Association with Combined Occupational Hazards Exposure and Risk of Metabolic Syndrome: A Workers' Health Examination Cohort 2012–2021

Background@#This study aimed to evaluate the association between exposure to occupational hazards and the metabolic syndrome. A secondary objective was to analyze the additive and multiplicative effects of exposure to risk factors. @*Methods@#This retrospective cohort was based on 31,615 health examinees at the Pusan National University Yangsan Hospital in Republic of Korea from 2012–2021. Demographic and behavior-related risk factors were treated as confounding factors, whereas three physical factors, 19 organic solvents and aerosols, and 13 metals and dust were considered occupational risk factors. Time-dependent Cox regression analysis was used to calculate hazard ratios. @*Results@#The risk of metabolic syndrome was significantly higher in night shift workers (hazard ratio = 1.45: 95% confidence interval = 1.36–1.54) and workers who were exposed to noise (1.15:1.07–1.24). Exposure to some other risk factors was also significantly associated with a higher risk of metabolic syndrome. They were dimethylformamide, acetonitrile, trichloroethylene, xylene, styrene, toluene, dichloromethane, copper, antimony, lead, copper, iron, welding fume, and manganese. Among the 28 significant pairs, 19 exhibited both positive additive and multiplicative effects. @*Conclusions@#Exposure to single or combined occupational risk factors may increase the risk of developing metabolic syndrome. Working conditions should be monitored and improved to reduce exposure to occupational hazards and prevent the development of the metabolic syndrome.

Magnetic Resonance Imaging Assessment of Blood Flow Distribution in Fenestrated and Completed Fontan Circulation with Special Emphasis on Abdominal Blood Flow

OBJECTIVE: To investigate the regional flow distribution in patients with Fontan circulation by using magnetic resonance imaging (MRI). MATERIALS AND METHODS: We identified 39 children (18 females and 21 males; mean age, 9.3 years; age range, 3.3–17.0 years) with Fontan circulation in whom flow volumes across the thoracic and abdominal arteries and veins were measured by using MRI. The patients were divided into three groups: fenestrated Fontan circulation group with MRI performed under general anesthesia (GA) (Group 1, 15 patients; average age, 5.9 years), completed Fontan circulation group with MRI performed under GA (Group 2, 6 patients; average age, 8.7 years), and completed Fontan circulation group with MRI performed without GA (Group 3, 18 patients; average age, 12.5 years). The patient data were compared with the reference ranges in healthy controls. RESULTS: In comparison with the controls, Group 1 showed normal cardiac output (3.92 ± 0.40 vs. 3.72 ± 0.69 L/min/m2, p = 0.30), while Group 3 showed decreased cardiac output (3.24 ± 0.71 vs. 3.96 ± 0.64 L/min/m2, p = 0.003). Groups 1 and 3 showed reduced abdominal flow (1.21 ± 0.28 vs. 2.37 ± 0.45 L/min/m2, p < 0.001 and 1.89 ± 0.39 vs. 2.64 ± 0.38 L/min/m2, p < 0.001, respectively), which was mainly due to the diversion of the cardiac output to the aortopulmonary collaterals in Group 1 and the reduced cardiac output in Group 3. Superior mesenteric and portal venous flows were more severely reduced in Group 3 than in Group 1 (ratios between the flow volumes of the patients and healthy controls was 0.26 and 0.37 in Group 3 and 0.63 and 0.53 in Group 1, respectively). Hepatic arterial flow was decreased in Group 1 (0.11 ± 0.22 vs. 0.34 ± 0.38 L/min/m2, p = 0.04) and markedly increased in Group 3 (0.38 ± 0.22 vs. −0.08 ± 0.29 L/min/m2, p < 0.0001). Group 2 showed a mixture of the patterns seen in Groups 1 and 3. CONCLUSION: Fontan circulation is associated with reduced abdominal flow, which can be attributed to reduced cardiac output and portal venous return in completed Fontan circulation, and diversion of the cardiac output to the aortopulmonary collaterals in fenestrated Fontan circulation.

