Yeo Ju Kim

Pulmonary Cement Embolism after Percutaneous Vertebroplasty in Osteoporotic Vertebral Compression Fractures: Incidence, Characteristics, and Risk Factors

PURPOSE To prospectively evaluate the incidence of, characteristics of, and risk factors for pulmonary cement embolism after percutaneous vertebroplasty (PVP) in osteoporotic vertebral compression fractures (VCFs). MATERIALS AND METHODS Institutional review board approval and written informed consent were obtained. From June 2006 to September 2007, 75 patients (57 women, 18 men; mean age, 74.78 years; range, 48-93 years) who underwent 78 PVP sessions at 119 levels for osteoporotic VCFs were prospectively enrolled in this study. Computed tomographic (CT) scans of the chest and treated vertebrae were obtained after PVP. The presence, location, involved pulmonary arteries, number, and size of each pulmonary cement embolus were analyzed at CT. Possible risk factors were analyzed as follows: Age, injected cement volumes, and numbers of treated vertebrae were analyzed by using the Mann-Whitney U test; operators (radiologist or nonradiologist), level of treated vertebrae, guidance equipment, approach (uni- or bipedicular), presence of intravertebral vacuum clefts, and presence of paravertebral venous leakage were analyzed by using Pearson chi(2) and Fisher exact tests. RESULTS Pulmonary cement emboli developed in 18 (23%) of 78 PVP sessions and were detected in the distal to third-order pulmonary arteries. Only cement leakage into the inferior vena cava showed a statistically significant relationship to pulmonary cement embolism (P = .03). A higher frequency of pulmonary cement embolism was noted for the absence of intravertebral vacuum clefts, for the bipedicular approach, and for a nonradiologist operator with C-arm fluoroscopy (P > .05). CONCLUSION In osteoporotic VCFs, pulmonary cement embolism was detected in 23% of PVP sessions, developed in the distal to third-order pulmonary arteries, and was related to leakage into the inferior vena cava.

Can Necrotizing Infectious Fasciitis Be Differentiated from Nonnecrotizing Infectious Fasciitis with MR Imaging

PURPOSE To retrospectively evaluate whether magnetic resonance (MR) imaging findings can be used to differentiate necrotizing infectious fasciitis (NIF) from nonnecrotizing infectious fasciitis (non-NIF). MATERIALS AND METHODS Institutional review board approval was obtained, but patient consent was not required for this retrospective review of records and images because patient anonymity was preserved. Thirty patients (seven with NIF, 23 with non-NIF) were included in the study. The following imaging findings were analyzed on fat-suppressed T2-weighted MR images: (a) signal intensity in the deep fascia (low, high, or mixed high and low), (b) thickness of abnormal signal intensity in the deep fascia (≥3 mm or <3 mm), (c) pattern of abnormal signal intensity in muscle (no abnormality, peripheral bandlike signal intensity, or patchy high signal intensity), (d) degree of deep fascia involvement (partial or extensive), and (e) degree of compartment involvement (fewer than three compartments or three or more compartments). On contrast material-enhanced fat-suppressed T1-weighted images, the contrast enhancement patterns of the abnormal deep fascia (no enhancement, enhancement, or enhancement with nonenhancing portion) and the muscle (no abnormality, peripheral bandlike signal intensity, or patchy high signal intensity) were evaluated. The presence of abscesses in the subcutaneous fat layer was evaluated with all sequences. RESULTS The patients with NIF had a significantly greater frequency of (a) thick (≥3 mm) abnormal signal intensity on fat-suppressed T2-weighted images, (b) low signal intensity in the deep fascia on fat-suppressed T2-weighted images, (c) a focal or diffuse nonenhancing portion in the area of abnormal signal intensity in the deep fascia, (d) extensive involvement of the deep fascia, and (e) involvement of three or more compartments in one extremity (P < .05). CONCLUSION MR imaging is potentially helpful for differentiating NIF from non-NIF. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101164/-/DC1.

