Imaging Finding of Multiple Endocrine Neoplasia Type 1: Case Report

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant inherited syndrome with characteristic clinical and radiological manifestations. Many reports on MEN1 have been published; however, no cases of radiologically diagnosed MEN1 have been reported. Therefore, we report on a radiologically diagnosed case of MEN1 with clinical symptoms of gastroduodenal ulcer.ope

Should We Recommend Ultrasonography for an Incidental Thyroid Nodule on Additional Cervicothoracic Sagittal T2-Weighted Image of Lumbar Spine MRI?

Purpose: To determine whether we should recommend ultrasonography (US) for an incidental thyroid nodule identified by additional cervicothoracic sagittal T2-weighted image (C-T sag T2WI) of lumbar spine magnetic resonance imaging (MRI). Materials and Methods: A retrospective study of 61 patients who underwent both lumbar spine MRI and thyroid US between December 2011 and April 2015 was conducted. For all US-found thyroid nodules > 1 cm, investigators evaluated whether there was any correlation between thyroid nodule detectability by C-T sag T2WI and US features such as echogenicity, composition, or suspicion of malignancy. Results: Solid hypoechoic (2/4; 50%) or mixed echoic nodules (4/8; 50%) appeared to be found relatively more easily by C-T sag T2WI than more benign-looking solid isoechoic (1/4; 25%) or spongiform nodules (0/6; 0%). Among six nodules with ultrasonographic suspicion for malignancy, only one nodule was detected by C-T sag T2WI. Conclusion: If an incidental thyroid nodule is seen by C-T sag T2WI, it would be better to recommend thyroid US for identifying malignancy.ope

Three-Dimensional Fast Spin-Echo Imaging without Fat Suppression of the Knee: Diagnostic Accuracy Comparison to Fat-Suppressed Imaging on 1.5T MRI.

PURPOSE: To evaluate the diagnostic performance of three-dimensional fast spin-echo (3D FSE-Cube) without fat suppression (NFS) for detecting knee lesions, using comparison to 3D FSE-Cube with fat suppression (FS). MATERIALS AND METHODS: One hundred twenty-four patients who underwent 1.5T knee magnetic resonance imaging (MRI) scans and 25 subsequent arthroscopic surgeries were retrospectively reviewed. Using arthroscopic results and two-dimensional images as reference standards, diagnostic performances of 3D FSE-Cube-NFS and FS imaging about lesions of ligament, meniscus, subchondral bone marrow edema (BME), and cartilage were compared. Scan parameters of 3D FSE-Cube imaging were previously optimized by a porcine knee phantom. RESULTS: No significant differences were observed between detection rates of NFS and FS imaging for detecting lesions of meniscus and cartilage (p>0.05). However, NFS imaging had lower sensitivity for detection of medial collateral ligament (MCL) tears, and lower sensitivity and specificity for detection of BME lesions, compared to FS imaging (p<0.05). CONCLUSION: 3D FSE-Cube-NFS imaging showed similar diagnostic performance for detecting lesions of meniscus or cartilage compared to FS imaging, unlike MCL or BME lesions.ope

Four-Dimensional Real-Time Cine Images of Wrist Joint Kinematics Using Dual Source CT with Minimal Time Increment Scanning

PURPOSE: To validate the feasibility of real time kinematography with four-dimensional (4D) dynamic functional wrist joint imaging using dual source CT. MATERIALS AND METHODS: Two healthy volunteers performed radioulnar deviation and pronation- supination wrist motions for 10 s and 4 s per cycle in a dual source CT scanner. Scan and reconstruction protocols were set to optimize temporal resolution. Cine images of the reconstructed carpal bone of the moving wrist were recorded. The quality of the images and radiation dosage were evaluated. RESULTS: The 4D cine images obtained during 4 s and 10 s of radioulnar motion showed a smooth stream of movement with good quality and little noise or artifact. Images from the pronation-supination motion showed noise with a masked surface contour. The temporal resolution was optimized at 0.28 s. CONCLUSION: Using dual source CT, 4D cine images of in vivo kinematics of wrist joint movement were obtained and found to have a shorter scan time, improved temporal resolution and lower radiation dosages compared with those previously reported.ope

