• Title/Summary/Keyword: patients under 7 years old

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Results of Total Body Irradiation in Allogeneic Bone Marrow Transplantation for Acute Non-Lymphocytic Leukemia (급성 골수성 백혈병에서 동종골수이식을 위한 전신 방사선 조사의 치료 결과)

  • Chung Su Mi;Choi Ihl Bohng;Kim In Ah;Kim Sung Hwan;Kang Ki Mun;Shinn Kyung Sub;Kim Choon Choo;Kim Dong Jip
    • Radiation Oncology Journal
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    • v.10 no.2
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    • pp.247-253
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    • 1992
  • Between August 1987 and July 1991, 22 patients with acute nonlymphocytic leukemia have received allogeneic bone marrow transplantation (BMT) with non-T-lymphocyte-depleted marrow obtained from matched sibling donors. Of these patients, 12 patients were in first complete remission (CR) and 10 patients in second CR or greater or in relapse. All patients were treated with a preparative regimen consisting of cyclophosphamide (CTX, 60 mg/kg) or combined drugs, and 850 cGy single-dose or $150\~200$ cGy fractionated total body irradiation (TBI) administered twice daily for a total dose of $1200\~1320$ cGy. Survivors have been followed from 8 to 64.5 months (median, 24 months). The overall 2 year survival rate, relapse rate and incidence of radiation pneumonitis and graft versus host disease (GVHD) have been evaluated by age, phase of disease, initial WBC count, modality of TBI or conditioning chemotherapy. Overall 2 year survival was $58{\%}$. The median survival was 31 months and mean survival was 23.2 months. Overall survival have significant impact in patients of age >19 years old (p=0.008), patients in first CR (p=0.09). Two year survival rate is significantly correlated with age ( >19 vs $\leqq$19, $79.4\%$ vs $14.3\%$, p=0.0008), regimen of chemotherapy (CTX vs combined drug, $76.9\%\;vs\;33.3\%$, p=0.04), phase of disease (1st CR vs \geqq2nd$ CR or relapse, $83.3\%\;vs\;30\%$, p=0.01) and method of TBI (fractionated vs single dose, $70.7\%\;vs\;37.5\%$, p=0.05). The influence of French-American-British (FAB) subtypes on relapse rate is not significant, but initial WBC count > 20000/$mm^3$ is associated with increased relapse rate. There is difference in the rate of radiation pneumonitis ($14.3\%\;vs\;25\%$), GVHD ($14.3\%\;vs\;50\%$) and relapse ($21.4\%\;vs\;50\%$) according to fractionated versus single-dose TBI. As mentioned above, fractionated TBI is compatible for the preparative regimen combined with chemotherapy En allogeneic BMT of first CR patients under 41 years of age with suitable donor. Those results from a retrospective, non-randomized study clearly need additional clinical data, ideally from a randomized study.

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A Study Concerning Health Needs in Rural Korea (농촌(農村) 주민(住民)들의 의료필요도(醫療必要度)에 관(關)한 연구(硏究))

