중부 식도 혈관환을 동반한 식도의 소화성 협착 1예

Esophageal strictures may result from common conditions such as gastroesophageal reflux disease. Dysphagia is by far the most common presenting complaint in patients with esophageal peptic stricture. Symptomatic peptic strictures are treated by dilatation via ballooning or bougienation. Vascular ring is a term given to a combination of vascular and often ligamentous structures that encircle the trachea and esophagus. Symptomatic vascular ring, also known as dysphagia lusoria, is generally treated by conservative management. However, surgery should be considered when symptoms persist regardless of the treatment. We experienced a case involving a 41-year-old man with dysphagia diagnosed with peptic stricture on upper endoscopy and concomitant vascular ring on chest CT, which proved asymptomatic.ope

Establishing cutoff values for a quality assurance test using an ultrasound phantom in screening ultrasound examinations for hepatocellular carcinoma: an initial report of a nationwide survey in Korea

OBJECTIVES: The purpose of this study was to evaluate the results of ultrasound (US) device testing using a US phantom and to determine cutoff values for phantom quality assurance tests in US examinations for the screening of hepatocellular carcinoma in Korea. METHODS: Ultrasound phantom images were acquired from the general hospitals in Korea that participated in the National Cancer Screening Program for hepatocellular carcinoma. Ultrasound images of the phantom were acquired with a 3.0- to 5.0-MHz convex transducer and evaluated in terms of the dead zone, vertical and horizontal measurement, axial and lateral resolution, sensitivity, and gray scale/dynamic range. Appropriate cutoff values were determined to guarantee minimal qualifications for the performance of the US scanners. RESULTS: Three hundred fifty-seven US scanners were tested using the following cutoff values: less than 2 mm for the dead zone, 5% discrepancy in the vertical measurement, 7.5% discrepancy in the horizontal measurement, all 11 identifiable line targets for axial and lateral resolution, more than 14 cm for sensitivity, and more than 4 cylindrical structures for gray scale/dynamic range. With these criteria, 283 US scanners (79.3%) passed the tests. The most common cause of disqualification was the dynamic range/gray scale. No statistical difference was observed in the disqualification rate between 3 groups based on different years of manufacture. CONCLUSIONS: Through this study, we have defined cutoff values for phantom images acquired with US scanners. These will be used in performing screening US examinations for hepatocellular carcinoma in Korea.ope

Radiation Doses of Various CT Protocols: a Multicenter Longitudinal Observation Study

Emerging concerns regarding the hazard from medical radiation including CT examinations has been suggested. The purpose of this study was to observe the longitudinal changes of CT radiation doses of various CT protocols and to estimate the long-term efforts of supervising radiologists to reduce medical radiation. Radiation dose data from 11 representative CT protocols were collected from 12 hospitals. Attending radiologists had collected CT radiation dose data in two time points, 2007 and 2010. They collected the volume CT dose index (CTDIvol) of each phase, number of phases, dose length product (DLP) of each phase, and types of scanned CT machines. From the collected data, total DLP and effective dose (ED) were calculated. CTDIvol, total DLP, and ED of 2007 and 2010 were compared according to CT protocols, CT machine type, and hospital. During the three years, CTDIvol had significantly decreased, except for dynamic CT of the liver. Total DLP and ED were significantly decreased in all 11 protocols. The decrement was more evident in newer CT scanners. However, there was substantial variability of changes of ED during the three years according to hospitals. Although there was variability according to protocols, machines, and hospital, CT radiation doses were decreased during the 3 years. This study showed the effects of decreased CT radiation dose by efforts of radiologists and medical society.ope

Mucosa-Associated Lymphoid Tissue Lymphoma of the Esophagus Coexistent with Bronchus-Associated Lymphoid Tissue Lymphoma of the Lung

Non-Hodgkin's lymphoma very rarely involves the esophagus, occurring in less than 1% of patients with gastrointestinal lymphoma. A few cases of mucosa-associated lymphoid tissue (MALT) lymphoma of the esophagus have been reported in the English literature. To our knowledge, there has been no report of MALT lymphoma of the esophagus coexistent with bronchus-associated lymphoid tissue lymphoma (BALT) of the lung. This report details the radiological and clinical findings of this first concurrent case.ope

A case of angiomyolipoma of the liver

Angiomyolipoma occurs most commonly in the kidneys; the liver is the second most frequent site of involvement. Hepatic angiomyolipoma is a rare, benign, mesenchymal neoplasm, composed mainly of blood vessels, smooth muscle cells, fat, and myelocomponents. Radiologic findings are non-specific because the various elements of these neoplasms vary in their proportion and distribution within the tumor. Thus, data obtained by imaging technologies such as computed tomography, ultrasonography, or magnetic resonance imaging tend to be merely suggestive; definitive diagnosis usually requires histologic confirmation. We report here a case of angiomyolipoma in an incidental tumor of the liver of a 53-year-old female. Tissue was removed from the tumor by ultrasonography-guided gun biopsy and subjected to immunohistochemical analysis. Data showed that tumor cells were positive for HMB-45 and SMA, but negative for cytokeratin, anti-hepatocyte antigen, and alpha-fetoprotein. The patient did not receive any treatment and is being followed upope

Prognostic value of gallbladder wall thickening in patients with acute hepatitis A.

