Journal of Yeungnam Medical Science

Review article

Hepatic encephalopathy on magnetic resonance imaging and its uncertain differential diagnoses: a narrative review: Chun Geun Lim, Myong Hun Hahm, Hui Joong Lee; J Yeungnam Med Sci. 2023;40(2):136-145. Published online January 10, 2023; DOI: https://doi.org/10.12701/jyms.2022.00689

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Hepatic encephalopathy (HE) is a severe neuropsychiatric abnormality in patients with either acute or chronic liver failure. Typical brain magnetic resonance imaging findings of HE are bilateral basal ganglia high signal intensities due to manganese deposition in chronic liver disease and hyperintensity in T2, fluid-attenuated inversion recovery, or diffusion-weighted imaging (DWI) with hemispheric white matter changes including the corticospinal tract. Low values on apparent diffusion coefficient mapping of the affected area on DWI, indicating cytotoxic edema, can be observed in acute HE. However, neuropsychological impairment in HE ranges from mild deficits in psychomotor abilities affecting quality of life to stupor or coma with higher grades of hepatic dysfunction. In particular, the long-lasting compensatory mechanisms for the altered metabolism in chronic liver disease make HE imaging results variable. Therefore, the clinical relevance of imaging findings is uncertain and differentiating HE from other metabolic diseases can be difficult. The recent introduction of concepts such as “acute-on-chronic liver failure (ACLF),” a new clinical entity, has led to a change in the clinical view of HE. Accordingly, there is a need to establish a corresponding concept in the field of neuroimaging diagnosis. Herein, we review HE from a historical and etiological perspective to increase understanding of brain imaging and help establish an imaging approach for advanced new concepts such as ACLF. The purpose of this manuscript is to provide an understanding of HE by reviewing neuroimaging findings based on pathological and clinical concepts of HE, thereby assisting in neuroimaging interpretation.

Citations

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Pattern Clustering of Symmetric Regional Cerebral Edema on Brain MRI in Patients with Hepatic Encephalopathy
Chun Geun Lim, Hui Joong Lee
Journal of the Korean Society of Radiology.2024; 85(2): 381. CrossRef
Rule out all differential causes before attributing cerebral bleeding to 5-aminolevulinic acid
Josef Finsterer, Sounira Mehri
Child's Nervous System.2023; 39(4): 847. CrossRef
Minimal hepatic encephalopathy: clinical, neurophysiological, neuroimaging markers
P. I. Kuznetsova, A. A. Raskurazhev, S. N. Morozova, I. M. Lovchev, M. S. Novruzbekov, M. M. Tanashyan
Russian neurological journal.2023; 28(5): 21. CrossRef

Case report

Transient osteoporosis of the hip with a femoral neck fracture during follow-up: a case report: Yusuke Tabata, Shuhei Matsui, Masabumi Miyamoto, Koichiro Omori, Yoichiro Tabata, Tokifumi Majima; J Yeungnam Med Sci. 2023;40(2):212-217. Published online September 26, 2022; DOI: https://doi.org/10.12701/jyms.2022.00479

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Abstract PDF

We report a case of transient osteoporosis of the hip with a femoral neck fracture found during follow-up. A 53-year-old man presented with left hip pain without trauma. The pain did not improve after 2 weeks and he was brought to our hospital by ambulance. Magnetic resonance imaging (MRI) of the left hip joint showed diffuse edema in the bone marrow, which was identified by low signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and increased signal intensity on short tau inversion recovery. This edema extended from the femoral head and neck to the intertrochanteric area. He was diagnosed with transient osteoporosis of the left hip. Rest gradually improved his pain; however, 3 weeks later, his left hip pain worsened without trauma. X-ray, computed tomography, and MRI results of the hip joint demonstrated a left femoral neck fracture, and osteosynthesis was performed. Differential diagnoses included avascular necrosis of the femoral head, infection, complex regional pain syndrome, rheumatoid arthritis, leukemia, and other cancers. Transient osteoporosis of the hip generally has a good prognosis with spontaneous remission within a few months to 1 year. However, a sufficient length of follow-up from condition onset to full recovery is necessary to avoid all probable complications such as fractures.

