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OBJECTIVE: White matter hyperintensities (WMH) are common among the elderly. Although WMH play a key role in lowering the threshold for the clinical expression of dementia in Alzheimer's disease (AD)-related pathology, the clinical significance of their location is not fully understood. This study aimed to investigate the association between WMH and cognitive function according to the location of WMH in AD. METHODS: Subjects underwent clinical evaluations including volumetric brain magnetic resonance imaging study and neuropsychological tests using the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet. WMH were calculated using automated quantification method. According to the distance from the lateral ventricular surface, WMH within 3 mm, WMH within 3-13 mm, and WMH over 13 mm were classified as juxtaventricular WMH (JVWMH), periventricular WMH (PVWMH), and deep WMH (DWMH), respectively. RESULTS: Total WMH volume was associated with poor performance in categorical verbal fluency test (ß=-0.197, p=0.035). JVWMH volume was associated with poor performances on categorical verbal fluency test (ß=-0.201, p=0.032) and forward digit span test (ß= -0.250, p=0.012). PVWMH volume was associated with poor performances on categorical verbal fluency test (ß=-0.185, p=0.042) and word list memory test (ß=-0.165, p=0.042), whereas DWMH volume showed no association with cognitive tests. PVWMH volume were also related to Clinical Dementia Rating Scale Sum of Boxes score (ß=0.180, p=0.026). CONCLUSION: WMH appear to exhibit different associations with the severity of dementia and cognitive impairment according to the distance from ventricle surface in AD.
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Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary small artery vasculopathy caused by mutations in the NOTCH3 gene on chromosome 19. Jeju Island has the highest reported prevalence of CADASIL patients in the world. Even though most studies on the neuroimaging characteristics of CADASIL have focused on Western populations, there are notable differences in Korean CADASIL patients compared to those in Western countries, which may impact their clinical manifestations and prognosis. Herein, this pictorial essay presents the neuroimaging patterns of CADASIL in patients in Korea, with an emphasis on the differences observed from previous reports based on a Western patient population.
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Incidental thyroid nodules are commonly detected on ultrasonography (US). This has contributed to the rapidly rising incidence of low-risk papillary thyroid carcinoma over the last 20 years. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors in small (1-2 cm) thyroid nodules. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.
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Radiología , Neoplasias de la Tiroides , Nódulo Tiroideo , Consenso , Humanos , Estudios Retrospectivos , Neoplasias de la Tiroides/diagnóstico por imagen , Nódulo Tiroideo/diagnóstico por imagen , UltrasonografíaRESUMEN
BACKGROUND: Frailty, one of serious global health problems in the elderly, is a growing concern in patients with Alzheimer's disease (AD) because of its high prevalence in AD and its impact on the prognosis. OBJECTIVE: To investigate the quantitative association between white matter hyperintensities (WMH) and frailty in AD. METHODS: A total of 144 outpatients were included. All subjects were evaluated by using Korean version of the CERAD assessment battery and diagnosed very mild to moderate AD. WMH volume was calculated using automated segmentation analysis from the 3D MRI image and further partitioned according to the distance from the ventricular surface. Using the Korean Frailty Index, prefrailty was defined by the scores of 3 and 4 and frailty by the score of 5 and higher. RESULTS: In total, 23.6%were frailty, 32.6%were pre-frailty, and 43.8%were classified as a robust group. The frailty group had higher WMH volume compared to the robust group (pâ=â0.02), and these trends remained significant after linear regression analyses. According to the subclassification of WMH, using the robust group as a reference, total WMH (ORâ=â6.297, pâ=â0.013, 95%CIâ=â1.463-27.114), juxtaventricular WMH (ORâ=â12.955, pâ=â0.014, 95%CIâ=â1.687-99.509), and periventricular WMH (ORâ=â3.382, pâ=â0.025, 95%CIâ=â1.163-9.8531) volumes were associated with frailty, but deep WMH volume was not. CONCLUSIONS: A quarter of patients with very mild to moderate AD is suffering from frailty. Our study provides the evidence of a cross-sectional relationship between WMH volume and frailty, and there is a difference in the association between the subclassification of WMH volume and frailty.
