• Nuclear Medicine and Molecular Imaging
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• 제43권4호
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• pp.317-322
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• 2009

목적: 담관암의 진단과 치료 평가를 위해서 여러 영상학적 방법이 이용되나 성장 형태를 포함한 질환의 성상이 아주 다양하고 종양과 주변 조직간의 대조도가 낮은 경우 발견이 어렵고 주로 종양 부분에 대한 국소 영상을 시행하여 질병의 전신 평가에는 충분하지 못할 수 있다. 이러한 점을 보완하기 위하여 $^{18}$F-FDG PET에 대한 연구가 이루어 지고 있는데, 본 연구에서는 담관암의 발생위치와 성장형태에 따라 $^{18}$F-FDG 섭취양상의 변화와 그에 따른 임상적 의의를 알아보고자 하였다. 대상 및 방법: 2005년 4월부터 2008년 5월까지 담관암으로 진단 받고 PET/CT를 촬영한 환자를 대상으로 하였다. 위치에 따른 담관암의 분류는 간내담관암과 간외담관암으로 나누고 간외담관암은 간문부암과 원위부 담도 암으로 나누었다. 간외담관암은 다시 그 성장형태에 따라 경화형, 결절형, 용종형으로 분류하여 PET양성인 환자들 중 SUV$_{max}$를 비교하였다. 결과: 총 82명의 담도암 환자들 중PET양성을 보인 환자는 81.7%이었다. PET 양성을 보인 간내담관암 환자는 23명으로 이들의 SUV$_{max}$는 9.4$\pm$4.1로 간외담관암보다 의미있게 높았다. 용종형의 간외담관암은 9명중 모두가 PET 양성이었고, SUV$_{max}$도 10.1$\pm$7.0으로 경화형, 결절형에 비해 높았다. 결론: 본 연구의 결과를 바탕으로$^{18}$F-FDG PET은 간외담관암보다는 간내담관암을 가진 환자의 진단에 더 유용할 것으로 보이며, 간외담관암의 진단에 있어서는 담도벽을 따라 침윤성으로 발생하는 경화형보다는 종괴를 형성하는 용종형에서 더 의미있는 검사방법이 될 수 있겠다.

• 생물정신의학
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• 제15권1호
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• pp.46-53
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• 2008

Posterior cortical atrophy(PCA) is a presenile dementia that presents primarily with signs and symptoms of cortical visual dysfunction, while memory is relatively preserved until the late stage of the disease. We report a patient with PCA, confirmed by brain magnetic resonance imaging (MRI) and $F^{18}$-fluorodeoxyglucose positron emission tomography(FDG PET). A 58-year-old right-handed woman presented initially with visual dimness and difficulty finding things around her. She had partial Balint's syndrome, partial Gerstmann syndrome, and idiomotor apraxia. She also had a mild memory disturbance, but preserved insight of her disease. Neuropsychological evaluation showed decreased parietal and left temporal functions bilaterally. Brain MRI and $F^{18}$-FDG PET revealed typical bilateral occipitoparietal atrophy and hypometabolism, which were slightly worse on the right side. Cholinesterase inhibitor administration for 6 months improved the memory impairment slightly, but not the cortical visual dysfunction. This is a typical case of PCA, confirmed by neurologic signs and imaging findings.

• Tuberculosis and Respiratory Diseases
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• 제74권4호
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• pp.181-186
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• 2013

We report a rare synchronous presentation of primary lung cancer and adrenal pheochromocytoma. A 59-year-old woman was diagnosed with right upper lobe non-small cell lung carcinoma measuring 2.8 cm and a right adrenal gland mass measuring 3.5 cm, which displayed increased metabolic activity on $^{18}F$-fluorodeoxyglucose positron emission tomography-computed tomography. The adrenal lesion was revealed to be asymptomatic. The patient underwent right adrenalectomy and histological examination revealed a pheochromocytoma. Ten days later, right upper lobectomy was performed for lung cancer. This case indicates that incidental adrenal lesions found in cases of resectable primary lung cancer should be investigated.

