• Investigative Magnetic Resonance Imaging
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• v.22 no.4
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• pp.260-265
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• 2018

Chordoid meningioma, an uncommon subtype of meningioma, occurs rarely in the spine. In this case report, the authors present a case of spinal chordoid meningioma in a young female patient, and include a detailed description of imaging findings and a literature review.

• Journal of Korean Neurosurgical Society
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• v.58 no.2
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• pp.112-118
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• 2015

Objective : Thoracic ossification of the ligamentum flavum (OLF) is a relatively rare disease. Because of ambiguous clinical symptom, it is difficult for early diagnosis of OLF and subsequent treatment can be delayed or missed. Therefore, the purpose of this study is to comprehensively assess the prevalence and distribution of thoracic OLF by magnetic resonance imaging (MRI) and coexisting spinal disease in Korean patients with back pain or leg pain. Methods : The sample included 2134 Korean patients who underwent MRI evaluation for back pain. The prevalence and distribution of thoracic OLF were assessed using lumbar MRI with whole spine sagittal images. Additionally, we examined the presence of coexisting lumbar and cervical diseases. The presence of thoracic OLF as well as clinical parameters such as age, sex, and surgery were retrospectively reviewed. Results : The prevalence of thoracic OLF in total patients was 16.9% (360/2134). The prevalence tended to increase with aging and was higher in women than in men. The lower thoracic segment of T10-11 was the most frequently affected segment. Of the 360 patients with OLF, 31.9% had coexisting herniated thoracic discs at the same level. Approximately 74% of the patients with OLF had coexisting lumbar and cervical disease. Nine (2.5%) of 360 OLF patients underwent surgery for thoracic lesion. Conclusion : The prevalenceof thoracic OLF was relatively higher than those of previous reports. And coexisting lumbar and cervical disease were very frequent. Therefore, we should check coexisting spinal diseases and the exact diagnostic localization of ossification besides lumbar disease.

• Journal of Chest Surgery
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• v.53 no.5
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• pp.310-312
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• 2020

Transcatheter leadless pacemaker dislodgment is a rare and potentially fatal complication of leadless device implantation. We present the first case of multidetector computed tomography images of leadless pacemaker migration and embolization in the pulmonary middle lobe artery. The patient was managed by percutaneous retrieval of the dislodged device and re-implantation in the appropriate position.

• Tuberculosis and Respiratory Diseases
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• v.40 no.4
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• pp.353-356
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• 1993

Advent of new imaging modalities such as computed tomography, magnetic resonance imaging and ultrasound contributed greately to the specific imaging diagnosis. However plain chest X-ray is still most prequently used for imaging diagnosis of respiratory disease in clinical pratic and it is important to make a good quality of X-ray film and good interpretation. The optimal chest X-ray should be taken with full inspiration without rotation and motion and the exposure is at the level of barely demonstrable thoracic vertebral disc space. It is recommended that higk KVP technique for detection of lesions which is overlaped by mediastinum, heart and rib cage. It is better to examine chest X-ray film start at some distance(6-8 feet) and closer to the film later on and the reader should not read a film in fatigue condition. The reading room should be quiet and relately dark illumination. It is important, to make a good X-ray film and good interpretation to reduce the observer error.

• Journal of Korean Neurosurgical Society
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• v.29 no.8
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• pp.1080-1084
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• 2000

Spinal neurenteric cyst results from the persistence of an abnormal communication between endodermal and ne-uroectodermal layer. Embryologically, neurenteric cyst is derived from endoderm that is fused with the developing notochord during the third week of gestation. It is a rare malformation that lead to spinal cord compression. The patient is 19-year-old male presented with chest pain, paresthesia and progressive weakness in his low extremities(grade II/II). Preoperative MR imaging revealed intradural extramedullary cyst with intracystic hemorrhage in T1 and T2 level that is ventrally located and compressed the spinal cord. Involved vertebral bodies were scalloped and fused. The cystic tumor were totally removed through costotransversectomy approach. Postoperatively, motor weakness of the low extremities were improved to the level of grade IV/V. And chest pain and paresthesia were gradually disappeared. Postoperative MR imaging showed the decompression of the thoracic spinal cord. Histologic examination revealed a ciliated columnar epithelial neurenteric cyst. The pre- and postoperative clinical, radiological features of a case of upper thoracic neurenteric cyst is described with review of literature.

