Usefullness of Upper Gastrointestinal Series Using Indirect Radiography in Mass Screening Program for Gastric Cancer

PURPOSE: To compare the image quality of UGIS (upper gastrointestinal series) obtained by direct radiography with that of UGIS obtained by indirect radiography in a mass screening program for gastric cancer, and to assess the validity of UGIS by indirect radiography. MATERIALS AND METHODS: A total of 994 persons participated in a mass screening test for gastric cancer between March 2003 and April 2003 at the Korea Association of Health Promotion (KAHP). Of these 994 persons, 494 underwent UGIS by direct radiography, while the remaining 500 underwent UGIS by indirect radiography (i.e. photofluorography using a mirror camera and a 100 mm-roll film). We compared the image quality of UGIS obtained by direct and indirect radiography with, in each case, the image quality being graded as 'excellent', 'good', 'fair', 'poor' or 'very poor'. RESULTS: The image quality of UGIS by both direct and indirect radiography was similar: most images in both groups were rated as either 'excellent', 'good', or 'fair', while the incidences of poorly rated images were similar in both cases (5% versus 6%, respectively); and there were no images rated as 'very poor' in either case. For certain sites of the stomach, the image quality of UGIS by direct radiography was superior to that of UGIS by indirect radiography, namely at the cardia (p0.05). CONCLUSION: There was no significant difference in the image quality between UGIS by indirect and direct radiography. Therefore, UGIS by indirect radiography may be used as a method of mass screening for gastric cancer.

Diagnosis of Superficial Esophageal Cancer: Comparative Study of Double Contrast Esophagography and Endoscopy

PURPOSE: To assess the diagnostic accuracy and limitations of double contrast esophagography in patients with superficial esophageal cancer, as compared with endoscopic, gross and microscopic findings. MATERIALS AND METHODS: In 43 patients with pathologically proven superficial esophageal cancer, the detection rate and diagnostic accuracy of double contrast esophagography and endoscopy were compared. The depth of invasion revealed by esophagography, and grossly and microscopically in resected specimens, was compared. RESULTS: The detection rate and diagnostic accuracy were, respectively, 86.0% and 76.7% for esophagography, and 100% and 95.3% for endoscopy. In addition, very different detection rates (54.6% and 100%, respectively) were noted for epithelial and mucosal lesions. In flat-type cases (0-IIb), esophagography showed limited ability to detect lesions, but the accuracy of this modality in predicting the depth of tumor invasion was relatively high (94.6%). CONCLUSION: In cases of superficial esophageal cancer, double contrast esophagography showed a lower detection rate and lower diagnostic accuracy than endoscopy, and this was especially so for epithelial and mucosal lesions. The modality was able, however, to reliably predict the depth of tumor invasion.

Diagnosis of Recurrent Uterine Cervical Cancer: Computed Tomography versus Positron Emission Tomography

OBJECTIVE: To determine the accuracy of CT and positron emission tomography (PET) in the diagnosis of recurrent uterine cervical cancer. MATERIALS AND METHODS: Imaging findings of CT and PET in 36 patients (mean age, 53 years) in whom recurrent uterine cervical cancer was suspected were analyzed retrospectively. Between October 1997 and May 1998, they had undergone surgery and/or radiation therapy. Tumor recurrence was confirmed by pathologic examination or follow-up studies. RESULTS: In detecting recurrent uterine cervical cancer, the sensitivity, specificity, and accuracy of CT were 77.8%, 83.3%, and 80.5%, respectively, while for PET, the corresponding figures were 100%, 94.4%, and 97.2%. The Chisquare test revealed no significant difference in specificity (p = .2888), but significant differences in sensitivity (p = .0339) and accuracy (p = .0244). CONCLUSION: PET proved to be a reliable screening method for detecting recurrent uterine cervical cancer, but to determine the anatomical localization of recurrent tumors, and thus decide an adequate treatment plan, CT was eventually needed.