• Radiation Oncology Journal
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• 제37권1호
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• pp.51-59
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• 2019

Purpose: We evaluated failure pattern and treatment outcomes of observational approach on regional lymph node (LN) in cutaneous melanoma of extremities and sought to find clinico-pathologic factors related to LN metastases. Material and Methods: We retrospectively reviewed 73 patients with cutaneous melanoma of extremities between 2005 and 2016. If preoperative 18-F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) findings were non-specific for regional LNs, surgical resection of primary tumors with adequate margins was performed without sentinel lymph node biopsy (SLNB) and/or complete lymph node dissection (CLND), irrespective of tumor thickness or size. In patients with suspicious or positive findings on PET/CT or CT, SLNB followed by CLND or CLND was performed at the discretion of the surgeon. We defined LN dissection (LND) as SLNB and/or CLND. Results: With a median follow-up of 38 months (range, 6 to 138 months), the dominant pattern of failure was regional failure (17 of total 23 events, 74%) in the observation group (n = 56). Pathologic LN metastases were significant factor for poor regional failure-free survival (hazard ration [HR] = 3.21; 95% confidence interval [CI], 1.03-10.33; p = 0.044) and overall survival (HR = 3.62; 95% CI, 1.02-12.94; p = 0.047) in multivariate analysis. In subgroup analysis for cN0 patients according to the preoperative PET/CT findings, LND group showed the better trend of LRFFS (log rank test, p = 0.192) and RFFS (p = 0.310), although which is not statistically significant. Conclusion: Observational approach on regional LNs on the basis of the PET/CT in patients with cutaneous melanoma of extremities showed the dominant regional failure pattern compared to upfront LND approach. To reveal regional lymph node status, SLND for cN0 patients may of importance in managing cutaneous melanoma patients.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제19권1호
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• pp.13-18
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• 2008

Objectives : Internet addiction or pathologic internet use is one of the major mental health problems in children and adolescents in Korea. Internet addiction is defined as uncontrollable, markedly time-consuming internet use, which lasts for a period of at least six months. Internet addiction results in poor academic performance and negative parent-child relationships. By using $^{18}F$-fluorodeoxyglucose-positron emission tomography (FDG-PET), we investigated the effects of internet addiction on functional changes occurring in the adolescent brain. Methods : Adolescent patients with an internet addiction (4 boys and 2 girls; $15.6{\pm}1.2$ years) participated in this study. Eight healthy young adults (5 males and 3 females; 18-30 years old) with no previous history of psychiatric illness also participated as normal controls. Brain FDG-PET data was obtained with the participants in the resting condition and with no addictive stimuli. Results : Statistic parametric mapping analysis of the brain FDG-PET data revealed hypometabolic changes in the visual information processing circuits and hypermetabolic changes in the prefrontal areas in the adolescents with internet addiction, as compared with normal controls (p<.001). Conclusion : These results suggest a neuronal adaptation to excessive visual stimulation and synaptic plasticity due to internet addiction.

• Tuberculosis and Respiratory Diseases
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• 제71권6호
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• pp.417-424
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• 2011

Background: Recent evidences have revealed metabolic functions of p53 in cancer cells; adaptation or survival to metabolic stress and metabolic shift toward oxidative phosphorylation. However, further studies in clinical setting are needed. We investigated whether p53 protein expression, as a surrogate marker for loss of p53 function, is associated with metabolic features of stage I non-small cell lung cancer (NSCLC), focusing on tumor necrosis and maximal standardized uptake value (SUVmax) on $^{18}F$-fluorodeoxyglucose positron emission tomography. Methods: Clinical information was obtained from retrospective review of medical records. p53 expression was assessed by immunohistochemical staining. Results: p53 protein expression was detected in 112 (46%) of 241 NSCLC cases included in this study. p53 expression was independently associated with the presence of necrosis (odds ratio [OR], 2.316; 95% confidence interval [CI], 1.215~4.416; p=0.011). Non-adenocarcinoma histology (OR, 8.049; 95% CI, 4.072~15.911; p<0.001) and poorly differentiation (OR, 6.474; 95% CI, 2.998~13.979; p<0.001) were also independently associated with the presence of necrosis. However, p53 expression was not a significant factor for SUVmax. Conclusion: p53 protein expression is independently associated with the presence of necrosis, but not SUVmax.