• Journal of Chest Surgery
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• v.49 no.1
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• pp.22-28
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• 2016

Background: Carotid endarterectomy (CEA) with selective shunting is the surgical method currently used to treat patients with carotid artery disease. We evaluated the incidence of major postoperative complications in patients who underwent CEA with selective shunting under transcranial Doppler (TCD) at our institution. Methods: The records of 45 patients who underwent CEA with TCD-based selective shunting under general anesthesia from November 2009 to June 2015 were reviewed. The risk factors for postoperative complications were analyzed using univariate and multivariate analysis. Results: Preoperative atrial fibrillation was observed in three patients. Plaque ulceration was detected in 10 patients (22.2%) by preoperative computed tomography imaging. High-level stenosis was observed in 16 patients (35.5%), and 18 patients had contralateral stenosis. Twenty patients (44.4%) required shunt placement due to reduced TCD flow or a poor temporal window. The 30-day mortality rate was 2.2%. No cases of major stroke were observed in the 30 days after surgery, but four cases of minor stroke were noted. Univariate analysis showed that preoperative atrial fibrillation (odds ratio [OR], 40; p=0.018) and ex-smoker status (OR, 17.5; p=0.021) were statistically significant risk factors for a minor stroke in the 30-day postoperative period. Analogously, multivariate analysis also found that atrial fibrillation (p<0.001) and ex-smoker status (p=0.002) were significant risk factors for a minor stroke in the 30-day postoperative period. No variables were identified as risk factors for 30-day major stroke or death. No wound complications were found, although one (2.2%) of the patients suffered from a hypoglossal nerve injury. Conclusion: TCD-based CEA is a safe and reliable method to treat patients with carotid artery disease. Preoperative atrial fibrillation and ex-smoker status were found to increase the postoperative risk of a small embolism leading to a minor neurologic deficit.

• Journal of Chest Surgery
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• v.54 no.1
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• pp.45-52
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• 2021

Background: Atrial septal defect (ASD) is the most common congenital heart disease. However, the details of cardiac chamber remodeling after surgery are not well known, although this is an important issue that should be analyzed to understand long-term outcomes. Methods: Between November 2017 and January 2019, cardiac magnetic resonance imaging was performed preoperatively, at a 1-month postoperative follow-up, and at a 1-year postoperative follow-up. Cardiac chamber volume, valve regurgitation volume, and ejection fraction were measured as functions of time. Results: Thirteen patients (10 men and 3 women) were included. The median age at surgery was 51.4 years. The preoperative median ratio of flow in the pulmonary and systemic circulation was 2.3. The preoperative mean right ventricular (RV) end-diastolic volume index (EDVi) and RV end-systolic volume index (ESVi) had significantly decreased at the 1-month postoperative follow-up (p<0.001, p=0.001, respectively). The decrease in the RVEDVi (p=0.085) and RVESVi (p=0.023) continued until the postoperative 1-year follow-up, although the rate of decrease was slower. Tricuspid valve regurgitation had also decreased at the 1-month postoperative follow-up (p=0.022), and continued to decrease at a reduced rate (p=0.129). Although the RVEDVi and RVESVi improved after ASD closure, the RV volume parameters were still larger than the left ventricular (LV) volume parameters at the 1-year follow-up (RVEDVi vs. LVEDVi: p=0.016; RVESVi vs. LVESVi: p=0.001). Conclusion: Cardiac remodeling after ASD closure is common and mainly occurs in the early postoperative period. However, complete normalization does not occur.

