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Accurate interpretation of radiological data is important for reliable paleopathological study of mummies. This is especially true for the mummified heart, an anatomically complicated organ that is distorted and displaced due to long-term dehydration and the action of gravity. In the present study, we compared post-factum autopsy results for mummified hearts of differing preservation statuses with corresponding radiological (computed tomography [CT]-image) findings in order to obtain information necessary for accurate radiological diagnosis. We found that the valvular apparatus (especially the aortic valve and chordae tendinae) was easily distinguishable on the CT images of mummies in which more cardiac structures were preserved. We also identified several situations that are known to incur misdiagnosis of cardiac CT images: the presence of pseudo-cavities in the cardiac wall, confusion of the valvular apparatus with cardiac-wall debris, and invisibility of cardiac structures on CT images due to collapse or adhesion. While acknowledging the merits of top-priority CT scanning in non-invasive research, post-factum autopsy also has value as a complementary and confirmatory analysis for enhanced accuracy of diagnoses in paleo-radiological studies.

BACKGROUND EPHB4 and its ligand, ephrin B2, which are receptor tyrosine kinases of the erythropoietin-producing hepatocellular (EPH) family, are known to be linked to several human cancers. The aim of this study was to investigate their expression patterns in cutaneous squamous cell carcinoma (CSCC) in association with tumor differentiation and other variable clinical characteristics. MATERIALS AND METHODS Immunohistochemical staining for EPHB4 and ephrin B2 was performed in 32 cases of CSCC with different histologic grades. The clinical characteristics and histologic grades of CSCC were evaluated in association with EPHB4 and ephrin B2 expression patterns. RESULTS EPHB4 and ephrin B2 expression levels were significantly inversely proportional to the grade of differentiation of CSCC (P

Background Knowledge-based iterative model reconstruction (IMR) is known to allow radiation dose reduction while preserving image quality. Purpose To investigate the effect of IMR on coronary computed tomography angiography (CCTA) by comparing it with filtered back projection (FBP) and hybrid iterative reconstruction (HIR). Material and Methods Forty-five patients (group A) who underwent CCTA with prospective electrocardiogram (ECG) triggering at 80 kVp were included. All images were reconstructed using three algorithms: FBP, HIR, and IMR. The control group comprised 45 patients (group B) who underwent CCTA at 100 kVp; their images were reconstructed with HIR alone. Objective and subjective image quality was assessed by two radiologists. Results In group A, the signal-to-noise and contrast-to-noise ratios were significantly higher for images reconstructed with IMR than with HIR or FBP ( P Conclusion Compared with HIR and FBP, IMR provided higher quality images with less radiation exposure in CCTA, using low kilovoltage and prospective ECG triggering.

OBJECTIVES The aim of the study is to evaluate whether horizontal ocular deviation (OD) from MR imaging in the emergency room (ER) reflects vestibular imbalance, by comparing the horizontal OD in patients with acute vestibulopathy to controls. STUDY DESIGN Retrospective review. PATIENTS AND METHODS A total of 69 patients with acute unilateral peripheral vestibulopathy and 30 healthy subjects were included. Horizontal OD was quantified by using the axial T2-weighted fast-spin echo (FSE) images of the brain at 1.5 T. In the study group, the results of VFTs (videonystagmography [VNG], caloric test, rotary chair test, and cervical vestibular evoked myogenic potentials [cVEMP]) were also reviewed. The averaged angle of right and left horizontal ODs was compared between patients with acute unilateral vestibulopathy and healthy controls. Also, the correlation between horizontal OD and results of VFTs was analyzed in the study group. RESULTS The averaged angle of horizontal OD in study group (23.7° ± 11.6°) was significantly greater than that of control group (4.27° ± 3.7°) (p

