Three Domains in Diagnostic Radiology

No abstract available.

Transarterial embolization in head and neck lesions

The transarterial embolization procedures have been performed in a total of 38 patients with head and necklesions, including 5 carotid-carvernous fistulas, 1 internal carotid aneurysm, 10 meningiomas, 16 nasopharyngealangiofibromas, 1 post-traumatic epistaxis and 5 other vascular tumors, over the 18 months-period. Six cases of C-Cfistulas and ICA aneurysm were treated with the detachable balloon catheter technique. The meningiomas, angiofibromas and all other lesions were embolized with superselection of the branches of the external carotidartery such as the internal maxillary, the middle meningeal, the ascending pharyngeal, the facial or otherbronches, using Berenstein superselective catheters of conventional angiographic catheters. The PVA(polyvinylalcohol foam) and/or Gelfoam particles were used as embolic materials in these cases. Most of the lesions weresuccessfully embolized with minor transient complications such as pain, headache, vomitting, fever and etc. But in4 cases occurred the serious complications; one cerebral hemorrhage, two cerebral infarctions, and one acutelaryngeal edema. The selection of the embolic materials and the catheters, and the complications are brieflydiscussed.

An experimental study on vascular changes in renal biopsy injury

An experimental study on the vascular alternations of the kidney following biopsy procedure was carried out in 47 kidneys from 28 rabbits to clarify their nature and frequency by renal arteriography and microangiography together with histopathologic investigation. Renal arteriography and microangiography were perforemd immediately 2 days, 1 week, and 2 weeks after percutaneous biopsy and the findings were correlated with histological nature. The results are summerized as follows; 1. Important biopsy injuries verified by renal arteriography and microangiography were arterial spasm, perfusion defect, arteriovenous fistula, injury to vasa recta and renaltubules, intrarenal and extrarenal extravasation of contrast media, and arterial obstruction, in order of frequency. 2. Artierial spasm observed in majority of the cases were relieved during the period of 2 weeks. 3. Detectability of perfusion defect was 57% and 72% by angiography and microangiography, respectively, and this perfusion defect seemed to be mostly caused by renal infarction due to vascular injury, such as arteriovenousfistula, arterial obstruction and other vascular injuries. 4. Arteriovenous fistula was detected in 28% byangiography and 50% by microangiography. Many of the arteriovenous fistula appeared to be closed spontaneously within a week. Above findings suggest that renal biopsy procedure results in various degree of vascular injuries with their sequential modification, and that microangiography is assumed the most effective approach in analysisof biopsy injuries such as small arteriovenous fistula, perfusion defect, injury to vasa recta and renal tubules, overcoming the limitation of traditional angiography.

Quantitative cine-left ventriculography

The volumetry by cineangiocardiography is known to have the most diagnostic and prognostic value in theevalutaion of various valvular heart diseases and ischemic heart diseases. Athough many authors favor thearea-length method for the voulmetry of left ventricle, 45degrees RAO projection seems to be more simple,inexpensive and acurate technique, considering the positional relationship of cardiac valves and obliquity of thelong axis of left ventricle within the chest cage. Authors present the anatomical, geometrical and radiologicalbasis for the superiority of 45degrees RAO projection by analyzing 20 normal heart specimen and 115cineangiocardiograms of valvular heart disease, and the results as follows; 1. Blood flow and motility of themitral and aortic valves can be more clearly demonstrated by 45degrees RAO projection than by AP view. 2. The longdiameter of left ventricular silhouette made 45degrees RAO projection reflects 90% or more of real diameter. 3. InRAO 45degrees position, patient's left nipple is optimal and convenient level for the ruler offering accuratemagnification coefficient of left ventricle. 4. Ejection fration after the extrasystole is exaggerated regardlessof the left ventricular function, so it is desirable to exclude the 2 or 3 beats after extrasystole.

An experimental study on effect of tourniquet ischemia and hyperthermia on irradiation

To evaluate the influence of tourniquet ischemia and hyperthermia on the radiation effect of skin, theexperimental study was undertaken using a total of 344 mice. A single dose of irradiation from 2000 rads to 8000rads was delivered on skin of mouse tail after hyperthermia of 40degrees(C) to 42degrees(C) with or withouttourniquet application in various subgroups. The resuls are summarized as follows; 1. Tourniquet ischemia duringirradiation caused radioprotective effect. 2. Hyperthermia before irradiation induced radiosensitizing effect,which was increased with temperature elevation of hyperthermia. 3. In combination of tourniquet ischemia andhyperthermia, evident radiosensitizing effect waas noticed. This enhancing effect on irradiation was greater thanthe effect i hyperthermia only. It could be suggested that the combination of tourniquet application andhyperthermia might be intorduced in clinical radiotherapy after trail of clinical experiments on applicable typeand sutiable location of tumors.