Liposarcoma: MR Findings in the Histologic Subtypes

PURPOSE: To evaluate the MR imaging findings of liposarcomas of different histologic subtypes. MATERIALS AND METHODS: We evaluated MR images of 21 patients (5 men and 16 women, mean age, 55 years) with liposarcoma andcorrelated the findings with the results of histopathology. In the study group seven liposarcomas werewell-differentiated, seven were myxoid, three were mixed, two were pleomorphic, and one was round cell. RESULTS: On T1 -and T2 - weighted images, six of seven well-differentiated liposarcomas showed signal intensity equal tothe fat and hypointense septa, while the other showed low signal intensity on a T1 -weighted image, heterogeneoushigh signal intensity on a T2- weighted image, heterogeneous enhancement after the administration of contrastmedia and was dedifferentiate. Nine masses in seven patients with myxoid liposarcoma showed low signal intensityon T1-weighted images, six of the nine showed lace-like foci of high signal intensity. On T2 -weighted images, allmasses showed homogeneous high signal intensity. After administration of contrast media, five of seven massesshowed heterogeneous enhancement. Two of three mixed form were well-differentiated and myxoid types, and twosubtypes were separable on MR. Pleomorphic, round cell, mixed type myxoid and pleomorphic and unclassified casesshowed low signal intensity on T1-weighted images, heterogeneous high signal intensity on T2-weighted andheterogeneous enhancement. CONCLUSION: Using MR imaging, well-differentiated and myxoid liposcarcomas may bedifferentiated from other types.

MR Imaging of Osteosarcoma: Emphasis on Joint Involvment

PURPOSE: To evaluate MR imaging findings of joint involvement in patients with osteosarcoma MATERIALS AND METHODS: Among 166 patients with osteosarcoma treated between January 1993 and July 1998, 67(44 men and 23 women,mean age 20 years) whose tumors had invaded the epiphysis were included in this study. Those with preserved normalbone marrow signal intensity between the tumor and cortical bone were excluded. Tumors were located around theknee (n=52), the hip (n=7), the shoulder (n=5), the ankle (n=2), or the wrist (n=1). For all patients,pre-operative spin echo pre- and post-contrast enhanced MR images were obtained. In all cases, we assessed thepresence or abscence of intrasynovial mass, intraarticular disruption of cortical bone and articular cartilage,and joint effusion, and also evaluated the mass around the cruciate ligaments of the knee. All patients underwentsurgery and MR findings were correlated with the results of pathologic examinations. RESULTS: In six patients thetumor was found to involve the knee joint. Sensitivity and specificity for the intrasynovial mass (n= 6),intraarticular disruption of cortical bone and articular cartilage (n= 19), mass around the cruciate ligaments (n=7), and joint effusion (n= 12) were 83.3%, 100%, 83.3%, 33.3% and 98.4%, 78.7%, 95.6%, 83.6%, respectively, whileaccuracy for the intrasynovial mass and mass around the cruciate ligaments was 97% and 94.2% respectively. CONCLUSION: If MR imaging indicates the presence of a mass in the synovial cavity or around the cruciateligaments, this is suggestive MR findings of joint involvement.

Osteosarcoma after Preoperative Chemotherapy: Tissue Characterization with Specimen MR and the Role of Enhanced MR Imaging

PURPOSE: To evaluate the role of enhanced MR imaging in monitoring tumor response to preoperativechemotherapy for osteosarcomas. MATERIALS AND METHODS: Fo r t y - s even patients (30 males and 17 females, witha mean age 17 years ; range 8 -44 years) with osteosarcomas were included in this study. We obtained spin echoT1-, T2-, and enhanced T1-weighted images before and after pre-operative chemotherapy and in all patientscorrelated changes in MR parameters with histopathologic response. We also obtained 19 specimen MR images,correlating these with histopathologic results in order to estimate tissue specific signals. Patients with morethan 10% viable tumor in the resected specimen were considered poor respon-ders(n=26), while those with 10% orless viable tumor were considered good respon-ders(n=21). RESULTS: Four distinct patterns of signal intensitycorresponded, respectively to dead bone and dense fibrosis (low on T1- and T2-weighted images), viable tumor cells(in-termediate on T1- and high on T2-weighted images), necrosis (low on T1- and high on T 2 - weighted images),and hemorrhage (high on T1- and T2-weighted images), but a wide range of overlap was noted. In all four groups,viable tumor cells remained. Increased tumor vo l u m e, stable or increased edema and enhancement were goodpre-dictors of poor response (predictive values of 83%, 77%, and 89%, respectively). Decreased enhancement was theonly reliable predictor of good response (predictive value, 73%). Changes in tumor margin, homogeneity, signalintensity, and joint effu-sion did not correlate with histopathologic response. CONCLUSION: Signal intensities donot reflect histologic nature. Enhanced MR imaging is a useful predictor of tumor response to preoperativechemotherapy.