  • Lee, Sung-Kwan;Kim, Doo-Hie;Jung, Jong-Hak;Chunge, Keuk-Soo;Park, Sang-Bin;Choy, Chung-Hun;Heng, Sun-Ho;Rah, Jin-Hoon
    • Journal of Preventive Medicine and Public Health
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    • v.7 no.1
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    • pp.29-94
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    • 1974
  • Today most developed countries provide modern medical care for most of the population. The rural area is the more neglected area in the medical and health field. In public health, the philosophy is that medical care for in maintenance of health is a basic right of man; it should not be discriminated against racial, environmental or financial situations. The deficiency of the medical care system, cultural bias, economic development, and ignorance of the residents about health care brought about the shortage of medical personnel and facilities on the rural areas. Moreover, medical students and physicians have been taught less about rural health care than about urban health care. Medical care, therefore, is insufficient in terms of health care personnel/and facilities in rural areas. Under such a situation, there is growing concern about the health problems among the rural population. The findings presented in this report are useful measures of the major health problems and even more important, as a guide to planning for improved medical care systems. It is hoped that findings from this study will be useful to those responsible for improving the delivery of health service for the rural population. Objectives: -to determine the health status of the residents in the rural areas. -to assess the rural population's needs in terms of health and medical care. -to make recommendations concerning improvement in the delivery of health and medical care for the rural population. Procedures: For the sampling design, the ideal would be to sample according to the proportion of the composition age-groups. As the health problems would be different by group, the sample was divided into 10 different age-groups. If the sample were allocated by proportion of composition of each age group, some age groups would be too small to estimate the health problem. The sample size of each age-group population was 100 people/age-groups. Personal interviews were conducted by specially trained medical students. The interviews dealt at length with current health status, medical care problems, utilization of medical services, medical cost paid for medical care and attitudes toward health. In addition, more information was gained from the public health field, including environmental sanitation, maternal and child health, family planning, tuberculosis control, and dental health. The sample Sample size was one fourth of total population: 1,438 The aged 10-14 years showed the largest number of 254 and the aged under one year was the smallest number of 81. Participation in examination Examination sessions usually were held in the morning every Tuesday, Wenesday, and Thursday for 3 hours at each session at the Namchun Health station. In general, the rate of participation in medical examination was low especially in ages between 10-19 years old. The highest rate of participation among are groups was the under one year age-group by 100 percent. The lowest use rate as low as 3% of those in the age-groups 10-19 years who are attending junior and senior high school in Taegu city so the time was not convenient for them to recieve examinations. Among the over 20 years old group, the rate of participation of female was higher than that of males. The results are as follows: A. Publie health problems Population: The number of pre-school age group who required child health was 724, among them infants numbered 96. Number of eligible women aged 15-44 years was 1,279, and women with husband who need maternal health numbered 700. The age-group of 65 years or older was 201 needed more health care and 65 of them had disabilities. (Table 2). Environmental sanitation: Seventy-nine percent of the residents relied upon well water as a primary source of dringking water. Ninety-three percent of the drinking water supply was rated as unfited quality for drinking. More than 90% of latrines were unhygienic, in structure design and sanitation (Table 15). Maternal and child health: Maternal health Average number of pregnancies of eligible women was 4 times. There was almost no pre- and post-natal care. Pregnancy wastage Still births was 33 per 1,000 live births. Spontaneous abortion was 156 per 1,000 live births. Induced abortion was 137 per 1,000 live births. Delivery condition More than 90 percent of deliveries were conducted at home. Attendants at last delivery were laymen by 76% and delivery without attendants was 14%. The rate of non-sterilized scissors as an instrument used to cut the umbilical cord was as high as 54% and of sickles was 14%. The rate of difficult delivery counted for 3%. Maternal death rate estimates about 35 per 10,000 live births. Child health Consultation rate for child health was almost non existant. In general, vaccination rate of children was low; vaccination rates for children aged 0-5 years with BCG and small pox were 34 and 28 percent respectively. The rate of vaccination with DPT and Polio were 23 and 25% respectively but the rate of the complete three injections were as low as 5 and 3% respectively. The number of dead children was 280 per 1,000 living children. Infants death rate was 45 per 1,000 live births (Table 16), Family planning: Approval