Superior Labral Anteroposterior Tears: Accuracy and Interobserver Reliability of Multidetector CT Arthrography for Diagnosis

PURPOSE To evaluate the accuracy and interobserver reliability of multidetector computed tomographic (CT) arthrography for the diagnosis and classification of superior labral anteroposterior (SLAP) lesions. MATERIALS AND METHODS Institutional review board approval and informed consent were obtained. Retrospective review of images from 161 multidetector CT arthrographic examinations was performed by two radiologists independently for detection and classification of SLAP lesions (type I-X), and sensitivity, specificity, accuracy, and interobserver agreement were evaluated. RESULTS The SLAP group included 94 patients, and the no-SLAP group included 67 patients with normal labrum. At arthroscopy, a total of 88 SLAP lesions (excluding type I) were found. For detection of SLAP lesions excluding SLAP type I lesions, sensitivity, specificity, and accuracy were 94.3%, 76.7%, and 86.3% for reader 1 and 97%, 72.6%, and 86.3% for reader 2, respectively, and the interobserver agreement was very good (κ = 0.87). The distribution of SLAP lesions was as follows: six type I, 58 type II, one type III, one type IV, 16 type V, one type VI, five type VII, three type VIII, one type IX, one type V and VI, and one type V and VII. Percentages of correct classification of SLAP lesions were variable according to the types, but the overall percentage was noted to be 69.2% for reader 1 and 68.1% for reader 2. The interobserver agreement of classification of SLAP lesions was good (κ = 0.72). CONCLUSION Multidetector CT arthrography shows high accuracy and good interobserver reliability for diagnosis of SLAP lesions in spite of its limitations in specific classification.

Computed tomography and magnetic resonance imaging findings of nasal cavity hemangiomas according to histological type.

Objective To compare computed tomography (CT) and magnetic resonance imaging (MRI) findings between two histological types of nasal hemangiomas (cavernous hemangioma and capillary or lobular capillary hemangioma). Materials and Methods CT (n = 20; six pre-contrast; 20 post-enhancement) and MRI (n = 7) images from 23 patients (16 men and seven women; mean age, 43 years; range, 13-73 years) with a pathologically diagnosed nasal cavity hemangioma (17 capillary and lobular capillary hemangiomas and six cavernous hemangiomas) were reviewed, focusing on lesion location, size, origin, contour, enhancement pattern, attenuation or signal intensity (SI), and bony changes. Results The 17 capillary and lobular hemangiomas averaged 13 mm (range, 4-37 mm) in size, and most (n = 13) were round. Fourteen capillary hemangiomas had marked or moderate early phase enhancement on CT, which dissipated during the delayed phase. Four capillary hemangiomas on MRI showed marked enhancement. Bony changes were usually not seen on CT or MRI (seen on five cases, 29.4%). Half of the lesions (2/4) had low SI on T1-weighted MRI images and heterogeneously high SI with signal voids on T2-weighted images. The six cavernous hemangiomas were larger than the capillary type (mean, 20.5 mm; range, 10-39 mm) and most had lobulating contours (n = 4), with characteristic enhancement patterns (three centripetal and three multifocal nodular), bony remodeling (n = 4, 66.7%), and mild to moderate heterogeneous enhancement during the early and delayed phases. Conclusion CT and MRI findings are different between the two histological types of nasal hemangiomas, particularly in the enhancement pattern and size, which can assist in preoperative diagnosis and planning of surgical tumor excision.

Pseudoaneurysm of the popliteal artery mimicking tumorous condition

Diagnosing pseudoaneurysms of the popliteal artery is usually straightforward in physical examinations and imaging findings. However, when a pseudoaneurysm shows a soft tissue mass with adjacent osseous change, it can mimic a bone tumor or a soft tissue sarcoma. We present a case of a 65-year-old man who had a pseudoaneurysm of the popliteal artery showing soft tissue mass and insinuating into the intramedullary cavity of the tibia. This presented case emphasizes the importance of considering pseudoaneurysms in the differential diagnosis of an apparent soft tissue mass with pressure erosion in adjacent bone.

