Pancreatic Metastasis from Adenocarcinoma of the Uterine Cervix / 대한소화기학회지

Pancreatic metastasis from cervical cancer is extremely rare. We report a case of metastatic adenocarcinoma of the pancreas from uterine cervical cancer. A 70-year-old woman was referred because of a pancreatic mass detected by CT. She had been diagnosed with uterine cervical adenocarcinoma 20 months previously. After concurrent chemoradiotherapy, CT showed no evidence of the cervical mass, and follow-up showed no evidence of recurrence. Endoscopic ultrasound-guided fine needle aspiration biopsy of the pancreatic mass resulted in a diagnosis of metastatic adenocarcinoma from uterine cervix.

Pretreatment of Populus tomentiglandulosa protects hippocampal CA1 pyramidal neurons from ischemia-reperfusion injury in gerbils via increasing SODs expressions and maintaining BDNF and IGF-I expressions / 中国天然药物

To examine the effects of Populus tomentiglandulosa (PT) extract on the expressions of antioxidant enzymes and neurotrophic factors in the cornu ammonis 1 (CA1) region of the hippocampus at 5 min after inducing transient global cerebral ischemia (TGCI) in gerbils, TGCI was induced by occlusion of common carotid arteries for 5 min. Before ischemic surgery, 200 mg·kg PT extract was orally administrated once daily for 7 d. We performed neuronal nuclear antigen immunohistochemistry and Fluoro-Jade B staining. Furthermore, we determined in situ production of superoxide anion radical, expression levels of SOD1 and SOD2 as antioxidant enzymes and brain-derived neurotrophic factor (BDNF) and insulin-like growth factor I (IGF-I) as neurotrophic factors. Pretreatment with 200 mg·kg PT extract prevented neuronal death (loss). Furthermore, pretreatment with 200 mg·kg PT extract significantly inhibited the production of superoxide anion radical, increased expressions of SODs and maintained expressions of BDNF and IGF-I. Such increased expressions of SODs were maintained in the neurons after IRI. In summary, pretreated PT extract can significantly increase levels of SODs and protect the neurons against TGCI, suggesting that PT can be a useful natural agent to protect against TGCI.

Extract Promotes Neurogenesis in the Hippocampal Dentate Gyrus of the Adult Mouse through Increasing Expressions of Brain-Derived Neurotrophic Factor and Tropomyosin-Related Kinase B / 中华医学杂志(英文版)

<p><b>Background</b>Glehnia littoralis has been used for traditional Asian medicine, which has diverse therapeutic activities. However, studies regarding neurogenic effects of G. littoralis have not yet been considered. Therefore, in this study, we examined effects of G. littoralis extract on cell proliferation, neuroblast differentiation, and the maturation of newborn neurons in the hippocampus of adult mice.</p><p><b>Methods</b>A total of 39 male ICR mice (12 weeks old) were randomly assigned to vehicle-treated and 100 and 200 mg/kg G. littoralis extract-treated groups (n = 13 in each group). Vehicle and G. littoralis extract were orally administrated for 28 days. To examine neurogenic effects of G. littoralis extract, we performed immunohistochemistry for 5-bromo-2-deoxyuridine (BrdU, an indicator for cell proliferation) and doublecortin (DCX, an immature neuronal marker) and double immunofluorescence staining for BrdU and neuronal nuclear antigen (NeuN, a mature neuronal marker). In addition, we examined expressional changes of brain-derived neurotrophic factor (BDNF) and its major receptor tropomyosin-related kinase B (TrkB) using Western blotting analysis.</p><p><b>Results</b>Treatment with 200 mg/kg, not 100 mg/kg, significantly increased number of BrdU-immunoreactive () and DCX cells (48.0 ± 3.1 and 72.0 ± 3.8 cells/section, respectively) in the subgranular zone (SGZ) of the dentate gyrus (DG) and BrdU/NeuN cells (17.0 ± 1.5 cells/section) in the granule cell layer as well as in the SGZ. In addition, protein levels of BDNF and TrkB (about 232% and 244% of the vehicle-treated group, respectively) were significantly increased in the DG of the mice treated with 200 mg/kg of G. littoralis extract.</p><p><b>Conclusion</b>G. littoralis extract promots cell proliferation, neuroblast differentiation, and neuronal maturation in the hippocampal DG, and neurogenic effects might be closely related to increases of BDNF and TrkB proteins by G. littoralis extract treatment.</p>

