Jung Kyu Ryu

Color Doppler Twinkling Artifacts in Various Conditions During Abdominal and Pelvic Sonography

Objective. The aims of this study were to describe the mechanisms likely to be responsible for color Doppler twinkling artifacts and their associated machine factors and to illustrate the various conditions that cause twinkling artifacts and those pitfalls. Methods. We evaluated various sonographic machine‐associated factors that influence artifact appearance and identified various conditions that display twinkling artifacts during abdominal and pelvic sonography. Results. The presence of twinkling artifacts was found to be dependent on focal zones, gray scale gains, color write priorities, and pulse repetition frequencies. Twinkling artifacts were found to be associated with calcified lesions in the liver, gallbladder adenomyomatosis, hepatic bile duct hamartoma, gallstones and choledocholithiasis, chronic pancreatitis, urinary stones, encrusted indwelling urinary stents, bowel gas, and metallic foreign bodies. However, some of the twinkling artifacts were found to be associated with false‐negative and ‐positive results. Conclusions. Color Doppler twinkling artifacts are additional useful sonographic signs in the diagnosis of calcified lesions, urinary and biliary stones, gallbladder adenomyomatosis, and some miscellaneous conditions.

Sonographic Findings of an Eccrine Spiradenoma : Case Report and Literature Review

An eccrine spiradenoma is a rare benign dermal tumor of the sweat gland. It is frequently solitary and presents as a small lesion (usually <1 cm) in the cutis and the subcutaneous tissue. 1 Because of its rare incidence and the lack of imaging workups for small superficial soft tissue nodules, few cases describing the imaging findings of an eccrine spiradenoma and other tumors of the sweat glands have been reported. We report the sonographic findings in a case of an eccrine spiradenoma that originated from the upper arm and discuss the previously reported imaging findings of sweat gland tumors.

Does Computed Tomography Have Any Additional Value After Sonography in Patients With Suspected Acute Appendicitis

The purpose of this study was to evaluate the additional value of supplementary computed tomography (CT) after sonography for diagnosing acute appendicitis.

Sonographic Appearances of Small Organizing Hematomas and Thrombi Mimicking Superficial Soft Tissue Tumors

We retrospectively reviewed 2 cases of organizing hematomas and 2 cases of intravascular organizing thrombi and investigated correlations between sonographic and pathologic findings. In all 4 cases, a well‐defined hypoechoic heterogeneous mass with surrounding increased echogenicity was evident in the subcutaneous fat layer. Organizing hematomas and thrombi have sonographic features similar to those of benign‐looking soft tissue tumors. These lesions should therefore be considered in the differential diagnosis of superficial soft tissue masses.

Benefit of adding digital breast tomosynthesis to digital mammography for breast cancer screening focused on cancer characteristics: a meta-analysis

PurposeWe evaluated the benefit of adding digital breast tomosynthesis (DBT) to full-field digital mammography (FFDM) compared to FFDM alone for breast cancer detection, focusing on cancer characteristics.MethodsWe searched electronic databases and relevant references for published studies comparing DBT plus FFDM to FFDM alone for breast cancer screening. Pooled risk ratios (RRs) for various pathologic findings were determined using random effects models.ResultsEleven eligible studies were included. Pooled RRs showed a greater cancer detection for DBT plus FFDM than for FFDM alone for invasive cancer (1.327; 95% CI, 1.168–1.508), stage T1 (1.388; 95% CI, 1.137–1.695), nodal-negative (1.451; 95% CI, 1.209–1.742), all histologic grades (grade I, 1.812; grade II/III, 1.403), and histologic types of invasive cancer (ductal, 1.437; lobular, 1.901). However, adding DBT did not increase for detection of carcinoma in situ (1.198; 95% CI, 0.942–1.524), stage ≥T2 (1.391; 95% CI, 0.895–2.163), or nodal-positive cancer (1.336; 95% CI, 0.921–1.938). Heterogeneity among studies was not significant in any subset analysis.ConclusionsAdding DBT to FFDM enabled detection of early invasive breast cancer that might have been missed with FFDM alone. Knowing which cancer characteristic DBT detects may allow it to play a complementary role in predicting long-term patient outcomes and facilitate treatment planning.

