Results of Carotid Artery Stenting using Filter Wire in 24 Consecutive Symptomatic Patients with Severe Stenosis

PURPOSE: The aims of this study were to analyze the results of carotid artery stenting using distal protection with FilterWire, and evaluate the effectiveness of FilterWire for distal embolic protection. MATERIALS AND METHODS: Between June and December in 2004, elective carotid artery stenting using FilterWire was attempted in 25 lesions of 24 consecutive patients. All patients were symptomatic, with recurrent transient ischemic attacks (TIA) or a stroke. The cerebral ischemic lesions of embolic origin were evaluated before and after the procedure using magnetic resonance imaging, including diffusion-weighted images. Both pre- and post-procedural 99mcTc-ECD SPECT were performed to assess the cerebral blood flows. Any visible debris within the FilterWire was sent for histological/cytological analyses. RESULTS: Technical success was achieved all 25 cases. The mean pre-procedural stenosis was 89% (range 70-100%), and that immediately after stent placement was nearly 0%. With the exception of only one major stroke (1/25, 4%), no periprocedural complications were encountered. On the diffusion weighted images, new lesions were observed in four patients (4/25, 16%), but these were clinically silent. FilterWire-related transient spasm occurred in eight of the 25 procedures (32%). CONCLUSION: Carotid artery stenting, with FireWire distal protection, seems technically feasible, safe and effective in preventing procedural related embolic complications.

Differentiation of Benign and Malignant Ulcers of the Stomach on Computed Tomography

PURPOSE: We wanted to determine the multidetector computed tomography (MDCT) findings for differentiating benign ulcers from malignant ones. MATERIALS AND METHODS: 18 clinicopathologically proven benign ulcers that had been detected by both endoscopy and MDCT were the focus of this study. 26 ulcerative advanced gastric cancers and 26 early gastric cancers with ulceration, all of which had been surgically proven, were selected as a control group. Five of the 26 early gastric cancers that were confined to the mucosa and that were not detected on CT were excluded in this study. The following CT findings were reviewed by two radiologists; ulcer size, the degree of enhancement and the thickness of inner enhancing layer in the ulcer base, the total thickness and the enhancing inner layer thickness in the largest part of the thickened ulcer mound, the presence of ulcer that projected beyond the healthy lumen, and the presence of perigastric fat infiltration and perigastric lymphadenopathy. RESULTS: An indiscernible thin-walled ulcer base (less than 1.5 mm) and suboptimal enhancement of the ulcer base for the discrimination of benign gastric ulcers from the malignant gastric ulcers showed sensitivities of 100% (18/18) and 78% (14/18), respectively, with specificities of 98% (46/47) and 92% (43/47), respectively. Ulcer projection was more significantly present in benign ulcer (13/18, 72%) than in the malignant gastric ulcers (7/47, 15%). The enhancing inner layer thickness in the ulcer mound was significantly greater in the AGC (mean: 7.4 mm) than in the benign gastric ulcers (mean, 2.2 mm). There were insignificant differences for ulcer size, total thickness of the ulcer mound, the perigastric fat infiltration and perigastric lymphadenopathy between the benign and malignant gastric ulcers. CONCLUSION: MDCT is an additional helpful diagnostic tool when benign gastric ulcers are histologically difficult to distinguish from malignant gastric ones.

Intraluminal Filling Defects of the Bile Ducts: Differentiation of Stones from Tumors-the Value of Magnetic Resonance Cholangiography in Conjunction with a 3D Spoiled Gradient Echo Gadolinium Enhanced Dynamic Sequence

