Journal of the Korean Society of Radiology最新文献

Cerebral hyperperfusion syndrome is a rare complication that can occur following carotid artery revascularization procedures in patients with chronic carotid artery stenosis. Cases of hyperperfusion syndrome resulting solely from intravenous tissue plasminogen activator administration, without a history of revascularization, are extremely rare. Only four of such cases have been reported with imaging evidence. This report presents a case of early neurological deterioration in acute ischemic stroke, identified as a form of hyperperfusion syndrome. Imaging evidence supports this diagnosis, and highlights the occurrence of hyperperfusion syndrome after intravenous tissue plasminogen activator administration.

Breast manifestations of autoimmune diseases are rare but may present as localized disease or as part of a systemic disease. The most common clinical presentations of autoimmune mastitis are palpable masses and mastalgia, but patients can also be asymptomatic. Its radiological features are nonspecific and varied; it usually appears as an irregular hypoechoic mass or ill-defined hypoechoic nonmass lesion that mimics malignancy, with or without duct ectasia on breast ultrasonography. On breast MRI, segmental or regional nonmass enhancement is observed. However, due to its nonspecific and rapid changes in its clinical and radiological features, its diagnosis is often challenging and delayed. Herein, we present a rare case of mastitis with mammary duct ectasia in a patient with Behcet's syndrome and its rapid changes in imaging features on serial radiologic studies. Furthermore, we review the literature focusing on the radiologic and histopathologic characteristics of autoimmune mastitis.

Purpose: We assessed the proportion of patients with a focal intrahepatic stricture (FIHS) that was a precursor lesion or malignancy and visualized only as a duct dilatation.

Materials and methods: This retrospective study assessed patients who underwent surgery or biopsy for an FIHS on CT or MRI between January 2010 and March 2022. The number and proportion of non-precursor benign lesions, precursors, and malignancies were calculated. Clinical variables and imaging features were compared between non-premalignant benign and premalignant/malignant FIHSs.

Results: Twenty-eight patients with confirmed histopathological diagnoses were identified, including 15 men (54.0%) and 13 women (46.0%). The median age of all patients at the first imaging diagnosis was 65 ± 9.54 (range, 43-78) years. Of the 28 patients with FIHSs, 9 (32%) were diagnosed with cholangiocarcinoma and 7 (25%) were diagnosed with precursor lesions, which included six intraductal papillary neoplasms of the bile duct and one biliary intraepithelial neoplasm. Accordingly, 16 (57%) patients had malignant or precursor lesions, and 12 (43%) were diagnosed with non-precursor benign lesions. None of the clinical variables and imaging features used for analysis showed a statistically significant difference between the non-premalignant benign and premalignant/malignant FIHS groups (p > 0.05).

Conclusion: FIHSs visualized only as duct dilatation can harbor malignant or precursor lesions.

In 2023, the Korean Core Data for Interoperability (KR-CDI), comprising 77 elements, was established as a compliance item for healthcare data exchange in Korea to promote patient-centered medical information exchange and reestablish national interoperability in healthcare standardization. Radiologic examinations are in the core classification of diagnostic imaging tests, and the examination name, results, and image data must be exchanged based on standard codes of terminology and transfer. Accordingly, the Korean Society of Radiology has formed a standardization committee that maps radiologic examination names to international standard codes, such as LOINC and SNOMED CT. Additionally, we propose a pilot project for the standardization and exchange of DICOM images and plan a project to map the terms of the Conclusion sections of diagnostic reports to standard codes. The Korean Society of Radiology is actively participating in these efforts.

