Efficacy Assessment of Endovascular Stenting in Patients with Unilateral Middle Cerebral Artery Stenosis Using Statistical Probabilistic Anatomical Mapping Analysis of Basal/Acetazolamide Brain Perfusion SPECT / 핵의학분자영상

PURPOSE: The aim of this study was to evaluate the hemodynamic changes after endovascular stenting in patients with unilateral middle cerebral artery (MCA) stenosis using statistical probabilistic anatomical mapping (SPAM) analysis of basal/acetazolamide (ACZ) Tc-99m ECD brain perfusion SPECT. MATERIALS AND METHODS: Eight patients (3 men and 5 women, 64.8+/-10.5 years) who underwent endovascular stenting for unilateral MCA stenosis were enrolled. Basal/ACZ Tc-99m ECD brain perfusion SPECT studies were performed by one-day protocol before and after stenting. Using SPAM analysis, we compared basal cerebral perfusion (BCP) counts and cerebrovascular reserve (CVR) index of the MCA territory before stenting with those after stenting. RESULTS: After stenting, no patient had any complication nor additional stroke. In SPAM analysis, 7 out of the 8 patients had improved BCP counts of the MCA territory and 7 out of the 8 patients had improved CVR index of the MCA territory after stenting. Before stenting, the mean BCP counts and CVR index in the affected MCA territory were 47.1+/-2.2 ml/min/100 g and -2.1+/-2.9%, respectively. After stenting, the mean BCP counts and CVR index in the affected MCA territory were improved significantly (48.3+/-2.9 ml/min/100 g, p=0.025 and 0.1+/-1.3%, p=0.036). CONCLUSION: This study revealed that SPAM analysis of basal/ACZ brain perfusion SPECT would be helpful to evaluate hemodynamic efficacy of endovascular stenting in unilateral MCA stenosis.

Radiation Induced Rib Fractures on Bone Scan after Breast Cancer Surgery and Radiation Therapy / 핵의학분자영상

PURPOSE: This study is to evaluate rib fractures on bone scan in breast cancer patients treated with breast cancer surgery and radiation therapy and to evaluate its relation with radiation therapy and operation modality. MATERIALS AND METHODS: Two hundred seventy cases that underwent serial bone scan after breast cancer surgery and radiation therapy were enrolled. Bone scan and chest CT findings of rib fracture were analyzed. RESULTS: The rib uptake was seen in 74 of 270 cases (27.4%) on bone scan and 50 cases (18.5%) were confirmed to have rib fracture by chest CT. The rate of modified radical mastectomy in patients with rib fracture was significantly higher than that in patients without rib fracture (66.0% vs. 27.0%, p=0.000). The rate of additional radiation therapy to axillar or supraclavicular regions in patients with rib fracture was significantly higher than that in patients without rib fracture (62.0% vs. 28.6%, p=0.000). Rib fracture was seen most frequently at 1-2 years after radiation therapy (51.9%) and single rib fracture was seen most frequently (55.2%). Of total 106 rib fractures, focal rib uptake was seen in 94 ribs (88.7%) and diffuse rib uptake was seen in 12 ribs (11.3%). On one year follow-up bone scan, complete resolution of rib uptake was seen in 15 ribs (14.2%). On chest CT, the rate of fracture line in ribs with intense uptake was significantly higher than that in ribs with mild or moderate uptake (p=0.000). The rate of presence of fracture line in ribs with focal uptake was significantly higher than that in ribs with diffuse uptake (p=0.001). CONCLUSION: Rib fracture in breast cancer patients after radiation therapy was related to radiation portal and operation modality. It should be interpreted carefully as a differential diagnosis of bone metastasis.

F-18 FDG PET/CT Finding in Solid Pseudo-papillary Tumor of the Pancreas 6 years After Initial Diagnosis / 핵의학분자영상

Solid pseudo-papillary tumor (SPT) is a rare pancreatic neoplasm with low malignant potential, which tends to occur predominantly in younger females. Only a few cases of SPT seen on F-18 FDG PET scan have been reported, and the findings are not fully evaluated. A 33 year-old woman underwent F-18 FDG PET/CT study for staging of renal cell carcinoma. She was diagnosed with SPT of the pancreas 6 years ago, and has not had any treatment so far. Recent PET/CT showed marked F-18 FDG uptake in the peripheral solid portion and relatively less F-18 FDG uptake to the central calcified portion of SPT. We report one case of SPT of the pancreas on F-18 FDG PET/CT.

