Clinical outcomes of totally implantable venous access port placement via the axillary vein in patients with head and neck malignancy.

PURPOSE:: To evaluate the clinical outcomes and complications of totally implantable venous access port implantation via the axillary vein in patients with head and neck malignancy. MATERIALS AND METHODS:: A total of 176 totally implantable venous access ports were placed via the axillary vein in 171 patients with head and neck malignancy between May 2012 and June 2015. The patients included 133 men and 38 women, and the mean age was 58.8 years (range: 19-84 years). Medical records were retrospectively reviewed. RESULTS:: This study included a total of 93,237 totally implantable venous access port catheter-days (median 478 catheter-days, range: 13-1380 catheter-days). Of the 176 implanted totally implantable venous access port, complications developed in nine cases (5.1%), with the overall incidence of 0.097 events/1000 catheter-days. The complications were three central line-associated blood-stream infection cases, one case of keloid scar at the needling access site, and five cases of central vein stenosis or thrombosis on neck computed tomography images. The 133 cases for which neck computed tomography images were available had a total of 59,777 totally implantable venous access port catheter-days (median 399 catheter-days, range: 38-1207 catheter-days). On neck computed tomography evaluation, the incidence of central vein stenosis or thrombosis was 0.083 events/1000 catheter-days. Thrombosis developed in four cases, yielding an incidence of 0.067 events/1000 catheter-days. All four patients presented with thrombus in the axillary or subclavian vein. Stenosis occurred in one case yielding an incidence of 0.017 events/1000 catheter-days. One case was catheter-related brachiocephalic vein stenosis, and the other case was subclavian vein stenosis due to extrinsic compression by tumor progression. Of the nine complication cases, six underwent port removal. CONCLUSION:: These data indicate that totally implantable venous access port implantation via the axillary vein in patients with head and neck malignancy is safe and feasible, with a low axillary vein access-related complication rate.

Vascular Pattern Analysis on Microvascular Sonography for Differentiation of Pleomorphic Adenomas and Warthin Tumors of Salivary Glands.

OBJECTIVES: Pleomorphic adenomas and Warthin tumors are the most common salivary gland tumors. It is important to differentiate between them because at least a partial parotidectomy is necessary for pleomorphic adenomas, whereas enucleation is sufficient for Warthin tumors. This study aimed to evaluate the usefulness of vascular pattern analysis using microvascular sonography to differentiate between the tumors. METHODS: Sixty-two patients with pathologically proven pleomorphic adenomas (n = 38) and Warthin tumors (n = 24) were included. For all tumors, grayscale, power Doppler, and microvascular sonographic examinations were performed. Differences in vascular patterns (vascular distribution and internal vascularity) on power Doppler and microvascular sonography as well as grayscale sonographic features (size, shape, border, echogenicity, heterogeneity, and cystic change) between pleomorphic adenomas and Warthin tumors were evaluated. A comparison of diagnostic performances of grayscale sonography with power Doppler sonography and grayscale sonography with microvascular sonography was performed. The level of interobserver agreement between 2 reviewers in diagnosing tumors was evaluated. RESULTS: No grayscale sonographic features showed a significant difference between the tumors. Vascular distributions and internal vascularity on power Doppler sonography (P = .01 and .002) and microvascular sonography (both P < .001) were all significantly different. The diagnostic accuracy of grayscale sonography with microvascular sonography (79.0%) was higher than that of grayscale sonography with power Doppler sonography (72.6%). This difference was significant according to the McNemar test (P = .004). Interobserver agreement was excellent in diagnosing tumors on both grayscale sonography with power Doppler sonography (κ = 0.83) and grayscale sonography with microvascular sonography (κ = 0.94). CONCLUSIONS: Vascular pattern analysis using microvascular sonography with other sonographic features is helpful for differentiating between pleomorphic adenomas and Warthin tumors.

Clinical Significance of Wall Changes After Recanalization Therapy in Acute Stroke: High-Resolution Vessel Wall Imaging.