PURPOSE: We wanted to determinate the value of a dynamic volumetric interpolated breath-hold examination (VIBE) as a supplement to MR cholangiography for differentiating biliary stones from tumors when patient are suspected of having intraluminal filling defects on direct cholangiography. MATERIALS AND METHODS: A retrospective analysis was performed for 49 patients who underwent MRI among all the patients who showed intraluminal filling defects on direct cholangiography for evaluating the cause of their jaundice from June 2002 to June 2003. After dividing these patients into two groups, i.e., the group with stones and the group with tumors, we analyzed and compared each MR patterns of 1) signal intensity, 2) shape, and 3) enhancement. RESULTS: High signal intensity on T1-weighted images (p< 0.001, chi-square test), dark signal intensity on T2-weighted images (p< 0.01, Fisher's exact test) or smooth contour of intraluminal filling defects (p< 0.001, chi-square test) could be significantly suggestive findings of stone rather than a tumor mass. Dynamic VIBE is the most specific sequence for differentiating non-enhancing stone from an enhancing mass (p< 0.001, Fisher's exact test). CONCLUSION: We showed that MR cholangiography, when added to the dynamic VIBE sequences, could be an important imaging technique for patients who are suspected of having intraluminal filling defects on direct cholangiography to differentiate stones from tumors. Especially, the addition of dynamic VIBE images can provide the increased level of confidence in the diagnosis.

The Clinical Efficacy of Percutaneous Bilateral Internal Drainage in Advanced Hilar Malignancy by T-Configured Dual Stent Placement: Comparison with Unilateral Endoscopic Stent Placement / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic or percutaneous internal drainage is a well-established palliative treatment for unresectable biliary tumors. Previous studies dealing with the unilateral versus bilateral liver lobe drainage have reported inconsistent results. This study evaluated the clinical efficacy of bilateral drainage with a newly designed T configured dual stent (T-stent) placement. METHODS: From 2001 to 2004, 46 hilar malignancies, which were not suitable for endoscopic retrograde biliary drainage (ERBD) on MR cholangiography were treated with the percutaneous placement of two self-expandable metallic endoprostheses in a T configuration through a single transhepatic access. The outcomes were examined retrospectively. The hilar malignancies, which were drain ed by unilateral ERBD were also reviewed. RESULTS: The 46 hilar malignancies drained by a T stent included a cholangiocarcinoma (n=36), gallbladder cancer (n=6), and metastatic cancer (n=4). Procedure related cholangitis occurred in 3 out of 46 patients (6.5%). The mean survival and stent patency times were 256 and 194 days, respectively. The 34 hilar malignancies drained by unilateral ERBD included cholangiocarcinoma (n=29), gallbladder cancer (n=3), and pancreatic cancer (n=2). Procedure related cholangitis occurred in 7 out of 34 patients (20.6%). The mean survival and stent patency times were 292 and 186 days, respectively. There were no statistically significant differences in the cholangitis frequency, survival and stent patency between the two groups. The frequency of cholangitis, mean survival and patency time in Klatskin tumors, which were drained by the T-stent (n=36) and ERBD (n=29), were compared. There were no significant differences in survival and stent patency time. CONCLUSIONS: T-configured dual stent placement can be used effectively in advanced biliary hilar malignancies. It can be used as a safe palliative drainage method in advanced hilar tumors, which are not suitable for ERBD.

The Usefulness of Multiplanar Reconstruction Images in Preoperative CT Evaluation of Advanced Gastric Cancer

PURPOSE: The purpose of this study was to assess the usefulness of multiplanar reconstruction (MPR) images in the preoperative evaluation of advanced gastric cancer. METHODS: Multidetector-row CT (MDCT) was performed on 61 patients with advanced gastric cancer, and the coronal and sagittal multiplanar images reconstructed from the transaxial data. The combined axial and MPR images were compared to the axial images alone to determine if the image quality and diagnostic accuracy had been improved. RESULTS: The observed image quality of the combined axial and MPR images, graded relative to the axial image alone, was fair in 22 (36.1%), good in 27 (44.2%), and excellent in 12 cases (19.7%). For the T staging, the diagnostic accuracy of combining the axial and MPR images (75.4%) was higher than that of the axial image alone (70.7%). However, there was no significant difference in the accuracies between the two methods (McNeamar test, P>0.05). For specific regions, the diagnostic accuracies of combining the axial and MPR images and the axial image alone were as follows: 90.2, and 73.8% with antral lesser curvature involvement; 93.4, and 75.4% with antral greater curvature involvement; 83.6, and 73.8% with gastric angle involvement; 96.7, and 88.5% with liver left lobe invasion; 90.2, and 83.6% with pancreas head invasion and 96.7, and 85.2% with colon or mesocolon invasion, respectively. CONCLUSION: Combining the axial and MPR images does not improve the depiction of the T staging compared to the axial image alone in advanced gastric cancer. However, combining the axial and MPR images improved the imaging quality and diagnostic accuracy of specific regions where the delineation of the conventional axial image was insufficient. Therefore, combining the axial and MPR images may be very useful in the preoperative evaluation of advanced gastric cancers.

