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Spontaneous tumor rupture is a serious but rare complication of hepatocellular carcinoma (HCC) and has a low survival rate. Here, we report a case of massive HCC that ruptured and was treated successfully with transarterial chemoembolization (TACE). A 55-year-old man with abdominal pain was diagnosed with a 12-cm-wide ruptured HCC at segment 8. The overall liver function was scored as Child-Pugh A, but the single nodule tumor had ruptured; therefore, TACE treatment was initiated. After the first TACE treatment, residual tumors were found; thus, secondary TACE was performed 5 months later. No new lesions or extrahepatic metastases were found 16 months after the first TACE treatment, so hepatic resection was performed for curative treatment. The postoperative pathology results did not reveal any cancer cells; hence, TACE alone resulted in a cure. We report this case because the cure has been maintained for more than 3 years after resection. (J Liver Cancer 2020;20:154-159) more...

Aims The incidence and mortality of hepatocellular carcinoma (HCC) have decreased over time in South Korea, where hepatitis B virus (HBV) in endemic. This study investigated the changes in the characteristics and clinical outcomes of HCC patients in Korea. Methods Patients initially diagnosed with HCC and treated at the National Cancer Center, Korea between 2000 and 2015 (n = 4,291) were followed up until February 2017. Differences in patient characteristics and outcomes were compared between chronological cohorts: cohort A (2000–2004, n = 1,157) vs. B (2005–2009, n = 1,678) vs. C (2010–2015, n = 1,456). Results The median age of the patient cohort was 57 years (range, 13–98 years), and male predominance was noted (81.6%). HBV infection was the most common etiology (74.8%). The proportion of patients diagnosed with good liver function and small tumors (ppvs. 20.4 vs. 64.5 months, p Conclusions The survival of patients with HCC, especially HBV-related HCC, has improved significantly over time in Korea. more...

INTRODUCTION: Intermittent pneumatic compression (IPC) is now a widely used therapy for the prophylaxis of deep vein thrombosis and pulmonary embolism. In general, the IPC sequence is composed of sequential compression and simultaneous deflation. Typically, veins are considered to be squeezed and emptied during the compression phase and to be refilled during the deflation phase. However, because the stop or sudden increase in blood flow can be dangerous, a further investigation is needed with respect to the blood flow. MATERIALS AND METHODS: We demonstrated a new compression protocol based on the investigation results of venous blood flow during IPC. This new compression protocol involves successive compression without the deflation phase; thus, the expelled blood volume flow during a given period can be maximized. To investigate the blood flow during IPC, sonography movie clips and in-laboratory developed blood flow analysis software was used. RESULTS: The increases in the peak volume flow during IPC were 49% (±24%) and 25% (±29%) with the conventional protocol and the new protocol, respectively, whereas the total volume flow (TVF) was not significantly changed (−1.0% and −13.0%, respectively). With the new protocol, the peak velocity (PV) was 49% lower than that with the conventional protocol. Thus, the new protocol has an effect of maintaining TVF without resulting in a sudden large increase or decrease in PV. CONCLUSION: The new suggested protocol might improve safety because it can maintain the stability of blood flow by reducing the risk of blood stasis and a rapid change in blood flow. more...

ObjectiveTo evaluate the prevalence and predictors of peripherally inserted central catheter-associated bloodstream infection (PBSI) and PBSI-related death in hospitalized adult patients.Materials and methodsA retrospective multicenter cohort of consecutive patients who underwent PICC placement from October 2016 to September 2017 at four institutes was assembled. Using multivariable logistic and Cox-proportional hazards regression models, all risk factors were analyzed for their association with PBSI. Multivariable logistic models were used to evaluate predictors of PBSI-related death.ResultsDuring the study period, a total of 929 PICCs were inserted in 746 patients for a total of 17,913 catheter days. PBSI occurred in 58 patients (6.2%), with an infection rate of 3.23 per 1,000 catheter days. Number of catheter lumens [double lumen, odds ratio (OR) 5.295; 95% confidence interval (CI), 2.220-12.627; hazard ration (HR) 3.569; 95% CI, 1.461-8.717], PICC for chemotherapy (OR 4.94; 95% CI, 1.686-14.458; HR 7.635; 95% CI, 2.775-21.007), and hospital length of stay (OR 2.23; 95% CI, 1.234-4.049; HR 1.249; 95% CI, 0.659-2.368) were associated with PBSI. Risk factors, such as receiving chemotherapy (OR 54.911; 95% CI, 2.755-1094.326), presence of diabetes (OR 11.712; 95% CI, 1.513-90.665), and advanced age (OR 1.116; 95% CI 1.007-1.238), were correlated with PBSI-related death.ConclusionOur results indicated that risk factors associated with PBSI included the number of catheter lumens, the use of PICCs for chemotherapy, and the hospital length of stay. Furthermore, PBSI-related death was common in patients undergoing chemotherapy, diabetics, and elderly patients. more...

