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Park S, Yu IK, Kim H. MRI Findings of Acute Hippocampal Disorders: Pictorial Essay. J Korean Soc Radiol 2022; 83:1046-1058. [PMID: 36276220 PMCID: PMC9574276 DOI: 10.3348/jksr.2021.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/29/2021] [Accepted: 09/23/2021] [Indexed: 12/05/2022]
Abstract
The hippocampus is one of the most metabolically active regions of the brain; therefore, it may be affected by various acute disorders. This study aimed to introduce and categorize various acute conditions that can involve the hippocampus and explain the findings of MRI, especially diffusion-weighted imaging (DWI). Acute hippocampal disorders are divided into six categories: infection, inflammation, metabolic, ischemic, traumatic, and miscellaneous. In this study, patients were retrospectively reviewed based on clinical findings and MRI, especially DWI. All diseases had been confirmed clinically or pathologically. Many acute hippocampal disorders overlap with the clinical manifestations. Thus, it is necessary to categorize acute hippocampal lesions and understand their specific imaging findings for differential diagnosis.
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Shin SH, Wan Byun S, Jin Kim S, Woo Kim M, Kyu Yu I, Yun Lee H. Clinical Significance of White Matter Lesions in Idiopathic Sudden Sensorineural Hearing Loss. J Int Adv Otol 2022; 18:100-105. [PMID: 35418356 PMCID: PMC9450213 DOI: 10.5152/iao.2022.21434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: We aimed to analyze the patient characteristics in accordance with white matter lesions and confirm whether white matter lesions affect final treatment outcomes in idiopathic sudden sensorineural hearing loss. Methods: Medical records of 126 patients treated for unilateral idiopathic sudden sensorineural hearing loss and who underwent magnetic resonance imaging of the brain at an otology clinic in a university hospital from 2013 to June 2019 were reviewed. The Fazekas scale was used to evaluate the severity of white matter lesions. Complete recovery was defined if final hearing at 3 months did not exceed 25 dB. Results: Overall, 107 patients were enrolled in this study. A score of 0 on the Fazekas scale was most frequent (n = 78, 72.9%), followed by 1 (n = 17, 15.9%), and 2 (n = 12, 11.2%). Prevalence of diabetes (P = .032) and/or hypertension (P = .006) and distribution of age (P < .001) were different according to Fazekas scale scores. Hearing level in the affected side was significantly different between those with scores of 1 and 2 (P = .009). Contralateral hearing thresholds were not different according to Fazekas scale scores, but hearing on the contralateral side was significantly poorer in patients with hypertension than those without hypertension (P < .001). Regression analysis revealed that Fazekas scale score and initial hearing thresholds of the affected side were significant prognostic factors for complete recovery. Conclusion: Although the prevalence of white matter lesions in idiopathic sudden sensorineural hearing loss was not high, severe white matter lesions and accompanying cardiovascular risk factors may increase the possibility of initially worse hearing and decrease response to treatment in idiopathic sudden sensorineural hearing loss. Therefore, it might be important to control cardiovascular abnormalities in idiopathic sudden sensorineural hearing loss to achieve a better prognosis.
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Affiliation(s)
- Seung-Ho Shin
- Department of Otorhinolaryngology, Ewha Womans University Faculty of Medicine, Seoul, South Korea
| | - Sung Wan Byun
- Department of Otorhinolaryngology, Ewha Womans University Faculty of Medicine, Seoul, South Korea
| | - Soo Jin Kim
- Department of Otorhinolaryngology, Ewha Womans University Faculty of Medicine, Seoul, South Korea
| | - Min Woo Kim
- Department of Otorhinolaryngology, Daejeon Eulji University Medical Center, Eulji University Faculty of Medicine, Daejeon, Korea
| | - In Kyu Yu
- Department of Diagnostic Radiology, Daejeon Eulji University Medical Center, Eulji University Faculty of Medicine, Daejeon, Korea
| | - Ho Yun Lee
- Department of Otorhinolaryngology, Ewha Womans University Faculty of Medicine, Seoul, South Korea
- Corresponding author: Ho Yun Lee, e-mail:
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Jeon SJ, Choi SS, Kim HY, Yu IK. Response: Acute Diffusion MRI Findings in Metabolic Encephalopathies are Diverse. Korean J Radiol 2022; 23:383-384. [PMID: 35213099 PMCID: PMC8876651 DOI: 10.3348/kjr.2021.0899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Se Jeong Jeon
- Department of Radiology, Wonkwang University Hospital, Iksan, Korea
| | - See Sung Choi
- Department of Radiology, Wonkwang University Hospital, Iksan, Korea
| | - Ha Yon Kim
- Department of Radiology, Eulji University Hospital, Deajeon, Korea
| | - In Kyu Yu
- Department of Radiology, Eulji University Hospital, Deajeon, Korea.
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Jeon SJ, Choi SS, Kim HY, Yu IK. Erratum: Acute Acquired Metabolic Encephalopathy Based on Diffusion MRI. Korean J Radiol 2022; 23:290. [PMID: 35083893 PMCID: PMC8814701 DOI: 10.3348/kjr.2021.0952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Se Jeong Jeon
- Department of Radiology, Wonkwang University Hospital, Iksan, Korea
| | - See Sung Choi
- Department of Radiology, Wonkwang University Hospital, Iksan, Korea
| | - Ha Yon Kim
- Department of Radiology, Eulji University Hospital, Deajeon, Korea
| | - In Kyu Yu
- Department of Radiology, Eulji University Hospital, Deajeon, Korea
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Jeon SJ, Choi SS, Kim HY, Yu IK. Acute Acquired Metabolic Encephalopathy Based on Diffusion MRI. Korean J Radiol 2021; 22:2034-2051. [PMID: 34564957 PMCID: PMC8628163 DOI: 10.3348/kjr.2019.0303] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 11/02/2020] [Accepted: 11/20/2020] [Indexed: 11/22/2022] Open
Abstract
Metabolic encephalopathy is a critical condition that can be challenging to diagnose. Imaging provides early clues to confirm clinical suspicions and plays an important role in the diagnosis, assessment of the response to therapy, and prognosis prediction. Diffusion-weighted imaging is a sensitive technique used to evaluate metabolic encephalopathy at an early stage. Metabolic encephalopathies often involve the deep regions of the gray matter because they have high energy requirements and are susceptible to metabolic disturbances. Understanding the imaging patterns of various metabolic encephalopathies can help narrow the differential diagnosis and improve the prognosis of patients by initiating proper treatment regimen early.
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Affiliation(s)
- Se Jeong Jeon
- Department of Radiology, Wonkwang University Hospital, Iksan, Korea
| | - See Sung Choi
- Department of Radiology, Wonkwang University Hospital, Iksan, Korea
| | - Ha Yon Kim
- Department of Radiology, Eulji University Hospital, Deajeon, Korea
| | - In Kyu Yu
- Department of Radiology, Eulji University Hospital, Deajeon, Korea.
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Lee JY, Yu IK, Kim SM, Kim JH, Kim HY. Fulminant Disseminating Fatal Granulomatous Amebic Encephalitis: The First Case Report in an Immunocompetent Patient in South Korea. Yonsei Med J 2021; 62:563-567. [PMID: 34027644 PMCID: PMC8149926 DOI: 10.3349/ymj.2021.62.6.563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/07/2021] [Accepted: 03/16/2021] [Indexed: 11/27/2022] Open
Abstract
Central nervous system infections caused by free-living amoeba are very rare, but often fatal. The typical image findings of amebic meningoencephalitis are non-specific, showing ring-like enhancement. We report the first case of fulminant disseminating fatal granulomatous amebic encephalitis caused by Balamuthia mandrillaris in an immunocompetent patient in South Korea. Our case exhibited two interesting features: one was the unusual clinical course and the other was additional image findings. Magnetic resonance imaging revealed a rim-enhancing lesion with intralesional blooming dark signal intensity on susceptibility weighted imaging and low signal intensity on diffusion weighted images and on apparent diffusion coefficient maps. Differential diagnosis was started from a tumor or non-tumorous lesion, and diagnosis was difficult due to the rarity of the disease. Following the clinical and diagnostic courses of our case, we recommend inspecting image findings of granulomatous amebic encephalitis for early diagnosis.
