Eil Seong Lee

Role of 18F-FDG PET/CT in the Diagnosis of Clinically Suspected Marjolin Ulcer

OBJECTIVE The purpose of our study is to retrospectively determine the diagnostic role of (18)F-FDG PET/CT at the primary lesion site in burned patients with chronic nonhealing ulcers who are suspected of having Marjolin ulcers. MATERIALS AND METHODS Thirty-three burn scar contractures with nonhealing chronic ulcer in 28 patients were included in this study. The lesions were sorted into two groups: 22 squamous cell carcinomas and one basal cell carcinoma were assigned to group 1 (Marjolin ulcer), and 10 lesions of chronic ulcer with inflammation and fibrosis were assigned to group 2. The maximum standardized uptake value (SUV(max)) and the lesion thickness and size for the two groups were evaluated. To determine the utility of PET/CT in the evaluation of invasion depth, we compared the imaging findings of PET/CT with surgical or pathologic results and the findings of additional imaging modalities, such as CT or MRI. RESULTS The SUV(max) and the lesion thickness for group 1 were significantly higher than those for group 2 (p < 0.01 and p = 0.03, respectively). The sensitivity, specificity, and area under the receiver operating characteristic curve were 82.6%, 90%, and 0.900, respectively, for SUV(max) and 65.2%, 80%, and 0.741, respectively, for lesion thickness. PET/CT was helpful and showed quite good correlation with surgical or pathologic results in determining invasion depth. CONCLUSION PET/CT is useful in differentiating Marjolin ulcer from benign inflammatory conditions of chronic nonhealing ulcer in burn scars. It is also useful in the evaluation of the depth of invasion in Marjolin ulcer cases.

Paget's Disease of the Bone in Korea The Possible Role of Osteocalcin and Osteonectin in Pathogenesis

Pagets disease of the bone is a process of increased bone remodeling; the primary event is increased resorption (osteoclastic activity) followed by subsequent reactive bone formation (osteoblastic activity). It may be present with wide variations in the clinical and radiographic picture. Pagets disease is well known in Western countries; however, it is extremely rare in Oriental countries, especially in Korea. Recently, the authors treated a case of Pagets disease in a 35-year-old man that involved the pubic bone. Open biopsy revealed irregular bony trabeculae with disconnected lamellar patterns forming characteristic mosaic patterns of cement lines. Immunohistochemical stains for osteocalcin and osteonectin showed strong cytoplasmic positive reactions on osteoblasts and weak reactions on osteocytes and osteoclasts. This immunostaining was also found along the irregular mosaic cement lines. This discrepancy of pattern distribution between normal and pagetic bone may reflect an abnormal binding of these molecules to the pagetic mineral phase of bone. The authors reviewed the clinicopathologic features of seven cases in Korea. Int J Surg Pathol 3(3):175-180, 1996

The predictability of the Tc-99m pyrophosphate scan and statistical evaluation of the trade-off point

The technetium (Tc)-99m pyrophosphate scans have been used to diagnose acute myocardial infarctions and to confirm the equivocal cases. Many articles have been reported about its diagnostic performance and pitfalls . But there has been no evaluation of its predictability according to the grades of the radioactivity and statistical evaluation of the trade-off point, i.e. , grade 2 and the area under the receiver operating characteristic curve. To achieve the goals , we reviewed 252 cases of Tc-99m pyrophosphate scans (acute transmural infarction [n =99] , acute subendocardial infarction [n=7] , unstable angina [n=16 ], old myocardial infarction [n =19] , ,others [n= 111]). The predictabilities of the scan are 98% in grade 4, 84% in grade 3 , 83% in grade 2, 53% in grade 1 and 18% in non-upt따<.e. The usual trade-off point, grade 2 is not statistic외ly significant (Z= l.945 , p=0.0259 > 0. 01) . The area under the receiver operating characteristic curve (Az) is 0.885. Our study shows that the probable main cause of the false negative cases is the time interval between the onset of symptoms and the test.