Association of Myosteatosis with Nonalcoholic Fatty Liver Disease, Severity, and Liver Fibrosis Using Visual Muscular Quality Map in Computed Tomography

Background@#The association of myosteatosis measured using visual muscular quality map in computed tomography (CT) with nonalcoholic fatty liver disease (NAFLD), its severity, and fibrosis was analyzed in a large population. @*Methods@#Subjects (n=13,452) with abdominal CT between 2012 and 2013 were measured total abdominal muscle area (TAMA) at L3 level. TAMA was segmented into intramuscular adipose tissue and skeletal muscle area (SMA), which was further classified into normal attenuation muscle area (NAMA) and low attenuation muscle area (LAMA). The following variables were adopted as indicators of myosteatosis: SMA/body mass index (BMI), NAMA/BMI, NAMA/TAMA, and LAMA/BMI. NAFLD and its severity were assessed by ultrasonography, and liver fibrosis was measured by calculating the NAFLD fibrosis score (NFS) and fibrosis-4 index (FIB-4) scores. @*Results@#According to multiple logistic regression analyses, as quartiles of SMA/BMI, NAMA/BMI, and NAMA/TAMA increased, the odds ratios (ORs) for NAFLD decreased in each sex (P for trend <0.001 for all). The ORs of moderate/severe NAFLD were significantly higher in the Q1 group than in the Q4 group for SMA/BMI, NAMA/BMI, and NAMA/TAMA in men. The ORs of intermediate/high liver fibrosis scores assessed by NFS and FIB-4 scores increased linearly with decreasing quartiles for SMA/BMI, NAMA/BMI, and NAMA/TAMA in each sex (P for trend <0.001 for all). Conversely, the risk for NAFLD and fibrosis were positively associated with LAMA/BMI quartiles in each sex (P for trend <0.001 for all). @*Conclusion@#A higher proportion of good quality muscle was associated with lower risks of NAFLD and fibrosis.

Endometrial thickness cut-off value by transvaginal ultrasonography for screening of endometrial pathology in premenopausal and postmenopausal women

OBJECTIVE: To assess the clinical usefulness and diagnostic accuracy of ultrasonographic measurement of endometrial thickness (ET) in women with endometrial hyperplasia or cancer (EH+). METHODS: This retrospective cohort study included 29,995 consecutive women who underwent transvaginal ultrasonography (TVS) for an incidental finding of a thickened endometrium at the health screening and promotion center at Asan Medical Center between 2006 and 2010. Among 959 patients with endometrial abnormalities, 92 patients were included in this study. A total of 867 patients were excluded: 416 were lost to follow-up; 263 did not undergo endometrial biopsy; 155 had endometrial polyps; 17 had submucosal myomas; and 16 had insufficient tissue samples. Endometrial histology was the reference standard for calculating accuracy. RESULTS: Of the 92 patients, 78 (84.8%) had normal pathology, while 14 (15.2%) had endometrial pathology (EH+), including 5 patients (35.7%) with simple hyperplasia without atypia, 3 (21.4%) with complex hyperplasia, and 6 (42.9%) with endometrial carcinoma, all stage Ia. The area under the receiver-operating characteristic curve was 0.75 (95% confidence interval [CI], 0.593–0.906). The cut-off value for ET was 8 mm, indicating that TVS ET had a fair accuracy in diagnosing carcinoma, had a sensitivity of 100% (95% CI, 62.9–100.0%) and a specificity of 24.3% (95% CI, 15.2–36.3%). CONCLUSION: TVS is useful for detecting EH+, with a cut-off value for ET of 8 mm having a high sensitivity for detecting endometrial pathologies and the ability to identify women highly unlikely to have EH+, thereby avoiding more invasive endometrial biopsy.

