• The Journal of the Korean bone and joint tumor society
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• v.11 no.1
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• pp.25-31
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• 2005

Purpose: This study was designed to know the usefulness of the MRI to distinguish lipoma and well differentiated liposarcoma (WDL). Materials and methods: 47 lipomatous tumors with MRI were reviewed among the 107 lipomatous tumors operated in our department. MRI examinations and their corresponding pathology reports were compared to determine sensitivity, specificity, diagnostic ability, positive predictable value and negative predictable value. Statistical analysis was performed to know the relationship between malignancy of the tumor (WDL) with the age and gender of the patients, and location, depth, size and the enhancement of tumors in MRI. Results: Among 28 lipoma in MRI examinations, 26 were proved as lipoma in pathology, and only 6 were WDL from 19 suspicious lesions in MRI, and others were proved as lipoma variants mostly. The varieties of lipoma variants were fibrolipoma, angiolipoma, spindle cell lipoma, lipoblastoma and angiomyolipoma. The sensitivity, specificity, diagnostic ability, positive predictable value and negative predictable value of MRI were 100%, 68 %, 72%, 31% and 100% in WDL, and 90%, 89%, 89%, 93% and 84% in lipoma. Among the variants to distinguish WDL and lipoma, the size of tumor and enhancement in MRI were significant statistically (p<0.05). Conclusion: MRI was highly sensitive in detection of WDL and highly specific in detection of simple lipoma. The size of tumor and enhancement in MRI were significant variants to distinguish WDL and lipoma. When MRI finding is non-specific, it is more likely to represent one of lipoma variants.

• The Korean Journal of Nuclear Medicine
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• v.28 no.1
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• pp.98-105
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• 1994

The search for tumor-avid agents for use in nuclear medicine imaging or therapy is a field of ongoing importance. Metallothionein (MT) is an intracellular protein that binds many metals with isotopes having imaging or radiotherapeutic potential. The purpose of the study was to determine whether uptake of radioisotopes that bind to MT is increased in tumor. We measured the uptake of Cd-109 and Ga-67 in tumor and normal tissues of sarcoma-bearing mice. Tumors were grown subcutaneously in female Balb/C mice from cultured Balb/3T3 cells transformed by the Moloney murine sarcoma virus (MMSV). When the tumors reached about 1 cm in diameter, mice were injected subcutaneously with Cd-109 and Ga-67. Eighteen and seventy-two hours later, the mice were sacrified. Organs and tissues were removed, weighed, and activity per mg tissue determined by gamma well-counting. Uptake of Cd-109 by MMSV tumors exceeded that by normal tissues examined, with the exception of liver and kidney (the organs known to be richest in MT). The tumor-to-tissue ratios of uptake for Cd-109 were far greater than those for Ga-67 for many normal tissues of great importance in terms of background activity (bone, intestine, fat, muscle, and blood). We concluded that metals that bind to MT may be useful for oncologic imaging or rediotherapy of cancer.

• The Journal of Korean Society for Radiation Therapy
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• v.30 no.1_2
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• pp.161-167
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• 2018

Purpose : This study evaluates the usefulness of the Modified Hybrid-VMAT scheme with consideration of background radiation when establishing a treatment plan for multiple bone metastatic cancer including multiple tumors on the same axis. Materials and Methods : The subjects of this study consisted of five patients with multiple bone metastatic cancer on the same axis. The planning target volume(PTV) prescription dose was 30 Gy, and the treatment plan was established using Ray Station(Ray station, 5.0.2.35, Sweden). In the treatment plan for each patient, two or more tumors were set as one isocenter. A volumetric modulated arc therapy(VMAT) plan, a hybrid VMAT(h) plan with no consideration of background radiation, and a modified hybrid VMAT(mh) with consideration of background radiation were established. Then, using each dose volume histogram(DVH), the PTV maximum dose($D_{max}$), mean dose($D_{mean}$), conformity index(CI), and homogeneity index(HI) were compared among the plans. In addition, the organ at risk(OAR) of each treatment site was evaluated, and the total MU(Monitor Unit) and treatment time were also analyzed. Results : The PTV $D_{max}$ values of VMAT, VMAT(h) and VMAT(mh) were 3188.33 cGy, 3526 cGy, and 3285.67 cGy, the $D_{mean}$ values were 3081 cGy, 3252 cGy, and 3094 cGy; the CI values were $1.35{\pm}0.19$, $1.43{\pm}0.12$, and $1.30{\pm}0.06$; the HI values were $1.06{\pm}0.01$, $1.14{\pm}0.06$, and $1.09{\pm}0.02$; and the VMAT(h) OAR value was increased 3 %, and VMAT(mh) OAR value was decreased 18 %, respectively. Furthermore, the mean MU values were 904.90, 911.73, and 1202.13, and the mean beam on times were $128.67{\pm}10.97$, $167.33{\pm}7.57$, and $190.33{\pm}4.51$ respectively. Conclusions : Applying Modified Hybrid-VMAT when treating multiple targets can prevent overdose by correcting the overlapping of doses. Furthermore, it is possible to establish a treatment plan that can protect surrounding normal organs more effectively while satisfying the inclusion of PTV dose. Long-term follow-up of many patients is necessary to confirm the clinical efficacy of Modified Hybrid-VMAT.

