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Kim DH, Yoon JH, Choi MH, Lee CH, Kang TW, Kim HA, Ku YM, Lee JM, Kim SH, Kim KA, Lee SL, Choi JI. Comparison of non-contrast abbreviated MRI and ultrasound as surveillance modalities for HCC. J Hepatol 2024:S0168-8278(24)00272-1. [PMID: 38636849 DOI: 10.1016/j.jhep.2024.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/23/2024] [Accepted: 03/31/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND AND AIMS Ultrasonography (US) is recommended for HCC surveillance in high-risk patients, but has limited performance in detecting early-stage HCC. We aimed to compare the diagnostic performance of biannual US and annual non-contrast abbreviated magnetic resonance imaging (NC-AMRI) as HCC surveillance modalities in high-risk patients. METHODS This prospective, multicenter cohort study enrolled participants with an estimated annual risk of HCC greater than 5% between October 2015 and April 2017. Participants underwent six rounds of HCC surveillance at 6-month intervals, with both US and NC-AMRI at rounds 1, 3, and 5, and only US at rounds 2, 4, and 6. The sensitivity, diagnostic yield (DY), and false referral rate (FRR) for HCC detection by US and NC-AMRI were compared. RESULTS In total, 208 participants underwent 980 US and 516 NC-AMRI examinations during 30 months of follow-up. Among them, 34 HCCs were diagnosed in 31 participants, with 20 (64.5%) classified as very early and 11 (35.5%) as early-stage. The sensitivity of annual NC-AMRI (71.0%, 22/31) was marginally higher than that of biannual US (45.2%, 14/31; p = 0.077). NC-AMRI showed a significantly higher DY than US (4.26% vs. 1.43%, p < 0.001), with a similar FRR (2.91% vs. 3.06%, p = 0.885). A simulation of alternating US and NC-AMRI at 6-month intervals yielded a sensitivity of 83.0% (26/31), significantly exceeding that of biannual US (p = 0.006). CONCLUSIONS Annual NC-AMRI showed a marginally higher sensitivity than biannual US for HCC detection in high-risk patients. The DY of annual NC-AMRI was significantly higher than that of biannual US, without increasing the FRR. Alternating US and NC-AMRI at 6-month intervals could be an optimal surveillance strategy for high-risk patients. IMPACT AND IMPLICATIONS Current guidelines permit the use of magnetic resonance imaging (MRI) as a surveillance tool for hepatocellular carcinoma (HCC) in patients in whom ultrasonography (US) is inadequate. However, the specific indications, imaging sequences, and surveillance intervals for MRI surveillance remain unclear. In our study, we found that annual non-contrast (NC)-abbreviated MRI (AMRI) exhibited marginally higher sensitivity and significantly better diagnostic yield than biannual US in high-risk patients for HCC. Adopting alternating US and NC-AMRI at 6-month intervals demonstrated significantly improved sensitivity compared to biannual US, making it a potentially optimal surveillance strategy for high-risk patients. CLINICAL TRIAL NUMBER ClinicalTrials.gov Identifier: NCT02551250.
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Affiliation(s)
- Dong Hwan Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea; Current address: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Republic of Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital and College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Hee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun A Kim
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Mi Ku
- Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital and College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Seong Hyun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Ah Kim
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Su Lim Lee
- Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon-Il Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea.
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Choi MH, Yoon SB, Lee YJ, Jung ES, Pak S, Han D, Nickel D. Rim enhancement of pancreatic ductal adenocarcinoma: investigating the relationship with DCE-MRI-based radiomics and next-generation sequencing. Front Oncol 2024; 14:1304187. [PMID: 38525415 PMCID: PMC10959187 DOI: 10.3389/fonc.2024.1304187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/16/2024] [Indexed: 03/26/2024] Open
Abstract
Purpose To identify the clinical and genetic variables associated with rim enhancement of pancreatic ductal adenocarcinoma (PDAC) and to develop a dynamic contrast-enhanced (DCE) MRI-based radiomics model for predicting the genetic status from next-generation sequencing (NGS). Materials and methods Patients with PDAC, who underwent pretreatment pancreatic DCE-MRI between November 2019 and July 2021, were eligible in this prospective study. Two radiologists evaluated presence of rim enhancement in PDAC, a known radiological prognostic indicator, on DCE MRI. NGS was conducted for the tissue from the lesion. The Mann-Whitney U and Chi-square tests were employed to identify clinical and genetic variables associated with rim enhancement in PDAC. For continuous variables predicting rim enhancement, the cutoff value was set based on the Youden's index from the receiver operating characteristic (ROC) curve. Radiomics features were extracted from a volume-of-interest of PDAC on four DCE maps (Ktrans, Kep, Ve, and iAUC). A random forest (RF) model was constructed using 10 selected radiomics features from a pool of 392 original features. This model aimed to predict the status of significant NGS variables associated with rim enhancement. The performance of the model was validated using test set. Results A total of 55 patients (32 men; median age 71 years) were randomly assigned to the training (n = 41) and test (n = 14) sets. In the training set, KRAS, TP53, CDKN2A, and SMAD4 mutation rates were 92.3%, 61.8%, 14.5%, and 9.1%, respectively. Tumor size and KRAS variant allele frequency (VAF) differed between rim-enhancing (n = 12) and nonrim-enhancing (n = 29) PDACs with a cutoff of 17.22%. The RF model's average AUC from 10-fold cross-validation for predicting KRAS VAF status was 0.698. In the test set comprising 6 tumors with low KRAS VAF and 8 with high KRAS VAF, the RF model's AUC reached 1.000, achieving a sensitivity of 75.0%, specificity of 100% and accuracy of 87.5%. Conclusion Rim enhancement of PDAC is associated with KRAS VAF derived from NGS-based genetic information. For predicting the KRAS VAF status in PDAC, a radiomics model based on DCE maps showed promising results.
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Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Bae Yoon
- Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Joon Lee
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Sun Jung
- Department of Hospital Pathology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seongyong Pak
- Research Collaboration, Siemens Healthineers Ltd., Seoul, Republic of Korea
| | - Dongyeob Han
- Research Collaboration, Siemens Healthineers Ltd., Seoul, Republic of Korea
| | - Dominik Nickel
- MR Applications Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
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Park HC, Joo Y, Lee OJ, Lee K, Song TK, Choi C, Choi MH, Yoon C. Automated classification of liver fibrosis stages using ultrasound imaging. BMC Med Imaging 2024; 24:36. [PMID: 38321373 PMCID: PMC10848434 DOI: 10.1186/s12880-024-01209-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/21/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Ultrasound imaging is the most frequently performed for the patients with chronic hepatitis or liver cirrhosis. However, ultrasound imaging is highly operator dependent and interpretation of ultrasound images is subjective, thus well-trained radiologist is required for evaluation. Automated classification of liver fibrosis could alleviate the shortage of skilled radiologist especially in low-to-middle income countries. The purposed of this study is to evaluate deep convolutional neural networks (DCNNs) for classifying the degree of liver fibrosis according to the METAVIR score using US images. METHODS We used ultrasound (US) images from two tertiary university hospitals. A total of 7920 US images from 933 patients were used for training/validation of DCNNs. All patient were underwent liver biopsy or hepatectomy, and liver fibrosis was categorized based on pathology results using the METAVIR score. Five well-established DCNNs (VGGNet, ResNet, DenseNet, EfficientNet and ViT) was implemented to predict the METAVIR score. The performance of DCNNs for five-level (F0/F1/F2/F3/F4) classification was evaluated through area under the receiver operating characteristic curve (AUC) with 95% confidential interval, accuracy, sensitivity, specificity, positive and negative likelihood ratio. RESULTS Similar mean AUC values were achieved for five models; VGGNet (0.96), ResNet (0.96), DenseNet (0.95), EfficientNet (0.96), and ViT (0.95). The same mean accuracy (0.94) and specificity values (0.96) were yielded for all models. In terms of sensitivity, EffcientNet achieved highest mean value (0.85) while the other models produced slightly lower values range from 0.82 to 0.84. CONCLUSION In this study, we demonstrated that DCNNs can classify the staging of liver fibrosis according to METAVIR score with high performance using conventional B-mode images. Among them, EfficientNET that have fewer parameters and computation cost produced highest performance. From the results, we believe that DCNNs based classification of liver fibrosis may allow fast and accurate diagnosis of liver fibrosis without needs of additional equipment for add-on test and may be powerful tool for supporting radiologists in clinical practice.
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Grants
- NTIS Number: 9991007146 the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety
- HI21C0940110021 the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea
- No. 2022-0-00101 the Institute of Information & communications Technology Planning & Evaluation (IITP) grant funded by the Korea government (MSIT)
- the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety
- the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea
- the Institute of Information & communications Technology Planning & Evaluation (IITP) grant funded by the Korea government (MSIT)
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Affiliation(s)
- Hyun-Cheol Park
- Division of Industrial Mathematics, National Institute for Mathematical Sciences, 70, Yuseong-daero, Yuseong-gu, 34047, Daejeon, Republic of Korea
| | - YunSang Joo
- Department of Computer Engineering, Gachon University, 1342, Seongnam-daero, Sujeong-gu, 13120, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - O-Joun Lee
- Department of Artificial Intelligence, The Catholic University of Korea, 43, Jibong-ro, 14662, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Kunkyu Lee
- Department of Electronic Engineering, Sogang University, 35 Baekbeom-ro, 04107, Seoul, Republic of Korea
| | - Tai-Kyong Song
- Department of Electronic Engineering, Sogang University, 35 Baekbeom-ro, 04107, Seoul, Republic of Korea
| | - Chang Choi
- Department of Computer Engineering, Gachon University, 1342, Seongnam-daero, Sujeong-gu, 13120, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Moon Hyung Choi
- Department of Radiology, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seoul, Republic of Korea.
| | - Changhan Yoon
- Department of Biomedical Engineering, Department of Nanoscience and Engineering, Inje University, Inje-ro 197, 50834, Gimhae, Gyeongnam, Republic of Korea.
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Choi MH, Lee SW, Pak S. Low-dose versus conventional CT urography using dual-source CT with different time-current product values and the same tube voltage: image quality and diagnostic performance in various diagnoses. Br J Radiol 2024; 97:399-407. [PMID: 38308025 DOI: 10.1093/bjr/tqad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 10/05/2023] [Accepted: 11/14/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES To compare the image quality and diagnostic performance of low-dose CT urography to that of concurrently acquired conventional CT using dual-source CT. METHODS This retrospective study included 357 consecutive CT urograms performed by third-generation dual-source CT in a single institution between April 2020 and August 2021. Two-phase CT images (unenhanced phase, excretory phase with split bolus) were obtained with two different tube current-time products (280 mAs for the conventional-dose protocol and 70 mAs for the low-dose protocol) and the same tube voltage (90 kVp) for the two X-ray tubes. Iterative reconstruction was applied for both protocols. Two radiologists independently performed quantitative and qualitative image quality analysis and made diagnoses. The correlation between the noise level or the effective radiation dose and the patients' body weight was evaluated. RESULTS Significantly higher noise levels resulting in a significantly lower liver signal-to-noise ratio and contrast-to-noise ratio were noted in low-dose images compared to conventional images (P < .001). Qualitative analysis by both radiologists showed significantly lower image quality in low-dose CT than in conventional CT images (P < .001). Patient's body weight was positively correlated with noise and effective radiation dose (P < .001). Diagnostic performance for various diseases, including urolithiasis, inflammation, and mass, was not different between the two protocols. CONCLUSIONS Despite inferior image quality, low-dose CT urography with 70 mAs and 90 kVp and iterative reconstruction demonstrated diagnostic performance equivalent to that of conventional CT for identifying various diseases of the urinary tract. ADVANCES IN KNOWLEDGE Low-dose CT (25% radiation dose) with low tube current demonstrated diagnostic performance comparable to that of conventional CT for a variety of urinary tract diseases.
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Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
| | - Sheen-Woo Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
| | - Seongyong Pak
- Siemens Healthineers Ltd, Seoul 06620, Republic of Korea
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Lee EH, Choi MH, Lee KH, Kim D, Jeong SH, Song YG, Han SH. Intrahospital transmission and infection control of Candida auris originating from a severely infected COVID-19 patient transferred abroad. J Hosp Infect 2024; 143:140-149. [PMID: 37939883 DOI: 10.1016/j.jhin.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Intrahospital spread of Candida auris, which survives tenaciously in many environments, can cause sustained colonization and infection. A large outbreak of C. auris was experienced in the intensive care units (ICUs) at the study hospital during the coronavirus disease 2019 (COVID-19) pandemic. METHODS The index patient with severe COVID-19, who was transferred from Vietnam in January 2022, developed C. auris candidaemia 10 days after hospitalization. From mid-June 2022 to January 2023, strengthened infection prevention and control (IPC) measures were implemented in three ICUs: (1) contact precautions and isolation (CPI) for C. auris-positive cases; (2) surveillance cultures including point-prevalence (N=718) for patients or close contacts or ICU-resident healthcare workers (HCWs); (3) intensive environmental disinfection with 10-fold diluted bleach; and (4) 2% chlorhexidine bathing for all ICU patients. Environmental cultures (ECx) on surfaces and shared objects (N=276) were conducted until early September 2022, when all ECx were negative. RESULTS Among 53 C. auris-positive patients between February 2022 and January 2023, invasive infections resulted in seven cases of candidaemia and one case of pneumonia. C. auris was isolated from reusable tympanic thermometers (TTMs) contaminated with earwax. The isolation rate of C. auris in ECx decreased from 6.8% in June 2022 to 2.0% in August 2022, and was no longer detected in TTMs. Colonization in HCWs was remarkably rare (0.5%). The number of C. auris-positive patients peaked in July (N=10) then decreased gradually. By January 2023, no C. auris were isolated in the ICU. CONCLUSION Aggressive IPC measures with CPI, ECx and surveillance, decontamination of TTMs, and bathing were effective in successfully controlling this C. auris outbreak.