(99m)Tc-MAG3 Renal Scan and Ultrasonography in Early Surgical Complications of 203 Renal Transplants / 대한이식학회지

PURPOSE: This study is designed to evaluate the usefulness of (99m)Tc-MAG3 renal scan in the diagnosis of early surgical complication of renal transplantation comparing with that of ultrasonography. METHODS: 203 renal transplantations, from January 2000 to December 2004, were studied retrospectively. (99m)Tc-MAG3 renal scan and ultrasonography were performed routinely for evaluation of allograft kidney at postoperative day 3, 7, 14 and 21 or 28 respectively. RESULTS: Thirteen early surgical complications (6.4%) from 203 recipients were developed during the first one month after transplantation. Six cases of urological complications were noticed. And six cases of hematoma and one case of lymphocele were also developed. (99m)Tc-MAG3 renal scan showed abnormality in ten cases (76.9%) of thirteen early surgical complications. (99m)Tc-MAG3 renal scan revealed all of six urologic complications (100%), and four of six hematomas (66.7%). But one lymphocele was not detected by (99m)Tc-MAG3 renal scan. Ultrasonography showed abnormal findings in eight cases of 13 early surgical complications (61.5%): one of four urine leakage (25%), two of two urinomas (100%), four of six hematomas (66.7%), and one lymphocele (100%). CONCLUSION: (99m)Tc-MAG3 renal scan is more sensitive than ultrasonography in detection of earlysurgical complications of renal transplantation. Then (99m)Tc-MAG3 renal scan is useful test for screening and follow-up of early surgical complications after renal transplantation.

A Case of ReVersible MRI and SPECT Abnormalities in the Neocortex of the Temporal and Parietal Lobes after a Generalized Seizure

We report a case with reVersible temporal and parietal neocortical abnormalities detected by MRI and SPECT following a brief seizure. Post ictal MRI abnormalities may indicate an underlying structural abnormality, but may also occur in non-lesional epilepsy and represent a transient physiologic change induced by ictal activity.

Significance of SPECT as a Confirming Test of the Brain Death / 대한이식학회지

In Korea, brain death was established by the law in year 2000 but organ procurements from brain dead donors have been performed before the law era under the social tacit approval. Contrary to expectations, organ transplantation from brain dead donor have been much decreased in the law era. Electroencephalogram (EEG) is mandatory to confirm brain death in Korea. However EEG has several shortcomings and EEG wave may persist several hours after declaration of brain death by other tests. PURPOSE: To evaluate the significance of EEG and single photon emission computerized tomography (SPECT) as a confirming test of the brain death. METHODS: Clinical records of 42 cadaveric donor and their kidney recipients were reviewed retrospectively. Flat EEG was declared by two board certified neurologist or neurosurgeon. Tc99m-ECD SPECT was done in recent 10 donors who didn't show flat EEG at 24 hours after declarartion of brain death on clinical examination. And compared interval from renal transplantation to the moment when serum creatinine level went down below 2.0 mg/dl. RESULTS: Among 42 donors, 3 went to cardiac arrest while waiting flat EEG. And one another donor also went to cardiac arrest just after taking flat EEG. All the ten donors who took brain SPECT showed absence of cerebral blood flow. After showing circulatory arrest to the brain on SPECT another 3 to 23 hours were needed to get the flat EEG. There was no difference in interval between EEG only group (9.8 days) and EEG plus SPECT group (9.2 days). But the interval was prolonged in cardiac arrest group up to 20 days. CONCLUSION: We could get the falt EEG 3 to 23 hours after circulatory arrest to the brain on SPECT scan. While waiting to get flat EEG three donors went to cardiac arrest and kidneys from these cardiac arrest donor showed delayed graft function in all cases. Brain SPECT should be used as a confirming test of brain death.

