The Correlation Between Visceral Fat Distance Measured by Ultrasonography and Visceral Fat Amount by Computed Tomography in Type 2 Diabetes / 당뇨병

BACKGROUND: Visceral adipose tissue accumulation highly correlates with metabolic abnormalities and cardiovascular disease. Computed tomography (CT) is considered to be the standard method for visceral fat evaluation, but it is not used as a routine procedure. Ultrasonography (US) is a safe method, fairly inexpensive and widely available modality for measuring abdominal fat thickness. The aim of this study was to investigate the correlation between the intra-abdominal fat distance by US measurement and the visceral fat amount by CT and cardiovascular risk factors and to evaluate whether the intra-abdominal fat distance is better correlate with visceral fat amount by CT than other anthropometric parameters and to assess the cut-off value of intra-abdominal fat distance for visceral obesity in type 2 diabetic patients. METHODS: We obtained abdominal subcutaneous and intra-abdominal fat distance by using a high-resolution US (HDI 5000, ATL, Phillps, USA) at 1 cm above umbilical level in one hundred twenty-eight type 2 diabetic patients. CT scan (Light Speed plus, GE, USA) for the measurement of subcutaneous and intra-abdominal visceral fat area was also performed in the supine position at the L4-5 level. Lean body mass and % body fat were measured in a bioimpedance using DSM (Direct Segmental Measurement by 8-point electrode) method (InBody 3.0, Biospace, Seoul, Korea). We measured patient's height, weight, BMI (Body mass index), waist circumference, WHR(Waist-hip ratio) and blood pressure and also measured fasting blood glucose, HbA1c and lipid profiles. RESULTS: Abdominal subcutaneous and visceral fat distance measured by US is 2.05 +/- 0.52 cm, 4.43 +/- 1.54 cm, respectively. In pearson's correlations, visceral fat distance were correlated with BMI (r = 0.681, P < 0.001), waist circumference (r = 0.661, P < 0.001), WHR (r = 0.571, P < 0.001), triglyceride (r = 0.316, P < 0.001), HDL-cholesterol (r = -0.207, P < 0.004). US-determined visceral fat distance was also correlated with visceral fat amount by CT (r = 0.674, P < 0.001) and BMI (r = 0.610, P < 0.001), waist circumference (r = 0.626, P < 0.001), WHR (r = 0.557, P < 0.001). When we used waist circumference (men: 90 cm, women: 85 cm) as parameters for visceral obesity, the cutoff value of visceral fat distance, obtained by the receiver operating characteristic curve analysis, were 4.670 cm in men, 3.695 cm in women diabetic patients. CONCLUSION: Intra-abdominal fat distance measured by US reveals strongly correlated with visceral fat area, which is determined by CT and also well correlated with anthropometric parameters and lipid profiles. We suggest that US provided a better index compared to anthropometry for the prediction of visceral obesity and could be an alternative method for CT for visceral fat determination in diabetic patients.

Sclerosing Stromal Tumor of the Ovary: MR-Pathologic Correlation in Three Cases

Sclerosing stromal tumor (SST) of the ovary is a very rare sex cord stromal tumor occurring in a younger age group than other types of stromal tumors and most commonly accompanied by menstrual irregularity. Several unique histologic features including pseudolobulation, sclerosis and prominent vascularity are clearly reflected at ultrasonography and MRI. We report the ultrasonographic and MR features of three cases of histologically confirmed SSTs, and relate them to the pathological findings.

Nodular Regenerative Hyperplasia of the Liver in an Infant: Case Report

Nodular regenerative hyperplasia (NRH) of the liver is an uncommon disease entity, especially in the pediatricage group. A few cases have been reported in the radiologic literature, but follow-up imaging studies are rare. We describe a case of NRH, diagnosed by ultrasound-guided needle biopsy, in a seven-month-old infant with cri-du-chat syndrome. Initial ultrasound revealed several small hypoechogenic nodules in the liver, but CT and MR failed to demonstrate their presence. Two follow-up sonographic examinations were performed 7 and 20 months later, revealing increases in the size and number of the nodules.

