• Journal of radiological science and technology
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• v.44 no.6
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• pp.635-643
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• 2021

The results of empirical researches on the diagnosis of lung cancer are insufficient, so it is limited to objectively judge the clinical possibility and utilization according to the accuracy of diagnosis. Thus, this study retrospectively analyzed the lung cancer diagnostic performance of PET-MRI (Positron Emission Tomography-Magnetic Resonance Imaging) by using the decision matrix. This study selected and experimented total 165 patients who received both hematological CEA (Carcinoembryonic Antigen) test and hybrid PET-MRI (¹⁸F-FDG, 5.18 MBq/kg / Body TIM coil. VIVE-Dixon). After setting up the result of CEA (positive:>4 ㎍/ℓ. negative:<2.5㎍/ℓ) as golden data, the lung cancer was found in the image of PET-MRI, and then the SUV_max (positive:>4, negative:<1.5) was measured, and then evaluated the correlation and significance of results of relative diagnostic performance of PET-MRI compared to CEA through the statistical verification (t-test, P>0.05). Through this, the PET-MRI was analyzed as 96.29% of sensitivity, 95.23% of specificity, 3.70% of false negative rate, 4.76% of false positive rate, and 95.75% of accuracy. The false negative rate was 1.06% lower than the false positive rate. The PET-MRI that significant accuracy of diagnosis through high sensitivity and specificity, and low false negative rate and false positive rate of lung cancer, could acquire the fusion image of specialized soft tissue by combining the radio-pharmaceuticals with various sequences, so its clinical value and usefulness are regarded as latently sufficient.

• The Korean Journal of Pain
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• v.24 no.2
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• pp.81-86
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• 2011

Background: Facet joint disease plays a major role in axial low-back pain. Few diagnostic tests and imaging methods for identifying this condition exist. Single photon emission computed tomography (SPECT) is reported that it has a high sensitivity and specificity in diagnosing facet disease. We prospectively evaluated the use of bone scintigraphy with SPECT for the identification of patients with low back pain who would benefit from medial branch block. Methods: SPECT was performed on 33 patients clinically suspected of facet joint disease. After SPECT, an ultrasound guided medial branch block was performed on all patients. On 28 SPECT-positive patients, medial branch block was performed based on the SPECT findings. On 5 negative patients, medial branch block was performed based on clinical findings. For one month, we evaluated the patients using the visual analogue scale (VAS) and Oswestry disability index. SigmaStat and paired t-tests were used to analyze patient data and compare results. Results: Of the 33 patients, the ones who showed more than 50% reduction in VAS score were assigned 'responders'. SPECT positive patients showed a better response to medial branch blocks than negative patients, but no changes in the Oswestry disability index were seen. Conclusions: SPECT is a sensitive tool for the identification of facet joint disease and predicting the response to medial branch block.

• Korean Journal of Radiology
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• v.24 no.11
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• pp.1142-1150
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• 2023

Objective: To evaluate ^99mtechnetium-three polyethylene glycol spacers-arginine-glycine-aspartic acid (^99mTc-3PRGD₂) single-photon emission computed tomography (SPECT)/computed tomography (CT) imaging for diagnosing lymph node metastasis of primary malignant lung neoplasms. Materials and Methods: We prospectively enrolled 26 patients with primary malignant lung tumors who underwent ^99mTc-3PRGD₂ SPECT/CT and ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET)/CT imaging. Both imaging methods were analyzed in qualitative (visual dichotomous and 5-point grades for lymph nodes and lung tumors, respectively) and semiquantitative (maximum tissue-to-background radioactive count) manners for the lymph nodes and lung tumors. The performance of the differentiation of lymph nodes with and without metastasis was determined at the per-lymph node station and per-patient levels using histopathological results as the reference standard. Results: Total 42 stations had metastatic lymph nodes and 136 stations had benign lymph nodes. The differences between metastatic and benign lymph nodes in the visual qualitative and semiquantitative analyses of ^99mTc-3PRGD₂ SPECT/CT and ¹⁸F-FDG PET/CT were statistically significant (all P < 0.001). The area under the receiver operating characteristic curve (AUC) in the semi-quantitative analysis of ^99mTc-3PRGD₂ SPECT/CT was 0.908 (95% confidence interval [CI], 0.851-0.966), and the sensitivity, specificity, positive predictive value, and negative predictive value were 0.86 (36/42), 0.88 (120/136), 0.69 (36/52), and 0.95 (120/126), respectively. Among the 26 patients (including two patients each with two lung tumors), 15 had pathologically confirmed lymph node metastasis. The difference between primary lung lesions in patients with and without lymph node metastasis was statistically significant only in the semi-quantitative analysis of ^99mTc-3PRGD₂ SPECT/CT (P = 0.007), with an AUC of 0.807 (95% CI, 0.641-0.974). Conclusion: ^99mTc-3PRGD₂ SPECT/CT imaging may notably perform in the direct diagnosis of lymph node metastasis of primary malignant lung tumors and indirectly predict the presence of lymph node metastasis through uptake in the primary lesions.

