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Breast cancer is one of the most common malignancies in women. It frequently metastasizes to the lungs, liver, and bone. Breast cancer metastasis to skeletal muscles is rare. Chest wall recurrence in patients that have undergone mastectomy is the most frequent form of local recurrence, and it is generally accompanied by nodules or masses on the chest wall. Here, we describe a case of the unusual appearance of invasive lobular cancer metastasis to the pectoral muscles without discrete nodules or masses in a patient who had undergone mastectomy 12 years ago.

Chondrolipomas, which are lipomas with chondroid metaplasia, are rare benign soft tissue tumors with no relevant epidemiological reports or radiological information. A limited number of lipomas with osteo/chondroid differentiation have been reported in the literature between 1960 and 2008. Moreover, only few studies have described the radiologic findings of chondrolipomas. Herein, we present a case of chrondrolipoma arising from the left supraclavicular region in a 77-year-old female.

Chlorfenapyr is widely used as an insecticide, despite it being fatal to humans. However, chlorfenapyr- induced central nervous system toxicity has rarely been reported. We report the magnetic resonance imaging (MRI) findings in a rare case of chlorfenapyr-induced toxic leukoencephalopathy. A 71-year-old man who had ingested chlorfenapyr approximately two weeks prior visited our hospital and presented with bilateral lower motor weakness and voiding dysfunction that had developed two days before admission. Brain MRI revealed extensive bilateral white matter abnormalities involving the corpus callosum, internal capsule, brain stem, and bilateral middle cerebellar peduncle. Furthermore, spine MRI revealed diffuse swelling and hyperintensity on the T2-weighted images.

Coronary artery aneurysm is a rare disease. It occurs in the epicardial space, mostly along the course of major coronary arteries. Here, we report a case of a giant incidental aneurysm embedded in the basal posterior wall of the left ventricle. A 43-year-old woman was referred to our institution for the evaluation of cardiac palpitations that had been present from the previous 2 months. She reported no medical history (such as Kawasaki’s disease or hypertension) or previous operative history. Echocardiogram and subsequent cardiac CT revealed a giant aneurysm in the left ventricle, with a direct fistulous connection to a dilated and tortuous left circumflex artery, which showed direct communication with the straight right coronary artery.

Lipoma of the spermatic cord or the round ligament is called inguinal canal lipoma. It may present as an inguinal herniating mass of fat tissue, with or without an accompanying herniating sac. There are few reports about large lipomas of the spermatic cord. We describe a case of a large spermatic cord pure lipoma, initially suspected to be an inguinal hernia upon physical examination. We diagnosed the lipoma with ultrasound and magnetic resonance imaging. The patient subsequently underwent left orchiectomy.

Objective: The aim of this study was to determine the inter- and intra-observer reliabilities of magnetic resonance imaging (MRI) for the diagnosis of lateral epicondylitis, to examine whether degree of common extensor tendon (CET) injury is related to other elbow abnormalities on MRI, and to investigate the correlation between elbow abnormalities on MRI and patients' symptoms. Methods: Fifty-one patients (32 women and 19 men; mean age: 50 years (range, 22–63)) with a diagnosis of lateral epicondylitis were included in the study. The average duration of symptoms was 2.3 years. MRI scoring system was used to grade the CET injuries and associated injuries in the elbow joint. Three independent radiologists retrospectively reviewed MRI images. Inter- and intra-observer reliabilities for diagnosing lateral epicondylitis were calculated using kappa statistics, and Spearman's rank correlation analysis was used to analyze relationships between degree of CET injury and the associated abnormalities of elbow joints. Statistical relations were considered significant for p values of

Purpose The purpose of this study was to investigate the relationship between abdominal fat as assessed by abdominal fat CT and metabolic syndrome (MS), especially in asymptomatic Korean individuals. Materials and Methods Retrospectively, a medical record analysis was performed in a total of 111 patients with screening abdominal fat CT. The data such as visceral fat (VF), subcutaneous fat (SF) and VF/SF were elicited by abdominal fat CT, and we analyzed the relationship of VF, SF, and VF/SF with MS and cardiovascular risk factors. Results In males, VF and SF had a positive correlation with many cardiovascular risk factors and MS, but VF was superior to SF. In females, VF, but not SF, had a positive correlation with some cardiovascular risk factors and MS. The cut-off values of VF and SF to predict MS, which were calculated by drawing receiver operating characteristic curves, were as follows: the cut-off value of VF in men: 136.50 cm2, the cut-off value of SF in men: 159.50 cm2, and the cut-off value of VF in women: 134.50 cm2. Conclusion In conclusion, VF accumulation was the best predictor of MS and it had a positive correlation with cardiovascular risk factors in both sexes. SF also had a significant association with MS, especially in men, although it was not superior to VF.

Purpose The aim of the study was to evaluate the correlation between decreased echogenicity of thyroid and thyroid hormones or autoantibodies. Materials and Methods From January 2009 to December 2011, 543 patients with decreased parenchymal echogenicity [M:F = 133:410, median age: 42 years (range: 9–82 years)], who did not have solid nodule, symptom or medication related to thyroid and underwent thyroid function test were retrospectively reviewed. Images were classified based on the degree of hypoechogenicity, heterogenicity or thyroid size. 1) Group A: mild decreased echogenicity, group B: marked decreased echogenicity, 2) group Ho: homogeneous echogenicity, group He: heterogeneous echogenicity, 3) group 1: decreased size, group 2: normal size, group 3: increased size. Differences in triiodiothyronyne (T3), free-thyroxine (fT4), thyrotropin (TSH), anti-thyroglobulin antibody (TgAb), thyroid peroxidase antibody (TPOAb), and anti-TSH receptor antibody (TSH-rAb) were evaluated among groups. Results T3, fT4, and TSH levels differed between groups A and B (p < 0.001, p = 0.001, p < 0.001). TgAb and TPOAb of group B were higher than group A (p = 0.006, p < 0.001). TPOAb of group He was higher than group Ho (p < 0.001). TSH-rAb and TPOAb of group 3 were higher than group 2 (p = 0.017, p < 0.001). Conclusion The patients with findings of markedly decreased, heterogeneous echogenicity or thyroid enlargement may have abnormal thyroid function and autoantibodies. These may facilitate the physicians' decision to order tests for thyroid function and autoimmune activity.

