Dong Woo Park

Roles of ultrasonography and computed tomography in the surgical management of cervical lymph node metastases in papillary thyroid carcinoma

AIMS Adequate evaluation and surgical management of cervical lymph node metastasis is very important in papillary thyroid carcinoma (PTC). The aim of this study was to evaluate the impact of preoperative ultrasonography (US) and computed tomography (CT) on the surgical management of cervical lymph node metastases in PTC. METHODS Medical records and imaging findings were retrospectively analyzed for 252 patients with PTC who underwent thyroidectomy with neck dissection. RESULTS The sensitivity of both imaging techniques was lower in the central neck (US 23%, CT 41%) than in the lateral neck (US 70%, CT 82%). The specificities of US and CT were 97% and 90% in the central neck, and 84% and 64% in the lateral neck, respectively. Our surgical plans for therapeutic neck dissection were based on imaging findings in 59% of patients who underwent lateral compartment neck dissection and in 32.1% of patients who underwent central compartment neck dissection, respectively. CONCLUSIONS The roles of preoperative US and CT in surgical planning for central compartment neck dissection in PTC are limited because of their low sensitivity in the central neck, but US and CT may be useful in cases with non-palpable lateral neck nodes.

Does contrast enhancement on CT suggest tumor response for chemotherapy in small cell carcinoma of the lung

Purpose The purpose of this article is to assess the correlation between contrast enhancement on CT and the tumor reduction ratio in small cell carcinoma of the lung after first-line chemotherapy. Materials and Methods Twenty-eight patients with small cell carcinoma of lung underwent preenhancement and postenhancement CT scans before and after first-line chemotherapy, followed by second-line chemotherapy in 7 patients who had relapsed. The authors retrospectively analyzed the correlation between the tumor reduction ratio and the CT numbers of contrast enhancement in each case by multiple regression analysis using SPSS. Results The mean tumor-reduction ratio was 58.2 ± 43.2% after first-line chemotherapy, and the mean CT enhancement was 33.2 ± 11.0 Hounsfield units (HU). The correlation coefficient between the tumor reduction ratio and the CT numbers of contrast enhancement was 0.57 (r2 = 0.32), and p value was < 0.002. After chemotherapy, more than 90% tumor reduction was seen in 11 patients. They revealed an average 41.9 ± 7.6 HU tumor enhancement. Less than 50% tumor reduction was seen in 10 patients. They revealed an average 26.2 ± 7.9 HU tumor enhancement. If these criteria of 30 HU contrast enhancement and 80% tumor reduction ratio were applied as a guide for chemotherapy response, the sensitivity, specificity, positive predictive value, and negative predictive value would be calculated as 85.7%, 84.6%, 85.7%, and 84.6%, respectively. Conclusion In small cell carcinoma of the lung, it is statistically proven that the more enhanced tumor on CT, the better response to chemotherapy. Tumor enhancement of 30 HU is a suggestive guide for chemotherapy response in patients with small cell carcinoma.

Hypereosinophilia with Multiple Thromboembolic Cerebral Infarcts and Focal Intracerebral Hemorrhage

We report a case of hypereosinophilia causing multiple areas of cerebral infarcts. A 52-year-old Korean man presented with dysarthria and weakness in both arms. A brain MRI revealed multiple acute infarcts in the distal border zone with focal intracerebral hemorrhage, whereas a cerebral angiogram was not remarkable. The eosinophil count was 5,500/µL and was accompanied by elevated cardiac enzyme levels. The pattern of cerebral infarcts and laboratory results suggest a thromboembolic infarction associated with hypereosinophilia.

Congenital supratentorial hemangioblastoma as an unusual cause of simultaneous supra- and infratentorial intracranial hemorrhage: case report

SummaryCongenital supratentorial hemangioblastomas are extremely rare tumors even in pediatric population. A 57-day-old female neonate presented with a pure motor seizure. On imaging studies, intracranial hemorrhagic lesions containing multiple cystic components in the cerebral and cerebellar areas were revealed, simultaneously. After the emergency surgical evacuation only to a fatal supratentorial lesion, an infratentorial lesion also regressed spontaneously. The authors report a case of full-term neonate presenting with supra- and infratentorial hemorrhagic lesions, which occurred as a result of congenital supratentorial hemangioblastoma bleeding.

Improved motion-sensitized driven-equilibrium preparation for 3D turbo spin echo T1 weighted imaging after gadolinium administration for the detection of brain metastases on 3T MRI

