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Purpose: To investigate the efficacy of ultrasound (US)-guided core biopsies after digital mammography-guided two-dimensional localization (DM-2DL) of breast microcalcifications. Materials and Methods: Twenty-two patients with 23 suspicious microcalcifications underwent US-guided core biopsies after DM-2DL, to mark the sites on the skin where microcalcifications had been found (craniocaudal and mediolateral (or lateromedial) views). Of the 23 lesions, 4 were sampled using a 14-gauge automated gun and the other 19 were sampled using an 8-gauge vacuum-assisted device. The lesions were categorized into two groups: those with and those without microcalcifications observed on US. The success rate for correctly sampling microcalcifications on the specimen radiograph in the two groups was assessed and their pathologic outcomes were investigated. Results: Of the 23 lesions, 16 were invisible and 7 were visible to ultrasonographic microcalcifications. The sampling success rate for the specimen radiographs was 100% for ultrasonographic visible microcalcifications and 88% (14/16) for lesions invisible to ultrasonography after DM-2DL (p = 1.000). The cancer rate of individuals with microcalcifications observed on US (57%, 4/7) was greater than in individuals without visible microcalcifications (13%, 2/16) (p=0.045). Conclusion: Although some microcalcifications are invisible on US, a US-guided biopsy after DM-2DL is a useful method for the successful sampling of the microcalcifications.

Purpose: The purpose of this study was to establish a quality standard for mammographic equipment in Korea and to eventually improve mammographic quality in clinics and hospitals throughout Korea by educating technicians and clinic personnel. Materials and Methods: For the phantom test and on site assessment, we visited 37 sites and examined 43 sets of mammographic equipment. Items that were examined include phantom test, radiation dose measurement, developer assessment, etc. The phantom images were assessed visually and by optical density measurements. For the clinical image assessment, clinical images from 371 sites were examined following the new Korean standard for clinical image evaluation. The items examined include labeling, positioning, contrast, exposure, artifacts, collimation among others. Results: Quality standard of mammographic equipment was satisfied in all equipment during on site visits. Average mean glandular dose was 114.9 mRad. All phantom image test scores were over 10 points (average, 10.8 points). However, optical density measurements were below 1.2 in 9 sets of equipment (20.9%). Clinical image evaluation revealed appropriate image quality in 83.5%, while images from non-radiologist clinics were adequate in 74.6% (91/122), which was the lowest score of any group. Images were satisfactory in 59.0% (219/371) based on evaluation by specialists following the new Korean standard for clinical image evaluation. Satisfactory images had a mean score of 81.7 (1 S.D.=8.9) and unsatisfactory images had a mean score of 61.9 (1 S.D=11). The correlation coefficient between the two observers was 0.93 (p

Purpose: To describe the morphologic features and enhancement patterns of the helical computed tomography (CT) observed in patients with epithelioid hemangioendothelioma (EH) of the liver. Materials and Methods: Seven patients (four men and three women; mean age, 41 years) with pathologically proven EHs underwent monophasic (n=2), biphasic (n=2) or triphasic (n=3) helical CT, and the findings were retrospectively analysed. The morphologic features to which attention was directed were tumor number, size, location, shape, margin, surface, the presence of adjacent capsular retraction, vascular encasement and confluent mass formation, while the enhancement pattern was examined in terms of the appearance and degree of enhancement during the arterial or portal phase, and enhancement change during the portal and equilibrium phases. Results: Six patients had multiple tumors, and one had a single lesion. The maximon diameter of these tumors ranged from 0.5 to 12.0 (mean, 3.2) cm, and almost all occurred in the peripheral portion of the liver. The shape, margin and surface features of the tumors varied: in four patients, the margin was poorly defined and the surface was smooth, while in five, adjacent capsular retraction was observed. Vascular encasement was noted in five of six patients with hepatic vessels abutting the tumors, and in all three who were follow up, the growth pattern involved confluent mass formation. In all patients, many tumors showed either nodular (n=3) or irregular (n=4) peripheral enhancement. In all five patients who underwent multiphasic CT, centripetal enhancement was demoustrated. Conclusion: Our results disclosed that most patients with EH had multiple tumors, and that almost all were located in the peripheral portion of the liver and involved capsular retraction. The other common CT findings were vascular encasement and a centripetal enhancement pattern. When these CT findings are observed in patients with hepatic tumors, EH should be included in the differential diagnosis.

