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ABSTRACT: OBJECTIVE: To study the correlation between the predicted thermal dose volume (TDV) and the actual ablation volumes in MR-guided focused ultrasound surgery (MRgFUS) for symptomatic uterine fibroids, and to follow up the outcome for 12 months post-treatment. STUDY DESIGN: Phase-difference fast spoiled gradient-echo MR images were used to analyze thermal change during the energy deliveries of MRgFUS in 60 consecutive patients treated for symptomatic uterine fibroids. The TDV obtained through analysis of these MR images was compared with the non-perfused volume (NPV) measured on post-treatment contrast enhanced T1-weighted images. Final values of TDV ratio and NPV ratio were obtained by dividing these values by original fibroid volume. Patients were followed for 12 months post-treatment to assess symptomatic relief using the symptom severity score (SSS). RESULTS: Treatments in which we managed to reach a TDV ratio larger than 27% of the treated fibroid yielded a ratio of NPV to TDV of 1.1±0.5, indicating accurate control of the non-invasive procedure. Patient symptoms, as measured by the SSS, continuously decreased from a mean baseline score of 50±22 to 19±12 (P<0.0001) 12 months post-treatment. CONCLUSIONS: At large treatment volumes (exceeding 27% TDV ratio), thermal dose estimates correspond very closely to non-perfused volumes measured immediately post treatment. These large treatment volumes result in continuous clinical improvement throughout the first 12 months after MRgFUS.
European journal of obstetrics, gynecology, and reproductive biology 03/2013; · 1.97 Impact Factor
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ABSTRACT: PURPOSE: To evaluate magnetic resonance (MR) imaging-guided focused ultrasound (US) as a treatment for pedunculated subserosal fibroids. MATERIALS AND METHODS: Over a 2-year period (March 2007 to March 2009), 135 women with symptomatic uterine fibroids were treated in the authors' institution using MR imaging-guided focused US. Of these women, nine (mean age, 39 years; range, 25-47 y) had a single pedunculated subserosal fibroid. During treatment, these pedunculated fibroids were targeted, while sparing the stalk connection between the fibroid and the uterus. Contrast-enhanced T1-weighted MR images were obtained immediately after the treatment to measure the nonperfused volume (NPV) ratio and to check stalk viability. Changes in tumor volume, diameter of the stalk, patient symptoms and adverse events were evaluated 6 months after treatment. RESULTS: The volume of the treated fibroids (n=9) ranged from 79-380cm(3) (mean, 198cm(3)), and NPV ratio ranged from 45%-80% (mean, 67%). MR imaging follow-up at 6 months showed a 14%-48% (mean, 30%) reduction in the volume of the treated fibroids (P =.008). In all cases, the pedunculated subserosal fibroids remained connected to the uterus with a 13% average decrease in the mean diameter of the stalks (from 3.5 to 3.0cm; P=.008). Eight of nine patients (89%) reported improvement in bulk-related fibroid symptoms after treatment. CONCLUSIONS: The results of this preliminary study suggest that MR imaging-guided focused US may be a safe and effective treatment for pedunculated subserosal fibroids. Larger prospective studies with longer follow-up are needed to confirm the suitability of MR imaging-guided focused US to treat this type of fibroid.
Journal of vascular and interventional radiology: JVIR 10/2012; · 1.81 Impact Factor
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Journal of vascular and interventional radiology: JVIR 11/2011; 22(11):1635-7. · 1.81 Impact Factor
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ABSTRACT: Tube current is an important determinant of radiation dose and image quality in X-ray-based examination. The combined automatic tube current modulation technique (ATCM) enables automatic adjustment of the tube current in various planes (x-y and z) based on the size and attenuation of the body area scanned.
To compare image quality and radiation dose of the ATCM with those of a fixed tube current technique (FTC) in CT of the abdomen and pelvis performed with a 16-slice multidetector row CT.