MR Imaging Findings of Chondroblastic Osteosarcoma

PURPOSE: To evaluate the MR imaging findings of chondroblastic osteosarcoma. MATERIALS AND METHODS: Weincluded 11patients (8 men, 3 women, mean age of 19 years) with pathologically proven chondroblastic osteosarcomaand, as a control group, 20 patients with conventional osteosarcoma. We obtained pre- and post-enhanced MR imagesof all patients and retrospectively reviewed the signal intensity and enhancement pattern of tumors. MR imageswere correlated with histopathology. RESULT: In chondroblastic osteosarcomas, the major portion (< 75%) of thetumor showed low signal intensity on T1-weighted images and homogeneous high signal intensity on T2-weightedimages, but did not show enhancement. The margin of the area showed a lobular pattern. Enhanced nodules (n=11) andstrands (n=8) were seen in the nonenhanced portion. Histopathologically, the nonenhanced portion, nodules, andstrands revealed a chondroid matrix, hypercellular area, and fibrovascular septa, respectively. Conventionalosteosarcomas showed heterogeneous enhancement ; six showed a focal (<25%) nonenhanced area representing necrosis. CONCLUSION: Chondroblastic osteosarcoma showed characteristic MR imaging findings.

CT Findings of Pleural Dissemination from Lung Cancer

PURPOSE: The purpose of our study was to identify the CT findings that help detect pleural dissemination from lung cancer and to evaluate the usefulness of selected diagnostic criteria. MATERIALS AND METHODS: After a computerized database search of 606 patients who had undergone thoracotomy for primary lung cancer, 23 patients were identified as h aving surgically documented pleural dissemination. From the same database, 50 patients without pleural dissemination during thoracotomy were randomly selected as controls. Preoperative CT scans and medical records were rev i ewed retrospectively, and findings were compared between the two groups. RESULT: One or more of three types of pleural thickening (plaque-like, nodular, and fissural) were identified on CT as the most discriminating finding (sensitivity, 74 % ; specificity, 60 %; p = 0.007). The following findings were also significantly discriminating (p<0.05): contiguity of primary tumor with the pleural surface as seen on CT; adenocarcinoma in cell type; and a peripheral tumor defined as one in which bronchoscopy revealed no endobronchial lesion. The use of combinations of these findings in addition to pleural thickening rendered diagnostic criteria more specific at the cost of the sensitivity. CONCLUSION: During preoperative CT evaluation of lung cancer, the recognition of subtle pleural thickening helps detect pleural dissemination. The likelihood that subtle pleural thickening represents pleural dissemination is increased when a primary tumor is contiguous with the pleural surface, is an adenocarcinoma, or is peripherally located.

