Carotid Doppler Ultrasound in Patients with Stenosis of the Intracranial Internal Carotid Artery

PURPOSE: To investigate the Doppler ultrasonographic parameters of a carotid ultrasound (CUS) for the stenosis of the intracranial internal carotid artery (IICA). MATERIALS AND METHODS: The authors evaluated 15 patients with normal extracranial ICA, the common carotid artery (CCA), and stenosis of IICA (patient group). The control group consisted of 22 patients with normal findings on a magnetic resonance angiography (control group). All subjects were subjected to a CUS, whereas subjects from the patient group underwent a cerebral angiography. The following parameters were investigated: peak systolic velocity (PSV) and end diastolic velocity (EDV) in ICA, PSV in CCA, resistive index (RI) in ICA, and PSV ratio. Stenosis was measured following an angiography and was graded as follows: normal (0-24%), mild (25-49%), moderate (50-69%), and severe (70-99%). Next, the CUS findings, which reflected the IICA stenosis, were investigated. RESULTS: Of the 74 ICAs, 52 were normal (44 ICAs in the normal group and 8 ICAs in the patient group), 10 had mild stenosis, 8 had moderate stenosis, and severe 4 had severe stenosis. As the stenosis grade increased, PSV and EDV in ICA as well as PSV in CCA, decreased (p value < 0.05); however, the PSV ratio and RI remained unchanged. CONCLUSION: As stenosis of IICA increases, PSV and EDV of ICA and PSV of CCA decreases following a CUS.

Polyvinyl Alcohol Embolization Adjuvant to Oily Chemoembolization in Advanced Hepatocellular Carcinoma with Arterioportal Shunts

OBJECTIVE: To assess the feasibility and safety of polyvinyl alcohol (PVA) embolization adjuvant to transarterial oily chemoembolization (P-TACE) in advanced hepatocellular carcinoma (HCC) with arterioportal shunts (APS). MATERIALS AND METHODS: Nineteen patients who underwent PVA embolization for APS before a routine chemoembolization (TACE) procedure were retrospectively reviewed. 10 of these 19 patients underwent follow-up TACE or P-TACE after P-TACE (Group A), but nine patients underwent only initial P-TACE because of progression of HCC and/or underlying liver cirrhosis (Group B). Hepatic function tests, APS grades, and portal flow directions were evaluated before and after P-TACE sessions. Complications after procedures and survival days were also evaluated. RESULTS: In group A, APS grade was improved in eight patients and five of six patients with hepatofugal flow showed restored hepatopetal flow postoperatively. No immediate complication was developed in either group. Transient hepatic insufficiency developed in eight (42.1%) of 19 patients after P-TACE, and seven (87.5%) of these eight recovered within two weeks under conservative care. The mean and median survival time all study subjects was 280 days and 162 days. CONCLUSION: P-TACE is feasible and safe in advanced HCC patients with APS.

Fat-Containing Lesions in Vertebrae and Spinal Canal: A Pictorial Review

The recent development of image techniques, including computed tomography and magnetic resonance imaging, plays an important role in the diagnosis and treatment of spinal disease. A variety of lesions in the spine may contain fat tissue, and these lesions have the possibility of being benign or malignancy. The principle of treatment varies depending on the characteristics of the lesions. The purpose of this pictorial assay is to document the radiologic findings to help physicians make the correct diagnosis, to confirm the characteristics and the extent of the lesion, to anticipate the prognosis and to select and decide upon the therapeutic method when a fat-containing lesion is located in the spinal vertebrae and/or spinal canal.

Fat-Containing Lesions in Vertebrae and Spinal Canal: A Pictorial Review

The recent development of image techniques, including computed tomography and magnetic resonance imaging, plays an important role in the diagnosis and treatment of spinal disease. A variety of lesions in the spine may contain fat tissue, and these lesions have the possibility of being benign or malignancy. The principle of treatment varies depending on the characteristics of the lesions. The purpose of this pictorial assay is to document the radiologic findings to help physicians make the correct diagnosis, to confirm the characteristics and the extent of the lesion, to anticipate the prognosis and to select and decide upon the therapeutic method when a fat-containing lesion is located in the spinal vertebrae and/or spinal canal.

