The Diagnostic Concordance of Endoanal Ultrasonography and Endoanal MRI in Cases of Anorectal Fistula

PURPOSE: To evaluate the preoperative diagnostic concordance of morphologic classification of anorectal fistula by endoanal ultrasonography (EUSG) and endoanal magnetic resonance imaging (EMRI). MATERIALS AND METHODS: Between January 1998 and March 1999, 17 patients with anorectal fistula underwent endoanal ultrasonography and magnetic resonance imaging for preoperative assessment. The types of fistula and abscess formation were evaluated, and the findings compared with those obtained during surgery. RESULT: The overall accordance of anorectal fistula was 76% (13 of 17 cases) on ultrasonography and 94% (16 of 17 cases) on magnetic resonance imaging. According to the findings of EUSG, the accordance of each type of anorectal fistula was as follows: transphineteric, 92% (11 of 12 cases); suprasphinteric, 33% (1 of 3); and extrasphincteric, 50% (1 of 2), while for EMRI, the respective figures were 100% (12 of 12 cases), 67% (2 of 3), and 100% (2 of 2). An analysis of reproducibility using kappa value showed that overall concordance between endoanal ultrasonography and surgery(K=0.820) as well as between endoanal MRI and surgery (K=0.866), was very close. CONCLUSION: For the evaluation of anorectal fistula, preoperative endoanal magnetic resonance imaging was more accurate and informative than endoanal ultrasonography.

Mixed Form of Congenital Cystic Adenomatoid Malformation and Extralobar Bronchopulmonary Sequestration: A Case Report

Bronchopulmonary sequestration(BPS) and congenital cystic adenomatoid malformation (CCAM) are rare, but both should be included in the differential diagnosis of fetal lung mass. We experienced a mixed form of Stocker type-III CCAM and extralo-bar BPS, and present this case, together with a rev i ew of the related literature.

Squamous Cell Carcinoma Associated with Chronic Empyema Caused by Metallic Fo reign Body: A Case Report

Malignant neoplasm associated with chronic empyema is rare. Most squamous cell carcinomas of the pleura may occur in association with chronic persistent empyema, with or without pleurocutaneous fistula. We report a case of squamous cell carcinoma associated with chronic empyema caused by a metallic foreign body.

Papillary Tumors of the Breast: US Findings of the Benign and Malignant Lesions

PURPOSE: To determine which sonographic findings usefully differentiate between benign and malignant papillary tumors. MATERIALS AND METHODS: We retrospectively rev i ewed the ultrasonographic findings of 42 surgically proven cases of papillary breast lesions [11 malignant lesions (7 inva s i ve papillary carcinomas, 4 intraductal papillary carcinomas) and 31 benign intraductal pa-pillomas]. All 42 cases were classified sonographically as cystic or ductal, or solid type, and the shape, wall change, margin, internal echo-pattern, posterior echo change and other associated findings for the two types were then analysed. RESULTS: Among the 25 cases (5 malignant and 20 benign) of cystic or ductal type, tubular shaped lesions were more frequently benign (60%). In all 20 benign lesions the wall of cystic portion was well-defined, smooth and thin. The solid portion of the cystic type showed an illdefined irregular margin in four malignant lesions (80%) and a smooth margin in 19 which were benign (95%). The internal echo-pattern was heterogeneous mixed-echo in three cases of malignancy, and homogeneously hypoechoic in 19 benign lesions (95%). Posterior enhancement was seen in two malignant lesions (40%), while in 19 benign lesions (95%), there was no posterior echo change. There were 17 solid type lesions (6 malignant cases, 11 benign cases), and most of these, whether benign or malignant, were smooth, oval or lobulated, hypoechoic masses. Posterior enhancement, howeve r, was more frequently observed in malignant lesions (three cases, 50%) than in those which were benign (one case, 9%). CONCLUSION: In cystic or ductal type lesions, an ill-defined irregular thick cystic wall, an illdefined irregular margin, a heterogeneous mixed internal echo-pattern and posterior enhancement of the solid portion suggested malignancy. In solid type lesions, posterior enhancement was more frequently found in malignant than in benign lesions.

