Dynamic Salivary Gland Scintigraphy in Clinical Sicca Syndrome: Comparison with Static images / 대한핵의학회잡지

PURPOSE: In this study, we compared the quantitative characteristics of dynamic salivary gland scintigraphy with static scintigraphy in patients with clinical sicca syndrome using Tc-99m pertechnetate. MATERIALS AND METHODS: Fifty-two parotid glands and 52 submandibular glands out of 26 patients with clinical sicca syndrome were studied by dynamic and static salivary gland scintigraphy. Ten normal volunteers were also studied as a control group for comparison of scintigraphic parameters. Ten minutes after injection of 370 MBq Tc-99m pertechnetate, we obtained pre-stimulus static images for a few minutes. Then dynamic salivary gland scintigraphy with lemon juice stimulation was performed for 20 minutes. Finally we obtained post-stimulus static images after dynamic images. On dynamic study, functional parameters such as uptake rate, secretion rate and re-uptake rate were calculated. The results of dynamic study and static images were compared. RESULTS: On dynamic study, we could obtain functional parameters of salivary glands successfully. On dynamic study, 22 parotid glands and 22 submandibular glands out of each of 52 glands are abnormal. The static images demonstrated somewhat different results, of which reasons we could assume via dynamic study. CONCLUSION: Dynamic salivary gland scintigraphy using Tc-99m perechnetate were more functional than static images and might be useful in the assessment of the functional change of the salivary gland in patients with clinical sicca syndrome.

Percutaneous Transcatheter Embolization of Extensive Congenital Arteriovenous Malformation Combined withAneurysms in the Chest Wall: A case report

Congenital arteriovenous malformation (AVM) usually involves the head, extremities and internal organs, but isuncommon in the chest wall. It is, moreover, rarely combined with aneurysms. It can be cured by surgery, but isoften difficult to treat. The purpose of this study is to report a case of extensive AVM involving the rightlateral chest wall combined with multiple aneurysms, which was successfully treated by transcatheter embolizationusing several embolic materials.

Percutaneous Transhepatic Cholangiography and Biliary Drainage by Antegrade Puncture Technique: Technical Note

The antegrade puncture technique represents a new approach to percutaneous transhepatic cholangiography andbiliary drainage. With this technique, ductal puncture begins with the liver capsule toward the hepaticparenchyma. This report briefly describes this new technique, and its safety and feasibility.

Pelvic Pain Syndrome - Successful Treatment by Ovarian Vein

Pelvic pain syndrome or pelvic congestion syndrome, with no apparent organic cause, is a common gynecologicaldisorder. Ovarian varix, one of the causes of this syndrome, presents a difficult diagnostic and therapeuticproblem, though surgical ligation of the ovarian vein is an effective method of treatment. Although ovarian veinembolization has been recently developed as a useful alternative, no previous reports have described thisprocedure in Korea. We report a case of pelvic pain syndrome successully treated by ovarian vein embolization.

MR Features of Myelofibrosis: Correlation with Bone Marrow Biopsy Findings

PURPOSE: To characterize the magnetic resonance (MR) imaging features of myelofibrosis and compare them with bone marrow biopsy findings. MATERIALS AND METHODS: The authors retrospectively reviewed sagittal T1-and T2 weighted and short tau inversion recovery (STIR) images of the thoracolumbar spine of six patients (five males and one female, mean age 46) with biopsy-proven myelofibrosis. Marrow signal intensity of the thoracolumbar spine was classified with respect to those of muscle and fat, based on the consensus of two radiologists after visual inspection. These MR features were compared with the degree of fibrosis and marrow cellularity, as determined by bone marrow biopsy. RESULTS: In all patients, marrow signal intensity of the thoracolumbar spine was reduced onT1 and T2 weighted images (invariably low on T1 weighted images, low (2/6) to intermediate (4/6) on T2 weighted images). On STIR images, marrow signal intensity was variable (high (3/6) or low (3/6)), and this correlated with degree of fibrosis, not with marrow cellularity. The signal intensity of marrow with mild to moderate fibrosis was high on STIR images, while that of marrow with marked fibrosis was low. CONCLUSION: MR imaging features of myelofibrosis were characterized as low on T1 weighted images and low to intermediate on T2 weighted images. In addition, the signal intensity of STIR imaging correlated with degree of fibrosis.

