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Mashhood A, Malik S, Yoon BC. Implicit screening of abdominal aortic aneurysms among veterans using lumbar spine MRI. Curr Probl Diagn Radiol 2024; 53:372-376. [PMID: 38246796 DOI: 10.1067/j.cpradiol.2024.01.022] [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: 12/07/2023] [Accepted: 01/16/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Early detection of abdominal aortic aneurysms (AAAs) is critical given the high morbidity and mortality of a ruptured aneurysm. Screening ultrasound is recommended for men 65 and 75 years of age with a smoking history. However, studies have shown that the rate of ultrasound screening is low and that implicit AAA screening by abdominal imaging studies that were not originally intended for AAA screening can play a major role in AAA detection. OBJECTIVE The main objective was to evaluate the role of lumbar spine MRIs as an implicit AAA screening study by assessing the detection rate of AAAs in a broader cohort of veterans that included screening and non-screening populations. METHODS 4085 consecutive lumbar spine MRIs from our institution between 2/2020 and 9/2023 were retrospectively reviewed. Each study was labeled AAA present, AAA not present, or indeterminate by radiologists. The correlation between the presence of AAAs and cardiovascular risk factors was assessed using multinomial logistic regression. RESULTS AAAs were present in 89 studies (2.2 %) from 80 patients (mean age 75.8 (56-93), M:F 10:0) and absent in 3935 cases (96.3 %) from 3310 patients (mean age 61.7 (19-100), M:F 9:1). Indeterminate cases (n = 61, 1.5 %) were mainly due to incomplete visualization (70.5 %). Mean AAA size was 3.6 cm with most AAAs (n = 43) smaller than 3.5 cm. Sixteen AAAs were 3.5-3.9 cm, 16 between 4 and 4.9cm, and 6 between 5 and 5.9 cm. Artifact precluded measurements in 8 cases. Among the AAA-positive cases, 20 had no prior documentation of AAA. Twenty-one patients with AAAs would not have met the criteria for the routine AAA screening ultrasound. Higher rates of hypertension, hyperlipidemia, and smoking were observed for the AAA cohort at 78.8 % (OR 2.037, CI 1.160-3.576, P = .013), 82.5 % (2.808, 1.543-5.110, P < .001), and 75 % (3.340, 1.979-5.638, P < .001), respectively, compared to the matched no-AAA cohort (58.2 %, 57.6 %, and 50.8 %; n = 2055). CONCLUSION Lumbar spine MRI is a valid modality for implicit screening of AAAs. CLINICAL IMPACT Those interpreting lumbar spine MRIs should be vigilant about assessing for AAAs, especially in men with a history of hypertension, hyperlipidemia, or tobacco smoking.
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Affiliation(s)
- Arian Mashhood
- Radiology Service, VA Palo Alto Health Care System, Palo Alto, CA, USA; Department of Radiology, Stanford University, Stanford, CA, USA.
| | - Sachin Malik
- Radiology Service, VA Palo Alto Health Care System, Palo Alto, CA, USA; Department of Radiology, Stanford University, Stanford, CA, USA.
| | - Byung C Yoon
- Radiology Service, VA Palo Alto Health Care System, Palo Alto, CA, USA; Department of Radiology, Stanford University, Stanford, CA, USA.
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Kim KA, Kim H, Ha EJ, Yoon BC, Kim DJ. Artificial Intelligence-Enhanced Neurocritical Care for Traumatic Brain Injury : Past, Present and Future. J Korean Neurosurg Soc 2024:jkns.2023.0195. [PMID: 38186369 DOI: 10.3340/jkns.2023.0195] [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: 09/06/2023] [Accepted: 01/04/2024] [Indexed: 01/09/2024] Open
Abstract
In neurointensive care units (NICU), particularly in cases involving traumatic brain injury (TBI), swift and accurate decision-making is critical because of rapidly changing patient conditions and the risk of secondary brain injury. The use of artificial intelligence (AI) in NICU can enhance clinical decision support and provide valuable assistance in these complex scenarios. This article aims to provide a comprehensive review of the current status and future prospects of AI utilization in the NICU, along with the challenges that must be overcome to realize this. Presently, the primary application of AI in NICU is outcome prediction through the analysis of pre-admission and high-resolution data during admission. Recent applications include augmented neuromonitoring via signal quality control and real-time event prediction. In addition, AI can integrate data gathered from various measures and support minimally invasive neuromonitoring to increase patient safety. However, despite the recent surge in AI adoption within the NICU, the majority of AI applications have been limited to simple classification tasks, thus leaving the true potential of AI largely untapped. Emerging AI technologies, such as generalist medical AI and digital twins, harbor immense potential for enhancing advanced neurocritical care through broader AI applications. If challenges such as acquiring high-quality data and ethical issues are overcome, these new AI technologies can be clinically utilized in the actual NICU environment. Emphasizing the need for continuous research and development to maximize the potential of AI in the NICU, we anticipate that this will further enhance the efficiency and accuracy of TBI treatment within the NICU.
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Affiliation(s)
- Kyung Ah Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea
| | - Hakseung Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea
| | - Eun Jin Ha
- Department of Critical Care Medicine, Seoul National University Hospital, Korea
| | - Byung C Yoon
- Department of Radiology, Stanford University School of Medicine, VA Palo Alto Heath Care System, Palo Alto, CA, USA
| | - Dong-Joo Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
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Au VH, Yoon BC, Juliano A, Sadow PM, Faquin WC, Varvares MA. Correlation of Intraoperative Ultrasonographic Oral Tongue Shape and Border and Risk of Close Margins. Otolaryngol Head Neck Surg 2023; 168:1576-1579. [PMID: 36880451 DOI: 10.1002/ohn.217] [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: 08/09/2022] [Revised: 10/12/2022] [Accepted: 11/16/2022] [Indexed: 01/20/2023]
Abstract
Intraoperative ultrasound (IOUS) is a potentially useful adjunct to the resection of oral tongue cancers (OTC). IOUS images of the tumor-normal tissue interface show different patterns of invasion. In this retrospective series of 29 patients treated for OTC, we evaluated if there was a correlation between IOUS findings of patterns of invasion and final histology and assessed if there was any associated risk of increased incidence of positive or close margins with different patterns of invasion as seen on ultrasound. Although we found no significant correlation between ultrasound patterns of invasion and histological evaluation, we did find that an infiltrative pattern of invasion on IOUS did result in a significant risk of a close margin. Further exploration of these findings in a larger prospective study could provide definitive information on the efficacy of this modality in OTC resections.
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Affiliation(s)
- Vivienne H Au
- SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Byung C Yoon
- Department of Radiology, Stanford Health Care/VA Palo Alto Heath Care, Stanford Medical School, Stanford, California, USA
| | - Amy Juliano
- Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark A Varvares
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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Yoon BC, Pomerantz SR, Mercaldo ND, Goyal S, L’Italien EM, Lev MH, Buch KA, Buchbinder BR, Chen JW, Conklin J, Gupta R, Hunter GJ, Kamalian SC, Kelly HR, Rapalino O, Rincon SP, Romero JM, He J, Schaefer PW, Do S, González RG. Incorporating algorithmic uncertainty into a clinical machine deep learning algorithm for urgent head CTs. PLoS One 2023; 18:e0281900. [PMID: 36913348 PMCID: PMC10010506 DOI: 10.1371/journal.pone.0281900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/05/2022] [Accepted: 02/03/2023] [Indexed: 03/14/2023] Open
Abstract
Machine learning (ML) algorithms to detect critical findings on head CTs may expedite patient management. Most ML algorithms for diagnostic imaging analysis utilize dichotomous classifications to determine whether a specific abnormality is present. However, imaging findings may be indeterminate, and algorithmic inferences may have substantial uncertainty. We incorporated awareness of uncertainty into an ML algorithm that detects intracranial hemorrhage or other urgent intracranial abnormalities and evaluated prospectively identified, 1000 consecutive noncontrast head CTs assigned to Emergency Department Neuroradiology for interpretation. The algorithm classified the scans into high (IC+) and low (IC-) probabilities for intracranial hemorrhage or other urgent abnormalities. All other cases were designated as No Prediction (NP) by the algorithm. The positive predictive value for IC+ cases (N = 103) was 0.91 (CI: 0.84-0.96), and the negative predictive value for IC- cases (N = 729) was 0.94 (0.91-0.96). Admission, neurosurgical intervention, and 30-day mortality rates for IC+ was 75% (63-84), 35% (24-47), and 10% (4-20), compared to 43% (40-47), 4% (3-6), and 3% (2-5) for IC-. There were 168 NP cases, of which 32% had intracranial hemorrhage or other urgent abnormalities, 31% had artifacts and postoperative changes, and 29% had no abnormalities. An ML algorithm incorporating uncertainty classified most head CTs into clinically relevant groups with high predictive values and may help accelerate the management of patients with intracranial hemorrhage or other urgent intracranial abnormalities.
