A Case of Gastritis Cystica Profunda Associated with Gastric Perforation and Hypertrophic Gastric Folds / 대한소화기내시경학회지

Gastritis cystica profunda (GCP) is a rare disease in which cystically dilated gastric foveolae or glands extend into the muscularis mucosae or below. The pathogenesis of GCP has been described as an interruption of the muscularis mucosae and migration of epithelial elements to submucosa caused by presence of suture materials after surgery or erosion of the gastric mucosa in chronic gastritis and ischemia. Macroscopically, GCP may present not only as a giant gastric mucosal folds but also as a submucosal tumor or as solitary or diffuse polyps. An endoscopic ultrasonographic (EUS) findings clearly differ from findings in the other disordes. The combination of EUS and mucosectomy appears to be very useful for the diagnosis of GCP. Therefore, all unnecessary surgical procedures should be avoided in cases of GCP. We report a case of GCP associated with gastric perforation which presented as diffuse giant gastric folds and clinically advanced gastric cancer was suspected.

Peripelvic and Perirenal Lymphangiectasia and Bilateral Renal Vein Thrombosis: A Case Report

We report the computed tomography (CT) and magnetic resonance imaging (MRI) findings in a patient with peripelvic and perirenal lymphangiectasia associated with bilateral renal vein thrombosis. CT scanning revealed multiple hypodense masses in the bilateral peripelvic and perirenal space, and on MR images, these masses had a multiple cystic appearance, with low signal intensity on T1-weighted and high signal intensity on T2-weighted images. CT, MR, and renal angiography failed to visualize bilateral renal veins, though serpigi-nous collateral veins were seen in the perirenal spaces.

Normal and Diseased Gallbladder Biles:Spectral Analysis by in vivo Proton MR Spectroscopy

PURPOSE: To investigate the in vivo proton MR spectra of the bile of human gallbladder in its normal and diseased states and to compare the findings between the two groups. MATERIALS AND METHODS: In vivo proton MRS was performed in 88 subjects comprising 33 healthy volunteers, 41 patients with gallstone, and 14 with distal common bile duct obstruction. For this, a clinical 1.5T system with a body coil and STEAM (STimulated Echo-Acquisition Mode) was used. We analyzed the MR spectra of normal and diseased gallbladder biles and tried to categorized the findings according to the significant peaks occuring within consistent ranges of chemical shift. We also compared the spectral patterns between normal and dis-eased bile. RESULTS: Proton MRS showed four significant major peaks in normal and diseased human bile: peak 1 at 0.8 - 1.4 ppm, peak 2 at 3.2 -3.4 ppm, peak 3 at 3.9 -4.1 ppm, and peak 4 at 5.2 -5.4 ppm. In each group, peak 1 was most frequent(healthy volunteers, 91%, patients with gallstone, 100%, patients with distal common bile duct obstruction, 93%), but as compared with normal bile (peak 2, 36%, peak 3, 33%), in patients with gall-stone, peak 3 was more frequently seen (46%), and in those with distal common bile duct obstruction, peaks 2 (64%) and 3 (64%) were most frequent. According to the significant peak, each MR spectra was categorized as follows: pattern I: peak 1; pattern II: peaks 1 and 2; pattern III: peaks 1 and 3; pattern IV: peaks 1, 2, and 3; pattern V: peaks 1 and 4; pattern VI: peak 3. In normal bile, the common MR spectral patterns were I (36%), II (27%), III, IV, VI, and V, in decreasing order of frequency. In patients with gallstone, however pattern I (44%) and pattern IV (34%) predominated, while in those with distal common bile duct obstruction, pattern IV (57%) CONCLUSION: The spectra of normal and diseased gallbladder bile obtained by in vivo proton MR spectroscopy varied, with some differences in spectral patterns between both groups.

