Radiation Doses of Various CT Protocols: a Multicenter Longitudinal Observation Study

Emerging concerns regarding the hazard from medical radiation including CT examinations has been suggested. The purpose of this study was to observe the longitudinal changes of CT radiation doses of various CT protocols and to estimate the long-term efforts of supervising radiologists to reduce medical radiation. Radiation dose data from 11 representative CT protocols were collected from 12 hospitals. Attending radiologists had collected CT radiation dose data in two time points, 2007 and 2010. They collected the volume CT dose index (CTDIvol) of each phase, number of phases, dose length product (DLP) of each phase, and types of scanned CT machines. From the collected data, total DLP and effective dose (ED) were calculated. CTDIvol, total DLP, and ED of 2007 and 2010 were compared according to CT protocols, CT machine type, and hospital. During the three years, CTDIvol had significantly decreased, except for dynamic CT of the liver. Total DLP and ED were significantly decreased in all 11 protocols. The decrement was more evident in newer CT scanners. However, there was substantial variability of changes of ED during the three years according to hospitals. Although there was variability according to protocols, machines, and hospital, CT radiation doses were decreased during the 3 years. This study showed the effects of decreased CT radiation dose by efforts of radiologists and medical society.

The Usefulness of Doppler Sonography in the Assessment of Disease Activity of Ulcerative Colitis / 대한소화기학회지

BACKGROUND/AIMS: Disease activity in ulcerative colitis (UC) is generally assessed using symptoms, laboratory data, endoscopic findings, and histology of the biopsy specimens. In this study, we compared disease activity of UC as determined by clinical features and endoscopic findings, and aimed to assess the clinical usefulness of Doppler sonography. METHODS: The duplex Doppler sonography of superior mesenteric artery (SMA) and inferior mesenteric artery (IMA) of 10 patients with clinically inactive UC and 20 patients with active UC were evaluated by one radiologist who was blinded to clinical information. Peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI), and pulsatility index (PI) of the SMA and IMA were evaluated. All patients underwent biochemical and endoscopic evaluations thereafter. Correlation between disease activity by the Truelove-Witts classification and the Mayo scoring system was measured, and we compared hemodynamic parameters between active and inactive UC. RESULTS: Correlation rate of disease activity between these two scoring systems was 93.3%. Flow velocities (PSV, p<0.001 and EDV, p=0.03) and PI (p=0.03) were significantly higher in patients with active UC than inactive UC. PSVs of the SMA and IMA were also significantly correlated with disease severity. The active UC could be accurately diagnosed using Doppler sonography (AUC=0.83; 95% confidence interval 0.68-0.99). CONCLUSIONS: In patients with UC, clinical stage was well matched with endoscopic disease activity. Doppler sonography was a readily available method, and PSV of SMA would be clinically useful in predicting of disease activity and severity.

Minimal Invasive Unilateral Transforaminal Lumbar Interbody Fusion by Sublaminar Decompression: Comparison to Bilateral Approach / 대한정형외과학회잡지

PURPOSE: This is a comparison of the unilateral and bilateral approaches for minimal invasive transforaminal lumbar interbody fusion (TLIF), and we did so by measuring the clinical and radiological results. MATERIALS AND METHODS: This study examined a consecutive series of 47 patients who underwent one-level TLIF (26 cases of the unilateral approach and 21 cases of the bilateral approach to the lumbar spine) and the follow-up data was compared with a minimum 1-year follow-up. Sublaminar decompression and contralateral foraminectomy were done in all the case of using the unilateral approach. The age of each patient, the amount of intraoperative blood loss, the postoperative drainage, the transfusion requirement and the surgery time were investigated. The clinical outcomes were analyzed using the visual analogue scale, the SF-36 Physical Composite Score (PCS) and the Oswestry disability index (ODI). The preoperative, postoperative & last follow-up changes in the height and angles of the disc in the fused segments and the lumbar lordotic angles were radiologically analyzed. RESULTS: There was no statistical difference between the two groups in terms of the clinical and radiographic results at the last follow-up. But the unilateral approach-group was found to have a less blood loss, less postoperative drainage, a lesser requirement for transfusion and a shorter surgery time. CONCLUSION: This study confirms that the unilateral approach can be the better way if the technical problems are solved.

