Left main coronary artery atresia masquerading as dilated cardiomyopathy treated with aortic reimplantation.
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Aorta, Thoracic↗
Biomedical subjects
Sheung-Fat Ko
Publications and source records attributed to Sheung-Fat Ko.
A prospective study to assess the bladder distension effects on dosimetry in intracavitary brachytherapy of cervical cancer via computed tomography-assisted techniques.
BACKGROUND AND PURPOSE: Intracavitary brachytherapy (ICBT) is as important as external beam radiotherapy (EBRT) for the radical radiotherapy of uterine cervical cancer. The degree of urinary bladder distension during ICBT may affect the dose distribution in the bladder and rectum, to which an overdose may increase the chance of developing treatment-related complications. The purpose of this prospective study was to assess and quantify the impact of bladder distension on dosimetry in ICBT in patients with cervical cancer. PATIENTS AND METHODS: We recruited 20 patients with cervical cancer during a 12-month period. Inclusion criteria included pathological diagnosis of cervical cancer with IA to IIIB stages, and intact uterus. Patients were evaluated for brachytherapy after EBRT, and eligible individuals (cervical os could be identified clearly) were invited enter to this protocol to receive ICBT. In the first brachytherapy, bladder preparation (evacuation and distension by a Foley catheter) and CT scan were performed soon after the insertion of CT-compatible applicators. Then the bladder wall doses [median dose, maximum dose and dose-volume histograms (DVH)] were calculated via the PLATO computer planning system (Nucletron PLATO-RTS version 2.0). The individual data regarding doses and DVH were collected and compared. Bladder distension may shift the applicator position, and posterior displacement of the applicator system may increase the dose to the rectal wall, so this effect was also evaluated. RESULTS: All the continuous variables of these 20 patients followed a normal distribution. By paired t-test and multiple linear regression analysis, we found that bladder distension statistically significantly decreased the median bladder wall dose with an average reduction of 48% of the dose of an empty bladder (P<0.001), and the maximum dose did not change; on the other hand, the bladder distension did not have any adverse effects on the rectal wall doses. CONCLUSIONS: Using CT-assisted three-dimensional techniques to assess the bladder and rectal wall doses is feasible. Bladder distension reduces the median dose in the bladder wall, which may reduce treatment-related complications.
Adult↗
Is there an association between duodenal atresia and choledochal cyst?
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Child↗
A case of axillary kaposiform hemangioendothelioma resembles a soft tissue sarcoma.
Kaposiform hemangioendothelioma is a rare, aggressive vascular proliferation in children that is clinically and histologically distinct from hemangioma of infancy. It is often complicated with Kasabach-Merritt syndrome. The authors describe a 2-month-old girl who developed a rapidly enlarging deep subcutaneous solid tumor in the left axilla. The tumor size was about 10x7 cm and there was no skin change over the mass. The results of laboratory tests were significant for a moderate anemia (7.0 g/dL) and a profound thrombocytopenia (3x10/L). The preoperative radiologic findings were suspicious for a soft tissue sarcoma with scapular erosion. Anemia and thrombocytopenia were corrected by preoperative corticosteroid therapy and blood component transfusion. The tumor was excised totally and the pathologic findings were consistent with Kaposiform hemangioendothelioma. Serial blood examinations showed that the hemoglobin and platelet count returned to the normal range after surgery.
Axilla↗
Laparoscopic fenestration of symptomatic liver cysts.
The purpose of this clinical study was to evaluate the usefulness of laparoscopic fenestration of symptomatic liver cysts. Between September 1996 and September 2001, 6 patients underwent laparoscopic fenestration for symptomatic hepatic cysts. All 6 patients were women. The mean age was 59.5 (range 40-74). Two patients had single and 4 had multiple cysts. The mean diameter of the lesions, measured by preoperative computed tomography (CT), was 16.8 cm (range 10-20). The indications for surgical treatment included abdominal fullness associated with pain or dyspepsia. The surgical procedure involved puncture and aspiration of the cyst and subsequent circular electroresection of the cystic wall. Laparoscopic fenestration was successfully done in all 6 patients. The operating time was 148 minutes (range 110-215). Mean blood loss was 93 mL (range 5-300). Histologic examination of the cyst wall showed 5 simple cysts and 1 papillary serous cystadenoma. There were no intraoperative or postoperative complications. The mean hospital stay after surgery was 4.3 days (range 3-5). Complete relief of symptoms was achieved in 5 patients during the postoperative follow-up (range 2-6 years, mean 4). Follow-up CT (1 month to 4 years) has shown regression of the cysts in all patients (mean 3.8 cm, range 2-8). Laparoscopic fenestration of symptomatic liver cysts is a simple and effective method to relieve symptoms with minimal surgical trauma.