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Affiliation(s)
- Ju Yeon Lee
- Department of Radiology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
| | - In Kyu Yu
- Department of Radiology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea.
| | - Seong Min Kim
- Department of Neurosurgery, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea.
| | - Joo Heon Kim
- Department of Pathology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
| | - Ha Youn Kim
- Department of Radiology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
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Jeon BU, Yu IK, Kim TK, Kim HY, Hwang S. Susceptibility-Weighted Imaging as a Distinctive Imaging Technique for Providing Complementary Information for Precise Diagnosis of Neurologic Disorder. J Korean Soc Radiol 2021; 82:99-115. [PMID: 36237474 PMCID: PMC9432415 DOI: 10.3348/jksr.2020.0054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/17/2020] [Accepted: 07/11/2020] [Indexed: 01/25/2023]
Abstract
Various sequences have been developed for MRI to aid in the radiologic diagnosis. Among the various MR sequences, susceptibility-weighted imaging (SWI) is a high-spatial-resolution, three-dimensional gradient-echo MR sequence, which is very sensitive in detecting deoxyhemoglobin, ferritin, hemosiderin, and bone minerals through local magnetic field distortion. In this regard, SWI has been used for the diagnosis and treatment of various neurologic disorders, and the improved image quality has enabled to acquire more useful information for radiologists. Here, we explain the principle of various signals on SWI arising in neurological disorders and provide a retrospective review of many cases of clinically or pathologically proven disease or components with distinctive imaging features of various neurological diseases. Additionally, we outline a short and condensed overview of principles of SWI in relation to neurological disorders and describe various cases with characteristic imaging features on SWI. There are many different types diseases involving the brain parenchyma, and they have distinct SWI features. SWI is an effective imaging tool that provides complementary information for the diagnosis of various diseases.
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Affiliation(s)
- Byeong-Uk Jeon
- Department of Radiology, Eulji University Hospital, Daejeon, Korea
| | - In Kyu Yu
- Department of Radiology, Eulji University Hospital, Daejeon, Korea
| | - Tae Kun Kim
- Department of Radiology, Eulji University Hospital, Daejeon, Korea
| | - Ha Youn Kim
- Department of Radiology, Eulji University Hospital, Daejeon, Korea
| | - Seungbae Hwang
- Department of Radiology, Chonbuk National University Hospital, Jeonju, Korea
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Lee M, Son HJ, Kim NY, Kim SJ, Yu IK. Nasopharyngeal undifferentiated carcinoma with sarcomatoid features: Pitfalls in the immunohistochemistry. Malays J Pathol 2019; 41:201-206. [PMID: 31427557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We present a case of an undifferentiated subtype of non-keratinizing squamous cell carcinoma (NK-SCC) with sarcomatoid features in the nasopharynx in a 69-year-old man who was difficult to diagnose due to spindle-shaped malignant cells. He was admitted because of a right nasal obstruction and right headache, and imaging revealed a heterogeneously enhanced irregularly shaped mass at the nasopharynx. Histopathologically, the tumour was partially organised, and the tumour cells were epithelioid or spindle-shaped. Initially, we erroneously diagnosed the tumour as an angiosarcoma owing to its false-negative immunoreaction for cytokeratins and a mistaken interpretation for CD31. After in situ hybridization for Epstein-Barr virus was positive, a consultation and additional immunostaining (including re-staining for cytokeratin with varying dilutions) were performed, and the diagnosis was revised to NK-SCC with sarcomatoid features. We believe that sarcomatoid features may be observed in nasopharyngeal carcinoma and in this case, immunostaining using various epithelial markers is necessary and careful attention should be paid to the interpretation of immunostaining.
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Affiliation(s)
- M Lee
- Eulji University School of Medicine, Department of Radiation Oncology, Daejeon, Republic of Korea.
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Lee J, Song K, Yu IK, Lee HY. A Case of Isolated Nodular Infarction Mimicking Vestibular Neuritis on the Contralateral Side. J Audiol Otol 2019; 23:167-172. [PMID: 31234246 PMCID: PMC6646894 DOI: 10.7874/jao.2018.00528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/27/2019] [Indexed: 11/22/2022] Open
Abstract
Differentiating central vestibulopathy from more common vestibular disorders is crucial because it often necessitates different treatment strategies, and early detection can help to minimize potential complications. Isolated nodular infarct is one of the central brain lesions that can mimic peripheral vertigo. We present a case of isolated nodular infarct that had been misdiagnosed as vestibular neuritis on the contralateral side at the initial evaluation. The patient was successfully treated with anticoagulants and antihyperlipidemic agents. Clinicians should keep in mind that some causes of central vertigo mimic peripheral vestibulopathy at the early stage.
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Affiliation(s)
- Jun Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Kudamo Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - In Kyu Yu
- Department of Radiology, Eulji University Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Ho Yun Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
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Son HJ, Lee H, Kim JH, Yu IK, Han HY. Unrecognised IgG4 association in progressively transformed germinal centers of lymph nodes with subsequent full-blown IgG4-related chronic fibrosing pancreatitis: A case report. Malays J Pathol 2018; 40:73-78. [PMID: 29704388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Progressively transformed germinal centers (PTGC) is a benign process characterised by a morphological variant of reactive follicular hyperplasia in lymph nodes. It was recently shown that some cases of PTGC are associated with IgG4-related disease (IgG4-RD) or increased IgG4 plasma cells. Five years ago, a 57-year-old woman presented with enlargement of multiple lymph nodes in the left parotid, submandibular, and neck areas, pathologically diagnosed as PTGC after excisional biopsy. Since then, she has experienced numbness in her extremities, especially the left shoulder and arm, pruritus on the left side of the face and intermittent facial palsy, for which she has been receiving regular symptomatic treatment. Recently the patient developed diabetes mellitus (approximately seven months ago). In routine follow-up scans, a mass was detected in left kidney and magnetic resonance imaging of the abdomen prior to surgery revealed a slightly enhanced bulky mass replacing the pancreatic tail and uncinate process. The mass in left kidney was diagnosed as clear cell renal cell carcinoma, and the pathological features of the pancreatic lesion were those of IgG4-related chronic fibrosing pancreatitis. Retrograde examination of the neck lymph node diagnosed as PTGC showed increased deposition of IgG4-positive plasma cells.
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Affiliation(s)
- H J Son
- Eulji University, School of Medicine, Department of Pathology, Daejeon, Republic of Korea.
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Son HJ, Yu IK, Kim SM. Lymphoplasmacyte-Rich Meningioma With Atypical Angiomatous Feature and an Increased Deposition of IgG4-Positive Plasma Cells: An Unusual Case Report. Int J Surg Pathol 2018; 26:93-97. [PMID: 28862040 DOI: 10.1177/1066896917728103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Lymphoplasmacyte-rich meningioma (LPRM) is an extremely rare variant of meningioma, and a small percentage of LPRM may be associated with IgG4-related disease. To date, the coexistence of 2 rare meningioma variants consisting of LPRM and angiomatous meningioma within one neoplasm has not been reported in the literature. A 56-year-old woman presented with episodes of frequent and severe epistaxis that began 4 months ago. Initial magnetic resonance imaging showed localized, heterogeneous, and intermediate to high signal lesion at the odontoid process and clivus. In subsequent magnetic resonance images, the mass grew to the posterior nasopharyngeal wall, and compression to the medulla, and a suspicious enhancement of both distal vertebral arteries became evident even though there was 3 times of partial resection over 17 years. The tumor showed regional and temporal heterogeneity, and atypical features such as mitoses and a high proliferative index were also identified in the area of angiomatous meningioma in addition to LPRM with an increased deposition of IgG4-positive plasma cells within the neoplasm.