rate of married women for family planning was as high as 86%. The rate of experiences of contraception in the past was 51%. The current rate of contraception was 37%. Willingness to use contraception in the future was as high as 86% (Table 17). Tuberculosis control: Number of registration patients at the health center currently was 25. The number indicates one eighth of estimate number of tuberculosis in the area. Number of discharged cases in the past accounted for 79 which showed 50% of active cases when discharged time. Rate of complete treatment among reasons of discharge in the past as low as 28%. There needs to be a follow up observation of the discharged cases (Table 18). Dental problems: More than 50% of the total population have at least one or more dental problems. (Table 19) B. Medical care problems Incidence rate: 1. In one month Incidence rate of medical care problems during one month was 19.6 percent. Among these health problems which required rest at home were 11.8 percent. The estimated number of patients in the total population is 1,206. The health problems reported most frequently in interviews during one month are: GI trouble, respiratory disease, neuralgia, skin disease, and communicable disease-in that order, The rate of health problems by age groups was highest in the 1-4 age group and in the 60 years or over age group, the lowest rate was the 10-14 year age group. In general, 0-29 year age group except the 1-4 year age group was low incidence rate. After 30 years old the rate of health problems increases gradually with aging. Eighty-three percent of health problems that occured during one month were solved by primary medical care procedures. Seventeen percent of health problems needed secondary care. Days rested at home because of illness during one month were 0.7 days per interviewee and 8days per patient and it accounts for 2,161 days for the total productive population in the area. (Table 20) 2. In a year The incidence rate of medical care problems during a year was 74.8%, among them health problems which required rest at home was 37 percent. Estimated number of patients in the total population during a year was 4,600. The health problems that occured most frequently among the interviewees during a year were: Cold (30%), GI trouble (18), respiratory disease (11), anemia (10), diarrhea (10), neuralgia (10), parasite disease (9), ENT (7), skin (7), headache (7), trauma (4), communicable disease (3), and circulatory disease (3) -in that order. The rate of health problems by age groups was highest in the infants group, thereafter the rate decreased gradually until the age 15-19 year age group which showed the lowest, and then the rate increased gradually with aging. Eighty-seven percent of health problems during a year were solved by primary medical care. Thirteen percent of them needed secondary medical care procedures. Days rested at home because of illness during a year were 16 days per interviewee and 44 days per patient and it accounted for 57,335 days lost among productive age group in the area (Table 21). Among those given medical examination, the conditions observed most frequently were respiratory disease, GI trouble, parasite disease, neuralgia, skin disease, trauma, tuberculosis, anemia, chronic obstructive lung disease, eye disorders-in that order (Table 22). The main health problems required secondary medical care are as fellows: (previous page). Utilization of medical care (treatment) The rate of treatment by various medical facilities for all health problems during one month was 73 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 52% while the rate of those who have health problems which did not required rest was 61 percent (Table 23). The rate of receiving of medical care for all health problems during a year was 67 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 82 percent while the rate of those who have health problems which did not required rest was as low as 53 percent (Table 24). Types of medical facilitied used were as follows: Hospital and clinics: 32-35% Herb clinics: 9-10% Drugstore: 53-58% Hospitalization Rate of hospitalization was 1.7% and the estimate number of hospitalizations among the total population during a year will be 107 persons (Table 25). Medical cost: Average medical cost per person during one month and a year were 171 and 2,800 won respectively. Average medical cost per patient during one month and a year were 1,109 and 3,740 won respectively. Average cost per household during a year was 15,800 won (Table 26, 27). Solution measures for health and medical care problems in rural area: A. Health problems which could be solved by paramedical workers such as nurses, midwives and aid nurses etc. are as follows: 1. Improvement of environmental sanitation 2. MCH except medical care problems 3. Family planning except surgical intervention 4. Tuberculosis control except diagnosis and prescription 5. Dental care except operational intervention 6. Health education for residents for improvement of utilization of medical facilities and early diagnosis etc. B. Medical care problems 1. Eighty-five percent of health problems could be solved by primary care procedures by general practitioners. 2. Fifteen percent of health problems need secondary medical procedures by a specialist. C. Medical cost Concidering the economic situation in rural area the amount of 2,062 won per residents during a year will be burdensome, so financial assistance is needed gorvernment to solve health and medical care problems for rural people.