Contrast-enhanced ultrasound approach to the diagnosis of focal liver lesions: the importance of washout

Contrast-enhanced ultrasound (CEUS) is a powerful technique for differentiating focal liver lesions (FLLs) without the risks of potential nephrotoxicity or ionizing radiation. In the diagnostic algorithm for FLLs on CEUS, washout is an important feature, as its presence is highly suggestive of malignancy and its characteristics are useful in distinguishing hepatocellular from non-hepatocellular malignancies. Interpreting washout on CEUS requires an understanding that microbubble contrast agents are strictly intravascular, unlike computed tomography or magnetic resonance imaging contrast agents. This review explains the definition and types of washout on CEUS in accordance with the 2017 version of the CEUS Liver Imaging Reporting and Data System and presents their applications to differential diagnosis with illustrative examples. Additionally, we propose potential mechanisms of rapid washout and describe the washout phenomenon in benign entities.

Aftermath of Child Sexual Abuse in Children in Korea: Data from the Nation-Funded Sexual Violence Victim Protection Center for Children

OBJECTIVES: This study aimed to investigate the 3-year mean periods aftermath of child sexual abuse and to compare the sexual violence victims regard to the treatment. METHODS: 682 sexual violence victims were recruited by Seoul Sunflower Children Center, a nation-funded sexual violence victim protection center for children age 13, from 2004 to 2008. Data from 49 victims among 116 consented a follow-up, were analyzed. The victims were assessed by psychological test. Data was analyzed by SPSS ver. 15.0 (SPSS Inc.). RESULTS: The average time elapsed from the last presumed sexual abuse was 39.7 months [standard deviation (SD) 26.02]. Overall, Children's Depression Inventory (CDI) was significantly decreased from 15.8 (SD 9.33) to 10.4 (SD 9.98), and several subscales (depression, anxiety, anger, posttraumatic stress, and dissociation) of Trauma Symptom Checklist for Children (TSCC) were also significantly decreased. CDI and TSCC scores showed no statistical difference between treatment-given and not-given groups, but Revised Children's Manifest Anxiety Scale (RCMAS) was decreased in treatment-given group, whereas it was increased in treatment-not-given group. The difference of RCMAS scores between the two groups was statistically significant [F(1,28)=4.54, p < 0.05]. CONCLUSION: Sexually abused children showed overall symptom decreases over time, but anxiety was not decreased in treatment not-given group.

Contrast-enhanced ultrasound (CEUS) liver imaging reporting and data system (LI-RADS) 2017 – a review of important differences compared to the CT/MRI system

Medical imaging plays an important role in the diagnosis and management of hepatocellular carcinoma (HCC). The Liver Imaging Reporting and Data System (LI-RADS) was initially created to standardize the reporting and data collection of CT and MR imaging for patients at risk for HCC. As contrast-enhanced ultrasound (CEUS) has been widely used in clinical practice, it has recently been added to the LI-RADS. While CEUS LI-RADS shares fundamental concepts with CT/MRI LI-RADS, there are key differences between the modalities reflecting dissimilarities in the underlying methods of image acquisition and types of contrast material. This review introduces a recent update of CEUS LI-RADS and explains the key differences from CT/MRI LI-RADS.

