• The Korean Journal of Nuclear Medicine
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• v.35 no.1
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• pp.52-60
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• 2001

Purpose: In young male patients who suffered several kinds of trauma with subsequent suspicious reflex sympathetic dystrophy syndrome, we performed three-phasic bone scan in order to investigate its usefulness. Materials and Methods: Patients with narrow range of age (21-25. mean $22.8{\pm}1.3$, all male) were included with suspicious reflex sympathetic dystrophy syndrome of 12 feet and 5 hands. Only one was bilateral feet case and 16 were ipsilateral (Rt:13, Lt:3). The etiologic traumas were 4 fractures, 4 sprains, 3 blunt trauma, 2 cellulitis, 1 tendon tear, 1 crush injury, 1 overexercise, and 1 unknown. Radiologically 3 showed osteoporotic changes. Three-phasic bone scans were performed $21.2{\pm}7.3wks$ after trauma. Results: According to symptom complex, confirmatory reflex sympathetic dystrophy syndrome 4 cases and suspicious 13 were analyzed. All confirmatory cases (100%) showed increased uptake at delay phase with periarticular accentuation. Of confirmatory 4 cases, 2 showed increased uptake in all three phases (perfusion: P, blood pool: B, and delay: D), and other 2 revealed decreased P but, both increased B and D. Of suspicious 13 cases, 9(69.2%) had increased D (4 periarticular and 5 focal), 2 decreased D, and 2 symmetric D. In 12 foot cases, so-called weight hearing patterns - increased contralateral sole at P and B - were revealed in 7(58.3%). Conclusion: Diffuse periarticular increased uptake at delay phase of three-phasic bone scan was a compatible finding to reflex sympathetic dystrophy syndrome in young male patients whose symptom complex strongly designated post traumatic reflex sympathetic dystrophy syndrome.

• Nuclear Medicine and Molecular Imaging
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• v.40 no.1
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• pp.16-22
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• 2006

Purpose: Malignant Mixed Mullerian Tumor (MMMT) of the uterine corpus is one of the very uncommon and the most lethal tumors in the uterus. The aim of this study was to evaluate the role of FDG PET in detecting distant metastasis and residual and/or recurrent disease. Methods: Ten patients who underwent FDG PET for detecting distant metastasis and recurrence were included. focal FDG accumulation was regarded as abnormal. We also reviewed serum CA 125 levels, anatomical images, and histopathoiogical examination. Results: Three patients of 10 FDG PET showed abnormal FDG uptake. One had high serum CA 125 levels and high fractions of carcinomatous element on histopathologic examination. FDG PET showed metastatic lesions in unexpected locations, which could not be detected by anatomical images. Another had normal serum CA 125 levels with high sarcomatous element and CT could only detect a few lesions. The other had high serum CA 125 levels and also had high carcinomatous element. Seven patients who had no abnormal uptake on FDG PET had no clinical evidence of recurrence during the follow up period ($51.7{\pm}12.2$ months). The mean disease free intervals of these 7 patients were $36.4{\pm}6.0$ months. Two patients with abnormal findings had never become disease-free condition during the follow up period ($6.0{\pm}4.2$ months. Conclusion: FDG PET could be a useful modality for unexpected distant metastasis and follow up tool in patients with MMMT.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.6
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• pp.444-450
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• 2008

Purpose: The aim of this study was to evaluate the usefulness of whole body positron emission tomography (PET) using $^{18}F-fluorodeoxyglucose$ ($^{18}F-FDG$) for cancer screening in asymptomatic subjects. Materials and Methods: The subjects were 1,762 men and 259 women who voluntarily underwent $^{18}F-FDG$ PET for cancer screening as a part of a routine health examination. Final diagnosis was decided by other diagnostic studies, pathological results or clinical follow-up for 1 year. Results: Of 2,021 subjects, 40 (2.0%) were finally proved to have cancer. Abnormal focal $^{18}F-FDG$ uptake suggesting malignancy was found in 102 subjects (5.0%). Among them, 21 subjects (1.0%) were proved to have cancer. Other tests in the routine health examination could not find 9 of 21 cancers (42.9%) detected by PET. The sensitivity, specificity, positive predictive value, and negative predictive value of PET for cancer screening were 52.5%, 95.9%, 20.6%, and 99.0%, respectively. Pathologies of cancers missed on PET were adenocarcinoma (n = 9; 3 colon cancers, 3 prostate cancers, 2 stomach cancers, and 1 rectal cancer), differentiated thyroid carcinoma (n = 6), bronchioalveolar cell carcinoma (n = 2), urinary bladder cancer (n = 1), and melanoma (n = 1). More than half of cancers which were not detected by PET were smaller than 1 cm in diameter. Conclusion: $^{18}F-FDG$ PET might be useful for cancer screening in asymptomatic subjects due to its high specificity and negative predictive value and playa supplementary role to the conventional health check-up, but it could not replace due to limited sensitivity for urological cancers, small-sized tumors and some hypometaboic cancers.

