Pulmonary tuberculosis occurred in patient with Tracheobronchopathia Osteochondroplastica

Tracheobronchopathia osteoplastica (TO) is a rare benign disease in which the anterior inner wall of the tracheobronchus changes because of abnormal chondrogenesis or ossification, while the posterior wall of the trachea is spared. The etiology is not clearly understood, but may relate with chronic infection, inflammation, and trauma. In some case studies, it has also been reported to be accompanied by other chronic diseases such as atrophic rhinitis and amyloidosis. However, Coexistence of TO and tuberculosis has rarely been reported, and has never been reported in Korea. Here, we report a case of a 70-year-old male patient who complained of hemoptysis and whose case was diagnosed as TO and pulmonary tuberculosis through bronchoscopy with bronchial washing and biopsy.

Comparison of Iohexol-380 and Iohexol-350 for Coronary CT Angiography: A Multicenter, Randomized, Double-Blind Phase 3 Trial

Objective

This multi-center, randomized, double-blind, phase 3 trial was conducted to compare the safety and efficacy of contrast agents iohexol-380 and iohexol-350 for coronary CT angiography in healthy subjects.

Materials and Methods

Volunteers were randomized to receive 420 mgI/kg of either iohexol-350 or iohexol-380 using a flow rate of 4 mL/sec. All adverse events were recorded. Two blinded readers independently reviewed the CT images and conflicting results were resolved by a third reader. Luminal attenuations (ascending aorta, left main coronary artery, and left ventricle) in Hounsfield units (HUs) and image quality on a 4-point scale were calculated.

Results

A total of 225 subjects were given contrast media (115 with iohexol-380 and 110 with iohexol-350). There was no difference in number of adverse drug reactions between groups: 75 events in 56 (48.7%) of 115 subjects in the iohexol-380 group vs. 74 events in 51 (46.4%) of 110 subjects in the iohexol-350 group (p = 0.690). No severe adverse drug reactions were recorded. Neither group showed an increase in serum creatinine. Significant differences in mean density between the groups was found in the ascending aorta: 375.8 ± 71.4 HU with iohexol-380 vs. 356.3 ± 61.5 HU with iohexol-350 (p = 0.030). No significant differences in image quality scores between both groups were observed for all three anatomic evaluations (all, p > 0.05).

Conclusion

Iohexol-380 provides improved enhancement of the ascending aorta and similar attenuation of the coronary arteries without any increase in adverse drug reactions, as compared with iohexol-350 using an identical amount of total iodine.

Cardiac Metastasis of Leiomyosarcoma Complicated with Complete Atrio-Ventricular Block and Ventricular Tachycardia

We described a case of a 54-year-old male who presented with dizziness and dyspnea due to cardiac metastasis of leiomyosarcoma. Cardiac metastasis of leiomyosarcoma caused both bradyarrhythmia and tachyarrhythmia in the patient. He was treated with implantation of a permanent pacemaker for management of complete atrio-ventricular block and anti-arrhythmic drug that suppressed ventricular tachycardia successfully.

A Case of Pneumonia Caused by Pneumocystis jirovecii Resistant to Trimethoprim-Sulfamethoxazole

A 50-year-old male visited the outpatient clinic and complained of fever, poor oral intake, and weight loss. A chest X-ray demonstrated streaky and fibrotic lesions in both lungs, and chest CT revealed multifocal peribronchial patchy ground-glass opacities with septated cystic lesions in both lungs. Cell counts in the bronchoalveolar lavage fluid revealed lymphocyte-dominant leukocytosis, and further analysis of lymphocyte subsets showed a predominance of cytotoxic T cells and few T helper cells. Video-assisted wedge resection of the left upper lobe was performed, and the histologic examination was indicative of a Pneumocystis jirovecii infection. Trimethoprim-sulfamethoxazole (TMP-SMX) was orally administered for 3 weeks; however, the patient complained of cough, and the pneumonia was aggravated in the follow-up chest X-ray and chest CT. Molecular studies demonstrated mutations at codons 55 and 57 of the dihydropteroate synthase (DHPS) gene, which is associated with the resistance to TMP-SMX. Clindamycin-primaquine was subsequently administered for 3 weeks replacing the TMP-SMX. A follow-up chest X-ray showed that the pneumonia was resolving, and the cough was also alleviated. A positive result of HIV immunoassay and elevated titer of HCV RNA indicated HIV infection as an underlying condition. This case highlights the importance of careful monitoring of patients with P. jirovecii pneumonia (PCP) during the course of treatment, and the molecular study of DHPS mutations. Additionally, altering the anti-PCP drug utilized as treatment must be considered when infection with drug-resistant P. jirovecii is suspected. To the best of our knowledge, this is the first case of TMP-SMX-resistant PCP described in Korea.

Pseudopathologic vertebral body enhancement in the presence of superior vena cava obstruction on computed tomography

BACKGROUND CONTEXT

Superior vena cava (SVC) obstruction can cause the development of collateral vessels. During contrast-enhanced thoracic computed tomography (CT), contrast material may reflux into the collaterals such as paravertebral venous plexus. However, an unusual pseudopathologic vertebral body enhancement on CT in the presence of SVC obstruction has not been studied previously.

PURPOSE

To demonstrate clinical presentation and imaging findings of pseudopathologic vertebral body enhancement in patients with SVC obstruction.

STUDY DESIGN

Retrospective study of diagnostic CT images examined at our clinic.

PATIENT SAMPLE

From March, 2009 to September, 2012, a retrospective radiologic database review was performed to identify patients with obstruction of SVC causing contrast reflux into collateral vessels and presented with an unusual vertebral body enhancement on thoracic CT. Thirteen patients (11 men, mean age 51.4 years) with vertebral body enhancement were enrolled.

OUTCOME MEASURES

Enhancement patterns of vertebral bodies were classified as nodular enhancement with round shape occupying less than one-third of vertebral body or polygonal enhancement occupying greater than or equal to one-third of vertebral body on axial image. The locations of enhanced areas within vertebral bodies were described using right lateral/central/left lateral, anterior/posterior, and upper/middle/lower in the x-, y-, or z-axis directions, respectively.