Age-dependent differences in myelin basic protein expression in the hippocampus of young, adult and aged gerbils / 한국실험동물학회지

Myelin degeneration is one of the characteristics of aging and degenerative diseases. This study investigated age-related alterations in expression of myelin basic protein (MBP) in the hippocampal subregions (dentate gyrus, CA2/3 and CA1 areas) of gerbils of various ages; young (1 month), adult (6 months) and aged (24 months), using western blot and immunohistochemistry. Western blot results showed tendencies of age-related reductions of MBP levels. MBP immunoreactivity was significantly decreased with age in synaptic sites of trisynaptic loops, perforant paths, mossy fibers, and Schaffer collaterals. In particular, MBP immunoreactive fibers in the dentate molecular cell layer (perforant path) was significantly reduced in adult and aged subjects. In addition, MBP immunoreactive mossy fibers in the dentate polymorphic layer and in the CA3 striatum radiatum was significantly decreased in the aged group. Furthermore, we observed similar age-related alterations in the CA1 stratum radiatum (Schaffer collaterals). However, the density of MBP immunoreactive fibers in the dentate granular cell layer and CA stratum pyramidale was decreased with aging. These findings indicate that expression of MBP is age-dependent and tissue specific according to hippocampal layers.

Pre-treated Populus tomentiglandulosa extract inhibits neuronal loss and alleviates gliosis in the gerbil hippocampal CA1 area induced by transient global cerebral ischemia / 대한해부학회지

The genus Populus (poplar) belonging to the Salicaceae family has been used in traditional medicine, and its several species show various pharmacological properties including antioxidant and anti-inflammatory effects. No study regarding protective effects of Populus species against cerebral ischemia has been reported. Therefore, in the present study, we examined neuroprotective effects of ethanol extract from Populus tomentiglandulosa (Korea poplar) in the hippocampal cornu ammonis (CA1) area of gerbils subjected to 5 minutes of transient global cerebral ischemia. Pretreatment with 200 mg/kg of P. tomentiglandulosa extract effectively protected CA1 pyramidal neurons from transient global cerebral ischemia. In addition, glial fibrillary acidic protein immunoreactive astrocytes and ionized calcium binding adapter molecule 1 immunoreactive microglia were significantly diminished in the ischemic CA1 area by pretreatment with 200 mg/kg of P. tomentiglandulosa extract. Briefly, our results indicate that pretreatment with P. tomentiglandulosa extract protects neurons from transient cerebral ischemic injury and diminish cerebral ischemia-induced reactive gliosis in ischemic CA1 area. Based on these results, we suggest that P. tomentiglandulosa can be used as a potential candidate for prevention of ischemic injury.

Radiofrequency Ablation Combined with Chemoembolization for Intermediate-Sized (3-5 cm) Hepatocellular Carcinomas Under Dual Guidance of Biplane Fluoroscopy and Ultrasonography

OBJECTIVE: To assess the technical feasibility and local efficacy of percutaneous radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) for an intermediate-sized (3-5 cm in diameter) hepatocellular carcinoma (HCC) under the dual guidance of biplane fluoroscopy and ultrasonography (US). MATERIALS AND METHODS: Patients with intermediate-sized HCCs were treated with percutaneous RFA combined with TACE. RFA was performed under the dual guidance of biplane fluoroscopy and US within 14 days after TACE. We evaluated the rate of major complications on immediate post-RFA CT images. Primary technique effectiveness rate was determined on one month follow-up CT images. The cumulative rate of local tumor progression was estimated with the use of Kaplan-Meier method. RESULTS: Twenty-one consecutive patients with 21 HCCs (mean size: 3.6 cm; range: 3-4.5 cm) were included. After TACE (mean: 6.7 d; range: 1-14 d), 20 (95.2%) of 21 HCCs were visible on fluoroscopy and were ablated under dual guidance of biplane fluoroscopy and US. The other HCC that was poorly visible by fluoroscopy was ablated under US guidance alone. Major complications were observed in only one patient (pneumothorax). Primary technique effectiveness was achieved for all 21 HCCs in a single RFA session. Cumulative rates of local tumor progression were estimated as 9.5% and 19.0% at one and three years, respectively. CONCLUSION: RFA combined with TACE under dual guidance of biplane fluoroscopy and US is technically feasible and effective for intermediate-sized HCC treatment.

