Seong Sook Hong

Correlation of the apparent diffusion coefficiency values on diffusion-weighted imaging with prognostic factors for breast cancer

OBJECTIVEnThe aim of this study was to correlate the apparent diffusion coefficient (ADC) value of breast cancer with prognostic factors.nnnMETHODSn335 patients with invasive ductal carcinoma not otherwise specified (IDC NOS) and ductal carcinoma in situ (DCIS) who underwent breast MRI with diffusion-weighted imaging were included in this study. ADC of breast cancer was calculated using two b factors (0 and 1000 s mm(-2)). Mean ADCs of IDC NOS and DCIS were compared and evaluated. Among cases of IDC NOS, mean ADCs were compared with lymph node status, size and immunochemical prognostic factors using Students t-test. ADC was also correlated with histological grade using the Kruskal-Wallis test.nnnRESULTSnMean ADC of IDC NOS was significantly lower than that of DCIS (p<0.001). However, the mean ADC of histological grade of IDC NOS was not significantly different (p=0.564). Mean ADC of oestrogen receptor (ER)-positive or progesterone receptor (PR)-positive cancer was significantly lower than that of ER-negative or PR-negative cancer (p=0.003 vs p=0.032). Mean ADC of Ki-67 index-positive cancer was significantly lower than that of Ki-67 index-negative cancer (p=0.028). Mean ADC values of cancers with increased microvascular density (MVD) were significantly lower than those of cancer with no MVD increase (p=0.009). No correlations were observed between mean ADC value and human growth factor receptor 2 expression, tumour size and lymph node metastasis.nnnCONCLUSIONnLow ADC value was correlated with positive expression of ER, PR, increased Ki-67 index, and increased MVD of breast cancer.

Safety and Efficacy of Ultrasound-Guided Fiducial Marker Implantation for CyberKnife Radiation Therapy

Objective To evaluate the safety and technical success rate of an ultrasound-guided fiducial marker implantation in preparation for CyberKnife radiation therapy. Materials and Methods We retrospectively reviewed 270 percutaneous ultrasound-guided fiducial marker implantations in 77 patients, which were performed from June 2008 through March 2011. Of 270 implantations, 104 were implanted in metastatic lymph nodes, 96 were in the liver, 39 were in the pancreas, and 31 were in the prostate. During and after the implantation, major and minor procedure-related complications were documented. We defined technical success as the implantation enabling adequate treatment planning and CT simulation. Results The major and minor complication rates were 1% and 21%, respectively. One patient who had an implantation in the liver suffered severe abdominal pain, biloma, and pleural effusion, which were considered as major complication. Abdominal pain was the most common complication in 11 patients (14%). Among nine patients who had markers inserted in the prostate, one had transient hematuria for less than 24 hours, and the other experienced transient voiding difficulty. Of the 270 implantations, 261 were successful (97%). The reasons for unsuccessful implantations included migration of fiducial markers (five implantations, 2%) and failure to discriminate the fiducial markers (three implantations, 1%). Among the unsuccessful implantation cases, six patients required additional procedures (8%). Conclusion The symptomatic complications following ultrasound-guided percutaneous implantation of fiducial markers are relatively low. However, careful consideration of the relatively higher rate of migration and discrimination failure is needed when performing ultrasound-guided percutaneous implantations of fiducial markers.

Radiologic Findings of Mesothelioma at the Tunica Vaginalis

Malignant mesothelioma of the tunica vaginalis testis is a rare, but often fatal, malignancy that usually appears during the fourth decade and has a strong relationship with occupational exposure to asbestos and long-lasting hydrocele. We present a case involving a 36-year-old man without a history of hydrocele, trauma, or exposure to asbestos who developed malignant mesothelioma.

Mini-Gastric Bypass to Control Morbid Obesity and Diabetes Mellitus: What Radiologists Need to Know

Laparoscopic mini-gastric bypass surgery is a safe and simple surgical intervention for treating morbid obesity and diabetes mellitus and is now being performed more frequently. Radiologists must be critical in their postoperative evaluation of these patients. In this pictorial review, we explain and illustrate the surgical technique, normal postoperative anatomy, and associated complications as seen on imaging examinations, including fluoroscopy and computed tomography.