A Case of Pancreatic Abscesses Complicating Acute Pancreatitis Associated with Interferon Therapy / 대한소화기내시경학회지

A patient experienced a silent gallstone accompanied by acute severe pancreatitis during interferon theraphy for renal cell carcinoma. Although the gallstone was highly suspected to be the cause of the pancreatits, there were no duodenoscopic or endoscopic retrograde cholangiopancreatographic findings suggesting gallstone pancreatitis such as papillitis, impacted papillary and common bile duct stones, and/or a wider cystic or pancreatic duct, respectively. It is believed that the acute pancreatitis in the presenting case was probably caused by interferon because 1) sludge nor biliary crystal was not detected by light microscopic examination, 2) no tumors, anomalies, nor any obstructing ductal lesions in the pancreas were found, 3) this patient had no other potential causes of acute pancreatitis, and 4) there was no use of potential drugs which could be responsible for the acute pancreatitis other than interferon. In addition, trials of endoscopic drainage of complicated pancreatic abscesses were discussed.

Comparison of Non-Breath-Hold T2-weighted Turbo Spin-Echo and Three Breath-Hold T2-weighted MR Images for Detection of Focal Hepatic Lesion

PURPOSE: The purpose of this study was to compare non-breath-hold T2-weighted turbo spin-echo (TSE) MR imaging with three types of breath-hold T2-weighted MR imaging (breath-hold TSE [BHTSE], half-Fourier single- shot TSE [HASTE], and true-fast imaging with steady-state precession [FISP]) for hepatic lesion detection. MATERIALS AND METHODS: T2-weighted MR images obtained using the above with the four sequences in 38 patients with 53 solid malignant and 90 non-solid benign hepatic lesions were retrospectively analyzed. Images were compared quantitatively (lesion-to-liver contrast-to-noise ratio and lesion detectability) and qualitatively (conspicuity of lesion and artifact). Statistical analysis involved the paired t-test for quantitative evaluation and Wilcoxon's signed rank test for qualitative evaluation. RESULTS: The values of lesion-to-liver contrast-to-noise ratios and lesion conspicuity for solid malignant hepatic lesions were better with non-breath-hold TSE imaging than with the three breath-hold T2-weighted sequences (p .05), and lesion detectability for non-solid benign lesions was similar (94% and 98%, compared with 91% and 96 %). CONCLUSION: In the cases of solid malignant hepatic lesions, the three breath-hold T2-weighted sequences were inferior to non-breath-hold TSE with regard to lesion-to-liver contrast-to-noise ratio and lesion detectability. Non-breath-hold TSE imaging should thus not be replaced by breath-hold T2-weighted imaging.

Comparison of Non-Breath-Hold T2-weighted Turbo Spin-Echo and Three Breath-Hold T2-weighted MR Images for Detection of Focal Hepatic Lesion

PURPOSE: The purpose of this study was to compare non-breath-hold T2-weighted turbo spin-echo (TSE) MR imaging with three types of breath-hold T2-weighted MR imaging (breath-hold TSE [BHTSE], half-Fourier single- shot TSE [HASTE], and true-fast imaging with steady-state precession [FISP]) for hepatic lesion detection. MATERIALS AND METHODS: T2-weighted MR images obtained using the above with the four sequences in 38 patients with 53 solid malignant and 90 non-solid benign hepatic lesions were retrospectively analyzed. Images were compared quantitatively (lesion-to-liver contrast-to-noise ratio and lesion detectability) and qualitatively (conspicuity of lesion and artifact). Statistical analysis involved the paired t-test for quantitative evaluation and Wilcoxon's signed rank test for qualitative evaluation. RESULTS: The values of lesion-to-liver contrast-to-noise ratios and lesion conspicuity for solid malignant hepatic lesions were better with non-breath-hold TSE imaging than with the three breath-hold T2-weighted sequences (p .05), and lesion detectability for non-solid benign lesions was similar (94% and 98%, compared with 91% and 96 %). CONCLUSION: In the cases of solid malignant hepatic lesions, the three breath-hold T2-weighted sequences were inferior to non-breath-hold TSE with regard to lesion-to-liver contrast-to-noise ratio and lesion detectability. Non-breath-hold TSE imaging should thus not be replaced by breath-hold T2-weighted imaging.

