Needle Entry Angle to Prevent Carotid Sheath Injury for Fluoroscopy-Guided Cervical Transforaminal Epidural Steroid Injection

OBJECTIVE: To suggest rotation angles of fluoroscopy that can bypass the carotid sheath according to vertebral levels for cervical transforaminal epidural steroid injection (TFESI). METHODS: Patients who underwent cervical spine magnetic resonance imaging (MRI) from January 2009 to October 2017 were analyzed. In axial sections of cervical spine MRI, three angles to the vertical line (α, angle not to insult carotid sheath; β, angle for the conventional TFESI; γ, angle not to penetrate carotid artery) were measured. RESULTS: Alpha (α) angles tended to increase for upper cervical levels (53.3° in C6-7, 65.2° in C5-6, 75.3° in C4-5, 82.3° in C3-4). Beta (β) angles for conventional TFESI showed a constant value of 45° to 47° (47.5° in C6-7, 47.4° in C5-6, 45.7° in C4-5, 45.0° in C3-4). Gamma (γ) angles increased at higher cervical levels as did α angles (25.2° in C6-7, 33.6° in C5-6, 43.0° in C4-5, 56.2° in C3-4). CONCLUSION: The risk of causing injury by penetrating major vessels in the carotid sheath tends to increase at upper cervical levels. Therefore, prior to cervical TFESI, measuring the angle is necessary to avoid carotid vessels in the axial section of CT or MRI, thus contributing to a safer procedure.

Ultrasonographic findings of posterior interosseous nerve syndrome

PURPOSE: The purpose of this study was to evaluate the ultrasonographic findings associated with posterior interosseous nerve (PIN) syndrome. METHODS: Approval from the Institutional Review Board was obtained. A retrospective review of 908 patients' sonographic images of the upper extremity from January 2001 to October 2010 revealed 10 patients suspicious for a PIN abnormality (7 male and 3 female patients; mean age of 51.8±13.1 years; age range, 32 to 79 years). The ultrasonographic findings of PIN syndrome, including changes in the PIN and adjacent secondary changes, were evaluated. The anteroposterior diameter of the pathologic PIN was measured in eight patients and the anteroposterior diameter of the contralateral asymptomatic PIN was measured in six patients, all at the level immediately proximal to the proximal supinator border. The size of the pathologic nerves and contralateral asymptomatic nerves was compared using the Mann-Whitney U test. RESULTS: Swelling of the PIN proximal to the supinator canal by compression at the arcade of Fröhse was observed in four cases. Swelling of the PIN distal to the supinator canal was observed in one case. Loss of the perineural fat plane in the supinator canal was observed in one case. Four soft tissue masses were noted. Secondary denervation atrophy of the supinator and extensor muscles was observed in two cases. The mean anteroposterior diameter of the pathologic nerves (n=8, 1.79±0.43 mm) was significantly larger than that of the contralateral asymptomatic nerves (n=6, 1.02±0.22 mm) (P=0.003). CONCLUSION: Ultrasonography provides high-resolution images of the PIN and helps to diagnose PIN syndrome through visualization of its various causes and adjacent secondary changes.

Desmoid Type Fibromatosis in the Facet Joint of Lumbar Spine: Case Report and Review of Literature

Desmoid type fibromatosis is a benign fibroblastic tumor arising from the fascia or musculoaponeurosis. It may occur in various locations, but most commonly in the shoulder girdle and neck; to our knowledge, there has been no reported case originating from a facet joint of the spine. We report CT and MR imaging findings of a desmoid type fibromatosis, involving the facet joint of the L3-4 spine with bone involvement.