The Study of Renal Perfusion Image in Rabbit by Harmonic Ultrasound with Microbble Contrast Agent in Comparison with 99mTc-DTPA: Focusing on US Scan Technique and Concentration of Contrast Agent

PURPOSE: To compare the results of harmonic ultrasound (US) renal perfusion imaging using 99mTc-DTPA as contrast agent with those obtained when a microbubble contrast medium was used. MATERIALS AND METHODS: Twenty rabbits underwent harmonic US renal perfusion imaging using 99mTc-DTPA as contrast agent, and the imaging procedure was then repeated using a microbubble contrast medium. Three different concentrations of contrast media (200, 300 and 400 mg/ml) and two different scanning techniques (intermittent and continuous) were used, and the images obtained were assessed using six different methods. By means of a computer program, the images were converted to a renal perfusion curve and Tpeak values were calculated. Images obtained after use of the two different contrast media were compared. RESULTS: Tpeak at renal perfusion imaging using 99mTc-DTPA was 6.3+/-0.9 sec, and where microbubble contrast agent was used, the findings were was as follows: 13.8+/-1.6 sec (method 1), 6.5+/-1.1 sec (method 2), 14.8+/-1.7 sec (method 3), 6.6+/-1.0 sec (method 4), 15.2+/-2.0 sec (method 5), 6.4+/-0.7 sec (method 6). Method 6 had the highest correlation coefficients. CONCLUSION: In conclusion, the harmonic ultrasound renal perfusion images acquired using 99mTc-DTPA were similar to those obtained using microbubble contrast agent. Continuous scanning techniques showed correlation.

Renal Cholesteatoma: Two Cases Report

Cholesteatoma of the urinary tract is an extremely rare disease occurring in the bladder and renal pelvis. We report the radiologic findings in two cases of renal cholesteatoma involving the renal pelvis, calyces and ureter, and correlate these with the histopathologic findings.

Influence of Mn-DPDP on MRI and Proton MR Spectroscopy of the Liver

PURPOSE: To determine the influence of manganese dipyridoxyl diphosphate (Mn-DPDP) on MRI and proton MRS. MATERIALS AND METHODS: In an in-vitro study designed to determine changes in the lipid peak at 1.3 ppm, 4.7T MR equipment was used to obtain proton MR spectrographic images of a lipid solution of varying concentration, with and without Mn-DPDP. Before; at 10, 20, and 30 minutes; and at 1, 2, 4, and 24 hours after the IV injection of Mn-DPDP (10umol, 1ml/kg), the concentration of Mn in liver tissue was measured by atomic absorption spectrometry. At the same intervals, T1-weighted MR images were obtained, the signal intensity ofthe liver was thus determined, and the relative enhancement ratio was calculated. MRS of rabbit liver was performed serially at the same intervals, and the peak areas of metabolites, as well as their peak areas relative to lipids, were calculated. The findings were correlated with tissue Mn concentration. RESULTS: At 1.3 ppm with Mn-DPDP, MRS showed that the peak area of the lipid had decreased. Tissue Mn concentration increased just after Mn-DPDP injection and peaked after 20 minutes, decreasing to a level within the normal range after 24 hours. Serial changes in the signal intensity of the liver, as seen at MRI, showed a similar pattern to that of Mn concentration. There was reverse correlation between serial change in the peak area of lipids at 1.3 ppm and Mn concentration after Mn-DPDP injection. CONCLUSION: At T1-weighted MR imaging, the injection of Mn-DPDP led to the enhancement of liver tissue, and at MRS, the lipid peak at 1.3 ppm decreased. There was close correlation between these effects and tissue Mn concentration.

