Seung Hyup Kim

Preoperative staging of uterine cervical carcinoma: comparison of CT and MRI in 99 patients.

Objective The aim of this study was to compare CT and MRI at 0.5 T in the preoperative staging of uterine cervical cancer in a large series of patients. Materials and Methods Ninety-nine patients with uterine cervical carcinoma underwent CT, MRI, and surgical exploration. Results Both CT and MR findings were compared using surgical-pathologic findings as gold standards. Magnetic resonance imaging was superior to CT in tumor detection (sensitivity 75 vs. 51%, p < 0.005), in parametrial evaluation (accuracy 87 vs. 80%, p < 0.005), in overall tumor staging (accuracy 77 vs. 69%, p < 0.025), and in pelvic lymph node evaluation (accuracy 88 vs. 83%, p < 0.01). Magnetic resonance imaging had an accuracy of 76% in assessment of the thickness of cervical stromal invasion. Conclusion Magnetic resonance imaging was superior to CT in preoperative staging of uterine cervical carcinoma and MRI should be used instead of CT for preoperative staging of this disease.

Detection of deep myometrial invasion in endometrial carcinoma: comparison of transvaginal ultrasound, CT, and MRI.

Objective The aim of this study was to compare the accuracy of transvaginal US (TVUS), CT, and MRI in detecting deep myometrial invasion in endometrial carcinoma. Materials and Methods Twenty-six patients with endometrial carcinoma were evaluated with TVUS, CT, and MRI. The depth of myometrial invasion was estimated in each examination. The invasion depth was categorized into no/superficial and deep and was compared to surgical and pathologic findings. Results At pathologic examination, the depth of myometrial invasion was no/superficial in 16 patients and deep in 10. The accuracy/sensitivity/specificity of TVUS, CT, and MRI in detecting deep myometrial invasion were 69/50/81, 61/40/75, and 89%/90%/88%, respectively. The sensitivity and accuracy of MRI in detecting deep myometrial invasion were significantly higher than those of TVUS and CT (p = 0.049 for both sensitivity and accuracy). Conclusion We recommend MRI instead of CT or TVUS for the evaluation of the depth of myometrial invasion in endometrial carcinoma.

CT and MR findings of Krukenberg tumors : Comparison with primary ovarian tumors

PURPOSE The purposes of this study were to evaluate the CT and MR findings of Krukenberg tumors and to compare them with those of primary ovarian tumors. METHOD This study included 20 patients with Krukenberg tumors and 65 patients with various primary ovarian tumors. CT/MR/both imaging studies were available in 15/1/4 patients with Krukenberg tumor and 31/10/24 patients with primary ovarian tumors, respectively. Imaging findings of the tumors were categorized into three subgroups: a solid mass with intratumoral cysts, a solid mass without intratumoral cysts, and a predominantly cystic mass. RESULTS Among 32 Krukenberg tumors (bilateral in 12 patients), 22 were solid masses with intratumoral cysts, in 14 of which the wall of the intratumoral cysts showed apparently strong contrast enhancement on CT and/or MRI. Six Krukenberg tumors were solid masses without intratumoral cysts, and four were predominantly cystic masses. Imaging findings of 88 primary ovarian tumors (bilateral in 23 patients) were 5 solid masses with intratumoral cysts, 27 solid masses without intratumoral cysts, and 56 predominantly cystic masses. None of the five primary ovarian tumors with solid mass with intratumoral cysts demonstrated apparently strong contrast enhancement of the cyst wall. CONCLUSION Krukenberg tumor should be suspected when one sees solid ovarian tumors containing well demarcated intratumoral cystic lesions, especially if the walls of those cysts demonstrate apparently strong contrast enhancement.

