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Jeong WK, Choi BI. [Burnout among Radiologists in Korea: Prevalence, Risk Factors, and Remedies]. J Korean Soc Radiol 2022; 83:776-782. [PMID: 36238907 PMCID: PMC9514575 DOI: 10.3348/jksr.2022.0087] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 11/15/2022]
Abstract
Burnout among radiologists has recently emerged as an issue that poses a threat to patient safety. Burnout adversely effects the quality of patient care and may lead to health problems in physicians. Approximately 84% of board-certified radiologists working in large hospitals in Korea responded that they had experienced burnout at least once. To overcome this, the standardization of physicians' workloads, as well as improvements in the professional workflow are necessary to ensure a healthy lifestyle balance.
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Bae JS, Lee DH, Lee JY, Kim H, Yu SJ, Lee JH, Cho EJ, Lee YB, Han JK, Choi BI. Quantitative Assessment of Fatty Liver using Ultrasound with Normalized Local Variance Technique. Ultraschall Med 2021; 42:599-606. [PMID: 32323278 DOI: 10.1055/a-1143-3091] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To assess the diagnostic performance of the normalized local variance (NLV) ultrasound technique in the detection of the fatty liver using histopathology as a reference standard. MATERIALS AND METHODS We prospectively enrolled 194 consecutive patients with clinical suspicion of diffuse liver disease or history of liver transplantation. Conventional grayscale ultrasound and NLV examinations were performed and immediately followed by liver biopsies. The degrees of fatty liver, necroinflammatory activity, and fibrosis stage were evaluated by histopathological assessment. The diagnostic performance of the NLV values in detecting each grade of fatty liver was determined using receiver operating characteristics analyses, and multivariate linear regression analyses were performed to identify variables significantly associated with the NLV values. RESULTS The number of patients in each degree of fatty liver and hepatic fibrosis was 118/37/26/13 and 81/68/24/6/14 for none/mild/moderate/severe steatosis and F0 / F1/F2 / F3/F4 fibrosis on histopathological examinations, respectively. The area under the receiver operating characteristics curve and optimal cut-off NLV value for detecting fatty liver of varying degrees were 0.911 and 1.095 for ≥ S1, 0.974 and 1.055 for ≥ S2, and 0.954 and 1.025 for ≥ S3, respectively. Multivariate analyses revealed that not fibrosis or inflammation but rather the degree of steatosis was associated with the NLV value. CONCLUSION The NLV value demonstrated excellent diagnostic performance for detecting varying degrees of fatty liver, and the degree of steatosis on histopathological examinations was the only significant factor affecting the NLV value.
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Affiliation(s)
- Jae Seok Bae
- Radiology, Seoul National University Hospital, Jongno-gu, Korea (the Republic of)
| | - Dong Ho Lee
- Radiology, Seoul National University Hospital, Jongno-gu, Korea (the Republic of)
| | - Jae Young Lee
- Radiology, Seoul National University Hospital, Jongno-gu, Korea (the Republic of)
| | - Haeryoung Kim
- Pathology, Seoul National University Hospital, Jongno-gu, Korea (the Republic of)
| | - Su Jong Yu
- Internal Medicine, Seoul National University Hospital, Jongno-gu, Korea (the Republic of)
| | - Jeong-Hoon Lee
- Internal Medicine, Seoul National University Hospital, Jongno-gu, Korea (the Republic of)
| | - Eun Ju Cho
- Internal Medicine, Seoul National University Hospital, Jongno-gu, Korea (the Republic of)
| | - Yun Bin Lee
- Internal Medicine, Seoul National University Hospital, Jongno-gu, Korea (the Republic of)
| | - Joon Koo Han
- Radiology, Seoul National University Hospital, Jongno-gu, Korea (the Republic of)
| | - Byung Ihn Choi
- Radiology, Chung Ang University Hospital, Seoul, Korea (the Republic of)
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Sugimoto K, Lee DH, Lee JY, Yu SJ, Moriyasu F, Sakamaki K, Oshiro H, Takahashi H, Kakegawa T, Tomita Y, Abe M, Yoshimasu Y, Takeuchi H, Choi BI, Itoi T. Multiparametric US for Identifying Patients with High-Risk NASH: A Derivation and Validation Study. Radiology 2021; 301:625-634. [PMID: 34519576 DOI: 10.1148/radiol.2021210046] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Nonalcoholic fatty liver disease (NAFLD) is common in the general population but identifying patients with high-risk nonalcoholic steatohepatitis (NASH) who are candidates for pharmacologic therapy remains a challenge. Purpose To develop a score to identify patients with high-risk NASH, defined as NASH with an NAFLD activity score (NAS) of 4 or greater and clinically significant fibrosis (stage 2 [F2] or higher). Materials and Methods This was a cross-sectional secondary analysis of data prospectively collected between April 2017 and March 2019 for a group of patients with NAFLD in Japan (Japan NAFLD, the derivation data set) with contemporaneous two-dimensional shear-wave elastography and biopsy-proven NAFLD (age range, 20-89 years). Three US markers (liver stiffness [LS, measured in kilopascals], attenuation coefficient [AC, measured in decibels per centimeter per megahertz], and dispersion slope [DS, measured in meters per second per kilohertz]) were determined, together with aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels and the AST-to-ALT ratio. The best-fit multivariate logistic regression model for identifying patients with high-risk NASH was determined. Diagnostic performance was assessed by using the area under the receiver operating characteristic curve (AUC). The findings were validated in an independent data set (Korea NAFLD; age range, 20-78 years). Results The Japan NAFLD data set included 111 patients (mean age, 53 years ± 18 [standard deviation]; 57 men), 84 (76%) with NASH. The Korea NAFLD data set included 102 patients (mean age, 48 years ± 18; 43 men), 55 (36%) with NASH. The most predictive model (LAD NASH score) combined LS, AC, and DS. Performance was satisfactory in both the derivation sample (AUC, 0.86; 95% CI: 0.79, 0.93) and the validation sample (AUC, 0.88; 95% CI: 0.80, 0.95). The LAD NASH score showed a positive predictive value of 86.5% and a negative predictive value of 87.5% for high-risk NASH in the derivation sample. Conclusion A score combining three US markers may be useful for noninvasive identification of patients with high-risk nonalcoholic steatohepatitis for inclusion in clinical trials and pharmacologic therapy. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Lockhart in this issue.
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Affiliation(s)
- Katsutoshi Sugimoto
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K. Sugimoto, H. Takahashi, T.K., Y.T., M.A., Y.Y., H. Takeuchi, T.I.); Departments of Radiology (D.H.L., J.Y.L.) and Internal Medicine, Division of Gastroenterology and Hepatology (S.J.Y.), Seoul National University, Seoul, Korea; Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Center for Data Science, Yokohama City University, Kanagawa, Japan (K. Sakamaki); Department of Pathology, Jichi Medical University, Tochigi, Japan (H.O.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
| | - Dong Ho Lee
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K. Sugimoto, H. Takahashi, T.K., Y.T., M.A., Y.Y., H. Takeuchi, T.I.); Departments of Radiology (D.H.L., J.Y.L.) and Internal Medicine, Division of Gastroenterology and Hepatology (S.J.Y.), Seoul National University, Seoul, Korea; Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Center for Data Science, Yokohama City University, Kanagawa, Japan (K. Sakamaki); Department of Pathology, Jichi Medical University, Tochigi, Japan (H.O.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
| | - Jae Young Lee
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K. Sugimoto, H. Takahashi, T.K., Y.T., M.A., Y.Y., H. Takeuchi, T.I.); Departments of Radiology (D.H.L., J.Y.L.) and Internal Medicine, Division of Gastroenterology and Hepatology (S.J.Y.), Seoul National University, Seoul, Korea; Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Center for Data Science, Yokohama City University, Kanagawa, Japan (K. Sakamaki); Department of Pathology, Jichi Medical University, Tochigi, Japan (H.O.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
| | - Su Jong Yu
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K. Sugimoto, H. Takahashi, T.K., Y.T., M.A., Y.Y., H. Takeuchi, T.I.); Departments of Radiology (D.H.L., J.Y.L.) and Internal Medicine, Division of Gastroenterology and Hepatology (S.J.Y.), Seoul National University, Seoul, Korea; Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Center for Data Science, Yokohama City University, Kanagawa, Japan (K. Sakamaki); Department of Pathology, Jichi Medical University, Tochigi, Japan (H.O.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
| | - Fuminori Moriyasu
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K. Sugimoto, H. Takahashi, T.K., Y.T., M.A., Y.Y., H. Takeuchi, T.I.); Departments of Radiology (D.H.L., J.Y.L.) and Internal Medicine, Division of Gastroenterology and Hepatology (S.J.Y.), Seoul National University, Seoul, Korea; Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Center for Data Science, Yokohama City University, Kanagawa, Japan (K. Sakamaki); Department of Pathology, Jichi Medical University, Tochigi, Japan (H.O.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
| | - Kentaro Sakamaki
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K. Sugimoto, H. Takahashi, T.K., Y.T., M.A., Y.Y., H. Takeuchi, T.I.); Departments of Radiology (D.H.L., J.Y.L.) and Internal Medicine, Division of Gastroenterology and Hepatology (S.J.Y.), Seoul National University, Seoul, Korea; Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Center for Data Science, Yokohama City University, Kanagawa, Japan (K. Sakamaki); Department of Pathology, Jichi Medical University, Tochigi, Japan (H.O.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
| | - Hisashi Oshiro
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K. Sugimoto, H. Takahashi, T.K., Y.T., M.A., Y.Y., H. Takeuchi, T.I.); Departments of Radiology (D.H.L., J.Y.L.) and Internal Medicine, Division of Gastroenterology and Hepatology (S.J.Y.), Seoul National University, Seoul, Korea; Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Center for Data Science, Yokohama City University, Kanagawa, Japan (K. Sakamaki); Department of Pathology, Jichi Medical University, Tochigi, Japan (H.O.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
| | - Hiroshi Takahashi
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K. Sugimoto, H. Takahashi, T.K., Y.T., M.A., Y.Y., H. Takeuchi, T.I.); Departments of Radiology (D.H.L., J.Y.L.) and Internal Medicine, Division of Gastroenterology and Hepatology (S.J.Y.), Seoul National University, Seoul, Korea; Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Center for Data Science, Yokohama City University, Kanagawa, Japan (K. Sakamaki); Department of Pathology, Jichi Medical University, Tochigi, Japan (H.O.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
| | - Tatsuya Kakegawa
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K. Sugimoto, H. Takahashi, T.K., Y.T., M.A., Y.Y., H. Takeuchi, T.I.); Departments of Radiology (D.H.L., J.Y.L.) and Internal Medicine, Division of Gastroenterology and Hepatology (S.J.Y.), Seoul National University, Seoul, Korea; Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Center for Data Science, Yokohama City University, Kanagawa, Japan (K. Sakamaki); Department of Pathology, Jichi Medical University, Tochigi, Japan (H.O.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
| | - Yusuke Tomita
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K. Sugimoto, H. Takahashi, T.K., Y.T., M.A., Y.Y., H. Takeuchi, T.I.); Departments of Radiology (D.H.L., J.Y.L.) and Internal Medicine, Division of Gastroenterology and Hepatology (S.J.Y.), Seoul National University, Seoul, Korea; Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Center for Data Science, Yokohama City University, Kanagawa, Japan (K. Sakamaki); Department of Pathology, Jichi Medical University, Tochigi, Japan (H.O.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
| | - Masakazu Abe
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K. Sugimoto, H. Takahashi, T.K., Y.T., M.A., Y.Y., H. Takeuchi, T.I.); Departments of Radiology (D.H.L., J.Y.L.) and Internal Medicine, Division of Gastroenterology and Hepatology (S.J.Y.), Seoul National University, Seoul, Korea; Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Center for Data Science, Yokohama City University, Kanagawa, Japan (K. Sakamaki); Department of Pathology, Jichi Medical University, Tochigi, Japan (H.O.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
| | - Yu Yoshimasu
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K. Sugimoto, H. Takahashi, T.K., Y.T., M.A., Y.Y., H. Takeuchi, T.I.); Departments of Radiology (D.H.L., J.Y.L.) and Internal Medicine, Division of Gastroenterology and Hepatology (S.J.Y.), Seoul National University, Seoul, Korea; Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Center for Data Science, Yokohama City University, Kanagawa, Japan (K. Sakamaki); Department of Pathology, Jichi Medical University, Tochigi, Japan (H.O.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
| | - Hirohito Takeuchi
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K. Sugimoto, H. Takahashi, T.K., Y.T., M.A., Y.Y., H. Takeuchi, T.I.); Departments of Radiology (D.H.L., J.Y.L.) and Internal Medicine, Division of Gastroenterology and Hepatology (S.J.Y.), Seoul National University, Seoul, Korea; Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Center for Data Science, Yokohama City University, Kanagawa, Japan (K. Sakamaki); Department of Pathology, Jichi Medical University, Tochigi, Japan (H.O.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
| | - Byung Ihn Choi
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K. Sugimoto, H. Takahashi, T.K., Y.T., M.A., Y.Y., H. Takeuchi, T.I.); Departments of Radiology (D.H.L., J.Y.L.) and Internal Medicine, Division of Gastroenterology and Hepatology (S.J.Y.), Seoul National University, Seoul, Korea; Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Center for Data Science, Yokohama City University, Kanagawa, Japan (K. Sakamaki); Department of Pathology, Jichi Medical University, Tochigi, Japan (H.O.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
| | - Takao Itoi
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K. Sugimoto, H. Takahashi, T.K., Y.T., M.A., Y.Y., H. Takeuchi, T.I.); Departments of Radiology (D.H.L., J.Y.L.) and Internal Medicine, Division of Gastroenterology and Hepatology (S.J.Y.), Seoul National University, Seoul, Korea; Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Center for Data Science, Yokohama City University, Kanagawa, Japan (K. Sakamaki); Department of Pathology, Jichi Medical University, Tochigi, Japan (H.O.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
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Lee DH, Cho EJ, Bae JS, Lee JY, Yu SJ, Kim H, Lee KB, Han JK, Choi BI. Accuracy of Two-Dimensional Shear Wave Elastography and Attenuation Imaging for Evaluation of Patients With Nonalcoholic Steatohepatitis. Clin Gastroenterol Hepatol 2021; 19:797-805.e7. [PMID: 32450363 DOI: 10.1016/j.cgh.2020.05.034] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [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: 03/11/2020] [Revised: 05/06/2020] [Accepted: 05/16/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS We evaluated the accuracy of a multiparametric approach using attenuation imaging and 2-dimensional shear wave elastography (2D-SWE) for the detection of steatosis and fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). METHODS We studied 102 patients with increased levels of liver enzymes or suspicion of NAFLD, examined by attenuation imaging and 2D-SWE, immediately before biopsy collection and analysis (reference standard), from January 2018 to July 2019. We collected data on the attenuation coefficient (dB/cm/MHz) from attenuation imaging, liver stiffness measurements, and shear wave dispersion slope (SWDS, [m/s]/kHz) from 2D-SWE. Multivariate linear regression analysis was performed to identify factors associated with each parameter. Diagnostic performance was determined from area under the receiver operating curve (AUROC) values. RESULTS The attenuation coefficient was associated with steatosis grade (P < .01) and identified patients with steatosis grades S1 or higher, S2 or higher, and S3 or higher, with AUROC values of 0.93, 0.88, and 0.83, respectively. Liver stiffness associated with fibrosis stage (P < .01) and lobular inflammatory activity was the only factor associated with SWDS (P < .01). SWDS detected inflammation grades I1 or higher, I2 or higher, and I3 or higher with AUROC values of 0.89, 0.85, and 0.78, respectively. We developed a risk scoring system to detect steatohepatitis based on the attenuation coefficient (score of 1 for 0.64 < attenuation coefficient ≤ 0.70; score of 2 for 0.70 < attenuation coefficient ≤ 0.73; and score of 3 for attenuation coefficient >0.73) and SWDS (score of 2 for 10.5 [m/s]/kHz < SWDS ≤ 11.7 [m/s]/kHz; and score of 3 for SWDS >11.7 [m/s]/kHz), using an unweighted sum of each score. Based on histopathology analysis, 55 patients had steatohepatitis. Risk scores correlated with NAFLD activity score (rho = 0.73; P < .01). Our scoring system identified patients with steatohepatitis with an AUROC of 0.93-this value was significantly higher than that of other parameters (P < .05), except SWDS (AUROC, 0.89; P = .18). CONCLUSIONS In the evaluation of patients with suspected NAFLD, the attenuation coefficient can identify patients with steatosis and liver stiffness can detect fibrosis accurately. SWDS was associated significantly with lobular inflammation. We developed a risk scoring system based on the attenuation coefficient and SWDS that might be used to detect steatohepatitis.