MR Features of Myelofibrosis: Correlation with Bone Marrow Biopsy Findings

PURPOSE: To characterize the magnetic resonance (MR) imaging features of myelofibrosis and compare them with bone marrow biopsy findings. MATERIALS AND METHODS: The authors retrospectively reviewed sagittal T1-and T2 weighted and short tau inversion recovery (STIR) images of the thoracolumbar spine of six patients (five males and one female, mean age 46) with biopsy-proven myelofibrosis. Marrow signal intensity of the thoracolumbar spine was classified with respect to those of muscle and fat, based on the consensus of two radiologists after visual inspection. These MR features were compared with the degree of fibrosis and marrow cellularity, as determined by bone marrow biopsy. RESULTS: In all patients, marrow signal intensity of the thoracolumbar spine was reduced onT1 and T2 weighted images (invariably low on T1 weighted images, low (2/6) to intermediate (4/6) on T2 weighted images). On STIR images, marrow signal intensity was variable (high (3/6) or low (3/6)), and this correlated with degree of fibrosis, not with marrow cellularity. The signal intensity of marrow with mild to moderate fibrosis was high on STIR images, while that of marrow with marked fibrosis was low. CONCLUSION: MR imaging features of myelofibrosis were characterized as low on T1 weighted images and low to intermediate on T2 weighted images. In addition, the signal intensity of STIR imaging correlated with degree of fibrosis.

Carbon Dioxide as a Venous Contrast Agent: Applications in Interventional Radiology

PURPOSE: To evaluate the safety and usefulness of carbon dioxide (CO2) as a venous contrast agent for upper-arm placement of peripherally inserted central venous catheter (PICC), vena caval filter placement, and for visualization of the portal vein in transjugular intrahepatic portosystemic shunt (TIPS). MATERIALS AND METHODS: About 20-30ml of CO2 was used as an alternative to iodinated contrast material for digital subtraction angiography (DSA) and fluoroscopy to guide upper-arm placement of PICC in 46 patients, for inferior venacavogram before filter placement in five, and for visualization of the portal vein during TIPS in two. Vital signs, peripheral arterial oxygen saturation, and renal function were checked during and after delivery of CO2. RESULTS: All CO2 DSA for PICC placement clearly delineated patency or stenosis of the central veins. In 41 of 46 patients (89%), PICC placement with CO2 guidance was successful. The mean number of venipunctures for PICC placement was 1.9, and the mean volume of CO2 injected for venipuncture was 35 ml. In five patients, Titanium Greenfield filters were successfully implanted into the inferior vena cava following CO2 vena cavography. In two patients in whom hepatopetal portal flow was seen on indirect portography, the portal vein was visualized by CO2-wedged hepatic venography. Injection of CO2 into the splenic vein following TIPS placement revealed shunt patency. Vital signs and oxygen saturation did not change, and there was no evidence of renal toxicity following CO2 injection. CONCLUSION: CO2 is a safe and useful alternative contrast agent for upper-arm placement of PICC, pre-filter placement cavography, and wedged hepatic venography and portography for TIPS.

