No abstract available.

PURPOSE: Either gated myocardial perfusion SPECT or attenuation corrected SPECT can be used to improve specificity in the diagnosis of coronary artery disease. We investigated in this study whether gating or attenuation correction improved diagnostic performance of rest/stress perfusion SPECT in patients having intermediate pre-test likelihood of coronary artery disease. MATERIALS AND METHODS: Sixty-eight patients underwent rest attenuation-corrected T1-20l/dipyridamole stress gated attenuation-corrected Tc-99m-MIBI SPECT using an ADAC vertex camera (M:F=29:39, aged 59+/-12 years, coronary artery stenosis> or =70%. one vessel: 13, two vessel: 18, three vessel: 8, normal: 29). Using a five-point scale, three physicians graded the post-test likelihood of coronary artery disease for each arterial territory (1 normal, 2: possibly normal 3:equivocal, 4: possibly abnormal, 5: abnormal). Sensitivity, specificity and area under receiver-operating-characteristic curves were compared for each operator between three METHODS: (A) non-attenuation-corrected SPECT; (B) gated SPECT added to (A); and (C) attenuation-corrected SPECT added to (B). RESULTS: When grade 3 was used as the criteria for coronary artery disease, no differences in sensitivity and specificity were found between the three methods for each operator Areas under receiver- operating-characteristic curves for diagnosis of coronary artery disease revealed no differences between each modality (p>005). CONCLUSION: In patients at intermediate risk of coronary artery disease, gated SPECT and attenuation-corrected SPECT did not improve diagnostic performance.
Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Humans ; Perfusion* ; ROC Curve ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*

We report a case of calcific bursitis of the shoulder in four-year-old boy who had severe pain and limitation of motion of the left shoulder joint for three days. Radiographs revealed the oval radiopaque lesion in the subacormial space, and the MR signal intensity of the mass was moderate on T2WI. Histological examination of the mass showed acute necrotizing inflammation with calcification.
Bursitis ; Humans ; Inflammation ; Male ; Shoulder ; Shoulder Joint

PURPOSE: Interictal F-18-fluorodeoxyglucose (FDG) PET and ictal Tc-99m-HMPAO SPECT are found to be useful in localizing epileptogenic zones in neocortical lateral temporal or frontal lobe epilepsy. We investigated whether interictal F-18-FDG PET or ictal Tc-99m-HMPAO SPECT was useful to find epileptogenic zones in occipital lobe epilepsy (OLE). MATERIALS AND METHODS: We reviewed patterns of hypometabolism in interictal F-18-FDG PET and of hyperperfusion in ictal Tc-99m-HMPAO SPECT in 17 OLE patients (mean age=27+/-6.8 year, M:F=10:7, injection time=30+/-17 sec). OLE was diagnosed based on invasive electroencephalography (EEG) study, surgery and post-surgical outcome (Engel class I in all for average 14 months). RESULTS: Epileptogenic zones were correctly localized in 9 (60%) out of 15 patients by interictal F-18-FDG PET. Epiletogenic hemispheres were correctly lateralized in 14 patients (93%). By ictal Tc-99m-HMPAO SPECT, epileptogenic hemispheres were correctly lateralized in 13 patients (76%), but localization was possible only in 3 patients (18%). Among patients who showed no abnormality with MR imaging and no correct localization with ictal Tc-99m-HMPAO SPECT, interictal F-18-FDG PET was helpful in 2 patients. CONCLUSION:: Ictal Tc-99m-HMPAO SPECT was helpful in lateralization but not in localization in OLE. Interictal F-18-FDG PET was helpful for localization of epileptogenic zones even in patients with ambiguous MR or ictal SPECT findings. Key KW: Occipital lobe epilepsy, Tc-99m-HMPAO, Ictal perfusion SPECT, F-18-FDG, PET, SPECT
Electroencephalography ; Epilepsies, Partial* ; Epilepsy, Frontal Lobe ; Humans ; Magnetic Resonance Imaging ; Occipital Lobe* ; Perfusion ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: The aim of this study was to evaluate the efficacy of periprostatic lidocaine injection according to lidocaine dose during transrectal ultrasound-guided prostate biopsy. MATERIALS AND METHODS: The subjects of this study were 92 patients who had undergone transrectal ultrasound-guided 12-core biopsy of the prostate. The patients were randomly assigned to three groups: group 1 (n=31, no lidocaine injection), group 2 (n=30, periprostatic injection of 10 ml 1% lidocaine), and group 3 (n=31, periprostatic injection of 20 ml 1% lidocaine). The patients were assessed for pain by use of a 10-point visual analogue scale (VAS) and for other complications after the procedure. RESULTS: The mean VAS scores of groups 1 through 3 were 0.93+/-0.89, 1.32+/-1.37, and 1.13+/-1.10, respectively. There were no statistically significant differences between the three groups. However, the mean VAS score of the biopsy pain was 5.0+/-1.48, 3.93+/-1.94, and 3.60+/-2.15, in the same groups, respectively, with statistically significant differences between group 1 and the other groups. Patients in groups 2 and 3 reported significantly less biopsy pain than did group 1 patients (p=0.004, 0.021), with no statistically significant difference in VAS score between groups 2 and 3 (p=0.533). With respect to post-biopsy complications, there were no significant differences in the incidence of hematuria, hematospermia, rectal bleeding, or infection among the three groups. CONCLUSIONS: Periprostatic injection of local anesthesia with lidocaine was associated with significantly less pain than in the absence of anesthesia. Furthermore, a 20-ml dose of lidocaine produced no better pain control than did a 10-ml lidocaine dose for prostate biopsy.
Anesthesia ; Anesthesia, Local ; Biopsy ; Hematuria ; Hemorrhage ; Hemospermia ; Humans ; Incidence ; Lidocaine ; Prostate