Usefulness of Sonography in Detection of Local Recurrent Soft Tissue Tumors

PURPOSE: To evaluate the usefulness of ultrasonography in the diagnosis of local recurrent soft tissue tumors. MATERIALS AND METHODS: We retrospectively analysed the results of 113 sonographic examinations in 102 patients (38males, 64 females) after surgical treatment of soft tissue tumors (82 malignancies, 20 benignancies) during thelast five years. Follow-up included physical and sonographic examinations using a 5-10MHz transducer every twomonths. In 17 cases, MR images were obtained The criterion for local recurrence was discrete mass, and size,shape, margin, echogenicity, and homogeneity were also analysed. Forty-one patients underwent surgery. RESULTS: Among 113 cases, 41 local recurrences were proven by surgery and histological analysis; well-defined, ovoid,homogeneous hypoechoic masses of various sizes were apparent. Sonographic sensitivity and specificity were both97%. MR sensitivity and specificity were 83% and 100% respectively, but in most cases in which MR had been usedthe masses were greater than 3cm in diameter. Two cases were false positive; these were thought to be granulomas,but were shown during follow-up lasting 36 and 14 months, respectively, to be unchanged hypoechoic nodules. Onecase was false negative. CONCLUSION: For the diagnosis of local recurrent soft tissue tumors, ultrasonography isvery useful. For early detcction, it is superior to MR imaging.

Desmoplastic Small Round Cell Tumor: Radiologic Findings

PURPOSE: To evaluate the radiologic findings of intra-abdominal DSRCT. MATERIALS AND METHODS: We reviewed sixcases of pathologically proven DSRCT of the abdomen. Five of these patients were men and one was a woman ; theiraverage age was 26.8 years. We retrospectively analyzed CT(n=6) and MRI(n=4). RESULTS: In all patients, largerelatively well defined lobulated mass was seen;this arose from the peritoneal surface, and its average size was12.6(range, 10-18)cm. After the administration of contrast material, the masses showed inhomogeneous enhancement,and in addition, the following features were seen: irregular internal septations (n=5); necrosis (n=3); andamorphous calcification (n=4). Various associated findings such as ascites (n=4) and multiple para-aortic lymphnode enlargement (n=4) were present; omental cake (n=5), liver metastasis (n=1), cervical lymphadenopathy (n=1),hydronephrosis (n=1), small bowel obstruction (n=1), scrotal swelling (n=1) and collateral vessels by encasedaorta and renal vein (n=1) were also seen. CONCLUSION: In young male patients with a large heterogeneous enhaneedcalcified abdominopelvic mass and findings of carcinomatosis on both CT and MR images, DSRCT should be inelvded inthe differential diagnosis.

Mechanical Characteristics of Self-expandable Metallic Stents: In Vitro Study with Three of Stress

PURPOSE: To obtain objective and comparable date for mechanical characteristics of self-expandable metallicstents widely used in the treatment of biliary obstruction. MATERIALS AND METHODS: The stents tested were the 6and 9 mm-band Hanaro spiral stent, Gianturco-R sch Z stent, Wallstent, Ultraflex stent, and Memotherm stent. Eachwas subjected to three types of load : point, area, and circular. We analyzed their mechanical characteristics(resistance force, expansile force, and elasticity) according to these three types of stress. RESULTS: Withregard to point loads, the Memotherm stent showed the highest resistance force and expansile force. The 8 mm-bandhanaro stent showed the lowest resistance force and the Gianturco-R sch Z stent and Ultraflex stent showed lowerexpansile force. With regard to area loads, the Ultraflex stent showed the highest resistance force. The 6 mm-bandHanaro stent, Gianturco-R sch Z stent, and Ultraflex stent showed higher expansile force. The 8 mm-band Hanarostent showed the lowest value in both resistance force and expansile force. For circular loads, the Memothermstent showed the highest resistance force and the Ultraflex stent and Wallstent showed lower Value. Under alltypes of stress, the Hanaro stent and Memotherm stent were completel elastic, and the Ultraflex stent andWallstent showed a wide gap between resistance force and expansile force. CONCLUSION: In clinical practice,awareness of the mechanical characteristics of each stent might help in choosing the one which is most suitable,according to type of biliary obstruction.