New Techniques for Intracranial Stent Navigation in Patients with Tortuous Arteries

PURPOSE: We wanted to describe several new techniques of intracranial stenting that are helpful for navigating the stent delivery system in the tortuous carotid or vertebral arteries. MATERIALS AND METHODS: Between May 1998 and June 2004, 65 patients with 73 symptomatic, stenotic intracranial arteries (more than 50%) were successfully treated with stent-assisted angioplasty. In eleven of the total cases, the standard technique failed to navigate the stent delivery system into the objective lesion because of the tortuous path of the carotid or vertebral arteries. In these cases, several new techniques were used to overcome the vessels' tortuous path. The several new techniques were 1) the waiting method (20-30 minutes) after advancement of microwire across the lesion; 2) the double wires technique using an additional microwire; and 3) the coaxial double guiding catheters technique using an additional smaller guiding catheter. Five lesions were located in the middle cerebral arteries, four were in the supraclinoid internal carotid arteries, and two were in the distal vertebral arteries. RESULTS: In all difficult cases, intracranial artery stenting was performed successfully by using the several new techniques. The waiting method made smooth stent navigation possible in 5 cases, the double wire technique was successful in 4 cases and the coaxial double guiding catheter technique was successful in 2 case. There was no complication related to the new techniques. CONCLUSION: In difficult cases where the standard technique failed to navigate the stent delivery system into the objective lesion because of the vessels' tortuous path, these new techniques for intracranial stent navigation were usefully implemented.

Magnetic Resonance Imaging Findings of Portal Biliopathy

PURPOSE: We wanted to evaluate the MR imaging findings of portal biliopathy. MATERIALS AND METHODS: We retrospectively reviewed the MR imaging of twelve patients having biliary abnormalities and portal cavernoma. Two radiologists working in consensus analyzed the presence of extrahepatic portal vein obstruction, cavernous transformation, portosystemic collaterals and bile ducts abnormalities that included irregular contour, stricture, ductal dilatation, wall thickening and enhancement of the ductal wall. RESULTS: Extrahepatic portal vein obstruction was replaced by cavernous transformations in all patients. The cavernous transformations depicted on the MR scans were paracholedochal veins in 12 patients and epicholedochal veins in 6 patients. Three different types of biliary abnormalities were present: 1) the pseudocholangiocarcinoma type (3 patients) that resembled extrahepatic cholangiocarcinoma, 2) the varicoid type (6 patients) that was mainly distinguished by the multiple smooth extrinsic impressions along the common bile duct and 3) the mixed type (3 patients). The highly specific findings for the pseudocholangiocarcinoma type disease were thickening and delayed enhancement of the biliary ductal wall. CONCLUSION: The MR findings of portal biliopathy include cavernous transformation of the portal vein and morphological alterations of the biliary tracts such as irregular contour, biliary stricture with proximal ductal dilatation and thickening of the ductal wall with delayed enhancement. Recognition of these MR findings should facilitate the accurate diagnosis of portal biliopathy and prevent the misinterpretation or inappropriate management of this disease as malignancy or sclerosing chloangitis.