Tc-99m MAG3 SPECT on Transplanted Kidney / 대한핵의학회잡지

PURPOSE: This study was designed to evaluate the usefulness of a technetium-99m mercaptoacetyltriglycine (Tc-99m MAG3) single photon emission computed tomography (SPECT) performed on transplanted kidney. MATERIALS AND METHODS: Thirty renal transplant patients were included in this study. Planar scan was performed for 30 minutes using 555 MBq Tc-99m MAG3. A post-voiding SPECT scan was acquired on the third, seventh, fourteenth and twenty eighth day after transplantation. RESULTS: SPECT scan showed interpretable image quality in 26 of 30 patients (86.7%) and 84 in 120 scans (70%). Fourteen of 26 patients with interpretable SPECT image showed decreased or increased radioactivity, but only 5 had abnormal findings on the planar scan. Focal SPECT defects were seen in allografts with normal function (n=3), acute tubular necrosis (n=3), and acute rejection (n=2). The defects are thought to reflect focally underperfused renal parenchyme or, in normal allografts, an artifact from uneven radioactivity distribution. Four of 10 patients with renal arterial variation showed focally decreased radioactivity and SPECT helped guide further studies that confirmed the exact cause. Five of 10 patients with acute tubular necrosis or acute rejection showed focally decreased radioactivity, but its relation to the patients' clinical course was not clear. Focally increased radioactivity was observed in 5 allografts with normal function and 1 with double ureter in which local clearance delay was observed. CONCLUSION: Tc-99m MAG3 SPECT renal scan can detect additional focal abnormalities compared to planar scan. Further study is necessary to elucidate the exact clinical significance of the SPECT findings.

Production of CD44v6 Antibody Fragments and Comparision of Their Speciticities / 대한면역학회지

CD44v6 was known as tumor marker for tumor progression and metastasis in various kinds of carcinomas. The CD44v6 monoclonal antibody was produced by cell cultures or mouse ascite fluids using CD44v6 hybridoma cells, and its immunogloburin G (IgG) was purified by Protein A column. Using immobilized ficin and cysteine, the antibody fragment Fab was produced and purified by Protein A. Four CD44v6 scFv molecules were produced from the recombinant DNA and phage antibody technology and prurified by His-tag affinity chromatography. In order to inspect the function and specificity of each antibody molecule, western-blotting and ELISA against CD44v5-6 recombinant proteins and irnmunodetection in human ovarian carcinomas were estabilished. The results showed that immunodiagnosis did not distinguish the types of antibody fragments, but western-blotting and ELISA results did show some difference of their specificities and biological properties. These studies will contribute as a model study for the immunodiagnosis and therapy using the IgG, Fab and scFv of CD44v6 antibody to obtain the early detection of tumor progression and metastasis using immunoscintigraphy.

Experimental Study on the Rim-Enhancing Lesion of Rabbit Brain Abscess: MR Imaging and Histopathologic Correlation

PURPOSE: To evaluate on the basis of histopathologic carrelation the MR findings of mature brain abscess inthe rabbit, with particular attention to rim-enhancing lesions. MATERIALS AND METHODS: The evolution of abscess formation was obtained by the direct inoculation of Staphylococcus aureus into the gray-white matter junctions ofthe brains of 16 rabbits. The stages of brain abscesses were divided into four : early cerebritis (days 1 to 5after inoculation of the organism) ; late cerebritis (days 6 to 14) ; early capsular (days 16 to 21) ; and latecapsular (days 22 to 28). The available MR images showed 14 cases at the stage of early cerebritis, seven at thelate cerebritis stage, three at the early capsular, and one at the late capsular stage. According to the known pathology of brain abscesses and on the basis of both MR imaging and histopathologic findings, the lesions weregrouped according to whether they were found in the central necrotic, border, or peripheral zone. We analyzed the patterns of rim-enhancement (completeness of the rim, thickness, and margin) and the signal intensities of theabscess walls on MR images at each stage. Histopathologic correlation was performed in one case of each stage. We evaluated the presence or absence and degree of infiltration by inflammatory granulation tissue, microhemorrhage, reticulin, collagen, and hemosiderin of the abscess walls. RESULTS: Rim-enhancing lesions were present in threeof 14 cases at the late cerebritis stage, in all three cases at the early capsular, in one at the late capsular, but in none at the early cerebritis stage. The enhancing pattern of the late cerebritis stage was irregular-margined incomplete rim-enhancement, with irregular thickness of the abscess walls (3/3). The enhancing pattern of the capsular stages was well-defined, complete rim-enhancement with uniform thickness of the abscess walls (3/4). The signal intensities of the abscess walls at the late cerebritis and early capsular stages were variable. The late capsular stage was characterized by hypointensity of the abscess wall on both T1- and T2-weighted images. Histopathologically, the capsular stages were distinguished from the late cerebritis stage bythe marked infiltration of reticulin and the presence of collagen in the abscess walls. The most conspicuous pathologic finding distinguishing the late from the early capsular stage was abundant infiltration of the abscess wall by collagen and hemosiderin. CONCLUSION: The enhancing pattern of a brain abscess with mature capsule formation was characterized by a well-defined, complete rim-enhancing abscess wall of uniform thickness. The mature abscess wall was hypointense on both T1- and T2-weighted images, may be explained by marked infiltration bymature collagen and hemosiderin.