Diagnosis of Hirschsprung's Disease: Accuracy of Barium Enema Findings

PURPOSE: To determine the relative accuracy of barium enema findings of Hirschsprung's disease (HD) and to calculate a level of probability for three signs combined. MATERIAL AND METHODS: Barium enema findings in 45 patients who had undergone rectal biopsy to prove or exclude the diagnosis of HD were retrospectively analyzed by evaluating the presence of a transition zone, irregular contractions and delayed evacuation of barium. Seventeen were neonates (group 1) and the other 28 were infants and children (group 2). The sensitivity, specificity, and positive and negative predictive values of the findings were compared. RESULTS: In visualization of a transition zone, sensitivity, specificity and positive predictive value were 76.5%, 72.7% and 89.7%, respectively. Sensitivity for irregular contractions and delayed evacuation of barium was 76.5% and 91.7%, respectively, whereas for specificity, the corresponding values were 63.6% and 40%. Sensitivities for radiologic signs were higher in group 1 than in group 2, but, the specificities were lower. If two or three findings were positive, the level of probability was 85 - 100%. If two findings were negative, however, the corresponding value was 30%. CONCLUSION: We conclude that the most reliable HD finding is the presence of a transition zone. Irregular contractions and the delayed evacuation of barium are not specific. Two or three positive findings may suggest a higher probability of HD than any single positive finding alone.

Radiologic Placement of Tunneled Central Venous Catheter

PURPOSE: To evaluate the efficacy and safety of fluoroscopy-guided, radiologic placement of a tunneled central venous catheter into the superior vena cava (SVC). MATERIALS AND METHODS: Thirty five patients underwent tunneled central venous catheter placement to facilitate long-term chemotherapy. They included 33 leukemicpatients, one colon cancer patient, and one multiple myeloma patient. After confirming central venous patency witha injection of contrast media via the peripheral cephalic or basilic vein in the wrist joint, the subclavian veinwas punctured under fluoroscopic guidance. A 7F double lumen TPN catheter was placed into the SVC through asubcutaneous tunnel in the anterior chest wall. RESULTS: Catheter placements were successful in all patients. The mean procedure time was 17.2 minutes, mean fluoroscopy time was 1.3 minutes, mean number of punctures was 1.4, and mean volume of injected contrast media was 43.5 cc. Only two of all leukemic patients developed mild hematomas atthe puncture site, but these soon resolved themselves. None of the patients developed pneumothorax or hemothorax.but late complications included local infection in two patients (6%) and thrombotic occlusion of the catheter inone (3%). The occluded catheter was successfully recanalized with Urokinase infusion. CONCLUSION: Fluoroscopy-guided, radiologic placement of a tunneled central venous catheter is an easy and safe method, anduseful for patients requiring long-term venous access.

The Modified Pulse-Spray Method Using Urokinase in Subacute and Chronic Thrombotic Arterial Occlusion

PURPOSE: To evaluate the effectiveness and safety of the modified pulse-spray method using Urokinase (UK) in subacute and chronic thrombotic arterial occlusion. MATERIALS AND METHODS: Modified pulse-spray methods using UKwere performed in seven patients with subacute (1week-1month) to chronic (1 month-5years) occlusive sysmptoms suchas limb pain, claudication and impotence. Angiographic examination revealed thrombotic occlusion of the aorta, common iliac arteries, brachial arterio-venous hemodialysis graft and femoro-popliteal bypass graft. The patients underwent thrombolysis using modified pulse-spray and additional constant infusion of UK. In the presence of underlying stenosis or organized clots, balloon angioplasty or stent placement was performed. RESULTS: Completelysis was obtained in five of seven patients. For initial lysis, the mean dose of UK was 420,000 units, and the mean modified pulse-spray time was 50 minutes. Mean total dose of UK and mean total time for complete lysis were 800,000 units and 161 minutes, respectively. Thrombolysis of the femoro-popliteal bypass graft failed due to severe occlusion of the distal anastomosis. Partial lysis was achieved in one patient with aorto-iliac occlusion, but further thrombolysis was stopped due to bleeding at the puncture site. CONCLUSION: The modified pulse-spraymethod using UK is effective in treating subacute and chronic arterial thrombotic occlusion. It augments the speed, safety and efficacy of thrombolysis. When underlying stenosis or organized clots remain after thrombolysis, balloon angioplasty or stent placement would be helpful.

