A Comparative Study of Survivor Outcomes between Preoperative Evaluation Using CT Alone and Combined CT and MRI in Patients with Pancreatic Ductal Adenocarcinoma

Purpose@#To compare the recurrence pattern, disease-free survival (DFS), and overall survival (OS) after curative surgery for pancreatic ductal adenocarcinoma (PDAC) in patients who underwent preoperative evaluation with CT alone or in combination with MRI, and to compare the prognosis according to the first recurrence site. @*Materials and Methods@#We retrospectively evaluated 152 patients who underwent R0 resection of PDAC. Preoperative CT or combined CT and MRI were performed for 103 and 49 patients, respectively. Two radiologists recorded the location and date of the first recurrence in consensus. The recurrence pattern, DFS, and OS were compared between the two groups. OS was analyzed according to the first recurrence site. @*Results@#In both groups, liver metastasis was the most common recurrence pattern. DFS (p = 0.247) or OS (p = 0.067) showed no significant difference between the two groups. OS according to the first recurrence site was the lowest for liver metastasis, followed by locoregional recurrence (p < 0.001). @*Conclusion@#There were no significant differences in the recurrence pattern, DFS, or OS between patients evaluated with preoperative CT alone or with CT and MRI after curative resection of PDAC. Liver metastasis was the most common tumor recurrence pattern with the lowest OS.

A Comparative Study of Survivor Outcomes between Preoperative Evaluation Using CT Alone and Combined CT and MRI in Patients with Pancreatic Ductal Adenocarcinoma

Purpose@#To compare the recurrence pattern, disease-free survival (DFS), and overall survival (OS) after curative surgery for pancreatic ductal adenocarcinoma (PDAC) in patients who underwent preoperative evaluation with CT alone or in combination with MRI, and to compare the prognosis according to the first recurrence site. @*Materials and Methods@#We retrospectively evaluated 152 patients who underwent R0 resection of PDAC. Preoperative CT or combined CT and MRI were performed for 103 and 49 patients, respectively. Two radiologists recorded the location and date of the first recurrence in consensus. The recurrence pattern, DFS, and OS were compared between the two groups. OS was analyzed according to the first recurrence site. @*Results@#In both groups, liver metastasis was the most common recurrence pattern. DFS (p = 0.247) or OS (p = 0.067) showed no significant difference between the two groups. OS according to the first recurrence site was the lowest for liver metastasis, followed by locoregional recurrence (p < 0.001). @*Conclusion@#There were no significant differences in the recurrence pattern, DFS, or OS between patients evaluated with preoperative CT alone or with CT and MRI after curative resection of PDAC. Liver metastasis was the most common tumor recurrence pattern with the lowest OS.

Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

The Korean Society of Neurogastroenterology and Motility first published guidelines for chronic constipation in 2005 and was updated in 2011. Although the guidelines were updated using evidence-based process, they lacked multidisciplinary participation and did not include a diagnostic approach for chronic constipation. This article includes guidelines for diagnosis and treatment of chronic constipation to realistically fit the situation in Korea and to be applicable to clinical practice. The guideline development was based upon the adaptation method because research evidence was limited in Korea, and an organized multidisciplinary group carried out systematical literature review and series of evidence-based evaluations. Six guidelines were selected using the Appraisal of Guidelines for Research & Evaluation (AGREE) II process. A total 37 recommendations were adopted, including 4 concerning the definition and risk factors of chronic constipation, 8 regarding diagnoses, and 25 regarding treatments. The guidelines are intended to help primary physicians and general health professionals in clinical practice in Korea, to provide the principles of medical treatment to medical students, residents, and other healthcare professionals, and to help patients for choosing medical services based on the information. These guidelines will be updated and revised periodically to reflect new diagnostic and therapeutic methods.

Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition / 대한내과학회지

The Korean Society of Neurogastroenterology and Motility first published guidelines for chronic constipation in 2005 and was updated in 2011. Although the guidelines were updated using evidence-based process, they lacked multidisciplinary participation and did not include a diagnostic approach for chronic constipation. This study includes guidelines for diagnosis and treatment of chronic constipation to realistically fit the situation in Korea and to be applicable to clinical practice. The guideline development was based upon the adaptation method because research evidence was limited in Korea, and an organized multidisciplinary group carried out systematical literature review and series of evidence-based evaluations. Six guidelines were selected using the Appraisal of Guidelines for Research & Evaluation II process. A total 37 recommendations were adopted, including 4 concerning the definition and risk factors of chronic constipation, 8 regarding diagnoses, and 25 regarding treatments. The guidelines are intended tohelp primary physicians and general health professionals in clinical practice in Korea, to provide the principles of medical treatment to medical students, residents, and other healthcare professionals, and to help patients for choosing medical services based on the information. These guidelines will be updated and revised periodically to reflect new diagnostic and therapeutic methods.