MATERIALS AND METHODS

Enhancement patterns, locations, and the presence of a connection between vertebral body enhancement and the paravertebral venous plexus were evaluated.

RESULTS

A total of 39 vertebral body enhancements were found in the 13 patients, involving cervical (n=12), thoracic (n=25), or lumbar (n=2) vertebrae. Vertebral body enhancements showed a nodular (n=19) or a polygonal (n=20) pattern. The central portions of vertebral bodies were more frequently involved. The connection to the paravertebral venous plexus was observed in 34 lesions (87.2%).

CONCLUSIONS

Patients with SVC obstruction with extensive collateral vessels might exhibit a pseudopathologic vertebral enhancement. They tended to involve the central portion of the vertebral body, and most of them showed connection to the paravertebral venous plexus.

Annual Change in Pulmonary Function and Clinical Characteristics of Combined Pulmonary Fibrosis and Emphysema and Idiopathic Pulmonary Fibrosis: Over a 3-Year Follow-up

BACKGROUND

Combined pulmonary fibrosis and emphysema (CPFE) have different pulmonary function tests (PFTs) and outcomes than idiopathic pulmonary fibrosis (IPF). The intention of this study was to identify unknown differences between CPFE and IPF by a retrospective comparison of clinical data including baseline and annual changes in pulmonary function, comorbidities, laboratory findings, clinical characteristics and cause of hospitalization.

METHODS

This study retrospectively enrolled patients with CPFE and IPF who had undergone PFTs once or several times per year during a follow-up period of three years. Baseline clinical characteristics and the annual changes in the pulmonary function during the follow-up period were compared between 26 with CPFE and 42 patients with IPF.

RESULTS

The baseline ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC%) in patients with CPFE was lower than that in patients with IPF (78.6±1.7 vs. 82.9±1.1, p=0.041). The annual decrease in FEV1/FVC in the CPFE was significantly higher than in the IPF. The annual decreases in diffusion capacity of carbon monoxide and FVC showed no significant differences between the two groups. The symptom durations of cough and sputum were in the CPFE significantly lower than in the IPF. The serum erythrocyte sedimentation rate level at the acute stage was significantly higher than in the IPF. There were no significant differences in the hospitalization rate and pneumonia was the most common cause of hospitalization in both study groups.

CONCLUSION

The annual decrease of FEV1/FVC was in patients with CPFE significantly higher than in the patients with IPF.

Fundamental electrochemiluminescence characteristics of fluorine-doped tin oxides synthesized by sol-gel combustion

Fluorine-doped tin oxide (FTO) materials synthesized by sol-gel combustion method were investigated for electrochemical luminescence (ECL) application. Effects of sol-gel combustion conditions on the structures and morphology of the porous FTO (p-FTO) materials were studied. ECL efficiency of p-FTO-based cell was about 251 cd/m2 at 4 V bias, which is higher than the sell using only FTO electrodes (102.8 cd/m2). The highest intensity of the emitting light was obtained at the wavelength of about 610 nm. The porous FTO layer was effective for increasing ECL intensities.

Multidetector CT and radiographic findings of lung injuries secondary to cardiopulmonary resuscitation

OBJECTIVES

Lung injury is one of the complications of cardiopulmonary resuscitation (CPR). This is the first study to describe the MDCT and radiographic findings of lung injuries secondary to CPR.

METHODS

A total of 44 patients who underwent CPR for a non-traumatic cause of cardiac arrest were retrospectively included in this study. We evaluated the presence of lung injuries in the initial chest radiograph and MDCT performed immediately after CPR and described the MDCT and radiographic findings of the CPR-associated lung injuries. Finally, we evaluated the temporal pattern of lung injury on the follow-up radiographies.

RESULTS

Chest CT demonstrated lung injury in 54 lungs of 35 patients, while initial chest radiography detected lung abnormality in 37 lungs of 28 patients. The most common patterns of lung injuries on chest CT were bilateral (n=19), ground-glass opacity (n=30) and consolidation (n=26), distributed along the bronchovascular bundles (n=13). Most of the abnormalities were located in the posterior part of both upper lobes and both lower lobes (n=29). Among seven patients who did not have abnormalities in the initial chest radiograph, lung abnormalities were detected on the follow-up radiographies (mean follow-up duration=1.6 days, range=1-3 days) in five patients, and 28 patients who had lung abnormalities on initial radiograph were improved (n=19) or aggravated (n=8) on the follow-up radiographies.

CONCLUSIONS

Lung injuries are frequent complications in patients who underwent CPR. Compared with radiography, MDCT has benefits for the detection and characterisation of CPR-associated lung injuries. The most common findings of lung injuries after CPR were bilateral ground glass opacity and consolidation, usually in the dependent area of both lungs.

The value of chest CT for prediction of breast tumor size: comparison with pathology measurement

Background

Little information is available on the use of chest computed tomography (CT) to predict breast tumor size in breast cancer, despite the fact that chest CT examinations are being increasingly used. The purpose of this study was to evaluate the value of chest CT for predicting breast tumor size using pathology measurements as reference standards.

Methods

Tumor sizes (defined as greatest diameter) were retrospectively measured on the preoperative chest CT images of 285 patients with surgically proven unifocal, invasive breast carcinoma. Greatest tumor diameters as determined by chest CT and pathologic examinations were compared by linear regression and Spearman’s rho correlation analysis. Concordance between CT and pathology results was defined as a diameter difference of <5 mm. Subgroup analyses were also performed with respect to tumor size (<20 mm or ≥20 mm) and histological subtype (invasive ductal carcinoma(IDC) or non-IDC).