• Applied Microscopy
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• v.39 no.2
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• pp.167-173
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• 2009

Capillaria hepatica is a parasitic nematode which causes hepatic capillariasis in rodents and other mammals, including man. Rat species of the genus Rattus are main primary host and rates of genus Rattus of up to 100% have been reported. Infection to reservoir and other mammalian hosts occur incidentally due to ingestion of water or food contaminated with C. hepatica embryonated eggs. The worms mature exclusively inside the liver, but they die and disassemble soon after egg spawning in rats. Dead worms and their eggs cause immune response of focal necrosis and inflammation within the liver. C. hepatica adult with a thin and long body is similar to capillary. The members of Order Trichurida are characterized by having a stichosome and the bacillary bands in front of the body. As already mentioned, the adult C. hepatica residesin the liver, where it deposits groups of eggs, and finally die in the encapsulated tissue of the liver. They produce eggs that elicit a marked granulomatous reaction that eventually destroy the worms. And the adult worms were mixed with eggs. So the complete isolation of the worm and observation of intact ultrastructure is very difficult. In this study, integument structure of C. hepatica isolated from the liver of mouse at 7 weeks after inoculation of embryonated eggs were observed with scanning and transmission electron microscopy. As a results, body length of isolated C. hepatica was about 99 mm. Cuticle, bacillary band and bacillary pore were obtained in the integument of worm. Bacillary pore across cuticular surface of the worm were observed. According to the existence of cap material, external forms of bacillary pore can be divided into three types such as flat, ingression, and ingression with the cap material type. The complete isolation of the worm and observation of ultrastructure of integument will provide the fundamental data which is important in the nematode research including C. hepatica.

• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.2
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• pp.166-171
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• 2010

Purpose: The SPECT/CT is able to acquire diagnostic information resolved the difficult problems that discriminate regions of focals by intergrating functional images and anatomical images. We introduce the usefulness of "Volumetrix Suite" which can describe 3D images by the convergence of the SPECT/CT images and reference CT images. Materials and Methods: We applied Volumetrix Suite program (Volumetrix IR, Volumetrix 3D) to patients, Bone, Venography, Parathyroid, WBC, taken diagnostic CT examination which have same regions of focal in Seoul Metropolitan Government Seoul National University Boramae Medical Center. After acquiring SPECT/CT images and reference CT images, we fused a couple of scans applying for this programs. The CT scan of Infinia Hawkeye 4 shows limitation of anatomical information. For this reason, we tried to transfer CT images that have lots of diagnostic informations as the form of Dicom file in PACS, and changed from 2D images to 3D images after image registering in Xeleris Workstaion of Hawkeye 4. Results & Conclusion: By using Volumetrix Suite program, we're able to acquire more accurate anatomical informations with 3D rendering which can distinguish both location and range of focals in Infinia Hawkeye 4. Thus, the result of utilizing this program indicate that nuclear medicine anatomical images can be improved by providing more diagnostic imformations produced by its program.