Background There has been no comparison study to assess the diagnostic efficacy of additional anterior cruciate ligament (ACL) views in three-dimensional (3D) volume isotropic turbo spin-echo acquisition (VISTA) and two-dimensional (2D) fast spin-echo (FSE) T2-weighted (T2W) images for the diagnosis of ACL tear. Purpose To compare the diagnostic performances of additional ACL views on VISTA with those on the 2D FSE T2W images. Material and Methods This retrospective study included 78 patients who were suspected to have ACL injury and underwent both 2D TSE T2W magnetic resonance imaging (MRI) and 3D VISTA MRI of the knee between November 2012 and March 2013. The diagnostic performance of each oblique sagittal and coronal view and the combined images was evaluated for sensitivity, specificity, and accuracy for diagnosing an ACL tear. The arthroscopically and clinically confirmed diagnoses were used as the reference standard. The values were statistically analyzed using the McNemar test. Results The inter-observer agreement between two readers of the additional ACL views on 3D VISTA and 2D FSE T2W images were substantial on 2D FSE images and nearly concurred on the VISTA image. When considering both views of the oblique sagittal and coronal images, the inter-observer agreement between readers nearly concurred. There were no statistically significant differences in the sensitivity, specificity, and accuracy between 2D FSE images and VISTA images. Conclusion The performance of the additional ACL view on 3D VISTA MRI is comparable to that of 2D FSE T2W MRI in the diagnosis of ACL tear though the image quality of the 3D VISTA MRI is not equal to that of 2D FSE MRI.

Charcoal is used for localization of a non-palpable breast mass. Although charcoal is known to be safe when injected subcutaneously for preoperative localization, it can cause a foreign body reaction (1). Several cases of post-charcoal-marking granuloma of the breast have been reported, but the imaging modalities employed were limited to mammography or ultrasonography (2, 3) and other imaging findings have not yet been reported. Herein, we report multimodal imaging [i.e., ultrasound (US), computed tomography (CT), 18F-fluorodeoxyglucose (FDG)positron emission tomography/CT (PET/CT), and breast-specific gamma imaging (BSGI)] findings of a recurrence-mimicking charcoal granuloma in a breast cancer patient.

Small patella syndrome (SPS) is characterized by aplasia or hypoplasia of the patella and pelvic girdle abnormalities, including bilateral absence or delayed ossification of the ischiopubic junction and infra-acetabular axe-cut notches. Here, we report a case of SPS in a 26-year-old female. Magnetic resonance image (MRI) showed a small patella with thick eccentric non-ossified patellar cartilage and femoral trochlear dysplasia with hypoplastic patellar undersurface. To our knowledge, this is the first report of MRI findings in SPS. MRI findings could be clinically relevant because elongation of the medial patellofemoral ligament and trochlear dysplasia with eccentric non-ossified patellar cartilage might lead to patellofemoral maltracking with an osteochondral lesion or acute dislocation or an extensor mechanism injury. Though the patient presented in this case report only had a gastrocnemius injury at the origin site, physicians should carefully examine abnormalities with MRI when an SPS patient has a trauma to the knee.

Purpose We explored the association between Framingham risk score (FRS) and coronary artery calcium score (CACS) in asymptomatic Korean individuals. Materials and Methods We retrospectively analyzed 2216 participants who underwent routine health screening and CACS using the 64-slice multidetector computed tomography between January 2010 and June 2014. Relationship between CACS and FRS, and factors associated with discrepancy between CACS and FRS were analyzed. Results CACS and FRS were positively correlated (p < 0.0001). However, in 3.7% of participants with low coronary event risk and high CACS, age, male gender, smoker, hypertension, total cholesterol, diabetes mellitus, and body mass index (BMI; ≥ 35) were associated with the discrepancy. In the diagnostic prediction model for discrepancy, the receiver operating characteristic curve including factors associated with FRS, diastolic blood pressure (≥ 75 mm Hg), diabetes mellitus, and BMI (≥ 35) showed that the area under the curve was 0.854 (95% confidence interval, 0.819–0.890), indicating good sensitivity. Conclusion Diabetes mellitus or obesity (BMI ≥ 35) compensate for the weakness of FRS and may be potential indicators for application of CACS in asymptomatic Koreans with low coronary event risk.

Sparganosis is a rare parasitic infection caused by the plerocercoid of the cestode Spirometra mansoni. The definitive hosts are dogs and cats, and humans are typically infected as aberrant hosts. The clinical manifestations are diverse and the most common symptom presents as movable or fixed subcutaneous nodules. Differentiation of sparganosis from a soft tissue tumor and subcutaneous or skin metastasis in a patient with cancer is difficult; and imaging finding of sparganosis in lymphoma patient has rarely been reported (1, 2). We reported multimodal image findings including ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography-computed tomography (PET-CT) and follow-up imagings on multifocal sparganosis, mimicking lymphoma involvement in a patient with lymphoma. This case was approved by the Institutional Review Board and informed consent was waived.

