Emphysema as a Risk Factor for the Outcome of Surgical Resection of Lung Cancer

It is unclear whether emphysema, regardless of airflow limitation, is a predictive factor associated with survival after lung cancer resection. Therefore, we investigated whether emphysema was a risk factor associated with the outcome after resection for lung cancer. This study enrolled 237 patients with non small cell lung cancer with stage I or II who had surgical removal. Patient outcome was analyzed based on emphysema. Emphysema was found in 43.4% of all patients. Patients with emphysema were predominantly men and smokers, and had a lower body mass index than the patients without emphysema. The patients without emphysema (n=133) survived longer (mean 51.2+/-3.0 vs. 40.6+/-3.1 months, P=0.042) than those with emphysema (n=104). The univariate analysis showed a younger age, higher FEV1/FVC, higher body mass index, cancer stage I, and a lower emphysema score were significant predictors of better survival. The multivariate analysis revealed a younger age, higher body mass index, and cancer stage I were independent parameters associated with better survival, however, emphysema was not. This study suggests that unfavorable outcomes after surgical resection of lung cancer should not be attributed to emphysema itself.

Morton Neuroma: Evaluated with Ultrasonography and MR Imaging

OBJECTIVE: The purpose of this study was to compare the diagnostic accuracy of both ultrasonography (US) and magnetic resonance imaging (MRI) for the assessment of Morton neuroma. MATERIALS AND METHODS: Our study group was comprised of 20 neuromas from 17 patients, and the neuromas were confirmed on surgery following evaluation with US, MRI, or both US and MRI. The diagnostic criterion for Morton neuroma, as examined by US, was the presence of a round or ovoid, well-defined, hypoechoic mass. The diagnostic criterion, based on MR imaging, was a well defined mass with intermediate to low signal intensity on both the T1- and T2-weighted images. The retrospective comparison between the sonographic and MR images was done by two experienced radiologists working in consensus with the surgical and pathologic correlations. RESULTS: The detection rate of Morton neuroma was 79% for 14 neuromas from 11 patients who had undergone US followed by an operation. The detection rate was 76% for 17 neuromas from 15 patients who had undergone MRI and a subsequent operation. The mean size of the examined neuromas was 4.9 mm on the US images and it was 5.1 mm on the MRI studies. Ten neuromas (71%) were 5 mm or less as measured by US, and three neuromas were not detected, whereas on the MRI analysis, 10 neuromas (59%) were 5 mm or less and four neuromas were not visualized. Among the patients examined during postoperative follow-up, symptoms were completely relieved in 85% and the symptoms were partially relieved in 15%. CONCLUSION: US and MR imaging are comparable modalities with high detection rate for the evaluation of Morton neuroma.

16-Slice MDCT Arthrography of the Shoulder: Accuracy for Detection of Glenoid Labral and Rotator Cuff Tears

PURPOSE: We wanted to determine the diagnostic accuracy of 16-slice MDCT arthrography (CTA) for glenoid labral and rotator cuff tears of the shoulder. MATERIALS AND METHODS: We enrolled forty-five patients who underwent arthroscopy after CTA for pain or instability of the shoulder joint. The CTA images were analyzed for the existence, sites and types of glenoid labral tears and the presence and severity of rotator cuff tears. We determined the sensitivity, specificity and accuracy of CTA for detecting glenoid labral and rotator cuff tears on the basis of the arthroscopy findings. RESULTS: At arthroscopy, there were 33 SLAP lesions (9 type I, 23 type II and 1 type III), 6 Bankart lesions and 31 rotator cuff lesions (21 supraspinatus, 9 infraspinatus and 1 subscapularis). On CTA, the sensitivity, specificity and accuracy for detecting 24 SLAP lesions, excluding the type I lesions, were 83%, 100% and 91%, the total rotator cuff tears were 90%, 100% and 98%, the full thickness supraspinatus tendon tears were 100%, 94% and 96%, and the partial thickness supraspinatus tendon tears were 29%, 100% and 89%, respectively. CONCLUSION: 16-slice MDCT arthrography has high accuracy for the diagnosis of abnormality of the glenoid labrum or rotator cuff tears and it can be a useful alternative to MRI or US.

Superior Mediastinal Widening from Traumatic Posterior Dislocation of Sternoclavicular Joint: A Case Report

Superior mediastinal widening, as seen on chest radiographs of traumatized patients, has been considered the hallmark of mediastinal injury. The usual causes of superior mediastinal widening are rupture of the aorta, esophagus or trachea, and hematoma as a result of spinal fracture. Posterior dislocation of the sternoclavicular joint is rarely a cause. We report a case of superior mediastinal widening resulting from traumatic posterior dislocation of the stern-oclavicular joint, and describe the CT findings, including those of 3-D imaging.

MR Imaging of the Denvervated Skeletal Muscles in Rabbits

PURPOSE: To determine the time of magnetic resonance(MR) signal intensity changes in denervated skeletal muscle and to compare MR imaging with electromyography(EMG) in the evaluation of peripheral nerve injury. MATERIALS AND METHODS: We evaluated MR imagings of denervated muscles after experimental transection of the sciatic nerve in five rabbits using 1.0T MR unit. MR imaging and EMG were performed 3 days and 1, 2 and 3 weeks after denervation. T1-weighted images(T1-WI), T2-WI and Short Tau Inversion Recovery(STIR) images were obtained. The signal intensity (SI) of muscles in the denervated and normal sides were visually and quantitatively compared. After measuring the SI of the normal and abnormal areas, the time of SI change was determined when there was significant difference (P<0.05) of SI between the normal and denervated sides. RESULTS: On STIR images, two of the five rabbits showed significant SI changes at the third day(P<0.05) and all showed significant changes(P<0.05)at the first week. On T2-WI, one rabbit showed significant SI changes at the third day, and all showed significant SI changes at the first week. On T1-WI, significant SI changes were seen in one rabbit at the second week and in one at the third. One week after denervation, all showed denervation potential on EMG. CONCLUSION: This study suggests that MR imaging using STIR images is a useful method in the evaluation of denervated muscle, and that MR signal changes of denervated muscle may precede EMG changes after denervation. To localize and to determine the severity of the peripheral nerve injury, future analysis of the distribution of abnormal MR SI in denervated muscles would be helpful.

