Jinhee Kim;Yoo Jin Hong;Kyunghwa Han;Jin Young Kim;Hye-Jeong Lee;Jin Hur;Young Jin Kim;Byoung Wook Choi
Korean Journal of Radiology
/
v.24
no.9
/
pp.838-848
/
2023
Objective: To quantitatively analyze the cardiac magnetic resonance imaging (CMR) characteristics of chemotherapy-related cardiac dysfunction (CTRCD) and explore their prognostic value for major adverse cardiovascular events (MACE). Materials and Methods: A total of 145 patients (male:female = 76:69, mean age = 63.0 years) with cancer and heart failure who underwent CMR between January 2015 and January 2021 were included. CMR was performed using a 3T scanner (Siemens). Biventricular functions, native T1 T2, extracellular volume fraction (ECV) values, and late gadolinium enhancement (LGE) of the left ventricle (LV) were compared between those with and without CTRCD. These were compared between patients with mild-to-moderate CTRCD and those with severe CTRCD. Cox proportional hazard regression analysis was used to evaluate the association between the CMR parameters and MACE occurrence during follow-up in the CTRCD patients. Results: Among 145 patients, 61 had CTRCD and 84 did not have CTRCD. Native T1, ECV, and T2 were significantly higher in the CTRCD group (1336.9 ms, 32.5%, and 44.7 ms, respectively) than those in the non-CTRCD group (1303.4 ms, 30.5%, and 42.0 ms, respectively; P = 0.013, 0.010, and < 0.001, respectively). They were not significantly different between patients with mild-to-moderate and severe CTRCD. Indexed LV mass was significantly smaller in the CTRCD group (65.0 g/m2 vs. 78.9 g/mm2; P < 0.001). According to the multivariable Cox regression analysis, T2 (hazard ratio [HR]: 1.14, 95% confidence interval [CI]: 1.01-1.27; P = 0.028) and quantified LGE (HR: 1.07, 95% CI: 1.01-1.13; P = 0.021) were independently associated with MACE in the CTRCD patients. Conclusion: Quantitative parameters from CMR have the potential to evaluate myocardial changes in CTRCD. Increased T2 with reduced LV mass was demonstrated in CTRCD patients even before the development of severe cardiac dysfunction. T2 and quantified LGE may be independent prognostic factors for MACE in patients with CTRCD.
Min Hye Kim;Kyeong Ah Kim;Yi Kyeong Chun;Jeong Woo Kim;Jongmee Lee;Chang Hee Lee
Journal of the Korean Society of Radiology
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v.85
no.2
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pp.445-450
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2024
Gastric metastasis (GM) from cervical cancer is extremely rare, and only a few cases have been reported in the English literature. Gastric-type mucinous adenocarcinomas (GAS) of the uterine cervix are rare. GAS is an aggressive cancer commonly found in advanced stages; however, GM has not been reported. This study presents a rare case of GM from GAS of the uterine cervix in a 61-year-old female and describes the radiological findings of both the GM and cervical mucinous adenocarcinoma. GM appeared as a poor enhancing submucosal mass. The cervical mucinous adenocarcinoma appeared as an infiltrating mass with poor contrast enhancement. It exhibited mildly high and low signal intensities on the diffusion-weighted image and apparent diffusion coefficient map, respectively. This case is extremely rare and challenging to diagnose; however, if cervical cancer is an human papillomavirus-independent GAS type and a submucosal lesion is found in the stomach, the possibility of metastasis with a pattern similar to our case could be considered.
Purpose : This study was peformed to evaluate the effectiveness and tolerance of craniospinal irradiation for patients with modulloblastoma and to define the optimal radiotherapeutic regimen. Materials and Methods : We retrospectively analyzed the records of 43 patients with modulloblastoma who were treated with external beam craniospinal radiotherapy at our institution between May, 1984 and April, 1998. Median follow up period was 47 months with range of 18 to U months. Twenty seven patients were male and sixteen patients were female, a male to female ratio of 1.7:1. Surgery consisted of biopsy alone in 5 patients, subtotal excision in 24 patients, and gross total excision in 14 patients. All of the patients were treated with craniospinal irradiation. All of the patients except four received at least 5,000 cGy to the posterior fossa and forty patients received more than 3,000 cGy to the spinal cord. Results : The overall survival rates at 5 and 7 years for entire group of patients were 57$\%$ and 56$\%$, respectively. Corresponding disease free survival rates were 60$\%$ and 51$\%$, respectively, The rates of disease control in the posterior fossa were 77$\%$ and 67$\%$ at 5 and 7 years. Gross total excision and subtotal excision resulted in 5 year overall survival rates of 76$\%$ and 66$\%$, respectively, In contrast, those patients who had biopsy alone had a 5 year survival rate of only 40$\%$. Posterior fossa was a component of failure in 11 of the 18 recurrences. Seven recurrences were isolated to the posterior fossa. Four patients had neuraxis recurrences, three had distant metastasis alone and four had multiple sites of failure, all involving the primary site. Conclusion : Craniospinal irradiation for patients with moduiloblastoma is an effective adjuvant treatment without significant treatment related toxicitles. There is room for Improvement in terms of posterior fossa control, especially in biopsy alone patients. The advances in radiotherapy including hypefractionation, stereotactic radiosurgery and 3D conformal radiotherapy would be evolved to improve the tumor control rate at primary site.