Eccrine spiradenoma is a rare, benign, adnexal skin tumor of the sweat gland, which may manifest in any part of the body. It is typically located in the dermal or the subcutaneous fat layer. Eccrine spiradenomas rarely progress to malignant transformation and only a few cases of malignant transformation have been reported. Due to its rarity, there have been few reports about the sonographic appearances of eccrine spiradenoma. We report the sonographic findings in one case of eccrine spiradenoma, located in the subcutaneous fat and the deep dermal layers of the upper arm in a middle-aged woman.

Proliferating trichilemmal tumor (PTT) is a rare tumor that originates from the outer root sheath of a hair follicle. About 90% of PTTs occur on the scalp. The sonographic findings of PTT in the subungual region have not been reported previously. In our case, sonography showed a heterogeneous mass containing echogenic foci with no detectable intratumoral vascularity. These echogenic foci probably represent keratin and cholesterol. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:215-217, 2018.

Tubulinopathy commonly refers to complex congenital and non-progressive brain malformations caused by mutations in the tubulin genes. Among tubulin-encoding genes, TUBB3 has rarely been reported as a cause of complex cortical malformations. Herein, we report a case of tubulinopathy in a 21-month-old boy who presented with delayed development. He could not walk on his own and was not able to speak more than five words. Physical examination revealed right esotropia and hypotonia of the lower extremities. MRI showed dysmorphic brainstem and dysmorphic and hypertrophic basal ganglia. The right thalamus was relatively smaller than the left one. The cerebellum showed disorganization of the cerebellar folia. DNA sequencing revealed a missense mutation of the TUBB3 gene.

We report a rare case of hyperglycemia-related osmotic demyelination syndrome (ODS) with focus on the imaging findings. A 61-year-old man with diabetes was admitted for general weakness and severe thirst. A few days later, he complained of dysarthria, dysphasia, and dysmetria. Laboratory examinations showed significant hyperglycemia, but normal electrolyte levels. Brain MRI revealed T2-signal abnormalities that were symmetrical, non-space occupying, and located in the central pons with a peripheral sparing pattern, which were suggestive of ODS. In addition, subsequent MRI revealed progression of signal hyperintensity; however, the patient’s symptoms improved.

Background: The authors report serial magnetic resonance imaging findings of osmotic demyelination syndrome (ODS) related to hyperglycemia in a patient with uncontrolled diabetes mellitus. Case presentation: A 61-year-old man with diabetes was admitted for general weakness and severe thirst. A few days later, he complained of dysarthria, dysphasia, and dysmetria. On admission, he exhibited significant hyperglycemia (33.5 mmol/L [627 mg/dL]), with a glycated hemoglobin level of 18.1%. Other laboratory investigations revealed a sodium level of 133 mEq/L, potassium 3.8 mEq/L, blood urea nitrogen 43.9 mg/dL, with a calculated serum osmolality of 324 mOsm/kg. Brain magnetic resonance imaging (MRI) revealed T2 signal abnormalities that were symmetrical, non-space occupying, and located in the central pons with a peripheral sparing pattern, which were findings suggestive of ODS. In addition, subsequent MRI revealed progression of signal hyperintensity; however, the patient's symptoms were improved and he was discharged after 2 months. Conclusion: We report a rare case of hyperglycemia-related ODS that exhibited gradual progression in imaging features despite the prompt correction of blood sugar levels and improvement of neurological symptoms

Background Thoracolumbar injury classification and severity score (TLICS) is not very reliable for assessment of injury to the posterior ligament complex, even when scored by experts. It is not reasonable to score every compression fracture or burst fracture the same as there is great variety in the severity of compression fractures and burst fractures. Purpose To propose a modified TLICS (mTLICS) and evaluate the performance of the mTLICS system by measuring the agreement between scores determined by radiologists using both systems and actual treatment procedure delivered. Material and Methods We retrospectively evaluated 134 patients with acute lumbar and thoracic spinal trauma after undergoing magnetic resonance imaging (MRI) using new mTLICS and conventional TLICS system. Inter-observer agreements of TLICS and mTLICS scores were analyzed using the kappa statistic. Nonparametric correlation analysis was used to determine correlation (R) among each score and the surgical intervention. Results The mTLICS system showed slightly higher correlation than TLICS (Rs, TLICS, 0.592 and 0.613 vs. mTLICS, 0.628 and 0.639). If we consider a total maximal score of 4 to be a negative surgical indication, mTLICS showed significantly higher sensitivities than TLICS, and if we consider a total minimal score of 4 to be a positive surgical indication, mTLICS showed significantly higher specificities than TLICS. Conclusion The mTLICS score corrects deficiencies in the TLICS system that lead to ambiguity in the radiological diagnostic criteria. mTLICS is a more suitable scoring system than TLICS for predicting surgical management accurately, especially for morphological injuries.

Although the thyroid gland is one of the most vascular organs of the body, metastatic disease in the thyroid is encountered infrequently. However, at autopsy, the incidence rate of thyroid metastasis ranges from 1.25% to 24%. The primary sites are the kidney, lung, breast, and gastrointestinal tract. We report a rare case of a hepatocellular carcinoma metastatic to the thyroid gland. The patient had multiple palpable masses in the anterior and left lateral neck along the internal jugular chain on physical examination 9 months after the initial diagnosis of liver tumor. These masses were confirmed as metastasis from hepatocellular carcinoma by ultrasonography-guided 16-G core needle biopsy. We discuss the sonographic findings of thyroid metastasis and their use as an additional aid for differentiating between unknown primary tumor and thyroid metastasis.