MR Imaging of Pineal Cysts

PURPOSE: To evaluate the incidence and characteristic findings of pineal cyst incidentally detected on magnetic resonance(MR) imaging. MATERIALS AND METHODS: Brain MR images obtained in 2432 patients were retrospectively reviewed to determine the incidence and MR findings of pineal cysts, which were evaluated according to their size, shape, location, signal intensity, interval change, contrast enhancement and mass effect on adjacent structures. RESULTS: Cysts were encountered in 107(4.4 %) of 2432 patients evaluated. Their size ranged from 1 x 1 x 1 to 15 x 8 x 9(mean, 5.97 x 3.87 x 4.82)mm. All were spherical(n=53) or oval(n=54) in shape. Their margin was smooth and they were homogeneous in nature. On T1-weighted images, the cysts were seen to be hyperintense(n=57) or isointense(n=50) to cerebrospinal fluid, but less so than brain parenchyma. T2-weighted images showed them to be isointense(n=51) or hyperintense(n=56) to cerebrospinal fluid. The cysts were centrally located in 65 cases and eccentrically in 42. Compression of the superior colliculi of the tectum was demonstrated in 17 cases(15.9 %). No patients presented clinical symptoms or signs related to either pineal or tectal lesions. Peripheral enhancement around the cyst after Gd-DTPA injection was demonstrated in 51 cases ( 1 00 %). Follow-up examinations in 19 cases demonstrated no interval change. CONCLUSION: The incidence of pineal cysts was 4.4%. The MR characteristics of simple pineal cysts include: (1) an oval or spherical shape, (2) a smooth outer margin and homogeneous nature, (3) isosignal or slightly high signal intensity to cerebrospinal fluid on whole pulse sequences, (4) ring enhancement after contrast injection,(5) an absence of interval change, as seen during follow up MR study. These MR appearances of pineal cysts might be helpful for differentiating them from pineal tumors.

Pyourachus: A Case Report

Pyourachus is an infection of urachal cyst which is one of congenital urachal anormalies. It should bedifferentiated from urachal tumor in adult, and abdominal desmoplastic round cell tumor, non-Hodgkin's lymphoma,and intra-abdominal desmoid tumor in children. The CT findings of pyourachus are characteristic to provide anaccurate preoperative diagnosis. The authors encountered a case of pyourachus in a 58-year-old male and report thecharacteristic CT findings. A large hypodense spherical mass with irregular thickened wall was present in themidline of the lower abdomen under the rectus abdominalis muscle extending from the dome of the urinary bladder tothe level of the umbilicus.

Infiltrating Ductal Carcinoma with Mammographic 'Halo Sign' Correlation with Histopathology

PURPOSE: To analyze and correlate mammographic/ sonographic features with pathologic findings in patientswith infiltrative ductal carcinoma with the mammographic 'halo sign'. MATERIALS AND METHODS: We retrospectivelyreviewed 27 cases of surgically confirmed infiltrative ductal breast carcinoma with the mammographic 'halo sign',analysing the mammographic/sonographic findings, clinical records and pathologic findings. RESULTS: Twenty-sevenpatients with infiltrating ductal breast carcinoma with the mammographic 'halo sign' were aged 32-72 (mean 49+/-12)years. For periods of between 2 days and 5 months(mean, 1.9 months), all had complained of a palpable mass.Histologic sections indicated parenchymal compression(27/27), microscopic infiltration of tumor margin(11/27) andparenchymal fat compression(15/27), without a true capsule. Infiltrating ductal carcinomas with the mammographic'halo sign' were nuclear grade 1 (17/27) or histologic grade III (14/27). Mammography (complete halo:3;partialhalo:24) showed a round(15/27) or macrolobulated (9/27) mass (size : 2.5+/-1cm) which showed partialspiculation(17/27) or-rarely-calcification(2/27). Sonography revealed a hypoechoic mass with a thinboundary(13/15);in five of these 13 cases, pathologic examination revealed microscopic infiltration of the tumormargin. Bilateral shadowing (8/15), posterior enhancement(13/15), and heterogeneous internal echogenicity(13/15)were also noted on sonography. CONCLUSION: When correlated with the histopathologic findings, infiltrating ductalbreast carcinoma with the 'halo sign' showed a relatively poor pathologic grade, which is known to be one of theprognostic factors. Surrounding parenchyma and fat compression at the margin of a tumor are considered to be oneof the causes of the mammographic 'halo sign'.