Evaluation of Mediastinal Lymph Node Metastasis in Lung Cancer: Factors influencing the Diagnostic Accuracy ofCT

PURPOSE: To evaluate factors influencing the CT assessment of mediastinal lymph node metastasis in patientswith non-small cell lung cancer. MATERIALS AND METHODS: CT scans of 198 patients who had undergone thoracotomyand mediastinal lymph node dissection for non-small cell lung cancer were retrospectively evaluated using a sizecriterion of > or = 10mm in the short axis. To evaluate the accuracy of CT in diagnosing lymph node metastasis on anodal station-by-station basis, CT and pathological results were correlated. Analysis included a comparison of thesensitivity and specificity of CT according to 1) cell type of tumor, squamous cell carcinoma versusadenocarcinoma (excluding bronchioloalveolar cell carcinoma) ; 2) histologic differentiation;3) tumor size;4)central and peripheral of the tumor;5) the presence or absence of obstructive pneumonitis and/or atelectasis;6)the presence or absence of prior granulomatous disease. RESULTS: The overall sensitivity, Specificity, positive predictive value, and negative predictive value of CT in diagnosing mediastinal lymph node metastasis were 65%,84%, 43%, and 93%, respectively. Sensitivity for squamous cell carcinoma (72%) was significantly higher than thatfor adenocarcinoma(44%)(p<0.01). Higher specificities were noted in patients without obstructive pneumonitisand/or atelectasis(91% versus 75%)(P<0.01), and with a peripherally located tumor (90% versus 82%)(P<0.01).sensitivity and specificity were not appreciably altered by other variables. CONCLUSION: In the CT assessment ofmediastinal lymph node metastasis the cell type of adenocarcinoma adversely affected sensitivity, with a highfrequency of normal-sized metastatic nodes. Obstructive pneumonitis caused by central tumor adversely affectedspecificity with the frequent occurrence of hyperplastc nodes.

Effect of Intraarterial and Systemic Chemotherapy for Stage IIb Cervical Carcinoma: Assessment of TherapeuticResponse Using MR Imaging

PURPOSE: To evaluate the effectiveness of intraarterial chemotherapy(IAC) and systemic chemotherapy(SC) incases of locally advanced cervical carcinoma, and to assess the accuracy of magnetic resonance(MR) imaging fordetermining parametrial invasion after IAC or SC. MATERIALS AND METHODS: Among 44 patients with stage IIbcervical carcinoma, IAC was performed in 25 and SC in 19. MR images obtained before and after IAC or SC wereprospectively analyzed with regard to tumor volume and parametrial invasion, and tumor response to chemotherapywas classified as complete, partial, or progressive. Forty-one patients underwent radical hysterectomy within twoweeks of the second MR examination, and postoperative pathologic findings were correlated with radiologicfindings. RESULTS: The average reduction rate of tumor volume in the IAC and SC group was 89.2% and 66.3%,respectively. Between the two groups, there was no statistically significant difference(P>0.05). In the IAC group,13 patients showed a complete response and 11 a partial response, and in one there was progression. In the SCgroup, eight patients showed a complete response and nine a partial response, and in two there was progression.The accuracy of MR imaging for determining parametrial invasion after chemotherapy was 87.8%. In each patientthere was close correlation between MR imaging and pathologic findings. CONCLUSION: There was no statisticallysignificant difference in tumor reduction between the IAC and SC group. After chemotherapy for stage IIb cervicalcarcinoma, MR imaging is a valuable modality for determining surgical candidates.

CT and MRI Findings of Malignant Mixed Mullerian Tumor of the Uterus: Irradiation-associated vs Non-associated

PURPOSE: The purpose of this study is to present imaging findings of MMMT developed after irradiation and to compare them with those not associated with irradiation. MATERIALS AND METHODS: Patients with pathologically-proven MMMT were divided into two groups ; group 1, with a history of pelvic irradiation (n=9), and group 2, without such history(n=4). With regard to tumor location, size, extent, degree of myometrial invasion, presence of enhancement, and internal texture of a tumor, we analyzed CT(n=10) and MR imaging (n=8) findings in each group. RESULTS: The tumor was larger in group 1 (average 8.7 cm) than in group 2 (average 5.5 cm). In eight patients in group 1, the endometrial cavity was distended, with remarkable fluid retention, and a mass was found in the fundus or body. The junctional zone was disrupted and hemorrhagic or necrotic foci were found within the mass. In all patients in group 2 and in one in group 1, a tumor had replaced the endometrial cavity, without fluid retention. CONCLUSION: Imaging findings of irradiation-associated MMMT appeared to be different from those not associated with irradiation. Where there are findings of a distended endometrial cavity filled with fluid andmural mass, one should be alert to the possibility of irradiation-associated MMMT.