Marrow Pattern in the Proximal Femoral Metaphysis of Patients with Osteonecrosis of Femoral Head and Normal Subjects: Comparison on MR Images

PURPOSE: To predict early risk of osteonecrosis of the femoral head by comparison of the bone marrow pattern of the proximal femoral metaphysis(PFM) in normal subjects and patients with osteonecrosis of the femoral head on T1-weighted magnetic resonance (MR) images. MATERIALS AND METHODS: The authors retrospectively reviewed T1 (TR525/TE 25 msec) weighted coronal MR images of 67 hips with osteonecrosis and 65 normal hips in 39 patients with osteonecrosis of the femoral head and in 27 normal subjects. On the basis of bright signal intensity of fat, the proportion of remaining hematopoietic marrow in PFM was subdivided into 4 grades (0 to 3) by two radiologists. No evidence of remaining hematopoietic marrow was assigned grade 0, and grades 1, 2 and 3 represented scanty, moderate, and prominent hematopoietic marrow, respectively. Grades 0 and 1 were collectively defined as "predominantly fatty", grades 2 and 3 as "predominantly hematopoietic". The frequency of the predominantly fatty marrow in PFM was analyzed in relation to three age groups(<25,25-50,50<) and both sexes. RESULTS: The overall frequency of predominantly fatty marro in PFM was higher in hips with osteonecrosis than in normal hips (p<0.001). Especially in the male population under the age of 50, the frequency was apparently higher in hips with osteonecrosis, compared with normal hips (p<0.001). However, the male population aged over 50 or female population showed no statistically significant difference in our series. CONCLUSION: In proximal femoral metaphysis with osteonecrosis of the femoral head, fatty marrow conversion occurs apparently earlier than in normal subject. T1-weighted MR imaging could therefore be useful in predictiong early risk of osteonecrosis of the femoral head because of early fatty marrow conversion of the proximal femoral metaphysis.

Adrenal paragonimiasis simulating adrenal tumor: a case report

We describe a case of adrenal paragonimiasis with its computed tomographic and ultrasonographic findings. Computed tomogram showed a well enhancing oval mass at right adrenal gland and ultrasonogram showed a dumbbell-shaped hyperechoic mass saddling on the top of the right kidney. Surgical specimen was multicystic mass filled with creamy material.

Craniodiaphyseal Dysplasia: A Case Report

Craniodiaphyseal dysplasia is a rare hereditary bone dysplasia characterized by craniofacial hyperostosis anddiaphyseal dysplatic changes. We reviewed the clinical, radiologic and laboratory features of one such case.

Radiologic Findings of Secondary Systemic Amyloidosis Associated with Tuberculosis: A Case Report

Amyloidosis is a rare systemic disease caused by extracellular deposition of insoluble protein. Systemic amyloidosis is subclassified into idiopathic primary and secondary form. The cause of secondary amyloidosis includes tuberculosis, familial Mediterranean fever, rheumatoid arthritis and multiple myeloma. We report a case of tuberculosis-related, secondary systemic amyloidosis which involved liver, spleen, kidneys, stomach, urinary bladder and lymph nodes.

Combined Transcatheter Arterial Chemoembolization and Percutaneous Ethanol Injection for Treatment of Hepatocellular Carcinoma: Preliminary Study