A microangiographic study on renal artery embolization

Renal artery embolization was induced experimentally in rabbits and microvascular changs were studiedangiographically, microangiographically and histopathologically. The results were as follows; 1. The mainmicroangiographic findings of renal artery embolization were arterial occlusion and collateral vessels arecharacterized by spiralling, dilatation, irregular lumen with abrupt caliber change, disoriented course andincreased number. 2. Collateral vessel formation was demonstrated in all cases of renal artery embolization bymicroangiography. 3. Recanalization of embolized vessels was better visualized by renal angiography thanmicorangiography. It was considered that microangiography is a valuable method for the observation ofmicrovascular changes in renal artery embolization and other renal diseases.

An experimental study of the effect of total lymphoid irradiation on the survival of skin allografts

The study was undertaken to detemine the effect of fractionated high-dose total lymphoid irradiation (TLI) onthe servival of skin allograft despite major histocompatibility difference. Total lymphoid irraditation is arelatively safe form of radiotherapy, has been used extensively to treat lymphoid malignancies in humans with fewside effects. A total of 90 rats, Sprague-Dawley rat as recipient and Wistar rat as donor, were used for theexperiment, of which 10 rats were used to determine mixed lymphocyte response (MLR) for antigenic difference andskin allografts was performed in 30 rats given total lymphoid irradiation to assess the immunosuppressive effectof total lymphoid irradiation despite major histocompatibility difference. In addition, the peripheral white bloodcell counts and the proportion of lymphocytes was studied in 10 rats given total lymphoid irradiation but no skingraft to determine the effects of bone marrow suppression. The results obtained are summerized as follows. 1. Theoptimum dose of total lymphoid irradiation was between 1800 rads to 2400 rads. 2. The survival of skin graft onrats given total lymphoid irradiation (23.2±6.0days) was prolonged about three folds as compared to unirradiated-control (8.7±1.3 days). 3. Total lymphoid irradiation resulted in a severe leukopneia with marked lymphopenia,but the count was normal by the end of 3rd week. 4. The study suggests that total lymphoid irradiation is anonlethal procedure that could be used successfully in animals to transplant allograft across major-histocompatibility barriers.

Scientific publication productivity of Korean medical colleges: an analysis of 1988-1999 MEDLINE papers

To identify where the quality research activity has been and is carried out in Korea, and to examine to what extents Korean medical colleges play leading roles in the production of international research papers, we investigated the publication productivity of Korean medical colleges and their medical departments as measured by the number of papers published in foreign journals indexed in MEDLINE. The 12-year period from 1988 to 1999 is covered. A total of 4,881 papers is published in MEDLINE foreign journals by the researchers in Korean medical colleges during the period. The production of MEDLINE papers are concentrated in a few universities. More than 60% of MEDLINE foreign journal papers is published by top five universities 25% by Seoul National University, and 15% by Yonsei University. The newly established medical colleges at the University of Ulsan and Sungkyunkwan University produced outstanding numbers of papers in less than ten years. Radiology has led the internationalization of Korean medical papers. It was the most productive specialty identified in this study. The productivity of Internal medicine is on the rise from the mid-1990s, and the field began to produce the most number of papers since then.

Analysis of percutaneous nephrostomy in 72 patients

Percutaneous nephrostomy has been effectively performed 107 times in 72 patients for relief of obstruction,drainage of urinary fistula and renal or extrarenal fluid collection, and functional preservation of urinarysystem, and follow-up check has been made for recent 3 years at department of Radiology in Seoul NatinalUniversity Hospital. All procedures were successful and bilateral nephrostomy was done in 1 case of bilateral congenital UPJ obstruction. Percutaneous nephrostomy was done in left kidney in 38 cases(52.8%), permanent drainagewas done in 55 cases(76.4%) and external drainage was done in 65 cases (90.3%), and the duration of follow-up wasup to 8 months. Underlying disease were supravesical obstruction in 63 cases(87.5%), urinary fistula in 3 casses,inflammatory disease in 5 cases and infravesical obstruction in 1 case. Satisfactory outcomes were made in 68patients, whose BUN and serum creatinine levels have decreased near to upper normal range in at least 3 weeks. Major complications have occurred in 7 cases; symptomatic urinary infection in 3 cases, fracture of the catheterin 2 cases, pneumothorax in 1 case and sepsis in 1 case. Minor complications have occurred in 76 cases; catheterdislodgement or obstruction in 42 cases, fever in 10 cases, perirenal extravasation in 2 cases and periureteralleakage in 2 cases, etc. These complications can be prevented by adequate method duing Seldinger technique undnerultrasonography, CT or fluoroscopy, prophylactic and post-nephrostomy antibiotics, use of disposable catheterkits, frequent irrigation of the catheter and dressing of catheter fixation site when contaminated, prevention ofextraction of the catheter due to patient's carelessness, adequate fixation of the catheter to skin, and continuous follow-up of patients, It is expected that the territory of this iterventional procedure will beextended by instrument insertion and drug instillation through the nephrostomy tract.