Usefulness of Multiplanar Reformatted Images of Multi-detector Row Helical CT in Assessment of Biliary Stent Patency

PURPOSE: To evaluate the usefulness of multi-detector row helical CT (MDCT), multiplanar reformatted images for the noninvasive assessment of biliary stent patency, and for the planning for management in patients with a self-expandable metallic stent due to malignant biliary obstruction. MATERIALS AND METHODS: Among 90 consecutive patients, from August 1999 to July 2003, 26 cases in 23 patients with malignant biliary obstruction who underwent self-expandable metallic stent insertion in the biliary system and percutaneous transhepatic biliary drainage within 7 days after CT were enrolled in this study. On CT images, the complete and functional obstruction of the stent and the precise level of obstruction were evaluated. The presence of an enhancing intraluminal mass or wall thickening around stent was determined, and the causes of obstruction were evaluated. These findings were then compared with percutaneous transhepatic cholangiography. RESULTS: Multi-detector row helical CT correctly demonstrated the patency of a stent in 24 cases (92.3%). It was adequate in helping to depict the precise level of stent occlusion in 23 cases (88.5%). Multi-detector row helical CT also revealed the extent of tumor that represented as an enhancing intraluminal mass or wall thickening around the stent in 23 cases, and this was represented as complete obstruction on percutaneous transhepatic cholangiography. In the case of functional obstruction, MDCT predicted the possible cause of the obstruction. CONCLUSION: Multiplanar reformatted images of multi-detector row helical CT is a useful imaging modality for the noninvasive assessement of stent patency and the precise level of obstruction when stent obstrution is suspected in the patients with self-expandable metallic stent due to malignant biliary obstruction. It can also predict the possible cause of the obstruction and allows adequate planning for the medical management of such cases.

The Usefulness of Multiplanar Reconstruction Images in Preoperative T-staging of Advanced Gastric Cancer

PURPOSE: The purpose of this study was to evaluate the performance of multidetector-row CT (MDCT) in the preoperative T-staging of patients with advanced gastric cancer. MATERIALS AND METHODS: A total of 65 patients with an established diagnosis of advanced gastric cancer (T2 or more) were evaluated with MDCT. The protocol of MDCT consisted of high-quality (HQ) mode helical scanning with a slice thickness of 2.5 mm. The axial CT images were reconstructed with a slice thickness of 5 mm. MPR images were reconstructed from the raw axial data with a slice thickness of 5 mm. A comparison between the standard axial and axial MPR images was performed by two radiologists with regard to the evaluation of the tumor location and T-stage. These findings were compared with the pathologic and surgical findings. RESULTS: T-staging of the advanced stomach cancer was correct in 89% (58/65) and 69% (45/65) of the MPR images and axial images, respectively. The MPR images improved the detection rate (5 lesions)of the tumors and increased the accuracy of the T-staging (13 lesions) in comparison with the axial images. The MPR images are of greater diagnostic value for the evaluation of omental seeding (5 lesions: axial images, 9 lesions: MPR images), tumor location and extension. CONCLUSION: Multiplanar reconstruction (MPR) images provide increased confidence in the location and T-staging of certain cases of advanced gastric cancer, such as those in locations where CT images are susceptible to be affected by the difficulties associated with partial volume averaging. In this study, the MPR images provided more precise information about the tumor location and T-staging than the standard axial images in the preoperative evaluation of advanced gastric cancer.

Standardization of MIP Technique in Three-dimensional CT Portography: Usefulness in Evaluation of Portosystemic Collaterals in Cirrhotic Patients

