Min Hoan Moon

Segmental Enhancement Inversion of Small Renal Oncocytoma: Differences in Prevalence According to Tumor Size

OBJECTIVE The purpose of this study was to retrospectively assess the prevalence of segmental enhancement inversion of small renal oncocytomas according to tumor size. MATERIALS AND METHODS Thirty-three patients (19 men, 14 women; mean age, 61 years; range, 40-74 years) with 33 oncocytomas diagnosed at surgical resection who had undergone contrast-enhanced biphasic CT between January 2000 and December 2011 were included. CT scans were analyzed by two radiologists blinded to the specifics of the pathology report for size, presence of segmental enhancement inversion, enhancement pattern, and homogeneity. Segmental enhancement inversion was present when a renal mass was divided into two differently enhanced segments in the corticomedullary phase (30-40 seconds after contrast injection) with the degree of enhancement reversed in the nephrographic phase (120-180 seconds after contrast injection). The masses were further assessed for fibrous septa, cystic change, hemorrhage, and necrosis. For statistical analysis, the Pearson chi-square test and linear regression were used to evaluate the relation between the prevalence of segmental enhancement inversion and tumor size or pathologic changes. RESULTS The mean diameter of 33 renal oncocytomas was 2.65 cm (range, 0.8-4.8 cm). There was no significant linear trend according to size (p = 0.762), although segmental enhancement inversion was significantly (p = 0.006) more common (10/12) in tumors measuring 1.5-2.9 cm. Pathologic change was present in 14 oncocytomas. There was no significant linear trend according to size (p = 0.068), but 2.5-cm and larger tumors had a significantly higher prevalence (57.9%) (p = 0.036). Segmental enhancement inversion was more common (13/19) in tumors without pathologic change (p = 0.024). CONCLUSION Segmental enhancement inversion was a characteristic finding in our series of small renal oncocytomas and was more common in tumors measuring 1.5-2.9 cm. Pathologic changes such as central scar were more common in oncocytomas larger than 2.5 cm and may be related to the low occurrence of segmental enhancement inversion.

Serial Transvaginal Sonographic Findings of Cervical Ectopic Pregnancy Treated With High-Dose Methotrexate

Objective. We analyzed transvaginal sonographic findings from patients with cervical ectopic pregnancies treated with high‐dose methotrexate (MTX). Methods. This was a retrospective analysis of cervical pregnancies diagnosed in our institution from 1996 through 2006. We divided the cases into an MTX treatment group and a surgical treatment group. We included cases treated with high‐dose MTX alone. We analyzed 9 cervical ectopic pregnancies treated with MTX, which was injected intravascularly at 100 mg/m2 plus 200 mg/m2 in 500 mL of a normal saline solution with folinic acid rescue. The gestational sac sizes and serum human chorionic gonadotropin (hCG) levels were periodically monitored to determine the resolution status. Results. Fifty cervical pregnancies were diagnosed during the study period. Thirty cases were treated with MTX, and 20 were treated with surgical procedures. Among the 30 cases in the MTX treatment group, 9 had high‐dose MTX injection without surgical procedures. Cervical mass regression appeared at a median of 40 (range, 10–88) days after treatment, whereas the serum hCG level decreased at a median of 14 (range, 9–17) days after treatment. The median time to complete regression of the cervical mass was 86 (range, 48–141) days, and the median time to complete regression of the serum hCG level was 68 (range, 19–143) days. Cervical pregnancy was noted as a gestational sac at first but coexisted with a mixed echoic lesion 19 days after treatment. At 33 days after treatment, the cervical pregnancy was completely replaced by the mixed echoic lesion. Conclusions. Resolution of the cervical mass on sonography lagged far behind resolution of the serum hCG level. The cervical mass evolved from a gestational sac into a mixed echoic lesion on serial transvaginal sonography.