Cardiovascular effects of contrast materials on left ventricular angiography in rabbits: comparing high osmolarand low osmolar contrast materials

No abstract available.

Digital subtraction angiography in head & neck diseases

Eighty-eight patients who presented with a variety of head and neck symptoms were examined with intravenous oritraarterial digital subtraction angiography (IV or IA DSA), using the DSA equipment developed by Seoul NationalUniversity Hospital. A grading system was used to evaluate the ability of DSA to answer specific diagnsoticquestions. Diagnostic information without need of further study was obtained in 71% with IV DSA, in 86% withaortic arch DSA and in 81% with selective arterial DSA, showing a total of 79% of diagnostic accuracy with DSA. Itis concluded that IV DSA is useful in the evaluation of the cervical carotid and vertebral arterial disease, andpituitary mass lesion, while IA DSA is useful in the evaluation of the cervical carotid and vertebral arterialdisease, and pituitary mass lesion, while IA DSA is useful in the evaluation of most of the intracranial lesions,spinal arteriography and intra-arterial embolization. DSA is both an accurate and safe imaging modality in thestudy of head and neck diseases.

The evaluation of the cervical lymph node metastases using computed tomography in the head and neck cancer

Fity-four patients with head and neck cancers were prospectively examined with the CT to determine its valuein staging cervical lymph nodes metastases and to compare with the clinical staging. The CT staging agreed withthe clinical staging in 61%(33/54), upgraded the clinical staging in 22%(12/54) and downgraded in 17%(9/54). Thepost-surgical confirmation was made in only 11 patients, The possible causes of disagreement between the CT andthe clinical staging, and the diagnostic value of the CT in the evaluation of the cervical nodes metastases werediscussed.

Computed tomography of bronchioloalveolar carcinoma showing open bronchus sign

Open brochus with diffuse narrowing, stretching, and leafless tree appearance of the bronchi is the well know bronchographic criterior of bronchiloalveolar carcinoma. Though similar findings are expected in CT, authors couldfind no report concerninng the open bronchus sign of bronchioloalveolar carcinoma demonstrated by CT., Authorspresents CT of bronchioloalveolar carcinoma showing lobar or segmental distribution and patent bronchus within thetumor mass.

CT findings of the mediastinal tumors; excluding mediastinal granuloma and primary carcinoma

Computerized Tomography can make accurate diagnosis in most of the mediastinal tumors and cysts by assessingtheir location, shape and internal architecture. Authors analysed and present CT findings of 89 surgically provenmediastinal tumpors and cysts that were studied and treated in Seoul National University Hospital during recent 5years. The results are as follows; 1. The most common tumor was teratoma(25 cases). Neurogenic tumor (20 cases),thymic tumor or cyst (16 cases), lymphoma(7 cases), bronchogenic cyst (6 cases), intrathoracic goiter (6 cases),pericardial cyst(3 cases) and cystic hygroma(2 cases) were next in order of frequency. 2. The most constant findings of teratoma was thick walled cystic area(100%), while pathognomonic fat and calcified density were seenonly in 52% and 48% of cases, respectively. 22 cases were located in anterior mediastinum, 2 cases were inposterior mediastinum and a case is in middle mediastinum. 3. There were 20 cases of neurogenic tumor consiting of6 neurilemmomas, 7 ganglioneuromas, 4 neurofibromas, 1 ganglioneuroblastoma, 1 neuroblastoma and 1 malignantschwannoma. Most of them were located in posterior mediastinum with exception of 2 neurilemmomas arising from leftvagus nerve and left recurrent laryngeal nerve in middle mediastinum. Cystic change was seen in 2 cases ofneurilemmoma and in a case of ganglioneuroma. Calcification was seen in 3 cases, of neuroblastoma, aneurilemmoma,and a ganglioneuroma. 4. There were 11 cases of thymoma showing homogeneous solid mass with speckeldcalcification in 4 cases and irregular cystic change in 3 cases. 2 cases were invasive thymoma and myastheniagravis was present in 4 cases. A case of thymolipoma and a case of thymic cyst were included. 5. Lymphoma(2Hodgkin's and 4 non-Hodgkin's) appeared as lobulated, matted mass in anterior mediastinum especially inprevascular area expnading bilaterally. 6. Intrathoracic goiter appeared as slingtly high density mass within termingled calcification and cystic area in 5 cases of secondary goiter and homogeneous high densitymass(100-110 H.U. in precontrast scan) in a case of primary goiter. 7. Among the 6 bronchogenic cysts, 3 werelocated in subcarinal area, 2 were above carina and one was in left hilar area. 3 cases showed high CT number morethan 70 H.U. and others showed water density. 8. 3 cases of pericardial cyst were located in right cardiophrenicangle and all of them showed water density. 9. 2 cases of cystic hygroma were located in superior mediastinum,with extension to lower neck and all of them showed water density.