BACKGROUND AND PURPOSE: Owing to the excellent recanalization rate of endovascular treatment, new outcome predictors are required for patients with acute stroke, who have sufficient recanalization. In this study, the effects of recanalization therapy on occluded arteries in patients with acute stroke were investigated using high-resolution vessel wall imaging. METHODS: Twenty-nine patients with stroke were included in the study. High-resolution vessel wall imaging was performed on patients with acute stroke and adequate postrecanalization results. We characterized the postrecanalization arterial wall changes as concentric enhancements and plaques and examined the associations of the postrecanalization changes with procedural factors and neurological outcomes. RESULTS: The most frequent high-resolution vessel wall imaging finding was concentric enhancement, which was associated with thrombectomy procedural factors such as the number of procedures and the type of device. Concentric enhancements were associated with hemorrhagic transformation, whereas plaque was not associated with procedural details. CONCLUSIONS: The use of high-resolution vessel wall imaging after successful recanalization can provide information about postrecanalization arterial wall changes and clinical outcomes.

A semi-automated volumetric software for segmentation and perfusion parameter quantification of brain tumors using 320-row multidetector computed tomography: a validation study.

PURPOSE: We developed a semi-automated volumetric software, NPerfusion, to segment brain tumors and quantify perfusion parameters on whole-brain CT perfusion (WBCTP) images. The purpose of this study was to assess the feasibility of the software and to validate its performance compared with manual segmentation. METHODS: Twenty-nine patients with pathologically proven brain tumors who underwent preoperative WBCTP between August 2012 and February 2015 were included. Three perfusion parameters, arterial flow (AF), equivalent blood volume (EBV), and Patlak flow (PF, which is a measure of permeability of capillaries), of brain tumors were generated by a commercial software and then quantified volumetrically by NPerfusion, which also semi-automatically segmented tumor boundaries. The quantification was validated by comparison with that of manual segmentation in terms of the concordance correlation coefficient and Bland-Altman analysis. RESULTS: With NPerfusion, we successfully performed segmentation and quantified whole volumetric perfusion parameters of all 29 brain tumors that showed consistent perfusion trends with previous studies. The validation of the perfusion parameter quantification exhibited almost perfect agreement with manual segmentation, with Lin concordance correlation coefficients (ρ c) for AF, EBV, and PF of 0.9988, 0.9994, and 0.9976, respectively. On Bland-Altman analysis, most differences between this software and manual segmentation on the commercial software were within the limit of agreement. CONCLUSIONS: NPerfusion successfully performs segmentation of brain tumors and calculates perfusion parameters of brain tumors. We validated this semi-automated segmentation software by comparing it with manual segmentation. NPerfusion can be used to calculate volumetric perfusion parameters of brain tumors from WBCTP.

Assessing the accuracy and reliability of ultrasonographic three-dimensional parathyroid volume measurement in a patient with secondary hyperparathyroidism: a comparison with the two-dimensional conventional method.

PURPOSE: The purpose of this study was to investigate the accuracy and reliability of the semi-automated ultrasonographic volume measurement tool, virtual organ computer-aided analysis (VOCAL), for measuring the volume of parathyroid glands. METHODS: Volume measurements for 40 parathyroid glands were performed in patients with secondary hyperparathyroidism caused by chronic renal failure. The volume of the parathyroid glands was measured twice by experienced radiologists by two-dimensional (2D) and three-dimensional (3D) methods using conventional sonograms and the VOCAL with 30°angle increments before parathyroidectomy. The specimen volume was also measured postoperatively. Intraclass correlation coefficients (ICCs) and the absolute percentage error were used for estimating the reproducibility and accuracy of the two different methods. RESULTS: The ICC value between two measurements of the 2D method and the 3D method was 0.956 and 0.999, respectively. The mean absolute percentage error of the 2D method and the 3D VOCAL technique was 29.56% and 5.78%, respectively. For accuracy and reliability, the plots of the 3D method showed a more compact distribution than those of the 2D method on the Bland-Altman graph. CONCLUSION: The rotational VOCAL method for measuring the parathyroid gland is more accurate and reliable than the conventional 2D measurement. This VOCAL method could be used as a more reliable follow-up imaging modality in a patient with hyperparathyroidism.

