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Park HY, Chung HW, Yoon MA, Chee CG, Kim W, Lee JS. Enhancing local recurrence detection in patients with high-grade soft tissue sarcoma: value of short-term Ultrasonography added to post-operative MRI surveillance. Cancer Imaging 2024; 24:12. [PMID: 38243293 PMCID: PMC10797984 DOI: 10.1186/s40644-023-00645-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/04/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Limited data exist on the optimal postoperative surveillance protocol for high-grade soft tissue sarcoma, particularly regarding the optimal imaging modality and imaging interval for detecting local recurrence. This study aimed to assess the benefit of short-term postoperative ultrasonography (USG) for detecting local recurrence in patients with high-grade soft tissue sarcoma. METHODS Patients with newly diagnosed high-grade soft tissue sarcoma who underwent surgical resection between January 2010 and June 2020 were included. Short-term USG was added to the follow-up protocol as a surveillance tool alongside routine magnetic resonance imaging (MRI). The primary outcome was the additional detection rate of short-term USG compared with routine MRI surveillance for early local recurrence detection. Subgroup analysis was performed to evaluate factors influencing USG detection rate. The additional detection rate of short-term USG for detection of metastatic lymph nodes was also evaluated. The secondary outcome was the false referral rate of short-term USG. RESULTS In total, 198 patients (mean age ± standard deviation: 52.1 ± 15.8 years; 94 women) were included. Local recurrence occurred in 20 patients (10.1%; 20/198). Short-term USG detected local recurrence in advance of routine MRI visits in 7 out of 198 patients, resulting in an additional detection rate of 3.5% (95% CI: 1.7-7.1%). Subgroup analysis showed no significant difference in the short-term USG detection rate based on initial tumor characteristics, and receipt of radiotherapy or chemotherapy. Short-term USG additionally detected five of seven patients with metastatic lymph nodes [2.5% (95% CI, 1.1-5.8%, 5/198)]. The false referral rate of short-term USG was 3.5% (95% CI: 1.7-7.1%; 7/198). CONCLUSIONS Short-term USG as part of postoperative surveillance for high-grade soft tissue sarcoma can enhance early detection of local tumor recurrence and metastatic lymphadenopathy. Early detection of local tumor recurrence could lead to a prompt surgical resection and aid in local disease control.
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Affiliation(s)
- Ho Young Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Hye Won Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Min A Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Choong Guen Chee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Wanlim Kim
- Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jong-Seok Lee
- Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Shin JI, Chee CG, Yoon MA, Chung HW, Lee MH, Lee SH. Vertebral Venous Congestion That May Mimic Vertebral Metastasis on Contrast-Enhanced Chest Computed Tomography in Chemoport Inserted Patients. Korean J Radiol 2024; 25:62-73. [PMID: 38184770 PMCID: PMC10788611 DOI: 10.3348/kjr.2023.0224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 08/20/2023] [Accepted: 09/22/2023] [Indexed: 01/08/2024] Open
Abstract
OBJECTIVE This study aimed to determine the prevalence of vertebral venous congestion (VVC) in patients with chemoport insertion, evaluate the imaging characteristics of nodular VVC, and identify the factors associated with VVC. MATERIALS AND METHODS This retrospective single-center study was based on follow-up contrast-enhanced chest computed tomography (CT) of 1412 adult patients who underwent chemoport insertion between January 2016 and December 2016. The prevalence of venous stenosis, reflux, and VVC were evaluated. The imaging features of nodular VVC, including specific locations within the vertebral body, were analyzed. To identify the factors associated with VVC, patients with VVC were compared with a subset of patients without VVC who had been followed up for > 3 years without developing VVC after chemoport insertion. Toward this, a multivariable logistic regression analysis was performed. RESULTS After excluding 333 patients, 1079 were analyzed (mean age ± standard deviation, 62.3 ± 11.6 years; 540 females). The prevalence of VVC was 5.8% (63/1079), with all patients (63/63) demonstrating vertebral venous reflux and 67% (42/63) with innominate vein stenosis. The median interval between chemoport insertion and VVC was 515 days (interquartile range, 204-881 days). The prevalence of nodular VVC was 1.5% (16/1079), with a mean size of 5.9 ± 3.1 mm and attenuation of 784 ± 162 HU. Nodular VVC tended to be located subcortically. Forty-four patients with VVC underwent CT examinations with contrast injections in both arms; the VVC disappeared in 70% (31/44) when the contrast was injected in the arm contralateral to the chemoport site. Bevacizumab use was independently associated with VVC (odds ratio, 3.45; P < 0.001). CONCLUSION The prevalence of VVC and nodular VVC was low in patients who underwent chemoport insertion. Nodular VVC was always accompanied by vertebral venous reflux and tended to be located subcortically. To avoid VVC, contrast injection in the arm contralateral to the chemoport site is preferred.
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Affiliation(s)
- Jeong In Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Choong Guen Chee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Min A Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hye Won Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Hee Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Do Y, Lee E, Chee CG, Lee JW. [Lumbar Facet Joint Injection: A Review of Efficacy and Safety]. J Korean Soc Radiol 2024; 85:54-76. [PMID: 38362388 PMCID: PMC10864157 DOI: 10.3348/jksr.2023.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 02/17/2024]
Abstract
Facet joint arthrosis is a progressive degenerative disease that is frequently associated with other spinal degenerative disorders such as degenerative disc disease or spinal stenosis. Lumbar facet joint arthrosis can induce pain in the proximal lower extremities. However, symptoms and imaging findings of "facet joint syndrome" are not specific as they mimic the pain from herniated discs or nerve root compression. Currently, evidence for therapeutic intra-articular lumbar facet joint injections is still considered low, with a weak recommendation strength. Nevertheless, some studies have reported therapeutic effectiveness of facet joint injections. Moreover, the use of therapeutic facet joint injections in clinical practice has increased. This review article includes opinions based on the authors' experience with facet joint injections. This review primarily aimed to investigate the efficacy of lumbar facet joint injections and consider their associated safety aspects.
