Usefulness of Apparent Diffusion Coefficient Value of Diffusion-Weighted Imaging and Peak Standardized Uptake Values of Positron Emission Tomography-CT for Predicting Prognostic Factors of Breast Cancer

PURPOSE@#This study was performed to retrospectively correlate the apparent diffusion coefficient (ADC) value and peak standardized uptake value (pSUV) with prognostic factors and MRI findings for breast lesions.@*MATERIALS AND METHODS@#Ninety four breast cancers in 82 women were included in this study. Our patients underwent presurgical MRI including diffusion-weighted imaging (DWI), 18-fluorodeoxyglucose PET-CT, and immunohistological staining of the surgical or biopsy specimens. We evaluated relationships between mean ADCs and pSUVs with a variety of prognostic factors (age, tumor size, histologic grade of tumor, hormone receptors, human epidermal growth factor receptor 2 expression status, and nodal metastasis) and MRI findings (shape, margin and internal enhancement of mass, T2-signal intensity, and kinetics), using statistical methods.@*RESULTS@#Both mean ADCs and pSUVs were significantly associated with histologic grade (p = 0.000 and p = 0.001) and nodal metastasis (p = 0.013 and p = 0.001). pSUVs were significantly associated with tumor size and estrogen receptor status, as well as irregular shape and rim enhancement pattern on MRI findings. On multivariate analysis, mean ADCs were significantly associated with invasiveness, estrogen receptor status and HER-2 expression status. PSUVs were only significantly associated with tumor size.@*CONCLUSION@#Mean pSUVs on PET-CT and ADCs on DWI helped predict prognosis of breast cancer.

The Association between Motor Laterality and Cognitive Impairment in Parkinson's Disease

BACKGROUND AND PURPOSE: The relationship between the side of motor symptoms and cognitive impairment has rarely been reported in Parkinson’s disease (PD). We aimed to estimate the influence of motor laterality on cognition in PD patients. METHODS: We enrolled 67 patients with PD, and they were divided into two groups according to side of symptom onset or predominant motor symptom presentation (right and left). Right-sided PD (RPD, 40) and left-sided PD (LPD, 27) patients underwent a neuropsychological battery exploring memory, attention/working memory, frontal/executive, visuospatial, and language functions. Student's t-test and Chi-square test have been carried out to compare the clinical and neuropsychological data between two groups. RESULTS: There were no significant differences in any neuropsychological test between the RPD and LPD groups, except for digit forward span test. RPD patients scored lower on the digit forward span test than LPD patients (5.43±9.49 vs. 6.15±1.38, p=0.045). CONCLUSIONS: RPD patients seem to experience more difficulties in attention and working memory than did LPD patients. The laterality of motor symptoms is not a major determinant for cognitive impairment in PD patients but, we should consider differences of cognitive deficits depending on the side of motor symptoms to treat patients with PD.

Can Ultrasound Be as a Surrogate Marker for Diagnosing a Papillary Thyroid Cancer? Comparison with BRAF Mutation Analysis

PURPOSE: We investigated the merit of ultrasound (US) features and BRAF(V600E) mutation as an additional study of cytology and compared the diagnostic performances of cytology alone, cytology with US correlation, cytology with BRAF(V600E) mutation, and a combination of cytology, US, and BRAF(V600E) mutation all together. MATERIALS AND METHODS: This study included 185 patients (mean age, 48.4 years; range 20-77 years) with 191 thyroid nodules who underwent US-guided fine-needle aspiration (FNA) with an additional BRAF(V600E) mutation test. Three radiologists highly experienced in thyroid imaging retrospectively reviewed US images and classified each nodule into two categories (positive for malignancy or negative for malignancy). Interobserver variability (IOV) of US assessment between the three readers was estimated using the generalized kappa statistic of Landis and Koch. We also calculated the diagnostic performances of these studies. RESULTS: There were 131 cases of malignancy (131/191, 68.6%) and 60 cases of benign nodules (60/191, 31.4%). In terms of IOV of US assessment, the generalized kappa value was 0.242, indicating fair agreement was reached. The combination of cytology with BRAF(V600E) showed higher specificity (100%) and positive predictive value (PPV) (100%) compared to the combination of cytology, BRAF(V600E), and US (specificity 28.3%, 66.7%, 68.3%; PPV 74.6%, 86.6%, 86.8%, respectively; p<0.001). However, cytology with BRAF(V600E) showed lower sensitivity (84.7%) than cytology with BRAF(V600E) and US (96.2%, 98.5%, 95.4%, respectively; p<0.001). CONCLUSION: Considering the diagnostic performance and low reproducibility of US, the combination of FNA with BRAF(V600E) is the most reliable and objective method for diagnosing thyroid malignancy.