BACKGROUND Insulin-like growth factor-1 receptor (IGF-1R) is a key regulator of cell transformation and controls the expression of genes that governs cell cycling and cell survival. The aim of this pilot study was to gain insight into the expression pattern of IGF-1R in conventional cutaneous squamous cell carcinoma (CSCC) using immunohistochemical analysis. MATERIALS AND METHODS Five cases of normal human paraffin-embedded skin sections, 4 cases of actinic keratosis, and 28 cases of paraffin-embedded sections of different histological subtypes of CSCC were selected for immunohistochemical analysis. RESULTS In normal skin, IGF-1R expression was detected in the epidermal basal cell layer. In actinic keratosis, IGF-1R was expressed in the lower part of the epidermis. IGF-1R was detected in the cell surface membrane of well-differentiated CSCC. In moderately differentiated CSCC, IGF-1R was expressed predominantly in the cytoplasm. Interestingly, IGF-1R was expressed in the nuclei of tumor cells of poorly differentiated CSCC. CONCLUSIONS The strong and differential expression of IGF-1R in different histological degrees of CSCC indicates a possible role for IGF-insulin receptor in the carcinogenesis and differentiation of this disease and identifies IGF-1R as an interesting target for prevention and treatment of CSCC that deserves further investigation.

In our previous study, we found that horizontal ocular deviation (OD) was significantly increased in patients with unilateral vestibular neuritis (VN). This study is aimed to compare the measurements of horizontal OD in various diseases which can present as acute vertigo in the emergency department. We retrospectively reviewed patients who visited the emergency department and underwent brain MRI due to acute vertigo. We compared them to healthy controls who underwent brain MRI for a regular health examination. Among the study participants, 149 patients who were diagnosed with benign paroxysmal positional vertigo (BPPV), unilateral Ménière's disease (MD), vestibular migraine (VM), unilateral vestibular neuritis (VN), or posterior inferior cerebellar artery (PICA) infarction were enrolled. Absolute angles of horizontal OD were larger in the definite MD (19.1 ± 12.7°), possible and probable MD (15.5 ± 11.7°), and VN (22.2 ± 11.7°) groups compared to the control group (4.3 ± 3.7°). Most VN patients (83.3%) had horizontal OD toward the direction of the lesion. About half of the MD patients (46.2%) and half of the patients with PICA infarction (50.0%) had horizontal OD toward the opposite direction of the lesion. Regarding PICA infarction, horizontal OD was observed only in patients who immediately underwent an MRI after developing the PICA territory vestibulocerebellar infarction. Although the exact mechanism of horizontal OD is unclear, this study suggests that horizontal OD reflects a static vestibular imbalance, and that the eyeball is deviated to the weaker of the two vestibular nuclei during neural resting activity. Therefore, horizontal OD could be helpful in assessing for a prior vestibular imbalance.

An abrupt change in the venous caliber, producing turbulent flow, may be a cause of pulsatile tinnitus (PT). The largest area/smallest area (L/S) ratio4.75 may be a criterion indicating abrupt caliber change and causing PT.Contrast-enhanced CT is recommended as an initial work-up modality in PT. But, in the majority of cases, no definite pathology can be found, even after extensive work-up. In these cases, the unilateral dominant venous system may be the cause of PT. The aim of this study was to compare, through 3D-reformatted images of the intracranial venous system, the volume, cross-sectional area, and caliber changes in patients with PT and normal controls.This was a cross-sectional study set in a tertiary referral center. Eleven patients (11 unilateral PT ears) and 12 normal control ears were enrolled. All the subjects were confirmed with normal CT angiography findings. The intracranial venous structure was three-dimensionally reconstructed. Three areas with the largest and the smallest dimension were selected for further analysis: the transverse sinus (T), isthmus (I), and the jugular bulb (B). The total volume, cross-sectional area, and cross-sectional area ratios of the three areas were compared in the PT group and the normal control group.The L/S ratio was significantly increased in the PT group (5.01), compared with the control group (3.42). When the threshold value of the L/S ratio was assessed by the ROC method, 4.75 seemed to be the significant dissecting point. The sensitivity of this method was 0.64 and the specificity was 0.83.