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Kim KH, Lee MH, Park SY, Kim HJ, Chee CG, Yoon MA, Chung HW, Lee SH. Ulnar neuropathy at the elbow: associations of pre-operative DTI parameters with clinical outcomes after cubital tunnel decompression. Eur Radiol 2023; 33:6351-6358. [PMID: 37014404 DOI: 10.1007/s00330-023-09562-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/23/2023] [Accepted: 03/09/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES To evaluate whether DTI parameters of the ulnar nerve at the elbow are associated with clinical outcomes in patients receiving cubital tunnel decompression (CTD) surgery for ulnar neuropathy. METHODS This retrospective study included 21 patients with cubital tunnel syndrome who received CTD surgery between January 2019 and November 2020. All patients underwent pre-operative elbow MRI, including DTI. Region-of-interest analysis was performed on the ulnar nerve at three levels around the elbow: above (level 1), cubital tunnel (level 2), and below (level 3). Fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) were calculated on three sections at each level. Clinical data on symptom improvement in respect to pain and tingling sensation after CTD were recorded. Logistic regression analysis was used to compare DTI parameters of the nerve at three levels and the entire nerve course between patients with and without symptom improvement after CTD. RESULTS After CTD, 16 patients showed improvement in symptoms, but five did not. ROC analysis of DTI parameters showed that AUCs of FA, AD, and MD were higher at level 1 than at levels 2 and 3, with FA showing the highest AUC (level 1: FA, 0.7104 [95% CI, 0.5206-0.9002] vs AD, 0.6521 [95% CI, 0.4900-0.8142] vs MD, 0.6153 [95% CI, 0.4187-0.8119]). CONCLUSION In patients who underwent CTD surgery for ulnar neuropathy at the elbow, the DTI parameters of FA, AD, and MD above the cubital tunnel level were associated with clinical outcomes, with FA showing the strongest associations. KEY POINTS • After CTD surgery for ulnar neuropathy at the elbow, persistent symptoms may be observed, depending on symptom severity. • DTI parameters of the ulnar nerve at the elbow showed differences in their capacity for discriminating between patients with and without symptom improvement following CTD surgery, with this capacity depending on the nerve level at the elbow. • FA, AD, and MD measured above the cubital tunnel on pre-operative DTI may be associated with surgical outcomes, with FA showing the strongest association (AUC at level 1, 0.7104 [95% CI, 0.5206-0.9002]).
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Affiliation(s)
- Kyung Ho Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
- Department of Radiology, BNS Neurosurgery, 68, Yangpyeong-ro, Yeongdeungpo-gu, Seoul, South Korea
| | - Min Hee Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Sun-Young Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hwa Jung Kim
- Department of Clinical Epidemiology and Biostatics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Choong Guen Chee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Min A Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hye Won Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Sang Hoon Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
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Abstract
BACKGROUND Recurrence is one of the most common complications following hallux valgus surgery. Moreover, hallux varus occurs in cases of overcorrection. We aimed to quantitatively measure, using radiographic examination, the dynamics of the soft tissues that act on deformities (recurrence of valgus and occurrence of varus) after the surgery. METHODS This retrospective single-institution study included 60 patients (98 feet) who underwent hallux valgus surgery between 2009 and 2018. According to radiographic findings of the foot under weightbearing conditions at postoperative month 1, we examined the tendons' pathway and calculated the forces on the first metatarsophalangeal joint, which we termed the deformity force angle (DFA). We compared whether there was a significant difference in DFAs between the groups in which deformities occurred and those in which deformities did not occur after correction. In addition, the DFA was compared to known radiographic measurements of hallux valgus recurrence (hallux valgus angle, distal metatarsal articular angle, intermetatarsal angle, and sesamoid position) to assess association with recurrence. RESULTS We observed a significant difference in the DFA between patients with and without hallux valgus recurrence (P < .001) and between those with and without hallux varus (P < .001) based on standing radiographs taken at a minimum of 6 months postoperation. For predicting the deformities, the areas under the curve were 0.863 (hallux valgus recurrence) and 0.831 (hallux varus occurrence), respectively, which was greater than other factors evaluated. The DFA values greater than 9.5 degrees and less than 5.5 degrees were associated with the recurrence of valgus and occurrence of varus, respectively. CONCLUSION In our study, DFA was associated with hallux valgus recurrence when it exceeded 9.5 degrees and hallux varus when it was less than 5.5 degrees. Moreover, in the hallux valgus surgery we performed, a DFA from 5.5 to 9.5 degrees appeared to be a "safe zone" for preventing early deformity after surgery. LEVEL OF EVIDENCE Level III, prognostic.
