Ding-Kwo Wu

Evaluation of galactography for nipple discharge

Galactography is useful in the evaluation of spontaneous discharge from the nipple of a nonlactating breast. Without galactography, surgeons have relied on either masectomy or excision of the major duct system responsible for the discharge. From January 1989 to May 1996, 106 galactograms were performed with monofilament polypropylene suture guiding for duct cannulation in 105 cases. The discharge duct was identified by pre-operative galactography, followed by a selective excision of ductal-lobular unit. In all tissue specimens, the cause of the pathologic secretion was found histologically; most often, it was intraductal papilloma (42.6%). In 35.6% of the specimens, findings with a prospective significance (papillomatosis, hyperplasia, carcinoma) were discovered and further operative treatment was initiated. The color of the discharge allowed no prediction of the histological findings. The accuracy of galactography was 88.4%, 84.6%, and 77.4% in papilloma, cancer, and other benign lesions, respectively. It is better than physical examination and other tests. Galactography represents a useful test in the diagnostic workup of secretory breasts.

Prediction of conversion from clinically isolated syndrome to clinically definite multiple sclerosis according to baseline MRI findings: comparison of revised McDonald criteria and Swanton modified criteria

Background: The International Panel on the Diagnosis of Multiple Sclerosis first incorporated abnormalities demonstrated by brain and spinal cord MRI into the diagnostic criteria (McDonald criteria) for multiple sclerosis (MS), which were later revised in 2005. In 2006, Swanton and colleagues modified the MRI criteria to simplify and speed the diagnosis. Objective: The purpose of this study was to compare the ability of two sets of criteria (the revised McDonald MRI criteria and Swanton’s modified criteria) to predict conversion from clinically isolated syndrome (CIS) to clinically definite multiple sclerosis (CDMS) from baseline MRI findings. Methods: Sixty-four patients presenting with CIS suggestive of multiple sclerosis were recruited from 2001 to 2006 and followed up for at least 2 years. Their baseline brain and spinal cord MRI studies were retrospectively evaluated. The patients who developed CDMS during follow-up were treated as positive cases. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the two MRI dissemination-in-space criteria were calculated. Results: Thirty patients (46.9%) converted to CDMS. The sensitivity specificity, PPV, NPV and accuracy (%) of the revised McDonald criteria were 53, 100, 100, 71 and 78, respectively, while those for Swanton’s modified criteria were 60, 100, 100, 74 and 81. Conclusions: In conclusion, Swanton’s modified criteria are more sensitive and accurate (but not significantly so). However, Swanton’s criteria are simpler to use and have equally high specificity and PPV.

Supraumbilical Skin Rash and Fat Necrosis after Transcatheter Arterial Chemoembolization: A Case Report

We report the case of a 63‐year‐old female who had chronic hepatitis C and who was diagnosed with hepatocellular carcinoma. Hepatic angiography showed one visible and tortuous falciform artery arising as the terminal branch of the left hepatic artery. Transcatheter arterial chemoembolization (TACE) was performed via the left hepatic artery. The patient developed supraumbilical skin rash with local tenderness on the following day. After supportive treatment by a dermatologist, the skin rash subsided gradually with sequelae of irregular skin surface and one small subcutaneous nodule. Skin biopsy of the lesion 1 year later showed fat necrosis with foreign body reaction and fibrosis. We discuss this rare complication of TACE and review the literature.

Inflammatory/infectious diseases and neoplasms of colon: Evaluation with CT

The purpose of this study is to review the computed tomography (CT) appearance of infectious and inflammatory diseases, and neoplasms of colon. Forty-five patients with 25 cases of colonic neoplasms and 20 cases of inflammatory and infectious diseases of colon were evaluated based on CT findings of colonic wall thickening (> 5 mm, soft tissue density versus pure wall edema or both), length of the involved segment (short (< or = 5 cm) versus long segment), pericolic infiltration, mesenteric infiltration, lateroconal fascial thickening, mechanical ileus, ascites, contiguous terminal ileum involvement, distribution of the diseased colon, and abscess formation. The results were compared using chi-square test or Fishers exact test. Our results showed that colonic wall thickening of soft tissue density with or without edema and pure bowel wall edema were the two statistically significant findings in differential diagnosis of colon (p < 0.05). We concluded that CT is a good imaging tool to make differential diagnosis between infectious/ inflammatory diseases and neoplasms.

