Captured Macro-embolus of Fractured Atheromatous Plaque by the Embolic Protection Device during Carotid Stent Assisted Angioplasty / 신경중재치료의학

The authors present a case in which macro-embolus from the ruptured atheromatous plaque developed during carotid artery stenting (CAS). A 63-year-old man who had suffered a left middle cerebral artery territory infarction had significant proximal left internal carotid artery stenosis required CAS procedure. Immediate after stent deployment, the patient showed abrupt neurological deterioration with 12 x 3 mm sized macro-embolus which was caught by the embolus protection device (EPD). Retrieval of the macro-embolus was performed safely and the patient recovered to pre-procedure status. Macro-embolus can be resulted during the CAS. The EPD can capture the macro-embolus and safe removal is technically feasible.

Two Cases of Female Sexual Dysfunction Treated by Estrogen and Testosterone / 대한남성과학회지

Female sexual dysfunction is now of great concern and have a relatively high prevalence. It is related with psychosocial disorder, organic disease and iatrogenic cause. But until recently, basic science and clinical study on it is limited and medical therapy stays in early experimental steps except conventional hormone replacement therapy. Hormonal based female sexual dysfunction can be caused by dysfunction of the hypothalamic-pituitary axis, surgical or medical castration, menopause and premature ovarian failure. We report two cases of female sexual dysfunction derived from hormonal deficiency. One case is about premature menopause induced and the other is about rare form of adult onset idiopathic hypogonadotropic hypogonadism.

A Case of Iatrogenic Wernicke's Encephalopathy Following Chemotherapy and Total Parenteral Nutrition / 대한혈액학회지

Wernicke's encephalopathy is a neuropsychiatric condition generally caused by acute thiamine deficiency. Although it is common in the severe alcoholics, several other causes also have been identified, such as total parenteral nutrition (TPN) use, persistent vomiting, hyperemesis gravidarum, anorexia nervosa and malnutrition. The classic triad of Wernicke's encephalopathy are ataxia, altered mentation and ophthalmoplegia. A 19-year-old boy had been treated with high dose Ara-C and mitoxantrone for acute myelogenous leukemia and intravenous hyperalimentation due to persistent vomiting. He suddenly complained of diplopia, gait disturbance and generalized weakness at 36th day after chemotherapy. Physical examinations showed disorientated mentality, oculomotor palsy and horizental nystagmus. The diagnosis of Wernicke's encephalopathy was made with classical brain MRI and decreased thiamine level. The patient was successfully treated with vitamin B1. We presented a case of acute Wernicke's encephalopathy developed after high dose Ara-C chemotherapy followed by intravenous hyperalimentation in a patient with acute myelogenous leukemia.

Percutaneous Vertebroplasty in Osteoporotic Vertebral Body Compression Fracture

PURPOSE: To determine the clinical efficacy of percutaneous vertebroplasty in cases of painful and medically intractable osteoporotic vertebral compression fracture. MATERIALS AND METHODS: Ninety-eight patients (20 men and 78 women; mean age, 69 years) underwent 122 per-cutaneous vertebroplasty procedures for the treatment of osteoporotic vertical compression fracture. For the evaluation of bone mass, bone densitometry was performed in 45 patients, and to assess the recent evolution of the fracture, all 98 underwent MRI. Percutaneous vertebroplasty involves percutaneous transpedicular puncture of the involved vertebrae followed by the injection of a Polymethylmethacrylate(PMMA)-Barium mixture into the vertebral body. To assess leakage of the mixture into the epidural tissue, neural foramina, venous plexus and paravertebral tissue, we then immediately obtained a computerized tomographic (CT) scan, assessing the clinical efficacy of the procedure on the basis of time required for pain relief (defined as more than 60% reduction of initial pain), and time required for ambulation without significant pain. RESULTS: Percutaneous vertebroplasty was successful in all patients. Pain relief was accomplished within 1-5(mean, 1.8) days and early ambulation without significant pain was possible within 2 -15 (mean, 3.3) days. Post-procedural CT scanning revealed leakage of the PMMA-barium mixture into Paravertebral tissue(n=41), the paravertebral venous plexus (n=34) and epidural tissue (n=4). No neural foraminal leakage was identified, and no procedure-related complication requiring surgical treatment occurred. CONCLUSION: Percutaneous vertebroplasty is an effective new interventional procedure for the treatment of osteoporotic vertebral compression fracture. It relieves pain, provides early mobilization, and strengthens involved vertebral bodies.

