Hot Uptake Research Articles

Extensive Central Nervous System Lymphoma Detected at the Time of Diagnosis of Chronic Lymphocytic Leukemia - An Isolated Central Nervous System Richter’s Syndrome: A Case Report

When a central nervous system (CNS) lesion is found in patients with chronic lymphocytic leukemia (CLL), the diagnostic possibilities include CNS involvement of CLL, transformation to a large B-cell lymphoma (Richter’s syndrome [RS]), or the coincidental presence of another tumorous or non-tumorous disease. CNS RS commonly occurs in preexisting CLL with other nodal/extra-nodal involvement, but it is extremely rare to find isolated CNS RS concurrently with the initial diagnosis of CLL. A 73-year-old woman presented with a headache and findings from another hospital of an elevated white blood cell count and intraventricular masses. A peripheral blood smear and a bone marrow biopsy revealed CLL. Brain magnetic resonance imaging with gadolinium enhancement showed a suprasellar mass and a pineal mass within the third ventricle, as well as extensive leptomeningeal enhancement. Whole-body fluorodeoxyglucose proton emission tomography-computed tomography showed no hot uptake except for the brain lesions. Cerebrospinal fluid cytology showed small atypical lymphocytes suggestive of CLL involvement. However, an endoscopic biopsy of the third-ventricle mass demonstrated diffuse large B-cell lymphoma. After 3 months of systemic high-dose methotrexate, all preexisting lesions disappeared, but new hemorrhagic masses were found in the right lateral ventricle and the fourth ventricle. The patient received palliative cranial radiotherapy but died 6 months after the initial diagnosis. Accurate CNS tissue diagnosis and appropriate treatment are critical.

Localization of osteomyelitis lesions for operative eradication of chronic osteomyelitis of the lower extremities by bone SPECT/CT: a feasibility study.

This study was performed to investigate the feasibility of bone single-photon emission tomography/computed tomography (SPECT/CT) for pre-operative planning of chronic osteomyelitis (COM) of the lower extremities by localization of osteomyelitis lesions. From January 2016 to January 2020, we surgically treated ten adult patients with Cierny-Mader type III COM in the tibia or femur for a mean duration of 24.4months (range 7.0-70.0months). We conducted pre-operative planning by bone SPECT/CT and localization of osteomyelitis lesions. The treatment consisted of intra-operative eradication of the infective focus and antibiotic administration. The clinical and radiological outcomes were retrospectively analyzed after a minimum of oneyear of follow-up. The patients were surgically treated by thorough debridement, dead space management, and appropriate antibiotics without bone transport or an external fixator. The location of the hot uptake region on bone SPECT/CT coincided with that of the osteomyelitis lesion, which was confirmed intra-operatively in all patients. At an average of 16.5 ± 4.3months (range, 13.0-25.0months), clinical eradication of osteomyelitis was achieved in nine of the ten patients. One patient required amputation due to recurrence of osteomyelitis. A successful clinical outcome was achieved in eight patients; one suffered persistent ankle pain due to a destructive change in the ankle joint despite eradication of the infection. Bone SPECT/CT is a feasible method for the localization and eradication of osteomyelitis lesions in COM of the lower extremities and has favourable clinical outcomes. It can also be applied in cases of distorted bony structures caused by previous trauma or surgery, or in the presence of implants.

Active Herpes Zoster Mimicking Worsening of Axillary Lymph Node Metastases of Breast Cancer after Chemotherapy on 18F-Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography.

A woman in her 60s presented to our hospital with a left breast mass that was diagnosed as breast cancer. 18F-Fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) revealed intense, hot uptake in the cancerous mass and left axillary lymph node metastasis. After chemotherapy, another PET/CT scan was performed. Although the mass and left axillary lymph nodes shrank and FDG uptake decreased, enlarged lymph nodes with high FDG uptake appeared in the right axilla. The patient had a painful vesicular eruption on the front to the back of the right upper hemithorax, which was diagnosed as active herpes zoster. Active herpes zoster mimics a worsening axillary lymph node metastasis on the PET/CT scan.