Results

CT and pathology measured diameters were found to be linearly related (size at pathology = 1.086 × CT determined tumor size - 1.141; Spearman’s rho correlation coefficient = 0.84, P<0.001). Most tumors (n = 228, 80.0%) were concordant by chest CT and pathology, but 36 tumors (12.7%) were underestimated by CT (average underestimation, 11 mm; range, 6–36 mm) and 21 tumors (7.4%) were overestimated (average overestimation by CT, 10 mm; range, 6–19 mm). The concordance rate between the two sets of measurements was greater for tumor of <20 mm and for IDC (P<0.001 and P = 0.011, respectively).

Conclusions

Tumor size by chest CT is well correlated with pathology determined tumor size in breast cancer patients, and the diameters of the majority of tumors by chest CT and pathology differed by <5 mm. In addition, the concordance rate was higher for breast tumors of <20 mm and for tumors of the IDC histologic subtype.

Axillary artery to pulmonary artery fistula following Nuss procedure for pectus excavatum

Systemic artery to pulmonary vessel fistula (SAPVF) is an uncommon condition, which is congenital or acquired. We recently encountered a patient with acquired axillary artery to pulmonary artery fistula detected by dual-source 64-slice computed tomography (DSCT) angiography who had a Nuss surgical procedure for pectus excavatum. He suffered from wound infection following bar removal. Conventional angiography also demonstrated the SAPVF and successful embolization for treatment was carried out using microcoils and polyvinyl alcohol particles. To our knowledge, there has been no report of an axillary artery to pulmonary artery fistula associated with wound infection following a Nuss procedure.

The relationship between coronary artery calcification and renal function in nondialyzed patients

PURPOSE

Coronary artery calcification (CAC) has been described in individuals with chronic kidney disease (CKD), and its presence is associated with an increased risk of cardiovascular death. However, it is unclear whether there is an independent relationship between renal function and CAC. Therefore, we evaluated the association between renal function and CAC.

MATERIALS AND METHODS

We retrospectively reviewed 870 Korean patients who had undergone computed tomographic coronary angiography. The glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease study formula with an ethnic factor for the Korean population. The CKD stages were classified using estimated GFR (eGFR) and proteinuria.

RESULTS

The mean age of the participants was 56.8±11.8 years, and the mean eGFR was 89.4±16.5 mL/min/1.73 m². Hypertension and diabetes were noted in 41.5 and 17.0% of patients, respectively. There were 584 and 286 patients with no CAC and with CAC, respectively. After adjusting for confounding variables, late stage CKD was associated with CAC [odds ratio (OR) 2.80, 95% confidence interval (CI) 1.05-7.46]. However, early stage CKD was not associated with CAC (OR 1.61, 95% CI 0.92-2.82). Diabetes was an independent risk factor of CAC (OR 2.06, 95% CI 1.36-3.13). There was no significant association between proteinuria and CAC (OR 1.65, 95% CI 0.96-2.85).

CONCLUSION

CAC is related to late stage CKD in nondialyzed patients. These findings emphasize that individuals with CAC should be considered a high-risk population for decreased renal function.

Missed rib fractures on evaluation of initial chest CT for trauma patients: pattern analysis and diagnostic value of coronal multiplanar reconstruction images with multidetector row CT

OBJECTIVE

The objective of this study was to review the prevalence and radiological features of rib fractures missed on initial chest CT evaluation, and to examine the diagnostic value of additional coronal images in a large series of trauma patients.

METHODS

130 patients who presented to an emergency room for blunt chest trauma underwent multidetector row CT of the thorax within the first hour during their stay, and had follow-up CT or bone scans as diagnostic gold standards. Images were evaluated on two separate occasions: once with axial images and once with both axial and coronal images. The detection rates of missed rib fractures were compared between readings using a non-parametric method of clustered data. In the cases of missed rib fractures, the shapes, locations and associated fractures were evaluated.

RESULTS

58 rib fractures were missed with axial images only and 52 were missed with both axial and coronal images (p=0.088). The most common shape of missed rib fractures was buckled (56.9%), and the anterior arc (55.2%) was most commonly involved. 21 (36.2%) missed rib fractures had combined fractures on the same ribs, and 38 (65.5%) were accompanied by fracture on neighbouring ribs.

CONCLUSION

Missed rib fractures are not uncommon, and radiologists should be familiar with buckle fractures, which are frequently missed. Additional coronal imagescan be helpful in the diagnosis of rib fractures that are not seen on axial images.

Role of coronary artery calcification score on the decrease in GFR among subjects with CT coronary angiography

OBJECTIVE

Higher levels of coronary artery calcification score (CACS) are associated not only with an increased risk for cardiovascular death, but also with lower glomerular filtration rates (GFRs). However, its role in renal disease progression in patients has not been elucidated.

MATERIALS AND METHODS

We evaluated the change of estimated GFR in 279 nondialytic outpatients, who had undergone computed tomographic coronary angiography and follow-up over a period of 3 months.

RESULTS

The mean age of the participants was 57.7 ± 10.5 years, and the mean GFR was 88.2 ± 15.7 mL/min/1.73 m(2). Although there was no difference in baseline GFR between the CACS ≤ 200 AU group (n = 240) and the CACS > 200 AU group (n = 39), the latter group had a lower level of final GFR and higher annual reduction rate of GFR than the former group after an observation period of 13.1 ± 5.97 months. After adjusting for confounding variables, including age, gender, baseline GFR, albumin, and proteinuria, high levels of CACS showed an independent association with an annual reduction rate of GFR (r = -0.142, P = .048).

CONCLUSIONS

The results suggest that CACS was related to an annual decrease in GFR and may predict the faster decline in GFR in patients with symptoms requiring computed tomographic coronary angiography.