Reference Value for the Cross Sectional Area of Fibular Nerve Ultrasonography through the Anatomic Investigation in Korean

OBJECTIVE: To investigate the reference value for cross sectional area (CSA) of the fibular nerve in Koreans. METHOD: One musculoskeletal radiologist and one physiatrist performed fibular nerve ultrasonography (US) on 60 lower extremities of 30 asymptomatic Korean volunteers (16 males, 14 females). The mean age was 46.6 years (range: 21-75 years). We measured CSA of the fibular nerve at three sites: proximal portion (PP) at the bifurcation, mid-portion (MP), and an area just above the fibular head (FH). In addition, the fibular nerves of 7 lower extremities from 4 cadavers were cut from the fibular head to the proximal portion and divided into three sections (PP, MP, FH). They were subsequently fixed with 10% neutral buffered formalin and perpendicularly excised to 2 mm thickness. They were photographed by an operating microscope and CSA was measured. Using the Kruskal-Wallis test, measurements obtained from US images were compared between asymptomatic volunteers with a significance level of 0.05. RESULTS: In asymptomatic volunteers, the CSA of the three portions were PP: 13.8+/-1.2 mm2, MP: 11.1+/-1.0 mm2, FH: 10.9+/-0.6 mm2. The fibular nerves were well visualized with clear borders by US. In cadavers, the CSA of three portions were PP: 20.3+/-10.3 mm2, MP: 16.7+/-8.6 mm2, FH: 14.4+/-8.9 mm2. There was no significant difference between the three portions in asymptomatic volunteers and cadavers (p>0.05). CONCLUSION: In normal Korean adults, the area of fibular nerve at the fibular head is 10.9+/-0.6 mm2. Ultrasonographic evaluation of the fibular nerve can be helpful in diagnosing fibular nerve lesions.

Pregnancy and Natural Delivery Following Magnetic Resonance Imaging-Guided Focused Ultrasound Surgery of Uterine Myomas

This report discusses a pregnancy case following a series of two consecutive magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS) procedures for the treatment of two different myomas in an individual patient. Both procedures were completed without adverse events, and the patient conceived naturally four months after treatment. At 39 weeks, she gave birth to a healthy baby girl, via a vaginal delivery. There were no complications in the pregnancy or during labor.

Sonographic Findings for Posttraumatic Pacinian Neuroma: A Case Report

Pacinian neuroma is a rare tumor characterized by hypertrophy and hyperplasia of preexisting pacinian corpuscles. This tumor most frequently presents as a small superficial mass affecting the hands and feet, which produces localized sharp pain. The etiology is unknown, but local trauma has been postulated as an important factor. Here we report a case of posttraumatic pacinian neuroma in a 24-year-old woman who presented with severe local pain in the palm. The clinical features, and the sonographic and pathologic findings of posttraumatic pacinian neuroma are discussed.

Combined Arthroscopic Gross Total Synovectomy and Radiotherapy for Diffuse Pigmented Villonodular Synovitis of the Knee: A Report of 2 Cases / 대한방사선종양학회지

Pigmented villonodular synovitis (PVNS) is a rare proliferative disease involving synovial membranes. Natural history and etiology of PVNS are not well known. PVNS presents as localized or diffuse tumor like nodular lesion of the synovial lining of the joint and the synovial spaces adjacent to the joints. Though histologically benign, it is a very aggressive lesion, capable of bone destruction and widespread infiltration of surrounding tissues. Standard therapy is surgical resection, but due to the infiltrative growth, the recurrence rate is significantly high. After several relapses surgical treatment of diffuse PVNS becomes difficult and may require amputation of the involved limb. Radiotherapy can provide an effective treatment option for patients with large lesions or lesions which are not suitable for surgery, after incomplete resection to prevent relapses or to avoid amputation. We report 2 cases of diffuse PVNS in the knee joint treated with arthroscopic gross total synovectomy and radiotherapy.