• The Journal of the Korean bone and joint tumor society
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• v.17 no.1
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• pp.44-50
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• 2011

Purpose: To compare clinical outcomes of the tumor prosthetic replacement and osteosynthetic fixation for pathologic fracture of skeletal metastatic lesion of the proximal femur. Materials and Methods: From 1994 May to 2009 May, medical records of 22 patients who underwent tumor prosthetic replacement with tumor resection (group 1) and 15 others (16 hips) who underwent osteosynthetic fixation without tumor resection (group 2) were reviewed. The mean age of overall patients were 59 (group 1) and 60 (group 2). Mean follow up periods were 23 and 11 months. The oncological and functional results were evaluated with Kaplan-Meier methods and Musculoskeletal Tumor Society (MSTS) scoring system, 1993. The statistical evaluation was assessed with Log rank test and t-test. Results: The mean survival periods were 24 months in group 1 and 11months in group 2. The 1 year survival rates were 86% in group 1 and 50 % in group 2, and 2 year survival rates were 29.7% in group 1 and 9.4% in group 2. The mean MSTS functional score were 26.4 (19-30), 87.9% in group 1 and 15.3 (10-23), 51.0% in group 2. Conclusion: The results of tumor resection and prosthetic replacement in selected cases was better than osteosynthetic fixation without tumor resection for metastatic bone tumors around proximal femur in oncological and functional aspects.

• The Journal of the Korean bone and joint tumor society
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• v.9 no.1
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• pp.124-129
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• 2003

Purpose: To analyze the clinical outcome and radiological features after surgical treatment of stage III giant cell tumor around the knee. Materials and Methods: 21 patients with stage III giant cell tumor around the knee joint, who were operated at our institutes between March 1991 and February 2000, were selected for this study. The average follow-up was 5.7 years (range, 1~9 years). After thorough curettage using high speed burr, cryosurgery and cementing with polymethymethacrylate (PMMA) were performed in 11 patients. 7 patients were treated with PMMA cementing (4 patients) or bone grafting (3 patients) after curettage without cryosurgery. Reconstruction with prosthesis composite allograft and knee fusion with Huckstep nail were performed in 3 patients with huge defect and joint perforation. Results: Local recurrence developed in 1 out of 11 patients who was treated with curettage and cementing with cryosurgery (9.1%) and 3 out of 7 patients who underwent curettage and cementing without cryosurgery (28.6%). Joint space narrowing more than 3mm was noted in 1 patient (9.1%), who treated with cryosurgery and anther patient (14.5%) who treated without cryosurgery. There was no local recurrence in case of wide resection and reconstruction. Conclusion: Thorough curettage and PMMA cementing with cryosurgery as an adjuvant is thought to be effective modalities in the treatment of stage 3 giant cell tumors around the knee. Wide resection and reconstruction can be reserved mainly for the cases of stage 3 giant cell tumor with significant cortical destruction and marked joint destruction, and the cases of local recurrence with poor bone stock.

