• Imaging Science in Dentistry
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• v.44 no.4
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• pp.307-314
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• 2014

Primitive neuroectodermal tumor (PNET), which belongs to the Ewing's sarcoma (ES) family of tumors, is mainly seen in children and young adults. PNETs are extremely rare in the maxilla. Here, we report a case of PNET of the left maxillary sinus in an elderly male. Magnetic resonance imaging (MRI) revealed a slightly enhanced solid mass occupying the left maxillary sinus and infiltrating into the retroantral space. A partial maxillectomy was performed. Despite postoperative chemotherapy, follow-up computed tomography (CT) and MRI revealed a nodal metastasis in the submandibular space. Neck dissection was performed. However, the patient died 10 months after the second surgery because of distant metastasis to the liver. MRI and CT were particularly useful in detecting the extent of the tumor, recurrence, and metastasis. Further, a literature review of the previously reported PNET cases of the maxilla was carried out. In this paper, we also discuss the current approach for the diagnosis and management of these tumors.

• Journal of the Korean Society of Radiology
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• v.17 no.3
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• pp.385-392
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• 2023

Caroli's disease is a fibrocystic liver disease. Autosomal recessive disorder is characterized by congenital multiple dilatation of the bile duct. Computerized tomography, magnetic resonance imaging, cholangiography and ultrasound are among the methods for diagnosing caroli disease. Computerized tomography is essential for detecting and distinguishing fibroplastic liver disease and is useful for determining intrahepatic bile duct dilatation. However, awareness of the possible side effects of using contrast mediums is necessary. A typical method of magnetic resonance cholangiography is used for magnetic resonance imaging. A non-invasive examination can reduce the pain of the patient, and the anatomical structure of the bile pancreatic duct and the presence or absence of lesions can be easily and quickly observed. Biliary contrast is an effective diagnostic method that can directly visualize various cystic dilatations throughout the enlarged bile duct. However, since this procedure is also an invasive procedure, it is recommended not for diagnosis but for treatment purposes. Ultrasonography can confirm similar findings to computerized tomography. The hepatic artery root is difficult to prove with conventional grayscale ultrasound. However, it is of clinical value in that it can not only describe dilated bile ducts with vascular roots in the tube but also easily identify color Doppler signals in the tube. With the development of video diagnostics, early diagnosis has become possible through computerized tomography, magnetic resonance imaging, cholangiography, and ultrasound. In order to further contribute to the development of video diagnostics so that long-term prognosis can be improved after treatment through early diagnosis, we examined what aspects of each test's caroli disease appear.

• Investigative Magnetic Resonance Imaging
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• v.25 no.4
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• pp.313-322
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• 2021

Purpose: To find diagnostic image features, to compare diagnostic performance of multiphase CT versus gadoxetic acid disodium-enhanced MRI (GAD-MRI), and to evaluate the impact of analyzing Liver Imaging Reporting and Data System (LI-RADS) imaging features, for distinguishing combined hepatocellular-cholangiocarcinoma (CHC) from hepatocellular carcinoma (HCC). Materials and Methods: Ninety-six patients with pathologically proven CHC (n = 48) or HCC (n = 48), diagnosed June 2008 to May 2018 were retrospectively analyzed in random order by three radiologists with different experience levels. In the first analysis, the readers independently determined the probability of CHC based on their own knowledge and experiences. In the second analysis, they evaluated imaging features defined in LI-RADS 2018. Area under the curve (AUC) values for CHC diagnosis were compared between CT and MRI, and between the first and second analyses. Interobserver agreement was assessed using Cohen's weighted κ values. Results: Targetoid LR-M image features showed better specificities and positive predictive values (PPV) than the others. Among them, rim arterial phase hyperenhancement had the highest specificity and PPV. Average sensitivity, specificity, and AUC values were higher for MRI than for CT in both the first (P = 0.008, 0.005, 0.002, respectively) and second (P = 0.017, 0.026, 0.036) analyses. Interobserver agreements were higher for MRI in both analyses (κ = 0.307 for CT, κ = 0.332 for MRI in the first analysis; κ = 0.467 for CT, κ = 0.531 for MRI in the second analysis), with greater agreement in the second analysis for both CT (P = 0.001) and MRI (P < 0.001). Conclusion: Rim arterial phase hyperenhancement on GAD-MRI can be a good indicator suggesting CHC more than HCC. GAD-MRI may provide greater accuracy than CT for distinguishing CHC from HCC. Interobserver agreement can be improved for both CT and MRI by analyzing LI-RADS imaging features.

