• Journal of the Korean Society of Radiology
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• v.84 no.5
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• pp.1047-1065
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• 2023

Multi-detector CT (MDCT) is a highly accurate diagnostic tool that is commonly used to evaluate appendicitis and its complications. The diagnosis of appendicitis based on MDCT findings can be difficult and challenging when the observed findings are inconsistent with the typical features. Atypical appendicitis includes a wide spectrum of features, such as variable positions of the appendix and cecum, complications, and unusual pathological findings of secondary appendicitis that mimic or induce appendicitis. Our pictorial essay describes the diverse spectrum of atypical appendicitis and appendicitis-like conditions in terms of location abnormalities, complications, and uncommon pathologies, including related tumors, reactive appendicitis, appendiceal diverticulitis, and IgG4-related disease. Through this essay, the readers can become more familiar with MDCT findings of atypical appendicitis.

• Korean Journal of Radiology
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• v.22 no.6
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• pp.890-900
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• 2021

Objective: To identify the association between morphological and functional characteristics of the bicuspid aortic valve (BAV) and bicuspid aortopathy and to identify the determinants of aortic dilatation using transthoracic echocardiography (TTE) and cardiac computed tomography (CCT). Materials and Methods: This study included 312 subjects (mean [SD] age, 52.7 [14.3] years; 227 males [72.8%]) who underwent TTE and CCT. The BAVs were classified by anterior-posterior (BAV-AP) or right-left (BAV-RL) orientation of the cusps and divided according to the presence (raphe+) or absence of a raphe (raphe-) based on the CCT and intraoperative findings. The dimensions of the sinus of Valsalva and the proximal ascending aorta were measured by CCT. We assessed the determinants of aortic root and proximal ascending aortic dilatation (size index > 2.1 cm/m²) by Univariable and multivariable logistic regression analyses. Results: Of the 312 patients, BAV-AP was present in 188 patients (60.3%), and 185 patients (59.3%) were raphe+. Moderate-to-severe aortic stenosis (AS) was the most common hemodynamic abnormality (54.8%). The most common type of aortopathy was the combined dilated root and mid-ascending aortic phenotype (62.5%). On multivariable analysis, age and AS severity were significantly associated with aortic root dilatation (p < 0.05), and age, sex, and AS severity were significantly associated with ascending aortic dilatation (p < 0.05). However, the orientation of the cusps, presence of a raphe, and severity of aortic regurgitation were not associated with aortic root and ascending aortic dilatation. Conclusion: BAV morphological characteristics were not determinants of aortic dilatation. Age, sex, and AS severity were predictors of bicuspid aortopathy. Therefore, age, sex, and AS severity, rather than valve morphology, need to be considered when planning treatment for BAV patients.

• Journal of the Korean Society of Radiology
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• v.82 no.2
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• pp.393-405
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• 2021

Purpose To determine the multidetector CT (MDCT) findings that differentiate adenomyoma of the ampulla of Vater (AOV) from localized adenocarcinoma of the AOV. Materials and Methods Sixteen and 30 patients with adenomyoma and localized adenocarcinoma of the AOV, respectively, were evaluated using MDCT. We analyzed the size and attenuation value and presence of uniform enhancement of the lesions, diameters of the extrahepatic bile duct (EHD) and main pancreatic duct, presence of regional lymph node enlargement, and laboratory findings. We determined the independent findings for differentiating adenomyoma from localized adenocarcinoma of the AOV using multivariate analysis. Results The size of the lesion and diameter of the EHD were significantly smaller for adenomyoma than those for localized adenocarcinoma of the AOV (all p < 0.001). In multivariate analyses, a lesion size of ≤ 1.3 cm, an EHD diameter of ≤ 1.3 cm, and an alanine transaminase level of ≤ 31 IU/L significantly differentiated adenomyoma from localized adenocarcinoma of the AOV. When all of these three findings were met, the specificity for adenomyoma of the AOV was 93.3%. Conclusion MDCT imaging may facilitate the differential diagnosis of adenomyoma and localized adenocarcinoma of the AOV based on the size of the lesion and diameter of the EHD.

• Journal of the Korean Society of Radiology
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• v.81 no.6
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• pp.1348-1363
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• 2020

The newly revised 2018 Organ Injury Scale (OIS) has a similar format to the previous American Association for Surgery and Trauma (AAST) Emergency General Surgery Grading System, dividing the criteria for grading solid organ damage into three groups; imaging, operation, and pathology. The most significant alteration in the OIS system 2018 revision is the incorporation of multidetector CT (MDCT) findings of vascular injury including pseudoaneurysm and arteriovenous fistula. Similar to the previous OIS, the highest of the three criteria is assigned the final grade. In addition, if multiple grade I or II injuries are present, one grade is advanced for multiple injuries up to grade III. This pictorial essay demonstrates the MDCT findings of solid organ injury grades based on the 2018 OIS system.

