Attenuation-Based Automatic Tube Potential Selection in Cerebral Computed Tomography Angiography: Effects on Radiation Exposure and Image Quality

OBJECTIVE@#To investigate the feasibility of using the attenuation-based automatic tube potential selection (ATPS) algorithm for cerebral computed tomography angiography (CTA) and to assess radiation dose, vascular attenuation, and image quality compared to a conventional fixed 120-kVp protocol.@*MATERIALS AND METHODS@#Among 36 volunteers for cerebral CTA, a total of 18 were scanned with fixed 120 kVp and 140 effective mAs using automatic tube current modulation. The other 18 were scanned with an ATPS algorithm. Radiation doses, attenuation, contrast-to-noise ratio (CNR) of the cerebral arteries, subjective scores for arterial attenuation, edge sharpness of the artery, visibility of small arteries, venous contamination, image noise, and overall image quality were compared between the groups.@*RESULTS@#The volume CT dose index and effective dose of the ATPS group were lower than those of the fixed 120-kVp group. The ATPS group had significantly higher arterial attenuation and no significant difference in CNR, compared with the fixed 120-kVp. The ATPS group had higher subjective scores for arterial attenuation, edge sharpness of the artery, visibility of small arteries, and overall image quality.@*CONCLUSION@#The ATPS algorithm for the cerebral CTA reduced radiation dose by 43% while maintaining image quality and improved the attenuation of cerebral arteries by selecting lower tube potential.

Plantar Dermatofibroma Misdiagnosed as Viral Warts / 대한피부과학회지

Dermatofibroma is a common benign fibrohistiocytic tumor. It can occur anywhere on the body surface, but it has a propensity for the extremities. However, dermatofibroma may show a wide variety of clinicopathologic variants and so it is often misdiagnosed. Our case was a 13-year-old male who presented with a 1-year history of a solitary skin-colored hyperkeratotic nodule on the right sole. The nodule had recurred after topical therapy for viral wart. Histopathologic examination of the patient's lesion revealed a poorly circumscribed nodular tumor composed of collagen bundles, fibroblasts and histocytes, which was all consistent with plantar dermatofibroma.

Clinical Study of 13 Cases with Subcutaneous Sweet's Syndrome / 대한피부과학회지

BACKGROUND: Sweet's syndrome is a neutrophilic dermatosis that has various clinical characteristics. Since its original description in 1964, many reports have expanded the clinical and pathological features of this condition. New histopathological variants, such as subcutaneous Sweet's syndrome, have also attracted particular attention. OBJECTIVE: This study was conducted to obtain a better understanding of the clinical features of subcutaneous Sweet's syndrome in Korea. METHODS: This was a retrospective study of subcutaneous Sweet's syndrome observed at our center over an 11-year period. Clinical manifestations and histopathological features of 13 patients with subcutaneous Sweet's syndrome were evaluated. RESULTS: Age varied from 24 to 64 years, averaging 42.3 years. The male to female ratio was 1 : 5.5. The site of predilection was the extremities, and the most commonly involved site was the lower extremities. Multiple erythematous subcutaneous nodules with tenderness were the most common manifestation. General symptoms, such as fever, arthralgia, and myalgia, were associated with subcutaneous Sweet's syndrome in varying frequencies. In laboratory examinations, increased erythrocyte sedimentation rate, leukocytosis, and neutrophilia occurred in some patients. An associated systemic disease was found in 69.2% of the patients, and acute myeloid leukemia was the most common. The majority of patients were treated with oral or topical steroids, and recurrence was observed in 25% of the patients. CONCLUSION: We demonstrated that most clinical features of subcutaneous Sweet's syndrome, including an association with hematological malignancy, were similarly encountered in classic Sweet's syndrome. But, some features such as preferred sites and skin manifestations were similar to other panniculitis diseases.

Exaggeration of Wrinkles after Botulinum Toxin Injection for Forehead Horizontal Lines

There have been no long-term complications or life-threatening adverse effects related to botulinum toxin treatment for any cosmetic indications. Nevertheless, there are well-known, mild side effects of botulinum toxin treatment on the upper face, though most of them are self limited with time. However, excluding brow ptosis, reports about site specific side effects are few and anecdotal. We experienced cases of exaggeration of wrinkles after botulinum toxin injection for forehead horizontal lines, and report them here. In our cases, new appearance of a noticeable glabellar protrusion following botulinum toxin injection on the forehead was observed in 2 patients. Also, a new deep wrinkle on one side of the forehead just above the eyebrow appeared in another 2 patients. The exaggerated wrinkles nearly disappeared without treatment by week 4 in all subjects. These exaggerations of wrinkles may be caused by hyperactivity and overcompensation of untreated muscles. With the increasing availability of diverse botulinum toxin for cosmetic purposes, physicians and patients should be aware of this temporary change after therapeutic injections. We recommend explaining this possible effect prior to injection, for better understanding of treatment for cosmetic indications.