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Affiliation(s)
- E H Lee
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - M H Choi
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - K H Lee
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - D Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - S H Jeong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y G Song
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - S H Han
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Kim DH, Kim B, Chung DJ, Kim KA, Lee SL, Choi MH, Kim H, Rha SE. Predicting resection margin status of pancreatic neuroendocrine tumors on CT: performance of NCCN resectability criteria. Br J Radiol 2023; 96:20230503. [PMID: 37750830 PMCID: PMC10646654 DOI: 10.1259/bjr.20230503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/18/2023] [Accepted: 08/21/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE To test the performance of the National Comprehensive Cancer Network (NCCN) CT resectability criteria for predicting the surgical margin status of pancreatic neuroendocrine tumor (PNET) and to identify factors associated with margin-positive resection. METHODS Eighty patients with pre-operative CT and upfront surgery were retrospectively enrolled. Two radiologists assessed the CT resectability (resectable [R], borderline resectable [BR], unresectable [UR]) of the PNET according to NCCN criteria. Logistic regression was used to identify factors associated with resection margin status. κ statistics were used to evaluate interreader agreements. Kaplan-Meier method with log-rank test was used to estimate and compare recurrence-free survival (RFS). RESULTS Forty-five patients (56.2%) received R0 resection and 35 (43.8%) received R1 or R2 resection. R0 resection rates were 63.6-64.2%, 20.0-33.3%, and 0% for R, BR, and UR diseases, respectively (all p ≤ 0.002), with a good interreader agreement (κ, 0.74). Tumor size (<2 cm, 2-4 cm, and >4 cm; odds ratio (OR), 9.042-18.110; all p ≤ 0.007) and NCCN BR/UR diseases (OR, 5.918; p = 0.032) were predictors for R1 or R2 resection. The R0 resection rate was 91.7% for R disease <2 cm and decreased for larger R disease. R0 resection and smaller tumor size in R disease improved RFS. CONCLUSION NCCN resectability criteria can stratify patients with PNET into distinct groups of R0 resectability. Adding tumor size to R disease substantially improves the prediction of R0 resection, especially for PNETs <2 cm. ADVANCES IN KNOWLEDGE Tumor size and radiologic resectability independently predicted margin status of PNETs.
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Affiliation(s)
- Dong Hwan Kim
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bohyun Kim
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Jin Chung
- Department of Radiology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung Ah Kim
- Department of Radiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Su Lim Lee
- Department of Radiology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hokun Kim
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Eun Rha
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Yoon SB, Jeon TY, Moon SH, Shin DW, Lee SM, Choi MH, Min JH, Kim MJ. Differentiation of autoimmune pancreatitis from pancreatic adenocarcinoma using CT characteristics: a systematic review and meta-analysis. Eur Radiol 2023; 33:9010-9021. [PMID: 37466708 DOI: 10.1007/s00330-023-09959-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVES To determine informational CT findings for distinguishing autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC) and to review their diagnostic accuracy. METHODS A systematic and detailed literature review was performed through PubMed, EMBASE, and the Cochrane library. Similar descriptors to embody the identical image finding were labeled as a single CT characteristic. We calculated the pooled diagnostic odds ratios (DORs) of each CT characteristic using a bivariate random-effects model. RESULTS A total of 145 various descriptors from 15 studies (including 562 AIP and 869 PDAC patients) were categorized into 16 CT characteristics. According to the pooled DOR, 16 CT characteristics were classified into three groups (suggesting AIP, suggesting PDAC, and not informational). Seven characteristics suggesting AIP were diffuse pancreatic enlargement (DOR, 48), delayed homogeneous enhancement (DOR, 46), capsule-like rim (DOR, 34), multiple pancreatic masses (DOR, 16), renal involvement (DOR, 15), retroperitoneal fibrosis (DOR, 13), and bile duct involvement (DOR, 8). Delayed homogeneous enhancement showed a pooled sensitivity of 83% and specificity of 85%. The other six characteristics showed relatively low sensitivity (12-63%) but high specificity (93-99%). Four characteristics suggesting PDAC were discrete pancreatic mass (DOR, 23), pancreatic duct cutoff (DOR, 16), upstream main pancreatic duct dilatation (DOR, 8), and upstream parenchymal atrophy (DOR, 7). CONCLUSION Eleven CT characteristics were informational to distinguish AIP from PDAC. Diffuse pancreatic enlargement, delayed homogeneous enhancement, and capsule-like rim suggested AIP with the highest DORs, whereas discrete pancreatic mass suggested PDAC. However, pooled sensitivities of informational CT characteristics were moderate. CLINICAL RELEVANCE STATEMENT This meta-analysis underscores eleven distinctive CT characteristics that aid in differentiating autoimmune pancreatitis from pancreatic adenocarcinoma, potentially preventing misdiagnoses in patients presenting with focal/diffuse pancreatic enlargement. KEY POINTS • Diffuse pancreatic enlargement (pooled diagnostic odds ratio [DOR], 48), delayed homogeneous enhancement (46), and capsule-like rim (34) were CT characteristics suggesting autoimmune pancreatitis. • The CT characteristics suggesting autoimmune pancreatitis, except delayed homogeneous enhancement, had a general tendency to show relatively low sensitivity (12-63%) but high specificity (93-99%). • Discrete pancreatic mass (pooled diagnostic odds ratio, 23) was the CT characteristic suggesting pancreatic ductal adenocarcinoma with the highest pooled DORs.
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Affiliation(s)
- Seung Bae Yoon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Tae Yeon Jeon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung-Hoon Moon
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, South Korea.
| | - Dong Woo Shin
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, South Korea
| | - Sang Min Lee
- Department of Radiology, Cha Gangnam Medical Center, Seoul, South Korea
| | - Moon Hyung Choi
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Min-Jeong Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
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Choi MH, Kim DH, Lee YJ, Rha SE, Lee JY. Imaging features of the PI-RADS for predicting extraprostatic extension of prostate cancer: systematic review and meta-analysis. Insights Imaging 2023; 14:77. [PMID: 37156971 PMCID: PMC10167060 DOI: 10.1186/s13244-023-01422-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/05/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES To systematically determine the diagnostic performance of each MRI feature of the PI-RADS for predicting extraprostatic extension (EPE) in prostate cancer. METHODS A literature search in the MEDLINE and EMBASE databases was conducted to identify original studies reporting the accuracy of each feature on MRI for the dichotomous diagnosis of EPE. The meta-analytic pooled diagnostic odds ratio (DOR), sensitivity, specificity, and their 95% confidence intervals (CIs) were obtained using a bivariate random-effects model. RESULTS After screening 1955 studies, 17 studies with a total of 3062 men were included. All six imaging features, i.e., bulging prostatic contour, irregular or spiculated margin, asymmetry or invasion of neurovascular bundle, obliteration of rectoprostatic angle, tumor-capsule interface > 10 mm, and breach of the capsule with evidence of direct tumor extension, were significantly associated with EPE. Breach of the capsule with direct tumor extension demonstrated the highest pooled DOR (15.6, 95% CI [7.7-31.5]) followed by tumor-capsule interface > 10 mm (10.5 [5.4-20.2]), asymmetry or invasion of neurovascular bundle (7.6 [3.8-15.2]), and obliteration of rectoprostatic angle (6.1 [3.8-9.8]). Irregular or spiculated margin showed the lowest pooled DOR (2.3 [1.3-4.2]). Breach of the capsule with direct tumor extension and tumor-capsule interface > 10 mm showed the highest pooled specificity (98.0% [96.2-99.0]) and sensitivity (86.3% [70.0-94.4]), respectively. CONCLUSIONS Among the six MRI features of prostate cancer, breach of the capsule with direct tumor extension and tumor-capsule interface > 10 mm were the most predictive of EPE with the highest specificity and sensitivity, respectively.
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Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Hwan Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - Young Joon Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Eun Rha
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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9
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Choi MH, Ha US, Park YH, Hong SH, Lee JY, Lee YJ, Lee W, Jung S. Combined MRI and PSA Strategy Improves Biopsy Decisions Compared with PSA Only: Longitudinal Observations of a Cohort of Patients with a PSA Level Less Than 20 ng/mL. Acad Radiol 2023; 30:509-515. [PMID: 36127254 DOI: 10.1016/j.acra.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 01/27/2023]
Abstract
RATIONALE AND OBJECTIVES To assess the diagnostic performances of prostate specific antigen (PSA) and PSA with prostate magnetic resonance imaging (MRI) to predict prostate cancer in patients with PSA ≤ 20 ng/mL. MATERIALS AND METHODS Patients suspected of prostate cancer with a PSA test and prebiopsy MRI were included (n = 881). Prostate biopsy results or follow-up clinical data for 2 years were used to determine the presence of prostate cancer. The diagnostic performance of PSA, MRI, and PSA with MRI (referred to as the protocol) was evaluated. The positive predictive value (PPV) and negative predictive value (NPV) of the MRI were calculated in subgroups of patients with specific ranges of PSA level. RESULTS Prostate cancer and CSC were diagnosed in 220 and 162 patients, respectively. Adding MRI to PSA could greatly improve specificity and PPV (0.833 and 0.567) for detecting CSC, compared to PSA ≥ 4 ng/mL alone (0.248 and 0.0219). Even though the sensitivity of the protocol (0.679) was lower than PSA (0.938), the NPV of the protocol was comparable to PSA (0.929 vs. 0.924). The protocol consistently showed the superior PPV and NVP to PSA only in not only patients within the gray zone of PSA, but also in patients with higher PSA. CONCLUSION In conclusion, this longitudinal observational study confirmed that adding prebiopsy MRI to PSA was consistently beneficial in patients with PSA ≤ 20 ng/mL for avoiding unnecessary biopsy despite decrease in the sensitivity.
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Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - U-Syn Ha
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Yong-Hyun Park
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Hoo Hong
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Youl Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Joon Lee
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Woojoo Lee
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Seungpil Jung
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
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10
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Choi MH, Lee YJ, Jung SE, Han D. High-resolution 3D T2-weighted SPACE sequence with compressed sensing for the prostate gland: diagnostic performance in comparison with conventional T2-weighted images. Abdom Radiol (NY) 2023; 48:1090-1099. [PMID: 36544053 DOI: 10.1007/s00261-022-03777-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To compare the diagnostic performance of high-resolution 3D T2-weighted imaging (T2WI) with compressed sensing (CS) sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) to that of conventional T2WI with turbo spin echo (TSE) in prostate MRI. MATERIALS AND METHODS This study evaluated 179 patients (mean age 69.1 ± 9.3) who underwent prostate biopsy after prostate prebiopsy MRI, including two sets of three-plane T2WI with TSE (thickness: 3 mm, scan time: 10 min 4 s) and CS SPACE (thickness: 0.6 mm, scan time: 4 min 55 s). Two radiologists evaluated two sets of images with the Prostate Imaging-Reporting and Data System (PIRADS) classification and determined the extraprostatic extension (EPE) of the lesion. The diagnostic performance to detect prostate cancer (PIRADS classification) and EPE was compared between the two T2WI sets. RESULTS Clinically significant cancer (CSC) was diagnosed in 103 patients (57.5%). Areas under the receiver operating characteristic curve of the PIRADS classification on both image sets with T2 TSE and T2 CS SPACE were higher than 0.7 and did not show significant differences for either radiologist (p > 0.05). EPE was confirmed in 25 of 70 patients underwent prostatectomy. For evaluating EPE on MRI, the sensitivity and specificity did not differ between the two T2WI sequences (p > 0.05). CONCLUSION High-resolution 3D T2WI using CS SPACE, which was acquired within a shorter acquisition time than three-plane T2 TSE, showed comparable diagnostic performance to conventional T2 TSE for detecting CSC and evaluating EPE.
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Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-Ro, Eunpyeong-Gu, Seoul, 03312, Republic of Korea
| | - Young Joon Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-Ro, Eunpyeong-Gu, Seoul, 03312, Republic of Korea.
| | - Seung Eun Jung
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-Ro, Eunpyeong-Gu, Seoul, 03312, Republic of Korea
| | - Dongyeob Han
- Siemens Healthineers Ltd, Seoul, Republic of Korea
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11
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Hu L, Fu C, Song X, Grimm R, von Busch H, Benkert T, Kamen A, Lou B, Huisman H, Tong A, Penzkofer T, Choi MH, Shabunin I, Winkel D, Xing P, Szolar D, Coakley F, Shea S, Szurowska E, Guo JY, Li L, Li YH, Zhao JG. Automated deep-learning system in the assessment of MRI-visible prostate cancer: comparison of advanced zoomed diffusion-weighted imaging and conventional technique. Cancer Imaging 2023; 23:6. [PMID: 36647150 PMCID: PMC9843860 DOI: 10.1186/s40644-023-00527-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Deep-learning-based computer-aided diagnosis (DL-CAD) systems using MRI for prostate cancer (PCa) detection have demonstrated good performance. Nevertheless, DL-CAD systems are vulnerable to high heterogeneities in DWI, which can interfere with DL-CAD assessments and impair performance. This study aims to compare PCa detection of DL-CAD between zoomed-field-of-view echo-planar DWI (z-DWI) and full-field-of-view DWI (f-DWI) and find the risk factors affecting DL-CAD diagnostic efficiency. METHODS This retrospective study enrolled 354 consecutive participants who underwent MRI including T2WI, f-DWI, and z-DWI because of clinically suspected PCa. A DL-CAD was used to compare the performance of f-DWI and z-DWI both on a patient level and lesion level. We used the area under the curve (AUC) of receiver operating characteristics analysis and alternative free-response receiver operating characteristics analysis to compare the performances of DL-CAD using f- DWI and z-DWI. The risk factors affecting the DL-CAD were analyzed using logistic regression analyses. P values less than 0.05 were considered statistically significant. RESULTS DL-CAD with z-DWI had a significantly better overall accuracy than that with f-DWI both on patient level and lesion level (AUCpatient: 0.89 vs. 0.86; AUClesion: 0.86 vs. 0.76; P < .001). The contrast-to-noise ratio (CNR) of lesions in DWI was an independent risk factor of false positives (odds ratio [OR] = 1.12; P < .001). Rectal susceptibility artifacts, lesion diameter, and apparent diffusion coefficients (ADC) were independent risk factors of both false positives (ORrectal susceptibility artifact = 5.46; ORdiameter, = 1.12; ORADC = 0.998; all P < .001) and false negatives (ORrectal susceptibility artifact = 3.31; ORdiameter = 0.82; ORADC = 1.007; all P ≤ .03) of DL-CAD. CONCLUSIONS Z-DWI has potential to improve the detection performance of a prostate MRI based DL-CAD. TRIAL REGISTRATION ChiCTR, NO. ChiCTR2100041834 . Registered 7 January 2021.