PURPOSE: Transcatheter arterial chemoembolization (TACE) and subsequent percutaneous ethanol injection (PEi) was attempted in 8 patients with 9 hepatocellular carcinomas (HCCs) for complete tumor necrosis of HCCs less than 5cm in greatest diameter. MATERIALS AND METHODS: PEI was performed with 2-8ml of absolute (99.9%) ethanol two weeks after TACE under CT or ultrasound guidance. For each patient PEI was done twice to four times within 4-10 days of each procedure. After completion of a series of PEI, follow up examination (range:3 months-l.5 year period) was done with angiography, CT or ultrasound and correlated with serum alpha-fetoprotein (AFP) level. RESULTS: On follow up anglograms, the lesions completely disappeared or decreased in size without tumor vessels or staining in 5 of 6 patients. On follow up CT of 6 patients, the lipiodol-laden HCCs were surrounded by non-enhancing low density and the losion sizes were slightly decreased or not changed. These are suggestive of necrosis of tumor itself and adjacent liver parenchyma. The tumors could not be detected on follow up ultrasound examination in 2 patients. Serum AFP was decreased in 7 patients and was well corresponded to the results of imaging modalities. CONCLUSION: The authors concluded that the combined TACE and PEI is an appropriate treatment for small HCCs having high surgical risks.

Radiologic Features of Posterior Fossa Hemangioblastomas: Emphasis on MR Findings

PURPOSE: To review MR findings of the posterior fossa hemangioblastomas and to evaluate diagnostic value of MRI correlated with CT and anglographic findings. MATERIALS AND METHODS: The MR findings in twelve patients with surgically proven posterior fossa hemangioblastomas including one case of von Hippel- Lindau disease were retrospectively analyzed and correlated with CT (7 patients) and anglographic findings (9 patients). RESULTS: On MRI, five hemangioblastomas were located in the cerebellar hemisphere and seven in the vermis. The masses appeared to be solid in 3 cases(25%), solid tumors with central cyst in 2 cases(17%), and cyst with mural nodules in 7 cases(58%). Abnormal tumor vessels represented by characteristic signal voids on MRI were observed in 9 cases(75%) and were not seen in 3 cases(25%) with mural nodule below 1.5cm in diameter. On pre-contrast CT, hemangioblastomas appeared poorly marginated slightly hyperdense masses in solid tumors, and hypodense cystic masses in cysts. After contrast enhancement, solid tumors were markedly enhanced, but it was difficult to differentiate hemangioblastomas from other tumors. In nine patients, anglograms demonstrated hypervascular blush corresponding to the solid component of the tumors. CONCLUSION: MRI was superior to CT in evaluating the characteristic of abnormal tumor vessels and mural nodules, delineation of tumor margin and tumor extent. Angiography was useful in the diagnosis of cystic hemangioblastomas which contain small mural nodule (less than 1.5cm in diameter) without definite vascular signal voids on MRI. MRI demonstrated solid or cystic tumor with small mural nodule and abnormal vascular signal voids in the posterior fossa should suggest hemangioblastoma.

Mucin-hypersecreting Biliary Neoplasms:Two Case Report

Mucin-hypersecreting biliary neoplasm excretes excessive mucin that fills the biliary tree and results in marked dilatation of the bile ducts and obstructive jaundice. In these neoplasm, the mucin produced by the tumor rather than the tumor itself plays an important role in clinical course and radiologic patterns. The purpose of this paper is to report characteristic radiologic patterns of mucin-hypersecreting biliary neoplasms in two cases. These neoplasms were characterized by not only multilocular cystic hepatic mass or extra-hepatic bile duct mass resulting in marked biliary dilatation distal to the mass on US or CT, but also change of shape and extent of amorphous filling defects in the markedly dilated bile duct on serial cholangiograms.

Percutaneous Ethanol Ablation of Hepatic and Renal Cyst: Therapeutic Effect and Follow-Up Study