CT and MR Findings of Presacral Epidermoid Cyst: A Case Report

Epidermoid cyst of the presacral space is a rare benign congenital lesion which is lined with keratinized squamous epithelium. We describe the computed tomography(CT) and magnetic resonance (MR) imaging findings in a case of presacral epidermoid cyst in a 35-year-old woman. The lesion appeared on CT as a well defined cystic mass with a thin wall. MR imaging showed heterogeneously low signal intensity on T1-weighted images and heterogeneously high signal intensity on T2-weighted images.

Utility of Dual Echo T2-Weighted Turbo Spin Echo MR Imaging for Differentiation of Solid, Malignant HepaticLesions from Nonsolid, Benign Hepatic Lesions

PURPOSE: To evaluate the additive value of multiphasic contrast-enhanced dynamic MR imaging as a supple-mentto dual-echo T2-weighted TSE MR imaging for the differentiation of solid, malignant hepatic lesions from nonsolid,benign hepatic lesions. MATERIALS AND METHODS: Two radiologists retrospectively reviewed dual-echo T2-weightedTSE MR images and gadolinium-enhanced MR images in 51 patients with hepatic lesions (28 malignant, 69 benign). Forthe dif-ferentiation of malignant from benign lesions, as seen on dual-echo T2-weighted TSE MR images, weevaluated sensitivity, specificity, and accuracy, and compared with the results with those for dual echoT2-weighted MR images plus multiphasic contrast-enhanced dynamic MR images. In addition, Az values for dual echoT2-weighted MR images were compared with those for dual echo T2-weighted MR images plus multiphasiccon-trast-enhanced dynamic MR images. RESULTS: For the differentiation of malignant from benign hepatic lesions,as seen on dual-echo T2-weighted TSE images, sensitivity, specificity, and accuracy were 80.0 %, 97.5 %, and 93.9%, respectively, for lesions less than 3 cm in diameter, and 92.3 %, 95.0 %, and 93.5 %, respectively, for thosethat were 3 cm or larger. The results for dual-echo T2-weighted MR imaging plus multiphasic contrast-enhanceddynamic MR imaging were 86.7%, 100.0%, and 97.3%, respectively, for lesions less than 3 cm, and 92.3%, 100.0 %,and 95.7 %, re-spectively for those that were 3 cm or larger. There were no significant differences insensitivity, specificity, or accuracy between the results obtained using dual-echo T2-weighted MR imaging andthose obtained with d-ual- echo T2-weighted MR imaging plus multiphasic contrast-enhanced dynamic MR imaging. Norwere there statistically significant differences in Az values between the two groups. CONCLUSIONS: For thedifferentiation of solid, malignant hepatic lesions from nonsolid, benign hepatic lesions, there is no differencein accuracy between dual-echo T2-weighted TSE MR imaging and the additional use of multiphasic contrast-enhancedMR imaging. Dual-echo T2-weighted TSE MR imaging may, therefore, be use-ful for the differentiation of solid,malignant hepatic lesions from nonsolid, benign hepatic lesions without the use of multiphasic contrast-enhancedMR imaging.

MR Imaging Findings of Renal Capsular Leiomyoma: A Case Report

In the literature, descriptions of the MR findings of renal leiomyoma are rare. We present the MR findings ofa capsular leiomyoma of the kidney in which hy pointensity relative to normal renal parenchyma was seen on bothT1- and T2-weighted MR images.

