Sarcomatoid Metaplastic Carcinoma of the Breast: A Case Report

Metaplastic breast carcinoma is a very rare disease with many different histologic subtypes including squamous cell, spindle cell, and heterologous mesenchymal growth (sarcomatoid, osseous). We report a case of sarcomatoid metaplastic carcinoma of the breast which was manifested as a well-circumscribed, round, hypoechoic mass on ultrasound.

Area-Based Occupational Disease Surveillance in Incheon, Korea: Results of an 11-year Data Survey / 대한산업의학회지

OBJECTIVES: Between Jan 1998 and Dec 2008, area-based occupational disease surveillance in Incheon was used to collect data on occupational diseases. The long-term data was used to estimate the scale of disease, to analyze disease characteristics, and to achieve surveillance in order to determine development tasks. METHODS: For a period of 11 years, occupation-related disease surveillance was performed on an annual basis for employees of Incheon industries. All cases of occupational disease were reported by means of the Incheon Occupational Disease Information Network (IODIN) web site, downloaded, and analyzed, subsequently. RESULTS: Between Jan 1998 and Dec 2008, 1577 cases of occupational disease were reported. Of these, there were 1043(66.1%) cases of occupational musculoskeletal disorders, 172(10.9%) cases of occupational asthma, 162(10.3%) cases of occupational dermatoses, 135(8.6%) cases of occupationally-related cancers, 30(1.9%) cases of pneumoconiosis, 27(1.7%) cases of toxic hepatitis, and 8(0.5%) cases of occupational neuronal disease. CONCLUSION: In the Incheon area, small and medium industries comprise 99% of business. The composition of the industry by category, in Incheon, is similar to the country on the whole. In actually, the data on occupational diseases in Korea are almost workers' compensation data. Thus, the survey of occupational disease based in Incheon, Korea, can serve as an estimate of the trends and size of the occupational disease throughout the entire country.

Ultrasonographic and Mammographic Findings of Polyacrylamide Gel Injection Mammoplasty: A Case Report

Polyacrylamide gel has been widely used for soft tissue contouring for more than 30 years and has been used for breast mammoplasty augmentation in China since 1997. As Korea is close to China, Korean clinicians often encounter the patients who have undergone polyacrylamide gel augmentation mammoplasty. Therefore, radiologists should know the ultrasonographic and mammographic findings and the complications of polyacrylamide gel augmented mammoplasty; this can be helpful in the diagnosis and management of those patients. We report the characteristic radiological findings of a patient who had undergone mammoplasty augmentation with polyacrylamide gel.

Fine Needle Aspiration Cytology of Granular Cell Tumor in Breast: A Case Report / 대한세포병리학회지

Granular cell tumor (GCT) of the breast is a rare clinical entity, and is believed to be of schwannian origin and to follow a benign clinical course. A 50-year-old woman presented with a slowly growing mass in the right breast. Fine needle aspiration cytology revealed a cellular smear containing isolated or clustered cells showing round to oval nuclei with abundant oncocytic granular cytoplasm. Nuclei showed a fine granular chromatin pattern and occasional small single nucleoli. Cell boundaries were poorly defined, and naked nuclei were frequently found. Histologically, the tumor showed features of typical GCT, and immunohistochemical staining findings strongly supported the diagnosis. The present study demonstrates that GCT of the breast can mimic malignant lesions of breast both clinically and radiologically. The recognition of its cytologic features and suspicion of this lesion would undoubtedly aid the correct diagnosis of mammary GCT.

Risk Factors for Recurrence After Surgical Treatment of a Malignant Phyllodes Tumor of the Breast / 한국유방암학회지

PURPOSE: Malignant phyllodes tumors are rare breast tumors. Information on the prognosis and optimal treatment of these lesions is not yet sufficient. The aim of this study was to determine parameters that predict the recurrence of malignant phyllodes tumors of the breast. METHODS: Retrospectively, we reviewed the medical records and pathological slides of 23 patients with malignant phyllodes tumors that had undergone surgical treatment from 1988 to 2006. The age of the patients, tumor size, type of surgery, resection margin, adjuvant therapy and pathological characteristics of the tumors such as stromal hypercellularity, cellular phleomorphism, mitosis, margins, and stromal pattern were examined. RESULTS: The mean age of the patients was 41 yr. The tumor size ranged from 1 cm to 25 cm, with a median of 7.42 cm. The median follow-up time was 29.0 months. Recurrence was observed in 6 patients (26.1%) and the 5-yr disease free survival was 48.9%. Risk factors for recurrence of a malignant phyllodes tumor were a mitotic index greater than 10 per high-powered field (p=0.0242) and an invasive margin (p=0.0437). CONCLUSION: Frequent mitosis and an invasive margin were the principal determinants of recurrence. Patients with poor prognostic components should be treated more aggressively and the patients need more close follow-up.