Cineangiographic analysis of T.O.F

The total 223 cases of tetralogy of Fallot is analysed angiographically, in which selective biplanecinecardioangiography with axial projection has been done at the Departement of Radiology, Seoul National University Hopital, in recent 2 year and 4 months, with specific refrence to the location of pulmonic stenosis,and associated cardiac anomalies. The summary of the analysis is as follow; 1. Left ventriculogram (long axialoblique view) was necessary to detect the ventricular septal defects including anterior marginal VSD, and washelpful to identify the coronary artery anatomy and presence of PDA and evaluate the size of left ventricle. 2.Right ventriculogram(elongated RAO view) was the best projection for the demonstration of pulmonic infundibulumand was essential to differenciate and localize the ventricular septal defects. 3.In the right ventriculogram(4chamber view), well demonstrated the right ventricular outflow tract, pulmonary valve, and pulmonaryarteries(main, right, left and peripheral), and also perimitted the detection of ASD in levophase. 4. The positionof ventricular septal defects was perimembranous in 199 cases(89.2%), subarterial in 15 cases(6.8%) andinfundibular (intracristal) in 9 cases(4%). Multiple ventricular septal defects (perimembranous& marginal ) werefound in 11 cases(4.5%). 5. In 35 cases(15.5%), pulmonary stenosis is found only in pulmonary infundibulum. Thecombination of its components was most commonly anterior wall and conus septum hypertrophy in 24 cases(68.6%) 6.Combined pulmonary stenosis was identified in 188 cases(84.3%). The most common combination was infundibular andpulmonary valvular stenosis in 56 cases(29.8%) 7. Associated cardiac anomalies were right aortic arch in 53 cases(23.8%), persistent left SVC in 17 cases (7.7%), ASD in 13 cases (5.9%), PDA in 9 cases(4.1%), aberrant subclavianartery in 5 cases(2.2%), IVC interruption with azygos continuation in 2 cases, single coronary artery in 2 cases,and anterior descending artery from right coronary artery in 1 case, etc. 8. Selective biplanecinecardioangiography with axial projection is essential to evaluate the size of left ventricle and to localizethe ventricular septal defects and pulmonary stenosis, and to detect associated cardiac anomalies in T.O.F. Sometimes aortography is necessary when anomaly of coronary arteries is suspected.

The role of the Computed Tomography in Head and Neck Cancer: Comparison of CT Staging with Clinical Staging in Oral Cavity, Oropharynx and Larynx Cancer

Thirty-six patients (24 with oral cavity or oropharynx cancers and 12 larynx cancers) were prospectively examined with computed tomography (CT) to determine its value in staging the primary tumor and to compare with the clinical staging. The CT staging agreed with the clinical staging in 50% (12/24) of the oral cavity or oropharynx cancers and in 67% (8/12) of the larynx cancers. The CT upgraded the clinical staging in 29% (7/24) of the oral cavity or oropharynx tumors and in 33% (4/12) of the larynx cancers, whereas the CT downgraded the clinical staging in 21 % (5/24) of the oral cavity or oropharynx cancers. There is no downgrade on CT in larynx cancer. The post-surgical confirmation was not made in most of the cases. The possible causes of disagreement between the CT and the clinical staging, and the diagnostic value of the CT in evaluation of the primary tumor in oral cavity, oropharynx and larynx were discussed.