Citations

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Hip effusion/synovitis influences results after multiple drilling core decompression for bone marrow edema syndrome of hip
Hua-zhang Xiong, Yan-li Peng, Yu-hong Deng, Ying Jin, Ming-hong Tu, Shu-hong Wu
BMC Surgery.2023;[Epub] CrossRef

Resident fellow section: Teaching images

A 40-year-old man with neuropathic pain in the entire left foot: Jae Hwa Bae, Mathieu Boudier-Revéret, Min Cheol Chang; J Yeungnam Med Sci. 2023;40(2):223-224. Published online August 30, 2022; DOI: https://doi.org/10.12701/jyms.2022.00486

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Original article

Clinical impact of spine magnetic resonance imaging as a valuable prognostic tool for patients with multiple myeloma: a retrospective study: Jung Min Lee, Hee Jeong Cho, Joon-Ho Moon, Sang Kyun Sohn, Byunggeon Park, Dong Won Baek; J Yeungnam Med Sci. 2022;39(4):300-308. Published online March 23, 2022; DOI: https://doi.org/10.12701/jyms.2021.01648

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Abstract PDF Supplementary Material

Background
This study investigated the prognostic impact of spine magnetic resonance imaging (MRI) in patients newly diagnosed with multiple myeloma (MM).
Methods
We retrospectively evaluated 214 patients who were newly diagnosed with MM between March 2015 and December 2019. The patients were classified into five different infiltration patterns based on spine MRI as follows: (1) normal appearance, (2) focal, (3) diffuse, (4) combined focal and diffuse infiltration, and (5) “salt-and-pepper.”
Results
Forty patients (18.7%) showed a normal appearance, whereas focal, diffuse, combined focal and diffuse infiltration, and “salt-and-pepper” patterns were identified in 68 (31.8%), 40 (18.7%), 52 (24.3%), and 14 patients (6.5%), respectively. The patients with normal and “salt-and-pepper” patterns were younger than patients with other patterns (median age, 61.6 vs. 66.8 years; p=0.001). Moreover, 63% and 59.3% of patients with normal and “salt-and-pepper” patterns were scored International Staging System (ISS) stage I and revised ISS (R-ISS) stage I, respectively, whereas only 12.5% of patients with other patterns were scored ISS stage I and R-ISS stage I. Patients with normal and “salt-and-pepper” patterns had a better prognosis than those with other patterns, whereas relapse and death rates were significantly higher in patients with focal, diffuse, and combined MRI patterns.
Conclusion
Characteristic MRI findings have a significant prognostic value for long-term survival in patients newly diagnosed with MM. In particular, focal, diffuse, and combined focal and diffuse infiltration patterns are unfavorable prognostic factors.

Citations

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Lesions of the spinal cord caused by multiple myeloma: A systematic review and meta-analysis regarding the neurosurgical aspects of patient management
Daniel Encarnacion, Gennady E Chmutin, Ismail Bozkurt, Jack Wellington, Emmanuel Batista Geraldino, Bipin Chaurasia
Journal of Craniovertebral Junction and Spine.2023; 14(4): 313. CrossRef

Case reports

Posterior reversible encephalopathy syndrome related to anemia correction in a patient with uterine myoma: a case report: Jisun Lee, Hyun Jung Lee; J Yeungnam Med Sci. 2022;39(4):336-340. Published online September 23, 2021; DOI: https://doi.org/10.12701/yujm.2021.01375

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Abstract PDF Supplementary Material: Although posterior reversible encephalopathy syndrome (PRES) is induced by various causes, a few cases have occurred after severe anemia correction. In this case report, a 45-year-old female patient visited emergency department with a chief complaint of dizziness due to severe anemia related to hypermenorrhea caused by uterine myoma. Before her operation, she had an abrupt headache and seizure during anemia correction with transfusion and injection of gonadotropin-releasing hormone agonist. Immediately after the operation, she experienced visual disturbances, followed by limb weakness and tonic-clonic movements. Magnetic resonance imaging showed alterations in parietal and occipital lobes suggesting cerebrovascular edema with hypoperfusion. Here, we presented and discussed the clinical and radiologic features of PRES related to anemia correction.