Cytomorphologic Comparison of Hodgkin Lymphoma and Anaplastic Large cell Lymphoma in Fine Needle Aspiration Cytology / 대한세포병리학회지

To study the differentiating cytomorphological features of Hodgkin lymphoma (HL) and anaplastic large cell lymphoma (ALCL) using fine needle aspiration cytology (FNAC), cytomorphological features of 16 patients with HL (n=8) or ALCL (n=8) were analyzed. In the initial cytological diagnosis prior to biopsy, HLs were properly diagnosed in 4 out of 8 cases (4 HL, 2 atypical, 2 benign), whereas all ALCL were diagnosed as malignancies. However, correct diagnosis of non-Hodgkin lymphoma (NHL) was made in only two ALCL patients (2 NHL, 1 HL, 1 sarcoma, 4 malignancy without specific type). Overall, the percentage of large abnormal cells ranged from 30% to 90% in ALCL except for one case, whereas it was less than 5% in all 8 HL. A spectrum of atypical cells was more characteristic of ALCL. In contrast, HL showed an sharp difference between reactive lymphoid cells and neoplastic ones (bimorphic pattern). Moreover, the emergence of kidney-shaped abnormal cells or wreath-like multinucleated cells was helpful in diagnosing ALCL. The combination of thesefeatures would be useful in differentiating HL and ALCL. Nevertheless, these two types of lymphomas cannot be definitely distinguished based on cytomorphological features alone. Therefore, the aim of FNAC would be to suggest a specific diagnosis and indicate the need for a biopsy.

Quality Assurance of Ultrasonic Diagnosis in Breast

Sonography is a subjective diagnostic method which is highly dependent on the experience of the operator and the equipment quality which requires real-time adjustments. Breast screening examination currently consists of clinical examination and mammography. Breast sonography, either supplementary to mammography or independently, is indicated for the dense breast, especially in younger women. Breast sonography is especially applicable for Korean women because of the denser breast parenchyma and the approximately 10-year younger incidence rate of breast cancer of Korean women compared to western women. To avoid unnecessary breast biopsy because of the high rate of false positive lesions in breast parenchyma, which is different from other body organs such as the liver or the kidney, a quality assurance program for breast sonography is essential. The quality assurance of breast ultrasound involves quality assurance of the equipment, imaging display and acquisition of clinical images, personnel qualifications and other aspects such as unification of lexicon, guideline of diagnostic examination and reporting system; US BI-RAD reporting system, assessment items and organization, education program, medical audit, certification issues, and medicolegal issues. A breast sonographic quality assurance system should be established before a scheme to initiate governmental medical insurance for breast sonography.

Clinicopathological Analysis of Systemic Anaplastic Large Cell Lymphoma

BACKGROUND: Several studies from western countries have reported variable prognoses for patients with systemic anaplastic large cell lymphoma (ALCL) depending strongly on the expression of anaplastic lymphoma kinase (ALK). However, no prognostic significance of ALK expression in Koreans was reported in a single report regarding these patients, although the number of cases was limited in that study. METHODS: We analyzed the clinicopathological features of ALK+ ALCL and ALK- ALCL in 30 Korean patients diagnosed with primary systemic ALCL. RESULTS: ALK expression was detected in 60% of all ALCL patients (18/30), and there was no statistical significance to ALK expression in overall survival. Patients with ALK+ ALCL were younger in age and had negative bcl-2 expression; these differences were statistically significant. Tumors positive for ALK protein and granzyme B expression, and negative for bcl-2 expression with a null-cell phenotype tended to have better survival outcomes, althought this trend failed to reach statistical significance (p<0.2), probably due to the limited number of cases in this study. CONCLUSION: ALK protein expression and the absence of bcl-2 in tumor cells tend to result in better survival despite the failure of this trend to achieve statistical significance. Further studies that examine potential pathologic prognostic factors combined with the expression of ALK and apoptotic factors such as bcl-2 are needed. Additional larger-scale studies are also needed to conclude that ALK expression has no prognostic significance among Koreans.