Renal Artery Evaluation: Comparison of Spiral CT Angiography to Intra-arterial DSA

PURPOSE To assess the role of spiral computed tomographic angiography (CTA) in renal artery evaluation. MATERIALS AND METHODS The authors prospectively performed both CTA and intraarterial digital subtraction angiography (IA-DSA) in 50 consecutive patients (24 males and 26 females) who ranged between 9 and 77 years old (mean, 39.3 years), in whom renovascular hypertension was suspected (n = 32) or who were potential renal donors (n = 18). The major scan parameters of CTA were 3-mm collimation, 4-5-mm/sec table speed, and 2-mm reconstruction interval. Both CTA and IA-DSA images were blindly interpreted by two radiologists with respect to the number of accessory renal arteries and the location and severity of renal artery stenosis. RESULTS CTA demonstrated 27 of 28 accessory renal arteries (detection rate = 96%). For the detection of stenoses greater than 50% (37 of 127 renal arteries, at 40 sites), the sensitivity and specificity of CTA were 90% and 97%, respectively. For the detection of stenoses greater than 50% in the main renal arteries (32 of 99 main renal arteries, at 32 sites), the sensitivity and specificity of CTA were 100% and 97%, respectively. CONCLUSION CTA is a reliable and accurate screening modality for the evaluation of renal arteries in patients with suspected renovascular hypertension and in potential renal donors.

Preoperative Magnetic Resonance Imaging Staging of Uterine Cervical Carcinoma: Results of Prospective Study

Objective To determine the accuracy of the preoperative staging of uterine cervical cancer by magnetic resonance (MR) imaging in 115 patients in a prospective study. Methods A prospective study was performed in 115 patients who underwent MR imaging at 1.5 T before surgery or biopsy. Histopathologic findings were correlated with MR imaging results for all patients. Results The accuracy of preoperative tumor staging by MR imaging in the 115 patients was 77%. In terms of the evaluation of parametrial status, this study had an accuracy of 94% and a sensitivity of 38%. The accuracy and sensitivity of MR imaging for vaginal invasion were 81% and 87%, respectively. In terms of lymph node metastasis, this study had an accuracy of 97% and a sensitivity of 36%. Conclusion Magnetic resonance imaging has high accuracy in the preoperative staging of uterine cervical cancer.

Small hepatocellular carcinoma: detection with sonography, computed tomography (CT), angiography and Lipiodol-CT

Seventy-three small hepatocellular carcinomas under 5 cm in diameter in 47 patients were examined by sonography, computed tomography (CT), hepatic angiography and CT after intra-arterial injection of iodized poppy-seed oil (Lipiodol-CT). The imaging techniques that first led to detection of small hepatocellular carcinomas were sonography in 53 cases (72.6%), CT in 10 (13.7%), angiography in eight (11%) and Lipiodol-CT in two (2.7%). Sensitivity for detecting small hepatocellular carcinomas was 73% with sonography, 82% with CT, 86% with angiography and 96% with Lipiodol-CT. As a screening method, sonographic and CT results in detecting small hepatocellular carcinomas were not significantly different (p greater than 0.05). Lipiodol-CT was superior to sonography (p less than 0.01), CT (p less than 0.01) and angiography (p less than 0.05) in detecting small hepatocellular carcinomas. We believe that the combined use of Lipiodol-CT with screening methods such as sonography or CT is indispensable for the accurate detection of small hepatocellular carcinomas.

Renal Angiomyolipoma: Embolotherapy with a Mixture of Alcohol and Iodized Oil

PURPOSE To evaluate the efficacy of superselective embolotherapy of renal angiomyolipomas with a 1:3 mixture of iodized oil and absolute ethanol as embolic material. MATERIALS AND METHODS Fifteen patients with 21 symptomatic renal angiomyolipomas were treated with embolization. The sizes of tumors ranged from 6 cm to 15 cm (mean, 8.6 cm). Six of 15 patients were diagnosed with tuberous sclerosis. The diagnoses of renal angiomyolipoma were made from characteristic computed tomographic findings. All angiomyolipomas were successfully embolized with a 1:3 mixture of iodized oil and absolute ethanol (2-20 mL; mean, 8.5 mL). Patients were followed up from 5 months to 8 years (mean, 35.6 months). The efficacy of embolotherapy was evaluated by symptom-free period, immediate and late complications, and follow-up imaging findings, including changes in tumor size. RESULTS Thirteen patients showed no symptom recurrence during follow-up periods from 3 months to 8 years. Two patients with incomplete embolization required repeated embolization because of the recurrence of perinephric hematoma or other symptoms. Twelve patients experienced mild postembolization syndrome, which subsided with conservative management. A moderate amount of pleural effusion developed in one patient and was managed with percutaneous drainage. No patients developed any severe late complications, hypertension, or renal failure. During the follow-up period, 12 tumors decreased in size, whereas there was no change in eight tumors, and in one tumor imaging follow-up was not available. CONCLUSION Embolization with a 1:3 mixture of iodized oil and absolute ethanol is an effective method of treatment in renal angiomyolipoma with favorable results. But incomplete embolization of angiomyolipoma results in a high incidence of recurrent symptoms due to bleeding.

