Primary Endobronchial Marginal Zone B-Cell Lymphoma of Bronchus-Associated Lymphoid Tissue: CT Findings in 7 Patients

윤라경,김미영,송재우,채은진,최창민,장세진 대한영상의학회 2013 Korean Journal of Radiology Vol.14 No.2

Objective: To investigate CT and 18F-flurodeoxyglucose (18F-FDG) positron-emission tomography/CT findings of primary endobronchial marginal zone B-cell lymphoma of the bronchus-associated lymphoid tissue (BALT). Materials and Methods: From June 2006 through April 2012, seven patients (six female, one male; age range, 21-61 years; mean age, 49 years) were examined who were pathologically diagnosed with the primary endobronchial marginal zone B-cell lymphoma of BALT. We evaluated the locations and characteristics of the lesions on CT and 18F-FDG-PET/CT scans. The lesions were classified into the following three patterns: 1) solitary intraluminal nodule; 2) several tiny nodular protrusions; and 3) diffuse wall thickening. Results: A solitary intraluminal nodule was observed in four patients (57.1%), several tiny nodular protrusion in two patients (28.6%), and diffuse wall thickening in one patient (14.3%). The lesions were categorized into 3 major locations: confined to the trachea (n = 3), confined to the lobar bronchus (n = 2), and diffuse involvement of the trachea and both main bronchi (n = 2). All lesions demonstrated homogeneous iso-attenuation as compared with muscle on pre- and postenhancement scans. Secondary findings in the lungs (n = 3; 42.9%) included postobstructive lobar atelectasis (n = 1), air trapping (n = 1), and pneumonia (n = 1). On 18F-FDG-PET/CT (n = 5), 4 lesions showed homogeneous uptake with maximum standardized uptake values (mSUV), ranging 2.3-5.7 (mean mSUV: 3.3). One lesion showed little FDG uptake. Conclusion: Primary endobronchial marginal zone B-cell lymphoma of the BALT manifests as three distinct patterns on CT, with the solitary intraluminal nodule presenting as the main pattern. Most lesions demonstrate homogeneous but weak FDG uptake on 18F-FDG-PET/CT.

High-Resolution Magnetic Resonance Imaging Findings of Reversible Cerebral Vasoconstriction Syndrome associated with Severe Anemia: A Case Report

김용상,윤라경,이지예,박종무 대한영상의학회 2021 대한영상의학회지 Vol.82 No.1

Ischemic stroke is one of the manifestations of reversible cerebral vasoconstriction syndrome (RCVS). Many precipitants and associated disorders of RCVS have been suggested. However, few case reports have indicated an association between anemia and RCVS. Here, we report a case of a 66-year-old female with severe iron deficiency anemia (IDA), who presented with ischemic stroke and cerebral vasoconstriction, which gradually improved with conservative treatment. High-resolution vessel wall magnetic resonance imaging findings and reversibility suggested the possibility of RCVS. In patients with RCVS and ischemic stroke, IDA should be considered. Prompt management should be delivered to prevent disease progression and recurrence.

Restricted Diffusion Abnormalities on Magnetic Resonance Imaging in a Patient with Tuberculous Pachymeningitis

강규식,윤라경,김병건 대한신경과학회 2021 Journal of Clinical Neurology Vol.17 No.1

Ultrasonographic Features and the Diagnostic Role of Core Needle Biopsy at Metastatic Breast Cancer in the Thyroid gland: A Case Report

이동현,윤라경,안진경,우정주 대한영상의학회 2020 대한영상의학회지 Vol.81 No.3

Metastases to the thyroid gland have rarely been reported in clinical settings, and the thyroid gland is an uncommon site for breast carcinoma metastasis. We report a case of a 64-year-old breast cancer patient diagnosed with metastatic breast carcinoma in the thyroid gland after performing ultrasonography (US)-guided core needle biopsy (CNB) and subsequent total thyroidectomy. On US, the thyroid lesion appeared to be mildly enlarged with multiple internal hypoechoic lines and a few microcalcifications without mass formation. Under US-guidance, CNB was performed by targeting the area with microcalcifications and subsequently diagnosed as metastatic breast carcinoma. Total thyroidectomy revealed that the patient had metastatic invasive ductal carcinoma of the breast with lymphatic spread involving both lobes and the isthmus of the thyroid gland. Although the thyroid gland is an uncommon metastatic site, the unusual features of thyroid metastasis can be observed on US; thus, US-guided CNB effectively aids the diagnosis of thyroid metastasis.

갑상선 유두암 환자에서 전이성 양측 림프절로 가장한 Kikuchi-Fujimoto병: 증례 보고 및 문헌 고찰

장동혁,이원미,윤라경,정아라 대한이비인후과학회 2021 대한이비인후과학회지 두경부외과학 Vol.64 No.11

Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is commonin young Asian women under the age of 30, and is usually characterized by fever, myalgia,fatigue, and cervical lymphadenopathy. Because patients with KFD often present withnecrotic lesions that are also features of lymph node metastasis, ipsilateral or bilateral lymphnode enlargement in head and neck cancer patients can be disguised as lymph node metastasis. We present an unusual case of KFD mimicking bilateral metastatic papillary carcinoma ofthe thyroid. This study emphasizes that KFD should be considered when diagnosing lymphnodes with necrotic lesions but without malignant cells in young women.