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Enfermedad de Alzheimer/diagnóstico por imagen , Fragilidad/epidemiología , Sustancia Blanca/patología , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador/estadística & datos numéricos , Imagenología Tridimensional , Entrevistas como Asunto , Imagen por Resonancia Magnética , Masculino , Pruebas Neuropsicológicas/estadística & datos numéricos , República de Corea/epidemiologíaRESUMEN
BACKGROUND AND PURPOSE: To identify clinical, laboratory, and magnetic resonance imaging (MRI) features in predicting incident stroke and dementia in Korean patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). MATERIALS AND METHODS: We enrolled 87 Korean CADASIL patients who had undergone baseline clinical, laboratory, and MRI examinations between March 2012 and February 2015. The primary outcome of this study is the occurrence of stroke and dementia during the study period. The occurrence of incident stroke was confirmed by neuroimaging study, and dementia was defined by the diagnostic and statistical manual of mental disorders, fourth edition, criteria. RESULTS: Of the 87 patients, 57.5% were men, and the mean age was 63 ± 13 years (range 34-90 years), and 82 patients (94.3%) had p.Arg544Cys mutation. During an average follow-up of 67 months (interquartile range: 53-69 months), incident stroke occurred in 14 of 87 patients (16.1%) and incident dementia in 7 of 70 non-demented patients (10.0%). In adjusted analysis, increased systolic blood pressure was associated with increased risk of incident stroke [for every 10-mmHg increase; hazard ratio, 1.44 (1.02-2.03)]. Apolipoprotein E ε4 genotype was associated with an increased risk of incident dementia [hazard ratio, 10.70 (1.27-89.88)]. CONCLUSION: In this study, apolipoprotein E ε4 genotype was associated with the development of incident dementia, and higher blood pressure was associated with increased risk of incident stroke in CADASIL patients with predominant p.Arg544Cys mutation.
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BACKGROUND: Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common genetic cause of stroke. In addition to ischemic stroke, CADASIL predisposes to development of cerebral microbleeds (CMB). CMB and hypertension are known to be associated with intracerebral hemorrhage (ICH). The purpose of this study was to analyze the relationships among CMB, hypertension, and ICH in CADASIL. MATERIALS AND METHODS: We enrolled 94 genetically confirmed CADASIL patients from 76 unrelated families at Jeju National University Hospital (Korea) between March 2012 and February 2015. We analyzed CMB presence, number, and distribution on susceptibility-weighted imaging MRI using the microbleed anatomical rating scale. Multiple logistic regression was used to determine factors associated with the presence of CMB and ICH. RESULTS: CMB were observed in 62 patients (66%), median number of CMB per patient was 4 (range 0-121). Twenty-two ICHs were found in 16 patients (17%). There was incongruence between the most common site of CMB (thalamus) and that of ICH (basal ganglia). Hypertension was independently associated with the presence of CMB (multiple regression OR, 2.71; 95% CI 1.02-7.18, p < 0.05), and CMB ≥ 9 (highest third) was significantly associated with the presence of ICH (multiple regression OR = 9.50, 95% CI 1.08-83.71, p < 0.05). CONCLUSION: In this CADASIL sample, presence of hypertension was independently associated with CMB presence, and CMB burden was independently associated with ICH. Incongruence of sites for CMB and ICH is currently unexplained and requires further study.
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PURPOSE: This study was conducted to assess the effect of using a double screw on the prevention of abutment screw loosening. MATERIALS AND METHODS: Internal connected abutment with a single screw (IS), internal connected abutment with a double screw (ID), external connected abutment with a single screw (ES), and external connected abutment with a double screw (ED) groups were prepared (n = 10 in each group). After 50,000 loading cycles, postload removal torque loss (RTL) percentage was measured. RESULTS: Postload RTL of ID and ED were smaller than those of IS and ES (P = .000 and P = .039, respectively). CONCLUSION: This study showed that a double screw was more effective in prevention of screw loosening.