Previous investigations have shown that magnetic resonance imaging (MRI) can be employed as an efficient non-invasive diagnostic tool in studies on Egyptian mummies. MRI, moreover, because it produces especially clear images of well-hydrated tissue, could be a particularly effective diagnostic option for mummies that still retain humidity within tissues or organs. Therefore, in the present study, we tested MRI on a 17th century mummy, one of the most perfectly preserved ‘hydrated mummies’ ever found in Korea, in order to determine the quality of images that could be obtained. We found that the diagnostic value of an MRI scan of the hydrated mummy was not inferior to that of a computed tomography scan. The T1- and T2-weighted magnetic resonance (MR) signals showed unique patterns not easily obtained by computed tomography, the resultant MR images revealing the organ specificities clearly. Overall, the quality of the MR images from the hydrated mummy was superb and the scientific value of MRI in the study of hydrated mummies should not be underestimated.

The objective of this study is to investigate the use of pattern classification methods for distinguishing different types of brain tumors, such as primary gliomas from metastases, and also for grading of gliomas. The availability of an automated computer analysis tool that is more objective than human readers can potentially lead to more reliable and reproducible brain tumor diagnostic procedures. A computer-assisted classification method combining conventional MRI and perfusion MRI is developed and used for differential diagnosis. The proposed scheme consists of several steps including region-of-interest definition, feature extraction, feature selection, and classification. The extracted features include tumor shape and intensity characteristics, as well as rotation invariant texture features. Feature subset selection is performed using support vector machines with recursive feature elimination. The method was applied on a population of 102 brain tumors histologically diagnosed as metastasis (24), meningiomas (4), gliomas World Health Organization grade II (22), gliomas World Health Organization grade III (18), and glioblastomas (34). The binary support vector machine classification accuracy, sensitivity, and specificity, assessed by leave-one-out cross-validation, were, respectively, 85%, 87%, and 79% for discrimination of metastases from gliomas and 88%, 85%, and 96% for discrimination of high-grade (grades III and IV) from low-grade (grade II) neoplasms. Multiclass classification was also performed via a one-vs-all voting scheme.

Summary Recently reported studies on the medieval mummies in Korea have been regarded as an invaluable source for studying the physical characteristics of medieval Koreans. However, since the reported medieval mummies were re-buried by their descendants without any scientific investigations, the development of a brief, non-invasive investigation technique was desperately needed among the researchers in Korea. In this regard, we tried to apply high-quality multi-detector computed tomography (MDCT) with three-dimensional (3D) reconstructions and multi-planar reformat (MPR) to investigate Korean mummies. In our study, after 1.25 or 2.5 mm thin slice axial images were taken, 3D reconstruction and MPR were performed to get more accurate information about internal organs. In this trial, we successfully showed high-quality images for the brain, muscles, bones, heart and liver. During various trials for getting selected organs, we could make the 3D reconstructed images of them. Since we could show that the current MDCT technique could be useful for obtaining high-quality 3D reconstructed images of the internal organs of Korean mummies, this technique will be used in forthcoming similar cases, which could not be investigated using invasive techniques.

In Korea, ancient DNA (aDNA) analysis has been applied to investigations into the genetic affiliations of mummies found in Joseon Dynasty tombs (1392-1910 CE), becoming now indispensable tool for researches studying human remains from archaeological sites. In the course of our recent examinations on a Korean mummy of Joseon Dynasty, we discovered many teeth contained in a pouch. And in fact, the historical literature on the topic of Joseon funerals contain general accounts of pouches in which an individual's lost teeth were collected over the course of a lifetime and, after death, placed in the coffin with the body. To test the veracity of the historical texts, the present study undertook aDNA analyses and compared the results between specifically questioned (Q) samples (teeth) and known (K) samples (brain and bone) from the mummy to ensure that they came from the same individual. Although the Q-K comparison of autosomal short tandem repeat results did not show full concordance due to allelic drop-outs in some loci, our statistical calculation indicated that the teeth in the pouch are highly likely those of the mummy. Additionally, Q-K comparison of mitochondrial DNA sequence results showed 100% matches between samples. There results, in short, could not gainsay the conjecture that the teeth samples originated from the person buried in the tomb; and if so, he must have kept his teeth for a long time after their loss. As the application of aDNA analysis to Korean mummy studies develops, there will be other opportunities to test historical documents, particularly those referring to funerary rites.