Imaging of the Ventriculoperitoneal Shunt-Related Complications in Infants and Children With Hydrocephalus

PURPOSE: To evaluate the frequency and imaging findings of various ventriculo-peritoneal shunt-relatedcomplications in pediatric patients with hydrocephalus. MATERIALS AND METHODS: We retrospectively reviewed 246plain radiographs, three shuntograms, 53 ultrasounds, 133 CT scans, and 24 MR images obtained before and after theventriculo-peritoneal shunt procedure in 33 pediatric patients with hydrocephalus. Using preoperative images, theetiology of the hydrocephalus was assessed. Changes in the size and shape of the ventricles, the location andcontinuity of shunt apparatus, and the presence of any abnormal enhancement, hemorrhage, edema or tissue loss, orother findings of complications, were analyzed on postoperative images; the frequency and imaging findings ofshunt-related complications such as shunt malfunction, infection, hemorrhage or isolated ventricle, andcomplications caused by overdrainage, were thus evaluated. The frequency of such complications was analyzedaccording to the etiology of the hydrocephalus, and in addition, medical records were reviewed and correlated withimaging findings. RESULTS: In 18 of the 33 patients(54%), a total of 31 complications was detected. These werepresent in four of five cases (80%) of hydrocephalus caused by meningitis and ventriculitis, seven of twelve (58%)intraventricular hemorrhage, two of four (50%) unknown cases, three of nine (33%) congenital malformations, one oftwo (50%) tumors, and one (100%) congenital infection. Shunt malfunction was most common(n=15), and wasaccompanied by findings of enlarged ventricles, periventricular and peritubal edema, and abnormal location of theshunt tube. Symptoms and signs of increased intracranial pressure were also noted. Subdural hemorrhage andinfection were present infour cases each;findings of infection were enhancement of the ventricular wall, meninges,and parenchyma, as well as sonographically noted intraventricular septation and increased ventricular wall echo.Isolated lateral ventricle (n=4) or 4th ventricle (n=1) was persistently distended in spite of the presence of ashunt tube within the other ventricle. Collapsed ventricles, thick calvarium, and symptoms of increasedintracranial pressure were helpful in the diagnosis of slit ventricle syndrome(n=1). Immediate postoperativeintraventricular and parenchymal hemorrhage were noted in one case each. CONCLUSION: Shunt-related complicationswere found on postoperative images in 54% of pediatric patients with hydrocephalus; the frequency was highest incases of hydrocephalus caused by infection. Shunt malfunction occurred most frequently and each complication hadvarious imaging findings. For the diagnosis of post-operative shunt-related complication, continuous follow-upstudies are therefore necessary.

Imaging of the Ventriculoperitoneal Shunt-Related Complications in Infants and Children With Hydrocephalus

