, Hyon-Joo Kwag, Jun-Hyek Song , Hyon-Joo Kwag, Myung-Hun Kim , Jong Oh Kim, Sang Hoon Ko The purpose of this study is the evaluate the diagnostic accuracy of MRI, frequent location of injury site and injury type in meniscal injury, retrospective review of false positive cases.
From September 193 to January 1997 in our hospital, we analyzed a hundred cases of meniscal injury suggested by MRI. And we tried to correct operatively in meniscal injury by arthroscopic or open method of operation.
1)Diagnostic accuracy of MRI was 90%
2)Most common site of meniscal injury was medial meniscus posterior horn(54.4%).
3)Most common injury type was Bucket handle tearing(34.4%).
4)Cause of pitfall in false positive case was most common popliteal tendon sheath(30%).
MRI was effective method on diagnosis of meniscus injury and most common injury was medial meniscus posterior horn, And diagnostic fault was caused by popliteal tendon sheath, lateral inferior genicular artery, truncation artifect, meniscofemoral ligament, transverse geniculate ligament.
, Eun Chul Chung The purpose of this study was to analyze the MR findings of intramedullary tumors and review the literatures for evaluating of characteristic findings of each intramedullary tumors.
We experienced eight intramedullary tumors from March 1993 to February 1995, including four astrocytomas two ependymoma, one hemangioblastoma, and one cavernoma. MR images were get by 1.5T GE Signa and analized retrospectively.
Intramedullary tumor was demonstrated by MR images in eight patients. They were five men and three women ranging in age from 3 to 56 years and complained both motor and sensory changes and symptom duration was between 6 months and 3 years. Ependymoma showed diffuse homogenous enhancing mass at the level of thoracic cord(T2-3) and thoracolumbar level(T11-L2) without cystic change, One had hemorrhage within the mass and massive leptomeningeal metastasis at all spinal cord and brain. Among astrocystomas, one case at the cervical cord unusually revealed hemorrhage in the mass and regional large syrinx. The other one occured at the conus medullaris portion and showed well-defined mass and intratumoral cystic change. We also experienced rare intramedullary hemangioblastoma, which demonstrated typical signal voided vascular structures revealed homogenous enhancing mass. A very rare intramedullary cavernoma at the level of cervical cord showed typical dark signal hemosiderin rim and variable staged hemorrhage in the mass.
Although, MR imaging appearance of intramedullary tumors is nonspecific, and it is often impossible to differentiate with certainty between the various possible tumors, especially ependymomas and astrucystomas. However, MR findings of hemangioblastoma and cavernoma are specific and possible to diagnose. MR imaging is the unquestioned technique of choice in demonstrating and differentiating the intramedullary tumors.
To compare fast spin echo(FSE) T2WI of the body coil(BC) with FSE T2WI of the endorectal surface coil(ERC) in the evaluation of parametrial and vaginal invasion and to evaluate tue dynamic enhanced images on the aspect of parametrial invasion.
Twenty consecutive patients of uterine cervical carcinomas confirmed by biopsy were included in this study and staging was determined by the surgery (2 cases) and the radiologic and clinical studies(18 cases). 1.5T Signa(GE,USA) was used and FSE T2-weighted axial and sagittal images were obtained by the body coil and endorectal surface coil respectively. Then dynamic enhanced axial images with FMPSPGR were performed at 2-3 slices of cervical cancer level. Parametrial and vaginal invasion on the body coil images were compared with those on the endorectal coil images retrospectively. Parametrial enhancement was evaluated on the dynamic enhanced images.
The accuracy of parametrial invasion was 100% of BC and 60% of ERC in 5 cases below stage Ib, 64% of BC and 73% of ERG in 11 cases of stage IIb and IIIa, 100% of BC and ERC in 4 cases above stage IVa. Overall accuracy of parametrial invasion was 80% of Bc and 75% of ERC without significant difference between two images. The accuracy of vagianl invasion was 80% of BC and 100% of ERC below stage Ib, 100% of BC and ERC above stage IIb. Overall accuracy of vaginal invasion was 95% of BC and 100% of ERC without difference between two images. On the dynamic enhanced images, parametrial enhancement was seen in all 20 cases and vascular enhancement in the parametrium was noted in 9 pf 20(45%) cases regardless of parametrial invasion.
There was no difference between BC and ERC images to evaluate the accuracy of parametrial and vaginal invasion. Therefore, ERC should be used in the cases which revealed suspicious invasion on BC images. Dynamic-enhanced images were not useful in the evaluation of parametrial invasion.
, Eun Chul Chung The cavernous malformation is increasingly recognized as a vascular malformation of the brain that presents with seizures, hemohhage, or neurologic deficit. We have identified 24 lesions in 12 patients that were diagnosed cavernous malformation of the brain based on the findings of follow-up magnetic resonance image and sugical biopsy. The location of the lesions were the supratentorial area in 20 and infratentorial area in 4. Ten lesions were seen at the periventricular white matter. Combined venous angioma was noted in 4 patients. The appearance of the lesions classified by signal intensities on MRI was divided into reticular pattern in 11, punctate pattern in 9, hematoma pattern in 3, and cystic pattern in one. Recent hemorrhage was identified at 9 lesions that classified into extralesional type in 5 and intralesion type in 4. Among 9 hemorrhagic lesions, eight lesions were located at the periventricular white matter and six lesions showed reticular patterns. We concludedthat the correlation between the evidence of recent hemorrhage and location and pattern of the lesions should be evaluated to predict possibility of rebleeding of the cavernous malformation.