Is Colonoscopy Necessary after Computed Tomography Diagnosis of Acute Diverticulitis?

BACKGROUND/AIMS: A diagnosis of acute diverticulitis is based on computed tomography (CT). Colonoscopy is commonly performed after the acute event to exclude other diagnoses. This study aimed to determine whether colonoscopy is necessary and what additional information is gained from a colonoscopy after acute diverticulitis. METHODS: Acute diverticulitis was diagnosed by clinical criteria and characteristic CT findings. We analyzed the number of patients in whom colorectal cancers were diagnosed and other incidental findings of polyps and other diseases. RESULTS: A total of 177 patients were analyzed retrospectively. The mean age was 43.3+/-15.3 years (range, 13-82 years) and 97 patients (54.8%) were male. Sixty-one patients had undergone a colonoscopy within 1 year of the acute attack. Advanced adenomatous lesions and colonic malignancy were not detected. Nineteen patients (31.1%) had > or =1 polyp and 11 patients (18.0%) had an adenomatous polyp. No new or different diagnosis was made after colonoscopy. None of the 116 patients who did not undergo colonoscopy within a year after acute diverticulitis had a diagnosis of colorectal cancer registered with the Korea Central Cancer Registry. CONCLUSIONS: Routine colonoscopy yields little benefit in patients with acute diverticulitis diagnosed by typical clinical symptoms and CT. The current practice of a colonoscopy after acute diverticulitis needs to be reevaluated.

Small Submucosal Tumors of the Stomach: Differentiation of Gastric Schwannoma from Gastrointestinal Stromal Tumor with CT

OBJECTIVE: To identify the CT features that help differentiate gastric schwannomas (GS) from small (5 cm or smaller) gastrointestinal stromal tumors (GIST) and to assess the growth rates of both tumors. MATERIALS AND METHODS: We included 16 small GSs and 56 GISTs located in the stomach. We evaluated the CT features including size, contour, surface pattern, margins, growth pattern, pattern and degree of contrast enhancement, and the presence of intralesional low attenuation area, hemorrhage, calcification, surface dimpling, fistula, perilesional lymph nodes (LNs), invasion to other organs, metastasis, ascites, and peritoneal seeding. We also estimated the tumor volume doubling time. RESULTS: Compared with GISTs, GSs more frequently demonstrated a homogeneous enhancement pattern, exophytic or mixed growth pattern, and the presence of perilesional LNs (each p < 0.05). The intralesional low attenuation area was more common in GISTs than GSs (p < 0.05). Multivariate analyses indicated that a homogeneous enhancement pattern, exophytic or mixed growth pattern, and the presence of perilesional LNs were statistically significant (p < 0.05). Tumor volume doubling times for GSs (mean, 1685.4 days) were significantly longer than that of GISTs (mean, 377.6 days) (p = 0.004). CONCLUSION: Although small GSs and GISTs show similar imaging findings, GSs more frequently show an exophytic or mixed growth pattern, homogeneous enhancement pattern, perilesional LNs and grow slower than GISTs.

Follicular Dendritic Cell Sarcoma of the Abdomen: the Imaging Findings

Follicular dendritic cell sarcoma is a rare neoplasm that originates from follicular dendritic cells in lymphoid follicles. This disease usually involves the lymph nodes, and especially the head and neck area. Rarely, extranodal sites may be affected, including tonsil, the oral cavity, liver, spleen and the gastrointestinal tract. We report here on the imaging findings of follicular dendritic cell sarcoma of the abdomen that involved the retroperitoneal lymph nodes and colon. It shows as a well-defined, enhancing homogenous mass with internal necrosis and regional lymphadenopathy.