• Journal of Veterinary Clinics
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• v.39 no.6
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• pp.326-333
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• 2022

The purpose of this study was to evaluate the radiographic positioning techniques used in local animal hospitals, identify the most common positioning problem, and determine whether there were changes after teleradiology consultations. From September 2016 to April 2021, 15 local animal hospitals that requested radiographic interpretation more than 10 times and for more than six cases of thoracic radiographs were selected. Six sets of two-views of (lateral and ventrodorsal [VD] or dorsoventral [DV] views) digital thoracic radiographs from six dogs per hospital were evaluated in four categories. For the lateral view, radiographic technique scores used in ten local animal hospitals improved, one remained the same, and four became worse. For the VD/DV view, the score for eleven hospitals improved and worsened for four. The most common problem was rotation (57/90) for the lateral view, followed by an inappropriate field of view (59/90), and incorrect beam center (71/90). For the VD/DV view, an inappropriate field of view (54/90) was the most common problem, followed by asymmetry (63/90), and incorrect beam center (73/90). Every factor, except rotation in the lateral view, improved after obtaining technical consultation; however, the degrees of improvement were not remarkable. There was no significant correlation between the number of requests and the degree of improvement. According to the results, the radiographic technique used in local animal hospitals was improved by technical advice on teleradiology. These changes make it possible to provide accurate diagnoses of the requested images. There are some limitations regarding the indicators of evaluation and the number of cases; therefore, further studies that use detailed indicators in large cohort group are needed. In addition, an effective method of teaching should be developed to improve radiographic techniques in local animal hospitals.

• Korean Journal of Radiology
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• v.23 no.1
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• pp.112-123
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• 2022

Objective: To investigate the relationship between ¹⁸F-FDG PET/CT semi-quantitative parameters and the International Association for the Study of Lung Cancer, American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) histopathologic classification, including histological subtypes, proliferation activity, and somatic mutations. Materials and Methods: This retrospective study included 419 patients (150 males, 269 females; median age, 59.0 years; age range, 23.0-84.0 years) who had undergone surgical removal of stage IA-IIIA lung adenocarcinoma and had preoperative PET/CT data of lung tumors. The maximum standardized uptake values (SUVmax), background-subtracted volume (BSV), and background-subtracted lesion activity (BSL) derived from PET/CT were measured. The IASLC/ATS/ERS subtypes, Ki67 score, and epidermal growth factor/anaplastic lymphoma kinase (EGFR/ALK) mutation status were evaluated. The PET/CT semi-quantitative parameters were compared between the tumor subtypes using the Mann-Whitney U test or the Kruskal-Wallis test. The optimum cutoff values of the PET/CT semi-quantitative parameters for distinguishing the IASLC/ATS/ERS subtypes were calculated using receiver operating characteristic curve analysis. The correlation between the PET/CT semi-quantitative parameters and pathological parameters was analyzed using Spearman's correlation. Statistical significance was set at p < 0.05. Results: SUVmax, BSV, and BSL values were significantly higher in invasive adenocarcinoma (IA) than in minimally IA (MIA), and the values were higher in MIA than in adenocarcinoma in situ (AIS) (all p < 0.05). Remarkably, an SUVmax of 0.90 and a BSL of 3.62 were shown to be the optimal cutoff values for differentiating MIA from AIS, manifesting as pure ground-glass nodules with 100% sensitivity and specificity. Metabolic-volumetric parameters (BSV and BSL) were better potential independent factors than metabolic parameters (SUVmax) in differentiating growth patterns. SUVmax and BSL, rather than BSV, were strongly or moderately correlated with Ki67 in most subtypes, except for the micropapillary and solid predominant groups. PET/CT parameters were not correlated with EGFR/ALK mutation status. Conclusion: As noninvasive surrogates, preoperative PET/CT semi-quantitative parameters could imply IASLC/ATS/ERS subtypes and Ki67 index and thus may contribute to improved management of precise surgery and postoperative adjuvant therapy.

• The Korean Journal of Pain
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• v.19 no.1
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• pp.119-122
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• 2006

Upper thoracic back pain can be musculoskeletal in origin or it could be visceral referred pain, which may be indicative of a serious medical condition. We experienced a case of a 55-years-old female patient who complained of upper thoracic back pain for 1 month, which started 10 days after a traffic accident. She described the pain as being a dull, constant nagging sensation with an intensity of 4/10 on the visual analogue scale. Her pain did not subside after trigger point injection of the rhomboid and trapezius muscles. She reported intermittent palpitation, which indicated that the cardiovascular or pulmonary systems were involved. She was diagnosed with pulmonary thromboembolism by the imaging studies. Refractory upper thoracic back pain should be investigated to rule out this treatable, but potentially fatal condition.