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Affiliation(s)
- Lei Hu
- grid.16821.3c0000 0004 0368 8293Department of Diagnostic and Interventional Radiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600, Yi Shan Road, Shanghai, 200233 China
| | - Caixia Fu
- MR Application Development, Siemens Shenzhen magnetic Resonance Ltd., Shenzhen, China
| | - Xinyang Song
- grid.443573.20000 0004 1799 2448Department of Radiology, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, 441000 China
| | - Robert Grimm
- grid.5406.7000000012178835XMR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Heinrich von Busch
- grid.5406.7000000012178835XInnovation Owner Artificial Intelligence for Oncology, Siemens Healthcare GmbH, Erlangen, Germany
| | - Thomas Benkert
- grid.5406.7000000012178835XMR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Ali Kamen
- grid.415886.60000 0004 0546 1113Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ USA
| | - Bin Lou
- grid.415886.60000 0004 0546 1113Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ USA
| | - Henkjan Huisman
- grid.10417.330000 0004 0444 9382Radboud University Medical Center, Nijmegen, Netherlands
| | - Angela Tong
- grid.137628.90000 0004 1936 8753New York University, New York City, NY USA
| | - Tobias Penzkofer
- grid.6363.00000 0001 2218 4662Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Moon Hyung Choi
- grid.411947.e0000 0004 0470 4224Eunpyeong St. Mary’s Hospital, Catholic University of Korea, Seoul, Republic of Korea
| | | | - David Winkel
- grid.410567.1Universitätsspital Basel, Basel, Switzerland
| | - Pengyi Xing
- grid.411525.60000 0004 0369 1599Changhai Hospital, Shanghai, China
| | | | - Fergus Coakley
- grid.5288.70000 0000 9758 5690Oregon Health and Science University, Portland, OR USA
| | - Steven Shea
- grid.411451.40000 0001 2215 0876Loyola University Medical Center, Maywood, IL USA
| | - Edyta Szurowska
- grid.11451.300000 0001 0531 3426Medical University of Gdansk, Gdansk, Poland
| | - Jing-yi Guo
- grid.16821.3c0000 0004 0368 8293Clinical Research Center, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233 China
| | - Liang Li
- grid.412632.00000 0004 1758 2270Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, 430060 China
| | - Yue-hua Li
- grid.16821.3c0000 0004 0368 8293Department of Diagnostic and Interventional Radiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600, Yi Shan Road, Shanghai, 200233 China
| | - Jun-gong Zhao
- grid.16821.3c0000 0004 0368 8293Department of Diagnostic and Interventional Radiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600, Yi Shan Road, Shanghai, 200233 China
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12
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Youn SY, Choi MH, Lee YJ, Grimm R, von Busch H, Han D, Son Y, Lou B, Kamen A. Prostate gland volume estimation: anteroposterior diameters measured on axial versus sagittal ultrasonography and magnetic resonance images. Ultrasonography 2023; 42:154-164. [PMID: 36475357 PMCID: PMC9816709 DOI: 10.14366/usg.22104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/24/2022] [Indexed: 01/13/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate the accuracy of prostate volume estimates calculated from the ellipsoid formula using the anteroposterior (AP) diameter measured on axial and sagittal images obtained through ultrasonography (US) and magnetic resonance imaging (MRI). METHODS This retrospective study included 456 patients with transrectal US and MRI from two university hospitals. Two radiologists independently measured the prostate gland diameters on US and MRI: AP diameters on axial and sagittal images, transverse, and longitudinal diameters on midsagittal images. The volume estimates, volumeax and volumesag, were calculated from the ellipsoid formula by using the AP diameter on axial and sagittal images, respectively. The prostate volume extracted from MRI-based whole-gland segmentation was considered the gold standard. The intraclass correlation coefficient (ICC) was used to evaluate the inter-method agreement between volumeax and volumesag, and agreement with the gold standard. The Wilcoxon signedrank test was used to analyze the differences between the volume estimates and the gold standard. RESULTS The prostate gland volume estimates showed excellent inter-method agreement, and excellent agreement with the gold standard (ICCs >0.9). Compared with the gold standard, the volume estimates were significantly larger on MRI and significantly smaller on US (P<0.001). The volume difference (segmented volume-volume estimate) was greater in patients with larger prostate glands, especially on US. CONCLUSION Volumeax and volumesag showed excellent inter-method agreement and excellent agreement with the gold standard on both US and MRI. However, prostate volume was overestimated on MRI and underestimated on US.
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Affiliation(s)
- Seo Yeon Youn
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moon Hyung Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Correspondence to: Moon Hyung Choi, MD, PhD, Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul 03312, Korea Tel. +82-2-2030-3013 Fax. +82-2-2030-3026 E-mail:
| | - Young Joon Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Robert Grimm
- Diagnostic Imaging, Siemens Healthcare, Erlangen, Germany
| | | | | | - Yohan Son
- Siemens Healthineers Ltd., Seoul, Korea
| | - Bin Lou
- Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ, USA
| | - Ali Kamen
- Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ, USA
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Abstract
Pancreatic cancer is a challenging disease with an increasing incidence and extremely poor prognosis. The clinical outcomes of pancreatic cancer depend on tumor biology, responses to treatments, and malnutrition or cachexia. Sarcopenia represents a severe catabolic condition defined by the age-related loss of muscle mass and strength and affects as much as 70% of malnourished pancreatic cancer patients. The lumbar skeletal muscle index, defined as the total abdominal muscle area at the L3 vertebral level adjusted by the square of the height, is widely used for assessing sarcopenia in patients with pancreatic cancer. Several studies have suggested that sarcopenia may be a risk factor for perioperative complications and decreased recurrence-free or overall survival in patients with pancreatic cancer undergoing surgery. Sarcopenia could also intensify chemotherapy-induced toxicities and worsen the quality of life and survival in the neoadjuvant or palliative chemotherapy setting. Sarcopenia, not only at the time of diagnosis but also during treatment, decreases survival in patients with pancreatic cancer. Theoretically, multimodal interventions may improve sarcopenia and clinical outcomes; however, no study has reported positive results. Further prospective studies are needed to confirm the prognostic role of sarcopenia and the effects of multimodal interventions in patients with pancreatic cancer.
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Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, South Korea
| | - Seung Bae Yoon
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 03312, South Korea
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14
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Wang M, Perucho JAU, Hu Y, Choi MH, Han L, Wong EMF, Ho G, Zhang X, Ip P, Lee EYP. Computed Tomographic Radiomics in Differentiating Histologic Subtypes of Epithelial Ovarian Carcinoma. JAMA Netw Open 2022; 5:e2245141. [PMID: 36469315 PMCID: PMC9855300 DOI: 10.1001/jamanetworkopen.2022.45141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Epithelial ovarian carcinoma is heterogeneous and classified according to the World Health Organization Tumour Classification, which is based on histologic features and molecular alterations. Preoperative prediction of the histologic subtypes could aid in clinical management and disease prognostication. OBJECTIVE To assess the value of radiomics based on contrast-enhanced computed tomography (CT) in differentiating histologic subtypes of epithelial ovarian carcinoma in multicenter data sets. DESIGN, SETTING, AND PARTICIPANTS In this diagnostic study, 665 patients with histologically confirmed epithelial ovarian carcinoma were retrospectively recruited from 4 centers (Hong Kong, Guangdong Province of China, and Seoul, South Korea) between January 1, 2012, and February 28, 2022. The patients were randomly divided into a training cohort (n = 532) and a testing cohort (n = 133) with a ratio of 8:2. This process was repeated 100 times. Tumor segmentation was manually delineated on each section of contrast-enhanced CT images to encompass the entire tumor. The Mann-Whitney U test and voted least absolute shrinkage and selection operator were performed for feature reduction and selection. Selected features were used to build the logistic regression model for differentiating high-grade serous carcinoma and non-high-grade serous carcinoma. EXPOSURES Contrast-enhanced CT-based radiomics. MAIN OUTCOMES AND MEASURES Intraobserver and interobserver reproducibility of tumor segmentation were measured by Dice similarity coefficients. The diagnostic efficiency of the model was assessed by receiver operating characteristic curve and area under the curve. RESULTS In this study, 665 female patients (mean [SD] age, 53.6 [10.9] years) with epithelial ovarian carcinoma were enrolled and analyzed. The Dice similarity coefficients of intraobserver and interobserver were all greater than 0.80. Twenty radiomic features were selected for modeling. The areas under the curve of the logistic regression model in differentiating high-grade serous carcinoma and non-high-grade serous carcinoma were 0.837 (95% CI, 0.835-0.838) for the training cohort and 0.836 (95% CI, 0.833-0.840) for the testing cohort. CONCLUSIONS AND RELEVANCE In this diagnostic study, radiomic features extracted from contrast-enhanced CT were useful in the classification of histologic subtypes in epithelial ovarian carcinoma. Intraobserver and interobserver reproducibility of tumor segmentation was excellent. The proposed logistic regression model offered excellent discriminative ability among histologic subtypes.
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Affiliation(s)
- Mandi Wang
- Department of Radiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
- Department of Diagnostic Radiology, School of Clinical Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jose A. U. Perucho
- Department of Radiology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham
| | - Yangling Hu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Lujun Han
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Esther M. F. Wong
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong Special Administrative Region, China
| | - Grace Ho
- Department of Radiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Xiaoling Zhang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Philip Ip
- Department of Pathology, Queen Mary Hospital, School of Clinical Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Elaine Y. P. Lee
- Department of Diagnostic Radiology, School of Clinical Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
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15
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Labus S, Altmann MM, Huisman H, Tong A, Penzkofer T, Choi MH, Shabunin I, Winkel DJ, Xing P, Szolar DH, Shea SM, Grimm R, von Busch H, Kamen A, Herold T, Baumann C. A concurrent, deep learning-based computer-aided detection system for prostate multiparametric MRI: a performance study involving experienced and less-experienced radiologists. Eur Radiol 2022; 33:64-76. [PMID: 35900376 DOI: 10.1007/s00330-022-08978-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the effect of a deep learning-based computer-aided diagnosis (DL-CAD) system on experienced and less-experienced radiologists in reading prostate mpMRI. METHODS In this retrospective, multi-reader multi-case study, a consecutive set of 184 patients examined between 01/2018 and 08/2019 were enrolled. Ground truth was combined targeted and 12-core systematic transrectal ultrasound-guided biopsy. Four radiologists, two experienced and two less-experienced, evaluated each case twice, once without (DL-CAD-) and once assisted by DL-CAD (DL-CAD+). ROC analysis, sensitivities, specificities, PPV and NPV were calculated to compare the diagnostic accuracy for the diagnosis of prostate cancer (PCa) between the two groups (DL-CAD- vs. DL-CAD+). Spearman's correlation coefficients were evaluated to assess the relationship between PI-RADS category and Gleason score (GS). Also, the median reading times were compared for the two reading groups. RESULTS In total, 172 patients were included in the final analysis. With DL-CAD assistance, the overall AUC of the less-experienced radiologists increased significantly from 0.66 to 0.80 (p = 0.001; cutoff ISUP GG ≥ 1) and from 0.68 to 0.80 (p = 0.002; cutoff ISUP GG ≥ 2). Experienced radiologists showed an AUC increase from 0.81 to 0.86 (p = 0.146; cutoff ISUP GG ≥ 1) and from 0.81 to 0.84 (p = 0.433; cutoff ISUP GG ≥ 2). Furthermore, the correlation between PI-RADS category and GS improved significantly in the DL-CAD + group (0.45 vs. 0.57; p = 0.03), while the median reading time was reduced from 157 to 150 s (p = 0.023). CONCLUSIONS DL-CAD assistance increased the mean detection performance, with the most significant benefit for the less-experienced radiologist; with the help of DL-CAD less-experienced radiologists reached performances comparable to that of experienced radiologists. KEY POINTS • DL-CAD used as a concurrent reading aid helps radiologists to distinguish between benign and cancerous lesions in prostate MRI. • With the help of DL-CAD, less-experienced radiologists may achieve detection performances comparable to that of experienced radiologists. • DL-CAD assistance increases the correlation between PI-RADS category and cancer grade.
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Affiliation(s)
- Sandra Labus
- Department of Radiology, Helios Klinikum Berlin-Buch, Schwanebecker Ch 50, 13125, Berlin, Germany.
| | - Martin M Altmann
- Department of Radiology, Helios Klinikum Berlin-Buch, Schwanebecker Ch 50, 13125, Berlin, Germany
| | - Henkjan Huisman
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Angela Tong
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Moon Hyung Choi
- Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | | | - David J Winkel
- Department of Radiology, University Hospital of Basel, Basel, Switzerland
| | - Pengyi Xing
- Department of Radiology, Changhai Hospital, Shanghai, China
| | | | | | - Robert Grimm
- Diagnostic Imaging, Siemens Healthcare, Erlangen, Germany
| | | | - Ali Kamen
- Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ, USA
| | - Thomas Herold
- Department of Radiology, Helios Klinikum Berlin-Buch, Schwanebecker Ch 50, 13125, Berlin, Germany
| | - Clemens Baumann
- Department of Radiology, Helios Klinikum Berlin-Buch, Schwanebecker Ch 50, 13125, Berlin, Germany
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16
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Jung W, Kim EH, Ko J, Jeong G, Choi MH. Convolutional neural network-based reconstruction for acceleration of prostate T 2 weighted MR imaging: a retro- and prospective study. Br J Radiol 2022; 95:20211378. [PMID: 35148172 PMCID: PMC10993971 DOI: 10.1259/bjr.20211378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The aim of this study was to develop a deep neural network (DNN)-based parallel imaging reconstruction for highly accelerated 2D turbo spin echo (TSE) data in prostate MRI without quality degradation compared to conventional scans. METHODS 155 participant data were acquired for training and testing. Two DNN models were generated according to the number of acquisitions (NAQ) of input images: DNN-N1 for NAQ = 1 and DNN-N2 for NAQ = 2. In the test data, DNN and TSE images were compared by quantitative error metrics. The visual appropriateness of DNN reconstructions on accelerated scans (DNN-N1 and DNN-N2) and conventional scans (TSE-Conv) was assessed for nine parameters by two radiologists. The lesion detection was evaluated at DNNs and TES-Conv by prostate imaging-reporting and data system. RESULTS The scan time was reduced by 71% at NAQ = 1, and 42% at NAQ = 2. Quantitative evaluation demonstrated the better error metrics of DNN images (29-43% lower NRMSE, 4-13% higher structure similarity index, and 2.8-4.8 dB higher peak signal-to-noise ratio; p < 0.001) than TSE images. In the assessment of the visual appropriateness, both radiologists evaluated that DNN-N2 showed better or comparable performance in all parameters compared to TSE-Conv. In the lesion detection, DNN images showed almost perfect agreement (κ > 0.9) scores with TSE-Conv. CONCLUSIONS DNN-based reconstruction in highly accelerated prostate TSE imaging showed comparable quality to conventional TSE. ADVANCES IN KNOWLEDGE Our framework reduces the scan time by 42% of conventional prostate TSE imaging without sequence modification, revealing great potential for clinical application.
