Background: Breast reconstruction using an extended latissimus dorsi (eLD) flap can supplement more volume than reconstruction using various local flaps after partial mastectomy, and it is a valuable surgical method since the reconstruction area is not limited. However, when performing reconstruction, the surgeon should consider latissimus dorsi (LD) volume reduction due to postoperative chemotherapy (POCTx) and postoperative radiotherapy (PORTx). To evaluate the effect of POCTx and PORTx on LD volume reduction, the effects of each therapy—both separately and jointly—need to be demonstrated. The present study quantified LD volume reduction in patients who underwent POCTx and PORTx after receiving breast-conserving surgery (BCS) with an eLD flap. Methods: This study included 48 patients who received immediate breast reconstruction using an eLD flap from January 2013 to March 2017, had chest computed tomography (CT) 7–10 days after surgery and 10–14 months after radiotherapy completion, and were observed for more than 3 years postoperatively. One surgeon performed the breast reconstruction procedures, and measurements of breast volume were obtained from axial CT views, using a picture archiving and communication system. A P-value <0.05 was the threshold for statistical significance. Results: The average volume reduction of LD at 10–14 months after completing POCTx and PORTx was 64.5% (range, 42.8%–81.4%) in comparison to the volume measured 7–10 days after surgery. This change was statistically significant (P<0.05). Conclusions Based on the findings of this study, when harvesting an eLD flap, surgeons should anticipate an average LD volume reduction of 64.5% if chemotherapy and radiotherapy are scheduled after BCS with an eLD flap.

OBJECTIVE: To investigate the image quality, radiation dose, and intermodality agreement of cervical spine CT using spectral shaping at 140 kVp by a tin filter (Sn140-kVp) in comparison with those of conventional CT at 120 kVp. MATERIALS AND METHODS: Patients who had undergone cervical spine CT with Sn140-kVp (n = 58) and conventional 120 kVp (n = 49) were included. Qualitative image quality was analyzed using a 5-point Likert scale. Quantitative image quality was assessed by measuring the noise and attenuation within the central spinal canals at C3/4, C6/7, and C7/T1 levels. Radiation doses received by patients were estimated. The intermodality agreement for disc morphology between CT and MRI was assessed at C3/4, C5/6, C6/7, and C7/T1 levels in 75 patients who had undergone cervical spine MRI as well as CT. RESULTS: Qualitative image quality was significantly superior in Sn140-kVp scans than in the conventional scans (p < 0.001). At C7/T1 level, the noise was significantly lower and the decrease in attenuation was significantly less in Sn140-kVp scans, than in the conventional scans (p < 0.001). Radiation doses were significantly reduced in Sn140-kVp scans by 50% (effective dose: 1.0 ± 0.1 mSv vs. 2.0 ± 0.4 mSv; p < 0.001). Intermodality agreement in the lower cervical spine region tended to be better in Sn140-kVp acquisitions than in the conventional acquisitions. CONCLUSION: Cervical spine CT using Sn140-kVp improves image quality of the lower cervical region without increasing the radiation dose. Thus, this protocol can be helpful to overcome the artifacts in the lower cervical spine CT images.
Artifacts ; Humans ; Magnetic Resonance Imaging ; Multidetector Computed Tomography ; Noise ; Spinal Canal ; Spine ; Tin

Meningeal melanocytoma is a rare benign tumor with relatively good prognosis. However, local aggressive behavior of meningeal melanocytoma has been reported, especially in cases of incomplete surgical resection. Malignant transformation was raised as possible cause by prior reports to explain this phenomenon. We present an unusual case of meningeal melanocytoma associated with histologically benign leptomeningeal spread and its subsequent aggressive clinical course, and describe its radiological findings.
Adult ; Humans ; Magnetic Resonance Imaging ; Male ; Melanoma/*pathology/surgery ; Meningeal Neoplasms/*pathology/surgery ; Neoplasm Invasiveness/pathology ; Prognosis

The pneumonia severity index (PSI) and CURB-65 are widely used tools for the prediction of community-acquired pneumonia (CAP). This study was conducted to evaluate validation of severity scoring system including the PSI and CURB-65 scores of Korean CAP patients. In the prospective CAP cohort (participated in by 14 hospitals in Korea from January 2009 to September 2011), 883 patients aged over 18 yr were studied. The 30-day mortalities of all patients were calculated with their PSI index classes and CURB scores. The overall mortality rate was 4.5% (40/883). The mortality rates per CURB-65 score were as follows: score 0, 2.3% (6/260); score 1, 4.0% (12/300); score 2, 6.0% (13/216); score 3, 5.7% (5/88); score 4, 23.5% (4/17); and score 5, 0% (0/2). Mortality rate with PSI risk class were as follows: I, 2.3% (4/174); II, 2.7% (5/182); III, 2.3% (5/213); IV, 4.5% (11/245); and V, 21.7% (15/69). The subgroup mortality rate of Korean CAP patients varies based on the severity scores and CURB-65 is more valid for the lower scores, and PSI, for the higher scores. Thus, these variations must be considered when using PSI and CURB-65 for CAP in Korean patients.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Cohort Studies ; Community-Acquired Infections/*mortality ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Pneumonia/*mortality ; Prospective Studies ; Republic of Korea ; *Severity of Illness Index ; Young Adult