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Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University Hospital; Institute of Radiation Medicine, Seoul National University Medical Research Center
| | - Eun Ju Cho
- Department of Internal Medicine and Liver Research Institute
| | - Jae Seok Bae
- Department of Radiology, Seoul National University Hospital
| | - Jae Young Lee
- Department of Radiology, Seoul National University Hospital; Institute of Radiation Medicine, Seoul National University Medical Research Center; Department of Radiology.
| | - Su Jong Yu
- Department of Internal Medicine and Liver Research Institute
| | - Haeryoung Kim
- Department of Pathology, Seoul National University College of Medicine
| | - Kyung Bun Lee
- Department of Pathology, Seoul National University College of Medicine
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital; Institute of Radiation Medicine, Seoul National University Medical Research Center; Department of Radiology
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea
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Choi SL, Park SB, Yang S, Lee ES, Park HJ, Lee JB, Choi BI. Detection of Ureteral Stones in Kidney Ureter Bladder Radiography: Usefulness of Digital Post-processing. Curr Med Imaging 2021; 17:1356-1362. [PMID: 33602099 DOI: 10.2174/1573405617666210218094812] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/30/2020] [Accepted: 01/01/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE Kidney, ureter, and bladder radiography (KUB) has frequently been used in suspected urolithiasis, but its performance is known to be lower than that of computed tomography (CT). This study aimed to investigate the diagnostic performance of digitally post-processed kidney ureter bladder radiography (KUB) in the detection of ureteral stones. MATERIALS AND METHODS Thirty patients who underwent digital KUB and CT were included in this retrospective study. The original digital KUB underwent post-processing that involved noise estimation, reduction, and whitening to improve the visibility of ureteral stones. Thus, 60 digital original or post-processed KUB images were obtained and ordered randomly for blinded review. After a period, a second review was performed after unblinding stone laterality. The detection rates were evaluated at both initial and second review, using CT as reference standard. The objective (size) and subjective (visibility) parameters of ureteral stones were analyzed. Fisher's exact test was used to compare the detection sensitivity between the original and post-processed KUB data set. Visibility analysis was assessed with a paired t-test. Correlation of stone size between CT and digital KUB data sets was assessed with Pearson's correlation test. RESULTS The detection rate was higher for most reviewers once stone laterality was provided and was non-significantly better for the post-processed KUB images (p > 0.05). There was no significant difference in stone size among CT and digital KUB data sets. In all reviews, visibility grade was higher in the post-processed KUB images, irrespective of whether stone laterality was provided. CONCLUSION Digital post-processing of KUB yielded higher visibility of ureteral stones and could improve stone detection, especially when stone laterality was available. Thus, digitally post-processed KUB can be an excellent modality for detecting ureteral stones and measuring their exact size.
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Affiliation(s)
- Sang Lim Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul. Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul. Korea
| | | | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul. Korea
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul. Korea
| | - Jong Beum Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul. Korea
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul. Korea
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Oh H, Park SB, Park HJ, Lee ES, Hur J, Choi W, Choi BI. Ultrasonographic features of uterine cervical lesions. Br J Radiol 2021; 94:20201242. [PMID: 33560888 DOI: 10.1259/bjr.20201242] [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: 11/05/2022] Open
Abstract
Currently, ultrasound (US) is a valuable imaging tool for the initial assessment and evaluation of the female genital organs, uterus, and adnexa. However, it is easy to overlook the uterine cervix while conducting a pelvic US. Uterine cervical lesions may range from benign to malignant in nature. Therefore, meticulous examination with US may play a key role in assessing uterine cervical lesions. Although there is substantial overlap in the US findings across various uterine cervical lesions, some US features, in tandem with clinical characteristics, may suggest a specific diagnosis. Familiarity with the clinical settings and US characteristics of different uterine cervical lesions can support prompt and accurate diagnosis of suspicious lesions. This review article aims to describe the features of US and possible values for distinction of these lesions in the uterine cervix.
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Affiliation(s)
- Hyunji Oh
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Joonho Hur
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Woosun Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
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Lee DH, Lee ES, Bae JS, Lee JY, Han JK, Yi NJ, Lee KW, Suh KS, Kim H, Lee KB, Choi BI. 2D shear wave elastography is better than transient elastography in predicting post-hepatectomy complication after resection. Eur Radiol 2021; 31:5802-5811. [PMID: 33459859 DOI: 10.1007/s00330-020-07662-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/11/2020] [Accepted: 12/21/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Both transient elastography (TE) and 2D shear wave elastography (SWE) are accurate methods to evaluate liver fibrosis. We aimed to evaluate the diagnostic performance of 2D-SWE in predicting post-hepatectomy complication and to compare it with TE. METHODS We prospectively enrolled 125 patients with liver tumors. Liver stiffness (LS) (kilopascal [kPa]) was measured using both TE and 2D-SWE before surgery. All post-operative complication was evaluated using the comprehensive complication index (CCI), and CCI ≥ 26.2 was defined as severe complication. Logistic regression analysis was performed to identify predictive factors for severe complication. Receiver operating characteristic analysis was used to evaluate the diagnostic performance of TE/2D-SWE in detecting liver fibrosis and severe complication. RESULTS Severe complication developed in 18 patients. The median LS in patients with severe complication was significantly higher for both 2D-SWE (11.4 kPa vs. 7.0 kPa, p < 0.001) and TE (8.9 kPa vs. 6.2 kPa, p = 0.009). LS obtained from 2D-SWE was a significant factor correlated with severe complication (odds ratio: 1.27 per kPa [1.10-1.46], p = 0.001). The diagnostic performance of 2D-SWE was significantly higher than that of TE in detecting both ≥F3 (p = 0.024) and F4 (p = 0.048). The area under the curve of 2D-SWE to predict severe complication was 0.854, significantly higher than 0.692 of TE (p = 0.004). The optimal cut-off LS from 2D-SWE to predict severe complication was 8.6 kPa, with sensitivity of 88.9% (16/18) and specificity of 73.8% (79/107). CONCLUSION LS obtained from 2D-SWE was a significant predictive factor for severe complication, and 2D-SWE showed significantly a better diagnostic performance than TE in detecting liver fibrosis and severe complication. KEY POINTS • The diagnostic performance of 2D-SWE was significantly higher than that of TE in detecting both ≥ F3 (AUC: 0.853 vs. 0.779, p = 0.024) and F4 (AUC: 0.929 vs. 0.872, p = 0.048). • Liver stiffness value obtained from 2D-SWE was a significant factor correlated with the development of severe complication defined as CCI ≥ 26.2 after hepatic resection for liver tumors (odds ratio: 1.27 per kPa [1.10-1.46], p = 0.001). • 2D-SWE provided significantly a better diagnostic performance in predicting severe complication after hepatic resection than TE (AUC for 2D-SWE: 0.853 vs. AUC for TE: 0.692, p = 0.004).
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Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul, 03080, South Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Seoul, South Korea.,Department of Radiology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul, 03080, South Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul, 03080, South Korea. .,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea. .,Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea.
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul, 03080, South Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung Bun Lee
- Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul, South Korea
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8
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Oh J, Park HJ, Lee ES, Park SB, Choi BI, Ahn S. Severity of hyperechoic pancreas on ultrasonography as a risk factor for glycemic progression. Ultrasonography 2021; 40:499-511. [PMID: 33730774 PMCID: PMC8446494 DOI: 10.14366/usg.20122] [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: 08/10/2020] [Accepted: 01/16/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose The aim of this study was to evaluate the association between the severity of hyperechoic pancreas (HP) on ultrasonography (US) and glycemic progression. Methods In total, 1,386 participants who underwent abdominal US as part of health examinations between December 2008 and May 2014 were included in this retrospective study. We classified pancreatic echogenicity on a 4-point scale, and compared it using two distinct criteria: fatty pancreas (FP) 1 criterion (normal vs. ≥mild HP) and FP2 criterion (normal/mild HP vs. ≥moderate HP). According to the presence of nonalcoholic fatty liver disease (NAFLD), participants were subdivided into four groups: non-NAFLD and non-HP, isolated NAFLD, isolated HP, and HP with NAFLD. Glycemic progression was defined as progression from normoglycemia to prediabetes or diabetes or progression from prediabetes to diabetes. Results During the follow-up (median, 5.9 years), 262 of the 1,386 participants developed glycemic progression. Using FP2, the probability of glycemic progression across the four subgroups showed cumulative aggravation for NAFLD and HP (all P<0.05). Isolated HP showed a higher probability of glycemic progression than isolated NAFLD according to FP2 (P<0.001). The highest probability of glycemic progression was observed in patients with both NAFLD and HP (P<0.001). The hazard ratio for glycemic progression increased with the severity of HP. Conclusion Increasing severity of HP on US was found to be significantly correlated with glycemic progression. Moreover, isolated HP of moderate or greater severity predicted glycemic progression independent of NAFLD.
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Affiliation(s)
- Jiyun Oh
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Soohyun Ahn
- Department of Mathematics, Ajou University, Suwon, Korea
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9
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Dietrich CF, Nolsøe CP, Barr RG, Berzigotti A, Burns PN, Cantisani V, Chammas MC, Chaubal N, Choi BI, Clevert DA, Cui X, Dong Y, D'Onofrio M, Fowlkes JB, Gilja OH, Huang P, Ignee A, Jenssen C, Kono Y, Kudo M, Lassau N, Lee WJ, Lee JY, Liang P, Lim A, Lyshchik A, Meloni MF, Correas JM, Minami Y, Moriyasu F, Nicolau C, Piscaglia F, Saftoiu A, Sidhu PS, Sporea I, Torzilli G, Xie X, Zheng R. Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver - Update 2020 - WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. Ultraschall Med 2020; 41:562-585. [PMID: 32707595 DOI: 10.1055/a-1177-0530] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The present, updated document describes the fourth iteration of recommendations for the hepatic use of contrast enhanced ultrasound (CEUS), first initiated in 2004 by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). The previous updated editions of the guidelines reflected changes in the available contrast agents and updated the guidelines not only for hepatic but also for non-hepatic applications.The 2012 guideline requires updating as previously the differences of the contrast agents were not precisely described and the differences in contrast phases as well as handling were not clearly indicated. In addition, more evidence has been published for all contrast agents. The update also reflects the most recent developments in contrast agents, including the United States Food and Drug Administration (FDA) approval as well as the extensive Asian experience, to produce a truly international perspective.These guidelines and recommendations provide general advice on the use of ultrasound contrast agents (UCA) and are intended to create standard protocols for the use and administration of UCA in liver applications on an international basis to improve the management of patients.
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Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
- Johann Wolfgang Goethe Universitätsklinik Frankfurt, Germany
| | - Christian Pállson Nolsøe
- Center for Surgical Ultrasound, Dep of Surgery, Zealand University Hospital, Køge. Copenhagen Academy for Medical Education and Simulation (CAMES). University of Copenhagen, Denmark
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, USA and Southwoods Imaging, Youngstown, Ohio, USA
| | - Annalisa Berzigotti
- Hepatology, University Clinic for Visceral Surgery and Medicine, DBMR, Inselspital, University of Bern, Switzerland
| | - Peter N Burns
- Dept Medical Biophysics, University of Toronto, Imaging Research, Sunnybrook Research Institute, Toronto
| | - Vito Cantisani
- Uos Ecografia Internistico-chirurgica, Dipartimento di Scienze Radiologiche, Oncologiche, Anatomo-Patologiche, Policlinico Umberto I, Univ. Sapienza, Rome, Italy
| | - Maria Cristina Chammas
- Institute of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, Brazil
| | - Nitin Chaubal
- Thane Ultrasound Centre, Jaslok Hospital and Research Centre, Mumbai, India
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Dirk-André Clevert
- Interdisciplinary Ultrasound-Center, Department of Radiology, University of Munich-Grosshadern Campus, Munich, Germany
| | - Xinwu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mirko D'Onofrio
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - J Brian Fowlkes
- Basic Radiological Sciences Division, Department of Radiology, University of Michigan Health System, Ann Arbor, MI, United States
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | - Pintong Huang
- Department of Ultrasound in Medicine, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Andre Ignee
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - Christian Jenssen
- Krankenhaus Märkisch Oderland, Department of Internal Medicine, Strausberg/Wriezen, Germany
| | - Yuko Kono
- Departments of Medicine and Radiology, University of California, San Diego, USA
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Nathalie Lassau
- Imaging Department. Gustave Roussy and BIOMAPS. Université Paris-Saclay, Villejuif, France
| | - Won Jae Lee
- Department of Radiology and Center For Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Departments of Health and Science and Technology and Medical Device Management and Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Adrian Lim
- Department of Imaging, Imperial College London and Healthcare NHS Trust, Charing Cross Hospital Campus, London United Kingdom
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | | | - Jean Michel Correas
- Service de Radiologie Adultes, Hôpital Necker, Université Paris Descartes, Paris, France
| | - Yasunori Minami
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Fuminori Moriyasu
- Center for Cancer Ablation Therapy, Sanno Hospital, International University of Health and Welfare, Tokyo, Japan
| | - Carlos Nicolau
- Radiology Department, Hospital Clinic. University of Barcelona, Barcelona, Spain
| | - Fabio Piscaglia
- Unit of Internal Medicine, Dept of Medical and Surgical Sciences, University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Adrian Saftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Romania
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, King's College London, London
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Guido Torzilli
- Department of Surgery, Division of Hepatobiliary & General Surgery, Humanitas University & Research Hospital, Rozzano, Milano, Italy
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Ultrasound, The 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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10
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Dietrich CF, Nolsøe CP, Barr RG, Berzigotti A, Burns PN, Cantisani V, Chammas MC, Chaubal N, Choi BI, Clevert DA, Cui X, Dong Y, D'Onofrio M, Fowlkes JB, Gilja OH, Huang P, Ignee A, Jenssen C, Kono Y, Kudo M, Lassau N, Lee WJ, Lee JY, Liang P, Lim A, Lyshchik A, Meloni MF, Correas JM, Minami Y, Moriyasu F, Nicolau C, Piscaglia F, Saftoiu A, Sidhu PS, Sporea I, Torzilli G, Xie X, Zheng R. Guidelines and Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound (CEUS) in the Liver-Update 2020 WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. Ultrasound Med Biol 2020; 46:2579-2604. [PMID: 32713788 DOI: 10.1016/j.ultrasmedbio.2020.04.030] [Citation(s) in RCA: 192] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/16/2020] [Accepted: 04/24/2020] [Indexed: 05/14/2023]
Abstract
The present, updated document describes the fourth iteration of recommendations for the hepatic use of contrast-enhanced ultrasound, first initiated in 2004 by the European Federation of Societies for Ultrasound in Medicine and Biology. The previous updated editions of the guidelines reflected changes in the available contrast agents and updated the guidelines not only for hepatic but also for non-hepatic applications. The 2012 guideline requires updating as, previously, the differences in the contrast agents were not precisely described and the differences in contrast phases as well as handling were not clearly indicated. In addition, more evidence has been published for all contrast agents. The update also reflects the most recent developments in contrast agents, including U.S. Food and Drug Administration approval and the extensive Asian experience, to produce a truly international perspective. These guidelines and recommendations provide general advice on the use of ultrasound contrast agents (UCAs) and are intended to create standard protocols for the use and administration of UCAs in liver applications on an international basis to improve the management of patients.
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Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland; Johann Wolfgang Goethe Universitätsklinik, Frankfurt, Germany.
| | - Christian Pállson Nolsøe
- Center for Surgical Ultrasound, Dep of Surgery, Zealand University Hospital, Køge. Copenhagen Academy for Medical Education and Simulation (CAMES). University of Copenhagen, Denmark
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, USA; Southwoods Imaging, Youngstown, Ohio, USA
| | - Annalisa Berzigotti
- Hepatology, University Clinic for Visceral Surgery and Medicine, DBMR, Inselspital, University of Bern, Switzerland
| | - Peter N Burns
- Department of Medical Biophysics, University of Toronto, Imaging Research, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Vito Cantisani
- Uos Ecografia Internistico-chirurgica, Dipartimento di Scienze Radiologiche, Oncologiche, Anatomo-Patologiche, Policlinico Umberto I, Univ. Sapienza, Rome, Italy
| | - Maria Cristina Chammas
- Institute of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, Brazil
| | - Nitin Chaubal
- Thane Ultrasound Centre, Jaslok Hospital and Research Centre, Mumbai, India
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Dirk-André Clevert
- Interdisciplinary Ultrasound-Center, Department of Radiology, University of Munich-Grosshadern Campus, Munich, Germany
| | - Xinwu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mirko D'Onofrio
- Department of Radiology, G. B. Rossi University Hospital, University of Verona, Verona, Italy
| | - J Brian Fowlkes
- Basic Radiological Sciences Division, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | - Pintong Huang
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Andre Ignee
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - Christian Jenssen
- Krankenhaus Märkisch Oderland, Department of Internal Medicine, Strausberg/Wriezen, Germany
| | - Yuko Kono
- Departments of Medicine and Radiology, University of California, San Diego, California, USA
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Nathalie Lassau
- Imaging Department, Gustave Roussy and BIOMAPS, Université Paris-Saclay, Villejuif, France
| | - Won Jae Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Departments of Health and Science and Technology and Medical Device Management and Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Adrian Lim
- Department of Imaging, Imperial College London and Healthcare NHS Trust, Charing Cross Hospital Campus, London, United Kingdom
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Jean Michel Correas
- Service de Radiologie Adultes, Hôpital Necker, Université Paris Descartes, Paris, France
| | - Yasunori Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Fuminori Moriyasu
- Center for Cancer Ablation Therapy, Sanno Hospital, International University of Health and Welfare, Tokyo, Japan
| | - Carlos Nicolau
- Radiology Department, Hospital Clinic. University of Barcelona, Barcelona, Spain
| | - Fabio Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Adrian Saftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Romania
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, King's College London, London, United Kingdom
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Guido Torzilli
- Department of Surgery, Division of Hepatobiliary & General Surgery, Humanitas University & Research Hospital, Rozzano, Milan, Italy
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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11
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Lee DH, Lee ES, Lee JY, Bae JS, Kim H, Lee KB, Yu SJ, Cho EJ, Lee JH, Cho YY, Han JK, Choi BI. Two-Dimensional-Shear Wave Elastography with a Propagation Map: Prospective Evaluation of Liver Fibrosis Using Histopathology as the Reference Standard. Korean J Radiol 2020; 21:1317-1325. [PMID: 32729274 PMCID: PMC7689142 DOI: 10.3348/kjr.2019.0978] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 12/29/2019] [Revised: 04/08/2020] [Accepted: 04/13/2020] [Indexed: 02/06/2023] Open
Abstract
Objective The aim of this study was to prospectively evaluate whether liver stiffness (LS) assessments, obtained by two-dimensional (2D)-shear wave elastography (SWE) with a propagation map, can evaluate liver fibrosis stage using histopathology as the reference standard. Materials and Methods We prospectively enrolled 123 patients who had undergone percutaneous liver biopsy from two tertiary referral hospitals. All patients underwent 2D-SWE examination prior to biopsy, and LS values (kilopascal [kPa]) were obtained. On histopathologic examination, fibrosis stage (F0–F4) and necroinflammatory activity grade (A0–A4) were assessed. Multivariate linear regression analysis was performed to determine the significant factors affecting the LS value. The diagnostic performance of the LS value for staging fibrosis was assessed using receiver operating characteristic (ROC) analysis, and the optimal cut-off value was determined by the Youden index. Results Reliable measurements of LS values were obtained in 114 patients (92.7%, 114/123). LS values obtained from 2D-SWE with the propagation map positively correlated with the progression of liver fibrosis reported from histopathology (p < 0.001). According to the multivariate linear regression analysis, fibrosis stage was the only factor significantly associated with LS (p < 0.001). The area under the ROC curve of LS from 2D-SWE with the propagation map was 0.773, 0.865, 0.946, and 0.950 for detecting F ≥ 1, F ≥ 2, F ≥ 3, and F = 4, respectively. The optimal cut-off LS values were 5.4, 7.8, 9.4, and 12.2 kPa for F ≥ 1, F ≥ 2, F ≥ 3, and F = 4, respectively. The corresponding sensitivity and specificity of the LS value for detecting cirrhosis were 90.9% and 88.4%, respectively. Conclusion The LS value obtained from 2D-SWE with a propagation map provides excellent diagnostic performance in evaluating liver fibrosis stage, determined by histopathology.
