[Show abstract][Hide abstract] ABSTRACT: Adenosine is a short-acting coronary vasodilator, and it is widely used during pharmacological stress myocardial perfusion imaging. It has a well-established safety profile, and most of its side effects are known to be mild and transient. Until now, coronary vasospasm has been rarely reported as a side effect of adenosine during or after adenosine stress test. This study reports a case of coronary vasospasm which was documented on stress myocardial perfusion CT imaging during adenosine stress test.
Korean journal of radiology: official journal of the Korean Radiological Society 05/2015; 16(3):673-7. DOI:10.3348/kjr.2015.16.3.673 · 1.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Torsion of the lipomatous appendage of the falciform ligament is extremely rare, and most patients have previously been treated surgically. We reported a case of torsion of the lipomatous appendage of the falciform ligament in a child, diagnosed by ultrasound (US) and computed tomography (CT) and treated conservatively. Real-time US and CT can aid an accurate diagnosis, and follow-up US can aid in making appropriate decisions for conservative treatment.
[Show abstract][Hide abstract] ABSTRACT: Although endoscopic retrograde cholangiopancreatography (ERCP) is an effective modality for diagnosis and treatment of biliary and pancreatic diseases, the risk for procedure-related complications is high. Hemorrhage is one of major complications of ERCP. Most ERCP-associated bleeding is primarily a complication related to sphincterotomy rather than diagnostic ERCP. We are reporting a case of massive hemobilia due to hepatic arteriobiliary fistula caused by guidewire-associated injury during ERCP, which was successfully treated with transarterial embolization of the hepatic artery.
[Show abstract][Hide abstract] ABSTRACT: Objective
Two-dimensional fluoroscopy-based computerized navigation for the placement of pedicle screws offers the advantage of using stored patient-specific imaging data in providing real-time guidance during screw placement. The study aimed to describe the accuracy and reliability of a fluoroscopy-based navigation system for pedicle screw insertion.
A total of 477 pedicle screws were inserted in the lower back of 96 consecutive patients between October 2007 and June 2012 using fluoroscopy-based computer-assisted surgery. The accuracy of screw placement was evaluated using a sophisticated computed tomography protocol.
Of the 477 pedicle screws, 461 (96.7%) were judged to be inserted correctly. Frank screw misplacement [16 screws (3.3%)] was observed in 15 patients. Of these, 8 were classified as minimally misplaced (≤2 mm); 3, as moderately misplaced (2.1-4 mm); and 5, as severely misplaced (>4 mm). No complications, including nerve root injury, cerebrospinal fluid leakage, or internal organ injury, were observed in any of the patients.
The accuracy of pedicle screw placement using a fluoroscopy-based computer navigation system was observed to be superior to that obtained with conventional techniques.
Journal of Korean Neurosurgical Society 07/2014; 56(1):16-20. DOI:10.3340/jkns.2014.56.1.16 · 0.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: PURPOSE
The purpose of this study is to determine the optimal dose of 0.75% ropivacaine for an ultrasonography-guided suprascapular nerve block (SNB) in order to manage both pain and disability in patients with chronic shoulder pain.
METHOD AND MATERIALS
This prospective study involved 100 patients with chronic shoulder pain; it was conducted between October 1, 2011 and August 31, 2012. Full-thickness or partial-thickness rotator cuff tear, bursitis or advanced adhesive capsulitis was not seen on MR imaging in any enrolled patients. All patients underwent ultrasonography-guided SNB at our medical institution. These patients were randomly divided into four groups (A ~ D) of 25 patients each and received infusion of 0.75% ropivacaine. In group A, the SNB was performed using 2.5 ml 0.75% ropivacaine. Group B was injected with 5 ml, group C with 7.5 ml, and group D with 10 ml. Each patient’s outcome was assessed on the basis of the visual analog scale (VAS) scores at rest and on movement, and American Shoulder and Elbow Surgeons (ASES) scores were recorded before the nerve block, immediately following the procedure, one week, and one month following the procedure, respectively .
There was no statistically significant difference among the four groups regarding the VAS score at rest before the procedure, immediately following the procedure or at the one-week and one-month follow-up examinations. On the one-month follow-up, the VAS score on movement in the group B patients was significantly different compared to that of group A, however, there was no significant difference compared to the scores of group C and group D. There was also no statistically significant difference in the ASES scores among the four groups before the procedure, immediately following the procedure or on the one-week and one-month follow–up examinations. There were no complications except for one patient in group D whose complaint of mild nausea immediately following the procedure.
These data suggest that the optimal volume of 0.75% ropivacaine is 5 ml for ultrasonography-guided SNB in patients with chronic shoulder pain.