Concurrent use of pigtail and loop snare catheters for percutaneous retrieval of dislodged central venous port catheter

The purpose of this study was to report our experience of percutaneous retrieval of dislodged port catheters with concurrent use of pigtail and loop snare catheters. During a 5‐year period at our institute (June 2005 to July 2010), a total of 23 dislodged port catheters were retrieved. The interval between port catheter implantation and dislodged catheter retrieval ranged from 43 days to 1,414 days (mean 586.7 days). The time of delayed retrieval ranged from 1 day to 45 days (mean 4.6 days). All dislodged catheters were retrieved with the concurrent use of pigtail and loop snare catheters via femoral venous route. The prevalence of port catheter dislodgement at our institute was 3.4%. All dislodged port catheters were removed successfully with pigtail and loop snare catheters together. No procedure‐related complications were encountered, except for transient arrhythmia in two patients, which required no medication. In conclusion, the concurrent use of pigtail and loop snare catheters is a feasible and easy way for percutaneous retrieval of a dislodged central venous port catheter.

Kaposiform Hemangioendothelioma Arising From the Maxillary Sinus: A Case Report

Kaposiform hemangioendothelioma is a very infrequent, locally aggressive vascular neoplasm, characterized by fascicular spindle cell proliferation. It occurs almost exclusively in infants and adolescents, and is often associated with Kasabach‐Merritt phenomenon. The tumor is predominantly located subcutaneously or in the deep soft tissue of the extremities and trunk, peritoneum, or retroperitoneum. However, this tumor can sometimes be located on the head and neck. We report a case of kaposiform hemangioendothelioma of the maxillary sinus in a 4‐month‐old female infant presenting with cheek swelling, thrombocytopenia, anemia, and disseminated intravascular coagulation. Sinus computed tomography presented an enhancing, bone‐destructing tumor. Magnetic resonance images showed an uncommon appearance as mostly low signal intensity on T2‐weighted images.

Imaging features of simultaneous occurrence of renal and pancreatic foreign body granuloma due to chronically retained gauze: a case report.

Herein we are reporting a case of simultaneous occurrence of renal and pancreatic foreign body granuloma due to retained gauze. The different imaging features of the two lesions make correct preoperative diagnosis difficult. Foreign body granulomas due to retained surgical gauze or sponges should be considered in patients who have previous histories of operations and who also have a mass in the surgical bed. Simultaneous occurrence of foreign body granuloma away from primary surgical field is also possible.

Tear of the Anterior Cruciate Ligament: Evaluations with MR Imaging

Sixteen patients with traumatic injury to the knees were surveyed with magnetic resonance (MR) machines with field strength of either 0.5 Tesla (T) using head coil (10 cases) or 1.5 T using dedicated knee coil (6 cases). Tears of the anterior cruciate ligament (ACL) were found in eight cases. The other eight cases had injuries of the other ligaments, meniscus or bone with intact ACL. All cases were proved by arthroscopy. Primary and secondary signs of the ACL tears were evaluated by MR imaging. Primary signs included the status of ACL. Secondary signs consisted of bone bruise in the posterolateral tibial plateau, in the lateral femoral condyle, or both (so-called kissing bone bruise), fracture at the posterolateral tibial plateau, Segond fracture, anterior dislocation of the tibia (> 5 mm), buckled posterior cruciate ligament (PCL), positive PCL line and the deep lateral femoral notch (> 1.5 mm). Of the eight cases of the ACL tears, 5 cases (62.5%) revealed thickening and edema of the ACL, 3 cases (37.5%) kissing bone bruise, 1 case (12.5%) Segond fracture, 2 cases (25%) buckled PCL, 2 cases (25%) deep lateral femoral notch, 2 cases (25%) anterior dislocation of the tibia and 0 case (0%) positive PCL line. The ACL had normal thickness of low signal intensity in 3 cases of chronic ACL tears (50%). Lateral meniscal tears were found in seven of the eight cases of ACL tears (87.5%). For the eight cases with intact ACL, the ACL was normal in thickness and of low signal intensity. Other findings were bone bruise in the lateral femoral condyle (1 case, 12.5%), fracture at the posterolateral tibial plateau (1 case, 12.5%), buckled PCL (1 case, 12.5%) and positive PCL line (1 case, 12.5%). It is concluded that primary sign is important in the MR diagnosis of the ACL tears. Secondary signs are helpful but may be present in lesions with intact ACL.