FLAIR-HASTE Sequence in Differential Diagnosis of Focal Hepatic Lesions

PURPOSE: To assess the feasibility of using the FLAIR (fluid-attenuated inversion recovery)-HASTE (half-fourier acquisition single-shot turbo spin-echo) sequence for the differential diagnosis of focal hepatic lesions. MATERIALS AND METHODS: During a 12-month period, 80 patients with 127 focal hepatic lesions [hemangiomas (n=60), hepatocellular carcinomas (HCC) (n=27), cysts (n=25), and metastases (n=15)] underwent MR imaging using a 1.5-T scanner. Verification of the diagnosis was based on the findings of pathology (n=11), of angiography and clinical investigation (n=17), or of dynamic contrast-enhanced MR imaging (n=99). MR sequences included T2-weighted HASTE (TE, 134 ms; echo space, 4.4 ms), FLAIR-HASTE (TE, 64 ms; echo space, 4.4 ms; inversion time, 2000 ms; number of slices, 5 -9; acquisition time, 13 -20 s), and dynamic gadolinium-enhanced T1-weighted FLASH (TR, 131 ms; TE, 4 ms). FLAIR-HASTE imaging was of any focal lesions seen on T2-weighted HASTE images was performed in the liver area, and their signal intensity was classified in one of five ways: very high (higher than the spleen), moderately high (similar to the spleen), slightly high (higher than the liver and lower than the spleen), intermediate (similar to the liver), or low (lower than the liver). RESULTS: The signal intensity of the 25 cysts, as determined by FLAIR-HASTE, was low in 21 cases (84%), intermediate in three (12%), and very high in one (4%), which was diagnosed as a complicated cyst in which ultrasound revealed internal septa. At FLAIR-HASTE, all 60 hemangiomas showed either very high (n=50, 83%) or moderately high (n=10, 17%) signal intensity, while that of 42 hepatic malignant tumors was very high in 14 cases (33%), moderately high in 8 (19%), slightly high in 18 (43%), intermediate in one (2.5%), and low in one (2.5%). CONCLUSION: FLAIR-HASTE showed that the signal intensity of the majority of hepatic cysts was low, while that of most hemangiomas and solid liver tumors was high. For the differentiatial diagnosis of cystic and non-cystic liver lesions, FLAIR-HASTE is an easily applicable MR imaging sequence.

CT and MR Findings of Genitourinary Tuberculosis

Genitourinary tuberculosis is a disease spread hematogenously from a small tuberculous abscess of the lung. The renal cortex is initially involved, and multiple granulomas form. Ultimately the cortex may cavitate and communicate with the collecting system, allowing downward extension of the infection and subsequent focal caliectasis with infundibular stenosis, ureteral fibrosis, and calcifications of urinary tract organs. The female genitourinary organ is also infected by the hematogenous spread of tuberculosis, the most common lesion be-ing hydrosalpynx with salpingitis. The clinical and radiologic features of genitourinary tuberculosis may mimic other acute abdominal diseases, and the diagnosis of tuberculosis remains difficult. This report describes the ways in which computed tomography and magnetic resonance imaging are valuable aids in the recognition and diagnosis of genitourinary tuberculosis.

Shape and Incidence of Rib Variations in Chest Radiographs / 결핵

BACKGROUND: The literature on variations of rib is limited. Very little has been written in the radiological journal of this country on the subject. It seemed of interest to investigate the nature and incidence of congenital variations in a series of routine chest roentgenograms. The topic of rib variations has not been covered extensively in the radiological journals in Korea. This has presented an opportunity to investigate the nature, type, shape and incidences of congenital rib variations in normal Korean adults from a series of routine roentgenograms. METHODS: Chest radiographs of 5,000 adults (,) who visited our hospital for a routine check-up or for employment physical examinations from January 1996 to September 1998, were consecutively reviewed. The sex distribution consisted of 2,827 male males and 2,173 females (ratio of 1.3:1) with the age range between 19 and 65 years (mean age: 34.6 years). The chest PAs was were analyzed for the presence, type, location, and shape of the rib variations (.) From this data, and we the incidence of each type of variations was calculated. RESULTS: Seventy-six of the 5000 adults (1.52%), 63 male (2.23%) and 13 female (0.6%), showed 88 cases of rib variation (Table 1). Bifid rib (n=35) was the The most common variation was the bifid rib (n=35), followed by hypoplasia of the rib (n=22), flaring of the rib (n=18), bridging of the ribs (n=7), cervical ribs (n=3), and fusion of between ribs (n=3) (Table 2). (New paragraph)Bifid The bifid rib (Table 1) was found most frequent in the right fourth rib (12/35, 34.3%), followed by the left fifth rib (6/35, 17.1%) and right third rib (6/35, 17.1%). Hypoplasia of the rib was common in first rib (20/22, 90.9%). Flaring of the rib was common at fourth rib (8/18. 44.4%, right and left combined) (,) and bridging between ribs was common between first and second rib (3/7, 42.9%). CONCLUSION: The percentage of incidence of rib variations in adults was 1.52%. Bifid rib was the most common variation, followed by hypoplasia, flaring, bridging, cervical rib, and fusion of ribs(,) in decreasing order.

