원발병소 불명 경부 림프절 전이암 환자에서 원발병소 확인: 3차원 THRIVE 자기공명영상, 2차원 스핀에코 자기공명영상, 컴퓨터 단층촬영의 임상적 유용성 비교

Objective: We evaluated and compared the utility of postcontrast three-dimensional (3D) T1-weighted high resolution isotropic volume examination (THRIVE), spin-echo (SE) T1-weighted MR, and contrast-enhanced CT imaging for detecting occult primary tumors in patients with cervical lymph node metastases. Materials and Methods: Seventy-three consecutive patients with tumors that went undetected during endoscopic or physical examinations underwent preoperative contrast-enhanced CT and MR imaging (SE and 3D THRIVE) after gadolinium injection. Guided biopsy or surgery results served as reference standards. The diagnostic performances of the imaging techniques were compared with McNemar’s tests. Results: Primary tumors were identified in 59 (80.8%) of the 73 patients after surgery. Of these, 36 were found in the palatine tonsil, 11 in the base of the tongue, seven in the nasopharynx, and five in the pyriform sinus. The sensitivity (72.9%) and accuracy (71.2%) of 3D THRIVE for detecting primary tumors were higher than were those of SE T1-weighted MR (49.2% and 53.4%, P ≤ 0.002) or CT (36.4% and 46.4%, P ≤ 0.001). The specificities of these techniques did not differ. The diagnostic performance of 3D THRIVE (area under the curve [AUC] = 0.681) for detecting tumors did not differ from that of SE T1-weighted MR or CT (AUC = 0.671 and 0.608, P > 0.05). Conclusion: 3D THRIVE was more sensitive at detecting primary tumors than was SE T1-weighted MR or CT imaging in patients with cervical metastases of unknown primary tumors; this sequence may improve biopsy and therapeutic planning in these patients.open석

Usefulness of Multiparametric Ultrasound for Evaluating Structural Abnormality of Transplanted Kidney: Can We Predict Histologic Abnormality on Renal Biopsy in Advance?

OBJECTIVE: The purpose of this study was to investigate the associations between microscopic abnormalities of transplanted kidneys and sonography-based imaging biomarkers, including elasticity, venous impedance index, arterial resistive index, and size. MATERIALS AND METHODS: Between 2011 and 2015, 159 recipients underwent sonography and biopsy of a transplanted kidney at our institution; 104 adult patients were included in this study. The maximal longitudinal length on gray-scale images, arterial resistive index, and venous impedance index on Doppler images and shear wave velocity on acoustic radiation force impulse imaging or Young modulus on supersonic shear imaging were measured before biopsy. The Banff criteria (2009 update), an international standardized classification and scoring system for renal allograft pathology, were used to evaluate the biopsy samples. Sonography parameters and clinical variables were analyzed with individual and summed Banff scores. RESULTS: Spearman rank correlation coefficients and ordinal logistic regression showed no association between sonography parameters and summed Banff scores. Only the interval between transplant and biopsy was significantly associated with summed Banff scores (p < 0.05). Univariate logistic regression analysis with individual Banff scores showed associations of one Banff feature with arterial resistive index, three with venous impedance index, and six with interval between transplant and biopsy (p < 0.05). Sonoelastography parameters were not associated with any individual Banff score. CONCLUSION: Neither sonoelastography parameter was associated with any histopathologic change of renal allografts. Although arterial resistive index and venous impedance index were related to a few individual Banff scores, length of time between transplant and biopsy showed stronger correlation than any imaging biomarkers with renal allograft deterioration.restrictio

Detection of clinically occult primary tumours in patients with cervical metastases of unknown primary tumours: comparison of three-dimensional THRIVE MRI, two-dimensional spin-echo MRI, and contrast-enhanced CT

AIM: To evaluate and compare the utility of contrast-enhanced three-dimensional (3D) T1-weighted high-resolution isotropic volume examination (THRIVE), spin-echo (SE) T1-weighted magnetic resonance imaging (MRI), and computed tomography (CT) for detecting clinically occult primary tumours in patients with cervical lymph node metastases. MATERIALS AND METHODS: Seventy-three consecutive patients with tumours that went undetected during endoscopic or physical examinations underwent preoperative contrast-enhanced CT and MRI (SE and 3D THRIVE) after gadolinium injection. Guided biopsy results served as reference standards. The diagnostic performances of the imaging techniques were compared with McNemar's tests. RESULTS: Primary tumours were identified in 59 (80.8%) of the 73 patients after surgery. Of these, 36 were found in the palatine tonsil, 11 in the base of the tongue, seven in the nasopharynx, and five in the pyriform sinus. The sensitivity (72.9%) and accuracy (71.2%) of 3D THRIVE for detecting primary tumours were higher than were those of SE T1-weighted MRI (49.2% and 53.4%, p0.05). CONCLUSION: 3D THRIVE was more sensitive at detecting primary tumours than was SE T1-weighted MRI or CT in patients with cervical metastases of unknown primary tumours. This sequence may improve biopsy and therapeutic planning in these patients.restrictio