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A fibromatosis or desmoid tumor of the breast is an extremely rare benign tumor, which is often presented clinically and radiologically as a malignant tumor. Although benign, fibromatosis or desmoid tumors can grow aggressively in local infiltrating patterns. The recurrence is relatively common; hence a wide excision with a clear margin around the tumor is necessary. We report a case of a young female patient with a recurring fibromatosis of the breast after a local excision.

Purpose: To evaluate the radiological and clinical results including the patient's satisfaction after total knee arthroplasty (TKA) using two differently designed system for both knees in the same patient. Materials and Methods: From January 2002 to January 2003, thirty-two bilateral TKAs were prospectively performed using two differently designed systems. One side TKA was performed using a mobile bearing (PFC RP, Dupey) system, and the other side was performed using a fixed bearing system (PFC, Dupey). All 32 patients were followed up for an average of 51.4 months. The mean age of the study group was 67 years (range 54-75). The clinical results were evaluated from the Knee Score, WOMAC score for the patient's satisfaction and range of motion. Radiological analysis including the tibiofemoral angle was also carried out. An independent T-test was used for statistical analysis. Results: The preoperative average knee score improved to 87.3 from 42.5 in the mobile bearing group and to 86 from 39 in the fixed bearing group respectively. The preoperative average WOMAC score decreased to 11.2 from 84.9 in the mobile bearing group and to 16 from 85.5 in the fixed bearing group. The average preoperative range of knee motion improved to 114.5 o from 104.5 in the mobile bearing group and to 113.8 from 104.7 in the fixed bearing group. The average preoperative tibiofemoral angle improved to 5.3 valgus form 4.5 varus in the mobile bearing group and to 6 valgus from 3.8 varus in the fixed bearing group. The only result statistically significant was the WOMAC score (p

Hamartomata is the most common benign type of tumor, occuring in the lung. However, a cystic pulmonary hamartoma is extremely rare, and is difficult to diagnose due to its nonspecific nature. We report a case of cystic pulmonary hamartoma in which a popcorn-like calcification is clearly identified, thus enabling a confident diagnosis of the disease.

A pathologic splenic rupture is rare, occurring primarily in a spleen affected by infective, hematological, and neoplastic disease. To the best of our knowledge, no prior reports of a pathologic splenic rupture due to scrub typhus exist. Intrasplenic pseudoaneurysms and focal infarctions are visible on an initial CT scan. Moreover, the spontaneous splenic rupture occurred a week later. We report a case of nontraumatic-splenic rupture in a patient with scrub typhus.

The carpo-metacarpal joint is important for thumb function and for strong pinching and grasping. Inadequately treated fracture of the trapezium can produce long term morbidity. Solitary fracture of the trapezium are uncommon, compose less than 3% of all carpal fractures in adults. However such fractures are very rare in growing patients. Routine anteroposterior (AP) and lateral radiographs of the wrist often fail to show these fractures because of the overlapping trapezoid. Special radiographic views have been described (Robert's view) to detect this fracture. Computer tomography (CT) was found to be essential for the diagnosis and proper treatment of the described injury. We report a case of sagittally split fracture of the trapezium associated with a subluxated carpo-metacarpal joint of the thumb that occurred while playing golf, which was treated by open reduction and percutaneous pinning using two K-wires.