Renal Impairment and Infarct Volume in Ischemic Stroke

BACKGROUND: The decreased estimated glomerular filtration rate (eGFR) levels at admission in patients with stroke have been associated with more severe clinical deficits and with worse outcomes; however, the relationship between eGFR levels and volumetric measurement of cerebral infarct size on neuroimaging has not been studied, to our knowledge. METHODS: Consecutive patients who presented within 48h of ischemic stroke and underwent brain diffusion-weighted imaging (DWI) over a 55-month period were studied. Patients with ischemic stroke of large artery atherosclerosis (LAA), small vessel occlusion (SVO), or cardioembolism (CE) etiologies were included. Those who were treated with thrombolysis and disabled before index stroke were excluded. Infarction volumes were log transformed to approximate normality. Chronic kidney disease (CKD) was defined as an eGFR < 60 mL/min per 1.73 m2. Subjects were categorized into two groups: CKD or no CKD. The relationship between CKD and DWI infarct volumes was examined using an analysis of covariance. RESULTS: Of the included 405 patients (mean age, 68 years; female, 60.2%; LAA, 60.0%; SVO, 16.5%; CE, 23.5%), 108 patients had CKD. Infarct volumes (mL, median [interquartile range]) were not significantly different between stroke patients with CKD and those without CKD in any stroke subtype (LAA, 0.77 [0.01-2.97] vs. 0.96 [0.01-5.22]; SVO, 0.18 [0.02-0.21] vs. 0.27 [0.01-0.52]; CE, 8.91 [0.04-28.54] vs. 5.22 [0.05-42.39]). Adjustment for possible confounders did not change the associations. CONCLUSIONS: Renal impairment is not associated with cerebral infarct volume among acute ischemic stroke patients.

Local ablation therapy with contrast-enhanced ultrasonography for hepatocellular carcinoma: a practical review

A successful program for local ablation therapy for hepatocellular carcinoma (HCC) requires extensive imaging support for diagnosis and localization of HCC, imaging guidance for the ablation procedures, and post-treatment monitoring. Contrast-enhanced ultrasonography (CEUS) has several advantages over computed tomography/magnetic resonance imaging (CT/MRI), including real-time imaging capability, sensitive detection of arterial-phase hypervascularity and washout, no renal excretion, no ionizing radiation, repeatability, excellent patient compliance, and relatively low cost. CEUS is useful for image guidance for isoechoic lesions. While contrast-enhanced CT/MRI is the standard method for the diagnosis of HCC and post-ablation monitoring, CEUS is useful when CT/MRI findings are indeterminate or CT/MRI is contraindicated. This article provides a practical review of the role of CEUS in imaging algorithms for pre- and post-ablation therapy for HCC.

Imaging findings of mimickers of hepatocellular carcinoma

Radiological imaging plays a crucial role in the diagnosis of hepatocellular carcinoma (HCC) as the noninvasive diagnosis of HCC in high-risk patients by typical imaging findings alone is widely adopted in major practice guidelines for HCC. While imaging techniques have markedly improved in detecting small liver lesions, they often detect incidental benign liver lesions and non-hepatocellular malignancy that can be misdiagnosed as HCC. The most common mimicker of HCC in cirrhotic liver is nontumorous arterioportal shunts that are seen as focal hypervascular liver lesions on dynamic contrast-enhanced cross-sectional imaging. Rapidly enhancing hemangiomas can be easily misdiagnosed as HCC especially on MR imaging with liver-specific contrast agent. Focal inflammatory liver lesions mimic HCC by demonstrating arterial-phase hypervascularity and subsequent washout on dynamic contrast-enhanced imaging. It is important to recognize the suggestive imaging findings for intrahepatic cholangiocarcinoma (CC) as the management of CC is largely different from that of HCC. There are other benign mimickers of HCC such as angiomyolipomas and focal nodular hyperplasia-like nodules. Recognition of their typical imaging findings can reduce false-positive HCC diagnosis.

The Effectiveness of Traumatic Symptom Checklist for Children(TSCC): Comparisons of Sexually Abused Children and Nonabused Normal Children

OBJECTIVES: The research is designed in order to know how much Traumatic Symptom Checklist for Children(TSCC) is effective in the case of child abuses, especially in the estimation of the psychopathology of child sexual abuse. METHODS: A sample includes a group of thirty children of 4th, 5th and 6th grade whose sexual abuse have confirmed and also a group of thirty four normal kids who have no abuse. Along with TSCC, Children's Depression Inventory(CDI) and Revised Children's Manifest Anxiety Scale(RCMAS) were used to children and child behavior checklist(K-CBCL), sexual behaviors(CSBI), and Kiddie-Schedule for Affective Disorder and Schizophrenia-Present and Lifetime version (K-SADS-PL) record sheets were used to kids' parents. RESULTS: In case of the sexual abuse group, the most meaningful difference from the analyzed result is shown at sexual concerns scale which is one of the clinical scale in TSCC(p<.01). Also, the sexual abuse group has the meaningful higher score than the general group's one in the stress scale after the other anxiety, depression, anger and dissociation (p<.01). CONCLUSION: The scale of TSCC has relatively shown the characteristic symptom and severity which were gained from the children who have experienced trauma, especially sexual abuse.

