A Case of Ankylosing Spondylitis with Follicular Lymphoma

Several autoimmune and chronic inflammatory conditions have been consistently linked with an increased risk of hematologic malignancies. Although ankylosing spondylitis (AS) is a chronic inflammatory disease, previous studies have demonstrated that it is not associated with an increase in risk of malignant lymphomas. Cases of AS accompanied by hematologic malignancies such as multiple myeloma, chronic myelogenous leukemia, and Hodgkin's disease have been reported. In Korea, AS with non-Hodgkin's lymphoma or follicular lymphoma has not been reported. We experienced a 38-year-old male who had been diagnosed with follicular lymphoma with bone metastasis, who achieved complete remission after having been treated with chemotherapy, developed new inflammatory back pain. An MRI of his hip showed an active inflammation of the left sacroiliac joint and a positive HLA-B27. The patient was diagnosed with AS and was treated with naproxen, which improved the pain in his back and buttock.

Intravascular Papillary Endothelial Hyperplasia (Masson's Tumor) of the Chest Wall: A Case Report

Intravascular papillary endothelial hyperplasia is a rare tumor-like lesion caused by hyperplastic proliferation of endothlial cells that is usually an incidental findings within thrombosed dilated blood vessels or vascular tumor. We report the sonographic appearance and pathological correlation of intravascular papillary endothelial hyperplasia that presented as an intramuscular solitary mass in chest wall.

Sonographic Appearance of a Solitary Intramuscular Cysticercosis: A Case Report

The development of antiparasitic drugs and public health strategies has reduced the prevalence of cysticercosis in South Korea. In contrast, the disease is still endemic in Southeast Asia. The influx of immigrants from endemic areas has been on the increase. We report the sonographic and pathological findings of cysticercosis that presented as an intramuscular solitary mass in a 27-year-old Philippine woman.

US Features of Angioleiomyoma Arising from Superficial Soft Tissue

PURPOSE: To describe the sonographic features of angioleiomyoma arising from superficial soft tissue. MATERIALS AND METHODS: A retrospective study of the sonographic findings of 11 pathologically proven angioleiomyomas was performed. We evaluated the location, layer, size, shape, margin, echotexture, echogenicity, internal content, presence of calcification, and relationship to adjacent structures on gray scale sonography. We evaluated the presence, degree, and distribution pattern of vascularity within the mass on color Doppler sonography. RESULTS: All tumors were located in the subcutaneous layers of the extremities (5 in hand, 2 in elbow, 2 in knee, 1 in foot, 1 in calf). The sizes ranged from 8 to 30 mm, with an average size of 15.5 mm. All lesions were relatively homogeneous and hypoechoic, with well-defined margins and oval to round shape. There were no intratumoral calcifications or cystic portions in any of the masses. Vascularity was not detected in any patient (type 1), but was easily detected in 10 other patients. The degree of vascularity was mild (type 2) in 1 patient, moderate (type 3) in 4, and abundant (type 4) in 5. CONCLUSION: Although angioleiomyoma is an uncommon entity, our study suggests that it must be included in the differential diagnosis of well-defined, hypoechoic, vascular subcutaneous tumors in the extremities.

Evaluation of Brain Death by CT Angiography: Initial Experience

PURPOSE: The angiographic demonstration of absent cerebral blood flow is presently considered to be the most reliable method of confirming brain death. The purpose of this study is to determine whether CT angiography (CTA) with spiral CT can rapidly and specifically establish a diagnosis of brain death. MATERIALS AND METHODS: A total of fifteen CT angiograms (brain death, n=9;severe coma, n=6 within 24 hours of the study) were obtained prospectively in 12 patients with an established clinical diagnosis; Two patients underwent repeated CTA. Twenty seconds after beginning the injection of contrast media (100 mL at a rate of 3 mL/sec), CT scanning (30 -second continuous exposure and 60 -mm length) was performed with a table speed of 2 mm/sec and a section thickness of 2 mm. For each case, the presence or absence of opacification of inter-nal carotid arteries (ICA), vertebral and basilar arteries (VBA), anterior cerebral arteries (ACA), middle cerebral arteries (MCA), posterior cerebral arteries (PCA), distal branches of cerebral arteries, and superficial temporal arteries (STA) was ascertained. RESULTS: Except in one clinically brain-dead patient, whose EEG was difficult to interpret due to excessive arti-facts, the distal branches of cerebral arteries did not opacify. STA, on the other hand, was always visible on both sides. In all brain-dead patients but three, the ICA and proximal ACA, MCA, or PCA escaped visualiza-tion. In the remaining three cases with large skull defect or skull fracture, however, CT angiography showed faint opacification of the ICA and proximal segments of cerebral arteries. Cerebral arterial flow was preserved in all six patients in whom there was no clinical evidence of brain death. CONCLUSION: CTA may be used as a confirmatory test for the determination of brain death.

