Suk Keu Yeom

An Innovative Ultrasound Technique for Evaluation of Tumor Vascularity in Breast Cancers: Superb Micro-Vascular Imaging

Tumor vascularity is an important indicator for differential diagnosis, tumor growth, and prognosis. Superb micro-vascular imaging (SMI) is an innovative ultrasound technique for vascular examination that uses a multidimensional filter to eliminate clutter and preserve extremely low-velocity flows. Theoretically, SMI could depict more vessels and more detailed vascular morphology, due to the increased sensitivity of slow blood flow. Here, we report the early experience of using SMI in 21 breast cancer patients. We evaluated tumor vascular features in breast cancer and compared SMI and conventional color or power Doppler imaging. SMI was superior to color or power Doppler imaging in detecting tumor vessels, the details of vessel morphology, and both peripheral and central vascular distribution. In conclusion, SMI is a promising ultrasound technique for evaluating microvascular information of breast cancers.

Biliary reflux detection in anomalous union of the pancreatico- biliary duct patients

AIM To demonstrate the imaging findings of biliopancreatic and pancreatico-biliary reflux in patients with anomalous union of the pancreatico-biliary duct (AUPBD) on gadoxetic acid-enhanced functional magnetic resonance cholangiography (fMRC). METHODS This study included six consecutive patients (two men and four women; mean age 47.5 years) with AUPBD. All subjects underwent endoscopic retrograde cholangiopancreatography (ERCP); one subject also underwent bile sampling of the common bile duct (CBD) to measure the amylase level because his gadoxetic acid-enhanced fMRC images showed evidence of pancreatico-biliary reflux of pancreatic secretions. Of the five patients with choledochal cysts, four underwent pylorus-preserving pancreaticoduodenectomy. RESULTS The five cases of choledochal cysts were classified as Todani classification I. In three of the six patients with AUPBD, injected contrast media reached the distal CBD and pancreatic duct on delay images, suggesting biliopancreatic reflux. In two of these six patients, a band-like filling defect was noted in the CBD on pre-fatty meal images, which decreased in size on delayed post-fatty meal images, suggesting pancreatico-biliary reflux of pancreatic secretions, and the bile sampled from the CBD in one patient had an amylase level of 113,000 IU/L. In one of the six patients with AUPBD, contrast media did not reach the distal CBD due to multiple CBD stones. CONCLUSION Gadoxetic acid-enhanced fMRC successfully demonstrated biliopancreatic reflux of bile and pancreatico-biliary reflux of pancreatic secretions in patients with AUPBD with and without choledochal cysts.

Diagnosis of acute cholecystitis: value of contrast agent in the gallbladder and cystic duct on Gd-EOB-DTPA enhanced MR cholangiography

To evaluate value of %volume of contrast agent in gallbladder and contrast in cystic duct in diagnosis of acute cholecysititis with Gd-EOB-DTPA MRC obtained 60 min after contrast injection (T1-MRC60min). We included 16 acute cholecystitis (AC), 23 chronic cholecystitis (CC), and 40 healthy volunteers. Receiver operating characteristic analysis showed cutoff value of 30.5% as predictor of AC comparing with healthy volunteers (sensitivity 93.8%, specificity 100%, AUC 0.958) and cutoff of 0% as predictor of AC comparing CC (sensitivity 81.2%, specificity 82.6%, AUC 0.823). In AC absent or obliterated cystic duct on T1-MRC60min showed 81.3%, 100%, sensitivity and specificity, respectively. These can be helpful for diagnosis of AC.

Endovascular repair of growing chronic type B aortic dissection with a vascular plug

We report the successful endovascular repair of a growing chronic type B aortic dissection using an Amplatzer Vascular Plug II. A 44-year-old man, with previous medical history of aortic surgery and stenting complained of vague back pain. An approximately 5-mm entry remained in the stented segment of the aorta on computed tomography (CT). Endovascular closure of the entry with a Vascular Plug was uneventful. A 3-month follow-up CT showed no leak, complete false lumen thrombosis in the thoracic segment, shrinkage of the false lumen, and a reduced diameter of thoracic aorta.

