Coiling as Retreatment in Intracranial Aneurysm of de novo Formation or Regrowth: Case Report / 신경중재치료의학

Development of de novo aneurysm or aneurysm regrowth after complete clipping of an intracranial aneurysm is rare. We report coiled cases of de novo aneurysm and aneurysm regrowth. We retrospectively reviewed 107 cases of intracranial aneurysm coiling performed in our hospital, identifying five cases of coiled aneurysm that were de novo aneurysm or aneurysm regrowth. In all the cases, total or near total occlusion was seen. There were no complications related to the procedure. In two of the three patients with ruptured aneurysms, consciousness level on admission was stupor. When the patient was discharged after the treatment, one of them had 4 of the modified Rankin Scale. The other one had 5 on discharge. The rest three patients had 0. As for a de novo aneurysm or a regrowth of aneurysm, coiling may be considered when clipping is difficult.

Transvenous Embolization of Cavernous Sinus Dural Arteriovenous Fistula Using the Direct Superior Ophthalmic Vein Approach: A Case Report / 신경중재치료의학

Transvenous coil embolization has been successfully applied for the treatment of cavernous sinus dural arteriovenous fistula (CSDAVF). Unfortunately, the technique cannot be applied in cases of poor or absent inferior petrosal sinus or facial venous access route to the fistula. Recently, we experienced a successful embolization using direct superior ophthalmic vein approach in cases of CSDAVF which were no opacification of inferior petrosal sinus or facial vein.

Diagnosis of Vertebral Artery Ostial Stenosis on Contrast-Enhanced MR Angiography: Usefulness of a Thin-Slab MIP Technique

It is a well-known clinical fact that contrast-enhanced magnetic resonance angiography exaggerates vertebral arterial ostial stenosis and sometimes shows pseudostenosis. Considering the clinical significance of a lesion in the posterior circulation ischemia, the importance of an accurate imaging diagnosis of ostial stenosis should not be underestimated. We were able to differentiate pseudostenosis of the ostium from true stenosis using thin-slab maximum-intensity-projection(MIP) images which are thought to be helpful for minimizing standard full thickness MIP images.

Differentiation between Benign and Malignant Solid Thyroid Nodules Using an US Classification System

OBJECTIVE: To evaluate the diagnostic accuracy of a new ultrasound (US) classification system for differentiating between benign and malignant solid thyroid nodules. MATERIALS AND METHODS: In this study, we enrolled 191 consecutive patients who received real-time US and subsequent US diagnoses for solid thyroid nodules, and underwent US-guided fine-needle aspiration. Each thyroid nodule was prospectively classified into 1 of 5 diagnostic categories by real-time US: "malignant," "suspicious for malignancy," "borderline," "probably benign," and "benign". We evaluated the diagnostic accuracy of thyroid US and the cut-off US criteria by comparing the US diagnoses of thyroid nodules with cytopathologic results. RESULTS: Of the 191 solid nodules, 103 were subjected to thyroid surgery. US categories for these 191 nodules were malignant (n = 52), suspicious for malignancy (n = 16), borderline (n = 23), probably benign (n = 18), and benign (n = 82). A receiver-operating characteristic curve analysis revealed that the US diagnosis for solid thyroid nodules using the 5-category US classification system was very good. The sensitivity, specificity, positive and negative predictive values, and accuracy of US diagnosis were 86%, 95%, 91%, 92%, and 92%, respectively, when benign, probably benign, and borderline categories were collectively classified as benign (negative). CONCLUSION: The diagnostic accuracy of thyroid US for solid thyroid nodules is high when the above-mentioned US classification system is applied.

Ultrasound-Guided Fine-Needle Aspiration Biopsy in Infracentimetric Thyroid Nodules

PURPOSE: The aim of this study is to determine the efficacy of ultrasound-guided fine-needle aspiration biopsy (US-FNAB) of thyroid nodules that are equal to or less than 1 cm at the maximum diameter. MATERIALS AND METHODS: The US-FNABs performed on thyroid nodules from March to August 2009 were included in this study. We retrospectively evaluated the cytopathologic results as well as any complications associated with the procedure. RESULTS: Of the 241 thyroid nodules (range: 0.1 - 1.0 cm, mean size: 5.8 mm) in 184 patients (female: male = 164:20, mean age: 49.0 years, age range: 18 - 77 years old), the incidence of an inadequate sample was 14.1% (34/241) for the US-FNABs. Eighty six nodules were surgically removed in 62 patients, of which 15 were confirmed to be benign nodules and 71 were confirmed to be malignant nodules. The number of true positive, false positive, true negative and false negative results for US-FNAB were 59, 0, 10 and 3%, respectively, and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 95.2%, 100%, 100%, 76.9% and 95.8%, respectively. All the false negative cases were less than 3 mm at the maximal diameter. There were no serious complications in all the patients. CONCLUSION: US-FNAB was effective for the cases of thyroid nodule under 1 cm at the maximal diameter. However, a false negative result of US-FNAB should be considered for the cases of very small nodules that are less than 3 mm at the maximal diameter.