Dual Phase CT Hepatic Arteriography in the Evaluation of Hypervascular Hepatocellular Carcinoma

PURPOSE: To assess the diagnostic accuracy of dual-phase computed tomography during hepaticarteriography(CTHA) in depicting hypervascular hepatocellular carcinoma. MATERIALS AND METHODS: Forty patientswith hepatocellular carcinoma underwent dual-phase CTHA. First-phase data was obtained 6 seconds after contrastmedia was injected into the common hepatic artery, while second-phase data was obtained 35-40 seconds later.Lipiodol CT was performed 10-17 days after 2mL of lipiodol was injected into the proper hepatic artery. As agold-standard of 172 lipiodol-uptaken nodules seen on lipiodol CT, the detectability and positive predictive valueof the first and second phases, and the simultaneous interpretation of both phases, were analysed. RESULTS: Allnodules were detected by first-phase CTHA, 162 (94%) by second-phase CTHA, and 170 (99%) by simultaneousinterpretation of both phases. The detection sensitivities of first-phase CTHA and simultaneous interpretation ofboth phases were statistically superior to that of second-phase CTHA. Positive predictive values were 87% withfirst-phase CTHA, 96% with second-phase CTHA, and 97% with simultaneous interpretation of both phases. CONCLUSION: Dual-phase CTHA was useful for increasing detectability and accuracy in the diagnosis of hypervascularhepatocellular carcinoma.

CT Angiography in Patients with Spontaneous Intracerebral Hematoma

PURPOSE: The purpose of this study was to assess the usefulness of CT angiography(CTA) in patients withintracerebral hematoma. MATERIALS AND METHODS: Eighteen patients with spontaneous intracerebral hematoma underwentCTA ; 20-30 seconds after the onset of an injection of contrast media(100mL, with the use of a power injector, ata rate of 3 mL/sec), Scanning(30-second continuous exposure and 60-90mm length) was performed with a table speedof 2-3 mm/sec and section thickness of 2mm. The starting point selected was the floor of the sella turcica. Theresulting data were reformatted by maximum intensity projection(MIP) after reconstruction at 1-mm intervals, andCTA findings were compared with those of conventional angiography(n=17), surgery(n=6), and postcontrast CT(n=10). RESULTS: The diagnostic findings of CTA included five arteriovenous malformations, two aneurysms, one venousangioma, and one venous sinus occlusion, while the remaining nine patients had no vascular lesion. In all cases,CTA findings correlated well with those of conventional angiography and surgery ; in four cases, they weresuperior to those of postcontrast CT. In one cases of arteriovenous malformation, however, the feeding artery anddraining vein were not definite on CTA, and in one case of sinus occlusion, the full length of the superiorsagittal sinus could not be delineated. CONCLUSION: In patients with spontaneous intracerebral hematoma, CTA is avaluable screening method.

Collateral Vessels in Moyamoya Disease: Comparison of MR and MRA with Conventional Angiography

PURPOSE: To determine the value of magnetic resonance imaging(MR) and magnetic resonance angiography(MRA) inassessing collateral vessels of moyamoya disease. MATERIALS AND METHODS: Twenty-four patients with moyamoyadisease who underwent MR, 3D TOF MRA, and conventional angiography participated in this study. Two radiologistsworking independently and with no knowledge of the angiographic findings, interpreted the MR and MRA images. Todetermine the presence of parenchymal and leptomeningeal collaterals(48 hemispheres) and transdural collaterals(38hemispheres in 19 patients were depicted by angiography of the external carotid), the findings were compared withthose of angiography. RESULTS: Parenchymal, leptomeningeal, and transdural collaterals were depicted byconventional angiography in 34(71%), 32(67%), and 11(29%) hemispheres respectively. The sensitivity andspecificity of MR/MRA for collateral vessels were 79.1/ 88.1% for parenchymal collaterals, 72.1/ 88.1% forleptomeningeal collaterals, and 0.1/18.1% for transdural collaterals, respectively. Respective sensitivity andspecificity of MR/MRA were 88.94/94.1% for leptomeningeal collaterals, and 18.93/55.1% for transdural collaterals,when the prominent posterior cerebral and external carotid artery were regarded as secondary signs ofleptomeningeal and transdural collateral vessels. CONCLUSION: In moyamoya disease, MR and MRA are useful imagingmodalities for the assessment of collateral vessels. The prominent posterior cerebral artery and external carotidartery can be useful secondary signs of leptomeningeal and transdural collateral vessels.

Gastritis Cystica Profunda: A case report

Gastritis cystica profunda is an uncommon benign mass that usually occurs on the gastric side of the site of a gastroenterostomy, but has also been known to develop in which has not been operated on. We report the case of stomach a 51-years-old man with pathologically proven gastritis cystica profunda. This patient had not undergone gastric surgery and CT showed a well-defined, 3 cm sized, cystic mass at the gastric antrum.

Distal Ureteral Calculi: The Usefulness of Transrectal Ultrasound and Comparision with Intravenous Urography

PURPOSE: To determine the usefulness of transrectal ultrasound (TRUS) and to compare TRUS with intravenousurography (IVU) in the evaluation of distal ureteral calculi. MATERIALS AND METHODS: TRUS and IVU were perfomed in 24 patients with distal ureteral calculi. Using TRUS, we evaluated the presence and size of calculus, type of ureteral jet at the affected site and diameter of ureter proximal to calculus, and using IVU evaluated the presence and size of calculus, degree of ureteral obstruction, and degree of hydroureter. TRUS and IVU findings, were compared. RESULTS: In each patient, TRUS detected calculus of the distal ureter ; in only 18cases (75%),were the calculi demonstrated with IVU. In 18 cases where calculi were detected by both modalities, average calculus size was 4.5 X 3.0mm (longest and shortest dimensions) by IVU, and 6.1 X 3.7 mm by TRUS. Betwee TRUS and IVU(p0.05). CONCLUSION: TRUS appears to be a useful adjunctive method for the evaluation of distal ureteral calculus.