Desmoplastic fibroma is a rare benign primary bone tumor that is histologically similar to the soft tissue desmoid tumor. It most often involves the mandible, large long bone or iliac bone. Desmoplastic fibroma in a toe has been extremely rarely reported. Authors report a rare case of desmoplastic fibroma of bone occurring in the distal phalanx of a foot, with descriptions of the radiographic and MRI findings, correlation of the radiologic and pathologic findings, and discussion on the differential diagnosis of the tumor.
Adolescent ; Bone Neoplasms/*diagnosis ; Diagnosis, Differential ; Female ; Fibroma, Desmoplastic/*diagnosis ; Humans ; Magnetic Resonance Imaging ; Male ; Toes/*pathology

Pigmented villonodular synovitis, synovial chondromatosis, long-standing rheumatoid arthritis, hemophilic arthropathy, chronic tophaceous gout, amyloid arthropathy, tuberculous arthritis, and hemangioma are the synovial diseases showing low signal intensity on T2-weighted image. Synovial deposition of hemosiderin, urate, and amyloid and fibrosis or caseous necrosis of hypertrophied synovium are known as the pathologic causes of T2 signal intensity. Because of the low incidence of the synovial lesions showing T2 low signal intensity, recognition of these diseases would be helpful for the exact diagnosis.
Amyloid ; Arthritis ; Arthritis, Rheumatoid ; Chondromatosis, Synovial ; Fibrosis ; Gout ; Hemangioma ; Hemosiderin ; Incidence ; Necrosis ; Synovial Membrane ; Synovitis, Pigmented Villonodular ; Uric Acid

Pigmented villonodular synovitis, synovial chondromatosis, long-standing rheumatoid arthritis, hemophilic arthropathy, chronic tophaceous gout, amyloid arthropathy, tuberculous arthritis, and hemangioma are the synovial diseases showing low signal intensity on T2-weighted image. Synovial deposition of hemosiderin, urate, and amyloid and fibrosis or caseous necrosis of hypertrophied synovium are known as the pathologic causes of T2 signal intensity. Because of the low incidence of the synovial lesions showing T2 low signal intensity, recognition of these diseases would be helpful for the exact diagnosis.
Amyloid ; Arthritis ; Arthritis, Rheumatoid ; Chondromatosis, Synovial ; Fibrosis ; Gout ; Hemangioma ; Hemosiderin ; Incidence ; Necrosis ; Synovial Membrane ; Synovitis, Pigmented Villonodular ; Uric Acid

Fibrous hamartoma of infancy (FHI) is a rare benign subcutaneous tumor that presents in children younger than two years. The tumor mostly affects the trunk, axilla and upper extremities. Imaging findings of FHI that involve the buttocks have not been reported in the clinical literature. We reported the imaging features of a lesion in a 9-month-old infant who presented with a palpable mass on the buttocks. The imaging findings were evaluated after a review of previous studies.
Axilla ; Buttocks ; Child ; Hamartoma ; Humans ; Infant ; Upper Extremity

Myelodysplastic syndrome (MDS) is a heterogeneous group of disorders characterized by ineffective hematopoiesis, morphological dysplasia, peripheral blood cytopenias, and progressive bone marrow failure. The only proven curative treatment for MDS is hematopoietic stem cell transplantation. However, invasive fungal infection following hematopoietic stem cell transplantation has become the leading cause of death from infection. Therefore, transplant candidates with previous invasive fungal infection have often been excluded from the transplant program due to high risk of reactivation and associated death. We report on a case involving an MDS patient with complications from invasive aspergillosis who had shown no response to amphotericin-B. The patient underwent successfully unrelated allogeneic hematopoietic stem cell transplantation.
Aspergillosis ; Bone Marrow ; Cause of Death ; Hematopoiesis ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Myelodysplastic Syndromes ; Transplants

Serotonin is one of the most important neurotransmitters involved in the pathophysiology of depressive illness. The assessment of alteration of cerebral serotonin has been still controversial but interesting topic to study. Recently, increasing evidence has accumulated that the N100 amplitude slope reflects cerebral serotonin activity and treatment response of selective serotonin reuptake inhibitors (SSRIs). We report on two patients who showed abrupt mood changes and side effects after taking SSRI antidepressants. In both patients, aberrantly high N100 amplitude slopes were observed. Our cases suggest that the N100 amplitude slope may be a reliable indicator for predicting manic conversion and side effects in the SSRI treatment of depressive patients. Controlled studies are necessary to confirm whether a high N100 amplitude slope is a useful indicator of SSRI supersensitivity.
Antidepressive Agents ; Depression ; Humans ; Neurotransmitter Agents ; Serotonin ; Serotonin Uptake Inhibitors