J.K. Han

Long-term outcome of conventional radiation therapy for central neurocytoma

The authors report the long-term outcome of conventional radiation therapy (RT) in six cases of central neurocytoma (CN). Between 1985 and 1992, six patients were treated with RT for residual tumors or for prevention of recurrence after surgery. The median follow-up period of radiological and clinical status were 171 (range: 128–229) and 202xa0months (range: 165–227), respectively. Tumors disappeared in three and reduced in three patients at the last follow-up. One-mortality case due to radiation necrosis and one radiation-induced malignancy occurred. White matter degeneration and cortical atrophy were noticed with slow progression of performance deterioration in two patients. Conventional RT seemed to effectively control residual CN after surgery. However, more sophisticated radiation techniques should be applied to minimize the late sequela.

Intrahepatic intraductal cholangiocarcinoma

Most intrahepatic peripheral cholangiocarcinomas (PCCs) develop in the small peripheral bile ducts and grow in a nodular (mass-forming) or a diffuse (infiltrating) pattern [1–7]. In some cases, polypoid or papillary cholangiocarcinomas arise from the peripheral duct, and tumor growth is confined to within the bile duct. These tumors form tumor casts along the peripheral tributaries of the bile duct (upstream ducts). This type of tumor is referred to as an intraductal variant of PCC [2, 8–11] or intraductal-growing cholangiocarcinoma by the Liver Cancer Study Group of Japan [12]. Unlike ordinary PCCs, this tumor has an indolent biologic behavior and a better prognosis [11]. However, if undetected at an early stage and left untreated, the tumor may invade the surrounding hepatic parenchyma. For advanced stage tumors, it might be difficult to differentiate the massforming type from the advanced intraductal-growing type with stromal invasion [13, 14] (Figs. 1, 2, 3). Therefore, early detection and a correct preoperative diagnosis are important when preparing a treatment plan [2, 10]. In our hospital, this tumor comprises about 15% of all surgically resected PCCs [11]. One variety of intraductal growing cholangiocarcinoma is the intraductal papillary mucinous tumor (IPMT) of the bile duct or mucin-hypersecreting bile duct tumor [15–20]. According to one autopsy report, most intrahepatic cholangiocarcinomas are mucin-producing adenocarcinomas, and the mucin usually is retained in the tumor cells [21, 22]. However, there are cholangiocarcinomas that secrete copious amount of mucin into the bile ducts. At our institute, adenocarcinomas, including the peripheral and hilar types, comprise about 4% of cholangiocarcinomas (unpublished data). They produce excessive amounts of mucin within the bile duct, causing ballooning or severe dilatation of the duct, especially downstream, and cause intermittent biliary obstruction. Recently, they were considered a biliary counterpart of pancreatic IPMT [15–17].

Colitis in Behçet's disease: Characteristics on double-contrast barium enema examination in 20 patients

We performed a retrospective review of double-contrast barium enema examinations of 20 patients with clinically proven Behçets colitis. Main lesion was ovoid or geographic ulcers with a mean diameter of 2.7 cm. The number of ulcers was single in 15 cases and multiple in five. On six resected specimens, ulcers involved submucosa in three, muscle layer in one, and serosa in two cases with an undermining tendency and transmural inflammation. Aphthous ulcers were present in three cases. Neither perforation nor fistula was demonstrated. In all 20 patients, the ulcer was localized in the ileocecal area, with extension to the ascending colon in seven. Skip lesions were observed in the transverse colon and descending colon in three cases. Destruction of surrounding mucosa resulted in cecal contraction in 19 cases, widening of the ileocecal valve in 19, and fold thickening in the terminal ileum in 12. Six cases (30%) manifested as ileocecal mass accompanied by ulcer, fold thickening, and adjacent mucosal deformity. The appendix was visualized in only three (20%) of the 15 patients with no history of appendectomy. On follow-up study of 15 cases, the ulcers disappeared or decreased in size in 13 cases (86%) and the mucosal deformity was not improved in all cases. On the basis of our results, we believe that the characteristic findings of colitis in Behçets disease in barium enema examination are ovoid or geographic, relatively large, and deep ulcerations with persistent surrounding deformity which tend to localize in the ileocecal area.

Real-time compound ultrasonography: pictorial review of technology and the preliminary experience in clinical application of the abdomen

The purposes of this essay are to illustrate the technology overview and theoretical benefits of real-time compound ultrasonography (US) and to present our preliminary clinical experience in the evaluation of normal and diseased abdomens. The application of compounding principles to real-time US and its recent reintroduction into mainstream commercial systems have offered new opportunities for its clinical application to the routine examination of the abdomen. In our early preliminary experience, this technique effectively suppressed many of the US artifacts, better depicted the margin or boundary of the lesion, and increased contrast resolution or lesion conspicuity. Therefore, we believe that real-time compound US is a promising technique that may enhance the diagnostic confidence of the examination in the evaluation of normal and diseased abdomens.