Purpose: To report the findings of a six-year medial oudit performed at our mammographic screening centre, comparing those findings with the follow-up data stored at our hospital and at the Korea Central Cancer Registry. Materials and Methods: We analyzed the findings of 32,289 mammographic examinations of 25,541 women performed at our screening center between 1994 and 1999. For follow-up and outcome monitoring, the guideline of the American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS) was used. All mammograms were categorized by means of BI-RADS, and cases in categories 0, 4, and 5 were followed up through a review of our hospital information system. To determine whether any cases were false negative, we compared breast cancer patients registered in our medical record department and in the Korean Central Cancer Registry during the study period, with women whose mammograms were interpreted as normal or benign at our screening center within a year prior to cancer diagnosis. Results: The mean age of women enrolled in this study was 48.6 years, ten years less than reported in the West. The recall rate was 6.2%. Among 256 women whose final assessment category was 4 or 5, breast cancer was diagnosed in 51. The cancer detection rate was 2.0/1,000 women; positive predictive value 1 (PPV1: PPV, based on abnormal findings at screening examination) was 2.5% of cases and PPV2 (PPV when biopsy or surgical consultation was recommended) was 20%. The most common mammographic finding was microcalcifications only (45%). The rate of minimal breast cancer, including invasive cancer less than 1 cm in diameter and ductal carcinoma in situ, was 72.5%. Node positivity was 27%. Sensitivity was 85.0% based on the tumor registry of our institution's medical record department, and 78.5% based on the tumor registry of the Korea Central Cancer Registry. Specificity was 99.0%. Conclusion: In our study, the cancer detection rate at screening mammography was 2.0/1,000 women. The rate of minimal breast cancer (72.5%) was very high but measurable sensitivity was 78.5%, somewhat lower than the ACR guideline of 85%. To improve the performance of screening mammography, appropriate interpretation of mammography and constant, follow-up and outcome monitoring are important

Purpose: The goal of this study was to survey the overall quality of mammographic images in Korea. Materials and Methods: A total of 598 mammographic images collected from 257 hospitals nationwide were reviewed in terms of eight image quality categories, namely positioning, compression, contrast, exposure, sharpness, noise, artifacts, and examination identification, and rated on a five-point scale: (1=severe deficiency, 2=major deficiency, 3=minor deficiency, 4=good, 5=best). Failure was defined as the occurrence of more than four major deficiencies or one severe deficiency (score of 1 or 2). The results were compared among hospitals of varying kinds, and common problems in clinical image quality were identified. Results: Two hundred and seventeen mammographic images (36.3%) failed the evaluation. Poor images were found in descending order of frequency, at The Society for Medical Examination (33/69, 47.8%), non-radiology clinics (42/88, 47.7%), general hospitals (92/216, 42.6%), radiology clinics (39/102, 38.2%), and university hospitals (11/123, 8.9%) (p

Purpose : To evaluate the sonographic findings and detection rate of ductal carcinoma in situ (DCIS) and to compare the results with mammographic findings. Materials and Methods : Of 134 patients with pathologically proven DCIS, 47 patients (48 breasts) who underwent sonography before surgery were included. Twenty-seven patients were asymptomatic, while 20 experienced symptoms. Whether a lesion was present, and the nature of the related sonographic finding were analyzed retrospectively. When a mass was identified by means of sonography, it was evaluated in terms of its shape, margin, echogenicity, associated microcalcifications, and intervening echogenic lines. Results : Sonography detected 39/48 cases of DCIS (81%). In 24 cases, detection was based only on the presence of the mass, while in nine cases this depended on additional findings alone [periductal thickening (n=6); micronodules (n=3)]. In three cases the presence of microcalcifications alone was sufficient for detection and in the other three cases, detection was based on the presence of microcalcifications as well as on additional findings [periductal thickening (n=2); micronodules (n=1)]. Thirteen lesions (54 %) were irregular in shape, while 11 (46 %) were oval or lobulated. The margins of 17 lesions (71 %) were ill-defined, and in 18(75 %), echogenicity was slightly hypoechoic. Conclusion : Sonography showed that for masses identified as DCIS, the most common findings were an ill-de-fined margin, irregular shape, and mild hypoechogenicity. Microcalcifications were identified in 13 of 48 breasts (27%), while in some cases intervening echogenic lines and microcalcifications were the only finding. For early detection of DCIS, mammography together with sonography may be helpful.

Purpose : To evaluate the use of CT in patients with vocal cord paralysis due to extralaryngeal cause s ,andto use CT for the assessment of extralaryngeal diseases causing vocal cord paralysis. Materials and Methods : Weprospectively studied the results of CT in 41 patients with vocal cord paralysis in whom laryngoscopy revealed nolaryngeal cause and physical examination demonstrated no definite extralaryngeal cause. The extralaryngeal causeof vocal cord palsy was determined after comprehensive clinical diagnosis. Enhanced CT scans were acquired fromthe skull base and continued to the level of the aorticopulmonary window. We used CT to assess the detection ratefor extralaryngeal causes and to extimate the extent of extralaryngeal disease and the distribution of lesions.Results : CT revealed that in 20 of 41 patients(49%) the extralarygeal causes of vocal paralysis were as follows :thyroid cancer(n=10), nodal disease(n=6), esophageal cancer(n=2), neurogenic tumor(n=1), aortic aneurysm(n=1).Lesions were located on the left side in 13 patients(65%), and in the tracheoesophageal groove in 15(75%).Conclusion : In patients with vocal cord paralysis in whom no definite lesion is seen on physical examination, CTcould be a useful primary imaging method for the assessment of extralaryngeal causes.

