Efficacy of Two-Phase Helical CT Emphasizing Gastric Mucosal Phase in Detection of Early Gastric Cancer with Atypical Enhancement Pattern

PURPOSE: To evaluate the efficacy of two-phase dynamic helical CT, including the gastric mucosal phase, for the detection of atypical non-hyperattenuating early gastric carcinoma (EGC). MATERIALS AND METHODS: In 32 patients, we evaluated the two-phase helical CT findings of endoscopically suspected EGC for changes of the inner hyperattenuating mucosal layer, the hypoattenuating outer layer and the serosal surface. Two gastrointestinal radiologists working together reached their conclusions before pathologic diagnosis had been made. The first, so-called gastric mucosal, phase was obtained 38 -45 sec after the start of IV injection of 150 ml/sec contrast material at a rate of 4 ml/sec to obtain maximum enhancement of the mucosal layer. RESULTS: Among 32 patients, EGC was confirmed in 30 and AGC (T2) in two. Using two-phase helical CT, the detection rate for typical hyperattenuating EGC was 27 % (8/30). Lesions showing focal interruption of the mucosal layer without abnormal enhancement of the outer layer (EGC atypical enhancement pattern type 1) were detected in five patients during the mucosal phase, and were pathologically confirmed as 3 EGC IIc+III, 1IIc+IIa, and I IIb+IIc. Lesions showing a locally protuding lesion of the inner and preserved outer layers, with a smooth serosal surface (EGC atypical enhancement pattern type 2) and which could be distinguished from normal folds, were detected in six patients during the mucosal phase, and were pathologically confirmed as 2 EGC IIb+IIc, 1 IIc+IIa, and 3 IIc+IIb. Lesions were less distinct during the equilibrium phase, and there was no change in the enhancement pattern. The overall detection rate for EGC in which an atypical enhancement pattern was added to the typical one showed improvement (19/30, 63 % ). CONCLUSION: Helical CT using a two-phasic scan technique including the mucosal phase was efficient for various combinations of EGC II and/or III, including IIc. The findings were atypical and non-hyperattenvating, but reliable, and improved the overall detection rate.

Transfemoral Internal Spermatic Vein Occlusion for Varicocele Using a Stainless Steel Spring Coil / 대한비뇨기과학회지

Transvenous embolization of the internal spermatic vein appears to be at least as effective as open surgical correction in treating men with varicocele and it has several advantages ; (1) it requires only local anesthesia and a short hospital stay ; (2) there is no risk of damage to the spermatic artery : (3) the veins can be occluded accurately whatever the arrangement of any collateral vessels. We reported a technique for non-operative management of varicocele by a occlusion of the internal spermatic vein using stainless steel spring coil.

Role of Renal Angiography in The Era of Ultrasonography and CT / 대한비뇨기과학회지

Role of renal angiography in the diagnosis of renal disease is changing after the advent of new imaging techniques such as ultrasonography and CT. Ultrasonography and CT examination started to be used clinically on March 1, 1979, in Seoul National University Hospital. Total 315 cases of renal angiography were made for recent 7 years from September 1, 1975 to August 30, 1982, 117 cases in 3 1/2 years before and 198 cases in 31/2 years after the installation of new imaging modalities. To evaluate the changing role of renal angiography, sequential flow patterns of various radiological examination were classified into 7 categories. Results of the analysis were as follows; 1. The increased ratio of renal angiography after the advent of new imaging modalities is 1.7 and slightly less than that of total radiological examinations. 2. The role of renal angiography is decreased in the diagnostic work-up of renal mass, hematuria, adrenal disease, renal failure and other renal evaluation. Angiography has significant role still in the evaluation for renovascular hypertension, renal trauma, transplantation donor, renalvein thrombosis and artificial embolization. 3. The most frequent flow pattern is AII (IVP-Aug) before and BII (IVP-US [CT]-Aug) after the advent of new imaging modalities.