Usefulness of Microvascular Ultrasonography in Differentiating Metastatic Lymphadenopathy from Tuberculous Lymphadenitis.

This study was undertaken to evaluate the usefulness of vascular pattern analysis on microvascular ultrasonography in distinguishing metastatic lymphadenopathy from tuberculous lymphadenitis, compared with conventional power Doppler ultrasonography, and to evaluate inter-observer agreement for microvascular ultrasonography. Thirty-four patients with metastatic lymphadenopathy and 27 patients with tuberculous lymphadenitis were included. The level of inter-observer agreement was excellent or good for all aspects of vascular pattern analysis on both ultrasonographic examinations. Vascular distribution, internal vascularity and internal vascular features of lymph nodes on microvascular ultrasonography differed significantly different (p ≤ 0.002) between metastatic lymphadenopathy and tuberculous lymphadenitis. A central vascular pattern with displacement was prevalent in metastasis, and an avascular pattern was more frequent in tuberculosis. Internal vascularity of metastasis was higher than that of tuberculosis. Vascular patterns on power Doppler ultrasonography did not differ significantly. Vascular pattern analysis using microvascular ultrasonography can be helpful in differentiating metastatic lymphadenopathy from tuberculous lymphadenitis with good inter-observer agreement.

Intracranial Stenting as a Rescue Therapy in Patients with Stroke-in-Evolution.

BACKGROUND: The feasibility and efficacy of intracranial stenting were evaluated for patients with a stroke-in-evolution after the time window for thrombolysis. METHODS: Patients with symptomatic intracranial steno-occlusive disease with progressive or fluctuating symptoms were treated using intracranial stenting after the time window for hyperacute thrombolysis. RESULTS: Within the study period, we identified 10 patients (7 men, 62.5 ± 11.3 years old) who were eligible for inclusion. The median onset-to-arrival time was 5.8 hours (range: .6-144 hours), and the median onset-to-procedure time was 33 hours (range: 8-346 hours). Only 1 patient previously received intravenous thrombolysis using alteplase. The symptomatic occlusive artery was the right middle cerebral artery, left middle cerebral artery, and basilar artery in 3, 1, and 6 patients, respectively. The median initial National Institutes of Health Stroke Scale (NIHSS) score was 4 (range: 0-6), and the median NIHSS score measured immediately before the procedure was 8 (range: 4-26). All but 1 patient underwent successful angioplasty and stenting using a Wingspan stent. Reocclusion of the stented artery occurred in 1 patient, and his neurological status deteriorated to coma. A favorable outcome (modified Rankin Scale ≤2) at 3 months was noted in 7 patients (70%). CONCLUSION: Intracranial stenting could be considered an alternative strategy for treating patients with medically intractable stroke-in-evolution.

Arterial Wall Imaging in Symptomatic Carotid Stenosis: Delayed Enhancement on MDCT Angiography.

