Jong Woon Song

Sonography of Patients with Hemiplegic Shoulder Pain After Stroke: Correlation with Motor Recovery Stage

OBJECTIVE This study was performed to clarify the cause of shoulder pain using sonography and to evaluate the relationship between the sonographic findings and the motor recovery stages in stroke patients with hemiplegic shoulder pain. SUBJECTS AND METHODS Between March 2005 and January 2007, 71 consecutive stroke patients with hemiplegic shoulder pain underwent shoulder sonography. For comparison, bilateral shoulder joints were evaluated in 20 of the 71 patients. The interpretations of the sonographic findings were based on the findings of previously published studies. Whether a correlation existed between the sonographic findings and the motor recovery stages was determined. RESULTS Subacromial-subdeltoid (SA-SD) bursal effusion (n = 36) was the most common abnormality seen on sonography. Tendinosis of the supraspinatus tendon (n = 7), partial-thickness tear of the supraspinatus tendon (n = 6), and full-thickness tear of the supraspinatus tendon (n = 2) were also noted. Biceps tendon sheath effusion (n = 39) and normal findings without any biceps tendon sheath effusion (n = 13) were detected. Clinicians managed each patients shoulder pain on the basis of the sonographic findings. No statistically significant correlation was found between the grade of sonographic findings and Brunnstrom stage (p = 0.183). A shoulder with hemiplegia had a higher number of abnormal sonographic findings than a noninvolved shoulder (p = 0.007). CONCLUSION The cause of shoulder pain was variable and there was no correlation between the stages of motor recovery and the grades of sonographic findings in patients with hemiplegic shoulder pain.

CT and MRI of fibrous dysplasia of the spine

OBJECTIVES The purpose of this study was to present the CT and MRI findings of patients with fibrous dysplasia (FD) of the spine. METHODS Among the patients with pathologically proven skeletal FD, 12 (8 males and 4 females; mean age, 43 years) who were evaluated with either spine CT or MRI were included. The number and location of the involved vertebral segments, the presence of lytic lesions, ground-glass opacity (GGO), an expansile nature, cortical disruption, a sclerotic rim, a decrease in body height and contour deformity were examined on CT scans (n=12), while signal intensity, enhancement patterns and the presence of a dark signal rim on the lesion were examined using MRI (n=9). RESULTS Nine patients had polyostotic FD, including one with an isolated spinal localisation, while three had monostotic FD. An expansile nature (n=3) and osteolytic lesions with GGO (n=3) were seen. On CT images, GGO was noted in all patients. An expansile nature (n=11) and presence of lytic lesions (n=11) were noted. A decrease in body height (n=9) and sclerotic rim formation (n=9) were indicated. Contour deformities were visible in six patients. The MRI findings were non-specific. Dark signal rims were visible on MRI in seven patients. CONCLUSION Typical imaging findings of extraspinal FD were noted on spine CT scans. These characteristic CT imaging findings of spinal FD may be helpful in differentiating FD from other common spine diseases.

CT and MRI findings of calcified spinal meningiomas: correlation with pathological findings.

ObjectiveThis study was designed to present characteristic CT and MR findings of calcified spinal meningiomas that correlate with pathological findings and to assess the efficacy of CT for the detection of calcifications within a mass in comparison to MRI.Materials and methodsBetween 1998 and 2009, 10 out of 11 patients who had pathologically confirmed psammomatous meningiomas showed gross calcifications on CT images and were included in this study. On CT scans of the 10 patients, the distribution pattern, morphology and number of calcifications within masses were evaluated. MRI was performed in seven patients and signal intensities of masses were assessed. The pathological results analyzed semi-quantitatively were compared with the density or the size of calcifications within a mass as seen on a CT scan.ResultsSeven of 10 masses were located at the thoracic spine level. Eight masses had intradural locations. The other two masses had extradural locations. Four masses were completely calcified based on standard radiographs and CT. Symptoms duration, the size of the mass and size or number of calcifications within a mass had no correlation. The location, size, and distribution pattern of calcifications within masses were variable. On MR images, signal intensity of calcified tumor varied on all imaging sequences. All the masses enhanced after injection of intravenous contrast material.ConclusionA calcified meningioma should be first suggested when extradural or intradural masses located in the spine contain calcifications regardless of the size or pattern as depicted on CT, especially in the presence of enhancement as seen on MR images.