The neuroendoscopic third ventriculostomy is becoming the standard treatment for aquired aqueduct stenosis because of its exellent results and very low morbidity. Usually the floor of third ventricle is perforated by closed forcep. Fogarty catheter, laser, saline torch, monopolar coagulator and endoscope itself. Whatever the method of ventriculostomy, the obstruction may occur. Recently the author experienced a case of obstruction at the previous site of third ventriculostomy. A 54 yr old man who had long standing ataxia developed headache, vomiting and urinary incontinence suddenly. It was revealed that he had cerebellar tumor, which had compressed the aqueduct of Sylvius anteriorly. I performed the endoscopic third ventriculostomy by monopolar coagulator and Fogarty ballon catheter. During this procedure, there was some bleeding from opening margin but all these bleedings were stopped by rinsing and electric coagulation. He was improved immediately in the postoperative period. 1 month later, the reattack of hydrocephalus developed and it was operated. On intraoperative view, the newly grown gliotic plug originated from the right mammillary body. On 5th day after reoperation., the patency of the artficial aqueduct was confirmed by 2-D cine PC MR CSF(2 dimensional cine phase contrast magnetic resonance cerebrospinal fluid) flow study.
I may suggest that in order to minimize the occlusion the opening should be made at the center of midline, thinnest area in front of both mammillary bodies, with less bleeding and without electric coagulation.
, Jeong Soo Suh , Sun Hee Maeng, Young Joo Cho We studied the open clinical trial to evaluate the efficacy and safety of TAGOCIN®, teicoplanin, glycopeptide anti microbial agent, which was manufactured in one Korean pharmacy.
We selected 15 patients hospitalized with presumed or proven infection due to gram positive organism, judged to require glycopeptiede and administered by intravenous bolus injection at a dose of 200mg TAGOCIN® per day. The efficacy was assessed by bacteriological result, clinical symptom and radiological change.
Mean age of 15 patients treated is 66. 13 cases were lower respiratory tract infection, I case was urinary tract infection and I case was soft tissue infection. Gram positive organism was isolated in Seven samples of five patients, and at four patients of them, gram positive organism were eliminated. During treatment, one patients liver enzyme elevated mildly.
TAGOCIN® is an effective and tolerated antibiotics against gram positive organism in severe infected patients.
, Soo-Seung Choi To demonstrate a number of advantages of Gd-enhanced MR-venography with FISP techinuque in diagnosis of extremity deep vein thrombosis.
Gd-enhanced MR venography with FISP technique was performed in patients had deep venous thrombosis of lower limb. Findngs of MR venography was retrogradely analyzed.
Gd-enhanced MR-venography clearly demonstrates venous anatomy of the lower extremities in all cases. And, deep vein thrombosis was well detected with signal void filling defect. MR-venography also shows additional combined findings in deep vein thrombosis.
Gd-enhanced MR venography well demonstrates the anatomy of lower extremities and is a useful method for detection of deep vein thrombosis.
, Byung Chul Kang, Jung Soo Suh, Eung Bum Park, Kang Sup Shim We studied to determine the usefulness of dynamic magnetic resonance imaging(MRI) in the preoperative evaluation of invasion of colorectal cancer and to compare its usefulness with the conventional CT. To observe the enhancement pattern of colorectal wall after iv administration of Gd-DTPA between normal and cancerous wall.
Twenty patients with colon cancer and 8 patients with rectosigmoid cancer, who were diagnosed between October 1997 and June 1998 by barium enema, colonoscopic biopsy were evaluated. The patients population consisted of 16 men and 12 women, with ages ranging from 46 to 68 years(mean 61years). Preoperative staging was done by conventional CT and dynamic MRI. All MR images were performed with 1.5T superconducting magneting unit(Vision, Siemens, Erlangen, Germany). 2D-FLASH(Fast Low-Angle Shot) sequence was used for the dynamic and delayed images(TR/TE/NEX/FA=72.5-117.3/4.1/1/80°), and acquisition time of 13-15sec.
For the dynamic images, five MR images were obtained with a single breath hold. Precontrast images(axial, or sagittal or coronal) was obtained first, and then dynamic MR images were obtained at 30, 60, 90, 120sec after intravenous injection of 0.1mmol/kg Gd-DTPA. Ten to fifteen delayed images were also obtained with the interval of 4-5 minutes with a single breath hold. Preoperative staging of CT and MRI were decided with a consensus by two radiologists. Pathologic staging were done by TNM classification.
The dynamic MR image-determined stage of colorectal cancer correlated with histopathologic findings in 2 of 3 pT2 tumor(67%), 19 of 21 pT3(90%), and 4 of 4 pT4 tumors(100%). MRI correctily diagnosed tumor deposits of involved lymph nodes in 16 patients, overall accuracy was 57%(16/28%). And the signal intensities after IV Gd-DTPA administration between the cancerous wall and normal wall ws not significantly different at the 30, 60, and 90 seconds MR images with the indifferent Student
Dynamic MRI has a role for the preoperative assesment of colorectal carcinoma.
The production of basic fibroblast growth factor(bFGF), which is known to have strong angiogenic activity in gastric cancer, was evaluated.
Using Alkaline phosphoatase-labelled, synthetic oligonucleotide probe of bFGF genes, the expression of the gene was evaluated with in situ hybridization method in 9 fresh advanced gastric cancer tissues.
In situ Hybridization of bFGF mRNA showed positive reaction in 8 of 9 patients.
In view of profuse expression of angiogenic growth factor, future therapeutic targeting for angiogenesis could be reasonable in patients with gastric cancer.
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