OBJECTIVE: To evaluate progressive enhancement in the carotid arterial wall overlying plaque in the symptomatic side for patients with cerebrovascular symptoms until delayed phase using MDCTA. MATERIALS AND METHODS: Twenty-one patients (all men; ages, 49-82 years; mean, 67.8 ± 8.4 years) with recent stroke and severe extracranial carotid stenosis were retrospectively analyzed. Pre-, early- and delayed phase images of MDCTA were obtained, and Hounsfield units (HU) of carotid walls were measured. We also measured HU of the asymptomatic contralateral carotid arterial wall for comparison. Friedman's test and Wilcoxon signed-rank test were used to evaluate the differences between groups. RESULTS: The averaged HU of the carotid wall in the symptomatic side was higher on the delayed phase (65.8 ± 14.2 HU) compared to early arterial phase (54.2 ± 12.6 HU). The averaged HU difference of wall enhancement between pre-contrast and delayed phase (28.0 ± 14.8 HU) was significantly higher than the between pre-contrast and early arterial phase (16.4 ± 12.1 HU) with P < 0.05. In analysis of the contralateral asymptomatic side, the HU difference between pre-contrast and delayed phase (15.5 ± 12.0 HU) showed no significant higher value than between pre-contrast and early arterial phase (14.9 ± 10.9 HU). CONCLUSION: The pronounced enhancement of the carotid wall in the delayed phase on MDCTA was demonstrated in symptomatic patients with severe internal carotid artery stenosis. In the future, we need more comparative studies to verify this finding as one of risk stratification.

The Short Breath-Hold Technique, Controlled Aliasing in Parallel Imaging Results in Higher Acceleration, Can Be the First Step to Overcoming a Degraded Hepatic Arterial Phase in Liver Magnetic Resonance Imaging: A Prospective Randomized Control Study.

OBJECTIVE: The aim of this study was to assess whether a short breath-hold technique can improve hepatic arterial phase (HAP) image quality in gadoxetic acid-enhanced magnetic resonance (MR) imaging compared with a conventional long breath-hold technique. MATERIALS AND METHODS: Institutional review board approval and patient consent were obtained for this prospective randomized control study. One hundred nineteen patients undergoing gadoxetic acid-enhanced MR imaging were randomly assigned to groups A or B. Group A patients underwent an 18-second long breath-hold MR technique (conventional VIBE [volumetric interpolated breath-hold examination] technique with GRAPPA [generalized autocalibrating partially parallel acquisition]), and group B patients underwent a 13-second short breath-hold MR technique (VIBE technique with CAIPIRINHA [controlled aliasing in parallel imaging results in higher acceleration]). Respiratory-related graphs of the precontrast and HAP were acquired. The breath-hold degree was graded based on the standard deviation (SD) value of respiratory waveforms. Gadoxetic acid-related dyspnea was defined as when the SD value of the HAP was 200 greater than that of the precontrast phase without degraded image quality in the portal and transitional phases (SD value of the HAP - SD value of the precontrast phase). The overall image quality and motion artifacts of the precontrast and HAP images were evaluated. The groups were compared using the Student t or Fisher exact test, as appropriate. RESULTS: The incidence of breath-holding difficulty (breath-hold grades 3 and 4) during the HAP was 43.6% (27/62) and 36.8% (21/57) for group A and B, respectively. The SD value during the precontrast phase and the SD value difference between the precontrast and HAP were both significantly higher in group A than in group B (P = 0.047 and P = 0.023, respectively). Gadoxetic acid-related dyspnea was seen in 19.4% (12/62) of group A and 7.0% (4/57) of group B. Group B showed better precontrast and HAP image quality than group A (P < 0.001). Degraded HAP (overall image quality ≥4) was observed in 9.7% (6/62) and 3.5% (2/57) of group A and B, respectively. CONCLUSIONS: The short breath-hold MR technique, CAIPIRINHA, showed better HAP image quality with less degraded HAP and a lower incidence of breath-hold difficulty and gadoxetic acid-related dyspnea than the conventional long breath-hold technique.

Hemorrhagic fever with renal syndrome-related encephalopathy: magnetic resonance imaging findings.

OBJECTIVE: To report the incidence and findings of brain magnetic resonance imaging (MRI) in patients with hemorrhagic fever with renal syndrome (HFRS)-related encephalopathy along with its clinical course. METHODS: Medical records and brain MRI were reviewed from January 2004 to January 2013. The final cohort consisted of 145 patients. Brain MRI findings were correlated with associated clinical stage of disease. RESULTS: The MRI findings associated with clinical course of HFRS-related encephalopathy were posterior reversible encephalopathy syndrome pattern (n=3) in oliguric phase and splenial lesion pattern (n=1) in febrile phase. CONCLUSIONS: Brain MRI findings in HFRS-related encephalopathy may be associated with the clinical course of HFRS.

