Cavernous Hemangioma of the Ilium Mimicking Aggressive Malignant Bone Tumor with Increased Activity on 18F-FDG PET/CT

Osseous hemangioma is a benign vascular tumor, and it usually occurs in the vertebrae and the skull. However, hemangiomas of flat bones are rare, and there are very few reports that describe the radiologic findings of osseous hemangioma of the ilium. We report a unique case of large cavernous hemangioma mimicking a chondrogenic malignant bone tumor originated from the ilium in a 22-year-old female. The mass showed stippled calcifications, heterogeneous enhancement with thick septa and enhanced soft tissue components on CT and MR, and also this mass demonstrated heterogeneous 2-fluoro [fluorine-18]-2-deoxy-D-glucose (18F-FDG) uptake on 18F-FDG PET/CT.

The Usefulness of High-Resolution Three-Dimensional Dynamic MR Imaging with Sensitivity Encoding for Evaluating Extrahepatic Bile Duct Cancer

PURPOSE: We assessed the usefulness of high-resolution 3D dynamic MR imaging with sensitivity encoding (mSENSE) for evaluating bile duct cancer. MATERIALS AND METHODS: Twenty-three patients with extrahepatic bile duct cancer underwent multiphasic 3D GRE MRI, including two delayed phases without and with mSENSE. The first delayed phases were obtained with volumetric interpolated breath-hold imaging (VIBE) and then the higher in-plane resolution images (320x168) were obtained using mSENSE. The two delayed phase images were compared quantitatively by measuring the signal-to-noise ratio (SNR) of liver and tumor, the liver-visceral fat contrast and the tumor-visceral fat contrast-to-noise ratio (CNR); the two delayed phase images were compared qualitatively by evaluating the sharpness of the hepatic vessels and bile duct, the artifacts and the conspicuity of bile duct cancer. RESULTS: The quantitative results with mSENSE image were significantly better than those with conventional VIBE. Though the clarity of the intrahepatic vessels and the intrahepatic bile duct, and the artifacts did not differ significantly between the two images (p>0.05), the clarity of the extrahepatic vessels, the extrahepatic bile duct and the bile duct cancer were better on the mSENSE image than on the VIBE (p<0.05). CONCLUSION: The higher in-plane resolution 3D GRE image obtained with mSENSE was of a better image quality than the conventional VIBE images. This technique shows promise for use as a comprehensive exam for assessing bile duct cancer.

US and Mammographic Findings of Myofibroblastoma in the Female Breast: A Case Report

Myofibroblastoma is a rare benign mesenchymal tumor of the breast. It presents as a well circumscribed, solitary nodular mass, and it has been reported to mainly occur in male patients. To our knowledge, few reports have described the radiologic appearance of myofibroblastoma in the female breast and there has been no report from Korea. We describe the mammographic, sonographic and histologic findings of a case of myofibroblastoma that presented as a well defined mass mimicking fibroadenoma in a 44-year-old woman.

Motor fMRI in Acute Infarction of Basal Ganglia and Thalamus

PURPOSE: We wanted to assess the cerebral activation of the motor function after deep cortical (lentiform nucleus and thalamus) infarction. MATERIALS AND METHODS: We studied the motor function of eight right-handed deep cortical infarcted patients (mean age, 61 years; 7 men and 1 woman) who suffered a single unilateral deep cortical (lentiform nucleus or thalamus) infarction. The grade of muscle power by the grading system of the Medical Research Council was II in two patients, III in three patients and IV in three patients. All the MRI experiments were performed with a 1.5T scanner. The fMRI protocol consisted of eight alternating periods of task performance and rest. The activation tasks consisted of finger movements. Data analysis of activated area and calculation of the activated volumes in sensorimotor cortex were done. RESULTS: For the six lentiform nucleus acute infarction patients, one right hemiparetic patient (MRC Grade: II), and only the right sensorimotor cortex (the unilateral non-lesion side) were activated. In five (MRC Grade: III-IV) of the six lentiform nucleus infarcted patients, bilateral activations of the primary sensorimotor cortex were recorded. In four of the five bilaterally activated patients, extended activations in the lesion side sensorimotor cortex were observed. In the two right thalamic infarction patients, bilateral activations of the primary sensorimotor cortex were recorded. One patient (MRC Grade: II) was observed to have an extended activation in the non-lesion side sensorimotor cortex. On the follow up fMRI done on this patient after 40 days (MRC Grade: III at that time), the activated volumes of both sensorimotor cortexes were increased. The activated volume in the lesion side sensorimotor cortex was more than that in the non-lesion side sensorimotor cortex. The other patient (MRC Grade: IV) was observed to have extended activation in the lesion side sensorimotor cortex. CONCLUSION: fMRI allows for the study of the motor function in deep cortical infarction. We were able to investigate the differences in motor activation according to the individual MRC Grades. fMRI may be a useful tool to monitor and study deep cortical infarction, and it may be important to help us understand the function of the deep cortical areas.

