Magnetic Resonance Evaluation of Müllerian Remnants in Mayer-Rokitansky-Küster-Hauser Syndrome

유노을,조정연,김상윤,김승협 대한영상의학회 2013 Korean Journal of Radiology Vol.14 No.2

Objective: To analyze magnetic resonance imaging (MRI) findings of Müllerian remnants in young females clinically suspected of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome in a primary amenorrhea workup. Materials and Methods: Fifteen young females underwent multiplanar T2- and transverse T1-weighted MRI at either a 1.5T or 3.0T MR imager. Two gynecologic radiologists reached consensus decisions for the evaluation of Müllerian remnants, vagina, ovaries, and associated findings. Results: All cases had bilateral uterine buds in the pelvic cavity, with unilateral cavitation in two cases. The buds had an average long-axis diameter of 2.64 ± 0.65 cm. In all cases, bilateral buds were connected with fibrous band-like structures. In 13 cases, the band-like structures converged at the midline or a paramedian triangular soft tissue lying above the bladder dome. The lower one-third of the vagina was identified in 14 cases. Fourteen cases showed bilateral normal ovaries near the uterine buds. One unilateral pelvic kidney, one unilateral renal agenesis, one mild scoliosis, and three lumbar sacralization cases were found as associated findings. Conclusion: Typical Müllerian remnants in MRKH syndrome consist of bilateral uterine buds connected by the fibrous bandlike structures, which converge at the midline triangular soft tissue lying above the bladder dome.

Percutaneous N-Butyl Cyanoacrylate Embolization of a Pancreatic Pseudoaneurysm after Failed Attempts of Transcatheter Embolization

김리현,유노을,김효철 대한영상의학회 2014 대한영상의학회지 Vol.71 No.4

One common complication after major pancreatic surgery is bleeding. Herein we describe a case of pancreatic pseudoaneurysm which developed after pylorous preserving pancreaticoduodenectomy for common bile duct cancer. Three attempts of transcatheter embolization failed since feeders to the pseudoaneurysm had unfavorable anatomy. Direct percutaneous N-butyl cyanoacrylate injection was performed under fluoroscopy-guidance and the pseudoaneurysm was successfully treated. Percutaneous fluoroscopy-guided direct N-butyl cyanoacrylate injection may be a useful alternative when selective transcatheter embolization fails or is technically challenging.

Ossification of the Medial Clavicular Epiphysis on Chest Radiographs: Utility and Diagnostic Accuracy in Identifying Korean Adolescents and Young Adults under the Age of Majority

윤순호,류혜진,유노을,임현주,윤정화,박창민,이상섭,유성호 대한의학회 2016 Journal of Korean medical science Vol.31 No.10

The aim of our study was to evaluate the utility and diagnostic accuracy of the ossification grade of medial clavicular epiphysis on chest radiographs for identifying Korean adolescents and young adults under the age of majority. Overall, 1,151 patients (age, 16-30) without any systemic disease and who underwent chest radiography were included for ossification grading. Two radiologists independently classified the ossification of the medial clavicular epiphysis from chest radiographs into five grades. The age distribution and inter-observer agreement on the ossification grade were assessed. The diagnostic accuracy of the averaged ossification grades for determining whether the patient is under the age of majority was analyzed by using receiver operating characteristic (ROC) curves. Two separate inexperienced radiologists assessed the ossification grade in a subgroup of the patients after reviewing the detailed descriptions and image atlases developed for ossification grading. The median value of the ossification grades increased with increasing age (from 16 to 30 years), and the trend was best fitted by a quadratic function (R-square, 0.978). The inter-observer agreements on the ossification grade were 0.420 (right) and 0.404 (left). The area under the ROC curve (AUC) was 0.922 (95% CI, 0.902-0.942). The averaged ossification scores of 2.62 and 4.37 provided 95% specificity for a person <19 years of age and a person ≥19 years of age, respectively. A preliminary assessment by inexperienced radiologists resulted in an AUC of 0.860 (95% CI, 0.740-0.981). The age of majority in Korean adolescents and young adults can be estimated using chest radiographs.