The 5ml of 0.75% of ropivacaine is the most effective dose for an ultrasonography-guided SNB and is recommended in patients with chronic shoulder pain.
75% Ropivacaine in Patients with Chronic Shoulder Pain: What Is the Optimal Dose?. Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
[Show abstract][Hide abstract] ABSTRACT: PURPOSE: To evaluate the efficacy of ultrasonography-guided (UG) and electrophysiology-guided (EG) suprascapular nerve block (SNB) for arthroscopic acromioplasty with regard to pain relief. METHODS: A prospective, double-blind, randomized controlled clinical trial was performed from June 2007 to April 2010. Patients who were scheduled for elective arthroscopic acromioplasty and who met the inclusion criteria were assigned to 1 of 2 experimental groups (UG or EG SNB) or to 1 blind group (using anatomic landmarks). Before surgery, an SNB was performed with either ultrasonographic or electrophysiologic guidance or with no assistive devices (blind). Variables were collected at 4, 24, 48, and 72 hours postoperatively. RESULTS: Sixty-three patients were initially enrolled in the study, but 11 dropped out for various reasons. In the UG group at 4 hours, the visual analog scale score at rest (30 ± 12.0 v 39 ± 9.9 for EG group and 41 ± 11.8 for blind group) and when the patient was moving (42 ± 15.2 v 52 ± 11.5 for EG group and 53 ± 12.6 for blind group) was significantly decreased compared with the EG and blind groups (P < .05). Opioid consumption during the first 24 hours was significantly reduced in the UG and EG groups (4.3 ± 1.9 mg and 3.8 ± 2.3 mg, respectively) compared with the blind group (5.1 ± 2.2 mg) (P < .05). The visual analog scale score at rest and when the patient was moving; the pain score on the University of California, Los Angeles questionnaire; and the activities of daily living score on the American Shoulder and Elbow Surgeons questionnaire in the EG and UG groups improved more than the values in the blind group over the follow-up intervals (P < .05). Morphine consumption in the EG and UG groups by the first, second, and third days was significantly smaller than that in the blind control group (P < .05). CONCLUSIONS: UG and EG SNB can reduce pain and painkiller consumption for up to 72 hours postoperatively. Ultrasonographic or electrophysiologic guidance is more effective than the blind method of SNB. LEVEL OF EVIDENCE: Level I, randomized controlled trial with significant difference.
Arthroscopy The Journal of Arthroscopic and Related Surgery 02/2013; 29(5). DOI:10.1016/j.arthro.2013.01.011 · 3.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study is to compare shunt patency and clinical outcomes between bare stents and expanded polytetrafluoroethylene (ePTFE) covered stents in patients who had undergone transjugular intrahepatic portosystemic shunt (TIPS) creation.
[Show abstract][Hide abstract] ABSTRACT: PURPOSE
The purpose of this study is to explore the usefulness of an ultrasound-guided suprascapular nerve block in patients with rotator cuff tear in order to manage their postoperative pain.
METHOD AND MATERIALS
This prospective study involved 31 patients (25 males and 6 females) who had been diagnosed with rotator cuff tear between July 1, 2010 and December 31, 2010. Fifteen patients underwent ultrasound-guided suprascapular nerve block, while another 16 patients underwent placebo injection of normal saline on hypodermic layer overlying the spine of scapula. Ultrasonography was performed using a linear-array transducer (5- to 12-MHz). A 20-gauge, 3.5-inch spinal needle was positioned directly into the suprascapular notch during real-time visualization while injecting a mixture of 5ml of 0.5% ropivacaine and 5ml of normal saline. Each patient’s outcome was assessed on the basis of the visual analog scale (VAS) results that were recorded at 4 hours, 24 hours, and 48 hours postoperatively with ultrasound-guided suprascapular nerve block group and placebo group.
In each case of ultrasound-guided suprascapular nerve block, a low echoic fluid collection in the suprascapular notch was seen on ultrasonography. The VAS scores of 4 hours, 24 hours, and 48 hours postoperatively were significantly reduced compared with the scores of patients’ who did placebo injection (p<0.05, respectively). There were no complications at the injection site, and none of the patients had pneumothorax or systemic side effects after injection.
Ultrasound-guided suprascapular nerve block for patients with rotator cuff tear is a safe and useful method for managing postoperative pain.
Preoperative ultrasound-guided suprascapular nerve block is an effective and safe method and is recommended for managing postoperative pain in patients with rotator cuff tear.
Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 11/2011
[Show abstract][Hide abstract] ABSTRACT: To describe and analyze the ultrasonographic appearance of subcutaneous angiolipoma in pathology-proven cases.