Arterial Occlusive Disease of Lower Extremity: Comparison of Spiral CT Angiography with ConventionalAngiography

PURPOSE: To evaluate and compare effectiveness of single acquisition CT and conventional angiography (CA) in grading stenosis in an artery of the lower extremity . MATERIALS AND METHODS: CA and CTA were performed in 12 patients with acclusive arterial disease of the lower extremity. CA extended from the bifurcation site of the abdominal aorta to the popliteal artery, 25-30 seconds after the injection of 120-150ml contrast media by a power injector at the rate of 2.5-3ml/sec via the antecubital vein. Using SSD and MIP methods, the data was reconstructed three-dimensionally. The artery was divided into five segments and the degree of lesion was definedas normal or mild (1-49%), moderate (50-74%), or severe stenosis (75-99%), or occlusion (100%). We retrospectively evaluated and compared the effectiveness of CTA and CA in the detection of each vessel and the grading ofstenosis. RESULTS: Although 11 segments were graded by CA as occluded, only five of these were similarly graded by CTA, and the remaining six were undergraded. The ratio of consistency for grading was 88.5% (46/52) in less thanmild stenosis, and 63.6% (7/11) in moderate or severe stenosis ; if the 11 segments detected only by CTA wereexcluded, the ratio of consistency for occlusion was 100%. Overall diagnostic accuracy was 84.2% (85/101) and whenthe 11 segments were excluded, this was 88.9% (80/90). Because of the capacity of CTA to distinguish vessles with greater than 50% stenosis from those with less than mild stenosis, sensitivity of 86.0%, specificity of 93.2% and accuracy of 89.1% were recorded. If the 11 vessels detected only by CTA were excluded, sensitivity and accuracy would be 91.3% and 92.2%, respectively. CONCLUSION: For detecting and grading stenosis in an artery of the lowerextremity, single acquisition CTA is more accurate than its conventional counter part, and we believe that CTA is a useful modality in the planning and follow-up of treatment.

Postoperative Ureteral Injury Treated by Percutaneous Nephrostomy and Ureteral Stent

PURPOSE: To evaluate percutaneous nephrostomy and ureteral stent placement in patients with postoperative ureteral injury. MATERIALS AND METHODS: Percutaneous nephrostomy and antegrade ureteral stent placement we reattempted in 12 patients with postoperative ureteral injuries. The previous operations which caused ureteral injuries included ureteroscopic extraction of ureteral stones(7), total abdominal hysterectomy due to uterinemyoma(2), ureteroscopic biopsy in a patient with ureteral tuberculosis(1), open ureteroplasty due to retroperitoneal fibrosis(1), and ureterocystostomy during renal transplantation(1). After percutaneousnephrostomy, a 7.0 F ureteral stent was inserted in each patient. The stent was removed under cystoscopic guidancefour to six weeks after this procedure. Urinalysis was performed to evaluate the presence of urinary tractinfection after ureteral stent placement. Ultrasonography and/or intravenous urography were performed three weeksafter stent placement, and every six months after the stent removal. RESULTS: Percutaneous nephrostomy andplacement of an antegrade ureteral stent were successfully performed in all 12 patients. In three patients, the diagnosis of ureteral injuries was made immediately and in nine was delayed for between two and nineteen days. Theureteral stents remained in position for 25-95 days (average, 51) ; no evidence of urine leakage or ureteralstricture was seen on the follow-up examinations carried out from six months to several years after removal of thestent and no case required reintervention. CONCLUSION: Percutaneous nephrostomy and antegrade ureteral stentingare easy to perform, provide for the drainage of urine, cause no significant complication and show a successful therapeutic effect, and are this effective non-operative interventional techniques for patients with postoperative ureteral injury.

A Study on the Simulation and the measurement of 6 MeV Electron Beam / 대한치료방사선과학회지

PURPOSE: We compared the calculated percent depth dose curves of 6 MeV electron beam to that of measured to evaluate the usefulness of Monte-Carlo simulation method in radiation physics. MATERIALS AND METHODS: The radiation dose values of 6 MeV electron beam using EGS4 code with one million histories in water were compared values that were measured form the depth dose curve of electron beam irradiated by medical accelerator ML6M. The central exis dose values were calculated according the changing field size, such as 5 X 5, 10 X 10, 15 X 15, 20 X 20 cm2. RESULTS: The value calculated showed a very similar shape to depth dose curve. The calculated and measured value of Dmax at 10 X 10cm2 cone is 15mm and 14mm respectively. The calculated value of the surface radiation dose rate is 65.52% and measured one is 76.94%. The surface radiation dose rate has vaied from 64.43% to 66.99. The calculated values of Dmax are in the range between 15mm and 18mm. The calculated value was fitted well with measured value around the Dmax area, excluding build up range and below the 90% depth dose area. CONCLUSION: This result suggested that the calculation of dose value can be replace the direct measurement of the dose for radiation therapy. Also, EGS4 may be a very convenient program to assess the effect of radiation dose using by personal computers.