Psychopathology of Sexually Abused Children In Korea / 신경정신의학

OBJECTIVES: This study aimed to identify psychopathologies of sexually abused children and intervening variables of symptom severity. METHODS: Eighty-four school-aged children were identified for sexual abuse from a center for child sexual abuse by psychiatrists, clinical psychologists, and social workers. We analyzed correlations among symptom severity, types of sexual abuse, gender, age, relationship with the abuser, family system, and current and past psychopathologies. RESULTS: The percentage of victims with particular psychiatric disorders (current) were 79.8%. Children without identifiable disorders were 20.2%, but these children had significantly increased scores on self report scales of anxiety (RCMAS), depression (CDI), and withdrawal scores on parental reports of child behavior checklist (K-CBCL). Sixty nine percent of abused children had primary diagnosis related to sexual abuse in DSM-IV diagnositic system. PTSD was 41.7%, depressive disorder was 38.1%, and anxiety disorder was 21.4%. Psychopathologies were more severe if perpetrators were of acquaintance or if victims had previous psychopathologies or parent-child relational problems. Types of primary caregiver and older age were also related to the severity of psychopathologies. CONCLUSION: Present study suggests that most victims of childhood sexual abuse suffer from significant psychological distress. Intervening variables are relationship with the perpetrator, previous mental health status, age of the child, type of the primary care taker, and the quality of parent-child relationship.

Mn-DPDP Enhanced T1-weighted Magnetic Resonance Cholangiography: Usefulness in the Diagnosis and Roadmap for the Treatment of Intrahepatic Choledocholithiasis

PURPOSE: To assess the preliminary findings of Mn-enhanced T1-weighted MR cholangiography for the evaluation of intrahepatic choledocholithiasis. MATERIALS AND METHODS: Seven patients with recurrent pyogenic cholangitis underwent conventional heavily T2-weighted and manganese-enhanced T1-weighted MR cholangiography. For the former, the two reviewers focused on intrahepatic ductal dilatation, calculi, and stricture; and for the latter, ductal enhancement. RESULTS: In seven patients, 13 diseased segments were depicted and intrahepatic bile ductal dilatation was present in all 13 of these in all seven patients. Calculi were present in eight segments in six patients, and stricture in four segments in three patients. Of the 13 diseased segmental ducts, six were seen at manganese-enhanced imaging to be filled with contrast material, suggesting a functioning bile duct. CONCLUSION: Combined T2-weighted and mangafodipir trisodium-enhanced T1-weighted MR cholangiography provides both anatomic detail and functional detail of the biliary system. Combined MR cholangiography is useful for the evaluation of intrahepatic choledocholithiasis, demonstrating the stricture and function of the segmental ducts involved.

Pulse Sequence Optimization for Superparamagnetic Iron Oxide-enhanced MR Imaging in the Detection of Hepatic VX2 Tumors in Rabbits