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Affiliation(s)
- Minsoo Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Seong Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Rak Choi
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeongho Kim
- Department of Mathematics, Research Institute for Natural Sciences, Hanyang University, Seoul, Korea.,Jeongho Kim is now affiliated to Department of Applied Mathematics, Kyung Hee University, Seoul, Korea
| | - Choong Guen Chee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Hyup Hong
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kim AY, Yoon MA, Ham SJ, Cho YC, Ko Y, Park B, Kim S, Lee E, Lee RW, Chee CG, Lee MH, Lee SH, Chung HW. Prediction of the Acuity of Vertebral Compression Fractures on CT Using Radiologic and Radiomic Features. Acad Radiol 2022; 29:1512-1520. [PMID: 34998683 DOI: 10.1016/j.acra.2021.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 12/14/2022]
Abstract
RATIONALE AND OBJECTIVES To develop and validate prediction models to differentiate acute and chronic vertebral compression fractures based on radiologic and radiomic features on CT. MATERIALS AND METHODS This study included acute and chronic compression fractures in patients who underwent both spine CT and MRI examinations. For each fractured vertebra, three CT findings ([1] cortical disruption, [2] hypoattenuating cleft or sclerotic line, and [3] relative bone marrow attenuation) were assessed by two radiologists. A radiomic score was built from 280 radiomic features extracted from non-contrast-enhanced CT images. Weighted multivariable logistic regression analysis was performed to build a radiologic model based on CT findings and an integrated model combining the radiomic score and CT findings. Model performance was evaluated and compared. Models were externally validated using an independent test cohort. RESULTS A total to 238 fractures (159 acute and 79 chronic) in 122 patients and 58 fractures (39 acute and 19 chronic) in 32 patients were included in the training and test cohorts, respectively. The AUC of the radiomic score was 0.95 in the training and 0.93 in the test cohorts. The AUC of the radiologic model was 0.89 in the training and 0.83 in the test cohorts. The discriminatory performance of the integrated model was significantly higher than the radiologic model in both the training (AUC, 0.97; p<0.01) and the test (AUC, 0.95; p=0.01) cohorts. CONCLUSION Combining radiomics with radiologic findings significantly improved the performance of CT in determining the acuity of vertebral compression fractures.
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Affiliation(s)
- A Yeon Kim
- Department of Radiology and Research Institute of Radiology (A.Y.K., M.A.Y., S.J.H., C.G.C., M.H.L., S.H.L., H.W.C.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; Biomedical Research Center (Y.C.C., Y.K.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Health Innovation Big Data Center (B.P.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Clinical Epidemiology and Biostatistics (S.K.), Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Radiology (E.L.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea; Department of Radiology (R.W.L.), Inha University Hospital, Jung-gu, Incheon, Korea
| | - Min A Yoon
- Department of Radiology and Research Institute of Radiology (A.Y.K., M.A.Y., S.J.H., C.G.C., M.H.L., S.H.L., H.W.C.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; Biomedical Research Center (Y.C.C., Y.K.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Health Innovation Big Data Center (B.P.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Clinical Epidemiology and Biostatistics (S.K.), Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Radiology (E.L.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea; Department of Radiology (R.W.L.), Inha University Hospital, Jung-gu, Incheon, Korea.
| | - Su Jung Ham
- Department of Radiology and Research Institute of Radiology (A.Y.K., M.A.Y., S.J.H., C.G.C., M.H.L., S.H.L., H.W.C.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; Biomedical Research Center (Y.C.C., Y.K.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Health Innovation Big Data Center (B.P.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Clinical Epidemiology and Biostatistics (S.K.), Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Radiology (E.L.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea; Department of Radiology (R.W.L.), Inha University Hospital, Jung-gu, Incheon, Korea
| | - Young Chul Cho
- Department of Radiology and Research Institute of Radiology (A.Y.K., M.A.Y., S.J.H., C.G.C., M.H.L., S.H.L., H.W.C.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; Biomedical Research Center (Y.C.C., Y.K.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Health Innovation Big Data Center (B.P.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Clinical Epidemiology and Biostatistics (S.K.), Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Radiology (E.L.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea; Department of Radiology (R.W.L.), Inha University Hospital, Jung-gu, Incheon, Korea
| | - Yousun Ko
- Department of Radiology and Research Institute of Radiology (A.Y.K., M.A.Y., S.J.H., C.G.C., M.H.L., S.H.L., H.W.C.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; Biomedical Research Center (Y.C.C., Y.K.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Health Innovation Big Data Center (B.P.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Clinical Epidemiology and Biostatistics (S.K.), Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Radiology (E.L.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea; Department of Radiology (R.W.L.), Inha University Hospital, Jung-gu, Incheon, Korea
| | - Bumwoo Park
- Department of Radiology and Research Institute of Radiology (A.Y.K., M.A.Y., S.J.H., C.G.C., M.H.L., S.H.L., H.W.C.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; Biomedical Research Center (Y.C.C., Y.K.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Health Innovation Big Data Center (B.P.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Clinical Epidemiology and Biostatistics (S.K.), Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Radiology (E.L.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea; Department of Radiology (R.W.L.), Inha University Hospital, Jung-gu, Incheon, Korea
| | - Seonok Kim