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Affiliation(s)
- Byung C. Yoon
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Stuart R. Pomerantz
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Mass General Brigham Data Science Office, Boston, MA, United States of America
| | - Nathaniel D. Mercaldo
- Massachusetts General Hospital Institute for Technology Assessment, Boston, MA, United States of America
| | - Swati Goyal
- Mass General Brigham Data Science Office, Boston, MA, United States of America
- Department of Radiology/ Information Systems, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Eric M. L’Italien
- Mass General Brigham Data Science Office, Boston, MA, United States of America
- Department of Radiology/ Information Systems, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Michael H. Lev
- Emergency Radiology & Neuroradiology Divisions, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Karen A. Buch
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Bradley R. Buchbinder
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - John W. Chen
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Massachusetts General Hospital Center for Systems Biology (CSB), Boston, MA, United States of America
| | - John Conklin
- Emergency Radiology & Neuroradiology Divisions, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Rajiv Gupta
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Massachusetts General Hospital Consortia for Integration of Medicine and Innovative Technologies (CIMIT), Boston, MA, United States of America
- Massachusetts General Hospital CT Innovation and Advanced X-ray Imaging Science (AXIS) Center, Boston, MA, United States of America
| | - George J. Hunter
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Shahmir C. Kamalian
- Emergency Radiology & Neuroradiology Divisions, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Hillary R. Kelly
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Department of Radiology, Massachusetts Eye and Ear Institute, Harvard Medical School, Boston, MA, United States of America
| | - Otto Rapalino
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Sandra P. Rincon
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Javier M. Romero
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Julian He
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Pamela W. Schaefer
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Mass General Brigham Enterprise Radiology, Boston, MA, United States of America
| | - Synho Do
- Mass General Brigham Data Science Office, Boston, MA, United States of America
| | - Ramon Gilberto González
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Mass General Brigham Data Science Office, Boston, MA, United States of America
- Massachusetts General Hospital Athinoula A. Martinos Center for Biomedical Imaging, Boston, MA, United States of America
- * E-mail:
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Yoon BC, Buch K, Cunnane ME, Sadow PM, Varvares MA, Juliano AF. Comparison between computed tomography and ultrasound for presurgical evaluation of oral tongue squamous cell carcinoma tumor thickness. Am J Otolaryngol 2021; 42:103089. [PMID: 34087615 DOI: 10.1016/j.amjoto.2021.103089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/22/2021] [Accepted: 05/18/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the accuracy of oral tongue squamous cell carcinoma (OTSCC) tumor thickness (TT) measured on CT to intraoperative ultrasound (US) and histopathology. METHODS AND MATERIALS Twenty-six patients with OTSCC who underwent tumor resection by a single surgeon with simultaneous intraoperative US between 3/2016 and 4/2019 were prospectively identified, and their data reviewed. TT was independently measured in 19 patients who underwent preoperative CT (cTT) by two neuroradiologists blinded to US and histological results. The confidence level of interpretation of cTT was recorded by each reader using a 5-point Likert scale. The degree of dental artifact on CT was also scored. cTT was compared to TT measured on intraoperative US (uTT) and histopathologic assessment of TT (hTT). RESULTS OTSCC was visualized on CT in 52% (10/19) and 63% (12/19) of cases for readers 1 and 2, respectively. Mean Likert score was 0.42 for reader 1 and 0.73 for reader 2. Mean cTT of OTSCCs was 5.8 mm +/- 1.7 mm (n = 11). In comparison, mean uTT and hTT were 7.6 mm±3.5 mm and 7.1 +/- 4.2 mm, respectively. The Pearson coefficient (95% confidence interval) was 0.10 (-0.53-0.66) between cTT and hTT (n = 11) and 0.93 (0.74-0.98) between uTT and hTT. CONCLUSIONS Preoperative CT is not reliable for assessment of TT in OTSCC compared to US and histopathology, particularly for OTSCC under 10 mm. US offers a practical complementary imaging tool with a unique role for primary tumor assessment that can aid in pre-operative planning, especially for small tumors.
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Affiliation(s)
- Byung C Yoon
- Departments of Radiology, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Karen Buch
- Departments of Radiology, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Mary E Cunnane
- Departments of Radiology, Massachusetts Eye and Ear, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Mark A Varvares
- Departments of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Amy F Juliano
- Departments of Radiology, Massachusetts Eye and Ear, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
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Lindsay ME, Dudzinski DM, Yoon BC, Jaff MR, Thakuria JV. Case 30-2021: A 47-Year-Old Man with Recurrent Unilateral Head and Neck Pain. N Engl J Med 2021; 385:1317-1325. [PMID: 34587390 DOI: 10.1056/nejmcpc2107347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Mark E Lindsay
- From the Departments of Medicine (M.E.L., D.M.D.), Pediatrics (M.E.L., J.V.T.), Radiology (B.C.Y.), and Surgery (M.R.J.), Massachusetts General Hospital, and the Departments of Medicine (M.E.L., D.M.D., M.R.J.), Pediatrics (M.E.L., J.V.T.), and Radiology (B.C.Y.), Harvard Medical School - both in Boston
| | - David M Dudzinski
- From the Departments of Medicine (M.E.L., D.M.D.), Pediatrics (M.E.L., J.V.T.), Radiology (B.C.Y.), and Surgery (M.R.J.), Massachusetts General Hospital, and the Departments of Medicine (M.E.L., D.M.D., M.R.J.), Pediatrics (M.E.L., J.V.T.), and Radiology (B.C.Y.), Harvard Medical School - both in Boston
| | - Byung C Yoon
- From the Departments of Medicine (M.E.L., D.M.D.), Pediatrics (M.E.L., J.V.T.), Radiology (B.C.Y.), and Surgery (M.R.J.), Massachusetts General Hospital, and the Departments of Medicine (M.E.L., D.M.D., M.R.J.), Pediatrics (M.E.L., J.V.T.), and Radiology (B.C.Y.), Harvard Medical School - both in Boston
| | - Michael R Jaff
- From the Departments of Medicine (M.E.L., D.M.D.), Pediatrics (M.E.L., J.V.T.), Radiology (B.C.Y.), and Surgery (M.R.J.), Massachusetts General Hospital, and the Departments of Medicine (M.E.L., D.M.D., M.R.J.), Pediatrics (M.E.L., J.V.T.), and Radiology (B.C.Y.), Harvard Medical School - both in Boston
| | - Joseph V Thakuria
- From the Departments of Medicine (M.E.L., D.M.D.), Pediatrics (M.E.L., J.V.T.), Radiology (B.C.Y.), and Surgery (M.R.J.), Massachusetts General Hospital, and the Departments of Medicine (M.E.L., D.M.D., M.R.J.), Pediatrics (M.E.L., J.V.T.), and Radiology (B.C.Y.), Harvard Medical School - both in Boston
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Bulbul MG, Tarabichi O, Parikh AS, Yoon BC, Juliano A, Sadow PM, Faquin W, Gropler M, Walker R, Puram SV, Varvares MA. The utility of intra-oral ultrasound in improving deep margin clearance of oral tongue cancer resections. Oral Oncol 2021; 122:105512. [PMID: 34564016 DOI: 10.1016/j.oraloncology.2021.105512] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 08/10/2021] [Accepted: 08/23/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate the potential utility of intra-oral ultrasound (IOUS) in guiding deep margin clearance and measuring depth of invasion (DOI) of oral tongue carcinomas (OTC). MATERIALS AND METHODS Retrospective chart review of consecutive patients with T1-T3 OTC who underwent intraoperative ultrasound-guided resection and a comparator group that had undergone resection without the use of IOUS both by a single surgeon. Data was extracted from operative, pathology and radiology reports. Deep margins and DOI were reviewed by a dedicated head and neck pathologist. Correlation between histologic and ultrasound DOI was assessed using Pearson correlation. RESULTS A total of 23 patients were included in the study cohort with a comparator group of 21 patients in the control group. None of the patients in the study cohort had a positive (cut-through) deep margin and the mean deep margin clearance was 8.5 ± 4.9 and 6.7 ± 3.8 for the IOUS and non-IOUS groups respectively (p-value 0.18) showing a non-significant improvement in the IOUS group. As a secondary outcome, there was a strong correlation between histologic and ultrasound DOI (0.9449). CONCLUSION Ultrasound appears to be a potentially effective tool in guiding OTC resections. In this small series, IOUS facilitated deep margin clearance and resulted in a non-statistically significant increase in deep margin clearance. Intraoral ultrasound can accurately measure lesional DOI.