The roles of the liver and pancreas in renal nutcracker syndrome

INTRODUCTION To assess the frequency and significance of presence of the liver and pancreas at the left renal vein (LRV) level in patients with suspected renal nutcracker syndrome (NCS). MATERIALS AND METHODS We included 101 patients with hematuria who underwent urography three-dimensional CT between April 2009 and November 2013. These patients were divided into NCS (n=25) and non-NCS (n=76) patients according to the following CT criteria: (1) the presence of beak sign and (2) hilar-aortomesenteric left renal vein diameter ratio >4. Patients were grouped according to the presence of the liver and pancreas at the LRV: group LP (both liver and pancreas), group L (only liver), group P (only pancreas), and group O (neither liver nor pancreas). The difference in the frequencies of groups was analyzed between NCS and non-NCS patients. Multivariate analysis was used to determine the independent factors between NCS and non-NCS patients. RESULTS The frequencies of group LP, group L, group P, and group O in NCS vs. non-NCS were 88% vs. 5.3% (p<0.001), 4.0% vs. 2.6% (p=0.75), 4.0% vs. 11.8% (p=0.45), 4.0% vs. 80.3% (p<0.001), respectively. Multivariate analysis demonstrated that group was a predictor for differential diagnosis between NCS and non-NCS (p=0.022), and group LP was an independent factor for the presence of NCS (odds ratio, 43.8; 95% confidence interval, 3.8-500.3; p<0.002; reference, group O). CONCLUSION The presence of the liver and pancreas at the level of the LRV was frequently found in NCS and was the independent factor for NCS.

Sonographic findings of inguinal endometriosis.

Objective. The purpose of this series was to describe the sonographic findings of inguinal endometriosis. Methods. This was a retrospective analysis of 3 cases of inguinal endometriosis. The following gray scale and color Doppler sonographic features were analyzed: size, shape, echogenicity, and blood flow within inguinal endometriosis. Results. The size of inguinal endometriosis ranged from 3.1 to 4.2 cm (mean, 3.7 cm). All 3 cases were cystic lesions. Two of 3 cases were lesions with internal septa. On color Doppler sonography, 1 of the 3 cases showed a few flow signals within the lesion, whereas in 2 of the 3 lesions, no blood flow could be identified within the lesions. Conclusions. Although the sonographic features of inguinal endometriosis may be variable, endometriosis should be included in the differential diagnosis when unilocular and multilocular cystic masses are seen on sonography.

Color Doppler Twinkling Artifacts in Small-Bowel Bezoars

Small‐bowel bezoars usually form in the stomach and may subsequently cause small‐bowel obstruction. Bezoars associated with small‐bowel obstruction have been accurately diagnosed by computed tomography, although some case reports have described the specific sonographic findings of small‐bowel bezoars. Bezoars can be overlooked by sonographic examination if a dilated small‐bowel loop contains a large amount of air. Twinkling artifacts on color Doppler images appear as rapidly fluctuating red and blue signals behind certain strongly reflecting structures. In this series, we hypothesize that twinkling artifacts might appear in small‐bowel bezoars, and we describe the presence of twinkling artifacts in 3 cases of small‐bowel bezoars presenting as small‐bowel obstruction.

Gallbladder carcinoma: causes of misdiagnosis at CT

Gallbladder carcinomas can present with varied imaging features on computed tomography. The three major imaging features include (1) focal or diffuse wall thickening with or without irregularity of the gallbladder; (2) polypoidal intraluminal mass; and (3) large mass obscuring and replacing the gallbladder, often extending to the liver. Patterns of wall thickening or polypoid growth are often confused with various benign gallbladder diseases due to overlap of imaging findings. Moreover, gallbladder carcinomas that coexist with benign gallbladder diseases make accurate preoperative diagnosis more difficult. Recently, high-resolution ultrasound (HRUS) has been regarded as a problem-solving tool for gallbladder diseases. In this article, we will illustrate various imaging presentations of gallbladder cancer, along with imaging pitfalls and recently updated HRUS findings.

Inguinal Endometriosis Presenting as a Multicystic Mass on Sonography

Endometriosis is a common gynecologic disorder in womens ovaries during their reproductive years. However, it may also occur in the gastrointestinal tract, urinary tract, chest, skin, umbilicus, abdominal wall, and inguinal canal.1 Although several cases of inguinal endometriosis have been described in the literature, its sonographic findings have rarely been reported. 2-6 In addition, most of the reported cases of inguinal endometriosis were seen as solid hypoechoic masses on sonography. 2-6 To the best of our knowledge, cystic appearances of inguinal endometriosis on sonography have not been described. We report the sonographic findings of a case of inguinal endometriosis presenting as a multicystic lesion.