Correlation of Anti-Cyclic Citrullinated Antibody with Hand Joint Erosion Score in Rheumatoid Arthritis Patients

BACKGROUND/AIMS: To examine the correlation between radiological joint damage and serological parameters in early rheumatoid arthritis (RA). METHODS: This retrospective study reviewed the records of 216 patients diagnosed with RA and classified them according to disease duration: group 1, 24 months; and group 3, all patients combined. The extent of joint damage was assessed from plain radiographs using a modified version of the Larsen method and compared among groups. RESULTS: The mean radiographic joint damage score was significantly higher in patients who had established RA (10.1 points) compared with those who had early RA. In group 1, the inflammatory parameters, erythrocyte sedimentation rate, and C-reactive protein were positively correlated with the joint damage score, but rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibody were not. A subgroup analysis revealed that the anti-CCP positive patients in groups 1 and 2 had greater joint damage scores than did the anti-CCP negative patients, but no difference in RF was observed between subgroups. Anti-CCP positivity was not significantly correlated with joint damage sores in group 3. CONCLUSIONS: Anti-CCP positivity was significantly correlated with more severe joint damage at diagnosis. A correlation was observed between the radiological joint damage score and inflammatory parameters in early and established RA, indicating that anti-CCP can serve as a diagnostic tool and predict structural joint damage. These findings suggest anti-CCP positive patients should receive aggressive therapeutic intervention.

Pseudohypertrophy of the Calf Muscles in a Patient with Diabetic Neuropathy: A Case Report

Partial or complete loss of innervation of skeletal muscle leads to muscle weakness and atrophic changes, resulting in decreased muscle volume with fatty replacement. Rarely, enlargement of the affected muscle may occur, related to two processes: true hypertrophy and pseudohypertrophy. We report CT and MR findings of the pseudohypertrophy of calf muscles, especially the soleus and gastrocnemius muscles, in a patient with diabetic neuropathy that showed increased muscle volume with diffuse fatty replacement and the presence of scanty muscle fibers.

Sclerosing Stromal Tumor of the Ovary: MR-Pathologic Correlation in Three Cases

Sclerosing stromal tumor (SST) of the ovary is a very rare sex cord stromal tumor occurring in a younger age group than other types of stromal tumors and most commonly accompanied by menstrual irregularity. Several unique histologic features including pseudolobulation, sclerosis and prominent vascularity are clearly reflected at ultrasonography and MRI. We report the ultrasonographic and MR features of three cases of histologically confirmed SSTs, and relate them to the pathological findings.

Nodular Regenerative Hyperplasia of the Liver in an Infant: Case Report

Nodular regenerative hyperplasia (NRH) of the liver is an uncommon disease entity, especially in the pediatricage group. A few cases have been reported in the radiologic literature, but follow-up imaging studies are rare. We describe a case of NRH, diagnosed by ultrasound-guided needle biopsy, in a seven-month-old infant with cri-du-chat syndrome. Initial ultrasound revealed several small hypoechogenic nodules in the liver, but CT and MR failed to demonstrate their presence. Two follow-up sonographic examinations were performed 7 and 20 months later, revealing increases in the size and number of the nodules.

Lack of Association Between Osteoarthritis of the Knee and Gene Polymorphisms of VDR in Korean Postmenopausal Women / 대한류마티스학회지

OBJECTIVE: To determine whether polymorphisms of the Vitamin D receptor (VDR)gene,known to be associated with osteoporosis and/or osteoarthritis (OA) in Caucasians,might also relate to the risk of OA and osteoporosis in Korean postmenopausal women METHODS: A population of 130 postmenopausal women,including 76 healthy controls and 54 knee OA patients,were studied using anteroposterior radiographs of the knee,which were graded for OA according to the Kellgren classification system.The VDR genotype was determined by using polymerase chain reaction and by digestion with the three restriction enzymes Taq I,Bsm I,and Apa I.Femoral neck bone mineral density (BMD)was assessed in all participants by dual energy X-ray absorptiometry . RESULTS: VDR genotype frequency distributions in Koreans were much different from Caucasian's both in the OA group and the control group.Especially, "t t", "B B" and "A A" genotype were very rare,prominently differentiating from Caucasians.But within Koreans,no significant differences in VDR genotype frequencies were observed between OA cases and controls.VDR genotype was not significantly associated with the radiographic grades of OA.And there were no significant relationships of VDR genotype with BMD scores in each group. CONCLUSION: In Korean postmenoposal women,the VDR gene polymorphisms do not significantly contribute to an increased prevalence of knee OA or to differences in BMD.VDR genotype analysis would not be helpful for assessing the risk of knee OA in Koreans because :(1)there is no correlation of VDR genotypes with the radiographic severity of OA ;and (2)there is a more skewed distribution of VDR genotypes in Korean population compared to the Caucasian's .