Intrasellar Schwannoma: A Case Report

Schwannomas usually arise from sensory nerves, and most often from the vestibular component of the acoustic nerve. Intrasellar and parasellar schwannomas are exceedingly rare. It is difficult to distinguish them from typical pituitary macroadenomas because of their clinical and radiological resemblance. In this report, we present an unusual case of an intrasellar schwannoma with a suprasellar extension that radiographically simulated a pituitary macroadenoma.

Airway Obstruction in Rheumatoid Arthritis: CT Manifestations, Correlated with Pulmonary Function Testing

In the present study, the signs of airflow obstruction on inspiratory and expiratory CT scans in 45 patients with rheumatoid arthritis were investigated. Radiologic findings were evaluated and correlated with the clinical data, which included rheumatoid factors and pulmonary function tests results. A lung biopsy was performed in five patients. The pattern of CT findings was as follows: infiltrative (n=15), obstructive (n=12), mixed (infiltrative and obstructive; n=10), other complicating diseases (n=7), and normal (n=1). The rheumatologic factor between patients with bronchial wall thickenings and patients without thickenings was significantly different (p=0.009). The forced expiratory flow rate between 25% and 75% of the vital capacity (FEF25-75%) was significantly more reduced in patients with interlobular septal thickenings than in patients without these thickenings. The patients with mosaic attenuation had significantly lower mean values of FEF25-75% (p=0.001) and a lower peak expiratory flow (p=0.003) than patients without mosaic attenuation. On expiratory scans, the mean air-trapping score was 21%. These air-trapping scores were found to be well correlated with FEV1/FVC (r=0.230, p=0.0452), and FEF25-75% (r=-0.63, p= 0.05). It is widely known that a relatively higher percentage of mosaic attenuation with air-trapping and a good correlation between these and functional values contribute to the detection of early airway obstruction in patients with rheumatoid arthritis, and even in patients with infiltrative lung disease only.

CT Analysis of Lung Cancer and Coexistent Emphysema

PURPOSE: To evaluate the relation of the location and cell type of lung cancer to the location and degree in coexistent emphysema on high-resolution computed tomography (HRCT) scans. MATERIALS AND METHODS: Ninety-eight of 209 lung cancer patients having HRCT scans were retrospectively analyzed to assess the total lung emphysema and peritumoral regional emphysema. Single and primary lung cancers were included. The clinical data, including sex, age, smoking history and the pathologic cancer subtype, were recorded to correlate with the HRCT findings. The lobar distribution, central-peripheral predominance, surrounding parenchymal abnormality for cancer, cephalocaudal predominance, and subtype for emphysema were analyzed on HRCT. Using a CT scoring method, we scored the whole lung emphysema and peritumoral emphysema, and correlated the grading of emphysema with pulmonary functional values. RESULTS: Sixty-nine of 98 patients with lung cancer (71%) had emphysema. Lung cancer with emphysema was significantly higher in men than in women, and was significantly related to smoking. The mean age of cancer patients without emphysema was significantly lower than that of cancer patients with emphysema (68 yrs vs. 61 yrs, p=0.0006). Emphysema of grade I (0-25%) was found in 52 cases, grade II (25-50%) in 15, and grade III (50-75%) in 2. Total emphysema score was paralleled to peritumoral emphysema score in 64.3%, while the remaining patients had a higher peritumoral emphysema score (grade II or III) than total emphysema score (grade 0 or I). There was no statistical correlation in the developmental location between the emphysema and the lung cancer (significant correlation was only noted in grade II group of total emphysema score). The incidence of non-small cell carcinoma tended to be higher than that of small cell carcinoma in the two groups. CONCLUSION: The possibility of lung cancer in patients with pulmonary nodule, coexisting emphysema, and especially in elderly patients having a history of smoking must be clarified on HRCT. The location or type of lung cancer was not significantly correlated to the location or the degree of coexistent emphysema.

Migration of a Slipped Aneurysmal Clip from the Intracranium into the Spinal Canal: Case Report

Very rarely, clips used for the ligation of intracranial aneurysms become detached and subsequently migrate into the spinal canal, causing lumbar pain or radiculopathy by compressing nerve roots or inducing inflammatory processes in their newly established location. However, it is easy to overlook the migration of the clip, because there may be either no noticeable symptoms, or a herniated disk may be mistakenly diagnosed as being the source of the present symptoms. Herein, the authors report a case in which an aneurysmal clip migrated into the spinal cord.