A Study of Prognostic Factors of Conservative Treatment in Plantar Fasciitis / 대한족부족관절학회지

PURPOSE: We analyzed to find out prognostic factors in the conservative treatment for the plantar fasciitis. MATERIALS AND METHODS: The data were collected from 145 patients, 159 feet (M:F = 51:108) with conservative treatment and analyzed for possible prognostic factors : sex, age of onset, the duration of symptom before treatment, pain score before treatment, the duration for symptom remission, medication period, calcaneal pitch angle, and presence of calcaneal spur. RESULTS: The duration of symptom before conservative treatment is affected to the prognosis, and the borderline of the effective period was about 6 months. CONCLUSION: With the conservative treatment of the plantar fasciitis, we found that (1) the duration of symptom before the conservative treatment was a prognostic factor, and (2) if the period before the conservative treatment was more than 6 months, the other treatment option such as surgery should be considered for this chronic group.

Glomus Tumor in a Extradigital Lesion of Foot: A Case Report / 대한족부족관절학회지

Glomus tumors are uncommon soft tissue tumors which usually found in a subungual lesion of hand, producing pain. This uncommon tumors have been reported in other locations, including nasal cavity, stomach, mediastinum, heart, lung, and vagina etc. Especially, it was a very rare case found in an extradigital lesion of foot. Glomus tumors should not be ruled out for an extradigital mass lesion of foot and also any other locations. Although glomus tumors are generally considered a benign lesion, it should be considered that glomus tumors have also reported as a malignant type tumor, even the diagnosis based on histologic features not clinical one.

Total Elbow Arthroplasty for the Fracture of Elbow Arthrodesis Site: A Case Report

Total elbow arthroplasty is a relatively rare procedure compared with total knee or total hip arthroplasty. Total elbow arthroplasty for bony ankylosis is even rarer, and the results are often unsatisfactory. We report a patient who gained good mobility of the elbow after total elbow arthroplasty for the treatment of fractured arthrodesis site with which the patient had lived with for 12 years.

Evaluation of the Patterns of Fractures and the Soft Tissue Injury Using MRI in Tibial Plateau Fractures

PURPOSE: To compare information about fracture type in MRI with simple radiograph in tibial plateau fractures and evaluate tibial plateau fractures type and accompanying soft tissue injury, and evaluate usefulness of MRI in tibial plateau fractures. MATERIALS AND METHODS: Compared MRI with simple radiograph about Schatzker classification, depression of articular surface and displacement of bone fragment from the 68 examples who checked MRI and we evaluated soft tissue injury around knee joint. RESULTS: There were 7 examples of Schatzker type change after MRI check. Average depression of articular surface in simple radiograph was 2.93 mm and 4.28 mm in MRI. It increased by 1.35 mm and it was meaningful statistically (p<0.05). There was no significant difference between MRI and simple radiograph of displaced bone fragment (p=0.168). There were 58 (85.3%) cases of soft tissue injury in MRI. CONCLUSION: MRI can find additional fracture line or articular depression that can't be found in simple radiograph and gives more information about articular depression and soft tissue that is useful in surgical plans. I think preoperative MRI is necessary to better treatment of fracture & treatment of periarticular soft tissue injury in tibial plateau fracture.

The Effect of Different Wavelength of Low Power Laser on Fracture Healing / 대한정형외과연구학회지