PURPOSE: To assess the usefulness of three-dimensional CT portography using a standardized maximum intensity projection (MIP) technique for the evaluation of portosystemic collaterals in cirrhotic patients. MATERIALS AND METHODS: In 25 cirrhotic patients with portosystemic collaterals, three-phase CT using a multidetector-row helical CT scanner was performed to evaluate liver disease. Late arterial-phase images were transferred to an Advantage Windows 3.1 workstation (Gener Electric). Axial images were reconstructed by means of three-dimensional CT portography, using both a standardized and a non-standardized MIP technique, and the respective reconstruction times were determined. Three-dimensional CT portography with the standardized technique involved eight planes, namely the spleno-portal confluence axis (coronal, lordotic coronal, lordotic coronal RAO 30 degree, and lordotic coronal LAO 30 degree), the left renal vein axis (lordotic coronal), and axial MIP images (lower esophagus level, gastric fundus level and splenic hilum). The eight MIP images obtained in each case were interpreted by two radiologists, who reached a consensus in their evaluation. The portosystemic collaterals evaluated were as follows: left gastric vein dilatation; esophageal, paraesophageal, gastric, and splenic varix; paraumbilical vein dilatation; gastro-renal, spleno-renal, and gastrospleno-renal shunt; mesenteric, retroperitoneal, and omental collaterals. RESULTS: The average reconstruction time using the non-standardized MIP technique was 11 minutes 23 seconds, and with the standardized technique, the time was 6 minutes 5 seconds. Three-dimensional CT portography with the standardized technique demonstrated left gastric vein dilatation (n=25), esophageal varix (n=18), paraesophageal varix (n=13), gastric varix (n=4), splenic varix (n=4), paraumbilical vein dilatation (n=4), gastro-renal shunt (n=3), spleno-renal shunt (n=3), and gastro-spleno-renal shunt (n=1). Using three-dimensional CT portography and the non-standardized MIP technique, the portosystemic collaterals demonstrated were similar to those demonstrated using the standardized technique. Additionally, howerer, the former revealed features not revealed by the latter, namely splenic varix (n=1), mesenteric collaterals (n=4), retroperitoneal collaterals (n=3), and omental collaterals (n=2). CONCLUSION: In patients with liver desease, three-dimensional CT portography using a standardized of MIP technique helps evaluate portosystemic collaterals, reduces interobserver bias, and saves reconstruction time.

MRI Findings of Nonprogressive Juvenile Spinal Muscular Atrophy of the Distal Upper Limbs (Hirayama's Disease)

PURPOSE: The aim of this study was to describe the dynamic changes of the cervical dural sac and the spinal cord during neck flexion in patients suffering from Hirayama's disease and to present the usefulness of flexion MR study for the diagnosis. MATERIALS AND METHODS: Seven consecutive male patients (age ranging 17-43 years, mean age 23.7 years) with the clinical diagnosis of Hirayama's disease and 5 healthy subjects (aged 25-32 years) for controls had done cervical MRI from January 2001 through June 2002. Cervical MRI was done in neutral and neck flexed positions using 1.5 T system (Sonata, Siemens, Germany) and obtained images were reviewed by two radiologists. We compared the cervical MRI findings of 7 patients with those of 5 healthy controls regarding neck flexion induced changes in the lower cervical segments. RESULTS: Neutral positioned cervical sagittal MR images revealed subtle or mild cord atrophy in only 2 patients. On maximal neck flexion, AP diameter of the cresent posterior epidural space was increased and also cord flattening with anterior shifting of posterior wall of the lower cervical dural canal was noted in all 7 patients. In all 7 cases, the level and side of spinal cord changes corresponded to the clinical phenotype. All control subjects showed neither cord flattening nor widening of posterior epidural space on neck flexion. CONCLUSION: In patients with the clinical diagnosis of Hirayama's disease, MRI scans obtained on maximal neck flexion showed characteristically dynamic flattening of lower cervical cord and widening of posterior epidural space. Therefore, a flexion MR study is needed to prove the diagnosis.

Magnetic Resonance Imaging and Histologic Findings of Acute and Subacute Stage of Experimental Cerebral Fat Embolism in Cats