Functional MRI of Language: Difference of its Activated Areas and Lateralization according to the Input Modality

PURPOSE: To compare fMRIs of visual and auditory word generation tasks, and to evaluate the difference of its activated areas and lateralization according to the mode of stimuli. MATERIALS AND METHODS: Eight male normal volunteers were included and all were right handed. Functional maps were obtained during auditory and visual word generation tasks in all. Normalized group analysis were performed in each task and the threshold for significance was set at p<0.05. Activated areas in each task were compared visually and statistically. RESULTS: In both tasks, left dominant activations were demonstrated and were more lateralized in visual task. Both frontal lobes (Broca's area, premotor area, and SMA) and left posterior middle temporal gyrus were activated in both tasks. Extensive bilateral temporal activations were noted in auditory task. Both occipital and parietal activations were demonstrated in visual task. CONCLUSION: Modality independent areas could be interpreted as a core area of language function. Modality specific areas may be associated with processing of stimuli. Visual task induced more lateralized activation and could be a more useful in language study than auditory task.

Do Clinical Manifestations Influence the Efficiency of Computed Tomography and Ultrasonography in Diagnosing Acute Appendicitis?

PURPOSE: Radiological readings of possible or suspicious appendicitis are often unhelpful for clinicians, and normal readings may be misleading if the patient has appendicitis. We conducted a retrospective study to determine whether the efficiency of computed tomography (CT) or ultrasonography (USG) in diagnosing acute appendicitis is altered by clinical manifestations. METHODS: Data were collected from all the pathologicallyproven acute appendicitis patients who underwent CT or USG and subsequently had appendectomy between January 2009 and March 2010 at Kangwon National University Hospital. We classified radiological findings of "compatible with" and "probable" appendicitis as "highly efficient" and "possible" or "suspicious" appendicitis and "normal appendix" as "less efficient." The following clinical manifestations were included: duration of the chief complaint prior to performing CT or USG, right lower quadrant pain, pain migration, body temperature, abdominal tenderness, rebound tenderness, muscle guarding, wall rigidity, white blood cell count, percentage of polymorphonuclear cells, and C-reactive protein level. RESULTS: A total of 202 patients underwent appendectomies after imaging studies (37.2+/-20.3-years-of-age; male-to-female ratio, 1.08). Of these, 154(76.2%) received CT, 44 (21.8%) received USG, and four (2.0%) received magnetic resonance imaging. Radiological findings were highly efficient in 155 cases (76.7%) but less efficient in 47 cases (23.3%). Multiple logistic regression analysis demonstrated that the absence of pain migration was related to less efficient results (adjusted odds ratio, 3.26; 95% confidence interval, 1.16-9.12). CONCLUSION: The 'efficient' sensitivity of CT or USG in diagnosing acute appendicitis is low in the absence of a history of pain migration.

Gadoxetic Acid (Gd-EOB-DTPA)-Enhanced MRI versus Gadobenate Dimeglumine (Gd-BOPTA)-Enhanced MRI for Preoperatively Detecting Hepatocellular Carcinoma: an Initial Experience

OBJECTIVE: This study was designed to compare the diagnostic performance of gadoxetic acid-enhanced magnetic resonance imaging (MRI) with gadobenate dimeglumine-enhanced MRI for preoperatively detecting hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Eighteen consecutive patients (17 men and one woman, age range: 31-73 years) with 22 HCCs underwent examinations with gadoxetic acid enhanced MRI and gadobenate dimeglumine-enhanced MRI on a 3.0-Tesla unit. The diagnosis of HCC was established after surgical resection and pathological conformation. Three observers independently reviewed each MR image in a random order on a tumor-by-tumor basis. The diagnostic accuracy of these techniques for the detection of HCC was assessed by performing an alternative free-response receiver operating characteristic (ROC) analysis. The sensitivity and positive predictive values were evaluated. RESULTS: The average value of the area under the ROC curve (Az) for gadoxetic acid enhanced MRI (0.887) was not significantly different from the Az (0.899) for gadobenate dimeglumine-enhanced MRI (p > 0.05). The overall sensitivities of gadoxetic acid enhanced MRI and gadobenate dimeglumine-enhanced MRI were 80% and 83%, respectively, with no significant difference (p > 0.05). The differences of the positive predictive values for the two contrast agents for each observer were not statistically significant (p > 0.05). CONCLUSION: The diagnostic performance of gadoxetic acid-enhanced MRI and gadobenate dimeglumine-enhanced MRI for preoperatively detecting HCC is quite similar.

