US Diagnosis of Sparganosis Within the Thigh: Case Report

Sparganosis is an uncommon infection caused by sparganum, a migrating plerocercoid larva. Currently, various imaging modalities have been actively used for the diagnosis of sparganosis before surgery. We present a case of sparganosis arising in the subcutaneous layer of the thigh that was diagnosed only by an ultrasound examination.

Usefulness of Spinal MR Angiography for Detecting Adamkiewicz Artery

PURPOSE: We wanted to evaluate the detection rate of the artery of Adamkiewicz (AKA) by contrast-enhanced MR angiography (CE-MRA) and to compare the detection rate of AKA between the coronal source image plane and the sagittal source image plane. MATERIALS AND METHODS: Between December 2004 and May 2005, 23 patients (9 men and 14 women. age range: 11-86 years, mean age: 43 years) who were examined by contrast-enhanced MRI for the purpose of evaluating spondylopathy were also studied by performing spinal CE-MRA. Spinal CE-MRA was performed with a 1.5-T system and with using 3D Fast field echo with a double dose (0.2 mmol/kg) of Gadolinium. Source images were obtained in either the sagittal plane (n = 11) or the coronal plane (n = 12) at random. The source images were reconstructed with multiplanar reconstruction and maximum intensity projection. Two radiologists, who were kept unaware of the source image plane, independently evaluated the CE-MRA with focusing on the AKA. The detection rate was evaluated and the difference of detection rates according to the source image plane was compared and analyzed. RESULTS: CE-MRA could demonstrate the AKA in 11 (47%) of the 23 patients. The interobserver agreement for detection was fair (κ=0.283). Among the 11 patients in whom the MRA was obtained with using the coronal plane source image, CE-MRA detected the AKA in three of them (27%); among the 12 patients in whom the CE-MRA was obtained with using the sagittal plane source image, CE-MRA detected the AKA in 8 of them (67%, p = 0.059). The AKA in 7 cases (63%) originated from the intercostal or lumbar arteries on the left side at L2 (n = 3), L1 (n = 2), T12 (n = 1) or T9 (n = 1), and on the right side at L1 (n = 1) or T12 (n = 3). CE-MRA with coronal slice orientation visualized the AKA in 8 (67%) of the 11 patients (p = 0.059). CONCLUSION: The detection rate of AKA by CE-MRA was 47%. By obtaining the source image in the coronal plane, the detection rate of AKA was 67%.

Usefulness of Spinal MR Angiography for Detecting Adamkiewicz Artery

PURPOSE: We wanted to evaluate the detection rate of the artery of Adamkiewicz (AKA) by contrast-enhanced MR angiography (CE-MRA) and to compare the detection rate of AKA between the coronal source image plane and the sagittal source image plane. MATERIALS AND METHODS: Between December 2004 and May 2005, 23 patients (9 men and 14 women. age range: 11-86 years, mean age: 43 years) who were examined by contrast-enhanced MRI for the purpose of evaluating spondylopathy were also studied by performing spinal CE-MRA. Spinal CE-MRA was performed with a 1.5-T system and with using 3D Fast field echo with a double dose (0.2 mmol/kg) of Gadolinium. Source images were obtained in either the sagittal plane (n = 11) or the coronal plane (n = 12) at random. The source images were reconstructed with multiplanar reconstruction and maximum intensity projection. Two radiologists, who were kept unaware of the source image plane, independently evaluated the CE-MRA with focusing on the AKA. The detection rate was evaluated and the difference of detection rates according to the source image plane was compared and analyzed. RESULTS: CE-MRA could demonstrate the AKA in 11 (47%) of the 23 patients. The interobserver agreement for detection was fair (κ=0.283). Among the 11 patients in whom the MRA was obtained with using the coronal plane source image, CE-MRA detected the AKA in three of them (27%); among the 12 patients in whom the CE-MRA was obtained with using the sagittal plane source image, CE-MRA detected the AKA in 8 of them (67%, p = 0.059). The AKA in 7 cases (63%) originated from the intercostal or lumbar arteries on the left side at L2 (n = 3), L1 (n = 2), T12 (n = 1) or T9 (n = 1), and on the right side at L1 (n = 1) or T12 (n = 3). CE-MRA with coronal slice orientation visualized the AKA in 8 (67%) of the 11 patients (p = 0.059). CONCLUSION: The detection rate of AKA by CE-MRA was 47%. By obtaining the source image in the coronal plane, the detection rate of AKA was 67%.

