Ultrasonography of acute flank pain: a focus on renal stones and acute pyelonephritis

심기춘 대한초음파의학회 2018 ULTRASONOGRAPHY Vol.37 No.4

Ultrasonography is a useful tool for the differential diagnosis of acute flank pain. Renal stonesappear as a focal area of echogenicity with acoustic shadowing on ultrasonography. In acutepyelonephritis (APN), the kidneys may be enlarged and have a hypoechoic parenchyma withloss of the normal corticomedullary junction. However, clinical and laboratory correlationsare essential for the diagnosis of renal stones and APN through imaging studies. This reviewdescribes the typical ultrasonography features of renal stones and APN. Moreover, in dailypractice, cross-sectional imaging is essential and widely used to confirm renal stones and APNand to differentiate them from other diseases causing flank pain. Other diseases causing acuteflank pain are also described in this review.

Radiomics Analysis of Magnetic Resonance Proton Density Fat Fraction for the Diagnosis of Hepatic Steatosis in Patients With Suspected Non-Alcoholic Fatty Liver Disease

심기춘,Kim Min Ju,Cho Yongwon,Kim Hyun Jin,Park Beom Jin,Sung Deuk Jae,Han Na Yeon,Han Yeo Eun,Kim Tae Hyung,Lee Yoo Jin 대한의학회 2022 Journal of Korean medical science Vol.37 No.49

Background: This study aimed to assess the diagnostic feasibility of radiomics analysis based on magnetic resonance (MR)-proton density fat fraction (PDFF) for grading hepatic steatosis in patients with suspected non-alcoholic fatty liver disease (NAFLD). Methods: This retrospective study included 106 patients with suspected NAFLD who underwent a hepatic parenchymal biopsy. MR-PDFF and MR spectroscopy were performed on all patients using a 3.0-T scanner. Following whole-volume segmentation of the MRPDFF images, 833 radiomic features were analyzed using a commercial program. Radiologic features were analyzed, including median and mean values of the multiple regions of interest and variable clinical features. A random forest regressor was used to extract the important radiomic, radiologic, and clinical features. The model was trained using 20 repeated 10-fold cross-validations to classify the NAFLD steatosis grade. The area under the receiver operating characteristic curve (AUROC) was evaluated using a classifier to diagnose steatosis grades. Results: The levels of pathological hepatic steatosis were classified as low-grade steatosis (grade, 0–1; n = 82) and high-grade steatosis (grade, 2–3; n = 24). Fifteen important features were extracted from the radiomic analysis, with the three most important being wavelet-LLL neighboring gray tone difference matrix coarseness, original first-order mean, and 90th percentile. The MR spectroscopy mean value was extracted as a more important feature than the MR-PDFF mean or median in radiologic measures. Alanine aminotransferase has been identified as the most important clinical feature. The AUROC of the classifier using radiomics was comparable to that of radiologic measures (0.94 ± 0.09 and 0.96 ± 0.08, respectively). Conclusion: MR-PDFF-derived radiomics may provide a comparable alternative for grading hepatic steatosis in patients with suspected NAFLD.

Correlation between Computed Tomography and Pathological Findings of Gastrointestinal Stromal Tumors Treated with Imatinib Mesylate

심기춘,박범진,한나연,성득제,김민주,조성범,하현권,김형래 대한영상의학회 2014 대한영상의학회지 Vol.71 No.5

Purpose: To evaluate the correlation between pathological and computed tomography (CT) findings of gastrointestinal stromal tumors (GISTs) after imatinib mesylate (imatinib) treatment. Materials and Methods: Twenty-six patients with GIST (17 men, 9 women; mean age, 56 years) who underwent treatment with imatinib and who were registered at our institution were included. Eight patients had primary and 18 had metastatic tumors. The correlation between CT and pathological findings was evaluated for all 26 tumors, which were resected after imatinib treatment. Results: The mean size change in the tumors after imatinib treatment was -1.4 cm (range, -7.8—2.5 cm). A reduction in tumor CT attenuation value was observed after imatinib treatment (mean, 29.1 Hounsfield units) in 20 of 26 tumors. Reduced attenuation was associated with non-tumorous pathological findings, including cystic degeneration (6/20), hemorrhagic necrosis (6/20), hyaline degeneration (6/20), and combined pathology without a viable portion (2/20). Of six tumors showing increased attenuation values after treatment, four (66.7%) showed an abundant viable portion. The increase in tumor size was not associated with the presence of a viable portion in any tumor. Conclusion: CT attenuation changes in GISTs may adequately reflect the pathological findings in GISTs after imatinib treatment.

Unusual venous route of pulmonary artery catheter in a liver transplant recipient: pericardiophrenic or highest intercostal vein? -a case report-

박지현,이수호,심기춘,황규삼 대한마취통증의학회 2014 Korean Journal of Anesthesiology Vol.67 No.1

We report an extraordinary case in which the venous route for pulmonary artery catheterization was unusual. A 41 year-old woman with an end-stage liver disease underwent a living-donor liver transplantation. After induction of anesthesia, the pulmonary artery catheter was revealed to be advanced into the left brachiocephalic vein and then slipped into another vein that drains into the left brachiocephalic vein. In this case, we assumed that the catheter had most likely slipped into the left pericardiophrenic vein since the catheter follows the left heart border similarly to the route of this vein according to the chest X-ray. Patients with liver cirrhosis develop many collateral vessels and have enlarged veins due to portal hypertension, which makes this vascular route possible. We present this case for anesthesiologists to be aware of the possibilities of unusual venous route due to dilated collateral vessels especially in liver transplant patients.