- Department of Radiology and Research Institute of Radiology (A.Y.K., M.A.Y., S.J.H., C.G.C., M.H.L., S.H.L., H.W.C.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; Biomedical Research Center (Y.C.C., Y.K.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Health Innovation Big Data Center (B.P.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Clinical Epidemiology and Biostatistics (S.K.), Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Radiology (E.L.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea; Department of Radiology (R.W.L.), Inha University Hospital, Jung-gu, Incheon, Korea
| | - Eugene Lee
- Department of Radiology and Research Institute of Radiology (A.Y.K., M.A.Y., S.J.H., C.G.C., M.H.L., S.H.L., H.W.C.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; Biomedical Research Center (Y.C.C., Y.K.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Health Innovation Big Data Center (B.P.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Clinical Epidemiology and Biostatistics (S.K.), Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Radiology (E.L.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea; Department of Radiology (R.W.L.), Inha University Hospital, Jung-gu, Incheon, Korea
| | - Ro Woon Lee
- Department of Radiology and Research Institute of Radiology (A.Y.K., M.A.Y., S.J.H., C.G.C., M.H.L., S.H.L., H.W.C.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; Biomedical Research Center (Y.C.C., Y.K.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Health Innovation Big Data Center (B.P.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Clinical Epidemiology and Biostatistics (S.K.), Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Radiology (E.L.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea; Department of Radiology (R.W.L.), Inha University Hospital, Jung-gu, Incheon, Korea
| | - Choong Guen Chee
- Department of Radiology and Research Institute of Radiology (A.Y.K., M.A.Y., S.J.H., C.G.C., M.H.L., S.H.L., H.W.C.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; Biomedical Research Center (Y.C.C., Y.K.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Health Innovation Big Data Center (B.P.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Clinical Epidemiology and Biostatistics (S.K.), Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Radiology (E.L.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea; Department of Radiology (R.W.L.), Inha University Hospital, Jung-gu, Incheon, Korea
| | - Min Hee Lee
- Department of Radiology and Research Institute of Radiology (A.Y.K., M.A.Y., S.J.H., C.G.C., M.H.L., S.H.L., H.W.C.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; Biomedical Research Center (Y.C.C., Y.K.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Health Innovation Big Data Center (B.P.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Clinical Epidemiology and Biostatistics (S.K.), Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Radiology (E.L.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea; Department of Radiology (R.W.L.), Inha University Hospital, Jung-gu, Incheon, Korea
| | - Sang Hoon Lee
- Department of Radiology and Research Institute of Radiology (A.Y.K., M.A.Y., S.J.H., C.G.C., M.H.L., S.H.L., H.W.C.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; Biomedical Research Center (Y.C.C., Y.K.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Health Innovation Big Data Center (B.P.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Clinical Epidemiology and Biostatistics (S.K.), Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Radiology (E.L.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea; Department of Radiology (R.W.L.), Inha University Hospital, Jung-gu, Incheon, Korea
| | - Hye Won Chung
- Department of Radiology and Research Institute of Radiology (A.Y.K., M.A.Y., S.J.H., C.G.C., M.H.L., S.H.L., H.W.C.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; Biomedical Research Center (Y.C.C., Y.K.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Health Innovation Big Data Center (B.P.), Asan Institute for Life Sciences, Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Clinical Epidemiology and Biostatistics (S.K.), Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Radiology (E.L.), Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea; Department of Radiology (R.W.L.), Inha University Hospital, Jung-gu, Incheon, Korea
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Yoon MA, Chee CG, Chung HW, Lee DH, Kim KW. Diagnostic performance of computed tomography and diffusion-weighted imaging as first-line imaging modality according to the International Myeloma Working Group (IMWG) imaging algorithm for monoclonal plasma cell disorders. Acta Radiol 2022; 63:672-683. [PMID: 33853375 DOI: 10.1177/02841851211008383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The latest International Myeloma Working Group (IMWG) guideline recommends low-dose whole-body (WB) computed tomography (CT) as the first-line imaging technique for the initial diagnosis of plasma cell disorders. PURPOSE To evaluate diagnostic performances of CT and diffusion-weighted imaging (DWI) as the first-line imaging modalities and assess misclassification rates obtained following the guideline. MATERIAL AND METHODS Two independent radiologists analyzed CT (acquired as PET/CT) and DWI (3-T; b-values = 50 and 900 s/mm2) of patients newly diagnosed with plasma cell disorder, categorizing the number of bone lesions. Diagnostic performance of CT and DWI was compared using the McNemar test, and misclassification rates were calculated with a consensus WB-MRI reading as the reference standard. Differences in lesion number categories were assessed using marginal homogeneity and kappa statistics. RESULTS Of 56 patients (36 men; mean age = 63.5 years), 39 had myeloma lesions. DWI showed slightly higher sensitivity for detecting myeloma lesions (97.4%) than CT (84.6%-92.3%; P > 0.05). CT showed significantly higher specificity (88.2%) than DWI (52.9%-58.8%; P<0.05). CT had a higher additional study requirement rate than DWI (7.7%-15.4% vs. 2.6%), but a lower unnecessary treatment rate (11.8% vs. 41.2%-47.1%). Both readers showed significant differences in categorization of the number of lesions on CT compared with the reference standard (P < 0.001), and one reader showed a significant difference on DWI (P = 0.006 and 0.098). CONCLUSION CT interpreted according to the IMWG guideline is a diagnostically effective first-line modality with relatively high sensitivity and specificity. DWI alone may not be an acceptable first-line imaging modality because of low specificity.
