Hye Jin Yoo

Angioleiomyoma in Soft Tissue of Extremities: MRI Findings

OBJECTIVEnThe purpose of our study was to describe the MRI findings of angioleiomyoma in the soft tissue of the extremities.nnnCONCLUSIONnAngioleiomyoma should be considered a possible diagnosis when a well-demarcated subcutaneous mass of isointense signal on T1-weighted images, heterogeneous high signal intensity on T2-weighted images with homogeneous strong enhancement, and an adjacent tortuous vascular structure is seen in the extremities.

Differentiating high-grade from low-grade chondrosarcoma with MR imaging

The purpose of the study was to evaluate the MR imaging features that differentiate between low-grade chondrosarcoma (LGCS) and high-grade chondrosarcoma (HGCS) and to determine the most reliable predictors for differentiation. MR images of 42 pathologically proven chondrosarcomas (28 LGCS and 14 HGCS) were retrospectively reviewed. There were 13 male and 29 female patients with an age range of 23–72xa0years (average age 51xa0years). On MR images, signal intensity, specific morphological characteristics including entrapped fat, internal lobular architecture, and outer lobular margin, soft tissue mass formation and contrast enhancement pattern were analysed. MR imaging features used to identify LGCS and HGCS were compared using univariate analysis and multivariate stepwise logistic regression analysis. On T1-weighted images, a central area of high signal intensity, which was not seen in LGCS, was frequently observed in HGCS (nu2009=u20095, 36%) (pu2009<u20090.01). Entrapped fat within the tumour was commonly seen in LGCS (nu2009=u200926, 93%), but not in HGCS (nu2009=u20091, 4%) (pu2009<u20090.01). LGCS more commonly (nu2009=u200924, 86%) preserved the characteristic internal lobular structures within the tumour than HGCSs (nu2009=u20094, 29%) (pu2009<u20090.01). Soft tissue formation was more frequently observed in HGCS (nu2009=u200911, 79%) than in LGCS (nu2009=u20091, 4%) (pu2009<u20090.01). On gadolinium-enhanced images, large central nonenhancing areas were exhibited in only two (7.1%) of LGCS, while HGCS frequently (nu2009=u20099, 64%) had a central nonenhancing portion (pu2009<u20090.01). Results of multivariate stepwise logistic regression analysis showed that soft tissue formation and entrapped fat within the tumour were the variables that could be used to independently differentiate LGCS from HGCS. There were several MR imaging features of chondrosarcoma that could be helpful in distinguishing HGCS from LGCS. Among them, soft tissue mass formation favoured the diagnosis of HGCS, and entrapped fat within the tumour was highly indicative of LGCS.

Congenital esophageal stenosis associated with esophageal atresia/tracheoesophageal fistula: clinical and radiologic features

BackgroundCongenital esophageal stenosis (CES) can be associated with esophageal atresia/tracheoesophageal fistula (EA/TEF). Because there are a variety of degrees of obstruction and symptoms of CES, it is frequently difficult to make a pre- and post-operative diagnosis of the distal CES associated with EA/TEF.ObjectiveTo evaluate the clinical and radiologic features of congenital esophageal stenosis associated with esophageal atresia/tracheoesophageal fistula.Materials and methodsWe retrospectively reviewed postoperative esophagograms and medical records of 187 children (107 boys, 80 girls) who had primary repair of EA/TEF from 1992 to 2009 at our institution. We evaluated the incidence of CES, clinical findings, radiologic features and management of CES in these children.ResultsCES was diagnosed in 22 of 187 EA/TEF children (12%); one child had double CES lesions, for a total of 23 lesions. Ten of those 22 children (45%) had presented with significant symptoms of esophageal obstruction. The diagnosis of CES was delayed in 10 children (45%) until 1–10xa0years of age. On esophagogram, CES (nu2009=u200923) was located in the distal esophagus (nu2009=u200920, 87%) or mid-esophagus (nu2009=u20093, 13%). The degree of stenosis was severe (nu2009=u20096, 26%), moderate (nu2009=u200910, 43%), or mild (nu2009=u20097, 30%). Eight children, including two with unsuccessful esophageal balloon dilatation of CES, were treated surgically. Histologic examination revealed tracheobronchial remnant (nu2009=u20097) or fibromuscular hyperplasia (nu2009=u20091). One child with surgically treated CES developed achalasia at the age of 3xa0years 9xa0months.ConclusionEsophagography after EA/TEF repair should be performed with a high index of suspicion for the presence of distal CES, because the diagnosis and adequate management of CES can often be delayed.