정상 고막과 기도골도차를 가지는 비외상성 난청의 임상양상과 측두골 Computed Tomography 분석

전승연,안용휘,윤라경,심현준 대한이비인후과학회 2023 대한이비인후과학회지 두경부외과학 Vol.66 No.11

Background and Objectives This study aimed to investigate the causes, clinical manifes-tations, temporal bone CT findings, and audiologic results of outpatients with non-traumatichearing loss with air-bone gaps and intact tympanic membranes. Subjects and Method The medical records from 2014 to 2022 of 66 patients (77 ears) withnormal tympanic membranes but who had the air-bone gap of more than 20 dB over two con-secutive frequencies were reviewed. Results The mean age of the patients was 46.8±17.0 years old. The mean air-bone gap was24.8±10.3 dB. Of the 77 ears (66 patients) studied, 10 ears were surgically diagnosed with oto-sclerosis (6 ears), ossicular discontinuity (2 ears), superior semicircular canal dehiscence (1 ear),and unknown etiology (1 ear). Additionally, 29 more ears (28 patients) were clinically diagnosedwith silent otitis media (7 ears), otosclerosis (5 ears), thickened tympanic membrane (5 eras),E-tube dysfunction (4 ears), ossicular anomaly (4 ears), semicircular canal dysplasia (2 ears),and endolymphatic hydrops (2 ears). Temporal bone CT images showed normal findings in 33ears (54.1%) and abnormal findings in 28 ears (45.9%). Patients with abnormal CT findingshad a poorer speech discrimination score than those with normal findings ( p<0.05). The air-bone gap was significantly decreased postoperatively from 30.5±12.7 dB to 6.4±4.0 dB, witha tendency to decrease greater at a low frequency than at a high frequency. Conclusion Among patients with air-bone gap and intact tympanic membrane, otosclerosiswas the most commonly confirmed diagnosis through surgery, while silent otitis media wasthe most frequently observed diagnosis based on clinical evaluations.

Superficially Palpable Masses of the Scalp and Face: A Pictorial Essay

김형섭,안진경,우정주,윤라경 대한영상의학회 2019 대한영상의학회지 Vol.80 No.2

Palpable lesions of the scalp and face are common in clinical practice. They are usually small and benign, and the lesions tend to be treated simply according to the clinical symptoms. However, radiologic evaluation is often performed to determine the exact type and location of a lesion to ensure appropriate management. Ultrasonography is useful as a primary and definitive modality for evaluating small superficial lesions. CT and MRI are better for characterizing soft tissue features and provide superior soft tissue resolution. This article discusses various lesions and their imaging findings of the scalp and face that may present as superficially palpable masses.

Superior Cervical Sympathetic Ganglion: Normal Imaging Appearance on 3T-MRI

이주연,이정현,송준선,송민정,황승준,윤라경,장승원,박지은,허영진,최영준,백정환 대한영상의학회 2016 Korean Journal of Radiology Vol.17 No.5

Objective: To identify superior cervical sympathetic ganglion (SCSG) and describe their characteristic MR appearance using 3T-MRI. Materials and Methods: In this prospective study, we recruited 53 consecutive patients without history of head and neck irradiation. Using anatomic location based on literature review, both sides of the neck were evaluated to identify SCSGs in consensus. SCSGs were divided into definite (medial to internal carotid artery [ICA] and lateral to longus capitis muscle [LCM]) and probable SCSGs based on relative location to ICA and LCM. Two readers evaluated signal characteristics including intraganglionic hypointensity of all SCSGs and relative location of probable SCSGs. Interrater and intrarater agreements were quantified using unweighted kappa. Results: Ninety-one neck sites in 53 patients were evaluated after exclusion of 15 neck sites with pathology. Definite SCSGs were identified at 66 (73%) sites, and probable SCSGs were found in 25 (27%). Probable SCSGs were located anterior to LCM in 16 (18%), lateral to ICA in 6 (7%), and posterior to ICA in 3 (3%). Intraganglionic hypointensity was identified in 82 (90%) on contrast-enhanced fat-suppressed T1-weighted images. There was no statistical difference in the relative location between definite and probable SCSGs of the right and left sides with intragnalionic hypointensity on difference pulse sequences. Interrater and intrarater agreements on the location and intraganglionic hypointensity were excellent (κ-value, 0.749–1.000). Conclusion: 3T-MRI identified definite SCSGs at 73% of neck sites and varied location of the remaining SCSGs. Intraganglionic hypointensity was a characteristic feature of SCSGs.