• Journal of the Korean Orthopaedic Association
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• v.55 no.1
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• pp.54-61
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• 2020

Purpose: Brown tumor is a tumor-like disease that can occur as a linked disease of hyperparathyroidism which can causes osteoporosis, osteitis fibrosa cystica, pathologic fractures. Brown tumor has been reported as a case report, but there is no comprehensive report on the exact diagnosis and principle of management for osseous lesion. The purpose of this study is to report the treatment and results of osseous lesions through 5 cases. Materials and Methods: From February 2004 to May 2015, five cases of Brown tumor were diagnosed in Chosun University Hospital and Chonnam National University Hospital orthopedic department. Medical records and radiographs were reviewed retrospectively. Parathyroid tumors were surgically removed, and surgical treatment and observation were performed for orthopedic osseous lesions. Results: The mean length of the long axis of the symptomatic osseous lesion was 6.2 cm (4.5-9.0 cm). An average of 7.6 (range, 3 to 14) of high uptake osseous lesion showed in whole body bone scan. The absolute value, T-score and Z-score of the vertebrae and proximal femur were adequate for diagnosis of osteoporosis using dual energy X-ray absorptiometry bone mineral density at diagnosis and recovered to normal at the last follow-up. In laboratory tests, serum concentrations of total calcium, ionized calcium, inorganic phosphorus, serum alkaline phosphatase, and parathyroid hormone were helpful to diagnosis and normalized upon successful removal of parathyroid adenoma or cancer. Conclusion: For accurate diagnosis of Brown tumor, it should be accompanied by systemic examination as well as clinical symptoms, laboratory tests and radiologic examination for osseous lesions. And a good prognosis can be expected if the hyperparathyroidism is treated together with the comprehensive treatment of osseous lesions.

• The Korean Journal of Nuclear Medicine
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• v.32 no.2
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• pp.151-160
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• 1998

Purpose: Piccolo et al. advocated the usefulness of $^{99m}Tc$-MDP breast scan in differential diagnosis of breast mass with high accuracy. But there are little or no follow-up studies about it as we know. We studied $^{99m}Tc$-MDP uptake pattern and lesion/background ratio in patients complaining palpable breast lesions to evaluate the clinical usefulness of $^{99m}Tc$-MDP scan. Materials and Methods: Total 34 patients were studied with physical examination, mammo-gram and $^{99m}Tc$-MDP scan prospectively. Anteroposterior and both lateral view of breast were obtained 5 minutes after iv injection of 740 MBq $^{99m}Tc$-MDP. Breast uptake pattern of $^{99m}Tc$-MDP was analyzed by a grade system: 0=no uptake, grade 1=bilateral diffuse uptake, grade 2=asymmetric faint uptake, grade 3=focal hot uptake. 20 cases were pathologically confirmed by excision biopsy or aspiration biopsy. 14 cases were normal in physical examination and mammogram. Results: Pathologic results showed 7 carcinomas, 6 benign solid tumors, and 7 fibrocystic changes. Grade 3 pattern of $^{99m}Tc$-MDP uptake was noted in 4/7 carcinomas, 3/6 benign solid tumors, and 1/7 fibrocystic changes. Grade 2 pattern was 217, 0/7, 3/7 respectively. The average L/B ratio was 1.66 in carcinomas, 1.68 in benign solid masses, 1.20 in fibrocystic diseases, 1.05 in normal patients. L/B ratio was higher in carcinoma and benign mass groups than in fibrocystic change and normal control groups(p=0.005). But there was no statistical difference between L/B ratio of malignant mass group and benign mass group. Conclusion: $^{99m}Tc$-MDP scan is not suitable to routine clinical use for breast mass diagnosis. It might be used in limited conditions when whole body bone scan is planned.

• The Journal of the Korean bone and joint tumor society
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• v.3 no.2
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• pp.80-88
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• 1997

Malignant tumors of extremeties involving major neurovascular structures have been treated by amputation. However recent development of diagnostic tools(CT, MRI etc.), surgical techniques, anticancer chemotherapeutic agents, and radiation techniques allow surgeons to treat malignant tumors in the limb without amputation. It has been reported that a local application of low-heat to the tissue with tumor can kill tumor cells. It is, however, not known if the attendant neural and vascular injuries may be recovered. The present study was, therefore, undertakn to address this question in rabbit sciatic nerves. A low-heat injury to the sciatic nerve was induced by perfusing the nerve with $60^{\circ}C$ saline for 30 minutes and the courses of functional and morphological recovery of the nerve were evaluated for 16 weeks. The results are summerized as follows : 1. In the electromyographic nerve conduction test the average amplitude was markedly attenuated at 4 and 8 weeks after the low-heat treatment, but it progressively increased to the level 89.5% of the control at 16 week post-treatment. The average latency in the control group was 0.62 msec. The latency in the experimental group was much longer than this at 4 and 8 week post-treatment, but it progressively reverted to the control level, showing 0.622 msec at 16 weeks. 2. In the needle EMG, many fibrillation potentials and positive sharp waves were appeared until 8 weeks post-treatment. After 16 weeks, however, no fibrillation potential was observed. 3. In the early phase of post-treatment period, the myelinated nerve fibers contained many vacuoles and the number of myelinated nerve fibers appeared to be considerably reduced. However, as time goes myelinated nerve fibers were regenerated, such that after 16 weeks the histologic appearance of the nerve was similar to that of the control group.