Comparison of Ultrasonographic Findings of Biopsy-Proven Tuberculous Lymphadenitis and Kikuchi Disease.

OBJECTIVE: Although tuberculous lymphadenitis and Kikuchi disease are common causes of cervical lymphadenopathy in Asians and exhibit similar clinical manifestations, their treatment strategies are totally different. The purpose of this study was to identify ultrasonographic features that distinguish these two diseases. MATERIALS AND METHODS: This study was approved by the Institutional Review Board. The study included 77 patients with tuberculous lymphadenitis and 135 patients with Kikuchi disease. The sex and age distributions of the patients were analyzed. The size and shape of lymph nodes (LNs), presence of conglomeration, increased perinodal echogenicity, echogenic hilum, posterior neck involvement, internal calcification, patterns of internal necrosis, laterality of involved LNs, and hilar vascular patterns on ultrasonography were compared between the two groups. Multiple logistic regression analysis was conducted to identify independent findings to discriminate tuberculous lymphadenitis from Kikuchi disease. Finally, diagnostic accuracies were calculated using the independent findings. RESULTS: The presence of an echogenic hilum, internal calcification, patterns of internal necrosis, and LN hilar vascular structures on power Doppler ultrasonography were independent findings that discriminated tuberculous lymphadenitis from Kikuchi disease. The diagnostic accuracy of each of these four factors was 84.9% (181/212), 76.9% (163/212), 84% (178/212), and 89.2% (189/212), respectively. A combination of internal calcification and hilar vascular structures showed the best accuracy of 89.6% (190/212) (sensitivity, 86.7% [117/135]; specificity, 94.8% [73/77]) for diagnosing Kikuchi disease. CONCLUSION: The presence of an echogenic hilum, internal calcification, pattern of internal necrosis, and LN hilar vascular structures are useful ultrasonographic findings to differentiate tuberculous lymphadenitis from Kikuchi disease.

Respiratory syncytial virus-related encephalitis: magnetic resonance imaging findings with diffusion-weighted study.

INTRODUCTION: Respiratory syncytial virus (RSV) is a common pathogen causing acute respiratory infection in children. Herein, we describe the incidence and clinical and magnetic resonance imaging (MRI) findings of RSV-related encephalitis, a major neurological complication of RSV infection. METHODS: We retrospectively reviewed the medical records and imaging findings of the patients over the past 7 years who are admitted to our medical center and are tested positive for RSV-RNA by reverse transcriptase PCR. In total, 3,856 patients were diagnosed with RSV bronchiolitis, and 28 of them underwent brain MRI for the evaluation of neurologic symptoms; 8 of these 28 patients had positive imaging findings. Five of these 8 patients were excluded because of non-RSV-related pathologies, such as subdural hemorrhage, brain volume loss due to status epilepticus, periventricular leukomalacia, preexisting ventriculomegaly, and hypoxic brain injury. RESULTS: The incidence of RSV-related encephalitis was as follows: 3/3,856 (0.08 %) of the patients are positive for RSV RNA, 3/28 (10.7 %) of the patient underwent brain MRI for neurological symptom, and 3/8 (37.5 %) of patients revealed abnormal MR findings. The imaging findings were suggestive of patterns of rhombenmesencephalitis, encephalitis with acute disseminated encephalomyelitis, and limbic encephalitis. They demonstrated no diffusion abnormality on diffusion-weighted image and symptom improvement on the follow-up study. CONCLUSION: Encephalitis with RSV bronchiolitis occurs rarely. However, on brain MRI performed upon suspicion of neurologic involvement, RSV encephalitis is not infrequently observed among the abnormal MR findings and may mimic other viral and limbic encephalitis. Physicians should be aware of this entity to ensure proper diagnosis and neurologic care of RSV-positive patients.