Ovarian Mucinous Cystadenocarcinoma in 17-year-old Girl: A Case Report

Malignant epithelial neoplasm usually occurs in postmenopausal women, with less than 10% of cases occurring in women under the age of 20. In patients below this age, the majority of ovarian tumors are of germ cell origin and malignant ovarian epithelial tumors are uncommon. We report US & CT imaging in a case of mucinous cystadenocarcinoma in a 17-year-old nullipara who complained of amenorrhea for 45 days and a palpable mass.

Radiologic Findings of Struma Ovarii

PURPOSE: Struma ovarii is ovarian tumor composed solely or predominantly of thyroid tissue or tumor in which hyperthyroidism results from ovarian thyroid tissue, and usually occurs in tandem with cystic teratoma. Ovarian cystic teratoma is radiologically easily diagnosed due to calcification or fat, for example, but the preoperative diagnosis of struma ovarii is often difficult due to rare characteristic features of thyroid tissue. Our purpose was to determine whether there were specific findings of struma ovarii which distinguished it from other ovarian tumors, and this involved analysis of its radiologic findings. MATERIALS AND METHODS: Using ultrasonography, computed tomography, and magnetic resonance imaging, preoperative radiologic findings of pathologically-proven struma ovarii in eleven patients were retrospectively evaluated for site, margin, nature (cystic, solid, mixed), contrast enhancement, septa, mural nodule, calcification, fat, and metastasis. These findings were compared with pathologic findings. RESULTS: All eleven tumors were unilateral, ten had smooth tumor margins, seven were mixed cystic and solid tumors (more than 70% of solid components in one tumor), and nine had regular septa. Three of four cystic masses (one unilocular, one bilocular and two multilocular cysts) had mural nodules. Calcifications were found in two tumors, and fat in one. Malignant change or metastasis was not found in any tumor. In one patient with hyperthyroidism due to struma ovarii, symptoms and signs of this subsided after removal of the tumor on salpingo-oophorectomy. CONCLUSION: Most cases of struma ovarii occurred unilaterally within ovarian teratomas in premenopausal women, and were mixed cystic and solid masses with smooth margins that are commonly enhanced on contrast enhanced scans. In one patient, hyperthyroidism was caused by struma ovarii. There were, however, no specific radiologic findings that were sufficiently typical to suggest the correct preoperative diagnosis of struma ovarii.

Colonic Diverticulosis: Evaluation wth Double Contrast Barium Enema

PURPOSE: To evaluate the pattern of colonic diverticulosis according to age and sex, and recent trend. MATERIALS AND METHODS: The authors retrospectively reviewed 120 cases of colonic diverticulosis in 1,020 patients who had undergone a double contrast barium enema examination between January 1st, 1993, and December 31st, 1995, and analyzed the frequency, size, multiplicity and anatomical site, according to age and sex. Diverticulum size was classified into one of three groups : less than 5mm, 5-10mm, over 10mm in diameter. RESULTS: The overall incidence of colonic diverticulosis was 120 cases among 1,020 patients(11.8%) with an incidence 5.3 times higher in males than in females. Peak incidence was in the fifth decade, with 19 cases (15.8%) among males, and after the sixth decade, with four cases(3.3%) among females. Mean age was 57.7 years. Diverticulum size of 5-10mm in diameter was predominant 2% of cases) ; average diameter was 5-6mm. The incidence of colonic diverticulosis was 5.1 times more frequent in the right colon(101 cases) than in the left (20 cases). CONCLUSION: The overal overall incidence of colonic diverticulosis has continually increased; in addition it has also recently increased slightly in left-sided colon. This is thought to be due to various factors, both congenital and acquired, including longer life with good health care, constipation, irritable bowel syndrome, stress and the tendency of eating patterns to more closely resemble those of the west.

The Size of the Main Pulmonary Artery in Patients with IPF: Relationship with the Extent of Honeycombing Lesion