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Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Kyung Bun Lee
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Su Jong Yu
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun Ju Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jeong Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Youn Cho
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
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12
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Lee JY, Minami Y, Choi BI, Lee WJ, Chou YH, Jeong WK, Park MS, Kudo N, Lee MW, Kamata K, Iijima H, Kim SY, Numata K, Sugimoto K, Maruyama H, Sumino Y, Ogawa C, Kitano M, Joo I, Arita J, Liang JD, Lin HM, Nolsoe C, Gilja OH, Kudo M. The AFSUMB Consensus Statements and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound using Sonazoid. J Med Ultrasound 2020; 28:59-82. [PMID: 32874864 PMCID: PMC7446696 DOI: 10.4103/jmu.jmu_124_19] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/09/2020] [Accepted: 02/17/2020] [Indexed: 12/13/2022] Open
Abstract
The first edition of the guidelines for the use of ultrasound contrast agents was published in 2004, dealing with liver applications. The second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some nonliver applications. The third edition of the contrast-enhanced ultrasound (CEUS) guidelines was the joint World Federation for Ultrasound in Medicine and Biology-European Federation of Societies for Ultrasound in Medicine and Biology (WFUMB-EFSUMB) venture in conjunction with other regional US societies such as Asian Federation of Societies for Ultrasound in Medicine and Biology, resulting in a simultaneous duplicate on liver CEUS in the official journals of both WFUMB and EFSUMB in 2013. However, no guidelines were described mainly for Sonazoid due to limited clinical experience only in Japan and Korea. The new proposed consensus statements and recommendations provide general advice on the use of Sonazoid and are intended to create standard protocols for the use and administration of Sonazoid in hepatic and pancreatobiliary applications in Asian patients and to improve patient management.
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Affiliation(s)
- Jae Young Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Yasunori Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Higashi-Osaka, Japan
| | - Byung Ihn Choi
- Department of Radiology, Chung Ang University Hospital, Seoul, Korea
| | - Won Jae Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yi-Hong Chou
- Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu, Taiwan.,Department of Radiology, National Yang Ming University, Taipei, Taiwan
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi-Suk Park
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Nobuki Kudo
- Laboratory of Biomedical Engineering, Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ken Kamata
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Higashi-Osaka, Japan
| | - Hiroko Iijima
- Department of Ultrasound, Hepatobiliary and Pancreatic Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - So Yeon Kim
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Hitoshi Maruyama
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Yasukiyo Sumino
- Department of Gastroenterology and Hepatology, Toho University Medical Center, Tokyo, Japan
| | - Chikara Ogawa
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Takamatsu, Japan
| | - Masayuki Kitano
- Department of Gastroenterology and Hepatology, Wakayama Medical University Hospital, Wakayama, Japan
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Junichi Arita
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ja-Der Liang
- Department of Gastroenterology and Hepatology, National Taiwan University, Taipei, Taiwan
| | - Hsi-Ming Lin
- Department of Gastroenterology and Hepatology, Chang Gung University, Taipei, Taiwan
| | - Christian Nolsoe
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital, Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Copenhagen, Denmark
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Higashi-Osaka, Japan
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13
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Lee JY, Minami Y, Choi BI, Lee WJ, Chou YH, Jeong WK, Park MS, Kudo N, Lee MW, Kamata K, Iijima H, Kim SY, Numata K, Sugimoto K, Maruyama H, Sumino Y, Ogawa C, Kitano M, Joo I, Arita J, Liang JD, Lin HM, Nolsoe C, Gilja OH, Kudo M. The AFSUMB Consensus Statements and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound using Sonazoid. Ultrasonography 2020; 39:191-220. [PMID: 32447876 PMCID: PMC7315291 DOI: 10.14366/usg.20057] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/27/2020] [Indexed: 12/11/2022] Open
Abstract
The first edition of the guidelines for the use of ultrasound contrast agents was published in 2004, dealing with liver applications. The second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some nonliver applications. The third edition of the contrast-enhanced ultrasound (CEUS) guidelines was the joint World Federation for Ultrasound in Medicine and Biology-European Federation of Societies for Ultrasound in Medicine and Biology (WFUMB-EFSUMB) venture in conjunction with other regional US societies such as Asian Federation of Societies for Ultrasound in Medicine and Biology, resulting in a simultaneous duplicate on liver CEUS in the official journals of both WFUMB and EFSUMB in 2013. However, no guidelines were described mainly for Sonazoid due to limited clinical experience only in Japan and Korea. The new proposed consensus statements and recommendations provide general advice on the use of Sonazoid and are intended to create standard protocols for the use and administration of Sonazoid in hepatic and pancreatobiliary applications in Asian patients and to improve patient management.
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Affiliation(s)
- Jae Young Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Yasunori Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Higashi-Osaka, Japan
| | - Byung Ihn Choi
- Department of Radiology, Chung Ang University Hospital, Seoul, Korea
| | - Won Jae Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yi-Hong Chou
- Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu, Taiwan.,Department of Radiology, National Yang Ming University, Taipei, Taiwan
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi-Suk Park
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Nobuki Kudo
- Laboratory of Biomedical Engineering, Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ken Kamata
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Higashi-Osaka, Japan
| | - Hiroko Iijima
- Department of Ultrasound, Hepatobiliary and Pancreatic Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - So Yeon Kim
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Hitoshi Maruyama
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Yasukiyo Sumino
- Department of Gastroenterology and Hepatology, Toho University Medical Center, Tokyo, Japan
| | - Chikara Ogawa
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Takamatsu, Japan
| | - Masayuki Kitano
- Department of Gastroenterology and Hepatology, Wakayama Medical University Hospital, Wakayama, Japan
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Junichi Arita
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ja-Der Liang
- Department of Gastroenterology and Hepatology, National Taiwan University, Taipei, Taiwan
| | - Hsi-Ming Lin
- Department of Gastroenterology and Hepatology, Chang Gung University, Taipei, Taiwan
| | - Christian Nolsoe
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital, Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Copenhagen, Denmark
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Higashi-Osaka, Japan
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14
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Ko A, Lee ES, Park HJ, Park SB, Kim HS, Choi BI. Added value of 2D shear wave imaging of the gallbladder bed of the liver for acute cholecystitis. Ultrasonography 2020; 39:384-393. [PMID: 32962334 PMCID: PMC7515659 DOI: 10.14366/usg.19060] [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: 10/23/2019] [Accepted: 03/23/2020] [Indexed: 12/07/2022] Open
Abstract
Purpose The purpose of this study was to evaluate whether shear wave elastography (SWE) and the shear wave dispersion slope (SWD) obtained from 2-dimensional shear wave imaging (2D-SWI) of the gallbladder (GB) bed of the liver could be helpful in the diagnosis of acute cholecystitis. Methods We included 44 patients referred for abdominal ultrasonography (US) under the impression of acute cholecystitis from April 2018 to March 2019. Patients with chronic liver disease were excluded from this study. In addition to routine upper abdominal US, we performed 2D-SWI including liver stiffness measurements by SWE and SWD, which reflects tissue viscosity. 2D-SWI was performed at the GB bed of the liver through the right intercostal approach at least 3 times with different frames. We assessed typical US findings and the added value of 2D-SWI in diagnosing acute cholecystitis. Histopathologic results of surgical specimens were used as the standard of reference. If a surgical specimen was unavailable, a bile fluid test or clinical follow-up for more than 3 months served as the reference standard. Results The optimal cutoff values for SWE and SWD were 8 kPa and 10.9 (m/sec)/kHz, respectively. In the univariate analysis, SWE, GB distension, and sludge were predictive factors of acute cholecystitis. In the multivariate analysis, categorized SWE was the only significant predictor (P<0.01). By using 2D-SWI, the diagnostic performance of two readers did not significantly increase, although the inter-reader agreement improved (k=0.654-0.778). Conclusion 2D-SWI of the GB bed of the liver could be helpful for diagnosing acute cholecystitis.
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Affiliation(s)
- Ara Ko
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hee Sung Kim
- Department of Pathology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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15
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Choi BI, Kim MJ, Kim SH, Mori H, Minami M. History of the Asian Society of Abdominal Radiology. Korean J Radiol 2020; 21:5-14. [PMID: 31920024 PMCID: PMC6960310 DOI: 10.3348/kjr.2019.0528] [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: 07/16/2019] [Accepted: 07/29/2019] [Indexed: 11/15/2022] Open
Abstract
The history and administrative system of the Asian Society of Abdominal Radiology (ASAR) are described briefly with a focus on its academic activity, including congresses and education. ASAR is one of the three regional societies in the field of abdominal radiology, comprising approximately 2500 members from seven countries in Asia. A further increase in the numbers of members and affiliated societies is expected with the advancement of imaging technology and the distribution of radiologic equipment and knowledge. ASAR is responsible in Asia for matters of interdisciplinary collaboration in the field of abdominal radiology and has successfully represented Asia in the field of radiology.
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Affiliation(s)
- Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea.
| | - Myeong Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hyup Kim
- Department of Radiology, Seoul National Univeristy Hospital, Seoul, Korea
| | - Hiromu Mori
- Department of Radiology, Oita University Faculty of Medicine, Oita, Japan
| | - Manabu Minami
- Department of Radiology, University of Tsukuba Hospital, Ibaraki, Japan
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16
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Bae JS, Lee DH, Lee JY, Kim H, Yu SJ, Lee JH, Cho EJ, Lee YB, Han JK, Choi BI. Assessment of hepatic steatosis by using attenuation imaging: a quantitative, easy-to-perform ultrasound technique. Eur Radiol 2019; 29:6499-6507. [PMID: 31175413 DOI: 10.1007/s00330-019-06272-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/02/2019] [Accepted: 05/10/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate the diagnostic performance of attenuation imaging (ATI) in the detection of hepatic steatosis compared with a histopathology gold standard. METHODS We prospectively enrolled 108 consecutive patients (35 males; median age, 54.0 years) who underwent percutaneous liver biopsy for evaluation of diffuse liver disease between January 2018 and November 2018 in a tertiary academic center. Grayscale ultrasound examination with ATI was performed just before biopsy, and an attenuation coefficient (AC) was obtained from each patient. The degree of hepatic steatosis, fibrosis stage, and necroinflammatory activity were assessed on histopathologic examination. The significant factor associated with the AC was found by a linear regression analysis, and the diagnostic performance of the AC for the classification into each hepatic steatosis stage was evaluated by receiver operating characteristic (ROC) analysis. RESULTS The distribution of hepatic steatosis grade on histopathology was 53/11/22/16/6 for none/mild (< 10%)/mild (≥ 10%)/moderate/severe steatosis, respectively. The area under the ROC curve, sensitivity, specificity, and optimal cutoff AC value for detection of hepatic steatosis ranged from 0.843-0.926, 74.5-100.0%, 77.4-82.8%, and 0.635-0.745, respectively. Multivariate analysis revealed that the degree of steatosis was the only significant determinant factor for the AC. CONCLUSIONS The AC from ATI provided good diagnostic performance in detecting the varying degrees of hepatic steatosis. The degree of steatosis was the only significant factor affecting the AC, whereas fibrosis and inflammation were not. KEY POINTS • Attenuation imaging (ATI) is based on two-dimensional grayscale ultrasound images that can incorporate into routine ultrasound examinations with less than 2 min of acquisition time. • ATI provided good diagnostic performance in detecting the varying degrees of hepatic steatosis with an area under the ROC curves ranging from 0.843 to 0.926, and there was no technical failure in this study indicating high applicability of this technique. • The degree of hepatic steatosis was the only significant factor affecting the result of ATI examination.
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Affiliation(s)
- Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Jae Young Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Su Jong Yu
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Eun Ju Cho
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yun Bin Lee
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
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17
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Ferraioli G, Wong VWS, Castera L, Berzigotti A, Sporea I, Dietrich CF, Choi BI, Wilson SR, Kudo M, Barr RG. Liver Ultrasound Elastography: An Update to the World Federation for Ultrasound in Medicine and Biology Guidelines and Recommendations. Ultrasound Med Biol 2018; 44:2419-2440. [PMID: 30209008 DOI: 10.1016/j.ultrasmedbio.2018.07.008] [Citation(s) in RCA: 276] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/02/2018] [Accepted: 07/13/2018] [Indexed: 06/08/2023]
Abstract
The World Federation for Ultrasound in Medicine and Biology has produced these guidelines for the use of elastography techniques in liver diseases. For each available technique, the reproducibility, results and limitations are analyzed, and recommendations are given. This set of guidelines updates the first version, published in 2015. Since the prior guidelines, there have been several advances in technology. The recommendations are based on the international published literature, and the strength of each recommendation is judged according to the Oxford Centre for Evidence-Based Medicine. The document has a clinical perspective and is aimed at assessing the usefulness of elastography in the management of liver diseases.
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Affiliation(s)
- Giovanna Ferraioli
- Ultrasound Unit, Department of Clinical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, School of Medicine, University of Pavia, Pavia, Italy
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong
| | - Laurent Castera
- Service d'Hepatologie, Hopital Beaujon, Clichy, Assistance Publique-Hopitaux de Paris, INSERM UMR 1149 CRI, Universite Denis Diderot Paris-VII, Paris, France
| | - Annalisa Berzigotti
- Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Switzerland
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Stephanie R Wilson
- Department of Diagnostic Imaging, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University School of Medicine, Osaka Sayama, Japan
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University and Southwoods Imaging, Youngstown, Ohio, USA.
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18
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Yoo J, Lee JB, Park HJ, Lee ES, Park SB, Kim YS, Choi BI. Classification of spontaneous isolated superior mesenteric artery dissection: correlation with multi-detector CT features and clinical presentation. Abdom Radiol (NY) 2018; 43:3157-3165. [PMID: 29550960 DOI: 10.1007/s00261-018-1556-6] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of the study is to propose a computed tomography (CT) classification of spontaneous isolated superior mesenteric artery dissection (SISMAD) correlated with clinical presentation METHODS: We retrospectively reviewed CT images of 40 patients with SISMAD at our institution from 2006 to 2015 and proposed a new classification: type I, patent false lumen with both entry and re-entry; type II, patent false lumen without re-entry; type III, completely or partially thrombosed false lumen; and type IV, thrombosed false lumen with ulcer-like projection. Additionally, we included a subtype (S) at each type when there was either a long segment of dissection and/or significant true lumen stenosis. CT features were statistically analyzed using Fisher's exact and Mann-Whitney test. RESULTS The CT findings classified patients as type I (15%), type II (12.5%), type III (35%), and type IV (37.5%). Of the 40 patients, 25 (62.5%) were symptomatic. There was a significantly different proportion of each type between symptomatic and asymptomatic patients (p = 0.005). There were 25 patients with subtype (S); no type I or II, 12 type III, and 13 type IV. The symptomatic patients showed longer dissection tendency and more severe true lumen stenosis (78% vs. 53%, p = 0.000) compared with asymptomatic patients. CONCLUSION The proposed multi-detector CT classification of SISMAD correlates with clinical presentation. This new classification could be helpful for treatment planning.
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Affiliation(s)
- Jeongin Yoo
- Department of Radiology, Chung-Ang University Hospital, 102 Heukseok-Ro, Dongjak-Gu, Seoul, 06973, Korea
| | - Jong Beum Lee
- Department of Radiology, Chung-Ang University Hospital, 102 Heukseok-Ro, Dongjak-Gu, Seoul, 06973, Korea.
