Acute osteomyelitis is usually shown as a localized area of increased activity (hot uptake) in the infectious focus on bone scintigraphy. In our patient, absence of radioactivity (cold lesion) was noted in the distal metaphyseal and diaphyseal regions of his right femur. Initial x-ray was interpreted as normal except for mild soft tissue swelling in the right thigh. The lesion was confirmed as an acute osteomyelitis with subperiosteal abscess on surgery. Staphylococcus aureus was the etiologic organism. We describe a case of acute osteomyelitis in a one-year-old boy shown as a cold lesion on bone scan.
Abscess ; Femur ; Humans ; Male ; Osteomyelitis* ; Radioactivity ; Radionuclide Imaging ; Staphylococcus aureus ; Technetium Tc 99m Medronate ; Thigh

PURPOSE: We compared the first postoperative diagnostic and post-therapy scans of patients who received therapeutic doses of I-131, to investigate the difference in clinical outcomes between patients with concordant findings of diagnostic and post-therapy scans and patients with discrepant (more lesions in post-therapy scan) findings. MATERIALS AND METHODS: The first postoperative diagnostic and post-therapy radioiodine scans of one hundred forty three patients with well differentiated thyroid carcinoma were reviewed. Diagnostic scans were obtained following ingestion of 185 MBq of I-131 and post-therapy scans were obtained after therapeutic dose of 3.7~9.3 GBq of I-131. Successful ablation was defined as no radioiodine uptake on diagnostic radioiodine scan and normal range of serum thyroglobulin level (<10 ng/ml) during serum TSH elevation. RESULTS: Discrepant scan findings were noted in 25 (17.5%) patients. Twenty-two patients (15.4%) showed more lesions in post-therapy scan and 3 patients (2.1%) showed stunning effect. Nine (64.3%) of 14 patients with distant metastasis revealed metastatic lesion(s) only on post-therapy scan. Stunning effect was considered as sublethal damage in 1 patient and treatment by a diagnostic dose in 2 patients. Ablation was achieved in 52.4% (75/143) of all patients. Ablation rate and mean cumulative radioiodine dose were not different statistically between concordant and discrepant groups. CONCLUSION: There were 17.5% difference between diagnostic and post-therapy scan findings when using 185 MBq of I-131 as a diagnostic dose. However, 64.3% of distant metastases were revealed only on post-therapy scan. Ablation rate and mean cumulative radioiodine dose were not different statistically between concordant and discrepant groups. The stunning effect was considered as not only sublethal damage but also treatment by a small diagnostic dose of radioiodine.
Eating ; Humans ; Neoplasm Metastasis ; Reference Values ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms*

Primary pulmonary tuberculosis is one of the common pulmonary disease affecting children in Korea. Simple chest film is essential in diagnosis of primary pulmonary tuberculosis, but it is difficult to interpret the findings in some cases. Authors reviewed chest films of 162 cases of clinically confirmed primary pulmonary tuberculosis from April 1978 to June 1981 at Seoul National University Hospital. The results are as follows; 1. Lymph node enlargement, either hilar or mediastinal, was found in 82.7% and pulmonary parenchymal infiltration in74%. 2. Incidence of unilateral and bilateral hilar lymph node enlargement is about 50% (81cases) and 30% (49cases) respectively. Incidence of unilateral and bilateral mediastinal lymph node enlargement is about 21% (34cases) and 4.3% (7 cases), more common in right side. 3. Pulmonary parenchymal lesion is demonstrated in 74% (120cases). The pattern of primary focus is as follows in order; patchy infiltration 47% (76 cases) linear-streaky infiltration 15% (25 cases), lobar or segmental homogenous infiltration 9% (14 cases), nodular infiltration 4% (7cases). The primary focus of right lung is two times as common as that of left. 4. Calcification in primary focusis noted in about 27% in pulmonary parenchyma and 49% in hilum. 5. Plerual effusion is identified in 10%, but pleural effusion without pulmonary parenchymal lesion or lymph node enlargement is noted in only 2% (3 cases).
Child ; Diagnosis ; Humans ; Incidence ; Korea ; Lung ; Lung Diseases ; Lymph Nodes ; Pleural Effusion ; Seoul ; Thorax ; Tuberculosis, Pulmonary