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Affiliation(s)
| | - Eu Hyun Kim
- Department of Radiology, St.Vincent’s Hospital, College
of Medicine, The Catholic University of Korea, Suwon,
Gyeonggi-do, Republic of Korea
| | - Jingyu Ko
- AIRS Medical, Seoul,
Republic of Korea
| | | | - Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea,
Seoul, Republic of Korea
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17
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Lee DH, Kim B, Lee JM, Lee ES, Choi MH, Kim H. Multidetector CT of Extrahepatic Bile Duct Cancer: Diagnostic Performance of Tumor Resectability and Interreader Agreement. Radiology 2022; 304:96-105. [PMID: 35412364 DOI: 10.1148/radiol.212132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background In extrahepatic bile duct (EHD) cancer, accurate assessment of resectability is essential for curative surgery, but pertinent guidelines from the perspectives of radiologists are yet to be developed. Purpose To investigate the performance of multiphasic CT in the assessment of longitudinal tumor extent, vascular invasion, and resectability of EHD cancer according to the Korean Society of Abdominal Radiology consensus recommendation and to evaluate the interreader agreement. Materials and Methods This retrospective study included patients with EHD cancer who underwent multiphasic CT examinations with section thickness of 3 mm or less before surgery from January 2016 to December 2018. Four abdominal radiologists independently evaluated the overall and biliary segment-wise longitudinal tumor extent, the presence of hepatic artery and/or portal vein invasion, and the resectability according to the Korean Society of Abdominal Radiology recommendations. The diagnostic performance was assessed with sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve. Interreader agreement was determined using κ statistics. Results A total of 112 patients (mean age ± SD, 61 years ± 11; 73 men) were evaluated. The accuracy of the overall longitudinal tumor extent assessment ranged from 56.3% (63 of 112 patients) to 74.1% (83 of 112 patients). The sensitivity for detecting secondary confluence involvement (n = 62) was lower than that for the primary confluence or intrapancreatic duct (n = 115; 38.5%-75% vs 72.1%-96.3%, respectively). Vascular invasion (n = 17) had moderate sensitivity (28.6%-71.4%) and high specificity (77.5%-99.0%). For predicting negative-margin (R0) resection (n = 85), the sensitivity and specificity ranged from 71.8% to 96.5% and from 11.1% to 66.7%, respectively, and the areas under the receiver operating characteristic curve ranged from 0.69 to 0.80. Interreader agreements for tumor extent, vascular invasion, and resectability had κ values of 0.65-0.89, 0.21-0.64, and 0.35-0.56, respectively. Conclusion For the preoperative evaluation of extrahepatic bile duct cancer, the Korean Society of Abdominal Radiology consensus recommendation enabled systematic assessment of longitudinal tumor extent and vascular invasion with acceptable performance in predicting negative-margin resection with use of multiphasic CT and with fair to good interreader agreement. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Dong Ho Lee
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (D.H.L., J.M.L.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (B.K., H.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (E.S.L.); and Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (M.H.C.)
| | - Bohyun Kim
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (D.H.L., J.M.L.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (B.K., H.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (E.S.L.); and Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (M.H.C.)
| | - Jeong Min Lee
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (D.H.L., J.M.L.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (B.K., H.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (E.S.L.); and Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (M.H.C.)
| | - Eun Sun Lee
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (D.H.L., J.M.L.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (B.K., H.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (E.S.L.); and Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (M.H.C.)
| | - Moon Hyung Choi
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (D.H.L., J.M.L.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (B.K., H.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (E.S.L.); and Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (M.H.C.)
| | - Hokun Kim
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (D.H.L., J.M.L.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (B.K., H.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (E.S.L.); and Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (M.H.C.)
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18
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Lee YS, Choi MH, Lee YJ, Han D, Kim DH. Magnetic resonance fingerprinting in prostate cancer before and after contrast enhancement. Br J Radiol 2022; 95:20210479. [PMID: 34415785 PMCID: PMC8978224 DOI: 10.1259/bjr.20210479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To assess the apparent diffusion coefficient (ADC) values and the T1 and T2 values derived from nonenhanced (NE) and contrast-enhanced (CE) magnetic resonance fingerprinting (MRF) in the prostate gland and to evaluate differences in values among prostate cancer, the normal peripheral zone (PZ) and the normal transition zone (TZ). METHODS Fifty-seven patients (median age, 73 years; range, 48-86) with prostate cancer who underwent multiparametric MRI including NE and CE MRF were included in this study. T1 and T2 values were extracted from NE and CE MRF, respectively. Five quantitative values (the ADC, NE T1, NE T2, CE T1 and CE T2 values) were measured in three areas: prostate cancer, PZ and TZ. We compared the values among the three areas and evaluated the differences between NE MRF and CE MRF values. RESULTS ADC values and MRF-derived values were significantly higher in PZ than prostate cancer or TZ (p < 0.001). TZ had a significantly lower CE T1 but significantly higher values of the other variables than prostate cancer (p < 0.001). The T1 values in all three areas and the T2 values in prostate cancer and TZ were significantly lower on CE MRF than on NE MRF (p < 0.001). CONCLUSIONS Quantitative analysis of NE and CE MRI can be conducted by using the MRF technique. The ADC value and the T1 and T2 values from CE MRF and NE MRF were found to be significantly different between prostate cancer and normal prostate tissue. ADVANCES IN KNOWLEDGE The T1 and T2 values from contrast-enhanced MR fingerprinting are significantly different between prostate cancer and normal prostate tissue.
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Affiliation(s)
- Young Sub Lee
- Department of Hospital Pathology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Joon Lee
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dongyeob Han
- Siemens Healthineers Ltd., Seoul, Republic of Korea
| | - Dong-Hyun Kim
- School of Electrical and Electronic Engineering, Yonsei University, Seoul, Korea
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Lee A, Lee J, Yang H, Sung SY, Jeon CH, Kim SH, Choi MH, Lee YJ, Chun HJ, Bae SH. Multidisciplinary treatment with immune checkpoint inhibitors for advanced stage hepatocellular carcinoma. J Liver Cancer 2022; 22:75-83. [PMID: 37383536 PMCID: PMC10035713 DOI: 10.17998/jlc.2022.03.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 06/30/2023]
Abstract
Hepatocellular carcinoma (HCC) is a cytotoxic chemotherapy-resistant tumor and most HCCs arise in a background of liver cirrhosis of various causes. Although the IMBrave150 trial showed remarkable advancements in the treatment of unresectable HCC with atezolizumab plus bevacizumab (AteBeva), therapeutic outcomes were unsatisfactory in more than half of the patients. Accordingly, many ongoing trials combine conventional modalities with new drugs such as immune checkpoint inhibitors for better treatment outcomes, and they are expected to benefit patients with limited responses to conventional treatment. Here, two patients with advanced stage HCC with preserved liver function and good performance status showed partial response after treatment with combination or sequential therapy of AteBeva, hepatic arterial infusion chemotherapy, radiation therapy, and transarterial chemoembolization. These findings indicate the efficacy of multidisciplinary treatment against advanced HCC. Additional studies are required to establish optimal treatment strategies.
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Affiliation(s)
- Ahlim Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jaejun Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Yang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo-Yoon Sung
- Department of Radiation Oncology, The Catholic University of Korea, Seoul, Korea
| | - Chang Ho Jeon
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Su Ho Kim
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Joon Lee
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho Jong Chun
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Si Hyun Bae
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
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20
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Kim YM, Choi MH, Lee JH, Lim YJ, Kim YJ, Park JS, Hong SJ, Oh JS, Park JS, Lee AL, Jung SE. Development of Entrustable Professional Activity, Core Competencies, and Guidelines in 2021 Radiology Competency Education Project. J Korean Soc Radiol 2022; 83:284-292. [PMID: 36237921 PMCID: PMC9514427 DOI: 10.3348/jksr.2021.0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 12/03/2022]
Abstract
급변하고 있는 의료환경에서 전공의에게 양질의 수련을 제공하기 위해 연차별 수련교과과정을 역량 중심으로 개선하고, 수련병원이 수련에 적합한 환경을 유지하도록 하는 것은 매우 중요하다. 대한영상의학회는 그동안 수련체계 개선을 꾸준히 진행해 왔고, 전공의 역량평가와 지도전문의의 내용을 강화하여 역량 중심 전공의 수련체계 개선을 제시하였다. 현재 대한영상의학회는 2021년 7월 제2차 연차별 수련교과과정 체계화 구축 사업에 선정되어 구축 사업을 추진하고 있으며, 구축 사업에서 요구하는 위임가능 전문직무와 핵심역량 평가항목 및 평가 가이드라인을 개발하였다. 이에 대한 개발과정과 평가항목 및 평가 가이드라인을 소개하여 전공의와 지도전문의들에게 정보를 제공하고자 한다.
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Affiliation(s)
- You Me Kim
- Department of Radiology, Dankook University Hospital, Cheonan, Korea
| | - Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary’s Hospital, Seoul, Korea
| | - Jei Hee Lee
- Department of Radiology, Ajou University Hospital, Suwon, Korea
| | - Yun-Jung Lim
- Department of Radiology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Young Jin Kim
- Department of Radiology, Severance Hospital, Seoul, Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University Hospital, Seoul, Korea
| | - Su Jin Hong
- Department of Radiology, Hanyang University Guri Hospital, Guri, Korea
| | - Jung Suk Oh
- Department of Radiology, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Ji Seon Park
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
| | - A Leum Lee
- Departmentof Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Seung Eun Jung
- Department of Radiology, Eunpyeong St. Mary’s Hospital, Seoul, Korea
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21
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Uhm KH, Jung SW, Choi MH, Hong SH, Ko SJ. A Unified Multi-Phase CT Synthesis and Classification Framework for Kidney Cancer Diagnosis with Incomplete Data. IEEE J Biomed Health Inform 2022; 26:6093-6104. [PMID: 36327174 DOI: 10.1109/jbhi.2022.3219123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Multi-phase computed tomography (CT) is widely adopted for the diagnosis of kidney cancer due to the complementary information among phases. However, the complete set of multi-phase CT is often not available in practical clinical applications. In recent years, there have been some studies to generate the missing modality image from the available data. Nevertheless, the generated images are not guaranteed to be effective for the diagnosis task. In this paper, we propose a unified framework for kidney cancer diagnosis with incomplete multi-phase CT, which simultaneously recovers missing CT images and classifies cancer subtypes using the completed set of images. The advantage of our framework is that it encourages a synthesis model to explicitly learn to generate missing CT phases that are helpful for classifying cancer subtypes. We further incorporate lesion segmentation network into our framework to exploit lesion-level features for effective cancer classification in the whole CT volumes. The proposed framework is based on fully 3D convolutional neural networks to jointly optimize both synthesis and classification of 3D CT volumes. Extensive experiments on both in-house and external datasets demonstrate the effectiveness of our framework for the diagnosis with incomplete data compared with state-of-the-art baselines. In particular, cancer subtype classification using the completed CT data by our method achieves higher performance than the classification using the given incomplete data.
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Affiliation(s)
- Kwang-Hyun Uhm
- Department of Electrical Engineering, Korea University, Seongbuk- gu, Seoul, South Korea
| | - Seung-Won Jung
- Department of Electrical Engineering, Korea University, Seongbuk- gu, Seoul, South Korea
| | - Moon Hyung Choi
- Department of Radiology, The Catholic University of Korea, Seoul, South Korea
| | - Sung-Hoo Hong
- Department of Urology, The Catholic University of Korea, Seoul, South Korea
| | - Sung-Jea Ko
- Department of Electrical Engineering, Korea University, Seongbuk- gu, Seoul, South Korea
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Choi MH, Lee SW, Kim HG, Kim JY, Oh SW, Han D, Kim DH. 3D MR fingerprinting (MRF) for simultaneous T1 and T2 quantification of the bone metastasis: Initial validation in prostate cancer patients. Eur J Radiol 2021; 144:109990. [PMID: 34638082 DOI: 10.1016/j.ejrad.2021.109990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the feasibility of using 3-dimensional MRF for bone marrow evaluation in the field of view of prostate MRI for T1 and T2 quantification of prostate cancer bone metastases, as well as comparing it to the ADC value. METHODS In this retrospective study, 30 prostate MRIs were included: 14 cases with prostate cancer bone metastasis and 16 cases without prostate cancer (control). MRF was obtained twice before (nonenhanced [NE] MRF) and after contrast injection (contrast-enhanced [CE] MRF), and T1 and T2 maps were generated from each MRF. Two radiologists independently drew regions of interest (ROIs) on the MRF maps and the ADC maps. Mann-Whitney U tests and the area under the receiver operating characteristic curve (AUROC) evaluated the two-reader means of T1, T2 and ADC values between bone metastasis and normal bone. RESULTS There were 83 ROIs, including 39 bone metastases and 44 normal bone. The two-reader average ADC, NE T2 and CE T2 values were significantly lower and NE T1 and CE T1 values were significantly higher in metastatic bone compared with normal bone (P < 0.001). The AUROC of the ADC was lowest (0.685), which was significantly lower than those of NE T1 (1.0, P = 0.001), NE T2 (0.932, P = 0.004), and CE T2 (0.876, P = 0.031). CONCLUSION MRF to assess the pelvic bone during a prostate gland evaluation provides a reliable parametric map for skeletal work-up. With higher diagnostic performance than the ADC value, NE MRF is a potential alternative for quantifying bone marrow metastases in prostate cancer patients.