Despite increasing use, the exact prevalence and predictors of peripherally inserted central catheter-associated bloodstream infection (PICC-CLABSI) in hospitalized patients with cancer are not elucidated.This retrospective cohort study included consecutive patients who underwent peripherally inserted central catheter (PICC) placement in 4 institutions (during 12 months in 3 hospitals and 10 months in 1 hospital). The prevalence of PICC-CLABSI was evaluated. The association between predictors and PICC-CLABSI were analyzed using Cox proportional hazards regression models and Kaplan-Meier survival analysis with log-rank tests.During the study period, 539 PICCs were inserted in 484 patients for a total of 10,841 catheter days. PICC-CLABSI occurred in 25 (5.2%) patients, with an infection rate of 2.31 per 1000 catheter days. PICC for chemotherapy (hazards ratio [HR] 11.421; 95% confidence interval (CI), 2.434-53.594; P = .019), double lumen catheter [HR 5.466; 95% CI, 1.257-23.773; P = .007], and PICC for antibiotic therapy [HR 2.854; 95% CI, 1.082-7.530; P = .019] were associated with PICC-CLABSI.PICC for chemotherapy or antibiotics, and number of catheter lumens are associated with increased risk of PICC-CLABSI in cancer patients. Careful assessment of these factors might help prevent PICC-CLABSI and improve cancer patients care. more...

Objective To assess the clinical efficacy, safety, and risk factors influencing local tumor progression, following CT-guided radiofrequency ablation (RFA) of recurrent or residual hepatocellular carcinoma (HCC), around iodized oil retention. Materials and methods Sixty-four patients (M : F = 51 : 13, 65.0 ± 8.2 years old) with recurrent or residual HCC (75 index tumors, size = 14.0 ± 4.6 mm) had been treated by CT-guided RFA, using retained iodized oil as markers for targeting. The technical success, technique effectiveness rate and complications of RFA were then assessed. On pre-ablative and immediate follow-up CT after RFA, we evaluated the size of enhancing index tumors and iodized oil retention, presence of abutting vessels, completeness of ablation of iodized oil retention, and the presence of ablative margins greater than 5 mm. Also, the time interval between transarterial chemoembolization and RFA was assessed. The cumulative local tumor progression rate was calculated using the Kaplan-Meier method, and the Cox proportional hazards model was adopted, to clarify the independent factors affecting local tumor progression. Results The technical success and technique effectiveness rate was 100% and 98.7%, respectively. Major complications were observed in 5.6%. The cumulative rates of local tumor progression at 1 and 2 years were 17.5% and 37.5%, respectively. In multivariate analyses, partial ablation of the targeted iodized oil retention was the sole independent predictor of a higher local tumor progression rate. Conclusion CT-guided RFA of HCC around iodized oil retention was effective and safe. Local tumor progression can be minimized by complete ablation of not only index tumors, but targeted iodized oil deposits as well. more...

Portal vein embolization (PVE) is increasingly performed worldwide to reduce the possibility of liver failure after extended hepatectomy, by inducing future liver remnant (FLR) hypertrophy and atrophy of the liver planned for resection. The procedure is known to be very safe and to have few procedure-related complications. In this study, we described 2 elderly patients with Bismuth–Corlette type IV Klatskin tumor who underwent right trisectional PVE involving the embolization of the right portal vein, the left medial sectional portal branch, and caudate portal vein. Within 1 week after PVE, patients went into sepsis combined with bile leak and died within 1 month. Sepsis can cause acute liver failure in patients with chronic liver disease. In this study, the common patient characteristics other than sepsis, that is, trisectional PVE; chronic alcoholism; aged >65 years; heart-related comorbidity; and elevated serum total bilirubin (TB) level (7.0 mg/dL) at the time of the PVE procedure in 1 patient, and concurrent biliary procedure, that is, percutaneous transhepatic biliary drainage in the other patient might have affected the outcomes of PVE. These cases highlight that PVE is not a safe procedure. Care should be taken to minimize the occurrence of infectious events because sepsis following PVE can cause acute liver failure. Additionally, prior to performing PVE, the extent of PVE, chronic alcohol consumption, age, comorbidity, long-lasting jaundice, concurrent biliary procedure, etc. should be considered for patient safety. more...