Intravoxel Incoherent Motion MR Imaging in the Head and Neck: Correlation with Dynamic Contrast-Enhanced MR Imaging and Diffusion-Weighted Imaging

Xiao Quan Xu,최영준,성유섭,윤라경,장승원,박지은,허영진,백정환,이정현 대한영상의학회 2016 Korean Journal of Radiology Vol.17 No.5

Objective: To investigate the correlation between perfusion- and diffusion-related parameters from intravoxel incoherent motion (IVIM) and those from dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion-weighted imaging in tumors and normal muscles of the head and neck. Materials and Methods: We retrospectively enrolled 20 consecutive patients with head and neck tumors with MR imaging performed using a 3T MR scanner. Tissue diffusivity (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) were derived from bi-exponential fitting of IVIM data obtained with 14 different b-values in three orthogonal directions. We investigated the correlation between D, f, and D* and model-free parameters from the DCE-MRI (wash-in, Tmax, Emax, initial AUC60, whole AUC) and the apparent diffusion coefficient (ADC) value in the tumor and normal masseter muscle using a whole volume-of-interest approach. Pearson’s correlation test was used for statistical analysis. Results: No correlation was found between f or D* and any of the parameters from the DCE-MRI in all patients or in patients with squamous cell carcinoma (p > 0.05). The ADC was significantly correlated with D values in the tumors (p < 0.001, r = 0.980) and muscles (p = 0.013, r = 0.542), despite its significantly higher value than D. The difference between ADC and D showed significant correlation with f values in the tumors (p = 0.017, r = 0.528) and muscles (p = 0.003, r = 0.630), but no correlation with D* (p > 0.05, respectively). Conclusion: Intravoxel incoherent motion shows no significant correlation with model-free perfusion parameters derived from the DCE-MRI but is feasible for the analysis of diffusivity in both tumors and normal muscles of the head and neck.

경추간공 경막외 주사 후 발생한 조영제에 의한 일과성 피질시각상실

윤소정(Michelle Youn),서정현(Jeong Hyun Seo),김병건(Byung-Kun Kim),윤라경(Ra Gyoung Yoon),정은혜(Eun Hye Jung) 대한안과학회 2022 대한안과학회지 Vol.63 No.11

목적: 경추간공 경막외 주사 중 동맥 내 조영제 투여에 의한 일과성 피질시각상실을 보인 증례를 보고하고자 한다. 증례요약: 당뇨, 고혈압을 가진 58세 남자 환자가 목 통증으로 정형외과에서 경추간공 경막외 주사 치료를 받은 직후 양안의 시력저하를 호소하여 안과에 의뢰되었다. 시술을 위해 조영제를 투약하여 주사의 위치를 조정하던 중 좌측 추골동맥이 조영증강된 것이 확인되었고, 직후 환자는 양안 시력저하와 함께 어지럼, 두통을 호소하였다. 12시간 경과 후 최대교정시력은 양안 안전수동이었으며, 전안부와 안저검사, 눈운동검사 및 동공검사에서 이상 소견은 관찰되지 않았다. 형광안저촬영 및 뇌자기공명영상촬영에서 특이 사항은관찰되지 않았으며, 신경계 진찰도 정상이었다. 조영제에 의한 일과성 피질시각상실로 진단하고, Dexamethasone 정맥 주사 및 nimodipine 을 투여하였다. 경막외 주사 2일 후부터 주관적인 시력의 회복을 보였으며, 3일 후 나안시력은 양안 1.0으로 완전히 회복되었다. 결론: 조영제를 이용한 검사 후 양안 시력저하가 발생하였을 때 드물지만 일과성 피질시각상실의 가능성을 고려해 보아야 한다. 가역적인 경과를 보이고 예후가 좋은 편이나 신속하고 정확한 진단이 필요하다. Purpose: To report a case of transient cortical blindness following cervical transforaminal epidural injection. Case summary: A 58-year-old diabetic and hypertensive male was referred to the ophthalmology department with sudden-onset bilateral visual disturbances after cervical transforaminal epidural injection for neck pain. During the procedure, an intravascular contrast medium was injected into the left vertebral artery. Immediately after the injection, the patient complained of bilateral visual disturbances, mild headache, and dizziness. Twelve hours after the procedure, his visual acuity was reduced to hand motion perception in both eyes. Anterior segment and fundus examinations were unremarkable. Pupillary light reflexes and extraocular muscle movements were normal. Brain magnetic resonance imaging, magnetic resonance angiography, and fluorescein angiography showed no significant findings. There were no other neurological abnormalities. The patient was treated conservatively with intravenous dexamethasone and nimodipine based on a provisional diagnosis of transient cortical blindness. The symptoms gradually improved 2 days after the procedure; visual acuity recovered to 20/20 by the third day. Conclusions: Although contrast-induced transient cortical blindness is rare, it should be considered in patients with bilateral visual loss after transforaminal epidural injection. It is a benign and reversible condition but requires a prompt diagnosis.