Multidetector CT Findings and Differential Diagnoses of Malignant Pleural Mesothelioma and Metastatic Pleural Diseases in Korea

OBJECTIVE: To compare the multidetector CT (MDCT) features of malignant pleural mesothelioma (MPM) and metastatic pleural disease (MPD). MATERIALS AND METHODS: The authors reviewed the MDCT images of 167 patients, 103 patients with MPM and 64 patients with MPD. All 167 cases were pathologically confirmed by sonography-guided needle biopsy of pleura, thoracoscopic pleural biopsy, or open thoracotomy. CT features were evaluated with respect to pleural effusion, pleural thickening, invasion of other organs, lung abnormality, lymphadenopathy, mediastinal shifting, thoracic volume decrease, asbestosis, and the presence of pleural plaque. RESULTS: Pleural thickening was the most common CT finding in MPM (96.1%) and MPD (93.8%). Circumferential pleural thickening (31.1% vs. 10.9%, odds ratio [OR] 3.670), thickening of fissural pleura (83.5% vs. 67.2%, OR 2.471), thickening of diaphragmatic pleura (90.3% vs. 73.4%, OR 3.364), pleural mass (38.8% vs. 23.4%, OR 2.074), pericardial involvement (56.3% vs. 20.3%, OR 5.056), and pleural plaque (66.0% vs. 21.9%, OR 6.939) were more frequently seen in MPM than in MPD. On the other hand, nodular pleural thickening (59.2% vs. 76.6%, OR 0.445), hilar lymph node metastasis (5.8% vs. 20.3%, OR 0.243), mediastinal lymph node metastasis (10.7% vs. 37.5%, OR 0.199), and hematogenous lung metastasis (9.7% vs. 29.2%, OR 0.261) were less frequent in MPM than in MPD. When we analyzed MPD from extrathoracic malignancy (EMPD) separately and compared them to MPM, circumferential pleural thickening, thickening of interlobar fissure, pericardial involvement and presence of pleural plaque were significant findings indicating MPM than EMPD. MPM had significantly lower occurrence of hematogenous lung metastasis, as compared with EMPD. CONCLUSION: Awareness of frequent and infrequent CT findings could aid in distinguishing MPM from MPD.

Significance of Serum Testosterone for Prostate-Specific Antigen (PSA) Elevation and Prediction of Prostate Cancer in Patients with PSA Above 10 ng/ml

PURPOSE: Testosterone is essential for the prostate gland's normal growth and development and is also a possible risk factor for prostate cancer. This study's aim was to determine the significance of serum testosterone for prostate-specific antigen (PSA) elevation and prostate cancer prediction in high-risk men. MATERIALS AND METHODS: The study included 120 patients with PSA >10 ng/ml who underwent a transrectal-prostate biopsy. Serum testosterone, prostate volume, and PSA density (PSAD) were checked in all patients. Patients were divided into two groups, patients with and those without prostate cancer; and testosterone-related factors, prostate volume, PSA, PSAD, age, prostate cancer prediction rate, and cancer aggressiveness were evaluated. RESULTS: Thirty-five patients (30.2%) were confirmed as having prostate cancer. The average serum testosterone level in patients without and in those with prostate cancer was 452.25+/-154.62 ng/dl and 458.10+/-158.84 ng/dl, respectively; average PSA was 17.58+/-9.02 ng/ml and 18.62+/-6.53 ng/ml, respectively; and average age was 69.02+/-7.52 years and 70.69+/-7.02 years, respectively (p>0.05). Hypogonadal and eugonadal patients showed no significant difference in cancer prevalence (30.3% vs. 32.0%, respectively). The testosterone level did not differ significantly in patients with and those without prostate cancer in either hypogonadal or eugonadal men (p>0.05). Serum testosterone showed no correlation with PSA, PSAD, or age in either group (p>0.05) and was unrelated to prostate cancer risk or aggressiveness (p>0.05). CONCLUSIONS: In our study's results, serum testosterone at the time of diagnosis was unrelated to PSA elevation, prostate cancer risk, and aggressiveness.

