Imaging Finding of Malignant Melanoma of Eustachian Tube with Extension to Middle Ear Cavity: Case Report

We report a case of malignant melanoma of Eustachian tube with extension to the middle ear cavity and nasopharynx in a 51-year-old woman who presented with right ear fullness. Computed tomography showed a soft tissue mass in the middle ear cavity and causedthe widening and eroding of the bony eustachian tube. Magnetic resonance imaging showed well enhancing mass in eustachian tube extending nasopharynx to middle ear cavity. A biopsy of the middle ear cavity mass revealed a malignant amelanotic melanoma.

Bilateral Medial Medullary Infarction Demonstrated by Diffusion-Weighted Imaging: Case Report / 영남의대학술지

A 78-year-old woman presented with weakness of the extremities, dysarthria, dizziness, and sensory impairment. Magnetic resonance imaging showed acute bilateral medial medullary infarction. Contrast enhanced magnetic resonance angiography demonstrated stenosis or occlusion of both intracranial vertebral arteries. We present a rare case of bilateral medullary infarction seen on diffusion-weighted imaging.

MR Imaging of a Cerebello-Pontine Angle Epidermoid Cyst with a Malignant Transformation: Case Report

The malignant transformation of an epidermoid cyst can be discovered at the same time as a pre-existing epidermoid cyst, or during a follow-up examination after an incomplete excision. We describe a rare case of malignant transformation of a cerebello-pontine angle epidermoid cyst which extended into the middle cerebellar peduncle.

MR Manifestations of the Brain in Neuropsychiatric Systemic Lupus Erythematosus Patients

PURPOSE: The primary goal of this study was to evaluate the MR findings of systemic lupus erythematosus (SLE) patients with neuropsychiatric symptoms. MATERIALS AND METHODS: The MR images of 38 patients with SLE were evaluated based on the presence of the following abnormal lesions: the locations of the abnormal signal intensity lesions in the white matter, infarctions, a small vessel vasculopathy, leukoencephalopathy, hemorrhage, abscess, and other lesions. RESULTS: The MR images showed an abnormality in 22 of 38 (58%) episodes. Abnormal signal intensities were noted in the subcortical and periventricular white matter in six cases, acute territorial infarctions in five cases, multiple small acute embolic infarctions in four cases and a brain abscess in two cases. A reversible posterior leukoencephalopathy was found in one case. In addition, another patient had vasogenic edema with focal central cytotoxic edema at the pons. The entire cerebral and corpus callosum volumes were significantly smaller in four patients with SLE as compared to the volumes in healthy control subjects. CONCLUSION: SLE may induce variable MR imaging findings of the CNS. Recognition of the variable findings is helpful for easy diagnosis and prompt treatment.

Diffusion Weighted MRI Patterns Caused by Acute Border Zone Infarction

PURPOSE: We investigated the causes and mechanisms driving acute border zone infarctions using diffusion-weighted imaging (DWI). MATERIALS AND METHODS: We analyzed DWI in 104 patients (male: 72 years, female: 32 years, age range: 44 to 84 years) with acute border zone infarction. The DWI patterns were classified as follows: pattern A- An acute border zone infarction combined with multiple small disseminated cortical infarctions, pattern B- An acute border zone infarction only. RESULTS: The most common cause of acute border zone infarctions was extracranial internal carotid artery (ICA) stenosis (45 cases, 43%). Other causes included middle cerebral artery stenosis (22 cases, 21%), intracranial ICA stenosis (14 cases, 13%), unknown, (12 cases 12%), iatrogenic (6 cases, 6%) and cardiogenic (5 cases, 5%), respectively. The most common pattern for DWI was pattern A (83 cases, 80%). We performed a transcranial Doppler in 7 of 75 cases (11%), and found at least 1 embolic pulse. CONCLUSION: The most common pattern of DWI for acute border zone infarctions was pattern A. We propose that the mechanisms driving acute border zone infarctions are emboli coupled with hypoperfusion.