Host Gene Profiling of Coxsackievirus B3 H3- and 10A1-infected Mouse Heart

Coxsackievirus B3 (CVB3) is a non-enveloped virus that has a single-stranded RNA genome. CVB3 induces myocarditis, and ultimately, dilated cardiomyopathy. A myocarditis variant of CVB3 (CVB3 H3) and its antibody-escape mutant (CVB3 10A1) were studied previously; H3 was found to induce myocarditis and 10A1 was found to be attenuated in infected mice. Although amino acid residue 165, located in a puff region of VP2, was found to be altered (i.e., the H3 asparagine was altered to aspartate in 10A1), the detailed mechanism of attenuation was not clearly elucidated. Here, DNA microarray technology was used to monitor changes in mRNA levels of infected mouse hearts after CVB3 H3 and 10A1 infection. This tool was used to elucidate the pathogenic mechanisms of viral infection by understanding virus-host interactions. We identified several genes, including protein tyrosine kinases, Ddr2 and Ptk2, as well as Clqb and Crry, involved in complement reactions, which may be involved in these viral processes. Thus, gene profiling can provide an opportunity to understand host immune responses to viral infection for gene therapy and may contribute to the identification of the target gene that is modified during treatment of viral myocarditis.

Development of Peptide Antibody against Coxsackievirus B3 VP2

Coxsackievirus B3 (CVB3) is the nonenveloped virus containing a single-stranded positive-sense RNA as a genome. CVB3 infection can induce acute myocarditis and dilated cardiomypathy. CVB3 of icosahedral symmetry has four capsid proteins called VP1, VP2, VP3, and VP4. Although VP1 is a major antigenic determinant, VP2 is also an important protein for viral physiology, such as maturation cleavage and attenuation. However, VP2 study has been hampered, partly because VP2 antibody is not available. In this study, we developed peptide-based polyclonal VP2 antibody and analyzed its potency by Western blotting analysis and immunofluorescent assay. Purified B3-1 antibody (VP2 peptide antibody developed in here) showed the sensitivity and specificity, similar to VP1 monoclonal antibody which is commercially available. Moreover, this peptide antibody may be useful for double-staining with other antibodies derived from mouse. Therefore, the VP2 antibody may allow us to study CVB assembly and understand VP2 function in depth.

Establishment of Quality Assessment Standard for Mammographic Equipments: Evaluation of Phantom and Clinical Images

PURPOSE: The purpose of this study was to establish a quality standard for mammographic equipment in Korea and to eventually improve mammographic quality in clinics and hospitals throughout Korea by educating technicians and clinic personnel. MATERIALS AND METHODS: For the phantom test and on site assessment, we visited 37 sites and examined 43 sets of mammographic equipment. Items that were examined include phantom test, radiation dose measurement, developer assessment, etc. The phantom images were assessed visually and by optical density measurements. For the clinical image assessment, clinical images from 371 sites were examined following the new Korean standard for clinical image evaluation. The items examined include labeling, positioning, contrast, exposure, artifacts, collimation among others. RESULTS: Quality standard of mammographic equipment was satisfied in all equipment during on site visits. Average mean glandular dose was 114.9 mRad. All phantom image test scores were over 10 points (average, 10.8 points). However, optical density measurements were below 1.2 in 9 sets of equipment (20.9%). Clinical image evaluation revealed appropriate image quality in 83.5%, while images from non-radiologist clinics were adequate in 74.6% (91/122), which was the lowest score of any group. Images were satisfactory in 59.0% (219/371) based on evaluation by specialists following the new Korean standard for clinical image evaluation. Satisfactory images had a mean score of 81.7 (1 S.D.=8.9) and unsatisfactory images had a mean score of 61.9 (1 S.D=11). The correlation coefficient between the two observers was 0.93 (p<0.01) in 49 consecutive cases. CONCLUSION: The results of the phantom tests suggest that optical density measurements should be performed as part of a new quality standard for mammographic equipment. The new clinical evaluation criteria that was used in this study can be implemented with some modifications for future mammography quality control by the Korean government.

