ABSTRACT
PURPOSE: To correlate the mammographic and ultrasonographic findings with the pathologic results in women undergoing hormone replacement therapy (HRT), and to determine the characteristic clinical, mammographic or histologic findings of breast cancer in these patients. MATERIALS AND METHODS: Twenty-five breast lesions in 25 patients aged 44-65 (mean, 55.5) years undergoing HRT were surgically removed due to abnormal mammographic findings or the presence of palpable masses. Mammograms in all patients and ultrasonograms in 23 were retrospectively analyzed in terms of the shape and margin of the mass, and microcalcifications, and the imaging findings were correlated with the pathologic results. As a control group, 45 cancer patients not undergoing HRT were selected. Using the student t test, detection methods, tumor size, mammographic findings, and the proportion of intraductal cancers were compared between the two groups. RESULTS: Surgical excision revealed ten benign lesions (four fibroadenomas and six cases of fibrocystic change) and 15 cancers (three intraductal and twelve invasive ductal cancers). Abnormal findings at mammography were a mass in 16 cases, clustered microcalcifications in seven, and a mass with microcalcifications in two. Mammography showed that all four circumscribed masses were benign. Five of seven ill-defined masses (71%) and all six spiculated masses were malignant. Three of seven cases (43%) with microcalcification, and both with a mass and microcalcification, were malignant. In two cases in which ultrasonography revealed cystic lesions, histologic examination showed that fibrocystic change had occurred. Compared to non-HRT-related cancers, HRT-related cancers were more often detected by mammography (60% vs 16%; p <0.001), smaller (17 mm vs 24 mm, p <0.01), showed microcalcification only (20% vs 13%; p <0.05), and were intraductal (20% vs 7%; p <0.01). CONCLUSION: In patients with HRT, mammographic findings of an ill-defined or spiculated mass, or one with microcalcifications, were associated with breast cancer. Compared to non-HRT-related cancers, breast cancers in patients undergoing HRT tend to manifest more frequently as a mammographic abnormality, and to be intraductal.
Subject(s)
Female , Humans , Breast Neoplasms , Breast , Fibroadenoma , Hormone Replacement Therapy , Mammography , Retrospective Studies , UltrasonographyABSTRACT
Wide-necked aneurysms, whether they are small or large, have remained a significant challenge for endovascular treatment. Several methods, such as balloon remodeling technique or use of three-dimensional coil, are introduced for this, however, they do not produce satisfactory results. We describe the efficacy and limitations in treating the wide-necked aneurysms with stent-assisted coil embolization technique.
Subject(s)
Aneurysm , Embolization, Therapeutic , Intracranial Aneurysm , StentsABSTRACT
PURPOSE: The goal of this study was to survey the overall quality of mammographic images in Korea. MATERIALS AND METHODS: A total of 598 mammographic images collected from 257 hospitals nationwide were reviewed in terms of eight image quality categories, namely positioning, compression, contrast, exposure, sharpness, noise, artifacts, and examination identification, and rated on a five-point scale: (1=severe deficiency, 2=major deficiency, 3=minor deficiency, 4=good, 5=best). Failure was defined as the occurrence of more than four major deficiencies or one severe deficiency (score of 1 or 2). The results were compared among hospitals of varying kinds, and common problems in clinical image quality were identified. RESULTS: Two hundred and seventeen mammographic images (36.3%) failed the evaluation. Poor images were found in descending order of frequency, at The Society for Medical Examination (33/69, 47.8%), non-radiology clinics (42/88, 47.7%), general hospitals (92/216, 42.6%), radiology clinics (39/102, 38.2%), and university hospitals (11/123, 8.9%) (p<0.01, Chi-square test). Among the 598 images, serious problems which occurred were related to positioning in 23.7% of instances (n=142) (p<0.01, Chi-square test), examination identification in 5.7% (n=34), exposure in 5.4% (n=32), contrast in 4.2% (n=25), sharpness in 2.7% (n=16), compression in 2.5% (n=15), artifacts in 2.5% (n=15), and noise in 0.3% (n=2). CONCLUSION: This study showed that in Korea, 36.3% of the mammograms examined in this sampling had important image-related defects that might have led to serious errors in patient management. The failure rate was significantly higher in non-radiology clinics and at The Society for Medical Examination than at university hospitals.
