Shoulder diseases, including adhesive capsulitis, rotator cuff tear, and osteoarthritis of the glenohumeral joint, can significantly impair daily activities in older adult patients. This review aims to examine the radiologic findings associated with these shoulder conditions in older patients, providing insights for accurate diagnosis and effective treatment. Adhesive capsulitis, commonly known as frozen shoulder, leads to pain and restricted movement, thereby causing shoulder dysfunction. Recent advances in diagnostic technology have greatly enhanced the sensitivity and accuracy of diagnosing this condition through radiologic evaluations, including MRI, magnetic resonance arthrography (MRA), and high-resolution ultrasound. Rotator cuff disease is another frequent issue in older adults, with full-thickness tears occurring in 50%–80% of cases. Both MRI and MRA are highly sensitive and specific in identifying rotator cuff tears. Additionally, ultrasonography is recognized for its high sensitivity and specificity in detecting tears of the supraspinatus tendon. Although osteoarthritis of the glenohumeral joint is less commonly prevalent, its advanced stages can severely affect the function of the upper extremity. Plain radiography is typically the first imaging technique used to assess this type of osteoarthritis. As the condition worsens, CT is utilized to measure glenoid bone loss, glenoid version, and inclination, which are crucial for accurate surgical planning. Each imaging modality provides distinct benefits: plain radiographs for initial structural assessment, ultrasonography for real-time evaluation of soft tissues, MRI/MRA for detailed visualization of capsular and tendinous lesions, and CT for precise bony analysis.
, Eun-Suk Cha, Jee Eun Lee, Jeoung Hyun Kim, Bom Sahn Kim, Jin Chung We aimed to compare the diagnostic performances of digital mammography (DM), digital breast tomosynthesis (DBT), ultrasound (US), magnetic resonance imaging (MRI), breast specific gamma imaging (BSGI) and/or positron emission tomography/computed tomography (PET/CT) for the detection of invasive lobular carcinoma (ILC).
Index ILCs and multifocal/multicentric (multiple) ILCs were analyzed using various imaging modalities. The final surgical pathology was regarded as the reference standard. The detection rate for index cancers and the diagnostic performance for multiple ILCs per breast were evaluated.
Seventy-eight ILCs in 76 women were enrolled. Twenty-six breasts had multiple ILCs. DM (n=72), DBT (n=15), US (n=77), MRI (n=76), BSGI (n=50), and /or PET/CT (n=74) were performed. For index cancer, the detection rate was 100% for DBT, US, and MRI. For multiple ILCs, the sensitivity was 100% for DBT and MRI (P<0.001). The diagnostic accuracy for multiple ILCs were 73.3% for DBT and 73.0% for PET/CT (P=0.460).
DBT was the most accurate imaging modality for both index and multiple ILCs. PET/CT was also valuable for multiple ILCs, whereas DM and BSGI showed relatively low diagnostic performances. DBT and PET/CT have promising roles in the diagnosis of multiple ILCs.
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, Dong Il Kim, Hyo Jin Yun, Se Hee Yoon, Sung Ro Yun, Won Min Hwang Prostatic abscess is not a common entity which is characterized by non-specific clinical presentations. This poses a diagnostic challenge for clinicians. Clinicians routinely consider antibiotic treatments concomitantly with drainage for the treatment of prostatic abscess. But there are no established guidelines for its optimal timing, methods and indications. Surgical drainage procedures include transurethral resection of the prostate and perineal incision and drainage. But there is variability in the prognosis of patients between the procedures. We have treated a 48-year-old diabetes patient with prostatic abscess accompanied by MRSA bacteremia using a percutaneous fine-needle aspiration under the computed tomography (CT) guidance. The patient achieved improvement of the symptoms and in follow up CT findings. A percutaneous drainage under the CT guidance is advantageous in that it causes fewer complications. However, Further studies are warranted to establish the optimal timing, methods and indications in patients with prostate abscess.
, Kyu-Man Shin, Jun-Hyeok Song To compare the diagnostic performance of a high-resolution picture archiving and communications system(PACS) workstation directly interfaced with computed tomography(CT) with hard-copy printouts and to compare the detection rate according to slice thickness in hepatocellular carcinomas(HCCs).