Lack of association between rheumatoid arthritis and vitamin D receptor polymorphisms in Koreans / 대한내과학회지

BACKGROUND: The purpose of this study was to determine whether the distribution of vitamin D receptor (VDR) polymorphisms in rheumatoid arthritis (RA) patients group is different from that of the control group and whether there is a relationship between VDR genotype and radiographic severity or bone mineral density (BMD) of RA patients. METHODS: The VDR genotype was determined by polymerase chain reaction and digestion with three restriction enzymes Taq I, Apa I and Bsm I in 78 healthy women and 97 female RA patients. Hand X-rays were scored by Larsen's method and bone mineral density was measured by dual energy X-ray absorptiometry (DEXA) in RA patients. RESULTS: VDR genotypic distributions in Koreans were much different from Caucasians in each control and RA patient groups. Especially, "tt" allele and "BB" allele were very rare, prominently differentiating from Caucasians. But within Koreans, no significant difference of VDR genotypic frequency was observed between control group and RA patients group. And there was no significant relationship of VDR genotype with radiographic scores, nor with BMD scores in RA patients. CONCLUSION: The distribution of VDR polymorphisms in Korean RA patients was not different from controls. The VDR polymorphisms correlate neither with the radiographic severity of RA, nor with BMD scores in Korean RA patients.

Adrenal Collision Tumor Consisted of Adrenocortical Carcinoma and Myelolipoma: A Case Report

The identification of fat density by unenhanced CT within an adrenal mass is highly suggestive of myelolipoma. Adrenal collision tumors which involve a myelolipoma are uncommon, though the involvement of adenomas and pheochromocytomas has been reported. We describe a case in which an adrenal collision tumor consisting of an adrenocortical carcinoma and myelolipoma, presented as a large fat-containing adrenal soft tissue mass.

The Effects of Erythromycin in Small-Bowel Follow-through

PURPOSE: To evaluate the efficacy of erythromycin(EM), known to accelerate gastric emptying, in modified small-bowel follow-through(SBFT). MATERIALS AND METHODS: We evaluated 32 normal patients who underwent modified SBFT by oral administration of methylcellulose. In the EM injection group(n=20), 500 mg EM (3 mg/kg in pediatric patients) in 100 ml saline was infused intravenously over a 15-minute period prior to the administration of a barium meal, while in the control group(n=12), EM was not infused. Gastric emptying time(GET), small-bowel transit time(SBTT) for barium and methylcellulose, small-bowel transit(SBT) during the first 15 minutes, luminal diameter and quality of image were compared between the two groups. SBT was assigned 1, 2, 3, or 4 points, depending on the extent to which the barium head reached the proximal or distal jejunum, and the proximal or distal ileum during the initial 15-minute. Three radiologists reached a consensus as to image quality. RESULTS: Mean GET was significantly faster in the EM injection group (18.5 mins for 150 ml barium suspen-sion and 25.8 mins for 600 ml methylcellulose). The SBT score during the initial 15 minutes was significantly higher in the EM injection group (3.3 points) than in the control group (2.4 points), but mean SBTT was not sig-nificantly different between the two groups. Luminal diameter and image quality were also higher in the EM injection group. CONCLUSION: EM does not decrease SBTT but is highly effective for shortening gastric emptying time, helping to increase the range of fluoroscopic examination and improve image quality in modified small-bowel follow-through, especially in patients with delayed gastric emptying.