PURPOSE: To evaluate the frequency and imaging findings of various ventriculo-peritoneal shunt-relatedcomplications in pediatric patients with hydrocephalus. MATERIALS AND METHODS: We retrospectively reviewed 246plain radiographs, three shuntograms, 53 ultrasounds, 133 CT scans, and 24 MR images obtained before and after theventriculo-peritoneal shunt procedure in 33 pediatric patients with hydrocephalus. Using preoperative images, theetiology of the hydrocephalus was assessed. Changes in the size and shape of the ventricles, the location andcontinuity of shunt apparatus, and the presence of any abnormal enhancement, hemorrhage, edema or tissue loss, orother findings of complications, were analyzed on postoperative images; the frequency and imaging findings ofshunt-related complications such as shunt malfunction, infection, hemorrhage or isolated ventricle, andcomplications caused by overdrainage, were thus evaluated. The frequency of such complications was analyzedaccording to the etiology of the hydrocephalus, and in addition, medical records were reviewed and correlated withimaging findings. RESULTS: In 18 of the 33 patients(54%), a total of 31 complications was detected. These werepresent in four of five cases (80%) of hydrocephalus caused by meningitis and ventriculitis, seven of twelve (58%)intraventricular hemorrhage, two of four (50%) unknown cases, three of nine (33%) congenital malformations, one oftwo (50%) tumors, and one (100%) congenital infection. Shunt malfunction was most common(n=15), and wasaccompanied by findings of enlarged ventricles, periventricular and peritubal edema, and abnormal location of theshunt tube. Symptoms and signs of increased intracranial pressure were also noted. Subdural hemorrhage andinfection were present infour cases each;findings of infection were enhancement of the ventricular wall, meninges,and parenchyma, as well as sonographically noted intraventricular septation and increased ventricular wall echo.Isolated lateral ventricle (n=4) or 4th ventricle (n=1) was persistently distended in spite of the presence of ashunt tube within the other ventricle. Collapsed ventricles, thick calvarium, and symptoms of increasedintracranial pressure were helpful in the diagnosis of slit ventricle syndrome(n=1). Immediate postoperativeintraventricular and parenchymal hemorrhage were noted in one case each. CONCLUSION: Shunt-related complicationswere found on postoperative images in 54% of pediatric patients with hydrocephalus; the frequency was highest incases of hydrocephalus caused by infection. Shunt malfunction occurred most frequently and each complication hadvarious imaging findings. For the diagnosis of post-operative shunt-related complication, continuous follow-upstudies are therefore necessary.

Transmission of DICOM 3.0 type MR data to the personal computer in the hospital without PACS

PURPOSE: To transmit DICOM data to a personal computer in the hospital without PACS, and estimate theusefulness of digital image management and its convenience for physicians through transmitted file size,transmission time and quality of transmitted images. MATERIALS AND METHODS: The raw data of three brain MRI andlumbar spine MRI were transmitted from an MR system to a personal computer via Ethernet TCP/IP connection. Thefile size and transmission time of transmitted images were measured according to the matrix number. Threeboard-certified radiologists compared the image quality of the transmitted and scanned images. RESULTS: Thetransmission of DICOM data to the personal computer was successful and the transmitted images and their headerinformation were displayed by various personal computer-based DICOM viewing programs. The file size andtransmission time of the 256 and 512 matrix images were 136 Kbyte, 2.17 seconds/slice and 520 Kbyte, 4.37seconds/slice, respectively. All radiologists regarded the transmitted brain MRI images as superior. Oneradiologist considered the transmitted lumbar spine MRI images superior, while others decided that the quality oftransmitted and scanned images was the same. CONCLUSION: The transmission of DICOM format image data to apersonal computer through an appropriate DICOM receiving program is useful for managing digital images andconvenient for physicians in the hospital without PACS.

The Carotid Artery Intima-Media Thickness Measured with B-Mode Ultrasonography in Adult Volunteers

OBJECTIVES: The purposes of this study were 1) to correlate the carotid intima-medial thickness (IMT) with risk factors of atherosclerosis, 2) to demonstrate the standarized methods of B-mode ultrasound (US) scanning of carotid artery and IMT measurement. MATERIALS AND METHODS: Bilateral carotid arteries of 95 adult volunteers were scanned using 12 MHz linear probe. The mean of bilateral IMT was regarded as the volunteer's IMT, which was measured on the far wall of distal common carotid artery. The normality test for measured IMT and correlation tests between IMT and various known risk factors of atherosclerosis including age, end-systolic blood pressure, end-diastolic blood pressure, fasting blood glucose level, body mass index, life-style data and lipid profiles were performed. Inter-observer and intra-observer variability were evaluated through correlation tests on 20 randomly sampled data. RESULTS: The measured IMT showed normal distribution (mean=0.673 mm, SD=+/-0.1, p=0.494) and the 95th percentile was 0.830 mm. The systolic blood pressure (r=0.101) and body mass index (r=0.200) showed positive correlation but they did not show statistically significant relationships with IMT (p>0.05). The age showed statistically significant correlation (r=0.585, p<0.001), but the other risk factors did not show statistically significant correlation with IMT. The correlation coefficients of inter-observer and intra-observer variability on IMT measurement were 0.8770 and 0.9213, respectively. CONCLUSION: The diagnostic criteria for early carotid atherosclerosis using B-mode US could be estimated from our data. Our measurement protocols showed high reproducibility. The associations between most risk factors that did not show statistically significant correlation in our study and IMT should be confirmed in a population-based study.

