Radiologic Findings of Endodermal Sinus Tumor of the Ovary

PURPOSE: To evaluate the radiologic features of endodermal sinus tumor of the ovary. MATERIALS AND METHODS:The radiologic findings of eight patients with pathologically-proven endodermal sinus tumor of the ovary wereretrospectively evaluated for bilaterality, size, margin, architecture, septa, local invasion, distant metastasis,ascites and lymphadenopathy ; serum alpha-FP was also evaluated. RESULTS: All endodermal sinus tumors were unilateralwith irregular septa and ascites ; the longest diameter was 7-18(mean, 12.6)cm. Four of eight tumors had smoothmargins and four, lobulated. Four were predominantly cystic in internal architecture, one was purely cystic, andthree were predominantly solid. There was local invasion or distant metastasis in three patients, andretroperitoneal lymphadenopathy in one ; in seven cases, alpha-FP level was more than 1.000ng/ml. CONCLUSION: Endodermal sinus tumors of the ovary appeared as nonspecific large complex abdominal masses and it was difficultto differentiate them from other malignant ovarian tumors. This tumor should be included in the differentialdiagnosis of a large complex abdominal mass in girls and young women, especially in patients with a predominantlycystic mass and markedly elevated serum alpha-FP.

Differential Diagnosis of Vertebral Lesions with paraspinal Mass with MRI

PURPOSE: To assess the characteristic features of MR findings which would be useful for the differentiation of various spinal diseases involving paraspinal soft tissue mass. MATERIALS AND METHODS: We retrospectively reviewed MR findings in 31 cases(M:F=20:11) of spinal disease in which paraspinal mass was involved. The breakdown of cases was as follows : spinal tuberculosis, 12; spinal metastasis, 13; multiple myeloma, 3; pyogenic spondylitis, 2; spinal aspergillosis; 1. RESULTS: The pattern of bone marrow invasion in spinal metastasis, multiple myeloma, spinal tuberculosis and aspergillosis was mixed ; focal, homogeneously diffuse and inhomogeneously patterns were seen. Pyogenic spondylitis showed inhomogeneously diffuse invasion; an intravertebral abscess was seen in the only five cases of spinal tuberculosis. Vertebral posterior compartment invasion was observed in seven cases of spinal tuberculosis, two of multiple myeloma, the one case of spinal aspergillosis and in all 13 cases of spinal metastasis. This and multiple myeloma showed no disc space invasion, in any case, but all cases of infectious spondylitis showed such invasion. Peripheral rim-enhancement in the paravertebral mass was seen in 11 cases of spinal tuberculosis, one case of pyogenic spondylitis and the case of aspergillosis. Bilobate anterior epidural mass was noted in 60% of spinal tuberculosis cases, 36% of spinal metastasis and one case of pyogenic spondylitis. CONCLUSION: MR findings of spinal disease involving a paraspinal soft tissue mass were useful for differentiation.

CT Findings in Differential Diagnosis of Benign and Malignant Parotid Tumors

PURPOSE: To evaluate CT findings which may help differentiate benign from malignant parotid tumors. MATERIALS AND METHODS: The CT findings of seventy-one cases with surgically-proven parotid tumors were retrospectively analysed for size, location, margin, internal density, adjacent tissue plane and lymphadenopathy. RESULTS: The margin of the mass was smooth and sharp in most benign tumors (89.5%), and irregular or indistinct in twelve which were malignant (75%, p<0.01). With regard to internal density, 70.2% of benign tumors were homogeneous (similar to muscle) and 81.3% of malignant tumors were heterogeneous (p<0.01). When analysing low density patterns within the mass, focal low densities in benign tumors (11/17) and diffuse or scattered multifocal low densities in those which were maligant (8/13) were frequently seen. Three malignant tumors invaded adjacent muscles, the parapharyngeal space, and bones, each in one case, and twelve malignant and one benign tumor infiltrated the adjacent fascia or subcutaneous fat layer. In five patients with a malignant tumor, obliteration by the mass of the fat plane between the mastoid tip and styloid process was noted, suggesting facial nerve invasion, while in three cases of malignancy, lymphadenopathy greater than 1cm was seen. CONCLUSION: In differentiating malignant and benign parotid tumors, the presence of irregular or indistinct margin of the mass, and invasion of adjacent structures, are important. Lymph node enlargement greater than 1cm and diffuse internal low densities, which may suggest necrosis or cystic change were also helpful in differential diagnosis.