• Journal of Chest Surgery
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• v.42 no.1
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• pp.79-86
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• 2009

Background: Background: Computed tomography (CT) is the main tool for detecting abnormalities of the thoracic aorta, but conventional CT only shows the cross-sectional images. These CT images have some limitations fo accuratly measuring the thoracic aortic diameters at various levels. Multidetector computed tomography (MDCT) overcomes these limitations. We measured the thoracic aortic diameter perpendicular to the loop-shaped thoracic aortic course and this was studied in relation to age, gender, height, weight, the body surface area, the body mass index and the presence of hypertension. Material and Method: Thirty hundred thirty one patients (males: 141 patients and females: 190 patients) who had no abnormalities of the thoracic aorta were investigated using MDCT aortography. They were divided into three age categories: 20~39 years old, 40~59 years old and over age 60. The image was reformed with multiplanar reconstruction and the diameter of the aorta was measured perpendicular to the aortic course at 5 anatomic segments. Level A was the mid-ascending aorta, level B was the distal ascending aorta, level C was the aortic arch, level D was the aortic isthmus and level E was the mid-descending aorta. Result: The mean age was 49.5 years old for males and 54.9 years old for females (p<0.05). The mean diameter of the thoracic aorta at level A was 31.1 mm, that at level B was 30.2 mm, that at level C was 26.5 mm, that at level D was 24.0 mm and that at level E was 22.6 mm. The diameters at all the levels were gradually increased with age. Hypertensive patients had larger diameters than did the non-hypertensive population. There was a positive correlation between the ascending aortic diameter (levels A&B) and height and the body surface area, but there were no statistical differences at the aortic arch (level C) and the descending aorta (levels D&E). There were no statistical differences of the weight and body mass index at all levels. Conclusion: The diameters of the thoracic aortas were directly correlated with gender, age and hypertension. Height and the body surface area were only correlated with the ascending aorta. Weight and the body mass index have no statistical difference at all levels. We measured the age related thoracic aortic diameters and the upper normal limits and we provide this data as reference values for the thoracic aortic diameter in the Korean population.

• Journal of radiological science and technology
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• v.39 no.4
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• pp.517-526
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• 2016

This study analyzed the correlation between BMD (bone mineral density) value calculated in the MDCT (multidetector computed tomography) and lifestyle, physical features and social characteristics. From July 15 2015 to June 6 2016, we converted from HU (hounsfield unit) value measured by using MDCT to T-score for BMD of 141 patients (male: 63, female: 78) in W medical center. We measured the 2nd, 3rd and 4th lumbar spine and analyzed the correlation between gender differences in BMD and lifestyle, physical features and social characteristics. Statistical significance was validated using independent sample T test with one way Anova. Gender BMD was confirmed that a statistically significant difference (p<0.05). BMD values decreased with increasing age but for the statistically men, there was no significant difference from 20s to 50s, it only showed a significant difference in 20s and 60s (p<0.001). For the statistically women, there was no significant difference from 20s to 40s. but since 50s BMD was decreased rapidly, which showed a significant difference (p<0.001). women showed significant differences for the menstruation and menopause, childbirth, alcohol, cereals and greasy food in bone mineral density (p<0.05) but there were no significant differences in men. The bone mineral density values calculated by the MDCT and lifestyle, physical features and social characteristics correlation analysis method is considered to be used as a basis for estimating the state in BMD and osteoporosis management.

• Tuberculosis and Respiratory Diseases
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• v.68 no.3
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• pp.140-145
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• 2010

Background: Pulmonary embolism (PE) is a common clinical problem in the West that is associated with substantial morbidity and mortality. The diagnostic modality has been changed since 2001. This study retrospectively reviewed the PE mortality with the aim of identifying the risk factors associated with mortality since the multidetector computed tomography (MDCT) was introduced. Methods: We analyzed 105 patients with acute PE proven by multidetector CT or ventilation perfusion scan. The primary outcome measure was the all-cause mortality at 3 months. The prognostic effect of the baseline factors on survival was assessed by multivariate analysis. Results: The main risk factors were prolonged immobilization, stroke, cancer and obesity. Forty nine percent of patients had 3 or more risk factors. The overall mortality at 3 months was 18.1%. Multivariate analysis revealed low diastolic blood pressure and the existence of cancer to be independent factors significantly associated with mortality. Forty two PE patients were examined for the coagulation inhibitors. Four of these patients had a protein C deficiency (9.5%), and 11 had a protein S deficiency (26%). Conclusion: PE is an important clinical problem with a high mortality rate. Close monitoring may be necessary in patients with the risk factors.