• Childhood Kidney Diseases
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• v.5 no.1
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• pp.22-29
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• 2001

Purpose : 99mTc DMSA renal scan have been widely used not only for tile evaluation of renal scars but also for the diagnosis of acute pyelonephritis. Recent studies have shown SPECT images have higher accuracy than the planar images with some controversy. We evaluated the availability of the SPECT images adding to planar images for the diagnosis of acute pyelonephritis(APN) and renal scar in children with urinary tract infection (UTI). Methods : 130 children with UTI (260 kidney units) and 22 follow-up children (44 kidney units) were included between January 1, 1997 and July 31, 1999 at Ewha University Mokdong Hospital. Planar Anterior and posterior images and SPECT axial and coronal images of 99mTc DMSA renal scan were obtained with Starcam 4000-i U.S.A. GE at 3 hours after 99mTc DMSA I.V. injection. The data were analyzed by Chi square test after Yates's correction. Results : The detection rate of the acute pyelonephritis by SPECT images was 12.3$\%$ higher than that of planar images ($47.7\%\;vs\;35.4\%$) by the patient and 6.9$\%$ higher also ($31.9\%\;vs\;25.4\%$) by the kidney unit. 18 kidney units with negative planar images had focal defect in 10 kidney units (3.8$\%$) and multifocal defect in 8 kidney units (3.1$\%$) on SPECT images, but 1 kidney unit with positive planar image had negative SPECT image. SPECT images were superior to tile planar images in 17.3$\%$. identical in 82.3$\%$ and inferior in 0.4$\%$ to planar image. The detection rate of tile renal scars by SPECT images was 13.7$\%$ higher than planar images by the patient ($68.2\%\;vs\;54.5\%$) and 6.8$\%$ higher also ($43.2\%\;vs\;36.4\%$) by the kidney unit. SPECT images were superior to the planar images in 17.3$\%$ and identical in 82.3$\%$ to planar image. Conclusion SPECT images had shown higher detection rate and better image than planar images for the diagnosis of the acute pyelonephritis and the evaluation of the renal scars. (J. Korean Soc Pediatr Nephrol 5 : 22- 9, 2001)

• Childhood Kidney Diseases
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• v.8 no.2
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• pp.205-213
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• 2004

Purpose: To evaluate the clinical manifestations of various glomerular diseases in children, a clinicopathological study was performed in 52 children who had renal biopsy. The type and relative incidence of the glomerular pathologies were analyzed, and the clinical predictability and usefulness of renal biopsy in glomerular diseases were assessed. Methods: Medical records of fifty two children with renal disease who had undergone percutaneous renal biopsy under ultrasonic guidance at Chungnam University Hospital from October 1995 to August 2003 were reviewed. In addition, we compared the clinical findings before renal biopsy with the pathological diagnosis. Results: The male to female ratio was 1.6:1 and they were $9.8\pm2.6$ years old on average. The chief complaints for biopsy were hematuria in 22 cases which was the most common (42.3%), proteinuria in 16 cases(30.8%), and hematuria & proteinuria(26.9%). Among the 22 cases of hematuria, there were 15 cases of gross hematuria(68.2%) and 7 cases of microscopic hematuria(31.8%). In terms of histopathologic diagnosis, most of them were primary glomerular diseases(84.6%), which included IgA nephropathy(28.8%), thin glomerular basement membrane disease(25.0%), focal segmental glomerulosclerosis(FSGS)(11.5%), membranous proliferative glomerulonephritis(7.7%), minimal change lesion(3.8%), acute poststreptococcal glomerulonephritis(3.8%) and membranous glomerulonephritis(3.8%). The clinical manifestations and pathologic diagnosis were not correlated. Conclusion: The clinical manifestations could not predict the pathological diagnosis. Therefore, renal biopsy would be inevitable in diagnosis of glomerular diseases for effective management and assessment of prognosis.

• Pediatric Infection and Vaccine
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• v.12 no.2
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• pp.140-148
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• 2005

Purpose : To characterize the epidemiology and clinical features of invasive pneumococcal infections in Korean children. Methods : One hundred ninety four cases of invasive pneumococcal infections diagnosed at the Seoul National University Children's Hospital from October 1985 to December 2003 were analysed retrospectively. All isolates were screened for resistance to penicillin by oxacillin disc diffusion test. Serotypes were determined for 125 isolates. Results : The types of infection were bacteremia without focus 84/194(43%), meningitis 36/194(19%), pneumonia with bacteremia 36/194(19%), peritonitis 24/194(12%), other focal infections 3/194(2%). Fifty seven percent(110/194) of the episodes developed in the immunocompromised and 20%(37/194) were nosocomially acquired. The patients younger than 2 years of age was 60% in the immunocompetent patients and 25% in the immunocompromised patients. The overall case fatality rate was 7%. All the isolates by 1988 were susceptible to penicillin screened by oxacillin disk. Penicillin resistance was first detected in 1989(20%), and then increased rapidly; 89% in 1995, 69% in 1996, and 80~100% thereafter. The seven most frequently isolated serotypes were 23F, 19F, 14, 6B, 6A, 9V and 19A, which accounted for 70% of total isolates. Conclusion : S. pneumoniaeis an important cause of morbidity and mortality in children. Invasive infections caused by S. pneumoniae most often occurred in infants and young children, while they are frequent in older immunocompromised children as well. This is the largest case series on invasive pneumococcal infections in Korean children.

