Mun, Yun Su;Kwon, Oh Sang;Lee, Jang Young;Park, Gyeong Nam;Han, Hyun Young;Lee, Min Koo
Journal of Trauma and Injury
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v.26
no.1
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pp.22-25
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2013
Severe blunt abdominal trauma frequently involves the liver. The development of nonsurgical treatment of liver trauma has led to more frequent appearance of unusual complications. A hepatic arterioportal fistula (APF) is a rare complication of liver trauma. We present a case of traumatic APF in a patient with liver trauma. A 31-year-old male visited our emergency department with pain in the right upper abdomen following a traffic accident. Initial physical exam and abdominal computed tomography (CT) revealed liver laceration with hemoperitoneum. An abdominal CT obtained on day 11 revealed early opacification of the right portal vein on the arterial phase. After we had come to suspect an APF of the liver, its presence was confirmed on angiography. It was subsequently managed by using transcatheter coil embolization. In patients with portal hypertension and no evidence or history of cirrhosis, one should consider an APF as a potential etiology if history of liver biopsy or penetrating trauma exists. In a patient with liver trauma, serial abdominal CT is important for early detection and treatment of an APF.
Background: Lymph node metastasis is believed to be a dependent negative prognostic factor of esophageal cancer. To explore detection methods with high sensitivity and accuracy for metastases to regional and distant lymph nodes in the clinic is of great significance. This study focused on clinical application of FDG PET/CT and contrast-enhanced multiple-slice helical computed tomography (MSCT) in lymph node staging of esophageal cancer. Materials and Methods: One hundred and fifteen cases were examined with enhanced 64-slice-MSCT scan, and FDG PET/CT imaging was conducted for neck, chest and upper abdomen within one week. The primary lesion, location and numbers of metastatic lymph nodes were observed. Surgery was performed within one week after FDG PET/CT detection. All resected lesions were confirmed histopathologically as the gold standard. Comparative analysis of the sensitivity, specificity, and accuracy based on FDG PET/CT and MSCT was conducted. Results: There were 946 lymph node groups resected during surgery from 115 patients, and 221 were confirmed to have metastasis pathologically. The sensitivity, specificity, accuracy of FDG PET/CT in detecting lymph node metastasis were 74.7%, 97.2% and 92.0%, while with MSCT they were 64.7%, 96.4%, and 89.0%, respectively. A significance difference was observed in sensitivity (p=0.030), but not the others (p>0.05). The accuracy of FDG PET/CT in detecting regional lymph node with or without metastasis were 91.9%, as compared to 89.4% for MSCT, while FDG PET/CT and MSCT values for detecting distant lymph node with or without metastasis were 94.4% and 94.7%. No significant difference was observed for either regional or distant lymph node metastasis. Additionally, for detecting para-esophageal lymph nodes metastasis, the sensitivity of FDG PET/CT was 72%, compared with 54.7% for MSCT (p=0.029). Conclusions: FDG PET/CT is more sensitive than MSCT in detecting lymph node metastasis, especially for para-esophageal lymph nodes in esophageal cancer cases, although no significant difference was observed between FDG PET/CT and MSCT in detecting both regional and distant lymph node metastasis. However, enhanced MSCT was found to be of great value in distinguishing false negative metastatic lymph nodes from FDG PET/CT. The combination of FDG PET/CT with MSCT should improve the accuracy in lymph node metastasis staging of esophageal cancer.
Park, Soo Ho;Park, Seung Keun;Kim, Sang Hyun;Choi, Won Kyu;Shim, Beom Jin;Park, Hee Ug;Jung, Chan Woo;Choi, Jae Won
Journal of Yeungnam Medical Science
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v.34
no.2
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pp.254-259
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2017
Mediastinal pancreatic pseudocyst is a rare complication of acute or chronic pancreatitis. Pleural effusion and pneumonia are two of the most common thoracic complications from pancreatic disease, while pancreaticopleural fistula with massive pleural effusion and extension of pseudocyst into the mediastinum is a rare complication of the thorax from pancreatic disease. To the best of our knowledge, there have been no case reports of mediastinal pancreatic pseudocyst-induced esophageal fistula in Korea to date. Here in, we report a case about 43-year-old man of mediastinal pancreatic pseudocyst-induced esophageal fistula presenting with chest pain radiating toward the back and progressive dysphagia. The diagnosis was confirmed by an esophagogastroduodenoscopy and abdomen computed tomography (CT). The patient was treated immediately using a conservative method; subsequently, within 3 days from treatment initiation, symptoms-chest pain and dysphagia- disappeared. In a follow-up gastroscopy 7 days later and abdomen CT 12 days later, mediastinal pancreatic pseudocyst showed signs of improvement, and esophageal fistula disappeared without any complications.
