Impact of the Use of Contrast-Enhanced Multidetector CT for Acute Appendicitis: A Prospective Comparison with the Alvarado Score

PURPOSE: To determine the diagnostic performance of contrast-enhanced multidetector CT (MDCT) and the Alvarado score for acute appendicitis. MATERIALS AND METHODS: MDCT and determination of the Alvarado score were prospectively performed in 282 patients with 146 pathologically proven cases of acute appendicitis and 136 pathologically proven or clinically diagnosed cases of non-acute appendicitis. To compare the diagnostic performance of MDCT and the Alvarado score, the patients were subdivided according to age and sex, and receiver operating characteristics (ROC) analysis and Spearman rank correlation were performed. RESULTS: ROC analysis revealed that the optimal cut off value of the CT appendicitis grades was 2 in all patients, resulting in a sensitivity of 96.6% and a specificity of 94.9%. The optimal cut off values of the Alvarado score was different according to age and sex, resulting in a sensitivity of 85.6% and a specificity of 48.5%. There was a significant correlation between the CT appendicitis grades and the surgical-pathological grades (r=0.496, p<.0001). However, no significant correlation was observed between the Alvarado score and the surgical-pathological grades. CONCLUSION: Contrast-enhanced MDCT has a higher diagnostic accuracy and significant correlation with pathological findings than those of the Alvarado score in patients with acute appendicitis.

Peliosis Hepatis with Hemorrhagic Necrosis and Rupture: a Case Report with Emphasis on the Multi-Detector CT Findings

We report here on an uncommon case of peliosis hepatis with hemorrhagic necrosis that was complicated by massive intrahepatic bleeding and rupture, and treated by emergent right lobectomy. We demonstrate the imaging findings, with emphasis on the triphasic, contrast-enhanced multidetector CT findings, as well as reporting the clinical outcome in a case of peliosis hepatis with fatal hemorrhage.

Hepatic Parasitic Abscess Caused by Clonorchiasis: Unusual CT Findings of Clonorchiasis

Clonorchiasis is caused by a chronic infestation of liver flukes, Clonorchis sinensis, and these reside mainly in the medium- and small-sized intrahepatic bile ducts. Therefore, diffuse, uniform, minimal or mild dilatation of these bile ducts, particularly in the periphery, without dilatation of the extrahepatic bile duct is the typical finding on several imaging modalities. We report here on the CT findings of an unusual case of hepatic parasitic abscess that was caused by clonorchiasis; this malady mimicked cholangiocarcinoma, and there was no dilatation of the intrahepatic bile ducts.

Ovarian Mature Cystic Teratoma Containing Multiple Mobile Globules: A Case Report

A 48-year-old woman was admitted to our hospital with a palpable mass in her lower abdomen. A left ovarian, cystic mass containing multiple mobile globules was seen on CT and MR images. The outer portion of the globules showed fat components on CT and fat-saturated T1-weighted MR images. Ultrasonography showed multiple echogenic, mobile globules with some sound attenuation and hyperechoic lines and dots within the cystic mass, which corresponded with the presence of lipid globules and hair shafts of ovarian mature cystic teratoma, respectively.

Giant Transverse Colon Diverticulitis Presenting as Indirect Right Inguinal Hernia Strangulation

A giant colonic diverticulum is a rare complication of diverticulosis, and an inguinal hernia is a common diagnosis for patients presenting with a painful groin mass. A 52-year-old male presented to the emergency room with a 3-hour complaint of progressive, constant, right-groin pain with an inguinal mass. After manual reduction of the inguinal hernia, the patient complained of pain in the right upper quadrant. Operative findings showed a transverse colon diverticulitis without perforation. We report here that case of a transverse colon giant diverticulum presenting as an atypical incarcerated inguinal hernia.

Usefulness of Screening Ultrasound for Thyroid Gland

PURPOSE: The purpose of this study was to investigate the usefulness of the ultrasonography as a screening test for thyroid diseases. MATERIALS AND METHODS: For 7 months, thyroid ultrasonography (7.5 MHz linear array) was performed prospectively by radiologists on 1,316 subjects who do not have a history of the thyroid disease. We analyzed the morphological abnormalities of thyroid gland and these were classified as the nodulal, cystic and diffuse types in accordance with the gender and ages of the patients. We performed ultrasound-guided fine needle aspiration in 21 patients who had sonographic features that were suggestive of malignant thyroid nodules. Physical examination was performed for all subjects by clinicians before the thyroid ultrasonography, and we compared the detectability of thyroid lesions between ultrasonography and physical examination. RESULTS: Thyroidal abnormalities were detected in 94 (7.1%) of 1,316 subjects. Among the 94 patients, 72 (5.5%) showed as nodules, 18 (1.4%) showed as cysts and 4 (0.3%) showed as diffuse abnormalities. The result of the ultrasound-guided aspiration on 21 patient showed 4 malignant nodules, 16 benign nodules and 1 undetermined nodule. Physical examination detected abnormalities in only 12 patients (12.8%) of the 94 patients, which were showed as nodules, cysts and the diffuse type by ultrasonography. CONCLUSION: Thyroid disease of the general population was relatively common and the detection rate with performing physical examination for the thyroid nodule, cyst and the diffuse type was lower than that for ultrasonography. Thyroid ultrasonography is a useful screening modality for detecting thyroid diseases.

Hepatic Tuberculosis: Unusual CT and Sonographic Findings

A case of infiltrative type of hepatic tuberculosis is presented. Ultrasonography revealed a very ill-margined, heterogenously low echoic lesion in the right hepatic lobe. CT scans demonstrated a very ill-defined, geographic, hypodense lesion with minimal contrast enhancement mimicking cholangiohepatitis or infiltrative tumor in the right hepatic lobe.

Immature Gastric Teratoma in an Infant: A Case Report

Gastric teratomas are extremely rare neoplasms and almost exclusively benign. They occur predominantly in males and generally present as a palpable abdominal mass. To our knowledge, only one adult case has been described in the Korean literature. We report a case in which an immature gastric teratoma in a 3-month-old boy was revealed by CT and US.

Qualitative Analysis of Barium Particles Coated in Small Intestinal Mucosa of Rabbit by Using Scanning ElectronMicroscopy

PURPOSE: To qualitatively analyse barium coating status in the intestinal mucosa, we used scanning electronmicroscopy to observe barium particles coated in the small intestinal mucosa of rabbit, and we attempted to assessthe relationship between electron microscopic findings and radiographic densities. MATERIALS AND METHODS: Sixdifferent combinations of barium and methylcellulose suspensions were infused into the resected small intestinesof 15 rabbits. Barium powders were mixed with water to make 40% and 70% w/v barium solutions, and also mixed with0.5% methylcellulose solution to make 40% and 70% w/v barium-methylcellulose mixtures. 0.5% methylcellulosesolutions were used as a double contrast agent. After the infusion of barium suspensions, a mammography unit wasused to obtain radiographs of the small intestine, and their optical densities were measured by a densitometer.Thereafter, photographs of barium-coated small intestinal mucosa were obtained using a scanning electronmicroscope (x8,000), and the number of barium particles in the unit area were measured. To compare therelationship between the electron microscopic findings and optical densities, statistical analysis using Spearmancorrelation was performed. RESULTS: With a Spearman coefficient of-0.544, correlation between the number of smallbarium particles of less than 1 micrometer and optical densities was statistically significant(p<0.05). CONCLUSION: Thisstudy shows that by using scanning electron microscopy, barium particles coated on the small intestinal mucosa canbe qualitatively analysed. It also shows that the number of small barium particles measured by scanning electronmicroscopy is related to optical densities.