CT Findings of Increased Attenuation of the Liver Adjacent to the Hemangioma

PURPOSE: The purpose of this study was to evaluate the frequency, location, and appearance of increasedattenuation of the liver adjacent to a mass during arterial-phase spiral CT in patients with hemangioma. Thecharacteristics of the mass associated with these findings were also evaluated. MATERIALS AND METHODS: Usingspiral CT, 153 lesions in 114 hepatic hemangioma patients were retrospectively reviewed. We evaluated thefrequency, location, and appearance of increased hepatic attenuation adjacent to the hemangioma, and determinedwhether lesion size varied according to whether or not there was increased hepatic attenuation. RESULTS: Areas ofincreased hepatic attenuation adjacent to the hemangioma were identified in 10.5% of cas-es(16/153) and seen inmasses which showed a homogeneously hyperdense (11/16, 69%) or peripherally hy-perdense pattern (5/16, 31%). Thelocation of increased hepatic attenuation was commonly the peripheral por-tion (9/16, 56%), and increased hepaticattenuation was frequently wedge shaped of the mass (11/16, 69%). Lesion size did not vary according to whether ornot there was increased hepatic attenuation. CONCLUSION: Increased hepatic attenuation adjacent to a hemangiomais not rare, and is usually located periph-eral to the mass. It is common in a mass showing a homogeneouslyhyperdense pattern.

CT Findings of Portal Vein Aneurysm

PURPOSE: To describe the CT findings of portal vein aneurysm in eight patients. MATERIALS AND METHODS: Allpatients included in this study (two men and six women) under went CT examinations between October 1996 and June1998. Of these eight, three were suffering from hepatic disease and portal hypertension. We determined thelocation, shape, size, and characteristics of the lesions, and the presence or ab-sence of portal vein anomaly. RESULTS: S even patients had intrahepatic portal vein aneurysm (at the umbilical por-tion of the left portal veinin five patients, between the transverse and umbilical por-tion of the left portal vein in one, and at thebifurcation of the anterior and posterior branch of the right portal vein in one), while extrahepatic portal veinaneurysm, at the confluence of the superior mesenteric and splenic vein was found in only one. Lesions werecyst-shaped in seven cases and saccular in one, and showed well - circum scribed, markedly enhanced mass, whichcommunicated with the portal vein and/or gives off major branches. Portal vein anomaly, in which the rightanterior segmental portal vein originated from the umbilical portion of the left portal vein, was seen in threepatients. In all three, intrahepatic portal vein aneurysm was present at the umbilical portion of the left portalvein, and in one, the umbilical portion of the left portal vein was located to the right of the Cantlie line. CONCLUSION: CT examination can help reveal portal vein aneurysm by detectinga well - circumscribed, markedlyenhanced mass which communicates with the portal vein and/or gives off major branches.

Acute Cholecystitis: Two-Phase Spiral CT Finding

PURPOSE: To describe the two-phase spiral CT findings of acute cholecystitis. MATERIALS AND METHODS: CTscans of nine patients with surgically-proven acute cholecystitis were retrospectively reviewed for wallthickening, enhancement pattern of the wall, attenuation of the liver adjacent to the gallbladder, gallstones,gallbladder distention, gas collection within the gallbladder, pericholecystic fluid and infiltration ofpericholecystic fat. RESULT: In all cases, wall thickening of the gallbladder was seen, though this was moredistinct on delayed images, Using high-low-high attenuation, one layer was seen in five cases, nd three layers infour. On arterial images, eight cases showed transient focal increased attenuation of the liver adjacent to thegall bladder;four of these showed curvilinear attenuation and four showed subsegmental attenuation. One caseshowed curvilinear decreased attenuation between increased attenuation of the liver and the gallbladder, andduring surgery, severe adhesion between the liver and gallbladder was confirmed. Additional CT findings wereinfiltration of pericholecystic fat (n=9), gallstones (n=7), gallbladder distension (n=6), pericholecystic fluid(n=3), and gas collection within the gallbladder (n=2). CONCLUSION: In patients with acute cholecystisis,two-phase spiral CT revealed wall thickening in one or three layers ; on delayed images this was more distint. Inmany cases, arterial images showed transient focal increased attenuation of the liver adjacent to the gallbladder.