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Affiliation(s)
| | - In Kyu Yu
- 1 Eulji University, Daejeon, Republic of Korea
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Cha WW, Song K, Yu IK, Choi MS, Chang DS, Cho CS, Lee HY. Magnetic resonance imaging predicts chronic dizziness after benign paroxysmal positional vertigo. Am J Otolaryngol 2017; 38:428-432. [PMID: 28390809 DOI: 10.1016/j.amjoto.2017.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/01/2017] [Accepted: 04/04/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We aimed to evaluate the clinical implications of magnetic resonance imaging (MRI) findings in patients with benign paroxysmal positional vertigo (BPPV). METHODS A total of 120 patients diagnosed with BPPV completed MRI at the emergency room between December 2012 and June 2015 and met our criteria for inclusion in this study. Epidemiologic characteristics, the results of audio-vestibular testing, and MRI findings were retrospectively analyzed. RESULTS The most common findings were white matter hyperintensities (70.0%), sinusitis (34.2%), and brain atrophy (25.0%). There were no significant differences in MRI findings or epidemiologic characteristics according to BPPV subtype (p>0.05). A multiple regression analysis revealed that BPPV recurrence (odds ratio, 6.88; 95% confidence interval, 1.67-34.48; p=0.009) and brain atrophy (odds ratio, 4.39; 95% confidence interval, 1.11-21.28; p=0.036) were positively associated with dizziness lasting longer than 3months. CONCLUSION Brain atrophy was independently associated with long-lasting dizziness after BPPV. Although the mechanism is unclear, brain atrophy may have relevance to otoneurotologic disease-related changes in brain structure.
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Affiliation(s)
- Wang Woon Cha
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Kudamo Song
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - In Kyu Yu
- Department of Diagnostic Radiology, Eulji University Medical Center, Eulji University School of Medicine, Eulji University, Daejeon, Republic of Korea
| | - Myoung Su Choi
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Dong Sik Chang
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Chin-Saeng Cho
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Ho Yun Lee
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea.
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Lee YJ, Lim YS, Lim HW, Yu IK, Kim YJ, Yoo WJ. Evaluation of In-Stent Restenosis After Stent Implantation in the Vertebral Artery Ostium by Multislice Computed Tomography Angiography: Factors Affecting Accurate Diagnosis. Clin Neuroradiol 2014; 25:379-86. [PMID: 24920183 DOI: 10.1007/s00062-014-0315-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 05/20/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE Few articles have evaluated vertebral artery ostium stents using multislice computed tomography (CT). The purpose of our study was to evaluate the diagnostic performance of 64- and 16-slice CT for detecting significant in-stent restenosis after vertebral artery ostium stenting, and to identify factors affecting the accurate diagnosis by CT. METHODS We reviewed 57 stents scanned using 64-slice CT and 34 stents using 16-slice CT. The accuracy of CT for diagnosing significant in-stent restenosis (≥ 50% diameter narrowing) was calculated using conventional angiography as a reference standard. Possible factors influencing the diagnostic performance of CT were analyzed, such as CT scanner, image quality, and stent characteristics. RESULTS With 64-slice CT, 46 (80.7%) of 57 stents were classified as evaluable, while with 16-slice CT, 28 (82.3%) of 34 stents were classified as evaluable. No stents with diameters ≤ 2.75 mm were evaluable. The respective results for 64- versus 16-slice CT were sensitivity 87.5% (95% confidence interval [CI] 47.3-99.7%) versus 100% (95% CI 15.8-100.0%), specificity 94.7% (95% CI 82.3%-99.4%) versus 96.2% (95% CI 80.4-99.9%). Factors reducing the accurate diagnosis were those associated with poor image quality, a diameter ≤ 2.75 mm, and drug-eluting stent type (p < 0.05). CONCLUSIONS 64-slice and 16-slice CT scans are adequate in stents with diameters > 2.75 mm for the evaluation of in-stent restenosis after stent implantation in the vertebral artery ostium.
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Affiliation(s)
- Y J Lee
- Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 137-701, Seoul, Republic of Korea
- Department of Radiology, Eulji University Hospital, Seo-gu Dunsan-dong 106, 302-799, Daejeon, Republic of Korea
| | - Y S Lim
- Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 137-701, Seoul, Republic of Korea
| | - H W Lim
- Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 137-701, Seoul, Republic of Korea
| | - I K Yu
- Department of Radiology, Eulji University Hospital, Seo-gu Dunsan-dong 106, 302-799, Daejeon, Republic of Korea
| | - Y J Kim
- Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 137-701, Seoul, Republic of Korea
| | - W J Yoo
- Department of Radiology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 137-701, Seoul, Republic of Korea.
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Moon SN, Jeon SJ, Choi SS, Song CJ, Chung GH, Yu IK, Kim DH. Can clinical and MRI findings predict the prognosis of variant and classical type of posterior reversible encephalopathy syndrome (PRES)? Acta Radiol 2013; 54:1182-90. [PMID: 23858507 DOI: 10.1177/0284185113491252] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is characterized by clinical symptoms that are associated with bilateral and symmetric vasogenic edema in the parietal and occipital lobes. However, this is rarely present with predominant involvement of the brain stem and cerebellum (variant). PURPOSE To evaluate which clinical or magnetic resonance imaging (MRI) findings can help to predict the prognosis of variant and classical type of PRES and whether or not there is difference between two types of PRES. MATERIAL AND METHODS We retrospectively evaluated MRI and clinical findings from 49 patients with PRES. These patients were divided into two groups. In group I, patients had atypical distribution of lesions. In group II, patients had typical distribution of lesions. Follow-up MRI was performed on 26 patients. We assessed the MRI features, clinical data, and the patients' outcomes. RESULTS The mean blood pressure (BP) was significantly higher in group I (195.52/121.09 mmHg and 156.78/99.53 mmHg for groups I and II, respectively). The other factors assessed were not significantly different between the two groups. Lesions in 24 of 26 patients reversed upon follow-up. Sequelae were observed in 11 patients (group I, 7; group II, 4). However, there were no significant differences between the two groups. Except for those patients who died, seven of the nine patients with sequelae upon follow-up imaging had hemorrhage or irreversibility of lesions. CONCLUSION Even though BP influences the involvement of the brain stem, involvement of the brain stem is not influential on the prognosis. It seems that the influential factor to prognosis is the reversibility of lesions and hemorrhage.