Diagnostic potential of three-dimensional ultrasound-based virtual cystoscopy: An experimental study using pig bladders

Objective:We sought to investigate the feasibility of 3-dimenstional ultrasound (3D US)-based virtual cystoscopy in experimentally designed bladder phantoms using pig bladders. Materials and Methods:Ten bladder phantoms with simulated polypoid tumors of different sizes were constructed to provide 3D US-based virtual cystoscopic images. The simulated polypoid tumors were divided by their location into 2 groups: group 1 included the polyps on the anterior and posterior walls, and group 2 included those on the remaining 4 walls. Two genitourinary radiologists independently interpreted the virtual cystoscopic images, with a consensus reached for cases with discrepant results. Results:In a consensus reading, 3D US-based virtual cystoscopy detected 44 (91.7%) of 48 polypoid lesions. All lesions (n = 4) with false-negative results were 5 mm or smaller in diameter, and so the detection rate was 81.8% (18/22) for lesions 5 mm or smaller whereas it was 100% (26/26) for lesions larger than 5 mm. The detection rate for group 1 (93.8%) was not significantly different from that for group 2 (90.6%; P = 1.000). There were 7 false-positive lesions. Of these, 5 lesions were seen in group 1, and reverberation artifacts were the most common source of these errors (n = 4). Blind areas were present in 19 (31.7%) of 60 virtual cystoscopic images and were seen only in group 2. The differences in the false-positive rate and the incidence of blind area were statistically significant between both groups (P = 0.036, P = 0.00008, respectively). Conclusion:3D US-based virtual cystoscopy may have diagnostic potential in the detection of polypoid bladder tumors.

Outcome Prediction for Treatment of Tubal Pregnancy Using an Intramuscular Methotrexate Protocol

Objective. The purpose of this study was to determine the outcome predictors of intramuscular methotrexate therapy for tubal pregnancy. Methods. This retrospective study was approved by our Institutional Review Board. Fifty‐five consecutive women (mean age, 31 years; range, 18–45 years) who were treated with intramuscular methotrexate therapy for tubal pregnancy were retrospectively reviewed. Clinical data (maternal age, gestational age, and serum β‐human chorionic gonadotropin [β‐hCG] level) and transvaginal sonographic findings (size, gross appearance, presence of a gestational product or heartbeat, and amount of the fluid collection) were assessed as potential predictors of the treatment outcome. The Fisher exact test was used for categorical variables, and the Wilcoxon signed rank sum test was used for continuous variables. Treatment failure was defined as the need for surgical intervention. Results. Women with successful treatment differed from women with unsuccessful treatment with respect to the serum β‐hCG level, the gross appearance of tubal pregnancy, and the presence of a gestational product such as a yolk sac or embryo (P <.001; P = .01; and P =.008, respectively). All of the tubal pregnancies with a gestational product appeared as a tubal ring on transvaginal sonography. A high serum β‐hCG level of greater than 2390 mIU/mL and a transvaginal sonographic appearance of a tubal ring were the important predictors associated with failure of intramuscular methotrexate therapy for tubal pregnancy. Conclusions. Measurement of the serum β‐hCG level and evaluation of the transvaginal sonographic appearance of tubal pregnancy are helpful for predicting treatment outcomes in women who receive intramuscular methotrexate therapy for tubal pregnancy.

Diagnostic Value of Integrated PET / MRI for Detection and Localization of Prostate Cancer : Comparative Study of

To evaluate the diagnostic value of integrated positron emission tomography/magnetic resonance imaging (PET/MRI) compared with conventional multiparametric MRI and PET/computed tomography (CT) for the detailed and accurate segmental detection/localization of prostate cancer.

P02.68: Various prenatal sonographic findings of normal and abnormal fetal genitalia

regression of the lesion. As it regards the other 9 cases, 4 cases with cyst diameter less than 5cm were aspirated in utero. Progressive decrease in size and subsequent prenatal or postnatal regression was observed. The remaining 5 cases were submitted to postnatal operative laparoscopy. 1 case among those treated in utero underwent premature rupture of membranes and 1 case showed preterm labor. Conclusion: Many complications associated with fetal and neonatal ovarian cysts have been reported, including gastrointestinal obstruction or perforation, ascites, polyhydramnios, cyst rupture, hemorrhage and torsion. Nevertheless, in utero procedures, make the patients at risk of rupture of membranes, bleeding, intrauterine infection and premature labor. Criteria for management are still debated. A controversial about conservative versus surgical therapy remains. Therapeutic approach should be personalized in order to considered gestational age, size of the cyst, the presence of complications. These considerations will be extensively discussed.