PURPOSE: The purpose of this experimental study was to determine the optimal pulse sequences for SPIO-enhanced MR imaging in the evaluation of multiple hepatic tumors. MATERIALS AND METHODS: Twelve rabbits with multiple VX2 liver tumors underwent SPIO-enhanced MRI using the following nine pulse sequences: TSE T2-weighted imaging (T2WI), TSE proton density-weighted imaging (PDWI), and GRE T2*-weighted imaging (T2*WI) with seven different echo times (TE). Liver-lesion contrastto-noise ratios (CNRs) were calculated, and images were also assessed qualitatively by two radiologists, who reached a consensus as to lesion conspicuity and imaging artefacts using a four-level scale. By means of pathologic correlation, the sensitivity and positive predictive value of each sequence was calculated. RESULTS: TSE T2WI and long-TE (35 msec) FLASH T2*WI showed the highest liver-lesion CNR. The best lesion conspicuity was seen at TSE T2WI and medium-TE (12 msec) GRE T2*WI. Short TE GRE T2*WI showed the least imaging artefacts. The four sequences which demonstrated the best sensitivity were medium-TE (12 msec), GRE T2*WI (FLASH, 84%; FISP, 82%), TSE T2WI (79%), and TSE PDWI (76%). All nine sequences showed overall high positive predictive value (86-97%), with no statistically significant difference (p>0.05). CONCLUSION: In terms of image quality and the detection of sensitivity, TSE T2WI and medium TE (12 msec) GRE T2*WI were the top two pulse sequences among the various sequences used for on SPIO-enhanced MRI. They are thus considered to be the optimal sequences for evaluating multiple malignant hepatic tumors.

Differential Diagnosis of Benign and Malignant Intraductal Papillary Mucinous Tumors of the Pancreas: MR Cholangiopancreatography and MR Angiography

OBJECTIVE: To compare the usefulness of magnetic resonance cholangiopancreatography (MRCP) and MR angiography (MRA) in differentiating malignant from benign intraductal papillary mucinous tumors of the pancreas (IPMTs), and to determine the findings which suggest malignancy. MATERIALS AND METHODS: During a 6-year period, 46 patients with IPMT underwent MRCP. Morphologically, tumor type was classified as main duct, branch duct, or combined. The diameter of the main pancreatic duct (MPD), the extent of the dilated MPD, and the location and size of the cystic lesion, septum, and communicating channel were assessed. For all types of IPMTs, enhanced mural nodules and portal vein narrowing were evaluated at MRA. RESULTS: Combined-type IPMTs were more frequently malignant (78%) than benign (42%) (p < 0.05). Compared with benign lesions, malignant lesions were larger, and the caliber of the communicating channel was also larger (p < 0.05). Their dilated MPD was more extensive and of greater diameter (p < 0.05), and the presence of mural nodules was more frequent (p < 0.001). CONCLUSION: Combined MRCP and MRA might be useful for the differential diagnosis of malignant and benign IPMTs of the pancreas.

The Utility of MR Imaging Using the HASTE and True FISP Sequences in Diagnosing Bowel Obstruction

PURPOSE: To determine the value of magnetic resonance imaging (MRI) using HASTE (half- Fourier single-shot turbo spin-echo) and true FISP (fast imaging with steady-state precession and heavy T2-weighting) sequences in diagnosing bowel obstruction. MATERIALS AND METHODS: Thirty-one consecutive patients in whom suspected bowel obstruction was revealed at plain abdominal radiography, barium study, and computed tomography (CT) were admitted during an eight-month period. Eighteen of 27 in whom bowel obstruction was confirmed underwent MRI using HASTE and true FISP sequences. RESULTS: At MRI, bowel obstruction was diagnosed in all patients. Using the HASTE sequence, the site of obstruction was correctly identified in 16 patients(89%) and the cause of obstruction was correctly diagnosed in 15(83%). Using the true FISP sequence, the corresponding figures were 16(89%) and 16(89%). Of the 18 patients with confirmed bowel obstruction, 33%(6/18) showed better lesion conspicuity at true FISP, for 39%(7/18), conspicuity was equal at both sequences, 28%(5/18) showed better conspicuity at HASTE. CONCLUSION: MRI can be useful for evaluation the presence, site and cause of bowel obstruction. On comparing the findings of HASTE and true FISP sequences, no significant differences were observed.