Association between renal dysfunction and the mixed plaque of coronary artery on computed tomographic angiography

Coronary artery plaque is related to development of coronary artery disease (CAD), and chronic kidney disease is associated with CAD. However, the association of renal dysfunction (RD) with coronary artery plaque characteristics has not been fully elucidated. We evaluated the association between RD and coronary artery plaque characteristics in patients with suspected CAD, who underwent multislice computed tomographic angiography (CTA). A total of 918 patients were classified into 4 groups: group with no plaque (NP) (48.9%), group with calcified plaque (CP) (16.0%), group with noncalcified plaque (NCP) (22.4%), and group with mixed plaque (MP) (12.7%). NCP is considered as rupture-prone soft plaque, and CP as more stable lesion. The mean of estimated glomerular filtration rate (eGFR) was 82.5 ± 15.4 mL/min/1.73 m(2), and the prevalence of RD (defined as eGFR < 60 mL/min/1.73 m(2)) was 6.3%. The prevalence of RD was 3.3% in the NP group, 10.2% in the CP group, 5.3% in the NCP group, and 14.5% in the MP group (P < 0.001 by ANOVA tests). The adjusted odds ratio for RD was 3.38 (95% confidence interval, 1.27-9.04) for the MP group, compared with the NP group. The presence of RD showed an independent association with the MP counts (r = 0.155, P < 0.001); however, there was no association between RD and other plaque characteristics. In conclusion, RD is associated with MP rather than CP or NCP, compared with NP, which may reflect one of the developmental processes of CAD in patients with RD.

Sternal fracture in the emergency department: diagnostic value of multidetector CT with sagittal and coronal reconstruction images

BACKGROUND

Multidetector CT (MDCT) is being increasingly used for patients with traumatic injuries in the emergency room. This is the first study to evaluate the diagnostic performance of MDCT for sternal fracture.

PATIENTS AND METHODS

For 87 patients who had motor vehicle accidents, we evaluated the diagnostic performance of MDCT for the sternal fractures. For 31 patients who underwent both MDCT and lateral radiography for the sternum, we compared the diagnostic performance of two examinations for the evaluation of sternal fracture.

RESULTS

Thirty-two patients had sternal fractures and all the sternal fractures (sensitivity=100%) were detected on MDCT, especially on the sagittal reconstruction images. However, the axial and coronal images detected 65% and 59% of all sternal fractures, respectively. For 31 patients who underwent both MDCT and lateral radiography for the sternum, MDCT showed superior diagnostic performance compared to that of radiography (accuracy=97% and 77%, respectively, P=.02). For the one case that showed false positivity for sternal fracture on MDCT due to respiratory artifact, the lateral radiography enabled making the correct diagnosis.

CONCLUSION

Sternal fracture is frequently seen in patients who have blunt trauma injury secondary to motor vehicle accidents. MDCT, particularly sagittal images detect all of the sternal fractures, is superior to lateral radiography for diagnosis of sternal fracture. In the limited case that CT has severe motion artifact, additional radiography could help the diagnosis of sternal fracture.

A paragonimiasis patient with allergic reaction to praziquantel and resistance to triclabendazole: successful treatment after desensitization to praziquantel

Paragonimiasis is an infectious disease caused by trematodes of the genus Paragonimus. This trematode can be treated successfully with praziquantel in more than 90% of the cases. Although praziquantel is generally well tolerated, anaphylactic reactions to this drug have been reported in a few cases. We report here a 46-year-old Korean female with paragonimiasis, presumed to be due to Paragonimus westermani, who displayed an allergic reaction to praziquantel and resistance to triclabendazole treatment. The patient was successfully treated with praziquantel following a rapid desensitization procedure. Desensitization to praziquantel could be considered when no alternative drugs are available.

The influence of liquid crystal display monitors on observer performance for the detection of interstitial lung markings on both storage phosphor and flat-panel-detector chest radiography

PURPOSE

To compare observer performance with a flat-panel liquid crystal display (LCD) monitor and with a high-resolution gray-scale cathode ray tube (CRT) monitor in the detection of interstitial lung markings using a silicon flat-panel-detector direct radiography (DR) and storage phosphor computed radiography (CR) in a clinical setting.

MATERIALS AND METHODS

We displayed 39 sets of posteroanterior chest radiographs from the patients who were suspected of interstitial lung disease. Each sets consisted of DR, CR and thin-section CT as the reference standard. Image identities were masked, randomly sorted, and displayed on both five mega pixel (2048x2560x8 bits) LCD and CRT monitors. Ten radiologists independently rated their confidence in detection for the presence of linear opacities in the four fields of the lungs; right upper, left upper, right lower, and left lower quadrant. Performance of a total 6240 (39 setsx2 detector systemsx2 monitor systemx4 fieldsx10 observers) observations was analyzed by multi-reader multi-case receiver operating characteristic (ROC) analysis. Differences between monitor systems in combinations of detector systems were compared using ANOVA and paired-samples t-test.

RESULTS

Area under curves (AUC) for the presence of linear opacities measured by ROC analysis was higher on the LCDs than CRTs without statistical significance (p=0.082). AUC was significantly higher on the DR systems than CR systems (p=0.006). AUC was significantly higher on the LCDs than CRTs for DR systems (p=0.039) but not different for CR systems (p=0.301).

CONCLUSION

In clinical conditions, performance of the LCD monitor appears to be better for detecting interstitial lung markings when interfaced with DR systems.

(18)F-FDG PET versus (18)F-FDG PET/CT for adrenal gland lesion characterization: a comparison of diagnostic efficacy in lung cancer patients

Objective

The aim of this study was to assess the diagnostic efficacy of integrated PET/CT using fluorodeoxyglucose (FDG) for the differentiation of benign and metastatic adrenal gland lesions in patients with lung cancer and to compare the diagnostic efficacy with the use of PET alone.

Materials and Methods

Sixty-one adrenal lesions (size range, 5-104 mm; mean size, 16 mm) were evaluated retrospectively in 42 lung cancer patients. Both PET images alone and integrated PET/CT images were assessed, respectively, at two-month intervals. PET findings were interpreted as positive if the FDG uptake of adrenal lesions was greater than or equal to that of the liver, and the PET/CT findings were interpreted as positive if an adrenal lesion show attenuation > 10 HU and showed increased FDG uptake. Final diagnoses of adrenal gland lesions were made at clinical follow-up (n = 52) or by a biopsy (n = 9) when available. The diagnostic accuracies of PET and PET/CT for the characterization of adrenal lesions were compared using the McNemar test.