Multilocular cystic hemangioma of the liver mimicking mucinous cystic neoplasm: a case report: Nam Kyung Lee, Suk Kim, Seung Baek Hong, So Jeong Lee, Hyung Il Seo; J Yeungnam Med Sci. 2022;39(1):53-57. Published online April 7, 2021; DOI: https://doi.org/10.12701/yujm.2021.00969

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Abstract PDF: Hepatic hemangiomas infrequently exhibit atypical imaging features, which may cause diagnostic confusion with hepatic malignancies and lead to unnecessary surgery. We report a rare case of multilocular cystic hemangioma of the liver mimicking a mucinous cystic neoplasm of the liver in a 48-year-old female, focusing on computed tomography and magnetic resonance imaging features and their differential diagnosis.

Ultrasonographic and magnetic resonance images of a gluteus maximus tear: Jong Bum Kim, Wonho Lee, Min Cheol Chang; Yeungnam Univ J Med. 2021;38(2):157-159. Published online July 31, 2020; DOI: https://doi.org/10.12701/yujm.2020.00500

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Abstract PDF

The diagnosis of a gluteal muscle tear or strain is based on clinical findings. However, for an accurate diagnosis, imaging examinations are also needed. Herein, we describe the case of a patient with a gluteus maximus muscle tear confirmed by ultrasonography (US) and magnetic resonance imaging (MRI). A 58-year-old woman complained of dull pain in the left lateral gluteal region that she had been experiencing for 8 days. In the axial US image, retraction of the left gluteus maximus muscle was noted around its insertion site in the iliotibial band. On an MRI, a partial tear in the left gluteus maximus was observed at its insertion site in the left iliotibial band. In addition, fluid infiltration due to edema and hemorrhage was observed. A partial left gluteal muscle tear was diagnosed. The patient was treated with physical therapy at the involved region and oral analgesics. She reported relief from the pain after 1 month of treatment. Based on this experience, we recommend US or MRI for accurate diagnosis of muscle tear or strain.

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Essentials of thoracic outlet syndrome: A narrative review
Min Cheol Chang, Du Hwan Kim
World Journal of Clinical Cases.2021; 9(21): 5804. CrossRef
Obturator hernia - a rare etiology of lateral thigh pain: A case report
Jun Young Kim, Min Cheol Chang
World Journal of Clinical Cases.2021; 9(34): 10728. CrossRef

Review article

Drug selection for sedation and general anesthesia in children undergoing ambulatory magnetic resonance imaging: Sung Mee Jung; Yeungnam Univ J Med. 2020;37(3):159-168. Published online April 17, 2020; DOI: https://doi.org/10.12701/yujm.2020.00171

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Abstract PDF

The demand for drug-induced sedation for magnetic resonance imaging (MRI) scans have substantially increased in response to increases in MRI utilization and growing interest in anxiety in children. Understanding the pharmacologic options for deep sedation and general anesthesia in an MRI environment is essential to achieve immobility for the successful completion of the procedure and ensure rapid and safe discharge of children undergoing ambulatory MRI. For painless diagnostic MRI, a single sedative/anesthetic agent without analgesia is safer than a combination of multiple sedatives. The traditional drugs, such as chloral hydrate, pentobarbital, midazolam, and ketamine, are still used due to the ease of administration despite low sedation success rate, prolonged recovery, and significant adverse events. Currently, dexmedetomidine, with respiratory drive preservation, and propofol, with high effectiveness and rapid recovery, are preferred for children undergoing ambulatory MRI. General anesthesia using propofol or sevoflurane can also provide predictable rapid time to readiness and scan times in infant or children with comorbidities. The selection of appropriate drugs as well as sufficient monitoring equipment are vital for effective and safe sedation and anesthesia for ambulatory pediatric MRI.

