[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 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] The purpose of this study was to investigate the final outcomes of magnetic resonance imaging (MRI)-identified additional lesions (MRALs) in breast cancer patients and the role of second-look ultrasound (SLUS) and imaging-guided interventions. We analyzed breast cancer patients with MRALs on preoperative MRI between January and June 2012. MRALs were defined as additional lesions suspected on MRI but not suspected on mammograms or ultrasound. The malignancy rate of MRALs, MRI-based Breast Imaging Reporting and Database System (BI-RADS) category, positional relationship with the index cancer, MRI-concordant lesion visibility on SLUS, performance of imaging-guided interventions, and total mastectomy (TM) rates were evaluated for the confirmed lesions. Among the 119 confirmed lesions, SLUS and imaging-guided interventions were performed in 94 (79.0%) and 82 cases (68.9%), respectively. The malignancy rate was 68.1% (81 of 119), and was significantly higher in BI-RADS 4C-5 lesions than in 4A-4B lesions (94.6% vs. 56.1%, P<0.01) and in ipsilateral same-quadrant lesions than in contralateral lesions (84.2% vs. 33.3%, P<0.01). The lesion visibility rate on SLUS was 90.4%. The malignancy rate was not significantly different according to lesion visibility on SLUS. The TM rate in the 98 cases with ipsilateral MRALs was 37.8%, while it was significantly lower in patients who underwent an imaging-guided intervention than in those who did not (27.9% vs. 54.1%, P=0.017). MRALs show a high probability of malignancy, especially if they are ipsilateral. SLUS and imaging-guided interventions can eliminate many unnecessary TMs

[en] Two patients with an unusual multisystemic syndrome characterized by polyneuropathy, organomegaly(especially hepatosplenomegaly), endocrine dysfunction, M-protein, and skin abnormalities(POEMS syndrome) are discussed.Characteristic radiographic features include hepatosplenomegaly, lymph node enlargement, sclerotic bony lesions,and a peculiar variety of bony proliferation

[en] Eagle's syndrome is a rare condition associated with recurrent throat pain, foreign body sensation and odynophagia. It is caused by elongation of the styloid process or calcification of the stylohyoid process. We present the clinical and radiologic findings of a case of Eagle's syndrome. (author)

[en] The aim of this study was to compare ultrasonographic features in patients with lymphocytic thyroiditis (LT) and papillary thyroid carcinoma (PTC) having suspicious thyroid nodule(s) in a background of heterogeneous parenchyma and to determine the clinical and radiological predictors of malignancy. We reviewed the cases of 100 patients who underwent ultrasonography between April 2011 and October 2012, and showed suspicious thyroid nodule(s) in a background of heterogeneous parenchyma. Eight patients who did not undergo ultrasonography-guided fineneedle aspiration cytology (FNAC) and 34 cases of follow-up ultrasonography after initial FNAC were excluded. We compared the benign and malignant nodules in terms of their clinical and radiological factors. For the 58 nodules including 31 LTs (53.4%) and 27 PTCs (46.6%), the mean tumor sizes of the two groups were 0.96 cm for LT and 0.97 cm for PTC. A univariate analysis revealed that PTCs were more frequent in patients younger than 45 years and having microcalcifications than was LT. An independent predictor of PTC after adjustment was an age of <45 years. LT mimics malignancy in a background of heterogeneous parenchyma on ultrasonography. A young age of <45 years is the most important predictor of malignancy in this condition

[en] A linear intracardiac foreign body was identified following a total hip replacement (THR) on chest CT and transesophageal echocardiography in a 60-year-old woman with rheumatoid arthritis. Leakage and migration of bone cement during arthroplasty is a possible explanation for this rare complication. Therefore, adequate preparation and handling of cement using biplane fluoroscopy are recommended during arthroplasty

[en] To evaluate the role and difficulties of the use of routine abdomen ultrasound (US) in postoperative breast cancer patients. We reviewed the clinical records of 2460 patients who received breast cancer surgeries and underwent routine follow-up abdomen US for more than five years. We evaluated the number and clinical conditions of patients with a liver metastasis. We also evaluated the cut-off point of the breast cancer stage where a metastasis was likely to occur using the chi-squared test and receiver operator characteristic (ROC) analysis. A metastasis developed in 238 patients (9.7%), and the liver was the third most common organ site. However, just 24 (0.98%) patients presented only with a liver metastasis. Among these 24 patients, a metastasis was detected in 17 patients with the use of routine abdomen US. The cut-off point for a metastasis was Stage 3A. The use of routine screening abdomen ultrasound for the detection of a liver metastasis in postoperative breast cancer patients is not recommended. However, US can be used selectively in patients with clinical symptom or that present with a high stage equal or greater than Stage 3A

[en] To evaluate the significance of T2-weighted MR imaging(T2WI) in the diagnosis of pituitary microadenoma. We retrospectively evaluated the MR imaging findings of 30 cases of pituitary microadenoma. Diagnosis was made on the basis of surgery, serum hormonal level, and the presence of mass lesion on MR (T1WI and T2WI), and conventional as well as dynamic contrast enhanced T1WI images were obtained. In each MR sequence, signal intensity and detectability of the tumor were evaluated. We also determined whether diagnosis was possible on both T1WI and T2WI. In eight cases, histopathologic findings (cellularity, fibrosis, and cystic change) were correlated with T2 signal intensity of the tumor. T2WI, T1WI, and dynamic and conventional enhanced T1WI detected the tumor in 21 cases (70%), 21 cases (70%), 28 cases (93.3%), and 22 cases (73.3%), respectively. On T2WI, pituitary microadenomas showed a high signal in 18 cases (60%), an iso-signal in nine (30%), and a low signal in three (10%) compared with normal pituitary gland. In 20 cases (66.7%), diagnosis of pituitary microadenoma was possible on both T1WI and T2WI, but in one case, the tumor was detected only on T2WI. Three cases with fibrosis, as seen on histopathologic examination showed an iso or low signal on T2WI. T2WI is useful in the diagnosis of pituitary microadenoma Decreased signal intensity on T2WI may suggest fibrosis

[en] We wanted to evaluate the characteristics of those lesions showing insufficient results on ultrasound-guided core needle biopsy. We retrospectively reviewed the pathologic results of 131 lesions from patients who underwent ultrasound-guided core needle biopsy following Mammotome or surgical excisional biopsy from January 2004 to December 2004. Compared with excisional biopsy, ultrasound-guided core needle biopsy showed 14 lesions with discordant results and 9 lesions with indeterminate results. 5 lesions were overestimated and 9 lesions were underestimated on the core needle biopsies. According to the histological tumor types, the papillary tumors showed 66.6% discordance or indetermination, and the phyllodes tumors showed 50% discordance or indetermination. On the results of core needle biopsy, discordant or indeterminate results were frequently reported for papillary and phyllodes tumor. Therefore, excisional biopsy is recommended for these types of tumor