MR Imaging Findings of Clonorchiasis

OBJECTIVE: The purpose of this study was to evaluate the MR spectrum and MR cholangiographic imaging findings of clonorchiasis. MATERIALS AND METHODS: We reviewed 26 patients with confirmed clonorchiasis by either stool tests (n=24) or surgery (n=2). MR imaging was performed on a 1.5 T system (GE Medical Systems, Milwaukee, WI) with a torso coil. Axial T1-and T2-weighted, gadolinium-enhanced dynamic images and MR cholangiography were obtained. Image analyses were used to identify abnormalities of the intrahepatic and extrahepatic bile ducts and the presence of hepatobiliary malignancy. All MR examinations were reviewed by the consensus of two abdominal radiologists. RESULT: Intrahepatic bile duct abnormalities were seen in 23 (89%) of the 26 patients. The most common finding was mild dilatation of the intrahepatic bile duct which was found in 21 (81%). "Too many intrahepatic ducts" were found in 16 (62%), wall enhancement and thickening in 21 (81%) and filling defects and ductal stricture in the intrahepatic bile duct in 6 (24%) and 3 (12%) patients, respectively. Extrahepatic ductal dilation was found in 5 (19%) and 9 (35%) revealed hepatobiliary malignancy. CONCLUSION: MR imaging revealed various findings of clonorchiasis, including dilatation, wall enhancement, stricture of the intrahepatic ducts and filling defect within the intrahepatic bile duct.

Jugular Bulb Diverticulum Combined with High Jugular Bulb: A Case Report with CT and MRA Findings

Jugular bulb diverticulum is a rare condition that is characterized by the outpouching of the jugular bulb, and this can lead to hearing loss, tinnitus and vertigo. A few reports have revealed the radiologic findings about jugular bulb diverticulum, but none of them have described the MRA findings concerning this lesion. We present here the CT and MR venography findings in regards to a large high jugular bulb and diverticulum we observed in a 47-year-old woman.

Radio-frequency Ablation in Patients with Malignant Hepatic Tumor and Experimental Model: Comparison of Expandable Needle and Water-Cooled Needle

PURPOSE: The purpose of this study was to compare the shape and volume of the radio-frequency induced lesions produced by two commercially available radio-frequency ablation (RFA) systems, the expandable and cooled-tip needles, in clinical patients and an experimental model. MATERIALS AND METHODS: A twelve-array anchor expandable needle electrode and a single cooled-tip needle electrode were used to treat hepatic tumors with a single session in 23 patients (20 hepatocellular carcinomas and 3 hepatic metastases) and fourteen patients (10 hepatocellular carcinomas and 4 hepatic metastases), respectively. Twenty RFA induced lesions were created with each system in 10 explanted bovine livers. The shape of the RFA induced lesions were divided into oval lesions along or perpendicular to the axis of the electrode and spherical lesions, and we then calculated the volumes of the RFA induced lesions. RESULTS: Fourteen (61%) lesions of the 23 patients treated with the expandable system were oval perpendicular to the axis of the electrode and nine (39%) of the lesions were spherical. All the lesions (100%) of the 14 patients treated with the cooled-tip needle were oval along the axis of the electrode. In the ex vivo bovine livers, the shape of the all RFA induced lesions was oval perpendicular to the axis of the electrode for the expandable needle, and oval along the axis of the electrode for the cooled-tip needle. The mean diameter and volume of the RFA induced lesions in the patients were 3.35+/-0.56cm and 19.9+/-6.53 cm3, respectively, for the expandable needle and 3.58+/-0.78 cm and 23.19+/-5.27 cm3, respectively, for the cooled-tip needle. In the ex vivo model, the mean diameter and volume of RFA induced lesions were 3.41+/-0.59 cm and 26.59+/-8.02 cm3, respectively, for the expandable needle, and 4.04+/-0.65 cm and 33.82+/-6.16 cm3, respectively, for the cooled-tip needle (p<0.05). CONCLUSION:These results indicate that the shape of RFA induced lesions with the expandable needle were oval perpendicular to the axis of the electrode but those with the cooled-tip needle were oval along the axis of the electrode in both the clinical and experimental models. The cooled-tip needle induced significantly larger lesions than the expandable needle in the clinical patients and the experimental model. We need to consider these characteristic findings for RFA when we are performing such procedures.