Subject(s)
Humans , Artifacts , Hospitals, General , Hospitals, University , Korea , Mammography , NoiseABSTRACT
The authors report a rare case of multiple schwannomas associated with intracranial, intraspinal and peripheral involvements. A 63-year-old woman presented with a seven-year history of palpable lumps on both sides of the supraclavicular area and hearing impairment in both ears. On physical examination, no skin manifestations were evident. Facial sensory change, deafness in the left ear and decreased gag reflex were revealed by neurological examination. Magnetic resonance imaging revealed multiple lesions of the trigeminal nerves, acoustic nerves, lower cranial nerves, spinal accessory nerve, brachial plexuses, and spinal nerves. Pathological examination of tumors from the bilateral brachial plexuses, the spinal nerve in the T8 spinal position and the neck mass revealed benign schwannomas.
Subject(s)
Female , Humans , Middle Aged , Accessory Nerve , Brachial Plexus , Cochlear Nerve , Cranial Nerves , Deafness , Ear , Hearing Loss , Magnetic Resonance Imaging , Neck , Neurilemmoma , Neurofibromatoses , Neurologic Examination , Physical Examination , Reflex , Skin Manifestations , Spinal Nerves , Trigeminal NerveABSTRACT
The authors report a 39-year-old male suffering pulsatile tinnitus of the left ear with dural arteriovenous malformation of the jugular bulb. There was a venous hypertension due to partial occlusion of the internal jugular vein and sigmoid sinus and venous drainage to the contralateral sinuses. Superselective embolization of these feeding arteries was successfully performed using 25% mixture of histoacryl and lipiodol. After embolization, his complaints of pulsatile tinnitus and buzzing noise behind his left ear disappeared. We present a case of dural arteriovenous malformation involving the jugular bulb, which completely disappeared after transarterial embolization with liquid adhesive.
Subject(s)
Adult , Humans , Male , Adhesives , Arteries , Arteriovenous Malformations , Colon, Sigmoid , Drainage , Ear , Enbucrilate , Ethiodized Oil , Hypertension , Jugular Veins , Noise , TinnitusABSTRACT
Embolization of a carotid cavernous fistula(CCF) by means of a detachable balloon is a well-established method for treating CCFs while preserving a patent parent internal carotid artery(ICA). However, failure to embolize the CCF may occur on a few occasions. Herein we describe a stent-assisted Guglielmi detachable coil embolization that completely occludes the fistulous opening rather than fills the cavernous sinus. By applying this technique, we successfully treated a CCF, without compromise of the parent ICA in patients who has failed with balloon technique previously.
Subject(s)
Humans , Cavernous Sinus , Embolization, Therapeutic , Fistula , Parents , StentsABSTRACT
Preoperative embolization of hypervascualr brain tumors is known to be an effective method to reduce intraoperative bleeding and to reduce the operative difficulty. The most commonly tumor vessels are branches of the external carotid artery, which are frequently embolized as a preoperative procedure. However, branches from the internal carotid artery, such as the ophthalmic artery, tentorial artery, or cortical branches sometimes feed tumors, but there are some limitations of embolization of branches from the internal carotid artery. In addition, hypervascular tumors are rarely associated with neoplastic aneurysms. Their possible role in producing massive intraoperative hemorrhage has been well recognized. We describe the successful embolization of the tumor vessels from branches of the internal carotid artery and their neovascularization.
