Dual-Energy CT in the Assessment of Mediastinal Lymph Nodes: Comparative Study of Virtual Non-Contrast and True Non-Contrast Images

OBJECTIVE: To evaluate the reliability of virtual non-contrast (VNC) images reconstructed from contrast-enhanced, dual-energy scans compared with true non-contrast (TNC) images in the assessment of high CT attenuation or calcification of mediastinal lymph nodes. MATERIALS AND METHODS: A total of 112 mediastinal nodes from 45 patients who underwent non-contrast and dual-energy contrast-enhanced scans were analyzed. Node attenuation in TNC and VNC images was compared both objectively, using computed tomography (CT) attenuation, and subjectively, via visual scoring (0, attenuation the aorta; 2, calcification). The relationship among attenuation difference between TNC and VNC images, CT attenuation in TNC images, and net contrast enhancement (NCE) was analyzed. RESULTS: CT attenuation in TNC and VNC images showed moderate agreement (intraclass correlation coefficient, 0.612). The mean absolute difference was 7.8 +/- 7.6 Hounsfield unit (HU) (range, 0-36 HU), and the absolute difference was equal to or less than 10 HU in 65.2% of cases (73/112). Visual scores in TNC and VNC images showed fair agreement (kappa value, 0.335). Five of 16 nodes (31.3%) which showed score 1 (n = 15) or 2 (n = 1) in TNC images demonstrated score 1 in VNC images. The TNC-VNC attenuation difference showed a moderate positive correlation with CT attenuation in TNC images (partial correlation coefficient [PCC] adjusted by NCE: 0.455) and a weak negative correlation with NCE (PCC adjusted by CT attenuation in TNC: -0.245). CONCLUSION: VNC images may be useful in the evaluation of mediastinal lymph nodes by providing additional information of high CT attenuation of nodes, although it is underestimated compared with TNC images.

A Case of Congenital Paraesophageal Hiatal Hernia in Infancy / 대한소아소화기영양학회지

Esophageal hiatal hernia is the hernia of a part of or the whole of stomach to posterior mediastinum through esophageal hiatus. Esophageal hiatal hernia can be classified as sliding hiatal hernia (type I), paraesophageal (type II), combined sliding and paraesophageal (type III), and complex paraesophageal (type IV). Type III and IV are clinically classified as paraesophageal hernia. The authors by chance found cystic mass filled with air in the lower lobe of the right lung during the treatment of mycoplasma pneumonia of 10 month-old patient. It was found to be paraesophageal hernia on the chest computed tomography and treated with the operation. As complex paraesophageal hernia is not usual among infants, the authors report it here with literature review.

Squamous Cell Carcinoma Associated with Chronic Empyema Caused by Metallic Fo reign Body: A Case Report

Malignant neoplasm associated with chronic empyema is rare. Most squamous cell carcinomas of the pleura may occur in association with chronic persistent empyema, with or without pleurocutaneous fistula. We report a case of squamous cell carcinoma associated with chronic empyema caused by a metallic foreign body.

The Diagnostic Concordance of Endoanal Ultrasonography and Endoanal MRI in Cases of Anorectal Fistula

PURPOSE: To evaluate the preoperative diagnostic concordance of morphologic classification of anorectal fistula by endoanal ultrasonography (EUSG) and endoanal magnetic resonance imaging (EMRI). MATERIALS AND METHODS: Between January 1998 and March 1999, 17 patients with anorectal fistula underwent endoanal ultrasonography and magnetic resonance imaging for preoperative assessment. The types of fistula and abscess formation were evaluated, and the findings compared with those obtained during surgery. RESULT: The overall accordance of anorectal fistula was 76% (13 of 17 cases) on ultrasonography and 94% (16 of 17 cases) on magnetic resonance imaging. According to the findings of EUSG, the accordance of each type of anorectal fistula was as follows: transphineteric, 92% (11 of 12 cases); suprasphinteric, 33% (1 of 3); and extrasphincteric, 50% (1 of 2), while for EMRI, the respective figures were 100% (12 of 12 cases), 67% (2 of 3), and 100% (2 of 2). An analysis of reproducibility using kappa value showed that overall concordance between endoanal ultrasonography and surgery(K=0.820) as well as between endoanal MRI and surgery (K=0.866), was very close. CONCLUSION: For the evaluation of anorectal fistula, preoperative endoanal magnetic resonance imaging was more accurate and informative than endoanal ultrasonography.

Proteus Syndrome: A Case Report

Proteus syndrome is a rare congenital hamartomatous condition with a variety of abnormalities affecting allthree germ layers including overgrowth of various parts of the body, hemihypertrophy, unusual skeletalmalformation, skin lesions, and various tumors. I describe the radiologic findings in a 12 year-old boy withProteus syndrome. Computed tomography and magnetic resonance imaging are very useful for the specific diagnosis.