PURPOSE: Gated myocardial perfusion SPECT provides not only myocardial perfusion status but also various functional parameters of left ventricle. We compared left ventricular ejection fraction, end-diastolic volume, LV mass by cardiac SPECT using Quantitative Gated SPECT (QGS), 4D-MSPECT software and standard 2D-echocardiography. MATERIALS AND METHODS: One hundred fourteen patients (male 51, female 63; 29-85 years old, mean 61.3+/-13.3 years old) with normal perfusion status on Tc-99m tetrofosmin gated myocardial perfusion SPECT were analyzed retrospectively. Ejection fraction (LVEF), End-diastolic volume (LVED), LV mass (LVM) were calculated using QGS, 4D-MSPECT, and LVEF, LVM using 2D-echocardiography. Statistical analysis including Bland-Altman plot was performed using MedCalc(R) (MedCalc software, Mariakerke, Belgium). RESULTS: The correlation of LVEF between methods was good: 0.95/0.96 (stress/rest) between QGS and 4D-MSPECT, 0.79 between QGS and echocardiography, 0.79 between 4D-MSPECT and echocardiography (p<0.001). Using Bland-Altman plot, the 95% confidence interval of agreement between QGS and 4D-MSPECT ranged from -12.7% to 7.3% / from -12.2% to 6.5% (stress/rest). The agreement between QGS and echocardiography, 4D-MSPECT and echocardiography ranged from -17.4% to 24.0%, and -14.8% to 27.0% respectively. The correlation of LVM between methods was also good: 0.95 between QGS and 4D-MSPECT, 0.76 between QGS and echocardiography, 0.73 between 4D-MSPECT and echocardiography (p<0.001). The 95% confidence interval of agreement between QGS and 4D-MSPECT ranged from -33.8 g to 14.1 g (stress/rest). The 95% confidence interval of agreement between QGS and echocardiography, 4D-MSPECT and echocardiography ranged from -148.7 g to 21.8. g, and -142.8 g to 35.5 g, respectively. CONCLUSION: There was a good correlation for LVEF, LVED, LVM among methods (QGS, 4D-MSPECT, echocardiography), but the variance between methods was big. Therefore, the functional parameters by each method cannot be used interchangeably.
Echocardiography ; Female ; Heart Ventricles ; Humans ; Perfusion ; Retrospective Studies ; Stroke Volume ; Tomography, Emission-Computed, Single-Photon

After surgical operation in patients with arteriovenous malformation (AVM), normal pressure perfusion breakthrough (NPPB) is one of the major complications. Brain perfusion SPECT with acetazolamide stress was known to be useful to evaluate the vascular reserve in several neurological and neurosurgical conditions. The authors performed acetazolamide brain perfusion SPECT in patients with AVM and compared the brain perfusion in the post-operative clinical courses. The acetazolamide brain perfusion SPECT was helpful in defining the prognosis of the patients with AVM. We describe 4 patients with AVM who had acetazolamide brain perfusion SPECT to examine the prognosis.
Acetazolamide* ; Arteriovenous Malformations* ; Brain* ; Humans ; Perfusion* ; Prognosis* ; Technetium Tc 99m Exametazime ; Tomography, Emission-Computed, Single-Photon*

A 56 years old woman referred to our hospital with dysphagia and epigastric soreness. Gastroendoscopy revealed huge submucosal tumor with ulceration extending from distal esophagus to lesser curvature of stomach. Subsequent computed tomography (CT) demonstrated soft tissue mass encircling distal esophagus, and 18F-FDG PET/CT demonstrated intense 18F-FDG accumulation in it. Finally this case was diagnosed as esophageal leiomyoma based on pathologic evaluation of the surgical specimen.
Deglutition Disorders ; Esophagus ; Female ; Fluorodeoxyglucose F18 ; Humans ; Leiomyoma ; Stomach ; Ulcer