Introduction: Distant metastases of mucoepidermoid carcinoma (MEC) are reported with the most common sites being the soft tissue of skin, lung, liver, and bone. We report here a very rare case of MEC with multiple metastases to the kidney, adrenal gland, skull and gluteus maximus muscle. Case report: A 63-year-old male patient presented with left-sided headache. Radiologic evaluations including CT and MRI showed ill-defined soft tissue lesion involving the left infratemporal fossa and left sphenoid sinus, and multiple enlarged lymph nodes in neck and mediastinum. PET-CT demonstrated multiple hypermetabolic lesions in and around the left kidney, left adrenal gland, right ischium, right gluteus maximus and skull base. These lesions were confirmed as MEC with multiple metastases through biopsy. Discussion: Only one case of metastasis to the skull has been previously reported, and moreover, there has not been a case of metastatic MEC to the kidney, adrenal gland and gluteus maximus muscle so far in the medical literature. It is important to acknowledge the possibility of every unusual MEC metastases, since the presence of metastasis has statistically significant influence on the survival of MEC.

Objective Chronic subdural hematoma (cSDH) is common condition in neurosurgical field. It is difficult to select the treatment modality between the surgical method and the conservative method when patients have no or mild symptoms. The purpose of this study is to provide a suggestion that the patients could be cured with conservative treatment modality. Methods We enrolled 16 patients who had received conservative treatment for cSDH without special medications which could affect hematoma resolution such as mannitol, steroids, tranexamic acid and angiotensin converting enzyme inhibitors. The patients were classified according to the Markwalder's Grading Scale. Results Among these 16 patients, 13 (81.3%) patients showed spontaneously resolved cSDH and 3 (18.7%) patients received surgery due to symptom aggravation and growing hematoma. They were categorized into two groups based on whether they were cured with conservative treatment or not. The first group was the spontaneous resolution group. The second group was the progression-surgery group. The mean hematoma volume in the spontaneous resolution group was 43.1 mL. The mean degree of midline shift in the spontaneous resolution group was 5.3 mm. The mean hematoma volume in the progression-surgery group was 62.0 mL. The mean degree of midline shift in the second group was 6 mm. Conclusion We suggest that the treatment modality should be determined according to the patient's symptoms and clinical condition and close observation could be performed in patients who do not have any symptoms or in patients who have mild to moderate headache without neurological deterioration.

To verify the usefulness of diffusion tensor imaging (DTI) and fiber tractography (FT) compared with routine magnetic resonance imaging (MRI) in patients with cervical spinal cord injury, and to clarify the relationship between motor and sensory impairments and DTI and FT parameters, we performed routine MRI and DTI on 10 patients with chronic cervical spinal cord injury and on 10 controls. Quantitative parameters of DTI, such as fractional anisotropy (FA) and apparent diffusion coefficient (ADC), were calculated for each cervical cord level. FT parameters of imaginary crossing fiber numbers were also determined at the C3 level, from C3-C6, and from C3-C7, as well as each connection rate. All patients' clinical motor and sensory functions were examined using the International Standards for the Neurological Classification of Spinal Cord Injury (ISCSCI). FA values in the controls and patients were 0.76 ± 0.08 (mean ± standard deviation) and 0.58 ± 0.11, respectively, and ADC values in the controls and patients were 1.29 ± 0.75 × 10(-3) mm(2)/sec and 1.26 ± 0.66 × 10(-3) mm(2)/sec, respectively. In patients with cervical cord injury, abnormal cervical levels detected on routine MRI were not correlated with clinical findings and DTI parameters, but FA of DTI was correlated with motor function, as were imaginary crossing fiber numbers and connection rates of FT. Quantitative DTI and FT analyses were useful in the evaluation of patients with cervical spinal cord injury. The injured cervical spinal cord can be evaluated in more detail and more precisely using DTI and FT, for which findings are correlated with clinical findings such as neurological impairments.