Purpose : This study examined the morphological characteristics of the thoracic and lumbar vertebrae of normal Koreans and the factors causing breakage of the pedicular wall by measuring the thoracolumbar vertebrae relative to the pedicle screw insertion. Materials and Methods : The effect of the pedicle screw shape on the pedicle wall integrity of 56 normal Koreans was examined by performing a computer simulation of the inserting pedicle screws into the pedicle wall by superimposing the graphical images of the screws onto the CT scan images. Results : Because the inner pedicle diameters of the most thoracic vertebrae from T4 to T10 were ＜5 mm, most pedicles of the thoracic vertebrae were expected to be broken after inserting the 5 mm-diameter cylindrical screws. The pedicles of the thoracic and lumbar vertebrae were classified into 6 groups by performing the cluster analysis using morphometric parameters. Group 1 was labeled "relatively narrow". Group 2 "moderate". Group 3 "wide and angular". Group 4 "severly narrow and short", Group 5 "long", and group 6 "relatively wide and angular". The simulation showed the pedicles of groups 1 and 4 to be too narrow for the 5 mm-diameter cylindrical screws to preserve the pedicular wall integrity. Conclusion : The pedicles of the vertebra of Koreans are similar in size to those of Caucasians. Personal morphological characteristics of the pedicles as well as their sizes and levels of the vertebrae are believed to be the significant factors that can cause the breakage of the pedicular wall.

Backgroud : Urinary tract infection (UTI) is common in children. The available gold standard methods for diagnosis, Tc-99m dimercaptosuccinic acid (DMSA) scan and computed tomography (CT) are invasive and expensive. This study was performed to assess the role of power Doppler ultrasound (PDU) for diagnosis of acute pyelonephritis (APN). Materials and Methods : A prospective study was conducted in 25 children with aged 2 weeks to 5 years who were hospitalized with the first episode of febrile UTI suggesting acute pyelonephritis. All children were examined in the first 3-5 days of admission by PDU and Tc-99m DMSA scan. The comparison between PDU and DMSA scan was performed on the basis of patients. Results : The sensitivity and specificity of PDU for the detection of affected kidneys were 38.1% and 50.0%, and the positive predictive value and negative predictive value were 61.9% and 50.0%, respectively. Vesicoureteral refluxes (VUR) were identified in 11 patients (44.4%) and 18 kidneys (36%). The PDU and DMSA scan showed a matching perfusion defect in 23.8% and 50.0% respectively. Conclusion : These data indicate the PDU has a relatively low sensitivity and specificity for differentiating APN from lower UTI but may be a complement tool to DMSA scan for the prediction of VUR in infants and children.

Granular cell tumor (GCT) is a benign neoplasm that frequently occurs in the skin, subcutaneous tissue, and oral cavity, although these tumors occur throughout the body. GCT of the bladder is an extremely rare disease, and only 10 cases have been reported. We report the use of ultrasonography and MRI for a case of GCT of the bladder; this lesion was pathologically confirmed.

Splenic infarction occurs when parenchymal ischemia of the spleen is evoked by an occlusion of the arterial or venous circulation. The most common causes include infiltrative hematological disease and thromboembolic conditions, but a hypotensive splenic infarction may be a rare cause of splenic infarction. A 62-year-old female patient presented with a hypotensive splenic infarction after massive bleeding. CT showed geographic low-density lesions in the central part of the spleen on the tissue equilibrium phase of dynamic CT. Usually, a depressed scar occurs in the course of healing of a splenic infarction. However, in this case recovery of blood flow and regeneration of the infarcted spleen was seen during the follow-up CT scans. We report a case of hypotensive splenic infarction with a review of the literature.

Purpose: We attempted to evaluate the relationship between transarteiral chemoembolization (TACE) and injury to the peribiliary plexus by evaluating the number of microvessels in the peribiliary plexus of surgical specimen. Materials and Methods: Surgical specimens were obtained from 78 hepatocellular carcinoma patients and 22 patients with liver metastases. They were divided into 4 groups (Group 1; hepatocellular carcinoma without TACE [n=30], Group 2; hepatocellular carcinoma receiving preoperative TACE once [n=37], Group 3; hepatocellular carcinoma receiving preoperative TACE more than two times [n=11] and Group 4; metastatic carcinoma of the liver patients without a history of liver disease [n=22]). Immunohistochemical staining for factor VIII-related antigen was performed in all the specimens and the number of microvessels in the inner capillary layer and the outer venous layer of the bile duct (> 200 μm in diameter) was counted. Results: The mean numbers of microvessels in the inner capillary layer were 4.50, 4.08, 1.64 and 2.05, and those in the outer venous layer were 25.23, 20.00, 18.36 and 12.32 for the 4 groups, respectively. The number of microvessels in group 4 was statistically fewer than that of group 1 (p