MR Imaging of Slow-flow Using a Flow Phantom

Purpose : To find sensitivity of MRI imaging methods to slow flow phantom study was performed with conventional Spin-Echo, gradient echo based Phase Contrast, fast GLASS, and heavily T2-weighted Fast Spin Echo pulse sequences. MATERIALS AND METHODS: A siphon driven flow phantom was constructed with a ventriculo-peritoneal shunt catheter and a GE phantom to achieve continuous variable flow. Four different pulse sequences including Spin-Echo, Phase Contrast, GRASS and Heavily T2-weighted Fast Spin Echo were evaluated to depict slow flow in the range from 0.08 ml/min to 1.7 ml/min and to compare signal intensities between static fluid and flowing fluid. RESULTS: In the slow flow above 0.17 ml/min conventional Spin-Echo showed superior apparent contrast between static and flowing fluid while GRASS was more sensitive to the very slow flow below 0.17 ml/min. It was not accurate to calculate flow and velocity below 0.1 ml/min with a modified PC imaging. CONCLUSION: Four different MR pulse sequences demonstrated different sensitivity to the range of slow flow from 0.08 ml/min to 1.7 ml/min. This finding may be clinically useful to measure CSF shunt flow or detecting CSF collection and thrombosis.

The Effects of Erythromycin in Small-Bowel Follow-through

PURPOSE: To evaluate the efficacy of erythromycin(EM), known to accelerate gastric emptying, in modified small-bowel follow-through(SBFT). MATERIALS AND METHODS: We evaluated 32 normal patients who underwent modified SBFT by oral administration of methylcellulose. In the EM injection group(n=20), 500 mg EM (3 mg/kg in pediatric patients) in 100 ml saline was infused intravenously over a 15-minute period prior to the administration of a barium meal, while in the control group(n=12), EM was not infused. Gastric emptying time(GET), small-bowel transit time(SBTT) for barium and methylcellulose, small-bowel transit(SBT) during the first 15 minutes, luminal diameter and quality of image were compared between the two groups. SBT was assigned 1, 2, 3, or 4 points, depending on the extent to which the barium head reached the proximal or distal jejunum, and the proximal or distal ileum during the initial 15-minute. Three radiologists reached a consensus as to image quality. RESULTS: Mean GET was significantly faster in the EM injection group (18.5 mins for 150 ml barium suspen-sion and 25.8 mins for 600 ml methylcellulose). The SBT score during the initial 15 minutes was significantly higher in the EM injection group (3.3 points) than in the control group (2.4 points), but mean SBTT was not sig-nificantly different between the two groups. Luminal diameter and image quality were also higher in the EM injection group. CONCLUSION: EM does not decrease SBTT but is highly effective for shortening gastric emptying time, helping to increase the range of fluoroscopic examination and improve image quality in modified small-bowel follow-through, especially in patients with delayed gastric emptying.

Gallbladder Dysmotility and Gallstone Development after Gastrectomy in Gastric Cancer Patients

PURPOSE: Gallstone disease has been presumed to be a sequellae of gastrectomy. To know correlation between gallbladder disease and gastrectomy, we check anatomical and functional status of gallbladder with ultrasonogram in our study. METHODS: Gallbladder motility after gastrectomy was studied by means of measuring fasting and postprandial gallbladder volume using real time ultrasonography in 50 gastrectomized patients and in 28 controls (healthy but not operated gastric cancer patients) were selected as study subjects. RESULTS: Mean fasting and postprandial gallbladder volume was significantly increased in gastrectomized patient group (FV: 37.63+/-20.70 ml, PV: 11.50+/-10.26 ml) than control group (FV: 22.17+/-10.35 ml, PV: 5.44+/-3.67 ml, p<0.01). The ejection fraction of gallbladder in gastrectomized patient group (69.05+/-14.57%)was significantly smaller than control group (75.57+/-10.26%, p<0.05). CONCLUSION: The risk of gallbladder disease was independent of age, sex, and post-operative duration in our study. Gastrectomy may have the possibility of increasing the risk of gallbladder disease by causing gallbladder dysmotility and bile stasis. So, gallbladder motility evaluation would be helpful for prevention and understanding gallstone formation. Further study will be needed about the clinical benefits of prophylactic cholecystectomy during gastrectomy.