Cystic Lesions of the Gastrointestinal Tract: Multimodality Imaging with Pathologic Correlations

The cystic lesions of the gastrointestinal (GI) tract demonstrate the various pathologic findings. Some lesions may present a diagnostic challenge because of non-specific imaging features; however, other lesions are easily diagnosed using characteristic radiologic features and anatomic locations. Cystic masses from the GI tract can be divided into several categories: congenital lesions, neoplastic lesions (cystic neoplasms, cystic degeneration of solid neoplasms), and other miscellaneous lesions. In this pictorial review, we describe the pathologic findings of various cystic lesions of the GI tract as well as the radiologic features of GI cystic lesions from several imaging modalities including a barium study, transabdominal ultrasound (US), computed tomography (CT), and magnetic resonance (MR) imaging.

Multidetector-Row CT Findings of Gastric Cystic Lymphangioma: A Case Report

Cystic lymphangioma is a rare benign submucosal tumor of the stomach thought to originate from sequestered lymphatic tissue that fails to communicate with the normal lymphatic system. The most commonly used method of evaluation for cystic lymphangioma of the stomach is an endoscopic ultrasonography. We report the multidetector-row computed tomography findings of a cystic lymphangioma of the stomach in a 46-year-old man along with a literature review.

Four Cases of Large Cell Neuroendocrine Carcinoma of the Stomach: Findings on CT and Barium Studies

A large cell neuroendocrine carcinoma of the stomach is extremely rare. We have reviewed the medical records and imaging studies of the four patients that presented with a large cell neuroendocrine carcinomas of the stomach. On a barium study and CT imaging, a gastric large cell neuroendocrine carcinoma is depicted as an ulcerofungating tumor with minimal peritumoral infiltration and metastatic lymphadenopathy in the perigastric area. These findings are similar to findings for advanced gastric cancer, especially Borrmann type II. However, a gastric large cell neuroendocrine carcinoma is highly malignant with a significantly worse prognosis than a usual adenocarcinoma.

Ultrasonography of the Acute Abdomen

The initial radiologic evaluation of a patient with acute abdominal symptoms begins with plain abdominal radiographs. Plain abdominal radiographs are helpful for the diagnosis of intestinal obstruction and pneumoperitoneum. However, cross-sectional imaging modalities, such as ultrasonography or computed tomography, are necessary for specific diagnosis of acute abdomen. Ultrasonography is a non-invasive and comfortable tool for patients visiting emergency room. This article describes the ultrasonographic findings of most common diseases presenting with acute abdominal symptoms.

Virtual CT Colonoscopy and Virtual CT Barium Enema using Multidetector-row CT / 대한소화기학회지

CT colonography is a promising technique that provides both multiplanar and endoluminal perspective of the air-filled, distended, cleaned colon. "Virtual colonoscopy" refers to computer-simulated 3D endoscopic visualization of the colonic mucosal surface. Unlike barium enema and conventional colonoscopy, CT colonography can give cross- sectional and endoluminal images of the colon and enables to image extracolic abnormality. CT colonography offers potential advantages over colonoscopy in that it causes little discomfort to the patient, and does not need sedation. It is more accurate in spatial location of lesions and creates no complication. To date, most studies assessing CT colonography have focused in technical development, less aggressive bowel preparation, and computer-aided diagnosis of polyp detection. In the future, CT colonography would be a diagnostic and screening tool for the colorectal polyp and cancer.

Depiction of Viable Tumor in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization: Multiphasic Helical CT with Review of the Previous Serial CT Images

OBJECTIVE: The purpose of our study was to assess whether a review of multiphasic helical CT combined with the previous serial CT images could be helpful to depict a viable tumor in hepatocellular carcinoma treated with transarterial chemoembolization. MATERIALS AND METHODS: Twenty-four consecutive patients with 35 hepatocellular carcinomas underwent transarterial chemoembolization followed by hepatic resection. First, three radiologists independently analyzed the last CT images taken before resection for the presence of viable tumor. A second analysis was then performed using the last CT combined with the previous serial CT images. The CT analyses were then compared with the pathologic results. The added value of the review of the previous serial CT images was evaluated by performing a receiver operating characteristic analysis. The sensitivity, specificity and diagnostic accuracy for the depiction of viable tumor were also assessed, and the characteristics of the false-negative lesions were pathologically evaluated. RESULTS: The mean diagnostic accuracies (Az values) for the depiction of viable tumor with using the last CT alone and with the review of the previous serial CT images for all observers were 0.885 and 0.901, respectively, which were not significantly difference (p> 0.05). However, the additional review of the previous serial CT images allowed the observers to render a correct diagnosis for three lesions that had been incorrectly diagnosed with the review of last CT alone. The sensitivity, specificity and diagnostic accuracy of the last CT along with the review of the previous serial CT images were 78%, 97% and 84%, respectively. All of the 16 false-negative lesions diagnosed by each observer showed 90% or greater necrosis on the pathologic examination. CONCLUSION: For the depiction of viable tumor in hepatocellular carcinoma treated with transarterial chemoembolization, although the difference in the diagnostic accuracies was not statistically significant, a review of the multiphasic helical CT combined with the previous serial CT images could help reach a correct diagnosis for those lesions incorrectly diagnosed with the review of the last CT alone.

