A Review of Brain Magnetic Resonance Imaging Correlates of Successful Cognitive Aging

Normal aging causes changes in the brain volume, connection, function and cognition. The brain changes with increases in age and difference of gender varies at all levels. Studies about normal brain aging using various brain magnetic resonance imaging (MRI) variables such as gray and white matter structural imaging, proton spectroscopy, apparent diffusion coefficient, diffusion tensor imaging and functional MRI are reviewed. Total volume of brain increases after birth but decreases after 9 years old. During adulthood, total volume of brain is relatively stable. After 35 years old, brain shrinks gradually. The changes of gray and white matters by aging show different features. N-acetylaspartate decreases or remains unchanged but choline, creatine and myo-inositol increase with aging. Apparent diffusion coefficient decreases till 20 years old and then becomes stable during adulthood and increase after 60 years old. Diffusion tensor properties in white matter tissue are variable during aging. Resting-state functional connectivity decreases after middle age. Structural and functional brain changes with normal aging are important for studying various psychiatric diseases such as dementia, schizophrenia and bipolar disorder. Our review may be helpful for studying longitudinal changes of these diseases and successful aging.

Sonographic and Mammographic Features of Breast Apocrine Metaplasia

PURPOSE: To evaluate the sonographic and mammographic features of apocrine metaplasia of the breast. MATERIALS AND METHODS: We retrospectively evaluated the sonographic and mammographic findings of 16 lesions that were diagnosed with only apocrine metaplasia after mammotome excision. The age ranged from 27 years old to 57 years old (mean age; 40 years old). The sonographic features were interpreted by the ACR BI-RADS (American College of Radiology Breast Imaging Reporting and Data System) for shape, orientation, margin, boundary, echo pattern, posterior acoustic feature, calcification and special cases. The mammographic features were interpreted by the ACR BI-RADS (American College of Radiology Breast Imaging Reporting and Data System) for breast composition, shape, margin, density and calcification. RESULTS: Sonographic features were that the shapes were oval (n = 16) in 100%. The orientation was parallel (n = 15) in 94%. The margins were circumscribed (n = 8) in 50% and microlobulated (n = 8) in 50%. The echo patterns were hypoechoic (n = 8) in 50%, complex (n = 5) in 31% and anechoic (n = 3) in 19%. Posterior acoustic enhancement was seen in 69% (n = 11). There was internal microcyst (n = 4) in 25%. There was no calcification. Mammography performed for 12 cases demonstrated negative findings (n = 10) for 83%, obscured hypodense mass (n = 1) for 8% in 11 cases of breast composition 3 and 4, and circumscribed isodense mass (n = 1) for 8% in one case of breast composition 2. There was no calcification. The final assessment was category 4a (n = 7) in 44%, category 3 (n = 6) in 38% and category 2 (n = 3) in 19%. CONCLUSION: Although sonographic and mammographic features of apocrine metaplasia are occasionally suspicious malignancy such as microlobulation and complex echo. We consider the possibility of apocrine metaplasia if masses show internal microcyst and abrupt boundary.

Sonographic Findings of Thyroid Cancer Initially Assessed as No Suspicious Malignancy

PURPOSE: To review the retrospective imaging findings of thyroid cancer initially assessed as no suspicious malignancy. MATERIALS AND METHODS: Of 338 nodules confirmed to be thyroid cancer, this study included 38 patients with 39 nodules assessed as no suspicious malignancy on initial sonography. (mean age: 39 years, 36 females and 2 males). We evaluated sonographic findings by shape, margin, echogenecity, calcification, cystic degeneration and peripheral hypoechoic rim retrospecively. We analyzed whether sonographic findings were different according to the size (standard: 1 cm). RESULTS: The most frequent sonographic findings were ovoid to round shape 90%, well-defined smooth margin 64%, hypoechogenecity 54%, no calcification 92%, no cystic degeneration 77% and peripheral hypoechoic rim 56%. Suspicious malignancy findings were taller than wide shape 10%, well-defined spiculated margin 36%, markedly hypoechogenecity 10% and microcalcifications 8%. Isoechogenecity, cystic degenetaion and peripheral hypoechoic rim were common in 1 cm more than nodules. Well-defined spiculated margin was common in 1 cm less than nodules. In retrospective, 56% showed no suspicious malignancy finding. CONCLUSION: Although nodules assessed as no suspicious malignancy on initial US had many retrospectively suspicious malignancy findings, still many nodules showed no suspicious malignancy finding. Suspicious findings were ignored due to equivocal finding in small size, isoechogenecity, cystic degeneration or peripheral hypoechioic rim. We need careful observation.