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Affiliation(s)
- Min A Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Choong Guen Chee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hye Won Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Dong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Cho J, Kim Y, Lee S, Min HD, Ko Y, Chee CG, Kim HY, Park JH, Lee KH. Appendiceal Visualization on 2-mSv CT vs. Conventional-Dose CT in Adolescents and Young Adults with Suspected Appendicitis: An Analysis of Large Pragmatic Randomized Trial Data. Korean J Radiol 2022; 23:413-425. [PMID: 35289144 PMCID: PMC8961010 DOI: 10.3348/kjr.2021.0504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/29/2021] [Accepted: 11/10/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jungheum Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Youngjune Kim
- Aerospace Medical Group, Air Force Education and Training Command, Jinju, Korea
| | - Seungjae Lee
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Hooney Daniel Min
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yousun Ko
- Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | | | - Hae Young Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Hoon Park
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyoung Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
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Kim J, Chee CG, Cho J, Kim Y, Yoon MA. Diagnostic accuracy and complication rate of image-guided percutaneous transthoracic needle lung biopsy for subsolid pulmonary nodules: a systematic review and meta-analysis. Br J Radiol 2021; 94:20210065. [PMID: 34662206 DOI: 10.1259/bjr.20210065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To determine the diagnostic accuracy and complication rate of percutaneous transthoracic needle biopsy (PTNB) for subsolid pulmonary nodules and sources of heterogeneity among reported results. METHODS We searched PubMed, EMBASE, and Cochrane libraries (until November 7, 2020) for studies measuring the diagnostic accuracy of PTNB for subsolid pulmonary nodules. Pooled sensitivity and specificity of PTNB were calculated using a bivariate random-effects model. Bivariate meta-regression analyses were performed to identify sources of heterogeneity. Pooled overall and major complication rates were calculated. RESULTS We included 744 biopsies from 685 patients (12 studies). The pooled sensitivity and specificity of PTNB for subsolid nodules were 90% (95% confidence interval [CI]: 85-94%) and 99% (95% CI: 92-100%), respectively. Mean age above 65 years was the only covariate significantly associated with higher sensitivity (93% vs 85%, p = 0.04). Core needle biopsy showed marginally higher sensitivity than fine-needle aspiration (93% vs 83%, p = 0.07). Pooled overall and major complication rate of PTNB were 43% (95% CI: 25-62%) and 0.1% (95% CI: 0-0.4%), respectively. Major complication rate was not different between fine-needle aspiration and core needle biopsy groups (p = 0.25). CONCLUSION PTNB had acceptable performance and a low major complication rate in diagnosing subsolid pulmonary nodules. The only significant source of heterogeneity in reported sensitivities was a mean age above 65 years. ADVANCES IN KNOWLEDGE This is the first meta-analysis attempting to systemically determine the cause of heterogeneity in the diagnostic accuracy and complication rate of PTNB for subsolid pulmonary nodules.
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Affiliation(s)
- Junghoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | | | - Jungheum Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Youngjune Kim
- Air Force Education and Training Command Base Hospita, Jinju, Korea
| | - Min A Yoon
- Department of Radiology, Asan Medical Center, Seoul, Korea
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Chee CG, Chung HW, Kim W, Yoon MA, Shin SM, Kim GB. Differences between 3D isovoxel fat suppression VIBE MRI and CT models of proximal femur osseous anatomy: A preliminary study for bone tumor resection planning. PLoS One 2021; 16:e0250334. [PMID: 33930040 PMCID: PMC8087022 DOI: 10.1371/journal.pone.0250334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 04/05/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose To evaluate the osseous anatomy of the proximal femur extracted from a 3D-MRI volumetric interpolated breath-hold (VIBE) sequence using either a Dixon or water excitation (WE) fat suppression method, and to measure the overall difference using CT as a reference standard. Material and methods This retrospective study reviewed imaging of adult patients with hip pain who underwent 3D hip MRI and CT. A semi-automatically segmented CT model served as the reference standard, and MRI segmentation was performed manually for each unilateral hip joint. The differences between Dixon-VIBE-3D-MRI vs. CT, and WE-VIBE-3D-MRI vs. CT, were measured. Equivalence tests between Dixon-VIBE and WE-VIBE models were performed with a threshold of 0.1 mm. Bland–Altman plots and Lin’s concordance-correlation coefficient were used to analyze the agreement between WE and Dixon sequences. Subgroup analyses were performed for the femoral head/neck, intertrochanteric, and femoral shaft areas. Results The mean and maximum differences between Dixon-VIBE-3D-MRI vs. CT were 0.2917 and 3.4908 mm, respectively, whereas for WE-VIBE-3D-MRI vs. CT they were 0.3162 and 3.1599 mm. The mean differences of the WE and Dixon methods were equivalent (P = 0.0292). However, the maximum difference was not equivalent between the two methods and it was higher in WE method. Lin’s concordance-correlation coefficient showed poor agreement between Dixon and WE methods. The mean differences between the CT and 3D-MRI models were significantly higher in the femoral shaft area (P = 0.0004 for WE and P = 0.0015 for Dixon) than in the other areas. The maximum difference was greatest in the intertrochanteric area for both techniques. Conclusion The difference between 3D-MR and CT models were acceptable with a maximal difference below 3.5mm. WE and Dixon fat suppression methods were equivalent. The mean difference was highest at the femoral shaft area, which was off-center from the magnetization field.