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Diseño de Implante Dental-Pilar/instrumentación , Implantes Dentales de Diente Único , Retención de Prótesis Dentales/instrumentación , Fracaso de la Restauración Dental , Fuerza de la Mordida , Humanos , Reproducibilidad de los Resultados , Estrés Mecánico , TorqueRESUMEN
BACKGROUND AND PURPOSE: Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most-common single gene disorder of cerebral small vessel disease. There is no definite evidence of genotype-phenotype correlation in CADASIL. However, recent studies have shown the unique phenotypic feature of NOTCH3 R544C mutation. METHODS: We investigated the phenotypic spectrum of NOTCH3 R544C mutation in 73 CADASIL patients in Jeju between April 2012 and January 2014. RESULTS: Of the 73 subjects from 60 unrelated families included in this study, 40 (55%) were men. The mean age of the subjects was 62.2±12.2 (range 34-86 years). Cerebral infarction was the most frequent manifestation (37%), followed by cognitive impairment (32%), headache (17%), psychiatric symptom (16%), intracerebral hemorrhage (12%), transient ischemic attack (7%), and seizure (1%). The mean age of the subjects with ischemic or hemorrhagic episodes was 64.9±10.9 (range 41-86 years). A diagnosis of dementia was made in 12 subjects (16%). The mean age of the subjects with dementia was 75.6±6.5 (range 62-86 years). About 3% of subjects were unable to walk without assistance at assessment. Only one subject had developed chronic headache before the 40s. CONCLUSIONS: Our data support the hypothesis that CADASIL patients with R544C mutation in Jeju have relatively late onset disease.
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OBJECTIVE: Organized hematoma of the maxillary sinus is rare. It occurs by organization of the hematoma in an unaerated maxillary sinus. The purpose of this study was to evaluate the CT features of this lesion. CONCLUSIONS: Organized hematoma should be included in the differential diagnosis when patients have recurrent epistaxis and an expansile mass in the maxillary sinus.
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Hematoma/diagnóstico por imagen , Seno Maxilar , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
We evaluated the ultrasonographic findings and performed ultrasonography-guided fine-needle aspiration biopsy of a newly detected nodule in the thyroid bed of 38 patients with postoperative thyroid carcinoma. Detection of a marginal irregularity, microcalcification, or a shape not parallel to the surrounding tissue plane might allow the identification of recurrent thyroid carcinoma from other benign pathologies mimicking local tumor recurrence.
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Carcinoma Papilar/diagnóstico por imagen , Recurrencia Local de Neoplasia/diagnóstico por imagen , Glándula Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/diagnóstico por imagen , Adolescente , Adulto , Anciano , Biopsia con Aguja Fina , Carcinoma Papilar/patología , Ablación por Catéter , Humanos , Hiperplasia/diagnóstico por imagen , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Sensibilidad y Especificidad , Glándula Tiroides/patología , Neoplasias de la Tiroides/patología , UltrasonografíaRESUMEN
Previous reports of increased rates of cardiovascular risk factors in major depressive disorder (MDD) with anger attacks led the authors to hypothesize that MDD with anger attacks may be associated with brain vascular changes (magnetic resonance imaging white matter hyperintensities [WMHs]). Sixty-five subjects meeting DSM-III-R criteria for major depressive disorder were administered brain magnetic resonance imaging scans at 1.5T to detect T2 WMH. The severity of brain WMH was classified with the Fazekas scale. We used standardized scales to assess melancholic MDD, atypical MDD, and MDD with anger attacks. In logistic regression analyses, MDD with anger attacks was associated with higher severity of subcortical WMH and of total WMH, but not with periventricular WMH. Atypical and melancholic MDD subtypes were not significantly associated with brain WMH. In conclusion, subcortical brain vascular lesions may be more prevalent or severe in MDD with anger attacks.
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Ira/fisiología , Encéfalo/patología , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/patología , Imagen por Resonancia Magnética , Adulto , Encéfalo/irrigación sanguínea , Ventrículos Cerebrales/patología , Trastornos Cerebrovasculares/diagnóstico , Trastornos Cerebrovasculares/epidemiología , Trastornos Cerebrovasculares/patología , Comorbilidad , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/epidemiología , Trastorno Depresivo/patología , Trastorno Depresivo Mayor/epidemiología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Modelos Logísticos , Masculino , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: The purposes of this study were to review the anatomy of the oculosympathetic pathway, to describe the clinical characteristics of the three types of Horner syndrome, and to illustrate underlying pathologic features with an emphasis on neuroimaging strategies based on three symptom complexes. CONCLUSION: Horner syndrome results from interruption of the oculosympathetic pathway and is usually associated with unique clinical features classified into central, preganglionic, and postganglionic types according to the anatomic location of the underlying pathologic process.