This study aimed at investigating the change of fat in each body part according to the wearing of sport underwear made of specially-processed materials. in this study. 6 females made up of three early twenties, and three later thirties took part in the exercises for 12 weeks to to out the change of fat amount in body, square of body part by CT and obesity after and before an exercise. The results are as follows: In the obesity condition after and before an exercise, Roller's index shows that in case of 51 and 54, one level was lowered concerning the basic physical strength and optimal index was not changed. In the silhouette between body frames. there are differences between ages. The body fat rate decreased 35.95% on the average. and the amount of the body fat of females in twenties was more than that in thirties. The amount of body fat decrease with the lapse of exercising time, while the amount of body fat shows increased of 0.75%, which showed the minus correlation. The rate of averaged flat by CT went up after an exercise in every body part. and also the decreased value of subcutaneous fat was not proportioned to that of weight and girth. Inbody parts, the lower abdomen was shown 49.7%, navel part 47.7% and waist part 37.3% each in numerical value. In the thickness of subcutaneous fat concerning waist, the value of front-center line was the lowest, and followed by rear-center line and lateral line. 1204degree part in the navel showed the most fat layed, and the lowest fat layed was in the lateral part. Concerning the lower part of abdomen, under-skin fat was the most layed in 120degree part like that of navel part.
Uses a Tomographic scan image and Table Object Distance(TOD) price after measuring, uses accuracy and usability of blood vessel diameter(Vessel Diameter) measurement under comparison evaluating boil TOD Calibration. The patient who enforces Prosecuting Attorney abdomen Tomographic scan in the object the superior mesentery artery uses PACS View from abdomen fault image and from blood vessel diameter and the table measures the height until of the blood vessel. Uses Angio Catheter from Angiography(5 Fr.) and enforces is measured from PACS View the height until of the table which and the blood vessel at TOD Calibration price and the size of the superior mesentery artery inputs measures an superior mesentery artery building skill. Catheter Calibration input Agnio Catheter where uses in Angiography the size of the superior mesentery artery at Catheter Calibration price and they measure. Produced an accuracy from monitoring data and comparison evaluated. The statistical program used SPSS. TOD Calibration accuracy was 96.53%, standard deviation is 0.03829. Catheter Calibration accuracy of 92.91%, standard deviation is 0.05085. Represents a statistically significant difference(p = 0). According to age and gender was not statistically significant(p > 0.05). TOD Calibration correlation coefficient R-squared of 88.8%, Catheter Calibration of the R-squared is 75.5%. High accuracy of both methods. Through this study, CT images using the measured distance between the table and the Object, TOD Calibration accuracy higher than two Catheter Calibration was measured. TOD and Catheter Calibration represents a statistically significant difference(p = 0).
To obtain the best SNR (signal to noise ratio) due to changes in CTDI (computed tomography dose index) made for the purpose of setting the optimum image obtained by reducing the dose in abdominal CT. Abdominal CT scans of 59 patients a $400-499cm^2$ (n = 12), $500-599cm^2$ (n = 21), $600-699cm^2$ (n = 17), $700-799cm^2$ (n = 9) were separated by four groups and the effective dose was used in the Excel to get the area of the patient using the ImageJ program. Patients of CTDI, DLP, SNR, the effective dose were analyzed. Abdominal CT area was increased to 13 mGy in CTDI is 7.3 mGy, DLP to 732 in $394.4mGy{\cdot}cm$, also effective dose was 5.9 mSv increase in 11mSv. SNR is 15 dB was maintained at 12.7. CTDI according to the average of the abdominal area of 8.9 mGy, the average of the DLP was $481.54mGy{\cdot}cm$, the effective dose is calculated to be 7.2 mSV. Effective dose was calculated by multiplying the load factor of DLP in the abdomen showed no statistically significant difference of (p < .05), there was a significant difference in SNR (p > . 05). To improve image quality of abdominal CT scan image in consideration of the CTDI according to the volume of the patient it should be able to reduce the radiation exposure of the patients.
The one-year-follow-up test of abdomen/pelvis from 10 patients who were scanned more than twice a years were analyzed the radiation dose and image quality depend on the position of the arm retrospectively from January to December in 2013. There were classified two groups, group A was examined with raising an arm on standard position and group B was performed with lowering an arm, respectively. Group A of an average mAs from the first dose amount was shown 11.4% less compared to Group B. And the value of CTDI from Group B also was investigated 11.3% less. To compare the quality comparison of the second image as histogram value, the value of max from both of two groups was measured similarly. However, a big difference was shown from the value of min and SD, the short dose was appeared depends on the position of arm even though Group A was radiated more than Group B. Less exposure to the medical image quality only by working CT scan when the examiner actively raise the arm before the development and testing of high-end equipment introduction of complex algorithms for obtaining an optimized image will be provided to the patient.