• The Journal of the Korean bone and joint tumor society
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• v.20 no.2
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• pp.60-65
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• 2014

Purpose: To diagnose soft tissue tumor, such as lipoma and Schwannoma, magnetic resonance imaging (MRI) is sufficient in most cases. However, various characteristics are found in MRI images of Schwannoma, thus other type of tumors are often misdiagnosed as Schwannoma with MRI images. In this study, we evaluate the diagnostic value of specific MRI findings of Schwannoma. Materials and Methods: From January 2002 to May 2013, 104 patients who are suspected as Schwannoma rith MRI images are included in data, and the final diagnosis is confirmed with biopsy. Patients are divided into group 1 and group 2 who are confirmed as Schwannoma and other disease with biopsy, respectively. Results: 92 patients were diagnosed as Schwannoma (group 1) and 12 patients were diagnosed as other disease (group 2). We investigate the diagnostic value of specific MRI findings of Schwannoma. 41 patients of group 1 (45%) and 0 patients of group 2 (0%) showed target sign, 47 patients of group 1 (51%) and 2 patients of group 2 (17%) showed fascicular sign, 44 patients of group 1 (48%) and 5 patients of group 2 (42%) showed fat split sign, 28 patients of group 1 (30%) and 1 patients of group 2(9%) showed nerve entering and exiting sign, and 8 patients of group 1 (9%) and 6 patients of group 2 (50%) showed none of four specific findings on their MRI images. 52 patients of group 1 (57%) and 5 patients of group 2 (42%) have tumors on the pathway of nerve. Target sign could be considered as the best diagnostic value of the sign we investigate (p<0.05). Conclusion: Although specific MRI findings have powerful diagnostic value, patients are often misdiagnosed as Schwannoma with MRI findings. Therefore, if patients who are suspected as Schwannoma based on MRI findings have no target sign on their MRI images, we should consider the possibility of other disease.

• Radiation Oncology Journal
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• v.22 no.4
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• pp.288-297
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• 2004

Puporse: The aims of this study were to evaluate the change of $[^18F]fluoromisonidazole$($[^18F]FMISO$) uptake in C3H mouse squamous cell carcinoma-VII (SCC-VII) treated with mild hyperthermia ($42^{circ}C$) and nicotinamide and to assess the biodistribution of the markers in normal tissues under similar conditions. Methods and Materials: $[^18F]FMISO$ was producedby our hospital. Female C3H mice with a C3H SCC-VII tumor grown on their extremities were used. Tumors were size matched. Non-anaesthetized, tumor-bearing mice underwent control or mild hyperthermia at $42^{circ}C$ for 60 min with nicotinamide (50 mg/kg i.p. injected) and were examined by gamma counter, autoradiography and animal PET scan 3 hours after tracer i.v. injected with breathing room air, The biodistribution of these agents were obtained at 3 h after $[^18F]FMISO$ injection. Blood, tumor, muscle, heart, lung, liver, kidney, brain, bone, spleen, and intestine were removed, counted for radioactivity and weighed. The tumor and liver were frozen and cut with a cryomicrotome into 10- um sections. The spatial distribution of radioactivity from the tissue sections was determined with digital autoradiography. Results: The mild hyperthermia with nicotinamide treatment had only slight effects on the biodistribution of either marker in normal tissues. We observed that the whole tumor radioactivity uptake ratios were higher in the control mice than in the mild hyperthermia with nicotinamide treated mice for $[^18F]FMISO$ ($1.56{\pm}1.03$ vs. $0.67{\pm}0.30$; p=0.063). In addition, autoradiography and animal PET scan demonstrated that the area and intensity of $[^18F]FMISO$ uptake was significantly decreased. Conclusion: Mild hyperthermla and nicotinamide significantly improved tumor hypoxia using $[^18F]FMISO$ and this uptake reflected tumor hypoxic status.