We investigated tissue responses to endoskeleton stent grafts for saccular abdominal aortic aneurysms (AAAs) in canines. Saccular AAAs were made with Dacron patch in 8 dogs, and were excluded by endoskeleton stent grafts composed of nitinol stent and expanded polytetrafluoroethylene graft. Animals were sacrificed at 2 months (Group 1; n = 3) or 6 months (Group 2; n = 5) after the placement, respectively. The aortas embedding stent grafts were excised en bloc for gross inspection and sliced at 5 to 8 mm intervals for histopathologic evaluation. Stent grafts were patent in all except a dog showing a thrombotic occlusion in Group 2. In the 7 dogs with patent lumen, the graft overhanging the saccular aneurysm was covered by thick or thin thrombi with no endothelial layer, and the graft over the aortic wall was completely covered by neointima with an endothelial layer. Transgraft cell migration was less active at an aneurysm than at adjacent normal aorta. In conclusion, endoskeleton stent grafts over saccular aneurysms show no endothelial coverage and poor transgraft cell migration in a canine model. more...

Background: In cases of endoscopic intervention treatment for biliary stricture which fail, a percutaneous approach can be subsequently attempted. However, the quality of life is lower for those patients with percutaneous transhepatic biliary drainage (PTBD) tubes than those with endoscopic retrograde biliary drainage tubes. In this study, we report the outcome of the application of percutaneous transhepatic biliary stenting (PTBS) for use in subsequent endoscopic treatment of biliary stricture after living donor liver transplantation (LDLT). Methods: Of 165 patients who underwent LDLT, 40 (24.2%) were diagnosed with anastomotic biliary strictures. Of these patients, seven agreed to treatment using PTBS using a plastic stent with endoscopic follow-up instead of treatment by insertion of a PTBD tube, and were enrolled in this study. Results: In all seven patients, the use of this technique enabled effective advancement of a guide wire and successful placement of one or two plastic stents (7 or 10 Fr) into the PTBD tract. There were no PTBS-related complications associated with the procedure. The median duration for stent use was 40.3 weeks (range; 27.6~65.0). Upon final removal of all stents, the stricture had been resolved in four (57%) of the seven patients. Conclusions: Our study data suggested that, after failed use of ERCP in the treatment of biliary stricture after LDLT, the use of PTBS and ERCP may be an effective and safe treatment. more...

Supplemental Digital Content is available in the text, The aim of the present study was to evaluate the clinical significance of dual radiotracer studies, 11C-acetate and 18F-fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT), for the prediction of response and recurrence after transarterial chemoembolization (TACE). This study retrospectively included a total 42 hepatoceullar carcinoma (HCC) patients (median age, 59; range, 34–85 years old) who underwent 11C-acetate and 18F-FDG PET/CT concurrently. Tumor uptake normalized by liver uptake (TNR; maximum tumor SUV to mean normal liver SUV ratio) was obtained first. Then, FAratio, which is the ratio of 18F-FDG TNR (TNR_FDG) to 11C-acetate TNR, was obtained and correlated with response after TACE and recurrence-free survival (RFS), using a Cox multivariate proportional-hazard model. Among clinical factors, including the Hepatoma Arterial Embolization Prognostic score and positron emission tomography (PET) parameters, multiple regression analysis revealed FAratio and tumor size to be the only significant factors. As a PET parameter, FAratio exhibited the largest area under the curve in the prediction of response after TACE. In the Cox multivariate proportional-hazard model, TNR_FDG was the only significant predictive factor for RFS. In subgroup analysis, TNR_FDG was the only significant predictive factor for recurrence in intermediate stage patients. However, FAratio was the only significant predictive factor for recurrence in advanced stage patients. Dual radiotracer use of 11C-acetate and 18F-FDG PET/CT contributed to the prediction of response and recurrence after TACE. Used in addition to 18F-FDG, 11C-acetate PET/CT could give additional information in advanced stage patients. Based on the characteristics of tumor metabolism assessed by dual radiotracer PET/CT, treatment plans could be more personalized and optimized. more...