Purpose : The aim of this study was to assess the diagnostic accuracy of chest comput-ed radiography for thedetection of bronchiectasis diagnosed by high-resolution CT. Materials and Methods : Our study included 100consecutive patients with bronchiec-tasis and 20 normal subjects, all seen on high-resolution CT. Two independentobservers analyzed chest computed radiographs and recorded the presence and type of bronchiectasis, and the invo lved lobe. Results : On high-resolution CT, bronchiectasis was seen in one lobe in 29 patients, two lobes in 29,three lobes in 16, four lobes in 14, five lobes in 10, and six lobes in t wo. The bronchiectasis was tubular in 55patients, mixed tubular and cystic in 29, and cystic in 16. For observer 1, the sensitivity, specificity, andaccuracy of chest com-puted radiography was 95%, 85%, and 93%, respective l y, while for observer 2, thecorresponding figures were 93%, 85%, and 92%. Sensitivity and specificity for observ-er 1 were 33% and 96% for theright upper lobe (46% and 95% for observer 2), 68% and 86% for the right middle lobe (76% and 86%), 70% and 78%for the right lower lobe (48% and 83%), 50% and 100% for the left upper lobe (50% and 97%), 63% and 90% for thelingular segment (49% and 93%), and 87% and 75% for the left lower lobe (75% and 90%), respective l y. Tubularbronchiectasis involving a single lobe was the most common source of false negative readings based on the findingsof chest com-puted radiography. Conclusion : Because chest computed radiography is not inferior to high-resolutionCT for the detection of bronchiectasis, the routine use of chest computed radiography in screening forbronchiectasis is feasible. Howeve r, due to its low sensitivity in detect-ing bronchiectasis in a specific lobe,preoperative high-resolution CT examination may be needed.

Purpose : To compare the detection rate of unenhanced CT, spin-echo T2-weighted, fast fluid-attenuatedin-version- recovery(FLAIR), and diffusion-weighted MR imaging in the diagnosis of hyperacute middle cerebralartery(MCA) territory infarction. Materials and Methods : Sixteen patients with clinically proven hyperacute MCAterritory infarction were e-valuated with unenhanced CT and MR. All CT examinations were performed within sixhours of the onset of symptoms and all MR studies were performed within two hours of CT. All images were evaluatedindepen-dently by two radiologists in possession of brief clinical information. Positive imaging criteria wereparenchy-mal hypoattenuation, as seen on CT, and increased signal intensity, as seen on MR. For quantitativeanalysis, we measured the attenuation and signal intensity of the lesion and contralateral normal parenchyma, andper-centage contrast-to-noise ratios(CNRs) of the lesions were also calculated . Results : Positive findings weredetected in all patients on diffusion-weighted images, in 13(81%) on CT, in 10 ( 63 %) on fast FLAIR images, andin 7(44 %) on T2-weighted images. Lesion percentage CNRs were 30% for diffusion-weighted imaging, 15 % for CT, 18% for FLAIR MR imaging, and 16 % for T2-weighted MR imag-ing(p

Mediastinal interfaces on a chest radiograph result from contact between mediastinal structures and the adjacent lung, while mediastinal lines result from contact between the two lungs across the midline. A variation of mediastinal interface is mediastinal stripe, a narrow band produced by contact of both sides of a mediastinal structure with the lungs. Alterations in mediastinal interfaces and lines may be due to variations in normal anatomy, or may reflect the presence of a abnormalities within the mediastinum. Familiarity with the various normal mediastinal interfaces and lines, and the changes that occur with disease is important for the interpretation of the chest radiograph and in the diagnosis of mediastinal abnormalities. The purpose of this pictorial essay is to illustrate the most imortant normal and abnormal interfaces and lines and also to correlate radiography and CT findings.

A case of primary adenosquamous carcinoma of the liver is reported. A large cystic mass with irregrlar enhancing wall was seen in the left lobe of the liver ; multiple hepatic cysts and metastatic nodules were scattered in both lobes. Sonoguided needle biopsy was performed and onhistopathology, adenosquamous carcinoma was diagnosed. The radiologic and pathologic relationships of this unusual neoplasm are discussed.