Interobserver and Intraobserver Reliability of Sub-Axial Injury Classification and Severity Scale between Radiologist, Resident and Spine Surgeon.

Objective The sub-axial injury classification (SLIC) and severity scale was developed to decide whether to operate the cervical injured patient or not, but the reliability of SLIC and severity scale among the different physicians was not well known. Therefore, we evaluated the reliability of SLIC among a spine surgeon, a resident of neurosurgery and a neuro-radiologist. Methods In retrograde review in single hospital from 2002 to 2009 years, 75 cases of sub-axial spine injured patients underwent operation. Each case was blindly reviewed for the SLIC and severity scale by 3 different observers by two times with 4 weeks interval with randomly allocated. The compared axis was the injury morphology score, the disco-ligamentous complex score, the neurological status score and total SLIC score; the neurological status score was derived from the review of medical record. The kappa value was used for the statistical analysis. Results Interobserver agreement of SLIC and severity scale was substantial agreement in the score of injury morphology [intraclass correlation (ICC)=0.603] and total SLIC and severity sacle (ICC value=0.775), but was fair agreement in the disco-ligamentous complex score (ICC value=0.304). Intraobserver agreements were almost perfect agreement in whole scales with ICC of 0.974 in a spine surgeon, 0.948 in a resident of neurosurgery, and 0.963 in a neuro-radiologist. Conclusion The SLIC and severity scale is comprehensive and easily applicable tool in spine injured patient. Moreover, it is very useful tool to communicate among spine surgeons, residents of neurosurgery and neuro-radiologists with sufficient reproducibility.

Muscular involvement of Behçet's disease: ultrasonography, computed tomography, and magnetic resonance imaging findings

Behçets disease (BD) is a form of systemic vasculitis with the classic triad of recurrent oral and genital ulcers along with uveitis. In BD, muscular involvement is very rare. We report a case of muscular involvement in BD with characteristic findings using ultrasonography, computed tomography, and magnetic resonance imaging.

Lipoma arborescens associated with osseous/chondroid differentiation in subdeltoid bursa

Lipoma arborescens (LA) is a rare benign lesion of unknown etiology. It is characterized histologically by villous proliferation of the synovial membrane and diffuse replacement of the subsynovial tissue by mature fat cells. This condition affects the knee joint most commonly. Cases involving other locations including glenohumeral joint,[1] hip,[2] elbow,[3] hand[4] and ankle[5] have been rarely described. Involvement of the subdeltoid bursa has also been reported, but to date no case has described LA with osseous/chondroid differentiation of this bursa. Another significant finding in our case was the coexistence of LA with intermuscular lipoma, SLAP lesion and labral cyst.

Airway centered invasive pulmonary aspergillosis in an immunocompetent patient: case report and literature review.

Invasive pulmonary aspergillosis is a major problem that occurs in severely immunocompromised patients. Airway centered invasive pulmonary aspergillosis is rare in patients with normal immunity or those without critical illness. Computed tomography (CT) is a very useful diagnostic modality, yielding characteristic imaging findings for early diagnosis of this infection in immunocompromised and immunocompetent patients. We describe the case of an immunocompetent patient with airway centered invasive aspergillosis, who was successfully treated with voriconazole.

Ectopic Hidradenoma Papilliferum of the Breast: Ultrasound Finding

Hidradenoma papilliferum (HP) is a benign neoplasm arising from mammary-like glands which typically involves the dermal layer of the female anogenital area. The prognosis for HP is good. Recurrence is unusual and is typically attributed to incomplete excision of the primary tumor. Malignant transformation is rare and HP of the breast has not yet been reported. Ectopic HP is usually solitary, small, and asymptomatic. It appears as a well-circumscribed, complex cystic mass in the dermis on ultrasound. We present a case of HP arising from the axillary tail of the breast.