Jo, Janghwan;Kim, Joongsuck;Kim, Yeongcheol;Chung, Ilyong;Park, Jongmin;Ahn, Eunjung;Kim, Eunyoung;Park, Seihyeog;Kim, Seongyup
Journal of Trauma and Injury
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v.27
no.4
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pp.145-150
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2014
Purpose: To assess the accuracy and role of single-contrast computed tomography (CT) in the management of anterior abdominal stab wound (AASW). Methods: During 8-years period, single-contrast CT was performed in 21 hemodynamically stable AASW patients (age range, 22-64 years; median age, 45 years), including 19 men and 2 women. CT scans were evaluated by one trauma surgeon and one senior resident to determine the depth of injury(peritoneal violation or not), and abnormal findings of intraperitoneal cavity associated with stab injury. We retrospectively reviewed medical records regarding operative findings. Results: Nine patients underwent abdominal surgery and 12 patients nonoperative management. In the abdominal surgery group, abnormal CT findings included peritoneal violation in 14 patients and abnormal intraperitoneal cavity findings in 5 patients. There was no statistical significant difference regarding abnormal CT findings between abdominal surgery group and nonoperative management group. Among the nine abdominal surgery patients, therapeutic laparotomy was performed on 4 patients. The positive predictive value (PPV) and negative predictive value (NPV) of peritoneal violation to predictive therapeutic laparotomy were 28.6% and 100%, respectively. In addition, the PPV and NPV of abnormal intraperitoneal cavity CT findings to predict therapeutic laparotomy were 40.0% and 87.5%, respectively. There was no statistical significant difference regarding the abnormal CT findings between therapeutic laparotomy group and non therapeutic laparotomy group. Conclusion: CT is a good adjunctive method to evaluate hemodynamicaly stable AASW patients. If peritoneal violation is not seen on CT scan, conservative treatment on local wound may be safely performed without additional abdominal surgery. However, further study is warranted to evaluate the exact role of CT in the diagnostic workup of AASW patients.
In this study, standard model of medical radiation dosage quality control system will be suggested and the useful of this system in clinical field will be reviewed. Radiation dosage information of modalities are gathered from digital imaging and communications in medicine(DICOM) standard data(such as DICOM dose SR and DICOM header) and stored in database. One CT scan, two digital radiography modalities and two mammography modalities in one health promotion center in Seoul are used to derive clinical data for one month. After 1 months research with 703 CT scans, the study shows CT $357.9mGy{\cdot}cm$ in abdomen and pelvic CT, $572.4mGy{\cdot}cm$ in brain without CT, $55.9mGy{\cdot}cm$ in calcium score/heart CT, screening CT at $54mGy{\cdot}cm$ in chest screening CT(low dose screening CT scan), $284.99mGy{\cdot}cm$ in C-spine CT and $341.85mGy{\cdot}cm$ in L-spine CT as health promotion center reference level of each exam. And with 1955 digital radiography cases, it shows $274.0mGy{\cdot}cm2$ and for mammography 6.09 mGy is shown based on 536 cases. The use of medical radiation shall comply with the principles of justification and optimization. This quality management of medical radiation exposure must be performed in order to follow the principle. And the procedure to reduce the radiation exposure of patients and staff can be achieved through this. The results of this study can be applied as a useful tool to perform the quality control of medical radiation exposure.
Nam, In Chul;Kim, Seung Ho;Kim, Seon-Jeong;Lim, Yun-jung
Investigative Magnetic Resonance Imaging
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v.20
no.4
/
pp.241-249
/
2016
Purpose: To evaluate the added value of diffusion weighted imaging (DWI) to computed tomography (CT) for detecting pancreatic abnormality in patients with clinically suspected acute pancreatitis (AP). Materials and Methods: 203 patients who underwent abdomen CT and subsequent DWI to do a workup for epigastric pain were analyzed. Two blinded radiologists independently performed an interval reading based on CT image sets first, then based on combined CT and DWI image sets. The diagnostic criterion on DWI was the increased signal intensity in the pancreas to that of the spleen. For quantitative analysis, the third radiologist measured ADC value of the pancreas in each patient. Results: For AP (n = 43), the sensitivity for detecting pancreatic abnormality increased, from 42% to 70% for reader 1 (P < 0.05) and from 44% to 72% for reader 2 (P < 0.05). For borderline pancreatitis (n = 42), the sensitivity also increased, from 10% to 26% for reader 1 (P < 0.05) and from 7% to 29% for reader 2 (P < 0.05). The mean ADC values (unit, ${\times}10^{-3}mm^2/s$) were significantly different among the three groups (for AP, $1.09{\pm}0.16$; for borderline pancreatitis, $1.28{\pm}0.2$; for control, $1.46{\pm}0.15$, P < 0.05). Conclusion: Sensitivity for detecting pancreatic abnormality increased significantly after adding DWI to CT in patients with clinically suspected AP.
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