Purpose: Our study was conducted to compare the effects of neoadjuvant external beam radiotherapy and radical cystectomy to surgery alone for the patients suffering with pathologic stage T3 (pT3) bladder transitional cell carcinoma (TCCa). Materials and Methods: We retrospectively analyzed 45 patients who were diagnosed between 1990 and 1998 as having pT3 bladder TCCa in their final cystectomy specimens. Among them, 22 patients underwent preoperative external beam radiotherapy, and the other 23 patients underwent radical cystectomy alone. The radiation consisted of a total dose of 2,000 cGy delivered to the pelvis in 5 equal fractions that consisted of 400cGy daily. Systemic chemotherapy was not used in either group unless there was evidence of recurrent disease. Results: There were no preoperative demographic differences between the two groups. The local recurrence rate was significantly lower in the preoperative radiotherapy group (p=0.0397), but the overall survival rate was not significantly different (p=0.2695). The distant metastasis free survival rate was not significantly different between the two groups (p=0.4682). Conclusions: We have shown that preoperative radiotherapy is an effective way to achieve local control of locoregionally advanced (pT3) bladder TCCa. However, our study did not have sufficient statistical power to identify a survival difference between the two groups. (Korean J Urol 2006; 47:232-236) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

An intratesticular simple cyst is a rare lesion. The pathogenesis of such lesions is uncertain. Clinically, an intratesticular simple cyst may be difficult to differentiate from a cystic neoplasm. However, preoperative diagnosis is possible using ultrasonography (US). Testis-sparing surgery with simple enucleation of the cyst has a favorable outcome. We report an intratesticular simple cyst in a 48-year-old male who had a non-tender cystic mass in the right testis for 2 years. The diagnosis was made by preoperative US. The patient underwent a testis-sparing surgery. After simple excision of the cyst, histological examination revealed a simple cyst lined by ciliated cuboidal and columnar epithelium.

Background: The purpose of this study was to determine the effectiveness of a percutaneously placed self-expanding metallic stent for the relief of biliary obstruction in patients with hilar cholangiocarcinoma. Materials and Methods: From November 2001 to December 2004, 48 patients with hilar cholangiocarcinoma were prospectively studied. After percutaneous placement of bilateral selfexpanding, uncovered metallic stents, follow-up evaluation was carried out until July 2005. Results: There were 4 cases of Bismuth type II, 21 cases of Bismuth type IIIa, 8 cases of Bismuth type IIIb and 15 cases of Bismuth type IV. Stent placement was technically successful in all patients. All patients had satisfactory biliary drainage, resulting in one week drainage rate of 72.8% and final drainage rate of 91.1%. There were 12 cases (21.3%) of abdominal pain requiring analgesics and 1 case (7.1%) of cholangitis; both were successfully managed with conservative treatments. Late complications occurred in four patient (8.3%), including two patients with cholangitis, one patient with liver abscess, and one patient with biloma; all were appropriately managed by percutaneous drainage. The average length and median durations of stent patency and median survival time were 303 days (range, 60~815) and 338 days (range, 60~1175), respectively. Conclusion: Placement of a percutaneous metallic stent is an effective and safe method for palliation of patients with hilar cholangiocarcinoma.