Measurement of fat content in vertebral marrow using a modified dixon sequence to differentiate benign from malignant processes

To determine whether fat‐signal‐fraction (FF) map using a modified Dixon sequence could help differentiate benign from malignant bone lesions.

Visual MRI Grading System to Evaluate Atrophy of the Supraspinatus Muscle

Objective To investigate the interobserver reproducibility and diagnostic feasibility of a visual grading system for assessing atrophy of the supraspinatus muscle on magnetic resonance imaging (MRI). Materials and Methods Three independent radiologists retrospectively evaluated the occupying ratio of the supraspinatus muscle in the supraspinatus fossa on 192 shoulder MRI examinations in 188 patients using a 3-point visual grading system (1, ≥ 60%; 2, 30-59%; 3, < 30%) on oblique sagittal T1-weighted images. The inter-reader agreement and the agreement with the reference standard (3-point grades according to absolute occupying ratio values quantitatively measured by directly contouring the muscles on MRI) were analyzed using weighted kappa. The visual grading was applied by a single reader to a group of 100 consecutive patients who had undergone rotator cuff repair to retrospectively determine the association between the visual grades at preoperative state and postsurgical occurrences of retear. Results The inter-reader weighted kappa value for the visual grading was 0.74 when averaged across three reader pairs (0.70-0.77 for individual reader pairs). The weighted kappa value between the visual grading and the reference standard ranged from 0.75 to 0.83. There was a significant difference in retear rates of the rotator cuff between the 3 visual grades of supraspinatus muscle atrophy on MRI in univariable analysis (p < 0.001), but not in multivariable analysis (p = 0.026). Conclusion The 3-point visual grading system may be a feasible method to assess the severity of supraspinatus muscle atrophy on MRI and assist in the clinical management of patients with rotator cuff tear.

Comparison of image quality of shoulder CT arthrography conducted using 120 kVp and 140 kVp protocols.

Objective To compare the image quality of shoulder CT arthrography performed using 120 kVp and 140 kVp protocols. Materials and Methods Fifty-four CT examinations were prospectively included. CT scans were performed on each patient at 120 kVp and 140 kVp; other scanning parameters were kept constant. Image qualities were qualitatively and quantitatively compared with respect to noise, contrast, and diagnostic acceptability. Diagnostic acceptabilities were graded using a one to five scale as follows: 1, suboptimal; 2, below average; 3, acceptable; 4, above average; and 5, superior. Radiation doses were also compared. Results Contrast was better at 120 kVp, but noise was greater. No significant differences were observed between the 120 kVp and 140 kVp protocols in terms of diagnostic acceptability, signal-to-noise ratio, or contrast-to-noise ratio. Lowering tube voltage from 140 kVp to 120 kVp reduced the radiation dose by 33%. Conclusion The use of 120 kVp during shoulder CT arthrography reduces radiation dose versus 140 kVp without significant loss of image quality.

Experience of Violence from the Clients and Coping Methods Among Intensive Care Unit Nurses Working in a Hospital in South Korea

PURPOSEnIt is difficult to develop a good defense system that can prevent nurses from experiencing physical and verbal violence from patients and families in intensive care units, which are closed spaces. This study aimed to identify intensive care nurses experience of violence from patients and families and investigate their coping methods, if there are any, in a tertiary hospital in South Korea.nnnMETHODSnThis study used a mixed methods design utilizing both a survey for collecting quantitative data and individual interviews for a qualitative one. A total of 200 intensive care nurses participated in the survey, with thirty of them taking part in individual interviews. Survey data were analyzed using SPSS 21.0 program, and qualitative data with qualitative content analysis method.nnnRESULTSnIn the survey, 99.5% of the nurses reported that they had experienced violence from the patients and 67.5% from their visitors (families or relatives). Verbal violence were reported more than physical ones. They showed moderate or severe responses to violence, scoring an average of 2.98±0.63 out of 5. The qualitative data were analyzed to draw 4 themes, 8 categories, and 17 subcategories. The four themes were perception of violence, coping with violence experience, coping resources, and caring mind after violence experience.nnnCONCLUSIONnWhile intensive care nurses experience unpredicted violence from patients and their visitors, they fail to cope well with the experience. The safe working environment of intensive care units is expected to contribute to quality care and an improvement of expertise in nursing.