Microstructural white matter abnormality and frontal cognitive dysfunctions in juvenile myoclonic epilepsy.

PURPOSE: Previous neuroimaging studies provide growing evidence that patients with juvenile myoclonic epilepsy (JME) have both structural and functional abnormalities of the thalamus and frontal lobe gray matter. However, limited data are available regarding the issue of white matter (WM) involvement, making the microstructural WM changes in JME largely unknown. In the present study we investigated changes of WM integrity in patients with JME, and their relationships with cognitive functions and epilepsy-specific clinical factors. METHODS: We performed diffusion tensor imaging (DTI) and neuropsychological assessment in 25 patients with JME and 30 control subjects matched for age, gender, and education level. Between-group comparisons of fractional anisotropy (FA) and mean diffusivity (MD) were carried out in a whole-brain voxel-wise manner by using tract-based spatial statistics (TBSS). In addition, both FA and MD were correlated with cognitive performance and epilepsy-specific clinical variables to investigate the influence of these clinical and cognitive factors on WM integrity changes. KEY FINDINGS: Neuropsychological evaluation revealed that patients with JME had poorer performance than control subjects on most of the frontal function tests. TBSS demonstrated that, compared to controls, patients with JME had significantly reduced FA and increased MD in bilateral anterior and superior corona radiata, genu and body of corpus callosum, and multiple frontal WM tracts. Disease severity, as assessed by the number of generalized tonic-clonic seizures in given years, was negatively correlated with FA and positively correlated with MD extracted from regions of significant differences between patients and controls in TBSS. SIGNIFICANCE: Our findings of widespread disturbance of microstructural WM integrity in the frontal lobe and corpus callosum that interconnects frontal cortices could further support the pathophysiologic hypothesis of thalamofrontal network abnormality in JME. These WM abnormalities may implicate frontal cognitive dysfunctions and disease progression in JME.

Enterovirus 71-related encephalomyelitis: usual and unusual magnetic resonance imaging findings.

INTRODUCTION: Most enterovirus (EV) 71 infections manifest as mild cases of hand-foot-mouth disease (HFMD)/herpangina with seasonal variations, having peak incidence during the summer. Meanwhile, EV 71 may involve the central nervous system (CNS), causing severe neurologic disease. In many cases, enteroviral encephalomyelitis involves the central midbrain, posterior portion of the medulla oblongata and pons, bilateral dentate nuclei of the cerebellum, and the ventral roots of the cervical spinal cord, and the lesions show hyperintensity on T2-weighted and fluid-attenuation inversion recovery (FLAIR) images. Our goal was to review usual and unusual magnetic resonance (MR) findings in CNS involvement of enteroviral infection. METHODS: Among consecutive patients who had HFMD and clinically suspected encephalitis or myelitis and who underwent brain or spinal MR imaging, five patients revealed abnormal MR findings. Diffusion-weighted and conventional MR and follow-up MR images were obtained. From cerebrospinal fluid, stool, or nasopharyngeal swabs, EV 71 was confirmed in all patients. RESULTS: MR imaging studies of two patients showed hyperintensity in the posterior portion of the brainstem on T2-weighted and FLAIR images, which is the well-known MR finding of EV 71 encephalitis. The remaining three cases revealed unusual manifestations: leptomeningeal enhancement, abnormal enhancement along the ventral roots at the conus medullaris level without brain involvement, and hyperintensity in the left hippocampus on T2/FLAIR images. CONCLUSION: EV 71 encephalomyelitis shows relatively characteristic MR findings; therefore, imaging can be helpful in radiologic diagnosis. However, physicians should also be aware of unusual radiologic manifestations of EV 71.

Gray scale and power Doppler study of biopsy-proven Kikuchi disease.