The purpose of this study was to evaluate the diagnostic usefulness of combining oblique sagittal and oblique coronal MRI views of the anterior cruciate ligament (ACL) with traditional orthogonal views for the evaluation of selective-bundle ACL injury and to evaluate whether there is a statistical difference in diagnostic ability between 1.5-T and 3-T MRI.This retrospective study included 114 patients who underwent knee MRI (46 on 1.5 T and 68 on 3 T) and arthroscopy at our institution. Two radiologists evaluated orthogonal views and ACL views on 1.5-T and 3-T MRI in variable combinations. They diagnosed ACL views as normal, entire ligament tear, anteromedial bundle tear, or posterolateral bundle tear. The surgeon then confirmed tears in the anteromedial or posterolateral bundle of the ACL arthroscopically if a selective-bundle tear did exist. The arthroscopically confirmed diagnoses were used as the reference standard. The values were statistically analyzed.Sixty-seven percent of patients showed an ACL tear on arthroscopy, and 33% had a selective bundle tear; of these, 75% were anteromedial bundle tears and 25% were posterolateral bundle tears. On 1.5-T MRI, specificities of each view and combined views were the same (80%). The sensitivities and accuracies of the combined views were higher than the individual views; differences between individual views ranged from 4% to 15%. Reader 1 saw statistically significant differences between the oblique coronal and combined views. Although the performances of reader 2 showed similar results, the p values exceeded the critical value of statistical significance (0.063). On 3-T MRI, differences in specificities between the orthogonal and combined views and between the orthogonal and oblique coronal views were statistically significant (p, 0.016 and 0.008 for readers 1 and 2, respectively). There were no significant differences in the diagnostic performance of 1.5-T and 3-T MRI.The oblique coronal view and the combination of the orthogonal view and both additional ACL views provide better diagnostic information with an improvement in specificity on 3-T MRI compared with orthogonal views alone in the diagnosis of selective-bundle tears. Although diagnostic performance was not improved with the addition of the oblique views over orthogonal views on 1.5-T imaging, diagnostic performance was improved on 3-T MRI. Accuracies for individual imaging planes were not significantly different when comparing 1.5-T and 3-T MRI.

The purpose of this article is to evaluate the correlations between breast-specific gamma imaging (BSGI) findings and mammographic and clinicopathologic characteristics of breast cancer.Our study included 56 breast cancers that had undergone BSGI between August 2010 and December 2012. We reviewed imaging findings (BSGI and mammography) with histopathologic findings, including tumor size, histologic type, nuclear grade, presence of ductal carcinoma in situ (DCIS), and presence of extensive intraductal component (EIC); and immunochemical features, including estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (ERBB2, formerly HER2), Ki67, and p53. We classified cancers into positive or negative groups on the basis of BSGI visibility and investigated the statistical differences in mammographic and histopathologic characteristics between the BSGI-positive and -negative groups.Among 56 malignancies, 48 (85.7%) were shown to be BSGI positive. Patients in the BSGI-positive group were statistically significantly older than those in the BSGI-negative group (p = 0.027). BSGI-positive cancers were statistically significantly larger than BSGI-negative cancers (p = 0.002). Cancers 1.0 cm or larger, unlike those of subcentimeter size, were statistically significantly more visible on BSGI (p = 0.004). The mammographic findings and mammographic densities did not statistically significantly differ between the BSGI-positive and -negative groups. Invasiveness of cancer showed no statistically significant difference on BSGI finding. Cancers with a DCIS component tended to be BSGI positive, but without statistical significance (p = 0.051). Visibility on BSGI was not statistically significantly associated with EIC, nuclear grade, ER, PR, ERBB2, Ki67, and p53.The sensitivity of BSGI for breast cancer was 85.7%. Breast cancers in older patients, cancers larger than 1.0 cm, and cancers with the DCIS component tended to be visible on BSGI. BSGI was an equally sensitive tool to detect the breast cancer in women with fatty and dense breast.

Cerebral air embolism is a rare, potentially catastrophic iatrogenic complication of central venous catheter removal. Cerebral air embolism can lead to serious neurological sequelae, resulting from cerebral infarction. Early radiological diagnosis of cerebral air embolism is critical for emergent hyperbaric oxygen treatment. In this study, we report the case of a 68-year-old man who developed cerebral air embolism after the removal of a central venous catheter that was immediately diagnosed using brain CT and brain diffusion-weighted imaging.

BACKGROUND AND PURPOSE: Recently, Lee et al reported a new grading system for the lumbar spinal foraminal stenosis. They considered the type of stenosis, the amount of fat obliteration, and the presence of nerve root compression. Our aim was to evaluate whether a new MR imaging grading system correlated with symptoms and neurologic signs and could replace the previous grading system. MATERIALS AND METHODS: We examined 91 patients (M/F = 49:42; mean age, 50 years) who visited our institution and underwent MR imaging of the L-spine and were evaluated by 2 musculoskeletal radiologists. The presence and grade of lumbar foraminal stenosis at the maximal narrowing point was assessed according to the new grading system suggested by Lee et al (Lee system) and the Wildermuth grading system (Wildermuth system). Results were correlated with clinical manifestations and neurologic physical examination. Statistical analysis was performed by using κ statistics, categoric regression analysis, and nonparametric correlation analysis (Spearman correlation). RESULTS: Interobserver agreement in the grading of foraminal stenosis between the 2 readers was substantially correlated (κ of Lee system = 0.767, κ of Wildermuth system = 0.734). The Rs for reader 1 and reader 2 between the Lee system and the Wildermuth system were 0.880 and 0.885, between Lee system and PNM were 0.715 and 0.604, and between the Wildermuth system and PNM were 0.800 and 0.680. For patients younger than 50 years of age, the R between the Lee and Wildermuth systems was higher than that for patients 50 years or older, but the Rs between the grading system and PNM were lower in the younger group than in the older group. The Rs of the Wildermuth system with PNM were higher in the older group than in the younger group; the differences between the Rs of the Lee system with PNM and the Wildermuth system with PNM were higher in the older group (0.016 [young] versus 0.130 [old] and 0.008 versus 0.107). CONCLUSIONS: Interobserver agreement of the Lee system was slightly higher than the Wildermuth system and substantially correlated. Both systems are good for evaluation of lumbar spinal foraminal stenosis, but the Lee system showed slightly better interobserver agreement and good clinical correlation in the younger group of patients.