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Affiliation(s)
- Seong-Nam Moon
- Wonkwang University Hospital, Wonkwang Medical School, Iksan, Republic of Korea
| | - Se Jeong Jeon
- Wonkwang University Hospital, Wonkwang Medical School, Iksan, Republic of Korea
| | - See Sung Choi
- Wonkwang University Hospital, Wonkwang Medical School, Iksan, Republic of Korea
| | - Chang June Song
- Chungnam National University Hospital, Daejeon, Republic of Korea
| | | | - In Kyu Yu
- Eulji University Hospital, Daejeon, Republic of Korea
| | - Dea Ho Kim
- Konyang University Hospital, Daejeon, Republic of Korea
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An HY, Kim KS, Yu IK, Kim KW, Kim HH. Image presentation. The nipple-areolar complex: a pictorial review of common and uncommon conditions. J Ultrasound Med 2010; 29:949-962. [PMID: 20498469 DOI: 10.7863/jum.2010.29.6.949] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The purpose of this presentation is to show the radiologic findings of normal variants and benign and malignant diseases that affect the nipple-areolar complex. METHODS We evaluated the imaging findings of nipple-areolar complex lesions, using multiple breast imaging modalities including mammography, sonography, galactography, contrast-enhanced magnetic resonance imaging (MRI), and positron emission tomography/computed tomography. RESULTS Radiologic features of nipple-areolar complex lesions, including Montgomery tubercles, nipple inversion, benign calcifications, inflammation, duct dilatations, intraductal papillomas, fibroadenomas, neurofibromatosis, dermatosis of the nipple, and breast malignancy, have been illustrated. CONCLUSIONS A clinical examination is essential and an appropriate imaging evaluation with multiple modalities is often necessary to accurately diagnose an underlying abnormality of the nipple-areolar complex. Given the limitations of conventional mammography, supplemental mammographic views often are needed, and sonography may be performed to further characterize a mammographic or clinical finding. Also, contrast-enhanced MRI may be useful for additional evaluation.
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Affiliation(s)
- Hee Yeon An
- Department of Radiology, Eulji University Hospital, Daejeon, Korea
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Ju SH, Kim TH, Na JS, Song HS, Yu IK, Yoon HJ. A Case of Immune Reconstitution Inflammatory Syndrome in AIDS-related Progressive Multifocal Leukoencephalopathy after Antiretroviral Therapy. Infect Chemother 2010. [DOI: 10.3947/ic.2010.42.3.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sung Hun Ju
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University College of Medicine, Daejeon, Korea
| | - Tae Hyung Kim
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University College of Medicine, Daejeon, Korea
| | - Jung Sik Na
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University College of Medicine, Daejeon, Korea
| | - Ho Sup Song
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University College of Medicine, Daejeon, Korea
| | - In Kyu Yu
- Department of Radiology, Eulji University College of Medicine, Daejeon, Korea
| | - Hee Jung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University College of Medicine, Daejeon, Korea
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Abstract
BACKGROUND AND PURPOSE MR imaging features of HE have not been fully established. The purpose of this study was to determine the topographic distribution and DWI findings of HE. MATERIALS AND METHODS We retrospectively evaluated HE MR imaging (n = 11). The topographic distribution of the lesions was evaluated on routine MR imaging, and DWI SI and ADC values were assessed. The ADC value of involved lesions was compared with the noninvolved subcortical WM area by use of the paired t test. RESULTS MR images demonstrated bilateral diffusion-restrictive lesions in the posterior limb of the IC (n = 6), cerebral cortex (n = 8), CR (n = 7), CS (n = 9), hippocampus (n = 4), and BG (n = 1). The mean ADC value of lesions was 448.82 +/- 92.34 x 10(-6) mm(2)/s compared with the mean ADC value of noninvolved lesions (837.72 +/- 62.14 x 10(-6) mm(2)/s); this difference was statistically significant (P < .000). The lesions showed complete resolution on follow-up DWI for 6 patients. Three patients with cortical involvement of > or = 2 lobes showed partial recovery or death, but most of the other patients with WM involvement or cortical involvement in only 1 lobe experienced complete recovery. CONCLUSIONS The topographic localization of the lesions was the posterior limb of the IC, cerebral cortex, CR, CS, hippocampus, and BG. Most HE lesions probably correspond to areas of reversible cytotoxic edema as seen on DWI, which can predict the prognosis of HE according to the degree of lesion extent.
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Affiliation(s)
- E G Kang
- Department of Radiology, Wonkwang University Hospital, Chunbuk, Republic of Korea
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Abstract
Cerebrospinal fluid (CSF) leak or shunt overdrainage is a well-known cause of orthostatic headaches and low CSF pressures. We report two cases of orthostatic headache with pneumocephalus on brain imaging. The orthostatic headache developed after drainage of spinal operation site and epidural block. Brain MRI revealed characteristic findings of CSF hypovolemia including pachymeningeal enhancement and mild subdural fluid collections. Air was also observed in the ventricular or subarachnoid space in both patients, which might enter the subarachnoid or ventricular space during a procedure via the pressure gradient or an injection.
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Affiliation(s)
- Soo Jin Yoon
- Department of Neurology, Eulji University College of Medicine, Daejeon, Korea
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Lee BH, Kim BM, Park MS, Park SI, Chung EC, Suh SH, Choi CS, Won YS, Yu IK. Reconstructive endovascular treatment of ruptured blood blister-like aneurysms of the internal carotid artery. J Neurosurg 2009; 110:431-6. [PMID: 19046039 DOI: 10.3171/2008.7.jns08257] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA) are rare but carry a high rate of morbidity and mortality. Furthermore, BBAs are very difficult to treat surgically as well as endovascularly. The authors present their experience in treating BBAs with reconstructive endovascular methods. METHODS Nine ruptured BBAs in 9 consecutive patients (2 men and 7 women; mean age 50 years, range 42-57 years) were treated using reconstructive endovascular methods between January 2006 and November 2007. Treatment methods and angiographic and clinical outcomes were retrospectively evaluated. RESULTS All 9 BBAs were initially treated with stent-assisted coil (SAC) embolization. This was followed by a second stent insertion using the stent-within-a-stent (SWS) technique in 3, covered stent placement in 3, and SAC embolization alone in 3. All 3 patients who underwent SWS placement had excellent outcomes (Glasgow Outcome Scale Score 5) with complete angiographic resolution of the BBAs. There were no treatment-related complications in the SWS group. Two of the 3 patients who received covered stents had excellent outcomes (Glasgow Outcome Scale Score 5) and complete occlusion of the BBA was achieved. The remaining patient who received a covered stent died of ICA rupture during the procedure. Aneurysm regrowth without rebleeding occurred in the 3 patients who underwent SAC embolization. Two of the 3 recurrent BBAs were treated with coil embolization with a second stent insertion, and as a result these belonged to the SWS group. The other recurrent BBA was treated with a covered stent. Of the 8 surviving patients, 5 underwent SWS, and 3 underwent covered stent placement. All surviving patients had excellent outcomes during the clinical follow-up period (mean 11 months, range 4-26 months); complete BBA resolution and smooth reconstruction of the affected ICA segment was shown on follow-up angiography. CONCLUSIONS In the present study, the SWS and covered-stent techniques effectively prevented rebleeding and regrowth of the BBA without sacrifice of the ICA. The SWS and covered-stent techniques can be considered an alternative treatment option for BBAs in selected patients in whom ICA sacrifice is not feasible. Stent-assisted coiling alone seems insufficient to prevent BBA regrowth.
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Affiliation(s)
- Byung-Hee Lee
- Departments of Radiology, Eulji University Hospital, Daejeon, Seoul, Republic of Korea
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Choi SY, Yu IK, Han MH, Lee BH, Song CJ, Kim KS. Fibrosing inflammatory pseudotumor of the nasopharynx: MR features and histopathologic correlation. Eur J Radiol 2008; 72:274-7. [PMID: 18778906 DOI: 10.1016/j.ejrad.2008.07.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 06/24/2008] [Accepted: 07/28/2008] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe the magnetic resonance (MR) imaging features of six cases of pathologically proven fibrosing inflammatory pseudotumor involving the nasopharynx, and to compare the MR signal intensities of the lesions with histopathologic findings. METHODS We reviewed the MR finding of six patients with pathologically proved fibrosing inflammatory pseudotumor at the nasopharyngeal wall with respect to the following points: extent, margins, signal intensity and enhancement degree of the lesion; cervical lymphadenopathy and response to steroid therapy. MR findings were correlated with histopathologic findings. RESULTS All lesions showed ill-defined margins and looked less-likely contour bulging features. The signal intensity of the lesions was hypointense or slightly heterogeneous relative to brain cortex on both T1- and T2-weighted images, and enhancement was weakly homogeneous in all cases. There was no demonstrable cervical lymphadenopathy in all cases. After steroid therapy, the lesions showed decreased extent and weaker enhancement in three patients. Histopathologic findings showed high degree of polymorphous inflammatory cellular infiltration with underlying significant reactive fibrosis. CONCLUSION Fibrotic inflammatory pseudotumors involving nasopharynx are very rare, and can mimic malignancy. MR imaging showed ill-defined margins, hypointensity or slightly heterogenous signal intensity on T2-weighted image and weak enhancement. There was no significant cervical lymphadenopathy.