Apocrine Carcinoma of the Breast: A Case Report

Apocrine carcinoma is a rare breast cancer and its frequency is about 0.4% of all breast cancers. Little is known about its clinical behavior and prognosis. To our knowledge, few studies have reported the radiologic appearances of apocrine carcinoma in the breast and there has been no such report from Korea. We describe the sonographic findings of a case of apocrine carcinoma in the breast. The sonographic findings are microlobulated heterogeneous hypoechoic lesion that has a central markedly hypoechoic portion and a peripheral mixture of iso and hypoechgenecity.

Sonographic Findings of Endometrial Polyps / 대한산부인과학회지

OBJECTIVE: To characterize the sonographic findings of endometrial polyp and to differentiate it from other endometrial lesions. METHODS: Using transvaginal sonography, preoperative sonographic findings of pathologically proven endometrial polyp in 24 patients were retrospectively evaluated for the size, margin, echogenicity, nature (cystic, solid, mixed), and blood flow signal by color Doppler sonography (CDS). The t-test was used to check the statistical significance for Resistive index (RI) between endometrial polyp and other endometrial lesions. RESULTS: Of 110 patients studied for abnormal vaginal bleeding, 24 (21.9%) patients had endometrial polyps, 4 (3.6%) patients had secretory phased endometriums, 4 (3.6%) patients had submucosal myomas, 4 (3.6%) had retained placentaes, 1 (0.9%) had endometrial hyperplasia, 1 (0.9%) had blood clot, 1 (0.9%) had endometrial carcinoma and 71 (64.6%) patients had normal findings. The sonographic findings of endometrial polyp were well defined (24 patients), round (16 patients), hyperechoic (20 patients), and solid mass (21 patients). Using transvaginal CDS, the location of blood flow (9 patients) showed a single feeding artery with a mean RI of 0.60. There were no statistical significant differences between endometrial polyp and other endometrial lesions in arterial waveform (mean RI: 0.6) by transvaginal CDS (p>0.05). CONCLUSION: Endometrial polyp has a characteristic sonographic appearance of a well-defined, hyperechoic round mass by transvaginal sonography. In addition, it contains a single feeding vessel to the vascular stalk with a characteristic color Doppler signal detected by transvaginal CDS. These findings enable us to make differential diagnosis from other endometrial lesions.

Ultrasonographic Findings of Struma Ovarii / 대한산부인과학회잡지

OBJECTIVES: To characterize the ultrasonographic findings of struma ovarii, a rare ovarian tumor composed solely or predominantly of thyroid tissue or the tumor in which hyperthyroidism results from the ovarian thyroid tissue. MATERIALS AND METHODS: Using ultrasonography, preoperative ultrasonographic findings of pathologically proven struma ovarii in six patients were retrospectively evaluated for the site, size, margin, nature (cystic, solid, mixed), septa, mural nodule, calcification, fat, and metastasis. The findings were compared with pathologic findings. RESULTS: All six were unilateral, and smooth tumor margins, 5 were mixed cystic and solid tumors, regular septa and scattered echogenic spots within cyst. One of our cystic tumor (bilocular) had hyperechoic mural nodules. Calcification was found in one tumor and no fat. Malignant change or metastasis was not any tumor. CONCLUSION: Most cases of struma ovarii occurred unilaterally within ovarian teratomas in premeno- pausal women, Struma ovarii has a characteristic ultrasonographic appearance of a complex mass of multiple cysts and solid components with scattered echogenic spots within cyst.