Background Patients with chronic lateral ankle instability also have peroneal tendinopathy often. However, preoperative MRIs of these patients are vague in many cases. Our study was performed to see the reliability of MRI findings of peroneal tendinopathy in patients with chronic lateral ankle instability. Methods MRI images for 82 patients who had chronic lateral ankle instability, and had received surgical treatment between March 2006 and November 2009 were compared with impressions from operating rooms. The mean age of patients was 36.4 years (range, 15 to 64 years), 82 ankles were studied, and patients with rheumatoid diseases were excluded from the study. Results Of the 82 cases, 26 were true positives, 38 true negatives, 13 false positives and 5 false negatives. Of 39 cases of peroneal tendinopathy diagnosed from MRI, 14 had peroneal tendon partial tears, 15 tenosynovitis, 3 dislocations, 17 low-lying muscle bellies, and 6 peroneus quartus muscles. Of 31 cases of peroneal tendinopathy observed in surgery 11 had peroneal tendon partial tears, 4 tenosynovitis, 5 dislocations, 12 low-lying muscle belliess, and 1 peroneus quartus muscle. Sensitivity and specificity of peroneal tendinopathy were 83.9% and 74.5%, respectively. Positive predictive value was 66.7%. Negative predictive value was 88.4%. Accuracy rate was 78.0%. Conclusions MRI is a useful diagnostic tool for detecting peroneal tendinopathy in patients with chronic lateral ankle instability. However, MRI is vague in many cases. Therefore, a thorough delicate physical examination and careful observation is needed.

We report three cases of eosinophilic cystitis. Contrast-enhanced computed tomography (CT) revealed characteristic bladder wall thickening exceeding 10 mm, with preservation of the mucosal lining and intense, progressive contrast enhancement on sequential arterial and delayed scans. Eosinophilic cystitis might have been associated with eosinophilic infiltration in other organs, such as the gastrointestinal tracts and liver.

Purpose To evaluate the feasibility of magnetic resonance voiding cystography (MRVC) compared with voiding cystourethrography (VCUG) for detecting and grading vesicoureteral reflux (VUR). Materials and Methods MRVC was performed upon 20 children referred for investigation of reflux. Either coronal T1-weighted spin-echo (SE) or gradient-echo (GE) (fast multiplanar spoiled gradient-echo (FMPSPGR) or turbo fast low-angle-shot (FLASH)) images were obtained before and after transurethral administration of gadolinium solution, and immediately after voiding. The findings of MRVC were compared with those of VCUG and technetium-99m (99mTc) dimercaptosuccinic acid (DMSA) single-photon emission computed tomography (SPECT) performed within 6 months of MRVC. Results VUR was detected in 23 ureterorenal units (16 VURs by both methods, 5 VURs by VCUG, and 2 VURs by MRVC). With VCUG as the standard of reference, the sensitivity of MRVC was 76.2%; the specificity, 90.0%; the positive predictive value, 88.9%; and the negative predictive value, 78.3%. There was concordance between two methods regarding the grade of reflux in all 16 ureterorenal units with VUR detected by both methods. Of 40 kidneys, MRVC detected findings of renal damage or reflux nephropathy in 13 kidneys, and 99mTc DMSA renal SPECT detected findings of reflux nephropathy in 17 kidneys. Conclusion Although MRVC is shown to have less sensitivity for VUR than VCUG, MRVC may represent a method of choice offering a safer nonradiation test that can additionally evaluate the kidneys for changes related to reflux nephropathy. J. Magn. Reson. Imaging 2005;21:406–414. © 2005 Wiley-Liss, Inc.

AST is commonly associated with pyriform sinus−thyroid fistula in children. Radiologic findings of AST are documented in a few reports. We report a new sign we term the “emerging echogenic tract sign,” which reflects a patent air-containing pyriform sinus−thyroid fistula on follow-up US. Recognition of this sign is an important finding suggesting an associated pyriform sinus−thyroid fistula in a patient with AST and also suggesting the adequate timing of barium esophagography to confirm the fistula.

We report the case of a 37-year-old man who underwent excision of small benign abdominal wall masses using a vacuum-assisted biopsy device designed for breast biopsy (Mammotome®). To our knowledge, this is the first application of such a device to remove a soft tissue mass other than a breast lesion. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2008

Amyloidosis involving the mesentery is very rare, and its radiological appearance has been poorly documented. To our knowledge, this is the first case of amyloidosis involving the mesentery being presented as a mesenteric haematoma.