Purpose: Normal pancreas has low uptake rate in $^{18}F$-FDG PET scan. However, it is possible to diagnose malignancy of pancreatic cancer which has high uptake rate. Many studies approve a high prevalence of diabetes in pancreatic cancer and if the blood glucose level (BGL) is over the normal range, FDG uptake will be decreased and there will be inconvenience for patients from the delay time to reduce the high BGL or could cause difficulty to arrange the schedule. Therefore, we studied the relation of BGL and image quality in pancreatic cancer on PET. Materials and Methods: A hundred patients had PET scan. The prevalence of pancreatic cancer and diabetes were evaluated using SPSS ver. 17. The fasting BGL of patients were examined and sorted as diabetes mellitus (DM) group and Non-DM group. For the evaluation, patients were divided into 3 groups (Non-DM, DM; BGL${\geq}7.0mmol/L$, and DM; BGL<7.0 mmol/L). The ROI was drown on Liver and Lung for the PET imaging analysis. Results: Fifty three male and forty seven female were in the patients. The average age was $60.1{\pm}13.5$. There were 36 patients (male: 22, female: 14, 36%) who had pancreatic cancer with DM. There were 15 patients who showed over 7.0 mmol/L in their fasting BGL and 85 patients who showed under 7.0 mmol/L in their fasting BGL. Among the Non-DM, DM; BGL${\geq}7.0mmol/L$, and DM; BGL<7.0 mmol/L, there was not a statistical significance (p>0.05). Conclusion: The prevalence of pancreatic cancer was comparatively high in this study. If the fasting BGL was slightly over the normal BGL, we believe it will not give a severe disturbance when the patients have PET scan. Furthermore, the examination schedule doesn't need to change and the inconvenience from the delay of patients preparation will be reduced.
The purpose of this study is to evaluate the distribution of clusters and blood flow rate in ADHD SPECT brain blood flow images of children using statistical parametric mapping (SPM99). We studied 64 ADHD children (4-15 y, $8.03{\pm}2.57$ y. male/female:52/12) and compared them with a control group of 12 children (6-l7 y, $9.42{\pm}3.37$ y, male/female:8/4). We injected blood flow tracer $^{99m}Tc$-ethylcysteinate dimer (ECD) as a rCBF agent and took blood flow images after 30 min. by SPECT camera. In the case of hyperperfusion of rCBF in the ADHD group, we found 3 clusters clearly separated at the cingulate gyrus, Rt.cerebral occipital lobe and Lt.cerebellar post. lobe, on probability level 0.05 (P<0.05). Thirty-six ADHD patients with average hyperfusion rates between 18.72-19.30% in each cluster had more increase in blood flow than the average perfusion rate at the Rt. cerebral occipital lobe. These levels were influenced by P-value. In the case of hypoperfusion in the ADHD children, 4 decreased clusters on Lt. and Rt. cerebral frontal lobe, Lt. cerebral claustrum and Rt. cerebral, sup. temporal gyrus at P<0.01 can be seen. The average hypoperfusion rates for the ADHD children were 18.41-18.69% in each cluster, which showed more hypopefusion than the average perfusion rate at the Lt. Cerebrum inf. Frontal gyrus. The perfusion rates and the number of patients were not affected by P-value. The result of this study shows significant hyperpefusion clusters at the probability level of P:0.05 and hypoperfusion clusters at P:0.01. The number of ADHD patients in each clusters and the perfusion rate were not affected by P-value.