Tc-99m MAG3 Renal Scan in Children: A Comparative Study with I-131 Hippuran Renal Scan / 대한비뇨기과학회지

To investigate the efficacy of Tc-99m MAG3 for renal scan, the images and renograms of Tc-99m MAG3 were compared to those of I-131 hippuran. Tc-99m MAG3 diuretic renal scan and I-131 hippuran diuretic renal scan were undertaken in 16 children with upper urinary tract anomalies within the time interval of 2 to 3 days. Their ages ranged from 1 week to 11 years old, and the male-to-female ratio was 14 to 2. Of these patients, 9 patients were less than 1 year old. The spectrum of upper urinary tract anomalies were unilateral ureteropelvic junction obstruction in 7 cases, bilateral ureteropelvic junction obstruction in 5 cases, bilateral non-obstructing non-refluxing megaureter, unilateral non-obstructing non-refluxing megaureter, bilateral obstructing megaureter and unilateral ulticystic dysplastic kidney in 1 case respectively. The images of Tc-99m MAG3 showed better resolution than those of I- 131 hippuran. The parameters of the Tc-99m MAG3 renogram in total functioning renal units, such as time to peak renal activity(r=0.98), half-time clearance to peak(r=0.88), half-time clearance after diuretic injection(r=0.96) and relative renal function(r=0.90), were correlated well with those of I-131 hippuran. In conclusion, Tc-99m MAG3 diuretic renal scan is considered to have a high potential to replace I-131 hippuran in routine radionuclide renal studies as well as renal tubular function test.

Usefulness of Dynamic Magnetic Resonance Imaging in Brain Tumors

PURPOSE: To investigate the usefulness of dynamic MR imaging in the differential diagnosis of brain tumors. MATERIALS AND METHODS: Dynamic MR imaging was performed in 43 patients with histopathologically proved brain tumrs. Serial images were sequentially obtained every 30 seconds for 3--5 minutes with use of spin-echo technique(TR 200msec/TE 15msec) after rapid injection of Gd-DTPA in a dose of 0.1mmol/kg body weight. Dynamics of contrast enhancement of the brain tumors were analyzed visually and by the sequential contrast enhancement ratio(CER). RESULTS: On the dynamic MR imaging, contrast enhancement pattern of the gliomas showed gradual increase in signal intensity(SI) till 180 seconds and usually had a longer time to peak of the CER. The SI of metastatic brain tumors increased steeply till 30 seconds and then rapidly or gradually decreased and the tumors had a shorter time to peak of the CER. Meningiomas showed a rapid ascent in SI till 30 to 60 seconds and then made a plateau or slight descent of the CER. Lymphomas and germinomas showed relatively rapid increase of Sl till 30 seconds and usually had a longer time peak of the CER. CONCLUSION: Dynamic MR imaging with Gd-DTPA may lead to further information about the brain tumors as the sequential contrast enhancement pattern and CER parameters seem to be helpful in discriminating among the brain tumors.

Bone Scanning in the Evaluation of Lung Cancer

PURPOSE: We studied the diagnostic significance of bone scan in evaluation of bone metastasis by lung cancer, prevalence rate, and the causes of false positive bone scan and soft tissue accumulation of bone seeking agent. MATERIALS AND METHODS: The subject included 73 lung cancer patients with bone scan. We analyzed the frequency of bone metastasis, its distribution and configuration, and any relationship between bone pain and corresponding region on bone scan. The positive findings of bone scan were compared with simple X-ray film, CT, MRI and other diagnostic modalities. The false positive bone scan and the soft tissue accumulation of bone seeking agent were analized. RESULTS: The positive findings on bone scan were noted in 26 cases(36%) and they were coexistant with bone pain in 30%. The correspondance between bone scan and bone X-ray was 38%. False positive bone scans were seen in 12 cases(16%), which include fracture due to thoracotomy and trauma, degenerative bone diseases, and bifid rib. Accumulation of bone seeking agent in soft tissue were seen in 13 cases(18%), which included primary tumor, enlarged cervical lymph node, pleural effusion, ascites and pleural thickening. CONCLUSION: Bone scans should be carefully interpreted in detecting bone metastasis in primary malignancy, because of the 16% false positivity and 18% soft tissue accumulation rate. It is very important to note that the correlation between bone pain and positive findings of bone scans was only 38%.