Missed Skeletal Trauma Detected by Whole Body Bone Scan in Patients with Traumatic Brain Injury.

ObjectiveUnclear mental state is one of the major factors contributing to diagnostic failure of occult skeletal trauma in patients with traumatic brain injury (TBI). The aim of this study was to evaluate the overlooked co-occurring skeletal trauma through whole body bone scan (WBBS) in TBI. MethodsA retrospective study of 547 TBI patients admitted between 2015 and 2017 was performed to investigate their cooccurring skeletal injuries detected by WBBS. The patients were divided into three groups based on the timing of suspecting skeletal trauma confirmed : 1) before WBBS (pre-WBBS); 2) after the routine WBBS (post-WBBS) with good mental state and no initial musculoskeletal complaints; and 3) after the routine WBBS with poor mental state (poor MS). The skeletal trauma detected by WBBS was classified into six skeletal categories : spine, upper and lower extremities, pelvis, chest wall, and clavicles. The skeletal injuries identified by WBBS were confirmed to be simple contusion or fractures by other imaging modalities such as X-ray or computed tomography (CT) scans. Of the six categorizations of skeletal trauma detected as hot uptake lesions in WBBS, the lesions of spine, upper and lower extremities were further statistically analyzed to calculate the incidence rates of actual fractures (AF) and actual surgery (AS) cases over the total number of hot uptake lesions in WBBS. ResultsOf 547 patients with TBI, 112 patients (20.4 %) were presented with TBI alone. Four hundred and thirty-five patients with TBI had co-occurring skeletal injuries confirmed by WBBS. The incidences were as follows : chest wall (27.4%), spine (22.9%), lower extremities (20.2%), upper extremities (13.5%), pelvis (9.4%), and clavicles (6.3%). It is notable that relatively larger number of positive hot uptakes were observed in the groups of post-WBBS and poor MS. The percentage of post-WBBS group over the total hot uptake lesions in upper and lower extremities, and spines were 51.0%, 43.8%, and 41.7%, respectively, while their percentages of AS were 2.73%, 1.1%, and 0%, respectively. The percentages of poor MS group in the upper and lower extremities, and spines were 10.4%, 17.4%, and 7.8%, respectively, while their percentages of AS were 26.7%, 14.2%, and 11.1%, respectively. There was a statistical difference in the percentage of AS between the groups of post-WBBS and poor MS (p=0.000). ConclusionWBBS is a potential diagnostic tool in understanding the skeletal conditions of patients with head injuries which may be undetected during the initial assessment.

Diagnosis of Complex Regional Pain Syndrome I Following Traumatic Axonal Injury of the Corticospinal Tract in a Patient with Mild Traumatic Brain Injury.

A 54-year-old male suffered from direct head trauma resulting from a fall while working. At approximately two months after the accident, he began to feel pain (burning sensation) and swelling of the dorsum of the right hand and wrist. He showed the following clinical features among the clinical signs and symptoms of revised diagnostic criteria for complex regional pain syndrome (CRPS): spontaneous pain, mechanical hyperalgesia, vasodilation, skin temperature asymmetries, skin color changes, swelling, motor weakness. No specific lesion was observed on brain MRI taken at ten weeks after onset. Plain X-ray, electromyography, and nerve conduction studies for the right upper extremity detected no abnormality. A three-phase bone scan showed hot uptake in the right wrist in the delayed image. On two-month diffusion tensor tractography, partial tearing of the corticospinal tract (CST) was observed at the subcortical white matter in both hemispheres (much more severe in the left CST). In addition, the fiber number of the right CST was significantly decreased than that of seven normal control subjects. CRPS I of the right hand in this patient appeared to be related to traumatic axonal injury of the left CST following mild traumatic brain injury.