The Investigation of Statistical Descriptions in the Original Articles of Journal of the Korean Radiological Society

PURPOSE: The purpose of this study was to identify errors in statistical descriptions in articles published in the journal of Korean Radiological Society and to suggest guidelines for the reduction of such errors. MATERIALS AND METHODS: In order to investigate statistical errors, 139 of the 514 original articles published between July 1994 were analysed. To assess the validity of statistical descriptions, five items were evaluated. The five items included descriptions of basic data, statistical tests and their results, tables, articles which had presented two or more statistical methods or results, and the Chi-square test. RESULTS: The percentages of correct descriptions of basic data, statistical tests and their results, tables, articles which had presented two or more statistical methods or results, and the Chi-square test were 86.3%, 74.8%, 24.4%, 76.7% and 79.4%, respectively. In 50 of 139 articles (36.0%), statistical descriptions were correct. CONCLUSION: More than half of the articles assessed contained statistical errors; inaccuracies of this kind might raise doubts about the objective validity of an article and the authors should there fore be careful when performing a study which needs statistical descriptions.

Chemoembolization of Hepatocellular Carcinoma: Long-term Survival and Prognostic Factors

PURPOSE: To analyse the long-term survival rate after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma and to determine prognostic factors. MATERIALS AND METHODS: In 1067 hepatocellularcarcinoma patients who had undergone TACE, of long-term survival rate and prognostic factors were retrospecfively analysed. Chemoembolization was accomplished by hepatic arterial infusion of a mixture of Lipiodol and Adriamycin(51%) or by Gelfoam embolization after infusion of the Lipiodol mixture(49%). The survival rate was calculated by the Kaplan-Meier method and multivariate analysis using the weibull model was applied to determine which prognostic factors were statistically significant. RESULTS: Among the 1067 patients, survival rates were asfollows : one-year, 60.6% ; two-year 42.3% ; three-year, 29.1% ; four-year, 23.7% ; and five-year, 14.7 %. The oneyear survival rate and median survival period of 432 patients with tumors 5cm in diameter or smaller were 77.7%and 33 months respectively, significantly higher than those of patients with larger tumors for whom the corresponding figures were 44.8% and 11 months. Other significant prognostic factors(p<0.0001) shown bymultivariate analysis included type of tumor, portal vein invasion and child-pugh classification. CONCLUSION: Theone-year survival rate agter chemoembolization in 1067 patients with hepatocellular carcinoma was 60.6%. The significant prognostic factors were size and type of the tumor, portal vein invasion, and Child-Pugh classification.

The Predictability of Stone Composition According to the Radiodensity of Urinary Stone on KUB Film / 대한비뇨기과학회지

A plain abdominal X-ray film (simple abdomen or KUB) is often used to display several types of urinary stones in vivo, or at least for a differentiation between calcium-containing 'radio-opaque' and calcium-noncontaining 'non-opaque' stones. We evaluated whether a KUB film could offer the information on composition of urinary calculi or not. The radiodensity of stone itself, the ratio of radio-opacity between the stones and the 2nd lumbar vertebra or lower renal pole parenchyme were measured in each 20 patients with renal stones above 1cm in diameter and variable compositions. However, such a definite distinction could not be resulted in our study. Therefore, we think that it is not possible to achieve a predictability of stone composition by measuring of its radiodensity on KUB film.