Which anthropometric measurements including visceral fat, subcutaneous fat, body mass index, and waist circumference could predict the urinary stone composition most?

BackgroundAlthough there is growing evidence of relationship between obesity and some specific stone compositions, results were inconsistent. Due to a greater relationship between metabolic syndrome and some specific stone type, obesity measured by body mass index (BMI) has limitation in determining relationship between obesity and stone compositions. The aim of this study was to determine the relationship among BMI, visceral fat, and stone compositions.MethodsWe retrospectively reviewed data of patients with urinary stone removed over a 5xa0year period (2011–2014). Data on patient age, gender, BMI, urinary pH, stone composition, fat volumes (including visceral fat, subcutaneous fat, total fat, waist circumference), and ratio for visceral to total fat using computed tomography based delineation were collected. To figure out the predicting factor while adjusting other confounding factors, discriminant analysis was used.ResultsAmong 262 cases, average age was 52.21xa0years. Average BMI and visceral fat were 25.03xa0cm2 and 124.75xa0cm2, respectively. By chi square test, there was significant (pu2009<u20090.001) difference in stone types according to sex. By ANOVA test, BMI, visceral fat, visceral to subcutaneous fat ratio, the percentage of visceral fat and total fat showed significant association with stone types. By discriminant analysis, visceral fat was proved to be a powerful factor to predict stone composition (structure matrix of visceral fatu2009=u2009−0.735) with 42.0% of predictive value.ConclusionVisceral fat adiposity strongly related with uric acid stone and has better predictive value than BMI or urinary pH to classify the types of stone.

The Relationship Between Urinary Stone Components and Visceral Adipose Tissue Using Computed Tomography–based Fat Delineation

OBJECTIVEnTo determine the relationship between body mass index (BMI), visceral adipose tissue (VAT), and stone components.nnnMETHODSnA cross-sectional study has been done for urinary stone cohort between 2010 and 2012. Data on patients age, gender, BMI, urinary pH, stone components, and VAT using computed tomography-based delineation were collected. Obesity was defined as BMI≥25 kg/m2 or as VAT≥100 cm2. To compare the differences between the types of stones, multinomial logistic regression analyses were conducted.nnnRESULTSnOf 203 cases, 49.3% patients were obese based on BMI, and 65.5% were obese using VAT criteria. Multinomial logistic regression analysis revealed that obesity defined by VAT was found to be associated with uric acid stones compared with calcium phosphate stones (odds ratio [OR] 6.544, 95% confidence interval [CI], P=.030) and mixed calcium oxalate phosphate stones (OR 5.582, 95% CI, P=.038). Similar results were observed in calcium oxalate stones over calcium phosphate stones (OR 2.984, 95% CI, P=.032) and calcium oxalate phosphate stones (OR 2.542, 95% CI, P=.041). On the contrary, obesity defined based on BMI has no correlation over all types of urinary stone components.nnnCONCLUSIONnThis result implies that VAT has a more important role in uric acid and calcium oxalate stone formation than total body fat, represented by BMI.

Acute diverticulitis of the terminal ileum: ultrasonography and CT findings

We describe a rare case of terminal ileal diverticulitis in a 68-year-old female with a day of history Epub ahead of print of right lower quadrant pain and tenderness, mimicking acute appendicitis. Ultrasonography revealed small sac-like out-pouching lesions with increased echogenicity of surrounding fat in thickened terminal ileum, suggesting inflamed diverticula. We diagnosed terminal ileal diverticulitis primarily by ultrasonography. The diagnosis was confirmed by subsequent computed tomography.We describe a rare case of terminal ileal diverticulitis in a 68-year-old female with a day of history of right lower quadrant pain and tenderness, mimicking acute appendicitis. Ultrasonography revealed small sac-like out-pouching lesions with increased echogenicity of surrounding fat in thickened terminal ileum, suggesting inflamed diverticula. We diagnosed terminal ileal diverticulitis primarily by ultrasonography. The diagnosis was confirmed by subsequent computed tomography.