CT Findings of Endometrioma: Differential Points from Other Benign Complex Cystic Adnexal Masses

PURPOSE: To evaluate whether CT scanning is useful in differentiating the between endometriomas and other benign complex cystic adnexal masses, and in determining the method of treatment for each mass lesion. MATERIALS AND METHODS: In 54 cases (47 patients), we retrospectively analysed the CT findings of 20 pathologically-proven twenty endometriomas (bilateral in four cases), eight hemorrhagic functional cysts, two tubal ectopic pregnancies, eight tubo-ovarian abscesses (bilateral in two cases), ten serous cystadenomas (bilateral in one case), and six mucinous cystadenomas. Internal attenuation, the hyperdense portion, adhesion, and cul-de-sac obliteration were evaluated by CT scanning. RESULTS: Fourteen endometriomas (70%) showed a hyperdense portion, and in only two of these (10%), was a focal nodular hyperdense portion seen on pre-contrast CT scan (10% sensitivity, 100% specificity). Partial or complete cul-de-sac obliteration was identified in 11 patients (75%), while hemorrhagic functional cysts showed a hyperdense portion in four cases (50%) and were accompanied by partial cul-de-sac obliteration in two (25%). Two unruptured tubal ectopic pregnancies showed CT findings of unilateral hyperdense cystic masses of more than 60 HU. In all cases, tubo-ovarian abscesses were accompanied by thickening of the uterosacral ligament and deviation of thickened mesosalpinx (anterior deviation in 87.5% of patients). Serous and mucinous cystadenomas showed CT findings of hypodense masses (less than 20 HU) without adhesion or cul-de-sac obliteration, and this was helpful in differentiating cystadenomas from other benign cystic adnexal masses, including endometriomas. CONCLUSION: The evaluation by CT scanning of benign complex cystic adnexal masses with respect to the hyperdense portion and the presence or absence of cul-de-sac obliteration was usful in differentiating endometriomas from other lesions, and might be helpful in determining the method of treatment for each mass lesion.

CT Findings of Thyroglossal Duct Cyst

PURPOSE: The purpose of this study was to evaluate the CT findings of thyroglossal duct cysts MATERIALS AND METHODS: Sixteen patients with pathologically proved thyroglossal duct cysts were included in the study. CT scans were assessed'retrospectively for shape, size, location, density of the central portions, septations, rim enhancement, changes in the adjacent fascial planes and investment within the strap muscles in the infrahyoid cysts. RESULT: Thirteen cases of thyroglossal duct cysts were seen as round or oval cystic masses, two cases of them were seen as irregular-shaped Iobulated cystic masses, and one case was seen as ovoid soft tissue mass. The cysts were from 1.4 to 5.7cm in diameter(mean, 2.6cm). The cyst was infrahyoid in 15 cases and suprahyoid in one case. The cyst was located in midline in eight cases, off midline in four cases, and both midline and off midline in four cases. The density of the central portions ranged from 15 to 82HU(mean, 32HU). Septations were noted in four cases. Rim enhancement was seen in 14 cases(93%), and heterogenously enhancing soft tissue mass was seen in one case. In four cases, abnormal fascial planes were observed. All but one of the infrahyoid cysts(14/15) were embedded within the strap muscles, and one case of them was located anteriorly to strap muscles. CONCLUSION: CT permits one to make the diagnosis a thyroglossal duct cyst with a high degree of accuracy, as it can differentiate thyroglossal duct cysts from the other anterior neck masses by their typical location, characteristic morphology, and investment within the strap muscles.

Correlation between MR Imaging and Histology of Intracranial Meningioma

PURPOSE: The magnetic resonance(MR) appearance of 23 biopsy-proven meningiomas were retrospectively evaluated and correlated with histologic pattern ;fibroblastic, transitional, syncytial, angioblastic. MATERIALS AND METHODS: Twenty three patients with biopsy-proven meningiomas were examined with MR imaging over a 3 years period. Images were assessed for average T1, T2 intensity score(1-5), degree of edema, calcification, cyst formation or necrosis, and dural tail sign. RESULTS: Tl-weighted images showed only one significant correlation between fibroblastic type and angiobiastic type (p<0.04). Angioblastic type was more hypointense than gray matter(1.83/isointense to gray 3) on T1-weighted image. Syncytial and angioblastic tumors had average T2 intensity scores much higher than those of fibroblastic and transitional types. All three cases of angioblastic tumors had shown severe edema. Calcified lesions were much more common in transitional and fibroblastic types than in syncytial and angioblastic types. CONCLUSION: MRI is a helpful diagnostic imaging modality with good correlation between its MR findings and histologic patterns.