Subject(s)
Aneurysm , Arteries , Brain Neoplasms , Brain , Carotid Artery, External , Carotid Artery, Internal , Hemorrhage , Ophthalmic Artery , Preoperative CareABSTRACT
Recent advances in stent technology have allowed the introduction of more flexible stents that may be tracked more easily in the intracranial vessels. We present a patient with improved cerebral perfusion as assessed by single-photon emission computed tomographic(SPECT) scan after stent-assisted angioplasty for symptomatic middle cerebral artery stenosis. A 72-year-old man presented with multiple episodes of transient verbral disturbance and right-sided motor weakness for 5 months despite treatment with aspirin and clopedigrel. Angiography revealed a 50% to 60% stenosis of the left middle cerebral artery. 99m Tc-exametazime-SPECT scan demonstrated decreased cerebral blood flow in the left cerebral hemisphere, particularly in the left middle cerebral artery territory. The patient was recommended a stent-assisted angioplasty for middle cerebral artery stenosis. The patient underwent uncomplicated stenting with S-660 2.5- by 9-mm stent(Arterial Vascular Engineering, Santa Rosa, CA) of the left middle cerebral artery, with excellent angiographic results. Follow-up brain SPECT scan showed markedly improved perfusion. Stent-assisted percutaneous transluminal angioplasty can provide a favorable clinical course as well as improved cerebral perfusion for a patient with middle cerebral artery stenosis. Long-term follow-up data and additional clinical experience are required to assess the durability of this procedure.
Subject(s)
Aged , Humans , Angiography , Angioplasty , Aspirin , Brain , Cerebrum , Constriction, Pathologic , Follow-Up Studies , Middle Cerebral Artery , Perfusion , Rosa , Stents , Tomography, Emission-Computed, Single-PhotonABSTRACT
Recent advances in stent technology have allowed the introduction of more flexible stents that may be tracked more easily in the intracranial vessels. We present a patient with improved cerebral perfusion as assessed by single-photon emission computed tomographic(SPECT) scan after stent-assisted angioplasty for symptomatic middle cerebral artery stenosis. A 72-year-old man presented with multiple episodes of transient verbral disturbance and right-sided motor weakness for 5 months despite treatment with aspirin and clopedigrel. Angiography revealed a 50% to 60% stenosis of the left middle cerebral artery. 99m Tc-exametazime-SPECT scan demonstrated decreased cerebral blood flow in the left cerebral hemisphere, particularly in the left middle cerebral artery territory. The patient was recommended a stent-assisted angioplasty for middle cerebral artery stenosis. The patient underwent uncomplicated stenting with S-660 2.5- by 9-mm stent(Arterial Vascular Engineering, Santa Rosa, CA) of the left middle cerebral artery, with excellent angiographic results. Follow-up brain SPECT scan showed markedly improved perfusion. Stent-assisted percutaneous transluminal angioplasty can provide a favorable clinical course as well as improved cerebral perfusion for a patient with middle cerebral artery stenosis. Long-term follow-up data and additional clinical experience are required to assess the durability of this procedure.
Subject(s)
Aged , Humans , Angiography , Angioplasty , Aspirin , Brain , Cerebrum , Constriction, Pathologic , Follow-Up Studies , Middle Cerebral Artery , Perfusion , Rosa , Stents , Tomography, Emission-Computed, Single-PhotonABSTRACT
We evalusted the magnetic resonance imaging (MRI) findings of the femoral heads in 20 normal and 45 abnormal patients. The bone marrow in the healthy adults consisted of a combination of hematopoietic and fatty marrow, which showed age-related dirtribation, that is the component of fatty marrow was increased and the marrow vascularity was dereased with age. Avascular necrosis (AVN) showed a decreased bone marrow signal within an normal appearing femoral head on T1 and T2-weighted images. In addition, we could see inhomogenous low signal intensity (31 cases), a ring of low intensity with central normal signal intensity (25cases), focal low signal intensity (12 cases), or a band of low signal intensity (4 cases). MRI findings were abnormal in 10 cases with normal radiographic findings as well as in all the cases with abnormal ones. In conclusion, MRI should be the choice of the imaging modality for the evaluation of early bone marrow chages of AVN.