• Investigative Magnetic Resonance Imaging
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• v.15 no.1
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• pp.22-31
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• 2011

Purpose : To compare free-breathing and respiratory-triggered diffusion-weighted imaging on 1.5-T MR system in the detection of hepatic lesions. Materials and Methods: This single-institution study was approved by our institutional review board. Forty-seven patients (mean 57.9 year; M:F = 25:22) underwent hepatic MR imaging on 1.5-T MR system using both free-breathing and respiratory-triggered diffusion-weighted imaging (DWI) at a single examination. Two radiologists retrospectively reviewed respiratory-triggered and free-breathing sets (B50, B400, B800 diffusion weighted images and ADC map) in random order with a time interval of 2 weeks. Liver SNR and lesion-to-liver CNR of DWI were calculated measuring ROI. Results : Total of 62 lesions (53 benign, 9 malignant) that included 32 cysts, 13 hemangiomas, 7 hepatocellular carcinomas (HCCs), 5 eosinophilic infiltration, 2 metastases, 1 eosinophilic abscess, focal nodular hyperplasia, and pseudolipoma of Glisson's capsule were reviewed by two reviewers. Though not reaching statistical significance, the overall lesion sensitivities were increased in respiratory-triggered DWI [reviewer1: reviewer2, 47/62(75.81%):45/62(72.58%)] than free-breathing DWI [44/62(70.97%):41/62(66.13%)]. Especially for smaller than 1 cm hepatic lesions, sensitivity of respiratory-triggered DWI [24/30(80%):21/30(70%)] was superior to free-breathing DWI [17/30(56.7%):15/30(50%)]. The diagnostic accuracy measuring the area under the ROC curve (Az value) of free-breathing and respiratory-triggered DWI was not statistically different. Liver SNR and lesion-to-liver CNR of respiratory-triggered DWI ($87.6{\pm}41.4$, $41.2{\pm}62.5$) were higher than free-breathing DWI ($38.8:{\pm}13.6$, $24.8{\pm}36.8$) (p value < 0.001, respectively). Conclusion: Respiratory-triggered diffusion-weighted MR imaging seemed to be better than free-breathing diffusion-weighted MR imaging on 1.5-T MR system for the detection of smaller than 1 cm lesions by providing high SNR and CNR.

• The Journal of the Korean bone and joint tumor society
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• v.14 no.2
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• pp.163-171
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• 2008

Purpose: We analyze the characteristics of soft tissue sarcomas presented with hematoma, which were misdiagnosed as simple hematoma initially and the proper management were delayed. Materials and Methods: The 7 patients with histologically proven soft tissue sarcoma with hematoma presented since February 1997 were evaluated retrospectively. Neither patient had a medical history of bleeding tendency nor anticoagulant therapy. Two of them had minor traumas. There were 2 men and 5 women. Average follow up period was 58 months. MRI findings, provided treatments and oncologic outcome were reviewed with the reference of related articles. Results: Retrospective review of initial MR images revealed deep seated intramuscular masses with focal solid enhanced nodules at the peripheral margin. The diagnoses were delayed at least 1 month in 3 of them which included 2 cases of simple hematoma evacuation without biopsy initially. After histologic diagnosis of soft tissue sarcoma, wide resections were performed in 4 cases. one patient underwent above knee amputation and the remained 2 patients were managed with wide resection followed by amputation due to local recurrence. At last follow up there were CDF and NED in 2 cases, respectively and AWD in 3 cases. Conclusion: To avoid the delay of diagnosis and treatment of soft tissue sarcomas presented with hematoma, high degree of clinical suspicion, careful analysis of MR images and early biopsy were important.