Background: To examine the ultrasonographic and magnetic resonance (MRI) imaging findings of a cervical mass type cervical pregnancy. Materials and Methods: The ultrasonographic and MRI findings of 5 patients pathologically confirmed as having a cervical pregnancy were analyzed retrospectively. On ultrasonography, the size and echo pattern of the uterine cervix, the shape and echo pattern of the lesion, the degree and the pattern of blood flow on the color Doppler study and the spectral Doppler pattern were analyzed. The shape, signal intensity, and degree and pattern of enhancement of the lesion were evaluated on MRI. Results: The uterine cervix was enlarged and the size of the lesion was 6.1 to 7.1 (average, 6.5) cm. The endocervical canal was irregularly dilated and showed heterogeneous echogenicity in all 5 cases. Four of the 5 lesions were heterogeneously hyper- or mixed echoic and remaining one was relatively homogeneous echogenic. Doppler ultrasonography revealed an increased vascularity of the peritrophoblastic flow pattern. In all 4 cases where MRI performed, the lesion was irregular in shape and the margin was not sharply demarcated. The T2-weighed image showed that the lesions were mixed signal intensity. Three of the 4 lesions contained high signal intensity nodular portions and a low signal intensity rim was observed along the margin of the nodular portions. The T1-weighted image revealed multiple signal voids along the periphery of the lesions and high signal intensity portions as a result of hemorrhage were noted. The dynamic enhanced study showed that the high signal intensity portions on the T2-weighted image were strongly enhanced similar to the vessels on the early phase and the contrast enhancement gradually decreased with time. Conclusion: A cervical mass type cervical pregnancy can be correctly diagnosed using the patient's clinical symptom, the elevation in the serum -HCG level, and characteristic ultrasonographic and MRI findings.

Primary carcinoma of the male urethra are rare. Among the malignant tumors of the male urethra, squamous cell carcinoma is the most common. Transitional cell carcinoma is very rare, particularly in the distal urethra. We experienced a case of distal urethral transitional cell carcinoma, arising at the fossa navicularis of the penis, which we report here with a review of the literature. A 68-year-old male patient presented with bloody discharge from the prepuce for 1 month. Ultrasonography showed a poorly marginating, heterogeneous mass, invading the glans penis and the corpus spongiosum. The mass encircled the glandular urethra of the penis glans, and obstructed the glandular urethra and the fossa navicularis. A Doppler ultrasonogram revealed hypervascularity in this mass. The mass was isointense to the corpus carvernosum on the T1-weighted images and slightly hypointense to the corpus carvernosum on the T2-weighted images. Contrast-enhanced MR imaging showed a poorly enhancing mass in the glans penis. This mass was confirmed as a transitional cell carcinoma by histologic study and a partial penectomy was performed.

We report a case in which an intramural uterine leiomyoma was transvaginally expelled after uterine arterial embolization (UAE). A 29-year-old unmarried female presented with vaginal bleeding, and at pre-treatment MRI an intramural leiomyoma was diagnosed. UAE was performed and after 13 days the tumor was transvaginally expelled. Follow-up MRI performed seven days later depicted a large myometrial defect in the anterior uterine wall; subsequent follow-up MRI showed that the defect became gradually smaller, and the size and configuration of the uterus progressively normalized.

Purpose: To assess the usefulness of MRI for determining the presence of a large (>10 cm) unilateral ovarian tumor by detecting the existence of a normal contralateral ovary, and to establish the difference in detection rates between premenopausal and postmenopausal women, and benign and malignant tumors. Materials and Methods: Forty-two patients who underwent MR imaging and in whom the intraoperative gross and pathologic findings indicated the preseace of a unilateral ovarian mass and a normal contralateral ovary were included in this study. The images obtained were retrospectively analyzed by two radiologists, who determined the detection rate of the normal contralateral ovary and whether this differed between premenopausal and postmenopausal women, and benign and malignant tumors. Results: Contralateral normal ovaries were detected in 35 (83.3%) of 42 patients [22 of 23 ovaries (95.7%) in premenopausal women and 13 of 19 (68.4%) in postmenopausal women], with a statistically significant difference (p=0.018). Twelve of 16 of these ovaries (75%) were present in women with malignant tumors, and 23 (88.5%) of 26 in those with benign tumors, but the difference was not statistically significant (p=0.256). Conclusion: MR imaging is useful for detecting a normal contralateral ovary and for determining the site at which a large (>10 cm) unilateral ovarian tumor originates, especially in premenopausal women.