CT and MRI Findings of Malignant Mixed Mullerian Tumor of the Uterus: Irradiation-associated vs Non-associated

PURPOSE: The purpose of this study is to present imaging findings of MMMT developed after irradiation and to compare them with those not associated with irradiation. MATERIALS AND METHODS: Patients with pathologically-proven MMMT were divided into two groups ; group 1, with a history of pelvic irradiation (n=9), and group 2, without such history(n=4). With regard to tumor location, size, extent, degree of myometrial invasion, presence of enhancement, and internal texture of a tumor, we analyzed CT(n=10) and MR imaging (n=8) findings in each group. RESULTS: The tumor was larger in group 1 (average 8.7 cm) than in group 2 (average 5.5 cm). In eight patients in group 1, the endometrial cavity was distended, with remarkable fluid retention, and a mass was found in the fundus or body. The junctional zone was disrupted and hemorrhagic or necrotic foci were found within the mass. In all patients in group 2 and in one in group 1, a tumor had replaced the endometrial cavity, without fluid retention. CONCLUSION: Imaging findings of irradiation-associated MMMT appeared to be different from those not associated with irradiation. Where there are findings of a distended endometrial cavity filled with fluid andmural mass, one should be alert to the possibility of irradiation-associated MMMT.

Invasive Ductal Carcinoma vs. Invasive Lobular Carcinoma: Mammographic Findings

PURPOSE: The purpose of this study is to evaluate mammographic findings of invasive ductal carcinoma(IDC) and invasive lobular carcinoma(ILC)and to find differential points between the two. MATERIALS AND METHODS: 239 patients, who underwent mammography prior to surgery and were proved to have IDC(224 patients) or ILC(15 patients)pathologically, were analized retrospectively. On mammogram, presence of mass and micro calcification were analized. When there was a mass on mammogram, lesion opacity was classified into high, equal, or low opacity andborder of the mass was classified into spiculated, poorly marginated, and well-marginated. When there was nodefinite mass, mammographic findings were classified into asymmetric opacity and no mass. RESULTS: Masses were observed in 168 patients(75%) of IDC and 12 patients(80%) of ILC. Border of the masses were spiculated(n=50,22.3%), poorly marginated(n=112, 50%), or well-marginated(n=6, 2.7%) in patients with IDC. Spiculated and poorly marginated borders were observed in 8 patients(53.3%) and 4 patients(26.7%) respectively, in patients with ILC. Microcalcifications were seen in 88 patients(39.3%) of IDC and 2 patients(13.3%) of ILC. Equal or low opacities ofthe lesions were observed in 29 patients(17.3%) of IDC and 5 patients(33.3%) of ILC. CONCLUSION: Although equalor low opacities were observed more frequently in ILC and microcalcifications were noted more frequently in IDC,it was difficult to differentiate the two diseases based on mammographic findings.

MR Imaging Findings of Malignant Fibrous Histiocytoma of Bone

PURPOSE: The purpose of this study is to assess magnetic resonance (MR) imaging findings of malignant fibrous histiocytoma (MFH) of bone and to evaluate the role of contrast-enhanced MR imaging in the diagnosis of bone MFH. MATERIALS AND METHODS: MR imagings of pathologically proven bone MFH in ten patients were reviewed. Enhanced study was also performed with Gd-DTPA. The MR images were evaluated for signal intensity, homogeneity, marginal definition, presence of internal septation, cortical destruction, soft tissue extension, joint involvement and contrast enhancement. RESULTS: Tumors showed iso- or slightly high signal intensity to muscle on T1-weighted images and heterogeneously high signal intensity on T2-weighted images. Four cases showed poor-marginated borderon T2-weighted images and four cases had internal septa. Eight of nine patients with intravenous administration of Gd-DTPA showed contrast enhancement, five were heterogeneous and three were homogeneous. All cases showed cortical destruction and soft tissue extension. Five cases showed joint involvement. CONCLUSION: Bone MFH showed similar MR imaging findings of soft tissue MFH or other malignant bone tumors, but joint involvement was suggestive finding of bone MFH.