Adult↗
MDCT angiography for evaluation of the complete vascular tree of hemodialysis fistulas.
OBJECTIVE: The purpose of our study was to assess the clinical feasibility of MDCT angiography for evaluating hemodialysis arteriovenous fistulas (AVFs). MATERIALS AND METHODS: MDCT angiography of the complete vascular trees of 36 failing AVFs or AVF-related complications (20 native and 16 polytetrafluoroethylene graft AVFs) was reviewed. The numbers and degrees of stenoses at the anastomoses, graft loops, and draining and central veins and the presence of aneurysms or thrombosis were recorded. Wilcoxon's signed rank test was used to compare the findings of MDCT angiography with those of digital subtraction angiography (DSA) (n = 10), surgery (n = 22), or both (n = 4) performed within 2-6 days. Kappa statistics were used to correlate the clinical feasibility of MDCT angiography assessed by two reviewers. RESULTS: Among the 14 AVFs examined with both MDCT angiography and DSA, no significant difference was seen in the detection and grading (p = 0.317 to > 0.999) of stenoses at various segments of the entire vascular tree. Among the 36 AVFs examined, MDCT angiography also showed no significant difference from DSA or surgery in revealing vascular stenoses, aneurysms, and thromboses from the supplying artery to central veins (p = 0.317 to > 0.999). Overall, the sensitivity, specificity, positive and negative predictive values, and accuracy of MDCT angiography in lesion detection were 98.7%, 97.5%, 98.8%, 97.2%, and 98.3%, respectively. High image quality with superb interobserver correlation (kappa = 0.809 to > 0.999) validated the clinical feasibility of MDCT angiography for assessing AVFs. CONCLUSION: MDCT angiography is clinically feasible for evaluating the complete vascular tree of failing AVFs and in showing uncommon complications, including brachial aneurysms and central vein lesions.
Adult↗
Effects of heart rate on motion artifacts of the aorta on non-ECG-assisted 0.5-sec thoracic MDCT.
OBJECTIVE: Our aim was to evaluate the effects of heart rate on aortic motion artifacts on 0.5-sec non-ECG-assisted thoracic MDCT. MATERIALS AND METHODS: A total of 124 non-ECG-assisted thoracic MDCT scans with satisfactory simultaneous ECG data were reviewed. Scans were grouped according to patient heart rates (beats per minute [bpm]: group A, 46-55; B, 56-65; C, 66-75; D, 76-85; E, 86-95; and F > 95). The groups were compared regarding the presence, locations, and spatial distributions of pulsation artifact, number of slices affected, maximum amplitude of pulsation, continuity of artifact, and the presence of superior vena cava (SVC) pseudoflaps. RESULTS: Of the 124 scans, 114 (91.9%) had aortic motion artifacts, with prevalence ranging from 85.3% (66-75 bpm) to 100% (65 bpm or less). Of the 114 motion artifacts, all affected the ascending aorta, 105 (92.1%) involved the left anterior and right posterior aspects of the aortic circumference, and 106 (93%) were associated with SVC pseudoflaps. Group B had significantly greater numbers of images with artifacts (p < 0.001-0.006), greater artifact amplitudes (p < 0.001-0.002), and a higher continuity trend for the artifacts (p = 0.003-0.194) than did the other five groups. CONCLUSION: Aortic motion artifacts are frequently seen on thoracic MDCT, especially in patients with heart rates of 65 bpm or less. The presence of a SVC pseudoflap is helpful for distinguishing artifacts from dissection. If aortic disease is suspected, then measures to reduce motion artifact, such as ECG-gating, should be considered.
Aorta, Thoracic↗
Contracture of the deltoid muscle: sonographic evaluation with MRI correlation.