OBJECTIVES: Kikuchi disease is a benign, self-limiting cause of cervical lymphadenopathy. It can show sonographic features similar to those of other common causes of lymphadenopathy. The purpose of this study was to characterize the sonographic features of Kikuchi disease that can contribute in differentiating between Kikuchi disease and other diseases causing cervical lymphadenopathy. METHODS: Sonographic findings of 175 patients with biopsy-proven Kikuchi disease were retrospectively reviewed. The mean age of the patients was 27.3 years, and the female to male ratio was 3.5:1. All patients had undergone sonographically guided core biopsy. Pathologic findings were classified into proliferative (n = 57), necrotizing (n = 109), and xanthomatous (n = 9) types. On gray scale sonography, lymph nodes were assessed by their size, shape (shortest/longest axis ratio), location, echogenicity, presence of conglomeration, gross necrosis, calcification, echogenic nodal hilum, and increased perinodal echogenicity. The vascular pattern was assessed on power Doppler imaging. RESULTS: The mean maximum diameter of the lymph nodes was 1.6 cm. Forty-four percent of them (77 of 175) were oval (shortest/longest axis ratio, 0.5-0.7) and 48% (84 of 175) were elongated (shortest/longest axis ratio, <0.5). Most were located in levels II and V. Seventeen lymph nodes showed gross necrosis, and none showed calcification. One hundred fifty-two lymph nodes (86.8%) had an echogenic hilum, and 76% (133 of 175) showed increased perinodal echogenicity. Increased perinodal echogenicity was seen in 93.5% of the necrotizing type (102 of 109) and 43.8% of the proliferative type (25 of 57); the difference between the two types was statistically significant (P = .001). Normal (n = 161), displaced (n = 13), and absent (n = 1) hilar vascularity was seen on power Doppler studies. CONCLUSIONS: Sonographic findings of Kikuchi disease can contribute to the differentiation between Kikuchi disease and other causes of cervical lymphadenopathy.

The correlation between carotid siphon calcification and lacunar infarction.

INTRODUCTION: The aim of this study was to evaluate the correlation between carotid siphon (CS) calcification and lacunar infarction caused by small-vessel disease. METHODS: This retrospective study included 445 patients (M/F = 256:189) older than 40 years (mean age 60.0 ± 12.3 years, range 41-98 years) without large intracranial lesions who had undergone both brain CT and MRI within an interval of 6 months. The patients were classified into three groups according to the number of lacunar infarctions: group I-zero infarctions (n = 328), group II-one to three infarctions (n = 94), and group III-four or more infarctions (n = 23). The severity of CS calcification was evaluated on CT and scored on a five-point scale (0-none, 1-stippled, 2-thin continuous or thick discontinuous, 3-thick continuous, 4-double tracts), and the calcification scores on both sides were summed. An ANOVA test was used to compare calcification scores among the three groups, and a logistic regression test was used to evaluate the influence of CS calcification and known cerebrovascular risk factors on the occurrence of lacunar infarction. RESULTS: On the ANOVA test, total calcification scores were significantly different among the three groups (group I = 1.28 ± 1.99, group II = 3.31 ± 2.39, group III = 4.36 ± 2.08; P < 0.05). Higher rates of lacunar infarction were associated with higher CS calcification scores. On the logistic regression test, CS calcification, age, and hypertension were significant risk factors for lacunar infarction (P < 0.05). CONCLUSION: CS calcification was correlated with the occurrence of lacunar infarction. The degree of CS calcification may be used to predict the possibility of a future lacunar infarction.

Cut-off value for needle washout thyroglobulin in athyrotropic patients.