MR Imaging of Slow-flow Using a Flow Phantom

Purpose : To find sensitivity of MRI imaging methods to slow flow phantom study was performed with conventional Spin-Echo, gradient echo based Phase Contrast, fast GLASS, and heavily T2-weighted Fast Spin Echo pulse sequences. MATERIALS AND METHODS: A siphon driven flow phantom was constructed with a ventriculo-peritoneal shunt catheter and a GE phantom to achieve continuous variable flow. Four different pulse sequences including Spin-Echo, Phase Contrast, GRASS and Heavily T2-weighted Fast Spin Echo were evaluated to depict slow flow in the range from 0.08 ml/min to 1.7 ml/min and to compare signal intensities between static fluid and flowing fluid. RESULTS: In the slow flow above 0.17 ml/min conventional Spin-Echo showed superior apparent contrast between static and flowing fluid while GRASS was more sensitive to the very slow flow below 0.17 ml/min. It was not accurate to calculate flow and velocity below 0.1 ml/min with a modified PC imaging. CONCLUSION: Four different MR pulse sequences demonstrated different sensitivity to the range of slow flow from 0.08 ml/min to 1.7 ml/min. This finding may be clinically useful to measure CSF shunt flow or detecting CSF collection and thrombosis.

MR Imaging Findings of Intraosseous Lipoma

PURPOSE: To evaluate the MR imaging findings of intraosseous lipoma. MATERIALS AND METHODS: The MR imaging findings of 12 cases of intraosseous lipoma were retrospectively analyzed with regard to internal signal intensity, enhancement patterns, the presence of calcification and the status of the margin. The findings relating to these last two features were compared with those of plain films and CT. RESULTS: Six tumors were located in the calcaneus, three in the tibia, two in the ilium, and one in the carpal lunate. A fat component was clearly identified in all cases, but no lesion was purely fatty. Cyst formation was noted in four cases, and hyperintense portions different from the cystic area were seen on T2WI in ten. Contrast enhancement was observed in four patients, and although plain film and CT images revealed, in all cases, the presence of calcification, in two cases this was not demonstrated by MRI. In all cases, however, MRI showed well-defined tumoral margins. CONCLUSION: MRI clearly depicts fat and other components related to the involutional changes occurring in cases of intraosseous lipoma. The information these images provide is useful for the diagnosis and histologic classification of intraosseous lipoma.

Distal Femoral Cortical Irregularity in Adult: MR Imaging and Pathologic Correlation

PURPOSE: To correlate the pathologic and MR findings of distal femoral cortical irregularity(DFCI) in adult. MATERIALS AND METHODS: We retrospectively reviewed knee MR images of 120 adult patients(25-62 years old) without infection, tumor, or fracture. Five femoral specimens of adult cadaver were used to correlate pathologic and MR findings. A double cortical line' on MR images was interpreted as DFCI, and MR findings were analyzed to determine the thickness, internal signal intensity, location of the DFCI, shape of the external cortex, and clarity of the inner cortex. The outer cortex was classified as either convex or flat, and the inner cortex was classified according to its thickness and continuity as one of three types. RESULTS: One hundred and sixteen patients(97%) had DFCI, which in all cases was observed at the attachment site of the medial head of the gastrocnemius muscle. Mean thickness was 3.7mm and DFCI was thicker in men than in women(p<0.05). The outer cortex was convex in 75 cases(65 %) and flat in 41(35 %). The inner cortex was thick and continuous in 47cases(41 %, mean age 31), thin and continuous in 54(47 %, mean age 38), and thin and discontinuous in 19(16 %, mean age 47). Clarity tended to diminish with age. The internal area of DFCI showed signal intensity equal to that of adjacent bone marrow and was pathologically proven to be normal marrow tissue. CONCLUSION: DFCI was observed in most adults and was considered to be a normal variation. Its MR and pathologic findings were different to those observed during periods of growth.