The Size of the Main Pulmonary Artery in Patients with IPF: Relationship with the Extent of Honeycombing Lesion

PURPOSE: To predict pulmonary arterial hypertension by comparing the extent of honeycombing lesion with the diameter of main pulmonary artery (MPA). MATERIALS AND METHODS: We retrospectively reviewed 21 patients (20 men, one woman) who showed honeycombing lesion on HRCT, and also analysized a control group of 30 (29men, one woman) who had no cardiopulmonary symptom and no abnormality on chest CT. On Chest HRCT, we scanned at four levels [1)aortic arch, 2) bifurcation of bronchus, 3) mid-portion of left ventricle, 4) dome of right diaphragm], and two radiologists then evaluated the proportion of honeycombing lesion within the entire lung field. According to the extent of this, we divided the patients into five groups [ or = 80% (V)], and then divided Group I into two subgroups [<10 % (I|1), 10-19% (I-2)]. Using contrast-enhanced routine CT, the main pulmonary artery (MPA) was measured at its the widest diameter perpendicular to the long axisat the level of its bifurcation. RESULT: In group I (n=11) MPA was 28.4+/-2.6mm ; in group II (n=6), it was31.7+/-2.0mm ; in group III (n=2), 33.5mm ; in group IV (n=1), 33mm ; and in group V (n = 1), 39mm. In subgroup I-1MPA was 26.1+/-1.9mm, and in subgroup I-2, it was 29.8+/-1.6mm. In the control group, MPA was 25.1+/- 2.0mm. CONCLUSION: The extent of honeycombing lesion is closely related to the change in diameter of the MPA. Honeycombing lesion extending over more than 10% of the lung field may lead to pulmonary arterial hypertension.

Pelvic ultrasonography of obstetric and gynecologic mass

The ultrasonography is a very useful diagnostic procedure in obstetric & gynecologic mass. so we anlayzedtotal 153 cases of pelvic ultrasonogram with pathologic diagnoses. The results were as follows: 1. The ages ofpatients were distributed from 16 to 70 years-old, and the third decade was the most prevalent. 2. Of 153 cases,the ovarian masses were 85 cases, the tubal ones were 49 cases, and the uterine were 19 cases. 3. Of 85 ovarianmasses, physiologic ovarian cysts were 44 cases, and cystic teratoma were 14 cases. Of 49 tubal masses, tubalpregnancies were 35 cases and the most prevalent. Of 19 uterine masses, leiomyomas were 11 ases and the mostprevalent. 4. Of 153 cases, the echo-complex masses were 103 cases, the cystic ones were 34 cases, and the solidones were 19 cases. 5. The characteristic findings of frequent masses were as follows: (1) The physiologic ovariancysts were 44 cases, and show mainly cytic or pure cystic masses in 42 cases. (2) The ectopic pregnancy were 36cases, and show echo-complex masses in 21 cases, and cul-de-sac fluid echo in 22 cases. (3) The cystic teratomaswere 1 cases, and reveal mainly cystic or pure cystic masses in 10 cases, and calcification with posterioracoustic shadowing in 6 cases. (4) The uterine leiomyoma were 11 cases, and reveal solid mass with abnormaluterine contour in 8 cases. (5) The malignant or borderline malignant lesions were 6 cases. (6) Of 153 cases, thepathologic diagnosis was possible in 98 cases(64.1%).

Ultrasonographic and pathologic study of ovarian tumors

This is a retrospective study of 161 ovarian neoplasms, all of which were surgically removed and had preoperative sonographic examinations. They were evaluated respect to age, tumor size and its echogenicity. The results were as follows: 1. Of all 161 tumors, physiologic lesions were 67 cases (41.6%), germ cell tumors were 28 cases (17.4%) and serous tumors were 19 cases (11.8%). 2. Of all 161 tumors, right ovarian lesions were 82 cases (50.9%), left were 59 cases (36.7%), and bilateral lesions were 20 cases(12.4%). 3. The most characteristic findings of tumors were as follows: 1) Physiologic tumors were 2-9cm sized (88.1%), anechoice-5% echogenic (79.1%), and developed during 4th & 5th decades (91.0%). 2) Inflammatory tumors were 2-9cm sized (94.1%), 50%-totally echogenic (76.5%), and during 4th & 5th decades (94.1%). 3) Serous tumors were 2-9cm sized (60.3%), anechoic-5% echogenic (89.5%), and during 3rd & 4th decades (84.2%). 4) Mucinous tumors were 5-19 cm sized (77.8%), anechoic-5% echogenic (77.8%), during 2nd-8th decades with diffuse distribution. 5) Endometrioid tumors were 5-14cm sized (100.0%), variable echogenic, and during 3rd & 4th decades (90.9%). 6) Germ cell tumors were 5-14cm sized (75.0%), variable echogenic, during 3rd & 4th decades (82.1%). 7) Parovarian cysts were 2-14cm sized (90.0%), anechoic-5% echogenic (100.0%), with diffuse age distribution. 4. The malignant and borderline malignant tumors were 9 caseswith more than 10cm sized (77.8%), and developed during older than 4th decade (100.0%). Anechoic 3 cases, 1-5% echogenic 2 cases, and totally echogenic 4 cases were found.

