Association of Non-alcoholic Fatty Liver Disease with Insulin Resistance in Non-Diabetic, Normal Weight Adults / 대한내과학회지

BACKGROUND: It is well known that non-alcoholic fatty liver disease is associated with type 2 diabetes mellitus, obesity, and dyslipidemia. Non-alcoholic fatty liver disease is frequently found in non-diabetic, normal weight adults, but the meaning of it is not fully investigated. We tested the hypothesis that there is association between non-alcoholic fatty liver disease with insulin resistance in non-diabetic, normal weight adults. METHODS: We examined 60 Korean adults above the age of 30 years, participating in medical check-up at the Chung-Ang University Hospital, from Sep 2003 to Jan 2004. Heapatitis B and C serologies were negative, and not the history of alcohol abuse. A standard interview, physical exam and biochemical study were conducted, and an experienced operator carried out ultrasound liver studies. We assessed the clinical characteristics of subjects and HOMA (Homeostasis Model Assessment), QUICKI (Quantitative Insulin Sensitivity Check Index) as an index of insulin resistance. RESULTS: We classified subjects into 2 groups: the controls (n=42), and those with non-alcoholic fatty liver disease (n=18). The frequency in the men was higher than that in the women (70 vs 30 %, p<0.05). Body mass index, waist circumference, hip circumference, waist/hip ratio, triglyceride, HDL-cholesterol, alanine transferase, and uric acid was significantly different between two groups (p<0.05). Insulin resistance (HOMA-IR) was significantly higher in subjects with non-alcoholic fatty liver disease (p<0.05). CONCLUSION: Non-alcoholic fatty liver disease is associated with insulin resistance in non- diabetic, normal weight adults.

Three-Dimensional CT Laryngography: Clinical Application

PURPOSE: To evaluate the clinical usefulness of 3D volume-rendering (VR) CT laryngography during quiet breathing, Valsalva, and modified Valsalva maneuvers, in those with laryngeal and pyriform sinus lesions. MATERIALS AND METHODS: Twenty-seven patients with various laryngeal and hypopharyngeal lesions were examined by means of four-channel multidetector-row helical CT (LightSpeed QX/i; GE Medical Systems, Milwaukee, Wis., U.S.A.) during quiet breathing, Valsalva, and modified Valsalva maneuvers. The protocol included 1.25-mm slice thickness, 3.75-mm rotation, 1.25 mm interval, and a pitch ratio of 3:1. Using an Advantage Windows 3.1 workstation (GE Medical Systems), 3D VR was generated in regions of interest, including all structures with a CT attenuation of between -1022 and -125 HU. Visual assessment of the findings of 3D CT laryngography, including the images obtained during the three different breathing maneuvers, were analyzed by three radiologists, who reached a consensus. These results were then compared with the findings of axial CT. The lesions discovered, in descending order of frequency, included laryngeal cancer (n=12), pyriform sinus cancer with an intact apex (n=6), pyriform sinus cancer with apex involvement (n=6), laryngeal papilloma (n=2), and hypopharyngeal obstruction with (n=1) and without (n=2) associated vocal cord palsy. In each case, the findings were confirmed by surgical biopsy, direct laryngoscopy, or CT. RESULTS: 3D CT laryngography using the VR technique can supplement the information provided by axial images, and in the assessment of subglottic invasion and pyriform sinus apical invasion, its findings are consistent. In many of our cases, its use during quiet breathing was able to determine whether or not glottic cancer involved subglottic invasion. In laryngeal cancer cases, furthormore, modified Valasalva can be used to clarify the condition of the pyriform sinus apex. Dynamic-phase 3D CT laryngography can be used to elucidate the condition of a patient with vocal cord palsy. CONCLUSION: 3D CT laryngography is a new method for the visual diagnosis of vocal cord and laryngeal cancer. When employed after dynamic diagnosis, it is useful for the evaluation of subglottic extension, pyriform sinus apical invasion and vocal cord palsy, important indicators in the staging of cancer.