Single-voxel Proton MR Spectroscopy of the Basal Ganglia in Patients with Neurofibromatosis Type 1

PURPOSE: To demonstrate the proton MR spectroscopic characteristics of non-neoplastic focal basal ganglialesions with high signal intensity on long TR MR images in patients with neurofibromatosis type 1(NF-1), and tocompare them with those of normal-appearing basal ganglia in patients without focal lesions. MATERIALS AND METHODS: Single-voxel proton MR spectroscopy was performed in six patients with NF-1 from two families(three with andthree without non-neoplastic focal brain lesions). All six individual spectra were obtained from basal gangliawith voxel sizes of about 1 x 1 x 1 cm, three from focal pallidal lesions in patients with focal lesions and threefrom normal-appearing basal ganglia in patients without focal lesions. Spectra were acquired using a 1.5T clinicalMR imager and stimulated echo acquisition mode sequence, with the following parameters: 30 ms of echo time, 13.7ms of mixing time, and 2560 ms of repetition time. Zero and first-order phase correction was performed. RESULTS:N-acetyl aspartate(NAA)/creatine(Cr) ratios were similar between focal basal ganglia lesions and normal-appearingbasal ganglia, though the former showed slightly lower choline(Cho)/Cr ratios and slightly higher NAA/Cho ratiosthan the latter. Relatively enhanced resonances around 3.75 ppm, assigned as glutamate/glutamine, were observed inthe spectra of three focal lesions. Lipid resonances around slightly different positions were observed in all sixpatients, regardless of the presence or absence of focal lesions. CONCLUSION: Slightly decreased Cho levels andrelatively enhanced glutamate/glutamine resonances are thought to characterize the focal basal ganglia lesions ofNF-1. Different mobile lipids appear to be present in the basal ganglia of NF-1 patients, regardless of thepresence of focal lesions.

Brain Tumors in Which Lactate and Lipid Have Been Detected: A Proton Magnetic Resonance Spectroscopy Study

To determine the spectral pattern of metabolites in 31 brain tumors in which the presence of lipids, lactate and additional intermediary metabolites had been detected, in vivo 1H-MR spectroscopy was performed. Metastasis (n=3), meningioma(n=7), astrocytic tumors of different grades(n=11), postop recurrent tumors(n=2) and other tumors(n=10) were examined using the stimulated echo(STEAM, TE=30ms) or double spin echo technique(PRESS, TE=272ms) with CHESS pulse for water suppression. The detection of lactate in astrocytic tumors correlated with a higher grade of malignancy, and lipid was observed in most glioblastomas. Elevated lactate levels in tumors do not simply originate in the necrotic region, but are related to the high glycolytic activity of adequately perfused, viable neoplastic cells. Lipid signals were detected in high grade, late stage brain tumors, indicating the need for enhanced phospholipid metabolism and membrane degradation, respectively. The absence of lactate and presence of alanine, glutamate/glutamine in most meningiomas distinguished them from schwannomas and other glial tumors. Observation of the spectral pattern of metabolites in brain tumors in which lipid and lactate has been detected might play an important prognostic role in the management and differentiation of metastasis, glial tumors, tumor recurrence, and other non-neoplastic diseases.

Utility of Diffusion-weighted MR Imaging in Acute Stage of Small Cerebral Infarction

PURPOSE: To demonstrate the usefulness of diffusion-weighted MR imaging(DWI) in patients with small acuteinfarction by comparing it with fast spin-echo T2-weighted MR imaging(FSE T2WI). MATERIAL AND METHOD: Weretrospectively analyzed the results of FSE T2WI in 26 consecutive patients who on DWI showed small discretehyperintensities of less than 1.5cm and whose final clinical diagnosis, within one week of clinical attack, wasacute inforction. Lacunar infarcts accounted for 24 cases and 2 small cortical infarcts for two. The onset ofsymptoms occurred within 12 hours (hyperacute stage) in two patients, within 24 hours in seven, within 3 days innine, and within one week in eight. Infarcts as seen on FSE T2WI were categorized as follows : (-) for cases ofimpossible localization with non-visualization ; (+/-) for cases of equivocal localization with faint visualizationand/or poor differentiation from combined chronic infarcts and chronic ischemic changes, or from subarachnoid CSFin cases of cortical infarction ; and (+) for cases of adequate localization with clear visualization andmoderately good differentiation from the associated brain changes, or from subarachnoid CSF in cases of corticalinfarction. These infarcts were analyzed according to the time of onset of symptoms. RESULT: For the localizationof small acute infarctions, DWI was markedly superior to the category(-), moderately superior to the category(+/-).With regard to the onset of symptoms, DWI was markedly or moderately superior to FSE T2WI in 2/2 (100%) ofhyperacute stage diagnosed within 12 hour of clinical attack, in 4/7(57%) diagnosed within 24 hours, in 5/9 (56%)diagnosed within 3 days, and in 1/8 (13%) diagnosed within 1 week(p<0.05). In 12/26 cases(46%), small acuteinfarcts were localized by DWI better than by FSE T2WI. CONCLUSION: Because the signal was unchanged or itsintensity was poor, small infarcts at the acute stage were frequently difficult to localize by FSE T2WI. Inaddition, differentiation of these from combined chronic infarcts and chronic ischemic change was poor. DWI canlocalize small acute infarcts even when the results of FSE T2WI are negative or inconclusive.

