Spinal Enumeration by Morphologic Analysis of Spinal Variants: Comparison to Counting in a Cranial-To-Caudal Manner

OBJECTIVE: To compare the spinal enumeration methods that establish the first lumbar vertebra in patients with spinal variants. MATERIALS AND METHODS: Of the 1446 consecutive patients who had undergone computed tomography of the spine from March 2012 to July 2016, 100 patients (62 men, 38 women; mean age, 47.9 years; age range, 19–88 years) with spinal variants were included. Two radiologists (readers 1 and 2) established the first lumbar vertebra through morphologic analysis of the thoracolumbar junction, and labeled the vertebra by counting in a cranial-to-caudal manner. Inter-observer agreement was established. Additionally, reader 1 detected the 20th vertebra under the assumption that there are 12 thoracic vertebra, and then classified it as a thoracic vertebra, lumbar vertebra, or thoracolumbar transitional vertebra (TLTV), on the basis of morphologic analysis. RESULTS: The first lumbar vertebra, as established by morphologic analysis, was labeled by each reader as the 21st segment in 65.0% of the patients, as the 20th segment in 31.0%, and as the 19th segment in 4.0%. Inter-observer agreement between the two readers in determining the first lumbar vertebra, based on morphologic analysis, was nearly perfect (κ value: 1.00). The 20th vertebra was morphologically classified as a TLTV in 60.0% of the patients, as the first lumbar segment in 31.0%, as the second lumbar segment in 4.0%, and as a thoracic segment in 5.0%. CONCLUSION: The establishment of the first lumbar vertebra using morphologic characteristics of the thoracolumbar junction in patients with spinal variants was consistent with the morphologic traits of vertebral segmentation.

Magnetic resonance imaging and pathological characteristics of pure mucinous carcinoma in the breast according to echogenicity on ultrasonography

PURPOSE: The aim of this study was to explore the clinical and pathological characteristics of pure mucinous breast carcinoma (PMBC) according to internal echogenicity on ultrasonography (US). METHODS: Thirty-three patients with PMBC diagnosed at surgery were included in this study. Cases of PMBC were classified according to internal echogenicity on US. The imaging features on magnetic resonance (MR) imaging and clinicohistopathological characteristics were compared between the hypoechogenic and the isoechogenic to hyperechogenic groups. RESULTS: Eleven cases of PMBC (33.3%) exhibited hypoechogenicity on US, while 22 cases (66.7%) exhibited isoechogenicity or hyperechogenicity. Of the isoechogenic to hyperechogenic PMBCs, 95.5% showed a high signal on T2-weighted images, which was a significantly greater percentage than was observed for the hypoechogenic group (54.5%) (P=0.010). Of the hypoechogenic PMBCs, 63.6% showed a washout pattern in the delayed phase, which was substantially more than the result of 23.8% observed for the isoechogenic to hyperechogenic PMBCs (P=0.053). CONCLUSION: PMBCs with isoechogenicity or hyperechogenicity were more likely to show a high signal intensity on T2-weighted images than hypoechogenic PMBCs. However, other MR imaging and clinicohistopathological characteristics were not significantly different between the two groups.