Psoriasis Aggravated by Adalimumab: A Paradoxical Adverse Reaction / 대한피부과학회지

Adalimumab, a recombinant human IgG monoclonal antibody, selectively blocks tumor necrosis factor-alpha (TNF-alpha) and has been successfully used in the treatment of immune-mediated diseases. In particular, its efficacy has been proven in the treatment of rheumatoid arthritis, spondylarthritis, lymphoproliferative diseases and inflammatory bowel disease. Its use has also been studied for the treatment of psoriasis and yet, paradoxically, cases of new onset or exacerbation of psoriasis continue to increase in patients undergoing treatment with anti TNF-alpha agents. A 51-year-old woman had arthritis for a year and was diagnosed with psoriatic arthritis. After she had received adalimumab for psoriatic arthritis five times during one year, erythematous eruptions were found on her entire body. She then stopped adalimumab therapy for two months, although her skin lesions did not resolve. The patient was diagnosed with psoriasis through biopsy and began using cyclosporine, a topical steroid used for treatment of psoriasis.

A Case of Primary Cutaneous CD4+ Small/Medium-sized Pleomorphic T-cell Lymphoma / 대한피부과학회지

Primary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoma (CSMTCL) is a rare disease constituting 2% of all cutaneous T-cell lymphomas. In most cases, CSMTCL occurs as a solitary lesion and has an indolent course. Here we present a 42-year-old woman with multiple, localized, recurrent, erythematous papules and macules that developed after combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP).

A Case of Xanthogranuloma on the Finger of an Adult / 대한피부과학회지

A 68-year-old woman presented with a solitary dome-shaped papule on the right forth finger and this lesion had been developing for the past 4 months. Histopathologic examination revealed the dermal infiltration of histiocytes with foam cells and Touton-type multinucleated giant cells, which was compatible with the diagnosis of xanthogranuloma. Based on the previous reports, xanthogranuloma of the finger is quite rare, and especially in adults. Herein, we report on a case of xanthogranuloma arising on the finger of an adult.

A Case of Doxifluridine-Induced Multiple Atypical Moles on the Palm and Sole of a Patient Taking Immunosuppressive Agents / 대한피부과학회지

Doxifluridine is a pyrimidine derivative and is activated to 5-fluorouracil by pyrimidine phosphorylase. Multiple acral hyperpigmented macules have been reported in patients treated with systemic 5-fluorouracil or some of its prodrugs. However, there have been no reports of this adverse event being induced by doxifluridine. Herein we present a 42-year-old woman with multiple pigmented lesions on the palm and sole after chemotherapy with oral doxifluridine.

Myocardial Tracer Uptake in SPECT Images after Direct Intracoronary Injection Of Tl-201: Comparison with Stress-Reinjection Images / 핵의학분자영상

PURPOSE: To investigate the feasibility of Tl-201 SPECT with intracoronary injection (IC-I) in the detection of viable myocardium, we have performed SPECT imaging after direct intracoronary injection of Tl-201 and images were compared with those of stress-reinjection (Re-I) SPECT. METHODS: Fourteen coronary artery disease patients (male 11, mean age 54 years) who had myocardial infarction or demonstrated left ventricular wall motion abnormality on echocardiography were enrolled. Three mCi of Tl-201 was injected into both coronary arteries during angiography and images were acquired between 6- and 24-hour after injection. Reinjection imaging with 1 mCi of Tl-201 was performed at 4-hour after adenosine stress imaging with 3 mCi of Tl-201. Images were interpreted according to 4-grade visual scoring system (grade 0-3). Segments with mild to moderated uptake (< or=grade 1), and upgraded more than one score with reinjection, and were defined as viable myocardium. RESULTS: Image quality was poor in two cases with IC-I. Numbers of non-viable segments were 60 (23.8%) with IC-I, and 38 (15.1%) with Re-I, respectively. Overall agreement for perfusion grade per myocardial segment in each IC-I and Re-I was 76.5%. Overall agreement for viable segment between IC-I and Re-I was 90.5%. Only one out of 38 segments interpreted as non-viable with Re-I were interpretated as viable with IC-I. And 23 out of 214 segments interpreted as viable with Re-I were interpreted as non-viable with IC-I. CONCLUSION: Intracoronary Tl-201 SPECT seemed to be not advantageous over stress-rest reinjection imaging in the assessment of myocardial viability, mainly due to low count statistics at 6-hour or 24-hour delayed time points. The feasibility of intracoronary Tl-201 SPECT is considered to be limited.