Diagnostic Usefulness of the Multimodality Study with Mammography, Ultrasonography,99mTc-MIBI Scan in Breast Cancer

PURPOSE: To assess the diagnostic usefulness of multimodality study in the diagnosis of breast cancer. MATERIALS AND METHODS: Eighty-one patients between January 1998 to December 1999 were involved in this study, and who underwent mammography, breast ultrasonography, and 99mTc-MIBI scintimammography in all cases the findings were retrospectively reviewed. Each modality was graded by two physicians specializing in nuclear medicine and two radiologists, all unaware of the pathologic results. A four-grade system(1=definitely benign, 2=probably benign, 3=probably malignant, 4=definitely malignant) was applied to those ofbreast ultrasonography and 99m Tc-MIBI scintimammography and BIRADS was applied to those ofmammography. All breast masses were confirmed by surgery (n=67) or FNA (n=14). Findings of grade 3 or 4 the four-grade system, BIRADS category 4 or 5, or positive coincidence in double and triple combination studies were defined as positive results, and on the basis of the data thus obtained, the sensitivity, specificity, positive and negative predictive value and diagnostic accuracy were calculated for each modality and for multimodality studies. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 99mTc-MIBI scintimammography were 83.6%, 88.5%, 93.9%, 71.9% and 85.2%, respectively. For ultrasonography, the corresponding figure were 94.5%, 65.3%, 85.2%, 85.0%, and 85.2%, and these for mammography, they were 87.3%, 69.2%, 87.3%, 81.8% and 80.2%. For the ultrasonography and mammography combination, the figures were 83.6%, 50.0%, 93.9%, 100.0% and 95.2%, respectively, and for 99mTc-MIBI scinti-mammography and mammography, the corresponding findings were 72.7%, 69.2%, 95.2%, 100.0% and 96.7%. For the 99mTc-MIBI scintimammography and ultrasonography combination, respective findings of were 80.0%, 61.5%, 95.7%, 94.1% and 95.2%, respectively, and in the triple modality study, respective findings of 70.9%, 50.0%, 97.5%, 100.0% and 98.1% were recorded. CONCLUSION: Among multimodality studies, sensitivity was greatest in the ultrasonography and mammography combination, which is thus extremely suitable for the diagnosis of breast cancer. The findings of two series suggest that in equivocal cases, 99mTc-MIBI scintimammography with its higher specificity and positive predictive value, is a useful adjunctive tool.

Experimentally Induced Cerebral Fat Embolism with Linoleic Acid: MR Imaging and Pathologic Correlation

PURPOSE: To investigate the correlation between the MRI findings of cerebral fat embolism induced by injecting linoleic acid into ten cats, and pathologic diagnosis. MATERIALS AND METHODS: Using a microcatheter, 30 microliter of linoleic acid was injected into the internal carotid artery of ten cats. MR T2-weighted (T2WI), diffusion-weighted (DWI), and Gd-enhanced T1-weighted images (Gd-enhanced T1WI) were obtained after 30 minutes and after 2 hours of embolization. We pathlogically examined endothelial cell damage, cellular change, perivascular abnormality and fat vacuoles, and then determined the correlation between MRI and the pathologic findings. RESULT: After 30 minutes of embolization, lesions of very high signal intensity were detected by T2WI in six cats, and of slightly high signal intensity in two; in the remaining two, signal intensity was normal. DWI showed lesions of very high intensity in nine animals and of slightly high intensity in one, while Gd-enhanced T1WI showed well-enhanced lesions in nine and a minimally enhanced lesion in one. After 2 hours of embolization, T2WI revealed lesions of very high signal intensity in nine cats, and of slightly high signal intensity in one, while DWI detected lesions of very high signal intensity in all cats. On Gd-enhanced T1WI, lesions in all cats were well enhanced. According to the findings of light microscopic examination, infarcted lesions mainly involved the gray matter, but also some white matter. In the lesions, neurophil matrix edema, neuronal degeneration, perivascular swelling, the widening of extracellular space, extravascular hemorrhage, and fat vacuoles were evident. CONCLUSION: During the initial two hours following injection, MR imaging of cerebral fat embolism induced by linoleic acid through the internal carotid artery in cats showed high signal intensity on T2WI and DWI, and clear enhancement on Gd-enhanced T1WI. In cases involving cellular edema, cerebrovascular injury and extracellular space widening, the pathologic evidence suggested the coexistence of cytotoxic and vasogenic edema.