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Affiliation(s)
- So-Young Choi
- Department of Radiology, Eulji University Hospital, 1306 Dunsan-dong, Seo-gu, Daejeon, South Korea
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Park JD, Chung YH, Kim CY, Ha CS, Yang SO, Khang HS, Yu IK, Cheong HK, Lee JS, Song CW, Kwon IH, Han JH, Sung JH, Heo JD, Choi BS, Im R, Jeong J, Yu IJ. Comparison of high MRI T1 signals with manganese concentration in brains of cynomolgus monkeys after 8 months of stainless steel welding-fume exposure. Inhal Toxicol 2007; 19:965-71. [PMID: 17849280 DOI: 10.1080/08958370701516108] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Several pharmacokinetic studies on inhalation exposure to manganese (Mn) have already demonstrated that Mn readily accumulates in the olfactory and brain regions. However, a shortening of the magnetic resonance imaging (MRI) T1 relaxation time or high T1 signal intensity in specific sites of the brain, including the globus pallidus and subcortical frontal white matter, as indicative of tissue manganese accumulation has not yet been clearly established for certain durations of known doses of welding-fume exposure in experimental animals. Accordingly, to investigate the movement of manganese after welding-fume exposure, six cynomolgus monkeys were acclimated and assigned to three dose groups: unexposed, low dose (31 mg/m(3) total suspended particulate [TSP], 0.9 mg/m(3) of Mn), and high dose (62 mg/m(3) TSP, 1.95 mg/m(3) of Mn) of total suspended particulate. The primates were exposed to manual metal arc stainless steel (MMA-SS) welding fumes for 2 h per day in an inhalation chamber system equipped with an automatic fume generator. Magnetic resonance imaging (MRI) studies were conducted before the initiation of exposure and thereafter every month. The tissue Mn concentrations were then measured after a plateau was reached regarding the shortening of the MRI T1 relaxation time. A dose-dependent increase in the Mn concentration was found in the lungs, while noticeable increases in the Mn concentrations were found in certain tissues, such as the liver, kidneys, and testes. Slight increases in the Mn concentrations were found in the caudate, putamen, frontal lobe, and substantia nigra, while a dose-dependent noticeable increase was only found in the globus pallidus. Therefore, the present results indicated that a shortening of the MRI T1 relaxation time corresponded well with the Mn concentration in the globus pallidus after prolonged welding-fume exposure.
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Son SM, Ahn YH, Sakong J, Moon HK, Ahn SH, Lee H, Yu IK, Shin YJ, Jang SH. Diffusion tensor imaging demonstrates focal lesions of the corticospinal tract in hemiparetic patients with cerebral palsy. Neurosci Lett 2007; 420:34-8. [PMID: 17512661 DOI: 10.1016/j.neulet.2007.04.054] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Revised: 02/21/2007] [Accepted: 04/01/2007] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to use diffusion tensor imaging (DTI) with fiber tractography (FT) to demonstrate focal lesions of the corticospinal tract (CST) in hemiparetic patients with cerebral palsy (CP) who showed no specific focal lesions on conventional brain MRI. Four hemiparetic patients with CP (three left hemiparesis, mean age: 2.5 years, range: 0.9-7.0) and four age-matched controls were recruited. DTI was performed using a 1.5-T system with a synergy-L Sensitivity Encoding head coil. Fractional anisotropy (FA) and apparent diffusion coefficients (ADC) were measured using the region of interest (ROI) method. We estimated the asymmetric anisotropy index (AA) and asymmetric mean diffusivity index (AD) to evaluate the asymmetry between right and left CSTs. All four patients showed interrupted FT at the affected periventricular white matter (PVWM) level compared to that of the opposite side; this was not detected on conventional brain MRI and explained the hemiparesis of these patients. Compared to the data of controls, all patients showed significant AA and AD only at the PVWM level. DTI with FT demonstrated focal lesions at the PVWM level. We conclude that DTI with FT may be a useful modality for investigating focal lesions in hemiparetic patients with CP.
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Affiliation(s)
- Su Min Son
- Department of Physical Medicine and Rehabilitation, School of Medicine, Eulji University, Daejeon, Republic of Korea
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Kim JE, Lee BR, Chun JE, Lee SJ, Lee BH, Yu IK, Kim S. Cognitive dysfunction in 16 patients with carotid stenosis: detailed neuropsychological findings. J Clin Neurol 2007; 3:9-17. [PMID: 19513337 PMCID: PMC2686931 DOI: 10.3988/jcn.2007.3.1.9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Accepted: 02/20/2007] [Indexed: 01/21/2023] Open
Abstract
Background Impairment of cognitive function is often present in patients with carotid artery stenosis but the details of this dysfunction have rarely been reported. Our purpose was to elucidate the cognitive dysfunction in patients with unilateral severe carotid stenosis using comprehensive neuropsychological testing, and also to identify the specific underlying clinical and radiological factors. Methods We analyzed the results of neuropsychological testing, the clinical history, and MR findings in 16 consecutive patients with angiographically proven severe (70-99%) stenosis of the extra cranial internal carotid artery (ICA). Cognitive functions were examined using the Seoul Neuropsychological Screening Battery and the Neglect Battery. We excluded patients with cortical infarction and those with contra lateral ICA occlusion or severe stenosis. Results Our comprehensive neuropsychological testing revealed obvious cognitive deficits in all patients with unilateral severe ICA stenosis, the most common being frontal executive impairment. The mean cognitive score on the memory test was also significantly lower in patients with symptomatic ICA stenosis than in asymptomatic patients (29.33±10.98, mean±SD, p < 0.05). The total score on the global cognitive test was significantly lower in patients with an ischemic lesion on MRI than in no lesion patients (113.23±34.78, p < 0.05). The presence of symptoms related to the ICA stenosis was related to cognitive dysfunction even when there were no ischemic lesions on MRI. SPECT revealed ipsilateral cortical hypoperfusion in 9 of 12 patients (75%). Conclusions Cognitive deficits are common in patients with unilateral severe ICA stenosis. Our findings suggest that an additional mechanism beyond the structural lesion such as chronic hypoperfusion may affect cognitive function in patients with high-grade ICA stenosis.
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Affiliation(s)
- Jung Eun Kim
- Department of Neurology, Konyang University College of Medicine, Daejeon, Korea
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Kim JE, Kim TH, Yu IK, Lee BR, Lee SJ, Oh GS. Diffusion-Weighted MRI in Recurrent Wernicke's Encephalopathy: a Remarkable Cerebellar Lesion. J Clin Neurol 2006; 2:141-5. [PMID: 20396499 PMCID: PMC2854955 DOI: 10.3988/jcn.2006.2.2.141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2005] [Accepted: 05/03/2006] [Indexed: 11/17/2022] Open
Abstract
We report unusual MRI findings (including those from diffusion-weighted imaging (DWI)) in a patient with recurrent Wernicke's encephalopathy with a remarkable cerebellar lesion. DWI showed high signal intensities in the superior portion of the cerebellar hemisphere and vermis area. After thiamine administration, clinical symptoms improved and the lesions with high signal intensities disappeared on follow-up DWI.