PURPOSE: To investigate the clinical significance of gallbladder (GB) wall thickening frequently observed in patients with acute hepatitis A. METHODS: A total of 328 consecutive patients who were diagnosed with acute hepatitis A and underwent abdominal ultrasonography were enrolled retrospectively. Patients were divided into two groups: GB wall thickening (≥3 mm, group A) and no thickening (group B). Group A was subdivided into two subgroups (GB wall thickening of ≥10 mm, group A-1 and ≥3 mm to <10 mm, group A-2). The laboratory results related to liver function, hospitalization duration, and time to normalization of liver function were compared between the groups. RESULTS: A total of 230 patients showed GB wall thickening (group A). Besides gamma-glutamyl transpeptidase and alkaline phosphatase, all laboratory results of group A were significantly higher than those of group B (P<0.05). Compared with group B, the hospitalization duration and the time to normalization of liver function were significantly longer in group A (P<0.05). Group A-1 included 146 patients and group A-2 included 84 patients. No significant differences in laboratory results, hospitalization duration, and time to normalization of liver function were found between the two subgroups. In the multivariate logistic regression analysis, serum alanine transaminase, total bilirubin and albumin levels, and hospitalization duration were significantly associated with GB wall thickening in patients with hepatitis A. CONCLUSION: The presence of GB wall thickening in patients with acute hepatitis A suggests a poorer prognosis irrespective of the degree of GB wall thickening or the degree of liver enzyme elevation.ope

뇌혈관 컴퓨터단층촬영 조영술에서의 감쇄 기반 자동 관전압 선택 알고리즘: 방사선 조사와 영상 품질에 미치는 영향

Objective: To investigate the feasibility of using the attenuation-based automatic tube potential selection (ATPS) algorithm for cerebral computed tomography angiography (CTA) and to assess radiation dose, vascular attenuation, and image quality compared to a conventional fixed 120-kVp protocol. Materials and Methods: Among 36 volunteers for cerebral CTA, a total of 18 were scanned with fixed 120 kVp and 140 effective mAs using automatic tube current modulation. The other 18 were scanned with an ATPS algorithm. Radiation doses, attenuation, contrast-to-noise ratio (CNR) of the cerebral arteries, subjective scores for arterial attenuation, edge sharpness of the artery, visibility of small arteries, venous contamination, image noise, and overall image quality were compared between the groups. Results: The volume CT dose index and effective dose of the ATPS group were lower than those of the fixed 120-kVp group. The ATPS group had significantly higher arterial attenuation and no significant difference in CNR, compared with the fixed 120-kVp. The ATPS group had higher subjective scores for arterial attenuation, edge sharpness of the artery, visibility of small arteries, and overall image quality. Conclusion: The ATPS algorithm for the cerebral CTA reduced radiation dose by 43% while maintaining image quality and improved the attenuation of cerebral arteries by selecting lower tube potential.ope

Segmental difference of the hepatic fibrosis from chronic viral hepatitis due to hepatitis B versus C virus infection: comparison using dual contrast material-enhanced MRI.

OBJECTIVE: We wanted to identify the geographic differences in hepatic fibrosis and their associations with the atrophy-hypertrophy complex in patients with chronic viral hepatitis using the dual-contrast material-enhanced MRI (DC-MRI) with gadopentetate dimeglumine and ferucarbotran. MATERIALS AND METHODS: Patients with chronic C (n = 22) and B-viral hepatitis (n = 35) were enrolled for determining the subjective grade of fibrosis (the extent and thickness of fibrotic reticulations) in the right lobe (RL), the caudate lobe (CL), the medial segment (MS) and the lateral segment (LS) of the liver, with using a 5-grade scale, on the gradient echo T2(*)-weighted images of DC-MRI. The fibrosis grades of different segments were compared using the Kruskal-Wallis test followed by post-hoc analysis to establish the segment-by-segment differences. The incidences of two pre-established morphologic signs of cirrhosis were also compared with each other between the two groups of patients. RESULTS: There were significant intersegmental differences in fibrosis grades of the C-viral group (p = 0.005), and the CL showed lower fibrosis grades as compared with the grades of the RL and MS, whereas all lobes were similarly affected in the B-viral group (p = 0.221). The presence of a right posterior hepatic notch was significantly higher in the patients with intersegmental differences of fibrosis between the RL and the CL (19 out of 25, 76%) than those without such differences (6 out of 32, 19%) (p < 0.001). An expanded gallbladder fossa showed no significant relationship (p = 0.327) with the segmental difference of the fibrosis grades between the LS and the MS. CONCLUSION: The relative lack of fibrosis in the CL with more advanced fibrosis in the RL can be a distinguishing feature to differentiate chronic C-viral hepatitis from chronic B-viral hepatitis and this is closely related to the presence of a right posterior hepatic notchope