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Affiliation(s)
- Mustafa G Bulbul
- Department of Otolaryngology - Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Osama Tarabichi
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa, Iowa City, IA, USA
| | - Anuraag S Parikh
- Department of Otolaryngology, Head and Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Byung C Yoon
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Amy Juliano
- Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - William Faquin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew Gropler
- Department of Otolaryngology - Head and Neck Surgery, University of Colorado School of Medicine, Denver, CO, USA
| | - Ronald Walker
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Sidharth V Puram
- Department of Otolaryngology - Head and Neck Surgery and Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA.
| | - Mark A Varvares
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
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Lang M, Li MD, Jiang KZ, Yoon BC, Mendoza DP, Flores EJ, Rincon SP, Mehan WA, Conklin J, Huang SY, Lang AL, Giao DM, Leslie-Mazwi TM, Kalpathy-Cramer J, Little BP, Buch K. Severity of Chest Imaging is Correlated with Risk of Acute Neuroimaging Findings among Patients with COVID-19. AJNR Am J Neuroradiol 2021; 42:831-837. [PMID: 33541897 DOI: 10.3174/ajnr.a7032] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/11/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Severe respiratory distress in patients with COVID-19 has been associated with higher rate of neurologic manifestations. Our aim was to investigate whether the severity of chest imaging findings among patients with coronavirus disease 2019 (COVID-19) correlates with the risk of acute neuroimaging findings. MATERIALS AND METHODS This retrospective study included all patients with COVID-19 who received care at our hospital between March 3, 2020, and May 6, 2020, and underwent chest imaging within 10 days of neuroimaging. Chest radiographs were assessed using a previously validated automated neural network algorithm for COVID-19 (Pulmonary X-ray Severity score). Chest CTs were graded using a Chest CT Severity scoring system based on involvement of each lobe. Associations between chest imaging severity scores and acute neuroimaging findings were assessed using multivariable logistic regression. RESULTS Twenty-four of 93 patients (26%) included in the study had positive acute neuroimaging findings, including intracranial hemorrhage (n = 7), infarction (n = 7), leukoencephalopathy (n = 6), or a combination of findings (n = 4). The average length of hospitalization, prevalence of intensive care unit admission, and proportion of patients requiring intubation were significantly greater in patients with acute neuroimaging findings than in patients without them (P < .05 for all). Compared with patients without acute neuroimaging findings, patients with acute neuroimaging findings had significantly higher mean Pulmonary X-ray Severity scores (5.0 [SD, 2.9] versus 9.2 [SD, 3.4], P < .001) and mean Chest CT Severity scores (9.0 [SD, 5.1] versus 12.1 [SD, 5.0], P = .041). The pulmonary x-ray severity score was a significant predictor of acute neuroimaging findings in patients with COVID-19. CONCLUSIONS Patients with COVID-19 and acute neuroimaging findings had more severe findings on chest imaging on both radiographs and CT compared with patients with COVID-19 without acute neuroimaging findings. The severity of findings on chest radiography was a strong predictor of acute neuroimaging findings in patients with COVID-19.
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Affiliation(s)
- M Lang
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - M D Li
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - K Z Jiang
- School of Medicine (K.Z.J.), Baylor College of Medicine, Houston, Texas
| | - B C Yoon
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - D P Mendoza
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - E J Flores
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - S P Rincon
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - W A Mehan
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - J Conklin
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Athinoula A. Martinos Center for Biomedical Imaging (J.C., S.Y.H., J.K.-C.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - S Y Huang
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Athinoula A. Martinos Center for Biomedical Imaging (J.C., S.Y.H., J.K.-C.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - A L Lang
- Department of Anesthesia, Critical Care, and Pain Medicine (A.L.L.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - D M Giao
- Harvard Medical School (D.M.G.), Boston, Massachusetts
| | | | - J Kalpathy-Cramer
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Athinoula A. Martinos Center for Biomedical Imaging (J.C., S.Y.H., J.K.-C.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - B P Little
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - K Buch
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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9
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Deng F, Yoon BC. Brachiocephalic vein compression with jugular venous reflux may mimic cavernous dural arteriovenous fistula on arterial spin labeling. Neuroradiology 2021; 63:291-294. [PMID: 33427902 DOI: 10.1007/s00234-021-02637-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Francis Deng
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, USA.
| | - Byung C Yoon
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, USA
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10
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Kim YT, Kim H, Lee CH, Yoon BC, Kim JB, Choi YH, Cho WS, Oh BM, Kim DJ. Intracranial Densitometry-Augmented Machine Learning Enhances the Prognostic Value of Brain CT in Pediatric Patients With Traumatic Brain Injury: A Retrospective Pilot Study. Front Pediatr 2021; 9:750272. [PMID: 34796154 PMCID: PMC8593245 DOI: 10.3389/fped.2021.750272] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The inter- and intrarater variability of conventional computed tomography (CT) classification systems for evaluating the extent of ischemic-edematous insult following traumatic brain injury (TBI) may hinder the robustness of TBI prognostic models. Objective: This study aimed to employ fully automated quantitative densitometric CT parameters and a cutting-edge machine learning algorithm to construct a robust prognostic model for pediatric TBI. Methods: Fifty-eight pediatric patients with TBI who underwent brain CT were retrospectively analyzed. Intracranial densitometric information was derived from the supratentorial region as a distribution representing the proportion of Hounsfield units. Furthermore, a machine learning-based prognostic model based on gradient boosting (i.e., CatBoost) was constructed with leave-one-out cross-validation. At discharge, the outcome was assessed dichotomously with the Glasgow Outcome Scale (favorability: 1-3 vs. 4-5). In-hospital mortality, length of stay (>1 week), and need for surgery were further evaluated as alternative TBI outcome measures. Results: Densitometric parameters indicating reduced brain density due to subtle global ischemic changes were significantly different among the TBI outcome groups, except for need for surgery. The skewed intracranial densitometry of the unfavorable outcome became more distinguishable in the follow-up CT within 48 h. The prognostic model augmented by intracranial densitometric information achieved adequate AUCs for various outcome measures [favorability = 0.83 (95% CI: 0.72-0.94), in-hospital mortality = 0.91 (95% CI: 0.82-1.00), length of stay = 0.83 (95% CI: 0.72-0.94), and need for surgery = 0.71 (95% CI: 0.56-0.86)], and this model showed enhanced performance compared to the conventional CRASH-CT model. Conclusion: Densitometric parameters indicative of global ischemic changes during the acute phase of TBI are predictive of a worse outcome in pediatric patients. The robustness and predictive capacity of conventional TBI prognostic models might be significantly enhanced by incorporating densitometric parameters and machine learning techniques.
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Affiliation(s)
- Young-Tak Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea
| | - Hakseung Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea
| | - Choel-Hui Lee
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea
| | - Byung C Yoon
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Jung Bin Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.,National Traffic Injury Rehabilitation Hospital, Yangpyeong, South Korea
| | - Dong-Joo Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea.,Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea.,Department of Artificial Intelligence, Korea University, Seoul, South Korea
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11
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Li MD, Lang M, Yoon BC, Applewhite BP, Buch K, Rincon SP, Leslie-Mazwi TM, Mehan WA. Chest CT Scanning in Suspected Stroke: Not Always Worth the Extra Mile. AJNR Am J Neuroradiol 2020; 41:E86-E87. [PMID: 32816772 DOI: 10.3174/ajnr.a6763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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12
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Yoon BC, Buch K, Lang M, Applewhite BP, Li MD, Mehan WA, Leslie-Mazwi TM, Rincon SP. Clinical and Neuroimaging Correlation in Patients with COVID-19. AJNR Am J Neuroradiol 2020; 41:1791-1796. [PMID: 32912875 PMCID: PMC7661080 DOI: 10.3174/ajnr.a6717] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/16/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Coronavirus disease 2019 (COVID-19) is increasingly being recognized for its multiorgan involvement, including various neurological manifestations. We examined the frequency of acute intracranial abnormalities seen on CT and/or MR imaging in patients with COVID-19 and investigated possible associations between these findings and clinical parameters, including length of hospital stay, requirement for intubation, and development of acute kidney injury. MATERIALS AND METHODS This was a retrospective study performed at a large academic hospital in the United States. A total of 641 patients presented to our institution between March 3, 2020, and May 6, 2020, for treatment of coronavirus disease 2019, of whom, 150 underwent CT and/or MR imaging of the brain. CT and/or MR imaging examinations were evaluated for the presence of hemorrhage, infarction, and leukoencephalopathy. The frequency of these findings was correlated with clinical variables, including body mass index, length of hospital stay, requirement for intubation, and development of acute kidney injury as documented in the electronic medical record. RESULTS Of the 150 patients, 26 (17%) had abnormal CT and/or MR imaging findings, with hemorrhage in 11 of the patients (42%), infarction in 13 of the patients (50%), and leukoencephalopathy in 7 of the patients (27%). Significant associations were seen between abnormal CT/MR imaging findings and intensive care unit admission (P = .039), intubation (P = .004), and acute kidney injury (P = .030). CONCLUSIONS A spectrum of acute neuroimaging abnormalities was seen in our cohort of patients with coronavirus disease 2019, including hemorrhage, infarction, and leukoencephalopathy. Significant associations between abnormal neuroimaging studies and markers of disease severity (intensive care unit admission, intubation, and acute kidney injury) suggest that patients with severe forms of coronavirus disease 2019 may have higher rates of neuroimaging abnormalities.