Usefulness and Limitation of Magnetic Resonance Cholangiopancreatography in Patients with Hepatolithiasis / 대한소화기학회지

BACKGROUND/AIMS: Diagnosis of bile duct strictures as well as detection and localization of hepatolithiasis is important for an effective treatment of hepatolithiasis. For this purpose, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) have been preferred as the diagnostic modalities of choice for hepatolithiasis. At present, magnetic resonance cholangiopancreatography (MRCP) is rapidly replacing ERCP. To determine the usefulness and limitation of MRCP for detecting hepatolithiasis and biliary strictures, we compared the result of MRCP with that of percutaneous transhepatic cholangioscopy (PTCS) as the standard reference. METHODS: Sixty-six patients with primary hepatolithiasis who underwent both MRCP and PTCS were enrolled. All patients underwent PTCS within 2 weeks of MRCP. The results of MRCP were reviewed by radiologists who were unaware of the clinical information about the location of hepatolithiasis and the presence of biliary strictures. RESULTS: The sensitivity and specificity of MRCP for detecting intrahepatic stones were 72.4 and 90%, respectively. The sensitivity of MRCP for depicting intraheptic bile duct strictures was 64%. The overall agreement between MRCP and PTCS for intrahepatic stones showed a good reliability (kappa value=0.64, p<0.05). The agreement of MRCP for hepatolithiasis with intrahepatic bile duct strictures with reference to PTCS showed a moderate reliability (kappa value=0.47, p<0.05). Imaging findings such as pneumobilia and hepatic parenchymal atrophy were related to false positive results in location of hepatolithiasis (p<0.05). CONCLUSIONS: MRCP has a good agreement rate in evaluation of intrahepatic stones and a moderate agreement rate in intrahepatic strictures, compared to PTCS.

Anatomic Variation in Intrahepatic Bile Ducts: an Analysis of Intraoperative Cholangiograms in 300 Consecutive Donors for Living Donor Liver Transplantation

OBJECTIVE: To describe the anatomical variation occurring in intrahepatic bile ducts (IHDs) in terms of their branching patterns, and to determine the frequency of each variation. MATERIALS AND METHODS: The study group consisted of 300 consecutive donors for liver transplantation who underwent intraoperative cholangiography. Anatomical variation in IHDs was classified according to the branching pattern of the right anterior and right posterior segmental duct (RASD and RPSD, respectively), and the presence or absence of the first-order branch of the left hepatic duct (LHD), and of an accessory hepatic duct. RESULTS: The anatomy of the intrahepatic bile ducts was typical in 63% of cases (n=188), showed triple confluence in 10% (n=29), anomalous drainage of the RPSD into the LHD in 11% (n=34), anomalous drainage of the RPSD into the common hepatic duct (CHD) in 6% (n=19), anomalous drainage of the RPSD into the cystic duct in 2% (n=6), drainage of the right hepatic duct (RHD) into the cystic duct (n=1), the presence of an accessory duct leading to the CHD or RHD in 5% (n=16), individual drainage of the LHD into the RHD or CHD in 1% (n=4), and unclassified or complex variation in 1% (n=3). CONCLUSION: The branching pattern of IHDs was atypical in 37% of cases. The two most common variations were drainage of the RPSD into the LHD (11%) and triple confluence of the RASD, RPSD and LHD (10%).

Effect of Life-Style Factors on Bone Mineral Density in the Community: Based Survey

OBJECTIVE: This study is designed to evaluate the relationship between bone mineral density (BMD) and life-style factors such as physical activity, smoking, and alcohol consumption and to offer the information for the modification of life-style. METHOD: Eight hundred and sixty nine inhabitants (354 males and 515 females whose age was 55.0+/-13.9 years- old) were participated in this study. BMD was measured in the right calcaneus by quantitative ultrasound (Mark 6000(R), Medison). Amount of physical activity, smoking, and alcohol consumption were got through the closely designed interview. Independent sample T-test and simple regression were used for data analysis. RESULTS: Amount of physical activities were 2656.8+/-732.3 cal/day, smokers were 329 persons (37.9% of inhabitants), and amount of alcohol consumption were 26.2+/-53.3 g/day. Increasing the amount of physical activity, BMD showed significantly higher T-score (p<0.01). Increasing the amount of alcohol consumption, BMD showed significantly lower T-score (p<0.01). BMD in smokers appeared significantly lower T-score than non-smokers (p<0.01). CONCLUSION: Life-style factors significantly effect on bone mineral density. Therefore prevention of osteoporosis through maintenance or augmentation of BMD needs proper physical activity, cessation of smoking, and no heavy drinking.