BACKGROUND/AIMS: Liver scintigraphy is a useful tool in evaluating the chronic liver disease, even though it is less sensitive to detect a mass lesion in the liver than ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI). We evaluate the clinical usefulness of liver scintigraphy in patients with liver cirrhosis by comparing with the clinical and biochemical indices. METHODS: Liver scintigraphy was taken beginning 20 minutes after the intravenous injection of 370 MBq of Tc-99m phytate. Images were obtained in multiple views with a gamma camera (Basicam(R), Siemens). The size of the liver, left lobe enlargement, inhomogeneity of radioactivity, the size of the spleen, the extrahepatic uptake were evaluated on liver scintigraphy. The compared clinical indices were serum albumin level, serum bilirubin level, INR (international normalized ratio) for prothrombin time, the presence of hepatic coma, and esophageal varix. RESULTS: Forty four patients (M:F=24:20) were included. The extrahepatic uptake such as bone marrow and splenic uptake was positively correlated with the level of serum bilirubin and negatively correlated with the level of serum albumin. The size of the spleen, inhomogenous liver uptake, hypertrophy of left lobe was positively correlated with the degree of esophageal varix. The size of the liver was negatively correlated with that of esophageal varix. CONCLUSION: We suggest that scintigraphic findings in liver scintigraphy could be used in the evaluation of patients with liver cirrhosis not only to diagnose cirrhosis but also to know the severity of cirrhosis.
Bilirubin ; Bone Marrow ; Esophageal and Gastric Varices ; Fibrosis ; Gamma Cameras ; Hepatic Encephalopathy ; Humans ; Hypertrophy ; Injections, Intravenous ; International Normalized Ratio ; Liver Cirrhosis* ; Liver Diseases ; Liver* ; Magnetic Resonance Imaging ; Phytic Acid ; Prothrombin Time ; Radioactivity ; Radionuclide Imaging* ; Serum Albumin ; Spleen ; Ultrasonography

Objective: The aim of the present study was to evaluate cortical hypometabolism of the F-18- fluorodeoxyglucose positron emission tomography (FDG-PET) based on a diagnostic cutoff point of the mini-mental state examination (MMSE) in de novo PD.Methods: We recruited 24 PD patients and 15 healthy controls to analyze FDG-PET. We divided the patients into two groups by the diagnostic cutoff point of MMSE for diagnosing dementia, with scores of>25 vs. < 25. FDG-PET was processed using statistical parametric mapping (SPM) 8 running on Matlab 11. Results: Patients with a MMSE < 25 presented lower score in time orientation, serial sevens, language and pentagon copying of MMSE compared to patients with a MMSE >25. Compared to healthy controls, patients with a MMSE> 25 and < 25 showed a fronto-temporo-parietal hypometabolism, which was more extended in patients with a MMSE < 25. Difference in cortical hypometabolism between patients with a MMSE >25 and < 25 was found in the right inferior parietal lobule. Conclusions: In the comparison by cutoff point of MMSE (25/24), hypometabolism in the right inferior parietal lobule suggests that the posterior cortical deficit is the main region ofde novo PD with cognitive impairment. Hypometabolism of right inferior parietal lobule is related to the damage of cerebral networkin de novo PD.
Parkinson Disease

BACKGROUND: Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor in the gastrointestinal tract. As all GISTs have the potential for aggressive clinical behavior, the guidelines for defining the risk of aggressive behavior have been developed and they have been recently revised to precisely assess these patients' prognosis. METHODS: We analyzed 94 gastric and 32 small intestinal GISTs to compare the patients' survival with the risk stratification (original and revised). RESULTS: For gastric GISTs, 10 mitoses/50HPF was an important cutoff value for the risk of metastasis (1.3% vs 29.4%, respectively), whereas 16.7% of all the small intestinal GISTs with less than 5 mitoses/50HPF metastasized. The small intestinal GISTs showed higher frequencies of mucosal invasion and coagulation necrosis than did the gastric ones. Gastric GISTs had a significantly lower incidence of metastasis/recurrence than did the small intestinal ones in the same risk group. On multivariate analysis, the anatomic location (small intestine), the tumor size (>10 cm) and the mitotic count (>10/50HPF) were independent prognostic factors for a shorter disease-free survival for patients with GISTs. The mitotic count was more important than tumor size for both gastric and small intestinal GISTs. CONCLUSION: Small intestinal GIST is a more aggressive tumor than gastric GIST and the mitotic count is the most important prognostic factor for GISTs.
Incidence ; Neoplasm Metastasis

Recent studies recommend pegylated interferon alpha2a as the first choice treatment for chronic hepatitis B, especially when the patient is negative for HBeAg. Pegylated interferon alpha is known to show variable side effects including skin symptoms, with alopecia as the most common dermatologic side effect experienced for 10% up to 36%. pcc) Most alopecia cases related to pegylated interferon alpha were presented with telogen effluvium pattern, but alopecia areata cases are reported rarely. In this case, typically localized alopecia areata was presented with pegylated interferon alpha2a treatment in hepatitis B patient, and the course of alopecia areata seemed to be related with administration and discontinuation of pegylated interferon alpha2a.
Alopecia Areata* ; Alopecia* ; Hepatitis B ; Hepatitis B e Antigens ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Interferon-alpha ; Interferons* ; Skin