Validation of 10-Minute Delayed Hepatocyte Phase Imaging with 30° Flip Angle in Gadoxetic Acid-Enhanced MRI for the Detection of Liver Metastasis

OBJECTIVES: To compare 10-minute delayed hepatocyte phase imaging using a 30° flip angle (10min-FA30) and 20-minute hepatocyte phase imaging using a 10° FA (20min-FA10) in gadoxetic acid-enhanced MRI of patients with possible liver metastases, regarding lesion-to-liver contrast-to-noise ratio (CNR) and focal hepatic lesion (FHL) detection to evaluate whether 10min-FA30 would be superior to 20min-FA10. MATERIALS AND METHODS: Eighty-three patients with 248 liver metastases and 78 benign FHLs who underwent gadoxetic acid-enhanced MRI with 10min-FA30 and 20min-FA10 were enrolled. Lesion-to-liver CNRs were compared between the two image groups. Two radiologists independently assessed the presence of FHLs using a four-point scale and detection sensitivity was calculated. RESULTS: The mean CNR for liver metastases on the 10min-FA30 (248.5 ± 101.6) were significantly higher than that of the 20min-FA10 (187.4 ± 77.4) (p < 0.001). The mean CNR difference between the two image groups was 61.2 ± 56.8. There was no significant difference in detection sensitivity of FHLs for two readers between 10min-FA30 (mean 97.7%) and 20min-FA10 (mean 97.9%), irrespective of the lesion size or malignancy. CONCLUSION: 10min-FA30 yielded higher CNR with similar sensitivity compared to 20min-FA10. This finding indicates that 10min-FA30 can potentially replace 20min-FA10 with higher diagnostic performance and save 10 minutes of time.ope

Apparent diffusion coefficient of hepatocellular carcinoma on diffusion-weighted imaging: Histopathologic tumor grade versus arterial vascularity during dynamic magnetic resonance imaging

OBJECTIVES: Apparent diffusion coefficient (ADC) has been suggested to reflect the tumor grades of hepatocellular carcinomas (HCCs); i.e., it can be used as a biomarker to predict the patients' prognosis. To verify its feasibility as a biomarker, the present study sought to determine how the ADC values of HCC are affected by a tumor's histopathologic grade and arterial vascularity. MATERIALS AND METHODS: From 131 consecutive patients, 141 surgically resected HCCs (16 well-differentiated [wd-HCCs], 83 moderately-differentiated [md-HCCs], and 42 poorly-differentiated HCCs [pd-HCCs]) were subjected to a comparison of the tumors' arterial vascularity (non-, slightly-, or markedly-hypervascular) determined on dynamic magnetic resonance imaging (MRI) and the ADC was measured retrospectively. RESULTS: The pd-HCCs (1.05+/-0.16 x 10-3 mm2/s) had a significantly lower ADC than md-HCCs (1.16+/-0.21 x 10-3 mm2/s; p = 0.010), but there was no significant difference compared to wd-HCCs (1.11+/-0.18 x 10-3 mm2/s; p = 0.968). The mean ADC was significantly higher in markedly hypervascular lesions (1.20+/-0.20 x 10-3 mm2/s) than in nonhypervascular lesions (0.95+/-0.14 x 10-3mm2/s; p<0.001) or slightly hypervascular lesions (1.04+/-0.15 x 10-3mm2/s; p<0.001). The ADC values and arterial vascularity were significantly correlated in wd-HCCs (p = 0.005) and md-HCCs (p<0.001). The mean ADC of pd-HCCs was significantly lower than those of other lesions, even in the markedly hypervascular lesion subgroup (p = 0.020). CONCLUSION: Although pd-HCC constantly shows low ADCs regardless of arterial vascularities, ADCs cannot stably stratify histopathologic tumor grades due to the variable features of wd-HCCs; and the ADC should be used with caution as a tumor biomarker of HCC.ope