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Affiliation(s)
- B C Yoon
- From the Departments of Radiology (B.C.Y., K.B., M.L., B.P.A., M.D.L., W.A.M., Jr., S.P.R.)
| | - K Buch
- From the Departments of Radiology (B.C.Y., K.B., M.L., B.P.A., M.D.L., W.A.M., Jr., S.P.R.)
| | - M Lang
- From the Departments of Radiology (B.C.Y., K.B., M.L., B.P.A., M.D.L., W.A.M., Jr., S.P.R.)
| | - B P Applewhite
- From the Departments of Radiology (B.C.Y., K.B., M.L., B.P.A., M.D.L., W.A.M., Jr., S.P.R.)
| | - M D Li
- From the Departments of Radiology (B.C.Y., K.B., M.L., B.P.A., M.D.L., W.A.M., Jr., S.P.R.)
| | - W A Mehan
- From the Departments of Radiology (B.C.Y., K.B., M.L., B.P.A., M.D.L., W.A.M., Jr., S.P.R.)
| | - T M Leslie-Mazwi
- Neurosurgery and Neurology (T.M.L.-M.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - S P Rincon
- From the Departments of Radiology (B.C.Y., K.B., M.L., B.P.A., M.D.L., W.A.M., Jr., S.P.R.)
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13
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Mehan WA, Yoon BC, Lang M, Li MD, Rincon S, Buch K. Paraspinal Myositis in Patients with COVID-19 Infection. AJNR Am J Neuroradiol 2020; 41:1949-1952. [PMID: 32763902 DOI: 10.3174/ajnr.a6711] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [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: 05/26/2020] [Accepted: 06/12/2020] [Indexed: 01/07/2023]
Abstract
Myalgia is a previously reported symptom in patients with COVID-19 infection; however, the presence of paraspinal myositis has not been previously reported. We report MR imaging findings of the spine obtained in a cohort of 9 patients with COVID-19 infection who presented to our hospital between March 3, 2020 and May 6, 2020. We found that 7 of 9 COVID-19 patients (78%) who underwent MR imaging of the spine had MR imaging evidence of paraspinal myositis, characterized by intramuscular edema and/or enhancement. Five of these 7 patients had a prolonged hospital course (greater than 25 days). Our knowledge of the imaging manifestations of COVID-19 infection is expanding. It is important for clinicians>a to be aware of the relatively high frequency of paraspinal myositis in this small cohort of patients with COVID-19 infection.
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Affiliation(s)
- W A Mehan
- From the Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - B C Yoon
- From the Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - M Lang
- From the Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - M D Li
- From the Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - S Rincon
- From the Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - K Buch
- From the Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
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14
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Lang M, Li MD, Buch K, Yoon BC, Applewhite BP, Leslie-Mazwi TM, Rincon S, Mehan WA. Risk of Acute Cerebrovascular Events in Patients with COVID-19 Infection. AJNR Am J Neuroradiol 2020; 41:E92-E93. [PMID: 32855192 DOI: 10.3174/ajnr.a6796] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
| | | | | | | | | | | | - S Rincon
- Department of RadiologyMassachusetts General Hospital, Harvard Medical SchoolBoston, Massachusett
| | - W A Mehan
- Department of RadiologyMassachusetts General Hospital, Harvard Medical SchoolBoston, Massachusett
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15
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Yoon BC, Bulbul MD, Sadow PM, Faquin WC, Curtin HD, Varvares MA, Juliano AF. Comparison of Intraoperative Sonography and Histopathologic Evaluation of Tumor Thickness and Depth of Invasion in Oral Tongue Cancer: A Pilot Study. AJNR Am J Neuroradiol 2020; 41:1245-1250. [PMID: 32554422 DOI: 10.3174/ajnr.a6625] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/24/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE For primary squamous cell carcinoma of the oral tongue, accurate assessment of tumor thickness and depth of invasion is critical for staging and operative management. Currently, typical imaging modalities used for preoperative staging are CT and MR imaging. Intraoperatively, CT or MR imaging cannot provide real-time guidance, and assessment by manual palpation is limited in precision. We investigated whether intraoperative sonography is a feasible technique for assessment of tumor thickness and depth of invasion and validated its accuracy by comparing it with histopathologic evaluation of the resected specimen. MATERIALS AND METHODS Twenty-six patients with squamous cell carcinoma of the oral tongue who underwent tumor resection by a single surgeon between March 31, 2016, and April 26, 2019, were prospectively identified. Intraoperative sonography was obtained in planes longitudinal and transverse to the long axis of the tumor. Twenty-two patients had archived images that allowed measurements of tumor thickness and depth of invasion sonographically. Two patients had dysplasia and were excluded. The remaining 20 patients had histologic tumor thickness and histologic depth of invasion measured by a single pathologist. RESULTS The mean sonographic tumor thickness was 7.5 ± 3.5 mm, and the mean histologic tumor thickness was 7.0 ± 4.2 mm. Mean sonographic depth of invasion and histologic depth of invasion were 6.6 ± 3.4 and 6.4 ± 4.4 mm, respectively. There was excellent correlation between sonographic and histologic measurements for both tumor thickness and depth of invasion with Pearson correlation coefficients of 0.95 (95% CI, 0.87-0.98) and 0.95 (95% CI, 0.87-0.98), respectively. CONCLUSIONS Intraoperative sonography can provide reliable, real-time assessment of the extent of tongue tumors.
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Affiliation(s)
- B C Yoon
- From the Departments of Radiology (B.C.Y.)
| | - M D Bulbul
- Departments of Otolaryngology Head and Neck Surgery (M.D.B., M.A.V.)
| | - P M Sadow
- Pathology (P.M.S., W.C.F.), Massachusetts General Hospital, Boston, Massachusetts.,Pathology (P.M.S., W.C.F.), Massachusetts Eye and Ear, Boston, Massachusetts
| | - W C Faquin
- Pathology (P.M.S., W.C.F.), Massachusetts General Hospital, Boston, Massachusetts.,Pathology (P.M.S., W.C.F.), Massachusetts Eye and Ear, Boston, Massachusetts
| | | | - M A Varvares
- Departments of Otolaryngology Head and Neck Surgery (M.D.B., M.A.V.)