CT and MR Findings of the Telangiectatic Osteosarcoma Arising from the Skull: Case Report

Telangiectatic osteosarcoma is rare malignant tumor causing aggressive bone destruction, though the skull is very rarely involved. We report a case in which the condition affected the skull of a 17-year-old male, involving the parietal bone and with intracranial and extracranial extension. CT and MR images depict an osteolytic lesion of the right parietal bone and an enhancing solid mass in the intracranial and extracranial portions. Matrix calcifications, periosteral reaction, and multiple fluid-fluid levels are seen within the masses.

Arachnoid Cyst in Cavernous Sinus: Case Report

Arachnoid cyst of the cavernous sinus is very rare. When present, its anatomic location frequently gives rise to cranial nerve palsy. We report a case of arachnoid cyst of the cavernous sinus in a 38-year-old man with impaired eyeball movement and diplopia.

Maffucci's Syndrome Associated with Chondrosarcoma and Aneurysm: Case Report

Maffucci syndrome is a rare congenital non-inherited condition characterized by multiple enchondromas and cutaneous hemangiomas. It is associated with increased risk of malignancy, including chondrosarcomas, and because of generalized mesodermal dysplasia, aneurysms can develop. We present a case of Maffucci syndrome associated with intracranial chondrosarcoma and aneurysm.

Retroperitoneal Malignant Mesenchymoma: A Case of Mesenchymal Mixed Tumor with Osteosarcoma, Leiomyosarcoma, Liposarcoma and Fibrosarcoma

Malignant mesenchymoma is an interesting but very rare tumor in which malignant differentiation has occurred twice or more. We report a case of retroperitoneal malignant mesenchymoma consisting of osteosarcoma, leiomyosarcoma, liposarcoma and fibrosarcoma. Abdominal CT showed a large retroperitoneal mass with two separate and distinct parts, namely an area of prominent calcification and one of clearly enhancing solid components. The mass contained histologically distinct tumorous components with no histologic admixure at the interfaces. The densely calcified nodule corresponded to osteosarcoma, and the noncalcified clearly enhancing nodules to leiomyosarcoma, liposarcoma and fibrosarcoma.

Cavernous Hemangioma of the Cavernous Sinus: A Case Report

Intracranial extra-axial cavernous hemangioma of the cavernous sinus is a very rare vascular malformation. It usually appears as a round non-encapsulated mass with well-defined borders, mimicking meningioma. We describe a case of cavernous hemangioma of the cavernous sinus, including the radiologic imaging findings, and also review the literature.

Acute Spontaneous Subdural Hemorrhage by Cerebral Aneurysmal Rupture: Report of Two Cases

Two cases of acute spontaneous subdural hemorrhage caused by cerebral aneurysmal rupture are presented. The patients’ chief complaints were sudden bursting headache and comatose mentality. There was no history of trauma or proclivity for spontaneous bleeding, and CT scans of the brain indicated subdural hemorrhage without remarkable subarachnoid hemorrhage. In case 1, an aneurysm at the distal segment of the right anterior cerebral artery was identified by CT angiography; the subdural hemorrhage was evacuated and the aneurysm surgically clipped. In case 2, an aneurysm at the junction of the anterior communicating artery and the right anterior cerebral artery was revealed by CT angiography and digital subtraction angiography, and Guglielmi detachable coil embolization of the aneurysm was performed.

A Case of Agenesis of Corpus Callosum with Chromosome anomaly / 대한산부인과학회잡지

The corpus callosum consists of white fibers connecting the cerebral hemispheres. Agenesis of the corpus callosum is an uncommon congenital anomaly which is easily diagnosed in the postnatal period by ultrasound and computed tomographic scan or MRI, but its prenatal sonographic diagnosis is difficult because of fetal head positioning and limiting trans-axial scans. We experienced a case of agenesis of the corpus callusum with chromosomal anomaly. The prenatal sonographic findings are ventricular abnormalities that demonstrated dilatation of lateral ventricles and disproportionate enlargement of the occipital horns, which were suggestive findings for the corpus callosal agenesis. We could confim the diagnosis of the corpus callosal agenesis with chromosome anomaly by postnatal MRI and chromosome analysis.