Background: This study was performed to reconsider the efficacy of transrectal ultrasonography (TRUS) in diagnosing prostate cancer by analyzing the results of a digital rectal examination (DRE), serum prostate-specific antigen (PSA) and a transrectal ultrasonography in patients with prostate specific antigen levels of 10 ng/ml or less. Materials and Methods: One-hundred and eighty one men with PSA levels of 10 ng/ml or less, who had a TRUS-guided tissue biopsy performed, were included in this study. The detection rate of prostate cancer was compared according to the TRUS result and the presence or absence of nodularity and the consistency of the prostate on DRE. Results: In a total 181 patients, there were 73 patients with PSA levels of 4 ng/ml or less and 4 of them had prostate cancer. Thre were 108 patients with PSA levels of 4-10 ng/ml and 18 of them were prostate cancer. TRUS was performed in 152 patients and 16 out of 58 patients diagnosed with prostate cancer, 3 out of 39 diagnosed with suspicious prostate cancer, and 2 out of 55 patients diagnosed as having no prostate cancer were found to have prostate cancer. In 40 patients, a nodule was palpated on DRE and 8 of them were found to have prostate cancer. Five out of 19 patients with a stony hard consistency, 3 of 12 with a firm to hard consisency, 12 of 129 with a firm consistency, 0 of 13 with a soft to firm consistency, and 2 of 8 with a soft consistency were prostate cancer. In the prostate cancer patients, there were 4 patients with PSA levels of 4 ng/ml or less and all these patients were diagnosed with prostate cancer or suspicious prostate cancer on TRUS but the nodule was not palpated in all patients. Two were soft and 2 were firm consistency on DRE. Conclusion: In patients with serum PSA levels of 10 ng/ml or less, TRUS is a more useful supporting method than DRE and a more active application of TRUS may lead to an early diagnosis and pertinent treatment of prostate cancer.

Purpose: To evaluate the safe triangle within the femoral triangle for the potential space of the true anterior hip approach. Materials and Methods: Cadaveric dissections were carried out on 28 femoral triangles from 14 cadavers. This study measured the length of the direct head of the rectus femoris from the anterior inferior iliac spine (AIIS) to the patella upper pole, the AIIS to the lateral border of the femoral nerve, and the entry point of the femoral nerve and vessel branches to the rectus. The safe portion within the risky femoral triangle was analyzed and applied to two clinical situations, a femoral head fracture and septic hip arthritis. Results: The examination showed that there were three terminal branches to the rectus femoris from the femoral nerve. The entry point of the first branch was at the proximal 20.0-28.9% portion of the rectus femoris. The second and the third branch entered at the proximal 22.5-37.5% and 24.9-41.0%, portion, respectively. The vessel entry was at 21.4-37.3%. The length from the AIIS to the femoral nerve was 3.5-8.0 ㎝. Using this space, the procedure was easier to perform in the two situations mentioned above. Conclusion: The space within the femoral triangle between the proximal 20% of the rectus femoris and iliacus can be used as one of the potential spaces for femoral head fracture fixation and septic hip irrigation in children, and as an arthroscopy portal.

Malignant fibrous histiocytoma (MFH) of the spermatic cord represents an uncommon location for the most common soft tissue tumor in adults. MFH of the spermatic cord is extremely rare. No case report has been described in the Korean literature. We report a case of malignant fibrous histiocytoma, myxoid type, arising from left spermatic cord. A 77-year-old male presented with a painless left upper scrotal mass for 5 months. Simple mass excision was performed for a diagnosis. Grossly, the mass closely contacted with the left spermatic cord. Since a myxoid type of malignant fibrous histiocytoma was diagnosed from histopathological findings, left radical orchiectomy with high ligation of the spermatic cord was performed additionally. There were no evidence of local recurrence or metastasis at 6 months after surgery.