PURPOSE: The purpose of this study is to evaluate the effect of different wave length of low power laser on early fracture healing. METHODS AND MATERIALS: Nine week old female English Hartley guinea pigs were used for this experiment. Sixty guinea pigs were divided into three groups, and then right femur was fractured and fixed with an intramedullary nail. The frequency of 632 nm and 830 nm semi-conductor laser machines were used. Finally, 46 guinea pigs were survived (including 14 cases in control group, 16 cases in 632 nm group and 16 cases in 830 nm group). Guinea pigs were sacrificed at 3 and 6 weeks separately. The gross, radiologic and histologic findings were assessed by the Modified Zorlu Scoring System. The statistical evaluation was done by repetitive measured ANOVA test. RESULTS: In the gross findings and radiologic findings, both of 632 nm and 830 nm radiation groups showed a greater amount of callus formation at postoperative 3 weeks with statistical significance (P0.05). The result of histological findings showed that an increase of osteoblastic proliferation in two radiation groups was greater than that in the control group at 3 and 6 weeks (P<0.01). Enhancement of osteoblastic proliferation was greater in 830 nm group compared to in 632 nm group at 3 weeks (P<0.05). The comparison between the experimental groups for wave length of 632 nm and 830 nm at 6 weeks showed significant difference (P<0.05). CONCLUSION: In this study, it became known that applying 632 nm and 830 nm wavelength laser to the fracture site accelerate bony union, and 830 nm wavelength laser showed earlier bony union than 630 nm wavelength laser.

Predictive Factors of Renal Scarring in Children with Acute Urinary Tract Infection / 대한핵의학회잡지

PURPOSE: The purpose of this study was to evaluate the usefulness of 99mTc DMSA scintigraphy on the dignosis of a renal scar in children with urinary tract infections. MATERIALS AND METHODS: Eighty three patients were included in this study, who were diagnosed as the urinary tract infection on the basis of symptom, urinalysis and urine culture. 99mTc DMSA scintigraphy and voiding cystoureterography were performed within 7days before the treatment in all patients. We classified the scintigraphic findings as follows: 1; a large hypoactive upper or lower pole. 2; a small hypoactive area. 3; single defect resulting in localized deformity of the outlines. 4; deformed outlines in a small or normal sized kidney. 5; multiple defects. 6; diffuse hypoactive kidney without regional impairment. Follow-up scintigraphy was done at least 6 months after the initial study. When the abnormality on the initial scintigraphy was not completely resolved on the follow-up scan, the lesion was defined as containing a scar. RESULTS: One hundred and fifteen renal units of 166 units (69.3%) showed abnormal findings on the DMSA scintigraphy. 65 units (56.5%) was diagnosed as containing renal scars on follow-up scintigraphies. Incidences of renal scar among renal units showing pattern 3, 4 and 5 on the initial scan was 75%, 78% and 78%, respectively. Whereas many of renal units showing 1, 2 and 6 pattern were recovered (65%, 76%, 50%). Sensitivity, specificity and accuracy of pattern-based DMSA scintigraphic findings on the diagnosis of renal scar was 76.9%, 85.1% and 81.9%, respectively. VUR was significantly associated with the renal scar when the initial DMSA shows unrecoverable findings (pattern 3, 4, 5). Odds ratio of the renal scar in a kidney showing unrecoverable initial scintigraphic findings was 19.1. Odds ratio in a kidney with mild or moderate-to-severe VUR was 3.5 and 14.4 respectively. CONCLUSION: In the urinary tract infection, renal scar was significantly developed in a kidney showing unrecoverable findings on the initial DMSA scan and VUR on voiding cystoureterography.

Ultrasonographic Findings of Nonlactiferous Breast Abscess

PURPOSE: To evaluate the ultrasonographic features of nonlactiferous breast abscess. MATERIALS AND METHODS: We retrospectively reviewed ultrasonograms of 21 cases with surgically and clinically proved nonlactiferous breast abscess. The cases included 17 cases of acute or chronic inflammation and 4 cases of tuberculosis. RESULTS: Location of the lesion was subareolar in 15 cases and peripheral in 6. Mean anteroposterior/transverse diameter ratio was 0.49. Internal echogenicitiy of the lesion was variable, with heterogeneous mixed-echoic echotexture in 18 cases and homogeneous hypoechoic in 3. Margin of the lesion was irregular in 18 cases(85.7%) and posterior sonic enhancement was observed in 17 cases(81%). There were also noted obliteration of adjacent superficial fascia, localized skin thickening, and sinus tract or ductal ectasia in 19(90.5%), 9 (42.9%), and 9(42.9%) cases respectively. CONCLUSION: Major ultrasonographic findings of nonlactiferous breast abscess was subareolar located, variable shaped mass with posterior enhancement. Additional findings were fistular formation, loss of superficial fascia, and axillary lymphadenopathy.

