Arthrosonography of the Shoulder Joint for Evaluation of the Glenoid Labrum, Glenoid Rim and Humeral Head: Comparison with Conventional Ultrasonography and MR Arthrography

PURPOSE: To compare the diagnostic role of arthrosonography, conventional ultrasonography and MR arthrography in the assessment of glenoid labral tear, glenoid rim fracture and humeral head fracture of the shoulder joint. MATERIALS AND METHODS: The findings of arthrosonography, conventional ultrasonography and MR arthrography were prospectively evaluated in 62 consecutive patients with chronic pain or a history of recurrent dislocation of the shoulder joint. The glenoid labrum was arbitrarily divided into four quadrants: anterosuperior, anteroinferior, posterosuperior, and posteroinferior, and for each, visibility at arthrosonography and conventional ultrasonography was subjectively scored as one of four grades. By means of statistical analysis, the two techniques were then compared. Twenty-six patients subsequently underwent arthroscopy, and the presence or absence of labral tear, glenoid rim fracture and humeral head fracture was determined. The sensitivity and specificity of each modality were separately calculated for each of the three types of shoulder joint injury, and observed differences in these findings were statistically analysed. RESULTS: For all individual quadrants of the labrum, visibility at arthrosonography was higher than at conventional ultrasonography (p.05), though its specificity was significantly higher (p=.003). In this respect, there was no significant difference in sensitivity or specificity between arthrosonography and MR arthrography (p>.05). For the detection of glenoid rim and humeral head fracture, there were no statistical differences in sensitivity and specificity between the three imaging modalities (p> .05). CONCLUSION: Compared with conventional ultrasonography, arthrosonography provides higher visibility of the labrum, thus improving the capacity of ultrasonography to detect labral tear. Arthrosonography could therefore be useful in the diagnosis of labral tear, glenoid rim fracture and humeral head fracture, and may thus partially replace MR arthrography.

Usefulness of CT in Patients with Gastrointestinal Fistula

PURPOSE: To evaluate the usefulness of CT in patients with gastrointestinal fistula. MATERIALS AND METHODS: We retrospectively reviewed the CT scans of 17 patients with various type of gastrointestinal fistula. The presence of these fistulae was confirmed by laparotomy in seven patients and by barium studies in fifteen. We evaluated the diagnostic accuracy of CT in these cases, and in correlation with barium studies and surgical findings, subsequently analyzed the CT findings. We determined the presence or absence of fistula tract, flow diversion of oral contrast media, bowel wall changes adjacent to the fistula tract, and extraluminal manifestations such as soft tissue mass, free air, leakage of oral contrast media, and peritoneal changes. RESULTS: The diagnosis of gastrointestinal fistula was possible on CT in nine (53%) of the 17 patients by using the CT criteria of direct visualization of the fistula tract (n=6) or flow diversion of oral contrast media (n=4). Other ancillary findings included bowel wall thickening adjacent to fistula tract in 15 patients, extraluminal soft-tissue mass in five, extraluminal free air in ten, extraluminal contrast leakage in four, and varying degrees of mesenteric and/or omental infiltration in 15. CONCLUSION: CT scanning is useful for the diagnosis of gastrointestinal fistula, which may be possible if the fistula tract and flow diversion of oral contrast materials are seen. It is also useful for evaluation of the extent of the etiologic disease.

The Role of Hepatobiliary Scintigraphy and Oral Cholecystography in Predicting the Performance of Laparoscopic Cholecystectomy / 대한핵의학회잡지

131I-6beta-iodomethyl-19-norcholesterol(NP-59) has an advantage to assess adrenal dysfunction caused by adrenal cortical disorders. The aim of this study is to evaluate the clinical usefulness of NP-59 scintigraphy in each adrenral disease. Ten patients who did eleven NP-59 adrenal scintigraphies at Dong-A University Hospital from March 1990 to December 1996 were selected as the subject. Among the subject there were 5 cases of Cushing's syndrome, 2 cases of incidentaloma, 1 case of metastatic adrenal tumor, liver cirrhosis with hirsutism and hypertension respectively. Among 5 case of Cushing's syndrome, there were 2 cases of Cushing's disease, 2 cases of adrenal adenoma and 1 case of adrenal carcinoma. There are no disagreement between clinical diagnosis and scan finding in Cushing's syndrome. In 2 incidentaloma cases, even though one is interpretated as a functioning tumor, both of 2 cases could avoid unnecessary biopsy according to scintigraphy result. One case of hirsutism, clinically adrenal originated, revealed the normal scintigraphic hirsutism was extra-adrenal origin. One case of hypertension took the study to exclude the possibility of primary aldosteronism. Normal suppression scan finding revealed that primary aldosteronism did not exist in this case. In conclusion, NP-59 scintigraphy was very useful in diagnosis and differential diagnosis of Cushing's syndrome and it could avoid unnecessary biopsy in the incidental adrenal tumor.

