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Cho J, Kim HY, Lee S, Park JH, Lee KH. Radiology Residents' Independent Diagnosis of Appendicitis Using 2-mSv Computed Tomography: A Secondary Analysis of a Large Pragmatic Randomized Trial. Korean J Radiol 2023; 24:529-540. [PMID: 37271207 DOI: 10.3348/kjr.2023.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/28/2023] [Accepted: 04/04/2023] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVE To compare the diagnostic performance and clinical outcomes of 2-mSv computed tomography (CT) and conventional-dose CT (CDCT), following radiology residents' interpretation of CT examinations for suspected appendicitis. MATERIALS AND METHODS Altogether, 3074 patients with suspected appendicitis aged 15-44 years (28 ± 9 years, 1672 females) from 20 hospitals were randomly assigned to the 2-mSv CT (n = 1535) or CDCT (n = 1539) groups in a pragmatic trial from December 2013 and August 2016. Overall, 107 radiology residents participated in the trial as readers in the form of daily practice after online training for 2-mSv CT. They made preliminary CT reports, which were later finalized by attending radiologists via addendum reports, for 640 and 657 patients in the 2-mSv CT and CDCT groups, respectively. We compared the diagnostic performance of the residents, discrepancies between preliminary and addendum reports, and clinical outcomes between the two groups. RESULTS Patient characteristics were similar between the 640 and 657 patients. Residents' diagnostic performance was not significantly different between the 2-mSv CT and CDCT groups, with a sensitivity of 96.0% and 97.1%, respectively (difference [95% confidence interval {CI}], -1.1% [-4.9%, 2.6%]; P = 0.69) and specificity of 93.2% and 93.1%, respectively (0.1% [-3.6%, 3.7%]; P > 0.99). The 2-mSv CT and CDCT groups did not significantly differ in discrepancies between the preliminary and addendum reports regarding the presence of appendicitis (3.3% vs. 5.2%; -1.9% [-4.2%, 0.4%]; P = 0.12) and alternative diagnosis (5.5% vs. 6.4%; -0.9% [-3.6%, 1.8%]; P = 0.56). The rates of perforated appendicitis (12.0% vs. 12.6%; -0.6% [-4.3%, 3.1%]; P = 0.81) and negative appendectomies (1.9% vs. 1.1%; 0.8% [-0.7%, 2.3%]; P = 0.33) were not significantly different between the two groups. CONCLUSION Diagnostic performance and clinical outcomes were not significantly different between the 2-mSv CT and CDCT groups following radiology residents' CT readings for suspected appendicitis.
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Affiliation(s)
- Jungheum Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hae Young Kim
- Department of Radiology, Asan Medical Center, Seoul, Korea.
| | - Seungjae Lee
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Ji Hoon Park
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Korea
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea
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Bachelet VC, Navarrete MS, Barrera-Riquelme C, Carrasco VA, Dallaserra M, Díaz RA, Ibarra ÁA, Lizana FJ, Meza-Ducaud N, Saavedra MG, Tapia-Davegno C, Vergara AF, Villanueva J. A multiyear systematic survey of the quality of reporting for randomised trials in dentistry, neurology and geriatrics published in journals of Spain and Latin America. BMC Med Res Methodol 2021; 21:153. [PMID: 34311704 PMCID: PMC8314448 DOI: 10.1186/s12874-021-01337-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 06/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Iberoamerican Cochrane Network is currently developing an extensive project to identify Spanish-language journals that publish original clinical research in Spain and Latin America. The project is called BADERI (Database of Iberoamerican Essays and Journal) and feeds the research articles, mainly randomised clinical trials (RCTs), into CENTRAL (Cochrane Collaboration Central Register of Controlled Trials). This study aims to assess the quality of reporting of RCTs published in Spanish and Latin American journals for three clinical fields and assess changes over time. METHODS We did a systematic survey with time trend analysis of RCTs for dentistry, geriatrics, and neurology. These fields were chosen for pragmatic reasons as they had not yet been completed in BADERI. After screening RCTs from 1990 to 2018 for randomised or quasi-randomised clinical trials, we extracted data for 23 CONSORT items. The primary outcome was the total score of the 23 predefined CONSORT 2010 items for each RCT (score range from 0 to 34). The secondary outcome measure was the score for each one of these 23 items. RESULTS A total of 392 articles from 1990 to 2018 were included as follows: dentistry (282), neurology (80), and geriatrics (30). We found that the overall compliance score for the CONSORT items included in this study for all 392 RCTs analysed was 12.6 on a scale with a maximum score of 34. With time, the quality of reporting improved slightly for all RCTs. None of the articles achieved the complete individual CONSORT item compliance score. The lowest overall compliance percentage was for item 10 (Randomisation implementation) and item 24 (Protocol registration), with a dismal 1% compliance across all included RCTs, regardless of country. CONCLUSIONS CONSORT compliance is very poor in the 392 analysed RCTs. The impact of the CONSORT statement on improving the completeness of RCT reporting in Latin America and Spain is not clear. Iberoamerican journals should become more involved in endorsing and enforcing adherence to the CONSORT guidelines.