Early Colon Cancer: Findings on Double Contrast Barium Enema

PURPOSE: To describe the radiologic findings of early colon cancer on double-contrast barium enema. MATERIALS AND METHODS: We retrospectively reviewed the double-contrast barium enemas of eight patients (M:F=6:2;mean age:67yrs;range:48-77 yrs) who were pathologically proven to be early colon cancer. The location, size and grossmorphology of lesions was evaluated using double-con-trast barium enema, while depth of invasion, degree ofdifferentiation, precancerous lesions and lymph node metastasis were evaluated histopathologically. RESULTS:Early colon cancer was found in the rectum(n=4), sigmoid colon (n=3) and ascending colon(n=1). The size of massranged from 2.3-8.3(mean, 4.6)cm. And the polypoid type was most common(n=7);this was subdivided into sessile(IS,n=5), semipedunculated (ISP, n=1) and pedunculated type(Ip, n=1). Another mass was a sessile polypoid combinedwith a flat depressed lesion. In eight cases, four cancers were confined to the mucosa, while the remaining fourhad infiltrated the submucosa. Most cancers arose from villous and villotubular adenoma. All cases werewell-differentiated adenocarcinoma and no metastasis to lymph nodes had occurred. CONCLUSION: In early coloncancer, lesions were mainly polypoid and large. Most arose from villous and villotubular adenoma.

(99m)Tc-MDP Scintigraphy of Femoral Head Necrosis Following Femoral Neck Fracture

Secondary ischemic necrosis of femoral head due to loss of blood supply following to femoral neck fracture is well known. The regional distribution of bone.seeking radiopharmaceuricals in the skeleton can depend on a number of facto rs, but bone blood flow is a major physiological determinant of regional skeletal uptake of Tc-99m polyphosphate and bone imaging may thus be used for the evaluation of vascularity of the femoral head. The authors made a comparative study of scintigraphic findings and operative findings of 28 cases of femoral neck fracture treated at Kyung Hee University Hospital from April ′80 to May ′84. The results were as follows: 1. In 16 cases of proven avscular necrosis of femoral head, scintigraphy showed absent or decreased activity in 14 cases (87.5%), while radiography showed increased density in 10 cases (62.5%). 2. In 12 cases of proven vital femoral head, scintigraphy showed increased activity in 9 cases (75%) and radiography showed decreased density in 9 cases (75%). 3. 99mTc-MDP scintigraphy was an excellent and useful method for assessing bone vitality of femoral head.

Multifocal Serous Cystadenoma of the Pancreas: A Case Report

Serous cystadenoma of the pancreas is a benign neoplasm and usually unifocal; multifocal tumors are rare, and to our knowledge, only a few cases have been reported. We describe a case involving two separate serous cystadenomas in the head and body of the pancreas. The patient was a 41-year-old woman with no subjective symptoms. Abdominal ultrasonography performed for the purpose of a routine check-up revealed a septated cystic mass in the body of the pancreas. CBC and blood chemistry revealed no abnormality, but abdominal computed tomography indicated two separate cystic masses with enhanced internal septa in the head and body of the pancreas. Whipple's operation was performed and two serous cystadenomas of the pancreas were diagnosed histopathologically.

Multifocal Serous Cystadenoma of the Pancreas: A Case Report

Serous cystadenoma of the pancreas is a benign neoplasm and usually unifocal; multifocal tumors are rare, and to our knowledge, only a few cases have been reported. We describe a case involving two separate serous cystadenomas in the head and body of the pancreas. The patient was a 41-year-old woman with no subjective symptoms. Abdominal ultrasonography performed for the purpose of a routine check-up revealed a septated cystic mass in the body of the pancreas. CBC and blood chemistry revealed no abnormality, but abdominal computed tomography indicated two separate cystic masses with enhanced internal septa in the head and body of the pancreas. Whipple's operation was performed and two serous cystadenomas of the pancreas were diagnosed histopathologically.