BACKGROUND/AIMS Although adipocytes secrete inflammatory cytokines and adipokines, their role in reflux esophagitis is controversial. We investigated the association between visceral fat and inflammatory cytokines or adipokines in reflux esophagitis. METHODS Abdominal visceral fat and cytokines were measured in 66 individuals with reflux esophagitis and 66 age- and sex-matched controls. The mean values for visceral fat and cytokines were compared in cases and controls. Second, correlations between visceral fat and inflammatory cytokines were measured. Finally, multiple logistic regression models for odds ratios (ORs) and 95% confidence intervals (CIs) were used to estimate the effects of visceral fat and cytokines on reflux esophagitis. RESULTS Visceral fat, leptin, interleukin (IL)-6, and IL-1β were higher in reflux esophagitis compared to controls. Visceral fat showed a strong positive correlation with IL-6 (r = 0.523, P < 0.001), IL-8 (r = 0.395, P < 0.001), and IL-1β (r = 0.557, P < 0.001), and a negative correlation with adiponectin (r = -0.466, P < 0.001). With adjusted analysis, visceral fat/100 (OR, 4.32; 95% CI, 2.18-8.58; P < 0.001) and leptin (OR, 1.36; 95% CI, 1.10-1.69; P = 0.005) independently increased the risk of reflux esophagitis, but the effects of other cytokines were abolished. CONCLUSIONS Visceral fat may increase the risk of reflux esophagitis by increasing the levels of inflammatory cytokines. Leptin showed a positive association with reflux esophagitis that was independent of visceral fat. more...

Splenic artery pseudoaneurysms can be caused by pancreatitis, trauma, or operation. Traditionally, the condition has been managed through surgery; however, nowadays, transcatheter arterial embolization is performed safely and effectively. Nevertheless, several complications of pseudoaneurysm embolization have been reported, including coil migration. Herein, we report a case of migration of the coil into the jejunal lumen after transcatheter arterial embolization of a splenic artery pseudoaneurysm. The migrated coil was successfully removed by performing endoscopic intervention. more...

[1] Llovet JM, Real MI, Montana X, Planas R, Coll S, Aponte J, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 2002;359:1734–1739. [2] Lo CM, Ngan H, Tso WK, Liu CL, Lam CM, Poon RT, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002;35:1164–1171. [3] Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet 2012;379:1245–1255. [4] Marelli L, Stigliano R, Triantos C, Senzolo M, Cholongitas E, Davies N, et al. Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc Intervent Radiol 2007;30:6–25. [5] Iwamoto S, Sanefuji H, Okuda K. Angiographic subsegmentectomy for the treatment of patients with small hepatocellular carcinoma. Cancer 2003;97:1051–1056. [6] Park JW, Koh YH, Kim HB, Kim HY, An S, Choi JI, et al. Phase II study of concurrent transarterial chemoembolization and sorafenib for patients with unresectable hepatocellular carcinoma. J Hepatol 2012;56:1336–1342. more...

The authors present a case of histologically proven bronchus-associated lymphoid tissue (BALT) lymphoma of the lung in a patient with primary Sjogren's syndrome that manifested on thin-section CT scan as a mosaic pattern of inhomogeneous attenuation due to mixed small airway and infiltrative abnormalities more...