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Cristiana Cannata, Thomas Backhaus, Irene Bramke, Maria Caraman, Anna Lombardo, Rhys Whomsley, Caroline T.A. Moermond, Ad M.J. Ragas
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Review of pediatric sedation and anesthesia for radiological diagnostic and therapeutic procedures
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Comparison of airway collapsibility following single induction dose ketamine with propofol versus propofol sedation in children undergoing magnetic resonance imaging: A randomised controlled study
Pooja Bhardwaj, Sakthirajan Panneerselvam, Priya Rudingwa, Kirthiha Govindaraj, M.V.S. Satya Prakash, Ashok S. Badhe, Krishnan Nagarajan
Indian Journal of Anaesthesia.2024; 68(2): 189. CrossRef
Comparison of oral triclofos and intranasal midazolam and dexmedetomidine for sedation in children undergoing magnetic resonance imaging (MRI): an open-label, three-arm, randomized trial
Shyam Chandrasekar, Bhagirathi Dwibedi, Rashmi Ranjan Das, Biswa Mohan Padhy, Bikram Kishore Behera
European Journal of Pediatrics.2023; 182(3): 1385. CrossRef
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Mijung Park, Ji Um, So Hyun Kim, Jiseon Yoon, Yeonjae Lee, Jiyeong Kwon, Seonhee Baek, Dong Yeon Kim
Child Health Nursing Research.2023; 29(1): 51. CrossRef
COMPARISON OF INTRAMUSCULAR VERSUS INTRAVENOUS KETAMINE FOR SEDATION IN CHILDREN UNDERGOING MAGNETIC RESONANCE IMAGING EXAMINATION
Jasim M. Salman, Jasim N. Al-Asadi, Husham H. Abdul-Ra’aoof, Jawad H. Ahmed, Ali H Reshak
Wiadomości Lekarskie.2023; 76(1): 198. CrossRef
Does sevoflurane sedation in pediatric patients lead to “pseudo” leptomeningeal enhancement in the brain on 3 Tesla magnetic resonance imaging?
Kiran Hilal, Kumail Khandwala, Saima Rashid, Faheemullah Khan, Shayan Sirat Maheen Anwar
World Journal of Radiology.2023; 15(4): 127. CrossRef
Intranasal dexmedetomidine versus intranasal midazolam as sole sedative agents for pelviabdominal magnetic resonance imaging in pediatrics: A randomized double-blind trial
TaysserM Abdelraheem, HamdyA Hendawy, AmiraM Elkeblawy
Bali Journal of Anesthesiology.2023; 7(2): 99. CrossRef
Prospective, randomized, double-blind, double-dummy, active-controlled, phase 3 clinical trial comparing the safety and efficacy of intranasal dexmedetomidine to oral midazolam as premedication for propofol sedation in pediatric patients undergoing magnet
Olivia Nzungu Wabelo, Denis Schmartz, Mario Giancursio, Françoise De Pooter, Giulia Caruso, Jean-François Fils, Philippe Van der Linden
Trials.2023;[Epub] CrossRef
The effect of age on outpatient pediatric procedural sedation with intranasal dexmedetomidine and oral midazolam
Xiaqing Zhou, Jialian Zhao, Haiya Tu, Kunwei Chen, Yaoqin Hu, Yue Jin
European Journal of Pediatrics.2023; 183(1): 169. CrossRef
Determination of the normal conus medullaris level in term infants: the role of MRI in early infancy
Mengchun Sun, Benzhang Tao, Gan Gao, Hui Wang, Aijia Shang
Journal of Neurosurgery: Pediatrics.2022; 29(1): 100. CrossRef
Patient background related to success and adverse event in pediatric sedated MRI
Yutaka Konda, Hajime Mihira, Louis Akiyama, Yuki Shiko, Yoshihito Ozawa, Yohei Kawasaki, Katsunori Fujii, Ryugo Hiramoto
Pediatrics International.2022;[Epub] CrossRef
Analysis of Risk Factors for Chloral Hydrate Sedative Failure with Initial Dose in Pediatric Patients: a Retrospective Analysis
Yu Cui, Langtao Guo, Qixia Mu, Lu Kang, Qin Chen, Qunying Wu, Yani He, Min Tang
Pediatric Drugs.2022; 24(4): 403. CrossRef
Using intranasal dexmedetomidine with buccal midazolam for magnetic resonance imaging sedation in children: A single-arm prospective interventional study
Bi Lian Li, Hao Luo, Jun Xiang Huang, Huan Huan Zhang, Joanna R. Paquin, Vivian M. Yuen, Xing Rong Song
Frontiers in Pediatrics.2022;[Epub] CrossRef
A Novel Propofol Dosing Regimen for Pediatric Sedation during Radiologic Tests
Ji-Young Min, Jeong-Rim Lee, Hye-Mi Lee, Ho-Jae Nam, Hyo-Jin Byon
Journal of Clinical Medicine.2022; 11(17): 5076. CrossRef
Psychiatric outcomes following ketamine administration for orthopedic surgical anesthesia
Alec E. Mansour, Elijah W. Hale, Daniel S. Saks
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Artificial intelligence in paediatric radiology: Future opportunities
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Original articles