Ultrasonographic Findings of Nonlactiferous Breast Abscess

PURPOSE: To evaluate the ultrasonographic features of nonlactiferous breast abscess. MATERIALS AND METHODS: We retrospectively reviewed ultrasonograms of 21 cases with surgically and clinically proved nonlactiferous breast abscess. The cases included 17 cases of acute or chronic inflammation and 4 cases of tuberculosis. RESULTS: Location of the lesion was subareolar in 15 cases and peripheral in 6. Mean anteroposterior/transverse diameter ratio was 0.49. Internal echogenicitiy of the lesion was variable, with heterogeneous mixed-echoic echotexture in 18 cases and homogeneous hypoechoic in 3. Margin of the lesion was irregular in 18 cases(85.7%) and posterior sonic enhancement was observed in 17 cases(81%). There were also noted obliteration of adjacent superficial fascia, localized skin thickening, and sinus tract or ductal ectasia in 19(90.5%), 9 (42.9%), and 9(42.9%) cases respectively. CONCLUSION: Major ultrasonographic findings of nonlactiferous breast abscess was subareolar located, variable shaped mass with posterior enhancement. Additional findings were fistular formation, loss of superficial fascia, and axillary lymphadenopathy.

US Characterization of Soft Tissue Hemangiomas of Extremities: Correlation with MR Signal Intensity

PURPOSE: To evaluate the US findings of soft tissue hemangiomas in extremities and to correlate the echo-pattern with MR signal characteristics of hemangiomas. MATERIALS AND METHODS: We retrospectively studied forty-two patients either with pathologically proven cases or with characteristic features of hemangiomas on MRI, US and plain film. Hemangiomas were divided into two types according to the locations;subcutaneous and intramuscular. Analytic points on US and MR findings were gross morphology of the mass, internal echo-pattern or signal characteristics. We correlated the echo-pattern with MR signal characteristics in hemangiomas. RESULTS: Subcutaneous hemangiomas revealed homogeneously anechoic mass on US, which were well correlated with MR signal characteristics' homogeneous low singnal intensity(SI) on Tl-weighted image(WI) and high SI on T2-WI. Intramuscular hemangiomas showed heterogeneously mixed echoic masses on US. An anechoic component on US corresponded to dilated vascular channels on MRI. The signal intensity of intramuscular hemangioma was less than that of subcutaneous fat on T1-WI and greater than that of fat on T2-WI. Both types of hemangiomas had tubular or lace-like appearance with interspersed fibrofatty septa. CONCLUSION: The echo-patterns in US were well associated with MR signal characteristics on MRI. Regarding US and MR features, intramuscular hemangiomas were different to subcutaneous hemangiomas.

Radiological Evaluation of the Parathyroid Masses

PURPOSE: To evaluate the radiologic findings and detectability of parathyroid masses in ultrasonograph computed tomography(CT), and radionuclide study(201TI-99mTc pertechnetate subtraction scintigraphy). MATERIALS AND METHODS: Surgically-proven 11 cases with parathyroid masses consisted of adenoma(n=8), adenomatous hyperplasia(n:2) and adenocarcinoma(n:l) were retrospectively analyzed. We performed US in all cases, CT in 8 cases, and radionuclide study in 7 cases. The parathyroid masses were analysed in regard to anatomic localization and imaging appearance on three modalities. RESULTS: Ten of the 11 parathyroid masses(91%) were located posterior to the thyroid gland and the remainder in the left superior mediastinum. Nine of the 11 cases(82%) were detected on US. The majority were well-defined hypoechoic mass on US. Six of the 8 cases(75%) were detected on CT scan. In the precontrst CT, all of the 8 masses were hypodense as compared with thyroid gland and most showed mild enhancement on post-contrast CT. Six of the 7 cases(86%) were detected on RI study as hot nodule. CONCLUSION: The typical radiological findings of the parathyroid mass were well-defined ovoid or round hypoechoic mass on US, hypodense mass with variable contrast enhancement on CT, and hot nodule on radionuclide study. US was a convenient and reliable imaging modality in detecting parathyroid masses. Improved diagnostic accuracy could be achieved with complementary CT scan and radionuclide study in addition to ultrasonography.