• Investigative Magnetic Resonance Imaging
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• v.25 no.3
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• pp.172-182
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• 2021

Purpose: We evaluated the diagnostic performance of LI-RADS version 2018 using gadoxetic acid enhanced MRI for recurrent but untreated HCC in patients with prior history of HCC. Materials and Methods: We enrolled 50 consecutive patients who 1) prior history of treatment of HCC, 2) underwent liver surgery for radiological/clinical diagnosis of new HCC between 2013 to 2018, 3) had gadoxetic acid enhanced MRI within one month before surgery, and 4) did not have more than five HCCs or infiltrative tumors only. Two radiologists reviewed MRI and determined the presence of LR3, LR4 and LR5 observations except previously treated tumors based on LI-RADS version 2018 in consensus. We sub-classified LR4 into LR4m (LR4 with major features only) and LR4u (LR4 upgraded from LR3 by ancillary features). LR4u were further sub-classified into LR4ua (with arterial phase hyperenhancement) and LR4un (without arterial phase hyperenhancement). Results: PPV for LR5, LR4 and LR3 observations for recurrent HCC were 100%, 61.5% and 25.0%, respectively. 100% (3/3) of LR4m were HCC. However, PPV of LR4u was 56.5%. PPV of LR4ua and LR4un were 73.3% and 25.0%, respectively. Sensitivity of LR5 and LR5+LR4 observations as a diagnostic threshold were 32.1% and 89.3%, respectively. Sensitivity for LR5+LR4m+LR4ua observations for diagnosis of HCC were 83.7% and significantly superior to that of LR5 without significant deterioration of specificity (75.0%). Conclusion: In patients with prior history of HCC, LR4 observations by major features or with APHE may be regarded as recurrent HCCs given high sensitivity and comparable specificity/PPV to LR5 observations.

• Clinical and Experimental Pediatrics
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• v.48 no.6
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• pp.660-664
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• 2005

Infantile hemangioendothelioma(IHE) of the liver is the most common vascular tumor in infants before the age of 6 months. It is a histologically benign tumor with potentially life-threatening complications. The clinical manifestations are variable, ranging from asymptomatic forms to intractable high-output heart failure. In addition, abdominal mass, intraperitoneal hemorrhage due to rupture of mass, respiratory distress, hematologic abnormalities and jaundice can occur. Diagnostic work-up is through doppler ultrasound sonography, computed tomography scan, magnetic resonance imaging and angiography. Treatment consists of medical treatment, interventional therapy, surgical resection and liver transplantation. We experienced symptomatic IHE in a premature neonate who presented with high output heart failure and respiratory distress. Initial medical treatment and steroid therapy failed to improve his condition. Coil embolization of left hepatic artery resulted in improvement of respiratory symptoms. However, a left lobectomy was performed because the mass size was not decreased with development of collateral vessels. The infant was well, after a successful discharge from the hospital.

• Clinical and Experimental Pediatrics
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• v.58 no.2
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• pp.69-72
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• 2015

Insulinoma, which arises from insulin-producing pancreatic beta cells, is a rare tumor in children. Only 5%-10% of insulinomas are malignant and undergo metastasis. We report a case of an 11-year-old girl who experienced hypoglycemia-related seizures induced by an insulinoma; after resection of the primary tumor, she developed hepatic focal nodular hyperplasia (FNH). Laboratory test results indicated marked hypoglycemia with hyperinsulinemia. Abdominal ultrasonography (US) and computed tomography results were normal; however, magnetic resonance imaging (MRI) showed a solid mass in the pancreatic tail. Therefore, laparoscopic distal pancreatectomy was performed. Two months after the surgery, an abdominal MRI revealed multiple nodular lesions in the liver. An US-guided liver biopsy was then performed, and histological examination revealed FNH without necrosis or mitotic activity. The patient has been free of hypoglycemia for 2 years, and recent MRI studies showed a decrease in the size of FNH lesions, without any evidence of metastasis. Even though no metastatic lesions are noted on imaging, close observation and follow-up imaging studies are required in a child with insulinoma that has malignant potential on histopathologic findings.

• Investigative Magnetic Resonance Imaging
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• v.1 no.1
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• pp.135-141
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• 1997

Purpose: To assess the usefulness of breath-hold fast MR imaging of liver with fat suppression (FS) by application of chemical saturation technique in the diagnosis of regional fatty changes suspected in sonography. Materials and Methods: Thirteen patients who had focal lesions with diffuse, homogeneous signal changes after FS through chemical saturation technique without additional changes of imaging parameter during MR imaging of liver were selected. T1-weighted fast low-angle shot and T2-weighted turbo spin-echo sequences were obtained with or without FS during each single breath-holding session. Subjective changes of signal intensity between the pre-FS and the FS images were compared with the sonographic findings in each lesion. Results: Seven lesions of decreased signal intensity after FS on T1 or T2-weighted images, including three lesions only at FS T1 images, were regarded as focal fat infiltration. All seven lesions had compatible sonographic findings as homogenously echogenic areas. Another six lesions of subjectively increased signal intensity including two lesions only at FS T2 images were regarded as focal fat sparing. All six lesions had sonographic findings as homogenous echo poor areas suggesting focal fat sparing. In cases regarded as fat infiltration, score changes were more prominent at FS T1 images than FS T2 images(p=0.0002). In cases regarded as fat sparing, score changes were more prominent at FS T2 images than FS T1 images(p=0.042). Conclusion: Breath-hold fast T1 and T2-weighted MR imaging with and without chemical saturation pre-pulse may be sufficient for characterization of regional fatty changes in the differential diagnosis of focal hepatic lesion found at sonography.

