Pelvic Pain Syndrome - Successful Treatment by Ovarian Vein

Pelvic pain syndrome or pelvic congestion syndrome, with no apparent organic cause, is a common gynecologicaldisorder. Ovarian varix, one of the causes of this syndrome, presents a difficult diagnostic and therapeuticproblem, though surgical ligation of the ovarian vein is an effective method of treatment. Although ovarian veinembolization has been recently developed as a useful alternative, no previous reports have described thisprocedure in Korea. We report a case of pelvic pain syndrome successully treated by ovarian vein embolization.

Biliary Stones: Change of CT Attenuation in Water Soluble Contrast Media

PURPOSE: To investigate change of CT attenuation of biliary stones in water soluble contrast media with time as well as the factors contributing to this change. MATERIALS AND METHODS: Thirty biliary stones were placed within cone-shaped plastic tubes, and as a control study, spiral CT scanning was performed 50 minutes after immersion in normal saline. The stones were rescanned at 5, 10, 20, 30, 45, 60, 90 and 120 minutes after immersion in water soluble contrast media. Mean CT attenuation value and volume of the stones were measured after three-dimensional reconstruction of images. Physical factors such as porosity[(wet weight - dry weight) / wetweight]x100, volume, and cholesterol as a chemical factor were measured. RESULTS: The pattern of change of CT attenuation was classified as one of three types. Fifteen stones (50%) were classified as type 1, in which attenuation increased with immersion time; in ten stones, this increase was rapid, particularly within the first 5 minutes. Twelve (40%) were classified as type 2, in which attenuation showed no significant change. Three stones showed no regular pattern, and these were classified as type 3. The mean porosity of type 1 (median; 32.7, mean+/-SD; 52.83+/-34.48) was greater than that of type 2 (median; 6.7, mean+/-SD; 30.58+/-48.25)(p<.05). The volume and cholesterol fraction of stones were not significantly different between type 1 and 2. CONCLUSION: In some biliary stones, CT attenuation value increases in water-soluble contrast media with time, and porosity is the most important factor in attenuation change.

Diaphyseal Osteomyelitis of the Long Bone: Evaluation of Radiograph and MRI

PURPOSE: To describe the radiographic and MR characteristics of subacute diaphyseal osteomyelitis of the long bone. MATERIALS AND METHODS: We retrospectively analyzed plain radiographs and MR images in nine children and two young adults with surgically-proven diaphyseal osteomyelitis of the long bones. MR imaging was carried out before and after Gd-DPTA administration. Patients charts were reviewed for clinical and laboratory data and histologic correlation was available in all cases. RESULTS: All patients had a history of a minimum of 2 weeks' duration. All presented with an insidious onset of mild pain; they showed apyrexia and normal erythrocyte sedimentation rate. In all patients, plain radiographs showed single or multiple linear periosteal reaction with cortical irregularity. Medullary abnormality was not found except in one case which showed an abscess cavity. MR images revealed thickening or irregularity of the cortex, periosteal reaction, bone marrow signal alteration, and perilesional edema. CONCLUSION: Subacute diaphyseal osteomyelitis of the long bone is broadly based on the cortex, and elicits more sclerosis and periosteal reaction. Familarity with plain radiographs and MR features may be useful in the diagnosis of subacute diaphyseal osteomyelitis.

Radiological Findings of Primary Abdominal Malignant Fibrous Histiocytoma: Emphasis on CT Findings

PURPOSE: To evaluate the radiological findings of abdominal malignant fibrous histiocytomas. MATERIALS AND METHODS: We retrospectively reviewed the radiological findings of 13 masses in seven patients including two patients with multiple masses. The masses were located at the mesentery and omentum in three patients and at theretroperitoneum in four. Gastrointestinal examination using barium was performed in four patients, ultrasonographyin five and computed tomography in all. RESULTS: The average diameter of masses was 7.8cm(range : 1-20cm); plain abdominal films revealed soft tissue masses in all patients. Three of four barium studies demonstrated only displacement of bowel loops and the other showed findings of submucosal tumor. Eight of 11 masses were detected on ultrasonography and all were round or lobulated and had well defined margins. Four of these masses were greater than 8cm in diameter and showed homogeneous echogenicity with central hypo or anechoic area ; the remaining wereless than 8cm and showed relatively homogeneous echogenicity. On computed tomography, all 13 masses were seen as highly enhanced and well circumscribed. Seven were greater than 5cm in diameter and had internal low-densityareas. Peritumoral vessel-like structures were seen in eight masses and on plain abdominal radiograph and computed tomogram, calcification was seen in one patient. In no patient was combined retroperitoneal or intraperitoneal lymphadenopathy noted. CONCLUSION: Abdominal malignant fibrous histiocytomas are well-circumscribed, round orlobulated bulky masses with frequent necrosis and occasional calcification. Characteristically, there is nocombined lymphadenopathy and multiple masses are a rare manifestation. These findings may be helpful in the diagnosis of malignant fibrous histiocytoma.