We retrospectively searched the January 2004 to May 2011 surgical pathology database for cases of pathology-proven angiolipoma. The ultrasonographic findings were analyzed for angiolipoma size, shape, margin, echo texture, echogenicity, acoustic enhancement, calcifications, and color Doppler flow.
Of 31 angiolipomas, 19 lesions occurred in an upper extremity, one in a lower extremity, nine in the chest and abdominal wall, and two in the back. The mean tumor size was 17.7 mm. Twenty-five cases (80%) appeared as oval mass and all tumors had well-defined margins. All cases showed hyperechoic; 14 (45%), homogeneous; 17 (55%), heterogeneous. Seven cases (23%) showed blood flow in the mass. Acoustic enhancement and calcification was not shown in any cases. A correct preoperative diagnosis was made in three cases (10%) by ultrasonography.
Most subcutaneous angiolipomas are oval-shaped, have well-defined margins, and hyperechoic appearance on ultrasonography. Although color Doppler flow of subcutaneous angiolipoma is not seen in many cases, it may helpful in differentiating angiolipoma from ordinary subcutaneous lipoma.
[Show abstract][Hide abstract] ABSTRACT: Persistent primitive trigeminal artery (PPTA) is the most common permanent carotid-basilar anastomosis. Magnetic resonance angiography (MRA) has become the primary non-invasive imaging technique for evaluation of cerebral vascular anatomy and can provide detailed 3D imaging of intracranial vessels.
To evaluate the usefulness of MRA for the detection of PPTA and to re-classify its variations based on the embryologic types of PcomA and its relationship with the basilar artery and its branches.
Of the total 7329 patients who underwent MRA at our institution from March 2008 through November 2010, we retrospectively analyzed the MRAs of 24 patients with a PPTA. Special attention was given to defining the relationship of the PPTA and the basilar artery with PcomA and to determine the site of origin, size, and course of the PPTA. The PPTA classification included five types based on their anatomic relationship to the neighboring arteries. Clinical features and associated vascular anomalies are also described.
Twenty-four (17 women and seven men, 34 ~ 81 years of age, mean age 59.67 years) of the 7329 patients had a PPTA (0.33 %). Eleven cases (45.8%) were classified as type 1, three (12.5%) as type 2, five (20.8%) as type 3, one (4.2%) as type 4, and four (16.7%) as type 5b. Fifteen PPTAs (62.5%) were located on the left side and nine were located (37.5%) on the right side. The basilar artery proximal to the insertion of the PPTA showed severe to moderate hypoplasia in 13 cases (54%). Nine intracranial artery aneurysms were detected in seven (29%) of the 24 study patients.
This study revealed five types of PPTA and necessitates an adjustment of the previous classification of PPTA on the basis of our MRA examinations. A PPTA should be considered by both the clinician and the radiologist who interpret MR angiography.
[Show abstract][Hide abstract] ABSTRACT: The presence of an intratesticular solid lesion is usually highly suspicious for malignancy. Conversely, most extratesticular solid lesions including paratesticular lesions are benign. The characteristic imaging features of malignant solid testicular lesions are well known, but various unusual causes and imaging features of benign solid testicular lesions can be particularly misleading. Therefore, a careful assessment of solid testicular and paratesticular lesions is warranted. The purpose of this article is to present the clinical and imaging features of the spectrum of benign solid testicular and paratesticular lesions.
We demonstrate a variety of benign solid testicular and paratesticular lesions and correlate them with pathologic results.
Specific the clinical and imaging features of the spectrum of benign solid testicular and paratesticular lesions have been described.
Familiarity with the clinical setting and imaging features of benign solid testicular and paratesticular lesions should facilitate prompt, accurate diagnosis and treatment.
European Radiology 05/2011; 21(10):2226-34. DOI:10.1007/s00330-011-2155-x · 4.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: PURPOSE/AIM
The purpose of this exhibit is: 1. Identify a possible spectrum of benign solid testicular lesions 2. Identify the clinical setting and imaging features that can be used to differentiate benign from malignant solid testicular lesions
Introduction - US and MR of evaluation for palpable testicular lesions. Usual Malignant Testicular Lesion - Germ cell tumor Seminoma, Non seminomatous germ cell tumor -Lymphoproliferative disease Lymphoma, Leukemia Unusual Benign Testicular Lesion - Intratesticular Lesion Epidermoid cyst, Mature cystic teratoma, Traumatic or spontaneous hemorrhage, isolated testicular tuberculosis - Abutting Lesion Leiomyoma, Torsed appendage, Adenomatoid tumor, Polyorchidism Conclusion
The major teaching points of this exhibit are: 1. More than 95% of solid testicular lesions are malignant. Benign solid testicular lesions are rare, but recognition is important to avoid unnecessary operation. 2. Familiarity with the clinical setting and the imaging features of both usual malignant and unusual benign solid testicular lesions will facilitate prompt, accurate diagnosis and treatment.