PURPOSE: To determine the magnetic resonance imaging (MRI) findings and natural history of cerebral fat embolism in a cat model, and to correlate the MRI and histologic findings. MATERIALS AND METHODS: Using the femoral arterial approach, the internel carotid artery of 11 cats was injected with 0.1 ml of triolein. T2-weighted (T2WI), T1-weighted (T1WI) and Gd-enhanced T1-weighted (Gd-T1WI) images were obtained serially at 2 hours, 1 and 4 days and 1, 2 and 3 weeks after embolization. Any abnormal signal intensity (SI) was evaluated. After MR imaging at 3 weeks, brain tissue was obtained for light microscopic (LM) examination using hematoxylin-eosin and Luxol fast blue staining, and for electron microscopic (EM) examination. The histologic and MRI findings were correlated. RESULTS: At 2 hours, lesions showed high SI at T2WI, iso- or low SI at T1WI, and strong enhancement at Gd-T1WI. The high SI seen at T2WI decreased thereafter, and most lesions became iso-intense. At week 3, however, small focal areas of high SI were seen in the grey matter of eight cats and in the white matter of three. The low SI noted at acute-stage T1W1 subsequcntly became normal, though in the areas in which T2W1 had depicted high SI, focal areas of low SI remained. Lesion enhancement demonstrated by Gd-T1WI decreased continuously from day 1, and at week 3, weak enhancement was seen at the margin of the remained hypointense lesions in the gray matter in five cats. At LM examination with hematoxylin-eosin staining revealed normal histologic findings in the greater park of an embolized lesion. Cystic change was observed in the gray matter of eight cats, and in the gray and white matter of three of the eight. At LM examination, Luxol fast blue, staining demonstrated demyelination around the cystic change occurring in the white matter, and EM examination of the embolized cortex revealed sporadic intracapillary fat vacuoles (n=11) and disruption of the blood-brain barrier (n=4). Most lesions were normal, however, and perivascular interstitial edema and cellular swelling were mild compared with the control side. CONCLUSION: Experimental cerebral fat embolism was clearly demonstrated by T2WI and Gd-T1WI images obtained at all time points. The greater part of an embolized lesion showed reversible findings at MR and histologic examination; irreversible focal necrosis was, however, observed in gray and white matter at week 3.

A Study about Histopathological Change of NBCA Injected into Subarachnoid Space of the Cat

PURPOSE: To determine the histopathological changes occurring after the injection of NBCA(n-butyl cyanoacrylate) into the subarachnoid space of the cat. MATERIALS AND METHODS: A 1: 4 NBCA-Lipiodol mixture was injected into the subarachnoid space of ten cats by cervical spinal tap. Two weeks later all cats were sacrificed, and histopathological examination of the cerebrospinal leptomeninges, blood vessels and parenchyma was undertaken. RESULTS: 1. Changes in leptomeninges: Foreign body giant cells were noted in five cases, fibrosis in six and acute inflammation in all ten. Chronic inflammatory change accompanied 7 of 10 acute inflammations. 2. Changes in blood vessels: One case was excluded because blood vessels were not included in pathologic tissue. Acute vasculitis was noted in six cases, thrombosis in one, and one showed fibrotic change without necrosis in the media of the vessel wall. Among the six with acute vasculitis, severe change was noted in one and mild change in five. 3. Changes in parenchyma: Mild parenchymal inflammation was discovered in two cases and mild infarction in one. Parenchymal changes were limited to the outer cortex. CONCLUSION: The injection of NBCA into the subarachnoid space of the cat caused toxic histopathological changes in the cerebrospinal meninges, blood vessels, and parenchyma.

Chest CT Findings in Breast Cancer Patients Treated with Postoperative Irradiation

PURPOSE: The determine the chest CT findings in breast cancer patients who have undergone postoperative irradiation. MATERIALS AND METHODS: The chest CT findings in 36 female patients who underwent breast surgery and radiotherapy between May 1996 and March 2000 were retrospectively analysed. Prior to radiotherapy, baseline chest CT depicted normal parenchyma in all cases. In 11 patients, the ipsilateral breast and chest wall were irradiated using opposed tangential fields, while 25 were treated by the four fields method (opposed tangential fields plus anterior and posterior supraclavicular/high axillary fields), with a total dose of 5040-5400 cGy for 5-9 weeks. RESULTS: CT after radiotherapy demonstrated reticular opacity (n=24), perpendicular linear opacity (n=15), traction bronchiectasis (n=7), consolidation (n=6), ground glass attenuation (n=3), pathologic rib fractures (n=3), pleural effusion (n=2), and pleural thickening (n=1), while in five patients no abnormality was observed. In addition, in the anterolateral lung area of 23 (64%) of 36 patients who underwent tangential beam irradiation, CT demonstrated peripheral opacities. When supraclavicular and axillary portals were used, radiation-induced lung changes mostly occurred at the apex of the lung (n=24). Chest radiographs were abnormal in 26 patients and normal in ten; in five of these ten, CT demonstrated reticular opacity. CONCLUSION: Depending on the irradiation CT findings of radiation-induced lung injury in breast cancer include areas of increased opacity with or without fibrosis, in apical and/or anterior subpleural regions. CT may help differentiate radiation-induced parenchymal change from superimposed or combined lung disease.