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, 102 Heukseok-Ro, Dongjak-Gu, Seoul, 06973, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, 102 Heukseok-Ro, Dongjak-Gu, Seoul, 06973, Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, 102 Heukseok-Ro, Dongjak-Gu, Seoul, 06973, Korea
| | - Yang Soo Kim
- Department of Radiology, Chung-Ang University Hospital, 102 Heukseok-Ro, Dongjak-Gu, Seoul, 06973, Korea
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, 102 Heukseok-Ro, Dongjak-Gu, Seoul, 06973, Korea
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19
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Ra JC, Lee ES, Park HJ, Kim HS, Lee JB, Do JH, Park SB, Choi BI. Efficacy of Superb Microvascular Imaging for Diagnosing Acute Cholecystitis: Comparison with Conventional Ultrasonography. Ultrasound Med Biol 2018; 44:1968-1977. [PMID: 29936027 DOI: 10.1016/j.ultrasmedbio.2018.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 05/08/2018] [Accepted: 05/14/2018] [Indexed: 06/08/2023]
Abstract
We evaluated the diagnostic performance of ultrasonography (US) plus superb microvascular imaging (SMI) compared with conventional US alone for diagnosing acute cholecystitis. We included 54 patients with suspected biliary disease. The SMI pixel count showing flow signal was measured in the region of interest of the gallbladder bed of the liver. Two radiologists independently evaluated imaging features and rated five-point diagnostic likelihood level before versus after the additional SMI using the cutoff SMI pixel count. The SMI pixel count was significantly higher in acute than in non-acute cholecystitis (169.84 vs. 27.48, p < 0.001). The optimal SMI cutoff pixel count for predicting acute cholecystitis obtained by receiver operating characteristic curve was 56.67(82.8% sensitivity, 92.0% specificity). The area under the curve value was significantly higher after the additional SMI than before (0.798-0.863 vs. 0.701-0.736, p < 0.05). US plus SMI could objectively improve diagnostic performance compared with conventional US for acute cholecystitis.
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Affiliation(s)
- Joon Chul Ra
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hee Sung Kim
- Department of Pathology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jong Beum Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae Hyuk Do
- Department of Gastroenterology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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20
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Seo M, Ahn HS, Park SH, Lee JB, Choi BI, Sohn YM, Shin SY. Comparison and Combination of Strain and Shear Wave Elastography of Breast Masses for Differentiation of Benign and Malignant Lesions by Quantitative Assessment: Preliminary Study. J Ultrasound Med 2018; 37:99-109. [PMID: 28688156 DOI: 10.1002/jum.14309] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To compare the diagnostic performance of strain and shear wave elastography of breast masses for quantitative assessment in differentiating benign and malignant lesions and to evaluate the diagnostic accuracy of combined strain and shear wave elastography. METHODS Between January and February 2016, 37 women with 45 breast masses underwent both strain and shear wave ultrasound (US) elastographic examinations. The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) final assessment on B-mode US imaging was assessed. We calculated strain ratios for strain elastography and the mean elasticity value and elasticity ratio of the lesion to fat for shear wave elastography. Diagnostic performances were compared by using the area under the receiver operating characteristic curve (AUC). RESULTS The 37 women had a mean age of 47.4 years (range, 20-79 years). Of the 45 lesions, 20 were malignant, and 25 were benign. The AUCs for elasticity values on strain and shear wave elastography showed no significant differences (strain ratio, 0.929; mean elasticity, 0.898; and elasticity ratio, 0.868; P > .05). After selectively downgrading BI-RADS category 4a lesions based on strain and shear wave elastographic cutoffs, the AUCs for the combined sets of B-mode US and elastography were improved (B-mode + strain, 0.940; B-mode + shear wave; 0.964; and B-mode, 0.724; P < .001). Combined strain and shear wave elastography showed significantly higher diagnostic accuracy than each individual elastographic modality (P = .031). CONCLUSIONS These preliminary results showed that strain and shear wave elastography had similar diagnostic performance. The addition of strain and shear wave elastography to B-mode US improved diagnostic performance. The combination of strain and shear wave elastography results in a higher diagnostic yield than each individual elastographic modality.
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Affiliation(s)
- Mirinae Seo
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
- Department of Radiology, Chung-Ang University Hospital, College of Medicine, Seoul, Korea
| | - Hye Shin Ahn
- Department of Radiology, Chung-Ang University Hospital, College of Medicine, Seoul, Korea
| | - Sung Hee Park
- Department of Radiology, Chung-Ang University Hospital, College of Medicine, Seoul, Korea
| | - Jong Beum Lee
- Department of Radiology, Chung-Ang University Hospital, College of Medicine, Seoul, Korea
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, College of Medicine, Seoul, Korea
| | - Yu-Mee Sohn
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | - So Youn Shin
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
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21
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Choi BI. Ultrasonography: current status, challenges, and future directions. Ultrasonography 2018; 37:1-2. [PMID: 29232463 PMCID: PMC5769946 DOI: 10.14366/usg.17069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 11/22/2017] [Accepted: 11/23/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Byung Ihn Choi
- Byung Ihn Choi, MD Department of Radiology, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Korea Tel. +82-2-3299-3204, Fax. +82-2-6299-2064, E-mail:
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Choi HW, Park HJ, Hong SA, Park SB, Lee ES, Ahn HS, Lee JB, Choi BI. Radiologic Findings in Extrapancreatic Solid Pseudopapillary Tumor with Aggressive Behavior: a Case Report. J Korean Med Sci 2017; 32:2079-2084. [PMID: 29115095 PMCID: PMC5680512 DOI: 10.3346/jkms.2017.32.12.2079] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 08/20/2016] [Indexed: 01/15/2023] Open
Abstract
Solid pseudopapillary tumor (SPT) is a low grade malignant tumor in the pancreas, and extrapancreatic SPT is extremely rare. We report a case of a 61-year-old woman who complained abdominal pain with diffuse tenderness. She was diagnosed with extrapancreatic SPT with extensive peritoneal dissemination and hepatic metastases. Although a few cases have reported imaging findings of extrapancreatic SPT, there have been no reports of extrapancreatic SPT with aggressive tumor behavior and dismal prognosis. Although imaging features closely resembled those of classical pancreatic SPTs, malignant transformation of extrapancreatic SPT should be considered when focal discontinuity of the tumor capsule with ill-defined margin and invasion of adjacent structures were identified.
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Affiliation(s)
- Hye Won Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
| | - Soon Auk Hong
- Department of Pathology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hye Shin Ahn
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jong Beum Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Lee ES, Lee JB, Park HR, Yoo J, Choi JI, Lee HW, Kim HJ, Choi BI, Park HJ, Park SB. Shear Wave Liver Elastography with a Propagation Map: Diagnostic Performance and Inter-Observer Correlation for Hepatic Fibrosis in Chronic Hepatitis. Ultrasound Med Biol 2017; 43:1355-1363. [PMID: 28431795 DOI: 10.1016/j.ultrasmedbio.2017.02.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/12/2017] [Accepted: 02/13/2017] [Indexed: 06/07/2023]
Abstract
The aim of this study was to determine the performance of shear wave elastography (SWE) with a propagation map in the diagnosis of hepatic fibrosis, and to assess its reliability with transient elastography (TE) as the reference standard. Our prospective study included 115 consecutive patients with suspected or alleged chronic hepatitis. Patients underwent SWE by two different operators and TE by sonographers on the same day. The correlation coefficient of the intra-class correlation test between an experienced radiologist and a third-year radiology resident was 0.878. There was a moderate correlation between SWE and TE (r = 0.511) in the diagnosis of hepatic fibrosis. The best cutoff values predicting significant hepatic fibrosis and liver cirrhosis by SWE were >1.78 m/s (area under the receiver operating characteristic curve [AUROC] = 0.777) and >2.24 m/s (AUROC = 0.935), respectively. SWE with a propagation map is a reliable method for predicting hepatic fibrosis regardless of operator experience.
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Affiliation(s)
- Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea; College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Jong Beum Lee
- Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea; College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
| | - Hwi Ryong Park
- Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea; College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Jeongin Yoo
- Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea; College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Ji In Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea; College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Hyun Woong Lee
- College of Medicine, Chung-Ang University, Seoul, Republic of Korea; Division of Gastroenterology and Hepatology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Hyung Joon Kim
- College of Medicine, Chung-Ang University, Seoul, Republic of Korea; Division of Gastroenterology and Hepatology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea; College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea; College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea; College of Medicine, Chung-Ang University, Seoul, Republic of Korea
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Abstract
BACKGROUND Rapid advances in liver imaging have improved the evaluation of hepatocarcinogenesis and early diagnosis and treatment of hepatocellular carcinoma (HCC). In this situation, detection of early-stage HCC in its development is important for the improvement of patient survival and optimal treatment strategies. Because early HCCs are considered precursors of progressed HCC, precise differentiation between a dysplastic nodule (DN), especially a high-grade DN, and early HCC is important. In clinical practice, these nodules are frequently called "borderline hepatic nodules." SUMMARY This article discusses radiological and pathological characteristics of these borderline hepatic nodules and offers an understanding of multistep hepatocarcinogenesis by focusing on the descriptions of the imaging changes in the progression of DN and early HCC. Detection and accurate diagnosis of borderline hepatic nodules are still a challenge with contrast enhanced ultrasonography, CT, and MRI with extracellular contrast agents. However, gadoxetic acid-enhanced MRI may be useful for improving the diagnosis of these borderline nodules. KEY MESSAGES Since there is a net effect of incomplete neoangiogenesis and decreased portal venous flow in the early stage of hepatocarcinogenesis, borderline hepatic nodules commonly show iso- or hypovascularity. Therefore, precise differentiation of these nodules remains a challenging issue. In MRI using hepatobiliary contrast agents, signal intensity of HCCs on hepatobiliary phase (HBP) is regarded as a potential imaging biomarker. Borderline hepatic nodules are seen as nonhypervascular and hypointense nodules on the HBP, which is important for predicting tumor behavior and determining appropriate therapeutic strategies.
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Affiliation(s)
| | - Byung Ihn Choi
- *Byung Ihn Choi, MD, Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 84 Heukseok-ro, Dongjak-gu, Seoul 06973 (Republic of Korea), E-Mail
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Kim JH, Cho C, Lee EJ, Suh YS, Choi BI, Kim KS. Prevalence and risk factors of chronic rhinosinusitis in South Korea according to diagnostic criteria. Rhinology 2017; 54:329-335. [PMID: 27395040 DOI: 10.4193/rhino15.157] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We aimed to compare the prevalence and risk factors of chronic rhinosinusitis (CRS) using two different diagnostic criteria with the same statistical data from the Korean National Health and Nutrition Examination Survey in 2009. METHODS Symptom-based CRS was defined as CRS diagnosed by questionnaires related to nasal symptoms. Endoscopy-based CRS was defined based on endoscopic findings and nasal symptoms of symptom-based CRS. RESULTS The overall prevalence of CRS based on the different diagnostic criteria was as follows: symptom-based CRS was 10.78% (797 of 7,394) and endoscopy-based CRS was 1.20% (88 of 7,343). Comparing symptom-based CRS to endoscopy-based CRS showed slight agreement (kappa = 0.183 (0.150-0.216, 95% confidence interval)). Allergic rhinitis was identified as a common risk factor for CRS based on the two diagnostic criteria. CONCLUSIONS The prevalence and risk factors of CRS were quite different from each other according to the different criteria, even in the same population. Therefore, it would be important to consider what specific diagnostic criteria have been adopted in the studies comparing the prevalence of CRS.
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Affiliation(s)
- J H Kim
- Department Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - C Cho
- Department Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - E J Lee
- Department Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Y S Suh
- Department Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - B I Choi
- Department Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - K S Kim
- Department Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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Ra JC, Lee ES, Lee JB, Kim JG, Kim BJ, Park HJ, Park SB, Choi BI. Diagnostic performance of stomach CT compared with endoscopic ultrasonography in diagnosing gastric subepithelial tumors. Abdom Radiol (NY) 2017; 42:442-450. [PMID: 27654991 DOI: 10.1007/s00261-016-0906-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the diagnostic ability of multi-detector computed tomography (MDCT) compared to endoscopic ultrasonography (EUS) as a standard reference, and investigate the factors influencing the detection of small gastric subepithelial tumors (SETs) (<5 cm) on MDCT with stomach protocol. METHODS We retrospectively investigated 70 patients who were suspected with gastric SETs on esophagogastroduodenoscopy (EGD), and underwent both EUS and computed tomographic (CT) scanning. EUS was performed by two gastroenterologists, and location, size, echotexture, echogenicity, and layer of origin were described when gastric SETs were detected on EUS. MDCTs were reviewed based on consensus of two radiologists blinded to the EUS result. Size, location, enhancement pattern, and contour of the lesion detected on CT were described. We calculated the diagnostic ability of CT compared to EUS with respect to detection of gastric SETs, and investigated the factors influencing detection of SETs on CT. We also used receiver operating characteristic (ROC) curve to obtain optimal cut-off size for predicting CT visibility of small SETs. RESULTS Of the 70 patients, who underwent both CT and EUS due to suspicious presence of SET on EGD, EUS detected 56 probable cases of SET and 14 cases of external compression. CT led to detection of 39 cases of SET out of the 56 cases. Sensitivity and specificity of CT was 69.6% and 100.0%, respectively. Positive predictive value (PPV) and negative predictive value (NPV) of CT were 100.0% and 45.2%, respectively. There was a significant difference in mean size of CT-detected lesions compared to CT-invisible lesions (14.36 mm vs. 8.52 mm, p < 0.001), but no significant differences in terms of layer of origin and location between these two groups (p > 0.5) were observed. The ROC analysis revealed that the optimal cut-off value, also referred to prediction of CT visibility, was 10 mm. Out of 70 cases, 26 cases (37.14%) were identified as external compression or insignificant lesions such as lipoma, hemangioma, lymphangioma, or gastritis cystica on CT, and do not require regular follow-up. CONCLUSIONS Stomach CT shows good feasibility with respect to depiction of small SETs, especially in cases where size is larger than 10 mm. Henceforth, it is proposed that stomach CT would be a complimentary or problem-solving tool for SET in evaluating the presence of external compression and characterization of tumors.
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Affiliation(s)
- Joon Chul Ra
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Korea.
| | - Jong Beum Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Korea
| | - Jae Gyu Kim
- Department of Gastroenterology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Korea
| | - Beom Jin Kim
- Department of Gastroenterology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Korea
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Korea
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Korea
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Yu MH, Lee JY, Kim HR, Kim BR, Park EJ, Kim HS, Han JK, Choi BI. Therapeutic Effects of Microbubbles Added to Combined High-Intensity Focused Ultrasound and Chemotherapy in a Pancreatic Cancer Xenograft Model. Korean J Radiol 2016; 17:779-88. [PMID: 27587968 PMCID: PMC5007406 DOI: 10.3348/kjr.2016.17.5.779] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 02/22/2016] [Accepted: 06/15/2016] [Indexed: 12/21/2022] Open
Abstract
Objective To investigate whether high-intensity focused ultrasound (HIFU) combined with microbubbles enhances the therapeutic effects of chemotherapy. Materials and Methods A pancreatic cancer xenograft model was established using BALB/c nude mice and luciferase-expressing human pancreatic cancer cells. Mice were randomly assigned to five groups according to treatment: control (n = 10), gemcitabine alone (GEM; n = 12), HIFU with microbubbles (HIFU + MB, n = 11), combined HIFU and gemcitabine (HIGEM; n = 12), and HIGEM + MB (n = 13). After three weekly treatments, apoptosis rates were evaluated using the terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling assay in two mice per group. Tumor volume and bioluminescence were monitored using high-resolution 3D ultrasound imaging and in vivo bioluminescence imaging for eight weeks in the remaining mice. Results The HIGEM + MB group showed significantly higher apoptosis rates than the other groups (p < 0.05) and exhibited the slowest tumor growth. From week 5, the tumor-volume-ratio relative to the baseline tumor volume was significantly lower in the HIGEM + MB group than in the control, GEM, and HIFU + MB groups (p < 0.05). Despite visible distinction, the HIGEM and HIGEM + MB groups showed no significant differences. Conclusion High-intensity focused ultrasound combined with microbubbles enhances the therapeutic effects of gemcitabine chemotherapy in a pancreatic cancer xenograft model.