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Affiliation(s)
- Choong Guen Chee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hye Won Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * E-mail: (HWC); (WK)
| | - Wanlim Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * E-mail: (HWC); (WK)
| | - Min A. Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Kim Y, Chee CG, Kim J, Cho J, Yoon MA, Chung HW. Diagnostic performance of plain radiography for sacroiliitis in patients with suspected axial spondyloarthritis: a systematic review and meta-analysis. Acta Radiol 2021; 62:500-509. [PMID: 32536262 DOI: 10.1177/0284185120930624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Plain radiography serves a pivotal role in diagnosing axial spondyloarthritis. However, a broad range of diagnostic performance of plain radiography has been reported. PURPOSE To perform a systematic review and meta-analysis to measure the diagnostic performance of plain radiography for sacroiliitis in patients suspected of having axial spondyloarthritis using magnetic resonance imaging (MRI) findings as the reference standard. MATERIAL AND METHODS Studies comparing radiography and MRI in the diagnosis of sacroiliitis in patients suspected of having axial spondyloarthritis were searched in PubMed and EMBASE. Additionally, studies analyzed SPondyloaArthritis Caught Early (SPACE), DEvenir des Spondylarthropathies Indifferenciées Récentes (DESIR), GErman Spondyloarthritis Inception Cohort (GESPIC), and South Swedish Arthritis Treatment Group (SSATG) cohorts were manually searched. Pooled sensitivity and specificity of radiography were calculated by using a bivariate random-effects model. Meta-regression analyses were performed to identify the sources of heterogeneity. RESULTS Eight eligible studies with 1579 patients were included. The pooled sensitivity and specificity of radiography were 0.55 (95% confidence interval [CI] = 0.40-0.69) and 0.87 (95% CI = 0.72-0.95). The meta-regression analyses showed prospective study design and criteria for MRI positivity considering only active bone marrow edema were associated with lower sensitivity. CONCLUSION The plain radiography showed low sensitivity and reasonable specificity in diagnosis of sacroiliitis in patients suspected of having axial spondyloarthritis.
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Affiliation(s)
- Youngjune Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Choong Guen Chee
- Department of Radiology, Asan Medical Center, Seoul, Republic of Korea
| | - Junghoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jungheum Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Min A Yoon
- Department of Radiology, Asan Medical Center, Seoul, Republic of Korea
| | - Hye Won Chung
- Department of Radiology, Asan Medical Center, Seoul, Republic of Korea
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12
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Cho J, Kim J, Lee JS, Chee CG, Kim Y, Choi SI. Comparison of core needle biopsy and fine‐needle aspiration in diagnosis of ma lignant salivary gland neoplasm: Systematic review and meta‐analysis. Head Neck 2020; 42:3041-3050. [DOI: 10.1002/hed.26377] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/28/2020] [Accepted: 06/23/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jungheum Cho
- Department of Radiology Seoul National University Bundang Hospital Seongnam South Korea
| | - Junghoon Kim
- Department of Radiology Seoul National University Bundang Hospital Seongnam South Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center Seoul South Korea
| | | | - Youngjune Kim
- Aerospace Medical Group Air Force Education and Training Command Jinju Korea
| | - Sang Il Choi
- Department of Radiology Seoul National University Bundang Hospital Seongnam South Korea
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Choi EJ, Chee CG, Kim W, Song JS, Chung HW. Bone oxaloma-a localized manifestation of bone oxalosis. Skeletal Radiol 2020; 49:651-655. [PMID: 31768582 DOI: 10.1007/s00256-019-03348-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/09/2019] [Accepted: 11/12/2019] [Indexed: 02/02/2023]
Abstract
Oxalosis is a metabolic disorder characterized by the accumulation of calcium oxalate deposits in various organ systems. Bone oxalosis is a systemic manifestation of oxalosis, in which calcium oxalate deposits accumulate in the skeletal system. This report describes a 69-year-old female patient who presented with right hip pain and was later found to have an osseous mass-like lesion in the right proximal femur, with radiographic findings resembling those of a benign bone tumor. CT-guided biopsy and surgical biopsy showed that the mass had pathologic findings typical of bone oxalosis. Because the patient had no predisposing factors for systemic oxalosis and had no hyperoxalemia or hyperoxaluria, she could be diagnosed with localized bone oxalate deposition disease or bone oxaloma rather than bone oxalosis. This is the first report of this clinical entity to present as a benign-appearing bone mass and without any predisposing systemic causes.
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Affiliation(s)
- Eun Ji Choi
- Department of Radiology, Asan Medical Center, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Choong Guen Chee
- Department of Radiology, Asan Medical Center, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Wanlim Kim
- Department of Orthopedic Surgery, Asan Medical Center, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Joon Seon Song
- Department of Pathology, Asan Medical Center, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Hye Won Chung
- Department of Radiology, Asan Medical Center, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, Republic of Korea
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Chee CG, Cho J, Kang Y, Kim Y, Lee E, Lee JW, Ahn JM, Kang HS. Diagnostic accuracy of digital radiography for the diagnosis of osteonecrosis of the femoral head, revisited. Acta Radiol 2019; 60:969-976. [PMID: 30326729 DOI: 10.1177/0284185118808083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The radiographic diagnosis of osteonecrosis of the femoral head (ONFH) is challenging for radiologists. Purpose To measure the sensitivity and specificity of digital radiography for diagnosing ONFH and to evaluate the diagnostic value of the frog-leg view. Material and Methods Patients diagnosed with ONFH by magnetic resonance imaging (MRI) (n = 132) and normal controls (n = 69) were included. Two radiologists independently graded the likelihood of ONFH and subchondral fracture on radiographs. First, the anteroposterior (AP) and frog-leg radiographs were assessed as a whole. Subsequently, randomly ordered unilaterally cropped AP radiographs were analyzed. Sensitivity and specificity were measured using MRI as reference standard. A subgroup analysis for pre-collapse ONFH was performed. The effect of within-subject correlation was analyzed using a generalized-estimating-equation approach. Inter-reader agreement was assessed with κ statistics. McNemar’s test was used to determine the additional diagnostic value of the frog-leg view. Results Among the 402 hips from 201 individuals, 191 were classified as normal, 73 as pre-collapse ONFH, and 138 as post-collapse ONFH. The sensitivity and specificity ranges for ONFH were 76–89% and 77–97%, respectively. For pre-collapse ONFH, the sensitivity and specificity were 52–71% and 78–97%, respectively. The κ ranges for the likelihood of ONFH and pre-collapse ONFH were 0.59–0.66 and 0.35–0.59, respectively. The frog-leg view did not provide additional value for diagnosing ONFH. Conclusion Diagnostic performance of digital radiography for ONFH revealed low sensitivity and poor-to-moderate inter-reader agreement for diagnosing pre-collapse ONFH. There was no additional value of the frog-leg view.