Clinical and CT Findings of Klebsiella Liver Abscess: Comparison with Non-Klebsiella Liver Abscess

PURPOSE: To analyse the clinical features and CT findings of pyogenic liver abscess due to Klebsiella pneumoniae, and to compare the findings with those of cases in which abscesses were caused by other pathogens. MATERIALS AND METHODS: Twenty-one cases of pyogenic liver abscess were assigned to either the Klebsiella or the non-Klebsiella group, and the patients' past medical history and intra-abdominal abnormalities such as calculus or malignancy were reviewed. Laboratory data such as alkaline phosphatase (ALP), SGOT and SGPT levels were analyzed, and on the basis of the CT findings, decisions were reached as to (a) whether abscesses were single or multiple, multiple contiguous or discontiguous, uniloculated or multiloculated; and (b) the presence or absence of gas, hepatic parenchymal enhancement, peripheral rim enhancement, and extrahepatic abnormality. For statistical analysis, Fisher's exact test was used. RESULTS: Among 21 abscesses, Klebsiella pneumoniae was the most common pathogen (n=11). The others were Pseudomonas (n=3), E.coli (n=2), Enterococcus (n=2), G. (+) cocci (n=2) and Polymicrobial (n=1). Diabetes mellitus was more common among patients in the Klebsiella group, among whom a multiloculated single cavity was a frequent finding. Five patients in the non-Klebsiella group experienced biliary tract obstruction, which was not demonstrated in the Klebsiella group. Hepatic parenchymal enhancement was more common in the non-Klebsiella group. CONCLUSION: In cases of pyogenic liver disease, especially where diabates mellitus is involved, Klebsiella pneumoniae is a major pathogen. Significant CT findings of Klebsiella liver abscess included a multiloculated single cavity, rare biliary tract obstruction, and little hepatic parenchymal enhancement.

Ultrasonographic Findings of Lateral Epicondylitis of Humerus

PURPOSE: To evaluate the ultrasonographic findings of lateral epicondylitis and their relationship with clinical outcome. MATERIALS AND METHODS: The findings of ultrasonographic examinations of eighteen elbow joints in 15 patients [M:F=5:10 ; age:38-65(mean, 47.6) years] with lateral epicondylitis were reviewed. Two patients underwent surgery, two were not treated, and the remaining 11 were treated conservatively. Symptomatic improvement was noted 1 week after conservative treatment in two cases, at 2 weeks in five cases, at 3 weeks in three cases, and at 5 weeks in one case. With patients in the 90 degree flexed elbow position and in a supinated wrist, we examined the extensor carpi radialis brevis (ECRB) tendon around the lateral epicondyle using ultrasound equipment with a 7-11-MHz linear transducer. The findings were assessed in terms of swelling of the tendon, changes in its echotexture, the presence of calcification or cystic degeneration, loss of the hypoechoic band between the tendon and bony cortex of the lateral epicondyle, cortical irregularity of the lateral epicondyle, and fluid collection around the tendon. Any relationships between each ultrasonographic finding and the treatment interval after which symptomatic improvement was noted were evaluated. RESULTS: In the 18 joints, change was observed in the echotexture of all ECRB tendons. This included homogeneous hypoechogenicity in two cases, heterogeneous hypoechogenicity in 13, and heterogeneous mixed echogenicity in three. Other ultrasonographic findings were swelling of the tendon in ten cases, loss of the hypoechoic band in 14, cortical irregularity in five, calcification in four, cystic degeneration in nine, and fluid collection around the tendon in four. In patients treated conservatively, there was no statistically significant difference between each ultrasonographic finding and the treament interval after which symptomatic improvement was noted. CONCLUSION: Ultrasonography can be used to assess changes in the ECRB tendon and lateral epicondyle occurring in lateral epicondylitis, but fails to provide information on the rapidity of symptomatic improvement.

Comparison of Shoulder Positions at MR Arthrography: Change of Labroligamentous Complex Shape and Diagnosis of Labral Tears