Aim To evaluate the clinical utility of the meniscal width to transverse diameter ratio (L/M ratio) of the lateral meniscus in the diagnosis of incomplete discoid lateral meniscus (IDLM) as compared with the arthroscopic diagnosis, meniscal width to tibial diameter ratio (L/T ratio) and conventional lateral meniscus width criteria. Materials and methods This retrospective study sample included 41 patients with IDLM who underwent knee magnetic resonance imaging (MRI) and arthroscopy, as well as 50 controls with normal lateral menisci. MRI examinations were interpreted independently by two radiologists, both of whom were blinded to clinical information and radiological reports. Assessment of meniscal width (L), maximal transverse diameter of the lateral meniscus (M), and transverse diameter of the tibia (T) was carried out on central coronal sections that were observed to pass through the medial collateral ligament. L/M and L/T ratios were calculated. These results were correlated with arthroscopic findings and analysed statistically using categorical regression analysis and non-parametric correlation analysis. Using arthroscopic findings as the standard of reference, sensitivity and specificity were calculated for: (1) 12, 13, 14, and 15 mm meniscal width thresholds; (2) 40%, 50%, 60%, and 70% L/M ratio thresholds; and (3) 15%, 18%, 20%, and 25% L/T ratio thresholds. Results The mean L/M ratio of the IDLM was approximately 67% and was statistically significantly higher than the control (44%). The best diagnostic discrimination was achieved using a threshold of 50%. The mean L/T ratio of the IDLM was approximately 23% and was statistically significant. The best diagnostic discrimination was achieved using a threshold of 18%. The threshold of 13 mm of meniscal width also showed high sensitivity and high specificity. Conclusion The use of the L/M ratio or L/T ratio in combination with meniscal width criteria may be a useful method for evaluating IDLM.

To propose a new and practical MRI grading method for cervical neural foraminal stenosis and to evaluate its reproducibility.We evaluated 50 patients (37 males and 13 females, mean age 49 years) who visited our institution and underwent oblique sagittal MRI of the cervical spine. A total of 300 foramina and corresponding nerve roots in 50 patients were qualitatively analysed from C4-5 to C6-7. We assessed the grade of cervical foraminal stenosis at the maximal narrowing point according to the new grading system based on T2 weighted oblique sagittal images. The incidence of each of the neural foraminal stenosis grades according to the cervical level was analysed by χ(2) tests. Intra- and interobserver agreements between two radiologists were analysed using kappa statistics. Kappa value interpretations were poor (κ0.1), slight (0.1≤κ≤0.2), fair (0.2κ≤0.4), moderate (0.4κ≤0.6), substantial (0.6κ≤0.8) and almost perfect (0.8κ≤1.0).Significant stenoses (Grades 2 and 3) were rarely found at the C4-5 level. The incidence of Grade 3 at the C5-6 level was higher than that at other levels, a difference that was statistically significant. The overall intra-observer agreement according to the cervical level was almost perfect. The agreement at each level was almost perfect, except for only substantial agreement at the right C6-7 by Reader 2. No statistically significant differences were seen according to the cervical level. Overall kappa values of interobserver agreement according to the cervical level were almost perfect. In addition, the agreement of each level was almost perfect. Overall intra- and interobserver agreement for the presence of foraminal stenosis (Grade 0 vs Grades 1, 2 and 3) and for significant stenosis (Grades 0 and 1 vs Grades 2 and 3) showed similar results and were almost perfect. However, only substantial agreement was seen in the right C6-7.A new grading system for cervical foraminal stenosis based on oblique sagittal MRI provides reliable assessment and good reproducibility. This new grading system is a useful and easy method for the objective evaluation of cervical neural foraminal stenosis by radiologists and clinicians.The use of the new grading system for cervical foraminal stenosis based on oblique sagittal MRI can be a useful method for evaluating cervical neural foraminal stenosis.

A 17-year-old man was admitted with a complaint of knee pain. He was diagnosed with Wilson disease by ophthalmologic and laboratory studies during hospitalization. Initial plain radiography of both knees showed multiple osteochondritis dissecans (OCD) on the medial and lateral femoral condyles of both knees. Subsequent magnetic resonance imaging showed multiple OCDs, which were symmetric on both knees. Subchondral cysts on the medial condyle and trochlear dysplasia were additionally evident on both femurs. We report this case with a focus on the imaging findings.

Primary sarcomas of the great vessels are extremely uncommon tumors, with aortic sarcoma being the rarest type. They tend to occur in the thoracic aorta, followed by the abdominal aorta and the thoracoabdominal aorta. They have a propensity for metastases and they cause acute arterial embolism (1). Undifferentiated pleomorphic sarcoma, also called malignant fibrous histiocytoma, has been defined as a group of pleomorphic, high-grade sarcomas that fail to show any line of differentiation using currently available ancillary techniques (2). To the best of our knowledge, no fewer than 24 cases of undifferentiated pleomorphic sarcoma originating from the aorta have been reported in the worldwide literature, but imaging findings have been rarely reported (3-7). Herein, we describe the case of a 67-year-old male who had a primary undifferentiated pleomorphic sarcoma of the descending thoracic aorta with an emphasis on computed tomography (CT) and magnetic resonance imaging (MRI) findings. CASE REPORT

Background Previous studies have shown that magnetic resonance imaging (MRI) has a high sensitivity for peroneal tendon pathology but more studies with surgery as a reference standard are needed. Purpose To evaluate the accuracy of MRI compared to surgery for characterizing chronic peroneal tendon pathology. Material and Methods Ninety-seven patients (57 men, 40 women; mean age, 39 years; range, 15–64 years) with chronic lateral ankle instability underwent MRI followed by surgery, with a mean MR to surgery interval of 30 days. Sagittal, coronal, and axial T1-weighted spin-echo and fat-suppressed T2-weighted fast spin-echo images were obtained for all patients. Two blinded observers evaluated the MR images without clinical information, and the results were compared to surgical findings. The following peroneal injuries were observed: tendon split, interstitial tear, swelling of the tendon, fluid collection, superior peroneal retinaculum injury, and tendon dislocation. Results Swelling of the peroneus longus tendon was the most common finding on MR imaging, followed by fluid collection and a split of the peroneus brevis tendon. Surgical findings showed that nine cases (9%) of interstitial tears were in the peroneus brevis and two cases (2%) were in the peroneus longus, with eight cases (8%) of splits in the peroneus brevis tendon. The sensitivity and specificity for detecting interstitial tears in the peroneus brevis were 44% and 99%, respectively. The sensitivity and specificity for detecting swelling in the peroneus brevis were 50% and 99%, respectively. The sensitivity and specificity for detecting interstitial tears for peroneus longus injuries were 50% and 96%, respectively. The sensitivity and specificity for detecting swelling in these injuries were and 100% and 96%, respectively. Conclusion MRI findings of chronic peroneal tendon pathology are diagnostically specific but not sensitive. MRI showed high sensitivity for diagnosing tendon swelling in the peroneus longus, but not in the peroneus brevis. MRI is sensitive but not specific for detecting negative findings.