We prospectively investigated the association between a change of serum vascular endothelial growth factor (VEGF) level after transcatheter arterial chemoembolization (TACE) and hepatocellular carcinoma (HCC) patient prognosis. The study involved 147 patients with unresectable HCC treated at the National Cancer Center, Korea, between July and December 2005. Serum samples were collected from each patient before TACE, and 1-2 days and 1 month after TACE. Serum VEGF concentrations were measured using an enzyme-linked immunosorbent assay (ELISA). The log(e)(VEGF/platelets) increased transiently 1-2 days after TACE and declined thereafter. Frequency of previous TACE did not correlate with log(e)(VEGF/platelets). This study found that log(e)(VEGF/platelets) 1-2 days after TACE, but not log(e)(VEGF/platelets) at baseline, was strongly correlated with vascular or nodal invasion and AJCC (American Joint Committee on Cancer)/UICC (International Union Against Cancer) stage, and was significantly greater in men. Relative changes in serum VEGF/platelet levels 1-2 days after TACE (DeltaVEGF)0.5 were directly correlated with tumor size, vascular invasion and modified UICC and AJCC/UICC stage (P0.05 for each). Additionally, DeltaVEGF0.5 was significantly correlated with newly developed extrahepatic metastases one and six months after TACE (P = 0.005 and 0.003, respectively). Progression free survival of patients with DeltaVEGF0.5 was significantly worse (P0.001) and DeltaVEGF0.5 was an independent prognostic factor for PFS (hazard ratio, 3.111; P0.001). This study showed that a high increment in serum VEGF level 1-2 days after TACE in HCC patients was associated with distant metastasis and unfavorable outcomes. more...

Extrahepatic metastasis in patients with hepatocellular carcinoma (HCC) occurs frequently. The most common site of metastasis is the lung, followed by regional lymph nodes and bones. However, gastrointestinal metastasis of HCC is a rare condition and solitary polypoid metastatic lesion on stomach without any evidence of direct invasion from primary mass is very rare. These metastatic lesions are usually asymptomatic, and most are discovered at postmortem examination or are found incidentally during laparotomy. The choice of treatment for gastrointestinal metastatic lesion of HCC includes surgery, transarterial chemoembolization, and local injection but the treatment is often difficult and unsuccessful. We report a case of 69 years old man who presented disappearance of a polypoid metastatic lesion of HCC on the gastric fundus by transarterial chemoembolization. more...

To identify the dose-volumetric parameters associated with the risk of radiation-induced hepatic toxicity (RIHT) in hepatocellular carcinoma patients treated with three-dimensional conformal radiotherapy.A total of 105 hepatocellular carcinoma patients underwent three-dimensional conformal radiotherapy (total dose range, 44-58.5 Gy; median, 54). RIHT was scored within 4 months of completing three-dimensional conformal radiotherapy. The dose-volume parameters analyzed were the gross tumor volume; normal liver volume; total liver volume; radiation dose; mean dose to the normal liver; percentage of the normal liver volume receivingor =20,or =25,or =30,or =35, andor =40 Gy; percentage of the total liver volume receivingor =20,or =25,or =30,or =35, andor =40 Gy; and the normal tissue complication probability.Of the 105 patients, Grade 1 RIHT was observed in 21 (20.0%), Grade 2 in 7 (6.7%), Grade 3 in 5 (4.8%), and Grade 4 in 1 (1.0%) patient. No fatal Grade 5 RIHT developed. On multivariate analysis for predicting Grade 2 or worse RIHT, the total liver volume receivingor =30 Gy was the only significant parameter (p0.001). Grade 2 or worse RIHT was observed in only 2 (2.4%) of 85 patients with a total liver volume receiving 30 Gy ofor =60% and in 11 (55.0%) of 20 patients with60% (p0.001).The total liver volume receivingor =30 Gy appears to be a useful dose-volumetric parameter for predicting the risk of RIHT. This volume should be limited toor =60% whenever possible to minimize the risk of Grade 2 or worse RIHT. more...

Objective: To evaluate the utility and advantages of the coaxial snare technique in the retrieval of tubular foreign bodies. Materials and Methods: Using the coaxial snare technique, we attempted to retrieve tubular foreign bodies present in seven patients. The bodies were either stents which were malpositioned or had migrated from their correct position in the vascular system (n=2), a fragmented venous introducer sheath (n=1), fragmented drainage catheters in the biliary tree (n=2), or fractured external drainage catheters in the urinary tract (n=2). After passing a guidewire and/or a dilator through the lumina of these foreign bodies, we introduced a loop snare over the guidewire or dilator, thus capturing and retrieving them. Results: In all cases, it was possible to retrieve or reposition the various items, using a minimum-sized introducer sheath or a tract. No folding was involved. In no case were surgical procedures required, and no complications were encountered. Conclusion: The coaxial snare technique, an application of the loop snare technique, is a useful and safe method for the retrieval of tubular foreign bodies, and one which involves minimal injury to the patient. more...