Usefulness of Fluoroscopy-Guided Intra-articular Injection of the Knee

PURPOSE: To determine the accuracy of the intra-articular location of hyaluroinc acid injection using a blind approach and to establish the usefulness of fluoroscopy-guided intra-articular injection. MATERIALS AND METHODS: A fluoroscopy unit was used for 368 intra-articular injections of hyaluronic acid to 93 knees in 65 patients. Initially, blind needle positioning was conducted on the fluoroscopy table. The failure rate of the blind approach among the 368 injections was evaluated, and a relationship between the Kellgren-Lawrence grade (K-L grade) and the incidence of repeated failures using the blind approach was determined for injections to 52 knees in 37 patients who received a complete cycle of injections (five consecutive injections with a one-week interval between injections). RESULTS: Using a blind approach, 298 of 368 trials (81.2%) resulted in a needle tip being placed in an intra-articular location, while 70 of 368 trials resulted in an extra-articular placement of the needle tip. Among 52 knees to which a complete cycle of injections (five consecutive injections with a one-week interval between injections) was administered, repeated failure of intra-articular placement using the blind approach was seen for 18 knees (34.6%); a more severe K-L grade assigned was associated with a higher rate of repeated failure. However, the trend was not statistically significant based on the Chi-squared test (p value = 0.14). CONCLUSION: Fluoroscopy-guided needle placement may be helpful to ensure therapeutic intra-articular injection of the knee.

Pelvic Fistulas Complicating Pelvic Surgery or Diseases: Spectrum of Imaging Findings

Pelvic fistulas may result from obstetric complications, inflammatory bowel disease, pelvic malignancy, pelvic radiation therapy, pelvic surgery, or other traumatic causes, and their symptoms may be distressing. In our experience, various types of pelvic fistulas are identified after pelvic disease or pelvic surgery. Because of its close proximity, the majority of such fistulas occur in the pelvic cavity and include the vesicovaginal, vesicouterine, vesicoenteric, ureterovaginal, ureteroenteric and enterovaginal type. The purpose of this article is to illustrate the spectrum of imaging features of pelvic fistulas.

Thymic Enlargement in Patients with Hyperthyroidism

PURPOSE: To evaluate the radiologic findings and clinical feasibility of thymic enlargement in patients with hyperthyroidism. MATERIALS AND METHODS: Seven patients with hyperthyroidism and anterior mediastinal bulging revealed by chest radiogaphy were evaluated. The CT findings were analyzed with regard to the shape of the anterior mediastinal mass, surrounding infiltration, and enlargement of mediastinal lymph nodes. Whether or not tumor markers (alpha-fetoprotein, beta-human chorionic gonadotrophin, and chorionic embryonic antigen) showed increased levels was determined, and the size and thickness of the anterior mediastinal mass were measured and compared with previously described age-matched thymus data. In addition, changes in the thyroid gland were evaluated. RESULTS: In all seven patients, anterior mediastinal masses were bi-lobed, with no surrounding infiltration or enlarged mediastinal lymph node, and tumor marker levels showed no increase. The masses were therefore considered to be thymus. In six patients, the size of the thymus exceeded two upper standard deviations of mean value and in one patient, it was smaller than this. In three patients, PCNB (percutaneous needle biopsy) revealed normal thymic tissue and in two, follow-up chest PA demonstrated no interval change. CT showed that in three patients, the thyroid glands were diffusely enlarged. CONCLUSION: In patients with hyperthyroidism, an anterior mediastinal mass seen on chest radiographs was due to thymic enlargement. The recognition of CT findings of thymic enlargement in such patients may avoid unnecessary biopsy.

Spiral CT in Kidney: Assumption of Renal Function by Objective Evaluation of Renal Cortical Enhancement

PURPOSE: To correlate the degree of renal cortical enhancement, objectively evaluated by means of spiral CT, with the serum level of creatinine, and to determine the extent to which this degree of enhancement may be used to detect renal parenchymal disease. MATERIALS AND METHODS: Eighty patients [M:F=50:30; age=25 -90 (mean, 53) years] with available serum level of creatinine who underwent spiral CT between September and October 1999 were included in this study. In fifty patients the findings suggested hepatic or biliary diseases such as hepatoma, biliary cancer, or stone, while in thirty, renal diseases such as cyst, hematoma, or stone appeared to be present. Spiral CT imaging of the cortical phase was obtained at 30 -40 seconds after the injection of 120 ml of non-ionic media at a rate of 3ml/sec. The degree of renal cortical enhancement was calculated by dividing the CT attenuation number of renal cortex at the level of the renal hilum by the CT attenuation number of aorta at the same level. The degree of renal cortical enhancement was compared with the serum level of creatinine, and the degree of renal cortical enhancement in renal parenchymal disease with that of the normal group. Among eighty patients there were five with renal parenchymal disease and 75 with normal renal function. RESULTS: The ratio of the CT attenuation number of renal cortex to that of aorta at the level of the renal hilum ranged between 0.49 and 0.99 (mean, 0.79; standard deviation, 0.15), while the serum level of creatinine ranged between 0.6 and 3.2 mg/dl. There was significant correlation (coefficient of -0.346) and a statistically significant probability of 0.002 between the ratio of the CT attenuation numbers and the serum level of creati-nine. There was a significant difference (statistically significant probability of less than 0.01) between those with renal parenchymal disease and the normal group. CONCLUSION: The use of spiral CT to measure the degree of renal cortical enhancement provides not only an effective index for estimating renal functional status but also a means of differentiating between patients with renal parenchymal disease and those who are normal.