The frequency of diagnostic radiation examinations in medical institutions has recently increased to 220 million cases in 2011, and the annual exposure dose per capita was 1.4 mSv, 51% and 35% respectively, compared to those in 2007. The number of chest radiography was found to be 27.59% of them, the highest frequency of normal radiography. In this study, we developed a shielding device to minimize radiation exposure by shielding areas of the body which are unnecessary for image interpretation, during the chest radiography. And in order to verify its usefulness, we also measured the difference in entrance surface dose (ESD) and the absorbed dose, before and after using the device, by using an international standard pediatric (10 years) phantom and a glass dosimeter. In addition, we calculated the effective dose by using a Monte Carlo simulation-based program (PCXMC 2.0.1) and evaluated the reduction ratio indirectly by comparing lifetime attributable risk of cancer incidence (LAR). When using the protective device, the ESD decreased by 86.36% on average, nasal cavity $0.55{\mu}Sv$ (74.06%), thyroid $1.43{\mu}Sv$ (95.15%), oesophagus $6.35{\mu}Sv$ (78.42%) respectively, and the depth dose decreased by 72.30% on average, the cervical spine(upper spine) $1.23{\mu}Sv$ (89.73%), salivary gland $0.5{\mu}Sv$ (92.31%), oesophagus $3.85{\mu}Sv$ (59.39%), thyroid $2.02{\mu}Sv$ (73.53%), thoracic vertebrae(middle spine) $5.68{\mu}Sv$ (54.01%) respectively, so that we could verify the usefulness of the shielding mechanism. In addition, the effective dose decreased by 11.76% from $8.33{\mu}Sv$ to $7.35{\mu}Sv$ before and after wearing the device, and in LAR assessment, we found that thyroid cancer decreased to male 0.14 people (95.12%) and female 0.77 people (95.16%) per one million 10-year old children, and general cancers decreased to male 0.14 people (11.70%) and female 0.25 people (11.70%). Although diagnostic radiation examinations are necessary for healthcare such as the treatment of diseases, based on the ALARA concept, we should strive to optimize medical radiation by using this shielding device actively in the areas of the body unnecessary for the diagnosis.
Jeongun(丁芸) Lee, Young-do (李永道), who is deemed a representative female poet of Korea, began her literary career in May, 1946 when she published in a publication called "Bamboo Sprout, (죽순)". Her Korean identity, which was formed through her Confucius upbringing as well as traditional value system of her family, had a strong presence in her work, and she remained a quintessential figure in Korea's female sijo poet circle for 30 years until her passing in 1976. Despite the highly acclaimed talent and her noble aspirations, it is undeniable that her works did not receive fair assessment due to her private life. Against this backdrop, it is necessary to deeply inquire the literary values and beauty of Young-do Lee's sijo. As mentioned, Young-do Lee is a solidly established figure in Korea's modern poetry. The following illustrates the spirit and the world of her poetry. First, Young-do Lee lived through turbulent times and it was her country that served as the source of her sijo work. Assessing the multitude of dramatic historical events such as Japanese colonization, 8.15 Liberation of Korea, division of the nation, 6.25 Korean war, 4.19 Revolution, 5.16 military coup, it is natural that patriotism was strongly present in her work who was one of the intellectuals at the time. Second, Young-do Lee is a poet who had experienced more pain than others in terms of the turbulence of the time. Her Korean identity, which was formed through her Confucius upbringing as well as traditional value system of her family, had a strong presence in her work. Third, Jeongun Lee, Young-do is a poet of longing. The abundance and richness of her emotions were fortified through the relationship with another poet, Chihwan Yu. Fourth, Young-do Lee is a poet opened up new horizons for the modennization. The transparency of image reflected in her work and the elaborate nature of her language are outstanding. In summary, Young-do Lee was a true artist, who has a strong presence in Korea's modern poetry society, and who was a poet of patriotism, poet who suffered the turbulence of the times, and a poet of longing.
