Mn-DPDP-enhanced MR Imaging: the Optimal Pulse Sequence for Detection of Focal Hepatic Tumor

PURPOSE: To assess the diagnostic value of Mn-DPDP for the detection of focal hepatic tumors on MR images and to determine the optimal pulse sequence to maximize its effect. MATERIALS AND METHODS: Twenty-three patients with 32 focal hepatic tumors were examined by means of 1.5-T MRI. Before and after the intravenous administration of Mn-DPDP, five pulse sequences were used to obtain T1-weighted images: two-dimensional fast low-angle shot (2D FLASH) with/without fat saturation (FS), spinecho (SE), and three-dimensional fast low angle shot reconstruction (3D FLASH) with/without FS. Quantitative assessment involved determination of the signal-to-noise ratio (SNR) of the liver and the tumor, the percentage signal enhancement ratio (PSER) of the liver, and tumor-to-liver contrast to noise ratio (CNR). Pulse sequences were also evaluated subjectively for tumor conspicuity, delineation, and image artifact. In addition, two experienced radiologists compared tumor detection rates between precontrast and postcontrast images. RESULTS: Mn-DPDP had a marked effect on liver SNR and absolute CNR at all pulse sequences (p<0.05). On postcontrast images, PSER and absolute CNR of the liver were highest at 3D FLASH and 2D FLASH FS, respectively, and significantly higher at GRE than at SE (p<0.05). On postcontrast images, the CNR of focal nodular hyperplasia and hepatocellular carcinoma was positive, while that of hemangioma, metastasis and cholangiocarcinoma was negative. The postcontrast CNR of all tumors except hepatocellular carcinoma increased more than 100%. Qualitative studies showed that tumor conspicuity increased significantly at all sequences except SE, and delineation increased significantly except at SE and postcontrast 2D GRE FS. After Mn-DPDP, GRE more effectively demonstrated tumor conspicuity and image artifact than did SE, and GRE other than 2D FLASH FS was also better than SE for tumor dilineation (p<0.05). The sensitivity of all postcontrast images increased and the tumor detection rate at GRE was significantly higher than at SE. CONCLUSION: Mn-DPDP favorably affects tumor-to-liver contrast, and may be useful in the imaging of focal hepatic tumors, more so with 2D or 3D FLASH pulse sequences than with SE.

The clinical significance of laparoscopic uterosacral nerve ablation (LUNA) in infertile women with pelvic pain and endometriosis / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the efficacy of laparoscopic uterosacral nerve ablation (LUNA) in infertile women with chronic pelvic pain and endometriosis. METHOD: Prospective randomized study was performed in 20 infertile women with endometriosis and chronic pelvic pain, who had undergone of laparoscopic uterosacral nerve ablation at Samsung Cheil hospital between April and September, 1998. Statistical analysis was perfomed using by DBSTAT (ver. 2.0). RESULT: The pelvic pain score of pre-operation was 3.72+/-1.07 (mean+/-SD) and it was significantly decreased to 1.83+/-0.85 at 1 month later and 1.93+/-0.92, 1.69+/-0.60, 1.56+/-0.62, 1.56+/-0.81 each in second, third, fourth and fifth month after operation. There was no correlation between pelvic pain and stage of endometriosis. Pregnancy rate was 65% after LUNA (twelve deliveries, one pregnancy is ongoing at IUP 24 weeks). CONCLUSION: Laparoscopic uterosacral nerve ablation would be effective for infertile women with endometriosis and pelvic pain.

The clinical significance of laparoscopic uterosacral nerve ablation (LUNA) in infertile women with pelvic pain and endometriosis / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the efficacy of laparoscopic uterosacral nerve ablation (LUNA) in infertile women with chronic pelvic pain and endometriosis. METHOD: Prospective randomized study was performed in 20 infertile women with endometriosis and chronic pelvic pain, who had undergone of laparoscopic uterosacral nerve ablation at Samsung Cheil hospital between April and September, 1998. Statistical analysis was perfomed using by DBSTAT (ver. 2.0). RESULT: The pelvic pain score of pre-operation was 3.72+/-1.07 (mean+/-SD) and it was significantly decreased to 1.83+/-0.85 at 1 month later and 1.93+/-0.92, 1.69+/-0.60, 1.56+/-0.62, 1.56+/-0.81 each in second, third, fourth and fifth month after operation. There was no correlation between pelvic pain and stage of endometriosis. Pregnancy rate was 65% after LUNA (twelve deliveries, one pregnancy is ongoing at IUP 24 weeks). CONCLUSION: Laparoscopic uterosacral nerve ablation would be effective for infertile women with endometriosis and pelvic pain.

Treatment of the Early Stage Small Cell Carcinoma of the Cervix / 대한부인종양콜포스코피학회잡지

OBJECTIVE: Small cell carcinoma of the cervix(SCC) is a rare aggressive tumor with a propensity for rapid distant recurrence and a high mortality rate. The purpose of this study was to review our experience in early stage disease and to perform a meta-analysis of the literature to compare neoadjuvant with adjuvant chemotherapy as prognostic factor. METHODS: Between 1990 and 1998, seven women with FIGO early stage(IB-IIA) SCC were treated with surgery and chemotherapy at our hospital. Medical records were retrospectively reviewed. And thirty-two early-stage SCC patients who similarly treated since 1990 were identified by a Medline search of the English literature and included in the analysis. The Kaplan-Meier method and log-rank test were used for survival analysis. RESULTS: Out of our patients, three patients died at 12-13 months after diagnosis due to distant metastases which were brain in two and was liver and lung in one. Other three are alive with no evidence of disease at 27, 66, and 121 months. From the meta-analysis, the overall 3-year survival rate was 49% in neoadjuvant and 33% in adjuvant chemotherapy, but there were no statistical significance.(log-rank test, 0.80) Neoadjuvant chemotherapy resulted in a high response rates(81.2%), no pelvic recurrence, and a low LN metastasis(18.8%), therefore the pelvic radiation therapy rates was low. CONCLUSIONS: Even in the early stage, SCC treatment must be combined with chemotherapy. There was no significant difference in prognosis between neoadjuvant and adjuvant chemotherapy. But this study showed neoadjuvant may extirpate the primary lesion, evaluate response, and assess more promising postoperative therapy according to pathologic features.