Aneurysms of the Nontraumatic Extracranial Carotid Artery and Vertebral Artery: Cases Report

No abstract available.

Scintigraphic features of choledochal cyst using technetium-99m-DISIDA hepatobiliary scan / 대한핵의학회잡지

No abstract available.

MR measurements of corpus callosum in normal adults

To evaluate criterial for detecting corpus callosum (CC) abnormality, measurements of CC were done in 100 Korean adults on midline sagittal T1 weighted images using the spin echo technique with a 2.0 Tesla MR unit. The mean (±SD) anteroposterior diameter of CC, and the mean (±SD) thicknesses of genu, body, transition, and splenium were 71.1±5.0, 11.2±1.6, 5.7±1.0, 3.6±10, and 11.6±1.6mm, respectively. The outlines of CC were traced directly from the scans, and the maximal anteroposterior length of the CC was divided into quartiles. Area measurements of the anterior quartile, body, splenium, and whole CC were made with a digitizer pad and computer, and the mean (±SD) areas of these were 211±36, 194±36, 205±34, and 610±90mm, respectively. The following ratios were calculated; Maximum anteroposterior diameter of CC/length of brain, area of anterior quartile/area of whole CC, area of body/area of whole CC, and area of splenium/area of whole CC. There was a statistically significant increased of maximum anteroposterior diameter of CC/length of brain by age, and a statistically significant decrease of the area of the body by age. However, there were no statistically significant differences of all measurements between males and females.

Multiple coronary arteriovenous fistulae combined with ventricular septal defect: a case report

No abstract available in English.

MR imaging of avascular necrosis of the femoral head: correlation with radiograph, radionuclide scan and clinical finding

To explore the ability of magnetic resonance imaging(MRI) in the diagnosis of avascular necrosis(AVN) of the femoral head, we compared appearances on MRI of 85 proven AVN lesions with those on radiographs(n=79)and radionuclide scans(n=75). Clinical symptoms(n=85) were also correlated. All MR studies included coronal and axial T1WI and coronal T2WI. All lesions involved the anterosuperior aspect of the femoral head and were surrounded by a low signal intensity rim of both T1 and T2WI. The signal intensity of the lesions was variable depending on the disease course, and lesions were divided into four classes according to the classification suggested by Mitchell. Radiogrphs were normal in 16%(13/79) of the lesions which were in MR class A(10), B(1), C(2). The radionuclide scans showed normal in 16%(12/75) of the lesions which were in MR class A(8), B(1), C(2), D(1). On the other hand. 93% of the lesions with MR class A(27/29) showed stage 1 and 2 lesions on radiographs. Clinical symptoms were absent in 25%(21/85) of the leions, and among these. 81%(17/21) were MR class A. Conclusively. MR is superior to the radiograph and radionuclide scan in the early detection of AVN, and can also show the exact location, extent and signal chasacteristics of the lesion. Therefore, MR is essential in diagnosis and management of AVN.

Results of living donor renal transplantation using donor kidneys with multiple renal arteries / 대한이식학회지

No abstract available.

Retroperitoneal cystic lymphangioma in an aged man: report of a case and review of the literature

Retroperitoneal cystic lymphangioma is a rare benign tumor which had previously been difficult to diagnose preoperatively by conventional radiographic technique(1). Recent reports describe the computed tomographic and ultrasonographic findings in cystic lymphangioma(1,2). We report a case of retroperitoneal cystic lymphangioma, accurately diagnosed by lymphography, with computed tomographic findings and percutaneous drainage findings. To the best of out knowledge, this is the most aged case of retroperitoneal cystic lymphangioma of preoperatively diagnosed.

99mTc-MDP scan in rhabdomyolysis / 대한핵의학회잡지

No abstract available.