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A Clinical Study of the Foreign Body in the Air Passage (기도이물의 임상적 고찰)

  • 조진규;안회영;홍남표;이익재
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1983.05a
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    • pp.13.3-14
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    • 1983
  • A clinical study was done on 24 cases with foreign body in the air passage, who were treated at the department of otolaryngology of Kyung Hee university hospital during the period from Apr. 1973 to Feb. 1983. The obtained results were as follows : 1) The incidence of sex was much higher in male than female and children under 4 years old were predominant. 2) Almost of all patients came in the hospital within 3 days after onset. However one patient came in hospital 5 months later. 3) The variety of foreign body was numerous, among which vegetables and plastic materials were most frequently found. 4) The most common sites of lodgement were trachea and right main bronchus. 5) The common clinical manifestations were dyspnea, decreasing breathing sound and cough. Negative X-ray findings did not exclude a foreign body in the air passage. 6) The important pulmonary complications due to foreign body were atelectasis, emphysema and pneumonia. 7) Foreign body was successfully removed by use of peroral or inferior endoscopy in all cases except one case, on whom thorachotomy was done. 8) The important complications due to the surgical procedure were decannulation difficulty and pneumothorax.

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Association between Respiratory Virus Infection and Pneumococcal Colonization in Children (소아에서의 호흡기바이러스 감염과 비인두 폐렴구균 보균의 연관성)

  • Lee, Hyeon Seung;Choe, Young June;Cho, Eun Young;Lee, Hyunju;Choi, Eun Hwa;Lee, Hoan Jong
    • Pediatric Infection and Vaccine
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    • v.21 no.3
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    • pp.207-213
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    • 2014
  • Purpose: This study aimed to investigate the association between respiratory virus infection and pneumococcal colonization in children. Methods: From May 2009 to June 2010, nasopharyngeal (NP) aspirates were obtained from patients under 18 years old who visited Seoul National University Children's Hospital for respiratory symptoms. NP samples were used to detect respiratory viruses (influenza virus A and B, parainfluenza virus 1, 2 and 3, respiratory syncytial virus A and B, adenovirus, rhinovirus A/B, human metapneumovirus, human coronavirus 229E/NL63 and OC43/HKU1) by RT-PCR and pneumococcus by culture. Results: Median age of the patients was 27 months old. A total of 1,367 NP aspirates were tested for respiratory viruses and pneumococcus. Pneumococcus was isolated from 228 (16.7%) of samples and respiratory viruses were detected from 731 (53.5%). Common viruses were rhinovirus (18.4%), respiratory syncytial virus (RSV) A (10.6%), adenovirus (6.9%), influenza virus A (6.8%). Pneumococcal isolation rate was significantly higher in the cases of positive virus detection than negative detection [21.3% (156/731) vs. 11.3% (72/636), P <0.001]. For individual viruses, pneumococcal isolation rate was positively associated with detection of influenza virus A [24.7% (23/93) vs 16.1% (205/1274), P=0.001], RSV A [28.3% (41/145) vs 15.3% (187/1222), P=0.001], RSV B [31.3% (10/32) vs 16.3% (218/1335), P=0.042], rhinovirus A/B [22.6% (57/252) vs 15.3% (171/1115), P=0.010]. Conclusion: The study revealed that pneumococcal isolation from NP aspirates is related with respiratory virus detection. The result of this study could be used to investigate how respiratory viruses and pneumococcus cause clinical diseases.

Positional Change of the Uterus during Definitive Radiotherapy for Cervix Cancer (자궁경부암의 방사선치료 시 자궁의 크기와 위치 변화)

  • Park, Won;Huh, Seung-Jae;Lee, Jeung-Eun
    • Radiation Oncology Journal
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    • v.21 no.2
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    • pp.135-142
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    • 2003
  • Purpose: The purpose of this study was to investigate the positional change of the uterus during radiotherapy. Materials and Methods: Between 1997 and 2001, 47 patients received definitive radiotherapy for cervical cancer at the Samsung Medical Center. For each patient, two MRI scans were taken; one before and the other 3$\~$4 weeks after the radiotherapy treatment. In T2 weighted MRI images, the positional change of the uterine was quantified by measuring six quantities; the distance from the cervix os to the isthmus of the uterus (Dcx), the maximum length from the isthmus of the uterus to the uterine fundus (Dco), the maximum vertical distance of the uterine body (Dco-per), the angle between the vertical line and the cervical canal in the sagittal images (Acx), the angle of the uterine corpus from the vertical line in the sagittal plan (Aco-ap), and the relative angle of the uterine corpus from a fixed anatomical landmark in the axial images (Aco-axi). Results: The mean Dcx values, before and during the treatment, were 36.7 and 27.8 mm, respectively. The Dco deviated by more than 10 mm in 14 cases (29.8$\%$). The change in the Acx ranged from 0.1 to 67.8$^{\circ}$ (mean 13.2$^{\circ}$). The Aco-ap changed by a maximum of 84.8$^{\circ}$ (mean 16.9$^{\circ}$). The differences in the Dcx plus the Dco in the smaller (<4 cm) and larger ($geq$4 cm) tumors were 5.3 and 19.4 mm, respectively. With patients less than 60 years old, or with a tumor size larger than 4 cm, the difference in the Acx was statistically significant. Conclusion: The positional changes of the uterus, during radiation treatment, should be considered in the 3DCRT or IMRT treatment planning, particularly in patients under 60 years of age or in those with a tumor size greater than 4 cm in maximum diameter.