Purpose: We evaluated the imaging findings, clinical course and treatment of biloma after transcatheter arterial chemoemolization (TACE) of hepatocelluar carcinoma (HCC). Materials and Methods: After TACE of HCC in 11 patients with intrahepatic biloma, the findings of dynamic CT and angiography were retrospectively analysed. Hemodynamic change occurring in the hepatic artery and portal vein, the presence of intrahepatic bile duct dilatation, and serum bilirubin levels were analyzed. Changes in the size of the biloma at follow-up study, the extent of additional management, and the overall clinical course were also analyzaed. Results: Hepatic artery obliteration was observed in all cases; this involved the right hepatic artery in eight, and the segmental artery in three. There was decreased portal venous flow in seven cases and portal thrombosis in one. The intrahepatic duct was dilated in all cases but significantly elevated serum bilirubin levels were not noted. Follow-up study showed that in five cases the size of the biloma had increased; in four of these there was infection, and drainage was performed. In the remaining six cases the size of the biloma did not change, even where a segment or lobe had atrophied. Conclusion: Angiography showed that after TACE hepatic arterial obliteration occurred in all patients with intrahepatic biloma after TACE. During infection or where a biloma has increased in size, intervention is required.

Background: In patients with endometrial carcinoma, preoperative evaluation of exact staging has important prognostic and therapeutic implications. The incidence of pelvic and aortic lymph node involvement in endometrial carcinoma depends on grade of tumor differentiation and depth of myometrial invasion. Material and method: To evaluate whether MRI provides a preoperative assessment for staging of endometrial carcinoma, MRI was undertaken in 28 patients, a few weeks before operation. Myometrial invasion was devided in three categories, and involvement of cervix, adnexa, and pelvic cavity were classified. Results: The results of MR imaging were compared with these of pathology. The preoperative MRI staging of endometrial carcinoma was correct in 22 out of 28 patients. In the evaluation of myometrial invasion, the MR imaging underestimated in 4 cases and overestimated in 1 case. Conclusion: In patients with endometrial carcinoma, MR imaging is very useful in the assessment of the depth of myometrial invasion, stromal invasion of cevix, lymphatic & pelvic metastases and extent of the lesion.

Primitive neuroectodermal tumor (PNET) is relatively uncommon, arising outside the central nervous system. Very rarely, it occurs within the urinary system. A 55-year-old woman presented with gross hematuria and right flank pain which had begun two months earlier. A well-marginated, low-density mass containing high-density portions representing hemorrhage was seen in the right kidney at pre-enhanced CT; contrast enhancement was not prominent. At both T1- and T2- weighted MR imaging, a multilocular cystic mass with high signal intensity portions representing hemorrhage was observed. Contrast enhancement was absent. We report the radiologic findings in this case of renal PNET.

Purpose: To compare the differential radiologic findings of renal cell carcinoma presenting as a homogeneous solid mass (HS-RCC) and muscle-predominant angiomyolipoma (MP-AML). Materials and Methods: Nine of 76 surgically and pathologically proven RCCs presenting at CT or magnetic resonance (MR) imaging as a homogeneous solid mass, and four cases of MP-AML were included in this study. Echogenicity at sonography, attenuation at non-enhanced CT (NECT), the contour of the mass, signal intensities at T1- and T2-weighted MR imaging, the existence of a capsule, and the pattern and degree of enhancement at CT and MR imaging were retrospectively analyzed. Results: Two of five HS-RCCs were isoechoic and three were hyperechoic. Two of three MP-AMLs, however, were isoechoic, and one was mixed echoic. All nine HS-RCCs were round or oval in shape, but three MPAMLs were lobulated and one was round. At NECT, seven of eight HS-RCCs were isodense and one was hypodense compared to surrounding normal renal parenchyme, but three MP-AMLs were hyperdense masses and one was isodense. At enhanced CT, HS-RCCs showed various degrees of homogeneous enhancement, but all MP-AMLs showed moderate homogeneous enhancement. All three MP-AMLs demonstrated heterogeneous hypointensity at T2-weighted MRI and homogeneous hypointensity at T1-weighted MRI. HS-RCCs showed various signal intensities at both T1- and T2-weighted MRI, and in five cases, heterogeneous high signal intensity at T2-weighted MRI. Capsules were observed in seven of nine HS-RCCs but not in any of the three MP-AMLs. At enhanced T1-weighted MRI, MP-AMLs showed mild to moderate enhancement, but HSRCCs showed mild, moderate, and strong enhancement in two, two, and five cases, respectively. Conclusion: Echogenicity, density at NECT, signal intensity at MR T2-WI, the contour of the mass, and the existence of a capsule are features which are useful in the differential diagnosis of HS-RCC and MP-AML.