Percutaneous Excision of a Benign Breast Mass Using Ultrasound-guided, Vacuum-assisted Core Biopsy: A Review of 197 Cases with Long Term Follow-up

PURPOSE: To assess long term results of excising benign masses using ultrasound (US)-guided, vacuum-assisted core biopsy (Mammotome). MATERIALS AND METHODS: We enrolled 163 patients (197 masses) receiving USguided excision using vacuum-assisted core biopsy and follow-up sonography in this retrospective study. The masses were category 3 as determined by ultrasound imaging according to the Breast Imaging Reporting and Data System (BI-RADS) (n=145) or pathologically confirmed as benign masses by a previous core-needle biopsy although category 4a and 4b (n = 52). Pathology, the presence of hematoma and residual tissue, as well as scar formation were assessed. RESULTS: We diagnosed 190 (96.5%) benign masses, 4 (2.0%) malignant masses, and 3 (1.5%) high-risk lesions. Most (176 masses, 91.2%) were excised completely as demonstrated by the follow-up ultrasound examination. Scar changes were minimal (68.7%) or moderate (31.3%), with regression in 53%. CONCLUSION: US-guided excision using vacuum-assisted core biopsy is effective for the removal of benign breast masses. The majority of scars are minimal, with good cosmetic effect. However, subsequent excision should be done for malignant masses or phyllodes tumor because radiologic absence does not guarantee complete removal.

Changes in Sonographic Findings after Treatment of Patients with Clonorchiasis in a Heavy Endemic Area

We measured changes in sonographic findings of patients with clonorchiasis after a treatment in a highly endemic area. A total of 347 residents showed positive stool results for Clonorchis sinensis eggs in a village in northeastern China, and were treated with praziquantel. Of them, 132 patients underwent abdominal sonography both before and 1 year after treatment, and the changes in sonographic findings of 83 cured subjects were compared. Diffuse dilatation of intrahepatic bile ducts (DDIHD) was found in 82 patients (98.2%) before and 80 (96.4%) after treatment, which was improved in 3, aggravated in 1, and unchanged in 79 patients. Increased periductal echogenicity (IPDE) was observed in 42 patients (50.6%) before and 45 (54.2%) after treatment, which was improved in 5, aggravated in 8, and unchanged in 70 patients. Floating echogenic foci in the gallbladder (FEFGB) was detected in 32 patients (38.6%) before and 17 (20.5%) after treatment, which was improved in 20, aggravated in 5, and unchanged in 58 patients. Improvement of FEFGB only was statistically significantly (P = 0.004). The present results confirm that DDIHD and IPDE persist but FEFGB decreases significantly at 1 year after treatment. In a heavy endemic area, the sonographic finding of FEFGB may suggest active clonorchiasis 1 year after treatment.

Diagnostic Value of Dynamic Perfusion MR Imaging in Benign and Malignant Musculoskeletal Lesions

PURPOSE: To assess the diagnostic value of dynamic perfusion MR imaging for differentiation between benign and malignant musculoskeletal lesions. MATERIALS AND METHODS: Dynamic perfusion MR imaging was performed using a 3.0 T system in 32 female and 30 male patients (aged 10-90 years, mean age, 43 years). Following the assessment of the precontrast imaging, a dynamic study was performed. This dynamic technique allowed for 638 images to be obtained at 11 levels throughout the lesion. Twenty-eight lesions originated within bone (8 benign, 20 malignant), whereas 34 lesions were of soft tissue origin (22 benign, 12 malignant). The final diagnosis was histopathologically confirmed in all patients. To differentiate between benign and malignant lesions, we analyzed the four parameters: (maximal relative enhancement (MRE), time to peak (TTP), wash in rate (WI), steepest slope (SS) and the distribution of time intensity curve (TIC) patterns. RESULTS: The TTP, WI, and SS values of malignant lesions were statistically significant from those of benign lesions (p < 0.05). However, the difference for the MRE values was not statistically significant. The distribution of TIC patterns was a helpful indicator of benign or malignant state, however the difference between the two states was not significant. CONCLUSION: Dynamic perfusion MR imaging is a helpful tool in differentiating benign and malignant musculoskeletal lesions.