Even in our modern era, the projection of monsters in the recent literature contains the critical imagination of human existence for the posthuman age. The meaning of the monster-abject, especially as from the perspective of feministic criticism, contains criticism of the violent and oppressive patriarch as observed in the modern times. This article focuses on the gendered imagination of the discussions of the "abject" discussed by Julia Kristeva, and the "monstrous femine" discussed by Barbara Creed. Kim Eon-Hee's poems and Han Kang's novels, which have been examined extensively for analysis, show that the practical strategy of abject that goes beyond hate and sublime, wonder and joy through the imagination and concepts of monsters. The monster-abject strategy of Kim Eon-Hee's poem can be summarized by the narrative method of mirroring and the imagination of the truncated body. Mirroring falsification, which mimics the male speaker, is a method that some feminists strategically utilize in relation to the problem of female aversion in recent years as noted in the literature. In Kim Eon-Hee's poem, "becoming a man" and "imitating a man," through the method of mirroring appear as an image of cutting to dismantle the body. In that way, the narrative strategy of the abject that draws out abominations and bizarre effects which contains a strong critique of the patriarchal dominant ideology. The monster-abject strategy of Han-Kang's novel is embodied through the being of plants and the process of vegetarian-anorexia process. The world of the adject which was oppressed in the Han-Kang's novel, returns to the senses of the body through the symbol of the body. It is noted that the fictional characters who realize the repressed desire through the pathological symptom expressed by the female, go on to body perform active transformation. The sense of a body in a novel is not only a rejection of the world of animalman-civilization, but also a radically questioning of the noted and recognized boundaries between human beings and non-human being entities. The two writer's works show that the imagination of the monster-adject is not limited to rejecting the existing gender categories, but also goes in the direction of exploring the possibilities of various associated gender actions.
An unusual success engendering loyalty among cult fans in the United States, Mamoru Oshii's 1995 cyberpunk anime, Ghost in the Shell (GITS) revolves around a female cyborg assassin named Motoko Kusanagi, a.k.a. "the Major." When the news came out last year that Scarlett Johansson was offered 10 million dollars for the role of the Major in the live action remake of GITS, the frustrated fans accused DreamWorks of "whitewashing" the classic Japanimation and turning it into a PG-13 film. While it would be premature to judge a film yet to be released, it appears timely to revisit the core achievement of Oshii's film untranslatable into the Hollywood formula. That is, unlike ultimately heteronormative and humanist sci-fi films produced in Hollywood, such as the Matrix trilogy or Cloud Atlas, GITS defies a Hollywoodization by evoking much bafflement in relation to its queer, posthuman characters and settings. This essay homes in on Major Kusanagi's body in order to update prior criticism from the perspectives of posthumanism and queer theory. If the Major's voluptuous cyborg body has been read as a liberating or as a commodified feminine body, latest critical work of posthumanism and queer theory causes us to move beyond the moralistic binaries of human/non-human and male/female. This deconstruction of binaries leads to a radical rethinking of "reality" and "identity" in an image-saturated, hypermediated age. Viewed from this perspective, Major Kusanagi's body can be better understood less as a reflection of "real" women than as an embodiment of our anxieties on the loss of self and interiority in the SNS-dominated society. As is warned by many posthumanist and queer critics, queer and posthuman components are too often used to reinforce the human. I argue that the Major's hybrid body is neither a mere amalgam of human and machine nor a superficial postmodern blurring of boundaries. Rather, the compelling combination of individuality, animality, and technology embodied in the Major redefines the human as always, already posthuman. This ethical act of revision-its shifting focus from oppressive humanism to a queer coexistence-evinces the lasting power of GITS.
Purpose: We evaluated the incidence and malignant risk of focal breast lesions incidentally detected by $^{18}F-FDG$ PET/CT. Various PET/CT findings of the breast lesions were also analyzed to improve the differentiation between benign from malignant focal breast lesions. Materials & Methods: The subjects were 3,768 consecutive $^{18}F-FDG$ PET/CT exams performed in adult females without a history of breast cancer. A focal breast lesion was defined as a focal $^{18}F-FDG$ uptake or a focal nodular lesion on CT image irrespective of $^{18}F-FDG$ uptake in the breasts. The maximum SUV and CT pattern of focal breast lesions were evaluated, and were compared with final diagnosis. Results: The incidence of focal breast lesions on PET/CT in adult female subjects was 1.4% (58 lesions in 53 subjects). In finally confirmed 53 lesions of 48 subjects, 11 lesions of 8 subjects (20.8%) were proven to be malignant. When the PET/CT patterns suggesting benignancy (maximum attenuation value>75 HU or <30HU; standard deviation of mean attenuation > 20) were added as diagnostic criteria of PET/CT to differentiate benign from malignant breast lesions along with maximum SUV, the area under ROC curve of PET/CT was significantly increased compared with maximum SUV alone ($0.680{\pm}0.093$ vs. $0.786{\pm}0.076$, p<0.05). Conclusion: The malignant risk of focal breast lesions incidentally found on $^{18}F-FDG$ PET/CT is not low, deserving further diagnostic confirmation. Image interpretation considering both $^{18}F-FDG$ uptake and PET/CT pattern may be helpful to improve the differentiation from malignant and benign focal breast lesion.
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