A Case of Primary Undifferentiated Small Cell Carcinoma of the Urinary Bladder / 대한비뇨기과학회지

Primary undifferentiated small cell carcinoma of the urinary bladder is a rare tumor. This tumor is basically identical to that of the small cell carcinoma of the lung in clinicopathologic aspect. The origin of the tumor is still obscure, but two hypothesis are proposed. The first is normal and metaplastic neuroendocrine cells located in the bladder mucosa. The second is proliferating mucosal stem cells with multidirectional differentiation. We report a case of undifferentiated small cell carcinoma of the urinary bladder in a 65 year-old man, who presented symptom of hematuria.

Tumor Grading of Adult Astrocytic Glioma on MR Imaging

PURPOSE: The purpose of this study is to determine predictive MR features for grading of astrocytic gliomas and to evaluate the accuracy of MR grading in these tumors. MATERIALS AND METHODS: We retrospectively reviewed 135 cases of supratentorial astrocytic gliomas in adult (age > 15 years), all of which were proved by open biopsy. Two observers analysed MR images independently with criteria of margin, edema, mass effect, signal heterogeneity, necrcosis, cyst formation, hemorrhage, tumor vascularity, enhancement degree, and enhancement size. The patterns of enhancement were categorized into no, homogeneous, heterogeneous, thin smooth rim, thin irregular rim, and thick irregular rim enhancement patterns. Observers finally diagnosed each case as one of low-grade astrocytoma, anaplastic astrocytoma or glioblastoma multiforme. RESULTS: Statistically significant MR features for grading of these tumors were revealed as necrosis (p < 0. 001), edema (0.008), and signal heterogeneity (p < 0.025). When compared with histopathologic grading, MR graded correctly 76%-77% of cases in two tiered system(low-grade astrocytoma versus high-grade astrocytoma), but only 67%-69% of cases in three tiered system(low-grade astrocytoma, anaplastic astrocytoma, glioblastoma multiforme). No contrast enhancement was seen in 45% and 23% of low-grade astrocytoma and anaplastic astrocytoma respectively. Glioblastoma multiforme frequently showed thick irregular rim enhancement (57%), but no enhancement at all in 8%. CONCLUSION: We have concluded that necrosis and edema are significant predictive MR features for gradomg of supratentorial astrocytic gliomas in adult, and MR was correct in 76%--77% of cases for predicting pathologic grading of astrocytomas in two tiered system.

An Experimental Study on Cerebral Paragonimiasis using Cats

PURPOSE: It is important to diagnose paragonimiasis in early active stage because it can be dured by chemotherapy. However, it is difficult to make a correct diagnosis of cerebral paragonimiasis in the early active stage, and the radiographic findings of cerebral paragonimiasis have been rarely reported. Thus, this experimental study was designed to produce early active cerebral paragonimiasis and to demonstrate radiologic-pathologic correlations. MATERIALS AND METHODS: In 8 cats, 7-8 metacercariae of Paragonimus westerrnani were directly introduced into the brain parenchyma of each cat's after trephination of the skull. In anogher 16 cats, the juvenile worms and the adult worms that had developed for varying periods (2 weeks, 4 weeks, 6 weeks, 8 weeks and 12 weeks) in the lunges of another cats were introduced into the brain parenchyma of each cat's with the same procedures described above. Follw-up MR images and chest radiographs were obtained at 2 days, 1 weeks, 2 weeks, 4 weeks and 8 weeks after innoculation. The autopsies and histopathological examinations of the cat's brain were undertaken in 22 cats. In 9 cats that were suspected with pulmonary lesions on chest radiograph, the soft tissue radiographs of inflated-fixed lungs were obtained. RESULTS: In one cat with innoculation of adult worm, acute suppurative inflammation of the brain parenchyma was demonstrated. But the other cats with innoculction of adult worm or juvenile worm and the cats with innoulation of metacercaris did not reveal any evidence of acute cerebral paragonimiasis. More than half of the introduced metacercariae(5 out of 8 cats) were found in the lung parenchyma, while only 25%(4 out of 16 cats) of the adult worm innoculated cats were. CONCLUSION: Acute suppurative inflammation suggesting acute stage cerebral paragonimiasis was obtained in one case of adult worm innoculated cat. Most of the innoculated metacercariae and some of the juvenile worms or adult worms were migrated to the lungs.

