• Title/Summary/Keyword: 영상의학과

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The Importance of Video Fluoroscopy Swallowing Study for Nasogastric Tube Removal in Rehabilitation Patients (재활치료환자의 비위관(nasogastric tube)제거에 따른 비디오 투시연하검사(VFSS)의 중요성 평가)

  • Jung, Myoyoung;Choi, Namgil;Han, Jaebok;Song, Jongnam;Kim, Weonjin
    • Journal of the Korean Society of Radiology
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    • v.9 no.1
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    • pp.1-7
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    • 2015
  • Acute phase patients who are unconscious and are suffering from cerebral infarction, cranial nerve disorders, or cerebral apoplexy are susceptible to aspiration pneumonia due to dysphagia. In these cases, a nasogastric tube is inserted to supply nutrients. Although bedside screening tests are administered during recovery after rehabilitation, clinical examinations may not be able to ascertain asymptomatic aspiration. Therefore, a video fluoroscopy swallowing study (VFSS) was performed in 10 patients with dysphagia after rehabilitation therapy; these patients had nasogastric tubes inserted, and a rehabilitation specialist assessed the degree of swallowing based on the patients' diet and posture. If aspiration or swallowing difficulties were observed, dysphagia rehabilitation therapy was administered. The patients were reassessed approximately 30-50 days after administration of therapy, based on the patients' condition. If aspiration is not observed, the nasogastric tube was removed. A functional dysphagia scale was used to analyze the VFSS images, and the scores were statistically calculated. The mean score of patients with nasogastric tubes was $49.79{\pm}9.431$, thereby indicating aspiration risk, whereas the group without nasogastric tubes showed a mean score of $11.20{\pm}1.932$, which indicated low risk of aspiration. These results demonstrated that a significantly low score was associated with nasogastric tube removal. Mann-Whitney's test was performed to assess the significance of both the groups, and the results were statistically significant with a P value <0.001. In conclusion, VFSS can effectively assess the movements and structural abnormalities in the oral cavity, pharynx, and esophagus. It can also be used to determine the aspiration status and ascertain the appropriate diet or swallowing posture for the patient. Therefore, VFSS can potentially be used as a reliable standard test to assess swallowing in order to determine nasogastric tube removal.

Analysis of bone bruise associated with anterior cruciate ligament injury (전방십자인대 손상과 관련된 골멍의 패턴 분석)

  • Jung, Dae-Won;Kim, Chang-Wan;Baik, Jong-Min;Seo, Seung-Suk
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.11 no.1
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    • pp.44-50
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    • 2012
  • Purpose: The purpose of this study is to analyze the relationship between acute anterior cruciate ligament (ACL) injury and bone bruise using the survey for location and incidence of bone bruise. Materials and Methods: From Jan. 2006 to Feb. 2010, 87 knees from who had complaint a traumatic knee pain were diagnosed as acute ACL tear using MRI evaluation. Associated injury, location and incidence of bone bruise were analyzed using MRI. The location of bone bruise on the MRI was classified as medial, central and lateral area on anteroposterior and lateral view of femur and tibia. The bone bruise was classified with Costa Paz classification. Results: Bone bruise of injury during daily living activity were located at medial area on coronary view and anterior area on sagittal view of distal femur, at medial area on coronary view and anterior area on sagittal view of proximal tibia (p=0.024, p=0.021, p=0.025 and p=0.029, respectively). Bone bruise of injury during sports activity were located at lateral area on coronary view and central area on sagittal view of distal femur, at lateral area on coronary view and posterior area on sagittal view of proximal tibia (p=0.014, p=0.015, p=0.018 and p=0.017, respectively). Bone bruise patterns due to traffic accident were inconclusive (p=0.264, p=0.254, p=0.229 and p=0.267, respectively). Conclusion: Injury mechanism of acute ACL injury from activities of daily living or sports activities compared to that of traffic accident showed a more consistent bone bruise patterns. Special attention to acute ACL tear must be paid in case of bone bruise at lateral tibial plateau and lateral femoral condyle.

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Evaluation of Fibrosis in Liver Cirrhosis by Superparamagnetic Iron Oxide (SPIO)-Enhanced MR Imaging: Does the Radiological Non-Invasive Fibrosis Index Correlate with the Laboratory Non-Invasive Fibrosis Index? (Superparamagnetic Iron Oxide-Enhanced MRI를 이용한 간섬유화의 평가: 영상의학적 비침습적 간섬유화 지표가 AST/혈소판 비와 상관 관계가 있는가?)

