Contrast-Enhanced Fat-Suppression MR Imaging of Avascular Necrosis of Femoral Head

PURPOSE: To evaluate the findings and role of contrast-enhanced fat suppression MR imaging in avascular necrosis(AVN) of the femoral head. MATERIALS AND METHODS: In 15 patients with AVN of the femoral head, MR T1-weighted and T2-weighted images and contrast-enhanced fat-suppression T1-weighted images were obtained, and the findings were re-viewed. Early and advanced groups were classified on the basis of clinical findings and imaging, and the en-hancement pattern was classified as either type I, rim enhancement; type II, surrounding diffuse enhance-ment; type III, intralesional enhancement; or type IV, II + III. RESULTS: Twenty-four cases of AVN of the femoral head were detected; in nine patients, lesions were bilateral. Eight cases occurred in the early group and 16 in the advanced. All eight in the early group showed the "double line sign" on T2-weighted images, with a type-I enhancement pattern. In the advanced goup, type II(8/16) and type IV(8/16) enhancement patterns were seen. Among the cases showing the type-IV pattern, the intrale-sional enhancing area showed low signal intensity on T1-weighted images and isosignal intensity on T2 weighted in one case, and low signal intensity on T1-weighted images and high signal intensity on T2-weight-ed in the other cases. There was no difference in the extent of the disease before and after enhancement. CONCLUSION: Contrast-enhanced fat-suppression MR images may be helpful in evaluating the extent of AVN of the femoral head and predicting the histopathologic findings of the disease

CT Findings of Renal Abscess

PURPOSE: The purpose of this study is to determine characteristic CT findings in renal abscess. MATERIAL AND METHODS: Twenty cases of renal abscess were retrospectively analyzed for CT findings relating to the shape andextent of the abscess, change of nephrogram, peripheral rim enhancment, wedge-shaped enhancement on delayed scans, enlargement of the kidney involved and associated findings. RESULTS: Seven patients had a renal abscess at the right kidney, nine at the left kidney and two bilaterally. The abscesses were round in 18 cases and finger-like in two. Rim enhancement around renal abscess was seen in four cases(20%). Changes in the nephrogram around the abscess were seen in 12 cases(60%). In all six patients who had undergone delayed postcontrast scans, wedge-shaped enhancement was shown around the abscess(100%). In the observation of the extent of renal abscesses, 14 cases were within the kidney, six cases extended the beyond renal capsule, and two were loculated in the renal fascia itself. Renal enlargement was seen in nine cases(45%). CONCLUSION: These results suggest that CT findings such as delayed wedge-shaped enhancement, change of nephrogram, peripheral rim enhancement, renal enlargement, and associated findings are valuable for diagnosis, and that CT also gives information concerning the extent, evolution and complication of a renal abscess.

CT Evaluation of Mechanical Intestinal Obstruction

PURPOSE: To evaluate the usefulness of CT for the diagnosis and treatment planning of mechanical intestinal obstruction. MATERIALS AND METHODS: We retrospectively reviewed 38 patients who were clinically suspected of mechanical intestinal obstruction and had undergone abdominal CT. The CT scans were evaluated for the absence or presence, severity, cause and site of intestinal obstruction. CT findings were compared with the results of laparotomy, barium study and clinical course. The absence or presence and severity of intestinal obstruction were classified into no obstruction, partial obstruction, complete obstruction. Diagnosis was estabilished by means of laparotomy in 20 cases, barium study in 9 cases and clinical course in 9 cases. RESULTS: Of 38 cases, 7(18.4%) showed no obstruction, 22(57.9%) showed partial obstruction, and 9(23.7%) showed complete obstruction. The presence or absence and severity on CT scans were corretly predicted in 36 of 38 cases (sensitivity 95%, specificity 97%, accuracy 96%) (in case of no obstruction:sensitivity 100%, specificity 94%, accuracy 95%;in case of partial obstruction:sensitivity 91%, specificity 100%, accuracy 95%;in case of complete obstruction:sensitivity 100%, specificity 100%, accuracy 100%). All 9 cases with complete obstruction underwent prompt and immediate laparotomy. 13 cases, excluding those with mass around the site of transition and adhesion with strangulation, with partial obstruction improved with conservative treatment without laparotomy. The causes of obstruction were adhesion in 13, hernia in 6, primary cancer in 5, metastatic cancer in 3, abscess in 2, intestinal tbc in 1, and Crohn's disease in 1. The cause of obstruction on CT scans were correctly predicted in 27 of 31 cases (87.1%). The sites of obstruction on CT scans were correctly predicted in 22 of 26 cases (84.6%). CONCLUSION: CT is valuable in the evaluation of absence or presence, severity, cause and site of intestinal obstruction, and is considered to be helpful in treatment planning for the patients with intestinal obstruction.