Time-Staged Gamma Knife Stereotactic Radiosurgery for Large Cerebral Arteriovenous Malformations: A Preliminary Report.

Objective We retrospectively analyzed our experience with time-staged gamma knife stereotactic radiosurgery (GKS) in treating large arteriovenous malformation(AVM)s;≥ 10 cm3). Methods Forty-five patients who underwent time-staged GKS (2-stage, n = 37;3-stage,n = 8) between March 1998 and December 2011 were included. The mean volume treated was 20.42±6.29 cm3 (range, 10.20–38.50 cm3). Obliteration rates of AVMs and the associated complications after GKS were evaluated. Results Mean AVM volume (and median marginal dose) at each GKS session in the 37 patients who underwent 2-stage GKS was 19.67±6.08 cm3 (13 Gy) at session 1 and 6.97±6.92 cm3 (17 Gy) at session 2. The median interval period was 39 months. After follow-up period of 37 months, the complete obliteration rate was 64.9%. The mean AVM volume (and median marginal dose) at each GKS session in the 8 patients who underwent 3-stage GKS was 23.90±6.50 cm3 (12.25 Gy), 19.43±7.46 cm3 (13.5 Gy), 7.48±6.86 cm3 (15.5 Gy) at session 1, 2, and 3, respectively. The median interval duration between each GKS session was 37.5 and 38 months, respectively. After a median follow-up period of 47.5 months, 5 patients (62.5%) achieved complete obliteration. Postradiosurgical hemorrhage developed in 5 patients (11.1%) including one case of major bleeding and 4 cases of minor bleeding. No patient suffered from clinically symptomatic radiation necrosis following radiation. Conclusion Time-staged GKS could be an effective and safe treatment option in the management of large AVMs.

Extended field-of-view sonography: advantages in abdominal application

OBJECTIVEnTo show the advantages of extended field-of-view sonography in abdominal applications.nnnMETHODSnThirty-one cases were prospectively analyzed in our study. Extended field-of-view images were obtained when the radiologist decided that they would offer potential advantages for the examination. When extended field-of-view scanning was used, the radiologist determined prospectively whether it was useful according to several categories. Images were obtained with a 2- to 5-MHz curved array transducer or 4- to 9- and 5- to 12-MHz linear array transducers.nnnRESULTSnExtended field-of-view sonography provided several potential benefits over conventional sonography in the abdominal area. The advantages of extended field-of-view sonography were better demonstration of the spatial relationship between lesions and adjacent normal structures in 18 cases (58%), accurate quantification of sizes or volumes of large organs or lesions in 16 (52%), better display of the extended and tubular structures in 6 (19%), usefulness for clinical consultations in 7 (23%), and documentation comparable with that of computed tomography or magnetic resonance imaging in 10 (32%).nnnCONCLUSIONSnExtended field-of-view sonography provided the anatomic context of the lesion in its surroundings and allowed precise measurement and tracing of the extended and tubular structures. The method has notable advantages and clinical applications.

Comparison of standard staging protocol and WB-MRI for initial staging of rectal cancer

Methods This retrospective study was approved by our IRB and the requirement for informed consent was waived. A total of 133 patients (M:F=87:46, mean age 62.4 years) who underwent standard protocol (chest, abdomen computed tomography and rectal MRI), WB-MRI (WBT1WI and DWIBS) at 3T for initial staging were included. One attending radiologist reviewed standard protocol and two attending radiologists reviewed WBMRI in consensus. Finally, “true” M staging was obtained using either biopsy or follow-up imaging. Agreement of M-staging for rectal cancer was obtained between standard protocol and WB-MRI, between true M-stage and standard-protocol and WB-MRI.

Recurrent Pyogenic Cholangitis: Pathology, Imaging, and Management by Interventional Radiology

Recurrent pyogenic cholangitis (RPC), also known as oriental cholangiohepatitis, oriental cholangitis, primary cholangitis, and intrahepatic pigment stone disease, is a distinct clinical entity characterized by recurrent attacks of fever, chills, abdominal pain, and jaundice caused by bacterial infection to the biliary tree (Cook et al. 1954; Ong 1962; Seel and Park 1983; Carmona et al. 1984). The intra- and extrahepatic bile ducts show dilatation and stricture, and they may contain calculi, debris consisting mainly of bile pigments, epithelial cells, and mixed exudates, and sometimes frank pus. Intrahepatic stones are usually multiple, soft, muddy, and often tenaciously adherent to the duct wall. These stones cause progressive biliary obstruction and recurrent infection, resulting in the formation of multiple cholangitic abscesses, biliary strictures, and eventually severe destruction, cirrhosis, and portal hypertension (Fan et al. 1991).