Dental Management in a Patient with Infantile Osteopetrosis : A Case Report with a 7-Year follow-up (유아기형 골화석증 환자의 치과적 관리 : 7년간의 경과 관찰)

  • Cheon, Minkyoung;Yang, Sunmi;Kim, Jaehwan;Choi, Namki;Kim, Seonmi
    • Journal of the korean academy of Pediatric Dentistry
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    • v.45 no.2
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    • pp.257-264
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    • 2018
  • Osteopetrosis is characterized by impaired osteoclast function and increased bone density. Infantile osteopetrosis is a severe form of the disease and has characteristics such as diffusely sclerotic skeleton, pancytopenia, cranial nerve entrapment, infection susceptibility, and abnormal craniofacial appearance. Patients with infantile osteopetrosis often experience developmental delay, and may have a short life span. A 14-month-old girl with osteopetrosis presented to the department of pediatric dentistry. Incipient caries on deciduous incisors were observed. The patient revisited 4 years of age. Besides medical problems, oral complications such as growth retardation, narrow upper arch, crowding, dental caries, and abnormal tooth development were observed. After consultation with her pediatrician, dental treatments were performed on the deciduous molars under sedation after a prophylactic antibiotic injection. At a periodic follow-up, multiple deciduous teeth were treated and extracted, and oralrehabilitation with a removable partial denture was initiated. Patient with osteopetrosis are highly susceptible to infection because of their compromised immune system and problems associated with wound healing that lead to osteomyelitis or sepsis development. Active participation in dental care for sugar intake management and proper oral hygiene are obligatory.

The Variation of Scan Time According to Patient's Breast Size and Body Mass Index in Breast Sentinel lymphangiography (유방암의 감시림프절 검사에서 유방크기와 체질량지수에 따른 검사시간 변화)

  • Lee, Da-Young;Nam-Koong, Hyuk;Cho, Seok-Won;Oh, Shin-Hyun;Im, Han-Sang;Kim, Jae-Sam;Lee, Chang-Ho;Park, Hoon-Hee
    • The Korean Journal of Nuclear Medicine Technology
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    • v.16 no.2
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    • pp.62-67
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    • 2012
  • Purpose : At this time, the sentinel lymph node mapping using radioisotope and blue dye is preceded for breast cancer patient's sentinel lymph node biopsy. But all patients were applied the same protocol without consideration of physical specific character like the breast sizes and body mass indexes. The purpose of this study is search the optimized scan time in breast sentinel lymphangiography by observing how much the body mass index and breast size influence speed of lymphatic flow. Materials and Methods : The Object of this study was 100 breast cancer patients(Female, 100 persons, average age $50.34{\pm}10.26$ years old)at Severance hospital from October 2011 to December 2011. They were scanned breast sentinel lymphangiography before operation. This study was performed on Forte dual heads gamma camera (Philips Medical Systems, Nederland B.V.). All patients were intra-dermal injected $^{99m}Tc$-Phytate 18.5 MBq, 0.5 ml. For 80 patients, we have scanned without limitation of scan time until the lymphatic flow from the lymph node since injection. We measured how long the lymphatic flow time between departures from injects site and arrival to lymph node using stopwatch. After we calculated patient's Body mass Index and classified as 4 groups. And we measured patient's breast size and classified 3 groups. The modified breast lymphangiography that changing scan time according to comparison study's result was performed on 20 patients and was estimated. Results : The mean scan time as breast size was A group 2.48 minutes, B group 7.69 minutes, C group 10.43 minutes. The mean scan time as body mass index was under weight 1.35 minutes, normal weight 2.56 minutes, slightly over 5.62 minutes, over weighted 5.62 minutes. The success rate of modified breast lymphangiography was 85%. Conclusion : As the Body mass index became higher and breast size became bigger, the total scan time is increased. Based on the obtained information, we designed modified breast lymphangiography protocol. At the cases applying that protocol, most of sentinel lymph nodes were visualized as lymphatic pool. In conclusion, we found that the more success rate in modified protocol considering physical individuality than study carrying out in the same protocol.