Prenatal Diagnosis of Complete Atrioventricular Septal, Defect:Clinical Outcome of 35 Cases

PURPOSE: Prenatal diagnosis of congenital heart disease has been made by fetal echocardiography and its clinical impact on the outcome of complete atrioventricular septal defect(AVSD) cases has been analysed. METHODS: A retrospective study was performed for the fetal cases for complete AVSD diagnosed, confirmed postnatally or at second study and/or at autopsy and/or follow up at CHA hospital between January 1993 and December 2001. The outcome of complete AVSD has been analysed, and the associated anomalies & chromosomal defects has been described. RESULTS: There were 450 cases of significant CHD that had been diagnosed prenatally during the study period. Of whom 35 cases had complete AVSD, and 32 cases had complete AVSD associated with visceral heterotaxy. In the cases with complete AVSD who with chromosomal study, 53.8% had Down syndrome and an additional 7.7% had other chromosomal anomaly. Associated cardiac malformation was 34.2%. Extracardiac anomaly without chromosomal defect was founded in 5 cases(14%) included polydactyly, hydrocephalus, duodenal atresia, omphalocele, cleft lip and single umbilical artery. Among 35 fetal complete AVSD cases, 29 cases of complete AVSD has been terminated, 1 case died in utero, 1 case died at neonatal period and 4 cases were referred to cardiac center for planned delivery. The most common factors of termination were extracardiac and chromosomal anomaly. CONCLUSION: Among the significant CHD, incidence rate of complete AVSD was 7.8%. And the most of the complete AVSD has been terminated. 4 cases(11.4%) were referred to the cardiac center for planned delivery. The rate of termination was 82.9%. Fetal diagnosis of complete AVSD greatly increased the rate of termination.

Prenatal Diagnosis and Impact on Prognosis of Fetal Echocardiography: Multicenter Study of Korean Fetal Cardiology Study Group Between 1998 and 1999

No abstract available.

Granulosa Cell Tumor of Scrotal Tunics: A Case Report

We report a case of adult granulosa cell tumor arising in the scrotal tunics. The patient was a 34-year-old man who presented with right scrotal swelling, first noticed four months previously. Under the initial clinical impression of epididymo-orchitis, antibiotic treatment was instituted but there was no response. The paratesticular nodules revealed by ultrasound and magnetic resonance imaging mimicked intratesticular lesion, and radical orchiectomy was performed. Although several cases of adult testicular granulosa cell tumor, have been reported, the occurrence of this entity in the paratesticular area has not, as far as we are aware, been previously described.

Ultrasonographic Measurement of Fetal Foot Length and Femur/Foot Length Ratio in Second Trimester of Normal Pregnancy in Korean Women

PURPOSE: The aim of this study was to determine, using prenatal ultrasongraphy, normal fetal foot length and the femur length ratio during the second trimester of a normal pregnancy in Korean women. MATERIALS AND METHODS: From May to July 1999, and in September of the same year, 1018 normal Korean singleton pregnancies showing no abnormality on prenatal sonograms were included in this study. The gestational age ranged from 19 to 30 weeks. Femur and foot length were measured by one radiologist. Regression analysis was performed for foot length and gestational age, and the mean value of the femur/foot length ratio and 95th percentile confidence interval of that mean value were calculated. The data obtained was compared with that obtained from caucasians. RESULTS: Foot length correlated with gestational age (r 2=0.87, p value = 0.0001). The regression formula was as follows; Gestational age (days) = 70.98-2.15 x foot length (mm). Mean foot length at each gestational week was not different from the corresponding figure for Cancasians. The mean (+/-SD) value of the femur/foot length ratio was 0.96 (+/-0.05) and the 95th percentile confidence interval of that mean value was 0.96+/-0.000301, figures which are significantly lower than those for Caucasians. CONCLUSION: Fetal foot length during the second trimester of a normal pregnancy in Korean women is a reliable parameter for use in the assessment of gestational age. In our study the fetal foot length was not different from that of caucasians, while the femur/foot length ratio was lower than the value in that group. The nomogram depicted in of this study will serve as a useful adjunct in the screening of chromosomal abnormality or skeletal dysplasia among Koreans.