Analysis of Papers in Radiological Journals in Recent Years: A Comparison of Journal of Korean Radiologic Society and Radiology

PURPOSE: The purpose of this study was to determine current trends and the mode of future development in the field of medical radiology and to promote research among the nation's radiologists by analyzing the contents of the Korean Radiologic Society(JKRS) and Radiology. MATERIALS AND METHODS: The number of articles published in JKRS each year between 1990 and 1994 was counted. The research articles in JKRS(n=740) and in Radiology(n=1748) between 1992 and 1994 were categorized according to the objective, type, topic, materials, and radiologic techniques of their contents on the basis of predetermined criteria. Domestic Masters theses(n=126) and doctoral dissertations(n=75) accepted between 1990 and 1994, and domestic materials published in international journals(n=416) between 1986 and 1994 were also categorized using the same criteria. RESULTS: The greatest increase in the number of articles published in JKRS was seen during 1994. The majority of these aimed to retrospectively analyse the findings of diseases while the majority of articles published in Radiology dealt prospectively with the development and/or evaluation of diagnostic methods. More variety of topics and issues was seen in Radiology than in JKRS. The number of articles of domestic materials published in international journals increased from1986 to 1994, while the number of articles of foreign materials published in korea was relatively stationary. A significant number of theses and dissertations dealt, mostly prospectively, with studies of pathophysiologic and/or pharmacologic mechanisms using animal models. CONCLUSION: In order to understand both current trends and the direction and mode of future developments in the field of radiology, and to be able to actively deal with challenges at the forefront of radiologic development, it is essential to review research articles published in radiology-related journals.

MRI Findings of Rathke Cleft Cyst

PURPOSE: To describe the characteristic MRI findings of the Rathke cleft cyst. MATERIALS AND METHODS: During a seven-year period, we retrospectively evaluated the MRI findings of 24 pathologically-proven Rathke cleft cysts. The patients included ten men and 14 women, And their mean age was 37. MRI findings were analyzed in terms of location, shape, size, signal intensity, homogeneity of cyst content, pattern of contrast enhancement, displacement of the pituitary stalk, and mass effect of the cyst on adjacent structures. RESULTS: The location of 14 cases (58%) was sellar or suprasellar; nine (37%) were intrasellar. The mean size of the cysts was 16 x 12mm, as seen on sagittal or coronal images. The characteristic shape of the cyst was a sagging water bag in 13 cases (54%) and upward tenting in eleven (46%). The signal intensity of the cyst varied ; on T1-and T2WI, eleven cases (46%) showed high signal intensity relative to brain parenchyma ; five (21%) showed iso signal intensity on T1WI and high signal intensity on T2WI. While 18 (75%) showed inhomogeneous signal intensity on T1- and T2WI;13 (54%) showed a smudge pattern within the cysts, and six (25%) showed homogeneous signal intensity on T1 and T2WI. On Gd-DTPA enhanced images, thin-rim enhancement surrounding the cyst was seen in 20 cases (83%). While no enhancement was seen within the cyst. Seventeen cases (71%) showed anterior displacement of the pituitary stalk; two showed posterior displacement and five were indeterminate. Mass effect included compression of the optic chiasm (11cases) and bony erosion or tilting of the sellar floor (8 cases). CONCLUSION: MRI findings of midline intrasellar cyst with a sagging water bag appearance, high signal intensity on T1- and T2WI, inhomogeneity of cyst content, and peripheral rim enhancement surrounding the cyst are common, and are characteristic of the Rathke cleft cyst.

Experimental Model of Arteriovenous Fistula in Pigs

PURPOSE: To establish an experimental model of arteriovenous fistula in pigs. MATERIALS AND METHODS: Ten fistulas were created in eight pigs, and angiography was performed 3 to 5 days after surgery. A follow-up angiogram of three fistulas was obtained 2 to 12 weeks later. In one animal, pathologic examination showed occlusion 8 weeks after a successful operation. RESULTS: Eight angiograms of nine fistulas in seven pigs were obtained; one animal died due to cardiac failure. In six pigs, high-flow fistulas were shown to be present, and in two, the fistulas were slow flow; a pseudoaneurysm was seen in one. A follow-up angiogram obtained in three cases showed occlusion of the fistula. Pathologic examination of one animal showed fibrosis in the occluded portion of the fistula. CONCLUSION: An arteriovenous fistula model was surgically established in 80% of cases; during follow-up, three fistulas were seen to be occluded due to fibrosis. This model can therefore be used within one week of surgery.