We reviewed 100 patients in whom initial and follow-up CT of the abdomen and pelvis were performed with FTC and ATCM. All acquisition parameters were identical in both techniques except for tube current. We recorded objective image noise in liver parenchyma, subjective image noise and diagnostic acceptability by using a five-point scale, radiation dose, and body mass index (BMI, kg/m(2)). Data were analyzed with parametric and non-parametric statistical tests.
There was no significant difference in image noise and diagnostic acceptability between two techniques. All subjects had acceptable subjective image noise in both techniques. The significant reduction in radiation dose (45.25% reduction) was noted with combined ATCM (P < 0.001). There was a significant linear statistical correlation between BMI and dose reduction (r = -0.78, P < 0.05).
The ATCM for CT of the abdomen and pelvis substantially reduced radiation dose while maintaining diagnostic image quality. Patients with lower BMI showed more reduction in radiation dose.
Acta Radiologica 09/2011; 52(10):1101-6. · 1.37 Impact Factor
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ABSTRACT: To assess the clinical potential of using an energy-blocking scar patch for magnetic resonance-guided focused ultrasound (MRgFUS) treatment of uterine leiomyomas in patients with abdominal scars.
A prospective, nonrandomized, single-arm study was conducted in 20 patients (mean age, 41.1 y; range, 33-51 y) with symptomatic leiomyomas (mean volume, 170 cm(3); range, 10-689 cm(3)) and abdominal scars (mean width, 3.3 mm; range, 1.5-8 mm; mean length, 131.6 mm; range, 86-178 mm) who underwent MRgFUS with an isolating patch covering the scar. Scar patches composed of US-blocking material were placed on patients' skin to cover the scar before treatment. Immediately after each treatment, contrast-enhanced T1-weighted MR images were acquired, and the nonperfused volume (NPV) ratio was measured to determine the technical success of the treatment. Patients were followed for 3 months after treatment for any procedure-related adverse events.
All treatments were completed with no technical problems. No serious adverse events were reported during treatments and during 3 months of follow-up. The mean NPV ratio was 53.5% ± 21%.
The scar patch provides an effective treatment option for patients with uterine leiomyomas and scars in the beam path, who were previously excluded from MRgFUS treatment as a result of an increased risk of skin burns.
Journal of vascular and interventional radiology: JVIR 08/2011; 22(12):1747-50. · 1.81 Impact Factor
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ABSTRACT: The objective of this study was to evaluate the degree of symptomatic relief obtained after treatment with magnetic resonance-guided focused ultrasound surgery in patients with adenomyosis. Quality of life and pain assessment questionnaires from 35 women, collected on the day of treatment and up to 6 months after treatment, indicated that the treatment was safe and there was a significant reduction in symptoms.
Fertility and sterility 10/2010; 95(3):1152-5. · 3.97 Impact Factor
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ABSTRACT: This report discusses a pregnancy case following a series of two consecutive magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS) procedures for the treatment of two different myomas in an individual patient. Both procedures were completed without adverse events, and the patient conceived naturally four months after treatment. At 39 weeks, she gave birth to a healthy baby girl, via a vaginal delivery. There were no complications in the pregnancy or during labor.
Yonsei medical journal 05/2010; 51(3):451-3. · 0.77 Impact Factor
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ABSTRACT: A 45-year-old premenopausal woman was referred to our clinic due to recurring symptoms of uterine fibroids, nine years after a uterine artery embolization (UAE). At the time of screening, the patient presented with bilateral impairment and narrowing of the uterine arteries, which increased the risk of arterial perforation during repeated UAE procedures. The patient was subsequently referred for magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS) treatment. Following the treatment, the patient experienced a significant improvement in symptoms (symptom severity score was reduced from 47 to 12 by 1 year post-treatment). MR images at 3 months showed a 49% decrease in fibroid volume. There were no adverse events during the treatment or the follow-up period. This case suggests that MRgFUS can be an effective treatment option for patients with recurrent fibroids following previous UAE treatment.