Assessment of Hepatic Arterial Variation Using Multidetector Helical CT-Angiography

PURPOSE: To evaluate the anatomy of the hepatic artery and normal variants using oblique thick-slab maximal intensity projection (MIP) 3-D CT angiography and multidetector helical CT technology. MATERIALS AND METHODS: In 70 patients, axial three-phase CT together with multidetector helical CT and a non-ionic contrast agent was used to evaluate liver disease. During the early arterial phase, the parameters were as follow: slice thickness, 2.5 mm; table speed, 15 mm/rotation, pitch, 6; contrast material, 4 ml/sec; total 120 ml. Using the MIP technique and an Advantage window voxtal 3.03 system (GE), the images obtained were reconstructed as 3D angiograms. In each case, the arterial anatomy and its variants were recorded. RESULTS: A typical anatomy was found in 53 cases (75.7 %). Common variants were a left hepatic artery arising from the left gastric artery(8 cases, 11.4 %) and a right hepatic artery arising from the superior mesenteric artery(3 cases, 4.3 %). Other variant cases were a right hepatic artery arising from the gastroduodenal artery(2 cases, 2.9%), a proper hepatic artery arising from the left gastric artery (1 case, 1.4%), a hepatomesenteric trunk (1 case), a hepatogastric / splenomesenteric trunk(1 case), and a celiomesenteric trunk (1 case). CONCLUSION: 3-D hepatic angiography using multidetector helical CT technology is non-invasive and as accurate as conventional angiography for the evaluation of hepatic arterial anatomy. It is thus considered that 3-D CT angiography is very helpful for the evaluation of hepatic arterial anatomy prior to liver surgery such as transplantation or the treatment of hepatocellular carcinoma.

Laparoscopic Inguinal Herniorraphy with an Extracorporea Suturing Needle

This report describes an innovative and effective application of the extracorporeal suturing needle (ESN) to perform a laparoscopic inguinal herniorraphy. Between 1/1/96 and 12/31/96, we treated 23 patients with inguinal hernia using this suturing needle uniquely designed by Nahm-gun Oh. This new technique and device allow sutures to be made in the tissues near the floor of the internal inguinal canal without exposing the area while the movement of the ESN is observed with a laparoscopic camera. In 16 patients, the internal inguinal ring was ligated and fixed medially to the fascial root of the inferior epigastric vessels and to laterally the internal oblique muscle, using the ESN. In 5 patients with large inguinal hernias, the sutures were placed to force the inguinal canal with intraperitoneal onlay mesh fixation to the fascia, using the ESN, causing a narrowing of the internal inguinal canal. In 2 patients with inguinal hernias, the peritoneum of the internal inguinal ring was closed and laterally fixed to the internal oblique muscle by using the ESN. The ESN has been used successfully in 96% of the patients with inguinal hernias. One patient had a recurrence of the hernia. No permanent complications were seen in the patients involved in this study. Some transient postoperative complications included groin pain (21%), urinary retention (13%), and abdominal wall hematoma (9%). In four patients (17%), contralateral inguinal hernias were discovered during their operations and were corrected using the same procedures. We conclude that the extracorporeal suturing needle was safely and effectively used in laparoscopic inguinal herniorrhaphies and should be considered for use in laparoscopic herniorrhaphies and other laparoscopic surgeries.

Miliary Tuberculosis: HRCT Findings in 14 Patientst

PURPOSE: To evaluate high-resolution CT(HRCT) findings of the miliary tuberculosis and their significancy. MATERIAL AND METHOD: We retrospectively studied clinical records, HRCT and chest radiographs of 14 patients with miliary tuberculosis. RESULTS: On HRCT, nodules were seen in all 14 cases, 10 of them evenly, and 4 were irregularly distributed. The size of each nodule was less than 1 mm in 7 cases, 1 --2ram in 6 cases, and 3mm or more in 1 case. The ground - glass opacity was accompanied in 8 cases, and fine reticular opacity was also noted in 8 cases. Other associated findings were pleural effusion (n=4), hilar and mediastinal lymphadenopathy (n=3), consolidation of the exudative tuberculosis (n=4). CONCLUSION: HRCT findings of miliary tuberculosis are diffusely distributed micronodules of variable size, less than 5mm in diameter. The ground-glass opacity can be combined.