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Affiliation(s)
- Jung Eun Kim
- Department of Neurology, Konyang University College of Medicine, Daejeon, Korea
| | - Tae Hyung Kim
- Department of Neurology, Eulji University College of Medicine, Daejeon, Korea
| | - In Kyu Yu
- Department of Radiology, Eulji University College of Medicine, Daejeon, Korea
| | - Bo Ram Lee
- Department of Neurology, Eulji University College of Medicine, Daejeon, Korea
| | - Soo Joo Lee
- Department of Neurology, Eulji University College of Medicine, Daejeon, Korea
| | - Gun Sei Oh
- Department of Neurology, Eulji University College of Medicine, Daejeon, Korea
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Yoo SY, Chang KH, Song IC, Han MH, Kwon BJ, Lee SH, Yu IK, Chun CK. Apparent diffusion coefficient value of the hippocampus in patients with hippocampal sclerosis and in healthy volunteers. AJNR Am J Neuroradiol 2002; 23:809-12. [PMID: 12006282 PMCID: PMC7974737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND AND PURPOSE MR diffusion-weighted (DW) imaging with apparent diffusion coefficient (ADC) has had widespread use clinically in a variety of intracranial diseases; however, only a few studies report ADC changes in patients with hippocampal sclerosis. We sought to determine the ability of ADC to lateralize the epileptogenic lesion in patients with hippocampal sclerosis. METHODS Nineteen healthy volunteers and 18 patients with intractable temporal lobe epilepsy whose MR imaging diagnosis was unilateral hippocampal sclerosis were examined prospectively with DW imaging and ADC mapping. DW images were obtained at 1.5 T with a spin-echo echo-planar sequence (6500/103 [TR/TE]) with variable diffusion gradients. ADCs were calculated from bilateral hippocampi. The ability of DW imaging and ADC to lateralize the lesion was evaluated visually and by comparing ADC values between healthy volunteers and patients with hippocampal sclerosis. RESULTS In all patients, visual assessment of DW images failed to lateralize the lesion. However, the mean ADC value measured at the hippocampal area was significantly higher on the lesion side than on the contralateral side (P <.001). The overall correct lateralization rate of ADC was 100% (18 of 18 patients). Mean ADC in sclerotic hippocampi was also significantly higher than that in healthy volunteers. The normal-appearing hippocampus of the contralateral side in the patients had higher ADC values compared with those of healthy volunteers (P =.045). CONCLUSION ADC can be used as a complementary tool in lateralizing the epileptogenic lesion in patients with hippocampal sclerosis, although the practical role of ADC value is yet to be determined in patients with inconclusive MR imaging findings.
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Affiliation(s)
- So Young Yoo
- Department of Radiology, Seoul National University College of Medicine, Korea
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Abstract
OBJECTIVE To compare the age distribution and characteristic MR imaging findings of ependymoma for each typical location within the neuraxis. MATERIALS AND METHODS During a recent eleven-year period, MR images of 61 patients with histologically proven ependymomas were obtained and retrospectively reviewed in terms of incidence, peak age, location, size, signal intensity, the presence or absence of cyst and hemorrhage, enhancement pattern, and other associated findings. RESULTS Among the 61 patients, tumor location was spinal in 35 (57%), infrartentorial in 19 (31%), and supratentorial in seven (12%). In four of these seven, the tumor was located in brain parenchyma, and in most cases developed between the third and fifth decade. Approximately half of the infratentorial tumors occurred during the first decade. The signal intensity of ependymomas was nonspecific, regardless of their location. A cystic component was seen in 71% (5/7) of supratentorial, 74% (14/19) of infratentorial, and 14% (5/35) of spinal cord tumors. Forty- nine percent (17/35) of those in the spinal cord were associated with rostral and/or caudal reactive cysts. Intratumoral hemorrhage occurred in 57% (4/7) of supratentorial, 32% (6/19) of infratentorial, and 9% (3/35) of spinal cord tumors. In 17% (6/35) of spinal ependymomas, a curvilinear low T2 signal, suggesting marginal hemorrhage, was seen at the upper and/or lower margins of the tumors. Peritumoral edema occurred in 57% (4/7) of supratentorial, 6% (3/19) of infratentorial and 23% (8/35) of spinal cord tumors. Seventy-two percent (5/7) of supratentorial and 95% (18/19) of infratentorial tumors showed heterogeneous enhancement, while in 50% (17/34) of spinal cord tumors, enhancement was homogeneous. CONCLUSION Even though the MR imaging findings of ependymomas vary and are nonspecific, awareness of these findings, and of tumor distribution according to age, is helpful and increases the likelihood of correct preoperative clinical diagnosis.
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Affiliation(s)
- Ja-Young Choi
- Department of Radiology, Seoul National University College of Medicine; Institute of Radiation Medicine, SNUMRC; Clinical Research Institute, Seoul National University Hospital, Korea
| | - Kee-Hyun Chang
- Department of Radiology, Seoul National University College of Medicine; Institute of Radiation Medicine, SNUMRC; Clinical Research Institute, Seoul National University Hospital, Korea
| | - In Kyu Yu
- Department of Radiology, Seoul National University College of Medicine; Institute of Radiation Medicine, SNUMRC; Clinical Research Institute, Seoul National University Hospital, Korea
| | - Keon Ha Kim
- Department of Radiology, Seoul National University College of Medicine; Institute of Radiation Medicine, SNUMRC; Clinical Research Institute, Seoul National University Hospital, Korea
| | - Bae Joo Kwon
- Department of Radiology, Seoul National University College of Medicine; Institute of Radiation Medicine, SNUMRC; Clinical Research Institute, Seoul National University Hospital, Korea
| | - Moon Hee Han
- Department of Radiology, Seoul National University College of Medicine; Institute of Radiation Medicine, SNUMRC; Clinical Research Institute, Seoul National University Hospital, Korea
| | - In-One Kim
- Department of Radiology, Seoul National University College of Medicine; Institute of Radiation Medicine, SNUMRC; Clinical Research Institute, Seoul National University Hospital, Korea
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Hwang SI, Kim JH, Park SW, Han MH, Yu IK, Lee SH, Lee DS, Lee SK, Chung CK, Chang KH. Comparative analysis of MR imaging, positron emission tomography, and ictal single-photon emission CT in patients with neocortical epilepsy. AJNR Am J Neuroradiol 2001; 22:937-46. [PMID: 11337340 PMCID: PMC8174931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND AND PURPOSE MR imaging, positron emission tomography (PET), and single-photon emission CT (SPECT) play important roles in presurgical localization of epileptic foci. However, comparative study of these imaging methods for cases of neocortical epilepsy has been limited. The purpose of this study was to compare the sensitivities of these three imaging methods for presurgical localization of neocortical epileptogenic foci. METHODS We studied 117 consecutive patients who underwent surgery for intractable neocortical epilepsy. The pathologic substrates were neuronal migration disorder (n = 77), tumor (n = 15), and others (n = 25). MR imaging was compared retrospectively with (18)F-fluorodeoxyglucose PET and ictal technetium-99m hexamethylpropyleneamine oxime SPECT regarding their capability to correctly localize the epileptogenic foci. The pathologic findings were used as the standard of reference. RESULTS Overall, MR imaging, PET, and ictal SPECT correctly localized the lesions for 59.8%, 77.7%, and 70.3% of the patients, respectively, with a 38% concordance rate among the three methods. PET was most sensitive (71-100%) in detecting all substrates. MR imaging was as sensitive (100%) as PET in detecting tumor but was least sensitive (48.1%) in detecting neuronal migration disorder. Ictal SPECT was more sensitive (75.8%) than MR imaging in detecting neuronal migration disorder. Patients with imaging abnormalities achieved good outcomes in 81.4% of the cases, in contrast to 59.5% for those without imaging abnormalities (P <.05). CONCLUSION PET and ictal SPECT were overall more sensitive than was MR imaging, despite the low concordance rate and variable sensitivity depending on substrates. The detection of abnormalities by MR imaging was associated with good outcome. PET or ictal SPECT can be well used as complementary tools, particularly in cases of negative MR imaging findings.
