Fascial Free Flap for Reconstruction of the Dorsolateral Hand and Digits: The Advantage of a Thin Contour

BACKGROUND: Fascial free flaps have been widely used for reconstruction of the hand because they are thin. However, studies reporting objective data regarding the advantages of this approach are lacking. Thus, we report our experience with such flaps. METHODS: Forty-five cases of fascial free flaps between November 2006 and March 2014 were reviewed. Nine cases involving reconstructed dorsal or lateral defects were included. Four anterolateral thigh fascial free flaps and 5 lateral arm fascial free flaps were examined. Maximal flap contour was assessed by measuring reconstructed tissue thickness at the central area from the surface of the skin to below the bone in a vertical manner using ultrasonography and X-ray data. Contralateral regions were examined in the same manner and a comparative analysis was performed. A questionnaire survey regarding aesthetic satisfaction was also administered. RESULTS: All reconstructed parts had a thicker contour than the contralateral side. The average relative percentage of reconstructed tissue thickness was found to be 152% using ultrasonography and 143% using X-ray imaging. According to the aesthetic satisfaction survey, the average rate of satisfaction for patients was 62%, and satisfaction with the flap contour was 72%. CONCLUSIONS: Using a fascial free flap, the reconstructed tissue was approximately 1.5× as thick as the contour of the normal side, which led to positive responses regarding aesthetic satisfaction.

Diagnostic Value of Dynamic Perfusion MR Imaging in Benign and Malignant Musculoskeletal Lesions

PURPOSE: To assess the diagnostic value of dynamic perfusion MR imaging for differentiation between benign and malignant musculoskeletal lesions. MATERIALS AND METHODS: Dynamic perfusion MR imaging was performed using a 3.0 T system in 32 female and 30 male patients (aged 10-90 years, mean age, 43 years). Following the assessment of the precontrast imaging, a dynamic study was performed. This dynamic technique allowed for 638 images to be obtained at 11 levels throughout the lesion. Twenty-eight lesions originated within bone (8 benign, 20 malignant), whereas 34 lesions were of soft tissue origin (22 benign, 12 malignant). The final diagnosis was histopathologically confirmed in all patients. To differentiate between benign and malignant lesions, we analyzed the four parameters: (maximal relative enhancement (MRE), time to peak (TTP), wash in rate (WI), steepest slope (SS) and the distribution of time intensity curve (TIC) patterns. RESULTS: The TTP, WI, and SS values of malignant lesions were statistically significant from those of benign lesions (p < 0.05). However, the difference for the MRE values was not statistically significant. The distribution of TIC patterns was a helpful indicator of benign or malignant state, however the difference between the two states was not significant. CONCLUSION: Dynamic perfusion MR imaging is a helpful tool in differentiating benign and malignant musculoskeletal lesions.

The Clinical Value about Pulmonary Tuberculosis of Indirect Chest Radiography in Physical Examination for Conscription / 결핵및호흡기질환

BACKGROUND: This study examined the clinical utility of using indirect chest radiography during a physical examination of new conscripts for determine the presence of pulmonary tuberculosis. METHOD: Over an eight-month period, this study examined 25386 people who underwent a physical examination after conscription. The abnormal findings on mass miniature radiography were followed-up using direct chest radiography. The positive predictive value of mass miniature radiography and direct chest radiography was compared. The incidence, degree of infiltration and clinical outcome of active pulmonary tuberculosis were also evaluated during a follow-up examination. RESULTS: The positive rate of mass miniature radiography was 1.19% (n=302). Various lesions were identified: Parenchymal lesions (n=109), mediastinal lesions (n=6), cardiovascular lesions (n=45), pleural lesions (n=49), bony lesions (n=90) and miscellaneous lesions (n=7). The incidence of active pulmonary tuberculosis by mass miniature radiography was 0.26% (n=67). The first diagnosis was made in 50 people; active pulmonary tuberculosis (n=42), pneumonia (n=1), a mediastinal mass (n=1), a rib fracture (n=2) and a pneumothorax (n=4). Most cases of active pulmonary tuberculosis were mildly infiltrated and either improved or were cured by the follow-up examination. CONCLUSION: Although mass miniature radiography in a physical examination after conscription has limitations, but it is a useful means for detecting the presence of early disease, particularly in active pulmonary tuberculosis.

Liquid-Crystal Display Monitors and Cathode-Ray Tube Monitors: A Comparison of Observer Performance in the Detection of Small Solitary Pulmonary Nodules

OBJECTIVE: To compare observer performance using liquid-crystal display (LCD) and cathode-ray tube (CRT) monitors in the interpretation of soft-copy chest radiographs for the detection of small solitary pulmonary nodules. MATERIALS AND METHODS: By reviewing our Medical Center's radiologic information system, the eight radiologists participating in this study (three board-certified and five resident) retrospectively collected 40 chest radiographs showing a solitary noncalcified pulmonary nodule approximately 1 cm in diameter, and 40 normal chest radiographs. All were obtained using a storage-phosphor system, and CT scans of the same patients served as the gold standard for the presence of a pulmonary nodule. Digital images were displayed on both high-resolution LCD and CRT monitors. The readers were requested to rank each image using a five point scale (1 = definitely negative, 3 = equivocal or indeterminate, 5 = definitely positive), and the data were interpreted using receiver operating characteristic (ROC) analysis. RESULTS: The mean area under the ROC curve was 0.8901+/-0.0259 for the LCD session, and 0.8716+/-0.0266 for the CRT session (p > 0.05). The reading time for the LCD session was not significantly different from that for the CRT session (37.12 and 41.46 minutes, respectively; p = 0.889). CONCLUSION: For detecting small solitary pulmonary nodules, an LCD monitor and a CRT monitor are comparable.

The Diagnosis of Small Solitary Pulmonary Nodule: Comparison of Standard and Inverse Digital Images on a High-Resolution Monitor using ROC Analysis

PURPOSE: To study the impact of inversion of soft-copy chest radiographs on the detection of small solitary pulmonary nodules using a high-resolution monitor. MATERIALS AND METHODS: The study group consisted of 80 patients who had undergone posterior chest radiography; 40 had a solitary noncalcified pulmonary nodule approximately 1 cm in diameter, and 40 were control subjects. Standard and inverse digital images using the inversion tool on a PACS system were displayed on high-resolution monitors (2048x2560x8 bit). Ten radiologists were requested to rank each image using a five-point scale (1=definitely negative, 3=equivocal or indeterminate, 5=definite nodule), and the data were interpreted using receiver operating characteristic (ROC) analysis. RESULTS: The area under the ROC curve for pooled data of standard image sets was significantly larger than that of inverse image sets (0.8893 and 0.8095, respectively; p0.05). CONCLUSION: For detecting small solitary pulmonary nodules, inverse digital images were significantly inferior to standard digital images.