CT Features of Primary Colorectal Signet-Ring Cell Carcinoma

PURPOSE: To evaluate the CT features of 15 patients with primary colorectal signet-ring cell carcinomas. MATERIALS AND METHODS: We retrospectively reviewed the CT scans of 15 patients (mean age, 44 years) with pathologically proven colorectal signet-ring cell carcinoma. The CT findings were evaluated in terms of site and length of the tumor, bowel wall thickening patterns, perirectal or pericolic infiltration, the presence or absence of colonic obstruction, and metastasis to other organs. RESULTS: The tumors were located in the rectum in nine patients, the sigmoid colon in one, the hepatic flexure in one, the transverse colon in one, the ascending colon in two, and the cecum in one. Tumor length ranged from 3.0 to 10.0 (mean, 6.1) cm, with a mean thickness of 2.1 cm. CT revealed concentric bowel wall thickening in all patients, and this was 'even' in eight and 'uneven' in seven. A target appearance was noted in four, perirectal or pericolic infiltration was moderate to severe in 12, and colorectal obstruction was seen in six. With regard to patterns of tumor spread, lymphadenopathy was noted in 13, invasion of adjacent pelvic organs in five, peritoneal carcinomatosis in four, liver metastasis in two, and periureteric metastasis in one. CONCLUSION: When CT shows a long section of concentric bowel wall thickening and a target sign, especially when such findings occur in the rectum and in young patients, primary signet-ring cell carcinoma should be included in the differential diagnosis.

The Effects of Urokinase Instillation Therapy via Percutaneous Transthoracic Catheter Drainage in Loculated Tuberculous Pleural Effusion: A randomized prospective study / 결핵

BACKGROUND: Tuberculous pleural effusion responds well to the anti-tuberculosis agents in general, so no further aggressive therapeutic managements to drain the tuberculous effusion is necessary except in case of diagnostic thoracentesis. But in clinical practice, we often see some patients who later decortication need due to dyspnea caused by pleural thickening despite the completion of anti-tuberculosis therapy in the patients with tuberculous effusion. Especially, the patients with loculated tuberculous effusion might have increased chance of pleural thickening after treatment. The purpose of this study was that intrapleural urokinase instillation could reduce the pleural thickining in the treatment of loculated tuberculous pleural effusion. METHODS: Thirty-seven patients initially diagnosed as having loculated tuberculous pleural effusion were randomly assigned to receive either the combined treatment of urokinase instillation and anti-tuberculosis agents(UK group) and anti-tuberculosis agents(Non-UK group) alone. The 16 patients in UK group received a single radiographically guided pig-tail catheter ranging in size from 10 to 12 French. 100,000 units of urokinase was dissolved in 150 ml of normal saline and instilled into the pleural cavity via pig-tail catheter every day, also this group was treated with anti-tuberculosis agents. While the 21 patients in Non-UK group were teated with anti-tuberculosis agents only except diagnostic thoracentesis. Then we evaluated the residual pleural thickening after treatment for their loculated tuberculous pleural effusion between the two groups. Also the duration of symptoms and the pleural fluid biochemistry like WBC counts, pH, lactic dehydrogenase (LDH), glucose, proteins, and adenosine deaminase (ADA) were compared. RESULTS: 1) The residual pleural thickening (RPT) (5.08 +/- 6.77 mm) of UK group was significantly lower than that (20.32 +/- 26.37 mm) of Non-UK group (Por=10 mm(5.23 +/- 3.89 wks) was significantly longer than the patients with RPT or=10 mm and the patients with RPT <10 mm. CONCLUSION: The treatment of loculated tuberculous pleural effusion with the urokinase instillation via percutaneous transthoraic catheter was effective to reduce the pleural thickening.