Gender Difference of Corpus Callosum in Korean Neonate / 체질인류학회지

Corpus callosum is a co mmisural fiber connecting the cerebral hemispheres. The gender difference in the size or the shape of corpus callosum is a long standing dispute. Analysis of sexual dimorphism has been expected to provide a clue to explain sociopsychological differences. Some reported that adult female CC had more bulbous splenium and larger area considering brain size, others failed to show sexual dimorphism reported in previous studies. Only few studies were reported on sexual dimorphism of the during development. The 200 midsagittal ultrasonographs were obtained through anterior fontanelle from healthy Korean neonates (100 males, 100 females). The neonates born after 38 ~42 weeks conception were scanned and each image was analyzed with NIH image. The average area of total corpus callosum was 97.61 +/-21.05 (Mean +/-SD) mm 2 in male, 99.54 +/-20.82 mm 2 in female. Mean length of corpus callosum was 45.06 +/-4.51 mm in male, 44.46 +/-3.71 in female and mean height was 14.06 +/-1.86 mm in male, 13.4 +/-1.75 mm in female. The height of male corpus callosum was significantly higher than that of female. We could find out sexual dimorphism of spatial orientation of the corpus callosum, although there was no significant gender difference in area of corpus callosum.

A Case of Aplasia Cutis Congenita Associated with Fetus Papyraceous / 대한주산의학회잡지

No abstract available.

Prostate Volume Measurement by TRUS Using Heights Obtained by Transaxial and Midsagittal Scanning : Comparison with Specimen Volume Following Radical Prostatectomy

OBJECTIVE: The purpose of this study was to determine, when measuring prostate volume by TRUS, whether height is more accurately determined by transaxial or midsagittal scanning. MATERIALS AND METHODS: Sixteen patients who between March 1995 and March 1998 underwent both preoperative TRUS and radical prostatectomy for prostate cancer were included in this study. Using prolate ellipse volume calculation (height x length x width x pi/6), TRUS prostate volume was determined, and was compared with the measured volume of the specimen. RESULTS: Prostate volume measured by TRUS, regardless of whether height was determined transaxially or midsagittally, correlated closely with real specimen volume. When height was measured in one of these planes, a paired t test revealed no significant difference between TRUS prostate volume and real specimen volume (p = .411 and p = .740, respectively), nor were there significant differences between the findings of transaxial and midsagittal scanning (p = .570). A paired sample test, however, indicated that TRUS prostate volumes determined transaxially showed a higher correlation coefficient (0.833) and a lower standard deviation (9.04) than those determined midsagittally (0.714 and 11.48, respectively). CONCLUSION: Prostate volume measured by TRUS closely correlates with real prostate volume. Furthermore, we suggest that when measuring prostate volume in this way, height is more accurately determined by transaxial than by midsagittal scanning.

Prostate Volume Measurement by TRUS Using Heights Obtained by Transaxial and Midsagittal Scanning : Comparison with Specimen Volume Following Radical Prostatectomy

OBJECTIVE: The purpose of this study was to determine, when measuring prostate volume by TRUS, whether height is more accurately determined by transaxial or midsagittal scanning. MATERIALS AND METHODS: Sixteen patients who between March 1995 and March 1998 underwent both preoperative TRUS and radical prostatectomy for prostate cancer were included in this study. Using prolate ellipse volume calculation (height x length x width x pi/6), TRUS prostate volume was determined, and was compared with the measured volume of the specimen. RESULTS: Prostate volume measured by TRUS, regardless of whether height was determined transaxially or midsagittally, correlated closely with real specimen volume. When height was measured in one of these planes, a paired t test revealed no significant difference between TRUS prostate volume and real specimen volume (p = .411 and p = .740, respectively), nor were there significant differences between the findings of transaxial and midsagittal scanning (p = .570). A paired sample test, however, indicated that TRUS prostate volumes determined transaxially showed a higher correlation coefficient (0.833) and a lower standard deviation (9.04) than those determined midsagittally (0.714 and 11.48, respectively). CONCLUSION: Prostate volume measured by TRUS closely correlates with real prostate volume. Furthermore, we suggest that when measuring prostate volume in this way, height is more accurately determined by transaxial than by midsagittal scanning.