Difference of Contrast Enhancement Characteristics of Hepatic Hemangiomas According to the Lesion Size onTwo-Phase Spiral CT

PURPOSE: To determine the different of enhancement patterns of hepatic hemangioma according to the lesionsize, using dual-phase spiral CT. MATERIALS AND METHODS: Fify-nine lesions in 45 patients with hepatichemangiomas were subjected to spiral Ct. According to size, the lesions were divided into two groups(_2.5cm : n=25). The enhancement patterns of the lesions were classified as one of four types (homogeneoushyperdense, peripheral hyperdense, central hyperdense, or hypodense) during the early phase, and as one of fivetypes homogeneous hyperdense, peripheral hyperdense, central hyperdense, hypodense or isodense) during the delayedphase. We evaluated differences in enhancement patterns during the early and delayed phase according to lesionsize. RESULTS: During the early phase, the enhancement patterns of lesions large than 2.5cm were peripheralhyperdense(96%) or homogeneous hyperdense (4%);those of less than 2.5cm were peripheral hyperdense (53%),homogeneous hyperdense(26%), hypodense(18%), or central hyperdense(3%). Thus, hemangiomas in these two groupsusually showed a peripheral enhancement pattern during the early phase, but in those which were smaller than2.5cm, atypical enhancement patterns were more common. During the delayed phase, the enhancement patterns oflesions larger than 2.5cm were peripheral hyperdense (60%) or homogenous hyperdense (40%), while the patterns ofthose smaller than 2.5cm were homogeneous hyperdense (67%), peripheral hyperdense (24%), central hyperdense (3%),hypodense (3%), or isodense (3%). Thus, the enhancement patterns of lesions larger than 2.5cm were usuallyperipherally hyperdense during the delayed phase, while those smaller than 2.5cm showed a homogeneous enhancementpattern. CONCLUSION: The enhancement patterns of hepatic hemangiomas differ according to lesion size. A knowledgeof these differences is helpful in the diagnosis of hepatic hemangioma.

Usefulness of US-Guided Automated Gun Biopsy of Nonpalpable Breast Lesions

PURPOSE: To evaluate the clinical usefulness of ultrasonography (US) - guided automated gun biopsy of nonpalpable breast lesions. MATERIALS AND METHODS: In 30 nonpalpable breast lesions over 0.6cm and detected on US, we performed US-guided biopsy using an 18-gauge automated biopsy gun. Two to four specimens were obtained from each lesion. We analyzed the site, size and depth of the lesions, and the length and histopathologic results of the specimens. In four lesions, surgical biopsy and gun biopsy results were compared. RESULTS: In 29 of 30 lesions (96.7%), specimens were adequate for histopathologic diagnosis, and this was as follows: one case of infiltrating ductal carcinoma, 13 of fibrocystic disease, 10 of fibrocystic disease versus fibroadenoma and one of fibroadenoma. There was also one reactive hyperplasia of LN, and one fatty one and two normal tissues, and inthese four lesions, agreement between gun and surgical biopsy results was 100%. The only complication was minor bleeding, which was controlled by compression. CONCLUSION: US-guided automated gun biopsy is a clinically useful and safe procedure for evaluating nonpalpable breast lesions detected on US.

Primary Paraganglioma of the Liver: A case report

Primary paraganglioma of the liver is a very rare disorder, and radiologic findings have not yet been described. We report a case of this entity in which the US, CT, MRI and 131I-MIBG scan findings are described.

Contrast Enhancement Characteristics of Hepatocellular Carcinoma According to the Tomor Size on Two-Phase Scan with Spiral CT

PURPOSE: To determine the enhancing patterns of hepatocellular carcinoma(HCC) and the difference of enhancing patterns according to the tumor size, using spiral CT. MATERIALS & METHODS: We reviewed 213 lesions in 76patients who had been clinically or histopathologically diagnosed as HCC sufferer. The tumors were divided into three groups, according to size(&3 cm, 3-5cm and >5 cm). The enhancing patterns of tumor and capsule in the earlyand delayed phase were analysed. The enhancing patterns of the tumor were divided into five types(high, peripheralhigh, mixed, iso and low attenuation) in the early phase and four types(central high, mixed, iso, and low attenuation) in the delayed phase. The enhancing patterns of the capsule were divided into three types such asiso, low and high attenuation. RESULTS: High attenuating lesions in the early phase were as follows : below 3cm 72% ; 3-5cm., 60% ; above 5cm., 49%. Mixed attenuating lesions in the early phase were as follows : below 3cm., 1%; 3-5cm., 22% ; above 5cm., 36%. Thus, most HCCs were high attenuation type in the early phase, but as the tumorbecame larger, less high attenuation and more mixed attenuation was demonstrated(p<0.01). There was no difference of enhancing patterns according to the tumor size in peripheral high, iso and low-attenuating lesions. In the delayed phase most of the hepatomas appeared as totally hypodense lesions. For capsules, the results were as follows : below 3cm., 20% ; 3-5cm.,58% ; above 5cm., 73%. As the tumors became larger, more capsules were demonstrated(p <0.01). The capsules were visualized as iso or low attenuating rim in the early phase and high attenuating rim in the delayed phase. CONCLUSIONS: To determine the enhancing patterns of HCC using spiral CT is considered to be helpful in the diagnosis of HCC.