The Outcome of Intraluminal Brachytherapy Using Iridium 192(IR-192) for Hepatobiliary Cancers with Biliary Tract Obstruction

Purpose: To investigate the outcome of intraluminal brachytherapy (ILBT) using Iridium 192 (Ir-192) for hepatobiliary cancers with biliary tract obstruction. Materials and Methods: The clinical data of eleven patients with hepatobiliary malignancies (clinical stage as Tl-4, NO-1, MO) were collected from March 2007 to March 2011. AII of them had biliary obstruction caused by hepatobiliary cancers. The age at the initial diagnosis ranged from 46 to 79 years with a median of 68 years. AII patients received three to five fractions of high dose-rate Ir-192 ILBT (twice a day, for two to three days) with mean dose 01 14 Gy (9-17.5 Gy, 3.13 Gy/fraction, b.i.d.) and 6 of them also received external beam radiotherapy (EBRT) with mean dose of 44 Gy (40-64.8 Gy, 2 Gy/fraction/day). The median follow-up time from initial diagnosis was 10 months (1-28 months). Results: The mean value of pre-RT total bilirubin was 9.66 mg/dL (1.05-29.22 mg/dL) and that of post-RT was 1.73 mg/dL (0.27-4.23 mg/dL). The median survival time was 19 months for three patients with extra-hepatic cholangiocarcinoma, 9 months for three patients with intra-hepatic cholangiocarcinoma, 22 months for two patients with ampulla of Vater cancer and 5 months for those with hepatocellular carcinoma. The only single patient with gall bladder cancer survived 15 months. Conclusion: Ir-192 intraluminal brachytherapy is a feasible treatment option to relieve biliary tract obstruction and improve bile drainage for patients with hepatobiliary cancers.

Quantitative Assessment of Image Quality in 64-slice-computed Tomography of Coronary Arteries in Subjects Undergoing Screening for Coronary Artery Disease

Accurate and consistent visualization of the entire coronary system with high‐grade imaging quality is crucial for routine applications of multi‐detector‐computed tomography (MDCT) coronary angiography. To determine the imaging quality of 64‐slice‐MDCT coronary angiography, we respectively explored the quantitative parameters of imaging quality in 105 consecutive subjects (71 men, 34 women; aged 58.66 ± 10.62 years) who underwent 64‐slice‐MDCT coronary angiography to screen for coronary disease. The interobserver agreement for semi‐quantitative image quality, visible length, signal‐to‐noise ratio (SNR) and contrast‐to‐noise ratio (CNR) of the coronary arteries was good. The SNR and CNR of the proximal segments of the coronary arteries were superior to that of the distal segments of coronary arteries (p < 0.001). The visible length of the stenosed right coronary artery was significantly shorter than that of the non‐stenosed right coronary artery (p = 0.03). The SNR and CNR of the stenosed and non‐stenosed coronary arteries revealed no significant difference (p > 0.05). Body weight and body mass index were inversely related to the SNR and CNR of the aorta (p < 0.001). In conclusion, 64‐slice‐MDCT coronary angiography can provide excellent imaging quality of coronary arteries in subjects undergoing screening for coronary disease, although the SNR and CNR were relatively low at the distal segments of coronary arteries.