Acoustic Calibration of Clinical Audiometers Used for Special Periodic Health Examination / 대한산업의학회지

OBJECTIVES: Various problems are encountered during audiometric testing. Deviation from reference threshold levels for supra-aural earphones is often a serious problem when hearing levels are measured. This paper reports the acoustic calibration of clinical audiometers used for special periodic health examination. METHODS: ANSI S3.6-1996 Specification for Audiometers represents our most current and best resource for information regarding audiometers. The acoustic calibration was measured in 211 clinical audiometers and compared with the ANSI S3.6-1996 reference threshold levels for supra-aural earphones. RESULTS: Among 211 clinical audiometers, 56 (26.5%) exceeded the permitted deviation from reference threshold levels at any test frequency in ANSI S3.6-1996 for left supra-aural earphones, and 54 (25.6%) for right. An exhaustive calibration was required for 16 audiometers (7.6%) in both supra-aural earphones. The absolute difference in dB deviation from reference threshold levels by performed acoustic calibration at least annually were statistically significant at any test frequency (p<.05). CONCLUSIONS: The results of this study strongly indicate that clinical audiometry is being conducted with pure-tone audiometers having unallowable sound pressure levels deviations for supra-aural earphones. The validity of audiometric hearing thresholds are significantly affected by these deviations from the acoustic calibration levels of audiometers. Therefore audiometer calibration need to be checked functionally daily and acoustically at least annually.

Assessment of Neurobehavioral Performance Among Rotogravure Printing Workers Exposed to Toluene / 대한산업의학회지

OBJECTIVES: The aims of this study were to investigate the occupational exposure level to toluene among rotogravure printers and neurobehavioral effects among them. METHODS: Fifty rotogravure printers and 147 controls participated in this study. Environmental and biological monitoring was performed for the investigation of toluene exposure level, and neurobehavioral performance test were performed by using the Behavioral Assessment and Research System with Korean language instructions(BARS-K). RESULTS: The major results were as follows; 1. Geometric mean toluene concentrations in the ambient air of 5 rotogravure printing workplaces were 10.5 (GSD 5.9)~181.9 (GSD 17.7), with a grand total of 56.7 (GSD60.9) ppm. 2. The geometric mean urinary hippuric acid level for rotogravure printers of 5 workplaces were 0.31 (GSD 0.11)~5.14 (GSD 0.55), with the grand total of 1.87 (GSD 2.06) g/g creatinine. 3. There was a linear correlation between hippuric acid levels in urine and the exposed toluene in air: urine hippuric acid (g/g creatinine)=0.03 toluene (ppm) + 0.15 (r=0.899, p<0.01, n=50). 4. After adjustment for confounders, significant associations were found between toluene exposure and Digit span forwards, Digit span backwards, Tapping preferred hand, Symbol digit and Selective attention trials. CONCLUSIONS: 1. Rotogravure printers were occupationally exposed to relatively high concentration to toluene, and their neurobehavioral performances were decreased. 2. The BARS neurobehavioral testing program, which minimizes the use of text in the instructions, was very effective in overcoming the cultural barriers in neurobehavioral testing.

Clinical Image Evaluation of Mammograms: A National Survey

PURPOSE: The goal of this study was to survey the overall quality of mammographic images in Korea. MATERIALS AND METHODS: A total of 598 mammographic images collected from 257 hospitals nationwide were reviewed in terms of eight image quality categories, namely positioning, compression, contrast, exposure, sharpness, noise, artifacts, and examination identification, and rated on a five-point scale: (1=severe deficiency, 2=major deficiency, 3=minor deficiency, 4=good, 5=best). Failure was defined as the occurrence of more than four major deficiencies or one severe deficiency (score of 1 or 2). The results were compared among hospitals of varying kinds, and common problems in clinical image quality were identified. RESULTS: Two hundred and seventeen mammographic images (36.3%) failed the evaluation. Poor images were found in descending order of frequency, at The Society for Medical Examination (33/69, 47.8%), non-radiology clinics (42/88, 47.7%), general hospitals (92/216, 42.6%), radiology clinics (39/102, 38.2%), and university hospitals (11/123, 8.9%) (p<0.01, Chi-square test). Among the 598 images, serious problems which occurred were related to positioning in 23.7% of instances (n=142) (p<0.01, Chi-square test), examination identification in 5.7% (n=34), exposure in 5.4% (n=32), contrast in 4.2% (n=25), sharpness in 2.7% (n=16), compression in 2.5% (n=15), artifacts in 2.5% (n=15), and noise in 0.3% (n=2). CONCLUSION: This study showed that in Korea, 36.3% of the mammograms examined in this sampling had important image-related defects that might have led to serious errors in patient management. The failure rate was significantly higher in non-radiology clinics and at The Society for Medical Examination than at university hospitals.