The objective of this study is to investigate the use of pattern classification methods for distinguishing different types of brain tumors, such as primary gliomas from metastases, and also for grading of gliomas. A computer-assisted classification method combining conventional magnetic resonance imaging (MRI) and perfusion MRI is developed and used for differential diagnosis. The proposed scheme consists of several steps including ROI definition, feature extraction, feature selection and classification. The extracted features include tumor shape and intensity characteristics as well as rotation invariant texture features. Features subset selection is performed using Support Vector machines (SVMs) with recursive feature elimination. The binary SVM classification accuracy, sensitivity, and specificity, assessed by leave-one-out cross-validation on 102 brain tumors, are respectively 87%, 89%, and 79% for discrimination of metastases from gliomas, and 87%, 83%, and 96% for discrimination of high grade from low grade neoplasms. Multi-class classification is also performed via a one-versus-all voting scheme.

Carcinoma of the paranasal sinuses is a very serious disease, but its incidence is lower than that of any other oral malignancy. Failure to diagnose it early because of misleading symptoms resembling sinusitis usually leads to its detection at a stage when it has already destroyed the bony walls of the sinus and has spread to surrounding structures (infratemporal fossa, posterior ethmoid cells, orbit, cribriform plate, nasopharynx, sphenoid sinus or base of the skull). It is uncommon for this cancer to spread to the regional lymph nodes as long as it remains confined within the maxillary sinus. CT scanning provides an accurate assessment of the extent of resection required and is usually used as an indicator of operability. A 56-year-old man with a chief complaint of palatal swelling, pain and pus discharge was referred to Seoul National University Dental Hospital. Orthopantomogram and Waters' view revealed an aggressive bone destruction in the right maxillary molar area, ipsilateral sinus opacification and destruction of the lateral wall of the maxillary sinus. The CT fidding showed that the right maxillary sinus was occupied by a soft tissue mass which represented a central low density, with an irregular shape at some levels. The tumor mass also involved the pterygopalatine fossa, right esthmoid sinus, nasal cavity and hard palate. Incisional biopsy was done and the biopsy report was squamous cell carcinoma. He was transferred to Internal Medicine for chemotheraphy because of inoperability.

하악골 연속성의 상실은 하악 기능의 균형과 대칭에 영향을 주며, 하악의 움직임에 변화를 유발하고 절제된 부위로 잔존하악골을 편위시킨다. 또한 연하, 발음, 하악의 운동, 저작, 호흡과 같은 다른 부분에서도 기능이상을 나타낸다. 하악골의 일부가 결손된 환자의 경우, 일반적으로 외과적 재건에 이어 보철적 수복이 이루어진다. 하지만 BRONJ (Bisphosphonate related osteonecrosis of the Jaw)와 같은 전신적 질환을 가진 환자의 경우, 외과적 재건의 적용에 제한이 있게 되고 전적으로 보철적 수복에 의지하게 된다. 다양한 보철적 방법이 하악의 변위를 최소화하고 저작 효율과 기능 및 심미를 개선하기 위하여 제시되었다. 가철성 국소의치로 치료 시, 입술, 뺨, 혀의 운동에 의해 측방 및 수평력이 발생하며 기능 인상을 통해 이를 최대한 줄여 주어야 한다. 또한, Twin occlusion을 사용하면 적절한 구순 및 협측의 지지를 얻으면서 교합관계의 형성을 가능하게 할 수 있다. 이 증례보고에서는 하악골 결손 증례에서 중립대 인상 방법과 twin occlusion을 통하여 기능적 심미적으로 만족할 만한 결과를 얻었기에 이를 보고하고자 한다. 【Loss of continuity of the mandible destroys the balance and symmetry of mandibular function, leading to altered mandibular movements and deviation of the residual fragment towards the resected side. Apart from deviation, other dysfunctions include difficulty in swallowing, speech, mandibular movements, mastication, and respiration are accompanied. In general, surgical reconstruction is considered first then proceeds to the prosthetic restorations. However, patients with systemic disease such as BRONJ (Bisphosphonate related osteonecrosis of the Jaw), surgical reconstruction may be limited. Thus, the prosthetic restoration remains as the only resort. Numerous prosthetic methods are employed to minimize deviation and to improve masticatory efficiency, function and esthetics. If a removable partial denture is the selected treatment modality, maximum stability of the partial denture base may be accomplished with a functional impression procedure by means of eliminating lateral and horizontal forces caused by the functional movements of the lips, cheeks and tongue. Also, Twin occlusion is used to obtain a favorable occlusal relationship and check support for esthetics. The purpose of this case report is to demonstrate how neutral zone impression technique and twin occlusion scheme were applied to restore a hemi-mandiblectomy patient with BRONJ syndrome to achieve satisfactory results in functional and esthetic aspects.】