Forty-six patients with 118HCCs underwent two-phase multi-detector row helical CT imaging of the entire liver after contrast administration. Late arterial phase images were obtained serially during a single breast-hold, and portal venous-phase images were then obtained. In soft-copy, images taken in each phase were reconstructed by 3mm and 7mm in thickness. Soft-copy readouts on a workstation in PACS and hard-copy printouts were independently compared for the presence of HCC by two radiologists unaware of the possible presence of tumors, and for each phase the detection rate was determined in 7mm thickness. The detection rate of HCC displayed on a workstation was analyzed in 3mm and 7mm thickness for each phase.
No significant differences in observer performance were observed between laserprinted hard copies and CT images displayed on a workstation(p>0.05). But the detection rate of HCC displayed on workstation was higher in 3mm thickness(p<0.05).
The diagnostic performance of CT hard copies is acceptable and comparable to a high-resolution PACS workstation in hepatocellular carcinomas and the detection rate of HCC on PACS workstation is significantly higher in thin slice thickness.
Axial computed tomographic scans were obtained from 40 normal sacrum for evaluation of screw length and angle in the posterior lumbosacral screw fixation. The best scans close to the inferior portion of S1 superior facet and the middle of S2 pedicle were chosen to evaluate various screw paths. Measurements of screw paths included the screw path lengths and angulations as well as the distances between the screw and the sacral canal. The results showed that no significant differences between male and female were found in any parameters, although the linear measurements were greater for male than for female. In Sl, the greatest value of screw path lengths was noted in screw path VI(anterolaterally directed) with an average of 34.8±2.97mm. The mean distance between screw path I and the lateral cortex of the sacral canal was 5.6±0.4mm. For S2, the mean value(30.6±2.08mm) of screw path II (anterolaterally directed) was significantly greater than that(23.8±1.93mm) of screw path I(30° anteromedially directed) (p≤0.001). The mean distance between screw path I and the lateral cortex of the sacral canal was 4.0±0.36mm. This study showed that computed tomography(CT) scans provide more accurate information of screw path lengths. Preoperative CT evaluation of the sacral screw path angle and length is recommended.
, Jeong Soo Suh, Chung Sik Rhee To investigate whether measurements of hepatic metastases before contrast administration are different from measuments after contrast administration. And to gain more effective follow up method by analyzing the difference of contrast between pre- and postcontrast scans.
Thirty patients with herpatic metastases were underwent conventional CT. Continuous 10mm thick slices were obtained from liver dome to pelvic inlet, then the patients received IV injection of contrast material, and same method as precontrast CT scan was performed. Additional 5mm thin slice scan was obtained in case of need. Three radiologists performed independent bidimensional measurements of the randomly selected lesion on both pre- and postcontrast images at the same level and analyzed the difference of the size and contrast.
The size of hepatic metastases were measured as smaller on postcontrast images ; average 41.4±43.5cm2 on precontrast scan & 35.2±37.5cm2 on postcontrast scan. There was significant difference by paired t-test(p<0.02). 24 of 30 cases(80%) showed better conspicuity on postcontrast images, 5(16.7%), on precontrast images and 1(3.3%) showed similiar conspicuity on both pre- and postcontrast images. The contrast of hepatic metastases was significantly higher on postcontrast scan by chi-square test(p<0.01).
Hepatic metastases are significantly smaller on postcontrast images. The contrast between metastatic lesion & liver parenchyme was better on postcontrast scan. Therefore, serial assessment of hepatic metastases size by CT should not be compared mixed pre- and postcontrast image. And postcontrast scan is more effective method than precontrast for follow up of hepatic metastasis.
, Tae-Hee Won, Yong-Soon Won, Jae-Jin Han, Jae-Ho Ahn, Guie-Young Lee Acute type A arotic dissection is a condition which requires emergency surgery. Surgeons want to know not only the extent of the disease but also the exact site of intimal tear as well as the presence of side branch involvement to plan the extent of surgery. Various non-invasive diagnostic tools(transthoracic and transesophageal echocardiography, conventional and spiral computed tomography and magnetic resonance imaging) and invasive angiography are available for the evaluation of the extent of dissection, site of intimal tear and side branch involvement. Each technique has its advantage and disadvantage. Especially, MRI has been accepted as a gold standard for the diagnosis of aortic dissection, but it is immobile and sometimes it cannot give us the information about the small intimal tear site. Transesophageal echocardiography has the advantage of movability and high resolution in addition to the ability of providing comprehensive information about the cardiac function. Because of these advantages, it has been widely utilized for the evaluation of patients with aortic dissection. We performed preoperative transesophageal echocardiography in addition to computed tomography in 3 cases of acute type A aortic dissection and report these cases with the review of articles.
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