PURPOSE: To compare the neutral, internal, and external rotation positions of the glenohumeral joint during magnetic resonance (MR) arthrography performed to assess changes in the shape of the labroligamentous complex (LLC) and in the labral tear. MATERIALS AND METHODS: MR arthrography of the shoulder was retrospectively evaluated in 36 patients aged 14-66 (mean, 40) years. Fourteen cases were confirmed by arthroscopic surgery (7 SLAP lesions, 2 Bankart lesions, 1 both SLAP and Bankart lesions). Axial fat-suppressed T1-weighted spin-echo images were acquired with each shoulder in the neutral position, and with internal and external rotations. In each position, we measured the angle of rotation between the perpendicular line on the glenoid fossa and the long axis of the humeral head, analyzing the relationship between the rotational angle and changes in the shape of the LLC at each internal and external rotation, relative to the neutral position. In addition, labral tears in 14 arthroscopically confirmed joints were evaluated in each position. RESULTS: Mean angles of rotation relative to the neutral position were 44.1 and 45.3 degrees in internal and external rotation, respectively. Changes in the anterior LLC occurred in 25 and 24 cases of internal and external rotation, respectively. There was a significantly meaningful relationship between rotational angle and change in the shape of the anterior LLC during external rotation, and when this change was noticed, the rotational angle was wider (p<0.05). The posterior LLC changed in shape in 13 and 16 cases of internal and external rotation, respectively, but changes according to the angle of rotation were not statistically significant. In arthroscopically confirmed joints, diagnosis of the eight SLAP lesions at external rotation tended to become more accurate, but no statistically significant differences were noted (p=0.07). Two Bankart lesions were interpreted as a tear in all three positions, and one other such lesion was interpreted as a tear in the neutral position and at external rotation, and a possible tear at internal rotation. CONCLUSION: In shoulder MR arthrography, changes in the shape of the anterior LLC were statistically prominent according to the angle of external rotation, and accuracy of diagnosis in SLAP lesions tended to be significantly higher at external rotation. If a SLAP lesion causes clinical concern, additional axial MR arthrography with the shoulder externally rotated is suggested.

A Case of Necrotizing FasciitisZ in Chronic Renal Failure Patient / 대한신장학회잡지

Necrotizing fasciitis is an uncommon severe infection involving the subcutaneous soft tissue, particularly the superficial and often deep fascia. It is usually associated with systemic toxicity, rapid progression and a mortality rate which varies between 20 and 60%. It can affect any part of the body but is most common on the extremities, especially the leg. Predisposing factors include diabetes mellitus, alcoholism, intravenous drug abusers, abdominal surgery, perineal infection. The prognosis for necrotizing fasciitis depends so heavily on early recognition and determination of the extent of necrosis. Whilist there are reports of acute renal failure occuring in the presence of necrotizing fasciitis, descriptions of the condition in patients with chronic renal failure are rare in the literature. Hence we report a case of necrotizing fasciitis, diagnosed by MRI(Magnetic Resonance Imaging) in chronic renal failure patient.

Evaluation of Chondromalacia in the Knee Joint using Three Dimensional Fourier Transformation Constructive Interference in Steady State(CISS)

PURPOSE: To assess the usefulness of three-dimensional Fourier transformation constructive interference in steady state (CISS) for the evaluation of chondromalacia. MATERIALS AND METHODS: In 110 knee joints which underwent both MR imaging and arthroscopy, the findings were retrospectively reviewed. MR imaging sequences included two-dimensional dual-echo turbo spin-echo imaging along the sagittal and coronal planes, two-dimensional fast low-angle shot (FLASH) with magnetization transfer along the axial plane, and three-dimensional CISS along the sagittal plane. After the cartilage surfaces of each joint were divided into eight areas (each medial and lateral area of patellar facets, trochlear surfaces, femoral condyles, and tibial plateaux), a total of 880 areas were assessed. Using both combined two-dimensional (2-D turbo spin-echo and FLASH) and CISS imaging during different sessions, each chondromalacia case was assigned one of five grades. RESULTS: Arthroscopy revealed the presence of chondromalacia in 162 areas. This was first grade in 77 areas, second grade in 38, third grade in 21, and fourth grade in 26. The sensitivity, specificity, and accuracy of 2-D and CISS imaging were 48.1%, 93.7% and 85.3%, and 45.7%, 95.3% and 86.1%, respectively. Agreement between MR and arthroscopic staging occurred in 81.48% of 2-D imaging procedures and 82.16% of CISS procedures. If a difference of one grade was accepted, these proportions rose to 84.32% and 85.22%, respectively, though this increase was statistically insignificant. CONCLUSION: Though CISS imaging was less sensitive than 2-D imaging in the grading of chondromalacia, additional CISS imaging can help improve the accuracy of this grading.