P02.57: Compensatory hyperplasia of the contralateral kidney: usefulness in the differential diagnosis of invisible single kidney in the fetus

by obstetric ultrasound. A 19-year-old primigravid woman was referred at 38 weeks of gestation for an obstetric ultrasound examination because of upper abdominal calcifications. Sonographic scan revealed a live fetus appropriate to the gestational age and no apparent structural abnormalities except for multiple non-shadowing echogenic mass within the upper abdomen. The echogenic mass was located only at fetal gallbladder region. Fetal gallstones were suspected and the couple was informed about the situation. The woman gave birth to a healthy, 3500 g, female newborn at 40 weeks. Postnatal ultrasound showed a dilatated gallbladder and multiple echogenic gallstones. Physical examination as well as laboratory studies were all within normal range. Conservative treatment with ursodeoxycholic acid has been initiated and follow-up scheduled. The baby is now two months of age and is doing well. We conclude that fetal gallstones should be considered in the differential diagnosis of localized calcifications within the fetal liver. Conservative management with ursodeoxycholic acid should be the choice of treatment.

P04.20: Pre & postnatal imaging findings of fetal neoplasms

by conventional 2D ultrasound, it was confirmed by another senior sonographer. 3D color and power Doppler were applied to delineate vascular anatomy of this area subsequently. Confirmation of antenatal diagnosis was made in all newborns. Results: Four fetuses with PRUV were detected in these 1067 cases. The estimate incidence is about 0.375% (1 : 267). Ductus venosus were found in all of the fetuses. All of them had no other additional malformation. Discussion: The diagnosis of persistent right umbilical vein was easily made in a transverse section of the fetal abdomen with ultrasound findings of the portal vein towards to the stomach and fetal gallbladder located medially to the umbilical vein by twodimensional sonography. The incidence of PRUV in our patients was similar to other articles. Reconstruction of portal system in fetus with PRUV by 3-dimensional ultrasound was easy to delineate the vascular anatomy of this area. We proposed this modality can be used to help to understand the vascular anatomy of the fetus with PRUV.

P04.21: Broad spectrum of ultrasound (US) findings of hydatidiform mole and molar mimicker

by conventional 2D ultrasound, it was confirmed by another senior sonographer. 3D color and power Doppler were applied to delineate vascular anatomy of this area subsequently. Confirmation of antenatal diagnosis was made in all newborns. Results: Four fetuses with PRUV were detected in these 1067 cases. The estimate incidence is about 0.375% (1 : 267). Ductus venosus were found in all of the fetuses. All of them had no other additional malformation. Discussion: The diagnosis of persistent right umbilical vein was easily made in a transverse section of the fetal abdomen with ultrasound findings of the portal vein towards to the stomach and fetal gallbladder located medially to the umbilical vein by twodimensional sonography. The incidence of PRUV in our patients was similar to other articles. Reconstruction of portal system in fetus with PRUV by 3-dimensional ultrasound was easy to delineate the vascular anatomy of this area. We proposed this modality can be used to help to understand the vascular anatomy of the fetus with PRUV.

OC24.07: Usefulness of measurement of the fetal thymus in the diagnosis of IUGR: a preliminary result

Comment: In CHD fetuses, increased DV Index, associated with reduced forward ductal flow to the right atrium, well correlates with increased right atrial pressure occurring in right outflow tract obstruction or in hypoplastic left ventricle. On the contrary in IUGR fetuses with increased DV Index and compensatory ductal dilatation, normal left cardiac output suggests normal myocardial function due to a maintained or even increased forward flow through the DV to right atrium.