CT Findings of Cervical Lymphadenopathy: Differential Diagnosis

PURPOSE: To evaluate the characteristics of CT findings in differential diagnosis of cervical lymphadenopathy. MATERIALS AND METHODS: We evaluated CT findings of histopathologically proved 32 cases of tuberculous lymphadenitis, 12 cases of nodal lymphoma, 29 cases of metastasis from March 1986 to Dec. 1992, retrospectively. We analyzed age and sex distribution, location of lymphadenopathy, internal nodal density, feature of contrast enhancement, extracapsular spread and nodal calcification. RESULTS: Tuberculous lymphadenitis was more preponderant in young female (mean;32) and CT showed internal low density(91%) with irregular thick marginal enhancement(46.9%), predilection for spinal accessory node(71.9%), and nodal calcification(5/32). Nodal lymphoma showed predilection for internal jugular chain (100%) and had conglomerated homogeneous internal node structures(83%). Metastasis showed old male preponderance (mean :52 years), predilected at internal jugular chain(89.7%),internal low density(93.3%) with regular thin marginal enhancement(44.8%), extracapsular spread(41.4%), and nodal calcification(2 cases of nodal metastasis of papillary type thyroid cancer). CONCLUSION: We concluded that CT evaluation of the chracteristics of lymphadenopathy is helpful for differential diagnosis of cervical lymphadenopathy.

Neurosonographic evaluation and follow-up study of GMH/IVH in infants with less than 2500mg

GMH/IVH(Germinal martrix-Intraventricular hemorrhage ) is an inportant factor that influences on the mortality rate of low-birth-weight infants. The real-time high resolution sonography with a mechanical sector scanner is a convenient and useful method for the detection and follow-up study of intracranial hemorrhage in low-birth-weight infants. Authors analysed 112 cases of neurosonographic findings in low-birth-weight infants, weighing less than 2,500gm. The incidence of GMH/IVH was 54.5%. The severity of GMH/IVH was classified into 4 grades(I-IV) and their percentages were 41%, 41% 8.1%, and 9.9%, respectively. The onset of GMH/IVH was within the first week after birth in 75.4% of cases. The overall mortality rate of low-birth-weight infants with GMH/IVH was 18% (4% for grade I, 12% for grade II, 40% for grade III and 83% for grade IV). In the follow-up study of 61 cases, complete absorption was seen in 25 cases, rebleeding in 5 cases, cystic change in 24 cases, ventriculomegaly in 9 cases and hydrocephalus in 7 cases. The incidence of GMH/IVH in neonates with pathologic lung conditions was 82.5% and that with normal lung conditions was 39%. In conclusion, sonography is very useful in the diagnosis and follow-up of GMH/IVH in low-birth-weight infants. Our study is the first step in the further study of the relationship between GMH/IVH and neuromotor outcome.

Computed tomographic findings of maxillary sinus cancer

No abstract available.

Computerized tomographic evaluation of intracranial metastases

In a study of intacranial metastases, 46 cases having satisfactory clinical, operative and histological proofswere analyzed by computerized tomography at Presbyterian Medical Center from May, 1982 to February, 1986. Theresults were as follows: 1. The male to female ratio of itracranial metastases were 67:33. The 5th decade group(34.8%) was the most prevalent age group, followed by the 6th decade(21.7%) and 7th decade(21.7%). 2. The numberof lesions was found to be: single-25 cases(54.3%); multiple-21 cases(45.7%). 3. The source of intracranialmetastases found to be: lung 15 cases(32.6%); unknown 12 cases(26.0%); chorioca 3 cases(6.5%); liver 3cases(6.5%); liver 3 cases(6.5%); stomach 2 cases(4.3%); parotid, breast, kidney, prostate, melanoma, rectal ca.rhabdomyosarcoma, nasal ca. lymphoma, testicular ca, cervix, each 1 case(2.2%). 4. The locations of theintracranial metastases were as follows: Cerebral hemisphere 37.7% in parietal region Cerebra hemisphere 15.9% inin frontal region Cerebral hemisphere 13.4% in occipital region Cerebra hemisphere 10.5% in temporal regionCerebellar hemisphere 3.2% Cerebellopontine angle 3.2% Intraventricular 4.8% Meninges 4.8% Skull vault 6.5% 5.Peritumor edema was found to be: Grade II-17 cases(37.0%): Grade III-14 cases(30.4%); Grade I-8 cases(17.4%);Grade 0–7 cases(15.2%) in that order. 6. The chief complaints of intracranial metastases on admission, were asfollows: Headache 30 cases(65.2%); Vomiting 11 casees(23.9%); deteriorated mental state 10 cases(21.6%);Hemiplegia 7 cases(15.2%); visual disturbance 6 cases(13.0%); hemiparesis 4 cases(8.7%); seizure 4 cases(8.7%);other symptoms were less frequent. 7. On pre-contrast scan, hyperdense lesions were present in 18 cases(39.1%);hypodense lesions in 15 cases(32.6%); mixed density in 8 cases(17.4%); isodenisty was present in 5 cases(10.9%).On post-contrast scan, ring enhancement was seen in 19 cases(41.3%); nodular enhancement in 17 cases(37%); mixedring-nodular enhancement in 8 cases(17.4%); only hypodense 2 cases(4.3%).