• Journal of the Korean Society of Radiology
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• v.79 no.6
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• pp.348-353
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• 2018

Hepatic pseudolymphoma is a rare benign liver mass that is characterized by proliferation of non-neoplastic lymphocytes extranodally. To the best of our knowledge, only 46 cases have been reported in the English literature. We described the case of a 75-year-old woman with hepatic pseudolymphoma mimicking a hypervascular tumor. After the histological confirmation of the rectal neuroendocrine tumor, CT scan revealed a 1.0 cm-sized, poorly-defined and low-density nodule in the liver. On MRI, the hepatic nodule showed an arterial enhancement and a low-signal intensity on the hepatobiliary phase. On diffusion-weighted imaging, the hepatic nodule showed a high signal intensity on a high b-value. On fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT, it revealed a high standardized uptake value nodule. The US showed the hypoechoic nodule and the US-guided biopsy confirmed the hepatic pseudolymphoma.

• Clinics in Shoulder and Elbow
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• v.23 no.2
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• pp.71-79
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• 2020

Background: The glenoid version of the shoulder joint correlates with the stability of the glenohumeral joint and the clinical results of total shoulder arthroplasty. We sought to analyze and compare the glenoid version measured by traditional axial two-dimensional (2D) computed tomography (CT) and three-dimensional (3D) reconstructed images at different levels. Methods: A total of 30 cases, including 15 male and 15 female patients, who underwent 3D shoulder CT imaging was randomly selected and matched by sex consecutively at one hospital. The angular difference between the scapular body axis and 2D CT slice axis was measured. The glenoid version was assessed at three levels (midpoint, upper one-third, and center of the lower circle of the glenoid) using Friedman's method in the axial plane with 2D CT images and at the same level of three different transverse planes using a 3D reconstructed image. Results: The mean difference between the scapular body axis on the 3D reconstructed image and the 2D CT slice axis was 38.4°. At the level of the midpoint of the glenoid, the measurements were 1.7°±4.9° on the 2D CT images and -1.8°±4.1° in the 3D reconstructed image. At the level of the center of the lower circle, the measurements were 2.7°±5.2° on the 2D CT images and -0.5°±4.8° in the 3D reconstructed image. A statistically significant difference was found between the 2D CT and 3D reconstructed images at all three levels. Conclusions: The glenoid version is measured differently between axial 2D CT and 3D reconstructed images at three levels. Use of 3D reconstructed imaging can provide a more accurate glenoid version profile relative to 2D CT. The glenoid version is measured differently at different levels.

• Asian Spine Journal
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• v.12 no.6
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• pp.1010-1016
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• 2018

Study Design: Retrospective cohort study. Purpose: To report on spinal fusion assessment using computed tomography (CT) after adult spinal deformity (ASD) surgery using ultra-low dose recombinant human bone morphogenetic protein 2 (RhBMP-2). Overview of Literature: The reported dose of RhBMP-2 needed for successful spinal posterolateral fusion in ASD ranges from 10 to 20 mg per spinal level. This study reports the use of ultra-low dose of RhBMP-2 (0.07 mg per facet) to achieve spinal fusion in multilevel ASD surgery. Methods: Consecutive patients who underwent ASD surgery using ultra-low dose RhBMP-2 were recruited. Routine postoperative CT analysis for spinal fusion was performed by two spine surgeons. Inter-observer agreement was calculated for facet fusion (FF) and interbody fusion (IBF) at 6 and 12 months after the procedure. Results: Six consecutive ASD patients with a mean age of 62 years (28-72 years) were examined. Each patient received a total dose of 12 mg with an average dose of $0.69{\pm}0.2mg$ (0.42-1 mg) per single FF and $1.38{\pm}0.44mg$ (0.85-2 mg) for IBF. Total 131 FF and 15 IBF were examined in the study, with 88 FFs and nine IBFs being analyzed specifically at 6 months after the surgery. FF and IBF reported by surgeons A and B at 6 months were 97.7% vs. 91.9% FF, respectively (${\kappa}=0.95$) and 100% vs. 100% IBF, respectively (${\kappa}=1$). Two patients underwent longitudinal follow-up CT at 12 months, and the FF rates reported by surgeons A and B were 100% vs. 95.8%, respectively (${\kappa}=0.96$). Five out of nine facet (56%) non-unions were identified at the cross-links. The remaining four facet pseudarthrosis were noted at 1-2 spinal levels caudal to the cross-links. At the final clinical follow-up, there was no rod breakage, deformity progression, neurological deficit, or symptom recurrence. The Oswestry Disability Index improved by an average of $32.8{\pm}6.3$, while the mental component summary of the 36-item Short-Form Health Survey improved by an average of $4.7{\pm}2.1$, and physical component summary improved by an average of $10.5{\pm}2.1$. Conclusions: To our knowledge, this is the first study to report a CT that defined 92%-98% FF and 100% IBF using the lowest reported dose of RhBMP-2 in multilevel ASD surgery. The use of ultra-low dose RhBMP-2 reduces the RhBMP-2 related complications and healthcare costs.