OBJECTIVE: This article evaluates the sonographic features of deltoid contracture (DC) with MRI correlation. MATERIAL AND METHODS: Two reviewers evaluated the imaging features in 22 painful shoulders of 20 patients with a sonographic diagnosis of DC and a subsequent confirming MRI study. The sonographic and MRI findings with regard to the lesion extent (assessed by a 3-point scale: 1 = less than or equal to one third of the longitudinal deltoid length involved, 2 = greater than one third and less than or equal to two thirds involved, and 3 = greater than two thirds involved), transverse lesion morphologic appearance, and maximal transverse diameter measured were compared with kappa statistics and Wilcoxon's signed rank test, respectively. RESULTS: Compared with MRI, there were two false-positive diagnoses of DC on sonography. Among the 20 true-positive diagnoses, sonography showed good agreement with MRI in assessing the lesion extent (kappa = 0.796, p < 0.001). Three sonographic lesion morphologic patterns for hyperechoic lesions (I = with multiple < 8-mm hypoechoic spots, II = heteroechoic lesions with predominant 8-15-mm hypointense areas, and III = > 15-mm calcified nodules, respectively) showed excellent agreement with three MRI lesion patterns (I = multiple < 8-mm hypointense spots, II = predominant 8-15-mm hypointense areas, and III = > 15-mm hypointense nodules, respectively) (kappa = 0.921, p < 0.001). However, the maximum lesion diameters appeared significantly larger on sonography than on MRI (2.8 +/- 0.6 cm vs 2.0 +/- 0.8 cm, mean +/- SD; p < 0.001), which was plausibly ascribed to the better sonographic delineation of hyperechoic immature fibrotic tissues. CONCLUSION: Sonography is helpful for evaluating DC and correlates well with MRI.
Adult↗
Scapulothoracic bursitis of the chest wall: sonographic features with pathologic correlation.
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Aged↗
18F-FDG PET and CT/MRI in oral cavity squamous cell carcinoma: a prospective study of 124 patients with histologic correlation.
UNLABELLED: Accurate evaluation of primary tumors and cervical lymph node status of squamous cell carcinoma (SCC) of the oral cavity is important to treatment planning and prognosis prediction. In this prospective study, we evaluated the use of 18F-FDG PET, CT/MRI, and their visual correlation for the identification of primary tumors and cervical nodal metastases of SCC of the oral cavity with histologic correlation. METHODS: One hundred twenty-four patients with pathologically proven diagnoses of oral cavity SCC underwent 18F-FDG PET and CT/MRI within 2 wk before surgery. We interpreted 18F-FDG PET, CT/MRI, and visually correlated 18F-FDG PET and CT/MRI separately to assess the primary tumors and their regional lymph node status. We recorded lymph node metastases according to the neck level system of imaging-based nodal classification. Histopathologic analysis was used as the gold standard for assessment of the primary tumors and lymph node involvement. We analyzed differences in sensitivity and specificity among the imaging modalities using the McNemar test. The receiver-operating-characteristic (ROC) curve and calculation of the area under the curve were used to evaluate their discriminative power. RESULTS: The accuracy of 18F-FDG PET, CT/MRI, and their visual correlation for the identification of primary tumors was 98.4%, 87.1%, and 99.2%, respectively. The sensitivity of 18F-FDG PET for the identification of nodal metastases on a level-by-level basis was 22.1% higher than that of CT/MRI (74.7% vs. 52.6%, P < 0.001), whereas the specificity of 18F-FDG PET was 1.5% lower than that of CT/MRI (93.0% vs. 94.5%, P = 0.345). The sensitivity and specificity of the visual correlation of 18F-FDG PET and CT/MRI were 3.2% and 1.5% higher than those of 18F-FDG PET alone (77.9% vs. 74.7%, P = 0.25; 94.5% vs. 93.0%, P = 0.18, respectively). The area under the curve obtained from the ROC curve showed that 18F-FDG PET was significantly superior to CT/MRI for total nodal detection (0.896 vs. 0.801, P = 0.002), whereas the visual correlation of 18F-FDG PET and CT/MRI was modestly superior to 18F-FDG PET alone (0.913 vs. 0.896, P = 0.28). CONCLUSION: 18F-FDG PET is superior to CT/MRI in the detection of cervical status of oral cavity SCC. The sensitivity of 18F-FDG PET for the detection of cervical nodal metastasis on a level-by-level basis was significantly higher than that of CT/MRI, whereas their specificities appeared to be similar. Visual correlation of 18F-FDG PET and CT/MRI showed a trend of increased diagnostic accuracy over 18F-FDG PET alone but without a statistically significant difference, and its sensitivity was still not high enough to replace pathologic lymph node staging based on neck dissection.