MR Findings of Giant Cell Tumor: Signal Intensity and Morphological Characteristics

PURPOSE: To describe the MR characteristics of giant cell tumor of bone. MATERIALS AND METHODS: MR iraagings of 15 cases of pathologically proved giant cell tumor were retrospectively analyzed. Signal intensity and homogeneity, involvement of articular surface, low signal intensity rim around the tumor, cortical disruption and soft tissue involvement were evaluated. RESULTS:Tumor showed low signal intensity on T1 weighted images(93%), inhomogenous high signal on T2 or T2* weighted images(93%) and inhomogeneous enhancing pattern(88%). In 11 cases of giant cell tumor of long bones, all cases showed involvement of articular margin and 10 cases(90%) showed rim of low signal intensity between tumor and normal marrow. Disruption of cortical bone(25%) and soft tissue involevement(7%) were also demonstrated. CONCLUSION: We concluded that giant cell tumor showed characteristic MR findings could be helpful in making correct diagnosis.

Idiopathic pulmonary fibrosis vs. pulmonary involvement of collagen vascular disease:HRCT findings

Both idiopathic pulmonary fibrosis (IPF) and pulmonary involvement of collagen vascular disease(CVD) are well known cause of diffuse interstitial lung disease which lead to fibrosis and honeycombing. We analyzed HRCT findings of 33 patients with IPF and 14 patients with CVD in terms of predominant pattern, site of involvement, mediastinal lymph node enlargement, pleural change and pulmonary volume loss. Criteria of mediastinal lymph node enlargement and pleural thickening were 15mm in long diameter and 3mm, respectively. Volume loss of the lung was measured by using hilar height ratio (apex to hilum/hilum to diaphragmatic dome). Mean age was 61 years for IPF and 46 years for CVD and male: female ratio was 27:6, 4:10, respectively. Predominant HRCT pattern was honeycombing for IPF (63%), and ground-glass opacity for CVD (66%) (p=0.001). Predominantly, subpleural involvement was seen in 90% for IPF and 74% for CVD. Mediastinal lymph node enlargement was seen in 47% of the patient with IPF and 14% with CVD (p=0.004). pleural thickening was seen in 97% of the patients with IPF and 42% with CVD (P=0.002), Pleural effusion was seen in 10% of the patients with IPF and 36% with CVD (P=0.009). Hilar height ratio of more than 1.5 was seen in 84% of the patients with IPF and 29% with CVD. In conclusion, our study shows that patients with IPF are prone to have more progressed stage of pulmonary fibrosis than the patients with CVD on HRCT.

Coronary arterial disease associated with arteriosclerosis in lower extremity: angiographic analysis

We performed both peripheral and coronary angiographies in 52 patients with an arteriosclerosis in lower extremities. The severity of arteriosclerotic narrowing of the coronany and peripheral anteries were compared on angiographies. An angiographic vascular score(AVS, 0-5) reflecting the number and the degree of stenosis in 12 lower extremity arteries and three major coronary arteries was assigned to each angiogram and the sum of scores in the lower extremity arteries was compared with the incidence of significant coronary artery disease(more than grade 3) and coronary score. Relation of incidence and severity of vascular stenosis and four risk factors(diabetes mellitus, hypertension, smoking, and hypercholesterolemia) was also analyzed. Thirty-four of 52 patients(65%) had an angiographically significant coronary artery disease. Thirteen of these 34 patients (38%) had no clinical symptom and sign of the ischemic heart disease. There was no statistically significant difference in the incidence and severity of coronary artery disease between high (more than 30) and low AVS group in lower extremity(P>0.14). All patients had at least one risk factor and 49 of 52 patients(94%) had multiple risk factors. Coronary angiography was normal in three patients with only one risk factors, and angiographically significant coronary artery disease existed in nine of 16 cases(56.3%) with two risk factors. 13 of 17 cases(76.5%) with three risk factors, and 12 of 16 cases(75.0%) with all four risk factors. There were no significant correlations between individual risk factors and incidence, severity of arteriosclerosis in coronary and lower extremity arteries. In conclusion, angiographic evaluation of the coronary artery disease in patients with lower extremity arteriosclerosis is necessary because of the high chance of coronary artery disease and difficulty in the prediction of coronary artery disease with a severity of the peripheral arteriosclerosis, presence of various risk factors, and clinical symptoms.