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Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sheen-Woo Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Hyun Gi Kim
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jee Young Kim
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Se Won Oh
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dongyeob Han
- Siemens Healthineers Ltd., Seoul, Republic of Korea
| | - Dong-Hyun Kim
- School of Electrical and Electronic Engineering, Yonsei University, Seoul, Republic of Korea
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Winkel DJ, Tong A, Lou B, Kamen A, Comaniciu D, Disselhorst JA, Rodríguez-Ruiz A, Huisman H, Szolar D, Shabunin I, Choi MH, Xing P, Penzkofer T, Grimm R, von Busch H, Boll DT. A Novel Deep Learning Based Computer-Aided Diagnosis System Improves the Accuracy and Efficiency of Radiologists in Reading Biparametric Magnetic Resonance Images of the Prostate: Results of a Multireader, Multicase Study. Invest Radiol 2021; 56:605-613. [PMID: 33787537 DOI: 10.1097/rli.0000000000000780] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the effect of a deep learning based computer-aided diagnosis (DL-CAD) system on radiologists' interpretation accuracy and efficiency in reading biparametric prostate magnetic resonance imaging scans. MATERIALS AND METHODS We selected 100 consecutive prostate magnetic resonance imaging cases from a publicly available data set (PROSTATEx Challenge) with and without histopathologically confirmed prostate cancer. Seven board-certified radiologists were tasked to read each case twice in 2 reading blocks (with and without the assistance of a DL-CAD), with a separation between the 2 reading sessions of at least 2 weeks. Reading tasks were to localize and classify lesions according to Prostate Imaging Reporting and Data System (PI-RADS) v2.0 and to assign a radiologist's level of suspicion score (scale from 1-5 in 0.5 increments; 1, benign; 5, malignant). Ground truth was established by consensus readings of 3 experienced radiologists. The detection performance (receiver operating characteristic curves), variability (Fleiss κ), and average reading time without DL-CAD assistance were evaluated. RESULTS The average accuracy of radiologists in terms of area under the curve in detecting clinically significant cases (PI-RADS ≥4) was 0.84 (95% confidence interval [CI], 0.79-0.89), whereas the same using DL-CAD was 0.88 (95% CI, 0.83-0.94) with an improvement of 4.4% (95% CI, 1.1%-7.7%; P = 0.010). Interreader concordance (in terms of Fleiss κ) increased from 0.22 to 0.36 (P = 0.003). Accuracy of radiologists in detecting cases with PI-RADS ≥3 was improved by 2.9% (P = 0.10). The median reading time in the unaided/aided scenario was reduced by 21% from 103 to 81 seconds (P < 0.001). CONCLUSIONS Using a DL-CAD system increased the diagnostic accuracy in detecting highly suspicious prostate lesions and reduced both the interreader variability and the reading time.
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Affiliation(s)
- David J Winkel
- From the Department of Radiology, University Hospital of Basel, Basel, Basel-Stadt, Switzerland
| | - Angela Tong
- Department of Radiology, NYU Langone Health, New York, NY
| | - Bin Lou
- Siemens Healthineers, Digital Technology and Innovation, Princeton, NJ
| | - Ali Kamen
- Siemens Healthineers, Digital Technology and Innovation, Princeton, NJ
| | - Dorin Comaniciu
- Siemens Healthineers, Digital Technology and Innovation, Princeton, NJ
| | | | | | - Henkjan Huisman
- Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - Moon Hyung Choi
- Eunpyeong St Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea
| | - Pengyi Xing
- Radiology Department, Changhai Hospital of Shanghai, Shanghai, China
| | | | - Robert Grimm
- Siemens Healthineers Diagnostic Imaging, Erlangen, Germany
| | | | - Daniel T Boll
- From the Department of Radiology, University Hospital of Basel, Basel, Basel-Stadt, Switzerland
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24
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Youn SY, Choi MH, Kim DH, Lee YJ, Huisman H, Johnson E, Penzkofer T, Shabunin I, Winkel DJ, Xing P, Szolar D, Grimm R, von Busch H, Son Y, Lou B, Kamen A. Detection and PI-RADS classification of focal lesions in prostate MRI: Performance comparison between a deep learning-based algorithm (DLA) and radiologists with various levels of experience. Eur J Radiol 2021; 142:109894. [PMID: 34388625 DOI: 10.1016/j.ejrad.2021.109894] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/30/2021] [Accepted: 08/01/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE To compare the performance of lesion detection and Prostate Imaging-Reporting and Data System (PI-RADS) classification between a deep learning-based algorithm (DLA), clinical reports and radiologists with different levels of experience in prostate MRI. METHODS This retrospective study included 121 patients who underwent prebiopsy MRI and prostate biopsy. More than five radiologists (Reader groups 1, 2: residents; Readers 3, 4: less-experienced radiologists; Reader 5: expert) independently reviewed biparametric MRI (bpMRI). The DLA results were obtained using bpMRI. The reference standard was based on pathologic reports. The diagnostic performance of the PI-RADS classification of DLA, clinical reports, and radiologists was analyzed using AUROC. Dichotomous analysis (PI-RADS cutoff value ≥ 3 or 4) was performed, and the sensitivities and specificities were compared using McNemar's test. RESULTS Clinically significant cancer [CSC, Gleason score ≥ 7] was confirmed in 43 patients (35.5%). The AUROC of the DLA (0.828) for diagnosing CSC was significantly higher than that of Reader 1 (AUROC, 0.706; p = 0.011), significantly lower than that of Reader 5 (AUROC, 0.914; p = 0.013), and similar to clinical reports and other readers (p = 0.060-0.661). The sensitivity of DLA (76.7%) was comparable to those of all readers and the clinical reports at a PI-RADS cutoff value ≥ 4. The specificity of the DLA (85.9%) was significantly higher than those of clinical reports and Readers 2-3 and comparable to all others at a PI-RADS cutoff value ≥ 4. CONCLUSIONS The DLA showed moderate diagnostic performance at a level between those of residents and an expert in detecting and classifying according to PI-RADS. The performance of DLA was similar to that of clinical reports from various radiologists in clinical practice.
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Affiliation(s)
- Seo Yeon Youn
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Moon Hyung Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Seoul, Republic of Korea.
| | - Dong Hwan Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Young Joon Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Seoul, Republic of Korea.
| | - Henkjan Huisman
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Evan Johnson
- Department of Radiology, New York University, NY, USA
| | - Tobias Penzkofer
- Department of Radiology, Charité, Universitätsmedizin Berlin, Berlin, Germany.
| | | | - David Jean Winkel
- Department of Radiology, University Hospital of Basel, Basel, Switzerland.
| | - Pengyi Xing
- Department of Radiology, Changhai Hospital, Shanghai, China.
| | | | - Robert Grimm
- Diagnostic Imaging, Siemens Healthcare, Erlangen, Germany.
| | | | - Yohan Son
- Siemens Healthineers Ltd., Seoul, Republic of Korea.
| | - Bin Lou
- Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ, USA.
| | - Ali Kamen
- Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ, USA.
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Uhm KH, Jung SW, Choi MH, Shin HK, Yoo JI, Oh SW, Kim JY, Kim HG, Lee YJ, Youn SY, Hong SH, Ko SJ. Deep learning for end-to-end kidney cancer diagnosis on multi-phase abdominal computed tomography. NPJ Precis Oncol 2021; 5:54. [PMID: 34145374 PMCID: PMC8213852 DOI: 10.1038/s41698-021-00195-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/26/2021] [Indexed: 11/09/2022] Open
Abstract
In 2020, it is estimated that 73,750 kidney cancer cases were diagnosed, and 14,830 people died from cancer in the United States. Preoperative multi-phase abdominal computed tomography (CT) is often used for detecting lesions and classifying histologic subtypes of renal tumor to avoid unnecessary biopsy or surgery. However, there exists inter-observer variability due to subtle differences in the imaging features of tumor subtypes, which makes decisions on treatment challenging. While deep learning has been recently applied to the automated diagnosis of renal tumor, classification of a wide range of subtype classes has not been sufficiently studied yet. In this paper, we propose an end-to-end deep learning model for the differential diagnosis of five major histologic subtypes of renal tumors including both benign and malignant tumors on multi-phase CT. Our model is a unified framework to simultaneously identify lesions and classify subtypes for the diagnosis without manual intervention. We trained and tested the model using CT data from 308 patients who underwent nephrectomy for renal tumors. The model achieved an area under the curve (AUC) of 0.889, and outperformed radiologists for most subtypes. We further validated the model on an independent dataset of 184 patients from The Cancer Imaging Archive (TCIA). The AUC for this dataset was 0.855, and the model performed comparably to the radiologists. These results indicate that our model can achieve similar or better diagnostic performance than radiologists in differentiating a wide range of renal tumors on multi-phase CT.
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Affiliation(s)
- Kwang-Hyun Uhm
- Department of Electrical Engineering, Korea University, Seoul, South Korea
| | - Seung-Won Jung
- Department of Electrical Engineering, Korea University, Seoul, South Korea
| | - Moon Hyung Choi
- Department of Radiology, The Catholic University of Korea, Seoul, South Korea
| | - Hong-Kyu Shin
- Department of Electrical Engineering, Korea University, Seoul, South Korea
| | - Jae-Ik Yoo
- Department of Electrical Engineering, Korea University, Seoul, South Korea
| | - Se Won Oh
- Department of Radiology, The Catholic University of Korea, Seoul, South Korea
| | - Jee Young Kim
- Department of Radiology, The Catholic University of Korea, Seoul, South Korea
| | - Hyun Gi Kim
- Department of Radiology, The Catholic University of Korea, Seoul, South Korea
| | - Young Joon Lee
- Department of Radiology, The Catholic University of Korea, Seoul, South Korea
| | - Seo Yeon Youn
- Department of Radiology, The Catholic University of Korea, Seoul, South Korea
| | - Sung-Hoo Hong
- Department of Urology, The Catholic University of Korea, Seoul, South Korea.
| | - Sung-Jea Ko
- Department of Electrical Engineering, Korea University, Seoul, South Korea.
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26
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Han D, Choi MH, Lee YJ, Kim DH. Feasibility of Novel Three-Dimensional Magnetic Resonance Fingerprinting of the Prostate Gland: Phantom and Clinical Studies. Korean J Radiol 2021; 22:1332-1340. [PMID: 34047506 PMCID: PMC8316768 DOI: 10.3348/kjr.2020.1362] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/08/2021] [Accepted: 03/17/2021] [Indexed: 01/24/2023] Open
Abstract
Objective To evaluate the feasibility of a new three-dimensional (3D) MR fingerprinting (MRF) technique for the prostate gland by conducting phantom and clinical studies. Materials and Methods The new 3D MRF technique used in this study enables quick data acquisition and has a high resolution. For the phantom study, the MRF T1 and T2 values in an in-house phantom were compared with those of gold-standard mapping methods using linear regression analysis. For the clinical study, we evaluated 90 patients who underwent prostate imaging with MRF for suspected prostate cancer between September 2019 and February 2020. The mean T1 and T2 values were compared in the peripheral zone, transition zone, and focal lesions using paired t tests. The differences in the T1 and T2 values according to cancer aggressiveness were evaluated using one-way analysis of variance. Results In the phantom study, the MRF T1 and T2 values showed a perfect correlation with the gold-standard T1 and T2 values (R > 0.99). In the clinical study, the T1 and T2 values in the peripheral zone were significantly higher than those in the transitional zone (p < 0.001, both). The T1 and T2 values in prostate cancer were significantly lower than those in the peripheral and transitional zones. The higher the grade of cancer, the lower the T2 values. Conclusion The T1 and T2 values obtained from the 3D MRF showed a perfect correlation with the gold standard values in the phantom study. Differences in the T1 and T2 values among the different zones of the prostate gland were identified using 3D MRF in patients.
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Affiliation(s)
| | - Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Young Joon Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Hyun Kim
- School of Electrical and Electronic Engineering, Yonsei University, Seoul, Korea
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27
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Youn SY, Kim DH, Choi JI, Choi MH, Kim B, Shin YR, Oh SN, Rha SE. Usefulness of Arterial Subtraction in Applying Liver Imaging Reporting and Data System (LI-RADS) Treatment Response Algorithm to Gadoxetic Acid-Enhanced MRI. Korean J Radiol 2021; 22:1289-1299. [PMID: 34047507 PMCID: PMC8316782 DOI: 10.3348/kjr.2020.1394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/21/2021] [Accepted: 02/16/2021] [Indexed: 12/19/2022] Open
Abstract
Objective We aimed to evaluate the usefulness of arterial subtraction images for predicting the viability of hepatocellular carcinoma (HCC) after locoregional therapy (LRT) using gadoxetic acid-enhanced MRI and the Liver Imaging Reporting and Data System treatment response (LR-TR) algorithm. Materials and Methods This study included 90 patients (mean age ± standard deviation, 57 ± 9 years) who underwent liver transplantation or resection after LRT and had 73 viable and 32 nonviable HCCs. All patients underwent gadoxetic acid-enhanced MRI before surgery. Two radiologists assessed the presence of LR-TR features, including arterial phase hyperenhancement (APHE) and LR-TR categories (viable, nonviable, or equivocal), using ordinary arterial-phase and arterial subtraction images. The reference standard for tumor viability was surgical pathology. The sensitivity of APHE for diagnosing viable HCC was compared between ordinary arterial-phase and arterial subtraction images. The sensitivity and specificity of the LR-TR algorithm for diagnosing viable HCC was compared between the use of ordinary arterial-phase and the use of arterial subtraction images. Subgroup analysis was performed on lesions treated with transarterial chemoembolization (TACE) only. Results The sensitivity of APHE for viable HCCs was higher for arterial subtraction images than ordinary arterial-phase images (71.2% vs. 47.9%; p < 0.001). LR-TR viable category with the use of arterial subtraction images compared with ordinary arterial-phase images showed a significant increase in sensitivity (76.7% [56/73] vs. 63.0% [46/73]; p = 0.002) without significant decrease in specificity (90.6% [29/32] vs. 93.8% [30/32]; p > 0.999). In a subgroup of 63 lesions treated with TACE only, the use of arterial subtraction images showed a significant increase in sensitivity (81.4% [35/43] vs. 67.4% [29/43]; p = 0.031) without significant decrease in specificity (85.0% [17/20] vs. 90.0% [18/20]; p > 0.999). Conclusion Use of arterial subtraction images compared with ordinary arterial-phase images improved the sensitivity while maintaining specificity for diagnosing viable HCC after LRT using gadoxetic acid-enhanced MRI and the LR-TR algorithm.