Objective We evaluated the effect of close contact between the stent and the graft on the induction of endothelial covering on the stent graft placed over an aneurysm. Materials and Methods Saccular abdominal aortic aneurysms were made with Dacron patch in eight dogs. The stent graft consisted of an inner stent, a expanded polytetrafluoroethylene graft, and an outer stent. After sacrificing the animals, the aortas with an embedded stent graft were excised. The aortas were inspected grossly and evaluated microscopically. Results The animals were sacrificed at two (n = 3), six (n = 3), and eight months (n = 2) after endovascular repair. In two dogs, the aortic lumen was occluded at two months after the placement. On gross inspection of specimens from the other six dogs with a patent aortic lumen, stent grafts placed over the normal aortic wall were covered by glossy white neointima, whereas, stent grafts placed over the aneurysmal aortic wall were covered by brownish neointima. On microscopic inspection, stent grafts placed over the normal aortic wall were covered by thin neointima (0.27 ± 0.05 mm, mean ± standard deviation) with an endothelial layer, and stent grafts placed over the aneurysmal aortic wall were covered by thick neointima (0.62 ± 0.17 mm) without any endothelial lining. Transgraft cell migration at the normal aortic wall was more active than that at the aneurysmal aortic wall. Conclusion Close contact between the stent and the graft, which was achieved with stent grafts with endo-exo-skeleton, could not enhance endothelial covering on the stent graft placed over the aneurysms. more...

A linear intracardiac foreign body was identified following a total hip replacement (THR) on chest CT and transesophageal echocardiography in a 60-year-old woman with rheumatoid arthritis. Leakage and migration of bone cement during arthroplasty is a possible explanation for this rare complication. Therefore, adequate preparation and handling of cement using biplane fluoroscopy are recommended during arthroplasty. more...

Kimura's disease is a benign chronic inflammatory condition with good prognosis, commonly involving the head and neck area. With regard to thoracic manifestation, however, the information contained in the literature is limited. The diagnosis of Kimura's disease on the basis of imaging is difficult, especially in thoracic cases manifesting as lymphadenopathy. The purpose of this report is to illustrate and discuss a thoracic case of the disease manifesting as lymphadenopathy. more...

Shaken baby syndrome (SBS) is a form of child abuse that can cause significant head injuries, of which subdural hematoma (SDH) is the most common manifestation. We report the MRI findings of chronic SDH in three cases of SBS, involving two-, three- and eight-month-old babies. The SDH signal was mostly low on T1-weighted images and high on T2-weighted images, suggesting chronic SDH. In chronic SDH, a focal high signal on T1-weighted images was also noted, suggesting rebleeding. Contrast-enhanced MRI revealed diffuse dural enhancement. more...

Objective To determine the incidence and etiologies of celiac axis stenosis in asymptomatic individuals. Materials and Methods This prospective study involved 400 consecutive patients (male: 319, female: 81) referred to us for celiac arteriography between April and July 1999. When celiac axis branches were opacified by collateral circulation during superior mesenteric arteriography, the presence of celiac axis stenosis was suspected; lateral projection celiac arteriography was performed and the pressure gradient was measured. The indicators used to determine whether or not celiac axis stenosis was significant were luminal narrowing of more than 50% and a resultant pressure gradient of at least 10 mmHg. Its etiology was determined on the basis of angiographic appearances and CT findings. Results Twenty-nine patients (7.3%) had celiac axis stenosis. The etiology of the condition was extrinsic compression due to the median arcuate ligament in 16 patients (55%) and atherosclerosis in three (10%), while in ten (35%) it was not determined. The incidence of celiac axis stenosis did not vary significantly according to sex, age and the presence of calcified aortic plaque representing atherosclerosis. Conclusion The incidence of hemodynamically significant celiac axis stenosis in this asymptomatic Korean population was 7.3% and the most important etiology was extrinsic compression by the median arcuate ligament of the diaphragm. Atherosclerosis was only a minor cause of the condition. more...