Severity of nonalcoholic fatty liver disease is associated with subclinical cerebro-cardiovascular atherosclerosis risk in Korean men

BACKGROUND: No studies have reported the relationship between nonalcoholic fatty liver disease (NAFLD) and concurrent cerebral artery and coronary artery atherosclerosis simultaneously. We aimed at determining whether NAFLD, as assessed by ultrasound, is associated with subclinical cerebro-cardio vascular atherosclerosis (CCVA) by multidetector-row computed tomography (MDCT), and high resolution-magnetic resonance angiography (HR-MRA). This cross-sectional study included men in the general Korean population aged 20-70 years. RESULTS: A total of 1,652 men participated in the study (normal, n = 835; mild-to-moderate NAFLD, n = 512; severe NAFLD, n = 305). The risk of subclinical CCVA was positively associated with age (odds ratio [OR] 1.068; 1.054-1.081, p < 0.001), body mass index (OR 1.120; 1.08 0-1.162, p < 0.001), hepatic enzyme levels (OR 1.012; 1.001-1.023, p = 0.027; OR 1.006; 1.001-1.012, p = 0.036), fasting glucose (OR 1.021; 1.015-1.027, p < 0.001), triglycerides (OR 1.002; 1.000-1.003, p = 0.016), hypertension (OR 2.836; 2.268-3.546, p < 0.001), and diabetes (OR 2.911; 2.137-3.964, p < 0.001). Also, high-density lipoprotein cholesterol was inversely associated with subclinical CCVA (OR 0.974; 0.965-0.982, p < 0.001). Compared with normal controls, the OR for subclinical CCVA after full adjustment was 1.46 in the mild-to-moderate NAFLD group (95% confidence interval [CI]: 1.10 to 1.93) and 2.04 in the severe NAFLD group (95% CI: 1.44 to 2.89). CONCLUSIONS: Our data show that NAFLD is common among Korean men, and NAFLD severity on ultrasonography is associated with subclinical CCVA, as assessed by MDCT, and HR-MRA.ope

Pancreatic tumors: emphasis on CT findings and pathologic classification

Pancreatic tumors can be classified by their morphologic features on CT. The subtypes include solid tumors, mixed cystic and solid lesions, unilocular cysts, multilocular cystic lesions, and microcystic lesions. Endoscopic US and MRI can provide detailed information for classifying pancreatic lesions. Each subtype has different kinds of tumors and malignant potential, thus the classification can be useful for a better differential diagnosis and treatment planning. For this purpose, we suggest an appropriate modified classification system by using the imaging features of pancreatic tumors with an emphasis on CT findings and illustrate various findings of typical and atypical manifestationsope

무릎 관절에서 지방신호억제를 하지 않은 등방성 3차원 고속스핀에코 영상 :