Use of 18F-sodium fluoride bone PET for disability evaluation in ankle trauma: a pilot study

BackgroundThere are no objective and accurate rating tools for permanent impairment of traumatized ankles. The purpose of this study is to assess the role of 18F-Sodium fluoride (18F-NaF) positron emission tomography-computed tomography (PET/CT) bone scans in evaluating patients with limited ankle range of motion (ROM) after trauma.Methods18F-NaF PET/CT was performed in 121 patients (75 men, 46 women; mean age: 45.8) who had ROM < 70% of normal after trauma affecting ankles. Metabolic target volume (MTV), the sum of voxels with standardized uptake value (SUV) > 2.5 was automatically obtained from the 3D volume that included the ankle joint. The maximum & mean SUV (SUVmax & SUVmean), and the total lesion activity (TLA) were measured.ResultsThe median period from injury to performing 18F-NaF PET/CT was 290 days. The causes of injury were as follows: fracture (N = 95), Achilles tendon rupture (N = 12), and ligament injury (N = 12). Hot uptake in the ankle was seen in 113 of 121 patients. The fracture group had higher SUVmax, SUVmean, and TLA values than the non-fracture group. More limited ROM correlated with higher hot-uptake parameters (SUVmax, SUVmean, TLA). In subgroup analysis, the same correlations were present in the fracture, but not in the non-fracture group.Conclusions18F-NaF PET/CT can provide considerable information in impairment evaluations of limited ankle ROM, particularly in fracture around the ankle. Thus, 18F-NaF bone PET/CT may provide an additional option as an objective imaging tool in disability assessment after ankle injury.

Surgical Treatment of Lesional Mesial Temporal Lobe Epilepsy.

Lesional mesial temporal lobe epilepsy (mTLE) concerns a lesion other than mesial hippocampal sclerosis present in the mesial temporal lobe and causing seizures. The lesions are usually composed of focal cortical dysplasia (FCD) or are tumorous. These are good candidates for surgical treatment. Sometimes, it is difficult to distinguish between tumors and FCD and to determine the extent of required removal. 11C-methionine positron emission tomography (PET) is helpful in differentiating lesions before surgery in lesional mTLE. In 11C-methionine PET imaging, tumors show a hot uptake, whereas FCD does not. In case of tumorous conditions, the removal of only specific lesions may be considered because the seizure outcome is dependent on complete excision of the tumor. There are several ways to safely access mesial temporal structures. The transsylvian-transcisternal approach is a good way to access the mesial structures while preserving the lateral and basal temporal structures. Actual lesions associated with epileptogenesis in FCD may be larger than they appear on magnetic resonance imaging. For this reason, evaluations to locate sufficient epileptogenic foci, including invasive studies, should be completed for FCD, and epilepsy surgery should be performed according to these results. Regardless, the ultimate goal of all epilepsy surgeries is to maximize seizure control while maintaining neurological function. Therefore, a tailored approach based on the properties of the lesion is needed.

Can osteoarthritic patients with mild varus deformity be indicated for high tibial osteotomy?

BackgroundWhether osteoarthritic patients with mild varus deformity can be indicated for high tibial osteotomy (HTO) is not established. We examined the preoperative characteristics and postoperative outcomes of HTO in patients with mild genu varum compared to patients with greater varus deformity. MethodsSeventy-one patients who underwent HTO were included in this retrospective study. Patients were divided into either mild varus (MV, mechanical femorotibial angle (mFTA) ≤4°, n = 31 (44%)) and greater varus (GV, mFTA >4°, n = 40 (56%)) groups. Preoperative characteristics on single photon emission computed tomography–computed tomography (SPECT–CT), magnetic resonance image and radiograph were evaluated. Alignment parameters and functional outcomes were compared pre- and postoperatively between the groups. ResultsPreoperative characteristics were similar between the two groups, except the severity of arthritis and coronal alignment. There was no difference in the proportion of hot uptake in the medial compartment; medial meniscus posterior horn root tear, complex or radial tear; bone marrow edema. Full-thickness cartilage defect of medial compartment was more frequent and arthritis grade was also more severe in GV group. Coronal alignment of the MV group was corrected into more valgus than the GV group (4.5° vs. 2.8° in mFTA, P = 0.012). Pre- and postoperative Knee Society knee and function scores were also comparable in the two groups. ConclusionsMild varus patients are similar to greater varus patients regarding preoperative features and achieve the comparable functional outcome. A selected subset of osteoarthritic patients with mild varus deformity might be indicated for HTO. Level of evidenceIII (Retrospective comparative study).