Cutaneous hamartoma of the hand: MR imaging findings

We report two cases of magnetic resonance imaging of the cutaneous hamartoma on the hand, which is a rare benign soft tissue tumor.

Usefulness of Dual-Echo in Steady State(DESS) Image in Chondromalacia of Knee Joint: Comparison of DESS and Turbo Spin-Echo MR Images

PURPOSE: To evaluate the usefulness of Dual Echo in State(DESS) image in the diagnosis of chondromalacia of the knee compared with turbo spin-echo MR images. MATERIALS AND METHODS: We included 26 patients with chondromalacia of the knee. MR imaging was obtained with a 1.5T imager. Sagittal and coronal double echo T2 weighted images(TR/TE 3000~4200/16-96msec, FOV 140-160140-160mm, matrix size 180256, slice thickness 4.0mm, interslice gap 0.5mm), and sagittal DESS image(TR/TE 25.4/9.0msec, flip angle 35-45, FOV 150-160150-160mm, matrix size 192256, effective slice thickness 1.5mm) were obtained. Cartilage lesions were staged according to a modified scheme proposed by Outerbridge: grade 0, normal; grade 1, softening or/and we swelling; grade 2, mild surface fibrillation or/and less than 50% of cartilage thickness; grade 3, severe surface fibrillation or/and loss of more than 50% of cartilage thickness but without exposure of subchondral bone; and grade 4, complete loss of cartilage with subchondral bone exposure. Gradings were determined by two readers with consensus, and patellofemoral, medial and lateral tibiofemoral compartments were evaluated. RESULTS: Arthroscopic findings revealed grade 1 in seven cases, grade 2 in 21 cases, grade 3 in six cases, and grade 4 in 18 cases. Sensitivity of turbo spin-echo MR images was as follows: 0%, 14%, 0%, 61% in each grade, and sensitivity of DESS image was as follows; 0%, 33%, 50%, 67% in each grade(p=0.001). In the detection of chondromalacic lesions regardless of gradings, sensitivity, specificity and accuracy of conventional MR image were 59.6%, 88.6%, 78.8% and of DESS image,73.1%, 88.4%, 82.2%(p=0.007). CONCLUSION: For chondromalacia of knee joints, DESS images showed higher sensitivity than turbo spinehco MR images. Therefore, DESS images will be helpful for diagnosis of chondromalacia of knee joints.

Age- Related Contrast Enhancement Study of Normal Bone Marrow in Lumbar Spinal MR Imaging

PURPOSE: The purpose of this study was to evaluate the degree of contrast enhancement of normal bone marrow in L-spine relating to aging and to determine the range of contrast enhancement in normal bone marrow. MATERIAL AND METHODS: We analyzed a total of 120 patients (20 per decade) who had undergone lumbar spinal MRI and who ranged in age from the 2nd decade to more than the 7th. Bone marrow revealed no abonormal pathology. Sagittal T1-weighted spin echo sequences were obtained before and after gadolinium administration. For each sequence, a region of interest was drawn within the L1 vertebral body from the midsagittal slice. Signal intensity (SI) values of each sequence were ascertained and the percentage increase in SI was calculated . RESULTS: After contrast enhancement, lumbar MRI revealed no statistically significant in the percentage increase in SI of normal bone marrow in relation to aging. Most patients (99 %) however showed an SI increase of between 10 % and 49 %. In only four, none of whom were aged over 40, was this increase above 50%. CONCLUSION: Lumbar MRI, revealed no statistically significant difference in percentage increase in SI in normal bone marrow relating to aging, but when the increase is above 50 % in a patient aged over 40, bone marrow pathology should be further investigated.