The Efficacy of an Ultrasound-guided Core Needle Biopsy with an 18G Cutting Needle for the Diagnosis of Pancreatic Diseases

PURPOSE: The objective of this study is to evaluate the efficacy and safety of an ultrasound-guided core needle biopsy with an 18G cutting needle in patients suspected of having a pancreatic disease by analyzing the diagnostic performance and complication rate. MATERIALS AND METHODS: The study population comprised 35 consecutive patients who underwent an ultrasound-guided core needle biopsy using a high-speed biopsy gun accompanied with an 18G cutting-type needle between May of 2001 and October of 2005. The diagnostic performance (i.e., the acquisition rate and diagnostic accuracy) and complications associated with core needle biopsies were evaluated for its efficacy and safety. RESULTS: Thirty-six sessions of ultrasound-guided core needle biopsies were performed in 35 consecutive patients. All patients, except two (serous cystadenoma and autoimmune pancreatitis) were diagnosed with various subtypes of pancreatic cancer. The acquisition rate and diagnostic accuracy were 97% (35/36) and 94% (34/36), respectively. A complication occurred only in one patient (3%), which further proved to be a delayed complicaton (i.e., needle tract implantation). CONCLUSION: According to our findings, the ultrasound-guided core needle biopsy is a viable and safe method for the dignosis of pancreatic diseases. Moreover, it enables the diagnosis of the pancreatic cancer subtype.

Cortical Involvement of Marchiafava-Bignami Disease: A Case Report

Marchiafava-Bignami disease is a rare complication of chronic alcoholism and this malady typically manifests as callosal lesion. I report here on one patient with Marchiafava-Bignami disease (MBD) who has symmetric restricted diffusion in both lateral-frontal cortices, in addition to the callosal lesion.

Endovascular Treatment of Traumatic Carotid- Jugular Fistula: Report of Two Cases

We report 2 patients with a traumatic carotid- jugular fistula. The first patient suffered a deep neck penetrating injury. The external carotid-jugular fistula was demonstrated by 3-dimension CT angiography (3D CTA) and digital subtraction angiography (DSA). The patient was treated with coil embolization. The second patient suffered a gun shot injury to the neck. 3D CTA and DSA revealed a common carotid-jugular fistula and a pseudoaneurysm. The common carotid-jugular fistula was treated with coil embolization in the fistula and the pseudoaneurysm was treated with stent assisted coil embolization.

Microvascular Injury of the Peribiliary Plexus Associated with Transarterial Chemoembolization: A Study of Surgical Specimens

PURPOSE: We attempted to evaluate the relationship between transarteiral chemoembolization (TACE) and injury to the peribiliary plexus by evaluating the number of microvessels in the peribiliary plexus of surgical specimen. MATERIALS AND METHODS: Surgical specimens were obtained from 78 hepatocellular carcinoma patients and 22 patients with liver metastases. They were divided into 4 groups (Group 1; hepatocellular carcinoma without TACE [n=30], Group 2; hepatocellular carcinoma receiving preoperative TACE once [n=37], Group 3; hepatocellular carcinoma receiving preoperative TACE more than two times [n=11] and Group 4; metastatic carcinoma of the liver patients without a history of liver disease [n=22]). Immunohistochemical staining for factor VIII-related antigen was performed in all the specimens and the number of microvessels in the inner capillary layer and the outer venous layer of the bile duct (> 200 micrometer in diameter) was counted. RESULTS: The mean numbers of microvessels in the inner capillary layer were 4.50, 4.08, 1.64 and 2.05, and those in the outer venous layer were 25.23, 20.00, 18.36 and 12.32 for the 4 groups, respectively. The number of microvessels in group 4 was statistically fewer than that of group 1 (p<0.01). In the hepatocellular carcinoma patients, the number of microvessels was decreased as the number of TACE sessions was increased. CONCLUSION: The number of microvessels in the peribiliary plexus is increased in chronic liver disease patients. It may be from the increased portal pressure and flow stagnation in the sinusoidal and portal venules. TACE can have an effect on microvascular injury of the peibiliary plexus, and this can be a cause of bile duct necrosis and biloma.

The Usefulness of MDCT in Acute Intestinal Bleeding

PURPOSE: We wanted to evaluate the usefulness of MDCT for localizing a bleeding site and for helping make a decision on further management for acute intestinal bleeding. MATERIALS AND METHODS: We conducted a retrospective review of 17 consecutive patients who presented with acute intestinal bleeding and who also underwent MDCT before angiography or surgery. The sensitivity of MDCT for detecting acute intestinal bleeding was assessed and compared with that of conventional angiography. RESULTS: The sensitivity of MDCT for the detection of acute intestinal bleeding was 77% (13 of 17), whereas that of angiography was 46% (6 of 13). All the bleeding points that were subsequently detected on angiography were visualized on MDCT. In three cases, the bleeding focus was detected on MDCT and not on angiography. In four cases, both MDCT and angiogphy did not detect the bleeding focus; for one of these cases, CT during SMA angiography was performed and this detected the active bleeding site. CONCLUSION: In patients with acute intestinal bleeding, MDCT is a useful image modality to detect the bleeding site and to help decide on further management before performing angiography or surgery. When tumorous lesions are detected, invasive angiography can be omitted.