Application of Synthetic MRI for Direct Measurement of Magnetic Resonance Relaxation Time and Tumor Volume at Multiple Time Points after Contrast Administration: Preliminary Results in Patients with Brain Metastasis

강경미,최승홍,Moonjung Hwang,유노을,윤태진,김지훈,손철호 대한영상의학회 2018 Korean Journal of Radiology Vol.19 No.4

Objective: The purpose of this study was to investigate the time-dependent effects of contrast medium on multi-dynamic, multi-echo (MDME) sequence in patients with brain metastases. Materials and Methods: This study included 7 patients with 15 brain metastases who underwent magnetic resonance (MR) examination which included MDME sequences at 1 minute, 10 minutes and 20 minutes after contrast injection. Two volumes of interests, covering an entire tumor (whole tumor) and the enhancing portion of the tumor, were derived from postcontrast synthetic T1-weighted images. Statistical comparisons were performed for three different time delays for histogram parameters of the longitudinal relaxation rate (R1) and the transverse relaxation rate (R2), and lesion volumes. Results: The mean and the median of R1 and the mean of R2 in both the whole tumor and the inner enhancing portion were larger on the 10 minutes delayed images than on the 1 minute or 20 minutes delayed images (mean of R1 in the whole tumor on the 1 minute, 10 minutes, and 20 minutes delayed images: 1.26 ms, 1.39 ms, and 1.37 ms; mean of R1 in the inner enhancing portion: 1.43 ms, 1.53 ms and 1.44 ms; all p < 0.017). The volumes of the whole tumor and the inner enhancing portion were significantly larger in the 10 minutes and 20 minutes delayed images than on the 1 minute delayed images (all p < 0.017). Conclusion: Magnetic resonance relaxation times and the volumes of the whole tumor and the inner enhancing portion were measured larger on the 10 minutes or 20 minutes delayed images than on the 1 minute delayed images. The MDME sequence immediately after contrast injection cannot fully reflect the effects of gadolinium-based contrast agent leakage in the tissue.

Distribution and malignancy risk of six categories of the pathology reporting system for thyroid core-needle biopsy in 1,216 consecutive thyroid nodules

손혜민,김지훈,김수진,유노을,배정모,서효빈,나동규 대한초음파의학회 2020 ULTRASONOGRAPHY Vol.39 No.2

Purpose: The purpose of this study was to present the distribution of lesions among the six categories of the pathology reporting system for thyroid core-needle biopsy (CNB), along with the range of malignancy risk of each category based on different diagnostic criteria for benignity in a clinical cohort. Methods: For 1,216 consecutive nodules (≥1 cm) of 1,125 patients who underwent CNB at two hospitals, the diagnostic results based on the six categories of thyroid CNB were analyzed. Patients were divided into three groups according to prior fine-needle aspiration (FNA) status: second-line CNB for nodules where prior FNA yielded nondiagnostic or unsatisfactory results (n=57), second-line CNB for nodules with prior FNA results of atypia/follicular lesion of undetermined significance (AUS/FLUS) (n=303), and first-line CNB (n=856). Results: The proportion of nodules in each CNB category and the range of the malignancy rate for each category was as follows, in order from category I to VI: 1.8%, 23.1%-75.0%; 57.9%, 0.7%-16.7%; 16.0%, 13.2%-46.7%; 8.8%, 53.8%-56.8%; 2.0%, 100%; and 13.5%, 100%. First-line CNB was associated with a higher rate of conclusive diagnoses (category II, IV, or VI) (725 of 856, 84.7%) than second-line CNB with prior nondiagnostic or AUS/FLUS FNA results (241 of 360, 66.9%; P<0.001). Conclusion: The overall distribution of nodules across the six categories of thyroid CNB and the ranges of malignancy risk for those categories were presented in a clinical cohort. Firstline CNB tended to produce a higher rate of conclusive results than second-line CNB with prior inconclusive FNA results.

Cerebrovascular Reservoir and Arterial Transit Time Changes Assessed by Acetazolamide-Challenged Multi-Phase Arterial Spin Labeling Perfusion MRI in Chronic Cerebrovascular Steno-Occlusive Disease

황인평,손철호,정근화,연응구,이지예,유노을,강경미,윤태진,최승홍,김지훈 대한영상의학회 2021 대한영상의학회지 Vol.82 No.3

Purpose To explore cerebrovascular reservoir (CVR) and arterial transit time (ATT) changes using acetazolamide-challenged multi-phase arterial spin labeling (MP-ASL) perfusion-weighted MRI in chronic cerebrovascular steno-occlusive disease. Materials and Methods This retrospective study enrolled patients with chronic steno-occlusion who underwent acetazolamide-challenged MP-ASL between June 2019 and October 2020. Cerebral blood flow, CVR, basal ATT, and ATT changes associated with severe stenosis, total occlusion, and chronic infarction lesions were compared. Results There were 32 patients (5 with bilateral steno-occlusion) in our study sample. The CVR was significantly reduced during total occlusion compared with severe stenosis (26.2% ± 28.8% vs. 41.4% ± 34.1%, respectively, p = 0.004). The ATT changes were not significantly different (p = 0.717). The CVR was marginally lower in patients with chronic infarction (29.6% ± 39.1% vs. 38.9% ± 28.7%, respectively, p = 0.076). However, the ATT was less shortened in patients with chronic infarction (-54 ± 135 vs. -117 ± 128 ms, respectively, p = 0.013). Conclusion Acetazolamide-challenged MP-ASL provides an MRI-based CVR evaluation tool for chronic steno-occlusive disease.