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Affiliation(s)
- Choong Guen Chee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul, Republic of Korea
- Department of Radiology, Asan Medical Center, Seoul, Republic of Korea
| | - Jungheum Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Youngjune Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seoul, Republic of Korea
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15
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Ahn C, Lee E, Lee JW, Chee CG, Kang Y, Kang HS. Two-site blind epidural blood patch versus targeted epidural blood patch in spontaneous intracranial hypotension. J Clin Neurosci 2019; 62:147-154. [DOI: 10.1016/j.jocn.2018.11.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 11/11/2018] [Indexed: 01/03/2023]
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Yoon MA, Chung HW, Yeo Y, Yoo HJ, Kang Y, Chee CG, Lee MH, Lee SH, Shin MJ. Distinguishing necrotizing from non-necrotizing fasciitis: a new predictive scoring integrating MRI in the LRINEC score. Eur Radiol 2019; 29:3414-3423. [PMID: 30887193 DOI: 10.1007/s00330-019-06103-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 11/27/2018] [Revised: 02/05/2019] [Accepted: 02/11/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To develop and validate a scoring system integrating MRI and laboratory findings to differentiate necrotizing fasciitis (NF) from non-necrotizing fasciitis (non-NF). METHODS This retrospective study included 144 subjects who underwent surgery in one of three tertiary referral centers for NF or cellulitis with non-NF. The development cohort consisted of 96 subjects (NF = 47; non-NF = 49) from one center, and the validation cohort consisted of 48 subjects (NF = 23; cellulitis with non-NF = 25) from two different centers. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system and five MRI findings (thickening of the intermuscular deep fascia ≥ 3 mm, extensive involvement of the deep fascia, multi-compartmental involvement in one extremity, presence of gas, and contrast-enhancement pattern) were included in univariate and multivariate logistic regression analysis to identify independent predictors of NF. An additive scoring system was developed using the coefficients of the final regression model. Model performance was assessed for discrimination and calibration. The scoring system was externally validated. RESULT The final scoring system consisted of three variables: thickening of the deep fascia ≥ 3 mm, multi-compartmental involvement, and LRINEC score. The new predictive model showed improved performance (area under the receiver operating characteristic curve [AUC], 0.862; positive and negative predictive values, 82% and 79%, respectively), compared with the LRINEC score alone (0.814, 77% and 67%, respectively). The model also showed good discrimination with the external validation dataset (AUC, 0.933). CONCLUSIONS Differentiation of NF from severe cellulitis with non-NF can be achieved with the new predictive scoring system. KEY POINTS • The new predictive scoring system integrating two MRI findings with the LRINEC score can help in the differentiation of necrotizing fasciitis from severe cellulitis with non-necrotizing fasciitis. • Thickening of the deep fascia ≥ 3 mm and multi-compartmental involvement were the most important MRI findings for the differentiation.
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Affiliation(s)
- Min A Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hye Won Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Yujin Yeo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hye Jin Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumidong, Bundang-Gu, Seongnam City, Gyeonggi-do, 13620, South Korea
| | - Choong Guen Chee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Min Hee Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Sang Hoon Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Myung Jin Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
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Kang Y, Ahn JM, Chee CG, Lee E, Lee JW, Kang HS. The pattern of idiopathic isolated teres minor atrophy with regard to its two-bundle anatomy. Skeletal Radiol 2019; 48:363-374. [PMID: 30091009 DOI: 10.1007/s00256-018-3038-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/19/2018] [Accepted: 07/30/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We aimed to analyze the pattern of teres minor atrophy with regard to its two-bundle anatomy and to assess its association with clinical factors. MATERIALS AND METHODS Shoulder MRIs performed between January and December 2016 were retrospectively reviewed. Images were evaluated for the presence and pattern of isolated teres minor atrophy. Isolated teres minor atrophy was categorized into complete or partial pattern, and partial pattern was further classified according to the portion of the muscle that was predominantly affected. The medical records were reviewed to identify clinical factors associated with teres minor atrophy. RESULTS Seventy-eight shoulders out of 1,264 (6.2%) showed isolated teres minor atrophy; complete pattern in 41.0%, and partial pattern in 59.0%. Most cases of partial pattern had predominant involvement of the medial-dorsal component (82.6%). There was no significant association between teres minor atrophy and previous trauma, shoulder instability, osteoarthritis, and previous operation. The history of shoulder instability was more frequently found in patients with isolated teres minor atrophy (6.4%), compared with the control group (2.6%), although the difference was not statistically significant. CONCLUSION Isolated teres minor atrophy may be either complete or partial, and the partial pattern may involve either the medial-dorsal or the lateral-ventral component of the muscle. The imaging findings of partial pattern teres minor atrophy indicate that the two muscle components may have separate innervation.