OBJECTIVE To evaluate the clinical usefulness of an improved motion-sensitized driven-equilibrium (iMSDE) preparation for three-dimensional turbo spin echo (TSE) T1 weighted imaging after gadolinium administration in 3.0-T MRI for the detection of brain metastases compared with conventional gradient echo (C-GRE) T1 weighted imaging with gadolinium. METHODS 40 patients with suspected brain metastases underwent MR studies, including two contrast-enhanced sequences, iMSDE-TSE and C-GRE. Post-enhancement images of 14 patients with suspected metastatic brain lesions were retrospectively analyzed, and comparisons between iMSDE-TSE and C-GRE were made using the Wilcoxon signed-rank test. RESULTS C-GRE detected 86 metastatic lesions, whereas iMSDE-TSE detected 97, including one false-positive lesion on both sequences. 11 of 96 metastases were detected on iMSDE-TSE only. On C-GRE, 15 of 85 metastases were equivocal. There was a significant difference between C-GRE and iMSDE-TSE in terms of the number of detected lesions (p = 0.024). Notably, the interobserver agreement for diagnosing metastases and identifying non-metastases was nearly identical. Overall, iMSDE-TSE achieves higher detectability of metastatic brain lesions, especially equivocal lesions. CONCLUSION Compared with C-GRE, iMSDE-TSE detected more brain metastases. This method is especially helpful in discerning equivocal metastases. ADVANCES IN KNOWLEDGE Previous studies have offered limited clinically useful information because they have all been preliminary studies such as comparing the contrast-to-noise ratio of each sequence without evaluating iMSDE-TSE. This study, however, is unique because we evaluate the clinical usefulness of iMSDE-TSE for the detection of brain metastases, and we compare these results to C-GRE.

Subcutaneous bronchogenic cyst: unusual unltrasonographic findings.

B cysts arise as developmental aberrations of the primitive foregut. They are commonly located in the lung or mediastinum, along the tracheobronchial tree, and rarely can appear in atypical locations, such as the neck, scapula, pericardium, and vertebral and subpleural areas. 1-9 Cervical and subcutaneous bronchogenic cysts are rare. 1-6 We recently encountered a subcutaneous bronchogenic cyst in the posterior triangle of the neck. On computed tomography (CT), the bronchogenic cyst appeared as a nonspecific cystic lesion in the subcutaneous fat layer. Ultrasonography showed a hypoechoic lesion with internal echogenic foci, suggesting a complicated cystic lesion. To our knowledge, the internal echogenic foci within the bronchogenic cyst shown on ultrasonography have not been described previously.

MR imaging of medullary streaks in osteosclerosis: a case report.

We present a case of medullary sclerosis of the appendicular skeleton in a patient with chronic renal insufficiency for whom MR imaging findings were characteristic. T1- and T2-weighted MR images showed multiple vertical lines (medullary streaks) of low signal intensity in the metaphyses and diaphyses of the distal femur and proximal tibia.

Characteristic MR findings suggesting presumed labyrinthine hemorrhage

Abstract Objectives: To evaluate the magnetic resonance imaging (MRI) findings of labyrinthine hemorrhage as a cause of sudden sensorineural hearing loss (SSNHL). Methods: MRI scans of 59 patients with SSNHL were retrospectively analyzed and compared to clinical features and audiometry data. MR images included pre-enhanced T1-weighted, 3D FLAIR volume isometric turbo spin-echo acquisition (VISTA), post-enhanced T1-weighted and 4-h-delayed enhanced FLAIR VISTA, and 3D thin-section proton density-weighted images. Results: High labyrinth signals were seen on pre-enhanced T1-weighted and 3D FLAIR VISTA images with no enhancement for 6 of 59 (10.2%) patients with SSNHL. In these six patients with presumed inner-ear hemorrhage, high signal intensity was seen in the endolymphatic and perilymphatic portions of the labyrinth on T1-weighted and 3D FLAIR VISTA images. In patients with SSNHL with nonhemorrhagic causes such as vestibular schwannoma or labyrinthitis, high signal or labyrinthine enhancement was seen only in the perilymphatic portion of the labyrinth on pre- or post-enhanced 3D FLAIR VISTA images. Conclusions: MRI using pre-enhanced T1-weighted, 3D FLAIR VISTA, and post-enhanced T1-weighted, 4-h delayed enhanced FLAIR VISTA images is able to identify labyrinthine hemorrhage as the cause of SSNHL. High signals in both the endolymphatic and perilymphatic portions of the labyrinth on pre- or post-enhanced 3D FLAIR VISTA images without enhancement indicate labyrinthine hemorrhage.

Noninfectious Meningitis Caused by Systemic Lupus Erythematosus: A Case Series of 4 Patients

Abstract We report magnetic resonance imaging findings of 4 patients with systemic lupus erythematosus who presented with noninfectious meningitis by lupus itself. Magnetic resonance imaging of the brain demonstrated diffuse or localized high-signal intensity in subarachnoid spaces on fluid-attenuated inversion recovery (FLAIR) or postcontrast fluid-attenuated inversion recovery. Cerebrospinal fluid study revealed no abnormalities other than increased level of proteins. Our report is the first description of magnetic resonance findings in context of leptomeningeal involvement in non-infectious meningitis of patients with systemic lupus erythematosus.

Pure intrasellar meningioma located under the pituitary gland: case report.

Most intrasellar meningiomas are located in the subdiaphragmatic and supraglandular region because they originate from the diaphragma sellae. Subglandular meningiomas located under the pituitary gland are extremely rare. Intrasellar meningiomas in the subdiaphragmatic and subglandular region probably originate from the dura in the sellar floor. We report a case of a subglandular meningioma along with a review of the literature.