Obstetrics and Gynecology International 01/2010; 2010.
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ABSTRACT: Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a non-invasive treatment approach for symptomatic uterine fibroids. One imaging characteristic considered in selecting patients who may benefit from MRgFUS of their uterine fibroids is the signal intensity of the fibroid compared with surrounding myometrium on T2-weighted MR images. Previous reports suggest that hyper-intense fibroids are less amenable to MRgFUS compared with iso- or hypo-intense fibroids. In this case study, we utilized contrast-enhanced dynamic MR imaging to further characterize the vascularity of a hyper-intense fibroid. Based on the results of dynamic T1-weighted contrast-enhanced images, we assumed that the hyper-intense appearance resulted from high fluid content rather than high vascularity and predicted that the fibroid would respond to MRgFUS. The patient underwent the MRgFUS without complication and reported significant decrease in fibroid symptoms at 3 and 12 months post-treatment. This case suggests that pre-treatment dynamic contrast-enhanced imaging used in conjunction with T2-weighted imaging may improve the criteria for selecting uterine fibroids amenable to treatment with MRgFUS, potentially leading to improved patient outcomes.
Obstetrics and Gynecology International 01/2010; 2010.
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ABSTRACT: To report a successful treatment of symptomatic adenomyosis using magnetic resonance-guided focused ultrasound surgery (MRgFUS).
Case study.
General hospital.
A 47-year-old premenopausal woman with focal symptomatic adenomyosis.
MRgFUS.
Score on the Uterine Fibroids Symptoms Quality of Life (UFS-QOL) questionnaire and the degree of menstrual pain.
Uterine Fibroids Symptoms reduced from 53 to 28 and the degree of menstrual pain reduced from 10 to 5.
For adenomyosis patients who wish to preserve their uterus, MRgFUS may be a promising alternative to hysterectomy. Additional studies of the safety and efficacy of MRgFUS in this indication should be conducted.
Fertility and sterility 09/2008; 90(5):2018.e13-5. · 3.97 Impact Factor
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ABSTRACT: Uterine leiomyomas (fibroids), the most common benign tumor in women of childbearing age, can cause symptoms including dysmenorrhea, menorrhagia, urinary symptoms, pain and infertility. Hysterectomy is a common approach to treating uterine fibroids, and less invasive surgical approaches such as myomectomy and uterine artery embolization also have been shown to alleviate symptoms. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is the only totally non-invasive surgical approved method for treating uterine fibroids. In clinical trials, MRgFUS resulted in significant relief of uterine fibroid symptoms. The safe and effective use of MRgFUS is affected by fibroid type and location, position relative to adjacent anatomical structures and the presence of co-existent pelvic disease. Additionally, successful outcomes with MRgFUS have been correlated with the volume of fibroids ablated during the procedure. Thus, selection of patients in whom sufficient fibroid volumes can be treated safely using the MRgFUS system is critical for successful outcomes. The MR images in this pictorial essay provide examples of uterine fibroids for which MRgFUS should be considered and is designed to facilitate the selection of patients for whom MRgFUS is most likely to provide sustained symptom relief.
European Radiology 08/2008; 18(12):2997-3006. · 3.22 Impact Factor
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ABSTRACT: Pure epidural cavernous hemangioma of the spine without vertebral involvement is rare. Due to the slow growth of this lesion, the most common symptoms are chronic pain, myelopathy, and radiculopathy. In our case, the patient complained of an acute onset sensory deficit of the C4 dermatome. An MRI revealed an epidural mass with an acute hematoma. Here, we report a case of a pure epidural cavernous hemangioma that presented with acute neurologic symptoms caused by intralesional hemorrhage and an acute epidural hematoma, which were demonstrated on the patient's MRI.