Value of Real-time Compound US in Diagnosis of Malignant Tumor in Breast Comparing with Conventional US, and Pulse Inversion Harmonic Images

PURPOSE: To compare the usefulness of real-time compound US (RCUS) with that of conventional US (CUS) and pulse inversion harmonic (PIH) imaging in the diagnosis of malignant breast tumors. MATERIALS AND METHODS: In 22 female patients whose mean age was 49 years, we evaluated the RCUS findings of pathologically proven [core biopsy (n=9), mammotome tissue bigpsy (n=10), excisional bispsy (n=3)] malignant breast tumors, comparing them with the findings of CUS and PIH imaging. Evaluation of these masses was in terms of their marginal distinction, internal echogenicity, boundary and posterior echo pattern, relationship with the adjacent lactiferous ductal system, and the presence of necrosis (12/22) and calcification (6/22). RESULTS: In terms of marginal distinction, internal echogenicity, boundary echo patterns, and the relationship with adjacent ductal system, RCUS was superior to both conventional US and PIH Imaging (p<0.05). CONCLUSION: For the diagnosis of malignant breast tumors RCUS was more useful than CUS or PIH imaging.

Radiologic Findings of Direct Splenic Invasion by Malignant Tumors of Adjacent Organs

PURPOSE: To evaluate the radiologic findings of direct invasion of the spleen by malignant tumors of adjacent organs. MATERIALS AND METHODS: We retrospectively reviewed the CT(n=6) and MR(n=3) images of six patients with direct invasion of the spleen by malignant tumor of left lower lung, stomach, colon, pancreas, left kidney, and left adrenal gland. We evaluated the tumor margin, attenuation or intensity, perisplenic fat infiltration, regional lymphnode enlargement, and invaded site of the spleen. RESULTS: Ill-defined masses were found in the spleen with central necrosis and infiltration into perisplenic fatty tissue in all six patients; left adrenal mass was present also in three patients. Regional lymphnode enlargement was found in four patients. The masses showed heterogenous low attenuation on CT. The invaded site was variable and corresponding to their anatomical connections to the spleen. CONCLUSION: Direct invasion of the spleen by malignant tumors of adjacent organs showed ill-defined masses with central necrosis and were commonly associated with infiltration to perisplenic fatty tissue and adrenal invasion. The pattern and invaded site can be helpful to assess the primary cancer.

Usefulness and Limitation of 3D-Ultrasoud Diagnosis of Breast Masses

PURPOSE: To compare 3D ultrasound (3D-US) with 2D ultrasound (2D-US) in terms of their usefulness and limitations in the diagnosis of breast masses. MATERIALS AND METHODS: We obtained 2D and 3D US images of 37 breast lesions present in 20 cases of fibroadenoma, nine of cancer, and eight of fibrocystic disease proven in a total of 26 cases [fibroadenoma (n=13), breast cancer (n=9), fibrocystic disease (n=4)] by histologic examination, and by clinical evaluation and clinical evaluation with sonographic imaging in eleven. When comparing 3D and 2D-US images we had no prior information regarding detection rate according to the size of lesions, whether or not internal and boundary echo patterns could be interpreted, accurate differentiation between tumorous and non-tumorous lesions, or the accuracy with which benign and malignant tumors could be differentiated. RESULTS: For lesions of 1 cm or less in diameter the detection rate of 3D-US was lower than that of 2D-US, but for lesions over 1 cm there was no difference between the two modalities. In fibroadenoma and breast cancer, 3D-US was more useful than 2D-US for the evaluation of both internal and boundary echo, but with fibrocystic disease and in the diagnosis of tumor/non-tumor, there was no significant difference. In breast cancer, however, 3D-US more accurately determined malignancy, and in fibroadenoma, because of the pseudospicule revealed by 3D-US, this modality was less exact in determining benignancy. CONCLUSION: In the evaluation of internal and boundary echo in breast mass diagnosis, 3D-US was more useful than its 2D counterpart. For lesions of 1 cm or less in diameter, however, the detection rate of 3D-US was low, and since in some benign cases a pseudospicule was apparent, the possibiliy of confusion with malignancy arose. For these reasons, the usefulness of 3D-US was limited.