CT Measurement of Normal Pericardial Thickness in Adults on Computed Tomography

PURPOSE: The purpose of this study was to establish, using computed tomography, the normal thickness of thepericardium in adults. MATERIALS AND METHODS: CT scans of 50 patients, including sections through the level of theheart, were reviewed. Patients were excluded if there were any suspicions of pericardial abnormality such asinfectious or neoplastic diseases. Twenty-four of the 50 were men and 26 were women; their mean age was 47.0(range,18-76) years. We measured pericardial thickness at the level of the right ventricle, interventricularseptum and left ventricle, and also compared pericardial thickness in terms of age and sex. RESULTS: In allpatients, the pericardium was observed in the right ventricular region; in 41 (82%) at the interventricularseptum; and in 41 (82%) along the left ventricle. The mean thickness of normal pericardium at the level of theright ventricle, interventricular septum, and left ventricle was 1.8 mm +/- 0.5 mm, 1.8 mm +/- 0.4 mm, and 1.7 mm +/-0.5 mm, respectively. No statistically significant correlation was apparent between pericardial thickness and agegroup (p > 0.63, ANOVA test). Mean pericardial thickness was 1.9 mm +/- 0.6 mm in males and 1.7 mm +/- 0.4 mm in females; thus, no statistically significant correlation was apparent between pericardial thickness and sex (p >0.29, Student's t-test). CONCLUSION: The pericardium was best visualized in sections through the right ventricle.The mean thickness of normal pericardium was 1.8 mm +/- 0.5 mm and pericardial thickness did not differ accordingto age or sex.

Sequential Radiographic Changes of Nodules in Patients with Miliary Pulmonary Tuberculosis

PURPOSE: To evaluate sequential changes in miliary nodules, as seen on chest radiographs in patients withmiliary tuberculosis. MATERIALS AND METHODS: We retrospectively analyzed sequential changes in miliary nodules,as seen on the chest radiographs of 13 patients with miliary tuberculosis who recovered completely ofterantituberculous medication. Two were children and 11 were adults, and their ages ranged from 2 monts to 73years(mean, 38 years). In cases in which miliary tuberculosis had been diagnosed from initial chest radiographs,follow-up chest radiographs were obtained 5 to 15(mean, 10) months later. After complete resolution of miliarynodules, as seen on chest radiographs, high-resolution CT scanning was performed in three patients. RESULTS: Asseen on follow-up chest radiographs obtained at one week, the number and size of miliary nodules had decreased ineight of nine patients (89%), and on those obtained at one month, these decreases were seen in all 13 patients.The mean duration of complete resolution of miliary nodules was 6.3 months ; in children, this was 3.5(range, 2-5)months, and in adults, 6.8 (range, 3-10) months. In all three patients involed, high-resolution CT scans obtainedafter complete radiographic resolution of miliary nodules showed no recurrence. CONCLUSION: In patients withmiliary tuberculosis, the size and number of nodules had decreased within one month of adequate chemotherapy andon chest radiographs, complete resolution was seen at 6.3 months, on average.