Usefulness of subtraction pelvic magnetic resonance imaging for detection of ovarian endometriosis: Hyun Jung Lee; Yeungnam Univ J Med. 2020;37(2):90-97. Published online October 10, 2019; DOI: https://doi.org/10.12701/yujm.2019.00353

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Abstract PDF

Background
To minimize damage to the ovarian reserve, it is necessary to evaluate the follicular density in the ovarian tissue surrounding endometrioma on preoperative imaging. The purpose of the present study was to evaluate the usefulness of subtraction pelvic magnetic resonance imaging (MRI) to detect ovarian reserve.
Methods
A subtracted T1-weighted image (subT1WI) was obtained by subtracting unenhanced T1WI from contrast-enhanced T1WI (ceT1WI) with similar parameters in 22 patients with ovarian endometrioma. The signal-to-noise ratio (SNR) in ovarian endometrioma, which was classified into the high signal intensity and iso-to-low signal intensity groups on the T2-weighted image, was compared to that in normal ovarian tissue. To evaluate the effect of contrast enhancement, a standardization map was obtained by dividing subT1WI by ceT1WI.
Results
On visual assessment of 22 patients with ovarian endometrioma, 16 patients showed a high signal intensity, and 6 patients showed an iso-to-low signal intensity on T1WI. Although SNR in endometrioma with a high signal intensity was higher than that with an iso-to-low signal intensity, there was no difference in SNR after the subtraction (13.72±77.55 vs. 63.03±43.90, p=0.126). The area of the affected ovary was smaller than that of the normal ovary (121.10±22.48 vs. 380.51±75.87 mm2, p=0.002), but the mean number of pixels in the viable remaining tissue of the affected ovary was similar to that of the normal ovary (0.53±0.09 vs. 0.47±0.09, p=0.682).
Conclusion
The subtraction technique used with pelvic MRI could reveal the extent of endometrial invasion of the normal ovarian tissue and viable remnant ovarian tissue.

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Biaxial ultrasound driving technique for small animal blood–brain barrier opening
Carly Pellow, Siyun Li, Sagid Delgado, G Bruce Pike, Laura Curiel, Samuel Pichardo
Physics in Medicine & Biology.2023; 68(19): 195006. CrossRef
Magnetic resonance imaging texture analysis for the evaluation of viable ovarian tissue in patients with ovarian endometriosis: a retrospective case-control study
Dayong Lee, Hyun Jung Lee
Journal of Yeungnam Medical Science.2022; 39(1): 24. CrossRef
Diagnosis and Nursing Intervention of Gynecological Ovarian Endometriosis with Magnetic Resonance Imaging under Artificial Intelligence Algorithm
Nijie Jiang, Hong Xie, Jiao Lin, Yun Wang, Yanan Yin, Arpit Bhardwaj
Computational Intelligence and Neuroscience.2022; 2022: 1. CrossRef

Assessment of solid components of borderline ovarian tumor and stage I carcinoma: added value of combined diffusion- and perfusion-weighted magnetic resonance imaging: See Hyung Kim; Yeungnam Univ J Med. 2019;36(3):231-240. Published online June 13, 2019; DOI: https://doi.org/10.12701/yujm.2019.00234; Correction in: J Yeungnam Med Sci 2020;37(2):147