  • Kim, Shin-Kee;Lee, Chang-Hee;Kim, Kyeong-Ah;Choi, Jae-Woong;Lee, Jong-Mee;Park, Cheol-Min
    • Investigative Magnetic Resonance Imaging
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    • v.12 no.2
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    • pp.115-122
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    • 2008
  • Purpose : To evaluate the correlation between the radiological non-invasive hepatic fibrosis index (RNHFI), as determined by SPIO-enhanced MRI, and the laboratory non-invasive hepatic fibrosis index. Materials and Methods : Patients (99 total: 61 men and 38 women; mean age: 58 years) who underwent SPIO-enhanced MRI (1.5T) during 5 years included. These patients were subdivided into a liver cirrhosis group (LCG) and a non-liver cirrhosis group (non-LCG). Using PACS view, we measured the RNHFI (mean standard deviation of hepatic signal intensity (SD), noise-corrected coefficient of variation (CV)) of three ROIs in the liver parenchyma by SPIO-enhanced MRI. The laboratory non-invasive hepatic fibrosis index (AST-platelet ratio index (APRI)) of all patients was calculated from the laboratory data. We compared the RNHFI and APRI of LCG with those of non-LC group using Student's t-test. A bivariate correlation was performed to investigate the relationship between the RNHFI and APRI in the LCG. Results : For the LCG, mean values of SD and CV by SPIO-enhanced MRI were $10.3{\pm}3.7$ and $0.19{\pm}0.08$, respectively. For the non-LCG, mean values of SD and CV were $6.5{\pm}1.6$ and $0.08{\pm}0.05$, respectively. The mean APRI of the LCG and the non- LCG were $2.04{\pm}1.7$ and $0.32{\pm}0.32$, respectively. The RNHFI and APRI were significantly different between both groups (p<0.05). For the LCG, the bivariate correlation between SD and APRI revealed a statistically significant positive correlation (r=0.5, p<0.001). In both groups, there was no statistically significant correlation between CV and APRI. Conclusion: A measurement of SD can be a simple and useful method for the evaluation of hepatic fibrosis.

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Characteristic Findings of Exercise ECG Test, Perfusion SPECT and Coronary Angiography in Patients with Exercise Induced Myocardial Stunning (게이트 심근관류 SPECT상 운동 유발성 기절심근을 보이는 환자의 운동부하 심전도, 관류 SPECT 및 심혈관 조영술 소견)

  • Ahn, Byeong-Cheol;Seo, Ji-Hyoung;Bae, Jin-Ho;Jeong, Shin-Young;Park, Hun-Sik;Lee, Jae-Tae;Chae, Shung-Chul;Lee, Kyu-Bo
    • The Korean Journal of Nuclear Medicine
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    • v.38 no.3
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    • pp.225-232
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    • 2004
  • Purpose : Transient wall motion abnormality and contractile dysfunction of the left ventricle (LV) can be observed in patients with coronary artery disease due to post-stress myocardial stunning. To understand clinical characteristics of stress induced LV dysfunction, we have compared the findings of exercise stress test, myocardial perfusion SPECT and coronary angiography between subjects with and without post-stress LV dysfunction. Materials and Methods : Among subjects who underwent exercise stress test, myocardial perfusion SPECT and coronary angiography within a month of interval, we enrolled 36 patients with post-stress LV election fraction (LVEF) was $\geq5%$ lower than rest (stunning group) and 16 patients with difference of post-stress and rest LVEF was lesser than 1 %(non-stunning group) for this study. Treadmill exercise stress gated myocardial perfusion SPECT was performed with dual head SPECT camera using 740 MBq Tc-99m MIBI and coronary angiography was also performed by conventional Judkins method. Results : Stunning group had a significantly higher incidence of hypercholesterolemia than non-stunning group(45.5 vs. 7.1%, p=0.01). Stunning group also had higher incidence of diabetes mellitus and lower incidence of hypertension, but these were not statistically significant. Stunning group had larger and more severe perfusion defect in stress perfusion myocardial SPECT than non-stunning group(extent 18.2 vs. 9.2%, p=0.029; severity 13.5 vs. 6.9, p=0.040). Stunning group also had higher degree of reversibility of perfusion defect, higher incidence of positive exercise stress test and higher incidence of having severe stenosis ($80{\sim}99%$) in coronary angiography than non-stunning group, but these were not statistically significant. In stunning group, all of 4 patients without perfusion defect had significant coronary artery stenosis and had received revascularization treatment. Conclusion : Patients with post-stress LV dysfunction had larger and more severe perfusion defect and severe coronary artery stenosis than patients without post-stress LV dysfunction. All of the patients without perfusion defect in stunning group had significant coronary artery stenosis and needed revascularization. Therefore, we suggest that invasive diagnostic procedures and therapeutic interventions might be needed in patients with post-stress LV dysfunction.