CT Staging of Renal Pelvis Tumor

PURPOSE: To assess the value of computed tomography (CT) in the preoperative staging of transitional cellcarcinoma (TCC) of the renal pelvis. MATERIALS AND METHODS: We retrospectively evaluated the CT TNM staging of 38patients with TCC of the renal pelvis who had undergone preoperative abdominal CT examination between January 1990and January 1998. In CT staging for differentiation between early-stage (TO-2) and advanced-stage disease (T3-T4),three criteria were used, namely the presence or obliteration of the renal sinus fat layer, the smoothness orirregularity of margin between the tumor and renal parenchyma, and the presence or absence of hydronephrosisproximal to the tumor. CT staging was performed by two genitourinary radiologists blinded to the pathologicresults, and was compared with pathologic staging. RESULTS: Pathologic results revealed 19 cases of early stagedisease (TO=8, T1=9, T2=2) and 19 of advanced stage (T3=12, T4=7). Overall CT staging accuracy was 82%(31/38);fourcases were overstaged and three were understaged. In early-stage disease, sensitivity and specificity were 79%,and 84%, and in advanced stage disease were 83% and 80%. Three of four overstaged cases showed hydronephrosisproximal to the tumor. In the second CT staging, using proximal hydronephrosis of the tumor as a criterion forearly-stage disease, the sensitivity and specificity of early-stage disease were 95% and 75%, respectively, andthe specificity of advanced-stage disease was 95%. CONCLUSION: When hydronephrosis proximal to a tumor wasconsidered to be a sign of early stage disease, the CT staging of renal pelvic TCC was highly accurate.

Mucocele-like Tumor of the Breast: A Case Report

Mucocele-like tumor(MLT) is a rare benign neoplasm occurring in the breast. Differentiation of MLT from mucinous carcinoma of the breast on the basis of fine-needle aspiration biopsy specimens is difficult, and in Korea, the radiologic findings of these lesions have not been reported. We describe a case of MLT of the breast, and review of the literature.

CT Differentiation of Solid Ovarian Tumor and Uterine Subserosal Leiomyoma

PURPOSE: On the basis of CT findings, to differentiate between solid ovarian tumor and uterine subserosalmyoma. MATERIALS AND METHODS: In eight surgically proven cases of solid ovarian tumor and in ten uterinesubserosal myoma patients, contrast-enhanced CT images were obtained. Two genitourinary radiologists reviewed thefindings with regard to degree of enhancement of the mass as compared with enhancement of uterine myometrium,thickening of round ligaments, visualization of normal ovaries, contour of the mass, and the presence of ascitesin the pelvic cavity. RESULTS: Six of eight ovarian tumors but only two of ten uterine myomas were less enhancedthan normal uterine myometrium (p 0.05). The contour of themass was lobulated in two of eight ovarian tumor patients, but in five of ten uterine myoma patients (p>0.05). CONCLUSION: CT findings suggestive of solid ovarian tumor were less contrast enhancement of the mass than ofnormal uterine myometrium, pelvic ascites, and nonvisualization of normal ovary.

Stage 1 Carcinoma of Cervix: Value of Endovaginal Surface Coil MR Imaging in Determining Depth of Invasion

PURPOSE: The purpose of this study was to determine the usefulness, with respect to depth of invasion, ofendovaginal surface coil (EVC) MR imaging for the evaluation of early-stage cervical cancer. MATERIALS AND METHODS: We retrospectively analyzed the MR images of 49 patients with pathologically-confirmed stage one cervicalcarcinoma who underwent EVC MR before hysterectomy. The tumor seen on MR images was identified as a high signalintensity lesion replacine the normal low signal intensity cervical stroma seen on T2WI. Depth of invasion, asseen on MR images and in pathologic specimens was divided into3-5mm, and the results werecompared. RESULTS: Depth of invasion in pathologic specimens was 5mm in25 patients(mean 6.34mm). On MR imaging, tumor was detected in 42 patients. Depth of invasion on MR was 5mm in 25 patients (mean 6.59mm). MR failed to detect tumors which infiltratedless than a certain depth;this cut-off point was 1mm in two patients, 2mm in two, and 3.5mm in one. All tumorswhich invaded more than 5mm were detected on EVC MR. There was no significant difference between depth of invasion seen on MR and in pathologic specimens(p=.59). The 95% confidence interval for difference in the value ofdepth of invasion between MR and on pathologic specimens ranged from -0.7mm to 1.2mm. CONCLUSION: EVC MR imagingmay be useful for assessing the depth of invasion of stage one cervical carcinoma.