Differentiation between Ovarian Fibroma and Subserosal Leiomyoma by MR Imaging

PURPOSE: To evaluate the findings and differential points of ovarian fibroma and subserosal leiomyoma, as seen on MR images. MATERIALS AND METHODS: The MR imaging findings of 31 surgically confirmed cases of ovarian fibroma(n=6) and subserosal leiomyoma (n=25 ; 28 lesions) were evaluated. Multiplanar T1- and T2-weighted and postcon-trast T1-weighted images were obtained using a 1.5T MR unit, and histologic examination was also performed. The MR findings were analyzed in terms of signal intensity, the presence and definition of margin, the histo-logic finding of hyperintense lesion on T2-weighted images, the presence of the bridging vessel sign, degree of enhancement, and the presence of ipsilateral ovary and ascites. RESULTS: Both fibromas and leiomyomas showed hypo-or isointensity compared with uterine myometrium on T1-weighted images and compared with skeletal muscle on T2-weighted images. The latter revealed intratu-moral hyperintense lesions in most cases of ovarian fibroma and subserosal leiomyoma. Three of four ovarian fibromas had a well defined margin after cystic change, but in 24 of 26 subserosal leiomyomas the margin was ill defined. The "bridging vessel sign" was visible only in subserosal leiomyomas (22/28), and in all cases the enhancement of ovarian fibromas were less than that of myomtetrium. Subserosal leiomyomas (12/28), seen on enhancement as isointense or hyperintense to myometrium, showed a greater degree of enhancement than ovarian fibromas (0/6). Ipsilateral ovary was rarely seen in ovarian fibromas (1/6), but commonly seen in sub-serosal leiomyomas (20/25). Ascites was present in one case of ovarian fibroma. CONCLUSION: A defined margin of an intratumoral hyperintense lesion, as seen on T2-weighted images, and the presence or absence of the "bridging vessel sign" and ipsilateral ovary are useful signs when differentiating be-tween ovarian fibromas and subserosal leiomyomas.

Dynamic Images for Prediction of Therapeutic Efficacy of Hepatocellular Carcinoma Treated with Transcatheter Oily Chemoembolization

PURPOSE: To predict the therapeutic efficacy of transcatheter oily chemoembolization(TOCE) in the treatment. MATERIALS AND METHODS: We reviewed the findings of 24 dynamic CT or MR scans examined for the purpose of diagnosis before TOCE, and follow-up CT scans obtained after this procedure. In 24 patients (M:F=20:4) with a mean age of 52.2 years, 43 nodular HCCs with a diameter of 5 cm or less were present. The patients underwent double dynamic CT or MR imaging as one arterial phase 30 seconds after the intravenous injection of contrast media, and this was followed by a delayed phase 5 minutes fter injection. HCCs were then classified as one of four types: Type I, high and low attenuation or intensity during the arterial and delayed phase, respectively; Type II, iso- and low; Type III, iso- and high; and Type IV, high and iso-. In addition, we classified the degree of lipiodol accumulation by HCC nodules as either Grade 5 (fullmoon-like lipiodolization), Grade 2 (about 40%), or Grade 1 (about 20%), as seen on follow-up CT scans after TOCE. RESULTS: Type I provided an accuracy of 72.1% considering to more than 50% lipiodol accumulation. However, a single finding demonstrating high atenuation or intensity during the arterial phase gave an accuracy of 79.1% better than that of Type I. CONCLUSION: A finding of high attenuation or intensity during the arterial phase, as seen on dynamic CT or MR images, provides the best information about the therapeutic efficacy of HCCs treated by means of with TOCE.

The Vocal Tract and Speech Intelligibility of Tracheoesophageal Shunt Patients after Total Laryngectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In this paper, rehabilitation of voice after total laryngectomy has been suggested through the correct estimation and simulation of patients' vocal tract. Material and Methods: The author studied the shape of vocal tract during the phonation of five Korean vowels /u, o, a, e, i/ in tracheoesophageal shunt patients by magnetic resonance images (MRI). The same vocal tract was determined in each vowels from MRI. First, speech data produced by them were analyzed and also checked for speech intelligibility. Then the author tried to synthesize vowels from the vocal tract area of each vowels and from the expanded pharyngeal section of the vocal tract. RESULTS: The obtained results were as follows: 1) The sounds of /a/, /e/, /i/ were similar to natural sounds in actual patients' speech. The sound of /o/ was heard as /sigma/. The sound of /u/ was heard as strained /u/. 2) The synthesized vowels of /a/, /e/ from MRI were heard as natural sounds. The sounds of /u/, /o/, /i/ were heard as other sounds. 3) The synthesized vowel by the expanded pharyngeal section of 3 times in vowel /o/ was more naturally heard than that of 2 times. The synthesized vowel from Formfrek was more naturally heard than that from AreatoFormant. CONCLUSION: In conclusion, some of the synthesized sounds from MRI disagrees with the actual sounds produced by the subjects. This could be best identified by the synthesis from the area data. Future MRI studies should consider this problem for more accurate measurements. Also, pharyngeal areas with varied sizes should be experimented to secure better speech output because the correct shapes of vocal tract ensures correct vowel pronunciation.