Biodistribution and Metabolism of I-123 Labelled Fatty Acid(I) : [I-123]15-(p-iodophenyl)pentadecanoic acid(IPPA) (I-123 표지 지방산의 체내 분포 및 대사(I) : [I-123]15-(p-iodophenyl)pentadecanoic acid(IPPA))

  • Chang, Young Soo;Lee, Dong Soo;Jeong, Jae Min;Suh, Yong-Sup;Chung, June-Key;Lee, Myung Chul;Koh, Chang-Soon
    • The Korean Journal of Nuclear Medicine
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    • v.32 no.1
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    • pp.50-60
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    • 1998
  • I-123 labelled fatty acids are suitable for investigation of regional myocardial metabolism, so they are on the clinical trial. However, the precise properties of these materials are not characterized yet. We have synthesized phenylpentadecanoic acid and labeled this compound with I-123. The purpose of this study was to examine the stability, biodistribution, metabolism and SPECT imaging of [I-123]15-(p-iodophenyl)pentadecanoic acid(I-123-IPPA) that we made. The stability test of I-123-IPPA in serum of rat, mouse and human showed no free I-123 after 1 hour. In biodistribution study in mice for various time intervals after injection(5, 10, 15, 30, 60 minutes), uptake in myocardium was 14.5%ID/g(5 min), and 1.9%ID/heart(5 min), while uptake in muscles was 2.6%ID/g(5 min). Myocardium to blood ratio and myocardium to lung ratio increased for 5 min after injection and then decreased rapidly. Chromatographic data of rat blood and urine showed that little PPA was found in blood and urine at 15-20 min after injection. The myocardial I-123-IPPA SPECT images of a dog with myocardial infarction showed defects similar to those of Tc-99m-MIBI and F-18-FDG. These data suggest that I-123-IPPA is quite stable in vitro and shows favorable biodistribution in mice. SPECT imaging with I-123-IPPA demonstrated infarct zone as photon defect in dog model of myocardial infarction. I-123-IPPA may be used for the evaluation of fatty acid metabolism in clinical trials in Korea.

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Correlation of SUV According to the Body Weight and Body Surface Area in PET/CT Imaging (PET/CT 검사 시 체중과 체표면적에 따른 SUV의 상관관계)

  • Park, Ju-Seon;Do, Yong-Ho;Kim, Jung-Soo;Lee, Hong-Jae;Kim, Jin-Eui
    • The Korean Journal of Nuclear Medicine Technology
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    • v.17 no.2
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    • pp.44-47
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    • 2013
  • Purpose: There are several methods of measuring SUV in PET/CT imaging including $SUV_{bw}$ which uses the body weight, $SUV_{bsa}$ which that uses body surface area and $SUV_{lbm}$ which uses lean body mass. Currently, Seoul National University Hospital uses $SUV_{bw}$ method which minimizes the variability. In this study, we compared and analyzed the correlation between $SUV_{bw}$ and $SUV_{bsa}$ according to patients' body mass index. Materials and Methods: Using Biograph mCT40 (Siemens, Germany), we conducted $^{18}F-FDG$ PET/CT imaging on 70 patients (41 males, 29 females; ages $58.04{\pm}12.44$). We classified the patients as underweight (BMI<20), normal weight (20$${\leq_-}$$BMI<25), overweight (25$${\leq_-}$$BMI<30), obese (30$${\leq_-}$$BMI<35) and severely obese (35$${\leq_-}$$BMI) according to the patient's sex, age and BIM. Then, bone, liver and lungs were set as ROI for calculation of maximum values of $SUV_{bw}$ and $SUV_{bsa}$, through Syngo.via VA11A analysis program. Results: Comparing the five groups divided according to the BMI by the standard differences between $SUV_{bw}$ to $SUV_{bsa}$, $SUV_{max}$ was measured to be $0.66{\pm}0.15$, $0.78{\pm}0.35$, $0.77{\pm}0.21$, $1.00{\pm}0.44$, $1.53{\pm}0.38$ for bones in underweight, normal weight, overweight, obese and severely obese groups, respectively. For liver, values of $SUV_{max}$ were $1.64{\pm}0.16$, $2.06{\pm}0.34$, $2.19{\pm}0.21$, $2.52{\pm}0.21$ and $2.74{\pm}0.40$ in the same order. And for lung, values of $SUV_{max}$ were $0.69{\pm}0.33$, $0.54{\pm}0.17$, $0.62{\pm}0.23$, $0.83{\pm0.29}$, $1.03{\pm}0.30$. Conclusion: By comparing and analyzing the differences between $SUV_{bw}$ and $SUV_{bsa}$ in this study, it was found that the differences between $SUV_{bw}$ and $SUV_{bsa}$ increased as patient's BMI increased. Thus, there is room for error in the values of SUV depending on the methods of calculations, and appropriate methods must be applied according to the circumstances in clinical settings.