Comparison of Ferucarbotran-Enhanced MRI and Triple-Phase MDCT for the Detection of Hepatocellular Carcinoma in Advanced Liver Cirrhosis

PURPOSE: To compare the diagnostic performance of ferucarbotran-enhanced MRI at 1.5-T with triple-phase multidetector-row helical CT (MDCT) to detect hepatocellular carcinoma in patients with advanced liver cirrhosis. MATERIALS AND METHODS: Twenty patients with advanced liver cirrhosis (Child's class B:C = 8:12) underwent ferucarbotran-enhanced MRI and triple-phase MDCT prior to liver transplantation. The mean time interval between the two imaging techniques was 18 days (range, 1-35 days). Three radiologists independently reviewed both images on a lesion-by-lesion basis and interpreted them for comparison with the pathologic findings of the explanted livers. As well, the sensitivity and an alternative-free response receiver operating characteristics (ROC) analysis was used to evaluate the diagnostic performance of each technique. RESULTS: The mean area under the ROC curve (Az) was significantly higher for the triple-phase MDCT (0.766) compared to the ferucarbotran-enhanced MRI (0.675) (p < 0.001). Similarly, the mean sensitivity of the triple-phase MDCT (60.3%) exceeded the ferucarbotran-enhanced MRI (43.1%). The results indicate that the triple-phase MDCT provides significantly greater mean sensitivity than the ferucarbotran-enhanced MRI (p < 0.001). CONCLUSION: The triple-phase MDCT provided a better diagnostic performance and higher sensitivity than the ferucarbotran-enhanced MRI for the detection of hepatocellular carcinomas in patients with advanced liver cirrhosis.

MR Imaging of the Internal Auditory Canal and Inner Ear at 3T: Comparison between 3D Driven Equilibrium and 3D Balanced Fast Field Echo Sequences

OBJECTIVE: To compare the use of 3D driven equilibrium (DRIVE) imaging with 3D balanced fast field echo (bFFE) imaging in the assessment of the anatomic structures of the internal auditory canal (IAC) and inner ear at 3 Tesla (T). MATERIALS AND METHODS: Thirty ears of 15 subjects (7 men and 8 women; age range, 22-71 years; average age, 50 years) without evidence of ear problems were examined on a whole-body 3T MR scanner with both 3D DRIVE and 3D bFFE sequences by using an 8-channel sensitivity encoding (SENSE) head coil. Two neuroradiologists reviewed both MR images with particular attention to the visibility of the anatomic structures, including four branches of the cranial nerves within the IAC, anatomic structures of the cochlea, vestibule, and three semicircular canals. RESULTS: Although both techniques provided images of relatively good quality, the 3D DRIVE sequence was somewhat superior to the 3D bFFE sequence. The discrepancies were more prominent for the basal turn of the cochlea, vestibule, and all semicircular canals, and were thought to be attributed to the presence of greater magnetic susceptibility artifacts inherent to gradient-echo techniques such as bFFE. CONCLUSION: Because of higher image quality and less susceptibility artifacts, we highly recommend the employment of 3D DRIVE imaging as the MR imaging choice for the IAC and inner ear.

Differentiation between Small Bowel Intussusception in Children and Adults and the Radiological Findings which Require an Operation