PURPOSE: The aim of this study was to evaluate the efficacy of periprostatic lidocaine injection according to lidocaine dose during transrectal ultrasound-guided prostate biopsy. MATERIALS AND METHODS: The subjects of this study were 92 patients who had undergone transrectal ultrasound-guided 12-core biopsy of the prostate. The patients were randomly assigned to three groups: group 1 (n=31, no lidocaine injection), group 2 (n=30, periprostatic injection of 10 ml 1% lidocaine), and group 3 (n=31, periprostatic injection of 20 ml 1% lidocaine). The patients were assessed for pain by use of a 10-point visual analogue scale (VAS) and for other complications after the procedure. RESULTS: The mean VAS scores of groups 1 through 3 were 0.93+/-0.89, 1.32+/-1.37, and 1.13+/-1.10, respectively. There were no statistically significant differences between the three groups. However, the mean VAS score of the biopsy pain was 5.0+/-1.48, 3.93+/-1.94, and 3.60+/-2.15, in the same groups, respectively, with statistically significant differences between group 1 and the other groups. Patients in groups 2 and 3 reported significantly less biopsy pain than did group 1 patients (p=0.004, 0.021), with no statistically significant difference in VAS score between groups 2 and 3 (p=0.533). With respect to post-biopsy complications, there were no significant differences in the incidence of hematuria, hematospermia, rectal bleeding, or infection among the three groups. CONCLUSIONS: Periprostatic injection of local anesthesia with lidocaine was associated with significantly less pain than in the absence of anesthesia. Furthermore, a 20-ml dose of lidocaine produced no better pain control than did a 10-ml lidocaine dose for prostate biopsy.
Anesthesia ; Anesthesia, Local ; Biopsy ; Hematuria ; Hemorrhage ; Hemospermia ; Humans ; Incidence ; Lidocaine ; Prostate

PURPOSE: As vesicoureteral reflux (VUR) could lead to renal functional deterioration when combined with urinary tract infection, we need to decide whether operative anti-reflux treatment should be performed at the time of diagnosis of VUR. Predictive value of radioisotope voiding cystography (RIVCG) for renal outcome was tested. MATERIALS AND METHODS: In 35 children (18 males, 17 females), radiologic voiding cystourethrography (VCU), RIVCG and DMSA scan were performed. Change in renal function was evaluated using the follow-up DMSA scan, ultrasonography, and clinical information. Discriminant analysis was performed using individual or integrated variables such as reflux amount and extent at each phase of voiding on RIVCG, in addition to age, gender and cortical defect on DMSA scan at the time of diagnosis. Discriminant function was composed and its performance was examined. RESULTS: Reflux extent at the filling phase and reflux amount and extent at postvoiding phase had a significant prognostic value. Total reflux amount was a composite variable to predict prognosis. Discriminant function composed of reflux extent at the filling phase and reflux amount and extent at postvoiding phase showed better positive predictive value and specificity than conventional reflux grading. CONCLUSION: RIVCG could predict renal outcome by disclosing characteristic reflux pattern during various voiding phases.
Child ; Diagnosis ; Follow-Up Studies ; Humans ; Male ; Prognosis ; Sensitivity and Specificity ; Succimer ; Ultrasonography ; Urinary Tract Infections ; Vesico-Ureteral Reflux