Myocardial Tracer Uptake in SPECT Images after Direct Intracoronary Injection Of Tl-201: Comparison with Stress-Reinjection Images / 핵의학분자영상

PURPOSE: To investigate the feasibility of Tl-201 SPECT with intracoronary injection (IC-I) in the detection of viable myocardium, we have performed SPECT imaging after direct intracoronary injection of Tl-201 and images were compared with those of stress-reinjection (Re-I) SPECT. METHODS: Fourteen coronary artery disease patients (male 11, mean age 54 years) who had myocardial infarction or demonstrated left ventricular wall motion abnormality on echocardiography were enrolled. Three mCi of Tl-201 was injected into both coronary arteries during angiography and images were acquired between 6- and 24-hour after injection. Reinjection imaging with 1 mCi of Tl-201 was performed at 4-hour after adenosine stress imaging with 3 mCi of Tl-201. Images were interpreted according to 4-grade visual scoring system (grade 0-3). Segments with mild to moderated uptake (< or=grade 1), and upgraded more than one score with reinjection, and were defined as viable myocardium. RESULTS: Image quality was poor in two cases with IC-I. Numbers of non-viable segments were 60 (23.8%) with IC-I, and 38 (15.1%) with Re-I, respectively. Overall agreement for perfusion grade per myocardial segment in each IC-I and Re-I was 76.5%. Overall agreement for viable segment between IC-I and Re-I was 90.5%. Only one out of 38 segments interpreted as non-viable with Re-I were interpretated as viable with IC-I. And 23 out of 214 segments interpreted as viable with Re-I were interpreted as non-viable with IC-I. CONCLUSION: Intracoronary Tl-201 SPECT seemed to be not advantageous over stress-rest reinjection imaging in the assessment of myocardial viability, mainly due to low count statistics at 6-hour or 24-hour delayed time points. The feasibility of intracoronary Tl-201 SPECT is considered to be limited.

Diagnosis of Coronary Artery Disease using Myocardial Perfusion SPECT in Patients with Diabetes Mellitus: Analysis of Risk Factors / 핵의학분자영상

PURPOSE: Diabetes mellitus (DM) is a critical disease with higher rates of cardiovascular morbidity and mortality due to myocardial ischemia and infarction. There is growing interest in how to determine high-risk patients who are candidates for screening testing. This study was performed to evaluate the incidence of coronary artery disease (CAD) in diabetic patients detected by Tc-99m MIBI myocardial perfusion SPECT (MPS) and to assess risk factors of CAD and cardiac hard events. SUBJECTS AND METHODS: 203 diabetic patients (64 male, mean age 64.1+/-9.0 years) who underwent MPS were included between Jan 2000 and July 2004. Cardiac death and nonfatal myocardial infarction (MI) were considered as hard events, and coronary angioplasty and bypass surgery >60 days after testing were considered as soft events. The mean follow-up period was 36+/-18 months. Patients underwent exercise (n=6) or adenosine stress (n=197) myocardial perfusion SPECT. RESULTS: Perfusion defects on MPS were detected in 28.6% (58/203) of the patients. There was no cardiac death but 11 hard events were observed. The annual cardiac hard event rate was 1.1%. In univariate analysis of clinical factors, typical anginal pain, peripheral vascular disease, peripheral polyneuropathy, and resting ECG abnormality were significantly associated with the ocurrence of hard events. Anginal pain, peripheral vascular disease, and resting ECG abnormality remained independent predictors of nonfatal MIs with multivariate analysis. Abnormal SPECT results were significantly associated with high prevalence of hard events but not independent predictors on uni- and multivariate analyses. CONCLUSION: Patients who were male, had longer diabetes duration (especially over 20 years), peripheral vascular disease, peripheral polyneuropathy, or resting ECG abnormality had higher incidence of CAD. Among clinical factors in diabetic patients, typical angina, peripheral vascular disease, peripheral polyneuropathy, and resting ECG abnormality were strong predictors of hard events.