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Affiliation(s)
- S I Hwang
- Department of Radiology, Seoul National University College of Medicine, 28 Yongondong, Chongno-gu, Seoul, 110744, Korea
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Kim YH, Chang KH, Park SW, Koh YW, Lee SH, Yu IK, Han MH, Lee SK, Chung CK. Hippocampal sclerosis: correlation of MR imaging findings with surgical outcome. Korean J Radiol 2001; 2:63-7. [PMID: 11752972 PMCID: PMC2718103 DOI: 10.3348/kjr.2001.2.2.63] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Atrophy and a high T2 signal of the hippocampus are known to be the principal MR imaging findings of hippocampal sclerosis. The purpose of this study was to determine whether or not individual MRI findings correlate with surgical outcome in patients with this condition. MATERIALS AND METHODS Preoperative MR imaging findings in 57 consecutive patients with pathologically-proven hippocampal sclerosis who underwent anterior temporal lobectomy and were followed-up for 24 months or more were retrospectively reviewed, and the results were compared with the postsurgical outcome (Engel classification). The MR images included routine sagittal T1-weighted and axial T2-weighted spin-echo images, and oblique coronal T1-weighted 3D gradient-echo and T2-weighted 2D fast spin-echo images obtained on either a 1.5 T or 1.0 T unit. The images were visually evaluated by two neuroradiologists blinded to the outcome; their focus was the presence or absence of atrophy and a high T2 hippocampal signal. RESULTS Hippocampal atrophy was seen in 96% of cases (55/57) [100% (53/53) of the good outcome group (Engel class I and II), and 50% (2/4) of the poor outcome group (class III and IV)]. A high T2 hippocampal signal was seen in 61% of cases (35/57) [62% (33/53) of the good outcome group and 50% (2/4) of the poor outcome group]. All 35 patients with a high T2 signal had hippocampal atrophy. 'Normal' hippocampus, as revealed by MR imaging, occurred in 4% of patients (2/57), both of whom showed a poor outcome (Engel class III). The presence or absence of hippocampal atrophy correlated well with surgical outcome (p<0.01). High T2 signal intensity did not, however, significantly correlate with surgical outcome (p>0.05). CONCLUSION Compared with a high T2 hippocampal signal, hippocampal atrophy is more common and correlates better with surgical outcome. For the prediction of this, it thus appears to be the more useful indicator.
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Affiliation(s)
- Yoon Hee Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Kee-Hyun Chang
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul, Korea
- Neuroscience Research Institute, Seoul, Korea
| | - Sun-Won Park
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Young Whan Koh
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Hyun Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - In Kyu Yu
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Moon Hee Han
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul, Korea
- Neuroscience Research Institute, Seoul, Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Chun-Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
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Park SW, Chang KH, Kim HD, Song IC, Lee DS, Lee SK, Chung CK, Yu IK, Han MH, Park YH. Lateralizing ability of single-voxel proton mr spectroscopy in hippocampal sclerosis: comparison with mr imaging and positron emission tomography. AJNR Am J Neuroradiol 2001; 22:625-31. [PMID: 11290468 PMCID: PMC7976017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND AND PURPOSE Proton MR spectroscopy (MRS) is still in the early stages in the evaluation of epilepsy, and comparisons with MR imaging and positron emission tomography (PET) in the same patients have rarely been documented. The purpose of this study was to evaluate the lateralizing ability of single-voxel MRS in comparison with MR imaging and PET in patients with hippocampal sclerosis. METHODS Thirty-three patients with intractable temporal lobe epilepsy whose MR imaging diagnosis was unilateral hippocampal sclerosis and who underwent anterior temporal lobectomy and had good postsurgical outcome over 1-year follow-up were included in the study. MR spectra were obtained from the hippocampus bilaterally, using the point-resolved spectroscopy sequence. Metabolite ratios of NAA/Cho and NAA/Cr were calculated from the relative peak height measurements. An NAA/Cho ratio of 0.8 or less and an NAA/Cr ratio of 1.0 or less were regarded as abnormal. The MRS results were compared retrospectively with those of MR imaging and PET as to the ability to lateralize the epileptogenic focus. RESULTS The sensitivity of MRS and PET (concordance with MR imaging) was 85% each in the lateralization of the ipsilateral lesion side. Bilateral abnormalities were seen in 30% of the patients. False-lateralization rates for MRS and PET were 3% and 6%, respectively. The concordance rate of MRS and PET was 73%, when comparing the results of the ipsilateral lesion side. CONCLUSION MRS may be used as an adjunct tool in the evaluation of hippocampal sclerosis, like PET, although its sensitivity has to be improved and the clinical significance of bilateral abnormality is still to be determined.
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Affiliation(s)
- S W Park
- Department of Radiology, Seoul National University College of Medicine, Korea
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Choi BY, Chang KH, Choe G, Han MH, Park SW, Yu IK, Park YH, Kim HJ. Spinal intradural extramedullary capillary hemangioma: MR imaging findings. AJNR Am J Neuroradiol 2001; 22:799-802. [PMID: 11290503 PMCID: PMC7976030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
SUMMARY Spinal intradural extramedullary capillary hemangiomas are extremely rare. We present the MR imaging and histologic findings in three patients with this abnormality. The three patients were men who had symptoms of either myelopathy (n = 2) or radiculopathy (n = 1). The tumors were well demarcated, 1.5-2.0 cm in diameter, and were located at the posterior or posterolateral portion of the thecal sac (one at the L1 level and the other two at the midthoracic level). On MR images, the tumor showed isointensity relative to the spinal cord on T1-weighted images, hyperintensity on T2-weighted images, and strong homogeneous enhancement on contrast-enhanced T1-weighted images in all three patients. In two patients, the dural tail sign was observed. Capillary hemangioma should be included in the differential diagnosis of a spinal intradural extramedullary tumor.
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Affiliation(s)
- B Y Choi
- Department of Radiology, Seoul National University College of Medicine, National Police Hospital, Korea
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Chang KH, Kim HD, Park SW, Song IC, Yu IK, Han MH, Lee SK, Chung CK, Park YH. Usefulness of single voxel proton MR spectroscopy in the evaluation of hippocampal sclerosis. Korean J Radiol 2000; 1:25-32. [PMID: 11752925 PMCID: PMC2718133 DOI: 10.3348/kjr.2000.1.1.25] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The purpose of our study was to determine the ability of H-1 MR spectroscopy (MRS) to lateralize the lesion in patients with hippocampal sclerosis. MATERIALS AND METHODS Twenty healthy volunteers and 25 patients with intractable temporal lobe epilepsy whose MR imaging diagnosis was unilateral hippocampal sclerosis were included. This diagnosis was based on the presence of unilateral atrophy and/or high T2 signal intensity of the hippocampus. Singlevoxel H-1 MRS was carried out on a 1.5-T unit using PRESS sequence (TE, 136 msec). Spectra were obtained from hippocampal areas bilaterally with volumes of interest (VOIs) of 6.0 cm(3) and 2.25 cm(3) in healthy volunteers, and of either 6.0 cm(3) (n = 14) or 2.25 cm(3) (n = 11) in patients. Metabolite ratios of NAA/Cho and NAA/Cr were calculated from relative peak height measurements. The capability of MRS to lateralize the lesion and to detect bilateral abnormalities was compared with MR imaging diagnosis as a standard of reference. RESULTS In healthy volunteers, NAA/Cho and NAA/Cr ratios were greater than 0.8 and 1.0, respectively. In patients, the mean values of these ratios were significantly lower on the lesion side than on the contralateral side, and lower than those of healthy volunteers (p <.05). The overall correct lateralization rate of MRS was 72% (18/25); this rate was lower with a VOI of 6.0 cm(3) than of 2.25 cm(3) (64% versus 82%, p <.05). Bilateral abnormalities on MRS were found in 24% (6/25) of cases. CONCLUSION Although its rate of correct lateralization is low, single-voxel H-1 MRS is a useful and promising diagnostic tool in the evaluation of hippocampal sclerosis, particularly for the detection of bilateral abnormalities. To improve the diagnostic accuracy of H-1 MRS, further investigation, including the use of a smaller VOI and measurement of the absolute amount of metabolites, are needed.