Results

Thirty-five (57%) of the 61 adrenal lesions were metastatic and the remaining 26 lesions were benign. For the depiction of adrenal gland metastasis, the sensitivity, specificity, and accuracy of PET were 74%, 73%, and 74%, respectively, whereas those of integrated PET/CT were 80%, 89%, and 84%, respectively (p values; 0.5, 0.125, and 0.031, respectively).

Conclusion

The use of integrated PET/CT is more accurate than the use of PET alone for differentiating benign and metastatic adrenal gland lesions in lung cancer patients.

Efficacy of Helical Dynamic CT Versus Integrated PET/CT for Detection of Mediastinal Nodal Metastasis in Non-Small Cell Lung Cancer

OBJECTIVE

The purpose of our study was to compare the diagnostic efficacies of helical dynamic CT and integrated PET/CT for the prediction of mediastinal nodal metastasis in stage T1 non-small cell lung cancer (NSCLC).

MATERIALS AND METHODS

One hundred forty-three patients with stage T1 NSCLC underwent both helical dynamic CT and integrated PET/CT followed by surgical nodal staging. In helical dynamic CT, patients were regarded to have stage N2 disease when a nodule showed a peak enhancement > or = 110 H or a net enhancement > or = 60 H. In integrated PET/CT, nodes were regarded as positive for malignancy when they showed > or = 3.5 in maximum standardized uptake value with a discrete margin and more 18F-FDG uptake than mediastinal structures. Sensitivities, specificities, and accuracies for mediastinal nodal metastasis detection were compared for helical dynamic CT and integrated PET/CT using the McNemar test.

RESULTS

Of the 143 patients, 34 (24%) had positive mediastinal nodes. The sensitivity, specificity, and accuracy for mediastinal nodal metastasis prediction on helical dynamic CT were 65% (22 of 34 patients), 89% (97 of 109), and 83% (119 of 143), respectively, whereas those on integrated PET/CT were 56% (19 of 34), 100% (109 of 109), and 90% (128 of 143). The p values were 0.664, < 0.001, and 0.015.

CONCLUSION

In stage T1 NSCLC, contrast-enhanced helical dynamic CT better predicts, but not significantly so, mediastinal nodal metastasis than PET/CT, whereas PET/CT shows perfect specificity and higher accuracy than helical dynamic CT.

Long-term results of percutaneous ethanol injection for the treatment of hepatocellular carcinoma in Korea

Objective

To evaluate the long-term follow-up results of percutaneous ethanol injection (PEI) for the treatment of hepatocellular carcinoma (HCC) in Korea.

Materials and Methods

Sixty-eight nodular HCCs initially detected in 64 patients, were subjected to US-guided PEI as a first-line treatment. Long-term survival rates, local tumor progression rates, and complications were evaluated, as were the influences of tumor size and Child-Pugh class on these variables.

Results

No major complications occurred. The overall survival rates of the 64 patients at three and five years were 71% and 39%, and their cancer-free survival rates were 22% and 15%, respectively. The overall survival rate of patients with a small HCC (≤ 2 cm) was significantly higher (p = 0.014) than that of patients with a medium-sized HCC (≤ 2 cm). The overall survival rate of patients with Child-Pugh class A was significantly higher (p = 0.049) than that of patients with Child-Pugh class B. Of 59 cases with no residual tumor, local tumor progression was observed in ablation zones in 18, and this was not found to be significantly influenced by tumor size or Child-Pugh class.

Conclusion

The results of our investigation of the long-term survival rates of PEI in HCC patients in Korea (a hepatitis B virus-endemic area) were consistent with those reported previously in hepatitis C endemic areas. Patients with a smaller tumor or a better liver function exhibited superior survival rates.

18F-FDG PET/CT of thymic epithelial tumors: usefulness for distinguishing and staging tumor subgroups

The purpose of our study was to assess the usefulness of integrated PET/CT using 18F-FDG for distinguishing thymic epithelial tumors according to the World Health Organization (WHO) classification.

METHODS

Thirty-three patients (age range, 34-68 y; mean age, 54.6 y) with thymic epithelial tumors, who underwent both integrated PET/CT and enhanced CT, were included. The clinicopathologic stages, maximum standardized uptake values (SUVs), and uptake patterns of tumors on integrated PET/CT images, and various enhanced CT findings, are described according to the simplified (low-risk [types A, AB, and B1] and high-risk [types B2 and B3] thymomas and thymic carcinomas) subgroups of the WHO classification. Discriminant analysis was performed to determine the relative capabilities of integrated PET/CT and enhanced CT findings to differentiate tumor subgroups.

RESULTS

Tumors included 8 low-risk thymomas, 9 high-risk thymomas, and 16 thymic carcinomas. The maximum SUVs of high-risk thymomas (P < 0.001) and low-risk thymomas (P < 0.001) were found to be significantly lower than those of thymic carcinomas. Homogeneous 18F-FDG uptake within tumors was more frequently seen in thymic carcinomas than in high-risk thymomas (P = 0.027) or low-risk thymomas (P = 0.001). The uptake pattern (homogeneous vs. heterogeneous) on integrated PET/CT images and the presence of mediastinal fat invasion on enhanced CT images were found to be useful for differentiating tumor subgroups. In addition, integrated PET/CT helped detect lymph node metastases, which were not identified on enhanced CT in 2 patients.

CONCLUSION

Integrated PET/CT was found to be useful for differentiating subgroups of thymic epithelial tumors and for staging the extent of the disease.

Radiofrequency ablation of rabbit liver in vivo: effect of the pringle maneuver on pathologic changes in liver surrounding the ablation zone

Objective

We wished to evaluate the effect of the Pringle maneuver (occlusion of both the hepatic artery and portal vein) on the pathologic changes in the hepatic vessels, bile ducts and liver parenchyma surrounding the ablation zone in rabbit livers.