Value of MR Imaging after CT in Patients with Focal Hepatic Lesion

PURPOSE: To determine the usefulness of magnetic resonance imaging (MRI) after computed tomography (CT) inpatients with focal hepatic lesion. MATERIALS AND METHODS: We evaluated 100 patients with 103 focal hepaticlesions. The diagnosis of each lesion was made pathologically (n=19), or radiologically and clinically (n=84), andthe findings were as follows: he-mangioma (n=53), hepatocellular carcinoma (n=17), metastasis (n=10), cyst (n=5),regenerative nodule (n=3), and adenomatous hyperplasia (n=3). The patients underwent conventional CT (n=25),two-phase spi-ral CT (n=17) or three-phase spiral CT (n=61). MRI was performed using conventional T1- andT2-weighted imaging and dynamic contrast enhancement. The value of MRI after CT was assigned to one of fourgrades, according to the consensus of three radiologists: grade I (decisive), grade II (helpful), grade III (notadditional), or grade IV (confused). RESULTS: The outcome of MRI of 103 lesions was grade I in 14 cases(14%), IIin 34 (33%), III in 49 (48%), and IV in 6 (6%). MRI was not helpful (grade III or IV) in 40% (10/25), 47% (8/17),and 61%(31/61) of lesions after conventional, two-phase spiral, and three-phase spiral CT, respectively. Grade IIIor IV lesions were present in 45% of hemangiomas (24/53), 59% of hepatocellular carcinomas (10/17), and 80% ofcases in which metastasis had occurred(8/10). CONCLUSION: MRI after CT in patients with focal hepatic lesion washelpful in less than half of all cases. It was particularly valuable for patients who did not undergo three-phasespiral CT and in whom hemangioma was suspected.

Role of Helical CT in Early Gastric Cancer

PURPOSE: To evaluate the value of helical CT in patients with endoscopically and pathologically proven early gastric cancer. MATERIALS AND METHODS: Helical CT scans(5-mm section thickness, 5-mm/sec table speed) were obtained in 45 patients with pathologically proven early gastric cancer. CT findings were retrospectively reviewed by two independent radiologists without surgical or pathologic information. Detection rate, depth of invasion, and lymph node staging were evaluated. RESULTS: The overall detection rate was 52% ; there was no significant difference in the rates between observer A(55%) and B(49%). The detection rate was higher in the anterior bodywall(100%) and antrum(63%) than in the posterior body wall(42%) and antrum(53%). The detection rate of the depressed type(63%) was higher than that of the elevated type(38%). Submucosal stripe was seen in 45% of mucosallesions and in 32% of submucosal lesions, though the stripe was not a reliable indicator for depth of invasion.Lymph node metastasis was detected in only one of eight patients. None was found to have distant metastasis. CONCLUSION: Helical CT is of little help in the evaluation of endoscopically evident early gastric cancer and the routine use of helical CT is not recommended in early gastric cancer.

Radionuclide scintigraphy of the scrotum

Radionuclide scrotal scintigraphy with 99m Tc-pertechnetate is an easy, well established, sueful and readilyavailable technique for evaluation of acute scrotum. We studied 41 cases of radionuclide scrotal scintigraphy andthe results were as follows; 1. The over all diagnostic accuracy of scrotal scintigraphy waas 93%(38/41 cases). 2.Scrotal scintigraphy was very useful and accurate in differential diagnosis of epididymo-orchitis and testiculartorsion in patient with acute scrotal pain and swelling, while there was some limitation in differential diagnosisof hematoma from acute epididymo-orchitis or torsion. 3. scintigraphy of epididymoorchitis showed increasedperfusion and radiocativity in the epididymis and/or testis and its diagnostic accuracy was 90%(19/21 cases) 4.Acute testicular torsion showed normal flow in perfusion and cold defect occupying affected testis in staticimage, while missed torsion showed slightly increased flow in perfusion image and cold defect surrounded by anuniform rim of hyperactivity (halo sign). Diagnostic accuracy of testicular torsion was 86%(6/7 cases).