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Affiliation(s)
- Mi Hye Yu
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Hae Ri Kim
- Department of Pre-Dentistry, Gangneung-Wonju National University College of Dentistry, Gangneung 25457, Korea
| | - Bo Ram Kim
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Eun-Joo Park
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Hoe Suk Kim
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul 06973, Korea
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Choi TW, Lee JM, Kim JH, Yu MH, Han JK, Choi BI. Comparison of Multidetector CT and Gadobutrol-Enhanced MR Imaging for Evaluation of Small, Solid Pancreatic Lesions. Korean J Radiol 2016; 17:509-21. [PMID: 27390542 PMCID: PMC4936173 DOI: 10.3348/kjr.2016.17.4.509] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 04/07/2016] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To compare multidetector computed tomography (MDCT) and MRI for lesion conspicuity, as well as the detection and characterization of small solid pancreatic lesions (SPLs). MATERIALS AND METHODS 193 patients with small SPLs (< 3 cm) and 52 patients with normal pancreas who underwent both multiphasic MDCT and gadobutrol-enhanced MRI were included in our study. Two radiologists blinded to the pathologic diagnoses independently reviewed those images, and determined the detection of "SPL per se" and "SPL in consideration of secondary features", the lesion conspicuity, the probability of pancreatic ductal adenocarcinoma (PDAC), and the most likely specific diagnosis. RESULTS The sensitivity of MRI for "detection of SPL per se" was significantly higher than that of CT in both reviewers: 92.7% (179/193) and 97.9% (189/193), respectively, for reviewer 1 (p = 0.031) and 90.7% (175/193) and 99.5% (192/193), respectively, for reviewer 2 (p < 0.001). In addition, MRI provided better lesion conspicuity than MDCT for both reviewers (p < 0.001). However, CT and MRI did not show significant difference in sensitivity for "detection of SPL in consideration of secondary features", specificity for SPL detection, and differentiation of PDAC vs. non-PDAC (p > 0.05). The accuracies of CT and MRI for making a specific diagnosis were as follows: 85.7% (210/245) vs. 86.9% (213/245), respectively, for reviewer 1 (p = 0.736), and 91.8% (225/245) vs. 93.5% (229/245), respectively, for reviewer 2 (p = 0.454). CONCLUSION MRI showed better lesion conspicuity than MDCT, but did not show significantly different diagnostic performance compared with MDCT for detecting and characterizing small SPLs.
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Affiliation(s)
- Tae Won Choi
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
- Institute of Radiation Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Jung Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
- Institute of Radiation Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Mi Hye Yu
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
- Institute of Radiation Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
- Institute of Radiation Medicine, Seoul National University Hospital, Seoul 03080, Korea
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Chang W, Lee JM, Yoon JH, Han JK, Choi BI, Yoon JH, Lee KB, Lee KW, Yi NJ, Suh KS. Liver Fibrosis Staging with MR Elastography: Comparison of Diagnostic Performance between Patients with Chronic Hepatitis B and Those with Other Etiologic Causes. Radiology 2016; 280:88-97. [PMID: 26844364 DOI: 10.1148/radiol.2016150397] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose To evaluate the diagnostic performance of magnetic resonance (MR) elastography in staging liver fibrosis in patients with chronic hepatitis B (CHB) and other etiologic causes. Materials and Methods This retrospective study was institutional review board-approved and the requirement for informed consent was waived. Before surgery, MR elastographic imaging was performed in 352 patients with chronic liver diseases (281 patients with CHB, 71 patients without CHB) and hepatocellular carcinomas and 64 living liver donor candidates. Liver stiffness (LS) values were measured on quantitative shear-stiffness maps of MR elastography, and the diagnostic performance of MR elastography in staging liver fibrosis was evaluated by using receiver operating characteristic curve analysis and the Obuchowski measure with the histopathologic analysis of liver fibrosis in the CHB group and in the group composed of other etiologic causes. In 120 patients (97 with CHB, 23 without CHB) and 51 donors, diagnostic performance of MR elastography was validated. Results Areas under the curve of LS values for the diagnosis of significant fibrosis (≥stage F2), severe fibrosis (≥stage F3), and cirrhosis (stage F4) in the CHB group were 0.972 (95% confidence interval: 0.948, 0.987), 0.946 (95% confidence interval: 0.916, 0.968), and 0.920 (95% confidence interval: 0.885, 0.947), respectively. Obuchowski measures were similarly high in the CHB group and in the group composed of other etiologic causes (0.970 vs 0.977). However, the estimated cutoff value for stage F4 in the group with CHB was substantially lower than in the participants with other etiologic causes: 3.67 kPa versus 4.65 kPa. In the validation study for stage F1 or greater, stage F2 or greater, stage F3 or greater, and stage F4, the Youden indexes were 0.807, 0.842, 0.806, and 0.639, respectively, in the group with CHB, and 0.783, 0.900, 1.000, and 0.917, respectively, in the group without CHB. Conclusion The diagnostic performance of MR elastography in liver fibrosis staging was similarly high in the groups with and without CHB, but the cutoff LS values for diagnosing liver cirrhosis differed between the groups with and without CHB. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Won Chang
- From the Departments of Radiology (W.C., J.M.L., Jeong Hee Yoon, J.K.H., B.I.C.), Internal Medicine (Jung Hwan Yoon), Pathology (K.B.L.), and Surgery (K.W.L., N.J.Y., K.S.S.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J.M.L., J.K.H., B.I.C.)
| | - Jeong Min Lee
- From the Departments of Radiology (W.C., J.M.L., Jeong Hee Yoon, J.K.H., B.I.C.), Internal Medicine (Jung Hwan Yoon), Pathology (K.B.L.), and Surgery (K.W.L., N.J.Y., K.S.S.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J.M.L., J.K.H., B.I.C.)
| | - Jeong Hee Yoon
- From the Departments of Radiology (W.C., J.M.L., Jeong Hee Yoon, J.K.H., B.I.C.), Internal Medicine (Jung Hwan Yoon), Pathology (K.B.L.), and Surgery (K.W.L., N.J.Y., K.S.S.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J.M.L., J.K.H., B.I.C.)
| | - Joon Koo Han
- From the Departments of Radiology (W.C., J.M.L., Jeong Hee Yoon, J.K.H., B.I.C.), Internal Medicine (Jung Hwan Yoon), Pathology (K.B.L.), and Surgery (K.W.L., N.J.Y., K.S.S.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J.M.L., J.K.H., B.I.C.)
| | - Byung Ihn Choi
- From the Departments of Radiology (W.C., J.M.L., Jeong Hee Yoon, J.K.H., B.I.C.), Internal Medicine (Jung Hwan Yoon), Pathology (K.B.L.), and Surgery (K.W.L., N.J.Y., K.S.S.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J.M.L., J.K.H., B.I.C.)
| | - Jung Hwan Yoon
- From the Departments of Radiology (W.C., J.M.L., Jeong Hee Yoon, J.K.H., B.I.C.), Internal Medicine (Jung Hwan Yoon), Pathology (K.B.L.), and Surgery (K.W.L., N.J.Y., K.S.S.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J.M.L., J.K.H., B.I.C.)
| | - Kyoung Bun Lee
- From the Departments of Radiology (W.C., J.M.L., Jeong Hee Yoon, J.K.H., B.I.C.), Internal Medicine (Jung Hwan Yoon), Pathology (K.B.L.), and Surgery (K.W.L., N.J.Y., K.S.S.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J.M.L., J.K.H., B.I.C.)
| | - Kwang-Woong Lee
- From the Departments of Radiology (W.C., J.M.L., Jeong Hee Yoon, J.K.H., B.I.C.), Internal Medicine (Jung Hwan Yoon), Pathology (K.B.L.), and Surgery (K.W.L., N.J.Y., K.S.S.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J.M.L., J.K.H., B.I.C.)
| | - Nam-Joon Yi
- From the Departments of Radiology (W.C., J.M.L., Jeong Hee Yoon, J.K.H., B.I.C.), Internal Medicine (Jung Hwan Yoon), Pathology (K.B.L.), and Surgery (K.W.L., N.J.Y., K.S.S.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J.M.L., J.K.H., B.I.C.)
| | - Kyung-Suk Suh
- From the Departments of Radiology (W.C., J.M.L., Jeong Hee Yoon, J.K.H., B.I.C.), Internal Medicine (Jung Hwan Yoon), Pathology (K.B.L.), and Surgery (K.W.L., N.J.Y., K.S.S.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J.M.L., J.K.H., B.I.C.)
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Kim JH, Lee JM, Yoon JH, Lee DH, Lee KB, Han JK, Choi BI. Portal Vein Thrombosis in Patients with Hepatocellular Carcinoma: Diagnostic Accuracy of Gadoxetic Acid-enhanced MR Imaging. Radiology 2016; 279:773-83. [PMID: 26780538 DOI: 10.1148/radiol.2015150124] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose To assess the diagnostic performance of gadoxetic acid-enhanced magnetic resonance (MR) imaging in the evaluation of portal vein thrombosis (PVT) in patients with hepatocellular carcinoma (HCC). Materials and Methods This retrospective study was approved by the institutional review board. The requirement to obtain informed consent was waived. A total of 366 patients with HCC who underwent gadoxetic acid-enhanced MR imaging between January 2007 and May 2013, including 134 with malignant PVT, 49 with benign PVT, and 183 without PVT matched for age and sex, comprised our study population. PVTs were complete in 125 patients and partial in 58 and were located in a major portal vein (n = 159) or segmental portal vein (n = 24). Two radiologists independently reviewed the MR images and assessed the sensitivity, specificity, and accuracy in the detection and characterization of PVT according to location (major vs segmental) and type (complete vs partial). The Fisher exact or χ(2) test was used to evaluate sensitivity difference between the subsets. Results Gadoxetic acid-enhanced MR imaging showed good sensitivity (reviewer 1, 84% [154 of 183 patients]; reviewer 2, 70% [129 of 183 patients]) and high specificity (reviewer 1, 89% [163 of 183 patients]; reviewer 2, 96% [176 of 183 patients]) in the detection of PVT. Diagnostic accuracy for differentiating malignant PVT from benign PVT was high (reviewer 1, 92% [141 of 154 patients]; reviewer 2, 95% [122 of 129 patients]). However, there was slightly lower sensitivity for detecting segmental PVT compared with that of major PVT in the malignant PVT group (reviewer 1, 95% [104 of 110 patients] vs 88% [21 of 24 patients]; reviewer 2, 82% [90 of 110 patients] vs 79% [19 of 24 patients]; P = .203 and .775 for reviewers 1 and 2, respectively). Conclusion Gadoxetic acid-enhanced MR imaging provided good diagnostic performance in the detection of PVT and the differentiation of malignant from benign PVT in patients with HCC. However, caution is needed when evaluating potential candidates for curative treatment because of the low sensitivity for segmental PVT in the malignant PVT group. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Jae Hyun Kim
- From the Departments of Radiology (J.H.K., J.M.L., J.H.Y., D.H.L., J.K.H., B.I.C.) and Pathology (K.B.L.), Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea
| | - Jeong Min Lee
- From the Departments of Radiology (J.H.K., J.M.L., J.H.Y., D.H.L., J.K.H., B.I.C.) and Pathology (K.B.L.), Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea
| | - Jeong Hee Yoon
- From the Departments of Radiology (J.H.K., J.M.L., J.H.Y., D.H.L., J.K.H., B.I.C.) and Pathology (K.B.L.), Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea
| | - Dong Ho Lee
- From the Departments of Radiology (J.H.K., J.M.L., J.H.Y., D.H.L., J.K.H., B.I.C.) and Pathology (K.B.L.), Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea
| | - Kyung Bun Lee
- From the Departments of Radiology (J.H.K., J.M.L., J.H.Y., D.H.L., J.K.H., B.I.C.) and Pathology (K.B.L.), Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea
| | - Joon Koo Han
- From the Departments of Radiology (J.H.K., J.M.L., J.H.Y., D.H.L., J.K.H., B.I.C.) and Pathology (K.B.L.), Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea
| | - Byung Ihn Choi
- From the Departments of Radiology (J.H.K., J.M.L., J.H.Y., D.H.L., J.K.H., B.I.C.) and Pathology (K.B.L.), Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea
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Yoo J, Park SB, Shin M, Lee ES, Park HJ, Lee JB, Choi BI. Imaging features of left ovarian and renal venous aneurysms: two case reports and literature review. Clin Imaging 2016; 40:583-6. [PMID: 27317200 DOI: 10.1016/j.clinimag.2016.01.004] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 12/21/2015] [Accepted: 01/08/2016] [Indexed: 11/11/2022]
Abstract
Venous aneurysms rarely occur in the visceral veins. We report two extremely rare cases of venous aneurysms, one of the ovarian vein and the other one of the renal vein. The aneurysms were depicted on grayscale and color Doppler ultrasonography as anechoic saccular structures with compressibility and blood flow. Pulsed Doppler ultrasonography showed venous flow. Contrast-enhanced computed tomography showed aneurysmal venous dilatation. We diagnosed left ovarian and renal venous aneurysms. We also review the clinical presentation and implications of visceral venous aneurysms.
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Affiliation(s)
- Jeongin Yoo
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, South Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, South Korea.
| | - Mack Shin
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, South Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, South Korea
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, South Korea
| | - Jong Beum Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, South Korea
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, South Korea
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Son JY, Lee JY, Yi NJ, Lee KW, Suh KS, Kim KG, Lee JM, Han JK, Choi BI. Hepatic Steatosis: Assessment with Acoustic Structure Quantification of US Imaging. Radiology 2016; 278:257-64. [DOI: 10.1148/radiol.2015141779] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Ahn SY, Lee JM, Joo I, Lee ES, Lee SJ, Cheon GJ, Han JK, Choi BI. Prediction of microvascular invasion of hepatocellular carcinoma using gadoxetic acid-enhanced MR and (18)F-FDG PET/CT. ACTA ACUST UNITED AC 2015; 40:843-51. [PMID: 25253426 DOI: 10.1007/s00261-014-0256-0] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To identify the gadoxetic acid-enhanced MR and the (18)F-fludeoxyglucose (FDG) PET/CT findings associated with microvascular invasion (MVI) of hepatocellular carcinoma (HCC) in patients who are undergoing liver transplantation (LT). METHODS Fifty-one patients with 78 HCCs underwent LT. Preoperative MRI and (18)F-FDG PET/CT findings were retrospectively analyzed and the association of the imaging findings with MVI was assessed. RESULTS Univariate analysis revealed that hypointensity seen on T1WI (OR = 4.329, p = 0.011), peritumoral enhancement (OR = 7.000, p = 0.008), inhomogeneity on arterial phase (OR = 4.321, p = 0.011), delayed phase (OR = 4.519, p = 0.009) or hepatobiliary phase (OR = 3.564, p = 0.032), and the large tumor size (>5 cm) (OR = 12.091, p = 0.001) showed statistically significant associations with MVI. The ratio of tumor maximum standardized uptake value (SUV) to normal liver mean SUV (TSUVmax/LSUVmean) (2.05 ± 1.43 vs. 1.08 ± 0.37) revealed significantly higher value in the MVI-positive group. Multivariate analysis revealed that peritumoral enhancement and a TSUVmax/LSUVmean of 1.2 or greater had a statistically significant association with MVI, with odds ratios of 10.648 (p = 0.016) and 14.218 (p = 0.001), respectively. CONCLUSIONS Preoperative imaging findings such as peritumoral enhancement seen on gadoxetic acid-enhanced MR and a TSUVmax/LSUVmean of 1.2 or more on (18)F-FDG PET/CT, may suggest the presence of MVI in HCC patients.
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Affiliation(s)
- Su Yeon Ahn
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea
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Kim R, Lee JM, Joo I, Lee DH, Woo S, Han JK, Choi BI. Differentiation of lipid poor angiomyolipoma from hepatocellular carcinoma on gadoxetic acid-enhanced liver MR imaging. ACTA ACUST UNITED AC 2015; 40:531-41. [PMID: 25231411 DOI: 10.1007/s00261-014-0244-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To investigate magnetic resonance (MR) findings of angiomyolipoma (AML) on gadoxetic acid-enhanced MR imaging, and to identify features that differentiate AML from hepatocellular carcinoma (HCC) in patients with a low risk of HCC development. METHODS This retrospective study was institutional review board approved, and the requirement for informed consent was waived. Twelve patients with hepatic AML who underwent gadoxetic acid-enhanced MRI with no risk factors for HCC development were recruited. Twenty-seven patients with HCC under the same inclusion criteria were recruited as control. Two radiologists analyzed the images in consensus for morphologic features, enhancement patterns, and hepatobiliary phase (HBP) findings. All results were analyzed using the Mann-Whitney test, two-tailed Fisher exact test, and chi-square test. RESULTS Patients with AML were younger than those with HCC (48.8 ± 15 years for AML vs. 62.7 ± 14.2 years for HCC, p = 0.008) with female predominance, while most HCC patients were male (75% (9/12) vs. 15% (4/27), p < 0.001). The most prevalent enhancement pattern was arterial enhancement followed by hypointensity at portal or transitional phases for both AMLs (58% (7/12)) and HCCs (74% (20/27)) (p = 0.455). However, during the HBP, AMLs frequently showed more homogeneous hypointensity than HCCs (83% (10/12) vs. 41% (11/27), p = 0.018). When compared with the signal intensity of the spleen, the mean relative signal intensity of the AML was 91.2 ± 15.4%, while in HCCs, it was 128.7 ± 40% (p < 0.001). CONCLUSIONS Although AMLs showed similar enhancement patterns to HCCs during the dynamic phases of gadoxetic acid-enhanced MRI, using characteristic MR features of AML during the HBP and demographic differences, one can better differentiate AML from HCC.
