• Journal of the Korean Orthopaedic Association
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• v.56 no.5
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• pp.419-426
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• 2021

Purpose: In the surgical treatment of pyogenic lumbar spondylodiscitis, screw insertion at the affected vertebra has been avoided because of biofilm formation, and the risk of infection recurrence. The authors analyzed the success rate of infection treatment while minimizing the number of instrumented segments by inserting pedicle screws into the affected vertebrae. Therefore, this study examined the usefulness of this technique. Materials and Methods: From January 2000 to June 2018, among patients with pyogenic lumbar spondylodiscitis treated surgically, group A consisted of patients with pedicle screws inserted directly at the affected vertebrae (28 cases), and group B underwent fusion by inserting screws at the adjacent normal vertebrae due to bone destruction of the affected vertebral pedicle (20 cases). The classified clinical results were analyzed retrospectively. All patients were treated via the posterior-only approach, so the affected disc and sequestrum were removed. Posterior interbody fusion was performed with an autogenous strut bone graft, and the segments were then stabilized with pedicle screw systems. The hospitalization period, operation time, amount of blood loss, EQ-5D index, duration of intravenous antibiotics, and the clinical and radiological results were analyzed. Results: In group A, the number of instrumented segments, operation time, blood loss, and EQ-5D index at one month postoperatively showed significant improvement compared to group B. There were no significant differences in the duration of antibiotic use, hospitalization, radiological bone union time, sagittal angle correction rate, and recurrence rate. Conclusion: Minimal segmental fixation, in which pedicle screws were inserted directly into the affected vertebrae through the posterior approach, reduced the surgery time and blood loss, preserved the lumbar motion by minimizing fixed segments and showed rapid recovery without spreading or recurrence of infection. Therefore, this procedure recommended for the surgical treatment of lumbar pyogenic spondyodiscitis.

• Journal of the Korean Society of Radiology
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• v.17 no.6
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• pp.903-909
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• 2023

The purpose of this study is to compare and analyze the effect of changes in the patient's central position on the exposure dose and image quality of surrounding organs during a chest lateral examination using an Auto Exposure Control(AEC). The experiment was conducted on a human body phantom. A needle was attached to the lower part of the center of the coronal plane of the phantom, and a lead ruler was attached to the lower part of the detector so that the 50 cm point was located at the lower center of the AEC ion chamber. The exposure conditions were 125 kVp, 320 mA, the distance between the source and the image receptor was 180 cm, and the exposure field size was 14 × 17 inches. Only one AEC ion chamber was used at the bottom center, and the density was set to '0' and sensitivity to 'Middle', and the central X-ray was incident vertically toward the 6th thoracic vertebra. With AEC mode applied, the 50 cm point of the needle and lead ruler were aligned and the phantom was moved 5 cm toward the stomach (F5) and 5 cm toward the back (B5), and the dose factor was analyzed by measuring ESD. The ESD of the thyroid gland according to the change in patient center position was 232.60±2.20 μGy for Center, 231.22±1.53 μGy for F5, and 184.37±1.19 μGy for B5, and the ESD of the breast was 288.54±3.03 μGy for Center, F5 was 260.97±1.93 μGy, B5 was 229.80±1.62 μGy, and the ESD of the center of the lung was 337.02±3.25 μGy for Center, F5 was 336.09±2.29 μGy, and B5 was 261.76±1.68 μGy. As a result of comparing the average values of dose factors between each group, the difference in average values was statistically significant (p<0.01), and each group appeared to be independent. As a result of the study, there was no significant difference in the dose to the thyroid, breast, and center of the lung according to the change in the patient's central position, except for the breast (10%) when the patient moved forward about 5 cm. However, movement of about 5 cm posteriorly resulted in an average dose reduction of 23.7%. Additionally, when the patient's central position was moved to the rear, image quality deteriorated.

• Nuclear Medicine and Molecular Imaging
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• v.41 no.1
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• pp.30-41
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• 2007

Purpose: Bone metastasis in breast cancer patients are usually assessed by conventional Tc-99m methylene diphosphonate whole-body bone scan, which has a high sensitivity but a poor specificity. However, positron emission tomography with $^{18}F-2-deoxyglucose$ (FDG-PET) can offer superior spatial resolution and improved specificity. FDG-PET/CT can offer more information to assess bone metastasis than PET alone, by giving a anatomical information of non-enhanced CT image. We attempted to evaluate the usefulness of FDG-PET/CT for detecting bone metastasis in breast cancer and to compare FDG-PET/CT results with bone scan findings. Materials and Methods: The study group comprised 157 women patients (range: $28{\sim}78$ years old, $mean{\pm}SD=49.5{\pm}8.5$) with biopsy-proven breast cancer who underwent bone scan and FDG-PET/CT within 1 week interval. The final diagnosis of bone metastasis was established by histopathological findings, radiological correlation, or clinical follow-up. Bone scan was acquired over 4 hours after administration of 740 MBq Tc-99m MDP. Bone scan image was interpreted as normal, low, intermediate or high probability for osseous metastasis. FDG PET/CT was performed after 6 hours fasting. 370 MBq F-18 FDG was administered intravenously 1 hour before imaging. PET data was obtained by 3D mode and CT data, used as transmission correction database, was acquired during shallow respiration. PET images were evaluated by visual interpretation, and quantification of FDG accumulation in bone lesion was performed by maximal SUV(SUVmax) and relative SUV(SUVrel). Results: Six patients(4.4%) showed metastatic bone lesions. Four(66.6%) of 6 patients with osseous metastasis was detected by bone scan and all 6 patients(100%) were detected by PET/CT. A total of 135 bone lesions found on either FDG-PET or bone scan were consist of 108 osseous metastatic lesion and 27 benign bone lesions. Osseous metastatic lesion had higher SUVmax and SUVrel compared to benign bone lesion($4.79{\pm}3.32$ vs $1.45{\pm}0.44$, p=0.000, $3.08{\pm}2.85$ vs $0.30{\pm}0.43$, p=0.000). Among 108 osseous metastatic lesions, 76 lesions showed as abnormal uptake on bone scan, and 76 lesions also showed as increased FDG uptake on PET/CT scan. There was good agreement between FDG uptake and abnormal bone scan finding (Kendall tau-b : 0.689, p=0.000). Lesion showed increased bone tracer uptake had higher SUVmax and SUVrel compared to lesion showed no abnormal bone scan finding ($6.03{\pm}3.12$ vs $1.09{\pm}1.49$, p=0.000, $4.76{\pm}3.31$ vs $1.29{\pm}0.92$, p=0.000). The order of frequency of osseous metastatic site was vertebra, pelvis, rib, skull, sternum, scapula, femur, clavicle, and humerus. Metastatic lesion on skull had highest SUVmax and metastatic lesion on rib had highest SUVrel. Osteosclerotic metastatic lesion had lowest SUVmax and SUVrel. Conclusion: These results suggest that FDG-PET/CT is more sensitive to detect breast cancer patients with osseous metastasis. CT scan must be reviewed cautiously skeleton with bone window, because osteosclerotic metastatic lesion did not showed abnormal FDG accumulation frequently.