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Affiliation(s)
- Seo Yeon Youn
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Hwan Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Joon Il Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bohyun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yu Ri Shin
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soon Nam Oh
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Eun Rha
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Choi MH, Lee YJ, Choi YJ, Pak S. Dual-energy CT of the liver: True noncontrast vs. virtual noncontrast images derived from multiple phases for the diagnosis of fatty liver. Eur J Radiol 2021; 140:109741. [PMID: 33991971 DOI: 10.1016/j.ejrad.2021.109741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/03/2021] [Accepted: 04/22/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the difference in liver density and to compare the performance to diagnose fatty liver between true noncontrast (TNC) images and virtual noncontrast (VNC) images generated from dual-energy CT (DECT). MATERIALS AND METHODS Patients who underwent liver dynamic DECT and MRI were included (n = 49). Two observers measured the liver and spleen densities on TNC images and three VNC images from the arterial, portal and delayed phases of DECT (VNCa, VNCp and VNCd, respectively). The liver-minus-spleen density (density L-S) and liver-to-spleen ratio (density L/S) were calculated. The CT parameters were compared between normal liver patients and fatty liver patients by using the independent t-test. Differences and agreements between measurements on TNC images and VNC images were evaluated by using the paired t-test and Bland-Altman analysis. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic performance of CT parameters for diagnosing fatty liver. RESULTS All CT parameters measured on TNC and VNC images were significantly higher in normal liver patients than in fatty liver patients. Although the mean liver densities on VNC images were significantly lower than those on TNC images, all CT parameters showed good agreement between TNC images and VNC images. The diagnostic performances of CT parameters on VNC images were not significantly different from those on TNC images. CONCLUSION Although the liver and spleen density on VNC images was significantly lower than that on TNC images, the diagnostic performances of CT parameters on three VNC images from multiple phases were similar to those on TNC images for diagnosing fatty liver.
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Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Young Joon Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea.
| | - Yun Jeong Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - SeongYong Pak
- Siemens Healthineers Ltd., 23 Chungjeong-ro, Seoul, 03737, Republic of Korea
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29
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Sung PS, Choi MH, Yang H, Lee SK, Chun HJ, Jang JW, Choi JY, Yoon SK, Choi JI, Lee YJ, Bae SH. Diffusion-Weighted Magnetic Resonance Imaging in Hepatocellular Carcinoma as a Predictor of a Response to Cisplatin-Based Hepatic Arterial Infusion Chemotherapy. Front Oncol 2020; 10:600233. [PMID: 33330098 PMCID: PMC7711158 DOI: 10.3389/fonc.2020.600233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022] Open
Abstract
This study aimed to identify the utility of diffusion-weighted magnetic resonance (MR) imaging with an apparent diffusion coefficient (ADC) map as a predictor of the response of hepatocellular carcinoma (HCC) to cisplatin-based hepatic arterial infusion chemotherapy (HAIC). We retrospectively evaluated 113 consecutive patients with Barcelona Clinical Liver Cancer (BCLC) stage B or C HCC, who underwent gadoxetic acid-enhanced and diffusion-weighted MR imaging. The appropriate cutoff for the pretreatment tumor-to-liver ADC ratio was determined to be 0.741. Of the 113 patients, 50 (44%) presented with a pretreatment tumor-to-liver ADC ratio < 0.741 (low group). Evaluation of the treatment response after 2-3 cycles of HAIC in these 50 patients revealed that 21 patients (42%) experienced an objective response to HAIC. On the other hand, only 11 of the 63 patients (17%) with a pretreatment tumor-to-liver ADC ratio ≥ 0.741 (high group) showed an objective response. Thus, the objective response rate was significantly higher in the low group than in the high group (P = 0.006). Multivariate logistic regression analysis using parameters including perfusion alteration, percentage of non-enhancing portions, and pretreatment tumor-to-liver ADC ratio revealed that a pretreatment tumor-to-liver ADC ratio < 0.741 (odds ratio 3.217; P = 0.014) was the sole predictor of an objective response to HAIC. Overall survival rates were significantly higher in patients with objective responses to HAIC than in those without objective responses (P = 0.001 by log-rank test). In conclusion, patients with BCLC stage C or C HCC with a pretreatment tumor-to-liver ADC ratio < 0.741 showed a favorable intrahepatic response to cisplatin-based HAIC. Therefore, diffusion-weighted MR imaging can play a critical role as a predictor of response to cisplatin-based HAIC in unresectable HCC.
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Affiliation(s)
- Pil Soo Sung
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Moon Hyung Choi
- Department of Radiology, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Hyun Yang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Soon Kyu Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Ho Jong Chun
- Department of Radiology, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jeong Won Jang
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jong Young Choi
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Seung Kew Yoon
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Joon-Il Choi
- Department of Radiology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Young Joon Lee
- Department of Radiology, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Si Hyun Bae
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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30
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Bae S, Jang J, Choi MH, Song TK. In Vivo Evaluation of Plane Wave Imaging for Abdominal Ultrasonography. Sensors (Basel) 2020; 20:E5675. [PMID: 33027916 PMCID: PMC7584017 DOI: 10.3390/s20195675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/29/2020] [Accepted: 10/03/2020] [Indexed: 12/18/2022]
Abstract
Although plane wave imaging (PWI) has been extensively employed for ultrafast ultrasound imaging, its potential for sectorial B-mode imaging with a convex array transducer has not yet been widely recognized. Recently, we reported an optimized PWI approach for sector scanning that exploits the dynamic transmit focusing capability. In this paper, we first report the clinical applicability of the optimized PWI for abdominal ultrasonography by in vivo image and video evaluations and compare it with conventional focusing (CF) and diverging wave imaging (DWI), which is another dynamic transmit focusing technique generally used for sectorial imaging. In vivo images and videos of the liver, kidney, and gallbladder were obtained from 30 healthy volunteers using PWI, DWI, and CF. Three radiologists assessed the phantom images, 156 in vivo images, and 66 in vivo videos. PWI showed significantly enhanced (p < 0.05) spatial resolution, contrast, and noise and artifact reduction, and a 4-fold higher acquisition rate compared to CF and provided similar performances compared to DWI. Because the computations required for PWI are considerably lower than that for DWI, PWI may represent a promising technique for sectorial imaging in abdominal ultrasonography that provides better image quality and eliminates the need for focal depth adjustment.
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Affiliation(s)
- Sua Bae
- Department of Electronic Engineering, Sogang University, Seoul 04107, Korea; (S.B.); (J.J.)
| | - Jintae Jang
- Department of Electronic Engineering, Sogang University, Seoul 04107, Korea; (S.B.); (J.J.)
| | - Moon Hyung Choi
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 03312, Korea
| | - Tai-Kyong Song
- Department of Electronic Engineering, Sogang University, Seoul 04107, Korea; (S.B.); (J.J.)
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31
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Lee MS, Moon MH, Kim CK, Park SY, Choi MH, Jung SI. Guidelines for Transrectal Ultrasonography-Guided Prostate Biopsy: Korean Society of Urogenital Radiology Consensus Statement for Patient Preparation, Standard Technique, and Biopsy-Related Pain Management. Korean J Radiol 2020; 21:422-430. [PMID: 32193890 PMCID: PMC7082664 DOI: 10.3348/kjr.2019.0576] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/12/2019] [Indexed: 11/15/2022] Open
Abstract
The Korean Society of Urogenital Radiology (KSUR) aimed to present a consensus statement for patient preparation, standard technique, and pain management in relation to transrectal ultrasound-guided prostate biopsy (TRUS-Bx) to reduce the variability in TRUS-Bx methodologies and suggest a nationwide guideline. The KSUR guideline development subcommittee constructed questionnaires assessing prebiopsy anticoagulation, the cleansing enema, antimicrobial prophylaxis, local anesthesia methods such as periprostatic neurovascular bundle block (PNB) or intrarectal lidocaine gel application (IRLA), opioid usage, and the number of biopsy cores and length and diameter of the biopsy needle. The survey was conducted using an Internet-based platform, and responses were solicited from the 90 members registered on the KSUR mailing list as of 2018. A comprehensive search of relevant literature from Medline database was conducted. The strength of each recommendation was graded on the basis of the level of evidence. Among the 90 registered members, 29 doctors (32.2%) responded to this online survey. Most KSUR members stopped anticoagulants (100%) and antiplatelets (76%) one week before the procedure. All respondents performed a cleansing enema before TRUS-Bx. Approximately 86% of respondents administered prophylactic antibiotics before TRUS-Bx. The most frequently used antibiotics were third-generation cephalosporins. PNB was the most widely used pain control method, followed by a combination of PNB plus IRLA. Opioids were rarely used (6.8%), and they were used only as an adjunctive pain management approach during TRUS-Bx. The KSUR members mainly chose the 12-core biopsy method (89.7%) and 18G 16-mm or 22-mm (96.5%) needles. The KSUR recommends the 12-core biopsy scheme with PNB with or without IRLA as the standard protocol for TRUS-Bx. Anticoagulants and antiplatelet agents should be discontinued at least 5 days prior to the procedure, and antibiotic prophylaxis is highly recommended to prevent infectious complications. Glycerin cleansing enemas and administration of opioid analogues before the procedure could be helpful in some situations. The choice of biopsy needle is dependent on the practitioners' situation and preferences.
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Affiliation(s)
- Myoung Seok Lee
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Min Hoan Moon
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
| | - Chan Kyo Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Yoon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon Hyung Choi
- Department of Radiology, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Seoul, Korea
| | - Sung Il Jung
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Oh JW, Rha SE, Choi MH, Oh SN, Youn SY, Choi JI. Immunoglobulin G4-related Disease of the Genitourinary System: Spectrum of Imaging Findings and Clinical-Pathologic Features. Radiographics 2020; 40:1265-1283. [PMID: 32870766 DOI: 10.1148/rg.2020200043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a systemic fibroinflammatory disease characterized by focal or diffuse organ infiltration of IgG4-bearing plasma cells. The diagnosis of IgG4-RD is based on a combination of clinical, serologic, radiologic, and histopathologic findings. IgG4-RD has been reported to affect almost all organ systems. The kidney is the most frequently involved of the genitourinary organs. The most common renal manifestation of IgG4-RD is IgG4-RD tubulointerstitial nephritis, followed by membranous glomerulonephropathy and, less frequently, obstructive nephropathy involving the renal pelvis, ureter, or retroperitoneum. Renal parenchymal lesions may appear as multiple nodular lesions, diffuse patchy infiltrative lesions, or a single nodular lesion. Multiple small nodular cortical lesions are the most common imaging findings of IgG4-RD involving the kidney. Renal pelvic, sinus, or perinephric lesions can also occur. IgG4-RD involvement of other genitourinary organs including the ureter, bladder, urethra, and male and female reproductive organs is rare compared with kidney involvement but may show variable imaging findings such as a localized mass within or surrounding the involved organ or diffuse enlargement of the involved organ. Imaging findings of IgG4-RD involving the genitourinary system are nonspecific but should be differentiated from inflammatory and neoplastic lesions that mimic IgG4-RD. The online slide presentation from the RSNA Annual Meeting is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Ji Woon Oh
- From the Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea (J.W.O., S.E.R., S.N.O., S.Y.Y., J.C.); and Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (M.H.C.)
| | - Sung Eun Rha
- From the Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea (J.W.O., S.E.R., S.N.O., S.Y.Y., J.C.); and Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (M.H.C.)
| | - Moon Hyung Choi
- From the Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea (J.W.O., S.E.R., S.N.O., S.Y.Y., J.C.); and Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (M.H.C.)
| | - Soon Nam Oh
- From the Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea (J.W.O., S.E.R., S.N.O., S.Y.Y., J.C.); and Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (M.H.C.)
| | - Seo Yeon Youn
- From the Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea (J.W.O., S.E.R., S.N.O., S.Y.Y., J.C.); and Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (M.H.C.)
| | - Joon-Il Choi
- From the Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea (J.W.O., S.E.R., S.N.O., S.Y.Y., J.C.); and Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (M.H.C.)
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Choi MH, Lee YJ, Jung SE. Tracking Changes in Clinical Practice Patterns Following Prebiopsy Biparametric Prostate MRI. Acad Radiol 2020; 27:1255-1260. [PMID: 31812576 DOI: 10.1016/j.acra.2019.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 12/25/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the change in clinical practice after implementation of prebiopsy biparametric MRI followed by targeted biopsy and the benefits of prebiopsy MRI based on real clinical practice. MATERIALS AND METHODS A total of 1,661 patients who underwent either transrectal biopsy or prebiopsy MRI for suspected prostate cancer between October 2015 and March 2018 were enrolled in this retrospective single-center study. To evaluate temporal changes in clinical practice, the study time was divided into five periods of six months. Prebiopsy prostate MRI was officially started in April 2016 in this center. Differences in practice patterns were compared among the five periods, and differences in biopsy results were compared in three groups: no prebiopsy MRI, negative MRI and positive MRI. RESULTS Prostate cancers were diagnosed in 463 patients. The proportion of patients who underwent prebiopsy MRI regardless of biopsy increased from 22.6% in period 1 to 84.4% in period 5 (P < 0.001). The proportion of patients who avoided biopsy according to MRI results increased significantly from 9.0% in period 1 to 48.1% in period 5 (P < 0.001). The prostate cancer detection rate and the number of positive cores were lower in the negative MRI group than those in the positive MRI and no prebiopsy MRI groups. CONCLUSION Prebiopsy MRI using biparametric MRI protocol has been well adapted to the practice and it is useful in stratifying the probability of clinically significant prostate cancer.