Purpose: To determine the rates at which normal ovaries in women of reproductive age were observed at MRI, as well as differences in the size of a normal ovary and follicles, and the number of follicles, according to age. Materials and Methods: The MRI findings in 46 patients with normal ovaries were retrospectively analysed and proven grossly at surgery and/or pathologically. The detection rate and size of the ovaries, and the number of follicles and size of the largest were determined, and differences were analyzed according to age: under 30, 30-39, and 40 years or over. Results: Among 46 patients, bilateral ovaries were detected in 39 and unilateral ovary in seven. The overall detection rate was 92.4% (85/92), varying according to age. It was 100% (18/18) in those aged under 30, 95% (38/40) in the 30-40 age group, and 85.3% (29/34) among those aged 40 or over. Ovary size ranged between 15 and 50 (average, 24.3) mm and was most commonly 20-30 mm, regardless of age (60%). The average size was 28.8 mm under 30 years of age, 25.3 mm between 30 and 39, and 20.3 mm at age 40 or over (p

Purpose : To determine which morphologic and radiologic characteristics and common features of HCC in patients with a survival time of more than five years are useful for prognosis and appropriate therapeutic modality. Materials and Methods : Among 178 patients in whom HCC was diagnosed at our hospital and who underwent dynamic CT and angiography, we retrospectively reviewed the cases of 12 who survived more than five years. Initially, the gross finding, size, number, vascularity of HCC, and extent of portal vein invasion were analyzed. The presence of lymph node enlargement was investigated during follow-up study and in cases confirmed surgically, the results were compared with the histopathologic findings. The therapeutic modalities of the 12 patients were as follows; only surgical resection, 3 cases(1 case: re-operation); surgical resection with transarterial chemoembolization(TAE), 5 cases(1 case: re-operation); only TAE, 4 cases (1 case: combined with hollium in-jection); and at present, expiry after survival for more than five years, 3 cases; survival with disease, 3 cases and survival without disease, 6 cases(2 cases: re-operation after recurrence). Results : In 12 patients who survived more than five years, initial gross classification was single nodular type in 11 cases and massive type in one case; all showed typical ypervascularity on dynamic CT and hepatic angiography. With regard to extent of portal vein invasion, two cases showed involvement of the lobar branch and in one case invasion of the segmental branch was noted. In the other nine cases there was either invasion of the distal small branch or no definite portal vein invasion. HCC size ranged from 2 to 10 (mean, 5)cm. In eight cases involving surgical resection (reoperation : two cases), the histopathologic findings indicated, pre-dominantly, the trabecular type and Edmondson grade II -III. The exception was one case of grade III -IV. In eight cases of single HCC at the time of diagnosis, multiple recurrent HCCs were present. In four cases tumors did not recur, and follow-up study revealed no lymph node enlargement. Conclusion : Initial radiologic findings [number of tumors (one only), gross classification (nodular type), vascu-larity(hypervascularity), portal vein invasion(lesser extent), histopathologic findings(predominantly trabecular type)] and the absence of lymph node enlargement are thought to be more important factors than tumor size in the prognosis of HCC. If initial examination of HCC reveals the above mentioned radiologic features, a more aggressive and active therapeutic management approach should be carefully considered.