Use of Self-Expanding Stents for the Treatment of Vertebral Artery Ostial Stenosis: a Single Center Experience

OBJECTIVE: To evaluate our early experience using self-expanding stents to treat atherosclerotic vertebral artery ostial stenosis (VAOS), with respect to technical feasibility and clinical and imaging follow-up results. MATERIALS AND METHODS: A total of 20 lesions in 20 patients underwent stenting of the VAOS using a self-expanding stent (Precise RX; Cordis Neurovascular, Miami Lakes, FL). Two patients were asymptomatic. We analyzed the technical success rate, causes of technical failure, occurrence of any vascular or neurological event, and the occurrence of any neurological abnormality or in-stent restenosis (ISR) seen on follow-up. The imaging follow-up was performed with Doppler ultrasound (DUS) as a primary screening modality. RESULTS: One instance of technical failure was caused by failure of the guidewire passage. The stent diameter was 5 mm, and post-stenting balloon dilatations were necessary in all cases. Stent misplacement requiring placement of an additional stent occurred in four cases. Following a 14.8 month average clinical follow-up time, two patients showed anterior circulation ischemia, which was not attributed to the VAOS we treated. Following a 13.7 month average DUS follow-up, five patients showed a mild degree of diffuse or focal intimal thickening in the stent lumen; however, none of the stenosis showed luminal loss of more than 50% and no stent fracture was noted. CONCLUSION: The use of self-expanding stents for treating VAOS was technically feasible and helped to improve artery patency during our limited follow-up interval.

Severe Atherosclerotic Cerebral Steno-occlusion in Koreans: Factors Related to Intracranial versus Extracranial Involvement / 신경중재치료의학

PURPOSE: To evaluate the factors related to severe intracranical atherosclerotic stenosis (intracranial vs. extracranial) as diagnosed by conventional angiography in Korean patients. MATERIALS AND METHODS: We retrospectively analyzed the angiographic results and clinical data of 127 consecutive patients with an angiographically confirmed stenosis greater than 70%. Nine factors, i.e. age, gender, hypertension, diabetes mellitus, hyperlipidemia, smoking and alcohol habit, previous stroke and ischemic heart disease were included as presumed explanatory variables to discriminate different types of atherosclerotic stenosis (extracranial versus intracranial stenosis). Multiple logistic regression analysis was used to estimate independent effects of the predictive variables on cerebral occlusive disease. RESULTS: Among 127 patients, 62 patients had intracranial stenosis and 65 patients had extracranial stenosis. Compared to extracranial stenosis, mean age was lower (p < 0.001), female-to-male ratio was higher (p = 0.001) and the number of patients with diabetes mellitus was less (p = 0.019) in group of severe intracranial stenosis significantly. There were no differences in hypertension, smoke and alcohol, hyperlipidemia, ischemic heart disease and previous stroke between two groups. CONCLUSION: In Korean patients, severe atherosclerotic intracranial stenosis has younger, female and diabetes-free preference than severe atherosclerotic extracranial stenosis.

Endovascular Treatment of Idiopathic Intracranial Hypertension: A Case Report / 신경중재치료의학

Increased pressure in the dural venous sinuses has been proposed as the cause of idiopathic intracranial hypertension and mostly from the stenoses or occlusions of the lateral sinuses. This hypothesis has received further support from manometry of the dural venous sinuses, showing a substantial proximalto-distal pressure gradient, and from reports of improvement of idiopathic intracranial hypertension following stenting of the dural sinuses. We described a 44-year-old woman with symptom of idiopathic intracranial hypertension, who was treated with transverse sinus stenting in our hospital.

Malignant Transformation of Nodular Hyperplasia in the Thyroid: A Case Report

Thyroid carcinogenesis is traditionally thought to originate 'de novo'. However, it is debatable whether a malignant transformation can possibly arise from a benign thyroid nodule, as suggested for the malignant transformation of a thyroid adenoma. To the best of our knowledge, no studies have been performed addressing the malignant transformation of nodular hyperplasia in the thyroid gland. Here, we report a case of nodular hyperplasia with focally malignant degeneration.