OBJECTIVES/HYPOTHESIS: The purpose of this study was to determine the appropriate cut-off value for fine needle aspiration-thyroglobulin (FNA-Tg) associated with postoperative recurrences and validate the diagnostic efficacy of FNA-Tg in patients after total thyroidectomy compared with concomitant cytology (C). STUDY DESIGN: Retrospective. METHODS: We retrospectively evaluated the results of ultrasound-guided FNAs performed for suspicious cervical lesions of 40 patients (male:female = 10:30; mean age, 44.0 years) after total thyroidectomy (mean duration, 89.1 months), to acquire the material for Tg and C analysis. After collection of the cytologic sample, we rinsed the same needle with 1 mL of normal saline for Tg radioimmunoassay. RESULTS: Of 40 lesions (mean size, 0.89 cm; range, 0.3-3.5 cm), 21 were confirmed as recurrences and 19 were nonrecurrences. The rates of nondiagnostic sampling and sensitivity and specificity of FNA-C when diagnostic sampling was obtained were 40% (16/40), 100% (14/14), and 90.0% (9/10), respectively. According to receiver operating characteristic analysis, the optimal cut-off value of FNA-Tg was 4.1 ng/mL (sensitivity, 100% [21/21]; specificity, 100% [19/19], P < .05). Furthermore, in 16 inconclusive lesions due to nondiagnostic cytologic results, the FNA-Tg results coincided with a final diagnosis (seven recurrences and nine nonrecurrences). The cases with maximum diameters <1 cm showed a significantly increased rate of nondiagnostic cytologic results, and the FNA-Tg results were more helpful than lesions > or =1 cm in diagnosing a recurrence (P < .05). CONCLUSIONS: Measurement of FNA-Tg is helpful for distinguishing recurrent from nonrecurrent lesions in the majority of patients who were previously treated for well-differentiated papillary thyroid carcinoma.

Sonography of biopsy-proven Langerhans cell histiocytosis in lymph nodes of the neck.

OBJECTIVE: The purpose of this series is to describe the sonographic findings of lymph nodes of the neck involved by Langerhans cell histiocytosis (LCH). METHODS: We reviewed and interpreted available images of lymph nodes in patients with cervical lymphadenopathies involved by LCH for the past decade. In all patients, each abnormal lymph node was pathologically confirmed by the use of a sonographically guided core needle biopsy or an incisional biopsy. RESULTS: We characterized 3 different kinds of imaging findings for cervical lymph nodes involved by LCH: (1) a lymphomalike lesion, (2) a lesion similar to reactive lymphadenopathy, and (3) a cystic lymph node. CONCLUSIONS: There was no specific imaging finding to diagnose lymphadenopathy involved by LCH. In our study, we characterized 3 different imaging patterns of lymph node involvement by LCH. This study represents an initial step to organize specific findings for LCH.

Hemodynamic depression during carotid angioplasty with stenting: potential risk factors determined by multidetector computed tomography angiography and related clinical factors.

OBJECTIVE: To investigate potential risk factors for hemodynamic depression (HD) in elective carotid angioplasty with stenting (CAS) by using multidetector computed tomography (MDCT) angiographic findings and clinical data. METHODS: A retrospective study was conducted for 32 patients that underwent MDCT angiography before CAS in our hospital. We reviewed the MDCT angiographic findings to evaluate parameters including total plaque volume, composition and the composition ratio of plaque, degree of stenosis, and distance of the most stenotic portion from carotid bifurcation. Clinical data such as patient age, presence of neurological symptoms, underlying medical disease, smoking history, and previous stroke history were noted. The MDCT angiographic parameters and clinical data were then analyzed to determine a prediction for periprocedural HD (systolic blood pressure, <90 mm Hg; or heart rate, <40 beats/min). RESULTS: Periprocedural HD was observed in 9 patients (28.1%). Among the MDCT angiographic parameters, the hemodynamic unstable group of patients had a smaller total plaque volume than that of stable group of patients (P = 0.04). The other MDCT parameters and clinical data did not show statistically significant difference between 2 groups. CONCLUSIONS: In this study, only the total volume of plaque was a positive factor for predicting HD during CAS. Multidetector computed tomography angiography can be helpful for predicting HD during CAS.