Dept. of Medicine/박사Background and Purpose: Three-dimensional fast spin-echo imaging sequence with variable flip angle (3D-FSE-Cube) images have been developed recently and established as an essential sequence in the routine knee magnetic resonance imaging (MRI) protocol. However, no study has compared 3D-FSE-Cube imaging of the knee joints “with” and “without” fat suppression, and the diagnostic performance of 3D-FSE-Cube imaging without fat suppression (3D-FSE-Cube-NFS) has not yet been investigated. The aims of this study were as follows: (1) to optimize scan parameters for 3D-FSE-Cube imaging with fat suppression (3D-FSE-Cube-FS) and 3D-FSE-Cube-NFS in 1.5T knee MRI and (2) to compare 3D-FSE-Cube-FS and 3D-FSE-Cube-NFS to evaluate the diagnostic performance of 3D-FSE-Cube-NFS for detecting lesions of the meniscus, ligaments, bone marrow, or cartilage in knee imaging. Materials and Methods: A porcine knee phantom was used to optimize scan parameters for 3D-FSE-Cube imaging both with and without fat suppression in a 1.5T MRI system (Signa Horizon; GE Healthcare, Waukesha, WI, USA). Sagittal images with varied settings of repetition time (TR) from 1000 to 1300 ms and echo train length (ETL) from 30 to 60 were acquired. The image acquired with TR=1300 ms and ETL=30 served as a reference scan. Two musculoskeletal radiologists graded all images on a scale from -8 to 8 on the basis of image blurring and overall image quality relative to the reference scan. Subsequently, the same survey was performed on a healthy human volunteer by using parameter settings that received scores of -2 or above in the phantom study. Images with a score of -1 or above were regarded as acceptable. Signal-to-noise ratio (SNR) and SNR per unit time were measured in the patellar cartilage and femoral bone marrow on each image. After consideration of both subjective image evaluation and SNR per unit time, optimized scan parameters were determined. Using these optimized parameters, knee MRI scans were performed on 124 patients with knee pain by using both 3D-FSE-Cube-FS and 3D-FSE-Cube-NFS between September 2015 and December 2015. Among these patients, 25 subsequently underwent arthroscopic surgeries. Using the arthroscopic results and 2D images as reference standards, the two radiologists compared the diagnostic performance of 3D-FSE-Cube-NFS and 3D-FSE-Cube-FS images to determine which sequence was more diagnostically useful in a particular clinical situation, such as ligament tear, meniscus tear, subchondral bone marrow edema (BME) lesions, or cartilage defect. McNemar’s test was performed to compare the diagnostic performance of the two sequences at a significance level of p < 0.05. Results: Image quality and SNR increased with longer TR and shorter ETL. Among phantom images with a score of -1 or above, the highest SNR per unit time was acquired with scan parameters of TR=1300 ms and ETL=45 in both images with fat suppression (FS) and without fat suppression (NFS). In subsequent volunteer imaging, the same parameters were found to be the best with and without FS. In the imaging study of the 124 patients, there were no significant differences between the two sequences for the detection of meniscus tears and cartilage defect except for medial collateral ligament (MCL) tears and subchondral BME lesions. Compared to 3D-FSE-Cube-FS, 3D-FSE-Cube-NFS had lower sensitivity for the detection of MCL tears, and lower sensitivity and specificity for the detection of BME lesions. Nevertheless, 3D-FSE-Cube-NFS images showed advantages, such as reduced susceptibility artifact, ability for replacing inappropriate 3D-FSE-Cube-FS images, and detection of subtle BME lesions. Conclusion: Considering both acceptable image quality and short scan time, the optimized scan parameters for both 3D-FSE-Cube FS and 3D-FSE-Cube NFS were found to be TR=1300 ms and ETL=45. 3D-FSE-Cube-FS and 3D-FSE-Cube-NFS also showed similar sensitivity and specificity for the detection of meniscus tears or carti...ope

How reliable is routine lumbar spine MRI for detection of renal cysts? Correlation with abdominal CT