Can Ultrasound Be as a Surrogate Marker for Diagnosing a Papillary Thyroid Cancer? Comparison with BRAF Mutation Analysis

PURPOSE: We investigated the merit of ultrasound (US) features and BRAF(V600E) mutation as an additional study of cytology and compared the diagnostic performances of cytology alone, cytology with US correlation, cytology with BRAF(V600E) mutation, and a combination of cytology, US, and BRAF(V600E) mutation all together. MATERIALS AND METHODS: This study included 185 patients (mean age, 48.4 years; range 20-77 years) with 191 thyroid nodules who underwent US-guided fine-needle aspiration (FNA) with an additional BRAF(V600E) mutation test. Three radiologists highly experienced in thyroid imaging retrospectively reviewed US images and classified each nodule into two categories (positive for malignancy or negative for malignancy). Interobserver variability (IOV) of US assessment between the three readers was estimated using the generalized kappa statistic of Landis and Koch. We also calculated the diagnostic performances of these studies. RESULTS: There were 131 cases of malignancy (131/191, 68.6%) and 60 cases of benign nodules (60/191, 31.4%). In terms of IOV of US assessment, the generalized kappa value was 0.242, indicating fair agreement was reached. The combination of cytology with BRAF(V600E) showed higher specificity (100%) and positive predictive value (PPV) (100%) compared to the combination of cytology, BRAF(V600E), and US (specificity 28.3%, 66.7%, 68.3%; PPV 74.6%, 86.6%, 86.8%, respectively; p<0.001). However, cytology with BRAF(V600E) showed lower sensitivity (84.7%) than cytology with BRAF(V600E) and US (96.2%, 98.5%, 95.4%, respectively; p<0.001). CONCLUSION: Considering the diagnostic performance and low reproducibility of US, the combination of FNA with BRAF(V600E) is the most reliable and objective method for diagnosing thyroid malignancy.

Acute Ischemic Stroke in Moyamoya Disease Associated With Thyrotoxic Crisis

There are several documented cases of coexistence of Graves' disease and Moyamoya disease, but an association between thyrotoxicosis and Moyamoya disease is largely unknown. A 32-year-old woman presented with impaired consciousness and left hemiparesis. Brain magnetic resonance imaging revealed acute infarction in the territory of the bilateral anterior cerebral arteries and occlusion of both internal carotid arteries. Antithyroid medication improved the patient's consciousness. Thyrotoxicosis could be a cause of acute infarction in patients with Moyamoya disease.

Multiple Territory Ischemic Stroke Aggravated by Severe Anemia

While acute anemia is regarded as a precipitating factor of ischemic stroke, there have been few reports on the evolution of infarction in the acute period of ischemic stroke by anemia. We describe a 71-year-old man with acute multiple territory infarction who had progressive neurologic deficits of paraparesis and dysarthria. This case suggests that sustained severe anemia due to intractable intestinal bleeding is an important cause of aggravation of ischemic stroke.

Nonconvulsive Status Epilepticus as the First Manifestation of Hashimoto's Encephalopathy / 대한간질학회지

Hashimoto's encephalopathy (HE) is an uncommon syndrome accompanied by Hashimoto's thyroiditis. It is an immune-mediated disorder characterized by subacute onset of confusion, altered consciousness, seizures and myoclonus. However, the diagnosis is often difficult because clinical manifestations are heterogeneous and nonspecific. Several reports of Hashimoto's encephalopathy presenting with focal or generalized seizures are described, but only few have focused on status epilepticus as the first clinical manifestation. We report a 60-year-old female patient who developed decreased consciousness with nonconvulsive status epilepticus due to Hashimoto's encephalopathy and was successfully treated with high doses of intravenous steroid.

Nonconvulsive Status Epilepticus as the First Manifestation of Hashimoto's Encephalopathy

Hashimoto's encephalopathy (HE) is an uncommon syndrome accompanied by Hashimoto's thyroiditis. It is an immune-mediated disorder characterized by subacute onset of confusion, altered consciousness, seizures and myoclonus. However, the diagnosis is often difficult because clinical manifestations are heterogeneous and nonspecific. Several reports of Hashimoto's encephalopathy presenting with focal or generalized seizures are described, but only few have focused on status epilepticus as the first clinical manifestation. We report a 60-year-old female patient who developed decreased consciousness with nonconvulsive status epilepticus due to Hashimoto's encephalopathy and was successfully treated with high doses of intravenous steroid.

Adventitial Cystic Disease of the Femoral Vein: a Case Report with the CT Venography

Fewer than 20 cases of adventitial cystic disease of the vein have been reported in the worldwide literature. This small number of reported cases may be due not only to the disease's low incidence, but also to the difficulty in making the proper diagnosis. Many techniques have been used to investigate this disease, but venography has been the traditional diagnostic tool. In this report we present a case of adventitial cystic disease that was well demonstrated by CT venography.

Electrocardiographic Changes in Typhoid Fever

Electrocardiograms were observed in 168 patients with typhoid fever and were analyzed according to the duration of illness and hemoglobin level. The following results were obtained. 1) 124 patients out of 168 patients showed abnormal electrocardiographic findings. 2) The most prevalent abnormal findings were observed during third to fourth week of illness. 3) The lower the hemoglobin level, the higher frequency of electrocardiographic abnormalities were found. 4) Among the electrocardiographic disorders, sinus tachycardia was the most common finding and it was found in 60 cases(35.7%). The major abnormalities were ST-T change, low QRS voltage, prolongation of Q-T interval and prolongation of P-R interval: the over all incidence of these were 26.8%, 15.5%, 13.7% and 9.55 respectively. In addition to the major abnormalities, incomplete right bundle branch block (5.4%), premature ventricular contractions(3.0%) and abnormal Q wave(1.2%) were observed.