Yonsei Medical Journal 01/2007; 47(6):877-80. · 1.14 Impact Factor
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ABSTRACT: The aim of our study is to present our experience with uterine restoration after repeated sloughing of uterine fibroids or transvaginal expulsion following uterine artery embolization (UAE) and to determine its safety and outcome. One hundred and twenty-four women (mean age, 40.3 years; age range, 29-52 years) with symptomatic uterine fibroids were included in this retrospective study. We performed arterial embolization with poly(vinyl alcohol) particles (250-710 microm). Clinical symptoms and follow-up information for each patient were obtained through medical records. At an average of 3.5 months (range, 1-8 months) after embolization, magnetic resonance imaging examinations with T1- and T2-weighted and gadolinium-enhanced T1-weighted images were obtained for all patients. The mean follow-up duration was 120 days (90-240 days). Eight (6.5%) patients experienced uterine restoration after repeated sloughing of uterine fibroids or spontaneous transvaginal expulsion. The locations of the leiomyomas were submucosal (n=5), intramural (n=2) and transmural (n=1). The maximum diameter of the fibroids ranged from 3.5 to 18.0 cm, with a mean of 8.4 cm. The time interval from embolization to the uterine restoration was 7-150 days (mean 70.5 days). The clinical symptoms before and during vaginal sloughing or expulsion were lower abdominal pain (n=4), vaginal discharges (n=3), infection of necrotic myomas (n=2) and cramping abdominal pain (n=1). Gentle abdominal compression (n=1) and hysteroscopic assistance (n=1) were required to remove the whole fibroid. No other clinical sequelae, either early or delayed, were documented. Magnetic resonance images revealed the disappearance of leiomyomas, intracavitary rupture resulting in transformation of intramural or transmural myomas into submucosal myomas and localized uterine wall defects. Although the small size of this study precludes a strict conclusion, there appear to be few serious complications directly related to vaginal expulsion. Vaginal expulsion or fibroid sloughing is a possible course following UAE that is manageable, and the patients should be informed about this possibility.
European Radiology 10/2005; 15(9):1850-4. · 3.22 Impact Factor
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ABSTRACT: Acute invasive small bowel anisakiasis is an extremely rare cause of small bowel obstruction. The authors report a case of surgically verified small bowel anisakiasis resulting in small bowel obstruction. A 54-year-old man presented with suddenly developed diffuse abdominal pain after ingestion of raw fish. The peripheral blood examination showed leukocytosis without eosinophilia. CT showed a long segment of thickened small bowel accompanied by a focal narrowed portion and combined with ascites. When these findings are noted in patients with a history of recent ingestion of raw or undercooked fish, the diagnosis of small bowel anisakiasis should be considered in order to avoid application of unnecessary surgical treatment, in spite of the severity of the abdominal pain and bowel obstruction.
Yonsei Medical Journal 09/2004; 45(4):739-42. · 1.14 Impact Factor
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ABSTRACT: Imaging findings of secondary hepatic lymphoma have been reported as variable, ranging from single or multiple small nodules to diffuse infiltrative tumor patterns. We hear present a rare case report concerning aggressive B cells, secondary Burkitt's lymphoma in non-AIDS demonstrating a surprising periportal lymphoma infiltration, without upper abdominal lymphadenopathy or splenomegaly on the sonography and CT scans. Clinically, the case was characterized by atypical and highly aggressive course, with the patient presenting an abruptly developed obstructive jaundice with rapidly deteriorating hepatic function that could be indicative of cholestatic hepatitis, which differs in its clinical manifestations from hepatic lymphoma without functional deterioration in respect of its non-tissue destructive growth pattern. We suggest that hepatic lymphoma can sometimes be consistent with periportal infiltrating homogeneous mass, with no lymphadenopathy or splenomegaly on the imaging examination, with a predictable aggressive clinical course of the disease and poor prognosis.