• Korean Journal of Radiology
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• v.20 no.8
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• pp.1293-1299
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• 2019

Objective: The purpose of this study was to evaluate the diagnostic performance of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) for chronic empyema-associated malignancy (CEAM). Materials and Methods: We retrospectively reviewed the ¹⁸F-FDG PET/CT images of 33 patients with chronic empyema, and analyzed the following findings: 1) shape of the empyema cavity, 2) presence of fistula, 3) maximum standardized uptake value (SUV) of the empyema cavity, 4) uptake pattern of the empyema cavity, 5) presence of a protruding soft tissue mass within the empyema cavity, and 6) involvement of adjacent structures. Final diagnosis was determined based on histopathology or clinical follow-up for at least 6 months. The abovementioned findings were compared between the ¹⁸F-FDG PET/CT images of CEAM and chronic empyema. A receiver operating characteristic (ROC) analysis was also performed. Results: Six lesions were histopathologically proven as malignant; there were three cases of diffuse large B-cell lymphoma, two of squamous cell carcinoma, and one of poorly differentiated carcinoma. Maximum SUV within the empyema cavity (p < 0.001) presence of a protruding soft tissue mass (p = 0.002), and involvement of the adjacent structures (p < 0.001) were significantly different between the CEAM and chronic empyema images. The maximum SUV exhibited the highest diagnostic performance, with the highest specificity (96.3%, 26/27), positive predictive value (85.7%, 6/7), and accuracy (97.0%, 32/33) among all criteria. On ROC analysis, the area under the curve of maximum SUV was 0.994. Conclusion: ¹⁸F-FDG PET/CT can be useful for diagnosing CEAM in patients with chronic empyema. The maximum SUV within the empyema cavity is the most accurate ¹⁸F-FDG PET/CT diagnostic criterion for CEAM.

• Journal of Gastric Cancer
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• v.9 no.3
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• pp.110-116
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• 2009

Purpose: The aim of this study was to examine the usefulness of positron emission tomography (PET)-computed tomography (CT) in the pre-operative staging of gastric cancer. Materials and Methods: Between February 2006 and August 2008, PET-CT and CT were performed on 70 patients diagnosed with gastric cancer by gastrofiberscopic biopsy. The sensitivities, specificities, Positive predictive value (PPV), and negative predictive value (NPV) of PET-CT and CT imaging for the detection of gastric cancer TNM staging were compared. Results: The detection rates for the primary tumor were as follows: PET-CT, 81.4% (57/70); and CT, 42.9% (30/70). For both early gastric cancer (EGC) and advanced gastric cancer (AGC), PET-CT was more accurate than CT in detecting the lesions. As the size of the tumor exceeded 3 cm, the detection rate increased. The sensitivities, specificities, PPV, and NPV of PET-CT for lymph node staging were 55.6%, 81%, 86.2%, and 45.9%, while the sensitivities, specificities, PPV, and NPV of CT were 40.0%, 85.7%, 85.7% and 40%, respectively. One case of multiple liver metastasis and two cases of dual primary cancer (rectal and pancreatic cancers) were detected by PET-CT. PET-CT also had a higher detection rate for all histologic types of primary tumors. PET-CT was more accurate than CT in detecting primary gastric cancer lesions. The detection of nodal metastasis by PET-CT was similar to CT; small-sized tumors or EGC detection rates were not high. However, PET-CT provided additional information to detect distant metastases and dual primary cancers and reduced unnecessary laparotomies to detect peritoneal seeding or carcinomatosis. Conclusion: It would be useful to make a pre-operative diagnosis of gastric cancer and determine treatment if PET-CT were added to other routine pre-operative studies.