PURPOSE: To assess the differences in small bowel intussusceptions between children and adults, and to interpret the radiological findings requiring a surgical procedure. MATERIALS AND METHODS: A total of 62 study subjects (35 children, 27 adults) with small bowel intussusception diagnosed by US or CT and seen between January 2005 and December 2007 were included in this study. Two radiologists retrospectively reviewed both the medical records and radiological findings of each study subject. We contrasted the range of features found to be typical of small bowel intussusception for both children and adults based on cause, abdominal symptoms, diagnostic tools, and treatments. Also, we evaluated the radiological findings requiring a surgical procedure. RESULTS: The causes of small bowel intussusception were not identified in children; however, 4 adults were found to have tumors (a lipoma, a hemangioma, 2 metastases) (p=0.031). All of the children (100%) and 8 adults (29.6%) had abdominal symptoms (p < 0.001). The primary diagnostic tool in children was the US (31 cases, 88.6%), as opposed to the CT in adults (27 cases, 100%) (p < 0.001). A spontaneous reduction was confirmed in all children (100%) and supposed in 23 adults (85.2%) (p=0.031). The noteworthy radiological findings of 4 study subjects having undergone a surgical procedure are masses at the lead point and small bowel obstruction (p < 0.0001). CONCLUSION: Cases of small bowel intussusception in children are different from cases observed in adults, based on cause, symptoms, and diagnostic tools. However, most cases are spontaneously reduced. Important radiological findings requiring a surgical procedure were found to be caused by masses at the lead point and at the small bowel obstruction.

Complications Following Radiofrequency Ablation of the Porcine Liver through Portal Vein Penetration: Radiological Findings

PURPOSE: To evaluate complications after radiofrequency ablation (RFA) of the porcine liver through portal vein penetration. MATERIALS AND METHODS: Twelve pigs were divided into two groups. In group I (n=11) animals, the portal veins were directly penetrated with an electrode, and in the group II (n=16) animals, the portal veins were located within the expected ablation area. For the group I pigs, RFA were performed for seven minutes after complete portal vein passing of the exposed tip. Gray-scale and Doppler ultrasonography, and CT were performed before and after RFA on the procedure day, and on day two. If any complications were found, the same studies were performed at day seven. We analyzed the presence and extent of thrombotic occlusion, the vascular stricture, the arterioportal shunt, and the presence of an intra-abdominal hemorrhage. We applied Fisher's exact test to compare the complication rate between the two groups;, a value was considered statistically significant if the p-value was less than 0.05. RESULTS: In the group I animals (n=11), three had complete thrombotic occlusion of the portal vein. Among these three animals,, one had a segmental infarction, and one animal showed a partial occlusion. In the group II animals (n=16), complications were not identified. Statistical analysis revealed the complication rate of group I was significantly higher than that of group II (p=.019). CONCLUSION: The portal vein occlusion rate was significantly higher in the portal vein penetrating group than in the non-penetrating group.

Usefulness of Fluoroscopy-Guided Intra-articular Injection of the Knee

PURPOSE: To determine the accuracy of the intra-articular location of hyaluroinc acid injection using a blind approach and to establish the usefulness of fluoroscopy-guided intra-articular injection. MATERIALS AND METHODS: A fluoroscopy unit was used for 368 intra-articular injections of hyaluronic acid to 93 knees in 65 patients. Initially, blind needle positioning was conducted on the fluoroscopy table. The failure rate of the blind approach among the 368 injections was evaluated, and a relationship between the Kellgren-Lawrence grade (K-L grade) and the incidence of repeated failures using the blind approach was determined for injections to 52 knees in 37 patients who received a complete cycle of injections (five consecutive injections with a one-week interval between injections). RESULTS: Using a blind approach, 298 of 368 trials (81.2%) resulted in a needle tip being placed in an intra-articular location, while 70 of 368 trials resulted in an extra-articular placement of the needle tip. Among 52 knees to which a complete cycle of injections (five consecutive injections with a one-week interval between injections) was administered, repeated failure of intra-articular placement using the blind approach was seen for 18 knees (34.6%); a more severe K-L grade assigned was associated with a higher rate of repeated failure. However, the trend was not statistically significant based on the Chi-squared test (p value = 0.14). CONCLUSION: Fluoroscopy-guided needle placement may be helpful to ensure therapeutic intra-articular injection of the knee.