Comparison of three-dimensional isotropic and conventional MR arthrography with respect to the diagnosis of rotator cuff and labral lesions: Focus on isotropic fat-suppressed proton density and VIBE sequences

AIM To compare the diagnostic accuracies of three-dimensional (3D) isotropic magnetic resonance arthrography (MRA) using fat-suppressed proton density (PD) or volume interpolated breath-hold examination (VIBE) sequences with that of conventional MRA for the diagnosis of rotator cuff and labral lesions. MATERIALS AND METHODS Eighty-six patients who underwent arthroscopic surgery were included. 3D isotropic sequences were performed in the axial plane using fat-suppressed PD (group A) in 53 patients and using VIBE (group B) in 33 patients. Reformatted images were obtained corresponding to conventional images, and evaluated for the presence of labral and rotator cuff lesions using conventional and 3D isotropic sequences. The diagnostic performances of each sequence were determined using arthroscopic findings as the standard. RESULTS Good to excellent interobserver agreements were obtained for both 3D isotropic sequences for the evaluation of rotator cuff and labral lesions. Excellent agreement was found between two-dimensional (2D) and 3D isotropic MRA, except for supraspinatus tendon (SST) tears by both readers and for subscapularis tendon (SCT) tears by reader 2 in group B. 2D MRA and 3D isotropic sequences had high diagnostic performances for rotator and labral tears, and the difference between the two imaging methods was insignificant. CONCLUSIONS The diagnostic performances of 3D isotropic VIBE and PD sequences were similar to those of 2D MRA.

Immediate Break-Down of Blood Retinal Barrier by Infusion of Triolein Emulsion Observed by Fluorescein Angiography

PURPOSE The purpose of this study is to investigate immediate changes in the blood retinal barrier (BRB) after the infusion of triolein emulsion. MATERIALS AND METHODS Triolein emulsion was infused into the carotid artery of 12 cats to induce experimental fat embolism. The injection of fluorescein dye into the carotid artery followed immediately. Early retinal vascular flow was recorded by a fluorescein angiography (FA) video, and then a FA photograph was obtained up to 30 min after the injection. Leakage of the dye in the choroidal or retinal vessels was evaluated. RESULTS In the early phase, multifocal non-perfuse areas were noted in all cats due to embolism by triolein emulsion, which was released by blood perfusion in the late phase. Perfusion defects persisted in the retina of five cats and in the choroid of four cats. Leakage of the dye through the retinal vessels was seen in five cats (42%) in the early phase and in nine cats (75%) in the late phase. In the choroid, leakage of the dye was seen in seven cats (58%) in the early phase and in all cats (100%) in the late phase. CONCLUSIONS The inner and outer BRB was opened immediately after infusion of triolein emulsion into the carotid artery. Embolism by triolein emulsion was readily resolved due to the liquid nature of triolein.

Magnetic Resonance Imaging Findings of Early Spondylodiscitis: Interpretive Challenges and Atypical Findings

MR findings of early infectious spondylodiscitis are non-specific and may be confused with those of other conditions. Therefore, it is important to recognize early MR signs of conditions, such as inappreciable cortical changes in endplates, confusing marrow signal intensities of vertebral bodies, and inflammatory changes in paraspinal soft tissues, and subligamentous and epidural spaces. In addition, appreciation of direct inoculation, such as in iatrogenic spondylodiscitis may be important, because the proportion of patients who have undergone recent spine surgery or a spinal procedure is increasing. In this review, the authors focus on the MR findings of early spondylodiscitis, atypical findings of iatrogenic infection, and the differentiation between spondylodiscitis and other disease entities mimicking infection.

Environmental lung diseases: Clinical and imaging findings

Environmental lung diseases are caused by exposure to adverse environmental conditions, such as atmospheric pressure changes or the ingestion or inhalation of toxic agents. The development of environmental lung diseases depends on the intensity and duration of exposure, the physiological and biological susceptibility of the host, and the toxic effects of the adverse environmental conditions encountered. A combination of clinical features, related exposure history, imaging findings, and a review of previous reports that support an association between exposure and the disease process is required for diagnosis.