Radiologic Findings of Renal Schwannoma: A Case Report and Literature Review

황성태,성득제,심기춘,한나연,박범진,김민주,이정현 대한영상의학회 2018 대한영상의학회지 Vol.78 No.4

Schwannoma is a benign nerve sheath tumor that involves Schwann cells mostly found in the head, neck, posterior mediastinum and extremities. Schwannoma develops rarely in the retroperitoneum; thus, renal schwannoma is extremely uncommon. Differentiation of renal schwannoma from renal cell carcinoma is difficult with radiologic analysis. A few cases of these tumors have been reported in literature, and little has been described regarding imaging appearances. In this study, we present a rare case of a renal schwannoma, resembling renal cell carcinoma, with radiological correlations.

MR Imaging Findings of Tamoxifenassociated Uterine Adenosarcoma: Report of Two Cases

최수연,성득제,한나연,박범진,김민주,심기춘,조성범 대한자기공명의과학회 2015 Investigative Magnetic Resonance Imaging Vol.19 No.1

Adenosarcoma of the uterus is a rare biphasic tumor containing benign glandularepithelial and malignant mesenchymal components. The tumor has been reportedto be associated with antiestrogen therapy, particularly tamoxifen, but there havebeen a few case reports with MRI. We present two cases of MRI findings of uterineadenosarcoma after antiestrogen therapy, tamoxifen and toremifene in breast cancerpatients. The tumor presents as a large polypoid mass occupying the endometrialcavity, and may protrude into the vagina. On MRI, the tumor typically shows solidcomponents with scattered small cysts and heterogeneous enhancement. Thesefindings are not significantly different from conventional adenosarcoma.

Renal Malakoplakia with Wide Extension into the Retroperitoneum: A Case Report

최수연,성득제,한나연,박범진,김민주,심기춘,조성범,이유진 대한영상의학회 2015 대한영상의학회지 Vol.73 No.1

Malakoplakia is a rare chronic inflammatory condition that results from defective phagolysosomal activity. Malakoplakia usually affects the urinary tract, and immunosuppression is a predisposing factor in most patients. A 78-year-old woman undergoing long-term steroid treatment presented with right flank pain. CT demonstrated a large, multilocular cystic mass with focal enhancing solid portion in the right kidney and retroperitoneum. The patient underwent ultrasonography-guided biopsy for enhancing the solid portion, and pathologic examination revealed malakoplakia.

MRI Findings of Obstructed Hemivagina and Ipsilateral Renal Agenesis (OHVIRA syndrome) with a Blind Megaureter: Case Report

조윤희,성득제,한나연,박범진,김민주,심기춘,조성범 대한자기공명의과학회 2015 Investigative Magnetic Resonance Imaging Vol.19 No.3

Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is anuncommon congenital abnormality of the female urogenital tract characterized bythe triad of uterine didelphys, obstructed hemivagina, and ipsilateral renal agenesis. A 13-year-old female presented with acute lower abdominal pain. Magneticresonance imaging (MRI) revealed uterine didelphys, hematometrocolpos, obstructedhemivagina, and right ipsilateral agenesis, consistent with OHVIRA syndrome. Also, awell-defined mass with fluid signal intensity, mimicking adnexal neoplasm was seenin the right lower pelvic cavity adjacent to the posterior wall of the bladder. Vaginalseptotomy and drainage of hematometrocolpos were done initially, but unilateralhysterectomy was later performed to relieve the patient’s symptoms. The cystic massin the right lower pelvic cavity was also excised and confirmed as a blind megaureter.

A Rare Case of Small Bowel Undifferentiated Pleomorphic Sarcoma: Imaging Findings on CT and Magnetic Resonance Enterography

한예은,채수영,이정현,박범진,성득제,한나연,심기춘,김민주 대한영상의학회 2019 대한영상의학회지 Vol.80 No.1

Gastrointestinal tract involvement in undifferentiated pleomorphic sarcoma (UPS) is extremely rare. To the authors’ knowledge, only 21 cases of primary small bowel UPS have been reported in the literature available in English. Reported CT findings in primary small bowel UPS have been nonspecific, and MRI findings have been reported in only one case. The present article describes a case involving a 72-year-old male with histologically confirmed primary UPS arising from the ileum, focusing on both CT and magnetic resonance enterography findings. On CT, primary small bowel UPS was noted as a heterogeneously enhanced small bowel mass without obstruction. Magnetic resonance enterography revealed heterogeneous intermediate T1 and T2 signal intensity, with hemorrhagic or necrotic foci within the mass and heterogeneous enhancement. The differential diagnosis included malignant gastrointestinal tumor; however, the prognosis of UPS is worse, with higher incidences of extra-abdominal metastasis.