Usefulness of CT and ERCP in Traumatic Pancreatic Injury

PURPOSE: To evaluate the usefulness of CT and ERCP in the diagnosis of traumatic pancreatic injury, and the degree of such injury. MATERIALS AND METHODS: Using CT (n=30) and ERCP (n=8), we retrospectively analyzed 30 cases of surgically proven traumatic pancreatic injury. Both CT and surgical findings were evaluated according to intra-and extra- pancreatic change and assigned to one of five grades, according to their pattern. ERCP findings were categorized as normal mass effect, parenchymal staining, or extravasation of contrast material. In all 30 cases CT and ERCP findings were compared with surgical findings. RESULTS: Pancreatic enlargement was the most common finding of intrapancreatic change in 21(67%) cases (67%). In 20 of 30 cases, there was good correlation between the CT grade and surgical grading. Of the remaining ten cases, seven cases (23%) were underestimated and three(10%) were overestimated. CT grade III or IV suggest pancreatic duct injury ; in two of 13 cases with this grade, such injury was not seen on surgery, however. Of the eight cases in which ERCP was performed, two were normal, one showed mass effect, one showed parenchymal staining, and four, all of which showed pancreatic duct injury on surgery, showed extravasation of contrast material. Two of these four cases were CT grade II, but on surgery, proven duct injury was seen. CONCLUSION: In cases of pancreatic duct injury, ERCP is superior to CT; where such injury is suspected, it should therefore be used to determine whether or not the injury is in fact present.

MRI Findings of Central Nervous System Granulocytic Sarcoma (Chloroma)

PURPOSE: To characterize MRI findings of central nervous system(CNS) granulocytic sarcoma (chloroma) and to analyse the points which differentiate it from other CNS tumors. MATERIALS AND METHODS: We evaluated MRI in six patients with CNS granulocytic sarcoma proven by surgery or bone marrow biopsy (intracranical, one case and spine five cases). A 0.5T superconductive MR machine was used for diagnosis and, axial, coronal and sagittal T1- and T2-weighted spin echo images and Gd-DTPA enhanced T1-weighted images were obtained. We retrospectively analized the location, signal intensity, margin, contrast enhancement and homogeneity, and bony change around the tumor. RESULTS: MRI findings of CNS granulocytic sarcomas were as follows : one tumor was seen to be an extra-axial mass in the posterior fossa of the brain, four were epidural, and one was an epidural and presacral masses in the spine ; tumor magins were lobulated and three were smooth. On T1-weighted images, all tumors were of isoignal intensity; on T2-weighted images, four were of isosignal intersity and two were of high signal intensity. Contrast enhancement was inhomogeneous in five of six cases. Bony change around the tumor was seen in two cases. CONCLUSION: On T1-weighted images, CNS granulocytic sarcomas (chloromas) were of isosignal intensity, relative to brain parenchyma or spinal cord ; on T2-weighted images, they were of iso or high signal intensity, with relative contrast enhancement. These points could be useful in differentiating them from other CNS tumors.

Arterial Embolization for Management of Hemoptysis in Pulmonary Tuberculosis: Factors of Rebleeding

PURPOSE: To evaluate the effectiveness of arterial embolization in reducing hemoptysis in pulmonary tuberculosis, and rebleeding factors after embolization. MATERIALS AND METHODS: Fifty-nine patients with massiveor recurrent hemoptysis from pulmonary tuberculosis were underwent percutaneous transcatheter embolotherapy and thirteen were subsequentyly operated on. In 46 patients, we retrospectively analyzed on plain chest PA the extent of pulmonary tuberculosis lesions, the period from initial diagnosis to embolization, and angiographic findings. the extent of lesions shown on plain chest PA were classified into minimal, moderately advanced, and far advanced. If there was no evidence of rebleeding after the first embolization, this was regarded as initial success in thecontrol of hemoptysis. Angiographic findings were classified into hypervascularity, shunt, aneurysmal dilatation,and extravasation. Using the chi-square test, differences in these findings between rebleeding and non-rebleeding cases were analysed. RESULTS: Immediate control of hemoptysis was achieved in 27 (58.7%) of 46 patients. Hemoptysis recurred in 19 (41.3%) of 46 patients followed up. Rebleeding cases showed more nonbronchial systemiccollateral vessels and shunt than non-rebleeding cases (p<0.05). More advanced lesions of pulmonary tuberculosison plain chest PA showed an increased rebleeding rate after embolization, but this was not statistically significant There was no correlation between the period from initial diabnosis of pulmonary tuberculosis to embolization and the rate of rebleeding. But the longer the period, the greater the number of nonbronchial systemic collateral vessels. CONCLUSION: In cases with more advanced lesions of pulmonary tuberculosis on plainchest PA and a long period from initial diagnosis of pulmonary tuberculosis to embolization, angiographic findings showed numerous nonbronchial systemic collateral vessels but increases in the rebleeding rate were statistically not significant. The greater the number of nonbronchial systemic collateral vessels and shunt, the higher there bleeding rate after embolization.