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Rha SE, Oh JW, Choi MH, Oh SN, Youn SY, Choi JI. Immunoglobulin G4–related Disease of the Genitourinary System: Spectrum of Imaging Findings and Clinical-Pathologic Features. Radiographics 2020. [DOI: 10.1148/rg.2020200043.pres] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lee DH, Kim B, Lee ES, Kim HJ, Min JH, Lee JM, Choi MH, Seo N, Choi SH, Kim SH, Lee SS, Park YS, Chung YE. Radiologic Evaluation and Structured Reporting Form for Extrahepatic Bile Duct Cancer: 2019 Consensus Recommendations from the Korean Society of Abdominal Radiology. Korean J Radiol 2020; 22:41-62. [PMID: 32901457 PMCID: PMC7772383 DOI: 10.3348/kjr.2019.0803] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 12/15/2022] Open
Abstract
Radiologic imaging is important for evaluating extrahepatic bile duct (EHD) cancers; it is used for staging tumors and evaluating the suitability of surgical resection, as surgery may be contraindicated in some cases regardless of tumor stage. However, the published general recommendations for EHD cancer and recommendations guided by the perspectives of radiologists are limited. The Korean Society of Abdominal Radiology (KSAR) study group for EHD cancer developed key questions and corresponding recommendations for the radiologic evaluation of EHD cancer and organized them into 4 sections: nomenclature and definition, imaging technique, cancer evaluation, and tumor response. A structured reporting form was also developed to allow the progressive accumulation of standardized data, which will facilitate multicenter studies and contribute more evidence for the development of recommendations.
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Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Bohyun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyoung Jung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nieun Seo
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seong Hyun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yang Shin Park
- Department of Radiology, Korea University Guro Hospital, Seoul, Korea
| | - Yong Eun Chung
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.
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Lee CS, Won DD, Oh SN, Lee YS, Lee IK, Kim IH, Choi MH, Oh ST. Prognostic role of pre-sarcopenia and body composition with long-term outcomes in obstructive colorectal cancer: a retrospective cohort study. World J Surg Oncol 2020; 18:230. [PMID: 32859211 PMCID: PMC7456379 DOI: 10.1186/s12957-020-02006-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/18/2020] [Indexed: 01/06/2023] Open
Abstract
Background The clinical significance of pre-sarcopenia in colorectal cancer obstruction has not yet been described. The present study aimed to determine the short- and long-term oncologic impacts of pre-sarcopenia in obstructive colorectal cancer. Methods We retrospectively analyzed 214 patients with obstructive colon cancer between January 2004 and December 2013. Initial staging computed tomography (CT) scans identified pre-sarcopenia and visceral obesity by measuring the muscle and visceral fat areas at the third lumbar vertebra level. Both short-term postoperative and long-term oncologic outcomes were analyzed. Results Among all 214 patients, 71 (33.2%) were diagnosed with pre-sarcopenia. Pre-sarcopenia had a negative oncologic impact in both disease-free survival (DFS) and overall survival (OS), (hazard ratio [HR] = 1.86, 95% confidence interval [CI] 1.04–3.13, p = 0.037, and HR = 1.92, CI 1.02–3.60, p = 0.043, respectively). Visceral adiposity, body mass index (BMI), and neutrophil-lymphocyte ratio (NLR) did not significantly impact DFS and OS. Conclusion Pre-sarcopenia is a clinical factor significantly associated with OS and DFS but not with short-term complications in obstructive colorectal cancer. In future, prospective studies should incorporate body composition data in patient risk assessments and oncologic prediction tools.
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Affiliation(s)
- Chul Seung Lee
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Graduate School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Daeyoun David Won
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soon Nam Oh
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoon Suk Lee
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Kyu Lee
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In-Ho Kim
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seong Taek Oh
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-Ro, Uijeongbu-si, Gyeonggi-do, 11765, Seoul, Republic of Korea.
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Choi MH, Lee YJ, Jung SE. A LESSON FROM AUTOMATIC TUBE VOLTAGE SELECTION: FEASIBILITY OF 100 kVp IN PORTAL VENOUS PHASE ABDOMINAL CT. Radiat Prot Dosimetry 2020; 188:424-431. [PMID: 31998958 DOI: 10.1093/rpd/ncz302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/17/2019] [Accepted: 12/23/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE To evaluate the relationship between ATVS-recommended tube voltage and patient body habitus and to compare radiation dose and diagnostic performance between fixed 120-kVp and ATVS protocols in portal venous phase abdomen CT. METHODS A total of 907 portal venous phase abdominal CTs were evaluated. Radiation dose in the ATVS protocol was compared according to tube voltage (80, 100 or 120 kVp). Quantitative image analysis and diagnostic performance were compared between 81 pairs of CT using ATVS and fixed 120-kVp protocols. RESULTS Most CT examinations with ATVS were performed with 80 or 100 kVp. The average reduction rate of radiation dose in the ATVS protocol was 15.4%. There was no significant difference in diagnostic performance (p = 0.388) between ATVS and fixed 120-kVp protocols. CONCLUSIONS In conclusion, ATVS frequently selected 80 or 100 kVp for portal venous phase abdominal CT without impairing the diagnostic performance, even with filtered back projection.
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Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Catholic Smart Imaging Center, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Radioogy, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Joon Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Catholic Smart Imaging Center, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Radioogy, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Eun Jung
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Catholic Smart Imaging Center, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Radioogy, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Jeon YJ, Han YJ, Choi MH, Lee JS, Lee JH, Jo SH, Kim SH. Mental health states and influencing factors of risky and problem drinking in South Korean female adolescents. Public Health 2020; 185:61-69. [PMID: 32570147 DOI: 10.1016/j.puhe.2020.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/12/2020] [Accepted: 04/21/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Alcohol is one of the most used and abused psychoactive substances by adolescents. We investigated influencing factors of risky and problem drinking in Korean female adolescents. STUDY DESIGN The study design used is a cross-sectional modeling. METHODS We used data from the 13th Korean Youth Risk Behavior Web-based Survey (KYRBS) conducted in 2017. KYRBS data were obtained from a stratified, multistage, clustered sample. Risky drinking was binge drinking and problem drinking was drinking with several conflicts association with alcohol consumption. RESULTS Among 62,276 participants, the rates of current, risky, and problem drinking among all participants were 16.1%, 8.3%, and 6.1%, respectively. Although all of these rates were higher in males, risky and problem drinking rates among current female drinkers were higher than those of males (55.4 vs 48.5%, 38.9 vs 37.2%, respectively). Problem drinking was most strongly associated with risky drinking (adjusted odds ratio: 17.53 [95% confidence interval: 14.63-21.00]), similarly, risky drinking was most strongly associated with problem drinking in female current drinkers (17.76 [14.84-21.27]). Current smoking was the second strongest risk factor for risky and problem drinking in females (5.22 [3.92-6.95] and 2.93 [2.21-3.89], respectively). CONCLUSION Many female adolescents in Korea drink alcohol in an unhealthy manner. The female risky and problem drinking rates among current drinkers were higher than those of males. Risky drinking and problem drinking was most significant influencing factor among females, reciprocally. Public education on abstinence in female adolescents is warranted.
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Affiliation(s)
- Y J Jeon
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Y J Han
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - M H Choi
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - J S Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - J H Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - S H Jo
- Department of Biostatstics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - S H Kim
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
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Park JJ, Kim KA, Nam Y, Choi MH, Choi SY, Rhie J. Convolutional-neural-network-based diagnosis of appendicitis via CT scans in patients with acute abdominal pain presenting in the emergency department. Sci Rep 2020; 10:9556. [PMID: 32533053 PMCID: PMC7293232 DOI: 10.1038/s41598-020-66674-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/26/2020] [Indexed: 02/08/2023] Open
Abstract
Acute appendicitis is one of the most common causes of abdominal emergencies. We investigated the feasibility of a neural-network-based diagnosis algorithm of appendicitis by using computed tomography (CT) for patients with acute abdominal pain visiting the emergency room (ER). A neural-network-based diagnostic algorithm of appendicitis was developed and validated using CT data from three institutions who visited the ER with abdominal pain and underwent abdominopelvic CT. For input data, 3D isotropic cubes including the appendix were manually extracted and labeled as appendicitis or a normal appendix. A 3D convolutional neural network (CNN) was trained to binary classification on the input. For model development and testing, 8-fold cross validation was conducted for internal validation and an ensemble model was used for external validation. Diagnostic performance was excellent in both the internal and external validation with an accuracy larger than 90%. The CNN-based diagnosis algorithm may be feasible in diagnosing acute appendicitis using the CT data of patients visiting the ER with acute abdominal pain.
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Affiliation(s)
- Jin Joo Park
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung Ah Kim
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Yoonho Nam
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Gyeonggi-do, Republic of Korea
| | - Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Young Choi
- Department of Radiology and Medical Research Institute, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jeongbae Rhie
- Department of Occupational and Environmental Medicine, College of Medicine, Dankook University, Cheonan, Republic of Korea
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Choi MH, Choi JI, Lee YJ. Manual versus automated image fusion of real-time ultrasonography and MR/CT images for radiofrequency ablation of hepatic tumors: results of a randomized prospective trial (NCT02705118). Ultrasonography 2020; 40:237-247. [PMID: 32660211 PMCID: PMC7994745 DOI: 10.14366/usg.20052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/21/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE This study compared the technical parameters and clinical outcomes of manual and automatic image fusion techniques of ultrasonography and magnetic resonance imaging/computed tomography for radiofrequency ablation (RFA) of hepatic tumors. METHODS Seventy consecutive patients (male:female=47:23, 67.1±10.9 years old) who underwent RFA for hepatic tumors were prospectively enrolled and randomly assigned to the manual or automatic registration group. Two operators performed RFA with one of two imaging fusion techniques. Technical parameters (the registration error, time required for image registration, number of point registrations) and clinical outcomes (technical success, technical effectiveness, local tumor progression [LTP]-free survival, and progression-free survival [PFS]) were compared. RESULTS The automatic group contained 35 patients with hepatocellular carcinoma, while the manual group included 34 hepatocellular carcinoma patients and a patient with colon cancer liver metastasis. The registration error, time required for registration, and number of point registrations were 5.7±4.3 mm, 147.8±78.2 seconds, and 3.26±1.20 in the automatic group, and 6.3±5.0 mm, 150.3±89.7 seconds, and 3.20±1.13 in the manual group, respectively. The technical success and effectiveness rates were both 97.1% in the automatic group and both 100.0% in the manual group. The above differences were not significant. The LTP-free survival and PFS (28.3 and 21.2 months in the automatic group, and 29.0 and 24.9 months in the manual group, respectively) showed no significant between-group differences during a median 20.1-month follow-up period. CONCLUSION The technical parameters and clinical outcomes of automatic image fusion were not significantly different from those of manual image fusion for RFA of hepatic tumors.
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Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Cancer Research Institute of the Catholic University of Korea, Seoul, Korea
| | - Joon-Il Choi
- Cancer Research Institute of the Catholic University of Korea, Seoul, Korea.,Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Joon Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Lee J, Choi MH, Lee A, Lee SH. Abstract P3-08-54: Pattern of hepatic metastasis as a prognostic index in breast cancer liver metastasis. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p3-08-54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Liver is one of a common site of metastasis in metastatic breast cancer, and associated with visceral crisis in breast cancer. The clinical course and prognosis of breast cancer with liver metastasis (BCLM) is quite different with other solid cancers presenting with liver metastasis. BCLM patients frequently develop hepatic failure due to liver metastasis, but there are no clinicopathologic or radiologic parameters estimating the prognosis of BCLM during their clinical course. In this study, we analyzed the relationship of radiologic, clinicopathologic characteristics and survival outcomes in BCLM patients. Methods Between January 2009 to May 2019, 156 BCLM patients were analyzed. Baseline and final abdomen CT scan or liver MRI during treatment was reviewed by experienced radiologist. The pattern of liver metastasis was classified as oligometasis (3 or less metastatic lesions), non-confluent mass formation, confluent mass formation, infiltrative and pseudocirrhosis pattern. Clinicopathologic characteristics including child-pugh score (CPS) and survival outcomes including liver metastasis associated overall survival (LMOS) was analyzed Results Among 156 patients, 77 patients were initially presented with oligometastasis, 58 patients with non-confluent mass-forming pattern, 14 patients with confluent mass formation, and 7 patients with infiltrative liver metastasis. Patients who showed liver metastasis at initial recurrence or metastasis showed confluent mass-forming (9 patients, 64.3%) or infiltrative liver metastasis (6 patients, 85.7%) as presentation. At patient’s death, initial confluent mass-forming or infiltrative liver metastasis patients showed hepatic dysfunction with CPS 2 or 3. Patients with oligometastasis showed superior LMOS compared to non-confluent mass-forming, confluent mass-forming and infiltrative liver metastasis with worst survival outcome (median LMOS 55.03 months vs. 36.87, 36.93 and 8.8 months, P=0.0021). In luminal B patients, radiologic liver metastasis pattern at patient’s death or last follow-up were associated to cause of patient’s death such as hepatic failure (P=0.044). There were no survival benefit of patients who received local treatment for liver metastasis, compared to patients who only received systemic chemotherapy. Conclusion Initial hepatic metastasis pattern were associated with LMOS, especially infiltrative liver metastasis associated to poor survival outcome. There were no survival benefit of local treatment of liver metastasis during follow-up. Authors are planning on subsequent analysis based on pathologic classification of liver metastasis.
Citation Format: Jieun Lee, Moon Hyung Choi, Ahwon Lee, Sung Hak Lee. Pattern of hepatic metastasis as a prognostic index in breast cancer liver metastasis [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-08-54.