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Encéfalo/diagnóstico por imagen , Síndrome de Horner/clasificación , Síndrome de Horner/diagnóstico , Aumento de la Imagen/métodos , Imagen por Resonancia Magnética/métodos , Médula Espinal/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en MedicinaRESUMEN
We report three cases of branchial cleft anomalies demonstrated by multidetector computed tomography (MDCT) fistulography. Multiplanar reformatted images using MDCT were excellent in delineating the whole fistulous tract and its surrounding structures. MDCT fistulography was very helpful in the diagnosis and surgical planning for sinus and fistula of branchial cleft anomalies.
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Región Branquial/anomalías , Fístula Cutánea/diagnóstico por imagen , Fístula/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Región Branquial/diagnóstico por imagen , Niño , Femenino , Humanos , Aumento de la Imagen , Lactante , MasculinoRESUMEN
We describe MR imaging features of discal cyst of the lumbar spine in nine patients who presented with low back pain and leg pain. Discal cyst of the lumbar spine has characteristic MR imaging features different from other epidural cysts: a ventrolateral extradural cyst attached to a herniated lumbar disc, consisting of a thick fibrous capsule without disc material, and having occasional extension into the lateral recess with rim enhancement on contrast-enhanced MR imaging.
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Quistes/patología , Disco Intervertebral/patología , Vértebras Lumbares/patología , Imagen por Resonancia Magnética , Enfermedades de la Columna Vertebral/patología , Adolescente , Adulto , Anciano , Quistes/complicaciones , Espacio Epidural/patología , Femenino , Humanos , Disco Intervertebral/lesiones , Dolor de la Región Lumbar/etiología , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: An increased incidence of brain white-matter hyperintensities has been described in major depressive disorder, butthe impact of such hyperintensities on treatment outcome is still controversial. AIMS: To investigate the relationship of brain white-matter hyperintensities with cardiovascular risk factors and with treatment outcome in younger people with major depressive disorder. METHOD: We assessed brain white-matter hyperintensities and cardiovascular risk factors in 84 people with major depressive disorder prior to initiating antidepressant treatment. We also assessed hyperintensities in 35 matched controls. RESULTS: We found no significant difference in the prevalence of white-matter hyperintensities between the depression and the control groups. Left-hemisphere subcortical hyperintensities correlated with lower rates of treatment response. We found no correlation between global hyperintensity measures and clinical outcome. Brain white-matter hyperintensities correlated with hypertension and age and withtotal cardiovascular risk score. CONCLUSIONS: Subcortical white-matter hyperintensities in the left hemisphere (but notin other brain areas) maybe associated with poor response to antidepressant treatment in major depression.
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Encéfalo/patología , Trastorno Depresivo Mayor/patología , Adolescente , Adulto , Factores de Edad , Anciano , Antidepresivos/uso terapéutico , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/patología , Trastorno Depresivo Mayor/complicaciones , Trastorno Depresivo Mayor/tratamiento farmacológico , Femenino , Humanos , Hipertensión/etiología , Hipertensión/patología , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
The following study evaluated blood loss in patients undergoing navigation-assisted minimally invasive total knee arthroplasty. The study included 100 patients divided into two groups. Group A consisted of patients with an immediate drain release, and group B consisted of patients with a 1-hour delayed drain release after surgery. The surgeon used a mini-midvastus approach with the OrthoPilot navigation system. The mean blood drainage was 465 mL in group A and 409 mL in group B. The mean hemoglobin loss was 2.59 g/dL in group A and 2.43 g/dL in group B.
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Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroscopía/efectos adversos , Hemorragia Posoperatoria , Cirugía Asistida por Computador , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/métodos , Artroscopía/métodos , Transfusión Sanguínea , Drenaje/métodos , Femenino , Hemoglobinas/análisis , Humanos , Masculino , Persona de Mediana Edad , Hemorragia Posoperatoria/terapia , Factores de TiempoRESUMEN
The objective of the present work was to study the interrelationship between white matter hyperintensities (WMHs), cardiovascular risk factors and elements of the one-carbon cycle including serum folate, vitamin B12, and homocysteine levels in a relatively young sample of outpatients with major depressive disorder (MDD), and to compare the severity of white matter hyperintensities in MDD patients and healthy volunteers. Fifty MDD outpatients (34% women, age 40.6+/-10.3 years), free of psychotropic medications for at least 2 weeks before enrollment, underwent magnetic resonance imaging (MRI) scans of the brain to detect T2 WMHs and also had (1) serum folate, vitamin B12, homocysteine and cholesterol levels measured, and (2) cardiovascular risk factors assessed during the same study visit. Thirty-five healthy comparison subjects (40% women, age 39.2+/-9.8 years) also underwent brain MRI scans. Hypofolatemia, hypertension and age independently predicted a greater severity of total brain WMHs. Separately, the same factors also predicted a greater severity of subcortical WMHs. Hypofolatemic and hypertensive patients had more severe WMHs than normal controls. In light of the adverse impact of WMHs on a number of health-related outcomes later in life, hypofolatemia and hypertension may represent modifiable risk factors to prevent the occurrence of such adverse outcomes.