The purpose of this study was to evaluate interobserver agreement and whether or not a new MRI grading system correlates with symptoms and neurologic signs for assessing spinal canal compression.One hundred patients (52 men and 48 women; mean age, 50 years) underwent MRI of the cervical spine at our institution and were evaluated by two musculoskeletal radiologists. The presence and grade of cervical canal stenosis at the maximal narrowing point was assessed according to the new grading system suggested by Kang et al. (Kang system). The results correlated with the clinical manifestations and neurologic examination. Statistical analysis was performed using kappa statistics, categoric regression analysis, and nonparametric correlation analysis (Spearman correlation).Interobserver agreement in the grading of spinal stenosis between the two readers was almost perfect (κ = 0.925). Most of the patients with grade 0 cervical canal stenosis showed no neurologic manifestation, and patients with grades 2 and 3 cervical canal stenosis had positive neurologic manifestations. The correlation coefficient (R) of reader 1 between MRI grade (0, 1, 2, and 3) and neurologic manifestations (positive or negative) was 0.846. The R of reader 2 was 0.808. In the younger age group (50 years old), the R of reader 1 was 0.834 and the R of reader 2 was 0.745. In the older age group (≥ 50 years old), the R of reader 1 was 0.839 and the R of reader 2 was 0.839.The interobserver agreement of the Kang system was almost perfect and was higher than in the study by Kang et al. Grade 0 cervical canal stenosis represents negative neurologic manifestations and grades 2 and 3 cervical canal stenosis represent positive neurologic manifestations. The Kang system and clinical manifestations are significantly correlated, especially in the older age group (≥ 50 years).

Purpose To propose a reproducible and constant MR grading system for osteoarthritis of the knee joint that provides high interobserver and intraoberver agreement and that does not require complicated calculation procedures. Materials and methods This retrospective study sample included 44 men and 65 women who underwent both MRI and plain radiography of the knee at our institution. All patients were older than 50 years of age (mean 57.7) and had clinically suspected osteoarthritis of the knee. The standard of 4 grades on the MR grade scale was based mainly on cartilage injury and additional findings. Kellgren–Lawrence grades were assessed for the same patient group. The relationship between the results was determined. Statistical analyses were performed including kappa statistics, categorical regression analysis and nonparametric correlation analysis. Results The interobserver and intraoberver agreements between the two readers in the grading of osteoarthritis were found to be almost perfect. Interobserver and intraobserver agreements were slightly lower for the MR grading system than for the Kellgren–Lawrence grading scale. The correlation between the MR grade and Kellgren–Lawrence grade was very high and did not differ with patient age. The MR grades were highly correlated with the Kellgren–Lawrence grades and showed excellent interobserver and intraobserver agreements. Conclusion This new MR grading system for osteoarthritis of the knee joint is reproducible and may be helpful for the grading of osteoarthritis of the knee without requiring reference to plain radiography.

The objective of our study was to evaluate the frequency and types of incidental findings of the lumbar spine during MR evaluation for herniated intervertebral disk disease.A total of 1268 patients (male-to-female ratio, 421:847; age range, 1-97 years) with clinically suspected herniated intervertebral disk disease underwent MRI of the lumbar spine. Musculoskeletal radiologists evaluated the MR examinations for the presence of incidental findings. We defined incidental finding as any abnormal finding not related to the chief complaint. Vertebral hemangioma, Tarlov cyst, fibrolipoma, synovial cyst, and sacral meningocele were included. Frequency distributions of the assessed imaging characteristics were calculated. For analysis of the relationship of incidental findings with patient characteristics, the chi-square test was used.Overall, 107 patients (8.4%) had incidental findings. Fibrolipoma was most common (41 cases, 3.2%), followed by Tarlov cyst (27 cases, 2.1%) and vertebral hemangioma (19 cases, 1.5%). Fibrolipoma and sacral meningocele were more common in males (p0.05). There was no difference in the incidence between the sexes in the other incidental findings (p = 0.26-0.96). Four of the five incidental findings were significantly more frequent in individuals younger than 50 years (p0.05), whereas the incidence of vertebral hemangioma did not differ by patient age (p = 0.32).Incidental findings at MRI of the lumbar spine were common and associated with age and sex. Most were benign findings. An awareness of the prevalence of the incidental findings detected at MRI of the lumbar spine is helpful for diagnosing lesions not related to symptoms.