MR Findings of Hepatic Actinomycosis: Case Report

Actinomycosis is an uncommon chronic infectious disease caused by Actinomyces. There are three distinct forms of the condition, namely cervicofascial, thoracic, and abdominal; the hepatic variety is an unusual form of abdominal actinomycosis, accounting for about 15% of cases of this type. Many reports of actinomycosis have been published, but few have detailed the MR findings of hepatic actinomycosis. We describe the contrast-enhanced CT and MR findings in one case of hepatic actinomycosis.

Mesenteric Fibromatosis with Spontaneous Cystic Degeneration: A Case Report with US and CT Findings

Mesenteric fibromatosis is an uncommon benign neoplasm occurring in the mesentery or retroperitoneum, and presenting as a firm mass with infiltrative margins and homogeneous parenchyma without necrosis or a cystic component (1-4). Cystic change may occur, usually after prolonged medical treatment, but is extremely rare (5-7). We describe the US and CT findings in a case of mesenteric fibromatosis with spontaneous extensive cystic degeneration.

The Usefulness of Three-Dimensional Spiral CT Angiography in the Evaluation of Atherosclerotic Diseases Involving the Arteries of the Lower Extremity

PURPOSE: To assess the usefulness of three-dimensional spiral CT angiography in the diagnosis and as a guide for the treatment of arteriosclerosis obliterans of the lower extremity. MATERIALS AND METHODS: During a recent one-year period, CTA and conventional angiography were performed in 12 patients with suspected ASO. From the upper margin of the third lumbar vertebral body to below the knee joint, helical CT scanning was performed 30-45 seconds after the injection of Ultravist 370(150-180ml) by a power injector at the rate of 2.5-3.0ml/sec via the antecubital vein. The resulting data were reformatted by SSD after reconstruction of 5mm intervals, and CTA was compared with CA for site and degree of stenotic or occlusive lesion. RESULTS: On CTA and CA, twenty-three occlusive lesions above the tibioperoneal artery were detected in 12 patients. On CA, three mild seven moderate and eight severe stenoses were seen, as well as five occlusions. There were three cases of overgrading and three of undergrading. Overall diagnostic accuracy was 73.9%(17/23). Calcifications were detected at on axial CT scanning in the two of three underestimated lesions. Migration of the thrombi was noted in one case. CONCLUSION: CTA may be useful in the evaluation of the arteries of the lower extremities, and valuable in the planning and follow-up of treatment.

MR Findings of Congenital Craniocerebral Anomaly: Correlation with Seizures and Developmental Delay

PURPOSE: To evaluate characteristic MR findings of craniocerebral anomaly and its relationship with neurologic manifestations. MATERIALS AND METHODS: We retrospectively reviewed MR images of 36 patients with craniocerebral anomaly diagnosed by MRI and clinical courses. We correlated the characteristic MR findings in 41 lesions with neurologic manifestastions focusing on seizures and developmental delay. RESULTS: Twenty-three patients with seizures consisted of 14 patients(60%) with neuronal migration disorders and seven(30%) with phakomatosis, among which 18 patients(78%) had generalized type of seizures. Locations of the lesions were the parietal lobes in 11 patients(52%) and the subependymal or periventricular regions in seven(33%). Two patients with tuberous sclerosis had the lesions in both parietal and subependymal areas. Nine patients had the signs of developmental delay that were seen in the four(44%) with schizencephaly, two (22%) with tuberous sclerosis, two(22%) with heterotopia, and one(ll %) with pachygyria. CONCLUSION: Neuronal migration anomaly was relatively common lesion that presented neurologic manifestations such as seizures and developmental delay. Generalized type of seizures was common. We were able to diagnose these anomalies using the MRI that helped establish therapeutic plans.