Imaging of the Jaw Cysts with a Dental CT Software Program: Distinction of Odontogenic Keratocysts from Other Cysts

PURPOSE: To evaluate the usefulness of a dental CT software program in the assessment of jaw cysts and in the differentiation of odontogenic keratocysts and other cysts. MATERIALS AND METHODS: Seventeen patients with proven jaw cysts (8 maxillae & 9 mandibles) were evaluated with a dental CT software program for location, locularity, the presence or absence of marginal scalloping, and height to length ratio. For the delineation of involvement or displacement of neurovascular bundles, cortical erosion, perforation or expansion, and tooth root resorption by the jaw cysts, images from this program were compared to conventional images. RESULTS: Seventeen lesions icomprised 15 odontogenic cysts (five odontogenic keratocysts, five radicular, three residual and two dentigerous cysts) and two non-odontogenic cysts (one nasopalatine duct cyst and one postoperative maxillary cyst). Images of jaw cysts obtained with the dental CT software program delineated much more clearly than conventional images the status of neurovascular bundle and cortical bone, but there was no clear difference between the two modalities in delineating tooth root erosion. Dental CT findings of five mandibular odontogenic keratocysts were scalloped margin in all, mandibular ramus involvement in four, height to length ratio below 60% in four, and multilocularity in two. The findings of the other 12 cysts (eight maxillae and four mandibles) were unilocularity in all, smooth inner margin in ten, height to length ratio below 60% in only two, and ramus involvement in none. CONCLUSION: Adental CT software program is an improved imaging modality for assessing jaw cysts ; and findings which tend to indicate odontogenic keratocysts are marginal scalloping, mandibular ramus involvement, prominent spread along the marrow space and multilocularity.

Redundant Nerve Roots of the Cauda Equina: MR Findings

PURPOSE: To evaluate MR findings of redundant nerve roots (RNR) of the cauda equina. MATERIALS AND METHODS: 17 patients with RNR were studied; eight were men and nine were women, and their ages ranged from 46 to 82 (mean63) years. Diagnoses were established on the basis of T2-weighted sagittal and coronal MRI, which showed a tortuous or coiled configuration of the nerve roots of the cauda equina. MR findings were reviewed for location, magnitude, and signal intensity of redundant nerve roots, and the relationship between magnitude of redundancy and severity of lumbar spinal canal stenosis (LSCS) was evaluated. RESULTS: In all 17 patients, MR showed moderate or severe LSCS caused by herniation or bulging of an intervertebral disc, osteophyte from the vertebral body or facet joint, thickening of the ligamentum flavum, degenerative spondylolisthesis, or a combination of these. T2-weighted sagittal and coronal MR images well clearly showed the location of RNR of the cauda equina; in 16 patients (94%), these were seen above the level of constriction of the spinal canal, and in one case, they were observed below the level of constriction. T2-weighted axial images showed the thecal sac filled with numerous nerve roots. The magnitude of RNR was mild in six cases (35%), moderate in five cases (30%), and severe in six cases (35%). Compared with normal nerve roots, the RNR signal on T2-weighted images was iso-intense. All patients with severe redundancy showed severe LSCS, but not all cases with severe LSCS showed severe redundancy. CONCLUSION: Redundant nerve roots of cauda equina were seen in relatively older patients with moderate or severe LSCS and T2-weighted MR images were accurate in identifying redundancy of nerve roots and evaluating their magnitude and location.