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Affiliation(s)
- K H Chang
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
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Abstract
Four cases of choroid plexitis of the brain (two with cryptococcosis and two with tuberculosis) are presented. The four patients showed either unilateral enlargement (3) or bilateral enlargement (1) and dense enhancement of the choroid plexus in the lateral ventricles (4) and fourth ventricle (1) in association with clinical findings of leptomeningitis. All patients had unilateral cystic dilatation of the temporal horn of the lateral ventricle presumably secondary to entrapment of the temporal horn and extensive oedema around the ipsilateral ventricle.
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Affiliation(s)
- I C Cho
- Department of Radiology, Seoul National University College of Medicine, South Korea
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Moon WK, Im JG, Yu IK, Lee SK, Yeon KM, Han MC. Mediastinal tuberculous lymphadenitis: MR imaging appearance with clinicopathologic correlation. AJR Am J Roentgenol 1996; 166:21-5. [PMID: 8571880 DOI: 10.2214/ajr.166.1.8571880] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The purpose of our study was to determine the MR imaging appearance of mediastinal tuberculous lymphadenitis and to compare these findings with clinical and pathologic findings. MATERIALS AND METHODS MR images of 23 consecutive patients with mediastinal tuberculous lymphadenitis were retrospectively analyzed with regard to homogeneity, signal intensity, and enhancement of diseased nodes after injection of contrast material (n = 19), and the imaging findings were grouped by patterns and correlated with clinical signs or symptoms and with pathologic (n = 9) findings. RESULTS Three imaging patterns of mediastinal tuberculous lymphadenitis (113 nodes) were seen of MR images. In six patients, nodes (type 1, n = 25) were relatively homogeneous and hyperintense to muscle on both T1- and T2-weighted images and enhanced homogeneously after injection of contrast material. The patients had mild (n = 2) or no (n = 4) constitutional symptoms. The nodes corresponded pathologically to tuberculous granulomas without or with minimal necrosis. In 14 patients, nodes (type 2, n = 71) were inhomogeneous with a strong peripheral enhancement after injection of contrast material. Enhancing areas were of intermediate intensity on T1-weighted images and hypointense on T2-weighted images, and corresponded pathologically to peripheral granulation tissue within the nodes. Unenhanced areas were relatively hypointense on T1-weighted images and markedly hyperintense on T2-weighted images, and corresponded pathologically to central caseation or liquefaction necrosis within the nodes. All but one patient with type 2 nodes had moderate to severe clinical signs and symptoms. In the remaining three patients, nodes (type 3, n = 17) were homogeneously hypointense on both T1- and T2-weighted images and did not enhance after injection of contrast material. No patient with type 3 nodes had clinical signs or symptoms. The nodes corresponded pathologically to fibrocalcified nodes. CONCLUSION The most common MR imaging appearance of mediastinal tuberculous lymphadenitis was as inhomogeneous nodes with marked hyperintensity on T2-weighted images and peripheral enhancement after injection of contrast material. This typical MR imaging appearance was mostly seen in severely symptomatic patients and was due to caseation necrosis of the tuberculous nodes.
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Affiliation(s)
- W K Moon
- Department of Radiology, Seoul National University College of Medicine, Korea
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Abstract
Six cases of undifferentiated embryonal sarcoma (UES) were reviewed to determine their characteristic features on ultrasonography (US) (n = 5) and computed tomography (CT) (n = 6). US demonstrated a single large, echogenic mass with some anechoic spaces. Contrast-enhanced CT scan revealed a well-demarcated low-attenuation mass with hyperdense septations of variable shape and thickness. Discrepancy of internal architecture on US and CT was one of the important characteristics of UES. CT numbers were 25-47 HU in low-attenuation areas. Enhancing peripheral rim was found in four cases and some solid portions at the periphery or adjacent to the septa were found in all cases. Two patients who had follow-up US and CT without treatment showed enhancing solid portions, changing to hypodense as the tumor grew. When compared with the pathologic findings, US showed a more accurate representation of internal architecture than did CT. Familiarity with these US and CT findings of UES of the liver will be helpful in the differential diagnosis of primary hepatic tumors in childhood.
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Affiliation(s)
- W K Moon
- Department of Radiology, Seoul National University College of Medicine, Republic of Korea
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Lee WJ, Choi BI, Chung JW, Park JH, Han JK, Goo JM, Han MC, Yeon KM, Yu IK, Kim CW, Choo SW, Yoon DY. Magnetic Resonance Imaging of Infarcted Liver Induced by Selective Ligation of Right Portal Vein in Rabbits. ACTA ACUST UNITED AC 1994. [DOI: 10.3348/jkrs.1994.31.1.99] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kong Y, Cho SY, Han MH, Goo JM, Yu IK, Shin YM, Lee SK, Chang KH, Cho SW. An Experimental Study on Cerebral Paragonimiasis using Cats. ACTA ACUST UNITED AC 1994. [DOI: 10.3348/jkrs.1994.30.6.1003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Moon WK, Im JG, Kim HC, Yu IK, Choo SW, Kim TK, Yeon KM, Han MC. Analysis of CT patterns and treatment response in patients with mediastinal tuberculous lymphadenitis. ACTA ACUST UNITED AC 1993. [DOI: 10.3348/jkrs.1993.29.5.987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Affiliation(s)
- R J Romani
- Department of Pomology, University of California, Davis, California 95616
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Romani RJ, Yu IK, Ku LL, Fisher LK, Dehgan N. Cellular senescence, radiation damage to mitochondria, and the compensatory response in ripening pear fruits. Plant Physiol 1968; 43:1089-96. [PMID: 16656887 PMCID: PMC1086977 DOI: 10.1104/pp.43.7.1089] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
A compensatory response, viz. in vivo recovery from radiation damage to mitochondria, occurs in preclimacteric pear fruits (Pyrus communis L.) treated with ionizing radiation. The compensatory response is absent or markedly impaired in senescent fruits irradiated at or near the climacteric peak. Senescent cells failed to recover from harmful effects of radiation on: 1) mitochondrial yield, 2) in vivo incorporation of amino acids into mitochondrial protein, and 3) mitochondrial respiratory control and ADP/O. A diminished response to "split-dose" irradiation and a delayed rate of recovery confirmed the degeneracy and loss of compensatory power with cell age.A loss of restorative activity, especially in mitochondria that supply the cell with essential energy, may underlie the more obvious signs of cumulative stress that accompany cellular senescence. Use of ionizing radiation as an investigative tool and the molecular implications of radiation damage, recovery, and cellular senescence are discussed.
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Affiliation(s)
- R J Romani
- Department of Pomology, University of California, Davis, California 95616
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