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Affiliation(s)
- Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - Choong Guen Chee
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea.
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Chee CG, Park KS, Lee JW, Ahn HW, Lee E, Kang Y, Kang HS. MRI Features of Aquaporin-4 Antibody-Positive Longitudinally Extensive Transverse Myelitis: Insights into the Diagnosis of Neuromyelitis Optica Spectrum Disorders. AJNR Am J Neuroradiol 2018; 39:782-787. [PMID: 29449281 DOI: 10.3174/ajnr.a5551] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/29/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE Longitudinally extensive transverse myelitis is a well-documented spinal manifestation of neuromyelitis optica spectrum disorders, however, other forms of nontumorous myelopathy can also manifest as longitudinally extensive transverse myelitis. Our aim was to evaluate the MR imaging features of aquaporin-4 antibody-positive longitudinally extensive transverse myelitis, which is strongly associated with neuromyelitis optica spectrum disorders. MATERIALS AND METHODS We evaluated cervicomedullary junction involvement, cord expansion ratios, bright spotty lesions, the number of involved segments, skipped lesions, enhancement patterns, and axial distribution patterns using spinal MR imaging of 41 patients with longitudinally extensive transverse myelitis who underwent aquaporin-4 antibody testing. Univariate logistic regression analysis was performed to identify factors associated with aquaporin-4 antibody seropositivity, which were then used to develop a scoring system for diagnosing aquaporin-4 antibody-positive longitudinally extensive transverse myelitis. Interrater reliability for cord expansion ratio measurement and bright spotty lesions was determined using intraclass correlation coefficients and κ values, respectively. RESULTS Fifteen patients with longitudinally extensive transverse myelitis were aquaporin-4 antibody-positive. Sex (female), cervicomedullary junction involvement, a cord expansion ratio of >1.4, and bright spotty lesions were significantly associated with aquaporin-4 antibody seropositivity. The sensitivity and specificity of the scoring system were 73.3% and 96.2%, respectively. The interclass correlation value for the cord expansion ratio was 0.78, and the κ value for bright spotty lesions was 0.61. CONCLUSIONS Our scoring system, based on cervicomedullary junction involvement, higher cord expansion ratio, bright spotty lesions, and female sex, can facilitate the timely diagnosis of neuromyelitis optica spectrum disorders.
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Affiliation(s)
- C G Chee
- From the Departments of Radiology (C.G.C., J.W.L., H.W.A., E.L., Y.K., H.S.K.)
| | - K S Park
- Neurology (K.S.P.), Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - J W Lee
- From the Departments of Radiology (C.G.C., J.W.L., H.W.A., E.L., Y.K., H.S.K.)
| | - H W Ahn
- From the Departments of Radiology (C.G.C., J.W.L., H.W.A., E.L., Y.K., H.S.K.)
| | - E Lee
- From the Departments of Radiology (C.G.C., J.W.L., H.W.A., E.L., Y.K., H.S.K.)
| | - Y Kang
- From the Departments of Radiology (C.G.C., J.W.L., H.W.A., E.L., Y.K., H.S.K.)
| | - H S Kang
- From the Departments of Radiology (C.G.C., J.W.L., H.W.A., E.L., Y.K., H.S.K.)
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Chee CG, Lee GY, Lee JW, Lee E, Kang HS. Fluoroscopy-Guided Lumbar Drainage of Cerebrospinal Fluid for Patients in Whom a Blind Beside Approach Is Difficult. Korean J Radiol 2015; 16:860-5. [PMID: 26175586 PMCID: PMC4499551 DOI: 10.3348/kjr.2015.16.4.860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 12/02/2014] [Accepted: 04/12/2015] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the rates of technical success, clinical success, and complications of fluoroscopy-guided lumbar cerebrospinal fluid drainage. Materials and Methods This retrospective study was approved by the Institutional Review Board of our hospital, and informed consent was waived. Ninety-six procedures on 60 consecutive patients performed July 2008 to December 2013 were evaluated. The patients were referred for the fluoroscopy-guided procedure due to failed attempts at a bedside approach, a history of lumbar surgery, difficulty cooperating, or obesity. Fluoroscopy-guided lumbar drainage procedures were performed in the lateral decubitus position with a midline puncture of L3/4 in the interspinous space. The catheter tip was positioned at the T12/L1 level, and the catheter was visualized on contrast agent-aided fluoroscopy. A standard angiography system with a rotatable C-arm was used. The definitions of technical success, clinical success, and complications were defined prior to the study. Results The technical and clinical success rates were 99.0% (95/96) and 89.6% (86/96), respectively. The mean hospital stay for an external lumbar drain was 4.84 days. Nine cases of minor complications and eight major complications were observed, including seven cases of meningitis, and one retained catheter requiring surgical removal. Conclusion Fluoroscopy-guided external lumbar drainage is a technically reliable procedure in difficult patients with failed attempts at a bedside procedure, history of lumbar surgery, difficulties in cooperation, or obesity.
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Affiliation(s)
- Choong Guen Chee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
| | - Guen Young Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
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