Clinical Meaning of Hot Uptake on Bone Scan in Symptomatic Accessory Navicular Bones.

We analyzed clinical factors related to uptake on a Tc-99m HDP bone scan of the accessory navicular (AN). We retrospectively reviewed patients who had been examined by an orthopedic surgeon and underwent bone scan due to suspected symptomatic AN. A three-point grading system was used to evaluate uptake on bone scan. Relationships between grade, symptoms, age, gender, symptom duration, and bone size were analyzed. In total, 73 ANs (30 asymptomatic, 43 symptomatic) were enrolled. The majority of asymptomatic ANs had no uptake but some had grade 1 (n = 8) or 2 (n = 2) uptake. All asymptomatic ANs with uptake remained asymptomatic during follow-up. For the asymptomatic ANs, larger bones showed a higher grade. With a cut-off value of size ≤6.8mm, there is no chance of uptake. All symptomatic ANs showed uptake on bone scan. For symptomatic ANs, larger size and shorter pain duration were related to a higher grade. Age, gender, and left-/right-sideness were not related to grade. Multiple regressions revealed that only uptake grade, not size or symptom duration, was the significant risk factor for a symptomatic AN. With a cut-off value of grade <1, a symptomatic AN could be ruled out with a negative predictive value of 100%. Bone scanning is useful for symptomatic ANs with a high negative predictive value. Higher grade is related to larger size and shorter pain duration. For asymptomatic ANs, grade was related to size but did not predict symptom development.

Primary peritoneal serous carcinoma, an extremely rare malignancy: A case report and review of the literature.

Primary peritoneal serous carcinoma (PPSC) is an extremely rare malignancy that was first described in 1959. This type of cancer arises from the peritoneal epithelium and is similar to serous ovarian carcinoma. A diagnosis of PPSC is typically made based on the Gynecology Oncology Group criteria; however, a correct differential diagnosis of PPSC is difficult preoperatively. The current study describes the case of a 66 year-old female patient presenting with abdomen distension. A computed tomography (CT) scan revealed abundant ascites in the abdominal cavity and omental infiltration. The results of positron emission tomography/CT showed hot uptake in the greater omentum. Furthermore, preoperative serum cancer antigen-125 levels were 1,032 U/ml. Upon surgical exploration, a whitish mass and nodule were found in the greater omentum. Therefore, omentectomy was performed. Pathological examination of the resected specimen revealed a diagnosis of PPSC. PPSC is extremely rare with few cases cited in the current literature. The present study describes a rare case of PPSC with a review of the literature.

Epstein-Barr Virus Positive Primary Lymphoepithelial Carcinoma of the Parotid Gland with Hot Uptake of the Nasopharynx at Positron Emission Tomography-Computed Tomography

림프상피암종(lymphoepithelial carcinoma)은 림프 모양 조직배경에 미분화된 악성종양세포가 침윤하는 특징이 있는 종양으로 대부분 비인강에 발생한다. 비인강 외에는 이하선 에서 가장 많이 발생하며, 타액선에서 발생하는 종양 중에서 는 0.4%를 차지하는 드문 종양으로 알려져 있다. 림프상피 암종은 Hilderman 등에 의해 1962년 최초로 보고되었으 며, 현재까지 소수의 증례보고가 있어 왔다. 최근 여러 연구에서 림프상피암종은 Epstein-Barr virus (EBV)와 관련성이 높으며, 인종지형학적으로 에스키모인, 중 국인, 일본인, 대만인에서는 EBV와 관련이 있으나 서양인에 서는 큰 관련이 없다는 결과가 보고되었다. 이에 본 저자 들은 positron emission tomography-computed tomography (PET-CT)에서 비인두의 이상섭취 소견이 동반된 EBV 양성 원 발성 이하선 림프상피암종을 수술적 절제 후 방사선 조사로 치 료한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Chronic bacterial seminal vesiculitis as a potential disease entity in men with chronic prostatitis.