• Tuberculosis and Respiratory Diseases
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• v.68 no.5
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• pp.298-300
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• 2010

Diaphragmatic paralysis can be demonstrated through diaphragmatic elevation on chest X-ray after thoracic lung surgery or the placement of chest tubing. Additional causes of diaphragmatic paralysis are iatrogenic, mass, atelectasis, etc. For the diagnosis of diaphragmatic paralysis, it required some studies (fluoroscopy, computed tomography [CT], magnetic resonance imaging). Diaphragmatic hernia of the liver is a rare clinical entity, usually found after trauma in adults. Congenital diaphragmatic hernia in neonates requires surgery. Non-traumatic diaphragmatic hernia of the liver in an adult is a rare right-sided diaphragmatic hernia. On developing any symptoms, surgery must be performed. When diaphragmatic hernia is incidentally found in adults without trauma, it is placed under observation for a time period. We diagnosed the diaphragmatic herniation of a right hepatic lobe by 16-slice CT scan without surgery.

• Korean Journal of Digital Imaging in Medicine
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• v.14 no.2
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• pp.57-61
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• 2012

To compare the accuracy of breath-hold magnetic resonance imaging sequences to establish the most effective superparamagnetic iron oxide-enhanced sequence for detection of hepatic metastases. A total of 100 patients(50men and 50women, mean age: 60years) with liver disease(including malignant and benign liver lesions) were investigated at 3.0T machine (GE, General Electric Medical System, Excite HD) with 8Ch body coil. Pulse sequence for MR imaging decided to the FS-T2-FSE-RT(TR/TE/Thick./Freq./Phase=12857ms/100ms/7mm/512/384), MGRE(TR/TE/Thick./Freq./Phase=100ms/9.7ms/7mm/384/288), in-out of phase echo(TR/$TE_1$, $TE_2$/Thick./Freq./Phase=140ms/2.4, 5.8ms/7mm/352/300), Images obtained before the injection of SPIO. Six sequences were optimized for lesion detection: FS-T2-FSE-RT, multigradient recalled echo data image(MGRE), T2-weighted MGRE with an 9.7msec echo time. Images were reviewed independently by five blinded observers. The accuracy of each sequence was measured by using picture archiving communication system analysis. All results were correlated with findings at multidectator computed tomography examination. Differences between the mean results of the six observers were measured by using paired student t-test analysis. Postcontrast T2-weighted MGRE sequences were the most accurate and were significantly superior to postcontrast FS-T2-FSE-RT, T2-weighted MGRE, in-out of phase MR sequences(p < .05). For all lesions that were malignant or smaller than 1 cm, respectively, contrast to noise ratio of pre and postcontrast sequences were -1and -0.3 for T2-weighted FSE, 0.53 and 4.5 in-out of phase, 7, 7.08, 5.08, 3.32, 1.7, 1.16, 0.79, 0.68 for GRE with 2.9, 7.5, 12.1, 16.6, 21.2, 25.8, 30.4, 35.0 TE values. Breath-hold various TE precontrast sequences offer improvement in sensitivity compared with fixed multigradient recalled echo sequences alone.

• Investigative Magnetic Resonance Imaging
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• v.5 no.1
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• pp.43-48
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• 2001

Purpose : To evaluate changes in rabbit liver parenchyma on MR images following percutaneous Holmium-166 injection, and to correlate those changes with histologic findings. Materials and methods. Holmium-166 (10-25 mCi) was percutaneously injected into the liver of rabbit (n=12) under sonographic guidance. MR images were obtained between one to two weeks (acute phasea) after the injection in four rabbits, and between two to four weeks (subacute phase) after the injection in four rabbits. Tissue specimens of these eight rabbits were obtained immediately after MR imaging. Tissue specimens were obtained without MR imaging in four rabbits (between one to two weeks in one rabbit and between three to four weeks in three rabbits). Results : Tissue specimens showed central liquefactive necrosis and peripheral coagulative necrosis containing deposition of small particles and hemorrhage. The peripheral margin of the lesions showed formation of the granulation tissue with fibrosis, which tended to be more prominent in subacute phase. The area of the necrosis tended to correlate with the dose of the radioactive Holmium-166. On MR images, the central portion of the necrosis showed hyperintensity on 72-weighted image, hypointensity on the precontrast T1-weighted images, and no enhancement on the dynamic MR images. The peripheral portion of the necrosis showed hypointensity on T2-weighted images, iso or mild hypointensity on the T1-weighted images, and mild peripheral enhancement on the delayed dynamic MR images. The peripheral margin of the lesion showed hypointensity on both T1- and T1-weighted images with increased enhancement on the delayed phase images of the dynamic MR images. Conclusion : After percutaneous Holmium-166 injection into rabbit liver parenchyma, the central portion showed liquefactive necrosis, the peripheral portion showed coagulative necrosis with granulation, fibrosis, hemorrhage and depostition of small granules. MR imaging may be helpful in evaluation of the histological change of the liver after percutaneous Holmium-166 treatment.