CISS MR Imaging Findings of Epidermoid Tumor: Comparison with Spin-Echo Images

PURPOSE: To evaluate CISS MR imaging findings of epidermoid tumor in comparison with conventional spin-echoimages. MATERIALS AND METHODS: We studied 6 cases of epidermoid tumor in the subarachnoid space. We used a 1.5TMR unit to obtain CISS images(TR/TE/FA ; 12.3msec/5.9 msec/700) and T1- and T2-weighted spin-echo images. CISS MRimaging findings were evaluated with respect to tumor's signal intensity, contour, and relation with adjacentstructures. Conspicuity of the tumor was compared between CISS and spin-echo images. A quantitative analysis wasperformed by measuring tumor to CSF contrast. In qualitative analysis, three radiologists independently comparedCISS image and conventional spin-echo images for visibility of the tumor and graded them into three categories(poor, good, and excellent). RESULTS: Epidermoid tumors were located in the cerebellopontine angle in 4 cases, theprepontine cisstern in 1 case, and the cerebellopontine angle-prepontine cistern in 1 case. The tumors werehyperintense relative to brain parenchyma and hypointense relative to CSF on CISS images, were lobulated, encasedadjacent cranial nerve and vessels, and invaginated into brain parenchyma. In qualitative analysis, CISS imagesshowed clear demarcation between tumor and CSF, exact tumor extension, and tumor's relation with cranial nervesand vessels better than conventional spin-echo images. In quantitative analysis, the mean contrast values of tumorto CSF on T1-, T2-weighted images, and CISS images were 0.12, 0.06, and 0.52, respectively. The contrast value forCISS images was significantly higher than that for T1- and T2-weighted images (P<0.05) . CONCLUSIONS: Epidermoid tumors in the subarachnoid space are better demonstrated on CISS images than on conventional spin-echoimages. This special MR sequence can be added as a routine protocol in the diagnosis of subarachnoid epidermoidtumor.

Diffusion- and T2-weighted MR Imagings of Cerebral Infarction in Rabbit: Time Course of Imaging Findings and Histologic Correlation

PURPOSE: To correlate the serial findings obtained by diffusion- and T2-weighted imaging with histologicfind-ings obtained from 30 minutes to 31 days after the development of cerebral infarction in rabbits. MATERIALS AND METHODS: Nineteen male New Zealand white rabbits were subjected to intracerebral embolic infarction.Diffusion- and T2-weighted imagings were performed at 30 min, 2, 4 and 6 hours, and 1, 3, 5, 7, 11, 21 and 31days. Apparent diffusion coefficient (ADC) ratios and T2 signal intensity ratios of infarcted and normal brainwere calculated. Microphotographic or electron microscopic (EM) examinations were performed during hyperacute,acute and chronic infarctions. RESULTS: During hyperacute infarction, diffusion-weighted images showed highsignal intensity in the infarcted area, and ADC ratios ranged from 0.81 to 0.56. High signal intensity ondiffusion-weighted images continued until day 3, decreasing thereafter. The ADC ratio increased continuouslyafter day 1. High signal intensity on T2-weighted images was noted from 6 hours and continued until day 7,decreasing thereafter. Microphotographic findings at 6 hours were normal, but EM examination revealed cellularswelling with intact basement membrane, suggesting cytotoxic edema. During acute infarction, abnormal dilatationof the perineural space, cell destruction, and loosening of the neuropil matrix were revealed bymicrophotography. During chronic infarction, microphotographic and EM findings revealed liquefaction necrosis. CONCLUSION: These data indicate that in cases of hyperacute infarction, diffusion-weighted images reflectcy-totoxic edema more accurately than do T2-weighted images. A gradually increasing ADC ratio during the course ofinfarction may be associated with vasogenic edema and cell lysis.