• Tuberculosis and Respiratory Diseases
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• 제72권5호
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• pp.452-456
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• 2012

Disseminated Mycobacterium avium complex (MAC) infection can occur in immunocompromised patients, and rarely in immunocompetent subjects. Due to the extensive distribution of the disease, clinical presentation of disseminated MAC may mimic malignancies, and thorough examinations are required in order to make accurate diagnosis. We report a case of disseminated Mycobacterium intracellulare disease in an immunocompetent patient, which involved the lung, lymph nodes, spleen, and multiple bones. F-18 fluorodeoxyglucose positron-emission tomography imaging showed multiple hypermetabolic lesions, which are suggestive of typical hematogenous metastasis. However, there was no evidence of malignancy in serial biopsies, and M. intracellulare was repeatedly cultured from respiratory specimens and bones. Herein, we should know that disseminated infection can occur in the immunocompetent subjects, and it can mimic malignancies.

• Asian Pacific Journal of Cancer Prevention
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• 제15권8호
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• pp.3525-3531
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• 2014

Objective: Fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) is a new technique for identifying different malignant tumors using different uptake values between tumor cells and normal tissues. Here we assessed the diagnostic accuracy of 18F-FDG-PET in patients with testicular cancer by pooling data of existing trials in a meta-analysis. Methods: PubMed/MEDLINE, Embase and Cochrane Central Trials databases were searched and studies published in English relating to the diagnostic value of FDG-PET for testicular cancer were collected. The summary receiver operating characteristic (SROC) curve was used to examine the FDG-PET accuracy. Results: A total of 16 studies which included 957 examinations in 807 patients (median age, 31.1 years) were analyzed. A meta-analysis was performed to combine the sensitivity and specificity and their 95% confidence intervals (CIs), from diagnostic odds ratio (DOR), positive likelihood ratios (PLR), negative likelihood ratio (NLR). SROC were derived to demonstrate the diagnostic accuracy of FDG-PET for testicular cancer. The pooled sensitivity and specificity were 0.75 (95% confidence interval (CI), 0.70-0.80) and 0.87 (95% CI, 0.84-0.89), respectively. The pooled DOR was 35.6 (95% CI, 12.9-98.3). The area under the curve (AUC) was 0.88. The pooled PLR and pooled NLR were 7.80 (95% CI, 3.73-16.3) and 0.31 (95% CI, 0.23-0.43), respectively. Conclusion: In patients with testicular cancer, 18F-FDG-PET demonstrated a high SROC area, and could be a potentially useful tool if combined with other imaging methods such as MRI and CT. Nevertheless, the literature focusing on the use of 18F-FDG-PET in this setting still remains limited.

• 대한영상의학회지
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• 제81권6호
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• pp.1424-1435
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• 2020

