Tuberculous Pneumonia: CT Findings in 20 Patients

PURPOSE: To evaluate CT findings of tuberculous pneumonia mainly presenting as parenchymal consolidation. MATERIALS & METHODS: CT scans of twenty patients with tuberculous pneumonia were retrospectively reviewed. Analyses included the location, extent, and homogeneity of consolidation, presence of volume loss of involved lung and air-bronchogram, associated lesions suggesting previous tuberculous infection and evidence of bronchogenic spread. RESULTS: The location of consolidation revealed relatively even distribution without any specific predilection site. The areas of consolidation were irregular in margin (95%), inhomogeneous in attenuation (75%) including focal areas of low attenuation and multiple cavities within it. Volume loss (70%) of the involved lobe was associated. There were lesions suggesting previous tuberculous infection (95%) in the surrounding area and evidences of bronchogenic spread (100%) such as poorly-defined nodules and Iobular consolidations in the remote site from main consolidation. CONCLUSION: In tuberculous pneumonia, the areas of consolidation are irregular in margin and inhomogeneous in attenuation on CT scan. The evidences of bronchogenic spread and lesions suggesting previous tuberculous infection are almost always associated in the surrounding or remote site from main consolidation.

MRI Findings of Intracranial Hemangioblastoma

PURPOSE: Complete resection of the tumor nodule(mural nodule or solid portion of the tumor) is the essential goal of surgical treatment for heman-gioblastoma. The purpose of this study was to classify the morphologic types of intracranial hemangioblastoma on MRI and to compare the location and contour of tumor nodule on MRI with those on angiography. MATERIALS AND METHODS: The MRI findings of 34 lesions(38 lesions if 4 spinal cord lesions were included) in 26 patients(17 males and 9 females, range of age, 18-67 years, mean, 39 years) with surgically and histopathologically proved intracranial hemangioblastomas were reviewed. Seventeen patients underwent CT scanning in a short interval. Contrast-enahnced T1 -weighted imaging pa- tterns of hemangioblastoma were classified according to Ho's morphologic types. The location and contour of tumor nodule were compared between MRI and angiography in 15 patients(24 lesions). RESULTS: By location, cerebellar hemisphere was predominated(55%), followed by cerebellar vermis(26%), supratentorial region(5%), and medulla oblongata (3%). Spinal cord lesions(11%) were seen in 3 patients of 5 von HippeI-Lindau diseases. The frequency of morphologic types was as follows; Type 1 (purely cystic), 3%, Type 2(mural nodule), 50%, Type 3(cyst with wall enhancement), 3%, Type 4 (cystic nodule), 15%, Type 5(solid with internal cyst), 9%, and Type 6(solid), 20%. All tumor nodules(33 lesions) enhanced intensely with intravenous contrast material on MRI, of which 24 lesions(in 15 patients) revealed hypervascular masses fed by pial arteries on angiography. They were superficial and abutted pia mater partially or in large portion on both MR I and angiography. CONCLUSION: Over 70% of intracranial hemangioblastomas had a surrounding cyst, and superficial, pial-based location and number of the tumor nodules on MRI was correlated well with those on angiography. MRI is the examination of choice for preoperative evaluation of intracranial hemangioblastoma.

Intrahepatic Duct Dilatation Caused by Extrahepatic Billiary Obstruction' Morphologic Differentiation Between Benign and Malignant Disease on CT Scan

PURPOSE: Retrospective studies were carried out to evaluate the usufulness of CT in differentiating benign or malignant intrahepatic duct(IHD) dilatation due to extrahepatic duct(EHD) obstruction. MATERIALS AND METHODS: Among 75 cases of IHD dilatation, 35 cases(47%) which did not show causative lesion on CT were classified into central or peripheral type according to the extent of the dilatation and into pruned or beaded form according to its pattern. We considered central type or pruned form as a benign feature while peripheral type or beaded from as a malignant feature. Predictions of benignancy or malignancy were made according to the pattern and the extent of IHD dilatation. In all 75 cases, maximum caliber of IHD at portal vein bifurcation were examined. RESULTS: In regard to the classification of the extent, 80% (28 out of the 35 cases:11 of 15 cases of benignancy and 17 of 20 cases of malignancy) of our prediction was correct. As to the classification of the pattern, similar results(82% correct prediction) were obtained(14 out of 17 cases):ln 15 cases of benignancy, we observed six cases of pruning and 1 case of beading. Among the 20 cases of malignancy, two cases of pruning and eight cases of beading of IHD dilatation were observed. Mean diameters of IHD at portal vein bifurcation were 10.1ram in benignancy and 15.1mm in malignancy.(Diameters less than 11mm was suggestive of benignancy(alpha =0.05). CONCLUSION: Evaluation of the extent, the pattern, and the degree of IHD dilatation is necessary in differential diagnosis of benignancy and malignancy of EHD obstruction. We conclude that CT is a useful tool for this purpose of differential diagnosis of the benignancy and the malignancy of extrahepatic biliary obstruction.

Physiologic AV Valvular Insufficiency in Cine MR Imaging

PURPOSE: To give a help in the interpretation of cardiac cine-MR examination, the extent, shape, and timing of appearance of signal void regions near atrioventricular(A-V) valve prospectively evaluated in the healthy population. MATERIALS AND METHODS: Using an axial gradient-echo technique with small flip angle, repetition time(TR) of 36 msec and echo time(TE) of 22 msec, 20 volunteers without known valvular abnormalities undertook cardiac cine-MR imaging including atrioventricualr valve areas. RESULTS: Transient signal void was observed within the atrium near the tricuspid(13/20 = 65%) and mitral valves(9/20 = 45%), respectively, which is so called "physiologic atrioventricular valvular insufficiency". Eight subjects revealed the signal void areas near both tricuspid and mitral valves but, 5 subjects didnot show any evidences of physiologic insufficiency. This physiologic condition does not extend more than lcm proximal to A-V valve plane and is generally observed only during early systole. Its morphology is semilunar or triangular configuration with the base to the valve plane in most cases of normal tricuspid insufficiency and small globular appearance in most cases of normal mitral insufficiency. CONCLUSION: Awareness of normal signal void areas near the A-V valve and their characteristics is critical in the interpretation of cardiac cine MR examinations and maybe helpfal in the study of the normal cardiac physiology.