PURPOSE: To predict pulmonary arterial hypertension by comparing the extent of honeycombing lesion with the diameter of main pulmonary artery (MPA). MATERIALS AND METHODS: We retrospectively reviewed 21 patients (20 men, one woman) who showed honeycombing lesion on HRCT, and also analysized a control group of 30 (29men, one woman) who had no cardiopulmonary symptom and no abnormality on chest CT. On Chest HRCT, we scanned at four levels [1)aortic arch, 2) bifurcation of bronchus, 3) mid-portion of left ventricle, 4) dome of right diaphragm], and two radiologists then evaluated the proportion of honeycombing lesion within the entire lung field. According to the extent of this, we divided the patients into five groups [ or = 80% (V)], and then divided Group I into two subgroups [<10 % (I|1), 10-19% (I-2)]. Using contrast-enhanced routine CT, the main pulmonary artery (MPA) was measured at its the widest diameter perpendicular to the long axisat the level of its bifurcation. RESULT: In group I (n=11) MPA was 28.4+/-2.6mm ; in group II (n=6), it was31.7+/-2.0mm ; in group III (n=2), 33.5mm ; in group IV (n=1), 33mm ; and in group V (n = 1), 39mm. In subgroup I-1MPA was 26.1+/-1.9mm, and in subgroup I-2, it was 29.8+/-1.6mm. In the control group, MPA was 25.1+/- 2.0mm. CONCLUSION: The extent of honeycombing lesion is closely related to the change in diameter of the MPA. Honeycombing lesion extending over more than 10% of the lung field may lead to pulmonary arterial hypertension.

Cystic Lymphangioma of Breast: A Case Report

Cystic lymphangioma are rare benign tumors that originate as a congenital anomaly of the lymphatic system. Their common presentation is in neck and axillary area at the birth, during infancy or early pediatric age group. Author reports an unusual case of cystic lymphangioma of breast which was diagnosed in a 32-year-old woman. The findings were very dense, sharply defined, and multilobulated masses on mammography, and mu-Itiloculated echo free lesions on ultrasonogram.

Urinary Tract Stone in Patients with Spinal Cord Injury: A Retrospective Radiological Study

PURPOSE: To compare the incidence between author's first and current report on urinary tract stone in patient with spinal cord injury and to evaluate the effectiveness of recent developed in medical technology and care on in treating the patients. MATERIALS AND METHODS: We reviewed urinary tract stone in 257 patients with paraplegia or quadriplegia after spinal cord injury. These patients were diagnosed retrospectively by KUB and intravenous urography at the Korea Veterans Hospital during 10years from January, 1984 to December, 1993. We evaluated and compared the overall incidence, incidence of specific location of urinary tract, recurrent rate, incidence according to the level of spinal cord injury, and the duration of development in urinary tract stone. RESULTS: Total patients were 257 with 186(72.4%) paraplegia and 71(27.6%)quadriplegia. Overall incidence of the stone was 16.0% in this study and 38.1% in the first study. Incidence of the stone in individual organ ;5.5% in kidney, 1.2% in ureter, and 13.6% in urinary bladder. The recurrent rate was 29.3% in this study and 40.6% in the first study. Incidence of the stone according to the level of spinal cord injury was as follows;15.6% in cervix, 17.1% in upper thorax, 17.9% in lower thorax and 13.9% in lumbar. The stone developed during the first 4 years and between 12 to 16 years following spinal cord injury was 28.3% each. CONCLUSION: Overall incidence and recurrent rate of urinary tract stone was obviously decreased since the first study. Highest incidence of the stone occurred in urinary bladder and in patient with lower thoracic spinal cord injury, which is similar to first report. Peak incidence of the stone was in the first 4years, and another peak was in 12-16years after spinal cord injury. The decreased overall incidence of urinary tract stone maybe attributable to the development in medical technology and care, and active rehabilitation.

Urinary Tract Stone in Patients with Spinal Cord Injury: A Retrospective Radiological Study

PURPOSE: To compare the incidence between author's first and current report on urinary tract stone in patient with spinal cord injury and to evaluate the effectiveness of recent developed in medical technology and care on in treating the patients. MATERIALS AND METHODS: We reviewed urinary tract stone in 257 patients with paraplegia or quadriplegia after spinal cord injury. These patients were diagnosed retrospectively by KUB and intravenous urography at the Korea Veterans Hospital during 10years from January, 1984 to December, 1993. We evaluated and compared the overall incidence, incidence of specific location of urinary tract, recurrent rate, incidence according to the level of spinal cord injury, and the duration of development in urinary tract stone. RESULTS: Total patients were 257 with 186(72.4%) paraplegia and 71(27.6%)quadriplegia. Overall incidence of the stone was 16.0% in this study and 38.1% in the first study. Incidence of the stone in individual organ ;5.5% in kidney, 1.2% in ureter, and 13.6% in urinary bladder. The recurrent rate was 29.3% in this study and 40.6% in the first study. Incidence of the stone according to the level of spinal cord injury was as follows;15.6% in cervix, 17.1% in upper thorax, 17.9% in lower thorax and 13.9% in lumbar. The stone developed during the first 4 years and between 12 to 16 years following spinal cord injury was 28.3% each. CONCLUSION: Overall incidence and recurrent rate of urinary tract stone was obviously decreased since the first study. Highest incidence of the stone occurred in urinary bladder and in patient with lower thoracic spinal cord injury, which is similar to first report. Peak incidence of the stone was in the first 4years, and another peak was in 12-16years after spinal cord injury. The decreased overall incidence of urinary tract stone maybe attributable to the development in medical technology and care, and active rehabilitation.