MR Imaging Findings of Intraosseous Lipoma

PURPOSE: To evaluate the MR imaging findings of intraosseous lipoma. MATERIALS AND METHODS: The MR imaging findings of 12 cases of intraosseous lipoma were retrospectively analyzed with regard to internal signal intensity, enhancement patterns, the presence of calcification and the status of the margin. The findings relating to these last two features were compared with those of plain films and CT. RESULTS: Six tumors were located in the calcaneus, three in the tibia, two in the ilium, and one in the carpal lunate. A fat component was clearly identified in all cases, but no lesion was purely fatty. Cyst formation was noted in four cases, and hyperintense portions different from the cystic area were seen on T2WI in ten. Contrast enhancement was observed in four patients, and although plain film and CT images revealed, in all cases, the presence of calcification, in two cases this was not demonstrated by MRI. In all cases, however, MRI showed well-defined tumoral margins. CONCLUSION: MRI clearly depicts fat and other components related to the involutional changes occurring in cases of intraosseous lipoma. The information these images provide is useful for the diagnosis and histologic classification of intraosseous lipoma.

The Role of Duplex Scan to Surgeon in Treatment of Primary Varicose Vein

PURPOSE: Anatomy and morphology of superficial veins vary from patient to patient. Thorough assessment of variations is mandatory for successful treatment of primary varicose vein. Alos in complex case clinical examination alone is unable to achieve diagnostic goals. Duplex scan is a highly accurate, noninvasive technique that can provide both anatomic and physiologic information. METHODS: Thirty-eight legs in 30 patients with primary varicose veins were examined clinically first then with portable doppler. Patients then underwent duplex scanning by surgical team and results of tests were compared with other clinical examinations. RESULTS: On duplex scanning, 25 legs (66%) had saphenofemoral junction (SFJ) incompetence, 9 legs (24%) had saphenopopliteal junction (SPJ) incompetence and 4 legs (10%) had perforator incompetence. The respective sensitivity of clinical examination with portable doppler in SFJ, SPJ was 91.6%, 81.8%. CONCLUSION: Clinical and doppler assessment was unreliable. Routine preoperative duplex scanning is likely to reduce recurrence by identifying sites of reflux with greater accuracy.

Distal Femoral Cortical Irregularity in Adult: MR Imaging and Pathologic Correlation

PURPOSE: To correlate the pathologic and MR findings of distal femoral cortical irregularity(DFCI) in adult. MATERIALS AND METHODS: We retrospectively reviewed knee MR images of 120 adult patients(25-62 years old) without infection, tumor, or fracture. Five femoral specimens of adult cadaver were used to correlate pathologic and MR findings. A double cortical line' on MR images was interpreted as DFCI, and MR findings were analyzed to determine the thickness, internal signal intensity, location of the DFCI, shape of the external cortex, and clarity of the inner cortex. The outer cortex was classified as either convex or flat, and the inner cortex was classified according to its thickness and continuity as one of three types. RESULTS: One hundred and sixteen patients(97%) had DFCI, which in all cases was observed at the attachment site of the medial head of the gastrocnemius muscle. Mean thickness was 3.7mm and DFCI was thicker in men than in women(p<0.05). The outer cortex was convex in 75 cases(65 %) and flat in 41(35 %). The inner cortex was thick and continuous in 47cases(41 %, mean age 31), thin and continuous in 54(47 %, mean age 38), and thin and discontinuous in 19(16 %, mean age 47). Clarity tended to diminish with age. The internal area of DFCI showed signal intensity equal to that of adjacent bone marrow and was pathologically proven to be normal marrow tissue. CONCLUSION: DFCI was observed in most adults and was considered to be a normal variation. Its MR and pathologic findings were different to those observed during periods of growth.

A Case of Polyorchidism / 대한비뇨기과학회지

Polyorchidism is a rare anomaly. It may result from transverse division of the urogenital ridge, a hypothesis that best explains the anatomical features of the supernumerary testicle. Until recently, histology provided the only proof of polyorchidism but new imaging techniques, such as sonography and magnetic resonance imaging(MRI), allows a highly accurate diagnosis of supernumerary testes rendering biopsy unnecessary. We report a case of polyorchidism in a 24 month-old-boy in whom the scrotal sonogram and magnetic resonance imaging confirmed the presence of 2 testicles without any evidence of tumor within his right hemiscrotum and who was treated conservatively and followed up 2 years.