Adenomyosis of the Uterus: Recognition of a Characteristic Enhancement Pattern on Contrast-enhanced Dynamic MRI

PURPOSE: To analyze the enhancement patterns of adenomyosis and evaluate the usefulness of dynamic MR imaging in detecting adenomyosis. MATERIALS AND METHODS: Dynamic MR imaging finding in 46 women with adenomyosis were analyzed retrospectively. Dynamic MR imaging was obtained in each patient. Fifteen consecutive FLASH images were obtained before, immediately after and 15, 30, 45, 90 second and 5 minute after bolus injection of Gd-DOTA. Signal intensities of adenomyosis and outer myometrium and standard deviations of image noise were measured using an electronic cursor. Contrast-to-noise ratio (C/N) of the lesion to outer myometrium were calculated as follows ; (signal intensity of outer myometrium-signal intensity of adenomyosis)/(standard deviation) of noise signal intensity. RESULTS: The mean signal intensity of adenomyosis was higher than surrounding outer myometrium before and immediately after contrast injection. On 15, 30, 45, 90 second, and 5 minute after injection the signal intensity of adenomyosis was lower than that of surrounding outer myometrium (p < 0.05). The mean C/N values between adenomyosis and surrounding myometrium on precontrast scan, immediate postcontrast, and 15, 30, 45, 90 second and 5 minute delayed images were 3.20, 5.03, 6.14, 6.87, 7.13, 7.78, 38.59, respectively. On T2-weighted images, the mean C/N value between adenomyosis and surrounding myometrium was 16.7. Mean C/N value between adenomyosis and surrounding myometrium on delayed images was significantly higher than those of other dynamic & T2-weighted images(p<0.05). CONCLUSION: Dynamic MR imaging is very useful in the evaluation of the enhancement pattern and especially in detection of adenomyosis because the mean C/N value between adenomyosis and surrounding myometrium on delayed images are higher than that of T2-weighted images.

CT Evaluation of Solitary Pulmonary Nodule: Value of Additional HRCT Scan

PURPOSE: The aim of our study was to evaluate the usefulness of high-resolution CT scans in addition tohelical CT for characterizing a solitary pulmonary nodule. MATERIALS AND METHODS: Our study included 49 patientswith a solitary pulmonary nodule ; in each patient this was evaluated by both additional high-resolution CT andhelical scanning. Images were evaluated by three independent observers, each of whom read them twice : initiallywith helical CT images only and then with helical images plus high-resolution CT images. After analysis, theobservers recorded the following : histologic diagnosis, benignancy or malignancy of a nodule, and confidence intheir diagnosis (three scales). RESULTS: In differentiating benign and malignant nodules, the accuracy of helicalscans only was 75% (110/147 readings) whereas that of helical plus high-resolution CT scans was 82% (121/147readings) (p=0.001). Correct histologic diagnosis was made in 47% of cases (69/147 readings) when helical scansonly had been evaluated and in 48% of cases (71/147 readings) for which both helical and high-resolotion CT scanswere available (p=0.815). Diagnosis was more often highly confident on the basis of additional high-resolution CTscans (25%) than helical scans only (5%) (p=0.001) . CONCLUSION: By enhancing differential diagnosticaccuracy between benign and malignant nodules and by increasing confidence in the histologic diagnosis of apulmonary nodule, additional high-resolution CT scans are valuable for the evaluation of a solitary pulmonarynodule.