Usefulness of Screening Ultrasound for Thyroid Gland

PURPOSE: The purpose of this study was to investigate the usefulness of the ultrasonography as a screening test for thyroid diseases. MATERIALS AND METHODS: For 7 months, thyroid ultrasonography (7.5 MHz linear array) was performed prospectively by radiologists on 1,316 subjects who do not have a history of the thyroid disease. We analyzed the morphological abnormalities of thyroid gland and these were classified as the nodulal, cystic and diffuse types in accordance with the gender and ages of the patients. We performed ultrasound-guided fine needle aspiration in 21 patients who had sonographic features that were suggestive of malignant thyroid nodules. Physical examination was performed for all subjects by clinicians before the thyroid ultrasonography, and we compared the detectability of thyroid lesions between ultrasonography and physical examination. RESULTS: Thyroidal abnormalities were detected in 94 (7.1%) of 1,316 subjects. Among the 94 patients, 72 (5.5%) showed as nodules, 18 (1.4%) showed as cysts and 4 (0.3%) showed as diffuse abnormalities. The result of the ultrasound-guided aspiration on 21 patient showed 4 malignant nodules, 16 benign nodules and 1 undetermined nodule. Physical examination detected abnormalities in only 12 patients (12.8%) of the 94 patients, which were showed as nodules, cysts and the diffuse type by ultrasonography. CONCLUSION: Thyroid disease of the general population was relatively common and the detection rate with performing physical examination for the thyroid nodule, cyst and the diffuse type was lower than that for ultrasonography. Thyroid ultrasonography is a useful screening modality for detecting thyroid diseases.

Depiction of Viable Tumor in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization: Multiphasic Helical CT with Review of the Previous Serial CT Images

OBJECTIVE: The purpose of our study was to assess whether a review of multiphasic helical CT combined with the previous serial CT images could be helpful to depict a viable tumor in hepatocellular carcinoma treated with transarterial chemoembolization. MATERIALS AND METHODS: Twenty-four consecutive patients with 35 hepatocellular carcinomas underwent transarterial chemoembolization followed by hepatic resection. First, three radiologists independently analyzed the last CT images taken before resection for the presence of viable tumor. A second analysis was then performed using the last CT combined with the previous serial CT images. The CT analyses were then compared with the pathologic results. The added value of the review of the previous serial CT images was evaluated by performing a receiver operating characteristic analysis. The sensitivity, specificity and diagnostic accuracy for the depiction of viable tumor were also assessed, and the characteristics of the false-negative lesions were pathologically evaluated. RESULTS: The mean diagnostic accuracies (Az values) for the depiction of viable tumor with using the last CT alone and with the review of the previous serial CT images for all observers were 0.885 and 0.901, respectively, which were not significantly difference (p> 0.05). However, the additional review of the previous serial CT images allowed the observers to render a correct diagnosis for three lesions that had been incorrectly diagnosed with the review of last CT alone. The sensitivity, specificity and diagnostic accuracy of the last CT along with the review of the previous serial CT images were 78%, 97% and 84%, respectively. All of the 16 false-negative lesions diagnosed by each observer showed 90% or greater necrosis on the pathologic examination. CONCLUSION: For the depiction of viable tumor in hepatocellular carcinoma treated with transarterial chemoembolization, although the difference in the diagnostic accuracies was not statistically significant, a review of the multiphasic helical CT combined with the previous serial CT images could help reach a correct diagnosis for those lesions incorrectly diagnosed with the review of the last CT alone.

Screen-Film Mammography and Soft-Copy Full-Field Digital Mammography: Comparison in the Patients with Microcalcifications

OBJECTIVE: We wanted to compare the ability of screen-film mammography (SFM) and soft-copy full-field digital mammography (s-FFDM) on two different monitors to detect and characterize microcalcifications. MATERIALS AND METHODS: The images of 40 patients with microcalcifications (three patients had malignant lesion and 37 patients had benign lesion), who underwent both SFM and FFDM at an interval of less than six months, were independently evaluated by three readers. Three reading sessions were undertaken for SFM and for FFDM on a mammography-dedicated review workstation (RWS, 2K x 2.5K), and for FFDM on a high-resolution PACS monitor (1.7K x 2.3K). The image quality, breast composition and the number and conspicuity of the microcalcifications were evaluated using a three-point rating method, and the mammographic assessment was classified into 4 categories (normal, benign, low concern and moderate to great concern). RESULTS: The image quality, the number and conspicuity of the microcalcifications by s-FFDM (on the RWS, PACS and both) were superior to those by SFM in 85.0%, 80.0% and 52.5% of the cases, respectively (p 0.01). The mammographic assessment category for the microcalcifications in the three reading sessions was similar. CONCLUSION: s-FFDM gives a superior image quality to SFM and it is better at evaluating microcalcifications. In addition, s-FFDM with the PACS monitor is comparable to s-FFDM with the RWS for evaluating microcalcifications.