Analyses of short-term follow-up MRI and PET-CT for evaluation of residual tumour after inadequate primary resection of malignant soft-tissue tumours

AIM To differentiate remnant tumour from postoperative changes on short-term follow-up magnetic resonance imaging (MRI) or combined positron-emission tomography (PET) and computed tomography (CT) after inadequate primary resection of malignant soft-tissue tumours. MATERIALS AND METHODS From January 2007 through September 2010, 35 patients (18 women and 17 men; mean age 48 years; age range 18-78 years) who underwent MRI and PET-CT within 64 days after surgery for malignant soft-tissue tumours were included. MRI images were assessed for the following findings: the presence of delineated enhancing portions; fascial thickening; and fluid or haematomas with measurable wall thickening. The PET-CT data were analysed using the standardized uptake value (SUV) and the uptake pattern. RESULTS The correlation of tumour grade and the presence of remnant tumour was significant (p = 0.026). After re-excision, remnant tumour was demonstrated in 15 patients and no tumour cells were discovered in 20 patients. The finding of focally delineated enhancing portions on MRI images and the SUVmax on PET-CT analysis were significantly correlated with the remnant tumour (each p = 0.001 and p = 0.036). CONCLUSIONS To evaluate the presence of remnant tumour after inadequate excision of malignant soft-tissue tumours, an MRI finding of a focally enhancing area and an SUVmax of >2 on PET-CT might be helpful factors. The coexistence of these two findings would be even more helpful for the detection of residual tumours.

Short-term follow-up MRI after unplanned resection of malignant soft-tissue tumours; quantitative measurements on dynamic contrast enhanced and diffusion-weighted MR images

OBJECTIVE To determine the diagnostic availability of dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) MR images for evaluating residual tumours at short-term follow-up after unplanned excision of malignant soft-tissue tumours. METHODS From January 2013 to September 2014, 38 patients underwent first follow-up MRI, including DCE and DW imaging (DWI), within 3 months of unplanned malignant soft-tissue tumour excision. The presence or absence of definite nodule formation, focal fluid/haematoma collection, oedema and fascial thickening around or at tumour beds were evaluated using conventional MR images. The volume transfer constant between blood plasma and extracellular/extravascular space (EES) (Ktrans), rate constant between EES and blood plasma (Kep), volume of EES space per unit volume of tissue and initial area under the concentration curve (iAUC) values with time-concentration curve (TCC) plots were obtained on DCE images, and apparent diffusion coefficient (ADC) values were measured on ADC maps. All data were statistically analyzed. RESULTS Of the 21 patients who underwent re-excision, 12 patients had a residual tumor and 9 did not. All conventional MRI variables, except definite nodule formation, were insignificantly related to the presence of residual tumour. However, ADC values were found to be significantly associated with the presence of residual tumour, as were the DCE MRI variables, Ktrans, Kep and iAUC. In particular, TCC pattern and Kep were most significantly associated with residual tumour. CONCLUSION Additional DCE images may be useful for determining the presence of residual tumours in tumour beds during short-term follow-up after inadequate malignant soft-tissue tumour excision. ADVANCES IN KNOWLEDGE The addition of DCE MRI and quantitative analysis of the images obtained might be useful for determining the presence of residual tumour in a tumour bed during short-term follow-up after inadequate excision of a malignant soft-tissue tumour, although DWI was also found to be helpful.

Intra-arterial delivery of triolein emulsion increases vascular permeability in skeletal muscles of rabbits

BackgroundTo test the hypothesis that triolein emulsion will increase vascular permeability of skeletal muscle.MethodsTriolein emulsion was infused into the superficial femoral artery in rabbits (triolein group, n = 12). As a control, saline was infused (saline group, n = 18). Pre- and post-contrast T1-weighted MR images were obtained two hours after infusion. The MR images were qualitatively and quantitatively evaluated by assessing the contrast enhancement of the ipsilateral muscles. Histologic examination was performed in all rabbits.ResultsThe ipsilateral muscles of the rabbits in the triolein group showed contrast enhancement, as opposed to in the ipsilateral muscles of the rabbits in the saline group. The contrast enhancement of the lesions was statistically significant (p < 0.001). Histologic findings showed that most examination areas of the triolein and saline groups had a normal appearance.ConclusionRabbit thigh muscle revealed significantly increased vascular permeability with triolein emulsion; this was clearly demonstrated on the postcontrast MR images.