Evaluation of Critical Function in Pathologic Solitary Kidneys Using 99mTc-DMSA Scintigram / 대한신장학회잡지

OBJECTIVE: To make decision of the dialysis or transplantation in the patient with renal failure should be demanded the precise measurement serving the critical level of the renal function. 99mTc- DMSA is a new renal scanning agent that provides a good quality of renal image as a result of preferential cortical accumulation and also makes feasible a quantitative assessment of renal function. We want to know the critical level of the renal function with 99mTc-DMSA scanning in the experimental rabbits with pathologic solitary kidney. MATERIALS AND METHODS: We made artificial left hydronephrosis having left ureter ligation at 2 weeks after performing right functional nephrectomy with vessels ligation in 20 experimental rabbits. At 24, 48, and 72 hours after then, 99mTc-DMSA renal uptake rates, serum urea nitrogen, and creatinine were checked to evaluate the critical levels of renal function impairment. RESULTS: Before left ureteral ligation 99mTc- DMSA renal uptake rates, serum urea nitrogen, and creatinine were 9.59+/-1.14%(mean+/-SD), 28.0+/-5.2 mg/dl, and 1.3+/-0.2 mg/dl respectively. Those of the fifteen pathologic solitary kidney at 24 hours after ureter ligation were 4.37+/-1.68%, 74.2+/-20.2mg/dl, and 7.6+/-2.4mg/dl respectively. Those of the thirteen at 48 hours were 4.25+/-1.09%, 126.0+/-33.5mg/dl, and 9.8+/-3.5mg/dl respectively. And serum urea nitrogen and creatinine of the twelve at 72 hours were 183.9+/-51.0mg/dl, and 14.4+/-2.3mg/dl respectively. 99mTc- DMSA renal uptake rates appeared indiscriminate values with approaching to death while the levels of serum urea nitrogen and creatinine revealed increasing values. CONCLUSION: 99mTc-DMSA renal scan was one of the appropriate tests to evaluate the critical level of renal function impairment.

Mechanism of Vocal Phonation in T-E Shunt Patients after Total Laryngectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Total laryngectomy has become a usual treatment for any advanced carcinoma of the larynx, but most patients who have undergone total laryngectomy have shown permanent disability in voice production. To solve this problem, studies of voice rehabilitation after total laryngectomy have been done. MATERIALS AND METHODS: We have developed an accurate method to measure the vocal tract shape along its length from magnetic resonance images acquired during the sustained phonation of Korean vowels by T-E shunt patients and normal subject. We estimated the accuracy of MRI and also compared the vocal tract spape of the normal and T-E shunt patients by comparing the first three formant frequencies estimated from MRI to those measured directly from speech data of the T-E patients and the normal subject. RESULTS: The length of T-E shunt patient's vocal tract is 17-18.5 cm. T-E shunt patients phonated strained voice. The length of resonant chamber of T-E shunt patients are shorter than that of the normal subject. The vocal tract is shortened during the phonation by T-E shunt patients. In cases of /e/ and /i/, front cavities are constricted while back cavities are shortened. The pseudoglottis of the T-E shunt patients is located at the region 14-15 cm from lip. CONCLUSION: Acoustic characteristics and vocal tract shapes of the T-E shunt patients are relatively similar to those of the normal subject. To achieve normal voice, reconstruction of pharyngeal and superior glottal resonant chamber will be desirable.

Role of EPI in Diagnosing Cavernous Hemangioma & Small HCC: Comparision with Fast T2-Weighted MR Imaging

PURPOSE: To compare single-shot echo-planar MR imaging(EPI) with breath-hold fast T2-weighted imaging(HASTEor Turbo spin-echo T2WI) for evaluation of the role of EPI in distinguishing small hepatocellular carcinoma fromcavernous hemangioma. MATERIALS AND METHODS: We retrospectively evaluated MR images of 35 patients (21 cases ofsmall HCC and 14 cases of cavernous hemangioma). EPI and breath-hold fast T2WI images were obtained and comparedon the basis of lesion detection sensitivity, lesion-to-liver signal intensity ratio(SIR), contrast ratio(CT), andlesion-to-liver contrast to noise ratio(CNR). RESULTS: For the detection of small HCC, the sensitivity of EPI andbreath-hold fast T2WI were equal in 14 of 21 cases(71.4%). The detection sensitivity of cavernous hemangioma withEPI and breath-hold fast T2WI was 100%(14/14). Mean SIR on breath-hold fast T2WI was 2.02+/-0.45 for small HCC and3.65+/-0.97 for cavernous hemangioma; on EPI, the corresponding figures wer 2.91+/-0.57 and 6.98+/-1.37. Mean CR onbreath-hold fast T2WI was 1.16+/-0.58 for small HCC and 2.65+/-0.57 for cavernous hemangioma; On EPI, the figuresobtained were 2.27+/-0.52 and 6.26+/-2.19, respectively. Mean CNR on breath-hold fast T2WI was 14.24+/- 4.098 forsmall HCC and 50.28+/-10.96 for cavernous hemangioma, while on EPI, the corresponding figures were 13.84+/-3.02 and45.44+/-11.21. CONCLUSION: In detecting focal hepatic mass, the sensitivity of EPI and breath-hold fast T2WI arecomparable; for the diagnosis of small HCC and cavernous hemangioma, EPI can provide additional information.