To investigate bacterial infection in the seminal vesicles by bacteriological examination and radionuclide imaging in men with chronic prostatitis. The study included 50 patients with chronic prostatitis who showed hot uptake in seminal vesicles on Tc-99m ciprofloxacin imaging and eight patients who did not show hot uptake. The evaluation included the National Institutes of Health Chronic Prostatitis Symptom Index and four-glass test. In all participants, transperineal aspiration of seminal vesicle fluid under the guidance of transrectal ultrasonography and bacteriological examination was carried out. Of the 50 patients who showed hot uptake in the seminal vesicles on the isotope study, microorganisms were isolated from the seminal vesicle fluid in 17 patients (positive predictive value, 34%). The most common causative organisms were Escherichia coli in 13 patients (26%), followed by coagulase-negative Staphylococcus species in two patients (4%), Enterococcus faecalis in one patient (2%) and Chlamydia trachomatis in one patient (2%). No microorganisms were isolated in the eight patients who did not show hot uptake in the seminal vesicles (negative predictive value, 100%). However, there were no significant differences in National Institutes of Health Chronic Prostatitis Symptom Index total scores and subscores between the study groups. Chronic bacterial seminal vesiculitis might simultaneously affect a considerable portion of patients with chronic prostatitis, although the clinical implication of the disease remains to be further investigated.

Practical Use of Bone Scan in Patients with an Osteoporotic Vertebral Compression Fracture

Rib fractures are one of main causes of chest or flank pain when related to an osteoporotic vertebral compression fracture (OVCF). The authors investigated the incidence and risk factors of rib fracture in 284 patients with OVCF using bone scans and evaluated the feasibility as to whether bone scans could be utilized as a useful screening tool. Hot uptake lesions on ribs were found in 122 cases (43.0%). The factors analyzed were age, sex, number and locations of fractured vertebrae, BMD, and compression rates as determined using initial radiography. However, no statistical significances were found. In 16 cases (5.6%), there were concurrent multiple fractures of both the thoracic and lumbar spines not detected by single site MRI. Sixty cases (21.1%) of OVCF with the a compression rate of less than 15% could not be identified definitely by initial plain radiography, but were confirmed by bone scans. It is concluded that a bone scan has outstanding ability for the screening of rib fractures associated with OVCF. Non-adjacent multiple fractures in both thoracic and lumbar spines and fractures not identified definitely by plain radiography were detected on bone scans, which provided a means for determining management strategies and predicting prognosis.

Degos Disease Associated with Behçet's Disease.