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Affiliation(s)
- Rihyeon Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-Gu, Seoul, 110-744, Korea
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Bae JS, Kim SH, Shin CI, Joo I, Yoon JH, Lee HJ, Yang HK, Baek JH, Kim TH, Han JK, Choi BI. Efficacy of Gastric Balloon Dilatation and/or Retrievable Stent Insertion for Pyloric Spasms after Pylorus-Preserving Gastrectomy: Retrospective Analysis. PLoS One 2015; 10:e0144470. [PMID: 26657405 PMCID: PMC4675538 DOI: 10.1371/journal.pone.0144470] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 11/18/2015] [Indexed: 01/01/2023] Open
Abstract
Purpose We retrospectively investigated the feasibility and clinical efficacy of balloon dilatation and subsequent retrievable stent insertion, when necessitated, for pyloric spasms after pylorus-preserving gastrectomy (PPG). Materials and Methods Forty-five patients experiencing pyloric spasms after PPG underwent fluoroscopic balloon dilations to alleviate obstructive symptoms due to delayed gastric emptying. Patients showing poor response to balloon dilation underwent subsequent retrievable stent insertion. Safety of the procedures was analyzed, and subjective symptoms and objective signs of pyloric spasms were analyzed and compared before and after treatment. Results Thirty-three patients (73.3%, 33/45) showed good response to balloon dilatation requiring no further treatment (balloon group). Conversely, 12 patients (26.7%, 12/45) showed poor or no response after balloon dilation requiring subsequent stent insertion (stent group). Balloon dilations and/or stent insertions were safely performed in all patients except one patient who suffered a transmural tear after balloon dilatation. In both groups, mean subjective symptom score was significantly improved and mean pyloric canal-to-height of the adjacent vertebral body ratio was significantly increased after the procedures (P <.05). Conclusion Balloon dilation is a safe and effective treatment for patients with pyloric spasms after PPG. In patients refractory to balloon dilations, retrievable stent placement can be a safe alternative tool.
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Affiliation(s)
- Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Se Hyung Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- * E-mail:
| | - Cheong-il Shin
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jee Hyun Baek
- Department of Radiology, New Korea Hospital, Gimpo, Gyeonggi-do, Korea
| | - Tae Han Kim
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea
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Yoon JH, Lee JM, Yu MH, Kim EJ, Han JK, Choi BI. Fat-suppressed, three-dimensional T1-weighted imaging using high-acceleration parallel acquisition and a dual-echo Dixon technique for gadoxetic acid-enhanced liver MRI at 3 T. Acta Radiol 2015; 56:1454-62. [PMID: 25480475 DOI: 10.1177/0284185114561038] [Citation(s) in RCA: 6] [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: 02/06/2014] [Accepted: 11/01/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Parallel imaging (PI) techniques are used for overcoming lower spatial and time resolution for magnetic resonance imaging (MRI). There is clinical need to overcome inevitable noise by decreased voxel size and signal-to-noise issue by using high-acceleration factor (AF). PURPOSE To determine whether the combination of a modified Dixon three-dimensional (3D) T1-weighted (T1W) gradient echo technique (mDixon-3D-GRE) and high-acceleration ([HA], AF = 5) PI can provide breath-hold (BH) T1W imaging with better image quality than conventional fat-suppressed 3D-T1W-GRE (SPAIR-3D-GRE) for Gd-EOB-DTPA-enhanced liver MR. MATERIAL AND METHODS This retrospective study was approved by our institutional review board and informed consent was waived. There were 138 patients who underwent Gd-EOB-DTPA-enhanced liver MR at 3 T using either standard SPAIR-3D-GRE sequences with an AF of 2.6 (n = 68, Standard group) or mDixon-3D-GRE with an AF of 5 (n = 70, HA group). In the HA group, hepatobiliary phase was obtained three times using HA-mDixon-3D-GRE (AF = 5), HA-SPAIR-3D-GRE (AF = 5), and standard-SPAIR-3D-GRE (AF = 2.6). Image noise, quality, and anatomic depiction of dynamic phase were compared between standard and HA groups, and those of hepatobiliary phase were compared among the three image sets in HA group. RESULTS As for dynamic imaging, the HA-mDixon-3D-GRE images showed better anatomic details and overall image quality than standard-SPAIR-3D-GRE sequence (arterial phase: 3.56 ± 0.63 vs. 2.66 ± 0.69, P < 0.001). In the intra-individual comparison, HA-mDixon-3D-GRE provided better orang depiction and overall image quality than standard-SPAIR-3D-GRE (3.99 ± 0.75 vs. 3.0 ± 0.72, P < 0.001) and better fat suppression and significantly less noise than HA-SPAIR-3D-GRE (4.76 ± 0.43 vs. 3.71 ± 0.54, P < 0.001). CONCLUSION The combined use of mDixon-3D-GRE sequence and high-acceleration PI provided better quality BH-T1W imaging compared with conventional SPAIR-3D-GRE for Gd-EOB-DTPA-enhanced liver MRI.
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Affiliation(s)
- Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Mi Hye Yu
- Konkuk University Hospital, Seoul, Republic of Korea
| | - Eun Ju Kim
- Philips Healthcare Korea, Seoul, Republic of Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine Seoul National University College of Medicine, Seoul, Republic of Korea
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Yoon JH, Lee JM, Lee KB, Kim SW, Kang MJ, Jang JY, Kannengiesser S, Han JK, Choi BI. Pancreatic Steatosis and Fibrosis: Quantitative Assessment with Preoperative Multiparametric MR Imaging. Radiology 2015; 279:140-50. [PMID: 26566228 DOI: 10.1148/radiol.2015142254] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of multiparametric pancreatic magnetic resonance (MR) imaging, including the T2*-corrected Dixon technique and intravoxel incoherent motion (IVIM) diffusion-weighted (DW) imaging, in the quantification of pancreatic steatosis and fibrosis, with histologic analysis as the reference standard, and to determine the relationship between MR parameters and postoperative pancreatic fistula. MATERIALS AND METHODS This retrospective study was approved by the institutional review board, and the informed consent requirement was waived. A total of 165 patients (93 men, 72 women; mean age, 62 years) underwent preoperative 3-T MR imaging and subsequent pancreatectomy (interval, 0-77 days). Fat fractions, IVIM DW imaging parameters (true diffusion coefficient [D], pseudodiffusion coefficient [D*], and perfusion fraction [f]), pancreas-to-muscle signal intensity ratios on unenhanced T1-weighted images, and pancreatic duct sizes were compared with the fat fractions and fibrosis degrees (F0-F3) of specimens. In 95 patients who underwent pancreatoenteric anastomosis, MR parameters were compared between groups with clinically relevant postoperative pancreatic fistula and those without. The relationship between postoperative pancreatic fistula and MR parameters was evaluated by using logistic regression analysis. RESULTS Fat fractions at MR imaging showed a moderate relationship with histologic findings (r = 0.71; 95% confidence interval: 0.63, 0.78). Patients with advanced fibrosis (F2-F3) had lower D*([39.72 ± 13.64] ×10(-3)mm(2)/sec vs [32.50 ± 13.09] ×10(-3)mm(2)/sec [mean ± standard deviation], P = .004), f (29.77% ± 8.51 vs 20.82% ± 8.66, P < .001), and unenhanced T1-weighted signal intensity ratio (1.43 ± 0.26 vs 1.21 ± 0.30, P < .001) than did patients with F0-F1 disease. Clinically relevant fistula developed in 14 (15%) of 95 patients, and f was significantly associated with postoperative pancreatic fistula (odds ratio, 1.17; 95% confidence interval: 1.05, 1.30). CONCLUSION Multiparametric MR imaging of the pancreas, including imaging with the T2*-corrected Dixon technique and IVIM DW imaging, may yield quantitative information regarding pancreatic steatosis and fibrosis, and f was shown to be significantly associated with postoperative pancreatic fistulas.
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Affiliation(s)
- Jeong Hee Yoon
- From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Pathology (K.B.L.), and Surgery (S.W.K., M.J.K., J.Y.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., J.K.H., B.I.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H., B.I.C.); and Siemens Healthcare, Erlangen, Germany (S.K.)
| | - Jeong Min Lee
- From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Pathology (K.B.L.), and Surgery (S.W.K., M.J.K., J.Y.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., J.K.H., B.I.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H., B.I.C.); and Siemens Healthcare, Erlangen, Germany (S.K.)
| | - Kyung Bun Lee
- From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Pathology (K.B.L.), and Surgery (S.W.K., M.J.K., J.Y.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., J.K.H., B.I.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H., B.I.C.); and Siemens Healthcare, Erlangen, Germany (S.K.)
| | - Sun-Whe Kim
- From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Pathology (K.B.L.), and Surgery (S.W.K., M.J.K., J.Y.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., J.K.H., B.I.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H., B.I.C.); and Siemens Healthcare, Erlangen, Germany (S.K.)
| | - Mee Joo Kang
- From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Pathology (K.B.L.), and Surgery (S.W.K., M.J.K., J.Y.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., J.K.H., B.I.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H., B.I.C.); and Siemens Healthcare, Erlangen, Germany (S.K.)
| | - Jin-Young Jang
- From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Pathology (K.B.L.), and Surgery (S.W.K., M.J.K., J.Y.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., J.K.H., B.I.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H., B.I.C.); and Siemens Healthcare, Erlangen, Germany (S.K.)
| | - Stephan Kannengiesser
- From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Pathology (K.B.L.), and Surgery (S.W.K., M.J.K., J.Y.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., J.K.H., B.I.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H., B.I.C.); and Siemens Healthcare, Erlangen, Germany (S.K.)
| | - Joon Koo Han
- From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Pathology (K.B.L.), and Surgery (S.W.K., M.J.K., J.Y.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., J.K.H., B.I.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H., B.I.C.); and Siemens Healthcare, Erlangen, Germany (S.K.)
| | - Byung Ihn Choi
- From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Pathology (K.B.L.), and Surgery (S.W.K., M.J.K., J.Y.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., J.K.H., B.I.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H., B.I.C.); and Siemens Healthcare, Erlangen, Germany (S.K.)
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Kang HJ, Lee JM, Joo I, Hur BY, Jeon JH, Jang JY, Lee K, Ryu JK, Han JK, Choi BI. Assessment of Malignant Potential in Intraductal Papillary Mucinous Neoplasms of the Pancreas: Comparison between Multidetector CT and MR Imaging with MR Cholangiopancreatography. Radiology 2015; 279:128-39. [PMID: 26517448 DOI: 10.1148/radiol.2015150217] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To compare the diagnostic performance of multidetector computed tomography (CT) and magnetic resonance (MR) imaging with MR cholangiopancreatography (MRCP) in identifying the malignant potential of pancreatic intraductal papillary neoplasms (IPMNs) and evaluate their intermodality agreement. MATERIALS AND METHODS Institutional review board approval was obtained, and the requirement for informed consent was waived for this retrospective study. In 129 patients with pathologically proved pancreatic IPMNs, three reviewers independently evaluated their preoperative CT and MR imaging with MRCP findings. Intermodality agreement between multidetector CT and MR imaging with MRCP, as well as interobserver agreement of each imaging modality, for depicting high-risk stigmata and worrisome features were assessed. Diagnostic values of other signs of overt malignancy, including the presence of a parenchymal mass and local-regional extension, were analyzed. Diagnostic performance and intermodality agreement were assessed by using receiver operating characteristics (ROC) curve analysis and weighted κ statistics. RESULTS Overall, multidetector CT and MR imaging with MRCP were similar in their ability to depict signs suspicious or indicative of malignancy in patients with IPMN (area under the ROC curve [AUC] = 0.82 for both), with good intermodality agreement (κ = 0.75) and moderate interobserver agreement (κ = 0.47-0.59) when high-grade dysplasia was used as the cutoff for malignancy. When parenchymal masses and local-regional extensions were also considered as overt signs of malignancy, the ability to identify invasive IPMNs significantly increased (AUC = 0.87 for CT and AUC = 0.88 for MR imaging), with high sensitivity (94.3%), while maintaining specificity (69.1%). CONCLUSION The diagnostic performance of multidetector CT and MR imaging with MRCP for identifying the malignant potential of pancreatic IPMNs was similar and showed good intermodality agreement, suggesting that follow-up with either modality may be used.
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Affiliation(s)
- Hyo-Jin Kang
- From the Departments of Radiology (H.J.K., J.M.L., I.J., J.H.J., J.K.H.), Surgery (J.Y.J.), Pathology (K.B.L.), and Internal Medicine (J.K.R.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea; Institute of Radiation Medicine, Seoul National University College Medical Research Center, Seoul, Korea (J.M.L., I.J., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L., J.H.J., J.K.H.); Department of Radiology, National Cancer Center, Seoul, Korea (B.Y.H.); and Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
| | - Jeong Min Lee
- From the Departments of Radiology (H.J.K., J.M.L., I.J., J.H.J., J.K.H.), Surgery (J.Y.J.), Pathology (K.B.L.), and Internal Medicine (J.K.R.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea; Institute of Radiation Medicine, Seoul National University College Medical Research Center, Seoul, Korea (J.M.L., I.J., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L., J.H.J., J.K.H.); Department of Radiology, National Cancer Center, Seoul, Korea (B.Y.H.); and Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
| | - Ijin Joo
- From the Departments of Radiology (H.J.K., J.M.L., I.J., J.H.J., J.K.H.), Surgery (J.Y.J.), Pathology (K.B.L.), and Internal Medicine (J.K.R.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea; Institute of Radiation Medicine, Seoul National University College Medical Research Center, Seoul, Korea (J.M.L., I.J., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L., J.H.J., J.K.H.); Department of Radiology, National Cancer Center, Seoul, Korea (B.Y.H.); and Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
| | - Bo Yun Hur
- From the Departments of Radiology (H.J.K., J.M.L., I.J., J.H.J., J.K.H.), Surgery (J.Y.J.), Pathology (K.B.L.), and Internal Medicine (J.K.R.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea; Institute of Radiation Medicine, Seoul National University College Medical Research Center, Seoul, Korea (J.M.L., I.J., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L., J.H.J., J.K.H.); Department of Radiology, National Cancer Center, Seoul, Korea (B.Y.H.); and Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
| | - Ju Hyeon Jeon
- From the Departments of Radiology (H.J.K., J.M.L., I.J., J.H.J., J.K.H.), Surgery (J.Y.J.), Pathology (K.B.L.), and Internal Medicine (J.K.R.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea; Institute of Radiation Medicine, Seoul National University College Medical Research Center, Seoul, Korea (J.M.L., I.J., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L., J.H.J., J.K.H.); Department of Radiology, National Cancer Center, Seoul, Korea (B.Y.H.); and Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
| | - Jin-Young Jang
- From the Departments of Radiology (H.J.K., J.M.L., I.J., J.H.J., J.K.H.), Surgery (J.Y.J.), Pathology (K.B.L.), and Internal Medicine (J.K.R.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea; Institute of Radiation Medicine, Seoul National University College Medical Research Center, Seoul, Korea (J.M.L., I.J., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L., J.H.J., J.K.H.); Department of Radiology, National Cancer Center, Seoul, Korea (B.Y.H.); and Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
| | - Kyoungbun Lee
- From the Departments of Radiology (H.J.K., J.M.L., I.J., J.H.J., J.K.H.), Surgery (J.Y.J.), Pathology (K.B.L.), and Internal Medicine (J.K.R.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea; Institute of Radiation Medicine, Seoul National University College Medical Research Center, Seoul, Korea (J.M.L., I.J., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L., J.H.J., J.K.H.); Department of Radiology, National Cancer Center, Seoul, Korea (B.Y.H.); and Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
| | - Ji Kon Ryu
- From the Departments of Radiology (H.J.K., J.M.L., I.J., J.H.J., J.K.H.), Surgery (J.Y.J.), Pathology (K.B.L.), and Internal Medicine (J.K.R.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea; Institute of Radiation Medicine, Seoul National University College Medical Research Center, Seoul, Korea (J.M.L., I.J., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L., J.H.J., J.K.H.); Department of Radiology, National Cancer Center, Seoul, Korea (B.Y.H.); and Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
| | - Joon Koo Han
- From the Departments of Radiology (H.J.K., J.M.L., I.J., J.H.J., J.K.H.), Surgery (J.Y.J.), Pathology (K.B.L.), and Internal Medicine (J.K.R.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea; Institute of Radiation Medicine, Seoul National University College Medical Research Center, Seoul, Korea (J.M.L., I.J., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L., J.H.J., J.K.H.); Department of Radiology, National Cancer Center, Seoul, Korea (B.Y.H.); and Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
| | - Byung Ihn Choi
- From the Departments of Radiology (H.J.K., J.M.L., I.J., J.H.J., J.K.H.), Surgery (J.Y.J.), Pathology (K.B.L.), and Internal Medicine (J.K.R.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea; Institute of Radiation Medicine, Seoul National University College Medical Research Center, Seoul, Korea (J.M.L., I.J., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L., J.H.J., J.K.H.); Department of Radiology, National Cancer Center, Seoul, Korea (B.Y.H.); and Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.)