PURPOSE: To evaluate the ability of percutaneous ethanol ablation in the treatment of benign cysts of the liver and kidney, and to decide the need and the time of retreatment when the cysts remain on the follow-up ultrasonogram. MATERIALS AND METHODS: Twenty benign cysts(8 hepatic and 12 renal cysts) in 18 patients diagnosed or confirmed either by ultrasound, CT or cytology were treated with percutaneous ethanol injection(PEI). After evacuation of cystic fluid, 15-900ml(amount corresponding to 40-50% of the volume of aspirated fluid) of absolute ethanol(99.9%) was injected into the cysts through the aspiration catheter. rln large cysts, two or more PEIs were done in one session. Follow-up ultrasonographic studies during the period of 12 months with 1-2 months interval after PEI were performed for evaluation of the therapeutic effect. RESULTS: Nine cysts(45%) disappeared completely within 2 months after initial PEI. Although 11 cysts(55.5%) recurred 2 months after initial PEI, 8 of them disappeared within 6 months and one within 8 months after inital PEI without additional PEI. As a result, 18 of 20 cysts(90%) disappeared within 8 months after initial PEI and most of the recurrent cysts disappeared within 6 months without additional PEI. No major complications were encountered concerning PEI, although transient abdominal pain, elevation of body temperature, and drowsiness were noted in 8 patients. CONCLUSION: PEI is an effective and safe modality for the treatment of benign hepatic or renal cysts and the apparent recurrence within 6 months after initial PEI might be mostly a transient, reactive or inflammatory fluid collection rather than real recurrence.

MR Imaging of Gastric Carcinoma' Comparison with CT

PURPOSE: To assess the value of MR imaging compared to CT for the staging of gastric carcinoma when body-wrap-around surface coil, intravenous glucagon, motion suppression technique and effervescent granules are used. MATERIAL AND METHOD: CT and MRI were performed for thirty-five patients with gastric carcinoma. Postcontrast CT scan was performed immediately after oral effervescent granules and Buscopan were given. Before MR imaging, BWA surface coil was wrapped around the upper abdomen. T1 coronal, sagittal and axial SE images (TRITE=400/15 msec) were obtained immediately after oral effervescent granules and glucagon were given. Respiratory compensation and presaturation techniques were used for each imaging. Three radiologists evaluated independently for randomly mixed 70 sets of CT and MR images. The signal intensity of gastric mass and enlarged lymph nodes were compared to the signal intensity of the adjacent pancreas, liver and spleen to evaluate any discriminating features between them. RESULTS: The accuracy in the diagnosis of pancreatic invasion was 83.8% on MRI and 74.3% on CT (p 0.05), 73.3% and 68.6% in gastric serosal invasion (p> 0.05), 50.5% and 42.9% in lymph node metastasis (p > 0.05). The gastric mass and enlarged lymph nodes were hypointense to the intensity of pancreas and liver in more than 78% of cases. CONCLUSION: MRI was comparable to CT scan for the staging of gastric carcinoma. Therefore, MRI could be used as an alternative or adjunctive diagnostic modality in the staging of gastric carcinoma.

Radiation Induced Acute Lung Injury: Chest Radiographic Findings

PURPOSE: Radiation pneumonitis and fibrosis are common complications of radiation therapy of the chest. Sixty-six patients with lung cancer were studied to evaluate the radiation injury according to radiation dose (total and estimated single dose), time after completion of radiation, overall treatment time, and combined chemotheraphy and chest surgery. METHODS AND MATERIALS: All 66 patients received fractionated radiotherapy (180 to 300 cGy/day) to the thctax with total 1000 to 6660 cGy encompassing primary site and regional lymphatics. RESULTS: Radiation pneumonitis was developed in 40(60%) of 66 patients. Radiation pneumonitis occurred average 11 weeks after completion of therapy in 14(44%) of 32 patients below 4000 cGy, and 6 weeks in 26 (76%) of 34 patients above 4000 cGy. Radiation pneumonitis occurred more frequently when the estimated! single dose was over 1100 units than below 1100 units. Radiation pneumonitis was more frequent when the overall treatment time was over 30 days than within 30 days. All 10 patients undergone Iobectomy or pneumonectomy developed radiation pneumonitis. CONCLUSION: The incidence of radiation induced lung injury is variably dependant on radiation dose, time, from completion of radiation therapy, overall treatment time, and history of surgery such as Iobectomy or pneumonectomy before radiation therapy.