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16
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Kim H, Yang X, Choi YH, Yoon BC, Kim K, Kim DJ. Abilities of a Densitometric Analysis of Computed Tomography Images and Hemorrhagic Parameters to Predict Outcome Favorability in Patients With Intracerebral Hemorrhage. Neurosurgery 2019; 83:226-236. [PMID: 28973583 DOI: 10.1093/neuros/nyx379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 06/19/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) is one of the most devastating subtypes of stroke. A rapid assessment of ICH severity involves the use of computed tomography (CT) and derivation of the hemorrhage volume, which is often estimated using the ABC/2 method. However, these estimates are highly inaccurate and may not be feasible for anticipating outcome favorability. OBJECTIVE To predict patient outcomes via a quantitative, densitometric analysis of CT images, and to compare the predictive power of these densitometric parameters with the conventional ABC/2 volumetric parameter and segmented hemorrhage volumes. METHODS Noncontrast CT images of 87 adult patients with ICH (favorable outcomes = 69, unfavorable outcomes = 12, and deceased = 6) were analyzed. In-house software was used to calculate the segmented hemorrhage volumes, ABC/2 and densitometric parameters, including the skewness and kurtosis of the density distribution, interquartile ranges, and proportions of specific pixels in sets of CT images. Nonparametric statistical analyses were conducted. RESULTS The densitometric parameter interquartile range exhibited greatest accuracy (82.7%) in predicting favorable outcomes. The combination of skewness and the interquartile range effectively predicted mortality (accuracy = 83.3%). The actual volume of the ICH exhibited good coherence with ABC/2 (R = 0.79). Both parameters predicted mortality with moderate accuracy (<78%) but were less effective in predicting unfavorable outcomes. CONCLUSION Hemorrhage volume was rapidly estimated and effectively predicted mortality in patients with ICH; however, this value may not be useful for predicting favorable outcomes. The densitometric analysis exhibited significantly higher power in predicting mortality and favorable outcomes in patients with ICH.
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Affiliation(s)
- Hakseung Kim
- Department of Brain and Cognitive Engi-neering, Korea University, Seoul, South Korea
| | - Xiaoke Yang
- Department of Brain and Cognitive Engi-neering, Korea University, Seoul, South Korea
| | - Young Hun Choi
- Department of Radiology, Se-oul National University Hospital, College of Medicine, Seoul, South Korea
| | - Byung C Yoon
- De-partment of Radiology, Stanford Uni-versity School of Medicine, Stanford, California
| | - Keewon Kim
- Department of Rehabilitation, Seoul National University Hospital, Coll-ege of Medicine, Seoul, South Korea
| | - Dong-Joo Kim
- Department of Brain and Cognitive Engi-neering, Korea University, Seoul, South Korea
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17
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Zhong Q, Yoon BC, Aryal M, Wang JB, Ilovitsh T, Baikoghli MA, Hosseini-Nassab N, Karthik A, Cheng RH, Ferrara KW, Airan RD. Polymeric perfluorocarbon nanoemulsions are ultrasound-activated wireless drug infusion catheters. Biomaterials 2019; 206:73-86. [PMID: 30953907 DOI: 10.1016/j.biomaterials.2019.03.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 01/18/2019] [Revised: 03/11/2019] [Accepted: 03/15/2019] [Indexed: 01/04/2023]
Abstract
Catheter-based intra-arterial drug therapies have proven effective for a range of oncologic, neurologic, and cardiovascular applications. However, these procedures are limited by their invasiveness and relatively broad drug spatial distribution. The ideal technique for local pharmacotherapy would be noninvasive and would flexibly deliver a given drug to any region of the body with high spatial and temporal precision. Combining polymeric perfluorocarbon nanoemulsions with existent clinical focused ultrasound systems could in principle meet these needs, but it has not been clear whether these nanoparticles could provide the necessary drug loading, stability, and generalizability across a range of drugs, beyond a few niche applications. Here, we develop polymeric perfluorocarbon nanoemulsions into a generalized platform for ultrasound-targeted delivery of hydrophobic drugs with high potential for clinical translation. We demonstrate that a wide variety of drugs may be effectively uncaged with ultrasound using these nanoparticles, with drug loading increasing with hydrophobicity. We also set the stage for clinical translation by delineating production protocols that are scalable and yield sterile, stable, and optimized ultrasound-activated drug-loaded nanoemulsions. Finally, we exhibit a new potential application of these nanoemulsions for local control of vascular tone. This work establishes the power of polymeric perfluorocarbon nanoemulsions as a clinically-translatable platform for efficacious, noninvasive, and localized ultrasonic drug uncaging for myriad targets in the brain and body.
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Affiliation(s)
- Q Zhong
- Department of Radiology, Stanford University, Stanford, CA 94305, USA; David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - B C Yoon
- Department of Radiology, Stanford University, Stanford, CA 94305, USA; Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - M Aryal
- Department of Radiology, Stanford University, Stanford, CA 94305, USA
| | - J B Wang
- Department of Radiology, Stanford University, Stanford, CA 94305, USA
| | - T Ilovitsh
- Department of Radiology, Stanford University, Stanford, CA 94305, USA; Department of Biomedical Engineering, University of California, Davis, CA 95616, USA
| | - M A Baikoghli
- Department of Molecular and Cellular Biology, University of California, Davis, CA 95616, USA
| | - N Hosseini-Nassab
- Department of Radiology, Stanford University, Stanford, CA 94305, USA
| | - A Karthik
- Department of Radiology, Stanford University, Stanford, CA 94305, USA
| | - R H Cheng
- Department of Molecular and Cellular Biology, University of California, Davis, CA 95616, USA
| | - K W Ferrara
- Department of Radiology, Stanford University, Stanford, CA 94305, USA; Department of Biomedical Engineering, University of California, Davis, CA 95616, USA
| | - R D Airan
- Department of Radiology, Stanford University, Stanford, CA 94305, USA.
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18
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Kim H, Kim YT, Song ES, Yoon BC, Choi YH, Kim K, Kim DJ. Changes in the gray and white matter of patients with ischemic-edematous insults after traumatic brain injury. J Neurosurg 2018; 131:1243-1253. [PMID: 30485242 DOI: 10.3171/2018.5.jns172711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 10/26/2017] [Accepted: 05/10/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Gray matter (GM) and white matter (WM) are vulnerable to ischemic-edematous insults after traumatic brain injury (TBI). The extent of secondary insult after brain injury is quantifiable using quantitative CT analysis. One conventional quantitative CT measure, the gray-white matter ratio (GWR), and a more recently proposed densitometric analysis are used to assess the extent of these insults. However, the prognostic capacity of the GWR in patients with TBI has not yet been validated. This study aims to test the prognostic value of the GWR and evaluate the alternative parameters derived from the densitometric analysis acquired during the acute phase of TBI. In addition, the prognostic ability of the conventional TBI prognostic models (i.e., IMPACT [International Mission for Prognosis and Analysis of Clinical Trials in TBI] and CRASH [Corticosteroid Randomisation After Significant Head Injury] models) were compared to that of the quantitative CT measures. METHODS Three hundred patients with TBI of varying ages (92 pediatric, 94 adult, and 114 geriatric patients) and admitted between 2008 and 2013 were included in this retrospective cohort study. The normality of the density of the deep GM and whole WM was evaluated as the proportion of CT pixels with Hounsfield unit values of 31-35 for GM and 26-30 for WM on CT images of the entire supratentorial brain. The outcome was evaluated using the Glasgow Outcome Scale (GOS) at discharge (GOS score ≤ 3, n = 100). RESULTS Lower proportions of normal densities in the deep GM and whole WM indicated worse outcomes. The proportion of normal WM exhibited a significant prognostic capacity (area under the curve [AUC] = 0.844). The association between the outcome and the normality of the WM density was significant in adult (AUC = 0.792), pediatric (AUC = 0.814), and geriatric (AUC = 0.885) patients. In pediatric patients, the normality of the overall density and the density of the GM were indicative of the outcome (AUC = 0.751). The average GWR was not associated with the outcome (AUC = 0.511). IMPACT and CRASH models showed adequate and reliable performance in the pediatric and geriatric groups but not in the adult group. The highest overall predictive performance was achieved by the densitometry-augmented IMPACT model (AUC = 0.881). CONCLUSIONS Both deep GM and WM are susceptible to ischemic-edematous insults during the early phase of TBI. The extent of the secondary injury was better evaluated by analyzing the normality of the deep GM and WM rather than by calculating the GWR.