Adult↗
Severe acute respiratory syndrome: prognostic implications of chest radiographic findings in 52 patients.
PURPOSE: To retrospectively assess prognostic implications of radiographic findings in severe acute respiratory syndrome (SARS). MATERIALS AND METHODS: Radiographic findings were reviewed by two radiologists for 52 patients with SARS. On each radiograph, each lung was separated into upper, middle, and lower zones. A four-point scale was used to score extent of SARS-related lesions in each zone; points from all zones were added for a cumulative score. Patient sex, age, comorbidities, duration of developing lesions, lesion score for each radiograph, need for mechanical ventilation, and percentage of lung affected were compared between patients who died (n = 20) and survivors (n = 32). Continuous and categorical variables were analyzed with Mann-Whitney test and Fisher exact or chi(2) test, respectively. RESULTS: Survival and mortality groups showed no significant differences with respect to patient sex, duration of SARS-related lesions, development of lesion shifting, and acute respiratory distress syndrome. Patients who died were significantly older (mean +/- standard deviation, 56.9 years +/- 17.2 vs 40.4 years +/- 16.6; P =.002) and had higher frequency of comorbid lung illnesses (nine of 20 vs two of 32, P =.001), maximal lesion extent score of 7 or higher (20 of 20 vs five of 32, P <.001), involvement of four or more lung zones (17 of 20 vs four of 32, P <.001), bilateral lung involvement (19 of 20 vs 14 of 32, P <.001), need for mechanical ventilation (18 of 20 vs two of 32, P <.001), and higher percentage of affected areas (41.5% +/- 8.6 vs 16.4% +/- 10.0, P <.001) than those of survivors. CONCLUSION: On chest radiographs, maximal SARS-related lesion extent score of 7 or higher is a strong predictor of mortality, especially in patients with comorbid lung illnesses and involvement of four or more lung zones.
Adult↗
Nodal metastases of nasopharyngeal carcinoma: patterns of disease on MRI and FDG PET.
The patterns of nodal spread of nasopharyngeal carcinoma (NPC) have an important influence on treatment planning, but have not yet been fully addressed. We prospectively used MRI and FDG PET to document the patterns of nodal spread in NPC. One hundred and one patients with newly diagnosed NPC were studied with MRI and FDG PET. On MRI, nodes were considered as metastatic according to criteria regarding size, the presence of nodal necrosis, and extracapsular spread. FDG PET images were interpreted visually, and nodes were considered metastatic if they showed prominent FDG uptake against the background. Nodal metastases were found in 89 of our 101 patients. Analysis of the distributions of nodal metastases in these 89 patients showed that retropharyngeal nodes were less frequently involved than cervical nodes (82.0% vs 95.5%). The vast majority of cervical nodal metastases were to the internal jugular chain, including nodes at levels II, III, and IV, with decreasing incidences of 95.5%, 60.7%, and 34.8%, respectively. Level V nodal involvement was found in 27% of patients. Supraclavicular fossa nodal metastases were not uncommon and occurred in 22.5% of patients. Skip metastases in the lower-level nodes or supraclavicular fossa nodes occurred in 7.9% of patients. Mediastinal and abdominal metastatic adenopathy was present in 4.5% and 3.4% of patients, respectively, and was associated with advanced nodal metastasis in the supraclavicular fossa. Level VI (2.2%), level VII (1.1%), submandibular (2.2%), and parotid (3.4%) nodal metastases were uncommon and were always associated with advanced ipsilateral nodal metastases of the neck. We conclude that the combined use of FDG PET and MRI can comprehensively depict the pattern of nodal metastasis in NPC patients. Nodal metastases principally affected level II nodes, from which lymphatic spread extended down in an orderly manner to involve level III, level IV, and the supraclavicular fossa nodes, or extended posteriorly to involve level V nodes. The frequency of skip metastases was 7.9%. Distant spread to mediastinal or abdominal nodes was found in 3-5% of patients, usually in association with supraclavicular nodal metastases.
Adolescent↗
Quality of life as a survival predictor for patients with advanced head and neck carcinoma treated with radiotherapy.