Hypoglycemia is caused by imbalance between glucose supply and glucose utilization. It is apt to be caused in diabetic patients as a side effect of excessive insulin and sulfonylurea uses. When hypoglycemic injury affects brain tissue and induces neurologic abnormalities, it is called hypoglycemic encephalopathy. There is a report of DWI image changes from subcortical white matter lesions to cortical lesions in hypoglycemic encephalopathy, but it took several days for the changes (1). We present a case of hypoglycemic encephalopathy, showing rapid changes and uncommon findings on sequential MRI examinations.

Aquagenic urticaria is a rare form of physical urticaria, in which contact with water evokes wheals. A 19-year-old man and a 4-year-old boy complained of recurrent episodes of urticaria. Urticaria appeared while taking a bath or a shower, in the rain, or in a swimming pool. Well-defined pin head to small pea-sized wheals surrounded by variable sized erythema were provoked by contact with water on the face, neck, and trunk, regardless of its temperature or source. Results from a physical examination and a baseline laboratory evaluation were within normal limits. Treatment of the 19-year-old man with 180 mg fexofenadine daily was successful to prevent the wheals and erythema. Treatment with 5 ml ketotifen syrup bid per day resulted in improvement of symptoms in the 4-year-old boy.

Here we report a case in a 41-year-old woman histologically proven cystic embryonal sarcoma of the kidney, with emphasis on the imaging findings and pathological features. A large lobulated solid mass in the cystically dilated pelvocalyceal region was accompanied with hydroureter as depicted on both ultrasound and contrast-enhanced CT images.

Purpose: To evaluate the relation between pre-operative MR findings and intradiscal bone cement leakage. Materials and Methods: Pre-operative MR and vertebroplasty were performed in 188 vertebral bodies, 376 superior and inferior cortical endplates and intervertebral discs of 126 patients. We analyzed the relation between endplate cortical injury and intradiscal linear low signal intensity lesions in the pre-operative MR images and measured intradiscal bone cement leakage on post-operative CT and fluoroscopy. Results: Intradiscal bone cement leakage was found in 11.4% (43/376) of the cases. The incidence of endplate cortical injury in T1, T2 weighted MR images were 52.1% and 38.8%, respectively; the incidence of intradiscal linear low signal intensity lesions in T1, T2 weighted images were 11.2% and 24.2%, respectively. In relation with pre-operative MR findings and intradiscal bone cement leakage, the sensitivities of end plate cortical injury in T1 and T2 weighted images and intradiscal low signal intensity lesions in T1 and T2 weighted images were 100%, 95.3%, 39.5%, 86.5%, the specificities were 54.1%, 68.5%, 92.5%, 83.9%, the positive predictive values were 21.9%, 28.1%, 40.5%, 40.7%, the negative predictive values were 100%, 99.1%, 92.2%, 97.9%, and the accuracy were 59.3%, 71.5%, 86.4%, 84.0%. The incidence of intradiscal bone cement leakage was significantly increased when endplate cortical injury and intradiscal linear low signal intensity lesions were observed (p

The pilomatricoma (calcifying epithelioma of Malherbe) is a rare, benign, asymptomatic tumor arising from the hair follicular matrix cells. It is usually a solitary lesion and it is most commonly found on the face and upper extremities. This tumor can occur in patients of any age, but about 60% of pilomatricomas are found in those patients less than twenty years old. The radiologic features of this neoplasm have rarely been described in the literature; in particular, the CT findings of pilomatricoma originating from the eyelid have not been published in Korea. We report here on a case of pilomatricoma that occurred in 69-year-old female; she had a hard subcutaneous mass on her right eyelid with overlying bluish skin.