목적 간세포암종과 혼합성 간세포암종-담관암종의 다위상 전산단층촬영술 소견과 ¹⁸F-fluorodeoxyglucose 양전자방출단층촬영(이하 FDG PET/CT)에서 섭취율 차이를 연구하여 이들의 감별 진단에 유용성이 있는지를 알아보고자 하였다. 대상과 방법 2007년 1월에서 2016년 4월까지 조직학적으로 간세포성 암종으로 진단된 84명과 혼합성 간세포암종-담관암종으로 진단된 9명의 환자를 대상으로 하였다. 조영증강 양상은 유형 I (동맥기 조영증강과 지연기 조영유실), 유형 II (지연기 조영유실이 없는 동맥기 조영증강), 유형 III (저혈관성 병변, 침투성 양상 혹은 변연부 조영증강)로 구분하였고, PET/CT 소견은 FDG 섭취 여부에 따라서 양성과 음성으로 분류하였다. 결과 혼합성 간세포암종-담관암종(89%)은 간세포암종(61%)보다 PET/CT 섭취 양성률이 높았으나 통계적으로 유의한 차이는 보이지 않았다(p = 0.095). 유형 I 조영증강양상을 보이는 58개의 간세포암종 중 37예(64%)가 PET/CT에서 양성이었다. 유형 II 조영증강양상을 보이는 19예 중 간세포암종 3예(21%)에서 PET/CT에서 양성을 보였고 혼합 간세포암종-담관암종 4예(80%)에서 PET/CT 양성을 보였다. 유형 II 조영증강양상을 보이는 경우 혼합 간세포암-담관암종이 간세포암종보다 PET/CT 양성률이 유의하게 높았다(p = 0.020). 유형 III 조영증강 양상을 보이는 16예 중 간세포암 11예(91.6%), 혼합 간세포암-담관암종 4예(100%)에서 PET/CT 양성을 보였다. 유형 III 조영증강양상을 보이는 경우 간세포암과 혼합 간세포암-담관암종의 PET/CT 양성률의 유의한 차이는 보이지 않았다. 결론 유형 II 조영증강 양상을 보이는 경우 간세포암종과 혼합성 간세포암종-담관암종의 감별진단에 전산단층촬영술과 병행하는 ¹⁸F-FDG PET/CT가 도움이 될 것으로 보인다.

• Nuclear Medicine and Molecular Imaging
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• 제43권2호
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• pp.137-142
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• 2009

목적: 이 연구는 $^{18}F$-FDG Positron Emission Tomography/computed Tomography(PET/CT) 영상 검사의 병원간 전송을 위해 사용되는 CD자료의 현황과 문제점에 대해 알아보고자 하였다. 대상 및 방법: 2006년 6월부터 2007년 10월까지 외부 병원에서 시행한 $^{18}F$-FDG PET/CT 검사에 대한 판독 의뢰가 있었던 746명의 환자들을 대상으로 하여, 56개의 병원 PET/CT영상 CD자료에 대해서 조사하였다. 그리고 DICOM표준 형식의 횡단면(transaxial) PET과 CT 영상이 없거나 제한적인 병원들을 대상으로 각 병원의 핵의학과 과장님들께 인터넷 메일을 통해 설문 조사를 실시하였다. 결과: 조사된 병원 전체의 37.5%(21/56)만이 정확한 판독과 진료를 위해 필요한 DICOM 표준 형식의 횡단면 전체 PET 영상과 CT 영상 모두를 제공해 주고 있었다. 나머지 병원들에서는 이차적인 캡쳐(secondary capture image) 영상 또는 PET/CT 융합 영상(fusion image)만으로 구성된 제한적인 영상 자료를 제공해 주고 있었다. 설문조사에는 14개의 병원에서 답변해주었는데 그 중 6개(42.9%) 병원의 핵의 학과에서는 제한적인 영상을 보낸다는 사실을 본 연구의 설문 조사 전에는 제대로 알지 못하고 있었다 나머지 병원들에서 PET/CT 영상 CD자료의 구성이 제한적이게 된 주된 이유는 의료영상저장전송장치(PACS, Picture Archiving and Communication System)의 용량상의 문제로 온전히 모든 PET/CT 영상을 PACS서버에 올리지 않는데, 환자는 PACS에 올라가 있는 영상만 복사해가기 때문이었다. 결론: 현재 각 병원들에서 외부 병원으로 복사하여 보내는 PET/CT영상 자료 CD는 전체 대상 병원의 절반 이상에서 제한적인 영상만을 포함하고 있어서, 외부 병원 영상을 받아서 환자 진료에 이용하는 병원에서는 제한된 영상 정보로 인한 PET/CT 검사의 판독 및 활용 상에 어려움, 재촬영에 따른 추가 의료비 지출이 상당한 문제가 되고 있다. 각 병원들에서 외부 병원으로 보내는 PET/CT 영상 자료에는 DICOM 표준 형식의 전체 횡단면 PET 영상과 전체 횡단면 CT 영상은 최소한 필수적으로 포함시키도록 하는 정부와 학회 차원에서의 PET/CT 영상에 대한 가이드라인 마련이 필요하다.