Computerized tomographic evaluation of primary brain tumors

In a study of primary brain tumors 104 cases having satisfactory clinical, operative and histological proofswere analyzed by computerized tomography at Presbyterian Medical Center from May, 1982 to April, 1985. The resultswere as follows: 1. The male to female ratio of primary brain tumor was 54:46. 2.The 2nd decade group (26%) wasthe most prevalent age group, followed by the 5th decade(16.3%), 1st decade(14.4%), 3rd decade(12.5%), 4thdecade(11.5%), 6th decade(10.6%), 7th decade(8.7%) in that order. 3. The incidence of primary brain tumors was found to be: glioma 64 cases(61.6%) (among the GM, the most frequent 17 cases(16.3%), followed by meningioma 12cases (11.5%), pituitary adenoma 10 cases (9.6%), craniopharyngioma 6 cases(5.8%), pinealoma and germinoma 3cases(2.9%) respectively, and dermoid cyst 2 cases(1.9%) in that order. 4. The locations of the primary braintumors were as follows: cb. hemisphere(49%) of these 24.5% in parietal region, 11.9% in temporal region, 9.7% infrontal region, 3.0% in occipital region: Juxtasella area(16.3%), cerebellar hemisphere(8.7%), Parapineal andintraventricle(7.7%) respectively, cerebello-pontine angle area(5.8%), vermis and 4th ventricular region(4.8%). 5.There were no remarkable differences in the findings of pre-and post-contast CT scanning of primary brain tumorscompared with others.

Radiological evaluation of pulmonary metastasis

158 cases of pulmonary metastasis having satisfactory histological proof of the primary malignant tumor, the frequency and pattern of which were analysed by conventional radiologically. The results are as follows: 1. The frequency of pulomonary metastasis according to the primary sites was 24%(38/158) hepatobiliary system,19.6%(31/158) gastrointestinal tract, 18.9%(30/158) uterine cervix and 12%(13/158) head and neck. 2. Pulmonary metastatic pattern showed nodular type 74% (117/158), granular type 10.1%(16/158), streaky type 9.5%(15/158),hilar enlargement 3.8%(6/158), patchy type 1.9% (3/158) and others 0.6%(1/158). Of all these type, nodular type was predominant. 3. The nodular type of pulmonary metastasis was classified into less than 10 nodules56.4%(66/17), 10-50 nodules 25.6%(30/117), more than 50, 17.9%(21/117), less than 1cm 12.8%(15/117) and more than5cm in 5.2%(1/117) of the cases. 4. The size of nodule was 1-3cm 36.6%(43/117), 2-3cm 20.5%(24/117), less than 1cm12.8%(15/117) and more than 5cm in 5.2%(1/117) of the cases. 5. Most cases of pulmonary metastasis involved bothlung fields 69.2%(110/58). Others were right lung field only 17.7% (28/158), left lung only 12.7%(20/158). 6. Theages between 40 and 70 represented 79.8%(126/158) of the cases and the raio of male and female was about 1.5:1.

Radiologic Evaluation of Colorectal Cancer

The incidence of colorectal cancer of Korea is much lower than that of Western countries, but has shown a tendency to a slight increase recently Barium enema is the most valuable, noninvasive and inexpensive method available to evaluate the size, shape and site of colorectal cancer. The authors reviewed and radiologically classified barium enema studies of 232 cases of colorectal cancer from Aug. 1967 to July 1982 at Presbyterian Medical Center, Jeon-ju , Confirmed clinically, operatively and pat hologically. The results were as follows; 1. The ratio of male and female was 1.3:1, and youngest was 13 year-old and the oldest 86 year-old. 2. The peak incidence occurred from 5th to 7th decades, accounting for 78% of all cases (181/232), and there was a relatively high incidence of the disease in patients below 30 years of age at 7.8% (18/232). 3. Rectum and rectosigmoid region are the most frequently involved regions (127/23 2:54.8%). 4. The positivity of barium enema examination was 4.0% (232/5807), and its accuracy was 96.5% (224/232) . 5. The radiologic findings were classified into 4 groups, and they were annular encircling 62.9% (146/232), polypoid fungating 26.8% (62/232), infiltrating 8.6% (20/232), and primary ulcerating 1.7% (4/232) in order of frequency. 6. The linear length of the cancer ranged from 1.5 Cm to 15 Cm , and the average length was 5.5 Cm. 7. There was no statistical correlation between the length of lesion, the site, and the radiologic findings, and stages of the lesion (P:0.750-0.250). 8. The majority of colorectal cancers was adenocarcinoma (217/232:93.6%).