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Encéfalo/metabolismo , Encéfalo/patología , Trastorno Depresivo Mayor/metabolismo , Trastorno Depresivo Mayor/patología , Ácido Fólico/metabolismo , Homocisteína/metabolismo , Imagen por Resonancia Magnética , Vitamina B 12/metabolismo , Adolescente , Adulto , Anciano , Trastorno Depresivo Mayor/diagnóstico , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Ácido Fólico/sangre , Homocisteína/sangre , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Vitamina B 12/sangreRESUMEN
The objective of this study was to investigate the relative impact of brain white matter hyperintensities (WMHs), cardiovascular risk factors and elements of the one-carbon cycle metabolism (including serum folate, vitamin B12 and homocysteine levels) on the outcome of antidepressant treatment in non-elderly subjects with major depressive disorder (MDD). Fifty MDD subjects were administered brain magnetic resonance imaging (MRI) scans at 1.5 T to detect T2 WMHs. The severity of brain WMHs was classified with the Fazekas scale (range=0-3). We assessed cardiovascular risk factors in all MDD subjects (age, gender, smoking, diabetes, family history, hypertension, cholesterol). MDD patients also had serum folate, vitamin B12 and homocysteine levels measured. All MDD subjects received treatment with fluoxetine 20 mg/day for 8 weeks. In a logistic regression, the severity of subcortical WMHs and the presence of hypofolatemia were independent predictors of lack of clinical response to antidepressant treatment. Separately, hypofolatemia also predicted lack of remission to antidepressant treatment. These associations were independent of the presence of smoking, diabetes, family history, hypercholesterolemia, hyperhomocysteinemia and low B12 levels. Although preliminary, the results of the present work suggest that subcortical brain WMHs and hypofolatemia may have an independent negative impact on the likelihood of responding to antidepressant treatment in non-geriatric subjects with MDD.
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Encéfalo/metabolismo , Encéfalo/patología , Trastorno Depresivo Mayor/metabolismo , Trastorno Depresivo Mayor/patología , Ácido Fólico/metabolismo , Homocisteína/metabolismo , Vitamina B 12/metabolismo , Adolescente , Adulto , Anciano , Atención Ambulatoria , Demografía , Trastorno Depresivo Mayor/terapia , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: Solitary fibrous tumor (SFT) is a very rare tumor. The purpose of this study is to determine the MR imaging features of SFT in the intracranial and extracranial head and neck regions. MATERIALS AND METHODS: We retrospectively reviewed six MR images and two CT images of six histologically proven cases of SFT that occurred in four men and two women, and their ages ranged from 46 to 59 years. These imaging findings were correlated with the microscopic findings of their surgical specimens. RESULTS: Six SFTs arose in the meninges (the petrous ridge and the pituitary fossa), the parotid gland, the parapharyngeal space, the buccal space and the maxillary sinus. On the MR images, SFTs in the intracranial and extracranial head and neck regions were mostly isointense to the muscle on the T1-weighted images, they were hyperintense on the T2-weighted images and they all had intense enhancement. On the T1- and T2-weighted images, hypointense lines were observed within in five SFTs. On the CT images, the SFTs were hypodense to the muscle on the unenhanced images and they were heterogeneously enhanced on the contrast-enhanced images. An exceptional case of pituitary SFT was hypointense on the T2-weighted images and it was hyperdense on the unenhanced CT images, which correlated with the increased collagenous component and the cellular compactness. CONCLUSION: The imaging features of SFT are nonspecific; however, SFT should be included in the differential diagnosis of masses involving the intracranial and extracranial head and neck regions.