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Affiliation(s)
- Vivienne C Bachelet
- Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Avenida Libertador Bernardo OHiggins 3363, Santiago, Estación Central, Chile.
| | - María S Navarrete
- Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Avenida Libertador Bernardo OHiggins 3363, Santiago, Estación Central, Chile
| | - Constanza Barrera-Riquelme
- Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Avenida Libertador Bernardo OHiggins 3363, Santiago, Estación Central, Chile
| | - Víctor A Carrasco
- Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Avenida Libertador Bernardo OHiggins 3363, Santiago, Estación Central, Chile
| | - Matías Dallaserra
- Departamento de Cirugía Maxilofacial, Facultad de Odontología, Universidad de Chile, Santiago, Chile
| | - Rubén A Díaz
- Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Avenida Libertador Bernardo OHiggins 3363, Santiago, Estación Central, Chile
| | - Álvaro A Ibarra
- Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Avenida Libertador Bernardo OHiggins 3363, Santiago, Estación Central, Chile
| | - Francisca J Lizana
- Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Avenida Libertador Bernardo OHiggins 3363, Santiago, Estación Central, Chile
| | - Nicolás Meza-Ducaud
- Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Avenida Libertador Bernardo OHiggins 3363, Santiago, Estación Central, Chile
| | - Macarena G Saavedra
- Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Avenida Libertador Bernardo OHiggins 3363, Santiago, Estación Central, Chile
| | - Camila Tapia-Davegno
- Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Avenida Libertador Bernardo OHiggins 3363, Santiago, Estación Central, Chile
| | - Alonso F Vergara
- Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Avenida Libertador Bernardo OHiggins 3363, Santiago, Estación Central, Chile
| | - Julio Villanueva
- Departamento de Cirugía Maxilofacial, Facultad de Odontología, Universidad de Chile, Santiago, Chile
- Hospital Clínico San Borja-Arriarán, Santiago, Chile
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Mustafa RA, Wiercioch W, Ventresca M, Brozek J, Schünemann HJ. Decision making about healthcare-related tests and diagnostic test strategies. Paper 5: a qualitative study with experts suggests that test accuracy data alone is rarely sufficient for decision making. J Clin Epidemiol 2017; 92:47-57. [PMID: 28917629 DOI: 10.1016/j.jclinepi.2017.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 02/16/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The objective of the study was to identify the critical factors that determine recommendations and other decisions about healthcare-related tests and diagnostic strategies (HCTDS). METHODS We used a qualitative descriptive approach and conducted semi-structured in-depth interviews with 24 international experts (informants) in evidence and decisions about HCTDS. RESULTS Although test accuracy (TA) was the factor most commonly considered by organizations when developing recommendations about HCTDS, informants agreed that TA is necessary but rarely, if ever, sufficient and may be misleading when solely considered. The informants identified factors that are important for developing recommendations about HCTDS. Informants largely agreed that laying out the potential care pathways based on the test result is an essential early step but is rarely done in developing recommendations about HCTDS. Most informants also agreed that decision analysis could be useful for organizing the clinical, cost, and preference data relevant to the use of tests in the absence of direct evidence. However, they noted that using models is limited by the lack of resources and expertise required. CONCLUSION Developing guidelines about HCTDS requires consideration of factors beyond TA, but implementing this may be challenging. Further development and testing of "frameworks" that can guide this process is a priority for decision makers.