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Affiliation(s)
- Hakseung Kim
- 1Department of Brain and Cognitive Engineering, Korea University, Seongbuk-gu, Seoul, South Korea
| | - Young-Tak Kim
- 1Department of Brain and Cognitive Engineering, Korea University, Seongbuk-gu, Seoul, South Korea
| | - Eun-Suk Song
- 1Department of Brain and Cognitive Engineering, Korea University, Seongbuk-gu, Seoul, South Korea
| | - Byung C Yoon
- 2Department of Radiology, Stanford University School of Medicine, Stanford, California; and
| | | | - Keewon Kim
- 4Rehabilitation, Seoul National University Hospital, College of Medicine, Jongno-gu, Seoul, South Korea
| | - Dong-Joo Kim
- 1Department of Brain and Cognitive Engineering, Korea University, Seongbuk-gu, Seoul, South Korea
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19
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Yoon BC, Saad AF, Rezaii P, Wintermark M, Zaharchuk G, Iv M. Evaluation of Thick-Slab Overlapping MIP Images of Contrast-Enhanced 3D T1-Weighted CUBE for Detection of Intracranial Metastases: A Pilot Study for Comparison of Lesion Detection, Interpretation Time, and Sensitivity with Nonoverlapping CUBE MIP, CUBE, and Inversion-Recovery-Prepared Fast-Spoiled Gradient Recalled Brain Volume. AJNR Am J Neuroradiol 2018; 39:1635-1642. [PMID: 30093483 DOI: 10.3174/ajnr.a5747] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 06/16/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Early and accurate identification of cerebral metastases is important for prognostication and treatment planning although this process is often time consuming and labor intensive, especially with the hundreds of images associated with 3D volumetric imaging. This study aimed to evaluate the benefits of thick-slab overlapping MIPs constructed from contrast-enhanced T1-weighted CUBE (overlapping CUBE MIP) for the detection of brain metastases in comparison with traditional CUBE and inversion-recovery prepared fast-spoiled gradient recalled brain volume (IR-FSPGR-BRAVO) and nonoverlapping CUBE MIP. MATERIALS AND METHODS A retrospective review of 48 patients with cerebral metastases was performed at our institution from June 2016 to October 2017. Brain MRIs, which were acquired on multiple 3T scanners, included gadolinium-enhanced T1-weighted IR-FSPGR-BRAVO and CUBE, with subsequent generation of nonoverlapping CUBE MIP and overlapping CUBE MIP. Two blinded radiologists identified the total number and location of metastases on each image type. The Cohen κ was used to determine interrater agreement. Sensitivity, interpretation time, and lesion contrast-to-noise ratio were assessed. RESULTS Interrater agreement for identification of metastases was fair-to-moderate for all image types (κ = 0.222-0.598). The total number of metastases identified was not significantly different across the image types. Interpretation time for CUBE MIPs was significantly shorter than for CUBE and IR-FSPGR-BRAVO, saving at least 50 seconds per case on average (P < .001). The mean lesion contrast-to-noise ratio for both CUBE MIPs was higher than for IR-FSPGR-BRAVO. The mean contrast-to-noise ratio for small lesions (<4 mm) was lower for nonoverlapping CUBE MIP (1.55) than for overlapping CUBE MIP (2.35). For both readers, the sensitivity for lesion detection was high for all image types but highest for overlapping CUBE MIP and CUBE (0.93-0.97). CONCLUSIONS This study suggests that the use of overlapping CUBE MIP or nonoverlapping CUBE MIP for the detection of brain metastases can reduce interpretation time without sacrificing sensitivity, though the contrast-to-noise ratio of lesions is highest for overlapping CUBE MIP.
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Affiliation(s)
- B C Yoon
- From the Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University, Stanford, California
| | - A F Saad
- From the Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University, Stanford, California
| | - P Rezaii
- From the Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University, Stanford, California
| | - M Wintermark
- From the Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University, Stanford, California
| | - G Zaharchuk
- From the Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University, Stanford, California
| | - M Iv
- From the Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University, Stanford, California.
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Iv M, Yoon BC, Heit JJ, Fischbein N, Wintermark M. Current Clinical State of Advanced Magnetic Resonance Imaging for Brain Tumor Diagnosis and Follow Up. Semin Roentgenol 2018; 53:45-61. [DOI: 10.1053/j.ro.2017.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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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Kim H, Jeong EJ, Park DH, Czosnyka Z, Yoon BC, Kim K, Czosnyka M, Kim DJ. Finite element analysis of periventricular lucency in hydrocephalus: extravasation or transependymal CSF absorption? J Neurosurg 2015; 124:334-41. [PMID: 26274984 DOI: 10.3171/2014.11.jns141382] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 11/06/2022]
Abstract
OBJECTIVE Periventricular lucency (PVL) is often observed in the hydrocephalic brain on CT or MRI. Earlier studies have proposed the extravasation of ventricular CSF into the periventricular white matter or transependymal CSF absorption as possible causes of PVL in hydrocephalus. However, there is insufficient evidence for either theory to be conclusive. METHODS A finite element (FE) model of the hydrocephalic brain with detailed anatomical geometry was constructed to investigate the possible mechanism of PVL in hydrocephalus. The initiation of hydrocephalus was modeled by applying a transmantle pressure gradient (TPG). The model was exposed to varying TPGs to investigate the effects of different geometrical characteristics on the distribution of PVL. The edema map was derived based on the interstitial pore pressure. RESULTS The model simulated the main radiological features of hydrocephalus, i.e., ventriculomegaly and PVL. The degree of PVL, assessed by the pore pressure, was prominent in mild to moderate ventriculomegaly. As the degree of ventriculomegaly exceeded certain values, the pore pressure across the cerebrum became positive, thus inducing the disappearance of PVL. CONCLUSIONS The results are in accordance with common clinical findings of PVL. The degree of ventriculomegaly significantly influences the development of PVL, but two factors were not linearly correlated. The results are indicative of the transependymal CSF absorption as a possible cause of PVL, but the extravasation theory cannot be formally rejected.
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Affiliation(s)
- Hakseung Kim
- Departments of 1 Brain and Cognitive Engineering, and
| | - Eun-Jin Jeong
- Biomedical Engineering, Korea University, Seoul, South Korea
| | | | - Zofia Czosnyka
- Department of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, United Kingdom
| | - Byung C Yoon
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California
| | - Keewon Kim
- Department of Rehabilitation, Seoul National University Hospital, College of Medicine, Seoul, South Korea; and
| | - Marek Czosnyka
- Department of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, United Kingdom
| | - Dong-Joo Kim
- Departments of 1 Brain and Cognitive Engineering, and
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Kim H, Kim GD, Yoon BC, Kim K, Kim BJ, Choi YH, Czosnyka M, Oh BM, Kim DJ. Quantitative analysis of computed tomography images and early detection of cerebral edema for pediatric traumatic brain injury patients: retrospective study. BMC Med 2014; 12:186. [PMID: 25339549 PMCID: PMC4219082 DOI: 10.1186/s12916-014-0186-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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: 07/10/2014] [Accepted: 09/18/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The purpose of this study was to identify whether the distribution of Hounsfield Unit (HU) values across the intracranial area in computed tomography (CT) images can be used as an effective diagnostic tool for determining the severity of cerebral edema in pediatric traumatic brain injury (TBI) patients. METHODS CT images, medical records and radiology reports on 70 pediatric patients were collected. Based on radiology reports and the Marshall classification, the patients were grouped as mild edema patients (n=37) or severe edema patients (n=33). Automated quantitative analysis using unenhanced CT images was applied to eliminate artifacts and identify the difference in HU value distribution across the intracranial area between these groups. RESULTS The proportion of pixels with HU=17 to 24 was highly correlated with the existence of severe cerebral edema (P<0.01). This proportion was also able to differentiate patients who developed delayed cerebral edema from mild TBI patients. A significant difference between deceased patients and surviving patients in terms of the HU distribution came from the proportion of pixels with HU=19 to HU=23 (P<0.01). CONCLUSIONS The proportion of pixels with an HU value of 17 to 24 in the entire cerebral area of a non-enhanced CT image can be an effective basis for evaluating the severity of cerebral edema. Based on this result, we propose a novel approach for the early detection of severe cerebral edema.
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Affiliation(s)
- Hakseung Kim
- Department of Brain and Cognitive Engineering, Korea University, Anam-dong, Seongbuk-gu, Seoul, 136-713, South Korea.
| | - Gwang-dong Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Byung C Yoon
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
| | - Keewon Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Byung-Jo Kim
- Department of Neurology, Korea University College of Medicine, Seoul, South Korea.
| | - Young Hun Choi
- Department of Radiology, Seoul National University Children's Hospital, Seoul, South Korea.
| | - Marek Czosnyka
- Academic Neurosurgical Unit, University of Cambridge Clinical School, Cambridge, UK.
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Dong-Joo Kim
- Department of Brain and Cognitive Engineering, Korea University, Anam-dong, Seongbuk-gu, Seoul, 136-713, South Korea. .,Academic Neurosurgical Unit, University of Cambridge Clinical School, Cambridge, UK.