Renal Damage induced by Doxorubicin-Lipiodol Emulsion infused into Rabbit Renal Artery: Comparison with CT andHistologic Findings

PURPOSE: The purpose of this study was to evaluate the utility of renal CT scanning and to histologicallycorrelate renal damage induced by renal arterial infusion of 0.2 ml/kg of doxorubicin-lipiodol emulsion. MATERIALS AND METHODS: Renal CT scans of 20 rabbit kidneys were obtained 15 days after transcatheter arterialchemoembolization and were classified into four grades, as follows : Grade 0 - no fleck, Grade 1 - one to threenodular flecks ; Grade 2 - four or more nodular flecks, or one semilunar fleck ; and Grade 3 - two or moresemilunar flecks. The percentage of histological section occupied by lesion was determined using squared paper,and compared with the grades determined on the basis of CT. RESULTS: The histologic findings were interstitialinflammatory cell infiltration, intratubular lipiodol droplets, dystrophic calcification, and cellular necrosis.The mean sizes of grade 0, 1, 2 and 3 histological lesions were 2.2%(n=5), 4.5%(n=4), 21.9%(n=7), and 24%(n=4),respectively. Grades 0 and 1 accounted for nine cases(3.2%), while grades 2 and 3 accounted for 11(22.6%) ; thisdifference was statistically significant(p<0.01). CONCLUSION: CT findings showing nodular or semilunar flecks 15days after infusion into the renal artery of doxorubicin-lipiodol emulsion correlate with the size of the damagedkidney, as seen on histological specimens.

Usefulness of CISS Technique in the MR Imaging Diagnosis of Intraocular Lesions

PURPOSE: To assess the usefulness of CISS images in the diagnosis of intraocular lesions, we compared CISSimages with 3mm and 1mm sliced spin-echo T2-weighted images. MATERIALS AND METHODS: In 14 patients with 15intraocular lesions(retinal detachment 10, choroidal melanoma, 2 ; cavernous hemangioma, 1 ; PHPV, 1 ; andretinoblastoma, 1). we used a 1.5T MR unit obtain CISS images and 3mm and 1mm sliced spin-echo T2-weighted images.All lesions were analyzed, and after dividing them into two subgroups(linear lesions, n=11 ; mass lesions, n=4),CISS and spin-echo T2-weighted images were compared for detection rate and conspicuity. RESULTS: With regard tothese two parameters, CISS images were superior to 1mm and 3mm sliced spin-echo T2-weighted images. For theassessment of linear lesions, CISS images (detection rate, 100% ; conspicuity, 2.88) were superior to both 1mm and3mm sliced spin-echo T2-weighted images. For mass lesions CISS images were superior to 3mm sliced spin-echoT2-weighted images, but for conspicuity, there was no significant difference between CISS images (2.75) and 1mmsliced spin-echo T2-weighted images(2.2). CONCLUSION: Due to their higher detection rate and greater conspicuity,CISS images were superior to spin-echo T2-weighted images for the diagnosis of intraocular lesions less than 3mmin diameter ; for the diagnosis of intraocular lesions, they might therefore be a useful adjunct to SE images.

MR Imaging Findings of Renal Infarction Induced by Renal Artery Ligation in Rabbits: The Usefulness of Diffusion-weighted Imaging

PURPOSE: To assess the usefulness of diffusion-weighted imaging(DWI) in evaluating serial parenchymal changesin renal infarction induced by renal artery ligation, by comparing this with the conventional spin echo techniqueand correlating the results with the histopathological findings. MATERIALS AND METHODS: In 22 rabbits, renalinfarction was induced by ligation of the renal artery. Spin-echo T1-weighted imaging(T1WI), turbo spin-echo(TSE)T2-weighted imaging(T2WI), and DWI were performed, using a 1.5-T superconductive unit, at 30 minutes, 1 hour, 2,3, 6, 12 and 24 hours, and 2, 3, 7 and 20 days after left renal artery ligation. Changes in signal intensity onT1WI, T2WI, and DWI were correlated with histopathologic findings. RESULTS: On MR images obtained 30 minutesafter ligation, the signal intensity of affected kidney was not significantly different from that of contralateralkidney, as seen on T1WI and T2WI, but was noticeably higher on DWI. On T2WI, the signal intensity ratio(SIR) wasslightly higher over time from 30 minutes to 2 days after ligation, and then decreased slightly. The SIR on DWIincreased abruptly at 30 minutes, remained high until 12 hours, and then fell, returning to close to the normalrange at between 2 and 3 days. It fell further, below the normal range, until 20 days after ligation. The mainhistopathologic findings after ligation were congestion and swelling of renal tubules (1-6 hours after ligation),degeneration and necrosis of renal tubules (12 hours - 2 days), coagulation necrosis of renal tubules(3 days),collection of cellular debris between renal tubules (7 days), and proliferation of fibroblast between renaltubules (20 days). CONCLUSION: Diffusion-weighted imaging is useful for the detection of hyperacute renalinfarction, and the apparent diffusion coefficient may provide additional information concerning its evolution.