Percutaneous transhepatic cholangiographic evaluation of obstructive jaundice

PTC is the single most valuable diagnostic method available to evaluate the size, shape and site of the causesof obstuctive jaundice among various radiological procedures. The authors reviewed and radiologically classifiedthe PTC films of 203 cases of obstructive jaundice from July 1977 to June 1983 at Presbyterian Medical Center,Jeon-ju confirmed clinically, operatively and pathologically. The resuls are as follows; 1. The most common causeof obstructive jaundice was bile duct stoen (64/203:31.53%) and the other causes were bile duct cancer(43/203:21.18%), pancreas cancer(41/203:20.19%), biliary ascariasis &/or clonorchiasis(20/203:9.85%), ampulla andduodenal cancer (7/203:3.45%), fibrotic stenosis of sphincter of Oddi(6/203: 2.96%) etc. in that order. Of theseprimary involvement with cancer was more frequent (91/203:44.33%) than stone. 2. 88.33%(179/203) of patients wasover 40-year-of- age and the sex ratio between male and female was about 2:1. 3. The average maximal diameter ofextrahepatic bile duct just proximal to the site of obstruction or stenosis by stones or by cancers was nearlyequal(2.36cm:2.38cm). 4. Cancers caused complete bile duct obstruction in about 75%(68/91) of cases and also wereassociated with intrahepatic duct dilatation about 92%(84/91) of cases. But in contrast biliary calculi showedgood drainage of contrast medium in 75%(48/64) of cases and 92%(59/64) showed normal diameter of intrahepaticduct. 5. The differential PTC findings between bile duct cancer and pancreas cancer were not so distinct but inbiel duct cancer the obstruction site of the bile duct was more irregular and serrated than pancreas cancer, whilethe latter showed a more downward convexity and a smoother end. Moreover annular filling defect with overhangingedges was seen only in bile duct cancer.

Radiological assessment of spinal cord tumor by myelographic finding

The authors analyzed a series of 49 cases of spinal cord tumor confirmed by operation and biopsy at Presbyterian Medical Center, Jeonju, from Jan. 1977 to Dec. 1981. Histologically vertified spinal cord tumors wereneurofibroma(36.7%: 18/49), meningioma(22.5%; 11/49), ependymoma(18.5%; 9/49), metastasis(10.2%; 5/49),astrocytoma(6.1%; 3/49), epidermoid (2.0%;1.49), glioblastoma multiforme(2.0%;1/49), and diffuse non-Hodgkin'slymphoma(2.0%;1.49). The results were as follows; 1. The most frequently encountered tumor was the intraduralextramedulary tumor(55.1%;27/49). The other tumors, in descending order, were intramedullary tumor(26.5%; 13/49),extradural extradural extramedullary tumor(10.2%;5/49), and intra-&extradural extramedullary tumor(8.2%;4/49).The most frequently encoutered tumor was neurofibroma(36.7%; 18/49). Four of the 18 neurofibroma were intra-&extradural extramedullary tumor, and three(3/4) were dumbbell type of neurofibroma. 2. Only 3 cases occurred under20 years of age. They were glioblastoma multiforme, neurofibroma and epidermoid. 3. No sex predominance of spinalcord tumor was seen, but the majority of the meningiomas occurred in females(81.8%). 4. The most frequent site oftumors was the thoracic region(53.1%;26/49). The order sites were the cervical regions(2.0%;1/49) . 5. Thirteencases (26.5%) showed bony changs on preliminary roentgenograms of the spine. None showed bony changes inextradural extramedullary tumor. 6. As a rule, the myelographic deformities produced by intramedullary tumorshowed fairly long fusiform dilatation of the contrast column without displacement of the spinal cord; theextradural extramedullary tumor showed coarse transverse serrated block of the contrast column; and the intraduralextramedullary tumor showed cup defect of the contrast column.