Boem Ha Yi

Evaluation of Patients With Suspected Ureteral Calculi Using Sonography as an Initial Diagnostic Tool How Can We Improve Diagnostic Accuracy

Objective. The purpose of this study was to evaluate the usefulness of sonography as an initial diagnostic tool in patients with suspected ureterolithiasis. Methods. We performed a prospective study of 318 patients with suspected ureteral stones over a 14‐month period. All patients underwent sonography after fasting for 8 hours and bladder filling. If no cause of the flank pain was found by sonography, computed tomography or intravenous urography was performed immediately to confirm the absence of ureteral stones. Results. We found urolithiasis with sonography in 291 of 296 patients with confirmed urolithiasis. The 5 remaining cases were identified after non–contrast‐enhanced computed tomography (n = 3), intravenous urography (n = 1), or the passage of a stone (n = 1, pregnant patient). We detected 313 calculi in the 291 patients with sonography as follows: 307 ureteral calculi in 285 patients, 5 urinary bladder calculi that were probably passed from the ureter in 5 patients, and 1 urethral calculus. The locations of the 313 calculi in the 291 patients with a sonographic diagnosis were as follows: 21 were in the ureteropelvic junction, 96 in the proximal half of the ureter, 69 in the distal half of the ureter, 121 in the ureterovesical junction, 5 in the urinary bladder, and 1 in the urethra. Hydronephrosis was seen in 200 of the 291 patients with calculi identified by sonography (68.7%). Twinkling artifacts helped confirm the presence of tiny calculi in 184 of the 214 calculi (86%). Conclusions. Sonography can be used as an initial diagnostic tool in patients with suspected ureterolithiasis.

Reducing Metallic Artifacts in Postoperative Spinal Imaging: Usefulness of IDEAL Contrast-enhanced T1- and T2-weighted MR Imaging—Phantom and Clinical Studies

PURPOSE To prospectively compare the effectiveness of iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) T2-weighted and contrast material-enhanced T1-weighted magnetic resonance (MR) imaging with that of a conventional MR imaging protocol in minimizing metallic artifacts in phantoms and in patients with metallic hardware after spinal surgery. MATERIALS AND METHODS Institutional review board approval and informed consent were obtained for this study. Coronal T1- and T2-weighted MR images of six titanium alloy pedicle screws in an oil bath containing tubes filled with diluted gadolinium contrast medium were obtained with frequency-selective fat saturation (FSFS) and IDEAL. Axial T2-weighted and contrast-enhanced T1-weighted MR imaging of the spine was performed with FSFS and IDEAL at 22 lumbar levels in 19 patients. Two musculoskeletal radiologists qualitatively analyzed the images in terms of the visualization of paravertebral muscle and the spinal canal region, uniformity of fat saturation, and noise. The paired images were rated by using a five-point scale. For the quantitative study with phantoms, the short- and long-axis lengths of metallic artifacts were determined on signal intensity profiles. RESULTS In the phantom study, metallic artifact size was markedly decreased in the IDEAL T2-weighted and contrast-enhanced T1-weighted images (P < .001). In the clinical study, IDEAL T2-weighted and contrast-enhanced T1-weighted images enabled significantly improved visualization of the dural sac (P < .001), spinal muscles (P < .05), uniformity of fat saturation (P < .001), and noise (P < .05). CONCLUSION IDEAL T2-weighted and contrast-enhanced T1-weighted MR imaging examinations effectively reduce the degree of tissue-obscuring artifacts produced by spinal fixation hardware and improve image quality compared with FSFS T2-weighted and contrast-enhanced T1-weighted MR imaging. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101856/-/DC1.

Contrast-Induced Nephropathy in Patients Undergoing Intravenous Contrast-Enhanced Computed Tomography in Korea: A Multi-Institutional Study in 101487 Patients

Objective To evaluate the prevalence of known risk factors for contrast-induced nephropathy (CIN) and their association with the actual occurrence of CIN in patients undergoing intravenous contrast-enhanced computed tomography (CECT) in Korea. Materials and Methods Patients who underwent CECT in 2008 were identified in the electronic medical records of 16 tertiary hospitals of Korea. Data on demographics, comorbidities, prescriptions and laboratory test results of patients were collected following a standard data extraction protocol. The baseline renal function was assessed using the estimated glomerular filtration rate (eGFR). We identified the prevalence of risk factors along the eGFR strata and evaluated their influence on the incidence of CIN, defined as a 0.5 mg/dL or 25% increase in serum creatinine after CECT. Results Of 432425 CECT examinations in 272136 patients, 140838 examinations in 101487 patients met the eligibility criteria for analysis. The mean age of the participants was 57.9 ± 15.5 years; 25.1% of the patients were older than 70 years. The prevalence of diabetes mellitus was 11.9%, of hypertension 13.7%, of gout 0.55% and of heart failure was 1.7%. Preventive measures were used in 40238 CECT examinations (28.6%). The prevalence of risk factors and use of preventive measures increased as the renal function became worse. A CIN was occurred after 3103 (2.2%) CECT examinations, revealing a significant association with decreased eGFR, diabetes mellitus, and congestive heart failure after adjustment. Conclusion Risk factors for CIN are prevalent among the patients undergoing CECT. Preventive measures were seemingly underutilized and a system is needed to improve preventive care.

Sonography of intrascrotal appendage torsion: varying echogenicity of the torsed appendage according to the time from onset.

The purpose of this study was to evaluate sonographic findings in torsed intrascrotal appendages and to assess the effect of the time from symptom onset on echogenicity and the relationship between the time from symptom onset and manual reduction success.

Manual reduction of torsion of an intrascrotal appendage under ultrasonographic monitoring.