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Affiliation(s)
- Reem A Mustafa
- Department of Health Research Methods, Evidence and Impact (formerly "Clinical Epidemiology and Biostatistics"), McMaster University, 1280 Main Street West Hamilton, ON L8S 4K1, Canada; Department of Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, MS3002, Kansas City, KS 66160, USA
| | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence and Impact (formerly "Clinical Epidemiology and Biostatistics"), McMaster University, 1280 Main Street West Hamilton, ON L8S 4K1, Canada
| | - Matthew Ventresca
- Department of Health Research Methods, Evidence and Impact (formerly "Clinical Epidemiology and Biostatistics"), McMaster University, 1280 Main Street West Hamilton, ON L8S 4K1, Canada
| | - Jan Brozek
- Department of Health Research Methods, Evidence and Impact (formerly "Clinical Epidemiology and Biostatistics"), McMaster University, 1280 Main Street West Hamilton, ON L8S 4K1, Canada; Department of Medicine, McMaster University, Health Sciences Centre, 4V33, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact (formerly "Clinical Epidemiology and Biostatistics"), McMaster University, 1280 Main Street West Hamilton, ON L8S 4K1, Canada; Department of Medicine, McMaster University, Health Sciences Centre, 4V33, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada.
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Seo N, Park SH, Kim KJ, Kang BK, Lee Y, Yang SK, Ye BD, Park SH, Kim SY, Baek S, Han K, Ha HK. MR Enterography for the Evaluation of Small-Bowel Inflammation in Crohn Disease by Using Diffusion-weighted Imaging without Intravenous Contrast Material: A Prospective Noninferiority Study. Radiology 2015; 278:762-72. [PMID: 26348103 DOI: 10.1148/radiol.2015150809] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To determine whether magnetic resonance (MR) enterography performed with diffusion-weighted imaging (DWI) without intravenous contrast material is noninferior to contrast material-enhanced (CE) MR enterography for the evaluation of small-bowel inflammation in Crohn disease. MATERIALS AND METHODS Institutional review board approval and informed consent were obtained for this prospective noninferiority study. Fifty consecutive adults suspected of having Crohn disease underwent clinical assessment, MR enterography, and ileocolonoscopy within 1 week. MR enterography included conventional imaging and DWI (b = 900 sec/mm(2)). In 44 patients with Crohn disease, 171 small-bowel segments that were generally well distended and showed a wide range of findings, from normalcy to severe inflammation (34 men, 10 women; mean age ± standard deviation, 26.9 years ± 6.1), were selected for analysis. Image sets consisting of (a) T2-weighted sequences with DWI and (b) T2-weighted sequences with CE T1-weighted sequences were reviewed by using a crossover design with blinding and randomization. Statistical analyses included noninferiority testing regarding proportional agreement between DWI and CE MR enterography for the identification of bowel inflammation with a noninferiority margin of 80%, correlation between DWI and CE MR enterography scores of bowel inflammation severity, and comparison of accuracy between DWI and CE MR enterography for the diagnosis of terminal ileal inflammation by using endoscopic findings as the reference standard. RESULTS The agreement between DWI and CE MR enterography for the identification of bowel inflammation was 91.8% (157 of 171 segments; one-sided 95% confidence interval: ≥88.4%). The correlation coefficient between DWI and CE MR enterography scores was 0.937 (P < .001). DWI and CE MR enterography did not differ significantly regarding the sensitivity and specificity for the diagnosis of terminal ileal inflammation (P > .999). DWI and CE MR enterography concurred in the diagnosis of penetrating complications in five of eight segments. CONCLUSION DWI MR enterography was noninferior to CE MR enterography for the evaluation of inflammation in Crohn disease in generally well-distended small bowel, except for the diagnosis of penetration.
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Affiliation(s)
- Nieun Seo
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
| | - Seong Ho Park
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
| | - Kyung-Jo Kim
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
| | - Bo-Kyeong Kang
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
| | - Yedaun Lee
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
| | - Suk-Kyun Yang
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
| | - Byong Duk Ye
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
| | - Sang Hyoung Park
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
| | - So Yeon Kim
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
| | - Seunghee Baek
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
| | - Kyunghwa Han
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
| | - Hyun Kwon Ha
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
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