Yonsei Medical Journal 09/2004; 45(4):723-6. · 1.14 Impact Factor
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ABSTRACT: Twelve patients with symptoms of acute cholecystitis underwent heavily T2-weighted and mangafodipir trisodium-enhanced T1-weighted magnetic resonance (MR) cholangiography and cholescintigraphy before they underwent cholecystectomy. On T2-weighted MR cholangiographic images, morphologic evidence of outflow obstruction of the gallbladder was definitive in seven patients, equivocal in one, and absent in four. In all 12 patients, biliary dynamics depicted at manganese-enhanced T1-weighted MR cholangiography agreed completely with those depicted at hepatobiliary scintigraphy. T2-weighted MR cholangiography combined with manganese-enhanced T1-weighted MR cholangiography provides not only morphologic information but also functional information about the biliary system.
Radiology 06/2003; 227(2):580-4. · 5.73 Impact Factor
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Mi-Suk Park,
Ki Whang Kim,
Jeong-Sik Yu,
Chanil Park,
Jai Keun Kim, Sang-Wook Yoon,
Kwang-Hun Lee,
Young Hoon Ryu,
Haeryoung Kim,
Myeong-Jin Kim,
Jong Tae Lee,
Hyung Sik Yoo
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ABSTRACT: We undertook this study to assess how well double-contrast radiography and CT allow radiologists to differentiate low-grade from high-grade mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach.
We retrospectively reviewed the upper gastrointestinal radiographs and contrast-enhanced CT scans of 57 patients with pathologically proven primary gastric lymphoma (low-grade [n = 29] and high-grade [n = 28] MALT lymphoma).
On upper gastrointestinal radiography, ulceration (39%) was the most common finding in low-grade lymphoma, whereas polypoid appearance (38%) was the most common in high-grade lymphoma. In the 29 patients (33 lesions) with low-grade MALT lymphoma, upper gastrointestinal radiography revealed 13 ulcerative lesions (39%), 10 nodular lesions (30%), four infiltrative lesions (12%), two polypoid lesions (6%), and four combined lesions (12%). In the 28 patients (29 lesions) with high-grade lymphoma, upper gastrointestinal radiography revealed 11 polypoid lesions (38%), nine infiltrative lesions (31%), six ulcerative lesions (20%), one nodular lesion (3%), and two combined lesions (7%). On CT, thickening of the gastric wall in low-grade lymphoma (range, 0.3-2.5 cm; mean, 0.8 cm) was much less than that in high-grade lymphoma (range, 0.7-8.0 cm; mean, 2.5 cm). Abdominal lymphadenopathy was less frequent in low-grade lymphoma (14%) than in high-grade lymphoma (75%).
Most low-grade lymphomas show superficial spreading lesions, such as mucosal nodularity, shallow ulcer, and minimal fold thickening, on upper gastrointestinal radiography, whereas most high-grade lymphomas show mass-forming lesions or severe fold thickening.
American Journal of Roentgenology 12/2002; 179(5):1297-304. · 2.78 Impact Factor
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ABSTRACT: To assess the capability of helical computed tomography (CT) to assist in the differentiation between mucinous and nonmucinous gastric carcinomas, with a focus on the thickened stomach wall itself.
In 62 patients with pathologically proved mucinous (n = 21) or nonmucinous (n = 41) gastric carcinomas, contrast material-enhanced helical CT images were obtained. The gross appearance, contrast enhancement pattern, predominant thickened layer, and degree of enhancement were retrospectively evaluated. Statistical analyses were performed with Fisher exact, chi(2), and Student t tests. A P value of less than.05 was considered to indicate a statistically significant difference.