Multiple Bone Metastases on Radionuclide Bone Scans Distributed to Batson's Plexus

PURPOSE: Multiple bone metastases that appear on 99mTc-MDP bone scans tend to be distributed in the axialskeleton, including the proximal humeri and femora;this is similar to the distribution seen in Batson'sparavertebral plexus. The purpose of this study was, therefore, to evaluate- by examining the anatomicdistribution of metastases- the metastatic mechanism of cancer cells of various primary tumors in Batson's plexus. MATERIALS AND METHODS: Three hundred and forth-five known cases of primary tumors and multiple bone metastaseswere confirmed by bone scan imaging. The axial skeleton was divided into seven parts: skull, ribs, scapulas,spine, pelvis, proximal humeri, and proximal femora. In addition, the spine was divided into cervical, thoracicand lumbar areas. RESULTS: Among the 345 cases, bony metastases were distributed as follows: ribs, 186 (53.9%);spinal areas, 172 (49.9%); pelvis, 94 (27.2%); proximal femora, 85 (24.6%); skull, 63 (18.3%); proximal humeri, 45(13%); and scapulas, 31 (9%). Among the 243 primarily thoracic cancer cases (e.g. lung, breast or esophagus),distribution was as follows: ribs, 142 (58.4%); spinal areas 111 (45.7%); and pelvis, 54 (22.2%). Among the 69cancers which were primarily of the upper abdomen (e.g. stomach or liver), distribution spinal areas, 44 (63.8%);ribs, 33 (47.8%); and pelvis, 26 (37.7%). While the 33 primarily pelvic cancers (e.g. prostate, uterine cervix orbladder), were distributed between spinal areas (17, 51.5%), the pelvis (13, 39.4%), and the ribs (11, 33.3%).There were no statistically significant differences in the distribution of bony metastases according to primarycancers. CONCLUSION: Multiple bone metastases, as seen on bone scan images, coincided with the distribution ofBatson's plexus. We therefore conclude that although pelvic tumors can metastasize to the axial skeleton bydirectly anastomosing into Batson's plexus, other primary tumors metastasize from systemic veins to Batson'splexus as a result of the occurrence of venous reflux when intrathoracic or intra-abdominal pressure is increased.

The Use of Ultrasound for the Early Evaluation of Evaluation of Fracture healing After Interlocking Nailing of the Tibia / 대한정형외과학회잡지

After the stabilization using unreamed intramedullary interlocking nails for the management of fractures of the tibial shaft, a large percentage of patients whose fractures would proceed to delayed bony union may be subject to secondary surgical procedure. The purpose of this study is to determine whether ultrasound, through its potential early assessment of the presence or absence of callus at the fracture site, can be used to predict the need for secondary surgical procedure. Fourteen tibial fractures (5 open, 9 closed) were treated with unreamed interlocking intramedullary nailing. Radiographs were obtained to monitor the maintenance of reduction and fracture healing. The results of ultrasound studies were obtained at two-week intervals for 10 weeks postoperatively and read by a radiologist. In prospective study of 14 patients, tibial fractures treated with unreamed interlocking intramedullary nailing were analyzed from June 1995 to February 1997 and following results were obtained. 1. Ultrasound correctly predicted fracture healing in all 10 fractures that subsequently progressed to fracture union. 2. Of the 4 fractures that did not heal, ultrasound was able to predict delayed union before it was radiographically evident. 3. Ultrasound predicted fracture healing at an average of 42 days (range, 22-70 days). In comparison, the plain radiographs showed fracture healing at an average of 126 days (range, 70 - 180 days). In conclusion, the tibia was ideal for ultrasound study because of the thin overlying soft tissue. Furthermore, the presence of the intramedullary nail facilitated evaluation of the intervening tissue. And there were several advantages of ultrasound over other imaging modalities. It was noninvasive, easy to use, and painless method of evaluation that does not use ionizing radiation.