CT Findings of Small Bowel Metastases From Primary Lung Cancer

PURPOSE: To evaluate the CT findings of small bowel metastases from primary lung cancer. MATERIALS AND METHODS: Of the 1468 patients with primary lung cancer between 1990 and 2000, 13 patients who had metastasis to the small intestine were collected. Of these 13 patients, nine who underwent CT scan were included for analysis. The pathologic diagnoses of primary lung cancer in these nine patients were squamous cell carcinoma in six, adenocarcinoma in two, and large cell carcinoma in one. CT scans were analyzed with regard to the site and patterns (intraluminal mass/bowel wall thickening/bowel implants) of metastatic masses, and the presence or absence of complication such as intussusception, obstruction, or perforation of the small bowel. The medical records of the patients were also reviewed retrospectively for evaluation of presenting abdominal symptom and time interval of metastases from initial diagnosis of lung cancer. RESULTS: Metastatic lesions were distributed throughout the small intestine: the duodenum in five, the jejunum in four, the ileum in six, and both jejunum and ileum in one patient. The size of metastatic masses of small bowel ranged from 1.3 cm to 5.0 cm (mean size, 2.6 cm) On CT, the small bowel was involved with intraluminal masses (mean size, 3.4 cm) in eight patients, diffuse wall thickening (mean thickness, 1.6 cm) in five, and bowel implants (mean size, 2.2 cm) in two. Complications occurred in seven patients, including intussusceptions without obstruction in two patients and with obstruction in two, obstruction without intussusceptions in two, and bowel perforation in one. Of 9 patients, 6 had at least one symptom referable to the small bowel including abdominal pain in 4, anemia in 3, vomiting in 1, and jaundice in 1. Lung cancer and small bowel lesions were detected simultaneously in four patients and the time interval of metastases from initial diagnosis of lung cancer ranged from 10 days to 30 months (median interval, 54 days) in 5 patients. CONCLUSION: CT helps in defining the extent and pattern of small bowel metastases as well as in demonstrating their complication.

Recurrent Pyogenic Cholangitis: Clinico-Pathologic Correlation of Focal Attenuation Differences on Multi-Phasic Spiral CT

PURPOSE: To determine the clinical and the pathologic significance of the focal attenuation differences (FAD) and bile duct wall enhancement occurring in recurrent pyogenic cholangitis (RPC) and seen at multiphasic spiral CT. MATERIALS AND METHODS: Among the multiphasic (non-contrast, arterial and portal or delayed phase) spiral CT findings of 60 consecutive patients, two types of FAD were noted during the non-contrast phase. These were Type A (iso) and Type B (low attenuation), and their distribution pattern (lobar versus patchy, multifocal) and the and the presence or absence of bile duct wall enhancement were recorded. The radiologic findings were correlated with the clinical and pathologic findings. RESULTS: Two types of FAD were noted in 40 of the 60 patients. Active in flammation was present in 19 of the 27 with Type-A and in ten of the 15 in whom the presence of RPC was pathologically proven. Ten of the 13 with Type-B FAD were in a subclinical state, and nine of the ten in whom RPC was pathologically proven had chronic inflammation. Among 20 patients who did not have FAD, RPC was subclinical in 18 and dormant in nine of the eleven in whom its presence was pathologically proven (p<0.001). Clinico-pathologic correlation with bile duct wall enhancement and the distribution pattern of FAD showed no statistical significance. CONCLUSION: The inflammatory activity of RPC can be predicted by analysis of the FAD seen at multiphasic spiral CT.

Biliary Ascariasis: MR Cholangiography Findings in Two Cases

We describe the imaging features of two cases of biliary ascariasis. Ultrasonography and CT showed no specific abnormal findings, but MR cholangiography clearly demonstrated an intraductal linear filling defect that led to the correct diagnosis. MR cholangiography is thus a useful technique for the diagnosis of biliary ascariasis.