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Abstract PDF

Background
We sought to determine the value of combining diffusion-weighted (DW) and perfusion-weighted (PW) sequences with a conventional magnetic resonance (MR) sequence to assess solid components of borderline ovarian tumors (BOTs) and stage I carcinomas.
Methods
Conventional, DW, and PW sequences in the tumor imaging studies of 70 patients (BOTs, n=38; stage I carcinomas, n=32) who underwent surgery with pathologic correlation were assessed. Two independent radiologists calculated the parameters apparent diffusion coefficient (ADC), Ktrans (vessel permeability), and Ve (cell density) for the solid components. The distribution on conventional MR sequence and mean, standard deviation, and 95% confidence interval of each DW and PW parameter were calculated. The inter-observer agreement among the two radiologists was assessed. Area under the receiver operating characteristic curve (AUC) and multivariate logistic regression were performed to compare the effectiveness of DW and PW sequences for average values and to characterize the diagnostic performance of combined DW and PW sequences.
Results
There were excellent agreements for DW and PW parameters between radiologists. The distributions of ADC, Ktrans and Ve values were significantly different between BOTs and stage I carcinomas, yielding AUCs of 0.58 and 0.68, 0.78 and 0.82, and 0.70 and 0.72, respectively, with ADC yielding the lowest diagnostic performance. The AUCs of the DW, PW, and combined PW and DW sequences were 0.71±0.05, 0.80±0.05, and 0.85±0.05, respectively.
Conclusion
Combining PW and DW sequences to a conventional sequence potentially improves the diagnostic accuracy in the differentiation of BOTs and stage I carcinomas.

Citations

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Advances in fertility preserving surgery for borderline ovarian tumors
Mingdan Wang, Kuiran Liu
European Journal of Obstetrics & Gynecology and Reproductive Biology.2022; 270: 206. CrossRef
Recurrence characteristics and clinicopathological results of borderline ovarian tumors
Lina Niu, Huihui Tian, Yongjun Xu, Jieqiong Cao, Xu Zhang, Junli Zhang, Jiajia Hou, Weiqin Lv, Junxia Wang, Li Xin, XuFeng Dong, Tao Xu, Yuan Nan, Hua Wei, Xinting Chai, Na Li, Yan Ni, Yun Shang, Lizhen Zhang, Ye Zhao
BMC Women's Health.2021;[Epub] CrossRef
Erratum to “Assessment of solid components of borderline ovarian tumor and stage I carcinoma: added value of combined diffusion- and perfusion-weighted magnetic resonance imaging”
See Hyung Kim
Yeungnam University Journal of Medicine.2020; 37(2): 147. CrossRef

Original Article

Evaluation of Computed Tomography and Magnetic Resonance Imaging of Sinonasal Inverted Papilloma.: Chang Hoon Bai, Young Jung Seo, Seok Choon Lee, Seung Min Chen, Un Hoi Baek, Eun Chae Jung, Si Youn Song, Yong Dae Kim; Yeungnam Univ J Med. 2005;22(2):191-198. Published online December 31, 2005; DOI: https://doi.org/10.12701/yujm.2005.22.2.191

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Abstract PDF: BACKGROUND
Computed tomography (CT) is commonly used to evaluate the degree of sinus involvement in cases of inverted papilloma (IP). However, CT cannot differentiate tumor from adjacent inflammatory mucosa or retained secretions. By contrast, magnetic resonance imaging (MRI) has been reported to be useful in distinguishing IP from paranasal sinusitis. This study investigated whether preoperative assessment with MRI and CT accurately predict the extent of IP. MATERIALS AND METHODS: CT and MRI were retrospectively reviewed in 9 cases of IP. Patients were categorized into stages based on CT and MRI findings, according to the staging system proposed by Krouse. The involvement of IP in each sinus was also assessed. RESULTS: Differentiation of IP from inflammatory disease may be more successful in routine cases where the inflammatory mucosa has low signal intensity on T1-weighted images and very high signal intensity on T2-weighted images. CT imaging could not differentiate tumor from adjacent inflammatory mucosa or retained secretions. CONCLUSION: Preoperative MRI of IP can predict the location and extent of the tumor involvement in the paranasal sinuses and sometimes predicts malignant changes.