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Kim DJ, Kim H, Kim YT, Yoon BC, Czosnyka Z, Park KW, Czosnyka M. Thresholds of resistance to CSF outflow in predicting shunt responsiveness. Neurol Res 2014; 37:332-40. [DOI: 10.1179/1743132814y.0000000454] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Precise navigation of axons to their targets is critical for establishing proper neuronal networks during development. Axon elongation, whereby axons extend far beyond the site of initiation to reach their target cells, is an essential step in this process, but the precise molecular pathways that regulate axon growth remain uncharacterized. Here we show that 14-3-3/14-3-3ς proteins-adaptor proteins that modulate diverse cellular processes including cytoskeletal dynamics-play a critical role in Xenopus retinal ganglion cell (RGC) axon elongation in vivo and in vitro. We have identified the expression of 14-3-3/14-3-3ς transcripts and proteins in retinal growth cones, with higher levels of expression occurring during the phase of rapid pathway extension. Competitive inhibition of 14-3-3/14-3-3ς by expression of a genetically encoded peptide, R18, in RGCs resulted in a marked decrease in the length of the initial retinotectal projection in vivo and a corresponding decrease in axon elongation rate in vitro (30-40%). Furthermore, 14-3-3/14-3-3ς (R1) co-localized with Xenopus actin depolymerizing factor (ADF)/cofilin (XAC) in RGC growth cones. Inhibition of 14-3-3/14-3-3ς function with either R18 or morpholinos reduced the level of inactive pXAC and increased the sensitivity to collapse by the repulsive cue, Slit2. Collectively, these results demonstrate that14-3-3/14-3-3ς participates in the regulation of retinal axon elongation, in part by modulating XAC activity.
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Affiliation(s)
- Byung C Yoon
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
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Lee SP, Lee HL, Kim DC, Lee KN, Lee OY, Choi HS, Yoon BC, Jun DW, Hahm JS, Joo YW. Percutaneous endoscopic gastrostomy using 10-cc syringe tubes for amyotrophic lateral sclerosis patients with limited mouth opening. Endoscopy 2012; 44 Suppl 2 UCTN:E190-1. [PMID: 22622738 DOI: 10.1055/s-0032-1306796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- S P Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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Jung H, Yoon BC, Holt CE. Erratum: Axonal mRNA localization and local protein synthesis in nervous system assembly, maintenance and repair. Nat Rev Neurosci 2012. [DOI: 10.1038/nrn3254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kwon OW, Jun DW, Lee SM, Lee KN, Lee HL, Lee OY, Yoon BC, Choi HS. Carbohydrate but not fat is associated with elevated aminotransferases. Aliment Pharmacol Ther 2012; 35:1064-72. [PMID: 22428533 DOI: 10.1111/j.1365-2036.2012.05061.x] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 01/04/2012] [Accepted: 02/24/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND Recently, many studies reported that high carbohydrate and simple sugar intake increase a risk of obesity and metabolic syndrome significantly. AIM To investigate the effect of carbohydrate on aminotransferase levels in Korea, where the proportion of carbohydrate in meals is extremely high but fat is low. METHODS We used the data of Korean National Health and Nutrition Examination Surveys (KNHANES). A total of 19 749 people were included. Amounts and types of consumed foods were examined by the 24 h recall method. RESULTS Mean carbohydrate and fat proportions in total energy intake were 67.7% and 17.4%, respectively. Aminotransferase activity increased according to the rise of the proportion of carbohydrate in the energy intake. A high carbohydrate intake (>70% of energy) was associated with abnormal aminotransferase activity and metabolic syndrome. After adjusting for covariates, such as age, energy intake and body mass index, abnormal aminotransferase activity was significantly associated with carbohydrate proportion. There was a negative correlation between fat proportion in the total energy intake and aminotransferase activity (P < 0.01). The relation between aminotransferase activity and carbohydrate composition showed a J-shaped curve. The lowest point (the J point) was located at 50-60% carbohydrate. CONCLUSIONS The proportion of carbohydrate in energy intake but not fat is positively correlated with abnormal aminotransferase activity in Koreans. This finding may be useful in planning a strategy of nutrition education for NAFLD in countries where the proportion of carbohydrate in most meals is extremely high.
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Affiliation(s)
- O W Kwon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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Abstract
Metastatic spine disease is becoming a more frequent problem in cancer patients as advancements in treatment for primary tumors prolong patient survival. Elderly patients over 60 years of age make up the majority of these cases, with the incidence of metastatic disease several folds higher in the elderly than in any other age group. These patients are also the most challenging group to treat, given higher rates of comorbidities and decreased tolerance to medical, surgical and radiation therapies. Advancements in therapeutic strategies, including minimally invasive surgeries and stereotactic radiosurgery, have provided increasingly attractive treatment options for elderly patients owing to their decreased procedure-associated morbidity. This article will discuss efficacy and limitations of conventional, as well as more recent, treatment modalities with an emphasis on their role in the management of elderly patients.
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Affiliation(s)
- Byung C Yoon
- The Johns Hopkins Hospital, Department of Neurosurgery, Meyer Building, Room 7–109, 600 N Wolfe Street, Baltimore, MD 21287, USA
| | - Camilo Molina
- The Johns Hopkins Hospital, Department of Neurosurgery, Meyer Building, Room 7–109, 600 N Wolfe Street, Baltimore, MD 21287, USA
| | - Ziya L Gokaslan
- The Johns Hopkins Hospital, Department of Neurosurgery, Meyer Building, Room 7–109, 600 N Wolfe Street, Baltimore, MD 21287, USA
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Abstract
Axons and their growth cones are specialized neuronal sub-compartments that possess translation machinery and have distinct messenger RNAs (mRNAs). Several classes of mRNAs have been identified using candidate-based, as well as unbiased genome-wide-based approaches. Axonal mRNA localization serves to regulate spatially the protein synthesis; thereby, providing axons with a high degree of functional autonomy from the soma during axon pathfinding. Importantly, de novo protein synthesis in navigating axonal growth cones is necessary for chemotropic responses to various axon guidance cues. This chapter discusses the molecular components involved in regulating axonal mRNA trafficking, targeting, and translation, and focuses on RNA binding proteins (RNBPs) and microRNAs. The functional significance of local mRNA translation in the directional response of growth cones to a gradient is highlighted along with the downstream signaling events that mediate local protein synthesis. The view that emerges is that local translation is tightly coupled to extracellular cues, enabling growth cones to respond to new signals with exquisite adaptability and spatiotemporal control.
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Affiliation(s)
- Byung C Yoon
- Department of Physiology, Development and Neuroscience, University of Cambridge, Downing Street, Cambridge, CB2 3DY, UK
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Affiliation(s)
- D W Jun
- Department of Internal Medicine, Euji University, Seoul, South Korea
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Yu BK, Yoon BC, Kim SS, Chun SL, Kim EH, Kim KM, Lim BV, Jang MH, Chung JH, Kim CJ. Treadmill exercise increases cell proliferation in hippocampal dentate gyrus in alcohol-intoxicated rats. J Sports Med Phys Fitness 2003; 43:393-7. [PMID: 14625522] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
AIM Effect of treadmill exercise on hippocampal cell proliferation under normal conditions has been well documented; however, this effect under alcohol intoxication conditions is not clarified, yet. In the present study, the effect of treadmill exercise on cell proliferation in the dentate gyrus in alcohol-intoxicated rats was investigated. METHODS EXPERIMENTAL DESIGN comparative investigation on number of 5-bromo-2'-deoxyuridine (BrdU)-positive cells in the dentate gyrus 8 days after commencement. SETTING animal laboratory. PARTICIPANTS male Sprague-Dawley rats of 5 weeks in age weighing 150+/-10 g. INTERVENTION animals were divided into 4 groups: the control-rest group, the control-exercise group, the alcohol-treated-rest group, and the alcohol-treated-exercise group. Animals of the alcohol-treated groups were injected intraperitoneally with alcohol (2 g/kg) once a day for 3 days. All animals were injected BrdU (50 mg/kg) intraperitoneally, and rats of exercise groups were made to run on treadmill for 30 min each day for 5 days following alcohol administration. MEASURES mean number of BrdU-positive cells in dentate gyrus was observed via immunohistochemistry. RESULTS Treadmill exercise significantly increased the number of BrdU-positive cells in the dentate gyrus. Also, treatment with alcohol for 3 days inhibited cell proliferation and treadmill exercise alleviated alcohol-induced inhibition of new cell formation. CONCLUSION These results suggest the possibility that treadmill exercise may help in improvement following alcohol-induced brain damage.