The purpose of this study was to evaluate the feasibility and safety of manual reduction of torsion of an intrascrotal appendage under ultrasonographic monitoring.

Diagnostic Effectiveness of Dynamic Colpocystoproctography in Women Planning for Combined Surgery with Urinary Incontinence and Pelvic Organ Prolapse

Objective: To evaluate the advantage of performing the dynamic cystoproctography (DCP) in patients planning for combined surgery due to urinary incontinence and pelvic organ prolapse (POP). Materials and Methods: We performed DCP on a total of 113 consecutive women with POP and compared the findings of the physical examination with POP quantification against those of DCP including squeezing, straining and evacuation phases, and analyzed the changes to the rates of surgical planning. For statistical analysis, sensitivity, specificity, and positive predictive value of each test were performed. Results: DCP identified an additional 10 cases of cystocele, 32 cases of rectocele, 2 cases of enterocele, 4 cases of sigmoidocele, and 8 cases of rectal intussusception compared to those cases who were only included for a physical examination. The initial surgical plan was changed in a total of 24 cases (22.1%). The prevalence of bowel symptoms in the group in which the surgical plan changed was higher than in the group with no changes to the surgical plan (p = 0.023). Conclusions: DCP may be a more sensitive test for diagnosing POP compared to physical examination alone, and it is useful to patients with bowel symptoms by making surgical planning for combined surgery with stress urinary incontinence and POP.

Accessory gallbladder in an intrahepatic location mimicking a cystic tumor of the liver: A case report

Background:Double gallbladder (GB) is a rare congenital anomaly of the biliary system characterized by the presence of an accessory GB. Clinical Findings:A 38-year-old female presented with a history of right upper quadrant (RUQ) pain. Computed tomography (CT) showed a lobulated cystic mass involving the center portion of liver. Magnetic resonance imaging (MRI) additionally revealed a tubular structure of T2 bright signal intensity (SI), which connected the cystic lesion of the liver to the bile duct. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) confirmed the connection between the intrahepatic cystic lesion and the left main hepatic duct. We regarded as a cystic mass with biliary communication, such as a cystic intraductal papillary neoplasm of the bile duct (IPNB) or localized Caroli disease. The patient underwent partial hepatectomy for the cystic mass of the liver and a final diagnosis of chronic inflammation of an intrahepatically located accessory GB was made. Conclusion:We report a case of an accessory GB in an intrahepatic location mimicking a cystic mass such as cystic IPNB or localized Caroli disease of the liver showing a cystic mass with biliary communication.

Henoch-Schonlein purpura: ultrasonography of scrotal and penile involvement

Testicular or scrotal involvement has been reported in children with Henoch-Schonlein purpura (HSP), but there are very few reports on penile involvement. We report the initial and follow-up ultrasonographic findings of scrotal and penile involvement of HSP in a 5-year-old boy. On ultrasonography, scrotal soft tissue thickening and epididymal swelling with increased vascularity were noted, and on the penis, a focal mass-like lesion appeared on the dorsal surface of the distal penis, having a hypoechoic mass-like appearance without visible vascular flow on a Doppler study. After 2 days of treatment, follow-up ultrasonography showed normal scrotum and penis with a resolved soft tissue mass-like lesion. Therefore, we think that HSP ultrasonographic findings involving the scrotum and penis might help to diagnose scrotal and penile involvement in a case of HSP and to avoid unnecessary medication and/or surgical procedures.

Computed tomographic features of inflammatory myofibroblastic tumour of the stomach in adult patients: An analysis of five multicentre cases with literature review

The aim of this study was to describe the clinical and computed tomography (CT) features of gastric inflammatory myofibroblastic tumour (IMT) in adult patients and provide a review of the literature.

Differentiation of hepatic abscess from metastasis on contrast-enhanced dynamic computed tomography in patients with a history of extrahepatic malignancy: emphasis on dynamic change of arterial rim enhancement

ObjectivesThe objective of the study is to identify computed tomography (CT) findings that differentiate hepatic abscess from hepatic metastasis in a patient with a history of extrahepatic malignancy.Materials and methodsThis retrospective study included 30 patients with 93 hepatic abscesses and 40 patients with 125 hepatic metastases who had a history of extrahepatic malignancy and underwent contrast-enhanced dynamic CT with arterial phase (AP) and portal venous phase (PVP). The diagnosis of hepatic abscess and hepatic metastasis was made using pathological confirmation or clinical diagnosis. Margin, patchy parenchymal enhancement, arterial rim enhancement, dynamic change of arterial rim enhancement, size discrepancy of lesions between arterial and portal phases, bile duct dilatation, perilesional hyperemia, and perilesional low density were evaluated by two radiologists independently. Significant findings for differentiating two groups were identified at univariate and multivariate analysis with nomogram for predicting hepatic abscess. Interobserver agreement was also analyzed for each variable.ResultsMultivariate analysis revealed that patchy parenchymal enhancement (P < 0.001), arterial rim enhancement persistent through PVP (P < 0.001), and perilesional hyperemia (P = 0.013) were independent significant findings to predict hepatic abscess than metastasis. Among them, arterial rim enhancement persistent through PVP showed a highest odds ratio (OR 33.73) on multivariate analysis and a highest predictor point on a nomogram for predicting hepatic abscess. When two of these three criteria were combined, 80.7% (75/93) of hepatic abscess were correctly identified, with a specificity of 85.6% (107/125). When all three criteria were satisfied, specificity was up to 100% (125/125).ConclusionsAt contrast-enhanced dynamic CT, patchy parenchymal enhancement, arterial rim enhancement persistent through PVP, perilesional hyperemia, and their combinations may be reliable CT features for differentiating hepatic abscess from metastasis in patients with a history of primary extrahepatic malignancy.