Aneurysmal Dilatation of Corpus Cavernosum as an Unusual Complication of Dorsal Penile Neurectomy / 대한남성과학회지

A 43-year-old man presented painless protruding mass on left side of penile shaft only during erection. 1 year ago he had a dorsal penile neurectomy for the treatment of premature ejaculation at local clinic. A protruding cavernousal aneurysm about 2 cm in diameter was developed 6 months after surgery and confirmed on penile duplex ultrasonography after PDE5 inhibitor ingestion with visual sexual stimulation. We have observed the lesion every month and found there was slight enlargement for the last 3 months without any other symptoms. We performed cavernosoplasty under the genereal anesthesia. There was a round cavernosal aneurysm on the left side of penile mid-shaft about 4cm in diameter after artificial erection with intracavernosal saline injection. We prevented cavernosal protrusion by covering the aneurismal surface with bovine pericardium patch (Supple Peri-Guard(R)). There was no side effect for 6 months postoperatively. This is an unusual type of complication of dorsal penile neurectomy.

A Case of Hereditary Hemorrhagic Telangiectasia Combined with Pulmonary- Systemic Fistula

We report the first case of hereditary hemorrhagic telangiectasia combined with multiple pulmonary-systemic fistulae. In this case, a 39-year-old woman presented with long standing chest pain, dyspnea and hemoptysis. Finally she was diagnosed as systemic- pulmonary fistula, a rare form of hereditary hemorrhagic telangiectasia.

Airway Reactivity to Bronchoconstrictor and Bronchodilator: Assessment Using Thin-Section and Volumetric Three-Dimensional CT

OBJECTIVE: To determine the extent to which thin-section and volumetric three-dimensional CT can depict airway reactivity to bronchostimulator, and to assess the effect of different airway sizes on the degree of reactivity. MATERIALS AND METHODS: In eight dogs, thin-section CT scans were obtained before and after the administration of methacholine and ventolin. Cross-sectional areas of bronchi at multiple levels, as shown by axial CT, proximal airway volume as revealed by three-dimensional imaging, and peak airway pressure were mea-sured. The significance of airway change induced by methacholine and ventolin, expressed by percentage changes in cross-sectional area, proximal airway volume, and peak airway pressure was statistically evaluated, as was correlation between the degree of airway reactivity and the area of airways. RESULTS: Cross-sectional areas of the bronchi decreased significantly after the administration of methacholine, and scans obtained after a delay of 5 minutes showed that normalization was insufficient. Ventolin induced a significant increase in cross-sectional areas and an increase in proximal airway volume, while the effect of methacholine on the latter was the opposite. Peak airway pres-sure increased after the administration of methacholine, and after a 5-minute delay its level was near that of the control state. Ventolin, however, induced no significant decrease. The degree of airway reactivity did not correlate with airway size. CONCLUSION: Thin-section and volumetric spiral CT with three-dimensional reconstruction can demonstrate airway reactivity to bronchostimulator. The degree of reactivity did not correlate with airway size.

MR Imaging of Fracture: MR Pathologic Correlation of Experimentally Produced Fractures on Rabbit Tibias

PURPOSE: To investigate MR imaging characteristics of the fracture healing process. MATERIALS AND METHODS: We performed MR-pathologic correlation of fractures experimentally produced by the three-point beding system inthe proximal tibias of 24 New Zealand white rabbits. Axial spin echo T1-weighted image(T1WI), T2-weighted image(T2WI) and T1WI after gadopentetate dimeglumine injection were obtained 1-28 days after fracture MR imaging was followed by freezing, sectioning along the MR imaging planes and histopathologic examinations. Changes in MR signal around the fractures were correlated with histopathologic findings. RESULTS: Hematomas and inflammatory tissue around the fractures, noted one day after fracture, showed slightly increased homogeneous signal intensityon T1WI, heterogeneous hyperintensity on T2WI and heterogeneous contrast enhancement. Granulation tissue,cartilage, and immature osteoid, noted 1-4 weeks after fracture, showed iso- or slight hyperintensity on T1WI, hyperintensity on T2WI and contrast enhancement. Hard callus containing ossified osteoid showed hypointensity onboth T1WI and T2WI without contrast enhancement. CONCLUSION: The characteristics of MR signal intensity and contrast enhancing pattern can explain the histopathology of the fracture healing process.