MRI of Cuboid Pulley Lesion

OBJECTIVEnThe aim of this study was to describe cuboid pulley lesions and associated abnormalities on the basis of clinical findings and the results of MRI examinations of the ankle.nnnMATERIALS AND METHODSnA retrospective search was performed to identify patients who had a cuboid pulley lesion during a 10-year period. A cuboid pulley lesion was defined as bone marrow edema in the lateroplantar ridge of the cuboid that was shown to be wrapped by the peroneus longus tendon on MRI of the ankle. A total of 19 patients (11 men and eight women; mean age, 45.4 years) were included in the group of patients with a cuboid pulley lesion, and 38 age-and sex-matched patients without a cuboid pulley lesion were randomly selected as the control group. We reviewed medical records and assessed MRI findings that could be associated with a cuboid pulley lesion.nnnRESULTSnThe mean (± SD) diameter of the cuboid pulley lesion was 8.9 ± 4.7 mm. Cuboid pulley lesions were associated with peroneal tenosynovitis (p < 0.001), Achilles enthesitis (p = 0.004), and a clinical diagnosis of inflammatory arthritis (p < 0.001). Eleven of the 19 patients in the group with cuboid pulley lesions had inflammatory arthritis (either rheumatoid arthritis [n = 7] or spondyloarthritis [n = 4]). The cuboid pulley lesions did not cause localized lateral foot pain and tenderness, except in one patient who had an accompanying stress fracture of the cuboid.nnnCONCLUSIONnMRI of the ankle rarely but clearly shows cuboid pulley lesions, which themselves are not likely to cause localized pain, and cuboid pulley lesions show significant associations with peroneal tenosynovitis, Achilles enthesitis, and clinically diagnosed inflammatory arthritis.

Disproportionate fluid sign as an aid in diagnosing high-grade bursal-sided supraspinatus tendon tear

Background Deep, high-grade bursal-sided supraspinatus tendon tears are sometimes preoperatively misinterpreted as full-thickness tears on shoulder magnetic resonance imaging (MRI). Purpose To determine the usefulness of disproportionate fluid sign for differentiating high-grade bursal-sided partial-thickness tears from full-thickness tears on conventional MRI. Material and Methods Preoperative MRIs of 198 patients with arthroscopically confirmed high-grade bursal-sided partial-thickness tears and full-thickness tears were independently reviewed by two readers on two occasions. The presence of high-grade bursal-sided partial-thickness tears with a confidence level using a five-point grading scale was assessed based on tear depth alone and also in combination with disproportionate fluid sign, defined as a prominent subdeltoid or subacromial-subdeltoid bursal fluid distension with a relative paucity of effusion in the glenohumeral joint. The sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) were calculated, as well as inter-observer reliability. Results The disproportionate fluid sign was identified in 60/74 (81.2%) bursal-sided partial-thickness tears and 9/124 (7.5%) full-thickness tears. The sensitivity and accuracy of the diagnosis of bursal-sided tear were higher when disproportionate fluid sign was used in conjunction with the tear depth, compared with tear depth alone (Pu2009<u20090.001). There was excellent inter-observer agreement for disproportionate fluid sign and deep bursal-sided tear. The AUCs were significantly higher in combination with disproportionate fluid sign. Conclusion The disproportionate fluid sign indicates the presence of a deep, high-grade bursal-sided partial-thickness tear, which can be misinterpreted as a full-thickness tear. Thus, it can provide greater diagnostic assistance to less-experienced radiologists and clinicians.

Fat-suppressed T2 mapping of femoral cartilage in the porcine knee joint: A comparison with conventional T2 mapping.

To investigate the effect of fat suppression on T2 mapping of the articular cartilage in the porcine knee joint using magnetic resonance imaging (MRI).