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Affiliation(s)
- Jieun Lee
- 1Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea, Republic of
| | - Moon Hyung Choi
- 2Department of Radiology, Eunpyeong St. Mary's Hospital, Catholic University of Korea, Seoul, Korea, Republic of
| | - Ahwon Lee
- 3Department of Hospital Pathology, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea, Republic of
| | - Sung Hak Lee
- 4Department of Hospital Pathology, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea, Republic of
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Yoon SB, Choi MH, Song M, Lee JH, Lee IS, Lee MA, Hong TH, Jung ES, Choi MG. Impact of preoperative body compositions on survival following resection of biliary tract cancer. J Cachexia Sarcopenia Muscle 2019; 10:794-802. [PMID: 31037838 PMCID: PMC6711415 DOI: 10.1002/jcsm.12431] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/18/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although surgical resection is the only potentially curative treatment for biliary tract cancer, the prognosis remains poor after a major operation such as pancreatoduodenectomy or hepatectomy. We aimed to investigate the impact of preoperative body compositions on long-term survival of patients undergoing resection of biliary tract cancer. METHODS We analysed data of patients diagnosed with biliary tract cancer who underwent surgery from 2009 to 2015. Skeletal muscle area, skeletal muscle radiation attenuation, and visceral and subcutaneous adipose tissue areas were measured from the computed tomography images at L3 vertebral levels obtained before resection of cancer. Patients were divided into two groups based on the sex-specific median values for each parameter, and long-term survival was compared between the groups. RESULTS A total of 371 patients (women, 39.6%; mean age, 66.2 ± 9.6 years) were finally included in the analysis. Patients with low skeletal muscle index (SMI) had significantly shorter median survival than those with high SMI (29 vs. 39 months; P = 0.026). Patients with low skeletal muscle attenuation (SMA) also showed reduced survival compared with those with high SMA (median survival 25 vs. 60 months; P = 0.002). Combining these two factors, survival was highest in the high SMI/high SMA group (reference) and lowest in the low SMI/low SMA group (hazard ratio, 2.18; 95% confidence interval, 1.44-3.30). Visceral and subcutaneous adipose tissue areas were not associated with long-term survival. CONCLUSIONS Low SMI and low SMA on computed tomography scan have a negative impact on survival after resection of biliary tract cancer. They can be used in preoperative risk assessment to assist in treatment decision making.
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Affiliation(s)
- Seung Bae Yoon
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moon Hyung Choi
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Meiying Song
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ju Hyun Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Seok Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myung Ah Lee
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae Ho Hong
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Sun Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myung-Gyu Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kim EY, Kim SR, Won DD, Choi MH, Lee IK. Multifrequency Bioelectrical Impedance Analysis Compared With Computed Tomography for Assessment of Skeletal Muscle Mass in Primary Colorectal Malignancy: A Predictor of Short-Term Outcome After Surgery. Nutr Clin Pract 2019; 35:664-674. [PMID: 31237032 DOI: 10.1002/ncp.10363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Herein, we evaluate the accuracy and reliability of multifrequency bioelectrical impedance analysis (BIA) to assess skeletal muscle mass (SMM) in the colorectal cancer patient compared with computed tomography (CT) scan and also analyze the association between SMM of BIA and postoperative outcomes. METHODS From March to May 2017, the body composition of patients scheduled for elective surgery due to primary colorectal cancer in our institution was analyzed at the time of admission using BIA (InBody S20, Biospace Co Ltd, Seoul, South Korea). The relationship between the single cross-sectional area of skeletal muscle at the lumbar region using preoperative CT scan and the SMM determined via BIA were assessed. Postoperative outcomes were compared according to different status of SMM on BIA categorized into 3 groups (low, medium, or high). RESULTS Fifty patients were analyzed, and the length of hospital stay was shorter and the initiation of oral diet was significantly earlier in the group with high SMM than in other groups (P = 0.001 and 0.038, respectively). The SMM on BIA showed a very significant correlation with skeletal muscle index using CT scan (0.705 of correlation coefficients, P < 0.001) and also strongly correlated with skeletal muscle index after adjusting for age, weight, and BMI on multivariate analysis (β = 0.391 ± 0.057, P < 0.001). CONCLUSION SMM determined by BIA is strongly correlated with SMM estimated by CT scan. Authors suppose that BIA could be an alternative to CT scan for the assessment of SMM in colorectal cancer patients.
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Affiliation(s)
- Eun Young Kim
- Division of Trauma and Surgical Critical Care, Department of Surgery, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Seong Ryong Kim
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Daeyoun David Won
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Moon Hyung Choi
- Department of Radiology, Seoul St. Mary's Hospital, Seoul, South Korea
| | - In Kyu Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, Seoul, South Korea
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Choi MH, Jung SE, Lee YJ, Yoon SB. More Frequent Follow-up CT Scans in Postsurgical Resection Patients Than in Postendoscopic Resection Patients of Early Gastric Cancers: Impracticality of CTs for Mucosal Cancer. Acad Radiol 2019; 26:651-657. [PMID: 30268723 DOI: 10.1016/j.acra.2018.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 07/25/2018] [Accepted: 07/25/2018] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to compare the utility and timing of computed tomography (CT) in the detection of recurrent tumors between patients after surgical and endoscopic resections for early gastric cancer (EGC). MATERIALS AND METHODS A total of 670 patients after surgical (n = 535) and endoscopic (n = 135) resections for EGC between 2007 and 2009 were enrolled. The mean numbers of CT and endoscopy between both treatment groups were compared. The mean and cumulative dose length products of CT examinations were calculated. The modality that detected recurrence was compared between the two groups using the Pearson chi-square test. RESULTS The mean interval of CT was significantly shorter and the mean number of CTs was significantly larger in the surgical resection group than in the endoscopic resection group. All 34 gastric recurrences were diagnosed by endoscopy. All seven extragastric recurrences occurred in patients treated for EGC with submucosal invasion. Six extragastric recurrences were detected by CT out of a total of 5417 CT scans. The average cumulative dose length product was significantly higher in the surgical group than in the endoscopic resection group (P = 0.004). CONCLUSION Follow-up CTs were performed more frequently in patients after surgical resection than in patients after endoscopic resection of EGCs. However, CT scans were not effective in detecting recurrent tumors after either treatment methods, especially for patients treated for mucosal gastric cancer.
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Choi MH, Kim CK, Lee YJ, Jung SE. Prebiopsy Biparametric MRI for Clinically Significant Prostate Cancer Detection With PI-RADS Version 2: A Multicenter Study. AJR Am J Roentgenol 2019; 212:839-846. [DOI: 10.2214/ajr.18.20498] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Cancer Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Kyo Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
- Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Young Joon Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Eun Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Choi MH, Lee YJ, Yoon SB, Choi JI, Jung SE, Rha SE. MRI of pancreatic ductal adenocarcinoma: texture analysis of T2-weighted images for predicting long-term outcome. Abdom Radiol (NY) 2019; 44:122-130. [PMID: 29980829 DOI: 10.1007/s00261-018-1681-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To assess the association between T2-weighted imaging (T2WI) texture-analysis parameters and the pathological aggressiveness or long-term outcomes in pancreatic ductal adenocarcinoma (PDAC) patients. METHODS A total of 66 patients (mean age 65.3 ± 9.0 years) who underwent preoperative MRI followed by pancreatectomy for PDAC between 2013 and 2015 were included in this study. A radiologist performed a texture analysis twice on one axial image using commercial software. Differences in the tex parameters, according to pathological factors, were analyzed using a Student's t test or an ANOVA with Tukey's test. Univariate and multivariate Cox proportional hazards regression analyses were used to evaluate the association between tex parameters and recurrence-free survival (RFS) or overall survival (OS). RESULTS The mean follow-up time was 18.5 months, and there were 58 recurrences and 39 deaths. The mean of the positive pixel (MPP)-related factors was significantly lower in poorly differentiated tumors than in well-differentiated tumors as well as in cases with perineural invasion. The univariate Cox proportional hazards analysis showed a significant association between the tex parameters and RFS or OS. However, only tumor size was statistically significant after the multivariate analysis. Only tumor size and entropy with medium texture were significantly associated with OS after the multivariate analysis. CONCLUSIONS Tumor size was a significant predictive factor for RFS and OS in PDAC patients. Although entropy with medium texture analysis was significantly associated with OS, there were also limitations in the texture analysis; thus, further study is necessary.
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Choi MH, Kim KA, Hwang SS, Byun JY. CT-quantified muscle and fat change in patients after surgery or endoscopic resection for early gastric cancer and its impact on long-term outcomes. Medicine (Baltimore) 2018; 97:e13878. [PMID: 30593194 PMCID: PMC6314738 DOI: 10.1097/md.0000000000013878] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The purpose of this study was to evaluate the impact of the body composition changes on patients' long-term outcomes after endoscopic resection or surgery for mucosal gastric cancer.This case-control study included 96 patients who underwent endoscopic resection or surgery after propensity score matching. Areas of fat and muscle measured on CT were compared between the 2 groups. The effects of the variables on disease-free and overall survival were assessed using Cox-regression analysis and Kaplan-Meier survival analysis.The median overall survival of the surgical and endoscopic resection groups was 91.1 and 93.9 months (P = .080). Fat area was decreased significantly more after surgery (P < .001). The number of patients with sarcopenia was increased in the surgery group. Kaplan-Meier plot showed that overall survival was significantly correlated with post-treatment sarcopenia (P = .049).CT-based body composition analysis was helpful to evaluate the change in fat and muscle areas after treatment of early gastric cancer. The losses of fat and muscle after treatment were negatively associated with the patient overall survival.
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Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, Seoul St. Mary's Hospital
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Choi MH, Park GE, Oh SN, Park MY, Rha SE, Lee YJ, Jung SE, Choi JI. Reproducibility of mRECIST in Measurement and Response Assessment for Hepatocellular Carcinoma Treated by Transarterial Chemoembolization. Acad Radiol 2018; 25:1363-1373. [PMID: 29555570 DOI: 10.1016/j.acra.2018.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 01/30/2018] [Accepted: 02/03/2018] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the reproducibility of Modified Response Evaluation Criteria in Solid Tumors (mRECIST) for hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) using multiphasic computed tomography. MATERIALS AND METHODS The institutional review board approved this retrospective study. We evaluated 97 patients who underwent TACE (60 conventional TACE [cTACE] and 37 drug-eluting bead TACE [DEB-TACE]) for HCC from 2010 to 2014. Four radiologists evaluated pairs of dynamic liver CTs scanned within 2 months before and after TACE based on mRECIST. Assessment of intra- or interobserver reproducibility for response categorization and sum of long diameter were evaluated using weighted kappa statistics (κ) and intraclass correlation coefficients, respectively. The relationship between concordance of target lesion selection and agreement of target lesion response was evaluated using Fisher exact test. RESULTS Intraobserver reproducibility for overall response was moderate to excellent (κ = 0.525-0.865). Interobserver reproducibility was improved on the second review compared to the first review and it was good in both treatment groups (κ = 0.627 for cTACE and 0.602 for DEB-TACE). Between the two treatment methods, intra- or interobserver reproducibility was better after cTACE than DEB-TACE. Intraclass correlation coefficients for sum of long diameter measurement showed excellent intra- or interobserver reproducibility. The concordance rate of target lesion selection was significantly higher for patients with radiologists' agreement for target lesion response than patients with disagreed response (P = .003). CONCLUSIONS The intra- and interobserver reproducibility of mRECIST in patients with HCC after TACE was moderate to excellent, and the reproducibility was slightly better after cTACE than DEB-TACE.
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Song M, Yoon SB, Lee IS, Hong TH, Choi HJ, Choi MH, Lee MA, Jung ES, Choi MG. Evaluation of the prognostic value of the new AJCC 8th edition staging system for patients with pancreatic adenocarcinoma; a need to subclassify stage III? Eur J Cancer 2018; 104:62-69. [PMID: 30326370 DOI: 10.1016/j.ejca.2018.08.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/19/2018] [Accepted: 08/29/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND There have been several proposed changes for the 8th edition of the American Joint Commission on Cancer (AJCC) for pancreatic adenocarcinoma. The aim of this study was to evaluate the prognostic value of the new staging system for patients with pancreatic adenocarcinoma, especially in stage III patients. METHODS We analysed the data of patients newly diagnosed with pancreatic adenocarcinoma between 2008 and 2016 at our hospital. Patients were staged according to 7th edition AJCC criteria, as well as the new 8th edition staging system. The pathologic stage was used in the surgical cases, and the clinical stage, determined by radiographic findings, was used in the unresectable cases. RESULTS Five hundred two patients were identified who met the inclusion criteria. In node-negative patients, there were no significant differences in survival among T 1, 2 and 3 groups according to the 8th edition. The survival rates of patients with N1 (1-3 positive nodes) and N2 (≥4 positive nodes) disease, according to 8th edition, were significantly different (p < 0.001). Although N2 and T4 patients are both stage III according to the new staging system, N2 patients had a better survival rate than T4 patients (p = 0.038). The new staging system stratifies patients more evenly across stages without sacrificing the prognostic accuracy. CONCLUSIONS The AJCC 8th edition has some advantages over the previous version. However, patients with N2 and T4, who have been integrated into stage III, showed different treatment modalities and prognoses, and we proposed dividing stage III into IIIA (T1-3N2M0) and IIIB (T4NanyM0).
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Affiliation(s)
- Meiying Song
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Seung Bae Yoon
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| | - In Seok Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Tae Ho Hong
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ho Joong Choi
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Moon Hyung Choi
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Myung Ah Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Eun Sun Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Myung-Gyu Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Jung YJ, Seo HS, Lee HH, Kim JH, Song KY, Choi MH, Park CH. Splenic Infarction as a Delayed Febrile Complication Following Radical Gastrectomy for Gastric Cancer Patients: Computed Tomography-Based Analysis. World J Surg 2018; 42:1826-1832. [PMID: 29270657 DOI: 10.1007/s00268-017-4401-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the incidence and clinical characteristics of splenic infarction (SI) in gastric cancer patients who have undergone gastrectomy. METHODS For this study, the medical records of 1084 patients were reviewed and 877 patients were ultimately enrolled. The times of symptom onset, diagnosis of SI, and complete resolution on CT were calculated from the day of the operation. Based on the wedge shape of the SI in all cases, the total volume of the SI was measured based on that of a corn kernel. RESULTS Thirty-six patients (4.10%) were diagnosed with SI after gastrectomy; four of these patients (0.45%) developed complications associated with the SI. Total gastrectomy and extended lymph node dissection were risk factors for development of SI. Patients with complications exhibited inflammatory signs between 7 and 10 days after surgery. The mean volume of the SI was 4025.69 mm3. The mean time to complete resolution on the CT scan was 327 days postoperatively. In 30 cases, small branched arteries from the splenic artery that could have caused the SI were retrospectively detected on the preoperative CT scans. CONCLUSION Although the incidence of the SI was low, large volume of the SI is associated with complication development. Measuring the infarction volume via a CT scan may be useful to decide on the treatment strategy. Preoperative 3-D reconstruction of the splenic artery tributaries may help reduce the risk of inadvertent SI.
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Affiliation(s)
- Yoon Ju Jung
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho Seok Seo
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Han Hong Lee
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Hyun Kim
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyo Young Song
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Moon Hyung Choi
- Department of Radiology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Cho Hyun Park
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
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