Utility of Diffusion-weighted MR Imaging in Acute Stage of Small Cerebral Infarction

PURPOSE: To demonstrate the usefulness of diffusion-weighted MR imaging(DWI) in patients with small acuteinfarction by comparing it with fast spin-echo T2-weighted MR imaging(FSE T2WI). MATERIAL AND METHOD: Weretrospectively analyzed the results of FSE T2WI in 26 consecutive patients who on DWI showed small discretehyperintensities of less than 1.5cm and whose final clinical diagnosis, within one week of clinical attack, wasacute inforction. Lacunar infarcts accounted for 24 cases and 2 small cortical infarcts for two. The onset ofsymptoms occurred within 12 hours (hyperacute stage) in two patients, within 24 hours in seven, within 3 days innine, and within one week in eight. Infarcts as seen on FSE T2WI were categorized as follows : (-) for cases ofimpossible localization with non-visualization ; (+/-) for cases of equivocal localization with faint visualizationand/or poor differentiation from combined chronic infarcts and chronic ischemic changes, or from subarachnoid CSFin cases of cortical infarction ; and (+) for cases of adequate localization with clear visualization andmoderately good differentiation from the associated brain changes, or from subarachnoid CSF in cases of corticalinfarction. These infarcts were analyzed according to the time of onset of symptoms. RESULT: For the localizationof small acute infarctions, DWI was markedly superior to the category(-), moderately superior to the category(+/-).With regard to the onset of symptoms, DWI was markedly or moderately superior to FSE T2WI in 2/2 (100%) ofhyperacute stage diagnosed within 12 hour of clinical attack, in 4/7(57%) diagnosed within 24 hours, in 5/9 (56%)diagnosed within 3 days, and in 1/8 (13%) diagnosed within 1 week(p<0.05). In 12/26 cases(46%), small acuteinfarcts were localized by DWI better than by FSE T2WI. CONCLUSION: Because the signal was unchanged or itsintensity was poor, small infarcts at the acute stage were frequently difficult to localize by FSE T2WI. Inaddition, differentiation of these from combined chronic infarcts and chronic ischemic change was poor. DWI canlocalize small acute infarcts even when the results of FSE T2WI are negative or inconclusive.

Redundant Nerve Roots of the Cauda Equina: MR Findings

PURPOSE: To evaluate MR findings of redundant nerve roots (RNR) of the cauda equina. MATERIALS AND METHODS: 17 patients with RNR were studied; eight were men and nine were women, and their ages ranged from 46 to 82 (mean63) years. Diagnoses were established on the basis of T2-weighted sagittal and coronal MRI, which showed a tortuous or coiled configuration of the nerve roots of the cauda equina. MR findings were reviewed for location, magnitude, and signal intensity of redundant nerve roots, and the relationship between magnitude of redundancy and severity of lumbar spinal canal stenosis (LSCS) was evaluated. RESULTS: In all 17 patients, MR showed moderate or severe LSCS caused by herniation or bulging of an intervertebral disc, osteophyte from the vertebral body or facet joint, thickening of the ligamentum flavum, degenerative spondylolisthesis, or a combination of these. T2-weighted sagittal and coronal MR images well clearly showed the location of RNR of the cauda equina; in 16 patients (94%), these were seen above the level of constriction of the spinal canal, and in one case, they were observed below the level of constriction. T2-weighted axial images showed the thecal sac filled with numerous nerve roots. The magnitude of RNR was mild in six cases (35%), moderate in five cases (30%), and severe in six cases (35%). Compared with normal nerve roots, the RNR signal on T2-weighted images was iso-intense. All patients with severe redundancy showed severe LSCS, but not all cases with severe LSCS showed severe redundancy. CONCLUSION: Redundant nerve roots of cauda equina were seen in relatively older patients with moderate or severe LSCS and T2-weighted MR images were accurate in identifying redundancy of nerve roots and evaluating their magnitude and location.

Clinical use of cholescintigraphy in acute cholecystitis:a comparative study with ultrasonography / 대한핵의학회잡지

No abstract available.

The diagnostic value of barium enema in acute appendicitis

Acute appendicitis is the most common acute surgical condition of the abdomen. when the clinical presentationis atypical, barium enema has proven to be safe and useful in confirming the diagnosis and reducing the negativesurgical exploration. However, the performance of barium enema in acute appendicitis has known contraindicationprimarily because of fear of leakage by perforation of the inflammed appendix. This study using barium enema as adiagnostic aid in acute appendicitis with atypical clinical presentation was performed to further support thepreviously noted efficacy and safety of this procedure. The results were as followings: 1. In case of acuteappendicitis with atypical clinical presentation, the use of barium enema as a diagnostic aid increased theaccuracy of diagnosis and decreased the negative surgical exploration. In women between 11 to 50 years old age,especially, it played important role differentiating appendicitis from nonsurgical acute abdomen. 2. The resultsof the study were 92.31% in sensitivity, 7.69% in false positive, 6.9% in false negative, and 10.26% in negativeappendectomy. 4. A simple partial or nonfilling of appendix without other associated possitive finding could notexclude appendicitis, therefore, close clinial observation was necessary. 5. The positive findings of barium enemaand their sensitivity were as followings: 1. Nonfilling of appendix: 9% 2. Partial filling of appendix: 91.7% 3.Displacement or a local impression on temrinal ileum: 100% *, In all cases, combined with a local impression oncecum and/or irritability of cecum or terminal ileum.