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Kim H, Lee JM, Yoon JH, Jang JY, Kim SW, Ryu JK, Kannengiesser S, Han JK, Choi BI. Reduced Field-of-View Diffusion-Weighted Magnetic Resonance Imaging of the Pancreas: Comparison with Conventional Single-Shot Echo-Planar Imaging. Korean J Radiol 2015; 16:1216-25. [PMID: 26576110 PMCID: PMC4644742 DOI: 10.3348/kjr.2015.16.6.1216] [Citation(s) in RCA: 45] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 07/21/2015] [Indexed: 02/01/2023] Open
Abstract
Objective To investigate the image quality (IQ) and apparent diffusion coefficient (ADC) of reduced field-of-view (FOV) di-ffusion-weighted imaging (DWI) of pancreas in comparison with full FOV DWI. Materials and Methods In this retrospective study, 2 readers independently performed qualitative analysis of full FOV DWI (FOV, 38 × 38 cm; b-value, 0 and 500 s/mm2) and reduced FOV DWI (FOV, 28 × 8.5 cm; b-value, 0 and 400 s/mm2). Both procedures were conducted with a two-dimensional spatially selective radiofrequency excitation pulse, in 102 patients with benign or malignant pancreatic diseases (mean size, 27.5 ± 14.4 mm). The study parameters included 1) anatomic structure visualization, 2) lesion conspicuity, 3) artifacts, 4) IQ score, and 5) subjective clinical utility for confirming or excluding initially considered differential diagnosis on conventional imaging. Another reader performed quantitative ADC measurements of focal pancreatic lesions and parenchyma. Wilcoxon signed-rank test was used to compare qualitative scores and ADCs between DWI sequences. Mann Whitney U-test was used to compare ADCs between the lesions and parenchyma. Results On qualitative analysis, reduced FOV DWI showed better anatomic structure visualization (2.76 ± 0.79 at b = 0 s/mm2 and 2.81 ± 0.64 at b = 400 s/mm2), lesion conspicuity (3.11 ± 0.99 at b = 0 s/mm2 and 3.15 ± 0.79 at b = 400 s/mm2), IQ score (8.51 ± 2.05 at b = 0 s/mm2 and 8.79 ± 1.60 at b = 400 s/mm2), and higher clinical utility (3.41 ± 0.64), as compared to full FOV DWI (anatomic structure, 2.18 ± 0.59 at b = 0 s/mm2 and 2.56 ± 0.47 at b = 500 s/mm2; lesion conspicuity, 2.55 ± 1.07 at b = 0 s/mm2 and 2.89 ± 0.86 at b = 500 s/mm2; IQ score, 7.13 ± 1.83 at b = 0 s/mm2 and 8.17 ± 1.31 at b = 500 s/mm2; clinical utility, 3.14 ± 0.70) (p < 0.05). Artifacts were significantly improved on reduced FOV DWI (2.65 ± 0.68) at b = 0 s/mm2 (full FOV DWI, 2.41 ± 0.63) (p < 0.001). On quantitative analysis, there were no significant differences between the 2 DWI sequences in ADCs of various pancreatic lesions and parenchyma (p > 0.05). ADCs of adenocarcinomas (1.061 × 10-3 mm2/s ± 0.133 at reduced FOV and 1.079 × 10-3 mm2/s ± 0.135 at full FOV) and neuroendocrine tumors (0.983 × 10-3 mm2/s ± 0.152 at reduced FOV and 1.004 × 10-3 mm2/s ± 0.153 at full FOV) were significantly lower than those of parenchyma (1.191 × 10-3 mm2/s ± 0.125 at reduced FOV and 1.218 × 10-3 mm2/s ± 0.103 at full FOV) (p < 0.05). Conclusion Reduced FOV DWI of the pancreas provides better overall IQ including better anatomic detail, lesion conspicuity and subjective clinical utility.
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Affiliation(s)
- Hyungjin Kim
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea. ; Aerospace Medical Group, Air Force Education and Training Command, Jinju 52634, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea. ; Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Jin-Young Jang
- Department of Surgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Sun-Whe Kim
- Department of Surgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Ji Kon Ryu
- Division of Gastroenterology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | | | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea. ; Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea. ; Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
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Kim R, Lee JM, Shin CI, Lee ES, Yoon JH, Joo I, Kim SH, Hwang I, Han JK, Choi BI. Differentiation of intrahepatic mass-forming cholangiocarcinoma from hepatocellular carcinoma on gadoxetic acid-enhanced liver MR imaging. Eur Radiol 2015; 26:1808-17. [PMID: 26373763 DOI: 10.1007/s00330-015-4005-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 08/16/2015] [Accepted: 09/02/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine the different imaging features of intrahepatic mass-forming cholangiocarcinoma (IMCC) from hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced magnetic resonance imaging (MRI). METHODS This retrospective study was institutional review board approved and the requirement for informed consent was waived. Patients who underwent gadoxetic acid-enhanced MRI with histologically confirmed IMCCs (n = 46) or HCCs (n = 58) were included. Imaging features of IMCCs and HCCs on gadoxetic acid-enhanced MRI including T2- and T1-weighted, diffusion weighted images, dynamic study and hepatobiliary phase (HBP) images were analyzed. Univariate and multivariate logistic regression analyses were performed to identify relevant differentiating features between IMCCs and HCCs. RESULTS Multivariate analysis revealed heterogeneous T2 signal intensity and a hypointense rim on the HBP as suggestive findings of IMCCs and the wash-in and "portal wash-out" enhancement pattern as well as focal T1 high signal intensity foci as indicative of HCCs (all, p < 0.05). When we combined any three of the above four imaging features, we were able to diagnose IMCCs with 94 % (43/46) sensitivity and 86 % (50/58) specificity. CONCLUSIONS Combined interpretation of enhancement characteristics including HBP images, morphologic features, and strict application of the "portal wash-out" pattern helped more accurate discrimination of IMCCs from HCCs. KEY POINTS • Analysis of enhancement characteristics helped accurate discrimination of IMCCs from HCCs. • Wash-out should be determined on the PVP of gadoxetic acid-enhanced MRI. • A hypointense rim on the HBP was a significant finding of IMCCs.
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Affiliation(s)
- Rihyeon Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea. .,Institute of Radiation Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea.
| | - Cheong-Il Shin
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu, Seoul, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Seong Ho Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Inpyeong Hwang
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu, Seoul, Korea
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Park HS, Han JK, Lee JM, Kim YI, Woo S, Yoon JH, Choi JY, Choi BI. Dynamic Contrast-Enhanced MRI Using a Macromolecular MR Contrast Agent (P792): Evaluation of Antivascular Drug Effect in a Rabbit VX2 Liver Tumor Model. Korean J Radiol 2015; 16:1029-37. [PMID: 26357497 PMCID: PMC4559774 DOI: 10.3348/kjr.2015.16.5.1029] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/18/2015] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate the utility of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) using macromolecular contrast agent (P792) for assessment of vascular disrupting drug effect in rabbit VX2 liver tumor models. Materials and Methods This study was approved by our Institutional Animal Care and Use Committee. DCE-MRI was performed with 3-T scanner in 13 VX2 liver tumor-bearing rabbits, before, 4 hours after, and 24 hours after administration of vascular disrupting agent (VDA), using gadomelitol (P792, n = 7) or low molecular weight contrast agent (gadoterate meglumine [Gd-DOTA], n = 6). P792 was injected at a of dose 0.05 mmol/kg, while that of Gd-DOTA was 0.2 mmol/kg. DCE-MRI parameters including volume transfer coefficient (Ktrans) and initial area under the gadolinium concentration-time curve until 60 seconds (iAUC) of tumors were compared between the 2 groups at each time point. DCE-MRI parameters were correlated with tumor histopathology. Reproducibility in measurement of DCE-MRI parameters and image quality of source MR were compared between groups. Results P792 group showed a more prominent decrease in Ktrans and iAUC at 4 hours and 24 hours, as compared to the Gd-DOTA group. Changes in DCE-MRI parameters showed a weak correlation with histologic parameters (necrotic fraction and microvessel density) in both groups. Reproducibility of DCE-MRI parameters and overall image quality was not significantly better in the P792 group, as compared to the Gd-DOTA group. Conclusion Dynamic contrast-enhanced magnetic resonance imaging using a macromolecular contrast agent shows changes of hepatic perfusion more clearly after administration of the VDA. Gadolinium was required at smaller doses than a low molecular contrast agent.
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Affiliation(s)
- Hee Sun Park
- Department of Radiology, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Joon Koo Han
- Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Jeong Min Lee
- Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Young Il Kim
- Department of Radiology, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates
| | - Sungmin Woo
- Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Jung Hwan Yoon
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Jin-Young Choi
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Byung Ihn Choi
- Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul 03080, Korea
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Joo I, Lee JM, Grimm R, Han JK, Choi BI. Monitoring Vascular Disrupting Therapy in a Rabbit Liver Tumor Model: Relationship between Tumor Perfusion Parameters at IVIM Diffusion-weighted MR Imaging and Those at Dynamic Contrast-enhanced MR Imaging. Radiology 2015. [PMID: 26200601 DOI: 10.1148/radiol.2015141974] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate whether perfusion-related intravoxel incoherent motion (IVIM) diffusion-weighted (DW) magnetic resonance (MR) imaging parameters correlate with dynamic contrast material-enhanced MR imaging parameters in between-subject and/or within-subject longitudinal settings for monitoring the therapeutic effects of a vascular disrupting agent (VDA) (CKD-516) in rabbit VX2 liver tumors. MATERIALS AND METHODS With institutional Animal Care and Use Committee approval, 21 VX2 liver tumor-bearing rabbits (treated, n = 15; control, n = 6) underwent IVIM DW imaging with 12 b values (0-800 sec/mm(2)) and dynamic contrast-enhanced MR imaging performed before (baseline) CKD-516 administration and 4 hours, 24 hours, and 7 days after administration. Perfusion-related IVIM DW imaging parameters of the tumors, including the pseudodiffusion coefficient (D*) and perfusion fraction (f), as well as dynamic contrast-enhanced MR imaging parameters, including the volume transfer coefficient (K(trans)) and initial area under the gadolinium concentration-time curve until 60 seconds (iAUC), were measured. IVIM DW imaging parameters were correlated with dynamic contrast-enhanced MR imaging parameters by using Pearson correlation analysis between subjects at each given time and by using a linear mixed model for within-subject longitudinal data. RESULTS In the treated group, D*, f, K(trans), and iAUC significantly decreased (-40.7% to -26.3%) at 4-hour follow-up compared with these values in the control group (-6.9% to +5.9%) (P < .05). For longitudinal monitoring of CKD-516 treatment, D* and f showed significant positive correlations with K(trans) and iAUC (P = .004 and P = .02; P < .001 and P = .006, respectively), while no significant correlations were observed between IVIM DW imaging and dynamic contrast-enhanced MR imaging parameters between subjects at any given time (P > .05). CONCLUSION In a rabbit tumor model, perfusion parameters serially quantified with IVIM DW imaging can be used as alternatives to dynamic contrast-enhanced MR imaging parameters in reflecting the dynamic changes in tumor perfusion during the within-subject longitudinal monitoring of VDA treatment.
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Affiliation(s)
- Ijin Joo
- From the Department of Radiology (I.J., J.M.L., J.K.H., B.I.C.) and Institute of Radiation Medicine (J.M.L., J.K.H., B.I.C.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; and Siemens, Healthcare Sector, Erlangen, Germany (R.G.)
| | - Jeong Min Lee
- From the Department of Radiology (I.J., J.M.L., J.K.H., B.I.C.) and Institute of Radiation Medicine (J.M.L., J.K.H., B.I.C.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; and Siemens, Healthcare Sector, Erlangen, Germany (R.G.)
| | - Robert Grimm
- From the Department of Radiology (I.J., J.M.L., J.K.H., B.I.C.) and Institute of Radiation Medicine (J.M.L., J.K.H., B.I.C.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; and Siemens, Healthcare Sector, Erlangen, Germany (R.G.)
| | - Joon Koo Han
- From the Department of Radiology (I.J., J.M.L., J.K.H., B.I.C.) and Institute of Radiation Medicine (J.M.L., J.K.H., B.I.C.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; and Siemens, Healthcare Sector, Erlangen, Germany (R.G.)
| | - Byung Ihn Choi
- From the Department of Radiology (I.J., J.M.L., J.K.H., B.I.C.) and Institute of Radiation Medicine (J.M.L., J.K.H., B.I.C.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; and Siemens, Healthcare Sector, Erlangen, Germany (R.G.)
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Yu MH, Lee JY, Jun SR, Kim KW, Kim SH, Han JK, Choi BI. Radiofrequency Ablation with an Internally Cooled Monopolar Directional Electrode: Ex Vivo and in Vivo Experimental Studies in the Liver. Radiology 2015; 278:395-404. [PMID: 26172531 DOI: 10.1148/radiol.2015142269] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the feasibility of using an internally cooled directional electrode (ICDE) to create sufficient directional ablation in the desired area and to investigate whether use of the ICDE reduces thermal injury to the adjacent organs. MATERIALS AND METHODS The animal care and use committee approved this animal study. In ex vivo studies of bovine livers and colons, temperature was measured in both ablation and nonablation directions with the ICDE, temperature at the liver-colon interface and the presence of burns on the colon were evaluated with each ICDE and internally cooled conventional electrode (ICCE), and the ablation area with the use of three ICDEs in the switching multichannel mode was evaluated. In an in vivo study of 10 pigs, 11 ablations were performed by using three ICDEs in the switching multichannel mode. In addition, the difference in thermal injury to the gallbladder and stomach was compared between use of the ICDE and the ICCE. Mann-Whitney test and the Fisher exact test were used for statistical analysis. RESULTS In the ex vivo study, the hepatic temperature in the nonablation direction was lower than 50°C; temperature higher than 47°C was maintained for less than 3 minutes, even 0.5 cm away from the ICDE; and the temperature at the liver-colon interface did not increase above 50°C. In the switching multichannel mode, a fused coagulation zone was created. In the in vivo study, confluent ablation was created in the inner circle of three ICDEs with a mean interelectrode distance of less than 2.6 cm. Use of the ICDE did not create a moderate-to-severe gallbladder wall injury in any of the pigs, but use of the ICCE caused injury in three of the five pigs (P > .05). The ICDE caused moderate-to-severe gastric wall injury at one of eight ablations, and the ICCE caused injury at eight of nine ablations (P < .05). CONCLUSION Use of an ICDE can create a sufficient ablation in the desired direction and can decrease thermal injury to the adjacent organs.
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Affiliation(s)
- Mi Hye Yu
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Jae Young Lee
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Su Ryoung Jun
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Kyung Won Kim
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Se Hyung Kim
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Joon Koo Han
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Byung Ihn Choi
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
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Woo H, Lee JY, Yoon JH, Kim W, Cho B, Choi BI. Comparison of the Reliability of Acoustic Radiation Force Impulse Imaging and Supersonic Shear Imaging in Measurement of Liver Stiffness. Radiology 2015; 277:881-6. [PMID: 26147680 DOI: 10.1148/radiol.2015141975] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To compare the reliability of acoustic radiation force impulse (ARFI) imaging and supersonic shear imaging (SSI) in measurement of liver stiffness. MATERIALS AND METHODS This study was approved by the institutional review board, and written informed consent was obtained for all patients. Seventy-nine patients (25 healthy patients, 26 with Child-Pugh class A, and 28 with Child-Pugh class B or C) were enrolled and analyzed from April 2012 to April 2013. In each patient, three abdominal radiologists performed nine measurements of hepatic shear-wave speed with both ARFI imaging and SSI on the same day. Four weeks later, a second session was performed with the same protocol. Interobserver and intraobserver agreements were calculated by using intraclass correlation coefficients. Technical failures and measurement time were evaluated. RESULTS There were four technical failures in the SSI group and one in the ARFI group (P = .375). The overall interobserver agreement of ARFI imaging was significantly higher than that of SSI (0.941 vs 0.828, P < .001). The overall intraobserver agreement of ARFI imaging was significantly higher than that of SSI (0.915 vs 0.829, P < .001). The overall shear-wave speed measured with SSI was higher than that measured with ARFI imaging (2.04 m/sec ± 0.88 vs 1.80 m/sec ± 0.81, P < .001). The measurement time of SSI was longer than that of ARFI imaging (310.8 seconds ± 88.5 vs 84.5 seconds ± 15.4, P < .001). CONCLUSION ARFI imaging was more reliable than SSI in measurement of liver stiffness. The hepatic shear-wave speed measured with SSI was higher than that measured with ARFI imaging, which means that the shear-wave speeds measured with ARFI imaging and SSI cannot be used interchangeably.
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Affiliation(s)
- Hyunsik Woo
- From the Departments of Radiology (H.W.) and Internal Medicine (W.K.), SMG-SNU Boramae Medical Center, Seoul, Korea; and Departments of Radiology (J.Y.L., J.H.Y., B.I.C.) and Family Medicine (B.C.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea
| | - Jae Young Lee
- From the Departments of Radiology (H.W.) and Internal Medicine (W.K.), SMG-SNU Boramae Medical Center, Seoul, Korea; and Departments of Radiology (J.Y.L., J.H.Y., B.I.C.) and Family Medicine (B.C.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea
| | - Jeong Hee Yoon
- From the Departments of Radiology (H.W.) and Internal Medicine (W.K.), SMG-SNU Boramae Medical Center, Seoul, Korea; and Departments of Radiology (J.Y.L., J.H.Y., B.I.C.) and Family Medicine (B.C.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea
| | - Won Kim
- From the Departments of Radiology (H.W.) and Internal Medicine (W.K.), SMG-SNU Boramae Medical Center, Seoul, Korea; and Departments of Radiology (J.Y.L., J.H.Y., B.I.C.) and Family Medicine (B.C.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea
| | - Belong Cho
- From the Departments of Radiology (H.W.) and Internal Medicine (W.K.), SMG-SNU Boramae Medical Center, Seoul, Korea; and Departments of Radiology (J.Y.L., J.H.Y., B.I.C.) and Family Medicine (B.C.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea
| | - Byung Ihn Choi
- From the Departments of Radiology (H.W.) and Internal Medicine (W.K.), SMG-SNU Boramae Medical Center, Seoul, Korea; and Departments of Radiology (J.Y.L., J.H.Y., B.I.C.) and Family Medicine (B.C.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea
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Barr RG, Nakashima K, Amy D, Cosgrove D, Farrokh A, Schafer F, Bamber JC, Castera L, Choi BI, Chou YH, Dietrich CF, Ding H, Ferraioli G, Filice C, Friedrich-Rust M, Hall TJ, Nightingale KR, Palmeri ML, Shiina T, Suzuki S, Sporea I, Wilson S, Kudo M. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 2: breast. Ultrasound Med Biol 2015; 41:1148-60. [PMID: 25795620 DOI: 10.1016/j.ultrasmedbio.2015.03.008] [Citation(s) in RCA: 285] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The breast section of these Guidelines and Recommendations for Elastography produced under the auspices of the World Federation of Ultrasound in Medicine and Biology (WFUMB) assesses the clinically used applications of all forms of elastography used in breast imaging. The literature on various breast elastography techniques is reviewed, and recommendations are made on evidence-based results. Practical advice is given on how to perform and interpret breast elastography for optimal results, with emphasis placed on avoiding pitfalls. Artifacts are reviewed, and the clinical utility of some artifacts is discussed. Both strain and shear wave techniques have been shown to be highly accurate in characterizing breast lesions as benign or malignant. The relationship between the various techniques is discussed, and recommended interpretation based on a BI-RADS-like malignancy probability scale is provided. This document is intended to be used as a reference and to guide clinical users in a practical way.