Dear Editor: Degos disease (DD) is a rare, thrombo-occlusive vasculopathy that primarily affect the skin, gastrointestinal tract, and central nervous system1. The cutaneous lesions present as characteristic papules with porcelain-white central atrophy and an erythematous raised border. Behcet's disease (BD) is a systemic vasculitis characterized clinically by recurrent oral aphthous and genital ulcers, cutaneous lesions, and iridocyclitis/posterior uveitis2. DD can be found as an apparent idiopathic disease or as a surrogate clinical finding in some connective tissue diseases. Here, we report a patient with cutaneous manifestation of DD, associated with mucocutaneous and systemic BD lesions. A 45-year-old woman had asymptomatic erythematous papules with central, porcelain-white colored umbilication on the trunk and both extremities for 20 years, and some of the lesions had healed to leave atrophic scars (Fig. 1A, B). She also had recurrent oral and genital ulcers for 20 years (Fig. 1C). She had been treated with prednisolone, dapsone, and colchicine for 2 years, but the cutaneous lesions did not improve with BD treatments. Fig. 1 (A, B) Erythematous to brownish papules with porcelainwhite central atrophy. (C) Recurrent oral aphthous ulcer. Histopathologic examination of a typical lesion showed a cell-poor, wedge-shaped area of dermal necrosis with vessel occlusion as well as dermal edema. Occluded vessels with thrombosis and vascular endothelial cell swelling were observed at the base of the wedge-shaped lesion, and the area was surrounded by lymphocytic infiltration (Fig. 2). Copious mucin deposition was visible in the dermis, which also showed positive staining for Alcian blue (data not shown). The laboratory findings for antinuclear antibody, lupus anticoagulant, anticardiolipin antibodies, and antiphospholipid antibodies were all negative. The results of the pathergy test were positive. The patient also had non-erosive asymmetric arthritis, and a 99m Tc-HDP 3-phase bone scan showed hot uptake. She had a scarring change on the retina due to recurrent chorioretinitis. Colonoscopy showed no specific findings for DD or BD. The patient was diagnosed with DD associated with BD. The cutaneous lesions, which were not responsive to BD treatment, improved after 4 months of treatment with aspirin and dipyridamole. Fig. 2 Histopathologic finding showing a wedge-shaped dermal infarct with a broad base toward the epidermis. An occluded dermal vessel is visible at the base of the dermal infarct area, and a lymphohistiocytic inflammatory infiltrate is visible at the lateral ... While the etiology of DD is unknown, evidence suggests a primary vaso-occlusive process. Vascular coagulopathy, endothelial cell damage, and an autoimmune process are considered the major pathogenic mechanisms3,4. In BD, an immune-mediated occlusive vasculitis is found in most sites of the active disease, and the endothelium appears to be the primary target5. The cutaneous lesions of the present patient were characteristic of DD and did not respond to BD treatments. This indicates that, while DD can be associated with BD, it is a distinct disease entity to BD. To the best of our knowledge, although Sweet's syndrome and pyoderma gangrenosum in BD have been reported in association with BD, our patient represents the first reported case of DD associated with BD. With the underlying vaso-occlusive process of both DD and BD, it is reasonable for an association between DD and BD to exist. Whether this patient had the same underlying mechanisms or the findings were coincidental is yet to be determined. We suggest that DD and BD are distinct disease entities but that DD can be associated with BD.

Indeterminate pulmonary nodules in colorectal cancer.

To investigate the clinicopathologic parameters of pulmonary metastasis in colorectal cancer (CRC) patients after lung operation of indeterminate pulmonary nodules (IPNs). From a prospective database of CRC patients, 40 cases that underwent lung operation between November 2008 and December 2012 for suspicious metastatic pulmonary nodules on chest computed tomography (CT) were enrolled. The decision to perform a lung operation was made if the patient met the following criteria: (1) completely resected or resectable primary CRC; (2) completely resectable IPNs; (3) controlled or controllable extrapulmonary metastasis; and (4) adequate general condition and pulmonary function to tolerate pulmonary operation. Lung operation was performed by a thoracic surgeon without CT-guided biopsy for pathologic confirmation. A total of 40 cases of lung resection was performed in 29 patients. Five patients underwent repeated lung resection. The final pathology result showed metastasis from the CRC in 30 cases (75%) and benign pathology in 10 cases (25%). The primary tumor site was the rectum in 26/30 (86.6%) cases with pulmonary metastasis, but only 3/10 (30%) cases in the benign group had a primary rectal cancer (P = 0.001). Positron emission tomography (PET)-CT was performed for 22/30 (73.4%) patients in the lung metastasis group and for 6/10 (60.0%) patients in the benign group. PET-CT revealed hot uptake of (18)fluorine 2-fluoro-2-deoxy-D-glucose with all IPNs in both groups. The group with pulmonary metastasis had a higher incidence of primary rectal cancer (P = 0.001), a more advanced tumor stage (P = 0.011), and more frequent lymphatic invasion of tumor cells (P = 0.005). Six cases with previous liver metastasectomy were present in the lung metastasis group. Serum carcinoembryonic antigen levels before lung operation were not elevated in any of the patients. The stage and location of the primary tumor and tumor cell infiltration of lymphatics provide useful indicators for deciding on lung resection of IPNs in CRC.