Schwannoma of the Appendix: A Case Report

Schwannoma is a benign neurogenic tumor arising from the nerve sheath, and it presents as a well defined mass. Isolated gastrointestinal schwannoma is a relatively rare finding and schwannoma of the appendix is extremely rare. We report here on a case of schwannoma that arose from the appendix, and this lesion was pathologically confirmed.

Undiffentiated Carcinoma with Osteoclast-like Giant Cells of the Pancreas / 대한소화기학회지

Undifferentiated carcinoma with osteoclast-like giant cells is a rare neoplasm of exocrine pancreas. Till recently, some cases have been reported, however histogenesis of the tumors are controversial and their characteristic findings have not been described yet. Thirty five-year-old men and 75-year-old men were presented with upper abdominal pain and a palpable mass. On computed tomography, one case showed a well enhancing solid tumor with low density and the other was showed a mainly cystic tumor with peripheral enhancement in the body and tail of the pancreas. One case accompanied multiple metastatic liver masses with subhepatic lymph node enlargement. Tumor staining was seen on angiography. Biopsy and pancreatectomy were performed. Pathological findings revealed tumors composed of neoplastic spindle shaped or pleomorphic large cells with scattered non-neoplastic osteoclast-like giant cells. In one case, there were small foci of adenocarcinoma components in the periphery of the tumor. On immunohistochemical stain, neoplastic cells showed focal positivity for epithelial membrane antigen and vimentin. Tumors were diagnosed as undifferented carcinoma with osteoclast-like giant cells. We report these rare cases with a review of literature.

Prepancreatic Postduodenal Portal Vein: A Case Report

Prepancreatic postduodenal portal vein (PPPV) is a rare anomaly in which the portal vein runs between the pancreatic head and the duodenum. Understanding of this portal vein anomaly is important to avoid devastating complications, including portal vein ligation, resection or intraoperative hemorrhage. A 28-year-old female patient presented with right upper quadrant pain that she had suffered with for 2 days. Before performing laparoscopic cholecystectomy, we detected an abnormal shaped portal vein that ran in front of the pancreatic head and posterior to the duodenum on the CT scan. We report here on a rare case of prepancreatic postduodenal portal vein that was incidentally discovered on the CT axial images and coronally reformated images, in addition to observing it on the conventional portography.

Influence of Lesion Location on Cortical Recovery Pattern in Hemiparetic Stroke Patients

OBJECTIVE: The aim of this study was to elucidate how the location of cerebral infarct influences cortical recovery pattern in hemiparetic stroke patients. METHOD: Forty-three chronic stroke patients and 21 control subjects were recruited for the study. The patients were classified into 4 groups according to infarct locations: cortex (CO), corona radiata (CR), posterior limb of the internal capsule (PL), and brainstem (BS). Functional MRI was performed using the blood oxygen level-dependent technique at 1.5 T with the motor task of hand grasp-release movements. RESULTS: The activation pattern of the primary sensori-motor cortex (SM1) was found to be significantly influenced by the lesion locations, but that of the secondary motor area was not (Pearson's chi-square test, p<0.05). The contralateral' SM1 activation was the major response in the control group (85.7%) and in the BS group (75.0%). On the other hand, the major activation pattern was `peri-lesional' in the CO group (peri-lesional 57.1%, peri-lesional and ipsilateral 42.9%), `bilateral activation' in the CR (85.7%) and the PL group (100.0%). CONCLUSION: Our results suggested that motor recovery mechanisms could be different according to location of cerebral infarct.