Radiological and histopathological study of benign tumors of the mandible

Benign tumors of the mendible are uncommon lesions. That were classifed into odontogenic tumors and nonodontogenic tumors. Author reviewed the radiological evaluation and pathological microscopic finding from 33 benign tumors of the mandible that were comfirmed by the biopsy during last 10 years in Dental Clinics, Ewha Womans University Hospital and Seoul Natinal University Dental Hospital. Following results were obainend; 1.Benign tumors of the mandible were classified into odontogenic (66.7%) and non-odontogenic tumors (33%). 2. The range of the age distribution was between 6 years and 67 years old. The commonest age group was the second decade(39.4%). 3. There was no difference to sex distribution. 4. The most frequent locatio was the body of the mandible (42.4%). 5. Radiographic findings were relatively characteristic in odontogenic tumors rather thannon-odontogenic tumors. 1) Radiolucent cystic lesions-ameloblastoma, odontogneic myxoma, odontogneic fibroma,aneurysmal bone cyst and neurofibroma. 2) Radiopaque mass lesions-odontoma, cementoma and osteoma. 3) Mixed patterns-ossifying fibroma, cementifying fibroma, calcifying odontogenic epithelial tumor and hemangioma. It was concluded that the radiographic examination was of value to diagnose the benign tumos of tee mandible in symptomless patients.

Congenital cystic adenomatoid malformation

The congenital cystic adenomatoid malformation of the lung is an unusual pulmonary entity, and usuallysymptomatic in infancy with sign of resiratory distress. This abnormality consists of enlarged, multicystic lobewith smooth-walled cysts of variable sized, which can communicate with major bronchi through malformed air passagethat usually lacks in cartilage. Roentgenographic findings are three types. First type is multicystic patternshowing various sized of cysts and causing mediastinal shift with pulmonary herniation. Second type is dominantcystic pattern underlying multicystic lesion, Third type is solid homogenous mass. Prompt surgical resection ischoice of treatment. We recently experienced a case of congenital cystic adenomatoid malformation of the lung of27 day female in fant and report with reviwe of literatures.

Evaluation of computed tomography of intraventricular hemorrhage

Prior to the introduction of CT, the clinical and radiological diagnosis of the intraventicular hemorrhage inliving patients was difficult. C.T. scanning is an invaluable investigation provding the rapid and noninvasivediagnosis of intracerebral and intraventricular hemorrhage. It reliably demonstrated the presence and distributionof fresh blood within the ventricular system. CT is also useful as a surgical guidance and in the evaluation offate of the hematoma by easily performable follow-up studies. We reviewed 3 cases of intraventricular hemorrhagein CT in the departement of radiology of Ewha Womans University hospital during the period from August, 1982 toAugust, 1983. The results were as follows: 1. The most patients were encountered in the 5th decade and the male tofemale ratio was 1.2:1. 2. Hypertension was the main cause of the intraventricular hemorrhage; 18 out of 31patients. Remaning 13 patients were caused by hypoxia, aneurysm, Moya Moya disease, coagulation defect, trauma andundetermined etiology. 3. 18 out of 31 patients showed hemorrhage in the lateral ventricles only and allventricles in 10 patients. 4. 28 out of 31 patients showed associated with intracranial hematoma: Those wereintracerebral hematomas in 16 patients, intracerebral hematoma with subarachnoid hemorrhage in 4 patients andextracerebral hematoma in 2 patients. 5. Outcome was assessed using the Glasgow scale. According to them the totalmortality rate was 54.8%, however, 32.2% of patients retured to normal or minor disablity. Patients, who hadhypertension and markded degree of hemorrhage in the ventricular systems had a poor outcome. Patients with onlyventricular hemorrhage had better outcome than associated intracranial hematoma. 6. 16 out of 31 patients weretreated by surgical methods and 15 out of 31 patients by conservative methods. 75% of patients were died inconservative treatment. 7. Conclusively, causes, degree of intraventricular hemorrhage and associatedintraventricular hematoma play an important role in outcome. And surgical treatment was beneficial in only a smallselective number of cases in intraventricular hemorrhage.