Radiologic Findings of Korean Gaucher Disease

PURPOSE: To document the radiologic characteristics of Korean Gaucher disease. MATERIALS AND METHODS: Fifteen bone marrow biopsy and laboratory data confirmed Gaucher disease patients (age 1 -21, mean 10.9 yr) wereundertaken plain X ray and MRI. Number of type I were 10, type II, 2, type III, 3. Seven were splenectomized oninitial evaluation or during follow up. Five enzyme treated patient were undertaken follow-up MR examinationduring 6 -40 month with 6 month interval. Conventional T1 and T2WI of spine and femur was performed and FMPSPGR inand out of phase image was also done. Volume of liver and spleen were measured, and bone marrow infiltration andpresence of infarction were scored according to 6 scale scoring system. Clinical data were also reviewed andcorrelated with the MR findings. RESULTS: Marrow infiltration was noted in 71.4% of all patients in MRI, while itwas in 45.7% with plain radiography. Type I group showed marrow infiltration in all but one cases, which wasparallel with ages, SGPT, and presence of osteopenia, reversely correlated with spleen size. Severe bonecomplications (infarction or fracture) were noted in 7 of 10 type I group, and 6 patients showed severe growthretardation (below 3rd percentile). Follow up MR examination of 5 patient showed decrease in liver and spleen sizefirst without bone change until 6 months. There showed bone regeneration in 2 patient 1 year after, and increasedfat signal in one patient 3.5 years after. In and out of phase images couldn't help in quantifying fatcomposition in bone marrow. CONCLUSION: Korean Gaucher patients revealed as more severe skeletal complicationsthan others reported from Western groups. MR examination is a effective modality to evaluate and monitor ofGaucher patients.

Evaluation of Cerebral Aneurysm with High Resolution MR Angiography using Slice Interpolation Technique: Correlation with Digital Subtraction Angiography (DSA) and MR Angiography (MRA)

PURPOSE: There have been some efforts to diagnose intracranial aneurysm through a non-invasive method using MRA, although the process may be difficult when the lesion is less than 3mm. The present study prospectively compare the results of high resolution, fast speed slice interpolation MRA and DSA therapy examing the potentiality of primary non-invasive screening test. MATERIALS AND METHODS: A total of 26 cerebral aneurysm lesions from 14 patients with subarachnoid hemorrhage from ruptured aneurysm (RA) and 5 patients with unruptured aneurysm(UA). In all subjects, MRA was taken to confirm the vessel of origin, definition of aneurysm neck and the relationship of the aneurysm to nearby small vessels, and the results were compared with the results of DSA. The images were obtained with 1.5T superconductive machine(Vision, Siemens, Erlangen, Germany) on 4 slabs of MRA using slice interpolation. the settings include TR/TE/FA=30/6.4/25, matrix 160x512, FOV 150x200, 7minutes 42seconds of scan time, effective thickness of 0.7mm and an entire thickness of 102.2mm. The images included structures from foramen magnum to A3 portion of anterior cerebral artery. MIP was used for the image analysis, and multiplanar reconstruction(MPR) technique was used in cases of intracranial aneurysm. RESULTS: A total of 26 intracranial aneurysm lesions from 19 patients with 2 patients having 3 lesion, 3 patients having 2 lesions and the rest of 14 patients having 1 lesion each were examined. Among those, 14 were RA and 12 were UA. Eight lesions were less than 2mm in size, 9 lesions were 3-5mm, 7 were 6-9mm and 2 were larger than 10mm. On initial exams, 25 out of 26 aneurysm lesions were detected in either MRA or DSA showing 96% sensitively. Specificity cannot be estimated since there was no true negative of false positive findings. When MRA and MPR were used concurrently for the confirmation of size and shape, the results were equivalent to those of DSA, while in the confirmation of aneurysm neck and parent vessels, the concurrent use of MRA and MPR was far superior to the sole use of either MRA or DSA. CONCLUSION: High resolution MRA using slice interpolation technique showed equal results as those of DSA for the detection of intracranial aneurysm, and may be used as a primary nin-invasive screening test in the future.

Peripheral neuroepithelioma of the kidney

Peripheral neuroepithelioma is a rare tumor, comprising less than 1% of all soft tissue malignancies arising from the peripheral nonautonomic nervous system. Most peripheral neuroepitheliomas reported were located in the extremities, thoraco-pulmonary region, and pelvic areas, and as many as 30% of cases were associated with peripheral nerve. We report one case of peripheral neuroepithelioma arising in the kidney, mimicking renal cell carcinoma on the CT scan.