The Suppression Effect of the Intrahepatic Recurrence of Transcatheter Arterial Chemoembolization with Cisplatin in the Hepatocellular Carcinoma Patients: The Comparison of Adriamycin-Lipiodol Emulsion Infusions with Adriamycin-Lipiodol Emulsion Infusions

PURPOSE: To compare the suppressive effects in hepatocellular carcinoma patients of transhepatic arterial chemoembolization by the infusion of adriamycin-lipiodol emulsion and of this plus 10ml of cisplatin solution. MATERIALS AND METHODS: In a total of 151 cases, the frequency of intrahepatic recurrence was compared with follow-up angiographic findings after the first and second transhepatic arterial chemoembolization with adriamycin-lipiodol emulsion and adriamycin-lipiodol emulsion plus 10ml of cisplatin solution, respectively. RESULTS: Among 46 patients whose first single infusion was after mean 119 days, the recurrence rate was 22% ; for 42 who were given their first multiple infusion after mean 76 days this rate was 5% ; for 35 whose second single infusion was administered after mean 147 days, the rate was 34%, and among 28 whose second multiple infusion was after mean 110 days, the rate was 43%. CONCLUSION: During the first trial of transcatheter arterial chemoembolization with adriamycin-lipiodol plus cisplatin solution, hepatocellular carcinoma recurred much less frequently, but during the second trial with cisplatin, recurrence was not suppresed.

Efficacy of Percutaneous Transhepatic Choledochoplasty of the Biliary Stricture, Using a 16F Silastic Catheter, in Patients with Recurrent Pyogenic Cholangitis

PURPOSE: To evaluate the efficacy of percutaneous transhepatic choledochoplasty of the main biliary stricture, using a 16F silastic foley catheter, in patients suffering from recurrent pyogenic cholangitis MATERIALS AND METHODS: In nine patients who had undergone stenting procedure at the site of the main stricture after the total removal of biliary stones, a 16F silastic catheter was held in position for 1-4 (mean, 2.7) months. Using ultrasonogrophy, we assessed the diameter of the bile duct 5 cm above the main stricture. RESULTS: During the follow-up period of 1-30 (mean, 18.1) months, the diameter of the bile duct above the main stricture was, in all cases, under 3 mm. CONCLUSION: In patients with recurrent pyogenic cholangitis, choledochoplasty of the biliary stricture, using a 16F silastic catheter, was therapeutically effective.

Color Doppler Energy(CDE): Initial Ten-Months Experience

PURPOSE: Color Doppler Imaging(CDI) has shortcomings, including random noise, aliasing, and angle dependence. To overcome these, a method using CD US, termed power doppler or Color Doppler Energy(CDE), has recently been introduced. The purpose of this study was to show the clinical usefulness of CDE. MATERIALS AND METHODS: We retrospectively analyzed the CDI and CDE of 61 cases(20 renal pseudotumors, 8 musculoskeletal inflammations, 17epididymitis or epididymo-orchitis, 3 vaicoceles, 1 normal testis, 1 hepatocellualar carcinoma, 7 renal cell carcinomas, 1 renal angiomyolipoma, and 3 splenic varices). CDI and CDE scans were obtained at the same region with constant scan plane. The color gain was increased until noise first became perceptible, and scans were always obtained in such a way that the maximum amount af vascularity was shown. There after, the vascularity, vascular displacement, and the vascular relationship between CDI and CDE were compared. RESULT: In 17 of 20 cases of pseudotumor in the kidney, normal vascularity was identified in CDI and CDE, but was more clearly visible in CDE. In three cases, there was no visible vascularity in CDI, but normal vascularity in CDE. In eight cases of musculoskeletal inflammation and 17 cases of epididymitis with or without or chitis, the vascularity was increased due to hyperemia, which was more prominently seen in CDE than in CDI. In three varicoceles, CDE appeared to bebetter in demonstration low velocity flow. In one patient who was suspected of having acute testicular torsion, CDE was helpful in excluding this suspicion. In one case of hepatocellular carcinoma, seven cases of renal cell carcinoma, one case of renal angiomyolipoma, and three cases of splenic varices, CDE was better than CDI in showing the vascularity, vascular relationship, and vascular displacement. CONCLUSION: CDE is a potential lyuseful adjunct to standard CDI.