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Research on Changing of Renal Relative Uptake Depending on the Setting of Background ROI in Kidney MAG3 Study of Hydronephrosis Patients (Hydronephrosis 환자의 Kidney MAG3 검사 시 Background ROI 설정에 따른 신장 상대 섭취율 변화에 관한 연구)

  • Noh, Ik Sang;Ahn, Byung Ho;Kim, Soo Yung;Choi, Sung Wook
    • The Korean Journal of Nuclear Medicine Technology
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    • v.17 no.2
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    • pp.25-30
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    • 2013
  • Purpose: To evaluate kidney function, renal relative uptake is very important and is affected by kidney and the setting of background region of interest (ROI). In particular, in the case of patients with hydronephrosis to the naked eyes, such as size, position and shape etc. can be difficult to identify. So according to ROI to be set by user, the results are many differences. This study assumes the ROI of a constant kidney. According to the change of background ROI by analyzing renal relative uptake affect how the results are intended to study. Materials and Methods: From January 2012 to February 2013, we analyzed 27 patients with hydronephrosis who were examined MAG3 test in nuclear medicine department of Samsung medical center. After patients were received intravenous injection of $^{99m}Tc-MAG3$ 185 MBq (5 mCi) data were obtained. While we reconstructed images of patients, we've changed background ROI in the process of setting up ROI. First, in the process of renal processing, automatic ROI which set automatically and background ROI which needed to set manually were compared. Second, we set the ROI position separated by above, lateral and bottom of kidney. Third, background setting time were compared with 1-2 min and 2-3 min. Results: The relative uptake occurred in 3.7%p of the errors on average in Automatic & Manual ROI study. And comparison of background ROI position study, located in the lower position was more accurate results. Above, lateral, bottom each of the values 74.6%, 67.6% and 62.0% showed respectively. The standard value was 59.9%. finally, split function range test doesn't show significant difference. Conclusion: The study shows that relative uptake of kidney is affected in the background ROI. Therefore, it should be set by considering various dependent factors.

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The Variation of Scan Time According to Patient's Breast Size and Body Mass Index in Breast Sentinel lymphangiography (유방암의 감시림프절 검사에서 유방크기와 체질량지수에 따른 검사시간 변화)

  • Lee, Da-Young;Nam-Koong, Hyuk;Cho, Seok-Won;Oh, Shin-Hyun;Im, Han-Sang;Kim, Jae-Sam;Lee, Chang-Ho;Park, Hoon-Hee
    • The Korean Journal of Nuclear Medicine Technology
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    • v.16 no.2
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    • pp.62-67
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    • 2012
  • Purpose : At this time, the sentinel lymph node mapping using radioisotope and blue dye is preceded for breast cancer patient's sentinel lymph node biopsy. But all patients were applied the same protocol without consideration of physical specific character like the breast sizes and body mass indexes. The purpose of this study is search the optimized scan time in breast sentinel lymphangiography by observing how much the body mass index and breast size influence speed of lymphatic flow. Materials and Methods : The Object of this study was 100 breast cancer patients(Female, 100 persons, average age $50.34{\pm}10.26$ years old)at Severance hospital from October 2011 to December 2011. They were scanned breast sentinel lymphangiography before operation. This study was performed on Forte dual heads gamma camera (Philips Medical Systems, Nederland B.V.). All patients were intra-dermal injected $^{99m}Tc$-Phytate 18.5 MBq, 0.5 ml. For 80 patients, we have scanned without limitation of scan time until the lymphatic flow from the lymph node since injection. We measured how long the lymphatic flow time between departures from injects site and arrival to lymph node using stopwatch. After we calculated patient's Body mass Index and classified as 4 groups. And we measured patient's breast size and classified 3 groups. The modified breast lymphangiography that changing scan time according to comparison study's result was performed on 20 patients and was estimated. Results : The mean scan time as breast size was A group 2.48 minutes, B group 7.69 minutes, C group 10.43 minutes. The mean scan time as body mass index was under weight 1.35 minutes, normal weight 2.56 minutes, slightly over 5.62 minutes, over weighted 5.62 minutes. The success rate of modified breast lymphangiography was 85%. Conclusion : As the Body mass index became higher and breast size became bigger, the total scan time is increased. Based on the obtained information, we designed modified breast lymphangiography protocol. At the cases applying that protocol, most of sentinel lymph nodes were visualized as lymphatic pool. In conclusion, we found that the more success rate in modified protocol considering physical individuality than study carrying out in the same protocol.