CT Evaluation of the Neck after Total Laryngectomy

PURPOSE: The purpose of this study was to determine normal CT appearance of the neck after total laryngectomy and to evaluate the role of CT in accessing recurrent neoplasm. MATERIALS AND METHODS: In 65 patients who had undergone total laryngectomy, CT findings relating to shape of the neopharynx and alterations of normal anatomic structures were retrospectively reviewed. Fifty-five patients had also undergone neck dissection, and 47 patients had had adjuvant radiation therapy. RESULTS: In 27 patients, a normal neopharynx with a round or ovoid structure connecting the base of the tongue with the cervical esophagus had even wall thickness and iso- or slight hyperdensity to muscle. Fourteen of 32 patients with recurrent neoplasm showed an ill-defined, peripherally enhancing hypodense mass. Twenty-three patients developed metastatic lymphadenopathy and five patients developed coincidental local recurrent mass and lymphadenopathy. Hypodense masses mimicking recurrence were found in six patients and two cases revealed granulation tissues in the oropharynx(n = 2) and abscesses(n = 2). Another four patients were considered to be cases of immediate postoperative fluid collection or lymphocele. CONCLUSION: Aknowledge of normal CT findings of the neck after total laryngectomy is useful in the evaluation of recurrent laryngeal carcinoma.

Clustered Microcalcifications without Mass on Mammography: Benignancy vs. Malignancy

PURPOSE: The purpose of this study is to evaluate the accuracy of differentiation between benign and malignant clustered microcalcifications without mass on mammogram. MATERIAL AND METHODS: Fourty six mammogramsof 44 patients showing clustered microcalcifications without mass were interpreted blindly by five independent observers majoring in breast imaging from different institutions. Twenty two were malignant (10 infiltratingductal carcinomas, 12 intraductal carcinomas) and 24 were benign (all fibrocystic disease). The observers judgebenignancy or malignancy of microcalcifications. The authors assess the accuracy of differential diagnosis of clustered microcalcifications. RESULT: Of 24 cases proved benign microcalcifications, five radiologists correctly interpreted 20 on average as benign and of malignant 22 cases, 16 on average were correctly interpreted asmalignant. The diagnostic accuracy of malignant microcalcifications was 71.8% on average(63.6%-81.8%) and the diagnostic accuracy for benign microcalcifications was 83% on average(71% - 92%). It was 9 among total 46 cases that were misinterpreted by more than three radiologists. Among these 9 cases, malignant microcalcifications thathad been misinterpreted as benign were seven, benign microcalcifications misinterpreted as malignant were two. CONCLUSION: The diagnostic accuracy of clustered malignant microcalcifications(71.8%) without mass on mammogramwas lower than that of benign microcalcifications(83.3%). So, in case of suspected malignant microcalcification onmammogram, it is preferable that along with magnification view, histopathologic confirmation by core biopsy mustbe obtained.

Multiple Giant Cell Tumors and Paget Disease: CT and MR Fingings

We report computed tomography (CT) and magnetic resonance (MR) findings of a patient with polyostotic Paget disease and multicentric giant cell tumor (GCT). Brain CT scan showed widening of diploic space, cortical thickening and enhancing soft tissue mass in occiput with underlying calvarial destruction. Ill-defined soft tissue masses were also detected in maxillary sinus and buttock with underlying bony destruction on CT. MR image showed multifocal nodules in wide diploic space with low signal intensity on T1 -weighted image and bright signal intensity on T2-weighted image. Mass in occiput showed homogeneous hypointensity to bone marrow on T1-weighted image and homogeneous iso- intensity on T2-weighted image. Multiple nodules in diploic space and occipital mass showed contrast enhancement following administration of Gd-DTPA. Biopsy was performed at scal p, maxillary sinus and buttock, and histologic analysis revealed GCT.