Non-obstructive Biliary Dilatation After Gastrectomy for Gastric Carcinoma

PURPOSE: To evaluate the incidence,. degree, and clinical significance of non-obstructive intrahepatic bile duct di'latation encountered on follow up CT after gastrectomy for gastric carcinoma. MATERIALS AND METHODS: We retrospectively analyzed follow-up abdominal CT of 65 patients who had undergone gastrectomy with truncal vagotomy and subtotal gastrectomy for gastric carcinoma. We classified those patients who showed intrahepatic duct dilatation into non-obstructive or obstructive groups depending on the presence or absence of the lesions obstructing the duct. We also evaluated the incidence, degree and pattern, and appearance time of non-obstructive type of duct dilatation. RESULTS: Non-obstructive and obstructive biliary dilatations were present in 8 cases(12.3%) and 9 cases(13. 8%), respectively. The degree of non-obstructive group was mild in 6 cases(75%) and moderate in 2 cases (25%) who had taken cholecystectomy during the follow up period, and patterns were proportional dilatation of the central and peripheral intrahepatic ducts. It appeared on follow up CT obtained 6 to 12 months after operation in 7 cases and 3.5 months in one case. No statistical significance was noted between the type of surgery and the incidence of non-obstructive dilatation(p>0.05). CONCLUSION: Mild dilatation of the central intrahepatic ducts without evidence of mechanical biliary obstruction can be seen on follow-up CT obtained more than 6 months after gastrectomy for gastric carcinoma, and the incidence is about 12%. We think that this finding is non-obstructive and clinical evaluation is unnecessary.

Imaging of Jaw with Dental CT Software Program Normal Anatomy

PURPOSE: Dental CT software program can provide reformatted cross-sectional and panoramic images that cannot be obtained with conventional axial & direct coronal CT scan. The purpose of this study is to describe the method of the technique and to identify the precise anatomy of jaw. MATERIALS AND METHODS:We evaluated 13 mandibles & 7 maxillae of 15 subjects without bony disease who were being considered for endosseous dental implants. Reformatted images obtained by the use of bone algorithm performed on GE HiSpeed Advantage CT scanner were retrospectively reviewed for detailed anatomy of RESULTS: Anatomy related to neurovascular bundle(mandibular foramen, inferior alveolar canal, mental foramen, canal for incisive artery, nutrient canal, lingual foramen and mylohyoid groove), muscular insertion(mylohyoid line, superior & inferior genial tubercle and digastric fossa) and other anatomy(submandibular fossa, sublingual fossa, contour of alveolar process, oblique line, retromolar fossa, temporal crest & retromolar triangle) were well delineated in mandible. In maxilla, anatomy related to neurovascular bundle(greater palatine foramen & groove, nasopalatine canal and incisive foramen) and other anatomy(alveolar process, maxillary sinus & nasal fossa) were also well delineated. CONCLUSION: Reformatted images using dental CT software program provided excellent delineation of the jaw anatomy. Therefore, dental CT noftware program can play an important role in the preoperative assessment of mandible and maxilla for dental implants and other surgical conditions.

Deep cervical space abscess: Role of CT for guiding surgical approach

Deep cervical space abscess may cause life-threatening complications despite the advent of antibiotics, so early detection and localization of the abscess are essential for management decision. To evaluate the efficacy of utilizing CT scanning in deep cervical space abscess, we retrospectively revieweed CT of 17 patients confirmed by surgery. CT was found tobe very accurate in defining the presence, location, and extent of the abscess along with the demonstration of life-threatening complications such as airway compression and mediastinal extension. In conclusion, CT can play and essential role in guiding surgical approach to deep cervical space abscess.

Clinical use of cholescintigraphy in acute cholecystitis:a comparative study with ultrasonography / 대한핵의학회잡지

No abstract available.