Radiological evaluation of myositis ossificans

The 35 patients who have suffered from myositis ossificans were investigated for 11 years. They wereposttraumatic patients, They trauma was divided into 3 groups; spinal cord injury, direct injury(fracture) andmixed type involving both. We evaluated the age distribution, the frequency of myositis ossificans, predilectionsite, bilaterality and relation between predilection site and bilaterality to the type of trauma. The results areas follows; 1. The age distribution was highest in 4th decades(12 among 35 patients). 2. In regard to distributionof 35 patients, spinal cord injury were most common (15 cases, 43%), the fracture nextly common (14, 40%) and thenmixed type (6,17%). 3. Among 51 cases of myositis ossificans, the frequency was highest in spinal cord injury(25cases, 49%), next was fracture(14, 27%). 4. The correlation between predilection site of myositis ossificans andlevel of spinal cord injury, hip is the most frequent site in thoracic injury. 6. The bilaterality of myositisossificans is 39%(20 among 51 lesions).

Ultrasonographic findings of ovarian tumors

The ultrasound is easily available and noninvasive diagnostic method without radiation hazard. We can approachto differential diagnosis of ovarian tumors by gray sale ultrasound which can display the detailed structure ofsoft tissue. In department of radiology, Korea Veterans Hospital, 27 cases of histologically confiremd ovariantumors collected from March 1984 to February 1986 were analized. The results were as follows: 1. The agedistribution was from 13 to 72 years. 2. The histologic diagnosis of ovarian tumors(27 cases) are as follows:teratoma(14), mucinous cystadenoma(8), mucinous cystadenocarcinoma(1), serous cystadenoma (2), Krukenburg tumor(1)and malignant thecoma (1). 3. The long diameter of ovarian tumors ranges from 4cm to 28cm. In these, mucinouscystadenoma is the largest and their size are as follows; less than 10cm; 25%, 11–15 cm; 12%, 16–20 cm; 25% andmore than 20cm; 38%. 4. The ultrasonographic findings of teratoma(14) were mainly cystic (8) or echogenic(6).There were echogenic solid components showing distal acoustic shadowing or fat-fluid level within cystic masses.Echogenecity of solid masses was heterogenous. 5. The ultrasonographic findings of mucinous cystadenoma&cystadenocarcinoma(9) were unilocular cystic (3) or multilocular cystic(6). There were variable amount ofechogenic component within cystic masses. 6. Those of serous cystadenoma(2) were unilocular cystic (1) ormultilocular cystic (1). 7. Krukenburg tumor(1) and Malignant thecoma(1) were heterogenously echogenic.

Urinary calculi in traumatic spinal cord injury

The evaluation of urinary calculi was done in 84 patients of paraplegia and quadriplegia due to traumatic spinal cord injury. These patients were diagnosed by KUB and intravenous urography at National Veterans Hospital during 6 years from Jan. 1975 to Dec. 1980. The results were as follows; 1. Overall incidence of urinary calculi was 38.1 %; Incidence of renal calculi was 8.3%, ureteral calculi 4.8%, and urinary bladder claculi 32.1%. 2.Relation of neurological level and incidence of urinary calculi were as follows; Cervical injury in 34.8% upper thoracic injury in 40.0%, lower thoracic injury in 45.0%, and lumbar injury in 36.5%. 3. Laterality was not toplay a role information of urinary claculi. 4. The urinary calculi were developed 62.5% during the first 36 months following spinal cord injury. 5. The recurrence of urinary calculi was 40.6%; True recurrence was 15.6% and pseudo recurrence was 25.05.