[en] To report the findings of a six-year medial oudit performed at our mammographic screening center, comparing those findings with the follow-up data stored at our hospital and at the Korea Central Cancer Registry. 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 fales negative, we compared breast cancer patients registered in our medical record department and in the Korean Central Cancer Registry during the the study period, with women whose mammograms were interpreted as normal or benign at our screening center within a year prior to cancer diagnosis. The mean age of women enrolled in this study was 48.6 years, the 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 2.0%. 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 positively 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%. In our study, the cancer detection rate ar 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

[en] Takayasu arteritis (TA) is an inflammatory disease of aorta and its major branches and pulmonary artery affecting young females in most cases. Diagnosis of TA in its early phase is important in prevention of serious complications. However, clinical diagnosis of TA may be difficult due to nonspecific symptoms. Thirty-three consecutive patients (aged 15 to 60 years; mean age, 44.6 years) with TA (19 in clinically active, 14 in inactive stage) were included in this study. Concentric wall thickening (1.2-4.0 mm ), stenosis or occlusion of one or both common carotid arteries or innominate artery was found in 78% (26/33) of patients with TA. Wall thickening or occlusion of one or both subclavian arteries was seen in 60.6% (20/33) of patients with TA. Most patients (91%, 31/33) except two chronic inactive patients with aortic stenosis had disease in at least one of four arteries at sonography. Because subclavian and carotid lesions are peculiar in young patients with TA. Carotid and subclavian US is sensitive and specific in diagnosis of TA as revealed in our study. Findings of carotid sonography in TA have been concentric wall thickening and calcifications. Early diagnosis mainly depends on detection of subtle mural thickening at sectional imaging studies, while stenosis or dilatation of aorta and its branches appears in the later stage. Changes in mural thickness after medical treatment could be assessed with sonography.

[en] We wanted to investigate the ability of breast MR imaging to identify the primary malignancy in patients with axillary lymph node metastases and initially negative mammography and sonography, and we correlated those results with the conventional imaging. From September 2001 to April 2006, 12 patients with axillary lymph node metastases and initially negative mammography and sonography underwent breast MR imaging to identify occult breast carcinoma. We analyzed the findings of the MR imaging, the MR-correlated mammography and the second-look sonography. We followed up both the MR-positive and MR-negative patients. MR imaging detected occult breast carcinoma in 10 of 12 (83%) patients. Two MR-negative patients were free of carcinoma in the ipsilateral breast during their follow-up period (39 and 44 months, respectively). In nine out of 10 patients, the MR-correlated mammography and second-look sonography localized lesions that were not detected on the initial exam. All the non-MR-correlated sonographic abnormalities were benign. Breast MR imaging can identify otherwise occult breast cancer in patients with metastatic axillary lymph nodes. Localization of the lesions through MR-correlated mammography and second-look sonography is practically feasible in most cases

[en] To compare the efficacy of the split-bolus contrast media injection technique in helical CT angiography (CTA) of the whole aorta and iliac arteries with that of the single-bolus technique. Using the split bolus technique in 23 patients, 90 ml of contrast medium (Ultravist 300) was injected at a rate of 3ml/sec ; this was followed by an 8-sec pause and the subsequent injection of 30ml. Using the single bolus technique in another 23 patients, 120ml of contrast medium was injected for 40sec. continuously. CT angiography of the thoracic aorta (slice thickness / pitch = 3mm / 2 : 1) was performed, first followed by an interscan delay 8sec, and the abdominal aorta and iliac arteries were then scanned(slice thickness / pitch = 3mm / 2: 1 or 5mm / 1.5 : 1). In all patients, CT density was measured in the aortic lumen at eight levels, from the origin of the aorta to the iliac bifurcation. Using the split bolus technique, visual assessment revealed second density peak in the aortic lumen of the upper abdomen in 15 of 23 patients(65%), while the use of the single bolus technique revealed no second density peak in any patient. CT density in the aortic lumen at the level of the esophagogastric junction, and at all levels below this except the abdominal aortic bifurcation, was significantly higher using the split bolus technique than with the single bolus technique (t-test, P < 0.05). For CTA of the whole aorta and iliac arteries, the split bolus technique is more effective than the single bolus technique

[en] To evaluate imaging findings of cystic hypersecretory carcinoma (CHC) of the breast, with an emphasis of the sonographic (US) features, and to correlate the US findings with the histology. During the last 13 years, six women with a mean age of 43 years were histologically confirmed with CHC of the breast. We retrospectively reviewed the clinical records, US images, and correlated them with histological findings. US showed a large complex cystic mass lined by a thin wall (n = 2), multiple small cysts in focally heterogeneous background parenchyma without predominant mass (n = 3), and an irregular mass with an ill-defined margin and ductectasia (n = 1). The pathology revealed that the thin walls of the cysts were all cystic hypersecretory intraductal carcinomas, while the solid portions of the lesions varied from benign intraductal papillomas to minimal infiltrating ductal carcinoma in the background of the cystic hypersecretory intraductal carcinomas. The characteristic US findings of cystic hypersecretory carcinoma are either a large complex cystic and solid mass or multiple small cysts in the background of a focally heterogeneous parenchyma