Traumatic cervical root injury: Diagnostic value of MR imaging

Although Soft tissue contrast and direct multiplanar imaging capability of MRI are well recognized, myelo Been the imaging modality of choice in evaluationg cervical root injury. We assessed the role of M compared its diagnostic accuracy with myelography in the evaluation of cervical root injury. MR finding Root injury in ten patients (55 roots) were retrospectively reviewed. In 26 explored roots (6 patin Frndings were compared with myelography and surgical results. In 29 roots (8 patients), which were By myelography or exploration, the MR findings were focal extraudral CSF collections (pseudomem In 21/29(72.4%, 8 patients), thickening of extradural roots in 4/29 (13.6%, 5 patients), and thickern Darn in 12/29 (41.4%, 6 patients) roots. T2-weighted axial image was superior to Tl weighted and Density-weighted images for delineationg root avulsion. The sensitivity and specificity of MRI were 7 93.3% respectively, while those of myelography were 83% and 90%. Overall diagnostic accuracy of Myelography were comparable (84.6% vs 87.5%). In conclusion, myelography is still considered as the Of choice in the preoperative evaluation of the cervical root avulsion because of its higher sensi, however, may obviate the myelography with some technical refinements.

Traumatic cervical root injury: Diagnostic value of MR imaging

Although Soft tissue contrast and direct multiplanar imaging capability of MRI are well recognized, myelo Been the imaging modality of choice in evaluationg cervical root injury. We assessed the role of M compared its diagnostic accuracy with myelography in the evaluation of cervical root injury. MR finding Root injury in ten patients (55 roots) were retrospectively reviewed. In 26 explored roots (6 patin Frndings were compared with myelography and surgical results. In 29 roots (8 patients), which were By myelography or exploration, the MR findings were focal extraudral CSF collections (pseudomem In 21/29(72.4%, 8 patients), thickening of extradural roots in 4/29 (13.6%, 5 patients), and thickern Darn in 12/29 (41.4%, 6 patients) roots. T2-weighted axial image was superior to Tl weighted and Density-weighted images for delineationg root avulsion. The sensitivity and specificity of MRI were 7 93.3% respectively, while those of myelography were 83% and 90%. Overall diagnostic accuracy of Myelography were comparable (84.6% vs 87.5%). In conclusion, myelography is still considered as the Of choice in the preoperative evaluation of the cervical root avulsion because of its higher sensi, however, may obviate the myelography with some technical refinements.

Pyogenic osteomyelitis of long bone: MR findings

To evaluate the usefulness of MR in the osteomyelitis, we reviewed MR examinations of 14 patients with pyogenic osteomyelitis of the long bone. All 14 patients were confirmed to have osteomyelitis either surgically (13/14) or by aspiration (1/14). MRI was performed with 0.5R (n=8) or 2.0T (n=6) SE technique, and Gd-DTPA enhanced T1WI was obtained in 10 examinations. Anatomic location of lesions were femur (8/14), tibia (5/14),m and fibula (1/14). The marrow cavity and soft tissue were involved in 13/14, 12/14 respectively. The signals of both intraosseous and extraosseous infected area were iso to low signal intensity to muscles on T1WI and high signal intensity on PDWI & T2WI. Rim or diffuse enhancement of the marrow cavity and soft tissue were seen in all (10/10) cases. Sequestra, periosteal reaction. And cortical defect were found in 12/14, 10/14, 9/14. MR provided more accurate and detailed anatomic information including extent of disease and possible activity than bone scintigraphy, CT, or conventional radiography. We conclude that MR might be the choice of modality in the diagnosis of osteomyelitis of the long bone.