Microcatheter Looping to Facilitate Aneurysm Selection in Coil Embolization of Paraclinoid Aneurysms

조영대,Jong Kook Rhim,Jeong Jin Park,Jin Sue Jeon,유노을,강현승,김정은,조원상,한문희 대한영상의학회 2015 Korean Journal of Radiology Vol.16 No.4

Described herein is a microcatheter looping technique to facilitate aneurysm selection in paraclinoid aneurysms, which remains to be technically challenging due to the inherent complexity of regional anatomy. This retrospective study was approved by our Institutional Review Board, and informed consent was waived. Microcatheter looping method was employed in 59 patients with paraclinoid aneurysms between January 2012 and December 2013. In the described technique, construction of a microcatheter loop, which is steam-shaped or preshaped, based on the direction of aneurysms, is mandatory. The looped tip of microcatheter was advanced into distal internal carotid artery and positioned atop the target aneurysm. By steering the loop (via inner microguidewire) into the dome of aneurysm and easing tension on the microcatheter, the aneurysm was selected. Clinical and morphologic outcomes were assessed with emphasis on technical aspects of the treatment. Through this looping technique, a total of 59 paraclinoid aneurysms were successfully treated. After aneurysm selection as described, single microcatheter technique (n = 25) was most commonly used to facilitate coiling, followed by balloon protection (n = 21), stent protection (n = 7), multiple microcatheters (n = 3), and stent/balloon combination (n = 3). Satisfactory aneurysmal occlusion was achieved through coil embolization in 44 lesions (74.6%). During follow-up of 53 patients (mean interval, 10.9 ± 5.9 months), only one instance (1.9%) of major recanalization was observed. There were no complications related to microcatheter looping. This microcatheter looping method facilitates safe and effective positioning of microcatheter into domes of paraclinoid aneurysms during coil embolization when other traditional microcatheter selection methods otherwise fail.

Corrigendum: Author's Name Correction. Study Protocol of Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro)

문재훈,김지훈,이은경,이규은,공성혜,김여군,정우진,이창윤,유노을,황보율,송영신,김민주,조선욱,김수진,정은재,최준영,류창환,이유진,하정훈,정유석,류준선,황윤지,Sue K. Park,성호경,이가희,박도준,박영주 대한내분비학회 2018 Endocrinology and metabolism Vol.33 No.3

Study Protocol of Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro)

문재훈,김지훈,이은경,이규은,공성혜,김여군,정우진,이창윤,유노을,황보율,송영신,김민주,조선욱,김수진,정은재,최준영,유창환,이유진,하정훈,정유성,류준선,황윤지,Sue K. Park,성호경,이가희,박도준,박영주 대한내분비학회 2018 Endocrinology and metabolism Vol.33 No.2

Background: The ongoing Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) aims to observe the natural course of papillary thyroid microcarcinoma (PTMC), develop a protocol for active surveillance (AS), and compare the long-term prognosis, quality of life, and medical costs between the AS and immediate surgery groups. Methods: This multicenter prospective cohort study of PTMC started in June 2016. The inclusion criteria were suspicious of malignancy or malignancy based on fine needle aspiration or core needle biopsy, age of ≥18 years, and a maximum diameter of ≤1 cm. If there was no major organ involvement, no lymph node/distant metastasis, and no variants with poor prognosis, the patients were explained of the pros and cons of immediate surgery and AS before selecting AS or immediate surgery. Follow-up visits (physical examination, ultrasonography, thyroid function, and questionnaires) are scheduled every 6 months during the first 2 years, and then every 1 year thereafter. Progression was defined as a maximum diameter increase of ≥3, ≥2 mm in two dimensions, suspected organ involvement, or lymph node/distant metastasis. Results: Among 439 enrolled patients, 290 patients (66.1%) chose AS and 149 patients (33.9%) chose immediate surgery. The median follow-up was 6.7 months (range, 0.2 to 11.9). The immediate surgery group had a larger maximum tumor diameter, compared to the AS group (7.1±1.9 mm vs. 6.6±2.0 mm, respectively; P=0.014). Conclusion: The results will be useful for developing an appropriate PTMC treatment policy based on its natural course and risk factors for progression.