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Characteristics of Exposure to Humidifier Disinfectant by Lung Injury Patients (가습기 살균제 폐 손상 피해자의 살균제 노출 특성 -태아와 임산부 노출을 중심으로 -)

  • Park, Dong-Uk;Ryu, Seung-Hun;Lim, Heung-Kyu;Kim, Sun-Kyung;Ahn, Jongju;Roh, Hyun-Suk;Choi, Ye-Yong;Cha, Won-Seok;Lee, Eun;Hong, Sang-Bum;Do, Kyung-Hyun;Cho, Jae-lim;Bae, Mun-Joo;Shin, Dong-Chun;Paek, Domyung;Hong, Soo-Jong
    • Journal of Environmental Health Sciences
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    • v.42 no.3
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    • pp.147-159
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    • 2016
  • In South Korea, many cases of humidifier disinfectant-associated lung injury (HDLI) have been reported among people who used humidifier products containing humidifier disinfectant (HD). The objective of this study is to characterize exposure to HD among a total of 221 HDLI patients who used HD. Information and data on the HDs used were collected through a structured questionnaire and home environmental investigations. The conditions of these 221 HDLI patients were clinically confirmed to be caused by the use of HD. Children aged under 5 years old made up the highest proportion of HDLI cases (n=125, 56.6 %), followed by pregnant women (n=35, 15.8%). Forty-three percent (n=95) of the victims died. There were three cases of fetuses and 35 pregnant women among the victims. The number of HDLI patients who used only the Oxy Saksak brand of HD was found to be 85 (38.5%), followed by the HD brands Cefu (n=24, 10.9%), Lottemart Wiselect (n=9, 4.1%) and Aekyung (n=3). Patients who exclusively used HD brands containing polyhexamethylene guanidine phosphate (PHMG) (n=13, 55.7%) as an active ingredient made up the largest share, followed by those who exclusively used HD containing only oligo(2-(2-ethoxy) ethoxyethyl guanidinium (PGH) (n=24, 10.9%) and by those who only used a mixture of chloromethylisothiazolinone (CMIT) and methylisothiazolinone (MIT) (n=3, 1.4%). HD products containing PHMG were found to be the most commonly used among the confirmed HDLI patients. Three exposed fetuses who never used HD after birth developed lung injuries, indicating a probability of exposure to HD during gestation. All HDLI patients responded that they used HD while sleeping and for longer than 10 hours per day. In conclusion, the development of HDLI was clinically found to be associated with the use of several HD products containing PHMG, PGH and CMIT/MIT.

Relationship between FSH Receptor Genotype and Clinical Outcomes of IVF-ET in Infertile Korean Women (한국 불임 여성에서 난포자극호르몬 수용체 유전자형과 체외수정 및 배아이식술 임상 결과와의 관련성)

  • Moon, Mi-Hye;Choi, Hye-Won;Kim, Min-Jee;Lee, Hyoung-Song;Cha, Sun-Hwa;Song, In-Ok;Koong, Mi-Kyoung;Jun, Jin-Hyun
    • Clinical and Experimental Reproductive Medicine
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    • v.35 no.1
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    • pp.69-76
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    • 2008
  • Objective: The purposes of this study were to determine the distribution of follicle-stimulating hormone receptor (FSHR) genotypes in infertile Korean women and to evaluate the relationship between FSHR genotypes and clinical outcomes of IVF-ET cycles. Methods: Genomic DNA was extracted from peripheral blood in 1, 020 of infertile Korean women. Genotypes of FSHR at Thr307Ala (T/A) and Asn680Ser (N/S) were screened by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. Clinical outcomes related to the genotypes of FSHR were evaluated in IVF-ET cycles (n=302) with controlled ovarian hyperstimulation (COH) of infertile women under 40 years old. Results: In a population of 1, 020 infertile Korean women, the frequency of TT/NN, TA/NS and AA/SS for the major variant Thr307Ala and Asn680Ser was 44.80%, 41.96% and 10.49%, respectively. There was no significant difference in characteristics of ovarian response and clinical pregnancy rate among the major genotypes of FSHR in IVF-ET cycles with COH. However, implantation rate of AA/SS patients was significantly higher than that of TT/NN patients (24.5% vs 15.7%, p<0.05). Conclusion: This study showed that FSHR genotype was not directly associated with ovarian response in IVF-ET cycles with COH. The relationship between clinical outcomes and FSHR genotypes of patients should be substantiated by further studies.