Materials and Methods

Radiofrequency (RF) ablation zones were created in the livers of 24 rabbits in vivo by using a 50-W, 480-kHz monopolar RF generator and a 15-gauge expandable electrode with four sharp prongs for 7 mins. The tips of the electrodes were placed in the liver parenchyma near the porta hepatis with the distal 1 cm of their prongs deployed. Radiofrequency ablation was performed in the groups with (n=12 rabbits) and without (n=12 rabbits) the Pringle maneuver. Three animals of each group were sacrificed immediately, three days (the acute phase), seven days (the early subacute phase) and two weeks (the late subacute phase) after RF ablation. The ablation zones were excised and serial pathologic changes in the hepatic vessels, bile ducts and liver parenchyma surrounding the ablation zone were evaluated.

Results

With the Pringle maneuver, portal vein thrombosis was found in three cases (in the immediate [n=2] and acute phase [n=1]), bile duct dilatation adjacent to the ablation zone was found in one case (in the late subacute phase [n=1]), infarction adjacent to the ablation zone was found in three cases (in the early subacute [n=2] and late subacute [n=1] phases). None of the above changes was found in the livers ablated without the Pringle maneuver. On the microscopic findings, centrilobular congestion, sinusoidal congestion, sinusoidal platelet and neutrophilic adhesion, and hepatocyte vacuolar and ballooning changes in liver ablated with Pringle maneuver showed more significant changes than in those livers ablated without the Pringle maneuver (p < 0.05)

Conclusion

Radiofrequency ablation with the Pringle maneuver created more severe pathologic changes in the portal vein, bile ducts and liver parenchyma surrounding the ablation zone compared with RF ablation without the Pringle maneuver. Therefore, we suggest that RF ablation with the Pringle maneuver should be performed with great caution in order to avoid unwanted thermal injury.

Pulmonary sclerosing hemangioma presenting as solitary pulmonary nodule: dynamic CT findings and histopathologic comparisons

OBJECTIVE

The purpose of this study was to describe the dynamic CT findings of pulmonary sclerosing hemangioma presenting as a solitary pulmonary nodule and to compare these findings with histopathologic findings.

CONCLUSION

On dynamic CT, sclerosing hemangioma has strong and rapid enhancement attributed histopathologically to the presence of hemangiomatous or papillary components in the tumor.

The balloon dilatation and large profile catheter maintenance method for the management of the bile duct stricture following liver transplantation

Objective

We wanted to evaluate the therapeutic efficacy of the percutaneous balloon dilatation and large profile catheter maintenance method for the management of patients with anastomotic biliary strictures following liver transplant.

Materials and Methods

From May 1999 to June 2003, 12 patients with symptomatic benign biliary stricture complicated by liver transplantation were treated with the percutaneous balloon dilatation and large profile catheter maintenance method (1-6 months). The patients were eight males and four females, and their ages ranged from 20 to 62 years (mean age: 44 years). Ten patients underwent living donor liver transplantation and two underwent cadaveric liver transplantation. Postoperative biliary strictures occurred from two to 21 months (mean age: 18 months) after liver transplantation.

Results

The initial technical success rate was 92%. Patency of the bile duct was preserved for eight to 40 months (mean period: 19 months) in 10 of 12 (84%) patients. When reviewing two patients (17%), secondary balloon dilatations were needed for treating the delayed recurrence of biliary stricture. In one patient, no recurrent stenosis was seen during the further 10 months follow-up after secondary balloon dilatation. Another patient did not response to secondary balloon dilatation, and he was treated by surgery. Eleven of 12 patients (92%) showed good biliary patency for 8-40 months (mean period: 19 months) of follow-up.

Conclusion

The percutaneous balloon dilatation and large profile catheter maintenance method is an effective therapeutic alternative for the treatment of most biliary strictures that complicate liver transplantation. It has a high success rate and it should be considered before surgery.

The "mini-perc" technique of percutaneous nephrolithotomy with a 14-Fr peel-away sheath: 3-year results in 72 patients

OBJECTIVE

To assess the efficacy and safety of a "mini-perc" technique of percutaneous nephrolithotomy using a 14-Fr peel-away sheath for the removal of pyelocaliceal stones, and to determine appropriate inclusion criteria.

MATERIALS AND METHODS

From July 1999 to June 2002, the medical records and radiographic images of 72 patients who underwent the "mini-perc" technique of percutaneous nephrolithotomy with a 14-Fr peel-away sheath, were reviewed to determine clinical history, stone characteristics, immediate stone free rate, final stone free rate after additional procedures, complications, and hospital stay. We also analyzed the effect of the longest stone diameter, the cumulative longest diameter of stones, the cumulative stone burden, and the stone density on the immediate stone free rate using a Fisher exact test.

RESULTS

The only major complication, arterial bleeding, occurred in a patient with Child A liver cirrhosis and was successfully treated by embolization with coils and a gelatin sponge. The immediate stone free rate was 80.6 %, which was significantly influenced by stone diameter but not stone density. The mean hospital stay after the procedure was 3.97 days.

CONCLUSION

The "mini-perc" technique of percutaneous nephrolithotomy, which uses the 14-Fr peel-away sheath, is a safe and effective modality for treating renal calculi.

Overexpression of the prostaglandin E2 receptor EP2 results in enhanced skin tumor development

We previously showed that the EP2 knockout mice were resistant to chemically induced skin carcinogenesis. The purpose of this study was to investigate the role of the overexpression of the EP2 receptor in mouse skin carcinogenesis. To determine the effect of overexpression of EP2, we used EP2 transgenic (TG) mice and wild-type (WT) mice in a DMBA (7,12-dimethylbenz[alpha]anthracene)/TPA (12-O-tetradecanoylphorbol-13-acetate) two-stage carcinogenesis protocol. EP2 TG mice developed significantly more tumors compared with WT mice. Overexpression of the EP2 receptor increased TPA-induced keratinocyte proliferation both in vivo and in vitro. In addition, the epidermis of EP2 TG mice 48 h after topical TPA treatment was significantly thicker compared to that of WT mice. EP2 TG mice showed significantly increased cyclic adenosine monophosphate levels in the epidermis after prostaglandin E2 (PGE2) treatment. The inflammatory response to TPA was increased in EP2 TG mice, as demonstrated by an increased number of macrophages in the dermis. Tumors and 7 x TPA-treated and DMBA-TPA-treated (6 weeks) skins from EP2 TG mice produced more blood vessels than those of WT mice as determined by CD-31 immunostaining. Vascular endothelial growth factor (VEGF) protein expression was significantly increased in squamous cell carcinoma (SCC) samples from EP2 TG mice compared that of WT mice. There was, however, no difference in the number of apoptotic cells in tumors from WT and EP2 TG mice. Together, our results suggest that the overexpression of the EP2 receptor plays a significant role in the protumorigenic action of PGE2 in mouse skin.