Evaluation of hepatobiliary imaging using Tc-99m-DISIDA in hepatobiliary disease

Hepatobiliary scintigraphy using Tc-labelled radiopharmaceuticals is employed primarily for the diagnosis ofacute cholecystitis and for demonstration of biliary tract patency. We conducted a retrospective study of 55patients with hepatobiliary disease from Jun. '84 to Sep. '84 at Taegu Catholic Hospital and tried to determinethe etiology and fine the possible differential points by analyzing the scintigraphic findings. The followingresults were obtained: 1. Tree-like photon defect on hepatic parenchyme was suggested characteristic of completeobstructive biliary diseases, but could be seen in either benign or malignant etiology. 2. The grade of hepatocyteclearance was not useful in detemining whether the cause of obstructive biliary disease was benign or malignant inthis study. 3. Hepatocyte clearance was more severely impaired in hepatocellular disease than in obstructivebiliary disease. 4. The photon defect in porta hapatis with complete biliary obstruction was suggestedcharacteristic of common bile duct cancer. 5. The meniscus appearance at obstructed site of common bile duct waspathognomonic sign of choledocholithiasis. 6. When the gallbladder was not visualized, the differential diagnosisbetween acute and chronic cholecystitis was possible without delayed image by observing the transist time tobowel. The delayed transit to bowel was a favorable of chronci cholecystitis rather than of acute cholecystitis.7. Acute pancreatitis could be easily differentiated from partial biliary obstruction by clinical and laboratoryexamination, but the finding of abrupt narrowing of pancreatic common bile duct with sligt proximal dilatation oncholescintigraphy was also a key point in acute pancreatitis. 8. The segmental dilatation of intrahepatic duct wasthought meaningful sign of clonorchiasis.

ERCP findings in clonorchiasis of the liver

ERCP was performed in 38 cases of clonorchiasis of the liver, which was confirmed by stool egg test withStoll's dilution method from Apr. 1979 to Oct. 1982. The resuls were as follows 1. The sex distribution ofclonorchiasis showed marked male predominance by 97.4% and age distrigution were higher in 5th and 6th decades. 2.Multiple small filling defects in the intrahepatic bile duct was the most characteristic finding in ERCP and widespread irregular stenosis, dilatation of terminal portion, disturbance of peripheral filling, fuziness andraggedness of intrahepatic duct were also noted. 3. The severity of clonorchiasis by ERCP were classifed asfollows; Grade I-7 cases (18.4%), GradeII-9 cases(23.7%) Grade III-12 cases (31.6%) and Grade IV-10 cases(26.3%)4. Chronic cholecystitis 10 cases(26.3%), Billary tree stone 7 cases (18.4%), malignancy of distal CBD 1 case(2.6%) were found with clonorchiasis by ERCP. 5. Three cases, treated with Niclofolan, showed marked improvementof pathology on follow-up ERCP.

Sonographic findings of biliary tract disease

Fourtyone patients fo gallbladder and bile duct diseases were studied clinically and sonographically.Tweentynine (Seventyone percent) patients were distributed between age fourty to fiftynine and male to femaleratio was 1:1.4. The order of frequency of biliary tract disease was cholelithiasis, acalculous cholecystitis, CBDstone and CBD cancer. Sonographic findings of cholelithiasis were strong echo with posterior shadowing, faintinternal echoes without shadowing, gallbladder wall thickneing and anechoicity of the gallbladder wall. Instead ofsmall proportion of gallbladder distension and wall anechoicity, faint internal echoes without shadowing were seenin ten of nineteen cases of cholelithiasis. On choledocholithiasis, meniscus sign at the junction of the stone andgallbladder wall was identified in most cases and was helpful to differentiation stone from malignancy. The degreeof CBD dilatation was more severe in malignancy than in CBD stones and ascaris in CBD. Sonographic examination wasuseful in detection of gallbladder and bilicary tree pathology and the cause of biliary tract obstruction could beidentified.