BACKGROUND: Incidental renal cysts are a very common finding in routine lumbar spine magnetic resonance imaging (MRI). However, there is no report of the renal cyst detection rate on routine lumbar spine MRI. PURPOSE: To determine the renal cyst detection rate in routine lumbar spine MRI based on findings of abdominal computed tomography (CT), and to investigate if the largest renal cyst seen by abdominal CT could be also detected by routine lumbar spine MRI. MATERIAL AND METHODS: A retrospective study was conducted of 70 patients who underwent both routine lumbar spine MRI and abdominal CT between December 2011 and January 2014. The detection rate of all renal cysts>5 mm as well as the largest renal cyst seen by abdominal CT were assessed in routine lumbar spine MRI. RESULTS: On routine lumbar spine MRI, the detection rate of renal cysts was 46.5% (73/157) for>5-mm renal cysts and 68.0% (34/50) for>10-mm renal cysts, correlating with abdominal CT. The detection rate of the largest renal cyst seen by abdominal CT was 60.0% (27/45). Non-detection of the largest renal cyst could be caused by upper positioning (n = 7), lateral positioning (n = 6), or relatively small cyst size (n = 5). CONCLUSION: Approximately half of renal cysts>5 mm and two-thirds of renal cysts>10 mm were detected on routine lumbar spine MRI. However, radiologists should be aware that kidney lesions may not be included in the scan coverage of routine lumbar spine MRI.restrictio

Sonographically guided fine-needle aspiration biopsy of major salivary gland masses: a review of 245 cases

OBJECTIVE: The purpose of this study was to determine the diagnostic accuracy of sonographically guided fine-needle aspiration biopsy (FNAB) for major salivary gland tumors by comparing the biopsy results for 245 salivary gland masses with the final pathologic diagnosis after surgical excision. MATERIALS AND METHODS: This retrospective study included a total of 245 major salivary gland tumors from 244 patients who had undergone sonographically guided FNAB followed by surgical excision. To evaluate the diagnostic accuracy of FNAB, we compared the histopathologic diagnoses with the preoperative cytology results obtained from FNAB. False-negative diagnoses based on the FNAB results were reviewed. RESULTS: Two hundred fifteen aspirates (87.8%) yielded adequate cytology results. In the 215 masses from which adequate material was obtained and an unequivocal cytology result was obtained, the overall sensitivity, specificity, and accuracy of sonographically guided FNAB in differentiating malignant from benign tumors was 75.7%, 100%, and 95.8%, respectively. The false-negative diagnostic rate was 4.2% (9/215), but there were no false-positive diagnoses of malignancy. Among the 47 malignancies, only 28 cases (59.6%) were detected preoperatively by FNAB. CONCLUSION: For the preoperative evaluation of major salivary gland tumors, sonographically guided FNAB is feasible for distinguishing between benign and malignant salivary gland tumors in the subset of patients with satisfactory cytologic diagnoses. However, negative or nondiagnostic cytologic results cannot always guarantee benignity of the final diagnosis, and therefore careful consideration of the sonographic features and cytologic results is necessary to avoid false reassurance.ope

다양한 원발성 암의 척추전이 병변의 특징적인 자기공명영상 소견들:병리학적으로 확인된 병변들의 후향적인 분석

Purpose The purpose of this study was to find and categorize the various magnetic resonance imaging (MRI) findings of spinal metastases that correlate with the type of primary cancer. Materials and Methods We retrospectively reviewed gadolinium-enhanced magnetic resonance images of 30 patients with 169 spinal metastatic lesions from lung cancer (n = 56), breast cancer (n = 29), colorectal cancer (n = 20), hepatocellular carcinoma (HCC) (n = 17), and stomach cancer (n = 47). The size, location, extent of invasion, signal intensity, margin, enhancement pattern, and osteoblastic or osteolytic characteristics of each metastatic tumor were analyzed. Results The metastatic lesions from HCC were larger than those from the other primary tumors (P < 0.05) except for colorectal cancer (P = 0.268). Well-defined metastatic tumor margins were more frequently seen in lung cancer and breast cancer (P < 0.01). All but HCC showed a tendency to invade the vertebral body rather than the posterior elements (P < 0.02). Colorectal cancer and HCC showed a tendency toward extraosseous invasion without statistical significance. HCC showed a characteristic enhancement pattern of 'worms-in-a-bag'. Rim enhancement with a sclerotic center was only seen in spinal metastases from stomach cancer. Conclusion Despite many overlapping imaging features, spinal metastases of various primary tumors display some characteristic MRI findings that can help identify the primary cancer.ope