Purpose : To compare the diagnostic value of gadolinium-enhanced MR angiography with that of conventional digital substraction angiography for the evaluation of lower extremity arterial occlusive diseases. Materials and Methods : In 26 patients with symptomatic lower extremity arterial occlusive disease, both conventional digital substraction angiography(DSA) and gadolinium-enhanced MR angiography (CE-MRA) were performed during the same week. MR angiography was performed using three-dimensional gradient-echo ac-quisition before, and two sequential acquisitions after, the administration of gadolinium(0.2 mmol/kg). In 23 patients, two separate, contiguous areas were scanned using additional doses. In three patients, only one field with a suspicious lesion was scanned. Three radiologists independantly analysed the CE-MRA and DSA find-ings of each vascular segment(20 segments per arterial tree) for the presence of obstructive lesions; the grade assigned was either mild or none (0.001), respectively. To prove the absence of lesions, we repeated DSA in two patients with arterial spasm due to puncture. Three occluded segments seen on DSA, which revealed intact segments on MR angiography, suggested slow distal flow after reconstitution. Conclusion : For the evaluation of lower extremity arterial occlusive disease, the diagnostic value of gadolini-um-enhanced MR angiography is comparable with that of digital substraction angiography. The advantages of the former are the absence of puncture-related spasm and visualization of slow distal flow. more...

Purpose: To analyze the cineangiographic appearance and determine the clinical importance of coronary-to-bronchial artery communication. Materials and Methods: The coronary cineangiograms of 4,620 patients were reviewed, and 12 cases of coro-nary-to-bronchial artery communications were observed in 10 patients (M:F=6:4; mean age, 48.4 years). The cineangiographic findings were analyzed and correlated with these of other imaging studies [perfusion scan (n=5), computed tomographic angiography (CTA) (n=4), conventional chest computed tomography (CT) (n=1), and conventional angiography (n=6)]. Results: Cineangiography revealed that hypertrophied branches of the coronary artery communicated with bronchial arteries in which adjacent hypervascular staining, was observed, and which were accompanied by pulmonary shunts (n=9). The underlying diseases identified among the ten patients were Takayasu arteritis (n=5), chronic inflammatory pulmonary disease (n=3), pulmonary thromboembolism (n=1), and or newly di-agnosed pulmonary tuberculosis (n=1). The lung fields supplied by coronary-to-bronchial communication showed close correlation with the territories of perfusion defects, decreased pulmonary vascularity, or inflam-matory lesions revealed by other imaging studies. Conclusion: Coronary-to-bronchial artery communication can present as a secondary result of occlusive disease of the pulmonary arteries or chronic pulmonary inflammation, and in patients with hemoptysis involv-ing, for example, incomplete embolization or myocardiac infarction, it may be problematic. more...

Purpose: To evaluate the MR findings of neuro-Behcet ’s disease, and changes occurring during follow up. Materials and Methods: Brain MR imaging was performed in 19 patients in whom neuro-Behcet ’s disease had been clinically diagnosed. After treatment with corticosteroids and immunosuppressive agents, 23 follow-up MR images were obtained in 12 patients, and a total of 42 MR images were retrospectively reviewed by two radiologists. Results: Of the 19 patients, 17 (89%) had parenchymal lesions, and the other two had dural venous sinus thrombosis. Among the 17 patients with parenchymal lesions, three showed leptomeningeal enhancement. A total of 72 parenchymal lesions were detected on initial MR images; 55 (76%) were patchy or nodular in shape and the lesion of the internal capsule appeared linear. Seventeen lesions (24%) in 12 patients were confluent. In order of frequency, the involved sites were the pons, midbrain, thalamus, basal ganglia, internal capsule, and frontal lobe. Thirteen lesions of 39 lesions detected on postcontrast images were enhanced, and a mass effect was seen in the area of 16 parenchymal lesions. Associated findings were microhemorrhage of the brain in two patients and spinal cord involvement in one. On short-term follow-up images obtained 1 week to 2 months after intensive treatment during the acute stage of the illness, the leptomeningeal enhancement seen in three patients had decreased and most parenchymal lesions showed improvement. Long-term follow-up im-ages obtained 3 months to 3 years later showed that parenchymal lesions had relapsed in five patients, and brainstem atrophy had developed or progressed in five others. Conclusion: The most characteristic MR finding of neuro-Behcet ’s disease is multiple non-hemorrhagic lesions involving the brainstem. Leptomeningeal enhancement and dural venous sinus thrombosis may also be noted. On follow-up MR, the lesions may show either improvement or aggravation, and brainstem atrophy is not uncommon. more...