Angiographic evaluation of arterial injuries in traumatic patients

No abstract available.

An analysis of the pulmonary lobe using computed tomography

Computed Tomograms of 45 patients with or without lung mass were reviewed to determine the characteristics of the major and minor fissures. Also pulmonary vascular distibutions were analyzed to localize each pulmonary lobe. The results were as follows; 1. Each major fissure area was imaged frequently as lucent band, less frequently dense band. 2. The minor fissure areas were imaged as oval or triangular lucent zones. The oval or triangularlucent zones were as same frequency. 3. Avascular planes without above mentioned lucent zones were also correspond to minor fissure areas. 4. Slices of avascular zones were observated between pulmonary arteries to posterior segment or apicoposterior segment of upper lobe and to superior segement of lower lobe on both lungs.

Computed tomographic evaluation of cerebral disorder in pediatric population

A total of 110 computed tomographic scans of the brain in pediatric population were reviewed. They wereretrospectively analyzed focusing on the ventricular dilatation, widening of subdural space in frontal region andprominence of cerebral sulci in hemisphere. The results were compared with clinical recored. In the measurementbicaudate ventricular index waas above 0.18, which ws considered ventricular dilatation. The subdural space in thefrontal region and teh prominent cerbral sulci in the hemisphere were visualized among the cases aged over twoyears with clinical evidence of cerbral problem is pediatric population. The diagnostic application of CT to thecases of cerebral disorder in pediatric population is highly recommended.

Radiological evaluation of the esophago-gastric junction

In evaluating the esophago-gastric junction, many difficulties are well known in a single contrast study, andit may often be resolved with double contrast technique. By double contrast technique, the special en face viewfor the esophago-gastric junction was obtained in 298 cases at Inje Medical College Paik Hospital from Jan. 1981 to June 1981. Five basic patterns were recognized and classifed from type I to V. Their incidences were obtained.-type I ; 18%, type II; 50%, type III; 23% type IV ; 7%, type V; 2%. The most common position of patients is left lateral, and zero degree is the most common at elevation of fluoroscopic table. Type III is the most common typeof the esophage-gastric junction in inspiration, and type I expiration. Any significant deviations from thesenormal geometry of the esophago-gastric junction as displayed by double contrast study, indicate an abnormality.More special attentions are required to evaluate a minute pathologic condition of the esophago-gastric junction.

Measurements of pulmonary vasculatures in normal adult postero-anterior chest x-ray

In spite of recent introduction of such highly sophisticated diagnostic modalities as computerized tomography,cardioangiography and polytomography the simple PA chest remaines as an essential and important method of chestdiagnosis especially in terms of vascular diseases of the lung and heart. Until recently, however, theinterpretation of chest x ray has been largely dependent on much subjective observation of roentgen anatomy of thechest. Several years ago Simon proposed a quantitative approach to interpretation of the chest in an attempt tomake the judgement more objective. In the present study we have carried out a clinical study on normalities of thestandard PA chest of Korean adults. The materials consisted of 216 normal chest films. Age ranged from 20 to 60years and sex distribution 103 males and 113 females, We counted the number of vessels in both lung fields,measured the diameter of the basal artery and investigated the level of hilum points as well as hilar distance.There were 9 to 11 vessels in the upper zone and 9 to 12 in the lower zone. There were no significant sexdifference. The number of vessels was not affected by aging. The average diameter of the basal artery was11.7±2.4mm in the right lower zone and 10±1.8mm in the left lower zone in female. There was significant sexdifference (p 0.01). Aging seemed not to be affected the size of the basal artery. The majority of hilum point waslocated at the level of 5-6th rib at axillary portion and the left hilar point is 0.3-2.0cm higher in locationthan the right. The hilar distance was 4.1±0.4cm on the right 5.0±1.1cm on the left in male and 4.0±0.7cm onthe right and 4.7±0.5cm on the left in female. There was significant sex difference (p 0.01). There wassignificant difference in size of the basal arteries and hilar distance between the Koreans and Englishmen but thenumbers of vessels were not significantly different.