Active surveillance (AS) has been widely adopted as an alternative to immediate surgery owing to the indolent nature and favorable outcomes of papillary thyroid microcarcinoma (PTMC). AS is generally recommended for tumors measuring ≤1 cm without aggressive cytological subtypes, risk of gross extrathyroidal extension (ETE), lymph node metastasis (LNM), or distant metastasis. AS requires careful patient selection based on various patient and tumor characteristics, and ultrasound (US) findings. Moreover, during AS, regular US is performed to monitor any signs of tumor progression, including tumor growth, new US features of potential gross ETE, and LNM. Therefore, appropriate imaging-based assessment plays a crucial role in determining whether AS or surgery should be pursued. However, detailed recommendations concerning US evaluation are currently insufficient, necessitating the formulation of this guideline. The Korean Society of Thyroid Radiology has developed a consensus statement for low-risk PTMC, covering US assessment methods when considering AS as a management option and conducting follow-up imaging tests during AS. This guideline aims to provide optimal scientific evidence and expert opinion consensus regarding a standardized US-based assessment protocol for low-risk PTMC.

Specialized medical equipment plays a crucial role in disease diagnosis and treatment in Korea. However, improper management can lead to unnecessary examinations, increased medical costs, and patient safety concerns. This review discusses the significance of exclusively and non-exclusively affiliated radiologists, focusing on changes in regulations governing the management of specialized medical equipment and the recent issue of MRI staffing standards. In addition, regulatory changes in the past and present, problems regarding the shared hospital bed system, and operational challenges with mammography and MRI are addressed. Lastly, the importance of exclusively affiliated radiologists in ensuring imaging quality control and patient safety is emphasized.

The spleen is occasionally referred to as the 'forgotten organ' because splenic lesions are less common and encountered rarely compared to pathologies of other abdominal solid organs. Therefore, although well-demonstrated using various abdominal imaging modalities, radiologists tend to be less familiar with splenic diseases, making interpretation challenging. This study aimed to review common and uncommon splenic diseases and illustrate the multimodal imaging (including ultrasonography, CT, MRI, and PET/CT) features of these lesions in correlation with their histopathology. Recognizing the radiological findings of various splenic lesions helps narrow down the differential diagnosis and guide appropriate clinical decision-making for radiologists.

Cardiac rupture is a rare but fatal complication among patients undergoing cardiopulmonary resuscitation (CPR). Myocardial rupture can manifest as a discontinuity in the myocardial wall, communication between the ventricle or atrium and the pericardium, hemopericardium, or active extravasation of contrast into the pericardium. It can also occur alongside pericardial rupture or hemothorax. Diagnosing myocardial rupture via imaging is uncommon due to its clinical urgency and high mortality rate. We present a rare case of a 50-year-old man who developed a right atrial rupture, as seen on CT angiography, following CPR and venoarterial extracorporeal membrane oxygenation (VA-ECMO) for sudden cardiac arrest.

Lupus mastitis is a presentation of lupus panniculitis that involves subcutaneous fat in patients with systemic lupus erythematosus (SLE). Moreover, lupus mastitis is a rare condition that typically presents as a palpable breast mass. Here, we report the case of a 29-year-old woman with a prior diagnosis of SLE who presented with palpable lumps in both breasts. Imaging studies were performed, and mammography revealed extensive and bizarre calcifications, mainly in the retromammary area. US revealed large irregular calcifications with posterior shadowing, and breast MRI images exhibited diffuse irregular persistent rim enhancement in the retromammary area. An US-guided biopsy was performed to differentiate the condition from breast cancer and confirmed the diagnosis of fat necrosis, consistent with the pathological characteristics of lupus mastitis. Herein, we present a case of lupus mastitis, an unusual clinical manifestation of SLE, and discuss the clinical, pathological, and imaging findings supporting the diagnosis and the differential diagnosis.

Pulmonary tumoral thrombotic microangiopathy (PTTM) is a rare but fatal complication in patients with cancer that causes death due to sudden respiratory distress, pulmonary hypertension, and right ventricular dysfunction. Early diagnosis and intensive treatment are important for improving patient prognosis. Herein, we describe the clinical and CT findings of 10 patients who were clinically diagnosed with PTTM at our hospital over the past 18 years. In patients with cancer complaining of dyspnea and hypoxia, CT findings such as right ventricular and pulmonary artery dilatation, perivascular or subpleural ground-glass opacity or consolidation, micronodules with a ground-glass halo, peripheral pulmonary vessel dilatation, and interlobular septal thickening may suggest PTTM.