Capsule, septum, and T2 hyperintense foci for differentiation between large hepatocellular carcinoma (≥5 cm) and intrahepatic cholangiocarcinoma on gadoxetic acid MRI

ObjectiveTo determine the added value of capsule, septum, and T2 hyperintense foci for differentiating large hepatocellular carcinoma (HCC; ≥ 5 cm) from intrahepatic cholangiocarcinoma (ICC) using gadoxetic acid MRI.MethodsThe study included 116 patients (94 men, 22 women; mean age, 56.8 years) with surgically confirmed HCCs (nu2009=u200987, 5.0–18.0 cm) or ICCs (nu2009=u200929, 5.0–14.0 cm) who underwent gadoxetic acid MRI. Three observers independently reviewed MRIs in two sessions, examining enhancement patterns only and then adding capsule, septum, and T2 hyperintense foci. Reviewers used a five-point scale to score accuracy, sensitivity, and specificity.ResultsA significant increase was observed in accuracy when ancillary features (96.1–98.3%) were added compared to enhancement pattern only (83.6–88.4%; pu2009≤u20090.02). Sensitivity was significantly increased with combined reading (97.1–98.3%) compared to enhancement features only (81.6–88.5%; pu2009≤u20090.006) for two observers, with no difference in specificity (84.5–89.7% vs. 86.2–98.3%; pu2009>u20090.05). We found substantial to excellent interobserver agreement for ancillary features (0.598–0.976).ConclusionAdding capsule, septum, and T2 hyperintense foci to enhancement patterns for gadoxetic acid MRI increased diagnostic performance for characterizing large HCC by differentiating it from ICC.Key Points• Capsule, septum, and T2 hyperintense foci were useful for characterizing large HCC.• Adding ancillary features to enhancement pattern increased accuracy for diagnosing large HCC.• Interobserver agreement was substantial to excellent for ancillary features.

Reduced field-of-view diffusion-weighted MRI in patients with cervical cancer

OBJECTIVEnDiffusion-weighted imaging (DWI) with reduced field-of-view (FOV) has been shown to provide high spatial resolution with reduced distorsion in the spinal cord, breast, pancreas, and prostate gland. Therefore, we performed this study to evaluate the qualitative image quality and quantitative ADC value of reduced FOV DWI in patients with cervical cancer in comparison with conventional DWI.nnnMETHODSnThis study retrospectively included 22 patients (mean age, 53.9 years) with biopsy-proven cervical cancer who underwent pelvic MR imaging including conventional DWI and reduced FOV DWI before therapy. Two observers independently rated image quality for reduced FOV DWI and conventional DWI regarding anatomic detail, lesion conspicuity, presence of artifacts, and overall image quality using the following 4-point scale. Quantitative analysis was performed by measuring the ADC value of the tumor. The Wilcoxon signed-rank test was used to compare qualitative scores and mean ADC value between two DWI sequences.nnnRESULTSnReduced FOV DWI achieved significantly better anatomic detail, lesion conspicuity, presence of artifacts, and overall image quality compared to conventional DWI (p < 0.05). There was no significant difference in mean tumor ADC value between the two DWI sequences (0.990 × 10-3 mm2xa0s-1xa0±xa00.364 at reduced FOV DWI vs 1.253 × 10-3 mm2xa0s-1xa0±xa00.387 at conventional DWI) (p = 0.067).nnnCONCLUSIONnReduced FOV DWI shows better image quality in terms of anatomic detail and lesion conspicuity with fewer artifacts compared to conventional DWI. Advance in knowledge: Reduced FOV DWI may enhance diagnostic performance for evaluation of cervical cancer.

The many faces of Meckel's diverticulum and its complications.

Meckels diverticulum is the most frequent congenital malformation of the gastrointestinal tract, occurring in 2% of the general population. Meckels diverticulum is usually asymptomatic and found incidentally. However, the lifetime risk of complications is 4–40%. In this essay, we describe the clinical and imaging findings in 12 cases of Meckels diverticula with complications over a 5‐year period, which were confirmed pathologically. The major complications of Meckels diverticulum include gastrointestinal bleeding, bowel obstruction, perforation and inflammation. Small bowel follow‐through (SBFT), computed tomography (CT) including CT enterography and RI scintigraphy can be used to show typical imaging features of Meckels diverticulum and its complications. Knowledge of the clinical and radiologic findings of Meckels diverticulum can aid in the early and accurate diagnosis of this anomaly and its complications.