Segmental Enhancement Inversion at Biphasic Multidetector CT: Characteristic Finding of Small Renal Oncocytoma

PURPOSE To retrospectively determine the usefulness of segmental enhancement inversion during the corticomedullary phase (CMP) and early excretory phase (EEP) of biphasic multidetector computed tomography (CT) in differentiating small renal oncocytoma from renal cell carcinoma (RCC). MATERIALS AND METHODS This retrospective study was institutional review board approved; informed consent was waived. Between January 2004 and December 2006, 98 patients with pathologically confirmed renal masses smaller than 4 cm (10 renal oncocytomas and 88 RCCs) were included in this study. Segmental enhancement inversion was defined as follows: In a mass with two segments showing different degrees of enhancement during CMP, the relatively highly enhanced segment became less enhanced during EEP, whereas the less-enhanced segment during CMP became highly enhanced during EEP. Two experienced radiologists retrospectively assessed the presence of segmental inversion in all masses and measured attenuation with consensus. The Fisher exact test was used to determine the significance of segmental enhancement inversion in differentiating small renal oncocytoma from RCC. RESULTS Eight of 10 renal oncocytomas and only one of 88 RCCs showed segmental inversion during CMP and EEP, which significantly differentiated small renal oncocytomas and RCCs (P < .0001). For differentiating oncocytoma from RCC, segmental inversion was found to have a sensitivity of 80% (eight of 10), a specificity of 99% (87 of 88), a positive predictive value of 89% (eight of nine), and a negative predictive value of 98% (87 of 89). The mean values of the attenuation differences shown by two segments during CMP and EEP were 62.75 HU +/- 36.96 (standard deviation) and -36.88 HU +/- 20.02, respectively. CONCLUSION Segmental enhancement inversion during CMP and EEP was found to be a characteristic enhancement pattern of small renal oncocytoma at biphasic multidetector CT and it may help in differentiating small oncocytoma from RCC. SUPPLEMENTAL MATERIAL http://radiology.rsnajnls.org/cgi/content/full/2522081180/DC1.

MRI for Pretreatment Lymph Node Staging in Uterine Cervical Cancer

OBJECTIVE The purpose of this article is to assess the accuracy of MRI in detecting pelvic and paraaortic lymph node metastasis from uterine cervical cancer using various imaging criteria. CONCLUSION Although MRI analysis resulted in relatively low sensitivity, size and margin (spiculated or lobulated) were useful criteria for predicting lymph node metastasis from cervical cancer.

Tuberculous epididymitis and epididymo-orchitis: sonographic findings.

The findings at scrotal sonography in 10 patients with tuberculous epididymitis and in 2 with nontuberculous epididymitis are presented. In 6 patients with tuberculous epididymitis the testes were also involved (epididymo-orchitis). The most notable sonographic findings of tuberculous epididymitis were an enlarged epididymis, predominantly in the tail portion, and marked heterogeneity of the echo texture of the involved epididymis. Sonographic findings of associated testicular involvement consisted of a diffusely enlarged hypoechoic testis or ill defined focal intratesticular hypoechoic areas, or an irregular margin between the testis and epididymis. The sonographic findings encountered in patients with tuberculous epididymitis appear to be different from those encountered in nontuberculous epididymitis. Sonography might prove helpful in aiding the clinical distinction between these 2 forms of epididymitis and in demonstrating associated testicular involvement in tuberculous epididymitis.