Ultrasound in Medicine & Biology 08/2009; 35(8). DOI:10.1016/j.ultrasmedbio.2009.06.815 · 2.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The imaging characteristics of renal cell carcinoma (RCC) vary widely, with masses ranging from cystic to solid, from homogeneous to heterogeneous and necrotic, from small to large, and from localized to extensive. Although the usual imaging features of RCC are well known to radiologists, various unusual imaging features can be particularly misleading; therefore, both usual and unusual imaging features should always be carefully assessed. In this pictorial review, we describe the following unusual imaging features: unusual subtypes, unusual tumor growth, unusual underlying disease, multiple and bilateral presentations, hemorrhage and arteriovenous fistula (AVF)-related presentations, and mimicking of benign tumors. Familiarity with the imaging features of both usual and unusual RCCs will facilitate prompt and accurate diagnosis and treatment.
[Show abstract][Hide abstract] ABSTRACT: Primary neuroendocrine (NE) carcinomas of the breast are tumors that have morphologic features similar to those of NE tumors of both the gastrointestinal tract and the lung. They express NE markers in more than 50% of the cell population.1 Although NE carcinomas can develop in many sites of the body, primary NE carcinomas of the breast are very rare, and to our knowledge, no case described in the radiologic literature has involved the nipple-areolar complex. We present our experience with a primary NE carcinoma of the breast involving the nipple-areolar complex and also describe the radiologic and histologic findings.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 10/2008; 27(9):1401-5. · 1.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare disorder. We examined two females and one male with multiple soft-tissue masses in the abdominal wall. One of these three patients also had soft-tissue masses in the right thigh and right buttock. The histologic diagnosis was revealed as SPTCL in all three cases. The ultrasound (US) findings in two of these cases were diffuse, ill-defined hyperechoic areas with a linear vascular signal. The findings of the abdominal and pelvic computed tomography (CT) scanning with contrast enhancement were multiple enhancing nodules with an infiltrative pattern of peripheral subcutaneous fat layer in all three cases. We report US and CT findings of SPTCL in these three patients.
[Show abstract][Hide abstract] ABSTRACT: Parathyroid carcinoma is a rare malignancy that is responsible for only 0.5 to 4% of all cases of primary hyperparathyroidism. Surgery is the only curative treatment. We report a case of a 46-year-old woman referred for a severe osteoporosis with frequent bone fracture associated with hypercalcemia. Initially, though she had multiple osteolytic lesions, we thought that the lesions were brown tumors resulting from hyperparathyroidism. The patient underwent surgery and was diagnosed with parathyroid carcinoma. After surgery, her intact PTH level normalized for brief period of time, but it was again elevated at 6 weeks after surgery. We suggest that the multiple osteolytic lesions were metastases because there was no evidence of local recurrence of parathyroid carcinoma, and the lesions looked like metastases on CT and PET-CT. The patient was treated with radiation therapy on the lumbar vertebra, one a site of the metastatic lesions. After radiotherapy, her serum intact PTH was decreased.
Journal of Korean Endocrine Society 01/2007; 22(5). DOI:10.3803/jkes.2007.22.5.344
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to prospectively assess the value of intermittent sonographic guidance in nonsurgical air reduction of childhood intussusception.
The study group included 86 consecutive childhood intussusceptions confirmed on sonography for which we designed an air enema. With intermittent sonographic guidance of our own method, air was gradually injected to the initial intracolonic pressure of 60 mm Hg, which we attempted for 30 seconds on the initial attempt. If the air enema reduction attempts were not successful at a given pressure setting, we repeated the technique at each pressure setting upgraded by increments of 20 mm Hg up to 120 mm Hg. Surgery was performed when even repeated reduction attempts at the maximum intracolonic pressure of 120 mm Hg were unsuccessful. We calculated the successful reduction rate for the intussusceptions at each pressure setting.
The overall success rate of sonographically guided air enema reductions was 95% (82/86). The success rates of air enema reductions at 60, 80, 100, and 120 mm Hg showed progressive increases of 53% (42/86), 67% (58/86), 78% (67/86), and 95% (82/86), respectively, with no immediate recurrence and no gross perforation.
The use of intermittent sonographic guidance in air enemas is thought to help safely increase successful reductions of childhood intussusception even with sufficient air enema attempts.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 10/2006; 25(9):1125-30. · 1.54 Impact Factor