[en] To analyze retrospectively the abnormalities visible on the false-negative screening mammograms of patients with breast cancer and to determine the performance of computer-aided detection (CAD) in the detection of cancers. Of 108 consecutive cases of breast cancer diagnosed over a period of 6 years, of which previous screening mammograms were available, 32 retrospectively visible abnormalities (at which locations cancer later developed) were found in the previous mammograms, and which were originally reported as negative. These 32 patients ranged in age from 38 to 72 years (mean 52 years). We analyzed their previous mammographic findings, and assessed the ability of CAD to mark cancers in previous mammograms, according to the clinical presentation, the type of abnormalities and the mammographic parenchymal density. In these 32 previous mammograms of breast cancers (20 asymptomatic, 12 symptomatic), the retrospectively visible abnormalities were identified as densities in 22, calcifications in 8, and densities with calcifications in 2. CAD marked abnormalities in 20 (63%) of the 32 cancers with false-negative screening mammograms; 14 (70%) of the 20 subsequent screening-detected cancers, 5 (50%) of the 10 interval cancers, and 1 (50%) of the 2 cancers palpable after the screening interval. CAD marked 12 (50%) of the 24 densities and 9 (90%) of the 10 calcifications. CAD marked abnormalities in 7 (50%) of the 14 predominantly fatty breasts, and 13 (72%) of the 18 dense breasts. CAD-assisted diagnosis could potentially decrease the number of false-negative mammograms caused by the failure to recognize the cancer in the screening program, although its usefulness in the prevention of interval cancers appears to be limited

[en] In Asia, mammography following the injection of foreign materials into the breasts for cosmetic augmentation is frequently seen and diagnosis based on the typical radiologic findings is straightforward. We report the unusual radiologic findings in two patients with foreign body granulomas caused by injected foreign materials and discovered incidentally during screening work up. The mammographic findings were bilateral, hyperdense, spiculated masses, with occasional microcalcification, and at sonography, markedly hypoechoic, spiculated solid masses, located near the pectoralis muscle and partly extending into it, were observed. These radiologic findings mimicked malignancy

[en] The aim of this study was to assess the diagnostic accuracy of chest computed radiography for the detection of bronchiectasis diagnosed by high-resolution CT. Our study included 100 consecutive patients with bronchiectasis and 20 normal subjects, all seen on high-resolution CT. Two independent observers analyzed chest computed radiographs and recorded the presence and type of bronchiectasis, and the involved lobe. 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 two. The bronchiectasis was tubular in 55 patients, mixed tubular and cystic in 29, and cystic in 16. For observer 1, the sensitivity, specificity, and accuracy of chest computed radiography was 95%, 85%, and 93%, respectively, while for observer 2, the corresponding figures were 93%, 85%, and 92%. Sensitivity and specificity for observer 1 were 33% and 96% for the right 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 the lingular segment (49% and 93%), and 87% and 75% for the left lower lobe (75% and 90%), respectively. Tubular bronchiectasis involving a single lobe was the most common source of false negative readings based on the findings of chest computed radiography. Because chest computed radiography is not inferior to high-resolution CT for the detection of bronchiectasis, the routine use of chest computed radiography in screening for bronchiectasis is feasible. However, due to its low sensitivity in detecting bronchiectasis in a specific lobe, preoperative high-resolution CT examination may be needed

[en] To investigate the usefulness of targeted ultrasound (US) in the identification of additional suspicious lesions found by magnetic resonance (MR) imaging in breast cancer patients and the changes in treatment based on the identification of the lesions by the use of targeted US. One-hundred forty nine patients who underwent breast MR imaging for a preoperative evaluation of breast cancer between January 2002 and July 2004 were included in the study. We searched all cases for any additional lesions that were found initially by MR imaging and investigated the performance of targeted US in identifying the lesions. We also investigated their pathological outcomes and changes in treatment as a result of lesion identification. Of the 149 patients with breast cancer, additional suspicious lesions were detected with MR imaging in 62 patients (42%). Of the 69 additional lesions found in those 62 patients, 26 (38%) were confirmed as cancers by histology. Thirty-eight lesions in 31 patients were examined with targeted US and were histologically revealed as cancers in 18 (47%), high risk lesions in two (5%), benign lesions in 15 (39%), and unidentified lesions in three (8%). The cancer rate was statistically higher in lesions with a US correlate than in lesions without a US correlate (p = 0.028). Of 31 patients, the surgical plan was altered in 27 (87%). The use of targeted US justified a change in treatment for 22 patients (81%) and misled five patients (19%) into having an unnecessary surgical excision. Targeted US can play a useful role in the evaluation of additional suspicious lesions detected by MR imaging in breast cancer patients, but is limited in lesions without a US correlate

[en] To evaluate the efficacy of stereotaxic breast core biopsy using a prone table system, and the effects of operator experience, lesion characteristics and number of samples on biopsy results in cases involving nonpalpable breast lesions. We performed stereotaxic core biopsies of 62 nonpalpable mammographic lesions in 61 patients. Subsequent surgical excision was performed in 11 cases with microcalcifications and one case with a mass. We equally divided patients with microcalcifications into two groups (early and late periods) and analyzed the mammographic findings. Correlation of the pathologic results of core biopsy with those of surgical excision were investigated. In two patients, stereotaxic biopsy was impossible due to poor visibility of microcalcifications and thinness of the compressed breast. In 59 patients, core biopsy was successfully performed and specimens were adequate for pathologic examination. The average number of microcalcifications seen on specimen mammography in the two groups was 1.8(range : 0x8) and 2.5(range : 0x4) respectively. In patients from whom less than five and five or more samples were taken, the average number of microcalcifications seen on specimen mammography was 1.5(range : 0x6) and 2.6(range : 0x8), respectively, throughout the whole period. The pathologic findings were fibrocystic change in 50 cases, fibroadenoma in four, ductal carcinoma in situ in four, invasive ductal carcinoma in one, and atypical ductal hyperplasia in one. The agreement rate of pathologic results between core biopsy and surgical excision was 83%(10/12) for malignancy and 75% for histology. In three cases with disagreement between core and surgical pathologic results, the sampling number was small (3x 4 times) and in two of the three cases, microcalcifications were not visible on mammography operator experience and sampling numbers larger than five results in an increased number of microcalcifications in specimens and more reliable core biopsy