SAPHO Syndrome in a Patient with Breast Cancer Mimicking Bone Metastasis: A Case Report

Bone is the most common site to which breast cancer metastasizes (1). Bone represents the first site of metastasis for 26~50% of patients with metastatic breast cancer (2, 3). If hot uptake in a patient with breast cancer is noted on the bone scintigraphy, the possibility of bone metastasis should be considered. However, because metastatic arthritis rarely occurs and the costosternoclavicular region is not common site for metastasis, other possibility should be considered such as SAPHO syndrome; it is an acronym of syndrome of synovitis, acne, pustulosis, hyperostosis, and osteitis (4) and its diagnosis can be made on the base of the solely musculoskeletal system without even skin lesions. And the costosternoclavicular region is known to be typical site of it (4). So, if the sclerotic and hyperostotic bone change of costosternoclavicular region was incidentally found in early breast cancer patient, try to include the SAPHO syndrome as a possible differential diagnosis. Here, we present a patient with right breast cancer and incidentally found sclerotic and hyperostotic bony lesion of her left costosternoclavicular region, which was confirmed as chronic active inflammation without causative organism. INTRODUCTION

Patterns of isotope uptake in sequential postoperative bone scan in undisplaced femoral-neck fractures

We aimed to investigate the changing pattern of isotope uptake in the sequential bone scan test for the prediction of osteonecrosis of the femoral head in patients with an undisplaced femoral-neck fracture. Fifty-four cases of sequential bone scan for nondisplaced femoral-neck fracture treated by internal fixation with cannulated screws between 2000 and 2009 were retrospectively studied. The mean follow-up period was 4.2 years. The first postoperative bone scan was performed two weeks postoperatively in all patients. Second, third, and fourth follow-up bone scans were performed at one to six months, 12-18 months, and 18-24 months postoperatively. Mean femoral-head ratio (FHR) in the first postoperative bone scan was 0.99. Although it was under 1.0 in 38 patients (70.4 % of the 54 patients), only one patient developed osteonecrosis of the femoral head. The others showed hot uptake in their second follow-up bone scan. Mean FHRs in the second, third, and fourth postoperative bone scans were 1.69, 1.29, and 1.05, respectively, and there were significant statistical differences in each follow-up period (P = 0.035). In addition, there were unique patterns of isotope uptake with the passage of time, such as cold uptake in the early stage, hot uptake in a couple of months, and iso-uptake in the late stage. Early postoperative bone scan results should not be over interpreted when predicting osteonecrosis of the femoral head.

Functional Mediastinal Pheochromocytoma

A 36-year-old man visited Yeungnam University Hospital with a sudden onset of palpitation, headache, and was found to be hypertensive. Chest radiography showed a 6 cm sized mass lesion on the posterior mediastinum. A biochemical study showed elevated levels of catecholamines. An I-123 metaiodobenzylguanidine scan revealed a hot uptake lesion on the posterior mediastinum. The patient was prepared for surgery with α and β blocking agents. Two months later, we removed the tumor successfully. A histological study proved that the resected tumor was mediastinal pheochromocytoma. Functional mediastinal pheochromocytomas are rare. Therefore, we reported the case with a literature review.

Utility of F-18 FDG-PET in Detecting Primary Aldosteronism in Patients with Bilateral Adrenal Incidentalomas

In patients with primary aldosteronism who have bilateral adrenal incidentalomas, it is important to identify which adrenal gland is secreting excess aldosterone. Traditionally, adrenal vein sampling (AVS) has been performed for lateralization despite its invasiveness. Here we report a case of bilateral adrenal incidentaloma in which 18-Fluorodeoxyglucose (FDG)-positron emission tomography (PET) was used to identify the functional adrenal mass. A 53-yr-old man was referred to our clinic due to bilateral adrenal incidentalomas (right: 1 cm, left: 2.5 cm) on computed tomography (CT). Given his history of colon cancer, FDG-PET/CT scanning was used to rule out metastasis. Although there was focal hot uptake lesion in the right adrenal gland, the patient was suspected primary aldosteronism clinically more than metastasis because of the patient's underlying hypertension with hypokalemia. It was consistent with the results of AVS. Based on these findings, we propose that FDG-PET/CT can be used instead of AVS to identify the source of primary aldosteronism between two bilateral adrenal incidentalomas.

Bone mineral density reduction and alterations in bone metabolism after chemotherapy in young bone sarcoma survivors

Bone mineral density reduction and alterations in bone metabolism after chemotherapy in young bone sarcoma survivors