The most common type of gross appearance in both carcinomas was fungating: It occurred in 71% of patients with mucinous carcinomas and in 59% of patients with nonmucinous carcinomas. The next most common gross appearance type was ulcerative (24% of patients) in nonmucinous carcinomas and diffusely infiltrative (29% of patients) in mucinous carcinomas (P =.009). The most common contrast enhancement pattern was homogeneous (61% of patients) in nonmucinous carcinomas and layered (62% of patients) in mucinous carcinomas (P =.001). These findings were significantly different. The predominantly affected thickened layer was the high-attenuating inner layer or the entire layer (88% of patients) in nonmucinous carcinomas and the low-attenuating middle or outer layer (57% of patients) in mucinous carcinomas. Only two mucinous tumors showed miliary punctate calcifications in infiltrative lesions.
Helical CT may assist in distinguishing mucinous from nonmucinous gastric carcinoma, primarily on the basis of enhancement pattern, predominant layer of the thickened wall, gross appearance, and presence of calcifications.
Radiology 06/2002; 223(2):540-6. · 5.73 Impact Factor
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ABSTRACT: To evaluate the diagnostic accuracy of 16-slice multidetector-row computed tomography (MDCT) for the detection of common bile duct (CBD) stones and to compare the diagnostic values between contrast-enhanced axial with multiplanar reformation (MPR) images and contrast-enhanced combined with non-contrast-enhanced axial images.
Fifty-four patients with suspected CBD stones underwent MDCT and endoscopic retrograde cholangiopancreatography (ERCP). Two radiologists independently evaluated contrast-enhanced axial with MPR images for the presence of CBD stones. Two weeks later, they performed a second review of contrast-enhanced and non-contrast-enhanced axial images. The ERCP was used as the criterion standard to confirm the presence of CBD stones. The McNemar test and receiver operating characteristic curve analysis were used to assess the differences in accuracy for detecting CBD stones.
The ERCP identified bile duct stones in 27 patients and no stones in the other 27. Contrast-enhanced axial with MPR images had a sensitivity of 88.9%, specificity of 92.6%, and diagnostic accuracy of 90.7%. Contrast-enhanced combined with non-contrast-enhanced axial images had a sensitivity, specificity, and diagnostic accuracy of 88.9%. However, the difference between the 2 groups was not statistically significant. The areas under the receiver operating characteristic curve of the 2 groups were 0.929 and 0.905, respectively.
The MDCT provides high accuracy in diagnosis for CBD stones. Adding non-contrast-enhanced images to contrast-enhanced images did not improve diagnostic accuracy, and therefore, additional non-contrast-enhanced images are not necessary.
Journal of Computer Assisted Tomography 31(4):508-12. · 1.22 Impact Factor
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ABSTRACT: The purpose of this work was to evaluate the radiologic findings of gastrointestinal (GI) tract involvement in hepatocellular carcinoma (HCC) and to discuss mechanisms of spread.
Eighteen patients with histologically proven GI tract metastasis in HCC for 4.5 years underwent CT and five also underwent upper GI (UGI) series. The cases were classified according to the mode of spread, based on the radiologic findings.
The involved portion of the GI tract was the stomach (n = 11), duodenum (n = 4), and colon (n = 4). The mode of spread was direct invasion from a contiguous primary tumor (n = 12), hematogenous metastasis (n = 3), peritoneal seeding (n = 1), and undetermined (n = 2). In cases of direct invasion from contiguous primary tumors, CT revealed GI tract invasion directly from bulky hepatic masses (n = 9) or daughter masses at the portion of the bowel wall contiguous to the hepatic masses (n = 3). In cases of hematogenous spread, CT revealed an intramural mass in the stomach and duodenum (n = 2) or a diffuse thickening of the wall of the stomach (n = 1). In the case of peritoneal seeding, CT revealed multiple small nodules in the right paracolic gutter, omentum, and mesentery with invasion to the colon.
GI tract involvement in HCC shows various radiologic findings according to the mode of spread, but the most common finding is direct invasion of the stomach, duodenum, or colon from contiguous primary tumor.
Journal of Computer Assisted Tomography 26(1):95-101. · 1.22 Impact Factor