US Characterization of Soft Tissue Hemangiomas of Extremities: Correlation with MR Signal Intensity

PURPOSE: To evaluate the US findings of soft tissue hemangiomas in extremities and to correlate the echo-pattern with MR signal characteristics of hemangiomas. MATERIALS AND METHODS: We retrospectively studied forty-two patients either with pathologically proven cases or with characteristic features of hemangiomas on MRI, US and plain film. Hemangiomas were divided into two types according to the locations;subcutaneous and intramuscular. Analytic points on US and MR findings were gross morphology of the mass, internal echo-pattern or signal characteristics. We correlated the echo-pattern with MR signal characteristics in hemangiomas. RESULTS: Subcutaneous hemangiomas revealed homogeneously anechoic mass on US, which were well correlated with MR signal characteristics' homogeneous low singnal intensity(SI) on Tl-weighted image(WI) and high SI on T2-WI. Intramuscular hemangiomas showed heterogeneously mixed echoic masses on US. An anechoic component on US corresponded to dilated vascular channels on MRI. The signal intensity of intramuscular hemangioma was less than that of subcutaneous fat on T1-WI and greater than that of fat on T2-WI. Both types of hemangiomas had tubular or lace-like appearance with interspersed fibrofatty septa. CONCLUSION: The echo-patterns in US were well associated with MR signal characteristics on MRI. Regarding US and MR features, intramuscular hemangiomas were different to subcutaneous hemangiomas.

Periosteal Reaction of Osteomyelitis: MRI Findings Compared with Plain Radiographs

PURPOSE: To evaluate MR characteristics of periosteal reactions and subperiosteal abscesses in osteomyelitis as compared with radiographs. MATERIALS AND METHODS: We retrospectively reviewed 28 patients(18 males, 10 females) with osteomyelitis. Nineteen patients underwent MR imaging with 0.5 T. We analyzed for morphologic patterns, intervals of appearance and disappearance of periosteal reactions after symptom onset. Twenty-three patients were confirmed by surgery and 5 patients by the radiologic findings, clinical and laboratory data. RESULTS: Periosteal reaction appeared as low signal intensity arc on the T1- and T2-weighted axial images. In 3-7 days after symptom onset, periosteal reactions and subperiosteal abscesses were noted on MR imaging, and only two of eleven patients were noted in radiographs. Periosteal reactions of 8-14 days after symptom onset were demonstrated in all of 13 patient on MR, and 9 on plain radiographs. All patients with 2 weeks after symptom onset showed perioste.al reaction in plain film and MR. The periosteal reactions persisted until approximately 2 to 3 months after treatment on follow up radiographs. CONCLUSION: Periosteal reactions in osteomyelitis are detected on the MR imaging earlier than plain film. MR is valuable in detecting subperiosteal abscess which is not appecent in simple radiographs. Periosteal reactions can be seen on MR in 3 days after symptom onset and persist for 2-3 months after treatment.

99mTc-MDP uptake pattern of normal pubic bone / 대한핵의학회잡지

No abstract available.

Computed tomographic features of tuberculous arthritis

The sparsity of publication concerning CT findings of tuberculous arthritis prompted authors to retrospectively evaluate 12 patients with tuberculous arthritis for characteristic CT findings. In each patient, the diagnosis of tuberculous arthritis was confirmed by surgery or biopsy. The CT examinations were evaluated by two radiologists retrospectively. Involved joints were the hip joint in seven patients, the sacroiliac joint in three parients, and the shoulder and ankle joint in one patients each. CT features included subchondral bony erosion(12 patients), soft tissue mass in the joint space(nine), widenining of the joint space(eight), ipsilateral muscle atrophy(eight), thickening of the joint capsule(seven), intra-articular effusion(six), soft tissue abscess(five),and bony sclerosis(four). In seven patients with the duration of symptoms less than 1 year, thickening of joint capsule and intra-articular effusion were the predominent findings, while bony sclerosis, gross bone destruction, and soft tissue mass in joint space were seen in five patients with the duration of symptoms longer than 1 year. Our results indicate that CT is useful in the diagnosis of tuberculous arthritis by demonstrating characteristic pathologic changes of the joint space, soft tissue abnormality and bony involvement.