Usefulness of volumetric BMD measurement by using low dose CT image acquired on L-spine Bone SPECT/CT (L-spine Bone SPECT/CT에서 획득된 저선량 CT 영상을 이용한 용적 골밀도 결과의 유용성)

  • Hyunsoo Ko;Soonki Park;Eunhye Kim;Jongsook Choi;Wooyoung Jung;Dongyun Lee
    • The Korean Journal of Nuclear Medicine Technology
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    • v.27 no.2
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    • pp.99-109
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    • 2023
  • Purpose: CT scan makes up for the weak point of the nuclear medicine image having a low resolution and also were used for attenuation correction on image reconstruction. Recently, many studies try to make use of CT images additionally, one of them is to measure the bone mineral density(BMD) using Quantitative CT(QCT) software. BMD exams are performed to scan lumbar and femur with DXA(Dual-Energy X-Ray Absorptiometry) in order to diagnose bone disease such as osteopenia, osteoporosis. The purpose of this study is to identify the usefulness of QCT_BMD analyzed with low dose CT images on L-spine Bone SPECT/CT comparing with DXA_BMD. Materials and Methods: Fifty five women over 50 years old (mean 66.4 ± 9.1) who took the both examinations(L-spine Bone SPECT/CT with SIEMENS Intevo 16 and DXA scan with GE Lunar prodigy advance) within 90 days from April 2017 to July 2022, BMD, T-score and disease classification were analyzed. Three-dimensional BMD was analyzed with low dose CT images acquired on L-spine Bone SPECT/CT scan on Mindways QCT PROTM software and two-dimensional BMD was analyzed on DXA scan. Basically, Lumbar 1-4 were analyzed and the patients who has lesion or spine implants on L-spine were excluded for this study. Pearson's correlation analysis was performed in BMD and T-score, chi-square test was performed in disease classification between QCT and DXA. Results: On 55 patients, the minimum of QCT_BMD was 18.10, maximum was 166.50, average was 82.71 ± 31.5 mg/cm3. And the minimum of DXA-BMD was 0.540, maximum was 1.302, average was 0.902 ± 0.201 g/cm2, respectively. The result shows a strong statistical correlation between QCT_BMD and DXA_BMD(p<0.001, r=0.76). The minimum of QCT_T-score was -5.7, maximum was -0.1, average was -3.2 ± 1.3 and the minimum of DXA_T-score was -5.0, maximum was 1.7, average was -2.0 ± 1.3, respectively. The result shows a statistical correlation between QCT T-score and DXA T-score (p<0.001, r=0.66). On the disease classification, normal was 5, osteopenia was 25, osteoporosis was 25 in QCT and normal was 10, osteopenia was 25, osteoporosis was 20 in DXA. There was under-estimation of bone decrease relatively on DXA than QCT, but there was no significant differences statistically by chi-square test between QCT and DXA. Conclusion: Through this study, we could identify that the QCT measurement with low dose CT images QCT from L-Spine Bone SPECT/CT was reliable because of a strong statistical correlation between QCT_BMD and DXA_BMD. Bone SPECT/CT scan can provide three-dimensional information also BMD measurement with CT images. In the future, rather than various exams such as CT, BMD, Bone scan are performed, it will be possible to provide multipurpose information via only SPECT/CT scan. In addition, it will be very helpful clinically in the sense that we can provide a diagnosis of potential osteoporosis, especially in middle-aged patients.