Purpose: To determine the detection rate of MRI in the diagnosis of adenomyosis and ascertain the accuracy of MRI in assessing the extent and depth of the myometrial invasion. Materials and Methods: By retrospective analysis of MR images of the pelvis in 65 pathologically proven cases of uterine adenomyosis, we investigated the detection rate and differences of in the detection rate when this was based on (a) the extent, and (b) the depth of myometrial invasion. The condition was classified as diffuse or focal according to the extent of invasion, and mild, moderate, or severe according to its depth. Results: Pathologically, there were 35 cases of focal adenomyosis (53.8%), and 30 of diffuse adenomyosis (46.2%). Among patients with the focal variety of this condition, 12 cases were mild, 14 were mild, 14 were moderate, and nine were severe, while among those with the diffuse variety, two were mild, ten were moderate and 18 were severe. A total of 48 cases (73.8 the detection rate of focal adenomyosis was 60.0% (21/35) and that of diffuse adenomyosis was 90.0% (27/30). The detection rates of mild, moderate, and severe adenomyosis were 42.9%(6/14), 79.2%(19/24), and 85.2% (23/27), respectively. Among the 48 cases detected on MR images, the pathologic and MR findings were consistent with regard to both the extent and depth of myometrial invasion in 26(54.2%). For diffuse adenomyosis, the consistency rate was higher than for the focal variety (81.5 compared with 19%, 4/21). The extent of myometrial invasion was correctly evaluated in 32 cases (66.7 the consistency rate for the diffuse form was higher than for the focal form [96.3% (26/27), compared with 28.6% (6/21)]. In 42 cases (87.5%), the depth of invasion was correctly evaluated, though differences in this depth were not significant. Conclusion: MR imaging was a useful imaging modality in the diagnosis of uterine adenomyosis. With regard to the extant of mymetrial invasion, the detection rate was higher among cases of the diffuse form than of the focal form, and with regard to depth, the rate was higher among moderate and severe cases than among mild ones. These findings may be useful for preoperative diagnosis based on clinical symptoms, and provide important yardstick for decisions as to whether hysterectony should be replaced by an alternative therapy.

Purpose: To determine the findings of diffusion-weighted magnetic resonance (MR) imaging of acute and chronic benign compression fracture, metastatic compression fracture, and spondylitis, and to differentiate between them. Materials and Methods: Forty-nine cases with vertebral compression fractures (17 metastatic, 16 acute osteo-porotic, 11 old osteoporotic, 5 acute traumatic) and seven with spondylitis (4 tuberculous, 3 pyogenic) under-went MR imaging. All cases were classified as belonging to one of four groups: A: acute osteoporotic and trau-matic, B: metastatic, C: old osteoporotic, or D: spondylitic. For MR imaging, a 1.5-T scanner (Magnetom Vision, Siemens, Erlangen, Germany) was used, and the diffusion-weighted imaging sequence was based on reversed fast imaging with steady-state precession (PSIF) and a relatively low b value of about 150 sec/mm 2. Signal intensity characteristics were evaluated in terms of the contrast ratio (CR) and signal-to-noise ratio (SNR) of bone marrow. Results: Diffusion-weighted MR imaging showed that signal intensity in group A was hypointense to adjacent normal vertebral bodies, but in group B, hyperintensity was noted. In group C, signal intensity was variable, while in group D, hyperintensity was again noted. Diffusion-weighted imaging revealed that in group A, bone marrow CR had a negative value, while in groups B and D, this value was positive (p .01). Conclusion: Diffusion-weighted MR imaging revealed that the signal intensity of metastatic compression fracture and spondylitis was hyperintense to adjacent normal vertebral bodies, that of acute benign compression fracture was hypointense, and that of chronic benign compression fracture was variable. This modality is therefore useful for differentiating between metastatic compression fracture, spondylitis and acute benign compression fracture.

Calcifying Fibrous Pseudotumor of the Retroperi We report a case of calcifying fibrous pseudotumor in theretroperitoneum. This is a rare soft tissue mass le-sion with specific radiologic and pathologic findings, and itis the first reported case arising in the retroperi-toneum. The CT, MR and angiographic findings are described.