Eagle's Syndrome: A Case Report

Eagle's syndrome is a rare condition associated with recurrent throat pain, foreign body sensation and odynophagia. It is caused by elongation of the styloid process or calcification of the stylohyoid process. We present the clinical and radiologic findings of a case of Eagle's syndrome.

Comparison of Imaging Diagnosis of Pyo genic Abscess and Inflammatory Cancer in the Breast: Focused on MRI

PURPOSE: To compare the radiologic findings of pyogenic abscess(PA) and inflammatory cancer(IC) of the breast, as seen on mammograms, US, and MR images and to evaluate the usefulness of the differential diagnostic findings of MRI for differentiation of PA and IC of the breast. MATERIALS AND METHODS: We retrospectively analyzed the mammographic, US and MR findings of nine histopathologically proven cases of PA and four cases of IC of the breast. Parenchymal density, mass density, skin thickening and calcification were evaluated by mammography, and the extent of lesion and its morphologic characteristics and changes of dermal lymphatics by US and MRI. The latter was also used to analyse signal intensity and enhancement pattern. RESULTS: Mammographic findings for both lesions were nonspecific. US showed that the pyogenic abscess was a hypoechoic and anechoic complex lesion with posterior acoustic enhancement, while inflammatory cancer was a spiculated lesion with a heterogeneous hypoechoic echotexture. On 3D-GRE dynamic enhanced M-RI, PA was shown in six cases(66.7 %) to be a lesion with superficial periareolar involvement, in contrast to the deep parenchymal spread seen in all cases of IC. A central non- enhanced portion with an irregular thick peripheral enhanced rim was seen in eight cases of PA(88.9 %) , and in all cases of IC an inhomogeneously enhanced spiculated lesion in parenchyma and a diffusely enhanced dermal and subcutaneous layer was apparent. An MRI time-intensity curve showed that the enhancement pattern was slow in five cases of PA(55.6 % ) and irregular in four(44.4 %), while for IC it was rapid in three cases(33.3 %) and irregular in one(11.1 % ). CONCLUSION: As compared with mammography and US, 3D-GRE dynamic MRI was a useful method for the differential diagnosis of PA and IC of the breast. The characteristic MR findings of PA were a central non-enhanced portion with an irregularly thick peripheral enhanced rim, located mainly in the superficial periareloar area and spreading into the parenchymal layer. An inhomogeneously enhanced spiculated solid mass in the parenchyma associated with diffuse dermal thickening and lymphatic dilatation was more suggestive of IC.

A Comparative Study of MRI Findings of Experimentally Induced Rapid Progressive Glomerulonephritis (RPGN) and Acute Tubular Necrosis (ATN) in Rabbits

PURPOSE: To evaluate the usefulness of MR imaging in the differential diagnosis of the underlying causes of early-stage acute renal failure (ARF) by comparing the MRI findings of experimentally-induced crescentic glomerulonephritis (CGN) and acute tubular necrosis (ATN) in rabbits. MATERIALS AND METHODS: Experimental CGN was induced by injecting anti-glomerular basement membrane antibody into six rabbits, and ATN by injecting glycerol solution into six rabbits. A normal control group of three rabbits was also used. Renal MR imaging (T1-and T2-weighted coronal images and dynamic MRI : DMRI) was performed the day before, and one, four, and seven days after the induction of CGN; and immediately before, and four, and eight hours, and one, four, and seven days after the induction of ATN. Sequential renal gun-biopsies and blood sampling (serum creatinine, sCr) were performed. Renal area, corticomedullary differentiation(CMD), and the passage of Gd-DTPA (pattern of dark band), as seen on MRI, were analyzed and correlated with serial change of sCr. RESULTS: In normal kidneys, CMD was clearly apparent on both T1- and T2-weighted images. DMRI demonstrated a progressively inwardly migrating dark band in the kidneys. CMD was relatively clearly demonstrated in the ATN group but less clearly identified in the CGN group. Renal size (area) and sCr gradually increased in both the CGN and ATN groups, and dark bands were moderately to poorly defined in both. CONCLUSION: We conclude that DMRI could be used to differentiate and evaluate disease processing and compromised renal function in cases of CGN and ATN. On T1- and T2-weighted images, CMD was relatively well preserved in the ATN group, but was less clear in the CGN group. These MRI findings may be helpful for differentiation of the underlying causes of early-stage ARF, particularly between CGN and ATN.