. In patients with grade III reflux, 13% of patients with medical treatment and 12% of patients with unilateral Cohen's reimplantation had contralateral reflux. Twelve patients with contralateral reflux had grade I (7 patients) and grade II (5 patients) reflux and resolved spontaneously within 18.2 months. CONCLUSIONS: The likelihood of trigonal distortion as the etiology of contralateral reflux is low given the similar incidence in cross-trigonal Cohen's reimplantation group and medical group with prophylactic chemotherapy in patients with grade III and IV primary vesicourerteral reflux.

Extracorporeal Shock Wave Lithotripsy Monotherapy for Staghorn Stone with EDAP LT-02 Lithotriptor / 대한비뇨기과학회지

PURPOSE: The clinical efficacy of extracorporeal shock wave lithotripsy (ESWL) monotherapy with EDAP LT-02 (LT-02) lithotriptor for staghorn stone was estimated. MATERIALS AND METHODS: Thirty eight patients (39 renal units) with staghorn stone had been treated by ESWL monotherapy with LT-02 lithotriptor that had piezoelectric system with mounted C-arm and ultrasound unit (dual localization system) between Jan. 1996 and Dec. 2000. Success rate (SR) and stone free rate (SFR) were evaluated according to the stone type, volume and associated hydronephrosis. RESULTS: Overall SR and SFR were 56% and 38%. SR (SFR) of complete and incomplete staghorn stone were 57 (36%) and 56 (40%). SR (SFR) of stone under and over 20ml of volume were 53 (40%) and 58 (38%). SR (SFR) according to the associated hydronephrosis were 78 (57%), 44 (27%), and 42 (27%) in patients with no (group 1), mild (group 2), and severe hydronephrosis (group 3). SR (SFR) were not different in terms of stone type and volume but significantly low in patients with hydronephrosis. Auxillary procedures (percutaneous nephrostomy: 4 renal units, ureteral stent: 1 renal unit) were required in 5 renal units due to complete ureteral obstruction. CONCLUSIONS: In spite of low SR and SFR and multiple treatment sessions, we consider ESWL monotherapy to be a minimally invasive alternative treatment in patients with staghorn stone as outpatient procedure without the fear of ureteral stent, percutaneous nephrostomy and other auxillary procedures. Associated hydronephrosis is considered to be poor outcome factor of ESWL monotherapy in patients with staghorn stone.

Clinical Characteristics of Postoperative Delirium after Urological Surgery / 대한비뇨기과학회지

PURPOSE: Delirium in the elderly is common in the postoperative period but there are only few reports on detailed studies of this condition. Number of urologic patients with postoperative delirium was increas ed in our hospital for recent 24 months. The clinical characteristics of patients with postoperative delirium was analyzed retrospectively. MATERIALS AND METHODS: We selected the patients with postoperative delirium from 1010 patients who had undergone urological surgery under general or spinal anesthesia in the period from Jan. 1997 to Dec. 1999. Diagnosis of postoperative delirium was established with Diagnostic and Statistical Manual of Mental Disorders(DAM-III-R) by psychiatric clinicians. Onset and recovery of symptoms, risk factors, previous psychiatric clinicians. Onset and recovery of symptoms, risk factors, previous psychiatric disorder, relationship with anesthesia, drugs, and surgical procedures, concomittant medical conditions, and complications were retrospectively reviewed. RESULTS: Postoperative delirium was observed in 13 patients (1.3%). All patients were male and mean age was 70.4 years (46-86 years). Surgical procedures included TURP(8 patients), cystectomy (3 patients), nephroureterectomy (1 patient), and bladder rupture repair (1 patient). Delirium became apparent between one day and two days after the operation (mean 32.2 hours) and lasted for up to 7 days (mean 53 hours). Several factors such as older age (>65 years), male patient, longterm medication, past history of CVA, memory impairment, hearing difficulty, traumatic brain contusion, and obsessive personality were thought to be risk factors of postoperative delirium. Treatment with Haloperidol(R) intramuscular injection (2.5-5mg, every 30 minutes, 2-4 times until symptom resolution was achieved) with or without Ativan(R) intravenous injection (2mg) were effective. Complete symptom recovery was seen in 92.3% (12/13) of patients. One patient (7.7%) with previous history of dementia had persistent memory disturbance and disorientation during follow-up periods. CONCLUSIONS: Generally, postoperative delirium is an acute transient confusional state without considerable sequeles. Treatment is sedation and prevention of inadvertent accident associated with confusional state. Urologic surgeon must be attentive to the development of this illness especially when high risk factors were present.