Purpose : To describe the MR imaging and clinical findings of spontaneous spinal epidural hematoma. Materials and Methods : The MR and clinical findings in six patients (M:F=4:2;adult:child=3:3) with spontaneous spinal epidural hematoma were reviewed. Five patients without any predisposing factor which might cause the condition and one with acute myelogeneous leukemia were included. Emergency surgery was performed in two patients, and the other four were managed conservatively. Results : The epidural lesion involved between three and seven vertebrae (mean: 4.5), and relative to the spinal cord was located in the posterior-lateral (n=4), anterior (n=1), or right lateral (n=1) area. The hematoma was isointense (n=1) or hyperintense (n=5) with spinal cord on T1-weighted images, and hy-pointense (n=2) or hyperintense (n=4) on T2-weighted images. It was completely absorbed in four of five patients who underwent follow-up MR imaging, but not changed in one. The clinical outcome of these patients was complete recovery (n=4), spastic cerebral palsy (n=1), or unknown (n=1). Conclusion : Because of the lesion ’s characteristic signal intensity, MR imaging is very useful in the diagnosis and evaluation of spontaneous spinal epidural hematoma. more...

Purpose : To evaluate the efficacy of as an intravenous nonionic contrast material by comparing it with an established nonionic contrast material (). Materials and Methods : Forty adult New Zealand white rabbits weighing about 3.0 kg were used in this study. Aortography and urography (scout, 5, 15 and 30 minutes delay after injection) were performed in ten rabbits with (370 mgI/mL) and in other ten rabbits with (370 mgI/mL). All twenty rabbits under-went abdominal triple-phase spiral CT before and 5 and 30 seconds after injection of the contrast material. The degree of contrast enhancement seen on aortograms and intravenous urograms was determined using a three-point scale by two radiologists, who reached a consensus. CT attenuation expressed in Hounsfield units (HU) was measured using the regions of interest (ROIs) facility in the liver, bilateral kidneys, aorta, portal vein, and inferior vena cava. The Mann-Whitney U test was used in image evaluation for intergroup comparisons. Results : There was no significant difference between the two groups in the degree of contrast enhancement seen on aortograns. In urography, however, was superior to in demonstrating calyces of the right kidney on 15-minute delay images and was superior to in demonstrating the right ureter and the renal pelvis on five minute-delay images and the left ureter on 30 minutes delay (p.05). Peak enhancement of the aorta during the first phase of bdominal CT was higher in the group in which was used. Conclusion : When normal rabbits were used for aortography, abdominal CT, and urography, provided more effective contrast enhancement than a previously used nonionic contrast material, namely Iopamiro. There were, however, slight differences in the enhancement features of renal calyces and ureters seen on 5-and 15-minute urograms. more...

Embolization of the bronchial artery is a well-established treatment for patients with hemoptysis. To our know ledge, a case involving an aberrant bronchial artery from the common carotid artery has never been reported. The authors describe a case in which an aberrant bronchial artery from the left common carotid artery was a potential hazard during embolization of the bronchial artery. more...

Purpose : To evaluate the efficacy of percutaneous transcatheter sclerotherapy using povidone-iodine andethanol for the treatment of postoperative pelvic lymphoceles Materials and Methods : Between January 1995 andApril 1998, 22 lymphoceles in 21 women who had under-gone pelvic surgery were subjected to percutaneoustranscatheter sclerotherapy using povidone-iodine and ethanol. Biochemical and cytological examination revealedthat 16 lymphoceles were sterile and six were in-fected. The diameter of lymphoceles varied between 3 and 20(average; 7.9 cm) and the initial volume of drainage ranged from 10ml to 1200ml. When the amount of drainagedecreased to less than 5 -10 ml/day and when the lymphocele was collapsed on follow-up sinography, the catheterwas removed. By means of sonog-raphy, all patients were followed up. The duration of this ranged from 1 month to 3years 4 months (average, 18 months). Results : After percutaneous transcatheter sclerotherapy, 21 of 22lymphoceles were seen to have collapsed. Three lymphoceles recurred during the follow-up period. Eventually 18 of22 lymphoceles (82 %) were suc-cessfully treated, without recurrence. The duration of catheter drainage rangedfrom 3 to 15 (average, 8.6) days. Conclusion : Because of its high initial success rate, low rate of recurrence,and the short duration of catheter drainage, percutaneous transcatheter sclerotherapy using povidone-iodine andethanol is thought to be an ef-fective treatment for postoperative pelvic lymphoceles. more...