Distribution of Pleural Effusion Associated with Ascites on Abdominal CT

PURPOSE: To determine through an analysis of the location of pleural effusion associated with ascites, as seen on abdominal CT scan, differences in the distribution of pleural effusion according to the etiology and distribution of ascites. MATERIALS AND METHODS: We retrospectively evaluated 77 consecutive patients in whom abdominal CT scan revealed pleural effusion associated with ascites. Patients with history of surgery or trauma and those with clinically and radiologically diagnosed lung or pleural diseases were excluded. We compared the location of pleural effusion with the etiology and distribution of ascites. RESULTS: Forty-two patients were suffering from hepatobiliary diseases, mainly right dominant pleural effusion (26/42, 62%). Fourteen had intraperitoneal carcinomatosis with no significant difference between the frequency of right dominant (5/14, 36%)and of left dominant (6/14, 43%) pleural effusion. Eleven patients had pancreatic diseases, with mainly left dominant pleural effusion (6/11, 55%). Patients with right dominant ascites usually had right dominant pleural effusion (22/24, 92%) and those with left dominant ascites had left dominant pleural effusion (9/10, 90%). CONCLUSION: Ascites-associated pleural effusion correlated with the anatomical location of the etiology of ascites ; its laterality was, in addition, usually the same as that of ascites.

CT Evaluation of Target-like Bowel Wall Thickening

PURPOSE: The purpose of this study was to evaluate the CT features of target-like bowel wall thickenings and to correlate target layers with histopathologic layers. MATERIALS AND METHODS: We retrospectively analyzed 37 target-like bowel wall thickenings with inner high-, middle low- and outer high attenuated layers on CT scan. Bowel lesions included 15 cases of ischemic lesion, 12 of inflammation, four of carcinomatosis, four of trauma, and two of radiation enteritis. Target-like bowel wall thickenings were classified into three types : with inner most thickened high-attenuated layer(type I); with middle most thickened low-attenuted layer(type II), and with outer most thickened high-attenuated layer(type III). We analyzed the characteristic CT features of these bowel lesions and correlated target and histopathologic layers in resected bowel specimens. RESULTS: Target-like bowel wall thickening was type I in 18 cases(49%), type II in 13 cases(35%), and type III in 6 cases(16%). Type I ischemic bowel lesions and inflammations were most common, and were found in 60% and 67% of cases, retrospectively. All cases of trauma were type II and radiation colitis was type III. Histopathologic findings showed that each layer of target lesions did not exactly correlate with histopathologic layers. However, the inner high attenuated layer correlated with mucosa and some submucosa, the middle low-attenuated layer correlated with most submucosa and some muscularis, and the outer high-attenuated layer correlated with muscularis, serosa, and periserosal mesentery. CONCLUSION: CT features of target-like bowel wall thickenings showed type characteristics according to bowel lesions. Histopathologic comparison and analysis were considered helpful for the differential diagnosis of bowel lesions.

Tracheal Luminal Diameter on Chest Radiographs: Demographic Data in 690 Normals

PURPOSE: To assess the normal range of transverse and AP diameter of the trachea on simple chest radiographs and to determine whether or not there is any correlation between tracheal diameter and age, sex, height, or bodyweight. MATERIALS AND METHODS: Six hundred and ninety patients with no lesion on chest radiographs and noclinical evidence of respiratory disease were involved in this study. To obtein transverse and lateral diameters,the internal diameter of the tracheal air column was measured at a level 2 cm above the top of the aortic arch onboth posteroanterior and lateral radiographs. RESULTS: The normal ranges of AP and transverse diameters of thetrachea were 16 to 25mm, and 14 to 22mm in men, respectively and 12 to 20mm and 12 to 18mm in women. Statistically significant differences were observed between AP and transverse diameter in both in men and women, the former being consistently larger than the latter in both sexes. In men, significant correlations were observed between transverse diameter and patients' height, and between AP diameter and age as well as height. In women, significant differences were observed between AP diameter and patients' height, and transverse diameter and height as well asbody weight of patients. CONCLUSIONS: Normal tracheal diameter was larger in men than in women. and AP diameter was larger than transverse diameter. Patients' height showed persistent correlation with luminal diameter.