Differential Diagnosis of Malignant Ovarian Tumors on CT Findings

PURPOSE: To assess the value of CT for the differential diagnosis of malignant ovarian tumors. MATERIALS AND METHODS: We reviewed CT scans of 31 patients with surgically confirmed 46 malignant ovarian tumors. (29 epithelial tumors, 9 Krukenberg tumors, 6 germ cell tumors, and 2 sex cord-stromal tumors.) CT scans were evaluated for the mass (bilaterality, size, internal component, and margin), peritoneal spread pattern, ascites, invasion of adjacent organ, and lymphadenopathy. RESULT: Bilateral masses were seen in epithelial or Krukenberg tumor in 61.1%(11/18) and 80%(4/5) respectively. Epithelial tumors showed predominantly cystic mass(37.9%, 11/29), irregular margin(82.8%, 24/29) of mass, and accompanying peritoneal and omental spread (66.7%, 12/18), whileKrukenberg tumor showed predominantly solid mass(55.5%, 5/9), smooth margin of mass(100%, 5/5), and no peritoneal and omental spread. All cases with germ cell tumor or sex cord-stromal tumor showed unilateral mass. Relatively young aged, unilateral solid (66.7%, 4/6) tumors were germ cell tumor. Of these cases, septa within solid portionof mass were prominent in all dysgerminoma. (3/3) CONCLUSION: CT may be a valuable tool for the differential diagnosis of malignant ovarian tumors.

Adenomatoid Tumor of Epididymis: US Findings

PURPOSE: To evaluate the US findings of epididymal adenomatoid tumor. MATERIALS AND METHODS: Were trospectively reviewed US findings of four patients with histopathologically proven epididymal adenomatoidtumors. Lesions were evaluated for their size, location, margin, shape and echogenicity. RESULTS: The size of thetumors ranged between 0.5cm and 2cm and all occurred on the left side of the epididymis. Of the four cases, three were located at the tail of the epididymis and one at its head. The tumors were well marginated and spherical andecho-texture was variable but homogenous. CONCLUSION: The possibility of and adenomatoid tumor should be considered when the epididymal mass is round and has a clear margin and the echo-texture of ultrasound ishomogenous.

Mammographic Findings of Benign Breast Calcifications

PURPOSE: To determine the characteristics of benign breast calcifications on mammogram. MATERIALS AND METHODS: Benign breast calcifications on mammograms of 25 patients, which were confirmed by needle localization and excisional biopsy(15 cases), cytology(1 case), or follow-up study(9 cases), were retrospectively analysed according to size, shape, number, distribution, and density. RESULTS: The size of benign breast calcifications was uniform in 4 cases (16%), and variable in 21 cases (84%). The shape of calcifications was round or oval in 18 cases(72%), linear or branching pattern in 6 cases (24%), and irregular in 1 case(4%). The number of calcifications was 2-5 in 7 cases(28%), and over 6 in 12 cases(48%). The distribution of calcifications was focal in 13 cases(52%) and diffuse in 12 cases(48%). The density of calcification was homogenous in all 25 cases(100%). CONCLUSION: Analysis of number, shape, size, and distribution is helpful for the diagnosis of benign breast calcifications. However the homogenous density of the calcification is suggested to be the most helpful criterion for the diagnosis of benign breast calcifications.