Percutaneous Antegrade Pyelography Guided by Ultrasound

The authors performed percutaneous antegrade pyelography guided by ultrasound on 33 patients, from J une 1982 to October 1984, at the department of radiology, Busan National University Hospital. The results obtained were as follows: 1. Of the 31 cases,17 cases (5 1.5%) were female and 16 cases (48.5 %)were male,and age distribution was nearly even, but most prevalent age group was third decade. 2. Comparing intravenous pyelographic findings with ultrasonographic findings, pyelographically non. visualized kidney 15 cases (45 .5%) were hydronephrosis 12 cases, multiple cysts 2 cases, and intrarenal cystic mass 1 case, ultrasonographically. Pyelographically hydronephrosis 9 cases (27.3%) were all hydronephrosis, ultrasonographically. Intrarenal mass 5 cases (15.2%) were all intrarenal cystic mass, NVK with air in kidney 1 case (3.0%) was air in perirenal space, partial NVK 1 case (3.0%) was per. irenal fluid , suprarenal mass 1 case (3 .0%) was suprarenal intrarenal and huge perirenal cystic masses, ultraso nograp h ically. 3. On technical reliability of antegrade pyelography under ultrasound gUide, 31 cases (93 .9%) could be done fluid aspiration and visualization, and 2 cases (6.1 %) could be only done fluid aspiration but failed visualization . 31 successful cases were visualization of collecting systems 23 cases, visualization of cyst 6 cases, i!nd visualization of perirenal space 2 cases. 2 partial successful cases were perirenal injection 1 case and parenchymal injection 1 case. 4. On fluid aspiration, 22 cases (66.7%) were clear, but 11 cases (33.3%) were not clear, which were pus 7 cases, turbid urine 2 cases, bloody urine 1 case, and bloody pus and air 1 case. 5. Comparing ultrasonographic findings with antegrade pyelographic findings, ultrasonographically hydronephrosis 21 cases revealed obstruction in 16 cases, antegrade pyelographically, which were consisted of ureteral stricture 14 cases, ureteral stone 1 case, and ureteral mass 1 case, non-obstruction in 4 cases, which were consisted of pyonephrosis 2 cases, posterior urethral valve 1 case, and megaureter 1 case, and other 1 case was visualization failure. Ultrasonographically intrarenal cystic mass 6 cases were simple renal cyst 4 cases, and infected renal cyst 2 cases, antegrade pyelographically. Multiple cysts 2 cases were lobulated huge renal cyst 1 case, and visualization failure 1 case, which was multi.cystic kidney. Air in perirenal space 1 case was emphysematous pyelone. phritis, suprarenal cystic mass 1 case was complete duplication with ectopic ureteral orifice, perirenal fluid 1 case due to kidney fracture was perirenal fluid , and intrarenal and perirenal cystic mass was per irenal abscess, antegrade pyelographically. 6. On ana lysis of anteg rade pyelography result as next diagnostic step of ultrasound, 31 successful cases were 27 conclusive diagnostic cases (87.1%), and 4 heplful diagnostic cases (12.9%) with percutaneous antegrade pyelography guided by ultrasound . 7. Antegrade pyelography provides significant diagnostic information on the nature of the obstructive lesion and can be performed as an adjunct to retrograde study or as an alterative to a pyelogram. 8. Ultrasonographic examination could be performed easiJy in diagnosis of renal and perirenal diseases as non.invasive method without risk of radiation hazard , and was not influenced by renal function. 9. Ultrasound is considered a most advantageous aid to the performance of antegrade pyelography and has yie lded valuab le diagnostic information in patients with obstructive hydronephrosis.