• Korean Journal of Head & Neck Oncology
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• v.36 no.2
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• pp.73-77
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• 2020

Ovarian cancer is common malignant disease with high mortality in the female. However, lymph node metastasis in the head and neck of ovarian cancer is very rare than in para-aortic, pelvic lymph node. A 49-year-old female patient came to our clinic with a left neck mass. After total thyroidectomy and left selective neck dissection for the cervical neck level II, III, IV, V, VI for ovarian cancer and thyroid cancer, she had already undergone chemotherapy (Paclitaxel+Carboplatin) 18 month ago. CT scan showed only lymph node enlargement in left neck level II. Positron emission tomography-computed tomography (PET-CT) revealed a hypermetabolic lesion in same area but no other hypermetabolic lesion, especially in the pelvic and abdominal cavity. Fine needle aspiration cytology revealed metastatic carcinoma. The serum level of CA-125 was elevated to 43.8U/mL, whereas other tumor markers (CA 19-9, CEA) were in the normal range. She underwent a revision of selective neck lymph node dissection for the cervical neck levels I, II, and III, and on the review of surgical pathology, metastatic carcinoma was suspected. Thus, we performed immunohistochemical staining for the tissue; as a result, it was finally diagnosed as metastatic ovarian cancer (positive for CK7, ER and PR, and negative for CK20). Adjuvant chemotherapy (Paclitaxel+Carboplatin) was planned on the tumor board, and the patient successfully received chemotherapy.

• Journal of Chest Surgery
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• v.42 no.2
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• pp.268-271
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• 2009

Solitary plasmacytoma of bone is a rare disease that accounts for only about $3{\sim}5%$ of all plasma cell tumors. Especially, no case of solitary plasmacytoma of a rib origin has been described in the Korean literature. A 54 year old Korean man was referred to our hospital for further evaluation of a lung mass that had been detected on a screening chest radiograph. A tumor with a left 6th rib origin was revealed by the computed tomography(CT) and positive emission tomography (PET-CT); therefore, surgical resection was performed. The histopathological findings of the tumor revealed plasmacytoma of a rib origin. The postoperative screening test revealed no evidence of multiple myeloma. Postoperative radiation therapy was not performed, and no new lesion has been noted during the 2 years of follow up.

• Journal of Yeungnam Medical Science
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• v.32 no.2
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• pp.132-137
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• 2015

Adrenocorticotropic hormone (ACTH)-producing pheochromocytoma has been rarely reported, whereas only a few cases of Cushing syndrome accompanied by opportunistic infections have been reported. We experienced a patient with pheochromocytoma with ectopic Cushing syndrome complicated by invasive aspergillosis. A 35-year-old woman presented with typical Cushingoid features. Her basal plasma cortisol, ACTH, and 24-hour urine free cortisol levels were significantly high, and 24-hour urine metanephrine and catecholamine levels were slightly elevated. The endogeneous cortisol secretion was not suppressed by either low- or high-dose dexamethasone. Abdominal computed tomography (CT) revealed a heterogeneous enhancing mass measuring approximately 2.5 cm in size in the left adrenal gland. No definitive mass lesion was observed on sellar magnetic resonance imaging. On fluorine-18 fluorodeoxyglucose positron emission tomography/CT, a hypermetabolic nodule was observed in the left upper lung. Thus, we performed a percutaneous needle biopsy, which revealed inflammation, not malignancy. Thereafter, we performed a laparoscopic left adrenalectomy, and its pathologic finding was a pheochromocytoma with positive immunohistostaining for ACTH. After surgery, the biochemistry was normalized, but the clinical course was fatal despite intensive care because of the invasive aspergillosis that included the lungs, retina, and central nervous system.

• Radiation Oncology Journal
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• v.37 no.1
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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 Cancer Prevention
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• v.23 no.4
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• pp.183-190
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• 2018

Background: As the number of big-cohort studies increases, validation becomes increasingly more important. We aimed to validate administrative database categorized as colorectal cancer (CRC) by the International Classification of Disease (ICD) 10th code. Methods: Big-cohort was collected from Clinical Data Warehouse using ICD 10th codes from May 1, 2003 to November 30, 2016 at Seoul National University Bundang Hospital. The patients in the study group had been diagnosed with cancer and were recorded in the ICD 10th code of CRC by the National Health Insurance Service. Subjects with codes of inflammatory bowel disease or tuberculosis colitis were selected for the control group. For the accuracy of registered CRC codes (C18-21), the chart, imaging results, and pathologic findings were examined by two reviewers. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for CRC were calculated. Results: A total of 6,780 subjects with CRC and 1,899 control subjects were enrolled. Of these patients, 22 subjects did not have evidence of CRC by colonoscopy, computed tomography, magnetic resonance imaging, or positron emission tomography. The sensitivity and specificity of hospitalization data for identifying CRC were 100.00% and 98.86%, respectively. PPV and NPV were 99.68% and 100.00%, respectively. Conclusions: The big-cohort database using the ICD 10th code for CRC appears to be accurate.