Non-Infectious Ischiogluteal Bursitis: MRI Findings

OBJECTIVE: We wished to report on the MRI findings of non-infectious ischiogluteal bursitis. MATER AND METHODS: The MRI findings of 17 confirmed cases of non-infectious ischiogluteal bursitis were analyzed: four out of the 17 cases were confirmed with surgery, and the remaining 13 cases were confirmed with MRI plus the clinical data. RESULTS: The enlarged bursae were located deep to the gluteus muscles and postero-inferior to the ischial tuberosity. The superior ends of the bursal sacs abutted to the infero-medial aspect of the ischial tuberosity. The signal intensity within the enlarged bursa on T1-weighted image (WI) was hypo-intense in three cases (3/17, 17.6%), iso-intense in 10 cases (10/17, 58.9%), and hyper-intense in four cases (4/17, 23.5%) in comparison to that of surrounding muscles. The bursal sac appeared homogeneous in 13 patients (13/17, 76.5%) and heterogeneous in the remaining four patients (4/17, 23.5%) on T1-WI. On T2-WI, the bursa was hyper-intense in all cases (17/17, 100%) ; it was heterogeneous in 10 cases and homogeneous in seven cases. The heterogeneity was variable depending on the degree of the blood-fluid levels and the septae within the bursae. With contrast enhancement, the inner wall of the bursae was smooth (5/17 cases), and irregular (12/17 cases) because of the synovial proliferation and septation. CONCLUSION: Ischiogluteal bursitis can be diagnosed with MRI by its characteristic location and cystic appearance.

Ultrasonographic and Magnetic Resonance Imaging Findings of Transitional Cell Carcinoma Arising at Penile Fossa Navicularis: Case Report

Primary carcinoma of the male urethra are rare. Among the malignant tumors of the male urethra, squamous cell carcinoma is the most common. Transitional cell carcinoma is very rare, particularly in the distal urethra. We experienced a case of distal urethral transitional cell carcinoma, arising at the fossa navicularis of the penis, which we report here with a review of the literature. A 68-year-old male patient presented with bloody discharge from the prepuce for 1 month. Ultrasonography showed a poorly marginating, heterogeneous mass, invading the glans penis and the corpus spongiosum. The mass encircled the glandular urethra of the penis glans, and obstructed the glandular urethra and the fossa navicularis. A Doppler ultrasonogram revealed hypervascularity in this mass. The mass was isointense to the corpus carvernosum on the T1-weighted images and slightly hypointense to the corpus carvernosum on the T2-weighted images. Contrast-enhanced MR imaging showed a poorly enhancing mass in the glans penis. This mass was confirmed as a transitional cell carcinoma by histologic study and a partial penectomy was performed.

MR Findings of Tuberculous Arthritis: Significance of Tuberculoma

PURPOSE: To determine the magnetic resonance (MR) imaging findings of tuberculous arthritis, and the frequency-in such cases-with which tuberculoma occurs. MATERIALS AND METHODS: MR images of 26 patients (M:F, 14:12; mean age, 46.2 years) with pathologically proven tuberculous arthritis were retrospectively reviewed. The presence of joint effusion, subchondral erosion, synovial proliferation and soft tissue abscess, and whether the inner wall of this abscess was smooth, were assessed. In particular, we determined whether a nodular lesion which showed low SI on T1WI, central low SI with peripheral high SI on T2WI, and rim enhancement on contrast study, was a tuberculoma. RESULTS: The joints involved were those of the knee (n=7), hip (n=7), shoulder (n=4), sacroiliac region (n=3), elbow (n=3), and ankle (n=2). Joint effusion was noted in 15 cases (58%), and subchondral erosion in 24(92%). synovial proliferation was found in 23 cases (88%), and soft tissue abscess in 24 (92%). The inner wall of this abscess was irregular in 17 cases (71%). A tuberculoma was present in intra- or extra-articular soft tissue in 18 cases (69%). CONCLUSION: The MR findings of tuberculous arthritis were subchondral erosion, synovial proliferation, and soft tissue abscess. The presence of a tuberculoma in intra- or extra-articular soft tissue, a specific finding in tuberculous arthritis, was noted in 69% of our cases.

MRI Findings of Neuro-Behcet' Disease / 영남의대학술지

MR findings in nine patients(three female, six male) with neuroBehcet's disease were retrospectively analyzed. NeuroBehcet's disease was diagnosed on the basis of typical clinical symptoms. Involved site, pattern, signal intensity, and contrast enhancement pattern on MRI were evaluated. In addition, follow up MR imaging was performed in four patients. The midbrain(7/9), internal capsule(7/9), pons(6/9), thalamus(6/9), basal ganglia(5/9), middle cerebella peduncle(4/9), medulla oblongata(2/9), and subcortical white matter(2/9) are involved on MRI. The size of lesions were 1cm to 3cm and their margin was ill-defined and patchy. Inhomogeneous high signal intensity on the T2-weighted images and low signal intensity on T1-weighted images was seen respectvely. In four of nine cases, there was focal enhancement. On follow up MR imaging, improvement or recurrance of the lesions was found. Also in two cases of follow up cases there was artophy in brainstem and/or middle cerebellar peduncles. In conclusion, MR imaging with systemic clinical symptoms is useful for diagnosing neuro-Behcet's disease.