Absence of association between angiotensin converting enzyme polymorphism and development of adult respiratory distress syndrome in patients with severe acute respiratory syndrome: a case control study

BACKGROUND

It has been postulated that genetic predisposition may influence the susceptibility to SARS-coronavirus infection and disease outcomes. A recent study has suggested that the deletion allele (D allele) of the angiotensin converting enzyme (ACE) gene is associated with hypoxemia in SARS patients. Moreover, the ACE D allele has been shown to be more prevalent in patients suffering from adult respiratory distress syndrome (ARDS) in a previous study. Thus, we have investigated the association between ACE insertion/deletion (I/D) polymorphism and the progression to ARDS or requirement of intensive care in SARS patients.

METHOD

One hundred and forty genetically unrelated Chinese SARS patients and 326 healthy volunteers were recruited. The ACE I/D genotypes were determined by polymerase chain reaction and agarose gel electrophoresis.

RESULTS

There is no significant difference in the genotypic distributions and the allelic frequencies of the ACE I/D polymorphism between the SARS patients and the healthy control subjects. Moreover, there is also no evidence that ACE I/D polymorphism is associated with the progression to ARDS or the requirement of intensive care in the SARS patients. In multivariate logistic analysis, age is the only factor associated with the development of ARDS while age and male sex are independent factors associated with the requirement of intensive care.

CONCLUSION

The ACE I/D polymorphism is not directly related to increased susceptibility to SARS-coronavirus infection and is not associated with poor outcomes after SARS-coronavirus infection.

Lobar mucinous bronchioloalveolar carcinoma of the lung showing negative FDG uptake on integrated PET/CT

We present a case of bronchioloalveolar carcinoma manifesting as air-space consolidation with negative FDG uptake on integrated PET/CT in a 42-year-old woman. To know this pattern of uptake especially in the case of mucin-predominant lobar bronchioloalveolar carcinoma may help avoid misdiagnosis of this particular tumor.

Retroperitoneal arteriovenous malformation extending through the inferior vena cava into the heart and causing inferior vena cava dissection

We present a case of retroperitoneal arteriovenous malformation extending through the inferior vena cava into the heart, which was associated with dissection of the inferior vena cava in a 32-year-old female. Computed tomography and magnetic resonance imaging showed a double-lumen inferior vena cava and a rod-like solid component attached to a sac-like lesion in the right heart chambers. Digital subtraction angiography showed an arteriovenous malformation draining to the inner lumen of the inferior vena cava.

Usefulness of multidetector-row CT in the evaluation of reperfused myocardial infarction in a rabbit model

Objective

To evaluate the usefulness of multidetector-row computed tomography (CT) in the evaluation of reperfused myocardial infarction.

Materials and Methods

Eleven rabbits were subjected to 90-min occlusion of the left anterior descending coronary artery followed by reperfusion. Multidetector-row CT was performed 31 hours ± 21 after the procedure and pre- and post-contrast multiphase helical CT images were obtained up to 10 min after contrast injection. The animals were sacrificed after 30 days and histochemical staining of the resected specimens was perfomed with 2'3'5-triphenyl tetrazolium chloride (TTC).

Results

In all 11 cases, the areas of myocardial infarction demonstrated with TTC-staining were identified on the CT images and the lesions showed hypoenhancement on the early phases up to 62 sec and hyperenhancement on the delayed phases of 5 min and 10 min compared with normal myocardial enhancement. The percentage area of the lesion with respect to the left ventricle wall on CT was significantly correlated with that of the TTC-staining results (p < 0.001 for both early and delayed phase CT) according to the generalized linear model analysis. The areas showing hypoenhancement on early CT were significantly smaller than those with hyperenhancement on delayed CT (p < 0.0001).

Conclusion

Multidetector-row CT may be useful in the detection and sizing of reperfused myocardial infarction.

Multidetector CT of bronchiectasis: effect of radiation dose on image quality

OBJECTIVE

The purpose of our prospective study was to assess the image quality with respect to the radiation dose incurred by multidetector CT (MDCT) in patients with suspected bronchiectasis. SUBJECTS AND METHODS. Image clusters, composed of nine images, using MDCT (120 kVp, a 2.5-mm collimation, a pitch of 6, and 2.5-mm reconstruction intervals) were obtained at each of two levels-the azygous arch and the right inferior pulmonary vein-at 170, 100, 70, 40, 20, and 10 mA. Independently, two chest radiologists assessed and compared the quality of the images obtained at the six milliamperage exposures. Image quality was graded using a 5-point scale with lung and mediastinal window settings. Radiation doses were measured at each of the six milliamperage settings while scanning the whole lung of a thoracic phantom using MDCT.

RESULTS

The mean image quality scores at exposures of 170, 100, 70, 40, 20, 10 mA were as follows: 3.9, 3.7, 3.8, 3.2, 2.5, 1.6 at lung window settings and 4.1, 4.3, 4.0, 3.4, 2.3, 1.3 at mediastinal window settings, respectively. Images obtained at 70 mA were rated significantly better than those obtained at 40 mA or less (p < 0.01). The mean radiation dose at 170, 100, 70, 40, 20, 10 mA was 23.72, 14.39, 10.54, 5.41, 2.74, and 1.50 mGy, respectively.