Functional magnetic resonance cholangiography with Gd-EOB-DTPA: A study in healthy volunteers☆

PURPOSE To describe the patterns of bile distribution in the biliary tree, duodenum, jejunum, and stomach, and to determine the gallbladder ejection fraction (GBEF) by using functional magnetic resonance cholangiography (MRC) with gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) in healthy volunteers. MATERIALS AND METHODS Forty subjects were included in this study. After conventional MRC, pre-fatty meal MRC (PRFM) was obtained at 30, 40, 50, and 60min after contrast agent injection. Then, post-fatty meal MRC (POFM) was obtained every 10min for 1h. We assessed the PRFM and POFM for opacification of contrast agent in the first- and second-order intrahepatic ducts (IHDs) and the common bile duct (CBD). Contrast agent opacification in the cystic duct was assessed, and the percentage volume of contrast agent filling in the gallbladder (GB) was calculated on PRFM. We calculated the GBEF and assessed the presence of contrast agent in the GB, duodenum, jejunum, and stomach. RESULTS Thirty-six (90%) subjects showed grade 3 CBD opacification (visible contrast and well-defined bile duct border) on 60-min PRFM. Thirty-four (85%) subjects showed grade 3 first-order IHD opacification on 60-min PRFM. All (100%) subjects showed cystic duct opacification of contrast agent, and the average percentage volume of contrast agent filling in the GB was 68.81%±16.84% on 60-min PRFM. The GBEF at 30-min POFM was 35.00%±18.26%. Ten (25%) subjects had no contrast agent in the stomach and small bowel on all PRFMs. Twelve (30%) subjects had contrast medium in the stomach on PRFM and/or POFM. CONCLUSIONS Functional MRC with Gd-EOB-DTPA can allow determining the distribution of bile in the biliary tree and small intestine, as well as the GBEF.

Usefulness of digital tomosynthesis for the detection of airway obstruction: A case report of bronchial carcinosarcoma

Bronchial carcinosarcoma is a very rare malignant tumor that is composed of carcinomatous and sarcomatous elements. We describe the first case in which digital tomosynthesis was useful for the evaluation of airway obstruction by bronchial carcinosarcoma that was overlooked on initial chest radiography.

Diagnosis of biliary stone disease: T1-weighted magnetic resonance cholangiography with Gd-EOB-DTPA versus T2-weighted magnetic resonance cholangiography

OBJECTIVE We aimed to compare diagnostic performance of gadoxetic-acid-enhanced-T1-weighted-MR cholangiography (MRC) with that of conventional T2-weighted-MRC in diagnosing biliary stone disease. MATERIALS AND METHODS Ninety patients who underwent MRC for evaluation of biliary disease were included. Presence of stones in extrahepatic duct, gallbladder and intrahepatic duct, and presence of acute cholecystitis were evaluated. Sensitivity, specificity, and accuracy of biliary stone disease diagnosis in each biliary duct location according to each image sets were measured. RESULTS There was no significant difference in diagnostic performance between two sets of MRC in diagnosing biliary stone disease. CONCLUSIONS Diagnostic performance of T1-MRC with gadoxetic-acid in diagnosing biliary stone disease is comparable to that of T2-MRC.

Safety and efficacy of a non-contact radiofrequency device for body contouring in Asians

ABSTRACT Background: The non-invasive reduction of subcutaneous abdominal fat became popular. Radiofrequency, non-contact, selective-field device Vanquish® has been developed to selectively induce deep fat tissue heating to reduce waist circumference. Objective: The objective of this study was to evaluate the efficacy and safety of clinical, radiological results of the radiofrequency, non-contact, selective-field device treatment. Methods: Twelve healthy individuals with no underlying medical problem were treated with five sessions of radiofrequency treatment to reduce abdominal subcutaneous fat. 45-minute sessions were performed with an 1-week interval. For efficacy evaluation, patient’s abdominal circumferences and body weight were measured, and photographs were taken at baseline and each follow-up visit for 12 weeks. One subject was examined with computed tomography (CT) before the first session and six weeks after the first CT scan, and we measured the volume of subcutaneous fat layer. Any adverse effect was assessed during the entire study period. Results: Reduction in abdominal circumferences was noted in most participants (10 of 12 patients). No serious adverse effect was reported. Volume reduction of abdominal subcutaneous fat layer was confirmed in a subject who took CT scan. Conclusions: Our study shows that the selective-field radiofrequency treatment seems to be safe and efficient for reduction of abdominal subcutaneous fat.