Purpose. We investigated whether the preoperative ultrasound (US)-guided hookwire localization for nonpalpable cervical masses allows surgeons to find these masses more easily and more confidently. Methods. Eight patients underwent preoperative US-guided hookwire insertion for nonpalpable cervical masses at our institution between January 2008 and January 2011. Cervical masses were detected by US or CT, and seven of the eight patients underwent US-guided fine-needle aspiration. Before surgery, a radiologist inserted a hookwire into the cervical mass, under US guidance. Results. US-guided hookwire insertion took about 5–10 minutes and was successful in all cases without complications. Final pathologic results were metastatic papillary thyroid cancer (n = 4), no metastasis (n = 1), parathyroid adenoma (n = 1), tuberculosis (n = 1), and Kikuchi's disease (n = 1). Conclusions. Preoperative US-guided hookwire insertion in nonpalpable cervical lesions provides surgeons with an effective means of lesion location. © 2011 Wiley Periodicals, Inc. J Clin Ultrasound, 2011

Aim To evaluate the accuracy of magnetic resonance imaging (MRI) findings in chronic lateral ankle ligament injury in comparison with that of surgical findings. Materials and methods Forty-eight cases (25 men, 23 women, mean age 36 years) of clinically suspected chronic ankle ligament injury underwent MRI studies and surgery. Sagittal, coronal, and axial, T1-weighted, spin-echo, proton density and T2-weighted, fast spin-echo images with fat saturation were obtained in all patients. MRI examinations were read in consensus by two fellowship-trained academic musculoskeletal radiologists who evaluated the lateral ankle ligaments, including the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) without clinical information. The results of the MRI studies were then compared with the surgical findings. Results The MRI findings of ATFL injury showed a sensitivity of detection of complete tears of 75% and specificity of 86%. The sensitivity of detection of partial tears was 75% and the specificity was 78%. The sensitivity of detection of sprains was 44% and the specificity was 88%. Regarding the MRI findings of CFL injury, the sensitivity of detection of complete tears was 50% and the specificity was 98%. The sensitivity of detection of partial tear was 83% and the specificity was 93%. The sensitivity of detection of sprains was 100% and the specificity was 90%. Regarding the ATFL, the accuracies of detection were 88, 58, 77, and 85% for no injury, sprain, partial tear, and complete tear, respectively, and for the CFL the accuracies of detection were 90, 90, 92, and 96% for no injury, sprain, partial tear, and complete tear, respectively. Conclusions The diagnosis of a complete tear of the ATFL on MRI is more sensitive than the diagnosis of a complete tear of the CFL. MRI findings of CFL injury are diagnostically specific but are not sensitive. However, only normal findings and complete tears were statistically significant between ATFL and CFL ( p

Purpose. We aimed to assess long-term ultrasound (US) findings after US-guided percutaneous ethanol ablation (EA) in benign thyroid cysts and predominantly cystic thyroid nodules. Methods. Forty patients with thyroid cysts (n = 14) and predominantly cystic thyroid nodules (n = 26) underwent long-term US follow-up (range, 12–36 months; mean, 18.2 months) after EA. US images of 40 post-EA nodules were retrospectively investigated to study the reduction in nodule volume and detailed US appearance. Results. On follow-up US, post-EA nodules showed the following features: Marked hypoechogenicity (n = 28), spiculated margin (n = 7), microcalcifications (n = 6), taller-than-wide shape (n = 2), centrally predominant vascularity (n = 3), no vascularity (n = 31), mixed vascularity (n = 3), and peripheral vascularity (n = 3). Post-EA nodules were diagnosed by US as benign (n = 3), probably benign (n = 2), borderline (n = 5), possibly malignant (n = 20), and malignant (n = 10). No statistical difference in the incidence of malignant US findings was observed between thyroid cysts and predominantly cystic thyroid nodules (p > 0.05, Fisher's exact test). Conclusions. Long-term follow-up US after successful EA of benign thyroid cysts and predominantly cystic thyroid nodules revealed a high incidence of findings that are usually associated with malignancy. Recognizing these consequences of the procedure would help avoid unnecessary FNA on post-EA nodules. © 2011 Wiley Periodicals, Inc. J Clin Ultrasound, 2011

Background. To evaluate the sonographic findings of soft-tissue nonsubungual glomus tumors. Methods. The sonographic appearances of nine histologically proven soft-tissue glomus tumors of nonsubungual location in nine patients (mean age, 49 years; M:F = 7:2) were reviewed retrospectively. Doppler examination and surgical excision were performed in all cases. Results. The mean size of the lesions was 1 cm. The margins of the lesions were relatively well-circumscribed in eight of nine patients (89%) with an ovoid shape in seven of nine patients (78%). The vascularity was moderate to rich in all cases, with an arterial flow pattern but no arteriovenous shunt patterns. The “vascular stalk sign” was noted in six cases (67%). Conclusions. Nonsubungual glomus tumors are rare soft-tissue tumors with abundant vascularity and arterial flow pattern. © 2011 Wiley Periodicals, Inc. J Clin Ultrasound, 2011

Purpose. To evaluate the feasibility and effectiveness of preoperative localization of cystic lesions in the knee using ultrasound-guided indigo carmine injection. Method. Twenty-three cysts in the knee in 23 patients (M:F = 15:8, mean age, 42 years) were localized preoperatively by ultrasound-guided indigo carmine injection. These included 12 meniscal cysts, 7 popliteal cysts, and 4 ganglion cysts. To stain the lesions, 0.2–3 mL of indigo carmine was injected into the cyst using a 22-gauge spinal needle. After localization, the patient was immediately transferred to the operating room and surgery was performed. Intraoperative findings and arthroscopic images were reviewed. Result. All 23 cysts were stained successfully. Twenty cases were confirmed during arthroscopy and 3 cases were confirmed during excisional surgery. There was no significant bleeding/hematoma or anaphylactic reaction. Four patients felt pain during aspiration before indigo carmine injection. The lesions were stained blue and could be clearly identified by the surgeon and were removed arthroscopically or by open surgery. Conclusion. Preoperative localization of cystic lesions in the knee joint region using ultrasound-guided indigo carmine injection is a feasible technique and can be easily and safely be performed. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound, 2010