CONCLUSION

With a tube current setting as low as 70 mA, MDCT provides images of acceptable quality and volumetric data sets for the evaluation of bronchiectasis. The trade-off of using MDCT rather than conventional high-resolution CT is that the radiation dose is five times higher with MDCT (10.54 mGy) than with conventional high-resolution CT (2.17 mGy with parameters of 120 kVp, 170 mA, 1-mm collimation, and 10-mm intervals).

Additional coronal images using low-milliamperage multidetector-row computed tomography: effectiveness in the diagnosis of bronchiectasis

PURPOSE

The aim of our study was to evaluate the effectiveness of additional coronal images using low-milliamperage multidetector-row computed tomography (CT) in the diagnosis of bronchiectasis.

METHODS

Helical volumetric CT scans (120 kVp, 70 mA, 2.5-mm collimation, table speed of 15 mm/s, table rotation time of 1 second) using low-milliamperage multidetector-row CT were obtained through the thorax in 110 patients who were suspected of bronchiectasis. Both axial (2.5-mm section thickness) and coronal (1.3-2.0-mm section thickness) reformatted images were made and sent to picture archiving and communication system (PACS) monitors. Two independent observers assessed CT scans twice; with axial images only and with both axial and coronal images. The detection rates of bronchiectasis were compared between readings with axial images only and with both axial and coronal images by using a nonparametric method of clustered data. Confidence grades were given to the distribution and type of bronchiectasis.

RESULTS

With axial images only, the detection rates of bronchiectasis on a per-patient basis were 97% (213/220 patients, kappa = 0.888) whereas with both axial and coronal images, the detection rates were 100% (220/220 patients, kappa = 1.000) (P = 0.0001). Confidence to the distribution of bronchiectasis was greater with both axial and coronal images than with axial images only (P = 0.008).

CONCLUSIONS

Additional coronal images using low-milliamperage multidetector-row CT are effective in the diagnosis of bronchiectasis by providing enhanced detection rates and confidence to the distribution of lesions.

Selective intra-arterial calcium stimulation with hepatic venous sampling for preoperative localization of insulinomas

OBJECTIVE

To determine the value of selective intra-arterial calcium stimulation with hepatic venous sampling using serum insulin and C-peptide gradients for the preoperative localization of insulinomas.

MATERIALS AND METHODS

Seven consecutive patients (three men and four women aged 15-77 (mean, 42.7) years) with hypoglycemia underwent selective intra-arterial calcium stimulation in conjunction with hepatic venous sampling. Insulin gradients were calculated by an individual blinded to all other preoperative imaging studies and operative findings. In all patients except one, C-peptide gradients were also analyzed. The results were compared with the preoperative findings of ultrasonography, computed tomography, arteriography and endoscopic ultrasonography, as well as with the intraoperative findings of ultrasonography and palpation at surgery.

RESULTS

Eight insulinomas (mean diameter, 12.5 mm) were diagnosed after surgery. In six patients, the calcium stimulation test with insulin gradients allowed accurate localization of the pathologic source of insulin secretion. Both C-peptide and insulin gradients substantially increased diagnostic accuracy. In one patient, C-peptide gradients were more helpful than insulin gradients for tumor localization.

CONCLUSION

Selective intra-arterial calcium stimulation with hepatic venous sampling is a highly accurate and safe method for the preoperative localization of insulinomas. Additional C-peptide gradients seem to be helpful in assessing tumor location, but further study is needed.

A genomic approach to mutation analysis of holocarboxylase synthetase gene in three Chinese patients with late-onset holocarboxylase synthetase deficiency

OBJECTIVE

Multiple carboxylase deficiency (MCD, MIM:253270) is a common organic aciduria and caused by deficiency of either biotinidase or holocarboxylase synthetase (HLCS; EC 6.3.4.10). Patients commonly present during early infancy with acute metabolic derangements and severe metabolic acidosis. Recently, a late onset form of HLCS deficiency was also described. The different phenotypes (early and late presenting) may be related to a spectrum of mutations in HLCS gene. Applications of mutation analysis in HLCS had been limited previously by the requirement of cDNA from living tissue for study. We described here a genomic approach for molecular diagnosis of HLCS deficiency which we have used to detect mutations in Chinese patients who had the late-onset form of HLCS deficiency. In addition, a fibroblast cell line with MCD from Coriell Cell repositories was also studied.

DESIGN AND METHODS

Three Chinese patients with late onset HLCS deficiency were studied. The genomic sequence of HLCS was retrieved and newly designed primers were used to cover all coding sequences of the gene. PCR products were analyzed by direct sequencing. Population allelic frequencies of mutations detected were determined by genotyping of control samples by restriction fragment length polymorphism.

RESULTS

We found a recurrent mutation, R508W, in the three unrelated Chinese patients. Two were homozygous for this mutation. The other patient was a compound heterozygote of R508W and a novel mutation, D634N. The results suggest that R508W may be an important and relatively prevalent disease-causing mutation in Chinese MCD patients. A fibroblast cell-line from an African patient revealed an additional novel mutation, R565X and a known mutation, V550M.

CONCLUSION

R508W is a recurrent mutation in Chinese MCD patients which is associated with the late onset phenotype. This new genomic approach for mutation analysis of HLCS gene provides new opportunities in studies of MCD.

E3 ligase activity of RING finger proteins that interact with Hip-2, a human ubiquitin-conjugating enzyme

To identify proteins that interact with Huntingtin-interacting protein-2 (Hip-2), a ubiquitin-conjugating enzyme, a yeast two-hybrid screen system was used to isolate five positive clones. Sequence analyses showed that, with one exception, all Hip-2-interacting proteins contained the RING finger motifs. The interaction of Hip-2 with RNF2, one of the clones, was further confirmed through in vitro and in vivo experiments. Mutations in the RING domain of RNF2 prevented the clone from binding to Hip-2, an indication that the RING domain is the binding determinant. RNF2 showed a ubiquitin ligase (E3) activity in the presence of Hip-2, suggesting that a subset of RING finger proteins may have roles as E3s.