Localized pulmonary alveolar proteinosis: two case reports.

BACKGROUND Pulmonary alveolar proteinosis (PAP) is a relatively rare disease characterized by abnormal accumulation of surfactant-like material in the alveolar spaces. The classic radiologic findings of PAP include bilateral, symmetric, diffuse ground-glass opacity (GGO) or consolidation. The most common computed tomography (CT) feature of PAP is widespread GGO with thickened interlobular septa, the so-called crazy-paving pattern, which strongly suggests the diagnosis. CASE REPORT Here, we report the cases of two young male patients with unusual presentations of PAP. One patient showed localized PAP in the left lower lobe on CT images and the other patient presented with unilateral PAP involving the right lower lung field and recurrence in the same area with the same pattern as the initial manifestation. CONCLUSION In conclusion, it is important for radiologists to be aware of potential atypical imaging findings of PAP in order to provide a correct diagnosis. Along these lines, PAP can present as a solitary nodular lesion or unilateral focal lesion, and can recur in the same pattern and location.

Focal Hepatic Steatosis That Appears as a Liver Mass in Imaging

f i f A man with heavy alcohol history (daily alcohol ingestion of 160 g for 25 years) presented for evaluation of cteric sclera and epigastric pain. Initial laboratory data were as ollows: white blood cell count, 10,500; hemoglobin, 14.3; plateet count, 121,000; aspartate aminotransferase/alanine aminoransferase, 325/66 IU/L; bilirubin level (total/direct), 26.4/12.8 g/dL; alkaline phosphatase, 177 IU/L; -guanosine triphosphate, 670 IU/L. Tumor markers (alpha-fetoprotein, carcinoembryonic antigen, protein induced by vitamin K absence or antagonist II) were within normal limits except carcinoembryonic antigen 199, 418.3 IU/mL. The computed tomography scan (Figure A) revealed hepatosplenomegaly and surface undulation of the liver, which represent alcoholic liver cirrhosis, and large bulging mass-like lesions (arrowheads) at segments I, IV, and V of the liver. Ascites was also noted. Sequential magnetic resonance imaging revealed mass-like enlargement of hepatic segments I, IV, and V, which were hyperintense on the in-phase (Figure B) and hypointense on opposed-phase (Figure C) chemical shift gradient echo images. These mass-like lesions showed no enhancement on contrast-enhanced dynamic studies. Ultrasonography-guided liver biopsy was performed with an 18-gauge gun needle. Obtained hepatic specimen included the area of hyperechoic mass-like lesion and adjacent hepatic parenchyma in segment V. Following pathologic examinations proved scattered neutrophils, severe fatty liver with hepatocyte swelling, and massive bilirubin pigment, which are consistent with alcoholic steatohepatitis (Figure D). Hepatic steatosis is frequently manifested in alcoholic liver disease with or without alcoholic hepatitis or cirrhosis. Even though the biopsy is considered the reference standard for assessment of hepatic steatosis, most patients do not undergo liver biopsy but are usually diagnosed as hepatic steatosis with ultrasonography.1 Ultrasonography is known as a routine noninvasive technique for the initial study of the liver in various clinical circumstances, but it still has severe diagnostic limitations, both in diffuse liver disease and in focal hepatic steatosis, that might lead to a misdiagnosis of hepatic mass.2 Especially in alcoholic liver disease, focal well-marginated fat deposit can be frequently diagnosed as hepatocellular carcinoma or its premalignant lesions such as regenerative or dysplastic nodules.1 Focal fatty deposition of the liver is usually a benign lesion that is developed by aberrant venous supply or focal metabolic change caused by perfusion decrease. It is usually represented as illdefined low attenuating lesions on computed tomography scan. For assessment of fatty accumulation of the liver, magnetic resonance imaging is widely used including chemical shift gradient echo imaging with in-phase and opposed-phase acquisitions.1,2 Hepatic steatosis might be present if there is a signal intensity loss on opposed-phase images in comparison with in-phase images, and the amount of hepatic fat present can also be quantified by assessing the degree of signal intensity loss.1 We can usually find the normal vascular structure that passes through the focal fatty deposition without distortion in contrast to true tumorous lesion (arrows in Figure A). Unlike at-containing lesions in other organs, the application of chemcal fat saturation sequences can be neither sensitive nor specific or the detection of fatty liver.1,2