Case Report

Evidence of Cortical Reorganization in a Monoparetic Patient with Cerebral Palsy Detected by Combined Functional MRI and TMS.: Yong Hyun Kwon, Sung Ho Jang, Mi Young Lee, Woo Mok Byun, Yoon Woo Cho, Sang Ho Ahn; Yeungnam Univ J Med. 2005;22(1):96-103. Published online June 30, 2005; DOI: https://doi.org/10.12701/yujm.2005.22.1.96

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Abstract PDF: The motor recovery mechanism of a 21-year-old male monoparetic patient with cerebral palsy, who had complained of a mild weakness on his right hand since infancy, was examined using functional Magnetic Resonance Imaging (fMRI) and Transcranial Magnetic Stimulation (TMS). The patient showed mild motor impairment on the right hand. MRI located the main lesion on the left precentral knob of the brain. fMRI was performed on this patient as well as 8 control subjects using the Blood Oxygen Level Dependent technique at 1.5 T with a standard head coil. The motor activation task consisted of finger flexion- extension exercises at 1 Hz cycles. TMS was carried out using a round coil. The anterior portion of the coil was applied tangentially to the scalp at a 1.0 cm separation. Magnetic stimulation was carried out with the maximal output. The Motor Evoked Potentials (MEPs) from both Abductor Pollicis Brevis muscles (APB) were obtained simultaneously. fMRI revealed that the unaffected (right) primary sensori-motor cortex (SM1), which was centered on precentral knob, was activated by the hand movements of the control subjects as well as by the unaffected (left) hand movements of the patient. However, the affected (right) hand movements of the patient activated the medial portion of the injured precentral knob of the left SM1. The optimal scalp site for the affected (right) APB was located at 1 cm medial to that of the unaffected (left) APB. When the optimal scalp site was stimulated, the MEP characteristics from the affected (right) APB showed a delayed latency, lower amplitude, and a distorted figure compared with that of the unaffected (left) APB. Therefore, the motor function of the affected (right) hand was shown to be reorganized in the medial portion of the injured precentral knob.

Original Article

MR Imaging of Uterine Malignant Mixed Mullerian Tumor: Comparison with Endometrial Carcinoma.: Jae Ho Cho, Jeen Woo Kim, Jay Chun Chang, Bok Hwan Park, Jung Sik Kim; Yeungnam Univ J Med. 1999;16(2):296-301. Published online December 31, 1999; DOI: https://doi.org/10.12701/yujm.1999.16.2.296

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Abstract PDF: BACKGROUND
Generally, it is difficult to differentiate uterine malignant mixed Mullerian Tumor(MMMT) from endometrial carcinom in radiological and clinical aspects. Our purpose is to investigate MR findings that distinguishes MMMT from endometrial carcinoma. MATERIALS AND METHODS: We retrogradely evaluated the magnetic resonance imaging findings of pathologically proven 5 cases of malignant mixed Mullerian Tumor(MMMT) and 13 endometrial carcinomas to know the differential points of these two tumors originating in the endometrial cavity. The size of the mass, presence or absence of myometrial or uterine cervical invasion, growth pattern of the mass, signal intensity and degree and pattern of contrast enhancement were analyzed and compared. RESULTS: The length of the long axis of the MMMT was 1.5-9.0cm(average, 5.7cm) but that of the endometrial carcinoma was 0.5-6.0cm(average, 2.5cm). Invasion of uterine cervix which was found in 3 MMMT cases, dilated the endometrial cavity and the lumen of the uterin cervix and showed the pattern of growing into the external os. Invasion of uterine cervix was found in only one case of endometrial carcinoma. The presence or absence of myometrial invasion, the signal intensity and homogeneity on T1-and T2-weighted images, and the degree and patterns of contrase enhancement showed no significant difference. CONCLUSION: Any specific finding to differentiate MMMT from endometrial carcinoma was not ascertained. However, MMMT can be suspected if the size of the endometrial mass is greater than 5cm and if the mass dilates the enocervical canal and invades the uterine cervix.

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