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Expression of CD40, CD86, and HLA-DR in CD1c+ Myeloid Dendritic Cells Isolated from Peripheral Blood in Primary Adenocarcinoma of Lung (원발성 폐선암환자의 말초혈액에서 분리한 CD1c+ 골수성 수지상 세포에서의 CD40, CD86 및 HLA-DR의 발현)

  • Kang, Moon-Chul;Kang, Chang-Hyun;Kim, Young-Tae;Kim, Joo-Hyun
    • Journal of Chest Surgery
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    • v.43 no.5
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    • pp.499-505
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    • 2010
  • Background: There have been several reports using animal experiments that CD1-restricted T-cells have a key role in tumor immunity. To address this issue, we studied the expression of markers for CD1c+ myeloid dendritic cells (DCs) isolated from peripheral blood in the clinical setting. Material and Method: A total of 24 patients with radiologically suspected or histologically confirmed lung cancer who underwent pulmonary resection were enrolled in this study. The patients were divided according to histology findings into three groups: primary adenocarcinoma of lung (PACL), primary squamous cell carcinoma of lung (PSqCL) and benign lung disease (BLD). We obtained 20 mL of peripheral venous blood from patients using heparin-coated syringes. Using flow-cytometry after labeling with monoclonal antibodies, data acquisition and analysis were done. Result: The ratio of CD1c+CD19- dendritic cells to CD1c+ dendritic cells were not significantly different between the three groups. CD40 (p=0.171), CD86 (p=0.037) and HLA-DR (p=0.036) were less expressed in the PACL than the BLD group. Expression of CD40 (p=0.319), CD86 (p=0.036) and HLA-DR (p=0.085) were less expressed in the PACL than the PSqCL group, but the differences were only significant for CD86. Expression of co-stimulatory markers was not different between the PSqCL and BLD groups. Expression of markers for activated DCs were dramatically lower in the PACL group than in groups with other histology (CD40 (p=0.005), CD86 (p=0.013) HLA-DR (p=0.004). Conclusion: These results suggest the possibility that CD1c+ myeloid DCs participate in control of the tumor immunity system and that low expression of markers results in lack of an immune response triggered by dendritic cells in adenocarcinoma of the lung.

Comparison of rCBF between Patients with Medial Temporal Lobe Epilepsy and Normal Controls using ${H_2}^{15}O\;PET$ (내측 측두엽 간질환자와 정상인의 ${H_2}^{15}O\;PET$을 이용한 뇌 혈류량 비교)

  • Kang, Eun-Joo;Lee, Jae-Sung;Nam, Hyun-Woo;Lee, Sang-Kun;Lee, Dong-Soo;Chung, June-Key;Lee, Myung-Chul
    • The Korean Journal of Nuclear Medicine
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    • v.36 no.3
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    • pp.155-165
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    • 2002
  • Purpose: The aim of this study was to identify the brain areas whose regional cerebral blood flow (rCBF) was changed in medial temporal lobe epilepsy (mTLE) using ${H_2}^{15}O-PET$. Materials and Methods: 12 patients with mTLE (6 left, 6 right mTLE) and 6 normal controls were scanned during a fixation baseline period and a sensory-motor condition where subjects pressed a button to an upward arrow. A voxel-based analysis using SPM99 software was peformed to compare the patient groups with the normal controls for the rCBF during fixation baseline period and for relative changes of rCBF during the sensory-motor task relative to fixation. Results: During the fixation baseline, a significant reduction of rCBF was found posterior insula bilaterally and right frontopolar regions in right mTLE patients compared to the normal controls. In left mTLE patients, the reduction was found in left frontopolar and temporal legions. During the sensory-motor task, rCBF increase over the fixation period, was reduced in left frontal and superior temporal legions in the right mTLE patients whereas in various areas of right hemisphere in left mTLE patients, relative to normal controls. However, the increased rCBF was also found in the left inferior parietal and anterior thalamic/fornix regions in both right and left mTLE patients compared to normal controls. Conclusion: Epilepsy induced changes were found not only in relative increase/decrease of rCBF during a simple sensory-motor control condition relative to a fixation rest condition but also in the relative rCBF distribution during the rest period.