MR Imaging of Tuberous Sclerosis: Emphasis on the Cortical and Subcortical Tubers

PURPOSE: To evaluate the frequency, location, and signal intensities of parenchymal (cortical andsubcortical) tubers and white matter lesion, as seen on MR images of patients with tuberous sclerosis. MATERIAL AND METHODS: Twenty patients diagnosed on the basis of clinical and MR findings as suffering from tuberoussclerosis, were retrospectively reviewed. Their ages ranged from 6 days to 21 years (mean, 5.2 years), and theywere divided into two groups according to age : under 18 months (n=9) and over 18 months(n=11). We analyzed thefrequency, location, and enhancement patterns of tubers and white matter lesions, and the difference of signalintensities between cortical and subcortical tubers according to age. RESULTS: Cortical tubers were detected in11 patients (55%), subcortical tubers in 18 (90%), and white matter lesions in 16 (80%). Subcortical tubers weremore frequently noted than cortical tubers and the two types did not always accompany each other. Cortical tuberswere most commonly located in the frontal lobe(10/11), followed by the parietal lobe(2/11), and temporallobe(2/11). Subcortical tubers were also most commonly located in the frontal lobe(17/18), followed by thetemporal lobe(10/18). White matter lesions were also frequently observed in the frontal lobe(13/16) and wererelated to the location of parenchymal tubers in 12 of 16 white-mater lesions. There were no lesions in thecerebellum. The signal intensities of cortical and subcortical tubers were different in all patients. Those ofsubcortical tubers showed no significant difference between the two age groups, but in patients under 18 months,signal intensity on T1WI tended to be high(5/6), and on T2WI, tended to be low(5/6). In 15 patients, Gd-DTPAenhanced MR images showed no demonstrable enhancement, except in one case involving white-matter lesion. CONCLUSION: Both cortical and subcortical tubers were commonly located in the frontal lobe, but the latter weremore frequently observed than the former. Subcortical tubers did not always accompany cortical tubers, and on MRimaging, the signal intensities of the two types were different in all cases. Differentiation of cortical andsubcortical tubers by MR imaging may therefore help analyze the parenchymal tubers seen in tuberous sclerosis.

Evaluation of Preoperative Embolization of Meningioma

PURPOSE: To evaluate the efficacy and safety of preoperative embolization of intrancranial meningioma. MATERIALS AND METHODS: We retrospectively reviewed intrancranial meningioma patients (n=37) who underwentpreoperative embolization. They were categorized into two groups, skull base lesions (n=22) and non-skull baselesions (n=15), according to tumor location. In addition, embolization results were classified by comparisonbetween pre- and post-embolization angiography as complete (residual tumor staining or= 10 or 30%). In each group, estimated blood loss (EBL) was estimated by amount ofintraoperative transfusion with pre- and post-operative hemoglobin level. Tumor resectability was evaluated byfollow-up computed tomography. New symptoms occurring within 24 hours of embolization were considered to be thoseassociated with embolization ; symptoms improved by conservative treatment were regarded as mild, while thoseresulting in new deficits were considered severe. RESULT: In the group with skull base lesions (n=22), completeembolization with the criteria of residual tumor staining of less than 30% was performed in 14 patients(EBL=1770ml;complete surgical removal in nine patients and incomplete removal four). Incomplete embolization wasperformed in eight patients (EBL=3210ml; complete and incomplete removal each in four patients). In the group withnon-skull base lesions, complete embolization with the criteria of residual tumor staining of less than 10% wasperformed in five patients (EBL=970ml) and incomplete embolization in ten (EBL=2260ml). Complete tumor removal waspossible in this group regardless of the completeness of preoperative tumor embolization. In a case ofintraventricular meningioma (3%), intratumoral hemorrage occurred on the day following embolization. Other mildpost-embolization complications occurred in three cases (8%). CONCLUSION: Preoperative embolization can be aneffective and safe procedure for meningioma and may reduce intraoperative blood loss. Its effectiveness may dependon tumor location and the degree of embolization, though the procedure seems to be helpful for lseions at theskull base.