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Affiliation(s)
- Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio and Radiology Consultants Inc., Youngstown, Ohio, USA.
| | | | - Dominique Amy
- Breast Center, 21 ave V.Hugo 13100 Aix-en-Provence, France
| | - David Cosgrove
- Imaging Departments, Imperial and Kings Colleges, London, United Kingdom
| | - Andre Farrokh
- Department of Gynecology and Obstetrics, Franziskus Hospital Bielefeld, Germany
| | - Fritz Schafer
- Department of Breast Imaging and Interventions, University Hospital Schleswig-Holstein Campus Kiel, Germany
| | - Jeffrey C Bamber
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Laurent Castera
- Service d'Hépatologie, Hôpital Beaujon, Clichy, Assistance Publique-Hôpitaux de Paris, INSERM U 773 CRB3, Université Denis Diderot Paris-VII, France
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Yi-Hong Chou
- Department of Radiology, Veterans General Hospital and National Yang-Ming University, School of Medicine, Taipei
| | | | - Hong Ding
- Department of Ultrasound, Zhongshan Hospital, Fudan University, China
| | - Giovanna Ferraioli
- Ultrasound Unit - Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo - University of Pavia, Italy
| | - Carlo Filice
- Ultrasound Unit - Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo - University of Pavia, Italy
| | - Mireen Friedrich-Rust
- Department of Internal Medicine 1, J. W. Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Timothy J Hall
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Mark L Palmeri
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Tsuyoshi Shiina
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichi Suzuki
- Department of Thyroid and Endocrinology, Fukushima Medical University, School of Medicine, Fukushima, Japan
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy Timişoara, Romania
| | - Stephanie Wilson
- Department of Diagnostic Imaging, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan
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Shiina T, Nightingale KR, Palmeri ML, Hall TJ, Bamber JC, Barr RG, Castera L, Choi BI, Chou YH, Cosgrove D, Dietrich CF, Ding H, Amy D, Farrokh A, Ferraioli G, Filice C, Friedrich-Rust M, Nakashima K, Schafer F, Sporea I, Suzuki S, Wilson S, Kudo M. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 1: basic principles and terminology. Ultrasound Med Biol 2015; 41:1126-47. [PMID: 25805059 DOI: 10.1016/j.ultrasmedbio.2015.03.009] [Citation(s) in RCA: 553] [Impact Index Per Article: 61.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Conventional diagnostic ultrasound images of the anatomy (as opposed to blood flow) reveal differences in the acoustic properties of soft tissues (mainly echogenicity but also, to some extent, attenuation), whereas ultrasound-based elasticity images are able to reveal the differences in the elastic properties of soft tissues (e.g., elasticity and viscosity). The benefit of elasticity imaging lies in the fact that many soft tissues can share similar ultrasonic echogenicities but may have different mechanical properties that can be used to clearly visualize normal anatomy and delineate pathologic lesions. Typically, all elasticity measurement and imaging methods introduce a mechanical excitation and monitor the resulting tissue response. Some of the most widely available commercial elasticity imaging methods are 'quasi-static' and use external tissue compression to generate images of the resulting tissue strain (or deformation). In addition, many manufacturers now provide shear wave imaging and measurement methods, which deliver stiffness images based upon the shear wave propagation speed. The goal of this review is to describe the fundamental physics and the associated terminology underlying these technologies. We have included a questions and answers section, an extensive appendix, and a glossary of terms in this manuscript. We have also endeavored to ensure that the terminology and descriptions, although not identical, are broadly compatible across the WFUMB and EFSUMB sets of guidelines on elastography (Bamber et al. 2013; Cosgrove et al. 2013).
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Affiliation(s)
- Tsuyoshi Shiina
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | | | - Mark L Palmeri
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Timothy J Hall
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Jeffrey C Bamber
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, London, UK
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio and Radiology Consultants Inc., Youngstown, Ohio, USA
| | - Laurent Castera
- Service d'Hépatologie, Hôpital Beaujon, Clichy, Assistance Publique-Hôpitaux de Paris, INSERM U 773 CRB3, Université Denis Diderot Paris-VII, France
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Yi-Hong Chou
- Department of Radiology, Veterans General Hospital and National Yang-Ming University, School of Medicine, Taipei
| | - David Cosgrove
- Imaging Departments, Imperial and Kings Colleges, London, United Kingdom
| | | | - Hong Ding
- Department of Ultrasound, Zhongshan Hospital, Fudan University, China
| | - Dominique Amy
- Breast Center, 21 Ave V. Hugo 13100 Aix-en-Provence, France
| | - Andre Farrokh
- Department of Gynecology and Obstetrics, University Hospital RWTH Aachen, Germany
| | - Giovanna Ferraioli
- Ultrasound Unit - Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo - University of Pavia, Italy
| | - Carlo Filice
- Ultrasound Unit - Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo - University of Pavia, Italy
| | - Mireen Friedrich-Rust
- Department of Internal Medicine 1, J. W. Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | | | - Fritz Schafer
- Department of Breast Imaging and Interventions, University Hospital Schleswig-Holstein Campus Kiel, Germany
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy Timişoara, Romania
| | - Shinichi Suzuki
- Department of Thyroid and Endocrinology, Fukushima Medical University, School of Medicine, Fukushima, Japan
| | - Stephanie Wilson
- Department of Diagnostic Imaging, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan
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Lee DH, Lee JM, Lee JY, Kim SH, Kim JH, Yoon JH, Kim YJ, Lee JH, Yu SJ, Han JK, Choi BI. Non-hypervascular hepatobiliary phase hypointense nodules on gadoxetic acid-enhanced MRI: risk of HCC recurrence after radiofrequency ablation. J Hepatol 2015; 62:1122-30. [PMID: 25529623 DOI: 10.1016/j.jhep.2014.12.015] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [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: 09/05/2014] [Revised: 11/27/2014] [Accepted: 12/09/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND & AIMS Hepatobiliary phase images (HBPI) of gadoxetic acid-enhanced MRI can depict borderline hepatocellular nodules that have the potential to progress into hypervascular hepatocellular carcinomas (HCCs), as non-hypervascular hypointense nodules. We retrospectively evaluated the impact of the presence of non-hypervascular hypointense nodules at HBPI of gadoxetic acid-enhanced MRI on the patient's prognosis after radiofrequency ablation (RFA) for early stage HCCs. METHODS A total of 139 patients who underwent pre-procedural gadoxetic acid-enhanced MRI followed by RFA were included. After a mean follow-up of 44.6±13.2 months, we compared the results of tumor recurrence as well as overall and recurrence-free survival (RFS) with the presence of non-hypervascular hypointense nodules on HBPI. RESULTS The presence of non-hypervascular hypointense nodules on HBPI did not affect overall survival (p=0.136). However, the estimated 5-year RFS rate was 71.3% in 29 patients without non-hypervascular hypointense nodules on HBPI compared to 27.9% in 110 patients with non-hypervascular hypointense nodules on HBPI, indicating a significant difference (hazard ratio=2.84 [1.39-5.98], p=0.006). When we classified recurrence into local tumor progression [LTP], intrahepatic distant recurrence [IDR], and extra-hepatic metastasis [EM], five-year cumulative incidences (CI) of IDR in patients with non-hypervascular hypointense nodules on HBPI were significantly higher than those in patients without non-hypervascular hypointense nodules on HBPI (17.9% vs. 67.5%, p<0.001). Five-year CIs of LTP and EM showed no significant difference (p>0.05). CONCLUSIONS The presence of non-hypervascular hypointense hepatocellular nodules on HBPI of gadoxetic acid-enhanced MRI taken prior to RFA is a significant predictive factor of recurrence after RFA of early stage HCCs, particularly IDR.
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Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Republic of Korea; Institute of Radiation Medicine, Seoul National University Hospital, Republic of Korea.
| | - Jae Young Lee
- Department of Radiology, Seoul National University Hospital, Republic of Korea; Institute of Radiation Medicine, Seoul National University Hospital, Republic of Korea
| | - Se Hyung Kim
- Department of Radiology, Seoul National University Hospital, Republic of Korea; Institute of Radiation Medicine, Seoul National University Hospital, Republic of Korea
| | - Jung Hoon Kim
- Department of Radiology, Seoul National University Hospital, Republic of Korea; Institute of Radiation Medicine, Seoul National University Hospital, Republic of Korea
| | - Jung Hwan Yoon
- Department of Internal Medicine, Seoul National University Hospital, Republic of Korea
| | - Yoon Jun Kim
- Department of Internal Medicine, Seoul National University Hospital, Republic of Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, Republic of Korea
| | - Su Jong Yu
- Department of Internal Medicine, Seoul National University Hospital, Republic of Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Republic of Korea; Institute of Radiation Medicine, Seoul National University Hospital, Republic of Korea
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Republic of Korea; Institute of Radiation Medicine, Seoul National University Hospital, Republic of Korea
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Ferraioli G, Filice C, Castera L, Choi BI, Sporea I, Wilson SR, Cosgrove D, Dietrich CF, Amy D, Bamber JC, Barr R, Chou YH, Ding H, Farrokh A, Friedrich-Rust M, Hall TJ, Nakashima K, Nightingale KR, Palmeri ML, Schafer F, Shiina T, Suzuki S, Kudo M. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 3: liver. Ultrasound Med Biol 2015; 41:1161-79. [PMID: 25800942 DOI: 10.1016/j.ultrasmedbio.2015.03.007] [Citation(s) in RCA: 429] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) has produced these guidelines for the use of elastography techniques in liver disease. For each available technique, the reproducibility, results, and limitations are analyzed, and recommendations are given. Finally, recommendations based on the international literature and the findings of the WFUMB expert group are established as answers to common questions. The document has a clinical perspective and is aimed at assessing the usefulness of elastography in the management of liver diseases.
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Affiliation(s)
- Giovanna Ferraioli
- Ultrasound Unit, Department of Infectious Diseases, Fondazione IRCCS Policlinico S. Matteo, School of Medicine, University of Pavia, Pavia, Italy
| | - Carlo Filice
- Ultrasound Unit, Department of Infectious Diseases, Fondazione IRCCS Policlinico S. Matteo, School of Medicine, University of Pavia, Pavia, Italy
| | - Laurent Castera
- Service d'Hépatologie, Hôpital Beaujon, Clichy, Assistance Publique-Hôpitaux de Paris, INSERM U 773 CRB3, Université Denis Diderot Paris-VII, Paris, France
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Timişoara, Romania
| | - Stephanie R Wilson
- Department of Diagnostic Imaging, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - David Cosgrove
- Division of Radiology, Imperial and Kings Colleges, London, UK
| | | | - Dominique Amy
- Breast Center, 21 ave V. Hugo, 13100 Aix-en-Provence, France
| | - Jeffrey C Bamber
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Richard Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio and Radiology Consultants Inc., Youngstown, Ohio, USA
| | - Yi-Hong Chou
- Department of Radiology, Veterans General Hospital and National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Hong Ding
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Andre Farrokh
- Department of Gynecology and Obstetrics, Franziskus Hospital, Bielefeld, Germany
| | - Mireen Friedrich-Rust
- Department of Internal Medicine 1, J. W. Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Timothy J Hall
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | | | | | - Mark L Palmeri
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Fritz Schafer
- Department of Breast Imaging and Interventions, University Hospital Schleswig-Holstein Campus, Kiel, Germany
| | - Tsuyoshi Shiina
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichi Suzuki
- Department of Endocrinology and Surgery, Fukushima University, Fukushima, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Japan.
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Jang SK, Kim JH, Joo I, Jeon JH, Shin KS, Han JK, Choi BI. Differential diagnosis of pancreatic cancer from other solid tumours arising from the periampullary area on MDCT. Eur Radiol 2015; 25:2880-8. [PMID: 25916385 DOI: 10.1007/s00330-015-3721-4] [Citation(s) in RCA: 12] [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: 09/02/2014] [Revised: 03/17/2015] [Accepted: 03/18/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE To investigate CT features and differential diagnosis of pancreatic adenocarcinoma compared to other solid tumours arising in the periampullary area. MATERIALS AND METHODS One hundred and ninety-five patients with pathologically proven, solid periampullary tumours, including pancreatic adenocarcinoma (n = 98), neuroendocrine tumours (n = 52), gastrointestinal stromal tumours (n = 31), and solid pseudopapillary neoplasms (n = 14), underwent preoperative CT. Two radiologists reviewed CT features and rated the possibility of pancreatic adenocarcinoma. RESULTS Statistically common findings for pancreatic adenocarcinoma included: patient age >50 years; ill-defined margin; completely solid mass; homogeneous enhancement; hypoenhancement on arterial and venous phases; atrophy; and duct dilatation. Statistically common findings for GIST included: heterogeneous enhancement; hyperenhancement on arterial and venous phases; rim enhancement; and prominent feeding arteries. The hyperenhancement on arterial and venous phases is statistically common in NET, and heterogeneous enhancement, hypoenhancement on the arterial and venous phases are statistically common in SPN. Diagnostic performance of CT for differentiating pancreatic adenocarcinomas from other solid periampullary tumours was 0.962 and 0.977 with excellent interobserver agreement (κ = 0.824). CONCLUSION CT is useful not only for differentiating pancreatic adenocarcinoma form other solid tumours but also for differentiating between other solid tumours, including NET, SPN, and GIST, arising in the periampullary area. KEY POINTS • Periampullary tumours arise within 2 cm of major duodenal papilla. • Many mass-forming periampullary tumours can be completely removed by minimal surgery. • Accurate differentiation of pancreatic adenocarcinoma from other solid tumours is important. • CT is useful for differentiating pancreatic adenocarcinoma from other solid tumours. • CT is useful for characterization of periampullary tumours other than adenocarcinomas.
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Affiliation(s)
- Suk Ki Jang
- Departments of Radiology, Daejin Medical Center, Bundang Jesaeng General Hospital, 20, Seohyeon-ro 180beon-gil, Bundang-gu, Seognam-si, Gyeonggi-do, 463-774, Korea
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Yoon JH, Lee JM, Woo S, Hwang EJ, Hwang I, Choi W, Han JK, Choi BI. Switching bipolar hepatic radiofrequency ablation using internally cooled wet electrodes: comparison with consecutive monopolar and switching monopolar modes. Br J Radiol 2015; 88:20140468. [PMID: 25873479 DOI: 10.1259/bjr.20140468] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To evaluate whether switching bipolar radiofrequency ablation (SB-RFA) using three internally cooled wet (ICW) electrodes can induce coagulations >5 cm in porcine livers with better efficiency than consecutive monopolar (CM) or switching monopolar (SM) modes. METHODS A total of 60 coagulations were made in 15 in vivo porcine livers using three 17-gauge ICW electrodes and a multichannel radiofrequency (RF) generator. RF energy (approximately 200 W) was applied in CM mode (Group A, n = 20) for 24 min, SM mode for 12 min (Group B, n = 20) or switching bipolar (SB) mode for 12 min (Group C, n = 20) in in vivo porcine livers. Thereafter, the delivered RFA energy, as well as the shape and dimension of coagulations were compared among the groups. RESULTS Spherical- or oval-shaped ablations were created in 30% (6/20), 85% (17/20) and 90% (18/20) of coagulations in the CM, SM and SB groups, respectively (p = 0.003). SB-RFA created ablations >5 cm in minimum diameter (Dmin) in 65% (13/20) of porcine livers, whereas SM- or CM-RFA created ablations >5 cm in only 25% (5/20) and 20% (4/20) of porcine livers, respectively (p = 0.03). The mean Dmin of coagulations was significantly larger in Group C than in Groups A and B (5.1 ± 0.9, 3.9 ± 1.2 and 4.4 ± 1.0 cm, respectively, p = 0.002) at a lower delivered RF energy level (76.8 ± 14.3, 120.9 ± 24.5 and 114.2 ± 18.3 kJ, respectively, p < 0.001). CONCLUSION SB-RFA using three ICW electrodes can create coagulations >5 cm in diameter with better efficiency than do SM- or CM-RFA. ADVANCES IN KNOWLEDGE SB-RFA can create large, regular ablation zones with better time-energy efficiency than do CM- or SM-RFA.
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Affiliation(s)
- J H Yoon
- 1 Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
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