BACKGROUND: Accumulating reports suggest that quality of life (QoL) may predict survival in patients with malignant disease. In the current study, the authors investigated if baseline QoL and changes in QoL during treatment were prognostic for patients with advanced head and neck squamous cell carcinoma (HNSCC) treated with radiotherapy. METHODS: The authors studied 102 consecutive new patients with HNSCC treated with primary radiotherapy. The Taiwan Chinese versions of the European Organization for the Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) and Head and Neck Quality of Life Questionnaire (EORTC QLQ-H&N35) were completed before and during radiotherapy. The Cox proportional hazards models were used to analyze the impact of clinical and QoL variables on survival. RESULTS: Clinical variables that were significant survival predictors included American Joint Committee on Cancer (AJCC) stage, N status, and Karnofsky performance status (KPS) after multivariate analysis. After introducing the QoL variables, baseline fatigue scale and N status emerged as the most significant survival predictors, whereas KPS lost its significance. Changes in the QoL scales during radiotherapy were not significantly correlated with survival. An increase in the baseline fatigue score of 10 points corresponded to a 17% reduction in the likelihood of survival (95% confidence interval: 8-27%). Significant correlations between baseline fatigue scale and KPS, comorbidity, hemoglobin level, AJCC stage, T status, and most QoL scales also were observed. CONCLUSIONS: The data support the correlation of patient reported QoL scales with survival. Pretreatment fatigue level was a significant survival predictor for patients with advanced HNSCC treated with radiotherapy.
Adult↗
Computer tomography-assisted three-dimensional technique to assess rectal and bladder wall dose in intracavitary brachytherapy for uterine cervical cancer.
We used a computer tomography (CT)-assisted three-dimensional (3D) technique to assess dose to the rectum and bladder in intracavitary brachytherapy (ICBT) for patients with cervical cancer, and compared this technique with the conventional method. The results revealed that the difference in dose to the rectal and bladder wall between these two methods were significant. The CT-assisted technique is a feasible method, and it gives different results than the conventional method.
Brachytherapy↗
Gastric hypothermic injury caused by accidental ingestion of dry ice: endoscopic features.
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Adolescent↗
Testicular dislocation: an uncommon and easily overlooked complication of blunt abdominal trauma.
STUDY OBJECTIVE: We report testicular dislocation as an unusual complication of blunt abdominal trauma. METHODS: The computer data bank of Chang Gung Memorial Hospital was searched for the period from 1987 to 2002, and 1,967 male patients with blunt abdominal trauma were admitted to the emergency department. Among these patients, records of 9 patients associated with testicular dislocation were collected. A retrospective review of the clinical records, abdominal computed tomography (CT) results, and subsequent scrotal sonograms was jointly performed by 2 radiologists, an emergency physician, and a trauma surgeon. RESULTS: Of these 9 patients (age range 6 to 53 years; mean 23 years), 7 patients were in motorcycle crashes, 1 patient had explosive injury, and 1 patient had seat belt injury. Associated testicular dislocation was initially missed in all patients. CT for evaluating blunt abdominal trauma revealed liver lacerations in 2 patients and pancreatic fracture, pancreatitis, bowel perforation, pubic bone fracture, and contralateral inguinal hernia in 1 each. Typical CT findings of testicular dislocation (empty scrotum and displaced testis) were retrospectively seen in 7 patients, but prompt CT diagnosis of testicular dislocation was achieved only in 3 patients, who were subsequently treated with closed manual reduction, obviating surgery. In the remaining 2 patients, CT examination did not include the scrotum and testicular dislocation, which was diagnosed by subsequent sonography. Delayed diagnosis occurred in 6 patients (duration 3 to 60 days; mean 19 days). Five of the patients underwent orchiopexy, and 1 underwent orchiectomy. CONCLUSION: In blunt abdominal trauma patients, associated testicular dislocation is easily overlooked. A complete physical examination in the trauma patient, including palpation of both testes, is strongly recommended.
Abdominal Injuries↗
Imaging spectrum of Castleman's disease.
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Adult↗
Eight cases of severe acute respiratory syndrome presenting as round pneumonia.
OBJECTIVE: The purpose of this study was to describe the radiographic findings and evolution of round pneumonia found in eight patients with confirmed severe acute respiratory syndrome (SARS). CONCLUSION: SARS may present as round pneumonia on chest radiographs initially or during the treatment course. It may remain unchanged for up to 9 days before evolution to ill-defined air-space opacities. Radiologists and physicians should consider the possibility of "SARS pneumonia" when spherical air-space opacities are noted on chest radiographs of febrile patients.
Adolescent↗