Computed Tomography in Staging of Bladder Carcinoma (prospective Study)

Staging of carcinoma of the urinary bladder is important for the choice of therapy and also has prognostic implications. Hitherto the staging has been based upon cystoscopy with bio psy, transurethral resection , and palpation with complementary radiographic examlnations such as cystography, urography, lymphangiography, ultrasound and angiography. However, with all these methods, the staging of bladder carcinomas still uncertain and inferior to CT. Authors analyzed CT staging of bladder cancers and compared with pathologic staging of laparotomy results. The results are as follows: 1. Overall accuracy of CT staging in bladder carcinoma was 72 percent. 2. Overstaging was 20 percent (5/25) and understaging was 8 percent (2/25). 3. All of CT stage B cancers were proven to be stage B, pathologlcally. 4. In 6 cases of CT stagec cancers,only one was correct,3 were overstaged and 2 were understaged. 5. In 7 cases of CT stage D cancers, 5 were correct and 2 were overstaged. 6. CT detected only 2 cases of pelvic Iymph node involvement in 4 of pathologically proven Iymphadenopathy.

Computed tomography in lumbar herniated disc

197 spine CTs were performed from 29th, March 1982 to 7th March, 1984. Among them, 39 patients preoperatively diagnosed as herniated nucleus pulposus ar bulging disc with CT and myelography were operated. 43 disc spaces ofdisc disease were analysed in true positive and false negative cases. Finally the accuracy, sensitivity and specifictiy of spine CT and myelography ar calculated. The resuslts are as follows; 1. The CT findings of disc diseases are in order of frequency, asymmetrical obliteration of epidural fat (82%), ventral indentation orcompression on dural sac(72%), focal protrusion of disc(64%), root changs

Plain chest PA evaluation of left atrial thrombosis in mitral valvular disease

Conventional posteroanterior chest radiographs of 73 patients with mitral valve disease who had surgery were analyzed, and particular attention was directed to the absence of the convexity of the left lower mid cardiacborder (left atrial segment) and to the relation with duration of illness, atrial fibrillation, pulmonary capillary wedge pressure (PCWP) as well as surgical findings. The results obtained are as follows; 1. The flatness or concavity of this segment, despite other evidence of left atrial enlargement, was observed in eleven (64.7%) of17 patients who had left atrial thrombosis and six(10.7%) of 56 patients who did not have thrombosis(false positive diagnosis). Six (35.3%) of the 17 patients who had left atrial thrombosis did not show this finding on radiographs(false positive diagnosis). Six(35.3%) of the 17 patients who had left atrial thrombosis did not showthis finding on radiographs (false negetive diagnosis). Therefore, the accuracy in the diagnosis of thrombosis of left atrium was 64.7%(eleven of seventeen) for patients who had thrombosis of left atrium. 2. The atrial fibrillation was observed in sixteen (94.1%) of 17 patients who had left atrial thrombosis. So, correlation between the presence of left atrial thrombosis and atrial fibrillation was evident. But there was no correlationbetween the duration of illness or the PCWP of patients and the presence of left atrial thrombosis.

Angiographic analysis of congenital mitral stenosis

Congenial mitral stenosis may be defined as a develpment abnormality of the mitral valve leaflets,commissures, interchordal spaces, papillary muscle,s annulus or immediate supravalvular area producing obstructionto left ventricular filling. Authors had experience of nine cases of congenital mitral stenosis confirmed by twodimenstional echocardiography, angiocardiography and surgery in recent 5 years since 1979, and analyzed them withemphasis on the angiographic findings. The results are as follows; 1. Among 9 cases, 6 patients were male and 3 were female. Age distribution was from 4 months to 11 years. 2. The types of congenital mitral stenosis were 1typical congenital mitral stenosis, 5 cases of parachute mitral valve and 3 cases of supramitral ring. 3. Angiographically typical congenital mitral stenosis showed narrowing of mitral valvular opening, parachute mitralvalve displayed single large papillary muscle with narrowed valvular opening and supramitral ring disclosedsemilunar shaped filling defect between left atrium and ventricle. 4. Associated cardiac and extracardiacanomalies of congenital mitral stenosis, as frequency wise, were ventricular septal defect, patent ductusarteriosus, coarctation of aorta, supra and subvalvular aortic stenosis, mitral regurgitation and double outletright ventricle. 5. Cardiac angiography is essential to diagnose congenital mitral stenosis, but the need of two dimensional echocardiography cannot be ignored.