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Affiliation(s)
- B K Yu
- Department of Physical Therapy, Shingu College, Kyonggi, Korea
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Abstract
Induction of angiotensin-converting enzyme was examined in proximal and distal intestinal segments of rats fed a low-protein (4%) diet and then switched to a high-protein (gelatin) diet. Animals were killed at varying time points, and brush-border membranes and total RNA were prepared from the segments. In the proximal intestine, there was a fivefold increase in angiotensin-converting enzyme levels after 14 days but only a twofold change in mRNA. In the distal intestine, there was no increase in enzyme activity but mRNA increased 2.4-fold. Organ culture was used to measure changes in enzyme biosynthesis. There was a 5- to 6-fold increase in the biosynthesis of angiotensin-converting enzyme in the proximal intestine 24 h after the switch to the gelatin diet and a 1.6-fold increase in mRNA levels. No change in biosynthesis was observed in the distal small intestine despite an increase in mRNA. These results support the conclusion that rapid dietary induction of intestinal angiotensin-converting enzyme is differentially regulated in proximal and distal segments of the small intestine.
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Affiliation(s)
- R H Erickson
- Gastrointestinal Research Laboratory, Department of Veterans Affairs Medical Center, San Francisco, California 94121, USA.
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Kim JH, Kim HY, Kim NY, Kim SW, Kim JG, Kim JJ, Roe IH, Seo JK, Sim JG, Ahn H, Yoon BC, Lee SW, Lee YC, Chung IS, Jung HY, Hong WS, Choi KW. Seroepidemiological study of Helicobacter pylori infection in asymptomatic people in South Korea. J Gastroenterol Hepatol 2001; 16:969-75. [PMID: 11595059 DOI: 10.1046/j.1440-1746.2001.02568.x] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Helicobacter pylori infection occurs throughout the world and causes gastroduodenal diseases in all age groups. The prevalence of H. pylori infection varies between countries and races. The aim of this study was to evaluate the seroprevalence of H. pylori infection in asymptomatic healthy people in South Korea. METHODS From March 1998 to October 1998, 5732 asymptomatic subjects who responded to the self-assessment questionnaires from 54 hospitals in South Korea were enrolled in this study. The serum levels of antibodies for H. pylori immunoglobulinG were measured by using an ELISA test. RESULTS The overall seroprevalence of H. pylori infection was 46.6% and there was no statistical difference between males (47.2%) and females (45.9%). In adults, a significant difference was observed between genders. According to the geographic areas, the high prevalent provinces were Kangwon (53.4%), Cheju (52.9%) and Cholla province (50.6%); Seoul (41.9%) was the lowest prevalent area. The seroprevalence increased with age and was highest when patients were aged in their 40s (78.5%). The characteristic feature of our study was that the infection rate was steeply increased in three age groups (10-12 year olds, 16-19 year olds and those aged in their 20s). In Seoul, there was no difference in the prevalence rate among the districts studied. CONCLUSIONS This nation-wide seroprevalence of H. pylori infection in South Korea was 46.6%, which showed the transition from a developing country to a developed country. More studies on the epidemiological factors and the route of transmission of H. pylori infection should be warranted.
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Affiliation(s)
- J H Kim
- Kangdong Sacred Heart Hospital, Seoul, Korea.
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Ahn MJ, Park YW, Han D, Choi JH, Shin SJ, Yoon BC, Choi HS, Lee YY, Jung TJ, Choi IY, Park MH, Kim IS. A case of primary intestinal T-cell lymphoma involving entire gastrointestinal tract: esophagus to rectum. Korean J Intern Med 2000; 15:245-9. [PMID: 11242815 PMCID: PMC4531775 DOI: 10.3904/kjim.2000.15.3.245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/27/2022] Open
Abstract
Primary intestinal T-cell lymphoma is a rare disease entity, which is approximately 10% to 25% of intestinal lymphomas, and most of the lymphomas occur in the small intestine. We report here a case of a 56-year-old woman who has been suffering from chronic diarrhea and weight loss for 6 months. Abdominal CT scan and small bowel series showed diffuse wall thickening of the small bowel. Gastroscopic examination showed diffuse erythematous lesions on the esophagus and small gastric ulcerations on the antrum of the stomach, and colonoscopic examination also showed multiple punched-out ulcerations and erosions on the entire colon, including the sigmoid colon to the terminal ileum. Diffuse infiltration of CD 3 positive lymphoma cells was found on biopsy. The patient was diagnosed as primary intestinal T-cell lymphoma with diffuse involvement of the entire gastrointestinal tracts from the esophagus to the rectum. Although the patient received systemic combination chemotherapy and achieved partial response initially, the lymphoma relapsed repeatedly.
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Affiliation(s)
- M J Ahn
- Department of Internal Medicine, Department of Pathology, Hanyang University College of Medicine, Seoul, Korea
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Hahm JS, Park JY, Song SC, Cho YJ, Moon KH, Song YH, Lee OY, Choi HS, Yoon BC, Lee MH, Kee CS, Park KN. Gallbladder motility change in late pregnancy and after delivery. Korean J Intern Med 1997; 12:16-20. [PMID: 9159032 PMCID: PMC4531973 DOI: 10.3904/kjim.1997.12.1.16] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [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: 02/04/2023] Open
Abstract
OBJECTIVES The incidence of gallstone disease has increased recently in Korea and there seems to be an increased prevalence of gallstones when in association with pregnancy. Although the pathogenesis is incompletely defined, and altered motility of the gallbladder may contribute to the increased risk of gallstones during pregnancy. METHODS We measured gallbladder volume using real-time ultrasonography to find out the mechanism for the changes of gallbladder motility during late pregnancy. Eighteen pregnant women took the gallbladder ultrasonography during their last trimester of pregnancy and after delivery; gallbladder volume and ejection fraction were calculated in each patient. RESULTS Fasting gallbladder volumes increased significantly in the last trimester of pregnancy (25.28 +/- 14.26ml) compared with postpartum (17.44 +/- 5.82 ml) (p < 0.05). Gallbladder volumes measured after fatty meals showed more increment in pregnant women (10.13 +/- 7.19 ml) than in those after delivery (4.34 +/- 3.36 ml) (p < 0.005). A significantly reduced gallbladder ejection fraction was found in the pregnant group (60.56 +/- 18.80%) compared with those after delivery (77.48 +/- 13.37%) (p < 0.005). CONCLUSION Gallbladder motility in late pregnancy shows significant impairment compared with that in postpartum. Thus, we suggest that gallbladder hypomotility may occur during late pregnancy, and this impairment of gallbladder motility may play an important role in gallstone formation.
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Affiliation(s)
- J S Hahm
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul Korea
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Song S, Yim KW, Kim NY, Yoon BC, Lee DH, Jung HC, Kim CY. Effects of long-term treatment of captopril and enalapril on rat intestinal angiotensin converting enzyme specific activities. Korean J Intern Med 1994; 9:67-71. [PMID: 7865491 PMCID: PMC4532061 DOI: 10.3904/kjim.1994.9.2.67] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES Angiotensin converting enzyme (ACE) has been shown to be an important peptidasse that play a role in digestion and assimilation of protein rich in proline such as casein, gliadin and collagen. Despite that ACE inhibitors have been popular for various types of hypertension and congestive heart failure, the effects of their long-term treatment on intestinal ACE activities are not known. Therefore, we measured intestinal specific activities in rats after four weeks' treatment of ACE inhibitors. METHODS Thirty Wistar rats weighing about 200g in average were divided into three groups, and supplied with tap water, captopril solution and enalapril solution respectively for four weeks. After sacrificing, intestinal ACE specific activities were measured in homogenate and brush border membrane fraction respectively, which was prepared from three equally divided segments of removed small intestine. RESULTS ACE specific activities of proximal, middle and distal segments of control group were 178.6 +/- 64.2, 180.3 +/- 60.2 and 48.6 +/- 13.1 in brush border membrane (mean +/- SD, nmol/min/mg protein) respectively. Those of captopril group were 314.2 +/- 72.5, 281.0 +/- 69.8 and 67.7 +/- 21.8 respectively, showing tendency of increase in proximal and middle segments (p < 0.01 and 0.05 respectively). By contrast, those of enalapril group were 48.5 +/- 27.6, 70.7 +/- 15.6 and 11.6 +/- 4.4 respectively, which were significantly lower (p < 0.01) than those of control group. CONCLUSION Rat intestinal ACE specific activities were not inhibited by captopril treatment, but inhibited by enalapril treatment. This finding may explain why there has not been any case report of malabsorption in patients taking captopril. But the malabsorption of prolyl peptide could be possible in cases with long-term administration of enalapril.
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Affiliation(s)
- S Song
- Department of Internal Medicine, Seoul National University College of Medicine, Korea
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