PURPOSE: To evaluate the effectiveness of radioiodine treatment for metastatic thyroid carcinoma, we reviewed results of radioactive iodine treatment in patients with functional lung or bone metastases. MATERIALS ANF METHODS: Of 760 patients who were treated for differentiated thyroid cancer between 1984 and 1998, we detected pulmonary metastases and bone metastases in 76 patients (10.0%) and 20 patients (2.6%), respectively. Among them, we could evaluate the effectiveness of I-131 therapy in 53 patients with lung metastases and 15 patients with bone metastases. RESULTS:Of 53 patients who received I-131 therapy with a mean cumulative dose of 26.2 GBq (1.1-84.4 GBq) for pulmonary metastases, metastatic lung lesions completely resolved in 19 patients (35.8%) and improved in 22 patients (41.5%). In 13 of 19 patients with complete remission of pulmonary metastases, the total accumulated dose of I-131 was less than 18.5 GBq. We found 43 sites of metastatic bone lesions in 15 patients with bone metastases. Of 29 lesions which received I-131 therapy, metastatic lesions improved in 14 sites (48.3%), but did not change or progress in 15 sites (51.7%) despite the I-131 therapy. Three lesions were completely cured with a combination treatment of surgery(+/- external radiotherapy) and I-131 therapy, and the other 11 lesions improved. CONCLUSION: Radioactive iodine treatment gives favorable results for pulmonary metastases. However, for bone metastases, there might be a need to use combination therapy including I-131 and surgery or external irradiation.
Atrial Natriuretic Factor ; Humans ; Iodine ; Lung ; Neoplasm Metastasis* ; Thyroid Gland* ; Thyroid Neoplasms*

PURPOSE: For quantitative estimation of cerebrovascular reserve (CVR), we estimated the cerebral blood flow (CBF) using Lassen's nonlinearity correction algorithm and Tc-99m HMPAO brain SPECT images acquired with consecutive acquisition protocol. Using the values of CBF in basal and acetazolamide (ACZ) stress states, CBF increase was calculated. MATERALS AND METHODS: In 9 normal subjects (age: 72+/-4 years), brain SPECT was performed at basal and ACZ stress states consecutively after injection of 555 MBq and 1,110 MBq of Tc-99m HMPAO, respectively. Cerebellum was automatically extracted as reference region on basal SPECT image using threshold method. Assuming basal CBF of cerebellum as 55 ml/100 g/min, CBF was calculated for every pixel at basal states using Lassen's algorithm. Cerebellar blood flow at stress was estimated comparing counts of cerebellum at rest and ACZ stress and Lassen's algorithm. CBF of every pixel at ACZ stress state was calculated using Lassen's algorithm and ACZ cerebellar count. CVR was calculated by subtracting basal CBF from ACZ stress CBF for every pixel. The percent CVR was calculated by dividing CVR by basal CBF. The CBF and percentage CVR parametric images were generated. RESULTS: The CBF and percentage CVR parametric images were obtained successfully in all the subjects. Global mean CBF were 49.6+/-5.5 ml/100g/min and 64.4+/-10.2 ml/100g/min at basal and ACZ stress states, respectively. The increase of CBF at ACZ stress state was 14.7+/-9.6 ml/100g/min. The global mean percent CVR was 30.7% and was higher than the 13.8% calculated using count images. CONCLUSION: The blood flow at basal and ACZ stress states and cerebrovascular reserve were estimated using basal/ACZ Tc-99m-HMPAO SPECT images and Lassen's algorithm. Using these values, parametric images for blood flow and cerebrovascular reserve were generated.
Acetazolamide ; Brain* ; Cerebellum ; Technetium Tc 99m Exametazime* ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: The purpose of this study was to evaluate the diagnostic accuracy of Tc-99m labeled antigranulocyte antibody immunoscintigrapy in the diagnosis of osteomyelitis and compare with the results of triphasic bone scan. MATERIALS AND METHODS: The study population was 39 patients (22 male, 17 female) who had uncertain diagnoses of osteomyelitis. Fifteen patients had history of orthopedic surgery, and 5 had previous fracture. One milligram of monoclonal antibody against NCA-95 was labeled with 370 MBq of Tc-99m, injected intravenously, and 4 hour images were obtained. Triphasic bone scan images were obtained in 30 p;tients. The final diagnosis was confirmed by bacteriologic culture, biopsy or long term clinical follow up. RESULTS: Twenty one patients were confirmed to have osteomyelitis (1 acute, 20 chronic). Eighteen patients were without osteomyelitis. Antigranulocyte antibody immunoscintigraphy had a sensitivity of 71% (15/21), and a specificity of 89% (16/18), while the sensitivity and specificity of triphasic bone scan was 93% (13/14) and 38% (6/16), respectively. Antigranulocyte antibody scan showed higher specificity of 100% (11/11) in comparison with 33% (3/9) of triphasic bone scan in patients with history of orthopedic surgery or fracture. CONCLUSION: Antigranulocyte antibody immunoscintigraphy is more specific than that of triphasic bone scan and may be helpful in patients with history of surgery or fracture. However, sensitivity is lower than triphasic bone scan in the detection of chronic osteomyelitis.
Biopsy ; Diagnosis ; Follow-Up Studies ; Humans ; Male ; Orthopedics ; Osteomyelitis ; Sensitivity and Specificity